Background: To elucidate the interaction between hypoxia-induced autophagy and glycolysis in nasal polyp fibroblasts, and the regulatory role of Sirtuin 6 (SIRT6) in the pathogenesis of nasal polyp. Objective: Through examining the expressions of lactate dehydrogenase (LDH), microtubule-associated protein II light chain 3 (LC3II) (an autophagy marker), and production of lactate under hypoxia, the interaction between autophagy and glycolysis was investigated. The role of SIRT6 on the hypoxia-induced autophagy and glycolysis was also examined. Methods: Nasal polyp specimens were used to examine the expressions of hypoxia-inducible factor (HIF) 1α, LDH, and LC3II by Western blot analysis, and primary cultures of nasal polyp fibroblasts were established from resected nasal polyps to measure hypoxia-induced LDH and LC3II expression by Western blot analysis and lactate production by colorimetry. Forced expression of SIRT6 with a lentiviral-based technique was used to evaluate its suppressive effect on autophagy and glycolysis. Immunohistochemical staining was performed to detect the expressions of SIRT6, LDH, and beclin (another autophagy marker) in nasal polyps. Results: Expression of HIF-1α, LDH, and an autophagy marker, LC3II, are increased in nasal polyp specimens, and forced expression of SIRT6 in nasal polyp fibroblasts inhibited LDH expression, lactate production under hypoxia, and SIRT6. An immunohistochemistry study of nasal polyp showed that SIRT6 expression was reduced and LDH and beclin were enhanced. Conclusion: Analysis of these data indicated that hypoxia may contribute to the formation of nasal polyp by promoting autophagy in nasal polyp fibroblasts. Through the antiglycolytic activity of SIRT6, the autophagy was suppressed, which was beneficial to nasal polyp formation. Modulation of glucose metabolism through SIRT6-based strategy may possess therapeutic potential for nasal polyposis in the future.

Background and Objectives: Chronic rhinosinusitis (CRS) frequently recurs following endoscopic sinus surgery (ESS), yet reported recurrence rates, risk factors, and treatment responses differ significantly across regions. This review aims to synthesize current evidence on recurrence patterns, predictive models, and treatment strategies, with a focus on comparing Asian and Western populations. Materials and Methods: A structured narrative review was conducted by searching PubMed, Embase, and Cochrane Library from January 2010 to June 2025. A total of 116 studies were included based on predefined criteria regarding recurrence definitions, risk factors, prediction models, and postoperative management. Results: Recurrence rates ranged from 12% to 76.6%, with wide variability attributed to differences in follow-up duration and recurrence definitions. Key risk factors included tissue eosinophilia, comorbid asthma, and type 2 inflammation. Asian predictive models emphasized inflammatory biomarkers such as tissue and blood eosinophils, whereas Western models incorporated imaging, prior surgical history, and symptom burden. While biologics are widely used in the West, their adoption remains limited in Asia, where endotype-driven corticosteroid strategies are predominant. Conclusions: CRS recurrence after ESS is influenced by inflammatory endotypes, comorbidities, and regional treatment paradigms. Cross-regional differences in immune profiles and healthcare access necessitate the development of standardized definitions and validated, endotype-driven prediction tools. Tailored treatment strategies, especially for non-type 2 CRS, are essential to achieving equitable and effective care globally.

Foreign bodies in the intraconal space are unusual, and lodgment at the orbital apex was even more unusual. High-velocity object injuries, such as gunshots or industrial accidents, are the common causes of intraorbital foreign bodies. It is difficult for surgeons to retrieve foreign bodies from the orbital apex as it is a deep, narrow space with critical surrounding structures. The use of an image-guided navigation system improves the accuracy of transnasal endoscopic surgery and causes less damage. We present a case in which a bullet became lodged in the orbital apex and was successfully removed using transnasal endoscopic surgery with the collaboration of otolaryngologists and ophthalmologists. To summarize, orbital apex foreign bodies are harmful, and prompt removal with a personalized multidisciplinary approach is critical.

Objectives. Chronic rhinosinusitis with nasal polyps (CRSwNP) demonstrates a high recurrence rate following endoscopic sinus surgery (ESS). The role of adjunctive biologic therapy remains incompletely understood. This study aims to assess the efficacy of dupilumab when used in conjunction with ESS for patients with CRSwNP.Methods. We conducted a retrospective cohort study of type 2 CRSwNP patients who underwent ESS. The study compared patients receiving postoperative dupilumab with those receiving standard care. Changes in the Lund-Kennedy endoscopic score (LKES) and nasal polyp score (NPS) were recorded, and linear mixed models (LMMs) were employed for the primary outcome analysis.Results. The study enrolled 49 CRSwNP patients, with 22 patients in the dupilumab group. Postoperative LKES and NPS decreased in both groups. LMM analysis revealed a significant improvement in LKES (B=–0.61; 95% CI, –0.90 to –0.31; P<0.001) and a more pronounced improvement in NPS (B=–0.14; 95% CI, –0.25 to –0.02; P=0.025) in the dupilumab group compared to controls from preoperative to postoperative measurements.Conclusion. Compared to ESS alone, the adjunctive use of dupilumab in the postoperative period was associated with greater reductions in both NPS and endoscopic scores.