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Key points: Bacterial composition is uniform in the sinuses of postviral olfactory dysfunction patients.Significant reduction of genus Corynebacterium in PVOD patients compared to controls. [ABSTRACT FROM AUTHOR]

Keywords: chronic rhinosinusitis; infection; inflammation; sinusitis; upper airway EN chronic rhinosinusitis infection inflammation sinusitis upper airway 1566 1569 4 12/02/22 20221201 NES 221201 INTRODUCTION Despite ongoing study into chronic rhinosinusitis (CRS) disease mechanisms, the origins of chronic inflammation are somewhat elusive.[1] CRS is defined by 3 months of symptoms with evidence of disease, either radiographically or endoscopically.[2] Interestingly, pathologic correlates of inflammation are not required for diagnosis, but are well described. Control samples had enriched RNA processing GO pathways but no KEGG pathways reaching statistical significance. [Extracted from the article]

Objective Compare machine learning (ML)-based predictive analytics methods to traditional logistic regression in classification of olfactory dysfunction in chronic rhinosinusitis (CRS-OD) and identify predictors within a large multi-institutional cohort of refractory CRS patients. Methods Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study were assessed for baseline CRS-OD using a smell identification test (SIT) or brief SIT (bSIT). Four different ML methods were compared to traditional logistic regression for classification of CRS normosmics versus CRS-OD. Results Data were collected for 611 study participants who met inclusion criteria between 2011 April and 2015 July. Thirty-four percent of enrolled patients demonstrated olfactory loss on psychophysical testing. Differences between CRS normosmics and those with smell loss included objective disease measures (CT and endoscopy scores), age, sex, prior surgeries, socioeconomic status, steroid use, polyp presence, asthma, and aspirin sensitivity. Most ML methods performed favorably in terms of predictive ability. Top predictors include factors previously reported in the literature, as well as several socioeconomic factors. Conclusion Olfactory dysfunction is a variable phenomenon in CRS patients. ML methods perform well compared to traditional logistic regression in classification of normosmia versus smell loss in CRS, and are able to include numerous risk factors into prediction models. Several actionable features were identified as risk factors for CRS-OD. These results suggest that ML methods may be useful for current understanding and future study of hyposmia secondary to sinonasal disease, the most common cause of persistent olfactory loss in the general population. [ABSTRACT FROM AUTHOR]

Background: Earlier studies have suggested that patients with chronic rhinosinusitis (CRS) report worse sleep quality than population norms. What remains unknown is whether these patients are actually experiencing measurable changes in objective sleep parameters. The goal of this study was to prospectively evaluate objective sleep measures in a cohort of patients with CRS. Methods: A prospective, multi‐institutional, case‐control study was designed to compare patients with CRS to nondiseased controls. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (EpSS). Home sleep studies were administered across all subjects and a battery of objective sleep measurements were recorded using a portable sleep diagnostic device. Regression models were used to control for any factors that differed across groups. Results: A total of 108 subjects were enrolled across 4 institutions, including 52 patients with CRS and 56 controls. Total PSQI scores were worse in patients with CRS when compared with controls (10.1 ± 4.3 vs 4.7 ± 2.5; p < 0.001). Similarly, daytime somnolence, as measured by the EpSS, was greater in patients with CRS (9.1 ± 5.3 vs 6.5 ± 3.7; p = 0.006). On home sleep studies, patients with CRS were found to have an increased number of awakenings during a night's sleep (8.6 ± 4.8 vs 6.3 ± 3.0; p = 0.004), lower average overnight oxygen saturation (93.2 ± 2.6% vs 94.3 ± 2.1%; p = 0.042), increased rapid eye movement sleep (REMS) latency (93.0 ± 67.1 vs 66.7 ± 35.3; p = 0.016), and spent a greater portion of the night snoring at >40 dB (24.7 ± 27.4% vs 14.6 ± 19.7%; p = 0.034). All differences except mean oxygen saturation remained significant after controlling for baseline differences. Conclusion: Differences in both patient‐reported and objective sleep measures exist between patients with CRS and controls. [ABSTRACT FROM AUTHOR]

Background Ergonomics is the methodologic study of people's efficiency in their work environment and is based on anatomy, physiology, psychology, and engineering. Although highly studied in other work environments, little attention has been paid to surgeons until the landmark survey by Park et al in 2010. Many unique aspects of endoscopic surgery amplify task-related physical discomfort, and, because of these issues, we aimed to study the physical fatigue effects of functional endoscopic sinus surgery (FESS) performed in the standing and sitting positions. Methods Bilateral FESS was performed in 8 cadaver heads (4 in the standing position, 4 in the sitting position), following established ergonomic principles. Physical fatigue was assessed using a 27-point physical discomfort questionnaire, surface electromyography (EMG), and the NASA Task Load Index Survey. Paired and unpaired t tests were used for statistical analysis. Results Physical fatigue was noted after FESS performed in both positions. An overall similar task burden was seen when comparing the 2 positions, although the sitting position was more 'frustrating' ( p < 0.05). Discomfort after FESS in the standing position was worse in the legs and low back, whereas, in the sitting position, it was seen predominantly in the upper back and arms ( p < 0.05). Mean power frequency EMG measurements demonstrated fatigue of major muscle groups in both positions. Conclusion Significant physical fatigue is reported after a single FESS operation, with measurable EMG changes. Surgeons should be aware of the short- and long-term physical implications of their daily tasks, and should use this information to be proactive in decision-making for their longevity. [ABSTRACT FROM AUTHOR]

Background In addition to known concerns regarding antibiotic overuse, recent research indicates that excessive antibiotic use is associated with poorer long-term health. Given that rhinosinusitis is the leading condition accounting for antibiotic prescriptions in the ambulatory setting, we aimed to evaluate characteristics associated with greater antibiotic use in chronic rhinosinusitis (CRS). Methods Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study evaluating treatment outcomes were included in this analysis. Study participants were asked to report the number of days out of the previous 90 days that systemic antibiotics were taken for sinus disease. Patient demographics, disease characteristics, and measures of disease severity were evaluated. Results A total of 561 patients from 4 institutions were included in the analysis, with mean antibiotic use of 17.4 ± 22.4 out of the prior 90 days. No differences between antibiotic-use groups were found for objective measures of disease severity (computed tomography [CT], endoscopy, Brief Smell Identification Test [BSIT] scores), however, increased patient-reported symptom burden (22-item Sino-Nasal Outcome Test [SNOT-22], Rhinosinusitis Disability Index [RSDI]) was associated with more antibiotic use. Patients reporting the most antibiotic use were older ( p = 0.004) but no ethnic or gender differences were seen. Comorbid diagnoses of allergy, asthma, diabetes, depression, or fibromyalgia were not associated with increased antibiotic use. In accordance with literature recommendations, CRS with nasal polyps (CRSwNP) patients were less likely to have used antibiotics. Endoscopic sinus surgery (ESS) significantly decreased antibiotic use. Conclusion Variability in antibiotic use in CRS appears to be driven by symptom burden, independent of objective measures of disease severity, patient demographics, and presence of comorbid disease. Clear guidelines are essential to define appropriate antibiotic use in CRS. [ABSTRACT FROM AUTHOR]

Background Endoscopic sinus surgery (ESS) has been shown to improve sleep in patients with chronic rhinosinusitis (CRS). However, it is unknown how this improvement compares with non-CRS control subjects' sleep, and medically treated CRS patients. Methods Patients meeting diagnostic criteria for CRS and controls from the same reference population were recruited from 4 academic centers. Patients chose either medical or surgical treatment. The Pittsburgh Sleep Quality Index (PSQI) was administered to patients before treatment and after 6 months, whereas controls received the PSQI at enrollment. Results The study population consisted of 187 cases (64 medical and 123 surgical) and 101 controls. Baseline PSQI scores for CRS patients (9.27 ± 4.76) were worse than for controls (5.78 ± 3.25), even after controlling for potential confounding factors such as asthma and allergy ( p < 0.001). There was no significant difference in baseline PSQI between patients choosing medical vs surgical treatment. The PSQI score in surgical patients improved from 8.36 ± 5.05 to 7.44 ± 5.09 ( p = 0.020). The PSQI score in medical patients demonstrated a nonsignificant increase with treatment from 8.71 ± 4.48 to 9.06 ± 4.80 ( p = 0.640). After controlling for allergy and asthma, 6-month PSQI scores in medical patients remained significantly higher than in controls ( p = 0.001), whereas a significant difference could not be demonstrated between surgical patients and controls ( p > 0.05). PSQI subdomain analysis mirrored the overall findings. Conclusion Patients with CRS report worse sleep compared with controls. Surgically treated CRS patients show significant improvement in PSQI scores, whereas those continuing with medical management fail to improve and remain worse than controls. [ABSTRACT FROM AUTHOR]

