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Keywords: COVID-19; olfactory disorders; olfactory test; parosmia; quality of Life; smell EN COVID-19 olfactory disorders olfactory test parosmia quality of Life smell 1570 1574 5 12/02/22 20221201 NES 221201 INTRODUCTION Olfactory dysfunction (OD) is one of the most common symptoms of acute and long COVID-19.[[1]] Qualitative OD frequently accompanies or follows quantitative olfactory loss.[3] Few studies to date have combined both qualitative and quantitative evaluation of OD.[4] The aim of this study was to estimate the prevalence of qualitative OD and evaluate its functional impact in post-COVID-19 patients by combining a validated questionnaire[5] and a comprehensive olfactory psychophysical evaluation. Patients were evaluated with a median follow-up of >12 months, at which point only one third of patients who developed parosmia had recovered. Among patients reporting parosmia or phantosmia at any time, more severe quantitatively measured OD was correlated with longer qualitative OD (r = -0.34, I p i < 0.001; Fig. In the present series, the prevalence of qualitative OD when assessed with a structured questionnaire was higher than the prevalence of quantitative OD, with 78% of patients classified as normosmic reporting qualitative OD. [Extracted from the article]

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2‐mediated inflammatory disease with high symptom burden and reduced health‐related quality of life (HRQoL). This report aimed to comprehensively understand the effects of dupilumab on domains of HRQoL, their individual elements, and health status in patients with severe CRSwNP from phase 3 SINUS‐24 (NCT02912468) and SINUS‐52 (NCT02898454) trials. Methods: Patients were randomized to dupilumab (n = 438) or placebo (n = 286) for 24 weeks (SINUS‐24), or 52 weeks (SINUS‐52). Disease‐specific HRQoL using 22‐item sino‐nasal outcome test (SNOT‐22), and health status using EuroQoL‐visual analog scale (EQ‐VAS) was evaluated in the pooled intention‐to‐treat (ITT) population (Week 24), SINUS‐52 ITT (Week 52) and in the subgroups with/without asthma; non‐steroidal anti‐inflammatory drug‐exacerbated respiratory disease (NSAID‐ERD); and prior sinus surgery. Results: At baseline, patients had poor disease‐specific HRQoL and general health status and identified "Decreased sense of smell/taste" and "Nasal blockage" as the most important symptoms. Dupilumab significantly improved SNOT‐22 total, domain (Nasal, Sleep, Function, Emotion, and Ear/facial), and 22‐item scores, and EQ‐VAS, at Week 24 vs placebo (all p <.0001), with continued improvements to Week 52 in SINUS‐52. Improvements occurred irrespective of comorbid asthma, NSAID‐ERD, or prior surgery. A significantly greater proportion of dupilumab‐treated patients exceeded clinically meaningful thresholds for SNOT‐22 total score and EQ‐VAS vs placebo (all subgroups p <.05 except patients without surgery at Week 24). Conclusions: Dupilumab treatment led to significant clinically meaningful improvements across all aspects of disease‐specific HRQoL, and general health status in patients with severe CRSwNP. [ABSTRACT FROM AUTHOR]

The article proposes a potential hypothesis about the pathophysiological mechanism of olfactory dysfunction (OD) based on some clinical observations. Topics include observation on some patients with persistent COVID-19 OD since the development of vaccination in Western countries, observation on olfactory region abnormalities in imaging study several months after the onset of OD, and analysis of the persistence of OD in COVID-19 patients.

Objectives: We set out to create Consensus Guidelines, based on current evidence and relative risks of adverse effects and the costs of different treatments, which reflect the views of the British Rhinological Society (BRS) Council on where the use of biologics should be positioned within treatment pathways for CRSwNP, specifically in the setting of the National Health Service (NHS). Design: An expert panel of 16 members was assembled. A review of the literature and evidence synthesis was undertaken and circulated to the panel. We used the RAND/UCLA methodology with a multi‐step process to make recommendations on the use of biologics. Setting: N/A. Participants: N/A. Results: Recommendations were made, based on underlying disease severity, prior treatments and co‐morbidities. A group of patients for whom biologics were considered an appropriate treatment option for CRSwNP was defined. Conclusions: Although biologics are not currently available for the treatment of CRSwNP, the BRS Council have defined a group of patients who have higher rates of "failure" with current treatment pathways, higher resource use and are more likely to suffer with uncontrolled symptoms. We would urge NICE to consider approval of biologics for such indications without applying further restrictions on use. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease treated with sinus surgery when refractory to medical intervention. However, recurrence postsurgery is common. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor for interleukin 4 (IL‐4) and IL‐13, key and central drivers of type 2 inflammation. We report the efficacy of dupilumab in patients with CRSwNP from the SINUS‐24/SINUS‐52 trials (NCT02912468/NCT02898454), by number of prior surgeries and time since last surgery. Methods: Patients were randomized to placebo or dupilumab 300 mg every 2 weeks. Post hoc subgroup analyses were performed for patients with 0, ≥1, 1/2, or ≥3 prior surgeries, and for patients who had surgery within <3, 3 to <5, 5 to <10, or ≥10 years. Efficacy outcomes at 24 weeks included co‐primary endpoints nasal polyp score (NPS) and nasal congestion (NC), and Lund‐Mackay (LMK), 22‐item Sino‐Nasal Outcome Test (SNOT‐22), and smell scores. Results: Of 724 patients randomized, 459 (63.4%) had ≥1 prior surgery. Baseline sinus disease (NPS, NC, LMK) and olfactory dysfunction (University of Pennsylvania Smell Identification Test [UPSIT] and loss of smell) scores were worse for patients with ≥3 prior surgeries vs no surgery. Baseline NPS and LMK were worse in patients with <3 years since last surgery than in patients with ≥5 years since last surgery. Dupilumab significantly improved all outcome measures vs placebo in all subgroups by number of surgeries and by time since last surgery. Improvements in NPS and LMK were greater in patients with <3 years since last surgery than patients with ≥5 years. Safety results were consistent with the known dupilumab safety profile. Conclusion: Dupilumab improved CRSwNP outcomes irrespective of surgery history, with greater improvements in endoscopic outcomes in patients with shorter duration since last surgery. [ABSTRACT FROM AUTHOR]

The first reports of a link between COVID-19 and anosmia emerged in late March 2020, followed by a rapid growth in associated publications. COVID-19, evidence-based medicine, olfaction, olfactory-based medicine, preprint Keywords: COVID-19; evidence-based medicine; olfaction; olfactory-based medicine; preprint EN COVID-19 evidence-based medicine olfaction olfactory-based medicine preprint 1128 1131 4 06/30/21 20210701 NES 210701 INTRODUCTION Traditional medical publishing involves a process of peer review prior to acceptance and publication, with manuscripts often embargoed prior to publication. [Extracted from the article]

