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Gengler I, Kavoosi TA, McCann AC, Trope M, Lindsey BA, Speth MM, Sassler AM, Seiden AM, Phillips KM, Sedaghat AR. Patient perspectives on recall period and response options in patient-reported outcome measures for chronic rhinosinusitis symptomatology: A pilot study. Clin Otolaryngol 2021; 46:1021-1027. [PMID: 33780598 DOI: 10.1111/coa.13774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Patient-reported outcome measures (PROMs) for assessment of chronic rhinosinusitis (CRS) employ a variety of recall periods and response scales for reporting CRS symptom burden. CRS patient perspective is unknown with respect to recall periods and response scales in PROMs. DESIGN Cross-sectional study. SETTING Tertiary rhinology clinic. PARTICIPANTS Sixty three adults with CRS. MAIN OUTCOME MEASURES Participants were asked to choose which CRS symptom recall period-1 day, 2 weeks, 1 month or greater than 1 month-was most reflective of their current disease state and best to base treatment recommendations (including surgery) upon. Participants were also asked to report which of six response scales (one visual analogue scale [VAS] and five Likert scales ranging from four to eight items) were easiest to use and understand, and most preferred. RESULTS A majority of participants felt the current state of their CRS symptoms was best reflected by a recall period of 2 weeks to 1 month; however, patients preferred that recommendations about treatments, including endoscopic sinus surgery, be determined by symptoms experienced over at least a one-month period. Participants generally found the VAS and seven-item Likert scale to be the easiest to use and understand, and their most preferred scales. No patient characteristics associated with preferences for recall periods or response scales. CONCLUSION Future PROMs for CRS symptoms should consider assessment of symptoms over a one-month time frame and use either a VAS or seven-item Likert response scale to optimally balance reflection of current disease state, need for intervention and patient preference.
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Affiliation(s)
- Isabelle Gengler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tazheh A Kavoosi
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Adam C McCann
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michal Trope
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brentley A Lindsey
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marlene M Speth
- Klinik für Hals-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Aarau, Switzerland
| | - Alfred M Sassler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Allen M Seiden
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Pandrangi VC, Farrell NF, Mace JC, Detwiller KY, Smith TL, Geltzeiler M. Perceived Financial Insecurity Impacts Healthcare Decision-Making Among Patients With Sinusitis. Laryngoscope 2021; 131:2403-2412. [PMID: 33851727 DOI: 10.1002/lary.29561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/16/2021] [Accepted: 04/04/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS The economic burden of sinusitis is significant, and socioeconomic factors can impact patient decision-making. The purpose of this study was to examine the impact of perceived financial insecurity on healthcare decision-making and treatment compliance among sinusitis patients. STUDY DESIGN Cross-sectional study using the 2018 National Health Interview Survey. METHODS Survey responses to nine questions regarding financial stressors and nine questions regarding cost-saving healthcare actions were recorded, which included seeking lower cost medication, medication noncompliance, and avoiding care visits due to costs. RESULTS There was a total weighted sample size of 28.9 million patients who self-reported a diagnosis of sinusitis (12% of the U.S. population). Sinusitis patients who reported cost-saving actions had an increased severity of perceived financial insecurity than those without cost-saving actions (P < .001). Sinusitis patients with perceived financial insecurity had the highest odds of at least one cost-saving action (odds ratio [OR] = 5.94, 95% CI = 5.911-5.970, P < .001), followed by lack of health insurance (OR = 5.13, 95% CI = 5.107-5.159, P < .001), and poor self-reported health status (OR = 2.81, 95% CI = 2.792-2.822, P < .001). Increasing the number of financial stressors increased the odds of at least one cost-saving action (P < .001). Across all financial stressors, the most commonly performed cost-saving action was asking for lower cost medication. CONCLUSIONS Perceived financial insecurity is associated with cost-saving healthcare actions among sinusitis patients, including treatment noncompliance. Interventions to assess financial insecurity among sinusitis patients may facilitate shared decision-making for optimal, individualized treatment plans that may lead to improved outcomes and quality of life. LEVEL OF EVIDENCE NA. Laryngoscope, 2021.
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Affiliation(s)
- Vivek C Pandrangi
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Nyssa Fox Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri, USA
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Kara Y Detwiller
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
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153
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Schlosser RJ, Smith TL, Mace JC, Alt JA, Beswick DM, Mattos JL, Ramakrishnan V, Massey C, Soler ZM. The Olfactory Cleft Endoscopy Scale: a multi-institutional validation study in chronic rhinosinusitis. Rhinology 2021; 59:181-190. [PMID: 33006331 DOI: 10.4193/rhin20.307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Olfactory dysfunction (OD) associated with chronic rhinosinusitis (CRS) remains quite challenging. Instruments to precisely assess olfactory cleft anatomy and their association with olfaction are needed. METHODS The olfactory cleft endoscopy scale (OCES) was used to assess the olfactory cleft in healthy control subjects and a cohort of patients with CRS. Psychophysical and psychosocial olfactory function were assessed and correlations with OCES scores were measured. RESULTS Control subjects and subjects with CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP) were enrol- led. OCES correlated with both psychophysical and psychosocial olfaction, as measured by threshold, discrimination and identi- fication (TDI) scores and Questionnaire on Olfactory Disorders (QOD-NS) scores for all case and control subjects combined. OCES improved in both CRS groups postoperatively with the highest correlation seen in postoperative olfaction in CRSwNP patients. CRS patients who achieve near perfect OCES and sinus endoscopy scores after surgery have olfactory metrics that are indistin- guishable from controls regardless of polyp status. CONCLUSIONS The OCES is a valid olfactory-specific measure that demonstrates strong validity and provides complimentary infor- mation to traditional sinus endoscopy to aid in our understanding of OD associated with CRS.
