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Objectives Published data examining the efficacy of olfactory training (OT) has used standardized concentrations of odorants and the Sniffin’ Sticks testing method. Although well‐validated, these methods are costly and time‐intensive for the average otolaryngology practice. The purpose of our study was to evaluate the efficacy of using essential oils at random concentrations and the University of Pennsylvania Smell Test (UPSIT) for training and testing, and compare this with the existing data on OT. Study Design Randomized Clinical TrialMethods: Patients presenting to a tertiary care rhinology center with subjective loss of smell and olfactory loss measured by UPSIT were randomized to OT or control for 6 months. Only patients with loss of smell greater than one‐year duration, and loss associated with post‐infectious and idiopathic etiologies were included. Baseline UPSIT was compared to 6‐month UPSIT. An accepted 10% change or better was used to establish a significant improvement on UPSIT. Results 43 patients were enrolled. Eight patients were lost to follow‐up, with a total of 35 completing the study. Age ranged from 39–71 with an average of 56. Of 19 patients in the OT group, 6 showed significant improvement (32%), while only two out of 16 patients (13%) in the control group improved. Increasing age and duration of loss were significantly correlated to lack of improvement. Conclusion Allowing patients to use random concentrations of essential oils to perform OT is as effective as published data using controlled concentrations of odorants for post‐infectious and idiopathic olfactory loss. Level of Evidence 1b.

Objective To summarize the current evidence regarding a relationship between chronic rhinosinusitis (CRS) and allergy. Methods Literature review. Results Despite frequent assumption of an association between CRS and allergy the relationship between these entities remains poorly defined. Certain CRS entities, however, have demonstrated a strong association with allergy—namely allergic fungal rhinosinusitis and central compartment atopic disease. Conclusion Studies are heterogeneous and largely retrospective in design with inconclusive evidence for an association between CRS and allergy. Knowledge of CRS endotypes is important in order to understand which entities may or may not be associated with allergy. Level of Evidence: 5

Background Intralymphatic immunotherapy (ILIT) is a potential treatment option for allergic rhinitis (AR). We aimed to determine the efficacy (primary outcomes) and safety (secondary outcomes) of ILIT in treating patients with AR. Methods An electronic literature search was performed using MEDLINE and Cochrane Central Register of Controlled Trials CENTRAL (from their inception to December 2020). A random‐effects model was used to estimate the pooled prevalence with 95% confidence intervals. This study is registered with PROSPERO (CRD42019126271). Results We retrieved a total of 285 articles, of which 11 satisfied our inclusion criteria. There were 452 participants with age ranged from 15 to 58 years old. Intralymphatic immunotherapy was given in three doses with intervals of four weeks between doses in 10 trials. One trial gave three and six doses with an interval of two weeks. Both primary and secondary outcomes showed no difference between ILIT and placebo for all trials. There was no difference in the combined symptoms and medication score (SMD ‐0.51, 95% CI −1.31 to 0.28), symptoms score (SMD −0.27, 95% CI −0.91 to 0.38), medication score (SMD −6.56, 95% CI −21.48 to 8.37), rescue medication (RR 12.32, 95% CI 0.72–211.79) and the overall improvement score (MD −0.07, 95% CI −2.28 to 2.14) between ILIT and placebo. No major adverse events noted. Conclusions Intralymphatic immunotherapy possibly has a role in the treatment of AR patients. This review found it is safe but not effective, which could be contributed by the high variation amongst the trials. Future trials should involve larger numbers of participants and report standardized administration of ILIT and outcome measures.

A few chronic rhinosinusitis (CRS) variants have demonstrated a strong association with environmental allergy, including allergic fungal rhinosinusitis (AFRS) and central compartment atopic disease (CCAD). However, the overall relationship between CRS and allergy remains poorly defined. The goal of this review is to evaluate the relationship between CRS and allergy with a focus on specific CRS variants.

