Publisher: Sage Publications   (Total: 1166 journals)

 A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  

        1 2 3 4 5 6 | Last   [Sort by number of followers]   [Restore default list]

Showing 1 - 200 of 1166 Journals sorted alphabetically
AADE in Practice     Hybrid Journal   (Followers: 6)
Abstracts in Anthropology     Full-text available via subscription   (Followers: 29)
Academic Pathology     Open Access   (Followers: 6)
Accounting History     Hybrid Journal   (Followers: 18, SJR: 0.527, CiteScore: 1)
Acta Radiologica     Hybrid Journal   (Followers: 1, SJR: 0.754, CiteScore: 2)
Acta Radiologica Open     Open Access   (Followers: 2)
Acta Sociologica     Hybrid Journal   (Followers: 39, SJR: 0.939, CiteScore: 2)
Action Research     Hybrid Journal   (Followers: 53, SJR: 0.308, CiteScore: 1)
Active Learning in Higher Education     Hybrid Journal   (Followers: 396, SJR: 1.397, CiteScore: 2)
Adaptive Behavior     Hybrid Journal   (Followers: 9, SJR: 0.288, CiteScore: 1)
Administration & Society     Hybrid Journal   (Followers: 18, SJR: 0.675, CiteScore: 1)
Adoption & Fostering     Hybrid Journal   (Followers: 25, SJR: 0.313, CiteScore: 0)
Adsorption Science & Technology     Open Access   (Followers: 9, SJR: 0.258, CiteScore: 1)
Adult Education Quarterly     Hybrid Journal   (Followers: 260, SJR: 0.566, CiteScore: 2)
Adult Learning     Hybrid Journal   (Followers: 51)
Advances in Dental Research     Hybrid Journal   (Followers: 11, SJR: 1.791, CiteScore: 4)
Advances in Developing Human Resources     Hybrid Journal   (Followers: 35, SJR: 0.614, CiteScore: 2)
Advances in Mechanical Engineering     Open Access   (Followers: 156, SJR: 0.272, CiteScore: 1)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 20)
Advances in Structural Engineering     Full-text available via subscription   (Followers: 51, SJR: 0.599, CiteScore: 1)
AERA Open     Open Access   (Followers: 14)
Affilia     Hybrid Journal   (Followers: 6, SJR: 0.496, CiteScore: 1)
Africa Spectrum     Open Access   (Followers: 17)
Agrarian South : J. of Political Economy     Hybrid Journal   (Followers: 3)
Air, Soil & Water Research     Open Access   (Followers: 13, SJR: 0.214, CiteScore: 1)
Alexandria : The J. of National and Intl. Library and Information Issues     Full-text available via subscription   (Followers: 68)
Allergy & Rhinology     Open Access   (Followers: 5)
AlterNative : An Intl. J. of Indigenous Peoples     Full-text available via subscription   (Followers: 39, SJR: 0.194, CiteScore: 0)
Alternative Law J.     Hybrid Journal   (Followers: 12, SJR: 0.176, CiteScore: 0)
Alternatives : Global, Local, Political     Hybrid Journal   (Followers: 12, SJR: 0.351, CiteScore: 1)
Alternatives to Laboratory Animals     Full-text available via subscription   (Followers: 11, SJR: 0.297, CiteScore: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 26, SJR: 0.982, CiteScore: 2)
American Economist     Hybrid Journal   (Followers: 7)
American Educational Research J.     Hybrid Journal   (Followers: 260, SJR: 2.913, CiteScore: 3)
American J. of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 23, SJR: 0.67, CiteScore: 2)
American J. of Cosmetic Surgery     Hybrid Journal   (Followers: 9)
American J. of Evaluation     Hybrid Journal   (Followers: 18, SJR: 0.646, CiteScore: 2)
American J. of Health Promotion     Hybrid Journal   (Followers: 35, SJR: 0.807, CiteScore: 1)
American J. of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 47, SJR: 0.65, CiteScore: 1)
American J. of Law & Medicine     Full-text available via subscription   (Followers: 12, SJR: 0.204, CiteScore: 1)
American J. of Lifestyle Medicine     Hybrid Journal   (Followers: 7, SJR: 0.431, CiteScore: 1)
American J. of Medical Quality     Hybrid Journal   (Followers: 13, SJR: 0.777, CiteScore: 1)
American J. of Men's Health     Open Access   (Followers: 9, SJR: 0.595, CiteScore: 2)
American J. of Rhinology and Allergy     Hybrid Journal   (Followers: 11, SJR: 0.972, CiteScore: 2)
American J. of Sports Medicine     Hybrid Journal   (Followers: 248, SJR: 3.949, CiteScore: 6)
American Politics Research     Hybrid Journal   (Followers: 36, SJR: 1.313, CiteScore: 1)
American Review of Public Administration     Hybrid Journal   (Followers: 28, SJR: 2.062, CiteScore: 2)
American Sociological Review     Hybrid Journal   (Followers: 357, SJR: 6.333, CiteScore: 6)
American String Teacher     Full-text available via subscription   (Followers: 3)
Analytical Chemistry Insights     Open Access   (Followers: 26, SJR: 0.224, CiteScore: 1)
Angiology     Hybrid Journal   (Followers: 5, SJR: 0.849, CiteScore: 2)
Animation     Hybrid Journal   (Followers: 15, SJR: 0.197, CiteScore: 0)
Annals of Clinical Biochemistry     Hybrid Journal   (Followers: 10, SJR: 0.634, CiteScore: 1)
Annals of Otology, Rhinology & Laryngology     Hybrid Journal   (Followers: 20, SJR: 0.807, CiteScore: 1)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 59, SJR: 1.096, CiteScore: 2)
Annals of the American Academy of Political and Social Science     Hybrid Journal   (Followers: 51, SJR: 1.225, CiteScore: 3)
Annals of the ICRP     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Anthropocene Review     Hybrid Journal   (Followers: 8, SJR: 3.341, CiteScore: 7)
Anthropological Theory     Hybrid Journal   (Followers: 48, SJR: 0.739, CiteScore: 1)
Antitrust Bulletin     Hybrid Journal   (Followers: 14)
Antiviral Chemistry and Chemotherapy     Open Access   (Followers: 2, SJR: 0.635, CiteScore: 2)
Antyajaa : Indian J. of Women and Social Change     Hybrid Journal   (Followers: 1)
Applied Biosafety     Hybrid Journal   (Followers: 1, SJR: 0.131, CiteScore: 0)
Applied Psychological Measurement     Hybrid Journal   (Followers: 21, SJR: 1.17, CiteScore: 1)
Applied Spectroscopy     Full-text available via subscription   (Followers: 27, SJR: 0.489, CiteScore: 2)
Armed Forces & Society     Hybrid Journal   (Followers: 25, SJR: 0.29, CiteScore: 1)
Arthaniti : J. of Economic Theory and Practice     Full-text available via subscription  
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 49, SJR: 0.305, CiteScore: 1)
Asia Pacific Media Educator     Hybrid Journal   (Followers: 1, SJR: 0.23, CiteScore: 0)
Asia-Pacific J. of Management Research and Innovation     Full-text available via subscription   (Followers: 3)
Asia-Pacific J. of Public Health     Hybrid Journal   (Followers: 15, SJR: 0.558, CiteScore: 1)
Asia-Pacific J. of Rural Development     Hybrid Journal   (Followers: 2)
Asian and Pacific Migration J.     Full-text available via subscription   (Followers: 8, SJR: 0.324, CiteScore: 1)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2, SJR: 0.305, CiteScore: 0)
Asian J. of Comparative Politics     Hybrid Journal   (Followers: 5)
Asian J. of Legal Education     Full-text available via subscription   (Followers: 4)
Asian J. of Management Cases     Hybrid Journal   (Followers: 6, SJR: 0.101, CiteScore: 0)
ASN Neuro     Open Access   (Followers: 2, SJR: 1.534, CiteScore: 3)
Assessment     Hybrid Journal   (Followers: 19, SJR: 1.519, CiteScore: 3)
Assessment for Effective Intervention     Hybrid Journal   (Followers: 15, SJR: 0.578, CiteScore: 1)
Australasian J. of Early Childhood     Hybrid Journal   (Followers: 7, SJR: 0.535, CiteScore: 1)
Australasian Psychiatry     Hybrid Journal   (Followers: 18, SJR: 0.433, CiteScore: 1)
Australian & New Zealand J. of Psychiatry     Hybrid Journal   (Followers: 30, SJR: 1.801, CiteScore: 2)
Australian and New Zealand J. of Criminology     Hybrid Journal   (Followers: 545, SJR: 0.612, CiteScore: 1)
Australian J. of Career Development     Hybrid Journal   (Followers: 5)
Australian J. of Education     Hybrid Journal   (Followers: 51, SJR: 0.403, CiteScore: 1)
Australian J. of Management     Hybrid Journal   (Followers: 13, SJR: 0.497, CiteScore: 1)
Autism     Hybrid Journal   (Followers: 356, SJR: 1.739, CiteScore: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 17)
Avian Biology Research     Hybrid Journal   (Followers: 6, SJR: 0.401, CiteScore: 1)
Behavior Modification     Hybrid Journal   (Followers: 14, SJR: 0.877, CiteScore: 2)
Behavioral and Cognitive Neuroscience Reviews     Hybrid Journal   (Followers: 27)
Behavioral Disorders     Hybrid Journal   (Followers: 1)
Beyond Behavior     Hybrid Journal   (Followers: 2)
Bible Translator     Hybrid Journal   (Followers: 13)
Biblical Theology Bulletin     Hybrid Journal   (Followers: 24, SJR: 0.184, CiteScore: 0)
Big Data & Society     Open Access   (Followers: 55)
Biochemistry Insights     Open Access   (Followers: 7)
Bioinformatics and Biology Insights     Open Access   (Followers: 12, SJR: 1.141, CiteScore: 2)
Biological Research for Nursing     Hybrid Journal   (Followers: 7, SJR: 0.685, CiteScore: 2)
Biomarker Insights     Open Access   (Followers: 1, SJR: 0.81, CiteScore: 2)
Biomarkers in Cancer     Open Access   (Followers: 11)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 14)
Biomedical Informatics Insights     Open Access   (Followers: 8)
Bioscope: South Asian Screen Studies     Hybrid Journal   (Followers: 4, SJR: 0.235, CiteScore: 0)
BMS: Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique     Hybrid Journal   (Followers: 4, SJR: 0.226, CiteScore: 0)
Body & Society     Hybrid Journal   (Followers: 29, SJR: 1.531, CiteScore: 3)
Bone and Tissue Regeneration Insights     Open Access   (Followers: 2)
Brain and Neuroscience Advances     Open Access  
Brain Science Advances     Open Access  
Breast Cancer : Basic and Clinical Research     Open Access   (Followers: 12, SJR: 0.823, CiteScore: 2)
British J. of Music Therapy     Hybrid Journal   (Followers: 9)
British J. of Occupational Therapy     Hybrid Journal   (Followers: 253, SJR: 0.323, CiteScore: 1)
British J. of Pain     Hybrid Journal   (Followers: 31, SJR: 0.579, CiteScore: 2)
British J. of Politics and Intl. Relations     Hybrid Journal   (Followers: 39, SJR: 0.91, CiteScore: 2)
British J. of Visual Impairment     Hybrid Journal   (Followers: 14, SJR: 0.337, CiteScore: 1)
British J.ism Review     Hybrid Journal   (Followers: 18)
BRQ Business Review Quarterly     Open Access   (Followers: 1)
Building Acoustics     Hybrid Journal   (Followers: 4, SJR: 0.215, CiteScore: 1)
Building Services Engineering Research & Technology     Hybrid Journal   (Followers: 3, SJR: 0.583, CiteScore: 1)
Bulletin of Science, Technology & Society     Hybrid Journal   (Followers: 9)
Business & Society     Hybrid Journal   (Followers: 15)
Business and Professional Communication Quarterly     Hybrid Journal   (Followers: 9, SJR: 0.348, CiteScore: 1)
Business Information Review     Hybrid Journal   (Followers: 17, SJR: 0.279, CiteScore: 0)
Business Perspectives and Research     Hybrid Journal   (Followers: 3)
Cahiers Élisabéthains     Hybrid Journal   (Followers: 1, SJR: 0.111, CiteScore: 0)
Calcutta Statistical Association Bulletin     Hybrid Journal   (Followers: 1)
California Management Review     Hybrid Journal   (Followers: 37, SJR: 2.209, CiteScore: 4)
Canadian Association of Radiologists J.     Full-text available via subscription   (Followers: 2, SJR: 0.463, CiteScore: 1)
Canadian J. of Kidney Health and Disease     Open Access   (Followers: 8, SJR: 1.007, CiteScore: 2)
Canadian J. of Nursing Research (CJNR)     Hybrid Journal   (Followers: 15)
Canadian J. of Occupational Therapy     Hybrid Journal   (Followers: 167, SJR: 0.626, CiteScore: 1)
Canadian J. of Psychiatry     Hybrid Journal   (Followers: 28, SJR: 1.769, CiteScore: 3)
Canadian J. of School Psychology     Hybrid Journal   (Followers: 12, SJR: 0.266, CiteScore: 1)
Canadian Pharmacists J. / Revue des Pharmaciens du Canada     Hybrid Journal   (Followers: 3, SJR: 0.536, CiteScore: 1)
Cancer Control     Open Access   (Followers: 2)
Cancer Growth and Metastasis     Open Access   (Followers: 1)
Cancer Informatics     Open Access   (Followers: 4, SJR: 0.64, CiteScore: 1)
Capital and Class     Hybrid Journal   (Followers: 10, SJR: 0.282, CiteScore: 1)
Cardiac Cath Lab Director     Full-text available via subscription   (Followers: 1)
Cardiovascular and Thoracic Open     Open Access   (Followers: 1)
Career Development and Transition for Exceptional Individuals     Hybrid Journal   (Followers: 10, SJR: 0.44, CiteScore: 1)
Cartilage     Hybrid Journal   (Followers: 6, SJR: 0.889, CiteScore: 3)
Cell Transplantation     Open Access   (Followers: 5, SJR: 1.023, CiteScore: 3)
Cephalalgia     Hybrid Journal   (Followers: 8, SJR: 1.581, CiteScore: 3)
Cephalalgia Reports     Open Access   (Followers: 4)
Child Language Teaching and Therapy     Hybrid Journal   (Followers: 34, SJR: 0.501, CiteScore: 1)
Child Maltreatment     Hybrid Journal   (Followers: 11, SJR: 1.22, CiteScore: 3)
Child Neurology Open     Open Access   (Followers: 6)
Childhood     Hybrid Journal   (Followers: 19, SJR: 0.894, CiteScore: 2)
Childhood Obesity and Nutrition     Open Access   (Followers: 12)
China Information     Hybrid Journal   (Followers: 9, SJR: 0.767, CiteScore: 2)
China Report     Hybrid Journal   (Followers: 11, SJR: 0.221, CiteScore: 0)
Chinese J. of Sociology     Full-text available via subscription   (Followers: 5)
Christian Education J. : Research on Educational Ministry     Hybrid Journal   (Followers: 1)
Chronic Illness     Hybrid Journal   (Followers: 6, SJR: 0.672, CiteScore: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 12, SJR: 0.808, CiteScore: 2)
Chronic Stress     Open Access  
Citizenship, Social and Economics Education     Full-text available via subscription   (Followers: 6, SJR: 0.145, CiteScore: 0)
Cleft Palate-Craniofacial J.     Hybrid Journal   (Followers: 8, SJR: 0.757, CiteScore: 1)
Clin-Alert     Hybrid Journal   (Followers: 1)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32, SJR: 0.49, CiteScore: 1)
Clinical and Translational Neuroscience     Open Access   (Followers: 1)
Clinical Case Studies     Hybrid Journal   (Followers: 3, SJR: 0.364, CiteScore: 1)
Clinical Child Psychology and Psychiatry     Hybrid Journal   (Followers: 45, SJR: 0.73, CiteScore: 2)
Clinical EEG and Neuroscience     Hybrid Journal   (Followers: 8, SJR: 0.552, CiteScore: 2)
Clinical Ethics     Hybrid Journal   (Followers: 13, SJR: 0.296, CiteScore: 1)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3, SJR: 0.537, CiteScore: 2)
Clinical Medicine Insights : Blood Disorders     Open Access   (Followers: 1, SJR: 0.314, CiteScore: 2)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 8, SJR: 0.686, CiteScore: 2)
Clinical Medicine Insights : Case Reports     Open Access   (Followers: 1, SJR: 0.283, CiteScore: 1)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 4, SJR: 0.425, CiteScore: 2)
Clinical Medicine Insights : Ear, Nose and Throat     Open Access   (Followers: 2)
Clinical Medicine Insights : Endocrinology and Diabetes     Open Access   (Followers: 33, SJR: 0.63, CiteScore: 2)
Clinical Medicine Insights : Oncology     Open Access   (Followers: 3, SJR: 1.129, CiteScore: 3)
Clinical Medicine Insights : Pediatrics     Open Access   (Followers: 3)
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 10)
Clinical Medicine Insights : Reproductive Health     Open Access   (Followers: 1, SJR: 0.776, CiteScore: 0)
Clinical Medicine Insights : Therapeutics     Open Access   (Followers: 1, SJR: 0.172, CiteScore: 0)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Nursing Research     Hybrid Journal   (Followers: 34, SJR: 0.471, CiteScore: 1)
Clinical Pathology     Open Access   (Followers: 5)
Clinical Pediatrics     Hybrid Journal   (Followers: 25, SJR: 0.487, CiteScore: 1)
Clinical Psychological Science     Hybrid Journal   (Followers: 16, SJR: 3.281, CiteScore: 5)
Clinical Rehabilitation     Hybrid Journal   (Followers: 78, SJR: 1.322, CiteScore: 3)
Clinical Risk     Hybrid Journal   (Followers: 5, SJR: 0.133, CiteScore: 0)
Clinical Trials     Hybrid Journal   (Followers: 22, SJR: 2.399, CiteScore: 2)
Clothing and Textiles Research J.     Hybrid Journal   (Followers: 28, SJR: 0.36, CiteScore: 1)
Collections : A J. for Museum and Archives Professionals     Full-text available via subscription   (Followers: 3)
Common Law World Review     Full-text available via subscription   (Followers: 17)
Communication & Sport     Hybrid Journal   (Followers: 8, SJR: 0.385, CiteScore: 1)
Communication and the Public     Hybrid Journal   (Followers: 2)
Communication Disorders Quarterly     Hybrid Journal   (Followers: 15, SJR: 0.458, CiteScore: 1)
Communication Research     Hybrid Journal   (Followers: 24, SJR: 2.171, CiteScore: 3)
Community College Review     Hybrid Journal   (Followers: 8, SJR: 1.451, CiteScore: 1)
Comparative Political Studies     Hybrid Journal   (Followers: 292, SJR: 3.772, CiteScore: 3)
Compensation & Benefits Review     Hybrid Journal   (Followers: 8)
Competition & Change     Hybrid Journal   (Followers: 12, SJR: 0.843, CiteScore: 2)

