Rhinitis medicamentosa poses a therapeutic challenge for both patients and physicians. Treatment strategies vary, starting with avoidance of decongestants, followed by medications or surgical intervention. This study aimed to compare two treatment strategies for this condition.

A review was conducted of patients diagnosed with rhinitis medicamentosa from 2013 to 2021, who were managed conservatively with medications or surgically by inferior turbinate reduction.

Forty-seven patients were included: 21 patients were treated conservatively and 26 underwent turbinate reduction. Following surgical therapy, the frequency of using decongestants was significantly reduced (p < 0.001), with a significant improvement in Sino-Nasal Outcome Test-22 scores (p < 0.001). The conservative treatment group was significantly older with more co-morbidities. Following medical therapy, the conservative treatment group had a significant decrease in the frequency of decongestant use, but there was no significant improvement in their Sino-Nasal Outcome Test-22 scores.

Compared to conservative treatment, inferior turbinate reduction for rhinitis medicamentosa resulted in reduced decongestant use and improved quality of life.

This review evaluated the safety profile and efficacy of probiotics in chronic rhinosinusitis and was registered with Prospero (Centre for Reviews and Dissemination number: 42020193529).

Literature databases were searched through inception to August 2022. Randomised, controlled trials exploring adjunctive probiotics in adult chronic rhinosinusitis patients were included. From 948 records screened, 4 randomised, controlled trials were included.

Probiotics-associated adverse effects comprised epistaxis and abdominal pain. No reduction in Sino-Nasal Outcome Test values before 4 weeks (p = 0.58) or beyond 8 weeks (p = 0.08) of treatment or reduction of severe symptom frequency (p = 0.75) was observed. Symptom relapse in probiotic-treated patients was significantly lower across all timepoints (p = 0.045). Lower sinusitis relapse risks during treatment (risk ratio = 0.49; p = 0.019) and 8 months post-treatment (risk ratio = 0.56, p = 0.013) were observed. Probiotics demonstrated potential in improving Sino-Nasal Outcome Test symptom subscales, including sleep, psychological and rhinology subscales.

The optimal mode of probiotic administration, treatment duration and target patient subgroups requires further study to evaluate the utility of probiotics.

Make-at-home nasal irrigation solutions are often recommended for treating chronic rhinosinusitis. Many patients will store pre-made solution for convenient use. This study investigated the microbiological properties of differing recipes and storage temperatures.

Three irrigation recipes (containing sodium chloride, sodium bicarbonate and sucrose) were stored at 5oC and 22oC. Further samples were inoculated with Staphylococcus aureus and Pseudomonas aeruginosa. Sampling and culturing were conducted at intervals from day 0–12 to examine for bacterial presence or persistence.

No significant bacterial growth was detected in any control solution stored at 5oC. Saline solutions remained relatively bacterial free, with poor survival of inoculated bacteria, which may be related to either lower pH or lower osmolality. Storing at room temperature increased the risk of contamination in control samples, particularly from pseudomonas.

If refrigerated, pre-made nasal irrigation solutions can be stored safely for up to 12 days without risking cross-contamination to irrigation equipment or patients.

This study aimed to determine the predictors of olfactory improvement after endoscopic sinus surgery among patients with chronic rhinosinusitis with nasal polyps.

This prospective cohort study included patients admitted to a university hospital between 2006 and 2012. Assessment using odour identification testing, a sinonasal symptom questionnaire, the Rhinosinusitis Disability Index and mucus biomarker levels was performed at various time points. Correlation of variables with identification score differences at six post-operative time points and at baseline was performed, followed by multiple linear regression to determine significant predictors at each of the six post-operative time points.

Baseline absence of acute sinusitis, elevated serpin F2 and anterior rhinorrhoea predict early olfactory improvement, whereas baseline allergic rhinitis predicts late olfactory improvement. Baseline odour identification score was the strongest predictor across all time points.

Patients with chronic rhinosinusitis and nasal polyps with worse disease or baseline olfactory function may benefit more from endoscopic sinus surgery in terms of olfactory improvement.

Nasal obstruction and congestion can occur because of turbinate and septal variations with or without rhinitis. A combined treatment for nasal obstruction and congestion was examined retrospectively in cases where the nasal swell body was addressed with inferior turbinectomy, with or without posterior nasal nerve ablation.

A 940 nm laser was utilised for contact (nasal swell body, septum and inferior turbinate) and non-contact (posterior nasal nerve) ablation. Total Nasal Symptoms Score, visual analogue scale pain score, complications and procedure location (office vs operating theatre) were recorded.

