Introduction: Chronic rhinosinusitis with nasal polyps is considered as a predominantly T2 immunopathological disease, which despite symptomatic medical and surgical treatments, often leads to persistent deterioration in the quality of life. The use of biological therapy has shown significant progress in treating refractory endotypes. With the first choice option dupilumab, there is a five-year experience in Hungary. Method: In a two-center retrospective study, we included 137 patients treated with dupilumab between October 2020 and January 2025; 107 of them have at least six months follow-up data. According to professional guidelines, we assessed the degree of nasal obstruction using a visual analogue scale, polyp extent by endoscopy, olfactory dysfunction with symptom scores, and the quality of life using specific questionnaires. Results: The average treatment duration was 554.6 +/- 355.3 days, with 6 patients treated for more than four years, 16 patients for more than three years, 54 patients for more than two years, and 104 patients whose therapy started more than one year ago. T2 comorbidities were as follows: asthma in 105 patients (76.64%), nonsteroidal anti-inflammatory drug intolerance in 63 patients (45.99%), and allergic rhinitis in 69 patients (50.36%). The patient parameters significantly improved in comparison to baseline values at all time points (p<0.001). Olfactory dysfunction, significantly affecting the quality of life, improved in 71.96% of patients. Side effects were observed in 25 cases (23.36%), leading to therapy discontinuation in 5 patients (3.65%). The most common side effects were joint pain, elevated blood eosinophil count (8 cases each), skin and mucous membrane reactions (n = 7). In 27% of patients, the dupilumab dose could be reduced without compromising efficacy. Conclusion: In our long-term follow-up study on a large patient cohort, we demonstrated that dupilumab is significantly more effective than conventional treatments and safe when treatment principles are followed.

Odontogenic sinusitis is classified as a localized, secondary form of the paranasal sinus inflammation, in which odontogenic focus, foreign body and/or any surgical intervention violating the Schneiderian membrane may be found in the background. Rhinosinusitis is defined by at least two from the symptoms of nasal blockage, anterior or posterior nasal discharge, facial discomfort/pain, loss of smell and typical alterations with nasal endoscopy. Acute rhinosinusitis seems to be infectious, while the chronic phenotype shows immunopathological signs of primary, diffuse bilateral disease. Acute and chronic rhinosinusitis as well as odontogenic sinusitis appear to have markedly different symptoms, pathomechanistic properties and therapeutic possibilities, thus the appropriate diagnosis is of utmost importance. The symptoms of the odontogenic sinusitis is similar compared to acute bacterial rhinosinusitis, though putrid nasal discharge and/or foetor from the nose might be pathognomic, while anosmia is usually not present. Mucosal changes and alterations in sinus-CT scans without typical clinical symptoms and nasal endoscopic findings do not define the diagnosis of odontogenic sinusitis. The goal of the therapy comprises treatment of the acute symptoms and inflammation, improvement of sinus drainage, eradication of the odontogenic focus, removal of foreign bodies if present, and finally closure of the oroantral fistules, if needed. Conservative medical therapy should be initiated first, and in the case of failure, endoscopic sinus surgical intervention is considered as the next step. In individual and more complicated cases, consultation with dental-, maxillo-facial surgeon and specialist in otorhinolaryngology is recommended, together with repeated nasal endoscopy and sinus-CT-scan. Diagnostic and therapeutic algorithms are suggested in order to promote up-to-date treatment of odontogenic sinusitis patients. Orv Hetil. 2025; 166(9): 323–330.

Az otosclerosis egy máig tisztázatlan eredetű csontanyagcsere-betegség, amely csakis humán temporalis csontban alakít ki apró csontátépüléssel járó gócokat. Ezek az elváltozások a leggyakrabban az ovális ablakfülke elülső részén és a stapestalpban alakulnak ki, és mechanikailag fixálják a hallócsontláncolatot, következményes vezetéses halláscsökkenést okozva ezzel. Az otosclerosis kezelésével kapcsolatban természetes igény, hogy különféle gyógyszeres terápiás lehetőségekkel próbáljuk visszafordítani a betegséget, ez idáig azonban csupán a csontátépülést sikerült lelassítani. A nátrium-fluorid- és a biszfoszfonátkezelés igen ígéretesnek mutatkozott, súlyos mellékhatásaik miatt azonban alkalmazásuk csak kivételes esetekben jöhet szóba. A célzott (biológiai) terápiákhoz nagy reményt fűznek, ezeket azonban Magyarországon még nem engedélyezték. Az otosclerosis terápiájának „gold standard” eljárása a sebészi megoldás, mely nem a betegséget gyógyítja meg, pusztán a halláscsökkenés vezetéses komponensét küszöböli ki. A régebbi műtéti technikát, a stapedectomiát egyre inkább felváltja a technikailag egyszerűbb stapedotomia, ám mindmáig szinte ekvivalens eljárásnak tekinti őket a szakirodalom. A szokványos mikroszkópos stapessebészet mellett külön bemutatjuk a legmodernebb endoszkópos stapedotomiát is. Orv Hetil. 2024; 165(32): 1237–1241.