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Affiliation(s)
- R J Schlosser
- Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - T L Smith
- Division of Rhinology and Sinus Surgery, Oregon Health Services University, Portland, OR, USA
| | - J C Mace
- Division of Rhinology and Sinus Surgery, Oregon Health Services University, Portland, OR, USA
| | - J A Alt
- University of Utah, Salt Lake City, UT, USA
| | | | - J L Mattos
- University of Virginia, Charlottesville, VA, USA
| | | | - C Massey
- University of Colorado, Aurora, CO, USA
| | - Z M Soler
- Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC, USA
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154
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Shah SJ, Hawn VS, Zhu N, Fang CH, Gao Q, Akbar NA, Abuzeid WM. Postoperative Infection Rate and Associated Factors Following Endoscopic Sinus Surgery. Ann Otol Rhinol Laryngol 2021; 131:5-11. [PMID: 33834876 DOI: 10.1177/00034894211007240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES There is a paucity of data on postoperative infections after endoscopic sinus surgery and associated risk factors. Our objective was to evaluate a cohort of patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis to determine which perioperative factors may be associated with infection in the 30-day postoperative period. METHODS A retrospective cohort study of adults who underwent ESS at a tertiary academic medical center from 2015 to 2018 was performed. The primary outcome was incidence of postoperative infection, defined by identification of sinus purulence on nasal endoscopy necessitating antibiotics within 30 days of surgery. Independent variables collated included the result of postoperative cultures and use of perioperative antibiotics, oral corticosteroids, packing, and steroid-eluting stents. Statistical analysis involved bivariate analysis to identify variables that correlated with postoperative infection and subsequent multivariate logistic regression to identify independent risk factors. RESULTS Three hundred seventy-eight unique ESS cases performed in 356 patients were reviewed. The mean age was 46 years (range, 18-87). The most common indication for surgery was chronic rhinosinusitis without nasal polyposis. The postoperative infection rate was 10.1%. The most commonly cultured pathogen was Staphylococcus aureus. Multivariate logistic regression analysis showed that postoperative systemic corticosteroid use was the only risk factor independently associated with infection (OR 3.47 [95% CI 1.23-9.76], P = .018). CONCLUSION The incidence of postoperative infection following ESS was 10.1%. The use of postoperative systemic corticosteroids independently increased the risk of infection by 3.47-fold.
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Affiliation(s)
- Sharan J Shah
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vivian S Hawn
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nina Zhu
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christina H Fang
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Qi Gao
- Department of Epidemiology and Population Health (Biostatistics), Albert Einstein College of Medicine, Bronx NY, USA
| | - Nadeem A Akbar
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Waleed M Abuzeid
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle WA, USA
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155
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Piromchai P, Phannikul C, Thanaviratananich S. Syringe with Nasal Applicator versus Syringe Alone for Nasal Irrigation in Acute Rhinosinusitis: A Matched-Pair Randomized Controlled Trial. Biomed Hub 2021; 6:25-29. [PMID: 33791314 DOI: 10.1159/000512664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Nasal saline irrigation is a common procedure to relieve nasal symptoms in upper respiratory tract diseases. There is no consensus on the recommended nasal saline delivery devices. The objectives of this study were to evaluate efficacy, satisfaction, adherence, and adverse effects in patients with acute upper respiratory tract diseases using a syringe with a nasal applicator for nasal irrigation. Methods Patients with acute nasopharyngitis, acute rhinitis, or acute rhinosinusitis were randomly allocated to use either (1) a syringe with a nasal applicator or (2) a syringe alone to irrigate one nostril. After the patients had completed irrigation with the allocated device in one nostril, they were instructed to perform nasal irrigation using the other device in the other nostril. All patients were instructed to use a syringe with a nasal applicator at home. The efficacy, satisfaction scores, adherence, and adverse effects were recorded. Results Sixty-four patients were enrolled. The mean age of the patients was 33.95 years (18-59 years). The mean duration of symptoms was 4.80 days. None of the enrolled patients regularly performed nasal irrigation. Forty-two had acute nasopharyngitis, 10 had acute rhinitis, and 12 had acute rhinosinusitis. At baseline, the mean overall efficacy score for the syringe with a nasal applicator was 8.17 ± 1.43, and that for the syringe alone was 5.95 ± 2.02 (MD 2.23, p < 0.001, 95% CI 1.75-2.70). At 1 week, the syringe with the nasal applicator had significantly higher scores in 3 of 4 domains, including symptom relief, ease of use, and patients' willingness to recommend the device to others, compared to baseline (p < 0.05). None of the enrolled patients had epistaxis, retained/dislodged the applicator during irrigation, or experienced an allergic reaction to the applicator after 1 week of nasal irrigation. Conclusion Use of a syringe with an applicator for nasal irrigation yielded high scores in overall efficacy.
