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1. Disease control after surgery for chronic rhinosinusitis: prospective, multi‐institutional validation of the Sinus Control Test

   https://doi.org/10.1002/alr.22659  

   Little, Ryan E. ; Schlosser, Rodney J. ; Smith, Timothy L. ; Storck, Kristina A. ; Alt, Jeremiah A. ; Beswick, Daniel M. ; Mace, Jess C. ; Mattos, Jose L. ; Ramakrishnan, Vijay R. ; Soler, Zachary M. ( July 2020 , International Forum of Allergy & Rhinology)

   The Sinus Control Test (SCT) is a 4‐question, patient‐reported questionnaire that assesses disease control in chronic rhinosinusitis (CRS). This prospective, multicenter study examines SCT outcomes following endoscopic sinus surgery (ESS), further validating its use as a control instrument for CRS.

   Adults with CRS undergoing ESS were prospectively enrolled from 5 centers across North America. The SCT was administered at baseline and once 6 months after surgery. Quality of life and disease burden were evaluated using the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) and Lund‐Kennedy endoscopy scores. Linear regression was used to determine whether specific demographic, comorbidity, or disease severity measures were independently associated with changes in SCT scores postoperatively.

   A total of 218 patients, 111 females (50.9%) and 107 males (49.1%), were enrolled, with mean ± standard deviation age of 50.1 ± 15.6 years. Mean SCT score improved from 8.9 ± 3.5 to 4.3 ± 3.7 postoperatively (p< 0.001). Preoperatively, 21.6% were uncontrolled, 71.5% partially controlled, and 6.9% controlled. Postoperatively, 6.0% were uncontrolled, 42.6% partially controlled, and 51.4% controlled (p< 0.001). Change in SCT score correlated independently with change in SNOT‐22 (r= 0.500,p< 0.001) and endoscopy scores (r= 0.310,p< 0.001). Endoscopy scores did not correlate with control status among patients with CRS without nasal polyposis (CRSsNP) nor between uncontrolled and partially controlled patients. Demographics and comorbidities were not associated with changes in SCT.

   Improvement in disease control following ESS as measured by the SCT correlated with improvements in SNOT‐22 and endoscopy scores. The SCT is an easily administered instrument that provides information complementary to existing patient‐reported and objective measures of disease severity.

    

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2. Risk factors for neo‐osteogenesis in cystic fibrosis and non‒cystic fibrosis chronic rhinosinusitis

   https://doi.org/10.1002/alr.22507  

   Karempelis, Peter ; Karp, Emily ; Rubin, Nathan ; Hunter, Ryan ; Dunitz, Jordan ; Boyer, Holly ( December 2019 , International Forum of Allergy & Rhinology)

   The purpose of this retrospective review was to determine how patient‐related factors and culture data affect neo‐osteogenesis in patients with chronic rhinosinusitis (CRS) and patients with cystic fibrosis (CF) with CRS.

   Information from a database associated with a large tertiary medical center was used to assess adult patients with CF CRS and non‐CF CRS (total, n = 102; CF CRS, n = 31; non‐CF CRS, n = 71). Radiologic evidence of neo‐osteogenesis was measured using the Global Osteitis Scoring Scale (GOSS), and mucosal disease was assessed using the Lund‐Mackay score (LMS) by 2 independent reviewers who were blinded to the patient's disease state. Bacterial cultures were obtained endoscopically. Multiple logistic regression models were used to evaluate the effect of age, sex, number of previous surgeries, CF, and culture species on the odds of neo‐osteogenesis.

   Fifty‐one of the 102 patients (50%) met radiologic criteria for neo‐osteogenesis. Sixty‐nine patients (67.6%) with CF CRS and non‐CF CRS had culture data. In the multiple logistic regression model, male gender was significantly associated with neo‐osteogenesis (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.68‐17.86;p= 0.006).Pseudomonas aeruginosawas not associated with neo‐osteogenesis (OR, 3.12; 95% CI, 0.84‐12.80;p= 0.097). Age, number of surgeries, CF,Staphylococcus aureus, and coagulase‐negativeStaphylococcuswere not statistically significant.

   To our knowledge, this is the first study to assess risk factors associated with neo‐osteogenesis and patients with CF CRS. Interestingly, male gender was the only significant predictor of neo‐osteogenesis.

    

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3. Role of inferior turbinate reduction in the quality of life of patients undergoing endoscopic sinus surgery for chronic rhinosinusitis

   https://doi.org/10.1002/alr.22356  

   Soudry, Ethan ; Mace, Jess ; Smith, Timothy L. ; Hwang, Peter H. ( June 2019 , International Forum of Allergy & Rhinology)

   The impact on quality of life (QoL) of bilateral inferior turbinate reduction (BITR) performed in the setting of endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) has been a point of controversy. The aim of this study was to determine whether addition of BITR to ESS is associated with improved QoL when compared with ESS alone.

   This study presented findings a multi‐institutional, retrospective analysis of a prospective open cohort of patients electing ESS for failed medical management of CRS. QoL parameters were compared between patients who underwent ESS alone vs those who underwent ESS with BITR.

