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Importance: Chronic rhinosinusitis (CRS) is a common inflammatory disease of the paranasal sinuses with significant quality of life impairments. There is a need to implement outcome-based metrics to evaluate the outcomes of CRS treatment with endoscopic sinus surgery or biologics. Objective: We aimed to understand Canadian otolaryngologists' opinions on patient-related outcome measures (PROM) for CRS and identify potential barriers to implementation. Design: Qualitative research. Setting and Participants: A cross-sectional survey was distributed via the Canadian Society of Otolaryngology-Head and Neck Surgery and direct emailing. Measures: Participants' demographics, practice information, and opinions on PROM were collected. Results: Of 346 (23%) Canadian otolaryngologists, 78 responded to the survey (26 rhinology fellowship–trained, 51 non-fellowship-trained, and 1 missing data). Thirty-eight responded that they collect PROM (69% with fellowship-trained, 39% non-fellowship-trained, P =.029). Regarding opinions on PROM, 74% of respondents agreed that it helps patients report their symptoms, 42% agreed that it improves the efficiency of the patient encounter, 54% agreed that it is easy for patients to understand, 62% agreed that it improves management and monitoring of clinical outcomes, and 71% disagreed that PROM is not helpful. Fellowship-trained otolaryngologists were 4 times more likely to agree that PROM improves management and monitoring of clinical outcomes (P =.014), and no other differences in opinions were significant. The most-frequently-identified barriers to PROM usage were lack of time for 67% of respondents, difficulty integrating into clinical workflow for 64%, and lack of integration into the electronic medical record for 47%. If these barriers were addressed, 86% of respondents said they would use PROM in their practice. Conclusions and Relevance: Despite the low uptake of PROM among otolaryngologists without rhinology fellowship, opinions were generally favorable. We identified barriers that, if addressed, may increase their use in clinical practice. As resource-limited therapies such as biologics become more prevalent in CRS management, PROM may find more applications in shared clinical decision making. [ABSTRACT FROM AUTHOR]

Background: The clinical phenotypes of CRS, such as the presence or absence of polyps, cannot well reflect the pathophysiological mechanisms and characteristics of patients. Only by distinguishing the different internal types of CRS can we individualize patients more accurately. Objective: To investigate the clinical characteristics of chronic rhinosinusitis with different cell types (CRSwNP), and to provide a reference for the diagnosis and treatment of CRSwNP. Materials and methods: The cytological endotypes of CRSwNP were divided into five groups by cluster analysis. Results: There was a significant difference in the proportion of CRSwNP with different endotypes. There were significant differences in peripheral blood eosinophils, cerebrovascular disease, and unilateral and bilateral nasal polyps among CRSWNP patients with different cytological types. Conclusions: Mixed CRSwNP and eosinophilic CRSwNP are the most common, while neutrophilic CRSWNP is the least common. Eosinophilic CRSwNP is more common in bilateral nasal polyps, with a high recurrence rate and a high probability of olfactory dysfunction. Neutrophilic CRSwNP is more common in elderly patients with cardiovascular and cerebrovascular diseases. Compared with total serum IgE, the percentage of eosinophils in peripheral blood is more helpful for the diagnosis of eosinophilic CRSwNP. [ABSTRACT FROM AUTHOR]

In nasal endoscopic surgery, recurrence of chronic rhinosinusitis is not uncommon which may be due to the trauma and injury viz. bone exposure, fibrous scarring, and ostia stenosis caused by surgical procedure. Here, we have investigated the various factors that contribute to such recurrence. Eligibility assessment was conducted on all patients with chronic rhinosinusitis admitted to our hospital between January 2020 and April 2023, resulting in the recruitment of 200 patients scheduled for nasal endoscopic surgery. After a minimum of 12 months postoperative follow-up, patients included in the final analysis were categorized into recurrence and non-recurrence groups. Through multifactorial logistic regression analysis, smoking, VAS score, pterygoid sinus (S) score, sinus-oral sinus complex (OMC) nasal polyps, allergic rhinitis, deviated septum, and postoperative infection were identified as independent influencing factors for postoperative recurrence (P <0.05). Thus, the factors influencing recurrence after nasal endoscopic surgery in patients with chronic sinusitis comprise smoking, VAS score, lesion extent (AE, S, OMC score), nasal polyps, allergic rhinitis, deviated septum, and postoperative infection. The study concludes that implementing effective clinical interventions targeting these factors is crucial for reducing recurrence rates in patients. [ABSTRACT FROM AUTHOR]

We report the case of a 55-year-old female with eosinophilic granulomatosis with polyangiitis and chronic rhinosinusitis with nasal polyp. Rhinosinusitis recurred 6 months after full-house endoscopic sinus surgery. Although conventional treatment with azathioprine and mepolizumab with steroids was given, it was difficult to simultaneously control both rhinosinusitis and eosinophilic granulomatosis with polyangiitis. Clinical examinations showed polyps in the olfactory cleft, and the patient's anosmia gradually became persistent. Even after administering mepolizumab for a certain period of time, symptoms did not improve, but when the biologic agent was switched to dupilumab, an improvement in recalcitrant chronic rhinosinusitis with nasal polyp was observed. While dupilumab was administered intermittently for refractory chronic rhinosinusitis with nasal polyp, the rhinosinusitis improved and symptoms such as worsening of eosinophilic granulomatosis with polyangiitis paresthesia were observed. Both symptoms gradually subsided 19 months after starting intermittent administration, leading to the discontinuation of dupilumab administration. Rhinosinusitis in the setting of eosinophilic granulomatosis with polyangiitis may be refractory in some cases, and this case provides findings demonstrating the strong effect of dupilumab on eosinophilic inflammation. [ABSTRACT FROM AUTHOR]

Background/Aim: Odontogenic maxillary sinusitis is a clinically popular disease, but radical surgery and endoscopic surgery are often required. In the present study, we compared for the first time the therapeutic efficacy of the extraction of causative teeth with or without irrigation of the extraction fossa. Patients and Methods: A total of 60 patients underwent extraction of causative tooth. Among them, 34 patients underwent irrigation, while other 26 patients did not. Based on computed tomography (CT) images, treatment efficacy was quantified by the percentage of the remaining maxillary sinus mucosal lesions. The extent of therapeutic efficacy was evaluated following five grades, based on the percentage of remaining lesions: Grade 1 (0%) (disappearance of lesions), Grade 2 (roughly 10%), Grade 3 (roughly 30%), Grade 4 (approximately 50%) and Grade 5 (100%) (no improvement of the lesions). Results: Irrigation significantly augmented the therapeutic efficacy of tooth extraction for maxillary sinus mucosal lesions (mean grade: decreasing from 3.27 to 1.35). Conclusion: The combination of tooth extraction and irrigation may contribute to the reduction of the necessity of surgery for the maxillary sinuses. [ABSTRACT FROM AUTHOR]

