Comparison of Long-Term Postoperative Outcomes of the Subtypes of Chronic Rhinosinusitis with Nasal Polyps.

(1) Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition that significantly impacts the health-related quality of life (HRQOL) of patients. This study aims to investigate the disparities in preoperative examination findings, postoperative HRQOL, and disease control status based on CRSwNP subtypes. (2) Methods: A retrospective analysis was conducted on 202 patients who underwent endoscopic sinus surgery for CRSwNP. The study assessed clinical characteristics, blood eosinophil and immunoglobulin E (IgE) levels, modified Lund-Kennedy and Lund-Mackay scores, and Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) scores. HRQOL was evaluated using the Sino-nasal Outcome Test (SNOT-22) scores, and disease control status was assessed based on the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 guidelines. (3) Results: Of the 202 patients, Eosinophilic CRSwNP patients exhibited significantly higher preoperative peripheral blood eosinophil ratios and IgE levels, and JESREC scores (p < 0.05). Two years postoperatively, patients in the non-eosinophilic group showed significantly improved SNOT-22 scores compared to preoperative scores (p = 0.007). Notably, the proportion of patients with uncontrolled disease was significantly higher in the eosinophilic group (p = 0.035). Logistic regression analyses identified preoperative SNOT-22 scores and eosinophilic CRSwNP subtype as influential factors on disease control status (p < 0.05). (4) Conclusions: Patients with more severe preoperative symptoms and eosinophilic CRSwNP demonstrated poorer long-term treatment outcomes.

Deep learning algorithm for the automated detection and classification of nasal cavity mass in nasal endoscopic images.

Nasal endoscopy is routinely performed to distinguish the pathological types of masses. There is a lack of studies on deep learning algorithms for discriminating a wide range of endoscopic nasal cavity mass lesions. Therefore, we aimed to develop an endoscopic-examination-based deep learning model to detect and classify nasal cavity mass lesions, including nasal polyps (NPs), benign tumors, and malignant tumors. The clinical feasibility of the model was evaluated by comparing the results to those of manual assessment. Biopsy-confirmed nasal endoscopic images were obtained from 17 hospitals in South Korea. Here, 400 images were used for the test set. The training and validation datasets consisted of 149,043 normal nasal cavity, 311,043 NP, 9,271 benign tumor, and 5,323 malignant tumor lesion images. The proposed Xception architecture achieved an overall accuracy of 0.792 with the following class accuracies on the test set: normal = 0.978 ± 0.016, NP = 0.790 ± 0.016, benign = 0.708 ± 0.100, and malignant = 0.698 ± 0.116. With an average area under the receiver operating characteristic curve (AUC) of 0.947, the AUC values and F1 score were highest in the order of normal, NP, malignant tumor, and benign tumor classes. The classification performances of the proposed model were comparable with those of manual assessment in the normal and NP classes. The proposed model outperformed manual assessment in the benign and malignant tumor classes (sensitivities of 0.708 ± 0.100 vs. 0.549 ± 0.172, 0.698 ± 0.116 vs. 0.518 ± 0.153, respectively). In urgent (malignant) versus nonurgent binary predictions, the deep learning model achieved superior diagnostic accuracy. The developed model based on endoscopic images achieved satisfactory performance in classifying four classes of nasal cavity mass lesions, namely normal, NP, benign tumor, and malignant tumor. The developed model can therefore be used to screen nasal cavity lesions accurately and rapidly.

Can EPOS2020 criteria of type 2 inflammation be applied to Asian patients with chronic rhinosinusitis?

BACKGROUND: There is a large diversity of mucosal immunologic chronic rhinosinusitis with nasal polyps (CRSwNP) endotypes across Western and Asian patient populations. OBJECTIVES: The objective of the study was whether the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 criteria for type 2 inflammation are appropriate for biological use in CRSwNP patients. METHODS: A total of 207 participants are enrolled for the study. Retrospective evaluations of the tissues taken during surgery and the patients' clinical features were performed. We investigated whether the criteria described in the EPOS2020 guideline were appropriate based on the criteria for type 2 inflammation identified based on prior studies using receiver-operating characteristic (ROC) analyses. RESULTS: The EPOS 2020 criteria are also shown to be an insufficient evaluation approach with low specificity (area under curve [AUC] = 0.645, specificity 8.4%). The authors created a novel scoring method using the total serum IgE level, blood eosinophil percentage, and tissue eosinophil percentage. This novel scoring system (AUC = 0.862, p < .001) fared better in ROC analyses than the EPOS 2020 criteria (AUC = 0.645) and Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis scoring system (AUC = 0.647). CONCLUSIONS AND SIGNIFICANCE: A novel standard for type 2 inflammation in Asian CRSwNP patients must be established, as the EPOS 2020 criteria do not appear to be sufficient.

