Search Results (234)

Background/Objectives: Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) or without NP (CRSsNP) are common upper airway diseases with major impact on healthcare utilization. Little is known about the overall national financial burden of CRS. We aimed to assess the excess financial burden of CRS from a countrywide perspective. Methods: Annual expenditure from healthcare, welfare transfers and foregone income was retrieved from national databases, annualized and compared to matched healthy comparators. Results: Of the 303,475 patients included with CRS (mean age 51, 55% female), 18,142 were subclassified as CRSsNP (24%) or CRSwNP (76%). For CRS patients, annual excess healthcare costs were €1315 (1296–1333) compared to comparators. Patients with CRS earned €1356 (1230–1479) less annually compared to comparators. Patients with CRS of working age (18–64 years) had excess welfare transfers (€816 (782–850) compared to comparators, driven by sick leave and disability. Increases in healthcare costs were seen for patients with CRSwNP (€5406 (4860–6012) annually) compared to CRSsNP (€4945 (4293–5696)) driven by increases in CRS-related costs. Total societal burden for the entire cohort was €686,052,898, of which systemic corticosteroid exposure-related conditions represented €20,332,825. Excess welfare transfers represented €174,394,048 annually. Conclusions: Chronic rhinosinusitis is associated with a significant financial burden, both in terms of societal healthcare and welfare expenditure and patients’ personal finances due to lost income. Full article

Background: This scoping review screens modern literature in search of effective treatment approaches that target both upper and lower airway diseases. Methods: After the establishment of a research protocol, 227 potential articles were obtained through a logged search method. These were screened and narrowed down to 26 included articles. Data were extracted using a standardized data extraction form and were analyzed thematically and analytically. Results: The main integrated treatment approaches are biological (dupilumab was the most mentioned molecule) and non-biological (allergen immunotherapy, nasal saline irrigation, and endoscopic polypectomy). Data suggest that these approaches are effective in improving upper and lower airway outcomes and showcase a good safety profile. Conclusions: Patients with upper and lower airway diseases should benefit from integrated treatment approaches when possible. Full article

Primary ciliary dyskinesia (PCD) is a rare, genetically heterogeneous disorder of motile cilia that leads to impaired mucociliary clearance and recurrent airway infections. Children with PCD often present with ear and sinus disease resembling common pediatric conditions, yet the true burden and management remain incompletely defined. To address this gap, a systematic search for pediatric cohort studies published between 2020 and 2025 reporting otologic and sinonasal features of PCD was performed. Searches of PubMed, Embase, Scopus, and Web of Science identified 12 eligible studies, encompassing 524 children with confirmed PCD. Data extracted focused on demographics, otologic and sinonasal manifestations, vestibular findings, radiographic imaging, and interventions. Across studies, 60.3% had a history of otitis media and 39.1% had hearing loss, predominantly conductive. Tympanostomy tubes were utilized in more than half of patients, with many requiring multiple sets over time due to recurrent effusions or tube occlusion. Sinonasal disease was nearly universal, with 78.5% demonstrating chronic rhinosinusitis and most reporting nasal congestion and rhinorrhea; nasal polyps were uncommonly noted. Vestibular symptoms were also infrequently assessed but present in some patient cohorts. In conclusion, otologic and sinonasal disease are highly co-prevalent in pediatric PCD, highlighting the need for early recognition, regular surveillance, and standardized outcome reporting to guide long-term management of this complex chronic disease. Full article

The concept of united airway disease (UAD) highlights the bidirectional relationship between inflammatory disorders of the upper airways—such as allergic rhinitis and chronic rhinosinusitis with or without nasal polyps (CRSwNP/CRSsNP)—and lower airway diseases, most notably asthma. This paradigm is supported by epidemiological, embryological, and immunological evidence demonstrating that airway inflammation represents a single, interconnected process rather than isolated compartmental pathology. Central to many UAD phenotypes is type 2 (T2) inflammation, driven by cytokines including IL-4, IL-5, and IL-13, and mediated by effector cells such as eosinophils and group 2 innate lymphoid cells (ILC2s). Epithelial barrier dysfunction often serves as the initiating trigger for this shared inflammatory cascade by production of TSLP, IL-25 and IL-33. Optimal diagnosis and management of UAD require an integrated, multidisciplinary framework. Clinical evaluation remains essential for patient characterization but must be complemented by pheno-endotypic assessment using imaging (CT), allergy testing, biomarker profiling (FeNO, blood eosinophils, IgE), and pulmonary function testing (spirometry, impulse oscillometry). Therapeutic strategies are layered, targeting both symptom control and inflammation across airway compartments. Standard approaches include intranasal and inhaled corticosteroids as well as saline irrigations, while severe T2-high disease increasingly benefits from biologic therapies (anti-IL-5/IL-5R, anti-IL-4R, anti-TSLP), which reduce dependence on systemic corticosteroids and surgical interventions such as endoscopic sinus surgery (ESS). Emerging precision-medicine models, particularly the “treatable traits” approach, further underscore the need to view the airway as a unified system. Collectively, these insights reinforce the clinical imperative of addressing upper and lower airway disease as a continuum, ensuring that inflammation in one district is neither overlooked nor treated in isolation. Full article

