O’Brien, Erin K.

Abstract Background Upper-airway and respiratory conditions impose a large and growing global burden, yet there is no standardized way to assess whether a nasal microbiome is “healthy”. Currently, monitoring remains reactive, beginning only after symptoms manifest. The nasal cavity is well suited to proactive monitoring: it shapes respiratory health and pathogen colonization resistance, and can be sampled non-invasively and repeatedly. To address this gap, we introduce the Nasal Microbiome Wellness Index (NMWI), a disease-agnostic, continuous score of nasal microbiome health derived from LASSO-penalized logistic regression. Rather than counting taxa, it learns which taxa (and in what balance) characterize a healthy nose and returns the predicted log-odds that a profile resembles a healthy state. The index was trained on 1654 nasal 16S rRNA gene amplicon sequencing samples (589 healthy, 1065 non-healthy) pooled from 27 publicly available studies, uniformly reprocessed through a single computational pipeline. Results The NMWI comprises an interpretable signature of 24 taxa whose combined relative abundances determine the health-associated log-odds. Health-associated genera such as Corynebacterium and Cutibacterium raised the score, while dysbiosis-associated genera such as Pseudomonas and Escherichia – Shigella lowered it. The NMWI substantially outperformed the Shannon, Simpson, and Chao1 diversity indices, which showed negligible, directionally inconsistent separation between healthy and non-healthy samples (|Cliff’s δ | = 0.01–0.20), whereas the NMWI produced large, consistent separation ( δ = 0.65). It achieved a balanced accuracy of 74.37% on the training data (resubstitution estimate), and 73.43% under repeated 10-times 10-fold cross-validation. Performance remained stable at mean balanced accuracy of 73.82% under a leave-one-study-out framework, reflecting cross-study generalizability. In independent external cohorts, the balanced accuracy was 71.49%, and leave-one-disease-out analysis (in which each disease condition was withheld from training) showed a mean balanced accuracy of 63.92% across unseen conditions, consistent with a disease-agnostic design. The index also generalized across heterogeneous datasets spanning multiple 16S rRNA gene hypervariable regions—to our knowledge the first demonstration of such cross-study, cross-region transferability for the nasal cavity. Conclusions The NMWI distills a complex nasal microbial profile into a single interpretable score computed directly from the 16S rRNA gene data that dominate existing nasal research, making it immediately applicable to published and future datasets without re-sequencing. By replacing descriptive, diversity-based comparison with a quantitative standard, it offers a reproducible, open-source foundation for cross-study benchmarking, individual-level phenotyping, and longitudinal respiratory wellness monitoring.

ABSTRACT Background Preoperative vascular embolization (PVE) is commonly used in managing juvenile nasopharyngeal angiofibroma (JNA) to improve outcomes. However, few studies have evaluated how embolization patterns and vascular features affect prognosis. Methods A 15‐year retrospective review was performed on 44 patients with JNA undergoing surgery at one institution. Data included demographics, vascular supply, embolization techniques, surgical outcomes, and recurrence. Results Forty‐three patients underwent PVE. Most tumors were embolized transarterially (93.0%) using polyvinyl alcohol‐based agents (79.1%). The internal maxillary artery was most commonly embolized (93.0%). Internal carotid artery supply was present in 34.9%, and more than two vessels were embolized in 23.3%. Postembolization tumor blush occurred in 60.5%, with a median of 5% of the pre‐embolization blush remaining after embolization. Neither internal carotid involvement, number of vessels embolized, nor residual blush significantly impacted operative time, surgical outcomes, or recurrence. Conclusion With effective embolization, vascular complexity might not affect JNA resection outcomes. Multicenter studies are required to confirm those findings.

Key points Staphylococcus aureus showed a significant increase in relative abundance in CRSwNP patients following endoscopic sinus surgery compared to pre‐surgery samples. Other Staphylococcus species were found to correlate positively with S. aureus in patients with nasal polyps; among those, S. caprae correlated strongly while being the most represented in samples. Patients with recurrent nasal polyp growth exhibited a substantially greater postoperative increase in the relative abundance of S. aureus .

Background Olfactory dysfunction (OD) is a common symptom in patients with coronavirus disease 2019 (COVID-19) with limited treatment options. Objective This pilot study aimed to investigate an acupuncture protocol in patients with COVID-19 related OD. Methods Thirty patients were randomized into 2 groups. The standard group was treated with budesonide nasal irrigation and olfactory training. The acupuncture group received ten sessions of acupuncture therapy in addition to the standard group treatment. Olfaction was assessed using the University of Pennsylvania Smell Identification Test, 10-point visual analog scale, and Sino-Nasal Outcome Test at baseline and after 3 months of treatment. Differences between study arms were compared using Fisher’s exact and Wilcoxon rank sum tests. Results Eighteen of the 30 (60%) enrolled patients completed the study, including 11 (73%) in the standard and 7 (47%) in the acupuncture group. Reasons for participant drop-out included cost of travel and time constraints. There were no acupuncture complications. Conclusions Acupuncture as an adjunct therapy for COVID-19 related OD is well tolerated. Subsequent studies with larger sample sizes are needed to assess the effect of acupuncture on OD.

