Enfrentamiento diagnóstico de la rinosinusitis aguda en pacientes adultos ambulatorios / Diagnostic Approach of acute rhinosinusitis in adults outpatients

Acute rhinosinusitis is a common condition, mainly of viral etiology and self-limiting course. There is coexistence of microbiological agents that favor bacterial superinfection. Therefore, it is necessary to know evidence that supports diagnostic approach in adults out- patients. Having reviewed the evidence, we mention the isolated symptoms and signs have such a low performance to guide the diagnostic approach, some with statistical evidence such as hemifacial pain, colored nasal discharge and radiographic alterations suggestive of rhinosinusitis. Also, it is possible to improve clinical performance by combining suggestive findings. The imaging study has little evidence that supports them, because non-specific and non-concordant findings. Finally, empirical management with antibiotics does not statistically or clinically modify the evolution of an acute non-complicated condition.

La rinosinusitis aguda es una condición frecuente, principalmente de etiología viral y de curso autolimitado. Existe coexistencia de agentes microbiológicos que favorece la sobreinfección bacteriana. Por ello, es necesario conocer la evidencia que dirige el enfrentamiento diagnóstico en pacientes adultos ambulatorios. Habiéndose revisado la evidencia, mencionamos que los síntomas y signos aislados poseen bajo rendimiento para guiar el proceso diagnóstico, destacando algunos con mejores atributos diagnósticos, pero de significancia estadística bastante discreta, como lo son el dolor hemifacial, la descarga nasal coloreada y alteraciones de la radiografía sugerentes de rinosinusitis. También, que se puede mejorar discretamente el rendimiento clínico combinando algunos de estos hallazgos sugerentes. El estudio imagenológico posee poca evidencia que lo respalde, dado la presencia de hallazgos inespecíficos o no concordantes, inclusive en pacientes asintomáticos. Finalmente, respecto de manejo empírico con antibióticos, destaca que su uso no modifica estadística ni clínicamente la evolución de un cuadro agudo no complicado.

Impacto en la calidad de vida de la cirugía endoscópica nasosinusal en el tratamiento de la rinosinusitis crónica

Introducción: La cirugía endoscópica nasosinusal (CEN) de cavidades paranasales es un tratamiento ampliamente utilizado para la rinosinusitis crónica, con un impacto significativo en mejorar la calidad de vida de los pacientes. Objetivo: Evaluar el impacto de la CEN en la calidad de vida en pacientes con diagnóstico de rinosinusitis crónica en una cohorte nacional y a largo plazo (1 año). Material y Método: Se realizó un estudio de cohorte prospectiva. Se incluyó 95 pacientes con diagnóstico de RSC operados en el servicio de otorrinolaringología del hospital del Salvador en el período 2017-2021. Se compararon síntomas como obstrucción nasal, rinorrea, descarga posterior, algia facial e hiposmia, además de la encuesta SNOT-22 pre y post cirugía utilizando como medidas la escala visual análoga (EVA) de sintomatología cardinal de RSC y SNOT-22. Resultados: Los resultados mostraron una mejoría significativa en todos los síntomas evaluados. La obstrucción nasal, rinorrea, descarga posterior, hiposmia y algia facial presentaron una disminución estadísticamente significativa después de la CEN. Además, la encuesta de calidad de vida SNOT-22 reveló una mejora significativa en la calidad de vida de los pacientes después de la cirugía. Conclusión: Este estudio sugiere que la CEN podría tener un impacto significativo en la mejora de los síntomas y la calidad de vida de los pacientes con rinosinusitis crónica. Los resultados de esta cohorte nacional respaldan la efectividad de la CEN como tratamiento para esta enfermedad a largo plazo (1 año) y destacan la importancia de considerar esta opción terapéutica en el manejo de la RSC.

Introduction: Functional endoscopic sinus surgery (FESS) is a widely employed treatment for chronic rhinosinusitis (CRS) and has shown significant benefits in enhancing the quality of life for affected patients. Objective: To assess the impact of FESS on the quality of life in patients diagnosed with chronic rhinosinusitis in a national and longterm cohort (1 year). Material and Method: A prospective cohort study was conducted at the otolaryngology service of Hospital del Salvador between 2017 and 2021, involving 95 patients diagnosed with CRS who underwent FESS. Symptoms such as nasal obstruction, rhinorrhea, posterior discharge, facial pain, and hyposmia were evaluated. The visual analog scale (VAS) was used to measure the cardinal symptoms of CRS, and the SNOT-22 survey was administered before and after the surgical procedure. Results: The study demonstrated a significant improvement in all evaluated symptoms following FESS. Nasal obstruction, rhinorrhea, posterior discharge, hyposmia, and facial pain exhibited a statistically significant decrease. Moreover, the SNOT-22 survey revealed a notable enhancement in the quality of life for patients after surgery. Conclusion: The highlights of this national cohort support the impact of FESS in alleviating symptoms and improving the quality of life for patients diagnosed with chronic rhinosinusitis. The findings provide strong evidence supporting the effectiveness of FESS as a treatment option for CRS and emphasize the importance of considering this surgical approach in the management of this condition.