        1 2 3 4 5 6 | Last   [Sort by number of followers]   [Restore default list]

Similar Journals
Journal Cover
American Journal of Rhinology and Allergy
Journal Prestige (SJR): 0.972
Citation Impact (citeScore): 2
Number of Followers: 11  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1945-8924 - ISSN (Online) 1945-8932
Published by Sage Publications Homepage  [1166 journals]
  • The Cutting Edge of Rhinology Research

    • Free pre-print version: Loading...

      Authors: David A. Gudis
      Pages: 556 - 558
      Abstract: American Journal of Rhinology & Allergy, Volume 35, Issue 5, Page 556-558, September 2021.

      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-09-09T04:52:01Z
      DOI: 10.1177/19458924211042213
      Issue No: Vol. 35, No. 5 (2021)
       
  • Chronic rhinosinusitis with nasal polyposis (CRSwNP): the correlation
           between expression of Galectin-10 and Clinical-Cytological Grading (CCG)

    • Free pre-print version: Loading...

      Authors: Matteo Gelardi, Giuseppe Stefano Netti, Rossana Giancaspro, Federica Spadaccino, Antonio Pennella, Valeria Fiore, Emanuel La Gatta, Gianluigi Mariano Grilli, Michele Cassano, Elena Ranieri
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) is typically characterized by Type 2 inflammation. Several biomarkers of eosinophilic inflammation, including Galectin-10, also known as Charcot-Leyden crystal protein (CLCP), have been identified to establish eosinophilic infiltration of polyps, a reliable predictor of recurrence.Objective: We aimed to evaluate the Galectin-10 expression in nasal polyps of patients with CRSwNP and to assess the correlation of Charcot-Leyden crystals expression to the severity of CRSwNP according to Clinical-Cytological Grading (CCG).MethodsA double-label immunofluorescence was performed to evaluate the expression of Gal-10, CD15, Tryptase, and CD63 and their eventual co-localization on histological samples of 18 patients with CRSwNP. Double-positive Gal-10+CD15+ and Galectin-10+Tryptase+ inflammatory cells were counted by confocal microscopy.ResultsGalectin-10 was detectable in all examined tissues from CRSwNP patients, and its expression increased as low, medium and high CCG tissues were examined, respectively. Galectin-10 was extensively present in inflammatory cells, while limited Galectin-10 deposits were detected around mucosal epithelial cells.ConclusionWe showed the strong correlation between CCG and Galectin-10 expression, mainly colocalized with infiltrating eosinophils and mast-cells, in patients affected by CRSwNP.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-10-14T10:02:17Z
      DOI: 10.1177/19458924211049867
       
  • Long-Term Outcomes of Nasoseptal Perforation Repair Using Anterior
           Maxillary Sinus Wall as an Interpositional Graft

    • Free pre-print version: Loading...

      Authors: Jae Woong Hwang, Mun Soo Han, Sung Hoon Kang, Ji Won Kwak, Hyun Keun Kim, Tae Hoon Kim, Sang Hag Lee
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundVarious graft materials have been used to repair nasoseptal perforation, but there is no standardized treatment method. The anterior maxillary sinus wall is flattened in appearance and can be easily obtained in a sufficient amount for a large-sized nasoseptal perforation.ObjectivesThe aim of this study is to determine whether the anterior maxillary sinus wall is suitable as an interpositional graft in the surgical repair of septal or nasoseptal perforation.MethodsThis is a retrospective review of 21 patients who underwent repair of nasoseptal perforation using anterior maxillary sinus wall as an interpositional graft. The etiology, pre- and post-operative NOSE and GBI score, and perforation size were reviewed. The surgical outcome was considered successful if total closure was achieved after postoperative follow-up.Results19 of the 21 perforations were successfully repaired with anterior maxillary sinus wall. Failure of the repair was found in 2 patients. Causal etiology of perforation was previous septoplasty in 10 patients, and electrocautery in 1 case, but not identified in 10 cases. The largest size was 2.7 × 2.2 cm. The most common symptoms were epistaxis, crusting, and nasal obstruction. Closure of septal perforation resulted in improved subjective symptoms and quality of life which were evaluated with NOSE and GBI score.ConclusionAnterior maxillary sinus wall as interpositional graft between mucoperichondrial flaps can be used to reliably repair nasoseptal perforations.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-10-12T12:39:44Z
      DOI: 10.1177/19458924211049608
       
  • Complications Associated With Nasopharyngeal COVID-19 Testing: An Analysis
           of the MAUDE Database and Literature Review

    • Free pre-print version: Loading...

      Authors: Amir A. Hakimi, Khodayar Goshtasbi, Edward C. Kuan
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundNasopharyngeal swab testing, which has greatly increased in utilization due to the COVID-19 pandemic, is generally safe and well-tolerated, although it may be rarely associated with adverse events.MethodsPublicly reported adverse events associated with nasopharyngeal COVID-19 testing within the Manufacturer and User Facility Device Experience (MAUDE) database and the published literature were queried.ResultsA total of 129 adverse events were reported, including 66 from the MAUDE database and 63 from literature review. The most common complications were swab fracture resulting in retained foreign body (47%), followed by epistaxis (17%), and headache (11%). Seven (12%) of the reported retained foreign body cases required removal under general anesthesia, while 1 (5%) of the epistaxis cases required surgical intervention. The most serious adverse event was meningitis following cerebrospinal fluid leak.ConclusionsPatients and healthcare providers should be aware of the potential risks associated with testing, with attention to ensuring proper technique, and be prepared to recognize and manage adverse events.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-09-22T06:28:40Z
      DOI: 10.1177/19458924211046725
       
  • Effect of Medical Therapy in Allergic Rhinitis: A Systematic Review and
           Meta-Analysis

    • Free pre-print version: Loading...

      Authors: Kathy Zhang, Andraia R. Li, Amar Miglani, Shaun A. Nguyen, Rodney J. Schlosser
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundIntranasal corticosteroids (INCS), oral antihistamines (POAH), and allergen-specific immunotherapy (ASIT) are widely used in the treatment of allergic rhinitis (AR); however, appraisal of treatment effect has been heterogenous, and few studies have interpreted these outcomes in context with measures of nasal airflow.ObjectiveTo provide a systematic review and meta-analysis of randomized placebo-controlled trials for common therapy classes for AR to assess standardized treatment effect on validated patient-reported outcomes and physiologic measures of airflow.MethodsA systematic search was performed in PubMed, Scopus, OVID, and Cochrane library databases to identify randomized controlled trials meeting inclusion criteria. Treatment effects of INCS, POAH, and ASIT on total nasal symptom score (TNSS), visual analog scale (VAS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and peak nasal inspiratory flow (PNIF) were analyzed by meta-analysis.ResultsTwenty-two studies with 4673 AR patients were identified, with 5 INCS, 8 POAH, and 9 ASIT trials. INCS improved TNSS (mean difference [MD] 0.90; P = .002) and PNIF (MD 13.31 L/min [P = .0007]. POAH improved quality of life assessed by RQLQ [MD 0.36; P 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-09-21T05:21:57Z
      DOI: 10.1177/19458924211041438
       
  • Effect of Silver Nitrate Application on the Success of Endoscopic
           Dacryocystorhinostomy

    • Free pre-print version: Loading...

      Authors: Yaser S. Çetin, Ramazan Akın, Ufuk Düzenli, Mahfuz Turan, Nazım Bozan
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      ObjectivesTo compare the clinical outcomes of patients undergoing additional procedures in endoscopic endonasal dacryocystorhinostomy (End-DCR) surgery and discuss the factors affecting the success of End-DCR surgery in light of relevant literature.MethodsThe study included 155 patients who underwent End-DCR surgery in our clinic due to epiphora. This was a prospective randomized, single-blind, controlled trial. Group I (control) included 54 patients who did not undergo silicone stent insertion or silver nitrate application, group II included 51 patients who underwent silicone stent insertion only, and group III included 50 patients who underwent silver nitrate application only. Statistical analysis was performed on follow-up data regarding anatomic and functional success rates.ResultsRevision surgery was performed in 16 patients who developed persistent epiphora in the postoperative period, including 6 in group I, 7 in group II, and 3 in group III (P = .4). The most common reason for revision surgery was stenosis of the neo-ostium (n = 8), followed by granulation tissue formation (n = 5) and synechia formation (n = 3). Granuloma formation was the most common postoperative complication, and a significant difference was found among the groups with regard to granuloma formation (P = .04). At postoperative month 12, the functional success rate was estimated to be 88%, 86%, and 94%, and the anatomic success rate was estimated to be 94%, 92%, and 96% in groups I, II, and III, respectively, with no significant difference, found among the 3 groups with regard to both rates (P = .79 and P = .76, respectively).ConclusionThe results indicated that stenting and silver nitrate application did not affect surgical success. Our preliminary results on silver nitrate cauterization showed that it is an effective, inexpensive, and practical method to reduce granulation formation in the postoperative period.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-09-09T02:36:46Z
      DOI: 10.1177/19458924211042786
       
  • Differentiation of Benign From Malignant Sinonasal Masses Using Diffusion
           

    • Free pre-print version: Loading...

      Authors: Radhika Daga, Jyoti Kumar, Gaurav Pradhan, Ravi Meher, Vikas Malhotra, Nita Khurana
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundThe sinonasal region is affected by a variety of neoplasms. A differentiation between benign and malignant masses is essential both for management and prognostication. Morphological analysis often does not allow this differentiation.ObjectivesThis article aims to assess the value of advanced MRI (diffusion [DWI] and dynamic contrast enhanced MRI [DCE-MRI]) in differentiation of benign and malignant sinonasal masses.MethodsThis prospective study included 40 patients with sinonasal masses who underwent advanced MR on 3T MR scanner. The lesions were analyzed based on morphological characteristics, qualitative, quantitative diffusion parameters, and time signal intensity curves. Apparent diffusion coefficient (ADC) values were acquired using b values of 50 and 1000 s/mm2. The accuracy of DWI, DCE-MRI, and combined DWI/DCE-MRI in differentiating benign from malignant sinonasal masses were analyzed.ResultsPerineural extension and growth pattern of the tumor were the best morphological discriminators. Mean ADC values for benign and malignant lesions were 1.675  ±  0.561 and 0.903  ±  0.405  × 10−3 mm2/sec, ,respectively. ROC revealed that ADC cutoff value of 1.005  × 10−3 mm2/sec provided an accuracy of 92.5% in differentiating benign from malignant masses (P value
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-09-06T06:55:40Z
      DOI: 10.1177/19458924211040602
       
  • Drug Release and Pharmacokinetic Evaluation of Novel Implantable
           Mometasone Furoate Matrices in Rabbit Maxillary Sinuses

    • Free pre-print version: Loading...

      Authors: Changcheng You, Ling-Fang Tseng, Alexander Pappas, Danny Concagh, Yina Kuang
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundIntranasal corticosteroid sprays (INCSs) used to treat chronic rhinosinusitis are suboptimal due to limited penetration into the middle meatus, rapid clearance, and poor patient compliance. A bioresorbable drug matrix, developed with the XTreoTM drug delivery platform, may overcome the limitations of INCS by providing continuous dosing over several months.ObjectiveTo evaluate the in vitro drug release and in vivo pharmacokinetics of novel mometasone furoate (MF) matrices in a rabbit dorsal maxillary osteotomy model.MethodsXTreoTM matrices were formulated to consistently elute MF for up to 6 months. Matrices were surgically placed bilaterally into the maxillary sinuses of New Zealand White (NZW) rabbits. Tissue and plasma MF concentrations were measured to assess the in vivo drug delivery. The in vivo and in vitro drug release kinetics of the matrices were quantified and compared to those of rabbits receiving daily Nasonex® MF nasal sprays.ResultsXTreoTM matrices self-expanded upon deployment to conform to the irregular geometry of the maxillary sinus cavities in the NZW rabbits. Sustained release of MF was demonstrated in vitro and in vivo for 2 MF matrices of distinct release durations and an in vitro–in vivo correlation was established. Therapeutic levels of MF in local tissues were measured throughout the intended dosing durations. In contrast to the variable peaks and troughs of daily nasal sprays, sustained dosing via a single administration of MF matrices was confirmed by quantifiable plasma MF concentrations over the intended dosing duration.ConclusionThe XTreoTM MF matrices provided targeted and efficient dosing to local sinus tissues that was superior to INCS. Sustained drug release was confirmed both in vitro and in vivo. The novel XTreoTM technology may provide precisely tuned, long-lasting drug delivery to sinus tissues with a single treatment.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-08-31T01:37:54Z
      DOI: 10.1177/19458924211039197
       
  • The Importance of Nasal Provocation Testing in the Diagnosis of
           Dermatophagoides pteronyssinus-Induced Allergic Rhinitis

    • Free pre-print version: Loading...

      Authors: Hao Xiao, Qiaoru Jia, Hongting Zhang, Li Zhang, Guo Liu, Juan Meng
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundAllergen identification is the first step for allergen-specific immunotherapy (AIT) of allergic rhinitis (AR). Currently, the diagnosis of AR is based mainly on the positive results of the skin prick test (SPT) and/or serum specific immunoglobulin E (sIgE) measurement. However, the results of these two tests may not always directly correlate with AR.ObjectiveTo investigate the importance of nasal provocation testing (NPT) in the diagnosis of Dermatophagoides pteronyssinus (Der p)-induced AR.MethodsRhinitis patients willing to undergo AIT (n = 171) were enrolled. The correlations of Der p SPT, sIgE, NPT, and clinical symptom severity were assessed.ResultsNPT-positive responses were more common in patients with higher SPT and sIgE levels. The optimal cut-off value for a NPT-positive response for SPT was 5.5 mm and for sIgE was 2.77 kUA/L, based on the respective receiver operating characteristic (ROC) curves. The area under the curve (AUC) of the ROCs was 0.814 (SPT only) and 0.794 (sIgE only) and increased to 0.828 with the combination of SPT and sIgE. The Der p-NPT concentration was inversely correlated with SPT and sIgE levels (r = −0.477, P 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-08-13T04:36:30Z
      DOI: 10.1177/19458924211037913
       
  • Defining the Efficacy of Omalizumab in Nasal Polyposis: A POLYP 1 and
           POLYP 2 Subgroup Analysis

    • Free pre-print version: Loading...

