BackgroundPublicly funded health services face persistent challenges in meeting demand for specialty care, particularly in rhinology. Task shifting-the redistribution of clinical tasks from specialists to trained non-specialists-may offer a strategy to optimize health-care delivery. This study evaluates the outcomes of a nurse-led assessment pathway within an outpatient rhinology service in New Zealand.MethodsTo address increased demand for rhinology services, a registered nurse (RN) at Waikato Hospital was trained to perform initial assessments for patients referred for undifferentiated chronic nasal symptoms. We describe outcomes of this approach over the initial 18-month period.ResultsA total of 309 patients were assessed through the nurse-led pathway. The average wait time from referral to assessment decreased when compared to the specialist-led clinic. Most patients were discharged with a treatment plan that did not require specialist care. Patient feedback indicated high satisfaction with the nurse-led consultation.ConclusionTask shifting offers a promising solution to address resource constraints in publicly funded health-care systems. Nurse-led assessments can enhance efficiency and optimize care delivery without compromising quality. These findings suggest that task-shifting may be broadly applied to improve outcomes in other resource-constrained health-care settings.
Prof. MUDr. Otto Piffl (1866-1926) was one of the most important representatives of the German otorhinolaryngological school in Prague at the turn of the 19th and 20th centuries. He was a pupil and close collaborator of Prof. Emanuel Zaufal, the founder of the first ear clinic in Prague, and became a leading authority on the diagnosis and treatment of otogenic and rhinogenic infections and their complications. He was appointed the first full professor of otology and rhinology at the German University in Prague. Besides his written work, two tangible reminders of his life remain: his villa and his mausoleum in Lanškroun.
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Suboptimal practices in the evaluation and workup of nasal masses may lead to patient outcomes that could be improved. Recognizing common pitfalls and mishandled clinical scenarios underscores the need for clear, consensus-driven recommendations. To provide expert consensus recommendations regarding the appropriate workup and evaluation of nasal masses to avoid common pitfalls, optimize management practices, and ultimately improve patient outcomes. A systematic review from 1990 to 2025 was conducted in PubMed to identify gaps and discrepancies in practice guidelines and to assist in the development of consensus statements. Expert physicians from both academic and private practice environments from the US, UK, and Canada were identified and included specialties of comprehensive otolaryngology, head and neck surgery, rhinology, neurosurgery, and medical oncology. A modified Delphi approach was used to conduct an expert consensus survey. The statement generation and surveys were conducted from February 2025 to June 2025. The formulation and expert evaluation of 23 consensus statements. A total of 25 multidisciplinary experts, including 17 male and 8 female physicians spanning comprehensive otolaryngology (n = 3), head and neck surgery (n = 7), rhinology (n = 12), neurosurgery (n = 1), and medical oncology (n = 2), participated in the survey. Of the 23 statements, 20 reached consensus during the initial iteration among the initial evaluation, biopsy, imaging, pathologic evaluation, and additional workup subgroups. Two of these statements underwent revision and were ultimately accepted, while the last statement did not achieve expert consensus. This multidisciplinary expert consensus statement can guide physicians and medical practitioners in adopting the proper evaluation and workup of nasal masses, helping them to avoid common pitfalls, optimize management practices, and ultimately improve patient outcomes.
Rhinomanometry, a reference measure for the nasal airway, is often considered a research tool with only weak-to-moderate correlations with patient symptoms. However, like lung spirometry curves offer information beyond forced expiratory volume (FEV), rhinomanometry curves (rhinograms) have characteristics beyond simple nasal resistance at 150 Pascals. This study explored the correlation between rhinogram curve features and patient-reported outcomes (PROMs), when compared with nasal airway resistance. A diagnostic cross-sectional study was conducted on patients from a rhinology clinic. PROMs collected included ordinal nasal obstruction and visual analogue scale (VAS) of the more obstructed side. Rhinomanometry curves underwent mathematical polynomial fitting to extract 835 features. The primary outcome was correlation using Spearman's rho (ρ) comparing curve-derived features with nasal airway resistance at 150 Pascals. Machine learning was applied to the top 8 correlated features to generate an AI predictive model. About 601 patients (mean age 45 ± 16 years, 45% female) were analysed. Curve-derived features (ρ = 0.305) correlated more than total NAR at 150 Pa (ρ = 0.222) with VAS. Similarly with ordinal nasal obstruction, curve-derived features correlated more (ρ = 0.230) than total NAR at 150 Pa (ρ = 0.112). The best performing AI prediction models achieved correlations of 0.133 (VAS) and 0.117 (nasal obstruction). This study offers a novel method for rhinogram analysis with curve-derived features for correlation and predictive modelling. Whilst correlation scores remain weak-moderate with PROMs, they outperform nasal airway resistance. Therefore, rhinograms produced from rhinomanometry may offer more clinical information than a simplistic numerical resistance testing.
