Clinical Otolaryngology最新文献

{"title":"Azelastine-Fluticasone Intranasal Combination Therapy in Otorhinolaryngology: Clinical Evidence, Current Practice Patterns and Future Perspectives.","authors":"Giorgio Ciprandi, Ignazio La Mantia, Attilio Varricchio","doi":"10.1111/coa.70168","DOIUrl":"https://doi.org/10.1111/coa.70168","url":null,"abstract":"<p><strong>Background: </strong>Allergic rhinitis (AR) represents a significant burden in Ear Nose Throat (ENT) practice and markedly affects quality-of-life and work productivity of AR patients. The fixed combination of intranasal azelastine and fluticasone propionate (AzeFlu) has emerged as a valuable therapeutic option for moderate-to-severe AR. Recent updates to international guidelines and real-world evidence warrant a comprehensive review of its role in ENT practice, with particular attention to both seasonal and perennial AR.</p><p><strong>Methods: </strong>This narrative review synthesises evidence from the ARIA-EAACI 2024-2025 guidelines, systematic reviews and network meta-analyses of randomised controlled trials, pharmacovigilance data, and results from an Italian multidisciplinary inter-societal Delphi Consensus. We evaluated efficacy, safety, patient acceptability and implementation considerations specific to otorhinolaryngology practice.</p><p><strong>Results: </strong>Network meta-analyses demonstrate that AzeFlu provides superior symptom control compared to monotherapy for both nasal and ocular symptoms in seasonal and perennial AR, with a rapid onset of action (15-30 min). The combination shows particular efficacy in patients with moderate-to-severe symptoms inadequately controlled by monotherapy. Safety profiles are comparable to those of monotherapy, with no significant effects on growth or the HPA axis in children. Real-world data indicate high treatment satisfaction and adherence. The Italian Delphi Consensus achieved > 80% agreement on key management principles, particularly emphasising control of Type 2 inflammation and the role of combination therapy in treatment algorithms. Evidence for perennial AR remains more limited, and future primary research specifically targeting perennial rhinitis populations is warranted.</p><p><strong>Conclusions: </strong>Azelastine-fluticasone combination therapy represents an evidence-based, guideline-recommended option for moderate-to-severe AR in ENT practice. Its dual mechanism, rapid onset, favourable safety profile and high patient acceptability support its integration into contemporary treatment algorithms, particularly for patients requiring enhanced symptom control beyond monotherapy. The combination represents a meaningful therapeutic advancement, and further research is needed to fully characterise its role in perennial AR management.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Norfolk Smell and Taste Clinic Experience-A Decade of Olfactory and Gustatory Dysfunction.","authors":"Jeremy J Wong, Adam Lloyd, Ishan Singh, Louis Luke, Carl Philpott","doi":"10.1111/coa.70110","DOIUrl":"10.1111/coa.70110","url":null,"abstract":"","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":"788-794"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13432454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Device to Improve the Tolerability of Intranasal Corticosteroid Sprays for Allergic Rhinitis and Postoperative Chronic Rhinosinusitis: A Crossover Trial.","authors":"Sethmi Ranasinghe, Xenia Berger, Wandia Kimita, Kristi Biswas, Raymond Kim, Richard Douglas","doi":"10.1111/coa.70137","DOIUrl":"10.1111/coa.70137","url":null,"abstract":"<p><strong>Background: </strong>Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are commonly treated with intranasal corticosteroid sprays. Despite their efficacy, unpleasant sensations associated with their application, including post-nasal drip and nasal irritation, are often cited as reasons for poor compliance. Optimising the intranasal application experience is key to improving long-term adherence. We developed a nasal adaptor for metered-dose inhalers (MDIs) to reduce the unpleasantness of nasal administration, potentially improving patient compliance.