Recurrent rhinorrhoea that occurs chronically, needs to consider the possibility of a fistula in the nasal cavity, which has the potential to form a rhinolith. We report the case of a 39-year-old man with complaints of recurrent rhinorrhoea since four years ago, accompanied by thick secretions, symptoms of post-nasal drips, and olfactory disturbances. The patient had a history of removing the left upper molar (molar I), which causes a fistula in the tooth extraction site, making it more likely for food and drink to enter the left nasal cavity. Anterior rhinoscopy examination revealed a white mass in the left inferior meatus and a purulent odour discharge. In addition, there were gingival defects of the first molar teeth, multi-sinusitis, and nasal septum deviation. Rinolith extraction was performed using functional endoscopic sinus surgery, submucosal resection, and repair of gingivo-nasal defects with rotational flaps. Follow-up for one week showed that the flap was in place and there were no complications.

OBJECTIVE: Allergic rhinitis (AR), a prevalent global health concern, is increasingly recognized for its impact beyond physical symptoms, affecting mental health. This research examined the extent of AR\'s psychological burden and sleep disturbances.
METHODS: A systematic search of four databases yielded 49 studies reporting mental health problems in 18,269,265 individuals (15,151,322 AR patients and 3,117,943 controls). The primary outcomes included all mental health problems in AR patients. Subgroup analyses based on outcome and AR severity, country, AR diagnosis, recruitment setting, and age were performed. Secondary outcomes included the risk of these problems compared to controls (healthy or without AR).
RESULTS: In AR, depression (25%), anxiety (25%), stress (65%), distress (57%), suicidal thoughts (14%) and attempts (4%), poor sleep quality (48%), insomnia (36%), sleep impairment (33%), and insufficient sleep duration <7 h (59%) were prevalent. The severity of these outcomes differed significantly. Patients\' country, AR diagnostic method, recruitment method/setting, and age group were significant effect modifiers. Compared to controls, AR resulted in significantly higher risk of depression, anxiety, stress, suicidal attempts and thoughts, insomnia, and sleep impairment.
CONCLUSIONS: AR patients had significantly lower sleep duration. Mental health problems are very common among AR patients, further exacerbating their sleep quality and duration and intention to suicide.

BACKGROUND: In patients with severe, uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP), dupilumab 300 mg every 2 weeks can completely resolve nasal polys, sinus disease, and symptoms. In this case, patients ask for de-escalation. Although trials have demonstrated recurrence after stopping the biologic at 24 weeks, reducing the dose of dupilumab to once every 4 weeks did not result in deterioration of control. An extension of the treatment intervals would, however, diverge from the approval text, and is currently not recommended.
METHODS: The course of 29 patients with severe CRSwNP, type‑2 inflammation-associated comorbidities, and an indication for biologic was retrospectively analyzed. After resolution of CRSwNP and symptoms under biweekly dupilumab 300 mg, the dupilumab interval had been prolonged individually, initially up to 4 weeks, thereafter up to 6 weeks, if applicable. Control was assessed via quality of life (22-item sinonasal outcome test, SNOT-22), nasal polyp score, and smell identification test (Sniffin\' Sticks; Burghart Messtechnik, Holm, Germany).
RESULTS: All patients showed an excellent improvement within the first 3 months. The dupilumab application interval was extended to 4 weeks after 7-31 months (median 13 months) and to 6 weeks (n = 9) after 17-35 months (median 23 months). No recurrent polyps or symptoms were subsequently observed.
CONCLUSIONS: In case of maximal regression of polyps and discomfort, extension of dupilumab injection intervals to 4 and potentially 6 weeks is possible without clinical worsening. Further studies on de-escalation or termination of biologic treatment when CRSwNP control is achieved are essential.
UNASSIGNED: HINTERGRUND: Eine schwere, nicht kontrollierte chronische Rhinosinusitis mit nasalen Polypen (CRSwNP) kann sich unter Dupilumab 300 mg 2‑wöchentlich komplett zurückbilden. Spätestens dann folgt die Frage der Patienten nach einer möglichen Therapiedeeskalation. Eine Beendigung der Antikörpertherapie nach 24 Wochen führte zum Rezidiv, hingegen blieb unter reduzierter Dupilumab-Dosis durch Streckung des Intervalls auf 4 Wochen die Kontrolle erhalten. Eine vom Zulassungstext abweichende Verlängerung der Therapieintervalle wird jedoch aktuell nicht empfohlen.
METHODS: Es erfolgte eine retrospektive Untersuchung des Verlaufs von 29 Patienten mit schwerer CRSwNP, mit Typ-2-Inflammation assoziierten Komorbiditäten und bestehender Indikation zur Biologikatherapie. Nach Rückbildung der CRSwNP und der Beschwerden unter Dupilumab 300 mg 2‑wöchentlich war das Applikationsintervall individuell zunächst auf 4 Wochen, danach ggf. auf 6 Wochen verlängert worden. Erfasst wurden u. a. die Lebensqualität (Sinonasal Outcome Test, SNOT-22), der nasale Polypenscore (NPS) und das Riechvermögen (Sniffinʼ Sticks, Fa. Burghart Messtechnik, Holm, Deutschland).
UNASSIGNED: Alle Patienten zeigten innerhalb der ersten 3 Monate ein sehr gutes Therapieansprechen. Eine Verlängerung des Dupilumab-Intervalls auf 4 Wochen erfolgte nach 7–31 Monaten (median 13 Monate), auf 6 Wochen (n = 9) nach 17–35 Monaten (median 23 Monate). Im Verlauf traten bei keinem Patienten ein Rezidiv, eine Verschlechterung der Lebensqualität oder des Riechens auf.
UNASSIGNED: Eine Verlängerung der Dupilumab-Injektionsintervalle auf 4 evtl. auch 6 Wochen ist individuell nach weitestgehender Rückbildung der Polypen und Beschwerden ohne klinische Verschlechterung möglich. Weitere Studien zur Deeskalation bzw. Beendigung der Biologikatherapie bei erzielter CRSwNP-Kontrolle sind unabdingbar.

