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Air pollution has become a serious public health problem and there is evidence that air pollution affects the incidence of allergic rhinitis. To further investigate the effect of ambient air pollutants on the severity of allergic rhinitis symptoms, a prospective follow-up study in patients with allergic rhinitis was conducted. A total of 167 allergic rhinitis patients with a mean age of 35.4 years, who were visiting the hospital, were enrolled. The daily symptom severity of allergic rhinitis and the concentrations of six air pollutants, including PM2.5, PM10, SO2, CO, O3 and NO2, were collected through follow-up investigations. The impact of ambient air pollutants on symptom severity was assessed via multi-pollutant models. Among several typical ambient air pollutants, we observed correlations of allergic rhinitis symptoms with PM2.5, PM10, CO, SO2 and NO2, whereas O3 showed no such correlation. Specifically, PM2.5 and PM10 were significantly associated with sneezing and nasal blockage. NO2 was significantly correlated with symptoms of rhinorrhea, itchy nose and itchy eyes. CO was significantly linked to sneezing and nasal blockage symptoms. These air pollutants not only had a direct impact on allergic rhinitis symptoms but also exhibited a lagging effect. This study indicates that short-term exposure to air pollutants is associated with exacerbation of nasal symptoms in patients with allergic rhinitis, leading to a decline in their quality of life. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of sublingual immunotherapy on clinical efficacy and mental health of children with allergic rhinitis (AR). Methods A total of 53 children diagnosed as AR admitted to the Department of Otolaryngology, Huai'an Hospital Affiliated to Xuzhou Medical University from June to December 2019 were selected as the observation group, and 53 healthy children with matching age, sex and education level were recruited as the control group. Rhinoconjunctivitis quality-of-life questionnaire (RQLQ), child behavioral checklist (CBCL) and sleep quality were compared between the two groups before treatment and 4 months, 1 year, 2 years and 3 years after treatment respectively. Results After treatment the scores of RQLQ, CBCL and sleep quality scores all decreased compared with those in the pre-operative in the observation group. The scores of RQLQ, CBCL and sleep quality between the two groups were all significantly different before treatment, and 4 months, 1 year and 2 years after treatment (P <0.05). There was no significant difference 3 years after the treatment between them (P <0.05). Conclusion Sublingual immunotherapy can effectively relieve the clinical symptoms of pediatric AR and promote their mental health development with less adverse reactions. [ABSTRACT FROM AUTHOR]

IntroductionSick building syndrome (SBS) refers to non-specific complaints, including upper-respiratory irritative symptoms, headaches, fatigue, and rash, which are usually associated with a particular building by their temporal pattern of occurrence and clustering among inhabitants or colleagues. The aim of the study was to determine the association between the clinical manifestations of sick building syndrome with outdoor pollutants and airborne pollen.MethodsIt was a descriptive and prospective observational study conducted from November 2021 to April 2022. It included subjects over 18 years old who completed an online survey on sick building syndrome (general symptoms, nasal, ocular, oropharyngeal, and skin symptoms) presented at home, housing information and personal history. The APS-330 from Pollen Sense ® was used to obtain data on pollen in the air and the local pollution monitoring system (SIMA) to obtain information regarding pollutants. For statistical analysis, SPSS version 16 was used.ResultsA total of 402 surveys were included; 91% of the subjects reported having at least 1 symptom. Females presented more general symptoms (fatigue and headache) than males. Subjects with a personal history of atopy showed a higher prevalence of practically all symptoms. Airborne pollen exposure was positively associated with mucosal symptoms in eyes and nose. Outdoor fungi spore exposure was positively associated with oculo-nasal and cutaneous symptoms in the scalp.ConclusionThis study found significant associations with female gender and a history of atopy, which suggests a higher risk for these subjects. Despite the limitations of the study, we can conclude that there is an association between the clinical manifestations of sick building syndrome with indoor and outdoor pollution.

Objectives: Montelukast is a well-known leukotriene receptor antagonist commonly used in treating allergic rhinitis and asthma. Omega-3 fatty acid is also known as an antiallergic and immunomodulator molecule. This study aimed to elucidate the efficacy of systemic montelukast and omega-3 fatty acid treatment in allergic rhinitis models in Wistar Hannover rats. Methods: This research was conducted on 28 healthy Wistar Hannover rats weighing 250–350 g. After establishing the allergic rhinitis model, nasal symptoms were observed and scored, and the nasal mucosa of all rats was investigated histologically. Light microscopy was utilized to evaluate the degree of ciliary loss, goblet cell hyperplasia, vascular congestion, vascular proliferation, inflammatory cell infiltration, eosinophil infiltration, and hypertrophy in chondrocytes. Results: As a result of the analysis of the data obtained from the study, it was determined that typical allergic rhinitis symptoms such as nasal scratching and sneezing were significantly reduced in the rats in the montelukast and omega-3 treated group, and these symptoms did not increase after repeated intranasal OVA-protease applications. Histological examinations after fish oil treatment did not reveal typical inflammatory changes in allergic rhinitis. None of the rats in the montelukast and omega-3 groups had any increase in goblet cells, whereas 14.3% of the rats in the control group and 28.6% of the rats in the allergic rhinitis group had mild increase. Last but not least, 71.4% of rats in the allergic rhinitis group had a moderate increase. The difference between the groups was statistically significant (p

Air pollution has become a serious public health problem and there is evidence that air pollution affects the incidence of allergic rhinitis. To further investigate the effect of ambient air pollutants on the severity of allergic rhinitis symptoms, a prospective follow-up study in patients with allergic rhinitis was conducted. A total of 167 allergic rhinitis patients with a mean age of 35.4 years, who were visiting the hospital, were enrolled. The daily symptom severity of allergic rhinitis and the concentrations of six air pollutants, including PM2.5, PM10, SO2, CO, O3 and NO2, were collected through follow-up investigations. The impact of ambient air pollutants on symptom severity was assessed via multi-pollutant models. Among several typical ambient air pollutants, we observed correlations of allergic rhinitis symptoms with PM2.5, PM10, CO, SO2 and NO2, whereas O3 showed no such correlation. Specifically, PM2.5 and PM10 were significantly associated with sneezing and nasal blockage. NO2 was significantly correlated with symptoms of rhinorrhea, itchy nose and itchy eyes. CO was significantly linked to sneezing and nasal blockage symptoms. These air pollutants not only had a direct impact on allergic rhinitis symptoms but also exhibited a lagging effect. This study indicates that short-term exposure to air pollutants is associated with exacerbation of nasal symptoms in patients with allergic rhinitis, leading to a decline in their quality of life.

Objective: This study aimed to evaluate the sinonasal-related Quality of Life (QoL) in patients undergoing endoscopic skull base surgery. Methods: A retrospective study was performed, including patients with benign and malignant tumors at a single institution. Each patient completed the 22-Item Sino-Nasal Outcome Test (SNOT-22) and the Empty Nose Syndrome 6 Item Questionnaires (ENS6Q) to assess their perceived QoL at least 2-months after treatment. Results: Forty-nine patients were enrolled in this study. The average score was 25.1 (Stander Deviation [SD] 14.99) for SNOT-22 and 6.51 (SD = 5.58) for ENS6Q. Analysis of the overall results for the SNOT-22 showed that olfactory damage was the most serious syndrome. The most frequently reported high-severity sub-domains in SNOT-22 were nasal symptoms and sleep symptoms. Nasal crusting was the most severe item in ENS6Q according to the report. Nine patients (18.4%) had a score higher than 10.5 which indicates the high risk of Empty Nose Syndrome (ENS). SNOT-22 score was related to the history of radiotherapy (p

Background: Since outbreak of COVID-19 pandemic, almost whole world asked to wear the facemask especially in the public areas as a precaution to avoid the transmission of the disease, and curbs the pandemic. Looking from another perspective, we need to consider the effect of the facemask in reducing allergic rhinitis symptoms. Objective: The current study objective was to assess the impact of facemasks on the symptoms of allergic rhinitis in subjects who were obligatory using facemask due to the COVID-19 pandemic. Methods: The current study was ethically approved self-administered validated survey (Cronbach Alfa 0.81) comprised of 28-items to assess the impact of wearing the facemask, and whether there was an improvement in symptoms of allergic rhinitis. The outcome measure was the responses to the four domains (knowledge, attitude, symptoms, and help/advice) measured on Likert scale to assess the responses of subjects with allergic rhinitis during the COVID -19 pandemic. Results: 82 respondents (mean age was 22.59 ±2.77 years) have completed the survey, of which 73 females (89%) and (52/82, 63.4%) university students. 29 (35.4%), stated that the fabric facemask is useful in reduction of symptoms. 44 (53.7%) believe that the surgical mask N95 is very beneficial in the reduction of symptoms. There was a significant difference in knowledge levels for both eye and nasal symptoms' reduction responses (P <0.001). Tukey's HSD (honestly significant difference) used to determine the specifics of the variances (differences in multiple means) in symptom reduction. For eye symptoms, the analysis revealed that respondents who reported that they had reduced symptoms had higher knowledge scores (6.74±2.7) than those who reported no reduction in allergic symptoms (mean ±SD: 4.96±3.2). The lowest score was associated with respondents that were uncertain regarding their symptom alleviation (mean ±SD: 4.53±3.1). For nasal symptoms, the analysis revealed that respondents who reported that they had reduced symptoms had higher knowledge scores (7.03±2.7) than those who reported no reduction in allergic symptoms (3.94±2.5). Conclusion: Our results reveal that facemask usage may reduce allergic rhinitis symptom severity in chronically affected individuals with intermittent disease. The study supports the hypothesis that facemask may reduce atopic allergic responses. [ABSTRACT FROM AUTHOR]

