BackgroundSubjective and objective evaluations of chronic rhinosinusitis with nasal polyps (CRSwNP) are often discordant.ObjectiveThis study aimed to investigate the feasibility of using a newly developed five-item Sino-Nasal Outcome Test (SNOT-5) to evaluate disease severity and to compare its results with objective assessments in patients with CRSwNP.MethodsAdult patients with bilateral CRSwNP planning to undergo sinus surgery were prospectively enrolled. The nasal polyp score (NPS), Lund-Mackay (L-M) score, olfactory cleft opacification (OC) score, and the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire were assessed. The SNOT-5 scores were retrospectively extracted from the SNOT-22 results. Three-month postoperative endoscopic modified Lund-Kennedy (MLK) scores and SNOT-22 data were collected when available.ResultsA total of 169 participants were enrolled. The SNOT-5 score rather than the SNOT-22 score, was significantly correlated with objective measurements of disease burden, including NPS, L-M, and OC scores. SNOT-5 score was significantly associated with younger age, comorbid asthma, NPS, L-M, and OC scores in the univariate regression analysis, and with age, L-M, and OC scores in the multivariate analysis. Additionally, the SNOT-5 score also significantly correlated with the MLK score at 3 months after surgery.ConclusionThe SNOT-5, rather than the SNOT-22, correlated more closely with objective measures of disease burden, including the NPS and L-M scores, and postoperative MLK score in patients with CRSwNP. Utilizing the SNOT-5 in clinical practice may help clinicians more accurately assess disease severity and treatment response in patients with CRSwNP.

BackgroundAt present, there are many therapeutic regimens for allergic rhinitis (AR), but their therapeutic effects are not better. Therefore, it is a focus to find new therapeutic targets by exploring AR immune regulation.ObjectiveTo explore the possible mechanism that adipose mesenchymal stem cell-derived exosomes (AMSC-exos) regulate the balance of Th2/Treg cells by mTOR pathway in AR patients.MethodsThirty patients with AR and 30 patients with deviated nasal septum alone were selected as AR group and control group. From each patient, 10 ml of peripheral blood were collected for determining the levels of blood plasma IL-4 and TGF- β as well as protein levels of p-PI3K (P85), p-AKT (Ser473), p-mTOR (Ser2448) and p-p70S6K (Thr389) in peripheral blood mononuclear cells (MCs) and the proportions of Th2 and Treg cells. And then MCs from AR patients were divided into two groups. One group was as AR cell group. Another group was co-cultured with AMSC-exos and served as AR cell + exos group. The levels of IL-4 and TGF- β in supernatant, the protein levels of p-PI3K (P85), p-AKT (Ser473), p-mTOR (Ser2448) and p-p70S6K (Thr389) in MCs and the proportions of Th2 and Treg cells were also determined.ResultsThe levels of p-PI3K (P85), p-AKT (Ser473), p-mTOR (Ser2448) and p-p70S6K (Thr389), the IL-4 level and the proportion of Th2 cells were significantly higher in the AR group than in the control group (all  < 0.05). However, the levels of p-PI3K (P85), p-AKT (Ser473), p-mTOR (Ser2448) and p-p70S6K (Thr389), the IL-4 level and the proportion of Th2 cells were significantly lower in the AR cell + exos group than in the AR cell group (all  < 0.05).ConclusionsAMSC-exos may regulate the balance between Th2 and Treg cells by PI3K/AKT/mTOR/p70S6K pathways in vitro.