Copyright of Türkiye Klinikleri Journal of Ophthalmology is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Typically treated medically, chronic rhinosinusitis (CRS) is a prevalent condition characterized by multiple craniofacial symptoms, some of which may respond favorably to dry needling intervention. To describe the outcomes of a patient presenting with craniofacial pain and symptoms consistent with a diagnosis of CRS who was treated with dry needling. Case Description: A 41-year-old male, self-referred to physical therapy with a diagnosis of CRS, with a 20-year history of signs and symptoms associated with CRS, including craniofacial pain and headaches. The patient had been treated with multiple medication regimens over this time, including antihistamines, anti-inflammatories, decongestants, leukotriene inhibitors, and antibiotics; all of which provided only short-term relief. On initial examination, the patient was tender to palpation in multiple muscles of the head, neck, and face. Intervention consisted of dry needling to these muscular tender points once or twice weekly over 2 months. After 2 months of dry needling, the patient demonstrated clinically meaningful improvements in pain and quality of life, which included a decrease in both medication usage and the frequency of sinus infections. Although CRS is generally managed medically, we observed areas of muscular tenderness in this case, which were effectively managed with dry needling. Rehabilitative providers may consider screening CRS patients for muscular impairments that may be modifiable with dry needling. Further research should be performed to determine whether dry needling has a role in the management of CRS. [ABSTRACT FROM AUTHOR]

Objectives: The Nasal Polyposis Symptom Diary (NPSD) is a novel and short patient-reported outcome (PRO) tool specifically developed to assess important and relevant symptoms reported by patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). We evaluated the psychometric properties of 4 predefined NPSD-derived scores intended to support symptom-improvement assessments of investigational therapies for inclusion in product labeling. Methods: Five hundred eighteen patients with severe CRSwNP from a Phase III clinical trial (NCT03401229) completed the NPSD, comprising 11 items: 8 symptom-specific, 2 symptom-impact, and 1 optional medication-compliance. The psychometric characteristics of 3 single-item symptom scores (Nasal Blockage Score [NBS], Nasal Congestion Score [NCS], and Difficulty with Sense of Smell Score [DSS]) and a Total Symptom Score (TSS, summary of the 8 symptom-specific items) were evaluated for reliability, validity, and ability to detect change. Within-patient meaningful change thresholds (MCTs) were established using anchor- and distribution-based methods. Comparative PROs included the 22-item Sino-Nasal Outcome Test (SNOT-22) and Patient Global Impression of Severity (PGI-S). Results: The TSS exhibited strong internal consistency (Cronbach α =.88) and test-retest reliability (intraclass correlation coefficient >.80). Correlation between the TSS and SNOT-22 total score indicated good convergent validity (r =.70). All 4 NPSD scores demonstrated known-groups validity (significant differences among subgroups of patients with predetermined disease severity levels based on PGI-S categories) and were sensitive to detect change in patients' clinical status (significant differences among subgroups of patients with reported changes between 2 time-points in PGI-S and Patient Global Impression of Change scores). MCTs for improvement were established at 1.0 point for NBS, NCS, and DSS, and 4.0 points for TSS. Conclusion: These findings support the reliability, validity, and suitability of the 4 NPSD-derived scores for evaluating treatment effect on CRSwNP symptoms and their use in clinical trials with predetermined MCTs for improvement. [ABSTRACT FROM AUTHOR]

This article provides a comprehensive systematic review and qualitative analysis of the current research investigating Ayurveda chronic rhinosinusitis (CRS) treatment. PRISMA guidelines for systematic reviews was followed and our search utilized MEDLINE, Embase, Ayush Portal, and Cochrane Library databases. Articles published prior to March 2022, 10 or more patients that investigated Ayurveda as a treatment for CRS in humans were included. This resulted in thirteen articles meeting inclusion criteria. Ayurvedic treatments included herbal medications for oral consumption, nasal instillation, and steam inhalation used alone or in combination. All studies concluded that Ayurvedic therapy led to improvements in subjective CRS symptoms and objective radiographic and hematologic criteria. However, all 13 studies had a significant risk of bias due to study design and statistical methods utilized. Ayurvedic therapy may be a useful CRS treatment for some patients and overall appears to be well tolerated. However, definitive recommendation for when Ayurvedic treatments would be beneficial in the treatment of CRS remains not possible. Given the overall positive effects shown in the current published evidence and growing interest in complementary and integrative therapies, Ayurvedic treatments for CRS deserve further investigation in the form of well-designed controlled trials. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis (CRS), a prevalent inflammatory illness, affects a sizeable portion of the global population. An important component of the upper respiratory system, nitric oxide (NO) controls inflammatory responses and functions as an antibacterial, antiviral, and antifungal agent. The enzymes arginase (ARG) and inducible nitric oxide synthase (iNOS), whose activity has been linked to a range of respiratory disorders, generate NO. N-acetylcysteine has demonstrated potential as a CRS treatment option. The present study aimed to evaluate the levels of iNOS, ARG, and constitutive isoforms of NO-synthase in sinonasal fluid at multiple time points after surgery. Significant differences were observed in the levels of iNOS, ARG, and constitutive isoforms of NO-synthase between the two groups after treatment. The experimental group, receiving topical N-acetylcysteine, exhibited increased iNOS activity on the 3rd day, followed by a decline on days 10 and 28. Similarly, ARG activity increased on day 3rd in both groups but was lower in the experimental group at later time points. The findings suggest that NO-related enzymes, particularly iNOS and ARG, play a crucial role in the pathophysiology of chronic rhinosinusitis without polyps. Additionally, topical Nacetylcysteine treatment seems to affect NO production and ARG activity, which may help to reduce inflammation and enhance clinical results. These results highlight the therapeutic potential of N-acetylcysteine in managing chronic rhinosinusitis and warrant further investigations into its broader implications for respiratory conditions. For patients with CRS without polyps, adding N-acetylcysteine to the treatment regimen may result in more focused and efficient therapeutic strategies. [ABSTRACT FROM AUTHOR]

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]

