International Forum of Allergy & Rhinology最新文献

{"title":"Real-World Treatment Escalation Patterns of Biologics and Functional Endoscopic Sinus Surgery in Chronic Rhinosinusitis (CRS): A Nationwide Database Study.","authors":"Omer Baker, Bita Naimi, Soraya Mehdipour, Adam S Deconde, Carol H Yan","doi":"10.1002/alr.70270","DOIUrl":"https://doi.org/10.1002/alr.70270","url":null,"abstract":"","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Rhinologic Surgery Within 90 Days Using Item-Level SNOT-22 Responses: A Multisite Machine Learning Study of 35,170 Patients.","authors":"Michael Sramek, Nitish Kumar, Shrinath Patel, Amar Miglani, Michael Marino, Devyani Lal","doi":"10.1002/alr.70273","DOIUrl":"https://doi.org/10.1002/alr.70273","url":null,"abstract":"<p><strong>Background: </strong>Optimizing access to cost-effective care in capacity-constrained health systems is a contemporary imperative. We evaluated whether machine learning (ML) models using patient-reported data could optimize access for patients requiring surgical care in rhinology clinics, without need for CT imaging. The outcome was defined as any rhinologic surgery within 90 days of initial evaluation.</p><p><strong>Methods: </strong>A de-identified electronic dataset from patients seen at five distinct sites within an integrated healthcare system between 2018 and 2025 was used to train models. Demographic data and 22-item Sinonasal Outcome Test (SNOT-22) responses were studied. Models were trained using stratified 5-fold cross-validation with an 80% development cohort and validated in a 20% held-out validation cohort. Hyperparameters were optimized with Optuna. The primary outcome was performance of any rhinologic surgical intervention within 90 days of initial SNOT-22.</p><p><strong>Results: </strong>Data from 35,170 patients were evaluated. Item-level responses outperformed use of total SNOT-22 score in the models. Among models, XGBoost demonstrated best discrimination with AUC of 0.70 (95% CI, 0.69-0.71), outperforming logistic regression (0.66), random forest (0.63), and TabNet (0.66) (all p < 0.001). At optimal threshold, XGBoost achieved 66% sensitivity, 64% specificity, 28% PPV, and 90% NPV. Top predictors for surgery were age, nasal blockage, facial pain or pressure, and decreased sense of smell or taste. Validation on the held-out cohort remained stable (AUC 0.70), with strong discrimination across sites despite surgical rates ranging from 11.5% to 27.4%.</p><p><strong>Conclusions: </strong>Demographics and item-level SNOT-22 responses were successful in developing an ML model that demonstrated moderate discrimination and high NPV (90%) for performance of surgery within next 90 days. ML models balanced with human oversight may accelerate triage and optimize surgical yield for rhinology clinics.</p>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Predictors of Response to Biologic Therapy and Endoscopic Sinus Surgery in Patients With Nasal Polyps: A Systematic Review.","authors":"Arun Chakravorty, Matthew E Lin, Rory Lubner, Jess C Mace, Jeffrey Suh, Jivianne Lee, Marilene Wang, Sarah Wise, Naweed Chowdhury, Zachary M Soler, Justin Turner, Timothy L Smith, Myung Sim, Daniel M Beswick","doi":"10.1002/alr.70264","DOIUrl":"https://doi.org/10.1002/alr.70264","url":null,"abstract":"<p><strong>Background: </strong>Biologics and endoscopic sinus surgery (ESS) treat refractory chronic rhinosinusitis with nasal polyposis (CRSwNP), but direct comparisons are lacking. We synthesized efficacy and subgroup data across randomized controlled trials (RCTs) of biologics and ESS.</p><p><strong>Methods: </strong>PubMed was searched through December 2025 for RCTs and subgroup analyses of biologics or ESS for adult CRSwNP. Included were ten Phase-3 placebo-controlled biologic RCTs, two pragmatic ESS trials, and one head-to-head biologic trial. 22-Item Sino-Nasal Outcome Test (SNOT-22) and nasal polyp score (NPS) effect sizes and subgroup interactions were extracted.