All 242 patients underwent nasal swell body reduction with inferior turbinate reduction, and 150 had posterior nasal nerve ablation also. No laser complications were observed. An 80 per cent reduction in medication usage was noted. Total Nasal Symptoms Score decreased by 73 per cent; rhinorrhoea and congestion scores decreased by 54 per cent and 81 per cent respectively. Crusting, epistaxis and infections were minimal, and resolved within two weeks.

Nasal swell body with inferior turbinate reduction, with or without posterior nasal nerve ablation, is a new method of treating nasal obstruction and congestion. Laser posterior nasal nerve ablation can be utilised as a complementary tool to deliver anatomical obstruction relief.

Practices vary regarding the timing of discharge after sinonasal surgery. This study aimed to examine the cost-effectiveness of same-day discharge compared to next-day discharge after sinonasal surgery.

A retrospective single-surgeon audit of sinonasal surgery over a 12-month period was performed. Demographic and clinical details, including distance travelled home, timing of discharge, hospital re-presentation, and complications, were collected and compared between the same-day discharge and next-day discharge groups. A cost-effectiveness analysis was performed.

A total of 181 patients were identified; 117 underwent day-case surgery, of which 6 re-presented to the emergency department. Sixty-four patients stayed overnight after surgery, and six of those patients re-presented to the emergency department. The per patient cost was $3262 for day-case sinonasal surgery and $5050 for those admitted overnight after surgery (p < 0.001).

Routine same-day discharge after sinonasal surgery is achievable, safe and cost-effective.

Chronic rhinosinusitis patients with biofilms cultured from their sinonasal cavity have greater symptom burden and risk of recalcitrant disease. A number of non-antibiotic, ‘anti-biofilm’ treatments exist which show anti-biofilm properties in preclinical studies. There is little evidence evaluating their impact on clinical symptom scores in chronic rhinosinusitis.

A systematic review was performed to assess the literature regarding the efficacy of non-steroid, non-antibiotic, anti-biofilm specific topical therapies in the treatment of chronic rhinosinusitis. The primary outcome assessed was change in validated patient reported outcome measures before and after anti-biofilm treatment.

Thirteen studies assessing the effect of anti-biofilm therapies in chronic rhinosinusitis through validated patient-reported outcome measures were included. Seven different anti-biofilm specific therapies for chronic rhinosinusitis were identified. None of the seven anti-biofilm therapies was identified as being confidently efficacious beyond placebo. Only one therapy (intranasal xylitol) showed a statistically significant reduction in symptom scores compared with placebo in more than one trial.

Robust evidence supporting the use of various anti-biofilm therapies in chronic rhinosinusitis is lacking. Further high quality, human, in vivo trials studying the effect of anti-biofilm therapies in chronic rhinosinusitis are needed to address the deficiencies of the current evidence base.

Laryngopharyngeal reflux symptoms assessed with the reflux symptom index can overlap with non-allergic rhinitis symptoms. This study aims to explore the association between the reflux symptom index and nasal symptoms in non-allergic rhinitis patients.

A cross-sectional study was conducted on consecutive adults with non-allergic rhinitis. The reflux symptom index (score of more than 13 = laryngopharyngeal reflux) and nasal symptoms (categorised as mild (total score of 0–3), moderate (4–7) or severe (8–12)) were assessed.

The study included 227 participants (aged 58.64 ± 12.39 years, 59.5 per cent female). The reflux symptom index scores increased with total nasal symptom scores (mild vs moderate vs severe, 8.61 ± 6.27 vs 12.94 ± 7.4 vs 16.40 ± 8.10; p < 0.01). Logistic regression indicated that laryngopharyngeal reflux is more likely in patients with severe nose block (odds ratio 5.47 (95 per cent confidence interval = 2.16–13.87); p < 0.01).

Laryngopharyngeal reflux symptoms are associated with nasal symptom severity, and nasal symptoms should be primarily treated. Those with predominant nose block and laryngopharyngeal reflux symptoms are more likely to have laryngopharyngeal reflux.

To evaluate the colour values of nasal mucosa for the purpose of presenting an objective parameter of allergic rhinitis.

Seventy-three patients with allergic rhinitis (allergy group) and 73 normal healthy individuals (control group) were included in the study. Endoscopic examinations were conducted, and endoscopic photographs of the septum and both inferior turbinates were taken. The Adobe Photoshop Elements 7.0 software program was used to measure the numerical values of red–green–blue (RGB) colour components in the endoscopic photographs of nasal mucosa.

