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Background: There is clear evidence that prevalence of primary antibody deficiency (PAD) is higher in children with chronic rhinosinusitis (CRS) than in the general population. The purpose of this multi‐institutional and multidisciplinary evidence‐based review with recommendations (EBRR) is to thoroughly review the literature on rhinosinusitis with PAD, summarize the existing evidence, and provide recommendations on the evaluation and management of rhinosinusitis in children with PAD. Methods: The PubMed, Embase, and Cochrane databases were systematically reviewed from inception through December 2023. Studies on the evaluation and management of rhinosinusitis in PAD patients were included. An iterative review process was utilized in accordance with EBRR guidelines. Levels of evidence and recommendations on the evaluation and management principles for PAD were generated. Results: A total of 50 studies were included in this evidence‐based review. These studies were evaluated on the incidence of PAD in rhinosinusitis patients, the incidence of rhinosinusitis in PAD patients, and on the different treatment modalities used and their outcome. The aggregate quality of evidence varied across the reviewed domains. Conclusion: Based on the currently available evidence, the incidence of PAD in children with recalcitrant CRS can be significantly elevated. Despite the presence of multiple studies addressing rhinosinusitis and PAD, the level of evidence supporting different treatment options continues to be lacking. Optimal management requires a multidisciplinary approach through collaboration with clinical immunology. There is need for higher level studies that compare different treatments in children with PAD and rhinosinusitis. [ABSTRACT FROM AUTHOR]

Key points: Novel topical therapeutics require extensive pre‐clinical testing to assess efficacy and safety.Antibiofilm or immunosuppressant agents can utilize ex vivo models to measure ciliotoxicity.Agents that are found to be effective and non‐toxic ex vivo warrant further investigation in vivo. [ABSTRACT FROM AUTHOR]

Key points: Asian‐American (AA) patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have comparable rates of tissue eosinophilia compared to Caucasians when defined as >10 eosinophils/high‐powered field (HPF).AA patients with CRSwNP have significantly higher incidence of mixed inflammation defined as >10 eosinophils/HPF and >10 neutrophils/HPF. [ABSTRACT FROM AUTHOR]

Background: Accurate identification of eosinophilic chronic rhinosinusitis is essentialg because its treatment and prognosis substantially differ from other subtypes. Methods: This retrospective observational study included 640 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis in a single tertiary center from January 2021 to December 2022. Receiver operating characteristic curves were generated to compare accuracy, sensitivity, specificity of the novel scoring system, and previous diagnostic criteria (Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis, European Forum for Research and Education in Allergy and Airway Diseases, European Position Paper on Rhinosinusitis and Nasal Polyps, and Sakuma et al.) for predicting eosinophilic chronic rhinosinusitis (ECRS) by tissue eosinophil count ≥70 per high power field. Results: Patients were randomly divided into estimation (n = 430) and validation (n = 210) groups. The area under the receiver operating characteristic curve for the novel score was 0.753 (95% confidence interval [CI], 0.670–0.835) in the estimation group, 0.729 (0.629–0.830) in the validation group, and 0.661 (0.584–0.738) in the 20‐fold cross‐validation with the entire dataset. Conclusions: We propose a novel scoring system that incorporates three key parameters: "novel score = blood eosinophil (%) + total Lund–Mackay score of anterior ethmoid sinuses + 2 if nasal polyp present" greater than 7 can be reliably used for diagnosing ECRS. This system can facilitate decision‐making processes regarding the administration of oral steroids and biologics targeting type 2 inflammation prior to surgical intervention. [ABSTRACT FROM AUTHOR]

Key points: Chitosan is a promising drug delivery vector for therapeutics owing to its biocompatibility.Once crosslinked with chitosan, prolonged drug release was noted regardless of hydrophilicity.Hydrophilic drugs may require different strategies to obtain a sustained release profile. [ABSTRACT FROM AUTHOR]

Key points: CRS patients exhibit little decision conflict in their choice of pursuing surgery.Standard counseling alone appears to suffice once patients express an interest in surgery.Decision aids may increase patient knowledge and improve postoperative care understanding. [ABSTRACT FROM AUTHOR]

Key points: Data on current practice patterns for the management of chronic rhinosinusitis with nasal polyps, including which medications are deemed by otolaryngologists to better manage patient symptoms, are limited.This study demonstrated that contemporary practice patterns are largely consistent with published clinical consensus statements.Off‐label nasal steroid irrigations and dupilumab are the most commonly used topical and systemic therapies for chronic rhinosinusitis with nasal polyps, respectively. [ABSTRACT FROM AUTHOR]

