Annals of Otology Rhinology and Laryngology最新文献

{"title":"Key Decision-Making Factors in Pediatric Microtia Repair.","authors":"Maya Guhan, Grace Anand, Yi-Chun Liu","doi":"10.1177/00034894241304935","DOIUrl":"10.1177/00034894241304935","url":null,"abstract":"","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"297-298"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808341","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":"Acute Kidney Injury (AKI) After Pediatric Tonsillectomy: An Opportunity for Quality Improvement.","authors":"Avivah J Wang, Avani Vasireddy, Jeffrey Cheng","doi":"10.1177/00034894251330063","DOIUrl":"https://doi.org/10.1177/00034894251330063","url":null,"abstract":"<p><strong>Purpose: </strong>There is emerging evidence showing even a single episode of transient acute kidney injury (AKI) in children can have negative long-term health consequences. AKI may be under-recognized in children undergoing tonsillectomy because of unique risk factors, such as recommended use of NSAIDs and restricted oral intake pre- and postoperatively.</p><p><strong>Methods: </strong>A consecutive case series with chart review was performed for patients under age 18 years at a single tertiary care institution who underwent tonsillectomy between July 1, 2013 and May 17, 2024, identified by CPT codes for tonsillectomy. ED visits within 30 days of surgery were documented. Serum creatinine values at ED visit were recorded, if available, and incidence of elevated serum creatinine and AKI were determined.</p><p><strong>Results: </strong>Charts of 3018 pediatric tonsillectomy patients were reviewed. About 295 (9.8% of 3018) had an ED visit within 30 days for any reason, of whom 110 (37.3% of 295) had a serum creatinine value at this ED visit. Of these, 13 (11.8% of 110) had elevated serum creatinine, and 8 (7.3% of 110) had AKI by standardized criteria. One patient had a follow-up serum creatinine performed within 1 year which showed resolution of AKI.</p><p><strong>Conclusion: </strong>Incidence of AKI following tonsillectomy has not been previously well recognized. Identification of previously unrecognized risks from post-tonsillectomy AKI represents an important potential area for quality improvement, including careful patient selection for use of non-steroidal anti-inflammatory drugs, close monitoring of those at higher risk for dehydration after surgery, and follow-up care for those diagnosed with AKI.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"34894251330063"},"PeriodicalIF":1.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722587","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":"Risk Factors Associated With Pediatric Post-Tonsillectomy Complications: A Focus on Racial, Ethnic and Socioeconomic Factors.","authors":"Emily Wikner, Catherine Nguyen, Turaj Vazifedan, Jaime Almirante, Benjamin Chilampath, Lauren Mason, Craig Derkay","doi":"10.1177/00034894251328095","DOIUrl":"https://doi.org/10.1177/00034894251328095","url":null,"abstract":"<p><strong>Objectives: </strong>Though a common procedure, tonsillectomy is often associated with significant risks such as bleeding, odynophagia, and dehydration. There has been some research investigating racial/ethnic and socioeconomic disparities in other pediatric otolaryngic issues such as otitis media and sleep disordered breathing. However, there is a paucity of research regarding disparities in children undergoing tonsillectomy.</p><p><strong>Methods: </strong>A retrospective case control study was performed on all pediatric patients who underwent tonsillectomy with or without adenoidectomy from January 1, 2019 to December 31, 2020 at a tertiary care center. Patient records were documented including demographics, race, ethnicity, type of insurance, surgical technique, and post-operative complications. A major post-operative complication was defined as post-surgical hemorrhage, uncontrolled pain, or dehydration requiring medical attention.</p><p><strong>Results: </strong>There were 1751 patients included in the study with an average age of 6.7 years old with 55.3% patients white, 41.6% black and 3% identified as another race and 8% patients Hispanic or Latino. A complication occurred in 7% of patients including 2.3% who experienced a post-operative hemorrhage and 4.6% with dehydration or poor pain control. Among the entire cohort, 64.2% were publicly insured while 35.8% had private insurance and 1.2% were self-pay.There was no statistically significant difference in terms of probability of complication among patients with different races (<i>P</i> = .85), ethnicities (<i>P</i> = .18) or insurance type (<i>P</i> = .48). Those with bleeding complications were found to be significantly older (<i>P</i> = .011). There was a statistically significant lower likelihood of complication in patients who underwent intracapsular tonsillectomy compared to total electrocautery tonsillectomy (<i>P</i> < .001).