Impact of endoscopic sinus surgery on otologic symptoms associated with chronic rhinosinusitis

ObjectiveTo evaluate improvements in otologic symptoms after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS), and identify differences in symptoms, if any, between CRS patients with (CRSwNP) and without (CRSsNP) nasal polyposis.Material and methodsThis is a prospective multi-center observational cohort study. Adults with medically recalcitrant CRS who elected ESS were enrolled in a prospective, multi-center, observational cohort study between March, 2011 and October, 2014. Preoperative evaluation of subjects included assessment of clinical characteristics, measures of disease severity, and quality of life evaluation using the 22-item SinoNasal Outcome Test (SNOT-22). Postoperative improvement in otologic symptoms (ear fullness, dizziness, ear pain) scores were evaluated and compared between CRSwNP and CRSsNP subgroups.ResultsThree hundred and ninety-five study patients completed both preoperative and postoperative evaluations, with an average follow-up of 13.9 months after ESS. The prevalence of patients reporting at least one otologic symptom preoperatively (87%) significantly decreased after ESS (63%, P < 0.001). Significant postoperative improvement across all otologic scores was also reported (P < 0.001). Relative mean improvement in otologic symptom severity was similar for both CRSwNP and CRSsNP, except patients with CRSwNP reported significantly greater postoperative improvement in ear fullness compared to CRSsNP (54% vs. 41%, P = 0.039). A total of 61%, 44%, and 43% of patients reported experiencing improvement in “ear fullness”, “dizziness” and “ear pain”, respectively.ConclusionSinus surgery significantly improves otologic symptoms associated with CRS. CRSwNP patients reported slightly greater relief of ear fullness than CRSsNP patients following ESS.     

Efficacy of buffered hypertonic seawater in different phenotypes of chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery: a randomized double-blind study

PurposeNasal douching is commonly used as a postoperative management strategy for chronic rhinosinusitis with nasal polyps (CRSwNP). Few studies to date have compared the effectiveness of nasal douching in CRSwNP phenotypes after endoscopic sinus surgery (ESS). We evaluated the efficacy of seawater types in eosinophilic CRSwNP (ECRSwNP) and noneosinophilic CRSwNP (nonECRSwNP) after ESS.MethodsPatients with bilateral CRSwNP who had undergone ESS were blindly randomized to receive buffered hypertonic seawater (BHS) (n = 48) or physiological seawater (PS) (n = 45). CRSwNP patients were stratified by phenotypes (ECRSwNP and nonECRSwNP) retrospectively according to whether tissue eosinophils exceeded 10%. Follow-up evaluations were conducted at 2, 8, 16, and 24 weeks after surgery. Evaluations included the 22-item Sino-Nasal Outcome Test (SNOT-22), visual analog scale (VAS), Lund-Kennedy endoscopic score (LKES), saccharine clearance time (SCT), and adverse events.ResultsAll of the patients experienced significant improvements in SNOT-22 scores, VAS scores, and LKES over time. BHS resulted in better improvement of LEKS and SCT relative to PS at 8 weeks postoperatively. Mucosal edema formation was significantly reduced with less crusting among HBS recipients at 8 weeks. After stratification, only patients in the nonECRSwNP + BHS subgroup showed a significant improvement in LEKS and SCT at 8 weeks postoperatively. Side effect profiles were not significantly different among the groups.ConclusionsBHS has a better inhibitory effect on mucosal edema and crusting during the early postoperative care period of CRSwNP. Among all of the patients, nonECRSwNP patients showed a significant improvement in LEKS and SCT at 8 weeks.     

Seeking an optimal dose of preoperative corticosteroids in chronic rhinosinusitis with nasal polyposis: A randomized controlled trial

