Edward D. McCoul

Caffeine is the most widely consumed habit‐forming drug in the world. A relationship has been proposed between caffeine consumption and rhinologic symptoms. To determine whether the potential deleterious effects of caffeine withdrawal are outweighed by the rhinologic symptom benefits, our group conducted a prospective study of patients presenting with rhinologic complaints at local clinics. Rhinologic symptom severity was assessed using the SNOT‐22 and the frequency and quantity of daily caffeine consumption was assessed by questionnaire. A total of 226 participants completed the study. No correlation was found between caffeine consumption and total SNOT‐22 ( P > .05), rhinologic SNOT‐22 subscale ( P > .05), or tertiles of low, medium, and high caffeine consumers ( P = .18). This suggests that caffeine consumption does not have an appreciable effect on rhinologic symptoms.

Objective: Chronic rhinosinusitis (CRS) affects all sociodemographic groups. While studies have explored social determinants of health (SDOH), sociodemographics, and health behaviors, their specific effects on CRS outcomes are unclear, making tailored care difficult. This review examines how these “Life‐Context” factors influence 22‐item Sinonasal Outcome Test (SNOT‐22) scores before and after treatment. Data Sources: A systematic review followed PRISMA guidelines, searching Medline, Embase, Cochrane CENTRAL, and Web of Science through 12/2024. Review Methods: Eligible CRS studies with comparison groups reporting SNOT‐22 outcomes were reviewed. Mixed Methods Appraisal Tool assessed bias. Random‐effects meta‐analysis estimated the pooled effect on SNOT‐22 when two studies reported comparable cohorts. Results: Of 3180 records identified, 61 studies met inclusion criteria. Females had worse baseline SNOT‐22 scores, but similar improvements postsurgery as males (baseline SMD = 0.30, 95% CI: 0.24‐0.36; 2‐years postsurgery: SMD = 0.04, 95% CI: −0.33‐0.41). Younger patients often had higher baseline SNOT‐22. Race and ethnicity data were limited and variable; no significant differences were found. Education and income showed inconsistent links to SNOT‐22 scores. Medicaid and private insurance patients had worse baseline scores than Medicare (SMD = 0.81, 95% CI: 0.48‐1.15 and 0.30, 95% CI: 0.10‐0.49, respectively). Smokers had worse SNOT‐22 (SMD = 0.37, 95% CI: 0.22‐0.53). Environmental factors showed weak, inconsistent effects. There is limited data on food security, social support, and care access. Conclusion: Various Life‐Context factors influence CRS and affect SNOT‐22 outcomes. Specifically, factors like sex, ethnicity, insurance status, and smoking impact these outcomes. Variability in studies and reporting methods hinder clear conclusions. Standardized data collection on these factors is vital for improving understanding and ensuring equitable care.

Objective: Mucus segmentation in nasal endoscopy is essential for sinusitis diagnosis, yet existing models struggle with separating thin mucus layers and serous secretions, delineating boundaries, and handling illumination artifacts like overexposure and reflections. We introduce SUM‐MucusNet, an artificial intelligence model designed to assist clinicians in identifying mucus across challenging settings. Methods: We trained SUM‐MucusNet, a deep learning model, on 3486 annotated endoscopy images from 454 patients. Performance was measured against expert physician observations using the Dice coefficient, Intersection over Union (IoU), precision and recall, and the comparative analysis was performed with the existing models. Results: SUM‐MucusNet achieved a Dice coefficient of 0.71 (95% CI: 0.70–0.72), representing a modest but statistically supported improvement over the next‐best model (Wilcoxon signed‐rank p = 0.027). In poor‐quality images, the model correctly segmented 89.3% of mucus regions, with improved boundary detection in cases of irregular mucus patterns and reduced false positives caused by glare and overexposure. The system's targeted architectural components address specific diagnostic challenges while maintaining real‐time processing at 17.3 frames per second. Conclusion: This work improves mucus segmentation in diagnostic nasal examinations by addressing image quality, boundary irregularity, and illumination challenges, advancing an under‐explored area in medical computer vision to support standardized, quantitative mucus assessment and longitudinal disease monitoring during diagnostic nasal endoscopy. Level of Evidence: 2.

Objective: Obesity is associated with increased risk and severity of chronic rhinosinusitis (CRS), yet the impact of weight loss (WL) on CRS development and burden is not well defined. This study investigates whether weight reduction influences the likelihood of developing CRS and improves clinical outcomes among obese adults. Methods: Retrospective cohort study using the NIH All of Us database. Obese adults (BMI ≥ 30) with complete demographics and follow‐up were included. To assess CRS onset, patients were stratified into sequential WL cohorts and followed for 1 year. To assess CRS outcomes, patients who lost ≥ 5 BMI points were categorized into any WL (AWL), unsustained WL (UWL), or sustained WL (SWL; ≥ 1, 2, 3 years) and compared with no WL (NWL) controls matched on demographics and healthcare visit frequency. Time‐to‐event analyses used Kaplan–Meier and Cox models to evaluate CRS onset. Among CRS patients, follow‐up visits, new nasal symptoms, and medication use were analyzed using odds ratios (ORs). Results: Among 3203 obese patients, a ≥ 5‐BMI decrease was associated with reduced CRS risk versus NWL (HR 0.57, 95% CI 0.37–0.87). Of 2714 obese CRS patients, 537 lost weight. Two‐year SWL was associated with fewer follow‐up CRS visits versus NWL (10.4% vs. 20.1%; OR 0.46, 95% CI 0.24–0.90). Any SWL demonstrated lower odds of nasal symptoms, and 2‐year SWL demonstrated reduced antibiotic usage (OR 0.43, 95% CI 0.21–0.88). Conclusion: Sustained WL may reduce both the risk of developing CRS and the burden of ongoing disease, supporting its relevance as a potential adjunctive management strategy. Level of Evidence: Level III.

