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Background: Definitions are essential for effective communication and discourse, particularly in science. They allow the shared understanding of a thought or idea, generalization of knowledge, and comparison across scientific investigation. The current terms describing olfactory dysfunction are vague and overlapping. Summary: As a group of clinical olfactory researchers, we propose the standardization of the terms "dysosmia," "anosmia," "hyposmia," "normosmia," "hyperosmia," "olfactory intolerance," "parosmia," and "phantosmia" (or "olfactory hallucination") in olfaction-related communication, with specific definitions in this text. Key Messages: The words included in this paper were determined as those which are most frequently used in the context of olfactory function and dysfunction, in both clinical and research settings. Despite widespread use in publications, however, there still exists some disagreement in the literature regarding the definitions of terms related to olfaction. Multiple overlapping and imprecise terms that are currently in use are confusing and hinder clarity and universal understanding of these concepts. There is a pressing need to have a unified agreement on the definitions of these olfactory terms by researchers working in the field of chemosensory sciences. With the increased interest in olfaction, precise use of these terms will improve the ability to integrate and advance knowledge in this field. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is a heterogeneous condition characterized by differing inflammatory endotypes. The identification of suitable biomarkers could enable personalized approaches to treatment selection. Objective: This study aimed to identify and summarize clinical studies of biomarkers in adults with CRS in order to inform future research into CRS endotypes. Methods: We conducted systematic searches of MEDLINE and Web of Science from inception to January 30, 2022 and included all clinical studies of adult CRS patients and healthy controls measuring biomarkers using enzyme-linked immunosorbent assays or Luminex immunoassays. Outcomes included the name and tissue type of identified biomarkers and expression patterns within CRS phenotypes. Study quality was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. A narrative synthesis was performed. Results: We identified 78 relevant studies involving up to 9394 patients, predominantly with CRS with nasal polyposis. Studies identified 80 biomarkers from nasal tissue, 25 from nasal secretions, 14 from nasal lavage fluid, 24 from serum, and one from urine. The majority of biomarkers found to distinguish CRS phenotypes were identified in nasal tissue, especially in nasal polyps. Serum biomarkers were more commonly found to differentiate CRS from controls. The most frequently measured biomarker was IL-5, followed by IL-13 and IL-4. Serum IgE, IL-17, pentraxin-3 and nasal phospho-janus kinase 2, IL-5, IL-6, IL-17A, granulocyte-colony stimulating factor, and interferon gamma were identified as correlated with disease severity. Conclusion: We have identified numerous potential biomarkers to differentiate a range of CRS phenotypes. Future studies should focus on the prognostic role of nasal tissue biomarkers or expand on the more limited studies of nasal secretions and nasal lavage fluid. We registered this study in PROSPERO (CRD42022302787). [ABSTRACT FROM AUTHOR]

Objectives: To determine the top 10 research priorities in Smell and Taste Disorders (SATD). Design: After steering group was established, an electronic survey was disseminated to determine the list of questions. After removing out‐of‐scope responses, the remainder were consolidated to create summary questions. A literature search was conducted to remove already answered questions. A second survey was used to determine the top questions that formed the subject of final debate at a workshop attended by clinicians and patients to determine the top 10 priorities. Setting: A James Lind Alliance Priority Setting Partnership (JLAPSP) was established by FifthSense to identify the top 10 research questions in SATDs in the United Kingdom. Participant: All stakeholders in SATDs (patients, healthcare professionals, family, carers, researchers). Main outcome measures: Final 10 research priorities. Results: The 665 respondents to the initial survey provided 1698 research questions. Thirteen were out‐of‐scope and removed; remaining 1685 were then consolidated to form 147 summary questions. Following literature search and discussion with the steering group, 37 questions remained for the second survey, which 235 people responded. The top ten priorities agreed upon in the workshop covered themes of improved understanding of pathophysiologlogy, improving health services, and managing long‐term effects of smell/taste disorders. The most important research question agreed was "How can we further our understanding of the mechanism of disease in the nerve pathways that affect smell and taste disorders, including where parosmia and phantosmia exist." Conclusion: We report the top 10 research priorities in smell and taste disorders. These priorities will now empower researchers to secure research funding and provide the basis of the FifthSense research hub. [ABSTRACT FROM AUTHOR]

Objectives: Smell/taste disturbances are a common but underrated, under‐researched and under treated sensory loss and an independent risk factor for reduced longevity. This study aimed to characterise the experience of patients with these disorders in seeking help. Design: The study was designed by patients together with clinicians through a dedicated workshop and conducted as a cross‐sectional survey to capture experiences in public and private healthcare settings internationally. Setting: Primary, secondary and tertiary care. Participants: Any members of the public self‐reporting a smell/taste disorder were invited to participate. Main outcome measures: The survey captured information including experience of getting consultations and referrals to medical professionals, treatments offered, costs incurred and related problems with mental health. Results: Of 673 participants; 510 female, 160 male, three not stated, self‐reported aetiology included sinonasal disease (24%), idiopathic (24%) and post‐viral olfactory dysfunction (22%); true gustatory disorders were typically rare. Failure of medical professionals to recognise the problem was a key concern ‐ 64%, 76% and 47% of GPs, ENT specialists and Neurologists acknowledged, respectively. Other issues included repeated ineffective treatments, difficulties getting referrals to secondary/tertiary care, mental health problems (60%) and a mean personal cost of £421 to seeking advice and treatment. Whilst the participants were self‐selecting, however, they do represent those who are seeking help and intervention for their disorders. Conclusion: There is an unmet need for these patients in accessing health care including a clear need to improve education of and engagement with the medical profession in Otorhinolaryngology, General Practice and other specialties, in order to remove the current barriers they face. [ABSTRACT FROM AUTHOR]

