Capsule Summary In this study we found a significantly lower eosinophilia in nasal polyps surgically removed from second-generation Asian patients, similar to studies of native-born patients in Asian countries, suggesting the hypothesis that there may be genetic regulation of eosinophilia.

Objective To evaluate if molecular markers of eosinophilia in olfactory enriched mucosa are associated with olfactory dysfunction. Study Design Cross-sectional study of tissue biopsies from 99 patients, and a further 30 patients who underwent prospective olfactory testing prior to sinonasal procedures. Methods Tissue biopsies were processed for analysis of inflammatory markers using qRT-PCR. Ipsilateral olfactory performance was assessed using the Sniffin Sticks threshold component and the UPSIT and age-adjusted data was correlated with inflammatory marker expression and clinical measures of obstruction from CT and endoscopy. Results Gene expression of the eosinophil marker CLC (Charcot Leyden crystal protein) was elevated in superior turbinate (ST) tissue in CRS with nasal polyps (CRSwNP) compared to ST and inferior turbinate (IT) tissue in CRS without nasal polyps (CRSsNP) and control patients (all p < 0.001 respectively). CLC in ST tissue was correlated with IL-5 and eotaxin-1 expression (all p<0.001; r = 0.65 and 0.49 respectively). CLC expression was strongly correlated with eosinophilic cationic protein levels (p<0.001; r=0.-76) and ST CLC expression was inversely related to olfactory threshold (p = 0.002, r = −0.57) and discrimination scores (p = 0.05, r = −0.42). In multiple linear regression of CLC gene expression, polyp status, radiographic and endoscopic findings with olfactory threshold, CLC was the only significantly correlated variable (p<0.05). Conclusions Markers of eosinophils are elevated in the ST of patients with CRSwNP and correlate with olfactory loss. These findings support the hypothesis that olfactory dysfunction in CRS correlates local eosinophil influx into the olfactory cleft.

Compared to sprays, irrigations provide a more effective method of delivering topical agents to the posterior and superior aspects of the nasal cavity. The thorough distribution of irrigations has important clinical implications for improving the delivery of therapeutic agents to the olfactory mucosa.

Objective Children at high risk for respiratory complication after adenotonsillectomy are often admitted to a pediatric intensive care unit (PICU) postoperatively. Although many patients receive care in such units, it is unknown how many utilize critical care resources. Methods A review was conducted to audit intensive care needs of postadenotonsillectomy patients admitted to the PICU at a tertiary, academic, pediatric hospital between July 2013, and March 2017. Demographic information, ICU indication, polysomnogram results, and comorbidities were collected. Patients were defined as needing ICU resources based on supplemental oxygen requirements greater than 2 L between 2 to 24 hours postoperatively, more than two desaturation events in a 2‐hour period, or more than hourly nursing intervention. Factors associated with utilization of ICU resources were assessed. Results One hundred and ten patients were admitted to the PICU after adenotonsillectomy. Median age was 4.2 years, median body mass index was 90.8 percentile, and median apnea hypopnea index (AHI) was 34.3. Twenty patients (18.2%) utilized ICU resources by criteria defined. Of these patients, 14 were known to need such resources by 2 hours postoperatively (70%, negative predictive value 93.8%). Neither AHI nor obesity status was correlated with need for resources; however, resource need was associated with young age, gastrostomy tube status, and neuromuscular disorders (P = 0.048, P = 0.002 and 0.013, respectively). Conclusion Most high‐risk adenotonsillectomy patients do not utilize critical care resources despite their increased perioperative risk. Patients with respiratory complications are frequently identifiable within the first 2 hours of surgery. Level of Evidence 4 Laryngoscope, 129:1229–1234, 2019