We present a case of nasopalatine duct cyst in a 35-yearold female. The cyst was diagnosed based on the presence of only one clinical symptom and no obvious clinical signs, which is a relatively rare occurrence. However, the radiographic and histological presentation of this lesion was typical of a nasopalatine duct cyst. Therefore, this case report aims to highlight the variable presentations of the nasopalatine cyst, which is often misdiagnosed and treated as an endodontic infection.

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Objective: To explore the clinical characteristics, pathological features, and diagnosis and treatment strategies of nasal chondromesenchymal hamartoma (NCMH) in infants and young children. Methods: A retrospective analysis was conducted on seven cases of NCMH infants and young children admitted to Beijing Children\'s Hospital, Capital Medical University from April 2015 to January 2022. The cohort included 5 males and 2 females, aged from 6 days to 2 years and 3 months. General information, clinical symptoms, imaging findings, treatment plans, postoperative complications, recurrence and follow-up time were collected, summarized and analyzed. Additionally, immunohistochemical characteristics of the lesion were examined. Results: The clinical symptoms of 7 children included nasal congestion, runny nose, open mouth breathing, snoring during sleep, difficulty feeding, and strabismus. All patients underwent electronic nasopharyngoscopy examination, with 5 cases of tumors located in the right nasal cavity and 2 cases in the left nasal cavity. No case of bilateral nasal cavity disease was found. All 7 patients underwent complete imaging examinations, with 5 patients underwent MRI and CT examinations, 1 patient underwent CT examination only, and 1 patient underwent MRI examination only. The CT results showed that all tumors were broad-based, with uneven density, multiple calcifications and bone remodeling, and some exhibited multiple cystic components. The MRI results showed that the tumor showed low signal on T1 weighted imaging and high or slightly high signal on T2 weighted imaging. All patients were diagnosed through histopathological examination and immunohistochemistry, including 7 cases of Ki-67 and SMA (+), 5 cases of S-100 and Vimentin (+), and all EMA and GFAP were negative. All patients underwent endoscopic resection surgery through the nasal approach, with 3 cases using navigation technology. Five cases of tumors were completely removed, and two cases of tumors were mostly removed. No nasal packing was performed after surgery, and no postoperative nasal, ocular, or intracranial complication occurred in all patients. Follow up assessments conducted 6 to 84 months post-surgery revealed no instances of tumor recurrence in any of the patients. Conclusions: The clinical symptoms of children with NCHM mainly depend on the size and location of the tumor. Nasal endoscopic surgery is the main treatment method. In cases where critical structures like the skull base or orbit are implicated, staged surgical interventions may be warranted. Long-term follow-up is strongly advised to monitor for any potential recurrence or complications.
目的： 探讨婴幼儿鼻软骨间叶错构瘤（nasal chondromesenchymal hamartoma，NCMH）的临床特点、病理特征及诊治策略。 方法： 回顾性分析2015年4月至2022年1月期间，首都医科大学附属北京儿童医院收治的7例NCMH婴幼儿病例，年龄6 d至2岁3个月，男性5例，女性2例。收集患儿一般资料、临床症状、影像学表现、治疗方案、术后并发症、复发及随访时间，以及病变的免疫组织化学特点等临床资料进行总结分析。 结果： 7例患儿的临床症状包括鼻塞、流涕、张口呼吸、睡眠打鼾、喂养困难及斜视。所有患儿均行电子鼻咽镜检查，肿物位于右侧鼻腔5例，左侧鼻腔2例，未见双侧鼻腔患病者。7例患儿均完善了影像学检查，5例患儿行MRI及CT检查，1例仅行CT检查，1例仅行MRI检查。CT结果显示所有肿瘤均为广基，密度不均匀，多有钙化灶和骨重塑，部分表现为多个囊性成分。MRI结果显示，肿物在T1加权像呈低信号，在T2加权像呈高或稍高信号。所有患儿通过组织病理学检查和免疫组织化学确诊，其中7例Ki-67、SMA（+），5例S-100、Vimentin（+），所有EMA和GFAP均为阴性。对所有患儿采用经鼻内镜入路切除手术，其中3例使用了导航技术。5例肿瘤完全切除，2例肿瘤大部分切除，术后均未行鼻腔填塞，所有患儿无术后鼻腔、眼部或颅内并发症出现。术后随访6~84个月，均未见复发。 结论： NCMH患儿的临床症状主要取决于肿瘤大小及部位，经鼻内镜手术是主要治疗方法，累及颅底或眼眶等重要结构时可考虑分期手术，建议长期随访。.

