Distinct subsets of innate lymphoid cells in nasal polyp.

BACKGROUND: Group 2 innate lymphoid cells (ILC2s) contribute to the pathogenesis of eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNPs). However, the role of other subsets of ILCs and the differentiation of ILCs in CRSwNPs is not well understood. This study aimed to characterize the ILC subsets and evaluate the differentiation of ILCs from ILC precursors (ILCPs) in NP tissue. METHODS: ILC subsets and ILCPs were evaluated by flow cytometry in fresh sinonasal mucosa from patients with CRSwNPs and control subjects. Subsets were compared based on clinical variables and immunological features of the patients. Sorted ILCPs (Lin-CD127+CD117+CD45RA+IL1R1+) were cultured with cytokines. RESULTS: The frequency of ILC1s and IFN-γ-producing ILC1s increased in non-eosinophilic NPs, whereas that of ILC2s and IL-5-producing ILC2s increased in eosinophilic NPs, particularly in patients with comorbid asthma. The frequency of ILC1s and IFN-γ-producing ILC1s, and frequency of ILC2s and IL-5-producing ILC2s positively correlated with that of neutrophils and eosinophils, respectively. The proportion of IFN-γ-producing ILC1s positively correlated with clinical severity and levels of IFN-γ and IL-8. The proportion of IL-5-producing ILC2s positively correlated with levels of IL-5, CCL24, and total IgE. ILCPs were identified in NP tissue and differentiated into IFN-γ-producing or IL-5-producing ILCs in response to increased IL-12 and IL-18 or IL-25 and IL-33 in non-eosinophilic NPs and eosinophilic NPs, respectively. CONCLUSIONS: ILC1s and ILC2s may be associated with neutrophilic and eosinophilic inflammation in CRSwNPs, respectively. In addition, ILCPs located in the sinus mucosa could differentiate into IFN-γ- or IL-5-producing cells in response to local cytokine stimuli.

Effect of olfactory bulb atrophy on the success of olfactory training.

PURPOSE: To evaluate the success of olfactory training in patients with olfactory loss and olfactory bulb (OB) atrophy detected on magnetic resonance imaging (MRI) and other characteristics. METHODS: This study included 48 patients with olfactory loss who underwent a nasal endoscopic examination and MRI before olfactory training. The Korean Version of the Sniffin' Sticks Test was performed before and after training. The olfactory training success was defined as an improvement of more than 6 points in the Threshold-Discrimination-Identification (TDI) score. Patient characteristics and OB atrophy pre-training were compared between successful and unsuccessful groups. RESULTS: The etiology of olfactory loss included respiratory viral infection in 30 (62.5%), trauma in 10 (20.8%), and idiopathic loss in 8 (16.7%) patients. Twenty-three (47.9%) of 48 patients exhibited successful olfactory training. Etiology, age, gender, and symptom duration were not different between unsuccessful and successful groups. Pre-training discrimination, identification, and TDI scores were significantly different between unsuccessful and successful groups (P < 0.05). Success rate of patients with bilateral OB atrophy was significantly lower than that of patients with unilateral OB atrophy and normal morphology (P = 0.006). OB height was significantly lower in the unsuccessful group than in the successful group (P < 0.05). Bilateral OB atrophy was an independent risk factor for failure of olfactory training according to the multivariate analysis. CONCLUSION: Olfactory loss patients with bilateral OB atrophy may not be able to improve olfactory function after olfactory training.

Human rhinovirus serotypes induces different immune responses.

BACKGROUND: Different species of human rhinovirus (HRV) can induce varied antiviral and inflammatory responses in human blood macrophages and lower airway epithelium. Although human nasal epithelial cells (HNECs) are a primary infection route of HRV, differences between major and minor groups of HRV in the upper airway epithelium have not been studied in detail. In this study, we investigated viral replications and immune responses of major and minor groups of HRV in the HNECs. METHODS: Viral replication, immune responses of IFN-ß, IFN-λ, proinflammatory cytokines, and viral receptors, and mRNA expression of transcription factors of HRV16 (major group) and HRV1B (minor group) in the HNECs were assessed. RESULTS: Compared with HRV16, HRV1B replicated more actively without excessive cell death and produced higher IFN-ß, IFN-λ1/3, CXCL10, IL-6, IL-8, and IL-18 levels. Furthermore, low-density lipoprotein receptor (LDLR), TLR3, MDA5, NF-κB, STAT1, and STAT2 mRNA levels increased in HRV1B-infected HNECs. CONCLUSION: HRV1B induces a stronger antiviral and inflammatory response from cell entry to downstream signaling compared with HRV16.

