BackgroundChronic rhinosinusitis (CRS) may share inflammatory pathways with metabolic disorders, yet the extent of its associations with metabolic comorbidities and metabolic syndrome-related abnormalities remains uncertain. Given the rising prevalence of both CRS and metabolic disease, clarifying these relationships has important clinical and public health implications.ObjectiveTo systematically evaluate reported metabolic comorbidities and metabolic parameters in patients with CRS.MethodsA search of CINAHL, Cochrane Library, PubMed, and Scopus (inception-June 2025) identified studies reporting individual metabolic comorbidities and parameters in CRS. Meta-analyzed outcomes included means, proportions (%), and odds ratios (ORs) with 95% confidence intervals (CI).ResultsAltogether, 53 studies were included. Among 1 115 790 CRS patients, pooled prevalences were 45.1% for body mass index >25 kg/m2, 25.3% for hypertension, 22.0% for dyslipidemia, and 11.7% for diabetes. Mean metabolic parameters trended slightly above population averages (eg, total cholesterol 195 mg/dL vs ∼189 mg/dL in global adults). CRS patients had comparable odds of diabetes (OR, 1.03; 95% CI, 0.87-1.22) and hypertension (OR, 1.04; 95% CI, 0.81-1.35), but lower odds of total cholesterol >240 mg/dL (OR, 0.96; 95% CI, 0.96-0.97), versus non-CRS controls.ConclusionMetabolic comorbidities were frequently reported among CRS populations, although pooled prevalence estimates were generally comparable to global reference estimates. Comparative analyses showed comparable odds of diabetes and hypertension between CRS patients and non-CRS controls, with lower odds of elevated total cholesterol among CRS patients. Overall, current evidence does not support a strong epidemiologic association between CRS and metabolic dysfunction, highlighting the need for prospective controlled studies to clarify potential relationships.
PurposeThe aim of this study was to explore longitudinal changes in the middle meatal microbiome following endoscopic sinus surgery (ESS), accounting for relevant clinical variables in a group of patients with chronic rhinosinusitis (CRS).MethodsParticipants with CRS without nasal polyps and CRS with nasal polyps admitted for ESS were prospectively recruited. Endoscopically guided swabs were collected from 40 CRS patients at the time of surgery and during the postoperative visit, approximately 6 weeks after the surgery, from the region of the middle meatus. Bacterial communities were characterized using the 16S rRNA gene sequencing. Paired samples from 22 patients with CRS were included in the final analysis.ResultsThe overall microbial community composition, as reflected in alpha- and beta-diversity metrics and relative taxon abundances, remained generally stable after surgery. However, using advanced statistical methods, we identified subtle alterations in the microbiome. Postoperative beta diversity differed by occupational exposure and vitamin D status, whereas the Linear Model for Differential Abundance extended to a linear mixed-effect model detected modest taxonomic variation associated with age, allergy, body mass index, 25(OH)D, and extent of surgery.ConclusionDespite various factors known to modulate CRS and anatomical changes resulting from ESS, this pilot study found that the baseline microbiome structure of the middle meatus remained largely stable postoperatively. While ESS did not result in pronounced alterations of the overall bacterial landscape, selected covariates appeared to be associated with postsurgical microbiome shifts, highlighting the need for further investigation in larger cohorts.
