Aatin K. Dhanda

Objectives: The pathophysiology of patulous Eustachian tube (PET) remains poorly understood. This study characterizes nasopharyngeal anatomy to identify features that distinguish PET patients from controls and determine whether anatomical measurements predict symptom laterality. Methods: Head CT scans from patients with PET diagnosed by Japanese Otologic Society criteria were compared to scans from demographically matched controls. Anatomical features of the Eustachian tube (ET), turbinates, and nasopharynx were measured. PET patients were stratified into bilateral PET, unilateral affected sides, and unilateral unaffected sides. Results: Thirty PET patients (23 unilateral, 7 bilateral) were included. Compared with controls, PET patients demonstrated significantly larger ET orifice diameters (5.61 vs. 4.54 mm, mean difference 1.07 mm, p < 0.001), greater ET patent depth (6.51 vs. 4.76 mm, mean difference 1.74 mm, p < 0.001), larger lateral recess length (6.40 vs. 3.86 mm, mean difference 2.54 mm, p = 0.002), larger lateral recess width (4.37 vs. 2.51 mm, mean difference 1.86 mm, p < 0.001), and greater inferior turbinate‐to‐ET asymmetry (2.67 vs. 1.24 mm, mean difference 1.43 mm, p < 0.001). Nasopharyngeal dimensions did not differ between groups. No significant differences were identified across groups in the primary analysis. Sensitivity analyses accounting for within‐patient correlation demonstrated greater ET patent depth and lateral recess width in symptomatic compared with asymptomatic unilateral PET ears. Conclusion: PET patients demonstrate distinct nasopharyngeal anatomy beyond simple ET patency, including enlarged lateral recesses and greater asymmetry in inferior turbinate positioning. However, anatomical measurements poorly predict symptom laterality, indicating that additional physiologic mechanisms not captured by static CT imaging likely contribute to symptom expression. Level of Evidence: 4.

Key Points: Machine learning identifies reproducible pre‐diagnostic CRS trajectories in large EHR cohorts. Models show stable external performance (AUC ∼ 0.81), supporting real‐world generalizability. Predictors highlight evolving CRS workups and models may serve as future decision support tools.

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(s): With growing cannabis use in the US, it is crucial to understand the impact of recreational use on sinonasal diseases like chronic rhinosinusitis (CRS), allergic rhinitis (AR), and chronic rhinitis (CR). Methods: This cross‐sectional study leveraged the NIH AllOfUs database to query patient surveys assessing cannabis usage frequency (lifetime never, monthly, weekly, or daily within the past 3 months) and consumption route (smoking or non‐smoking). Cannabis users were matched to never users for demographics, healthcare visit frequency, and insurance. A stringent logistic regression model calculated odds ratios (OR) of developing AR, CRS, or CR after survey completion. Cox regression hazard ratios (HR) compared consumption routes. Results: Twenty‐five thousand one hundred sixty‐four cannabis users were matched with 113,418 never users. Users demonstrated significantly lower odds of AR, CRS, and CR than never users. For CRS, the ORs compared to never users are as follows: daily users 0.64 (95% CI 0.53–0.78), weekly users 0.61 (95% CI 0.48–0.77), and monthly users 0.80. For AR, the ORs were 0.64 (95% CI 0.58–0.71) for daily users, 0.62 (95% CI 0.54–0.71) for weekly users, and 0.69 (95% CI 0.58–0.80) for monthly users. For CR, the ORs were 0.61 (95% CI 0.47–0.79) for daily users, 0.64 (95% CI 0.47–0.87) for weekly users, and 0.41 (95% CI 0.26–0.65) for monthly users. There was no significant difference between smokers and non‐smokers (HR 0.64, 95% CI 0.27–1.5). Conclusion: There is an inverse, associative relationship between cannabis use and sinonasal disease. This relationship is insufficiently understood, and there remain significant concerns about the impact of cannabis use, especially smoking, on airway pathologies. Level of Evidence: 4.

Objectives: This study aims to characterize quantitative data pertaining to sinonasal symptoms and their related medication use aboard the International Space Station (ISS). A secondary focus involves correlating these findings with mission parameters such as extravehicular activity (EVA) participation and mission duration.Methods: This retrospective cohort study was conducted utilizing data requested from the National Aeronautics and Space Administration (NASA) Lifetime Surveillance of Astronaut Health (LSAH) program.Results: Of 71 de‐identified ISS astronauts beginning with Expedition 1 in the year 2000 through 62 in 2019, there were 754 logged medical events; 60 astronauts reported any type of sinonasal medical event (85%), the most common being general nasal congestion in 53 astronauts (75%). Symptoms were attributed to microgravity‐induced fluid shifts in 34 astronauts (57%) while 17 (28%) attributed symptoms to ear clearing and barotrauma. Pseudoephedrine was the most used medication, with 95 recorded uses, followed by oxymetazoline spray at 51. Among the 60 astronauts with sinonasal medical events, the 24 with references to extravehicular activity (EVA) participation in their records had on average, 9.19 more records than those without (95% CI: 2.29–17.06).Conclusion: Sinonasal symptoms are a prevalent medical concern among astronauts aboard the ISS. The findings suggest that early spaceflight‐associated fluid shifts contribute significantly to these symptoms, often requiring medication use. A correlation between EVA participation and a higher number of medical events highlights an occupational risk factor.Level of Evidence: 3.