Otosclerosis is a bone remodeling disorder with still unclear origin, which exclusively forms tiny foci in the human temporal bone. These foci most often develop in the anterior part of the oval window niche and in the stapes footplate, and mechanically fix the ossicles, causing a consequent conductive hearing loss. In relation to the treatment of otosclerosis, it is a natural demand to try to reverse the progression of the disease with various medical treatment options, but until now only bone remodeling has been slowed down. Sodium fluoride and bisphosphonate treatment have shown to be highly promising, but due to their serious side effects, they can only be considered in exceptional cases. There is still great hope for targeted (biological) therapies, but they are not yet approved in Hungary. The „gold standard” procedure for otosclerosis is the surgical solution, which does not cure the disease, just simply eliminates the conductive component of the hearing loss. The older stapedectomy is increasingly being replaced by the technically simpler stapedotomy, however, they are still considered almost equivalent procedures in the literature. In addition to standard microscopic stapes surgery, the most modern endoscopic stapedotomy is also presented. Orv Hetil. 2024; 165(32): 1237–1241.

Otosclerosis is a bone remodeling disorder with still unclear origin, which exclusively forms tiny foci in the human temporal bone. These foci most often develop in the anterior part of the oval window niche and in the stapes footplate, and mechanically fix the ossicles, causing a consequent conductive hearing loss. In relation to the treatment of otosclerosis, it is a natural demand to try to reverse the progression of the disease with various medical treatment options, but until now only bone remodeling has been slowed down. Sodium fluoride and bisphosphonate treatment have shown to be highly promising, but due to their serious side effects, they can only be considered in exceptional cases. There is still great hope for targeted (biological) therapies, but they are not yet approved in Hungary. The ,,gold standard" procedure for otosclerosis is the surgical solution, which does not cure the disease, just simply eliminates the conductive component of the hearing loss. The older stapedectomy is increasingly being replaced by the technically simpler stapedotomy, however, they are still considered almost equivalent procedures in the literature. In addition to standard microscopic stapes surgery, the most modern endoscopic stapedotomy is also presented.

A T2-es endotípussal jellemezhető kétoldali, orrpolyposissal járó krónikus rhinosinusitis nehezen kezelhető, a konvencionális gyógyszeres és műtéti terápiára rezisztens formája tartósan nem kontrollált tünetekkel jár együtt. A páciensek életminősége, napi aktivitása és alvásminősége tartósan és súlyos fokban károsodott. Az elmúlt évtizedek tüneti, kóroki, műtéti, általános gyulladáscsökkentő (szisztémás szteroid) kezelési formái nem nyújtottak kellően hatékony megoldást a refrakter krónikus rhinosinusitis kezelésében. A meghatározó effektorsejteket és mediátormolekulákat blokkoló humanizált monoklonális antitest-terápia minőségi javulást eredményezett ezen a területen. A biológiai terápia a többi T2-es szervi manifesztációt is kiválóan befolyásolja, így további életminőség-javulást jelent, és egyben költséghatékony eljárás. A szerző összefoglalja a patogenetikai és klinikai alapismereteket, az elérhető és indikált biológiai gyógyszereket, a legújabb terápiás evidenciákat, valamint a kezdeti hazai tapasztalatokat. Orv Hetil. 2023; 164(18): 694–701.