BackgroundAlthough several reports suggest that antidiabetic agents may exert anti-inflammatory effects, the influence of glycemic status and antidiabetic agents on chronic rhinosinusitis remains unexplored.ObjectiveThis study aimed to assess the impact of glycemic status and antidiabetic agents on postoperative recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP).MethodsWe conducted a retrospective review of records from six medical centers, including patients who underwent endoscopic sinus surgery for bilateral CRSwNP, with a minimum follow-up duration of 3 years. Patients were stratified into normoglycemic patients, dysglycemic patients without antidiabetic agent use, and dysglycemic patients receiving antidiabetic agents. Clinical characteristics were compared both across these groups and between patients with and without postoperative rhinosinusitis recurrence. Binary logistic regression analysis was used to identify independent predictors of recurrence and analyze medication-specific effects. Cumulative hazard of rhinosinusitis recurrence according to perioperative glycemic status and antidiabetic agent use were analyzed.ResultsA total of 503 patients were analyzed. During the postoperative follow-up period, rhinosinusitis recurrence occurred least frequently among dysglycemic patients receiving antidiabetic agents (P = .008). Antidiabetic agent users had a significantly reduced cumulative hazard of recurrence compared with nonusers (P < .001). Consistently, the proportion of antidiabetic agent users was significantly higher in the nonrecurrence group than in the recurrence group (P = 0.008). In contrast, perioperative fasting blood glucose and glycated hemoglobin levels were not significantly associated with postoperative recurrence. Binary logistic regression analysis identified younger age, absence of antidiabetic agent use, and poorer preoperative olfactory identification scores as independent predictors of recurrence.ConclusionPerioperative antidiabetic agent use was associated with a significantly reduced risk of postoperative recurrence in CRSwNP patients. The lack of significant association between glycemic status and recurrence further suggests that antidiabetic agents themselves, distinct from glycemic control, may exert a modulatory effect on the CRSwNP disease course.
Objective(s)Biologic therapies have expanded treatment options for chronic rhinosinusitis with nasal polyps (CRSwNP), but many patients have inadequate response to their initial biologic and requiring switching. Outcomes after switching, particularly patient-reported measures, remain poorly characterized. We aimed to identify predictors and outcomes of biologic switching in adults with CRSwNP.MethodsWe retrospectively reviewed adults initiating biologics for CRSwNP between 2009 and 2025 at a tertiary center. Demographic, clinical, radiographic, histopathologic, and Sinonasal Outcome Test-22 (SNOT-22) data were collected. Predictors and outcomes of biologic change were analyzed.ResultsAmong 400 patients, 70 (18%) switched biologics after a mean of 38 months. All patients were diagnosed with CRSwNP, which was the primary indication in 61%. Baseline demographics were comparable between groups. Switching was more common with omalizumab (39%) and mepolizumab (40%) than dupilumab (5%) (P < .01). Most from omalizumab or mepolizumab transitioned to dupilumab for inadequate CRSwNP control (42% and 50%), whereas dupilumab was typically discontinued due to adverse effects (39%). Compared with nonswitchers, switchers more often exhibited radiologic air-fluid levels (P < .01), asthma (P < .01), aspirin-exacerbated respiratory disease (P = .01), and chronic obstructive pulmonary disease (P = .04). Baseline SNOT-22 scores were similar (P = .20), but higher for switchers at 6 months (P < .01). After switching, 70.6% of patients improved, with a mean SNOT-22 reduction of 9.4 points (P = .02), approaching outcomes of nonswitchers.ConclusionPatients who switch biologics for CRSwNP typically transition to dupilumab due to inadequate symptom control. Biologic switching appears to be an effective strategy for refractory CRSwNP, leading to outcomes comparable to those who respond to initial therapy, despite greater baseline severity.
BackgroundMedical treatment has been the mainstay of chronic rhinitis management. Meanwhile, innovative minimally invasive nasal surgery has shown promising results. The therapeutic outcomes of these surgical interventions compared with medical treatment in chronic rhinitis have not been discussed previously.ObjectiveThis study aimed to evaluate the efficacy of radiofrequency ablation of the inferior turbinate of the intraturbinate segment of the posterior nasal nerve (RAPN) in comparison with intranasal corticosteroid spray (INCS) plus oral antihistamines for the treatment of chronic rhinitis.MethodsA retrospective cohort study was conducted on patients with chronic rhinitis who had an inadequate response to medication. Inclusion criteria included a 24-h Reflective Total Nasal Symptom Score (rTNSS) ≥4 and a rhinorrhea score ≥1. Patients with prior nasal surgeries, caudal septal deviation, or acute/chronic rhinosinusitis were excluded. The primary endpoint was the change in 24-h rTNSS and Nasal Obstruction Symptom Evaluation (NOSE) scores at the 3-month follow-up.ResultsA total of 64 patients were included: 44 received RAPN, and 20 received INCS. Baseline rTNSS was 7.3 ± 2.1 for RAPN and 6.9 ± 2.3 for INCS (p = .497). Both groups showed significant improvement in rTNSS and NOSE scores at 1 and 3 months (p < .001). However, the RAPN group demonstrated significantly greater improvement than the INCS group at 1 to 3 months of follow-up (p = .001). Subscore analysis revealed that rhinorrhea (at 1 and 3 months) and sneezing (at 1 month) did not differ significantly between groups. One case of postoperative anterior epistaxis was noted in the RAPN group.ConclusionsBoth INCS and RAPN are highly effective in alleviating chronic rhinitis symptoms. Although RAPN does not establish definitive superiority over medical therapy across all neurogenic domains, it provides comparable, sustained symptom control with the distinct advantage of drug-free maintenance, offering a valuable therapeutic alternative.