Objectives: With the increasing use of GLP‐1 receptor agonist (GLP‐1 RA) drugs for weight loss and diabetes management, concerns have been raised regarding their potential side effects. We aim to assess the frequency of otolaryngologic adverse events (AEs). Study Design: Retrospective analysis of national registry. Methods: The Food and Drug Administration's Adverse Event Reporting System (FAERS) database was queried for events related to the GLP‐1 RA: exenatide, liraglutide, dulaglutide, semaglutide, and tirzepatide from 1 year after their approval until the end of 2023. AEs were collected and sub‐stratified according to anatomic site. Reporting odds ratios (ROR) and proportional reporting ratios (PRR) were determined for all AEs. Results: The number of AEs reported from all drugs within this study totaled 9,746. Significant signal ratios were defined as a PRR≥2 and a lower CI ROR >1. Medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) had the highest signals and were significant in virtually all medications. This was followed by GERD which also had very high signal ratios and was significant in all drugs assessed. Semaglutide also had significant signals in anosmia, dry mouth, dysgeusia, and Bell's palsy. Liraglutide had significance in both signals in dysphonia, dysgeusia, tinnitus, and Bell's palsy. This was followed by exenatide which also included dysgeusia and hearing disability. Conclusions: GLP‐1 RA were associated with various otolaryngologic AEs, with significant signals observed for semaglutide and liraglutide. GERD, MTC, and PTC were of significance in all GLP‐1 RA in this study. Monitoring these AEs is recommended. Level of Evidence: 4 Laryngoscope , 135:2291–2298, 2025

Key points: Viral infections lead to a greater than twofold increased risk of developing chronic rhinosinusitis within 1 year. Viral infections lead to a greater than twofold increased risk of developing chronic rhinosinusitis within 1 year. Recurrent viral infections pose a greater risk of chronic rhinosinusitis than single episodes.

Introduction: Despite effects on quality of life from olfactory and gustatory dysfunction (OD and GD), screening practices are limited, and patients’ self‐reporting of symptoms remains the only way to understand the burden of chemosensory dysfunction (CSD). Using a large population‐based database, we sought to understand factors leading to reduced likelihood of discussing CSD with a provider.Methods: The 2013‒2014 National Health and Nutrition Examination Survey (NHANES) chemosensory protocol was queried for factors influencing discussion of OD/GD with a healthcare provider. Sociodemographic, comorbidity, and objective OD/GD testing results were assessed with a multivariate analysis.Results: Out of 146.1 million US adults, there were an estimated 41.4 million individuals with self‐reported OD/GD in the prior 12 months (28.3%). A total of 86.8% of participants did not discuss their problem with a healthcare provider. Men were about half as likely to speak with a healthcare provider (odds ratio [OR] 0.42; 0.26–0.66; p < 0.001) and those with a college education were about nine times more likely to discuss the problem compared to those with less than a ninth‐grade educational achievement (OR 8.83; 1.86–41.98; p = 0.02). Those with objective confirmation of CSD were still unlikely to speak with a provider (OR 0.77; 0.44–1.33; p = 0.36).Conclusion: Men and those with less education are less likely to discuss OD/GD with a healthcare provider. These populations tend to be at increased risk for CSD, and there are severe downstream health and quality of life implications related to CSD. Dedicated screening and increased public awareness are critical to ensure more equitable care.

Background: Postnasal drip (PND) syndrome is a prevalent complaint encountered in otolaryngology practices. PND may be refractory to medical therapy, and surgical treatments are complicated by side effects. Objective: While posterior nasal nerve (PNN) ablation has demonstrated efficacy for chronic rhinitis overall, we sought to examine the effect of PNN ablation for patients with PND as their primary complaint. Methods: This is a retrospective case series study of 40 chronic rhinitis (CR) patients with a primary complaint of PND. Included patients had to have failed medical therapy such as anti-cholinergic nasal sprays, reflux treatments, and/or nasal steroids. Primary outcome measures included 22 item Sino-Nasal Outcome Test (SNOT-22) PND component and Total Nasal Symptom Score. Secondary outcome measure was subjective improvement, defined as a > 30% improvement in PND symptoms. Results: Median follow-up was 138 days (interquartile range: 72-193). 72.5% (29/40) of patients reported at least a 30% improvement in PND symptoms. Mean PND SNOT-22 scores were 4.2/5 (SD = 0.8) pre-procedure versus 1.9/5 (SD = 1.3) post-procedure ( P = .001). PNN ablation response did not correlate to ipratropium bromide nasal spray response, although younger and non-smoker patients had better response rates. Conclusion: This exploratory study of PNN ablation for the primary symptom of PND demonstrates efficacy as assessed by the PND component of SNOT-22 and subjective improvement. These results can be useful in guiding physician–patient discussions in determining treatment options for medically refractory PND.

Objective: In‐office ablation of the posterior nasal nerve (PNN) has emerged as an effective treatment option for chronic rhinitis patients. This study explored questions patients commonly search online regarding this therapy and the quality of content available.Study Design: A retrospective analysis of online search criteria and sources was performed with subsequent analysis of results.Setting: Search and data acquisition was in September of 2023.Methods: Most common search terms related to cryotherapy and radiofrequency neurolysis of the PNN were identified with associated People Also Ask (PAA) questions. Questions were categorized and organized into subtopics and sources evaluated using readability and quality metrics.Results: A total of 255 unique PAA questions and 175 unique websites were identified. The most common subtopics were related to facts about chronic rhinitis (26.7%) and rhinitis treatment options (25.1%). Nearly a quarter (24.3%) of websites were from commercial sources. Quality metrics indicate difficult‐to‐read and low‐quality materials.Conclusion: Existing online resources need improvement to provide patients material that is easier to read. Physicians counseling patients should be aware of these areas for adequate shared decision making.