The therapeutic goal in chronic airway diseases is shifting from symptom control to disease remission. Disease-modifying therapies, including biologics and allergen immunotherapy, have made remission achievable in patients with severe asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), or allergic rhinitis (AR). This EUFOREA consensus aims to establish practical guidance for inducing and maintaining remission in global airway diseases. An international panel of experts in pneumology, rhinology, and allergology convened in Rome (October 2025) to review current evidence and develop consensus statements. The panel achieved consensus on key principles: (i) remission is a therapeutic target independent of disease severity prior to treatment initiation and should not be reserved for severe cases; (ii) CRSwNP with nonallergic eosinophilic asthma, and AR with allergic asthma should be considered features of a single disease rather than comorbidities; (iii) remission should be assessed by each subspecialty separately while warranting combined approaches; (iv) pragmatic definitions prioritizing achievability and clinical utility are recommended; and (v) a 4-week recall window is preferred to assess symptom control within the evaluation of remission and a 12-month period is suggested as the minimal period to define remission. Remission represents an ambitious yet achievable goal, with practical guidance for optimizing patient outcomes.
Facial pain or pressure is often non-rhinogenic but is frequently misdiagnosed as sinusitis, leading to inappropriate treatment with antibiotics and surgery. The objective of this study was to develop and validate a brief self-administered questionnaire, the Sinus Headache Screener (SHS), to help differentiate chronic rhinosinusitis (CRS) from non-rhinogenic facial pain or pressure (NRFP). Patients presenting to the rhinology clinic with a chief complaint of facial pain or pressure completed an 89-item questionnaire bank developed previously through qualitative methods. A diagnosis of CRS or NRFP was given based on imaging criteria. Psychometric analysis and logistic regression were utilized to select items and create a scoring system that could reliably differentiate the two conditions. Predictive performance was evaluated through the area under the receiver operating characteristic curve (AUC) with bootstrapping. Of 251 patients enrolled, 114 had CRS and 137 had NRFP. Mean (SD) age was 50 (16), and 69.3% were women. Eight items with scoring weights were included in the SHS. Scores ranged from -4 to 9, with higher positive values predictive of NRFP. With a score cutoff of > 0, the SHS had a sensitivity/specificity of 0.87/0.64, and positive/negative predictive values of 0.74/0.80 for NRFP. The optimism-corrected AUC was 0.798 (95% CI: 0.766, 0.877). In patients presenting with sinus headache, the SHS accurately differentiated NRFP from CRS. The use of the SHS as a point-of-care clinical tool can improve diagnostic accuracy and facilitate cost-effective management.
Biologicals have revolutionized care for severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). Currently, real-world efficacy (RWE) data of dupilumab in patients who switch to dupilumab after having no or minimal therapeutic response to either omalizumab or mepolizumab are lacking. No comparison has been performed between patients switching from omalizumab or mepolizumab to dupilumab and those receiving dupilumab as their first biological. 55 CRSwNP patients receiving dupilumab in the RELIBIO trial were divided into those who were biological naive (n = 30) and those who showed no to poor therapeutic response to 6 months therapy with either omalizumab or mepolizumab (n = 25), with evaluation of the following parameters at baseline and 6 months: SNOT-22 scores, nasal congestion scores (NCS), VAS scores for nasal obstruction, smell loss and postnasal drip, ACQ-5, AQLQ and total nasal polyp scores (TNPS). We determined disease control and therapeutic response evaluation (TRE) at 6 months for both groups using the EUFOREA/EPOS criteria. Dupilumab showed significant improvements on all patient-reported outcome measures (PROMs) and TNPS in both groups. When comparing the efficacy between switchers and naive patients, dupilumab showed equal efficacy in both groups on SNOT-22, TNPS, NCS, VAS scores for smell loss, nasal blockage and postnasal drip, ACQ-5 and AQLQ. A good to excellent therapeutic response at 6 months was observed in 67% of switchers compared to 97% of the biological naive patients. Regarding disease control at 6 months, we observed 44% being controlled in the switchers and 67% in the biological naive group, with smell loss being the main reason for not being controlled. This prospective RWE study shows that dupilumab significantly reduced symptom severity and nasal polyp scores in CRSwNP patients at 6 months of therapy, also in those showing a minimal therapeutic response to mepolizumab or omalizumab. Patients in the biologic naive group showed a higher likelihood of achieving disease control.