Clinical Characteristics of Patients with Dental Malocclusion: An Otolaryngologic Perspective.

Purpose: Allergic rhinitis (AR), which is a major cause of upper airway obstruction, may affect the development of the dental malocclusion. This retrospective study was aimed to investigate association between AR and dental malocclusion in otolaryngologic perspectives. Methods: Patients (n = 217) referred to the otolaryngology department before initiating orthodontic treatment were recruited. The frequency and severity of AR symptoms, sinonasal outcome test (SNOT-22) scores, physical examination findings, acoustic rhinometry results, and treatment modalities were retrospectively assessed. Patients with positive skin prick test findings (SPT) (n = 173; orthodontic group) were compared with age- and sex-matched patients being treated for AR (AR group). Results: We found that 76.5% of the enrolled patients had subjective nasal symptoms, and 93.1% patients showed abnormal physical examination findings such as inferior turbinate hypertrophy (82.0%), adenotonsillar hypertrophy (31.8%), or deviated nasal septum (7.4%). The 173 (79.7%) patients with positive SPT results exhibited a significantly higher incidence of rhinorrhoea, sneezing, and inferior turbinate hypertrophy compared to those with negative SPT results. The proportion of patients who underwent pharmacological or surgical treatments was significantly higher among patients with nasal obstruction (92.0%) than among patients without nasal obstruction (36.9%). The frequency and mean visual analogue symptom scores for nasal obstruction, rhinorrhoea, and sneezing, as well as all SNOT-22 domain scores, were significantly higher in the AR group than in the orthodontic group. The minimal cross-sectional area measured with acoustic rhinometry showed no significant difference between groups. Conclusion: Patients with dental malocclusion had a high SPT (+) rate and a high prevalence of structural abnormalities of the upper airway. The early detection and treatment of subclinical AR, other rhinological problems, and structural abnormalities of the upper airway in patients with malocclusion may help us manage malocclusion from an otolaryngologic perspective.

Dorsal Augmentation Using a Glued Diced Cartilage Graft Fashioned with a Newly Developed Mold in Asian Rhinoplasty.

BACKGROUND: In dorsal augmentation, costal cartilage can be used in a number of different ways: monobloc, fascia wrapped, or glued diced cartilage grafting (GDCG). The authors developed a mold to make the use of GDCG more convenient. This report describes their experience with GDCG using a novel mold for dorsal augmentation. METHODS: The study involved 80 patients who underwent dorsal augmentation with the molded GDCG. Facial photographs and medical records were reviewed to assess patient satisfaction and postoperative complications. For the 23 patients who had three-dimensional scanned imaging, dorsal widths and dorsal heights at the radix and rhinion levels were measured to investigate changes in the implants over time. Resorption of the graft was assessed comparing the 3-month postoperative photograph with the latest photograph taken at the last follow-up (at least 1 year after the surgery). Serial changes of the dorsum were assessed with three-dimensional scanned images. RESULTS: A total of 66 patients (82.5 percent) were satisfied with their surgical outcomes. Complications were encountered in 19 patients (23.8 percent) and eight revision procedures (10 percent) were performed. One patient underwent revision surgery because of resorption of the GDCG. Analysis using a three-dimensional scanning device showed a significant increment of the dorsal height ( p < 0.05) without dorsal widening when comparing preoperative with 1-year postoperative follow-up data. There were no significant reductions in dorsal height between postoperative 3 months and 1 year. CONCLUSION: The use of a novel mold for shaping glued diced cartilage appears to be a useful technique for dorsal augmentation in rhinoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Long-term efficacy of turbinoplasty compared with medical treatment in patients with allergic rhinitis.