Adipose-derived stem cells (ASCs) and their secretome have been reported to improve allergic airway inflammation. Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) is characterized by type 2 helper T (Th2)-diven inflammation, which shares similar mechanisms with allergic airway diseases. We assessed the immunomodulatory effects of ASC secretome on an ECRSwNP mouse model. ECRSwNP was induced by ovalbumin (OVA) and Staphylococcus aureus enterotoxin B (SEB) intranasal challenges in five-week-old BALB/c mice. To evaluate the effect of ASC secretome on eosinophilic nasal inflammation, 10 μg/50 μL of ASC-conditioned media were administered three times a week during the eight weeks. H&E and Sirius red staining were performed to evaluate the formation of nasal polyps (NPs) and the infiltration of eosinophils. The cytokine levels of interleukin (IL)-4, IL-5, IL-13, interferon-γ, IL-8, and eotaxin-1 were measured using ELISA(eBiosciences, San Diego, CA, USA). The expression levels of IL-8 and eotaxin-1 mRNA were determined by quantitative PCR. Eosinophil cationic protein (ECP) and eotaxin-1 expression were assessed by immunohistochemistry. Intranasal administration of ASC secretome significantly decreased NP-like formation and eosinophilic infiltration in the sinonasal mucosa of ECRSwNP mice. The increased IL-4, IL-5, and eotaxin-1 levels after OVA + SEB challenge remarkably decreased by ASC secretome treatment. Furthermore, ASC secretome notably decreased the gene expression of eotaxin-1 by PCR, as well as ECP and eotaxin-1 expression by immunohistochemistry. ASC secretome had immunomodulatory effects in a mouse model of ECRSwNP. Intranasal administration of ASC secretome resulted in a significant reduction in NP formation and eosinophilic inflammation through the suppression of IL-4, IL-5, eotaxin-1, and ECP. Full article

Objective: To describe the sociodemographic profile and prevalence of different phenotypes of patients with chronic rhinosinusitis (CRS) treated at a specialized outpatient clinic of a university hospital in Brazil. Methods: A cross-sectional retrospective study was conducted on patients treated at a clinic in Brazil. The following were evaluated: sex, age, age at symptom onset, primary CRS phenotype, etiology of secondary CRS, and severity of symptoms. Results: A total of 342 patients were included, of whom 45.61% were men and 8.24% had secondary CRS. The median age of all patients with CRS was 61 years. Nasal polyps were present in 86.22% of patients. The median age at symptom onset was 41 years. The prevalence of primary CRS phenotypes was chronic eosinophilic rhinosinusitis (eCRS) (75%), anti-inflammatory drug exacerbated respiratory disease, which was considered a subgroup of eCRS (19.40%), chronic non-eosinophilic rhinosinusitis (18.66%), central compartment atopic disease (4.1%), and allergic fungal rhinosinusitis (2.24%). The most prevalent diagnoses of secondary CRS were allergic bronchopulmonary aspergillosis (ABPA) (27.59%), immunodeficiencies (20.69%), and vasculitis (13.79%). Conclusions: Patients diagnosed with CRS are predominantly women over 60 years of age who began experiencing nasal symptoms in their fifth decade of life. Most patients have CRS with nasal polyps, primary CRS, and a predominant eCRS phenotype. Secondary CRS accounted for 8.4% of cases, and the most prevalent diagnoses of secondary CRS were Allergic Bronchopulmonary Aspergillosis, immunodeficiencies, and vasculitis. Full article

