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Introduction: Olfactory dysfunction (OD) is common among people with cystic fibrosis (PwCF). The Questionnaire of Olfactory Disorders (QOD) is a validated instrument that evaluates olfactory‐specific quality‐of‐life. The QOD minimal clinically important difference (MCID) and factors associated with olfactory improvement after elexacaftor/tezacaftor/ivacaftor have not been determined for PwCF. Methods: Prospective observational data were pooled from three studies that enrolled adult PwCF with chronic rhinosinusitis (CRS). QOD scores and disease characteristics were assessed. To evaluate internal consistency and calculate the QOD MCID, Cronbach's alpha and four distribution‐based methods were employed. For participants who enrolled prior to elexacaftor/tezacaftor/ivacaftor, QOD scores were obtained at baseline and after elexacaftor/tezacaftor/ivacaftor initiation. Multivariable regression was used to identify factors associated with QOD improvement. Results: Of 129 PwCF included, 65 had QOD scores before and 3–6 months after starting elexacaftor/tezacaftor/ivacaftor. Mean baseline QOD score was 6.5 ± 7.9. Mean Cronbach's alpha was ≥0.85. The MCID estimates were as follows: Cohen's effect size = 1.6, standard error of measurement = 2.5, ½ baseline standard deviation = 4.0, and minimal detectable change = 6.9. Mean MCID was 3.7. Of those with pre/post elexacaftor/tezacaftor/ivacaftor QOD scores, the mean change in QOD was −1.3 ± 5.4. After elexacaftor/tezacaftor/ivacaftor, QOD improvement surpassed the MCID in 22% of participants (14/65). Worse baseline QOD scores and nasal polyps were associated with improved QOD scores after elexacaftor/tezacaftor/ivacaftor (both p < 0.04). Conclusion: The QOD MCID in PwCF was estimated to be 3.7. Elexacaftor/tezacaftor/ivacaftor led to qualitative but not clinically meaningful improvements in QOD score for most PwCF; PwCF with worse baseline QOD scores and nasal polyps improved in a clinically significant manner. [ABSTRACT FROM AUTHOR]

This research note discusses the role of individual sinus inflammation in chronic rhinosinusitis (CRS) and olfaction after highly effective modulator therapy. The study found that individual sinus opacification (ISO) can be measured using a convolutional neural network approach. ISO decreased over a two-year period after initiating modulator therapy. However, ISO did not correlate with quality of life or olfaction in adults with cystic fibrosis. The study highlights the importance of understanding disease in specific sinuses for targeted treatments. Another article discusses the relationship between sinus opacification (SO) and patient outcomes in individuals with cystic fibrosis (CF) who have undergone highly effective modulator therapy. The study found that greater sphenoid SO was correlated with worse rhinologic and extranasal rhinologic scores after 24 months of therapy. However, the clinical significance of this correlation is unknown. The study also found that there was no consistent correlation between SO and other outcome measures such as health utility value and smell identification test scores. The findings suggest that further research is needed to understand the impact of individual sinus inflammation on chronic rhinosinusitis and olfaction in individuals with CF. [Extracted from the article]

Key Points Patients with giant adenomas are more likely to have tumor extension into the paranasal sinuses. Compared to macroadenomas, giant adenomas are not associated with worse preoperative SNOT‐22 scores. [ABSTRACT FROM AUTHOR]

Treating AECRS based on culture results can improve antibiotic stewardship; however, this can also put patients at risk for worsening symptoms due to treatment delays. Keywords: bacteriology; chronic rhinosinusitis; medical therapy of chronic rhinosinusitis; sinusitis EN bacteriology chronic rhinosinusitis medical therapy of chronic rhinosinusitis sinusitis 950 953 4 04/25/23 20230501 NES 230501 INTRODUCTION The 2021 International Consensus Statement on Allergy and Rhinology defines acute exacerbation of chronic rhinosinusitis (AECRS) as a sudden worsening of CRS symptoms with a return to baseline, often after treatment with corticosteroids and/or antibiotics.[1] Bacterial infections are thought to have a significant role in the development of AECRS.[[1]] Studies have cited I Staphylococcus aureus i , I Pseudomonas aeruginosa i , I Streptococcus pneumoniae i , I Haemophilus influenzae i , and anaerobic species as common pathogens in AECRS.[[3], [5]] Patients seen in clinic for AECRS can either be started on empiric antibiotics, or treatment can be delayed for culture-directed therapy (CDT). Empiric antibiotics and CDT are both reasonable treatment strategies for AECRS, and the approach taken can be chosen based on clinical judgment, severity of symptoms, and patient preference. [Extracted from the article]

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