</p><p><strong>Results: </strong>A total of 13 trials (n = 3775) from 21 publications were included. By indirect comparison, tezepelumab and dupilumab produced the largest improvements (tezepelumab: SNOT-22: -27.4; NPS: -2.1; dupilumab: SNOT-22: -17 to -21; NPS: -1.7 to -2.1), while mepolizumab and omalizumab showed intermediate effects (SNOT-22: -10.6 to -16.5); benralizumab improved NPS but not SNOT-22, and depemokimab showed improvement below clinically discernible differences. ESS effects varied by trial and follow-up (SNOT-22: -21.9 at 6 months in MACRO vs. -4.9 at 12 months in PolypESS). Predictors of improvement differed across therapies (blood eosinophil count, NSAID-exacerbated respiratory disease, and prior ESS for dupilumab; asthma for benralizumab; baseline severity for ESS), while tezepelumab and omalizumab showed consistent efficacy without effect modification.</p><p><strong>Conclusions: </strong>ESS and biologics provide clinically meaningful benefit. Among biologics, dupilumab and tezepelumab demonstrated the largest effect sizes, though cross-trial differences in baseline severity, follow-up, and comparators limit indirect comparisons. Head-to-head trials and standardized subgroup analyses are needed to guide treatment selection.</p>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rhinology Fellowship Training in the United States: Insights From a National Survey.","authors":"Daniel B Spielman, Jacob Rosenstadt, Hemali Shah, Joshua M Levy, Carol Yan, Tran Locke, Tyler Merrill, Nicholas R Rowan","doi":"10.1002/alr.70274","DOIUrl":"10.1002/alr.70274","url":null,"abstract":"<p><strong>Background: </strong>The proportion of otolaryngology trainees pursuing fellowship has increased alongside rapid expansion in rhinology fellowship programs. Contemporary data evaluating trainee motivations, expectations, and outcomes remain limited. This study assesses contemporary data evaluating trainee motivations, expectations, and outcomes among US rhinology fellows over a 7-year period.</p><p><strong>Methods: </strong>A combined prospective and retrospective survey study was conducted using questionnaires administered to incoming and outgoing fellows at US rhinology fellowship programs from 2018 to 2025. Surveys evaluated motivations, procedural comfort, research expectations, career plans, and overall satisfaction. Responses were analyzed descriptively.</p><p><strong>Results: </strong>A total of 241 responses were analyzed (124 incoming, 117 outgoing). The primary motivation for fellowship was to enhance surgical skills and clinical decision-making, with fewer respondents citing research or mentorship. Fellows reported high comfort with standard endoscopic sinus procedures but lower confidence with advanced skull base and rhinoplasty techniques. Protected research time was inconsistent, with 16%-45% of graduating fellows reporting none, differing from incoming expectations. Interest in a 2-year fellowship was low (29% incoming vs. 18% outgoing). While 71.8% of incoming fellows anticipated academic careers, 64.1% ultimately entered academic practice. Overall satisfaction was high, with 86.3% reporting that fellowship met expectations. Reported shortcomings included limited skull base exposure, reduced surgical autonomy, inadequate billing/coding training, and insufficient research time.</p><p><strong>Conclusion: </strong>Rhinology fellowship trainees primarily pursue subspecialty training to enhance surgical skills and clinical decision-making. Although training is overwhelmingly perceived as meeting expectations, meaningful gaps persist between anticipated and actual experiences, particularly in protected academic time, exposure to advanced procedures, and non-clinical skill development.