A nasal symptoms questionnaire (NSQ) was used to evaluate nasal symptoms and quality of life (QOL) in patients with rhinosinusitis. The characteristics of symptoms and postoperative changes in these symptoms were examined using the NSQ in patients undergoing surgery for chronic sinusitis.

Methods: The subjects were 27 patients (18 men, 9 women; average age 53.8 years old) with chronic sinusitis who underwent initial endoscopic sinus surgery (ESS) in our department between April 2020 and October 2022, and completed the NSQ. The NSQ total score and the score for each NSQ item were compared pre- and post-ESS. Correlations of pre- and post-ESS NSQ scores with pre- and post-ESS nasal symptom VAS scores and with pre-ESS CT scores and post-ESS endoscopic findings (E score) were examined. Patients were also classified into ECRS (n = 13) and non-ECRS (n = 14) groups based on the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis Study, and the characteristics of symptoms in each group were evaluated.

Results: The pre-ESS NSQ score was significantly lower than the post-ESS NSQ score (p < 0.001, n = 27). The ECRS group showed significant improvement in NSQ items of “nasal obstruction”, “postnasal drip and/or sputum”, “olfactory loss”, “pain”, and “reduced productivity at school/work and limitation of outdoor life and/or social functioning” after ESS. Both pre- and post-ESS NSQ scores were significantly correlated with nasal symptom VAS (p < 0.01). In a comparison of NSQ item scores, the ECRS group had significantly worse “nasal obstruction” (p < 0.05) and “olfactory loss” (p < 0.01) compared to the non-ECRS group.

Conclusion: The results of this study show that surgical treatment for sinusitis is useful for improving subjective symptoms and QOL.

Regenerative medicine using mesenchymal stem cells (MSCs), which are somatic stem cells, has been studied in human subjects and clinical trials worldwide, mainly for neuronal disorders such as brain infarction and spinal cord injury. MSCs show organ-specific differentiation abilities based on the site of the harvested tissues.

Here, we report isolation and characterization of MSCs from the human nose and paranasal sinus mucosa derived from surgical specimens with a normal sinus appearance. We examined expression of cell surface markers on mesenchymal progenitor cells (MPCs) and the capacity of these cells to differentiate into adipogenic, osteogenic, and neurogenic lineages.

Cells from normal ethmoid sinus and inferior turbinate mucosa were harvested and successfully isolated and cultivated. Analysis of cell surface markers by flow cytometry indicated that most of the cells expressed CD44⁺, CD73⁺, CD90⁺, CD105⁺, CD34⁻ and CD45⁻, consistent with MSCs. The MSC cultures were induced to differentiate toward osteoblasts and adipocytes, with observation of calcium deposition and lipid droplets, respectively. Additionally, neural induction confirmed by positive immunofluorescent staining of Tuj1, NF-M and NeuN was observed after 10 days of culture. There was no qualitative difference in surface marker expression and differentiation abilities between specimens derived from the ethmoid sinus and inferior turbinate mucosa.

Human sinonasal mucosa-derived mesenchymal cells may be a uniquely promising source of MSCs due to their high proliferation ability and superior capacity for wide range differentiation. The underlying mechanisms remain to be investigated and a further study is needed to define the pathways involved in induction and to sustain the programmed cell maturation process.

Eosinophilic chronic rhinosinusitis (ECRS) is a refractory form of sinusitis characterized by type 2 inflammation. Recently, biologics targeting type 2 inflammation have been developed, and dupilumab, an anti-IL-4/13 receptor antibody, is now indicated for management of chronic sinusitis with nasal polyps. Dupilumab exhibits profound efficacy and safety in treating ECRS; however, it may occasionally lead to severe adverse events. In this study, we present a case of eosinophilic granulomatosis with polyangiitis (EGPA) that developed during dupilumab treatment for bronchial asthma with ECRS.

The patient was a 37-year-old female in whom dupilumab therapy was started 14 months after discontinuation of benralizumab (an anti-IL-5 receptor antibody) for severe asthma. After 20 weeks of dupilumab treatment, she had a significant rise in blood eosinophils and aggravated cough, and subsequently, dupilumab was discontinued. At 22 weeks after dupilumab discontinuation, the patient developed myalgia, limb numbness, skin rash, and infiltrated lung shadows, resulting in hospitalization with a confirmed diagnosis of EGPA. The general condition improved following a tapering regimen of systemic corticosteroids, leading to discharge after 28 weeks.

The exact mechanism behind dupilumab-induced EGPA remains unclear, but it is plausible that the abrupt surge in eosinophils following the switch from an anti-IL-5 agent, cessation of systemic steroids, eosinophil infiltration into tissues, thromboembolism, and other factors collectively contributed to the development of EGPA. While the association between dupilumab and increased blood eosinophils lacks a definitive consensus, cautious monitoring of symptoms such as cough and limb tingling, in addition to regular assessment of blood eosinophils, is crucial when administering dupilumab to patients with ECRS, with vigilant awareness of the potential risk of EGPA development.