Patients with difficult-to-treat chronic bilateral rhinosinusitis with nasal polyps - a type 2 inflammatory endotype - who are resistant to conventional medical and surgical therapy exhibit prolonged and not controlled symptoms. Quality of life, daily activities and sleeping are severely affected. Symptomatic, etiopathologic, surgical and general antiinflammatory (systemic steroid) therapeutic options of the past decades have not been sufficient enough in the treatment of refractory chronic rhinosinusitis. The new therapy with humanized monoclonal antibodies directed against the most relevant mediators and effector cells resulted in outstanding impovements in this field. Other type 2 manifestations may also be effectively treated at the same time, which improves the quality of life and is considered cost-effective as well. The author summarizes the actual etiopathogenic and clinical implications, the approved and available biologics, the related evidences and the preliminary clinical experiences. Orv Hetil. 2023; 164(18): 694-701.

Összefoglaló. Az utóbbi időben egyre gyakoribbá vált fogászati implantáció egyik nem kívánt szövődménye az arcüregbe került implantátum, amely a maxilla molaris, esetenként praemolaris régiójának implantációjakor fordulhat elő. Ennek oka lehet a kúpsugaras komputertomográfia nélküli, azaz nem megfelelő tervezés, fennálló arcüreggyulladás és -ventilációs probléma, kevés, puha csont, a fúrási vagy implantátumbehelyezési sebészi gyakorlat hiánya, észre nem vett membránperforáció arcüreg-csontfeltöltés esetén. Esetünkben implantáció előtt a beteg szájsebész orvosa kúpsugaras komputertomográfia alapján sinusventilációs zavart és arcüreggyulladást véleményezett. Az arcüreggyulladás funkcionális endoszkópos sinussebészeti műtéttel történő kezelését és gyógyulását követően két lépésben, először arcüreg-csontfeltöltést, majd 6 hónappal később implantációt végeztek. 4 hónap panasz- és tünetmentes gyógyulást követően az implantátumfeltárás előtt derült fény az arcüregbe került implantátumra, amelyet funkcionális endoszkópos sinussebészeti eljárással, transnasalis (Lothrop) és intraoralis behatolás kombinációjával távolítottunk el. Az implantátumok arcüregbe kerülésének gyakorisága továbbra is ismeretlen, a szakirodalomban kb. 70 közölt esetről tudunk; a leggyakrabban egy-egy implantátummal kapcsolatban születnek cikkek, ami az összes beültetett implantátum számához képest elenyésző. Az arcüregben lévő szabad implantátum arcüreggyulladást okoz, eltávolítása szükséges, kötelező. A sinus hátsó részében elhelyezkedő implantátum esetén elsősorban funkcionális endoszkópos sinussebészeti eljárás javasolt. Az első recessusban lévő implantátum eltávolítására a legjobbnak a praelacrimalis recessusból végzett korszerű behatolás tűnik. Tradicionális transoralis/Luc–Caldwell-féle behatolást a friss sinuslift utáni gyulladt csontexcochleatio esetén javasolunk, illetve ha fennálló oroantralis fistulát is zárnunk kell. Orv Hetil. 2022; 163(13): 527–531. Summary. Accidental implant displacement into the maxillary sinus is often due to inappropriate surgical planning or technique, unrecognised sinus disease, failure to recognise low residual bone quality and quantity during implant-supported maxillary molars and premolars rehabilitation. Secondary implant migration can be attributed to the risk of failing osteointegration due to unnoticed sinus membrane rupture during surgery, incomplete soft tissue closure over the implant’s site, preexistent sinus ventilation problems. In this study, we present the case of a patient with a symptomless preexistent sinus infection, which had been treated with functional endoscopic sinus surgery. After the healing period, the following two-stage procedures were performed: 1) maxillary sinus bone augmentation, 2) 6 months later dental implant placement, based on a routine orthopantomogram. At the end of the 4-month planned healing period, the implant displacement was noticed in the sinus cavity. The implant was removed with a combination of endoscopic surgery, transnasal and transoral Luc–Caldwell approach. The possible reasons for displaced implant into the sinus cavity, the treatment decision tree and lessons we learned, updated by the international literature, are discussed. Our recommendation for displaced implant removal is primarily transnasal under general anaesthesia. In the case of the implant in the anterior recess of the maxillary sinus, the functional endoscopic sinus surgery through the prelacrimal recess approach seems to be the preferred approach. A transoral approach should be the chosen method in the case of present oro-anthral fistulae or recent sinus bone graft, when the infected graft should also be removed. Orv Hetil. 2022; 163(13): 527–533.