Objectives: This post hoc analysis assessed disease characteristics and response to dupilumab treatment in male and female patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) (SINUS‐52 study; NCT02898454). Methods: Patients received dupilumab 300 mg or placebo every 2 weeks for 52 weeks on background intranasal corticosteroids. Efficacy was assessed through Week 52 using nasal polyp score (NPS), nasal congestion/obstruction score, loss of smell score and University of Pennsylvania Smell Identification Test score. Disease‐specific health‐related quality of life (HRQoL) was assessed using the 22‐item Sino‐Nasal Outcome Test (SNOT‐22). Results: The analysis included 192 male and 111 female patients. Female patients had higher mean SNOT‐22 total score (56.6 vs. 49.1, P < 0.01) and more coexisting asthma (78.4% vs. 46.4%, P < 0.0001) and non‐steroidal anti‐inflammatory drug‐exacerbated respiratory disease (NSAID‐ERD) (38.7% vs. 18.8%, P = 0.0001) than male patients, but other baseline characteristics were similar. Dupilumab significantly improved CRSwNP outcomes vs. placebo at Week 52, regardless of gender: least squares mean differences (95% confidence interval) for NPS were −2.33 (−2.80, −1.86) in male and −2.54 (−3.18, −1.90) in female patients (both P < 0.0001 vs. placebo), and for SNOT‐22 were −19.2 (−24.1, −14.2) in male and −24.4 (−31.5, −17.3) in female patients (both P < 0.0001 vs. placebo). There were no significant efficacy‐by‐gender interactions. Conclusion: Female patients had greater asthma, NSAID‐ERD and HRQoL burden at baseline than male patients. Dupilumab treatment significantly improved objective and subjective outcomes compared with placebo, irrespective of gender. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disorder with a wide range of validated subjective and objective assessment tools to assess disease severity. However, a comprehensive and easy-to-use tool that integrates these measures for determining disease severity and response to treatment is still obscure. The objective of this study was to develop a standardized assessment tool that facilitates diagnosis, uniform patient monitoring, and comparison of treatment outcomes between different centers both in routine clinical practice and in research. Methods: To develop this tool, published literature on assessment tools was searched on various databases. A panel of 12 steering committee members conducted an advisory board meeting to review the findings. Specific outcome measures to be included in a comprehensive assessment tool and follow-up sheet were then collated following consensus approval from the panel. The tool was further validated for content and revised with expert recommendations to arrive at the finalized Nasal Polyp Patient Assessment Scoring Sheet (N-PASS) tool. Results: The N-PASS tool was developed by integrating the subjective and objective measures for CRS assessment. Based on expert opinions, N-PASS was revised to be used as an easy-to-use guidance tool that captures patient-reported and physicianassessed components for comprehensively assessing disease status and response to treatment. Conclusion: The N-PASS tool can be used to aid in the diagnosis and management of CRS cases with nasal polyps. The tool would also aid in improved monitoring of patients and pave the way for an international disease registry. Level of evidence: Oxford Level 3. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusion Benralizumab, a humanized, afucosylated monoclonal antibody against the interleukin 5 receptor, α subunit, causes rapid depletion of eosinophils by antibody‐dependent cellular cytotoxicity. We investigated the pharmacokinetic and pharmacodynamic effects of benralizumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) from the phase III OSTRO trial.Patients received a placebo or 30 mg of benralizumab by subcutaneous injection every 8 weeks (first three doses every 4 weeks) to week 48; a subset of patients continued in an extended follow‐up period to assess treatment durability to week 80. Serum benralizumab concentrations and blood eosinophil and basophil counts were assessed to week 80. Biomarker assessments were performed on nasal polyp tissue biopsies at week 56 and nasal lining fluid at weeks 24 and 56 to examine changes in immune cells and inflammatory mediators.Among 185 patients in this analysis, 93 received benralizumab. Serum benralizumab concentrations reached a steady state by week 24 (median concentration 385.52 ng mL−1); blood eosinophils were almost fully depleted and blood basophils were reduced between weeks 16 and 56. Nasal polyp tissue eosinophils decreased with benralizumab from 57.6 cells mm−2 at baseline to 0 cells mm−2 at week 56 (P < .001 vs placebo), and tissue mast cells were numerically reduced. In nasal lining fluid, eosinophil‐derived neurotoxin was significantly reduced at weeks 24 and 56 (P < .001) and interleukin‐17 at week 56 (P < .05) with benralizumab.Benralizumab treatment led to rapid, sustained, nearly complete depletion of eosinophils from blood and nasal polyp tissue in patients with CRSwNP. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of the study is to provide recommendations for the investigation and management of patients with new onset loss of sense of smell during the COVID‐19 pandemic. Design: After undertaking a literature review, we used the RAND/UCLA methodology with a multi‐step process to reach consensus about treatment options, onward referral, and imaging. Setting and participants: An expert panel consisting of 15 members was assembled. A literature review was undertaken prior to the study and evidence was summarised for the panellists. Main outcome measures: The panel undertook a process of ranking and classifying appropriateness of different investigations and treatment options for new onset loss of sense of smell during the COVID‐19 pandemic. Using a 9‐point Likert scale, panellists scored whether a treatment was: Not recommended, optional, or recommended. Consensus was achieved when more than 70% of responses fell into the category defined by the mean. Results: Consensus was reached on the majority of statements after 2 rounds of ranking. Disagreement meant no recommendation was made regarding one treatment, using Vitamin A drops. Alpha‐lipoic acid was not recommended, olfactory training was recommended for all patients with persistent loss of sense of smell of more than 2 weeks duration, and oral steroids, steroid rinses, and omega 3 supplements may be considered on an individual basis. Recommendations regarding the need for referral and investigation have been made. Conclusion: This study identified the appropriateness of olfactory training, different medical treatment options, referral guidelines and imaging for patients with COVID‐19‐related loss of sense of smell. The guideline may evolve as our experience of COVID‐19 develops. [ABSTRACT FROM AUTHOR]

