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Abstract The relationship between obstructive sleep apnea (OSA) and chronic rhinosinusitis (CRS) has not yet been fully elucidated. Therefore, the objective of this study was to evaluate the connection between OSA risk and CRS by investigating associations between the STOP-Bang questionnaire and presence of CRS in a nationwide, population-based study. This is a cross-sectional study based on the Korean National Health and Nutrition Examination Survey (KNHANES). We evaluated 10,081 subjects who completed both the STOP-Bang and CRS-related questionnaires. Among the total subjects, 390 (3.9%) were CRS patients. The median STOP-Bang score was 3.0 [2.0; 4.0] in CRS patients, compared to 2.0 [1.0; 3.0] in subjects without CRS. In a low-risk group according to the STOP-Bang questionnaire, 3.1% of subjects were CRS patients. However, a gradual increase was observed among different risk groups. In the higher risk group, CRS patients accounted for 5.3% (P

Abstract Objectives Chronic rhinosinusitis is one of the common diseases that cause morbidity and affects a person's quality of life. We tried to provide a more appropriate and effective approach to selecting patients for endoscopic sinus surgery. Methods The study population is chronic rhinosinusitis children referred to the ear, nose, and throat clinic of two general hospitals in Tehran, Iran, who have previously undergone sufficient drug treatment and have not recovered. The Lund–Mackay score is calculated by examining the computed tomography (CT) scan. The Sino‐nasal Outcome Test‐22 (SNOT‐22) questionnaire was provided to the patients before the operation, after the operation, and 3 and 6 months later in the clinic. Results Before the operation, the most SNOT‐22 score people were in the range of 40–59 points. The SNOT‐22 score before the operation is significantly different from 3 and 6 months after the operation. The highest frequency of Lund–Mackay CT (LMCT) scan score was in the range of 18–23 points. The LMCT scan score did not show any significant relationship with the SNOT‐22 score before surgery, 3 months, and 6 months after surgery. Sensitivity to aspirin had a significant relationship with SNOT‐22 scores and the history of asthma and nasal polyps had a significant relationship with the preoperative LMCT scan score. Conclusions The LMCT scan scoring system cannot be a good measure of chronic rhinosinusitis severity or the prognosis of patients after surgery. The SNOT‐22 questionnaire can be used as a predictive tool to help the doctor and the patient in deciding to operate and the possibility of obtaining a relative recovery.

No abstract available. Article truncated after 150 words. A 79-year-old man presented to our institution for evaluation of intermittent fevers, profound nasal pain with congestion, cough, sore throat, voice changes, fatigue, generalized weakness, and loose stools which had been progressively affecting the patient for the last 6 months. The patient has a past medical history of ulcerative colitis, hypothyroidism, atrial fibrillation, and hypertension. Just preceding the onset of symptoms, the patient had gone on a month-long trip through Africa and Asia. His symptoms were presumed infectious in the outpatient setting and had responded somewhat to an extended course of ciprofloxacin and metronidazole. The patient had an outpatient head and neck CT that demonstrated significant mucosal thickening of the maxillary sinuses (Figure 3A). An outside hospital CT of the abdomen/pelvis was unremarkable aside from sigmoid diverticulosis. The patient’s significant nasal pain and congestion along with the fevers was suggestive of granulomatosis with polyangiitis (GPA). The differential also included hematologic …

Introduction: Unknown fever in critically ill patients could be caused by occult sinusitis, which may also be related to healthcare interventions. The aim of this study was to uncover the correlation between a tube in the upper airways and children’s susceptibility to sinusitis. Methods: We retrieved data retrospectively and evaluated radiological images for the presence of nasogastric (NG) and endotracheal (ET) tubes, as well as any findings of sinusitis or nasopharyngeal (NF) secretions. We also recorded the intervals between the images. Results: The study included 65 patients with a total of 162 images. The results showed a significant increase in the occurrence of sinusitis between the first (13/30, 43.3%) and second (20/30, 66.6%) images (p=0.039). The cut-off time for the onset of sinusitis was found to be 2.5 days [area under the curve: 0.50, 95% confidence interval (CI): 0.355-0.646]. There was no significant difference in the occurrence of sinusitis or NF secretion formation between single or double tubes (p=0.389). The presence of an NG or ET tube also did not show a significant relationship with sinusitis. However, the study found that NF secretions were present in 52% of images with an ET tube [p=0.004, odds ratio (OR): 6.21, 95% CI: 0.001-0.003] and 84% with an NG tube (p=0.003, OR: 6.9, 95% CI: 0.001-0.003). Conclusion: The placement of NG and ET tubes, separately or combined, can raise the likelihood of sinusitis development in critically ill children due to reduced clearance of NF secretions.

A 17-year-old boy presented with a high-grade fever. The patient had been previously diagnosed with Cornelia de Lange syndrome (CdLS). The patient visited a local physician and was diagnosed with sinusitis. Owing to persistent fever, the patient was referred to our hospital. At the initial presentation, his body temperature was 38.2°C, while maintaining previous living activities and neurological function. Despite changing the antibiotic to amoxicillin, the patient's fever persisted with worsened activity. At the second presentation, the patient presented with left hemiparesis. Blood examination revealed increased white blood cell count and serum C-reactive protein level. Emergency magnetic resonance imaging revealed acute cerebral infarcts in the right cerebral hemisphere, with evident stenosis in the right paraclinoid segment of the internal carotid artery (ICA). In addition, an abscess was found in the cerebellar hemisphere, which was punctured through the burr hole. Computed tomography performed after the completion of antibiotic therapy revealed a restored diameter of the stenotic ICA. Sinusitis can cause ischemic stroke due to compressive stenosis of the paraclinoid ICA, particularly in patients with CdLS. Sinusitis should be preferentially managed in patients with CdLS.

Background Orbital complications arising from acute rhinosinusitis (ARS) are a major concern for clinicians and serve as important warning indicators of ARS. Prompt recognition and appropriate management are crucial for preventing potential vision-threatening sequelae. Orbital complications of rhinosinusitis are markedly more common in children than in adults. The aim of this study was to investigate the clinical characteristics and treatment outcomes of orbital complications of ARS in adult patients. Methods This retrospective observational cohort study analyzed the medical records of 176 patients admitted for orbital cellulitis/abscess (ICD code: H050) who underwent orbit or paranasal computed tomography from January 2001 to February 2022 at a tertiary hospital. Results Eighteen adults with a mean age of 53.2±18.9 years were diagnosed with orbital complications due to ARS: five (27.8%) had preseptal cellulitis, eight (44.4%) had orbital cellulitis, and five (27.8%) had subperiosteal orbital abscess. None of the patients had an orbital abscess or cavernous sinus thrombosis. All patients had unilateral orbital complications (7 right and 11 left) and were managed with intravenous antibiotics for an average of 10.3±6.6 days. Five patients with subperiosteal orbital abscesses underwent intranasal endoscopic drainage at an average of 1.4±1.9 days after admission, while two patients required additional external drainage. Complete recovery was observed in all patients. Conclusions Conservative antimicrobial therapy can be effective for treating orbital complications from ARS, and not all adult patients require immediate surgical intervention for subperiosteal abscesses. Nonetheless, careful monitoring is essential, and an ophthalmologist must check patients’ visual acuity to prevent irreversible blindness.

Introduction: Maxillary sinus pathology, particularly its association with odontogenic infections, is a significant concern in dentistry. This retrospective study explored the prevalence of maxillary sinus pathologies and their association with odontogenic infections in Saudi Arabia. Methods: This retrospective study included 411 patients aged 20–80 years. Cone-beam computed tomography was performed to identify the presence, location, and characteristics of odontogenic infections and maxillary sinus pathologies. Patients’ age and sex were also recorded. Results: Sinusitis was prevalent in 50.6 % of the cases, with no significant sex or age differences in the pathology distribution. A notable association was found between odontogenic and sinus pathologies, particularly on the left side. Conclusion: A significant prevalence of sinus pathologies, particularly sinusitis, was observed, with an association between odontogenic and sinus pathologies, notably on the left side. While acknowledging the limitations of the study, these findings underscore the need for integrated dental and sinus health assessments.

