Rhinology最新文献

{"title":"Budesonide nasal irrigation for chronic rhinosinusitis: a meta-analysis of therapeutic outcomes and safety profile.","authors":"N Magboul, A F Alharbi, A T Alqutub, S Almatrafi, A Alroqi, S H Aldousary, S R Alromaih, A S Alrasheed, S A Alsaleh","doi":"10.4193/Rhin24.349","DOIUrl":"https://doi.org/10.4193/Rhin24.349","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroids are used in managing Chronic Rhinosinusitis (CRS) through several formulations, including oral steroids and nasal sprays. More recently, incorporating concentrated budesonide respules into high-volume saline irrigations has been proposed to enhance the penetration of topical steroids into the paranasal sinuses. We aim to evaluate the safety and efficacy of budesonide nasal irrigation (BNI) in managing CRS.</p><p><strong>Methodology: </strong>A systematic review with meta-analysis was performed following PRISMA guidelines. Data were extracted independently from the eligible studies. In double-arm and single-arm meta-analyses, continuous outcomes were pooled using mean difference (MD) with a 95% confidence interval (CI).</p><p><strong>Results: </strong>Twenty-six studies were reviewed, comprising 1464 patients. BNI had better outcomes than saline nasal irrigation (SNI) regarding Sino-Nasal Outcome Test score (SNOT-22). Lund-Kennedy Endoscopy scores (LKES) changed from baseline. Regarding safety, there was no significant difference between BNI and SNI regarding Intraocular Pressure (IOP). Single-arm analysis showed a pooled mean serum cortisol level within the normal range after BNI.</p><p><strong>Conclusions: </strong>BNI demonstrated improved SNOT-22 and LKES scores, with normal post-treatment IOP and cortisol levels, indicating a beneficial impact on CRS while maintaining safety.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897129","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":"Hydration alters viscosity of nasal secretions in postnasal drip.","authors":"S Bucher, T M L Friederici, Y Stanossek, M B Soyka","doi":"10.4193/Rhin24.459","DOIUrl":"https://doi.org/10.4193/Rhin24.459","url":null,"abstract":"<p><p>In our recent study, increased viscosity, delayed mucociliary clearance as well as hyposensitivity/dysesthesia of the nasopharynx seemed to play a relevant role in the pathophysiology of postnasal drip (PND) (1). Earlier concepts of PND, regarding an increased volume of secretions and atopy, do not seem to hold true since our latest analyses showed no significant difference between cases and controls (1). However, to this day its therapy is debated and the evidence for an effective treatment of PND is lacking so far. The fundamental rheological properties of nasal mucus constitute of the viscosity and elasticity (2-4).</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829843","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":"\"Diversity\" in rhinology.","authors":"S Reitsma","doi":"10.4193/Rhin24.906","DOIUrl":"https://doi.org/10.4193/Rhin24.906","url":null,"abstract":"","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772131","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":"IL-17A disrupts the nasal mucosal epithelial barrier in patients with chronic rhinosinusitis by activating the ERK/STAT3 pathway.","authors":"H Wu, Y Li, X Li, W Huang, Z Huang, X Lai, J Ma, Y Jiang, Y Zhang, L Chang, G Zhang","doi":"10.4193/Rhin24.127","DOIUrl":"10.4193/Rhin24.127","url":null,"abstract":"<p><strong>Background: </strong>The mucosal epithelial barrier, the first line of immune defense, is vulnerable to allergens, pathogens, and inflammatory cytokines, contributing to CRS development. Our previous studies found high interleukin-17A(IL-17A) expression correlated with CRS severity and low glucocorticoid efficacy. The role of IL-17A in disrupting the nasal mucosal epithelial barrier leading to CRS remains unclear. We aimed to investigate how IL-17A promoting epithelial barrier damage and identify new treatment targets for CRS.