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Schwannomas of the sinonasal tract are rare, accounting for

Objective: To identify the differences in cytokine expression between sinonasal tissue from patients treated with Leptospermum (Manuka) honey (LH) irrigation versus normal saline irrigation twice-daily for twelve weeks following sinus surgery (FESS). Methods: Forty-six CRS patients were recruited. Sinus tissue biopsies were collected during FESS and then at 5 and 12 weeks postoperatively during the course of treatment. A multiplex cytokine assay quantified the abundance of 17 cytokines in biopsied tissue. Cytokine expression fold-change was analyzed between each time point using a robust linear regression model and compared between the two treatment groups. Results: Compared to the saline irrigation group, five cytokines were differently expressed (CI = 95%) in sinonasal tissue obtained from subjects in the LH irrigation group during the 12-week treatment period. Cytokines IL-6 (P = 0.0400), IL-8 (P = 0.0398), MCP-1 (P = 0.0284), and MIP-1β (P = 0.016) were significantly increased in the LH irrigation group compared to the saline irrigation group. IL-13 was significantly increased in the saline irrigation group compared to the LH group (P = 0.0086). Conclusion: LH may potentially act to modulate the expression of IL-6, IL-8, IL-13, MCP-1 and MIP-1β in sinonasal tissue. Key words: Leptospermum honey; Sinusitis; Inflammation; Postoperative care; Irrigation

We assess the literature on different medical treatment options and their effectiveness in chronic rhinosinusitis (CRS). Although there is significant overlap in the management of CRS, not all therapies are equally effective within CRS phenotypes. CRS is one of the most common chronic health problems affecting a large proportion of adult population and generating significant economic implications. Despite an unclear pathophysiology of this complex disorder, it is widely recognised that surgery alone does not resolve the chronic inflammation and that ongoing medical treatment remains the key to the successful management of patients with CRS.

BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous group of inflammatory sinonasal disorders with key defining symptoms, but traditionally separated into phenotypes by clinical/endoscopic findings. It is not known whether the two phenotypes have differing socioeconomic, comorbidity, and lifestyle differences. This analysis of the Chronic Rhinosinusitis Epidemiology Study (CRES) database sought to analyze any key differences in the socioeconomic variables between those with CRS with nasal polyps (CRSwNPs) and those without nasal polyps (CRSsNPs). We also sought to analyze differences in comorbidities, lifestyle, and quality of life. METHODS Patients with a confirmed diagnosis of CRS in secondary and tertiary care outpatient settings in the UK were invited to participate in a questionnaire-based case-control study. Variables included demographics, socioeconomic factors, comorbidities, lifestyle factors, and health-related quality of life (HRQoL) (level 3 evidence). RESULTS A total of 1204 patients' data were analyzed: 553 CRSsNP and 651 CRSwNP participants. The key socioeconomic variables did not demonstrate any notable differences, nor did lifestyle variables other than alcohol consumption being higher in those with CRSwNP (P = .032), but the latter was not significant after adjusting for age and sex. Aside from confirmation of asthma being more common in CRSwNP, it was notable that this group complained less of upper respiratory tract infections (URTIs), and CRSsNP participants showed evidence of worse HRQoL scores in respect of body pain (P = .001). CONCLUSIONS Patients with CRSwNP experience higher rates of asthma and lower rates of URTIs; patients with CRSsNP have worse body pain scores. Otherwise, there are no demonstrable significant socioeconomic, comorbidity, lifestyle, or quality of life differences between the two phenotypes. LEVEL OF EVIDENCE 3 Laryngoscope, 131:2179-2186, 2021.

