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Abstract Objectives Chronic rhinosinusitis is one of the common diseases that cause morbidity and affects a person's quality of life. We tried to provide a more appropriate and effective approach to selecting patients for endoscopic sinus surgery. Methods The study population is chronic rhinosinusitis children referred to the ear, nose, and throat clinic of two general hospitals in Tehran, Iran, who have previously undergone sufficient drug treatment and have not recovered. The Lund–Mackay score is calculated by examining the computed tomography (CT) scan. The Sino‐nasal Outcome Test‐22 (SNOT‐22) questionnaire was provided to the patients before the operation, after the operation, and 3 and 6 months later in the clinic. Results Before the operation, the most SNOT‐22 score people were in the range of 40–59 points. The SNOT‐22 score before the operation is significantly different from 3 and 6 months after the operation. The highest frequency of Lund–Mackay CT (LMCT) scan score was in the range of 18–23 points. The LMCT scan score did not show any significant relationship with the SNOT‐22 score before surgery, 3 months, and 6 months after surgery. Sensitivity to aspirin had a significant relationship with SNOT‐22 scores and the history of asthma and nasal polyps had a significant relationship with the preoperative LMCT scan score. Conclusions The LMCT scan scoring system cannot be a good measure of chronic rhinosinusitis severity or the prognosis of patients after surgery. The SNOT‐22 questionnaire can be used as a predictive tool to help the doctor and the patient in deciding to operate and the possibility of obtaining a relative recovery.

Abstract Background Sinusitis is a common diagnosis that can be erroneously associated with routine weather‐related barometric pressure changes. In actuality, these pressure changes likely exacerbate migraine headaches, which can cause facial pain and pressure rather than true sinus inflammation. Objective The present study sought to characterize the representation of both sinusitis and migraine in association with barometric pressure changes across websites on the Internet. Methods An Internet search for relevant terms was conducted, and content of the resulting pages was assessed for associations between weather‐related pressure changes and either sinusitis or migraine. Variations in reported results across different subtypes of Internet sources were analyzed. The primary outcomes measured were (1) whether a given media source associated barometric weather changes with sinusitis, (2) whether that source associated barometric weather changes with migraine, and (3) treatment options offered by that source. Results Of the 116 included webpages, 36 (31.03%) associated sinusitis and routine barometric pressure changes. Of these, 10 (27.77%) were otolaryngology practice sites. Sixty‐seven webpages (57.76%) associated migraine and routine barometric pressure changes. Of these, nonotolaryngology webpages were more likely to report this link. Conclusions Otolaryngology practice sites were observed to be the most frequent professional medical resource reporting the unsubstantiated claim that routine barometric pressure changes are associated with sinusitis. Nonotolaryngology sources were more likely to link weather‐related pressure changes to migraine. These results suggest that opportunities exist for otolaryngology practice sites to educate patients about nonrhinogenic headache etiologies.

Abstract Objective This study aimed to evaluate the impact of endoscopic sinus surgery (ESS) on asthma severity up to 12 months after surgical intervention. Study Design Retrospective cohort. Setting Tertiary care center. Methods Patients with a history of asthma and Chronic Rhinosinusitis (CRS) who underwent ESS between 2013 and 2023 were included. Asthma severity was assessed according to current Global Initiative for Asthma (GINA) guidelines, classifying patients into mild, moderate, and severe based on medication requirements. Asthma severity was evaluated up to 3 months prior to ESS and 1‐year post‐ESS. Patients with aspirin‐exacerbated respiratory disease (AERD) were excluded. Statistical analysis was performed using McNemar test and Wilcoxon signed‐rank test to assess differences in asthma severity, medication doses, and number of medications. Results Sixty‐five patients were included, of which 44 (67.7%) had CRS with nasal polyps (CRSwNP) and 21 (32.3%) had CRS without nasal polyps (CRSsNP). No significant differences were found in asthma severity pre‐ and post‐ESS (P = .175). Similarly, no differences were found in ICS doses (P = .999), total number of prescribed medications (P = .157) or presence of exacerbations before and after ESS (P = .078). However, a significant increase in time from last rescue inhaler use was noted after ESS, increasing from a median of 6.71 to 23.1 weeks (P = .004). Conclusion This study is the first to assess the impact of ESS on asthma severity in a real‐world setting. Our findings suggest that ESS does not impact asthma severity classification. However, it might provide relief of asthma symptoms in the early postoperative period.