BackgroundPreoperative corticosteroids have been shown to improve surgical visibility and intraoperative blood loss for chronic rhinosinusitis with nasal polyposis (CRSwNP) patients undergoing endoscopic sinus surgery (ESS). However, there is no consensus on the optimal dosing regimen.MethodsA randomized, controlled trial was conducted to compare low, medium, and high dose corticosteroids prior to ESS. Patients with CRSwNP refractory to medical management were randomized to low (N = 8), medium (N = 10), or high (N = 5) dosing regimens of corticosteroids prior to ESS. Baseline disease severity was measured with the 22-item Sino-nasal Outcome Test and Lund-Mackay scores. Modified Lund-Kennedy endoscopic scores (MLKES) were measured at baseline and after corticosteroid treatment. Intraoperative parameters were measured including Boezaart surgical visibility score, intraoperative blood loss, and operative time.ResultsMedium dose corticosteroids demonstrated a superior surgical visibility score to low dose and comparable results to high dose, but these results were not significant (p = 0.33). No significant difference was observed between groups for total blood loss (p = 0.15), operative time (p = 0.87), or change in MLKES (p = 0.27).ConclusionsCurrent recommendations include the use of preoperative corticosteroids in patients with CRSwNP undergoing ESS, but there is no consensus on dose or duration. We did not find a statistically significant difference in surgical field visibility, intraoperative blood loss, or operative time between different dosing regimens. Further studies are needed to evaluate the efficacy of a low-dose preoperative regimen with the goal of reducing cumulative patient exposure to systemic corticosteroids.     

The importance of follow-up examinations in chronic rhinosinusitis with nasal polyposis

PurposeClinical examinations following functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) are critical for physicians to assess results of the intervention and to early identify recurrences. However, no clear consensus on the frequency and timing of clinical examinations following surgery exists. The aim of this study was to analyze CRSwNP recurrences after FESS with a specific focus on the adherence to follow-up examinations.Materials and methodsSixty patients who underwent FESS for CRSwNP were enrolled. Clinical parameters were recorded. Adherence to follow-up examinations with nasal fiber optic endoscopy and regular administration of nasal steroids were analyzed.ResultsAdherence to periodic clinical examinations and regular treatment with nasal steroids was 25 %. CRSwNP recurrence was observed in 56.7 % of cases at the last follow-up examination. No statistically significant difference concerning nasal symptoms was observed between patients with and without current recurrence (p > 0.05). Subjects who underwent regular examinations and prompt treatment of small recurrences had a lower probability of relapse at their last examination (7.7 % versus 38.2 %, respectively; p < 0.001). Polyp grade > 2 in patients with or without adherence were seen in 15.4 % and 42.9 % of cases, respectively (p < 0.05).ConclusionsAdherence to follow-up examinations with nasal optic fiber endoscopy is crucial to early identify recurrence after surgery and promptly treat it with medical therapy.     

Long-term evaluation of nasal polyposis recurrence: A focus on multiple relapses and nasal cytology

PurposeRecurrence of chronic rhinosinusitis with nasal polyps (CRSwNP) is highly variable, reaching 55–60% of cases. Different results about clinical parameters as recurrence predictors has been reported. The aim of this retrospective study was to evaluate CRSwNP recurrence risk after a long-term follow-up (up to 20 years). Moreover, the role of nasal cytology was assessed.Materials and methodsSixty-one patients who underwent functional endoscopic sinus surgery for CRSwNP were enrolled. Clinical parameters were recorded. Nasal cytology was performed at follow-up examinations. The Kaplan-Meier method was used to obtain the recurrence-free survival curves. The median number of recurrences per year was evaluated.ResultsFive- and 10-year recurrence rates were 30.29% and 66.06%, respectively. Median recurrence-free survival was 106 months. Asthma and Aspirin-Exacerbated Respiratory Disease represented predictors of multiple recurrences (p < 0.05). Intranasal steroids were the main treatment to prevent relapses (p < 0.05). Patients with normal cytology at follow-up evaluation had a lower probability to have first recurrence within 10 years (59% of cases), compared to neutrophil or eosinophil infiltrate (100% and 88% of cases, respectively) (p < 0.05).ConclusionsCRSwNP has a high recurrence risk, also more than 10 years after surgery. Nasal cytology may identify subjects with a higher risk of early recurrence.     

