Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease often resistant to standard treatments. Dupilumab, a monoclonal antibody targeting the IL-4α receptor, has shown efficacy in CRSwNP, but a significant subset of patients do not respond to this therapy. This study aims to investigate pretreatment complete blood count (CBC)-based inflammatory biomarkers as predictors of response to dupilumab in patients with CRSwNP. Methods: This mono-centric, retrospective, single-arm longitudinal cohort study included 80 patients with uncontrolled CRSwNP who received dupilumab treatment at the Medical University of Graz. Patients were classified into responder and non-responder groups based on a reduction of >1 in nasal polyp score (NPS) and a sinonasal outcome test-22 (SNOT-22) score <40 points at six months. Pretreatment CBC-derived biomarkers, including eosinophil count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammation indices including the aggregate inflammation systemic index (AISI), systemic inflammation index (SII), and systemic inflammation response index (SIRI), were analyzed for their predictive value. Results: Of the 80 patients, 72.5% were classified as responders, while 27.5% were non-responders. A significant positive correlation was found between baseline eosinophil count and NPS reduction (p = 0.027), suggesting that higher eosinophil levels may predict higher NPS reduction in dupilumab treatment. However, no significant associations were observed between NLR, PLR, and systemic inflammation indices with treatment outcomes. Conclusions: Pretreatment eosinophil count may serve as a potential biomarker for predicting nasal polyp reduction in dupilumab treatment of CRSwNP. Other CBC-based inflammatory markers did not show significant predictive value. Further prospective studies are needed to validate these findings and explore additional, reliable biomarkers to optimize treatment outcomes for CRSwNP patients.

Chronic rhinosinusitis with nasal polyps (CRSwNP) significantly impacts quality of life and often presents therapeutic challenges, with biologics like dupilumab showing promise in managing severe, uncontrolled cases. The aim of this study was to assess the influence of overweight on the effectiveness of dupilumab in patients with uncontrolled CRSwNP. This retrospective study analyzed treatment outcomes of 75 CRSwNP patients receiving dupilumab, categorizing them into underweight/normal-weight (BMI ≤ 24.9 kg/m²) and overweight/obese (BMI ≥ 25 kg/m²) groups. Outcome measures included changes in nasal polyp score (NPS) and sinonasal outcome test (SNOT-22) scores. Results demonstrated that the underweight/normal-weight group experienced significantly greater improvements in NPS and a higher rate of total NPS improvement compared to the overweight/obese group. While SNOT-22 scores improved in both groups, no significant differences were observed. Among patients with comorbid asthma, the underweight/normal-weight subgroup also showed significantly better outcomes, including greater reductions in both NPS and SNOT-22 scores. Multiple regression analysis identified BMI as an independent prognostic factor for NPS outcomes. The findings suggest that overweight/obesity adversely affects the response to dupilumab in CRSwNP, emphasizing the need for personalized treatment strategies considering BMI.

Objectives: to evaluate our real-world data on the efficacy and safety of switching between two monoclonal antibodies in biologic treatment of uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: All patients receiving biologic treatment for uncontrolled CRSwNP between April 2020 and March 2024 at a tertiary referral center who needed transitioning between biologic agents were retrospectively analyzed. The following parameters were investigated: patient’s clinical characteristics, wash-out periods, treatment outcome, and switching-related side effects. Results: Out of 91 CRSwNP patients who received biologic treatment, 4 patients (4.4%) necessitated switching to an alternative biologic agent. Three patients were switched to a different antibody because of insufficient symptom control with the initially prescribed biologic, while the other patient required switching to an alternative agent due to a side effect. Switching resulted in all four patients achieving a significant improvement in all outcome parameters. There were no switching-related side effects, and the switching procedure was performed in three cases without a wash-out period. Conclusion: CRSwNP patients under biologic therapy with an insufficient response or medication-related side effect may benefit from switching to an alternative biologic agent. Larger, prospective multicenter studies are warranted to further validate the effectiveness and safety of switching agents in the biologic treatment of CRSwNP.

This report describes a rare occurrence of benign fibrous histiocytoma in the frontal sinus of a 38-year-old male. The patient presented with acute symptoms, including sudden-onset headache, nausea, and general discomfort, although neurological, otorhinolaryngological and laboratory examinations showed no abnormalities. A cranial CT scan revealed a cystic, osteodestructive lesion measuring 2.5 cm in the far lateral right frontal sinus, initially suspected to be a mucocele due to radiological characteristics and the patient’s history of recurring frontal headaches and retrobulbar pressure. Elective surgical excision was performed via an external supraorbital approach due to the lesion’s lateral location. Histopathological examination of the excised tissue revealed characteristic features of benign fibrous histiocytoma, including spindle cell proliferation and the presence of histiocytes and siderophages. Immunohistochemistry further supported the diagnosis, showing EMA, S100, and creatinine negativity with SMA positivity. This case is unique, as it represents the first reported benign fibrous histiocytoma in the frontal sinus. During regular follow-up, the patient remained symptom-free and showed no recurrence. This report underscores the importance of considering rare diagnoses for cystic skull lesions and supports tailored surgical approaches based on lesion location.

Background/Objectives: Dupilumab is an effective long-term treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), but continuous biweekly (Q2W) treatment is associated with high costs, cumulative drug exposure, and treatment burden. Extending injection intervals may reduce these burdens. This real-world study aimed to evaluate the feasibility and clinical outcomes of dupilumab interval extension compared with continued standard Q2W dosing. Methods: In this retrospective single-center study, 35 adults with CRSwNP who had received dupilumab 300 mg Q2W for >12 months underwent a stepwise interval-extension attempt (two-week increments, ≥6 months between steps) and were compared with 30 patients who continued Q2W dosing. Clinical outcomes were assessed every six months using the Sino-Nasal Outcome Test-22 (SNOT-22) and Nasal Polyp Score (NPS). Results: Of the 35 patients, 19 patients (54%) reached a dosing interval of Q4W or longer, and eight patients (23%) maintained a partial extension to Q3W after not tolerating Q4W. The remaining eight patients (23%) returned to Q2W. Thus, 27 patients (77%) stayed on an extended interval beyond the standard Q2W regimen, which was maintained throughout follow-up without reversion to a shorter regimen. SNOT-22 and NPS improved significantly after dupilumab initiation and remained stable throughout follow-up in both groups, with no significant between-group differences in longitudinal outcomes. No patient needed rescue treatments during follow-up. Conclusions: In selected clinically stable patients with CRSwNP, dupilumab interval extension appeared feasible and was associated with maintained disease. Individualized dose tapering, including intermediate intervals such as Q3W, may reduce treatment burden without compromising disease control. Larger prospective studies are needed to define optimal extension protocols and identify predictors of successful interval extension.

This case report details the unusual occurrence of a live ant invading the middle ear cavity through a pre-existing perforation in the tympanic membrane of a 42-year-old female patient. She presented to an outpatient clinic with symptoms of sudden-onset tinnitus (“ringing”) and a foreign body sensation in her left ear. Otomicroscopy revealed an oval-shaped perforation in the posterior part of the left tympanic membrane, through which a dark, moving foreign object was observed in the middle ear. The object was identified as a live ant. Initial attempts to remove the insect under local anesthesia were unsuccessful, necessitating the patient’s admission for surgery. Under general anesthesia, an endoscopic tympanotomy was performed, and the ant was successfully removed without complications. The patient recovered and was discharged the following day. At her follow-up appointment, she remained symptom-free. This case highlights the rare yet possible occurrence of live foreign bodies entering the middle ear through tympanic perforations and the need for timely surgical intervention to prevent complications.