Background Chronic rhinosinusitis (CRS) is a multifactorial inflammatory airway disorder in which bacteria are implicated in the initiation and/or sustenance of disease in some patients. The sinuses are colonized by bacteria even in health, and the potential for sinus-specific niches harboring unique microbial consortia raises questions for clinical and research investigation. The objective was to determine the degree to which resident upper airways microbiota differ between individuals and anatomic sites, in order to determine the optimal site of microbial sampling for study in CRS. Methods Eight CRS patients undergoing primary surgery were sampled bilaterally at the anterior nares, middle meatus, nasopharynx, maxillary sinus, frontal sinus, and sphenoid sinus for investigation using broad-range bacterial 16S ribosomal RNA (rRNA) sequencing. Results Between-subject variability in bacterial microbiota was substantially greater than within-subject variability. The middle meatus was fairly representative of the underlying sinuses, although corynebacteria were detected at higher abundances in the middle meatus, relative to the maxillary ( p < 0.1), frontal ( p < 0.05), or sphenoid ( p < 0.1) sinuses. Conclusion Interpersonal variation of the upper airway microbiome greatly outweighs niche-specific differences. The middle meatus is a fair representation of the underlying sinuses and may be considered for use as a simple single site for sampling in longitudinal studies or in subjects who have not undergone sinus surgery. [ABSTRACT FROM AUTHOR]

Air pollution, health care economics, allergy workforce, rhinology workforce Deaths due to healthcare-related emissions alone, however, are of the same order of magnitude as those due to preventable medical errors.[5] Yet, despite healthcare being one of the most carbon-intensive service-sectors worldwide,[[3], [6]] few initiatives currently aim to reduce healthcare-related emissions and consequent mortality. Keywords: air pollution; allergy workforce; health care economics; rhinology workforce EN air pollution allergy workforce health care economics rhinology workforce 2001 2003 3 10/25/23 20231101 NES 231101 It is increasingly apparent that U.S. healthcare has adopted a "throw-away" culture where goods, drugs, and even human capital are disregarded before their utility runs out. [Extracted from the article]

Background Effective mucus lavage and delivery of topical pharmaceuticals are central to successful management of chronic rhinosinusitis (CRS). The frontal sinus remains difficult to penetrate with topical therapies. This study evaluates the benefit of Draf III frontal dissection compared to traditional Draf IIa for distribution of topical therapies. Methods Fresh human cadaver heads were dissected sequentially with Draf IIa frontal sinusotomy and then Draf III procedures. Each cavity was irrigated with pediatric (120 mL) and adult (240 mL) irrigation bottles with 1/1000 10% fluorescein-labeled free water in 2 fixed positions (vertex and Frankfort horizontal). An endoscope at a fixed position within the frontal sinus recorded frontal sinus and frontal recess penetration. The images then underwent blinded evaluation of fluid distribution scored as 0 to 4 (nasal cavity only, frontal recess, medial one-half, lateral one-half, and lavage). Ordinal distribution score was analyzed with Kendall's tau-b. Results Eight specimens (age 76 ± 11.2 years; 50% female) were assessed. Draf III was superior to Draf IIa in ability to achieve frontal sinus distribution of irrigation (90.6% vs 50.1%, p < 0.001). Vertex head position improved distribution (90.6% vs 50.1%, p < 0.001), was synergistic with Draf III (100% with 87.5% lavage, p < 0.001), but was unable to overcome Draf IIa (81.2% with 25% lavage, p < 0.001). Irrigation volume trended toward improved distribution with larger volume irrigations. Conclusion Successful treatment of sinonasal disease may require postoperative delivery of topical therapies. Draf III frontal sinusotomy achieves superior topical access, and access to the frontal sinus with Draf IIa appears limited, despite large volumes and positioning. [ABSTRACT FROM AUTHOR]

Background: Although cigarette smoking aggravates chronic rhinosinusitis (CRS), a detailed examination of the sinus microbiota in CRS and its clinical subtypes has yet to be performed in relation to history of smoking. Consequently, we examined associations between smoking history and sinonasal microbiome alterations in both CRS and non-CRS populations. Methods: Middle meatus swabs collected during endoscopic sinus surgery were analyzed by analysis of 16S ribosomal RNA (rRNA) sequences.Multiple analysis of variance tests were performed to determine whether microbiome composition varied with smoking history and other clinical/demographic covariates associated with CRS subtypes. Results: A total 70 CRS patients and 31 control subjects were analyzed. In a univariate analysis, smoking (p = 0.04), preoperative antibiotics (p = 0.03), and purulence (p = 0.0002) were significantly associated with the genus-level composition of the middle meatus microbiota. When included in a multivariable model, smoking was found to have significant interactions with CRS (p = 0.02), polyposis (p = 0.03), purulence (p=0.0004), and use of saline rinses (p= 0.05). Diverse bacterial taxa differed significantly in abundance between never-smokers and current/former smokers, as well as between different CRS subtypes. Conclusion: Substantial changes in sinus bacterial colonization were observed in smokers and nonsmokers. Although the microbiota of both CRS and non-CRS subjects were altered with smoking history, different bacterial taxa were affected by smoking in the 2 patient groups. Thus, the effects of smoking on the sinusmicrobiota are likely to be modified by physiological and immunological functions of the underlying sinus mucosa. [ABSTRACT FROM AUTHOR]

Background Bronchiectasis is an uncommon disease of the lower airways characterized by bronchial wall destruction and permanent bronchiolar dilation. Several etiologic categories exist, and patients with bronchiectasis often complain of symptoms suggestive of chronic rhinosinusitis (CRS). The present study investigates the association between bronchiectasis and CRS using radiologic and bacteriologic data. Methods Retrospective chart review from a tertiary care respiratory hospital was performed. Sinus computed tomography (CT) scans were examined for extent of disease and relationship to pulmonary disease severity. Statistical analysis was performed with Student t test and linear regression. Upper and lower airway cultures from patients with both bronchiectasis and CRS were compared using the chance adjusted agreement. Results Patients with bronchiectasis were found to have a significantly higher Lund-Mackay score when compared to patients with allergic rhinitis ( p = 0.047). Lund-Mackay CT score did not correlate with forced expiratory volume in 1 second (FEV1) and FEV1:forced vital capacity (FVC), or presence of Pseudomonas aeruginosa. Correlation of upper and lower airway bacterial cultures in patients with both bronchiectasis and CRS was noted (kappa = 0.294, p = 0.004), particularly when P. aeruginosa was present (kappa = 0.49, p < 0.0001). Conclusion The current study suggests that the upper and lower airways may be linked in CRS and bronchiectasis from both an objective radiologic standpoint and a bacteriologic perspective. This finding carries implications for disease pathogenesis, clinical care, and future research. [ABSTRACT FROM AUTHOR]

Background Chronic rhinosinusitis (CRS) is an idiosyncratic and multifactorial disease process. Bacteria play a role in some patients, by infection or stimulation of inflammation. Staphylococcus aureus (SA) appears to be implicated in a number of infectious and inflammatory mechanisms, and may be particularly relevant in CRS patients with nasal polyps and asthma. Methods Middle meatus swabs from control and CRS patients collected during endoscopic sinus surgery were analyzed by quantitative polymerase chain reaction (QPCR). Total bacterial count, SA prevalence, and SA abundance were examined with respect to patient demographics and disease characteristics. Results Total bacteria, as measured by QPCR, was not statistically different between controls, CRS without nasal polyps (CRSsNP), CRS with nasal polyps (CRSwNP), or CRS with asthma groups ( p < 0.09). Total bacterial counts did not correlate with disease severity as measured by Lund-Mackay computed tomography (CT) scores ( p = 0.65). The prevalence of SA was similar between groups (15-25%); however, the abundance increased in CRS patients with allergic rhinitis, nasal polyps, and asthma. Conclusion The paranasal sinuses are not sterile. SA is implicated in a subset of CRS patients with nasal polyps and/or asthma. Further study is required to predict this subset of patients, and to define the mechanisms of SA pathogenesis. [ABSTRACT FROM AUTHOR]

