Search Results (79)

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease with a complex pathogenesis that significantly affects patients’ quality of life. Type 2 inflammation plays a dominant role in its course and is associated with the activation of immune pathways involving interleukins IL-4, IL-5 and IL-13, eosinophils, and immunoglobulin E. Standard treatment methods, including corticosteroids and surgical interventions, despite their proven efficacy, often fail to provide sustained disease control and are associated with a high rate of recurrence. The aim of this review is not only to summarize the available evidence on biological therapies in CRSwNP, but also to critically evaluate their current position within treatment algorithms, with particular emphasis on patient selection, integration with endoscopic sinus surgery, comparison of available biologic mechanisms, and remaining challenges in personalized treatment strategies. The paper discusses available monoclonal antibodies, such as dupilumab, omalizumab, mepolizumab, and benralizumab, which act by selectively inhibiting key mediators of type 2 inflammation. Analysis of clinical trial results indicates that biological therapies lead to a significant reduction in nasal polyp size, improvement in nasal patency, restoration of olfactory function, and enhancement of quality of life as measured by the SNOT-22 scale. Furthermore, they demonstrate a favourable safety profile and may represent an effective therapeutic option for patients with severe, treatment-resistant disease, particularly in cases with coexisting eosinophilic asthma. Biological therapies represent a breakthrough in the treatment of CRSwNP and align with the concept of personalised medicine. Their role in clinical practice continues to expand; however, further research is required to optimise patient selection and assess long-term treatment outcomes. Full article

Background and Objectives: Rhinosinusitis contributes to the development of sleep-disordered breathing (SDB) by causing nasal obstruction and airway inflammation; however, the extent to which treatment improves these conditions remains unclear. To address this, this study systematically evaluated the impact of rhinosinusitis-directed therapy on nasal symptoms, endoscopic findings, and sleep-related respiratory parameters. Materials and Methods: Methodologically, this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was conducted across the PubMed, Medline, Web of Science, Science Direct, and Google scholar databases. Specifically, studies reporting pre- and post-treatment outcomes in patients with rhinosinusitis were included. Due to substantial clinical and methodological heterogeneity among the included studies, a quantitative meta-analysis was not performed; instead, findings were synthesized narratively. Results: Ultimately, fifteen studies met the inclusion criteria and demonstrated consistent improvements in sleep-related outcomes following the treatment of rhinosinusitis. Across the surgical and medical interventions, reductions in apnea-hypopnea index (AHI) and improvement in endoscopic findings were frequently reported. For instance, functional endoscopic sinus surgery (FESS) produced notable enhancements in sleep quality, daytime sleepiness, and sinonasal symptom scores in several studies, while biologic therapy and medical management also showed benefit in reducing nasal obstruction, rhinorrhea, and inflammatory markers. Conclusions: The available evidence suggests that rhinosinusitis treatment may be associated with improvements in measures of sleep-disordered breathing (SDB) and mucosal inflammation, although subjective nasal symptom outcomes were more variable across studies. Consequently, targeted sinonasal therapy may play an important role in reducing SDB burden, particularly in patients with inflammatory airway compromise. Full article

