Dysthyroid optic neuropathy (DON) is a vision-threatening complication of Graves’ ophthalmopathy, and insufficient orbital decompression may result in persistent or irreversible visual impairment. While endoscopic transnasal orbital decompression (ETOD) has become a mainstream surgical approach for orbital decompression, the optimal extent of ETOD remains incompletely defined, particularly regarding reproducible anatomical landmarks and safe surgical boundaries. This retrospective study evaluated patients with DON who underwent an extended ETOD procedure at a tertiary medical center. The surgical technique involved decompression of the medial, inferior, and superior orbital walls, with standardized anterior, posterior, superior, and inferior anatomical landmarks. Clinical characteristics, imaging findings, treatment outcomes were reviewed before surgery and during postoperative follow-up. Factors associated with improvement in visual acuity and exophthalmos were further explored. Most affected eyes showed postoperative improvement in visual acuity, accompanied by reductions in exophthalmos, intraocular pressure, and lagophthalmos. The extended procedure did not result in major surgical complications or new-onset diplopia. Younger age, poorer preoperative visual acuity, and shorter duration of visual impairment were associated with greater visual recovery, while more severe baseline exophthalmos was associated with greater reduction in exophthalmos. By contrast, diabetes appeared to be associated with less exophthalmos improvement. Extended ETOD appears to be a safe and effective surgical strategy for DON. By defining clear anatomical boundaries, this standardized decompression approach may provide clinicians with effective and reproducible surgical guidance and thereby improving patients’ prognosis and psychosocial well-being.

The prevalence of allergic rhinitis (AR) continues to rise, severely impairing patients’ quality of life and causing enormous social and economic burdens. For refractory AR that cannot be adequately controlled by standardized firstline therapies, neurotomy has become an important secondline therapeutic option. However, due to various remaining controversial issues, there is currently a lack of internationally unified clinical guidelines, which restricts its clinical application and generalization. To better guide the clinical practice of neurotomy for AR in China, 49 experts in the field of rhinology and allergy nationwide, led by the Third Affiliated Hospital of Sun Yat-sen University, carried out the work of formulating a consensus. Using the Delphi method, we focused on seven dimensions: the purpose and significance of neurotomy for AR, relevant applied anatomy, pathophysiological basis, surgical indications and contraindications, surgical techniques, efficacy and evaluation criteria, and surgical complications and their management, ultimately generating a series of core viewpoints. This consensus is expected to further promote the standardized development of neurotomy for AR in China, and help improve the overall prevention and management of AR.

This study aimed to examine the clinical features and assess the surgical outcomes of traumatic optic neuropathy in pediatric patients. A retrospective analysis was conducted on the clinical data of 15 cases (17 eyes) of traumatic optic neuropathy in pediatric patients aged 1 to 6 years between January 2015 and July 2024. Two of them presented with binocular trauma, resulting in a total of 17 affected eyes. The injuries were attributed to various causes: 4 cases resulted from falls, 5 from car accidents, and 6 from localized impact trauma. Of the 15 patients (17 eyes), 10 patients (12 eyes) demonstrated postoperative improvement. Preoperatively, 3 eyes had residual vision, all of which revealed improvement following surgery. Among the 14 eyes with no light perception, 9 exhibited postoperative improvement. In one case (1 eye), where the interval between trauma and surgery was within 7 days, treatment was effective postoperatively. In 14 cases (16 eyes), where the interval exceeded 7 days, 11 eyes revealed postoperative improvement. Radiologic examination revealed optic canal fractures or optic nerve swelling in 6 cases. All patients underwent surgical intervention: 1 patient (1 eye) underwent transnasal endoscopic left orbital apex decompression combined with left periorbital hematoma evacuation, while 14 patients (16 eyes) underwent transnasal endoscopic optic nerve decompression. Imaging assessments should be integrated into the diagnostic process to help in selecting the most appropriate surgical approach for pediatric patients with traumatic optic neuropathy. Transnasal endoscopic optic nerve decompression significantly enhances the prognosis in these cases.