Outcomes of sinonasal oncocytic papilloma by endoscopic approach in 69 patients

ObjectiveSinonasal oncocytic papilloma (SOP) is a rare subtype of sinonasal papilloma. There are currently few reports on its clinical features and outcomes after endoscopic surgical resection. This study aims to explore the clinical characteristics of SOP and potential factors predicting tumor recurrence through a single-center retrospective case series analysis.MethodsWe conducted a retrospective analysis of 69 patients who underwent endoscopic surgery of SOP from June 2012 to April 2019. The data of patients’ demographics, clinical features, follow-up period, and treatment outcomes were collected.ResultsThe series includes 43 males and 26 females with an average age of 60.2 years. The tumor commonly involved the nasal cavity (n = 59; 89.4%), followed by maxillary sinus (n = 31; 44.9%), ethmoid sinus (n = 28; 40.6%), frontal sinus (n = 6; 8.7%) and sphenoid sinus (n = 6; 8.7%). The follow-up period ranged from 3 months to 96 months (mean, 34.6 months) and nine patients (13%) developed tumor recurrence during the follow-up period. Univariate analysis found that the recurrence of SOP was significantly related to tumor attachment site, Oikawa tumor stage, and histological dysplasia (p<0.05). Multivariate COX regression analysis found that Oikawa staging system (p = 0.024) and presence of dysplasia (p = 0.04) were significantly related to tumor recurrence.ConclusionSOP had low recurrence rate which was comparable to sinonasal inverted papilloma in the endoscopic era. Our findings also demonstrated that presence of dysplasia is an independent prognostic factor for recurrence free survival.     

Variables predictive of surgical outcomes after hyoid myotomy with suspension to thyroid cartilage

ObjectivesTo evaluate variables predicting improvement in obstructive sleep apnea (OSA) with hyoid suspension to thyroid cartilage 4-suture technique.MethodsSixty adult patients (age range 23–78 years) with OSA underwent hyoid suspension to thyroid cartilage with or without concurrent multi-level surgery over an eight-year period from 2011 to 2019 at a tertiary academic center. All patients had a preoperative apnea hypopnea index (AHI) ≥ 5. Changes in mean AHI, Epworth Sleepiness Scale (ESS), and lowest oxygen saturation (LSAT) were measured with paired Student t-test. Linear and logistic regression models were used to predict change in AHI and surgical success respectively with respect to body mass index (BMI), age, sex, previous sleep surgery, concurrent retrolingual surgery, concurrent palatopharyngoplasty, and preoperative AHI.ResultsThe mean AHI demonstrated a significant improvement from a preoperative AHI of 39.0 ± 25.5 to a postoperative AHI of 31.2 ± 23.4 (p = 0.005). The mean Epworth Sleepiness Score (ESS) significantly improved from 13.1 ± 6.0 to 9.2 ± 5.7 (p = 0.000012). Surgical success, defined as a 50% reduction in preoperative AHI to a postoperative AHI ≤ 20, was obtained in 18/60 (30.0%) patients. Preoperative BMI significantly correlates with variation of change in AHI in multivariable linear regression model (p = 0.003). Preoperative AHI was significant predictor of surgical success in multivariable logistic regression model.ConclusionThe magnitude of improvement in polysomnographic parameters after hyoid suspension to thyroid appears to be more significant in patients with lower BMI. Even patients with an obese BMI and severe OSA achieve significant improvement from this procedure.     

Validation of epistaxis severity score for hereditary hemorrhagic telangiectasia in Japan

ObjectiveThis study aimed to assess the health-related QoL (HR-QoL) of patients with hereditary hemorrhagic telangiectasia (HHT), with emphasis on the role/social aspects, and validate the Japanese version of the epistaxis severity score (ESS) in these patients.MethodsThe Japanese version of the ESS was created through forward and reverse translation, and consultation with the original author. A validation analysis was performed by comparing ESS severity with the invasiveness of previous treatments for epistaxis and assessing the correlation between the ESS and HR-QoL. Medical history forms, ESS questionnaires, and the Medical Outcomes Study Short Form 36 (SF-36) were distributed to participants with HHT in August 2020. The relation between the ESS and summary scores of SF-36 was assessed by performing analysis of variance and Spearman's correlation.ResultsIn total, 73 participants were included in this study. The average ESS was 5.02; there were mild (32.9%), moderate (45.2%), and severe (21.9%) epistaxis groups. Patients with higher ESS received a significantly more invasive treatment (Fisher's exact test, p < 0.05). The ESS was also negatively correlated with the physical component score (PCS) (r = -0.489, p < 0.001). Comorbid liver and gastrointestinal arteriovenous malformations significantly reduced the PCS (p < 0.05). Multiple regression analysis revealed that the ESS was a significant variable (p < 0.01). The role/social component score was significantly lower in the severe ESS group than in the mild or moderate group.ConclusionThe Japanese version of the ESS was considered valid and may be useful as an outcome measure of future HHT-associated epistaxis trials in Japan.     

