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Objective: To develop a clinical consensus statement on septoplasty with or without inferior turbinate reduction.Methods: An expert panel of otolaryngologists with no relevant conflicts of interest was assembled to represent general otolaryngology and relevant subspecialty societies. A working definition of septoplasty with or without inferior turbinate reduction and the scope of pertinent otolaryngologic practice were first established. Patients 18 years and older were defined as the targeted population of interest. A modified Delphi method was then used to distill expert opinion into clinical statements that met a standardized definition of consensus.Results: The group defined nasal septoplasty as a surgical procedure designed to correct a deviated nasal septum for the purpose of improving nasal function, form, or both. After 2 iterative Delphi method surveys, 20 statements met the standardized definition of consensus, while 13 statements did not. The clinical statements were grouped into 8 categories for presentation and discussion: (1) definition and diagnosis, (2) imaging studies, (3) medical management prior to septoplasty, (4) perioperative management, (5) surgical considerations, (6) adjuvant procedures, (7) postoperative care, and (8) outcomes.Conclusion: This clinical consensus statement was developed by and for otolaryngologists and is intended to promote appropriate and, when possible, evidence-based care for patients undergoing septoplasty with or without inferior turbinate reduction. A complete definition of septoplasty with or without inferior turbinate reduction was first developed, and additional statements were subsequently produced and evaluated addressing diagnosis, medical management prior to septoplasty, and surgical considerations, as well as the appropriate role of perioperative, postoperative, and adjuvant procedures, in addition to outcomes. Additionally, a series of clinical statements were developed, such as "Computed tomography scan may not accurately demonstrate the degree of septal deviation," "Septoplasty can assist delivery of intranasal medications to the nasal cavity," "Endoscopy can be used to improve visualization of posterior-based septal deviation during septoplasty," and "Quilting sutures can obviate the need for nasal packing after septoplasty." It is anticipated that the application of these principles will result in decreased variations in the care of septoplasty patients and an increase in the quality of care. [ABSTRACT FROM AUTHOR]

The American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Allergic Rhinitis. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 recommendations developed address the evaluation of patients with allergic rhinitis, including performing and interpretation of diagnostic testing and assessment and documentation of chronic conditions and comorbidities. It will then focus on the recommendations to guide the evaluation and treatment of patients with allergic rhinitis, to determine the most appropriate interventions to improve symptoms and quality of life for patients with allergic rhinitis. [ABSTRACT FROM PUBLISHER]

Objective: To critically review the literature on nasal nitric oxide (nNO) and its current clinical and research applicability in the diagnosis and treatment of different sinonasal inflammatory diseases, including acute bacterial rhinosinusitis (ABRS), allergic rhinitis (AR), and chronic rhinosinusitis (CRS). Methods: A search of the PubMed database was conducted to include articles on nNO and sinonasal diseases from January 2003 to January 2020. All article titles and abstracts were reviewed to assess their relevance to nNO and ABRS, AR, or CRS. After selection of the manuscripts, full-text reviews were performed to synthesize current understandings of nNO and its applications to the various sinonasal inflammatory diseases. Results: A total of 79 relevant studies from an initial 559 articles were identified using our focused search and review criteria. nNO has been consistently shown to be decreased in ABRS and CRS, especially in cases with nasal polyps. While AR is associated with elevations in nNO, nNO levels have also been found to be lower in AR cases with higher symptom severity. The obstruction of the paranasal sinuses is speculated to be an important variable in the relationship between nNO and the sinonasal diseases. Treatment of these diseases appears to affect nNO through the reduction of inflammatory disease burden and also mitigation of sinus obstruction. Conclusion: nNO has been of increasing interest to researchers and clinicians over the last decade. The most compelling data for nNO as a clinical tool involve CRS. nNO can be used as a marker of ostiomeatal complex patency. Variations in measurement techniques and technology continue to impede standardized interpretation and implementation of nNO as a biomarker for sinonasal inflammatory diseases. [ABSTRACT FROM AUTHOR]

The article focuses on the development of consensus statement on the use of computed tomography (CT) for paranasal sinus disease. It mentions the use of Delphi method that was modified to refined the expert opinion gathered and for the panel to reach consensus. It states that the CT is consider as an essential diagnostic tool for patients with sinusitis and skull base pathology. It mentions the negative effect of CT imaging such as significant costs, radiation exposure, and overuse concerns.