Background: Pott’s Puffy tumor (PPT) is a complicated frontal sinusitis that is also described as frontal bone osteomyelitis and a localized sub periosteal abscess. Early diagnosis and immediate active treatment are necessary to prevent severe neurologic sequelae. Case Presentation: Here, we report on a case of Pott’s puffy tumor in a previously healthy 13-year-old girl with a worsening headache and swelling of the frontal bone accompanied by vomiting and fever. Magnetic resonance imaging revealed osteomyelitis of the frontal bone. A foreign body was discovered and removed via endoscopy which was then followed by 6 weeks of parenteral and enteral antibiotic therapy, resulting in resolution of all symptoms. Conclusion: A complete history in terms of trauma and insect bite or foreign body in the nose is paramount for a correct diagnosis, and performing a full examination of ear, nose and throat (ENT) to rule out a foreign body is advised.

Abstract Background Headache is a common occurrence after endoscopic endonasal surgery (EES) for pituitary adenomas and significantly impacts the quality of life of patients. This study aims to investigate the effectiveness of nasal irrigation in relieving postoperative headache after EES. Methods A retrospective analysis was conducted on a cohort of 101 patients (Cohort I) who underwent EES for pituitary adenomas to explore the risk factors associated with postoperative headache. Another cohort of 72 patients (Cohort II) who received adjuvant nasal irrigation following surgery was enrolled for further analysis. The Headache Impact Test (HIT-6) was used to score the severity of headache, and patients with a HIT score > 55 were classified as having headache. Results In Cohort I, 21.78% of patients experienced headache one month after EES, which decreased to 5.94% at the three-month follow-up. Multivariate analysis revealed that postoperative nasal sinusitis (OR = 3.88, 95%CI 1.16–13.03, p = 0.028) and Hardy’s grade C-D (OR = 10.53, 95%CI 1.02-109.19, p = 0.049) independently predicted the presence of postoperative headache at one month. At the three-month follow-up, patients with sinusitis had higher HIT-6 scores compared to those without sinusitis (44.43 ± 9.78 vs. 39.72 ± 5.25, p = 0.017). In Cohort II, the incidence of sinusitis at three months was significantly lower than that in Cohort I (p = 0.028). Importantly, both the incidence of headache and HIT-6 scores in Cohort II were significantly lower than those in Cohort I at the one- and three-month follow-ups. Conclusions Postoperative sinusitis is an independent risk factor for the development of headache following EES for pituitary adenomas. Prophylactic nasal irrigation helps relieve postoperative headache, possibly by preventing the occurrence of sinusitis.

El empiema subdural sinogénico es una infección purulenta que se desarrolla en el espacio situado entre la duramadre y las membranas aracnoides. Esta condición es poco frecuente, lo que subraya la necesidad de estar atentos a cualquier manifestación neurológica. El siguiente caso es un paciente masculino, adolescente y mestizo, tiene 11 años de edad y es de procedencia urbana, con antecedentes de litiasis renal recurrente que dos semanas después de haber sido dado de alta de un ingreso por sinusitis maxilar y etmoidal izquierdas reingresa con síntomas de cefalea de carácter opresivo constante, de moderada a gran intensidad, holocraneal, con vómitos ocasionales, fiebre en cifras de 39-40 grados centígrados, de difícil control, somnolencia, dos eventos convulsivos tónico-clónico generalizados, hemiparesia derecha total, directa, a predominio crural y signo de Babinski de ese lado. Se decide realizar una tomografía de cráneo simple monocorte, tomografía de cráneo contrastada y una resonancia magnética nuclear diagnosticándose un empiema subdural. Se decidió alternativa quirúrgica de emergencia con recuperación postoperatoria favorable. Se concluye que el empiema subdural ha sido descrito como una de las emergencias neuroquirúrgicas más urgentes. Su diagnóstico eficaz está en la resonancia magnética nuclear como la mejor opción. La gestión a realizar como medio de aprendizaje para el personal de salud se presentó como complicación de la sinusitis.

Sinusitis is a disease of usually mild course - however, sometimes secondary diseases might develop such as pneumonia which might have moderate to severe course. Pneumonia is usually treated ambulatory, regardless some patients’ state worsens and they are in need of hospital treatment, sometimes even in Intensive Care Unit. In this article is presented a case of a patient with such history - a young adult with no medical history of chronic diseases, whose state worsened and required ICU treatment.

Objectives: The purpose of this study is to investigate the lung function in Chronic Rhinosinusitis (CRS) patients with Chronic Cough (CC). Methods: A total of 1413 CC patients were retrospectively screened and 109 CRS patients with CC were enrolled. Lung function, Lund-Mackay Computed Tomography (CT) score, smoking status, peripheral blood eosinophil count, and immunoglobulin E concentration in serum samples, and Sino-Nasal Outcome Test were examined. Normal control subjects are also recruited. Results: The Forced Expiratory Volume in 1 second (FEV1.0), Percent Predicted FEV1.0, and FEV1.0/Forced Vital Capacity (FVC) ratio in the patients were significantly low as compared with the control subjects. The FEV1.0/FVC ratio was negatively correlated with the Lund-Mackay CT scores of the patients with a high CT score. Conclusions: The CRS patients with CC should be investigated with lung function. In addition, the multidisciplinary evaluation including a pulmonologist is needed to manage the CRS patients with CC. Level of evidence: Level 4.

Objective: Orbital apex syndrome (OAS) is a rare condition with multiple cranial nerve involvement caused by varied etiologies. It is not only a threat to the patient’s vision but also life-threatening due to the intracranial spread of infection, if not diagnosed early and treated accurately. To study the outcome of endoscopic sinus surgery (ESS) for OAS secondary to sinusitis concerning resolution of ptosis, improvement of ophthalmoplegia, visual prognosis, intracranial spread of infection, and mortality. Methods: A retrospective review of patients with OAS secondary to sinusitis who underwent ESS from 2011 to 2021 was tabulated and analyzed. Results: Twenty-seven patients (mean age: 55.11+/-16 years; male 62%) were included in this study. At presentation, blurring of vision (81%), headache (66%), diplopia (63%) ptosis (63%) were the most common symptoms, and ophthalmoplegia (100%) was the most common sign. Five patients had no perception of light and the rest had various degrees of vision impairment. The most common etiopathology of sinusitis was fungal sinusitis (12 mucormycosis and four aspergillus). The final visual prognosis at three months follow-up post-ESS showed vision stabilization (no improvement or worsening) in 13 (48%) patients, improvement in seven (26%) patients, and vision deterioration in two (7%) patients. There was a significant improvement in ptosis (70%) and ophthalmoplegia (85%). There was no intracranial spread of infection or recurrence with a mortality rate of 3.7% (one patient). Conclusion: ESS coupled with appropriate antimicrobials effectively treats OAS secondary to sinusitis with decreased morbidity and mortality.

Abstract Background Sinusitis is a common diagnosis that can be erroneously associated with routine weather‐related barometric pressure changes. In actuality, these pressure changes likely exacerbate migraine headaches, which can cause facial pain and pressure rather than true sinus inflammation. Objective The present study sought to characterize the representation of both sinusitis and migraine in association with barometric pressure changes across websites on the Internet. Methods An Internet search for relevant terms was conducted, and content of the resulting pages was assessed for associations between weather‐related pressure changes and either sinusitis or migraine. Variations in reported results across different subtypes of Internet sources were analyzed. The primary outcomes measured were (1) whether a given media source associated barometric weather changes with sinusitis, (2) whether that source associated barometric weather changes with migraine, and (3) treatment options offered by that source. Results Of the 116 included webpages, 36 (31.03%) associated sinusitis and routine barometric pressure changes. Of these, 10 (27.77%) were otolaryngology practice sites. Sixty‐seven webpages (57.76%) associated migraine and routine barometric pressure changes. Of these, nonotolaryngology webpages were more likely to report this link. Conclusions Otolaryngology practice sites were observed to be the most frequent professional medical resource reporting the unsubstantiated claim that routine barometric pressure changes are associated with sinusitis. Nonotolaryngology sources were more likely to link weather‐related pressure changes to migraine. These results suggest that opportunities exist for otolaryngology practice sites to educate patients about nonrhinogenic headache etiologies.

