The self-MOQ is a sufficient screening tool for OD after SARS-CoV-2 infection. Patients with persistent OD show signi-ficantly poorer QoL than those without. Olfactory function can be assessed in patients with COVID-19 using a simple 5-item questionnaire (self-MOQ). Patients with OD show reduced QoL. In our population-based cross-sectional study of 667 patients with PCR-confirmed SARS-CoV-2 infection, par-ticipants with persistent OD had significantly poorer OF-related QoL. The self-MOQ is a simple, valid and reliable means to screen OD in patients with COVID-19.

Biologic therapy has emerged as a key treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), particularly in refractory cases, but its effect on healthcare utilization is not well established. We conducted a retrospective big-data analysis using the Clalit Health Services database, identifying all CRSwNP patients treated with dupilumab or mepolizumab following endoscopic sinus surgery (ESS) between 2010â€"2024. We assessed antibiotic and systemic steroid use, visits to clinics, emergency rooms (ER), hospitalizations, and repeat ESS before and after biologic initiation. Among 861 patients (54.2% on dupilumab, 45.8% on mepolizumab), 62% had asthma. Median therapy duration was 25 months. Mean follow-up was 130 ± 78 months before treatment and 43 ± 42 months after. Biologics significantly reduced antibiotic and systemic steroid use, as well as community clinic, hospitalization, and revision ESS rates. Serum eosinophils declined from 520 ± 440 to 430 ± 460 cells/μL. Post-ESS biologic therapy in CRSwNP patients is associated with reduced healthcare utilization and systemic medication use, highlighting its positive impact on disease burden and healthcare efficiency.

Olfactory dysfunction (OD) is an underrecognized feature of CHARGE syndrome (CS), often associated with CHD7 mutations and structural anomalies of the olfactory system. This systematic review examines the burden, assessment methods, and clinical correlates of OD in CS. A systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251040500). A comprehensive search of six databases up to May 2025 was performed. Two independent reviewers screened, extracted data, and assessed study quality. A narrative synthesis was performed. From 1,643 records, 16 studies met inclusion criteria. Most were retrospective cohort studies and employed clinical diagnostic criteria for CS, with a subset reporting CHD7 mutation data. OD was most frequently identified radiologically. Psychophysical testing and self/parent reports were less common. Neurodevelopmental delays, feeding/swallowing issues, and reduced quality of life were reported in association with OD, but causal relationships remain unclear. OD is highly prevalent in CS, often exceeding 80%, yet remains underrecognized. Radiologic imaging and electrophysiological techniques may be alternatives when psychophysical testing is not feasible. Future research should focus on validating paediatric-specific and developmentally appropriate olfactory assessments and integrating olfaction into quality-of-life frameworks. OD should be considered for inclusion in revised CHARGE diagnostic criteria.

Chronic rhinosinusitis (CRS) is a common cause of olfactory dysfunction (OD), and eosinophilic CRS is one of the subtypes characterized by eosinophilic infiltration. Animal models of olfactory dysfunction in eosinophilic CRS are necessary for exploring potential therapeutic strategies. Glucocorticoids are therapeutic for eosinophilic CRS-OD and the mechanism of action requires further exploration. The eosinophilic CRS-OD rat model was induced by intranasal administration of ovalbumin (OVA) and Aspergillus oryzae protease (AP) for 8 weeks, followed by intraperitoneal injection of dexamethasone. Olfactory function was assessed behaviorally, neuronal activity electrophysiologically, and neurotransmitter/inflammatory factor levels via high-performance liquid chromatography (HPLC). Histological analyses of nasal tissue and the olfactory bulb were performed. All OVA/AP-induced eosinophilic CRS-OD rats developed chronic nasal inflammation and olfactory dysfunction. Reduced olfactory bulb (OB) volume was accompanied by thinning of the olfactory neuron layer (ONL) and the glomerular layer (GL). The OB exhibited increased microglia and elevated inflammatory cytokine expression. Further analysis revealed decreased glutamate (Glu), increased γ-aminobutyric acid (GABA), and a significant reduction in the spontaneous firing rate (SFR) of mitral/tufted cells (M/Ts) within the OB. Dexamethasone treatment significantly ameliorated olfactory impairment in this model, decreasing OB microglia numbers and inflammatory cytokine levels, and significantly increasing M/T SFR. Microglia-mediated neuroinflammation contributes to abnormal neural activity in the olfactory bulb, which may be one mechanism for the development of eosinophilic CRS-OD. The neuroprotective effect of dexamethasone, mediated through microglial inhibition, highlights microglia as an important therapeutic target for eosinophilic CRS-OD.

Chronic rhinosinusitis with nasal polyps (CRSwNP) often leads to poor sleep quality and fatigue. Many patients with CRSwNP are also at risk for obstructive sleep apnea (OSA). This study examined how mepolizumab and/or endoscopic sinus surgery (FESS) affect sleep quality and OSA in patients with severe uncontrolled CRSwNP. In a randomised trial with 58 patients, participants received mepolizumab alone or combined with FESS. Sleep quality was measured using FOSQ-10 and ESS, and OSA severity via AHI from home sleep apnea tests. At baseline, 70% of participants had OSA (AHI ≥5), with 34.6% having moderate-to-severe OSA. After six months, there were significant improvements in sleep quality (SNOT-22, FOSQ-10, ESS) in both groups but no significant change in objective OSA measures (AHI, ODI). Patients with OSA showed a reduction in severity, however non-significant. There were no severe adverse events (SAE) during the follow-up. Mepolizumab, with or without FESS, improved subjective sleep quality and reduced fatigue but did not significantly affect OSA severity. This suggests that while treatment eases sleep-related symptoms, it may not resolve underlying OSA, particularly in more severe cases.

