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Introduction High-volume corticosteroid nasal irrigation is a treatment option in patients with chronic rhinosinusitis. In Brazil, alternatives are used to optimize its cost and popularize its use, such as 1% compounded budesonide drops or betamethasone cream, and it is necessary to study these treatment modalities. Objective To evaluate the clinical response of nasal irrigation with 1% compounded budesonide drops or betamethasone cream compared to nasal sprays utilized in patients with chronic rhinosinusitis. Methods This was a retrospective observational study with 257 patients. One hundred and eight patients using corticosteroid nasal irrigation (292 treatment cycles) and 149 using corticosteroid nasal spray (300 treatment cycles) were included. Evaluation of subjective improvement, adverse events, exacerbations, and objective assessments with SNOT-22 and Lund–Kennedy endoscopic score were performed, in addition to sub-analyses related to nasal polyps and previous surgery. Results Corticosteroid nasal irrigation and corticosteroid nasal spray improved the Lund–Kennedy endoscopic score, with more adverse events in the corticosteroid nasal irrigation group. Previous surgery increased corticosteroid nasal irrigation improvement, with greater subjective improvement and fewer exacerbations. 1% compounded budesonide drops were better than betamethasone cream in the Lund–Kennedy endoscopic score, with fewer adverse events. A 1,000 µg dose of 1% compounded budesonide drops was more effective than 500 µg. Conclusion Corticosteroid nasal irrigation was effective in improving the Lund–Kennedy endoscopic score in chronic rhinosinusitis, especially in patients with nasal polyps and previous surgery, in addition to promoting a higher rate of subjective improvement and fewer exacerbations than corticosteroid nasal spray, but with more adverse events. 1% compounded budesonide drops improved the Lund–Kennedy endoscopic score with fewer adverse events than betamethasone cream, particularly at higher doses (1000 µg).

The severity of pediatric obstructive sleep apnea (OSA) can vary from mild to very severe (AHI ≥ 30 events/h) with the seasons. The efficacy of medical treatment has been investigated in cases of mild and moderate pediatric OSA, but not in severe cases thoroughly.Our prospective cohort study involved 205 children who visited our outpatient clinic between December 2014 and May 2020. We performed home sleep tests after the initial visit, and then polysomnography after optimizing the control of rhinitis, sinusitis, adenoid hypertrophy, and tonsillitis by using medical treatments.The respective proportions of patients who improved to obstructive AHI (O-AHI)1/h or who proceeded to surgery were 43.4% and 62.3% in mild cases; 43.3% and 52.2% in moderate cases; 30.2% and 68.4% in severe cases; and 0.0% and 100% in very severe cases. Additionally, nadir SaOMedical treatment instituted before a surgical decision is made can provide substantial benefits and avoid unnecessary surgery if there is time for such treatments. In contrast, it may be difficult to normalize the O-AHI in pediatric patients with very severe OSA or a nadir SaO

In the clinical assessment of chronic rhinosinusitis with nasal polyps (CRSwNP), evaluation of symptoms, nasoendoscopy findings and sinus computed tomography (CT) scan staging is employed in the management plan. Although prior studies have been done to assess the correlation of the three modalities in CRSwNP, such evaluation in patients with eosinophilic and non-eosinophilic types of CRSwNP requires further investigation. The aim of this study was to correlate the sinus CT scan staging to symptom and endoscopic scores in both types of CRSwNP.Patients with CRSwNP were classified into 2 types, eosinophilic and non-eosinophilic. Both types were assessed by Sino-Nasal Outcome Test 22 (SNOT-22) symptom score, nasal endoscopy Lund Kennedy grading (LK) score and sinus CT Lund Mackay (LM) staging score. All three modalities were correlated.Forty-four patients were recruited for this study. There was significant correlation between sinus CT and symptom scores in the eosinophilic (r=.51, p=.031) and the non-eosinophilic (r=.76, p.001) types. There was no significant correlation between symptom and nasoendoscopic scores in the eosinophilic (r=.12, p=.641) and the non-eosinophilic (r=.22, p=.276) types. There was also no significant correlation between sinus CT and nasoendoscopic scores in the eosinophilic (r=.20, p=.418) and the non-eosinophilic (r=.14, p=.508) types.Sinus CT staging correlates well with the symptom score for both the eosinophilic and the non-eosinophilic types of CRSwNP. The good correlation suggests both modalities are a reliable guide for their evaluation and management planning.

Sinogenic intracranial and orbital complications are infrequent complications of chronic rhinosinusitis with nasal polyposis (CRSwNP), leading to potentially fatal intracranial and orbital sequelae. The mortality and morbidity associated with these complications remain high despite the widespread use of antibiotics. We report a patient with CRSwNP presenting with acute onset extradural empyema and sixth nerve palsy in whom the diagnosis was delayed, necessitating early surgical intervention. Our case shows that delay in management and underdiagnosis of sinusitis with nasal polyposis can lead to devastating complications. A high index of suspicion, early recognition of the clinical findings and radiological evaluation with contrast-enhanced CT of paranasal sinuses, orbit and brain are essential to rule out fatal complications associated with CRSwNP. Timely endoscopic intervention and the use of antibiotics can lead to good outcomes, even in complicated cases.

BACKGROUND: Chronic rhinosinusitis frequently occurs in people with cystic fibrosis. Several medical interventions are available for treating chronic rhinosinusitis in people with cystic fibrosis; for example, different concentrations of nasal saline irrigations, topical or oral corticosteroids, antibiotics ‐ including nebulized antibiotics ‐ dornase alfa and modulators of the cystic fibrosis transmembrane conductance regulator (CFTR) (such as lumacaftor, ivacaftor or tezacaftor). However, the efficacy of these interventions is unclear. This is an update of a previously published review. OBJECTIVES: The objective of this review is to compare the effects of different medical interventions in people diagnosed with cystic fibrosis and chronic rhinosinusitis. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and hand searching of journals and conference abstract books. Date of last search of trials register: 09 September 2021. We also searched ongoing trials databases, other medical databases and the reference lists of relevant articles and reviews. Date of latest additional searches: 22 November 2021. SELECTION CRITERIA: Randomized and quasi‐randomized trials of different medical interventions compared to each other or to no intervention or to placebo. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials identified for potential inclusion in the review. We planned to conduct data collection and analysis in accordance with Cochrane methods and to independently rate the quality of the evidence for each outcome using the GRADE guidelines. MAIN RESULTS: We identified no trials that met the pre‐defined inclusion criteria. The most recent searches identified 44 new references, none of which were eligible for inclusion in the current version of this review; 12 studies are listed as excluded and one as ongoing. AUTHORS' CONCLUSIONS: We identified no eligible trials assessing the medical interventions in people with cystic fibrosis and chronic rhinosinusitis. High‐quality trials are needed which should assess the efficacy of different treatment options detailed above for managing chronic rhinosinusitis, preventing pulmonary exacerbations and improving quality of life in people with cystic fibrosis.