Infecciones fúngicas en otorrinolaringología: revisión de la literatura

Ante el aumento a nivel mundial de condiciones inmunosupresoras, la incidencia de enfermedades fúngicas que afectan órganos y sistemas propios del estudio otorrinolaringológico va en alza. Entre estas patologías es posible encontrar la candidiasis orofaríngea, laringitis fúngica, otomicosis, y distintos tipos de rinosinusitis. El estudio de los aspectos clínicos, agentes causantes y mecanismos patogénicos de estas enfermedades será fundamental para la práctica médica de los tiempos por venir.

With the worldwide increase of immunosuppressive conditions, the incidence of fungal diseases affecting organs and systems of otorhinolaryngological study is on the rise. Among these pathologies it is possible to find oropharyngeal candidiasis, fungal laryngitis, otomycosis, and different types of rhinosinusitis. The study of the clinical aspects, causative agents and pathogenic mechanisms of these diseases will be fundamental for the medical practice of the times to come.

Regulation of Local Immunoglobulin Expression by MZB1 in Chronic Rhinosinusitis with Nasal Polyps / 中山大学学报(医学科学版)

ObjectiveThe heightened expression of local immunoglobulins is a significant pathological characteristic of chronic rhinosinusitis with nasal polyps （CRSwNP）， particularly in the Asian population. This study is centered on exploring the association between MZB1 and the localized aggregation of immunoglobulins in Asian individuals with CRSwNP. MethodsNasal polyp tissues obtained from 40 CRSwNP patients and inferior turbinates from 6 healthy controls underwent examination for both mRNA and protein levels. The assessments were conducted using polymerase chain reaction， luminex， and immunohistochemical staining. Statistical analyses， including one-way Anova （ANOVA）， independent samples t-test， and Pearson's correlation analysis， were employed for comprehensive data evaluation. ResultsThe mRNA expression levels of MZB1（P < 0.01） and HSP90B1 （P < 0.01） were significantly higher in type 2 CRSwNP patients compared with those in healthy controls. Immunohistochemical staining revealed a significant increase in MZB1 protein expression in type 2 CRSwNP. MZB1 demonstrated correlation with the expression of immunoglobulin E in nasal polyp tissues （P < 0.01， r = 0.52）. Additionally，MZB1correlated with the expression ofIL-5（P < 0.05， r = 0.4） and IL-13 （P < 0.05， r = 0.44） in nasal polyp tissues. Furthermore，MZB1showed correlation with the number of eosinophils in nasal polyp tissues （P < 0.05， r = 0.72）. ConclusionThe expression of MZB1 is notably elevated in Asian CRSwNP， particularly in type 2 CRSwNP， when compared with controls.MZB1expression correlates significantly with high IgE expression and disease severity in nasal polyp tissues.

Alternativa terapéutica para mejorar la calidad de vida en pacientes con fibrosis quística y discinesia ciliar primaria / Therapeutic alternative to improve quality of life in patients with cystic fibrosis and primary ciliary dyskinesia

Objective: To evaluate the clinical response of patients with cystic fibrosis and primary ciliary dyskinesia after endoscopic sinus surgery at the Dr. Robert Reid Cabral Children's Hospital from September 2021 to February 2022. Methods: An ambispective, cross-sectional, observational case series study was conducted, where the study population was made up of patients with cystic fibrosis and primary ciliary dyskinesia at the Dr. Robert Reid Cabral children's hospital during the study period. Inclusion criteria: Patients older than 6 years with a confirmed diagnosis of cystic fibrosis and primary ciliary dyskinesia (Genetic test with 2 homozygous mutations, positives electrolytes in sweat), severe respiratory symptoms of CRS that did not improve with conventional treatment and underwent endoscopic surgery for sinuses. Results: Of a total of 41 patients, only 10 met the inclusion criteria, the most prevalent age range was 14 to 18 years. Both CF and PCD patients decreased the frequency of CRS symptoms. After ENC, there were discrete changes in lung function, and only patients with severe to moderate disease increased % of FEV1. Most of the patients did not require admission after surgery. The most common germ found in nasopharyngeal and sputum cultures in preoperative patients was Pseudomonas aeruginosa in 86%; after ESS there was a significant increase in MRSA colonization in both CF and PCD patients. More than 50% of postoperative patients improved their quality of life, so endoscopic sinus surgery is effective in this population in the treatment of chronic rhinosinusitis.