The G and B values were significantly higher in the allergy group compared to the control group (both p < 0.05). Cumulative R, G and B values of all measurement points were significantly higher in the allergy group compared to the control group (p < 0.05).

Nasal mucosa discolouration can be measured objectively with RGB analysis to aid the diagnosis of allergic rhinitis.

The nasal septal swell body is a normal anatomical structure located in the superior nasal septum anterior to the middle turbinate. However, the impact of the septal swell body in nasal breathing during normal function and disease remains unclear. This study aimed to establish that the septal swell body varies in size over time and correlates this with the natural variation of the inferior turbinates.

Consecutive patients who underwent at least two computed tomography scans were identified. The width and height of the septal swell body and the inferior turbinates was recorded. A correlation between the difference in septal swell body and turbinates between the two scans was performed using a Pearson's coefficient.

A total of 34 patients (53 per cent female with a mean age of 58.3 ± 20.2 years) were included. The mean and mean difference in septal swell body width between scans for the same patient was 1.57 ± 1.00 mm. The mean difference in turbinate width between scans was 2.23 ± 2.52 mm. A statistically significant correlation was identified between the difference in septal swell body and total turbinate width (r = 0.35, p = 0.04).

The septal swell body is a dynamic structure that varies in width over time in close correlation to the inferior turbinates. Further research is required to quantify its relevance as a surgical area of interest.

To analyse the associations between chronic respiratory diseases and intakes of total flavonoids and their major subclasses (flavanones, anthocyanins, flavan-3-ols, flavonols, flavones, polymers and proanthocyanidins).

Multi-case–control study.

The analysis was conducted in the frame of the Genes Environment Interaction in Respiratory Diseases (GEIRD) study. The European Prospective Investigation into Cancer and Nutrition FFQ was used to ascertain dietary intake. Multinomial regression models adjusting for age, sex, centre, BMI, smoking habit, alcohol intake, education, total energy intake, vitamin C intake and total fruit intake were used to examine the associations between dietary exposures and the relative risk ratio (RRR) of being a case.

Individuals (n 990) hierarchically defined as follows: cases with asthma (current, n 159; past, n 78), chronic bronchitis (n 47), rhinitis (allergic rhinitis, n 167; non-allergic rhinitis, n 142) and controls (n 97).

An increase of 1 sd in flavanones was associated with a reduced risk of non-allergic rhinitis (adjusted RRR = 0·68, 95 % CI 0·47, 0·97); a similar result was found comparing the highest v. lowest quartile of flavanones intake (adjusted RRR = 0·24, 95 % CI 0·10, 0·59).

Flavonoids contained in fruits and vegetables, especially flavanones, might reduce the risk of non-allergic rhinitis. No associations were found between other flavonoids and the considered outcomes.

Nasal disease imposes a significant disease burden upon the individual in the general population, but is relatively under studied in athletes. This study sought to define the frequency of nasal symptoms in the active population, and to quantify the impact of these symptoms on quality of life and on the frequency of upper respiratory tract infections.

A total of 296 participants completed the study (246 athletes and 50 sedentary controls). Nasal symptoms were significantly more frequent in the active group than in the sedentary controls (70 per cent vs 52 per cent). Upper respiratory tract infections were significantly more common in athletes with regular nasal symptoms than in athletes without nasal symptoms. Quality-of-life scores, as measured by the 22-item Sino-Nasal Outcome Test, were significantly worse in athletes with regular nasal symptoms.

This study suggests that regular exercise is associated with a significant increase in the prevalence of troubling nasal symptoms, and nasal symptoms in athletes are associated with increased susceptibility to upper respiratory tract infections. Quality of life was negatively affected, confirming the importance of nasal health to athlete welfare.

The prevalence of rhinitis in athletes has frequently been studied in combination with asthma, but the impact of exercise on the paracrine and secretory functions of nasal mucosa is less well established. This systematic review aimed to examine the effect of exercise on nasal mucosa in elite athletes.

A systematic search of Medline, Embase and the non-Medline subset of PubMed, from inception to 8th March 2016, was performed to identify studies on rhinitis in athletes.

Of the 373 identified unique articles, a total of 8 studies satisfied the criteria for this review.

There is no evidence in the existing literature that indicates a reduction in nasal airway induced by exercise. Olfaction and mucociliary transport time are affected in swimmers, which can likely be attributed to chlorine irritation and which resolves with training cessation. Short-term strenuous exercise may trigger changes in cytology and prolonged mucociliary transport time, which also resolve quickly with rest.