TheCOVID-19 pandemic has rapidly spread worldwide. Individual prevention approaches include FFP2/N95 mask use. Healthcare (HC) workers wear face masks for a long time during their work shifts and often complain of nasal symptoms. Current data on mask-associated symptoms or upper airway epithelium transformations are limited. Nasal cytology (NC) is a useful, non-invasive diagnostic method to assess cellular alterations. The aim of this study is to compare NC in HC workers before and after the continuous wearing of FFP2 face masks. We conducted a pilot observational study on 10 volunteer HC workers, who continuously used FFP2 masks during the work shift. All subjects underwent NC at the beginning (T0) and at the end of their workshift (T1) and the cytological findings were compared. Moreover, nasal symptoms were collected. Rare inflammatory cells were detected at T0 and, comparing cytological data about T0 and T1, no significant differences were observed. The most reported nasal symptoms were itching (70%) and a dry nose (60%). Difficulty of breathing and nasal blockage were not relevant. These preliminary data seem to suggest that wearing an FFP2 mask does not determine observable alterations in NC in daily work. However, further studies on a larger population for a longer period are needed. [ABSTRACT FROM AUTHOR]

Featured Application: Few studies have examined the efficacy of masks in preventing the effects of ionic components of air pollution on health. The results of this study should serve as a base for future research. Mask wearing can protect health care workers. However, its efficacy in avoiding the health effects of air pollution is not well studied. Recently, we evaluated the relationship between air pollution and health status or peak expiratory flow rate (PEFR). At the beginning of that study, about 20% of people were wearing masks. However, in the same period one year later, most people were wearing masks because of the COVID-19 pandemic. Therefore, in this study, we examined the relationship between mask wearing, concentration of ionic components of PM2.5, respiratory symptoms, and PEFR. Seventy-two patients in Fukuoka City with asthma and allergic diseases measured PEFR daily and recorded respiratory symptoms and mask wearing in a diary. We measured the ionic components of PM2.5 in Fukuoka City and examined the relationships between patient measurements, mask wearing, and air pollution. Univariate analysis showed that, in 2020, but not in 2021, some ionic components of PM2.5, i.e., Cl−, NO3−, Na+, and Mg2+, were significantly correlated with the frequency of cough and nasal symptoms and a decrease in PEFR. Some ionic components of PM2.5 may increase the frequency of respiratory symptoms and decrease PEFR in patients with allergic diseases; however, this tendency is not seen when masks are used. The use of masks may be one of the factors that attenuate the effects of PM2.5 ionic components. [ABSTRACT FROM AUTHOR]

Featured Application: Few studies have evaluated the relationship between the concentration of ionic components in PM2.5 and clinical symptoms or peak expiratory flow rate. The present study is an important stepping stone for future research. (1) Background: Few studies have evaluated the association between the ionic components of PM2.5 and respiratory symptoms or peak expiratory flow rate (PEFR). The aim of this study was to clarify these associations. (2) Methods: Patients with allergic diseases treated at Fukuoka Hospital recorded their morning and evening PEFR and respiratory symptoms in a diary. We measured PM2.5 and its ionic components in Fukuoka City and examined the relationship with PEFR and respiratory symptoms by univariate and multivariate analysis. (3) Results: Among the ionic components of PM2.5, Cl−, NO3−, Na+, K+, and Mg2+ were significantly correlated with the frequency of coughing and nasal symptoms. In univariate analysis, the concentrations of each of the above ions was significantly associated with a decrease in PEFR and the concentrations of each was associated with at least one respiratory symptom or PEFR. Multivariate analysis of items significantly correlated with PEFR indicated that the concentration of ionic components may predict changes in PEFR. (4) Conclusions: In patients with allergic diseases, some ionic components of PM2.5 may increase the frequency of respiratory symptoms and decrease PEFR, so further study and caution are required in daily clinical practice. [ABSTRACT FROM AUTHOR]

Background: Rhinomanometry, acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) are popular methods for nasal patency evaluation. The aim of the present study was to compare these three methods with the reported nasal symptoms to determine the best diagnostic tool to assess nasal obstruction. Methods: 101 subjects were evaluated using PNIF, 4-phase rhinomanometry (4PR), AR, Visual Analogue Scale for nasal obstruction (VAS-NO) and Sino-Nasal Outcome Test (SNOT-22). Correlations among PNIF, 4PR, AR, VAS-NO and SNOT-22 were obtained. Results: VAS-NO and SNOT-22 were moderately correlated with each other (r = 0.54, p < 0.001). 4PR was moderately correlated with PNIF (r = –0.31, p = 0.0016) and AR (r = –0.5, p < 0.001). VAS-NO was mildly correlated with PNIF (r = –0.29, p = 0.0034). SNOT-22 was moderately correlated with PNIF (r = –0.31, p = 0.0017). After dividing the population into symptomatic and asymptomatic subjects, based on their VAS-NO score, the former showed significantly lower PNIF values (p = 0.009) and higher 4PR values (p = 0.013) compared to the latter ones. Conclusion: PNIF and 4PR showed a significant moderate correlation with each other, but PNIF showed a significant correlation (weak-moderate) with the reported nasal symptom scores. [ABSTRACT FROM AUTHOR]

Existing data suggest that people with multiple sclerosis (pwMS) are at an elevated risk for experiencing olfactory impairment. We investigated if smell dysfunction can be used as an MS disease marker. This is a cross-sectional, case–control study. All data were collected prospectively from 171 participants, 115 pwMS and 56 controls (age and sex stratified and matched to the patients), who reported smell, taste, and nasal breathing, and completed the Greek-validated questionnaires for nasal obstruction (NOSE), nasal-symptoms QoL (SNOT-22), and olfaction-associated QoL (QOD). The smell was assessed with the "Sniffin' sticks" (odor threshold (OT), discrimination (OD), identification (OI) test, and total TDI). We recorded the pwMS disease characteristics (Expanded Disability Status Scale-EDSS, the disease type and duration), cognitive function, emotional status, fatigue, and impact of MS in everyday activities. A TDI < 30.75 (hyposmia) was detected in 30.8% of the patients. The patients' OD and TDI scores were significantly lower than the controls' (p = 0.005, and 0.015, respectively). The hyposmia correlated with disease severity and duration. The EDSS score correlated negatively with OD (r = −0.299, p = 0.001) and TDI (r = −0.242, p = 0.01). The disease duration correlated negatively with OD (r = −0.305, p = 0.001, OI (r = −0.253, p = 0.008) and TDI (r = −0.3, p = 0.001). The information processing speed (SDMT) correlated with OD, OT, and TDI (r = 0.302, p = 0.002; r = 0.242, p = 0.016; r = 0.326, p = 0.001). The olfactory function is changing in MS in accordance with disease progression. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review was conducted to answer the following 3 questions: 'Does nasal pathology affect CPAP use?', 'What is the effect of CPAP on the nose?' and 'Does treatment of nasal pathology affect CPAP use?'. Methods: Pubmed and Scopus databases were searched for articles relevant to the study questions up to October 2020. Results: Sixty-three articles were selected, of which a majority were observational studies. Most studies identified a correlation between larger nasal cross-sectional area or lower nasal resistance and higher CPAP compliance or lower CPAP pressures; however, nasal symptoms at baseline did not appear to affect CPAP use. The effect of CPAP on the nose remains uncertain: while most studies suggested increased mucosal inflammation with CPAP, those investigating symptoms presented contradictory results, with some reporting an increase and others an improvement in nasal symptoms. Evidence is clearer for nasal surgery leading to an increase in CPAP compliance and a decrease in CPAP pressures, whereas there is little evidence available for the use of topical nasal steroids. Conclusion: There appears to be a link between nasal volumes or nasal resistance and CPAP compliance, an increase in nasal inflammation caused by CPAP and a beneficial effect of nasal surgery on CPAP usage, but no significant effect of CPAP on nasal patency or effect of topical steroids on CPAP compliance. Results are more mitigated with regard to the effect of nasal symptoms on CPAP use and vice versa, and further research in this area would help identify patients who may benefit from additional support or treatment alongside CPAP. [ABSTRACT FROM AUTHOR]