Objetivo: Evaluar la respuesta clínica de los pacientes con fibrosis quística y discinesia ciliar primaria posterior a la cirugía endoscópica de senos paranasales en el Hospital Infantil Dr. Robert Reid Cabral en el período septiembre 2021 a febrero 2022. Métodos: Se realizó un estudio observacional tipo serie de casos, de corte transversal y ambispectivo, donde la población estudiada estuvo conformada por los pacientes con fibrosis quística y discinesia ciliar primaria del hospital infantil Dr. Robert Reid Cabral en el período de estudio. Criterios de inclusión: Pacientes mayores de 6 años con diagnóstico confirmado de fibrosis quística y discinesia ciliar primaria (Prueba genética con 2 mutaciones homocigotas, electrolitos en sudor positivos), síntomas respiratorios severos de RSC que no mejoraron con tratamiento convencional y sometidos a la cirugía endoscópica de senos paranasales. Resultados: De un total de 41 pacientes, sólo 10 cumplieron con los criterios de inclusión, el rango de edad más prevalente fue de 14 a 18 años. Tanto los pacientes con FQ como los de DCP disminuyeron la frecuencia de los síntomas de RSC. Posterior a la CEN hubo cambios discretos en la función pulmonar, y sólo los pacientes con enfermedad grave a moderada aumentaron el % de FEV1. La mayoría de los pacientes no ameritaron ingresos posterior a la cirugía. El germen más común encontrado en los cultivos nasofaríngeo y esputo en los pacientes preoperatorios fue la Pseudomonas aeruginosa en el 86%, luego de la CEN hubo un aumento significativo de la colonización por MRSA tanto en los pacientes con FQ como en los de DCP. Más del 50% de los pacientes postquirúrgicos mejoraron su calidad de vida, por lo que la cirugía endoscópica de senos paranasales es efectiva en dicha población en el tratamiento de la rinosinusitis crónica.

Brazilian guideline for the use of immunobiologicals in chronic rhinosinusitis with nasal polyps ‒ 2024 update

Abstract Introduction Biologics targeting type 2 inflammation have revolutionized the way we treat patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Particularly in severe and difficult-to-control cases, these drugs have provided a new reality for these patients, allowing for the effective and safe treatment of extensive diseases that were not completely managed with the typical strategy of surgery and topical medications. Objectives The experience achieved with the approval of these medications by ANVISA for use in CRSwNP and the knowledge obtained regarding outcomes, adverse effects, and the ideal patient profile prompted the update of the previously published guideline, with a detailed review of the most recent scientific literature, the personal experiences of experts, and the adaptation to the reality of the Brazilian healthcare system, both public and private. Results We proposed a new eligibility criterion for biologics in patients with CRSwNP based on four pillars of indication: the impact of the disease on the patient's life, whether in the presence of specific symptoms or in overall quality of life; the extent of sinonasal disease; the presence of type 2 comorbidities, considering other associated diseases that may also benefit from anti-T2 biologics, and the presence of biomarkers to define type 2 inflammation, especially those associated with worse disease prognoses. Conclusions This innovative and pioneering method has two major advantages. First, it ensures a comprehensive evaluation of patients; second, it is flexible, as advancements in our understanding of the disease and changes in cost-effectiveness can be addressed by simply adjusting the required score for indication, without the need to modify the entire evaluation scheme.

Identification of core gene in chronic rhinosinusitis with nasal polyps and correlations with inflammation-related genes

Abstract Objective Our aim in this study is to identify the core genes of chronic rhinosinusitis with nasal polyps and analyze the correlations between it and inflammation-related genes. Methods GSE72713 dataset containing gene expression data of ECRSwNP, nonECRSwNP and healthy samples was obtained from Gene Expression Omnibus (GEO) and filtered by limma to identify DEGs among three groups, then the functions and correlated pathways of DEGs were analyzed using GO and KEGG. The core DEGs were selected by the intersection of DEGs and the PPI network was constructed via STRING. The correlations between the expression levels of CRSwNP core gene and inflammation-related genes were analyzed via the Mann-Whitney U test. Results The DEGs among ECRSwNP, nonECRSwNP, and CTRL were filtered respectively, and enrichment analysis showed they were associated with olfaction and/or immune responses. The PPI network was constructed by 7 core DEGs obtained via the intersection among three groups, and ALOX15 was confirmed as the core gene in the network. Subsequently, the correlations between the expression levels of ALOX15 and inflammation-related genes were illustrated. Conclusion In this study, the core gene ALOX15 was selected from the DEGs among ECRSwNP, nonECRSwNP, and CTRL. IL5, IL1RL1, and IL1RAP were found to exhibit a significant positive correlation with ALOX15. Level of Evidence Level 3.