Key points Viral infections lead to a greater than twofold increased risk of developing chronic rhinosinusitis within 1 year. Viral infections lead to a greater than twofold increased risk of developing chronic rhinosinusitis within 1 year. Recurrent viral infections pose a greater risk of chronic rhinosinusitis than single episodes. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Type 2 biologics have been used increasingly for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). However, patterns of biologic switching are understudied, and established guidelines for sequential or simultaneous use do not yet exist.This is a Canadian multicenter retrospective study of real‐world patient data. Patients were included if they had recurrent CRSwNP despite maximal medical and surgical management, and received at least one dose of a type 2 biologic. Patients who remained on their initial biologic comprised the continuous group. Patients with sequential or simultaneous use of more than one biologic comprised the switched group. We compared the characteristics of patients who continued and switched biologics.Note that 225 consecutive patients were included. Thirty‐six (16%) switched biologics at least once, and six (3%) switched twice. The most common switch was from mepolizumab to dupilumab, with poor control of CRSwNP symptoms being the leading cause for this switch. Lack of efficacy was the main reason for switching off mepolizumab and omalizumab, while adverse events were the leading cause for switching off dupilumab. Additionally, mepolizumab patients were more likely to switch biologics late in their treatment, while dupilumab patients rarely switched after 12 months of therapy (p‐value < 0.001).Switching biologics for CRSwNP is frequent in Canadian rhinology practices, with 16% of patients switching at least once. The most common switch is from mepolizumab to dupilumab with inadequate CRSwNP control driving this switch. This study may help guide sequential or simultaneous use of biologics in CRSwNP patients. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Olfactory dysfunction (OD) is a key symptom of chronic rhinosinusitis (CRS). Although extensively studied in CRS with nasal polyps (CRSwNP), OD in CRS without nasal polyps (CRSsNP) remains under‐researched. This study aims to assess the prevalence of OD and its evolution in surgically naïve patients with CRSsNP undergoing endoscopic sinus surgery (ESS).This prospective study included 97 participants with CRSsNP (mean age, 46.5 years; 70.1% men) and 97 healthy controls (mean age, 46.5 years; 70.1% men). Participants underwent psychophysical evaluations of orthonasal (using the Sniffin’ Sticks test) and retronasal olfaction (using powdered aromas) at enrolment and 6 months post‐ESS.Out of 97 patients, 81 (83.5%) completed all assessments. At enrolment, 23 (28.4%) CRSsNP patients had OD based on composite threshold, discrimination, identification scores, compared with 7 (8.6%) controls (absolute % difference, 19.8% [95% CI, 8.2–31.4]). Retronasal olfactory function was also significantly worse in CRSsNP patients. Six months post‐ESS, 30 patients (37.0%) experienced a clinically significant improvement in olfactory, whereas nonsignificant changes were observed in retronasal olfactory score, and 3.7% of patients experienced a deterioration of the olfactory function.In conclusion, although 37% of patients experienced a clinically significant improvement in their sense of smell following ESS, the overall prevalence of OD in this surgically naive population appears relatively low, especially when compared to that observed in patients with CRSwNP. Therefore, ESS may offer some benefits for enhancing orthonasal olfactory function, but the extent of these improvements appears to be limited. [ABSTRACT FROM AUTHOR]

Objectives: Recently, a set of consensus criteria and near‐consensus criteria for the evaluation of chronic rhinosinusitis (CRS) disease control was identified by an international multidisciplinary panel of key stakeholders. The objective of this study is to evaluate patient perspectives on these disease control criteria. Methods: This is a qualitative phenomenological study using constant comparative methodology. Twenty‐one one‐on‐one interviews, ranging from 6 to 15 min and based on a standardized semi‐structured script, with CRS patients from diverse backgrounds were performed. The authors analyzed transcripts of the interviews to identify recurrent themes in patient responses. Conclusions were drawn based on these themes. Results: All participants agreed with the consensus criteria (overall symptom severity, nasal obstruction severity, patients' self‐assessed CRS control, and need for CRS‐related oral corticosteroids), and most participants agreed with near‐consensus criteria (nasal endoscopy, smell loss and nasal drainage severities, impairment of day‐to‐day activities, and overall quality of life) identified by the international multidisciplinary panel. Some patients disagreed with inclusion of smell loss due to common etiologies—such as post‐viral or iatrogenic causes—that would not necessarily be an indicator of active sinonasal inflammation. One theme that emerged was the need for a facial pain/pressure criterion to be added. Conclusions: CRS patients overwhelmingly affirmed recently described consensus and near‐consensus criteria for CRS disease control with the caveat that a question asking about facial pain/pressure should be included as well. Recently, identified consensus criteria for CRS disease control should be interpreted within the context of patient perspectives. [ABSTRACT FROM AUTHOR]

Key points: Inhalational exposure (IE) history assessment is important and may guide chronic rhinosinusitis disease management.Combined exposure status was the most significant factor across differential gene expression analyseIE history was associated with pro‐inflammatory transcriptome changes and worse clinical outcomes. [ABSTRACT FROM AUTHOR]

Key points: GPT‐4 generated moderate quality information in response to questions regarding sinusitis and surgery.GPT‐4 generated significantly higher quality responses to questions regarding treatment of sinusitis.Future studies exploring quality of GPT responses should seek to limit bias and use validated instruments. [ABSTRACT FROM AUTHOR]

Key points: Unilateral or destructive sinonasal disease should raise suspicion for tumor.Patients receiving biologic therapy for CRSwNP should be carefully selected.Tissue diagnosis should be considered prior to starting biologics for nasal polyposis. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To assess the effect of allergen immunotherapy (AIT) on patients with central compartment atopic disease (CCAD) and house dust mite (HDM) sensitization post‐surgery.A retrospective cohort of surgically treated, HDM‐sensitized CRSwNP patients phenotyped as CCAD was assessed. Patients were divided into two groups based on whether they had AIT commenced as part of their surgical care. All AIT patients started immunotherapy prior to their surgery. The primary endpoint was reformation of middle turbinate (MT) edema 12 months postsurgery. Secondary endpoints were corticosteroid irrigation use (<4 times/week vs. ≥4 times/week, %) and the rhinologic domain of the 22‐item sino‐nasal outcome test (SNOT‐22). Demographic characteristics, concomitant asthma, smoking status, history of aspirin‐exacerbated respiratory disease, conjunctival symptoms, polysensitization, serum eosinophils (cell × 109/L), tissue eosinophilia (% > 100/HPF), and serum IgE (kU/L) were also recorded.Eighty‐six CCAD patients were assessed (41 ± 14 yrs, 64% female). AIT was applied in 37% (n = 32). Baseline features were similar apart from greater conjunctival symptoms (72 vs. 45%, p = 0.02) in the AIT group. At 12 months post‐surgery, the AIT group has less MT edema (% ≥ diffuse 15.6 vs. 52.9, p < 0.01). Patients on AIT also had less pharmacotherapy requirements at 12 months (% ≥ 4/week, 37.5 vs. 79.6%, p < 0.01). The rhinologic symptoms were similar (21.1 ± 17.1 vs. 20.1 ± 21.6, p = 0.83).Surgery and pharmacotherapy are effective in managing CCAD, but the addition of AIT improved allergic phenomenon and allowed de‐escalation of topical therapy. Longer term studies are required to demonstrate further immunomodulation. [ABSTRACT FROM AUTHOR]

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]