Background/Objectives: Sellar solitary fibrous tumors (SFTs) are exceptionally rare mesenchymal neoplasms that frequently mimic non-functioning pituitary adenomas (PAs) because of overlapping clinical manifestations and nonspecific radiological findings. Consequently, preoperative diagnosis remains challenging and definitive diagnosis relies on histopathological and immunohistochemical evaluation. Methods: We report a sellar SFT initially diagnosed as a PA and analyze the diagnostic features of previously reported cases to identify recurring diagnostic pitfalls. Clinical, endocrinological, radiological, intraoperative, histopathological, and immunohistochemical findings from a patient with a sellar SFT were retrospectively reviewed. A structured literature review of previously reported sellar SFTs was performed to compare presenting symptoms, endocrine abnormalities, imaging characteristics, pathological findings, and diagnostic features. Results: A 65-year-old man presented with headache, progressive visual impairment, fatigue, and anterior hypopituitarism. Magnetic resonance imaging demonstrated a heterogeneously enhancing sellar lesion with suprasellar extension and cavernous sinus involvement, leading to an initial diagnosis of non-functioning PA. Endoscopic transsphenoidal surgery revealed an unexpectedly hypervascular and firm tumor. Histopathological examination demonstrated a spindle-cell neoplasm with a hemangiopericytoma-like vascular pattern, six mitoses per 10 high-power fields, absence of necrosis, and diffuse nuclear STAT6 positivity, establishing the diagnosis of CNS WHO grade 2 solitary fibrous tumor according to the 2021 WHO classification. Review of the literature demonstrated that most sellar SFTs share similar clinical and radiological features with PAs and are diagnosed only after surgical resection. Conclusions: Sellar SFT should be considered in the differential diagnosis of atypical sellar masses despite the absence of characteristic imaging findings. Recognition of intraoperative features, together with appropriate immunohistochemical evaluation, particularly STAT6 staining, is essential for accurate diagnosis. Current evidence remains insufficient to define the optimal postoperative management of completely resected sellar SFTs, emphasizing the importance of individualized treatment decisions and long-term surveillance. Full article

Background: Despite growing evidence supporting the efficacy of dupilumab in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), studies directly comparing biologic therapy with revision endoscopic sinus surgery remain limited. This study aimed to compare the effectiveness of dupilumab and revision endoscopic sinus surgery (ESS) in patients with recurrent CRSwNP. Methods: A retrospective cohort study was conducted in 50 patients with CRSwNP who had previously undergone at least two endoscopic sinus surgeries. Twenty-three patients received dupilumab, while twenty-seven underwent revision surgery. Changes in Nasal Polyp Score (NPS), quality of life assessed using the Sino-Nasal Outcome Test-22 (SNOT-22), and olfactory function evaluated with the Sniffin’ Sticks test were analyzed. Final clinical outcomes and the proportion of patients achieving very good disease control were also assessed. Results: Both treatment modalities improved disease control. However, dupilumab was associated with significantly greater reductions in NPS (median [IQR]: −6.00 [−6.00 to −5.00] vs. −4.00 [−6.00 to −3.00]; p = 0.012), larger improvements in SNOT-22 scores (−59.39 ± 12.14 vs. −21.37 ± 20.15; p < 0.001), and better recovery of olfactory function (+4.65 ± 2.79 vs. +2.19 ± 2.08; p = 0.001) compared with revision surgery. Analysis of final outcomes also favored dupilumab, with lower NPS scores (median [IQR]: 0.00 [0.00–1.00] vs. 1.00 [0.00–2.50]; p = 0.023), and better olfactory function (7.65 ± 3.11 vs. 4.78 ± 2.34; p < 0.001). Very good symptom control (SNOT-22 < 20) was achieved by 82.6% of patients treated with dupilumab compared with 7.4% of those undergoing revision surgery. Conclusions: Both revision surgery and dupilumab improved disease control in patients with CRSwNP. In this cohort, dupilumab was associated with greater reductions in disease severity, superior quality-of-life outcomes, and better olfactory function than revision endoscopic sinus surgery. Full article