Nasal polyps in eosinophilic granulomatosis with polyangiitis: Structured histopathology and CD105 expression

PurposeDistinguishing the prodromal nasal polyposis of eosinophilic granulomatosis with polyangiitis (EGPA) from chronic rhinosinusitis with nasal polyps (CRSwNP) is a challenge for rhinologists and rheumatologists. It has recently been reported that angiogenesis and CD105 expressed on vascular endothelial cells could have a role in the pathogenesis and development of nasal polyps.This exploratory study examined the structured histopathology of nasal polyps in patients with EGPA and CRSwNP, comparing CD105 expression in their nasal tissue with that of a control group with no chronic sinonasal inflammation.MethodsA structured histopathological study was performed on surgical specimens of nasal tissue from 32 adults (13 with EGPA, 14 with CRSwNP, 5 controls), considering CD105 as a marker to determine microvessel density (MVD).ResultsThe mean eosinophil count was higher in EGPA patients with tissue inflammation (p = .002), and in CRSwNP patients with sub-epithelial edema (p = .009). Neutrophil infiltration was significantly associated with severe tissue inflammation in EGPA patients (p = .04), but with the absence of fibrosis in CRSwNP patients (p = .04). In the EGPA group, CD105-MVD correlated with tissue eosinophil count (p = .05). Mean CD105-MVD was significantly higher in EGPA patients with mucosal ulceration (p = .004). In the CRSwNP group, a CD105-MVD correlated positively and significantly with tissue eosinophil count (p = .01).ConclusionAlongside the known abundance of eosinophils, other cells might contribute to inflammatory processes. Neutrophils may amplify inflammation, eosinophil recruitment and tissue damage. CD105 expression in CRSwNP and EGPA nasal polyps supports the hypothesized involvement of angiogenesis in the pathogenesis and development of nasal polyps.     

Predictive markers of long-term recurrence in chronic rhinosinusitis with nasal polyps

BackgroundIn last years, many attempts were made to recognize chronic rhinosinusitis with nasal polyps (CRSwNP) phenotypes focusing on identifying relevant key pathogenic molecules. Polyps recurrence rate ranges from 4% to 60%, so it's clear that not all clinical and immunologic factors associated with recurrence are known.ObjectiveWe investigate the inflammatory profile in patients with long term recurrent and non-recurrent CRSwNPs and if a specific profile is associated with recurrence, comparing eosinophilic, neutrophilic and lymphocytic infiltration, as well as IL-5 and IL-8 expression to long term recurrence rate.MethodsThis prospective study included 44 adult patients with CRSwNP treated with endoscopic sinus surgery between 2008 and 2010. Long term follow-up data (8–10 years) indicated that among 44 patients, 18 (40.1%) experienced long term recurrence of nasal polyposis needing maximal medical treatment or revision surgery. We realized two groups: one with patients who didn't present long term recurrence (26 patients) and another with patients who presented long term recurrence (18 patients) and in both groups eosinophilic, neutrophilic and lymphocytic infiltration and IL-5 and IL-8 expression were measured.ResultsThe parameters that reached statistical significance (p < 0.05) comparing the two groups were eosinophilic infiltration and IL-5 expression, whereas neutrophilic and lymphocytic infiltration, as IL-8 expression didn't show any significant difference.Asthma and aspirin intolerance seemed significantly more frequent in patients with recurrence, while allergy presented not statistically significant difference between two groups.ConclusionsWe can conclude that high eosinophilic infiltration and high IL-5 expression in CRSwNP correlate with higher rate of long term recurrence, while neutrophilic and lymphocytic infiltration, and IL-8 expression don't correlate with it. These findings provide the opportunity to improve our ability to predict the prognosis of surgical intervention, although it is still needed to explore the optimal predictor of outcome in CRSwNP.     

