American Journal of Rhinology & Allergy最新文献

{"title":"Prescription Patterns and Outcomes of Topical Antibiotic Irrigations in Difficult-to-Treat Chronic Rhinosinusitis.","authors":"Bastien A Valencia-Sanchez, Christopher Jabbour, Prishae Wilson, Natasha Najmi, Alaa Alhalabi, Jacqueline Squire, Janalee Stokken, Angela M Donaldson","doi":"10.1177/19458924251413671","DOIUrl":"10.1177/19458924251413671","url":null,"abstract":"<p><p>BackgroundA substantial proportion of patients with chronic rhinosinusitis (CRS) remain partly controlled or uncontrolled despite endoscopic sinus surgery (ESS) and maximal medical therapy. For these difficult-to-treat cases, topical antibiotic irrigations have been proposed as an adjunctive therapy, particularly when delivered via large-volume, low-pressure systems that enhance sinus penetration post-ESS. Evidence on their efficacy and prescribing patterns in this population remains limited.ObjectiveThis study aims to evaluate the use and outcomes of topical antibiotic irrigations in patients with difficult-to-treat CRS.MethodsA retrospective, multi-site cohort study was conducted across tertiary academic medical centers. Adult patients with persistent CRS symptoms despite bilateral full-house ESS and conventional postoperative medical management were included. Patients with cystic fibrosis or granulomatosis with polyangiitis were excluded. Demographic, clinical, and treatment data were collected. Primary outcomes were infection resolution at 8 weeks and changes in Sino-Nasal Outcome Test-22 (SNOT-22) scores.ResultsSixty-seven patients met inclusion criteria. Mupirocin (41.8%), tobramycin (23.9%), and gentamicin (17.9%) were the most commonly prescribed agents. After 8 weeks, 62.7% of patients achieved infection clearance. Among 44 patients with SNOT-22 data, scores improved significantly from 34.8 ± 20.2 to 21.8 ± 14.7 (<i>P</i> < .001). Improvement in SNOT-22 scores was more pronounced in patients who cleared the infection compared to those who did not.ConclusionLarge-volume topical antibiotic irrigations were associated with high infection resolution rates and clinically meaningful SNOT-22 improvements in patients with difficult-to-treat CRS. These findings support their potential utility as an adjunctive therapy in select postsurgical patients and warrant further prospective investigation.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"230-238"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Office Biopsy for Inverted Papilloma.","authors":"Alison J Yu, Iulia Tapescu, Sanjena Venkatesh, Kathleen Montone, Maria C Espinosa, Jennifer E Douglas, James N Palmer, Michael A Kohanski, Nithin D Adappa","doi":"10.1177/19458924251414779","DOIUrl":"10.1177/19458924251414779","url":null,"abstract":"<p><p>BackgroundWith a 10% risk for malignant transformation to squamous cell carcinoma (SCC), the treatment of inverted papilloma (IP) is surgical resection. Biopsy of IP can be helpful for diagnosis, but there are accuracy limitations.ObjectiveTo determine the diagnostic accuracy of office biopsy in patients who underwent surgical resection for sinonasal papilloma, and to examine clinical and pathological factors that impacted this accuracy.MethodsThis was a retrospective review of patients who underwent resection of sinonasal papilloma at a tertiary care center from January 2015 to April 2025 and had office biopsies performed at the same institution before surgery. Patient demographic and tumor characteristics were reviewed. We compared the accuracy of office biopsy against the final pathology from surgical resection.ResultsA total of 94 patients were included. Mean age was 59.6 (±12.5) years, with 69.1% male. Final pathology revealed 72 (76.6%) sinonasal papilloma without dysplasia, 19 (20.2%) sinonasal papilloma with dysplasia, and 3 (3.2%) SCC in situ. 13.9% (10/72) of the papilloma without dysplasia cases had false negative biopsies showing inflammatory lesions, while none of the pre-malignant papillomas had a false negative (non-neoplastic) biopsy (<i>P</i> < .001). The false negative biopsy cases were significantly associated with contralateral pathology on CT (50.0% vs 12.9%, <i>P</i> = .005) and concurrent inflammatory polyp (40.0% vs 4.8%, <i>P</i> < .001). Tumor characteristics were not significantly associated with higher rates of false negative biopsy.ConclusionsInaccurate biopsy results were mainly attributed to concurrent inflammatory processes. With a false negative rate of 14% on office biopsy, proceeding to surgical resection is warranted when there is a strong clinical suspicion for IP.