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BACKGROUND: Olfactory dysfunction (OD) associated with chronic rhinosinusitis (CRS) remains quite challenging. Instruments to precisely assess olfactory cleft anatomy and their association with olfaction are needed. METHODS: The olfactory cleft endoscopy scale (OCES) was used to assess the olfactory cleft in healthy control subjects and a cohort of patients with CRS. Psychophysical and psychosocial olfactory function were assessed and correlations with OCES scores were measured. RESULTS: Control subjects (N=164) and subjects with CRS with nasal polyps (CRSwNP, N=127) and CRS without nasal polyps (CRSsNP, N=114) were enrolled. OCES correlated with both psychophysical and psychosocial olfaction, as measured by threshold, discrimination and identification (TDI) scores (R= −0.533, p

Background The Sinus Control Test (SCT) is a patient-reported questionnaire designed to help physicians identify sub-optimally controlled chronic rhinosinusitis (CRS). This study measures responsiveness to surgery and reliability of the SCT. Methodology Adults meeting diagnostic criteria for CRS were recruited from rhinology clinics at a tertiary academic institution. To measure responsiveness, the SCT was administered at baseline and at least 3 months after surgery to 62 CRS patients. To measure reliability, the SCT was administered at two clinical encounters a maximum of 14 days apart to 22 CRS patients. Results Total SCT scores significantly improved from baseline to post-operative follow-up, and the distribution of patients with total SCT scores falling into the uncontrolled, partially controlled, and controlled categories before and after surgery were significantly different in the direction of improvement. The SCT met minimum standards for reliability and internal consistency as measured by: test-retest reliability coefficient, intra-class correlation coefficients, and item-total correlations. Cronbach alpha; values with each item deleted were lower than the overall Cronbach alpha. The SCT captures the full range of disease control as measured by floor and ceiling effects. Conclusion The SCT is responsive to surgical intervention and a reliable tool to monitor changes in CRS control levels.

BACKGROUND: With an aging population, it is important to understand age-related anatomic changes in the nasal cavity and cribriform plate (CP) that may have clinical implications. METHODOLOGY: Computed tomography (CT) scans obtained for non-rhinologic conditions were divided into a young cohort (N=35, 18–34 years old) and an old cohort (N=32, 80–99 years old). Intranasal airspace volumes and bony anatomy of the CP were manually segmented using OsiriX software. The CP was assessed for mean Hounsfield Units (HU) and percentage of olfactory foramina. Deformation based morphometry (DBM) was then performed on the same cohort and correlated with manual measurements. RESULTS: Individual nasal cavity volumes increased 17–75% with age (p0.8, p

Introduction: Appropriate indications for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) are currently poorly defined. The lack of clear surgical indications for ESS likely contributes to the large geographic variation in surgical rates and contributes to reduced quality of care. The objective of this study was to define appropriateness criteria for ESS during management of adult patients with uncomplicated CRS. Methods: The RAND/UCLA appropriateness methodology was performed. An international, multi-disciplinary panel of 10 experts in CRS was formed and completed two rounds of a modified Delphi ranking process along with a face-to-face meeting. Results: A total of 624 clinical scenarios were ranked, 312 scenarios each for CRS with and CRS without nasal polyps. For adult patients with uncomplicated CRS with nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus a short-course of systemic corticosteroid with a post-treatment total SNOT-22 score ≥ 20. For adult patients with uncomplicated CRS without nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus either a short-course of a broad spectrum/culture-directed systemic antibiotic or the use of a prolonged course of systemic low-dose anti-inflammatory antibiotic with a post-treatment total SNOT-22 score ≥ 20. Conclusion: This study has developed and reported of list of appropriateness criteria to offer ESS as a treatment option during management of uncomplicated adult CRS. The extent or technique of ESS was not addressed in this study and will depend on surgeon and patient factors. Furthermore, these criteria are the minimal threshold to make ESS a treatment option and do not imply that all patients meeting these criteria require surgery. The decision to perform ESS should be made after an informed patient makes a preference-sensitive decision to proceed with surgery. Applying these appropriateness criteria for ESS may optimize patient selection, reduce the incidence of unwarranted surgery, and assist clinicians in providing high quality, patient-centered care to patients with CRS.

The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007. The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed. This executive summary for otorhinolaryngologists focuses on the most important changes and issues for otorhinolaryngologists. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

There is significant debate on the influence of inflammatory mucosal disease on paranasal sinus pneumatization (PSP) and temporal bone pneumatization (TBP) in cystic fibrosis patients (CF). It is often assumed that mucosal disease of the paranasal sinuses will negatively influence development and pneumotization of the paranasal sinuses and temporal bone system.A case-control study of TBP and PSP in CF, chronic rhinosinusitis (CRS) and healthy control patients from a tertiary rhinology clinic. TBP and PSP were assessed by computed tomography (CT) using a previously validated scale. Genotype data for patients with CF was determined.In total, 186 temporal bones and paranasal sinuses from 93 adult patients were assessed through evaluation of CT scans. Tha patients had a mean age of 43.4 +/- 14.9 yrs. The interobserver correlation for TB scoring was 0.86. TBP did not differ between CF, CRS and controls (chi(2) = 6.93, p = 0.38). PSP was less in the CF group (chi(2) = 34.2, p0.001) than the CRS and control groups. CRS and controls did not differ in PSP. 51.6% of CF patients were homozygous for DeltaF508 and 16.1% were heterozygous. The DeltaF508 status correlated with poorer SP (chi(2) = 34.2, p0.001), but greater TBP (chi(2) = 14.9, p = 0.002)PSP is impaired in CF and DeltaF508 homozygosity is related to poor PSP. TBP is well preserved in the CF population and DeltaF508 homozygosity correlates with greater TBP, with the underlying mechanisms being unclear. Genotype might play a role in skull base pneumatization.