Összefoglaló. Az utóbbi időben egyre gyakoribbá vált fogászati implantáció egyik nem kívánt szövődménye az arcüregbe került implantátum, amely a maxilla molaris, esetenként praemolaris régiójának implantációjakor fordulhat elő. Ennek oka lehet a kúpsugaras komputertomográfia nélküli, azaz nem megfelelő tervezés, fennálló arcüreggyulladás és -ventilációs probléma, kevés, puha csont, a fúrási vagy implantátumbehelyezési sebészi gyakorlat hiánya, észre nem vett membránperforáció arcüreg-csontfeltöltés esetén. Esetünkben implantáció előtt a beteg szájsebész orvosa kúpsugaras komputertomográfia alapján sinusventilációs zavart és arcüreggyulladást véleményezett. Az arcüreggyulladás funkcionális endoszkópos sinussebészeti műtéttel történő kezelését és gyógyulását követően két lépésben, először arcüreg-csontfeltöltést, majd 6 hónappal később implantációt végeztek. 4 hónap panasz- és tünetmentes gyógyulást követően az implantátumfeltárás előtt derült fény az arcüregbe került implantátumra, amelyet funkcionális endoszkópos sinussebészeti eljárással, transnasalis (Lothrop) és intraoralis behatolás kombinációjával távolítottunk el. Az implantátumok arcüregbe kerülésének gyakorisága továbbra is ismeretlen, a szakirodalomban kb. 70 közölt esetről tudunk; a leggyakrabban egy-egy implantátummal kapcsolatban születnek cikkek, ami az összes beültetett implantátum számához képest elenyésző. Az arcüregben lévő szabad implantátum arcüreggyulladást okoz, eltávolítása szükséges, kötelező. A sinus hátsó részében elhelyezkedő implantátum esetén elsősorban funkcionális endoszkópos sinussebészeti eljárás javasolt. Az első recessusban lévő implantátum eltávolítására a legjobbnak a praelacrimalis recessusból végzett korszerű behatolás tűnik. Tradicionális transoralis/Luc-Caldwell-féle behatolást a friss sinuslift utáni gyulladt csontexcochleatio esetén javasolunk, illetve ha fennálló oroantralis fistulát is zárnunk kell. Orv Hetil. 2022; 163(13): 527-531. Summary. Accidental implant displacement into the maxillary sinus is often due to inappropriate surgical planning or technique, unrecognised sinus disease, failure to recognise low residual bone quality and quantity during implant-supported maxillary molars and premolars rehabilitation. Secondary implant migration can be attributed to the risk of failing osteointegration due to unnoticed sinus membrane rupture during surgery, incomplete soft tissue closure over the implant's site, preexistent sinus ventilation problems. In this study, we present the case of a patient with a symptomless preexistent sinus infection, which had been treated with functional endoscopic sinus surgery. After the healing period, the following two-stage procedures were performed: 1) maxillary sinus bone augmentation, 2) 6 months later dental implant placement, based on a routine orthopantomogram. At the end of the 4-month planned healing period, the implant displacement was noticed in the sinus cavity. The implant was removed with a combination of endoscopic surgery, transnasal and transoral Luc-Caldwell approach. The possible reasons for displaced implant into the sinus cavity, the treatment decision tree and lessons we learned, updated by the international literature, are discussed. Our recommendation for displaced implant removal is primarily transnasal under general anaesthesia. In the case of the implant in the anterior recess of the maxillary sinus, the functional endoscopic sinus surgery through the prelacrimal recess approach seems to be the preferred approach. A transoral approach should be the chosen method in the case of present oro-anthral fistulae or recent sinus bone graft, when the infected graft should also be removed. Orv Hetil. 2022; 163(13): 527-533.

