Impact of Atmospheric Conditions on Epistaxis Incidence.

PURPOSE: A possible correlation between epistaxis occurrence and atmospheric parameters' variation has long been hypothesized. This study aims to determine whether cumulative epistaxis incidence is related to seasonal variation and its relationship to monthly, weekly, and daily recordings of atmospheric measurements in the city of Patras, Greece. METHODS: In this retrospective study, data concerning the patients who presented with active epistaxis at the ED of a tertiary university hospital in Western Greece between January 2020 and December 2021 were collected. Only cases of spontaneous epistaxis were included in the study; patients bleeding secondarily due to a known mechanical cause, i.e., a tumor, trauma, or surgery, were excluded. The measurements of atmospheric parameters were supplied by the Department of Physics, University of Patras. RESULTS: In total, 230 cases of spontaneous, active epistaxis were evaluated in the ED over the course of the study. The median frequency of epistaxis presentations was two cases per week. Most of the patients were male, comprising 62.6% of the cohort, and the median age stood at 70 years, with an interquartile range (IQR) of 54 to 81 years. A minor yet statistically significant negative correlation between the incidence of epistaxis and mean relative humidity was observed both on a daily and weekly basis. Mean relative humidity emerged as a significant predictor for the incidence of epistaxis, both daily and weekly. Significantly lower mean relative humidity values were recorded during weeks with a high incidence of epistaxis cases (57.72% vs. 63.39%, p = 0.02). No discernible seasonality was observed in the frequency of epistaxis presentations to the ED. CONCLUSION: A modest yet statistically significant trend toward fewer epistaxis cases was observed in conditions of higher ambient humidity during the study period in the region of Western Greece.

Expression profiles of MMP-9 and EMMPRIN in chronic rhinosinusitis with nasal polyps.

Objective: Metalloproteinases (MMPs) are implicated in tissue remodeling in chronic rhinosinusitis with nasal polyps (CRSwNP). This study aimed to evaluate the expression profiles of MMP-9 and the extracellular matrix metalloproteinase inducer (EMMPRIN) in nasal polyps compared to healthy mucosa. Methods: Tissue samples from 37 CRSwNP patients undergoing functional endoscopic sinus surgery and mucosal specimens from 12 healthy controls were obtained intra-operatively. MMP-9 and EMMPRIN mRNA levels were assessed by reverse transcription-polymerase chain reaction and their protein expression by Western blot analysis. Results: MMP-9 mRNA expression levels were significantly elevated in CRSwNP compared to controls (p < 0.05). MMP-9 protein levels presented an increasing trend but with no statistical significance (p > 0.05). No statistically significant difference in EMMPRIN mRNA and protein levels was identified. Conclusions: Upregulation of MMP-9 in nasal polyps is evident and highlights its role in the pathogenesis of CRSwNP. The lack of concordance between MMP-9 mRNA and protein levels may be attributed to post-translational gene expression regulation. Although EMMPRIN expression was not significantly different between the two groups, its role remains to be elucidated. MMP-9 may be a valuable biomarker and treatment target in CRSwNP.

The Clinical Significance of Pollen and Fungi Concentrations for Allergic Rhinitis: A Three-Year Study.

INTRODUCTION: The relationship between disease severity and exposure to allergens in allergic rhinitis (AR) patients is not fully clarified presently. We aimed to detect the correlation between airborne pollen and fungi concentrations in a Mediterranean region with symptom scores. METHODS: A total of 98 patients suffering from AR rated their symptoms at the time of exacerbation using the Total 5 Symptoms Score (T5SS) and the Visual Analogue Scale (VAS). Patients' quality of life (QoL) was estimated by using either disease-specific (Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and mini-RQLQ) or generic (Short-Form 36 (SF-36) and Beck Depression Inventory (BDI)) questionnaires. All patients' responses were correlated with aerobiological data. Skin prick tests (SPTs) were used to detect sensitivities to the most common registered pollen and fungi species. RESULTS: A significant positive correlation between total pollen and fungi counts and disease-specific questionnaires was found only for the RQLQ. Accordingly, a significant positive correlation was found between total pollen and fungi counts and T5SS (r = 0.655, p = 0.021), with breathing (r = 0.620, p = 0.032) and sneezing (r = 0.660, p = 0.020) being strongly affected. Moreover, a tendency toward a higher VAS score was found as total pollen and fungi counts increased (r = 0.523, p = 0.081). CONCLUSION: We found a significant correlation between patients' symptoms and pollen and fungal air concentrations. Our results emphasize the clinical significance of pollen and fungi maps in everyday clinical practice.