Endoscopic sinus surgery (ESS) carries risks such as vision loss and intracranial injury due to the proximity of critical structures and unrecognised anatomical variants. We developed convolutional neural networks (CNNs) to detect free-floating anterior ethmoidal arteries (FFAEA), Onodi cells, and Haller cells on coronal sinus CT, and evaluated BioMedCLIP, a biomedical vision-language model (VLM), in a few-shot setting. CT scans from 122 ESS patients were anonymised, standardised coronal CT images were captured, and variant presence was annotated. Five ImageNet-pretrained CNN backbones were assessed using repeated patient-wise five-fold cross-validation across 40 configurations. The best CNNs achieved balanced accuracies of 77.8 ± 2.3% (FFAEA), 74.6 ± 2.5% (Onodi), and 63.7 ± 6.2% (Haller). BioMedCLIP achieved 65.5 ± 3.2%, 63.8 ± 1.8%, and 73.5 ± 3.6%, respectively, outperforming CNNs for Haller cell detection while providing competitive performance for the other variants. These models demonstrate proof-of-concept performance for automated identification of selected sinonasal variants on standardised coronal CT images under internal patient-wise cross-validation.
Hyperuricemia (HUA) and gout are endocrine disorders resulting from abnormal uric acid (UA) metabolism, with gout typically developing secondary to HUA and being associated with an exacerbated inflammatory response. Epigenetic modifications and post-translational modifications (PTMs) may contribute to the progression from HUA to gout by modulating the function of UA transporters such as ABCG2 and GLUT9 and involving the NLRP3/IL-β inflammatory axis. However, the specific mechanisms underlying these processes remain incompletely understood. Therefore, this review systematically examines recent research on epigenetic modifications, such as methylation, lactylation, and crotonylation, as well as PTMs including succinylation, phosphorylation, glycosylation, ubiquitination, and acetylation in this process, with the aim of identifying potential therapeutic targets for these two diseases.
Nasal obstruction is a common complaint in otolaryngology. Choosing between septoplasty or septorhinoplasty may be challenging due to anatomical variability. Computational fluid dynamics (CFD) has emerged as a complementary, patient-specific tool enabling bilateral simulation and virtual planning, allowing simulation of post-surgical outcomes under physiological conditions. Virtual surgeries were performed on patients with nasal obstruction using Flowgy® software. For each patient, three anatomical models were simulated: baseline, virtual septoplasty, and virtual septorhinoplasty (with turbinoplasty when indicated). CFD analysis was used to assess pressure drop (ΔP), flow symmetry (Φ), and nasal resistance (R), among other airflow parameters. Comparative data were analysed to determine the functional impact of each intervention. In all five cases, septoplasty resulted in improvements in pressure drop ranging from 10.5% to 50.9%, as well as changes in resistance ranging from +2.98% to -64.3%. Septorhinoplasty provided additional functional gains in pressure (up to 44.8%) and resistance (up to 51%) in selected cases. Based on the analysis, surgical benefit thresholds were proposed: ≥30% improvement in ΔP or R from baseline to justify septoplasty, and ≥20-30% additional benefit over septoplasty to indicate septorhinoplasty. CFD analysis is a valuable adjunct in functional nasal surgery, enabling personalised decision-making. While not a substitute for clinical judgement, CFD-guided planning may enhance the selection of surgical strategy and reduce unnecessary interventions.
