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OBJECTIVES/HYPOTHESIS The European Position Paper on Rhinosinusitis and Nasal Polyps proposes an assessment of clinical control of chronic rhinosinusitis (CRS). However, there are limited data about the percentage of postoperative control, and no prediction models for uncontrolled CRS have been reported. The aim of the study was to develop prediction models for postoperative uncontrolled CRS. STUDY DESIGN Retrospective case series. METHODS Patients (n = 136) who had undergone endoscopic sinus surgery at least 1 year prior to the study were recruited to assess the clinical control. Risk factors were determined by logistic models and presented as odds ratio (OR) with a 95% confidence interval. Receiver operating characteristics curves were constructed to set the cutoff points and create predictive models. RESULTS Approximately 47.8% of patients had controlled, 22.1% partially controlled, and 30.1% uncontrolled CRS. Univariate regression models revealed the risk factors for uncontrolled CRS: tissue eosinophilia, blood eosinophilia, high computed tomography (CT) score, bilateral disease, asthma, and allergic rhinitis. Multiple regression models found tissue eosinophil ratio >0.206 (OR: 12.96, P = .001) or blood eosinophil ratio >0.025 (OR: 4.56, P = .003), Lund-Mackay (LM) score ≥ 15 (OR: 15.50, P

The European Position Paper on Rhinosinusitis and Nasal Polyps proposes an assessment of clinical control of chronic rhinosinusitis (CRS). However, there are limited data about the percentage of postoperative control, and no prediction models for uncontrolled CRS have been reported. The aim of the study was to develop prediction models for postoperative uncontrolled CRS.Retrospective case series.Patients (n = 136) who had undergone endoscopic sinus surgery at least 1 year prior to the study were recruited to assess the clinical control. Risk factors were determined by logistic models and presented as odds ratio (OR) with a 95% confidence interval. Receiver operating characteristics curves were constructed to set the cutoff points and create predictive models.Approximately 47.8% of patients had controlled, 22.1% partially controlled, and 30.1% uncontrolled CRS. Univariate regression models revealed the risk factors for uncontrolled CRS: tissue eosinophilia, blood eosinophilia, high computed tomography (CT) score, bilateral disease, asthma, and allergic rhinitis. Multiple regression models found tissue eosinophil ratio0.206 (OR: 12.96, P = .001) or blood eosinophil ratio0.025 (OR: 4.56, P = .003), Lund-Mackay (LM) score ≥ 15 (OR: 15.50, P .001) and CT ethmoid (E) score ≥ maxillary (M) score (OR: 3.51, P = .037) were independent risk factors. We generated a pathological model (tissue eosinophil ratio and LM score) and a clinical model (blood eosinophil ratio, LM score and E ≥ M score) to categorize CRS into mild, moderate, and severe.This research provides simplified and efficient prediction models for uncontrolled CRS. It may help otolaryngologists to predict the prognosis before surgery in daily practice.2b Laryngoscope, 128:2673-2680, 2018.

Objective/Hypothesis Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by significant goblet hyperplasia and mucus hypersecretion. However, the molecular mechanism underlying mucin overexpression in CRSwNP has not been well characterized. This study sought to assess the expression of SAM-pointed domain-containing Ets-like factor (SPDEF) and its regulation of mucin production in CRSwNP patients. Study design Prospective laboratory-based study. Methods Polyp and control nasal tissues were collected from 27 CRSwNP patients and 15 control subjects. The expression of SPDEF and MUC5AC in the nasal tissues was examined by immunohistochemistry staining, quantitative reverse transcription polymerase chain reaction (qRT-PCR) and western blotting. In addition, SPDEF and MUC5AC expression was evaluated in cultured polyp epithelial cells and bronchial epithelial cells (BECs) in the presence of proinflammatory cytokines, corticosteroids and SPDEF small interfering RNA (siRNA) using qRT-PCR and western blot analysis. Results We found significantly increased SPDEF and MUC5AC expression in CRSwNP patients compared to the controls (P