</p>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Refractory Primary Chronic Rhinosinusitis Following Endoscopic Sinus Surgery.","authors":"Ismail M Khaderi, Kosuke Tochigi, Nathan R Barefoot, Priya J Desai, Elena Quinonez Del Cid, Katrina Bootes, Kazuhiro Omura, Yasuhiro Tanaka, Cristine Klatt-Cromwell, Jackson R Vuncannon, Charles S Ebert, Brian D Thorp, Adam J Kimple, Brent A Senior","doi":"10.1002/alr.70267","DOIUrl":"https://doi.org/10.1002/alr.70267","url":null,"abstract":"<p><strong>Background: </strong>Refractory chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS) has traditionally been defined by revision surgery alone. With the emergence of biologic therapies, treatment escalation now includes revision surgery and/or biologic initiation. We sought to identify independent predictors of refractory primary CRS using a composite outcome incorporating surgery and/or biologic initiation.</p><p><strong>Methods: </strong>Adult patients with primary CRS undergoing FESS after 2015 were identified in the TriNetX Research Network. Patients with secondary CRS, prior biologic therapy, or sinonasal neoplasms were excluded. The primary outcome was refractory CRS, defined as revision FESS or biologic initiation from 3 months to 5 years postoperatively. Preoperative covariates were evaluated using Cox proportional hazards modeling with stepwise selection.</p><p><strong>Results: </strong>Among 24,759 patients, 2866 (11.6%) had refractory CRS after FESS. Of these, 66.6% underwent revision FESS, 42.0% initiated biologic therapy, and 8.7% had revision surgery and initiated a biologic therapy. In multivariable analysis, asthma was the strongest predictor (HR 2.06, p < 0.001), followed by allergy to analgesic agents (e.g., NSAIDs) (HR 1.87, p < 0.001), nasal polyps (HR 1.67, p < 0.001), food allergy (HR 1.37, p = 0.096), COPD (HR 1.27, p = 0.006), eosinophilia (HR 1.27, p < 0.001), and Black or African American race (HR 1.16, p = 0.044).</p><p><strong>Conclusion: </strong>Refractory CRS following FESS is strongly associated with type 2 inflammatory comorbidities and select demographic factors. Incorporating biologic therapy into outcome definitions provides a contemporary framework for risk stratification and postoperative counseling.</p>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Paranasal Sinus Pressures in Patients With Obstructive Sleep Apnea Following Transsphenoidal Sellar/Parasellar Surgery: A Pilot Study for Normative Data.","authors":"Emma J Anisman, Abdulghafoor Alani, Shreya Mandloi, Kelsey Limage, Hani Samarah, Benjamin F Bitner, Elina M Toskala, Marc R Rosen, Gurston G Nyquist, Christopher Farrell, James Evans, Mindy Rabinowitz","doi":"10.1002/alr.70266","DOIUrl":"https://doi.org/10.1002/alr.70266","url":null,"abstract":"","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A U-Shaped Association Between Olfactory Cleft Opacification and Olfactory Recovery After Endoscopic Sinus Surgery in Chronic Rhinosinusitis.","authors":"Shunke Li, Lin Wang, Huijuan Zhao, Longgang Yu, Liwei Jiang, Lingling Li, Lin Han, Jisheng Zhang, Xudong Yan, Yan Jiang","doi":"10.1002/alr.70272","DOIUrl":"https://doi.org/10.1002/alr.70272","url":null,"abstract":"","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poly(I:C)-Activated Nasal Fibroblasts Promote Eosinophil Recruitment in CRSwNP.","authors":"Chaewon Shin, An-Gi Kim, Byeong Min Yu, Woo-Keun Kwon, Min-Ho Hwang, Joo-Hoo Park","doi":"10.1002/alr.70271","DOIUrl":"https://doi.org/10.1002/alr.70271","url":null,"abstract":"<p><strong>Background: </strong>Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by persistent mucosal inflammation and eosinophilic infiltration. Although epithelial and immune cells have been widely studied, the role of nasal fibroblasts in innate immune activation and eosinophil recruitment remains unclear.</p><p><strong>Methods: </strong>Public single-cell RNA sequencing data from sinonasal tissues were analyzed to define the cellular distribution of TLR3 and inflammatory mediators. TLR3 expression was validated in patient-derived sinonasal tissues. Primary human nasal fibroblasts were stimulated with polyinosinic-polycytidylic acid (Poly(I:C)), and cytokine and chemokine expression was assessed by real-time PCR and ELISA. Signaling pathways were examined using pharmacologic inhibitors and western blotting. Eosinophil migration toward Poly(I:C)-stimulated fibroblasts was evaluated using a microfluidic chemotaxis platform.