Background International guidelines recommend judicious antibiotic use for acute sore throat. However, inappropriate prescribing remains common across Southeast Asia, contributing to the region’s growing burden of antimicrobial resistance (AMR). This consensus statement provides a regionally harmonised framework to optimise adult sore throat management and strengthen antimicrobial stewardship. Methods A multidisciplinary panel of 13 healthcare experts from six Southeast Asian countries participated in a study employing a modified Delphi methodology. Based on a structured literature review, 12 preliminary statements were drafted addressing prescribing patterns, diagnostic strategies, and symptomatic treatments. The panel refined and voted on these statements. A priori consensus threshold was set as ≥ 70% agreement (10/13 experts), while strong consensus was set as ≥ 80% agreement. Results All 12 statements achieved strong consensus, with 92.3% to 100% agreement. The panel identified public misconception and physician diagnostic uncertainty as primary drivers of inappropriate prescribing. To minimise unwarranted antibiotics, the consensus recommends utilising the McIsaac score for clinical evaluation, combined with targeted point-of-care testing for patients with intermediate scores of 3 or 4. Empirical antibiotics are strictly reserved for maximum scores. Furthermore, the panel strongly endorsed prompt targeted symptomatic therapy including topical non-steroidal anti-inflammatory drugs, specifically flurbiprofen, as a crucial strategy to alleviate patient discomfort and potentially reduce unnecessary antibiotic use. Conclusions This regionally harmonised consensus bridges the gap between international guideline recommendations and the clinical realities of Southeast Asia. It empowers primary care practitioners to adapt objective risk-stratification and effective symptomatic management to their specific healthcare resource contexts, serving as the frontline defence against AMR.

Allergic Rhinitis and its Impact on Asthma (ARIA) was, up until 2017, a guideline using the best evidence (Grading of Recommendations, Assessment, Development and Evaluation, GRADE) and developed as a change management strategy. A second change management strategy-in collaboration with the European Academy of Allergy and Clinical Immunology (ARIA-EAACI)-was developed as a person-centred, digitally enabled, artificial intelligence-assisted care (person-centred care) with strong political involvement. The digital tools of ARIA are mainly based on MASK-air, an Organisation for Economic Co-operation and Development (OECD) Best Practice for integrated care for chronic diseases. Artificial intelligence was used, in particular, to approach the patients' views and expectations. The current paper describes the steps to build and achieve a new change management strategy. The future of the Change Management strategy is (i) a collaboration between ARIA and EAACI, (ii) the development of ARIA 2024-2025 guidelines, (iii) the new ARIA-MeDALL classification of multimorbid airway diseases and (iv) embedding MASK-air in a registry for severe allergic diseases. The ultimate goals of the ARIA-EAACI change management strategy will be (i) the transformation of health and care in rhinitis and asthma multimorbidity and (ii) the development of novel guidelines and policies in a cost-effective manner, improving shared-decision-making.

PURPOSE OF REVIEW:Botulinum toxin type A (BTX-A) is emerging as a promising intervention for refractory allergic rhinitis. This study evaluates its effectiveness in treating refractory allergic rhinitis. RECENT FINDINGS:The primary outcome was total nasal symptom score (TNSS), while secondary outcomes included individual nasal symptom scores, quality of life (QOL), and adverse effects. Five trials involving 187 patients (mean age: 31.8 years) were included. BTX-A significantly improved TNSS at 4 weeks [SMD -2.07, 95% confidence interval (95% CI) -3.58 to -0.56; P  < 0.001] and 12 weeks (SMD -2.42, 95% CI -4.22 to -0.62; P  < 0.001). Neither comparison of BTX-A with triamcinolone injection nor oral cetirizine showed a significant difference in TNSS (SMD - 0.51, 95% CI -1.25 to 0.24; P  = 0.18 and SMD 0.50, 95% CI -0.07 to 1.06; P  = 0.08, respectively). In the BTX-A group, significant improvements were observed in rhinorrhea (SMD -2.18, 95% CI -3.74 to -0.62; P  < 0.001), sneezing (SMD -1.88, 95% CI -2.60 to -1.15; P  < 0.001), and itchiness (MD -1.57, 95% CI -2.45 to -0.69; P  < 0.001) at 4 weeks, with these effects persisting up to 12 weeks. No serious adverse events occurred following BTX-A administration. SUMMARY:BTX-A shows promise as an adjunctive therapy for refractory allergic rhinitis.

