Fenghong Chen

Objective: Chronic Rhinosinusitis With Nasal Polyps (CRSwNP) is predominantly associated with type 2 inflammation (85.4%) and significant disease severity. This study aims to investigate the overall control status of CRSwNP patients one to seven years after endoscopic sinus surgery (ESS) and identify the real‐world factors influencing these outcomes. Methods: The study included 427 adult patients diagnosed with primary diffuse CRSwNP who underwent bilateral ESS performed by a senior, well‐trained surgeon between 2017 and 2022. Among them, 315 patients completed follow‐ups in January 2024. Data collected included demographic information, comorbidities, symptom questionnaires (VAS, TNSS, SNOT‐22), blood test results, nasal endoscopic scores, and Lund‐Mackay CT scores. The clinical control status was assessed postoperatively using EPOS 2020 criteria. Ordinal logistic regression was used to analyze the factors influencing postoperative control status. Results: The median follow‐up period was 34 months. The most pronounced symptom is a decline in olfactory function (VAS 8, IQR: 4–10), followed by nasal obstruction (VAS 7, IQR: 5–9) before surgery. Generally, postoperative outcomes showed that 54.6% of patients achieved controlled status, 30.2% were partly controlled, and 15.2% remained uncontrolled. A high blood eosinophil ratio (> 4.75%), worse smell VAS scores (> 9.5), and higher Lund‐Mackay CT scores (> 14.5) were associated with poorer control status, whereas medication adherence significantly improved postoperative outcomes. Conclusions: Proper surgical techniques combined with good medication adherence play a crucial role in improving postoperative outcomes for CRSwNP patients, including those with type 2 inflammation. Level of Evidence: 4.

Background: Eosinophilic chronic rhinosinusitis with nasal polyps (eos‐CRSwNP), especially those with diffuse disease as indicated by CT scans, has high recurrence rate and low control rate after endoscopic sinus surgery (ESS). Most of them are difficult to treat.Objective: This study sought to identify if eos‐CRSwNP patients were to undergo surgery earlier, while the disease is still limited on CT, they might achieve better postoperative outcomes.Methods: This study enrolled eos‐CRSwNP patients with different degree of sinus involvement who underwent primary ESS and compared the surgical outcomes of the patients exhibiting mild sinus involvement with those displaying severe sinus involvement. The demographic data, preoperative disease severity, and surgery outcomes at 1 year postoperatively were collected. CRS control status was the primary endpoint to evaluate the outcomes.Results: This study included 118 patients with at least one‐year follow‐up. The overall uncontrolled rate was 33.1% at 1 year postoperatively. The best cut‐off value for CT Lund–Mackay (L‐M) score was 13 to predict the uncontrolled status (AUC = 0.67). Then, patients were divided into the mild group (L‐M < 13, n = 70) and the severe group (L‐M ≥ 13, n = 48) according to L‐M score. The follow‐up data indicated that 24.3% of patients (17/70) in the mild group and 45.8% of patients (22/48) in the severe group were uncontrolled (p = 0.015). Postoperative endoscopic score in the mild group was significantly better than those in the severe group (p = 0.002).Conclusion: ESS performed on eos‐CRSwNP patients with mild sinus involvement have better postoperative outcomes at 1 year than patients with severe sinus involvement.Level of Evidence: 3 Laryngoscope, 135:1021–1028, 2025

Objectives. Despite the efficacy of surgical treatments, the high rate of recurrence in juvenile nasopharyngeal angiofibroma (JNA) after surgery remains an unresolved problem. The present study comprehensively analyzed the risk factors and characteristics of JNA recurrence, providing clinical guidance for reducing recurrence.Methods. A total of 123 patients who underwent surgery for JNA between 1997 and 2019 at a single hospital were analyzed retrospectively. Univariate and multivariate analyses were used to assess the clinical risk factors for the recurrence of JNA. The relapse-free survival and annual cumulative recurrence rates were analyzed for subgroups defined according to clinical parameters.Results. After screening, 78 of the 123 patients were included in the present study. The main risk factors associated with JNA recurrence included the year of diagnosis, tumor size, sphenoid bone invasion, Radkowski stage, surgical approach, and intraoperative bleeding. Importantly, the surgical approach and sphenoid bone invasion were independent prognostic factors affecting recurrence. Patients who underwent endoscopic surgery without sphenoid bone invasion exhibited longer relapse-free survival. In the present study, the overall cumulative recurrence rate of JNA was 38.7%, and recurrence occurred mainly in the first year after the initial surgery.Conclusion. Endoscopic surgery achieved better relapse-free survival in JNA patients, and patients with sphenoid bone invasion should be carefully explored to avoid residual JNA. The recurrence rate of JNA differed among subgroups defined based on clinical parameters and was highest in the first year after surgery. Computed tomography or magnetic resonance imaging, along with close follow-up, should be performed strictly within 1 year after the primary operation.

The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines-with a focus on China-will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.