Objective: Rhinosinusitis (RS) is prevalent in the ambulatory setting. When indicated, treatment with penicillin is recommended. However, up to 25% of the US population has a penicillin allergy label (PAL) within their health record, which can result in treatment with second‐line antibiotics. The study explored the effect of PAL on clinical outcomes in RS. Study Design: Retrospective chart review. Setting: Ochsner Medical Centre. Methods: A chart review was performed in adult patients with RS who received antibiotics between 2011 and 2024. Treatment failure was defined as need for a second antibiotic within 30 days. Adverse events (AE) were indexed to a new diagnosis of diarrhea within 30 days. Odds ratio (OR) of success:AE was calculated and compared to standard of care, using Cohen's h to measure the effect size of nonpenicillin antibiotics. Results: 335,015 subjects who received antibiotics for RS were included. Of these, 55,557 (16.6%) had PAL. These patients were more likely to receive a nonpenicillin antibiotic for initial therapy (87.8%). Patients with a PAL had a slightly greater rate of treatment success (78.2% vs 75.8%, h = 0.057), but a greater AE rate (1.8% vs 1.7%, h ‐0.015). Among second‐line treatments for patients with PAL, tetracycline had a superior OR of success: AE (0.983, 95% CI 0.906‐0.894) compared to fluoroquinolones (0.842, 95% CI 0.843‐0.831). Conclusion: In patients with RS, PAL often leads to the prescription of a second‐line antibiotic, which has decreased benefit‐to‐risk ratio compared to first‐line treatment. This emphasizes the need for additional efforts to remove PALs from patients without true penicillin allergy.

Objective: Eustachian tube dysfunction (ETD) is traditionally classified as either patulous or obstructive. Recent evidence suggests that obstructive ETD may comprise a broad array of clinical presentations. This study aimed to define subtypes of obstructive ETD according to common clinical features. Methods: This cross‐sectional study included adults diagnosed with ETD at a single academic medical center between October 2014 and June 2022. Clinical data was recorded, including patient‐reported ETDQ‐7 score, nasal endoscopy findings, tympanometry findings, medical comorbidities, timing of symptoms, symptom laterality and duration of ear fullness. Principle component analysis (PCA) was used to distinguish the most important clinical features and hierarchical cluster analysis was used to delineate symptom cluster groups. Results: Among 490 obstructive ETD patients, seven clinical characteristics were found to be the most important: duration, severity, laterality, constancy, sinusitis symptoms, history of pressure equalization tube, and comorbid reflux disease. Five phenotypic clusters were described by the clinical data, which were predictive of relative risk of comorbidity of sinusitis and GERD, as well as abnormality on endoscopy and tympanometry. Patients with bilateral symptoms had longer mean symptom duration than patients with unilateral symptoms (8.5 vs. 6.1 months; p < 0.001) and patients with sinusitis symptoms were more likely to have bilateral symptoms compared to those without (76.6% vs. 59.1%; OR = 0.442 [95% CI: 0.330, 0.651]; p < 0.001). Conclusion: Our group has identified five data‐driven symptom cluster groups that may be translated into clinical practice. Level of Evidence: 3

Objectives: Odontogenic sinusitis (ODS) refers to purulent sinusitis caused by infectious maxillary dental pathologies, with > 90% occurring unilaterally. While various clinical features suggest ODS, diagnosing some ODS patients can be challenging. This study aimed to determine the value of maxillary sinus papillary edema (MSPE) in predicting ODS. Methods: A retrospective cohort study was conducted on patients who underwent at least maxillary antrostomy for unilateral sinus disease (USD). Adequately powered samples of three USD cohorts were generated: ODS, infectious maxillary CRS without nasal polyps (CRSsNP), and noninfectious CRSwNP. Multiple variables were collected, but the primary outcome was MSPE presence via double‐blinded endoscopic image review by three rhinologists. Inter‐rater agreement was calculated, and a predictive model for MSPE was generated. Results: Of 41 ODS, 22 infectious CRSsNP, and 13 noninfectious CRSwNP patients, mean age was 57.0 years and 55.3% were female. There was almost perfect agreement between rhinologists when assessing for MSPE on endoscopic images ( κ = 0.927). MSPE was seen in 100% of ODS, 22.7% infectious CRSsNP, and 0% CRSwNP. MSPE was significantly more likely in ODS compared to non‐odontogenic CRS ( p < 0.0001), demonstrating 100% sensitivity and 89.1% specificity for ODS, with 85.7% positive and 100% negative predictive values. Conclusions: MSPE is a distinct finding that is reliably identifiable and is significantly more likely in ODS compared to infectious CRSsNP and noninfectious CRSwNP. With 100% sensitivity and NPV, MSPE absence makes ODS very unlikely. With 86% PPV, MSPE is not pathognomonic for ODS, but should arouse suspicion for a possible odontogenic source. Level of Evidence: 3.