Perception of Young European Otolaryngologists toward Transoral Robotic Surgery in Head and Neck Oncology and Surgery.

Background: To investigate the perception of young European otolaryngologists (OTOs), i.e., head and neck surgeons, toward transoral robotic surgery (TORS). Methods: Members of the Young Confederation of European Otorhinolaryngology-Head and Neck Surgery and Young Otolaryngologists of International Federation of Otorhinolaryngological Societies were surveyed about TORS perception and practice. Results: The survey was completed by 120 young OTOS (26%). The most important barriers to TORS were robot availability (73%), cost (69%), and lack of training (37%). The participants believed that the main benefits include better surgical filed view (64%), shorter hospital stay (62%), and better postoperative outcomes (61%) than the conventional approach. Head and neck surgeons considered cT1-T2 oropharyngeal cancers (94%), resection of base of tongue for sleep apnea (86%), or primary unknown cancer (76%) as the most appropriate indications. A total of 67% of TORS surgeons assessed themselves as adequately trained in TORS. Conclusions: Young European OTOs report positive perception, adoption, and knowledge of TORS. The cost-related unavailability and the lack of training or access are reported to be the most important barriers for the spread of TORS.

Persistent brain metabolic impairment in long COVID patients with persistent clinical symptoms: a nine-month follow-up [18F]FDG-PET study.

PURPOSE: A hypometabolic profile involving the limbic areas, brainstem and cerebellum has been identified in long COVID patients using [18F]fluorodeoxyglucose (FDG)-PET. This study was conducted to evaluate possible recovery of brain metabolism during the follow-up of patients with prolonged symptoms. METHODS: Fifty-six adults with long COVID who underwent two brain [18F]FDG-PET scans in our department between May 2020 and October 2022 were retrospectively analysed, and compared to 51 healthy subjects. On average, PET1 was performed 7 months (range 3-17) after acute COVID-19 infection, and PET2 was performed 16 months (range 8-32) after acute infection, because of persistent severe or disabling symptoms, without significant clinical recovery. Whole-brain voxel-based analysis compared PET1 and PET2 from long COVID patients to scans from healthy subjects (p-voxel < 0.001 uncorrected, p-cluster < 0.05 FWE-corrected) and PET1 to PET2 (with the same threshold, and secondarily with a less constrained threshold of p-voxel < 0.005 uncorrected, p-cluster < 0.05 uncorrected). Additionally, a region-of-interest (ROI) semiquantitative anatomical approach was performed for the same comparisons (p < 0.05, corrected). RESULTS: PET1 and PET2 revealed voxel-based hypometabolisms consistent with the previously reported profile in the literature. This between-group analysis comparing PET1 and PET2 showed minor improvements in the pons and cerebellum (8.4 and 5.2%, respectively, only significant under the less constrained uncorrected p-threshold); for the pons, this improvement was correlated with the PET1-PET2 interval (r = 0.21, p < 0.05). Of the 14,068 hypometabolic voxels identified on PET1, 6,503 were also hypometabolic on PET2 (46%). Of the 7,732 hypometabolic voxels identified on PET2, 6,094 were also hypometabolic on PET1 (78%). The anatomical ROI analysis confirmed the brain hypometabolism involving limbic region, the pons and cerebellum at PET1 and PET2, without significant changes between PET1 and PET2. CONCLUSION: Subjects with persistent symptoms of long COVID exhibit durable deficits in brain metabolism, without progressive worsening.

Prospective Evaluation of Aesthetic and Functional Outcomes following Video-Assisted Rhino-Septoplasty.