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"239-244"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145958322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Don't Collapse the Wave.","authors":"Neal Rajan Godse","doi":"10.1177/19458924261434308","DOIUrl":"https://doi.org/10.1177/19458924261434308","url":null,"abstract":"","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"40 3","pages":"180-182"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147643583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Ultra-Processed Food Intake and Sinusitis.","authors":"Anthony Thai, Noel F Ayoub","doi":"10.1177/19458924251404161","DOIUrl":"10.1177/19458924251404161","url":null,"abstract":"<p><p>BackgroundUltra-processed foods (UPF) are industrial formulations derived mostly from substances refined or extracted from foods. UPF intake has been linked to obesity, cardiovascular disease, and adult mortality, with recent studies demonstrating possible associations with asthma and allergy.ObjectiveWe investigate the association of UPF intake with self-reported sinusitis and other sinonasal symptoms.MethodsWe retrospectively reviewed 3 cycles of the National Health and Nutrition Examination Survey (NHANES), ranging from 2005 to 2014, which includes dietary and sinonasal symptom data on a large, representative sample of the US population. Individuals were divided into quartiles based on the percent of daily caloric intake consisting of Nova category 4 UPF. Multivariable logistic regression was performed to assess the association of UPF intake with sinonasal symptoms, adjusting for demographic data and medical comorbidities.ResultsAnd 10,068 individuals (mean age 54.2 years, 52.1% female) were studied. Compared to the lowest quartile of UPF intake, the highest quartile had a higher rate of asthma (16% vs 11%, <i>P</i> = .03), obesity (40% vs 30%, <i>P</i> < .001), smoking (51.6% vs 44.4%, <i>P</i> < .001), emphysema (2.9% vs 1.8%, <i>P</i> = .02), and food insecurity (26% vs 21%, <i>P</i> = .002). On multivariable regression, the highest quartile of UPF intake was associated with self-reported sinusitis (odds ratio [OR] = 1.54, 95% confidence interval [CI] 1.15-2.05, <i>P</i> = .007). UPF intake was also associated with xerostomia-related dysgeusia (OR 1.79, CI 1.15-2.80, <i>P</i> = .02) but not with other sinonasal symptoms, including hyposmia, allergies, hay fever, or nasal congestion from allergies.ConclusionUPF intake is significantly associated with self-reported sinusitis and xerostomia-related dysgeusia, although not with other sinonasal symptoms. Further studies are needed to elucidate the mechanism of this association.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"191-196"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Topical Levofloxacin Rinses on Chronic Rhinosinusitis.","authors":"Ali M Baird, Russell Whitehead, Vidit Talati, Grant S Owen, Romney Hansen, Peter Filip, Bobby A Tajudeen, Pete S Batra, Peter Papagiannopoulos","doi":"10.1177/19458924251408176","DOIUrl":"10.1177/19458924251408176","url":null,"abstract":"<p><p>BackgroundTreatment of postoperative exacerbations with topical antibiotics has grown in popularity due to their ability to administer a high local drug concentration to the sinuses and mitigate systemic side effects. Published literature on the efficacy of topical levofloxacin for treating CRS is scarce.ObjectivePatients who started levofloxacin 100 mg nasal rinses twice daily following functional endoscopic sinus surgery (FESS) were retrospectively identified. Data collected included rinse duration, bacterial cultures, Sino-Nasal Outcome Test-22 (SNOT-22) scores, Lund-Kennedy (LK) scores, and adverse effects. SNOT and LK scores were compared at 3 time points: pre-operative (<b>Baseline</b>), 3 month postoperative pre-rinse (<b>PostOp</b>), and at the completion of rinse therapy (<b>PostRinse</b>). Analysis of variance (ANOVA) and Wilcoxon rank sum tests were used for pairwise comparisons.ResultsOne hundred and thirty-three patients received levofloxacin rinses for a mean 8.4 ± 18.9 months. On pairwise comparison for LK scores, the difference between PostOp and PostRinse LK scores was -1.0 ± 1.7 (<i>P</i> <i><</i> <i>.</i>001). The change from Baseline to PostOp was -2.0 ± 2.8 (<i>P</i> <i><</i> <i>.