Purpose of review Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogenous inflammatory disease that often persist despite optimal medical and surgical treatment. Advances in the understanding of CRS immunopathophysiology have led to the development of biologic therapies targeting specific inflammatory pathways. This review summarizes the current knowledge on the downstream biologics and the latest update on the next generation upstream biologics therapies in CRSwNP, with focus on endotype-driven treatment selection. Recent findings Biologic therapies targeting downstream mediators of type 2 inflammation, including immunoglobulin E and interleukins interleukin (IL)-4, IL-5 and IL-13, have demonstrated substantial clinical benefit in selected patients. Nevertheless, CRSwNP commonly involves overlapping inflammatory endotypes, which may limit treatment response. Newer biologics targeting upstream epithelial-derived cytokines offer broader approach by modulating multiple inflammatory pathways simultaneously and may address current therapeutic gaps. The development of long-acting biologics also improves treatment convenience and adherence. Summary Biologic therapy has shifted CRSwNP management towards a more personalized, mechanism-based approach. Upstream-targeted treatments represent an important step forward, particularly for patients with refractory or mixed disease. Future research should focus on biomarker-guided therapy and long-term clinical outcomes.

ABSTRACT Allergic Rhinitis and its Impact on Asthma (ARIA) was, up until 2017, a guideline using the best evidence (Grading of Recommendations, Assessment, Development and Evaluation, GRADE) and developed as a change management strategy. A second change management strategy—in collaboration with the European Academy of Allergy and Clinical Immunology (ARIA‐EAACI)—was developed as a person‐centred, digitally enabled, artificial intelligence‐assisted care (person‐centred care) with strong political involvement. The digital tools of ARIA are mainly based on MASK‐air, an Organisation for Economic Co‐operation and Development (OECD) Best Practice for integrated care for chronic diseases. Artificial intelligence was used, in particular, to approach the patients' views and expectations. The current paper describes the steps to build and achieve a new change management strategy. The future of the Change Management strategy is (i) a collaboration between ARIA and EAACI, (ii) the development of ARIA 2024‐2025 guidelines, (iii) the new ARIA‐MeDALL classification of multimorbid airway diseases and (iv) embedding MASK‐air in a registry for severe allergic diseases. The ultimate goals of the ARIA‐EAACI change management strategy will be (i) the transformation of health and care in rhinitis and asthma multimorbidity and (ii) the development of novel guidelines and policies in a cost‐effective manner, improving shared‐decision‐making.

Purpose of review This narrative review aims to summarize current evidence on thermal energy generation during endoscopic sinus surgery (ESS), with particular emphasis on the powered devices, their safe application, and an understanding of device-specific thermal characteristics. Recent findings Powered instrumentation has become integral to ESS, contributing to improved precision, efficiency, and visualization. However, different powered devices generate heat through distinct mechanisms related to their design, operating principles, and patterns of tissue interaction. Heat-related effects may occur during the use of microdebriders, coblation, radiofrequency, high-speed drills, and laser systems. The risk of thermal injury to sinonasal mucosa, bone, and adjacent critical structures is influenced by both device characteristics and operator-dependent factors, including activation time, contact time, and cooling techniques. Tissue injury depends not only on peak temperatures achieved but also on the duration and cumulative burden of heat exposure. Summary Appropriate selection and informed use of powered instruments are central to minimizing thermal risk in ESS. A thorough understanding of how different devices generate and dissipate heat, together with attention to modifiable operative factors, can enhance surgical safety and reduce the likelihood of thermal injury.