OBJECTIVE: The role of bacterial communities in the pathophysiology of canine nasal disease is still unclear. How and when to treat dogs with suspected secondary bacterial rhinitis and on which test to rely before making a decision to treat with antimicrobials has not been established. The objective is to compare the results of bacterial identification using agar-plate cultures and 16S rRNA gene amplicon sequencing in dogs with nasal discharge suspected to be of bacterial origin.
METHODS: Twenty-nine client-owned dogs presented for investigation of nasal disease were included in the study. Paired swabs were collected from the same affected nasal cavity. One swab was streaked on 4 agar media (Columbia Blood Agar, MacConkey, Chapman and Edward\'s). The other swab was stored in a sterile cryotube at -80°. Extracted DNA underwent a polymerase chain reaction targeting the V1-V3 region of the 16S rRNA gene.
RESULTS: At least one of the species detected by amplicon sequencing with a relative abundance of >10% was also identified by culture in 14 cases (48.3%), in association with marked predominance of one taxon (>80% relative abundance) in six of 14 cases. In 12 dogs (41.4%), the cultured isolates were rare or undetected components of the corresponding sequence libraries. A negative culture in the face of bacterial predominance (>50% relative abundance) of a potentially pathogenic bacteria detected by sequencing occurred in 17% (n=5) of cases; however, the use of other agar media may have decreased this percentage.
CONCLUSIONS: Standard culture does not reliably predict the bacterial profile detected by 16S rRNA gene amplicon sequencing.

Nasal obstruction, rhinorrhea, and epistaxis are common presenting concerns in primary care clinics. Nasal disorders affect the quality of life for many children and families. Rarely, these complaints may represent a life-threatening condition among infant obligate nasal breathers or cases of unusual pathology. The most common causes of rhinorrhea and nasal obstruction vary by age and include physiologic, infectious, allergic, foreign body, irritant, and traumatic causes. Less commonly, children may have congenital malformations, sinonasal masses, or autoimmune disease. The most common causes of epistaxis are inflammatory, environmental, and traumatic causes and medication misuse, but rarely, children may have predisposing anatomic, hematologic, or vascular abnormalities or even sinonasal tumors. In this article, we provide a thorough review of the common nasal disorders treated every day in primary care clinics and mention briefly some of the rare but serious cases that may be overlooked without considering a full differential diagnosis.

OBJECTIVE: Empty nose syndrome (ENS) is an underdiagnosed but burdensome clinical condition. Studies that have addressed the impact of remnant inferior turbinate volume (ITV) on ENS are scarce. We aimed to evaluate the impact of ITV and phenotyping on the severity and presentation of ENS.
METHODS: All the enrolled patients underwent the following subjective assessments: the ENS 6-Item Questionnaire (ENS6Q), Sino-Nasal Outcome Test-25 (SNOT-25), Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI). The ITV was obtained from finely cut (1-mm-thick slices) sino-nasal computed tomography scan images and analyzed using ImageJ. The correlation between ITV, subjective measurements, and morphology of inferior turbinates was evaluated. ENS was categorized as torpedo type (balanced tissue volume) or pistol type (posterior dominance) based on the morphology.
RESULTS: Overall, 54 patients met the inclusion criteria. The ITV was positively correlated with the ENS6Q score and domain of ENS symptoms in SNOT-25. Neither BDI-II nor BAI scores had a significant correlation with ITV. Based on their morphological classification, the torpedo type exhibited diverse manifestations in the SNOT-25 analysis in response to changes in ITV, while the pistol type demonstrated an elevated rhinologic symptom burden and ENS-specific symptoms as their ITV increased. Nasal resistance did not correlate with the ITV in either type of ENS.
CONCLUSIONS: Symptoms were paradoxically worse in ENS patients with greater remnant ITV, and distinct morphological phenotypes in the nasal cavities may result in different presentations. Further investigation into the correlation between remnant inferior turbinates and nerve function is warranted.
METHODS: 3 Laryngoscope, 134:3060-3066, 2024.