Chronic rhinosinusitis (CRS) constitutes a multicausal inflammatory disease of the nose and paranasal sinuses, often associated with olfactory dysfunction (OD), a symptom that significantly impacts patients’ quality of life. OD in CRS was traditionally thought to be related to mechanical obstruction of the olfactory cleft, but is now considered to be multifactorial, involving conductive, inflammatory, and sensorineural mechanisms as well. Type-2 inflammatory response (high interleukins IL-4, IL-5, IL-13), eosinophilia, and increased IgE are involved in epithelial damage, impaired neurogenesis, and persistent olfactory loss, especially in chronic rhinosinusitis with nasal polyps (CRSwNP). In addition, peripheral chronic inflammation may also play a role in central neural remodeling, which may potentially affect olfactory function. Objective psychophysical testing is necessary to accurately assess olfactory function because self-reports may lack reliability. Management strategies aim at reducing inflammation and restoring sinonasal ventilation. First-line therapy with intranasal corticosteroids and short courses of systemic corticosteroids may be useful for symptomatic relief. Biologic agents directed against type-2 inflammation have demonstrated significant benefits in selected cases. Functional Endoscopic Sinus Surgery (FESS) plays an important role in the treatment of refractory CRS to restore the airflow and to improve the delivery of topical drugs. Olfactory outcomes following surgery, however, are variable and often incomplete, reflecting underlying inflammation and neuroepithelial damage. Disease recurrence, especially in type-2–driven CRS, affects long-term outcomes, underscoring the necessity to incorporate surgery in an individualized, endotype-informed treatment strategy. Full article

Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disease of the paranasal sinuses. Imaging, particularly high-resolution computed tomography (HRCT), cone-beam computed tomography (CBCT) in selected scenarios, and magnetic resonance imaging (MRI), supports diagnosis, treatment planning, and follow-up by combining anatomic mapping, disease extent, remodeling, and complication assessment. This systematic review synthesizes evidence on endotype-aware imaging in CRS and proposes a structured reporting model grounded in quantitative, management-oriented criteria. Methods: Following PRISMA 2020, the review protocol was registered in PROSPERO 2026 (CRD420261356154); we searched MEDLINE, Scopus, Embase, and Cochrane (January 2000–September 2025). Ninety-six studies were included in qualitative synthesis; 38 studies reported quantitative outcomes summarized descriptively. We evaluated HRCT/CBCT/MRI protocols, radiologic indices (Lund–Mackay, GOSS), diagnostic performance in relevant clinical domains, imaging–endotype correlations, and radiomics/artificial intelligence (AI) applications. Key Results: HRCT served as the reference modality for anatomic assessment and preoperative planning in most cohorts; CBCT was selectively used for bony evaluation with lower radiation exposure than conventional CT, albeit without reliable soft-tissue characterization. MRI was mainly applied for soft-tissue characterization, unilateral disease, and suspected complications. Radiomics/AI studies reported areas under the receiver operating characteristic curve (AUC) ranging from 0.79 to 0.93 for distinguishing type 2-high from non-type 2-high CRS, with external validation reported in a minority of studies. Conclusions: Endotype-aware imaging can support more precise, quantitative CRS management when interpreted together with clinical, endoscopic, and biomarker data. Structured reporting and radiomics may contribute to standardization, but require prospective validation and transparent reporting to enable clinical translation within multidisciplinary care pathways aligned with international guidance. Full article

Background and Objectives: Controlled hypotension during functional endoscopic sinus surgery (FESS) improves surgical field visibility but may pose a risk of subclinical cerebral hypoperfusion. Serum S100Β and neuron-specific enolase (NSE) are established biomarkers of glial and neuronal injury and may reflect perioperative neuroprotection associated with different anesthetic regimens. This study evaluated the effect of four anesthetic protocols on perioperative brain biomarker release during FESS. Materials and Methods: In this single-center, randomized, controlled trial, 88 adult patients (ASA I–III) undergoing FESS under moderately controlled hypotension (mean arterial pressure < 55 mmHg) were allocated to one of four groups: propofol–remifentanil, propofol–remifentanil with ketamine–magnesium, sevoflurane–remifentanil, or sevoflurane–remifentanil with ketamine–magnesium. Serum S100Β and NSE concentrations were measured at three timepoints: early intraoperatively, during hypotension, and at the end of surgery. Biomarker data were analyzed using nested ANOVA and linear mixed-effects models adjusted for relevant covariates. Secondary outcomes included recovery characteristics, surgical field quality, bleeding scores, and perioperative hemodynamics. Results: Baseline demographic and perioperative characteristics were comparable across groups. The group receiving sevoflurane–remifentanil combined with ketamine–magnesium showed the lowest S100B levels (p = 0.01 compared to the propofol–remifentanil group; p = 0.04 compared to the sevoflurane–remifentanil group). Additionally, NSE concentrations were markedly lower in both sevoflurane groups (sevoflurane–remifentanil and sevoflurane–remifentanil plus ketamine–magnesium) compared to the propofol–remifentanil group (p = 0.003 and p = 0.007, respectively). No intergroup differences were observed at baseline and surgical field quality, bleeding, and hemodynamic parameters did not differ significantly among groups. Recovery and extubation times were shortest with propofol–remifentanil, whereas ketamine–magnesium prolonged emergence. Conclusions: Anesthetic technique significantly influences perioperative brain biomarker release during FESS. Sevoflurane-based regimens, with or without ketamine–magnesium, demonstrate more favorable neurobiological profiles under controlled hypotension, although propofol-based anesthesia offers faster recovery. Full article