Background: Remission, defined as absence of symptoms and objective markers of disease, is emerging as the penultimate goal in the management of several chronic diseases. The concept of remission, well-established in Rheumatology as well as Gastroenterology, is currently emerging in Respiratory Medicine for asthma. It is interesting to consider whether the disease remission concept might successfully be applied to Otolaryngology-Head and Neck Surgery in the management of chronic rhinosinusitis with nasal polyposis (CRSwNP). Objective: The purpose of this letter is to explore the evidence supporting the concept of remission under continued medical therapy in chronic rhinosinusitis with nasal polyposis. Methods: The authors reviewed the literature and summarized studies in chronic rhinosinusitis with nasal polyposis evaluating for evidence of clinical, biochemical, and endoscopic remission. Results: Findings of the studies revealed that endoscopic sinus surgery with continued medical therapy achieved remission in approximately 50% of all patients. CRSwNP patients after primary endoscopic sinus surgery were able to achieve remission in 72% of instances, however this drops to 42% for patients having revision sinus surgery. For CRSwNP patients with co-morbidities such as asthma and aspirin exacerbated respiratory disease, remission rate drops to 23% and 23.5%, respectively compared to non-asthmatic CRSwNP patients who present a remission rate under continued medical therapy of 60%. Conclusion: Remission of symptoms and evidence of disease under medical therapy is indeed a concept achievable in patients with CRSwNP, as demonstrated by studies in the literature. Various co-morbidities, notably asthma, apparently influence rate of remission. Better defining this outcome through consensus-based definitions will allow for the development of strategies in CRSwNP care that can help affected patients attain complete relief from clinical, biochemical, and endoscopic markers of CRS with judicious use of medication and surgery. Future efforts will attempt to improve on these outcomes by achieving symptomatic and endoscopic control of disease following cessation of therapy, potentially paving the way towards clinical remission or a 'cure' in CRS. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disorder with a wide range of validated subjective and objective assessment tools to assess disease severity. However, a comprehensive and easy-to-use tool that integrates these measures for determining disease severity and response to treatment is still obscure. The objective of this study was to develop a standardized assessment tool that facilitates diagnosis, uniform patient monitoring, and comparison of treatment outcomes between different centers both in routine clinical practice and in research. Methods: To develop this tool, published literature on assessment tools was searched on various databases. A panel of 12 steering committee members conducted an advisory board meeting to review the findings. Specific outcome measures to be included in a comprehensive assessment tool and follow-up sheet were then collated following consensus approval from the panel. The tool was further validated for content and revised with expert recommendations to arrive at the finalized Nasal Polyp Patient Assessment Scoring Sheet (N-PASS) tool. Results: The N-PASS tool was developed by integrating the subjective and objective measures for CRS assessment. Based on expert opinions, N-PASS was revised to be used as an easy-to-use guidance tool that captures patient-reported and physicianassessed components for comprehensively assessing disease status and response to treatment. Conclusion: The N-PASS tool can be used to aid in the diagnosis and management of CRS cases with nasal polyps. The tool would also aid in improved monitoring of patients and pave the way for an international disease registry. Level of evidence: Oxford Level 3. [ABSTRACT FROM AUTHOR]

Inasmuch as this limited evidence raised corticosteroid irrigation to a "strong recommendation", surely the Grade A evidence in NAVIGATE I/II should earn EDS-FLU a "strong recommendation" for use as a component of appropriate medical treatment, particularly after inadequate response to standard INCS treatment. Corticosteroid use, irrigations, medical therapy for chronic rhinosinusitis, rhinosinusitis, sinusitis, topical therapies for chronic rhinosinusitis Keywords: corticosteroid use; irrigations; medical therapy for chronic rhinosinusitis; rhinosinusitis; sinusitis; topical therapies for chronic rhinosinusitis EN corticosteroid use irrigations medical therapy for chronic rhinosinusitis rhinosinusitis sinusitis topical therapies for chronic rhinosinusitis 893 895 3 05/17/22 20220601 NES 220601 The International Consensus Statement on Allergy and Rhinology: Rhinosinusitis 2021 (ICAR-RS-2021) provides important updates on new therapies that have become available since 2016.1 As authors of the NAVIGATE I and II studies, we bring to your attention an apparent misunderstanding regarding controlled clinical trials that evaluated the efficacy and safety of the exhalation delivery system with fluticasone (EDS-FLU; XHANCE SP ® sp ) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). [Extracted from the article]

