Search Results (17)

Cholesterol granuloma is an uncommon inflammatory lesion whose etiology is still unclear. It is thought to originate from blood accumulation in a pneumatized space, probably after bleeding. The most frequent site is the petrous apex of the temporal bone, whilst it is very uncommon in the paranasal sinuses. We present a clinical case of an 80-year-old female patient with intense frontal headache and diplopia who underwent a neuro-navigated endoscopic sinus surgery. The histological diagnosis was a cholesterol granuloma of the frontal sinus, contaminated by Aspergillus Fumigatus hyphae. Cholesterol granuloma of the frontal sinus is a rare finding in clinical practice, but it should be taken into account in the diagnostic path in presence of rapidly increasing sight alterations and headache, even without rhinological symptoms. Full article

Background: Reconstruction of nasal, septal, and nasosinusal defects is challenging when the native mucosa is absent or damaged. Oral mucosal grafts have been proposed as a reconstructive option due to their favorable biological properties, but their use in rhinology remains poorly defined. Objective: To evaluate the clinical efficacy and technical characteristics of oral mucosal grafting for nasal, septal, nasosinusal, and skull base reconstruction. Data Sources: PubMed, Embase, Web of Science, and Cochrane Library were searched for studies published between January 2005 and May 2025. Study Eligibility Criteria: We included original human studies (case reports or series) reporting the use of free or pedicled oral mucosal grafts in nasal, septal, nasosinusal, or skull base reconstruction. Non-original studies, animal or preclinical studies, and articles not in English or Spanish were excluded. Methods of Review: One reviewer screened titles, abstracts, and full texts using Rayyan. Methodological quality was assessed using JBI tools for case reports and case series. A narrative synthesis was conducted due to clinical heterogeneity and absence of comparison groups. The resulting assessments were reviewed by the co-authors to confirm accuracy and resolve any potential discrepancies. Results: Of 467 records identified, 10 studies were included. All were case reports or series involving buccal, palatal, or labial mucosa. Most reported good graft integration, low complication rates, and favorable functional outcomes. No randomized studies or comparative analyses were found. Limitations: Included studies had small sample sizes, lacked control groups, and showed heterogeneous methods and follow-up. The certainty of evidence could not be formally assessed. Conclusions: Oral mucosal grafting is a promising reconstructive option in selected nasosinusal and skull base defects. However, stronger comparative studies are needed to determine its clinical superiority. Registration: This review was not registered in any public database. Full article

Cone-beam computed tomography (CBCT) offers low radiation, cross-sectional imaging that is a suitable alternative to conventional fan-beam computed tomography (FBCT). The initial experience using in-clinic CBCT in the Rhinology outpatient clinic at Waikato Hospital, New Zealand, is described. The first 5 months of CBCT use for Rhinologic imaging was compared to FBCT use in the equivalent 5-month period one year prior. Data relating to 61 CBCTs and 115 FBCTs was analysed. We compared the time and number of hospital visits required for a confirmed treatment decision (CTD) to be made and the duration of the clinic appointment at which the scan was requested between the two groups. The CBCT group required significantly less time (171 vs. 316 days, p < 0.001) and fewer hospital visits (1.5 vs. 3.2 visits, p < 0.001) before a CTD was made, but a longer appointment duration (86 vs. 53 min, p < 0.001). The use of in-clinic CBCT in Rhinology was therefore associated with reduced time and fewer hospital visits before definitive management was decided, but longer clinic appointments were observed. Increased access to CT imaging may result in increased demand. Expertise is required to optimise the quality of imaging, and we recommend that a dedicated Radiographer be allocated. Full article

Background: Sinonasal exophytic papillomas (SNEP) are benign tumours arising from nasal mucosa. Human papillomavirus (HPV) infection seems to be related to the aetiology of a fraction of SNEP cases. SNEP presentation can be focal (FSNEP) or diffuse (DSNEP), but factors related to focal or diffuse presentation have not yet been well ascertained. This study aimed to analyse clinical, histological, and HPV-related differences between FSNEP and DSNEP. Methods: A retrospective cohort of 18 patients with SNEP from our centre were evaluated. Demographic, clinical and follow-up data were collected. All samples were subject to histopathological evaluation, DNA quality control, HPV-DNA detection, and viral load assessment. Univariate analyses were performed to evaluate differences between FSNEP and DSNEP. Results: Twelve SNEP patients were included in the final analysis. Seven patients had a diffuse nasal presentation, being younger than patients affected with FSNEP (42.7 years vs. 65.2 years, p = 0.019). The nasal septum was significantly more affected in DSNEP than in FSNEP (85.7% vs. 20%, p = 0.029). HPV-DNA was detected more frequently (100%) in DSNEP (HPV11 in six cases, HPV6 in one case) than in FSNEP (40%, p = 0.045, HPV6 in two cases). The median viral load among HPV6-positive samples was 626.8 virus/cell for FSNEP and 80.2 for DSNEP, and among HPV11-positive samples was 1673.7 for DSNEP. Recurrences were more frequent in the diffuse than in the focal group (85.7% vs. 20%, p = 0.029). Conclusions: The diffuse presentation of SNEP seems to be related to younger patients, nasal septum involvement, HPV infection, mostly HPV11, and a higher risk of recurrence. Full article

