AbstractObjectiveNicotine‐containing products have historically been tobacco derivatives like cigarettes, cigars, and dip. Recently, tobacco‐free nicotine (TFN) products have been marketed as a healthy alternative. TFN pouches are small, discreet, flavored pouches containing nicotine designed to be placed between the gum and lip. This product does not fit a conventional tobacco category, leading to inaccurate reporting. This study aims to investigate discrepancies in physician documentation of TFN pouches.MethodsA retrospective chart review was conducted on TFN users.SettingSingle Health Care System.MethodsStatistical analyses assessed TFN documentation concordance between social history templates and physician notes.ResultsThere were 150 patients who used TFN and 841 patients who vaped. Concordance was higher for vape documentation than TFN pouch documentation (55.9%, 470/841 vs 25.3%, 38/150; P < .001). Of those who used TFN, 60% (90/150) were classified as “Smokeless Tobacco Users” in the social history; however, 35 were inaccurately classified as chew, and 17 did not specify TFN use. Only 38 specified TFN use; only 25% (38/150) of records demonstrated concordance.ConclusionOnly 25% of records were concordant with physician notes, highlighting the need for a designated place for TFN use within social history templates. Nicotine use history is crucial in the setting of microvascular reconstruction and cosmetic surgeries. Thus, accurate reporting is crucial for future research on the long‐term effects of TFN. This study's findings underscore a deficit in current social history templates and the need to recognize TFN pouches as distinct entities.

BACKGROUND:Priming is a psychological phenomenon where subconscious cues in the environment impact our behavioral responses in certain situations. Well studied in the worlds of business, marketing, and even politics, it is unclear how the priming phenomenon impacts patient perception of their own disease state nor how they report that perception using tools like the Sinonasal Outcomes Test (SNOT-22), used to measure that perception in chronic rhinosinusitis. OBJECTIVE:To determine the impact of positive or negative priming on self-reported patient perception of their chronic rhinosinusitis disease using the SNOT-22 disease-specific quality of life instrument. METHODS:Single-blind, randomized, prospective cohort pilot study of 206 consecutive adult patients with a clinical diagnosis of chronic rhinosinusitis presenting to a university rhinology clinic. Patients were randomized to receive "positive priming" (103) or "negative priming" (103) by reading a passage about the positive or negative aspects of chronic sinusitis and its treatment respectively. Patients were then asked to fill out the SNOT-22 and results between the two groups were compared. RESULTS:The negative priming group had a higher median SNOT-22 score of 49 [IQR = 39] compared to the positive priming groups' score of 22 [IQR = 27], p < 0.0001), a difference of nearly three times the minimal clinical impactful difference (MCID). This effect was consistent regardless of age or sex of the patient. Subgroup analysis revealed a greater impact when priming was performed by the senior male attending regardless of patient age or sex (p < 0.001), while priming performed by the younger female research fellow had greater impact on older patients (>59 years, p = 0.001) and female patients (p = 0.003). CONCLUSIONS:Priming impacts how patient's perceive their chronic rhinosinusitis as determined by the SNOT-22. It is imperative that the rhinologist understand this when using this instrument in research applications and in clinical decision-making for patients.

INTRODUCTION:Over the last 3 years, the FDA has approved dupilumab, omalizumab, and mepolizumab for the treatment of CRSwNP; however, adverse events of these biologics have not been described in post-marketing surveillance trials. By utilizing the FDA Adverse Event Reporting System (FAERS), this study describes and compares biologic-associated adverse events in T2 disease.METHODS:This case-non-case study assessed disproportionate reporting rates using reporting odds ratios (RORs). RORs and p values for biologic-associated AEs were categorized and compared among dupilumab, omalizumab, and mepolizumab. This analysis included AEs associated with all treatment indications. Relative AE rates and outcomes were calculated.RESULTS:There were a total of 112,560, 24,428, and 18,741 unique AE reports associated with dupilumab, omalizumab, and mepolizumab, respectively. Omalizumab had the strongest association with anaphylaxis (ROR = 20.80, 95% confidence interval [CI]: 18.58, 23.29). Dupilumab had large relative proportions and positive signals in the ophthalmologic category (7.76%, ROR = 6.20, 95% CI: 6.06, 6.35), such as with blurry vision (ROR = 3.80, CI: 3.52, 4.12) and visual impairment (ROR = 1.98, CI: 1.80, 2.19). Dupilumab was the only biologic associated with injection-site reactions (7.98%, ROR = 8.17, 95% CI: 7.98, 8.37).DISCUSSION/CONCLUSION:This is the first large-scale comparative analysis of the AE profiles of dupilumab, omalizumab, and mepolizumab. Our data suggest possible relations between dupilumab and ophthalmologic and injection-site AEs. Omalizumab was the only biologic with a positive anaphylaxis signal. This FAERS investigation suggests important AE differences among these biologics.

Granulomatosis with polyangiitis is a rare autoimmune disease that affects small to medium-sized blood vessels throughout the body. Here, we present a case of an infratemporal mass that was the result of granulomatosis with polyangiitis. A 51-year-old male presented to the emergency department due to right cheek and facial pain that he had been experiencing for 2 to 3 months. An MRI revealed a mass within the right infratemporal and pterygopalatine fossae extending into the inferior right orbital fissure along the maxillary division of the trigeminal nerve (V2) and the vidian nerve causing concern for malignancy. Histology from an endoscopic biopsy demonstrated multiple arteries with luminal obliteration with non-necrotizing granulomas. The patient was started on steroids and immunosuppressive therapy, which improved his symptoms and decreased the size of the residual mass. This case illustrates the need for laboratory testing, imaging, and biopsy of the involved tissue in cases where GPA is suspected to prevent treatment delays that could lead to the destruction of vital organs.

