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Objectives The primary aim of this study was to assess disparities in nasal nitric oxide (NO) levels between individuals diagnosed with eosinophilic chronic rhinosinusitis (ECRS) and those without ECRS. The second aim was to ascertain the comparative predictive efficacy of these nasal NO levels for the presence of ECRS.Methods A systematic analysis was conducted on relevant studies that compared nasal NO levels in individuals with ECRS and those without. Furthermore, the discriminatory capacity of nasal NO in distinguishing ECRS from non-ECRS cohorts was quantified. The risk of bias across studies was evaluated utilizing the Newcastle-Ottawa scale.Results The comprehensive review encompassed a total of 5 studies involving 470 participants. Findings revealed that patients diagnosed with ECRS exhibited significantly higher levels of nasal NO, as measured in parts per billion (ppb), compared to their non-ECRS patients. The mean difference was 130.03 ppb (95% confidence interval: [66.30, 193.75], I2 = 58.7%). The diagnostic odds ratio for nasal NO in identifying ECRS was 9.29 ([5.85, 14.75], I2 = 26.4%). The area under the summary receiver operating characteristic curve was 0.82. The correlation between sensitivity and false positive rate was 0.53, suggesting a lack of heterogeneity. Sensitivity, specificity, negative predictive value, and positive predictive value were 69% ([0.55, 0.79], I2= 77.0%), 83% ([0.73, 0.90], I2= 68.5%), 77% ([0.69, 0.83], I2= 50.1%), and 75% ([0.67, 0.82], I2= 41.5%), respectively.Conclusion Nasal NO has the potential as a noninvasive diagnostic measure and endotype tool for ECRS.

Objectives: To evaluate the efficacy of topically applied tramadol in peritonsillar area for pain control and induction of perioperative morbidity in children undergoing adenotonsillectomy.Methods: Two authors independently searched the databases (MEDLINE, SCOPUS, and Cochrane databases) up to April 2022 for randomized controlled trials comparing the efficacy of an intraoperative peritonsillar administered tramadol with placebo or other agents only in pediatric patients. The outcomes were postoperative pain scores, time to take the first pain reducing drugs, and postoperative nausea/vomiting.Results: Our analysis was based on 17 trials. Peritonsillar administered tramadol significantly reduced postoperative pain at less than 20 minutes (SMD −1.5852, 95% CI [−2.3900; −0.7804]), 1 hour (SMD −1.5811, 95% CI [−2.3400; −0.8222]), 8 hours (SMD −1.0258, 95% CI [−1.8792; −0.1724]), 16 hours (SMD −0.8397, 95% CI [−1.4266; −0.2529]), and 1 day (SMD −1.0110, 95% CI [−1.5213; −0.5007]) and the time to take the first analgesic drug (SMD 1.6565, 95% CI [0.2838; 3.0293]) compared with the placebo. However, tramadol showed no significant difference on postoperative pain relief effects and the time to take the first analgesic drug compared to the other topical agents (bupivacaine, lidocaine, ketamine, and dexamethasone). Tramadol did not cause significant postoperative nausea and vomiting.Conclusions: This study demonstrated that intraoperatively applied topical tramadol could control postoperative pain and reduce the analgesic uptake compared with a control. However, the efficacy of tramadol in pain control was similar to other agents in pediatric adenotonsillectomy.

Background There have been reports investigating the use of olfactory training in olfactory dysfunction after COVID-19.Objective We evaluated the effect of olfactory training on the olfactory dysfunction of patients infected with COVID-19.Methods We searched PubMed, EMBASE, the Web of Science, the Cochrane database, SCOPUS, and Google Scholar up to May 2022. We retrieved studies that compared the extents of olfactory dysfunction before and after olfactory training. We performed a subgroup analysis by the duration of olfactory dysfunction.Results The olfactory score after olfactory training (standard mean difference [SMD] = 1.0830, 95% confidence interval [CI] [0.6416; 1.5245], P< .0001, I2= 90.4%) was higher than that before training. The olfactory dysfunction rate differed significantly (OR = 0.0232, 95% CI [0.0052; 0.1044], P< .0001, I2= 63.1%) before and after olfactory training. On subgroup analysis, although patients with both acute (onset < 30 days prior) and chronic (onset > 30 days prior) olfactory dysfunction evidenced clinically significant improvements, training during acute dysfunction (compared to acute dysfunction) increased the olfactory score to a greater extent (SMD = 1.7779, 95% CI [1.0077; 2.5481] vs 0.6928 [0.2143; 1.1712], P= 0.0190). Moreover, as a result of subgroup analysis by dividing the included studies into2 using 2-month training period as standard, there was no statistically significant difference in the effect of the training period in the included study.Conclusion Olfactory training improved olfactory disorders caused by COVID-19. Such training was effective in both the acute and chronic phases.