Background Methods Results Conclusions Acute exacerbations of chronic rhinosinusitis (AECRS) are thought to arise from common viral infections progressing to secondary bacterial infections. However, the pathophysiology of AECRS remains poorly understood due to a lack of prospective longitudinal studies.We conducted a one‐year prospective longitudinal study involving chronic rhinosinusitis (CRS) adults. At baseline, we assessed subjective symptom scores using a validated upper respiratory infection questionnaire (WURSS), sinonasal outcome testing scores (SNOT‐22), and endoscopic scores (modified Lund‐Kennedy score). Every 2 weeks, we contacted subjects to collect WURSS and SNOT‐22 scores. If WURSS scores were ≥1 and SNOT‐22 scores were ≥ 8.9 compared with baseline, subjects underwent an AECRS assessment. We identified rhinovirus (RV) incidence through viral nasal brushings at each visit and bacterial infection through bacterial swabs if mucus scores were ≥1.Thiry‐five of 80 CRS subjects reported at least one AECRS episode during the year, predominantly occurring in the fall and winter seasons. RV infections were detected in 8 of 35 cases, bacterial infections in 17 of 35, and co‐occurring infections in 7 of 35. All subjects with AECRS visits exhibited significantly higher endoscopic scores compared with baseline. Subjects with co‐occurring RV and bacterial infections demonstrated higher disease severity compared with those with either RV or bacterial infection, or no infection.In a one‐year prospective longitudinal study involving CRS adults, we identified significant risk factors for AECRS including seasonality and the presence of RV and bacterial infections. These data suggest a standard definition of AECRS and the need to target RV and bacterial infections if we are to help reduce disease severity. [ABSTRACT FROM AUTHOR]

The vast majority of people with cystic fibrosis (pwCF) have untreated secondary chronic rhinosinusitis (CRS). Whereas the introduction of the cystic fibrosis transmembrane conductance regulator modulator (CFTRm) treatment regime has improved the lung function of pwCF, few studies have been published examining the effect on sinonasal symptoms in children. Our aim was to explore the effect of double CFTRm treatment on CRS and olfaction in children with CF. pwCF were included in this non‐randomized cross‐sectional study, where an otolaryngologist performed a complete ENT examination before initiating treatment with elaxacaftor/tezacaftor/ivacaftor (ETI). Twenty‐three pwCF aged 6–12 years were included. Eighteen of 23 patients were on a double CFTRm treatment, and 5 patients were CFTRm naive, respectively. Altogether, 19 had normal olfaction, 20 had none or mild CRS symptoms according to SNOT‐22, and 14 had a normal endoscopy. None of the patients had symptoms of chronic rhinosinusitis lasting for more than 12 weeks, thus none of the patients fulfilled the criteria for CRS. Children with CF treated with double CFTRm have few to no symptoms of CRS and normal olfaction, which is an improvement compared with children following treatment modalities prior to CFTRm. [ABSTRACT FROM AUTHOR]

Introduction: To comprehensively evaluate the reported clinical effectiveness of platelet‐rich plasma (PRP) in patients with chronic sinusitis undergoing endoscopic sinus surgery (ESS). Methods: We performed a systematic review and meta‐analysis of randomised controlled trials (RCTs). Five digital online databases (PubMed, Scopus, Web of Science, Google Scholar and Cochrane CENTRAL) were searched from inception up to 1st May 2023. Our specific outcomes involved postoperative nasal endoscopy scores measured via Lund‐Kennedy score or Meltzer score, olfactory sensation scores and pre‐operative anosmia duration. All data were pooled as standardised mean difference (SMD) with a 95% confidence interval (CI), using the RevMan software. Results: Six RCTs were included in this systematic review and meta‐analysis, with a total of 169 patients. The risk of bias in the included RCTs was low in three RCTs, some concerns in one RCT and high risk in two RCTs. The overall analysis of the postoperative nasal endoscopy scores showed that the PRP group had lower scores compared to the control group (n = 3 RCTs, SMD = −1.19; 95% CI [−1.94, −0.44], p =.002). There was no significant difference between the PRP and control groups regarding anosmia duration (n = 2 RCTs, SMD = 0.21; 95% CI [−0.17, 0.59], p = 0.28) or olfactory sensation scores, despite the PRP group having higher scores (n = 2 RCTs, SMD = 0.53; 95% CI [−0.32, 1.39], p = 0.22). Conclusion: This study highlights the potential advantages of using PRP as an additional treatment for individuals with chronic sinusitis undergoing ESS. The improvements associated with PRP include facilitating wound healing, reducing inflammation and enhancing surgical outcomes. To optimise the use of PRP in clinical settings, future research should focus on conducting larger trials with standardised protocols. [ABSTRACT FROM AUTHOR]