Nasal obstruction is considered to be one of the risk factors for obstructive sleep apnea, together with a high arched narrow palate, elongated uvula, malocclusion, and tongue and tonsil size. The impact of nasal obstruction on sleep apnea is controversial, however, and its relation to sleep quality is rarely discussed. The purpose of this study was to investigate the independent effect of nasal obstruction on sleep quality.Sixty-nine patients with nasal obstructive symptoms and without sleep apnea episodes were enrolled from September 2018 to August 2019, and compared before and after surgery with thirty-four patients who had benign diseases of the thyroid or parathyroid as a control group, to investigate effects of surgery. Sleep quality was evaluated using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J). All cases were reassessed at three months after surgery.The postoperative PSQI scores in the nasal surgery group were significantly lower than the preoperative scores (p 0.001). In contrast, there was no statistically significance difference between the pre- and postoperative PSQI scores in the neck surgery group. Difference of PSQI scores before and after surgery in the nasal surgery group was significantly higher than the neck surgery group.This double-arm study suggests that reduction of nasal disfunction with nasal surgery contributes significantly to sleep quality, in patients who may not have noticed their impaired quality of sleep previously because of their long-term nasal symptoms.

Abstract: Respiratory tract infections are underestimated because they are mild and disabling, but in clinical medicine, these are the most prevalent problems. According to the World Health Organization third-most comprehensive cause of death in the world till 2030 would be Chronic Obstructive Pulmonary Disease (COPD). Dominating viruses of respiratory infections are influenza, respiratory syncytial virus, rhinoviruses, and human coronaviruses. Antibiotics are mostly used to treat bacterial infections, and they do not effectively manage viral infections like sinusitis, sore throats, bronchitis, influenza, and common respiratory infections. Presently no medication is available only symptomatic interventions is an option in our hand. However, a lot of research is going on the vaccine and drugs-based approaches against respiratory viruses worldwide. Traditional medicines are getting the attraction to treat many diseases. It is vital to screen the medicinal plants to find the potential of new compounds for treatment against antiviral and antimicrobial activities. Glycyrrhiza glabra L. (Licorice) pharmacological actions modulate the immune system, inhibit virus growth, produce anti-inflammatory activity, and inactivate viruses. This comprehensive review mainly focuses on the role of licorice in managing respiratory infections caused by viruses and bacteria, including complications associated with its excess intake. There has been limited human research’s exhibited licorice effectiveness in respiratory infections; therefore, there is a need for uncompromising and long-term research. This paper will be a valuable reference for biologists and physicians looking for a medication for respiratory infections. Glycyrrhiza glabra could open the door to novel agents in drug discovery and development.

Background/purpose In this study we aimed to investigate the prevalence of abnormal nasality in patients with unilateral rhinosinusitis and their nasality outcomes following functional endoscopic sinus surgery (FESS). Methods A total of 42 patients with unilateral chronic rhinosinusitis who underwent unilateral FESS between April 2016 and November 2017 were enrolled. Questionnaires on sinonasal symptoms and nasality were recorded. The change in the nasalance score of vowels [a], [i] [u], nasal consonant [m], 2 nasal syllable repetitions, and 2 Chinese sentences were measured. The patients were evaluated preoperatively, 6 months, and 12 months after the operation. The patients were divided into two groups, wide opening surgery and limited surgery, according to the severity of the disease. Results Among 42 patients, the subjective reports showed that one-third of unilateral chronic rhinosinusitis (CRS) patients had abnormal nasality preoperatively and significant improvement following FESS. The Lund–Mackay score was significantly negatively correlated with preoperative nasalance of [i] and positively correlated with change of nasalance of [i]. The increase in the value of [i] is statistically significant (p = 0.01) following FESS. In the further subgroup analysis, the change in nasalance was significant in the wide opening surgery group, but not in the limited surgery group. Conclusion Although only one side of the nasal airway was involved, one-third of the patients reported abnormal nasality. In patients with more disease severity who underwent wide opening surgery, the nasalance significantly increased 1 year after FESS. The increase in the objective nasalance score was corresponded to a significant improvement of subjective self-reported nasality assessment postoperatively.

A 77-year-old woman presented at the otorhinolaryngology department with left maxillary sinusitis. She reported having discomfort in her throat with no other symptoms. Her medical history included Parkinson’s disease, breast cancer, kidney stones but no vascular malformations. Her regular

A 10-year-old child had painful periorbital swelling in the left eye. It was diagnosed as preseptal cellulitis and treated with oral antibiotics. Three days later, the ocular condition worsened so the child was referred for further management. On examination, the child had a temperature of 102 °F. Ocular examination revealed proptosis, restricted ocular movements and a relative afferent pupillary defect in the left eye. Ocular examination of the right eye was normal. There was a history of recurrent episodes of cold in the past. CT scan orbit and sinuses revealed signs of orbital cellulitis with sinusitis on the left side. The child was treated with parenteral antibiotics and endoscopic sinus surgery. A child presenting with unilateral periorbital swelling needs to be thoroughly evaluated. It is important to differentiate orbital cellulitis from preseptal cellulitis. Orbital cellulitis is an emergency and delay in diagnosis can lead to vision and life-threatening intracranial complications.

A 72-year-old male patient was seen in ear, nose and throat (ENT) clinic with chronic rhinosinusitis and diplopia. He had previously undergone partial ethmoidectomy and maxillary antrostomies for sinus issues 6 years ago. One month prior to this visit, he had developed right nasal congestion

Background: The objective of this study is to investigate the position and frequency of dehiscences in the medial orbital wall and to reveal that dehiscences and orbital adipose tissue hernias are distinct entities. Materials and methods: Two hundred-thirty medial orbital walls of 115 patients with a preliminary diagnosis of headache and sinusitis but without active ethmoidal sinusitis were examined by computer tomography in the axial plane. Two separate radiologists assessed continuity of the medial orbital wall and orbital fat tissue herniation in ethmoid cells. The medial orbital wall was divided into four quadrants and the dehiscence distribution was evaluated. Results: Bone defects were detected in 71 patients (30.9%) in 230 orbital medial wall reviews of 115 patients (59 males, 56 females). Eight of these cases (4 male, 4 female) (3.5%) had herniation of the orbital adipose tissue into the ethmoid sinus. Of the 108 dehiscences, 47 were localized in the posterior upper quadrant. A statistically significant difference was found in the dehiscence distribution according to the quadrants. No significant relationship was found among age, gender, side of dehiscence and frequency of dehiscence. Conclusions: Dehiscences in the posterior upper quadrant are more common in the medial orbital wall. Although bone dehiscences in the medial orbital wall and the herniation of the orbital fat tissue are two different entities, they are used interchangeably in most of the literature and in radiological reporting.

BACKGROUND Early identification of fungal sinusitis remains a challenge. Previously, we observed a high false negative rate of using A-mode ultrasound to diagnose maxillary fungal sinusitis. This study aims to assess the accuracy of the diagnosis of fungal maxillary sinusitis using sinus plain film and ultrasound. METHODS The screening criteria is defined as the combination of a positive sinus plain film and a false negative sinus ultrasound. We retrospectively reviewed pre-operative imaging of patients with fungal sinusitis and unilateral bacterial sinusitis of the maxillary sinus undergoing functional endoscopic sinus surgery from May 2013 to December 2019 in our hospital and evaluated the diagnostic performance of this screening method. RESULTS 48 patients were included. 22 and 26 patients were diagnosed with fungal sinusitis and bacterial sinusitis, respectively. 16 patients (72.7%) with fungal sinusitis presented with a false negative sinus ultrasound and met our screening criteria for fungal sinusitis. The screening criteria reached significance in the receiver operating characteristic (ROC) curve analysis (p

In the last 2 decades, an increasing understanding of pathophysiological mechanisms in chronic rhinosinusitis (CRS) opened an avenue from phenotyping to endotyping, from eosinophilic inflammation to type 2 immunity, and from the ventilation and drainage paradigm to the mucosal concept for therapeutic considerations. With the advent of type 2 endotyping and targeted biomarkers, precise endotype-driven therapeutic options are possible including biologics and adapted surgical approaches. We here aim to focus on the complexity and heterogeneity of the features of CRS endotypes, especially for those with nasal polyps, including its history, latest developments, clinical associations, and endotype-driven solutions. In order to better manage uncontrolled severe CRS in clinical practice, medical decisions based on a profound understanding of the pathology and immunology of this heterogeneous disease, aiding a precision-medicine based approach for patient's treatment, are pivotal.