Background Conventional minimally invasive surgery has a high recurrence rate, and nasal morbidity can occur if the scope of surgery is expanded to complete removal of maxillary sinus inverted papilloma.Objective To analyze the efficacy of the endoscopic prelacrimal recess approach (EPLRA) for maxillary sinus inverted papilloma removal.Methods Eighteen studies were included in this meta-analysis. Articles comparing the prelacrimal recess approach with conventional surgery (endoscopic surgery or the Caldwell–Luc operation) for inverted papilloma removal were included. Outcomes of interest included recurrence and postoperative morbidities. The methodological quality was assessed using the Newcastle–Ottawa scale.Results The recurrence rates of inverted papilloma, postoperative facial or gingival numbness, and alar collapse were 3.13% (95% confidence interval [CI]: 1.32, 7.27), 9.02% (95% CI: 3.70, 20.39), and 3.39% (95% CI: 1.28, 8.68), respectively. The recurrence rate of inverted papilloma was significantly lower after the EPLRA than after conventional surgery (odds ratio [OR] = 0.2290; 95% CI: 0.0808, 0.6489). However, there were no significant differences between the procedures in the rates of facial or gingival numbness (OR = 0.4567; 95% CI: 0.1497, 1.3933), epistaxis (OR = 0.3150; 95% CI: 0.0471, 2.1044), or periorbital swelling (OR = 1.2405; 95% CI: 0.1205, 12.7731).Conclusions The EPLRA can preserve the lacrimal system and is useful for maxillary sinus inverted papilloma removal due to a lower recurrence rate compared with conventional surgeries.

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Several surgical techniques have been used during tonsillectomy to reduce complications.

•Bilateral Axillo-Breast Approach Robotic Thyroidectomy (BABART) has been developed.•We directly compare BABART with other approaches in outcomes and complications.•BABART's operation time, drainage, and cosmetic satisfaction were insufficient.•However, the surgical performance of BABART was not inferior.

Background Current treatment paradigms recommend surgical intervention when conventional medical management proves ineffective in resolving chronic rhinosinusitis with nasal polyposis.Objectives To assess and compare the efficacy of dupilumab and functional endoscopic sinus surgery (FESS) for the treatment of chronic rhinosinusitis with nasal polyp (CRSwNP) over time.Methods Studies comparing CRSwNP patients who received dupilumab with those who underwent FESS were included. Outcome measures included the nasal congestion score (NCS), Sino-nasal Outcome Test-22 (SNOT-22), University of Pennsylvania Smell Identification Test-40 (UPSIT-40), and nasal polyp score (NPS). The risk of bias was evaluated using the Newcastle-Ottawa Scale.Results A total of 4 studies with 724 participants were included. The dupilumab group had a superior NCS, but an inferior NPS, compared to the FESS group during the follow-up period. The SNOT-22 score of the dupilumab group was inferior to that of the FESS group until 6 months posttreatment, but the scores were similar at around 1 year. A similar trend was observed for the UPSIT-40 score, but the score of the dupilumab group was higher at around 1 year.Conclusion Functional endoscopic sinus surgery was more effective than dupilumab for several months after treatment. However, at 1 year after treatment, the effects of the 2 treatments became similar, with greater olfactory improvement seen in the dupilumab group.

