Incidence and prognosis of olfactory and gustatory dysfunctions related to infection of SARS-CoV-2 Omicron strain: a national multi-center survey of 35 566 population / 中华耳鼻咽喉头颈外科杂志

Objective: This cross-sectional investigation aimed to determine the incidence, clinical characteristics, prognosis, and related risk factors of olfactory and gustatory dysfunctions related to infection with the SARS-CoV-2 Omicron strain in mainland China. Methods: Data of patients with SARS-CoV-2 from December 28, 2022, to February 21, 2023, were collected through online and offline questionnaires from 45 tertiary hospitals and one center for disease control and prevention in mainland China. The questionnaire included demographic information, previous health history, smoking and alcohol drinking, SARS-CoV-2 vaccination, olfactory and gustatory function before and after infection, other symptoms after infection, as well as the duration and improvement of olfactory and gustatory dysfunction. The self-reported olfactory and gustatory functions of patients were evaluated using the Olfactory VAS scale and Gustatory VAS scale. Results: A total of 35 566 valid questionnaires were obtained, revealing a high incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain (67.75%). Females(χ2=367.013, P<0.001) and young people(χ2=120.210, P<0.001) were more likely to develop these dysfunctions. Gender(OR=1.564, 95%CI: 1.487-1.645), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), oral health status (OR=0.881, 95%CI: 0.839-0.926), smoking history (OR=1.152, 95%CI=1.080-1.229), and drinking history (OR=0.854, 95%CI: 0.785-0.928) were correlated with the occurrence of olfactory and taste dysfunctions related to SARS-CoV-2(above P<0.001). 44.62% (4 391/9 840) of the patients who had not recovered their sense of smell and taste also suffered from nasal congestion, runny nose, and 32.62% (3 210/9 840) suffered from dry mouth and sore throat. The improvement of olfactory and taste functions was correlated with the persistence of accompanying symptoms(χ2=10.873, P=0.001). The average score of olfactory and taste VAS scale was 8.41 and 8.51 respectively before SARS-CoV-2 infection, but decreased to3.69 and 4.29 respectively after SARS-CoV-2 infection, and recovered to 5.83and 6.55 respectively at the time of the survey. The median duration of olfactory and gustatory dysfunctions was 15 days and 12 days, respectively, with 0.5% (121/24 096) of patients experiencing these dysfunctions for more than 28 days. The overall self-reported improvement rate of smell and taste dysfunctions was 59.16% (14 256/24 096). Gender(OR=0.893, 95%CI: 0.839-0.951), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), history of head and facial trauma(OR=1.180, 95%CI: 1.036-1.344, P=0.013), nose (OR=1.104, 95%CI: 1.042-1.171, P=0.001) and oral (OR=1.162, 95%CI: 1.096-1.233) health status, smoking history(OR=0.765, 95%CI: 0.709-0.825), and the persistence of accompanying symptoms (OR=0.359, 95%CI: 0.332-0.388) were correlated with the recovery of olfactory and taste dysfunctions related to SARS-CoV-2 (above P<0.001 except for the indicated values). Conclusion: The incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain is high in mainland China, with females and young people more likely to develop these dysfunctions. Active and effective intervention measures may be required for cases that persist for a long time. The recovery of olfactory and taste functions is influenced by several factors, including gender, SARS-CoV-2 vaccination status, history of head and facial trauma, nasal and oral health status, smoking history, and persistence of accompanying symptoms.