BACKGROUND:Oral and ocular medications are frequently used in the treatment of allergic rhinitis (AR). As part of the update of the Allergic Rhinitis and its Impact on Asthma (ARIA)-EAACI guidelines, this manuscript presents the ARIA-EAACI 2024-2025 recommendations for oral and ocular treatments. METHODS:The ARIA-EAACI 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgements and recommendations, including systematic reviews, mHealth and pharmacovigilance data as well as a survey on costs. RESULTS:Eight guideline questions concerning oral treatments for AR and three questions concerning ocular treatments were addressed. These questions led to the recommendations. Overall, these questions concern the choice between different classes of medication. They also discuss the role of oral antihistamines (OAH), leukotriene receptor antagonists (LTRA), ocular antihistamines (OcAH) and ocular mast cell stabilisers. Four questions had not been previously evaluated in ARIA guidelines, while, for the other four, there was a change in the strength or directionality of the recommendations. Overall, these guidelines recommend using intranasal corticosteroids over OAH and using OAH over LTRA. Moreover, they suggest using OAH over OcAH and suggest being against adding LTRA to OAH. Finally, considerations for choosing between different individual OAHs are presented. CONCLUSION:This ARIA-EAACI 2024-2025 article supports patients, their caregivers and healthcare professionals in choosing oral and ocular treatments for AR. Decisions on treatment should consider the clinical variability of the disease, patients' values and the affordability of medications.

INTRODUCTION: Chronic Rhinosinusitis (CRS) is a common condition causing a significant worldwide burden, affecting 5%-12% of the general population. The immunoregulatory mechanisms underlying eosinophilic and non-eosinophilic CRS with polyps (CRSwNP) remain incompletely understood, particularly with respect to regulatory T cells, FOXP3⁺. MATERIALS AND METHODS: Using immunohistochemistry, nasal polyp tissues from eosinophilic (ECRS) and non-eosinophilic (NECRS) CRSwNP patients were examined for FOXP3⁺ Treg expression, and symptoms and disease severity measures were obtained, including on quality of life. RESULTS: Comparative analysis along with clinical severity assessment did not demonstrate significant differences between eosinophilic and non-eosinophilic CRSwNP in FOXP3⁺ score (5.14 vs. 4.81, p=0.453), nasal polyp score (p=0.315), SNOT-22 (p=0.510), SST (p=0.295), or VAS (p=0.182), with small to medium effect sizes (Cohen’s d=0.25-0.50). Correlation analysis revealed no significant associations between FOXP3⁺ expression and clinical parameters, although SST showed a weak inverse association (ρ= –0.335, p=0.070). Significant correlations were observed between VAS and SNOT-22 (ρ= –0.549, p=0.0017) and between SNOT-22 and SST (ρ= –0.470, p=0.0088), indicating consistency between subjective and objective measures. CONCLUSION: These findings suggest that FOXP3⁺ regulatory T cell infiltration alone may not distinguish CRSwNP endotypes, underscoring the complexity of immune regulation beyond eosinophilic status. Larger, functionally focused studies are required to further elucidate the role of Tregs in CRSwNP.

To determine the clinical relevance of periostin as a biomarker in chronic rhinosinusitis with or without nasal polyps (CRSwNP or CRSsNP), with a focus on its utility in disease classification, evaluating disease burden, and monitoring therapeutic outcomes. A meta-analysis of 20 studies involving 2,869 patients demonstrated significantly elevated periostin levels in CRSwNP, particularly in patients with comorbid asthma. Serum periostin measurements were more consistent than tissue-based assays. Elevated periostin correlated with eosinophilic inflammation, higher sinus computed tomography opacity score, and overall disease burden. While it may play a role in assessing the effectiveness of treatment, its significance in biological therapy is not reliably shown. Periostin could serve as a useful addition to eosinophil counts when assessing type 2 inflammation in CRSwNP. It has the potential to aid in identifying patients with a substantial disease burden. However, its role in monitoring treatment response remains uncertain and needs more study. Future investigations should focus on its combined use with other biomarkers, relevance to treatment effectiveness, and establishing clinical cut-off points.

Purpose of review This review evaluates the current evidence on the effectiveness of platelet-rich plasma (PRP) as an adjuvant therapy to endoscopic sinus surgery (ESS) in adults with chronic rhinosinusitis with nasal polyps (CRSwNP). Recent findings Nine randomized controlled trials involving 488 participants were included. PRP significantly improved mucosal healing based on postoperative endoscopic scores, particularly when delivered via injection into the middle meatus or olfactory region. Borderline improvements in olfactory function were observed, with significant benefits when PRP was applied directly to the olfactory region. PRP consistently reduced postoperative pain, scarring or synechiae, bleeding, crusting and oedema. No significant improvement was found in health-related quality of life (SNOT-22). Heterogeneity across studies was substantial, largely due to variations in PRP preparation, delivery methods and outcome assessment. Summary PRP appears to be a promising adjunct to ESS, offering improvements in mucosal healing and postoperative recovery, with potential but uncertain benefits for olfactory outcomes. Standardized, larger-scale trials are needed to further define optimal administration and long-term efficacy.