Objectives. Hypoxia-inducible factor 1α (HIF1α) and Tet methylcytosine dioxygenase 2 (TET2) have been reported to mediate nasal polypogenesis through the epithelial-to-mesenchymal transition (EMT). Additionally, HIF1α can regulate the expression and function of TET2. However, the precise mechanism of how TET2 regulates the EMT through HIF1α mediation in nasal epithelial cells is still poorly understood. Methods. Nasal tissue samples were collected from patients with chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), CRS without nasal polyps (CRSsNP), and controls. The expression of HIF1α and TET2 was detected using Western blotting and immunohistochemistry. EMT markers (E-cadherin and vimentin) were also evaluated by immunohistochemistry. Primary human nasal epithelial cells (hNECs) were stimulated with CoCl2 to mimic hypoxia. Vitamin C (VC), a TET2 non-specific activator, and small interfering RNA (siRNA) transfection of TET2 were used to further determine the role of TET2 in hypoxia-induced EMT. Finally, reactive oxygen species (ROS) and Nrf2 were measured to explore the downstream consequences of TET2 in hypoxic hNECs. Results. TET2 levels were lower in the nasal epithelium of CRSwNP patients and were positively correlated with E-cadherin but negatively correlated with vimentin in CRS. However, HIF1α exhibited the opposite pattern and was negatively correlated with TET2 expression. CoCl2-simulated hypoxia led to EMT and increased HIF1α in hNECs in vitro, with simultaneous downregulation of TET2 expression. Addition of VC activated TET2 expression in hNECs, but inhibited EMT and HIF1α expression. Furthermore, siRNA knockdown of TET2 contributed to the EMT in CoCl2-simulated hNECs despite the addition of VC. Finally, TET2 regulated the EMT in hypoxic hNECs through Nrf2 expression and ROS generation. Conclusion. TET2 was negatively correlated with HIF1α and EMT in vivo. TET2 was downregulated by HIF1α, resulting in the EMT in CoCl2-hypoxic hNECs via regulation of oxidative stress in vitro. Hence, TET2 might provide a new therapeutic approach for CRSwNP

Background: Ear pain, known as otalgia, has diverse origins, spanning from benign to severe conditions. Accurate diagnosis and treatment require an understanding of its etiology. Otalgia can be categorized as primary (ear-related) or referred (originating elsewhere). Referred otalgia poses unique challenges, as pain is perceived in the ear despite non-ear origins. Aim: The aim of present study is to investigate the potential causes of referred otalgia involving cranial and cervical nerves, and to explore the interplay between ear and distant body structures. Materials & Methods: A prospective study from March 2023 to June 2023 in an ENT OPD of Sharda Hospital, Greater Noida involved 360 patients. Evaluations encompassed dental, nasal, and head & neck assessments. Data included age, gender, side affected, and underlying cause statistical analysis was conducted using SPSS version. Results: Out of 360 patients, 16.1% had referred otalgia. Most were female (67.2%), and right-sided involvement was predominant (47%). Toothache (31.6%) and pharyngitis (29.1%) were the most common leading causes. Other causes included Gastroesophageal reflux disease, sinusitis, temporomandibular joint disease, cervical spine arthritis, and Bell's palsy. Two cases (0.5%) were associated with supraglottic and base of tongue malignancies. Conclusion: This study provides insights into referred otalgia's diverse origins, stressing the importance of comprehensive clinical evaluation for accurate diagnosis and tailored treatment. Collaboration among medical specialists is vital. Further research and clinical cooperation are needed to enhance our understanding of this complex condition.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by stereotyped and repetitive behavior patterns. In addition to neurological and behavioral problems, individuals with ASD commonly experience otolaryngological comorbidities. Individuals with ASD often have auditory disorders including hearing loss and auditory processing disorders such as central auditory processing disorder (CAPD), as well as both chronic and recurrent otitis media. These challenges negatively impact a person’s ability to effectively communicate and may further impact their neurological functioning, particularly when not appropriately treated. Individuals diagnosed with ASD also have difficulty sleeping which contributes to increased irritability and may further aggravate the core behavioral symptoms of autism. The individuals with ASD also have a higher rate of sinusitis which contributes to the worsening of the autism behavior phenotype. The high prevalence of otolaryngological comorbidities in individuals with ASD warrants a better collaboration between their various healthcare providers and otolaryngologists with expertise in auditory, sleep, and sinus disorders in pursuit of improving the quality of life of affected individuals and their families/caregivers.

Chronic sinusitis (CS) is characterized by sinonasal inflammation, mucus overproduction, and edematous mucosal tissue. CS impacts one in seven adults and estimates suggest up to 15% of the general U.S. population may be affected. This research sought to assess a potential role for receptors for advanced glycation end-products (RAGE), an inflammatory receptor expressed in tissues exposed to secondhand smoke (SHS). Human sinus tissue sections were stained for RAGE and S100s, common RAGE ligands. Wild-type mice and mice that over-express RAGE in sinonasal epithelium (RAGE TG) were maintained in room air (RA) or exposed to secondhand smoke (SHS) via a nose-only delivery system five days a week for 6 weeks. Mouse sections were stained for RAGE and tissue lysates were assayed for cleaved caspase 3, cytokines, or matrix metalloproteases. We discovered increased RAGE expression in sinus tissue following SHS exposure and in sinuses from RAGE TG mice in the absence of SHS. Cleaved caspase-3, cytokines (IL-1β, IL-3, and TNF-α), and MMPs (-9 and -13) were induced by SHS and in tissues from RAGE TG mice. These results expand the inflammatory role of RAGE signaling, a key axis in disease progression observed in smokers. In this relatively unexplored area, enhanced understanding of RAGE signaling during voluntary and involuntary smoking may help to elucidate potential therapeutic targets that may attenuate the progression of smoke-related CS.

Objectives: Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) is a disease characterized by chronic inflammation and tissue remodeling process. The remodeling process in nasal polyps has mainly been studied by histology analysis. However, it is limited to a polyp fragment and requires tissue removal. The present study aims to evaluate the ability of Magnetic Resonance Imaging (MRI) to depict and characterize the remodeling process in patients with CRSwNP. Methods: 30 patients that met clinical diagnostic criteria for CRSwNP, without previous history of rhinosinusitis surgery were submitted to MRI scan (conventional, diffusion-weighted and DCE MRI) and compared with polyp tissue histological findings, IL-6 concentrations in the tissue and eosinophil count in the blood. The examinations were evaluated, independently, by two radiologists blinded to other radiological and histological data. The pathologist, blinded to MRI results, also compared the tissue sample from the most central and the most peripheral portion of the polypoid tissue adjacent to the floor of the nasal fossa. Results: This study demonstrated a characteristic pattern of nasal polyps, whose peripheral portions of nasal polypoid tissue are edematous, whereas the central portions in the middle meatus and in the middle and upper ethmoid are predominantly fibrotic. ADC values found in the most anterior portion of the polyps may be a marker for radiological phenotyping the remodeling process. This non-invasive analysis presented a high degree of agreement in the fibrosis and edema rating by two radiologists and the histological analysis was concordant with the MRI findings. The polyps were characterized as eosinophilic, and no relationship was found between the severity of the eosinophilic inflammatory process or concentration of IL-6 and the remodeling process. Conclusion: MRI by using T2-weighted imaging sequence and ADCs values allows tissue characterization and is an effective tool for the differentiation of edematous and fibrotic components in CRSwNP. Level of evidence: 3.