Background Elexacaftor-tezacaftor-ivacaftor (ETI) improves pulmonary health and chronic rhinosinusitis (CRS) for people with cystic fibrosis (PwCF), however its impact on olfaction has not been investigated. Olfactory dysfunction impairs quality-of-life (QOL). This study evaluated the impact of ETI on multiple olfactory metrics. Methods Adult PwCF/CRS with CF transmembrane conductance regulator genotype F508del/F508del or F508del/minimal function who clinically initiated ETI participated in a prospective, observational study. Endpoints included changes after 6 months of ETI in quantitative olfactory function (Smell Identification Test, SIT), olfactory QOL (Questionnaire of Olfactory Disorders, QOD) and percent olfactory cleft opacification (%OCO), representing superior nasal cavity inflammation where afferent olfactory neurons are concentrated. Results 30 PwCF/CRS met inclusion criteria; 25 completed the study. Mean ETI adherence was 93%. At baseline, participants were hyposmic (mean SIT 31.3), had significant %OCO (mean 65.6%), yet reported non-impaired olfactory QOL (mean QOD 6.1). At follow-up, mean SIT worsened mildly (p=0.009), mean %OCO remained stable (p=0.46), and mean QOD improved modestly (p=0.008). No outcomes were impacted by prior modulator use, genotype, nasal polyps, or CF-related diabetes. Prior sinus surgery was associated with QOD improvement (p=0.04). Increased (worse) baseline QOD scores and %OCO were associated with greater improvements (p Conclusions ETI was not associated with improvement in quantitative olfaction or olfactory cleft opacification after 6 months. PwCF/CRS have hyposmia but do not report impairment in olfactory QOL. Further study to investigate mechanisms explaining olfactory dysfunction and whether olfaction improves with greater duration of ETI or in younger age groups is warranted.

Assessment of asthma comorbidities, conditions that adversely affect the pathobiology of asthma or impair its response to therapies, is a fundamental step in the evaluation and management of patients with difficult-to-treat asthma. Identifying and effectively treating asthma comorbidities, such as obesity, obstructive sleep apnea, and chronic sinusitis with nasal polyps may improve asthma control and reduce exacerbations. Additionally, identifying comorbid T2 inflammatory conditions may help guide optimal selection of biologic therapies. Here, we describe common comorbid conditions found in adult and pediatric difficult-to-control asthma, discuss evidence for the association with asthma morbidity and treatment benefit, and provide information on how and when to assess comorbidities.

Chronic rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses defined by classic symptoms, imaging findings, and/or endoscopic findings. There are a growing number of emerging pharmacologic therapies being evaluated to treat patients with CRS, some of which have gained indication status in the United States. There have not been updated treatment guidelines published in the United States however since 2014. This document is meant to serve as an updated expert consensus document for the pharmacologic management of patients with CRS We review available data focusing on prospective clinical trials on oral and intranasal corticosteroids, nasal irrigation, biologics, antibiotics, and allergy immunotherapy for CRS both with and without nasal polyposis, as well as specific therapies for aspirin exacerbated respiratory disease associated CRS and allergic fungal CRS. There are multiple options to treat CRS, and clinicians should be knowledgeable about the efficacy and risks of these available therapies. Allergists/Immunologists now have various therapies available to treat patients with CRS.

Inhalations (inhalation of medicinal substances) are one of the effective ways to treat upper respiratory tract diseases and colds. Inhalation therapy is used to treat rhinitis, sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis and pneumonia, which can be complications of acute respiratory viral infections. The main rules of inhalation are as follows to conduct the procedure better after 1.5 hours after eating; clothes should not impede breathing; the procedure can be carried out only while sitting or standing; solution for the inhaler for treatment of bronchitis should be fresh; it is necessary to strictly keep the prescribed dosage; the time of the procedure should also be respected — usually it is from 1 to 4 minutes, sometimes for adults up to 10 minutes, for children the inhalation period is shorter — 1–2 minutes. Contraindications to inhalation are body temperature above 37.5 degrees; propensity to nasal blee­ding in a patient; propensity to increased arterial pressure, with cardiovascular failure; purulent inflammation of the tonsils; respiratory failure. The procedure should be stopped immediately in case of appearance of adverse symptoms such as shortness of breath, dizziness, difficulty in breathing. Therefore, inhalations must be prescribed by a doctor after examination of a patient. During inhalations in rhinitis, you should try to inhale the vapor through the nose. For effective treatment of rhinitis, inhalations from conife­rous plants are very suitable: fir, pine, juniper, larch, from steamed dried chamomile flowers, mint, and blackberry leaves. Honey inhalations can be used for the treatment of acute and chronic diseases of the upper respiratory tract (tonsillitis, pharyngitis, laryngitis and tracheitis). Medical herbal inhalation for children should be carried out from the age of two years. This must be done under the constant supervision of an adult. Leaves of coniferous trees: pine, fir, if or juniper, cedar are recommended for the treatment of children. Dried leaves of eucalyptus, lime, black currant, chamomile, mint and sage are also useful. During pregnancy, inhalations are one of the least risk ways to treat colds. It is necessary to keep precautions and correctly select herbs. For example, the use of medical herb farfara for inhalations is not recommended during pregnancy as well as the medical herbs that can cause allergies. In case of a cold, it is useful for pregnant women to use raspberry leaves, marigold flowers, flax flowers, as well as flowers and herb thyme for inhalations. Optimal herbs for inhalation during pregnancy will become chamomile, herb St. John's wort, thyme, althea and plantain if you need to cure a dry cough. In case of a moist cough, doctors recommend breat­hing a couple of herbs of yarrow decoction, rosemary or eucalyptus.

Obliterative paranasal sinusitis is a rare sequela and end stage of chronic rhinosinusitis, which is often overlooked on imaging. It is an exuberant form of neo-osteogenesis characterized by complete or partial obliteration of the sinus cavity by new bone formation. This article presents a series of cases of obliterative sinusitis involving the sphenoid and maxillary sinuses. It is important to comment on the presence of obliterative sinusitis in the radiology report and not confuse it for native bone, fibro-osseous lesion, or arrested pneumatization, as this may have clinical implications for patients being considered for surgery. Given its potential implications for severity of sinusitis as well as prognostic significance for outcomes following endoscopic sinus surgery, awareness and timely identification of this entity is important to guide referring clinicians.