Introduction: Olfactory testing must be culturally adapted to be relevant to the target population. This study aimed to validate the Sniffin' Sticks test for the UK setting. Methods: A cohort study was conducted at a tertiary olfactory dysfunction clinic. Phase 1—healthy volunteers underwent the original German identification test followed by a UK adapted version. Phase 2—patients with olfactory dysfunction underwent the extended smell test (TDI) including the new descriptors. Outcome measures included differences in identification test (phase 1), retest reliability and differences in scores before and after treatment. Results: A total of 31 healthy volunteers and 87 patients were recruited (6 and 31 males, respectively). Phase 1—mean identification scores showed a small improvement after descriptor adaptations (13.77 and 14.57, p = 0.0029). Phase 2—41 untreated participants had a mean identification score of 7.31 at both intervals (95% CI: − 1.15 to 1.15, p > 0.999). The mean change in treated participants was 1.88 (0.70 to 3.06, p = 0.0224). TDI score difference between treated and untreated groups was 6.63 (2.48 to 10.79, p = 0.0023). The intraclass correlation coefficient for untreated patients was high for both TDI score (ICC = 0.82, 95% CI 0.57 to 0.93) and identification score (ICC = 0.80, 0.52 to 0.93); CIs suggest the reliability is moderate to excellent. Conclusions: This study confirms the validity of the descriptor adaptations of the identification component of the Sniffin' Sticks test to distinguish between health and disease. Implications: The Sniffin' Sticks test can now reliably be used for clinical assessment of British patients, modifying only the descriptors. [ABSTRACT FROM AUTHOR]

Introduction: To highlight the importance of the need for new treatment modalities, this study aimed to characterise the experience of patients with postinfectious olfactory dysfunction (PIOD) in terms of the treatment they received. Methods: An online survey was hosted by the Norwich Clinical Trials Unit on the secure REDCap server. Members of the charity Fifth Sense (the UK charity that represents and supports people affected by smell and taste disorders) were invited to participate. Results: There were 149 respondents, of whom 127 had identified themselves as having (or had) PIOD. The age range of respondents to the survey was 28–85 years, with a mean of 58 ± 12 years, with the duration of their disorder <5 years in 63% of cases. Respondents reported experiencing variable treatment with oral and/or intranasal steroids given typically (28%), often with no benefit, but with 50% receiving no treatment whatsoever; only 3% reported undertaking olfactory training. Over two-thirds of patients experience parosmia and, up to 5 years from the onset of the problem, were still actively seeking a solution. Conclusion: There appears to be a need to encourage greater use of guidelines for olfactory disorders amongst medical practitioners and also to develop more effective treatments for patients with PIOD, where there is clearly an unmet need. [ABSTRACT FROM AUTHOR]

Objectives: To assess the safety of paediatric tonsillectomy procedures conducted in NHS hospitals in England between 2008 and 2019. Design: Retrospective observational cohort study using Hospital Episode Statistics (HES) data. Setting: Acute NHS trusts in England conducting paediatric tonsillectomy procedures. Participants: Children (≤16 years old) undergoing bilateral tonsillectomy. Main outcome measures: Number of tonsillectomies performed per year by procedural method. In‐hospital complications including return to theatre for arrest of haemorrhage. Readmission within 28 days, including those for pain, haemorrhage and surgical arrest of haemorrhage. Long‐term outcomes: all‐cause mortality, revision tonsillectomy. Results: A total of 318 453 paediatric tonsillectomies were performed from 2008 to 2019:278,772 dissection (87.5%) and 39 681 coblation (12.5%). The proportion of tonsillectomy performed using coblation increased from 7% in 2008/9 to 27% in 2018/9. Five patients died in hospital (including 4 due to respiratory complications). In‐hospital complications occurred in 4202 children (1.3%), with the most frequent being haemorrhage. Within 28 days of tonsillectomy, 28 170 patients (8.8%) were readmitted and 7 deaths occurred. Readmission rates for haemorrhage and pain have increased since 2008. The proportion of children undergoing revision tonsillectomy procedures within 5 years following coblation tonsillectomy (1.4%) was approximately double that of dissection (0.6%). Conclusions: Clinical practice of paediatric tonsillectomy has changed in England over the past 11 years. The overall mortality rate associated with the procedure is 0.0037%. Differences in outcomes have been identified for different procedural methods. However, routine administrative data are limited in differentiating procedural detail (eg we are unable to differentiate intra or extra‐capsular techniques from current clinical coding of tonsillectomy procedures). Therefore, prospective national data collection or more granular clinical coding is essential to capture relative outcomes of the different tonsillectomy methods and techniques being used in the NHS. [ABSTRACT FROM AUTHOR]