BACKGROUND: Conservative techniques have been developed in the field of rhinoplasty, focusing on limited tissue resection while emphasizing the reshaping of nasal structural elements. OBJECTIVES: We aimed to prospectively evaluate aesthetic and functional outcomes following Video-Assisted Rhino-Septoplasty (VARS) using validated tools. METHODS: Patients' self-reported outcomes were assessed before and 6 months after surgery. Aesthetic evaluations used FACE-Q Rhinoplasty modules (FQRM) Satisfaction with Nose and Nostrils. Functional evaluations were performed with NOSE scores. T-tests were used to determine the significance of the change in scores before and after surgery. p value < 0.05 was considered statistically significant. RESULTS: Fifty patients were included (sex ratio = 0.16, mean age = 30 y.o., 78% primary cases). All patients had associated septoplasties, and 32 had inferior turbinate reductions. Mean FQRM Nose scores were 28.1 ± 16.3 before vs. 83.4 ± 17.2/100 after surgery. Mean FQRM Nostrils scores were 61.5 ± 28.6 before vs. 85 ± 21/100 after surgery. Mean NOSE scores were 49.5 ± 36.3 before vs. 14.8 ± 16.6/100 after surgery. All p <0.001. We found no correlation between FQRM Nose and NOSE scores after surgery (ρ = -0.1553, IC95% (-0.41;0.12), p = 0.28). CONCLUSION: Our study showed that VARS is an effective technique, yielding high patient satisfaction in both aesthetic and functional outcomes. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Past, Present, and Future Diagnostic Methods for the Early Noninvasive Detection of Oral Premalignant Lesions: A State of the Art and Systematic Review.

Objectives: To provide an in-depth analysis of noninvasive methods for the early diagnosis of oral premalignant lesions, focusing on novel biomarkers and optical technologies, and to discuss their potential in improving the prognosis of patients with oral oncological diseases. Methods: This state-of-the-art review examines various noninvasive diagnostic techniques, including the utilization of salivary microRNAs and optical technologies such as Raman spectroscopy, elastic scattering spectroscopy, diffuse reflectance spectroscopy, narrow-band imaging, autofluorescence imaging, toluidine blue staining, and microendoscopy. Results: Several noninvasive techniques have shown varying degrees of effectiveness in detecting oral cancer. Autofluorescence imaging exhibited sensitivities up to 100% but had variable specificity. toluidine blue staining reported sensitivity between 77% and 100% for high-risk lesions or cancer, with specificity around 45% to 67%. Spectroscopy techniques achieved 72% to 100% sensitivities and specificities of 75% to 98%. Microendoscopy presented a sensitivity of 84% to 95% and a specificity of 91% to 95%. Conclusion: The review highlights the strengths and limitations of each noninvasive diagnostic method and their recent advancements. Although promising results have been demonstrated, there is a need for further development of reliable strategies for early detection and intervention in oral oncology.

Performance and Consistency of ChatGPT-4 Versus Otolaryngologists: A Clinical Case Series.

OBJECTIVE: To study the performance of Chatbot Generative Pretrained Transformer-4 (ChatGPT-4) in the management of cases in otolaryngology-head and neck surgery. STUDY DESIGN: Prospective case series. SETTING: Multicenter University Hospitals. METHODS: History, clinical, physical, and additional examinations of adult outpatients consulting in otolaryngology departments of CHU Saint-Pierre and Dour Medical Center were presented to ChatGPT-4, which was interrogated for differential diagnoses, management, and treatment(s). According to specialty, the ChatGPT-4 responses were assessed by 2 distinct, blinded board-certified otolaryngologists with the Artificial Intelligence Performance Instrument. RESULTS: One hundred cases were presented to ChatGPT-4. ChaGPT-4 indicated a mean of 3.34 (95% confidence interval [CI]: 3.09, 3.59) additional examinations per patient versus 2.10 (95% CI: 1.76, 2.34; P = .001) for the practitioners. There was strong consistency (k > 0.600) between otolaryngologists and ChatGPT-4 for the indication of upper aerodigestive tract endoscopy, positron emission tomography and computed tomography, audiometry, tympanometry, and psychophysical evaluations. Primary diagnosis was correctly performed by ChatGPT-4 in 38% to 86% of cases depending on subspecialty. Additional examinations indicated by ChatGPT-4 were pertinent and necessary in 8% to 31% of cases, while the treatment regimen was pertinent in 12% to 44% of cases. The performance of ChatGPT-4 was not influenced by the human-reported level of difficulty of clinical cases. CONCLUSION: ChatGPT-4 may be a promising adjunctive tool in otolaryngology, providing extensive documentation about additional examinations, primary and differential diagnoses, and treatments. The ChatGPT-4 is more effective in providing a primary diagnosis, and less effective in the selection of additional examinations and treatments.

