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Purpose of Review Olfactory dysfunction is a frequent complication of SARS-CoV-2 infection. This review presents the current literature regarding the management of post-COVID-19 olfactory dysfunction (PCOD). Recent Findings A systematic review of the literature using the PubMed/MEDLINE, EMBASE, and Cochrane databases for the following keywords, “Covid-19,” “SARS-CoV-2,” “anosmia,” “olfactory,” “treatment,” and “management” was performed. While most cases of post-COVID-19 olfactory dysfunction resolve spontaneously within 2 weeks of symptom onset, patients with symptoms that persist past 2 weeks require medical management. The intervention with the greatest degree of supporting evidence is olfactory training, wherein patients are repeatedly exposed to potent olfactory stimuli. To date, no large-scale randomized clinical trials exist that examine the efficacy of pharmacologic therapies for PCOD. Limited clinical trials and prospective controlled trials suggest intranasal corticosteroids and oral corticosteroids may alleviate symptoms. Summary Olfactory training should be initiated as soon as possible for patients with PCOD. Patients may benefit from a limited intranasal or oral corticosteroid course. Further research on effective pharmacologic therapies for PCOD is required to manage the growing number of patients with this condition.

Purpose of review This review explores the comprehensive management and treatment strategies for pediatric chronic rhinosinusitis with nasal polyps (CRSwNP). It addresses questions regarding the efficacy and safety of both current treatments and emerging therapies. Additionally, this paper examines the diagnostic challenges in pediatric CRSwNP, particularly its distinct presentations and characteristics compared to those in adults. Recent findings Current research highlights various approaches for treating pediatric CRSwNP. Intranasal corticosteroids are found to be effective in managing symptoms, while oral corticosteroids are used to manage severe cases. Antibiotic therapy is recommended for acute exacerbations of CRSwNP when a bacterial cause is suspected. Surgical interventions such as adenoidectomy and endoscopic sinus surgery are considered when medical therapy fails. Emerging biologic therapies show promise but require further investigation regarding safety and cost-effectiveness in the pediatric population. Summary The findings suggest that a multimodal approach is essential for treating pediatric CRSwNP. Future research should aim to develop targeted therapies and refine treatment guidelines specifically for the pediatric population.

Chronic rhinosinusitis (CRS), especially if severe, recurrent, or refractory to standard medical management, should prompt consideration of an underlying primary or secondary immunodeficiency. Early identification and co-management amongst a multidisciplinary medical team is critical to optimizing short and long-term outcomes in these patients. This article reviews the workup and management of immunodeficiency in patients with chronic rhinosinusitis.

Purpose of Review Chronic rhinosinusitis (CRS) is a common yet complex and heterogeneous inflammatory condition of the paranasal sinuses that is likely caused by a combination of infectious and inflammatory factors. The role of the microbiome in the pathogenesis of CRS remains poorly defined. The purpose of this review is to examine the role of the microbiome in CRS and evaluate current and emerging therapies that may alter the sinonasal microbiome. Recent Findings There are complex interactions among the various microorganisms that make up the sinonasal microbiome with a growing body of evidence that increased microbial biodiversity may be protective against the development of CRS and patients with improved biodiversity may have better treatment outcomes. Topical and systemic antimicrobials, intranasal corticosteroids, and surgery have demonstrated transient changes to the microbiome without significant change in symptoms. The use of probiotics and bacteriophages remain areas of active investigation regarding alterations to the sinonasal microbiome. Summary CRS seems to be associated with decreased sinonasal microbial diversity, but whether this is the cause of CRS or a downstream effect remains unclear. Additional evaluation into the role of the microbiome on CRS and the impact of therapies that may yet alter the microbiome are necessary.

Purpose of Review Central compartment atopic disease (CCAD) is a variant of chronic rhinosinusitis with nasal polyps (CRSwNP) that is highly associated with aeroallergen sensitivity. The purpose of this review is to define this relationship and highlight the clinical manifestations and treatment strategies for this condition. Recent Findings CCAD presents with polypoid mucosal changes or frank polyps in the central compartment of the nasal cavity, defined as the middle and superior turbinates and the posterior superior nasal septum. These changes can be observed both endoscopically and via imaging. It is more strongly associated with allergic rhinitis than the other subtypes of CRSwNP, with increased allergic symptoms and eosinophilic nasal polyps. Local allergy may also play an important role. Treatment strategies are not yet well-defined, and endoscopic sinus surgery (ESS), nasal steroid or saline irrigation, and allergen immunotherapy are all treatment options. Summary CCAD is a developing but distinct subtype of CRSwNP with a unique presentation, pathophysiology, relationship with allergic rhinitis, and possible therapeutic management compared to other endotypes. Continued research is necessary to further define the treatment options for this disease process to best manage the increasing number of affected patients.