Following the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) treatment algorithm for chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), patients suffering from severe uncontrolled CRSwNP are recommended to receive oral corticosteroids, (revision) sinus surgery, systemic biologicals and/or aspirin treatment after desensitization (ATAD). Given the major differences in indications, outcomes, practical considerations, risks and costs of these key pillars of treatment, there is a growing need to define criteria for each treatment option and list the clinically relevant and major considerations for them. This EUFOREA document therefore provides an expert panel overview of the expected outcomes, specific considerations and (contra)indications of the five major treatment arms of severe uncontrolled CRSwNP: oral corticosteroids, primary and revision sinus surgery, biological treatment and ATAD. This overview of treatment considerations is needed to allow physicians and patients to consider the different options in the context of providing optimal and personalized care for severe uncontrolled CRSwNP. In conclusion, the five major treatment options for severe uncontrolled CRSwNP have intrinsic advantages, specific indications and considerations that are of importance to the patient, the physician and the society. This EUFOREA statement supports the unmet need to define criteria for the indication of every treatment pillar of CRSwNP. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease of the nose and paranasal sinuses, with worldwide prevalence. Many patients are unable to attain sufficient improvement in symptoms with the standard medical therapy, and remain symptomatic even after surgical intervention. Recent developments in identifying immunotherapeutics that target the type 2 inflammatory pathway have proven useful for patients with persistent symptoms of CRSwNP. Mepolizumab, a monoclonal antibody against interleukin-5, is currently used to treat various eosinophilic inflammatory conditions, such as severe eosinophilic asthma, eosinophilic granulomatosis with polyangiitis, and hypereosinophilic syndrome; in July 2021, it was approved by the US Food and Drug Administration for use in CRSwNP This review summarizes the critical clinical trials involving mepolizumab in CRSwNP management. These studies show that mepolizumab presents another efficacious add-on treatment for patients with refractory CRSwNP [ABSTRACT FROM AUTHOR]

Background: In the 52‐week Phase III SYNAPSE study, mepolizumab given every 4 weeks (100 mg subcutaneously) reduced nasal polyp (NP) size, improved symptoms and quality of life (QoL), and reduced corticosteroid use and number of sinus surgeries in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP), versus placebo. Because the durability of mepolizumab's efficacy after discontinuation is poorly understood in CRSwNP, the efficacy of mepolizumab after discontinuation was analyzed in severe CRSwNP, over a 24‐week follow‐up. Methods: Changes from SYNAPSE baseline to end of treatment (week 52) and end of follow‐up (week 76) were assessed for total endoscopic NP score, nasal obstruction and overall symptoms visual analog scale scores, and 22‐item Sino‐Nasal Outcome Test score. Time to first sinus surgery, time to first corticosteroid use, and geometric mean blood eosinophil counts (BECs) were also assessed. Results: Among 134 follow‐up patients, clinical improvements observed with mepolizumab versus placebo were partially evident 24 weeks after discontinuation despite BEC returning to baseline. The mean (95% confidence interval [CI]) change from baseline in NP score (week 52: −1.3 [1.8 to −0.9] vs. −0.3 [−0.6 to 0.1]; week 76: −1.2 [−1.6 to −0.7] vs. −0.1 [−0.5 to 0.3]) and the proportion of patients having sinus surgery (week 52: 4% vs. 25%; week 76: 9% vs. 31%) remained substantially improved with mepolizumab versus placebo. Mepolizumab‐associated improvements in overall symptoms, quality of life, and corticosteroid use versus placebo were partially sustained at week 76. Conclusion: Fifty‐two weeks of mepolizumab treatment is associated with sustained clinical benefits up to 24 weeks after discontinuation in patients with severe CRSwNP, which should be considered by physicians when making treatment decisions. [ABSTRACT FROM AUTHOR]

The rhinologists and non-rhinologists were divided in agreeing that terminologies such nasal polyposis, nasal polyps, chronic rhinosinusitis (CRS) with nasal polyps, and CRS with nasal polyposis to classify nasal diseases with nasal polyps can be used interchangeably (Figure 1). In a cross-sectional survey conducted with 56 otolaryngologists (28 subspecializing in rhinology) at the University of British Columbia, Canada, addressing nasal polyp-related terminology and diagnoses in several scenarios of patients with nasal polyps showed a difference in the understanding and usage of nasal polyp-related terminology (a multinational sample of respondents). Although polyps in the setting of CRSwNP falls within the broad definition of nasal polyps outlined in the MeSH, other types of lesions categorized in MeSH as nasal polyps differ significantly in pathophysiology. [Extracted from the article]