Periostin as a biomarker in chronic rhinosinusitis: A contemporary systematic review.

BACKGROUND: The role of periostin, a matricellular protein encoded by the POSTN gene, in chronic rhinosinusitis with nasal polyposis (CRSwNP) is reviewed. Periostin is considered a potential biomarker of endotype and may be useful for evaluating response to treatment. METHODS: Search terms in PubMed and Web of Science (1990-March 2022) included: ((periostin) OR (POSTN)) AND ((sinusitis) OR (nasal polyp) OR (CRSwNP) OR (CRS). The primary outcomes were differences in tissue, serum, and nasal lavage between CRSwNP and CRS without NP (CRSsNP) or controls. Associated factors reported to affect periostin expression, data regarding participants' clinical characteristics, disease endotypes, laboratory methods, and samples' origin were also pooled. Studies on <10 patients were excluded. RESULTS: Out of 101 records harvested through database searching, 29 prospective cross-sectional or case-control studies were eligible for review and qualitative analysis. Tissue sample origin, concurrent infection, current and past medication, primary or recurrent disease, allergic rhinitis, and smoking status should be considered as confounding factors for periostin levels. Periostin and POSTN messenger RNA (mRNA) levels were consistently and significantly higher in CRSwNP than CRSsNP and controls. Despite the distinctly different inflammation patterns among CRSwNP endotypes, periostin-related remodeling patterns seemed to be similar. CONCLUSION: Tissue and serum periostin levels, and POSTN expression appear elevated in CRSwNP, especially in eosinophilic inflammation, compared to CRSsNP and controls. Disease severity and comorbidities are also reflected in periostin and POSTN values. Carefully designed prospective studies may establish the role of periostin as a biomarker in CRSwNP and allow its incorporation in clinical practice.

Mixed hemangioma of the external auditory canal and the tympanic membrane in a young woman: A case report.

Hemangiomas are benign vascular tumors frequently located in the head and neck area, but rarely encountered in the ear, often originally misdiagnosed due to their rarity and absence of specific clinical manifestations. We report the second case of a mixed hemangioma involving the external auditory canal in literature to date.

Newborn Hearing Screening: Analysing the Effectiveness of Early Detection of Neonatal Hearing Loss in a Hospital in Greece.