Autotransplant tissue selection criteria with or without stereomicroscopy in parathyroidectomy for treatment of renal hyperparathyroidism

IntroductionSeveral methods have been proposed to improve operative success in renal hyperparathyroidism.ObjectiveTo evaluate stereomicroscopy in parathyroid tissue selection for total parathyroidectomy with autotransplantation in secondary (SHPT)/tertiary (THPT) hyperparathyroidism.Methods118 renal patients underwent surgery from April of 2000 to October 2009. They were divided into two groups: G1, 66 patients operated from April of 2000 to May of 2005, with tissue selection based on macroscopic observation; G2, 52 patients operated from March of 2008 to October 2009 with stereomicroscopy for tissue selection searching for the presence of adipose cells. All surgeries were performed by the same surgeon. Patients presented SHPT (dialysis treatment) or THPT (renal-grafted). Follow-up was 12–36 months. Intra-operative parathyroid hormone (PTH) was measured in 100/118 (84.7%) patients.ResultsData are presented as means. G1 included 66 patients (38 SHPT, 24 females/14 males; 40.0 years of age; 28 THPT, 14 females/14 males; 44 years of age). G2 included 52 patients (29 SHPT, 11 females/18 males; 50.7 years of age; 23 THPT, 13 females/10 males, 44.4 years of age). SHPT patients from G2 presented preoperative serum calcium higher than those of SHPT patients in G1 (p < 0.05), suggesting a more severe disease. Definitive hypoparathyroidism was found in seven of 118 patients (5.9%). Graft-dependent recurrence occurred in four patients, two in each group. All occurred in dialysis patients.ConclusionStereomicroscopy in SHPT/THPT surgical treatment may be a useful tool to standardize parathyroid tissue selection.     

Overexpression of hypoxia-inducible factor 1α is associated with neutrophilic inflammation in chronic rhinosinusitis with nasal polyps

ObjectiveThis study aimed to assess the possible role of hypoxia-inducible factor 1α (HIF-1α) in promoting neutrophilic inflammation in chronic rhinosinusitis with nasal polyps (CRSwNP) patients.MethodsWe examined HIF-1α expression in sinonasal tissues from CRSwNP patients and healthy controls by using immunohistochemistry, qRT-PCR, and western blot. Next, the stimulatory effects of several cytokines (IFN-γ, IL-17A, IL-6, etc.) and reagents (dexamethasone (DEX), clarithromycin (CAM) and curcumin (CUM)) on HIF-1α expression in cultured normal nasal epithelial cells (NECs) were also evaluated. Moreover, the effects of CAM and glucocorticoid on nasal symptoms and signs of uncontrolled neutrophilic CRSwNP patients were evaluated.ResultsThe mRNA and protein expression of HIF-1α were significantly increased in polyp tissues compared with healthy controls (P < 0.05), and the HIF-1α level in polyp tissues was positively associated with IL-17A production and tissue neutrophilia (P < 0.05). Moreover, in cultured NECs, HIF-1α expression was upregulated in the presence of IL-17A and IL-6 (P < 0.05). Both CAM and CUM showed an additive effect with DEX in inhibiting HIF-1α expression (P < 0.05). Moreover, combined glucocorticoid and CAM significantly improved nasal symptoms and signs compared with glucocorticoid alone in uncontrolled neutrophilic CRSwNP patients (P < 0.05).ConclusionOur findings indicate that HIF-1α is associated with neutrophilic inflammation and glucocorticoid resistance in CRSwNP patients.     

Correlation between chronic rhinosinusitis with nasal polyposis (CRSwNP) severity and asthma control

BackgroundChronic rhinosinusitis with nasal polyposis (CRSwNP) is a predominantly type 2-mediated inflammatory disease with high social and economic burdens. According to the “unified airway diseases theory”, CRSwNP and asthma often occur simultaneously as comorbidities, complicating their overall management.ObjectiveWe aimed to evaluate the correlation between CRSwNP severity, according to the Clinical-Cytological Grading (CCG), and asthma control.Methods151 patients suffering from both CRSwNP and asthma step Gina 4–5 were recruited. We examined patients' clinical history and administered to each patient the Asthma Control Test (ACT). Moreover, we performed nasal endoscopy and nasal cytology on all patients. According to nasal cytology findings and comorbidities each patient was assigned a CCG score. Kolmogorov-Smirnov and Shapiro-Wilk tests were performed. A ROC curve was constructed to detect the accuracy of the CCG in detecting not well controlled asthma.ResultsThe mean ACT was 18.44 ± 4.53. 57 % of patients suffered from not well controlled or poorly controlled asthma. The mean CCG score was 6.68 ± 2.01. 54.3 % of patients had a severe CCG value. Well-controlled asthmatic patients had a lower percentage of severe CCG and a higher percentage of mild CCG. 50 % of patients with non-well or poorly controlled asthma showed a mixed eosinophil-mast cell infiltrate. A CCG <6 and the absence of the simultaneous presence of eosinophils and mast cells in the nasal cytology were associated with well-controlled asthma.ConclusionsPatients with high-grade CCG, especially with mixed eosinophil-mast cell inflammatory infiltrate at nasal cytology, are more prone to uncontrolled asthma.     