Background: There is increasing evidence that probiotics are effective in treating allergic rhinitis (AR), while some controversies remain. This study was performed to evaluate the therapeutic effect and safety of a mixture of Bifidobacterium longum and Lactobacillus plantarum (NVP-1703) in children with AR., Methods: In a randomized, double-blind, placebo-controlled study, children aged 6 to 19 years with perennial AR were treated with NVP-1703 at a dose of 1 × 10 10 CFU/day or placebo once a day for 4 weeks. Total nasal symptom score (TNSS), nasal symptom duration score (NSDS), quality of life (QoL), allergic inflammatory markers, and safety parameters were evaluated., Results: After 4 weeks of treatment, the TNSS in the NVP-1703 group significantly decreased compared to that in the placebo group ( P = 0.011), both in the morning and the evening ( P = 0.031 and P = 0.004, respectively). The NSDS also significantly decreased in the NVP-1703 group compared to that in the placebo group ( P = 0.018). QoL scores, particularly those related to mouth breathing and itchy nose, showed a significant improvement in the NVP-1703 group compared to the placebo group. The ratios of interleukin (IL)-4/IL-22 and IL-5/IL-22 were significantly reduced in the NVP-1703 group after the treatment compared to the baseline values. No notable adverse events were reported in the NVP-1703 group., Conclusion: Oral administration of a mixture of B. longum and L. plantarum (NVP-1703) improved both AR symptoms and QoL in children with perennial AR, accompanied by decreases in the ratios of T helper 2 cytokines to IL-22., Trial Registration: Clinical Research Information Service Identifier: KCT0002661., Competing Interests: Jang SW, Han SW, and Kang SH are employed by NVP Healthcare Co., Ltd. The remaining authors report no conflicts of interest in this work., (© 2024 The Korean Academy of Medical Sciences.)

Background: T ranssphenoidal surgery (TSS) is the standard approach for resection of pituitary lesions. Historically, this has utilized the microscopic approach (mTSS); however, the past decade has seen widespread uptake of the endoscopic approach (eTSS). The purported benefits of this include improved visualization and illumination, resulting in improved surgical and endocrinological patient outcomes. It is also believed that eTSS results in fewer post-operative nasal symptoms compared to mTSS; however, few papers have directly compared these groups. Objectives: We sought to compare nasal symptoms after endoscopic uninostril (eTSS-uni), endoscopic binostril (eTSS-bi) and microscopic endoscopic transsphenoidal surgery (mTSS). Methods: The General Nasal Patient Inventory (GNPI) was prospectively administered to 136 patients (71 non-functioning adenomas, 26 functioning adenomas, 39 other pathology) undergoing transsphenoidal surgery at multiple time points (pre-operatively; days 1, 3 and 7–14; months 1, 3 and 6 and 1 year post-operatively). All surgeries were performed by subspecialist pituitary surgeons in three subgroups — mTSS (25), eTSS-uni (74) and eTSS-bi (37). The total GNPI scores (0–135) and subscores for the 45 individual components were compared across three groups assessing for temporal and absolute changes. Results: Irrespective of surgical approach used, GNPI scores were significantly higher on post-operative day 1 (p < 0.001) and day 3 (p ≤ 0.03) compared to pre-treatment baseline (mixed-effects model). By 1 month post-operatively, however, post-operative GNPI scores were no different from pre-treatment (p > 0.05, mixed-effects model). Whilst the eTSS-uni group demonstrated significantly lower GNPI scores at day 1 post-op compared to the mTSS group (p = 0.05) and eTSS-bi group (p < 0.001), there was no significant difference in post-operative scores between approaches beyond 1–2 weeks post-operatively. Similar results were obtained when the non-functioning tumour group was analysed separately. Conclusions: Transsphenoidal pituitary surgery is well tolerated. Post-operative nasal symptoms transiently worsen but ultimately improve compared to pre-operative baseline. Operative approach (microscopic, endoscopic uninostril or endoscopic binostril) only has a transient effect on severity of post-operative nasal symptoms. [ABSTRACT FROM AUTHOR]

Abstract Background Allergic rhinitis is one of the most prevalent allergic diseases worldwide which diagnosis is based on typical clinical signs and positive results of allergic tests. Selection and evaluation of treatment is based mainly on subjective symptoms. Objective measurement of patients’ complaints is necessary for proper documentation and follow-up. There are no short simple validated questionnaire assessing nasal symptoms in patients with allergic rhinitis in Lithuania. Total nasal symptoms score (TNSS) is a brief questionnaire which evaluate the severity of main symptoms of allergic rhinitis widely used in different countries. Our aim was to translate the TNSS in the Lithuanian language and to validate it. Methods Prospective cross-cultural adaption and validation study was performed. Linguistic validation of TNSS was performed and validity and reliability were assessed. Patients with chronic allergic and non-allergic rhinitis and healthy individuals were included in this study. Patients had to complete translated version of TNSS. Patients with allergic rhinitis additionally were asked to fill Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Results Seventy-six individuals were involved into the study: 16 with non-allergic rhinitis (NAR) (21.1%), 49 with allergic rhinitis (AR) (64.5%) and 11 healthy individuals (14.5%). Cronbach’s α was 0.87. TNSS score was significantly higher in patients with NAR and AR compared with healthy individuals (3.56 ± 2.28 vs. 4.28 ± 2.46 vs. 0.27 ± 0.91). Positive significant correlation was found between TNSS score and RQLQ score (rs = 0.77, p

Abstract Objective To find the lowest effective injection dose of abobotulinum toxin A (Dysport) for allergic rhinitis. Study Design Dose‐escalation randomized controlled trial. Methods We included all patients aged 18 years or older who had persistent allergic rhinitis and positive allergy skin prick test. The patients were randomly allocated to receive 40, 30, or 20 U of abobotulinum toxin A by injection at the inferior turbinate. We followed up on patients for 12 weeks to evaluate nasal symptoms, ocular symptoms, minimum nasal cross‐sectional area as measured using acoustic rhinometry, and complications. Results Seventeen patients were included in this study, with 7 receiving 20 U of abobotulinum toxin A and 5 each receiving 30 U and 40 U. Abobotulinum toxin A significantly improved nasal congestion, rhinorrhea, sneezing, and loss of smell at 40 U (P

Objectives: Loss of smell or taste are early symptoms of COVID-19. Given the high asymptomatic rate of COVID-19, as well as unreliable temperature checking and contact history taking, it is important to understand the role of olfactory and gustatory dysfunction (OGD) in the diagnosis of COVID-19. The aim of this study is to determine how initial symptoms of OGD can be used to screen patients for COVID-19 laboratory testing.Methods: We followed recommendations from the Preferred Reporting Items for Systemic Reviews and Meta-analysis (PRISMA) statement to conduct this systematic review study. We used OGD-related key words to search for literature published between January 1, 2020 and September 30, 2020 on Pubmed, Ovid Medline databases. We estimated the prevalence of OGD and compared it with that of other OGD-related symptoms. The weighted summary proportion under the fixed and random effects model was assessed using MedCalc statistical software. Whenever there was heterogeneity, a random effects model was selected. Publication bias was assessed by funnel plot asymmetry and Egger's regression test.Results: A total of 25 articles (evidence level III:5; IV:20) were identified and reviewed. Data synthesis of 19 articles revealed that the pooled prevalence of olfactory dysfunction in COVID-19 is 53.56% (range 5.6-100%, 95% CI 40.25-66.61%). The pooled prevalence of gustatory dysfunction in COVID-19 is 43.93% (range 1.5-85.18%, 95% CI 28.72-59.74%), just behind fever (62.22%, range 18.18-95.83%, 95% CI 54.82-69.33%), cough (64.74%, range 38.89-87.5%, 95% CI 57.97-71.22%), and fatigue (56.74%, range 6.25-93.62%, 95% CI 32.53-79.35%). The prevalence of gustatory dysfunction in subgroup with objective evaluation is lower than those without (9.91% vs. 49.21%, relive risk 2.82, p<0.001).Conclusion: Our updated systematic review attests that OGD is an important early symptom of COVID-19 infection. Screening for OGD should be further emphasized to prioritize patients for laboratory test. [ABSTRACT FROM AUTHOR]

