American Journal of Rhinology & Allergy

Disorders of autonomic dysregulation appear increasingly prevalent in chronic rhinosinusitis (CRS).

The purpose of this study was to investigate if dysautonomia portends a riskier postoperative course in patients with CRS undergoing sinonasal surgery.

The TriNetX database was queried for patients with CRS with or without comorbid dysautonomia undergoing functional endoscopic sinus surgery, septoplasty, and/or inferior turbinate reduction. Cohorts were propensity-matched based on age, gender, race, and potentially confounding comorbid conditions. Main outcome measures were emergency department utilization, inpatient admission, incidence of postoperative cerebrospinal fluid leak, epistaxis, or hypotension. The use of opioid, neuropathic, antibiotic, benzodiazepine, muscle relaxant, corticosteroid medications, and intravenous fluids within 90 days of surgery were also recorded.

Each group contained n = 1122 patients. The dysautonomia group had higher risks of epistaxis (odds ratio [OR]: 2.03; confidence interval [CI]: 1.13, 3.66; P = .016) and neuropathic medication use (OR: 2.92; CI: 1.35, 6.31, P = .005) following sinonasal surgery.

Patients with CRS and comorbid dysautonomia appear at a greater risk of postoperative epistaxis and neuropathic pain medication use following sinonasal surgery. Although further study is necessary, these findings suggest patients with dysautonomia may have a higher rate of postoperative bleeding and increased pain sensitivity.

Dendritic cells (DCs) are antigen-presenting cells that play a critical role in airway diseases by initiating and regulating immune responses. DCs are classified into plasmacytoid DCs (pDCs) and conventional DCs (cDCs), with the cDC lineage further divided into cDC1 and cDC2 subsets. Each subset exhibits distinct functions in immune regulation and disease pathogenesis. Thus, analyzing DC subsets is crucial for understanding the pathogenesis of airway diseases with diverse endotypes.

Allergic rhinitis (AR) and chronic rhinosinusitis (CRS), further divided into eosinophilic CRS (ECRS) and non-eosinophilic CRS (NECRS), are typical upper airway diseases with diverse endotypes. AR and CRS often occur simultaneously, and their severity tends to increase when they are comorbid. To understand the endotypes of AR and CRS, we classified the presence or absence of AR and CRS, analyzed the changes in DC subsets in the nasal mucosa, and compared these results with clinical features.

Nasal polyp tissues and ethmoid mucosa were collected from 42 patients who underwent endoscopic sinus surgery. DC were analyzed by flow cytometry to detect the expression of blood DC antigen (BDCA)-1, BDCA-2, and BDCA-3.

BDCA-3⁺ cDC levels were significantly reduced in patients with both AR and CRS, compared to those with AR alone or CRS alone. This reduction was especially prominent in patients with ECRS, polysensitization, and total serum IgE ≥ 200 IU/mL. BDCA-3⁺ cDC levels were also inversely correlated with preoperative computed tomography scores and serum eosinophil and immunoglobulin E levels.

BDCA-3⁺ cDC levels may be involved in mucosal immune regulation and are associated with increased disease burden in patients with comorbid AR and ECRS.

To investigate the impact of pathogenic bacterial distribution in the nasal cavity on postoperative nasal function recovery in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) after endoscopic sinus surgery (ESS), and to analyze the risk factors for postoperative recurrence.

A total of 178 CRSwNP patients who underwent ESS in our hospital from May 2021 to May 2023 were selected. Based on preoperative nasal secretion pathogen culture results, patients were categorized into the pathogen-negative group (42 cases), bacterial-positive group (90 cases), and fungal-positive group (46 cases). The nasal symptom visual analogue scale (VAS) score, Lund–Kennedy endoscopic score, and Lund–Mackay computed tomography (CT) score were assessed preoperatively and at 12 weeks postoperatively. Patients were followed up for 24 months and categorized into the recurrence group (36 cases) and the recurrence-free group (142 cases) based on postoperative recurrence. Relevant risk factors for recurrence were analyzed.

