Challenging the gold standard: methods of sampling for microbial culture in patients with chronic rhinosinusitis.

PURPOSE: Chronic rhinosinusitis (CRS) is a highly prevalent multifactorial disorder. Culture-directed antibiotics are frequently prescribed to patients with CRS and the middle nasal meatus (MM) is traditionally believed to be a representative sampling site of the sinuses as a whole. The purpose of our study was to reevaluate the reliability of the MM as a sampling site in patients with CRS who suffer from impaired drainage from the sinuses to the MM. METHODS: Swabs and tissue biopsies were collected from the MM, maxillary sinus and frontal sinus from 50 patients with CRS. The results of bacterial culture were compared between sampling methods and sites in relation to the patency of the sinus ostia. RESULTS: 782 bacterial isolates were cultured from the samples. Concordant results between the MM and the sinus cavity were noted in 80% of patients for the maxillary sinus, but only 66% for the frontal sinus and 76% for the sinuses a whole. The differences were similarly prevalent in patients with open and occluded sinus ostia. Notably, swabs from all three sites provided representative information in 92% of patients and tissue biopsies did not provide additional information compared to multiple swabs. CONCLUSION: The traditional method of sampling from the middle meatus provides inadequate information in 24% of patients with CRS, which may result in inadequate antibiotic therapy and contribute to increasing antibiotic resistance. Additional sampling from the sinuses should be recommended whenever possible, while invasive sampling is not necessary.

[Evaluation of the impact of symptomatic gastroesophageal reflux disease on the result of surgical treatment with the use of endoscopic techniques and postoperative pharmacological treatment in patients with chronic sinusitis]. / Ocena wplywu objawowego refluksu zoladkowo-przelykowego na wyniki chirurgii endoskopowej i pooperacyjnej farmakoterapii u chorych z PZZP.

It is estimated that in Europe 10% of adults suffer from chronic sinusitis. Chronic sinusitis can be caused by many different diseases that share chronic inflammation of the sinuses as a common symptom. Rhinitis can be caused by stomach acid coming up from the stomach into the esophagus, which successively can result in chronic sinusitis. The current gold standard for diagnosing GERD is--bothersome for the patient--24 h esophageal pH monitoring. This method can be unpleasant for the patients, which makes it less acceptable. Because of that the criteria for symptomatic GERD were made an alternative diagnostic way. We acknowledge that the presence of heartburn and stomach acid coming up from the stomach into the esophagus at least once a week can be diagnosed as symptomatic GERD. The aim of the study is the assessment of the frequency of symptomatic GERD in patients operated because of chronic sinusitis and impact of symptomatic GERD on the follow-up treatment up to 12 months after endoscopic nasal surgery. The authors analysed 144 patients operated at the JUCM Otolaryngological Clinic in Kraków between 2011 and 2013 because of sinusitis. The inclusion criteria were: diagnosed chronic sinusitis, indications for endoscopic sinus surgery, and a written consent for the research. Each patient was examined laryngologically and surveyed. Patients were divided into two groups: with and without symptomatic GERD. We analysed the symptoms in patients treated for sinusitis with or without GERD before, between 3 and 6 as well as in the 12th month after endonasal surgery. Moreover, we analysed the intensity of the global symptoms (expressed in the VAS scale) and separately for each of the 13 symptoms of chronic sinusitis (expressed on a scale 0 - 3). We established that 33 out of the 144 patients (22.9%) qualified for the first survey reported the symptoms of GERD. In the second survey, which was conducted between 3 and 6 month after ESS, 24 out of 119 (20%) people reported the symptoms and in the third survey, which took place in the 12th month after ESS, 14 out of 52 patients reported symptomatic GERD. The intensity of global symptoms rated in the VAS scale in patients with chronic sinusitis during the first survey was 7.8 and in the second and third survey the intensity was 4.2 and 4.3 respectively. But in patients without any symptoms they were 7.4, 2.8, 3.2. We also analysed 13 symptoms of chronic sinusitis rated on a scale 0 - 3. The result of the research was that in patients with symptomatic GERD, even after FESS and the appropriate follow-up, we can still suspect such symptoms as streaming the fluid over the back side of the throat, cough, pain or the feeling of fullness in the ear, headache or halitosis. We should take it under consideration during qualification for the surgery as well as predicting the results of the treatment. Further research is required to state if and how different methods and procedures used in case of patients with symptomatic GERD can reduce the uncomfortable influence of this disease on the effects of chronic sinusitis treatment.