Background Nasal polyps in patients with cystic fibrosis (CF) are believed to be phenotypically different than polyps affecting non-CF patients. The aim of this study was to investigate differences in cell cycle regulatory mechanisms between these 2 groups. In this prospective study at a tertiary care academic medical center, multiple techniques were used to confirm the upregulation of antiapoptotic Bcl-2 family proteins in CF polyps. Methods Nasal polyps were prospectively obtained from CF and non-CF patients. The Sigma Panorama Protein Microarray for Cell Signaling was used to identify differences in protein expression between the 2 polyp groups. Western blot analysis confirmed altered expression of a subset of these proteins. Immunohistochemical staining was performed on archived tissue to further investigate B-cell lymphoma 2 protein (Bcl-2) expression. Following review by a pathologist, slides were digitized using an Aperio™ ScanScope XT system and staining intensity was quantified with the Positive Pixel Count algorithm. The mean staining intensity for each polyp group was compared. Results The protein microarray suggested a greater than 2-fold upregulation of Bcl-xl in CF polyps relative to non-CF polyps. Western blot analysis confirmed the upregulation in CF polyps of Bcl-2, a more commonly studied protein analog of Bcl-xl. The CF polyp group was noted to have a higher quantitative intensity of immunohistochemical staining for Bcl-2 compared to the non-CF group ( p < 0.05). Conclusion Through multiple modalities of protein investigation, we have demonstrated an upregulation of Bcl-2 family proteins in CF polyps relative to polyps from non-CF patients. [ABSTRACT FROM AUTHOR]

Background The frequency of endoscopic sinus surgery (ESS) appears to be increasing, and the use of image-guided surgery (IGS) in these procedures is becoming more widespread. The use of IGS in ESS and anterior skull base surgery is predicated on the notion that its ability to aid in anatomic identification during surgery will lead to fewer complications and improved surgical outcomes. The purpose of this article is to provide an evidence-based examination of the benefits of IGS in ESS. Methods A systematic review of the literature was performed and recommendations were created based on the Clinical Practice Guideline Manual, Conference of Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instruments. Results This review identified and evaluated literature regarding the effect of IGS on surgical complications and on postoperative outcomes in ESS. Currently, there is grade C evidence to support the use of IGS in ESS. Conclusion Based on the best available evidence in the literature, the use of IGS has not clearly been shown to decrease surgical complications or improve surgical outcomes. These evidence-based recommendations are based on limited literature with suboptimal research methodology. However, the importance, utility, and acceptance of IGS through expert opinion and consensus are supported by the available literature. Therefore, the use of IGS in ESS is an option and should be based on clinical judgment and applied on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Objectives: Malignant tumors of the paranasal sinuses are traditionally approached by a variety of external incisions. Recent advances in endoscopie endonasal surgery have allowed for some of these tumors to be treated endoscopically. The purpose of this study was to assess the outcomes and complications of the endoscopie approach in a series of patients with paranasal sinus malignancies. Methods: A retrospective chart review was performed of patients with sinonasal or skull base malignancies treated with endoscopie or endoscopic-assisted resections at a tertiary care institution from 2002 to 2010. Patient data were collected on symptoms, tumor type, operative technique, and postoperative course. Baseline risk factors, overall and disease-free survival data, and surgical outcomes were compared between the two groups. Results: Of the total 49 patients, 36 (73%) underwent an endoscopie approach and 13 (27%) underwent endoscopic- assisted approaches. Sarcomas (9 cases) were the most common tumor type, followed by squamous cell carcinoma (8), adenocarcinoma (8), and melanoma (7). The mean follow-up time for all patients was 3.58 years (range, 1.1 to 8.8 years). Surgical complications were more frequent with open approaches than with endoscopie approaches (23.1% versus 5.6%; p = 0.11). Medical complications were significantly more common with open approaches (38.5% versus 8.3%; p = 0.02). The disease-specific mortality rate was 8% (4 of 49). The local tumor recurrence rate was 16% (8 of 49). The 3-year disease-free survival rates were 86.8% in the endoscopie group and 67.7% in the open group (p = 0.047); however, the patients in the endoscopie group had lower T stages (p = 0.0068) and lower ASA scores (p = 0.03). Conclusions: Endoscopie approaches to the sinuses and skull base have become progressively more sophisticated with advances in skull base reconstruction, advances in surgical technique, and improvements in technology. This study demonstrates the relative safety and utility of the endoscopie approach for sinonasal and skull base malignancies. In carefully selected patients, endoscopie approaches demonstrate survival rates comparable to those of traditional surgery, and fewer perioperative complications. With appropriate planning and careful surgical decision-making, endoscopie surgery shows promise as a minimally invasive alternative in the treatment of sinonasal malignancies. [ABSTRACT FROM AUTHOR]

Objectives: Donor sites for free mucosal grafts for endoscopic endonasal reconstruction of the skull base have traditionally included the middle turbinate, the inferior turbinate, and the nasal septum. The aim of this study was to demonstrate a free mucoperiosteal graft from the nasal cavity floor as a simple alternative donor site for mucosal grafts. Methods: In a cadaver study with clinical correlation, we performed endoscopic endonasal harvest of the nasal floor free mucosal graft on two sides of a cadaveric nasal cavity. We also describe the cases of two patients in whom a nasal floor free mucosal graft was used to repair a skull base defect. Results: The harvest of a nasal floor free mucosal graft is a quick, potentially less morbid method of obtaining free mucosal grafts. In the cases examined, use of this graft carried minimal morbidity and allowed for successful reconstruction of a skull base defect. Conclusions: Harvest of nasal floor mucosa is a technically simple method of obtaining free mucoperiosteum for reconstruction of the skull base. [ABSTRACT FROM AUTHOR]

Background: Endoscopic sinus surgery (ESS) is one of the most commonly performed procedures in otolaryngology. Major complications are estimated to occur in 1-3% of cases, based on early studies with relatively small patient cohorts in academic institutions. The aim of this study was to update data regarding major complication rates associated with ESS by analyzing a large patient database. Methods: Retrospective review of a nationwide database of patients who underwent ESS between 2003 and 2007. Major postoperative complications-cerebrospinal fluid (CSF) leak, orbital injury, and hemorrhage requiring blood transfusion-were identified by searching the database for related International Classification of Diseases, 9th edition (ICD-9) and Current Procedural Terminology (CPT) codes. Complication rates were examined and time to occurrence analyzed. Two-tailed test of proportions, global chi-square test, and logistical regression analysis were used for statistical comparison. Results: A total of 62,823 patients who met rigorous inclusion criteria were included. The overall major complication rate was 1.00% (CSF leak 0.17%; orbital injury 0.07%; hemorrhage requiring transfusion 0.76%). CSF leak was less likely to occur in the pediatric population ( p = 0.05), whereas orbital injury was more likely to occur in children ( p < 0.001). Examination of the impact of image guidance (IGS) was limited by study design. Conclusion: The incidence of major complications associated with ESS appears to have decreased since early reports over 10 years ago. There may be different complication rates in the pediatric population. Study design limitations did not allow for comprehensive assessment of IGS in the development of these complications. These data help to educate otolaryngologists and patients about complication rates in ESS in a modern context. © 2011 ARS-AAOA, LLC. [ABSTRACT FROM AUTHOR]

Aims: Survey the clinical symptoms, radiological features, management, and long-term outcomes of sinonasal and anterior skull base schwannomas. Patients and Methods: Retrospective review of patients with sinonasal schwannomas treated from June 2001 through January 2010 at two academic institutions. Results: There were 4 women and 3 men in this study. The mean age was 46 years (range 17-68). The mean tumor size was 2.4 cm (range 1.4-3.8 cm). Tumor locations included ethmoid sinuses (3), nasal cavity (2) and pterygopalatine fossa (2). Six patients had endoscopic resections, while 1 was approached and resected via a lateral rhinotomy. The mean follow-up was 2.8 years. There were no tumor recurrences during the study period. Conclusions: Schwannomas of the paranasal sinuses and nasal cavity are uncommon tumors that can usually present with vague and nonspecific symptoms. Magnetic resonance imaging can suggest the diagnosis; however, a definitive diagnosis is made by correlation with histopathological findings. Treatment is complete surgical resection. This study illustrates the effectiveness of the endoscopic endonasal approach in the treatment of these benign tumors. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