Clinical symptoms of chronic rhinosinusitis with nasal polyps (eosinophilic and non-eosinophilic) are related to sinus computed tomography but not to endoscopic findings

BackgroundIn the clinical assessment of chronic rhinosinusitis with nasal polyps (CRSwNP), evaluation of symptoms, nasoendoscopy findings and sinus computed tomography (CT) scan staging is employed in the management plan. Although prior studies have been done to assess the correlation of the three modalities in CRSwNP, such evaluation in patients with eosinophilic and non-eosinophilic types of CRSwNP requires further investigation. The aim of this study was to correlate the sinus CT scan staging to symptom and endoscopic scores in both types of CRSwNP.Material and methodPatients with CRSwNP were classified into 2 types, eosinophilic and non-eosinophilic. Both types were assessed by Sino-Nasal Outcome Test 22 (SNOT-22) symptom score, nasal endoscopy Lund Kennedy grading (LK) score and sinus CT Lund Mackay (LM) staging score. All three modalities were correlated.ResultsForty-four patients were recruited for this study. There was significant correlation between sinus CT and symptom scores in the eosinophilic (r = .51, p = .031) and the non-eosinophilic (r = .76, p < .001) types. There was no significant correlation between symptom and nasoendoscopic scores in the eosinophilic (r = .12, p = .641) and the non-eosinophilic (r = .22, p = .276) types. There was also no significant correlation between sinus CT and nasoendoscopic scores in the eosinophilic (r = .20, p = .418) and the non-eosinophilic (r = .14, p = .508) types.ConclusionsSinus CT staging correlates well with the symptom score for both the eosinophilic and the non-eosinophilic types of CRSwNP. The good correlation suggests both modalities are a reliable guide for their evaluation and management planning.     

Development of the maxillary sinus in infants and children

ObjectiveTo examine the age related volume change of the maxillary sinus in children by measuring the change of the height, weight, and depth using computed tomography (CT).MethodsChildren <18 years of age who underwent a CT Scan of the sinuses for reasons other than sinus related issues were included in the study.Results139 patients were included (68 females and 71 Males) and the mean age of the patients was 9.6 ± 5.4 years. The cohort was divided into three groups based on their ages – Age <6 years (n = 45), age between 6 and 12 years (n = 44) and age > 12 years (n = 50). Patients in each age group demonstrated an increase in their Maxillary sinus height (p<0.001). Patients < 6years of age and between 6 and 12 years of age had a significant increase in their maxillary sinus width and depth (p < 0.001). The maxillary sinus width, depth and volume did not increase significantly after the age of 12 years in these patients.ConclusionWe demonstrated periods of significant size increase of the maxillary sinuses as determined by different dimensions in children at various ages. The height of the maxillary sinus has steady growth from birth to at least the age of 18 years. The width and depth increase up to 12 years of age.     

The recurrent factors of idiopathic vocal process granulomas after cold steel excision