Objectives: Conebeam computed tomography (CBCT) imaging is commonly requested by dental implant surgeons, preoperatively, for patients being considered for dental implants. Incidental maxillary sinus findings often result in otolaryngology (ENT) referral for further assessment. CBCT findings include transient and benign mucosal changes that may not require any intervention and therefore unnecessarily delay implant surgery. We aim to define appropriateness criteria for ESS in the management of adult dental implant patients with incidental maxillary sinus findings on CBCT and provide guidance to both dental implant and ENT surgeons. Design: The RAND/UCLA appropriateness methodology was used to develop and define the appropriateness criteria. Setting: A virtual panel of 13 international experts in ESS. Participants: The expert panel completed two rounds of a modified Delphi ranking process for nine clinical scenarios, considering various factors affecting decision‐making processes. Main outcome measures: To define appropriateness criteria for ESS in adult dental implant patients who have incidental maxillary sinus findings on CBCT. Results: Patients with clinical symptoms and endoscopic findings of chronic rhinosinusitis together with an obstructed ostiomeatal complex (OMC) and concentric mucosal thickening of the ipsilateral maxillary sinus or pansinusitis were deemed appropriate candidates for ESS prior to their dental implant. ESS was not appropriate in asymptomatic patients with a patent OMC and mucosal thickening isolated to floor of the ipsilateral maxillary sinus. For uncertain scenarios, further discussion between dental implant and ENT surgeon should be considered. Conclusions: This study has developed and reported a list of appropriateness criteria to offer ESS in adult dental implant patients with incidental maxillary sinus findings on CBCT. [ABSTRACT FROM AUTHOR]

Objective: To explore the relative frequency of a family history of cholesteatoma in patients with known cholesteatoma, and whether bilateral disease or earlier diagnosis is more likely in those with a family history. Associations between cleft lip or palate and bilateral disease and age of diagnosis were also explored. Design: An online survey of patients with diagnosed cholesteatoma was conducted between October 2017 and April 2019. Participants: The sample consisted of patients recruited from two UK clinics and self‐selected respondents recruited internationally via social media. Main outcome measures: Side of cholesteatoma, whether respondents had any family history of cholesteatoma, age of diagnosis and personal or family history of cleft lip or palate were recorded. Results: Of 857 respondents, 89 (10.4%) reported a positive family history of cholesteatoma. Respondents with a family history of cholesteatoma were more likely to have bilateral cholesteatoma (P =.001, odds ratio (OR) 2.15, 95% confidence interval (CI) 1.35‐3.43), but there was no difference in the age of diagnosis (P =.23). Those with a history of cleft lip or palate were not more likely to have bilateral disease (P =.051, OR 2.71, CI 1.00‐7.38), and there was no difference in age of diagnosis (P =.11). Conclusion: The relatively high proportion of respondents that reported a family history of cholesteatoma offers supporting evidence of heritability in cholesteatoma. The use of social media to recruit respondents to this survey means that the results cannot be generalised to other populations with cholesteatoma. Further population‐based research is suggested to determine the heritability of cholesteatoma. [ABSTRACT FROM AUTHOR]

Objectives: There are large numbers of patients with olfactory disturbance in the UK and shortfalls in assessment and support amongst mainstream practice in both primary and secondary care leading to significant quality‐of‐life impairment and potential missed diagnoses. The aim of this study was to determine the key themes which can be identified from the accounts of anosmia sufferers and to identify important areas to target for future research or service development. Design: Qualitative analysis of written patient accounts from patients corresponding with a tertiary smell and taste clinic in the UK. This qualitative study utilised unstructured written patient accounts from consenting patients experiencing olfactory disturbances received by the smell and taste clinic. Framework analysis was performed using Nvivo 10 software. Setting: Tertiary smell and taste clinic. Participants: Consenting patients who contacted the smell and taste clinic with accounts of their experiences. Main outcome measures: Themes generated by qualitative analysis with Nvivo software. Results: Accounts submitted by 71 participants were included in the analysis; age range 31‐80 years, 45 females, 26 males. Themes identified include negative emotional impact, feelings of isolation, impaired relationships and daily functioning, impact on physical health and the difficulty and financial burden of seeking help. Conclusions: Olfactory disturbances have a wide‐ranging impact on the lives of sufferers, compounded by a lack of knowledge of the disorder amongst clinicians. There is a role for further support and education both for sufferers and for clinicians, as well as a need to improve our understanding of olfactory disturbance. [ABSTRACT FROM AUTHOR]