Objectives/Hypothesis: The aim of this article was to describe our surgical technique for the treatment of nasal septal perforations with diameters of 1 to 2 cm. Study Design: Retrospective clinical research. Methods: We reviewed 13 patients with moderate nasal septal perforations (1–2 cm diameter) treated with a sandwich technique (bone or cartilage and quadriceps fascia graft as an interposition graft) by an endoscope-assisted intranasal approach from January 2008 to June 2011. Follow-up periods were 3 months. Results: Thirteen patients were treated with the sandwich technique. Twelve cases (92.3%) were completely healed. One case received incomplete closures without any postoperative symptoms. All patients were found not to have any complications after surgery. Conclusions: The transnasal endoscopic sandwich technique for repairing moderate nasal septal perforation (1–2 cm) has a high success rate and is easy to perform. Laryngoscope, 2012

Background: It has been suggested that human hepatitis A virus cellular receptor, also known as T-cell immunoglobulin and mucin domain-1 (TIM-1), plays an important role in the development of allergic diseases on the basis of epidemiologic data, but the molecular mechanism has been unclear. In a murine model of ovalbumin (OVA)-sensitized allergic rhinitis (AR), we examined the expression of TIM-1 and its correlation with T helper1-associated transcription factor, T-bet, as a potential mediator of T-cell immunoglobulin expression. Methods: Mice were challenged intranasally with OVA to elicit AR. The expression of TIM-1 in nasal tissues was examined by real-time reverse-transcription polymerase chain reaction (RT-PCR), and the surface expression of TIM-1 in peripheral blood mononuclear cells was evaluated by means of flow cytometry. In addition, the expression of TIM-1 as well as T-bet in splenic lymphocytes was examined by Western blotting. Results: TIM-1 mRNA was increased significantly in nasal tissues (P < .05) as seen by real-time RT-PCR. Flow cytometry indicated a differential TIM-1 expression of 135.5 ± 34.2 in the AR group versus 51.1 ± 10.9 in the control group (P < .05). The mean values of normalized TIM-1 were 0.43 ± 0.18 and 0.21 ± 0.10 in AR and control groups, respectively, whereas the mean values of normalized T-bet were 0.22 ± 0.13 and 0.67 ± 0.17 in the AR and control groups, respectively. There was a significant difference in the production of TIM-1 as well as T-bet in AR mice versus control mice (P < .05). The increased production of TIM-1 correlated significantly with the decreased T-bet in spleen tissue of AR mice (r = −0.52, P < .05). Conclusion: Our experimental model recapitulates an increase in lymphocyte TIM-1 expression seen in AR both locally and systemically. Our results also demonstrate an inverse relationship between lymphocyte TIM-1 and T-bet expression, suggesting a possible mechanism that TIM-1 influences the development of AR.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by significant goblet hyperplasia and mucus hypersecretion. However, the molecular mechanism underlying mucin overexpression in CRSwNP has not been well characterized. This study sought to assess the expression of SAM-pointed domain-containing Ets-like factor (SPDEF) and its regulation of mucin production in CRSwNP patients.Prospective laboratory-based study.Polyp and control nasal tissues were collected from 27 CRSwNP patients and 15 control subjects. The expression of SPDEF and MUC5AC in the nasal tissues was examined by immunohistochemistry staining, quantitative reverse transcription polymerase chain reaction (qRT-PCR) and western blotting. In addition, SPDEF and MUC5AC expression was evaluated in cultured polyp epithelial cells and bronchial epithelial cells (BECs) in the presence of proinflammatory cytokines, corticosteroids and SPDEF small interfering RNA (siRNA) using qRT-PCR and western blot analysis.We found significantly increased SPDEF and MUC5AC expression in CRSwNP patients compared to the controls (P .05); the mRNA level of SPDEF was positively correlated with MUC5AC expression in CRS patients (P .05). There was a significant difference in SPDEF and MUC5AC expression in eosinophilic and noneosinophilic CRSwNP patients (P .05). Interleukin (IL)-13, IL-8, and IL-17A significantly increased SPDEF and MUC5AC expression in vitro (P .05). SPDEF siRNA significantly inhibited SPDEF and MUC5AC expression in BECs in response to IL-13, IL-8, and IL-17A (P .05).Our findings suggested that SPDEF may be regarded as a promising therapeutic target for modulating mucus hypersecretion in CRSwNP.