Aims: To systematically review the currently available evidence investigating the association between olfactory dysfunction (OD) and the novel coronavirus (COVID‐19). To analyse the prevalence of OD in patients who have tested positive on polymerase chain reaction (PCR) for COVID‐19. To perform a meta‐analysis of patients presenting with olfactory dysfunction, during the pandemic, and to investigate the positive predictive value for a COVID‐19‐positive result in this population. To assess whether olfactory dysfunction could be used as a diagnostic marker for COVID‐19 positivity and aid public health approaches in tackling the current outbreak. Methods: We systematically searched MedLine (PubMed), Embase, Health Management Information Consortium (HMIC), Medrxiv, the Cochrane Library, the Cochrane COVID‐19 Study Register, NIHR Dissemination centre, Clinical Evidence, National Health Service Evidence and the National Institute of Clinical Excellence to identify the current published evidence which associates coronaviridae or similar RNA viruses with anosmia. The initial search identified 157 articles. A total of 145 papers were excluded following application of our exclusion criteria. The 12 remaining articles that presented evidence on the association between COVID‐19 and olfactory dysfunction were critically analysed. Results: Olfactory dysfunction has been shown to be the strongest predictor of COVID‐19 positivity when compared to other symptoms in logistic regression analysis. In patients who had tested positive for COVID‐19, there was a prevalence of 62% of OD. In populations of patients who are currently reporting OD, there is a positive predictive value of 61% for a positive COVID‐19 result. Conclusion: Our review has shown that there is already significant evidence which demonstrates an association between OD and the novel coronavirus—COVID‐19. It is unclear if this finding is unique to this coronavirus as individual viral phenotypes rarely present in such concentrated large numbers. We have demonstrated that OD is comparatively more predictive for COVID‐19 positivity compared to other associated symptoms. We recommend that people who develop OD during the pandemic should be self‐isolate and this guidance should be adopted internationally to prevent transmission. [ABSTRACT FROM AUTHOR]

Background: The lack of objective data makes it difficult to establish the prognostic value of chemosensitive disorders in coronavirus disease 2019 (COVID-19) patients. We aimed to prospectively monitor patients diagnosed with COVID-19 to see if the severity of olfactory and gustatory dysfunction associates with subsequent disease severity. Methods: Multicentre prospective study that recruited 106 COVID-19 subjects at diagnosis. Chemosensitive functions were assessed with psychophysical tests within 4 days of clinical onset, at 10 and 20 days. Daily body temperature and oxygen saturation were recorded as markers of disease severity alongside need for hospitalisation. The correlation between olfactory and gustatory scores and disease severity was assessed with linear regression analysis. Results: At T0, 71 patients (67%) presented with olfactory dysfunction while gustatory impairment was detected in 76 cases (65.6%). Chemosensitive disorders gradually improved over the observation period. No significant correlations were found between T0 chemosensitive scores and final disease severity. The correlation between olfactory scores and fever proved significant at T2 (p = 0.05), while the relationship with gustatory scores was significant at T1 (p = 0.01) and T2 (p < 0.001), however neither was clinically relevant. The correlation between chemosensitive scores and oxygen saturation was significant only for taste at T2 (p < 0.001). Logistic regression analysis found significant correlations between olfactory impairment severity and need for hospitalization at T2 (OR 3.750, p = 0.005). Conclusions: Initial objective olfactory and gustatory scores do not seem to have a significant prognostic value in predicting the severity of the COVID-19 course; however, persistence of olfactory dysfunction at 20 days, associated with a more severe course. Unfortunately, olfactory and gustatory dysfunction do not seem to hold prognostic value at the time of initial diagnosis. [ABSTRACT FROM AUTHOR]

Background: Initial reports describing coronavirus 2019 (COVID‐19) were dominated by the presence of cough, breathlessness, and fever; anecdotal reports suggested anosmia may also be a manifestation. We used Google Trends (GT) to investigate whether there was a surge in individuals searching for information related to smell loss during the COVID‐19 epidemic in Italy, Spain, the United Kingdom, the United States, Germany, France, Iran, and The Netherlands. Methods: GT was used to explore internet activity related to loss of smell in the 8 aforementioned countries. Spearman rank analysis was performed to correlate loss‐of‐smell‒relative search volumes (RSVs), with the increases of daily confirmed cases of COVID‐19 and deaths attributed to disease. As a control event, we also performed analysis of smell‐related searches during the last UK influenza epidemic of 2009. Results: In all 8 countries, we observed strong correlations between daily RSVs related to loss of smell, increases of daily COVID‐19+ cases and deaths ranging from 0.633 to 0.952. All correlations were statistically significant (p < 0.05). Conclusion: There is a strong correlation between the frequency of searches for smell‐related information and the onset of COVID‐19 infection in Italy, Spain, UK, USA, Germany, France, Iran, and The Netherlands. We hypothesize this may relate to a previously underrecognized symptom. [ABSTRACT FROM AUTHOR]

Background: A rapidly evolving evidence suggests that smell and taste disturbance are common symptoms in COVID-19 infection. As yet there are no reports on duration and recovery rates. We set out to characterise patients reporting new onset smell and taste disturbance during the COVID-19 pandemic and report on early recovery rates. Methods: Online Survey of patients reporting self-diagnosed new onset smell and taste disturbance during the COVID-19 pandemic, with 1 week follow-up. Results: Three hundred eighty-two patents completed bot an initial and follow-up survey. 86.4% reported complete anosmia and a further 11.5% a very severe loss of smell at the time of completing the first survey. At follow-up 1 week later, there is already significant improvement in self-rating of severity of olfactory loss. 80.1% report lower severity scores at follow-up, 17.6% are unchanged and 1.9% are worse. 11.5% already report compete resolution at follow up, while 17.3% report persistent complete loss of smell, with reported duration being 1 to over 4 weeks. This is reflected in the overall cumulative improvement rate of 79% patients overall in the interval between surveys. Conclusions: A review of the growing evidence base supports the likelihood that out cohort have suffered olfactory loss as part of COVID-19 infection. While early recovery rates are encouraging, long term rates will need to be further investigated and there may be an increase in patients with persistent post-viral loss as a result of the pandemic. We further call for loss of sense of smell to be formerly recognised as a marker of COVID-19 infection. [ABSTRACT FROM AUTHOR]

A 50-year-old man presents with a 5-year history of progressive nasal obstruction and reduction in his sense of smell. Symptoms were initially intermittent but have become persistent and very bothersome, with the patient rating them as severe. He reports sleep disturbance and postnasal drip and recently received a diagnosis of asthma. Alcohol consumption exacerbates his nasal congestion. Anterior rhinoscopy reveals pale, fleshy polyps filling both sides of the nasal cavity. How would you further evaluate and manage this case? [ABSTRACT FROM AUTHOR]

Keywords: Monkeypox; Symptoms; Otolaryngology; Oropharynx; Oral; ENT EN Monkeypox Symptoms Otolaryngology Oropharynx Oral ENT 5975 5976 2 11/14/22 20221201 NES 221201 Dear Editor, Human monkeypox (HMPX) is caused by an orthopoxvirus having a wide range of hosts and a reservoir in wild animals and infrequently affecting humans. More than 1/3 patients developed systemic symptoms after the onset of mucocutaneous lesions [[7]] and up to 14% of patients presented with mucocutaneous lesions without systemic symptoms [[7]]. [Extracted from the article]