During hospitalization for AIFS, diagnoses included immunocompromised state in 67.7% and diabetes/long term insulin use in 55.8%. We could not definitively exclude patients who had pulmonary or other fungal infections whose diagnoses were coded as unspecified or other mycoses, and who during the same hospitalization also had sinus surgery for indications other than AIFS, including chronic invasive fungal sinusitis (CIFS). Keywords: COVID-19; invasive fungal sinusitis; mucormycosis EN COVID-19 invasive fungal sinusitis mucormycosis 233 236 4 01/27/22 20220201 NES 220201 INTRODUCTION Acute invasive fungal sinusitis (AIFS) is a rare and often fatal disease caused by aggressive fungal invasion in the nose and paranasal sinuses, with subsequent thrombosis and progressive tissue necrosis capable of spreading to the orbits and brain over hours. [Extracted from the article]

Background: It is unclear whether chronic rhinosinusitis (CRS) endotypes show a differential response to endoscopic sinus surgery (ESS). We explored patient mucous inflammatory cytokine expression and associations with patient‐reported and clinically measured post‐operative outcome measures. Methods: Patients with CRS were prospectively recruited between 2016 and 2021 into a national multicenter, observational study. Mucus was collected from the olfactory cleft preoperatively and evaluated for 26 biomarkers using cluster analysis. Patient‐reported outcome measures included the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) and Questionnaire of Olfactory Dysfunction (QOD). Additional clinical measures of disease severity included threshold, discrimination, and identification (TDI) scores using "Sniffin' Sticks" testing and Lund–Kennedy endoscopic score (LKES). Results: A total of 115 patients were clustered into type 2 inflammatory, non–type 2 inflammatory, noninflammatory, and two indeterminate clusters based on individual protein levels. Overall, the type 2 inflammatory cluster was found to have the highest mean improvement in both SNOT‐22 (−28.3 [standard deviation, ±16.2]) and TDI (6.5 [standard deviation, ±7.9]) scores 6 months after ESS. However, on average, all endotype clusters demonstrated improvement in all outcome measures after ESS without statistically significant between‐group differences in SNOT‐22 (p = 0.738), QOD (p = 0.306), TDI (p = 0.358), or LKES (p = 0.514) measures. Conclusions: All CRS endotype clusters responded favorably to surgery and showed improvements in patient‐reported and objective outcome measures. Thus, ESS should be considered a more generalized CRS therapy, and benefits appear to not be limited to specific endotypes. [ABSTRACT FROM AUTHOR]

Background: Poor air quality increases the risk of developing chronic rhinosinusitis (CRS) and other airway diseases. However, there are limited data on air pollutants and CRS‐specific disease severity. We assessed the impact of air pollutants on sinonasal‐specific and general quality‐of‐life (QOL) measures in a multi‐institutional cohort of patients with CRS. Methods: Participants with CRS were prospectively enrolled in a cross‐sectional study and self‐selected continued appropriate medical therapy or endoscopic sinus surgery (ESS). The 22‐item SinoNasal Outcome Test (SNOT‐22) and Medical Outcomes Study Questionnaire Short‐Form 6‐D (SF‐6D) health utility value scores were recorded. Patient exposure to air pollutants was determined using residence zip codes. Unadjusted group differences were compared, and correlation coefficients were evaluated to identify the magnitude of bivariate association. Results: A total of 486 patients were enrolled and followed for a mean of 6.9 (standard deviation [SD] ± 2.3) months. Pollutant exposure did not significantly correlate with baseline SNOT‐22 or SF‐6D scores. Revision ESS was associated with higher median fine particulate matter (PM2.5; Δ = 0.12, [95% confidence interval {CI}: 0.003, 0.234]; p = 0.006) compared with primary surgery. PM2.5, PM10, and nitrogen dioxide concentrations (μg/m3) did not correlate with change in total SNOT‐22 or SF‐6D scores after treatment. Nevertheless, sulfur dioxide (SNOT‐22: ρ = –0.121 [95% CI: –0.210, –0.030]; p = 0.007; SF‐6D: ρ = 0.095 [95% CI: 0.002, 0.186]; p = 0.04) and carbon monoxide (SNOT‐22: ρ = ‐0.141 [95% CI: –0.230, 0.050]; p = 0.002) exposure did correlate with these outcome measures. Conclusion: Air pollutants may contribute, at least in part, to disease severity in CRS; future investigation is needed to further elucidate the nature of this relationship. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions Socioeconomic status (SES) is linked to health outcomes but has not been well studied in patients with chronic rhinosinusitis (CRS). The area deprivation index (ADI) is a comprehensive measure of geographic SES that ranks neighborhood disadvantage. This investigation used ADI to understand the impact of neighborhood disadvantage on CRS treatment outcomes.A total of 642 study participants with CRS were prospectively enrolled and self‐selected endoscopic sinus surgery (ESS) or continued appropriate medical therapy as treatment. The 22‐item SinoNasal Outcome Test (SNOT‐22) and Medical Outcomes Study Questionnaire Short‐Form 6‐D (SF‐6D) health utility value scores were recorded pre‐ and post‐treatment. Using residence zip codes, national ADI scores were retrospectively assigned to patients. Spearman's correlation coefficients (Rs) and Cramer's V effect size (φc) with 95% confidence interval (CI) were calculated.A history of ESS was associated with significantly worse ADI scores compared to no history of ESS (φc = 0.18; 95% CI: 0.10, 0.25; p < 0.001). Baseline total SNOT‐22 (Rs = 0.14; 95% CI: 0.06, 0.22; p < 0.001) and SF‐6D values (Rs = −0.20; 95% CI: −0.27, −0.12; p < 0.001) were significantly negatively correlated with national ADI rank. No significant correlations between ADI and within‐subject improvement, or achievement of >1 minimal clinically important difference, in SNOT‐22 or SF‐6D scores after treatment were found.Geographic socioeconomic deprivation was associated with worse baseline disease severity and history of prior surgical intervention. However, ADI did not correlate with improvement in disease‐specific outcomes. The impact of socioeconomic deprivation on outcomes in CRS requires further investigation. [ABSTRACT FROM AUTHOR]