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Affiliation(s)
- Patorn Piromchai
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chayakorn Phannikul
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Carmel-Neiderman NN, Safadi A, Wengier A, Ziv-Baran T, Warshavsky A, Ringel B, Horowitz G, Fliss DM, Abergel A. The Role of Imaging in the Preoperative Assessment of Patients with Nasal Obstruction and Septal Deviation-A Retrospective Cohort Study. Int Arch Otorhinolaryngol 2021; 25:e242-e248. [PMID: 33968227 PMCID: PMC8096514 DOI: 10.1055/s-0040-1712933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 04/18/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction Isolated nasal obstruction (INO) is a common complaint of multiple etiology. The preoperative evaluation of patients presenting with nasal obstruction and deviated nasal septum (DNS) does not typically include imaging. The benefits of performing computed tomography (CT) in the preoperative setting are inconclusive. Objective Assessing the contribution of preoperative CT to the surgical treatment of non-sinusitis patients presenting with INO and DNS. Methods A retrospective cohort study on patients referred to surgery for nasal obstruction due to DNS or turbinate hypertrophy between 2006 and 2015. Data was retrieved from patients' medical charts. The CT scans and clinical data were reassessed by a second surgeon blinded to the patients' clinical course. Results Seventy of the 843 patients (8.06%) who underwent endoscopic sinonasal procedures during the study period had presented with INO and met the inclusion criteria. Thirty-eight (55.88%) of them underwent CT scans during their preoperative assessment. Modification of the initial preoperative planning based on the radiological findings was required in 32 cases (84.2%). When reassessed by a second blinded surgeon, 58% of cases required surgical modification rather than classical submucosal resection of nasal septum and turbinate reduction ( P = 0.048). Conclusion Computed tomography was found beneficial in the preoperative planning for patients with INO. The original surgical plan based upon physical examination findings was modified based on radiological findings in 84.2% of the patients.
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Affiliation(s)
- Narin Nard Carmel-Neiderman
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ahmad Safadi
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Wengier
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Anton Warshavsky
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Barak Ringel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan M. Fliss
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avraham Abergel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Changes in Maxillary Sinus Mucosal Thickening following the Extraction of Teeth with Advanced Periodontal Disease: A Retrospective Study Using Cone-Beam Computed Tomography. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6688634. [PMID: 33860050 PMCID: PMC8009702 DOI: 10.1155/2021/6688634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/06/2021] [Accepted: 03/13/2021] [Indexed: 11/17/2022]
Abstract
Objectives To explore the alterations in maxillary sinus mucosal thickening after extracting teeth with severe periodontal disease using cone-beam computed tomography (CBCT). Methods 30 patients with severe periodontal disease of maxillary posterior teeth that needed to be extracted and who were radiographically diagnosed with mucosal thickening (MT) in the maxillary sinus participated in the study. CBCT scans were taken before tooth extraction and 2-29 months after tooth extraction. The postextraction follow-up time was divided into two groups: group 1 (<4 months) and group 2 (≥4 months). Dimensions of maxillary sinus MT, including the MT zone length (SL) and the maximum thickness of the MT zone (ST), were evaluated preextraction and postextraction; the residual ridge height (RRH) was evaluated at the sites of extracted and nonextracted teeth. Result Of the 24 patients with unilateral tooth extraction, there was a statistically significant difference in MT between the extraction and nonextraction sides (p < 0.05). The RRH at the site of the extracted teeth was significantly lower than that of the nonextracted teeth (p < 0.05). MT decreased significantly after tooth extraction on the extraction side but not on the nonextraction side. There was no significant difference between group 1 and group 2 regarding the reduction in mucosal thickness over time. Conclusions Severe periodontitis can cause MT in the maxillary sinus. The RRH was lower at the sites of extracted teeth. MT reduced quickly by a thorough debridement after tooth extraction in 4 months. MT will not decrease further over time.
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Khafagy Y, Ghonim M, Elgendy A, Elzayat S. The prognostic variables affecting the frontal sinusotomy patency outcome and how to manage: A prospective study. Clin Otolaryngol 2021; 46:969-975. [PMID: 33745238 DOI: 10.1111/coa.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/03/2021] [Accepted: 03/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The study aimed to assess the factors affecting the frontal sinus patency after endoscopic frontal sinusotomy. DESIGN A prospective cohort study. SETTING Tertiary centre hospital. MAIN OUTCOME MEASURES Fifty patients with refractory chronic frontal sinusitis (83 operated frontal sinuses) had frontal sinusotomy and followed up for six months. Multiple operative factors were included the type of the procedure, intraoperative sinus findings, degree of mucosal preservation and middle turbinate stability. Other factors were also assessed, including smoking, the presence of allergic rhinitis, asthma, gastroesophageal reflux and other associated medical comorbidities. RESULTS The sinus patency success rate was 75.9%. There was a significant difference regarding the intraoperative anteroposterior sinus ostium diameter (5.36 ± 1.45 mm vs 8.88 ± 2.38 mm, P-value: .001* in the failed group and the success group, respectively). There was a significant association between the patency outcome and the presence of associated medical comorbidities (P-value: .001*), the presence of allergic rhinitis (P-value: .001*), the degree of sinus mucosal preservation (P-value: .012*) and the degree of middle turbinate stability (P-value: .001*). The multivariate analysis showed that the intraoperative anteroposterior diameter of the sinus ostium, middle turbinate stability and presence of allergic rhinitis were significant predictors (P-value: .012*, .042* and .013*, respectively). CONCLUSION Sinuses with anteroposterior ostium diameters less than 5.36 mm are more susceptible to restenosis. The flail middle turbinate increases the risk of postoperative middle meatus synechia and frontal sinus patency failure. The presence of allergic rhinitis has a negative impact on the patency outcome.
