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Congestion and rhinorrhea represent the most severe presenting symptoms among adults with rhinitis Patients with allergic rhinitis tend to have a more severe presentation than patients with nonallergic rhinitis Symptom duration does not clinically differentiate patients with persistent allergic symptoms versus those with intermittent allergic symptoms

Purpose To provide up-to-date and detailed normative data based on a large-scale sample, increasing diagnostic validity by reference to narrow age groups as previous normative values were based upon smaller sample sizes—especially in the group of older subjects. Method Data were obtained from 9139 healthy subjects (4928 females aged 5–96 years and 4211 males aged 5–91 years). The standard “Sniffin’ Sticks” test was applied, comprising threshold (T), discrimination (D) and identification (I) subtests, and yielding a TDI sum score. Results Hyposmia was established at a TDI score of less than 30.75. Age-related changes were found in each domain, most pronounced for thresholds. Individuals aged 20–30 years performed best, whereas children below the age of 10 and adults above the age of 71 scored only half as well. Sex-related differences were in favor of women. Conclusions Data provide guidance for assessing individual olfactory performance in relation to specific age groups. Significant gender and age effects were observed, with a most pronounced increase of olfactory test scores between age 5 through 20 years and a dramatic decrease at the age of 60 through 71 years.

Objective To investigate the occurrence of olfactory and gustatory dysfunctions in patients with laboratory-confirmed COVID-19 infection. Methods Patients with laboratory-confirmed COVID-19 infection were recruited from 12 European hospitals. The following epidemiological and clinical outcomes have been studied: age, sex, ethnicity, comorbidities, and general and otolaryngological symptoms. Patients completed olfactory and gustatory questionnaires based on the smell and taste component of the National Health and Nutrition Examination Survey, and the short version of the Questionnaire of Olfactory Disorders-Negative Statements (sQOD-NS). Results A total of 417 mild-to-moderate COVID-19 patients completed the study (263 females). The most prevalent general symptoms consisted of cough, myalgia, and loss of appetite. Face pain and nasal obstruction were the most disease-related otolaryngological symptoms. 85.6% and 88.0% of patients reported olfactory and gustatory dysfunctions, respectively. There was a significant association between both disorders ( p  < 0.001). Olfactory dysfunction (OD) appeared before the other symptoms in 11.8% of cases. The sQO-NS scores were significantly lower in patients with anosmia compared with normosmic or hyposmic individuals ( p  = 0.001). Among the 18.2% of patients without nasal obstruction or rhinorrhea, 79.7% were hyposmic or anosmic. The early olfactory recovery rate was 44.0%. Females were significantly more affected by olfactory and gustatory dysfunctions than males ( p  = 0.001). Conclusion Olfactory and gustatory disorders are prevalent symptoms in European COVID-19 patients, who may not have nasal symptoms. The sudden anosmia or ageusia need to be recognized by the international scientific community as important symptoms of the COVID-19 infection.

Disorders causing a loss of the sense of smell remain a therapeutic challenge. Basic research has, however, greatly expanded our knowledge of the organization and function of the olfactory system. This review describes advances in our understanding of the cellular components of the peripheral olfactory system, specifically the olfactory epithelium in the nose. The article discusses recent findings regarding the mechanisms involved in regeneration and cellular renewal from basal stem cells in the adult olfactory epithelium, considering the strategies involved in embryonic olfactory development and insights from research on other stem cell niches. In the context of clinical conditions causing anosmia, the current view of adult olfactory neurogenesis, tissue homeostasis, and failures in these processes is considered, along with current and future treatment strategies. Level of Evidence NA

Background Endoscopic skull base surgery (ESBS) is a rapidly expanding field. Despite divergent reported preferences for reconstructive techniques and perioperative management, limited data exist regarding contemporary practice patterns among otolaryngologists performing ESBS. This study aims to elucidate current practice patterns, primarily the volumes of cases performed and secondarily a variety of other perioperative preferences. Methods An anonymous 32‐item electronic survey examining perioperative ESBS preferences was distributed to the American Rhinologic Society membership. Statistical significance between variables was determined utilizing Student t, chi‐square, and Fisher exact tests. Results Seventy otolaryngologists completed the survey. The effective response rate was approximately 22.5%. Sixty percent of respondents were in full‐time academic practice and 70% had completed rhinology/skull base fellowships. Annually, 43.3 mean ESBS cases were performed (29.1 private practice vs. 52.9 academic practice, P = .009). Academic practice averaged 24.1 expanded cases versus only 11 in private practice (P = .01). Of respondents, 55.7% stood on the same side as the neurosurgeon and 72.9% remained present for the entire case. Current procedural terminology coding and antibiotic regimens were widely divergent; 31.4% never placed lumbar drains preoperatively, while 41.4% did so for anticipated high‐flow cerebrospinal fluid leaks. While considerable variation in reconstructive techniques were noted, intradural defect repairs utilized vascularized flaps 86.3% of the time versus only 51.3% for extradural repairs (P < 0.001). Major complications were rare. Postoperative restrictions varied considerably, with most activity limitations between 2–8 weeks and positive airway pressure use for 2–6 weeks. Most respondents started saline irrigations 0–2 weeks postoperatively. Conclusions Based on responses from fellowship‐ and non‐fellowship‐trained otolaryngologists in various practice settings, there remains considerable variation in the perioperative management of patients undergoing ESBS. Level of Evidence 5

Objectives To present current literature on the topic of odontogenic sinusitis. Data Source PubMed literature search for odontogenic sinusitis. Results Odontogenic sinusitis is an inflammatory condition of the paranasal sinuses that is the result of dental pathology, most often resulting from prior dentoalveolar procedures, infections of maxillary dentition, or maxillary dental trauma. Infections are often polymicrobial with an anaerobe‐predominant microbiome requiring special considerations for antimicrobial therapy. Medical management and treatment of the underlying dental pathology remains a critical initial step in the treatment of odontogenic sinusitis, however recent literature suggests that a significant portion of patients may require endoscopic sinus surgery for successful disease resolution. Conclusions This review describes the essential epidemiological and etiological factors, relevant clinical findings and diagnostic modalities, microbiologic and antimicrobial considerations, as well as the medical and surgical treatment approaches commonly utilized for the management of odontogenic sinusitis. Level of Evidence NA.