Among the 178 patients, the bacterial positivity rate was 50.56% (mainly Corynebacterium, Staphylococcus, and Haemophilus influenzae), while the fungal positivity rate was 25.84% (mainly Candida albicans and Aspergillus). Postoperatively, the nasal symptom VAS scores for individual items, Lund–Kennedy endoscopic scores, and Lund–Mackay CT scores showed significant improvement compared to preoperative values (P < 0.05). Comparisons among the 3 groups revealed a trend of pathogen-negative group < bacterial-positive group < fungal-positive group in nasal symptom VAS scores, Lund–Kennedy endoscopic scores, and Lund–Mackay CT scores, with significant differences observed between each pair of groups (P < 0.05). Univariate analysis showed that the proportions of asthma, history of revision surgery, eosinophilic (EOS)-type nasal polyps, and preoperative Lund–Mackay CT scores were all higher in the recurrence group than in the recurrence-free group (P < 0.05). Multivariate analysis identified history of revision surgery (OR = 6.963, 95% CI: 2.275–21.313), EOS-type nasal polyps (OR = 4.566, 95% CI: 1.449–14.392), and high preoperative Lund–Mackay CT scores (OR = 1.928, 95% CI: 1.475–2.522) as independent risk factors for postoperative recurrence (P < 0.05). Corynebacterium infection might reduce the risk of recurrence (P = 0.065).

Nasal bacterial and fungal colonization in patients with CRSwNP are associated with poor postoperative nasal function recovery, with fungal colonization leading to the worst prognosis. Postoperative recurrence is closely related to EOS-type nasal polyps, a history of previous surgery, and a high preoperative Lund–Mackay CT score. Corynebacterium may serve as a protective microbial population.

The mechanisms driving chronic rhinosinusitis with nasal polyps (CRSwNP)-related olfactory loss remain largely unknown. Here we sought to identify novel modulators of olfactory function via the examination of nasal mucus biomarkers using an expansive 71-cytokine plex analyzed via machine learning models.

Olfactory testing was performed via 40-question smell identify test (UPSIT). During endoscopic sinus surgery, sponges were placed in the middle meatus of individuals with CRSwNP (n = 15). Nasal mucus samples were screened by multiplex analysis for 71-cytokine/chemokines. Results underwent analysis with statistical and machine learning model approaches to assess whether protein concentrations were predictive of olfactory dysfunction.

In CRSwNP, multiple machine learning models revealed novel cytokines IL-21 and MIP-1δ as positive predictors of greater olfactory dysfunction. Other cytokines detected by more than one model as predictive of olfactory dysfunction were IL-18, MCP-1, IL-22, and BCA-1. Other cytokines identified to be predictive by at least one model were FLT-3L, LIF, IL-20, SCF, IL-23, and TPO.

Using a 71-cytokine/chemokine plex analyzed via machine learning, we identified potentially novel roles for MIP-1δ and IL-21 as modulators of olfactory function in CRSwNP. Use of machine learning for the analysis of nasal mucus cytokines, may serve as powerful tool to analyze complex multiplex immune mediator data.

Immunosuppressed organ transplant recipients experience higher rates of medically refractory chronic rhinosinusitis (CRS) requiring endoscopic sinus surgery (ESS).

To better understand the pathogenesis of CRS in immunosuppressed organ transplant recipients to aid in developing effective treatment protocols.

Structured histopathology (SHP) reports of sinonasal mucosa were obtained for 27 transplant and 505 nontransplant patients with CRS undergoing ESS. SHP reports were compared to identify differences in the inflammatory environment between the 2 groups.

SHP analysis revealed significantly higher rates of neutrophil infiltrate (48.1% vs 10.7%, P < .001), basement membrane thickening (74.1% vs 30.9%, P < .001), subepithelial edema (85.2% vs 25.7%, P < .001), and fibrosis (37.0% vs 16.8%, P = .008) in the sinus tissue of transplant patients compared to nontransplant patients, respectively.

CRS patients with a history of organ transplant overall displayed higher tissue neutrophilia and extensive tissue modeling on SHP. This patient population could potentially benefit from treatment modalities that are comparable to those used in patients with non-type 2 CRS.

Saline nasal irrigation (SNI) is an effective first-line treatment for allergic rhinitis (AR) and chronic rhinosinusitis (CRS), yet adherence remains challenging. Better understanding of adherence patterns and related barriers is important for the development of patient-centered interventions to improve adherence.