</i>001) and the change from Baseline to PostRinse LK scores was -3.2 ± 2.8 (<i>P</i> <i><</i> <i>.</i>001). On pairwise comparison for SNOT scores, significant improvement was observed between Baseline and PostRinse scores (-19.4 ± 20.7, <i>P</i> <i>=</i> <i>.</i>001) but not between PostOp and PostRinse scores. There was one musculoskeletal adverse event noted.ConclusionTopical levofloxacin rinses afforded a possible benefit in endoscopic appearance of operated sinuses but less definitive benefit in symptom scores. Further, they were safely tolerated with one mild musculoskeletal adverse event.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"207-213"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145761898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Middle Turbinate Medialization With Absorbable Packing After Trans-sphenoidal Skull Base Surgery: Outcomes and Significance of a Simple Technique.","authors":"Mark T Liu, Joyce Lee, Matthew J Kabalan, Christopher R Roxbury, Raj Sindwani","doi":"10.1177/19458924251409273","DOIUrl":"10.1177/19458924251409273","url":null,"abstract":"<p><p>BackgroundMiddle turbinate (MT) medialization after endoscopic skull base surgery (ESBS) allows natural positioning of the turbinate, re-opening of the osteomeatal complex, and potential skull base protection from iatrogenic injury by endonasal device insertion. Our institution routinely preserves and medializes the MTs in ESBS by placing bioabsorbable nasal packing in both middle meatuses.ObjectiveThe goal of our study was to use postoperative endoscopic MT scoring to objectively assess the efficacy and durability of our simple technique, in which bioabsorbable nasal packing is placed in both middle meatuses to position the MTs against the septum, following trans-sphenoidal skull base surgery.MethodsA single-center retrospective review was performed of consecutive trans-sphenoidal ESBS patients from 2023 to 2024 to assess postoperative MT positioning. Patients with recorded postoperative nasal endoscopies more than 20 days after surgery were included. Recorded endoscopies were evaluated by 2 independent raters using 2 standardized MT scoring systems assessing station and apposition. An additional subgroup analysis was performed in patients with multiple postoperative endoscopies to assess effect of time on MT position.ResultsFifty patients (100 turbinates) scored by 2 raters were included for a total of 200 turbinate ratings. One hundred ninety-two turbinates (96%) had station assessed as 1+, signifying medialization, and 176 turbinates (88%) demonstrated direct apposition to the septum. Nasal endoscopies were analyzed 43.5 days (median) after surgery. Cohen's kappa coefficient was 0.90 for station and 0.63 for apposition, signifying substantial inter-rater reliability. Subgroup analysis demonstrated no significant effect of time on turbinate station or apposition.ConclusionsOur experience with bioabsorbable nasal packing in the middle meatus demonstrates that a simple technique can achieve durable MT medialization in many patients following ESBS. Optimizing MT positioning can improve postoperative sinus function and help protect against inadvertent skull base injuries in ESBS patients.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"214-221"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Adipose Mesenchymal Stem Cell-Derived Exosomes on the Th2/Treg Cells in Peripheral Blood of the Patients with Allergic Rhinitis and its Mechanism.","authors":"Feiyan Han, Xiaojie Xu, Ying Wang","doi":"10.1177/19458924251401732","DOIUrl":"10.1177/19458924251401732","url":null,"abstract":"<p><p>BackgroundAt present, there are many therapeutic regimens for allergic rhinitis (AR), but their therapeutic effects are not better. Therefore, it is a focus to find new therapeutic targets by exploring AR immune regulation.ObjectiveTo explore the possible mechanism that adipose mesenchymal stem cell-derived exosomes (AMSC-exos) regulate the balance of Th2/Treg cells by mTOR pathway in AR patients.MethodsThirty patients with AR and 30 patients with deviated nasal septum alone were selected as AR group and control group. From each patient, 10 ml of peripheral blood were collected for determining the levels of blood plasma IL-4 and TGF- β as well as protein levels of p-PI3K (P85), p-AKT (Ser473), p-mTOR (Ser2448) and p-p70S6K (Thr389) in peripheral blood mononuclear cells (MCs) and the proportions of Th2 and Treg cells. And then MCs from AR patients were divided into two groups. One group was as AR cell group. Another group was co-cultured with AMSC-exos and served as AR cell + exos group. The levels of IL-4 and TGF- β in supernatant, the protein levels of p-PI3K (P85), p-AKT (Ser473), p-mTOR (Ser2448) and p-p70S6K (Thr389) in MCs and the proportions of Th2 and Treg cells were also determined.ResultsThe levels of p-PI3K (P85), p-AKT (Ser473), p-mTOR (Ser2448) and p-p70S6K (Thr389), the IL-4 level and the proportion of Th2 cells were significantly higher in the AR group than in the control group (all <i>P</i> < 0.05). However, the levels of p-PI3K (P85), p-AKT (Ser473), p-mTOR (Ser2448) and p-p70S6K (Thr389), the IL-4 level and the proportion of Th2 cells were significantly lower in the AR cell + exos group than in the AR cell group (all <i>P</i> < 0.05).ConclusionsAMSC-exos may regulate the balance between Th2 and Treg cells by PI3K/AKT/mTOR/p70S6K pathways in vitro.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"183-190"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145666767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Exposure to Phenols and Parabens and Allergy-Related Outcomes.","authors":"Caishan Fang, Xiangjun Qi, Qinwei Fu, Shipeng Zhang, Xi Chen, Qinxiu Zhang","doi":"10.1177/19458924251408169","DOIUrl":"10.1177/19458924251408169","url":null,"abstract":"<p><p>BackgroundParabens and phenols (PAPs) are widely used in consumer and personal care products. Although prior studies suggest links between PAP exposure and allergic outcomes, evidence across adolescents and adults remains limited.ObjectiveTo investigate associations between urinary PAPs and allergy-related outcomes.MethodsWe conducted a cross-sectional analysis of NHANES 2005-2006. Eight urinary PAPs were considered; three with >33.3% values below the limit of detection were excluded. Allergic symptoms and sensitization were assessed based on participants' self-reported health conditions. Three survey-weighted generalized linear models (crude model: unadjusted; Model I: partially adjusted; Model II: fully adjusted) and weighted quantile sum regression were used to evaluate the associations between PAPs exposure and allergy-related outcomes in both adolescents and adults.ResultsAmong adolescents, higher triclosan (TCS) exposure was positively associated with allergic rhinitis, allergies, sinus infection, and sneezing; in the fully adjusted model, odds ratios (ORs) were 2.04 (95% CI: 1.18-3.54), 2.36 (1.25-4.47), 3.28 (1.36-7.91), and 2.12 (1.27-3.52), respectively. Higher TCS, methyl paraben (MPB), and propyl paraben (PPB) were associated with dust-mite sensitization, with ORs of 2.00 (1.16-3.45), 2.09 (1.05-4.17), and 3.87 (2.09-7.16). Among adults, MPB was positively associated with allergic rhinitis (OR = 1.95, 95% CI: 1.26-3.00) and sneezing (OR = 1.99, 1.27-3.10), and TCS was associated with hay fever (OR = 1.99, 1.22-3.23) and plant sensitization (OR = 1.40, 1.03-1.91). In mixture analyses, PAPs were positively associated with allergies (adjusted OR = 1.27, 95% CI: 1.07-1.51), sneezing (1.15, 1.00-1.33), and plant sensitization (1.21, 1.02-1.43) in adolescents, but no significant mixture associations were found in adults.ConclusionHigher levels of specific PAPs, particularly TCS, MPB, and PPB, and PAP mixtures were associated with increased risks of allergy-related outcomes in adolescents. In adults, TCS and MPB showed positive associations with multiple outcomes, whereas the overall PAP mixture was not statistically significant.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"197-206"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Nasoseptal-Lacrimal Fossa Distance as a Predictor of Endoscopic DCR Failure: A Retrospective Analysis.","authors":"Kalena Liu, Christopher Valentini, Kelsey Limage, Henry Moss, Ava Whitlark, Tiffany Cheng, Henry Bair, Charlotte Marous, Adam Flanders, Marc Rosen, Gurston Nyquist, Elina Toskala, Karine Shebaclo, Alison Watson, Mindy Rabinowitz","doi":"10.1177/19458924251410664","DOIUrl":"10.1177/19458924251410664","url":null,"abstract":"<p><p>BackgroundDacryocystorhinostomy (DCR) is a surgery performed for nasolacrimal duct obstruction (NLDO). A high septal deflection may limit surgical access, and if not corrected, contribute to an increase in DCR failure rates due to increased adhesion formation. We hypothesize that a