Concurrent diagnosis of sinus fungus ball and invasive fungal sinusitis: A retrospective case series.

BACKGROUND: Sinus fungal ball (SFB) is the most common type of non-invasive fungal sinusitis and develops mostly in immunocompetent individuals, whereas invasive fungal sinusitis (IFS), with high mortality, develops mostly in immunocompromised patients. SFB may progress to IFS depending on the patient's immune status and underlying diseases. OBJECTIVES: To investigate the possibility of SFB progressing to IFS. PATIENTS/METHODS: A total of 10 patients histopathologically diagnosed with concurrent IFS and SFB from January 2013 to December 2019 were enrolled. Their clinical characteristics, histopathology and clinical course information were obtained and compared with those of 56 patients with IFS alone and 617 patients with SFB alone. RESULTS: Acute, chronic and chronic granulomatous IFS was diagnosed in two (20%), five (50%) and three (30%) patients, respectively. All patients had severe facial pain and/or headache, with the most common comorbidity being diabetes (n = 5, 50%). SFB was identified in the maxillary (60%) and sphenoid (40%) sinuses. The tissue culture was positive for Aspergillus species in five (50%) patients. Eight patients with chronic or chronic granulomatous IFS were successfully treated by debridement with voriconazole, and the two patients with acute IFS and severe neutropenia due to haematologic malignancy died. Compared to patients with IFS alone, patients with combined SFB and IFS were older, female dominant, and commonly had chronic or chronic granulomatous IFS. In addition, they were older and more commonly diabetic and immunocompromised than patients with SFB alone. CONCLUSIONS: SFB may progress to IFS particularly in elderly and immunocompromised patients.

Image findings in patients with chronic invasive fungal infection of paranasal sinuses.

OBJECTIVES: More clear classification of chronic invasive fungal infection of paranasal sinuses in the clinical presentation, radiologic findings, and pathology is needed. To describe the imaging findings of patients with chronic invasive fungal sinusitis (CIFS) and chronic granulomatous invasive fungal sinusitis (CGIFS). METHODS: Eleven patients with CIFS or CGIFS between January 2014 and July 2019 were included in this retrospective study. The demographic, pathologic, and imaging characteristics of the included patients were reviewed by rhinologist, pathologist, and radiologist, respectively. In terms of imaging analysis, overall lesions were categorized as diffuse infiltrative and mass-forming patterns. RESULTS: Among eleven patients, ten patients were aged ≥ 60 years (mean age 74.2 years) and nine had hypertension and/or diabetes mellitus. Aspergillus species were the most common pathogens (82%). Of the seven patients with CIFS, five (71%) had diffuse infiltrative patterns and two (29%) had mass-forming patterns, whereas all four patients (100%) with CGIFS had a mass forming pattern. All 11 patients showed both bony erosion and sclerosis. Almost all proven pathologic sites showed predominantly intermediate to high signal intensity on T1WI. CONCLUSIONS: CIFS or CFIFS showed chronic course of rhinosinusitis in the patients with old age, imaging findings of bone erosion and sclerosis, and imaging patterns of diffuse infiltration or mass formation.

Development of a mouse model of eosinophilic chronic rhinosinusitis with nasal polyp by nasal instillation of an Aspergillus protease and ovalbumin.

One subtype of chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by the development of a T-helper type 2 (Th2) response and eosinophilic infiltration. Here, we aimed to establish an eosinophilic CRSwNP murine model, which would be essential to understand the underlying pathogenesis and establish a treatment strategy. C57BL/6 mice were challenged intranasally with a mixture of an Aspergillus oryzae-derived protease (AP) and ovalbumin (OVA) for 6, 8, or 12 consecutive weeks (12 mice/group); control mice received the same volume of phosphate-buffered saline for 12 weeks (n = 12). Sinonasal samples were evaluated histologically, and interleukin (IL)-4, IL-5, IL-13, eotaxin, keratinocyte chemoattractant, and macrophage inflammatory protein-2 mRNA levels in sinonasal mucosa were measured by real-time PCR. Protein levels of Th2 cytokines, INF-γ, IL-17A, and chemokines in nasal lavage fluid, and total serum IgE were measured by ELISA. Greater eosinophil infiltration in the subepithelial layer was observed in the challenged groups, compared with the control group. Polypoid mucosal lesions were predominantly observed in the 12-week group, which also exhibited mucosal thickening on micro-CT scans. The IL-4, IL-5, and IL-13 mRNA and protein levels were elevated in the sinonasal mucosa and nasal lavage fluid. INF-γ and IL-17A were undetectable or not elevated relative to the control group levels. In contrast, eotaxin levels were particularly elevated in the sinonasal mucosa and nasal lavage fluid in the 12-week group. In conclusion, intranasal AP and OVA exposure successfully induced Th2-specific CRSwNP in a murine model.