      Authors: Cecelia Damask, Meng Chen, Cecile T. J. Holweg, Bongin Yoo, Lauren A. Millette, Christine Franzese
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disease with variable underlying pathophysiologies. Numerous patient factors have been linked to differences in disease severity, control, and response to treatment, including asthma status, aspirin sensitivity, previous sinonasal surgery, and blood eosinophil levels.ObjectiveThe present study examines the efficacy of the anti-immunoglobulin E therapy, omalizumab, versus placebo in patients with CRSwNP from the replicate POLYP 1 (NCT03280550) and POLYP 2 (NCT03280537) trials, grouped by inherent patient characteristics to determine the response to therapy.MethodsPatients in prespecified subgroups from POLYP 1 and POLYP 2 (studies pooled for analysis) were examined. Subgroups included blood eosinophil count at baseline (>300 or ≤300 cells/μL), previous sinonasal surgery (yes or no), asthma status (yes or no), and aspirin sensitivity status (yes or no). Subgroups were examined for subgroup-specific adjusted mean difference (95% confidence interval [CI]) (omalizumab–placebo) in change from baseline at week 24 in Nasal Congestion Score (NCS), Nasal Polyp Score (NPS), Sino-Nasal Outcome Test-22 (SNOT-22), Total Nasal Symptom Score (TNSS), and University of Pennsylvania Smell Identification Test (UPSIT).ResultsAdjusted mean difference (95% CI) (omalizumab–placebo) in NCS, NPS, SNOT-22, TNSS, and UPSIT change from baseline at week 24 consistently favored omalizumab treatment over placebo in patients with blood eosinophil count>300 and ≤300 cells/μL, with or without previous sinonasal surgery, asthma, and aspirin sensitivity.ConclusionTogether, these data suggest broad efficacy of omalizumab across clinical and patient-reported outcomes in patients with CRSwNP, independent of the underlying patient factors examined, including those with high eosinophil levels and those who have undergone previous surgery, which are associated with high recurrence.Clinical Trial RegistrationClinicalTrials.gov identifiers: POLYP 1: ClinicalTrials.gov identifier NCT03280550 (https://clinicaltrials.gov/ct2/show/NCT03280550); POLYP 2: ClinicalTrials.gov identifier NCT03280537 (https://clinicaltrials.gov/ct2/show/NCT03280537).
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-08-12T10:18:07Z
      DOI: 10.1177/19458924211030486
       
  • Temperature-Controlled Radiofrequency Neurolysis for the Treatment of
           Rhinitis

    • Free pre-print version: Loading...

      Authors: Dale Ehmer, Chad M. McDuffie, W. Cooper Scurry, J. Bradley McIntyre, Neelesh H. Mehendale, John H. Willis, Ronald B. Shealy, Jeremy P. Watkins, V. Vasu. Kakarlapudi
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundChronic rhinitis is a prevalent condition with a significant impact on quality of life. Posterior nasal nerve and vidian neurectomy are surgical options for treating the symptoms of chronic rhinitis but are invasive procedures.ObjectiveTo determine the outcomes of patients diagnosed with refractory chronic rhinitis and treated with temperature-controlled radiofrequency neurolysis of the posterior nasal nerve area in a minimally invasive procedure.MethodsA prospective, single-arm multicenter study with follow-up through 52 weeks. Eligible adult patients had chronic rhinitis symptoms of at least 6 months duration with inadequate response to at least 4 weeks usage of intranasal steroids and an overall 12-h reflective total nasal symptom score (rTNSS) ≥ 6 with subscores 2 to 3 for rhinorrhea, 1 to 3 for nasal congestion, and 0 to 3 for each of nasal itching and sneezing. Temperature-controlled radiofrequency energy was delivered to the nasal cavity mucosa overlying the posterior nasal nerve region with a novel single-use, disposable, handheld device.ResultsA total of 50 patients were treated (42.0% male; mean age 57.9 ± 11.9 years), and 47 completed the study through 52 weeks. Mean rTNSS significantly improved from 8.5 (95% CI 8.0, 9.0) at baseline to 3.6 (95% CI 3.0, 4.3) at 52 weeks (P 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-08-12T10:17:31Z
      DOI: 10.1177/19458924211033400
       
  • Complications Associated with PROPEL Mometasone Furoate Bioabsorbable
           Drug-eluting Sinus Stents From 2012 to 2020

    • Free pre-print version: Loading...

      Authors: Viraj N. Shah, Luke J. Pasick, Daniel A. Benito, Michael K. Ghiam, Christine D’Aguillo
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundTill date, there have been no studies that have analyzed a database to examine postmarket adverse events associated with PROPEL mometasone furoate bioabsorbable drug-eluting sinus stents.ObjectiveTo determine the postmarket complications associated with PROPEL mometasone furoate bioabsorbable drug-eluting sinus stents.MethodsThe US Food and Drug Administration’s Manufacturer and User Facility Device Experience database was searched for adverse events associated with PROPEL bioabsorbable drug-eluting sinus stents between January 1, 2012 and December 31, 2020. Data were extracted and analyzed from medical device reports (MDRs) that involved sinus stents.ResultsAfter 47 MDRs were identified, 25 reports involving PROPEL bioabsorbable drug-eluting sinus stents were reviewed, from which 40 adverse events were recorded. Of these, there were 32 adverse events to patients and 8 device malfunctions. The most common adverse events to patients included infection (21.8%), oropharyngeal obstruction (15.6%), and headache/pain (12.5%). The most common device malfunction reported was migration and expulsion of the stent (87.5%).ConclusionsPROPEL sinus stents have been shown to be effective in preventing sinus outflow obstruction after functional endoscopic sinus surgery. Both adverse events to patients and device malfunctions are reported infrequently. A more comprehensive understanding of rare postmarket complications seen with PROPEL sinus stents may further aid informed decision-making regarding their usage.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-08-03T02:25:14Z
      DOI: 10.1177/19458924211035641
       
  • Effects of Fluticasone Exhalation Delivery System in Patients With Chronic
           Rhinosinusitis With Nasal Polyps: A Systematic Review

    • Free pre-print version: Loading...

      Authors: Dawei Wu, Tianhao Huang, Yongxiang Wei
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundNasal sprays with corticosteroids deliver medication to the restricted areas including anterior and inferior parts of the nasal cavity. The fluticasone exhalation delivery system (EDS-FLU) has recently been proved to improve care by increasing superior/posterior intranasal corticosteroid deposition.ObjectiveThis study aims to evaluate the efficacy of EDS-FLU in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).MethodologyA systematic literature review using Pubmed, Embase, Cochrane Library, and Web of Science was conducted to identify studies assessing the effect of EDS-FLU on outcomes in patients with CRSwNP.ResultsOf the initial 108 abstracts reviewed, 4 full-text articles were included. The 22-item sinonasal outcome test scores were significantly decreased in patients with CRSwNP after receiving EDS-FLU twice a day (93, 186, or 372 μg) for 16 weeks when compared with exhalation delivery system (EDS)-placebo (all P 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-08-03T02:19:58Z
      DOI: 10.1177/19458924211033214
       
  • The Role of Regional Disease and Patterns of Treatment Failure in Primary
           Sinonasal Malignancies

    • Free pre-print version: Loading...

      Authors: Christian M. Meerwein, Panagiotis Balermpas, Domenic G. Vital, Martina A. Broglie, Michael B. Soyka, David Holzmann
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundThe question how to treat the clinically negative neck in sinonasal malignancies is controversial.ObjectivesTo investigate patterns of treatment failure and to assess outcome measures in patients with primary sinonasal malignancies.MethodsRetrospective cohort study of patients treated for primary malignant sinonasal malignancies.ResultsLymph node (LN) metastases at initial presentation were present in 8 of 152 patients (5.3%). Ipsi- and contralateral LN levels 1 and 2 were identified as nodal basins at risk. We found a 5-year overall survival (OS) of 75.2% and disease free survival of 61.1%. Among patients with cN0 neck, nodal recurrence free survival was not different between patients with and without elective neck treatment (P  =  .23). On logistic regression analysis, we found initial T classification as an independent factor for achievement of complete remission (CR) and OS.ConclusionsLN metastases at initial presentation are rare and initial T classification was identified as the most important prognostic factor for OS and CR, emphasizing the need for a thorough initial staging of the primary tumor.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-07-22T03:55:28Z
      DOI: 10.1177/19458924211033402
       
  • Is Body Mass Index Related to Skin Reactivity to Histamine but not to
           Specific Allergens' A 2-Year Follow-up Study on Korean Children

    • Free pre-print version: Loading...

      Authors: Michelle J. Suh, Jin A. Park, Hyekyung Ko, Minji Kang, Junhyeong Kim, Jiin Lee, Jueun Kim, Seungjae Baek, Keun-Hwa Lee, Sung-Chul Hong, Ju Wan Kang
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundSkin prick tests are widely used to diagnose allergic sensitization. The influence of obesity on the skin prick test result has not been clearly established, even though the association between allergic disease and obesity is relatively well known.ObjectiveTo determine whether a change in body mass index (BMI) contributes to skin reactivity to histamine and allergens in a skin prick test, we performed a 2-year follow-up study on Korean children.MethodsSkin prick tests for common aeroallergens were performed on elementary school students from Jeju Island, Korea. BMI was calculated using weight and height after measuring both, and demographic characteristics were surveyed. The same tests were repeated after 2 years.ResultsThe sensitization rate increased during the 2 years between tests and the children’s mean BMI also increased, along with their age. The wheal sizes induced by Dermatophagoides pteronyssinus, Dermatophagoides farinae, Japanese cedar, and histamine were significantly increased during 2 years; however, only the histamine reaction associated with increased BMI had statistical significance. Furthermore, other variables—including the number of sensitized allergens—were not related to histamine skin reactivity.ConclusionHistamine skin reactivity increased in children over time and some allergens showed increased specific reactions; however, BMI gain is a specific predictor of histamine reactivity. Further studies are needed to elucidate the clinical significance of these changes.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-07-21T03:07:20Z
      DOI: 10.1177/19458924211032469
       
  • Hypochlorous Acid Versus Saline Nasal Irrigation in Allergic Rhinitis: A
           Multicenter, Randomized, Double-Blind, Placebo-controlled Study

    • Free pre-print version: Loading...

      Authors: Ho Chan Kim, Dong-Kyu Kim, Ji Sun Kim, Ho Jun Lee, Mi Rye Bae, Woo Ri Choi, Yong Ju Jang
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundLow concentrations of hypochlorous acid (HOCl) have proven antipruritic, anti-inflammatory, and antimicrobial effects without toxicity, although the mechanism has not been fully elucidated.ObjectiveThe aim of this study was to evaluate the effectiveness of HOCl nasal irrigation to reduce allergic rhinitis (AR) symptoms compared with saline nasal irrigation.MethodsThis was multicenter, randomized, double-blind, placebo-controlled study. Initially, 139 patients with perennial AR were enrolled; however, 25 did not successfully complete the study. Patients were randomly assigned to the nasal irrigation with low-concentration HOCl (n = 55) or normal saline (n = 59) treatment groups for the 4-week study period. Participants completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) at every visit (baseline, Weeks 2 and 4), and Total Nasal Symptom Score (TNSS) was determined before and after nasal irrigation every morning and evening.ResultsWe found that RQLQ scores significantly decreased after 4 weeks in the HOCl and placebo groups, but the decrement of the RQLQ score was similar between the 2 groups. Additionally, TNSS improved in both groups between baseline and Week 4, whereas there were no significant differences in the change of TNSS between the 2 groups. The HOCl group did not show any clinical side effects related to nasal irrigation.ConclusionAllergic symptoms significantly decreased with low-concentration HOCl nasal irrigation, without significant adverse events. However, HOCl showed no additional improvement in symptoms compared with saline nasal irrigation for patients with perennial AR.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-07-08T02:32:37Z
      DOI: 10.1177/19458924211029428
       
  • Prevalence of Maxillary Sinus Hypoplasia and Silent Sinus Syndrome: A
           Radiological Cross-Sectional Retrospective Cohort Study

    • Free pre-print version: Loading...

      Authors: Umberto D’Agostino Fiorenza, Chiara Spoldi, Liudmila Nekrasova, Carlotta Pipolo, Paolo Lozza, Alberto Scotti, Alberto Maccari, Giovanni Felisati, Alberto Maria Saibene
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundMaxillary sinus hypoplasia (MSH), associated with enophthalmos and hypoglobus in the silent sinus syndrome (SSS), is a poorly studied condition. The real incidence of MSH and SSS in the adult population is not known. Our study aims at estimating the radiological prevalence of MSH and identifying undiagnosed cases of SSS in a retrospective cohort.MethodsA cross-sectional retrospective cohort study was performed in adults, without a history of maxillofacial surgery or trauma, undergoing head CT scans. A radiological database of 1012 consecutive scans was reviewed independently by two authors to identify patients with signs of MSH and SSS and associated findings (septal deviation, uncinate deviation, concha bullosa, sinus opacification, bony rarefaction, and pterygopalatine fossa enlargement). The findings of MSH and SSS were compared with radiological reports.Results891 eligible CT scans were analyzed. MSH and SSS prevalences were 6.17% (n = 55) and 0,56% (n = 5), respectively. The maxillary sinus was normally or partially ventilated in 96.36% of MSH patients. Lateralization of the uncinate process was detected in about 50% of MSH patients, while a septal deviation towards the affected sinus was detected in 21.82%. In 20% of MSH scans, a concha bullosa was identified. Radiological reports identified a single MSH case.ConclusionsOur study confirmed the literature data on MSH prevalence, while it determined a precedently unknown prevalence for SSS, underestimated in the radiology reports. This prevalence needs further confirmation but suggests a routine accurate comparison of both maxillary sinuses in CT scans.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-07-08T02:30:37Z
      DOI: 10.1177/19458924211029418
       
  • 17,18-Epoxyeicosatetraenoic Acid Inhibits TNF-α-Induced Inflammation in
           Cultured Human Airway Epithelium and LPS-Induced Murine Airway
           Inflammation

    • Free pre-print version: Loading...

      Authors: Shiori Hara, Ichiro Tojima, Shino Shimizu, Hideaki Kouzaki, Takeshi Shimizu
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      Background17,18-Epoxyeicosatetraenoic acid (17,18-EpETE), an eicosapentaenoic acid metabolite, is generated from dietary oil in the gut, and antiinflammatory activity of 17,18-EpETE was recently reported.ObjectiveTo evaluate the inhibitory effects of 17,18-EpETE in airway inflammation, we examined in vitro and in vivo effects on mucus production, neutrophil infiltration, and cytokine/chemokine production in airway epithelium.MethodsNasal tissue localization of G protein-coupled receptor 40 (GPR40), a receptor of 17,18-EpETE, was determined by immunohistochemical staining. Expression of GPR40 mRNA in nasal mucosa of chronic rhinosinusitis (CRS) patients and control subjects was determined by reverse transcription-polymerase chain reaction (RT-PCR). The in vitro effects on airway epithelial cells were examined using normal human bronchial epithelial cells and NCI-H292 cells. To examine the in vivo effects of 17,18-EpETE on airway inflammation, we induced goblet cell metaplasia, mucus production, and neutrophil infiltration in mouse nasal epithelium by intranasal lipopolysaccharide (LPS) instillation.ResultsGPR40 is mainly expressed in human nasal epithelial cells and submucosal gland cells. RT-PCR analysis revealed that the expression of GPR40 mRNA was increased in nasal tissues from CRS patients compared with those from control subjects. 17,18-EpETE significantly inhibited tumor necrosis factor (TNF)-α-induced production of interleukin (IL)-6 , IL-8, and mucin from cultured human airway epithelial cells dose dependently, and these antiinflammatory effects on cytokine production were abolished by GW1100, a selective GPR40 antagonist. Intraperitoneal injection or intranasal instillation of 17,18-EpETE significantly attenuated LPS-induced mucus production and neutrophil infiltration in mouse nasal epithelium. Inflammatory cytokine/chemokine production in lung tissues and bronchoalveolar lavage fluids was also inhibited.ConclusionThese results indicate that 17,18-EpETE plays a regulatory role in mucus hypersecretion and neutrophil infiltration in nasal inflammation. Local or systemic administration may provide a new therapeutic approach for the treatment of intractable airway disease such as CRS.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-07-08T02:28:52Z
      DOI: 10.1177/19458924211027682
       
  • Dynamic Changes, Correlation of Basophils, and the Therapeutic Effect in
           Patients With Allergic Rhinitis During Allergen-specific Immunotherapy

    • Free pre-print version: Loading...