</p><p><strong>Methodology: </strong>Nasal tissue samples from 36 CRSwNP, 34 CRSsNP, and 39 controls were examined for the expression of IL-17A and tight junction (TJ) proteins using qRT-PCR, immunohistochemistry and immunofluorescence. The integrity of TJs and signaling pathways activation were observed using western blot, immunofluorescence, TEER and FITCâ€\"FD4, transmission electron microscopy before and after IL-17A stimulation in human primary nasal epithelial cells (hNECs). Concurrently, studies were also conducted in an CRS mouse model induced by anti-IL-17A neutralizing antibody administration.</p><p><strong>Results: </strong>TJs expression in the nasal mucosa of CRS patients was lower than in controls. IL-17A stimulation reduced TJs expression and TEER while increasing hNECs permeability. Inhibition of the (ERK/STAT3) pathway reversed the downregulation of TJs and the disruption of the epithelial barrier induced by IL-17A stimulation. In the CRS mouse model, anti-IL-17A antibody treatment rescued the nasal mucosal epithelial barrier.</p><p><strong>Conclusions: </strong>IL-17A disrupts the nasal mucosal epithelial barrier by activating the ERK/STAT3 pathway in patients with CRS.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"726-738"},"PeriodicalIF":4.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372757","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":"The impact of mepolizumab on sleep impairment in CRSwNP: post hoc analyses of SYNAPSE and MUSCA.","authors":"J Mullol, W J Fokkens, S G Smith, T Keeley, L Zhang, P Howarth, R H Chan, C Bachert","doi":"10.4193/Rhin24.021","DOIUrl":"10.4193/Rhin24.021","url":null,"abstract":"<p><strong>Background: </strong>The impact of mepolizumab on impaired sleep, one of the most bothersome symptoms in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), is unknown. This study aimed to determine the effect of mepolizumab and impact of comorbid upper and lower airway disease and blood eosinophil count (BEC) on sleep-/fatigue-related outcomes in CRSwNP.</p><p><strong>Methods: </strong>This was an analysis of the Phase III SYNAPSE and MUSCA (NCT03085797/NCT02281318) trials of mepolizumab in patients with severe CRSwNP and severe asthma, respectively. Endpoints included change from baseline in 22-item Sino-Nasal Outcome Test (SNOT-22) sleep and fatigue domains (SYNAPSE: Weeks 24 and 52; MUSCA: Week 24) in the overall populations and post hoc subgroups (SYNAPSE: comorbid asthma, comorbid non-steroidal anti-inflammatory drug-exacerbated respiratory disease [N-ERD] and BEC; MUSCA: comorbid CRSwNP).</p><p><strong>Results: </strong>In SYNAPSE, 289/407 patients with severe CRSwNP had comorbid asthma, 108 had N-ERD, and 278 had BEC ≥300 cells/µL. In MUSCA, 105/551 patients with severe asthma had comorbid CRSwNP. Baseline sleep and fatigue scores were worse in patients with comorbid airway disease and higher BEC. Improvements from baseline in sleep and fatigue scores were greater with mepolizumab versus placebo at Week 52 in SYNAPSE (difference in least squares mean change: -2.7 [sleep], -3.4 [fatigue], and Week 24 in SYNAPSE (-1.6 and -2.2) and MUSCA (-0.8 and -1.2), with consistent results across comorbidity and BEC subgroups.</p><p><strong>Conclusion: </strong>Mepolizumab improves sleep and fatigue in severe CRSwNP, irrespective of comorbid airway disease and BEC, with consistent effects in severe asthma with and without comorbid CRSwNP.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"669-680"},"PeriodicalIF":4.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353031","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":"Recent advances in chronic rhinosinusitis: pathophysiology, treatments, and outcome measures.","authors":"W J Fokkens, A R Sedaghat, M B Soyka, S Reitsma","doi":"10.4193/Rhin24.801","DOIUrl":"10.4193/Rhin24.801","url":null,"abstract":"<p><p>This review discusses major developments in chronic rhinosinusitis. The latest papers on prevalence of the disease, the burden for patients and society, the lack of awareness, the development of patient classifications and the consequences for the management of the disease. Our discussion includes major developments in the treatment of the disease with biologics but also their limitations. Recent developments also include evolution in the goals of care, where until recently we were content with control of disease but now start to aim for remission and maybe even cure. To reach that aim we need better definitions of disease, outcomes and biomarkers to predict the optimal moment of intervention in the development of the disease. Time will tell whether earlier intervention can prevent development of the disease and later sequelae.