Non-steroidal anti-inflammatory drugs-exacerbated respiratory disease （N-ERD） is a chronic respiratory disease characterized by eosinophilic inflammation, featuring chronic rhinosinusitis （CRS）, asthma, and intolerance to cyclooxygenase 1 （COX-1） inhibitors. The use of these medications can lead to an acute worsening of rhinitis and asthma symptoms. This condition has not yet received sufficient attention in China, with a high rate of misdiagnosis and a lack of related research. The Chinese Rhinology Research Group convened a group of leading young experts in otolaryngology from across the country, based on the latest domestic and international evidence-based medical practices to formulate this consensus.The consensus covers the epidemiology, pathogenesis, clinical manifestations, diagnostic methods, and treatment strategies for N-ERD, including pharmacotherapy, surgery, biologic treatments, and desensitization therapy. The goal is to improve recognition of N-ERD, reduce misdiagnosis, and enhance treatment outcomes.

Background: Allergic rhinitis (AR) is a common hyperreactive nasal disease in otolaryngology, mainly manifested as rhinorrhea, nasal obstruction, nasal itching, and sneezing. Despite medication and immunotherapy, a large proportion of patients do not completely eliminate rhinorrhea. In recent years, the use of nasal anticholinergics in the treatment of AR has gained attention. However, there is currently no consensus on the timing and selection of nasal anticholinergics for AR treatment. Summary: We reviewed previous studies on nasal anticholinergic drugs in AR and summarized the pathogenesis of AR, the role of anticholinergic drugs, cholinergic neural pathways, the mechanisms of nasal anticholinergic drugs, common types and clinical efficacy of nasal anticholinergic drugs, and precautions for their use. We also provided some suggestions for their clinical application. Key Messages: At present, the main drugs of nasal anticholinergics are ipratropium bromide and phencyquine bromide. The cholinergic nervous system is the main neural pathway mediating nasal secretion. Anticholinergic drugs work by blocking the interaction between Ach and the high density of M receptors in the nasal cavity. The clinical effect of nasal anticholinergics is generally good, and there are almost no major or systemic adverse reactions. Nasal anticholinergics provide a more complete treatment for AR patients with poorly controlled rhinorrhea. In the future, nasal anticholinergics will be assessed in high-quality clinical trials and applied clinically.

鼻部炎症性疾病临床主要包括变应性鼻炎(AR)、非变应性鼻炎(NAR)和慢性鼻窦炎(CRS),其发病机制尚未完全阐明,涉及遗传学、免疫调节、炎症介质、环境因素、微生物群状态等多方面,传统药物治疗后部分患者症状仍无法缓解或出现不必要的副作用,且容易反复发作或呈慢性持续状态,因其发病多与免疫失衡相关,免疫调节是一个有效的治疗方案.近年来,免疫调节剂的品种和应用越来越广泛,主要包括化学合成制剂、生物制剂、人和动物免疫系统的产物、中药及其制剂等.但免疫调节剂治疗鼻部炎症疾病缺乏高水平的循证医学证据,使用尚不规范,因此,我们特组织该领域有经验的中青年鼻科专家,基于临床经验和循证医学证据制定了免疫调节剂治疗鼻部炎症性疾病专家共识,本共识从鼻部炎症性疾病发病机制角度出发,系统总结了鼻炎及CRS常用免疫调节剂的免疫作用机制、临床研究证据、适应证、用法用量及注意事项等,以供临床医生在选择和应用免疫调节剂时参考.

Background: Chronic rhinosinusitis (CRS) is a common inflammatory disease in otolaryngology, mainly manifested as nasal congestion, nasal discharge, facial pain/pressure, and smell disorder. CRS with nasal polyps (CRSwNP), an important phenotype of CRS, has a high recurrence rate even after receiving corticosteroids and/or functional endoscopic sinus surgery. In recent years, clinicians have focused on the application of biological agents in CRSwNP. However, it has not reached a consensus on the timing and selection of biologics for the treatment of CRS so far. Summary: We reviewed the previous studies of biologics in CRS and summarized the indications, contraindications, efficacy assessment, prognosis, and adverse effects of biologics. Also, we evaluated the treatment response and adverse reactions of dupilumab, omalizumab, and mepolizumab in the management of CRS and made recommendations. Key Messages: Dupilumab, omalizumab, and mepolizumab have been approved for the treatment of CRSwNP by the US Food and Drug Administration. Type 2 and eosinophilic inflammation, need for systemic steroids or contraindication to systemic steroids, significantly impaired quality of life, anosmia, and comorbid asthma are required for the use of biologics. Based on current evidence, dupilumab has the prominent advantage in improving quality of life and reducing the risk of comorbid asthma in CRSwNP among the approved monoclonal antibodies. Most patients tolerate biological agents well in general with few major or severe adverse effects. Biologics have provided more options for severe uncontrolled CRSwNP patients or patients who refuse to have surgery. In the future, more novel biologics will be assessed in high-quality clinical trials and applied clinically.

