To compare the diagnostic accuracy of nasal endoscopy, computed tomography and magnetic resonance imaging for chronic rhinosinusitis and chronic rhinosinusitis with nasal polyps.

PubMed, Embase, Web of Science, Scopus and the Cochrane Library were searched from 1990 to August 2025. Studies reporting 2 × 2 diagnostic data for diagnostic nasal endoscopy, computed tomography or magnetic resonance imaging were pooled using random-effects models to estimate sensitivity, specificity and summary receiver-operating characteristic measures.

Nine diagnostic datasets were included. Diagnostic nasal endoscopy showed high sensitivity (0.87) but moderate specificity (0.63) versus computed tomography. Computed tomography demonstrated good sensitivity (0.90) but limited specificity (0.50) versus histopathology. Magnetic resonance imaging provided moderate sensitivity (0.71) and high specificity (0.88) versus computed tomography. Substantial heterogeneity existed across modalities and reference standards.

Diagnostic nasal endoscopy is highly sensitive but moderately specific. Computed tomography is sensitive but limited by false positives. Magnetic resonance imaging appears more specific, although evidence remains scarce. Further paired imaging–histopathology studies are required.

Chronic rhinosinusitis with nasal polyps patients awaiting functional endoscopic sinus surgery have unmet psychological needs. This study evaluated cognitive behavioural therapy’s efficacy in relieving their anxiety, depression and sinus symptoms.

A single-centred randomised controlled trial enrolled 144 patients (51 females, 93 males), randomising 72 to six weeks of cognitive behavioural therapy (cognitive restructuring, behavioural activation) and 72 to routine pre-operative education. Outcomes were assessed via Self-rating Anxiety Scale, Self-rating Depression Scale and Sino-Nasal Outcome Test at pre-intervention and 1, 3, 6 and 12 months post–functional endoscopic sinus surgery.

Compared with the control group, the cognitive behavioural therapy group had significantly lower scores at all post–functional endoscopic sinus surgery time points (all p < 0.001), with benefits sustained for one year. Efficacy was consistent across most subgroups (ages and disease duration), except the 61- to 70-year-old cognitive behavioural therapy subgroup with late-phase score increases (still lower than controls).

Six weeks of structured cognitive behavioural therapy improves chronic rhinosinusitis with nasal polyps patients’ pre-operative mental health and sinus symptoms and should be core to their multimodal pre-rehabilitation.

While Eustachian tube dysfunction is a known comorbidity of chronic rhinosinusitis with nasal polyps, the prevalence of Eustachian tube dysfunction symptoms in this population is poorly understood.

Retrospective analysis of patient-reported sino-nasal (Sino-Nasal Outcome Test 22) and ear (Eustachian Tube Dysfunction Questionnaire 7) symptoms with type-2 markers (peripheral blood eosinophils and total immunoglobulin E, Nasal Polyp Score and Lund-Mackay Score on computed tomography in chronic rhinosinusitis with nasal polyps (study group) and non–chronic rhinosinusitis patients (control group). The control group were patients presenting with symptoms of chronic rhinosinusitis and Eustachian tube dysfunction with normal endoscopy and computed tomography sinus scan.

Chronic rhinosinusitis with nasal polyps patients were significantly older, had a higher proportion of males and higher levels of type-2 markers. There was no significant difference in Sino-Nasal Outcome Test 22, Eustachian Tube Dysfunction Questionnaire 7 and the proportion of patients with Eustachian tube dysfunction between the groups. Sino-Nasal Outcome Test 22, Sino-Nasal Outcome Test 5 and Sino-Nasal Outcome Test 22 ear domain correlated significantly with Eustachian Tube Dysfunction Questionnaire 7 in chronic rhinosinusitis with nasal polyps patients.

The clinical relevance of the Eustachian Tube Dysfunction Questionnaire 7 in chronic rhinosinusitis with nasal polyps is rather debatable as our findings reveal the presence of elevated scores not only in chronic rhinosinusitis with nasal polyps but also in the control group.

This study evaluates the effectiveness of long-term, low-dose antibiotic treatment (macrolides and doxycycline) combined with intra-nasal corticosteroids in patients with chronic rhinosinusitis with nasal polyps.