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Affiliation(s)
- Yasser Khafagy
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Ghonim
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Elgendy
- Department of Otorhinolaryngology, Faculty of Medicine, Kafrelsheikh University, Kafr el-Sheikh, Egypt
| | - Saad Elzayat
- Department of Otorhinolaryngology, Faculty of Medicine, Kafrelsheikh University, Kafr el-Sheikh, Egypt
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Khafagy Y, Ghonim M, Elgendy A, Elzayat S. The impact of bolgerization versus partial resection of the middle turbinate on frontal sinusotomy patency outcome: A randomised controlled study. Clin Otolaryngol 2021; 46:954-960. [PMID: 33730409 DOI: 10.1111/coa.13758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/09/2021] [Accepted: 03/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to compare the effects of middle turbinate resection vs bolgerization on the incidence of middle meatus synechia and their prognostic value on the patency outcomes after frontal sinusotomy. DESIGN A randomised controlled study. SETTING Tertiary centre hospital. MAIN OUTCOME MEASURES Thirty-eight patients undergoing bilateral frontal sinusotomy for chronic frontal sinusitis were included. Partial middle turbinate resection was alternated with bolgerization in both nasal cavities of every patient. The Lund-Kennedy endoscopic scores (LKESs) for both sides were compared at the first, third and sixth months postoperatively. Middle meatus synechia was assessed using the visual analogue score (VAS). Sinus patency was assessed at the end of the sixth month using a 70° nasal endoscope. RESULTS The sinus patency outcome was significantly higher in the resected group (34\38) than the bolgerized group (26\38), (P = .047*). The VAS scores suggested that the middle turbinate bolgerization group showed a significantly higher incidence of middle meatal synechia than the partial middle turbinate resection group (4.47 ± 2.617 vs 3.29 ± 2.301; P = .040*). CONCLUSION Middle turbinate resection showed more favourable results than bolgerization concerning the sinus patency outcome after frontal sinusotomy. It also showed a lower incidence of middle meatus synechia postoperatively.
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Affiliation(s)
- Yasser Khafagy
- Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Ghonim
- Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Elgendy
- Otorhinolaryngology, Faculty of medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Saad Elzayat
- Otorhinolaryngology, Faculty of medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 374] [Impact Index Per Article: 124.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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161
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Khafagy Y, Ghonim M, Elgendy A, Elzayat S. The preoperative radiological findings associated with failure of frontal sinusotomy: A prospective study. Clin Otolaryngol 2021; 46:834-840. [PMID: 33655644 DOI: 10.1111/coa.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The study aimed to assess the association between the preoperative CT findings and the patency outcome of the frontal sinus after endoscopic frontal sinusotomy in the early follow-up period. DESIGN A prospective cohort study. SETTING Tertiary hospital centre. MAIN OUTCOME MEASURES The study measures the association between the frontal sinusotomy outcome and the standard preoperative radiological scores, including Harvard, Kennedy and Lund-Mackay. It also measures the impact of the degree of sinus mucosal thickness on the outcome. Furthermore, it measures the effect of the anteroposterior lengths of both the frontal sinus ostium and the frontal recess on postoperative frontal sinus patency. RESULTS Harvard, Kennedy and modified Lund-Mackay scores showed no evidence of association with the frontal sinusotomy patency outcome (P-values .397, .487 and .501), respectively. Still, the Lund-Mackay score showed a negative correlation with symptom improvement. Sinuses with a high-grade mucosal thickness on CT scan were associated with high failure rates (P-value: .009*). The anteroposterior length of the frontal sinus ostium significantly affects the outcome (P-value: .001*). In contrast, there was no association between the anteroposterior length of the frontal recess and the outcome (P-value: .965). CONCLUSION The Harvard, Kennedy and Lund-Mackay scores could not predict the frontal sinusotomy patency outcome. Failed cases were associated with advanced degrees of mucosal pathology in the preoperative CT scan. Sinuses ostia with anteroposterior diameters less than 5.36 mm showed more susceptibility for sinus restenosis postoperatively. The variability of the anteroposterior length of the frontal recess did not affect the surgical outcome.
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Affiliation(s)
- Yasser Khafagy
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Ghonim
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Elgendy
- Department of Otorhinolaryngology, Faculty of medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Saad Elzayat
- Department of Otorhinolaryngology, Faculty of medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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162
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Smith TL, Schlosser RJ, Soler ZM, Mace JC, Mattos JL, Ramakrishnan VR, Beswick DM, Alt JA, Mulligan JK. Olfactory cleft mucus inflammatory proteins in CRS: a case-control study. Int Forum Allergy Rhinol 2021; 11:1321-1335. [PMID: 33629532 DOI: 10.1002/alr.22770] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/14/2020] [Accepted: 12/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Multiple hypotheses are evolving that suggest several, potentially overlapping etiologies for olfactory dysfunction (OD) in chronic rhinosinusitis (CRS). Understanding inflammatory cytokine profiles of the olfactory cleft (OC) and their association with olfactory function is foundational for future clinical care and research. METHODS This cross-sectional, case-control study evaluates associations among OC mucus inflammatory proteins, psychophysical olfactory testing, and computed tomography (CT) analysis of the OC and sinuses. Normative reference intervals were determined for each protein and odds ratios (ORs) were used to compare proportions of altered expression between CRS without nasal polyposis (CRSsNP) and CRS without nasal polyposis (CRSwNP). RESULTS Case subjects with CRS (n = 151) and controls (n = 74) were evaluated. A majority of OC proteins tested were found within detectable ranges for cases and controls. The CRS cohort had significantly higher concentrations for 23 of 26 proteins. CRS cases with abnormal levels of C-C motif chemokine ligand 2 (CCL2), CCL3, interleukin 5 (IL5), IL10, and IL13 associated with greater olfactory deficits. The prevalence of elevated IL5 and IL13 in anosmic patients was 64.6% and 62.5%, respectively (p < 0.004). CRS cases with the highest odds of elevated expression in CRSwNP were IL5 (OR = 10.83) and IL13 (OR = 8.36). However, both IL5 and IL13 were still elevated in approximately 14% of CRSsNP patients. The highest magnitude of correlation between the total percent of OC opacification was found to be with IL5 (r = 0.543; p < 0.001), whereas other moderate correlations were noted with immunoglobulin E (IgE), IL10, and IL13. CONCLUSION This study confirmed that OC inflammatory proteins vary both by disease phenotype and in their association with OD. Type 2 inflammatory mediators are increased in CRS, especially within the CRSwNP group. However, a substantial proportion of CRSsNP also express type 2 inflammatory mediators. Further research is necessary to understand the complex roles OC mucous inflammatory proteins might play in defining endotype and in impacting CRS-related OD. ©2021 ARSAAOA, LLC.