Background: Endotypic and prognosticating features of chronic rhinosinusitis without nasal polyposis (CRSsNP) are poorly understood. Our objectives were to use an unbiased symptom‐based approach to: (1) study symptoms, clinical and endotypic features; and (2) identify features predicating outcomes from endoscopic sinus surgery (ESS). Methods: Clinical, computed tomography (CT), histopathology, and 22‐item Sino‐Nasal Outcome Test (SNOT‐22) data was collected on 146 adult CRSsNP patients who underwent ESS. Unsupervised network modeling of presurgical SNOT‐22 scores was performed to classify symptom‐based clusters. Subject characteristics and post‐ESS SNOT‐22 scores were compared between clusters. Results: Baseline characteristics of the subject population were as follows: females, 56.2%; revision ESS status in 35%; asthma prevalence, 32.6%; median Lund‐Mackay CT score, 8; and median SNOT‐22 total score, 43. Network mapping and unsupervised clustering of preoperative SNOT‐22 scores revealed 4 clusters: (A) severely burdened with high scores in all 4 subdomains; (B) moderately burdened with high scores in the rhinologic subdomain; (C) moderately burdened with high scores in psychological‐sleep subdomains; and (D) mildly burdened. The number of previous ESS and asthma prevalence differed significantly between clusters; CT scores were similar. Asthma burden and tissue eosinophilia were greatest in cluster A (p = 0.03). All groups showed significant improvement at 3 months post‐ESS (p < 0.0001). At 6 months, patients in cluster C tended to worsen. Conclusion: SNOT‐22–based network modeling of CRSsNP patients yielded 4 clusters with distinct features. Asthma prevalence and tissue eosinophilia were highest in the cluster with highest SNOT‐22 scores. All patients showed significant improvement from ESS at 3 months; those with high sleep‐psychosocial symptoms tended to show worsening at 6 months. [ABSTRACT FROM AUTHOR]

Introduction: No studies have reported data on 3-year prevalence and recovery rates of self-reported COVID-19-related olfactory and gustatory dysfunction. The aim of the present study was to estimate the 3-year prevalence and recovery rate of self-reported COVID-19-related chemosensory dysfunction in a cohort of patients with antecedent mild COVID-19. Methods: This is a prospective observational study, measuring the prevalence of altered sense of smell or taste at follow-up and their variation from baseline, on adult patients consecutively assessed at Treviso and Trieste University Hospitals, who tested positive for SARS-CoV-2 RNA by polymerase chain reaction during March 2020. Results: Overall, out of 403 respondents, 267 patients (66.3%) reported an altered sense of smell or taste (SNOT-22 > 0) at baseline, while 56 (13.9%), 29 (7.2%), and 21 (5.2%) reported such alterations at 6–24 months, 2 years, and 3 years, respectively. Among the 267 patients with COVID-19-associated smell or taste dysfunction at baseline, 246 (92.1%) reported complete resolution at 3 years. Of the patients who still experienced smell or taste dysfunction 2 years after COVID-19, 27.6% and 37.9% recovered completely and partially, respectively, at the 3-year follow-up. Conclusion: Among subjects with antecedent mildly symptomatic SARS-CoV-2 infection, the 3-year prevalence and recovery rate of COVID-19-related alteration in sense of smell or taste was 5% and 92%, respectively. In approximately two-thirds of patients experiencing chemosensory dysfunction still 2 years after COVID-19, it is still possible to observe a delayed complete or partial recovery after a period of 3 years, while the remaining one-third of individuals continues to have unchanged persistent chemosensory alteration. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between laryngopharyngeal reflux (LPR), gastroesophageal reflux disease (GERD) and recalcitrant chronic rhinosinusitis (CRS). Data Sources: PubMed, Cochrane Library and Scopus. Review Methods: Three investigators searched the specified databases for studies investigating the relationship between LPR, GERD and recalcitrant CRS with or without polyposis. The following outcomes were investigated with PRISMA criteria: age; gender; reflux and CRS diagnosis; association outcomes and potential treatment outcomes. The authors performed a bias analysis of papers and provided recommendations for future studies. Results: A total of 17 studies investigated the association between reflux and recalcitrant CRS. According to pharyngeal pH monitoring, 54% of patients with recalcitrant CRS reported hypo or nasopharyngeal acid reflux events. The number of hypo‐ and nasopharyngeal acid reflux events was significantly higher in patients compared to healthy individuals in 4 and 2 studies, respectively. Only one study did not report intergroup differences. The proportion of GERD was significantly higher in CRS patients compared to controls, with a prevalence ranging from 32% to 91% of cases. No author considered nonacid reflux events. There was significant heterogeneity in the inclusion criteria; definition of reflux and association outcomes, limiting the ability to draw clear conclusions. Pepsin was found in sinonasal secretions more frequently in CRS patients than controls. Conclusion: Laryngopharyngeal reflux and GERD may be contributing factors of CRS therapeutic resistance, but future studies are needed to confirm the association considering nonacid reflux events. [ABSTRACT FROM AUTHOR]

The last decade has seen significant developments in the field of biologics for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). Translational research borne from knowledge of the pathophysiology of type 2 inflammatory disease of the lower airways and the strong association with CRSwNP, has led to major therapeutic breakthroughs, with phase 3 trials of four biologics completed at the time of writing, and more underway. This article explores the evidence behind biologics for CRSwNP, the guidance on their use and the health economic factors influencing their position amongst the established therapeutic options for this common chronic condition. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis has a significant impact on health-related and generic quality-of-life, has a high cost burden to both society and patients, and may be associated with absenteeism, loss of productivity and poor respiratory function. Though there is a paucity of level 1 evidence, endoscopic sinus surgery may be considered in medically refractory patients and a variety of objective and subjective outcome measures exist to assess the effectiveness of intervention. We outline the outcome measurements available and review in-depth the published outcomes to date. Furthermore we discuss the literature that indicates that endoscopic sinus surgery can have a positive effect on respiratory function in asthma. How patient selection, timing and extent of surgery, and post-operative care interventions may optimise surgical outcomes is explored. [ABSTRACT FROM AUTHOR]

How far have we come and how far do we have to go? Professor Claire Hopkins discusses her experiences. [ABSTRACT FROM AUTHOR]

Most journals now allow citation of preprint articles, with the National Institutes of Health (NIH) simply requesting that the document object identifier (DOI) is included and the status as a preprint is made clear. If "change is the law of life", the challenges of the coronavirus disease 2019 (COVID-19) pandemic have certainly ensured we are living within the letter of the law. But has COVID-19 changed our attitude to the use of search servers and are authors seeing this as an alternative to more traditional publishing?. [Extracted from the article]

