Candelo, Estephanía

Importance Acute invasive fungal rhinosinusitis (AIFRS) is a rapidly progressive and potentially life-threatening infection that predominantly affects immunocompromised patients. Recent advances in diagnostic imaging, antifungal therapy, and surgical techniques may have altered its incidence, morbidity, and mortality. Objective To evaluate temporal trends in the pooled proportion, morbidity, and mortality of AIFRS in immunocompromised patients and assess the association of diagnostic and therapeutic advances. Data Sources Systematic searches of Ovid MEDLINE, Ovid Embase, PubMed, Scopus, Web of Science, Cochrane, and Google Scholar from 1977 through October 20, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study Selection Prospective, retrospective, and cross-sectional studies and case series reporting pooled proportion, morbidity, or mortality of AIFRS in immunocompromised patients were included. Non-English articles, reviews, editorials, and studies with fewer than 10 patients were excluded. Data Extraction and Synthesis Two independent reviewers extracted data using standardized templates; disagreements were resolved by consensus. Risk of bias was assessed using the Newcastle-Ottawa Scale and Murad tool for case series. Random-effects meta-analysis generated pooled proportion, morbidity, and mortality rates with 95% CIs. Heterogeneity was quantified using I 2 statistics. Meta-regression and sensitivity analyses evaluated temporal trends and study-level effects. Main Outcomes and Measures Pooled proportion, morbidity, and mortality rates of AIFRS stratified by publication period (1983-2012 vs 2013-2025). Results A total of 205 studies comprising 48 437 immunocompromised patients (median [range] age, 49.4 [5.2-68.8] years), including 10 311 (21.3%) with AIFRS, were analyzed. The pooled proportion was 11.8% (95% CI, 7.9%-17.2%), rising to 16.6% (95% CI, 8.7%-29.2%) in studies from 2013 to 2025. Overall mortality was 31.2% (95% CI, 28.3%-34.3%), declining from 41.9% (95% CI, 35.0%-49.1%) before 2013 to 28.2% (95% CI, 25.1%-31.4%) after 2013. Morbidity was 37.0% (95% CI, 32.9%-41.4%), with similar rates across periods (39.3% before 2013 vs 36.4% after 2013). The most common complications were vision loss, exophthalmos/proptosis, and orbital exenteration. Conclusions and Relevance This systematic review and meta-analysis suggests that the pooled proportion of AIFRS among immunocompromised patients has increased while mortality has declined, reflecting advances in diagnostic and therapeutic approaches. Early detection and aggressive management remain critical to improving outcomes.

Abstract Objective Recurrent acute rhinosinusitis (RARS) significantly decreases quality of life. Transplant recipients (TR) are particularly vulnerable to rhinologic conditions. There is a lack of guidelines for managing RARS in this population. Our study aims to determine the prevalence of and risk factors for RARS among TR and assess the need for sinus surgery within this group. Study Design Retrospective cohort. Setting Mayo Clinic between 2017 and 2022. Methods A total of 1116 patients met the inclusion criteria and were divided based on the presence or absence of a new incident RARS diagnosis during the posttransplant period and frequency of sinus surgery. Logistic regression (LR) analysis was performed to identify the odds ratio. Results In total, 111/1116 (9.95%) had RARS. Patients with RARS had an increased history of asthma, viral infection, and rheumatoid arthritis (RA) ( P = .003) in the pretransplant period. According to the LR analysis, patients with neutropenia, RA, and mantle cell lymphoma were 1.91, 2.71, and 4.02 times more likely to develop RARS (95% CI: 1.19‐3.05, P = .01), (95% CI: 0.90‐8.14, P = .07), and (95% CI: 1.16‐13.89, P = .02) during the posttransplant period, respectively. In those that developed RARS, only 5.5% failed medical therapy and required surgery. Conclusion This is the first cohort to investigate the incidence of RARS in TR and the predictive factors associated with its development posttransplant. We found that patients with pretransplant comorbidities such as RA, viral infections, hematologic deficiencies, and malignancies were at an increased risk for developing RARS, though this is not linked to an increased necessity for sinus surgery.