ObjectiveTo identify the factors predicting postoperative recurrence after cold steel excision for the market trader with idiopathic vocal process granulomas (VPGs).Material and methodsThe market traders with idiopathic VPGs who do not respond to medical treatment were treated by cold steel excision. The factors considered likely to affect the recurrence were evaluated by univariate and multivariate logistic regression.ResultsThe total of 80 idiopathic VPGs underwent the cold steel excision. All postoperative 6 months, the complete remission rate was 37.5% (30 VPGs) and 50 recurrences developed (62.5%). The recurrence rate was not significantly associated with sex (P = 0.119), side (P = 0.468), VPG size (P = 0.726), LPR (P = 0.293), diabetes mellitus (P = 0.5611), cerebrovascular disease (P = 0.129), or chronic pulmonary disease (P = 0.190). Multivariate logistic regression showed that only vocalization frequency (P = 0.006) and smoking and alcohol consumption (P = 0.001) were independent predictors of recurrence. There was no significant correlation between age and recurrence (P = 0.59). However, recurrence was more common in those aged 51–60 years than those aged ≥61 years (P = 0.019). Of the recurrent 49 VPGs treated conservatively via behavioural modification and oral deanxit, the granulomas disappeared spontaneously in 38 (77.6%) within 6–10 months and in 11 (22.4%) within 2–3 years.ConclusionsThe market traders with VPG would be a high recurrence rate after cold steel excision, the frequency of voice use and smoking and alcohol consumption were significant independent predictors of recurrence. Antidepressant medications and behavioural modification could effectively improve the outcome of VPG.     

Laryngopharyngeal reflux in chronic rhinosinusitis patients and the role of endoscopic sinus surgery

ObjectivesLatest literature proposes laryngopharyngeal reflux (LPR) as the underlying contributory factor for chronic inflammation in both upper and lower airways. In this study, we investigated LPR symptoms and signs of CRS patients and the various factors on their LPR symptoms and signs. We also evaluated the effect of the LPR symptoms and signs of CRS patients after endoscopic sinus surgery (ESS).MethodsWe performed a retrospective analysis from 91 patients who underwent primary ESS. They were assessed for LPR symptoms with Reflux Symptom Index (RSI) and Reflux Finding Scores (RFS) before ESS. Sino-Nasal Outcome Test (SNOT)-22, Lund–Mackay (LM) scoring system, and Lund-Kennedy (LK) scoring system were evaluated for CRS severity. They had to fulfill SNOT-22, RSI, and RFS at 6 months after surgery.ResultsNasal polyps, smoking, asthma, allergy, LM scores and LK scores didn't have significant correlations with preoperative RSI and RFS (P > .05 for all). RSI had significant correlations with SNOT-22 preoperatively and postoperatively (P < .05 for all). RFS had a significant correlation with postoperative SNOT-22 (P = 0.034). RSI and RFS decreased significantly more after ESS (P < 0.001 for both). Smoking had a significant effect on the postoperative RFS (P = 0.003). Non-smoker showed significantly lower scores of postoperative RFS (P = .0.003).ConclusionOur study suggests that subjective CRS symptoms were related with subjective LPR symptoms and ESS was effective in reducing signs and symptoms of LPR in CRS patients. Especially, smoking was associated with less improvement of laryngoscopic findings after ESS.     

Diagnostic assessment of patients with Meniere's disease through caloric testing and the video-head-impulse test

IntroductionMeniere's disease is a labyrinth disease that usually presents with episodes of spontaneous vertigo associated with sensorineural hearing loss, tinnitus and ipsi- and unilateral aural fullness in most cases. Vestibular function tests, video-head-impulse test and the caloric test, are not specific for diagnosis of the disease, but may show alterations that help to evaluate the functional impairment.ObjectiveTo describe the results obtained at the caloric test and video-head-impulse test in patients with definite Meniere's disease and compare them between symptomatic, asymptomatic ears and those of the control group.MethodsCross-sectional and observational study including patients with definite Meniere's disease diagnosed according to the Bárány Society criteria (2015) and healthy individuals (control group) undergoing caloric test and video-head-impulse test. All subjects were assessed by neurotological anamnesis and audiological evaluation (pure-tone, vocal and immittance audiometry) to characterize the sample. The findings obtained at the caloric test and video-head-impulse test were described and compared between the symptomatic and asymptomatic ears of patients with Meniere's disease and those of the control group.ResultsThirty-two patients with definite Meniere's disease were evaluated, with a mean age of 45.7 years, mostly females (68.8%) and unilateral disease. The control group consisted of 20 healthy individuals, with a mean age of 44.7 years, mostly females (70.0%). The groups were homogeneous in relation to age and gender. The patients’ main complaint was vertigo (71.9%), and most patients had more than six episodes in the last six months (71.9%). Moderate sensorineural hearing loss was present in 38.5% of patients. The prevalence of hyporeflexia at the caloric test was higher in symptomatic (56.4%) and asymptomatic (36%) ears of patients with Meniere's disease compared to the ears of control subjects (7.5%), p < 0.001 and p = 0.004, respectively. Video-head-impulse test alterations in the lateral semicircular canals were more frequent in the symptomatic ears of patients with Meniere's disease than in the ears of control subjects (p = 0.026).ConclusionMost patients with definite Meniere's disease showed hyporeflexia at the caloric test and video-head-impulse test with normal function in the symptomatic ear. Vestibular hyporeflexia at the caloric test was more frequent in the symptomatic and asymptomatic ears of patients with Meniere's disease than in the control group. The video-head-impulse test showed more alterations in the lateral semicircular canals.     