Purpose: Endoscopic transsphenoidal surgery causes nasal morbidity and negatively affects health-related quality of life (HRQoL). Knowledge on actionable symptoms that could improve postoperative HRQoL is therefore important. This study assessed the impact of nasal symptoms on postoperative HRQoL. Methods: This perioperative cohort study included 103 adult patients undergoing endoscopic pituitary adenoma resection (August 2016–December 2018), with measurements preoperatively, and 5 days, 6 weeks and 6 months after surgery. Nasal symptoms were measured with the Anterior Skull base nasal inventory-12, and HRQoL with the Short Form-36 (SF-36) physical (PCS) and mental component scores (MCS). Linear regression analysis was used to assess (1) determinants of postoperative nasal morbidity, (2) associations between number of symptoms or (3) individual symptoms and HRQoL, and (4) the percentage of variance of HRQoL explained by nasal symptoms. Results: The number of nasal symptoms transiently increased after surgery. No significant treatment- or disease-related determinants of nasal morbidity were identified. The number of nasal symptoms was significantly associated with a lower PCS (β = − 1.0; 95%CI − 1.5, − 0.4), but not with MCS at 6 weeks. Similar results were observed at 6 months. Headaches (42.2%), problems with smell (42.0%), and taste (36.0%) were the most prevalent symptoms, while sense of smell and taste, and nasal discharge showed the strongest associations with HRQoL. Conclusions: Postoperative nasal symptoms, in particular problems with smell and taste, significantly affect pituitary patients' physical HRQoL. Monitoring of these symptoms may aid in determining which patients may benefit from intensified follow-up and treatment, aiming to optimize HRQoL. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is a global health burden and it manifests in both nasal and non-nasal symptoms. Skin prick test (SPT) is a routine procedure to diagnose AR sensitized to common allergens including house dust mites (HDMs). The degree of sensitivity of a patient toward allergens is determined by the size of the wheal formed by SPT procedure. SPT wheal sizes are influenced by recent anti-histamine usage, however it remains unclear if SPT wheal sizes are also influenced by other factors. In this study, we set out to investigate the association between SPT wheal sizes with the demographical, clinical and environmental characteristics, as well as nasal and non-nasal symptoms severity scores, of AR patients (n = 30) sensitized to common HDMs (i.e., Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis). We showed that SPT wheal sizes of HDM allergens were not associated with clinical, demographical and environmental characteristics examined. Nonetheless, significant correlations were observed between SPT wheal sizes of D. farinae sensitization with worse severity scores of all five nasal symptoms examined (i.e., sneezing, runny nose, itchy nose, congestion and postnasal drip) and four of the six non-nasal symptoms examined (i.e., throat symptoms, ear symptoms, headache and mental function). Such relationships were not observed in SPT wheal sizes of D. pteronyssinus and B. tropicalis sensitization. We suggest that increased SPT wheal sizes for D. farinae sensitization may predict the likelihood of more severe nasal and, to a lesser extent, non-nasal manifestations in AR patients.

Allergic rhinitis (AR) is prevalent, and many patients present with moderate-to-severe symptomatic disease. The majority of patients are not satisfied with their AR treatment, despite the use of concurrent medications. These gaps underscore the need for treatment with more effective options for moderate-to-severe AR. The authors' objective was to review systematically the efficacy and safety of MP-AzeFlu for the treatment of AR. The primary outcomes studied were nasal, ocular, and total symptoms. Other outcomes included time to onset and of AR control, quality of life, and safety. Searches of PubMed and Cochrane databases were conducted on May 14, 2020, with no date restrictions, to identify publications reporting data on MP-AzeFlu. Clinical studies of any phase were included. Studies were excluded if they were not in English, were review articles, did not discuss the safety and efficacy of MP-AzeFlu for AR symptoms. Treatment of AR with MP-AzeFlu results in effective, sustained relief of nasal and ocular symptoms, and faster onset and time to control compared with intranasal azelastine or fluticasone propionate. Long-term use of MP-AzeFlu was safe, with benefits in children, adults, and adults aged ≥65 years. Other treatment options, including fluticasone propionate and azelastine alone or the combination of intranasal corticosteroids and oral antihistamine, do not provide the same level of efficacy as MP-AzeFlu in terms of rapid and sustained relief of the entire AR symptom complex. Furthermore, MP-AzeFlu significantly improves patient quality of life. MP-AzeFlu is a currently available combination that may satisfy all these patient needs and expectations. [ABSTRACT FROM AUTHOR]

Introduction: Sick building syndrome (SBS) refers to non-specific complaints, including upper-respiratory irritative symptoms, headaches, fatigue, and rash, which are usually associated with a particular building by their temporal pattern of occurrence and clustering among inhabitants or colleagues. The aim of the study was to determine the association between the clinical manifestations of sick building syndrome with outdoor pollutants and airborne pollen., Methods: It was a descriptive and prospective observational study conducted from November 2021 to April 2022. It included subjects over 18 years old who completed an online survey on sick building syndrome (general symptoms, nasal, ocular, oropharyngeal, and skin symptoms) presented at home, housing information and personal history. The APS-330 from Pollen Sense ® was used to obtain data on pollen in the air and the local pollution monitoring system (SIMA) to obtain information regarding pollutants. For statistical analysis, SPSS version 16 was used., Results: A total of 402 surveys were included; 91% of the subjects reported having at least 1 symptom. Females presented more general symptoms (fatigue and headache) than males. Subjects with a personal history of atopy showed a higher prevalence of practically all symptoms. Airborne pollen exposure was positively associated with mucosal symptoms in eyes and nose. Outdoor fungi spore exposure was positively associated with oculo-nasal and cutaneous symptoms in the scalp., Conclusion: This study found significant associations with female gender and a history of atopy, which suggests a higher risk for these subjects. Despite the limitations of the study, we can conclude that there is an association between the clinical manifestations of sick building syndrome with indoor and outdoor pollution., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 González-Díaz, Hernández-Salcido, de Lira-Quezada, Cantú-Hernández, Macouzet-Sánchez, Macias-Weinmann and Acuña-Ortega.)

Mask wearing can protect health care workers. However, its efficacy in avoiding the health effects of air pollution is not well studied. Recently, we evaluated the relationship between air pollution and health status or peak expiratory flow rate (PEFR). At the beginning of that study, about 20% of people were wearing masks. However, in the same period one year later, most people were wearing masks because of the COVID-19 pandemic. Therefore, in this study, we examined the relationship between mask wearing, concentration of ionic components of PM2.5, respiratory symptoms, and PEFR. Seventy-two patients in Fukuoka City with asthma and allergic diseases measured PEFR daily and recorded respiratory symptoms and mask wearing in a diary. We measured the ionic components of PM2.5 in Fukuoka City and examined the relationships between patient measurements, mask wearing, and air pollution. Univariate analysis showed that, in 2020, but not in 2021, some ionic components of PM2.5, i.e., Cl−, NO3−, Na+, and Mg2+, were significantly correlated with the frequency of cough and nasal symptoms and a decrease in PEFR. Some ionic components of PM2.5 may increase the frequency of respiratory symptoms and decrease PEFR in patients with allergic diseases; however, this tendency is not seen when masks are used. The use of masks may be one of the factors that attenuate the effects of PM2.5 ionic components.

Objectives: Montelukast is a well-known leukotriene receptor antagonist commonly used in treating allergic rhinitis and asthma. Omega-3 fatty acid is also known as an antiallergic and immunomodulator molecule. This study aimed to elucidate the efficacy of systemic montelukast and omega-3 fatty acid treatment in allergic rhinitis models in Wistar Hannover rats., Methods: This research was conducted on 28 healthy Wistar Hannover rats weighing 250-350 g. After establishing the allergic rhinitis model, nasal symptoms were observed and scored, and the nasal mucosa of all rats was investigated histologically. Light microscopy was utilized to evaluate the degree of ciliary loss, goblet cell hyperplasia, vascular congestion, vascular proliferation, inflammatory cell infiltration, eosinophil infiltration, and hypertrophy in chondrocytes., Results: As a result of the analysis of the data obtained from the study, it was determined that typical allergic rhinitis symptoms such as nasal scratching and sneezing were significantly reduced in the rats in the montelukast and omega-3 treated group, and these symptoms did not increase after repeated intranasal OVA-protease applications. Histological examinations after fish oil treatment did not reveal typical inflammatory changes in allergic rhinitis. None of the rats in the montelukast and omega-3 groups had any increase in goblet cells, whereas 14.3% of the rats in the control group and 28.6% of the rats in the allergic rhinitis group had mild increase. Last but not least, 71.4% of rats in the allergic rhinitis group had a moderate increase. The difference between the groups was statistically significant (p < 0.001)., Conclusion: Regarding the outcomes of this research, it was observed that w-3 fatty acids had antiallergic effects, both histopathological and clinical, in the allergic rhinitis model. We believe that further randomized controlled trials incorporating larger cohorts are warranted to verify the use of omega-3 fatty acids in treating allergic rhinitis. The level of evidence of this article is Level 2., (Copyright © 2024 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier España S.L.U. All rights reserved.)