Objectives We assessed the effect of tranexamic acid on postoperative bleeding, and any adverse effects, in patients undergoing head-and-neck surgery.Methods We searched databases (PubMed, SCOPUS, Embase, the Web of Science, Google Scholar, and the Cochrane database) from their dates of inception to August 31, 2021. We analyzed studies that compared bleeding-related morbidity between perioperative tranexamic acid and placebo (control) groups. We subanalyzed tranexamic acid administration methods.Results The extent of postoperative bleeding (standardized mean difference [SMD] = –0.7817, [–1.4237; –0.1398], P= 0.0170, I2= 92.2%) was significantly less in the treatment group. However, there were no significant between-group differences in terms of operative time (SMD = –0.0463 [–0.2147; 0.1221]; P= 0.5897, I2= 0.0% [0.0%; 32.9%]); intraoperative blood loss (SMD = –0.7711 [–1.6274; 0.0852], P= 0.0776, I2= 94.4%); drain removal timing (SMD = –0.3382 [–0.9547; 0.2782], P= 0.2822, I2= 81.7%); or the amount of infused perioperative fluid (SMD = –0.0622 [–0.2615; 0.1372], P= 0.5410, I2= 35.5%). Also, there were no significant between-group differences in laboratory findings (serum bilirubin, creatinine, and urea levels; and the coagulation profiles) between the tranexamic acid and control groups. Topical application was associated with a shorter postoperative drain tube dwell time than was systemic administration.Conclusion Perioperative tranexamic acid significantly reduced postoperative bleeding in patients undergoing head-and-neck surgery. Also, topical administration might be more effective in postoperative bleeding and postoperative drain tube dwell time.

Objectives: Respiratory mechanics instability (RMI) based on paradoxical movement is correlated with respiratory disturbance such as apnea-hypopnea index (AHI) and reflects the severity of obstructive sleep apnea (OSA). The purpose of this study was to identify RMI as a method for assessing the effectiveness of continuous positive airway pressure (CPAP) in the management for OSA.Methods: A total of 71 consecutive OSA patients with CPAP titration were included in this study. We compared sleep (sleep efficiency, arousal index, and sleep stages), respiratory (AHI, oxygen desaturation index ≥3% [ODI3], and lowest oxygen saturation), and RMI parameters (events, index, duration, and % of stage duration) between diagnostic polysomnography and CPAP titration data.Results: All RMI parameters (events [157.5 ± 80.9 vs 80.0 ± 47.1; P< .001], index [25.3 ± 12.4 vs 12.7 ± 7.0; P< .001], duration [182.6 ± 96.2 vs 79.8 ± 88.9; P< .001], and % of stage duration [49.0 ± 24.4 vs 20.5 ± 21.3; P< .001]) were significantly improved by the alleviation of obstructive respiratory disturbance parameters (AHI [45.1 ± 23.0 vs 4.2 ± 4.3; P< .001], ODI3 [44.9 ± 22.6 vs 4.8 ± 4.6; P< .001], and lowest oxygen saturation [77.7 ± 7.3 vs 89.3 ± 3.8; P< .001]) compared to diagnostic polysomnography and CPAP titration data.Conclusion: RMI may be a useful method for evaluating the effect of CPAP in OSA patients.

Background We evaluated the accuracy of nasal endoscopy in diagnosing chronic rhinosinusitis (CRS) compared with paranasal sinus computed tomography (CT).Methods Two authors independently searched the 5 databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) up to March 2019. For all included studies, we calculated correlation coefficients between the endoscopic and CT scores. We extracted data on true-positive and false-positive and true-negative and false-negative results. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool (version 2).Results We included 16 observational or retrospective studies. A high correlation (r= .8543; 95% confidence interval [CI] [0.7685–0.9401], P< .0001, I2= 76.58%) between endoscopy and CT in terms of the diagnostic accuracy for CRS was apparent. The odds ratio (Lund–Kennedy endoscopic score ≥1) was 7.915 (95% CI [4.435–14.124]; I2= 28.361%). The area under the summary receiver operating characteristic curve was 0.765. The sensitivity and specificity were 0.726 (95% CI [0.584–0.834]) and 0.767 (95% CI [0.685–0.849]), respectively. However, high interstudy heterogeneity was evident given the different endoscopic score thresholds used (Lund–Kennedy endoscopic score ≥1 vs 2). In a subgroup analysis of studies using a Lund–Kennedy endoscopic score threshold ≥2, the area under the summary curve was 0.881, and the sensitivity and specificity were 0.874 (95% CI [0.783–0.930]) and 0.793 (95% CI [0.366–0.962]), respectively.Conclusion Nasal endoscopy is a useful diagnostic tool; the Lund–Kennedy score was comparable with that of CT.

Tranexamic acid is a hemostatic agent, which inhibits fibrin degradation, which may be beneficial in controlling bleeding during surgery.

