Efficacy of dupilumab in real-life settings: a STROBE study

BACKGROUND

Dupilumab, a monoclonal antibody targeting IL-4 and IL-13, has demonstrated its efficacy in several clinical trials. However, to date, real-life data remains limited.

OBJECTIVE

The aim of our study was to assess the real-life impact of dupilumab on patients with severe and uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) quality of life.

MATERIALS AND METHODS

This was a retrospective, monocentric, observational, real-life study, conducted in accordance with the STROBE guidelines. The following parameters were collected before treatment and at 1, 4, and 12 months: Sino-Nasal Outcome Test-22 (SNOT-22), nasal polyp score (NPS), Sniffin' Sticks-16 (SST-16), visual analog scale (VAS) for loss of smell, nasal congestion score (NCS), gustatory VAS, asthma control, oral corticosteroid usage, surgery rates, and occurrence of side effects.

RESULTS

The study included 47 patients. SNOT-22 scores decreased from 52.4 ± 24.3 to 12.7 ± 10.5 at 12 months (p < 0.001). NPS decreased from 6.15 ± 1.71 to 1.57 ± 1.40 at 12 months (p < 0.001). SST-16 scores increased from 1.6 ± 2.83 to 9.1 ± 5.4 at 12 months (p < 0.001). NCS decreased from 2.45 ± 0.72 to 0.38 ± 0.63 at 12 months (p < 0.001). Prior to treatment, 72.3% were using oral corticosteroids, compared to 17.0% at 12 months (p < 0.01). Two patients required additional surgery, and 17% reported completely uncontrolled asthma, compared to 0% at 12 months (p < 0.01).

CONCLUSION

Our real-life results confirm the efficacy of Dupilumab in the treatment of severe and uncontrolled CRSwNP.

Writing in the European Annals of Otorhinolaryngology Head & Neck Diseases. Dos and Don'ts!

Too many articles are still rejected by scientific medical journals due to lack of preparation of the manuscript and of knowledge of the modern editorial rules that govern scientific medical writing. Therefore, the editorial board of the European Annals of Otorhinolaryngology Heads & Neck Diseases summarized studies published by its members since 2020 in the columns of the scientific journal of the French Society of Otorhinolaryngology and the International Francophone Society of Otorhinolaryngology and data from the PubMed indexed literature dedicated to scientific medical writing in otolaryngology in the 21st century. The authors hope that this review, in the form of a list of "Dos and Don'ts", will provide authors with a practical guide facilitating publication of rigorous, reproducible and transparent scientific studies, in accordance with the movement toward better science that society as a whole has been fighting for since the beginning of this century.

Keys for successful publication in Eur Ann Otorhinolaryngol Head Neck Dis: A STROBE analysis of peer reviews of articles submitted in 2020-2021

OBJECTIVE

To evaluate reviewing and editorial decision for articles submitted to the European Annals of Otorhinolaryngology Head & Neck Diseases.

MATERIALS AND METHODS

A retrospective analysis was made of reviewers' comments on 1,133 scientific articles (700 original articles, 96 literature reviews, and 337 case reports), originating from 69 countries, consecutively submitted on-line between January 1st, 2020 and December 31st, 2021. The main objective was to document the acceptance rate and decision time. Accessory objectives were to synthesize the main comments and to screen for correlations between acceptance and the main characteristics of first authors, articles and reviewers' comments.

RESULTS

In total, 4.1% of submitted articles were accepted. Median decision time differed significantly (P<0.0001), at 1 month in case of refusal and 4 months in case of acceptance. Reviewers mentioned failure to adhere to the journal's authors' guide, to use the appropriate EQUATOR guidelines and to adopt the recommended P<0.005 significance threshold in 94.8%, 54.2%, and 39.9% of cases, respectively. On multivariate analysis, 3 variables significantly impacted acceptance, which increased from 1.3% to 44.6% (P<0.0001) when an appropriate EQUATOR guideline was used and from 0.3% to 57.4% (P<0.0001) when the significance threshold was set at P<0.005, and decreased from 10.5% to 1.1% (P=0.0001) when the article did not originate from a French-speaking country (member of the Francophonie organization).

CONCLUSION

Adhesion to modern scientific medical writing rules increased acceptance rates for articles in the European Annals of Otorhinolaryngology Head & Neck Diseases. Teaching modern scientific medical writing needs to be enhanced in otorhinolaryngology.