Non-eosinophilic asthma in nonsteroidal anti-inflammatory drug exacerbated respiratory disease.

BACKGROUND: The cellular inflammatory pattern of nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) is heterogeneous. However, data on the heterogeneity of non-eosinophilic asthma (NEA) with aspirin hypersensitivity are scanty. By examination of N-ERD patients based on clinical data and eicosanoid biomarkers we aimed to identify NEA endotypes potentially guiding clinical management. METHODS: Induced sputum was collected from patients with N-ERD. Sixty six patients (49.6% of 133 N-ERD) with NEA were included in the hierarchical cluster analysis based on clinical and laboratory data. The quality of clustering was evaluated using internal cluster validation with different indices and a practical decision tree was proposed to simplify stratification of patients. RESULTS: The most frequent NEA pattern was paucigranulocytic (PGA; 75.8%), remaining was neutrophilic asthma (NA; 24.2%). Four clusters were identified. Cluster #3 included the highest number of NEA patients (37.9%) with severe asthma and PGA pattern (96.0%). Cluster #1 (24.2%) included severe only asthma, with a higher prevalence of NA (50%). Cluster #2 (25.8%) comprised well-controlled mild or severe asthma (PGA; 76.5%). Cluster #4 contained only 12.1% patients with well-controlled moderate asthma (PGA; 62.5%). Sputum prostaglandin D2 levels distinguished cluster #1 from the remaining clusters with an area under the curve of 0.94. CONCLUSIONS: Among identified four NEA subtypes, clusters #3 and #1 represented N-ERD patients with severe asthma but a different inflammatory signatures. All the clusters were discriminated by sputum PGD2 levels, asthma severity, and age of patients. The heterogeneity of non-eosinophilic N-ERD suggests a need for novel targeted interventions.

The influence of botulinum toxin on auditory disturbances in hemifacial spasm.

BACKGROUND AND PURPOSE: Hemifacial spasm (HFS) is frequently accompanied by other symptoms, such as visual and auditory disturbances or pain. The aim of the study was to assess the occurrence of auditory symptoms accompanying HFS using subjective and objective methods, their relation with other HFS symptoms, and their resolution after botulinum toxin (BTX-A) treatment. MATERIAL AND METHODS: The occurrence of hypoacusis, ear clicks and tinnitus was assessed by questionnaire in 126 HFS patients from an electronic database which included medical data such as severity of HFS rated by clinical scale and magnetic resonance imaging focused on the presence of vascular nerve VII and VIII conflict. Forty consecutive patients treated with BTX-A and 24 controls matched by sex and age underwent laryngological examination including audiometry, tympanometry and acoustic middle ear reflex before injection and two weeks later. RESULTS: About 45.2% of patients complained of auditory disturbances (31.7% hypoacusis, 30.2% ear clicks and 7.1% tinnitus) on the side of HFS. Auditory disturbances correlated with severity of HFS symptoms but not with age, disease duration, or neurovascular conflict with nerves VII and VIII. We did not find abnormalities in audiometric and tympanometric assessment in patients in comparison with controls. No abnormalities were detected in brainstem evoked potentials comparing the sides with and without HFS symptoms. Tinnitus and absence of ipsilateral acoustic middle ear reflex occurred more often in patients with auditory symptoms than those without them. BTX-A treatment caused resolution of subjective acoustic symptoms without any improvement in audiometric assessment. CONCLUSIONS: Auditory disturbances accompanying HFS are probably caused by dysfunction of the Eustachian tube, which improves after BTX-A treatment.

