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Objectives Orbital apex syndrome (OAS) is characterized by visual loss, ophthalmoplegia, ptosis, and orbital pain. This study aims to analyze neuro-ophthalmologic outcomes of OAS resulting from invasive fungal rhinosinusitis (IFS). Methods This retrospective study analyzed 25 patients diagnosed with OAS resulting from IFS between January 2018 and July 2022. Patient's visual acuity, degree of ophthalmoplegia, ptosis, and orbital pain were analyzed. Poor and nonpoor visual acuity were classified based on 20/200. The study also investigated risk factors for the failure of vision restoration. Results Only 1 of 25 patients died from the progression of IFS. Among the 25 patients, 5 (20%) had initial visual acuity better than 20/200 before treatment and 20 (80%) had worse vision than 20/200. Four (80%) of five patients with better than 20/200 maintained visual acuity. Four (20%) of 20 patients with worse than 20/200 recovered to better than 20/200 but others remained or declined to worse vision after treatment. The presence of an infiltrative lesion in cavernous sinus on magnetic resonance image scans was significant in univariate but not multivariate analysis (odds ratio, 24.39; 95% confidence interval, 1.543–333.333; P -value = 0.023). Among the patients with worse than 20/200 vision, the patients whose treatment started less than 4 weeks achieved 33.3% (4/12 patients) vision recovery. In contrast, ophthalmoplegia, ptosis, and pain recovered more successfully than vision. Conclusion Although OAS caused by IFS has been reported as very rare, early pathological diagnosis and appropriate treatment can result in good survival and favorable neuro-ophthalmologic outcomes. [ABSTRACT FROM AUTHOR]

Background: Despite growing concern regarding over-prescription of narcotic pain medication following ambulatory surgery, little is known about the analgesic prescribing practices following endoscopic sinus surgery (ESS) in obese patients in comparison to non-obese patients. Objective: To compare the rates of opioid versus non-opioid prescriptions, the need for steroids, and post-operative adverse events between obese and non-obese adult patients undergoing ESS. Methods: Using TriNetX Live database, we identified all patients aged ≥18 years who underwent ESS (n = 1303) between 2014 and 2022 across several healthcare institutions across the state of Tennessee. We 1:1 propensity score-matched obese (BMI ≥ 30 kg/m2) and non-obese (18.5 kg/m2 ≤ BMI < 30 kg/m2) cohorts for age, gender, race, and comorbidities including asthma, nicotine dependence, and sleep apnea. Rates of prescriptions and post-operative adverse events between cohorts were analyzed using risk ratios (RR) and confidence intervals (CI). Results: A toal of 532 obese patients were compared to 532 propensity score-matched non-obese patients in the first 14 post-operative days following ESS. The obese cohort was significantly more likely to be prescribed analgesics generally (RR = 1.72; 95% CI = 1.20-2.47), non-opioid analgesics (RR = 1.73; 95% CI = 1.19-2.50), and opioid analgesics (RR = 1.64; 95% CI = 1.14-2.36) than non-obese patients. There was no difference in rates of antibiotic or antiemetic prescription, prednisone/methylprednisolone, dexamethasone, ED visits, critical care service, epistaxis, transfusion, anemia, revision sinus surgery, mechanical ventilation, CPAP, or inhalation airway treatments. Conclusion: Obese patients undergoing ESS were significantly more likely to be prescribed non-opioid and opioid analgesia in the first 14 days post-operatively compared to non-obese patients. There were no differences in post-operative adverse events or other prescriptions. Otolaryngologists should be aware that obese patients are at increased risk of opioid induced airway obstruction and steroid induced hyperglycemia, especially in patients with comorbid sleep apnea or diabetes. Emphasis on non-opioid analgesics and multimodal pain management should be advocated for this population. [ABSTRACT FROM AUTHOR]

Objectives: Allergic fungal rhinosinusitis (AFRS) often results in expansion of disease beyond the paranasal sinuses, which may put important structures, such as the anterior ethmoid artery (AEA) or lateral lamella of the cribiform, at risk of injury during endoscopic sinus surgery (ESS). This study aims to compare the AEA to skull base (AEA-SB) length in patients with AFRS versus chronic rhinosinusitis with nasal polyps (CRSwNP), as well as additional anatomic variants. Methods: A single institutional retrospective chart review of patients undergoing ESS for AFRS and CRSwNP was performed. AEA-SB length were compared between the 2 groups. Other anatomic variants, including Keros measurement and presence of supraorbital ethmoid air cells (SOEC), concha bullosa (CB), sphenoethmoidal, and infraorbital ethmoid cells were measured and compared between the 2 groups. Results: Twenty-one patients were included in each cohort. The AFRS group was younger in age (P =.015) and had a significantly longer AEA-SB length (P =.014) compared to the CRSwNP group. No significant differences were observed between the 2 groups regarding Keros measurement, presence of concha bullosa, infraorbital ethmoid, sphenoethmoidal, or SOEC. No association was seen between AEA-SB length and Keros class in either group. Conclusions: AFRS harbors anatomical differences when compared to CRSwNP, with the former associated with a longer AEA-SB length. This key difference should be considered in preoperative planning to prevent injury to the AEA in patients undergoing ESS for AFRS. [ABSTRACT FROM AUTHOR]

Background/Objectives: Rhinogenic contact point headache (RCPH) is a controversial secondary headache disorder involving mucosal contact points in the nasal sinuses. The efficacy of surgical versus medical management has been debated, with some studies showing excellent long-term outcomes but others citing placebo effects. This study aimed to clarify the correlation with nasal anatomical variation detected by CT and RCPH treatment outcomes. Methods: A prospective cohort study was conducted on 90 RCPH patients undergoing surgery or medical therapy. Patients were diagnosed using CT scans, endoscopy, and lidocaine testing. The surgery group had endoscopic procedures to remove contact points. The medical group received intranasal steroids. Outcomes were measured by visual analog scale (VAS) for pain and headache frequency. Predictors like age, gender, and nasal anatomical variations were analyzed. Results: The surgery group showed significant reductions in VAS scores (6.02 to 2.51, p < 0.001) and headache frequency (9.11 to 3.04, p < 0.001). The medical group did not improve significantly. All nasal subtypes improved with surgery but concha bullosa had worse VAS outcomes (4.0) than septal deviation (1.8, p < 0.001) or spur (1.73, p < 0.001). Multivariate analysis found nasal anomalies predicted postoperative VAS scores (p < 0.001) but not headache frequency (p = 0.255). Conclusions: Surgery demonstrated superiority over medications for RCPH. This study provides new evidence that preoperative CT scans should be considered a non-invasive gold standard for analyzing nasal subtypes as they significantly influence surgical success, with concha bullosa associated with worse pain relief. Larger studies should validate these findings to optimize RCPH management. [ABSTRACT FROM AUTHOR]