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Affiliation(s)
- Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.,Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, SC
| | - Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Jose L Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Daniel M Beswick
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Jennifer K Mulligan
- Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, FL
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163
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Bhattacharyya N. Contemporary Incremental Healthcare Costs for Chronic Rhinosinusitis in the United States. Laryngoscope 2021; 131:2169-2172. [PMID: 33606274 DOI: 10.1002/lary.29454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE/HYPOTHESIS Determine contemporary incremental increases in healthcare expenditures and utilization associated with chronic rhinosinusitis (CRS). STUDY DESIGN Cross-sectional analysis of national health care survey data. METHODS Patients reporting a diagnosis of CRS were extracted from the 2018 Medical Expenditure Panel Survey medical conditions file and linked to the consolidated expenditures file. CRS patients were then compared to non-CRS patients determining differences in healthcare utilization for office visits, emergency facility visits, and prescriptions filled as well as differences in total healthcare costs, office-based costs, prescription medication costs, and self-expenditures using demographically and comorbidity adjusted multivariate models. Results were compared to 2007, adjusted for inflation. RESULTS An estimated 7.28 ± 0.36 million adult patients reported CRS in 2018 (3.0 ± 0.1% of the adult U.S. population). The additional incremental healthcare utilizations associated with CRS relative to non-CRS patients for office visits, emergency facility visits, and number of prescriptions filled were 4.2 ± 0.6, 0.10 ± 0.03, and 6.0 ± 0.9, respectively (all P ≤ .003). Similarly, additional incremental healthcare expenditures associated with CRS for total health care expenses, office-based visit expenditures, prescription expenditures, and self-expenditures were $1,983 ± 569, $772 ± 139, $678 ± 213, and $68 ± 17, respectively (all P ≤ .002). Increases in total (+$1,062) and office based expenditures (+$360) compared to 2007 were significant. CONCLUSION CRS continues to be associated with a substantial incremental increase in healthcare utilization and expenditures. These expenditures have significantly outpaced inflation expected increases. The national healthcare costs of CRS have increased to an estimated $14.4 billion per year. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Neil Bhattacharyya
- Department of Otolaryngology, Massachusetts Eye & Ear, Boston, MA, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, MA, U.S.A
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164
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Craig JR, Poetker DM, Aksoy U, Allevi F, Biglioli F, Cha BY, Chiapasco M, Lechien JR, Safadi A, Simuntis R, Tataryn R, Testori T, Troeltzsch M, Vaitkus S, Yokoi H, Felisati G, Saibene AM. Diagnosing odontogenic sinusitis: An international multidisciplinary consensus statement. Int Forum Allergy Rhinol 2021; 11:1235-1248. [PMID: 33583151 DOI: 10.1002/alr.22777] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Odontogenic sinusitis (ODS) is distinct from non-odontogenic rhinosinusitis, and often requires multidisciplinary collaboration between otolaryngologists and dental providers to make the diagnosis. The purpose of this study was to develop international multidisciplinary consensus on diagnosing ODS. METHODS A modified Delphi method was used to assess for expert consensus on diagnosing bacterial ODS. A multidisciplinary panel of 17 authors with ODS expertise from 8 countries (8 otolaryngologists, 9 dental specialists) was assembled. Each author completed 2 of 3 surveys (2 specialty-specific, and 1 for all authors). Thirty-seven clinical statements were created, focusing on 4 important diagnostic components: suspecting ODS; confirming sinusitis in ODS; confirming different dental pathologies causing ODS; and multidisciplinary collaborative aspects of diagnosing ODS. Target audiences were all otolaryngologists and dental providers. RESULTS Of the 37 clinical statements, 36 reached consensus or strong consensus, and 1 reached no consensus. Strong consensus was reached that certain clinical and microbiologic features should arouse suspicion for ODS, and that multidisciplinary collaboration between otolaryngologists and dental providers is generally required to diagnose ODS. To diagnose ODS, otolaryngologists should confirm sinusitis mainly based on nasal endoscopic findings of middle meatal purulence, edema, or polyps, and dental providers should confirm dental pathology based on clinical examination and dental imaging. CONCLUSION Based on multidisciplinary international consensus, diagnosing ODS generally requires otolaryngologists to confirm sinusitis, and dental providers to confirm maxillary odontogenic pathology. Importantly, both dental providers and otolaryngologists should suspect ODS based on certain clinical features, and refer patients to appropriate providers for disease confirmation.