Objective: The study aimed to assess a possible association between allergic rhinitis and asthma and surgical management of chronic rhinosinusitis. Methods: A retrospective study was carried out to review the clinical charts of adult patients who underwent functional endoscopic sinus surgery as a surgical treatment for chronic rhinosinusitis. Data regarding clinical symptoms, endoscopic findings, and radiological findings were considered. Results: The studied population included 74 patients. An average Lund-Mackay score of 10.59 ± 5.427 was identified with no statistically significant difference between the presence or absence of allergic rhinitis or asthma. There was a statistically significant association between the presence of sneezing attacks, nasal itching, and hyposmia before surgery and the presence of asthma previously diagnosed. There is no statistically significant difference between the Lund-Mackay score before the surgery or the presence of nasal polyposis, asthma, or allergic rhinitis. Overall, we verified a reduced prevalence of symptoms after functional endoscopic sinus surgery with no difference between the groups with and without allergic rhinitis or asthma. Conclusions: There was a statistically significant association between the presence of sneezing attacks, nasal itching, and hyposmia before surgery and the presence of asthma previously diagnosed. We did not find a statistical difference between the degree of regression of nasal polyposis in the sub-samples of patients with allergic rhinitis or asthma. Our findings are also in line with the literature which shows that symptoms improved significantly in both asthmatics and non-asthmatics postoperatively. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health Sciences of Kocaeli University / Kocaeli Üniversitesi Sağlık Bilimleri Dergisi is the property of Institute of Health Sciences of Kocaeli University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Head and neck surgeries may cause changes in the nasal airflow, and radiotherapy irreversibly damages paranasal sinus epithelial cells. Some chemotherapeutic drugs have been reported to negatively affect airway ciliary activity in mice, and chronic rhinosinusitis could be an adverse effect of head and neck cancer (HNC) treatment. To evaluate whether HNC treatment is a risk factor for developing sinonasal mucosal thickening that may reflect paranasal sinus inflammation, we compared pre- and post-treatment paranasal sinus computed tomography (CT) images of patients treated for HNC at a single university hospital.Methods: The patients who received curative treatment for HNC (oral, pharyngeal, and laryngeal cancers) and started receiving first-line therapy between January 2015 and December 2019 were included. Data on age, sex, primary lesion, clinical stage, treatment, smoking history, drinking history, comorbidities (diabetes and chronic lung disease), and pre- and post-treatment (three months and one year after the final treatment) paranasal sinus CT images were analyzed from medical records. Pre- and post-treatment paranasal sinus CT images were scored using the Lund-Mackay (LM) staging system.Results: In total, 245 patients participated in this study. Three months after the final treatment, 80.4% of patients had no change in their total LM scores (p=0.621). Almost 80% of patients who underwent total laryngectomy also had no change in their total LM scores (p=0.833). One-third of patients with nasopharyngeal cancer (NPC) had worse LM scores after treatment (5/15), although no significant difference was observed (p=0.171). None of the various factors collected were significantly related to changes in LM scores three months after the completion of treatment. One year after the final treatment, 211 patients were included and no significant changes in the pre-and post-LM scores were observed in the same analyses, while changes in LM scores were significantly different between T categories (T1-2 vs. T3-4) (p=0.020).Conclusion: We found no significant changes in the LM scores after HNC treatment in all the patients, which implies that HNC treatment may not be an apparent risk factor for sinonasal mucosal inflammation. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis is a complex multifactorial inflammatory disease that affects up to 12% of the adult population globally. Chronic rhinosinusitis is associated with significant morbidity and represents a large healthcare burden. Despite medical and surgical treatment, a subset of “difficult-to-treat” patients have poor symptom control due to substantial inflammatory disease persistence. These patients represent ideal candidates for biologic therapeutics, which specifically modulate key inflammatory processes implicated in chronic rhinosinusitis pathophysiology. Chronic rhinosinusitis is often dichotomized phenotypically between those presenting with and without nasal polyps. Chronic rhinosinusitis with nasal polyps often represents the more severe disease phenotype and is classically associated with type 2 inflammation mediated by type 2 helper T cells, innate lymphoid cells, immunoglobulin E B cells, basophils, mast cells, and eosinophils. Biologic agents targeting known key mediators of type 2 inflammation have been shown to reduce disease burden. Phase 3 clinical trials studying the effects of anti-immunoglobulin E, anti- inter leuki n-5/a nti-i nterl eukin -5Rα, and anti- inter leuki n-4/i nterl eukin -13 humanized monoclonal antibodies have shown that these biologics can reduce both polyp size and the need for revision surgeries, improve symptoms, and downregulate inflammatory markers while maintaining an acceptable safety profile. Currently, biologics should be reserved for patients with chronic rhinosinusitis nasal polyps with moderate-to-severe disease who have failed maximal medical and surgical therapy, with sufficient surgery having been previously undertaken. Further studies are needed to better endotype patients to optimize biologic use and compare the relative effectiveness of biologics in difficult-to-treat patients. [ABSTRACT FROM AUTHOR]

Objectives: Objectives: In this study, the objective was to compare the effectiveness of fluticasone dipropionate and platelet-rich plasma treatments added to the treatment in patients undergoing functional endoscopic sinus surgery in patients with chronic sinusitis involving odor dysfunction, different stages and types of sinusitis. Methods: The study included a total of 60 patients between 18 and 60 years who underwent endoscopic sinus surgery due to chronic paranasal sinus infection followed by olfactory dysfunction. Group 1: paranasal sinus surgery + steroid therapy (first 30 patients) and Group 2: paranasal sinus surgery + steroid therapy + PRP therapy (second 30 patients) were grouped together without the patients' knowledge of the operating physician and of the treatment protocol. For the paranasal sinus CT evaluation, Lund-Mackey staging was used and the degree of the disease was determined using the Kennedy staging system. Modified Sniffin Stick test was applied to all patients in the preoperative 1st week and in the 3rd month postoperatively. The Modified Sniffin Stick test was conducted on all patients during the preoperative 1st week and the postoperative 3rd month. The modified Sniffin Stick test and endoscopic evaluation score were evaluated and whether or not the patients benefited from PRP treatment were compared. Results: According to the postoperative endoscopy score, there was a difference between the experimental group and the control group in terms of postoperative endoscopy score, and it was found to be statistically significant. Besides, the postoperative endoscopy score of the experimental group was found to be lower than the control group. The average of Modified Sniffin' Stick Test scores in the postoperative period of the patients in the study was 28.27 ± 7.88 for the experimental group, while it was determined as 20.08 ± 5.75 for the control group, and this difference was statistically significant. The average anosmia times of the experimental and control group patients in the study were compared, and the mean duration of anosmia was 48.53 ± 20.40 (6-96) for the experimental group and 44.27 ± 19.45 (6.96) for the control group. The difference in the mean duration of anosmia between the experimental and control groups was not found statistically significant. Conclusions: In this research, PRP, which is applied to functional endoscopic sinus surgery and fluticasone dipropionate treatment, has been shown to be a readily applicable, safe and highly efficient method of treatment in patients with chronic sinusitis accompanied by smell dysfunction. [ABSTRACT FROM AUTHOR]