Introduction: Although surgical navigation is commonly used in rhinologic surgery, data on real world performance are sparse because of difficulties in collecting measurements for target registration error (TRE). Despite publications showing submillimeter TRE, surgeons do report TRE of >3 mm. We describe a novel method for assessing TRE during surgery and report findings with this technique. Methods: The TruDi navigation system (Acclarent, Irving, CA) was registered using a contour-based protocol. The surgeon estimated target registration error (e-TRE) at up to 8 points (anatomic regions of interest [ROI]) during endoscopic sinus surgery (ESS). System logs were used to simulate the localization for quantitative assessment of TRE (q-TRE). Results: We performed 98 localizations in 20 patients. The ROI in the sinuses were ethmoid (33 sites), maxillary (28 sites), frontal (17 sites), and sphenoid (22 sites). For localizations, mean qTRE and eTRE were 0.93 and 0.84 mm (P =.56). Notably, 80% of qTRE and 81% of eTRE were 1 mm or less. Mean qTRE and eTRE were less for attending-performed registrations at the maxillary, frontal and sphenoid. Conclusion: Surgical navigation accuracy, as measured by qTRE and eTRE, approaches 1 mm or better at all sinus sites in a real-world setting for 80% of localizations. The qTRE method provides a unique approach for assessing TRE. Surgeons underestimate TRE (overstate navigation accuracy), but this difference does not seem to be statistically significant. Registration performed by trainees yields higher TRE than registration performed by attendings. These data may be used to guide navigation optimization. [ABSTRACT FROM AUTHOR]

Purpose: Anatomical associations between the frontal sinus and anterior skull base must be carefully understood in preoperative imaging to minimize surgical complications. This study aims to investigate the relationship between frontal sinus volume and lateral lamella angle. Methods: 150 computed tomography scans of paranasal sinuses (300 sides) were retrospectively reviewed. Pneumatization patterns were classified according to volume using a three-dimensional reconstruction analysis of the frontal sinuses. The angle formed between the lateral lamella and the horizontal plane in continuation with the cribriform plate was measured and grouped according to Gera classification based on the hypothetical risk of iatrogenic injury. Analysis of these measurements was conducted. Results: A positive correlation was found between frontal sinus volume and lateral lamella angle. Hyperplastic frontal sinuses were the most prevalent followed by middle-sized sinuses. 5% of the frontal sinuses were aplastic. Lateral lamella angles ranging from 45 to 80 degrees (Gera class II) were the most common. Aplastic and hypoplastic frontal sinuses were common in subjects with less than 45 degrees lateral lamella angles (Gera class III). Males had significantly higher frontal sinus volumes and lateral lamella angles than females, while the influence of age was insignificant. Lateral lamella angles were significantly higher on the left side. Conclusion: The frontal sinus volume affects the lateral lamella angle. Larger frontal sinuses are associated with higher lateral lamella angles and vice versa. Understanding this anatomical relationship can help prevent surgical complications. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to validate a method for successful frontal sinus surgery. The method classifies the frontal sinus drainage pathway (FSDP) into five categories based on three bony walls of the anterior ethmoid sinus, including the uncinate process (UP), accessory uncinate process (UPa), and basal lamella of the ethmoid bulla (BLEB), which was tested in actual surgical procedures. Methods: This study analyzed 53 sides of 48 patients who underwent frontal sinus surgery between October 2022 and March 2023. We classified the FSDPs using preoperative computed tomography (CT) and multiplanar reconstruction (MPR). During surgeries for FSDPs located anterior to the BLEB, we used a two-step method involving resection of the turbinal UP, followed by upward resection from the lower edge of the ethmoidal UP. For FSDPs located posterior to the BLEB, we resected the BLEB at the superior semilunar recess. Results: We confirmed the origin of each of the five types of FSDP during surgery. These origins, which were located at the lowest part of the anterior ethmoid, could be identified in the early stages of ethmoid sinus surgery before proceeding to the frontal recess area. Conclusion: The origins of the five types of FSDP, classified based on the bony walls, can be clearly and accurately identified during surgery. This provides a reliable method for preoperatively predicting and locating the inferior end of the FSDP (origin), without extensive manipulation of the cells formed in the frontal fossa. [ABSTRACT FROM AUTHOR]

Background: Control of bleeding is very important during endoscopic sinus surgery. Saline heated up to 50 °C causes dilatation of vessels and edema without nasal mucosa necrosis. It also promotes the clotting cascade so helps in having a bloodless procedure. Methods and materials: This randomized controlled trial was conducted on 60 patients divided into two groups (30 each). Group A was the interventional group in which patients were irrigated with saline of 50 °C during surgery. Group B was the control group where room-temperature saline was used. The operative field was assessed using the Boezaart score, duration of surgery, and bleeding in ml. Results: The Boezaart score in group A came out to be 2.23 ± 0.72 whereas it was 3.43 ± 0.72 in group B. Most of the patients who were in the interventional group had their surgery completed within 60 min with comparatively less bleeding (mean bleeding = 221.83 ml). Patients of the control group had increased duration of surgery mostly and bleeding (mean = 265.67 ml). Our study showed a strong correlation amongst the Boezaart score, duration of surgery, and bleeding in ml with a p value of < 0.001 where all three variables significantly improved in the interventional group due to a good operative field provided by warm saline heated up to 50 °C. Conclusion: Normal saline heated up to 50 °C is a cost-effective way to achieve a bloodless operative field during endoscopic sinus surgery. Reduced bleeding also decreases the duration of surgery. [ABSTRACT FROM AUTHOR]

Actinomycosis is a bacterial infection caused by actinomyces. Although almost 50% of cases are related to the head and neck region, those in the nose and paranasal sinuses (PNS) are rare. Actinomycosis of the PNS is presumed to be typically caused by dental caries, dental manipulation, and maxillofacial trauma, which facilitate the penetration of oral pathogens into the sinus, and should thus be treated by the combination of surgical removal and potent antibiotics for at least two months. The current use of these antibiotics might be redundant, considering the nature of actinomycosis of the PNS, which does not invade the mucosal surface. We herein report a 67-year-old female treated with endoscopic sinus surgery (ESS) and diagnosed with actinomycosis of the PNS by pathological findings. She had no history of dental impairment or treatment. She was given routine perioperative prophylactic antibiotics (cefazolin) during the surgery, followed by low-dose clarithromycin. The mucosa of the PNS normalized without any discharge by three months after the operation. The patient is a valuable example that should prompt reconsideration of the commonly accepted pathogenesis and treatment of actinomycosis of the PNS. [ABSTRACT FROM AUTHOR]