Objectives/Hypothesis The aims of this study were to evaluate the efficacy of functional endoscopic sinus surgery (FESS)–oriented multimodality treatment in chronic rhinosinusitis (CRS) patients with asthma and its impact on asthma. Study Design Prospective, nonrandomized cohort. Methods Twenty-seven CRS patients with asthma who underwent FESS with postoperative topical corticosteroid spray were evaluated preoperatively; 25 of them were evaluated 1 year and 3 years postoperatively. CRS was evaluated by visual analogue scale, clinical control of CRS, and objective measurement endoscopy Lund-Kennedy scores. Asthma was assessed by subjective asthma control test and asthma control level, also by objective antiasthma medication use and pulmonary function tests. Results VAS scores of general symptoms (8.09 ± 0.87 preoperatively) were significantly improved at 1 year (2.94 ± 2.21) and 3 years (3.77 ± 2.16) postoperation (P = .000). No difference in these items was found between 1 year and 3 years (P = .463). Endoscopy Lund-Kennedy scores at 1 year (4.34 ± 3.09) and 3 years (5.80 ± 3.38) postoperatively were significantly better (9.33 ± 2.03 preoperatively, P = .000), and there was no difference between 1 year and 3 years of follow-up (P > .05). Significantly, asthma control level improved postoperatively (P = .025). However, antiasthma drug and pulmonary function showed no significant change postoperatively (P > .05). Conclusions FESS-oriented multimodality treatment improves CRS with asthma significantly and persistently. Asthma control level improved. Antiasthma medication use and pulmonary function remained stable. Level of Evidence 4. Laryngoscope, 124:24–28, 2014

BACKGROUND: Allergic rhinitis (AR) is a Th2 predominant disease, and its pathogenic mechanism is still poorly understood. CD4(+)CD25(+) T cells account for approximately 5% to 10% peripheral CD4(+) T cells and has been shown to regulate the activation of effector T cells in the periphery. The activity of CD4(+)CD25(+) T cells is associated with the transcription factor Foxp3. The present study aimed to evaluate the possible role of CD4(+)CD25(+) T cells as well as Foxp3 in the pathogenesis of AR. METHODS: Nasal tissues and peripheral blood mononuclear cells (PBMCs) were obtained from 17 patients with AR and 11 control subjects. Foxp3 was detected in nasal tissues by immunohistochemistry and real-time reverse transcription-polymerase chain reaction (RT-PCR). CD4(+)CD25(+) T cells and Foxp3 were evaluated in PBMCs by using flow cytometry. Concentrations of interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) were measured by enzyme-linked immunosorbent assay (ELISA) in cultured PBMCs in the presence or absence of stimulation with phorbol ester (PMA) and Ionomycin. RESULTS: The numbers of Foxp3(+) cells was 129.5 +/- 35.6 and 44.2 +/- 20.5 cells/mm(2) in nasal mucosa of two groups (P < .05). There were less Foxp3(+) lymphocytes and decreased Foxp3 mRNA in AR compared with the control (P < .05). The frequencies of the CD4(+)CD25(+) population in PBMCs of two groups were 1.99 +/- 0.95% and 3.55 +/- 1.27% (P < .05). There was significant difference in the frequencies of the Foxp3(+)CD4(+) CD25(+) population (1.81 +/- 0.77 vs 3.37 +/- 1.04, P < .05) and mean fluorescence intensity (MFI) of Foxp3 (5.93 +/- 2.64 vs 11.72 +/- 4.29, P < .05) in PBMCs of two groups. After stimulation, the concentrations of IL-2 and IFN-gamma were 182.72 +/- 85.11 pg/mL and 348.94 +/- 151.88 pg/mL in PBMCs with AR, while those were 90.6 +/- 61.5 pg/mL and 155.64 +/- 68.33 pg/mL in controls (P < .05). CONCLUSION: Our results indicate that CD4(+) CD25(+) regulatory T cells as well as Foxp3 may play a crucial role in immunological imbalance of AR. These findings suggest that increasing Foxp3 and CD4(+)CD25(+) T cells have the potential to be new therapeutic targets for the treatment of AR.