OBJECTIVE: Exercise-induced bronchoconstriction (EIB) without asthma and non-allergic rhinitis is frequently reported in athletes who are facing high-risk of airway dysfunctions such as elite swimmers. Therefore, we aimed to evaluate the effect of exercise on nasal and pulmonary functions, additionally to determine the prevalence of EIB and rhinitis in adolescent elite swimmers. METHODS: The study included 47 adolescent licensed-swimmers (26 males and 21 females) aged between 10 and 17 years old. The prevalence of asthma and allergic disease and the symptom severity scores measured before and after swimming training were assessed through an interview form which includes information related to our study goal. In addition, acoustic rhinometry was utilized to evaluate nasal airway, spirometry was utilized to evaluate EIB in accordance with standard protocols. RESULTS: Six swimmers had a history of allergic rhinitis (12.8%), while three (6.4%) had asthma. Post-swim mean forced vital capacity (FVC) was significantly higher than pre-swim FVC (p=0.019) and forced expiratory volume 1 (FEV-l)/FVC ratio was significantly lower than pre-swim FEV-l/FVC ratio (p=0.034). In addition, the prevalence of EIB was 8.5%. Moreover, level of nasal discharge statistically increased in post-swim period (p=0.003). CONCLUSION: We have documented that swimming cause’s nasal discharge but do not effect nasal passages. In addition, we observed that the overall prevalence of EIB in swimmers was not different from that of the general population, furthermore swimming exercise significantly increased FVC of swimmers. Therefore, we concluded swimming training can be recommended for children diagnosed with asthma or allergic rhinitis. [ABSTRACT FROM AUTHOR]

(1) Background: Few studies have evaluated the association between the ionic components of PM2.5 and respiratory symptoms or peak expiratory flow rate (PEFR). The aim of this study was to clarify these associations. (2) Methods: Patients with allergic diseases treated at Fukuoka Hospital recorded their morning and evening PEFR and respiratory symptoms in a diary. We measured PM2.5 and its ionic components in Fukuoka City and examined the relationship with PEFR and respiratory symptoms by univariate and multivariate analysis. (3) Results: Among the ionic components of PM2.5, Cl−, NO3−, Na+, K+, and Mg2+ were significantly correlated with the frequency of coughing and nasal symptoms. In univariate analysis, the concentrations of each of the above ions was significantly associated with a decrease in PEFR and the concentrations of each was associated with at least one respiratory symptom or PEFR. Multivariate analysis of items significantly correlated with PEFR indicated that the concentration of ionic components may predict changes in PEFR. (4) Conclusions: In patients with allergic diseases, some ionic components of PM2.5 may increase the frequency of respiratory symptoms and decrease PEFR, so further study and caution are required in daily clinical practice.

Chinese herbal medicine (CHM) has long been used for allergic rhinitis (AR). This systematic review aimed to investigate the clinical effects and safety of oral CHM for AR by comparing it to Western medications (WM). Nineteen databases were searched up to May 27, 2020. Randomized controlled trials (RCTs) assessing the effects of CHM on the primary or secondary outcomes comparing to WM, in any age of the patients, were included. The pooled results were expressed as mean difference, standardized mean difference, or odds ratio with 95% confidence intervals. Eighteen RCTs were included and 17 of them were evaluated in the meta‐analysis. CHM may improve total nasal symptom scores, individual symptom scores (rhinorrhea, nasal congestion, sneezing, and nasal itching), quality of life, and recurrence rate, compared to antihistamines (loratadine and chlorpheniramine). Only mild and transient adverse events of CHM were reported. However, there were no significant differences in some subgroup analyses in total nasal symptom scores, rhinorrhea, nasal obstruction, sneezing, nasal itching, and SF‐36. Due to the small number of included studies, poor quality of trial design, and substantial heterogeneities, the potential of CHM for AR should be validated in large, multicenter, and well‐designed RCTs in the future. [ABSTRACT FROM AUTHOR]

Abstract Background Different clinical trials showed the superior efficacy of rupatadine compared to placebo at improving seasonal allergic rhinitis (SAR) symptoms, but no study has assessed if the response promoted is clinically meaningful. Methods This study is a pooled analysis of data of seven randomized, double-blind, placebo-controlled SAR studies comparing responder proportions upon treatment with rupatadine (10 or 20 mg) or placebo. We evaluated the following symptom scores at baseline (Visit 1) and over 14 days of treatment: Total 4 Nasal Symptom Score (T4NSS), Total 2 Ocular Symptom Score (T2OSS) and Total 6 Symptom Score (T6SS). The proportion of responders (50% and 75% response) and the time to response were compared between groups on days 7 (Visit 2) and 14 (Visit 3). Responder rates were compared between groups on days 7 and 14 for the complete/near-to-complete response for T4NSS (TN4SS score ≤ 2 and each symptom score ≤ 1) and T6SS (T6SS score ≤ 3 and each symptom score ≤ 1). Results Data from 1470 patients were analyzed: 332 treated with placebo, 662 with rupatadine 10 mg and 476 with rupatadine 20 mg. The reduction in T4NSS, T2OSS and T6SS over 14 days of treatment relative to baseline was statistically higher in rupatadine groups vs the placebo group, with greater improvements in the 20 mg group. A statistically higher proportion of patients reached the 50% and 75% response for T4NSS, T2OSS and T6SS in rupatadine groups compared to the placebo group across the visits. Among rupatadine-treated patients, those receiving 20 mg compared favourably for both cut-off responses. The time to achieve a proportion of responders was shorter in the rupatadine 20 mg group than in the rupatadine 10 mg and placebo groups for all the symptom scores. The number of patients who achieved a complete/near-to-complete response for both symptom scores was higher in rupatadine groups than in the placebo group, with higher proportions in the 20 mg group. Conclusions This responder analysis confirms the superior efficacy of rupatadine vs placebo to treat SAR. Rupatadine promoted higher proportions of responders according to stringent response criteria and in a dose-dependent manner, with faster and higher response rates in the 20 mg group.

Background: As the endoscope has become more common in the otolaryngologist's office, there is a need to reevaluate the value of traditional nasal examination methods. The objective of this study was to determine the sensitivity and specificity of traditional nasal examination tools compared to those of the rigid endoscope. Methods: A prospective diagnostic study was conducted. Eligible patients with nasal symptoms were recruited and examined using 4 tools: (1) a nasal speculum, (2) an otoscope, (3) a posterior rhinoscopy mirror, and (4) a rigid nasal endoscope. The diagnostic value of each tool was evaluated. Results: There were a total of 53 patients eligible for inclusion in the study. The mean age of all patients was 40.9 years. The most common nasal symptom was nasal obstruction (90.6%). With regard to the tools used in anterior rhinoscopy, the nasal speculum had a sensitivity of 54.69% (95% confidence interval [95% CI]: 41.75-67.18) and specificity of 88.10% (95% CI: 74.37-96.02); and the otoscope had a sensitivity of 57.81% (95% CI: 44.82-70.06) and specificity of 85.71% (95% CI: 71.46-94.57). After application of topical anesthesia and decongestant, the nasal speculum had a sensitivity of 67.19% (95% CI: 54.31-78.41) and specificity of 85.71% (95% CI: 71.46-94.57); and the otoscope had a sensitivity of 65.62% (95% CI: 52.70-77.05) and specificity of 83.33% (95% CI: 68.64-93.03). The posterior rhinoscopy mirror had a sensitivity of 12.50% (95% CI: 5.18-24.07) and specificity of 94.00% (95% CI: 83.45-98.75). All adverse events in this study were minor. Conclusion: The traditional nasal examination tools exhibited excellent specificity. However, the sensitivity was only average, meaning that they may not be suitable for screening. We do not recommend routine use of topical anesthesia and decongestants when applying these tools, as the application of these agents did not improve the clinical sensitivity or specificity. The posterior rhinoscopy mirror had a lowest sensitivity. We thus do not recommend using a posterior rhinoscopy mirror to rule out pathologies of the posterior nasal cavity. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis is one of the most prevalent allergic diseases worldwide which diagnosis is based on typical clinical signs and positive results of allergic tests. Selection and evaluation of treatment is based mainly on subjective symptoms. Objective measurement of patients' complaints is necessary for proper documentation and follow-up. There are no short simple validated questionnaire assessing nasal symptoms in patients with allergic rhinitis in Lithuania. Total nasal symptoms score (TNSS) is a brief questionnaire which evaluate the severity of main symptoms of allergic rhinitis widely used in different countries. Our aim was to translate the TNSS in the Lithuanian language and to validate it.Methods: Prospective cross-cultural adaption and validation study was performed. Linguistic validation of TNSS was performed and validity and reliability were assessed. Patients with chronic allergic and non-allergic rhinitis and healthy individuals were included in this study. Patients had to complete translated version of TNSS. Patients with allergic rhinitis additionally were asked to fill Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ).Results: Seventy-six individuals were involved into the study: 16 with non-allergic rhinitis (NAR) (21.1%), 49 with allergic rhinitis (AR) (64.5%) and 11 healthy individuals (14.5%). Cronbach's α was 0.87. TNSS score was significantly higher in patients with NAR and AR compared with healthy individuals (3.56 ± 2.28 vs. 4.28 ± 2.46 vs. 0.27 ± 0.91). Positive significant correlation was found between TNSS score and RQLQ score (rs = 0.77, p < 0.01).Conclusions: The Lithuanian version of the TNSS proved to be a valid instrument for assessing nasal symptoms in patients with allergic rhinitis. [ABSTRACT FROM AUTHOR]