      Authors: Meixu Huo, Susu Tang, Daihua Wang, Xiaoqing Liu, Qianxu Liu
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundThe role of basophils in allergic rhinitis (AR) has been studied extensively; however, there are very few reports on changes in basophils after allergen-specific immunotherapy (SIT).ObjectiveTo examine the changes and correlation of peripheral blood basophils and the therapeutic effect in patients with AR during allergen-SIT.MethodsA total of 77 patients with AR who were allergic only to house dust mites received allergen-SIT. At 3 time points, patients underwent testing for the percentage and activation rate of basophils in peripheral blood, skin index (SI) measurement, visual analog scale (VAS) assessment, and rhinoconjunctivitis quality of life questionnaire (RQLQ) evaluation. The results were compared to a control group with congenital preauricular fistula.Results(1) Before treatment, the percentage and activation rate of basophils in patients with AR were significantly higher than those in controls. There was no significant difference in the percentages and activation rates of basophils at the 3 time points. (2) The SIs, VAS, and RQLQ scores of the patients immediately after treatment and 2 years posttreatment decreased significantly compared to those before treatment; the SI, VAS, and RQLQ scores of the patients 2 years posttreatment increased significantly compared with those immediately after treatment. (3) There was no correlation between the patients’ basophil activation rate and percentage and the SI, VAS, and RQLQ scores at all time points.ConclusionThe percentage and activation rate of basophils were higher in patients with AR than in controls. The values did not change significantly after allergen-SIT and showed no correlation with treatment effectiveness. Therefore, the frequency and activation rate of basophils cannot be used as criteria for assessing the effectiveness of allergen-SIT for house dust mites. Allergen-SIT is effective for the management of AR, but the effect declines after the completion of therapy.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-07-08T02:26:31Z
      DOI: 10.1177/19458924211027073
       
  • Effects of Urban Particulate Matter on the Olfactory System in a Mouse
           Model

    • Free pre-print version: Loading...

      Authors: Boo-Young Kim, Ju Y. Park, Kwang J. Cho, Jung H. Bae
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundExposure to urban particulate matter (UPM) is linked to the aggravation of various health problems. Although the nasal cavity is the first barrier to encounter UPM, there is a lack of studies on the impact of UPM on the olfactory area. The purpose of this study was to investigate the cytotoxic effects of UPM on mouse olfactory epithelium, the underlying pathophysiology involved, and changes in cytokine levels.MethodsMice were divided into 4 groups: control, 400UPM (administered 400 µg UPM daily; standard reference material 1649b; average particle diameter 10.5 μm) 1week, 400UPM 2weeks, and recovery 1week after 400UPM 2weeks (n = 10, 6, 6, and 6, respectively). Olfactory function was evaluated by conducting a food-finding test once a week. The olfactory neuroepithelium was harvested for histologic examination, gene ontology, quantitative real-time polymerase chain reaction, and western blotting.ResultsCompared to those in the control group, olfactory marker protein, olfactory receptor 1507, adenylyl cyclase 3, and GNAL mRNA levels were lower and S-100, 2′,3′-cyclic nucleotide 30-phosphodiesterase, nerve growth factor receptor-associated protein, brain-derived neurotrophic factor, and tachykinin receptor mRNA levels were higher in the 400UPM group olfactory neuroepithelium. There were no significant differences in neuroepithelial inflammatory marker levels between the 400UPM and saline group.ConclusionsUPM decreased olfactory function and might have cytotoxic effects on the olfactory epithelium. Olfactory ensheathing cells and trigeminal nerve might be related to the regeneration of the olfactory epithelium after olfactory destruction associated with UPM.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-07-08T02:24:10Z
      DOI: 10.1177/19458924211026416
       
  • Safety of Endoscopic Sinus Surgery in the Elderly—Are Octogenarian
           Patients at a Higher Risk'

    • Free pre-print version: Loading...

      Authors: Lirit Levi, Yonatan Reuven, Daniel Ben-Ner, Noam Koch, Mor Gunders-Peleg, Yuval Nachalon, Ilan Koren, Alain Hazan, Gabriel Nakache, Ella Reifen, Ethan Soudry
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundSurgeons are often faced with concerns regarding the risks versus benefits of endoscopic sinus surgery (ESS) in elderly patients.ObjectiveTo analyze the risk for complications of ESS in the elderly (age ≥70 years) compared to younger patients, with emphasis on octogenarians.MethodsRetrospective review of medical charts of adult patients who underwent ESS at a tertiary referral center during the years 2014 to 2018.ResultsWe compared 128 elderly patients with 276 matched younger patients. In the elderly group mean age was 76 years (range, 70-91 years ). Thirty-one elderly patients were 80 years or older. Surgical complications in the elderly patients were 3.9%. Minor complications were 2.3% and major complications were 1.7%. The surgical complications rate was similar in the younger group (8%, P value: .127). Medical complications were observed in 2.3% comparing to 0.7% in younger patients. Interestingly, age, revision surgery, extent and duration of surgery, and modality of anesthesia were not identified as risk factors. Only ischemic heart disease (IHD) was identified as a risk factor for complications in a multivariate analysis in elderly patients. Comparison of elderly patients younger than 80 years with octogenarians revealed no difference in complication rate between these groups.ConclusionsOverall, ESS was found to be a safe procedure in elderly patients compared to younger patients. Octogenarian patients should not be denied upfront surgery. IHD is a risk factor for complications in elderly patients.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-07-08T02:21:11Z
      DOI: 10.1177/19458924211025374
       
  • Extended Anterior Inferior Approach to Endoscopic Medial Maxillectomy for
           Maxillary Sinus Lesions

    • Free pre-print version: Loading...

      Authors: Alice E. Huang, Christopher M. Low, Janalee K. Stokken
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundMyriad open and endoscopic approaches are employed to resect maxillary sinus lesions, each with associated advantages and disadvantages. The inferior and anterior portion of the sinus remains a challenging space to access.ObjectivesTo describe the extended anterior inferior approach to endoscopic medial maxillectomy (EAMM) as a novel and valuable addition to a stepwise approach for minimizing surgical morbidity without compromising tumor outcomes. To report the outcomes of patients treated with this approach.MethodsA retrospective case series study of 9 patients who underwent EAMM between 2016 and 2019 at a tertiary care referral center was performed. The endoscopic technique is described. The duration of follow-up ranged from 1 to 53 months. Intraoperative steps, including transection of the nasolacrimal duct and execution of an intraoperative dacryocystorhinostomy, were reviewed. Postoperative outcomes, including patient symptoms at follow-up and tumor recurrence, were recorded.ResultsAdequate exposure with gross total tumor resection or margin-negative tumor resection was achieved in all cases. Sparing of the nasolacrimal duct was achieved in 2 patients. No patients reported persistent epiphora, empty nose syndrome, or changes in cosmesis such as alar or nasal tip collapse. One patient reported unilateral V2 hypoesthesia at 6 months postoperatively that had resolved by his next follow-up 18 months after surgery. Postoperative tumor surveillance was achieved by endoscopic examinations in all patients and there was no evidence of tumor recurrence at a median follow-up of 22 months.ConclusionsThe EAMM provides improved access to the inferior–posterior–medial maxillary sinus. This approach minimizes the risk of hypoesthesia and change in cosmesis present in other approaches, and obviates division of the nasolacrimal duct for inferior, posterior–medial attached lesions. This progressive escalation of approach for maxillary sinus lesions minimizes injury to nasal and nasolacrimal structures without compromising tumor outcomes.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-07-08T02:00:24Z
      DOI: 10.1177/19458924211025371
       
  • Identifying Best Practices for Managing Internal Carotid Artery Injury
           During Endoscopic Endonasal Surgery by Consensus of Expert Opinion

    • Free pre-print version: Loading...

      Authors: Zachary M. Kassir, Paul A. Gardner, Eric W. Wang, Georgios A. Zenonos, Carl H. Snyderman
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundInjury to the internal carotid artery (ICA) is a potentially devastating complication of endoscopic endonasal surgery (EES) that as many as 20% of skull base surgeons will experience at least once during their careers. Managing these injuries is difficult given the small operative field and poor visibility created by high-flow hemorrhage, and, at present, there is no consensus regarding best practices.ObjectiveThis study seeks to consolidate the practices and opinions of experienced skull base surgeons from high-volume tertiary care centers into a single consensus statement regarding the best practices for managing ICA injuries during EES.MethodsA panel of 23 skull base surgeons (15 neurosurgeons and 8 otolaryngologists) completed a 3-round Delphi survey that assessed experiences and opinions regarding various aspects of ICA injury management. Mean (SD) years since fellowship completion was 15.6 (8.1) and all but 3 surgeons had experienced an ICA injury at least once.ResultsThe final consensus statement included 36 guidelines all of which were grouped under 1 of 4 categories: 11 statements concerned preoperative management and equipment for high-risk patients; 14 statements concerned hemorrhage control; 4 statements concerned definitive management; 7 statements concerned pharmacologic treatment, blood pressure, and neurophysiologic monitoring.ConclusionsThere are numerous decisions that a surgeon must make when facing a carotid artery injury. In our estimation, many questions can be grouped under 1 of the 4 categories outlined in our consensus statement and can be addressed by these findings.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-07-08T01:55:05Z
      DOI: 10.1177/19458924211024864
       
  • Regulation of the Expression of SARS-CoV-2 Receptor Angiotensin-Converting
           Enzyme 2 in Nasal Mucosa

    • Free pre-print version: Loading...

      Authors: Tetsuji Takabayashi, Kanako Yoshida, Yoshimasa Imoto, Robert P. Schleimer, Shigeharu Fujieda
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundCoronavirus disease 2019 (COVID-19) has caused a global pandemic. Higher expression of the virus receptor angiotensin-converting enzyme 2 (ACE2) in the nasal mucosa may be associated with high transmissibility and asymptomatic infection. In COVID-19, the elucidation of the determinants of ACE2 expression at nasal tissue level is crucial. The development of strategies to downregulate ACE2 expression in nasal epithelial cells might reduce transmission and be useful as a novel therapeutic approach.ObjectiveTo verify ACE2 expression in the nasal mucosa of patients with seasonal allergic rhinitis induced by Japanese cedar pollen (SAR-JCP) and chronic rhinosinusitis with nasal polyp (CRSwNP) and to examine the effects of short-chain fatty acids (SCFAs) on ACE2 expression in airway epithelial cells.MethodsWe assessed ACE2 expression in the nasal mucosa of control subjects, patients with SAR-JCP, and those with CRSwNP using real-time polymerase chain reaction. We also quantified ACE2 gene expression in cultured airway epithelial cells.ResultsAlthough ACE2 expression was greatly increased in a few patients with SAR-JCP during the Japanese cedar pollen season, mean levels were not significantly increased. ACE2 mRNA expression was significantly decreased in nasal polyp tissue from patients with chronic rhinosinusitis compared with the expression in that from control subjects. SCFAs generated by gastrointestinal microbiota significantly reduced resting ACE2 expression in cultured airway epithelial cells. SCFAs also significantly suppressed the dsRNA-dependent upregulation of ACE2 expression in airway epithelial cells.ConclusionInflammatory endotype affects ACE2 expression in the nasal mucosa and influences susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In particular, type 2 inflammation could downregulate ACE2 expression in the nasal mucosa and reduces susceptibility to SARS-CoV-2 in patients with CRSwNP. Although in vivo experiments are required, administration of SCFAs to the nasal cavity might be worthy of consideration as a preventative or therapeutic strategy for the early-stage COVID-19.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-07-07T04:30:30Z
      DOI: 10.1177/19458924211027798
       
  • Comparison of Sinonasal Histopathological Changes in Biological Treatment
           of Eosinophilic Chronic Rhinosinusitis

    • Free pre-print version: Loading...

      Authors: Jacqueline Ho, Raquel Alvarado, Janet Rimmer, William A. Sewell, Sophie Walter, Peter Earls, Raewyn G. Campbell, Raymond Sacks, Larry H. Kalish, Richard J Harvey
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundBiologic therapies such as mepolizumab and benralizumab are currently utilised in the treatment of eosinophilic asthma, and are emerging in the management of eosinophilic chronic rhinosinusitis (eCRS). These biologics inhibit the interaction of IL-5 with its receptor, thus impairing cytokine signalling and eosinophil inflammation. Mepolizumab does so by targeting IL-5, whereas benralizumab targets the α chain of the IL-5 receptor. This study compares the sinonasal tissue response to anti-IL-5 biologic therapies in patients with eCRS.MethodsA cross-sectional study of adult eCRS patients who had completed at least 2 cycles of biologic therapy and underwent endoscopic sinus surgery as part of their management were included. Sinonasal mucosal tissue biopsies were obtained intraoperatively and assessed with structured histopathological examination. Comparisons of tissue histopathology outcomes following treatment with mepolizumab or benralizumab were performed.Results18 patients (age 49.6 ± 14.2 years, 47% female, 100% co-morbid asthma) were included in this study, comprising 10 patients managed with mepolizumab and 8 patients managed with benralizumab. Even after mepolizumab, the tissue had predominantly eosinophilic inflammation compared to benralizumab (90% v 0%, p 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-06-06T01:38:44Z
      DOI: 10.1177/19458924211021031
       
  • The Effectiveness and Safety of Intrathecal Fluorescein in the Management
           of Cerebrospinal Fluid Leaks

    • Free pre-print version: Loading...

      Authors: Karan Jolly, Keshav Kumar Gupta, Abishek Banota, Shahzada K. Ahmed
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundCerebrospinal fluid (CSF) leaks can be associated with significant morbidity such as meningitis. Surgical management has proven effective, with endoscopic approaches having become the gold standard due to success rates>90%. Inability to localise the leak site prior to surgery is associated with surgical failure. The use of intrathecal fluorescein (IF) to localise CSF fistulae sites was first demonstrated in 1960. Despite this, its use in this context is unlicensed.ObjectiveEvaluate the safety and efficacy of IF use in the management of CSF leak repairs in our centre.MethodsAll patients who underwent endoscopic repair of CSF fistula by a single surgeon where IF was used between January 2010 – September 2019 at a single-centre (tertiary skull base referral unit in the United Kingdom) were retrospectively analysed. Primary outcome measures were localisation of CSF fistula with IF (efficacy) and peri-operative complications likely to be attributable to IF (safety).ResultsThere were 55 patients included (60 procedures) with a positive localisation rate of 90.0% with IF. The overall peri-operative complication rate was 8.3% (n = 5). It is likely that none were related to IF use. However, three complications may be linked giving a complication rate potentially related to IF of 5.0%. There were no peri-operative mortalities.ConclusionMany studies have demonstrated IF to be safe at low doses (
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-06-02T05:28:58Z
      DOI: 10.1177/19458924211020564
       
  • The Utility of Preoperative Phone Calls for Endoscopic Sinus Surgery
           Procedures

    • Free pre-print version: Loading...