Introduction The uncinate process (UP) is the most important and constant landmark in the ostiomeatal complex and the middle meatus. Objective To identify the UP variations that have not been published before and establish a categorization using computed tomography (CT). Methods The current study was carried out on 110 paranasal CT scans (220 sides). Axial images were acquired with multiplanar reformats to capture delicate details in other planes. Results Out of 120 CT scans (220 sides), the UP was found to be of type 1 in 84.5%, type 2 in 12.3%, and type 3 in 3.2%, without significant diferences between genders, and it was found to be medialized in 81.9%, vertical in 16.3%, lateralized in 0.9%, and absent in 0.9%, without significant differences between genders. A total of 8.63% of the UPs were pneumatized. Conclusion The present study improves surgeons' and radiologists' knowledge of the UP, while creating a standard classification and description to be used as a common language between otorhinolaryngologists and radiologists, which could also be used for training. [ABSTRACT FROM AUTHOR]

Background: Preoperative review of computed tomography (CT) imaging assists with endoscopic sinus surgery (ESS) planning, where trainees may benefit from a systematic approach. We have previously developed an optimized preoperative checklist for sinus CT imaging using an iterative modified Delphi method. Objective: In this study, we assess the utility of an optimized preoperative checklist for residents performing ESS. Methods: Resident sinus CT scan education consisted of a preintervention questionnaire, an 18-min video outlining the optimized preoperative checklist, and a delayed postintervention questionnaire; these were distributed via Qualtrics to otolaryngology residents across 5 training programs in the NY metro area. The preintervention questionnaire contained 25 survey questions and a 225-point quiz on sinus CT anatomy; the delayed postintervention questionnaire contained the same 25 survey questions and a second, distinct 225-point quiz. Results: In total, 74 residents completed the preintervention questionnaire, 47 completed the postintervention questionnaire, and 36 completed both. Among residents completing both questionnaires, the average preintervention quiz score was 136.8 ± 24.0 and the average postintervention quiz score was 156.0 ± 23.5 (P <.001). Resident habitual utilization of a systematic preoperative CT imaging checklist increased significantly from 21.6% to 72.9% as a result of the curriculum intervention. Conclusion: We find that an educational program centered on an iteratively optimized preoperative checklist for ESS improves the ability of trainees to identify critical sinus CT structures. Further integration of checklists and educational curricula may enhance rhinology education efforts and improve surgical anatomy competency. [ABSTRACT FROM AUTHOR]

After endoscopic sinus surgery (ESS), nasal packing is often used to stop bleeding and promote wound healing. Because maintaining a moist environment is important to enhance wound healing, hydrogel-based wound dressings are effective to promote wound healing. Chitosan is used in the medical field because of its high hemostatic and wound healing properties. We developed a pH-neutral and non-toxic chitosan hydrogel, which was difficult to achieve using conventional methods. In this study, we show in animal experiments that the chitosan hydrogel (hydrogel particles) had higher wound healing properties than a commercially available solid wound dressing (dry state) composed of the same polymer. Additionally, we applied the injectable chitosan hydrogel particles as nasal packing materials to patients with bilateral chronic sinusitis undergoing ESS in a pilot clinical study. Concerning symptom scores, though the results narrowly missed statistical differences (p < 0.05), the average scores of our chitosan hydrogel were superior to those of a commercially available wound dressing (especially p = 0.09 for nasal bleeding). These findings suggest that the injectable chitosan hydrogel could be a viable option as a packing material following ESS. [ABSTRACT FROM AUTHOR]

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In 2018, Medicare introduced new codes to the Endoscopic Sinus Surgery (FESS) and balloon sinus dilation (BSD) families of Current Procedural Terminology (CPT) codes. Using the Medicare Part B National Summary Data File from 2010 to 2022, an interrupted time‐series analysis examined trends in volume and reimbursements before and after 2018. Prior to 2018, volume and reimbursements for FESS grew at a mean rate of 2.5% ± 2.2% per year and 6.9% ± 6.6% per year, respectively, before reimbursements decreased significantly in 2018 by −13.9% (P =.014), leading to a stabilization of volume (growth of 0.72%, P =.602). Volume and reimbursements for BSD saw rapid growth from 2011 to 2015 which plateaued prior to the introduction of bundled codes and did not appear to change significantly in 2018 (−0.6%, P =.306 and 11.9%, P =.392, respectively). In addition to concurrent devaluation of FESS and BSD codes, bundling appears to have further contributed to falling reimbursements in rhinology. [ABSTRACT FROM AUTHOR]

Background : Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition that often requires surgical intervention. Despite advances in endoscopic sinus surgery (ESS), recurrence rates remain significant. Platelet-rich plasma (PRP), known for its regenerative properties, has been suggested to reduce inflammation and promote healing. Methodology: This prospective randomized controlled clinical trial was carried out on 40 patients which aims to evaluate the effectiveness of PRP in reducing the recurrence and healing of sinonasal polyps after functional endoscopic sinus surgery (FESS) after 6 months follow-up. Patients aged over 18 years and under 60 years old, with more than 3 months of CRS symptoms with endoscopic evidence of polyps and/or mucosal changes on a CT scan were included in our study. Previous sinus surgery, systemic vasculitis, immune deficiency, allergic fungal rhinosinusitis, patients with uncontrolled systemic diseases or coagulopathy, history of asthma, aspirin sensitivity, cystic fibrosis, and congenital mucociliary problems were excluded from our study. Results: Both groups showed improvement in Lund-Kennedy scores and SNOT-22 scores postoperatively. However, Group 1 demonstrated significantly greater improvement at 3 months (median Lund-Kennedy score: 4.0 vs. 6.0, p < 0.001) and 6 months (median Lund-Kennedy score: 4.5 vs. 6.0, p < 0.001) compared to Group 2. Additionally, the percent change in Lund-Kennedy scores was significantly higher in Group 1 (median 40.18% vs. 14.29%, p < 0.001). Group 1 also exhibited a substantial reduction in SNOT-22 scores at 6 months (median score: 7.0 vs. 45.0, p < 0.001) with a higher median percent change (90.91% vs. 43.65%, p < 0.001). Notably, relapse rates were lower in Group 1 (15.0%) compared to Group 2 (50.0%) at 6 months (p = 0.018). Conclusions: PRP injection during FESS significantly reduces the recurrence of sinonasal polyps and improves clinical outcomes in patients with CRSwNP. These findings suggest PRP as a promising adjunctive treatment to enhance surgical outcomes and reduce healthcare burdens associated with recurrent sinonasal polyposis. [ABSTRACT FROM AUTHOR]