Objective: To find the lowest effective injection dose of abobotulinum toxin A (Dysport) for allergic rhinitis. Study Design: Dose‐escalation randomized controlled trial. Methods: We included all patients aged 18 years or older who had persistent allergic rhinitis and positive allergy skin prick test. The patients were randomly allocated to receive 40, 30, or 20 U of abobotulinum toxin A by injection at the inferior turbinate. We followed up on patients for 12 weeks to evaluate nasal symptoms, ocular symptoms, minimum nasal cross‐sectional area as measured using acoustic rhinometry, and complications. Results: Seventeen patients were included in this study, with 7 receiving 20 U of abobotulinum toxin A and 5 each receiving 30 U and 40 U. Abobotulinum toxin A significantly improved nasal congestion, rhinorrhea, sneezing, and loss of smell at 40 U (P <.05) and nasal congestion, sneezing, and loss of smell at 30 U (P <.05). However, at a dose of 20 U, only nasal congestion and loss of smell improved (P <.05). Nasal patency had also significantly improved two weeks after treatment at doses of 40 and 30 U (P <.05). Complications included epistaxis (11.8%) and nasal dryness (23.5%). Conclusion: Abobotulinum toxin A at a dose of at least 30 U effectively reduced most nasal symptoms. Level of Evidence: 2. Trial registration: Clinicaltrials.in.th/ TCTR20200526014. [ABSTRACT FROM AUTHOR]

Introduction: Seasonal allergic rhinitis (SAR) and bronchial asthma are typical manifestations of pollen-food sensitization in adults. There is limited information regarding the sensitization patterns of pollen-food allergy in children. Aim: To evaluate the prevalence of SAR in children with pollen-food sensitization and assess the impact of food allergens on nasal symptoms. Material and methods: Forty-three children with pollen-food sensitization aged 2--14 years were evaluated for evidence of SAR. The inclusion criteria was IgE-mediated sensitization to pollen and homologous food allergens. The control group consisted of 19 children with SAR caused by pollen without sensitization to homologous food allergens. Results: Allergic rhinitis was the main symptom in 65.1% of children; in 25.6% an association between ingestion of pollen-related foods and nasal symptoms was observed. The simultaneous sensitization to animal origin food allergens was stated in 63.3% of children with SAR. In 25.6% anaphylactic reactions to foods were registered. 37.2% of children were asymptomatic to pollen origin foods despite pollen-food sensitization. The statistically significant differences between values were noticed in comparison to the control group. Conclusions: Allergic rhinitis is a common manifestation of pollen-food sensitization in children and this type of immunological hyperreactivity should be taken into account regardless of age. The lack of association of symptoms with plant origin foods in the majority of cases and the asymptomatic course of food sensitization in more than one third of patients indicates the need for follow-up and being careful in routine recommending the avoidance diet. [ABSTRACT FROM AUTHOR]

Background: Several factors may influence quality of life (QOL) for patients with primary ciliary dyskinesia (PCD). We aimed to evaluate the association between pulmonary functions, nasal symptoms and QOL in PCD patients., Methods: A prospective single center study. Patients performed spirometry, whole body plethysmography, forced oscillation technique (FOT), lung clearance index (LCI), 6-min walk test (6MWT), and filled two questionnaires: a specific PCD QOL questionnaire (PCD-QOL) and Sino-nasal outcome test (SNOT-22) questionnaire, assessing symptoms of chronic rhinosinusitis and health related QOL., Results: Twenty-seven patients (56% females), age 19.4 ± 10.5 years were included; their, FEV1 was 74.6 ± 22.7%, and RV/TLC was (157.3 ± 39.3% predicted). Health perception and lower respiratory symptoms domains of PCD-QOL had the lowest score (median [IQR]: 50 [33.3-64.6] and 57.1 [38.9-72.2], respectively). FOT parameters correlated with several PCD-QOL domains. R5 z-score (indicating total airway resistance) and AX z-score (indicating airway reactance) correlated negatively with physical domain (r = -0.598, p = .001, and r = -0.42, p = .03, respectively); R5 z-score also correlated negatively with hearing domain (r = -0.57, p = .002). R5-20 z-score (indicating small airway resistance) correlated negatively with role domain (r = -0.49, p = .03). SNOT-22 score correlated negatively with several PCD-QOL domains (lower respiratory symptoms r = -0.77, p < .001; physical r = -0.72, p < .001; upper respiratory symptoms r = -0.66, p < .001). No correlations were found between spirometry values, LCI, 6MWT, and PCD-QOL., Conclusions: FOT suggested small airway dysfunction, and correlated negatively with several PCD-QOL domains. Nasal symptoms had strong negative correlations with PCD-QOL. Larger longitudinal studies will further elucidate factors affecting QOL in PCD., (© 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.)

Megan E Cavet,1 Paul J Gomes,2 Warner W Carr,3 Jon I Williams4 1Bausch + Lomb, Rochester, NY, 2Ora, Andover, MA, 3Allergy and Asthma Associates of Southern California, Mission Viejo, CA, 4Bausch + Lomb, Irvine, CA, USA Background: Bepotastine besilate ophthalmic solution (BBOS) 1.5% is a topical antihistamine for the treatment of ocular itching associated with allergic conjunctivitis (AC). Allergic rhinitis and AC are common comorbid conditions. We explored the efficacy of BBOS 1.5% in alleviating nasal symptoms in an integrated analysis of two Phase III conjunctival allergen challenge (CAC) studies and a Phase IV environmental allergen study. Methods: In the Phase III trials, a CAC was performed 15 minutes, 8 hours, and 16 hours following ocular instillation of BBOS 1.5% (n=78) or placebo (n=79), and subjects evaluated nasal symptoms. In the environmental study, subjects instilled BBOS 1.5% (n=123) or placebo (n=122) twice daily and nasal symptoms were evaluated over 2 weeks. Results: In the Phase III trials, BBOS 1.5% had reduced CAC-induced nasal congestion and pruritus at 15 minutes and 8 hours postdosing and rhinorrhea and a non-ocular composite-symptom score (sum of nasal scores plus ear or palate pruritus) at all time points postdosing (all P≤0.01 vs placebo). In the Phase IV environmental study, BBOS 1.5% reduced sneezing and nasal pruritus over 2 weeks and median number of days to improvement of nasal pruritus and total nasal symptom score (sum for rhinorrhea, sneezing, nasal pruritus, and nasal congestion; P≤0.04 vs placebo). Additionally, investigator-reported improvement in overall ocular (pruritus, hyperemia, tearing) and nasal symptoms was greater with BBOS 1.5% vs placebo (P≤0.03). Conclusion: Results of these exploratory analyses indicate that topical ocular BBOS 1.5% reduced nasal symptoms, supporting its use for alleviating rhinitis symptoms associated with AC. Keywords: bepotastine besilate, nasal symptoms, allergic rhinitis, conjunctivitis, conjunctival allergen challenge, antihistamine

Background: Hundreds of plant species release their pollen into the air every year during early spring. During that period, pollen allergic as well as non‐allergic patients frequently present to doctors with severe respiratory tract infections. Our objective was therefore to assess whether pollen may interfere with antiviral immunity. Methods: We combined data from real‐life human exposure cohorts, a mouse model and human cell culture to test our hypothesis. Results: Pollen significantly diminished interferon‐λ and pro‐inflammatory chemokine responses of airway epithelia to rhinovirus and viral mimics and decreased nuclear translocation of interferon regulatory factors. In mice infected with respiratory syncytial virus, co‐exposure to pollen caused attenuated antiviral gene expression and increased pulmonary viral titers. In non‐allergic human volunteers, nasal symptoms were positively correlated with airborne birch pollen abundance, and nasal birch pollen challenge led to downregulation of type I and ‐III interferons in nasal mucosa. In a large patient cohort, numbers of rhinoviruspositive cases were correlated with airborne birch pollen concentrations. Conclusion: The ability of pollen to suppress innate antiviral immunity, independent of allergy, suggests that high‐risk population groups should avoid extensive outdoor activities when pollen and respiratory virus seasons coincide. [ABSTRACT FROM AUTHOR]

