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This article discusses the long-term effects of aspirin desensitization on the inflammatory response in patients with aspirin-exacerbated respiratory disease (AERD). The study found that after long-term aspirin desensitization, there were significant increases in interferon-gamma (IFN-γ) and interleukin-10 (IL-10), suggesting a shift in the inflammatory response. These cytokines are associated with immune tolerance and may play a role in the mechanism of aspirin desensitization. However, the specific cells producing these cytokines and the role of lipid mediators in aspirin desensitization were not addressed in this study. Further research is needed to understand the cellular context and mechanisms associated with these cytokine shifts. [Extracted from the article]

This article discusses the use of histopathology to predict the success of macrolide therapy in patients with chronic rhinosinusitis (CRS). The study analyzed a cohort of over fifty CRS patients who were on macrolide therapy, and examined the histopathological findings at the time of surgery to determine their association with the success of macrolide treatment. The findings showed that fibrosis, absence of squamous metaplasia, absence of eosinophilia, presence of neutrophilic infiltrate, and lymphoplasmocytic predominance were all associated with the objective success of macrolide treatment. These findings may help clinicians in selecting appropriate patients for macrolide therapy. [Extracted from the article]

Background: Aspirin-exacerbated respiratory disease (AERD) is optimally managed by endoscopic sinus surgery (ESS) followed by aspirin therapy after desensitization (ATAD). Most AERD quality of life (QOL) studies use the 22-item Sinonasal Outcomes Test (SNOT-22), which focuses predominantly on sinonasal outcomes. Objective: This study seeks to assess QOL outcomes in AERD patients after ESS and ATAD via the 12-item Short Form Survey (SF-12), a well-validated QOL measure for general health status of chronic conditions. Methods: Retrospective review of 112 AERD patients who underwent ESS followed by ATAD at our institution between 2016 and 2019. SF-12 was collected preoperatively, postoperatively/pre-AD, and serially post-AD (1–3, 4–6, 7–12, and >12 months). Optum® PRO CoRE software was used to compare data to national norms. ANOVA was performed comparing physical component summary (PCS), mental component summary (MCS) and eight health domains (physical functioning, role physical, general health, bodily pain, vitality, social functioning, role emotional, and mental health). Results: AERD patients showed improvement in PCS scores across all timepoints after ESS and ATAD (p = 0.004). When stratified by gender, women demonstrated an improvement in PCS scores (p = 0.004). Within the domains, there were significant improvements in social functioning (SF), role physical (RP), and bodily pain (BP) at all timepoints (SF: p = 0.006; RP: p = 0.005; BP: p < 0.001). Conclusions: AERD patients undergoing ESS and ATAD show improvement in physical QOL and 3 of the 8 health domains as measured by the SF-12. Future studies can use the SF-12 to study the impact of AERD treatment versus other chronic diseases and health demographics. [ABSTRACT FROM AUTHOR]

Keywords: chronic rhinosinusitis; corticosteroid implant; endoscopic sinus surgery; nasal polyps; T2 biologic; topical corticosteroid; treatment algorithm EN chronic rhinosinusitis corticosteroid implant endoscopic sinus surgery nasal polyps T2 biologic topical corticosteroid treatment algorithm 1407 1416 10 11/02/21 20211001 NES 211001 SUMMARY Chronic rhinosinusitis (CRS) represents a significant health care problem in the United States and CRS patients have a significant decreased quality of life. Only FDA-approved treatment options were considered in this stepwise approach for CRSwNP because these therapies had undergone rigorous safety and efficacy evaluation. The value of these therapies compared with those of time tested and better studied therapies such as ESS and aspirin desensitization certainly need to be considered on an individual basis. Most otolaryngologists and allergists would agree that this patient would require a host of interventions including a complete ESS, oral and topical corticosteroids, endotype-specific therapies such as type 2 targeting biologics and consideration for aspirin desensitization in aspirin triad (also known as AERD) patients. [Extracted from the article]

Background Methods Results Conclusions Endoscopic sinus surgery (ESS) maximized for topical steroid irrigations is highly effective for polyp disease. As extent and completeness of ESS varies widely by situation and practitioner, it is important to understand when revision surgery is appropriate, particularly in the era of biologic treatments.A Completion of Surgery Index (CoSI) was developed to assess operative changes in polyp patients using pre‐ and postoperative computed tomography scans. The CoSI was then applied and tested in a cohort of consecutive chronic rhinosinusitis with nasal polyps (CRSwNP) patients, and examined within the context of quality‐of‐life improvements.The CoSI assesses surgical extent on a scale of 0–100, with 100 representing the highest possible degree of surgical completeness. Among 100 consecutive CRSwNP patients undergoing ESS in 2021 with postoperative topical steroid irrigations, including 75 revision surgeries, SNOT‐22 scores improved at 6 months postoperatively, with durable and consistent improvement at 24 months (p < 0.001). Preoperative CoSI scores in revision surgery patients were 49.4 ± 26.0, improving to 91.0 ± 8.1 postoperatively. SNOT‐22 scores for primary ESS patients and patients with a preoperative CoSI score of less than 70 improved by 26.4 and 28.1 points, respectively, in contrast to patients with a preoperative CoSI of 70 or greater (14.1 points, p = 0.029).It is important to define extent of surgery in CRSwNP to stratify postsurgical patients based on likelihood to benefit from revision surgery or alternative medications. The CoSI can be utilized to identify patients who are likely to improve significantly with revision surgical intervention. [ABSTRACT FROM AUTHOR]