Concordant systemic and local eosinophilia relates to poorer disease control in patients with nasal polyps / 中华耳鼻咽喉头颈外科杂志

Objective: To explore whether blood and polyp tissue eosinophil numbers are independent risk factors for poor disease control in patients with nasal polyp. Methods: By using the electronic medical records database and manual evaluation, 183 nasal polyp patients who had undergone endoscopic sinus surgery at least one year prior to the study with complete data of tissue specimens, baseline blood routine test, nasal endoscopy and sinus computed tomography, were identified and recruited to assess disease control based on the criteria of a European Position Paper on Rhinosinusitis and Nasal Polyps 2012 (EPOS 2012). Multiple logistic regression model was used to determine the association between blood and tissue eosinophil numbers and risk of poor disease control by adjusting for demographics and comorbidities. Results: We broke down the cohort into 4 groups according to blood (0.3×109/L) and tissue (10%) eosinophils. The patients without eosinophilic inflammation represented the largest group (41.5%). The group with concordant blood and tissue eosinophilia represented the second largest (31.2%), and the patients with isolated tissue (15.3%) or blood (12.0%) eosinophilia were relatively rare. Multiple logistic regression models found blood eosinophil count and tissue eosinophil percentage were independently associated with increased risk for poor disease control after adjustments for covariates related to poor treatment outcome. Furthermore, subjects with concordant blood and tissue eosinophilia had a higher risk for poor disease control than those with isolated blood or tissue eosinophilia. Conclusion: Concordant blood and tissue eosinophilia relates to a higher likelihood of poor disease control than isolated blood or tissue eosinophilia after adjustment of potential confounders in nasal polyp patients.

Clinical Characteristics and Endoscopic Endonasal Removal of Foreign Bodies within Sinuses, Orbit, and Skull Base / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Foreign bodies within the sinuses, orbit, and skull base (FBSOS) are rare; hence, diagnosis and management guidelines are lacking. Endoscopic sinus surgery (ESS) removal is preferred because of the less invasiveness and minimal morbidity. This study was designed to summarize clinical experience with ESS management of FBSOS.</p><p><b>METHODS</b>We retrospectively reviewed clinical manifestations, imaging findings, treatment, and outcomes in consecutive patients with ESS removal of FBSOS between 2004 and 2015 at a tertiary academic medical center. The Chi-square test was performed to compare the infection rate between wooden and nonwooden FBSOS.</p><p><b>RESULTS</b>There were 23 male and five female patients, with median age of 11 years. FBSOS were located within the sinuses (86%), orbit (75%), and skull base/intracranial region (46%). Wooden FBSOS had a significantly higher risk of infection (78%) compared with nonwooden FBSOS (5%, P < 0.05). Contrast-enhanced computed tomography (CT) plus three-dimensional reconstruction was sensitive in all cases. Twenty-seven (96%) FBSOS were removed by ESS alone, while 1 (4%) FBSOS was removed using the combined ESS and lateral cervical approach. Four of the nine intracranial penetrating FBSOS patients had intraoperative cerebrospinal fluid (CSF) leak and received endoscopic CSF leak repair. Twelve (43%) patients suffered complications (meningitis, diplopia, and vision loss).</p><p><b>CONCLUSIONS</b>ESS is a minimally invasive, safe, and promising surgical approach for FBSOS removal. Contrast-enhanced CT is effective in preoperative diagnosis and intraoperative guidance. Wooden FBSOS had higher risk of infection, thus antibiotics are recommended.</p>