Objective:By simulating transnasal endoscopic resection of nasolacrimal duct and lacrimal sac on cadaveric specimens with vascular perfusion,the basic process of this procedure and the anatomical relationship between nasolacrimal duct and lacrimal sac were explored,providing anatomical basis for clinical application.Methods:Five adult cadaver head specimens（10 sides in total） were used for anatomical study.The nasolacrimal duct and lacrimal sac were exposed under transnasal endoscopy,and the anatomical landmarks and their relationship with adjacent areas during the resection of nasolacrimal duct and lacrimal sac were observed.Results:Ten sides of nasolacrimal duct and lacrimal sac showed that all lacrimal sacs were located anterior and slightly lateral to the nas al mound.The roof of lacrimal sac was almost the same height as the roof of nasal mound.The body of lacrimal sac was almost located above the horizontal line of the middle turbinate axilla.The posterior inner wall of the lacrimal fossa was composed of lacrimal bone.The posterior inner side of the lacrimal bone was adjacent to the agger nasi cell.The bottom of the lacrimal sac moved downward as the membranous part of the nasolacrimal duct located in the bony part of the nasolacrimal duct.The projection of the nasolacrimal duct on the lateral nasal wall was located about 3-7 mm in front of the anterior edge of the vertical part of the uncinate process.The distance between the inferior meatus opening of the nasolacrimal duct and the anterior end of the inferior turbinate was（16±3） mm.The length of the lacrimal sac was（13.8±1.8） mm,and the length of the nasolacrimal duct was（23.2±3.6） mm.Conclusion:The transnasal endoscopic approach can fully expose and resect the nasolacrimal duct and lacrimal sac.The basic operation process and anatomical landmarks demonstrated in this anatomical study provide an anatomical reference for the clinical development of transnasal endoscopic resection of nasolacrimal duct and lacrimal sac.

面对新型冠状病毒肺炎(COVID-19)疫情在世界范围内大流行的严峻局面,加强个人防护成为抗击疫情的重要一环.在疫情流行的现阶段,以鼻腔为代表的上呼吸道病毒感染的预防与治疗已成为防控重点,除了规范佩戴口罩外,鼻腔盐水冲洗作为常用的鼻腔局部物理疗法,能减少病毒感染并加快炎症恢复,成本低且副作用小,可作为防治新型冠状病毒(SARS-CoV-2,简称新冠病毒,又称2019-nCoV)感染的经济、有效手段.为了有力抗击疫情,维护人民健康,中国鼻病研究协作组召集国内中青年鼻科专家,基于临床经验和循证医学证据制订了鼻腔盐水冲洗预防新冠病毒感染的专家共识.本共识在系统总结鼻腔生理功能和鼻腔盐水冲洗治疗机制的基础上,提出了一系列规范化操作建议,旨在指导鼻腔盐水冲洗的临床应用,以期更经济、有效地防治新冠病毒感染.

变应性鼻炎(AR)是一种变应原致敏和激发引起的、有神经介质参与的特异性IgE介导的、Th2类型鼻黏膜慢性炎症.AR的外科手术作为二线治疗手段,能够有效改善顽固性鼻塞和鼻黏膜高分泌及高敏感性反应,临床上推荐酌情使用.但目前AR的外科手术还存在一些争议性问题,诸如适应证的选择、并发症规避及疗效评价等.有鉴于此,中国鼻病研究协作组召集国内中青年鼻科专家,基于临床经验和循证医学证据制订了AR的外科手术治疗专家共识.本共识从AR手术治疗历史、相关解剖与生理病理学原理等角度出发,系统总结了AR手术治疗中的相关机制、手术方式与适应证选择,以及并发症处理与注意事项等,旨在指导并规范临床医师开展AR外科手术治疗,以期进一步拓展AR的治疗方式并提高相应的治疗疗效.