Background: Macrolides have shown beneficial effects in the treatment of chronic rhinosinusitis (CRS). This study aimed to compare the effect of azithromycin and clarithromycin in combination with conventional therapies for the treatment of CRS. Methods: This single-blind randomized controlled trial was conducted during 2018-2019 at the Otorhinolaryngology Clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran. Out of 102 selected patients, 90 were included in the analysis. Patients were selected through convenience sampling and randomly assigned to two equal groups. In addition to conventional therapies (nasal irrigation, betamethasone injection, oxymetazoline and fluticasone spray, guaifenesin syrup, and steam inhalation), the patients in the clarithromycin group received clarithromycin 500 mg tablets twice daily for four weeks. The other group received azithromycin 500 mg tablets daily for four weeks. Patients' symptoms were evaluated pre- and post-intervention, and the Lund-Mackay (LM) scoring system was used for the staging of CRS based on computed tomography scan findings. Data were analyzed using SPSS software, and P<0.05 was considered statistically significant. Results: Patients in both groups were comparable in terms of age and sex. Complete resolution of symptoms was significantly higher in the azithromycin group than the clarithromycin group (71.1% vs. 24.4%, P<0.001). Baseline LM scores did not differ significantly between the groups (P=0.120). However, postintervention, LM scores reduced considerably in both groups, but the change was significantly higher in the azithromycin group (P<0.001). Conclusion: In combination with conventional therapies for CRS in adults, a four-week course of treatment with azithromycin is more effective than clarithromycin. Trial Registration Number: IRCT20201209049661N1. [ABSTRACT FROM AUTHOR]

Background: Functional endoscopic sinus surgery (FESS) is one of the most frequently performed operative procedures in the head and neck field. It has become a standard therapy for chronic rhinosinusitis (CRS) including nasal polyposis that is refractory to conservative measures. Aim of the work: The aim of the study was to compare the outcome of dissolvable carboxy-methylcellulose (CMC) and vinyl gloved Merocele packing in functional endoscopic sinus surgery (FESS) in adult patients. Methods: This prospective, randomized controlled trial study included 26 consecutive adult patients with a diagnosis of CRS with or without polyposis undergoing bilateral FESS, who admitted to the Otorhinolaryngology Head and Neck Outpatients Clinic, Faculty of Medicine, Zagazig University Hospital during the period from December 2017 to December 2018. Results: There were statistical significance difference between CMC and Merocele after 1st and 2nd weeks of operation but this difference disappeared after 4th and 8th weeks in all items. There was a statistical significance reduction in pain score and bleeding score in CMC at all times. There was no statistical significance correlation between age and pain, bleeding or synechia score in either CMC side versus Merocel nasal side. Conclusion: CMC can be a safe candidate for replacing conventional packing materials after endoscopic sinus surgery (ESS). [ABSTRACT FROM AUTHOR]

Background: Management of allergic fungal sinusitis after surgery is difficult and prolonged steroid use has significant side effects and there are a group of patients who are unresponsive to standard treatment with corticosteroid. Other modalities are suggested as adjunct to steroid in the treatment of AFRS including Oral itraconazole which is an antifungal agent that seems to be benefit to patients with AFS. The aim of the present study is to study the effect of post-operative use of systemic Itraconazole as an adjunct to local steroids in management of patients of Allergic fungal rhino sinusitis. Methods: This prospective study was conducted in Otorhinolaryngology Department, Faculty of Medicine, Zagazig University. This study included 18 patients with AFRS met the inclusion and exclusion criteria in our study. Results: In our study there was no statistically significant difference in the affected nasal sinus between the two studied groups, there was statistically significant decrease in IgE post-operatively in both groups. there was no statistically significant difference preoperatively and six-month post-operative in both groups. Conclusions: Systemic Itraconazole can be considered as an effective treatment alternative to the systemic steroid for postoperative management of AFRS,especially when there is intolerance, decrease response or contraindication to system steroid. [ABSTRACT FROM AUTHOR]

Background: One of the most important surgical issues in the treatment of pilonidal sinus disease is recurrence. Aim of the work: The aim of this study is to compare two surgical techniques (rhomboid flap and semi closure method) for treatment of recurrent pilonidal sinus. Patients and Methods: This randomized clinical trial was conducted in Zagazig University Hospitals the work has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for studies involving humans between the period of Aug 2018 to Feb 2019 on 12 patients with recurrent pilonidal sinus, divided randomly into 2 groups: Group A 6 patients managed by semi closure method and Group B 6 patients operated with rhomboid flap method. Results: There was a significant difference regarding pain duration, time of comfort sit, total time of healing and time of return to work between the two groups for the favor of group B which was markedly short in patients of group B. according to postoperative complication regarding delayed wound healing and wound infection had no significant difference between group A and group B. Regarding post-operative recurrence, follow up of both groups done during postoperative care and at time of 2nd, 3rd, 4th and 6th post-operative months. Only one case of group B had recurrence with no recurrent cases reported during the 6 post-operative months in group A . Conclusions: Patient of group B shows decreased pain duration, time need for comfortable sit and early return to work. There no significant difference between the 2 groups in post-operative complications. Rhomboid flap repair is an advantageous and effective modality than semi closure method in treatment of sacrococcygeal disease. [ABSTRACT FROM AUTHOR]

Objective: The present article reports how a dental implant with an internal port dental implant valve approach (DIVA) can be utilized as oroantral port to treat chronic rhinosinusitis (CRS) in a minimally invasive manner. Method and Materials: Eleven patients (age mean 68.1 years) with CRS were subjected to the transimplant lavage technique. For three patients the CRS treatment was performed via previously installed dental implants and for another eight patients the implantation procedure was combined with the CRS treatment. The moment the implant was fully installed, the sinus membrane was punctured via the implant channel. Upon completion of the pus drainage the sinus was irrigated with normal saline, followed by the injection of a steroid solution (100 mg hydrocortisone). Results: Patients began to report symptomatic improvement from the first day after the first-session procedure. Nine patients had complete relief of most of their symptoms (nasal obstruction/discharge, anosmia/hyposmia) at day 30. The follow- up nasal endoscopy demonstrated no evidence of active sinus disease. All the implants used were found to be wellosseointegrated and still in use for prosthetic purposes. Clinical and radiologic results showed stability and no recurrence in the follow-up period. Conclusion: The dental implant with an internal central port and integral dedicated sealing screw may be used for irrigation, observation and further treatment of the maxillary sinus in cases of CRS. [ABSTRACT FROM AUTHOR]