BACKGROUND Chronic oroantral fistulae (OAF) with secondary sinusitis can occur following repulsion of cheek teeth in horses. CASE REPORT An 8-year-old Andalusian cross gelding presented with an iatrogenic clinical crown fracture of tooth 209, which underwent repulsion of its apical portion (day 0). The horse was treated with intramuscular penicillin and intravenous gentamicin (5 days), followed by oral trimethoprim-sulphonamide (10 days) and then oral doxycycline (14 days). The acute iatrogenic OAF created during the initial repulsion persisted; a chronic OAF was identified on day 24. On day 48, septic sinusitis with multidrug-resistant (MDR) Escherichia coli was confirmed. Although susceptible to enrofloxacin in vitro, 30 days of therapy was unsuccessful. Subsequent serial cultures grew multiple MDR and extensively drug-resistant (XDR) gram-negative microorganisms. Whole-genome sequencing (WGS) revealed multiple sequence types of E. coli, with a range of resistance and virulence genes. The orientation of the OAF, regional osteomyelitis and septic sinusitis were confirmed with computed tomography on day 70. On day 74, enteral nutrition was provided through a cervical oesophagostomy tube for 3 months for prevention of oral feed contamination. The OAF was treated with various alternative therapeutics, including apple cider vinegar, propolis and amikacin impregnated products, until resolution on day 116. CONCLUSION These non-conventional therapeutics, antimicrobials and long-term oesophagostomy contributed to the successful treatment of a complicated OAF. In the future, WGS may be useful to inform antimicrobial selection when MDR or XDR organisms are identified.

To document incidence rate and severity of specific sub-categories of respiratory tract illness (RTill) in rugby players during the Super Rugby tournament.Cross-sectional study.Team physicians completed daily illness logs in 537 professional male rugby players from South African teams participating in the Super Rugby Union tournaments (2013-2017) (1141 player-seasons, 102,738 player-days). The incidence rate (IR: illness episodes/1000 player-days) and severity [%RTill resulting in time-loss, illness burden (IB: days lost to illness/1000 player-days) and days until return-to-play (DRTP)/single illness (mean: 95% Confidence Intervals)] are reported for the following specific sub-categories of RTill: non-infective respiratory tract illness (RTnon-inf), respiratory tract infections (RTinf), influenza-like illness, infective sinusitis, upper respiratory tract infections (URTinf), lower respiratory tract infections (LRTinf).The overall IR of RTill was 2.9 (2.6-3.3). IR was higher for RTinf (2.5; 2.2-2.9) vs. RTnon-inf (0.4; 0.3-0.6) (p 0.001). For sub-categories the highest IR was in URTinf (1.9; 1.7-2.2), while the % illness causing time-loss was influenza-like illness (100%), LRTinf (91.7%), infective sinusitis (55.6%), and URTinf (49.0%). IB was highest for URTinf (2.0; 1.6-2.5), and the DRTP/single illness was highest for LRTinf (3.2; 2.3-4.4), and influenza-like illness (2.1; 1.6-2.8).RTinf accounted for57% of all illness during the Super Rugby tournament, and mostly URTinf. Influenza-like illness. LRTinf caused time-loss in90% cases. URTinf, LRTinf and influenza-like illness resulted in the highest burden of illness and LRTinf caused the highest DRTP. Prevention strategies should focus on mitigating the risk of RTinf, specifically URTinf, LRTinf and influenza-like illness.

Background: Patients with chronic rhinosinusitis (CRS) often have Eustachian tube dysfunction (ETD) symptoms. This study aimed to prospectively investigate the effect of endoscopic sinus surgery (ESS) on improvement of Eustachian tube function in CRS patients with ETD from a Chinese population and determine factors associated with improvement. Methods: A prospective study was performed in CRS patients with ETD who underwent ESS from 3 tertiary medical centers in south China. The Eustachian tube Dysfunction Questionnaire 7 (ETDQ-7), Sinonasal Outcome Test 22 (SNOT-22), tympanograms, endoscopic findings and Valsalva maneuver were recorded and analyzed preoperatively and postoperatively at 8-12 weeks. Results: A total of 70 CRS patients with ETD were included in this study. The ETDQ-7 score and the ability of positive Valsalva maneuver in CRS patients were significantly improved postoperatively at 8-12 weeks. The number of patients with type A tympanogram was increased postoperatively. Reduced Eustachian tube mucosal inflammation was also observed postoperatively. In addition, ESS appeared to reverse slight tympanic membrane atelectasis after 8-12 weeks. Moreover, improvement in tympanogram was presented in more than half of CRS patients with concomitant otitis media with effusion postoperatively at 8-12 weeks. Univariate and multivariate analysis revealed failure of normalization of ETDQ-7 postoperatively was associated with concomitant allergic rhinitis and higher preoperative SNOT-22 score. Conclusions: This study confirms Eustachian tube function is often improved after ESS in CRS patients with ETD. Concomitant allergic rhinitis and higher preoperative SNOT-22 score are associated with failure of normalization of ETD symptoms.

Patients with severe chronic rhinosinusitis with nasal polyps represent an unmet clinical need in terms of recurrent disease despite current medical and surgical therapy. Targeting type 2 inflammatory cytokines (IL4/5/13) appears to be a promising therapeutic approach for such patients akin to what has already been seen in severe asthma. An indirect comparison from phase 3 placebo-controlled trials has shown relative improvements in the coprimary end point of nasal polyp score (NPS) ranging from a 15% reduction (-0.8 units) with mepolizumab, 18% with omalizumab (-1.14 units), and 35% (-2.06 units) with dupilumab. This trend was mirrored by relative improvements in health status with the 22-item Sinonasal Outcome Test score showing a 21% reduction (-13.7 units) with mepolizumab, 27% (-16.1 units) with omalizumab, and 43% (-21.1 units) with dupilumab, all exceeding the minimal clinically important difference of 8.9 units. All biologics improved the coprimary end point of nasal airway blockage and also reduced the need for rescue medical and/or surgical polypectomy. We advocate performing real-life studies looking at the response to biologics in patients who are at increased risk for disease recurrence, including initial optimal medical and surgical polyp clearance before commencing biologics.

Multisystem involvement has not been uncommon in SARS-CoV-2 infection. There has been reports of devastating neurological complication both during the infection and after the virus clears out. Here we present a rare case of sino-orbital mucormycosis, diagnosis of which was confirmed only on histopathology. Our patient presented with headache, 18 days after her recovery from SARS-CoV-2 infection and was extensively worked up for the cause. Initially she was treated as a severe sinusitis but failure to response to antibiotics treatment warranted for further investigations and imaging. Our patient had to undergo right eye enucleation plus debridement under general anesthesia under the care of ENT, Ophthalmology, Neurosurgery and Neurology. She is currently on anti-fungal treatment as advised by infectious disease department.