Computational rhinology is a specialized branch of biomechanics leveraging engineering techniques for mathematical modelling and simulation to complement the medical field of rhinology. Computational rhinology has already contributed significantly to advancing our understanding of the nasal function, including airflow patterns, mucosal cooling, particle deposition, and drug delivery, and is foreseen as a crucial element in, e.g., the development of virtual surgery as a clinical, patient-specific decision support tool. The current paper delves into the field of computational rhinology from a nasal airflow perspective, highlighting the use of computational fluid dynamics to enhance diagnostics and treatment of breathing disorders. This paper consists of three distinct parts—an introduction to and review of the field of computational rhinology, a review of the published literature on in vitro and in silico studies of nasal airflow, and the presentation and analysis of previously unpublished high-fidelity CFD simulation data of in silico rhinomanometry. While the two first parts of this paper summarize the current status and challenges in the application of computational tools in rhinology, the last part addresses the gross disagreement commonly observed when comparing in silico and in vivo rhinomanometry results. It is concluded that this discrepancy cannot readily be explained by CFD model deficiencies caused by poor choice of turbulence model, insufficient spatial or temporal resolution, or neglecting transient effects. Hence, alternative explanations such as nasal cavity compliance or drag effects due to nasal hair should be investigated. Full article

Background: Intranasal administration of lysine aspirin (LAS) is a safe and effective method for aspirin treatment after desensitisation (ATAD). Changes in quality of life (QoL) in patients on intranasal LAS have not been documented and we aimed to investigate QoL in N-ERD patients on or off nasal ATAD. Moreover, an estimate of the cost burden of intranasal LAS is given. Methods: A cross-sectional review was conducted for all challenge-confirmed N-ERD patients who were in follow-up in our rhinology clinic. They were asked to complete a SNOT-22 questionnaire, a visual analogue scale for sense of smell (sVAS). Information on prices of LAS and other consumables used for intranasal ATAD was obtained from our hospital pharmacy to obtain an estimate of the cost burden. Results: Thirty-four patients replied to the email (79.1% response rate). Of these, 21 (61.8%) were on intranasal LAS. A statistically significant lower score in the total SNOT-22 was found amongst patients on intranasal LAS (p = 0.02). The subanalysis of SNOT-22 domains showed that patients on LAS had statistically significant lower scores in the domains “rhinologic symptoms” (p = 0.05), “function” (p = 0.02), and “emotion” (p = 0.01). No significant differences were observed when looking at sVAS. The cost of 1-year treatment of LAS per person was ≈GBP 180.7 with a daily cost of ≈GBP 0.50. Conclusions: This study supports the efficacy of nasal ATAD in the management of N-ERD and suggests that long-term use can lead to QoL improvement with cost benefits. Full article

This CT-based study aimed to characterize and explain the existence of two anatomical structures positioned near the maxillary sinuses, which are of clinical relevance in rhinology and maxillofacial surgery. A total of 182 head scans (92 males and 90 females) were inspected for infraorbital ethmoid cells (IECs) and for the type (route) of infraorbital canal (IOC). The maxillary sinuses were segmented, and their volumes were measured. Statistical analysis was conducted to reveal the associations between the two anatomical variations, namely, sex and the maxillary sinus volume. Infraorbital ethmoid cells were noted in 43.9% of the individuals studied; they were more frequent in males (53.3%) than in females (34.4%). The descending infraorbital nerve (type 3 IOC) was found in 13.2% of individuals and was independent of sex. Infraorbital ethmoid cells were associated with the IOC types. The maxillary sinus volume was found to be sex-dependent. A large sinus volume is significantly associated with IOC Type 3 (the descending canal) and the presence of IEC. Dentists, radiologists, and surgeons should be aware that individuals with extensive pneumatization of the maxillary sinuses are more likely to display a descending IOC and IEC. These findings should be studied, along with CT scans, before treatment and surgery. Full article