Background. Chronic rhinosinusitis (CRS) is a highly prevalent disease associated with poor quality of life. In this paper, we appraised the role of acupuncture in the treatment of CRS. Methods. Electronic databases were searched for randomized controlled clinical trials (RCTs) that examined the role of acupuncture in CRS. The primary outcome measures included posttreatment CRS severity, as measured by the Visual Analogue Scale (VAS) and Total Effective Rate (TER). The risk of bias and quality of evidence were evaluated according to the Cochrane Collaboration's risk-of-bias tool and GRADE tool, respectively. Results. Evidence from the RCTs (n = 10) suggested that acupuncture as a monotherapy or adjunctive therapy to conventional treatment was associated with significant improvements in VAS, TER, and quality of life when compared with conventional treatments for CRS. However, there was a similar incidence of adverse events. The risk of bias was unclear and the quality of evidence for each finding was generally moderate to low. Conclusions. Acupuncture as a stand-alone or adjunctive treatment for CRS was associated with clinical symptom improvement and better quality of life, without any risk for serious adverse events. However, the high clinical heterogeneity of the included RCTs and overall moderate-to-low quality of evidence necessitates rigorous, well-designed trials to confirm these findings. Trial Registrations. This trial is registered with PROSPERO (no. CRD42021292135). [ABSTRACT FROM AUTHOR]

Chronic nasal crusting is a commonly encountered entity in an otolaryngology office. Progressive, extensive nasal crusting with erosion is relatively unusual, however. We present the case a 58-year-old renal transplant patient with a history of vasculitis and immunosuppression who presents with subjective headache and facial pain, nasal crusting, and isolated left ethmoid sinusitis. She developed extensive intranasal necrosis and underwent multiple endoscopic sinus surgeries with intraoperative biopsies, which played a critical role in her workup and eventual diagnosis of Acanthamoeba rhinosinusitis. Although she endured a difficult course, proper diagnosis and treatment allowed for her recovery over time. The differential diagnosis for intranasal necrosis is often broad. This case highlights the wide range of etiologies to be considered in a patient with extensive nasal crusting and erosion/necrosis, and the importance of thorough diagnostic evaluation in these patients, especially those in an immunocompromised state. [ABSTRACT FROM AUTHOR]

Objectives: Appropriate management of chronic rhinosinusitis (CRS) among patients with cystic fibrosis (CF) is important in improving quality of life. Otolaryngologists play a critical role in reducing CRS symptom burden. This study seeks to evaluate the role of patient-reported quality-of-life measures in guiding interventions for CF-related sinus disease. Methods: We performed a prospective, cross-sectional study of 105 patients presenting to a CF-accredited clinic between July and September 2018. Demographic data and sinus surgery history were collected, in addition to Sino-Nasal Outcome Test (SNOT-22) and Questionnaire of Olfactory Disorders (QOD-NS) scores. Statistical analysis was conducted using correlation and non-parametric Mann-Whitney U tests. Results: Baseline well-care visits accounted for 71.4% of all clinical evaluations. Prior otolaryngology intervention was noted in 69 (66%) patients, where the majority of these patients (63/69; 91%) underwent endoscopic sinus surgery (ESS). Patients with a history of otolaryngology intervention had an average SNOT-22 score of 33.2 (SD = 20.6) compared to 24.9 (SD = 18.5) for patients without prior intervention (P =.048). The average QOD-NS score was 5.5 (SD = 6.4) among patients referred to otolaryngologists and 3.1 (SD = 5.7) for non-referred patients (P =.012). SNOT-22 and QOD-NS scores were modestly correlated (R of.43). Conclusion: CF patients with symptoms resulting in worse quality-of-life assessments were more likely to have established coordinated care with an otolaryngologist. Further validation of the utility of SNOT-22 and QOD-NS questionnaires as care coordination metrics is necessary in the CF population. [ABSTRACT FROM AUTHOR]

Background: Rhinosinusitis, one of the most common conditions encountered by clinicians, affects quality of life and reduces work productivity. Despite its high prevalence and economic burden, there are considerable differences in practice regarding the management of rhinosinusitis. Based on many studies, including the updated guidelines, classifications have been subdivided, and new treatments have been added. Current Concepts: Rhinosinusitis can be classified as acute rhinosinusitis (ARS) or chronic rhinosinusitis (CRS) with a cut-off duration of 12 weeks. It is diagnosed based on subjective symptoms and objective findings on computed tomography or endoscopy. Viral infections account for the majority of the causes of ARS, with watchful waiting without antibiotics as its important initial management. Meanwhile, CRS is divided into primary and secondary CRS, which is further subdivided by anatomic distribution and endotype. Particularly, the Type 2 endotype is characterized by a high recurrence rate and high resistance to current therapies. Biologics using monoclonal antibodies could therefore be used as new therapeutic options for the treatment of primary type 2 CRS. Furthermore, given the chronicity of CRS, it is important to recognize that endoscopic sinus surgery and continuous postoperative medical treatment are important for its management. Discussion and Conclusion: Accurate diagnoses based on diagnostic criteria and subdivided classifications are necessary to determine the treatment plan and prognosis. In particular, it is important to differentiate the endotype of CRS and provide appropriate treatments to improve the patient's symptoms and quality of life. [ABSTRACT FROM AUTHOR]

Background: Complex airway disease such as Chronic Rhinosinusitis with Asthma or Aspirin Exacerbated Respiratory Disease requires a multidisciplinary approach to management and treatment. Many centers in the USA have created collaborative multidisciplinary clinics to support the management of these patients; however, similar structures do not appear to exist in Canada. Methods: This mixed methods study used a combination of structured interviews and a cross-sectional national survey. Interviewees included members of the Canadian Rhinology Working Group and survey participants were a combination of academic and community Rhinologists, Respirologists and Allergists. All participation was voluntary and selection criteria was based on their involvement in treating complex airway disease. Our objective was to identify the current state of diagnosis and treatment of complex airway patients in Canada between Rhinology, Respirology and Allergy and understand the barriers, challenges and propose solutions to establishing a multidisciplinary airway clinic in Canada. Results: Four Rhinologists participated in qualitative interviews and a convenience sample of 42 specialists through our known network responded to our quantitative survey. From our survey, 54.8% believed multidisciplinary clinics were necessary in the management of complex airway disease, providing better outcomes and cost-savings (69%, 45.2%). Most specialties agreed that history, physical, pulmonary function and skin prick testing was important for diagnosis (92.9%, 92.9%, 88.1%). If clinicians were to participate in a multidisciplinary clinic, they would be willing to forego an average of 14.2% of their mean daily income for that clinic. The ideal clinic location was split between a neutral shared location vs. a Rhinology clinic space (38.1%, 45.2%). Conclusions: Complex airway diseases are currently managed in subspecialty silos resulting in fragmented care. Our study highlights gaps in management, areas for improvement and support for establishing multidisciplinary complex airway disease clinics in Canada to better treat this population. [ABSTRACT FROM AUTHOR]