Objectives. Chronic rhinosinusitis with nasal polyps (CRSwNP) is a more severe inflammatory form of CRS that often coexists with obstructive sleep apnea (OSA). However, little is known about the relationship between OSA and the immune profile in patients with CRSwNP. We aimed to investigate the immune profile of patients with CRSwNP according to OSA severity.Methods. This study included 63 patients with CRSwNP and nine control subjects. Protein levels of inflammatory mediators were determined using multiplex immunoassays. All patients underwent standard polysomnography.Results. In patients with eosinophilic CRSwNP (ECRSwNP), interleukin (IL)-6 and chemokine [C-X-C motif] ligand (CXCL)-1 (type 1 immune-related markers) were upregulated in cases of moderate-to-severe OSA. Additionally, IL-4, IL-13, C-C motif chemokine (CCL)-11, CCL-24 (type 2 immune-related markers), and IL-17A (a type 3 immune-related marker) were present at elevated levels in patients with moderate-to-severe OSA. Although there were no significant differences in type 1, 2, or 3 immune-related markers among patients with non-eosinophilic CRSwNP (NECRSwNP) according to the severity of OSA, transforming growth factor-beta expression was higher in those with moderate-to-severe OSA. Furthermore, in ECRSwNP with moderate-to-severe OSA, associations were detected between serum markers and some upregulated inflammatory markers.Conclusion. OSA may increase the heterogeneity of the immune profile (types 1, 2, and 3) in patients with ECRSwNP, but not in those with NECRSwNP.

Well-characterized in chronic rhinosinusitis, type 2 inflammation is frequently associated with nasal polyps, comorbid asthma, and nonsteroidal anti-inflammatory drug hypersensitivity. Despite medical and surgical treatment, it recurs in a significant proportion of patients. Thus, severe uncontrolled type 2 chronic rhinosinusitis with nasal polyps is the most difficult-to-treat phenotype of chronic rhinosinusitis. Recently, dupilumab, a monoclonal antibody against IL-4 receptor α, and omalizumab, a monoclonal antibody against immunoglobulin E, were approved for patients with chronic rhinosinusitis with nasal polyps in the United States, Europe, and Korea. Therefore, rhinologists should understand novel biologics and their use. Here, we provide a literature review of several biologics with their indications, effectiveness, and safety.

Objective: To investigate the use of near-infrared (NIR) imaging as a tool for outpatient clinicians to quickly and accurately assess for maxillary sinusitis and to characterize its accuracy compared to computerized tomography (CT) scan. Methods: In a prospective investigational study, NIR and CT images from 65 patients who presented to a tertiary care rhinology clinic were compared to determine the sensitivity and specificity of NIR as an imaging modality. Results: The sensitivity and specificity of NIR imaging in distinguishing normal versus maxillary sinus disease was found to be 90% and 84%, normal versus mild maxillary sinus disease to be 76% and 91%, and mild versus severe maxillary sinus disease to be 96% and 81%, respectively. The average pixel intensity was also calculated and compared to the modified Lund-Mackay scores from CT scans to assess the ability of NIR imaging to stratify the severity of maxillary sinus disease. Average pixel intensity over a region of interest was significantly different ( P < .001) between normal, mild, and severe disease, as well as when comparing normal versus mild ( P < .001, 95% CI 42.22-105.39), normal versus severe ( P < .001, 95% CI 119.43-174.14), and mild versus severe ( P < .001, 95% CI 41.39-104.56) maxillary sinus disease. Conclusion: Based on this data, NIR shows promise as a tool for identifying patients with potential maxillary sinus disease as well as providing information on severity of disease that may guide administration of appropriate treatments.

Background Chronic rhinosinusitis (CRS) describes a heterogenous group of diseases including CRS with (CRSwNP) or without nasal polyps (CRSsNP), aspirin-exacerbated respiratory disease (AERD), and allergic fungal rhinosinusitis (AFRS). It affects 10 to 15% of the US population and is more common in women and White patients. However, these estimates are based on survey and database studies with innate diagnostic inaccuracy. Additionally, few studies report subtype-specific demographics. We explore the demographic differences of CRS in the U.S. by subtype and region. Objective To characterize demographic differences between the CRS population and the overall US population, and also between different CRS subtype populations. Methods We performed a systematic review for articles reporting on US demographics of adults with CRS. Study participants were required to have been diagnosed using consensus criteria. Data on demographics, geographic region, and CRS subtype were analyzed. Results Our study analyzed 31 unique studies representing 8409 patients with 50.7% females and weighted mean age of 48.0 years. Compared to the overall US population, CRS patients were predominantly White (78.5%) and non-Hispanic (94.5%) with under-representation of other races. Grouped by subtype, CRSwNP affected a significantly higher proportion of men (59.8%). AFRS affected a significantly higher proportion of Black patients (53.8%) while CRSsNP was more prevalent in White patients (84.2%). When grouped by region, the South had a significantly higher proportion of female (53%) and Black (17.8%) CRS patients. The West had a significantly higher proportion of Asian (4.5%) and Hispanic (12.3%) patients. Conclusions Significant demographic differences exist in CRS patients based on subtype and region. These data provide an estimation of the demographic make-up of CRS, but further high-level demographic studies are needed.

ObjectiveThe aim of this study was to perform a systematic review and meta-analysis of existing evidence on the role of hot saline irrigation in patients undergoing functional endoscopic sinus surgery and its impact on the visibility of the surgical field.MethodA search of PubMed, Cochrane, Ovid databases and Google Scholar was performed.ResultsThree randomised controlled trials were included. Pooled meta-analysis demonstrated a statistically significant better visibility of the surgical field, and a reduction in total blood loss and operating time during functional endoscopic sinus surgery in the hot saline irrigation group compared with the room temperature irrigation group. Subgroup analysis of studies that did not use vasoconstrictors showed a significant reduction in total blood loss and operating time.ConclusionThis is the first systematic review that addresses hot saline irrigation for haemostasis in functional endoscopic sinus surgery. The results suggest that hot saline irrigation in functional endoscopic sinus surgery for chronic rhinosinusitis may significantly improve visibility of the surgical field, reduce total blood loss by 20 per cent and decrease operating time by 9 minutes. However, there are limitations of the study because of the significant heterogeneity of the methods, quality and size of the studies.

Background Endoscopic sinus surgery is a well-established treatment for chronic rhinosinusitis in patients with cystic fibrosis, though its benefits seem to be limited to improving sinonasal symptoms rather than affecting lung function. Objective This study aims to identify clinical and demographic factors that may influence sinonasal and pulmonary outcomes after surgery. Methods This is a six-year retrospective analysis of adult cystic fibrosis patients who underwent endoscopic sinus surgery at a tertiary care center. 22-Item Sino-Nasal Outcomes Test scores and mean forced expiratory volume data at baseline and three to six months after surgery were analyzed using t-test and stepwise regression with the following covariates: age, gender, lung transplant, revision surgery, and pseudomonas on sinus culture. Results 119 surgeries were performed on 88 patients, with 69% on patients with transplant. The overall mean (Standard Deviation) improvement in 22-Item Sino-Nasal Outcomes Test score was 9.42 (18.15) for the entire cohort ( P Conclusion Although surgery was associated with a clinically and statistically significant improvement in sinonasal scores in cystic fibrosis patients, patients with pseudomonas may experience less benefit. Revision surgery and older age may be associated with less favorable pulmonary outcomes. Awareness of such variables may help when deciding which cystic fibrosis patients should undergo surgery.