Background: Poor sleep quality is common in chronic rhinosinusitis (CRS). Prior studies have demonstrated improvements in patient‐reported measures of sleep quality following endoscopic sinus surgery (ESS). The purpose of this study was to evaluate the effect of ESS on objective sleep parameters and identify any associations between specific objective measures and patient characteristics, comorbidities, and patient‐reported outcome measures (PROMs). Methods: Adults with CRS undergoing ESS were prospectively enrolled from 4 centers across North America. Any subject previously diagnosed with a known primary sleep disorder was excluded. Objective sleep indices were recorded using a portable sleep diagnostic device preoperatively and postoperatively. Patient‐reported outcome instruments were completed including the Pittsburgh Sleep Quality Index (PSQI) and the 22‐item Sino‐Nasal Outcome Test (SNOT‐22). Results: Thirty‐six patients (mean age 47 years, 56% male) completed baseline and postoperative sleep studies with mean ± standard deviation (SD) follow‐up 9.6 ± 7.7 months. Mean PSQI and SNOT‐22 before and after ESS was 10.2 ± 3.9 vs 7.8 ± 4.4 (p = 0.001); and 54.6 ± 14.6 vs 28.5 ± 15.3 (p < 0.001), respectively. Total sleep time, sleep latency, and awakenings after sleep onset did not change following ESS (all p > 0.5) despite improvements in PSQI and SNOT‐22. Changes in PSQI did not correlate with comorbidities or objective sleep indices (all p > 0.1). Conclusion: In this multicenter prospective cohort, objective sleep indices were not improved following ESS for CRS despite significant improvements in patient‐reported sleep quality and CRS‐specific QOL. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to investigate otolaryngologists' knowledge, trust, acceptance, and concerns with clinical applications of artificial intelligence (AI). Methods: This study used mixed methods with survey and semistructured interviews. Survey was e‐mailed to American Rhinologic Society members, of which a volunteer sample of 86 members responded. Nineteen otolaryngologists were purposefully recruited and interviewed until thematic saturation was achieved. Results: Seventy‐six respondents (10% response rate) completed the majority of the survey: 49% worked in academic settings and 43% completed residency 10 or fewer years ago. Of 19 interviewees, 58% worked in academic settings, and 47% completed residency 10 or fewer years ago. Familiarity: Only 8% of survey respondents reported having AI training in residency, although 72% had familiarity with general AI concepts; 0 interviewees had personal experience with AI in clinical settings. Expected uses: Of the surveyed otolaryngologists, 82% would use an AI‐based clinical decision aid and 74% were comfortable with AI proposing treatment recommendations. However, only 44% of participants would trust AI to identify malignancy and 53% to interpret radiographic images. Interviewees trusted AI for simple tasks, such as labeling septal deviation, more than complex ones, such as identifying tumors. Factors influencing AI adoption: 89% of survey participants would use AI if it improved patient satisfaction, 78% would be willing to use AI if experts and studies validated the technologies, and 73% would only use AI if it increased efficiency. Sixty‐one percent of survey respondents expected AI incorporation into clinical practice within 5 years. Interviewees emphasized that AI adoption depends on its similarity to their clinical judgment and to expert opinion. Concerns included nuanced or complex cases, poor design or accuracy, and the personal nature of physician‐patient relationships. Conclusion: Few physicians have experience with AI technologies but expect rapid adoption in the clinic, highlighting the urgent need for clinical education and research. Otolaryngologists are most receptive to AI "augmenting" physician expertise and administrative capacity, with respect for physician autonomy and maintaining relationships with patients. Level of Evidence: Level VI, descriptive or qualitative study. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic rhinosinusitis (CRS) commonly experience both reduced quality of life (QOL) and olfactory dysfunction (OD). Literature on the impacts of appropriate medical therapy (AMT) for CRS on QOL and OD is limited, and the focused design of these studies may limit their applicability to usual clinical practice. Methods: Adults with symptomatic CRS were prospectively enrolled (November 2016 to October 2018) into an observational, multi‐institutional study. Individualized AMT was initiated using standard practice according to evidence‐based guidelines. Endoscopy examination (Lund‐Kennedy), olfactory function (Sniffin' Sticks) testing, and QOL survey responses (22‐item Sino‐Nasal Outcome Test [SNOT‐22], Questionnaire of Olfactory Disorders―Negative Statements [QOD‐NS]) were obtained at enrollment and follow‐up. Results: Baseline measures demonstrated heterogeneity of QOL and OD. After an average of 7.8 weeks, within‐subject median SNOT‐22 total improved by 39.5% (n = 39, p < 0.001) relative to baseline, including 50% (p = 0.014) improvement for item #21, "Sense of smell/taste." QOD‐NS improvement was also statistically significant (p = 0.044). Sniffin' Sticks score relative improvement of 10.9% (n = 33, p = 0.109) was not statistically significant and lacked correlation with SNOT‐22 total scores (R = −0.247, p = 0.165) or QOD‐NS total scores (R = −0.016, p = 0.930), but correlated moderately with endoscopy score (R = −0.436, p = 0.018). Conclusions: Participants with varied impacts of CRS, treated with individualized short‐term AMT, demonstrated significant improvements in CRS‐ and olfactory‐specific QOL measures, without corresponding improvement in clinically measured olfactory function. Olfactory function changes moderately correlated with endoscopy score changes, but lacked an association with QOL measurements. [ABSTRACT FROM AUTHOR]

Forkhead box protein J1 (FOXJ1), a member of the forkhead family transcription factors, is a transcriptional regulator of motile ciliogenesis. The nasal respiratory epithelium, but not olfactory epithelium, is lined with FOXJ1-expressing multiciliated epithelial cells with motile cilia. In a transgenic mouse where an enhanced green fluorescent protein (eGFP) transgene is driven by the human FOXJ1 promoter, robust eGFP expression is observed not only in the multiciliated cells of the respiratory epithelium but in a distinctive small subset of olfactory sensory neurons in the olfactory epithelium. These eGFP-positive cells lie at the extreme apical part of the neuronal layer and are most numerous in dorsal-medial regions of olfactory epithelium. Interestingly, we observed a corresponding small number of glomeruli in the olfactory bulb wherein eGFP-labeled axons terminate, suggesting that the population of eGFP+ receptor cells expresses a limited number of olfactory receptors. Similarly, a subset of vomeronasal sensory neurons expresses eGFP and is distributed throughout the full height of the vomeronasal sensory epithelium. In keeping with this broad distribution of labeled vomeronasal receptor cells, eGFP-labeled axons terminate in many glomeruli in both anterior and posterior portions of the accessory olfactory bulb. These findings suggest that Foxj1 -driven eGFP marks a specific population of olfactory and vomeronasal sensory neurons, although neither receptor cell population possess motile cilia. [ABSTRACT FROM AUTHOR]

Rhinitis and rhinosinusitis are multifactorial disease processes in which bacteria may play a role either in infection or stimulation of the inflammatory process. Rhinosinusitis has been historically studied with culture-based techniques, which have implicated several common pathogens in disease states. More recently, the NIH Human Microbiome Project has examined the microbiome at a number of accessible body sites, and demonstrated differences among healthy and diseased patients. Recent DNA-based sinus studies have suggested that healthy sinuses are not sterile, as was previously believed, but the normal sinonasal microbiome has yet to be thoroughly examined. Middle meatus swab specimens were collected from 28 consecutive patients presenting with no signs or symptoms of rhinosinusitis. Bacterial colonization was assessed in these specimens using quantitative PCR and 16S rRNA pyrosequencing. All subjects were positive for bacterial colonization of the middle meatus. Staphylococcus aureus, Staphylococcus epidermidis and Propionibacterium acnes were the most prevalent and abundant microorganisms detected. Rich and diverse bacterial assemblages are present in the sinonasal cavity in the normal state, including opportunistic pathogens typically found in the nasopharynx. This work helps establish a baseline for understanding how the sinonasal microbiome may impact diseases of the upper airways. [ABSTRACT FROM AUTHOR]

Background: Productivity loss and activity limitations due to chronic rhinosinusitis (CRS) are known to contribute to the significant economic and personal burden of disease. The purpose of this study was to assess productivity and activity impairment before and after endoscopic sinus surgery (ESS) for medically refractory CRS. Methods: This investigation was a prospective, multi‐institutional, observational cohort study. Patients diagnosed with medically refractory CRS completed the Work Productivity and Activity Impairment—Specific Health Problem (WPAI‐SHP) questionnaire before surgery and approximately 6 months after the procedure. Factors associated with minimal clinical important differences (MCIDs) for productivity and activity impairment were identified. Results: A total of 279 study participants were screened for inclusion, of whom 176 (63.1%) with postoperative follow‐up were included in the final cohort. Preoperative productivity and activity impairment were observed in 63.2% and 69.8% of the patients, respectively. Among these patients, postoperative improvement equaling at least 1 MCID was reported in both productivity (76.1%) and activity (76.4%) impairments. Multivariate regression identified sphenoidotomy (odds ratio [OR], 4.18; 95% confidence interval [CI], 1.03‐17.02) as the only factor associated with increased likelihood of productivity improvement, whereas septoplasty during ESS (OR, 8.45; 95% CI, 2.33‐30.68) and migraine (OR, 0.35; 95% CI, 0.12‐0.96) were associated with differential odds of activity improvement. Conclusion: CRS is associated with a substantial burden on productivity and activity that significantly improves after treatment with ESS. These data may facilitate improved patient counseling and shared decision‐making regarding surgical management for CRS. [ABSTRACT FROM AUTHOR]

Keywords: computed tomography; cystic fibrosis; modulator; quality of life; sinusitis EN computed tomography cystic fibrosis modulator quality of life sinusitis 1435 1438 4 11/15/22 20221101 NES 221101 INTRODUCTION The highly effective cystic fibrosis transmembrane conductance regulator modulator therapy (HEMT) with elexacaftor/tezacaftor/ivacaftor (ETI) improves pulmonary disease and chronic rhinosinusitis (CRS) in people with cystic fibrosis (PwCF).1,2 Adequately managing the sinonasal manifestations of CF is critical for maximizing quality of life (QOL) and optimizing pulmonary status.3 CRS severity can be quantified by patient-reported, radiographic, and endoscopic methods, with patient-reported and objective measures thought to represent different constructs of disease. Computed tomography, cystic fibrosis, quality of life, sinusitis, modulator Objective and patient-based measures of chronic rhinosinusitis in people with cystic fibrosis treated with highly effective modulator therapy. [Extracted from the article]