Abstract BACKGROUND Endoscopic endonasal approaches pose the potential risk of olfactory loss. Loss of olfaction and potentially taste can be permanent and greatly affect patients’ quality of life. Treatments for olfactory loss have had limited success. Omega-3 supplementation may be a therapeutic option with its effect on wound healing and nerve regeneration. OBJECTIVE To evaluate the impact on olfaction in patients treated with omega-3 supplementation following endoscopic skull base tumor resection. METHODS In this multi-institutional, prospective, randomized controlled trial, 110 patients with sellar or parasellar tumors undergoing endoscopic resection were randomized to nasal saline irrigations or nasal saline irrigations plus omega-3 supplementation. The University of Pennsylvania Smell Identification Test (UPSIT) was administered preoperatively and at 6 wk, 3 mo, and 6 mo postoperatively. RESULTS Eighty-seven patients completed all 6 mo of follow-up (41 control arm, 46 omega-3 arm). At 6 wk postoperatively, 25% of patients in both groups experienced a clinically significant loss in olfaction. At 3 and 6 mo, patients receiving omega-3 demonstrated significantly less persistent olfactory loss compared to patients without supplementation (P = .02 and P = .01, respectively). After controlling for multiple confounding variables, omega-3 supplementation was found to be protective against olfactory loss (odds ratio [OR] 0.05, 95% CI 0.003-0.81, P = .03). Tumor functionality was a significant independent predictor for olfactory loss (OR 32.7, 95% CI 1.15-929.5, P = .04). CONCLUSION Omega-3 supplementation appears to be protective for the olfactory system during the healing period in patients who undergo endoscopic resection of sellar and parasellar masses.

Increasing interest in sublingual immunotherapy (SLIT) among practitioners and patients has resulted in numerous publications and clinical trials in recent years. With the clinical growth of SLIT, discussions of its efficacy, safety, and immunologic effects have intensified, as have comparisons to subcutaneous immunotherapy (SCIT). In the United States, SCIT has been the traditional form of immunotherapy for inhalant allergy and is the only immunotherapy method approved by the U.S. Food and Drug Administration at this time. The similarities and differences between SLIT and SCIT are often discussed, yet clinical studies directly comparing these immunotherapy methods are scarce. A literature review of specific issues and controversies between SLIT and SCIT for allergic rhinitis was conducted. Safety, efficacy, and immunologic effects of these two immunotherapy techniques are reviewed. Unanswered questions relating to SLIT are examined.

Chronic rhinosinusitis with nasal polyposis is a common inflammatory condition, with subtypes like aspirin-exacerbated respiratory disease, allergic fungal rhinosinusitis, and central compartment atopic disease sharing a common type 2 inflammatory pathway. Respiratory biologic therapies have been developed that target type 2 inflammation. In this article, we discuss the use of respiratory biologic therapies for nasal polyposis in general, as well as within the various subtypes of nasal polyps. Further, we discuss future roles of novel biologic therapies targeting type 2 inflammation in nasal polyposis.

Understanding paranasal sinus anatomy is crucial for successful outcomes in endoscopic sinus surgery (ESS). This study was designed to evaluate subjective and objective differences in ESS cadaver dissections among participants of varying experience levels in association with the use of image guidance and computer-aided technologies in a physician training cadaver dissection laboratory. Participants in a 2-day cadaver dissection course completed daily predissection surveys evaluating subjective comfort with ESS. Pre- and postdissection computer tomography (CT) scans assessed completeness of dissection. Images were analyzed for maxillary antrostomy, frontal and sphenoid sinusotomy, residual ethmoid cells and partitions, and residual frontal recess cells. Fifty-one sides were dissected. Participant comfort increased significantly from day 1 to 2 for overall ESS (p = 0.001) and for individual sinuses (p < 0.001 to p = 0.047). Participants with more years in practice had fewer unopened ethmoid cells (p = 0.015) and frontal recess cells (p = 0.014) on dissection day 1. Participants with increased comfort in ethmoid dissection had fewer retained ethmoid partitions on day 1 (p = 0.017). Observed differences on dissection day 1 for unopened ethmoid and frontal recess cells and retained ethmoid partitions were not present on day 2. No significant differences were found based on use of image guidance for any parameter. Surgeons with increased comfort and more years in practice had more complete endoscopic cadaver dissections initially. Differences among participants diminished on dissection day 2, indicating the ability to review postdissection CT scans may improve surgeon comfort level and completeness of dissection.