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) and severe eosinophilic asthma (SEA) are common comorbidities characterised by type 2 inflammation associated with increased expression of interleukin 5. Methods: Eight patients with SEA and severe CRSwNP attended the Scottish Centre for Respiratory Research as part of a clinical trial (EudraCT number 2019-003763-22). Following an initial 4-week run-in period (baseline) when patients took their usual inhaled and intranasal corticosteroid treatment for SEA and CRSwNP, they all received subcutaneous benralizumab 30 mg q4w for 12 weeks. Results: Following 12 weeks of benralizumab, no significant differences were detected in nasal global symptom visual analogue score (VAS), hyposmia VAS, total nasal symptom score, or peak nasal inspiratory flow. In contrast, Asthma Control Questionnaire significantly improved along with near-complete depletion of peripheral blood eosinophils by 99%, while eosinophil-derived neurotoxin fell by 72%. Conclusions: Greater improvements in patient-reported outcomes related to asthma were observed than with CRSwNP in response to benralizumab. Full article

Background: Medication overuse is an increasing global problem, especially for those rhinology diseases whose management requires over-the-counter drugs. This observational community pharmacy-based study aimed to investigate the actual use of the best-selling topical nasal medications and to characterize the clinical issues underlying their query through the pharmacist’s perception. Methods: In the pilot phase, a preliminary survey was developed by a team of researchers and tested on a small sample of practitioners to assess usability and intelligibility. Eventual amendments were made according to the feedback obtained, and the final version was submitted to practitioners working in 376 pharmacies evenly distributed over the Italian territory. Results: Two groups of customers (18–30 years old and 60–75 years old) were the ones who most frequently purchased topical decongestants. The dosage applied for sympathomimetic amines was higher than recommended in up to 44.4% and the duration of use longer than 5 days in up to 31.9% of the cases. Patients’ queries of alpha agonists and topical corticosteroids resulted in significantly higher numbers than practitioners’ prescriptions. Allergic rhinitis was the most common disease affecting patients seeking sympathomimetic amines. Conclusions: The prolonged use of sympathomimetic amines in patients suffering from rhinology diseases is a significant problem that requires greater attention in terms of social education and surveillance. Full article

Background: Three-dimensional (3D) printing has allowed great progression in the medical field. In otolaryngology practice, 3D printing can be used for planning in case of malformation/complex surgery, for surgeon training, and for recreating missing tissues. This systematic review aimed to summarize the current benefits and the possible future application of 3D technologies in the otolaryngology field. Methods: A systematic review of articles that discuss the use of 3D printing in the otolaryngology field was performed. All publications without the restriction of time and that were published by December 2021 in the English language were included. Searches were performed in the PubMed, MEDLINE, Scopus, and Embase databases. Keywords used were: “3D printing”, “bioprinting”, “three-dimensional printing”, “tissue engineering” in combination with the terms: “head and neck surgery”, “head and neck reconstruction”, “otology”, “rhinology”, “laryngology”, and “otolaryngology”. Results: Ninety-one articles were included in this systematic review. The articles describe the clinical application of 3D printing in different fields of otolaryngology, from otology to pediatric otolaryngology. The main uses of 3D printing technology discussed in the articles included in the review were surgical planning in temporal bone malformation, the reconstruction of missing body parts after oncologic surgery, allowing for medical training, and providing better information to patients. Conclusion: The use of 3D printing in otolaryngology practice is constantly growing. However, available evidence is still limited, and further studies are needed to better evaluate the benefits of this technology. Full article

The maxillary sinus is a structure at the border of specialties: otorhinolaryngology and maxillofacial surgery. Due to this fact, regarding etiology, it can be affected by both the rhinogenic and odontogenic path and can impose diagnostic difficulties. The etiopathogenic mechanisms that can affect the Schneiderian membrane are mainly inflammatory, iatrogenic, traumatic, and tumorous in nature. From a microbiological point of view, the bacteriology is polymorphic, including both aerobic and anaerobic species in acute OS, the predominating species in acute OS being aerobic, and in chronic anaerobic germs. The role of fungi in the determination of this pathology and in the production of the biofilm that leads to resistance to antibiotic treatment is also discussed. The present paper aims to present the etiopathogenesis, bacteriology, clinical manifestations, as well as treatment of odontogenic sinusitis (OS) from an updated perspective through reviewing the literature. If unilateral maxillary sinusitis is usually due to odontogenic causes, this does not clinically exclude the possibility of strictly rhinogenic causes in the occurrence of sinusitis. This underlines the important role of complex oral and rhinological clinical examination as well as the role of preclinical examinations in specifying the certainty diagnosis. Simple radiography, orthopantomography, CT, and CBCT are compared in terms of diagnostic accuracy. The treatment of OS is complex, involving medication, dental, and surgical measures. The value of endoscopic surgery is emphasized, comparing its advantages over the classic Caldwell-Luc technique. Full article