Purpose of review Eustachian tube dysfunction (ETD) is a common disease caused by abnormal function of the Eustachian tube. Sinonasal diseases, such as allergic rhinitis (AR) and chronic rhinosinusitis (CRS), are known to induce ETD through mucosal edema and Eustachian tube obstruction. As a result, ETD is often treated with medical therapies used to manage AR and CRS. This review serves to summarize the pathologic link between sinonasal diseases and ETD and the current state of evidence on the impact of treatments used for sinonasal diseases on ETD. Recent findings There is a high prevalence of ETD in patients with sinonasal disease, ranging from 15.5 to 89%, with a strong correlation in severity of sinonasal disease and ETD (Bernstein, Otolaryngol - Head Neck Surg. 1996 ;114:562–8; Hardy et al., Otolaryngol - Head Neck Surg. 2001 ;125:339–45; Knight et al., Clin Otolaryngol Allied Sci. 1992 ;17:308–12; Juszczak and Loftus, Curr Allergy Asthma Rep. 2020 ;20; Lazo-Sáenz et al., Otolaryngol - Head Neck Surg. 2005 ;132:626–9; Ma et al., Clin Transl Allergy. 2020 ;10:1–11; Yeo et al., Am J Otolaryngol - Head Neck Med Surg. 2007 ;28:148–52; Fireman, J Allergy Clin Immunol. 1997 ;99:787–97). Traditional medical treatments used to treat sinonasal diseases, including topical steroids, antihistamines, and decongestants, have demonstrated limited success in normalizing tympanograms and improving ETDQ-7 scores. Endoscopic sinus surgery (ESS), however, has been demonstrated to be effective in reducing ETD symptoms in patients with CRS, with ETDQ-7 scores reduced postoperatively by a mean of 7.4. Summary ETD is driven by various etiologies, such as AR and CRS. Recognizing the cause behind patients’ ETD is important in effectively managing their symptoms.

Purpose of Review Chronic rhinosinusitis in children has a complicated pathophysiology, leading to various treatment options. We aim to review the current literature regarding surgical management of pediatric chronic rhinosinusitis. Recent Findings Pediatric chronic rhinosinusitis should first undergo optimal medical management including antibiotics and topical nasal sprays prior to surgical intervention. Adenoidectomy is the first-line surgical treatment in children; however, its success rate can be suboptimal depending on patients’ age and comorbidities. Further surgical management includes sinus lavage, balloon catheter sinuplasty, functional endoscopic sinus surgery (FESS). FESS is safe with low complication rate and offers a high success rate when other medical and surgical treatments fail. Summary Surgical management for pediatric chronic rhinosinusitis varies widely and includes multiple safe options.

Purpose of Review Aspirin-exacerbated respiratory disease (AERD), or NSAID-exacerbated respiratory disease (NERD), is a heterogeneous inflammatory syndrome characterized by Samter’s clinical triad of chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and nonallergic hypersensitivity to all cyclooxygenase-1 (COX-1) inhibiting NSAIDs. This review focuses on randomized controlled trials and meta-analyses published on the clinical efficacy of aspirin therapy in AERD/NERD, as well as recent works published to explore the current outpatient ASA desensitization protocols in the US. Recent Findings Many AERD/NERD patients fail first-line therapies for treatment of asthma and CRSwNP and often need repeated sinus surgeries and frequent courses of oral corticosteroids to control symptoms. While COX-1 inhibiting NSAIDs are known to cause exacerbations in AERD/NERD, aspirin desensitization followed by maintenance oral high-dose aspirin therapy is proven to modulate the inflammatory cascade and has become a well-established treatment for most AERD/NERD patients. However, biologics are an emerging treatment option for pediatric patients and patients who are not candidates for aspirin desensitization. Summary Aspirin therapy after desensitization is beneficial for the majority of patients; however, the benefits, adverse effects, patient comorbidities, patient preferences, and all available treatment options must be considered in selecting an individualized treatment plan to address AERD/NERD.

Purpose of Review The purpose of this review is to provide an update on the current biologic treatments available for severe asthma, focusing on the mechanism and clinical efficacy of each agent. Prior to the FDA approval for biologic agents, patients diagnosed with severe asthma frequently depended on the use of systemic steroids in order to control their disease. Since the introduction of first approved biologic for IgE-mediated asthma, other biologic agents surfaced and are now available for other asthma phenotypes. Recent Findings In addition to omalizumab, which targets IgE-mediated asthma, there are now multiple other biologic agents that target different asthma phenotypes. Anti-IL-5 agents approved for eosinophilic asthma include mepolizumab, reslizumab, and benralizumab. Mepolizumab and reslizumab are approved for pediatric patients (6 and 12 years older, respectively), though benralizumab is only approved for adult patients. Dupilumab is a monoclonal IgG4 antibody that blocks the shared component of the IL-4 and IL-13 receptors and is approved for patients 6 years and older. Tezepelumab is an IgG2λ human monoclonal antibody that binds to TSLP which was recently approved for children 12 years and older. Summary With the availabilities of different biologic agents, severe asthma therapy can now be tailored based on phenotype. Studies focusing on the treatment duration and discontinuing therapy if appropriate would lead to improved outcomes moving forward.

Introduction Purpose of review Obstructive sleep apnea (OSA) is a prevalent condition characterized by repetitive collapse of the upper airway leading to sleep fragmentation and hypoxemia. The resulting hypoxemia leads to cascades of inflammatory, vascular and metabolic dysregulation which underlies the cardiovascular repercussions of the condition. The purpose of this review is to examine recent studies shedding light on treatments which highlight the impact of sinonasal pathology on OSA. Recent findings The medical treatment for nasal congestion can indirectly improve OSA. Studies on multiple anti-inflammatory agents have demonstrated reduction in the apnea hypopnea index (AHI), improvement in oxygen saturation and increased positive airway pressure (PAP) compliance. There are surgical interventions for OSA which are targeted for a specific patient population – such procedures generally increase nasal air space to improve nasal airflow. These procedures have been shown to reduce AHI, increase oxygen saturation and improve nasal and daytime symptoms. Septoplasty and turbinectomy are effective for those with deviated septum, or turbinate hypertrophy. Rapid palatal expansion is specifically for pediatric patients with a narrow and/or high palate. Distraction osteogenesis maxillary expansion is for adults with a narrow and/or high palate. Summary Sinonasal pathology can have an impact on OSA severity and treatment. Medications and surgeries treating sinonasal pathology can potentially improve OSA symptoms, reduce OSA severity and promote longevity in PAP compliance.