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Objective: The aim of this analysis is to explore views of patients with chronic rhinosinusitis (CRS) about of the aetiology of their respiratory symptoms and the relationship between upper and lower respiratory symptoms.Methods: This study is part of a larger mixed methods study investigating the epidemiology of CRS, which comprises a questionnaire study of patients with CRS and controls and a qualitative study of 21 patients with CRS. Semi structured qualitative interviews were undertaken with these patients; 11 males and 10 females. Twelve patients had asthma. Patients were recruited with a tertiary outpatient rhinology clinic. Interviews were transcribed verbatim and analysed using thematic analysis, using Nvivo software (QSR International, Melbourne, Australia). Several important and recurring themes were highlighted.Results: Patients described many perceived triggering factors and an interaction between upper and lower respiratory tract symptoms. They felt that their symptoms could be managed more holistically.Conclusions: Concerns about triggers of respiratory symptoms and interactions between upper and lower respiratory symptoms are of significant concern to patients. These should be appropriately managed and acknowledged in formal treatment pathways, for example, through the use of combined ENT/respiratory clinics. [ABSTRACT FROM AUTHOR]

Olfactory disorders are believed to affect 5% of the general population and have been shown to bear significant psychosocial consequences to sufferers. Although more common than blindness and profound deafness in the United Kingdom, the impact of these disorders has not been assessed to date and the plight of British patients has yet to be quantified. In 2012, a patient support organization, Fifth Sense, was founded to provide information and support to sufferers of chemosensory disorders. Following a recent members conference, a survey of the membership was conducted anonymously using a series of questions based on an existing olfactory disorders questionnaire. From 496 respondents, this has demonstrated high rates of depression (43%) and anxiety (45%), impairment of eating experience (92%), isolation (57%), and relationship difficulties (54%). Women appear to have significantly more issues than men in terms of social and domestic dysfunction relating to olfactory loss (P = 0.01). Qualitative disorders also affected more than 1 in 5 members with parosmia reported in 19% and phantosmia in 24%. This paper discusses the details of the British story of anosmia and other related disorders as depicted by those most affected. [ABSTRACT FROM AUTHOR]

We present a case of long-standing unilateral cacosmia in a healthy 67-year-old man due to maxillary fungal infestation. Treatment with septoplasty had been attempted 10 years prior but no further investigation or management undertaken and symptoms continued. Subsequent MRI scan revealed significant opacification of the left maxillary sinus. This was readily amenable to treatment by balloon sinuplasty. This yielded viscous grey mucus which grew Scedosporium apiospermum. The case highlights the need for careful investigation of olfactory symptoms, including blood tests to exclude systemic causes, endoscopy and imaging where indicated. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether or not patients receiving rhinoplasties following nasal trauma sought intervention for a functional or cosmetic reason and look at underlying psychosocial influences. Methods: A cross-sectional questionnaire study was performed in the setting of otorhinolaryngology outpatient clinics in the Cambridge University Hospitals. New patients referred to the clinic with nasal deformities secondary to recent trauma were included. To provide a control group, new patients attending for nonrhinological reasons were also asked to complete 2 questionnaires (a study specific one and the SF36). The age range of patients was 21 to 66 years in the control group and 17 to 67 years in the rhinoplasty group. Results: Patients attending for rhinoplasty were more likely to be male (79% vs 37%, P = .008) and have had previous nasal trauma (relative risk = 2.14, P = .0086) They neither had significantly higher scores for the SF36 or higher alcohol consumption nor were more likely to participate in contact sports than the control group nor did they differ significantly in terms of social class. Conclusion: This study did not find evidence that posttrauma rhinoplasty patients are anymore introspective and depressed than the normal control population and that function was the predominant concern over cosmesis. [ABSTRACT FROM AUTHOR]

