INTRODUCTION: The Lund-MacKay score (LMS) correlates poorly with chronic rhinosinusitis (CRS) symptom severity. Patients with CRS also tend to report relatively lower levels of mental wellbeing. Our purpose was to determine if there is a correlation between socio-economic status (SES) and CRS severity as measured by the LMS, and if there is an association between depression symptoms and the severity of CRS using the LMS.
METHODS: A total of 127 patients diagnosed with CRS were prospectively recruited and assessed with a sinonasal assessment questionnaire (SNAQ-11), and the Patient Health Questionnaire (PHQ-9) for depression. Each patient’s education level, family income, and smoking behavior were determined. The sinus CT scan was scored using the LMS. The data were analyzed using ordinary least squares (OLS) regression techniques.
RESULTS: Having a highschool education or less was associated with higher SNAQ-11 scores while being a daily smoker was associated with higher SNAQ-11 scores. There was no significant relationship between educational attainment, financial income or daily smoking and sinus CT score. Including depression scores in the SNAQ-11, regression equations indicated a significant and positive relationship between depression severity and SNAQ-11 score. CRS with polyps was negatively associated with SNAQ-11 scores but, as expected, it was positively associated with a higher LMS.
CONCLUSIONS: Lower SES status is a negative modifying factor of subjective CRS severity but it has no impact on the LMS. Depression symptoms are associated with increased subjective CRS severity but they have no effect on the LMS. How SES and depression impact on a patient’s self-reported disease severity requires further study.

BACKGROUND: Loss of sense of smell is one of the most frequent complaints in patients with nasal polyposis (NP). The aim of this study was to evaluate the impact of asthma and its severity on the sense of smell.
MATERIAL AND METHODS: Patients with massive NP and healthy controls were included. More than half of patients presented with asthma. Olfactometry by Barcelona Smell Test 24, nasal symptoms score, nasal endoscopy, allergy study, and paranasal sinus CT scan were assessed.
RESULTS: NP patients showed a significant impairment in smell detection, identification, and forced choice compared to the control. Asthmatics reported lower scores for detection, identification, and forced choice than non-asthmatic patients. Patients with persistent asthma had an increased impairment of sense of smell on detection, identification, and forced choice than patients with intermittent asthma. No significant differences were found between mild, moderate, and severe persistent asthmatics. Paranasal sinuses opacification was inversely correlated with smell detection, identification and forced choice.
CONCLUSION: These findings suggest that patients with NP have an impaired sense of smell, that asthma -particularly persistent asthma- has a further impact on sense of smell, and that loss of smell may be used as a clinical tool to identify the severity of both NP and asthma.

The differences in the shape and size of the nose have been proposed to be an adaptation to climate with broad noses (platyrrhine) evolving in a warm humid environment where there was little need for air conditioning and narrow noses (leptorrhine) evolving in colder climates where the air needed more warming. The main aim of this research was to determine if there was any relationship between the shape of the nose as expressed in terms of nasal height and width (nasal index) and total nasal airway resistance (NAR), as one would predict that the narrower leptorrhine noses would have a greater resistance to air flow than the broader platyrrhine noses. It was also proposed that the narrow leptorrhine nose would have better developed vascular tissue than the broad platyrrhine nose in order to condition cold air, and would exhibit a greater response to nasal decongestion. No correlation was found between nasal index and NAR (r = -0.09) and similarly no correlation was found between nasal index and response to a topical nasal decongestant (r = 0.02). The absence of any physiological differences between the different nose types may be due to acclimatisation of participants to the area of recruitment.

We questioned how many patients with epistaxis can be treated by cautery without the use of nasal packing, as cautery is more effective and efficient. To investigate this, we performed a retrospective study of a cohort of 418 patients with epistaxis who presented to one ENT consultant at the ENT department of Medisch Centrum Leeuwarden (the Netherlands) between 1997 and 2007. Main outcomes were the treatment modality (cautery and/or nasal packing), recurrence of epistaxis and need for hospitalization. In 98% of all patients the bleeding site could be found and treated by cautery. The incidence of recurrent bleeding was 6%. Two percent of all patients had to be admitted to the hospital. This is considerably lower compared with recurrence rates and hospitalization after treatment by nasal packing known from the literature. Therefore we concluded that nearly all patients can be effectively treated by cautery with a low recurrence rate. In addition, this method of treatment is very cost effective. Because cautery requires skill and appropriate facilities, we recommend special attention for this in ENT training programs.

BACKGROUND: Weight loss is considered an effective treatment for obstructive sleep apnoea (OSA) in overweight patients. Some patients, however, do not benefit from weight loss. It has been postulated that nasal obstruction may act as an independent risk factor for OSA.
OBJECTIVE: Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands The aim of our study was to evaluate whether impaired nasal airflow might explain the missing effect of weight reduction on OSA.
METHODOLOGY: Fifty-two overweight adult patients with mild OSA were recruited. After the 12-month lifestyle intervention, all patients who achieved ≥ 5% weight loss were divided into two groups based on whether they still had OSA or not. Change in nasal resistance measured by rhinomanometer and AHI were the main outcome variables.
RESULTS: A total of 26/52 patients achieved 5% weight reduction. Of those 26 patients, 16 were objectively cured from OSA and 10 patients did not benefit from weight loss. Nasal resistance reduced significantly more in patients who had been cured from OSA. Smoking had a negative impact on both nasal resistance and improvement of AHI.
CONCLUSIONS: Impaired nasal breathing and smoking may prevent the beneficial effects of weight reduction in the treatment of OSA.