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"652-658"},"PeriodicalIF":4.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558651","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":"SNOT-22 in general population, a Spanish cohort study with an updated meta-analysis.","authors":"L N Pineros-Garcia, N I Gonzalez-Sanchez, C Calvo-Henrique, M J Rojas-Lechuga, C Hopkins, J Mullol, I Alobid","doi":"10.4193/Rhin24.233","DOIUrl":"10.4193/Rhin24.233","url":null,"abstract":"<p><strong>Background: </strong>Olfactory loss (OL) has emerged as one of the most prevalent and debilitating symptoms of SARS-CoV-2 infection and long-COVID-19. The present prospective observational study aimed to evaluate the efficacy of olfactory training (OT) on orthonasal and retronasal olfactory function in a cohort of individuals with persistent post-COVID-19 OL.</p><p><strong>Methodology: </strong>Participants with post-COVID-19 olfactory impairment underwent 4 months of OT, self-assessing their smell perception and undergoing comprehensive psychophysical evaluation of orthonasal and retronasal olfaction at baseline and after training. Orthonasal olfactory function was assessed using the extended Sniffin' Sticks test battery. Retronasal olfactory function was tested with powdered aromas.</p><p><strong>Results: </strong>Among 114 participants with post-COVID-19 olfactory loss, adherence to OT was 60%. In adherents, the average increase in composite TDI score was 6.0 points compared to 2.6 points in non-adherents. Fifty-seven percent of adherent participants achieved a clinically significant improvement in TDI score (≥ 5.5 points), compared to 22% of non-adherents. In retronasal olfactory identification, 56% of adherents achieved a clinically significant improvement (≥4 points), compared to 16% of non-adherents.</p><p><strong>Conclusion: </strong>Adherence to a 4-month OT regimen can yield clinically meaningful improvements in both orthonasal and retronasal olfactory function among individuals with persistent post-COVID-19 olfactory dysfunction.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"700-709"},"PeriodicalIF":4.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294345","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":"Blood transcriptomics reveal systemic eosinophilic and neutrophilic inflammation patterns in patients with nasal polyps.","authors":"W Liu, K Wang, H Guan, L Ma, Y Cui, C Liu, J Shi, Y Fan, Y Sun","doi":"10.4193/Rhin24.248","DOIUrl":"10.4193/Rhin24.248","url":null,"abstract":"<p><strong>Background: </strong>Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic sinonasal disease characterized by heterogeneous inflammation. However, the presence of systemic inflammation heterogeneity in CRSwNP patients remains unknown. This study aims to profile transcriptomic alterations in the blood of CRSwNP patients and characterize the CRSwNP heterogeneity based on blood transcriptomic biomarkers.</p><p><strong>Methodology: </strong>Patients with CRSwNP were prospectively recruited from three hospitals and chronologically divided into exploratory (n=123) and independent validation (n=46) cohorts. Transcriptomic profiles were generated by whole blood mRNA sequencing and subjected to patient clustering, differential expression, and pathway analysis. Differences in immune pattern and clinicopathologic features between clusters were assessed. A transcriptomic signature was defined and applied to an independent cohort to validate the findings.