</p><p><strong>Discussion: </strong>We found no racial/ethnic or socioeconomic disparities in the risk of post-operative complications in children who underwent tonsillectomy. Despite the frequency of tonsillectomy in children, there are few studies addressing inequalities. Further investigation of disparities in other regions of the United States should be performed.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"34894251328095"},"PeriodicalIF":1.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694318","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":"Pitfalls and Strategies for Implementing and Sustaining an Otolaryngology Perioperative Registry in Mekelle, Ethiopia.","authors":"Mateo Useche, Daniel G Eyassu, Ariana S Rincon, Nicholas Hable, Zaid M Yehala, Brhanu H Asgedom, Joshua P Wiedermann","doi":"10.1177/00034894251326007","DOIUrl":"https://doi.org/10.1177/00034894251326007","url":null,"abstract":"<p><strong>Background: </strong>Surgical registries have been widely adopted in high-income countries to improve patient outcomes. However, similar data-driven initiatives are still scarce in low- and middle-income countries (LMICs).</p><p><strong>Aims: </strong>This study aimed to address the challenges of implementing a perioperative registry for otolaryngology-head and neck surgery (OHNS) in Mekelle, Ethiopia, and to assess strategies for ensuring its long-term sustainability.</p><p><strong>Methods: </strong>The registry was developed using REDCap, through a collaborative effort between otolaryngologists in the United States and Ethiopia, ensuring its relevance to the local context. On-site training sessions were conducted for 13 OHNS residents and four senior surgeons to facilitate their use of the registry. A Wi-Fi router was installed in the operating room to enable real-time data entry. Continuous support was provided through remote communication between the local team and the U.S. research team. Sustainability strategies focused on fostering local ownership, integrating the registry into existing workflows, and maintaining continuous data monitoring.</p><p><strong>Results: </strong>Despite facing challenges like intermittent internet connectivity and issues with workflow integration, the local team successfully integrated the registry into routine clinical and surgical practices. Key strategies included providing dedicated Wi-Fi routers, modifying registry fields for improved efficiency, and emphasizing the registry's value to the institution. Ongoing collaboration between the local team and the U.S. team enabled continuous optimization and data collection.</p><p><strong>Conclusion: </strong>The successful implementation of this perioperative registry underscores the importance of engaging local stakeholders and integrating sustainable workflows. This initiative serves as a model for other LMICs seeking to establish surgical registries that enhance data-driven decision-making at both the patient and institutional levels.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"34894251326007"},"PeriodicalIF":1.3,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634735","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":"Device Survival After Pediatric Cochlear Implant Surgery: A 15-Year Single-Center Retrospective Analysis.","authors":"Bin Xu, Yong Fu, Jing Bi, Wenxin Chen, Lulu Yu","doi":"10.1177/00034894251325955","DOIUrl":"https://doi.org/10.1177/00034894251325955","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate device survival and identify risk factors for failure in pediatric cochlear implant (CI) surgery to guide strategies for minimizing failure rates and improving survival outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on pediatric patients who underwent CI surgery at the Children's Hospital, Zhejiang University School of Medicine, from September 2008 to September 2023. Device survival was assessed using the Kaplan-Meier method while independent factors influencing device survival were analyzed using the log-rank test and Cox regression model.