Natural Killer Cell Deficits Aggravate Allergic Rhinosinusitis in a Murine Model.

OBJECTIVE: Defective innate immune functions can contribute to chronic rhinosinusitis (RS). Recently, it has been reported that chronic RS patients show impaired function of natural killer (NK) cells. We investigated the role of NK cells in eosinophilic inflammation in an allergic RS mouse model. METHODS: Mice sensitized to ovalbumin (OVA) by intraperitoneal injection received nasal challenges with OVA for 5 weeks. NK cell depletion was achieved by intraperitoneal injections of anti-asialo ganglio-N-tetraosylceramide (ASGM1) antibodies 10 days before OVA sensitization and every 5 days thereafter until sacrifice. Sinonasal complex samples were evaluated histologically, and IL-4, IL-5, IL-13, IFN-γ, MIP-2, and eotaxin levels were measured in the nasal lavage fluid. Differential white blood cell counts were also obtained. RESULTS: Allergic RS mice showed significantly more eosinophilic inflammation in the sinonasal mucosa, elevated levels of IL-4, IL-5, IL-13, and eotaxin in the nasal lavage fluid, and peripheral blood eosinophilia compared to control mice. The depletion of NK cells by anti-ASGM1 treatment induced more prominent eosinophilic inflammation and increased secretion of IL-5 and peripheral blood eosinophilia in allergic RS mice. CONCLUSION: The depletion of NK cells aggravates allergen-induced sinonasal eosinophilic inflammation, suggesting that impaired NK cell activity may be an exacerbating factor in eosinophilic chronic RS.

Interleukin-1 (IL-1) signaling in intestinal stromal cells controls KC/ CXCL1 secretion, which correlates with recruitment of IL-22- secreting neutrophils at early stages of Citrobacter rodentium infection.

Attaching and effacing pathogens, including enterohemorrhagic Escherichia coli in humans and Citrobacter rodentium in mice, raise serious public health concerns. Here we demonstrate that interleukin-1 receptor (IL-1R) signaling is indispensable for protection against C. rodentium infection in mice. Four days after infection with C. rodentium, there were significantly fewer neutrophils (CD11b+ Ly6C+ Ly6G+) in the colons of IL-1R−/− mice than in wild-type mice. Levels of mRNA and protein of KC/CXCL1 were also significantly reduced in colon homogenates of infected IL-1R−/− mice relative to wild-type mice. Of note, infiltrated CD11b+ Ly6C+ Ly6G+ neutrophils were the main source of IL-22 secretion after C. rodentium infection. Interestingly, intestinal stromal cells isolated from IL-1R−/− mice secreted lower levels of KC/CXCL1 than stromal cells from wild-type mice during C. rodentium infection. Similar effects were found when mouse intestinal stromal cells and human nasal polyp stromal cells were treated with IL-1R antagonists (i.e., anakinra) in vitro. These results suggest that IL-1 signaling plays a pivotal role in activating mucosal stromal cells to secrete KC/CXCL1, which is essential for infiltration of IL-22-secreting neutrophils upon bacterial infection.

Aesthetic Motivation of Geriatric Rhinoplasty The Surgical Outcome.

