RECENT FINDINGS: Due to the heterogeneity of diseases, biologic therapies may efficiently control CRSwNP but give inadequate control for asthma, or vice versa. Changing an ineffective first-line biologic to a second-line treatment or others is generally referred to as switching. The most common reasons for switching biologics are poor symptom management or ineffectiveness, and undesirable adverse effects. The ineffectiveness was largely due to the use of omalizumab or mepolizumab, whereas the adverse effects were due to dupilumab.
SUMMARY: Switching biologics is a nuanced process influenced by a variety of patient-specific and clinical factors. Biologics that effectively treat upper and lower airway diseases are recommended for optimal control in CRSwNP patients with concurrent asthma. There was no difference in outcomes between switching biologics with and without a washout period. Switching between biologics in the same class is generally not recommended. Dupilumab serves as an effective treatment option for refractory cases particularly aspirin-exacerbated respiratory disease.
CASE REPORT: Here we report an unusual case of surgical subcutaneous emphysema after multiple attempts of purging to remove an ingested fishbone. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Fishbone foreign body is a common presentation to the ED. A thorough history and examination for the migratory foreign body is essential, as the complications are consequential.
METHODS: In this cross-sectional study, healthy participants were recruited from a hospital, senior citizen homes, and schools from 2019 until 2021. Participants were divided into 5 different age groups (A: children, B: adolescents, C: young adults, D: middle-aged adults, and E: older adults) and underwent the identification smell test. Scores below the 10th percentile in these age groups were used to determine the cutoff points for hyposmia.
RESULTS: The cutoff points for the smell identification scores for hyposmia at the 10th percentile in children, adolescents, and adults (young, middle-aged, and older) were less than 6, 9, and 11, respectively. Pairwise comparisons were made using the Bonferroni post hoc test, with p < 0.001. Scores showed a significant difference between males (mean [SD]: 11.43 [2.42]) and females (12.01 [1.98]); p = 0.005.
CONCLUSION: Our study found that the cutoff points of the identification smell test for hyposmia were lower than those of other studies. It is important to use these cutoff points in our population to establish the correct integrity of olfaction function in the clinic setting and in future research.
DESIGN: Systematic review and meta-analysis.
METHODS: Using PRISMA guidelines, SCOPUS and PUBMED databases were searched from inception until 1 March 2022. The regions and populations identified were from Europe, Asia, Middle East, Australia-New Zealand-Oceania, South America, North America and Africa. Random-effects model was used to estimate the pooled prevalence with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic and Cochran's Q test.
MAIN OUTCOME MEASURES: Anatomical variations of the lateral nasal wall and anterior skull base confirmed by computed tomography scan.
RESULTS: Fifty-six articles were included with a total of 11 805 persons. The most common anatomical variation of the ostiomeatal complex was pneumatization of the agger nasi (84.1%), olfactory fossa was Keros type 2 (53.8%) and ethmoids was asymmetry of the roof (42.8%). Sphenoethmoidal and suprabullar cells have a higher prevalence in North Americans (53.7%, 95% CI: 46.00-61.33) while asymmetry of ethmoid roof more common in Middle Easterns (85.5%, 95% CI: .00-100). Bent uncinate process has greater prevalence in Asians while supraorbital ethmoid cells and Keros type 3 more common in non-Asians. The overall studies have substantial heterogeneity and publication bias.
CONCLUSION: Certain anatomic variants are more common in a specific population. The 'approach of analysis' plays a role in the prevalence estimates and consensus should be made in future studies regarding the most appropriate 'approach of analysis' either by persons or by sides.
METHODS: A retrospective study was performed over 4 years involving three surgeons from Malaysia, Singapore, and Thailand. Hospital records were reviewed to determine the patients' characteristics, the causes and sites of leaks, methods of investigation, skull base configurations, choices of treatment, and outcomes.
RESULTS: A total of 15 cases (7 traumatic and 8 non-traumatic) were included. Imaging was performed in all cases. The most common site of leakage was the cribriform plate (9/15 cases). The mean ± SD of the Keros heights were 4.43 ± 1.66 (right) and 4.21 ± 1.76 mm (left). Type II Keros was the most common (60%). The mean ± SD angles of the cribriform plate slope were 51.91 ± 13.43 degrees (right) and 63.54 ± 12.64 degrees (left). A class II Gera configuration was the most common (80%). All except two patients were treated with endonasal endoscopic surgical repair, with a success rate of 92.3%. A multilayered repair technique was used in all patients except one. The mean ± SD postoperative hospital stay was 9.07 ± 6.17 days.
CONCLUSIONS: Non-traumatic CSF rhinorrhea outnumbered traumatic CSF rhinorrhea, with the most common site of leak at the cribriform plate. Imaging plays an important role in investigation, and Gera classification appears to be better than Keros classification for evaluating risk. Both conservative and surgical repairs are practiced with successful outcomes. Endonasal endoscopic CSF leak repair is the mainstay treatment.
OBJECTIVE: This review aims to determine medication adherence, sensory attributes and adverse effects of INCS in AR patients.
METHODS: A systematic search of PubMed, Web of Science, Scopus, and Cochrane database was conducted for English articles published from 2004 to 2023. Eligibility includes clinical trials and observational studies with adult patients (18 years old or older) receiving INCS for AR (both intermittent and persistent).
RESULTS: Thirty-one studies with 10,582 patients, comprising 10 cross-sectional studies and 21 randomized controlled trials (RCT) were included. Adherence rates ranged from 28% to 87%, with an average of 55.8%. Forgetfulness was the primary reason for non-adherence (63.1-77.8%), followed by adverse events (26.4-61.5%) and fear of adverse events (3.8-31.5%). Scent (38%), taste (28.5%), or aftertaste (24.3%) were the main differentiators for sensory attribute, with varying levels of intensity and preferences for each INCS. Common adverse events encompass epistaxis, nasal dryness/irritation, headache and nasopharyngitis. A meta-analysis of eight RCT detected no significant difference in adverse events between the INCS and control groups (risk ratio 1.05; 95% confidence interval, 0.88-1.24; p = 0.61).
CONCLUSIONS: The findings of this review indicate that medication adherence to INCS is not optimal, with non-adherence mostly attributed to forgetfulness, preferences for sensory attributes, and unpleasant effects associated with INCS. The underlying factors should be addressed as part of a multimodal strategy to improve adherence.
METHODS: This was a cross-sectional study, conducted at Otorhinolaryngology outpatient clinic of Universiti Kebangsaan Malaysia Medical Centre, Secondary Science School, and Children Learning Centre in Kuala Lumpur, Malaysia, from August 2019 until December 2021.
RESULTS: In 450 healthy participants, the cut-off points of the threshold discrimination identification (TDI) scores at the 10th percentile for olfactory abilities were 19 in children, 30.1 in adolescents, 32.1 in young adults, 31.1 in middle-aged adults, and 28.6 in older adults. The children had significantly lower olfactory abilities, with the Bonferroni post-hoc tests of p<0.001. The young adults had higher olfactory abilities than older adults (p<0.05). The results showed that the identification score was highest in middle-aged adults (p<0.001). The discrimination score was the highest in young adults (p<0.001). The best odor threshold performance was observed in adolescents (p<0.001). The TDI score showed a significant difference in olfactory abilities between men and women (p=0.001).
CONCLUSION: Using a culturally adapted smell test, our population was able to identify, discriminate, and perceive odorants better than the European population. This data will help clinicians and researchers with a tool to reliably establish the correct results of olfactory function in our population. Women had better olfactory abilities than men.