Measuring olfactory cleft mucus biomarkers provides critical insights into the pathogenesis of the olfactory dysfunction. This study aimed to develop a novel centrifugal extraction device to collect the olfactory cleft mucus. The olfactory cleft mucus was collected from 18 patients with chronic rhinosinusitis (CRS) and 10 healthy controls using polyvinyl alcohol (PVA) sponges. Both novel centrifugal extraction devices and traditional devices which consisted of a falcon tube and a syringe shaft were utilized. Levels of Galectin-10 were assessed using the enzyme-linked immunosorbent assay. The olfaction was evaluated with Sniffin' Sticks. The average extraction efficiency of recovered volume for novel centrifugal extraction devices and traditional devices was 85.44 and 79.15%, respectively. Galectin-10 levels of the olfactory cleft mucus in patients with CRS were significantly higher than that in controls when extracted through novel devices (p <.001). Furthermore, levels of Galectin-10 in patients with CRS significantly correlated with TDI score (p =.020, r = −0.546). There was no significant difference between novel and traditional devices regarding Galectin-10 levels in CRS (p =.966). The novel centrifugal extraction device with PVA sponges proved to be a feasible method to collect the olfactory cleft mucus. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the effectiveness of pharmacological therapy with and without direct maxillary sinus saline irrigation for the management of chronic rhinosinusitis without polyps. Methods: In this prospective randomised controlled trial, 39 non-operated patients were randomly assigned to be treated with direct maxillary sinus saline irrigation in conjunction with systemic antibiotics and topical sprays (n = 24) or with pharmacological therapy alone (n = 15). Endoscopy, Sino-Nasal Outcome Test and Lund–MacKay computed tomography scores were obtained before, six weeks after and one to two years after treatment. Results: Post-treatment Lund–Mackay computed tomography scores were significantly improved in both cohorts, with no inter-cohort difference identified. Post-treatment nasal endoscopy scores were significantly improved in the study group but were similar to those measured in the control group. The Sino-Nasal Outcome Test-20 results showed improvement in both cohorts, with no difference between treatment arms. Conclusion: Maxillary sinus puncture and irrigation with saline, combined with pharmacological treatment improves endoscopic findings in patients with chronic rhinosinusitis without polyps, but has no beneficial effect on symptoms and imaging findings over conservative treatment alone. [ABSTRACT FROM AUTHOR]

Copyright of ScienceRise: Medical Science is the property of PC TECHNOLOGY CENTER and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Patient satisfaction has a significant bearing on medical therapy compliance and patient outcomes. The purpose of this study was to (1) describe patient satisfaction, as characterized by the Patient Satisfaction Questionnaire-18 (PSQ-18), in the care of patients with chronic rhinosinusitis (CRS) and (2) analyze the impact of comorbidities on satisfaction using the functional comorbidity index (FCI). Methods: Patient demographics, disease severity measures, and PSQ-18 scores for patients with CRS presenting to a tertiary rhinology clinic between November 2019 and April 2020 were collected and analyzed. FCI was calculated retrospectively using the electronic medical record; individual comorbidities were tabulated. Spearman's correlations followed by multivariate regression was used to assess the relationship between medical comorbidities and PSQ-18. Results: Sixty-nine patients met criteria for analysis. There were no significant differences in age, gender, and Sinonasal Outcomes Test-22 scores between CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps. There was no significant difference in the mean FCI for patients with CRSwNP versus CRSsNP (5.1 and 4.3, respectively) (P =.843). Similarly, there was no significant difference in the mean sum PSQ-18 score (78/100 in both) between these cohorts (P =.148). The mean sum PSQ-18 score was not significantly associated with anxiety (P =.728), depression (P =.624), or FCI (P =.282), but was significantly associated with hearing impairment (P <.001). Conclusion: Patient satisfaction in the care of CRS is generally high with a diagnosis of comorbid hearing impairment demonstrating a negative association with satisfaction in this cohort. [ABSTRACT FROM AUTHOR]

The frequency of secondary infections has also increased following the ongoing coronavirus pandemic. We aimed to attract attention to the COVID-19-related mucormycosis, a highly mortal complication of COVID-19, and its treatment. A retrospective review of the patient database was performed after the pandemic declaration. These patients’ medical files, treatment charts, and radiological and histological data were examined. The study group consisted of three COVID-19-related mucormycosis patients. All three patients had uncontrolled diabetes. One patient had no previously diagnosed diabetes and died due to widespread mucor infection and severe ketoacidosis. In the other two patients, the diagnosis was made promptly by frozen examination, endoscopic debridement was performed, antifungal treatment was started immediately, and infection was controlled following strict blood sugar control. The widespread use of steroids, and uncontrolled diabetes, are major risk factors that make patients susceptible to mucormycosis. In patients with COVID-19, physicians should be cautious of the possibility of invasive fungal infection. In addition to debridement, an active interdisciplinary approach can help reduce mortality. [ABSTRACT FROM AUTHOR]

Acute rhinosinusitis (ARS) is a very common condition and mostly of viral origin. About 0.5-2% of cases of viral ARS are complicated by a bacterial infection. Due to viral etiology and inflammatory mechanisms of rhinitis and rhinosinusitis, symptomatic treatment including phytotherapy has been used for their treatment for decades. Scientific societies and expert groups recommend the use of herbal medicines in acute viral and acute postviral rhinosinusitis. In 2021, Polish patients gained access to a new therapeutic option for acute sinusitis in the form of a drug containing a distillate of a mixture of rectified essential oils of eucalyptus, sweet orange, myrtle and lemon common. [ABSTRACT FROM AUTHOR]