BackgroundUltra-processed foods (UPF) are industrial formulations derived mostly from substances refined or extracted from foods. UPF intake has been linked to obesity, cardiovascular disease, and adult mortality, with recent studies demonstrating possible associations with asthma and allergy.ObjectiveWe investigate the association of UPF intake with self-reported sinusitis and other sinonasal symptoms.MethodsWe retrospectively reviewed 3 cycles of the National Health and Nutrition Examination Survey (NHANES), ranging from 2005 to 2014, which includes dietary and sinonasal symptom data on a large, representative sample of the US population. Individuals were divided into quartiles based on the percent of daily caloric intake consisting of Nova category 4 UPF. Multivariable logistic regression was performed to assess the association of UPF intake with sinonasal symptoms, adjusting for demographic data and medical comorbidities.ResultsAnd 10,068 individuals (mean age 54.2 years, 52.1% female) were studied. Compared to the lowest quartile of UPF intake, the highest quartile had a higher rate of asthma (16% vs 11%,  = .03), obesity (40% vs 30%,  < .001), smoking (51.6% vs 44.4%,  < .001), emphysema (2.9% vs 1.8%,  = .02), and food insecurity (26% vs 21%,  = .002). On multivariable regression, the highest quartile of UPF intake was associated with self-reported sinusitis (odds ratio [OR] = 1.54, 95% confidence interval [CI] 1.15-2.05,  = .007). UPF intake was also associated with xerostomia-related dysgeusia (OR 1.79, CI 1.15-2.80,  = .02) but not with other sinonasal symptoms, including hyposmia, allergies, hay fever, or nasal congestion from allergies.ConclusionUPF intake is significantly associated with self-reported sinusitis and xerostomia-related dysgeusia, although not with other sinonasal symptoms. Further studies are needed to elucidate the mechanism of this association.

BackgroundOdontogenic sinusitis (ODS) is a form of maxillary sinusitis caused by dental infections. In patients with ODS, oroantral fistula (OAF) is a common complication often requiring multidisciplinary management. However, clinical indicators of when to perform oral and maxillofacial surgery (OMS) remain unclear, particularly the need for surgical closure and coordination with endoscopic sinus surgery (ESS).ObjectiveTo identify large OAF predictors and determine when OMS co-management is warranted in patients undergoing ESS for ODS.MethodsData of adults with ODS and OAF who underwent ESS at a tertiary center (2014-2021) were retrospectively reviewed, and stratified by concurrent OMS intervention at the time of index surgery (ESS alone vs ESS + OMS). The maximum bony defect diameter of the OAF size on preoperative paranasal sinus computed tomography, measured in millimeters on coronal/axial reformats using the picture archiving and communication system (PACS) caliper, was reported as β with 95% confidence intervals (CIs) and -values.ResultsNinety-one patients were included (ESS alone, n = 47; ESS + OMS, n = 44). OMS cases had larger OAFs (mean 9.5 ± 5.2 vs 5.6 ± 5.2 mm); the between-group mean difference was 3.9 mm (95%CI 1.8-6.0). In multivariable analysis, odontogenic cysts (β=9.78 mm, 95%CI 5.30-14.25; p < .001) and OMS treatment (β=2.78 mm, 95%CI 0.30-5.26; p = .028) were independently associated with greater OAF size. Gingival pain/swelling and shorter symptom duration were more common among patients with OMS, suggesting more acute presentations.ConclusionAdjusted analyses showed that odontogenic cysts were independently associated with larger OAFs. OMS involvement at the index operation reflected predefined clinical and radiological criteria, rather than cyst status alone. These findings highlight the importance of standardized dental-sinonasal co-planning and provide descriptive insights into surgical patterns and outcomes in ODS with OAF, while recognizing the limitations of a retrospective, single-center cohort.

BackgroundBurn injuries and surgical drape fires are known potential complications of endoscopic surgery. Automatic standby technology (AST) triggers the light source to immediately enter "standby mode" when the light cable disconnects from the endoscope, which should reduce the likelihood of patient and caregiver injuries and operating room drape fires.ObjectiveThis study compared AST versus a conventional light source without this technology, examining temperature differences at the endoscope tip and adapter, as well as the propensity of disconnected light cables to burn surgical drapes.MethodsAST and conventional light sources with standard light cables were connected to 4 mm rigid nasal endoscopes. Temperature was measured using a thermocouple sensor at the endoscope tip (112 time points at 15 s intervals) and adapter (52 time points at 15 s intervals), comparing AST and conventional light sources. A thermal camera assessed the temperature of the light cable ends immediately upon disconnection. Light cables were held to standard surgical drapes immediately after disconnection, both with direct and indirect contact.ResultsAverage endoscope tip temperature was 24.0 °C for AST and 25.2 °C for conventional ( < 0.001). Average adapter temperature was 26.6 °C for AST and 27.3 °C for conventional ( = 0.003). Immediately upon disconnection, light cable temperature averaged 40.9 °C for cables attached to AST, versus 56.8 °C for conventional light sources. Conventional light cables showed notable drape burns at all time intervals with both direct and indirect contact. Damage was significantly greater with indirect contact via thermal radiation. The AST system did not burn drapes with either direct or indirect contact.ConclusionAST technology provides significant safety value by removing radiative heat transfer as a possible agent of patient and caregiver harm, rapidly lowering the temperature of an accidentally disconnected light cable to levels well below the threshold for causing skin injury and drape burns.