To investigate adherence to SNI in patients with AR and CRS, including clinical and sociodemographic predictors of adherence, reported barriers to adherence, and patient-recommended methods to increase adherence.

Adult patients treated with SNI for AR or CRS at our medical center in January 2024 were surveyed via phone in December 2024, and their medical records were reviewed. The primary outcome was adherence rate. Secondary outcomes included patient-reported barriers and proposed methods for improving adherence.

Of 174 patients surveyed, 38.9% were adherent. Adherence was significantly associated with English as a primary language (P = .026) and history of allergies (P = .043), with a borderline significant association with prior endoscopic sinus surgery (ESS) (P = .053). The most cited barriers were logistical issues (n = 26, 21.3%), discomfort or pain (n = 21, 17.2%), forgetting (n = 17, 13.9%), and the time required (n = 16, 13.1%). The most commonly suggested interventions were better instructions for use (n = 28, 28.0%), increased education about SNI (n = 27, 27.0%), offering a list of affordable options (n = 24, 24.0%), and help setting up reminders (n = 21, 21.0%).

In our urban population, adherence to SNI among patients with AR and CRS is relatively low. English speakers, those with allergies, and those with prior ESS are more likely to adhere. Barriers include logistics, discomfort, forgetfulness, and time commitment. Patient-centered interventions such as education, clearer instructions, cost transparency, and reminders may increase adherence.

We aim to predict eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) employing preoperative clinical parameters and machine learning algorithms, evaluating, and selecting the optimal model.

Retrospective collection of preoperative clinical parameters from 331 individuals suffering from chronic rhinosinusitis with nasal polyps. Independent predictors for ECRSwNP were determined through the application of the least absolute shrinkage and selection operator in conjunction with multivariate logistic regression. Four ML models for classification were constructed and cross-validated through the training set (223 patients), with predictive performance further evaluated on the testing set (98 patients). Shapley additive explanations (SHAP) technology provides importance rankings for predictive variables and explains personalized predictions from optimal models. Net reclassification improvement and integrated discrimination improvement values assessed the improvement in predictive performance. The prognostic value of the model further validated through Kaplan–Meier analysis.

Peripheral eosinophil percentage, visual analog scale, ethmoid/maxillary sinuses ratio, and nasal polyps score were identified as key variables for model construction. Extreme gradient boosting (XGBoost) proved to be the superior prediction model, attaining an area under the receiver operating characteristic curve of 0.981 in the training cohort and 0.928 in the testing cohort. The model demonstrated optimal net benefit across various risk thresholds and effectively predicted postoperative recurrence in patients with ECRSwNP.

We constructed an XGBoost predictive model and visualized its interpretation using the SHAP method, providing a reference for preoperative noninvasive assessment of ECRSwNP patients and guiding individualized treatment.

Olfactory dysfunction (OD) is a significant symptom in non-eosinophilic chronic rhinosinusitis with nasal polyps (neCRSwNP), but its non-type 2 inflammation-driven mechanisms remain unclear.

To investigate the roles of local nasal non-type 2 inflammatory cytokines and systemic immune indicators in neCRSwNP-associated OD.

Seventy-nine neCRSwNP patients were enrolled and divided into neCRSwNP with OD (neCRSwNP-wOD, n = 49) and neCRSwNP without OD (neCRSwNP-woOD, n = 30) groups. Olfactory function was assessed using the T&T Olfactometer. Nasal mucus cytokines (IFN-γ, TNF-α, IL-1β, IL-17) were measured by ELISA. Peripheral blood inflammatory indicators including absolute neutrophil count (Neut), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), were analyzed. Statistical methods included the Mann-Whitney U test, Spearman correlation analysis, multivariate logistic regression, and ROC curve analysis.

Nasal IFN-γ and IL-17 levels were significantly elevated in the OD group (both P < 0.05), while TNF-α and IL-1β showed no difference. Patients with OD also exhibited higher Neut, NLR, and SII (all P < 0.05). Olfactory scores strongly correlated with Neut (r = 0.639, P < 0.01) and moderately with IFN-γ (r = 0.533, P < 0.01). Multivariate regression identified IFN-γ, IL-17, and Neut as independent risk factors for OD. ROC analysis indicated that Neut had the highest predictive accuracy (AUC = 0.839), and a combined model of three indicators (Lund-Kennedy score, IL-17 and Neut) achieved excellent diagnostic performance (AUC = 0.964).