Objectives: To adapt the existing German language olfactory disorders questionnaire for use with English‐speaking patients. To validate the adapted version for routine clinical use. Design: The translated version of the original German questionnaire was revised with a patient and a clinician to reflect British language and culture. Patients attending an olfactory dysfunction clinic were recruited to perform the adapted questionnaire on two occasions at least 1 month apart. Additional online participants completed the questionnaire via the charity Fifth Sense. Main outcome measures: Retest reliability of the English olfactory disorders questionnaire (eODQ) in affected patients including potential for redundancy in any of the included questions. Correlation of eODQ scores with Sniffin' Sticks scores. Results: Eighty‐seven patients reporting olfactory dysfunction were recruited and had a mean age of 48 with 35% of them being male; 50 datasets were available for analysis. A total of 957 members of the charity entered responses into the online questionnaire; 699 responses could be scored with participants' mean age of 55 years and with 69% reporting as female. The eODQ score and Sniffin' Sticks threshold, discrimination and identification score at timepoint 1 were correlated to assess for concurrent validity, (r = −0.15, P = 0.17) and showed no significant correlation. Female participants had a significantly higher mean total eODQ score than men, 55.75 compared to 52.28 (P = 0.001). The average score was 54.7 (SD 13.5) with a range from 26 to 87. The internal consistency of the questionnaire was good with a Cronbach's alpha of 0.90 (confidence intervals 0.89, 0.91). Conclusions: The results of this study support the use of the eODQ in a native English‐speaking population and highlight the different distinctions between "objective" testing of olfaction with the Sniffin' Sticks test, and the patient reported impact of olfactory dysfunction on daily life. These two types of assessment can be easily administered in an outpatient setting and used in the assessment and management of olfactory dysfunction. [ABSTRACT FROM AUTHOR]

Objectives To explore patient views and perspectives of current management of chronic rhinosinusitis (CRS) in primary and secondary care. Design Semistructured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic RhinOsinusitis). Setting Primary care and secondary care ear, nose and throat outpatient clinics in the UK. Participants Twenty-five patients consented to in-depth telephone interviews. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis. Results CRS has a significant impact on patients' quality of life, affecting their ability to work effectively, their social interactions and daily living. Patients seek help when symptoms become unmanageable, but can become frustrated with the primary care system with difficulties obtaining an appointment, and lack of continuity of care. Patients perceive that general practitioners can be dismissive of CRS symptoms, and patients often prioritise other concerns when they consult. Health system barriers and poor communication can result in delays in accessing appropriate treatment and referral. Adherence to intranasal steroids is a problem and patients are uncertain about correct technique. Nasal irrigation can be time-consuming and difficult for patients to use. Secondary care consultations can appear rushed, and patients would like specialists to take a more 'holistic' approach to their management. Surgery is often considered a temporary solution, appropriate when medical options have been explored. Conclusions Patients are frustrated with the management of their CRS, and poor communication can result in delays in receiving appropriate treatment and timely referral. Patients seek better understanding of their condition and guidance to support treatments decisions in light of uncertainties around the different medical and surgical options. Better coordinated care between general practice and specialist settings and consistency of advice has the potential to increase patient satisfaction and improve outcomes. [ABSTRACT FROM AUTHOR]

Background: Given the differences in pathophysiology between allergic fungal rhinosinusitis (AFRS) and other chronic rhinosinusitis (CRS) subgroups, it remains unclear about whether these patients respond differently to a combination of surgical and medical treatments. Objective: To evaluate differences in quality-of-life (QoL) outcomes for a cohort of patients who underwent endoscopic sinus surgery (ESS) for CRS. Methods: This retrospective review included patients with CRS who underwent ESS between 2010 and 2013. QoL was measured by using the 22-item Sino-Nasal Outcome Test (SNOT-22). Variables collected included baseline demographics, SNOT-22 scores before ESS and at 1, 3, 6, 9, and 12 months after ESS. Groups tested were CRS with nasal polyposis, CRS without nasal polyposis (CRSsNP), and patients with AFRS. A linear mixed- effects regression model was used to calculate the adjusted mean QoL differences. Results: Among the 250 patients included, 61.6% had CRS with nasal polyposis (n = 154), 28.8% had CRSsNP (n = 72), and 9.6% had AFRS (n = 24). Significant differences were seen in SNOT-22 scores between pre- and postoperative visits and between the etiologic subgroups (p < 0.001). Multivariate analysis revealed significantly greater improvement in QoL for patients with AFRS in comparison with those with CRSsNP at the 9-month follow-up (change in SNOT-22 score, 22.6 [95% confidence interval, 1.2-44.1]; p < 0.0) and the 12-month follow-up (change in SNOT-22 score, 20.2 [95% confidence interval, 0.5-39.9]; p < 0.04). Conclusions: Patients with AFRS experienced a more-prolonged QoL benefit from surgical and targeted medical intervention compared with those with CRSsNP, which may reflect the severity of inflammation that they presented with compared with other CRS subtypes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this analysis is to explore views of patients with chronic rhinosinusitis (CRS) about of the aetiology of their respiratory symptoms and the relationship between upper and lower respiratory symptoms.Methods: This study is part of a larger mixed methods study investigating the epidemiology of CRS, which comprises a questionnaire study of patients with CRS and controls and a qualitative study of 21 patients with CRS. Semi structured qualitative interviews were undertaken with these patients; 11 males and 10 females. Twelve patients had asthma. Patients were recruited with a tertiary outpatient rhinology clinic. Interviews were transcribed verbatim and analysed using thematic analysis, using Nvivo software (QSR International, Melbourne, Australia). Several important and recurring themes were highlighted.Results: Patients described many perceived triggering factors and an interaction between upper and lower respiratory tract symptoms. They felt that their symptoms could be managed more holistically.Conclusions: Concerns about triggers of respiratory symptoms and interactions between upper and lower respiratory symptoms are of significant concern to patients. These should be appropriately managed and acknowledged in formal treatment pathways, for example, through the use of combined ENT/respiratory clinics. [ABSTRACT FROM AUTHOR]