Clinical features of patients who had two COVID-19 episodes: a European multicentre case series

OBJECTIVE

To investigate the clinical features of patients who had two demonstrated coronavirus disease 2019 (COVID-19) episodes.

METHODS

Data of patients with both COVID-19 episodes were recruited from 22 March to 27 December 2020. The following outcomes were studied: epidemiological, comorbidities, prevalence and severity of general and otolaryngological symptom, olfactory, aroma, and gustatory dysfunctions. A comparison between first and second episodes was performed.

RESULTS

Forty-five patients reported having two confirmed COVID-19 episodes. The majority of patients had mild infections in both episodes. The second clinical episode was significantly similar to the first. The symptom duration of the second episode was shorter than the first. The occurrence of loss of smell was unpredictable from the first to the second episode.

CONCLUSION

The recurrence of COVID-19 symptoms is associated with a similar clinical picture than the first episode in patients with initial mild-to-moderate COVID episode. The pathophysiological mechanisms underlying the development of second episode remain uncertain and may involve either true reinfection or virus reactivation from sanctuaries.

Methanobrevibacter smithii tonsillar phlegmon: a case report

Untreated tonsillar phlegmon is a life-threatening condition commonly caused by Streptococcus pyogenes and Fusobacterium necrophorum, among other pathogens. Here, using specific laboratory tools, we detected Methanobrevibacter smithii in addition to S. pyogenes. This unprecedented observation questions the role of methanogens in phlegmon and the optimal treatment of this mixed infection.

Patterns of smell recovery in 751 patients affected by the COVID-19 outbreak

BACKGROUND AND PURPOSE

Post-viral olfactory dysfunction is well established and has been shown to be a key symptom of COVID-19 with more than 66% of European and US patients reporting some degree of loss of smell. Persistent olfactory dysfunction appears to be commonplace and will drive the demand for general practitioner, otolaryngology or neurology consultation in the next few months - evidence regarding recovery will be essential in counselling our patients.

METHODS

This was a prospective survey-based data collection and telemedicine follow-up.

RESULTS

In total, 751 patients completed the study, of whom 477 were females and 274 males. The mean age of the patients was 41 ± 13 years (range 18-60). There were 621 patients (83%) who subjectively reported a total loss of smell and 130 (17%) a partial loss. After a mean follow-up of 47 ± 7 days (range 30-71) from the first consultation, 277 (37%) patients still reported a persistent subjective loss of smell, 107 (14%) reported partial recovery and 367 (49%) reported complete recovery. The mean duration of the olfactory dysfunction was 10 ± 6 days (range 3-31) in those patients who completely recovered and 12 ± 8 days (range 7-35) in those patients who partially recovered.

CONCLUSIONS

According to our results, at this relatively early point in the pandemic, subjective patterns of recovery of olfactory dysfunction in COVID-19 patients are valuable for our patients, for hypothesis generation and for treatment development.

COVID-19 and rhinology, from the consultation room to the operating theatre

The purpose of this article is to give rhinologists advice on how to adapt their standard practice during the COVID-19 pandemic. The main goal of these recommendations is to protect healthcare workers against COVID-19 while continuing to provide emergency care so as to prevent loss of chance for patients. We reviewed our recommendations concerning consultations, medical prescriptions and surgical activity in rhinology.

Maxillary fungus balls due to Fusarium proliferatum

Fungus ball is the most common form of non-invasive fungal rhinosinusitis. Aspergillusfumigatus (between 44.8% and 75%) and Aspergillusflavus (14%) are the two most common species recovered. However, recent advances in mycological laboratory methods have enhanced the detection and identification of fungi within fungus balls. Fusarium species, sometimes recovered from other forms of fungal rhinosinusitis such as allergic fungal rhinosinusitis or acute invasive fungal rhinosinusitis, are poorly associated with sinonasal fungus ball. Here, we describe two further cases of a fungus ball due to Fusariumproliferatum and provide the first description of this fungal pathogen with a fungus ball of odontogenic origin. These case reports demonstrate that uncommon fungal species such as Fusarium spp. might be underestimated as agents of sinusal cavity fungus ball. Enhanced mycological detection and diagnostic techniques might give rise, in the near future, to the emergence of new or rare fungal species associated with this clinical entity.