鼻用减充血剂可以快速缓解鼻塞,但长期过量使用可导致药物性鼻炎.目前临床上对鼻用减充血剂的使用和药物性鼻炎的治疗还存在很多误区.鉴于此,中国鼻病研究协作组召集国内中青年鼻科专家,基于临床经验和循证医学证据制订了鼻用减充血剂的临床应用暨药物性鼻炎的诊治专家共识.本共识系统总结了临床应用鼻用减充血剂治疗鼻塞的注意事项及药物性鼻炎的治疗原则,旨在指导并规范临床应用鼻用减充血剂,并正确有效地治疗药物性鼻炎.

Background: Nowadays, the heterogeneity of chronic rhinosinusitis (CRS) has attracted extensive attention. The histological patterns and clinical characteristics may vary greatly in different areas and among different groups of people. Prior studies found a shift from the neutrophilic inflam-matory pattern to the eosinophilic inflammatory pattern in Asian cities. This study set out with the aim of investigating the changes that have occurred in the past 18 years of southern China and exploring the causes. Methods: Tissues, clinical, and demographic characteristics were obtained from 473 patients (91 in 2000-2001, 170 in 2010-2011, 212 in 2017-2018) who satisfied the criteria of diffuse (bilateral) chronic rhinosinusitis. The clinical characteristics, including the previous history of allergic rhinitis and asthma, and the major symptoms of rhinosinusitis, were collected. Formalin-fixed nasal tissue was obtained from each patient for calculating inflammatory cells. We also performed immuno-histochemistry to evaluate the expression levels of eosinophilic cationic protein (ECP), IgE, mye-loperoxidase (MPO), and other Type 1, Type 2, and Type 3 related inflammatory cytokines. Results: The comorbidity of asthma and atopic disease was higher in 2017-2018 compared to 2000-2001. The histological characteristics revealed a significant increase in tissue eosinophils and decrease in neutrophils in 2017-2018 as compared with 2000-2001. Meanwhile, the proportion of eosinophilic CRS (eCRS) increased significantly from 2000 to 2001 to 2017-2018 (P = 0.03). The tissue eosinophil increase was higher in overweight patients (Body Mass Index, BMI >= 24) as compared with non-overweight. There was an increasing trend of ECP, IL-13 and IL-17. Besides, IFN-gamma and TNF-alpha decreased. Conclusions: There was an eosinophilic shift of diffuse rhinosinusitis inflammatory pattern in southern China over the last 18 years. The proportion of eCRS and difficult-to-treat rhinosinusitis has steadily increased, which is associated with the increase of Type 2, Type 3 cytokines and the decrease of Type 1 cytokines. This study also provided firstly evidence of a strong relationship between overweight and eosinophil shift in the southern Chinese population.

Glucocorticoids are the first-line medical treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), whose local metabolism is catalyzed by 11β-HSD1 and 11β-HSD2. This study investigates the role of 11β-HSD1 and 11β-HSD2 on the glucocorticoid response of CRSwNP patients and the pathogenic mechanism of these polyps.