BackgroundSinonasal pathology, such as chronic inflammatory disease or neoplasm, can cause secondary nasolacrimal duct obstruction (sNLDO). There is a paucity of data on dacryocystorhinostomy (DCR) techniques and outcomes for NLDO secondary to known sinonasal pathologies.ObjectiveTo describe case characteristics, management, and surgical outcomes of sNLDO at a tertiary academic center.MethodsCharts of DCR cases with at least 3 months follow-up done at a single institution over a 5-year period (2018-2022) were reviewed. Patient and surgical characteristics were recorded and compared between secondary and primary NLDO groups. The primary outcome was early functional success of DCR, assessed by improvement or resolution of epiphora at 3 months.ResultsA total of 236 cases were included. Of those, 79 (33.5%) were classified as secondary NLDO associated with sinonasal pathology. Reasons for sNLDO were sinonasal cancer (46.8%), chronic inflammatory disease (24.1%), trauma (16.5%), or prior head and neck radiation (31.6%). When comparing primary acquired NLDO to sNLDO cases, DCR for sNLDO was more likely to be performed endoscopically (68.4% vs 31.8%,  < .01), by a multidisciplinary team of rhinologist and oculoplastic surgeon (70.9% vs 8.3%,  < .01), and required bilateral surgery (36.7% vs 5.7%,  < .01). The overall functional success rate was 79.7% for sNLDO compared to 87.9% for primary acquired NLDO ( < .01). Revision surgery for sNLDO, history of sinonasal malignancy, and radiation were associated with lower functional success rates (66.7%, 70.3%, and 68.0%, respectively). Canalicular pathology was more common in sNLDO cases (29.0% vs 8.3%,  < .01).ConclusionsSecondary NLDO was more commonly managed with an endoscopic approach by a multidisciplinary team. Revisions for sNLDO, as well as cases with a history of sinonasal malignancy and radiation, had a markedly lower success rate, and sNLDO was frequently associated with canalicular obstruction. These findings may facilitate surgical planning and patient counseling.

BackgroundRace or ethnicity may influence chronic rhinosinusitis (CRS) endotype. Asian patients with CRS with nasal polyps (CRSwNP) may have increased Th1/Th17/mixed endotypes. However, there is a paucity of research concerning the endotype of non-Caucasian and non-Asian patients.ObjectiveThis review seeks to summarize literature as it pertains to associations between race or ethnicity and endotype with the goal highlighting knowledge gaps to guide future inquiry.MethodsSystematic scoping review methodology was used to summarize the current literature in accordance with PRISMA guidelines.ResultsOf the 8877 articles identified, 261 articles pertaining to race or ethnicity and endotype in CRSwNP were included. 163 studies with race or ethnicity-specific data involved Asian patients and demonstrated increased presence of Th1, Th17, and mixed endotypes, but also increasing prevalence of Th2 endotypes in multiple countries across Asia. There were 56 studies involving Caucasian patients demonstrating a predominance of Th2 endotypes though several recent studies also demonstrated that mixed inflammation may contribute to disease. There was a relative lack of literature involving other races and ethnicities, specifically: South Asian ( = 2), Middle Eastern ( = 9), African/African-American ( = 16), and Latino/Hispanic-American ( = 9). Allergic fungal rhinosinusitis appeared relatively prevalent in South Asian, Middle Eastern and African/African-American patients, though, relatively low numbers of studies and patients preclude definitive conclusions.ConclusionThis scoping review demonstrates that both race and ethnicity appear to play a role in affecting CRSwNP endotype. Additional research is necessary to investigate these factors, particularly in non-Caucasian and non-Asian patients.