[Prognostic factors in patients operated on eardrum perforation with intact ossicular chain]. / Czynniki prognostyczne u chorych leczonych operacyjnie z powodu perforacji blony bebenkowej przy nieuszkodzonym lancuchu kosteczek sluchowych.

BACKGROUND: Ear drum perforation is a typical feature in chronic otitis media. It can have posttraumatic etiology or it is observed in acute otitis media too. AIM: This paper is intended to evaluate effectiveness of tympanic membrane reconstruction and indicate factors which have an influence on hearing improvement after myringoplasty. MATERIAL AND METHODS: Analysis involves ca. 500 individuals operated on ear in Department of Otolaryngology at the Jagiellonian University between 2004 and 2009. RESULTS: 120 individuals were operated on for the first time due to chronic otitis media with intact ossicular chain. Statistically significant heating improvement was observed in patients with discharge, without discharge and in group with scars. CONCLUSIONS: The presence of granulation changes is an unfavorable prognostic condition in the patients with ear drum perforation. In clinical practice, the criterion which often determines the application of either of the materials in myringoplasty are operator's preferences, as well as the availability of given material for transplanting.

[Reoperations in patients with chronic otitis media cholesteatomatosa]. / Reoperacje w przebiegu otitis media chronica cholesteatomatosa.

INTRODUCTION: Chronic cholesteatoma otitis media, apart from destruction of bones and possibility of otogenous complications, is characterized by possibility of recurrence of the disease after non radical treatment or presence of risk factors. AIM: This paper intends to analyze changes typical for cholesteatoma, observed during otosurgery including the results of bacteriological investigations. MATERIAL AND METHODS: Nearly 450 otosurgeries were performed in Department of Otolaryngology at Jagiellonian University 2004-2007. Analysis refers to patients reoperated on chronic cholesteatoma otitis media. RESULTS: 47 reoperations in the course of chronic choleateatoma otitis media were performed. Bacteriological analysis was provided in 21 cases. The most common bacteria were Staphylococcus aureus and Pseudomonas aeruginosa. Biofilms were not observed in specimens. CONCLUSIONS: The recurrence of the process should be expected in patients with cholesteatoma. They require regular, periodical follow-up examination.

[Vertigo and labyrinthine fistules at the patients operated on chronic otitis media]. / Zawroty glowy i przetoki perylimfatyczne u chorych operowanych z powodu przewleklego zapalenia ucha srodkowego.

BACKGROUND: Otitis media is a frequent condition. Chronic infections of the middle ear can lead to defects of bony walls and development of complications. MATERIAL AND METHODS: We performed prospective analysis of patients operated on chronic otitis media in ENT Department Jagiellonian University of Krakow between 2004-2008. Nearly 650 operations on ears were performed in that period of time. RESULTS: Labyrinthine fistule was observed in 40 patients: 36 with COM, 3 with otosclerosis and 1 after head trauma. Vertigo was mentioned in ca. 30% of individuals in preoperative history. Labyrinthine fistule was usually noticed in the course of chronic cholesteatoma otitis media and chronic granulomatous otitis media and almost always it was located on lateral semicircular canal. In these patients defects of facial nerve bony canal were more frequent but the frequency of skull base defects was like in patients without labyrinthine fistule. The fistules were sealed routinely with a fragment of fascia. This procedure proved effective.

[Defects of facial nerve canal according to a character and localisation of lesions in middle ear]. / Ubytki kostne kanalu nerwu VII a charakter i lokalizacja zmian w uchu srodkowym.