目的 观察不同浓度维替泊芬对鼻咽癌细胞株CNE1增殖、侵袭、凋亡、细胞周期的影响,并探讨及其机制.方法 取对数生长期CNE1细胞分为实验组和对照组,实验组分别加入1、2、4μmol/L的维替泊芬,记为A、B、C组,对照组加入等量培养基.采用CCK-8法测算各组细胞存活率(以细胞存活率表示细胞增殖能力),采用细胞克隆形成实验测算细胞克隆形成个数(以细胞克隆形成个数表示细胞克隆形成能力),采用Transwell小室侵袭实验测算侵袭细胞数(以侵袭细胞数表示细胞侵袭能力),采用流式细胞术测算各组细胞凋亡率及各细胞周期细胞百分比,采用实时荧光定量PCR法检测B组及对照组细胞中YAP1、TEAD、半胱氨酸天冬氨酸蛋白酶-3(caspase-3)、B细胞瘤-2(Bcl-2)、细胞周期素D1(CyclinD1)、髓细胞组织增生蛋白(MYC)、Axl mRNA,采用Western Blotting法检测B组及对照组细胞中YAP1、TEAD、caspase-3、Bcl-2、CyclinD1、MYC、Axl蛋白.结果 A、B、C及对照组细胞培养24 h时细胞存活率分别为85.27％ ±0.63％、74.18％ ±1.01％、57.67％ ±0.92％、100.00％ ±0.42％,组间相比,P均<0.05;A、B、C及对照组细胞培养48 h时细胞存活率分别为70.35％ ±0.61％、59.33％ ±1.27％、41.39％ ±0.46％、100.00％ ±0.85％,组间相比,P均<0.05;A、B、C组细胞在培养48 h时的细胞存活率,与24 h时相比,P均<0.05.A、B、C及对照组细胞克隆形成个数分别为183.67±12.92、118.67±10.50、47.33±5.31、253.67±8.18个,组间相比,P均<0.05.A、B、C及对照组细胞侵袭细胞数分别为44.67±2.87、28.67±4.11、16.67±3.68、56.67±5.31个,组间相比,P均<0.05.A、B、C及对照组细胞凋亡率分别为14.52％ ±1.03％、26.56％ ±2.10％、38.64％ ±1.42％、5.31％ ±0.77％,组间相比,P均<0.05.A组G2/M、S、G0/G1期细胞分别为15.46％ ±1.74％、42.37％ ±2.69％、42.17％ ±1.73％,B组G2/M、S、G0/G1期细胞分别为8.39％ ±0.77％、34.48％ ±0.57％、57.13％ ±0.39％,C组G2/M、S、G0/G1期细胞分别为3.82％ ±1.89％、26.16％ ±0.81％、70.02％ ±1.42％,对照组G2/M、S、G0/G1期细胞分别为21.52％ ±0.75％、53.14％ ±1.31％、25.34％ ±0.95％,各细胞周期比例组间相比,P均<0.05.B组细胞中YAP1、TEAD、caspase-3、Bcl-2、CyclinD1、MYC、Axl mRNA的相对表达量分别为0.37±0.12、0.56±0.17、0.35±0.25、0.43±0.29、0.48±0.27、0.39±0.35、0.35±0.71,对照组细胞中YAP1、TEAD、caspase-3、Bcl-2、CyclinD1、MYC、Axl mRNA的相对表达量分别为1.00±0.33、1.00±0.67、1.00±0.14、1.00±0.28、1.00±0.81、1.00±0.33、1.00±0.11,两组相比,P均<0.05.B组细胞中YAP1、TEAD、caspase-3、Bcl-2、Cy-clinD1、MYC、Axl蛋白的相对表达量分别为0.51±0.45、0.44±0.31、0.42±0.23、0.61±0.09、0.39±0.41、0.52±0.38、0.48±0.21,对照组细胞中YAP1、TEAD、caspase-3、Bcl-2、CyclinD1、MYC、Axl蛋白的相对表达量分别为1.00±0.56、1.00±0.82、1.00±0.73、1.00±0.32、1.00±0.34、1.00±0.14、1.00±0.29,两组相比,P均<0.05.结论 1、2、4μmol/L的维替泊芬均可抑制CNE1细胞的增殖、侵袭能力,诱导细胞凋亡,阻滞生长周期,呈浓度依赖性,其作用机制可能与抑制YAP1及其下游因子的表达有关.

Background: Cellulose powder (CP) has been reported as a safe and effective complementary treatment for allergic rhinitis (AR). Currently, CP has gained increasing application for clinical management worldwide, particularly in China. However, studies focusing on the effect of CP on normal human nasal epithelial cells (hNECs) and ciliary function are lacking. Here, we aimed to explore the adverse effects of CP on the activity and ciliary function of hNECs. Methods: We biopsied ethmoid sinus or middle turbinate tissues during surgical resection from control subjects who underwent endoscopic sinus surgery for diseases other than AR. Cells were isolated and passaged, followed by differentiation in an air-liquid interface (ALI). Flow cytometry and cell viability test (cell counting kit-8) were performed to detect the cytotoxicity of CP (effects on cell proliferation) on normal hNECs. By using the ALI culture model, we investigated the effects of CP on ciliary beat frequency (CBF). Results: There was a significant reduction in hNEC count at high concentrations of CP (2.5 mg/mL) at days 3 and 7 (both p < 0.05). As the concentration increased, cell death increased progressively from day 3 to day 7. However, these effects were not evident at low concentrations (0.25 mg/mL, p > 0.05). High-dose CP (2.5 mg) significantly reduced the CBF (p < 0.05). At lower concentrations (0.25–2.5 mg/mL), CP initially increased but subsequently reduced the CBF of hNECs compared with control group. Conclusions: Cytotoxicity and the suppression of ciliary beat at high concentrations justify more prudent use of CP for the management of AR.