Keywords: allergic rhinitis; allergies; anxiety; depression; mood disorders EN allergic rhinitis allergies anxiety depression mood disorders 1489 1491 3 07/26/23 20230801 NES 230801 SUMMARY Our patients today stand at the junction of two worrisome trends: allergy seasons are worsening, and rates of depression and anxiety are rising.[[1], [3]] We may not often think about the relationship between allergic rhinitis (AR) and mood disorders, but their increasing incidence and severity should serve as a reminder of their remarkable association. Allergy treatment can improve symptoms of both allergies and concomitant mood disorders, and simultaneously treating mood disorders with therapy appears to help even more.[28] However, we cannot offer appropriate treatment or referrals if we do not know what our patients experience. Rhinologists should likewise make patients aware of the association between AR and mood disorders and feel comfortable inquiring about such symptoms. Whether by administering validated mood disorder patient-reported outcome instruments, or simply by maintaining open and nonjudgmental inquiry and support for our patients, identifying and addressing concomitant mood disorders facilitates holistic patient care. [Extracted from the article]

Following the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) treatment algorithm for chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), patients suffering from severe uncontrolled CRSwNP are recommended to receive oral corticosteroids, (revision) sinus surgery, systemic biologicals and/or aspirin treatment after desensitization (ATAD). Given the major differences in indications, outcomes, practical considerations, risks and costs of these key pillars of treatment, there is a growing need to define criteria for each treatment option and list the clinically relevant and major considerations for them. This EUFOREA document therefore provides an expert panel overview of the expected outcomes, specific considerations and (contra)indications of the five major treatment arms of severe uncontrolled CRSwNP: oral corticosteroids, primary and revision sinus surgery, biological treatment and ATAD. This overview of treatment considerations is needed to allow physicians and patients to consider the different options in the context of providing optimal and personalized care for severe uncontrolled CRSwNP. In conclusion, the five major treatment options for severe uncontrolled CRSwNP have intrinsic advantages, specific indications and considerations that are of importance to the patient, the physician and the society. This EUFOREA statement supports the unmet need to define criteria for the indication of every treatment pillar of CRSwNP. [ABSTRACT FROM AUTHOR]

Sir, 'In my youth, the consultant was "God"', writes Hedley Piper,1 in a letter that I'm sure is deliberately provocative. Unfortunately, Graham Reeves was not so lucky; the 70 year old died 5 weeks after a wrong side nephrectomy and his surgeon and their assistant were left facing manslaughter charges. There was a catalogue of avoidable errors that would have been detected in a time where the consultant is no longer afforded a God-like status in theatre. [Extracted from the article]

Background: This post hoc analysis of the international SINUS‐24/‐52 trials (NCT02912468/NCT02898454) aimed to assess dupilumab efficacy in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) according to different definitions of type 2 inflammatory signature. Methods: Six definitions of type 2 inflammation were used: ≥150 eosinophils/μL or total immunoglobulin E (IgE) ≥100 IU/mL with a coexisting type 2 condition; ≥150 eosinophils/μL or total IgE ≥100 IU/mL; ≥150 eosinophils/μL; ≥250 eosinophils/μL or total IgE ≥100 IU/mL; coexisting asthma or ≥300 eosinophils/μL; presence of a coexisting type 2 condition. Odds ratios (ORs; dupilumab vs. placebo) for achieving clinically meaningful improvement (≥1 point) from baseline to week 24 (pooled SINUS‐24/‐52) and week 52 (SINUS‐52) were calculated for nasal polyp score (NPS; range 0–8), nasal congestion/obstruction score (NC; 0−3), and loss of smell score (LoS; 0−3). Results: At baseline (n = 724), most patients displayed a type 2 inflammatory signature across definitions (64.2%–95.3%). At week 24, ORs for clinically meaningful improvement ranged from 11.9 to 14.9 for NPS across type 2 definitions, 6.5–9.6 for NC, and 12.2–17.8 for LoS (all p < 0.0001). OR ranges were similar or greater at week 52: 19.0–36.6, 7.6–12.1, and 9.2–33.5, respectively (all p < 0.0001). Conclusion: Most patients with CRSwNP in the SINUS study had type 2 inflammation. Dupilumab demonstrated robust efficacy across definitions of type 2 inflammation, consistent with its profile as an inhibitor of Interleukin‐4 and Interleukin‐13 signaling, key and central drivers of type 2 inflammation in CRSwNP. Key Points: This study assessed type 2 inflammation prevalence and dupilumab efficacy in chronic rhinosinusitis with nasal polyps according to algorithm‐defined type 2 inflammationDupilumab efficacy was similar across all type 2 definitions [ABSTRACT FROM AUTHOR]

Objectives: Olfactory dysfunction (OD) is common and carries significant personal and societal burden. Accurate assessment is necessary for good clinical and research practice but is highly dependent on the assessment technique used. Current practice with regards to UK/international clinical assessment is unknown. We aimed to capture current clinical practice, with reference to contemporaneously available guidelines. We further aimed to compare UK to international practice. Design: Anonymous online questionnaire with cross‐sectional non‐probability sampling. Subgroup analysis according to subspeciality training in rhinology ('rhinologists' and 'non‐rhinologists') was performed, with geographical comparisons only made according to subgroup. Participants: ENT surgeons who assess olfaction. Results: Responses were received from 465 clinicians (217 from UK and 17 countries total). Country‐specific response rate varied, with the lowest rate being obtained from Japan (1.4%) and highest from Greece (72.5%). Most UK clinicians do not perform psychophysical smell testing during any of the presented clinical scenarios—though rhinologists did so more often than non‐rhinologists. The most frequent barriers to testing related to service provision (e.g., time/funding limitations). Whilst there was variability in practice, in general, international respondents performed psychophysical testing more frequently than those from the UK. Approximately 3/4 of all respondents said they would like to receive training in psychophysical smell testing. Patient reported outcome measures were infrequently used in the UK/internationally. More UK respondents performed diagnostic MRI scanning than international respondents. Conclusions: To our knowledge, this is the most comprehensive UK‐based, and only international survey of clinical practice in the assessment of OD. We present recommendations to improve practice, including increased education and funding for psychophysical smell testing. We hope this will promote accurate and reliable olfactory assessment, as is the accepted standard in other sensory systems. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses topics within the issue related to rhinology, including the microbiology of acute sinusitis, the diagnostic value of computed tomography (CT) and the growth of endoscopic techniques in sinus surgery.

The article offers information on the national audit of epistaxis management, which mention that the team decided the standards de novo to audit care based on a suite of comprehensive literature reviews.