Increased expression of nucleophosmin is associated with the pathophysiology of chronic rhinosinusitis with nasal polyposis

ObjectiveNucleophosmin (NPM1) has been suggested to be involved in the pathophysiologic mechanism of inflammatory disorders. We measured the expression level of NPM1 in nasal polyp (NP) tissues of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). We also assessed the correlation between NPM1 expression and other parameters such as eosinophilic infiltration, inflammatory cytokines, and clinical indicators such as Lund-Mackay computed tomography (CT) score.MethodsThirty patients with CRSwNP were included. We performed pre-operative CT scan to determine Lund-Mackay CT scores. During endoscopic sinus surgery, we harvested NP tissues from patients with CRSwNP. We performed Sirius red staining to evaluate eosinophilia and conducted immunohistochemical staining for NPM1 and real-time PCR for cytokines including interleukin (IL)-5, IL-17A, and IL-32.ResultsThe mRNA expression of NPM1 was significantly up-regulated in eosinophilic NP tissues (RQ 0.58 ± 0.06), compared to non-eosinophilic NP tissues (RQ 0.38 ± 0.08, p < 0.05). In the epithelium of NP tissue, a significant positive correlation was observed between eosinophilic infiltration and NPM1 expression. The expression of NPM1 was significantly correlated with that of IL-5 (r = 0.6229, p = 0.0004), IL-17A (r = 0.5971, p = 0.001), and IL-32 (r = −0.5985, p = 0.0068). There was no significant correlation between the mRNA expression of NPM1 and the Lund-Mackay CT score (Spearman r = −0.2563, p = 0.1879).ConclusionExpression of NPM1 was significantly increased in eosinophilic NP tissues from patients with CRSwNP. We observed an association between NPM1 expression and various pro-inflammatory cytokines such as IL-5, IL-17, and IL-32 and eosinophilic infiltration, which is thought to contribute to the pathophysiology of NP.     

Artificial intelligence for objectively measuring years regained after facial rejuvenation surgery

BackgroundFew objective measures are available for assessing the success of facial rejuvenation after face lift surgery. Convolutional neural networks (CNNs) may be used for this type of measurement. The purpose of this investigation is to use artificial intelligence (AI) via CNNs to objectively classify patient photos by age before and after aesthetic surgery. Uniquely, men and patients undergoing deep plane face lifts were included.MethodsA CNN (FaceX) was used for facial age recognition and age estimation. Patient photos were analyzed preoperatively, and at three (PO1) and 12 months (PO2) postoperatively. The study population included male and female patients who underwent facial rejuvenation at our institution from 2017 to 2021. Patient photos were collected with the same camera, distance, and lighting.Results226 patients were analyzed with a mean true age of 62.2 (SD 6.7) years. The AI estimated the mean preoperative age to be 64.7 (SD 10.4) years. The AI was 96.0 % accurate. Across all subjects, a 3.5-year, 5 % reduction in age (p ≤ 0.001) was attributed at PO1, and a 1.7 year, 3 % age reduction (p = 0.034) at PO2. No single ancillary procedure or technique conferred more benefit than others. The 15 males had a 2.0 year, 4 % age reduction (p = 0.06) at PO1.ConclusionAI can be used to objectively measure the success of facelift surgery and compare outcomes among rhytidectomy techniques. Additionally, multiple, different approaches were effective with no single approach being superior. As AI continues to rapidly advance, more accurate models may be developed for multiple applications in facial plastic surgery.