Effects of Metabolic Syndrome and its components on the postoperative recurrence in Chronic Rhinosinusitis with Nasal Polyps' patients

Abstract Objectives Metabolic Syndrome (MetS) has been established as a significant factor in the pathogenesis of numerous chronic inflammatory conditions. However, its role in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is unknown. This study aims to investigate the association between MetS, its components, and the risk of postoperative recurrence in Chinese patients with CRSwNP. Methods A retrospective cohort study was conducted on CRSwNP patients who underwent endoscopic sinus surgery in our hospital. Patients were divided into MetS and non-MetS groups, and the clinical characteristics and recurrence rates were compared. All CRSwNP patients were followed up for more than 2-years and further categorized into non-recurrent and recurrent groups. Binary logistic regression analyses were performed to examine the effects of MetS and its components on the risk of postoperative recurrence. Results A total of 555 CRSwNP patients were enrolled in the present study, 157 patients were included in the MetS group and 398 patients were categorized into the non-MetS group. The recurrence rate in the MetS group was significantly higher compared to the non-MetS group (p< 0.05). The rate of MetS, overweight or obesity, hyperglycemia and dyslipidemia were higher in the recurrent group in comparison with the non-recurrent group (p< 0.05). Multivariate logistic regression analysis suggested that MetS, overweight or obesity, hyperglycemia, dyslipidemia, and accompanying allergic rhinitis were associated with the risk of postoperative recurrence of CRSwNP (p< 0.05). Moreover, adjusted and unadjusted regression models showed that MetS was an independent risk factor for postoperative recurrence of CRSwNP, and the risk increased with more components of MetS included (p< 0.05). Conclusion Our findings revealed that MetS independently increased the risk of postoperative recurrence in patients with CRSwNP, with the risk escalating as the number of MetS components increased. Moreover, accompanying allergic rhinitis was also demonstrated to be a potential risk factor for CRSwNP recurrence. Level of evidence: Level 4.

Exploring the impact of inflammatory endotypes on olfactory function and quality of life in chronic rhinosinusitis patients

Abstract Objectives The aim of this observational cross-sectional study was to determine the endotypic inflammatory pattern of a sample of patients with CRS in Brazil, correlate it with olfactory function, and evaluate the clinical severity of the disease. Methods In this cross-sectional study, 73 CRS patients were recruited. Patients were classified into type 2 and non-type 2 endotypic patterns based on IgE and eosinophilia levels. All subjects performed the University of Pennsylvania Smell Identification Test (UPSIT®) and responded to the Sino-Nasal Outcome Test (SNOT-22). Results The majority of patients had type 2 CRS (n = 57, 78.1%). Patients with type 2 CRS compared to non-type 2 CRS had a higher prevalence of nasal polyps (93% vs. 12.5%), asthma (40.3% vs. 12.5%), and non-steroidal anti-inflammatory drug exacerbated respiratory disease (NERD, 17.5% vs. 0%). Type 2 patients also had significantly lower UPSIT® and higher SNOT-22, Lund-Kennedy, and Lund-Mackay scores. Conclusion Our study provides evidence that type 2 CRS is associated with a higher prevalence of nasal polyps, asthma, and NERD, as well as decreased olfactory function and worse quality of life scores. These data will contribute to the body of knowledge on CRS and the development of treatments for this disease in Brazil. Level of evidence: 3.

Prognostic Value of Polypoid Changes of the Middle Turbinate in Relapsed Nasal Polypi after FESS: A Prospective Cohort Study

Abstract Introduction Despite the high level of patient satisfaction with functional endoscopic sinus surgery (FESS) and the clinical improvement, polyp recurrence is observed in 23% to 87% of patients and requires reoperation. Objective To assess the prognostic value of polypoid changes of the middle turbinate (PCMT) in relapse of paranasal sinus polyps in patients with chronic rhinosinusitis with nasal polyp (CRSwNP) after FESS and the effect of partial middle turbinectomy (PMT) on the outcome of surgery. Methods We conducted a prospective clinical study on 60 patients with CRSwNP with and without PCMT. The patients were allocated into three groups: group I included twenty patients without PCMT; group II, twenty patients with PCMT; and group III included twenty patients with PCMT submitted to PMT. The patients were evaluated endoscopically according to the Lund-Kennedy endoscopic scoring system, radiologically according to the Lund-Mackay scoring system, and symptomatically through the 22-item Sinonasal Outcome Test (SNOT-22). Results The total postoperative Lund-Kennedy score differed significantly among the 3 groups (p < 0.001), with a group II presenting a significantly higher total score compared to groups I and III. The Preoperative SNOT-22 score differed significantly among the three groups (p = 0.013), with group II presenting a significantly higher score compared to group I. There was a significant association involving the 3 groups and relapse at 12 months (p = 0.029); relapse was higher in group II (50.0%) than in groups I (20%) and III (15.0%). Conclusion There was a significant association between PCMT and the relapse of nasal polyps. Also, nasal polyposis recurred at a lower rate in the group submitted to middle turbinate resection compared to the group in whom it was preserved.