Systemic administration of corticosteroids is used in the treatment of chronic eosinophilic pneumonia (CEP). However, in patients with CEP as well as other comorbidities, the adverse effects of corticosteroids should be minimized as much as possible. A 71-year-old woman was presented with aggravating asthma with CEP and sinusitis, and she had uncompensated liver cirrhosis (LC) with a Child-Pugh score of 7. Initial treatment with a low dose of oral corticosteroids (OCSs) in combination with tezepelumab, an anti-thymic stromal lymphopoietin (TSLP) antibody, resulted in rapid improvement of asthma and CEP without deteriorating LC. Sinusitis also improved after ceasing OCS. This case suggested that tezepelumab may be useful as a treatment option for patients with CEP, especially those with liver dysfunction.

Situs inversus, chronic sinusitis, and bronchiectasis together make up the trinity that characterize the uncommon autosomal recessive genetic ciliary condition known as Kartagener's syndrome. The fundamental issue is the improper movement of cilia, which causes infertility, frequent chest infections, and ear, nose, and throat complaints. A fertile male with Kartagener's disease is a unique case of this rare entity, which we are reporting here. The significance of having a high index of suspicion in such patients cannot be stressed to arrive at an early diagnosis and, whenever possible, provide alternatives for fast treatment and avoid needless symptom evaluation.

Objective: Chronic rhinosinusitis (CRS) is a common inflammatory disease that significantly impacts the quality of life. Endoscopic sinus surgery (ESS) is indicated for refractory CRS. This study aims to estimate the predictors of CRS recurrence, and the rates with time intervals of recurrent CRS and revision ESS. Methods: A retrospective cohort study included 516 patients who underwent ESS for CRS at King Abdulaziz Medical City in Riyadh between January 2017 and May 2020. Patients were followed up for 12–48 months postoperatively. The study sample was divided into two groups based on the recurrence status and compared using the appropriate statistical tests. Significant variables were included in the logistic regression model to determine the predictors of CRS recurrence. Results: The recurrence rate of CRS following ESS was 14.5%, with a time interval of 28.31 months, and standard deviation (SD) =18.76. On the other hand, the rate of revision ESS for recurrent CRS was 6.8%, with a time interval of 34.18 months, SD =16. In the multivariable logistic regression model, the significant predictors of recurrent CRS were a high Lund–Mackay (LM) score [odds ratio (OR): 1.055, p=0.04] and a high eosinophil count (OR: 3.619, p=0.03). Almost half of the patients who developed recurrent CRS underwent revision surgery (46.7%). Conclusion: CRS has a considerable recurrence rate despite the high success rate of ESS, and nearly half of the recurrent CRS patients need revision surgery. A high LM score and eosinophilic count significantly increase the likelihood of CRS recurrence.

Objective To investigate the change in olfactory function after endoscopic sinus surgery in patients with chronic rhinosinusitis (CRS) and related influencing factors. Methods Clinical data were collected from 176 patients with CRS who underwent endoscopic sinus surgery in our hospital from February 2019 to October 2021, and according to the improvement in olfactory function at 3 months after surgery, they were divided into good improvement group with 143 patients and poor improvement group with 33 patients. The two groups were compared in terms of the changes in olfactory function score and objective score before surgery and at 3 months after surgery, and the correlation between preoperative olfactory function score and objective score was analyzed. For the factors with significant differences in the univariate analysis, the multivariate logistic regression model was used to further investigate the independent risk factors for postoperative olfactory function. Results Both groups had significant changes in T&T olfactory score, VAS olfactory score, Lund-Mackay score, and Lund-Kennedy score after treatment (t=2.334,3.943,χ2=8.624,5.568,P

Objectives Several criteria exist for classifying chronic rhinosinusitis with nasal polyps (CRSwNP) as eosinophilic or non-eosinophilic. This study attempted to evaluate several criteria for defining eosinophilic CRSwNP from clinical and immunological perspectives. Methods A cohort of 84 patients (73 patients with CRSwNP and 11 control patients) was retrospectively analyzed. Patients were divided into eosinophilic and non-eosinophilic CRSwNP based on four different criteria: eosinophils (EOS) accounting for more than 20% of the total inflammatory cells; ≥70 EOS per high-power field (HPF); >55 EOS/HPF; and ≥10 EOS/HPF. Preoperative clinical characteristics, the immunological profiles of 14 cytokines from nasal tissue, and postoperative outcomes were compared between eosinophilic and non-eosinophilic CRSwNP based on each criterion. These criteria were immunologically validated by using 14 cytokines to predict the performance of tissue eosinophilia with a random forest model. Results Patients with eosinophilic CRSwNP were significantly older when the criterion of ≥10 EOS/HPF or EOS >20% was used. The number of patients with aspirin intolerance was significantly higher in eosinophilic CRSwNP based on the criterion of EOS >20%. From an immunological perspective, non-type 2 inflammatory cytokines were significantly higher in non-eosinophilic CRSwNP with the criterion of EOS >20% of the total inflammatory cells. In addition, the criterion of EOS >20% of the total inflammatory cells resulted in the best prediction of eosinophilic CRSwNP, with an accuracy of 88.10% and area under the curve of 0.94. Conclusion Clinical and immunological characteristics were different between eosinophilic and non-eosinophilic CRSwNP depending on a variety of criteria, and the results of this study should be taken into account when choosing the criterion for defining eosinophilic CRSwNP and interpreting the data accordingly.

Abstract Maxillary air sinus (MS) is the largest and clinically most important air sinus because of its anatomical relationship with the nasal cavity and especially with teeth of the upper jaw. Periapical dental infection frequently spreads to the maxillary sinus leading to its secondary infection. The occurrence of maxillary sinusitis due to the odontogenic causes is one of the common clinical conditions which is frequently encountered by the endodontists. While handling such cases, the gross anatomy and structure of MS are visualized using various radiological images. However, most of the time, it is challenging for dentists to understand the MS due to its complicated morphology. Keeping this in mind, this literature review is done to comprehensively compile the details on MS from anatomy, radiology, and endodontic importance point of view. The articles were selected from databases like PubMed, Scopus, Embase, and Google Scholar using the keywords “maxillary sinus,” “maxillary sinusitis,” “Endo antral syndrome,” “periapical surgery,” and “odontogenic infections.” In addition, a literature survey was also done using phrases like “roots extending into maxillary sinus,” “foreign bodies in maxillary sinus,” etc. Anatomical variation of sinus could be of clinical importance and the knowledge about the same could come in handy in treatment planning of upper teeth. Extruded materials from the root of a tooth into the sinus can make it prone to infection. The dentist should carefully evaluate the root of a tooth during root canal treatment.

AbstractBackground Acute sinusitis is a frequent reason for primary care visits. Most patients recover within two weeks without antibiotic treatment. Despite this, about 50% of patients with acute sinusitis in Norwegian general practice are still prescribed antibiotics. We do not know the reason behind this discrepancy.Aim To explore the clinical decision-making process and reasons for treatment with antibiotics for acute sinusitis among Norwegian general practitioners (GPs).Methods Five focus group interviews were conducted (N = 25) in different parts of Norway, including GPs of various age, gender, and experience. The interviews were analysed using Systematic Text Condensation.Results The results showed a very diverse management of acute sinusitis among GPs, with decisions regarding antibiotics not always aligning with guideline recommendations. Many of the GPs did not agree with the Norwegian guidelines for antibiotics and chose something other than phenoxymethylpenicillin as their first choice. Clinical predictors emphasized in decision-making were pain complaints and patient exhaustion. Pragmatic factors such as weekday, travel plans, or a full waiting room could also influence the decision.Conclusion GPs found it difficult to identify when patients would benefit from antibiotic treatment for acute sinusitis, and different strategies were used to make prescribing decisions. For several GPs the degree of pain was one of the decisive reasons for antibiotic prescribing, however the guidelines for antibiotics do not give sufficient advice regarding pain treatment. These results suggest a need for revaluation of guideline contents and the way they are communicated to GPs.