Background: Qualitative olfactory (smell) dysfunctions are a common side effect of post-viral illness and known to impact quality of life and health status. Evidence is emerging that taste and smell loss are common symptoms of Covid-19 that may emerge and persist long after initial infection. The aim of the present study was to document the impact of post Covid-19 alterations to taste and smell. Methods: We conducted exploratory thematic analysis of user-generated text from 9000 users of the AbScent Covid-19 Smell and Taste Loss moderated Facebook support group from March 24 to 30th September 2020. Results: Participants reported difficulty explaining and managing an altered sense of taste and smell; a lack of interpersonal and professional explanation or support; altered eating; appetite loss, weight change; loss of pleasure in food, eating and social engagement; altered intimacy and an altered relationship to self and others. Conclusions: Our findings suggest altered taste and smell with Covid-19 may lead to severe disruption to daily living that impacts on psychological well-being, physical health, relationships and sense of self. More specifically, participants reported impacts that related to reduced desire and ability to eat and prepare food; weight gain, weight loss and nutritional insufficiency; emotional wellbeing; professional practice; intimacy and social bonding; and the disruption of people's sense of reality and themselves. Our findings should inform further research and suggest areas for the training, assessment and treatment practices of health care professionals working with long Covid. [ABSTRACT FROM AUTHOR]

Background: From the start of the pandemic, many European otolaryngologists observed an unprecendented number of anosmic patients. Early reports proposed that anosmia could be the first or even the only symptom of COVID-19 infection, prompting calls for self-isolation in affected patients. Methods: In the present article, we review the COVID-19 anosmia literature and try to answer the following two questions: first, why is COVID-19 infection responsible for such a high incidence of anosmia? Second, in patients with more severe forms is anosmia really less prevalent and why? Results: In terms of the etiology of olfactory dysfunction, several hypotheses were proposed at the outset of the pandemic; that olfactory cleft inflammation and obstruction caused a localized conductive loss, that there was injury to the sustentacular supporting cells in the olfactory epithelium or, given the known neurotropic potential of coronavirus, that the virus could invade and damage the olfactory bulb. Olfactory cleft obstruction may contribute to the olfactory dysfunction in some patients, perhaps most likely in those that show very early resolution, it cannot account for the loss in all patients. Moreover, disordered regrowth and a predominance of immature neurons have been shown to be associated with parosmia, which is a common finding amongst patients with Covid-related anosmia. A central mechanism therefore certainly seems to be consistent with the group of patients with more prolonged olfactory deficits. Sustentacular cells showing ACE-2 immunohistochemical expression 200 to 700 times greater than nasal or tracheal epithelia seem to be the main SARS-CoV-2 gateway. As the pathophysiology of COVID-19 anosmia seems to be better understood, the question of why patients with a moderate to severe form of COVID-19 infection have less olfactory involvement remains unresolved. Different potential explanations are discussed in this review. Conclusions : The last 5 months have benefited from great international collaborative research, first highlighting and then proving the value of loss of smell and taste as a symptom of COVID-19. Adoption of loss of smell into the case definition by international public health bodies will facilitate control of disease transmission. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the recovery of olfactory function at six months in individuals infected with the coronavirus disease 2019 omicron variant, using psychophysical tests. Methods: A prospective case–control study that included severe acute respiratory syndrome coronavirus-2 patients infected in February and March 2022 was conducted. Patients underwent the Sniffin' Sticks test within 10 days of infection and again after at least 6 months. The olfactory scores were compared with those of a control group. Results: In all, 102 patients and 120 controls were enrolled in the study. At baseline, 26 patients (25.5 per cent) self-reported smell loss. The median threshold, discrimination and identification score was 33.6 (interquartile range, 12.5) for the cases and 36.5 (interquartile range, 4.38) for the controls (p < 0.001). Based on the threshold, discrimination and identification scores, 12 controls and 34 patients reported olfactory dysfunction (p < 0.001). Eighty cases underwent re-evaluation at six months; the median threshold, discrimination and identification score was 37.1 (interquartile range, 4.75) with no significant differences compared with the controls. Conclusion: Six months after infection, the prevalence of olfactory dysfunction in patients did not differ significantly from the control population. [ABSTRACT FROM AUTHOR]

Background: We identify chronic rhinosinusitis (CRS) manifestations associated with how rhinologists assess CRS control, with a focus on patient perspectives (patient‐reported CRS control). Methods: Fifteen rhinologists were provided with real‐world data from 200 CRS patients. Participating rhinologists first classified patients' CRS control as "controlled," "partly controlled," and "uncontrolled" using seven CRS manifestations reflecting European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) CRS control criteria (nasal obstruction, drainage, impaired smell, facial pain/pressure, sleep disturbance, use of systemic antibiotics/corticosteroids in past 6 months, and nasal endoscopy findings) and patient‐reported CRS control. They then classified patients' CRS control without knowledge of patient‐reported CRS control. Interrater reliability and agreement of rhinologist‐assessed CRS control with patient‐reported CRS control and EPOS guidelines were determined. Results: CRS control classification with and without knowledge of patient‐reported CRS control was highly consistent across rhinologists (κw = 0.758). Rhinologist‐assessed CRS control agreed with patient‐reported CRS control significantly better when rhinologists had knowledge of patient‐reported CRS control (κw = 0.736 vs. κw = 0.554, p < 0.001). Patient‐reported CRS control, nasal obstruction, drainage, and endoscopy findings were most strongly associated with rhinologists' assessment of CRS control. Rhinologists' CRS control assessments weakly agreed with EPOS CRS control guidelines with (κw = 0.529) and without (κw = 0.538) patient‐reported CRS control. Rhinologists classified CRS as more controlled than EPOS guidelines in almost 50% of cases. Conclusions: This study directly demonstrates the importance of patient‐reported CRS control as a dominant influence on rhinologists' CRS control assessment. Knowledge of patient‐reported CRS control may better align rhinologists' CRS control assessments and treatment decisions with patients' perspectives. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to psychophysically evaluate the prevalence of smell and taste dysfunction 2 years after mildly symptomatic severe acute respiratory syndrome–coronavirus‐2 (SARS‐CoV‐2) infection compared to that observed at 1‐year follow‐up and while considering the background of chemosensory dysfunction in the no‐coronavirus disease 2019 (COVID‐19) population. Method: This is a prospective case‐control study on 93 patients with polymerase chain reaction (PCR)‐positive SARS‐CoV‐2 infection and 93 matched controls. Self‐reported olfactory and gustatory dysfunction was assessed by 22‐item Sino‐Nasal‐Outcome Test (SNOT‐22), item "Sense of smell or taste." Psychophysical orthonasal and retronasal olfactory function and gustatory performance were estimated using the extended Sniffin' Sticks test battery, 20 powdered tasteless aromas, and taste strips test, respectively. Nasal trigeminal sensitivity was assessed by sniffing a 70% solution of acetic acid. Results: The two psychophysical assessments of chemosensory function took place after a median of 409 days (range, 366–461 days) and 765 days (range, 739–800 days) from the first SARS‐CoV‐2–positive swab, respectively. At 2‐year follow‐up, cases exhibited a decrease in the prevalence of olfactory (27.9% vs. 42.0%; absolute difference, −14.0%; 95% confidence interval [CI], −21.8% to −2.6%; p = 0.016) and gustatory dysfunction (14.0% vs. 25.8%; absolute difference, −11.8%; 95% CI, −24.2% to 0.6%; p = 0.098). Subjects with prior COVID‐19 were more likely than controls to have an olfactory dysfunction (27.9% vs. 10.8 %; absolute difference, 17.2%; 95% CI, 5.2% to 28.8%) but not gustatory dysfunction (14.0% vs. 9.7%; absolute difference, 4.3%; 95% CI, −5.8% to 14.4% p = 0.496) still 2 years after the infection. Overall, 3.2% of cases were still anosmic 2 years after the infection. Conclusions: Although a proportion of subjects recovered from long‐lasting smell/taste dysfunction more than 1 year after COVID‐19, cases still exhibited a significant excess of olfactory dysfunction 2 years after SARS‐CoV‐2 infection when compared to matched controls. [ABSTRACT FROM AUTHOR]