ObjectiveChronic rhinosinusitis with nasal polyp (CRSwNP) is a chronic inflammatory disease characterized by epithelial remodeling. This study aimed to investigate the role of peroxiredoxin 2 (PRDX2) in CRSwNP and its potential mechanisms.MethodsProteomics analysis was conducted on nasal tissues from CRSwNP patients and healthy controls. Top-rank differentially expressed proteins were validated by immunofluorescence (IF) staining and reverse transcription quantitative-polymerase chain reaction (RT-PCR). In vitro experiments validated the effects and regulatory mechanisms of PRDX2 on nasal epithelial remodeling.ResultsProteomics results revealed a disease-specific protein expression profile in CRSwNP polyp tissues, with DEGs primarily associated with oxidative stress. Our validation results demonstrated elevated reactive oxygen species (ROS) levels in CRSwNP with predominant accumulation in the nasal epithelium. Among these DEGs, PRDX2 was the most significantly downregulated, which was further confirmed by RT-PCR and IF. Moreover, PRDX2 was primarily expressed in nasal epithelial cells (NECs). RT-PCR results indicated that tissue PRDX2 expression was positively correlated with E-cadherin and negatively correlated with TGF-β1 and Vimentin expression in CRSwNP. In vitro experiments demonstrated that HO stimulation promoted ROS and epithelial-mesenchymal transition (EMT) in NECs, while PRDX2 overexpression (OE) mitigated these effects. Furthermore, PRDX2 OE suppressed the HO-induced activation of the TGF-β1/SMAD signaling pathway, which plays a crucial role in regulating EMT in NECs.ConclusionOur findings suggest that the accumulation of ROS plays a critical role in the pathogenesis of CRSwNP. PRDX2 modulates ROS-induced epithelial remodeling, contributing to disease progression by activating the TGF-β1/Smad signaling pathway.

BackgroundRecurrence of chronic rhinosinusitis with nasal polyps (CRSwNP) following endoscopic sinus surgery (ESS) is common, with reported rates varying considerably depending on follow-up duration. A clinically practical and reliable model for predicting long-term recurrence risk remains an unmet need.ObjectiveTo identify clinical predictors of recurrence and develop a prognostic model for estimating recurrence-free survival at 2, 5, 10, and 15 years after ESS.MethodsA retrospective, single-institution cohort study of 437 patients with CRSwNP who underwent ESS was analyzed for time-to-event recurrence. Candidate predictors, including age, sex, smoking status, asthma, NSAID hypersensitivity, symptom duration, blood eosinophil count (BEC), modified Lund-Kennedy (MLK) score, and Lund-Mackay (LM) score, were entered into a LASSO penalized Cox model for variable selection. A nomogram was constructed to estimate recurrence-free survival at predefined time points. Model performance was assessed using time-dependent area under the ROC curve (AUROC), Brier scores, calibration curves, internal validation via 1000 bootstrap resamples, and clinical utility through decision curve analysis (DCA).ResultsRecurrence occurred in 54.0% of patients. The LASSO-penalized Cox model identified age, NSAID hypersensitivity, asthma, symptom duration, BEC, MLK, and LM scores as significant predictors. The nomogram demonstrated strong discrimination, with AUROCs of 0.878, 0.870, 0.886, and 0.873 at 2, 5, 10, and 15 years post-ESS, respectively. Corresponding Brier scores were 0.150, 0.147, 0.135, and 0.138, indicating low prediction error. Internal validation confirmed the model's stability, with AUROCs of 0.873, 0.866, 0.879, and 0.864 at the same time points. Calibration plots showed good agreement between predicted and observed outcomes across all time horizons. DCA demonstrated greater net benefit compared to treat-all or treat-none strategies across the 0.1 to 0.9 threshold range.ConclusionThe nomogram developed using a LASSO-penalized Cox model offers a robust, well-calibrated, and clinically applicable tool for individualized long-term recurrence risk prediction in patients with CRSwNP following ESS.

BackgroundSeptoplasty is a common cause of nasal septal perforation (NSP), especially when bilateral apposing septal mucosal tears (BATs) occur intraoperatively. While prior studies have largely focused on NSP management once formed, there is limited evidence on how to prevent NSPs should BATs occur during septal surgery.ObjectiveThe purpose of this study was to assess the efficacy of intraseptal synthetic interposition graft (SIG) placement to prevent NSPs following BATs during septal surgery.MethodsA single-institution retrospective cohort study was conducted with adult patients who underwent septoplasty or septorhinoplasty by 2 surgeons. Patients who had BATs intraoperatively had SIGs placed between the septal flaps (cadaveric acellular dermal or porcine collagen grafts). Patients were monitored endoscopically for NSP development at a minimum of 2 months postoperatively.ResultsOf 1132 operative patients between January 2016 and July 2024, 50 patients (4.4%) experienced BATs and had SIGs placed intraoperatively. Of the 50 patients, the median age was 52.7 years, 72.0% were males, and the median follow-up duration was 4.8 months (range: 2.0-85.4). Regarding the SIGs placed, 54.0% were porcine collagen and 46.0% were cadaveric dermis. While 46/50 patients experienced complete mucosalization of their BATs (92.0%), 4 developed NSPs postoperatively (8.0%). Two NSPs occurred within 2 months postoperatively, and 2 were delayed after complete mucosalization. All NSPs occurred following porcine collagen grafts.ConclusionIntraseptal synthetic IP graft placement demonstrated 92% success in preventing NSPs following BATs during septal surgery. Future studies should explore the efficacy of different SIGs at preventing NSPs following BATs during septal surgery.