Introduction: EuroQol‐5‐dimensions‐5‐levels (EQ‐5D‐5L), visual analog scale (VAS), time trade‐off (TTO), and standard gamble (SG) are used for the assessment of Health Utility Scores (HUS) of chronic rhinosinusitis (CRS). This study aimed to determine the overall HUS of CRS, the factors which influence the HUS, and the preferable method. Methods: A cross‐sectional study was conducted. Patients with primary CRS were recruited. Clinical and socioeconomic data together with HUS were assessed. Four HUS scores determined from the four different methods were compared. Results: A total of 335 patients were enrolled. The overall HUS, as measured by EQ‐5D‐5L, VAS, TTO, and SG, was 0.88 ± 0.14, 0.79 ± 0.17, 0.89 ± 0.15, and 0.86 ± 0.16, respectively. The multivariable linear regression revealed that each increasing 22‐item sinonasal outcome test (SNOT‐22) score predicted a reduction of 0.002 to 0.003 in HUS (all methods, p < 0.01). Patients who scheduled for endoscopic sinus surgery had 0.06 to 0.11 HUS lower than other groups in EQ‐5D‐5L and VAS (all p < 0.05). Higher endoscopy score, age, presence of comorbid airway diseases, and lower education correlated with lower HUS (p < 0.05). Given the HUS results and regression models, the EQ‐5D‐5L is likely the preferable choice. Conclusion: The overall HUS of CRS was approximately 0.79–0.89. High SNOT‐22 score and those who failed medications, presence of comorbid AR/asthma, increased age, high endoscopy score, and low education negatively impacted HUS. Our data suggest that EQ‐5D‐5L is a preferable method for measuring HUS in patients with CRS. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the impact of different types of nasal inflammation on the regulation of entry‐associated genes of respiratory viruses, including severe acute respiratory syndrome coronavirus 2 (SARS CoV‐2), Middle East respiratory syndrome coronavirus (MERS‐CoV), human coronavirus 229E (HCoV‐229E), and influenza virus, in the nasal epithelium. Subjects were classified into three groups: control, eosinophilic chronic rhinosinusitis (ECRS), and noneosinophilic CRS (NECRS) groups. Angiotensin‐converting enzyme 2 (ACE2) and transmembrane protease serine subtype 2 (TMPRSS2), alanyl aminopeptidase (ANPEP), dipeptidyl peptidase 4 (DPP4), and beta‐galactoside alpha‐2,6‐sialyltransferase 1 (ST6GAL1), and beta‐galactoside alpha‐2,3‐sialyltransferase 4 (ST3GAL4) were selected as key entry‐associated genes for SARS‐CoV‐2, HCoV‐229E, MERS‐CoV, and influenza, respectively, and were evaluated. Brushing samples obtained from each group and human nasal epithelial cells cultured using an air–liquid interface system were treated for 7 days with typical inflammatory cytokines and analyzed using real‐time polymerase chain reaction. Western blot analysis and confocal microscopy were performed. The entry‐associated genes showed distinct regulation patterns in response to each interleukin‐4 (IL‐4), interleukin‐13 (IL‐13), tumor necrosis factor‐α (TNF‐α), and interferon‐γ (IFN‐γ). Specifically, ACE2 significantly decreased in type 2 cytokines (IL‐4 and IL‐13), while TMPRSS2 significantly decreased in type 1 cytokines (TNF‐α and IFN‐γ). ANPEP significantly decreased in both types of cytokines. Remarkably, DPP4 significantly increased in type 2 cytokines and decreased in type 1 cytokines. Moreover, ST6GAL1 and ST3GAL4 significantly increased in type 2 cytokines and decreased in type 1 cytokines, particularly IFN‐γ. These findings were supported by western blot analysis and confocal imaging results, especially for ACE2 and DPP4. The findings regarding differential regulation suggest that patients with ECRS, primarily mediated by type 2 inflammation, may have lower susceptibility to SARS‐CoV‐2 and HCoV‐229E infections but higher susceptibility to MERS‐CoV and influenza infections. [ABSTRACT FROM AUTHOR]

Objectives: Previously, we developed a novel double‐coated sinus stent containing ciprofloxacin (inner layer) and azithromycin (outer layer) (CASS), but released drug concentrations were found to be insufficient for clinical usage. Our objectives are to improve drug release of CASS and assess safety and pharmacokinetics in rabbits. Methods: Dip coating was used to create the CASS with 2 mg ciprofloxacin and 5 mg azithromycin. A uniformed double coating was assessed with scanning electron microscopy (SEM), and the release patterns of both drugs and lactate dehydrogenase (LDH) assay were evaluated over 14 days in vitro. Safety, tolerability, and pharmacokinetics of the CASS were tested in rabbits through insertion into the maxillary sinus and evaluated with nasal endoscopy, CT scans, histology, blood counts and chemistries, and in vivo drug release. Results: SEM confirmed the uniformity of the dual coating of ciprofloxacin and azithromycin, and thickness (μm) was found to be 14.7 ± 2.4 and 28.1 ± 4.6, respectively. The inner coated ciprofloxacin showed a sustained release over 14 days (release %) when soaked in saline solution (day 7, 86.2 ± 3.4 vs. day 14,99.2 ± 5.1). In vivo analysis showed that after 12 days, 78.92 ± 7.67% of CP and 84.12 ± 0.45% of AZ were released into the sinus. There were no significant differences in body weight, white blood cell counts, and radiographic changes before and after CASS placement. No significant histological changes were observed compared to the contralateral control side. Conclusion: Findings suggest that the CASS is an effective method for delivering therapeutic levels of antibiotics. Further studies are needed to validate efficacy in a preclinical sinusitis model. Level of Evidence: N/A Laryngoscope, 134:3953–3959, 2024 [ABSTRACT FROM AUTHOR]

Key points Treatment of cystic fibrosis‐related chronic rhinosinusitis should target sinonasal biofilms. NaHCO3 salts with/without xylitol have limited antibiofilm properties, whereas rhDNAse has not. Phage effectivity varies and depends on the phage and the combination with antibiotics. [ABSTRACT FROM AUTHOR]

Objective Background Methods Results Conclusion To compare healthcare resource utilization and healthcare costs in patients with migraine with or without a history of misdiagnosis.Despite the high prevalence of migraine, migraine is commonly misdiagnosed. The healthcare resource use and cost burden of a misdiagnosis is unknown.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.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.Patients with migraine who have a history of misdiagnoses have higher rates of healthcare resource utilization and cost accrual versus those without such history. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The inability of topical medications to reach sinus cavities is a potential reason for lack of efficacy in chronic rhinosinusitis (CRS). One purpose of endoscopic sinus surgery (ESS) is to enable delivery of medications into the sinus cavities. The exhalation delivery system with fluticasone (EDS‐FLU; XHANCE) creates unique biomechanics that enable deposition of intranasal corticosteroid into sinuses and sinus drainage pathways but may have differing efficacy in operated versus unoperated sinuses. Two 24‐week randomized trials (ReOpen1/2) evaluated EDS‐FLU versus EDS‐placebo in patients with CRS, stratified by surgical status.Surgery‐naive (n = 332) and prior‐surgery (n = 215) patient groups were analyzed as pooled data from ReOpen1/2. Outcome measures (least‐squares mean change from baseline) included combined symptom score (CSS) and congestion score at weeks 4, 8, and 12 and average of percentages of opacified volume (APOV) of ethmoid/maxillary sinuses on CT and Sinonasal Outcome Test 22 (SNOT‐22) total score at week 24.Baseline scores suggested moderate–severe disease: mean CSS = 5.8; APOV = 67.2%. EDS‐FLU produced significant improvement versus placebo (p < 0.05): CSS (surgery‐naive, −0.68 vs. −1.42; prior ESS, −0.70 vs. −1.87); congestion (surgery‐naive, −0.24 vs. −0.59; prior ESS, −0.24 vs. −0.69); and SNOT‐22 (surgery‐naive, −7.56 vs. −18.30; prior ESS, −10.72 vs. −18.74). Similar results were observed for APOV (p < 0.05). No statistically significant difference was observed between surgery subgroups with either EDS‐FLU dose.EDS‐FLU improved symptoms, sinus opacification, and quality of life in patients with CRS with or without prior ESS, suggesting a role for EDS‐FLU in both populations. [ABSTRACT FROM AUTHOR]