Use of a novel chinchilla skull base repair model to test a photo-initiated thiol-ene biopolymer Keywords: biomaterials; chinchilla; cerebrospinal fluid leak repair; hydrogel; polyethylene glycols; reconstructive surgical procedures; skull base; skull base repair; wound healing EN biomaterials chinchilla cerebrospinal fluid leak repair hydrogel polyethylene glycols reconstructive surgical procedures skull base skull base repair wound healing 1317 1320 4 09/30/22 20221001 NES 221001 INTRODUCTION Widespread adoption of minimally invasive skull base surgery requires reliable reconstructive options.1 Although reliable vascularized flaps are available, there is associated morbidity, and such repairs may still fail in challenging situations. Hydrogel, skull base, wound healing, biomaterials, chinchilla, cerebrospinal fluid leak repair, polyethylene glycols, reconstructive surgical procedures, skull base repair. [Extracted from the article]

Numbers of chronic conditions represent illness diagnoses that were thought to affect the patient for greater than 12 months, but do not specify the kind of illness. Patients with the highest SOI had higher readmission rates when compared with those with mild illness severity (odds ratio 10.77, 95% confidence interval [CI] 2.05-56.53, I p i = 0.005). Readmission, reoperation, and infection A total of 49 patients (8.2%) were readmitted within 30 days, 11 (1.9%) underwent reoperation for persistent CSF leak, and 16 (2.7%) developed postdischarge intracranial infections. [Extracted from the article]

Yolk sac tumors are rare in the head and neck. A previously healthy 2-year-old female presented with a large parapharyngeal mass. Pathology was pathognomonic for yolk sac tumor, with glandular differentiation and focal mucin production, which has not been reported in a yolk sac tumor. She was treated aggressively with chemotherapy followed by endoscopic exploration with planned resection, but no viable tumor was encountered. Yolk sac tumors can be difficult to diagnose in the head and neck, but complete clinical response can be achieved. New endoscopic approaches to skull base tumors are applicable to the pediatric population with some technical modifications. [ABSTRACT FROM AUTHOR]

• People with cystic fibrosis and sinus disease have impaired olfactory function. • These individuals have inflammation of the olfactory cleft on computed tomography. • Olfactory quality of life deficits were not prominently reported by people with CF. • Six months of CFTR modulator therapy did not lead to improvements in olfaction. • Future study will evaluate olfactory changes with greater duration of CFTR therapy. Elexacaftor-tezacaftor-ivacaftor (ETI) improves pulmonary health and chronic rhinosinusitis (CRS) for people with cystic fibrosis (PwCF), however its impact on olfaction has not been investigated. Olfactory dysfunction impairs quality-of-life (QOL). This study evaluated the impact of ETI on multiple olfactory metrics. Adult PwCF/CRS with CF transmembrane conductance regulator genotype F508del/F508del or F508del/minimal function who clinically initiated ETI participated in a prospective, observational study. Endpoints included changes after 6 months of ETI in quantitative olfactory function (Smell Identification Test, SIT), olfactory QOL (Questionnaire of Olfactory Disorders, QOD) and percent olfactory cleft opacification (%OCO), representing superior nasal cavity inflammation where afferent olfactory neurons are concentrated. 30 PwCF/CRS met inclusion criteria; 25 completed the study. Mean ETI adherence was 93%. At baseline, participants were hyposmic (mean SIT 31.3), had significant %OCO (mean 65.6%), yet reported non-impaired olfactory QOL (mean QOD 6.1). At follow-up, mean SIT worsened mildly (p=0.009), mean %OCO remained stable (p=0.46), and mean QOD improved modestly (p=0.008). No outcomes were impacted by prior modulator use, genotype, nasal polyps, or CF-related diabetes. Prior sinus surgery was associated with QOD improvement (p=0.04). Increased (worse) baseline QOD scores and %OCO were associated with greater improvements (p<0.003), but not SIT (p=0.44). ETI was not associated with improvement in quantitative olfaction or olfactory cleft opacification after 6 months. PwCF/CRS have hyposmia but do not report impairment in olfactory QOL. Further study to investigate mechanisms explaining olfactory dysfunction and whether olfaction improves with greater duration of ETI or in younger age groups is warranted. [ABSTRACT FROM AUTHOR]

Endoscopic endonasal approaches to the middle fossa and orbital apex have traditionally included resection of the middle turbinate to improve visualization and operating space. The aim of this publication is to demonstrate a surgical technique that affords similar visualization and space but preserves the middle turbinate. We describe a technical modification that allows for conservation of the middle turbinate and describe an illustrative case. As current surgical techniques evolve towards progressively less morbidity, preservation of anatomic structures such as the middle turbinate will be pursued. In the case described, middle turbinate preservation did not negatively affect access or visualization and did not appear to alter postoperative wound healing. With middle turbinate preservation, the principle function of airflow conditioning and potential neural regeneration are maintained. [ABSTRACT FROM AUTHOR]

Background Nasal polyps (NPs) are hallmark inflammatory lesions of sinusitis. Despite the spectrum of NP conditions, cellular differences between NPs from patients with chronic rhinosinusitis with NPs (CRSwNP) and aspirin-exacerbated respiratory disease (AERD) are poorly understood. NPs are associated with abundant eosinophils; the contributions of neutrophil and basophil granulocytes are less defined. We therefore sought to assess granulocyte subpopulations, and differential effects following prednisone pretreatment, within NPs of CRSwNP and AERD patients. Methods NPs, adjacent ethmoid sinus tissue, and peripheral blood mononuclear cells (PBMCs) were obtained from patients undergoing endoscopic sinus surgery. Samples from 5 cohorts: CRSwNP ± prednisone (n = 6 each), AERD ± prednisone (n = 6 each), and controls (n = 9), were analyzed by high-dimensional flow cytometry to gate granulocyte populations. Specimens were also assessed using immunohistochemistry (IHC) staining. Results Systemic prednisone administration was associated with a lower frequency of eosinophils ( p < 0.0001, n = 6) in NPs in both CRSwNP and AERD patients, whereas a decrease in neutrophils ( p = 0.0070, n = 6) in NPs was only observed in CRSwNP patients after prednisone treatment. In contrast, steroids do not alter basophil proportions ( p = 0.48, n = 6) within NPs from either group. No significant shift in granulocyte subsets after steroid treatment was identified in the adjacent ethmoid mucosa or PBMCs from the same patients. Immunohistochemistry (IHC) staining supported these findings. Conclusion Granulocyte subpopulations are focally affected within NPs by systemic steroid exposure, without notable granulocyte alterations in the surrounding regional tissues. These data provide direct insights into the cellular effects of routine prednisone exposure in CRS patients, and highlight a unique microenvironment present within NP lesions. [ABSTRACT FROM AUTHOR]

Background: The impact of multiple coexisting medical comorbidities on treatment outcomes in chronic rhinosinusitis (CRS) is unknown. In this study we sought to evaluate the effect of comorbidities on sinonasal quality of life (QOL) and general health utility values by utilizing the Functional Comorbidity Index (FCI) in CRS patients. Methods: Patients with CRS were prospectively enrolled in a cross‐sectional study of medical and surgical therapies. The 22‐item Sino‐Nasal Outcome Test (SNOT‐22) and Medical Outcomes Study Short‐Form 6D (SF‐6D) scores were recorded at enrollment and 6‐month follow‐up; Lund‐Kennedy endoscopy and Lund‐Mackay computed tomography scores were recorded at enrollment. The FCI was calculated using the electronic medical record. The impact of cumulative comorbidity burden on baseline and posttreatment outcomes was assessed using univariate and bivariate correlations. Results: A total of 428 participants with CRS were included. The average (mean standard ± deviation) FCI score was 3.03 ± 2.28 (range, 0‐12). Significant linear correlations were identified between increasing FCI score and baseline SNOT‐22 and SF‐6D scores (R = 0.166, p = 0.001 and R = −0.245, p < 0.001, respectively). There was no correlation between FCI and change in SNOT‐22 or SF‐6D scores after CRS treatment (R = 0.066, p = 0.17 and R = −0.087, p = 0.074, respectively). Achievement of a minimally clinically important difference was also independent of FCI. Conclusion: Although cumulative comorbidity burden, as measured by FCI, is associated with worse baseline SNOT‐22 and SF‐6D scores, it does not appear to limit posttreatment improvement in either outcome measure. On average, patients with high comorbidity burden report substantial improvement in both QOL and health utility after CRS treatment, similar to those with fewer comorbidities. [ABSTRACT FROM AUTHOR]