BackgroundOlfactory dysfunction (OD) is both under-recognized and underdiagnosed in aging adults. Prior studies in chronic rhinosinusitis have demonstrated a correlation between the Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS) and psychophysical olfactory testing, indicating potential utility for screening in this group. This study examined the correlation between QOD-NS scores, psychophysical function, and olfactory-associated patient-reported outcome measures (PROMs) in a novel, aging population. Additionally, we examined the potential utility of the QOD-NS as a screening instrument in this population.MethodsProspective cohort study in which healthy, adult volunteers completed the QOD-NS, olfaction-related visual analog scale (VAS) questions, Sniffin' Sticks (TDI), De Jong Giervald Loneliness Scale, UCLA loneliness survey (UCLA), and the Patient Health Questionnaire-9 (PHQ9).ResultsTwo-hundred and twenty-eight adults with mean age 50.3 ± 17.7 years were included. Subjects ≥50 years old had higher prevalences of hyposmia (58.3% vs 19.8%, P < 0.001) and anosmia (9.1% vs 3.1%, P < 0.001), and had worse QOD-NS and VAS (P < 0.001 for both). Aging subjects had significant correlations between QOD-NS and TDI (r = -0.386, p < 0.001), all VAS scores (P < 0.001), PHQ9 (r = 0.283, P = 0.001). Receiver operating characteristic curve demonstrated a QOD-NS of 8.0 as the optimal cutoff for a Youden's index of 0.23 for detection of dysosmia in aging patients.ConclusionsThe QOD-NS has significant, although weak correlation with psychophysical testing and psychosocial PROMs in aging subjects. However, a low Youden Index suggests limited potential of the QOD-NS as an OD screening tool in this population.

ObjectivesWhile autoimmune diseases (ADs) are known for systemic inflammation, their specific association with upper airway inflammation (UAI) has not been extensively characterized. We aim to investigate the associations between various ADs and subsequent UAI development in a large, national cohort.MethodsThis retrospective cohort study utilized de-identified electronic health records from TriNetX, a national collaborative database. Adolescent and adult patients with a diagnosis of 1 or more ADs were identified. A 12 month washout period was implemented to exclude preexisting UAI. The primary outcome was the incidence of UAI (chronic rhinosinusitis, allergic rhinitis, nonallergic rhinitis, chronic laryngitis, obstructive sleep apnea) following AD diagnosis. Hazard ratios and relative risks (RRs) with 95% confidence intervals (CIs) were calculated.ResultsAfter propensity matching, 1 327 186 patients with ADs and 1 327 186 controls were included. Patients with ADs exhibited a significantly lower overall incidence of UAI compared to controls (9.11% vs 13.81%; RR 0.71, 95% CI 0.70-0.71). This reduced risk was notable for allergic rhinitis (RR 0.64, 95% CI 0.64-0.65) and chronic sinusitis (RR 0.88, 95% CI 0.87-0.89). Juvenile idiopathic arthritis and type 1 diabetes demonstrated the most pronounced reductions in UAI risk. However, granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis were associated with a significantly increased risk of UAI.ConclusionMost ADs were associated with a reduced overall risk of subsequent UAI. However, certain vasculitides significantly increased UAI risk, highlighting disease-specific pathophysiological mechanisms. These findings suggest a complex interplay between systemic autoimmunity and localized airway inflammation, warranting further investigation into underlying mechanisms and the impact of AD treatments.