</p><p><strong>Methods: </strong>Two crossover trials were conducted in AR and postoperative CRS participants (n = 16 per group). Participants used a standard fluticasone nasal spray (50 μg) and a fluticasone MDI (125 μg) with the adaptor for 3 weeks each, separated by a 1-week washout period. Device order was alternated, and doses were adjusted to ensure an approximately equal fluticasone dose. Device preference was determined using an adjusted Clinical Trial Patient Preference Questionnaire, and symptom improvement was assessed using Total Nasal Symptom Score and Sino-nasal Outcome Test-22 questionnaires.</p><p><strong>Results: </strong>Symptom improvement was comparable between the devices. However, in both groups, 11/16 (69%) participants preferred the MDI with the adaptor over the standard nasal spray, citing fewer unpleasant sensations. Satisfaction score improvement was significantly greater with the novel device in the CRS cohort. Participants reported a higher likelihood of compliance with the novel device, suggesting improved adherence.</p><p><strong>Conclusions: </strong>An MDI with the adaptor was preferred over a standard nasal spray among AR and postoperative CRS participants. The enhanced tolerability may promote improved compliance, and consequently, more effective long-term symptom control.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":"776-783"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13432547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Paediatric Sialorrhea: Outcomes of Botulinum Toxin and Surgical Procedures in a UK Tertiary Centre.","authors":"J Yapp, P Bruno, Y Embury-Young, F Protts, M Saunders","doi":"10.1111/coa.70132","DOIUrl":"10.1111/coa.70132","url":null,"abstract":"","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":"801-804"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13432519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Inspiratory Oropharyngeal Obstruction in Children With Obstructive Sleep-Disordered Breathing: A Cross-Sectional Study.","authors":"Amani Kais, Ruifeng Cui, Ryan S Ziltzer, Christopher Deskins, Hussein Jaffal","doi":"10.1111/coa.70113","DOIUrl":"10.1111/coa.70113","url":null,"abstract":"","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":"784-787"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13432501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxymetazoline Can Shorten the Time Required for a Bronchoscope to Reach the Vocal Cords in Patients With Turbinate Hypertrophy.","authors":"Jie Zhang, Fanliang Meng","doi":"10.1111/coa.70118","DOIUrl":"10.1111/coa.70118","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to investigate the effects of oxymetazoline on the time required for the bronchoscope to reach the vocal cords, nasal manipulation difficulty during bronchoscopy, nasal mucosal injury, and patient-reported pain in individuals with turbinate hypertrophy undergoing bronchoscopic examination.</p><p><strong>Materials and methods: </strong>This prospective, double-blinded, randomised controlled trial enrolled 240 patients with turbinate hypertrophy (November 2023 to July 2024), randomised into oxymetazoline, saline, and blank control groups (n = 80 each). The primary outcome was bronchoscope-to-vocal-cords time. Secondary outcomes included operator-assessed nasal passage ease (negotiation visual analog scale [VAS]), assistant-evaluated facial pain (Facial Pain Scale), patient-reported nasal pain (Pain VAS), operator-rated mucosal trauma (Trauma VAS) and hemodynamic parameters.</p><p><strong>Results: </strong>The oxymetazoline group demonstrated significantly shorter bronchoscope-to-vocal-cords time compared to the saline group (44.00 s [41.00-47.00] vs. 52.00 s [50.00-58.00], p < 0.001), improved nasal passage ease (negotiation VAS: 3.00 [2.00-4.00] vs. 5.00 [4.00-6.00], p < 0.001), and reduced mucosal trauma (Trauma VAS: 7.00 [6.00-8.00] vs. 9.00 [8.00-9.00], p < 0.001). Patients receiving oxymetazoline reported lower nasal pain scores (assistant-assessed: 4.00 [3.00-5.00] vs. 5.00 [5.00-6.00]; patient-reported: 4.00 [3.00-4.75] vs. 5.50 [5.00-6.00], both p < 0.001).