To evaluate the clinicopathological and mycological manifestations of fungal rhinosinusitis occurring in the Tengku Ampuan Rahimah Hospital, in Klang, Malaysia, which has a tropical climate.

Records of patients treated from 2009 to 2016 were analysed retrospectively. Data from the records were indexed based on age, gender, clinical presentations, symptom duration, clinical signs and mycological growth.

Of 80 samples, 27 (33.75 per cent) had fungal growth. Sixteen patients were classified as having non-invasive fungal rhinosinusitis and 11 as having invasive fungal rhinosinusitis. The commonest clinical presentation was nasal polyposis in non-invasive fungal rhinosinusitis patients (p < 0.05) and ocular symptoms in invasive fungal rhinosinusitis patients (p < 0.05). The commonest organism was aspergillus sp. (p < 0.05) in non-invasive fungal rhinosinusitis and mucorales in invasive fungal rhinosinusitis.

There is an almost equal distribution of both invasive and non-invasive fungal rhinosinusitis, as seen in some Asian countries. Invasive fungal rhinosinusitis, while slightly uncommon when compared to non-invasive fungal rhinosinusitis, is potentially life threatening, and may require early and extensive surgical debridement. The clinical presentation of nasal polyposis was often associated with non-invasive fungal rhinosinusitis, whereas ocular symptoms were more likely to be associated with invasive fungal rhinosinusitis.

Wound healing after endoscopic sinus surgery may result in adhesion formation. Hyaluronic acid may prevent synechiae development. A systematic review was performed to evaluate the current evidence on the clinical efficacy of hyaluronic acid applied to the nasal cavity after sinus surgery.

Studies using hyaluronic acid as an adjunct treatment following endoscopic sinus surgery for chronic rhinosinusitis were identified. The primary outcome was adhesion formation rates. A meta-analysis was performed on adhesion event frequency. Secondary outcome measures included other endoscopic findings and patient-reported outcomes.

Thirteen studies (501 patients) met the selection criteria. A meta-analysis of adhesion formation frequency on endoscopy demonstrated a lower risk ratio in the hyaluronic acid intervention group (42 out of 283 cases) compared to the control group (81 out of 282) of 0.52 (95 per cent confidence interval = 0.37–0.72). Hyaluronic acid use was not associated with any significant adverse events.

Hyaluronic acid appears to be clinically safe and well tolerated, and may be useful in the early stages after sinus surgery to limit adhesion rate. Further research, including larger randomised controlled trials, is required to evaluate patient- and clinician-reported outcomes of hyaluronic acid post sinus surgery.

This study aimed to compare two sampling methods for nasal nitric oxide in healthy individuals and allergic rhinitis patients, and to examine the within-subject reliability of nasal nitric oxide measurement.

The study included 23 allergic rhinitis patients without concomitant asthma and 10 healthy individuals. For all participants, nitric oxide levels were measured non-invasively from the lungs through the mouth (i.e. the oral fractional exhaled nitric oxide) and the nose. Nasal nitric oxide was measured by two different methods: (1) nasal aspiration via one nostril during breath holding and (2) single-breath quiet exhalation against resistance through a tight facemask (i.e. the nasal fractional exhaled nitric oxide).

Compared with healthy participants, allergic rhinitis patients had significantly higher average oral and nasal nitric oxide levels. All methods of nitric oxide measurement had excellent reliability.

Nasal nitric oxide measurement is a useful and reliable clinical tool for diagnosing allergic rhinitis in patients without asthma in an out-patient setting.

This study aimed to explore the effects of curcumin on experimental allergic rhinitis in rats.

Twenty-eight male Wistar albino rats were randomly divided into four groups: a control group; a group in which allergic rhinitis was induced and no treatment given; a group in which allergic rhinitis was induced followed by treatment with azelastine hydrochloride on days 21–28; and a group in which allergic rhinitis was induced followed by treatment with curcumin on days 21–28. Allergy symptoms and histopathological features of the nasal mucosa were examined.

The sneezing and nasal congestion scores were higher in the azelastine and curcumin treatment groups than in the control group. Histopathological examination showed focal goblet cell metaplasia on the epithelial surface in the azelastine group. In the curcumin group, there was a decrease in goblet cell metaplasia in the epithelium, decreased inflammatory cell infiltration and vascular proliferation in the lamina propria.

Curcumin is an effective treatment for experimentally induced allergic rhinitis in rats.