IntroductionChildren with choanal atresia (CA) typically present with nasal obstruction and require surgical intervention to establish a patent airway. Transnasal endoscopic surgery is the preferred treatment approach. However, long-term outcome data are lacking. This study aims to assess the long-term outcomes and quality of life (QoL) after endoscopic repair of CA.MethodsChildren under age 18 years underwent endoscopic repair of CA using mucoperichondrial flaps developed from the nasal septum between 2007 and 2022. Their parents completed two standardized telephonic QoL questionnaires (Hebrew version, Sino-Nasal 5 (SN-5H) and Nasal Obstruction Symptom Evaluation (He-NOSE)).ResultsThe cohort consisted of 40 children, 60% female. Eight had syndromic disease; seven were born prematurely. Mean age at surgery was 25 days for bilateral atresia (65% of patients) and 3.8 years for unilateral atresia. Ten children, most with unilateral CA, needed revision surgery. The mean duration of follow-up was 3.1 years. At the last follow-up, 84.6% of the children had normal choanae, and the remainder had narrowed choanae. Mean time from last follow-up to the parental interview was 5.2 years. SN-5H and He-NOSE scores were similar to those of historical healthy subjects: 1.95 versus 1.76 ( = 0 .4) and 22.3 versus 14.9 ( = 0.08), respectively. Children born prematurely had a higher rate of sinus infections ( = 0 .01) and nasal congestion ( = 0 .05) than children born at term.ConclusionsLong-term follow-up of children who underwent endoscopic repair of CA using mucoperichondrial flaps showed a stable patent nasal passage with normal QoL for both unilateral and bilateral disease.

BackgroundPrevious research has reported inconsistent results when evaluating long-term revision rates of patients undergoing balloon sinus dilation (BSD) compared to primary endoscopic sinus surgery (ESS).ObjectiveWe aimed to compare outcomes and long-term rates of revision surgery in patients with chronic rhinosinusitis without nasal polyps (CRSsP) who underwent primary standalone BSD versus primary ESS. We also wanted to better understand the post-procedure utilization of major healthcare resources between these groups.MethodsRetrospective cohort study using the TriNetX platform to identify patients with CRSsP undergoing standalone BSD versus primary ESS. 1:1 propensity score matching was performed to balance age and gender in each cohort. The primary outcome was revision ESS rates at 1 and 10 years. Secondary outcomes were rates of healthcare utilization and complications, including orbital, cerebrospinal fluid (CSF) leak, and epistaxis within 90 days.ResultsAfter matching, each cohort had 2112 patients. At 1 year, the revision ESS rate was 3.5% in the balloon cohort and 3.5% in the ESS cohort (OR = 0.97, 95% CI: 0.70-1.35). Extending follow-up to 10 years, revision rates were also not statistically different: 5.8% in the balloon cohort and 6.3% in the ESS cohort (OR = 0.92, 95% CI: 0.72-1.19). Patients in the balloon cohort had a lower 90-day risk of inpatient encounters (OR = 0.29, 95% CI: 0.23-0.38), CRS-related patient visits (OR = 0.63, 95% CI: 0.55-0.71), diagnostic nasal endoscopies (OR = 0.57, 95% CI: 0.50-0.65), antibiotic prescriptions (OR = 0.53, 95% CI: 0.43-0.66), and corticosteroid prescriptions (OR = 0.62, 95% CI: 0.53-0.71).ConclusionNo significant difference was observed in revision ESS rates in CRSsP patients who underwent primary BSD versus ESS after 10 years in this large database study. Findings suggest that in appropriately selected patients, BSD offers a durable response and a favorable value proposition in the management of patients with CRSsP.

BackgroundAcute invasive fungal rhinosinusitis (AIFRS) is an aggressive and often fatal disease process that principally impacts immunocompromised patients. Maxillary dental trauma and infections have been associated with the development of maxillary sinus fungal balls, but the role of dental procedures/trauma in the pathogenesis of AIFRS remains poorly defined.ObjectiveThis study seeks to review a single-institutional experience with AIFRS and examine the association between dental events and AIFRS severity and outcomes.MethodsRetrospective review of 95 consecutive patients with biopsy-proven AIFRS treated at a tertiary institution between 2010 and 2024. Demographic information, comorbidities, disease course and outcomes were evaluated. The primary objective was to evaluate the impact of antecedent dental events on AIFRS morbidity and mortality. Secondary objectives included evaluating variability in demographic factors, comorbidities, and extent of disease.ResultsEleven patients with an antecedent dental event within 2 weeks of AIFRS diagnosis were identified for a rate of 11.6%. Dental AIFRS patients were more likely to be African American ( = .003) and more likely to have diabetes mellitus as their underlying immunodeficiency ( = .03) than non-dental AIFRS patients. Patients with dental-related AIFRS were more likely to present with invasion of the orbit (OR 6.0, 95% CI 1.2-29.5) and nasal floor (OR 4.2, 95% CI 1.1-17.1) than non-dental AIFRS patients. There was no difference in mortality between dental and non-dental AIFRS (36.4% vs 52.4%,  = .31).ConclusionMore investigation is necessary to further evaluate the association between dental events and the development of AIFRS. In our cohort, 11.6% of patients experienced AIFRS within 2 weeks of a dental event and these patients tended to present with higher rates of orbital involvement without a resultant increase in mortality.