Objective: To estimate the relative risk of meningitis after repair of spontaneous lateral skull base cerebrospinal fluid (CSF) leaks through meta-analysis of published studies. Databases Reviewed: PubMed, Medline, Embase, Cochrane, SCI-EXPANDED, ESCI, Epistemonikos, and WHO Global Index Medicus were queried for terms including and related to meningitis, CSF leak, surgery, and spontaneous from inception to April 02, 2024. Methods: Prospective and retrospective studies in any language reporting either preoperative or postoperative rates of meningitis in adults with spontaneous lateral skull base CSF leaks were included. Two reviewers independently screened 2,564 studies and extracted data and evaluated risk of bias in 57 studies that met inclusion criteria. A random effects generalized linear mixed model was used to pool and compare logit transformed risk of meningitis before and after repair. Results: Of 1,310 patients who met inclusion criteria, 1,239 underwent CSF leak repair. Fifty-two studies reported rates of preoperative meningitis, and 27 studies reported rates of postoperative meningitis. Twenty-two studies with a total of 511 patients reported both rates. The average follow-up period of 17 studies reporting duration of follow-up was 23.1 months. The preoperative pooled risk of meningitis was 0.16 (95% CI: 0.13–0.25, I 2 = 40.57%). The postoperative pooled risk was considerably lower at 0.01 (95% CI: 0.01–0.14, I 2 = 4.16%). With substantial heterogeneity (I 2 = 62.94%), we observed a relative risk of meningitis after repair of 0.02 (95% CI: 0.00–0.79, p = 0.04). Conclusion: Surgical repair of spontaneous lateral skull base CSF leaks may significantly reduce the risk of adult meningitis.

Objective: To explore the associations between social determinants of health (SDOH) and the access to, delivery of, and outcomes of cholesteatoma care. Study Design: Retrospective review. Setting: Multisite tertiary care institution. Methods: Seventy-five adults (aged 18–83) with cholesteatoma who completed SDOH questionnaires were included. Outcome measures included SDOH risk factor prevalence (stress, housing instability, financial resource strain, social connectedness, food insecurity, intimate partner violence), disease severity, hearing loss degree at presentation, mean time from symptom onset to diagnosis, postoperative improvements in air-bone gaps (ABG), complication rates, and two-stage surgery rates. Results: Stress (n = 45; 60%) was the most prevalent SDOH risk factor. Females (n = 23; 79.3%; P = 0.05; d = –0.24]), younger adults (mean age = 45; P = 0.01; d = –0.69), and individuals with lower education (n = 23; 82.1%; P = 0.04; d= –0.26) were more likely to have at least one SDOH risk factor. Patients with SDOH risk factors had better preoperative air pure tone averages (mean [SD] = 39.7 [16]; P = 0.01; d = –0.69) than patients without SDOH risk factors (mean [SD] = 50.1 [13.5]); but the ABG was similar between groups (P = 0.16; d = –0.38). No differences were identified in any measure of cholesteatoma care between patients with and without SDOH risk factors. Conclusion: Stress is a prevalent SDOH risk factor among patients with cholesteatoma, but it might not influence cholesteatoma care. Though female sex, younger age, and lower education levels were associated with having at least one SDOH risk factor, these also might not influence cholesteatoma care. Intentional study of larger, more heterogeneous populations is necessary to validate these observations.

ABSTRACTBackgroundDespite the general perception of minimal donor‐site morbidity associated with scapular free flaps, the surgical harvest of scapular bone and subsequent reattachment of parascapular muscle have the potential to compromise postoperative shoulder function. A comprehensive assessment of functional impairment remains undocumented in the literature. Therefore, this systematic review was conducted to thoroughly explore both subjective and objective donor‐site morbidity following free flap surgery.MethodsSearches were conducted on PubMed, Embase, and CENTRAL to locate articles addressing functional donor‐site morbidity after the transfer of scapular bone. Qualifying articles reported scapular free flaps which utilized bone, including lateral border, medial border, and scapular tip. Each measured donor‐site morbidity using at least one of these measures: Constant‐Murley score (CM), Disabilities of Arm, Shoulder, and Hand questionnaire (DASH), shoulder range of motion (ROM), and shoulder strength.ResultsThe search culminated in 16 eligible studies, incorporating data from 316 cases. The CM was employed in five studies, yielding mean values from 60.6 to 95, while the DASH was utilized in nine studies, with means ranging from 10.44 to 46.7. Compared to normative values, these CM and DASH scores reflected negligible to mild impairment in shoulder function. Additional evaluations of shoulder ROM, conducted in four studies, revealed modest yet statistically significant reductions in flexion, abduction, and external rotation. Three studies measuring shoulder strength reported associated mild weakening of these motions.ConclusionsThis systematic review enables healthcare providers to characterize the probable scope of shoulder dysfunction following scapular bone harvest. Patient‐reported outcomes imply a high tolerance for the procedure, while objective measures denote the potential for substantial restoration of shoulder function approaching preoperative levels. To augment the understanding of functional recovery, future research should incorporate a comparative analysis of preoperative and postoperative functional metrics for each subject.