INTRODUCTION:Medication availability and costs can be highly variable across countries and in different time periods. We aimed to conduct a survey among local experts to obtain information on the availability and costs of allergic rhinitis medications in different countries. METHODS:We sent a survey to members of the Allergic Rhinitis and its Impact on Asthma (ARIA) group, asking for the availability and the lowest cost of specific allergic rhinitis medications in their respective countries. Data in local currencies were converted to 2024 US Dollars adjusted for Purchasing Power Parity (PPP). We compared the costs of different medication classes, assuming, for each class, the least expensive drug in each country, as well as full treatment adherence. RESULTS:We received responses from ARIA experts in 51 different countries. Intranasal corticosteroids (INCS) and oral antihistamines (OAH) were available in all countries, but this was not observed for intranasal antihistamines (INAH) or for INAH+INCS. In most countries, OAH was the least costly drug class, while INAH+INCS was the most expensive. Among INCS, beclomethasone was the medication most frequently identified as the cheapest, while cetirizine and loratadine were the OAH most frequently reported as the least expensive. Among INAH+INCS, azelastine-fluticasone was more frequently identified as less costly than olopatadine-mometasone. CONCLUSION:There is an important across-country and across-class variability in terms of costs of allergic rhinitis medications. The results of this study will inform the ARIA-EAACI 2024-2025 guidelines.

Inflammatory nasal polyps (NPs) are a chronic condition of the nasal mucosa linked with prolonged airway obstruction, frequent infections, and immune dysregulation. While the exact mechanisms underlying NP development remain unknown, new research indicates that immune-regulatory pathways are essential. Forkhead box P3 (FOXP3) and Interleukin-35 (IL-35) have attracted much interest. In this narrative review, we examine how regulatory T cells (Tregs) release the potent immunosuppressive cytokine IL-35, suppressing effector T cell responses and encouraging Treg proliferation. Studies have shown that IL-35 is essential for preserving immunological homeostasis. FOXP3, a crucial transcription factor necessary for the development and maintenance of developing and maintaining immunological tolerance, controls the development and activity of Tregs. The pathophysiology of NPs is also included in this review, along with pertinent immunological indicators linked to the advancement of the condition. The balance between inflammatory and regulatory responses is upset in NP patients due to dysregulation of IL-35 and FOXP3, exacerbating chronic inflammation. Studying how they interact offers novel insight into the pathophysiology of NP and identifies potential curative approaches, such as Treg regulation and IL-35 supplementation. Parallel to this, pharmacological treatments such as corticosteroids and biologics (such as dupilumab) aim to reduce type 2 inflammation. FOXP3 and IL-35 play an important role in maintaining immunological homeostasis, and their dysregulation is associated with the persistent inflammation seen in NPs. Relying on these regulatory mechanisms may represent a promising therapeutic direction, although further experimental and clinical validation is required beyond existing anti-inflammatory therapies. Further investigation is necessary to confirm their clinical relevance.

Antimicrobial resistance (AMR) is exacerbated by the ongoing misuse of antibiotics for upper respiratory tract infections (URTIs), and it is vital to try and determine factors associated with antibiotic misuse. The Sore Throat and Antibiotic Resistance (STAR) study aims to evaluate public knowledge, perceptions, and behaviors to antibiotic use for acute URTIs and sore throat in Malaysia. A nationwide online survey was carried out in June 2024 among Malaysian adults who reported having sore throats with other URTI symptoms in the past six months using a random sampling method. A 26-item (plus 5 for screening) self-administered questionnaire, adapted from the Eurobarometer survey on AMR, was shared through the Toluna online panel. The questionnaire included four sections that covered demographic details, URTI symptom patterns, antibiotic use, and self-medication practices for symptomatic relief, as well as knowledge, perceptions, and behaviors about these practices. Among 1031 respondents, sore throat was the most common symptom (62