Oronasal breathing may adversely impact obstructive sleep apnea (OSA) patients either by increasing upper airway collapsibility or by influencing continuous positive airway pressure (CPAP) treatment outcomes. Predicting a preferential breathing route would be helpful to guide CPAP interface prescription. We hypothesized that anthropometric measurements but not self-reported oronasal breathing are predictors of objectively measured oronasal breathing. Seventeen OSA patients and nine healthy subjects underwent overnight polysomnography with an oronasal mask with two sealed compartments attached to independent pneumotacographs. Subjects answered questionnaires about nasal symptoms and perceived breathing route. Oronasal breathing was more common (P = <0.001) among OSA patients than controls while awake (62 ± 44 vs. 5 ± 6%) and during sleep (59 ± 39 vs. 25 ± 21%, respectively). Oronasal breathing was associated with OSA severity (P = 0.009), age (P = 0.005), body mass index (P = 0.044), and neck circumference (P = 0.004). There was no agreement between objective measurement and self-reported breathing route among OSA patients while awake (κ = -0.12) and asleep (κ = -0.02). The breathing route remained unchanged after 92% of obstructive apneas. These results suggest that oronasal breathing is more common among OSA patients than controls during both wakefulness and sleep and is associated with OSA severity and anthropometric measures. Self-reporting is not a reliable predictor of oronasal breathing and should not be considered an indication for oronasal CPAP. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis (AR) is a common allergic diseases which affect a patient's quality of life. Another important disease which has a negative impact on quality of life is fibromyalgia (FM). Some studies have suggested that a probable relationship exists between atopic diseases and FM. Objectives: This study was designed to determine the prevalence of FM and its impact on quality of life among AR patients. Methods: One hundred five consecutive adult patients with AR who were between 18 and 57 years old were prospectively recruited in this study between April 2017 and May 2018. All patients were evaluated for the presences of FM. Patients were diagnosed with FM according to the classification criteria of the 2010 American College of Rheumatology. The patients' quality of life was evaluated by Turkish versions of the Rhinoconjunctivitis Quality of Life Questionnaire and the Nottingham Health Profile (NHP). Results: Thirty-four patients were diagnosed as having FM (32.4%). The percentage of FM was considerably higher than in the general population (2%–5%). Median individual domain scores except practical problems (P =.108) and eyes symptoms (P =.227) were significantly higher in AR with FM patients (P <.001). All median levels of the NHP domains were significantly higher in AR with FM patients (P <.001). Conclusion: We would like to suggest that FM may be considered as one of the overlooked comorbid conditions in AR patients. Physicians should be aware of the occurrence of FM, especially in patients with impaired quality of life. [ABSTRACT FROM AUTHOR]

Abstract Background Nasal nitrous oxide (nNO) is increased in allergic rhinitis (AR), but not in asthma, and is a non-invasive marker for inflammation in the nasal passages. Methods Levels of nNO were measured and compared in healthy children and children with mild and moderate-to-severe AR. Levels of nNO before and after treatment with steroids and/or antihistamine were then compared in the 2 AR groups. Their relationship to quality of life and nasal symptom and reactivity to outdoor and outdoor allergens were examined. Results nNO levels were higher in mild AR than in healthy children and higher in moderate-to-severe AR than in mild AR. One month steroid and/or antihistamine treatment lowered nNO levels to control levels in mild AR and approximately halfway to control levels in moderate-to-severe AR. nNO levels had a weak correlation to quality of life questions and a fair correlation to nasal symptom scores before treatment. This correlation was weakened or lost after treatment, and no correlation was seen between nNO levels and responses to indoor or outdoor allergens. Conclusion nNO levels in children with AR may be useful for assessing the response to treatment. Their relationship to quality of life, nasal symptoms, and sensitivity to specific allergens needs further study.

Background: The protective effect of farm upbringing on allergic rhinitis is well known, but how upbringing in other environments influences the development of allergic rhinitis is scarcely investigated. The aim of this study was to investigate the association between place of upbringing and pet keeping in childhood and allergic rhinitis and nasal symptoms in adulthood. Methods: The population-based Respiratory Health in Northern Europe study includes subjects from Denmark, Norway, Sweden, Iceland, and Estonia born in 1945–1973. This paper analyses 13,376 participants of the third study wave. Six categories of place of upbringing were defined: farm with livestock, farm without livestock, village in rural area, small town, city suburb, and inner city. Pets in the home at birth and during childhood were recorded. Data were analysed using adjusted logistic regression models. Results: Livestock farm upbringing predicted less adult allergic rhinitis [odds ratio (OR) 0.68, 0.54–0.85] and nasal symptoms (OR 0.82, 0.68–0.99) than city upbringing, and an urban–rural gradient with decreasing risk per level of urbanisation was observed (OR 0.92, 0.88–0.94). Pets in the home at birth (OR 0.78, 0.68–0.88) and during childhood (OR 0.83, 0.74–0.93) were associated with less subsequent allergic rhinitis. Pet keeping did not explain the protective effect of place of upbringing. Conclusion: Risk of allergic rhinitis and nasal symptoms in adulthood was inversely associated with the level of urbanisation during upbringing. Pets at birth decreased the risk further, but did not explain the urban–rural gradient. Persistent beneficial effects of microbial diversity in early life might be an explanation for the findings.

Objective: This study aimed to evaluate the sinonasal-related Quality of Life (QoL) in patients undergoing endoscopic skull base surgery., Methods: A retrospective study was performed, including patients with benign and malignant tumors at a single institution. Each patient completed the 22-Item Sino-Nasal Outcome Test (SNOT-22) and the Empty Nose Syndrome 6 Item Questionnaires (ENS6Q) to assess their perceived QoL at least 2-months after treatment., Results: Forty-nine patients were enrolled in this study. The average score was 25.1 (Stander Deviation [SD] 14.99) for SNOT-22 and 6.51 (SD=5.58) for ENS6Q. Analysis of the overall results for the SNOT-22 showed that olfactory damage was the most serious syndrome. The most frequently reported high-severity sub-domains in SNOT-22 were nasal symptoms and sleep symptoms. Nasal crusting was the most severe item in ENS6Q according to the report. Nine patients (18.4%) had a score higher than 10.5 which indicates the high risk of Empty Nose Syndrome (ENS). SNOT-22 score was related to the history of radiotherapy (p< 0.05), while the ENS6Q score was not., Conclusions: The possibility of patients suffering from ENS after nasal endoscopic skull base surgery is at a low level, although the nasal cavity structure is damaged to varying degrees. Meanwhile, patients undergoing endoscopic skull base surgery were likely to suffer nasal problems and sleep disorders. Patients who had received radiotherapy have a worse QoL than those without a history of radiotherapy., Level of Evidence: Level 3., (Copyright © 2023 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier España S.L.U. All rights reserved.)

Objective: To investigate whether changes in postoperative symptoms and signs in patients can predict the recurrence of ECRS after nasal endoscopic sinus surgery. Methods: A total of 70 adult patients with ECRS were enrolled for ESS surgery from June 2020 to March 2022 in a single center. There were 50 males and 20 females, with an average age of （46.9±14.5） years. Follow-up after ESS was at least 52 weeks. Patients undergo peripheral blood tests, CT of the sinuses, olfactory T&T test, visual analogue scale of symptoms（VAS）, and endoscopic scoring. Results: VAS scores and endoscopic scores were analyzed at preoperative and 6th week, 12th week, 24th week and 52th week postoperative. After 12th week postoperatively, there was a clear correlation between symptom scores and endoscopic scores. Moreover, olfactory disorder and nasal discharge were the two most obvious symptoms. There were differences in the expression of multiple preoperative clinical inflammatory indicators between the symptom-controled group and the symptom-uncontrolled group（previous surgical history, concomitant asthma, nasal smear eosinophil, serum EOS%, total IgE, CT score, olfactory score, and symptom score, all with P <0.05）, while there was no difference in baseline endoscopic score（ P >0.05）. At 12th week postoperative, the two groups of patients showed significant differences in both symptom scores and endoscopic scores. The symptoms and endoscopic score at the 12th week point of follow-up were used as predictive indicators for recurrence, with sensitivity and specificity of 62.5% and 83.3%, respectively. Conclusion: The changes in postoperative symptom score and endoscopic score in ECRSwNP patients indicated that the recurred ECRS. In the symptom-uncontrolled group, symptomatic and endoscopic scores showed consistent increased scores; In the symptom-controlled group, conflicting results between increased endoscopic scores and stable symptoms suggest that the presence of asymptomatic recurrence must be considered. The changes in symptoms and signs at the 12th week point of follow-up can serve as clinical indicators for preventing disease recurrence., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Background: The minimal clinically important difference (MCID) of the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) is specific but not sensitive for identifying patients experiencing noticeable improvement in symptoms of chronic rhinosinusitis (CRS). It is unclear why some patients with less than 1 MCID change in SNOT‐22 score nevertheless report noticeable improvement in their CRS symptoms. Methods: This investigation was a retrospective study of 247 CRS patients undergoing medical management who completed SNOT‐22 surveys in 2 consecutive visits 2‐12 months apart. The validated nasal, sleep, ear/facial discomfort, and emotional SNOT‐22 subdomain scores were calculated. At the second visit, patients reported their global change in CRS symptoms on a 5‐item transition rating scale as: "Much worse"; "A little worse"; "About the same"; "A little better"; or "Much better." Patient‐reported improvement in symptoms (at least "A little better") was tested for association with changes in SNOT‐22 subdomain scores. Results: In the entire cohort, patient‐reported improvement in CRS symptoms was associated with improvement in all SNOT‐22 subdomain scores (p < 0.001). In patients with less than 1 MCID (12 points) of change in the SNOT‐22, only the nasal subdomain (adjusted odds ratio, 0.89; 95% confidence interval [CI], 0.79‐0.99; p = 0.042) was associated with patient‐reported improvement in CRS symptoms. Changes in none of the other SNOT‐22 subdomain scores were associated with patient‐reported improvement in CRS symptoms. Conclusions: Among patients with less than 1 MCID change in the SNOT‐22, improvement in only nasal symptoms—but not extranasal symptoms—of CRS is associated with those who nevertheless report improvement of their CRS symptoms. [ABSTRACT FROM AUTHOR]