Background A cross-sectional, questionnaire-based study was conducted in primary schools located in the capital of Hungary. We aimed to evaluate the prevalence of asthma and its risk factors within a 6-12-year-old population. Methods After meeting selection criteria, 3836 eligible parent-reported questionnaires were evaluated. The survey included the ISAAC phase three core questions for asthma and assessed the association with other atopic conditions and various environmental, lifestyle and nutritional risk factors. Results Cumulative asthma had a prevalence of 12.6% among the sampled population, with a girl-boy percentage of 37.4–62.6%. The proximity of any air-polluting factories, heavy-vehicle traffic and weedy area associated with greater risk for asthma while a suburban residence showed lesser odds (odds ratios were 1.3319, 1.2883, 1.3939 and 0.6390 respectively). Indoor smoking, visible mould, and keeping a dog were defined as risk factors for asthma (odds ratios: 1.6509, 2.1282, 1.4362), while the presence of a plant in the bedroom and pet rodents associated with lower odds ratios (0.7884, 0.7231 respectively). The consumption of fast food, beverages containing additives and margarine were significantly higher in asthmatics (odds ratios 1.7488, 1.2669, 1.3549), while we found frequent sport activity (0.6883) and cereal intake (0.5403) had favorable odds ratios for asthma. Conclusions Some of the obtained results have confirmed the outcomes of previous similar epidemiological studies, while in other cases, differences were found. These differences could have been a natural consequence of regional variability and other undiscovered factors; however, the correct evaluation of these controversial results require further investigation in the future. The current data can serve as a milestone for a prospective trial. Having the findings of this study, we can articulate recommendations for the public regarding the most common risk factors of asthma that should be avoided at home and in our surroundings and how to transform our daily habits for a prosperous future.

We aimed to evaluate the prevalence of asthma and its associating environmental factors within a 6–12-year-old population. A cross-sectional, questionnaire-based study was conducted in primary schools located in the capital of Hungary; 3836 eligible parent-reported questionnaires were evaluated. Besides the International Study of Asthma and Allergies in Childhood (ISAAC) phase three core questions for asthma, the survey also assessed various potential risk factors. We introduced the umbrella term cumulative asthma as the union of physician-diagnosed asthma and current wheezing to estimate the lifetime prevalence of asthma. Current wheezing and physician-diagnosed asthma showed a frequency of 9.5% and 6.3%, respectively. They contributed to a cumulative asthma prevalence of 12.6% among the sampled population, with a girl-boy percentage of 37.4% to 62.6%. Air-pollution and weedy areas were associated with greater risk for asthma, while a suburban residence showed lesser odds. Indoor smoking, visible mold, and keeping a dog were defined as risk factors for asthma, while the presence of plants in the bedroom and pet rodents were associated with lower odds ratios. The consumption of fast food, beverages containing additives and margarine were significantly higher in asthmatics, while we found frequent sport activity and cereal intake associated with lower odds ratios for asthma. In this urban environment, we identified an increased asthma prevalence compared to some previously published studies, but the cross-sectional design and the different methodology did not permit us to draw timeframe-dependent conclusions.