It is established that non-white people experience worse health outcomes than white people within the same population. Equity addresses differences between patient subgroups, allowing needs-based distribution of resources. The use of quality-of-life (QoL) tools to assist clinical decision making such as the SNOT-22 for chronic rhinosinusitis promotes equality, not equity, as quality-of-life (QoL) tools provide the same criteria of symptom scoring across diverse populations. We considered the effects of ethnicity and race on SNOT-22 scores and whether these scores should be adjusted to improve equity. PubMed and MEDLINE provided papers for a scoping review. A combination of the following search terms was used: patient-reported outcome measures (PROM) (OR) quality of life; (AND) race (OR) ethnicity (OR) disparities; (AND) otolaryngology (OR) SNOT-22 (OR) sinusitis. The first study identified no evidence of ethnic variability in SNOT-22 scores. However, the study did not represent the local population, including 86% white people. Other studies identified baseline SNOT-22 disparities with respect to population demographics, gender, and age. Ethnic differences appear to exist in acute sinusitis symptomatology. In other fields both within and outside of otorhinolaryngology, ethnic differences exist with regard to QoL tools. This scoping review identified a paucity of data in rhinology. However, evidence implies some form of correction to QoL scores could help promote equity for non-white patients. Full article

Chronic rhinosinusitis (CRS) is one of the most common persistent disorders of the developed world, requiring input from various specialists including primary care physicians, otolaryngologists, respiratory physicians, and allergologists. B-cell lymphoproliferative disorders (BLPDs) are a heterogenous group of malignant conditions defined by an accumulation of mature B lymphocytes in the bone marrow, blood, and lymphoid tissues. We present a case report of an elderly man with rhinosinusitis-like symptoms and atypical features prompting further investigations that culminated in a diagnosis of BLPD. Full article

Objective: We investigate the prevalence of the self-reported and objective sudden loss of smell (SLS) in patients with severe coronavirus disease 2019 (COVID-19). Methods: Severe COVID-19 patients with self-reported SLS were recruited at hospitalization discharge. Epidemiological and clinical data were collected. The Sino-nasal Outcome Test-22 (SNOT-22) was used to evaluate rhinological complaints. Subjective olfactory and gustatory functions were assessed with the National Health and Nutrition Examination Survey (NHNES). Objective SLS was evaluated using psychophysical tests. Potential associations between olfactory evaluation and the clinical outcomes (duration of hospitalization; admission biology; one month serology (IgG), and chest computed tomography findings) were studied. Results: Forty-seven patients completed the study (25 females). Subjectively, eighteen (38.3%) individuals self-reported subjective partial or total SLS. Among them, only three and four were anosmic and hyposmic, respectively (38.9%). Considering the objective evaluation in the entire cohort, the prevalence of SLS was 21.3%. Elderly patients and those with diabetes had lower objective olfactory evaluation results than young and non-diabetic individuals. Conclusions: The prevalence of SLS in severe COVID-19 patients appears to be lower than previously estimated in mild-to-moderate COVID-19 forms. Future comparative studies are needed to explore the predictive value of SLS for COVID-19 severity. Full article

Rhinology studies the anatomy, physiology, and diseases affecting the nasal region—one of the most modern techniques to diagnose these diseases is nasal cytology, which involves microscopic analysis of the cells contained in the nasal mucosa. The standard clinical protocol regulates the compilation of the rhino-cytogram by observing, for each slide, at least 50 fields under an optical microscope to evaluate the cell population and search for cells important for diagnosis. The time and effort required for the specialist to analyze a slide are significant. In this paper, we present a smartphones-based system to support cell segmentation on images acquired directly from the microscope. Then, the specialist can analyze the cells and the other elements extracted directly or, alternatively, he can send them to Rhino-cyt, a server system recently presented in the literature, that also performs the automatic cell classification, giving back the final rhinocytogram. This way he significantly reduces the time for diagnosing. The system crops cells with sensitivity = 0.96, which is satisfactory because it shows that cells are not overlooked as false negatives are few, and therefore largely sufficient to support the specialist effectively. The use of traditional image processing techniques to preprocess the images also makes the process sustainable from the computational point of view for medium–low end architectures and is battery-efficient on a mobile phone. Full article