Background:A subset of individuals suffering from Coronavirus Disease 2019 (COVID-19) will experience ongoing symptoms that last longer than three months (i.e., long-haul COVID). This includes olfactory dysfunction (OD), which is currently estimated to occur in 1-63.5% of patients at one-year post-infection. However, OD in individuals with long-haul COVID-19 is poorly understood, and there is little information regarding how initial SARS-CoV-2 variants correlate with long-haul symptoms. In this study, we investigated the prevalence and severity of OD in patients with long-haul COVID-19 and investigated how OD severity varied with SARS-CoV-2 variants.Methods:Patients were recruited from the University of North Carolina-Chapel Hill COVID Recovery Clinic. Each patient completed the University of Pennsylvania Smell Identification Test (UPSIT). The dominant strain at the time of infection was determined using the date of COVID-19 diagnosis, and Centers for Disease Control and Prevention, World Health Organization, and North Carolina Department of Health and Human Services databases.Results:Nearly 85% of patients with long-haul COVID-19 reported some degree of OD, which persisted in some patients for two or more years from the date of the initial infection. There was no association between the time since COVID-19 infection and severity of OD. No difference was detected between OD in patients with long-haul COVID-19 based on the dominant variant at the time of infection (p=0.0959).Conclusion:A vast majority of patients with long-haul COVID-19 had some degree of ongoing olfactory complications, although the severity of symptoms was not dependent on the dominant SARS-CoV-2 variant at the time of infection.

KEY POINTS:We present the largest cohort of structured histopathology reports on primary ciliary dyskinesia-related chronic rhinosinusitis (PCD-CRS). Despite endoscopic differences, PCD-CRS and cystic fibrosis-related chronic rhinosinusitis (CF-CRS) had similar structured histopathology reports. Compared to healthy patients and those with idiopathic chronic rhinosinusitis without nasal polyps, patients with PCD-CRS had an increased neutrophil count.

International Forum of Allergy & RhinologyEarly View CLINICAL LETTER Cranial nerve zero: What the rhinologist needs to know Ibtisam Mohammad MD, Corresponding Author Ibtisam Mohammad MD [email protected] Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA Department of Otolaryngology, Gazi University, Ankara, Turkey Correspondence Ibtisam Mohammad, MD, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, CB 7070, Chapel Hill, NC 27599-7070, USA. Email:[email protected]Search for more papers by this authorKazuhiro Omura MD, Kazuhiro Omura MD orcid.org/0000-0002-4337-4745 Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA Department of Otolaryngology, Jikei University, Tokyo, JapanSearch for more papers by this authorTaylor Stack BS, Taylor Stack BS orcid.org/0000-0002-6014-3308 Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this authorAbdullah Zeatoun MD, Abdullah Zeatoun MD Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this authorMeghan Norris PA, Meghan Norris PA Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this authorSulgi Kim BS, Sulgi Kim BS Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this authorMeredith Lamb BS, Meredith Lamb BS Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this authorAdam Kimple MD, PhD, Adam Kimple MD, PhD Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this authorBrent Senior MD, Brent Senior MD orcid.org/0000-0002-1503-3150 Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this author Ibtisam Mohammad MD, Corresponding Author Ibtisam Mohammad MD [email protected] Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA Department of Otolaryngology, Gazi University, Ankara, Turkey Correspondence Ibtisam Mohammad, MD, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, CB 7070, Chapel Hill, NC 27599-7070, USA. Email:[email protected]Search for more papers by this authorKazuhiro Omura MD, Kazuhiro Omura MD orcid.org/0000-0002-4337-4745 Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA Department of Otolaryngology, Jikei University, Tokyo, JapanSearch for more papers by this authorTaylor Stack BS, Taylor Stack BS orcid.org/0000-0002-6014-3308 Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this authorAbdullah Zeatoun MD, Abdullah Zeatoun MD Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this authorMeghan Norris PA, Meghan Norris PA Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this authorSulgi Kim BS, Sulgi Kim BS Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this authorMeredith Lamb BS, Meredith Lamb BS Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this authorAdam Kimple MD, PhD, Adam Kimple MD, PhD Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this authorBrent Senior MD, Brent Senior MD orcid.org/0000-0002-1503-3150 Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USASearch for more papers by this author First published: 14 April 2023 https://doi.org/10.1002/alr.23166Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Fields RD. Sex and the secret nerve. Sci Am Mind. 2007; 18: 20-27. 2Fritsch G. 1878, cited in Vilensky J. Clin Anat. 2014; 27: 46-53. 3Vilensky JA. Devries 1905, cited in Vilensky J. Clin Anat. 2014; 27: 46-53 4Vilensky JA. Johnson, 1914, cited in Vilensky J. The neglected cranial nerve: nervus terminalis (cranial nerve N). Clin Anat. 2014; 27: 46-53. 5Whitmore I. Terminología Anatómica: new terminology for the new anatomist. Anat Rec. 1999; 257: 50-53. 6Peña-Melián Á, Cabello-de la Rosa JP, Gallardo-Alcañiz MJ, et al. Cranial pair 0: the nervus terminalis. Anat Rec (Hoboken). 2019; 302: 394-404. 7Lopez-Ojeda W, Hurley RA. Cranial nerve zero (CN 0): multiple names and often discounted yet clinically significant. J Neuropsychiatry Clin Neurosci Spring. 2022; 34(2): 94-99. 8Wirsig CR, Leonard CM. 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KEY POINTS:Left-hand-dominant (LHD) respondents reported higher rates of training difficulties because of handedness differences. LHD respondents cited particular difficulty with functional endoscopic sinus surgery. Both LHD and right-hand-dominant respondents perceived a need for laterality-specific training during residency.