Allergic rhinitis (AR) is among the most prevalent allergic diseases in the world and has a large impact on quality of life, school performance, and work productivity. The aim of this exploratory study was to identify the genetic variants that might be associated with AR in the Malaysian population through whole-exome sequencing. A total of 13 AR patients and 10 healthy controls were recruited from the ENT Clinic at the Pusat Kanser Tun Abdullah Ahmad Badawi and Universiti Sains Malaysia Specialist Hospital. Whole-exome sequencing of genomic DNA was performed. To prioritize the variants, bioinformatic analysis was performed according to the American College of Medical Genetics (ACMG) guidelines, and potentially pathogenic variants were looked for. The 5 HLA-DRB1 variants identified (rs1059582, rs17882084, rs17879995, rs11554463, and rs188617679) were classified as potentially pathogenic or likely pathogenic, using ACMG criteria. Of these, rs1059582 had a statistically significant association with AR (P = .0457), which implies that it may be involved in susceptibility to AR. The present preliminary exploratory study revealed that a number of HLA-DRB1 variants, especially HLA-DRB1 rs1059582, are candidate genetic risk factors for AR in the Malaysian population. These results are preliminary and suggest that HLA-DRB1 may be a potential biomarker, but needs to be further validated in larger cohorts.

AIM: To review the success rates and complications of interventions for functional epiphora in adults. METHODS: A systematic review of English-language articles from the electronic databases PubMed, SCOPUS, and Google Scholar. The primary outcome was subjective resolution or improvement of epiphora symptoms. Secondary outcomes were treatment-related adverse events. Subjects above 18 years of age who underwent surgical or non-surgical treatment for functional epiphora (exhibited symptoms of epiphora with a patent lacrimal system) were included. Articles were excluded if they were 1) case reports; 2) abstract only studies; 3) published in a language other than English. Data extraction was performed independently by two authors. The Effective Public Health Practice Project checklist was used for quality assessment of the included studies. RESULTS: A total of 762 articles were identified; 28 met the study criteria. Most studies employed silicone tube intubation alone or as an adjuvant procedure to dacryocystorhinostomy (DCR). Other interventions included lacrimal probing, balloon dacryoplasty, lateral tarsal strip and botulinum toxin A. DCR had the highest success rate, as well as the longest mean follow-up time. Complications were minor, transient, and mostly stent-related. CONCLUSION: This updated systematic review on the success rates of interventions for functional epiphora in adults proposes the following management algorithm. Dacryocystography (DCG) should be performed in all patients with functional epiphora. If DCG is abnormal, we advocate DCR. If DCG is normal, proceed with dacryoscintigraphy (DSG). We perform DCR for post-sac delay on DSG and lateral tarsal strip for pre-sac delay. Botulinum toxin A is an off-label, short-term treatment option in those with normal DSG.

Background Biofilm has been identified as the contributing factor for refractory chronic rhinosinusitis with nasal polyposis (CRSwNP). Nasal douching using baby shampoo was thought to be effective in patients with CRSwNP. We aimed to study the in-vitro reduction of biofilm using diluted 1% baby shampoo. Methods Sixty nasal polyps taken from patients who met the inclusion and exclusion criteria were sent for histopathological examination using haematoxylin and eosin staining. Another portion of the same samples was sent for tissue culture and tissue culture plate assay to identify S. aureus and P. aeruginosa and determine their biofilm forming capacity. The efficacy of diluted 1% baby shampoo versus normal saline was tested on the biofilm in vitro where the optical density readings were compared pre- and post-treatment. Results The prevalence of biofilm in patients with CRSwNP is 21.7%. Thirteen samples were positive for biofilm; P. aeruginosa 23% (n = 3), S. aureus 15% (n = 2), no bacterial growth 54% (n = 7) and others 8% (n = 1). Biofilm formation was significant in both S. aureus and P. aeruginosa (p < 0.001) whilst a significant reduction of biofilm was seen in diluted 1% baby shampoo (p = 0.043). Conclusion In conclusion, diluted 1% baby shampoo is an effective treatment in the reduction of biofilm for CRSwNP.