Importance The negative association of smoking with the respiratory tract is well known; however, the association between smoking and chronic rhinosinusitis (CRS) has not been well characterized. Objective To analyze whether active smoking was a risk factor for CRS development, smoking was associated with disease-specific quality of life, and smokers experience an increased symptom burden than nonsmokers. Design, setting, and participants This subanalysis of the Chronic Rhinosinusitis Epidemiology Study (CRES), a prospective, questionnaire-based case-control study conducted between October 2007 and September 2013 was conducted across 30 UK tertiary/secondary care sites. Participants were identified at ear, nose, and throat outpatient clinics and classified into CRS phenotypes as per European Position Paper on Rhinosinusitis and Nasal Polyps 2012 criteria. The overall response rate of those identified to take part in the study was 66%. A total of 1535 questionnaires were returned, with 1470 considered eligible for inclusion. Data analysis was conducted in January 2020. Main outcomes and measures The CRES was designed to distinguish differences in socioeconomic status, geography, medical comorbidities, lifestyle, and quality of life between patients with CRS and healthy controls. Results A total of 1450 patients completed the smoking question, comprising 219 controls (15.1%; mean [SD] age, 47.3 [14.9] years; 143 women [68%]), 546 participants with CRS (37.7%; mean [SD] age, 51.8 [15.3] years; 259 women [53%]) without nasal polyps (CRSsNPs), and 685 participants (47.2%; mean [SD] age, 56.0 [14.5] years; 204 women [33%]) with CRS and nasal polyps/allergic fungal rhinosinusitis (CRSwNPs+). The mean age was similar, with a greater female preponderance in the control group and male in the CRSwNP group. The greatest number of active smokers was found among control participants (33 [15%]), with a lower rate of smokers in the patients with CRSwNPs+ (9.9%) and CRSsNPs (13.9%), respectively. We found a clinically significant difference in the mean difference in Sino-nasal Outcome Test (SNOT-22) scores between active smokers and nonsmokers for both CRS phenotypes (4.49, 12.25). In both CRS subgroups active smokers had significantly worse SNOT-22 scores than nonsmokers by a mean (SD) magnitude of 10 (18.99, 24.14) points. Nonsmokers also demonstrated a higher percentage of surgical procedures (1 or more), although this was not clinically or statistically different (0.34, 1.10). Conclusions and relevance This questionnaire-based case-control study demonstrated a clinically significant symptom burden associated with active cigarette smoking, with worse SNOT-22 scores in the smoking cohort by a mean magnitude of 10 points. We could find no demonstrable evidence that smoking increases the likelihood of need for revision sinus surgery. Clinicians should encourage smoking cessation alongside general CRS medical management.

Background: Chronic rhinosinusitis (CRS) is a heterogenous group of inflammatory sinonasal disorders with key defining symptoms, but traditionally separated into phenotypes by clinical/endoscopic findings. It is not known if the two phenotypes have differing socioeconomic, co-morbidity and lifestyle differences. Objective: This analysis of the Chronic Rhinosinusitis Epidemiology Study (CRES) database sought to analyse any key differences in the socioeconomic variables between those with CRS with nasal polyps (CRSwNPs) and those without nasal polyps (CRSsNP). We also sought to analyse differences in comorbidities, lifestyle and quality of life. Methods: Patients with a confirmed diagnosis of CRS in secondary and tertiary care outpatient settings were invited to participate in a questionnaire based case-control study. Variables included demographics, comorbidities, socioeconomic factors, lifestyle factors and health related quality of life. Results: A total of 1204 patients’ data were analysed; 553 CRSsNP and 651 CRSwNP participants. The key socioeconomic variables did not demonstrate any notable differences, nor did lifestyle variables other than alcohol consumption being higher in those with CRSwNP (p=0.032). Aside from confirmation of asthma being more common in CRSwNP, it was notable that this group complained less of URTIs and CRSsNP participants showed evidence of lower HRQoL scores in respect of body pain (p=0.001). Conclusions: Patients with CRSwNP experience higher rates of asthma and lower rates of URTIs but otherwise do not demonstrate significant socioeconomic, comorbidity, lifestyle or quality of life issues other than for body pain and alcohol consumption.