Abstract Objectives Chronic rhinosinusitis (CRS) is a heterogeneous disease, which can be subdivided into CRS with (CRSwNP) or without (CRSsNP) nasal polyps. An intractable form of CRSwNP that is associated with an eosinophil‐dominant inflammatory cell infiltration (eosinophilic CRS) has become more prevalent in Japan. There is currently limited information on the burden of CRS in Japan and treatment approaches used in real‐world practice. Methods This retrospective, observational, comparative cohort study used information from the Japanese JMDC insurance claims database (study period April 1, 2015, to March 31, 2020). A CRS cohort was identified and matched with a control group without CRS. The primary objective was to clarify disease burden and treatment approaches by comparing comorbidities, healthcare resource utilization (HRU), and drug prescriptions in the CRS and non‐CRS groups. Results In total, 23,256 individuals with CRS (1762 with CRSwNP and 21,494 with CRSsNP) were matched with 23,256 controls. The mean age was 45 years and the majority of individuals were male (57%). Individuals with CRS had a higher disease burden than controls, with more frequent comorbidities (particularly, type 2 inflammatory disease [e.g., allergic rhinitis and asthma], and those caused by systemic corticosteroids [SCS]), and higher HRU (including outpatient visits, laboratory examinations and surgical procedures). Further, individuals with CRS were prescribed more medications, both for CRS (including SCS) and non‐CRS conditions, than controls. Conclusion In Japan, CRS is associated with a high disease burden, and multiple treatment approaches are used in affected individuals, including long‐term SCS, which is generally not recommended. Level of Evidence 3

Abstract Background The emergence of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) has resulted in an unprecedented global pandemic. Most infected patients are either asymptomatic or have mild upper respiratory infection symptoms. However, life‐threatening sequelae have been observed. In this report, we reviewed nine cases of patients with severe complications from sinonasal disease in the setting of acute SARS‐CoV‐2 infection. Methods IRB approval was obtained prior to study initiation. A retrospective chart review was performed of patients admitted to a tertiary hospital with complex sinonasal symptoms that required otolaryngologic evaluation and management in the setting of concomitant SARS‐CoV‐2 infection. Results Nine patients, ranging from ages 3 to 71 years, with sinonasal disease and simultaneous SARS‐CoV‐2 infection were identified. Initial presentations ranged from asymptomatic infection to mild/moderate disease (nasal obstruction, cough) or more severe sequelae including epistaxis, proptosis, or neurologic changes. SARS‐CoV‐2 tests were positive from one to 12 days after symptom onset, with three patients receiving SARS‐CoV‐2‐directed treatment. Complex disease presentations included bilateral orbital abscesses, suppurative intracranial infection, cavernous sinus thrombosis with epidural abscess, systemic hematogenous spread with abscess development in four distinct anatomic locations, and hemorrhagic benign adenoidal tissue. Eight of nine patients (88.8%) required operative intervention. Patients with abscesses also required prolonged, culture‐directed antibiotic courses. Conclusion Though most SARS‐CoV‐2 infections are asymptomatic and/or self‐limited, there is significant morbidity and mortality in patients with severe disease sequela as outlined in our reported cases. This suggests early identification and treatment of sinonasal disease in this patient population is critical to minimizing poor outcomes. Further research on the pathophysiology of these atypical presentations is needed. Level of Evidence 4 (Case Series).

Abstract Objectives An increased incidence of acute invasive fungal sinusitis associated with the recent COVID‐19 pandemic has been observed, which is considered a public health concern. This study aims to detect the incidence, risk factors, causative agents, clinical presentations, outcomes, and susceptibility rate of various antifungals. Methods In this cross‐sectional cohort study, a total of 30 patients showing acute invasive fungal rhinosinusitis following a COVID‐19 infection were investigated. Histopathological biopsies, culture identification, and molecular confirmation of the causative agents were conducted. The demographic data, risk factors, clinical presentations, treatment regimen and its outcomes, and efficacy of antifungals were listed and analyzed. Results A total of 30 cases with a mean age of 59.6 ± 11.9 years were included. Diabetes mellitus was the most recorded comorbidity with a rate of 86.7%, whereas most of the patients received corticosteroids. The mycological examination confirmed the existence of Mucor (Rhizopus oryzae) and Aspergillus (Aspergillus niger) in 96.7% and 3.3% of the cases, respectively. Various stages of sinonasal involvement (ethmoid, maxillary, sphenoid, and inferior turbinate) represented 100%, 83.3%, 66.7%, and 86.7% of the cases, respectively. Headache and facial pain, ophthalmoplegia, visual loss, and blindness represented 100%, 66.7%, 90%, and 53.3% of the cases, respectively. All the cases were simultaneously treated with surgical debridement and amphotericin B. Moreover, R. oryzae was susceptible to it, whereas A. niger was sensitive to voriconazole, resulting in a survival rate of 86.7% (26/30). The R. oryzae and A. niger isolates were proven to be sensitive to acetic acid, ethyl alcohol, formalin, and isopropyl alcohol. Conclusions In patients with COVID‐19, the diagnosis of acute invasive fungal sinusitis and prompt treatment with antifungal medicine and surgical debridement are important in achieving better outcomes and survival rates. Level of Evidence 4