Olfactory disorders are believed to affect 5% of the general population and have been shown to bear significant psychosocial consequences to sufferers. Although more common than blindness and profound deafness in the United Kingdom, the impact of these disorders has not been assessed to date and the plight of British patients has yet to be quantified. In 2012, a patient support organization, Fifth Sense, was founded to provide information and support to sufferers of chemosensory disorders. Following a recent members conference, a survey of the membership was conducted anonymously using a series of questions based on an existing olfactory disorders questionnaire. From 496 respondents, this has demonstrated high rates of depression (43%) and anxiety (45%), impairment of eating experience (92%), isolation (57%), and relationship difficulties (54%). Women appear to have significantly more issues than men in terms of social and domestic dysfunction relating to olfactory loss (P = 0.01). Qualitative disorders also affected more than 1 in 5 members with parosmia reported in 19% and phantosmia in 24%. This paper discusses the details of the British story of anosmia and other related disorders as depicted by those most affected. [ABSTRACT FROM AUTHOR]

We present a case of long-standing unilateral cacosmia in a healthy 67-year-old man due to maxillary fungal infestation. Treatment with septoplasty had been attempted 10 years prior but no further investigation or management undertaken and symptoms continued. Subsequent MRI scan revealed significant opacification of the left maxillary sinus. This was readily amenable to treatment by balloon sinuplasty. This yielded viscous grey mucus which grew Scedosporium apiospermum. The case highlights the need for careful investigation of olfactory symptoms, including blood tests to exclude systemic causes, endoscopy and imaging where indicated. [ABSTRACT FROM AUTHOR]

Objective: To correlate patient reports of olfactory dysfunction after surgical intervention for allergic fungal rhinosinusitis (AFRS) with endoscopic findings, psychophysical testing, and quality-of-life scores. Design: A prospective cohort study. Setting: A tertiary care rhinology clinic at St Paul's Hospital, Vancouver, British Columbia, Canada. Patients: Eighty-one patients with AFRS seen at routine postoperative follow-up. Main Outcome Measures: The Sniffin' Sticks test and a visual analog scale for the perceived olfactory ability of patients with AFRS were administered, along with a 36-Item Short-Form Health Survey. An endoscopic staging score was assigned for each patient. Results: Forty men and 41 women with AFRS underwent olfactory testing; 52 of these individuals completed all parts of the assessment. The mean threshold, discrimination, and identification score was 19 (hyposmic), with a significant correlation between patients' performance on the Sniffin' Sticks test and endoscopic staging, as well as their reported olfactory ability (P<.001 for all 3 tests). The mean score for the 36-Item Short- Form Health Survey was 71, but there was a poor correlation between it and the threshold, discrimination, and identification score; visual analog scale; and endoscopic scores (P<.05 for all 3 tests). Conclusion: All patients with AFRS should be evaluated with olfactory testing and treated according to the results. [ABSTRACT FROM AUTHOR]

Nanotechnology and nanomedicine are new and rapidly developing areas which are concerned with the utilisation of structures and devices, one billionth of a metre in scale and how their special properties may be utilised in the diagnosis and treatment of diseases. In otorhinolaryngology, there have been some inroads into utilising these new treatment modalities and there is future prospect for significant developments. Their impact may be to revolutionise the current practice of otorhinolaryngology. This review considers current developments and future prospects for nanotechnology in our specialty and considers the pitfalls that may be encountered. The online medical reference databases PubMed, Google Scholar, ISI Web of Science and Science Direct were searched with search terms 'Nanotechnology, Nanomedicine' in combination with 'Otolaryngology, ENT, Rhinology, Otology, Head and Neck Surgery, Laryngology' in turn. A number of developments are already showing promise in animal models, particularly for nanoparticle delivery of drugs, which may avoid some of the inherent systemic side effects seen with conventional application. Other possibilities include nanoscale reconstruction and regeneration of tissues and even unexpected spin-off technologies such as haemostatic agents. The future treatment of otorhinolaryngological diseases could be revolutionised by advances in nanomedicine and nanotechnology and diseases, such as olfactory disorders may become radically more amenable to medical treatment. [ABSTRACT FROM AUTHOR]