Objectives: The aim of this study was to assess the role of functional endoscopic sinus surgery (FESS) in the treatment of chronic rhinosinusitis (CRS) in children with cystic fibrosis (CF). Methods: We performed a comprehensive review of the literature by searching PubMed/MEDLINE. Results: CRS affects most children with CF. Though subjective symptoms are variable, radiological and endoscopic examination demonstrated typical objective findings. FESS is recommended for children with significant nasal symptoms that do not respond to medical treatment. At present, there are no uniform criteria for timing and extension of surgery. Primary surgery includes nasal polypectomy and correction of any bone anatomical variants that reduce ventilation of paranasal sinuses predisposing to recurrent sinusitis and complications. In case of recurrences, revision surgery supports a more expanded surgical approach. Moreover, FESS can relieve symptoms, improve patients’ quality of life, manage complications, ameliorate the delivery of medical therapy, and reduce sinonasal and lung superinfections. Conclusions: FESS has emerged as a safe and effective procedure for the treatment of CRS in children with CF. Since children with CF and CRS are difficult-to-treat patients, a multidisciplinary approach in tertiary-care referral centers is required. Full article

We report a case of a patient admitted to our coronary intensive care unit with chest pain and elevated cardiac troponin. Coronary angiography showed no obstructive coronary artery disease. The patient had a history of chronic rhinosinusitis and nasal polyps, treated with dupilumab. Laboratory tests revealed marked hypereosinophilia, prompting a cardiac MRI, which showed findings consistent with eosinophilic myocarditis. This diagnosis was later confirmed by endomyocardial biopsy. This case highlights the importance of differential diagnosis in cases of myocardial injury (characterized by increased cardiac troponin) and underscores the value of CMR as the most accurate non-invasive technique for detecting myocarditis. Full article

Background and Objectives: Emerging evidence indicates that γδ T cells contribute to mucosal inflammation, yet their composition and functional characteristics in the nasal mucosa and nasal polyps remain insufficiently defined. This study aimed to characterize γδ T cell subsets in patients with non-eosinophilic chronic rhinosinusitis with nasal polyps (non-ECRSwNP) and to assess their associations with clinical features. Materials and Methods: Using flow cytometry, we analyzed the frequencies and phenotypes of γδ T cell subsets in middle nasal turbinate (MNT) tissue and nasal polyps from patients with non-eosinophilic chronic rhinosinusitis with nasal polyps (non-ECRSwNP), and compared them with nasal mucosa from healthy controls. Correlations with age, sex, disease severity, and allergy were also examined. Results: Distinct alterations in γδ T cell composition were observed in non-ECRSwNP, marked by a predominance of Vδ1⁺ and double-negative (DN) subsets. In nasal polyps, these shifts were influenced by age and sex, with a decline in Vδ1⁺ and a rise in Vδ2⁺ cells in older individuals showing decreased Vδ1⁺ and increased Vδ2⁺ cell frequencies, and males exhibiting consistently higher Vδ1⁺ levels. Higher disease severity (Lund–Mackay score > 12) was associated with an increased proportion of DN cells relative to Vδ1⁺ cells. Conclusions: There were observed alterations in γδ T cell subsets. These results suggest their potential role for certain γδ T cell subsets in non-ECRSwNP pathogenesis, warranting further studies on their function and involvement in the pathogenesis of non-ECRSwNP. These findings highlight the need for further studies to define the functional roles of these subsets across different stages of the disease. Full article