Background: Chronic Rhinosinusitis (CRS) affects approximately 1 in 10 UK adults and impacts quality of life quality of life significantly. Response to treatment may be driven by individual CRS endotypes and therefore work to delineate biomarker clusters that may separate responders from non-responders is needed. The ongoing MACRO three-arm parallel-group trial randomises adult CRS patients to endoscopic sinus surgery, macrolide therapy or placebo. Aim: This study aims to correlate CRS endotypes with clinical parameters from the ongoing MACRO trial, including olfactory function and outcomes in terms of response to treatment using core biomarkers sets. Methods: Adult CRS patients enrolled into the MACRO trial will be recruited from participating UK otorhinolaryngology departments. Nasal tissue samples and swabs will be obtained in theatre or clinic from patients randomised to all three trial arms. Nasal tissue will be analysed with multiplex electrochemiluminescence for 32 cytokines including IL-5, IL-13, IgE and periostin. Bacterial swabs will be analysed using illumina miSeq 16S amplicon sequencing. Mean expression for each biomarker will be reported for treatment responder and non-responder groups. Correlation of biomarkers with MACRO trial outcome data such as endoscopic evaluation scores and quality-of-life improvement scores will be reported. Discussion: Defining clear endotypes in CRS will contribute to refining patient pathways for the efficient use of clinical resources. This work may lay the groundwork for future studies to predict which patients might respond to medical or surgical therapy. [ABSTRACT FROM AUTHOR]

Objectives: To characterise the real‐world burden of chronic rhinosinusitis with nasal polyps (CRSwNP) in the UK, stratified by number of surgeries. Design: Retrospective cohort study. Setting: UK Clinical Practice Research Datalink Aurum database with Hospital Episodes Statistics linkage (2007–2019). Participants: Adults ≥18 years of age with a first NP diagnosis (index) and 365 days of baseline and ≥180 days of follow‐up data. Follow‐up continued until disenrollment, death or end of data collection. Main Outcome Measures: Primary: primary care physician prescribed CRSwNP‐related treatments, and all‐cause healthcare resource utilisation (HCRU) in 90 days post‐index, stratified by surgeries during follow‐up. Secondary: rate of surgery and CRSwNP point prevalence. Baseline patient demographics, clinical characteristics and comorbidities were also assessed. Results: Of the 33 107 patients included, 23.5% and 2.2% had ≥1 and ≥2 surgeries during follow‐up, respectively (mean follow‐up: 5.3 years). Patients with more surgeries (≥2/≥1/0) during follow‐up were more likely to be male (67.3%/69.0%/58.0%), have asthma (37.8%/28.2%/20.2%) and have baseline blood eosinophil counts ≥300 cells/μL (68.5%/66.0%/51.5%). During the first 90‐days post‐index as surgery number increased, the proportion of patients using oral corticosteroids (25.8%/20.7%/14.2%) and mean (SD) number of all‐cause healthcare visits (5.9 [4.2]/5.4 [4.0]/4.9 [4.2]) increased. Time between surgeries was shorter among patients with more surgeries. CRSwNP prevalence on 31 December 2018 was 476 cases per 100 000 persons. Conclusion: A small proportion of patients in the UK required multiple surgeries for CRSwNP and this was associated with increasing comorbidity burden, baseline blood eosinophil counts, CRSwNP‐related treatment and HCRU use. [ABSTRACT FROM AUTHOR]

Tonsillectomy is regularly performed in adults with acute tonsillitis, but with scarce evidence. A reduction in tonsillectomies has coincided with an increase in acute adult hospitalisation for tonsillitis complications. We aimed to assess the clinical effectiveness and cost-effectiveness of conservative management versus tonsillectomy in patients with recurrent acute tonsillitis. This pragmatic multicentre, open-label, randomised controlled trial was conducted in 27 hospitals in the UK. Participants were adults aged 16 years or older who were newly referred to secondary care otolaryngology clinics with recurrent acute tonsillitis. Patients were randomly assigned (1:1) to receive tonsillectomy or conservative management using random permuted blocks of variable length. Stratification by recruiting centre and baseline symptom severity was assessed using the Tonsil Outcome Inventory-14 score (categories defined as mild 0–35, moderate 36–48, or severe 49–70). Participants in the tonsillectomy group received elective surgery to dissect the palatine tonsils within 8 weeks after random assignment and those in the conservative management group received standard non-surgical care during 24 months. The primary outcome was the number of sore throat days collected during 24 months after random assignment, reported once per week with a text message. The primary analysis was done in the intention-to-treat (ITT) population. This study is registered with the ISRCTN registry, 55284102. Between May 11, 2015, and April 30, 2018, 4165 participants with recurrent acute tonsillitis were assessed for eligibility and 3712 were excluded. 453 eligible participants were randomly assigned (233 in the immediate tonsillectomy group vs 220 in the conservative management group). 429 (95%) patients were included in the primary ITT analysis (224 vs 205). The median age of participants was 23 years (IQR 19–30), with 355 (78%) females and 97 (21%) males. Most participants were White (407 [90%]). Participants in the immediate tonsillectomy group had fewer days of sore throat during 24 months than those in the conservative management group (median 23 days [IQR 11–46] vs 30 days [14–65]). After adjustment for site and baseline severity, the incident rate ratio of total sore throat days in the immediate tonsillectomy group (n=224) compared with the conservative management group (n=205) was 0·53 (95% CI 0·43 to 0·65; <0·0001). 191 adverse events in 90 (39%) of 231 participants were deemed related to tonsillectomy. The most common adverse event was bleeding (54 events in 44 [19%] participants). No deaths occurred during the study. Compared with conservative management, immediate tonsillectomy is clinically effective and cost-effective in adults with recurrent acute tonsillitis. National Institute for Health Research. [ABSTRACT FROM AUTHOR]

Nasal endoscopy is not only used for the diagnosis of chronic rhinosinusitis with nasal polyps (CRSwNP), but also for monitoring the response to therapy playing an important role in both daily practice and research. In contrast to patient‐reported outcomes, endoscopic nasal polyp scoring by independent blinded readers is an objective measurement, not influenced by the placebo effect. It is safer and cheaper compared with computed tomography imaging and therefore, better suited for regular assessments of the extent of the disease. Since the early 90s, a variety of endoscopic staging methods have been proposed and used in clinical research, making it hard to compare results from different studies. This paper resulted from a task force with experts in the field of CRSwNP, originated by the Ear, Nose and Throat section of the European Academy of Allergy and Clinical Immunology and aims to provide a unified endoscopic NP scoring system that can serve as a reference standard for researchers, but also as a useful tool for practitioners involved in the management of CRSwNP. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor with regard to impact of interim report of the National Prospective Tonsillectomy Audit.