The Messerklinger technique is an endoscopic approach to sinus surgery designed to be minimally invasive and preserve mucosa and hence physiological function. More recently there have been advocates for more radical endoscopic approaches to the frontal sinus such as the Modified Lothrop. This review discusses different approaches to frontal sinus surgery including any advantages and disadvantages to each approach. After examining the evidence from the literature, meticulously performed endoscopic frontal sinusotomy with or without computer guidance appears to be the most effective minimally invasive procedure for treating chronic frontal sinusitis secondary to outflow tract obstruction. Properly performed, it is almost always effective in dealing with even the most diseased frontal sinus. It offers clear advantages in reducing complications and recurrence rates in frontal sinus disease, even for revision cases. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: The Messerklinger technique is an endoscopic approach to sinus surgery designed to be minimally invasive and preserve mucosa and therefore physiological function. More recently there have been advocates for more radical endoscopic approaches to the frontal sinus such as the modified Lothrop procedure. This study aims to determine the effectiveness of endoscopic frontal sinusotomy in preventing recurrent frontal sinus disease and the need for any revision frontal sinus surgery. Study Design: Retrospective data review. Methods: A retrospective review of the chronic rhinosinusitis database at St. Paul's Sinus Centre was performed, randomly selecting 200 patients who had undergone primary bilateral functional endoscopic sinus surgery between 2000 and 2009. Any endoscopic or radiological recurrences listed on the database were counted along with the number of cases returned to theater for revision surgery. The preoperative Lund-Mackay score was also extracted from the database. Results: In the 200 patients who had undergone their primary surgery at St. Paul's Hospital, the recurrence rate of frontal sinus disease was 19%, with less than one half (8%) requiring revision surgery. The Lund-Mackay scores showed no correlation between disease severity and the incidence of recurrence (P = .35), and there was no difference between polyp and nonpolyp forms of chronic rhinosinusitis (P = .14). A comparison with 100 patients in the database who had received their primary surgery at another center showed that the revision patients had a recurrence rate of 34% and a revision rate of 21%. The patients who did not receive surgical revision were treated satisfactorily with topical medications in the outpatient clinic. Conclusions: Meticulously performed endoscopic frontal sinusotomy with computer guidance appears to be an effective minimally invasive procedure to treat chronic frontal sinusitis secondary to outflow tract obstruction. Properly performed, it is effective in dealing with the most diseased frontal sinus. It offers clear advantages in reducing complications and recurrence rates in frontal sinus disease even in revision cases. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Objectives: To assess whether or not patients receiving rhinoplasties following nasal trauma sought intervention for a functional or cosmetic reason and look at underlying psychosocial influences. Methods: A cross-sectional questionnaire study was performed in the setting of otorhinolaryngology outpatient clinics in the Cambridge University Hospitals. New patients referred to the clinic with nasal deformities secondary to recent trauma were included. To provide a control group, new patients attending for nonrhinological reasons were also asked to complete 2 questionnaires (a study specific one and the SF36). The age range of patients was 21 to 66 years in the control group and 17 to 67 years in the rhinoplasty group. Results: Patients attending for rhinoplasty were more likely to be male (79% vs 37%, P = .008) and have had previous nasal trauma (relative risk = 2.14, P = .0086) They neither had significantly higher scores for the SF36 or higher alcohol consumption nor were more likely to participate in contact sports than the control group nor did they differ significantly in terms of social class. Conclusion: This study did not find evidence that posttrauma rhinoplasty patients are anymore introspective and depressed than the normal control population and that function was the predominant concern over cosmesis. [ABSTRACT FROM AUTHOR]

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Objective: To see if nasal peak inspiratory flow rate and subjective sense of smell had any correlation with olfactory thresholds. Study design and setting: A cohort study of 186 normal volunteers was recruited from among staff and visitors at a university hospital. Olfactory thresholds were detected for each subject (103 with eucalyptol and 83 with phenethyl alcohol), along with nasal peak inspiratory flow (PIFR). Subjective sense of smell, along with nasal symptoms, mood, and alertness, were recorded on visual analogue scores. Results: Subjective perception of smell had no correlation with olfactory thresholds detected (P = 0.4057) and the other subjective measures also had no correlation. There was a significant relationship of PIFR to thresholds in the group tested with phenethyl alcohol (P = 0.002). Conclusion: As with the sensation of nasal patency, the self-assessment of a subject’s sense of smell has poor correlation with their actual olfactory ability. Significance: A patient’s history cannot be relied upon when determining their olfactory ability and formal testing should be performed. EBM rating: A-1b [Copyright &y& Elsevier]

Background: Chronic rhinosinusitis (CRS) is a common disorder associated with other respiratory tract diseases such as asthma and inhalant allergy. However, the prevalence of these co-morbidities varies considerably in the existing medical literature and by phenotype of CRS studied. The study objective was to identify the prevalence of asthma, inhalant allergy and aspirin sensitivity in CRS patients referred to secondary care and establish any differences between CRS phenotypes.Methods: All participants were diagnosed in secondary care according to international guidelines and invited to complete a questionnaire including details of co-morbidities and allergies. Data were analysed for differences between controls and CRS participants and between phenotypes using chi-squared tests.Results: The final analysis included 1470 study participants: 221 controls, 553 CRS without nasal polyps (CRSsNPs), 651 CRS with nasal polyps (CRSwNPs) and 45 allergic fungal rhinosinusitis (AFRS). The prevalence of asthma was 9.95, 21.16, 46.9 and 73.3% respectively. The prevalence of self-reported confirmed inhalant allergy was 13.1, 20.3, 31.0 and 33.3% respectively; house dust mite allergy was significantly higher in CRSwNPs (16%) compared to CRSsNPs (9%, p < 0.001). The prevalence of self- reported aspirin sensitivity was 2.26, 3.25, 9.61 and 40% respectively. The odds ratio for aspirin sensitivity amongst those with AFRS was 28.8 (CIs 9.9, 83.8) p < 0.001.Conclusions: The prevalence of asthma and allergy in CRS varies by phenoytype, with CRSwNPs and AFRS having a stronger association with both. Aspirin sensitivity has a highly significant association with AFRS. All of these comorbidities are significantly more prevalent than in non-CRS controls and strengthen the need for a more individualised approach to the combined airway. [ABSTRACT FROM AUTHOR]