Key points The study found a higher incidence of chronic rhinosinusitis (CRS) and recalcitrant CRS in cadaveric organ transplant recipients compared to those receiving living donor transplants. Recipients of cadaveric transplants were 1.32 times more likely to develop CRS and 1.68 times more likely to develop medically recalcitrant CRS. Living kidney transplants significantly reduced the risk of developing CRS (OR = 0.12) and recalcitrant CRS (OR = 0.11), highlighting a potentially protective effect against these conditions. In contrast, cadaveric liver transplants were associated with an increased risk of CRS and medically recalcitrant CRS. Kaplan–Meier survival analysis indicated a significant difference in time to CRS onset between cadaveric and living donor transplants. Median time to CRS onset was longer for living donor recipients (21.1 months) compared to cadaveric recipients (15.6 months). This study underscores the need for transplant teams and otolaryngologist to consider donor type during transplant follow‐up due to differing risks of CRS development. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions The indications for endoscopic modified Lothrop procedure (Draf 3) in patients with refractory chronic rhinosinusitis with nasal polyposis (CRSwNP) remain unclear. This study evaluates the effectiveness of Draf 3 for refractory CRSwNP focusing on improvements in disease severity and need for subsequent dupilumab rescue therapy.Retrospective review of patients with CRSwNP undergoing Draf 3 surgery at a tertiary center between 2012 and 2022. Clinicodemographic variables were compared across those who did versus did not require rescue with postoperative dupilumab. Time to postoperative dupilumab rescue was analyzed and longitudinal disease‐specific outcomes were measured using the sinonasal outcomes test (SNOT‐22).Within 87 patients with CRSwNP, 24.1% had aspirin‐exacerbated respiratory disease (AERD). Significant improvement in SNOT‐22 score was found in CRSwNP with AERD (p < 0.001) and without AERD (p = 0.01) up to 24 months postoperative. 14.9% eventually required rescue with a dupilumab. More specifically, of 21 patients with AERD, 24.1% eventually required rescue with dupilumab. Dupilumab rescue was associated with a greater number of prior sinus surgeries (p = 0.02), prior aspirin desensitization (p = 0.02), and worse preoperative Lund‐MacKay scores (p < 0.001). No association between biologic rescue and frontal recess antero‐posterior diameter was found (p = 0.20).Draf 3 surgery in CRSwNP was associated with significant improvement in SNOT‐22 score at 24 months. Furthermore, only 14.9% of patients required dupilumab rescue. Patients with AERD were more likely to require rescue with dupilumab even though 75.1% avoided treatment with the biologic over the study period. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Ptosis associated with rhinosinusitis may indicate orbital or cavernous sinus involvement, typically accompanied by various other symptoms. However, isolated ptosis is a rare occurrence. This explains the diverse treatment approaches found in this literature review, ranging from conservative management to surgery. Imaging plays a crucial role in diagnosis and treatment planning. Isolated upper lid ptosis is a rare manifestation of acute rhinosinusitis, typically occurring without other neuro‐ophthalmological or orbital signs. This report presents a case of unilateral isolated ptosis in an adult male with acute rhinosinusitis. A 30‐year‐old male with asthma and bipolar disorder, and recent intranasal drug use, presented with nasal congestion, facial pressure, headache, and left eye droopiness. Neurological examination found left ptosis as the only abnormality. Lab results were normal, and COVID‐19 PCR was negative. Imaging showed pansinusitis without complications. The patient received IV antibiotics and steroids, followed by oral antibiotics and steroids. Ptosis resolved within 3 days and did not recur at three‐month follow‐up. Only seven cases of isolated ptosis with rhinosinusitis have been reported, all in males, most recovering with medical therapy alone. This is the first case treated with high‐dose steroids in addition to antibiotics. Isolated ptosis may be due to inflammation of the oculomotor nerve's distal branch or related muscular structures. Isolated ptosis in rhinosinusitis has a favorable prognosis. Imaging is crucial to exclude severe complications. The role of steroids needs further evaluation, and the timing for considering surgery remains to be defined. [ABSTRACT FROM AUTHOR]

Summary: Despite the widespread adoption of nasal endoscopy (NE) in the evaluation of sinonasal disease, its diagnostic potential may still be underutilized. Developments in endoscopic technology have led to significant improvements in video quality and maneuverability. However, there is concern that NE continues to be used primarily for the identification of gross pathology, with relative neglect of more subtle findings such as surface features of inflammation and mucus. With fewer technical limitations to perceive these abnormalities, there is potential to greatly improve the diagnostic value of NE. The reader is herein asked to consider several important visual nuances encountered during NE, with the hope that this engenders an appreciation of the versatility of NE as a diagnostic tool. [ABSTRACT FROM AUTHOR]

Key points: SinoNasal Microbiota Transfer (SNMT) was safe with immediate benefit in all recipients, with sustained improvement in two of three recipients for up to 180 days.The addition of antimicrobial photodynamic therapy worsened chronic rhinosinusitis.These promising SNMT results warrant further study of safety and efficacy. [ABSTRACT FROM AUTHOR]