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) impacts patients' concentration, ability to work, and overall quality of life. Current treatment options include topical and oral medications, and surgery. Recent evidence supports the efficacy of biologics in improving symptoms and quality of life. This study addresses the lack of consensus in the ASEAN region, providing guidance for otolaryngologists on appropriate CRSwNP management.Methods A modified Delphi panel was conducted to gather expert opinion and establish consensus on the use of biologics and management of CRSwNP among otolaryngologists in the ASEAN region. Statements were developed based on a literature review and inputs from a Steering Committee of eight experts from Malaysia, Singapore, and Thailand. A three-stage process was utilized for consensus generation: two online surveys for voting by at least 12 panelists from seven ASEAN countries, followed by moderated online Consensus Meetings with the Steering Committee.Results Consensus was achieved on 61/69 statements (88%). In Rounds 1 and 2, 37/67 statements (55%) and 13/28 statements (46%) achieved consensus, respectively. During the moderated Consensus Meetings, consensus was achieved on 12/16 statements (75%). Key aspects addressed include symptoms, comorbidities, diagnosis, and treatment pathways, with a focus on biologics. Eligibility criteria and considerations for biologic use were also defined.Conclusions Insights from this Delphi consensus provide guidance on biologic use for managing CRSwNP in the ASEAN region. Future efforts, such as developing a regional guideline, continued medical education, and further research are essential for appropriate biologic use.

Background Allergic rhinitis (AR) impacts quality of life, work and school productivity. Over the last years, an important body of evidence resulting from mHealth data has led to a better understanding of AR. Such advances have motivated an EAACI-endorsed update of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (ARIA 2024-2025). This manuscript presents the ARIA 2024-2025 recommendations for intranasal treatments, one of the mainstays for AR management.Methods The ARIA 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgments and recommendations, including systematic reviews, evaluation of mHealth and pharmacovigilance data, as well as a survey of experts on costs.Results Eleven guideline questions concerning intranasal treatments for AR were prioritized, leading to recommendations. Overall, these questions concern the choice between different classes of intranasal medications-most notably, intranasal corticosteroids (INCS), antihistamines (INAH), fixed combinations of INAH+INCS and decongestants-or between different individual medications within each class. Four questions had not been evaluated in previous ARIA guidelines, while for the other three there was a change in the strength or directionality of recommendations. Overall, recommendations point to the suggested use of INAH+INCS over INAH or INCS and INCS over INAH.Conclusion This ARIA 2024-2025 article supports patients, their caregivers, and healthcare professionals in choosing an intranasal treatment. However, decisions on AR treatment should consider the clinical variability of the disease, patients' values, and the affordability of medications.

Purpose of review Although biologics had been used to treat CRSwNP, not all patients respond favourably, necessitating the use of other biologics. As there are currently no guidelines available, the process and rationale for switching biologic therapy in the treatment of CRSwNP are examined in this review. Recent findings Due to the heterogeneity of diseases, biologic therapies may efficiently control CRSwNP but give inadequate control for asthma, or vice versa. Changing an ineffective first-line biologic to a second-line treatment or others is generally referred to as switching. The most common reasons for switching biologics are poor symptom management or ineffectiveness, and undesirable adverse effects. The ineffectiveness was largely due to the use of omalizumab or mepolizumab, whereas the adverse effects were due to dupilumab. Summary Switching biologics is a nuanced process influenced by a variety of patient-specific and clinical factors. Biologics that effectively treat upper and lower airway diseases are recommended for optimal control in CRSwNP patients with concurrent asthma. There was no difference in outcomes between switching biologics with and without a washout period. Switching between biologics in the same class is generally not recommended. Dupilumab serves as an effective treatment option for refractory cases particularly aspirin-exacerbated respiratory disease.

Olfactory disorder (OD) is a common but often underdiagnosed symptom in patients with chronic rhinosinusitis (CRS). As the sense of smell contributes significantly to life quality, appetite, safety, and emotional well-being, its impairment can profoundly impact daily functioning. Despite its importance, OD remains a neglected symptom in routine CRS assessment, with limited attention given to its actual burden globally. Various studies have suggested that the prevalence of OD in CRS is high, yet the estimates vary widely depending on the population, diagnostic methods, and definitions used. This inconsistency calls for a more comprehensive approach to understanding the scale of the problem. This study aims to determine the worldwide occurrence of olfactory disorder amidst patients with chronic rhinosinusitis through a systematic review with meta-analysis. Using predefined eligibility criteria, after screening by title and abstract, 50 documents were identified. Then, these documents were subjected to full-text review. Twenty-nine studies were deemed eligible and added to the meta-analysis following the application of the final inclusion and exclusion criteria. The studies varied in geographical origin, patient characteristics, and methods of olfactory assessment. The analysis revealed that the overall global prevalence of olfactory disorder among CRS patients was 72.5