Background There is a dearth of information regarding the histological and hematological differences between primary and recurrent chronic rhinosinusitis with nasal polyps (CRSwNP). The present study analyzed the histological changes in recurrent CRSwNP in terms of eosinophilic infiltrate, subepithelial edema, goblet cell hyperplasia, and basement membrane thickness. Blood levels of eosinophils and basophils were also measured prior to surgery on both primary and recurrent disease. Methods Thirty‐two consecutive adult patients with nasal polyposis treated with primary surgery who subsequently underwent revision surgery were retrospectively enrolled. Results At primary surgery, a significant positive correlation (all p < 0.05) emerged between all histopathological parameters, and between tissue eosinophil and blood eosinophil counts. A positive correlation between subepithelial edema scores and blood basophil levels (p < 0.025) also came to light. At revision surgery, only basement membrane thickness correlated positively with: (1) tissue eosinophil count; and (2) goblet cell hyperplasia (both p = 0.001). In recurrent disease, there was again a positive correlation between eosinophil counts in tissue and blood (p < 0.05). The mean tissue eosinophil count in recurrent CRSwNP was significantly lower than in the primary disease (p < 0.001). Conclusion Our preliminary results support the hypothesis that tissue remodeling due to surgical and medical treatments for CRSwNP is a dynamic process involving important differences in tissue eosinophil counts between primary and recurrent CRSwNP. How tissue remodeling evolves after CRSwNP treatment warrants further investigation, not only in larger series of patients, but also after stratifying patients by the time elapsing since their treatment.

Background: Rhinomanometry, acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) are popular methods for nasal patency evaluation. The aim of the present study was to compare these three methods with the reported nasal symptoms to determine the best diagnostic tool to assess nasal obstruction. Methods: 101 subjects were evaluated using PNIF, 4-phase rhinomanometry (4PR), AR, Visual Analogue Scale for nasal obstruction (VAS-NO) and Sino-Nasal Outcome Test (SNOT-22). Correlations among PNIF, 4PR, AR, VAS-NO and SNOT-22 were obtained. Results: VAS-NO and SNOT-22 were moderately correlated with each other (r = 0.54, p < 0.001). 4PR was moderately correlated with PNIF (r = –0.31, p = 0.0016) and AR (r = –0.5, p < 0.001). VAS-NO was mildly correlated with PNIF (r = –0.29, p = 0.0034). SNOT-22 was moderately correlated with PNIF (r = –0.31, p = 0.0017). After dividing the population into symptomatic and asymptomatic subjects, based on their VAS-NO score, the former showed significantly lower PNIF values (p = 0.009) and higher 4PR values (p = 0.013) compared to the latter ones. Conclusion: PNIF and 4PR showed a significant moderate correlation with each other, but PNIF showed a significant correlation (weak-moderate) with the reported nasal symptom scores.

ObjectivesPediatric bilateral vocal cord immobility (BVCI) represents a severe life‐threatening condition that often causes severe dyspnea. Endoscopic arytenoid lateral abduction (EALA) is a relatively new, secure, minimal‐invasive surgical technique. The present prospective observational study aims to evaluate the effects of EALA in terms of respiratory function, voice quality, and swallowing capabilities.MethodsTwenty‐one pediatric patients with BVCI underwent EALA. Eleven out of 21 patients had tracheostomy at the time of surgery. Pre and postoperative functional assessments included endoscopic evaluation, maximum phonation time, pediatric Voice Handicap Index (pVHI), GIRBAS Scale criteria, and Montreal Children's Hospital Feeding scale (MCH‐Feeding scale). peak tidal inspiratory flow or peak inspiratory flow (PIF) and number of desaturations/hour (ODI/h) were evaluated in patients without tracheostomy.ResultsPostoperative endoscopy showed glottic airway improvement in all patients. Average time for decannulation was 4.6 weeks. One patient has not yet been decannulated. No major complications occurred. In patients without tracheostomy, we observed a significant improvement of ODI/h and PIF after surgery (p < 0.05) as expected. PVHI, MCH‐Feeding scale, and GIRBAS score significantly worsened 1 month after surgical intervention (p < 0.05). One year after surgery, however, all values, except for B and A parameters of the GIRBAS score, returned to levels comparable to those preoperative.ConclusionsEALA represents a simple, safe and effective solution in pediatric patients with BVCI, avoiding tracheostomy, allowing early decannulation, preserving swallowing function, and maintaining good quality voice.Level of Evidence4 Laryngoscope, 133:2325–2332, 2023

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