Background:: In this study, we manufactured a complex of human nasal septal cartilage (hNC) with polycaprolactone (PCL) for transplantation into cartilaginous skeletal defects and evaluated their characteristics. Methods:: Nasal septum tissue was obtained from five patients aged ≥ 20 years who were undergoing septoplasty. hNCs were isolated and subcultured for three passages in vitro. To formulate the cell–PCL complex, we used type I collagen as an adhesive between chondrocyte and PCL. Immunofluorescence staining, cell viability and growth in the hNC–PCL complex, and mycoplasma contamination were assessed. Results:: hNCs in PCL showed viability ≥ 70% and remained at these levels for 9 h of incubation at 4 °C. Immunostaining of the hNC–PCL complex also showed high expression levels of chondrocyte-specific protein, COL2A1, SOX9, and aggrecan during 24 h of clinically applicable conditions. Conclusion:: The hNC–PCL complex may be a valuable therapeutic agent for implantation into injured cartilage tissue, and can be used clinically to repair cartilaginous skeletal defects. From a clinical perspective, it is important to set the short duration of the implantation process to achieve effective functional implantation.

IMPORTANCE: Studies have shown the controllability and porosity of polycaprolactone as well as the use of 3-dimensional (3-D) printing for nasal reconstruction in animal models. The utility of polycaprolactone with 3-D technology in nasal cartilaginous framework reconstruction in humans remains unknown. OBJECTIVE: To investigate the safety and efficacy of 3-D printed, bioresorbable polycaprolactone nasal implants. DESIGN, SETTING, AND PARTICIPANTS: This multicenter clinical trial comprised 20 patients with caudal septal deviations who underwent septoplasty, which used a 3-D printed polycaprolactone mesh, at 2 centers in South Korea. Patients were included if they were aged 18 to 74 years and had nasal septal deviations, Nasal Obstruction Symptom Evaluation scores greater than 20, and persistent nasal obstructions. Twenty-two patients met the inclusion criteria, but 2 patients were excluded before the operation. The study was conducted from July 1, 2016, to June 30, 2017. MAIN OUTCOMES AND MEASURES: The change in total Nasal Obstruction Symptom Evaluation score between the preoperative examination and the week 12 postoperative examination was the primary outcome. Changes in bilateral nasal cavity minimum cross-sectional area and volume on acoustic rhinometry at weeks 4 and 12 after the operation as well as changes in the nasal cavity cross-sectional area at the osteomeatal unit and nasal septum angle in the paranasal sinus on computed tomography after week 12 were among the secondary outcomes. RESULTS: Of the 20 patients included in the study, 4 (20%) were female, 16 (80%) were male, with a mean (SD) age of 34.95 (11.96) years. The preoperative and week 12 postoperative results revealed significant changes in the minimal cross-sectional areas on acoustic rhinometry (0.41 [SD, 0.39] vs –0.11 [SD, 0.18]; difference, 0.42; 95% CI, 0.23-0.61), nasal septum angles on computed tomography (11.22 [SD, 6.57] vs 2.89 [SD, 3.12]; difference, 8.33; 95% CI, 5.08-11.58), and Nasal Obstruction Symptom Evaluation scores (73.50 [SD, 19.88] vs 3.75 [SD, 6.26]; difference, 69.75; 95% CI, 59.22-80.28). The surgeons’ convenience level with the procedure was favorable (visual analog scale score [SD], 90.90 [9.45]), and so were the patients’ symptom improvements and satisfaction after 12 weeks (visual analog scale score [SD], 88.30 [9.87]). CONCLUSIONS AND RELEVANCE: The 3-D printed, homogeneous, composite, microporous polycaprolactone nasal implant demonstrated proper mechanical support and thinness with excellent biocompatibility and surgical manipulability. Polycaprolactone may be a clinically biocompatible material for use in various craniofacial reconstructions in the future.

Background We investigated the relationship between olfactory dysfunction and depressive symptoms and suicidal ideation in South Korea by using data from the 2010-2011 Korea National Health and Nutrition Examination Surveys (KNHANES).Methods Cross-sectional data of 11,972 adults who completed the KNHANES were analyzed.Results The prevalence of olfactory dysfunction was 5.0% among the population ≥ 19 years of age. Olfactory dysfunction was significantly associated with age, alcohol consumption, waist circumference, job, education level, and rhinitis. Depressed mood for two or more continuous weeks was reported by 19.2% of participants with olfactory dysfunction and 12.8% of participants without olfactory dysfunction (p = 0.0009). Suicidal ideation was reported by 20.5% of participants with olfactory dysfunction and 14.1% of participants without olfactory dysfunction (p < 0.0001). The participants with olfactory dysfunction were at higher risk for depressed mood than were participants without olfactory dysfunction (odds ratio [OR] 1.505 [95% confidence interval [CI], 1.106-2.048]) after adjusting for confounders. The participants with olfactory dysfunction were also at higher risk for suicidal ideation (OR 1.306 [95% CI, 1.027-1.662]).Conclusion In the Korean population, olfactory dysfunction was associated with an increased risk for depressed mood and suicidal ideation. Further epidemiologic and experimental studies are necessary to clarify the impact of olfactory dysfunction on psychological diseases.