AimsWe compared the outcomes of endoscopic dacryocystorhinostomy (En-DCR) in patients with chronic dacryocystitis (CD), with or without previous temporary nasolacrimal stent implantation (TNLSI), then explored whether previous TNLSI influenced postoperative outcomes.MethodsThis retrospective study included consecutive patients with CD and previous TNLSI who underwent En-DCR (group A) between September 2019 and May 2022, and an age- and sex-matched control group of patients with CD who had not undergone previous implantation (group B). Lacrimal sac parameters were measured by computed tomography-dacryocystography, and surgical findings were recorded during surgeries. The surgical success rates were compared between the two groups at 12 months after surgery.ResultsThere were 53 patients in group A and 106 patients in group B. In group A, the mean horizontal, sagittal, and vertical lengths were 4.94 ± 1.30 mm, 4.88 ± 1.17 mm, and 7.85 ± 2.03 mm; in group B, these three lengths were 6.16 ± 1.25 mm, 5.97 ± 1.20 mm, and 10.00 ± 2.18 mm, respectively. All three parameters were significantly smaller in group A than in group B. Scar formation in the sac was observed in all patients in group A; it was not present in group B. At 12 months after surgery, the anatomical and functional success rates were 75.47% (40/53) and 71.70% (39/53), respectively, in group A; they were 93.40% (99/106) and 91.51% (97/106) in group B. The success rates were significantly higher in group B than in group A.ConclusionPrevious TNLSI may reduce lacrimal sac parameters and cause scar formation, thereby reducing the likelihood of success after En-DCR.

ObjectivesPosterior nasal nerve (PNN) neurectomy is an effective surgical option for refractory allergic rhinitis (AR), but delayed massive hemorrhage remains a concern. This study aimed to evaluate whether preserving a mucosal flap to cover the sphenopalatine foramen (SPF) affects postoperative efficacy and complications.MethodsThis prospective cohort study included 61 patients with moderate-to-severe AR who underwent PNN neurectomy. Patients were divided into two groups based on whether a mucosal flap was preserved to cover the SPF. Outcomes included mucosal epithelialization time, incidence of delayed bleeding, Visual Analog Scale (VAS), reflective Total Nasal Symptom Score (rTNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), nasal airway resistance (NAR), and inflammatory markers. Follow-up was conducted at 1, 3, 6, and 12 months postoperatively.ResultsNo significant differences were found between groups in baseline characteristics. Both groups showed significant improvements in VAS, rTNSS, RQLQ, and NAR, with sustained benefits up to 12 months. The With Mucosal Flap Preservation group had a significantly shorter epithelialization time ( < .001) and lower incidence of delayed bleeding ( = .046). Mediation analysis indicated that epithelialization time mediated the relationship between the surgical method and delayed bleeding ( = .046), while the direct effect was not significant ( = .748).ConclusionThis study shows that PNN neurectomy with mucosal flap preservation reduces the risk of delayed postoperative bleeding through the key mediating mechanism of accelerated mucosal epithelialization, while achieving comparable improvements in nasal symptom relief and quality of life compared to the procedure without mucosal flap preservation.