narrower distance between the nasal septum (NS) and lacrimal fossa (LF) is associated with higher rates of DCR failure.ObjectiveTo evaluate whether a reduced nasal septum-lacrimal fossa (NS-LF) distance is associated with higher rates of endoscopic DCR (Endo DCR) failure and to determine a clinically relevant cutoff distance that may guide consideration for concomitant septoplasty.MethodsA single-institution retrospective chart review was performed for patients who received an endoscopic \"Endo\" DCR between July 2018 and July 2023. Data collected included demographics, septal deviation presence and laterality, NLDO laterality, and failure rates, where failure was defined as the need for a repeat ipsilateral DCR. The NS-LF distance was determined on preoperative computed tomography.ResultsA total of 521 patients were identified, with an average age of 60.3 years (SD = 16.47); 4.4% (n = 23) of patients experienced Endo DCR failure, requiring revision Endo DCR; 8.7% (n = 45) of patients underwent concomitant septoplasty with initial DCR. Patients who failed had a significantly shorter NS-LF distance (8.47 mm vs 9.25 mm, <i>P</i> = .028). Receiver operating characteristic curve analysis cutoff distance of 8.85 mm demonstrated a NS-LF distance ≥8.85 mm had a significantly lower failure rate compared to those with a distance <8.85 mm (2.6% vs 7.3%, <i>P</i> = .016). All revision DCRs were successful regardless of septoplasty status.ConclusionA NS-LF distance of <8.85 mm was significantly associated with Endo DCR failure, suggesting that concomitant septoplasty should be considered in these patients. Prospective studies and standardized preoperative imaging may improve surgical planning and outcomes in Endo DCR.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"222-229"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145987741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steroid-Sparing Effects of Biologics in Chronic Rhinosinusitis with Nasal Polyps: Systematic Review and A Meta-Analysis of Randomized Controlled Trials.","authors":"Ali M Alsudays, Yasser G Alarimah, Khaled A Almanea, Ahmad Alroqi","doi":"10.1177/19458924251414922","DOIUrl":"10.1177/19458924251414922","url":null,"abstract":"<p><p>BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) presents significant management challenges, largely due to reliance on systemic corticosteroids (SCS) for symptom control. Advances in biologic therapies targeting type 2 inflammation have shown promise in reducing polyp burden, improving symptoms, and decreasing the need for SCSs and surgery.ObjectiveThis systematic review and meta-analysis compare the steroid-sparing efficacy of biologics and safety with other biologics or standard care in CRSwNP. Key outcomes include reducing SCS Use and drug safety.MethodsWe searched PubMed, Embase, Cochrane Library, Scopus, and the Web of Science. We included randomized controlled trials (RCTs) comparing biologics versus placebo/standard care in adults with CRSwNP. The primary outcomes were SCS reduction and safety. Meta-analyses, which use a statistical method called random effects models, were employed.ResultsThis meta-analysis of seven RCTs (n = 3097) revealed that biologic therapies significantly reduce SCS use in CRSwNP patients (pooled proportion: 20.9%, 95% CI: 8.4%-37.0%), though with substantial heterogeneity (I² = 98.3%). Trial-level predictors included control-arm safety profiles (higher serious adverse events (SAEs) reduced treatment effects) [odds ratio (OR) 0.70]. In contrast, placebo-arm SAEs enhanced them [OR 1.81]) and sample size (larger trials showed diluted responses [OR 0.993 per patient]). These results highlight the role of trial design and baseline patient risk in determining the interest of the results. They further highlight the possibility for individualized strategies in terms of treatment and call for more in-depth studies with patient-level data to refine the steroid-sparing therapeutic strategy, providing an impetus for future work in this area.ConclusionsThe biologics, specifically dupilumab, represent a paradigm shift in treating CRSwNP, significantly decreasing the burden of SCS-their consistent safety and efficacy support integration into treatment algorithms for severe cases.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"245-256"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145964982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}