Background Endonasal phototherapy can relieve the symptoms of allergic rhinitis (AR) for the patient. However, there is no consensus on whether or not endonasal phototherapy is effective in reducing the symptoms of AR.Objective The goal of this meta-analysis was to perform a systematic review of the available literature on the effects of endonasal phototherapy on symptoms of AR.Methods Two authors independently searched medical literature databases from their inception of article collection to July 2014. Studies that scored the nasal symptoms of AR and quality of life related to AR before and after endonasal phototherapy, and that compared the effects of phototherapy (treatment groups) with sham treatment (sham group) or antihistamine administration (antihistamine group) were included in the analysis. The outcomes of interest were total nasal symptom scores, disease-specific quality of life questionnaire assessments, and endoscopic findings (discharge and turbinate hypertrophy). Overall, a total of 13 trials met the inclusion criteria of this study, with a total sample size of 679 patients.Results Phototherapy significantly reduced nasal symptoms compared with pretreatment values and improved quality of life. The endoscopic findings also significantly improved after phototherapy. In addition, the symptom score and disease-specific quality of life after treatment were significantly lower in the treatment group versus the sham group, and were similar to those in the antihistamine group.Conclusions Phototherapy could provide nasal symptom relief and improve quality of life related to AR. However, when considering the insufficient evaluation of the efficacy of phototherapy according to the treatment methods and the high heterogeneity apparent in some parameters, further clinical trials with robust research methodologies should be conducted to confirm the results of this study.

Early detection of potentially malignant oral cavity disorders is critical for a good prognosis, and it is unclear whether the use of chemiluminescence as an adjunctive diagnostic screening method improves diagnostic accuracy.

This study aimed to investigate the anatomy of the optic nerve (ON), extraocular muscles (EOMs), and paranasal structures with regard to an endoscopic endonasal approach to the orbit using multiplanar reconstruction of computed tomographic (CT) scans.

Background The pterygopalatine fossa (PPF) can be entered endoscopically, but the endoscopic landmarks to localize the bony structures in the PPF are not well described. This study aimed to investigate the anatomy of the sphenopalatine foramen (SPF), vidian canal (VC), and foramen rotundum (FR) with regard to an endoscopic endonasal approach to the PPF using three-dimensional reconstruction of computed tomography (CT) scans.Methods The CT scans of 98 patients were retrospectively evaluated. The morphology of the SPF, VC, and FR as well as the spatial relationship between the SPF and VC were measured on a three-dimensional model.Results The mean diameters of the SPF, VC, and FR were 5.3 ±1.3 mm, 2.4 ± 0.7 mm, and 2.8 ± 0.5 mm, respectively. The mean distance between the VC and posteroinferior margin of SPF was 3.8 ± 1.0 mm. The mean vertical and horizontal distances on the surface plane of sphenoid bone between the VC and FR were 5.8 ± 1.9 mm and 8.5 ± 1.9 mm, respectively. The whole or partial margin of the VC was above the inferior margin of the SPF in 92% (180/196) of the VC and lateral to the posterior margin of the SPF in 98% (195/196) of the VC. The distance between the VC and SPF had a positive correlation with the distances between the VC and FR.Conclusion The endoscopic endonasal approach to the PPF will be performed with greater accuracy and safety through comprehension of the spatial relationships between the SPF, VC, and FR.

Traditional meta-analyses on the diagnostic accuracy of oral lesions have been conducted, but they were inherently limited to direct pairwise comparisons between a single method and a single alternative, while multiple diagnostic options and the ranking thereof were methodologically not possible.

•The initial diagnosis of necrotizing otitis externa has not been established.•CT and MRI are the currently preferred imaging modalities.•The diagnostic sensitivity of technetium-99m, gallium-67, and MRI was favorable.