BackgroundA retrospective cohort study of 69,170 patients who underwent endoscopic sinus surgery between 2015 and 2022 found that 38.7% of the variation in the number of postoperative debridements was explained at the surgeon level. The extent to which postoperative debridements patterns after endoscopic sinus surgery depended on the surgeon motivates further research about relevant surgeon characteristics.ObjectiveTo identify surgeon characteristics associated with average Current Procedural Terminology (CPT®) 31237 utilization per Medicare beneficiary.MethodsWe performed a retrospective cross-sectional study using summary Medicare data from 2023, filtering for CPT 31237 ("[b]iopsy or removal of nasal polyp or tissue using an endoscope"). We hypothesized that where surgeons train, whether they complete a fellowship in rhinology, or how much they are reimbursed is associated with average CPT 31237 utilization per beneficiary. We performed multivariable linear regression to analyze surgeon characteristics.ResultsThe sample included 1016 surgeons. Their sex distribution was 86.8% male and 13.2% female, and their mean years of postgraduate experience was 22.6 (SD 10.3). Of the 33.4% of surgeons who completed a fellowship, the majority trained in rhinology (71.4%), followed by facial plastics (14.8%). Approximately 96.5% of surgeons had average CPT 31237 utilization per beneficiary of 3 or less. The median number of beneficiaries per surgeon was 18 (IQR 13-28). Residency or fellowship program did not explain variation in average CPT 31237 utilization per beneficiary. Completing fellowship in rhinology was associated with 0.13 (95% CI 0.01-0.25, P = .027) greater average CPT 31237 utilization per beneficiary. Each additional $100 in the average standardized amount paid for CPT 31237 by Medicare was associated with 0.32 (95% CI 0.20-0.43, P < .001) greater average CPT 31237 utilization per beneficiary.ConclusionAverage CPT 31237 utilization per beneficiary may be associated with the type of fellowship which surgeons complete and the amount which they are reimbursed.
BackgroundBiologic therapies for chronic rhinosinusitis with nasal polyps (CRSwNP) broaden options beyond endoscopic sinus surgery (ESS) and conventional medications. However, the short-term impact of biologic therapy on healthcare utilization relative to ESS is unclear.ObjectiveTo compare 12-month healthcare utilization and costs after biologic initiation versus ESS.MethodsUsing the Atropos Health platform (2019-2024; ∼66 million patients), adults with CRSwNP and ≥12-month follow-up who received treatment with ESS or an approved biologic were identified. After 1:1 propensity-score matching, 12-month outcomes were compared, including medication use, CRSwNP-related visits, subsequent sinus surgery, complications, and Current Procedural Terminology (CPT)-based costs.ResultsOf 7519 ESS and 2084 biologic-treated eligible patients, 998 remained per arm after matching. Biologics and ESS patients had similar office (41.3% vs 38.7%; OR 0.90, 95% CI 0.77-1.07) and ED visit rates (2.0% vs 1.3%; OR 0.65, 95% CI 0.32-1.30). Subsequent sinus surgery was more frequent after biologics (3.6% vs 12.9%; OR 3.97, 95% CI 2.71-5.80). No significant differences were identified in CPT-based costs, complication rates, or steroid use.ConclusionsWithin 1 year, ESS and biologic patients showed similar healthcare utilization, with the exception of subsequent sinus surgery rates, which were higher in biologic patients. These findings may guide shared decision-making and payer policy.