Advancing the Era of Liquid Rhinoplasty: A Methodological Approach to Injection Protocols.

BACKGROUND: Liquid rhinoplasty, a non-surgical procedure using hyaluronic acid (HA) to reshape and refine the nose, has gained in popularity as an alternative to traditional surgical rhinoplasty although its results are not definitive. However, the lack of standardized injection protocols has raised concerns about treatment consistency and patient safety. OBJECTIVES: In this article, the authors propose a systematic protocol for the most common indications of liquid rhinoplasty. METHODS: By adopting a standardized methodology, healthcare professionals can enhance patient safety, improve treatment consistency, and optimize patient satisfaction. RESULTS: The protocol includes standardized injection sites categorized as dorsal, paramedian, tip and endonasal injections. Specific injection areas are recommended for different nasal shapes such as droopy noses, dorsal humps, nasal saddle deformity, inverted V deformity, tip shape abnormalities, twisted noses, revision cases with dorsal irregularities, and internal nasal valve dysfunction. While variations in filler dosages may be necessary based on individual patient needs, a conservative approach is recommended to maintain natural-looking results and reduce the risk of complications. CONCLUSIONS: The increase in non-surgical techniques for nasal refinement offers patients more options, and systematized injection protocols based on different nasal types provide a structured framework for liquid rhinoplasty. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reply to: "Invited Discussion on: Video Assisted Septo-Rhinoplasty, the Future of Endonasal Rhinoplasty-a Technical Note".

We respond to Gryskiewic and Alameddine's commentary on our recent study regarding endoscopic use in rhinoplasty. Highlighting the context-dependent nature of technique superiority, we discuss the alternative approach of Video Assisted Rhinoseptoplasty (VARS) in mitigating visible scarring concerns. Additionally, we emphasize the benefits of comparing closed procedures with and without endoscopic assistance, underscoring the advantages of optical utilization. Our perspective on nasal tip surgery advocates for enlarged marginal incisions to facilitate direct visual control, complementing our approach. Addressing concerns on the learning curve, we share insights from our training experience, stressing the feasibility of achieving proficiency with practice. Lastly, we acknowledge the need for surgical flexibility, particularly in cases of cartilaginous weakness, where alternative strategies like spreader grafts may be considered. Our response contributes to advancing rhinoplasty techniques, promoting context-driven approaches and adaptability for optimized outcomes.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Impact of the Post-Traumatic Facial Reconstruction on Postoperative Weight Loss.

Objectives: To identify risk factors and evaluate the impact of various facial fractures and reconstruction surgeries on postoperative weight change. Methods: Retrospective, monocentric study was performed at a tertiary care center. Medical history, type and mechanism of fracture, operative factors, and postoperative weights at follow-up appointments for 145 adult patients undergoing surgical repair for maxillofacial fractures were collected. Further information was obtained on postoperative diet and whether patients received maxillomandibular fixation (MMF). Univariate and multivariate analyses were utilized to evaluate effects of surgical reconstruction after facial trauma on postoperative weight loss. Results: Patients lost 3.2 ± 4.9 kg (95% confidence interval = 2.7-4.1, P < .0001) on average, with maximum loss between date of surgery and first follow-up. Univariate analysis demonstrated that intensive care unit admission (5.9 kg, SD 5.4, P = .001), nasogastric tube placement (5.1 kg, SD 4.6, P = .012), and MMF (4.4 kg, SD 5.4, P < .0001) were associated with more severe weight loss. Multivariate analyses showed that only MMF remained a significant risk factor for increased weight loss (avg. 6.0, standard error 1.93, t value 3.11, P = .0024). Conclusions: We report significant weight loss following facial trauma and reconstruction, which emphasizes the need to perform further studies on nutrition protocols for this patient population to optimize wound healing.

The Prognostic Value of Olfactory Dysfunction in Patients with COVID-19: The COVIDORA Study.