BACKGROUND: The effectiveness of turbinate surgery has been proven in patients with allergic rhinitis (AR). OBJECTIVES: This study evaluated the long-term efficacy of turbinoplasty in AR and to compare the results with those of medical treatment. METHODS: This study included 192 patients diagnosed with AR who underwent surgical or medical treatment. Medical records were reviewed to assess pre-treatment and 2-year post-treatment frequency and severity of AR symptoms, prescription frequency for AR medication, and satisfaction score for treatment. Parameters for 5-year post-treatment efficacy were acquired via a telephone survey. A total of 128 patients who had undergone turbinoplasty were defined as a 'turbinoplasty group,' and 64 patients who were treated only with medications were defined as a 'medication group'. Allergic symptom, medication, and satisfaction scores were compared. RESULTS: Patients in the turbinoplasty group demonstrated significant improvements in all allergic symptom scores, while those in the medication group showed significant symptom improvement only in nasal obstruction on long-term follow-up. Patients in the turbinoplasty group also showed a lower prescription frequency after treatment and higher subjective satisfaction scores than those in the medication group. CONCLUSIONS: This long-term follow-up study demonstrated that turbinoplasty for AR appears to be an effective treatment option compared with medical therapy alone.

Restoration of olfactory dysfunctions by nanomaterials and stem cells-based therapies: Current status and future perspectives.

Dysfunction in the olfactory system of a person can have adverse effects on their health and quality of life. It can even increase mortality among individuals. Olfactory dysfunction is related to many factors, including post-viral upper respiratory infection, head trauma, and neurodegenerative disorders. Although some clinical therapies such as steroids and olfactory training are already available, their effectiveness is limited and controversial. Recent research in the field of therapeutic nanoparticles and stem cells has shown the regeneration of dysfunctional olfactory systems. Thus, we are motivated to highlight these regenerative approaches. For this, we first introduce the anatomical characteristics of the olfactory pathway, then detail various pathological factors related to olfactory dysfunctions and current treatments, and then finally discuss the recent regenerative endeavors, with particular focus on nanoparticle-based drug delivery systems and stem cells. This review offers insights into the development of future therapeutic approaches to restore and regenerate dysfunctional olfactory systems.

Increased Anti-Allergic Effects of Secretome of Low-Level Light Treated Tonsil-Derived Mesenchymal Stem Cells in Allergic Rhinitis Mouse Model.

BACKGROUND: Low-level light therapy (LLLT) is widely used for the photobiomodulation of cell behavior. Recent studies have shown that LLLT affects the proliferation and migration of various types of mesenchymal stem cells (MSCs). However, there is a lack of studies investigating the effect of LLT on enhancing the immunomodulatory properties of tonsil-derived MSCs (T-MSCs). OBJECTIVE: The aim of this study was to investigate the immunomodulatory effects of conditioned media from T-MSCs (T-MSCs-CM) treated with LLLT in allergic inflammation. METHODS: We isolated T-MSCs from human palatine tonsils and evaluated the ingredients of T-MSCs-CM. The effect of T-MSCs-CM treated with LLLT was evaluated in a mouse model of allergic rhinitis (AR). We randomly divided the mice into four groups (negative control, positive control, T-MSCs-CM alone, and T-MSCs-CM treated with LLLT). To elucidate the therapeutic effect, we assessed rhinitis symptoms, serum immunoglobulin (Ig), the number of inflammatory cells, and cytokine expression. RESULTS: We identified increased expression of immunomodulatory factors, such as HGF, TGF-ß, and PGE, in T-MSCs-CM treated with LLLT, compared to T-MSCs-CM without LLLT. Our animal study demonstrated reduced allergic symptoms and lower expression of total IgE and OVA-specific IgE in the LLLT-treated T-MSCs-CM group compared to the AR group and T-MSCs-CM alone. Moreover, we found that T-MSCs-CM treated with LLLT showed significantly decreased infiltration of eosinophils, neutrophils, and IL-17 cells in the nasal mucosa and reduced IL-4, IL-17, and IFN-γ expression in OVA-incubated splenocytes compared to the AR group. CONCLUSIONS: The present study suggests that T-MSCs-CM treated with LLLT may provide an improved therapeutic effect against nasal allergic inflammation than T-MSCs-CM alone.

Long-term outcome of concurrent coblator turbinoplasty with adenotonsillectomy in children with allergic rhinitis.