This systematic review and meta-analysis evaluated the effect of oral corticosteroid (CS) treatment on tissue eosinophil count (EC) in chronic rhinosinusitis (CRS) patients. A comprehensive database search identified 16 studies with 1,003 patients for the systematic review. Nine studies with 493 patients reporting mean tissue EC per high-power field (HPF) with 400x magnification were included in the meta- analysis. Within-subject (pre- vs. post CS treatment) and controlled comparisons (oral CS vs. no CS or topical CS) were analyzed. Results showed a significant reduction in tissue EC following oral CS treatment in both within-subject analyses and controlled trials. A similar effect was found when comparing oral vs. topical CS treatment. Meta-regression showed a significant negative association between cumulative CS dose and post-treatment EC/HPF. These findings provide strong evidence that oral CS significantly reduces tissue eosinophilia in CRS, including comparisons with topical CS. The effect was consistent across study designs and should be considered when assessing endotypes in CRS with nasal polyps.

Recurrent anterior idiopathic epistaxis is common in children, yet optimal management remains debated. This study compared the efficacy of antiseptic cream, antiseptic plus corticosteroid cream, and silver nitrate cautery in reducing epistaxis severity in paediatric patients. In a prospective randomised dual-centre clinical trial, 136 children with recurrent idiopathic anterior epistaxis were evenly allocated to antiseptic cream, antiseptic plus corticosteroid cream, or silver nitrate cautery. Epistaxis Severity Score was assessed at baseline, 2 weeks, and 1, 3, and 6 months. All groups showed significant reductions in ESS over time. At 2 weeks, silver nitrate cautery produced the most rapid early improvement, compared with antiseptic cream and the combination cream. By 1 month, the antiseptic plus corticosteroid group showed the greatest improvement, with further reductions at 3 months and 6 months. At 6 months, improvement rates were highest with the combination therapy, followed by antiseptic cream and cautery. Cautery achieves rapid short-term control, but antiseptic plus corticosteroid cream provides the most durable improvement following a short, two-week course. It should be considered a first-line therapy for recurrent idiopathic anterior epistaxis in children.

The COVID-19 pandemic brought attention to post-viral smell distortion, or parosmia, which is defined as a qualitative dysfunction resulting from distorted odor perception in the presence of an odorous medium (1). Very often, qualitative and quantitative alterations occur simultaneously. Patients severely affected by qualitative odor disorders find that their quality of life has deteriorated (2). For quantitative loss from viruses, the role of olfactory training has been emphasized (3), along with high volume steroid nasal irrigations (4), and even injections with platelet-rich plasma (5). However, there has been no high-level evidence demonstrating an effective treatment for qualitative olfactory disorders.

Skull base reconstruction is a critical component of endoscopic endonasal skull base surgery (EESBS). Bed rest remains an indispensable element of post-operative care, which should be carefully considered for reducing the risk of cerebrospinal fluid (CSF) leaks and enhancing surgical outcomes (1, 2). However, the necessity of bed rest continues to be controversial as indicated by the expert consensus on perioperative management of skull base reconstruction, due to a lack of high-quality evidence to support its effectiveness (1-4). This study focuses exclusively on anterior skull base reconstruction, which is frequently employed in EESBS but has not been sufficiently investigated. In this study, we retrospectively collected patient data from three skull base centres to analyse the impact of bed rest on the occurrence of post-operative CSF leakage.

A healthy olfactory cleft is critical to normal olfactory function. The aim of this study was to explore the differential orthonasal and retronasal olfactory functions in patients with olfactory cleft (OC) obstructions including a combination of OC syndrome, chronic rhinosinusitis with or without nasal polyps (CRSwNP or CRSsNP), and respiratory adenomatoid epithelial hamartoma (REAH). Patients (n = 93) presenting to an ENT clinic with OC obstruction underwent nasal endoscopy, chemosensory event-related potential (ERP) recordings, and radiologic assessment, and were subsequently diagnosed with OC syndrome, CRSsNP with OC syndrome, CRSwNP in the OC, REAH, and CRSwNP with REAH. Orthonasal and retronasal function were assessed using the complete Sniffin’ Sticks test and a set of 30 powders, respectively. Orthonasal function was lower in patients with REAH and CRSwNP+REAH compared to CRSwNP in OC patients. Retronasal function was similarly diminished in REAH compared to CRSwNP in OC. Patients with OC syndrome alone had higher orthonasal scores than those with CRSsNP plus OC syndrome and CRSwNP in OC but not statistically different retronasal function. There was no significant difference in orthonasal or retronasal scores in REAH patients based on concurrent CRSwNP. REAH corresponded with greater orthonasal and retronasal olfactory loss compared to other olfactory cleft obstructions, indicating a greater effect on the olfactory mucosa beyond disrupting airflow. The difference between CRS and OC syndrome is more pronounced orthonasally than retronasally.