IntroductionThe impairment of the sense of smell is often related to chronic rhinosinusitis (CRS) with or without nasal polyps (CRSwNP, CRSsNP). CRSwNP is a frequent condition that drastically worsens the quality of life of those affected; it has a higher prevalence than CRSsNP. CRSwNP patients experience severe loss of smell with earlier presentation and are more likely to experience recurrence of their symptoms, often requiring revision surgery.MethodsThe present study performed a multicentric data collection, enrolling 811 patients with CRS divided according to the inflammatory endotype (Type 2 and non-Type 2). All patients were referred for nasal endoscopy for the assessment of nasal polyposis using nasal polyp score (NPS); Sniffin’ Sticks olfactory test were performed to measure olfactory function, and SNOT-22 (22-item sinonasal outcome test) questionnaire was used to assess patients’ quality of life; allergic status was evaluated with skin prick test and nasal cytology completed the evaluation when available.ResultsData showed that Type 2 inflammation is more common than non-type 2 (656 patients versus 155) and patients suffer from worse quality of life and nasal polyp score. Moreover, 86.1% of patients with Type 2 CRSwNP were affected by a dysfunction of the sense of smell while it involved a lesser percentage of non-Type 2 patients. Indeed, these data give us new information about type-2 inflammation patients’ characteristics.DiscussionThe present study confirms that olfactory function weights on patients’ QoL and it represents an important therapeutic goal that can also improve patients’ compliance when achieved. In a future – and present – perspective of rhinological precision medicine, an impairment of the sense of smell could help the clinician to characterize patients better and to choose the best treatment available.

The pseudo-aneurysm is a hematoma of post-traumatic origin, and capsulated button which is in communication with the lumen of the artery of relevance. Singular occurrence in the district ENT, if not recognized early the pseudo-aneurysm can result in dramatic events such cataclysmic bleeding or acute occlusion of the upper airway. In literature there are outstanding references to the pseudo-aneurysm of the superior thyroid (ATS). We present a rare case of pseudo-aneurysm occurred after the ATS trans-esophageal echocardiography (TEE) and external cardioversion. KeywordsPseuduoaneurysm; ENT Complication; Endovascular Coil Embolization homogeneously enhancing mass, 9.5 x 3.2 cm diameter in left neck spaces extending superiorly to parapharyngeal spaces, inferiorly to hypopharynx displacing hyoid bone , thyroid cartilage, posterior to crycoid cartilage displacing cervical esophagus and laterally to subcutaneous tissue displacing sternocleidomastoid muscle (Figure 1). The mass was suggestive for hematoma. The angiography revealed a pseudoaneurysm with active bleeding of the terminal tract of superior thyroid artery (STA) (Figure 2). An endovascular procedure was performed with a superselctive microcateter and a endovascular occlusion by coil embolizzation of STA with exclusion of the pseudoaneurysm demonstrated at the end of the procedure (Figure 3). The symptoms resolved after one day from the endovascular procedure. The patient was discharged after two days without evidence of bleeding and an endoscopic control after 4 weeks revealed a disappearance of swelling. DiscussionPseudoaneurysm, also called "false aneurysm", is an 2/3A fast development of an expanding mass under the angle of the mandible or in lateral pharyngeal wall after surgical procedure of the neck, percutaneous biopsy and neck trauma should always raise the suspect of an extra cranial arterial pseudoaneurysm.In our knowledge only three cases of pseudoaneurysm of superior thyroid artery have been reported previously. The first case was a pseudoaneurysm occurred after ultrasonographically guided chemical parathyriodectomy [15]. The diagnosis was made by angiography and treated by selective coil embolization. The second case reported a pseudoaneurysm occurred in a patient with hypopharyngeal squamous cell carcinoma during simultaneous radiotherapy and chemotherapy [13]. The diagnosis was made by a CT scan and treated by selective coil embolization. The third case reported a pseudoaneurysm after ultrasonographically guided biopsy of a thyroid nodule [10]. The diagnosis was made after ultrasonography and color Doppler examination and treated waiting spontaneous thrombosis.In our patient the pseudoaneurysm occurred after a transesophageal echocardiography guided cardioversion (TEEguided). The diagnosis was made by a computed tomography scan and treated by selective coil embolization. Transesophageal echocardiography guided cardioversion with short-term anticoagulation can be considered a safe and clinically effective for patients with atrial fibrill...

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