American Journal of Rhinology & Allergy最新文献

BackgroundIn chronic rhinosinusitis (CRS), nasal nitric oxide (nNO) levels are concurrently influenced by radiological disease burden and type 2 (T2) inflammation, yet their independent and interactive effects remain unquantified.ObjectiveTo quantify the independent and opposing effects of radiological disease burden (Lund-Mackay [LMK] score) and type 2 (T2) inflammation on nNO in patients with CRS.MethodsA total of 169 CRS patients undergoing sinus surgery were enrolled. Radiologic burden was quantified using the LMK score, assessed both continuously and by tertiles (low, mid, high). T2 inflammation was stratified based on fractional exhaled nitric oxide (FeNO) and peripheral blood eosinophils into T2-Low/Low, T2-Mid, and T2-High/High groups. nNO was measured using a standardized protocol. Multivariable linear regression was performed with log-transformed nNO as the outcome, adjusting for clinical and inflammatory covariates. Percentage change (%Δ) was back-calculated from the regression coefficients.ResultsEach one-point increase in LMK score was associated with an 8.8% decrease in nNO (95% confidence interval [CI], -10.9% to -6.7%; p < .001). The T2-High/High phenotype was independently associated with an 86.9% increase in nNO (95% CI, +28.7% to +171.4%; p = .001). LMK score remained inversely correlated with nNO across all T2 strata (interaction p = .237). In the LMK-High group, nNO levels were significantly reduced across all T2 categories (13.2%-19.1% decrease; all p ≤ .031).ConclusionIn CRS, radiological disease burden and T2 inflammation exert opposing yet independent effects on nNO. Structural obstruction predominantly lowers nNO, whereas high T2 inflammation may partially offset this reduction. These findings support the role of nNO as a composite biomarker integrating both anatomical patency and inflammatory activity, which can be utilized for CRS phenotyping and treatment monitoring.

BackgroundNo prior meta-analysis has directly compared restenosis or revision rates between Draf IIb and Draf III in chronic rhinosinusitis (CRS) or evaluated how Type 2 versus non-Type 2 endotypes influence these outcomes.MethodsFollowing PRISMA guidelines, PubMed, MEDLINE, Embase, and ClinicalTrials.gov were searched on 5 January 2025 for studies reporting restenosis or revision after Draf IIb or Draf III in adults with CRS. Random-effects meta-analyses of proportions (Freeman-Tukey transformation; Hartung-Knapp CIs), pooled restenosis and revision rates, with subgroup analyses by procedure type and endotype.ResultsThirty-eight studies met inclusion criteria (restenosis n = 1550; revision n = 1305). The pooled restenosis proportion across procedures was 9% (95% CI: 5-14%) and the pooled revision proportion was 9% (95% CI: 5-13%). Restenosis was lower after Draf IIb than Draf III (0.8% vs. 12%), with revision rates showing a similar pattern (2% vs. 10%). Type 2 CRS demonstrated higher pooled rates of restenosis (8% vs. 1%) and revision (12% vs. 3%) compared with non-Type 2 CRS.ConclusionsDraf IIb is associated with lower pooled restenosis and revision rates than Draf III in CRS. Type 2 inflammatory endotype confers substantially higher risk of adverse frontal sinus outcomes. Incorporating endotype into procedural decision-making may improve prognosis. Prospective, endotype-stratified studies are needed to refine indications for Draf IIb versus Draf III and optimize adjunctive management strategies.