The influence of the female ovarian hormones on nasal physiology has been the subject of ongoing research, especially over the last 20 years, yet their role remains unclear. This review looks at the evidence to date from the studies that have looked at the different physiologic and therapeutic scenarios in which the ovarian hormones are raised. It also examines the current pathophysiologic links between the hormonal surges and nasal congestion and the missing links that need to be addressed in future studies. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Design and Setting Results Conclusion To identify factors associated with cholesteatoma in a large UK cohort. Although some risk factors are frequently reported (male sex, history of chronic otitis media), other associations require further evidence (deprivation, smoking).Briefly, 1140 cholesteatoma cases from UK BioBank were compared to 4551 non‐cholesteatoma middle ear disease and 493 832 ear disease‐free controls. Adjusted odds ratios were calculated for demographic factors including age, sex, ethnicity, deprivation and smoking status with logistic regressions. Odds ratios for overlapping ICD‐10 codes are also calculated.Cholesteatoma was significantly associated with sex (Adjusted odds ratio (AOR) for males = 1.33, 95%CI = [1.179–1.491]), age (AOR = 1.02, 95%CI = [1.011–1.026]) and deprivation (AOR = 1.08, 95%CI = [1.059–1.097]) compared to ear disease‐free controls (p < 0.001). Age and deprivation distributions for cholesteatoma and non‐cholesteatoma ear disease were similar. Although there was no significant association with smoking status, cholesteatoma was significantly associated with the ICD‐10 code mental and behavioural disorders due to tobacco use (OR = 2.34, p < 0.001, 95%CI = [1.942, 2.813]). Cholesteatoma was also strongly associated with a wide range of inflammatory middle ear conditions and chronic sinus inflammation, suggesting an increased susceptibility to inflammation of the upper airways.This study shows a large overlap between cholesteatoma and non‐cholesteatoma ear disease in terms of numbers and demographics, with sex being a key factor distinguishing between the two, suggesting that there are both common and distinct associated factors. [ABSTRACT FROM AUTHOR]

Objective: To correlate patient reports of olfactory dysfunction after surgical intervention for allergic fungal rhinosinusitis (AFRS) with endoscopic findings, psychophysical testing, and quality-of-life scores., Design: A prospective cohort study., Setting: A tertiary care rhinology clinic at St Paul's Hospital, Vancouver, British Columbia, Canada., Patients: Eighty-one patients with AFRS seen at routine postoperative follow-up., Main Outcome Measures: The Sniffin' Sticks test and a visual analog scale for the perceived olfactory ability of patients with AFRS were administered, along with a 36-Item Short-Form Health Survey. An endoscopic staging score was assigned for each patient., Results: Forty men and 41 women with AFRS underwent olfactory testing; 52 of these individuals completed all parts of the assessment. The mean threshold, discrimination, and identification score was 19 (hyposmic), with a significant correlation between patients' performance on the Sniffin' Sticks test and endoscopic staging, as well as their reported olfactory ability (P < .001 for all 3 tests). The mean score for the 36-Item Short-Form Health Survey was 71, but there was a poor correlation between it and the threshold, discrimination, and identification score; visual analog scale; and endoscopic scores (P > .05 for all 3 tests)., Conclusion: All patients with AFRS should be evaluated with olfactory testing and treated according to the results.

Objectives: To demonstrate that computer-assisted endoscopic management of inverted papillomas yields excellent long-term results in terms of preventing recurrence and minimizing significant morbidity and mortality., Methods: A retrospective chart review of patients who are being followed up for tumour recurrence or have undergone tumour removal between 2000 and 2008. All cases were undertaken using the GE Instatrak 3500+ navigation system., Results: Inverted papillomas are the most common tumour managed endoscopically (57% of all sinonasal tumours) with 76 patients seen over the last 8 years. Approximately 50% of these cases had undergone previous surgery in another centre where the tumour was either not recognized or the resection was incomplete. Twentynine percent of these patients had a recurrence but only three required a revision procedure using an open approach; otherwise recurrences were successfully managed endoscopically. Endoscopic recurrence during the first half was 32% (versus 14% for open procedures), dropping to a recurrence rate of 11% in the latter period., Conclusions: Endoscopic management of inverted papillomas allows good control of the disease and avoids unnecessary morbidity associated with open procedures. Although there is a higher initial recurrence rate, these recurrences can be successfully managed endoscopically, and computer navigation can be a useful adjunct in achieving this.