A total of 72 patients diagnosed with chronic rhinosinusitis with nasal polyps, aged 18–65, were followed for at least six months. Patients were randomized into three treatment groups: group 1 (intra-nasal corticosteroids and nasal saline irrigation), group 2 (intra-nasal corticosteroids, saline irrigation and macrolides) and group 3 (intra-nasal corticosteroids, saline irrigation and doxycycline).

Of the 72 patients, 43 (59.7 per cent) were male, and 29 (40.3 per cent) were female, with an average age of 48.69 plus or minus 15.71 years. A significant reduction in polyp stages was observed bilaterally and unilaterally in group 3 (p < 0.05). Lund–Mackay Score showed significant improvement in group 2 and group 3.

Adding doxycycline to intra-nasal corticosteroids therapy led to significant reductions in polyp stages and Lund–Mackay Score, suggesting potential clinical and radiological benefits.

The primary objective of our study was to survey ENT surgeons who perform functional endoscopic sinus surgery in the UK regarding their post-sinus surgery practices.

A 28-item questionnaire on post-functional endoscopic sinus surgery practices was distributed electronically to ENT UK members specialising in rhinology.

Ninety (90 per cent) surgeons prescribe saline nasal irrigation post-functional endoscopic sinus surgery but administration timing and methods vary. Following functional endoscopic sinus surgery, 17.7 per cent (n = 17) of respondents routinely prescribe antibiotics, whilst about a quarter (26.0 per cent, n = 25) do not prescribe antibiotics at all. The rest of the respondents only prescribe antibiotics in specific cases. Thirty-three (34.7 per cent) respondents do not prescribe oral steroids whilst most clinicians (83.9 per cent, n = 78) prescribe intranasal corticosteroids post-operatively.

Our study highlights homogeneous, evidence-based practices post-functional endoscopic sinus surgery from UK-based specialists, specifically in the use of saline irrigation and intranasal corticosteroids. However, our cohort displayed significant heterogeneity regarding oral antibiotics, oral steroids, and other specific aspects of post-operative care.

To evaluate the predictive value of peripheral blood eosinophil levels for eosinophilic chronic rhinosinusitis.

Electronic searches were conducted in PubMed, Embase and the Cochrane Library. Data were analysed using Stata 16.0.

In total, 23 studies that fulfilled the inclusion criteria were analysed. For peripheral blood eosinophil percentage in identifying eosinophilic chronic rhinosinusitis, the pooled sensitivity was 0.77 (95 per cent confidence interval (CI) = 0.69–0.83) and specificity was 0.74 (95 per cent CI = 0.68–0.80), with a positive likelihood ratio of 2.97 (95 per cent CI = 2.38–3.72) and a negative likelihood ratio of 0.31 (95 per cent CI = 0.24–0.42). Similarly, for peripheral blood eosinophil count, the pooled sensitivity was 0.78 (95 per cent CI = 0.73–0.82) and specificity was 0.73 (95 per cent CI = 0.69–0.77), with a positive likelihood ratio of 2.93 (95 per cent CI = 2.45–3.50) and a negative likelihood ratio of 0.30 (95 per cent CI = 0.24–0.37).

There is not sufficient evidence to support peripheral eosinophilia as a good predictor of eosinophilic chronic rhinosinusitis.

Oral corticosteroids are used to treat exacerbations of chronic rhinosinusitis with nasal polyps. Oral corticosteroid prescribing practices vary as reported from national surveys in Italy, China, Canada and the USA.

A nationwide online survey of ENT doctors practicing in Scotland was conducted using Microsoft Forms.

There was a 31 per cent response rate. The most common daily doses of oral corticosteroid courses were 25 mg and 40 mg with the lengths being 14 and 7 days, respectively. Seventy-seven per cent of respondents prescribed the same daily dose throughout the course. Rhinologists prescribed longer courses with a smaller daily dose of prednisolone. Only one respondent fully agreed that there were clear guidelines regarding the daily dose and the length of oral corticosteroid course in the treatment of chronic rhinosinusitis with nasal polyps.