BACKGROUND: Rhinoplasty in the elderly population has recently emerged as an issue in terms of rejuvenation. There, however, is a paucity of published data on geriatric rhinoplasty in Asian patients. The aims of this study were to investigate the motivation of aged Korean patients to undergo the procedure, and to demonstrate our experience of rhinoplasty in patients of 60 years of age and older. METHODS: A total of 20 patients, 11 men and 9 women, underwent rhinoplasty between December 2003 and September 2012 at the Asan Medical Center. Anthropometric measurements were performed preoperatively and postoperatively. Two independent ENT surgeons viewed photographs to assess the surgical outcomes. Patient satisfaction was graded using a visual analogue scale (from 1 = dissatisfied, to 4 = satisfied) by telephone interview. RESULTS: The rhinoplasty performed in our patient cohort aimed to address deviated nose (30%), postinfectious deformed nose (15%), flat nose (15%), saddle nose (10%), and additional cosmetic rhinoplasty for planned septoplasty (10%). Anthropometric measurements showed statistically significant improvements in nasal tip projection, nasal length, dorsal height, and radix height. The mean satisfaction scores were 2.9 for physicians and 2.5 for patients. Three patients (15%) experienced incomplete improvement of nasal obstruction, and 7 patients (35%) expressed aesthetic dissatisfaction about tip shape or dorsal deviation after rhinoplasty. Three patients (15%) underwent revision rhinoplasty. CONCLUSIONS: The aged patients in this study received rhinoplasty to resolve their long-cherished desires. If elderly patients have no risk of general condition, surgeons do not need to discourage a patient's wish to improve their appearance.

The effects of endoscopic sinus surgery on the postoperative outcomes of open rhinoplasty.

OBJECTIVE: Several studies have advocated concurrent endoscopic sinus surgery and rhinoplasty. However, concerns about increased surgical risk, complications, and unsuccessful cosmetic outcomes following the concurrent procedures have been reported. The aim of this study was to investigate the overall safety of concurrent endoscopic sinus surgery and rhinoplasty and to specifically examine the effect of endoscopic sinus surgery on cosmetic outcomes. METHODS: We retrospectively reviewed 57 patients who underwent concurrent open rhinoplasty and endoscopic sinus surgery (ESS). We then selected a control group of patients, who underwent rhinoplasty only and were matched with a study group for age, sex, external nose deformity, and implant graft material. The postoperative outcomes of the 2 groups were compared. RESULTS: Fifty-seven patients underwent concurrent open rhinoplasty and ESS. Postoperative assessment showed that a successful outcome was achieved in 82.5% of the patients who underwent concurrent procedures and in 87.7% of the patients who underwent rhinoplasty only (P = .56). The rate of revision due to a dissatisfied outcome was 5 patients (8.7%) in the concurrent surgery group and 3 patients (5.3%) in the rhinoplasty-only group (P = .36). Minor complications occurred in 6 patients (10.5%) from the group who underwent the concurrent procedures and 5 patients (8.8%) from the rhinoplasty-only group (P = .76). CONCLUSION: Combined rhinoplasty and endoscopic sinus surgery achieves a similar aesthetic outcome to rhinoplasty only, with no significant increase in rates of revision or complication.

The impact of maxillary dimensions on determining surgical approach of fungal ball in the maxillary sinus.

Endoscopic middle meatal antrostomy (MMA) is commonly used for maxillary sinus (MS) fungal ball removal. For challenging cases involving anterior or inferior recess, an additional inferior meatal approach (IMA) might be needed. We analyzed the differences in MS dimensions on CT scans according to the surgical approach to suggest preoperative variables that could facilitate an additional IMA. CT scans of 281 adult patients who underwent ESS for the MS fungal ball (139 MMA, 62 MMA & IMA) were evaluated for comparative analysis of 8 MS measurements based on the surgical approach. Complete removal was achieved in all cases. Age and sex didn't differ significantly (p > 0.05). The maximum distances between the anterior-posterior walls, the inferior ostium border to the lateral recess, and the ostium to the inferior wall of the MS were statistically greater in the MMA & IMA group compared to the MMA group (p = 0.003, p = 0.005, and p = 0.010, respectively), especially among females. This study underscores the clinical importance of specific measurements-anterior to posterior wall, medial wall to lateral recess, and ostium to inferior wall of the maxillary sinus-for guiding optimal surgical approaches in MS lesions.

Sinonasal Organizing Hematoma: Demographics, Diagnosis, and Treatment Outcomes of 112 patients.