Background and Objectives: Complicated cholesteatomatous otomastoiditis includes a spectrum of inflammatory, suppurative, and destructive lesions affecting the temporal bone and surrounding critical structures, including the dura mater, labyrinth, facial nerve, sigmoid sinus, and skull base. The selection of appropriate surgical techniques and closure materials is decisive for long-term outcomes, functional preservation, and prevention of life-threatening complications. This systematic review and meta-analysis evaluates the evidence base for surgical approaches, intraoperative technologies, and autologous and synthetic closure materials used in the management of iatrogenic and disease-related fistulas in otomastoid surgery. Materials and Methods: A PRISMA 2020-compliant search was conducted across PubMed, Cochrane Library, Embase, and Scopus (2000–2024). The review was registered in PROSPERO (CRD420261370406). After the systematic screening process, 56 eligible studies involving 4218 patients were selected for inclusion. The primary outcome measures analysed were infection rates, fistula recurrence, preservation of function, and long-term integrity of the closure. Limitations include the predominance of observational studies and the absence of prospective registration prior to data extraction. Results: Autologous materials demonstrated consistently low infection rates (<10%) in contaminated operative fields and therefore remain the preferred first-line option for the reconstruction of small to moderate defects. In contrast, synthetic materials exhibited superior mechanical durability in large sterile defects, achieving closure integrity rates of 85–92% at two-year follow-up. Hybrid reconstructive constructs provided the most favourable overall outcomes, with pooled closure integrity reaching 91.6%, suggesting a synergistic advantage when combining biologic and synthetic components. Furthermore, the adjunctive use of combined microscopic–endoscopic surgical techniques was associated with a significant reduction in residual cholesteatoma rates (OR 0.56, 95% CI 0.38–0.82), supporting the growing role of endoscopic assistance in middle ear and mastoid surgery. When biologic closure strategies were appropriately selected according to defect characteristics and contamination status, functional preservation rates exceeded 90–95%, underscoring the importance of tailored reconstructive approaches. Conclusions: The durability of long-term outcomes is most strongly influenced by complete pathological clearance and by the strategic alignment of biomaterial properties with defect dimensions, contamination status, and surrounding anatomical structures. In response to these findings, an evidence-based algorithmic framework is proposed to facilitate rational intraoperative material selection. Full article

