Biologic treatment for severe chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis.

BACKGROUND: Chronic rhinosinusitis with nasal polyps is often severe, debilitating and difficult to treat. Biologics that target key inflammatory pathways have the potential to treat this disease; this study aimed to evaluate their effectiveness. METHODOLOGY: Systematic review and meta-analysis of randomised controlled trials of biologics in chronic rhinosinusitis with nasal polyps. Primary outcomes were extent of disease, objective disease severity and disease-specific quality of life, with outcomes measured at different end-of-treatment timepoints in different studies (range 16-52 weeks). RESULTS: Eleven trials were identified with 2035 participants. Ten studies reported change in polyp size, estimating a reduction of -1.25 in the treatment group. Six studies reported reduction in Lund-Mackay score where the pooled mean difference was -4.90. Five studies included peak nasal inspiratory flow with a pooled mean difference of 33.54, indicating improved nasal airflow. Seven studies reported change in olfactory score with an overall pooled effect of 6.56 suggesting improved olfaction. The SNOT-22 score in nine studies gave an overall pooled effect of -14.53, indicating improved quality of life. CONCLUSIONS: Biologics can be effective in treating nasal polyps, with reduction in polyp size and extent of disease, and improved sense of smell and quality of life. There is significant heterogeneity in the outcomes for individual biologics, highlighting the need for further studies.

Isolated sudden onset anosmia in COVID-19 infection. A novel syndrome?

BACKGROUND: The amelioration of the current COVID pandemic relies on swift and efficient case finding as well as stringent social distancing measures. Current advice suggests that fever or new onset dry cough are the commonest presenting complaints. METHODOLOGY: We present a case report and case series as well as other evidence that there is an important fourth presenting syndrome, namely isolated sudden onset anosmia (ISOA), which should be considered highly suspicious for SARS-CoV-2. RESULTS: A patient presenting with ISOA who went on to test positive for infection with COVID-19 and did not develop any further symptoms as well as a case series of similar patients although limited by the lack of reliable testing at the moment. CONCLUSIONS: We posit the existence of a fourth common syndrome of COVID-19 infection: isolated sudden onset anosmia (ISOA) and urge the international community to consider this presentation in current management advice.

Diseases mimicking allergic rhinitis.

Although allergic rhinitis is the commonest diagnosis in the child with nasal obstruction and rhinorrhoea, the differential must include other, much rarer, conditions. We present three case histories and discussion of several other diagnoses which should be considered.