      Authors: Sabina Dang, Mallory McKeon, Varun Menon, Rakesh Chandra, Marc L. Bennett
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      ObjectivePerioperative patient education improves patient satisfaction, surgical outcomes, and can reduce postoperative call volume. Here, we investigate whether the use of standardized preoperative phone calls elicits similar results in patients undergoing endoscopic sinus surgery (ESS).MethodsPatients undergoing ESS at a tertiary rhinology center were identified prospectively through the electronic medical record (EMR). In the intervention cohort, a standardized preoperative educational phone call was performed. A postoperative survey was utilized to collect self-assessment of satisfaction and understanding in all patients. Postoperative call rates were obtained from the EMR. Wilcoxon rank sum and chi-squared analyses were conducted to compare results. Demographics of the otology and rhinology cohorts were compared with a Mann Whitney U-test.ResultsData from 43 cases and 58 controls were collected. Patients receiving the intervention were similar to controls with regard to patient-reported understanding (case:9.1 ± 1.1 vs control:9.0 ± 1.4, p = 0.801) and satisfaction (case:9.4 ± 1.1 vs 8.9 ± 1.4, p = 0.155). Both cases and controls called the clinic regarding surgical outcomes more often than for postoperative medications or administrative concerns. Independent of receiving the intervention, patients that did not call clinic postoperatively had significantly better understanding of their procedures (call:8.6 ± 1.6 vs no-call:9.5 ± 1.0, p 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-06-02T05:28:42Z
      DOI: 10.1177/19458924211020550
       
  • Anatomic Variations of Ethmoid Roof and Risk of Skull Base Injury in
           Endoscopic Sinus Surgery: Statistical Correlations

    • Free pre-print version: Loading...

      Authors: Gian Luca Fadda, Alessio Petrelli, Federica Martino, Giovanni Succo, Paolo Castelnuovo, Maurizio Bignami, Giovanni Cavallo
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundRecent developments in endoscopic sinus surgery (ESS) have increased the need to investigate the complex anatomic variations in the ethmoid roof and skull base, to inform the surgeon about the risk of damaging these crucial areas during ESS.ObjectiveTo offer a detailed description of sinus anatomy focusing on the key surgical landmarks in ESS and frontal recess surgery to standardize a systematic approach during the preoperative sinuses imaging evaluation.Methodology: A total of 220 computed tomography (CT) scans were reviewed to obtain six sets of measurements: the depth of the cribriform plate (CP); the length of the lateral lamella of the cribriform plate (LLCP); the angle formed by the LLCP and the continuation of the horizontal plane passing through the CP; the position of the anterior ethmoidal artery (AEA) at the skull base; the extent of frontal sinus pneumatization (FSP); the type of superior attachment of the uncinate process (SAUP).ResultsThe length of the LLCP was statistically significantly correlated with the different Keros classification types, the angle formed by the LLCP with the continuation of the horizontal plane passing through the CP, and with the AEA position at the skull base. The depth of the olfactory fossa was correlated with FSP.ConclusionsAccording to the Keros and Gera classifications, the data obtained from these evaluations allow the assessment of anatomic-radiological risk profiles and can help identify those patients who are high risk for ethmoid roof injury.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-05-27T04:26:56Z
      DOI: 10.1177/19458924211020549
       
  • Association Between Chemosensory Dysfunction and Diet Quality in United
           States Adults

    • Free pre-print version: Loading...

      Authors: Christopher R. Roxbury, Isaac A. Bernstein, Sandra Y. Lin, Nicholas R. Rowan
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundEvidence suggests chemosensory dysfunction (CSD) patients have altered diet, but population-level evidence assessing diet quality in CSD patients is lacking.ObjectiveWe examined the association between CSD and diet quality in a representative sample of United States adults.MethodsThis cross-sectional study included 2831 adults aged greater than 40 years from the 2013-2014 National Health and Nutrition Examination Survey who completed the taste/smell questionnaire and examination. Mean nutrient intake in subjects with self-reported olfactory/gustatory dysfunction (sOD/sGD) and measured olfactory/gustatory dysfunction (mOD/mGD) were compared to those without CSD using univariate Wilcoxon rank-sum tests. The Healthy Eating Index (HEI), a validated measure of diet quality, was calculated. The proportion of subjects with CSD with bottom-quartile HEI was compared to those without CSD using multivariate logistic regression, adjusting for demographic and socioeconomic covariates.ResultsThe population-weighted prevalence of sOD, sGD, mOD, and mGD was 20.1%, 14.4%, 15.9% and 25.6%, respectively. Subjects with mOD had lower mean intake of total calories, total fat, protein, sodium, and potassium compared to normal subjects (1873.4 ± 49.6 vs 2010.2 ± 24.2 kcal, 72.3 ± 2.7 vs 78.6 ± 1.0 gm, 74.0 ± 2.5 vs 80.4 ± 0.6 gm, 3122 ± 97.2 vs 3353.2 ± 37.0 mg, 2509.8 ± 69.8 vs 2684.7 ± 26.1 mg, P 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-05-18T04:15:34Z
      DOI: 10.1177/19458924211016611
       
  • Conditional and Overall Disease-Specific Survival in Patients With
           Paranasal Sinus and Nasal Cavity Cancer: Improved Outcomes in the
           Endoscopic Era

    • Free pre-print version: Loading...

      Authors: Rahul K. Sharma, Alexandria L. Irace, Rodney J. Schlosser, Jonathan B. Overdevest, Nicholas R. Rowan, Scott H. Troob, David A. Gudis
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundThe management of paranasal sinus and nasal cavity malignancies has evolved significantly with the development of advanced endoscopic techniques and improvements in adjuvant therapy. We sought to characterize both disease-specific survival (DSS) and 5-year conditional disease-specific survival (CDSS, the change in life expectancy with increasing survivorship) for sinus malignancies diagnosed before and after the year 2000.MethodsPatients diagnosed with sinus and nasal cavity cancer between 1973-2015 were extracted from the Surveillance, Epidemiology, End Results (SEER) registry. Kaplan-Meier analysis for DSS was stratified by year of diagnosis before and after 2000. Cox-proportional hazards models of DSS controlling for stage, age, and year of diagnosis were generated. CDSS was calculated using Cox-regression models stratified by stage.ResultsWe analyzed 10,535 patients. Diagnosis after the year 2000 was independently associated with improved DSS (HR:0.81, 95% CI: 0.75-0.87, P 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-05-18T04:15:32Z
      DOI: 10.1177/19458924211019158
       
  • Investigation of Repeatability of Peak Nasal Inspiratory Flow Rate
           Measurements Under Baseline Conditions and After Administration of 0.05%
           Oxymetazoline

    • Free pre-print version: Loading...

      Authors: Anna Dor-Wojnarowska, Anna Radlińska, Marek Rabski, Andrzej Fal, Jerzy Liebhart, Anna Zaleska, Mariana Babchyshyn, Bolesław Samoliński
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      ObjectivesPeak nasal inspiratory flow (PNIF) measurement is an inexpensive and user-friendly method to assess nasal patency. However, the repeatability of PNIF measurements, as well as the threshold value of a change in PNIF, which can be considered significant remain unclear. This study aims to investigate the repeatability of PNIF measurements and the change in PNIF after the administration of 0.05% oxymetazoline.MethodsRepeated measurements of PNIF (Clement Clarke In-Check nasal inspiratory flow meter; Clement Clarke International, Ltd, Harlow, Essex, UK) were obtained in 333 healthy volunteers (174 women). Based on age, participants were categorized into three groups (6–7 years, 13–14 years, and 20–45 years). We obtained five measurements in each participant. PNIF was remeasured in 294 subjects 30 min after administration of 0.05% oxymetazoline. The variability in PNIF measurements was assessed using the coefficient of variation (CV = standard deviation × 100%/mean).ResultsThe first four PNIF measurements significantly differed from each other. The difference in PNIF measurements ceased to be statistically significant only between the fourth and fifth measurements (p = 0.19). PNIF repeatability was acceptable; the median CV was 15.5% (0–66), which did not significantly differ between age groups. The administration of 0.05% oxymetazoline led to a statistically significant increase in the PNIF value by 14.3% (−45, 157%) (p = 0.000000).Conclusions1. No statistically significant difference was observed in PNIF values only between the fourth and fifth measurements; therefore, at least three measurements are essential to draw meaningful conclusions. 2. PNIF measurements were satisfactorily characterized by a relatively low CV (15%). 3. The administration of 0.05% oxymetazoline led to an increase in PNIF by approximately 14% over the baseline value.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-05-07T03:48:26Z
      DOI: 10.1177/19458924211015584
       
  • Identification of Heat Shock Protein 90 as a Recurrence Related Marker in
           Juvenile Nasopharyngeal Angiofibroma

    • Free pre-print version: Loading...

      Authors: Jingjing Wang, Li Hu, Zhuofu Liu, Huan Wang, Huankang Zhang, Xiaole Song, XiCai Sun, DeHui Wang
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundJuvenile nasopharyngeal angiofibroma (JNA) is a highly recurrent tumor after curative surgery.ObjectiveThe purpose of this study was to evaluate heat shock protein 90 (HSP90) expression in JNA and its association with tumor recurrence.MethodsImmunohistochemistry was performed to assess HSP90 expression using tissue microarrays containing 70 JNA patients and 10 control subjects. The associations of HSP90 expression with clinicopathological features and tumor recurrence were analyzed.ResultsImmunohistochemistry revealed high HSP90 expression in JNA compared with normal middle turbinate samples. High expression of HSP90, which correlated with MVD (P = .001), ER-α (P = .001), VEGF (P 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-05-04T03:58:28Z
      DOI: 10.1177/19458924211012820
       
  • Assessment of Biomarker Heterogeneity in Sinus Versus Inferior Turbinate
           Tissue in Patients Without Chronic Rhinosinusitis

    • Free pre-print version: Loading...

      Authors: Taylor R. Carle, Tara J. Wu, Vivian Wung, Jeffrey D. Suh, Marilene B. Wang, Christine R. Wells, Maura Rossetti, Jivianne T. Lee
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundCurrently, no consensus exists on the appropriate control specimen site to utilize in studies evaluating for biomarkers in chronic rhinosinusitis (CRS). Studies thus far have utilized tissue from various anatomic sites despite regional heterogeneity.ObjectiveWe set out to quantify the differences in biomarker levels present in inferior turbinate versus sphenoid sinus mucosa in paired healthy control patients. We hypothesize that statistically significant differences in cytokine/chemokine expression exist between these two distinct sites.MethodsA 38-plex commercially available cytokine/chemokine Luminex Assay was performed on 54 specimens encompassing paired inferior turbinate and sphenoid sinus mucosa samples from 27 patients undergoing endoscopic anterior skull base surgery. Patients with a history of CRS were excluded. Paired sample t-tests and Fisher’s exact tests were performed.ResultsTwenty-seven patients were included in the study, including 10 male and 17 female patients with an average age of 48 years. The following 8 biomarkers had statistically significant concentration differences between inferior turbinate mucosa and sphenoid mucosa sites: Flt-3L, Fractalkine, IL-12p40, IL-1Ra, IP-10, MCP-1, MIP-1β, and VEGF, with all P-values
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-04-29T03:51:58Z
      DOI: 10.1177/19458924211012808
       
  • Comorbidities Known to Affect Physical Function Negatively Impact Baseline
           Health-Related Quality-of-Life in Patients With Chronic Rhinosinusitis

    • Free pre-print version: Loading...

      Authors: Amarbir S. Gill, Shaelene Ashby, Gretchen M. Oakley, Toby O. Steele, Dennis Menjivar, Richard R. Orlandi, Jeremiah A. Alt
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundMedical comorbidities are commonly encountered in chronic rhinosinusitis (CRS) and may impact both physical function and patient reported health-related quality-of-life (HRQOL). The functional comorbidity index (FCI) is designed to elucidate the role of comorbidities on functional prognosis. The objective of this study was to understand the impact of comorbidities known to impact physical function on baseline HRQOL using the FCI.Methodology: Patients meeting diagnostic criteria for CRS were prospectively enrolled in a cross-sectional study. Responses from the Sinonasal Outcomes Test-22 (SNOT-22), a measure of patient HRQOL, as well as the Lund-Kennedy and Lund-Mackay scores were recorded at enrollment. FCI was calculated retrospectively using the electronic medical record. Information was collected and compared for patients without (CRSsNP) and with nasal polyps (CRSwNP) using chi-square and t-tests. Spearman’s correlations, followed by multivariate regression analysis, were used to assess the association between FCI and SNOT-22 scores.ResultsOne hundred and three patients met inclusion criteria for analysis. There were no significant differences in age, gender, and SNOT-22 scores between patients with CRSsNP and those with CRSwNP. FCI was significantly and independently associated with worse SNOT-22 scores (P = .012). FCI did not correlate with endoscopy and computed tomography scores. The mean FCI for patients with CRSsNP and CRSwNP was 2.02 and 2.24, respectively, and did not differ significantly between the two cohorts (P = .565).ConclusionsMajor medical comorbidities known to affect physical function are associated with worse SNOT-22 scores in patients with CRS as measured by the FCI.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-04-28T04:01:23Z
      DOI: 10.1177/19458924211013610
       
  • Long Term Outcomes of Nasoseptal Perforation Repair With an Anterior
           Ethmoidal Artery Flap

    • Free pre-print version: Loading...

      Authors: Jacopo Zocchi, Federico Russo, Luca Volpi, Hassan Ahmed Elhassan, Giacomo Pietrobon, Alberto Arosio, Maurizio Bignami, Paolo Castelnuovo
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundNasoseptal perforation repair is a challenging condition with no standard technique for repair recognized.MethodsA case series of consecutive patients who underwent nasoseptal perforation repair with an anterior ethmoidal artery flap was conducted. Demographic data, preoperative features of the perforation and postoperative outcomes were analyzed. Closure rate, complications and persistence of nasal symptoms were documented.ResultsThirty-two patients were included in the study. The average perforation diameter was 1.48 cm (range: 0.4–3 cm). Iatrogenic trauma was the most common cause (56% of patients). Nine cases ended up being idiopathic. The overall closure rate was 81%, but 87.5% when perforation had a 2-cm diameter or less. Of the six failures, 2 were due to flap necrosis and 4 to a residual anterior perforation. Despite the persistence, 2 patients solved their symptoms. One patient underwent revision surgery.ConclusionThe anterior ethmoidal artery flap is a reliable and minimal invasive technique for closure of symptomatic perforations. For defects larger than 2 cm, a lower success rate and additional reconstructive measures should be considered. Objective questionnaires are needed in order to evaluate functional outcomes.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-04-21T03:48:34Z
      DOI: 10.1177/19458924211012120
       
  • A Phase II, Multicenter, Randomized, Placebo-Controlled Study of
           Benralizumab, a Humanized Anti-IL-5R Alpha Monoclonal Antibody, in
           Patients With Eosinophilic Chronic Rhinosinusitis

    • Free pre-print version: Loading...

      Authors: Tetsuji Takabayashi, Daiya Asaka, Yoshitaka Okamoto, Tetsuo Himi, Shinichi Haruna, Naohiro Yoshida, Kenji Kondo, Mamoru Yoshikawa, Yasunori Sakuma, Kunihiko Shibata, Motohiko Suzuki, Masayoshi Kobayashi, Ryo Kawata, Kenzo Tsuzuki, Mitsuhiro Okano, Takaya Higaki, Sachio Takeno, Satoru Kodama, Syuji Yonekura, Hiromi Saito, Akiyo Nozaki, Nobuyoshi Otori, Shigeharu Fujieda
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundStrong eosinophil infiltration in chronic rhinosinusitis with nasal polyp (CRSwNP) is highly associated with recalcitrance and higher nasal polyp recurrence rate after surgery. The prevalence of eosinophilic CRSwNP (ECRS) is increasing in Asian countries including Japan. Benralizumab is a humanized anti-IL-5R alpha monoclonal antibody that depletes eosinophils by antibody-dependent cell-mediated cytotoxicity.ObjectiveTo assess the efficacy and safety of benralizumab in patients with ECRS.MethodsThis phase II, randomized, double-blind, placebo-controlled study was conducted in Japan. Patients were randomized 1:2:2 to placebo, a single administration of benralizumab 30 mg, or benralizumab 30 mg every 4 weeks (q4w) for a total of three doses. The primary endpoint was the change in nasal polyp score from baseline at Week 12.ResultsOverall, 56 patients were enrolled (placebo, n = 11; benralizumab single dose, n = 22; benralizumab q4w, n = 23). Although the mean total nasal polyp score began to decrease after the initiation of benralizumab treatment, there were no statistically significant differences in change in nasal polyp score from baseline at Week 12 between benralizumab and placebo (placebo, −0.5 ± 0.8; benralizumab single, −0.3 ± 0.8; benralizumab q4w, −0.5 ± 1.5). Post-hoc analysis showed that the administration of benralizumab decreased nasal polyp scores ≥2 points in 42.2% of ECRS patients and that patients with high blood eosinophil levels had a greater tendency to respond to benralizumab treatment. The safety profile was similar to that in previous studies and no unexpected adverse events were noted.ConclusionAlthough benralizumab did not meet the primary efficacy endpoint, reductions of nasal polyp scores were seen in the benralizumab group compared with the placebo group over the whole study period, especially in patients with high levels of blood eosinophils.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-04-12T04:10:22Z
      DOI: 10.1177/19458924211009429
       
  • High Histamine Control Concentration Leads to False Negative Allergy Skin
           Testing

    • Free pre-print version: Loading...