Objective To assess the effectiveness of combining physiotherapy techniques with conservative medical treatment in chronic rhinosinusitis (CRS) patients. Methods Sixty-eight volunteers with CRS were randomly assigned. Group A received only traditional medical treatment, whereas group B received a physiotherapy program that included pulsed ultrasound therapy, sinus manual drainage techniques, and self-sinus massage technique in addition to traditional medical treatment. Interventions were applied 3 sessions a week for 4 weeks. The rhinosinusitis disability index (RSDI) served as the main outcome indicator for assessing the quality of life, and the secondary outcome measure was the pressure pain threshold (PPT) using a pressure algometer. Results Wilcoxon signed rank test revealed a significant reduction (p

Introduction: Pott’s puffy tumour is a rare entity defined by the presence of a subperiosteal abscess of the frontal bone associated with frontal osteomyelitis. Several predisposing conditions can lead to this entity, such as frontal sinusitis. Case description: We report the case of a 15-year-old patient who presented to the emergency department for headache, fever and forehead swelling. Computed tomography revealed severe pansinusitis complicated by a subperiosteal abscess associated with frontal osteomyelitis, leading to the diagnosis of Pott’s puffy tumour. The management combined intravenous antibiotics and surgical drainage of both the sinusitis and subperiosteal abscess. Discussion: Pott’s puffy tumour represents a rare but serious complication of frontal sinusitis. Clinicians should be aware of this potential complication as the diagnosis can be challenging at an early stage but may influence the subsequent prognosis.

Background: We evaluated whether EPs® 7630 prescription in patients with acute sinusitis (AS) is associated with less frequent recurrence of AS, occurrence of chronic sinusitis or nasal polyps, or fewer antibiotic prescriptions.Methods: This retrospective cohort study used electronic medical records from the IQVIA Disease Analyzer database. Associations between initial therapy [EPs® 7630, antibiotics, intranasal corticosteroid (INCS), or corticosteroid-free nasal spray within 3 days of AS diagnosis] and AS recurrence, incidence of chronic sinusitis or nasal polyps or rate of antibiotic prescription were studied using multivariable Cox or logistic regression models, adjusting for sex, age, insurance status, month of diagnosis, and comorbidity.Results: A total of 216,360 patients were analyzed. INCS prescription was associated with a higher risk of recurrent AS (HR: 1.40; 95% CI: 1.01–1.92) and a higher incidence of chronic sinusitis or nasal polyp diagnosis (HR: 1.39; 95% CI: 1.01–1.92) compared to EPs® 7630. Initial antibiotic therapy was significantly associated with higher risk of new antibiotic prescription in the period of 31–365 days after the index date compared to EPs® 7630 (OR: 2.20; 95% CI: 1.66–2.92).Conclusion: EPs® 7630 prescription is associated with long-term benefits in AS patients. EPs® 7630 can help to reduce inappropriate antibiotic use and might reduce the risk of chronic sinusitis or nasal polyps.

Background: Chronic rhinosinusitis (CRS) is a common comorbid condition of asthma that affects the long-term outcome of asthmatic patients. CRS is a heterogeneous disease requiring multiple biomarkers to explain its pathogenesis. This study aimed to develop potential biomarkers for predicting CRS in adult asthmatic patients in a real-world clinical setting. Methods: This study enrolled 108 adult asthmatic patients who had maintained anti-asthmatic medications, including medium-to-high doses of inhaled corticosteroid plus long-acting β2-agonists, and compared clinical characteristics between patients with CRS (CRS group) and those without CRS (non-CRS group). CRS was diagnosed based on the results of paranasal sinus X-ray and/or osteomeatal-unit CT as well as clinical symptoms. Type-2 parameters, including blood eosinophil count, serum levels of periostin/dipeptidyl peptidase 10 (DPP10) and clinical parameters, such as FEV1% and fractional exhaled nitric oxide (FeNO), were analyzed. All biomarkers were evaluated by logistic regression and classification/regression tree (CRT) analyses. Results: The CRS group had higher blood eosinophil counts/FeNO levels and prevalence of aspirin-exacerbated respiratory disease (AERD) than the non-CRS group (n = 57, 52.8% vs. n = 75, 47.2%; P

Objective: To develop a mobile application with a standardized routine, to be used by general otolaryngologists for evaluating patients with chronic rhinosinusitis. Methods: A systematic review was made to identify outcomes, recommendations and what tests that would be used in the routine evaluation of patients with chronic rhinosinusitis; establish an expert consensus on items to be included in this routine evaluation of patients with chronic rhinosinusitis using the Delphi method; development of an application for use on a mobile device, with the routine evaluation of patients with chronic rhinosinusitis. Results: Based on the systematic review, the outcomes used in studies about chronic rhinosinusitis were identified, as well as guidelines recommendations, which showed discrepancies between them. These recommendations and outcomes were presented to specialists in chronic rhinosinusitis, until a consensus was reached. As a result of the Delphi method, the flowchart of the routine evaluation of patients with chronic rhinosinusitis was defined, and then was used for the development of the mobile application. Conclusion: The creation of the mobile application for evaluating patients with chronic rhinosinusitis followed an adequate methodology of elaboration made by specialists in the field of chronic rhinosinusitis, standardizing the investigation of these patients. Level of evidence: Level 5.

Background: Hyaluronic acid (HA), the main component of the extracellular matrix, has the ability to promote tissue repair and regulate inflammation. It is used in otolaryngology as an adjuvant treatment to alleviate postoperative nasal symptoms. However, there is currently insufficient evidence demonstrating the therapeutic efficacy of HA for patients with nasal inflammatory diseases (NIDs). Therefore, this study aimed to evaluate the efficacy and safety of topical HA in the treatment of NID patients without receiving surgery.Methods: In this meta-analysis, comprehensive searches were conducted in PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science. Keywords searched included “hyaluronic acid,” “sinusitis,” “allergic rhinitis,” “rhinitis,” and “randomized controlled trials (RCTs).” The Cochrane Collaboration’s “Risk of Bias Assessment” tool was used to assess the quality of the included trials, and the meta-analysis was performed using the RevMan 5.3 and STATA 15 statistical software.Results: A total of 11 articles and 825 participants were enrolled. For the primary outcomes, the pooled results revealed that HA significantly improves nasal obstruction (SMD, −0.53; 95% CI, −0.92 to −0.14; p = 0.008; and I2 = 79%) and rhinorrhea (SMD, −0.71; 95% CI, −1.27 to −0.15; p = 0.01; and I2 = 90%) in patients with NIDs. As for the secondary outcomes, the pooled results demonstrated that when compared with the control group, HA could significantly improve nasal endoscopic scores (p < 0.05), rhinitis scores (p < 0.05), rhinomanometry (p < 0.05), nasal neutrophils (p < 0.05), and mucociliary clearance (p < 0.05). However, no significant differences were observed between the two groups regarding nasal itching, sneezing, hyposmia, quality-of-life scores, and nasal eosinophils. For the risk of bias, 54.5% and 45.5% of trials had a low risk of bias in the randomization process and deviation of the intended intervention, respectively.Conclusion: In the present study, the results reveal that HA might ameliorate symptoms of patients with NIDs. However, more clinical trials with larger participant cohorts are required to confirm this result.Systematic review registration number:clinicaltrials.gov, identifier CRD42023414539.