A letter to the editor is presented in response to the article on tonsillectomy, published in the previous issues.

A total of 69.8% (579/829) of responders with smell loss reported that their smell dysfunction had adversely impacted their quality of life (QoL). Keywords: olfaction; olfactory disorders; quality of life EN olfaction olfactory disorders quality of life 1558 1560 3 07/26/23 20230801 NES 230801 The coronavirus disease 2019 (COVID-19) pandemic has put unprecedented strains on healthcare systems across the globe and this is thought to continue with the advent of long COVID. High prevalence of persistent smell loss and qualitative smell dysfunction during the coronavirus disease 2019 (COVID-19) pandemic in the United States: Urgent need for clinical trials. [Extracted from the article]

Background: A core outcome set (COS) is an agreed standardised collection of outcomes that should be measured and reported by all trials for a specific clinical area, in this case chronic rhinosinusitis. These are not restrictive and researchers may continue to explore other outcomes alongside these that they feel are relevant to their intervention. The aim of this systematic review was to identify the need for a COS for chronic rhinosinusitis.Methods: A sensitive search strategy was used to identify all published Cochrane systematic reviews and randomised control trials of intervention for adult patients with chronic rhinosinusitis. Two independent authors reviewed these to obtain a list of outcomes and outcome measures reported by each clinical trial.Results: Sixty-nine randomised control trials and eight Cochrane systematic reviews were included in this study. They reported 68 individual outcomes and outcome measures, with an average of four to ten outcomes per clinical trial. These outcomes were mapped to 23 subcategories belonging to eight core categories.Conclusions: The key finding of this review was the heterogeneity of outcomes reported and measured by clinical trials of patients with chronic rhinosinusitis, precluding meaningful meta-analysis of data. This review supports the need for development of a COS, to be used in future trials on adult patients with chronic rhinosinusitis. [ABSTRACT FROM AUTHOR]

Introduction: As elective surgical services recover from the COVID‐19 pandemic a movement towards day‐case surgery may reduce waiting lists. However, evidence is needed to show that day‐case surgery is safe for endoscopic sinus surgery (ESS). The aim of this study was to investigate the safety of day‐case ESS in England. Design: Secondary analysis of administrative data. Methods: We extracted data from the Hospital Episodes Statistics database for the 5 years from 1 April 2014 to 31 March 2019. Patients undergoing elective ESS procedures aged ≥17 years were included. Exclusion criteria included malignant neoplasm, complex systemic disease and trans‐sphenoidal pituitary surgery. The primary outcome was readmission within 30 days post‐discharge. Multilevel, multivariable logistic regression modelling was used to compare outcomes for those operated on as day‐cases and those with an overnight stay after adjusting for demographic, frailty, comorbidity and procedural covariates. Results: Data were available for 49 223 patients operated on across 129 NHS hospital trusts. In trusts operating on more than 50 patients in the study period, rates of day‐case surgery varied from 20.6% to 100%. Nationally, rates of day‐case surgery increased from 64.0% in the financial year 2014/2015 to 78.7% in 2018/2019. Day‐case patients had lower rates of 30‐day emergency readmission (odds ratio 0.71, 95% confidence interval 0.62 to 0.81). Outcomes for patients operated on in trusts with ≥80% day‐case rates compared with patients operated on in trusts with <50% rates of day‐case surgery were similar. Conclusions: Our data support the view that ESS can safely be performed as day‐case surgery in most cases, although it will not be suitable for all patients. There appears to be scope to increase rates of day‐case ESS in some hospital trusts in England. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to estimate the prevalence of self‐reported chemosensory dysfunction in a study cohort of subjects who developed a mild‐to‐moderate coronavirus disease 2019 (COVID‐19) in the period from January 17, 2022, to February 4, 2022 (Omicron proxy period) and compared that with a historical series of patients testing positive for severe acute respiratory syndrome–coronavirus‐2 (SARS‐CoV‐2) infection between March and April, 2020 (comparator period). Methods: Prospective study based on the 22‐item Sino‐Nasal Outcome Tool (SNOT‐22), item "sense of smell or taste" and additional outcomes. Results: Patients' characteristics and clinical presentations of COVID‐19 were evaluated and compared in 779 patients, 338 of the study cohort and 441 of the historical series. The prevalence of self‐reported chemosensory dysfunction during the proxy Omicron period (32.5%; 95% confidence interval [CI], 27.6–37.8) was significantly lower from that during the comparator period (66.9%; 95% CI, 62.3–71.3) (p < 0.001). Nearly one‐quarter of patients (24.6%; 95% CI, 20.1–29.5) reported an altered sense of smell during the proxy Omicron period compared to 62.6% (95% CI, 57.9–67.1) during the comparator period (p < 0.001). Similarly, the prevalence of an altered sense of taste dropped to 26.9% (95% CI, 22.3–32.0) during the proxy Omicron period from 57.4% (95% CI, 52.6–62.0) during the comparator period (p < 0.001). The severity of chemosensory dysfunction was lower in the proxy Omicron period compared to the comparator period (p < 0.001). Conclusion: The prevalence and the severity of COVID‐19–associated smell and taste dysfunction has dropped significantly with the advent of the Omicron variant but it still remains above 30%. [ABSTRACT FROM AUTHOR]

Although still present in 20% to 30% of patients, this relative sparing of the olfactory sense will lead to a significant reduction in the long-term morbidity associated with COVID-19 by decreasing the overall percentage of COVID-19 patients who will suffer from long-term severe olfactory loss. Keywords: ageusia; anosmia; COVID-19; olfaction; olfactory disorders; omicron EN ageusia anosmia COVID-19 olfaction olfactory disorders omicron 958 960 3 04/25/23 20230501 NES 230501 Soon after the coronavirus disease (COVID-19) pandemic began to unfold, an altered sense of smell and taste was quickly identified as one of the most common yet unusual symptoms. Ageusia, anosmia, COVID-19, olfaction, omicron, olfactory disorders. [Extracted from the article]

A letter to the editor is presented about the use of the facial nerve monitor in mastoid surgery.