Objectives: This analysis uses data from the Chronic Rhinosinusitis Epidemiology Study (CRES). The overarching aim of CRES is to determine factors which influence the onset and severity of chronic rhinosinusitis (CRS). Sino‐Nasal Outcome Test (SNOT‐22) is a widely used score for nasal symptoms in many ENT clinics internationally, although there are few data characterizing SNOT‐22 scores for a normal population. The aim of this analysis is to establish a dataset of normal values for SNOT‐22 in a British population. Methods: Study‐specific questionnaires including demographic and socioeconomic factors and past medical history as well as SNOT‐22 and SF‐36 were distributed to patients with CRS attending ENT clinics and to a control population across several centers in the United Kingdom. This analysis considered just the control population. Controls had no self‐reported nasal problems in the past, no chronic conditions undergoing active treatment, and no hospital admissions in the preceding 12 months. Results: A total of 1529 participants were recruited; 57 with AFRS (allergic fungal rhinosinusitis), 659 CRSwNP (with nasal polyps), 577 CRSsNP (without nasal polyps), and 236 controls. Age range was 18 to 98 years. Two hundred thirteen controls included sufficient information to calculate SNOT‐22 score. Score range was 0 to 85; median 9, mean 13.4. Conclusions: SNOT‐22 is an important tool for measuring the impact of nasal symptoms and evaluating effectiveness of treatments. Data for a large population without nasal problems will be invaluable in both clinical and academic settings. Further analysis will characterize SNOT scores for different types of CRS and subgroup analysis of different elements of SNOT‐22. [ABSTRACT FROM AUTHOR]

Objectives: There is currently conflicting level 1 evidence in the use of long‐term antibiotics for chronic rhinosinusitis. The primary aim of this study was to look at recruitment and retention of patients in preparation for a formal trial. The aim of this paper is to describe the preliminary outcomes in terms of symptomatic relief in patients with CRSsNP. Methods: Adult patients fulfilling the EPOS criteria for CRSsNPs with no prior surgery were recruited in 6 UK centers during 2013. Participants received a 12‐week course of clarithromycin 250 mg alongside topical mometasone and nasal douching, all twice daily. Follow‐up was at 3 months and 6 months. For the purpose of this analysis, the Sinonasal Outcome Test (SNOT‐22) score was recorded at baseline and both follow‐up assessments. Results: Preliminary data from 29 patients at 3 months and 24 patients at 6 months showed significant symptomatic improvement in mean SNOT‐22 scores on paired t tests at 3 months (40.4 to 33.7, P =. 026), which was sustained at 6 months (30, P =. 02). The number of subjects showing ≥9 point reduction in SNOT‐22 scores was 45% (n = 13), increasing to 58% at 6 months (n = 14). Nine patients have been listed for surgery to date. Conclusions: While the results here do not have the power of the full randomized controlled trial, the findings suggest that long‐term macrolides have the potential to achieve significant symptomatic reduction in approximately 50% of patients with CRSsNPs. [ABSTRACT FROM AUTHOR]

Objectives: Long‐term follow‐up of 1045 patients with chronic rhinosinusitis with nasal polyposis (CRSwNPs) in the national Sinonasal Audit demonstrated that at 5 years 20.6% of patients had undergone revision surgery. The aim of this study was to see if the Chronic Rhinosinusitis Epidemiology Study (CRES) data reflected a continued burden of revision surgery in patients with CRSwNPs. Methods: A prospective questionnaire‐based study at 30 sites around the UK of patients with CRS presenting to secondary care between October 2007 and September 2013. This paper presents a specific analysis of patients with CRS who reported undergoing sinus surgery. Results: A total of 651 patients with CRSwNPs, 553 with CRSsNPs, and 45 with AFRS were included in the CRES. 365 (57%) of patients with CRSwNPs/AFRS reported undergoing endoscopic nasal polypectomy (ENP) in which 175 (25% or 48% of surgical cases) reported having received more than one ENP. The mean number of ENPs per patient in the revision group was 3.3 with a range of 2 to 30. Only 27.9% of patients reported concurrent endoscopic sinus surgery (n = 102). For comparison, patients with CRSsNPs reported ESS in 13% of cases with only 17% of those surgical cases reporting multiple procedures (chi‐squared P <. 001). Conclusions: This study demonstrated a significantly higher burden of both primary and revision surgery to the health care system for patients with CRSwNPs. Extrapolation of these findings to the HES data for 2011 and 2012 would suggest a bill of approximately £5.3 million per year spent on revision surgery. [ABSTRACT FROM AUTHOR]