      Authors: Amulya Amirneni, Jody Tversky
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundAllergy skin test reliability depends on the reagents and controls selected. Histamine is used at 1 mg/ml and 6 mg/ml concentration but few studies address the rationale for selecting one versus the other and how this may impact diagnostic accuracy.ObjectiveTo determine the rate of false negative allergen skin tests responses between UniTest PC (using the 1 mg/mL histamine) and Quintip devices (using 6 mg/mL) for 4 common aeroallergens.MethodsSubjects aged 18-65 with symptoms of allergy to cat and/or ragweed received skin testing with 4 aeroallergens (dust mite mix, timothy grass, ragweed, cat), histamine and control diluent. Those individuals who tested positive to cat or ragweed with one skin prick test (SPT) device but not the other then proceeded to nasal allergen challenge (NAC). The primary outcomes were the aeroallergen false negative rates and sensitivities of the skin test devices followed by nasal allergen (NAC).ResultsTwenty-five individuals were recruited and underwent a total of 300 SPTs. SPT to allergens (ragweed, dust mite, cat, and timothy grass) resulted in a statistically significant difference in wheal size among the two skin testing devices (p value
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-04-08T04:27:20Z
      DOI: 10.1177/19458924211008685
       
  • COVID-19-Induced Anosmia and Ageusia Are Associated With Younger Age and
           Lower Blood Eosinophil Counts

    • Free pre-print version: Loading...

      Authors: Esha Sehanobish, Mali Barbi, Valerie Fong, Meryl Kravitz, Denise Sanchez Tejera, Mohammad Asad, Cynthia Matsumura, Denisa Ferastraoaru, Meaghan O’Neill, Merhunisa Karagic, Nadeem Akbar, Danielle M. Bottalico, Viraj Patel, Alexandre Peshansky, Mahendra Rangareddy, Golda Hudes, Mimi Kim, Ruth Eisenberg, Avindra Nath, Bryan R. Smith, Thomas J. Ow, Elina Jerschow
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundAnosmia and ageusia are symptoms commonly associated with COVID-19, but the relationship with disease severity, onset and recovery are unclear.ObjectiveTo examine factors associated with anosmia and ageusia and the recovery from these symptoms in an ethnically diverse cohort.MethodsIndividuals tested for SARS-CoV-2 between March and April 2020 were eligible for the study. Randomly selected participants answered a telephone questionnaire on COVID-19 symptoms with a focus on anosmia and ageusia. Additionally, relevant past medical history and data on the COVID-19 clinical course were obtained from electronic medical records. 486 patients were in the COVID-19 group and 103 were COVID-19-negative.ResultsPatients who were younger were more likely to report anosmia and/or ageusia (odds ratio (OR) for anosmia per 1-year increase in age: 0·98, 95%CI:0–97-0·99, p = 0·003; for ageusia: 0·98, 95%CI:0·97-0·99, p = 0·005) as were patients with lower eosinophil counts (OR for anosmia per 0.1-K/μL increase in eosinophils: 0·02, 95%CI:0·001-0·46, p = 0·01, for ageusia 0·10, 95%CI:0·01-0·97, p = 0·047). Male gender was independently associated with a lower probability of ageusia (OR:0·56, 95%CI:0·38-0·82, p = 0·003) and earlier sense of taste recovery (HR:1·44, 95%CI:1·05-1·98, p = 0·02). Latinos showed earlier sense of taste recovery than white patients (HR:1·82, 95%CI:1·05-3·18, p = 0·03).ConclusionAnosmia and ageusia were more common among younger patients and those with lower blood eosinophil counts. Ageusia was less commonly reported among men, and time to taste recovery was earlier among both men and Latinos.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-04-04T04:54:12Z
      DOI: 10.1177/19458924211004800
       
  • Simplifying Access to the Lateral Sphenoid Recess: A Modification of the
           Transpterygoid Approach

    • Free pre-print version: Loading...

      Authors: Satyan B. Sreenath, Dennis M. Tang, João Paulo De Almeida, Pranay Soni, Troy D. Woodard, Pablo F. Recinos, Varun R. Kshettry, Raj Sindwani
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundMeningoencephaloceles originating in the lateral recess of the sphenoid sinus can be difficult to access. Historically, the endoscopic transpterygoid approach was advocated, which carries additional morbidity given the dissection of the pterygopalatine fossa (PPF) contents to provide a direct line approach to the defect. Given our increased facility with angled endoscopes and instrumentation, we now approach this region in a less invasive manner.MethodsWe describe the endoscopic modified transpterygoid approach (MTPA), a quicker approach to the lateral sphenoid recess which preserves the PPF contents through a single nostril corridor.ResultsIn the MTPA, the face of the sphenoid and anterior junction of the pterygoid plates are removed, allowing for mobilization of the PPF contents with the periosteum intact. Angled instrumentation is then used to resect the meningoencephalocele and repair the skull base defect in the lateral recess. If increased exposure is needed, this can be gained by sacrificing the sphenopalatine artery and even the vidian nerve, although this is rarely required.ConclusionsThe MTPA obviates the need for PPF dissection and simplifies access to the lateral sphenoid recess while minimizing postoperative morbidity. This approach should be considered for accessing meningoencephaloceles and other benign lesions in this challenging location.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-03-25T04:08:38Z
      DOI: 10.1177/19458924211003813
       
  • Immunosuppressive Regulation of Dendritic Cells and T Cells in Allergic
           Rhinitis by Semaphorin 3A

    • Free pre-print version: Loading...

      Authors: Honghui Liu, Jinye Xia, Yu Chen, Jingang Ai, Tiansheng Wang, Guolin Tan
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundSemaphrin3A (Sema3A) was found to play a major role in immune regulation in autoimmune diseases and to be of importance in allergic disease. However, the effect of Sema3A on allergic rhinitis (AR) is not fully clear.ObjectiveWe sought to elucidate the effects of Sema3A on the regulation of dendritic cells (DCs) and naive CD4+ T cells in AR.MethodsThe expression of Sema3A in nasal mucosa was measured by immunohistochemical staining and western blotting. Human peripheral blood mononuclear cells were separated by the Ficoll-Hypaque method. DCs and naive CD4+ T cells were purified by magnetic selection. A human Sema3A Fc chimera was added to DCs and naive CD4+ T cells in vitro to evaluate the effect of Sema3A on the function of DCs and T cells. Labeling T cells with CFSE was used to determine cell proliferation. Flow cytometry was used to detect the DC maturation markers (CD40 and CD83) and T helper 17 (Th17) and regulatory T cell (Treg) percentages. ELISA was used to detect the IL10, IL17, IL4, and IFNγ cytokine levels.ResultsThe expression of Sema3A in AR inferior turbinate tissue was lower than that in healthy control tissue. Compared with healthy control DCs, AR DCs showed decreased levels of the DC maturation markers CD40 and CD83 after Sema3A treatment. Furthermore, Sema3A decreased naive CD4+ T cell proliferation in AR. In addition, Sema3A increased the percentage of Tregs but had no obvious effect on Th17 cells. Moreover, Sema3A significantly increased levels of IL10 and IFNγ, and decreased level of IL4, but had no obvious effect on level of IL17.ConclusionAR presented with low expression of Sema3A in nasal mucosa, and Sema3A could decrease DC maturation, T cell proliferation, and Treg polarization.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-03-25T04:08:37Z
      DOI: 10.1177/19458924211005592
       
  • Simulation of Cerebrospinal Fluid Leak Repair Using a 3-Dimensional
           Printed Model

    • Free pre-print version: Loading...

      Authors: Muhamed A. Masalha, Kyle K. VanKoevering, Omar S. Latif, Allison R. Powell, Ashley Zhang, Keren H. Hod, Daniel M. Prevedello, Ricardo L. Carrau
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundAcquiring proficiency for the repair of a cerebrospinal fluid (CSF) leak is challenging in great part due to its relative rarity, which offers a finite number of training opportunities.ObjectiveThe purpose of this study was to evaluates the use of a 3-dimensional (3D) printed, anatomically accurate model to simulate CSF leak closure.MethodsVolunteer participants completed two simulation sessions. Questionnaires to assess their professional qualifications and a standardized 5-point Likert scale to estimate the level of confidence, were completed before and after each session. Participants were also queried on the overall educational utility of the simulation.ResultsThirteen otolaryngologists and 11 neurosurgeons, met the inclusion criteria. A successful repair of the CSF leak was achieved by 20/24 (83.33%), and 24/24 (100%) during the first and second simulation sessions respectively (average time 04:04 ± 1.39 and 02:10 ± 01:11). Time-to-close-the-CSF-leak during the second session was significantly shorter than the first (p 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-03-20T07:47:49Z
      DOI: 10.1177/19458924211003537
       
  • Urban Particulate Matters May Affect Endoplasmic Reticulum Stress and
           Tight Junction Disruption in Nasal Epithelial Cells

    • Free pre-print version: Loading...

      Authors: Soo Kyoung Park, Sun Hee Yeon, Mi-Ra Choi, Seung Hyeon Choi, Sung Bok Lee, Ki-sang Rha, Yong Min Kim
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundExposure to airborne urban particulate matter (UPM) has been closely related to the development and aggravation of respiratory disease, including sinonasal disorders.ObjectiveThe aims of this study were to investigate the effect of UPM on nasal epithelial tight junctions (TJs) and mucosal barrier function and delineate the underlying mechanism by using both in vitro and in vivo models.MethodsIn this study, human nasal epithelial cells (hNECs) and BALB/c mice were exposed to UPMs. UPM 1648a and 1649 b were employed. TJ and endoplasmic reticulum (ER) stress marker expression was measured using western blot analysis and immunofluorescence. TJ integrity and nasal epithelial barrier function were evaluated by transepithelial electric resistance (TER) and paracellular flux. In addition, the effects of N‐acetyl‐L‐cysteine (NAC) on UPM-induced nasal epithelial cells were investigated.ResultsUPM significantly impaired the nasal epithelial barrier, as demonstrated by decreased protein expression of TJ and ER stress markers in human nasal epithelial cells. This finding was in parallel to reduced transepithelial electrical resistance and increased fluorescein isothiocyanate–dextran permeability. Pretreatment with NAC decreased the degree of UPM-mediated ER stress and restored nasal epithelial barrier disruption in human nasal epithelial cells (hNEC) and the nasal mucosa of experimental animals.ConclusionThese data suggest that UPMs may induce nasal epithelial barrier dysfunction by targeting TJs and ER stress could be related in this process. Based on these results, we suggest that suppression of this process with an inhibitor targeting ER stress responses could represent a novel promising therapeutic target in UPM-induced sinonasal disease.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-03-19T04:30:41Z
      DOI: 10.1177/19458924211004006
       
  • Combined Treatment With H1 and H4 Receptor Antagonists Improves Th2
           Inflammatory Responses in the Nasal Mucosa of Allergic Rhinitis Rats

    • Free pre-print version: Loading...

      Authors: Weiwei Wang, Hongwei Yu, Yongliang Pan, Shengwen Shao
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundHistamine H1 receptor (H1R) antagonists are the first-line drugs for the treatment of allergic rhinitis (AR) at present. Emerging evidence supports an important role of histamine H4 receptor (H4R) in allergic diseases. However, information regarding the effects of combined treatment with H1 and H4 receptor antagonists in AR is limited.ObjectivesWe aimed to assess the effects of combined treatment with H1R and H4R antagonists on Th2 inflammatory responses in the nasal mucosa of AR rats.MethodsSprague Dawley rats were sensitized with ovalbumin and treated with H1R antagonist desloratadine or/and H4R antagonist JNJ7777120. Western blotting was used to assay the phenotypic markers of mature dendritic cells in the nasal mucosa, including major histocompatibility complex class II (MHC-II) and co-stimulatory molecules CD80, CD86 and OX40 ligand (OX40L). Th2 inflammatory cytokines including interleukin-4, 5 and 13 in nasal lavage fluids were determined by using enzyme-linked immunoassay.ResultsThe treatment with desloratadine alone down-regulated the CD86 expression, and decreased the production of Th2 cytokines, but had no impact on the expression of MHC-II, CD80 and OX40L. The administration of NJ7777120 alone reduced the levels of CD86, OX40L and Th2 cytokines, whereas MHC-II and CD80 expression was unaffected. The combination of desloratadine and JNJ7777120 showed more significant synergistic therapeutic effects than monotherapy.ConclusionH4R antagonist acted synergistically with H1R antagonist to reduce Th2 inflammatory responses by down-regulating CD86 and OX40L expression in the nasal mucosa of AR rats. The combination with H1R and H4R antagonists might be a new strategy for AR treatment.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-03-17T05:03:16Z
      DOI: 10.1177/19458924211002604
       
  • Medical Malpractice Allegations in Nasal Turbinate Surgery

    • Free pre-print version: Loading...

      Authors: Steven M. Coppess, Sims G. Weymuller, Greg E. Davis
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundDespite studies showing most patients significantly improve their nasal congestion with surgical management of nasal turbinates, not all achieve acceptable results. Rarely, patients report substantial worsening of symptoms leading to litigation risk.ObjectiveDocument the United States medicolegal environment for nasal turbinate surgery.MethodsWe searched the Westlaw database for turbinate related terms for 1987- July 2019, recording demographics, claims, legal arguments, and outcomes in legal cases related to nasal turbinate surgery. We assessed prevalence and correlations with case outcomes.ResultsOf the 39 cases identified, the most common complaint was nose/facial pain (53.8% of cases). Surgeons prevailed in 87.2% of cases, with total liabilities of $3,224,606 [mean $97,715.3, ±$283,900.8]. Surgeons had statistically significant favorable outcomes when patients claimed dryness, headache, congestion, crusting, breathing problems, and disfigurement (all p 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-03-16T04:08:46Z
      DOI: 10.1177/19458924211004052
       
  • Treatment Outcomes in Aspirin-Exacerbated Respiratory Disease Based on the
           12-Item Short Form Survey

    • Free pre-print version: Loading...

      Authors: Tran B. Locke, Auddie M. Sweis, Jennifer E. Douglas, Kevin I. Ig-Izevbekhai, Elizabeth M. Stevens, Alyssa M. Civantos, Elizabeth B. McCarty, Ankur Kumar, Michael A. Kohanski, David W. Kennedy, James N. Palmer, John V. Bosso, Nithin D. Adappa
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundAspirin-exacerbated respiratory disease (AERD) is optimally managed by endoscopic sinus surgery (ESS) followed by aspirin therapy after desensitization (ATAD). Most AERD quality of life (QOL) studies use the 22-item Sinonasal Outcomes Test (SNOT-22), which focuses predominantly on sinonasal outcomes.ObjectiveThis study seeks to assess QOL outcomes in AERD patients after ESS and ATAD via the 12-item Short Form Survey (SF-12), a well-validated QOL measure for general health status of chronic conditions.MethodsRetrospective review of 112 AERD patients who underwent ESS followed by ATAD at our institution between 2016 and 2019. SF-12 was collected preoperatively, postoperatively/pre-AD, and serially post-AD (1–3, 4–6, 7–12, and>12 months). Optum® PRO CoRE software was used to compare data to national norms. ANOVA was performed comparing physical component summary (PCS), mental component summary (MCS) and eight health domains (physical functioning, role physical, general health, bodily pain, vitality, social functioning, role emotional, and mental health).ResultsAERD patients showed improvement in PCS scores across all timepoints after ESS and ATAD (p = 0.004). When stratified by gender, women demonstrated an improvement in PCS scores (p = 0.004). Within the domains, there were significant improvements in social functioning (SF), role physical (RP), and bodily pain (BP) at all timepoints (SF: p = 0.006; RP: p = 0.005; BP: p 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-03-11T03:39:41Z
      DOI: 10.1177/19458924211001640
       
  • Measurement of Tryptase and CC16/Albumin in Nasal Lavage Fluid as a
           Screening Tool of Allergic Rhinitis

    • Free pre-print version: Loading...