</p><p><strong>Results: </strong>TLR3 and inflammatory mediators, including CCL2, IL6, CXCL8, and CCL11, were preferentially enriched in stromal cells. Fibroblast subclustering revealed expansion of activated, remodeling, and inflammatory fibroblast states in CRSwNP, accompanied by increased TLR3 and chemokine expression. Tissue TLR3 expression was increased in CRSwNP and positively correlated with Lund-Mackay CT scores. Poly(I:C) stimulation induced dose-dependent production of IL-6, CXCL8, CCL2, and CCL11 in primary nasal fibroblasts. These responses were mediated through TRIF, p38, JNK, and PI3K/AKT signaling. Functionally, Poly(I:C)-stimulated fibroblasts promoted eosinophil chemotaxis, which was attenuated by inhibition of TRIF, JNK, and PI3K signaling.</p><p><strong>Conclusions: </strong>Nasal fibroblasts function as active stromal mediators of TLR3-dependent innate immune activation in CRSwNP. Fibroblast-derived inflammatory and eosinophil-recruiting mediators may link viral-like stimulation to eosinophilic inflammation and tissue remodeling in CRSwNP.</p>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining the Minimal Clinically Important Difference of the 40-Item Smell Identification Test in People With Cystic Fibrosis","authors":"Eugene Oh,&nbsp;Jessa E. Miller,&nbsp;Michelle J. Lee,&nbsp;Anna Zemke,&nbsp;David Baraghoshi,&nbsp;Matthew J. Strand,&nbsp;Jeremiah A. Alt,&nbsp;Todd E. Bodner,&nbsp;Michael Chang,&nbsp;Naweed I. Chowdhury,&nbsp;Patricia H. Eshaghian,&nbsp;Anne E. Getz,&nbsp;Jennifer L. Goralski,&nbsp;David A. Gudis,&nbsp;Peter H. Hwang,&nbsp;Ashoke Khanwalkar,&nbsp;Adam J. Kimple,&nbsp;Jivianne T. Lee,&nbsp;Douglas A. Li,&nbsp;Jess C. Mace,&nbsp;Jayakar V. Nayak,&nbsp;Jonathan B. Overdevest,&nbsp;Zara Patel,&nbsp;Daniella K. Safatian,&nbsp;Rodney J. Schlosser,&nbsp;Brent Senior,&nbsp;Amanda L. Stapleton,&nbsp;Timothy L. Smith,&nbsp;Zachary M. Soler,&nbsp;Jeffrey D. Suh,&nbsp;Grant A. Turner,&nbsp;Marilene B. Wang,&nbsp;Milene T. Saavedra,&nbsp;Jennifer L. Taylor-Cousar,&nbsp;Daniel M. Beswick","doi":"10.1002/alr.70136","DOIUrl":"10.1002/alr.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic rhinosinusitis (CRS) and olfactory dysfunction (OD) are highly prevalent among people with cystic fibrosis (PwCF) and negatively impact quality of life. The 40-item Smell Identification Test (SIT) is widely used to assess psychophysical olfaction, but a CF-specific minimal clinically important difference (MCID) has not been established. This study aimed to determine the SIT MCID in PwCF treated with elexacaftor/tezacaftor/ivacaftor (ETI) and/or endoscopic sinus surgery (ESS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from three prospective, multi-institutional observational studies were pooled. Participants were ≥12 years old with confirmed CF and CRS who completed SIT at baseline and ≥1 follow-up (3, 6, 9, 12, or 24 months). Distribution-based MCIDs were calculated using four methods: standard error of measurement (SEM), minimal detectable change (MDC = 1.96 × SEM), 0.5 × baseline standard deviation (SD), and 0.5 × SD of change scores (ΔSD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 122 participants were enrolled (mean age 32.9 years, 54% female). Of these, 99 contributed follow-up SIT scores (79 ETI, 20 ESS). SIT scores remained stable with ETI, with a small but statistically significant decline at 6 months (−1.4, <i>p</i> = 0.02). ESS was associated with mean gains of 3.1–4.5 points at early follow-up, though these did not reach significance. Pooled distribution-based MCID estimates ranged from 2 to 4 points, with an overall threshold of 3.1 (95% CI: 2.1–4.1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This CF-specific SIT threshold provides a clinically interpretable cut-off for assessing olfaction. These findings establish a foundation for future work and highlight the importance of developing disease-specific MCIDs to guide clinical care and research.