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Affiliation(s)
- John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI
| | - David M Poetker
- Department of Otolaryngology- Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, WI.,Division of Surgery, Zablocki VAMC, Milwaukee, WI
| | - Umut Aksoy
- Division of Surgery, Zablocki VAMC, Milwaukee, WI.,Department of Endodontics, Faculty of Dentistry, Near East University, Mersin, Turkey
| | - Fabiana Allevi
- Department of Health Sciences, San Paolo and Carlo Hospital, Maxillofacial Surgery, University of Milan, Milan, Italy
| | - Federico Biglioli
- Division of Endodontology, School of Dental Medicine, University of Connecticut, Farmington, CT
| | - Bruce Y Cha
- Division of Endodontology, School of Dental Medicine, University of Connecticut, Farmington, CT
| | - Matteo Chiapasco
- Department of Biomedical, Surgical, and Dental Sciences, San Paolo and Carlo Hospital, Oral Surgery Unit, University of Milan, Milan, Italy
| | - Jerome R Lechien
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Saint-Aubin, France
| | - Ahmad Safadi
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Regimantas Simuntis
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Roderick Tataryn
- Tataryn Endodontics, Spokane, WA.,Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA
| | - Tiziano Testori
- Dental Clinic, Section of Implant Dentistry and Oral Rehabilitation, IRCCS Orthopedic Institute Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Saulius Vaitkus
- Department of Otolaryngology-Head and Neck Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hidenori Yokoi
- Department of Otolaryngology-Head and Neck Surgery, Kyorin University, Tokyo, Japan
| | - Giovanni Felisati
- Department of Health Sciences, San Paolo and Carlo Hospital, Otolaryngology Unit, University of Milan, Milan, Italy
| | - Alberto M Saibene
- Department of Health Sciences, San Paolo and Carlo Hospital, Otolaryngology Unit, University of Milan, Milan, Italy
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165
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Jeon Y, Lee K, Sunwoo L, Choi D, Oh DY, Lee KJ, Kim Y, Kim JW, Cho SJ, Baik SH, Yoo RE, Bae YJ, Choi BS, Jung C, Kim JH. Deep Learning for Diagnosis of Paranasal Sinusitis Using Multi-View Radiographs. Diagnostics (Basel) 2021; 11:diagnostics11020250. [PMID: 33562764 PMCID: PMC7914751 DOI: 10.3390/diagnostics11020250] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 01/01/2023] Open
Abstract
Accurate image interpretation of Waters’ and Caldwell view radiographs used for sinusitis screening is challenging. Therefore, we developed a deep learning algorithm for diagnosing frontal, ethmoid, and maxillary sinusitis on both Waters’ and Caldwell views. The datasets were selected for the training and validation set (n = 1403, sinusitis% = 34.3%) and the test set (n = 132, sinusitis% = 29.5%) by temporal separation. The algorithm can simultaneously detect and classify each paranasal sinus using both Waters’ and Caldwell views without manual cropping. Single- and multi-view models were compared. Our proposed algorithm satisfactorily diagnosed frontal, ethmoid, and maxillary sinusitis on both Waters’ and Caldwell views (area under the curve (AUC), 0.71 (95% confidence interval, 0.62–0.80), 0.78 (0.72–0.85), and 0.88 (0.84–0.92), respectively). The one-sided DeLong’s test was used to compare the AUCs, and the Obuchowski–Rockette model was used to pool the AUCs of the radiologists. The algorithm yielded a higher AUC than radiologists for ethmoid and maxillary sinusitis (p = 0.012 and 0.013, respectively). The multi-view model also exhibited a higher AUC than the single Waters’ view model for maxillary sinusitis (p = 0.038). Therefore, our algorithm showed diagnostic performances comparable to radiologists and enhanced the value of radiography as a first-line imaging modality in assessing multiple sinusitis.
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Affiliation(s)
- Yejin Jeon
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.J.); (K.L.); (D.C.); (D.Y.O.); (K.J.L.); (S.J.C.); (S.H.B.); (Y.J.B.); (B.S.C.); (C.J.); (J.H.K.)
| | - Kyeorye Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.J.); (K.L.); (D.C.); (D.Y.O.); (K.J.L.); (S.J.C.); (S.H.B.); (Y.J.B.); (B.S.C.); (C.J.); (J.H.K.)
| | - Leonard Sunwoo
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.J.); (K.L.); (D.C.); (D.Y.O.); (K.J.L.); (S.J.C.); (S.H.B.); (Y.J.B.); (B.S.C.); (C.J.); (J.H.K.)
- Center for Artificial Intelligence in Healthcare, Seoul National Univeristy Bundang Hospital, Seongnam 13620, Korea
- Correspondence: ; Tel.: +82-31-787-7631
| | - Dongjun Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.J.); (K.L.); (D.C.); (D.Y.O.); (K.J.L.); (S.J.C.); (S.H.B.); (Y.J.B.); (B.S.C.); (C.J.); (J.H.K.)
| | - Dong Yul Oh
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.J.); (K.L.); (D.C.); (D.Y.O.); (K.J.L.); (S.J.C.); (S.H.B.); (Y.J.B.); (B.S.C.); (C.J.); (J.H.K.)
| | - Kyong Joon Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.J.); (K.L.); (D.C.); (D.Y.O.); (K.J.L.); (S.J.C.); (S.H.B.); (Y.J.B.); (B.S.C.); (C.J.); (J.H.K.)
| | - Youngjune Kim
- Aerospace Medical Group, Air Force Education and Training Command, Jinju 52634, Korea;
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.J.); (K.L.); (D.C.); (D.Y.O.); (K.J.L.); (S.J.C.); (S.H.B.); (Y.J.B.); (B.S.C.); (C.J.); (J.H.K.)
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.J.); (K.L.); (D.C.); (D.Y.O.); (K.J.L.); (S.J.C.); (S.H.B.); (Y.J.B.); (B.S.C.); (C.J.); (J.H.K.)
| | - Roh-eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea;
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.J.); (K.L.); (D.C.); (D.Y.O.); (K.J.L.); (S.J.C.); (S.H.B.); (Y.J.B.); (B.S.C.); (C.J.); (J.H.K.)
| | - Byung Se Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.J.); (K.L.); (D.C.); (D.Y.O.); (K.J.L.); (S.J.C.); (S.H.B.); (Y.J.B.); (B.S.C.); (C.J.); (J.H.K.)
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.J.); (K.L.); (D.C.); (D.Y.O.); (K.J.L.); (S.J.C.); (S.H.B.); (Y.J.B.); (B.S.C.); (C.J.); (J.H.K.)