Background: Eustachian Tube Dysfunction (ETD) presents significant diagnostic challenges, particularly in patients with chronic nasal disease, which often mimic or complicate ETD symptoms. Tubomanometry (TMM) is emerging as an objective tool for diagnosing ETD, but its application in patients with concurrent nasal pathologies remains underexplored. Methods: One hundred patients with concurrent ETD and chronic nasal disease were recruited. They were categorized into three groups: chronic rhinitis (35 patients, group A), nasal septal deviation (31 patients, group B) and chronic rhinosinusitis with polyps (34 patients, group C). Treatments included nasal irrigation, septoplasty, and nasal polypectomy with functional endoscopic sinus surgery, respectively. The TMM parameters (R, C2 and C2–C1 scores) were assessed before and after interventions. The patient reported outcome measures (ETDQ-7 and NOSE scores) were also recorded and statistically correlated with TMM measures. Results: Group A showed improvements in R, C2 and C2–C1 scores and mild post-treatment reductions in ETDQ-7 and NOSE scores. Similar improvements were observed in Group B, with significant symptom reduction post-septoplasty, particularly on the side of the nasal septal deviation. Group C demonstrated the greatest improvement, with significant improvements in TMM values and substantial reductions in both ETDQ-7 and NOSE scores. The statistical results revealed correlations between the treatment of nasal pathologies and ETDQ-7 and NOSE scores. Conclusions: All TMM parameters improved in each group following the nasal intervention. This study highlights the utility of TMM in evaluating ETD in the context of chronic nasal disease and suggests that treating underlying nasal conditions can significantly alleviate ETD symptoms. Full article

Frontal sinus fractures typically reflect high-energy trauma and must be evaluated and treated carefully to avoid long-term problems including contour deformity, sinus dysfunction, cerebrospinal fluid (CSF) leakage, chronic sinusitis, and mucocele formation. This article outlines frontal sinus anatomy, diagnostic pathways, and evolving treatment concepts in detail. An anatomically driven treatment algorithm is emphasized, with a focus on preservation of sinus function whenever possible and preference for conservative management. Advanced procedures, such as endoscopic sinus surgery and cranialization, are reviewed in the context of managing more severe injuries. Key points: (1) Clinical decision-making in the management of frontal sinus fractures is best guided by evaluating the status of the anterior table, posterior table, and nasofrontal outflow tract, with treatment options ranging from nonoperative care to open or endoscopic surgery. (2) Improvements in endoscopic techniques, combined with evidence supporting less aggressive strategies, have shifted management toward more conservative approaches, reserving open procedures for higher-grade injuries. (3) Extended follow-up is essential to identify delayed problems such as mucoceles, chronic sinusitis, frontal bone osteomyelitis, and contour irregularities. Full article

Endoscopic sinus surgery (ESS) is commonly performed to treat chronic rhinosinusitis and selected sinonasal tumors, yet postoperative complications such as neo-osteogenesis and restenosis remain frequent, largely due to impaired mucosal regeneration after extensive epithelial and bony tissue loss. Successful nasal epithelial repair requires a microenvironment that preserves cell viability, phenotype, and barrier integrity. Conventional culture substrates often lack physiological relevance or rely on animal-derived components, limiting translational applicability. In this study, we evaluated nanofibrillar cellulose (NFC) hydrogel (GrowDex^®) as a xeno-free scaffold for primary human nasal epithelial cells (NECs). NECs isolated from healthy donor tissue were characterized by immunofluorescence and qPCR for basal, goblet, and ciliated cell markers. Cells embedded in NFC were assessed for viability, cytotoxicity, epithelial morphology, and barrier function. Transepithelial electrical resistance (TEER) and FITC-dextran permeability assays were used to quantify barrier integrity and compared with collagen- and polylysine-based controls. NECs cultured in NFC maintained high viability, stable epithelial morphology, and preserved subtype-specific marker expression without detectable cytotoxicity. NFC-supported cultures demonstrated enhanced barrier formation, indicated by higher TEER values and reduced paracellular permeability relative to controls, and sustained structural integrity during extended culture. These findings identify NFC hydrogel as a biocompatible, non-animal scaffold that supports functional human nasal epithelium regeneration and may contribute to advanced tissue engineering strategies for craniofacial bone repair. Full article

