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Location, location, location: How to get the steroid where you need it, in chronic rhinosinusitis
What almost all current guidelines on chronic rhinosinusitis have in common is the importance of intranasal steroid (INCS) use. However, it is increasingly understood that the efficacy of INCS depends on their efficient delivery to the point of need, i.e....
Antibiotics in orthognathic surgery
This paper from the Netherlands looked at 137 patients over a one-year period, 18 of whom had Le Fort I procedures, 68 bilateral sagittal split surgery, and 51 bi-maxillary surgery. A further 54 surgical procedures were undertaken, including 15 having...
Can we avoid FESS in patients with true isolated odontogenic sinusitis?
This is a useful study looking at how best to manage patients with odontogenic sinusitis and if FESS can be safely avoided. The authors treated patients by removing the odontogenic cause of the rhinosinusitis by extracting the offending tooth and...
CRS vs. migraine: which is the culprit in most headaches?
‘Sinus headache’ is a common diagnosis according to patients and primary care physicians, but relatively infrequent in the eyes of otolaryngologists. This study examines 104 patients with a primary headache syndrome (PHS) and 130 patients with CRS, looking at SNOT-22...
How much does FESS improve the sense of smell?
We are all familiar with patients who undergo a seemingly successful FESS but, in spite of this, have persistent smell dysfunction postoperatively. This study compares a surgical group with a control group, measuring olfactory function pre and postoperatively using Sniffin...
A new era in the treatment of recalcitrant nasal polyps?
Chronic rhinosinusitis with nasal polyps (CRSwNP) can be difficult to treat effectively in patients with aggressive or recalcitrant disease. Omalizumab (Xolair) is a monoclonal anti-IgE antibody with proven benefits for patients with moderate/severe asthma and CRSwNP, but this study looks...
Serum biomarkers for CRSwNP
This cross-sectional comparative study looked at 50 patients with nasal polyps who, at the time of diagnosis, also had a blood test evaluating serum total IgE, IL-17 and Pentraxin-3. The study assesses whether these blood markers are useful in the...
When to operate on a patient without chronic disease?
As ENT surgeons, we spend a lot of time managing chronic rhinosinusitis, so a review and update on the management of the acute disease is always helpful. The standard medical treatment of antibiotics, nasal steroids and nasal decongestants are reported...
Eosinophilic or not eosinophilic: dupilumab seems to work
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammation with interleukin (IL)-4, IL-13, and IL-5. Tissue eosinophilia in nasal polyps dramatically increased over a 10-20-year period. Classification of the severity of eosinophil status is expected to lead to...
Not as rare as we think? Silent sinus syndrome incidence on CT heads
It is relatively uncommon to come across a case of silent sinus syndrome (SSS), but not as rare as the prevalence in the literature might suggest – the authors of this study note that only 100 cases are reported in...
Does sleep quality improve when we adequately treat CRS?
In addition to the well-known symptoms associated with chronic rhinosinusitis (CRS), patients often suffer with poor sleep quality which is also detrimental to health and wellbeing. This meta-analysis looked at 35 papers reporting outcomes for CRS patients post surgery on...