Background: Odontogenic sinusitis is an underdiagnosed entity and is one cause of failure of conventional treatments of sinusitis. Unfortunately, there is no consensus so far on the best management protocol. This retrospective study aimed to suggest a practical management protocol that can reduce misdiagnosis and improve treatment outcomes. Methods: The study included 74 patients with confirmed odontogenic sinusitis who were diagnosed and treated over 10 years (2010–2019). The patient data were recorded and analysed. Results: Dental pain was reported in only 31.1 per cent of patients. Fifty-six patients (75.7 per cent) had received dental treatment during the last year, but only 13 (23.1 per cent) reported it. Dental pathology was missed on initial computed tomography evaluation in 24 patients (32.4 per cent). Forty-one patients (55.4 per cent) were successfully treated by dental procedures and antibiotics. Fourteen patients needed functional endoscopic sinus surgery in addition to dental procedures. Conclusion: Successful management of odontogenic sinusitis requires good communication between rhinologists, radiologists and dentists. Dental treatment should be the logical first step in the treatment protocol, unless otherwise indicated. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis and otitis media with effusion (OME) are common diseases in otorhinolaryngology field. However, a small number of studies have examined the relationship between them. Purpose The aim of this study was to find out the incidence of OME in patients of chronic rhinosinusitis with nasal polypi (CRSwNP) and to highlight the relationship between them. Patients and methods: This prospective cross-sectional analytical study has been conducted on 50 selective cases complaining from the CRSwNP. They were examined well, both general and local. Tympanometry to assess function of Eustachian tube was done and also pure-tone audiometry. All patients were 18-55 years old and were admitted in ENT Department at Al-Zahraa University Hospital during the period from March 2019 to April 2020. Research has been approved by the Research Ethical Committee of Otolaryngology Department, Faculty of Medicine for Girls, Al Azhar University. Results: According to the results, more than a third of patients had OME, so we believe that chronic rhinosinusitis with polyps increases the chance of OME. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine multiple return to sport rates, long-term clinical outcomes and safety for subtalar arthroscopy for sinus tarsi syndrome. Methods: Subtalar arthroscopies performed for sinus tarsi syndrome between 2013 and 2018 were analyzed. Twenty-two patients were assessed (median age: 28 (IQR 20–40), median follow-up 60 months (IQR 42–76). All patients were active in sports prior to the injury. The primary outcome was the return to pre-injury type of sport rate. Secondary outcomes were time and rate of return to any type of sports, return to performance and to improved performance. Clinical outcomes consisted of Numerous Rating Scale of pain, Foot and Ankle Outcome Score, 36-item Short Form Survey and complications and re-operations. Results: Fifty-five percent of the patients returned to their preoperative type of sport at a median time of 23 weeks post-operatively (IQR 9.0–49), 95% of the patients returned to any type and level sport at a median time of 12 weeks post-operatively (IQR 4.0–39), 18% returned to their preoperative performance level at a median time of 25 weeks post-operatively (IQR 8.0–46) and 5% returned to improved performance postoperatively at 28 weeks postoperatively (one patient). Median NRS in rest was 1.0 (IQR 0.0–4.0), 2.0 during walking (IQR 0.0–5.3) during walking, 3.0 during running (IQR 1.0–8.0) and 2.0 during stair-climbing (IQR 0.0–4.5). The summarized FAOS score was 62 (IQR 50–90). The median SF-36 PCSS and the MCSS were 46 (IQR 41–54) and 55 (IQR 49–58), respectively. No complications and one re-do subtalar arthroscopy were reported. Conclusion: Six out of ten patients with sinus tarsi syndrome returned to their pre-injury type of sport after being treated with a subtalar arthroscopy. Subtalar arthroscopy yields effective outcomes at long-term follow-up concerning patient-reported outcome measures in athletic population, with favorable return to sport level, return to sport time, clinical outcomes and safety outcome measures. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Introduction: The main objective of the study was to determine the validity of intraoperative antiseptic treatment during endoscopic sinus surgery and the impact of such a treatment on the postoperative outcomes. Material and methods: Fifty-five patients with chronic sinusitis, qualified for surgical treatment were enrolled into the trial. It was designed as a prospective, randomized, blinded study. The surgical procedures were performed on both sides, in the same scope. In the next stage, after opening, one side was flushed with saline solution, and the other side with octenidine solution. Results: The analysis showed a statistically significant reduction in postoperative crusting measured using the Lund-Kennedy scale between the test and the control group. Intraoperative lavage of the paranasal sinuses in both control and study group showed an effect on decreasing the total number of positive postoperative cultures relative to preoperative ones. Discussion: Study showed a beneficial effect of the intervention consisting in rinsing with Octenisept on the reduction of crusting in the postoperative assessment. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This study comprised a long-term follow-up of a cohort of patients with chronic rhinosinusitis (CRS) regarding clinical features and symptomatology. Methods: Data from 42 patients with CRS were available from a previous study. Forty of these patients were alive and were contacted for inclusion after approximately 10 years. Patients completed a questionnaire about disease and symptoms, and underwent a clinical examination. Results: Thirty-four patients (85%) responded and could be included and evaluated. For the participants in this follow-up study median length of time between initial inclusion (C1) and follow-up (C2) was 11 years (range: 8-15). In some patients the CRS shifted phenotype over time, from CRS with nasal polyposis to CRS without nasal polyposis or vice versa. The median total visual analogue score for combined sinonasal symptoms for all patients was statistically significantly reduced at follow-up. For individual patients, scores for nasal congestion, nasal discharge, facial pressure, and hyposmia were also statistically significantly reduced. The most frequently reported symptom-relieving treatments were nasal steroids and saline rinsing of the nose. Self-reported general quality of life was statistically significantly improved at C2 compared to C1. Conclusion: At long-term follow-up, symptoms were generally reduced and patients reported an improved quality of life. Patients can be given hope for eventual symptom relief. CRS is a chronic condition that seems to harbor the ability to alter its phenotype after several years. Topical corticosteroids and saline rinsing of the nose should be emphasized, since patients consider these treatments to be of high value. [ABSTRACT FROM AUTHOR]

Chordoma is a rare form of cancer that forms from the notochord remnants, and affects the skull and the spine. The standard treatment for a sacrococcygeal chordoma is surgery and radiation. Chordoma has a high rate of recurrence and surgery with radiation treatment can leave patients with surgical site complications, such as wounds, fistulas or sinus tracts. Repeat surgical intervention on an irradiated surgical site increases incidence of complications leading to decreased quality of life, and increased morbidity and mortality. Treatment of wound complications after surgery and high-dose radiation for a chordoma tumour is rarely reported in the literature. Herein, the author describes the case of a chronic sinus tract after surgery and radiation for a sacral chordoma tumour successfully healed by hyperbaric oxygen therapy (HBOT) in conjunction with topical antibiotics. [ABSTRACT FROM AUTHOR]

Background: Recent evidence suggests that biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of chronic rhinosinusitis with nasal polyposis (CRSwNP). There remains a population in CRSwNP that despite medical therapy and endoscopic sinus surgery have persistent signs and symptoms of disease. Therefore, biologics, monoclonal antibody agents, could be beneficial therapeutic treatments for these patients. There have been eight randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL-5R, IL-33, and immunoglobulin (Ig)E. However, there are no formal recommendations for the optimal use of biologics in managing Chronic Rhinosinusitis (CRS) within the Canadian health care environment. Methods: A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. 17 fellowship trained rhinologists across Canada evaluated the 28 original statements on a scale of 1–10 and provided comments. A rating within 1–3 indicated disagreement, 8–10 demonstrated agreement and 4–7 represented being neutral towards a statement. All ratings were quantitively reviewed by mean, median, mode, range and standard deviation. Consensus was defined by removing the highest and lowest of the scores and using the "3 point relaxed system". Results: After three rounds, a total of 11 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with CRS. Conclusion: This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of patients with CRS, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. [ABSTRACT FROM AUTHOR]