Összefoglaló. Az allergiás betegségekben szenvedő emberek száma világszerte, köztük Magyarországon is növekszik. Az egészségügyi ellátórendszerek azon dolgoznak, hogy minél hatékonyabban tudják felhasználni a rendelkezésre álló forrásokat. Az Allergic Rhinitis and its Impact on Asthma (ARIA) szervezet célja az allergiás náthában szenvedő betegek ellátásának javítása, szakmai ajánlások készítése, aktualizálása. Ennek egyik módja integrált betegellátási utak kidolgozása. Célunk ezek hazai elérhetővé tétele, az ajánlások széles körű elterjesztése az Európai Unió (EU) többi tagállamához hasonlóan Magyarországon is. Az ARIA más nemzetközi innovatív szervezetek bevonásával olyan integrált betegellátási utakat fejlesztett ki, amelyek allergiás nátha, esetleg társbetegsége, az asztma esetén támogatják a kezelést. Ezeket újgenerációs irányelvek kidolgozása útján alkották, amelyekhez felhasználták a mobiltechnológiából és pollenkamra-vizsgálatokból származó valós evidenciákat is. A gyógyszeres terápia optimalizálásához a vizuális analóg skálán alapuló, úgynevezett Mobil Légúti Figyelő Hálózat algoritmusát digitalizálták, és valós evidenciák felhasználásával tovább finomították. Allergén immunterápiára az ARIA a világon elsőként dolgozott ki integrált betegellátási utakat 2019-ben. A kezelési irányelvekhez való adherenciaszint alacsony, a betegek a tüneteik erőssége alapján módosítják a kezelést. A flutikazon-propionát–azelasztin kombináció hatása erősebb az intranasalis kortikoszteroidokénál, míg az utóbbi hatásosabb az oralis H1-antihisztaminoknál. A mobiltelefonokban tárolt elektronikus napló vagy más ’mobile health’ (mHealth) eszközök használata segíti a betegek kiválasztását allergén immunterápiára. Az ARIA által javasolt algoritmus megfelelőnek mutatkozott az allergiás rhinitis kezelésére, ezért ezek az irányelvek bekerülnek integrált betegellátási utakba, és részét fogják képezni az EU Egészségügyi és Élelmiszer-biztonsági Főigazgatósága digitalizált, személyközpontú gondozási anyagainak. Az allergén immunterápia hatékony az inhalatív allergének által okozott allergiás betegségekben, alkalmazását azonban korlátozni kell gondosan válogatott betegekre. Orv Hetil. 2020; 161(49): 2059–2071. Summary. The number of allergic patients is increasing all over the world, also in Hungary. Delivering effective and cost-effective health care is essential for all health care systems. ARIA (Allergic Rhinitis and its Impact on Asthma) aims to improve the care of patients who suffer from allergic rhinitis by setting up guidelines and updating them. Development of ICPs (integrated care pathways) can play an essential role in attaining this goal. Our aim is to make ICP-s developed by ARIA available also in Hungary, as is already the case in other countries of the European Union (EU). Together with other international initiatives, ARIA has worked out digitally-enabled ICPs to support care in allergic rhinitis and comorbid asthma. ICPs are based on new-generation guidelines using RWE (real-world evidence) from chamber studies and mobile technology. The MASK (Mobile Airways Sentinel NetworK) algorithm – based on visual analogue scale – was digitalized to support pharmacotherapy, and was refined by using RWE. ARIA was the first to develop ICPs for allergen immunotherapy (AIT) in 2019. Based on MASK data, patients did not follow guidelines and their adherence to treatment was poor. Patients would modify their treatments, depending on the disease control. The effect of fluticasone propionate–azelastine combination is superior to intranasal corticosteroids which are superior to oral H1-antihistamines. Electronic diaries obtained from cell phones and other ’mobile health’ (mHealth) devices help select patients for AIT. The ARIA algorithm for AR was found appropriate and no change is necessary. These guidelines will inform ICPs and will be included in the DG Santé digitally-enabled, person-centred care system. AIT is an effective treatment for allergic diseases caused by inhaled allergens. Its use should, however, be restricted to carefully selected patients. Orv Hetil. 2020; 161(49): 2059–2071.

Background The study aimed to determine the prevalence and risk factors of allergic rhinitis and related comorbidities in school-age children in Budapest, capital of Hungary. Data and epidemiological studies on this disease are still limited. Methods A cross sectional study was conducted in 21 representative and randomly selected primary schools in 2019. International Study of Asthma and Allergies in Childhood-based questionnaires (n = 6869) inquiring about prevalence and related risk factors of allergic rhinitis were distributed to all parents. The data were characterised with standard descriptive statistics: frequencies (percentages) and means for categorical and quantitative data, respectively. Results 3836 of the questionnaires (1857 M/1979F) were completed. The prevalence of current allergic rhinitis was 29.3% (1043), physician-diagnosed allergic rhinitis was 9.7% (373), cumulative allergic rhinitis was 36.2% (1289) and current allergic rhinoconjunctivitis was 16.2% (577). The presence of physician diagnosed atopic disease–asthma (p < 0.0001, OR = 4.398, 95% CI 3.356–5.807), food allergy (p < 0.0001, OR = 2.594, 95% CI 1.995–3.378), and eczema (p < 0.0001, OR = 1.899, 95% CI 1.568–2.300)-were significantly related to an increased risk of cumulative allergic rhinitis. Significant factors associated with allergic rhinitis include male gender (p < 0.0001), family history of atopy (p < 0.0001), frequent upper respiratory tract infections (p < 0.0001), tonsillectomy (p = 0.0054), antibiotics given in the first year of life (p < 0.0001), paracetamol given in the first year of life (p = 0.0038), long-lasting common infections caused by viruses and/or bacteria before the appearance of the allergy (p < 0.0001), consumption of drinks containing preservatives or colourants (p = 0.0023), duration of living in Budapest (p = 0.0386), smoking at home (p = 0.0218), smoking at home in the first year of life (p = 0.0048), birds at home (p = 0.0119), birds at home in the first year of life (p = 0.0052), visible mould in the bedroom (p = 0.0139), featherbedding (p = 0.0126), frequent or constant heavy-vehicle traffic (p = 0.0039), living in a weedy area (p < 0.0001) and living in the vicinity of an air-polluting factory or mine (p = 0.0128). Conclusions The prevalence of allergic rhinoconjunctivitis in 6–12-year-old children in Budapest is higher than reported for most of the surrounding European countries. While asthma (OR = 4.398) is the most significant comorbidity, environmental factors such as birds at home in the first year of life (OR = 2.394) and living in a weedy area (OR = 1.640) seem to be the most important factors associated with AR. Strategies for preventive measures should be implemented. Trial registration number : KUT-19/2019. The study was approved by the Ethics Committee at Heim Pál National Pediatric Institute,

