Assessment of chronic rhinosinusitis with nasal polyps: Development of the Nasal Polyp Patient Assessment Scoring Sheet tool.

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disorder with a wide range of validated subjective and objective assessment tools to assess disease severity. However, a comprehensive and easy-to-use tool that integrates these measures for determining disease severity and response to treatment is still obscure. The objective of this study was to develop a standardized assessment tool that facilitates diagnosis, uniform patient monitoring, and comparison of treatment outcomes between different centers both in routine clinical practice and in research. Methods: To develop this tool, published literature on assessment tools was searched on various databases. A panel of 12 steering committee members conducted an advisory board meeting to review the findings. Specific outcome measures to be included in a comprehensive assessment tool and follow-up sheet were then collated following consensus approval from the panel. The tool was further validated for content and revised with expert recommendations to arrive at the finalized Nasal Polyp Patient Assessment Scoring Sheet (N-PASS) tool. Results: The N-PASS tool was developed by integrating the subjective and objective measures for CRS assessment. Based on expert opinions, N-PASS was revised to be used as an easy-to-use guidance tool that captures patient-reported and physician-assessed components for comprehensively assessing disease status and response to treatment. Conclusion: The N-PASS tool can be used to aid in the diagnosis and management of CRS cases with nasal polyps. The tool would also aid in improved monitoring of patients and pave the way for an international disease registry. Level of evidence: Oxford Level 3.

Management of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in the Pan-Arab Region: Consensus Recommendations from a Multidisciplinary Expert Working Group.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic and often debilitating inflammatory condition of the nasal and paranasal tissues. An expert panel of specialists from the Gulf region (the Kingdom of Saudi Arabia, Kuwait, Oman and the United Arab Emirates) and from Egypt gathered to evaluate existing guidance and develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the main observations and recommendations from this panel. CRSwNP diagnosis requires the presence of bilateral, endoscopically visualized polyps in the middle meatus (via nasal endoscopy or CT). In most patients, CRSwNP is mediated through predominantly type 2 inflammatory processes and is often observed in patients with asthma and other allergic disease. While many patients respond to medical treatment (principally topical irrigation and intranasal corticosteroids, and adjunctive short-term use of systemic corticosteroids), clinical management of CRSwNP is challenging, and a multidisciplinary approach for complete evaluation and treatment is recommended. Patients with more severe/uncontrolled disease (despite adequate medical therapies) require a complete endoscopic sinus surgery (ESS), although outcomes can be unsatisfactory, and further revision surgery is common. Biological therapies targeting underlying inflammatory processes offer additional, effective treatment options for those patients with persistent symptoms despite complete ESS, and also in those patients where surgery may be contraindicated.

Surgical treatment of sinonasal inverted papilloma.

PURPOSE OF REVIEW: To highlight how surgery of inverted papilloma has developed during the past year. Moreover, to give our own opinion on the state of research regarding inverted papilloma surgical management. RECENT FINDINGS: Recent studies covering surgical treatment of inverted papilloma concentrated on the optimum surgical management aiming at complete resection, least morbidity and best outcome, with special interest regarding the maxillary and frontal sinuses. In maxillary sinus inverted papilloma, to avoid empty nose and/or epiphora, recent articles exerted all attempts to preserve the integrity of both the inferior turbinate and nasolacrimal duct, yet offer best exposure of all maxillary sinus walls specially the anterior and inferior ones. These included the new modifications of the prelacrimal and Denker approaches and lateral nasal wall transposition. In frontal sinus inverted papilloma, to avoid an external approach and insure postoperative patency of frontal sinus ostium, the periorbital suspension was introduced and orbital transposition approach was comprehensively utilized especially in far lateral located lesions and/or in supraorbital recess involvement. Associated malignancy is an important issue to identify as management plans significantly differ. Recurrence occurs early within the first 2 years but long-term follow-up is mandatory. SUMMARY: Surgical procedures of sinonasal inverted papilloma are planned according to origin rather than the tumor extent. Origin targeted surgery and proper management of the site of attachment are the key to achieve complete surgical resection of sinonasal inverted papilloma. Recent trends advise the least destructive surgical techniques that offer best exposure, complete excision SNIP and least recurrence.

Development of an International Odor Identification Test for Children: The Universal Sniff Test.

OBJECTIVE: To assess olfactory function in children and to create and validate an odor identification test to diagnose olfactory dysfunction in children, which we called the Universal Sniff (U-Sniff) test. STUDY DESIGN: This is a multicenter study involving 19 countries. The U-Sniff test was developed in 3 phases including 1760 children age 5-7 years. Phase 1: identification of potentially recognizable odors; phase 2: selection of odorants for the odor identification test; and phase 3: evaluation of the test and acquisition of normative data. Test-retest reliability was evaluated in a subgroup of children (n = 27), and the test was validated using children with congenital anosmia (n = 14). RESULTS: Twelve odors were familiar to children and, therefore, included in the U-Sniff test. Children scored a mean ± SD of 9.88 ± 1.80 points out of 12. Normative data was obtained and reported for each country. The U-Sniff test demonstrated a high test-retest reliability (r27 = 0.83, P < .001) and enabled discrimination between normosmia and children with congenital anosmia with a sensitivity of 100% and specificity of 86%. CONCLUSIONS: The U-Sniff is a valid and reliable method of testing olfaction in children and can be used internationally.

Development of the Arabic version of the "Sniffin' Sticks" odor identification test.

