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Rhinology Dec 2023Loss of sense of smell is one of the most burdensome symptoms of chronic rhinosinusitis with nasal polyps (CRSwNP) but its relationship to sinus disease on imaging is...
BACKGROUND
Loss of sense of smell is one of the most burdensome symptoms of chronic rhinosinusitis with nasal polyps (CRSwNP) but its relationship to sinus disease on imaging is unclear. Dupilumab improves sense of smell and radiographic severity of sinus disease in patients with CRSwNP. We investigated the relationship of sinus opacification severity and loci to olfactory impairment and dupilumab efficacy in patients with CRSwNP from the SINUS-24/SINUS-52 (NCT02912468/NCT02898454) studies.
METHODS
Sinus opacification was evaluated using the Lund-Mackay computed tomography (LMK-CT) score and sense of smell using patient-reported loss of smell (LoS) score, University of Pennsylvania Smell Identification Test (UPSIT) score and the 22-item Sino-Nasal Outcome Test (SNOT-22) smell/taste item.
RESULTS
At baseline, 95% of patients (688/724) had impaired sense of smell and opacification was extensive across all sinuses. Greater olfactory impairment was associated with greater opacification, especially in the ethmoid, sphenoid and frontal sinuses. At Week 24, reductions in LMK-CT total score and ethmoid and sphenoid sinus scores with dupilumab were weakly correlated with improvements in sense of smell assessed by LoS, UPSIT and SNOT-22 smell/taste item. More dupilumab than placebo patients achieved clinically meaningful improvement in LMK-CT total score at Week 24 and Week 52.
CONCLUSION
Radiographic disease severity on imaging was associated with smell outcomes in this cohort. Opacification of the ethmoid, sphenoid and frontal sinuses was associated with severe smell loss. These data suggest that dupilumab effects on smell may be partly mediated through reduced sinus inflammation.
Topics: Humans; Nasal Polyps; Smell; Rhinitis; Sinusitis; Chronic Disease; Olfaction Disorders; Frontal Sinus
PubMed: 37453138
DOI: 10.4193/Rhin22.220 -
European Archives of... Nov 2023Worldwide, the incidence of chronic fungal rhinosinusitis (CFRS) has increased. Although ageing leads to weakening of the immune system, which increases susceptibility...
PURPOSE
Worldwide, the incidence of chronic fungal rhinosinusitis (CFRS) has increased. Although ageing leads to weakening of the immune system, which increases susceptibility to CFRS, the CFRS characteristics in geriatric patients are unclear. Therefore, we comparatively analysed the clinical characteristics of CFRS in geriatric and non-geriatric patients.
METHODS
This retrospective analysis compared the demographics, rhinologic symptoms, multiple allergen simultaneous tests, olfactory function tests, paranasal sinus computed tomography findings, and outcomes of 131 patients with CFRS who underwent functional endoscopic sinus surgery and 131 enrolled patients were divided in geriatric (> 65 years) and non-geriatric (≤ 65 years) groups.
RESULTS
Among the geriatric and non-geriatric participants (n = 65, 49.6% and n = 66, 50.4%, respectively), hypertension and diabetes mellitus were more common in the geriatric group. Demographics, including symptoms, showed no significant intergroup differences. Normosmia and hyposmia were significantly less prevalent, whereas phantosmia and parosmia were more prevalent in the geriatric group than in the non-geriatric group (p = 0.03 and p = 0.01, respectively). Sphenoidal sinus involvement was significantly higher in geriatric patients than in non-geriatric patients (p = 0.02).
CONCLUSION
Based on greater sphenoidal sinus involvement, a deeper anatomical area is more vulnerable to fungal infection in the geriatric group than in the non-geriatric group. Increasing clinicians' awareness of CFRS in geriatric patients with olfactory dysfunction, including phantosmia and parosmia, is important for early intervention.
Topics: Humans; Aged; Retrospective Studies; Rhinitis; Sinusitis; Olfaction Disorders; Chronic Disease; Republic of Korea
PubMed: 37389593
DOI: 10.1007/s00405-023-08089-4 -
Neuroradiology Aug 2023The sphenoid sinus (SS) is one of the four paired paranasal sinuses (PNSs) within the sphenoid bone body. Isolated pathologies of sphenoid sinus are uncommon. The...
The sphenoid sinus (SS) is one of the four paired paranasal sinuses (PNSs) within the sphenoid bone body. Isolated pathologies of sphenoid sinus are uncommon. The patient may have various presentations like headache, nasal discharge, post nasal drip, or non-specific symptoms. Although rare, potential complications of sphenoidal sinusitis can range from mucocele to skull base or cavernous sinus involvement, or cranial neuropathy. Primary tumors are rare and adjoining tumors secondarily invading the sphenoid sinus is seen. Multidetector computed tomography (CT) scan and magnetic resonance imaging (MRI) are the primary imaging modalities used to diagnose various forms of sphenoid sinus lesions and complications. We have compiled anatomic variants and various pathologies affecting sphenoid sinus lesions in this article.