Olfaction and Quality of Life in Patients with Eosinophilic CRS Undergoing Endoscopic Sinus Surgery

Abstract Introduction Chronic rhinosinusitis (CRS) is a common inflammatory disease. This high prevalence leads to high direct and indirect public health costs, which include medical visits, laboratory tests and imaging, pharmacotherapy, hospitalizations, and surgical treatment. Furthermore, CRS has a substantial impact on patient quality of life, affecting productivity and being a common cause of absence from work CRS-associated olfactory dysfunction is highly prevalent, the actual effectiveness of surgical intervention remains inconsistent. Although there are studies evaluating the postoperative course of patients with eosinophilic Chronic rhinosinusitis (eCRS) treated with high-volume budesonide irrigation, there is little objective information regarding the impact of this intervention on olfactory status and quality of life. Objective To conduct a pre- and postoperative analysis of olfaction and quality of life in patients with eCRS treated with surgical intervention followed by high-volume budesonide nasal irrigation. Methods Prospective, descriptive, uncontrolled study of patients with eCRS. All patients underwent pre- and postoperative nasal endoscopy, SNOT-22 questionnaire, and the University of Pennsylvania Smell Identification Text (UPSIT), always by the same previously trained examiner. The SNOT-22 questionnaire and the UPSIT were readministered to all patients at 3 months, 6 months, and 1 year postoperatively, and scores compared with those obtained preoperatively. Results Twenty patients were included in the study, 13 males and 7 females, between the ages of 23 and 65; 8 patients had comorbid asthma. Quantitative evaluation using the UPSIT test showed a significant improvement in olfaction 3 months after surgery, which remained 6 months and 1 year after surgery (p = 0.0063). There was no significant association between eosinophil concentrations in polypoid tissue and postoperative SNOT-22 and UPSIT results. Patients with tissue eosinophils >50 had a lower preoperative UPSIT score. As early as 3 months postoperatively, a significant improvement in quality of life was already noticeable, as represented by a decrease in SNOT-22 values, which persisted through the 1-year postoperative follow-up evaluation (p = 0.0005). Quantitative evaluation using the UPSIT test showed a significant improvement in olfaction 3 months after surgery, which remained 6 months and 1 year after surgery (p = 0.0063). Conclusion Surgery effectively controlled eCRS in patients who adhered to high-volume budesonide nasal irrigation postoperatively. There were significant improvements in quality of life and olfaction, which persisted at least up to one year postoperatively.

Tumor inflamatorio de Pott en escolar de 7 años: a propósito de un caso / Pott's inflammatory tumor in a 7-year-old schoolboy: a case report

El tumor inflamatorio de Pott (PPT) es una osteomielitis del hueso frontal con un absceso subperióstico concomitante, principalmente secundario a sinusitis frontal complicada. Es infrecuente, pero puede tener consecuencias fatales debido a su alta asociación con complicaciones intracraneales. Presentamos el caso de una escolar de 7 años sin antecedentes, que consulta en el Servicio de Urgencia por un cuadro de 5 semanas de rinorrea mucopurulenta derecha y aumento de volumen frontal progresivo, habiendo recibido antibioticoterapia sin respuesta. Se realizan neuroimágenes que confirman el diagnóstico de rinosinusitis aguda fronto-etmoidal complicada con absceso subperióstico frontal compatible con PPT, asociado a un absceso epidural. Se manejó con antibiótico endovenoso prolongado y aseo quirúrgico mediante craniectomía por abordaje bi-coronal con drenaje de ambas colecciones y reconstrucción de base de cráneo con colgajo de pericráneo, evolucionando favorablemente. El diagnóstico del tumor inflamatorio de Pott es clínico y radiológico, siendo el aumento de volumen frontal el signo cardinal. La tomografía computarizada es útil para establecer el diagnóstico diferencial con otras entidades y la resonancia magnética permite con mayor sensibilidad y especificidad detectar complicaciones intracraneales. El tratamiento es médico y quirúrgico mediante antibioticoterapia endovenosa y aseo quirúrgico oportuno.