ObjectiveTo evaluate disparities in the management of chronic rhinosinusitis (CRS) across racial, ethnic, and gender groups, focusing on treatment patterns and associated comorbidities.MethodsThis cross-sectional study analyzed data from 28,278 adults with CRS in the NIH All of Us Research Program between 2018 and 2022. Multivariable logistic regression was used to assess associations between demographic variables, associated comorbidities, and receipt of treatments including systemic steroids, leukotriene modifiers, antibiotics, biologics, and sinus surgery.ResultsBlack individuals had higher odds of receiving systemic steroids (OR: 1.59,  < .0001) and antibiotics (OR: 1.67,  < .0001), but were less likely to receive biologics (OR: 0.30,  = .051). Non-Hispanic individuals were more likely to receive systemic steroids (OR: 1.54,  < .001) and antibiotics (OR: 1.54,  = .0007), but were less likely to undergo sinus surgery (OR: 0.67,  = .016). Male sex was associated with reduced odds of receiving systemic steroids (OR: 0.86,  < .0001), leukotriene modifiers (OR: 0.81,  < .001), and antibiotics (OR: 0.91,  < .001) but increased odds of undergoing surgery (OR: 1.37,  < .0001). Presence of nasal polyps and comorbid asthma strongly predicted use of biologics (ORs: 4.39 and 13.83, respectively,  < .0001) and surgical intervention (ORs: 13.13 and 1.34, respectively,  < .0001).ConclusionSignificant racial, ethnic, and gender disparities exist in the treatment of CRS, independent of comorbidities. These findings highlight the need for equity-focused strategies to ensure timely access to advanced therapies and to address structural barriers that may influence treatment allocation.

BackgroundSinonasal squamous cell carcinoma (SNSCC) is an aggressive subtype of sinonasal cancer. While elective neck dissection (END) is not typically recommended for SNSCC, occult nodal involvement (ONI) may be present. We therefore sought to evaluate the incidence, associated factors, and survival impact of ONI in SNSCC.MethodsThe National Cancer Database was queried for patients with SNSCC from 2004 to 2016. Data regarding patient demographics, clinicopathology, and treatment were obtained. Univariate and multivariate logistic regression and Kaplan-Meier analyses were conducted to identify predictors of ONI with odds ratios (ORs) and overall survival.ResultsIn total, 522 patients satisfied inclusion criteria. Most patients were elderly (>60 years old, 55.0%), male (67.2%), White (86.4%), and insured with Medicare (44.1%). Cases of SNSCC most frequently involved the paranasal sinuses (69.7%), were T-stage 4 (50.6%), moderately differentiated (52.5%), underwent treatment at academic centers (76.4%), and lacked lymphovascular invasion (LVI, 84.4%). ONI was observed in 10.9% of patients. Following propensity score matching, ONI significantly negatively impacted survival: 3 year survival was 65% for patients without ONI and 35% for patients with ONI (log-rank  < .001). The highest rate of ONI was observed in patients with LVI (31.4%). On multivariate analysis, LVI was the sole predictor of ONI (OR: 6.75, 95% confidence interval: 3.09-14.73,  < .001).ConclusionsONI was identified in 10.9% of patients with SNSCC and was found to be a negative prognostic factor for survival. Patients with identified LVI may benefit from END. 4.

BackgroundEndoscopic sphenopalatine artery ligation (ESPAL) is a safe and effective procedure to manage intractable epistaxis. However, in the literature, the peri-operative and patient factors which contribute to surgical success or failure have been poorly defined.ObjectiveThe purpose of this study was to identify the patient, disease and surgical factors which influence the effectiveness of ESPAL in the management of intractable epistaxis.MethodsAll ESPALs performed over a 14-year period at a single tertiary otolaryngology department to manage epistaxis refractory to conservative management were retrospectively analyzed. Recurrence of epistaxis was defined as any patient who presented to an emergency department with epistaxis on the same side as their previous ESPAL at any time post-operatively. Subjects were grouped as either a non-recurrence or recurrence group.Results40 patients underwent ESPAL to treat intractable epistaxis. Anticoagulation, smoking, and active malignancy were associated with higher rates of recurrence after ESPAL ( < .05). The recurrence rate was 20% with an average follow-up period of 5 years. The average time between ESPAL and epistaxis recurrence was 10 days. 50% (n = 4) of patients with recurrence required escalation to endovascular embolization. No patients had recurrence of epistaxis following additional radiological intervention.ConclusionOne in five patients experienced a recurrence in epistaxis following ESPAL within 3 weeks of their surgery. Smokers, patients on anticoagulation and patients with malignancy are more likely to experience recurrence. If re-presenting with epistaxis following ESPAL, patients are likely to require radiological intervention.