Inflammatory diseases of the maxillary sinus of odontogenic aetiology have a high prevalence and hold leading positions in the structure of otorhinolaryngological and dental morbidity. High-intensity lesions in all age and social groups, the lack of over the last decade a downward trend in frequency, refractory to traditional drug therapy determine the high medical and social problem significance.To date, the main treatment standard is the surgical removal of the “causal” infection focus, but this stage is not always resolved by complete recovery, in consequence of which the disease acquires a cyclical character. Many authors point out the role of the immune system in chronization of the inflammatory process in the sinuses and the development of exacerbation frequent periods. Treatment of odontogenic sinusitis is more complex and prone to relapses. The main objectives of treatment are differential diagnosis of odontogenic sinusitis and its treatment.In this regard, determination of the immunological reactivity state and search for pathogenetically significant disorders in the effector protective link in patients with odontogenic sinusitis becomes especially relevant. The article presents a detailed analysis of the immune status of 60 patients with odontogenic maxillary sinusitis caused by acute periodontitis, radicular cyst, and filling material. Clearly demonstated the results of the paranasal sinuses x-ray examination and clinical examination of patients. In the course of the research were found significant changes of immunological indicators for several considered criteria. They indicate the presence of pronounced autoimmune shifts in the subjects, which play a key role in aggravating the disease severity and its outcome. This type of research is crucial for the development of improved drug therapy strategies for individuals with odontogenic sinusitis aimed at correcting immune disorders. The aim of the article is research of the immunological molecular changes that occur in odontogenic sinusitis, and to lay the foundation for studying the molecular mechanism of odontogenic sinusitis.

Background. An estimated 25% of primary and secondary syphilis, a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum, occurs in patients coinfected with human immunodeficiency virus (HIV) (Chesson et al., 2005). This association is especially evident in men who have sex with men (MSM). In HIV-positive patients, primary syphilis infection may progress more rapidly to the tertiary, and most destructive, stage and reinfection can start with the latent or tertiary stage; in such patients, advanced syphilis may arise without clinical warning signs (Kenyan et al., 2018). It is important to note that neurosyphilis can occur during any stage of infection in all patients, regardless of immunocompetence status (CDC, 2021). Case Presentation. A 56-year-old male with a past medical history of well-controlled HIV with a CD4 count of 700 cells/mm3 and an undetectable viral load, psoriasis, and a remote episode of treated syphilis, presented with a two-week history of a diffuse desquamating rash, alopecia, sinusitis, unilateral conjunctivitis, and blurred vision. His last sexual encounter was over ten months ago. The diagnosis of syphilis was confirmed by microhemagglutination assay, and he was treated for presumed neuro-ocular infection with a two-week course of intravenous Penicillin G. Conclusion. Syphilis has acquired a reputation as “the great masquerader” due to its protean manifestations. It may follow an unpredictable course, especially in HIV-positive patients, including those whose treatment has achieved undetectable serology. For example, ocular syphilis may present in an otherwise asymptomatic individual (Rein, 2020) and alopecia may arise as the sole indication of acute syphilitic infection (Doche et al., 2017). Therefore, a high index of suspicion is warranted in order to prevent severe and irreversible complications.

Respiratory Viral infections predispose patients to various coinfections and this may lead to enhanced disease severity and mortality. Despite the proven importance of co-infections, these are understudied during the large outbreaks of respiratory infections. Occurrence of invasive fungal respiratory superinfections in patients with COVID-19 has gained increasing attention recently. This study aims to assess Clinical & Microbiological profile of patients with invasive sinusitis in setting of COVID-19 disease at our institute Study Design: A retrospective observational study. Study included patients diagnosed with acute invasive fungal rhinosinusitis (AIFR) suffering from or having a history of coronavirus disease infection over the period of three months.(April 21 – June 21). The patients’ presentation details, imaging findings, co-morbidities, management details, and follow-up information were obtained, recorded and analysed. A total of 32 patients with AIFR with a mean age of 54.46±13.13 years old were included. Most common associated disease was diabetes mellitus (62.5%). Mycological analysis revealed most common fungi isolated from these patients were Mucor species.(56.25%) followed by Aspergillus species(15.62%) while coinfection with both of these species was seen in 5 patients.(15.62%) Candida species was isolated from samples of 4 patients (12.5%). Radiological studies of nose and paranasal sinuses showed that ethmoid (62.5%) and maxillary (46.87%) sinuses being the most commonly affected sinuses followed by Frontal (31.25%) and sphenoid (21.87%) sinuses. Peri-orbital invasion was seen in 5 (15.62%) cases whereas intracranial involvement was seen in 1 patient.(3.12%) In 8 (25%) patients only medical line of treatment was sufficient whereas 20 (62.5%) patients required surgical debridement during the treatment. 4 patients were lost to follow up. Overall survival was 90.62% (29/32) at the conclusion of the study. We are still learning the new and long-term complications of COVID- 19.The puzzle still remains unsolved about the cause and increased prevalence of invasive fungal infections in post-covid-19 population. High clinical suspicion and early and accurate diagnosis of AIFR in COVID-19 patients are essential for better prognosis.

BACKGROUND Recent studies have revealed that the nasal microbiota in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) is profoundly altered and is correlated with systemic inflammation. However, little is known regarding whether the microbiota can be utilized to predict nasal polyp recurrence. This study is aimed to determine whether altered nasal microbiota constituents could be used as biomarkers to predict CRSwNP recurrence. METHODS Nasal microbiota constituents were quantified and characterized using bacterial 16S ribosomal RNA gene sequencing. Selected features for least absolute shrinkage and selection operator regression-based predictors were the nasal microbiota community composition and CRSwNP patient clinical characteristics. The primary outcome was recurrence, which was determined post-admission. RESULTS By distinguishing recurrence-associated nasal microbiota taxa and exploiting the distinct nasal microbiota abundance between patients with recurrent and non-recurrent CRSwNP, we developed a predictive classifier for the diagnosis of nasal polyps' recurrence with 91.4% accuracy. CONCLUSIONS Key taxonomical features of the nasal microbiome could predict recurrence in CRSwNP patients. The nasal microbiome is an understudied source of clinical variation in CRSwNP and represents a novel therapeutic target for future prevention and treatment.

To be investigated whether Th17/Treg cells regulated by Interleukin-6 in the pathogenesis of chronic rhinosinusitis with nasal polyps. The distributions of Th17 and Treg cells in peripheral blood mononuclear cells (PBMCs) and tissues got from 46 CRSwNP patients and 14 controls were evaluated. Th17 and Treg cells and cells-related cytokines in serum were assessed in means of cytometric bead array (CBA) multiplex assays and enzyme-linked immunosorbent assays (ELISAs). Spleen cells were isolated from spleen of 20 normal BALB/c mice (male), isolated and purified with CD4 antibody immunomagnetic bead kit. CD4+ cells were divided into three groups, including TGF-β1, TGF-β1+ IL-6 and control (PBS). Treg and Th17 cells and cells related cytokines were detected by flow cytometry (FCM) after collecting spleen cells. The level of IL‐10 and IL‐17 in supernatant was measured by ELISA. Th17/Treg ratio and the level of IL-6 in both ECRSwNP (P

Sporotrichosis is usually a subcutaneous infection caused by thermodimorphic fungi of the genus Sporothrix. The disease occurs worldwide, but endemic areas are located in tropical and subtropical regions. The epidemiology of sporotrichosis in Brazil is peculiar because of the cat’s entry in the chain of transmission of this mycosis, associated with Sporothrix brasiliensis, the most virulent species in the genus. Sinusitis caused by Sporothrix species is unusual and may be underdiagnosed or confused with other fungal etiologies, like mucormycosis. We report a case of sinusitis due to a Sporothrix species in a 6-year renal transplant recipient. Direct examination of smears of exudate of the sinus specimen (aspirate, biopsy) revealed budding yeasts and cigar-shaped cells. Sporothrix was subsequently recovered from the patient’s exudate culture and identified as S. brasiliensis using species-specific polymerase chain reaction, and she was successfully treated with antifungal therapy. Her parents also developed the disease a week later, both only cutaneous involvement. Sporotrichosis sinusitis is a rare disease, even in immunocompromised patients. Diagnosis is crucial, and benefits from good epidemiological history.