Tumour-to-tumour metastasis is a rare phenomenon. It occurs when a primary tumour is a recipient of a separate tumour within the same individual. We present a case of a 66-year-old woman with known breast cancer who presented with one-sided nasal symptoms. Examination and imaging revealed a unilateral polyp arising from the skull base. She underwent endoscopic polypectomy with the histology demonstrating tumour-to-tumour metastasis from a breast carcinoma to an olfactory neuroblastoma, a rare sinonasal tumour. Clinicians should be cautious of distant metastases in any patient presenting with head and neck symptoms and a known primary tumour. This is the first documented case of this type.

In late 2019 a novel coronavirus, SARS-CoV-2 causing Coronavirus disease 2019 (COVID-19) appeared in Wuhan China, and on 11th March 2020 the World Health Organisation declared it to have developed pandemic status. In early SARS-CoV-2 infection, viral titres of greater than 107/mL in saliva and nasal mucous can be found; minimisation of these titres should help to reduce cross infection. Povidone-iodine (PVP-I) disinfectant has better anti-viral activity than other antiseptics and has already been proven to be an extremely effective virucide in vitro against severe acute respiratory syndrome and Middle East respiratory syndrome coronaviruses (SARS-CoV and MERS-CoV). Its in vivo virucidal activity is unknown, but it retains its antimicrobial activity against bacteria in vivo intraorally and one application can reduce oral microbial flora for greater than 3 hours. PVP-I disinfectant has been shown to be safe when administered to the nasal cavity and as a mouthwash. We propose a protocolised intra-nasal and oral application of PVP-I for both patients and their attendant healthcare workers (HCWs) during the current COVID-19 pandemic to help limit the spread of SARS-CoV-2 from patients to healthcare workers and vice versa. The aim is to reduce the viral ‘load’ in two of the key areas from where droplets and aerosols containing the virus are expectorated (the lower respiratory tract being the other). The aim of use in HCWs is to destroy virus that has entered the upper aerodigestive tract before it has the opportunity to infect the host. We suggest the protocol is considered for routine use during the care of COVID-19 patients, particularly before any procedure that involves the upper aerodigestive tract, including intubation, nasal and oral procedures, endoscopy and bronchoscopy. We suggest it should be considered when such procedures are carried out in all patients during the pandemic regardless of COVID-19 status, due to the reported significant rates of asymptomatic infection The total iodine exposure proposed is well within previously recorded safe limits in those without contraindications to its use. The intervention is inexpensive, low risk and potentially easy to deploy at scale globally. We acknowledge that the proposal we present extrapolates in vitro finding into the in vivo setting and that assumptions are made that under normal circumstances we would confirm with in vivo data prior to recommendations for use. However, given the strength of in vitro evidence and the low risk, minimal cost and global applicability of the proposed intervention, which amounts to disinfection of the oro/nasal cavities, we feel that there is little to lose and potentially much to gain.

Endometrial carcinoma is the fourth most common cancer affecting women in the UK. Its most frequent sites of spread are to the pelvic and para-aortic lymph nodes, vagina and peritoneum. We report a case of a 63-year-old woman with known endometrial cancer who presented with left facial swelling and eye displacement. Investigations revealed an expansile soft-tissue density mass arising within the bone, centred on the left zygoma, with exophytic extension into the left maxillary antrum, infratemporal fossa and inferiorly into the orbit. Endoscopic biopsies were taken and histology confirmed metastatic deposits of endometrial cancer. Clinicians should be aware that distant spread of endometrial cancer is linked with advanced disseminated disease and palliative treatments should be considered.

Background: The Sinonasal Outcome Test (SNOT-22) has been used as a patient reported outcome measure to grade symptom severity before and after treatment for chronic rhinosinusitis (CRS). Methodology: This analysis uses data from the CRS Epidemiology Study (CRES). The overarching aim of CRES was to determine factors that influence the onset and severity of CRS. A study-specific questionnaire including SNOT-22 was distributed to patients with CRS attending ENT clinics across 30 centres in the United Kingdom. The aim of this analysis was to compare SNOT-22 scores between those with different types of CRS to determine any differences present in the total score or the subdomains and to assess whether any differences varied according to gender. Results: There were a total of 1249 CRS participants in the following subgroups: CRS without nasal polyps (CRSsNPs) (n=553), CRS with nasal polyps (CRSwNPs) (n=651), allergic fungal rhinosinusitis (AFRS) (n=45). Since there were differing gender ratios in each subgroup, males and females were analysed separately. The mean and standard deviation for SNOT-22 was: males CRSsNP 41.1 (21.0), CRSwNP 41.7 (20.5); females CRSsNP 49.6 (19.7), CRSwNP 49.5 (22.9). In the nasal domain, those with CRSwNP recorded a higher score than those with CRSsNP; for males 18.1 (8.1) vs. 15.9 (7.9); for females 19.6 (8.0) vs 16.7 (7.5) (p