AIM: The aim of this study is the assessment the occurence of facial nerve canal (Fallopian canal) dehiscence in patients operated due to chronic medial otitis (depending on the location and type of inflammatory lesions) and in patients operated due to otosclerosis. Facial nerve paresis in patients with dehiscence found during surgery was also assessed. MATERIAL AND METHODS: The study group consisted of 456 patients operated at the Department of Otolaryngology at the University Hospital in Krakow, 359 due to chronic otitis media and 97 due to otosclerosis. Facial nerve canal dehiscence was found during surgery in 26 patients (6% of operated patients) more frequently in men. RESULTS: In most cases (54%) dehiscence was observed in patients with chronic medial otitis with cholesteatoma (27% with choleseatoma and 27% with cholestatoma and granulation), and equally (23% each) dehiscences were observed in patients with granulation and even in patients with otosclerosis and chronic simple otitis media. In over than half (54%) of patients with dehiscence inflammatory lesions involved all the middle ear spaces, in 15% the tympanic cavity, attic and antrum while in 4% of patients inflammatory lesions were limited to the tympanic cavity, attic or antrum. CONCLUSIONS: The facial canal nerve dehiscence is observed in majority in patients with cholestatoma and granulation, especially in tympanic region. In some cases its coexistence with circuit canals dehiscence.

[Orbital complications of sinusitis treated endoscopically]. / Endoskopowe leczenie chorych z powiklaniami oczodolowymi zapalen zatok przynosowych.

BACKGROUND: Subperiosteal inflammatory disease, subperiosteal abscess and orbital cellulitis are the most common sequelae of both acute and chronic sinusitis. Early, appropriate evaluation and management observing signs and symptoms of orbital inflammation are required to prevent blindness. Computerised tomography (CT) is the investigation of choice in diagnosing the discussed pathological conditions. Cellulitis does not require drainage of the orbit on a routine basis. Conventionally, the orbital abscess is drained via an external incision and sinus surgery is performed at the same time to remove the focus of infection. More recently, successful treatment both of the sinuses and decompression of the orbit has been accomplished endoscopically via an intranasal approach. AIM: The aim of the paper was to analyse the results of intranasal endoscopic procedures performed in individuals with orbital complications of sinusitis in search for optimal treatment of this group of patients. MATERIAL AND METHODS: Records of 7 patients aged from 14 to 68 (mean 33) years treated in our department for orbital complications of sinusitis between February 2005 and August 2006 were analysed retrospectively. One retrobulbar abscess was diagnosed. In the remaining 6 patients the diagnosis of cellulitis, in one case complicated with cavernous sinus thrombosis, was established. 7 endoscopic frontosphenoethmoidectomies, one with endonasal decompression of the orbital abscess, were performed. RESULTS: All preoperative symptoms subsided in all operated individuals. No complications were observed. CONCLUSIONS: Surgical treatment of the focus of infection in the sinuses and drainage of orbital abscess can be accomplished endoscopically via an intranasal approach with little morbidity, easy identification of anatomical structures, physiological drainage of the sinuses and superior cosmetic result. Our experience suggests that the optimal method of treatment consists in surgical endoscopic removal of the focus of infection located in the sinuses with simultaneous drainage of the abscess in the orbit.

[Biofilm from patients with chronic rhinosinusitis. Morphological SEM studies]. / Biofilm w przebiegu przewleklego zapalenia zatok przynosowych. Badania morfologiczne w SEM.