Abstract Background COVID‐19 measures such as masking, social distancing, and staying indoors may mitigate chronic rhinosinusitis (CRS) symptoms. We evaluate whether these measures correlated with improved symptoms in patients with CRS. Methods This retrospective study compared SNOT‐22 survey data from the Northwestern CRS Registry at the time of enrollment and at years 1–5 of follow‐up. The final sample consisted of 1826 SNOT‐22 surveys for 598 patients. April 10, 2020 to December 31, 2021 was considered "during the pandemic" and prior to March 11, 2020 was considered "pre‐pandemic." Wilcoxon test was used to compare SNOT22 at enrollment pre‐pandemic versus during pandemic. Separate linear mixed models were performed to estimate SNOT22 at 1 to 5 years after enrollment pre‐pandemic versus during pandemic. Results Subjects enrolled during the pandemic had worse SNOT22 scores than those enrolled pre‐pandemic (53 vs. 42, p = .0024). Total SNOT‐22 scores were improved during the pandemic than before the pandemic at 1 year follow‐up (18.17 vs. 12.22, p = .001). This effect persists when evaluating the nasal (7.33 vs. 5.13, p = .003), sleep (2.63 vs. 1.39, p = .008), function (1.40 vs. 0.72, p = .015), and emotion (0.77 vs. 0.17, p

Abstract Background This study aimed to evaluate the effect of local nasal desmopressin premedication on blood loss and the quality of surgical field in Functional Endoscopic Sinus Surgery (FESS). Material and methods In a randomized clinical trial, patients referred for FESS to treat their bilateral chronic rhinosinusitis were recruited. The participants were adults (≥18 years). They were randomly assigned (1:1:1) to receive low‐dose (20 μg) or high‐dose (40 μg) intranasal desmopressin (DDAVP) or placebo 60 min before the induction of general anesthesia. Standard FESS was performed by the same surgeon. The primary outcomes were volume of intraoperative bleeding and the quality of surgical field. Clean surgical field was defined as a score ≤2 on the Boezaart grading system. Results A total of 120 patients were included on an intention‐to‐treat basis (mean age: 41.0 years; 40 women, 80 men). There were no significant differences in primary outcomes between low‐dose DDAVP and placebo. As for the volume of blood loss, however, there was a significant difference between high‐dose DDAVP and placebo (mean difference: 29.6 ml; adjusted Cohen's d: −1.02; p

Abstract Objective The role of neurogenic inflammation in pathogenesis of chronic rhinitis is well known. However, very little is known about its importance in pathogenesis of nasal polyposis (NP), especially in form of NP which appears as a part of aspirin‐exacerbated respiratory disease (AERD). The aim of this study was to examine the concentrations of neuropeptides substance P (SP) and bradykinin (BK) in nasal secretions of patients with NP. Methods Fourteen patients with NP as a part of AERD with mild persistent asthma, 14 patients with NP without aspirin sensitivity, and 14 control subjects without nasal inflammation (C) entered this cross‐sectional study. Clinical parameters (symptoms, endoscopic, and radiological findings) were assessed. The concentrations of SP and BK were measured in the nasal secretion samples using commercial human enzyme immunoassay kits. Results The concentration of SP in nasal secretions was significantly higher in NP patients without aspirin sensitivity and AERD patients compared to controls (p = .022; p