Key points CRS patients with asthma show differential nasal mucus cytokine signatures based on endotype. IL‐7 concentration is positively associated with higher %FEV1 and %FVC in CRS patients with asthma. [ABSTRACT FROM AUTHOR]

Background: Aside from the obvious negative effects on patients and society's financial well-being, chronic rhinosinusitis (CRS) can lead to absenteeism, decreased productivity, and impaired respiratory function, all of which have a major influence on patients and society's overall quality of life. Endoscopic sinus surgery is an option for patients who have not responded to other treatments, and there are several objective and subjective ways to evaluate the success of the procedure, even if there is little level 1 evidence. We summarize the available outcome metrics and provide a thorough evaluation of the published results up to this point. Also covered is research suggesting that endoscopic sinus surgery may improve asthma patients' respiratory performance. Conclusion: There has been a shift in the last 20 years toward using patient-reported outcomes rather than objective data as the main result in sinus disease, especially CRS. The variety of instruments at our disposal enables us to assess the efficacy of surgery in relation to health-specific and general quality of life, burden of illness, healthcare utilization, and pulmonary function. [ABSTRACT FROM AUTHOR]

Extended endoscopic sinus surgery (EESS) can reduce the recurrence rate of chronic rhinosinusitis (CRS). The purpose of this study was to investigate the effect of the application of modified "protective middle turbinate-EESS" (mEESS) on patients with CRS with nasal polyps (CRSwNP) and allergic rhinitis (AR). Forty-three patients with CRSwNP and AR were classified into 2 groups, the mEESS group (n=23) and the functional endoscopic sinus surgery (FESS) group (n=20), and were followed up for 6 months and 1 year after surgery. The disease severity was assessed by the Lund-Mackay score, the Lund-Kennedy score, and the visual analog scale (VAS) score. The patency rate of the frontal sinus was evaluated by endoscopy. Patient satisfaction was also followed up. No preoperative differences or postoperative complications were found between the 2 groups. The VAS score and Lund-Kennedy score of the 2 groups were lower at 6 months and 1 year after surgery. The olfactory function of the mEESS group was significantly better than that of the FESS group at 6 months post-operative. The patency rate of the frontal sinus orifice in the mEESS group was significantly higher than that in the FESS group at 6 months and 1 year post-operative. Patient satisfaction in the mEESS group was relatively higher than that in the FESS group. mEESS improves frontal sinus drainage, olfactory sense, and patient satisfaction in the short term. [ABSTRACT FROM AUTHOR]

Maxillary sinusitis is a recognized complication following dental procedures, but its occurrence after orthognathic surgery, such as Le Fort osteotomies, remains less documented. This case report presents a 58‐year‐old female who developed unilateral maxillary sinusitis 23 years post‐orthognathic surgery. The patient was asymptomatic, aside from occasional cacosmia, and was incidentally found to have sinus opacification on a computed tomography (CT) scan performed for implant‐prosthetic rehabilitation. Nasal endoscopy revealed purulence and mucosal edema, prompting endoscopic sinus surgery (ESS). Intraoperatively, purulent material and fungal debris were removed from the maxillary sinus, confirming bacterial sinusitis with a concurrent fungal ball. S. salivarius and Klebsiella species were identified from the cultures. The patient's condition improved following the removal of both the sinus contents and the retained titanium plates and screws. This case underscores the potential for maxillary sinusitis to develop long after orthognathic surgery, particularly in the presence of retained dental hardware. It highlights the importance of thorough imaging and endoscopic evaluation in patients with a history of dental or facial surgeries presenting with sinonasal symptoms. Additionally, it raises questions about the role of retained hardware in the persistence or recurrence of infection and the possible association with fungal ball formation. The need for further research to establish guidelines for the management of sinusitis in such contexts, particularly regarding the removal of facial hardware, is emphasized. [ABSTRACT FROM AUTHOR]

Due to the close relationship between the maxillary sinus and the posterior maxillary tooth apices, oro-antral fistula and maxillary sinusitis may occur after interventional procedures performed in this region. In this case, a 53-year-old male patient placed an implant for his left second premolar tooth 7 months ago, but migration of the implant into the maxillary sinus has been detected. Nasal endoscopic examination revealed edema and hyperemia at the level of the left maxillary sinus ostium, but no foreign body was observed. A hyperdense image was reported on paranasal sinus tomography, narrowing the left maxillary sinus ostium and creating obstruction in the osteomeatal unit. Surgical intervention was planned for the patient, implant material was removed, and the maxillary sinus was cleared of inflamed tissues by the functional endoscopic sinus surgery was performed under general anesthesia. With this case that we present to the literature, we aimed to draw attention to odontogenic factors in the etiology of maxillary sinusitis and to raise awareness for the diagnosis and treatment of the disease. [ABSTRACT FROM AUTHOR]

Key points: Penetrating orbital trauma from marine creatures, especially needlefish, should be considered after injuries sustained in open water.Advances in endoscopic sinus surgery have enabled surgeons to remove certain orbital foreign bodies through endoscopic endonasal approaches.3D segmentation is a valuable pre‐operative tool in complex endoscopic orbital cases. [ABSTRACT FROM AUTHOR]

The text discusses the comparison between surgery and biologics as treatments for chronic rhinosinusitis with nasal polyposis (CRSwNP). Biologics like dupilumab, mepolizumab, and omalizumab have emerged as powerful therapies for CRSwNP, with dupilumab showing strong performance in various endpoints. However, the data comparing surgery and biologics remain mixed, with surgery showing better improvement in nasal congestion score and polyp size. Cost-effectiveness is a significant factor, with surgery being more cost-effective than biologics like dupilumab. The text concludes that surgery should be considered before biologic therapy for most CRSwNP patients, with treatment decisions guided by individual patient needs and shared decision-making. [Extracted from the article]