Background: To elucidate the role of balloon Eustachian tuboplasty (BET) in the management of chronic rhinosinusitis with obstructive Eustachian tube dysfunction (ETD), we evaluated the results of endoscopic sinus surgery (ESS) with and without BET in patients with chronic rhinosinusitis with obstructive ETD. Methods: This randomized controlled trial conducted in a single‐institution tertiary care center setting included 50 patients diagnosed with primary chronic rhinosinusitis and obstructive ETD between July 2018 and June 2022. Twenty‐five patients were prospectively enrolled for combined ESS/BET. The control group (25 patients) underwent ESS alone. Outcome measurements of the Sinonasal Outcome Test 22, modified Lund–Kennedy score, Eustachian Tube Dysfunction Questionnaire‐7 (ETDQ‐7), and serial Eustachian tube function test results were analyzed 3 months postoperatively. Results: The improvement (12.60 ± 6.50) in the ETDQ‐7 score in the BET group was significantly higher than that in the control group (6.60 ± 5.58). The ratio of improvement in the ETDQ‐7 score was also significantly higher in the BET than in the control group (92% vs. 68%, p = 0.034). Logistic regression analysis showed that performing BET (odds ratio [OR]: 5.41, 95% confidence interval [CI]: 1.02–28.79, p = 0.048) and a low post‐modified Lund–Kennedy score (OR: 0.15, 95% CI: 0.04–0.54, p = 0.004) were significantly associated with ETDQ‐7 score improvement. Conclusion: Combined BET/ESS could decrease otologic symptoms and improve Eustachian tube function. BET may be an appropriate adjunctive procedure for treating chronic rhinosinusitis with obstructive ETD. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to elucidate the bacterial profile of chronic rhinosinusitis (CRS) in patients with end‐stage renal disease (ESRD) and chronic kidney disease (CKD) compared with nonrenal patients, guiding antibiotic selection for clinicians. Methods: We retrospectively analyzed 13,906 inpatients from the Chang Gung Research Database who underwent sinus surgery (2004–2018). Patients were categorized into ESRD‐CRS, CKD‐CRS, and non‐CKD‐CRS based on the estimated glomerular filtration rate. Bacterial cultures from surgical samples were classified as facultative anaerobes or aerobes (e.g., Klebsiella pneumoniae [KP], Pseudomonas aeruginosa [Ps.a]), anaerobes, and fungi and ranked by prevalence. Results: Data from 47 ESRD‐CRS, 230 CKD‐CRS, and 13,123 non‐CKD‐CRS patients were analyzed. In ESRD‐CRS, the predominant species were KP (31.6%), Ps.a (21.1%), and Coagulase‐negative Staphylococcus (CoNS, 15.8%). CKD‐CRS showed Staphylococcus epidermidis (27.7%), CoNS (20.5%), and Ps.a (20.5%). Non‐CKD‐CRS had Staphylococcus epidermidis (29.8%), CoNS (25.0%), and Staphylococcus aureus (15.5%). For anaerobes, ESRD‐CRS was dominated by Fusobacterium nucleatum (10.5%) and Peptostreptococcus micros (10.5%), whereas CKD‐CRS and non‐CKD‐CRS showed Propionibacterium acnes as a primary strain (14.5% and 28.7%, respectively). Conclusion: For CRS in ESRD, antibiotics targeting KP and Fusobacterium nucleatum are recommended. In CKD‐CRS, a focus on Staphylococcus epidermidis and Propionibacterium acnes is suggested. Level of Evidence: 4 Laryngoscope, 134:3499–3507, 2024 [ABSTRACT FROM AUTHOR]

A study published in Clinical & Experimental Allergy reveals that asthma is often overlooked and poorly managed in preoperative patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The study, conducted at a tertiary center, aimed to determine the prevalence of asthma and assess its control in this group. The findings indicate a high prevalence of asthma in these patients, with approximately half potentially having undiagnosed or uncontrolled asthma prior to undergoing endoscopic sinus surgery. The study also identifies factors associated with asthma in this population. However, the document acknowledges the study's limitations, such as its small sample size, and suggests the need for further research to validate the results. [Extracted from the article]

This article discusses the role of nasal tissue-resident memory T (TRM) cells in chronic rhinosinusitis (CRS) with nasal polyps. The study found that non-eosinophilic CRS (NECRS) is characterized by an abundance of CD69+CD103+ TRM cells, which produce type 1 and type 17 cytokines. These TRM cells may contribute to NECRS pathogenesis and could indicate difficult-to-treat cases. The findings provide new insights into the role of nasal-resident T cells in CRS and suggest potential therapeutic targets. [Extracted from the article]

Summary: Background: Antibiotic resistance is an increasing global threat to human and veterinary practices. The relevance and efficacy of antibiotic therapy in the treatment of various diseases has been poorly documented in the literature. One such disease is equine sinusitis secondary to dental disease where dental extraction is most often combined with broad‐spectrum antibiotic treatment. It, however, remains undocumented if antibiotic treatment reduces the risk of complication in horses where the diseased tooth is removed by extraction. Objectives: The aim of this study was to analyse the effects of perioperative antibiotics in horses with dental sinusitis treated by dental extraction with or without concurrent antibiotic treatment. Study design: Retrospective cohort study. Methods: Clinical records from horses presenting with nasal discharge between September 2016 and May 2022 were reviewed. Horses with sinusitis secondary to dental disease were identified, and data from clinical records were collected supplemented by online questionnaires. The final statistical model was built using logistic regression. Results: A total of 59 horses with dental sinusitis were included in the study. Following dental extraction, 62.5% (15/24) of horses that did receive perioperative antibiotics and 60% (21/35) of horses that did not receive perioperative antibiotics were successfully treated without the need for further treatment. The final model showed no significant difference on the probability of success (p = 0.85) between treatment with and without antibiotics. Main limitations: The retrospective nature of this study may increase the risk of biases in relation to data collection and follow‐up information and the limited number of individuals available for the analysis. Conclusions: These findings indicate that the use of perioperative antibiotics does not influence the likelihood of complications or the probability of a successful outcome in horses with dental sinusitis undergoing dental extraction. [ABSTRACT FROM AUTHOR]