INTRODUCTION: Bacterial biofilm is a three-dimensional structure made of aggregates of bacterial cells (microcolonies) and the extra cellular matrix released by them, adhering to organic and inorganic surfaces. It is estimated that 99% of all bacteria exist in biofilms, and only 1% live in a free-floating or planktonic state at any given time. The aim of the study was to demonstrate biofilms in mucosal specimens of patients undergoing endoscopic sinus surgery for chronic rhinosinusitis and co-occurrence of such illnesses as nasal polyps, bronchial asthma, NSAIDs allergy, and aspirin-induced asthma. MATERIAL AND METHODS: A prospective study of 25 patients suffering from chronic rhinosinusitis. All patients underwent completed a otolaryngological examination and paranasal sinus CT scans. Endoscopic surgery of nasal sinuses (ESS) was performed in all patients. The mucous membrane samples were taken from the inside of the sinus and concha bullosa. They were prepared and examined with a scanning electron microscope (SEM). The images were then compared with the available database of the biofilm images. RESULTS: Using SEM morphologic criteria, the biofilms were identified in the studied material in nineteen patients (83%). In four patients with chronic rhinosinusitis, no biofilms were found on the samples taken. A bacteriological examination of smears from inside of the sinus, revealed the presence of various types of bacteria. In two patients no bacteria was found in the smears. CONCLUSIONS: It is supposed that bacterial biofilms perform an essential role in the pathogenesis of chronic sinusitis. One may speculate that, the presence of biofilms in patients with chronic rhinosinusitis could induce the co-occurrence of such illnesses as nasal polyps, bronchial asthma, aspirin-induced asthma or a NSAIDs allergy. In order to evaluate better the role of biofilms in chronic rhinosinusitis, it seems justified to extend the research to a larger group of patients and a control group.

[Endoscopic treatment of patients with intracranial complications of sinusitis]. / Endoskopowe leczenie chorych z wewnatrzczaszkowymi powiklaniami zapalenia zatok.

INTRODUCTION: Intracranial complications of sinusitis (cerebral, epidural, and subdural abscesses, meningitis, and dural sinus thrombophlebitis) remain a challenging and current topic. Although they are nowadays relatively rare, prompt recognition of these disease states is important to prevent permanent neurological deficit or fatality. Infection may spread hematogenously or by direct extension. Patients with complications require surgery to remove the focus of infection from the sinuses and drain the abscess. Recently, endoscopic frontal and sphenoid sinus surgery has emerged as the preferred technique for the treatment of the most advanced and complicated chronic sinusitis. MATERIAL AND METHODS: Records of 7 patients aged from 13 to 65 (mean 30.6) years treated in our department for intracranial complications between January 2002 and September 2006 were analysed retrospectively. The diagnosis of meningitis was established in 2 patients, in one case with accompanying bilateral oculomotor nerve palsy. Cavernous sinus thrombosis, frontal abscess with hemiplegia, cerebral oedema, bilateral oculomotor nerve palsy and retrobulbar optic nerve neuritis with blindness was diagnosed each in one individual. 5 endoscopic bilateral frontosphenoethmoidectomies and 2 endoscopic sphenoethmoidectomies were performed. In one case a frontosphenoethmoidectomy was combined with craniotomy. RESULTS: All preoperative symptoms subsided in 4 operated individuals. Vision improved in the patient with bilateral retrobulbar optic nerve neuritis. In patients with hemiplegia and bilateral oculomotor nerve palsy the symptoms persisted. No complications of the surgery were observed. CONCLUSIONS: Surgical treatment of the focus of infection in the sinuses can be accomplished endoscopically via an intranasal approach with less morbidity, easy identification of anatomical structures, physiological drainage of the sinuses and superior cosmetic effects.

[Endoscopic treatment of cerebral rhinorrhea]. / Endoskopowe leczenie plynotoku nosowego.