INTRODUCTION: Sinonasal organizing hematoma (OH) is a rare, nonneoplastic lesion that often presents with epistaxis, a reddish mass, and destruction of the involved sinonasal structures. Due to its rarity, the demographics, diagnostic modalities, treatment strategies, and outcomes have not yet been studied in a large, long-term study. MATERIALS AND METHODS: Retrospect cohort of 112 sinonasal OH patients treated between 1997 and 2020 in a tertiary, university hospital were evaluated. Demographics, systemic comorbidities, sinonasal surgery history, serum laboratory tests, radiological findings, and treatment results were collected. The present study aimed to assess the accuracy of preoperative computed tomography (CT), Gadolinum-enhanced magnetic resonance (MR), and punch biopsies in detecting sinonasal OH as the most likely diagnosis. In addition, incidental differences by age and year of diagnosis were calculated using the Poisson log-linear regression model. RESULTS: The median age was 44, and 58% were male. Fewer than 20% of these cases had a chronic systemic comorbidity, bleeding tendency, or sinonasal surgery history. MR had the highest accuracy of (87%) to detect sinonasal OH as the most likely diagnosis, compared with contrast-enhanced-CT (53%), punch biopsy (49%), and non-enhanced-CT (16%) (all <0.05). Sinonasal OH incidence did not vary by age, but the yearly rate significantly increased by 1.05 times over 23 years (p < 0.05). Notably, 84% of 112 patients received surgical removal through the assistance of an endoscope, and none had substantial bleeding without preoperative embolization. CONCLUSION: Sinonasal OH was observed regardless of age, sex, systemic comorbidities, bleeding tendency, prior sinonasal surgery, or trauma. Preoperative MR gives the highest accuracy for detecting this disease. Sinonasal OH may be safely managed with endoscopic-assisted surgery removal without embolization. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1581-1590, 2024.

Impact of long-term nasal airflow deprivation on sinonasal structures and chronic rhinosinusitis in total laryngectomy patients.

Objective: Total laryngectomy (TL) patients are good models in which to evaluate the effects of nasal airflow cessation on the sinonasal tract. Here, we evaluated changes in sinonasal structures and association with sinus opacification in the computed tomography (CT) images 3 years post-TL. Methods: Patients who underwent TL from 2005 to 2017 in a teaching academic center were reviewed retrospectively. Patients with a final follow-up CT taken less than 3 years after TL, tracheoesophageal puncture, inadequate CT image, or history of sinonasal surgery were excluded. The control group included patients who underwent a partial laryngectomy or hypopharyngectomy without requiring a tracheotomy for more than a month. Altogether, 45 TL patients and 38 controls were selected. The volume of all four paranasal sinuses, inferior turbinate soft tissue volume (ITSTV), maxillary sinus natural ostium (MSNO) mucosal width, and Lund-Mackay scores (LMS) were measured on preoperative and postoperative CT scans. Results: The mean duration between surgery and the final CT scan was 6.3 ± 2.4 and 5.5 ± 2.3 years for the TL and control groups, respectively. Neither group showed significant changes in the four paranasal sinuses' volume or MSNO mucosa width. The ITSTV decreased significantly, from 4.6 ± 1.3 to 2.8 ± 1.1 mL (p < .001), in the TL group, regardless of the presence of nasal septal deviation, showing ITSTV reduction on both concave and convex sides. By contrast, the control group showed no significant changes in ITSTV. Postoperative LMS changes in both groups were insignificant. The number of patients with LMS aggravation or alleviation was the same in both groups, regardless of preoperative sinus opacification. Conclusions: Paranasal sinus structures and sinus opacification are not affected significantly by nasal airflow cessation; however, the inferior turbinate mucosa is affected by long-term discontinuation of nasal airflow. Level of Evidence: 4 (case-control study).

Treatment Outcomes of Olfactory Neuroblastoma: A Multicenter Study by the Korean Sinonasal Tumor and Skull Base Surgery Study Group.

OBJECTIVES: Due to the rarity of olfactory neuroblastoma (ONB), there is ongoing debate about optimal treatment strategies, especially for early-stage or locally advanced cases. Therefore, our study aimed to explore experiences from multiple centers to identify factors that influence the oncological outcomes of ONB. METHODS: We retrospectively analyzed 195 ONB patients treated at nine tertiary hospitals in South Korea between December 1992 and December 2019. Kaplan-Meier survival analysis was used to evaluate oncological outcomes, and a Cox proportional hazards regression model was employed to analyze prognostic factors for survival outcomes. Furthermore, we conducted 1:1 nearest-neighbor matching to investigate differences in clinical outcomes according to the use of neoadjuvant chemotherapy. RESULTS: In our cohort, the 5-year overall survival (OS) rate was 78.6%, and the 5-year disease-free survival (DFS) rate was 62.4%. The Cox proportional hazards model revealed that the modified Kadish (mKadish) stage and Dulguerov T status were significantly associated with DFS, while the mKadish stage and Hyams grade were identified as prognostic factors for OS. The subgroup analyses indicated a trend toward improved 5-year DFS with dural resection in mKadish A and B cases, even though the result was statistically insignificant. Induction chemotherapy did not provide a survival benefit in this study after matching for the mKadish stage and nodal status. CONCLUSION: Clinical staging and pathologic grading are important prognostic factors in ONB. Dural resection in mKadish A and B did not show a significant survival benefit. Similarly, induction chemotherapy also did not show a survival benefit, even after stage matching.