      Authors: Oh Eun Kwon, Young Chan Lee, Jung Min Park, Sung Wan Kim, Young-Gyu Eun, Seong-Gyu Ko
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundThere is no trial to make a diagnostic tool of allergic rhinitis (AR) utilizing biomarkers from nasal fluid. Base on previous studies, we selected following five biomarkers in nasal fluids that represent the characteristics of allergic reactions: tryptase, eosinophil cationic protein (ECP), interleukin 5 (IL-5), Clara cell protein 16 (CC16) and CC16-to-albumin ratio.ObjectiveThis study aimed to identify biomarkers in nasal discharge that may be used in biosensors to diagnose AR as an additional diagnostic tool.MethodsPatients showed rhinorrhea and tested positive on allergic skin and specific immunoglobulin E (IgE) tests were included in the AR group. The non-AR group included individuals no dominant nasal symptoms and tested negative on allergy tests. Nasal lavage fluid samples were collected from all participants. Biomarkers in the samples were quantified using enzyme-linked immunosorbent assay.ResultsForty-five patients with AR and 28 non-AR subjects were enrolled in this study. Comparing the concentrations of biomarkers, the concentrations of tryptase and IL-5 were significantly higher in the AR group than in the NAR group. And CC16 level and CC16-to-albumin ratio were significantly lower in the AR group. In the combination of tryptase or CC16-to-albumin ratio, the sensitivity was 90.7% and the specificity was 64.3% (p = 0.013).ConclusionThe combination of “tryptase or CC16-to-albumin” could be used as a screening tool for AR. Although this diagnostic method could not replace conventional diagnostic tools, we could consider the method we proposed as an additional screening tool for patients who could not undergo allergy tests.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-02-26T04:55:04Z
      DOI: 10.1177/1945892421998260
       
  • Changes in Immunologic Indicators During Allergen-Specific Immunotherapy
           for Allergic Rhinitis and Determinants of Variability: A Systematic Review
           and Meta-analysis of Randomized Controlled Trials

    • Free pre-print version: Loading...

      Authors: Zihan Jiang, Hao Xiao, Shixi Liu, Juan Meng
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundTo date, there are no generally recognized biomarkers for allergen immunotherapy (AIT) and even the changes in immunological indicators during AIT are inconsistent in different publications.ObjectiveThis study was conducted to quantify the immunological changes that occur during AIT and identify the determinants of heterogeneity.MethodsRandomized controlled trials of AIT published in the past 10 years were searched in Medline, Embase and Cochrane CENTRAL. Data on immunological indicators were extracted, and the characteristics of the included studies were collected. Meta-analysis and meta-regression were conducted for each indicator. The study was registered on the PROSPERO website (CRD42020176127).ResultsWe reviewed 1898 studies. Forty-six studies met the inclusion criteria, and 31 studies were included in the quantitative analyses. Subset analyses by time demonstrated that serum allergen-specific IgE (sIgE) of AIT patients increased in the first 12 months, then decreased and became slightly lower than that of control patients. Allergen-specific IgG4 (sIgG4) was elevated in the AIT group during and after treatment. IgE-blocking factor (IgE-BF) was increased and IgE-facilitated allergen binding (IgE-FAB) was reduced in AIT patients. Both of them of the 2 factors were associated with clinical efficacy in the multivariate regression analysis. sIgE/sIgG4 decreased in AIT patients, while there was no change in total IgE.ConclusionThe levels of serum sIgE and sIgG4 during AIT showed a time-dependent pattern. IgE-BF and IgE-FAB should be further investigated as biomarkers for predicting and monitoring AIT efficacy.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-02-26T04:55:03Z
      DOI: 10.1177/1945892421999649
       
  • High Mobility Group Box Chromosomal Protein-1 Induces Myofibroblast
           Differentiation and Extracellular Matrix Production via RAGE, p38, JNK and
           AP-1 Signaling Pathways in Nasal Fibroblasts

    • Free pre-print version: Loading...

      Authors: Soo-Hyung Lee, Jae Hoon Cho, Joo-Hoo Park, Jung-Sun Cho, Heung-Man Lee
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundChronic rhinosinusitis is involved in myofibroblast differentiation and extracellular matrix (ECM) accumulation. High mobility group box chromosomal protein 1 (HMGB-1) is known to stimulate lung fibroblast to produce ECM in lung fibrosis. The aim of this study was to investigate whether HMGB-1 induces myofibroblast differentiation and ECM production in nasal fibroblasts and to identify the signal pathway.MethodsHuman nasal fibroblasts were cultured. After stimulation with HMGB-1, expressions of α-smooth muscle actin (α-SMA) and fibronectin were determined by real-time PCR and western blot. Total collagen was measured by Sircol assay. To investigate signal pathway, various signal inhibitors and RAGE siRNA were used.ResultsHMGB-1 increased α-SMA and fibronectin in mRNA and protein levels. It also increased collagen production. RAGE siRNA inhibited HMGB-1-induced α-SMA and fibronectin, and production of collagen. Furthermore, the inhibitors of RAGE downstream molecules such as p38, JNK and AP-1 also blocked the HMGB-1-induced effects.ConclusionsHMGB-1 induces myofibroblast differentiation and ECM production in nasal fibroblast, which is mediated by RAGE, p38, JNK and AP-1 signal pathway. These results suggest that HMGB-1 may play an important role in tissue remodeling during chronic rhinosinusitis progression.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-02-25T04:01:10Z
      DOI: 10.1177/1945892421998142
       
  • Management of Recurrent Acute Rhinosinusitis: A Systematic Review

    • Free pre-print version: Loading...

      Authors: Mohamad Z. Saltagi, Brett T. Comer, Samuel Hughes, Jonathan Y. Ting, Thomas S. Higgins
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      Background Objective Study DesignRARS is a challenging clinical problem that impacts many patients. This article seeks to systematically review the literature on RARS management.MethodsCochrane, PubMed, EMBASE, and other databases were queried for articles related to RARS dating from 1990 to present, according to PRISMA guidelines. Inclusion criteria included articles specifically addressing RARS management; studies with 3 or more patients; and articles in English.ResultsA total of 1022 titles/abstracts potentially related to RARS were identified. Of these, sixty-nine full texts were selected for review, and 10 met inclusion criteria (five with level 4 evidence, four with level 3 evidence, one with level 2 evidence). The studies included a total of 890 patients (Age range 5.8 to 53.5 years), with follow up ranging from 1 to 19 months. Endpoints were primarily based on symptomatic improvement, although some articles also reported post-treatment endoscopic and radiographic findings. Management options included medical therapy (intranasal steroids, antibiotics, nasal saline irrigations, N-acetylcysteine, allergy treatment, and decongestants), balloon sinus dilation (BSD), and endoscopic sinus surgery (ESS). Surgical patients (BSD and ESS) had a trend towards greater symptom control than medically-treated patients, but meta-analysis was not possible.ConclusionDespite increasing interest in the treatment of RARS, there remains a lack of consensus regarding optimal management. The literature thus far, largely based on expert opinion, suggests that surgical management, either through balloon sinus dilation or endoscopic sinus surgery, may be helpful in improving symptoms and quality of life in those who do not respond to initial trials of medical management.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-02-24T05:00:26Z
      DOI: 10.1177/1945892421994999
       
  • The Impact of Maxillary Expansion on Adults’ Nasal Breathing: A
           Systematic Review and Meta-Analysis

    • Free pre-print version: Loading...

      Authors: Christian Calvo-Henriquez, Joaquim Megias-Barrera, Carlos Chiesa-Estomba, Jerome R. Lechien, Byron Maldonado Alvarado, Badr Ibrahim, David Suarez-Quintanilla, Sandra Kahn, Robson Capasso
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      ObjectiveNasal surgery fails to restore nasal breathing in some cases. Maxillary constriction is suggested as a major cause of failure. It is thought that maxillary constriction leads to the closure of the internal and external nasal valves. Moreover, it is well established in the literature that maxillary expansion, both in adults and children, increases upper airway volume. However, it is yet unclear whether maxillary expansion may improve nasal function.Review Methods: Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database were checked by two authors from the Rhinology Study Group of the Young Otolaryngologists section of the International Federation of Otorhinolaryngological Societies. Two authors extracted the data. The main outcome was expressed as the value (in variable units) prior to treatment (T0), after expansion procedures (T1), after the retention period (T2), and after a follow-up period (T3).ResultsA total of 10 studies (257 patients) met the inclusion criteria. The data pooled in the meta-analysis reveals a statistically significant reduction of 0.27 Pa/cm3/s (CI 95% 0.15, 0.39) in nasal resistance after palatal expansion As far as subjective changes are concerned, the pooled data for the change in the NOSE score shows a statistically significant mean reduction after maxillary expansion of 40.08 points (CI 95% 36.28, 43.89).ConclusionThe initial available evidence is too limited to suggest maxillary expansion as a primary treatment option to target nasal breathing. However the data is encouraging with regards to the effect of maxillary expansion on nasal function. Further higher quality studies are needed in order to define clearer patient selection criteria, distinguish optimal techniques, and demonstrate long-term efficacy in long term follow up studies.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-02-15T04:04:20Z
      DOI: 10.1177/1945892421995350
       
  • Association of Air Pollutant Exposure and Sinonasal Histopathology
           Findings in Chronic Rhinosinusitis

    • Free pre-print version: Loading...

      Authors: Tirth R. Patel, Bobby A. Tajudeen, Hannah Brown, Paolo Gattuso, Phillip LoSavio, Peter Papagiannopoulos, Pete S. Batra, Mahboobeh Mahdavinia
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundAmbient air pollution is well known to cause inflammatory change in respiratory epithelium and is associated with exacerbations of inflammatory conditions such as asthma and chronic obstructive pulmonary disease. However, limited work has been done on the impact of air pollution on pathogenesis of chronic rhinosinusitis and there are no reports in the literature of how pollutant exposure may impact sinonasal histopathology in patients with chronic rhinosinusitis.ObjectiveThis study aims to identify associations between certain histopathologic characteristics seen in sinus tissue of patients with chronic rhinosinusitis (CRS) and levels of particulate air pollution (PM2.5) and ground-level ozone in their place of residence.MethodsA structured histopathology report was created to characterize the tissues of CRS patients undergoing sinus surgery. An estimate for each patient’s exposure to air pollutants including small particulate matter (PM2.5) and ground-level ozone was obtained using the Environmental Protection Agency’s (EPA) Environmental Justice Screening and Mapping Tool (EJSCREEN). Mean pollutant exposures for patients whose tissues exhibited varying histopathologic features were compared using logistic regression models.ResultsData from 291 CRS patients were analyzed. Higher degree of inflammation was significantly associated with increased ozone exposure (p = 0.031). Amongst the patients with CRSwNP (n=131), presence of eosinophilic aggregates (p = 0.018) and Charcot-Leyden crystals (p = 0.036) was associated with increased ozone exposure.ConclusionExposure to ambient air pollutants may contribute to pathogenesis of CRS. Increasing ozone exposure was linked to both higher tissue inflammation and presence of eosinophilic aggregates and Charcot-Leyden crystals in CRSwNP patients.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-02-11T03:54:53Z
      DOI: 10.1177/1945892421993655
       
  • Upregulated Expression of Toll-Like Receptor 7 in Peripheral Blood
           Basophils of Patients With Allergic Rhinitis

    • Free pre-print version: Loading...

      Authors: Lihong Wang, Mengmeng Zhan, Junling Wang, Dong Chen, Nan Zhao, Ling Wang, Wei Wang, Xiaowen Zhang, Yixia Huang, Huiyun Zhang, Shaoheng He
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundRecently, it has been reported that Toll-like receptor 7 (TLR7) agonists can improve allergic rhinitis (AR) symptoms by up-regulation of Th1 cytokine release and suppression of Th2 cell functions. However, little is known of the expression of TLR7 in basophils of AR.ObjectiveTo explore the expression of TLR7 in basophils of AR, and influence of allergens on TLR7 expression.MethodsThe expression levels of TLR7 in basophils of patients with AR were determined by flow cytometry, and the influence of allergens on TLR7 expression was examined by real time (q) PCR.ResultsThe percentages of TLR7+CCR3+ cells (P 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-02-09T03:33:40Z
      DOI: 10.1177/1945892421993034
       
  • Educational Informed Consent Video Equivalent to Standard Verbal Consent
           for Rhinologic Surgery: A Randomized Controlled Trial

    • Free pre-print version: Loading...

      Authors: Joseph P. Penn, Rohit Nallani, Erin L. Dimon, Taylor C. Daniels, Kevin J. Sykes, Alexander G. Chiu, Mark R. Villwock, Jennifer A. Villwock
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundInformed consent is an integral part of pre-operative counseling. However, information discussed can be variable. Recent studies have explored the use of multimedia in providing informed consent for rhinologic surgery.ObjectiveTo measure impact of an educational video (Video) compared to verbal informed consent (Verbal) on knowledge gained, alleviation of concerns, and efficiency.MethodsPatients undergoing endoscopic sinus surgery (ESS), septoplasty, or ESS+septoplasty were prospectively enrolled and randomized to receive Video or Verbal consent. The Video group watched an educational video; the Verbal group received standard verbal consent from an Otolaryngology resident per institutional protocol. Both groups had the opportunity to discuss questions or concerns with their attending surgeon. Prior to, and after, consent was signed, both groups completed surveys regarding knowledge of purpose, risks, and benefits of surgery as well as surgical concerns. Decision regret and patient satisfaction were also assessed post-operatively.Results77 patients were enrolled (39 Video, 38 Verbal). Demographics were not significantly different between groups. Overall knowledge significantly improved (p 
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-02-03T06:28:38Z
      DOI: 10.1177/1945892421992659
       
  • Frontal Sinus Drainage in Acute Pediatric Sinusitis With Intracranial
           Complications

    • Free pre-print version: Loading...

      Authors: Stephen R. Chorney, Adva Buzi, Mark D. Rizzi
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundThe indication for frontal sinus drainage is uncertain when managing pediatric acute sinusitis with intracranial complications.ObjectiveThe primary objective was to determine if addressing the frontal sinus reduced need for subsequent surgical procedures in children presenting with acute sinusitis complicated by intracranial abscess.MethodsA case series with chart review was performed at a tertiary children’s hospital between 2007 and 2019. Children under 18 years of age requiring surgery for complicated acute sinusitis that included the frontal sinus with noncontiguous intracranial abscess were included. Outcomes were compared among children for whom the frontal sinus was drained endoscopically, opened intracranially, or left undrained.ResultsThirty-five children with a mean age of 11.1 years (95% CI: 9.9-12.3) met inclusion. Most presented with epidural abscess (37%). Hospitalizations lasted 12.9 days (95% CI: 10.2-15.5), 46% required a second surgery, 11% required three or more surgeries, and 31% were readmitted within 60 days. Initial surgery for 29% included endoscopic frontal sinusotomy, 34% had a frontal sinus cranialization and 37% did not have any initial drainage of the frontal sinus. Groups were similar with respect to demographics, severity of infection, need for repeat surgery, length of stay, and readmissions (p > .05). Further, persistence of cranial neuropathies, seizures, or major neurological sequelae after discharge were no different among groups (p > .05).ConclusionDrainage of the frontal sinus, when technically feasible, was not associated with reduced surgical procedures or increased complications and there is unclear benefit on measured clinical outcomes.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-02-01T05:32:30Z
      DOI: 10.1177/1945892421991311
       
  • Polyurethane Versus Chitosan-Based Polymers Nasal Packs After Functional
           Endoscopic Sinus Surgery: A Prospective Randomized Double-Blinded Study

    • Free pre-print version: Loading...