Background: Management of sinonasal malignancy (SNM) often includes surgical resection as part of the multimodality treatment. Treatment‐related surgical morbidity can occur, yet risk factors associated with complications in this population have not been sufficiently investigated. Methods: Adult patients with histologically confirmed SNM whose primary treatment included surgical resection were prospectively enrolled into an observational, multi‐institutional cohort study from 2015 to 2020. Sociodemographic, disease, and treatment data were collected. Complications assessed included cerebrospinal fluid leak, orbital injury, intracranial injury, diplopia, meningitis, osteoradionecrosis, hospitalization for neutropenia, and subsequent chronic rhinosinusitis. The surgical approach was categorized as endoscopic resection (ER) or open/combined resection (O/CR). Associations between factors and complications were analyzed using Student's t test, Fisher's exact test, and logistic regression modeling. Results: Overall, 142 patients met the inclusion criteria. Twenty‐three subjects had at least 1 complication (16.2%). On unadjusted analysis, adjuvant radiation therapy was associated with developing a complication (91.3% vs 65.5%, p = 0.013). Compared with the ER group (n = 98), the O/CR group (n = 44) had a greater percentage of higher T‐stage lesions (p = 0.004) and more frequently received adjuvant radiation (84.1% vs 64.4%, p = 0.017) and chemotherapy (50.0% vs 30.6%, p = 0.038). Complication rates were similar between the ER and O/CR groups without controlling for other factors. Regression analysis that retained certain factors showed O/CR was associated with increased odds of experiencing a complication (odds ratio, 3.34; 95% confidence interval, 1.06‐11.19). Conclusions: Prospective, multicenter evaluation of SNM treatment outcomes is feasible. Undergoing O/CR was associated with increased odds of developing a complication after accounting for radiation therapy. Further studies are warranted to build upon these findings. [ABSTRACT FROM AUTHOR]

Background: The Questionnaire of Olfactory Disorders‐Negative Statements (QOD‐NS) is a 17‐item instrument measuring olfactory‐specific quality of life (QOL). However, in clinical research patients can be overwhelmed with multiple questionnaires. We recently developed the 7‐item brief QOD‐NS (B‐QOD). Our objective was to evaluate the psychometric properties of the B‐QOD in both the development (D) sample, and in a separate replication (R) sample. Methods: Testing on D (n = 203) and R (n = 281) samples included initial exploratory factor analysis (EFA), followed by internal reliability, information loss, and confirmatory factor analysis (CFA). Finally, incremental predictive utility analysis (IPUA) was performed by correlating the B‐QOD with the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) survey. Results: EFAs of both D and R demonstrated an underlying single‐factor structure (eigenvalue = 4.17 and 3.57, respectively) with comparable loading factors (R > 0.30 for both). B‐QOD also had good internal reliability in both D and R (Cronbach's alpha = 0.88 and 0.83, respectively). Also, there is minimal information loss with B‐QOD compared to QOD‐NS in both D and R (R = 0.98 and 0.96, respectively). CFA indicates that the B‐QOD single‐factor model has good overall fit as measured by the Comparative Fit Index (CFI) and the Standardized Root Mean Squared Residuals (SRMSR) in the D and R samples (CFI = 0.99 and 0.97; SRMSR = 0.035 and 0.053). IPUA shows that the QOD‐NS offers no additional predictive benefit of SNOT‐22 scores when compared with B‐QOD. Conclusion: The 7‐item B‐QOD captures a structurally coherent and reliable single dimension, with minimal information loss and excellent external predictive utility when compared to the QOD‐NS. [ABSTRACT FROM AUTHOR]

Background: Multiple hypotheses are evolving that suggest several, potentially overlapping etiologies for olfactory dysfunction (OD) in chronic rhinosinusitis (CRS). Understanding inflammatory cytokine profiles of the olfactory cleft (OC) and their association with olfactory function is foundational for future clinical care and research. Methods: This cross‐sectional, case‐control study evaluates associations among OC mucus inflammatory proteins, psychophysical olfactory testing, and computed tomography (CT) analysis of the OC and sinuses. Normative reference intervals were determined for each protein and odds ratios (ORs) were used to compare proportions of altered expression between CRS without nasal polyposis (CRSsNP) and CRS without nasal polyposis (CRSwNP). Results: Case subjects with CRS (n = 151) and controls (n = 74) were evaluated. A majority of OC proteins tested were found within detectable ranges for cases and controls. The CRS cohort had significantly higher concentrations for 23 of 26 proteins. CRS cases with abnormal levels of C‐C motif chemokine ligand 2 (CCL2), CCL3, interleukin 5 (IL5), IL10, and IL13 associated with greater olfactory deficits. The prevalence of elevated IL5 and IL13 in anosmic patients was 64.6% and 62.5%, respectively (p < 0.004). CRS cases with the highest odds of elevated expression in CRSwNP were IL5 (OR = 10.83) and IL13 (OR = 8.36). However, both IL5 and IL13 were still elevated in approximately 14% of CRSsNP patients. The highest magnitude of correlation between the total percent of OC opacification was found to be with IL5 (r = 0.543; p < 0.001), whereas other moderate correlations were noted with immunoglobulin E (IgE), IL10, and IL13. Conclusion: This study confirmed that OC inflammatory proteins vary both by disease phenotype and in their association with OD. Type 2 inflammatory mediators are increased in CRS, especially within the CRSwNP group. However, a substantial proportion of CRSsNP also express type 2 inflammatory mediators. Further research is necessary to understand the complex roles OC mucous inflammatory proteins might play in defining endotype and in impacting CRS‐related OD. ©2021 ARSAAOA, LLC. [ABSTRACT FROM AUTHOR]

Summary: The frequent association between coronavirus disease 2019 (COVID‐19) and olfactory dysfunction is creating an unprecedented demand for a treatment of the olfactory loss. Systemic corticosteroids have been considered as a therapeutic option. However, based on current literature, we call for caution using these treatments in early COVID‐19–related olfactory dysfunction because: (1) evidence supporting their usefulness is weak; (2) the rate of spontaneous recovery of COVID‐19–related olfactory dysfunction is high; and (3) corticosteroids have well‐known potential adverse effects. We encourage randomized placebo‐controlled trials investigating the efficacy of systemic steroids in this indication and strongly emphasize to initially consider smell training, which is supported by a robust evidence base and has no known side effects. [ABSTRACT FROM AUTHOR]

Background: Understanding viral infection of the olfactory epithelium is essential because the olfactory nerve is an important route of entry for viruses to the central nervous system. Specialized chemosensory epithelial cells that express the transient receptor potential cation channel subfamily M member 5 (TRPM5) are found throughout the airways and intestinal epithelium and are involved in responses to viral infection. Results: Herein we performed deep transcriptional profiling of olfactory epithelial cells sorted by flow cytometry based on the expression of mCherry as a marker for olfactory sensory neurons and for eGFP in OMP-H2B::mCherry/TRPM5-eGFP transgenic mice (Mus musculus). We find profuse expression of transcripts involved in inflammation, immunity and viral infection in TRPM5-expressing microvillous cells compared to olfactory sensory neurons. Conclusion: Our study provides new insights into a potential role for TRPM5-expressing microvillous cells in viral infection of the olfactory epithelium. We find that, as found for solitary chemosensory cells (SCCs) and brush cells in the airway epithelium, and for tuft cells in the intestine, the transcriptome of TRPM5-expressing microvillous cells indicates that they are likely involved in the inflammatory response elicited by viral infection of the olfactory epithelium. [ABSTRACT FROM AUTHOR]

