Use of Vandenberg and Kuse Mental Rotation Test to Predict Practical Performance of Sinus Endoscopy

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Benralizumab in severe eosinophilic asthma in real life: confirmed effectiveness and contrasted effect on sputum eosinophilia versus exhaled nitric oxide fraction - PROMISE.

peer reviewedBACKGROUND: Randomised controlled trials have shown that benralizumab, an anti-interleukin-5 receptor monoclonal antibody, reduces exacerbations and oral corticosteroid dose and improves asthma control and lung function in severe eosinophilic asthma. The aim of this study was to confirm results of randomised controlled trials in real life in a population of 73 patients with severe eosinophilic asthma treated with benralizumab for at least 12 months. METHODS: Patients underwent careful monitoring of asthma exacerbations, exhaled nitric oxide fraction, lung function, asthma control and quality of life questionnaire responses and sputum induction, and gave a blood sample at baseline, after 6 months and then every year. RESULTS: We found significant reductions in exacerbations (by 92%, p<0.0001) and oral corticosteroid dose (by 83%, p<0.001) after 6 months that were maintained over time, with 78% of patients able to stop oral corticosteroid therapy. Patients improved their Asthma Control Test (ACT) score (from 11.7±5.1 to 16.9±5.35, p<0.0001), Asthma Control Questionnaire (ACQ) score (from 2.88±1.26 to 1.77±1.32, p<0.0001) and Asthma Quality of Life Questionnaire score (+1.04, p<0.0001) at 6 months and this was maintained during follow-up. Only 35% and 43% of patients reached asthma control according to an ACT score ≥20 and ACQ score <1.5, respectively. We observed stable post-bronchodilation lung function over time and a significant reduction in sputum eosinophil count, with 85% of patients exhibiting sputum eosinophil counts <3% after 6 months (p<0.01) with no effect on exhaled nitric oxide fraction. CONCLUSION: In our real-life study, we confirm the results published in randomised controlled trials showing a sharp reduction in exacerbations and oral corticosteroid therapy, an improvement in asthma control and quality of life, and a dramatic reduction in sputum eosinophil count

Responsiveness of acoustic rhinometry to septorhinoplasty by comparison to rhinomanometry and subjective instruments.

peer reviewedOBJECTIVES: Nose patency measures and instruments assessing subjective health are increasingly being used in rhinology. However, there is very little evidence of comparing existing methods' responsiveness to change. We evaluated the responsiveness of acoustic rhinometry to nasal valve surgery by comparison to rhinomanometry and patient-reported outcome instruments. DESIGN: Prospective case-control study Setting: Tertiary referral University Hospital Participants: Sixty consecutive patients with internal nasal valve dysfunction and 20 healthy volunteers as control group were enrolled. Prospectively collected data included acoustic rhinometry, rhinomanometry, NOSE scale, SNOT-23 questionnaire, visual analogue scale and demographics. MAIN OUTCOME MEASURES: Primary endpoint was the responsiveness of acoustic rhinometry to functionnal septorhinoplasty surgery at 3 months. Secondary endpoints were ability of acoustic rhinometry to reflect "known group" differences and correlation to subjective symptoms. RESULTS: Acoustic rhinometry was highly responsive to septorhinoplasty (p<0.0001) while anterior rhinomanometry was not (p=0.08). Based on the quartiles of the post-operative change in NOSE score, patients were classified as respectively non responders, mild, moderate and good responders to surgery. Logistic regression model showed that acoustic rhinometry was able to discriminate non responders to responders to surgery (p=0.019), while anterior rhinomanometry failed (p=0.611). Sensitivity and specificity of acoustic rhinometry were significantly higher (ROC area=0.76) than rhinomanometry (ROC area =0.48). Acoustic rhinometry was also superior than rhinomanometry to discriminate patients from control subjects, and agreed better with patients-based subjective questionnaires. CONCLUSIONS: Our study confirms and quantifies the responsiveness of acoustic rhinometry to nasal valve surgery, with a higher sensitivity and specificity than rhinomanometry. This article is protected by copyright. All rights reserved

Crooked nose: an anatomical retrospective study

editorial reviewedIntroduction and Aim: Crooked nose is a common term used for all deviations of the nasal axis from the midline, leading to both aesthetic and breathing issues. Predisposing factors are numerous. The goal of this study was to determine the anatomical structures involved in nose assymetry and their eventual relationship with childhood injury. Methods: In this retrospective study, 70 septorhinoplasty patients with pre-operative crooked noses were assessed from 2015 to 2020. Demographic and clinical variables were collected, especially history of nasal injury in relation to pubertal growth spurt. Using each patient’s pre-operative imaging, frontal process of the maxilla, nasal bones, septal cartilage, perpendicular plate, vomer, crest of maxilla and lateral nasal wall (inferior and middle turbinates) were evaluated. Results: In the childhood inujry crooked nose population (n=24), 17 (70.8%) had deviated frontal process of the maxilla, 15 (32.5%) deviated basal bones, 18 (75%) deviated crista maxillaris, 20 (83.3%) deviated septal cartilage and 10 (41.7%) deviated perpendicular plate. In the post-puberty trauma crooked nose population (n=28), 10 (35.7%) had deviated frontal process of the maxilla, 22 (78.6%) deviated nasal bones, 9 (32.1%) deviated crista maxillaris, 19 (67.9%) deviated septal cartilage and 10 (35.7%) deviated perpendicular plate. In the non-traumatic crooked nose population (n=12), 11 (91.7%) had deviated frontal process of the maxilla, 11 (91.7 %) deviated nasal bones, 8 (66.7%) deviated crista maxillaris, 10 (83.3%) deviated septal cartilage, 10 (83.3%) deviated perpendicular plate. Conclusion: Deviated nose is more complex than just an asymmetric position of nasal bones. It involves the frontal process of maxillary bone, the nasal bones (length and position), the lateral nasal wall and the septum. History of childhood injury was associated to more complex deformities. A good understanding of these anatomical factors might help surgical planning

Les vascularites à ANCA chez les consommateurs de cocaïne : de la poudre aux yeux ?

ocaine use is a typical etiological trap for vasculitis. The Cocaine Induced Midline Destruction Lesions (CIMDL) is a challenge considering the mimic clinical and serological presentation with localized manifestation of the granulomatosis with polyangiitis (GPA). CIMDL lesions are characterised by painful nasal obstruction, with perforation of septum and inferior turbinates, with no ophthalmologic, auditory and systemic signs. In opposed to localised GPA, CIMDL lesions are more painful with more epistaxis. The localisation of the lesions is mainly medial, with frequent septal perforation and limited to rhinologic involvement. C-reactive protein is usually negative. Biopsy reveals a chronic inflammation, frequently ulcerated without granulomas or multinucleated giant cells. Serological biomarkers typically show ANCA-PR3 positivity, but with perinuclear pattern, as opposed to the cytoplasmic pattern in GPA. Anti-HNE Antibodies could also be detected and are highly specifics. Corticosteroids and either immunosuppressive treatment are poorly effective. The mucosal damage caused by ischemia or by crystal-induced microtrauma may predispose cocaine users to the development of chronic low-grade infection with S.Aureus. S.Aureus releases toxins known to be powerful superantigens, which can explain ANCA formation. The first aim is the complete avoidance of cocaine consumption. Local ENT treatment is indicated. Trimetoprim-Sufamethoxazole has been reported to be beneficial because it reduces the nasal carriage of S.Aureus

LOCALIZED NECROTIZING VASCULITIS AMONG COCAINE USUERS : SMOKE AND MIRROS ?

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