Assessing normal values for the FACE-Q rhinoplasty module: An observational study

OBJECTIVES

The goal of this study was to determine normal values for the FACE-Q rhinoplasty module.

DESIGN

A prospective monocentric observational cohort study.

SETTING

We tested FACE-Q Satisfaction with Nose and Satisfaction with Nostrils in two groups of patients, seeking or not a rhinoplasty.

PARTICIPANTS

One hundred and four patients were included in the study, fifty-two in each group.

MAIN OUTCOME MEASUREMENTS

Primary outcome was to identify possible cutting scores to establish normal values for each of the FQRM questionnaires.

RESULTS

Regarding the Satisfaction with Nose scale, there was a statistically significant difference between the two groups (P < .001). Area under the ROC curve was 0.964 (95% CI = 0.931-0.997). Forty-seven points was the value presenting the best Youden index (sensitivity = 96.2%, specificity = 86.5%). Regarding the Satisfaction with Nostrils scale, there was a statistically significant difference between the two groups (P < .001). Area under the ROC curve was 0.820 (95% CI = 0.741-0.899). Sixty-four points was the value presenting the best Youden index (sensitivity = 94.2%, specificity = 53.8%).

CONCLUSION

This is the first study to generate normative data for the FACE-Q rhinoplasty module. The findings presented here have important implications for future clinical care and research. The definition of a normal score can help practitioners to better analyse their patients and to support a therapeutic indication.

Outcomes of septorhinoplasty: a new approach comparing functional and aesthetic results

The aim of this study was to compare objective and subjective functional results of septorhinoplasty with subjective aesthetic results. A prospective study was performed including global and subgroup analyses (primary versus secondary septorhinoplasty). Three instruments were used to evaluate pre- and postoperative results: rhinomanometry for the objective functional analysis, the Nasal Symptom Obstruction Evaluation (NOSE) scale for the subjective functional analysis, and the Rhinoplasty Outcome Evaluation (ROE) scale for the subjective aesthetic analysis. A septorhinoplasty was performed in all cases. Thirty-five patients were included (22 female), of whom 74% underwent primary septorhinoplasty. The correlation between rhinomanometry, NOSE and ROE scores was analysed. Mean resistance of the two nasal cavities was 4.9 (standard deviation (SD) 8.35) sPa/ml before surgery and 0.8 (SD 0.7) sPa/ml after surgery. NOSE and ROE scores were, respectively, 72.5/100 (SD 21.7) and 7.5/24 (SD 11.3) before surgery and 22/100 (SD 20.6) and 18/24 (SD 17.3) after surgery. Patients complaining of postoperative nasal obstruction had a worse aesthetic evaluation. Correction of the functional disease appears to be as important as aesthetic correction. This study comparing functional and aesthetic results after septorhinoplasty could provide a basis for future studies.

Endoscopic surgery for sinonasal tumors: The transcribriform approach

Over the past 10 to 20 years, endoscopic endonasal surgery has become for many teams the preferred treatment for sinonasal tumors. Technical advances in the field of surgical instrumentation (good visualization, hemostasis…) and the progress of imaging guidance (to avoid neurovascular complication) has made those procedures simpler and safer. Nevertheless, endonasal endoscopic procedures require a trained surgical team of ENT specialist and neurosurgeon. Endoscopic endonasal surgery has been reported to be feasible for all types of sinonasal tumors whether benign tumors such as inverted papillomas, or malignant tumors. In this paper, we mostly focus on the principles underlying the transcribriform approach, which is dedicated to the surgery of CSF leaks, encephaloceles/meningoceles, access to benign intracranial tumors such as olfactory groove meningiomas, and the resection of sinonasal malignancies with skull base invasion such as olfactory neuroblastomas.

The MiRa scale, a new standardised scale for evaluating nasal deformities before and after septorhinoplasty: A prospective study comparing patient satisfaction and the surgeon's assessment

OBJECTIVES

The objective was to assess the reliability of a new standardised scale for evaluating nasal anomalies in order to compare the surgeon's assessment and patient satisfaction.

DESIGN

Monocentric prospective cohort study.

SETTINGS

First, we validated the reliability of the MiRa scale; then, we compared the surgeon's assessment and patient satisfaction.