BACKGROUND: Among all studies describing COVID-19 clinical features during the first wave of the pandemic, only a few retrospective studies have assessed the correlation between olfac-tory dysfunction (OD) and the evolution of disease severity. The main aim was to assess whether OD is a predictive factor of COVID-19 severity based on the patient's medical management (outpa-tient care, standard hospital admission, and ICU admission). METHODS: A national, prospective, mul-ticenter cohort study was conducted in 20 public hospitals and a public center for COVID-19 screen-ing. During the first wave of the pandemic, from 6 April to 11 May 2020, all patients tested positive for COVID-19 confirmed by RT-PCR underwent two follow-up ENT consultations within 10 days of symptom onset. The main outcome measures were the evolution of medical management (out-patient care, standard hospital admission, and ICU admission) at diagnosis and along the clinical course of COVID-19 disease. RESULTS: Among 481 patients included, the prevalence of OD was 60.7%, and it affected mostly female patients (74.3%) under 65 years old (92.5%), with fewer comor-bidities than patients with normal olfactory function. Here, 99.3% (290/292) of patients with OD presented with non-severe COVID-19 disease. Patients reporting OD were significantly less hospi-talized than the ones managed as outpatients, in either a standard medical unit or an ICU. Conclu-sions: As regards the clinical course of COVID-19 disease, OD could predict a decreased risk of hospitalization during the first wave of the pandemic.

Is generative pre-trained transformer artificial intelligence (Chat-GPT) a reliable tool for guidelines synthesis? A preliminary evaluation for biologic CRSwNP therapy.

INTRODUCTION: Biologic therapies for Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) have emerged as an auspicious treatment alternative. However, the ideal patient population, dosage, and treatment duration are yet to be well-defined. Moreover, biologic therapy has disadvantages, such as high costs and limited access. The proposal of a novel Artificial Intelligence (AI) algorithm offers an intriguing solution for optimizing decision-making protocols. METHODS: The AI algorithm was initially programmed to conduct a systematic literature review searching for the current primary guidelines on biologics' clinical efficacy and safety in treating CRSwNP. The review included a total of 12 studies: 6 systematic reviews, 4 expert consensus guidelines, and 2 surveys. Simultaneously, two independent human researchers conducted a literature search to compare the results. Subsequently, the AI was tasked to critically analyze the identified papers, highlighting strengths and weaknesses, thereby creating a decision-making algorithm and pyramid flow chart. RESULTS: The studies evaluated various biologics, including monoclonal antibodies targeting Interleukin-5 (IL-5), IL-4, IL-13, and Immunoglobulin E (IgE), assessing their effectiveness in different patient populations, such as those with comorbid asthma or refractory CRSwNP. Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha subunit, demonstrated significant improvement in nasal symptoms and quality of life in patients with CRSwNP in several randomized controlled trials and systematic reviews. Similarly, mepolizumab and reslizumab, which target IL-5, have also shown efficacy in reducing nasal polyp burden and improving symptoms in patients with CRSwNP, particularly those with comorbid asthma. However, additional studies are required to confirm the long-term efficacy and safety of these biologics in treating CRSwNP. CONCLUSIONS: Biologic therapies have surfaced as a promising treatment option for patients with severe or refractory CRSwNP; however, the optimal patient population, dosage, and treatment duration are yet to be defined. The application of AI in decision-making protocols and the creation of therapeutic algorithms for biologic drug selection, could offer fascinating future prospects in the management of CRSwNP.

ChatGPT-4 performance in rhinology: A clinical case series.

KEY POINTS: Chatbot Generative Pre-trained Transformer (ChatGPT)-4 indicated more than twice additional examinations than practitioners in the management of clinical cases in rhinology. The consistency between ChatGPT-4 and practitioner in the indication of additional examinations may significantly vary from one examination to another. The ChatGPT-4 proposed a plausible and correct primary diagnosis in 62.5% cases, while pertinent and necessary additional examinations and therapeutic regimen were indicated in 7.5%-30.0% and 7.5%-32.5% of cases, respectively. The stability of ChatGPT-4 responses is moderate-to-high. The performance of ChatGPT-4 was not influenced by the human-reported level of difficulty of clinical cases.

Pediatric Inferior Turbinate Hypertrophy: Diagnosis and Management. A YO-IFOS Consensus Statement.

