Donaldson, Angela M.

Abstract This study aimed to investigate the association between objective and subjective olfactory assessments in patients with recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection undergoing endoscopic endonasal skull base surgery (EESBS). Retrospective cohort study. Academic medical center. Adult patients with and without recent SARS-CoV-2 infection who underwent EESBS for sellar and parasellar lesion resection between 2020 and 2024 at the Mayo Clinic in Florida, Jacksonville, FL. Pre- and postoperative self-reported olfactory dysfunction and University of Pennsylvania Smell Identification Test (UPSIT) scores were collected. Patients with recent SARS-CoV-2 infection had a similar rate of discrepant preoperative objective olfactory assessments (38.2%, 26/68) compared with SARS-CoV-2-negative patients (39.9%, 127/318). SARS-CoV-2-positive patients were twice as likely to report postoperative subjective olfactory dysfunction (46.2%, 12/26) compared with SARS-CoV-2-negative patients (18.1%, 23/127, p = 0.002). There was no statistically significant difference in the mean preoperative (p = 0.162) or postoperative (p = 0.724) UPSIT scores between both groups. Patients with recent SARS-CoV-2 infection and discrepant preoperative objective olfactory assessments were twice as likely to self-report olfactory dysfunction following EESBS compared with SARS-CoV-2-negative controls. This increase in self-reported olfactory dysfunction was not accompanied by changes in objective psychophysical testing. These findings suggest that SARS-CoV-2 infection may impact subjective olfactory recovery following EESBS.

ABSTRACTBackgroundIn sinonasal cancer (SNC), treatment with proton therapy (PT) provides excellent local control, especially after gross total resection. Because of the heterogeneity and rarity of this disease site, a comprehensive assessment of toxicity, survival, and control rates is lacking. Our primary objective was to assess the toxicity outcomes of PT in SNC patients, with a secondary aim of assessing survival and tumor control after PT.MethodsPubMed, Embase, EBSCO, Scopus, Science Direct, Web of Science, Ovid, Proquest, and Cochrane Library were searched from inception to August 2024 reporting PT acute and late toxicity, survival, and tumor control outcomes in SNC patients. A random‐effect meta‐analysis was used to assess the pooled safety, survival, and tumor control outcomes. The primary analysis was to report acute and late toxicity. The secondary aims included overall survival (OS), disease‐free survival (DFS), local control (LC), regional control (RC), and distant metastasis control (DMC) rate.ResultsFourteen studies were included for qualitative analysis. We pooled data from 756 patients who received PT for SNC. Among acute toxicity (AT), there was a 31.9% occurrence rate of grade ≥ 3 events, whereas within late toxicity (LT), grade ≥ 3 events occurred at a rate of 35.3%. Most LT (62.1%) were classified as grade 2, with the most frequent being ocular (24.8%) or neurological (18.4%) toxicities. The most common grade ≥ 3 toxicities were mucositis (15.3%) in AT and ocular toxicity (9.6%) in LT. The pooled 5‐year OS, DFS, LC, RC, and DMC were 36.8%, 34.2%, 35.6%, 28.6%, and 54.3%, respectively.ConclusionOur analysis demonstrates that PT‐treated SNC patients experience acceptable rates of acute and LT consistent with other published outcomes with highly conformal radiation techniques. PT demonstrates favorable OS and DFS. Further prospective and comparative effectiveness research is needed to better quantify the magnitude of the benefit of PT or other forms of radiation modalities.

AbstractObjectiveThis study aimed to evaluate the impact of endoscopic sinus surgery (ESS) on asthma severity up to 12 months after surgical intervention.Study DesignRetrospective cohort.SettingTertiary care center.MethodsPatients with a history of asthma and Chronic Rhinosinusitis (CRS) who underwent ESS between 2013 and 2023 were included. Asthma severity was assessed according to current Global Initiative for Asthma (GINA) guidelines, classifying patients into mild, moderate, and severe based on medication requirements. Asthma severity was evaluated up to 3 months prior to ESS and 1‐year post‐ESS. Patients with aspirin‐exacerbated respiratory disease (AERD) were excluded. Statistical analysis was performed using McNemar test and Wilcoxon signed‐rank test to assess differences in asthma severity, medication doses, and number of medications.ResultsSixty‐five patients were included, of which 44 (67.7%) had CRS with nasal polyps (CRSwNP) and 21 (32.3%) had CRS without nasal polyps (CRSsNP). No significant differences were found in asthma severity pre‐ and post‐ESS (P = .175). Similarly, no differences were found in ICS doses (P = .999), total number of prescribed medications (P = .157) or presence of exacerbations before and after ESS (P = .078). However, a significant increase in time from last rescue inhaler use was noted after ESS, increasing from a median of 6.71 to 23.1 weeks (P = .004).ConclusionThis study is the first to assess the impact of ESS on asthma severity in a real‐world setting. Our findings suggest that ESS does not impact asthma severity classification. However, it might provide relief of asthma symptoms in the early postoperative period.