</p><p><strong>Results: </strong>Among 602 children, the mean age at first CI surgery was 50.3 months (range = 8-155 months). The cohort included 353 males (58.6%) and 249 females (41.4%). Revision surgery was required in 28 cases (4.7%), primarily due to device failure (17/28, 60.7%), including 14 hard and 3 soft failures. Kaplan-Meier analysis showed CI survival rates of 99.1%, 98.1%, 96.7%, 96.4%, and 96.4% at 1, 2, 3, 5, and 10 years post-surgery, respectively. The log-rank test identified sex, age, and history of head trauma as significant factors affecting device survival (<i>P</i> < .05). Multivariate Cox regression confirmed that male sex, first implantation ≤3 years of years, and postoperative head trauma were independent risk factors for device failure.</p><p><strong>Conclusions: </strong>Pediatric cochlear implantation is generally safe and effective, though device failure remains a concern, necessitating revision surgery remains. Male children who undergo cochlear implantation at ≤3 years of age or have a history of postoperative head trauma require enhanced postoperative care. This includes avoiding vigorous head impacts and increasing follow-up visits to monitor device function and speech recovery. Manufacturers should prioritize developing more durable, impact-resistant cochlear implants to reduce failure rates and improve long-term device survival.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"34894251325955"},"PeriodicalIF":1.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607047","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":"Composite Outcomes of Sleep Surgery Using the Modified Sleep Apnea Severity Index (mSASI).","authors":"Praneet C Kaki, Sophia N Shah, Julianna Rodin, Thomas M Kaffenberger, Maurits Boon, Colin Huntley","doi":"10.1177/00034894251324340","DOIUrl":"https://doi.org/10.1177/00034894251324340","url":null,"abstract":"<p><strong>Objective: </strong>The apnea-hypopnea index (AHI) defines obstructive sleep apnea (OSA) severity but fails to describe nuances in disease burden. The modified sleep apnea severity index (mSASI) combines patient anatomy, weight, sleep study metrics, and symptoms to provide a composite OSA index ranging from 1 to 3. While prior studies have associated mSASI with quality of life and hypertension, its utility in continuous positive pressure intolerant (CPAPi) surgical patients remains unexplored.</p><p><strong>Methods: </strong>A retrospective cohort study of surgically treated CPAPi patients who underwent upper airway stimulation (UAS), maxillomandibular advancement (MMA), or expansion sphincter pharyngoplasty (ESP) at our Tertiary Care Academic Center from 2014 to 2021. Five hundred twenty-eight patients were identified and 260 had available data to calculate mSASI pre- and postoperatively using the published method. Wilcoxon rank-sum tests were used during the analysis.</p><p><strong>Results: </strong>Out of 260 patients, 167 underwent UAS (64%), 73 ESP (28%), and 20 MMA (8%). Fifty-five percent had a preoperative mSASI = 1 (average = 1.56, standard deviation = 0.68). The average overall change in mSASI postoperatively was -0.32 (<i>p</i> < .01). mSASI change in UAS, ESP, and MMA groups was -0.21, -0.51, and -0.50, respectively. Of note, 64% of UAS patients had a preoperative mSASI = 1, compared to 40% and 37% for MMA and ESP, respectively. The change in mSASI score was not significantly associated with treatment efficacy per Sher's Criteria (<i>p</i> = .6)Conclusion:The mSASI is a valuable alternative index to measure preoperative OSA severity and characterize surgical outcomes. Further prospective studies are needed to confirm these findings and to determine its ability to detect risk reduction post-treatment.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"34894251324340"},"PeriodicalIF":1.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607045","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":"Validation of an In Situ Self-Administered Hearing Test with a Self-Fitting Device for Mild to Moderately Severe Hearing Loss in Various Acoustic Environments.","authors":"Tun-Shin Lo, Hung-Yue Chang","doi":"10.1177/00034894251325617","DOIUrl":"https://doi.org/10.1177/00034894251325617","url":null,"abstract":"<p><strong>Objectives: </strong>This study compared a simplified in situ self-administered hearing screening test, conducted with a neckband-type self-fitting device, with conventional pure-tone audiometry. It evaluated the maximum speech-shaped noise level for screening (MSNLS), crucial for evaluating the feasibility of this in situ screening test in quiet environments.