OBJECTIVE: Pediatric inferior turbinate hypertrophy (PedTH) is a frequent and often overlooked cause or associated cause of nasal breathing difficulties. This clinical consensus statement (CCS) aims to provide a diagnosis and management framework covering the lack of specific guidelines for this condition and addressing the existing controversies. METHODS: A clinical consensus statement (CCS) was developed by a panel of 20 contributors from 7 different European and North American countries using the modified Delphi method. The aim of the CCS was to offer a multidisciplinary reference framework for the management of PedTH on the basis of shared clinical experience and analysis of the strongest evidence currently available. RESULTS: A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria was performed. From the initial 96 items identified, 7 articles were selected based on higher-evidence items such as randomized-controlled trials, guidelines, and systematic reviews. A 34-statement survey was developed, and after three rounds of voting, 2 items reached strong consensus, 17 reached consensus or near consensus, and 15 had no consensus. CONCLUSIONS: Until further prospective data are available, our CCS should provide a useful reference for PedTH management. PedTH should be considered a nasal obstructive disease not necessarily related to an adult condition but frequently associated with other nasal or craniofacial disorders. Diagnosis requires clinical examination and endoscopy, whereas rhinomanometry, nasal cytology, and questionnaires have little clinical role. Treatment choice should consider the specific indications and features of the available options, with a preference for less invasive procedures. LEVEL OF EVIDENCE: 5 Laryngoscope, 134:1437-1444, 2024.

Effectiveness of Platelet-Rich Plasma for COVID-19-Related Olfactory Dysfunction: A Controlled Study.

OBJECTIVE: To investigate the effectiveness of platelet-rich plasma (PRP) injection into the olfactory clefts of coronavirus disease 2019 (COVID-19) patients with persistent olfactory dysfunction (OD). STUDY DESIGN: Controlled study. SETTING: Multicenter study. METHODS: From March 2022 to November 2022, COVID-19 patients with persistent OD were recruited from three European hospitals to undergo PRP injections into the olfactory clefts. Olfactory function was evaluated at baseline and 10 weeks postinjection with the Olfactory Disorder Questionnaire (ODQ) and threshold, discrimination, and identification (TDI) test. Data were compared with a control group of untreated patients. RESULTS: Eighty-one patients who underwent PRP injection and 78 controls were included. Sixty-five PRP patients (80.3%) experienced subjective smell improvement after a mean duration of 3.4 ± 1.9 weeks. The parosmia, life quality statement, and ODQ sub- and total scores significantly decreased from pre- to 10-week postinjection in the PRP group. The TDI sub- and total scores significantly increased 10 weeks postinjection. In controls, the ODQ score did not change over time, while the discrimination, identification, and total TDI scores significantly increase after 10 weeks of follow-up. The 10-week TDI and ODQ scores were significantly better in the PRP group compared with the controls. CONCLUSION: Patients who underwent PRP injection reported better 10-week subjective and objective smell outcomes than controls. Future randomized-controlled studies using saline injection into the olfactory cleft of controls are needed to determine the superiority of PRP over placebo.

Effectiveness and rapidity on olfatory fuction recovery in CRS patients treated with Dupilumab: a real life prospective controlled study.

BACKGROUND: Recovery of olfactory function plays a prominent role in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). While rates and timing of such recovery vary, monoclonal antibodies might yield better results which we aimed at evaluating with this study. METHODOLOGY: A prospective controlled study was conducted at our tertiary otolaryngological center from April 1, 2021, to October 1, 2022, in CRSwNP patients. We included an active group (n = 60 patients) performing dupilumab treatment and a control group (n = 60 patients) treated with intranasal and oral corticosteroids. Primary endpoints were changes in smell visual analogical scale (VAS) and SS-I (Sniffin' Sticks-identification) scores, and olfactory recovery rate. The secondary efficacy endpoints were nasal obstruction, rhinorrhea, headache, SNOT-22, and nasal congestion score (NCS). RESULTS: At 6 months, the active group demonstrated better outcomes than control in SS-I scores (10.23 ± 4.21 vs.3.68 ± 3.08; p < 0.001). No significant differences were found in blood eosinophil count, SNOT-22, and NPS (p > 0.05 for all). Olfactory function in the treatment arm improved in 86.66% (52/60 cases), with normal scores in 48.33% (29/60), while the control group reported a lower recovery rate (3/60; 5%), with no normal olfaction cases. Log-rank comparison for Kaplan-Meier functions was statistically significant (p < 0.001), but no differences were found in subanalysis in the active group based on blood eosinophil count at baseline, SNOT-22, and NPS scores. CONCLUSIONS: Patients who receive dupilumab treatment may experience a faster recovery of olfactory function compared to those receiving corticosteroid therapy. This result would be maintained regardless of the severity of type 2 CRSwNP inflammation, the volume of the polyps, or the patient's subjective symptomatology.