OBJECTIVE This study aimed to provide data on extended outcomes in primary clival chordomas, focusing on progression-free survival (PFS) and overall survival (OS). METHODS A retrospective single-center analysis was conducted on patients with clival chordoma treated between 1987 and 2022 using surgery, stereotactic radiosurgery, or proton radiation therapy (PRT). RESULTS The study included 100 patients (median age 44 years, 51% male). Surgery was performed using the endoscopic endonasal approach in 71 patients (71%). Gross-total resection (GTR) or near-total resection (NTR) was attained in 39 patients (39%). Postoperatively, new cranial nerve deficits occurred in 7%, CSF leak in 4%, and meningitis in none of the patients. Radiation therapy was performed in 79 patients (79%), with PRT in 50 patients (50%) as the primary treatment. During the median follow-up period of 73 (interquartile range [IQR] 38–132) months, 41 recurrences (41%) and 31 deaths (31%) were confirmed. Patients with GTR/NTR had a median PFS of 41 (IQR 24–70) months. Patients with subtotal resection or biopsy had a median PFS of 38 (IQR 16–97) months. The median PFS of patients who received radiation therapy was 43 (IQR 26–86) months, while that of patients who did not receive radiation therapy was 18 (IQR 5–62) months. The Kaplan-Meier method showed that patients with GTR/NTR (p = 0.007) and those who received radiation therapy (p < 0.001) had longer PFS than their counterparts. The PFS rates following primary treatment at 5, 10, 15, and 20 years were 51%, 25%, 17%, and 7%, respectively. The OS rates at the same intervals were 84%, 60%, 42%, and 34%, respectively. Multivariate Cox regression analysis showed that age < 44 years (p = 0.02), greater extent of resection (EOR; p = 0.03), and radiation therapy (p < 0.001) were associated with lower recurrence rates. Another multivariate analysis showed that age < 44 years (p = 0.01), greater EOR (p = 0.04), and freedom from recurrence (p = 0.02) were associated with lower mortality rates. Regarding pathology data, brachyury was positive in 98%, pan-cytokeratin in 93%, epithelial membrane antigen in 85%, and S100 in 74%. No immunohistochemical markers were associated with recurrence. CONCLUSIONS In this study, younger age, maximal safe resection, and radiation therapy were important factors for longer PFS in patients with primary clival chordomas. Preventing recurrences played a crucial role in achieving longer OS.

OBJECTIVE The objective of this study was to clarify the detailed clinical course of recurrent clival chordoma and the outcomes of each treatment modality. METHODS A single-center retrospective analysis was conducted on patients seen for recurrent clival chordoma. The cohort was identified from those who underwent surgery, stereotactic radiosurgery, or proton therapy at the authors’ institution between 1990 and 2022. RESULTS A total of 95 recurrences in 40 patients with a median (interquartile range [IQR]) follow-up of 43 (18–79) months were identified. The median (IQR) age at the time of diagnosis was 48 (36–62) years, and 55% of patients were male. Twenty-three patients were treated with surgery followed by adjuvant radiation before the first recurrence. The median (range) number of recurrences per patient was 2 (1–8), and the median (IQR) time to the first recurrence was 29 (9–51) months. The recurrences were treated with one or more of the following therapies: surgery, radiation, systemic therapy, and laser interstitial thermal therapy (LITT). Surgery was performed for 44 recurrences in 25 patients. Radiation was used to treat 42 recurrences in 28 patients. Patients with recurrences treated with surgery plus radiation had the longest progression-free survival (PFS) (median [95% CI] overall survival [OS] 120 [0–245] months, p < 0.01, log-rank test). Patients with recurrences but without prior radiation had longer PFS than those patients with prior radiation. The median (95% CI) OS after the first recurrence was 68 (54–82) months, 5-year OS after the first recurrence was 48%, and 10-year OS was 27%. Multivariate Cox regression analysis showed that mortality after the first recurrence was significantly associated with no adjuvant radiation (HR 0.149, 95% CI 0.038–0.59, p = 0.0067), older age at the time of the first recurrence (HR 1.04, 95% CI 1.01–1.08, p = 0.021), and total number of recurrences (p = 0.032). Seven patients received systemic therapy, and the median (95% CI) OS of these patients since initiation of systemic therapy was 31 (11–51) months. Imatinib and/or nivolumab were used in 6 patients (15%). One patient (3%) was treated with LITT for his fourth recurrence. CONCLUSIONS Despite the aggressive nature of recurrent chordoma, 14 of 29 patients (48%) survived for more than 5 years after the initial recurrence using combined therapies. Multiple treatment options may contribute to the long-term survival of patients with this intractable tumor.