Our goal is to help patients with nasal pruritus, a prevalent condition in otolaryngology that can significantly affect their comfort and quality of life. Despite a lack of sufficient clinical investigation, traditional and regional medicines are commonly used to alleviate nasal itching. The primary objective of this investigation was to assess the efficacy of jojoba oil, a naturally occurring product, as a topical remedy for nasal pruritus. Forty-six men with chronic nasal pruritus participated in a clinical trial. Intranasal topical jojoba oil was administered to all patients in a controlled environment. A visual analog scale (VAS) was used to measure symptom severity both before and after a specific treatment time. Patient satisfaction and tolerability were also recorded as additional metrics. The results showed that after using jojoba oil, nasal pruritus scores were markedly lower. There was a significant improvement in mean VAS scores compared with baseline values. After therapy, the mean nasal pruritus VAS score decreased considerably from 8.0±0.81 to 2.5±0.5, with a P<0.001. From a clinical standpoint, every patient showed either a full or substantial improvement. Throughout the trial, there were no serious side effects, and most patients were quite satisfied. Everyone who received the treatment reported no side effects. Topical jojoba oil appears to be a safe, effective, and well-tolerated way to address an itchy nose. It has shown good clinical results and is derived from a natural source, so it could be an alternative or adjunct treatment. To confirm these results, larger-scale randomized controlled trials are necessary.
ImportanceThe injections of platelet-rich plasma (PRP) in the olfactory clefts of patients with olfactory dysfunction (OD) is an emerging treatment. To date, no study investigated the effectiveness of multiple PRP injections.ObjectiveTo evaluate the effectiveness and usefulness of multiple injections of PRP in the olfactory clefts of patients with OD.DesignProspective controlled study.SettingMonocentric medical center.ParticipantsPatients with long-lasting OD treated with PRP injections and controls who underwent olfactory training with multiple psychophysical olfactory assessments.InterventionTwo PRP injections into the olfactory clefts at 4- to 6-month intervals.Main OutcomesOutcomes included adverse events, dose-effect relationships, and olfactory function changes measured by threshold, discrimination, and identification (TDI) testing with minimal clinically important difference (MCID).ResultsEighty-three subjects completed the evaluations. Patients had anosmia (n = 39), hyposmia (n = 27), and parosmia (n = 17). The mean duration of OD was 49.1 ± 46.9 months. Seventy-seven patients received 2 injections. Transient epistaxis was the primary adverse event (46.2%). The mean injected PRP volume ranged from 1.4 to 1.7 mL. TDI significantly increased after both first and second injections across all OD subgroups. MCID was achieved in 49.4% after a first injection and 28.9% after a second. MCID was reached in 63 cases (75.9%) from baseline to final evaluation. Baseline TDI strongly predicted post-second injection TDI (rs = .919; P = .001), but the first PRP response didn't significantly predict second response (rs = -.201; P = .069). TDI did not significantly change in the control groups. MCID was achieved in 22.2% and 40% controls at the first and second TDI evaluations.Conclusion and RelevanceTwo injections of PRP demonstrate significant improvement in psychophysical olfactory evaluations. Future studies are needed to determine the optimal number of injections and identify predictors of therapeutic effectiveness.
BackgroundPostoperative care following endoscopic sinus surgery (ESS) aims to optimize mucosal healing, reduce inflammation, and minimize infectious complications. Although saline irrigation is considered standard of care, the potential benefit of adding topical antibiotics, such as mupirocin, during the early postoperative period remains uncertain.ObjectiveTo evaluate whether short-term postoperative mupirocin nasal irrigation improves clinical, endoscopic, and microbiological outcomes compared with saline irrigation alone following ESS.MethodsThis prospective, randomized, double-blinded, placebo-controlled trial included adults with chronic rhinosinusitis undergoing ESS. Patients were randomized to receive either mupirocin (0.05%) nasal irrigation or placebo saline irrigation twice daily for 21 days postoperatively. Outcomes assessed within the first 3 months included patient-reported symptoms using the sinonasal outcomes test (SNOT-22) and visual analog scale (VAS), endoscopic findings (mucosal edema, polyp formation, crusting, granulation tissue, and purulence), postoperative sinus culture results, and need for systemic antibiotics.ResultsSixty-eight patients were enrolled, and 56 completed follow-up. Both groups demonstrated significant postoperative improvement in SNOT-22 and VAS scores compared with preoperative baseline, without significant between-group differences. However, the mupirocin group showed significantly lower rates of endoscopic mucosal edema and polyp formation at 1 month postoperatively. Negative postoperative cultures were also more frequent in the mupirocin group, with reduced need for systemic oral antibiotics. No significant differences were observed in crusting, granulation tissue, purulence, steroid use, or pain medication requirements.ConclusionShort-term prophylactic postoperative mupirocin nasal irrigation after ESS does not confer additional improvement in patient-reported quality-of-life outcomes compared with saline alone but appears to reduce early inflammatory endoscopic changes, bacterial culture positivity, and need for systemic antibiotics. Larger studies with longer follow-up are needed to confirm these findings.
