Chronic rhinosinusitis with nasal polyps (CRSwNP) in the severe forms is associated with a poor quality of life. Dupilumab has been suggested as an add-on treatment option for severe CRSwNP. Severe CRSwNP patients treated with Dupilumab in different rhinological units were considered for this study via their evaluation at the baseline at first and the consequential follow-up at 6-, 12-, and 24 months from the first administration. At baseline (T0) and at each follow-up, patients underwent NPS, Sinonasal Outcome Test (SNOT)-22, Visual Analogue Scale (VAS) for smell, and Sniffin’ sticks identification test (SSIT). The SNOT-22 domains for function and emotion were also analysed separately. Two hundred and seventeen patients with at least 6 months of follow-up were included. All parameters have improved during treatment (p < 0.0001). Noticeably, both the function and emotion SNOT-22 domains have improved within 6 months of treatment and have continued to progress during every interval within 12 months from the baseline, positively influencing patients’ emotivity and augmenting their social and economic performances. Dupilumab improves the QoL of CRSwNP patients with good effects on the reported productivity and emotional health. Clinicians should pay attention to these two aspects when dealing with patients affected by severe CRSwNP.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory disorder of the upper airways, severely impacting quality of life. Dupilumab, targeting type 2 inflammatory pathways, is effective in managing severe, uncontrolled CRSwNP. However, the comparative accuracy of endoscopic scoring systems in monitoring therapeutic response to dupilumab remains unclear. This study compared the accuracy of the nasal polyp score (NPS) and the modified Lund–Kennedy endoscopic score (M-LKS) in assessing dupilumab response. Methods: A retrospective cohort analysis included 66 severe CRSwNP patients treated with dupilumab at Padua University. Endoscopic scores (NPS and M-LKS), patient-reported outcome mesures (PROMs), and clinician-reported outcome measures (CROMs), including peak nasal inspiratory flow (PNIF) and the Sniffin’ Sticks test, were evaluated at baseline and over 24 months. Results: Both NPS and M-LKS showed significant reductions over time (p < 0.001), significantly correlating with PNIF (p < 0.001). Given time and patient, PNIF emerged to be the only covariate related to endoscopic scores. No significant differences were observed between NPS and M-LKS regarding clinical outcome associations, suggesting equivalent accuracy. PNIF was identified as a critical predictor of endoscopic improvement, highlighting its clinical utility. These findings reinforce the role of standardized endoscopic metrics in assessing the efficacy of biologic therapies for CRSwNP.

Background: Healing dynamics after anterior skull base (ASB) reconstruction following transnasal endoscopic surgery (TES) for sinonasal malignancies remain poorly characterized. This study aimed to describe the postoperative healing process, quantify time to healing, identify factors influencing healing, and assess radiologic evolution over time. Methods: This multicenter retrospective study included adult patients undergoing TES with craniectomy and ASB reconstruction for sinonasal malignancies between 2016 and 2024. Serial endoscopic examinations were reviewed using a novel stage‐based classification system. Postoperative contrast‐enhanced magnetic resonance imaging (MRI) was analyzed to evaluate reconstruction layers, enhancement patterns, thickness changes, and brain sagging. Cumulative incidence analysis, multistate modeling, and uni‐ and multivariable analyses were performed to identify factors associated with healing. Results: A total of 173 patients were included. Complete endoscopic healing was achieved in 15.9% of patients at 6 months, 69.9% at 12 months, and 94.4% at 24 months. Local pedicled flap reconstruction was associated with faster healing, with complete healing achieved in 89.4% of patients at 12 months compared with 60.7% in graft‐based reconstructions ( p < 0.001). Adjuvant radiotherapy (RT), particularly intensity‐modulated proton therapy, was independently associated with delayed healing. MRI showed progressive reduction in reconstruction thickness, decreased visibility of adipose tissue and the outer graft layer, and increased brain sagging over time. RT was associated with greater remodeling changes, whereas flap‐based reconstruction appeared to mitigate these effects. Conclusions: Healing after ASB reconstruction following TES is a prolonged and dynamic process influenced mainly by reconstruction technique and adjuvant RT. Local vascularized flaps promote faster and more stable healing and may be particularly advantageous in patients requiring postoperative RT.