</p><p><strong>Methods: </strong>This study included 30 adults with normal hearing and 30 adults with mild to moderately severe hearing impairment. A binaural neckband-type self-fitting device was developed. The results of an in situ hearing screening test conducted using the self-fitting device were compared with those obtained using traditional pure-tone audiometry conducted using TDH-50 earphones. Subsequently, MSNLS was determined by assessing noise-masking effects on screening outcomes. All tests were conducted in an audiometric booth, with the hearing screening test conducted in the booth with the door open.</p><p><strong>Results: </strong>Strong positive correlations were observed between the results of pure-tone audiometry and those of hearing screening tests across all test frequencies, with the strongest correlation observed at 2000 Hz (<i>r_s</i> = 0.793, <i>P</i> < .001) and the weakest correlation observed at 500 Hz (<i>r_s</i> = 0.625, <i>P</i> < .001). Comparisons of screening tests results with pure-tone thresholds across all test frequencies revealed differences of approximately 10 dB HL for 80% of all ears. The sensitivity and specificity of the hearing screening test in detecting candidates with hearing loss (>30 dB HL) who are suitable for this device were 93% and 90%, respectively. The hearing-impaired group exhibited MSNLSs, such as 57 dB SPL at 500 Hz, exceeding ambient noise levels in an empty classroom.</p><p><strong>Conclusion: </strong>The in situ hearing screening test, conducted using a self-fitting device, exhibited reasonable accuracy for self-fitting scenarios in general quiet environments. This test can be used for monitoring mild to moderate hearing loss or fluctuating hearing loss, such as that associated with Ménière's disease.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"34894251325617"},"PeriodicalIF":1.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607083","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":"Ceftazidime-Cefazolin Empiric Therapy for Pediatric Gradenigo Syndrome.","authors":"Brendan K Tao, Fahad Alotaibi, Alastair McAlpine","doi":"10.1177/00034894241301289","DOIUrl":"10.1177/00034894241301289","url":null,"abstract":"<p><strong>Objective: </strong>Gradenigo Syndrome (GS), a rare complication of petrous apicitis secondary to acute otitis media, is characterized by (an often incomplete) triad of otorrhea, abducens nerve palsy, and facial pain along the trigeminal nerve distribution. There are several causative pathogens of petrous apicitis, including <i>Streptococcus</i> and <i>Staphylococcus</i> species, while <i>Pseudomonas aeruginosa</i> is the most common. However, the case report literature often describes antibiotic management of GS with antibiotics that do not cover <i>Pseudomonas</i>, potentially predisposing to further intracranial complications or mortality. The purpose of this work was to describe a case of pediatric Gradenigo Syndrome, successfully treated with sufficiently broad-spectrum antibiotics.</p><p><strong>Methods: </strong>This is case report.</p><p><strong>Results: </strong>A previously healthy 5-year-old boy with a history of swimming presented with esotropia and acute otitis media. Initial symptoms included otorrhea, otalgia, and pruritis, which were refractory to ciprofloxacin-dexamethasone drops. He subsequently developed a right sixth nerve palsy, suggestive of Gradenigo Syndrome, and neuroimaging showed evidence of petrous apicitis, clival osteomyelitis, and internal carotid artery stenosis. The causative organism was not elucidated to laboratory error. Given this uncertainty, he was successfully treated with empiric intravenous ceftazidime and cefazolin. After 16 weeks, he recovered fully without the need for surgery.</p><p><strong>Conclusions: </strong>In the setting of delayed or absent culture results with suspicion of skull-base infection, our case supports the use of empiric antibiotic therapy with sufficient coverage of all common pathogens including <i>Streptococcus</i>/<i>Staphylococcus</i> and <i>Pseudomonas aeruginosa</i> species, the latter of which is often not adequately covered by antibiotic regimens described in the literature.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"234-237"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683434","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":"Paranasal Sinus Mucoceles With Intraorbital and Intracranial Involvement: A Case Series Analysis and Surgical Outcomes Assessment.","authors":"Raisa Chowdhury, Ahmad Aldajani, Hamad Almhanedi, Dana Al Majid, Marc A Tewfik, Lamiae Himdi","doi":"10.1177/00034894241300806","DOIUrl":"10.1177/00034894241300806","url":null,"abstract":"<p><strong>Background: </strong>Paranasal sinus mucoceles, by virtue of extension into the orbit or cranial vault, can lead to significant ocular, nasal, or neural complications. There is limited comprehensive data on the presentation, management, and outcomes of cases with intraorbital or intracranial extension. A thorough analysis is essential to enhance clinical practices and improve patient outcomes.