Damage to the mucociliary clearance system is a typical change in the pathogenesis in chronic rhinosinusitis. However, the mechanisms underlying cilia loss remain unclear. WDPCP is a key protein essential for ciliogenesis, and is also an effector of the planar cell polarity signaling system. In this study, we sought to determine the role of WDPCP in cilia loss in patients with chronic rhinosinusitis. We demonstrated the expression of WDPCP in human sinonasal epithelium from patients with chronic rhinosinusitis and control subjects. We also used air-liquid interface to culture primary human sinonasal epithelial cells in-vitro model and to investigate WDPCP function. We then explored links between rhinosinusitis, WDPCP and inflammation. Accompanied with cilia loss, expression of WDPCP in human sinonasal epithelium from patients with chronic rhinosinusitis was decreased significantly compared with control subjects. In vitro study, we found that WDPCP level increased at first, and then decreased. Inhibiting WDPCP expression could lead to the poor quantity and length of cilia with reduced expression of Septin7. Also, Th1 type inflammatory mediators could decrease the expression of WDPCP. In conclusion, inflammatory cytokines cause reduced WDPCP expression, which contributes to impaired ciliogenesis in human rhinosinusitis.

BackgroundCysteinyl leukotriene (LT) has been proposed in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). This study sought to examine the expression of the LT receptor (LTR) in CRSwNP patients and evaluate the potential role of LTR antagonist (LTRA) in the management of eosinophilic CRSwNP (ECRS) patients.MethodsNasal polyps and uncinate process tissues were collected from 18 ECRS patients, 13 non-eosinophilic CRSwNP (non-ECRS) patients, and 16 control subjects. The messenger RNA (mRNA) and protein expression of LTR (cysteinyl leukotriene receptor 1 [CysLT1R] and cysteinyl leukotriene receptor 2 [CysLT2R]) was examined using quantitative reverse-transcription polymerase chain reaction (qRT-PCR), immunohistochemistry, and Western blot analysis. Moreover, the effects of LTRA and steroids on total nasal symptom scores (TNSS) of uncontrolled ECRS patients were evaluated.ResultsThe mRNA and protein expression of CysLT1R and CysLT2R was significantly increased in polyp tissues compared with healthy controls (p < 0.05). Compared with the non-ECRS subset, the ECRS subset showed significantly increased expression of CysLT1R and CysLT2R, as well as leukotriene C4 (LTC4) and leukotriene D4 (LTC4) levels (p < 0.05). Moreover, combined LTRA and steroids significantly decreased TNSS more than steroids alone in uncontrolled ECRS patients (p < 0.01).ConclusionOur findings indicate that LTR was differentially expressed between ECRS and non-ECRS patients, and that LTRA may be used as an additional therapy for ECRS patients.

Sinonasal squamous papilloma is a benign epithelial tumor having variable squamous differentiation. It occurs in the nasal cavity and paranasal sinuses. Malignant transformation of sinonasal squamous papilloma is responsible for cancer-related deaths worldwide. We reported a 52-year old man diagnosed as malignant transformation of a large sinonasal squamous cell papilloma. Moreover, bilateral nasopharyngeal metastasis followed by parapharyngeal space and cervical lymph node metastasis are appeared. The pathology results of sinonasal and nasopharyngeal mass are both malignant transformation of inverted squamous cell papilloma. Considering the extension of the tumor and the fact that nasopharyngeal carcinoma is more sensitive to chemotherapy and radiation, we had strongly counseled the patient that operation should be evaluated after he received concurrent chemoradiation.