Background: The Sinus Control Test (SCT) is a 4‐question, patient‐reported questionnaire that assesses disease control in chronic rhinosinusitis (CRS). This prospective, multicenter study examines SCT outcomes following endoscopic sinus surgery (ESS), further validating its use as a control instrument for CRS. Methods: Adults with CRS undergoing ESS were prospectively enrolled from 5 centers across North America. The SCT was administered at baseline and once 6 months after surgery. Quality of life and disease burden were evaluated using the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) and Lund‐Kennedy endoscopy scores. Linear regression was used to determine whether specific demographic, comorbidity, or disease severity measures were independently associated with changes in SCT scores postoperatively. Results: A total of 218 patients, 111 females (50.9%) and 107 males (49.1%), were enrolled, with mean ± standard deviation age of 50.1 ± 15.6 years. Mean SCT score improved from 8.9 ± 3.5 to 4.3 ± 3.7 postoperatively (p < 0.001). Preoperatively, 21.6% were uncontrolled, 71.5% partially controlled, and 6.9% controlled. Postoperatively, 6.0% were uncontrolled, 42.6% partially controlled, and 51.4% controlled (p < 0.001). Change in SCT score correlated independently with change in SNOT‐22 (r = 0.500, p < 0.001) and endoscopy scores (r = 0.310, p < 0.001). Endoscopy scores did not correlate with control status among patients with CRS without nasal polyposis (CRSsNP) nor between uncontrolled and partially controlled patients. Demographics and comorbidities were not associated with changes in SCT. Conclusion: Improvement in disease control following ESS as measured by the SCT correlated with improvements in SNOT‐22 and endoscopy scores. The SCT is an easily administered instrument that provides information complementary to existing patient‐reported and objective measures of disease severity. [ABSTRACT FROM AUTHOR]

Background: Inflammatory profiles for patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) vary between North American and Asian populations. An elevated ethmoid‐to‐maxillary (E/M) opacification ratio on preoperative imaging is associated with certain postoperative outcomes in Asian populations and populations that are non‒type 2 dominant. In this study we explore this factor in North American/type 2‒based populations. Methods: Adult patients (n = 165) from a North American population with CRSwNP who underwent endoscopic sinus surgery (ESS) were prospectively enrolled into an observational, multi‐institutional study. The 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Brief Smell Identification Test (BSIT), and Lund‐Kennedy (LK) endoscopic scores were obtained pre‐ and postoperatively. Patients were stratified according to increasing E/M ratios based on Lund‐Mackay (LM) scores. Results: On average, significant within‐subject postoperative improvement was found in all patients for SNOT‐22 total and domain scores, and also BSIT results (p ≤ 0.019). Preoperatively, elevated E/M ratio correlated with worse BSIT scores (r = −0.343, p < 0.001). Postoperatively, elevated E/M ratio correlated with BSIT improvement (r = 0.284, p = 0.002), but did not correlate with SNOT‐22 improvement or polyp recurrence. An elevated E/M ratio was associated with greater likelihood of reporting a minimal clinically important difference in BSIT scores (χ2 = 9.96, p = 0.041). Conclusion: Elevated E/M ratios were found to associated with worse baseline olfaction and an increased likelihood of achieving a clinically meaningful postoperative improvement in olfaction in this North American population with CRSwNP. Elevated E/M ratios did not predict postoperative changes in SNOT‐22 measures or polyp recurrence. This suggests that prognostic factors may vary according to geography and generalized inflammatory profiles (type 2 vs non‒type 2) in patients with CRS. [ABSTRACT FROM AUTHOR]

Background: Computed tomography (CT) plays a key role in evaluation of paranasal sinus inflammation, but improved, and standardized, objective assessment is needed. Computerized volumetric analysis has benefits over visual scoring, but typically relies on manual image segmentation, which is difficult and time‐consuming, limiting practical applicability. We hypothesized that a convolutional neural network (CNN) algorithm could perform automatic, volumetric segmentation of the paranasal sinuses on CT, enabling efficient, objective measurement of sinus opacification. In this study we performed initial clinical testing of a CNN for fully automatic quantitation of paranasal sinus opacification in the diagnostic workup of patients with chronic upper and lower airway disease. Methods: Sinus CT scans were collected on 690 patients who underwent imaging as part of multidisciplinary clinical workup at a tertiary care respiratory hospital between April 2016 and November 2017. A CNN was trained to perform automatic segmentation using a subset of CTs (n = 180) that were segmented manually. A nonoverlapping set (n = 510) was used for testing. CNN opacification scores were compared with Lund‐MacKay (LM) visual scores, pulmonary function test results, and other clinical variables using Spearman correlation and linear regression. Results: CNN scores were correlated with LM scores (rho = 0.82, p < 0.001) and with forced expiratory volume in 1 second (FEV1) percent predicted (rho = −0.21, p < 0.001), FEV1/forced vital capacity ratio (rho = −0.27, p < 0.001), immunoglobulin E (rho = 0.20, p < 0.001), eosinophil count (rho = 0.28, p < 0.001), and exhaled nitric oxide (rho = 0.40, p < 0.001). Conclusion: Segmentation of the paranasal sinuses on CT can be automated using a CNN, providing truly objective, volumetric quantitation of sinonasal inflammation. [ABSTRACT FROM AUTHOR]

Background: Collection of biologic samples from the nasal cavity and paranasal sinuses is of critical importance to the study of infectious or inflammatory conditions that affect both upper and lower airways. Numerous techniques for the study of ex‐vivo samples exist, with specific applications, strengths, and weaknesses associated with each of them. In this compendium we summarize the available methods for collection of primary human samples and incorporate expert discussion of the pros, cons, and applications associated with each technique. Methods: An expert panel containing members of the American Rhinologic Society's Research and Grants Committee compiled this educational reference. Rationale for use and the potential advantages and disadvantages are discussed. Research protocols and key references are enumerated. Results: Sampling of the nasal cavity and paranasal sinuses can be achieved through a number of methods. Nonspecific sinonasal secretions may be collected via forced exhalation, nasal lavage, and nasal spray aspiration. Targeted collection of sinonasal secretions may be achieved via endoscopic placement of absorbent matrices. Nasal cytology or collection of superficial epithelium may be completed via brushing or scraping of endonasal structures. Collection of mucosal biopsies may be completed via sinonasal explant or full‐thickness biopsy. Conclusion: Multiple sampling techniques are available to collect biologic samples from the sinonasal cavity. These techniques differ in their ease of application, reproducibility, sample yield, and utility for different sinonasal pathologies or research goals. An appreciation of the benefits and drawbacks of each approach will allow investigators to select the techniques most appropriate for achieving research objectives. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is one of the most common causes of olfactory loss, but the pathophysiology underlying olfactory dysfunction in CRS has not been fully elucidated. Previous studies found correlations between olfactory cleft (OC) inflammatory cytokines/chemokines and olfaction in CRS. The purpose of this study was to evaluate the relationship between OC mucus inflammatory proteins and olfaction in a multi‐institutional cohort. Methods: Adults with CRS were prospectively recruited. Demographics, comorbidities, olfactory assessment (Sniffin' Sticks), computed tomography (CT), and OC mucus for protein analysis were collected. Statistical analysis was performed to determine associations between olfactory function, OC mucus protein concentrations, and CT opacification. Results: Sixty‐two patients were enrolled in the study, with an average age of 48.2 (standard deviation, 16.2) years, and 56.5% were female and 59.7% were classified as CRS with nasal polyps (CRSwNP). Ten of 26 OC mucus proteins were significantly correlated with threshold, discrimination, and identification (TDI) scores and OC opacification. Subgroup analysis by polyp status revealed that, within the CRSwNP group, C‐C motif ligand 2 (CCL2), interleukin‐5 (IL‐5), IL‐6, IL‐13, IL‐10, IL‐9, tumor necrosis factor‐α (TNF‐α), CCL5, and CCL11 were significantly correlated with olfaction. For CRS without nasal polyps (CRSsNP), only C‐X‐C ligand 5 (CXCL5) showed a correlation. In CRSwNP, IL‐6, IL‐10, vascular endothelial growth factor‐A, and immunoglobulin E (IgE) correlated with OC opacification, whereas, in CRSsNP, only CXCL5 showed a correlation. OC mucus proteins and Lund‐Mackay score correlated only in the CRSsNP group (CXCL5, IL‐5, IL‐13, IgE). Conclusion: Several OC mucus proteins have been found to correlate with olfactory function and OC opacification. The profile of OC mucus proteins differs between CRSsNP and CRSwNP subgroups, suggesting different mechanisms between groups, but further study is required. [ABSTRACT FROM AUTHOR]