Background: Recalcitrance of allergic rhinitis (AR) to medical management may be reflective of patient-specific impact of AR symptoms. Aims: To understand the relationship between AR symptoms and general health-related quality of life (QOL) or AR control, based on treatment status. Methods: Cross-sectional cohort study of 130 adult participants—65 using no allergy medications and 65 consistently using intranasal corticosteroid sprays (ICS) in the last 3 months—presenting with persistent AR. General health-related QOL was measured using the EuroQol 5-dimensional visual analog scale (EQ-5D VAS). Severity and control of AR symptoms were measured using the 22-item Sinonasal Outcome Test (SNOT-22) and the Rhinitis Control Assessment Test (RCAT), respectively. We compared associations between AR symptoms and general health-related QOL and AR control in patients presenting with persistent AR with and without ICS use. Results: Severity of AR symptoms was similar between cohorts. In participants using no allergy medications, extranasal AR symptom severities were most dominantly associated with decreased EQ-5D VAS and RCAT score. In participants using ICS, only nasal symptom severities were associated with decreased EQ-5D VAS and RCAT scores. Consistently, only in participants on ICS was a deviated septum associated with decreased EQ-5D VAS (β = − 12.1, 95% CI − 21.1 to − 3.1, p = 0.011) and poorly controlled AR (OR = 4.27, 96% CI 1.27 to 14.33; p = 0.019). Conclusions: In persistent AR despite consistent ICS use, nasal symptoms may be the dominant drivers of AR-associated decreased general health-related QOL in contrast to persistent AR on no medication, when extranasal symptoms of AR are most significant. Longitudinal study is needed to investigate whether these results are predictive of responsiveness to ICS. [ABSTRACT FROM AUTHOR]

Background Specific immunoglobulin E (sIgE) within the nasal airway is likely to be the most ideal marker of allergic status, but little is known of the normative values in asymptomatic patients and those with rhinitis. Objective The aim of this study was to assess the diagnostic characteristics of inferior turbinate tissue biopsy sIgE in asymptomatic and rhinitic patients. Methods A diagnostic cross-sectional study was undertaken, involving patients who underwent inferior turbinate surgery with or without other surgical interventions. Inferior turbinate tissue biopsy was performed during surgery and was assessed for allergen sIgE (dust mite, grass [temperate or subtropical], and animal epithelium) using an automated immunoassay. Tissue sIgE was assessed among asymptomatic patients and those with nasal symptoms. Data were presented as median (interquartile range). A receiver operating curve was used to predict the diagnostic utility of turbinate tissue sIgE in determining allergic rhinitis. Results A total of 160 patients (41.89 ± 14.65 years, 36.9% females) were included. The median tissue sIgE concentration among the asymptomatic nonatopic group of patients was 0.09 (0.08–0.10) kUA/L and tissue sIgE > 0.10 kUA/L was determined as a positive threshold. Inferior turbinate tissue sIgE was shown to be a predictive test for allergic rhinitis (area under curve: 0.87, 95% confidence interval: 0.84–0.90) with 90% sensitivity and 89% negative predictive value. Conclusion Inferior turbinate tissue biopsy sIgE is a sensitive tool to predict allergic rhinitis. The threshold value of 0.1 kUA/L corresponded well with the asymptomatic nonatopic group of patients. This method detects sIgE in the nasal mucosa and may be a useful test for allergic rhinitis in future research. [ABSTRACT FROM AUTHOR]

Background: Many respiratory conditions have been attributed to toxic dust and fume exposure in World Trade Center (WTC) rescue and recovery workers, who frequently report symptoms of OSA. We examined the prevalence of new-onset OSA and tested if the prevalence and severity of OSA are related to the presence of chronic rhinosinusitis (CRS).Methods: A total of 601 subjects (83% men; age, 33-87 years; BMI, 29.9 ± 5.5 kg/m2) enrolled in the WTC Health Program, excluding those with significant pre-September 11, 2001, snoring or prior CRS, underwent two nights of home sleep testing. OSA was defined as Apnea Hypopnea Index 4% ≥ 5 events/h or respiratory disturbance index of ≥ 15 events/h. CRS was assessed using nasal symptom questionnaires.Results: The prevalence of OSA was 75% (25% no OSA, 46% mild OSA, 19% moderate OSA, and 10% severe OSA), and the prevalence of CRS was 43.5%. Compared with no CRS, new and worsening CRS was a significant risk factor for OSA with an OR of 1.80 (95% CI, 1.18-2.73; P = .006) unadjusted and 1.76 (95% CI, 1.08-2.88; P = .02) after adjustment for age, BMI, sex, gastroesophageal reflux disorder, and alcohol use.Conclusions: The high prevalence of OSA in WTC responders was not explained fully by obesity and sex. Possible mechanisms for the elevated risk of OSA in subjects with CRS include increased upper airway inflammation and/or elevated nasal/upper airway resistance, but these need confirmation. [ABSTRACT FROM AUTHOR]

Background: Different clinical trials showed the superior efficacy of rupatadine compared to placebo at improving seasonal allergic rhinitis (SAR) symptoms, but no study has assessed if the response promoted is clinically meaningful. Methods: This study is a pooled analysis of data of seven randomized, double‐blind, placebo‐controlled SAR studies comparing responder proportions upon treatment with rupatadine (10 or 20 mg) or placebo. We evaluated the following symptom scores at baseline (Visit 1) and over 14 days of treatment: Total 4 Nasal Symptom Score (T4NSS), Total 2 Ocular Symptom Score (T2OSS) and Total 6 Symptom Score (T6SS). The proportion of responders (50% and 75% response) and the time to response were compared between groups on days 7 (Visit 2) and 14 (Visit 3). Responder rates were compared between groups on days 7 and 14 for the complete/near‐to‐complete response for T4NSS (TN4SS score ≤ 2 and each symptom score ≤ 1) and T6SS (T6SS score ≤ 3 and each symptom score ≤ 1). Results: Data from 1470 patients were analyzed: 332 treated with placebo, 662 with rupatadine 10 mg and 476 with rupatadine 20 mg. The reduction in T4NSS, T2OSS and T6SS over 14 days of treatment relative to baseline was statistically higher in rupatadine groups vs the placebo group, with greater improvements in the 20 mg group. A statistically higher proportion of patients reached the 50% and 75% response for T4NSS, T2OSS and T6SS in rupatadine groups compared to the placebo group across the visits. Among rupatadine‐treated patients, those receiving 20 mg compared favourably for both cut‐off responses. The time to achieve a proportion of responders was shorter in the rupatadine 20 mg group than in the rupatadine 10 mg and placebo groups for all the symptom scores. The number of patients who achieved a complete/near‐to‐complete response for both symptom scores was higher in rupatadine groups than in the placebo group, with higher proportions in the 20 mg group. Conclusions: This responder analysis confirms the superior efficacy of rupatadine vs placebo to treat SAR. Rupatadine promoted higher proportions of responders according to stringent response criteria and in a dose‐dependent manner, with faster and higher response rates in the 20 mg group. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the frequency of nasal symptoms termed nasal vestibulitis, including nasal dryness, crusting, bleeding, and pain, among patients receiving systemic, antineoplastic therapy.Methods: Patients undergoing systemic antineoplastic therapy were interviewed regarding the presence of nasal symptoms. In an explorative approach, Fisher's exact tests were used to identify groups in which frequencies of nasal symptoms were higher than the comparator arm. To account for potential confounding factors, including demographic variables and concurrent therapies, logistic regression analyses were performed, and estimated proportions with their standard errors (SEs) and odds ratios (ORs) were reported.Results: Forty-one percent of the 100 surveyed patients had nasal symptoms, including dryness, pain, bleeding, and scabbing. Higher frequencies were reported among those who had received taxanes (71%) and VEGF-related therapies (78%). For the patients who had received taxanes, after controlling for other factors, the odds of experiencing nasal symptoms were 4.86 times higher than those for patients who did not receive taxanes (90% CI 2.01, 11.76). For patients who received VEGF-related therapies, after controlling for other factors and exposure to taxanes, the odds of experiencing nasal symptoms were 7.38 (90% CI 1.68, 32.51) times higher than those for patients who did not. Sixty-one percent of patients with symptoms said they reported them to their provider, but only 41% of chart notes contained documentation of such; 49% of patients reported treating their symptoms.Conclusions: Nasal vestibulitis is common among patients receiving taxane- and VEGF-related therapies; these symptoms are infrequently recorded or treated by healthcare providers. [ABSTRACT FROM AUTHOR]