Background: Chronic rhinosinusitis (CRS) exhibits marked symptom heterogeneity that is not fully explained by anatomy or endotypes. Although allergen types shape symptom patterns in allergic rhinitis, largescale systematic analyses linking allergen sensitization profiles to patient-reported outcome measures in patients with CRS are limited. Methods: We conducted a multicenter, retrospective surgical cohort study (n = 1880) including patients with CRS who underwent preoperative specific IgE testing for 35 inhalant allergens and completed the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire within 1 year. Using a previously validated nonnegative matrix factorization model, we deconvolved each patient’s IgE profile into four allergen signatures (Mite, Grass/Weed, Pet, and Tree) and defined a dominant group. Associations between signature contributions and SNOT-22 items, domain subscores, and total score were estimated by ordinary least squares, adjusting for age, sex, nasal polyps, and asthma, with coefficients scaled per 10-percentage-point increase. Item-level multiplicity was controlled for using the false discovery rate. Seasonality was assessed using monthly means and the coefficient of variation of the dominant group. Results: Dominant groups were nonallergic (50%), mite (26%), grass/weed (9%), pet (9%), and tree (5%). Symptoms varied by age and sex, characterized by notably low nasal scores with aging and a high female burden for several items, motivating covariate adjustment. Signature–symptom associations were domain-specific: the pet signature showed the strongest and most consistent associations with nasal domain (such as rhinorrhea and nasal obstruction) and emotion domain (feelings of embarrassment); mite and grass/weed signatures were linked to the function domain (daytime fatigue/productivity); whereas the tree signature showed no significant associations. Seasonal patterns aligned with exposure ecology: grass/weed and tree groups had the largest relative variation (high coefficient of variations), the pet group showed the highest absolute burden year-round, and the mite group varied modestly with winter–spring predominance. Conclusions: Allergen signatures distilled from routine IgE panels explained meaningful variations in CRS patient-reported outcome measures, mapping to distinct symptom domains and seasonal profiles. Incorporating signature information into clinical assessments may support personalized counseling, anticipatory management around exposure windows, and targeted evaluation of environmental or immunologic interventions. Full article

Background: In this study, we attempted to compare the bacteriology of chronic rhinosisusitis (CRS) with and without nasal polyps between geriatric and adult patients. Methods: This retrospective cross-sectional study included 751 patients with CRS who underwent bilateral primary functional endoscopic sinus surgery. Before surgery, swab samples were collected from the middle meatus for bacterial cultures using cotton-tipped sticks. Subjects were divided into adult (20 to 64 years, n = 683) and elderly (65 years, n = 68) groups. The results of the bacteria culture were analyzed according to age group and the presence of nasal polyps. Results: The bacterial culture rate was higher in geriatric patients (55.9%) than in adults (44.9%), but the difference was not statistically significant. However, geriatric patients showed a higher bacterial culture rate (57.6%) than adult patients (29.6%) without nasal polyps. This difference was statistically significant. Conclusions: Geriatric patients with CRS exhibited higher bacterial culture rates, particularly on the non-polyp side. These findings suggest a possible age-related susceptibility to microbial colonization, underscoring the need for age-specific infection management strategies. Full article

Introduction: Chronic rhinosinusitis (CRS) with frontal sinus outflow tract (FSOT) obstruction frequently requires frontal beak reduction during endoscopic sinus surgery (ESS). While technical approaches such as rotary drilling or piezoelectric osteotomy may differ in precision and tissue preservation, it is unclear whether surgical instrument choice or patient-specific clinical characteristics influence postoperative quality of life (QoL). Methods: In this prospective cohort study, 49 adult CRS patients undergoing ESS with frontal beak reduction were enrolled (28 males, mean age 50 ± 15 years). Osteotomy was performed using either a conventional drill (n = 25) or piezoelectric knife (n = 24). Baseline clinical data included presence of nasal polyps, asthma, and radiologic severity (Lund–Mackay and Zinreich CT scores). Outcomes included patient-reported symptoms with the 22-item Sino-Nasal Outcome Test (SNOT-22) and visual analogue scale (VAS), and endoscopic Lund–Kennedy scores, recorded preoperatively and at 1, 4, and 24 weeks postoperatively. Results: Both groups demonstrated significant postoperative improvement in SNOT-22 and VAS scores. No significant correlation was observed between SNOT-22 changes and Lund–Kennedy scores in either tool group. Presence of nasal polyps was associated with higher pre- and postoperative Zinreich and Lund–Mackay scores (p < 0.05). Asthma was linked to higher early postoperative symptom burden (nasal blockage, clear discharge; p < 0.05). Tool choice did not significantly influence QoL recovery or modify the effect of clinical characteristics on outcomes. Conclusions: Postoperative QoL improvement was driven primarily by baseline disease phenotype—particularly nasal polyposis and asthma—while the choice of osteotomy instrument did not significantly influence recovery trajectories. The Zinreich score provided additional phenotypic stratification in CRS with FSOT obstruction. Full article

