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The future of biologics?

This paper takes a deep dive into how eosinophilia affects the responsiveness of the host to the two monoclonal antibodies mepolizumab and bendralizumab, both of which are active against IL5. We know that eosinophils are attracted and trapped into the...

Do adhesions actually cause nasal blockage?

All of us who perform nasal surgery are familiar with the disappointing presence of nasal adhesions (NA) or synechiae in our postop patients. These can often lead to patients deriving less perceived benefit from their surgery than that which they...

CRSwNP initiation, not always an interleukin fault

CRSwNP, similar to asthma, is an inflammatory disorder (type II) with eosinophilia and raised IL-5 and IL-13. Inflammation in CRSwNP is thought to be started by IL-25, IL-33 and thymic stromal lymphopoietin (TSLP), all of which form an important part...

Balloons – more complicated than first thought?

This study describes the complications seen after balloon sinuplasty (BSP) - a commonly performed procedure (particularly in the USA where it is often performed as an office procedure) versus traditional functional endoscopic sinus surgery (FESS). The data source was a...

Zinc and rhinosinusitis

Patients with chronic rhinosinusitis (CRS) in general, and those with nasal polyps (CRSwNP) in particular, have been shown to have down-regulation of tight junction genes. Zinc, on the other hand, is well-known for its role in immune regulation and deficiency...

A novel way to reduce postoperative nausea and vomiting

This is an interesting RCT which evaluates the prophylactic effect of bilateral endoscopic injection of local anaesthetic in the sphenopalatine ganglion (SPG) on postoperative nausea and vomiting (PONV). It has a robust design, and is sufficiently powered and blinded, with...

Sinonasal undifferentiated carcinoma – slowly getting there

The rarest of the rare, sinonasal tumours form only a small part of the total number of head and neck tumours and undifferentiated carcinoma (SNUC) is one of the rarest of this group. There is some data (and some expert...

Chronic rhinosinusitis, are we treating the same disease?

Chronic rhinosinusitis (CRS) is a heterogenic disease. The effects of heterogeneity on treatment outcome are not very clear. Authors used clinical features such as endoscopic findings scores and full blood count findings in addition to analysis of 35 molecular markers....

Interleukins, cilia and polyps

Interleukins (ILs) including IL13 (Th2 cytokine) are inflammatory mediators and their role in asthma has been detailed before. This study explores IL13 receptor expression in chronic rhinosinusitis with nasal polyps (CRSwNP). The authors investigate protein and mRNA expression levels of...

Is non-allergic rhinitis as bad as allergic?

Non-allergic rhinitis (NAR) occurs when rhinitis symptoms are not associated with allergic, infective or anatomical reason. It is responsible for almost half of all cases of rhinitis and affects around 300 million worldwide. Assessing NAR patients’ quality of life (QoL)...

A new treatment for chronic rhinitis

The review paper looks at the efficacy of cryoablation of the posterior nasal nerve (PNN) to treat chronic rhinitis, an increasingly popular method of treating a highly prevalent and morbidity-inducing disease. Five studies were included in the meta-analysis, all dating...

More aggressive FESS for recalcitrant CRS is the key

This is an interesting paper assessing the effectiveness of endoscopic modified medial maxillectomy (MMM) in cases of recalcitrant chronic rhinosinusitis (CRS), (the technique was also used for tumours, cystic fibrosis, FB, odontogenic disease and AFS) in 551 patients. The technique...