Background: Studies have indicated a close association between dysbiosis of the gut microbiota and chronic sinusitis. However, the causal relationship between the gut microbiota and the risk of chronic sinusitis remains unclear. Methods: Using genome‐wide association study (GWAS) data for the gut microbiota and chronic sinusitis, we conducted a two‐sample Mendelian randomization (MR) study to determine the potential causal relationship between the microbiota and chronic sinusitis. We employed the inverse variance‐weighted (IVW) method as the primary analytical approach to estimate the effect. Additionally, sensitivity, heterogeneity, and pleiotropy analyses were conducted to evaluate the robustness of the results. Reverse MR analysis was also applied to investigate potential reverse causality. Results: Through MR analysis, we identified 17 gut microbiota classifications that are closely associated with chronic sinusitis. However, after Bonferroni multiple correction, only class Bacilli (odds ratio: 0.785, 95% confidence interval: 0.677–0.911, p =.001, false discovery rate = 0.023) maintained a significant causal negative relationship with chronic sinusitis. Sensitivity analysis did not reveal any evidence of heterogeneity or horizontal pleiotropy. Reverse MR analysis found five gut microbiota classifications that are significantly associated with chronic sinusitis, but they were no longer significant after Bonferroni multiple correction. There was no evidence to suggest a reverse causal relationship between chronic sinusitis and class Bacilli. Conclusion: Specific gut microbiota predicted by genetics exhibit a potential causal relationship with chronic sinusitis, and class Bacilli may have a protective effect on chronic sinusitis. [ABSTRACT FROM AUTHOR]

Key points: In 2021, Medicare spending on biologics was $926 million in Part B (FFS) and $1.3 billion in Part D (FFS/MA).Between 2017 and 2021, annual Medicare spending on biologics increased by approximately 200%.Between 2023 and 2025, Medicare Part D OOP costs for biologics will decrease by an estimated 50%–60%. [ABSTRACT FROM AUTHOR]

Key points: T‐cell activation in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) is enriched by late cytotoxic T cells.The proportion of early and intermediate activated cytotoxic T cells decreases in nasal polyps of patients with CRSwNP.Our results identify late activated cytotoxic T cells as potential biomarkers or therapeutic targets for patients with CRSwNP. [ABSTRACT FROM AUTHOR]

Key points: Increased dupilumab utilization coincided with decreased ESS in patients with CRSwNP between 2019 and 2021.One potential confounder was the concurrent COVID‐19 pandemic, which may have negatively impacted surgery utilization rates. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) may have a heterogeneous response to medical/surgical treatments based on endotypes. Data correlating biomarkers and severity of the disease are lacking. We aimed to determine if IL‐5 and calprotectin may be useful in defining severity of disease and identifying uncontrolled patients. Methods: This was a case–control study including 81 patients with diffuse CRSwNP who underwent at least one previous surgery and treated with intranasal steroids. We enrolled 39 uncontrolled patients (SNOT‐22 ≥ 40 and two or more cycles of systemic corticosteroids in last year) (Group A) and 42 controlled one (SNOT‐22 < 40 and less than two cycles of systemic corticosteroids in last year) (Group B). We analyzed IL‐5 and calprotectin in both nasal secretions and nasal polyp tissue. Results: Calprotectin and IL‐5 were significantly higher in Group A in both secretions and tissue, and the higher the number of previous surgeries, the higher the levels detected in nasal secretions. At univariate analyses, smoking, asthma, non‐steroidal anti‐inflammatory drugs‐exacerbated respiratory disease (NSAID‐ERD), blood eosinophilia, neutrophils, and eosinophils at nasal cytology were significantly associated with uncontrolled disease. Multivariate analyses showed that asthma, NSAID‐ERD, and IL‐5 in nasal secretion/polyp tissue were significantly related to the risk of uncontrolled disease. Conclusions: Our data suggest that asthma, NSAID‐ERD, and IL‐5 in nasal secretions/tissue may be helpful to identify more severe patients, as they are related to the risk of uncontrolled disease. Nonetheless, high levels of calprotectin and neutrophilia were also observed in uncontrolled patients, especially after multiple surgeries. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have high incidence of sleep impairment. We evaluated the impact of omalizumab treatment on sleep characteristics and associated health status in patients with CRSwNP. Methods: Prespecified exploratory analysis assessed outcomes from patients included in the POLYP 1 and POLYP 2 phase 3 clinical trials and the open‐label extension. Sleep was assessed by the sleep domain of the Sino‐Nasal Outcome Test‐22 (SNOT‐22; MCID > 4 in patients with CRS) and the Medical Outcomes Study Sleep Scale (MOS‐Sleep). Health status was assessed by Healthy Days Core Module (HDCM) and sinonasal‐specific Patient Global Impression of Change (PGIC). Results: Omalizumab improved sleep as assessed by the SNOT‐22 sleep domain. At week 24, adjusted mean (95%CI) SNOT‐22 sleep scores had reduced from baseline by −8.5 (–9.9 to –7.1) with omalizumab versus –2.7 (–4.1 to –1.3) with placebo. At week 52 (all patents on OMA), adjusted mean (95%CI) SNOT‐22 sleep scores had reduced from baseline by −10.1 (–11.4 to –8.7) with omalizumab. Improvements were observed in all eight items of the SNOT‐22 sleep domain: difficulty falling asleep, fatigue, frustration/restlessness/irritability, lack good night's sleep, reduced concentration, reduced productivity, wake up tired, and wake up at night. In addition, omalizumab improved six of eight sleep outcomes on the MOS‐Sleep scale. There were concurrent improvements in HDCM and PGIC. Conclusion: Omalizumab improved sleep and self‐reported health status in patients with CRSwNP. This contributes to evidence that omalizumab provides value for patients beyond the reduction of sinonasal symptoms. [ABSTRACT FROM AUTHOR]

Objective: To investigate the frequency and nature of adverse events related to type 2 biologic use in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), including dupilumab and mepolizumab. Methods: This is a single‐institution retrospective study of real‐world patient data. Patients were included if they have a diagnosis of CRSwNP, have undergone at least one endoscopic sinus surgery, and have taken at least two doses of dupilumab or mepolizumab between January 1, 2016, and July 1, 2023. Data collected include clinicodemographic information and past medical/surgical history. The primary outcomes are the incidence and types of adverse events. Adjusted odds ratio was calculated to compare the biologics using logistic regression. Risk factors for developing adverse events were investigated. Results: Eighty‐seven patients on dupilumab and 51 patients on mepolizumab were included. Thirty‐nine (45%) and 10 (20%) patients respectively encountered adverse events, which differed from phase 3 trial data. The adjusted odds ratio for adverse event rates between these two treatment groups was 3.8 (95% CI, 1.5–10.5). The most common adverse events for dupilumab were arthralgia (16%), rash (14%), and conjunctivitis or xerophthalmia (10%). The main adverse events for mepolizumab were headache (6%) and fatigue (6%). Seven dupilumab and three mepolizumab patients discontinued therapy due to adverse events. The average duration of treatment was 22.5 (range: 1–77) months for mepolizumab and 15.9 (range: 1–35) months for dupilumab. Conclusion: Dupilumab and mepolizumab have distinct adverse event profiles. This study contributes to informing clinicians' decisions regarding the use of type 2 biologics in CRSwNP patients. Level of Evidence: 3 Laryngoscope, 134:3054–3059, 2024 [ABSTRACT FROM AUTHOR]