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

Although technical causes of endoscopic sinus surgery (ESS) failure have long been reported, we were curious about the quality of contemporary sinus surgery. The electronic health database of Mayo Clinic, Arizona was scrutinized to identify adult patients with diffuse chronic rhinosinusitis (CRS) who underwent revision ESS between January 2019 and September 2023 with a history of bilateral full-house ESS. Anatomical features on preoperative radiology and intraoperative endoscopy were cataloged: residual uncinate tissue, maxillary antrostomy with a non-incorporated natural os, residual ethmoidal septations (three septations > 3 mm), and inadequate sphenoid osteotomy (os size < 6 mm). Sixty-nine subjects were identified. A deviated nasal septum was present in 53.6%. Residual uncinate tissue was noted in 50.7% of patients associated with missed natural maxillary os in 39.13% of antrostomies. An inadequate os diameter was noted in 63.8% of sphenoidotomies. Significant residual septations were seen in posterior ethmoidal cells in 66.7% and anterior ethmoidal cells in 62.3% of patients. Residual frontoethmoidal cells were noted in 72.4% of patients. Although the extent of ESS must be individualized, a high prevalence of features reflecting suboptimal surgery that could limit the success of ESS was identified. These findings merit further consideration for focused training during residency and continuous professional development activities. [ABSTRACT FROM AUTHOR]

Trigeminal schwannomas are rare tumours comprising 0.2% of all intracranial tumours and 0.5% of all head and neck tumours. Patients with trigeminal schwannomas presented with facial hypoesthesia and pain. We presented a case with left bulging oropharynx. The CT scan showed a 3.8x2.6x4.9cm left parapharyngeal tumour compressed to the oropharynx and middle cranial fossa. We performed 3 ways in two times of operation to excise the whole tumour. We chose the transoral approach for parapharyngeal space, trans-parotid approach for deep parotid part and the endoscopic endonasal trans-pterygoid approach and trans-maxillary with Canine fossa trephination for intracranial lesions. The pathology showed schwannoma. A huge schwannoma extended from intracranial to several spaces is difficult to resect just by one approach. We should separate the tumour to several parts by clinical image before the operation and design a plan to remove the whole tumour in different approach. The different space of tumour involvement had several ways to access. We needed to choose the less harm but with better surgical field. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy and adverse events of different oral corticosteroids (OCSs) withdrawal methods for chronic rhinosinusitis with nasal polyp after endoscopic sinus surgery (ESS). Methods: This was a randomized prospective study conducted from Oct 2019 to Jan, 2021. 35 patients who underwent ESS were randomly divided into 2 groups. Regular group (n = 18) received 0.4mg/kg/day of methylprednisolone orally for 10 days, tapering group (n = 17) received 0.4mg/kg/day of methylprednisolone orally for 7 days, followed by progressive reduction of 8 mg of methylprednisolone per week for 3 weeks. The visual analogue scale (VAS) score, the Lund-Kennedy endoscopy (LKE) score, and the E score were assessed preoperatively and at half and 1, 2, and 12 months postoperatively. Statistical analyses were performed using SPSS. Results: There was no statistical difference in the baseline characteristics between the 2 groups. The postoperative VAS scores and LKE scores of patients were significantly improved from those preoperatively (P-values < 0.05). There was no statistical difference in the LKE score, E score, and VAS score between the 2 groups both preoperatively and postoperatively (P-values > 0.05). There was no statistical difference in adverse events between the 2 groups (P-values > 0.05). Conclusions: The combination of OCSs and ESS can improve the clinical symptoms of patients and the recovery of nasal mucosa. There was no difference between the 2 drug withdrawal methods in efficacy and adverse events. Drug withdrawal gradually is more complicated therefore, in clinical practice, OCSs withdrawal directly would be the better option for patients. [ABSTRACT FROM AUTHOR]

The article from Clinical & Experimental Allergy highlights the high prevalence of asthma in patients with uncontrolled chronic rhinosinusitis with nasal polyps undergoing endoscopic sinus surgery. The study found that half of these patients may have undiagnosed or uncontrolled asthma preoperatively. The research emphasizes the importance of systematically evaluating both upper and lower airway diseases in patients with uncontrolled CRSwNP before surgery. The study was conducted as part of a larger multicenter trial and suggests that asthma and uncontrolled asthma are common in this patient population. [Extracted from the article]

Background: Functional endoscopic sinus surgery (FESS) is a common procedure for the treatment of chronic sinusitis and minimal bleeding inside the narrow surgical field affects the surgical visualization, prolongs operative time, and increases ocular and intracranial injuries. Our study aims to evaluate and compare the effectiveness of oral versus intravenous Tranexamic acid on surgical field bleeding in endoscopic sinus surgery. Methods: A prospective, randomized, controlled trial enrolled 159 participants (ASA I-II, both sex and age 18–40 years) undergoing FESS who were equally randomized into 3 groups. Group O received 2 gm of TXA orally 2 hours before surgery, Group I received 15 mg/kg of IV TXA slowly after induction of anesthesia, and Group C didn't receive any. Intraoperative surgical field bleeding was assessed by the Wormald grading scale and Surgeon satisfaction on a 5-point Likert scale. At 24 hours post-operatively, the incidence of nasal bleeding, PONV, and D-dimer level were recorded. Results: Showed significantly higher surgical field score, duration of surgery, recovery time, and postoperative (24 hours) D-dimer in group-C (p-value <0.001) with no difference between groups-I and O, while surgeon satisfaction was significantly lower in group-C (p-value <0.001) with no difference between groups-I and O. No differences regarding hemodynamic parameters, postoperative bleeding, pain, and PONV were found. Conclusions: Oral TXA was safe, cheap, and as effective as IV TXA regarding surgical field visualization, surgeon satisfaction, and operative time during FESS; with limited adverse effects and no evidence of thromboembolic complications. [ABSTRACT FROM AUTHOR]

Objective: Paranasal sinus mucoceles are benign cystic lesions resulting from mucus accumulation, which can cause severe complications, including sinus wall erosion and compression of surrounding structures. This study aims to evaluate and compare the clinical features and treatment outcomes of primary versus secondary mucoceles Methods: We reviewed the medical records of 76 mucoceles treated at the Ear, Nose, and Throat Hospital in Ho Chi Minh City, Vietnam, between June 2022 and June 2024. This study emphasizes the role of advanced diagnostic imaging and endoscopic sinus surgery in effectively managing these lesions. Results: Primary mucoceles were most frequently located in the frontal-ethmoid region, accounting for 47.4% of cases. Primary mucoceles often present with less severe symptoms compared to secondary mucoceles, which occur post-surgery or post-trauma and are associated with more severe symptoms and complications. Treatment primarily involved endoscopic sinus surgery, with secondary mucoceles frequently requiring more complex surgical interventions. Conclusion: This study demonstrates key differences in the clinical presentation and treatment outcomes of primary and secondary paranasal sinus mucoceles. Effective management requires distinguishing between the two types, with secondary mucoceles often needing more complex surgical interventions. [ABSTRACT FROM AUTHOR]