The heterogeneity of oral corticosteroid prescribing practice in different countries, including Scotland, reveals the need for clear guidelines with a specific oral corticosteroid daily dose and length of the course.

This study aimed to analyse clinical and radiological features (phenotypes) to predict revision risk after functional endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps.

Phenotype characteristics of the patients with chronic rhinosinusitis with nasal polyps who underwent functional endoscopic sinus surgery were analysed retrospectively.

The rates of asthma, aspirin sensitivity, smoking and a positive prick test result were significantly higher in revision functional endoscopic sinus surgery cases (p < 0.001, 0.001, < 0.001 and < 0.001, respectively). Multivariate analysis demonstrated that only gender, pre-operative nasal steroid use, pre-operative systemic steroid use, intra-operative systemic steroid use and smoking were significant risk factors for revision functional endoscopic sinus surgery (p = 0.034, 0.001, 0.010, 0.007 and 0.001, respectively). In addition, only eosinophilia and aspirin sensitivity were significant risk factors for multiple revision functional endoscopic sinus surgery procedures (p = 0.043 and 0.005, odds ratio = 2.4 and 5.2).

Beyond the endotype of chronic rhinosinusitis with nasal polyps, defining clinical and radiological factors enables a valid prediction of patients at high risk of revision functional endoscopic sinus surgery.

To review the literature comparing functional endoscopic sinus surgery to dupilumab for the treatment of chronic rhinosinusitis with nasal polyps, in terms of symptom control, cost-effectiveness and complications.

A literature review was conducted using PubMed, ScienceDirect and Cochrane databases. Data were extracted manually.

A total of six papers relevant to the main objective were found.

Chronic rhinosinusitis with nasal polyps has a significant impact on patients’ quality of life. Both functional endoscopic sinus surgery and dupilumab achieve comparable disease control and result in good symptom relief. Dupilumab is far more expensive than functional endoscopic sinus surgery and is not considered cost-effective for the time being. This is expected to change after 10 years when the drug patent expires. More research is needed to compare the complications of both treatment modalities.

To investigate epidermal growth factor, transforming growth factor-α and interleukin-8 production in nasal mucosa irrigated with hypertonic 2.3 per cent solution with algae extracts, in comparison to 0.9 per cent NaCl during the first two weeks after surgery for nasal polyposis, in relation to symptoms and local findings.

This prospective study included 20 nasal polyposis patients postoperatively irrigated with hypertonic solution and 20 nasal polyposis patients postoperatively irrigated with isotonic solution. We evaluated nasal symptom score, endoscopic score and mediator levels in nasal secretions before and after irrigation.

Following treatment, nasal symptom score and endoscopic score were significantly lower in the hypertonic solution group (p = 0.023; p < 0.001, respectively). The increase in the epidermal growth factor and the decrease in the transforming growth factor-α and interleukin-8 concentration were higher in the hypertonic group (p < 0.001 for all mediators).

Irrigation with a hypertonic solution was found to be more effective than an isotonic solution in nasal mucosa reparation.

To assess the efficacy of budesonide intrapolyp injection in chronic rhinosinusitis with nasal polyps.

Ninety patients were divided into three groups; group A was given oral prednisolone, group B was given budesonide intrapolyp injection weekly for five consecutive weeks and group C was given budesonide as nasal irrigation for one month. Patients were assessed using Sino-Nasal Outcome Test 22 score, total nasal polyp score, serum immunoglobulin E, absolute eosinophilic count, and morning cortisol level before treatment, one week and three months after completing their treatment.

Total nasal polyp score decreased significantly in all groups compared to those at baseline. Reduction in the oral and injection groups was greater than the wash group (p2 = 0.004), (p3 < 0.001), and the same trend concerning Sino-Nasal Outcome Test 22 score (p2 < 0.001), (p3 < 0.001).

Budesonide is an effective agent used in intrapolyp injection with no documented systemic or visual side effects that has comparable results with oral steroids.

Some chronic rhinosinusitis with nasal polyps patients undergo revision surgery at some point following initial functional endoscopic sinus surgery. This review aimed to identify the predictive factors for recurrence of nasal polyps requiring oral corticosteroids or revision surgery in chronic rhinosinusitis with nasal polyps following functional endoscopic sinus surgery.