Pott's inflammatory tumor is an osteomyelitis of the frontal bone with a concomitant subperiosteal abscess, mainly secondary to complicated frontal sinusitis. It is rare entity but may have fatal consequences due to its high association with intracranial complications. We present the case of a healthy 7-year-old girl who presented to the emergency department with a 5-week history of mucopurulent right rhinorrhea and progressive forehead swelling without response to oral antibiotic therapy. Neuroimaging confirms the diagnosis of acute frontoethmoidal rhinosinusitis complicated with frontal subperiosteal abscess compatible with PPT and an epidural abscess. She received prolonged intravenous antibiotics for six weeks and surgical treatment with craniectomy by bi-coronal approach with drainage of both collections and reconstruction of the skull base with pericranial flap, progressing favorably. The diagnosis of Pott's inflammatory tumor is clinical and radiological. The increased frontal volume is the cardinal sign, and computed tomography is the image of choice, which is also helpful in establishing the differential diagnosis with other entities. Magnetic resonance imaging is practical, given its greater sensitivity and specificity to detect intracranial complications. Treatment is imperative and is based on adequate antibiotic therapy and prompt surgical debridement.

Revisiting the orbital complications of acute rhinosinusitis

Abstract Objective: The present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz & Anselmo-Lima) and observed which of them presented the best clinical applicability. Methods: Clinical data and CT scan findings of patients with orbital infection were retrospectively collected. To compare the three classification systems, we revised and graded all CT images accordingly, and divided the patients into four groups: Eyelid cellulitis (EC), orbital cellulitis (OC), subperiosteal abscess (SA), and orbital abscess (OA). The groups were compared regarding the presence of sinus opacification, the need for hospitalization and/or surgical treatment, and the presence of further complications/sequelae. Results: 143 patients were included. The median number of sinuses involved in patients in the OC, SA, and OA groups was 2.0. ARS was rarely associated with signs of EC (present in both Chandler's and Mortimore & Wormald's classifications. The hospitalization rate was significantly lower in the EC group compared to the other three groups. Surgery was performed in all cases in the OA group, in 58.1% in the SA group, 19.4% in the OC group, and 12.5% in the EC group (p-value < 0.0001 ). Complications were present at higher rates in the OA group compared to the other three groups. Conclusions: ARS was rarely associated with Eyelid Cellulitis. The stratification in the other three groups showed to be clinically relevant. Velasco e Cruz & Anselmo-Lima's classification system proved valid, simple, and effective for categorizing orbital complications of ARS. Level of evidence: 3.

Outcomes of Endoscopic Sinus Surgery for Chronic Rhinosinusitis in Adults with Primary Ciliary Dyskinesia

Abstract Introduction Primary ciliary dyskinesia (PCD) is a rare inherited disease associated with impairment of mucociliary transport and, consequently, with a high incidence of chronic rhinosinusitis. For patients with chronic rhinosinusitis who remain symptomatic despite medical treatment, endoscopic sinus surgery is a safe and effective therapeutic option. However, to date, no studies have been found evaluating the effect of surgery on the quality of life associated with the effect on olfaction and nasal endoscopy findings of patients with primary ciliary dyskinesia and chronic rhinosinusitis. Objective To describe the effect of endoscopic sinus surgery on the quality of life, on olfaction, and on nasal endoscopy findings of adults with PCD and chronic rhinosinusitis. Methods Four patients who underwent endoscopic sinus surgery were included. The Sinonasal Outcome Test-22 (SNOT-22) score, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and the Lund-Kennedy score were collected preoperatively and at 3 and 6 months postoperatively. The olfaction as assessed with the University of Pennsylvania Smell Identification Test (UPSIT), which was administered preoperatively and 3 months postoperatively. Results A total of 4 patients with a mean age of 39.3 years old (3 men and 1 woman) completed the study. All patients showed clinically significant improvement in the SNOT-22, NOSE, and Lund-Kennedy scores at 3 months postoperatively, and this improvement was sustained throughout the follow-up period. However, olfaction did not improve after surgery. Conclusion The endoscopic sinus surgery treatment of chronic rhinosinusitis in adults with PCD was associated with improvement in quality of life and endoscopic findings. However, no improvement in olfaction was demonstrated. Studies with a larger number of patients and control groups should help confirm these findings.