Introduction The introduction of newborn hearing screening programs (NHSP) has drastically contributed to the early diagnosis of hearing loss (HL) in children, with the prospect of children developing speech as early as possible. This retrospective study aims to present and discuss the preliminary results of the NHSP at the University Hospital of Patras, Greece, highlighting the strengths and weaknesses of the program. The evaluation of the implementation of NHSP is important to confirm the effectiveness of the process and elaborate system failures. Materials The study describes the results of previous data collected from the NHSP in the Rio hospital of Patra and analyzed the conditions of the sample collected. The random sample involved newborns born between November 2018 - December 2020 at the University Hospital in Patra, Greece, which was assessed using transient evoked otoacoustic emissions (TEOAEs). Testing was performed twice per week on Thursday and Friday with a random sample, specifically examining the babies in the hospital these days. From the 2014 newborns assessed, 1491 were healthy neonates, while the other 523 required hospitalization in the neonatal unit. Results In total, there were 2014 live births; 1491 healthy neonates were screened with TEOAEs. Of them, 44 did not pass the first test. After retesting one month later, 31 passed the test, while the other 13 were referred to a hearing centre for further audiological testing with auditory brainstem response (ABR) tests. Two infants never showed up for the follow-up appointment. Of the remaining 11, six infants had normal hearing, three had otitis media with effusion or other conductive HL. The last two infants had HL. Specifically, one had bilateral sensorineural HL greater than 40db, and one had unilateral sensorineural HL greater than 40db. Risk factors were identified in 523 newborns admitted to the unit. The most common risk factors identified were the use of ototoxic drugs, low Apgar scores, and prematurity. Of all the newborns, 491 passed the test the first time, and the rest 32 infants came back 1-2 months after leaving the neonatal unit. All the babies who had failed in the first screening test appeared for the follow-up appointment for the second screening test. Of these, 24 babies passed the test, but eight did not. Of these, four were diagnosed with media otitis with effusion or other conductive HL. Sensorineural HL was identified in the last four babies using ABR tests. In detail, two had unilateral sensorineural HL greater than 40db, while two had bilateral sensorineural HL greater than 40db. Conclusion In conclusion, we found that for the NHS programs to be effective, they must be implemented long-term and have monetary support. Early diagnosis and cochlear implantation are the keys to excellent outcomes. Cooperation between different specialties and a patient-centred approach will help physicians holistically face neonatal HL. Building trust between the parents and doctor is essential for the program's success and reducing the lost-to-follow-up rate. To run a successful program, trained staff, equipment, and financial support are required. However, the gold standards for the success of the program are proper implementation of the program, close follow-up, strict adherence to the guidelines in the neonatal intensive care unit (NICU), and the early detection and diagnosis of HL.

Pleomorphic adenoma of the maxillary sinus with orbital extension presenting with exophthalmos: a case report.

We report a case of pleomorphic adenoma (PA) of the maxillary sinus, an unusual and rare location of this frequent benign neoplasm originating from salivary glands and accounting for 70% of all salivary gland tumors, presenting with compressive phenomena from the orbit and the challenges in its differential diagnosis and management. A 66-year-old male presented with progressively worsening exophthalmos over the past 4 months and symptoms of nasal obstruction on the left side for the past year. Clinical evaluation and imaging studies revealed complete occupation of the left maxillary sinus by a mass with soft tissue characteristics, extending to the homonymous nasal cavity and orbit. Functional endoscopic sinus surgery (FESS) was performed. The surgical plan included septoplasty and medial maxillectomy and complete resection of the tumor with clear margins. The histopathology report was consistent with a PA of the maxillary sinus. PA of the maxillary sinus is an extremely rare disease entity. Orbital involvement due to extension of an undiagnosed PA as described in this case is very uncommon. Thorough investigation is required in cases of unilateral nasal obstruction. Complete surgical excision and close long-term follow-up are required due to the probability of tumor recurrence and potential malignant transformation.

Impact of different therapeutic regimens on survival of patients with nasopharyngeal carcinoma.

PURPOSE: Nasopharyngeal carcinoma (NPC) demonstrates specific histo-genetic features that affect its biological behaviour. Our aim was to investigate the correlation between different therapeutic approaches and survival of patients with NPC in southwestern Greece based on specific clinicopathological features. METHODS: Seventy-two NPC patients (n=72) were treated between 1990 and 2014 at the University Hospital of Patras. Patient demographics, tumor histology, use of tobacco and alcohol, exposure to mutagenic agents, chosen treatment and survival were recorded. All patients were treated with radiotherapy (RT), chemotherapy, surgery or their combinations. RESULTS: In the patients who used immobilization mask during RT, the 5-year survival rate and overall survival was higher than the rest of patients (57% and 6 years vs. 13.6% and 3.36 years, p=0.0001, respectively)*. RT with mask combined with chemotherapy increased survival rates compared to RT without chemotherapy conventional regimen (p=0.0001). Additionally, patients who received chemotherapy demonstrated a 5-year survival of 51.6% compared to those without chemotherapy (11% p=0.0014). (*The 5-year survival rate group of patients refers to the percentage of people who will be alive 5 years after diagnosis. It does not include those who die from other diseases. Sometimes, this includes all people with a specific cancer type. Researchers call this an overall rate. In contrast, overall survival provides information for the length of time from either the date of diagnosis or the start of treatment for a disease, such as cancer, that patients diagnosed with the disease are still alive. In a clinical trial, measuring the overall survival is one way to see how well a new treatment works.) Conclusions: In the majority of examined NPC cases treated with the use of immobilization RT mask along with chemotherapy, a significantly better prognosis compared to conventional RT-chemotherapy treatment was observed. Thus, chemotherapy offers an advantage to patient survival as an adjuvant treatment regimen in conjunction with RT.