Olfactory dysfunction in neCRSwNP is associated with the combined involvement of local Th1/Th17 pathway activation (IFN-γ/IL-17) and neutrophil-mediated systemic inflammation. IFN-γ, IL-17, and peripheral blood neutrophils may be involved in the development of olfactory dysfunction in neCRSwNP.

The efficacy of adjunctive procedures targeting allergic rhinitis (AR) symptoms during septoplasty remains controversial. While radiofrequency ablation of the inferior turbinates (ITRA) is commonly performed, its impact on allergic symptoms beyond nasal obstruction is limited. Posterior nasal nerve ablation (PNNA) has recently gained attention as a promising alternative.

To compare the effects of PNNA and ITRA performed concurrently with septoplasty on allergic and obstructive nasal symptoms in patients with septal deviation and AR.

This prospective cohort study included 69 patients with septal deviation and AR who underwent septoplasty with either PNNA (n = 35) or ITRA (n = 34). Symptoms were assessed preoperatively and at 3 months postoperatively using the Mini-Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ), reflective Total Nasal Symptom Score (rTNSS), and Nasal Obstruction Symptom Evaluation (NOSE) scale. The rTNSS was divided into obstruction-related (rTNSS-A) and allergic (rTNSS-B) sub scores.

Both groups showed significant postoperative improvement in all parameters (p < 0.001). Compared with ITRA, the PNNA group demonstrated greater reductions in MiniRQLQ (mean changes = 36.97 ± 12.4 vs 32.00 ± 11.8; p = 0.025), rTNSS-B (median changes = 4.0 vs 2.0; p < 0.001), and rTNSS (median changes = 4.0 vs 2.5; p < 0.001). Changes in rTNSS-A and NOSE scores were comparable between groups (p > 0.05). No serious adverse events occurred; transient crusting was observed in 5 ITRA and 3 PNNA patients, and mild bleeding in 2 ITRA patients.

Both techniques effectively improved nasal symptoms, but PNNA provided superior relief of allergic symptoms and quality-of-life gains, supporting its consideration as an adjunctive treatment in septoplasty patients with comorbid AR.

To evaluate and compare the efficacy and safety of endoscopic neurectomy versus radiofrequency ablation targeting both the posterior nasal nerve (PNN) and lateral internal nasal branches of the anterior ethmoidal nerve (LINB-AEN) in patients with allergic rhinitis (AR).

In this prospective randomized controlled trial, adult patients with moderate to severe AR undergoing endoscopic nerve intervention from November 2023 to September 2025 were randomized to receive either neurectomy or ablation. Surgical targets included both PNN and LINB-AEN. Outcomes were assessed at 1, 3, and 6 months postoperatively and included nasal symptom visual analog scale (VAS), total nasal symptom score (TNSS), rhinoconjunctivitis quality of life questionnaire (RQLQ), total nasal resistance (TNR), olfactory function (VAS, QOD-NS, and Sniffin’ Sticks), and adverse events.

61 patients completed follow-up (neurectomy group: n = 30; ablation group: n = 31). Both groups achieved significant symptomatic improvement by 6 months (p < 0.001). The ablation group demonstrated significantly greater improvement in nasal obstruction (p < 0.001) and sneezing (p = 0.008) at 1 month, while the neurectomy group showed earlier improvement in rhinorrhea (p = 0.002). Both procedures improved nasal resistance. Neurectomy provided a faster, sustained nasal resistance improvement (p _{3 months} = 0.001, p _{6 months} = 0.003) with superior improvement in odor identification (p < 0.001) and TDI score (p = 0.005). Notably, no serious complications were reported. Additionally, symptoms of nasal dryness improved from baseline in both groups.

This is the first randomized controlled study to compare dual-target endoscopic neurectomy and ablation for AR. Both approaches are effective and safe. Ablation offers faster symptom relief, while neurectomy provides superior long-term control of nasal airflow and olfactory function. Individualized surgical planning is recommended based on symptom profile and patient preference.

Chinese Clinical Trial Registry Identifier: ChiCTR2500111543

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