Topics: Humans; Sphenoid Sinus; Paranasal Sinus Diseases; Sphenoid Sinusitis; Multidetector Computed Tomography; Magnetic Resonance Imaging; Mucocele
PubMed: 37202536
DOI: 10.1007/s00234-023-03163-4 -
Auris, Nasus, Larynx Dec 2023Chronic rhinosinusitis (CRS) is common and often requires surgical intervention. Surgical failure may lead to persistent symptoms and recalcitrant disease, often...
OBJECTIVE(S)
Chronic rhinosinusitis (CRS) is common and often requires surgical intervention. Surgical failure may lead to persistent symptoms and recalcitrant disease, often secondary to synechiae between the middle turbinate (MT) and lateral nasal wall. Synechiae prevention techniques have been extensively investigated, however evidence for the effect of synechiae on sinonasal physiology is lacking. We aimed to model the effects of MT synechiae on a post-functional endoscopic sinus surgery (FESS) sinonasal cavity using computational fluid dynamics (CFD).
METHODS
DICOM data from a CT-sinus of a healthy 25-year-old female was segmented to create a three-dimensional model. Virtual surgery was performed to simulate a "full-house" FESS procedure. Multiple models were created, each with a single unilateral virtual MT synechia of varying extent. CFD analysis was performed on each model and compared with a post-FESS control model without synechiae. Airflow velocity, humidity and mucosal surface and air temperature values were calculated.
RESULTS
All synechiae models demonstrated aberrant downstream sinonasal airflow. There was reduced ventilation of the ipsilateral frontal, ethmoid and sphenoid sinuses, with a concentrated central "jet" in the middle meatus region. Effects were proportionate to the size of synechiae. The impact on bulk inspired airflow was negligible.
CONCLUSION
Post-FESS synechiae between the MT and lateral nasal wall significantly disrupt local downstream sinus ventilation and nasal airflow. These findings may explain the persistent symptoms seen in post-FESS CRS patients with MT synechiae, reinforcing the importance of prevention and adhesiolysis. Larger cohort studies with multiple models of actual post-FESS patients with synechiae are required to validate these findings.
Topics: Female; Humans; Adult; Turbinates; Hydrodynamics; Endoscopy; Paranasal Sinuses; Nasal Cavity; Sinusitis
PubMed: 37137797
DOI: 10.1016/j.anl.2023.04.003 -
Asian Journal of Surgery Sep 2023
Topics: Humans; Sphenoid Sinusitis; Brain Abscess; Tomography, X-Ray Computed
PubMed: 37105816
DOI: 10.1016/j.asjsur.2023.04.036 -
Clinical Characteristics of Sphenoid Sinus Fungus Ball: A Nine-year Retrospective Study of 77 Cases.The Laryngoscope Dec 2023This study aimed to investigate the clinical characteristics of sphenoid sinus fungus ball (SSFB) to help increase the accuracy of diagnosis and efficiency of treatment.
OBJECTIVE
This study aimed to investigate the clinical characteristics of sphenoid sinus fungus ball (SSFB) to help increase the accuracy of diagnosis and efficiency of treatment.
METHODS
We retrospectively analyzed the data of 77 patients who were histopathologically diagnosed with SSFB.
RESULTS
The mean age of SSFB patients was 52.4 years (range 25-84), and 47 patients (61.0%) were female. Compared to age-matched and sex-matched chronic rhinosinusitis (CRS) patients, headache was more common in SSFB patients (79.2%; p < 0.0001). SSFB patients also had higher prevalence of diabetes than CRS (p = 0.0420). The features of computed tomography (CT) were sphenoid sinus opacification (100%), sclerosis (93.5%), calcification (76.6%), and bone erosion (41.6%). Functional endoscopic sinus surgery (FESS) was the best treatment option, and the trans-ethmoid (n = 64, 83.1%) was the most commonly used approach. No one experienced a recurrence of SSFB in 44 successfully contacted patients. Six months after FESS, 91.0% of patients (40/44) established proper drainage in the sphenoid sinus. The recovery rates for headache and nasal symptoms were 91.7% (33/36) and 77.8% (7/9) respectively.
CONCLUSION
SSFB is more prevalent in older women and usually presents as unilateral headache. Diabetes is a potential risk factor for SSFB. CT findings provide evidence for diagnosis and suggestions for surgical approaches. FESS is the optimal treatment for SSFB. After FESS, most patients had good prognosis with no recurrence of SSFB. However, regular endoscopic follow-up is required due to the possibility of the postoperative closure of sphenoid ostium.
LEVEL OF EVIDENCE
3 Laryngoscope, 133:3292-3298, 2023.
Topics: Humans; Female; Aged; Adult; Middle Aged; Aged, 80 and over; Male; Sphenoid Sinus; Retrospective Studies; Sinusitis; Endoscopy; Headache; Chronic Disease; Diabetes Mellitus; Fungi
PubMed: 37022141
DOI: 10.1002/lary.30683 -
Relationship of Lesion Location to Postoperative Steroid Use in Eosinophilic Chronic Rhinosinusitis.The Laryngoscope Oct 2023Eosinophilic chronic rhinosinusitis (ECRS) is known to recur after surgery. The treatment choice for recurrent ECRS, such as oral steroids or biological agents, must be...