</p><p><strong>Conclusion: </strong>Oxymetazoline optimises bronchoscopy in turbinate hypertrophy patients by shortening procedural time, easing nasal passage, mitigating mucosal injury, and alleviating pain. This trial is registered at chictr.org.cn (ChiCTR2300077642).</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":"770-775"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13432570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathologies Detected Using In-Office Transnasal Oesophagoscopy: Our Cohort of 234 Cases.","authors":"Paraskevi Karamitsou, Ismail Sherwani, Ahmad Moinie, Panagiotis A Dimitriadis, Ananth Vijendren","doi":"10.1111/coa.70131","DOIUrl":"10.1111/coa.70131","url":null,"abstract":"","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":"795-800"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13432571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survey of National Approaches to Practice in Local Anaesthetic Rhinology Surgery (SNAP-LARS): A United Kingdom National Cross-Sectional Collaborative Survey.","authors":"Dhruv Patel, Behrad Barmayehvar, Shayan Shahidi, Tharsika Myuran, Ding Yang, Vikas Acharya, Miran Pankhania, Raj K Bhalla, Ashok Rokade","doi":"10.1111/coa.70162","DOIUrl":"https://doi.org/10.1111/coa.70162","url":null,"abstract":"<p><strong>Introduction: </strong>Local anaesthetic rhinology surgery (LARS) offers a safe and cost-effective alternative to procedures traditionally performed under general anaesthesia. Despite publication of British Rhinological Society guidance in 2022, the landscape of LARS provision in the United Kingdom (UK) remains unclear. This study aimed to characterise current practice, whilst highlighting variations and perceived barriers to LARS.</p><p><strong>Methods: </strong>A cross-sectional national multi-centre collaborative survey was conducted between October 2025 and February 2026. The protocol followed the CROSS reporting checklist for survey studies. Only endonasal procedures were included. Each response captured a consultant's typical LARS practice over the preceding 12 months. Free-text responses underwent thematic analysis.</p><p><strong>Results: </strong>Sixty-three consultant responses from 39 sites were analysed. The most frequently performed procedures were endonasal biopsy (n = 60, 95.2%), septal button insertion (n = 46, 73.0%) and nasal polypectomy (n = 35, 55.6%). Most consultants performed ≤ 30 cases annually (76.2%) and typically ran one LARS session per month (76.2%). Most cases (76.6%) were performed in operating theatres. Sedation was offered by 19.0% (n = 12), and most patients were discharged within 2 h (n = 57, 90.5%). Routine PROM collection was only reported by 49.2% (n = 31). Utilisation of reusable equipment varied widely, with 47.6% (n = 30) using ≤ 50% reusable equipment. Barriers to service expansion included space, equipment, staffing and funding.</p><p><strong>Conclusion: </strong>LARS is delivered through heterogeneous models, and responses showed skew towards England. There is considerable opportunity to expand outpatient procedure-room delivery, standardise care pathways and outcome measurement, and address organisational barriers. These could enhance efficiency, reduce costs, minimise environmental impact, and ultimately improve patient experience.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Xylitol-Containing Nasal Irrigation or Nebulization in Postoperative Sinonasal Care: A Systematic Review and Meta-Analysis With GRADE Assessment.","authors":"Mohamed Saad Rakab, Yasir Majhud S Alzahrani, Abdulaziz Muhayya Alotaibi, Nourah Almarri, Lamyaa Hamdan Almutairi, Rakan Y Alsuwayyid, Aasheq Mamdouh W Alanazi, Abdullah O Almutairi, Turki Nashi Alharbi, Abdullah Mohammed Alghaith, Talal Dhifallah A Alanazi, Saad Hamdi Alenzi","doi":"10.1111/coa.70155","DOIUrl":"https://doi.org/10.1111/coa.70155","url":null,"abstract":"<p><strong>Background: </strong>Xylitol, a five-carbon polyol with antibiofilm effects, is increasingly added to postoperative sinonasal irrigations, yet its advantage over saline remains uncertain.