BackgroundPediatric paranasal rhinosinusitis is one of the more common pediatric diseases of the upper respiratory tract and it entails significant morbidity. Most commonly, it is caused by a viral infection of the nasal mucosa, which spreads through the natural passages within the cavities of the paranasal sinuses, leading to inflammation of the mucosa that lines the nasal cavity and paranasal sinuses.MethodsThe objective of this cohort study was to assess whether there is a correlation between pediatric rhinosinusitis, physical activity, and selected dietary habits among pupils aged 6 to 16 years from elementary schools in Wrocław, Poland. This study – as part of the pro-health program “Let us Get the Kids Moving” – is also aimed at establishing factors that potentially predispose children to developing RS. The survey study was conducted on a group of 2,458 children and adolescents from elementary schools in Wrocław. The age of the examined children ranged from 6 to 17 years (mean = 10.8 years; standard deviation = 2.7).ResultsRhinosinusitis was more common in the children aged 13–17 years than in those aged 6–9 years (6.4% vs. 1.5%; p 11 years, attending swimming classes fewer than 1–2 times a week, using a computer, consuming milk, salty snacks, and carbonated sweet drinks, consuming fruit fewer than 1–2 times a week, not attending physical education classes, eating fewer than 4 meals, and not eating breakfast at home (p

Objective: This article describes a case of polymicrobial Arcanobacterium haemolyticum pharyngitis and sinusitis complicated by intracranial complications and reviews similar cases in the literature Case summary: A 21-year-old immunocompetent male presented with symptoms of sore throat, rhinorrhoea, lethargy, headache, and rash. Imaging demonstrated sinusitis, pre-septal sinusitis, peritonsillar abscess formation, subdural empyema and cerebritis. He was managed with endoscopic sinus surgery, craniotomy for evacuation of subdural empyema and antibiotics. Microbiological samples demonstrated growth of A. haemolyticum, strep. anginosus, and fusobacterium necrophorum. He subsequently developed a cerebral abscess requiring stereotactic needle drainage. After a prolonged course of antibiotics, the patient was discharge and made a good recovery. Discussion: A. haemolyticum is an uncommon cause of non-streptococcal pharyngitis that may occur alongside other microorganisms and is rarely associated with severe intracranial complications. This organism and its antibiotic susceptibility patterns should be considered in complicated upper respiratory tract infections in immunocompetent hosts. Penicillins and macrolide antibiotics form the mainstay of therapy for A. haemolyticum.

Oral 3rd generation cephalosporin cefpodoxime proxetil has been available in the antibiotic armamentarium for more than 30 years, however, unlike other oral cephalosporins (e.g. cefixime), it has not been given due recognition in clinical practice in Russia due to its low availability on the domestic pharmaceutical market. At the same time, the high activity of cefpodoxime against respiratory pathogens (S. pneumoniae, H. influenzae and S. pyogenes), pharmacological characteristics, results of clinical trials of its safety and efficacy, allow us to discuss the inclusion of this antimicrobial into Russian clinical guidelines for the treatment of community-acquired respiratory infections, primarily in outpatients, as well as for stepdown therapy of these infections in the hospital. In addition, cefpodoxime is a reliable option to replace parenteral therapy, in particular with ceftriaxone, which is unreasonably often prescribed in outpatient practice in Russia, without the threat of loss of the treatment efficacy.

Abstract Dupilumab and other biologics have revolutionized the management of recalcitrant polyps in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). Despite strong evidence for the efficacy of dupilumab in treating polyps, factors such as cost and uncertain efficacy over surgery have limited its use to patients who have failed the use of topical nasal steroids and initial surgical management. Likewise, the use of this drug is often directed towards patients with greater polyp burdens. Recent studies, however, have investigated the use of dupilumab and other biologics in expanded patient populations, including those with limited polyp burden. The overall trend in the literature suggests a future move towards the use of biologics as first-line therapy for all patients with CRSwNP. The arguments against widespread, routine use of dupilumab and biologics in all patients with CRSwNP are threefold. First, endoscopic sinus surgery has been found to provide similar symptomatic benefit to dupilumab in the treatment of these patient populations. The surgical improvement of patients’ sinonasal anatomy offers a rapid elimination of sources of ongoing inflammation that contribute to long-term polyp formation and symptoms. Medical non-compliance in this specific patient population is known to be an issue, with surgery offering a much greater long-term prospect of symptomatic relief in non-compliant patients. The second concern revolves around the potential for side effects of dupilumab and other biologics. Initial studies have shown an acceptable safety profile, but trials assessing the use of dupilumab for a separate indication revealed a higher rate of conjunctivitis. Long-term safety data is limited for biologics, and we must be prepared for the possibility of severe, unanticipated adverse events in the future. Our third and most profound concern is the significant cost of dupilumab. This medication is enormously expensive, and all current literature suggests that treatment would need to be life-long to remain effective. Studies comparing endoscopic sinus surgery to various biologics, including dupilumab, have shown comparable overall quality of life metrics with biologics, all while delivering considerably higher anticipated lifetime costs. As our knowledge progresses regarding the efficacy of dupilumab and other biologics in a variety of clinic situations, it is important to understand the context in which these advances are being made. While dupilumab and other biologics offer undeniable efficacy in the treatment of chronic rhinosinusitis with nasal polyposis which has failed to respond to standard therapies, we argue that biologics remain only a component of effective management in this patient population. Endoscopic sinus surgery and topical nasal steroids offer equal efficacy and substantially lower costs than biologics, and these factors should be considered when selecting treatment options for patients.

Objective To summarize the clinical characteristics, treatment regimens, and outcomes of IgG4-related sinusitis in order to improve clinicians' knowledge of the disease. Methods A retrospective descriptive study was conducted on 3 cases of IgG4-related sinusitis admitted to our hospital from January 2019 to January 2023. Their clinical manifestation, results of laboratory tests, radiological findings, surgical methods, postoperative pathologic results, treatment and managements, and outcomes during follow-up were analyzed, and relevant literature was also reviewed. Results Among the 3 patients, there were 1 male and 2 females, at an average age of 63 (53 to 71) years, with a course of disease for 1~5 years. The main symptoms included nasal congestion, ear fullness, eyelid lumps, cervical lymphadenopathy and enlarged submandibular gland. Serum IgG4 level was elevated to 3.2~4.7 g/L. Sinus CT scans confirmed sinusitis with nasal polyps. No involvement of organs other than the head and neck was observed in radiological examination. All 3 cases underwent functional endoscopic sinus surgery and polypectomy. Post-surgical pathology confirmed IgG4-related sinusitis. Other treatments included nasal steroids and nasal lavage conventionally. Recurrence of the disease was noted 3~10 months postoperatively, then 30~40 mg/d prednisone acetate was given orally as induction therapy for 1 month, which effectively controlled the conditions in all cases. The dose of prednisone acetate was gradually reduced to 5 mg/day for long-term maintenance. One patient took oral immunosuppressant mycophenolate mofetil in combination. All 3 patients were followed up for 14~32 months, and no further recurrence was observed. Conclusion IgG4-related sinusitis shows similar clinical characteristics as chronic sinusitis, and pathologic observation is essential for its diagnosis. Its preferred treatment is steroid therapy, particularly low-dose long-term as maintenance, is key to preventing recurrence. Combined steroid and immunosuppressant therapy can more effectively control the condition of disease.

Abstract Background Abrupt visual impairment constitutes a medical urgency, necessitating an interdisciplinary diagnostic and therapeutic approach owing to the broad spectrum of potential etiologies, thereby engaging numerous medical specialties. Case presentation A 21-year-old Mixed White and Asian female patient, with medical history of nonsteroidal antiinflammatory drug-exacerbated respiratory disease necessitating previous sinus surgery, reported sudden monocular vision loss. Unremarkable ophthalmological examination of the fellow eye and hematological parameters, save for a slight elevation in lymphocytes and eosinophils, were observed. Imaging studies indicated recurrence of bilateral chronic rhinosinusitis with nasal polyps and a mucocele in the left sphenoid sinus, accompanied by bony structural deficits. Emergency revision sinus surgery, guided by navigation, was promptly performed. The patient received treatment with methylprednisolone, ceftriaxone, cyanocobalamin, pyridoxine, thiamine, and acetylsalicylic acid. During the hospital stay, she developed steroid-induced glaucoma, which was subsequently managed successfully. Negative microbiological swabs, along with pathohistological evidence of increased tissue eosinophilia and the patient’s clinical history, led to the diagnosis of toxic retrobulbar neuritis secondary to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-associated chronic rhinosinusitis of the left sphenoid sinus. Conclusions In cases of acute unilateral vision loss, optic neuritis is a highly probable differential diagnosis and may be induced by pathologies of the paranasal sinuses. Nonsteroidal antiinflammatory drug-exacerbated respiratory disease, a subtype of chronic rhinosinusitis, is associated with type 2 inflammation, which is increasingly recognized for its role in the pathogenesis of bronchial asthma, eosinophilic esophagitis, and atopic eczema. Clinicians should consider chronic rhinosinusitis as a potential differential diagnosis in unilateral visual loss and be cognizant of the rising significance of type 2 inflammations, which are relevant to a variety of diseases.