Introduction Surgical procedures incorporating a cosmetic element such as septorhinoplasty and otoplasty are currently under threat in the National Health Service (NHS) as they are deemed to be procedures of ‘limited clinical benefit’ by many primary care providers. Patient reported outcome measures (PROMs), which assess the quality of care delivered from the patients’ perspective, are becoming increasingly important in documenting the effectiveness of such procedures. Methods The Rhinoplasty Outcomes Evaluation (ROE) questionnaire, a validated PROM tool, was used to assess patient satisfaction in 141 patients undergoing septorhinoplasty surgery over a 90-month period at the University Hospital Southampton NHS Foundation Trust. Results Overall, 100 patients with a mean follow-up period of 36 months completed the study. The mean ROE score was 73.3%. In addition, 75% of patients questioned were happy with the final result of their operation and 83% would undergo the procedure again if required. These benefits occurred irrespective of age, sex and primary versus revision surgery, and were maintained for up to 71 months following surgery. Conclusions This study has shown that patients are generally satisfied with their functional and cosmetic outcomes following septorhinoplasty surgery. These results help support the case for septorhinoplasty surgery to continue being funded as an NHS procedure.

Objectives:There is currently conflicting level 1 evidence in the use of long-term antibiotics for chronic rhinosinusitis without nasal polyps. The primary aim of this feasibility study was to optimise future randomised trial design by assessing recruitment and retention of patients alongside providing preliminary data on symptomatic control. Design: Prospective, multi-centre feasibility (cohort) study with all patients receiving macrolide therapy for 12-weeks and a further subsequent 12-week follow-up. Participants received a 12-week course of Clarithromycin 250mg alongside twice daily topical Mometasone and nasal douching. Primary outcomes focused on recruitment, retention and compliance. Clinical and quality-of-life outcomes measures were also recorded. Setting: Patients were prospectively recruited from 6 UK outpatient clinics. Participants: Adult patients with chronic rhinosinusitis without nasal polyps and no prior endoscopic sinus surgery underwent baseline assessment and then follow-up at 3 and 6 months. Main outcome measures: Six-month recruitment and retention data. Results: Over 13 months, 55 adults were recruited from 5 centres. Four patients declined participation. 75% of patients were retained within the study. Dropouts included 1 medication contraindication, 3 unable to tolerate medication, 10 not attending full follow-up. Sino Nasal Outcome Test-22 and endoscopic scores showed statistically significant improvement. No other clinical or quality-of -life assessment improvements were seen. Conclusion: Retention and recruitment to a trial using long-term Clarithromycin to treat chronic rhinosinusitis without nasal polyps is achievable and this data will support a future Randomised Controlled Trial. The study provides vital insight into trial design thus informing UK research networks and rhinology researchers internationally.

Background: There are generally two methods to access the sphenoid sinus: either through the natural ostium {trans-sphenoethmoidalor via sphenoethmoidal recess), or by creating a second opening through the posterior ethmoids (trans-ethmoidal).This study psychophysically and subjectively evaluates the effect of the trans-sphenoethmoidal technique to the trans-ethmoidal technique for sphenoid sinusotomy on olfactory function. Methods: Prospective cohort analysis of 48 patients with comparable sinus disease underwent primary sphenoidotomy via transsphenoethmoidal(n = 24) versus trans-ethmiodal (n = 24) technique between September 2011 and February 2012. The patients had their olfaction measured psychophysically with "Sniffin' Sticks" and subjectively with a visual analogue scale (VAS) pre-operatively and at 5 weeks post-operatively. Results: Psychophysical scores from the Sniffin' sticks provide a Threshold, Discrimination and Identification (TDI) score out of 48.The TDI change (post-operative TDI score minus pre-operative score) as well as VAS change (post-operative VAS minus pre-operativeVAS) were analyzed using t-test analysis, which showed no significant difference between the two measurements. Conclusion: If the trans-sphenoethmoidal technique is done meticulously, patients have the same olfactory relief, psychophysically and subjectively, as those undergoing the trans-ethmoidal technique.