Efficacy of endoscopic sinus surgery-based on multidisciplinary treatment for chronic rhinosinusitis with asthma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of endoscopic sinus surgery (ESS)-based on multidisciplinary treatment for patients with chronic rhinosinusitis (CRS) and asthma.</p><p><b>METHODS</b>The study included 25 CRS patients with asthma who received ESS from September 2006 to March 2009, besides surgery, who also used corticosteroid nasal spray, oral macrolide antibiotics and nasal irrigation perioperatively. Evaluation was performed before ESS, 1 year and 3 years post-ESS. Evaluation index included visual analogue scale (VAS) and endoscopy Lund-Kennedy assessment for CRS, and asthma control test (ACT) and pulmonary function tests for asthma.</p><p><b>RESULTS</b>Twenty-three (92%) patients were followed up for 12 months. Twelve (48%) of them were followed up for 36 months. CRS efficacy: VAS of general symptom significantly improved after ESS compared to pre-ESS (8.12 ± 0.60, x(-) ± s), after 1 year (3.20 ± 2.19) and 3 year (3.79 ± 2.32) follow up (both P = 0.000). There was no statistic difference between 1 year and 3 year follow up (P = 0.851). Endoscopy Lund-Kennedy score significantly improved in post-ESS after 1 year (4.35 ± 3.21) and 3 year (5.50 ± 2.64) follow up compared to pre-ESS (9.80 ± 2.10, both P = 0.000), and there was no difference between 1 year and 3 year follow up (P = 0.606). Asthma efficacy: ACT pre-ESS, 1 year and 3 year were 21.96 ± 2.16, 23.61 ± 1.94 and 22.33 ± 3.47, without statistic difference (F = 2.871, P = 0.065). Pulmonary function showed no significant change after surgery (Pre-ESS 74.68 ± 11.09, 1 year 73.27 ± 12.27, 3 year 73.50 ± 7.87, F = 0.076, P > 0.05).</p><p><b>CONCLUSIONS</b>ESS improves CRS with asthma significantly and persistently. Asthma control level, anti-asthma drug dose and pulmonary function remain stable after ESS.</p>

Transnasal endoscopic frontal sinus surgery using expanded agger nasi approach / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility of endoscopic modified agger nasi approach for the surgical treatment of frontal sinus diseases.</p><p><b>METHODS</b>The data of patients undergoing modified agger nasi approach for frontal diseases were prospectively collected since January 2009, including demographic data, findings at surgery, presence of postoperative symptoms, endoscopic appearance of the frontal recess and sinus, and complications.</p><p><b>RESULTS</b>Nineteen patients were enrolled from January 2009 to August 2010. Seventeen patients had chronic rhinosinusitis, in which 13 patients (76.5%) completely healed, 3 patients (17.6%) improved and 1 patient (5.9%) failed. Two patients had frontal sinus and anterior ethmoid sinus inverted papilloma, with no recurrence. The patients were followed up from 6 to 24 months, medium 16 months. No severe complication occurred. No frontal recess adhesion was found. Four sides of frontal recess showed stenosis caused by tissue hypertrophy.</p><p><b>CONCLUSION</b>The modified agger nasi approach provides excellent access to frontal recess and frontal sinus, with good effect for preventing re-stenosis after surgery.</p>

Ophthalmic complication and management of endoscopic sinus surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the possible reasons and the treating experiences of ophthalmic complications in order to elevate the attention of the nasal endoscopic surgeon.</p><p><b>METHODS</b>This study was involved 8 categories in 22 cases which had typical characteristic of ophthalmic complications of endoscopic sinus surgery, including injury of lamina papyracea, obstructive cyst of frontal and ethmoid sinuses, orbital infection, injuries of lacrimal passages, injury of extraocular muscles, orbital hemorrhage, optic nerve injury and arterial embolism of optic fundi. The patients were given corresponding treatment.</p><p><b>RESULTS</b>Injury of lamina papyracea was cured by medical treatment while orbital infection, injury of lacrimal passages, obstructive cyst of frontal and ethmoid sinuses were completely recovered by endoscopic surgery. In one of the cases, the injured optic nerve had recovered after transnasal optic and orbital apex decompression but the other 6 sides of 6 patients had not been improved. In one case who had suffered from injury of extraocular muscles, their diplopia disappeared mostly, but the other cases had a slight diplopia after surgery. One case who had visual descending caused by orbital hemorrhage recovered. Two cases of visual loss caused by intraorbital hemorrhage and arterial embolism of optic fundi respectively were not improved.</p><p><b>CONCLUSIONS</b>It is very difficult to cure if the patients lose the sight because of optic nerve injury, orbital hemorrhage and the ischemia of orbit, however, if the patients had remnant vision the prognosis should be much better.</p>