Chronic rhinosinusitis (CRS) is a relatively common inflammatory disease of the nasal and paranasal sinus mucosa. Several epidemiological studies have established an association between particulate matter (PM) and CRS. Based on those data, PM has emerged as an important environmental factor in the development of CRS. Recent research has investigated the mechanisms and treatment options for CRS caused by PM through cellular experimentation. Therefore, the authors would like to explain the definition of PM, present research investigating the relationship between PM and CRS, and summarize the involved mechanisms reported to date.

Background and Objectives Evidence bearing on the safety and efficacy of dupilumab treatment for chronic rhinosinusitis with nasal polyps (CRSwNP) has recently been presented by researchers from various institutions. Therefore, we compared the safety and efficacy of dupilumab treatment to those of endoscopic sinus surgery. Methods The PubMed, Scopus, Embase, Web of Science, and Cochrane databases were searched independently by two authors from the dates of their inception to December 2022. We retrieved the clinical results of CRSwNP patients after dupilumab administration, including changes in patient symptoms and the effects on the quality of life, and compared the results of dupilumab (treatment group) to those of endoscopic sinus surgery (control group). Results Eight articles (1,251 patients) were ultimately included. Dupilumab significantly improved nasal symptoms (nasal congestion) (mean difference [MD], -1.4433; 95% confidence interval [CI], -1.7233 to -1.1632; I2=94.2%), the visual analog sinusitis score (MD, -5.0506; 95% CI, -5.4744 to -4.6267; I2=84.0%), olfactory function (standardized MD, 1.2691; 95% CI, 1.1549 to 1.3833; I2=18.4%), the quality of life (SNOT-22 score) (MD, -34.4941; 95% CI, -39.4187 to -29.5695; I2=90.8%), the Lund-Mackay computed tomography score (MD, -7.2713; 95% CI, -8.9442 to -5.5984; I2=87.7%), and the nasal polyp score (MD, -3.1021; 95% CI, -3.7066 to -2.4977; I2=95.6%) at about 12 months after treatment compared to the pretreatment values. Compared to endoscopic sinus surgery, dupilumab similarly improved olfactory function (MD, 1.9849; 95% CI, -1.6190 to 5.5888; I2=0.0%) but was less effective in terms of reducing the SNOT-22 score (MD, 3.8472; 95% CI, 1.9872 to 5.7073; I2=96.7%) and reducing nasal congestion (MD, 0.6519; 95% CI, 0.5619 to 0.7420; I2=97.7%). Conclusion Dupilumab reduced subjective symptom scores and improved the quality of life and objective measures of progression compared to the preoperative values.

Abstract Introduction Endoscopic sinus surgery is often challenging because of bleeding and pain. A variety of techniques have been explored to reduce surgical function and pain, with the sphenopalatine ganglion block showing the most promising results. All of these researches, however, had methodological flaws since saline was used as a placebo injection, which could have irritated the ganglion and produced less-than-ideal results, in accordance with our theory. Aim and objective To determine the effect of sphenopalatine ganglion block with bupivacaine on intraoperative endoscopic surgical field and postoperative pain. Patients and methods A prospective double blind, randomized study was conducted in 50 subjects undergoing endoscopic sinus surgery for chronic rhinosinusitis with or without polyp. The case group received 1.5 ml of 0.5% bupivacaine in sphenopalatine ganglion block while control group didn’t receive any drug in ganglion. The intra-operative surgical field grade and postoperative pain score was recorded to analyze the effect of the block. Results We discovered a statistically significant difference in the endoscopic surgical field between the case and control groups. In comparison to the control group, the surgical field was more visible in the sphenopalatine ganglion block group. The case group significantly outperformed the control group in terms of pain visual analogue score throughout the observation period, with the exception of the first day following surgery. Conclusion Sphenopalatine ganglion block with bupivacaine 0.5% is a straightforward, efficient, and secure way to improve the endoscopic surgical field and lessen postoperative pain in patients undergoing endoscopic sinus surgery.

Abstract Purpose The purpose of this study was to perform a systematic review with meta-analysis on the long-term survival rates of zygomatic implants (ZI). ZI success, prostheses survival and success, sinus pathology and patient reported outcomes were also investigated. Methods Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed. Embase and OvidMedline databases were searched alongside the grey literature. The systematic review was recorded in PROSPERO (CRD42022358024). Studies reporting titanium/titanium alloy ZI survival data, ZI-supported prosthesis data, ZIs directly compared to any other implant therapy including grafted sites, a minimum follow-up time of 3 years and a minimum number of 10 patients were included. All study designs were considered if they met the inclusion criteria. Studies not involving ZIs, ZIs not made from titanium/titanium alloy, a follow-up time of

A 77-year-old-man with arterial hypertension, diabetes mellitus type II presented at our clinic for a routine ophthalmological exam. He complained of intermittent double vision. The ophthalmic examination revealed paralysis of III (n. oculomotorius) and VI (n. abducens) cranial nerves with ptosis, deficit in elevation and abduction of the left eye. The patient underwent urgent MRI imaging of the brain/orbits and paranasal sinuses, and urgent neurological assessment. MRI revealed a volume-occupying process, starting from the posterior wall of the left maxillary sinus with perineural diffusion and involvement of the homolateral trigeminal nerve, intracranial spread in the medial cranial fossa and involvement of the cavernous, sphenoidal sinuses and the orbital apex on the left side. Biopsy was performed, and the histology resulted in sinonasal squamous cell carcinoma with intracranial spread.

Background: Pediatric odontogenic sinusitis (PODS) is a rare condition with limited research on its clinical features, diagnostic criteria, and treatment options. The current guidelines on pediatric rhinosinusitis do not mention a possible dental origin of the disease. This systematic review aims to summarize and analyze the existing literature on PODS, focusing on epidemiology, etiology, diagnostic tools, complications, treatment options, and outcomes. Methods: A systematic review was conducted following PRISMA reporting guidelines. Electronic searches were performed in multiple databases using keywords related to PODS and therapeutic strategies. Original articles reporting data on treatment outcomes for PODS were included. Results: The review highlighted the scarcity of high-quality evidence on PODS. The literature mainly consists of case reports and low-grade evidence studies. Limited data on the epidemiology, etiology, diagnostic tools, complications, and treatment outcomes of PODS in children are available. Conclusions: Further research is needed to better understand the clinical features, diagnosis, and treatment of PODS in pediatric patients. High-quality studies are required to establish evidence-based guidelines for the management of this condition, especially given the apparently high rate of complications when compared to adult ODS.

Background. Sinus floor elevation is considered a safe procedure to properly augment the height of the edentulous crest. Often, complications may arise due to multiple causes and can lead to a poor outcome of the graft and implant’s osseointegration. A careful surgical approach, a good knowledge of possible obstacles, and careful treatment planning can reduce the risks of complications, as well as their impact on the surgical outcome. This study aims to make a literature review of 40 articles, analyzing the incidence and type of complications related to maxillary sinus graft surgeries and graft materials. Material and methods. A total of 40 articles published between 2015 and 2021 were selected for a systematic literature review on maxillary sinus floor complications. The studies were selected from 2 different internet databases: PubMed and Science Direct. The sinus lift complications were counted and their incidence was organized upon the surgical technique and the timing of occurrence (intraoperative, postoperative). It was also analyzed if the graft material influences the complication rate. Results. In a group of 1757 sinus augmentation surgeries performed on 1605 patients, 363 complications were found. Sinus membrane perforation occurred in 242 cases, 29 procedures resulted in partial or total graft loss, there were 26 postoperative cases of sinusitis, 24 sinus infections, 16 wound dehiscence, 6 bleeding complications, 5 lost implants, and 2 oro-antral fistulas. Conclusion. Sinus lift complications are sometimes inherent circumstances of the procedures, but they can also be prevented through an accurate technique and preoperative plan. The type of bone graft does not influence the incidence of surgical complications.