A retrospective analysis of 221 patients who underwent functional endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps in a tertiary rhinology centre, between January 2015 and December 2018, was undertaken.

Forty-four (21.6 per cent) patients underwent medical polypectomy, 19 (9 per cent) underwent revision surgery and 51 (24.3 per cent) underwent combined polypectomy during the mean follow-up time of 5.3 years. Patients aged less than 55 years of age, with a history of previous functional endoscopic sinus surgery, peripheral blood eosinophil counts of 300 cells/μl or higher, a Lund–Mackay score of more than 17 and concomitant aspirin-exacerbated respiratory disease had significantly increased odds for medical polypectomy, revision surgery and combined polypectomy.

Knowing these predictive factors, clinicians can better identify patients with an increased likelihood of severe polyp recurrence and therefore arrange closer follow-up to optimise therapy.

This study aimed to examine the association between nasal septal deviation and antrochoanal polyp.

This was a retrospective review of medical records and imaging of patients who underwent endoscopic sino-nasal surgery for antrochoanal polyp.

Forty-eight patients operated on for antrochoanal polyp between 2009 and 2019 were eligible for the study. The median age was 32 years, and 52.1 per cent were male. Antrochoanal polyp was diagnosed equally in the right and left nasal cavities. Septal deviation was present in 77 per cent of such cases. In 44 per cent of septal deviation cases, the antrochoanal polyp was ipsilateral to the deviation, which was not statistically significant. The type of deviation according to the Mladina classification was not correlated with the laterality of septal deviation and antrochoanal polyp.

The laterality of the septal deviation was not found to be correlated with that of the antrochoanal polyp. Therefore, performing routine septoplasty during antrochoanal polyp surgery is unnecessary unless the deviation interferes with the complete extraction of the polyp.

Make-at-home nasal irrigation solutions are often recommended for treating chronic rhinosinusitis. Many patients will store pre-made solution for convenient use. This study investigated the microbiological properties of differing recipes and storage temperatures.

Three irrigation recipes (containing sodium chloride, sodium bicarbonate and sucrose) were stored at 5oC and 22oC. Further samples were inoculated with Staphylococcus aureus and Pseudomonas aeruginosa. Sampling and culturing were conducted at intervals from day 0–12 to examine for bacterial presence or persistence.

No significant bacterial growth was detected in any control solution stored at 5oC. Saline solutions remained relatively bacterial free, with poor survival of inoculated bacteria, which may be related to either lower pH or lower osmolality. Storing at room temperature increased the risk of contamination in control samples, particularly from pseudomonas.

If refrigerated, pre-made nasal irrigation solutions can be stored safely for up to 12 days without risking cross-contamination to irrigation equipment or patients.

This study aimed to discuss the role of large cavity functional endoscopic sinus surgery in the management of chronic rhinosinusitis with nasal polyps in patients with non-steroidal anti-inflammatory drug exacerbated respiratory disease.

This was a retrospective review of patients undergoing large cavity functional endoscopic sinus surgery for non-steroidal anti-inflammatory drug exacerbated respiratory disease from January 2016 to March 2022. Population characteristics, pre- and post-operative number of functional endoscopic sinus surgical procedures, endoscopic polyp grade, Lund–Mackay score and nasal symptoms were recorded.

Thirteen consecutive patients with a median age of 47 years were included. They all failed maximal medical treatment and/or conservative functional endoscopic sinus surgery and underwent large cavity sinus surgery followed by post-operative maximal medical therapy. All patients showed an improvement in nasal symptoms with improved Lund–Mackay scores post-operatively. The median length of follow up was 1.5 years.

Large cavity functional endoscopic sinus surgery seems to halt the progression of chronic rhinosinusitis with nasal polyps in non-steroidal anti-inflammatory drug exacerbated respiratory disease. In this case series, large cavity functional endoscopic sinus surgery combined with optimal post-operative medical treatment appeared to switch off chronic rhinosinusitis with nasal polyps in patients with non-steroidal anti-inflammatory drug exacerbated respiratory disease.

This study aimed to explore the utility of the eosinophil percentage in peripheral blood for guiding post-operative glucocorticoid therapy in patients with chronic rhinosinusitis with nasal polyps.