Background and Clinical Significance: Otitis media with effusion (OME) is characterized by persistent middle ear effusion without acute infection. Type 2 inflammation, mediated by IL-4 and IL-13 signaling via the IL-4Rα receptor, has been implicated in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and possibly OME. Refractory OME in adults remains a therapeutic challenge, as conventional treatments often fail to achieve long-term resolution. Targeted biologic therapies that modulate type 2 inflammation may offer a novel treatment option. Case Presentation: We report the case of a 60-year-old man with a 15-year history of allergic rhinitis and CRSwNP, complicated by recurrent asthma exacerbations, who presented with bilateral aural fullness, hearing loss, and tinnitus. His symptoms persisted despite repeated tympanic punctures, Eustachian tube insufflation, and corticosteroid therapy. Otoscopy revealed dull tympanic membranes with effusion, and audiometry showed conductive hearing loss with a B-type tympanogram on the left. Laboratory findings demonstrated mild peripheral eosinophilia. The patient was diagnosed with OME, likely secondary to type 2 inflammation. After nine biweekly injections of Stapokibart (CM310)—a humanized monoclonal antibody targeting IL-4Rα—aural fullness completely resolved. Otoscopic findings and tympanograms normalized, and hearing thresholds improved significantly. Retrospective evaluation using Iino’s diagnostic framework suggested that the patient did not meet the full criteria for eosinophilic otitis media (EOM); nevertheless, marked symptomatic and functional improvement was achieved. No recurrence or adverse effects were observed during follow-up. Conclusions: This case suggests that IL-4Rα blockade with Stapokibart may be effective in treating refractory OME associated with type 2 inflammation, even in patients who do not fulfill the diagnostic criteria for EOM. These findings highlight the potential of anti-IL-4Rα biologics as a novel therapeutic option for middle ear diseases driven by type 2 inflammation. Full article

Background: Mucins, particularly MUC1, are involved in the pathogenesis of chronic respiratory diseases. In chronic rhinosinusitis with nasal polyposis (CRSwNP), altered mucin expression may contribute to chronic inflammation and tissue remodeling. However, the specific role of MUC1 in CRSwNP and its correlation with clinical severity and inflammatory pathway remains unclear. Objective: We aimed to evaluate the MUC-1 expression in nasal polyps of patients with CRSwNP and to assess the correlation of MUC-1 expression and disease severity, according to Clinical-Cytological Grading (CCG). Methods: Eighteen consecutive patients with CRSwNP who underwent endoscopic sinus surgery (ESS) were enrolled. A double-label immunofluorescence was performed to evaluate the expression of MUC-1, CD15 and Tryptase and their eventual co-localization on histological samples. Double-positive MUC-1+CD15+ and MUC-1+Tryptase+ inflammatory cells were counted by confocal microscopy. Results: MUC1 was expressed in all samples, with a significantly increasing expression in relation to CCG (p < 0.001). A significant co-localization between MUC1 and CD15+ eosinophils was observed, with a progressive increase in the number of double-positive cells from low to high CCG (p < 0.001). On the contrary, the co-localization between MUC1 and Tryptase+ mast cells was not significant, although both markers showed a higher expression in cases with high CCG (p < 0.001). Conclusions: A strong correlation between CRSwNP severity and MUC-1 expression, mainly colocalized with infiltrating eosinophils, was shown. This offers a promising perspective for the use of MUC-1 as a biomarker of CRSwNP. Full article

Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) are common comorbid sinonasal conditions. CRS is classically divided into two distinct phenotypes: CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP). The purpose of this retrospective observational study is to determine whether aeroallergen sensitization profiles in patients with comorbid CRS and AR can distinguish between CRSwNP and CRSsNP. A total of 241 patients diagnosed with comorbid CRS and AR who underwent skin prick testing or in vitro allergy testing in a single tertiary rhinology practice were included for evaluation. The rates of allergen-specific sensitizations in CRSwNP patients were compared with those in CRSsNP patients. Of the allergens tested in the routine panels, Dermatophagoides pteronyssinus (OR = 1.82, p = 0.03), Alternaria (OR = 2.55, p < 0.01), and animal dander (OR = 1.48 for cat and OR = 3.01 for dog, p < 0.01) were predictive of CRSwNP. Sensitization to any grass allergen was also predictive of CRSwNP (OR = 2.09, p < 0.01). Multiple perennial aeroallergens showed strong associations with CRSwNP; however, broad sensitization to perennial allergens as a whole group was not significantly predictive of CRSwNP (OR = 1.83, p = 0.22). Full article