Allergic sensitization prevalence in a children and adolescent population of northeastern Greece region.

OBJECTIVES: To evaluate the prevalence of allergic sensitization in a childhood and adolescent population, to explore age- and gender-specific variations and finally to discover co-sensitivities among allergens. METHODS: A two-stage cross-sectional survey among school-aged children. The two stages of the study involved enrollment of schools and then skin prick testing (SPT) within schools. A total of 675 school children were included in the study. Of those, 231 were diagnosed with allergic rhinitis (AR), according to the medical history as provided by parental-completed questionnaires and positive SPT results. The antigen panel consisted of common allergens and more specifically house dust mites-HDM (Dermatophagoides farinae and Dermatophagoides pteronyssinus), grass mix, trees (olive, cypress and pine), weeds (Parietaria spp.), cat and dog epithelium and moulds (Alternaria spp., Cladosporium spp.). The SPT sensitivity was graded according to SPT-USA Standards. RESULTS: The overall prevalence rate of AR was 34.22%. In total, 93 school children (40.3%) were mono- and 138 (59.7%) were poly-sensitized. Overall, the most prevalent sensitizations in decreasing order were to HDM (59.74%), to grasses (48.9%), to Alternaria (34.6%) and to olive (14.71%). There were no age- and sex-specific differences, except for Alternaria mould that showed a significant prevalence among primary school-aged children and predominance in the female gender, by contrast to grass pollen allergy that was predominant to males. A 32% of SPT-positive individuals were not aware of their allergy, with no statistically significant differences between ages. Co-sensitivities were detected for grass pollens and pine and olive trees, for Alternaria and Cladosporium moulds, for cypress and pine trees, and finally for dog and cat danders. CONCLUSIONS: Given data among school-aged children should be a baseline from which to monitor disease trends and is considered important for the optimal management of AR patients.

Predictors of quality of life improvement in allergic rhinitis patients after sublingual immunotherapy.

OBJECTIVES: Sublingual immunotherapy (SLIT) has been described as a significant intervention in the treatment of allergic rhinitis (AR). However, factors that may predict treatment outcomes with respect to quality of life (QoL) results and mainly the role of olfactory function are still being underestimated. In this study, we investigated determinants that best predict treatment outcomes for QoL, exploring mainly the role of olfaction. METHODS: One hundred forty-five patients following SLIT, 45 placebo-controls, and 48 healthy subjects were studied. Olfactory function was objectively evaluated using "Sniffin' Sticks" test pre- and post-cessation of SLIT. Three categories of validated QoL questionnaires were filled out by all subjects: questionnaire specific for olfaction (Questionnaire of Olfactory Deficits), questionnaires for assessing psychology (Beck Depression Inventory, Zung Depression Scale, State & Trait Anxiety Inventory), general Short Form-36 health survey. RESULTS: Statistically significant improvement of olfactory function by 11.1% and of all QoL questionnaires results (all P<.001) was observed on final evaluation. Anosmia, asthma history, and the severity of symptoms-expressed by the Total Symptoms Score-were proven independent determinants of clinically significant improvement in patients' QoL. CONCLUSIONS: Several factors were found that may predict QoL outcomes in AR patients following SLIT.