Cross-cultural adaptation of the CRS-PRO questionnaire into French.

BACKGROUND: Chronic rhinosinusitis (CRS), encompasses many different clinical patterns with variable response to treatment. Precise criteria specifying disease severity and control are lacking in the current literature. Our aim was to perform a cross-cultural adaptation of the CRS-PRO, creating a French version for use as a routine questionnaire in the assessment of patients with CRS. METHODS: The CRS-PRO questionnaire was translated according to the recommendations of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) through a three-step procedure including a backward translation. RESULTS: Seven of 12 items were initially discordant between the three translators before achieving consensus (Step 1). Two of 12 items were discordant between the backward translation and the initial CRS-PRO version regarding the word "mucus"(Step 2). Step 3 allowed the creation of a French proof-read version of the CRS-PRO questionnaire. Thirty patients were included for initial validation, mean age of 49.2 ± 15 years and 63.3% (19/30) male. It took them 67 ± 23 s to complete the questionnaire without any patients requiring more than 2 min. CONCLUSION: This study presents the French version of the CRS-PRO questionnaire-an adapted, validated, and well-accepted instrument to evaluate the CRS symptoms in the French speaking population.

The Role of Ear, Nose, and Throat Specialists in the Nose-to-Brain Pathway.

This Viewpoint discusses the role of ear, nose, and throat specialists in the understanding, development, growth, and administration of direct nose-to-brain delivery route devices and therapies.

Video-Assisted Septo-rhinoplasty, the Future of Endonasal Rhinoplasty-A Technical Note.

INTRODUCTION: Surgeons have sought to improve outcomes in rhinoplasty through innovative techniques. Although many publications illustrate the advantages of endoscopic septoplasty over conventional methods, few have evaluated the benefits of endoscopy for rhinoplasty. In this article, the authors meticulously describe their own technique that offers a sustainable alternative to open approach rhinoplasty, with high reproducibility and enhanced knowledge for young surgeons. METHODS: The technique involves using video-assisted endoscopy for enhanced visibility and access. Various steps are performed, including hemitransfixion incision, septoplasty if necessary, dorsal reduction, and the development of endoscopic spreader flaps. Nasal tip surgery follows standard endonasal rhinoplasty techniques. RESULTS: This technique has been successfully performed for years in primary and secondary rhinoplasties, resulting in improved aesthetic and functional outcomes without external scars. The endoscopic view enhances understanding for surgeons and residents, while preserving internal valve function and minimizing swelling. Patients express high satisfaction with the procedure. CONCLUSIONS: Video-assisted endoscopic septo-rhinoplasty offers a valuable alternative, providing natural outcomes with improved visualization and reduced complications. It is applicable to various indications and demonstrates its effectiveness compared to traditional approaches. The advanced endoscopic guided septo-rhinoplasty technique combines the benefits of open approach rhinoplasty while avoiding its drawbacks. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Surgical management of chronic rhinosinusitis with nasal polyps under local anaesthesia: indications and results.

Objective: Our objective was to specify the indications and duration of effectiveness of Awake Patient Polyp Surgery (APPS) in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Secondary objectives were to evaluate complications and Patient-Reported Experience (PREMs) and Outcome Measures (PROMs). Methods: We collected information regarding sex, age, comorbidities and treatments. Duration of effectiveness was the duration of non-recurrence defined by the time between APPS and a new treatment. Nasal Polyp Score (NPS) and Visual Analogic Scales (VAS, from 0/10 to 10/10) for nasal obstruction and olfactory disorders were assessed preoperatively and one month after surgery. PREMs were evaluated using a new tool: the APPS score. Results: Seventy-five patients were enrolled (SR = 3.1, mean age = 60.9 ± 12.3 years). 60% of patients had a previous history of sinus surgery, 90% had stage 4 NPS and more than 60% had overuse of systemic corticosteroids. Mean time of non-recurrence was 31.3 ± 2.3 months. We found a significant improvement (all p < 0.001) for NPS (3.8 ± 0.4 vs 1.5 ± 0.6), VAS obstruction (9.5 ± 1.6 vs 0.9 ± 1.7) and VAS olfactory disorders (4.9 ± 0.2 vs 3.8 ± 1.7). Mean APPS score was 46.3 ± 5.5/50. Conclusions: APPS is a safe and efficient procedure in the management of CRSwNP.