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"16 9","pages":"924-930"},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interspecies Biofilm Dynamics Among Staphylococci: Inflammatory Contributions to Chronic Rhinosinusitis","authors":"Sintayehu Ambachew,&nbsp;Mahnaz Ramezanpour,&nbsp;Clare M. Cooksley,&nbsp;Sholeh Feizi,&nbsp;Muhammed Awad,&nbsp;Kevin Aaron Fenix,&nbsp;Peter-John Wormald,&nbsp;Alkis J. Psaltis,&nbsp;Sarah Vreugde","doi":"10.1002/alr.70148","DOIUrl":"10.1002/alr.70148","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;&lt;i&gt;Staphylococcus&lt;/i&gt; species are frequently isolated from the sinonasal niche of chronic rhinosinusitis (CRS) patients. While &lt;i&gt;Staphylococcus aureus&lt;/i&gt; is often associated with recalcitrant CRS, &lt;i&gt;Staphylococcus epidermidis&lt;/i&gt; and &lt;i&gt;Staphylococcus lugdunensis&lt;/i&gt; are largely deemed commensal. The purpose of this study was to investigate interspecies interactions and how those might influence inflammation and susceptibility to antibiotics.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Twelve staphylococcal isolates were harvested from six CRS patients, each infected with &lt;i&gt;S. aureus&lt;/i&gt; and &lt;i&gt;S. epidermidis&lt;/i&gt;, or with &lt;i&gt;S. aureus&lt;/i&gt; and &lt;i&gt;S. lugdunensis&lt;/i&gt;. Bacteria were cultured to allow biofilm formation in direct and indirect interspecies interactions, followed by measuring their biofilm biomass, antibiotic sensitivity, and toxicity and inflammatory potential when applied to human nasal epithelial cells (HNECs).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;&lt;i&gt;S. epidermidis&lt;/i&gt; produced up to 7.4-fold higher biomass than &lt;i&gt;S. aureus&lt;/i&gt; in monocultures, with a reduction in &lt;i&gt;S. epidermidis&lt;/i&gt; biomass under indirect coculture conditions with &lt;i&gt;S. aureus&lt;/i&gt; biofilm (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). In contrast, the biofilm biomass values of both &lt;i&gt;S. lugdunensis&lt;/i&gt; and &lt;i&gt;S. aureus&lt;/i&gt; were higher under indirect coculture conditions compared to monocultures for 2/3 paired isolates (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). &lt;i&gt;S. epidermidis&lt;/i&gt; monocultures and &lt;i&gt;S. aureus&lt;/i&gt;/&lt;i&gt;S. epidermidis&lt;/i&gt; cocultures were less toxic to HNECs than &lt;i&gt;S. aureus&lt;/i&gt; monocultures. &lt;i&gt;S. aureus&lt;/i&gt; and &lt;i&gt;S. lugdunensis&lt;/i&gt; monocultures and &lt;i&gt;S. aureus/S. lugdunensis&lt;/i&gt; cocultures induced interleukin-6 (IL-6) and toxicity to a similar extent versus controls. An increased tolerance to amoxicillin was observed for 2/3 &lt;i&gt;S. epidermidis&lt;/i&gt; biofilm and for 3/3 &lt;i&gt;S. lugdunensis&lt;/i&gt; biofilm when in indirect contact with &lt;i&gt;S. aureus&lt;/i&gt; biofilm (&lt;i&gt;p&lt;/i&gt; &lt; 0.05).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Overall, staphylococcal interactions were highly strain specific, with &lt;i&gt;S. aureus&lt;/i&gt; influencing the biofilm-forming capacity and increasing the tolerance to amoxicillin of both &lt;i&gt;S. epidermidis&lt;/i&gt; and &lt;i&gt;S. lugdunensis&lt;/i&gt;. &lt;i&gt;S. epidermidis&lt;/i&gt; but not &lt;i&gt;S. lugdunensis&lt;/i&gt; could mitigate &lt;i&gt;S. aureus&lt;/i&gt; induced epithelial cytotoxicity. These findings support the complex nature of interactions among staphylococci with &lt;i&gt;S. aureus&lt;/i&gt; and potentially &lt;i&gt;S. lugdunensis&lt;/i&gt; having a pathogenic role and &lt;i&gt;S. epider","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"16 9","pages":"956-967"},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}