INTRODUCTION: The frequency of different factors causing cerebrospinal fluid rhinorrhea (CFR) has lately changed. The incidence of iatrogenic CFR has reached 10% of all cases of CFR, due to an increasing number of endoscopic operations of the sinuses and skull base, while idiopathic CFR is nowadays very rare. The current treatment method for CFR is surgical repair of the fistula. Endoscopic surgery of the anterior skull base has become the standard procedure for the repair of cerebrospinal fluid (CSF) leaks of various origins. The aim of this study was to analyse results of endoscopic surgical technique used in our department for the treatment of CFR. MATERIAL AND METHODS: Records of 5 patients aged from 46 to 69 (mean 58.2) years treated in the department between April 2004 and March 2006 were analysed retrospectively. 4 individuals had underwent endoscopic sinus surgery for sinus problems which resulted in iatrogenic CSF leak. One patient had idiopathic CFR. 3 fistulas localised in the neighbourhood of the cribriform plate were closed using an "underlay" technique with synthetic dura, and covered with free mucosal grafts from the nasal septum, kept in place by fibrin glue. The fistula in the neighbourhood of the sphenoid sinus posterior wall was closed using an ,,overlay" technique with surgical, covered with synthetic dura. RESULTS: In the 3 patients with cribriform plate fistulas the closure was successful and CFR did not recur during 6 to 9 month's follow-up. In the patient with sphenoid sinus fistula CFR recurred on exertion after 4 months. In one patient with cribriform plate fistula, CFR resolved spontaneously during preparation to surgery. CONCLUSIONS: Endoscopic closure of the skull base fistula represents a minimally invasive and highly successful procedure. Our experience suggests thet the optimal surgical technique in the region of cribriform plate consists in performing an "underlay" procedure with synthetic dura and covering the graft with free mucosal grafts from the nasal septum.

[Endoscopic management of osteomas of the paranasal sinuses--own experience]. / Endoskopowe leczenie chorych z kostniakami zatok przynosowych--doswiadczenie wlasne.

Osteomas are relatively common, benign, slow-growing, often asymptomatic neoplasms of the paranasal sinuses, occurring mainly in frontal and ethmoid sinuses. Surgical removal is done if they extend beyond the boundaries of the sinus, keep enlarging, are localised in the region adjacent to the nasofrontal duct, or if signs of chronic sinusitis are present and, irrespective of their size, in symptomatic tumours. Progressive headaches and chronic inflammation of the adjacent mucous membrane are most common symptoms. Endoscopic surgery plays an important role in management of ethmoid, sphenoid and frontal osteomas. Aim. The aim of the paper was to report own experience in endoscopic treatment of patients with osteomas of the paranasal sinuses. Material and methods. 6 patients with osteomas of paranasal sinuses were included in the group, mean age 36 years (range 15-52). Most common involvement was ethmoid cells (3). There were also patients with frontal, maxillary and sphenoid osteoma. All tumours were removed under endoscopic giudance. Frontoethmoidectomy was performed to remove ethmoid and frontal osteomas. Antrotomy was used in case of maxillary involvement and sphenoethmoidectomy in the patient with sphenoid sinus osteoma. Sphenoid sinus was approached through its anterior wall with a Stammberger punch. All the tumours were removed using fine forceps. Results. No post-operative complications were observed. No recurrences were noted. All patients remain asymptomatic. Conclusions. Resection of small and medium size osteomas of the paranasal sinuses can be safely and radically performed using endoscopic techniques. It allows their radical resection and very good cosmetic effects.

[Endoscopic surgical treatment of patients with isolated sphenoid sinus disease]. / Endoskopowe leczenie chorych z izolowanymi stanami patologicznymi zatoki klinowej.

INTRODUCTION: Cases of isolated lesions of the sphenoid sinus are rare. For descriptive purposes, clinicians divide them into inflammatory and non-inflammatory with prevalence of the former. Symptoms of the sphenoid sinus disease are difficult to characterise, the most common of them being vague headache and visual disturbances. Thorough preoperative evaluation of the lesion is essential - nasal endoscopy must be performed and computerised tomography or magnetic resonance imaging results analysed. The purpose of the study is to present the assessment of endoscopic surgery outcome in the own group of patients with isolated sphenoid disease. MATERIAL AND METHODS: Clinical data of 22 subjects were analysed retrospectively. There were 5 patients with bacterial sinusitis, 6 with fungal sinusitis, 4 with allergic thickening of the mucous membrane with no evidence of bacterial or fungal infection, 2 with mucocele, 1 with sphenoid osteoma, 1 with inverted papilloma, 1 with a foreign body and 2 with cerebral fluid fistula. Each patient had preoperative nasal endoscopy and CT/MRI imaging performed. Then they underwent endoscopic transnasal sphenoethmoidectomy with removal of the lesion or closure of the fistula. The sphenoid sinus was approached through its front wall. RESULTS: The patients' postoperative course was uneventful. They noted improvement in all preoperative symptoms, except for bilateral oculomotor nerve paralysis in one individual, and were asymptomatic to ophthalmological examination. CONCLUSIONS: Isolated lesions of the sphenoid sinus, even very rare tumours like those presented here, can be in most cases safely approached and removed endoscopically. All risks of the method must be considered prior to the operation. High frequency of fungal sinusitis should be noted.