The mechanism underlying development of intranasal inverted teeth is not fully understood. Here, we report a rare case of bilateral intranasal inverted teeth. A 2-year-old girl who had a cough was diagnosed with bilateral intranasal masses at an ENT clinic, as well as suspected inverted teeth in the nasal cavity. Sinus CT showed a tooth-like shadow in the nasal cavity on both sides, accompanied by a translucent image in the center. Considering her young age and the narrowness of the nasal cavity, endoscopic sinus surgery was performed at age 7 years. Bilaterally, the inverted teeth only adhered to the nasal mucosa and were pedunculated, making removal easy. Histopathological examination confirmed the diagnosis of inverted teeth, and the postoperative course was uneventful.

A review of the literature indicates that more than 60% of intranasal inverted teeth are supernumerary teeth with similar features, including age at diagnosis, a higher rate in males, and more inverted teeth on the left. In our case, the inverted tooth on the right side was located lower than that on the left side on CT at the first visit, and was in contact with the nasopalatine duct. However, 2 years and 5 months later, CT showed that the tooth had separated from the maxilla and was present in the nasal cavity. Sagittal evaluation was useful for determining the position and mechanism of the inverted teeth; for example, supernumerary teeth might erupt into the nasal cavity from the interincisal suture or near the nasopalatine duct. With bilateral intranasal inverted teeth, diagnosis may be difficult if the lesion is symmetrical. To prevent complications, such as delayed eruption of permanent teeth and abnormal dentition, it is important to consider inverted teeth as a differential diagnosis in cases with intranasal masses.

Primary immunodeficiency syndrome (PID) is an incurable condition that comprises a group of congenital diseases that involve monogenic abnormalities of immunocompetent cells and molecules. In this report, we describe a 30-year-old man with PID diagnosed in adulthood due to recurrent acute sinusitis. The patient had no history that suggested immunodeficiency until he developed sinusitis. Initially, he was diagnosed with common chronic sinusitis and underwent endoscopic sinus surgery. Following hospital discharge, PID was diagnosed due to repeated acute exacerbations of chronic rhinosinusitis and pneumonia. The patient was managed using immunoglobulin replacement therapy and was making a good recovery at the last follow-up.

PID is diverse because not all cases develop in childhood and some are not diagnosed until adulthood. PID may also be complicated by malignancy and bronchiectasis that adversely affect prognosis, and the possibility of PID should be considered in patients with frequent infections. Patients with infectious diseases are often seen in otolaryngology; therefore, a deep understanding of PID is important for those working in this field. For patients with repeated otitis media and sinusitis, the frequency of past infections and family history should be considered. If immunodeficiency is suspected, a careful medical consultation is most important and immunoglobulins should be assessed via serology.

Nasopalatine duct cysts (NDCs) are relatively rare non-odontogenic cysts of the jaw, accounting for about 2–4% of all jaw cysts. Surgery is the first-line treatment for NDCs. Transpalatal or transgingival surgery is common for NDCs, but transnasal endoscopic surgery has recently been increasingly reported. We present a case of a 38-year-old man with an NCD in the median hard palate that was opened using endoscopic endonasal surgery. Endonasal endoscopy revealed raised lesions at the floor of the bilateral nasal cavities. Endoscopic transnasal surgery was performed from the right nasal floor, and the upper surface of the cyst was opened as wide as possible. After the operation, swelling of the bilateral nasal floor improved; and more than a year later, the cyst remained open and showed no malignant findings. There are several cases of NDCs complicated by malignancy. Therefore, it is important to follow the patient for a long period postoperatively. There are also several reports of surgery-related injury to the nasopalatine duct nerves and tooth sensory abnormalities; thus, surgical manipulation should be done carefully. Opening cysts by transnasal endoscopic surgery is less invasive than cystectomy by transpalatal or transgingival surgery. Our case suggests that transnasal endoscopic surgery can be very useful in cases of NDCs that do not show substantial components on imaging findings.

Congenital nasolacrimal duct cysts are caused by retention of contents due to obstruction of the Rosenmüller valve at the lacrimal sac opening and the Hasner valve at the distal end of the nasolacrimal duct. Cases may have no symptoms or resolve spontaneously depending on the size of the cyst and the degree of nasal obstruction. Since neonates mainly breathe nasally, obstruction of the nasal cavity can cause serious breathing problems, and there have been reports of cases requiring airway management and early treatment. In this report, we describe a case of bilateral congenital nasolacrimal duct cysts that presented with respiratory distress and required endoscopic opening. The patient was born vaginally at an obstetric clinic. On day 1, respiratory distress was observed and the patient was admitted to the neonatology department of a general hospital for emergency hospitalization. The respiratory condition continued to worsen after hospitalization and the patient was intubated and managed on a ventilator. An imaging examination showed soft shadows occupying both nasal cavities, which were suspected to be the cause of nasal respiratory disorder, and the patient was transferred to our hospital at age 10 days. CT and MRI showed a mass lesion in the bilateral inferior nasal meatus with medial compression of the inferior nasal ducts, and a continuous soft shadow from the bilateral nasolacrimal ducts to the inferior nasal meatus. The patient was diagnosed with respiratory disorder due to bilateral congenital nasolacrimal duct cysts. Endoscopic surgery was performed under general anesthesia on the same day to release the cysts. The patient was extubated at 11 days of age, and thereafter the respiratory condition improved and feeding progressed without problems. Two years have passed since the surgery and the patient is doing well with no recurrence. As shown by this case, nasolacrimal duct cysts should be kept in mind as a potential cause of respiratory distress in neonates.