Forty-four patients with chronic rhinosinusitis with nasal polyps underwent functional endoscopic sinus surgery and were randomly divided into two groups. Patients in the standard treatment group used oral and nasal spray glucocorticoids. In the biomarker treatment group, patients with peripheral blood eosinophil percentage values less than 3.05 per cent did not receive glucocorticoid treatment, whereas patients with values 3.05 per cent or above were part of the standard treatment group. Visual Analogue Scale, Sino-Nasal Outcome Test-22 scores, endoscopic Lund–Kennedy scores, eosinophils, interleukin-5 and eosinophil cationic protein in peripheral blood, and nasal secretions were measured.

After functional endoscopic sinus surgery, the Visual Analogue Scale, Sino-Nasal Outcome Test-22 and Lund–Kennedy scores were significantly reduced in both groups; there were no significant differences in those indicators between the groups during the three follow-up visits.

Peripheral blood eosinophil percentage offers a potential biomarker to guide post-operative glucocorticoid therapy in patients with chronic rhinosinusitis with nasal polyps.

Chronic or recurrent mucoid respiratory tract symptoms may be difficult to diagnose.

Ninety-two children with chronic respiratory symptoms were divided into 4 groups: 18 children with refractory asthma, 10 with bronchiectasis without dextrocardia, 18 with dextrocardia and 46 with recurrent respiratory tract infections. Except for five neonates, cytology samples were taken under general anaesthesia. Ciliary beat frequency was measured photometrically and analysed by in-house computer software.

Nasal polyps were found in one child with normal ciliary beat frequency. Twenty-six children had no beating cilia (male to female ratio, 15:11). The effect of increasing temperature on the ciliary beat frequency of the remaining 66 patients was evaluated (42 patients, more than 30°C, median, 8.3 Hz; 24 patients, 30–37°C, median, 11.8 Hz; p = 0.0003).

The measurement of ciliary beat frequency is part of the diagnostic work up of patients with persistent or recurrent respiratory tract infections.

The objective of this systematic review and meta-analysis was to evaluate the role of doxycycline in the management of chronic rhinosinusitis.

This was a systematic review using Ovid Medline, Cinahl, Scopus and Cochrane and was limited to meta-analyses, systematic reviews and randomised, clinical trials. A combination of the following search terms was used: ‘sinusitis’, ‘nasal polyps’, ‘doxycycline’ and ‘tetracycline’. Raw means and standard deviations were extracted from the included studies. The meta-analysis was performed using mean differences of pre- versus post-doxycycline treatment.

A total of 279 studies were screened, of which 5 studies met the criteria (all randomised, controlled trials published between 2010 and 2021). The interventions, endpoints and measured outcomes varied across all studies. Meta-analysis performed on pre- versus post-doxycycline treatment for Sino-Nasal Outcome Test-22, nasal polyp scores and symptom scores did not yield statistically significant results.

This review identified a small number of high-quality studies on the use of doxycycline in chronic rhinosinusitis. There does not seem to be convincing evidence for the routine use of doxycycline in patients with chronic rhinosinusitis. Further research may try to identify certain phenotypes of chronic rhinosinusitis that may better respond to doxycycline.

This study aimed to determine the predictors of olfactory improvement after endoscopic sinus surgery among patients with chronic rhinosinusitis with nasal polyps.

This prospective cohort study included patients admitted to a university hospital between 2006 and 2012. Assessment using odour identification testing, a sinonasal symptom questionnaire, the Rhinosinusitis Disability Index and mucus biomarker levels was performed at various time points. Correlation of variables with identification score differences at six post-operative time points and at baseline was performed, followed by multiple linear regression to determine significant predictors at each of the six post-operative time points.

Baseline absence of acute sinusitis, elevated serpin F2 and anterior rhinorrhoea predict early olfactory improvement, whereas baseline allergic rhinitis predicts late olfactory improvement. Baseline odour identification score was the strongest predictor across all time points.

Patients with chronic rhinosinusitis and nasal polyps with worse disease or baseline olfactory function may benefit more from endoscopic sinus surgery in terms of olfactory improvement.