Abstract Objective Odontogenic maxillary sinusitis (OMS) is a well‐recognized disease in otolaryngology and oral and maxillofacial surgery. It is diagnosed comprehensively based on the presence of dental disease and radiographic evaluation. Although the disease involves a combination of dental and otorhinolaryngological features, appropriate criteria have not been well established for prioritizing dental procedures in the initial treatment of OMS. We investigated whether computed tomography (CT) score, including the Lund–Mackay score, can help prioritize tooth extraction as the initial treatment for OMS. Methods We also investigated the radiographic features of 32 patients with OMS treated by tooth extraction alone. Both pre‐and post‐extraction CT images of OMS cases were evaluated. Results Lund–Mackay scores before tooth extraction were significantly lower in postoperatively healed patients than in non‐healed patients. Furthermore, CT scores of the anterior and posterior ethmoid sinuses and frontal sinuses, obtained before tooth extraction, were significantly lower in postoperatively healed patients than in non‐healed patients. Conclusions Collectively, low Lund–Mackay and CT scores of the ethmoid and frontal sinuses are significantly associated with healing of OMS treated by tooth extraction alone. The sinus CT score can help identify a treatment strategy for OMS.

Abstract Objective Chronic rhinosinusitis (CRS) is a highly prevalent and burdensome disease. The pathophysiology is not fully elucidated, but environmental pollutants have been suggested to impact the inflammatory component of the disease process. This review aims to summarize the role of environmental pollution in CRS onset and disease severity. Methods A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were queried in August 2021. Original articles reporting on air pollution exposure in CRS were included. Other forms of sinonasal disease were excluded. Results Literature search produced 11,983 articles, of which 10 met inclusion criteria. Outcomes evaluated included incidence/prevalence, disease severity, quality of life, and histopathologic/microbial changes. Air pollutant exposure was associated with higher odds of CRS, particularly with particulate matter (PM) exposure. Increasing air pollution exposure was also associated with worsened disease severity and detectable histopathologic changes. Impact on quality of life was less clear. Conclusion Air pollution (particularly PM) is correlated with CRS incidence/prevalence and disease severity, with evidence of histopathologic changes in CRS tissue samples. Further research is warranted to better understand the mechanisms by which air pollution components may cause CRS and type 2 inflammation. Level of Evidence 3a

Objective: To evaluate the clinical efficacy of vidian neurectomy (VN) or posterior nasal neurectomy (PNN) combined with endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP)., Data Sources: A systematic search of six databases (PubMed, SCOPUS, Embase, Web of Science, Google Scholar, and Cochrane) was conducted to identify relevant studies up to May 2024., Review Methods: The effects of combining VN or PNN with ESS were evaluated in comparison to ESS alone. Outcomes were assessed by evaluating changes in Lund-Kennedy score, patient-reported symptom scores (VAS), quality of life, as well as adverse effects and recurrence rate of CRSwNP., Results: A total of 6 studies, comprising 407 patients, were included in the analysis. The neurectomy group showed significant improvements in Lund-Kennedy score (SMD = 0.7276 [0.5695; 0.8857]), with statistically significant improvements maintained at 6, 12, and 24 months postoperatively. The treatment group maintained better improvements in sinusitis-related quality of life (SMD = 0.4540 [0.1784; 0.7297]) and VAS (SMD = 0.7096 [0.4356; 0.9837]) until 12 months postoperatively, but not at 24 months. Regarding adverse effects, additional neurectomy did not significantly induce epistaxis (odds ratio [OR] = 0.9806 [0.2348; 4.0960]) or dry eye (OR = 2.4194 [0.1114; 52.5255]) compared to the control group. On the other hand, there was no difference in the recurrence rate of CRSwNP between the 2 groups during the follow-up periods., Conclusion: Additional neurectomy shows better efficacy in improving endoscopic findings and symptoms in patients with CRSwNP and appears to be a safe and effective treatment., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: Critical components of the nasal endoscopic examination have not been definitively established for either the normal examination or for clinical disorders. This study aimed to identify concordance among rhinologists regarding the importance of examination findings for various nasal pathologies., Study Design: A consortium of 19 expert rhinologists across the United States was asked to rank the importance of findings on nasal endoscopy for 5 different sinonasal symptom presentations., Setting: An online questionnaire was distributed in July 2023., Methods: The questionnaire utilized JotForm® software and featured 5 cases with a set of 4 identical questions per case, each covering a common indication for nasal endoscopy. Rankings were synthesized into Normalized Attention Scores (NASs) and Weighted Normalized Attention Scores (W-NASs) to represent the perceived importance of each feature, scaled from 0 to 1., Results: General concordance was found for examination findings on nasal endoscopy within each case. The perceived features of importance differed between cases based on clinical presentation. For instance, in evaluating postnasal drip, the middle meatus was selected as the most important structure to examine (NAS, 0.73), with mucus selected as the most important abnormal finding (W-NAS, 0.66). The primary feature of interest for mucus was whether it was purulent or not (W-NAS, 0.67). Similar analyses were performed for features in each case., Conclusion: The implicit framework existing among rhinologists may help standardize examinations and improve diagnostic accuracy, augment the instruction of trainees, and inform the development of artificially intelligent algorithms to enhance clinical decision-making during nasal endoscopy., (© 2024 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Abstract Background Previous investigations suggest the use of extract from the roots of Pelargonium sidoides (EPs 7630) for the therapy of uncomplicated rhinosinusitis. The aim of this prospective study was to compare the effects of herbal drug EPs 7630 and antibiotic roxithromycin on chemokine production in nasal mucosa and clinical parameters in patients with uncomplicated acute bacterial rhinosinusitis (ABRS). Methods Seventy‐eight ABRS patients were divided into 26 patients receiving EPs 7630 tablets, 3 × 20 mg/day per os (group 1), 26 patients receiving roxithromycin tablets, 2 × 150 mg/day per os (group 2), both for 10 days, and 26 patients who received no therapy (Control group). We measured chemokine levels in nasal secretions by flow cytometry and assessed clinical parameters on day 0 and day 10 of investigation. Results EPs 7630 increased concentrations of MCP‐1 (P = .001) and IP‐10 (P = .049) and decreased levels of MIP‐1α (P

