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dysbiosis is more common in fungal CRS and limited to the middle meatus. This Special Issue of JCM includes two papers on disease-specific form of CRS. The study of Chang et al. [18] examined the occurrence of CRS among patients with Sjögren’s syndrome (SS). A huge database was analyzed: 18,723 SS patients diagnosed between 1997 and 2011 were retrospectively reviewed. A control group of 59,568 patients without SS were matched at the 1:4 ratio to SS patients. Patients were matched by gender, age, income, urban and comorbidities. Comorbidities retrieved included: rhinitis, septal deviation, gastroesophageal reflux disease (GERD) chronic obstructive pulmonary disease (COPD), asthma, diabetes mellitus (DM), and hypertension (HT). The main outcome was CRS occurrence. The authors demonstrated that the cumulative incidence of CRS was statistically increased in the SS group as compared to controls. The Cox proportional model demonstrated that patients with SS have a significant increased CRS incidence (adjusted HR, 2.51; 95% CI, 2.22–2.84; p < 0.001). Subgroup analyses of GERD, COPD, asthma, DM, HT, and RA showed that SS is an independent risk factor in the occurrence of CRS. The percentage of patients undergoing surgery in the SS group was significantly lower. Further research is undeniably needed to highlight the features of CRS among SS patients. The naso-sinusal disease of 64 adult patients with primary ciliary dyskinesia (PCD) is deeply analyzed in the study of Bequignon et al. [19] Among patients included, hearing loss and rhinorrhea were most commonly encountered. Symptom burden was increased in older patients. Abnormal nasal endoscopy was recorded in every case: polyps were present in 33% of patients and sticky, thick, immobile mucus in 87.5% of cases. On the CT scan, sinuses displayed partial opacities, and hypoplasia/agenesis was present in one third of patients. Culture-guided cultures grew Haemophilus influenzae, Streptococcus pneumoniae and Pseudomonas aeruginosa. Otitis media with effusion (OME) was frequently encountered during childhood, but less common in adults. Half of the patients presented sensorineural hearing loss. Ciliary function and ultrastructure were not associated with disease seriousness in the otolaryngology field. The OME occurrence was statistically associated with a forced expiratory volume (FEV1) < 70%. Thus, the existence of OME in adults with PCD could be a marker of severe lung disease. In the same issue of JCM, Bequignon et al. [20] published another interesting study on the management of CRS in adult patients with PCD. A retrospective review of 41 adult patients with PCD is presented. On the CT scan, partial opacities were described, mainly positioned in the ethmoids and maxillary sinuses. Positive bacteriological cultures were obtained in 83.9% of patients with purulent mucus. Positive cultures for Pseudomonas aeruginosa were not significantly different between patients bellow and above 40 years. Surgery was employed in only 19% of patients to improve sinus drainage. The authors emphasize that in PCD patients, sinuses should be considered a bacterial pool. The paper suggests that bacteriology and sinus symptoms rather than CT scans should guide medical and surgical management in this group of patients. Practical approaches to common problems are also discussed in this issue of JCM. Inverted papilloma (IP) of the maxillary sinus is still considered a challenge for the endoscopic surgeon. In a beautifully illustrated paper, Hildebrand et al. [21] retrospectively review 17 patients with primary or recurrent IP of the maxillary sinus. The prelacrimal endoscopic approach has been used in all patients. No recurrences were described after a median follow-up of 3.8 years. The surgical technique is
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