Functional endoscopic sinus surgery (FESS) is the gold-standard surgical treatment for chronic rhinosinusitis (CRS) not responding to appropriate medical therapy. Identifying the natural maxillary ostium (NMO) during FESS is often challenging due to the lack of definitive landmarks. To aid in the identification of the NMO, we describe and assess the feasibility of using a new surgical landmark, the infra-bullar groove (IBG), and evaluate its visibility and reproducibility during FESS. Methods: Video recordings of 41 maxillary antrostomy procedures in patients with varying severity of CRS were reviewed. Surgeons of different experience levels assessed IBG visibility and its termination at the NMO. Results: In video recordings where the ethmoid bulla was preserved during uncinectomy, the IBG and its connection to the NMO were successfully identified by all reviewers in 100% of analyzable cases. The mean time to IBG identification did not significantly differ among surgeons. The IBG was consistently more pronounced in cases with well-pneumatized bullae. Conclusions: Under controlled surgical conditions where the ethmoid bulla is preserved during uncinectomy, the IBG demonstrates high visibility and reproducibility for locating the NMO. However, further prospective studies are needed to establish its real-world utility and impact on surgical outcomes. Full article

Background/Objectives: Myocardial injury after non-cardiac surgery (MINS) is a common and serious postoperative complication. Its largely asymptomatic course hampers early recognition, highlighting the importance of systematic biomarker monitoring. The aim of this review is to summarize current evidence on the diagnosis, risk factors, and management of MINS, with a focus on otolaryngology, where intraoperative hypotensive techniques may increase risk. Methods: A basic science review was conducted using PubMed, Embase, and the Cochrane Library (2005–2025). From 2712 records, 30 studies met the inclusion criteria after removing duplicates, screening titles/abstracts, and full-text assessment. These studies formed the basis for the final analysis. Results: Observational studies and reviews identify perioperative troponin monitoring as the diagnostic gold standard. However, no evidence-based management guidelines exist, and otorhinolaryngology-specific data remain rare but not entirely absent. Troponin elevation in the early postoperative period reliably predicts adverse outcomes. While MINS is well documented in vascular and orthopedic surgery, evidence in otolaryngology is limited. Controlled hypotension in procedures such as functional endoscopic sinus surgery or head and neck tumor resection may further elevate risk. Conclusions: MINS is an underrecognized complication with major prognostic significance. The lack of standardized management and the absence of large otolaryngology cohorts underscore an urgent need for targeted research and specialty-specific guidelines and support the justification for integrating existing evidence into otolaryngologic practice. Full article

Previous cases of trigeminal neuralgia (TN) caused by fungal sinusitis have been reported, but mainly in immunocompromised patients. We present a case of fungal sinusitis masquerading as trigeminal neuralgia in an immunocompetent patient and discuss the potential implications of these two diseases. The patient is a 59-year-old male who presented with a four-year duration of left facial pain. He had been diagnosed and treated for trigeminal neuralgia by a pain specialist but was subsequently referred to ENT after a MRI of the brain showed left maxillary sinusitis. Nasoendoscopy findings and a CT scan of the paranasal sinuses were concordant with left maxillary sinusitis. The patient underwent left functional endoscopic sinus surgery and recovered uneventfully. Our study shows that even in immunocompetent patients who present with non-resolving or worsening facial pain resembling the original diagnosis of TN, clinicians should remain vigilant for the possibility of alternative underlying pathologies including fungal sinusitis. Full article

Iatrogenic maxillary sinusitis accounts for a significant proportion of unilateral sinus infections. This report describes a 36-year-old HIV-positive patient with Serratia marcescens chronic left maxillary sinusitis and ethmoiditis caused by migration of a dental implant into the maxillary sinus. The implant was successfully removed endoscopically via functional endoscopic sinus surgery. Histopathological examination revealed polypoid mucosa with chronic inflammation, while microbiological culture grew Serratia marcescens, an uncommon and opportunistic pathogen. Targeted antibiotic therapy with trimethoprim/sulfamethoxazole was administered for 20 days. Six-month follow-up revealed complete remission without recurrence of sinusitis. Full article