Abstract Objective Characterize sinonasal complications associated with endoscopic orbital decompression for thyroid eye disease (TED). Methods Retrospective analysis of patients who underwent endoscopic orbital decompression at Houston Methodist Hospital by two otolaryngologists and one ophthalmologist between May 2016 and February 2020 for TED. Patient ethnicity, age, laterality, operative approach (middle turbinectomy vs middle turbinate sparing), and history of prior sinusitis were collected. Results One hundred and forty‐five orbital decompressions met the inclusion criteria. Postoperative obstructive sinusitis where herniated orbital fat caused obstruction of the sinus ostium occurred in 5.5% of operations. Patients who had a prior history of sinusitis were more likely to develop postoperative obstructive sinusitis (P = .02). The middle turbinectomy approach was more likely to show a reduced incidence of postoperative sinusitis (P = .014). Conclusion Given the increased difficulty of managing sinonasal complications in the context of a decompressed orbit, efforts should be made to identify factors that might reduce the incidence of postoperative endonasal complications. The current study suggests that resection of the middle turbinate may allow for increased space for orbital fat herniation and lead to a decreased incidence of postoperative obstructive sinusitis. Level of Evidence IV.

Abstract We report a case of lophomoniasis in a kidney post‐transplantation patient. The patient, 46‐year‐old man, had pneumonia, acute sinusitis, and tonsillitis on admission. We recommend that lophomoniasis should be essentially ruled out in all patients suffering from post‐transplantation infection, particularly in those who do not respond to routine antibiotic regimens.

