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The epithelial immune regulation is an essential and protective feature of the barrier function of the mucous membranes of the airways. Damage to the epithelial barrier can result in chronic inflammatory diseases, such as chronic rhinosinusitis (CRS) or bronchial asthma. Thymic stromal lymphopoietin (TSLP) is a central regulator in the epithelial barrier function and is associated with type 2 (T2) and non-T2 inflammation.The immunology of chronic rhinosinusitis with polyposis nasi (CRSwNP) was analyzed in a literature search, and the existing evidence was determined through searches in Medline, Pubmed as well as the national and international study and guideline registers and the Cochrane Library. Human studies or studies on human cells that were published between 2010 and 2020 and in which the immune mechanisms of TSLP in T2 and non-T2 inflammation were examined were considered.TSLP is an epithelial cytokine (alarmin) and a central regulator of the immune reaction, especially in the case of chronic airway inflammation. Induction of TSLP is implicated in the pathogenesis of many diseases like CRS and triggers a cascade of subsequent inflammatory reactions.Treatment with TSLP-blocking monoclonal antibodies could therefore open up interesting therapeutic options. The long-term safety and effectiveness of TSLP blockade has yet to be investigated.

Background Non-steroidal anti-inflammatory drugs (NSAIDs)-exacerbated respiratory disease (N-ERD) complicates the clinical course of chronic rhinosinusitis with nasal polyps (CRSwNP) and severe asthma. We aimed to determine the detection rate of NERD in patients with CRSwNP, asthma, and history of NSAID intolerance using nasal challenge with acetylsalicylic acid (ASA) and the relationship between the severities of response to ASA challenges and the grade of N-ERD. Materials and methods Three groups of patients were included: CRSwNP with asthma and clinical history of analgesics intolerance (CRSwNP-AAI n = 18), CRSwNP with asthma but without a clinical history of analgesics intolerance (CRSwNP-A n = 20), and CRSwNP without asthma or analgesics intolerance (n = 18). All subjects were challenged nasally with 16 mg ASA and monitored with active anterior rhinomanometry. Rhinological (nasal polyp score), pulmonary (spirometry, Asthma Control Test (ACT), and asthma treatment), and psychometric questionnaire scores were recorded and correlated with rhinomanometric data following nasal challenges (flow depressions and symptom scores). Results Nasal ASA challenge detected N-ERD in 96.7% of CRSwNP-AAI patients and 45% of CRSwNP-A patients. No N-ERD was seen in the CRSwNP group. The control grade of asthma measured with ACT scores was significantly lower in the groups CRSwNP-AAI (MV 18.22) and CRSwNP-A (MV 19.75) when compared to the CRSwNP group (MV 24.39) (p = 0.000). In the CRSwNP-AAI group, 11 patients had uncontrolled asthma (61%), and in the CRSwNP-A group, 9 patients had uncontrolled asthma (45%). No correlation was found between rhinology and pulmonary parameters, nasal symptoms, and the severity of nasal ASA challenges. Specific reactions were detectable under the therapy of prednisolone and omalizumab. Conclusion N-ERD might not always be detected by screening a patient's medical history. Nasal ASA challenges are recommended in patients with CRSwNP and asthma. The nasal challenge with ASA positively confirms the N-ERD diagnosis. Moreover, N-ERD is a differential diagnosis in patients with severe asthma with the need for prednisolone or omalizumab therapy. The severity of the reaction to the ASA challenge in controlled and uncontrolled asthma patients is independent of the grade of N-ERD. .

A patient with severe CRSwNP, asthma, and NSAIDS received dupilumab treatment. Three weeks after therapy onset, the patient was diagnosed with Covid-19, had a mild course of the disease, and fully recovered from the infection.

The objective of this study was to evaluate the outcome of cochlear implantation in elderly patients (80 or older) with progressive bilateral deafening. The measured outcomes included the quality of life, speech understanding, tinnitus distress, stress level, anxiety, and depressiveness.Prospective cohort study.Seventeen 80+ years (mean 82.9 ± 2.7 years) patients with progressive, postlingual, bilateral deafness were unilaterally implanted with multichannel cochlear implants. Data about their health-related quality of life (Nijmegen Cochlear Implantation Questionnaire) and their comorbidities were collected using specific validated questionnaires (tinnitus questionnaire, General Anxiety Disorder-7, Depression Scale, Perceived Stress Questionnaire). The speech understanding was assessed with the Freiburg Monosyllabic Test, whereas the subjective hearing was evaluated with the Oldenburg Inventory.After the surgery, not only the subjective hearing but also health-related quality of life, speech understanding, and tinnitus distress of the implanted patients improved significantly. The perceived stress, general anxiety, and depressiveness were low or normal prior and after surgery.This study demonstrates a significant improvement in the quality of life and speech understanding in a group of elderly patients who underwent cochlear implantation. An additional positive indicator of a promising hearing rehabilitation was a significant improvement of the tinnitus distress. Perceived stress level, general anxiety, and the depressiveness of implanted patients were low and remained unaffected.4. Laryngoscope, 126:2811-2816, 2016.