BackgroundChronic rhinosinusitis (CRS) comprises heterogeneous eosinophilic (type-2) and neutrophilic (type-1/3) endotypes, yet existing murine models rarely distinguish them or compare their therapeutic responsiveness.MethodsSeven-week-old female C57BL/6N mice received intranasal instillations three times weekly for 4 or 12 weeks with either (1) a clinically relevant airborne allergen cocktail (house dust mite [HDM], Aspergillus fumigatus, Alternaria alternata, and Staphylococcus aureus protease) to induce eosinophilic CRS (ECRS) or (2) an innate stimulus mixture (lipopolysaccharide, β-1,3-glucan, and S. aureus protease) to induce neutrophilic CRS (NCRS). A parallel cohort received weekly dexamethasone administration (2 mg/kg). Endpoints included flow cytometry, enzyme-linked immunosorbent assays, quantitative PCR, histology, and immunofluorescence assays.ResultsFour-week allergen exposure produced a pure ECRS phenotype characterized by robust tissue eosinophilia, type-2 cytokines, and marked responsiveness to dexamethasone. Extending allergen delivery to 12 weeks generated mixed CRS with superimposed neutrophilia, upregulation of Il1b/Tgfb1, mucus hypersecretion, and attenuated steroid efficacy. Innate stimulus treatment yielded a steroid-resistant NCRS phenotype dominated by neutrophils, elevated Ifng/Il17a expression, and minimal type-2 biomarkers. Systemic eotaxin and HDM-specific immunoglobulin E mirrored those found in local eosinophilia, whereas circulating granulocytes remained unchanged across groups.ConclusionsBy adjusting the stimulus type and duration, we established tunable murine models that recapitulate pure ECRS, mixed CRS, and steroid-resistant NCRS within a single genetic background. These paired models provide a versatile platform for dissecting endotype-specific mechanisms and evaluating tailored interventions, highlighting the potential importance of early, phenotype-directed CRS therapy.

BackgroundEpithelial-myoepithelial carcinoma of the sinonasal tract is rare, and optimal postoperative management remains unclear, particularly regarding the role of adjuvant radiotherapy.ObjectiveTo evaluate associations between surgical margin status, adjuvant radiotherapy, insurance status, and overall survival (OS) in patients with epithelial-myoepithelial carcinoma of the sinonasal tract.MethodsThe National Cancer Database (2004-2020) was queried for patients with epithelial-myoepithelial carcinoma arising in sinonasal subsites (ICD-O 8562). Demographic, tumor, and treatment variables were analyzed for 81 patients. OS was estimated using the Kaplan-Meier analysis with log-rank testing. Cox proportional hazards models were used to evaluate associations between treatment modality, margin status, insurance status, and OS.ResultsMean age was 64.2 years; 56.8% were female. Surgery was performed in 69/81 patients (85.2%); 51 had documented margin status (37 negative, 14 positive). Overall 1-, 5-, and 10-year OS were 95.0%, 76.3%, and 44.9%, respectively. Negative-margin resection was associated with superior OS compared with positive margins (log-rank p = .002). Among patients with negative margins, adjuvant radiotherapy was not associated with improved OS (log-rank p = .82). Insurance-related differences in OS were observed (p = .002).ConclusionIn epithelial-myoepithelial carcinoma of the sinonasal tract, achievement of negative surgical margins is the principal determinant of overall survival. Adjuvant radiotherapy following negative-margin resection was not associated with improved overall survival in this cohort.

BackgroundPostoperative care following endoscopic sinus surgery (ESS) aims to optimize mucosal healing, reduce inflammation, and minimize infectious complications. Although saline irrigation is considered standard of care, the potential benefit of adding topical antibiotics, such as mupirocin, during the early postoperative period remains uncertain.ObjectiveTo evaluate whether short-term postoperative mupirocin nasal irrigation improves clinical, endoscopic, and microbiological outcomes compared with saline irrigation alone following ESS.MethodsThis prospective, randomized, double-blinded, placebo-controlled trial included adults with chronic rhinosinusitis undergoing ESS. Patients were randomized to receive either mupirocin (0.05%) nasal irrigation or placebo saline irrigation twice daily for 21 days postoperatively. Outcomes assessed within the first 3 months included patient-reported symptoms using the sinonasal outcomes test (SNOT-22) and visual analog scale (VAS), endoscopic findings (mucosal edema, polyp formation, crusting, granulation tissue, and purulence), postoperative sinus culture results, and need for systemic antibiotics.ResultsSixty-eight patients were enrolled, and 56 completed follow-up. Both groups demonstrated significant postoperative improvement in SNOT-22 and VAS scores compared with preoperative baseline, without significant between-group differences. However, the mupirocin group showed significantly lower rates of endoscopic mucosal edema and polyp formation at 1 month postoperatively. Negative postoperative cultures were also more frequent in the mupirocin group, with reduced need for systemic oral antibiotics. No significant differences were observed in crusting, granulation tissue, purulence, steroid use, or pain medication requirements.ConclusionShort-term prophylactic postoperative mupirocin nasal irrigation after ESS does not confer additional improvement in patient-reported quality-of-life outcomes compared with saline alone but appears to reduce early inflammatory endoscopic changes, bacterial culture positivity, and need for systemic antibiotics. Larger studies with longer follow-up are needed to confirm these findings.

BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by significant tissue remodeling, in which Epithelial-mesenchymal transition (EMT) plays a pivotal role in this process. Autophagy, a cellular degradation mechanism crucial for maintaining cellular homeostasis, may also contribute to EMT in CRSwNP.ObjectivesTo investigate the role of autophagy in EMT during CRSwNP.MethodsTissue specimens were obtained from control subjects and patients with CRSwNP. The expression levels of human neutrophil elastase (HNE), Transforming growth factor-β1 (TGF-β1), the autophagic protein LC3, and EMT-related markers (E-cadherin, N-cadherin, and vimentin) were detected using immunohistochemistry and Western blotting. The expression characteristics of TGF-β1 in CRSwNP and their relationship with autophagy caused by HNE was assessed by in-vitro culture of the human nasal epithelial cell line RPMI-2650 treated with human recombinant HNE.ResultsPatients with CRSwNP had more protein expression of TGF-β1, LC3, N-cadherin, and vimentin, whereas the expression of E-cadherin was significantly decreased (P < .05). Treatment of nasal epithelial cells with recombinant HNE also induced the upregulation of TGF-β1, LC3, N-cadherin and Vimentin, while reducing E-cadherin levels (P < .05). Alternatively, treatment of nasal epithelial cells with an autophagy inhibitor or a TGF-β1 inhibitor mitigated EMT.ConclusionHNE induced EMT by activating the autophagy in CRSwNP and TGF-β1 also played an important role in this process.

BackgroundIt is important to use odor threshold and odor identification (OI) tests to evaluate children's olfactory function. However, there is a lack of Chinese normative data obtained in a large sample for these tests.ObjectiveThe purpose of this study was to provide normative data for Chinese children regarding olfactory threshold (OT) and OI tests, as well as combined scores, which help clinicians distinguish between normosmia and dysfunction in clinical diagnosis.MethodsOlfactory testing was conducted using the "Sniffin' Sticks" OT test and the 12-item "U-Sniff" OI test; TI score was calculated as the sum of OT and OI scores. The data were collected from 450 children between the age of 5 and 17 years. In line with previous studies, participants were divided into subgroups regarding their age: (1) 5-8 years, (2) 9-11 years, and (3) 12-17 years.ResultsNormative data for OT, OI, and TI score were established across different age groups. Age was found to have a significant impact on OT, OI, and TI performance. Elder children achieved higher scores compared to younger children (P < 0.001 for all).ConclusionThis study offers normative data for evaluating the sense of smell in Chinese children using both the OT and OI tests. These tests can help differentiate between a normal sense of smell and dysfunction. Combining these two tests can provide a comprehensive evaluation of the olfactory function in children.

BackgroundSinonasal sarcoidosis (SNS) is an under-recognized manifestation of a multisystem granulomatous disease that often mimics common nasal inflammatory conditions, leading to diagnostic delays and uncertainty regarding optimal long-term management.ObjectiveThe purpose of this study was to review the clinical presentation, diagnosis, and medical management of SNS.MethodsA systematic review was conducted using CINAHL, Cochrane Library, PubMed, and Scopus through August 2025. Eligible studies included case reports, case series, and observational studies. Extracted variables included demographics, symptoms, diagnostic findings, treatments, and outcomes. Data was summarized as means, proportions, and 95% confidence intervals (CIs). Risk of bias was assessed with the Joanna Briggs Institute tool.ResultsSixty-eight studies (n = 369) were included. Mean age was 39.6 years (95% CI: 37.7-41.5), and 66.5% were female. The average interval from symptom onset to diagnosis was 61.7 months (95% CI: 35.8-87.6). Common presenting symptoms included nasal obstruction (39.3%), rhinorrhea (29.1%), and crusting (26.4%). Extra-nasal manifestations were frequent, particularly cutaneous involvement (39.1%) and peripheral lymphadenopathy (29.7%). Abnormal nasal endoscopy commonly demonstrated nasal crusting (38.2%) and mucosal inflammation (38.1%). Histological confirmation was most often obtained via sinonasal mucosal biopsy (75.4%). Systemic corticosteroids were the predominant first-line therapy, with 77.0% of patients demonstrating clinical improvement, though prolonged treatment courses and relapses were common.ConclusionThere is typically a prolonged delay between the onset of symptoms and the diagnosis of SNS. Understanding the common presenting symptoms, endoscopic features, and laboratory findings may facilitate proper diagnosis and treatment.