Background: Type 2 inflammation has been described as a pathophysiological basis common to some diseases, such as atopic dermatitis (AD), chronic rhinosinusitis with nasal polyps, and asthma (CRSwNP). Objective: The present study used population‐based prevalence in Catalonia to analyse the coexistence of type 2 inflammatory diseases in patients primarily diagnosed with the above mentioned conditions. Results: We found a high degree of coexistence of type 2 inflammatory diseases among these patients, with the prevalence being higher in the severe forms, except for AD. For the severe forms of primary diseases, the proportion of patients with coexisting type 2 inflammatory diseases (severe or non‐severe) was 16.2% for AD, 19.8% for asthma, and a striking 62.4% for CRSwNP. This patient population has the highest proportion of coexisting type 2 inflammatory diseases, both severe (48.9%) and non‐severe (13.5%). Conclusion: Our findings have significant implications for the management of patients with AD, asthma, and CRSwNP. [ABSTRACT FROM AUTHOR]

Objectives: This post hoc analysis assessed disease characteristics and response to dupilumab treatment in male and female patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) (SINUS‐52 study; NCT02898454). Methods: Patients received dupilumab 300 mg or placebo every 2 weeks for 52 weeks on background intranasal corticosteroids. Efficacy was assessed through Week 52 using nasal polyp score (NPS), nasal congestion/obstruction score, loss of smell score and University of Pennsylvania Smell Identification Test score. Disease‐specific health‐related quality of life (HRQoL) was assessed using the 22‐item Sino‐Nasal Outcome Test (SNOT‐22). Results: The analysis included 192 male and 111 female patients. Female patients had higher mean SNOT‐22 total score (56.6 vs. 49.1, P < 0.01) and more coexisting asthma (78.4% vs. 46.4%, P < 0.0001) and non‐steroidal anti‐inflammatory drug‐exacerbated respiratory disease (NSAID‐ERD) (38.7% vs. 18.8%, P = 0.0001) than male patients, but other baseline characteristics were similar. Dupilumab significantly improved CRSwNP outcomes vs. placebo at Week 52, regardless of gender: least squares mean differences (95% confidence interval) for NPS were −2.33 (−2.80, −1.86) in male and −2.54 (−3.18, −1.90) in female patients (both P < 0.0001 vs. placebo), and for SNOT‐22 were −19.2 (−24.1, −14.2) in male and −24.4 (−31.5, −17.3) in female patients (both P < 0.0001 vs. placebo). There were no significant efficacy‐by‐gender interactions. Conclusion: Female patients had greater asthma, NSAID‐ERD and HRQoL burden at baseline than male patients. Dupilumab treatment significantly improved objective and subjective outcomes compared with placebo, irrespective of gender. [ABSTRACT FROM AUTHOR]

Background: The PI3K/Akt/mTOR pathway and autophagy are important physiological processes. But their roles in eCRSwNP remains controversial. Methods: In this study, we used the eCRSwNP mouse model, PI3K/Akt/mTOR pathway inhibitors, and autophagy inhibitors and activators to investigate the regulatory effects of the PI3K/Akt/mTOR pathway on autophagy, and their effects on eosinophilic inflammation, and tissue remodeling. The role of ILC2s in eCRSwNP was also studied, and the relationship between ILC2s and autophagy was preliminarily determined. Results: Our results show that eosinophilic inflammation in eCRSwNP mice could be inhibited by promoting the autophagy; otherwise, eosinophilic inflammation could be promoted. Meanwhile, inhibition of the PI3K/Akt/mTOR pathway can further promote autophagy and inhibit eosinophilic inflammation. Meanwhile, inhibiting the PI3K/Akt/mTOR pathway and promoting autophagy can reduce the number of ILC2s and the severity of tissue remodeling in the nasal polyps of eCRSwNP mice. Conclusions: We conclude that the PI3K/Akt/mTOR pathway plays roles in eosinophilic inflammation and tissue remodeling of eCRSwNP, in part by regulating the level of autophagy. The downregulation of autophagy is a pathogenesis of eCRSwNP; therefore, the recovery of normal autophagy levels might be a new target for eCRSwNP therapy. Furthermore, autophagy might inhibit eosinophilic inflammation and tissue remodeling, in part by reducing the number of ILC2s. [ABSTRACT FROM AUTHOR]

Key points: Expanded types of functional endoscopic sinus surgery (FESS) significantly improve quality of life and reduce revision surgeries rates, supporting their early application for moderate‐to‐severe cases.Minimal clinically important difference may play as a crucial role in defining surgical treatment response (i.e., responder and super‐responder conditions).Expanded FESS benefits patients with chronic rhinosinusitis with nasal polyps but more data are required to have a clearer understanding of its uses due to varied approaches and reported outcomes in the literature. [ABSTRACT FROM AUTHOR]

Key points: Disease severity in acute radiation rhinosinusitis (ARRS) peaks after radiation therapy.ARRS is mainly local inflammation, manifested by increased pro‐inflammatory cytokines.Intranasal corticosteroids are effective anti‐inflammatory drugs in the treatment of ARRS. [ABSTRACT FROM AUTHOR]

Key points: We created a LangChain/OpenAI API‐powered chatbot based solely on International Consensus Statement of Allergy and Rhinology: Rhinosinusitis (ICAR‐RS).The ICAR‐RS chatbot is able to provide direct and actionable recommendations.Utilization of consensus statements provides an opportunity for AI applications in healthcare. [ABSTRACT FROM AUTHOR]