   A total of 571 patients with CRS who elected to undergo ESS were identified. Sixty‐one of these patients also underwent concurrent BITR, whereas 510 patients underwent ESS without BITR. Mean length of follow‐up was 15.1 months. Comparison between baseline and last postoperative QoL, olfaction, and endoscopic scores revealed significant improvement in both groups. Overall, BITR surgery was not significantly associated with clinically significant incremental improvement in QoL in either the polyp or non‐polyp group. Nevertheless, statistically significant improvement was noted for the nasal congestion/blockage symptom in polyp patients (p= 0.006) and in primary surgery patients (p= 0.027) who underwent BITR.

   BITR in the setting of ESS for CRS is not associated with significant incremental improvement in overall QoL vs ESS alone. However, BITR in polyp and primary surgery patients undergoing ESS appears to offer a significant incremental improvement in nasal congestion/blockage symptoms compared with ESS alone. Future studies are warranted to better corroborate these findings.

    

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4. Central compartment atopic disease: prevalence of allergy and asthma compared with other subtypes of chronic rhinosinusitis with nasal polyps

   https://doi.org/10.1002/alr.22454  

   Marcus, Sonya ; Schertzer, Joseph ; Roland, Lauren T. ; Wise, Sarah K. ; Levy, Joshua M. ; DelGaudio, John M. ( October 2019 , International Forum of Allergy & Rhinology)

   Central compartment atopic disease (CCAD) is a recently described variant of chronic rhinosinusitis with nasal polyp (CRSwNP) associated with inhalant allergy. An association with asthma was noted to be uncommon within our clinical practice. The purpose of this study was to determine allergy and asthma prevalence in CCAD and other CRSwNP subtypes.

   A retrospective analysis at a tertiary care institution was performed over the period from 2015 to 2019. CRSwNP was grouped into the following subtypes: allergic fungal rhinosinusitis (AFRS); aspirin‐exacerbated respiratory disease (AERD); CCAD; and CRSwNP not otherwise specified (CRSwNP NOS). Patients with sinonasal polyps and concomitant polypoid disease in the central compartment (CRSwNP/CC) were analyzed as a separate cohort for the purpose of this study. Prevalence of allergy and asthma was compared between groups.

   Three hundred fifty‐six patients were included. CRSwNP NOS was the most common subtype (37.1%) and CRSwNP/CC was the least common (3.7%), with other CRS subtypes ranging between 11.5% and 24.2%. Asthma prevalence was highest in AERD (100%) and CRSwNP NOS (37.1%), but substantially lower in AFRS (19.0%) and CCAD (17.1%). Asthma was significantly more common in AERD and CRSwNP NOS when compared with CCAD (p< 0.001 andp= 0.039, respectively). Prevalence of allergy was significantly higher in AFRS (100%), CCAD (97.6%), CRSwNP/CC (84.6%), and AERD (82.6%) when compared with CRSwNP NOS (56.1%) (p< 0.001).

   CCAD represents a clinically distinct phenotype of CRSwNP with a high prevalence of allergy and low prevalence of asthma. Patients with both CCAD and diffuse sinonasal polyps had an allergy prevalence approaching that of CCAD and an asthma prevalence approaching CRSwNP NOS.

    

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5. Factors driving olfactory loss in patients with chronic rhinosinusitis: a case control study

   https://doi.org/10.1002/alr.22445  

   Schlosser, Rodney J. ; Smith, Timothy L. ; Mace, Jess C. ; Alt, Jeremiah ; Beswick, Daniel M. ; Mattos, Jose L. ; Payne, Spencer ; Ramakrishnan, Vijay R. ; Soler, Zachary M. ( January 2020 , International Forum of Allergy & Rhinology)

   Olfactory dysfunction (OD) in chronic rhinosinusitis (CRS) is common. It is likely that numerous factors such as sex, race, age, allergies, asthma, smoking, and other comorbidities play a role in CRS‐related OD. In order to determine which aspects of OD are due solely to CRS and which are associated with other confounders, control populations are needed to allow appropriate risk assessments.

   Prospective, multi‐institutional enrollment of patients with CRS and control subjects without CRS was performed. Demographic information, comorbidities, and olfactory testing (Sniffin’ Sticks) of threshold (T), discrimination (D), and identification (I) scores (TDI) was collected.

   A total of 224 patients with CRS and 164 control subjects were enrolled. Olfaction was worse in CRS patients compared to controls (mean ± standard deviation (SD) TDI = 22.4 ± 9.5 vs 28.8 ± 7.0, respectively,p< 0.001). Only 27% of CRS patients were normosmic compared to 49% of controls (p< 0.001). When stratifying by nasal polyp (NP) status, CRSwNP patients had significant impairments in TDI, T, D, and I compared to controls with mean differences of 11.2, 3.3, 3.5, and 4.4 points, respectively (allp< 0.001). In contrast, CRSsNP patients only had impaired T when compared to controls with a mean difference of 2.2 points (p< 0.001). Multivariate modeling of TDI scoring showed that OD was driven by polyps, asthma, diabetes, and age. CRSsNP was not independently associated with worse TDI scores.

   OD in CRS patients is multifactorial. Independent drivers appear to be polyp status, asthma, diabetes, and age. OD in patients with CRSsNP is similar to controls with the exception of impaired thresholds.

    

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