Regressão da polipose nasal induzida pelo dupilumabe / Regression of dupilumab-induced nasal polyps

Relato de caso de paciente com rinossinusite crônica com polipose nasal em tratamento com dupilumabe. São descritos os aspectos clínicos e o impacto na qualidade da vida do paciente. Imagens tomográficas evidenciam a melhora do processo inflamatório e a regressão dos pólipos nasais.

We report the case of a patient with chronic rhinosinusitis with nasal polyps treated with dupilumab. The clinical features and impact on the patient's quality of life are described. Computed tomography shows improvement of the inflammatory process and regression of the nasal polyps.

Combination of Merocel sponge with Lipopolysaccharide to establish rat rhinosinusitis model

Abstract Objective The study aimed to investigate the feasibility of establishing rhinosinusitis model in rats combinated with Lipopolysaccharide (LPS) and merocel sponge. Methods SD (Sprague Dawley) rats that underwent nasal obstruction using Merocel sponge packing, rats with LPS instillation alone, and rats with both nasal obstruction and LPS instillation were used to establish rat models of rhinosinusitis. After the models were established, the nasal symptoms of rats were recorded, the histopathological examination and Transmission Electron Microscopy (TME) of the sinus tissue were performed and the levels of Tumor Necrosis Factor-α (TNF-α), Interleukin-6 (IL-6) in the blood were also analyzed. The expressions of Aquaporin-5 (AQP5), Occludin, Toll-Like Receptor-4 (TLR4), Medullary differentiation factor 88 (MyD88) and phosphorylated (p)-p65 protein were detected by Western blot to evaluate the effect and mechanism of the experimental models. Results We found that compared with the control group and LPS group, the sinusitis symptom scores in the Merocel sponge combined with LPS group were significantly increased; the respiratory epithelia of the maxillary sinus were degenerated, cilia were detached, and even inflammatory cell infiltration occurred; the levels of TNF-α and IL-6 were increased; the expression of AQP5 and Occludin protein was decreased; and the expressions of TLR4, MyD88, and p-p65 protein were increased. Conclusion For the first time, we successfully established a rat rhinosinusitis model using Merocel sponge with LPS and explored the possible mechanism of LPS action.

Sinonasal Outcomes Using Oral Corticosteroids in Patients with Chronic Rhinosinusitis with Nasal Polyps and Positive Sinonasal Cultures

Abstract Introduction Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and positive sinonasal bacterial cultures may be recalcitrant to topical therapy alone due to the additional local inflammatory burden associated with bacterial infection/colonization. Objectives To evaluate sinonasal outcomes in CRSwNP patients with a positive perioperative bacterial culture, who were treated with postoperative intranasal corticosteroids (INCS) alone versus INCS in combination with a short-term course of oral corticosteroids (OCS). Methods This is a retrospective chart review of CRSwNP patients. A total of 59 patients met inclusion criteria, including positive perioperative bacterial culture and treatment with INCS with or without concomitant use of OCS. Two cohorts were formed based on the chosen postoperative medical treatment; 32 patients underwent postoperative INCS alone, while 27 underwent INCS plus a ≤ 2-week course of OCS. The 22-item sinonasal outcome test (SNOT-22) scores and Lund-Kennedy scores (LKS) were assessed preoperatively, and at 2-week, 4-week, and 4 to 6 months after endoscopic sinus surgery (ESS). Results There were no statistically significant differences in postoperative sinonasal symptoms or endoscopic scores between the cohorts treated with INCS plus OCS versus those prescribed INCS alone (p > 0.05). Our regression model failed to demonstrate a relationship between the use of OCS and better sinonasal outcomes at 2-week, 4-week, and 4 to 6 months after ESS (p > 0.05). Conclusions Our study suggests that in a cohort of CRSwNP patients with recent bacterial infections, the postoperative use of combined OCS and INCS did not result in a statistical improvement of endoscopic and symptomatic outcomes over INCS irrigation alone. However, both treatment groups had a clinically significant improvement based on the Minimal Clinically Important Difference.

The Value of Multiple Medication Trials Prior to Balloon Sinuplasty in the Management of Chronic Sinonasal Disease

Abstract Introduction In patients with chronic rhinosinusitis, conservative interventions with extended medical trials are often attempted prior to procedural treatment. Balloon sinuplasty (BSP) is an established procedure for symptomatic relief from chronic rhinosinusitis. However, data suggesting the suboptimal efficacy of prolonged medication management trials, prior to BSP, is lacking. Objectives The purpose of this study was to evaluate the efficacy of prolonged medication management trials, prior to BSP, for patients with chronic rhinosinusitis. Methods A retrospective review was performed for all adults with chronic rhinosinusitis who received extended medical management prior to their BSP at two outpatient clinics, from November 1, 2013, to June 31, 2018. The patients' Sino-Nasal Outcome Test (SNOT) scores were compared between baseline, post-medication trials, and post-BSP. Results The SNOT scores of a total of 64 patients were collected. Overall, patients showed a significant worsening of symptoms during the medication management trials from baseline (p = 0.002126) but significant improvement of symptoms after undergoing BSP (p < 0.0001). Conclusions The patient symptom burden worsened and prolonged during medication management trials. The BSP procedure alone showed significant improvement in the quality of life for chronic rhinosinusitis patients, when considering their SNOT scores. The worsening of patients' symptoms during medication management may invalidate the necessity of prolonged medication management trials.