Respiratory epithelial adenomatoid hamartoma (REAH) is a relatively rare disease that commonly occurs in the olfactory cleft, followed by the posterior nasal septum within the nasal cavity. We herein report a case of REAH on the nasal floor, which is an extremely rare anatomical site for the occurrence of REAH. A 63-year-old man was referred to our department because he had developed right epistaxis. Endoscopic examination revealed a protruding lesion on the floor of the right nasal cavity. The tumor was endoscopically removed and histopathological examination revealed that the tissue was characterized by proliferation of glandular duct structures composed of multiciliated cells and glandular cells, consistent with isolated REAH. No evidence of recurrence was observed endoscopically 14 months after surgery. The findings indicate that REAH can occur in the nasal cavity at sites covered by the respiratory mucosa that have not been previously reported and should be treated with caution. [ABSTRACT FROM AUTHOR]

Objective: Endoscopic sinus and skull base surgery has led to significant improvements in patient outcomes, yet may have come at a cost to surgeons' musculoskeletal (MSK) health. We aimed to determine the prevalence and characteristics of work‐related MSK disorders (WRMDs) in endoscopic sinus and skull base surgeons; to investigate contributing factors for WRMD in this population; and to evaluate the effectiveness of ergonomic interventions on the severity or prevalence of WRMD in this population. Data Sources: Medline, Embase, CINAHL, Web of Science, and Scopus from inception to April 2, 2024. A bibliographic examination was performed for further papers. Review Methods: Inclusion criteria included original peer‐reviewed papers with work‐related MSK outcomes (prevalence, contributing factors, and interventions) relating to endoscopic sinus and/or skull base surgeons in any language. Results: Of 25,772 unique citations, 37 studies met the inclusion criteria. The pooled lifetime, point, and 12‐month prevalences of WRMD were 75.9% (95% confidence interval; I2, 67.2%‐83.6%, I2 95.6%), 80.8% (77.0%‐84.3%, I2 98.0%), and 82.0% (71.8%‐90.3%, I2 60.96%) respectively. The neck, lumbar spine, and thoracic spine were the most commonly involved areas. One of 9 studies on contributing factors investigated discomfort as an outcome. The remainder focussed on surrogate outcomes (eg, posture, hand dysfunction). Two of the 13 intervention studies investigated pain or fatigue as an outcome. The remainder targeted posture, muscle activity, or workload. Conclusion: WRMDs are highly prevalent in endoscopic sinus and skull base surgeons. Further studies focusing on the direct outcomes of WRMD such as pain are needed. [ABSTRACT FROM AUTHOR]

Abstract Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition that often requires surgical intervention. Despite advances in endoscopic sinus surgery (ESS), recurrence rates remain significant. Platelet-rich plasma (PRP), known for its regenerative properties, has been suggested to reduce inflammation and promote healing. Methodology This prospective randomized controlled clinical trial was carried out on 40 patients which aims to evaluate the effectiveness of PRP in reducing the recurrence and healing of sinonasal polyps after functional endoscopic sinus surgery (FESS) after 6 months follow-up. Patients aged over 18 years and under 60 years old, with more than 3 months of CRS symptoms with endoscopic evidence of polyps and/or mucosal changes on a CT scan were included in our study. Previous sinus surgery, systemic vasculitis, immune deficiency, allergic fungal rhinosinusitis, patients with uncontrolled systemic diseases or coagulopathy, history of asthma, aspirin sensitivity, cystic fibrosis, and congenital mucociliary problems were excluded from our study. Results Both groups showed improvement in Lund-Kennedy scores and SNOT-22 scores postoperatively. However, Group 1 demonstrated significantly greater improvement at 3 months (median Lund-Kennedy score: 4.0 vs. 6.0, p

Context: The anterior skull base (ASB) and the paranasal sinuses are known for anatomical variations. Therefore, a preoperative assessment for the assessment of these variations is a necessity. This study aims to determine the profile of variations of the ASB using computed tomography of the paranasal sinuses (CT-PNS) scans. Settings and Design: Observational Study. Materials and Methods: Forty CT-PNS scans were studied with measurement of different parameters. Statistical Analysis: Observational study analysis – Descriptive stats, t-tests, Chi-square, nonparametric tests, analysis of variance, regression, P < 0.05 significance level. A significance level of P < 0.05 was used for all tests. Results: Seventeen male and 23 female CT-PNS scans were studied. Different measurements on the right and left sides, as well as between genders, were examined and compared. The supraorbital ethmoidal cell is the most often seen anatomical variation. Variations in the ASB are equally visible on both sides in men and on the right in females (Type-II > Type-1). Type I was more common among female, whereas Type II was more common. The existence of the anterior ethmoidal foramen is a dependable marker for the anterior ethmoidal artery. In the group under investigation, there was no lamina papyracea abnormality. Conclusion: This study aims to assess anatomical variations in the Indian population undergoing ASB surgeries, contributing to the current understanding of Indian paranasal sinuses and skull base dynamics.

Abstract Objectives This review aims to evaluate the utility of nonmedicated middle meatal packing compared to no packing on synechia formation up to 12 weeks after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Methods We conducted a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. A literature search was performed on Medline (PubMed), EBSCO CINAHL plus, CENTRAL, and Clinicaltrials.org and included randomized controlled trials in the English language only. We extracted all relevant data and conducted quality assessment using the Cochrane risk of Bias tool (version 2). We also performed the quality assessment of the outcomes using Grading of Recommendations Assessment, Development and Evaluation. Results Our search identified 390 articles of which four met our eligibility criteria. A total of 139 patients were randomized to receive middle meatal pack in either of the nostrils. At 4 weeks of follow‐up, there was no difference in the risk of synechia formation on either the packed side or the unpacked side, with a relative risk (RR) of 0.77 (95% confidence interval [CI]: 0.48–1.25). Similarly, no difference was seen at either 8–12 weeks of follow‐up, with an RR of 0.68 (95% CI: 0.42–1.20). Nasal congestion was reported to be less on the packed side on the follow‐up in one of the trials. Conclusions Our systematic review, with limited evidence, indicates no difference in synechia formation between the nonmedicated packed and unpacked middle meatus at four and eight or 12 weeks after ESS for CRS. Further studies are required to ascertain the true effect of packing the middle meatus with different materials and its long‐term sequelae.