Összefoglaló. Az allergiás betegségekben szenvedő emberek száma világszerte, köztük Magyarországon is növekszik. Az egészségügyi ellátórendszerek azon dolgoznak, hogy minél hatékonyabban tudják felhasználni a rendelkezésre álló forrásokat. Az Allergic Rhinitis and its Impact on Asthma (ARIA) szervezet célja az allergiás náthában szenvedő betegek ellátásának javítása, szakmai ajánlások készítése, aktualizálása. Ennek egyik módja integrált betegellátási utak kidolgozása. Célunk ezek hazai elérhetővé tétele, az ajánlások széles körű elterjesztése az Európai Unió (EU) többi tagállamához hasonlóan Magyarországon is. Az ARIA más nemzetközi innovatív szervezetek bevonásával olyan integrált betegellátási utakat fejlesztett ki, amelyek allergiás nátha, esetleg társbetegsége, az asztma esetén támogatják a kezelést. Ezeket újgenerációs irányelvek kidolgozása útján alkották, amelyekhez felhasználták a mobiltechnológiából és pollenkamra-vizsgálatokból származó valós evidenciákat is. A gyógyszeres terápia optimalizálásához a vizuális analóg skálán alapuló, úgynevezett Mobil Légúti Figyelő Hálózat algoritmusát digitalizálták, és valós evidenciák felhasználásával tovább finomították. Allergén immunterápiára az ARIA a világon elsőként dolgozott ki integrált betegellátási utakat 2019-ben. A kezelési irányelvekhez való adherenciaszint alacsony, a betegek a tüneteik erőssége alapján módosítják a kezelést. A flutikazon-propionát-azelasztin kombináció hatása erősebb az intranasalis kortikoszteroidokénál, míg az utóbbi hatásosabb az oralis H1-antihisztaminoknál. A mobiltelefonokban tárolt elektronikus napló vagy más 'mobile health' (mHealth) eszközök használata segíti a betegek kiválasztását allergén immunterápiára. Az ARIA által javasolt algoritmus megfelelőnek mutatkozott az allergiás rhinitis kezelésére, ezért ezek az irányelvek bekerülnek integrált betegellátási utakba, és részét fogják képezni az EU Egészségügyi és Élelmiszer-biztonsági Főigazgatósága digitalizált, személyközpontú gondozási anyagainak. Az allergén immunterápia hatékony az inhalatív allergének által okozott allergiás betegségekben, alkalmazását azonban korlátozni kell gondosan válogatott betegekre. Orv Hetil. 2020; 161(49): 2059-2071. Summary. The number of allergic patients is increasing all over the world, also in Hungary. Delivering effective and cost-effective health care is essential for all health care systems. ARIA (Allergic Rhinitis and its Impact on Asthma) aims to improve the care of patients who suffer from allergic rhinitis by setting up guidelines and updating them. Development of ICPs (integrated care pathways) can play an essential role in attaining this goal. Our aim is to make ICP-s developed by ARIA available also in Hungary, as is already the case in other countries of the European Union (EU). Together with other international initiatives, ARIA has worked out digitally-enabled ICPs to support care in allergic rhinitis and comorbid asthma. ICPs are based on new-generation guidelines using RWE (real-world evidence) from chamber studies and mobile technology. The MASK (Mobile Airways Sentinel NetworK) algorithm - based on visual analogue scale - was digitalized to support pharmacotherapy, and was refined by using RWE. ARIA was the first to develop ICPs for allergen immunotherapy (AIT) in 2019. Based on MASK data, patients did not follow guidelines and their adherence to treatment was poor. Patients would modify their treatments, depending on the disease control. The effect of fluticasone propionate-azelastine combination is superior to intranasal corticosteroids which are superior to oral H1-antihistamines. Electronic diaries obtained from cell phones and other 'mobile health' (mHealth) devices help select patients for AIT. The ARIA algorithm for AR was found appropriate and no change is necessary. These guidelines will inform ICPs and will be included in the DG Santé digitally-enabled, person-centred care system. AIT is an effective treatment for allergic diseases caused by inhaled allergens. Its use should, however, be restricted to carefully selected patients. Orv Hetil. 2020; 161(49): 2059-2071.