BackgroundNo prior national-level hospital admission analysis has compared acute rhinosinusitis (ARS) outcomes between cystic fibrosis (CF) and non-CF pediatric patients, leaving clinicians without population-level data to contextualize hospitalization burden and complication rates in this group.ObjectiveWe aimed to compare the complication risks and healthcare utilization between patients with CF versus without CF in children hospitalized with ARS.MethodsThe study examined inpatient admissions for pediatric ARS patients with or without CF in 2003-2019 using the Kids' Inpatient Database (KID), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Outcomes included orbital complications, intracranial complications, sinus involvement, sinus procedure rates, length of stay, and hospital charges.ResultsOf the weighted 41,148 patients with ARS, 1.5% had CF (n = 632). CF patients had lower odds of orbital complications (aOR 0.09, 95% CI 0.04-0.20, P < .001) but higher odds of sinus procedures (aOR 1.59, 95% CI 1.14-2.20, P = .006) compared to non-CF patients. CF patients also had longer hospital stays (8 vs 3 days, P < .001) and higher hospital charges ($43,918 vs $11,129, P < .001) compared to non-CF patients.ConclusionChildren with concurrent CF and ARS experience greater overall disease burden, reflected in prolonged hospitalization, higher healthcare costs, and higher rates of sinus surgeries. However, CF patients appear less prone to orbital complications.
BackgroundOne of the defining symptoms of chronic rhinosinusitis is nasal discharge. There are multiple treatment options, and the relative efficacy of each medication on discharge is unclear.ObjectiveTo characterize the effects of medical treatment on the various forms of nasal discharge in chronic rhinosinusitis.Review MethodsThe literature was searched from inception through 2024 for articles reporting nasal discharge symptom data both at baseline and after treatment with medical therapy. Specific symptoms of interest on the Sino-nasal Outcomes Test 22 (SNOT-22) were "Need to Blow Nose," "Runny Nose," "Postnasal Discharge," and "Thick Nasal Discharge." SNOT-22 scores ranged from 0 to 5 based on severity. Visual Analogue Scale equivalents were recorded when available.ResultsA total of 19 studies (n = 1758) were included. All four nasal discharge questions saw statistically significant improvement, with postnasal drip and thick nasal discharge seeing the largest degree of improvement (both -1.4 [95% CI: -2.3, -0.5). Both patients with polyps (-39.2 [-49.2, -29.2]) and without nasal polyps (-26.0 [-41.9, -10.1]) saw significant improvement in rhinorrhea. Only patients with polyps saw significant improvement in postnasal discharge (PND) (-30.1 [-47.5, -12.7]). Nasal polyp patients treated with biologics saw a mean decrease of 44.1 points [95% CI: 29.9-58.3] in their total SNOT, compared with 15.9 [95% CI: 8.8-22.9] and 14.5 [95% CI: 4.1-25.0] point decreases in standard and alternative medical treatments, respectively. Both biologic and standard medical treatments led to reductions in VAS Rhinorrhea, with biologics leading to a greater reduction (P = .03). Only patients receiving biologics underwent significant improvement in VAS PND scores.ConclusionIn chronic rhinosinusitis, all 4 types of nasal discharge reported on the SNOT-22 saw significant improvement. Both patients with polyps and without polyps see improvement in discharge. Treatment of nasal polyps with biologics results in significantly greater improvement in nasal discharge compared to standard medical therapy and alternative treatments.