Detection of respiratory viruses in adult patients with perennial allergic rhinitis.

BACKGROUND: The symptoms of allergic rhinitis may be worsened by a viral respiratory infection. However, there are few data on the presence of respiratory virus in patients with allergic rhinitis. OBJECTIVE: To evaluate whether patients with allergic rhinitis have an increased frequency of respiratory virus detection in a prospective case-control study. METHODS: Fifty-eight adult patients diagnosed with perennial allergic rhinitis were evaluated from September 2011 through June 2012. A control group of 61 adult patients without allergy was included. Multiplex polymerase chain reaction was used to detect respiratory viruses in nasal lavage samples. RESULTS: Respiratory viruses were detected in 25 of 58 patients (43.1%) with perennial allergic rhinitis, but in only 15 of 61 control patients (24.6%). In virus-positive samples, multiple viruses were detected in 9 of 25 patients (36.0%) with perennial allergic rhinitis but in only 2 of 15 control patients (12.5%). Rhinovirus was the most common virus in patients without allergy and those with allergic rhinitis. There were significant differences in the detection rates of overall and multiple respiratory viruses and rhinovirus between the 2 groups (P < .05). However, in patients with allergic rhinitis, there was no statistically significant association between the detection of respiratory viruses and symptom scores. CONCLUSION: This study shows that there is a high prevalence of respiratory viruses, especially rhinovirus, in patients with allergic rhinitis. Subsequent studies are needed to determine the clinical significance of highly prevalent respiratory viruses in patients with allergic rhinitis.

Features of Odontogenic Sinusitis Associated With Dental Implants.

OBJECTIVES: With the increase in dental implants for tooth loss, odontogenic sinusitis following maxillary dental implants is frequently encountered in otorhinolaryngology practice. The authors aimed to reveal the association between implant extrusion into maxillary sinus, along with implant-related complications in patients diagnosed with implant-related odontogenic sinusitis (IR-ODS). STUDY DESIGN: Case-control study. METHODS: This study enrolled 60 patients who received functional endoscopic sinus surgery due to IR-ODS. The preoperative sinus computed tomography was retrospectively reviewed. Among the 120 maxillary sinuses of the 60 patients, 68 sides were diagnosed with IR-ODS sides, whereas 27 sides showed no clinical or radiological evidence of this condition after the implant insertion and were defined as the control sides. Statistical analysis between these two groups was conducted, in addition to odds ratio (OR) calculations for associations with IR-ODS. RESULTS: The mean age of the IR-ODS subjects was 59.5 ± 19.1, with a male to female ratio of 32/28 (53.3%/46.7%). Implants extruding by more than 4 mm into the maxillary sinus, peri-implantitis, bone graft disruption-extrusion were associated with a significantly higher incidence in the IR-ODS (p = 0.035, p = 0.003, p = 0.011, respectively). The IR-ODS sides showed an adjusted-OR (95% confidence interval) of 27.4 (2.7-276.5) for extrusion length >4 mm, 11.8 (3.0-46.5) for peri-implantitis, and 34.1 (3.3-347.8) for bone graft disruption (p = 0.005, p < 0.001, and p = 0.003, respectively). CONCLUSION: Maxillary dental implants extruding more than 4 mm into the maxillary sinus, peri-implantitis, and disrupted-extruded bone grafts show significant association with IR-ODS. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:237-243, 2023.

Preoperative Prediction of Sinonasal Inverted Papilloma-associated Squamous Cell Carcinoma (IP-SCC).