Patients with chronic rhinosinusitis (CRS) report improved sleep quality after dupilumab, an anti IL4/13 therapy. Concurrent CRS and obstructive sleep apnea (OSA) cases are not rare, and CRS seemingly raises nasal resistance. Thus, we hypothesized that improved sleep quality by dupilumab therapy in CRS patients might be due to lowered nasal resistance and subsequent improvement of unrecognized comorbid OSA. Patients with concurrent CRS and OSA were recruited. Nasal resistance was measured invasively with transnasal pressure and flow data collected during normal respiration in the supine position. Results from the first five participants did not support our hypothesis. Subjective and objective measures for CRS and nasal resistance values were improved with dupilumab therapy in CRS patients with nasal polyps. However, apnea severity and sleep-related subjective parameters did not change. In the patients with CRS without nasal polyps, no significant changes in either CRS or OSA-related measures were observed.

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis that is associated with antineutrophil cytoplasmic antibodies (c-ANCA). It classically presents with sinonasal, pulmonary and renal involvement. We are presenting a case of a 32-year-old male who presented with septal perforation, crusting and nasal obstruction. He had been operated on twice for sinonasal polyposis. Relevant investigations revealed that he was actually suffering from GPA. The patient was started on remission induction therapy. A combination of methotrexate and prednisolone was started with a 2-weekly follow-up. The patient had experienced his symptoms for 2 years before presentation. This case highlights the importance of correlating ENT and pulmonary symptoms to reach the correct diagnosis.

Abstract Background Antrochoanal polyps (ACPs) are pathologically benign nasal swellings. The maxillary sinus is the commonest reported origin. The polyps are usually unilateral and often exit through the progressively widened maxillary sinus ostium to occupy the choana and may reach the nasopharynx. It is a disease of adolescents and young adults who often present with progressive unilateral nasal obstruction. Encountering bilateral antrochoanal polyps is very rare. Case presentation We report a forty years old male who had progressive bilateral nasal obstruction for 8 years associated with hyposmia and intermittent facial pain and headaches. A nasal mass could be seen on anterior rhinoscopy on both sides, more prominent on the left. Endoscopy revealed bilateral masses hanging down the choanae. Computerized tomography scan of the nose and paranasal sinuses demonstrated bilateral nasal polypi and widening of the maxillary sinus ostia. During endoscopic surgical excision of the lesions, polypi were found to dilate the ostia of both maxillary sinuses. The polypi had antral, nasal, and choanal parts typical of antrochoanal polypi on both sides. The histopathology showed the inflammatory nature characteristic of antrochoanal polyp. Postoperatively, the patient’s symptoms resolved dramatically, and he is on continuous regular scheduled follow-up. Conclusion Bilateral antrochoanal polyps can present with nasal obstruction and can be misdiagnosed as sinusitis; radiological and endoscopic features are useful to reach specific diagnosis; what is special about our presentation is that it is an addition to the literature of a rare disease (bilateral ACPs), and we are reporting it in an older age rather than the common younger age of presentation in the literature reports, which is an addition to the demographic data.

Objectives The aim of this study was to compare the effect of steroid-impregnated spacers to that of conventional management after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). Methods Six databases were searched from inception until November 2022. Sixteen studies were found that compared the improvement of chronic sinusitis-related symptoms and postoperative outcomes between a steroid-impregnated spacer group and a control group (non-steroid-impregnated spacers). The Cochrane risk of bias tool (for randomized controlled studies) and the Newcastle-Ottawa Scale (for non-randomized controlled studies) were used to assess the quality of the works included. Results Regarding the endoscopic findings, the degree of mucosal edema, ethmoid inflammation, crust formation at 2–3 months postoperatively, nasal discharge, polyposis, and scarring/synechia were significantly lower in the steroid-impregnated spacer group. The steroid-impregnated spacer group also showed significantly lower Lund–Kennedy scores and perioperative sinus endoscopy scores than the control group at 2–3 weeks postoperatively. Furthermore, the steroid-impregnated spacer group had lower rates of adhesions, middle turbinate lateralization, polypoid changes, the need for oral steroid use, the need for postoperative therapeutic interventions, and lysis of adhesions than controls. However, no significant between-group differences were found in short-term (2–3 weeks postoperatively) endoscopic findings regarding nasal discharge, postoperative crusting, polyposis, or scarring/synechia. Conclusion Steroid-impregnated nasal packing reduced the rates of postoperative intervention and recurrent polyposis and inflammation in CRS patients undergoing ESS.

Update of the consensus on acute otitis media (AOM) (2012) and sinusitis (2013) following the introduction of pneumococcal vaccines in the immunization schedule, and related changes, such as epidemiological variation, colonization by of nonvaccine serotypes and emerging antimicrobial resistances. A majority of studies show that the introduction of the pneumococcal 13-valent conjugate vaccine has been followed by a reduction in the nasopharyngeal carriage of pneumococcus, with an increase in the proportion of drug-resistant nonvaccine serotypes. The diagnosis of AOM is still clinical, although more stringent criteria are proposed, which are based on the visualization of abnormalities in the tympanic membrane and the findings of pneumatic otoscopy performed by trained clinicians. The routine diagnosis of sinusitis is also clinical, and the use of imaging is restricted to the assessment of complications. Analgesia with acetaminophen or ibuprofen is the cornerstone of AOM management; watchful waiting or delayed antibiotic prescription may be suitable strategies in select patients. The first-line antibiotic drug in children with AOM and sinusitis and moderate to severe disease is still high-dose amoxicillin, or amoxicillin-clavulanic acid in select cases. Short-course regimens lasting 5–7 days are recommended for patients with uncomplicated disease, no risk factors and a mild presentation. In allergic patients, the selection of the antibiotic agent must be individualized based on severity and whether or not the allergy is IgE-mediated. In recurrent AOM, the choice between watchful waiting, antibiotic prophylaxis or surgery must be individualized based on the clinical characteristics of the patient. Resumen: Actualización de los documentos de consenso de OMA (2012) y sinusitis (2013) tras la introducción de vacunas antineumocócicas en calendario vacunal, tras los cambios derivados de las variaciones epidemiológicas, colonización por serotipos no vacunales y la aparición de resistencias. Según la mayoría de los estudios, la introducción de la vacuna antineumocócica conjugada tridecavalente (VNC-13) se ha traducido en un descenso de la colonización nasofaríngea por neumococo, con un aumento porcentual de serotipos resistentes no cubiertos. El diagnóstico de OMA continúa siendo clínico, aunque se proponen criterios más rigurosos, apoyados en la visualización de alteraciones en la membrana timpánica y la otoscopia neumática realizada por personal entrenado. El diagnóstico rutinario de la sinusitis es clínico y la realización de pruebas de imagen está limitada al diagnóstico de complicaciones asociadas. La analgesia con paracetamol o ibuprofeno es la base del tratamiento en la OMA; la conducta expectante o la prescripción antibiótica diferida podrían ser estrategias adecuadas en pacientes seleccionados. El tratamiento antibiótico de elección en niños con OMA y sinusitis aguda con síntomas moderados-graves continúa siendo amoxicilina a dosis altas, o amoxicilina-clavulánico en casos seleccionados. En cuadros no complicados, sin factores de riesgo y con buena evolución se proponen pautas cortas de 5–7 días. En pacientes alérgicos se debe individualizar especialmente la indicación de tratamiento antibiótico, que dependerá del estado clínico y si existe o no alergia IgE-mediada. En OMA recurrente, la elección entre un manejo expectante, profilaxis antibiótica o cirugía se debe individualizar según las características del paciente.