</p><p><strong>Methods: </strong>We systematically reviewed comparative studies evaluating xylitol-containing nasal solutions after ESS, septoplasty, or turbinate surgery. Searches spanned PubMed, Scopus, Web of Science, and CENTRAL from inception to 18 June 2026. Outcomes included patient-reported symptoms (SNOT-20/22, NOSE, VAS), endoscopic healing, and safety. Random-effects meta-analysis pooled effects as mean differences (MD) or standardized mean differences (SMD); certainty was appraised with GRADE.</p><p><strong>Results: </strong>Eight studies met eligibility. Xylitol showed no clear overall advantage on SNOT-20/22 (SMD -0.49, 95% CI -1.12 to 0.14; p = 0.107; I² = 72.9%). The effect was larger yet heterogeneous post-ESS (SMD -0.79, 95% CI -1.99 to 0.41), while non-ESS effects centred on no difference (SMD -0.09, 95% CI -0.45 to 0.26). Excluding Lin 2017 resolved most heterogeneity and significantly favoured xylitol (SMD -0.27, 95% CI -0.47 to -0.06; p = 0.0098; I² = 24.2%). VAS score showed modest yet statistically significant improvement with xylitol (MD -1.16 points, 95% CI -2.30 to -0.03; p = 0.045). NOSE showed no overall benefit (MD -4.18, 95% CI -13.04 to 4.68; p = 0.2299); non-ESS improved slightly (MD -1.17, 95% CI -2.08 to -0.26; p = 0.0387), while ESS was heterogeneous and uncertain. Endoscopic scores were not significantly different (SMD -0.21, 95% CI -0.51 to 0.08; p = 0.1157).</p><p><strong>Conclusions: </strong>Xylitol-containing postoperative irrigations may provide modest symptomatic benefit in selected postoperative populations, but the evidence remains low to very low certainty and does not establish a reliable clinically important SNOT-22 benefit. Larger, multicentre RCTs with standardized dosing/delivery and head-to-head comparators are needed to define candidates, optimal regimens, and durability of benefit.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manuka Honey Sinus Irrigation Versus Systemic Itraconazole in Allergic Fungal Rhinosinusitis: Randomised Clinical Trial for Efficacy and Safety.","authors":"Khalaf Hamead, Mostafa Ismail, Abdelrahim A Abdelkarim, Abdelhakim Atef Abdelhakim, Khaled Mohamed Abdelzaher","doi":"10.1111/coa.70161","DOIUrl":"https://doi.org/10.1111/coa.70161","url":null,"abstract":"<p><strong>Background: </strong>Allergic fungal rhinosinusitis (AFRS) is a persistent sinus condition caused by fungal allergies. Endoscopic sinus surgery (ESS) and postoperative systematic and local medical therapies are the most common treatment protocols. Although oral antifungals such as itraconazole are frequently utilised postoperatively, there is increasing interest in alternate therapies that exhibit fewer systemic adverse effects. Manuka honey, recognised for its powerful antibacterial, antifungal and anti-inflammatory characteristics, is a promising alternative. The aim of this study was to assess the efficacy of Manuka honey sinus irrigation in comparison with oral itraconazole for the postoperative management of AFRS.</p><p><strong>Methods: </strong>Thirty patients diagnosed with AFRS were recruited for the current randomised clinical trial after ESS. Patients in the two groups randomly received either oral itraconazole (Group A) or Manuka honey sinus irrigation (Group B) for 6 weeks postoperatively. Both cohorts were monitored for 6 months postoperatively.</p><p><strong>Results: </strong>Lund-Kennedy endoscopic scores, total IgE levels and SNOT-22 scores were significantly improved in Group B after Manuka honey sinus irrigation. Both groups had similar Lund-Mackay radiological scores and numbers of postoperative sinus infections during the follow-up period.</p><p><strong>Conclusions: </strong>Postoperative Manuka honey sinus irrigation is more effective than oral itraconazole for reducing symptoms and preventing the recurrence of AFRS. It is considered a promising therapeutic alternative in the postoperative management of AFRS.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}