The effects of smoking on quality of life recovery after surgery for chronic rhinosinusitis.

BACKGROUND: The effects of smoking on quality of life (QoL) results in chronic rhinosinusitis (CRS) patients still remain a matter of debate. OBJECTIVE: To explore the impact of smoking on QoL and determine how quantity of daily smoking and duration affect QoL results after endoscopic sinus surgery (ESS). METHODOLOGY: Patients with CRS were prospectively asked to evaluate their QoL pre- and after ESS. All subjects' QoL was evaluated by means of validated questionnaires either specific (Questionnaire of Olfactory Deficits), for assessing psychology (Zung Anxiety Scale, State -Trait Anxiety Inventory, Zung Depression Scale and Beck Depression Inventory) or generic (Short-Form-36). Smoking habits were expressed in pack-years. RESULTS: No statistically significant differences were found in the pre-treatment scores in any of the questionnaires between smokers and non smokers. Post-operatively, all QoL questionnaires' results were significantly improved among both groups, although non smokers exhibited significantly greater improvement compared to smokers. There was a negative impact of the number of pack-years on the changes of QoL results; less improvement was observed as the number of pack-years was increasing. CONCLUSION: Although smoking did not improve preoperative QoL results and proved not to be a contra-indication factor for ESS regarding QoL, smokers presented worse treatment outcomes. Quantity and duration of smoking were significantly associated with worse postoperative results in all QoL questionnaires.

Demographic correlates of anxiety and depression symptoms in chronic sinonasal diseases.

OBJECTIVES: To explore mental health of patients with olfactory loss due to chronic sinonasal diseases and investigate the effects of age-, gender-, and socio-economic variables on anxiety and depression symptoms. METHODOLOGY: One hundred and eight patients (62 males; mean age: 39.78 ± 16.11 years), suffering from olfactory impairment due to chronic rhinosinusitis and allergic rhinitis and 30 healthy subjects (16 males; mean age, 37.03 ± 13.09 years) were studied. Olfactory function was evaluated using "Sniffin' Sticks" test. All patients completed four validated questionnaires specific for assessing anxiety and depression (Zung Anxiety Scale, State-Trait Anxiety Inventory-STAI, Zung Depression Scale, and Beck Depression Inventory-BDI). RESULTS: We found significantly more severe anxiety and depression symptoms in anosmic (all p < 0.001) and hyposmic patients compared to healthy controls. No significant differences were observed between normosmic patients and controls. Scores in all psychological measures were significantly higher in elderly and female patients as well as in low, compared to high, socio-economic status patients. No significant differences were found between low and medium socio-economic level. CONCLUSIONS: Olfactory loss in chronic sinonasal diseases was found to be associated with anxiety and depression symptoms. Moreover, anxiety was correlated with depression. With regard to patients' demographics, female gender and low socioeconomic status proved to be independently correlated with anxiety and depression levels.

Predictors of quality of life outcomes in chronic rhinosinusitis after sinus surgery.

The predictive value of olfaction for quality of life (QoL) recovery after endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) is still underestimated. The aim of this study was to explore the proportion of patients suffering from CRS who experience clinically significant QoL improvement after ESS and identify pre-operative clinical phenotypes that best predict surgical outcomes for QoL, focusing mainly on the role of patients' olfaction. One hundred eleven patients following ESS for CRS and 48 healthy subjects were studied. Olfactory function was expressed by the combined "Threshold Discrimination Identification" score using "Sniffin' sticks" test pre-treatment and 12 months after treatment. All subjects completed validated, widely used QoL questionnaires, specific for olfaction (Questionnaire of Olfactory Deficits: QOD), for assessing psychology (Beck Depression Inventory: BDI) and for general health (Short Form-36: SF-36). Statistically significant improvement of olfactory function by 41.8% and of all QoL questionnaires scores (all p < 0.001) was observed on the 12-month follow-up examination. Clinically significant improvement for QoL was measured in a proportion of 56.8% of patients on QOD, 64.9% on SF-36 and 49.5% on BDI scales results. Although olfactory dysfunction, nasal polyps, female gender, high socio-economic status and non-smoking habits were significantly associated with better QoL results, multivariate logistic regression analysis revealed that only olfactory dysfunction and nasal polyps were independent predictors significantly associated with higher likelihood of clinically significant improvement in all QoL questionnaire results. Olfactory dysfunction and nasal polyps were independent pre-operative predictors for surgical outcomes with regard to QoL results.