Respiratory epithelial adenomatoid hamartoma (REAH) is a relatively rare disease that commonly occurs in the olfactory cleft, followed by the posterior nasal septum within the nasal cavity. We herein report a case of REAH on the nasal floor, which is an extremely rare anatomical site for the occurrence of REAH. A 63-year-old man was referred to our department because he had developed right epistaxis. Endoscopic examination revealed a protruding lesion on the floor of the right nasal cavity. The tumor was endoscopically removed and histopathological examination revealed that the tissue was characterized by proliferation of glandular duct structures composed of multiciliated cells and glandular cells, consistent with isolated REAH. No evidence of recurrence was observed endoscopically 14 months after surgery. The findings indicate that REAH can occur in the nasal cavity at sites covered by the respiratory mucosa that have not been previously reported and should be treated with caution.

Abstract Background Paranasal sinus mucoceles are benign cystic lesions characterized by mucous accumulation that can lead to significant complications due to erosion of sinus walls and compression of adjacent structures. This retrospective study aims to compare the clinical characteristics and treatment outcomes of primary and secondary mucoceles. Methods We reviewed medical records of 68 patients treated for mucoceles at the Ear, Nose, and Throat Hospital in Ho Chi Minh City, Vietnam, from June 2022 to June 2024. Advanced diagnostic imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), were utilized in the management of these lesions. Statistical analysis was conducted using chi-square and t-tests to compare the characteristics and outcomes between the two groups. Results The study found that primary mucoceles often presented with less severe symptoms compared to secondary mucoceles, which occur post-surgery or post-trauma and are associated with more severe symptoms and complications. Primary mucoceles were most frequently located in the frontal-ethmoid region (47.4%), while secondary mucoceles had a similar distribution but were more prevalent following previous surgical interventions. Endoscopic sinus surgery was the primary treatment for both groups, with secondary mucoceles frequently requiring more complex surgical interventions. Postoperative improvement was significant in both groups, though secondary mucoceles exhibited slower recovery and higher rates of residual minor visual impairments. Conclusion The comparison between primary and secondary paranasal sinus mucoceles reveals critical differences in clinical profiles and treatment outcomes. Understanding these differences is essential for optimizing management strategies and improving prognosis for patients with these challenging conditions. Further research is needed to explore long-term treatment effects and the efficacy of different surgical approaches.

Yuan Yuan,1 Ze Wu,2 Xu Chen,3 Bin Xie2 1Department of Pathology, Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 2Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 3Pathology Center, First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Bin Xie, Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China, Email mrxiebin@163.comObjective: To assess the impact of rheumatoid arthritis (RA) on histopathological features and the risk of postoperative recurrence in chronic rhinosinusitis with nasal polyps (CRSwNP) patients.Methods: A retrospective cohort study of CRSwNP patients who underwent functional endoscopic sinus surgery was performed. Patients were followed up for more than two years, and classified into RA and Non-RA groups, recurrent and non-recurrent groups. The influence of RA on histopathological features and the risk of CRSwNP recurrence was explored.Results: A total of 517 CRSwNP patients were finally recruited, including 78 RA patients. The RA group exhibited a higher recurrence rate, tissue eosinophil counts and percentages compared to the non-RA group (P < 0.05). Tissue eosinophil count and percentage, and the prevalence of allergic rhinitis were significantly higher in the recurrent group in compared to the non-recurrent group (P < 0.05). Multivariate logistic regression analysis identified tissue eosinophil count and percentage, RA, and allergic rhinitis as significant predictors of increased recurrence risk (P < 0.05). Both adjusted and unadjusted models affirmed RA as an independent risk factor for CRSwNP postoperative recurrence (P < 0.05). Kaplan-Meier curves further indicated a higher recurrence risk in CRSwNP patients with RA than those without (P < 0.05).Conclusion: Our findings suggest that RA significantly exacerbates tissue eosinophilic inflammation and independently heightens the risk of postoperative recurrence in CRSwNP patients. These insights underscore the need for tailored therapeutic strategies addressing the complex interplay between CRSwNP and RA to mitigate recurrence risks and improve clinical outcomes.Keywords: rheumatoid arthritis, chronic rhinosinusitis with nasal polyps, endoscopic sinus surgery, recurrence

Background: The pathology of the maxillary sinus (MS) can be treated using the prelacrimal recess approach, an intranasal method for accessing the MS. This approach exhibits significant individual variations in its prevalence and varying widths. Aim: To determine the occurrence of the prelacrimal recess (PLR) in the MS and explore its morphological variations. Methods: A retrospective analysis was performed on 225 cone beam computed tomography scans obtained from the department’s archives. The patients ranged in age from 18 to 78. Statistical analysis were conducted to evaluate the frequency of PLR occurrence in the MS. Data from both sides were compared between males and females. Results: The analysis of the data revealed that PLR was present in 84.9% of patients with MS. Each patient exhibited asymmetry between the left and right sides. Although PLR was less likely to occur in women, the difference was not statistically significant. Conclusion: The anatomical variations of the PLR in individuals should be considered prior to procedures to prevent complications.

Background: Paranasal sinus mucoceles are benign cystic lesions characterized by mucous accumulation that can lead to significant complications due to erosion of sinus walls and compression of adjacent structures. This retrospective study aims to compare the clinical characteristics and treatment outcomes of primary and secondary mucoceles. Methods: We reviewed medical records of 68 patients treated for mucoceles at the Ear, Nose, and Throat Hospital in Ho Chi Minh City, Vietnam, from June 2022 to June 2024. Advanced diagnostic imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), were utilized in the management of these lesions. Statistical analysis was conducted using chi-square and t-tests to compare the characteristics and outcomes between the two groups. Results: The study found that primary mucoceles often presented with less severe symptoms compared to secondary mucoceles, which occur post-surgery or post-trauma and are associated with more severe symptoms and complications. Primary mucoceles were most frequently located in the frontal-ethmoid region (47.4%), while secondary mucoceles had a similar distribution but were more prevalent following previous surgical interventions. Endoscopic sinus surgery was the primary treatment for both groups, with secondary mucoceles frequently requiring more complex surgical interventions. Postoperative improvement was significant in both groups, though secondary mucoceles exhibited slower recovery and higher rates of residual minor visual impairments. Conclusion: The comparison between primary and secondary paranasal sinus mucoceles reveals critical differences in clinical profiles and treatment outcomes. Understanding these differences is essential for optimizing management strategies and improving prognosis for patients with these challenging conditions. Further research is needed to explore long-term treatment effects and the efficacy of different surgical approaches. [ABSTRACT FROM AUTHOR]