Objectives: This study is part of the Chronic Rhinosinusitis Epidemiology Study (CRES). The overarching aim is to determine factors that influence the onset and severity of chronic rhinosinusitis (CRS). The aim of this analysis is to determine the number of patients consulting with their family physician about anxiety or depression among those with CRS and controls. Methods: CRES is a mixed methods study of patients with CRS including qualitative interviews and study‐specific questionnaires. This analysis considers only the questionnaires. These included comprehensive questions about demographic and socioeconomic factors and past medical history as well as SNOT‐22 (nasal symptom score) and SF‐36 (quality of life tool). Questionnaires were distributed to patients with CRS attending general ENT and rhinology clinics within the National Health Service and private sector and to a control population across many centers in the United Kingdom from 2004 to 2013. Results: A total of 1519 participants, including 57 with AFRS (allergic fungal rhinosinusitis), 659 CRSwNP (with nasal polyps), 577 CRSsNP (without nasal polyps), and 236 controls. Self‐reported consultation with family physician for depression was 9 out of 57 (15.8%), 132 out of 659 (20.0%), 142 out of 577 (24.6%), and 36 out of 226 (15.9%), respectively. P <. 02 for differences between participant subgroups. For anxiety: AFRS 10 out of 57 (17.5%), CRSwNP 105 out of 659 (15.9%), CRSsNP 130 out of 577 (22.5%), controls 39 out of 236 (16.5%), P =. 04 between groups. Conclusions: There are differences in rates of consulting with family physicians for depression and anxiety disease between those with different types of CRS and controls; those with CRS without polyps were most likely to have consulted. This may influence management strategies for patients with different nasal pathologies. [ABSTRACT FROM AUTHOR]

Objective: Validate the applicability of Sniffin' Sticks in a UK population. These pen‐like odor dispensing devices are used to assess threshold, discrimination, and identification. Odor identification is strongly dependent on familiarity with the odors and has an important cultural component, which has limited the usefulness of other validated tests. Method: A prospective study of 63 subjects, 24 healthy volunteers with a reported normal sense of smell, and 39 patients with an impaired sense of smell presenting either at a rhinology or an olfactory disorder clinic. Each subject's olfactory function was assessed using the Sniffin' Stick test. Results: The mean age of the subjects tested was 46.7 years; 40 female and 23 male. In the patient group, 30 were hyposmic and 9 anosmic. In the healthy volunteers group, all subjects were normosmic. The mean TDI score for patients and healthy volunteers was 21.06 (range, 8‐30.5) and 33.73 (range, 29.25‐37.75) respectively. Mean identification score in the 2 groups was 8.84 (range, 1‐15) for patients (range) and 13.69 (range, 11‐16) for healthy volunteers. Conclusion: In our sample of the UK population the TDI and odor identification scores for healthy volunteers and patients with olfactory disorders are comparable with the normative data published on large samples of European populations. Discussion of commonly mistaken odors in the odor identification test is undertaken. [ABSTRACT FROM AUTHOR]

Problem: Rhinitis in pregnancy has been previously investigated piecemeal with contrasting results. This study examines all the variables of the nasal airway simultaneously for the first time.Methods: Eighteen women were recruited in the first trimester of pregnancy and followed through to the postpartum period to monitor the changes that occurred. Measurements of the nasal airway included anterior rhinoscopy, peak inspiratory nasal flow, acoustic rhinometry, anterior rhinomanometry, and saccharin test with rhinitis questionnaire scores providing a symptomatic measurement.Results: All the tests showed a trend consistent with decreasing nasal patency when expressed as an average for the group as a whole, although only anterior rhinoscopy, anterior rhinomanometry, mucociliary clearance time, and rhinitis questionnaire scores were statistically significant (P < 0.05).Conclusion: This confirms the effect of pregnancy on the nasal mucosa and coincides with the rise in the serum concentration of the female sex hormones with gestational age, returning to normal postpartum.Significance: Pharmacological antagonism of oestrogens may therefore relieve nasal congestion and is currently under further research.Support: None reported. [Copyright &y& Elsevier]

Problem: The changes in the nasal mucosa during the female menstrual cycle have been little researched and the role of oestrogens debated. The aim of this study was to measure a spectrum of physiological parameters in relation to the peak and trough of these hormonal levels.Methods: Ten women underwent measurements at the onset of menses and at the time of ovulation. On each occasion, anterior rhinoscopy, peak inspiratory nasal flow, acoustic rhinometry, anterior rhinomanometry, mucociliary clearance time, and rhinitis questionnaire score were recorded.Results: All measurements except anterior rhinoscopy showed a difference between the 2 readings consistent with nasal congestion at the peri-ovulatory stage of the cycle, of which anterior rhinomanometry and mucociliary time were significant (P < 0.05).Conclusion: Nasal congestion therefore occurs in conjunction with the rise in serum oestrogens that occur at ovulation in the normal menstrual cycle.Significance: Pharmacological antagonism of oestrogens may therefore relieve nasal congestion and is currently under further research.Support: None reported. [Copyright &y& Elsevier]