</p><p><strong>Objective: </strong>This retrospective case series investigates the clinical presentations, radiological features, and surgical outcomes of 10 patients with paranasal sinus mucoceles exhibiting intraorbital or intracranial extensions.</p><p><strong>Methods: </strong>Ten diagnosed cases of paranasal sinus mucoceles with intraorbital or intracranial extensions, as identified on CT or MRI imaging, were selected and retrieved from the electronic database of an academic-affiliated hospital from July 2013 to December 2023. Data were analyzed using descriptive statistics with IBM SPSS version 23.0 software.</p><p><strong>Results: </strong>The study revealed a mean patient age of 65 years, with females (60%) affected more than males (40%). The ethmoidal and frontal sinuses were predominantly involved, with varied clinical symptoms ranging from periorbital pain to visual disturbances. Radiologically, CT and MRI scans depicted extensive sinus involvement, often with intraorbital (50%), intracranial (20%), or combined (30%) extensions. Surgical interventions, primarily endoscopic sinus surgery, resulted in favorable outcomes, including symptom resolution, minimal complications, and no recurrence.</p><p><strong>Conclusion: </strong>This case series emphasizes the importance of thorough preoperative evaluation, individualized surgical approaches, and vigilant postoperative care in managing mucoceles with orbital and cranial involvement. Further research with larger cohorts and extended follow-up periods is essential to refine treatment strategies and enhance patient outcomes for this complex pathology.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"225-233"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669963","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":"Prediction of Clinical Response to Dupilumab for CRSwNP Based on the Amsterdam Classification of Completeness of Endoscopic Sinus Surgery (ACCESS) Score.","authors":"Gian Marco Pace, Francesco Giombi, Francesca Pirola, Michele Cerasuolo, Enrico Heffler, Giovanni Paoletti, Francesca Puggioni, Giuseppe Mercante, Giuseppe Spriano, Luca Malvezzi","doi":"10.1177/00034894241300812","DOIUrl":"10.1177/00034894241300812","url":null,"abstract":"<p><strong>Purpose: </strong>Although the effectiveness of molecular antibodies has been established, evidence is still lacking on objective predictors of response. The aim of this study was to assess whether the extent of previous endoscopic sinus surgeries, assessed by means of the Amsterdam Classification of Completeness of Endoscopic Sinus Surgery (ACCESS) score, may influence clinical outcomes in refractory CRSwNP patients treated with dupilumab.</p><p><strong>Materials and methods: </strong>A consecutive sample of patients treated with dupilumab for previously operated recalcitrant CRSwNP were enrolled in the study. Every patient was required to undergo a CT scan at baseline (T0), at 3 (T1), and 12 (T2) months after treatment start. ACCESS score was calculated at baseline, whilst at every timepoint patients underwent assessment of Nasal-Polyp-Score (NPS), Lund-Kennedy-Score (LKS), and had to fill in the 22-item Sinonasal-Outcome-Test (SNOT-22) and Visual-Analog-Scales (VAS) for sinonasal symptoms. Favorable outcome was considered based on EUFOREA guidelines, namely improving at least 3 of the followings: (i) NPS; (ii) SNOT-22; (iii) VAS-olfaction; and (iv) need for systemic corticosteroids.</p><p><strong>Results: </strong>Overall favorable outcome was achieved in 69.1% (n = 38/55) of cases at T1, while in 89.1% (n = 49/55) at T2. There were no differences in baseline characteristics between responders and non-responders at both timepoints. At T1, out of all the included variables, no statistically significant predictor of favorable outcome was observed. Conversely, at T2, ACCESS score was the only confirmed independent predictive factor of response to dupilumab treatment (OR = 0.81 [95% CI = 0.67-0.92], <i>P</i> = .010).</p><p><strong>Conclusions: </strong>Our findings suggest that the extent of previous endoscopic sinus surgeries may have a role in influencing clinical outcomes in patients with refractory CRSwNP undergoing treatment with dupilumab.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"201-210"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677448","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}