Objective: To compare healthcare resource utilization and healthcare costs in patients with migraine with or without a history of misdiagnosis., Background: Despite the high prevalence of migraine, migraine is commonly misdiagnosed. The healthcare resource use and cost burden of a misdiagnosis is unknown., Methods: This retrospective cohort study identified adults with an incident migraine diagnosis from the Merative™ Marketscan® Commercial and Medicare Supplemental Databases between June 2018 and 2019. Patients with a diagnosis of commonly considered misdiagnoses (headache, sinusitis, or cervical pain) before their migraine diagnosis were classified as the "misdiagnosed cohort." Patients in the misdiagnosed cohort were potentially misdiagnosed, then eventually received a correct diagnosis. Patients without a history of commonly considered misdiagnoses prior to their migraine diagnosis were classified as the "correctly diagnosed cohort." Healthcare resource utilization and healthcare costs were assessed in the period before migraine diagnosis and compared between the cohorts. Outcomes were reported as per patient per month and compared with incidence rate ratios., Results: A total of 29,147 patients comprised the correctly diagnosed cohort and 3841 patients comprised the misdiagnosed cohort and met the inclusion criteria. Patients in the misdiagnosed cohort had statistically significantly higher rates of inpatient admissions (0.02 vs. 0.01, incidence rate ratio [IRR] 1.61, 95% confidence interval [CI] 1.47-1.74), emergency department visits (0.10 vs. 0.05; IRR 1.89, 95% CI 1.79-1.99), neurologist visits (0.12 vs. 0.02; IRR 5.95, 95% CI 5.40-6.57), non-neurologist outpatient visits (2.64 vs. 1.58; IRR 1.67, 95% CI 1.62-1.72) and prescription fills (2.82 vs. 1.84; IRR 1.53, 95% CI 1.48-1.58) compared to correctly diagnosed patients. Misdiagnosed patients had statistically significantly higher rates of healthcare cost accrual for inpatient admissions ($1362 vs. $518; IRR 2.62, 95% CI 2.50-2.75), emergency department visits ($222 vs. $98; IRR 2.27, 95% CI 2.18-2.36), neurologist visits ($42 vs. $9; IRR 4.39, 95% CI 4.00-4.79), non-neurologist outpatient visits ($1327 vs. $641; IRR 2.07, 95% CI 1.91-2.24), and prescription fills ($305 vs. $215; IRR 1.41, 95% CI 1.18-1.70) compared to correctly diagnosed patients., Conclusion: Patients with migraine who have a history of misdiagnoses have higher rates of healthcare resource utilization and cost accrual versus those without such history., (© 2024 The Author(s). Headache: The Journal of Head and Face Pain published by Wiley Periodicals LLC on behalf of American Headache Society.)

Objective: This study aims to evaluate the accuracy of ChatGPT in answering allergic rhinitis (AR) and chronic rhinosinusitis (CRS) related questions., Study Design: This is a cross-sectional study., Setting: Each question was inputted as a separate, independent prompt., Methods: Responses to AR (n = 189) and CRS (n = 242) related questions, generated by GPT-3.5 and GPT-4, were independently graded for accuracy by 2 senior rhinology professors, with disagreements adjudicated by a third reviewer., Results: Overall, ChatGPT demonstrated a satisfactory performance, accurately answering over 80% of questions across all categories. Specifically, GPT-4.0's accuracy in responding to AR-related questions significantly exceeded that of GPT-3.5, but distinction not evident in CRS-related questions. Patient-originated questions had a significantly higher accuracy compared to doctor-originated questions when utilizing GPT-4.0 to respond to AR-related questions. This discrepancy was not observed with GPT-3.5 or in the context of CRS-related questions. Across different types of content, ChatGPT excelled in covering basic knowledge, prevention, and emotion for AR and CRS. However, it experienced challenges when addressing questions about recent advancements, a trend consistent across both GPT-3.5 and GPT-4.0 iterations. Importantly, the accuracy of responses remained unaffected when questions were posed in Chinese., Conclusion: Our findings suggest ChatGPT's capability to convey accurate information for AR and CRS patients, and offer insights into its performance across various domains, guiding its utilization and improvement., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Abstract Objective To compare the effectiveness of amoxicillin‐clavulanate versus amoxicillin for adults diagnosed with acute sinusitis (AS). A secondary objective compared antibiotic effectiveness in patients meeting risk criteria for treatment failure. Methods A retrospective cohort study of adults diagnosed with AS prescribed amoxicillin ± clavulanate within Veterans Affairs emergency departments from 2012–2019 was conducted. The primary outcome was sinusitis‐related return visits for amoxicillin versus amoxicillin‐clavulanate. Secondary outcomes included 30‐day infectious complications, gastrointestinal‐related adverse events (AEs), and hospitalizations. Propensity‐score matching and logistic regression models adjusted for potential confounders. Results A total of 89,627 AS patient visits were identified: 18,576 prescribed amoxicillin and 71,051 amoxicillin‐clavulanate. Most patients were male (75,604; 84.4%) and afebrile (80,624; 91.7%). The propensity score‐matched cohort comprised 17,929 amoxicillin and 42,294 amoxicillin‐clavulanate patient visits. There was no difference in sinusitis‐related return visits between amoxicillin (4.9%) and amoxicillin‐clavulanate (5.1%) (adjusted odds ratio [OR], 0.96; 95% confidence interval [CI], 0.88, 1.04; P = 0.317). Infectious complications (amoxicillin [0.3%] vs amoxicillin‐clavulanate [0.4%]); (adjusted OR, 0.78; 95% CI, 0.57, 1.07; P = 0.124) and hospitalization (amoxicillin [2.0%] vs amoxicillin‐clavulanate [2.4%]); (adjusted OR, 0.92; 95% CI, 0.81, 1.04; P = 0.173) were not different. Gastrointestinal‐related AEs were lower with amoxicillin (0.5%) relative to amoxicillin‐clavulanate (0.7%); (adjusted OR, 0.67; 95% CI, 0.53, 0.86; P = 0.002). Comorbidity was the only guideline‐recommended risk factor that was a significant predictor of infectious complications with respect to treatment (amoxicillin vs amoxicillin‐clavulanate, OR, 0.63; 95% CI, 0.40 to 0.94; P = 0.022). Conclusion Amoxicillin demonstrated similar efficacy to amoxicillin‐clavulanate for AS with fewer gastrointestinal‐related AEs. Amoxicillin is a viable option in adults with AS meeting criteria for antibiotic therapy.