Objective: Chronic rhinosinusitis patients with biofilms cultured from their sinonasal cavity have greater symptom burden and risk of recalcitrant disease. A number of non-antibiotic, 'anti-biofilm' treatments exist which show anti-biofilm properties in preclinical studies. There is little evidence evaluating their impact on clinical symptom scores in chronic rhinosinusitis. Method: A systematic review was performed to assess the literature regarding the efficacy of non-steroid, non-antibiotic, anti-biofilm specific topical therapies in the treatment of chronic rhinosinusitis. The primary outcome assessed was change in validated patient reported outcome measures before and after anti-biofilm treatment. Results: Thirteen studies assessing the effect of anti-biofilm therapies in chronic rhinosinusitis through validated patient-reported outcome measures were included. Seven different anti-biofilm specific therapies for chronic rhinosinusitis were identified. None of the seven anti-biofilm therapies was identified as being confidently efficacious beyond placebo. Only one therapy (intranasal xylitol) showed a statistically significant reduction in symptom scores compared with placebo in more than one trial. Conclusion: Robust evidence supporting the use of various anti-biofilm therapies in chronic rhinosinusitis is lacking. Further high quality, human, in vivo trials studying the effect of anti-biofilm therapies in chronic rhinosinusitis are needed to address the deficiencies of the current evidence base. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects and adverse events of preparation Sinulan forte® containing extracts of five medicinal plants in comparison to mometasone furoate nasal spray (MFNS) in therapy of acute postviral rhinosinusitis (APRS). Methods: We included 46 APRS patients in this prospective investigation and randomized to two groups. The patients in group 1 (n=23) received MFNS 200 μg two times/day for ten days, and patients in group 2 (n=23) received Sinulan forte®, tablets 225 mg per os, two times/day also for ten days. We evaluated the total symptom score (TSS), the separate scores for individual symptoms (nasal congestion, rhinorrhea, postnasal discharge, facial pain, impaired sense of smell), the quality-of-life outcome, and the findings from nasal endoscopy (edema of the nasal mucosa, nasal secretion) prior and after the therapy. Results: Significantly lower absolute post-treatment scores and better relative improvement were identified for TSS, nasal congestion, facial pain, loss of the sense of smell, edema of the mucosa and nasal secretion in patients receiving herbal preparation (group 2). However, lower absolute post-treatment score and better relative improvement were found for rhinorrhea and postnasal drip in group 1. Clinically important differences were found regarding the TSS and endoscopic findings, with no adverse effects in group 2, but in group 1 two patients had mild nasal bleeding and two had sensation of dryness in the nasal mucosa. Conclusion: Herbal product Sinulan forte® can be a safe and effective treatment for APRS. Our results suggest no adverse events of this herbal preparation in comparison to intranasal corticosteroid spray therapy. [ABSTRACT FROM AUTHOR]

This investigation explored the outcomes of 4 standardized treatments in patients with refractory chronic rhinosinusitis (CRS), despite recent maximal medical therapy (MMT). In a prospective observational study, we compared continued nasal steroids and irrigation (cNSI), repeated MMT (rMMT), pulsed nasal steroid inhalation (PSI), and endoscopic sinus surgery (ESS). Between November 2015 and March 2016, patients with symptomatic CRS despite having received MMT during the year prior to symptom reoccurrence were offered 1 of 4 standardized treatments. Reflecting real-world conditions, patients selected their treatment option following physician counseling. Sino-Nasal Outcome Test-22 (SNOT-22) scores were obtained before treatment, at the end of treatment, and at 2 months and 1 year following treatment. The mean (± standard deviation [SD]) duration since last MMT was 144 (±36 days). Of the 130 patients, 52 selected cNSI, 16 PSI, 19 rMMT, and 43 ESS. Mean SNOT-22 scores before treatment did not significantly differ between treatments (P =.99). Overall, SNOT-22 scores decreased from 38 ± 2 before treatment to 20 ± 2 after 1 year (P <.001), with a higher reduction for patients having CRS with nasal polyps than for those without nasal polyps (35 ± 2 to 15 ± 2 vs 41 ± 3 to 25 ± 4, respectively; both P <.001). Overall, no difference between the 3 medical treatments was observed (all P >.2). Post-treatment scores following ESS (19 ± 2) were significantly lower than for each of the 3 medical treatments (cNSI 26 ± 2, P =.004; PSI 27 ± 3, P =.026; rMMT 28 ± 3, P =.008). At 1 year following ESS, 26 of 31 patients were asymptomatic and did not require additional systemic steroids, compared to 25 of 50 patients following medical treatment (P =.002). The investigated standardized treatments significantly improved SNOT-22 scores in patients with refractory CRS under real-world conditions. Both patients having CRS with and those without nasal polyps showed significant improvement in SNOT-22 scores, although a less profound effect was found among the latter group. Patients who selected ESS were less symptomatic during the first follow-up year than patients who selected medical treatment alone. Patients with refractory CRS did not benefit from an additional course of MMT in comparison to those who were treated only with cNSI. [ABSTRACT FROM AUTHOR]

Invasive fungal sinusitis often occurs in patients with immune deficiency. We can group fungal sinusitis under 4 groups. Invasive forms: 1-Acute (Fulminant) 2-Chronic (Indolent). Non-invasive forms are 3-Mycetoma and 4- Allergic fungal sinusitis..Invasive fungal sinusitis is generally seen in immunocompromised patients. Diabetes mellitus and leukemia are the most common underlying pathologies, respectively. Delayed diagnosis and inadequate treatment can be mortal, especially for invasive forms. In this case report, the management of a patient with invasive fungal sinusitis, who was referred to us due to unilateral preseptal edema developing during hospitalization for diabetic ketoacidosis treatment, is presented in the light of the current literature. [ABSTRACT FROM AUTHOR]

Purpose: Acute upper respiratory tract infections are the most common infections in infants and children. Saline nasal irrigation (SNI) is widely prescribed and recommended. We conducted a systematic review to assess the efficacy and safety of SNI in infants and children with acute rhinopharyngitis.Methods: We searched CENTRAL, Medline, Embase and clinicalTrials.gov. Two authors selected randomized control trials (RCTs), including infants ≥3 months and children ≤12 years, comparing the use of isotonic saline solutions, whatever their mode of administration, with one therapeutic abstention, or a therapy deemed less important for nasal lavage. Trial quality was assessed independently by two authors, who, with a third author, extracted and analysed data. Statistical analysis was conducted using Comprehensive Meta-Analysis software. The standard difference in means (SMD) between groups and its 95% confidence interval were estimated.Results: Four RCTs (569 participants) were included. The analysis showed a benefit of SNI for certain clinical rhinological symptoms (SMD = -0.29 [-0.45; -0.13]) but no significant improvement of respiratory symptoms (SMD = -0.19 [-0.70; 1.08]) or health status (SMD = -0.30 [-0.68; 0.07]). Its use appeared to limit the prescription of other treatments, whether local or systemic, and particularly antibiotics. Long-term use led to a decrease in the incidence of acute rhinosinusitis and its complications. SNI appeared to be a safe treatment.Conclusions: SNI is beneficial for rhinological symptoms but not respiratory symptoms. Further research is needed to address the full benefits/risks of this treatment. [ABSTRACT FROM AUTHOR]