Background: Sinus surgery removes inflamed tissue, restores airflow, and improves delivery of medication into surgically opened spaces. The exhalation delivery system with fluticasone (EDS‐FLU; XHANCE®) uses a novel delivery system to create closed‐palate, positive‐pressure, bidirectional mechanics that significantly alter the deposition of the topically acting anti‐inflammatory medication. We ask whether EDS‐FLU efficacy differs for patients with recurrent symptoms after sinus surgery versus patients without surgery. Objective: We aimed to compare EDS‐FLU treatment responses in patients with recurrent symptoms after endoscopic sinus surgery (ESS) and patients who have never had sinus surgery. Methods: Data were pooled from two large, controlled trials (NAVIGATE I and II) for exploratory analyses. Chronic rhinosinusitis symptoms, polyp grade, and quality‐of‐life measures were compared between patients with prior ESS and those without prior ESS. Results: Patients with prior ESS (exhalation delivery system–placebo [n = 53], EDS‐FLU 186 μg [n = 52], and EDS‐FLU 372 μg [n = 49]) and unoperated patients (exhalation delivery system–placebo [n = 108], EDS‐FLU 186 μg [n = 108], and EDS‐FLU 372 μg [n = 111]) treated with EDS‐FLU reported similar and substantial benefits as measured by multiple symptom and quality‐of‐life/functioning outcomes (congestion score, 22‐Item Sinonasal Outcomes Test [SNOT‐22], Rhinosinusitis Disability Index [RSDI], Patient Global Impression of Change) and by nasal polyp grade. In previously operated patients, unlike surgery‐naive patients, multiple outcomes (SNOT‐22, RSDI, polyp grade) consistently showed numerically but not statistically greater responses to the higher dose. Conclusions: Patients with recurrent symptoms after sinus surgery who were treated with EDS‐FLU demonstrated significant symptom and quality‐of‐life improvement. Unlike unoperated patients, patients with prior ESS had a numerically but not statistically greater response to the higher dose of EDS‐FLU (two sprays per nostril twice a day). [ABSTRACT FROM AUTHOR]

Absorbable steroid‐eluting sinus implants provide targeted corticosteroid release over a sustained period and are designed to prevent both undesirable adhesion formation and sinus ostia restenosis. Here, we highlight the key evidence of these implants to date and query a group of experts via a Delphi process on the indications and optimal timing for intraoperative or in‐office placement of these implants. Six of a total of 12 statements reached consensus and were accepted. Overall, experts largely agree that intraoperative or in‐office use of steroid‐eluting stents could be considered for patients: (1) who are diabetic or intolerant of oral steroids, (2) undergoing extended frontal sinus surgery, and (3) with recurrent stenosis. Given the lack of expert consensus on other key statements, clinicians should carefully consider these treatment options on a case‐by‐case basis after shared decision‐making. [ABSTRACT FROM AUTHOR]

Dupilumab-treated patients were significantly more likely to achieve response versus placebo from the earliest timepoints measured and at all subsequent timepoints, including when more stringent responder criteria were applied, such as the requirement for improvements in both objective and patient-reported measures. Taken together, these data suggest that patient-reported symptom scores were driving the early increase in improvement in the NPS or any symptom score threshold. Significantly, more dupilumab-treated patients achieved response across multiple objective and patient-reported CRSwNP outcomes versus placebo. Responder analysis to demonstrate the effect of targeting type 2 inflammatory mechanisms with dupilumab across objective and patient-reported endpoints for patients with severe chronic rhinosinusitis with nasal polyps in the SINUS-24 and SINUS-52 studies. [Extracted from the article]

Background: Nasal valve collapse is one of several causes of nasal obstruction. The safety and efficacy of a temperature‐controlled radiofrequency (RF) device for the treatment of the nasal valve for nasal airway obstruction (NAO) has been established in single‐arm studies. The objective of this trial was to compare active device treatment against a sham procedure (control). Methods: In a prospective, multicenter, single‐blinded, randomized controlled trial (RCT), patients were assigned to bilateral temperature‐controlled RF treatment of the nasal valve (n = 77) or a sham procedure (n = 41), in which no RF energy was transferred to the device/treatment area. The device was applied to the mucosa over the lower lateral cartilage on the lateral nasal wall. The primary endpoint was responder rate at 3 months, defined as a ≥20% reduction in Nasal Obstruction Symptom Evaluation (NOSE)‐scale score or ≥1 reduction in clinical severity category. Results: At baseline, patients had a mean NOSE‐scale score of 76.7 (95% confidence interval [CI], 73.8 to 79.5) and 78.8 (95% CI, 74.2 to 83.3) (p = 0.424) in the active treatment and sham‐control arms, respectively. At 3 months, the responder rate was significantly higher in the active treatment arm (88.3% [95% CI, 79.2%‐93.7%] vs 42.5% [95% CI, 28.5%‐57.8%]; p < 0.001). The active treatment arm had a significantly greater decrease in NOSE‐scale score (mean, −42.3 [95% CI, −47.6 to −37.1] vs −16.8 [95% CI, −26.3 to −7.2]; p < 0.001). Three adverse events at least possibly related to the device and/or procedure were reported, and all resolved. Conclusion: This RCT shows temperature‐controlled RF treatment of the nasal valve is safe and effective in reducing symptoms of NAO in short‐term follow‐up. [ABSTRACT FROM AUTHOR]