      Authors: Ahmed Gamal Khafagy, Ahmed Mahmoud Maarouf
      First page: 624
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundDifferent packing materials are applied to the nose at the end of surgery to maintain drainage and sinus ventilation of the paranasal sinuses and avoid some complications such as bleeding, infection, crustations, adhesions in the middle meatus and lateralization of the middle turbinate.ObjectiveThe study aims to compare the clinical outcomes of two absorbable packing materials, the synthetic polyurethane, and the naturally occurring Chitosan-based polymers (CBP) nasal packs, after functional endoscopic sinus surgery.MethodsFifty patients with bilateral chronic rhinosinusitis with nasal polypi were operated with 100 surgical cavities. At the end of the surgery, one side was randomly packed with synthetic polyurethane and the opposite side with CBP nasal pack. Measure their outcomes at week 1, 2, 4, 8 and 12 as the presence of remnants materials in the middle meatus, crustations, adhesions, bleeding, granulations, infection, and general satisfaction of patients.ResultsCBP nasal pack shows a statistically significant advantage only in the first two weeks as regard remnants material, crusting and bleeding. All over the 12 weeks, there was no statistically significant difference between the two types of packs as regard granulations, adhesions and infection. In the first month, eight patients of the CBP group experienced bad smell and two patients had watery rhinorrhea as adverse reaction without a statistically significant difference. Patients were generally satisfied without a statistically significant difference between the two types of packs.ConclusionSynthetic polyurethane and Chitosan-based polymers nasal packs are safe and efficient regarding; the mucosal healing, bleeding control, and the overall satisfaction of patients. The CBP showed a higher statistically significant advantage in the first two weeks only regarding the amount of the retained material, crusting as well as bleeding. Patients packed with CBP experienced fish-like smelly odor and watery rhinorrhea but there is no statistically significant difference.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-01-12T04:12:28Z
      DOI: 10.1177/1945892420983645
       
  • Mucosal Eosinophilia and Neutrophilia Are Not Associated With QOL or
           Olfactory Function in Chronic Rhinosinusitis

    • Free pre-print version: Loading...

      Authors: Nyssa F. Farrell, Jess C. Mace, David A. Sauer, Andrew J. Thomas, Mathew Geltzeiler, Kara Y. Detwiller, Timothy L. Smith
      First page: 647
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundChronic rhinosinusitis (CRS) is often differentiated by histopathologic phenotypes (eosinophilic versus neutrophilic), which may impact disease severity measures and outcomes. As such, it has been suggested that counts of cellular elements be included as part of a standard pathological report following endoscopic sinus surgery (ESS).ObjectivesThis cross-sectional study evaluated associations of mucosal eosinophilia and neutrophilia with measures of quality-of-life (QoL) and olfactory function.MethodsPatients with medically refractory CRS completed the SNOT-22 survey and Brief Smell Identification Test (BSIT) at enrollment. In addition, baseline Lund-Mackay computed tomography (CT) and Lund-Kennedy endoscopy scores were collected. Ethmoid mucosa was biopsied during ESS and reviewed using microscopy to quantify densest infiltrate of eosinophils or neutrophils per high-powered-field (HPF). Eosinophilic CRS (eCRS) and neutrophilic CRS (nCRS), both with and without nasal polyposis (NP), were compared across SNOT-22 and BSIT scores.Results77/168 patients demonstrated mucosal eosinophilia (eCRS) while a total of 42/168 patients demonstrated mucosal neutrophilia (nCRS). After adjusting for polyp status, 35/168 had eCRSsNP, 42/168 eCRSwNP, 75/168 non-eCRSsNP, 16/168 non-eCRSwNP. Additionally, 22/161 were noted to have nCRSsNP, 20/161 nCRSwNP, 84/161 non-nCRSwNP, and 35/161 non-nCRSsNP. A small subset of patients demonstrated both eosinophilia and neutrophilia: 14 CRSwNP and 7 CRSsNP. When evaluating average Lund-Mackay Scores (LMS), significant differences existed between non-eCRSsNP and eCRSsNP (p = 0.006). However, after controlling for nasal polyps, eosinophilia did not significantly associate with differences in the Lund-Kennedy Score. Neutrophilia did not significantly associate with any changes in LMS or LKS after controlling for NP. Eosinophilic and neutrophilic histopathologic subtypes did not significantly associate with differences in baseline SNOT-22 or BSIT measures after controlling for NP.ConclusionNeither the presence of mucosal eosinophilia nor mucosal neutrophilia demonstrated significant associations with SNOT-22 quality-of-life or BSIT olfactory function scores when controlling for comorbid nasal polyposis.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-01-12T04:11:28Z
      DOI: 10.1177/1945892420987439
       
  • Comparative Analysis of Mucociliary Clearance and Mucosal Morphology Using
           High-Speed Videomicroscopy in Children With Acute and Chronic
           Rhinosinusitis

    • Free pre-print version: Loading...

      Authors: Svetlana Alekseenko, Sergey Karpischenko, Svetlana Barashkova
      First page: 656
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      Objectiveevaluation of mucociliary clearance and mucosal morphology using high-speed videomicroscopy, and their association with markers of disease severity in children with acute (ARS) and chronic rhinosinusitis (CRS).MethodsA total of 67 children aged from 6 to 17 years including 15 healthy children, 20 pediatric patients with acute rhinosinusitis, and 32 cases with chronic rhinosinusitis were enrolled in the present study. SNOT20, Lund-Kennedy, and Lund-Mackay scores were also evaluated.ResultsChildren with rhinosinusitis were characterized by significantly lower number of cells with motile cilia, ciliary beat frequency, cilia length, and cell viability, as well as ciliary beat asynchrony, epithelia dystrophy and reduced epithelial cell height, being more severe in ARS group. Neutrophil infiltration of sinonasal mucosa was more profound in children with ARS, whereas the number of lymphocytes was significantly reduced. Markers of ciliary function were characterized by a significant correlation with epithelia dystrophia and neutrophil infiltration. Discriminant analysis demonstrated significant group separation based on the parameters of mucociliary clearance and mucosal morphology. In regression models mucociliary function was also associated with SNOT20, Lund-Kennedy, and Lund-Mackay scores.ConclusionThe results of the present study demonstrate significant alteration of mucociliary clearance and mucosal morphology and its association with sinonasal inflammation and disease severity in patients with rhinosinusitis. Given a tight association between altered mucociliary clearance and severity of the disease, modulation of inflammation and ciliary function both in acute and chronic rhinosinusitis may be considered as the potential tool in therapeutic and surgical management of the disease.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-01-20T05:11:35Z
      DOI: 10.1177/1945892420988804
       
  • Inflammatory Profile of Antrochoanal Polyps in the Caucasian Population
           – A Histologic Study

    • Free pre-print version: Loading...

      Authors: Meir Warman, Alma Kamar Matias, Ady Yosepovich, Doron Halperin, Oded Cohen
      First page: 664
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundAntrochoanal polyp (ACP) is a rare and unique unilateral nasal polyp. In contrast to diffuse primary chronic rhinosinusitis (d-CRS) the inflammatory profile of ACP in the Caucasian population have not been determined.ObjectiveThe purpose of the study is to describe and differentiate the inflammatory features of ACP compared with d-CRS and its phenotypic subgroups and hypertrophic turbinates (HT) in the Caucasian population, and compare the mast and plasma cell marker expression of each pathology.MethodsA retrospective case control study of 96 patients operated on between the years 2005–2017. Nasal biopsies of ACPs, d-CRS and HTs were compared. A comparison of the different phenotypic subgroups of d-CRS was made as well. Demographics, comorbidities, and histologic and immunohistochemical (IHC) staining of mast (CD117) and plasma cell (CD138) receptor antibodies, were compared and analyzed.ResultsA total of 96 patients were included, consisting of 40 (41.6%) ACP, 36 (37.5%) d-CRS and 20 (20.8%) HT patients. ACPs displayed a significantly higher level of edema and intramural cysts compared to the other groups. Squamous metaplasia was demonstrated in ACP (27.5%) and d-CRS (25.6%), but not in HT. The ACP group was characterized by neutrophilic predominant infiltrates as opposed to the eosinophilic predominance in the d-CRS group, especially in eosinophilic CRS and central compartment allergic disease. ACP presented lower levels of both mast and plasma cells compared to d-CRS and HT in IHC staining.ConclusionsACP in the Caucasian population has unique features of cyst formation and edema which is compatible with its clinical presentation. It is characterized by neutrophilic predominant infiltrates and expresses lower levels of mast and plasma cells as demonstrated by IHC.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-02-05T05:15:35Z
      DOI: 10.1177/1945892421990529
       
  • Evaluating the Role of Anesthesia on Intraoperative Blood Loss and
           Visibility during Endoscopic Sinus Surgery: A Meta-analysis

    • Free pre-print version: Loading...

      Authors: David C. Moffatt, Robert A. McQuitty, Alex E. Wright, Tawanda S. Kamucheka, Ali L. Haider, Mohamad R. Chaaban
      First page: 674
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundPrevious studies and meta analyses have led to incongruent and incomplete results respectively when total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) are compared in endoscopic sinus surgeries in regards to intraoperative bleeding and visibility.ObjectiveTo perform a more comprehensive meta-analysis on randomized controlled trial (RCTs) comparing TIVA with IA in endoscopic sinus surgery to evaluate their effects on intraoperative bleeding and visibility.MethodsA systematic review and meta-analysis of studies comparing TIVA and IA in endoscopic sinus surgery for chronic rhinosinusitis was completed in May 2020. Utilizing databases, articles were systematically screened for analysis and 19 studies met our inclusion criteria. The primary outcome included intraoperative visibility scores combining Boezaart, Wormald and Visual Analogue Scale (VAS). Secondary outcomes included rate of blood loss (mL/kg/min), estimated total blood loss (mL), Boezaart, Wormald scores, VAS, heart rate, and mean arterial pressure (MAP).Results19 RCTs with 1,010 patients were analyzed. TIVA had a significantly lower intraoperative bleeding score indicating better endoscopic visibility (Boezaart, VAS, and Wormald) than IA (−0.514, p = 0.020). IA had a significantly higher average rate of blood loss than TIVA by 0.563 mL/kg/min (p = 0.016). Estimated total blood loss was significantly lower in TIVA than IA (−0.853 mL, p = 0.002). There were no significant differences between TIVA and IA in the mean heart rate (−0.225, p = 0.63) and MAP values (−0.126, p = 0.634). The subgroup analyses revealed no significant difference between TIVA and IA when remifentanil was not utilized and whenever desflurane was the IA agent.ConclusionTIVA seemed to have superior intraoperative visibility scores and blood loss during endoscopic sinus surgery when compared to IA. However, the results are not consistent when stratifying the results based on the use of remifentanil and different inhaled anesthetics. Therefore, the conclusion cannot be made that one approach is superior to the other.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-01-22T04:45:40Z
      DOI: 10.1177/1945892421989155
       
  • Microbiology, Histopathology, and Radiographic Findings in Silent Sinus
           Syndrome

    • Free pre-print version: Loading...

      Authors: Henry D. Zheng, Jeffrey C. Mecham, Yassmeen Abdel-Aty, Devyani Lal, Michael J. Marino
      First page: 685
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundThe histopathology and microbiology associated with silent sinus syndrome (SSS) have not been well described.ObjectiveThis study details the histopathological and microbiological characteristics in addition to radiographic findings of SSS in comparison to those of chronic maxillary sinusitis (CRS).Methods42 patients diagnosed with SSS at Mayo Clinic Hospital in Arizona were identified. Paranasal computed tomography scans of the 42 SSS patients as well as 42 matched CRS patients were analyzed in order to assess differences in the prevalence of septal spurs/deviation. 20 of the SSS patients and 19 of the matched CRS patients also had histopathology and microbiology reports, which were compiled and summarized. Additionally, 19 SSS and 19 matched CRS patients were contacted via phone survey for a more complete patient history regarding maxillary dental disease/surgery.ResultsSSS patients have a significantly higher prevalence of septal spurs/deviation than CRS patients. The microbiomes of SSS patients more closely resemble those of healthy controls than those of CRS patients. Analysis of the histopathology of SSS reveals chronic, non-specific inflammation similar to that seen in non-eosinophilic CRS without polyps. SSS patients were significantly more likely to have a history of maxillary dental disease requiring surgery.ConclusionThese data support the hypothesis that the pathogenesis of SSS is more likely due to anatomical/mechanical factors than inflammatory/microbiological factors.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-01-19T11:19:51Z
      DOI: 10.1177/1945892421989161
       
  • Olfactory Perception and Different Decongestive Response of the Nasal
           Mucosa During Menstrual Cycle

    • Free pre-print version: Loading...

      Authors: Maja S. Bogdan, Danijel O. Slavic, Sinisa S. Babovic, Biljana S. Zvezdin, Violeta P. Kolarov, Vladimir L. Kljajic
      First page: 693
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundSex hormones are known to have some influence on nasal functions, but their effect on the decongestive response of the nasal mucosa during menstrual cycle is still undetermined.ObjectivesThe aim of this study was to examine the nasal physiology, the interconnectedness of olfactory and respiratory nasal function and the decongestive response of the nasal mucosa during menstrual cycle.MethodsThis study included 101 healthy women aged 23.26 ± 4.81 years with a regular menstrual cycle. The nasal respiratory function and the decongestive response of the nasal mucosa were examined by rhinomanometry. Subjective sense of nasal obstruction and the subjective odor intensity were assessed by standardized questionnaires. The odor identification ability was assessed by Sniffin’ Sticks test.ResultsStatistically significant higher values of nasal resistance (0.311 ± 0.107 Pa/cm3/s) and NOSE score (11.893 ± 13.83) were observed in the ovulatory phase compared to the luteal (0.281 ± 0.084 Pa/cm3/s and 9.029 ± 11.12). An odor identification test score was significantly higher in luteal phase (12.476 ± 1.48) compared to the ovulatory phase (11.971 ± 1.51), opposite of odor intensity. The difference of nasal resistance before and after decongestion was significantly higher in ovulatory phase (0.105 ± 0.097 Pa/cm3/s) compared to the luteal (0.084 ± 0.079 Pa/cm3/s). Correlation between subjective and objective parameters of the examinated nasal functions was not statistically significant in any menstrual phase.ConclusionIn the population of women studied, total nasal resistance and NOSE score were significantly lower in the luteal phase of the menstrual cycle. Odor identification was significantly higher in the luteal phase but odor intensity significantly higher in the ovulatory phase. The decongestive response of nasal mucosa was better in the ovulatory phase of the menstrual cycle.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-01-26T02:46:21Z
      DOI: 10.1177/1945892421990308
       
  • The Use of Postoperative Antibiotics Following Endoscopic Sinus Surgery
           for Chronic Rhinosinusitis: A Systematic Review and Meta-analysis

    • Free pre-print version: Loading...

      Authors: Chloe E. Swords, Jeremy J. Wong; BA, Kara N. Stevens, Alkis J. Psaltis, Peter J. Wormald, Neil C.-W. Tan
      First page: 700
      Abstract: American Journal of Rhinology & Allergy, Ahead of Print.
      BackgroundEndoscopic sinus surgery is performed for medically recalcitrant chronic rhinosinusitis. There is no universally accepted strategy regarding post-operative antibiotics despite the high rates of usage worldwide. The aim of this study was to analyse patient-reported and objective outcomes behind antibiotic use following endoscopic sinus surgery.MethodsA search of electronic databases was performed. Eligible randomised controlled trials (RCTs) and observational trials were included. The primary outcome was patient reported outcome measures. Secondary outcomes were local infections, endoscopy scores and adverse events. Meta-analysis was performed.ResultsOf 1045 publications identified, 7 were included in the qualitative synthesis and 5 RCTs were included in meta-analysis. Antibiotic regimens varied between studies in terms of antibiotic selection, timing commenced and duration of use. Meta-analysis suggested no significant difference between placebo and antibiotics in patient reported outcome measures (standardised mean difference (SMD) –0.215, 95% confidence interval (CI) –0.637 to 0.207) or endoscopic scores (SMD –2.86, 95% CI –0.846 to 0.273). There was no consistent definition in reporting of infection; therefore, this outcome cannot be comprehensively considered. No severe adverse events were attributable to antibiotics.ConclusionsFrom the studies analysed, there is no level 1 evidence to suggest that antibiotics improved patient outcomes following sinus surgery. However, there was significant heterogeneity in outcome measures and no clear data exists regarding the effects of antibiotics on postoperative infections. The available evidence at present is not enough to make a recommendation in either direction. Further designed larger RCTs are required to investigate these questions in more detail.
      Citation: American Journal of Rhinology & Allergy
      PubDate: 2021-01-25T04:11:21Z
      DOI: 10.1177/1945892421989142
       
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
 


Your IP address: 3.237.16.210
 
Home (Search)
API
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-