Introduction: This is the first systematic review and meta‐analysis to investigate the effectiveness of the nasal airflow‐inducing maneuver (NAIM) in olfactory rehabilitation for total laryngectomy (TL) patients. Methods: We conducted a systematic literature search following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. The inclusion criteria required that patients must have undergone a TL with subsequent NAIM training for at least 2 weeks and olfactory evaluation. The impact of NAIM on olfactory outcomes compared to that at baseline was measured. Olfactory measures included the Sniffin' Sticks Test, Smell Disk Test, Scandinavian Odor Identification Test, and Quick Odor Detection Test. The primary outcome measures were the proportion of patients with normosmia at baseline and after intervention. Results: Seven studies from 2000 to 2023 comprising a total of 290 TL patients met the inclusion criteria. The meta‐analysis revealed that prior to intervention, the pooled proportion of patients with normosmia was 0.16 (95% confidence interval [CI]: 0.09‒0.27, p = 0.01). After intervention, the same proportion increased to 0.55 (95% CI: 0.45‒0.68, p = 0.001). Among the included patients, 88.3% were initially anosmic or hyposmic, which was reduced to 48.9% after NAIM practice, with 51.1% achieving normosmia. The percent improvement was not found to be significantly associated with the timing of intervention post‐TL (p = 0.18). Conclusions: NAIM increased the proportion of patients who achieved normosmia in TL patients. NAIM stands out as a safe, easily teachable maneuver with promising results. Further efforts are warranted to provide specific recommendations and guidelines for the use of NAIM in clinical practice. [ABSTRACT FROM AUTHOR]

Backgrounds: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a medical condition characterized by persistent inflammation of the nasal mucosa and sinuses, accompanied by the presence of nasal polyps. When medical treatments prove ineffective, endoscopic sinus surgery (ESS) is recommended, yielding variable outcomes and recurrence rates ranging from 5% to 60%. Aims/Objectives: The primary objectives of this study were to evaluate the outcomes of ESS and to identify independent predictors of recurrence and revision surgery. Material and Methods: Retrospective cross-sectional study, focusing on patients diagnosed with CRSwNP who underwent ESS with a minimum follow-up period of 60 months. Various variables were collected. Multivariate and regression analyses were employed to assess the predictors associated with both recurrence and revision surgery. Results: The study analyzed 130 patients. The 5-year recurrence rate was 35.4%, and 17.7% of patients required revision surgery. These variables included asthma (p < 0.001), frontal sinus involvement (p < 0.001), Lund–Mackay score (p < 0.001), Endoscopic Nasal Polyps Score (p < 0.001), and eosinophilia in peripheral blood (p < 0.001). All the variables mentioned above were identified as predictors of recurrence and revision surgery. Conclusions and Significance: Asthma, frontal sinus involvement, increased eosinophilia in peripheral blood, and a higher score on the LM system and NPS are poor prognostic factors in CRSwNP. [ABSTRACT FROM AUTHOR]

Objective: Evaluating the possibility of predicting chronic rhinosinusitis with nasal polyps (CRSwNP) disease course using Artificial Intelligence. Methods: We prospectively included patients undergoing first endoscopic sinus surgery (ESS) for nasal polyposis. Preoperative (demographic data, blood eosinophiles, endoscopy, Lund‐Mackay, SNOT‐22 and depression PHQ scores) and follow‐up data was standardly collected. Outcome measures included SNOT‐22, PHQ‐9 and endoscopy perioperative sinus endoscopy (POSE) scores and two different microRNAs (miR‐125b, miR‐203a‐3p) from polyp tissue. Based on POSE score, three labels were created (controlled: 0–7; partial control: 8–15; or relapse: 16–32). Patients were divided into train and test groups and using Random Forest, we developed algorithms for predicting ESS related outcomes. Results: Based on data collected from 85 patients, the proposed Machine Learning‐approach predicted whether the patient would present control, partial control or relapse of nasal polyposis at 18 months following ESS. The algorithm predicted ESS outcomes with an accuracy between 69.23% (for non‐invasive input parameters) and 84.62% (when microRNAs were also included). Additionally, miR‐125b significantly improved the algorithm's accuracy and ranked as one of the most important algorithm variables. Conclusion: We propose a Machine Learning algorithm which could change the prediction of disease course in CRSwNP. [ABSTRACT FROM AUTHOR]

Objectives: The incidence of odontogenic sinusitis has been gradually increasing due to the recent increases in invasive dental procedures. This study aimed to describe the clinical features of present patients with odontogenic sinusitis compared to the past, confirm the importance of endoscopic sinus surgery (ESS), and analyze the predictive factors for ESS. Methods: This retrospective review included all patients diagnosed with odontogenic sinusitis between January 2010 and December 2011 and between January 2019 and December 2020. The patients were classified into 2 groups (past and present) depending on the time of the first visit. The clinical characteristics and treatment modalities were compared between the two groups. In addition, among patients in the present group, we analyzed variables to identify factors contributing to the risk of undergoing ESS. Results: This study included 56 patients (23 in the past group and 33 in the present group). Compared to the past group, the present group had an older mean age (P =.001) and significantly increased iatrogenic etiologies (52.1% vs 90.9%; P =.002). The proportion of patients treated with ESS also increased in the present group compared to that in the past group (39.1% vs 66.7%; P =.041). In the present group, 11 patients (33.3%) were cured with conservative treatment, while 22 patients (66.7%) underwent additional ESS. Multivariate analysis revealed that the Lund–Mackay score was the only significant predictor of ESS (odds ratio [OR]: 14.901, P =.035). Conclusion: The incidence of odontogenic sinusitis with iatrogenic etiologies has increased compared to the past. In addition, two-thirds of the patients in the present study underwent ESS, a significantly higher proportion than in the past. Therefore, ESS is one of the most important treatment modalities for odontogenic sinusitis, especially iatrogenic, in recent years. A severe Lund–Mackay score was associated with a significantly increased risk of ESS. [ABSTRACT FROM AUTHOR]