BackgroundThe rate of functional endoscopic sinus surgery (FESS) in cystic fibrosis (CF) with chronic rhinosinusitis (CRS) is greater than 20%, and the rate of revision FESS is higher in CF patients compared to patients without CF. Revision FESS also occurs sooner in CF. Triple modulator therapy has made a positive impact on CRS symptoms and imaging in CF, but little is known regarding its relation to revision FESS.MethodsA retrospective review of CF patients with CRS treated at a single institution identified 53 patients who met inclusion criteria and underwent FESS between 2006 and 2022. There were 32 patients treated with triple modulator therapy, or elexacaftor/tezacaftor/ivacaftor (ETI). We hypothesized that ETI would be associated with a decreased likelihood of revision FESS. Additional cofactors included age, prior modulator treatment, and history of lung transplant.ResultsThere was a decrease in revision FESS in patients treated with ETI, with only one of the 32 patients undergoing surgery since treatment initiation (3.13%). In the years prior to ETI, 18 of these same patients (56.25%) underwent revision FESS. Patients on other modulator therapy had a hazard ratio of 0.85 for revision FESS (not significant).ConclusionThe current study shows a low rate of revision FESS in patients taking ETI, consistent with prior reports on improved quality of life and radiographic measures in these patients.
BackgroundOlfactory dysfunction is a common disorder linked to adverse health outcomes and is more prevalent in men than in women. Sex steroid hormones have been proposed to underlie these sex differences, but population-based evidence remains limited.ObjectiveTo examine the associations of serum free testosterone and estradiol with olfactory dysfunction in US adults and to explore sex and age differences.MethodsWe analyzed data from 2750 participants (1373 men and 1377 women) aged ≥40 years in the 2013-2014 National Health and Nutrition Examination Survey. Olfactory function was assessed using the 8-item Pocket Smell Test. Dysfunction was defined as a score ≤5. Serum sex hormones were measured by mass spectrometry, and free testosterone was calculated from total testosterone, sex hormone-binding globulin, and albumin. Survey-weighted multivariable logistic and linear regression models evaluated associations between hormone quartiles and olfactory dysfunction or test scores, adjusting for sociodemographic factors, lifestyle, comorbidities, and olfaction-related medical history.ResultsThe weighted prevalence of olfactory dysfunction was 16.49% in men and 10.58% in women. Among men, higher free testosterone was associated with lower odds of olfactory dysfunction (adjusted odds ratio for highest vs lowest quartile, 0.47; 95% CI, 0.26-0.83; P for trend = .004), particularly in those older than 50 years. No significant associations were observed for free testosterone or estradiol in women.ConclusionHigher free testosterone levels are associated with a lower prevalence of olfactory dysfunction in men, whereas no clear hormone-olfaction associations were detected in women. Circulating testosterone may contribute to sex differences in olfactory performance.
BackgroundEndoscopic dacryocystorhinostomy (eDCR) is the preferred surgical treatment for nasolacrimal duct obstruction. However, long-term outcome data and reliable predictors of surgical success remain limited.ObjectiveTo assess long-term functional outcomes of eDCR and identify factors associated with recurrence in a large single-center cohort with long-term follow-up.MethodsWe conducted a retrospective cohort study including all patients who underwent primary endonasal eDCR between 1998 and 2022 at a tertiary referral center. Primary outcomes were functional success (absence of epiphora) after first and, if necessary, second surgery, and time to recurrence following primary eDCR. Recurrence-free survival was analyzed using Kaplan-Meier methods and Cox proportional hazards regression. Secondary outcomes included concordance among preoperative diagnostic tests and perioperative complications.ResultsA total of 280 patients underwent 313 primary unilateral eDCR procedures. Functional success after first surgery was achieved in 86.9% of cases, with 41 recurrences (13.1%). After secondary procedures, 95.2% of operated sides were symptom-free. Estimated recurrence-free survival was 93.5% at 1 year, 90.8% at 3 years, and 88.5% at 5 years. On multivariable analysis, concomitant unciformectomy was independently associated with a reduced risk of recurrence (hazard ratio 0.27; 95% CI, 0.13-0.56; P < .001). Agreement among preoperative diagnostic tests was limited, with only fair concordance between fluorescein testing or dacryography and dacryo-CT-scan imaging (Cohen's κ 0.25-0.29). No major surgical complications were observed.ConclusioneDCR provides durable long-term relief of epiphora with high functional success rates. Concomitant unciformectomy appears to reduce the risk of recurrence significantly and may represent an important surgical step in optimizing long-term outcomes. Limited concordance among preoperative diagnostic tests supports the use of a complementary diagnostic approach in clinical practice.
BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition affecting the sinuses, resulting in the appearance of nasal polyps and is often associated with comorbidities. Many cases do not respond to corticosteroid treatment or surgery.ObjectiveThis study aimed to explore the role of tezepelumab in the treatment of CRSwNP.MethodsPubmed, Embase, Scopus, Web of Science, and Cochrane Library were searched. Three randomized controlled trials (RCTs) comparing tezepelumab and placebo in 655 patients with CRSwNP were included. The main outcomes were nasal polyp size (nasal polyp score, NPS), nasal congestion or obstruction (nasal congestion score, NCS), and quality of life using the sino-nasal outcome test (SNOT-22).ResultsThree RCTS were included, in which tezepelumab was used to treat CRSwNP. The mean age was 50.9 years, with 56.9% male patients and 75.6% of patients with coexisting asthma. The mean difference (MD) for NPS ranged from -0.9 to -2.0 compared to placebo. Consistent benefits were observed for NCS with MD between -0.8 and -1.0 compared to placebo and SNOT-22 with MD ranging from -10 to -28 points compared to placebo.ConclusionIn conclusion, evidence suggests that tezepelumab may improve NPS and NCS, SNOT-22, loss of sense of smell, and clinically relevant endpoints (reduced need for surgery and corticosteroid use), as demonstrated in all included trials. However, the certainty and clinical applicability remain limited due to small trial size, industry sponsorship, and the lack of direct comparison with standard management and endoscopic sinus surgery. Large-scale, independent clinical trials are needed to confirm the position of tezepelumab in clinical practice for patients with moderate to severe CRSwNP.
ObjectivesSinonasal metastases are far rarer than primary sinonasal malignancies, hence seldom reported or analyzed in existing literature. To address these gaps, we have retrospectively analyzed 35 patients with sinonasal metastasis in a single university hospital in South Korea, over a 24-year period.MethodsFrom 1998 to 2022, among 11,814 pathology reports of sinonasal tissues, 35 (0.3%) were identified with sinonasal metastasis from solid organ cancers. Patients' clinical characteristics, presentation, primary tumor profiles, treatment modalities for the sinonasal metastasis, and overall survival (OS) were retrospectively reviewed and analyzed, in addition to the literature review.ResultsHepatocellular carcinoma (HCC) was the most common primary cancer (37.1%), followed by lung (14.3%), breast (11.4%), and thyroid (8.6%). The most common presentation was epistaxis (20%), however, 20% were identified incidentally. The nasal cavity (37.1%), sphenoid and maxillary sinus (31.4%), and skull base (34.3%) were the most prevalent metastatic locations. Although the median OS following a sinonasal metastatic diagnosis was 7.0 months, patients with isolated sinonasal metastasis, thyroid cancer- metastases, or definitive therapy for sinonasal metastasis had significant longer OS (p=0.037, 0.035, and p-trend=0.003, respectively).ConclusionIn our study, HCC was the most common primary cancer for sinonasal metastasis, contrasting with renal cell carcinoma prevalence in Western literature, suggesting that regional cancer incidence variations may influence sinonasal metastasis epidemiology. Despite the poor prognosis in general, in selected patients with thyroid cancer or solitary sinonasal metastases, the definitive treatment for the sinonasal metastasis may aid in an increased duration of survival.
BackgroundHereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder with multiorgan manifestations, necessitating a multidisciplinary approach. Epistaxis is a common manifestation leading to significant morbidity. Current treatments are variable in efficacy, and adequate control of epistaxis remains a significant challenge.ObjectiveTo describe the cohort of patients treated at a dedicated multidisciplinary HHT clinic and to evaluate the efficacy of an HHT-related epistaxis treatment protocol at a multidisciplinary HHT clinic.MethodsThis study included both retrospective and prospective cohorts of adult patients (≥ 18 years) with confirmed HHT attending a tertiary multidisciplinary clinic. The retrospective cohort comprised patients managed prior to the establishment of the treatment protocol and contributed to baseline demographic and disease characteristics only. The prospective cohort of patients, recruited from September 2022 to September 2024, was managed using a tiered protocol progressing from topical treatment to surgical intervention to systemic therapy. Epistaxis severity score (ESS) was recorded longitudinally. Treatment efficacy was assessed by comparing ESS at baseline, pre-intervention, and post-intervention time points.ResultsA total of 62 patients, including 31 retrospective and 31 prospective patients, were identified with a mean age of 52.5 ± 17.4 years and female predominance of 62.9%. Baseline ESS scores were highest in patients in the "Bevacizumab" group, followed by those in the "Surgical treatment" group, and lowest in patients in the "Topical treatment only" cohort (P = .001). Within the prospective cohort, significant improvements in ESS were observed following surgery (ΔESS = 4.31, P = .006) and bevacizumab (ΔESS = 4.74, P = .005). Nearly half (48.4%) of patients in this clinic achieved satisfactory control with conservative measures alone.ConclusionA structured, multidisciplinary protocol enables effective management of HHT-related epistaxis, matching treatment intensity to disease severity to achieve satisfactory symptom control for patients.
BackgroundThe frontal sinus drainage pathway (FSDP) includes the frontal recess as its most anatomically complex segment, where surrounding cell pneumatization can influence drainage patterns. Despite this variability, large-scale 3-dimensional characterization of the drainage pathway in both opacified and nonopacified sinuses remains limited, particularly with operative validation.ObjectiveTo perform 3-dimensional mapping of the FSDP and evaluate its relationship to adjacent cells, focusing on drainage patterns associated with frontal sinus opacification.MethodsThis single-center cross-sectional study analyzed 1008 frontal sinuses using 3-dimensional computed tomography reconstruction software. Frontal recess cells were classified according to the International Frontal Sinus Anatomy Classification. The course of the FSDP relative to adjacent cells was mapped and compared between opacified and nonopacified sinuses. A subset of 112 opacified sinuses that underwent endoscopic frontal sinus surgery was included for surgical validation, with preoperative mapping correlated with intraoperative findings.ResultsThe FSDP most frequently coursed posterior to the agger nasi cell (63.9%). In the presence of supra-agger cell and supra-agger frontal cell, it predominantly followed a medial course (55.3% and 68.7%, respectively). It consistently ran anterior to supra-bulla cell (100%), lateral to frontal septal cell (100%), and most commonly anterior to supra-bulla frontal cell and supraorbital ethmoid cell (79.7% and 97.3%, respectively). Pathway-cell relationships did not differ between opacified and nonopacified groups. Preoperative 3-dimensional mapping showed high intraoperative concordance.ConclusionThis study demonstrates that the anatomical configuration of the FSDP is largely consistent across both opacified and nonopacified sinuses. These findings provide a structured 3-dimensional anatomical framework that may assist preoperative assessment and surgical orientation in endoscopic frontal sinus surgery.
BackgroundNo prior meta-analysis has directly compared restenosis or revision rates between Draf IIb and Draf III in chronic rhinosinusitis (CRS) or evaluated how Type 2 versus non-Type 2 endotypes influence these outcomes.MethodsFollowing PRISMA guidelines, PubMed, MEDLINE, Embase, and ClinicalTrials.gov were searched on 5 January 2025 for studies reporting restenosis or revision after Draf IIb or Draf III in adults with CRS. Random-effects meta-analyses of proportions (Freeman-Tukey transformation; Hartung-Knapp CIs), pooled restenosis and revision rates, with subgroup analyses by procedure type and endotype.ResultsThirty-eight studies met inclusion criteria (restenosis n = 1550; revision n = 1305). The pooled restenosis proportion across procedures was 9% (95% CI: 5-14%) and the pooled revision proportion was 9% (95% CI: 5-13%). Restenosis was lower after Draf IIb than Draf III (0.8% vs. 12%), with revision rates showing a similar pattern (2% vs. 10%). Type 2 CRS demonstrated higher pooled rates of restenosis (8% vs. 1%) and revision (12% vs. 3%) compared with non-Type 2 CRS.ConclusionsDraf IIb is associated with lower pooled restenosis and revision rates than Draf III in CRS. Type 2 inflammatory endotype confers substantially higher risk of adverse frontal sinus outcomes. Incorporating endotype into procedural decision-making may improve prognosis. Prospective, endotype-stratified studies are needed to refine indications for Draf IIb versus Draf III and optimize adjunctive management strategies.