INTRODUCTION: Sinonasal inverted papillomas (IP) can undergo transformation into IP-squamous cell carcinomas (IP-SCC). More aggressive treatment plan should be established when IP-SCC is suspected. Nevertheless, inaccuracy of the preoperative punch biopsy results to detect IP-SCC from IP raises the need for an additional strategy. The present study aimed to investigate significant clinicoradiological remarks associated with IP-SCC than IP. MATERIAL AND METHODS: Postoperative surgical specimens obtained from patients with confirmed IP or IP-SCC at a single tertiary medical center from 1997 to 2018 were retrospectively evaluated. Patients' demographic and clinical characteristics, preoperative in-office punch biopsy results, and preoperative computed tomography (CT) or magnetic resonance images were reviewed. Univariate and multivariate analyses were performed to assess the odds ratio (OR) associated with IP-SCC. The area under the curve (AUC) in the receiver Operating Characteristic (ROC) curve was calculated in the prediction model to discriminate IP-SCC from IP. RESULTS: The study included 44 IP-SCC and 301 patients with IP. The diagnostic sensitivity of in-office punch biopsy to detect IP-SCC was 70.7%. Multivariate analysis showed that factors significantly associated with IP-SCC included tobacco smoking >10PY (adjusted-OR [aOR]: 4.1), epistaxis (aOR: 3.4), facial pain (aOR: 4.2), bony destruction (aOR: 37.6), bony remodeling (aOR: 36.3), and invasion of adjacent structures (aOR: 31.6) (all p < 0.05). Combining all significantly related clinicoradiological features, the ability to discriminate IP-SCC from IP reached an AUC of 0.974. CONCLUSION: IP patients with a history of tobacco smoking, facial pain, epistaxis, and bony destruction, remodeling, or invasion of an adjacent structure on preoperative images may be at higher risk for IP-SCC. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:2502-2510, 2023.

Effects of rhinovirus infection on the expression and function of cystic fibrosis transmembrane conductance regulator and epithelial sodium channel in human nasal mucosa.

BACKGROUND: Changes in expression and function of the cystic fibrosis transmembrane conductance regulator (CFTR) and epithelial sodium channel (ENaC) have been found to cause airway surface liquid (ASL) derangement and to impair mucociliary clearance, both of which have been linked to the pathogenesis of rhinovirus (RV) infection. OBJECTIVES: The effects of RV infection on the expression and function of CFTR and ENaC in nasal epithelial cells were investigated. METHODS: Nasal epithelial cells obtained from 14 turbinoplasty patients were infected with RV serotype 16 (RV-16) for 4 hours. Expression of CFTR, α-ENaC, ß-ENaC, and γ-ENaC was determined by real-time polymerase chain reaction, Western blot analysis, and confocal immunofluorescence microscopy. Functional changes in the CFTR and ENaC proteins were assessed by measuring transepithelial resistance (TER) using a voltmeter combined with ion channel modulators. RESULTS: Rhinovirus infection increased expression of CFTR, α-ENaC, ß-ENaC, and γ-ENaC messenger RNA (mRNA) and protein compared with controls (P < .05 each) and increased the expression of all 4 proteins on confocal immunofluorescence microscopy. Treatment of cells with the ENaC blocker amiloride and the CFTR activator forskolin increased TER in RV-infected cells, whereas forskolin decreased TER in uninfected cells. The CFTR inhibitor NPPB, however, blocked CFTR more in RV-infected than in noninfected cells. CONCLUSIONS: Rhinovirus increased the expression of CFTR and appeared to alter its function. In contrast, ENaC expression and function were increased by RV infection. Therefore, RV infection may impair mucociliary transport of nasal epithelium by these alterations.

Analysis of hearing improvement in patients with severe to profound sudden sensorineural hearing loss according to the level of pure tone hearing threshold.

Patients with profound sudden sensorineural hearing loss (SSNHL) have a poor prognosis regardless of the type of treatment they receive. However, there is evidence that a proportion of patients with profound hearing loss may exhibit variable degrees of recovery, and this has yet to be specifically investigated. Here, we report a comparison of levels of hearing improvement in patients stratified according to their level of hearing threshold before treatment. We divided patients with severe to profound SSNHL into three groups: patients with an initial hearing threshold of 80-89 dB (n = 18), 90-99 dB (n = 16), and ≥100 dB (n = 34). We compared improvements in hearing threshold at different frequencies and recovery rates between the three groups. No significant differences were observed in hearing threshold improvements at different frequencies in the three groups after treatment. However, in the group with an initial hearing threshold of ≥100 dB, significantly less complete and partial recoveries occurred compared to those in the 80-89 or 90-99 dB groups. Our results suggest that initial hearing threshold in excess of 100 dB alters the likelihood of satisfactory recovery in patients with severe to profound SSNHL.