AbstractBackgroundWe identify chronic rhinosinusitis (CRS) manifestations associated with how rhinologists assess CRS control, with a focus on patient perspectives (patient‐reported CRS control).MethodsFifteen rhinologists were provided with real‐world data from 200 CRS patients. Participating rhinologists first classified patients’ CRS control as “controlled,” “partly controlled,” and “uncontrolled” using seven CRS manifestations reflecting European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) CRS control criteria (nasal obstruction, drainage, impaired smell, facial pain/pressure, sleep disturbance, use of systemic antibiotics/corticosteroids in past 6 months, and nasal endoscopy findings) and patient‐reported CRS control. They then classified patients’ CRS control without knowledge of patient‐reported CRS control. Interrater reliability and agreement of rhinologist‐assessed CRS control with patient‐reported CRS control and EPOS guidelines were determined.ResultsCRS control classification with and without knowledge of patient‐reported CRS control was highly consistent across rhinologists (κw = 0.758). Rhinologist‐assessed CRS control agreed with patient‐reported CRS control significantly better when rhinologists had knowledge of patient‐reported CRS control (κw = 0.736 vs. κw = 0.554, p < 0.001). Patient‐reported CRS control, nasal obstruction, drainage, and endoscopy findings were most strongly associated with rhinologists’ assessment of CRS control. Rhinologists’ CRS control assessments weakly agreed with EPOS CRS control guidelines with (κw = 0.529) and without (κw = 0.538) patient‐reported CRS control. Rhinologists classified CRS as more controlled than EPOS guidelines in almost 50% of cases.ConclusionsThis study directly demonstrates the importance of patient‐reported CRS control as a dominant influence on rhinologists’ CRS control assessment. Knowledge of patient‐reported CRS control may better align rhinologists’ CRS control assessments and treatment decisions with patients’ perspectives.

Abstract Introduction Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and positive sinonasal bacterial cultures may be recalcitrant to topical therapy alone due to the additional local inflammatory burden associated with bacterial infection/colonization. Objective To evaluate sinonasal outcomes in CRSwNP patients with a positive perioperative bacterial culture, who were treated with postoperative intranasal corticosteroids (INCS) alone versus INCS in combination with a short-term course of oral corticosteroids (OCS). Methods This is a retrospective chart review of CRSwNP patients. A total of 59 patients met inclusion criteria, including positive perioperative bacterial culture and treatment with INCS with or without concomitant use of OCS. Two cohorts were formed based on the chosen postoperative medical treatment; 32 patients underwent postoperative INCS alone, while 27 underwent INCS plus a ≤ 2-week course of OCS. The 22-item sinonasal outcome test (SNOT-22) scores and Lund-Kennedy scores (LKS) were assessed preoperatively, and at 2-week, 4-week, and 4 to 6 months after endoscopic sinus surgery (ESS). Results There were no statistically significant differences in postoperative sinonasal symptoms or endoscopic scores between the cohorts treated with INCS plus OCS versus those prescribed INCS alone (p > 0.05). Our regression model failed to demonstrate a relationship between the use of OCS and better sinonasal outcomes at 2-week, 4-week, and 4 to 6 months after ESS (p > 0.05). Conclusion Our study suggests that in a cohort of CRSwNP patients with recent bacterial infections, the postoperative use of combined OCS and INCS did not result in a statistical improvement of endoscopic and symptomatic outcomes over INCS irrigation alone. However, both treatment groups had a clinically significant improvement based on the Minimal Clinically Important Difference.

AbstractObjectivesDysfunction in smell or taste is well recognized phenomenon in patients infected with SARS‐CoV‐2. This study aimed to quantify the incidence and associated co‐morbidities of reported olfactory or gustatory dysfunction in patients who tested positive for SARS‐CoV‐2.MethodsFrom March 23, 2020 through July 31, 2020, 192,683 patients were tested for SARS‐CoV‐2 at Mayo Clinic. These patients with a positive test were contacted via telephone by physicians at Mayo Clinic and information gathered on patient demographics, comorbidities, symptoms and clinical risk stratification based on these factors.ResultsTwo thousand two hundred and fifty patients tested positive for SARS‐CoV‐2 (1.2%). Six hundred and sixty‐seven (29.6%) of these patients reported loss of smell or taste. Factors found to be correlated with reporting loss of smell or taste on multivariate analysis were: younger age, female sex, or symptoms of chest pain or tightness, cough, or headache and lower clinical risk category. Coronary artery disease (CAD) was associated with not reporting loss of taste or smell.ConclusionOf 2250 patients testing positive for SARS‐CoV‐2 at Mayo Clinic, 667 reported loss of taste and smell. Patients who reported loss of smell or taste were younger, female and more likely to report cough, chest pain, headache, or history of chronic obstructive pulmonary disease (COPD), but overall had fewer high‐risk comorbidities. Those who were older, male, and a reported history of CAD were less likely to report chemosensory dysfunction. Our data are the largest single institution data reporting COVID‐19 associated loss of smell or taste, and the first to associate COPD and CAD as factors that affect rates of reported chemosensory dysfunction.Level of evidenceIIB.