</p><p><strong>Results: </strong>CRSwNP patients showed diverse blood transcriptomic profiles versus healthy controls, or when stratified by tissue and blood eosinophils and asthma comorbidity. Transcriptome-wide correlation analysis revealed a transcriptional signature associated with blood eosinophil levels, consisting of nine T2-related genes (CLC, SIGLEC8, ALOX15, IL5RA, PTGDR2, CCL23, CCR3, EPX and IL1RL1). Three distinct clusters with differing systemic eosinophilic and neutrophilic inflammation patterns and asthma comorbidity were identified based on transcriptomic profiling of T2 and T1/3-related blood biomarkers. A 36-gene signature was developed by machine learning and accurately predicted the three CRSwNP subtypes. Validation on an independent cohort confirmed the prediction robustness.</p><p><strong>Conclusions: </strong>There is heterogeneous systemic inflammation associated with eosinophilic and neutrophilic patterns in patients with CRSwNP. Endotyping based on blood transcriptomic biomarkers might lead to more personalized treatment strategies for CRSwNP in the future.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"739-749"},"PeriodicalIF":4.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372756","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":"Correlations of pre- and post-operative symptoms with cytokines in different phenotypes and endotypes of chronic rhinosinusitis.","authors":"S A Han, H Cha, J-A Park, A Jo, D W Kim, H T Ryu, S K Yang, S-N Hong, J Y Kim, S H Oh, D W Kim","doi":"10.4193/Rhin23.215","DOIUrl":"10.4193/Rhin23.215","url":null,"abstract":"<p><strong>Background: </strong>Recognising inflammatory endotypes in chronic rhinosinusitis (CRS) has become more important, especially with the advent of biological treatments. In this study, we investigated the correlations of pre- and post-operative symptoms with cytokine positivity in different endotypes and phenotypes of CRS.</p><p><strong>Methodology: </strong>In total, 102 patients undergoing routine functional endoscopic sinus surgery were enrolled. The endotype classification (type 1, 2, or 3 CRS) was defined based on positivity for interferon-Α, interleukin (IL)-5, or IL-17 respectively, in sinonasal tissue samples. Clinical symptom scores were evaluated pre- and post-operatively using the 22-item Sinonasal Outcome Test and its four symptom subdomains: sleep, nasal, otologic/facial symptoms, and emotional function. Symptoms were compared between endotypes and phenotypes, and exploratory factor analysis (EFA) based on principal component analysis (PCA) was performed. The correlations of cytokine levels with baseline symptoms and changes in symptoms after 1 year were analysed.</p><p><strong>Results: </strong>Symptoms in the otologic/facial pain category were associated with non-type 2 endotypes in PCA and confirmatory analysis. Non-type 2 CRS patients exhibited significantly more improvement in facial symptoms 1 year after surgery. Neutrophil-associated cytokines, such as IL-17, matrix metalloproteinase 9, and myeloperoxidase, were significantly correlated with baseline otologic/facial pain symptoms and changes in those symptoms after surgery.</p><p><strong>Conclusions: </strong>Otologic/facial pain symptoms may be indicative of non-type 2 endotypes. Neutrophil-associated cytokines, such as IL-17, MMP-9, and MPO, were significantly correlated with these symptoms. The establishment of links between specific symptoms and certain cytokines may help use and develop biological therapies for CRS.</p>","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"716-725"},"PeriodicalIF":4.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353027","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 phenomenon not to be missed: delayed postoperative cerebrospinal fluid rhinorrhea following no identifiable intraoperative leak in sellar surgery.","authors":"R S Kshirsagar, J G Eide, A Abiri, K P Asmaro, P Filip, D Pangal, J Ruzevick, N D Adappa, P S Batra, M S Bergsneider, J R Craig, J C Fernandez-Miranda, P A Gardner, M S Grady, A A Halderman, F P K Hsu, A Mohyeldin, J N Palmer, P Papagiannopoulos, C H Snyderman, B A Tajudeen, E W Wang, M B Wang, G Zada, G A Zenonos, E C Kuan","doi":"10.4193/Rhin24.175","DOIUrl":"10.4193/Rhin24.175","url":null,"abstract":"","PeriodicalId":21361,"journal":{"name":"Rhinology","volume":" ","pages":"759-762"},"PeriodicalIF":4.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634397","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}