We characterized long-term trends, regional disparities, and socioeconomic inequalities of occupational noise-induced hearing loss (ONIHL) among Asian working populations. Using GBD 2023 data, we analyzed DALYs and age-standardized DALY rates (ASDR) from 1990-2023. Joinpoint regression, spatial autocorrelation, socioeconomic associations (SDI/HDI), inequality metrics, and projections (2024-2053) were employed. From 1990-2023, Asian ONIHL DALYs increased while ASDR remained stable. South/Southeast Asia, males, and older workers bore the highest burden. ASDR was inversely associated with SDI and HDI, with widening cross-country inequalities. Projections suggest rising absolute burdens and regional disparities through 2053. The ONIHL burden in Asia persists and is increasingly unequal, disproportionately affecting low-development regions. Targeted prevention and strengthened occupational health management are essential to mitigate future impacts.
Allergic rhinitis and asthma can impair work productivity. To validate a daily work productivity visual analog scale (VAS work), comparing it with the Work Productivity and Activity Impairment Questionnaire plus Classroom Impairment Questions: Allergy Specific (WPAI+CIQ:AS). We also aimed to quantify how allergy control relates to work impairment and indirect costs. We conducted a cross-sectional study using data from the MASK-air® app. Patients recorded daily VAS and weekly WPAI+CIQ:AS responses. We calculated correlations between VAS work and WPAI+CIQ:AS outcomes. Mixed-effects regression models assessed associations between disease control, measured by the Combined Symptom-Medication Score (CSMS) and the electronic daily asthma control score (e-DASTHMA), and VAS work. Indirect costs were estimated using the human capital approach, applying VAS-based productivity losses to country-specific wage distributions. VAS work correlated strongly with the WPAI+CIQ:AS, with Spearman coefficients ≥0.70 for total work impairment and presenteeism. Each 1-point increase in CSMS and e-DASTHMA was associated with mean 0.97 and 0.79-point increases in VAS work, respectively. In poorly controlled days, the estimated daily indirect cost based on CSMS ranged from 12.50 US$ PPP (P25-P75=5.60-26.70) in Brazil to 129.90 US$ PPP (P25-P75=80.40-199.40) in Iceland. Based on e-DASTHMA, daily estimates ranged from 9.30 US$ PPP (P25-P75=3.70-21.50) in Brazil to 101.90 US$ PPP (P25-P75=51.20-172.40) in Iceland. VAS work is a valid simple daily measure of work impairment due to rhinitis and asthma. CSMS and e-DASTHMA can be used to estimate productivity losses attributable to poor disease control.
To evaluate subjective and objective olfactory outcomes in patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). Prospective, single-center study including adult patients undergoing ESS for CRSwNP from July 2022 to May 2024. Olfactory status was assessed using the Sinonasal Outcome Test (SNOT-22) and Sniffin' Sticks odor identification test preoperatively and at 1-, 3-, and 6-months postoperatively. Thirty-six patients (45% female, mean age: 48 ± 14) were included. Among them, 47% had asthma, 53% had a history of previous sinus surgery, and 28% had aspirin-exacerbated respiratory disease. Mean SNOT-22 score decreased from 57 ± 20 to 22 ± 18, 15 ± 14, and 25 ± 19, at 1-, 3-, and 6-months postoperatively, respectively (p < 0.001). Mean Sniffin' Sticks identification test score improved from 5.2 ± 4.4 odors identified (out of 16) to 7.9 ± 3.9, 8.3 ± 4.7, and 7.7 ± 4.9 points at 1-, 3-, and 6-months postoperatively, respectively, with statistically significant improvements at 1- and 3-months (p < 0.001) and at 6-months (p = 0.012). This prospective study demonstrates improvements in subjective and objective measures of olfaction after ESS in patients with CRSwNP. While the sense of smell may be the most difficult symptom to address with surgical intervention, our study provides direct evidence that appropriate surgical intervention can in fact provide meaningful improvements to a large proportion of patients with nasal polyps. Longer-term studies will be required to determine if these improvements will remain sustained. 3.