Objectives:There is currently conflicting level 1 evidence in the use of long-term antibiotics for chronic rhinosinusitis. The primary aim of this study was to look at recruitment and retention of patients in preparation for a formal trial. The aim of this paper is to describe the preliminary outcomes in terms of symptomatic relief in patients with CRSsNP.Methods:Adult patients fulfilling the EPOS criteria for CRSsNPs with no prior surgery were recruited in 6 UK centers during 2013. Participants received a 12-week course of clarithromycin 250 mg alongside topical mometasone and nasal douching, all twice daily. Follow-up was at 3 months and 6 months. For the purpose of this analysis, the Sinonasal Outcome Test (SNOT-22) score was recorded at baseline and both follow-up assessments.Results:Preliminary data from 29 patients at 3 months and 24 patients at 6 months showed significant symptomatic improvement in mean SNOT-22 scores on paired t tests at 3 months (40.4 to 33.7, P = .026), which was sustained at 6 ...

The objectives of this study were as follows: (1) to evaluate frontal sinus ostial patency following balloon dilation with the Ventera Sinus Dilation System, compared with frontal sinusotomy (Draf 2a); and (2) to compare mean blood loss and mean surgical time for frontal sinusotomy using balloon dilation compared with traditional surgical methods.A single blinded, randomized, controlled, prospective study was performed at St. Paul's Sinus Center, Vancouver, a tertiary referral rhinology center. Thirty patients undergoing functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS) were randomized to a hybrid approach with exposure of the frontal recess using standard instrumentation and then balloon dilation of 1 frontal sinus drainage pathway and traditional frontal sinusotomy for the opposite side. Blood loss and surgical time for opening the frontal sinus drainage pathway was recorded for each side. Patients acted as their own controls. Ostial patency and size were assessed 5 weeks and 3 months postoperatively using endoscopy. Ostial patency was also recorded at 1 year following surgery.All frontal sinus ostia in both groups (n = 30) were successfully opened and were patent with both techniques 3 months postoperatively. All frontal sinus ostia assessed at 1 year (73%) remained patent and none required revision frontal surgery. Balloon dilation showed a mean surgical time of 655 seconds compared to 898 seconds for traditional FESS (p = 0.03). Mean blood loss was less with balloon dilation (58 mL vs 91 mL; p = 0.008).A hybrid balloon technique successfully dilates the frontal sinus drainage pathway with reduced blood loss. Also, short-term patency appears to be comparable to traditional frontal sinusotomy.

Objective: 1) To evaluate frontal sinus ostia patency after balloon dilation with the Ventera Sinus Diltation System (which has not been tested before) compared with traditional frontal sinusotomy. 2) To compare the mean blood loss and the mean surgical time for frontal sinusotomy during balloon dilatation compared with traditional methods.Method: A single-blinded, randomized, controlled, prospective study of 30 patients will be conducted. Patients undergoing FESS for chronic rhinosinusitis are randomized to balloon dilation of 1 frontal sinus and traditional frontal sinusotomy on the opposite sinus. Patients act as their own controls. Ostial patency and size will be assessed 5 weeks, 3 months, and 6 months postoperatively using endoscopy and curved suctions.Results: Our initial results in 19 patients are promising. All frontal sinus ostia in both groups were successfully opened and 100% were patent with both techniques at 5 weeks and 3 months postoperatively. Balloon dilatation shows a mean surgical time...