UNLABELLED: Sniffin' Sticks Test (SST) is a comprehensive tool for medical or scientific diagnosis of olfactory sensitivity. Although it is widely used around the world, it is recommended to develop a cultural adaptation of any odor identification test prior to using it in a particular cultural space. The aim of the present work is to adapt SST to Arabic population, running experiments in Egypt. Prospective controlled study. We included 382 people (174 women and 208 men) aged 8-74 years; 323 healthy subjects and 59 patients. The use of original list of odors revealed that four of the descriptors were poorly recognized (<75 %) in Egypt. Accompanied by several control measurements descriptors and targets were replaced with more familiar names. The result of the present study is a modified version of the original SST, adapted to the Arabian space with a high test-re-test reliability. In addition, first tentative normative data are presented for the Arabic population. The 10th percentile for the whole group of healthy subjects equaled 13, whereas in 16-35 age category it equaled 14. The revised SST test can be used in studies on olfactory sensitivity in Arabic populations. LEVEL OF EVIDENCE: 2b.

Transnasal endoscopic medial maxillectomy in recurrent maxillary sinus inverted papilloma.

BACKGROUND: Maxillary sinus inverted papilloma entails medial maxillectomy and is associated with high incidence of recurrence. OBJECTIVE: To study the impact of prior surgery on recurrence rate after transnasal endoscopic medial maxillectomy. METHODOLOGY: Eighteen patients with primary and 33 with recurrent maxillary sinus inverted papilloma underwent transnasal endoscopic medial maxillectomy. Caldwell-Luc operation was the primary surgery in 12 patients, transnasal endoscopic resection in 20, and midfacial degloving technique in one. The follow-up period ranged between 2 to 19.5 years with an average of 8.8 years. RESULTS: Recurrence was detected in 8/51 maxillary sinus inverted papilloma patients (15.7 %), 1/18 of primary cases (5.5 %), 7/33 of recurrent cases (21.2 %); 3/20 of the transnasal endoscopic resection group (15%) and 4/12 of the Caldwell-Luc group (33.3%). Redo transnasal endoscopic medial maxillectomy was followed by a single recurrence in the Caldwell-Luc group (25%), and no recurrence in the other groups. CONCLUSION: Recurrence is more common in recurrent maxillary sinus inverted papilloma than primary lesions. Recurrent maxillary sinus inverted papilloma after Caldwell-Luc operation has higher incidence of recurrence than after transnasal endoscopic resection.

Inverted papilloma: new classification and guidelines for endoscopic surgery.

BACKGROUND: Surgery is the gold standard in the management of inverted papilloma (IP); however, the approach and extent of the surgical procedure are still controversial. Moreover, there is still no universal staging system of IP to plan surgery and/or evaluate results. We performed a retrospective study. METHODS: A new classification depending on the origin of the lesion was used to plan surgery in 70 cases of IP. Conservative transnasal endoscopic excision was performed in lesions arising from the nasal septum and lateral nasal wall (type I IP, 42 cases) and radical transnasal endoscopic medial maxillectomy was performed in lesions arising from the maxillary sinus (type 1 IF, 28 cases). RESULTS: Excluding cases with a follow-up of <2 years, follow-up for periods ranging between 2 and 13.3 years with a median of 78 months showed recurrence in a single case of type I (3.2%) and 2 cases of type II (9.5%). CONCLUSION: The new classification system, based on the origin of IP, is a simple tool for grading IP. It can be used to define cases suitable for conservative excision or radical medial maxillectomy. Both could be performed transnasally and endoscopically.

Nasal and paranasal sinus changes after radiotherapy for nasopharyngeal carcinoma.

OBJECTIVE: To study sinonasal side-effects after radiotherapy (RT) in nasopharyngeal carcinoma (NPC) patients. MATERIAL AND METHODS: The study subjects comprised 32 cases of NPC (23 new cases, 9 old cases) who had been treated with RT with no recurrence. They were subjected to a saccharine test, nasal endoscopy and CT. RESULTS: There was a gradual and persistent increase in the saccharine delay time after RT. Endoscopy showed that, early post-RT, edema and discharge were replaced by delayed crusting and adhesions. CT showed that the maxillary sinus, anterior ethmoid sinus and ostiomeatal complex were the areas most affected. CONCLUSIONS: Rhinosinusitis is a common post-RT side-effect in NPC patients. A pre-RT saccharine test is a good predictor of those patients who are more likely to develop sinonasal side-effects. Functional endoscopic sinus surgery should be considered with caution in post-RT rhinosinusitis.

Manometric measurement of lacrimal sac pressure after endoscopic and external dacryocystorhinostomy.

OBJECTIVE: To evaluate endoscopic and external dacryocystorhinostomy (DCR) using a quantitative, objective functional tool. MATERIAL AND METHODS: This study comprised 58 cases divided into 4 groups: healthy controls; patients suffering from epiphora due to nasolacrimal duct (NLD) obstruction; patients who had undergone endoscopic DCR; and patients who had undergone external DCR. The lacrimal sac pressure was measured during blinking, forced blinking and the Valsalva maneuver using a polygraph. RESULTS: Negative pressure was detected during blinking and forced blinking in all normal subjects and in most patients who had successfully undergone DCR. In contrast, positive pressure was detected in cases with epiphora and patients in whom DCR had failed. Negative pressure was higher after endoscopic than external DCR. During the Valsalva maneuver there were no pressure changes in normal cases and patients with epiphora. In contrast, positive pressure was detected after all of the successful procedures (being higher after external than endoscopic DCR) and in most of the patients in whom external DCR failed. CONCLUSIONS: In normal subjects, negative pressure is created during blinking. In cases with epiphora due to NLD obstruction, the lacrimal pump is affected but its function is restored after successful DCR. The suction power of the pump mechanism is more effective after endoscopic than external DCR.