The submucosal approach influences long-term outcomes of refractory obstructive rhinitis: A prospective study and a STROBE analysis.

OBJECTIVE: The surgical approach to refractory hypertrophy of the inferior turbinates is the main therapeutic choice in the management of its symptoms. Although submucosal approaches have demonstrated efficacy, long-term results are debated in the literature and show variable stability. Therefore, we compared the long-term outcomes of three submucosal turbinoplasty methods with regard to the efficacy and stability managing the respiratory disorders. DESIGN: Multicenter prospective controlled study. A computer-generated table was used to allocate participants to the treatment. SETTING: Two teaching and university medical centers. METHODS: We used the EQUATOR network for guidelines describing design, conduct, and reporting of studies and searched the references of these guidelines to identify further relevant publications reporting adequate study protocols. Patients with persistent bilateral nasal obstruction due to lower turbinate hypertrophy were prospectively recruited from our ENT units. Participants were randomly assigned to each treatment and then underwent symptom assessment by visual analog scales, endoscopic assessment at baseline and 12, 24 and 36 months after treatment. RESULTS: Of the 189 patients with bilateral persistent nasal obstruction initially assessed, 105 met the study requirements; 35 were located in the MAT group, 35 in the CAT group and 35 in the RAT group. Nasal discomfort was significantly reduced after 12 months with all the methods. The MAT group presented better outcomes for all VAS scores at the 1-year follow-up, greater stability at the 3-year follow-up for VAS results (p < 0.001 in all cases) and lower disease recurrence (5/35; 14.28 %). At the 3-year follow-up intergroup analysis, a statistically significant difference was confirmed except for RAA scores (H = 2.88; p = 0.236). Rhinorrhea (r = -0.400; p < 0.001) was demonstrated as a predictive factor of 3-year recurrence, while sneezing (r = -0.25; p = 0.011), and operative time needed (r = -0.23; p = 0.016) did not reach statistical significance. CONCLUSIONS: Long-term symptomatic stability varies depending on the turbinoplasty method used. MAT demonstrated greater efficacy in controlling nasal symptoms, presenting better stability in reducing turbinate size and nasal symptoms. In contrast, radiofrequency techniques presented a higher rate of disease recurrence both symptomatically and endoscopically.

Sensibility, specificity, and accuracy of the Sinonasal Outcome Test 8 (SNOT-8) in patients with chronic rhinosinusitis (CRS): a cross-sectional cohort study.

PURPOSE: To analyze as the primary endpoint the accuracy, sensitivity, and specificity of the SNOT-22 assessing CRS severity and to compare the results with a version of the SNOT-8 obtained from the nasal domain items. METHODS: Data were obtained from a prospective multicenter controlled study of dupilumab in adults with moderate-severe CRSwNP. EQUATOR and STROBE network guidelines were adopted. A multivariate logistic regression model was used to evaluate the accuracy of the model with the full (SNOT-22) and reduced (SNOT-8) item set to predict the severity outcome. RESULTS: SNOT-22 demonstrated an AUC of 0.885 (95% CI 0.825, - 0.945), and sensitivity and specificity of 91.49% (83.92-96.25%) and 69.23% (48.21-85.67%), respectively. Interestingly, after stepwise items elimination good outcomes were reported for SNOT-8, with an AUC of 0.818 (95% CI 0.744-0.892), achieving a sensitivity of 93.51% (85.49-97.86%) and specificity of 57.14% (40.96-72.28%). CONCLUSION: Psychometric analyses support the accuracy, sensitivity, and specificity of the nasal domains of SNOT-22 to assess the impact on HRQoL in patients with CRSwNP.