Roger Jankowski

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Isam Alobid, MD, PhD1, Nithin D. Adappa, MD2, Henry P. Barham, MD3, Thiago Bezerra, MD4, Nadieska Caballero, MD5, Eugene G. Chang, MD6, Gaurav Chawdhary, MD7, Philip Chen, MD8, John P. Dahl, MD, PhD9, Anthony Del Signore, MD10, Carrie Flanagan, MD11, Daniel N. Frank, PhD12, Kai Fruth, MD, PhD13, Anne Getz, MD14, Samuel Greig, MD15, Elisa A. Illing, MD16, David W. Jang, MD17, Yong Gi Jung, MD18, Sammy Khalili, MD, MSc19, Cristobal Langdon, MD20, Kent Lam, MD21, Stella Lee, MD22, Seth Lieberman, MD23, Patricia Loftus, MD24, Luis Macias‐Valle, MD25, R. Peter Manes, MD26, Jill Mazza, MD27, Leandra Mfuna, MD28, David Morrissey, MD29, Sue Jean Mun, MD30, Jonathan B. Overdevest, MD, PhD31, Jayant M. Pinto, MD32, Jain Ravi, MD33, Douglas Reh, MD34, Peta L. Sacks, MD35, Michael H. Saste, MD36, John Schneider, MD, MA37, Ahmad R. Sedaghat, MD, PhD38, Zachary M. Soler, MD39, Neville Teo, MD40, Kota Wada, MD41, Kevin Welch, MD42, Troy D. Woodard, MD43, Alan Workman44, Yi Chen Zhao, MD45, David Zopf, MD46

How Does Measured Olfactory Function Correlate With Self-Ratings of the Sense of Smell in Patients With Nasal Polyposis?

The objectives of this study were to investigate correlations, before and after surgery, between olfactory function self‐ratings and measurements, and self‐ratings of nasal obstruction and smell; and to establish cutoff points of self‐rating scores for smell reduction in patients with nasal polyposis (NP).

Revisiting human nose anatomy: Phylogenic and ontogenic perspectives †

This review suggests revisiting nose anatomy by considering the ethmoidal labyrinths as part of the olfactory nose and not as paranasal sinuses.

Respiratory epithelial adenomatoid hamartoma of the nose: an updated review.

Background This study was designed to update clinical and imaging features as well as treatment outcomes of the nasal respiratory epithelial adenomatoid hamartoma (REAH). Data sources included case reports, original articles, and reviews published in English or French in PubMed from 1995 to date. Methods Only published articles that met Wenigs histological criteria for the diagnosis of REAH were included. Results REAH is not rare and is probably underdiagnosed. It is usually observed in the fifth decade of life with a 3:2 male/female predilection. REAH can be represented in two forms: as an isolated lesion (less frequent) or in association with an inflammatory process (especially nasal polyposis). It was observed in 35–48% of patients undergoing endoscopic endonasal surgery for nasal polyposis. Its origin is found, in most cases, in the olfactory cleft, which is exhibited on computed tomography (CT) scans by widened opacified olfactory clefts without bone erosion. Resection of REAH from the olfactory clefts does not worsen, but instead, can improve the sense of smell after surgery. Conclusion Looking for REAH on CT scans and during endoscopic examination can lead to its diagnosis and help avoid aggressive surgical procedures and their complications. Endoscopic resection is the treatment of choice. The removal of REAH constitutes a specific surgery on the olfactory clefts, which can improve nasal obstruction as well as sense of smell. Whether REAH can be defined as a hamartoma, an inflammatory reactive process, or a neoplastic lesion remains to be determined.

Does surgery of the olfactory clefts modify the sense of smell

Background The olfactory outcome after surgery of polyps in the olfactory clefts (OCs) is unknown. This study was designed to (1) investigate the relationship between clinical characteristics and the presence of the respiratory epithelial adenomatoid hamartoma (REAH) in the OCs and (2) assess the olfactory outcome after surgery in the OC for either eosinophilic polyps (EP) or REAH in patients with ethmoidectomy for nasal polyposis (NP). Methods Seventy-four patients with NP having undergone nasalization procedure were enrolled in this prospective study. The OCs were systematically examined during endoscopic surgery. Small polyps or edematous mucosa of the OC were systematically biopsied. Moderate or big polyps in the OC were removed after nasalization of the ethmoidal labyrinths. The distinction between REAH and EP relied on histopathological examinations. The olfactory function was measured with standardized odor threshold and identification tests 1 day before and 6 weeks after surgery. Results There was a close relationship between the presence of REAH-OC and the duration of NP disease (p = 0.0009), asthma (p = 0.004), and previous surgery (p = 0.0006). Before surgery, 90.6% of patients with REAH-OC were hypo-anosmic in contrast with one-half of patients having EP-OC (p = 0.0003). Predictors of poor olfactory outcomes after surgery were long-standing nasal symptoms (p = 0.027), history of previous surgery (p = 0.01), and history of previous middle turbinates resection (p = 0.0006). Polyp histology and surgery of the OC were not predictors of poor olfactory outcomes. Conclusion The resection of REAH or EP of the OC in patients with NP does not worsen but instead can improve the sense of smell after surgery.