Purpose This study aimed to evaluate the utility of large language model (LLM) artificial intelligence tools, Chat Generative Pre-Trained Transformer (ChatGPT) versions 3.5 and 4, in managing complex otolaryngological clinical scenarios, specifically for the multidisciplinary management of odontogenic sinusitis (ODS). Methods A prospective, structured multidisciplinary specialist evaluation was conducted using five ad hoc designed ODS-related clinical scenarios. LLM responses to these scenarios were critically reviewed by a multidisciplinary panel of eight specialist evaluators (2 ODS experts, 2 rhinologists, 2 general otolaryngologists, and 2 maxillofacial surgeons). Based on the level of disagreement from panel members, a Total Disagreement Score (TDS) was calculated for each LLM response, and TDS comparisons were made between ChatGPT3.5 and ChatGPT4, as well as between different evaluators. Results While disagreement to some degree was demonstrated in 73/80 evaluator reviews of LLMs’ responses, TDSs were significantly lower for ChatGPT4 compared to ChatGPT3.5. Highest TDSs were found in the case of complicated ODS with orbital abscess, presumably due to increased case complexity with dental, rhinologic, and orbital factors affecting diagnostic and therapeutic options. There were no statistically significant differences in TDSs between evaluators’ specialties, though ODS experts and maxillofacial surgeons tended to assign higher TDSs. Conclusions LLMs like ChatGPT, especially newer versions, showed potential for complimenting evidence-based clinical decision-making, but substantial disagreement was still demonstrated between LLMs and clinical specialists across most case examples, suggesting they are not yet optimal in aiding clinical management decisions. Future studies will be important to analyze LLMs’ performance as they evolve over time.

Purpose Historically managed with intranasal corticosteroids (INCS) and endoscopic sinus surgery (ESS), type-2 Chronic RhinoSinusitis with Nasal Polyps (CRSwNP) treatment was revolutionized by the introduction of dupilumab but universally accepted guidelines are still lacking. Methods Patients treated at our University Hospital for type-2 CRSwNP were enrolled. Demographic data were collected, as well as laboratory (eosinophils, total IgE), endoscopic [nasal polyps score (NPS), modified Lund–Kennedy score (mLKS)], radiological [Lund–Mackay score (LMS) at CT scan], SNOT-22, and olfactory [Sniffin’ Sticks identification test (SSIT)] features. Patients were treated with dupilumab or ESS and re-evaluated after 3 and 12 months. Results At 3 and 12 months, patients undergoing ESS achieved a higher reduction of NPS and mLKS, while patients receiving dupilumab experienced a higher improvement at SNOT-22 and SSIT with a greater positive variation in the prevalence of anosmia (− 57.7% vs − 42.9%) and normosmia (+ 37.8 vs + 28.5%). Mean mLKS and LMS were quite similar. Results were independent of clinical features known to contribute to CRSwNP severity, except for patients with ≥ 2 prior ESS who had a significantly lower smell improvement. Conclusion ESS and dupilumab were effective at reducing CRSwNP inflammatory burning. CRSwNP smell impairment cannot be attributed only to olfactory cleft obstruction and other mechanisms may be involved. Dupilumab acts systemically with poor correlation with NPS. As of today, dupilumab appears to be more suitable for elderly patients with anesthesiological contraindications and/or several previous surgeries, while ESS may represent the first-line choice in surgery-naive patients.

Purpose The aim of our study is to evaluate the incidence and characteristics of otolaryngology symptoms in COVID 19 patients . Methods 116 patients with positive PCR test results for COVID-19 and followed up by otolaryngologists at a tertiary referral center/COVID-19 pandemic hospital were questioned in terms of otolaryngology symptoms associated with COVID-19 infection. Data including demographics, disease severity, concomitant diseases, previous otolaryngologic diseases,incidence and duration of new onset symptoms were collected and categorically analyzed. In addition, the severity of loss of smell and taste was evaluated by visual analogue score (VAS). Results A total of 58 men and 58 women participated. The mean age of the patients was 57.24 ± 14.32 (19–83). The most common otolaryngological findings were hyposmia/anosmia (37.9%) and hypogeusia/ageusia (41.37%), respectively. These complaints were followed by headache (37.1%), and nausea/vomiting (31%). The most common oropharyngeal symptoms were sore throat (32.7%) and dysphagia (20.6%). The rate of otological/vestibular symptoms was dizziness (31.8%), tinnitus (11%), true vertigo (6%), and hearing impairment (5.1%), respectively. The most of symptoms were more frequent in > 60 years and women. There was a significant correlation between nasal itching and smell disturbance in patients with allergic rhinitis. Considering the duration of symptoms, the longest were hyposmia/anosmia and hypogeusia/ageusia. The mean VAS’s in patients with hyposmia/anosmia and hypogeusia/ageusia were 5.52 ± 2.08 and 5.79 ± 2.21, respectively. Conclusion The most common otolaryngologic symptoms of COVID-19 infection are known as sore throat, smell and/or taste disturbances. However, our study showed that these patients can be seen with different symptoms in otological or laryngeal areas. Therefore, a more careful evaluation should be made in terms of otolaryngologic symptoms when COVID 19 infection is suspected.