OBJECTIVES
Eosinophilic chronic rhinosinusitis (ECRS) is known to recur after surgery. The treatment choice for recurrent ECRS, such as oral steroids or biological agents, must be chosen carefully, and identifying the lesion location may be useful. This study aimed to evaluate the postoperative course of ECRS patients and assess the relationship between endoscopic lesion location and postoperative oral steroid use.
METHODS
Patients with chronic rhinosinusitis who underwent bilateral endoscopic sinus surgery from April 2018 to March 2020 were divided into two groups based on the presence or absence of oral steroid use after surgery. The primary endpoint was the lesion location on endoscopic findings during surgery: middle turbinate, middle meatus, superior turbinate, superior meatus, nasal septum, and sphenoethmoidal recess. Subjective symptoms, blood tests, and computerized tomography (CT) findings (Lund-Mackay score) were evaluated as secondary endpoints.
RESULTS
Among 264 patients, 88 were diagnosed histologically with ECRS (mean 48.98 ± 1.40 years, 67 males/21 females). Twenty-three patients were steroid-using, 65 were steroid-free, and six stopped attending their appointments. Patients with sphenoethmoidal recess lesions were significantly more likely to require steroids (p = 0.019). There was a significant association between steroid use and younger age (p = 0.041), olfactory dysfunction (p = 0.021), and all sinuses (Frontal sinus: p < 0.001, Anterior ethmoid sinus: p = 0.002, Posterior ethmoid sinus: p = 0.011, Maxillary sinus: p = 0.018, Sphenoid sinus: p = 0.034, Total score: p < 0.001).
CONCLUSION
A sphenoethmoidal recess lesion was a risk factor for requiring postoperative steroids. Young age, olfactory dysfunction, and preoperative severe CT findings were also significant risk factors.
LEVEL OF EVIDENCE
3 Laryngoscope, 133:2511-2516, 2023.
Topics: Male; Female; Humans; Rhinitis; Eosinophilia; Sinusitis; Frontal Sinus; Chronic Disease; Endoscopy; Olfaction Disorders
PubMed: 36692200
DOI: 10.1002/lary.30586 -
Journal of Neuro-ophthalmology : the... Mar 2024
Topics: Humans; Sphenoid Sinusitis; Optic Nerve Diseases; Optic Nerve; Rare Diseases
PubMed: 36255078
DOI: 10.1097/WNO.0000000000001702 -
The Annals of Otology, Rhinology, and... Aug 2023Performing an effective maxillary antrostomy is critical to improving chronic maxillary sinusitis symptomatology. Incomplete dissection of the uncinate process and...
BACKGROUND AND OBJECTIVES
Performing an effective maxillary antrostomy is critical to improving chronic maxillary sinusitis symptomatology. Incomplete dissection of the uncinate process and failure to incorporate the natural drainage pathway may lead to recirculation and need for revision surgery. The purpose of this study is to determine if 70° endoscopes provide added value in determining incomplete dissection or residual disease.
METHODS
Prospective study of 35 sinuses from 18 patients undergoing FESS for Chronic Rhinosinusitis (CRS) between 11/1/2020 and 4/30/2021. Two fellowship trained Rhinologists initially performed maxillary antrostomies exclusively using a 0° endoscope, then transitioned to a 70° endoscope. Surgeons completed a survey to assess completion of the antrostomy prior to use of 70° endoscope, sino-nasal anatomy, and difficulty of the operation. Intraoperative photographs before and after using a 70° endoscope were evaluated by a third party. Pre-operative CT scans were used to evaluate the sphenoid keel-caudal septum-nasolacrimal duct (SK-CS-NL) angle.
RESULTS
Of 35 sinuses from 18 patients all 35 sinuses had CRS with 48.5% having nasal polyposis and 42.9% having active infection. There was residual inflammatory tissue in the anterior maxillary sinus, including polypoid tissue and uncinate process prior to using the 70° endoscope in 82.9% of sinuses. The natural drainage pathway was not incorporated into the dissection in 28.6% of sinuses before converting to 70° endoscope. Incomplete dissection with 0° endoscope was not associated with nasal polyposis ( = .086) or uncinate position (0.741). Narrow SK-CS-NL angles were associated with incomplete dissection of the anterior maxillary sinus with 0° endoscope (16.0° ± 3.0° vs 20.6° ± 3.2°; = .013).
CONCLUSION
Use of 70° endoscope in maxillary antrostomy may be beneficial in identifying and resecting disease within the anterior maxillary sinus that may otherwise be difficult to find using a 0° endoscope. This is especially true in patients with narrow nasolacrimal duct positioning.
Topics: Humans; Endoscopy; Prospective Studies; Sinusitis; Maxillary Sinus; Maxillary Sinusitis; Nasal Polyps; Chronic Disease
PubMed: 35983610
DOI: 10.1177/00034894221119306