Primary cancer of the sphenoid sinus—A GETTEC study

Primary involvement of the sphenoid sinus occurs in 2% of all paranasal sinus tumors and is associated with dismal prognosis. Optimal management remains debatable.

Transfacial versus endoscopic approach in the treatment of woodworker's nasal adenocarcinomas

The purpose of this study was to present a monocentric retrospective study designed to compare oncologic results and morbidity between transfacial surgery and endoscopic endonasal surgery for nasal adenocarcinomas.

Respiratory epithelial adenomatoid hamartoma: a poorly recognized entity with mast cell recruitment and frequently associated with nasal polyposis.

Abstract:Respiratory epithelial adenomatoid hamartoma (REAH) is regarded as a rare tumor of the nasal cavity. The mechanisms driving the development of REAH are unknown, and its nature as a benign tumor, hamartoma, or reactive inflammatory process is still open to discussion. A total of 150 consecutive patients operated on for nasal polyposis (NP) were extensively checked for the diagnosis of REAH. The profile of REAH occurring in association with NP was compared with solitary REAH in a series of 19 cases. The possible role of tryptase-producing mast cells (MC) and of metalloproteinases MMP2 and MMP9 in REAH development was investigated by immunohistochemistry. REAH lesions were identified in 35% of patients who had surgery for NP (53/150). The distribution of the lesions suggested that REAH originated in the olfactory cleft. Solitary REAH occurred about 20 times less frequently than those observed in an NP context but shared the same microscopic characteristics. Tryptase-producing MCs were recruited at high density in REAH (135/10 hpf), compared with inflammatory polyps (45/10 hpf; P<0.00005) and hypertrophied turbinates (51/10 hpf; P<0.0005). REAH also showed constant MMP9 expression and to a lesser degree MMP2 expression in epithelial cells. If solitary REAH is a relatively rare lesion, we demonstrated that an exhaustive sampling allows the detection of a high proportion of NP-associated REAH, sharing the same clinical and histologic characteristics with solitary REAH. Tryptase-producing MCs, possibly in association with MMP expression, may play a central role in REAH formation.

Olfactory neuroblastoma behavior inside and outside the olfactory cleft.

PurposeOlfactory neuroblastoma (ONB) is a rare malignant tumor of the nose. The currently available evidence links this disease with cells of the olfactory epithelium. The detailed description of tumor site and its extension is the key of treatment. The aim of the present study was to describe the way ONB develops inside and outside the olfactory cleft.MethodsThirteen consecutive patients treated between 2004 and 2014 for ONB with unequivocal pathologic diagnosis, complete diagnostic imaging and endonasal endoscopy surgery were enrolled in this retrospective study. The site of origin and local extension of each tumor were studied in detail based on computed tomography/magnetic resonance imaging, surgical report, registered videotape of the surgery, and pathological reports.ResultsThis series shows the behavior of a tumor arising either in the olfactory clefts (11 cases) or in the ethmoidal labyrinth (2 cases). When the setting begins with a tumor located in the olfactory cleft (below or in contact with the cribriform plate), the further step can be the extension to the ethmoidal labyrinth before intracranial or intraorbital extension. When tumors originate inside the ethmoidal labyrinths, the extension can first be into frontal sinus or orbital cavity.ConclusionsThis fine anatomic and radiologic description shows the natural behavior of ONB inside and outside the olfactory cleft. As a consequence, the staging system developed by Kadish seems inadequate and Dulguerov’s staging system could be improved. However, the preliminary proposed modification has to be evaluated in a prospective and large, multicenter cohort of patients.

Eosinophilia and Cell Activation Mediators in Nasal Secretions

Objectives/Hypothesis In rhinologic disorders such as polyposis or rhinitis, nasal cytology allows differentiation between patients according to the degree of eosinophilia in nasal secretions. The egress of eosinophil and/or neutrophil polymorphonuclears from the underlying mucosa might correlate with the release of soluble mediators of cell activation such as the chemokine IL‐8, and such molecules of the innate immunity as the LPS‐receptor CD14 or lysozyme. We assayed the levels of these three molecules in nasal secretions in correlation with cytologic findings and especially the degree of eosinophilia.