[Correlation between computed tomography and microbiological results in chronic sinusitis]. / Korelacja obrazu tomografii komputerowej w przewleklym zapaleniu zatok przynosowych z wynikami badan mikrobiologicznych.

This article presents the observed correlation between the advancement of inflammatory lesions in paranasal sinuses found on computed tomography and microbiological specimen results in chronic sinusitis. The examined study group consisted of 28 patients, aged 19-59 years, in whom endoscopic sinus surgery was performed. In each patient prior to planned surgery a sinus CT scan was performed the result of which was scored using the Lund-Mackay scale, bacteriological and mycological examinations of nasal mucous secretion were also performed. In the study group a positive correlation between the CT score point sum and the number of pathogen species (regression test: r = 0.46; p = 0.0141) was found. With each additional pathogen species found the CT grading rose by 2.3 points. We also found that in patients with positive bacterial culture the average CT score rose by 4.4 (ANOVA: F(1,23)= 3.69; p = 0.0333). However no rise was found in the case of fungi and no interaction between bacteria and fungi was found. In cases of advanced sinusitis where a high CT lesion score of is found antimicrobial therapy based on exact microbiological diagnostics should be given in the perioperative period.

Incidence of aspirin hypersensitivity in patients with chronic rhinosinusitis and diagnostic value of urinary leukotriene E4.

INTRODUCTION: Chronic rhinosinusitis (CRS) with nasal polyposis (NP) may be associated with hypersensitivity to nonsteroidal anti-inflammatory drugs, representing a syndrome of aspirin-exacerbated respiratory disease (AERD). OBJECTIVES: The aim of the study was to validate a simple measurement of urinary leukotriene E4 (uLTE4) excretion for the diagnosis of AERD in patients with CRS and indication for surgery. PATIENTS AND METHODS: Subjects requiring functional endoscopic sinus surgery (FESS) were recruited from the Department of Otolaryngology (n = 24). Before surgery, a standard oral placebo-controlled aspirin challenge was performed to diagnose aspirin hypersensitivity. Urine samples were collected on the placebo day and both before and within 2 to 4 hours after aspirin challenge for uLTE4 measurement. RESULTS: All patients with CRS had sinusitis confirmed by computed tomography. Previous ear, nose, and throat surgery was performed in 70% of the patients, NP was present in 86%, and asthma was diagnosed in 62.5%. AERD was diagnosed in 8 subjects (7 women and 1 man). Five of those patients had bronchoconstriction. At baseline, median uLTE4 was 7.5-times higher in AERD subjects than in the remaining patients. It increased almost 6-fold following the challenge, while remained unchanged in patients without aspirin hypersensitivity. Pretest uLTE4 had a sensitivity of 87.5% and specificity of 93.75% to diagnose aspirin hypersensitivity in patients with CRS. After the challenge, the values improved to 100% sensitivity and 93% specificity. CONCLUSIONS: Among CRS subjects requiring FESS, as many as 33.3% may have AERD and respond to a small provocative dose of aspirin with bronchoconstriction and/or mucosal and skin edema. A simple and inexpensive measurement of uLTE4 can help diagnose AERD in patients with CRS with sensitivity of 87.5%, but its specificity is limited and depends on the arbitrary threshold of uLTE4.