Olfactory dysfunction and asthma as risk factors for poor quality of life in upper airway diseases.

BACKGROUND: The study of olfaction/quality of life (QoL) interaction has not been adequately discussed and remains to be further explored. Determination of clinical predictors for poor QoL may support consultation of respective patients. This study explores QoL of patients with olfactory dysfunction and evaluates associated clinical risk factors for QoL prediction. METHODS: One hundred eight patients suffering from chronic rhinosinusitis (CRS) and allergic rhinitis (AR) and 30 healthy subjects were studied. Olfactory function was evaluated using objective olfactory test. All patients completed six validated questionnaires either specific for olfaction (Questionnaire of Olfactory Deficits [QOD]) and for assessing psychological state (Zung Anxiety Scale [ZAS], State-Trait Anxiety Inventory, Zung Depression Scale, and Beck Depression Inventory [BDI]) or a generic one (Short Form 36). RESULTS: Significantly poorer QoL and more severe anxiety and depression symptoms were observed in anosmic (all p < 0.001) and hyposmic patients compared with controls. Anosmic patients presented significantly worse results compared with hyposmic and normosmic patients. However, higher scores were observed in hyposmic compared with normosmic patients only in the QOD, ZAS, and BDI scale. Patients with CRS presented significantly poorer QoL than patients with AR only. The presence of nasal polyps or concomitant AR in patients with CRS did not show any differentiation in the results. Asthma was associated with significantly worse scores in all the psychometric questionnaires. CONCLUSION: Olfactory dysfunction was found to decrease QoL among patients. Anosmia, CRS disease, and asthma as clinical predictors were proved to be independently correlated with QoL, anxiety, and depression levels.

Improvement of olfactory function for quality of life recovery.

OBJECTIVES/HYPOTHESIS: To explore quality of life (QoL) improvement after treatment of patients with chronic olfactory disorders; and to correlate QoL with olfactory rehabilitation and evaluate olfactory improvement values over which QoL outcomes are significantly recovered. STUDY DESIGN: Prospective clinical study. METHODS: Eighty-nine patients following endoscopic sinus surgery for chronic rhinosinusitis (CRS) and immunotherapy for allergic rhinitis (AR) were studied. Olfactory function was evaluated using Sniffin' Sticks test pre-and 12 months after treatment. All patients completed six validated QoL questionnaires either specific for olfaction (Questionnaire of Olfactory Deficits-QOD) and for assessing mental health (Zung Anxiety Scale, State-Trait Anxiety Inventory, Zung Depression Scale, Beck Depression Inventory), or generic one (Short Form-36). RESULTS: Significant improvement (all P < 0.001) of olfactory function by 27.4% in total cohort (AR: 10.4%, P = 0.004; CRS: 39.9%, P < 0.001), expressed by the combined Threshold-Discrimination-Identification (TDI) score-and of all QoL questionnaires scores (all P < 0.01) as well, was observed after treatment. There was a positive correlation between olfactory recovery and improvement of patients' QoL. ROC analysis revealed that an increase in the TDI score by 3.50 points in AR and 4.75 points in CRS was necessary for a clinically significant improvement in all QoL questionnaires results. CONCLUSIONS: QoL and mental health of patients suffering from chronic sinonasal diseases are totally recovered after treatment, presenting a direct positive relationship with smell improvement. An increase of olfactory function by 3.50 points for AR and 4.75 points for CRS might be considered the cutoff point for patients' QoL significant recovery.