BackgroundHealth locus of control (HLC) reflects an individual's perception of what influences their health and is categorized into four loci: Internal (IHLC), Chance, Powerful Others, and Doctors (DHLC). In other chronic conditions, HLC has been shown to impact patient recovery outcomes. However, its role in sinonasal disease remains unexamined. This pilot study investigates the influence of HLC on post-operative sinonasal outcomes in patients with chronic rhinosinusitis (CRS).MethodsMultidimensional Health Locus of Control Form C surveys (MHLC-C), demographics, and pre- and post-operative SNOT-22 surveys were collected from 81 adult patients with CRS who underwent endoscopic sinus surgery and attended ≥ 3 post-operative visits. Associations between MHLC-C scores and changes in SNOT-22 scores were analyzed.Results81 patients were enrolled in the study. Greater DHLC scores were positively correlated with pre-operative SNOT-22 scores (β = 2.26, P = 0.011) and negatively correlated with change in SNOT-22 post-operatively (β = -1.83, P = 0.026). When split by median scores into high and low scoring groups, the high DHLC group was associated with improved post-operative SNOT-22 scores (P = 0.009; 95% CI, -19.70 to -2.98), with statistically significant improvements in the ear/facial, psychological, and sleep subdomains (P = 0.015, 0.023, 0.025, respectively).ConclusionA higher DHLC was associated with greater improvements in SNOT-22, and with significant improvements in 3 of the 5 SNOT-22 subdomains. This outcome differs from studies in other fields that suggest improved outcomes with greater IHLC alignment, and may be explained by nuance in the patient-provider relationship and various treatment modalities unique to the management of CRS.

BackgroundPrior microRNA expression profiling investigations have identified hsa-miR-664b-5p as one of the markedly upregulated microRNAs in patients with allergic rhinitis (AR), suggesting its potential important role in the pathogenesis of this condition. This study focused on hsa-miR-664b-5p, elucidate its fundamental mechanistic basis along with its influence on cellular proliferation and apoptotic processes.MethodsUsing reverse transcription-quantitative polymerase chain reaction, the expression profiles of hsa-miR-664b-5p and EGR2 were examined in nasal mucosal samples obtained from individuals with AR. The diagnostic usefulness of hsa-miR-664b-5p was evaluated through receiver operating characteristic (ROC) analysis. In human nasal epithelial cell lines (RPMI 2650 and primary HNEPCs), apoptotic rates were assessed by flow cytometry, and proliferative capacity was measured using the cell counting kit-8 assay. The targeting interaction between hsa-miR-664b-5p and EGR2 was verified by dual-luciferase reporter assay to investigate its regulatory mechanism.ResultsResults confirmed that hsa-miR-664b-5p was significantly upregulated in AR nasal mucosal tissues, while EGR2 was downregulated, showing a strong inverse correlation. ROC analysis demonstrated that hsa-miR-664b-5p holds considerable diagnostic value for AR ( area under the curve = 0.875). Overexpression of hsa-miR-664b-5p was found to promote proliferation and inhibit apoptosis in human nasal epithelial cells. Through dual-luciferase reporter assays, EGR2 was identified as a direct target of hsa-miR-664b-5p. Rescue experiments further supported that hsa-miR-664b-5p influences epithelial cell growth and death by specifically repressing EGR2.ConclusionThe hsa-miR-664b-5p/EGR2 axis exerts a crucial role in the pathogenesis of AR and could serve as a novel molecular target for the diagnosis and treatment of AR.