Epidemiology and potential risk factors for cystic fibrosis arthropathy (CFA) were studied in a relevant cystic fibrosis (CF) patient cohort.Cohort study of patients included in the German CF registry in 2016-2017. Descriptive analysis, exploratory tests and multivariable logistic regression were used to assess prevalence of CFA and associated potential risk factors for adult patients with/without chronic Pseudomonas aeruginosa infection.6069 CF patients aged from 0 to 78 years were analysed. CFA was observed in 4.9% of the patients. Prevalence was significantly higher in adult patients (8.4%) compared to patients18 years (0.7%; p0.0001). Logistic regression analyses in adult patients (n=3319) showed that CFA was significantly associated with increasing age (OR=1.04; 95% CI: 1.02-1.05; p0.0001), female gender (OR=2.10; 95%CI:1.52-2.90; p0.0001), number of hospitalizations (OR=1.24; 95%CI:1.12-1.36; p0.0001), chronic P. aeruginosa infection (OR=1.83; 95%CI:1.28-2.61; p=0.0009), CF-related diabetes (OR=1.69; 95%CI:1.23-2.33; p=0.0013), pancreatic insufficiency (OR=2.39; 95%CI:1.28-4.46; p=0.0060) and sinusitis/polyps (OR=1.91; 95%CI:1.39-2.62; p0.0001). In a subgroup analysis of adults without chronic P. aeruginosa infection (n=1550) CFA was also significantly associated with increasing age, female gender, increasing number of hospitalizations, pancreatic insufficiency as well as sinusitis/polyps; antimycotic treatment associated only in this subgroup while association with CF-related diabetes was not significant.CFA is a frequent and clinically relevant co-morbidity particularly in adult CF patients. CFA is significantly more common in patients with chronic P. aeruginosa colonization but associations with other indicators for a more severe disease course were identified regardless of P. aeruginosa colonization status.

Kartagener's syndrome (KS) is a rare genetic disease characterised by the triad of sinusitis, bronchiectasis, and situs inversus. This syndrome is associated with an increased risk of respiratory complications. Therefore, both the anaesthetic technique and the agents used must be carefully chosen according to the type of intervention and the patient's baseline condition. We present the case of a 48-year-old woman with KS, scheduled for functional endoscopic sinus surgery (FESS) and septoplasty under general anaesthesia. The main anaesthetic considerations in patients with KS are related to anatomical variations, pulmonary and cardiac functions, and respiratory infections. In this case, measures that reduce perioperative complications in KS are reviewed together with the special anaesthetic management in FESS, derived primarily from the need to maintain a bloodless surgical field and the use of induced hypotension techniques.

The human microbiome, which consists of a collective cluster of commensal, symbiotic, and pathogenic microorganisms living in the human body, plays a key role in host health and immunity. The human nasal cavity harbors commensal bacteria that suppress the colonization of opportunistic pathogens. However, dysbiosis of the nasal microbial community is associated with many diseases, such as acute respiratory infections including otitis media, sinusitis and bronchitis and allergic respiratory diseases including asthma. The nasopharyngeal acquisition of pneumococcus, which exists as a pathobiont in the nasal cavity, is the initial step in virtually all pneumococcal diseases. Although the factors influencing nasal colonization and elimination are not fully understood, the adhesion of opportunistic pathogens to nasopharyngeal mucosa receptors and the eliciting of immune responses in the host are implicated in addition to bacterial microbiota properties and colonization resistance dynamics. Probiotics or synbiotic interventions may show promising and effective roles in the adjunctive treatment of dysbiosis; however, more studies are needed to characterize how these interventions can be applied in clinical practice in the future.

Introduction Common variable immunodeficiency (CVID) is one of the primary humoral immunodeficiencies. Despite the inborn nature, the first symptoms may appear in both children and adults. It is characterized by hypogammaglobulinaemia, severe infections, autoimmunity, allergies, and a predisposition to cancer. A delay in diagnosis is a significant problem: the time from the first symptoms of the disease to diagnosis and the implementation of proper treatment is usually very long. The consequence can be irreversible complications, which is why it is so important to promote knowledge on this immunodeficiency. Aim To present the clinical and laboratory manifestation of primary immunodeficiencies such as common variable immunodeficiency. Material and methods The study presents the clinical and laboratory phenotype of 14 patients diagnosed with CVID, aged 5 to 58 years. A detailed medical history was taken, and clinical symptoms, immunological test results and complications were analysed in each patient. According to the ESID guidelines, in the differential diagnosis process of CVID the secondary hypogammaglobulinaemia was excluded. Results The follow-up period ranged from 39 to 133 months (median: 79 months). The median delay for the entire group was 5 years, which was shorter in children than in adults. In the presented group, the infectious phenotype (pneumonia, sinusitis) was dominant. Autoimmune and allergic diseases, malignant tumours and enteropathies have also been observed. Conclusions The diagnostic delay is still too long, especially in adults, which can lead to serious and irreversible complications. Early diagnosis and appropriate treatment with intravenous and subcutaneous immunoglobulins reduces the frequency of infections and their potential complications.

Background: Laryngopharyngeal Reflux (LPR) may be part of Gastroesophageal Reflux Disease (GERD). However, sometimes suspected LPR seems refractory to Proton Pump Inhibitors (PPI), questioning therefore the GERD diagnosis. Our aim was to evaluate the real-life prevalence of GERD in patients with a recent laryngoscopic diagnosis of LPR, and unresponsive to PPI. We also assessed whether other causes than GERD could explain the laryngoscopic findings in those patients. Methods: We retrospectively analyzed patients with the diagnosis of LPR, and unresponsive to PPI. Those patients must have been investigated by: upper gastrointestinal endoscopy with biopsies; multichannel intraluminal impedance and pH monitoring (MII-pH); X-ray of the chest and/or of the paranasal sinuses; hormonal thyroid assessment; prick tests to assess food and/or inhalants and pollen allergy. Results: We enrolled 28 patients (18, 64.3%, males and 10, 35.7%, females; median, IQR age 39.4, 21-75 yrs). Endoscopic hiatal hernia was found in 9/28 (32.1%) patients; the MII-pH analysis showed abnormality in 2/28 (7.14%) patients (both having also GERD symptoms); Chest X-ray found chest diseases in 2/28 (7.14%) patients and X-rays of the paranasal sinuses found sinusitis in 1/28 (3.6%); 2/28 (7.14%) patients had hyperthyroidism; food and/or inhalants and pollen allergy was found in 9 (32.1%) patients. In 12/28 (42.9%) patients, any of the investigated diseases was found. Conclusions: This study found that the real prevalence of GERD in patients with a recent laryngoscopic diagnosis of LPR, and unresponsive to PPI, is low. Moreover, more than 40% of them did not show any of the investigated diseases in real life.