Significance of leukocyte-specific transcript 1 levels in nasal mucosal tissue to predict recurrence of nasal polyps

Abstract Objective: Chronic Rhinosinusitis with Polyps (CRSwNP) is characterized by high heterogeneity and postoperative recurrence rate. This study aims to explore the clinical significance of tissue Leukocyte-Specific Transcript 1 (LST1) in predicting CRSwNP recurrence. Methods: We enrolled 62 CRSwNP patients including 30 primary CRSwNP and 32 recurrent CRSwNP patients, and 40 Healthy Controls (HC). Tissue samples were collected. Tissue LST1 expression was assessed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR), Western Blotting (WB) and Immunofluorescence (IF) staining. The predictive values of LST1 expression for CRSwNP postoperative recurrence were assessed through the Receiver Operating Characteristic (ROC) curves. Results: The tissue levels of LST1 were significantly increased in the CRSwNP group than the HC group, especially in the recurrent group, and the elevated LST1 mRNA levels were positively correlated with the peripheral eosinophil percentages, tissue eosinophil counts and percentages. IF staining results showed that the LST1 protein levels were higher in CRSwNP patients, especially in the recurrent patients than in the HC group. ROC curves highlighted that tissue LST1 levels were associated with recurrent CRSwNP and exhibited a higher predictive ability for postoperative CRSwNP recurrence. Conclusion: This was the first report suggesting that LST1 expression was upregulated and associated with mucosal eosinophil infiltration and CRSwNP recurrence. Tissue LST1 could be a promising biomarker for predicting postoperative recurrence in CRwNP patients.

Efficacy of Guanqiao Zhengqi holistic therapy for chronic rhinosinusitis / 中国基层医药

Objective:To investigate the efficacy of Guanqiao Zhengqi holistic therapy in the treatment of chronic rhinosinusitis. Methods:A total of 200 patients with chronic rhinosinusitis who received treatment in the Department of Otolaryngology, Shanxi Provincial Integrated Traditional Chinese Medicine and Western Medicine Hospital ( n = 72) and Shanxi Yishengtang Traditional Chinese Medicine Center ( n = 128) from January 2021 to January 2022 were included in this study. These patients were randomly assigned to undergo treatment either with mometasone furoate nasal spray and levocetirizine hydrochloride tablets (control group, n = 100) or Guanqiao Zhengqi holistic therapy combined with mometasone furoate nasal spray and levocetirizine hydrochloride tablets (observation group). All patients were treated for 4 weeks and followed up for 3 months. Clinical efficacy, modified Visual Analogue Scale score, Lund-Kennedy endoscopy scoring system score, and duration of glucocorticoid and anti-leukotriene use were compared between the two groups. Results:The total response rate in the observation group was significantly higher than that in the control group [92.00% (92/100) vs. 73.00% (73/100), χ2 = 18.45, P < 0.001). There was no significant difference in the modified Visual Analogue Scale score between the two groups before treatment ( Z = 1.37, P = 0.170). There was a significant difference in the modified Visual Analogue Scale score between the two groups after treatment ( Z = -5.27, P < 0.001). Before treatment, there was no significant difference in the Lund-Kennedy endoscopy scoring system score between the two groups ( Z = -1.65, P = 0.098) and the Lund-Kennedy endoscopy scoring system score differed significantly between the two groups after treatment ( Z = -6.03, P < 0.001). The duration of glucocorticoid and anti-leukotriene use in the observation group was significantly shorter than that in the control group [10.00 (10.00, 14.00) days vs. 42.00 (28.00, 70.00) days, 7.00 (7.00, 7.00) days vs. 21.00 (14.00, 26.25) days, Z = -11.27, P < 0.001, Z = -12.31, P < 0.001). Conclusion:Based on the conventional treatment with western medicine, Guanqiao Zhengqi holistic therapy for the treatment of chronic rhinosinusitis can effectively reduce clinical symptoms, reduce the dose of hormones and anti-leukotriene used, shorten the use cycle, and improve the therapeutic efficacy.