Otosclerosis is a bone remodeling disorder affecting exclusively the human temporal bone which causes small bony lesions in the otic capsule. The symptoms depend on the location and the extent of the otosclerotic foci. Hence, clinically the most relevant sign is the conductive hearing loss due to the stapedial otosclerosis with fixation of the stapes footplate. In many cases, the specific anamnestic features, the age of presentation and usually the absence of tympanic membrane pathology can provide a strong clinical suspicion for otosclerosis. Although audiometric and imaging examinations and VEMP testing can confirm our preoperative diagnosis, the histolopathologic examination of the removed stapes footplate is the most accurate way to determine the diagnosis. Orv Hetil. 2019; 160(51): 2007-2011.

Abstract: The endoscopic middle ear surgery as a new technique has been introduced during the past few years in our country and it is available in only a few hospitals. Beyond the lack of external incision, endoscopic transcanal approach provides wide field of view to previously hidden middle ear spaces compared to the traditional microscopic technique. In this case report, we present an endoscopic surgery of middle ear capillary haemangioma that is a rare entity in tympanic cavity, therefore little has been published in the literature. Generally, these kind of vascular tumours occur in the internal auditory canal or in the perigeniculate ganglion area while this lesion originated from the inner surface of the inferior part of the bony tympanic ring. We discuss the difficulties in differential diagnosis and imaging tests then the treatment options. Orv Hetil. 2019; 160(41): 1639–1643.

The endoscopic middle ear surgery as a new technique has been introduced during the past few years in our country and it is available in only a few hospitals. Beyond the lack of external incision, endoscopic transcanal approach provides wide field of view to previously hidden middle ear spaces compared to the traditional microscopic technique. In this case report, we present an endoscopic surgery of middle ear capillary haemangioma that is a rare entity in tympanic cavity, therefore little has been published in the literature. Generally, these kind of vascular tumours occur in the internal auditory canal or in the perigeniculate ganglion area while this lesion originated from the inner surface of the inferior part of the bony tympanic ring. We discuss the difficulties in differential diagnosis and imaging tests then the treatment options.

Otosclerosis can be found exclusively in the human otic capsule of the temporal bone. Its etiology is still unknown. In the past decades, several potential etiopathogenetic factors have been revealed, however, most studies were based on otosclerotic patients diagnosed by clinical symptoms only. The current experience indicates that one third of this group suffer from non-otosclerotic stapes fixation. In our experimental series, we have diagnosed and classified otosclerotic patients based on histologic examination, and analyzed also the pathogenetic factors. Recent data demonstrate that measles virus and rs1800472 SNP of transforming growth factor beta 1 (TGF1 beta) gene are marked obvious etiologic factors, which have no therapeutic consequences so far. Furthermore, we summarize the genetic and environmental factors to be found in the literature, which may play a fundamental role in the pathogenesis of otosclerosis.

Abstract: Otosclerosis can be found exclusively in the human otic capsule of the temporal bone. Its etiology is still unknown. In the past decades, several potential etiopathogenetic factors have been revealed, however, most studies were based on otosclerotic patients diagnosed by clinical symptoms only. The current experience indicates that one third of this group suffer from non-otosclerotic stapes fixation. In our experimental series, we have diagnosed and classified otosclerotic patients based on histologic examination, and analyzed also the pathogenetic factors. Recent data demonstrate that measles virus and rs1800472 SNP of transforming growth factor beta 1 (TGFβ1) gene are marked obvious etiologic factors, which have no therapeutic consequences so far. Furthermore, we summarize the genetic and environmental factors to be found in the literature, which may play a fundamental role in the pathogenesis of otosclerosis. Orv Hetil. 2018; 159(30): 1215–1220.