Abstract Gardner syndrome with odontogenic sinusitis is rare but should be suspected in patients with multiple osteomas of the skull and facial bones, excess teeth, impacted teeth, and odontomas. Early diagnosis and treatment of GS may improve prognosis.

Objectives Chronic rhinosinusitis (CRS) has an impact on health‐related quality of life (HRQOL). The objective of this study was to examine generic and disease‐specific HRQOL and symptoms in CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps before and 6 months after sinus surgery, and to identify preoperative patient factors associated with HRQOL outcome in the two groups separately. Methods This prospective, observational study consisted of 220 CRSwNP and 196 CRSsNP patients. Generic and disease‐specific HRQOL were measured using the Short‐Form‐Health‐Survey (SF‐36) and Sino‐Nasal‐Outcome‐Test (SNOT‐20). Symptoms were assessed on a visual analog scale. Results Preoperatively, CRSwNP patients reported worse score in general health (SF‐36), rhinologic subset (SNOT‐20): nasal obstruction, nasal discharge, and altered sense of smell compared to CRSsNP patients, who reported worse score in physical role, bodily pain, ear/face subset, and facial pain. After surgery, generic and disease‐specific HRQOL and symptoms improved in both groups. CRSwNP patients had greater improvement in general health, vitality and social function, nasal obstruction, and altered sense of smell, compared to CRSsNP‐patients. In both groups, higher age, daily smoking, and having had sinus surgery previously were associated with less generic HRQOL improvement, in addition to female sex and allergy in CRSsNP patients. Conclusion The greater improvement in general health, vitality, and social function after surgery may indicate a greater potential for generic HRQOL improvement in CRSwNP patients compared to CRSsNP patients. Female sex and allergy was associated with less improvement of generic HRQOL in the CRSsNP group, but not in the CRSwNP group. Level of evidence 2c outcome research.

Abstract Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a therapeutic challenge because of the high recurrence rate. Surgical intervention should be considered in patients who fail to improve after medical treatment. We monitored recurrence and revision surgery over 12 years after endoscopic sinus surgery in CRSwNP patients. Methods In this prospective cohort study, 47 patients with CRSwNP, who underwent primary or revision extended endoscopic sinus surgery, were followed. Clinical symptoms and total nasal endoscopic polyp score were evaluated before, 6 years and 12 years after surgery. Results Twelve years after surgery, 38 out of 47 patients (80.9%) were available for examination. There still was a significantly better symptom score and total nasal endoscopic polyp score compared to before surgery (P