BACKGROUND: Allergic rhinitis (AR) is one of the most prevalent chronic diseases in children. Patients with AR tend to have more persistent symptoms after adenotonsillectomy (T&A). OBJECTIVES: This study was aimed to evaluate the outcome of additional concurrent coblation-assisted turbinoplasty with adenotonsillectomy (T&A + T) in patients with AR. MATERIAL AND METHODS: This study included 104 children who underwent T&A, and 67 who underwent T&A + T. All patients were diagnosed as AR and were aged < 12 years at the time of surgery. Symptoms (snoring, mouth breathing, nasal obstruction, rhinorrhea, itching, and sneezing) were evaluated preoperatively and postoperatively via a questionnaire and a telephone survey. RESULTS: None of the six symptoms investigated differed significantly between the two groups preoperatively, and all evaluated symptoms exhibited dramatic improvements after the surgery in both groups. The T&A + T group showed significantly greater difference of improvement in mouth breathing and nasal obstruction than T&A group. There were no significant difference of improvements in snoring, rhinorrhea, itching and sneezing postoperatively between two groups. In multiple regression analysis, postoperative obstructive symptoms including mouth breathing and nasal obstruction were significantly associated with concurrent turbinoplasty. CONCLUSION: Concurrent turbinoplasty should be considered especially in patients who have AR and adenotonsillar hypertrophy to improve obstructive symptoms.

Dorsal Augmentation in Facial Profiloplasty.

Nasal profile line has central importance in forming an aesthetically balanced facial profile. Thus, rhinoplasty is a critically necessary surgery in shaping ideal profile line. For successful rhinoplasty, meticulous preoperative evaluation and proper planning should be performed before surgery. The nasal dorsum is the broadest and most prominent part of the nose; any minor imperfection is readily appreciated by an observer. Thus, dorsal augmentation is one of the most challenging areas in rhinoplasty as there is virtually no single ideal graft material and method for the nasal dorsum, which is free of aesthetic complication The surgeon should be able to discern the pattern of the abnormal nasal profile and to strategize the best possible surgical option to create a long-lasting, aesthetically pleasing dorsal line in good harmony with the overall facial profile. This study addresses our strategy to deal with various types of aesthetically unpleasant nasal profile line. The characteristics of augmentation materials and considerations in surgical technique are also addressed.

Rib cartilage in Asian rhinoplasty: new trends.

PURPOSE OF REVIEW: Costal cartilage has many advantages over other grafting materials because of its large quantity and high biocompatibility. As a result, it has been considered as a good option for Asian rhinoplasty. However, costal cartilage is difficult to use and is associated with a high complication rate. To avoid the disadvantages and complications of costal cartilage graft, several techniques have been proposed in the literature. This review addresses the conventional uses of costal cartilage in Asian rhinoplasty and recent updates. RECENT FINDINGS: Different techniques have been reported for Asian rhinoplasty using costal cartilage. Solid-block costal cartilage and diced cartilage with or without wrapping materials are widely used for dorsal augmentation. Many different grafting techniques for the tip and septal reconstruction have been reported by numerous surgeons. When using costal cartilage graft, surgeons should pay attention to both graft complications, such as warping or infection, and donor-site morbidity. Several strategies have recently been developed to avoid these complications. SUMMARY: This article summarises grafting options for Asian rhinoplasty using costal cartilage and possible complications. This information may assist with proper selection of appropriate techniques for harvesting, carving and grafting costal cartilage.

Incidence and risk factors for morbidity and mortality in elderly head and neck cancer patients undergoing major oncological surgery.

PURPOSE: Cancer incidence in the elderly population has been continuously rising, and their treatment is an increasing concern among oncologists. This study aimed to evaluate the incidence and risk factors for morbidity and mortality after major oncological surgery in elderly patients with head and neck squamous cell carcinoma (HNSCC). METHODS: The 196 HNSCC patients aged 55 and older who underwent major curative surgery. Patients were categorized into three groups: far-old (≥75 years; n = 41); old (65-74 years; n = 72); or middle-aged (55-64 years; n = 83). The rates of early and late postoperative complications, hospital stays, and mortality were compared among groups. Univariate and multivariate analyses were performed to identify the factors associated with early postoperative complications. RESULTS: No study patients had mortality during surgery or within 3-month postoperation. Karnofsky performance status, frail functional status, comorbidity, and index cancer and noncancer mortality were the poorest in the far-old group. The far-old group demonstrated significantly higher rates of early overall complications, readmission within 1 month, and recurrence rates (P < 0.05 each). Multivariate analysis showed that age, postoperative hemoglobin, and C-reactive protein are independent predictors of early postoperative complications (P < 0.05 each). CONCLUSIONS: In elderly patients, chronological age affects the increased risk of early postoperative morbidity and later mortality following major HNSCC surgery. In combination with these risk factors, older patients who are diagnosed with HNSCC should be carefully monitored in order to determine the potential occurrence of postsurgical complications.