BackgroundChronic rhinosinusitis (CRS) comprises heterogeneous eosinophilic (type-2) and neutrophilic (type-1/3) endotypes, yet existing murine models rarely distinguish them or compare their therapeutic responsiveness.MethodsSeven-week-old female C57BL/6N mice received intranasal instillations three times weekly for 4 or 12 weeks with either (1) a clinically relevant airborne allergen cocktail (house dust mite [HDM], Aspergillus fumigatus, Alternaria alternata, and Staphylococcus aureus protease) to induce eosinophilic CRS (ECRS) or (2) an innate stimulus mixture (lipopolysaccharide, β-1,3-glucan, and S. aureus protease) to induce neutrophilic CRS (NCRS). A parallel cohort received weekly dexamethasone administration (2 mg/kg). Endpoints included flow cytometry, enzyme-linked immunosorbent assays, quantitative PCR, histology, and immunofluorescence assays.ResultsFour-week allergen exposure produced a pure ECRS phenotype characterized by robust tissue eosinophilia, type-2 cytokines, and marked responsiveness to dexamethasone. Extending allergen delivery to 12 weeks generated mixed CRS with superimposed neutrophilia, upregulation of Il1b/Tgfb1, mucus hypersecretion, and attenuated steroid efficacy. Innate stimulus treatment yielded a steroid-resistant NCRS phenotype dominated by neutrophils, elevated Ifng/Il17a expression, and minimal type-2 biomarkers. Systemic eotaxin and HDM-specific immunoglobulin E mirrored those found in local eosinophilia, whereas circulating granulocytes remained unchanged across groups.ConclusionsBy adjusting the stimulus type and duration, we established tunable murine models that recapitulate pure ECRS, mixed CRS, and steroid-resistant NCRS within a single genetic background. These paired models provide a versatile platform for dissecting endotype-specific mechanisms and evaluating tailored interventions, highlighting the potential importance of early, phenotype-directed CRS therapy.
ObjectiveTo evaluate the long-term anatomical and functional efficacy of a hybrid surgical technique combining endoscopic dacryocystorhinostomy (En-DCR), endoscopic common canaliculotomy, and temporary bicanalicular silicone intubation in patients with severe common canalicular obstruction (CCO).MethodsThis retrospective case series analyzed 43 eyes of 43 patients (mean age: 55.4 ± 8.0 years) with severe CCO treated between February 2018 and July 2022. Severe CCO was confirmed intraoperatively by soft resistance to probing ≥10 mm from the punctum. The surgical technique included wide bony ostium creation, lacrimal sac marsupialization, direct endoscopic incision of the fibrotic common canaliculus, and bicanalicular silicone tube intubation (stent removed at 3 months). Outcomes were assessed at ≥12 months postoperatively using epiphora symptom resolution, lacrimal irrigation, nasal endoscopy, and fluorescein dye disappearance test. Anatomical success was defined as a patent ostium with unobstructed irrigation; functional success required anatomical patency plus complete epiphora resolution.ResultsAt a mean follow-up of 18.8 ± 6.9 months, anatomical success was achieved in 37 eyes (86.0%), and functional success in 35 eyes (81.4%). Failures included 5 cases of ostial fibrosis and 1 recurrent CCO; 2 patients reported persistent epiphora despite anatomical patency. No major complications (eg, orbital hemorrhage, sinusitis) occurred.ConclusionsIn carefully selected patients with isolated severe CCO, the hybrid technique of En-DCR with canaliculotomy and temporary intubation demonstrates promising success rates and a favorable safety profile while preserving physiological drainage. These findings suggest it may serve as a physiologically favorable alternative to conjunctivodacryocystorhinostomy, mitigating the long-term complications associated with permanent bypass tubes.