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disorder with a wide range of validated subjective and objective assessment tools to assess disease severity. However, a comprehensive and easy-to-use tool that integrates these measures for determining disease severity and response to treatment is still obscure. The objective of this study was to develop a standardized assessment tool that facilitates diagnosis, uniform patient monitoring, and comparison of treatment outcomes between different centers both in routine clinical practice and in research., Methods: To develop this tool, published literature on assessment tools was searched on various databases. A panel of 12 steering committee members conducted an advisory board meeting to review the findings. Specific outcome measures to be included in a comprehensive assessment tool and follow-up sheet were then collated following consensus approval from the panel. The tool was further validated for content and revised with expert recommendations to arrive at the finalized Nasal Polyp Patient Assessment Scoring Sheet (N-PASS) tool., Results: The N-PASS tool was developed by integrating the subjective and objective measures for CRS assessment. Based on expert opinions, N-PASS was revised to be used as an easy-to-use guidance tool that captures patient-reported and physician-assessed components for comprehensively assessing disease status and response to treatment., Conclusion: The N-PASS tool can be used to aid in the diagnosis and management of CRS cases with nasal polyps. The tool would also aid in improved monitoring of patients and pave the way for an international disease registry., Level of Evidence: Oxford Level 3., Competing Interests: Saad Alsaleh received honoraria from Sanofi and GSK for lectures and advisory board activities. Nehal Kamal, BS Pharm, is an employee of Sanofi and may hold shares and/or stock options in the company. Claire Hopkins has done advisory board work for Sanofi, GSK, Lilly, and Astra Zeneca. Omar Abu Suliman has been involved in advisory board work for Sanofi and GSK. Naif H. Al‐Otaibi has received advisory board fees and honoraria for lectures from Sanofi and GSK. Joseph K. Han is a research consultant for Sanofi Regeneron GSK AZ and Genentech. Amin Javer is a speaker/consultant for GSK, Sanofi Regeneron, iView Therapeutics, and SaNOtize. Ahmad R. Sedaghat has been involved in research funding and advisory board participation for Sanofi/Regeneron and GSK. Philippe Gevaert declares he has received lecture fees and/or participation at expert board meetings from ALK‐Abelló, Argenx, AstraZeneca, Genentech, GlaxoSmithKline, Novartis, Regeneron, Roche, Sanofi, and Stallergenes Greer. The remaining authors declare no conflicts of interest., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Objective: Social media may inform health care decisions among younger patient populations. TikTok is a social media platform that allows users to post short-form videos. This study aimed to assess the quality of sinusitis-related videos on TikTok., Study Design: We searched TikTok on January 29, 2023, for sinusitis-related hashtags: #sinusitis, #sinus, #sinusinfection., Setting: Internet., Methods: The number of views/shares per day, uploader type (nonmedical influencer, lay individual, and medical professional) content categories (medical advice, marketing, comedy, and lifestyle/acceptability), and content type (educational vs factual) were collected. The Patient Education Materials Assessment Tool for Audiovisual Material and Journal of the American Medical Association criteria score was used to measure understandability, actionability, and reliability. The Global Quality Scale (GQS) was used to evaluate the quality of videos; the harm/benefit score was used to evaluate causative effects. Analyses were performed using analysis of variance (α = .05)., Results: There were 221 videos identified, which garnered over 300 million views and 1 million shares. Almost half of the videos were published by nonmedical influencers. When controlling for covariates, nonmedical influencers and lay uploaders were more likely to have harmful harm/benefit scores, less understandable videos, and lower GQS scores compared to medical professionals. Less than half of videos posted by nonmedical influencers categorized as educational were factual (46.7%); lay individuals and medical professionals had higher rates of factual educational content (79.9% and 83.7%, respectively)., Conclusion: Most nonmedical influencer-posted TikTok videos about sinusitis are inaccurate, despite being portrayed as medical advice/educational. Rhinologists must find modern ways to disseminate true disease-related content via social media to combat medical misinformation., (© 2024 The Authors. Otolaryngology‐Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology‐Head and Neck Surgery Foundation.)

Objectives: Identify demographic and clinical characteristics that may help differentiate non-rhinogenic facial pain or pressure (NRFP) from sinusitis., Study Design: Retrospective single-institution study., Setting: Tertiary Care Center Rhinology Clinic., Methods: All patients presenting with a complaint of facial pain or pressure over a 3-year period were included. Patients were categorized into either NRFP or sinusitis groups based on computed tomography imaging and nasal endoscopy. Data pertaining to demographics, history, and SNOT-22 questionnaire domains were compared via univariate analysis as well as logistic regression with backwards variable selection., Results: A total of 296 patients met inclusion criteria, of which 128 had NRFP and 168 had sinusitis. A significantly greater percentage of patients in the NRFP group were women of childbearing age (40.6% vs 28.0%, P = .02). Backwards variable selection resulted in a model with four variables predicting a diagnosis of NRFP-female sex (odds ratio [OR] = 2.998, P < .0001), no history of prior sinonasal surgery (OR = 0.340 for history vs no history, P < .01), low nasal domain score (OR = 0.551, P < .0001), and high ear/facial domain score (OR = 1.453, P < .01)., Conclusion: Accurately identifying patients with NRFP at initial presentation based on history would help direct patients to the appropriate care pathway and prevent ineffective treatments such as antibiotics and sinus procedures. Our findings suggest that the suspicion for NRFP should be higher in women of child-bearing age as well as patients with greater ear/facial symptoms or lesser nasal symptoms., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)