Patterns and treatment of neck metastases in patients with salivary gland cancers.

BACKGROUND: Management of the neck in patients with salivary gland cancer is controversial. This study aimed to identify clinicopathologic characteristics associated with regional metastases and regional recurrence in patients with salivary gland carcinoma. METHODS: Of 363 study patients, 51 underwent therapeutic neck dissection (TND) and 312 underwent either elective neck dissection (END, n = 110) or no neck dissection (NoND, n = 202). Univariate and multivariate analyses were performed to identify clinicopathologic characteristics associated with regional metastases and recurrence. RESULTS: Pathologic neck metastases were identified in 17/110 (15.5%) END patients and neck recurrence was identified in 5/202 (2.5%) NoND patients. Histologic grade (P < 0.001), tumor site (P = 0.008), and lymphovascular invasion (P < 0.001) were independent risk factors for neck metastases. Nodal metastases were more common in high-grade tumors (P < 0.001), at levels I-III in END patients and levels I-V in TND patients. Multivariate analyses identified histologic grade (P = 0.020), clinical N2 classification (P = 0.007), and extranodal extension (P = 0.005) as independent factors for regional recurrence after treatment. CONCLUSIONS: Patients with high-grade cancers should receive END involving levels I-III, whereas patients with node-positive salivary cancers should receive comprehensive TND involving all levels (I-V).

Short-term hearing results using ossicular replacement prostheses of hydroxyapatite versus titanium.

The aim of this study was to compare the short-term audiologic results of the ossiculoplasty using partial or total ossicular replacement prostheses (PORP or TORP) made of hydroxyapatite (HA) and titanium (Ti). Fifty-two consecutive patients who underwent ossiculoplasty due to chronic otitis media with or without cholesteatoma were enrolled. Patients were assessed at 6 months postoperatively to establish short-term audiologic results. Preoperative and postoperative air-conduction and bone-conduction thresholds were measured at five frequencies: 0.25, 0.5, 1, 2, and 3 kHz. Postoperative air-bone gap (ABG) of less than 20 dB was considered as successful. Success rates for HA PORP versus Ti PORP and HA TORP versus Ti TORP were compared. Postoperative ABGs at each frequency according to the types of prostheses were also compared. All types of prostheses showed a significant decrease of ABG postoperatively. Regarding PORP, the success rate of postoperative ABG of less than 20 dB was non-significantly higher in Ti group (89%) than in HA group (72%). Regarding TORP, HA group showed non-significantly higher success rate (100%) than Ti group (67%). Comparing postoperative ABGs at each frequency, there was no significant difference in ABGs between HA and Ti groups. There was no difference between the two materials. Both HA and Ti gave good functional results and operator can choose any types of prostheses by personal preference and affordability. Further randomized controlled long-term trials with large sample sizes are needed to establish the difference exactly.

Relationship between positive bacterial culture in maxillary sinus and surgical outcomes in chronic rhinosinusitis with nasal polyps.

OBJECTIVES: There are many studies on clinical prognosis following endoscopic sinus surgery (ESS) for the treatment of chronic rhinosinusitis with nasal polyp (CRSwNP). However, there are no independent reports on bacterial infection as a factor that influences surgical outcomes. We investigated the association between bacterial infection and surgical outcomes following ESS. METHODS: This retrospective review of medical records was performed on 71 patients with CRSwNP that was refractory to medical treatment and who were diagnosed between July 2007 and June 2012. The extent of the polyps and the Lund-Mackay CT score (L-M score) were preoperatively evaluated in all the patients. For this analysis, patients were classified into three groups (normal flora, culture-positive, and culture-negative) according to their intraoperative bacterial culture results. We compared the objective endoscopic findings between these groups at 6-months postsurgery. RESULTS: Bacteria were cultured in 55 of the 71 patients (77%). Of these, 43 patients (61%) demonstrated endoscopic improvement at the 6-month follow-up examination. The preoperative L-M score and polyp grade demonstrated no significant statistical differences in terms of surgical outcome, but the cure rate was statistically higher in culture-negative patients in comparison with normal flora and culture-positive patients (87.5% vs. 46.2% vs. 54.8, respectively). CONCLUSION: Intraoperative culture results can be a prognostic factor for the clinical outcomes of ESS in CRSwNP patients. Hence, the intraoperative culturing of pathologic secretions and the postoperative administration of susceptible antibiotics could improve surgical results.