PARTICIPANTS

Fifty-two patients underwent septorhinoplasty surgery and gave their written consent before inclusion.

MAIN OUTCOME MEASUREMENTS

Primary outcome measurement was to validate the reliability of the MiRa scale: two observers analysed all records twice. Intra-observer reproducibility and interobserver reproducibility were evaluated using the intraclass correlation coefficient (ICC). Secondary outcome measurement was to compare the surgeon's assessment and patient satisfaction: MiRa and ROE (Rhinoplasty Outcome Evaluation) scores were established for each patient prior to and 6 months after surgery.

RESULTS

Using the MiRa scale, ICC for intra- and interobserver reproducibility was, respectively, 95.4% and 96%, showing no statistical difference (P=.70, P=.45). Good correlation scores were, respectively, 93% and 92%. Mean ROE scores were 7.1/24 (SD=11.3) before and 19.3/24 (SD=17.3) after surgery (P<.05). We found an increase in MiRa and ROE scores of +19.75% and +51.25% (P<.05), respectively. The average postoperative ROE score in the primary septorhinoplasty group was 20.4 (SD=14.4) and 17.2 (SD=23.1) in the secondary septorhinoplasty group (P<.05).

CONCLUSION

MiRa scale is a reliable, standardised tool to evaluate surgical outcome in septorhinoplasty surgery. It provides an objective and reproducible score. The surgeon's assessment was more critical than patient satisfaction. Patient satisfaction is more difficult to achieve in cases involving a secondary septorhinoplasty.

Maxillary sinus volume: new physiopathological data in fungal ball genesis? A retrospective study

OBJECTIVES

The goal of this study was to compare maxillary sinus (MS) volume in patients with, or without, maxillary fungal ball.

DESIGN

Monocentric retrospective study performed on 115 patient CT scans.

SETTINGS

We defined two groups of patients according to the absence (control group) or the presence (fungal ball group) of unilateral fungal ball in the MS. Sinus 3D reconstruction was created from CT scan.

PARTICIPANTS

Control group: 71 patients (36 women - 50.7%); mean age was 51 years. Fungal ball group: 44 patients (29 women - 65.9%); mean age was 54.5 years.

MAIN OUTCOME MEASURE

The univariate association between MS volume and sinus covariates was tested by anova. Multivariate analysis was made including all variables statistically significant in univariate analysis.

RESULTS

In the control group, mean MS volume was 14 766 mm³ . The volumes of the two MSs were not statistically different in the control group (P = 0.145). In the fungal ball group, mean MS volume was 15 982 mm³ . Fungal ball was found in the smallest MS in 41 of 44 cases. Univariate analysis showed a statistical difference between the pathological and the non-pathological MS volumes (P < 10^-4 ). Multivariate analysis confirmed the correlation between MS volume and the presence of a fungal ball (P < 10^-4 ).

CONCLUSIONS

This study suggests that maxillary fungal ball is associated with a smaller size of the affected MS.

[Septoplasties and associated procedures]

Observing a morphological alteration of the nasal septum should in no way automatically lead to a septoplasty. Only poorly tolerated septal deviations creating a mechanical nasal obstruction are a surgical indication. This delicate operation requires meticulousness to preserve the muco-perichondrial envelope. The statement follows a rigorous clinical assessment where endoscopy is important because it points out the septal deformities, the size of the inferior turbinates and possible valvate problems. Performing a rhinomanometry and sometimes a CAT scan will complete the preoperative assessment.

[Twisted noses]

Correction of a twisted or crooked nose can be very complex and require the use of a broad range of surgical techniques. Patient needs are often mixed--aesthetic and functional--particularly in post-trauma cases. The quality of postoperative breathing is therefore as important as correction of the nasal deviation. Extracorporeal septoplasty or spreader grafts are very effective not only in correction of the nasal pyramid deformation, but also in resolution of functional respiratory issues. Reconstruction and proper support of the septum are necessary components for a straight nose. Aesthetic deformation can be difficult to correct owing to the memory of the bone and cartilage. Although minor deformations can be corrected with simple techniques, a more aggressive procedure is often necessary in the most complex cases. Despite attempts to correct deformation thanks to the various techniques described here, a postoperative deviation can persist. Preoperative discussion is very important and enables the surgeon to explain to the patient that it is very difficult to obtain a perfectly straight nose.