Septic cavernous sinus thrombosis (SCST) is a rare, yet severe, process typically arising from infections of the paranasal sinuses (predominately ethmoid and/or sphenoid sinusitis) and less commonly, otogenic, odontogenic, and pharyngeal sources. Clinical symptoms of SCST arise from obstruction of venous drainage from the orbit and compression of the cranial nerves within the cavernous sinus. In the preantibiotic era SCST was considered universally fatal (80-100%); however, with the introduction of antibiotics the overall incidence, morbidity, and mortality of SCST have greatly declined. In spite of dramatic improvements, morbidity and mortality remain high, with the majority of patients experiencing neurological sequalae, highlighting the severity of the disease and the need for prompt recognition, diagnosis, and treatment. Here we review of the literature on SCST with a focus on the current recommendations and recent evidence for diagnostic and medical management of this condition.

Aim of the work – to compare the frequency of upper respiratory tract (URT) involvement in patients with ANCAassociated vasculitides (AAV), to reveal its main clinical and radiological patterns and to estimate their association with the serological profile (ANCA presence and type).Material and methods. This retrospective study evaluated 369 patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). The enrolled patients were diagnosed with AAV according to the ACR criteria, CHCC classification (2012) and EMA algorithm. Patients with URT manifestations underwent standard ENT assessment and X-ray/CT. Serum ANCA levels were measured by ELISA.Results. URT involvement was diagnosed in 280 (75.9%) patients with AAV. It was significantly more common amongthe patients with GPA (86.4%) and EGPA (85.5%) compared with the MPA group (29.2%) (pConclusion. The frequency and patterns of upper respiratory tract manifestations depend both on the nosologic form of AAV and type of ANCA. Localized forms of URT involvement can be observed in patients with GPA and are closely associated with absence of ANCA, which determines the need for especially high suspicion level.

Objective: This case report presents a case of a rapidly progressive complicated sinus infection in a child with the multisystem inflammatory syndrome in children. Methods: Case report with literature review. Results/Case Report: We present a novel case of severe rapidly progressive complicated sinusitis in a 14-year-old African American male diagnosed with the multisystem inflammatory syndrome in children. Infection was caused by an aggressive pathogen, Streptococcus intermedius (anginosus), and within 48 hours progressed to orbital, subgaleal, and intracranial abscess, requiring multidisciplinary intervention by ophthalmology, neurosurgery, and otolaryngology. Following surgical intervention and a 4-week course of intravenous antibiotic therapy, the patient had resolution of the infection with no neurologic sequelae. Conclusion: Despite the low incidence of multisystem inflammatory syndrome in children, physicians should be aware that immunologic changes and the cytokine storm induced by severe acute respiratory syndrome coronavirus 2 can potentially predispose patients to severe bacterial or opportunistic infections. As more cases of MIS-C develop, associated complications can become evident. Similar cases of SARS-CoV-2 and severe bacterial sinusitis have been published in the literature, but it remains unclear if there is an association between SARS-CoV-2 disease and an increased risk of complicated sinusitis in children.

OBJECTIVES Undetected cystic fibrosis transmembrane regulator (CFTR) mutations may predispose individuals to develop CRS independent of formal CF diagnosis. The objective of this study was to determine the prevalence of CFTR mutations among individuals with CRS. DESIGN A systematic search following PRISMA guidelines was performed. A meta-analysis was performed to calculate pooled estimates for the prevalence of any CFTR mutation and for the DF508 mutation. SETTING AND PARTICIPANTS The systematic search included all studies identifying adults diagnosed with CRS, with no limitation to region or publication date. Studies had to identify a sample of patients previously diagnosed with CRS but not with CF and reporting testing for the prevalence of CF or the CFTR gene mutation. MAIN OUTCOME MEASURES Prevalence of CFTR mutations among the general CRS population, with subgroup analysis of individuals with the dF508 mutation. RESULTS AND CONCLUSIONS The 6 included studies represented five countries: the United States, the UK, France, Poland and Finland. The pooled prevalence of CFTR mutations of any kind in CRS subjects without CF was 5.65% (RE 95% CI 2.99 - 10.41). The overall prevalence for the dF508 mutation was 4.22% (RE 95% CI 1.71 - 10.07). These estimates were significantly higher than the baseline estimated prevalence of CFTR carrier status of 3%-4% in the general population. However, the clinical relevance of the presence of CFTR mutations in CRS patients who have not been diagnosed with CF is currently unclear. Future studies should include sweat chloride testing as a measure of CFTR function.

BACKGROUND Abnormal chloride (Cl- ) transport dehydrates airway surface liquid (ASL) in sinonasal epithelium leading to mucus stasis and chronic rhinosinusitis. As an experimental epithelium, rabbit tissue provides an excellent representation of human sinus disease, and the rabbit sinusitis model is both established and well suited for therapeutic interventions in vivo. Our objective in this study was to evaluate whether ivacaftor reverses the consequences of Pseudomonas aeruginosa-induced acquired cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction. METHODS Rabbit nasal cavities were assessed for responsiveness to ivacaftor in vivo (by nasal potential difference [NPD] assay). Rabbit nasal epithelial (RNE) cultures were incubated with an ultrafiltrate of P aeruginosa (PAO1 strain) for 4 hours and tested for acquired CFTR dysfunction. Markers of mucociliary function, including airway surface liquid depth (ASL), periciliary liquid depth (PCL), ciliary beat frequency (CBF), and mucociliary transport (MCT), were measured by micro-optical coherence tomography (μOCT) after PAO1 and/or ivacaftor incubation. RESULTS Ivacaftor resulted in a significant mean NPD polarization of 21.8 ± 2.1 mV, which was significantly greater than that seen in the low Cl- control (12.9 ± 1.3; p = 0.01). PAO1 exposure induced a state of acquired CFTR dysfunction in rabbit nasal epithelium as measured by forskolin-stimulated short-circuit current (ISC ) (control, 37.0 ± 1.1 μA/cm2 ; PAO1, 24.4 ± 1.1 μA/cm2 ; p

BACKGROUND We aimed to compare the clinical and laboratory characteristics and imaging methods of patients diagnosed with preseptal cellulitis and orbital cellulitis in the pediatric age group. METHODS The study was designed retrospectively, and the medical records of all patients who were hospitalized with the diagnosis of preseptal cellulitis and orbital cellulitis were reviewed. The findings of preseptal cellulitis and orbital cellulitis groups were compared. The risk factors for the development of orbital involvement were analyzed. RESULTS A total of 123 patients were included, 90.2% with preseptal cellulitis and 9.8% with cellulitis. The male gender ratio was 60.2%, and the mean age was 72 ± 43 months. While all patients had eyelid swelling and redness, 20.3% had fever. Ocular involvement was 51.2% in the right eye and 4.9% in both eyes. The most common predisposing factor was rhinosinusitis (56.1%). Radiological imaging (computed tomography/magnetic resonance imaging) was performed in 83.7% of the patients. Subperiostal abscess was detected in 7 cases (5.6%) in which three of the cases were managed surgically and four were treated with medically. The levels of C-reactive protein were significantly higher in patients with orbital involvement (P = 0.033), but there was no difference between the presence of fever, leukocyte and platelet values. CONCLUSIONS Rhinosinusitis was the most common predisposing factor in the development of preseptal cellulitis and orbital cellulitis. Orbital involvement was present in 9.8% of the patients. It was determined that high C-reactive protein value could be used to predict orbital involvement.