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.J.); (K.L.); (D.C.); (D.Y.O.); (K.J.L.); (S.J.C.); (S.H.B.); (Y.J.B.); (B.S.C.); (C.J.); (J.H.K.)
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166
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Soler ZM, Schlosser RJ, Bodner TE, Alt JA, Ramakrishnan VR, Mattos JL, Mulligan JK, Mace JC, Smith TL. Endotyping chronic rhinosinusitis based on olfactory cleft mucus biomarkers. J Allergy Clin Immunol 2021; 147:1732-1741.e1. [PMID: 33549569 DOI: 10.1016/j.jaci.2021.01.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although chronic rhinosinusitis (CRS) is considered the most treatable form of olfactory dysfunction, there has been relatively little clinical attention focused on assessing endotypes as they pertain to olfactory loss. OBJECTIVES The goal of this study was to explore inflammatory endotypes in CRS using an unsupervised cluster analysis of olfactory cleft (OC) biomarkers in a phenotype-free approach. METHODS Patients with CRS were prospectively recruited and psychophysical olfactory testing, Questionnaire of Olfactory Dysfunction (QOD-NS), and bilateral OC endoscopy were obtained. Mucus was collected from the OC and evaluated for 26 biomarkers using principal component analysis. Cluster analysis was performed using only OC biomarkers and differences in olfactory measures were compared across clusters. RESULTS A total of 198 subjects (128 with CRS and 70 controls) were evaluated. Evaluation of OC biomarkers indicated 6 principal components, explaining 69.50% of the variance, with type 2, mixed type 1/Th17-cell, growth factor, and neutrophil chemoattractant inflammatory signatures. A total of 10 clusters were identified that differed significantly in frequency of controls, and subjects with CRS with nasal polyps, and subjects with CRS without nasal polyps across the clusters (likelihood ratio test, χ182=178.64; P < .001). Olfactory measures differed significantly across clusters, including olfactory testing, QOD-NS, and OC endoscopy (P < .001 for all). CONCLUSIONS Clustering based solely on OC biomarkers can organize patients into clinically meaningful endotypes that discriminate between subjects with CRS and controls. Validation studies are necessary to confirm these findings and further refine olfactory endotypes.
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Affiliation(s)
- Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC; Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, SC
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, Ore
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Vijay R Ramakrishnan
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado-Anschutz Medical Campus, Aurora, Colo
| | - Jose L Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Va
| | - Jennifer K Mulligan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Fla
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Ore
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Ore.
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167
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Lambert PA, Gill AL, Gill SR, Allen PD, Man L. Microbiomics of irrigation with xylitol or Lactococcus lactis in chronic rhinosinusitis. Laryngoscope Investig Otolaryngol 2021; 6:64-70. [PMID: 33614931 PMCID: PMC7883620 DOI: 10.1002/lio2.524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/11/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Topical sinonasal rinse therapies may alter the local microbiome and improve disease control in chronic rhinosinusitis (CRS). The objective of this study was to examine microbiome changes in post-surgical CRS patients when rinsing with commercially available products containing xylitol or Lactococcus lactis. METHODS A crossover-type protocol with a washout period was designed. Swab samples from anterior ethmoid cavities of CRS patients were collected prospectively at baseline. Subjects were provided packets containing either L. lactis W136 or xylitol in non-blinded fashion and instructed to add it to their rinse bottles daily for 28 days, after which another swab was taken. A saline wash-out period was completed and a third swab taken. A final 28-day regimen of the opposite product was followed by a final swab. DNA extraction and sequencing of the 16S rRNA gene allowed for global microbiome analysis. RESULTS We enrolled 25 subjects with CRS and 10 controls resulting in 70 adequate samples. Increased detection of Lactococcus was observed after use of L. lactis. No significant trends in alpha or beta diversity as a result of treatment were observed. SNOT-22 score did not change significantly following treatment with xylitol, L. lactis, or saline. CONCLUSION We did not detect any major clinical or microbiome-level effect due to treatment with two topical rinse products. Further research is needed to elucidate their clinical utility and possible probiotic effect. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Paul A. Lambert
- Department of Otolaryngology Head and Neck SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Ann L. Gill
- Department of Microbiology and ImmunologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Steven R. Gill
- Department of Microbiology and ImmunologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Paul D. Allen
- Department of Otolaryngology Head and Neck SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Li‐Xing Man
- Department of Otolaryngology Head and Neck SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
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Perić A, Vezmar Kovačević S, Barać A, Perić AV, Vojvodić D. Effects of Pelargonium sidoides extract vs roxithromycin on chemokine levels in nasal secretions of patients with uncomplicated acute rhinosinusitis. Laryngoscope Investig Otolaryngol 2021; 6:25-33. [PMID: 33614926 PMCID: PMC7883607 DOI: 10.1002/lio2.514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/12/2020] [Accepted: 12/14/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Previous investigations suggest the use of extract from the roots of Pelargonium sidoides (EPs 7630) for the therapy of uncomplicated rhinosinusitis. The aim of this prospective study was to compare the effects of herbal drug EPs 7630 and antibiotic roxithromycin on chemokine production in nasal mucosa and clinical parameters in patients with uncomplicated acute bacterial rhinosinusitis (ABRS). METHODS Seventy-eight ABRS patients were divided into 26 patients receiving EPs 7630 tablets, 3 × 20 mg/day per os (group 1), 26 patients receiving roxithromycin tablets, 2 × 150 mg/day per os (group 2), both for 10 days, and 26 patients who received no therapy (Control group). We measured chemokine levels in nasal secretions by flow cytometry and assessed clinical parameters on day 0 and day 10 of investigation. RESULTS EPs 7630 increased concentrations of MCP-1 (P = .001) and IP-10 (P = .049) and decreased levels of MIP-1α (P < .001), ENA-78 (P < .001), and IL-8 (P < .001). Roxithromycin increased levels of IP-10 (P = .049) and decreased levels of MCP-1 (P < .001), MIP-1α (P < .016), ENA-78 (P < .001), and IL-8 (P < .001). Comparison of the non-treated patients' group with groups 1 and 2 revealed significant improvement of all clinical parameters in treated patients (P < .001), but therapy with roxithromycin resulted in better improvement in nasal symptoms and endoscopic findings than therapy with EPs 7630. CONCLUSION Our results suggest the presence of similar modulatory effects of both therapies on production of chemokines that regulate the function of neutrophils and monocytes in nasal mucosa. Roxithromycin shows better clinical efficacy than EPs 7630 in patients with uncomplicated ABRS. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Aleksandar Perić
- Department of Otorhinolaryngology, Military Medical Academy Faculty of MedicineUniversity of DefenceBelgradeSerbia
- MediGroup General HospitalBelgradeSerbia
| | - Sandra Vezmar Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of PharmacyUniversity in BelgradeBelgradeSerbia
| | - Aleksandra Barać
- Clinical Center of Serbia, School of MedicineUniversity in BelgradeBelgradeSerbia
| | - Aneta V. Perić
- Institute for Pharmacy, Military Medical Academy Faculty of MedicineUniversity of DefenceBelgradeSerbia
| | - Danilo Vojvodić
- Institute for Medical Research, Division of Clinical and Experimental Immunology, Military Medical Academy Faculty of MedicineUniversity of DefenceBelgradeSerbia
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169
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Kazi A, West E, Rahman S, Kim S, Sima A, Schuman TA. Pain Catastrophizing and Quality of Life in Adults With Chronic Rhinosinusitis. Laryngoscope 2021; 131:1939-1945. [PMID: 33513282 DOI: 10.1002/lary.29405] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Psychological comorbidity is common in patients with chronic rhinosinusitis (CRS) and is correlated with decreased overall and disease-specific quality of life (QoL). Prior research reported that anxiety and depression, as measured by the hospital anxiety and depression scale (HADS), are associated with worse CRS-specific QoL, as assessed via the Rhinosinusitis Disability Index (RSDI). Furthermore, patients prone to anxiety/depression may display an exaggerated response to real or anticipated discomfort; the pain catastrophizing scale (PCS) is a validated instrument designed to measure this phenomenon. This study is intended to explore the role of pain catastrophizing in relation to anxiety, depression, and disease-specific QoL in patients with facial pain attributed to CRS. STUDY DESIGN Prospective cohort study. METHODS Diagnosis of presumed CRS was based upon current American Academy of Otolaryngology - Head & Neck Surgery (AAO-HNS) guidelines; all participants reported facial pain as a component of their CRS symptomatology. RSDI, HADS, and PCS questionnaires were administered upon presentation prior to intervention, and objective measurements of sinonasal inflammation were obtained via nasal endoscopy and computed tomography (CT). RESULTS Seventy-five patients were enrolled in the study. Significant positive correlations were found between PCS and HADS, total RSDI, and RSDI emotional sub-scores (P < .05). The incidence of objective evidence of disease, as measured via nasal endoscopy and CT, was not significantly different in catastrophizing patients. CONCLUSIONS Pain catastrophizing correlates with anxiety/depression and worse disease-specific QoL in patients meeting symptomatic criteria for CRS. Otolaryngologists should be aware that catastrophic thinking can intensify a patient's perception of sinonasal symptoms, and clinicians may consider management of psychological comorbidity to optimize rhinologic outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1939-1945, 2021.
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Affiliation(s)
- Aasif Kazi
- Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Emma West
- Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Shahryar Rahman
- Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Sarah Kim
- Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Adam Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Theodore A Schuman
- Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
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170
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Bergeron JM, Parsel SM, Do TM, Unis GD, McCoul ED. Association of a standardized measure of nasopharyngeal inflammation with Eustachian tube dysfunction questionnaire score. Int Forum Allergy Rhinol 2021; 11:1177-1186. [PMID: 33502803 DOI: 10.1002/alr.22771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Standardized diagnostic criteria for Eustachian tube (ET) dysfunction (ETD) have not been established. The purpose of this study was to characterize the relationship between ET inflammation and ETD symptoms and to determine the diagnostic performance of a quantitative score. METHODS Patients were enrolled in a rhinology clinic between October 2018 and June 2019. Patients underwent nasal endoscopy and completed the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Nasopharyngeal inflammation identified on endoscopy was quantified using the Endoscopic Evaluation of the Eustachian Tube (3ET) score. Tympanometry was performed as indicated. Comorbid conditions were assigned during the patient encounter. RESULTS A total of 414 patients were included in the study. Patients with clinically significant ETD symptoms (ETDQ-7 ≥2.1) had higher 3ET scores than those without symptoms. A 1-point increase in 3ET score was associated with a 1.7-fold increase in odds of clinically significant ETD symptoms (adjusted OR [aOR], 1.72; 95% CI, 1.46 to 2.05). The 3ET scores were correlated with ETDQ-7 scores (ρ = 0.54) and 22-item Sino-Nasal Outcome Test (SNOT-22) scores (ρ = 0.52). 3ET scores were not associated with tympanometric peak pressures. Patients with ETD symptoms were more likely to have laryngopharyngeal reflux (aOR, 2.71; 95% CI, 1.24 to 6.18). A 3ET score of 4 predicted symptomatic state in 80% of cases with a specificity of 97.8% and positive predictive value of 96.6%. CONCLUSION Inflammatory findings at the nasopharyngeal ET orifice are associated with clinically significant ETD symptoms. The 3ET score is specific for a symptomatic state and has potential clinical utility in the evaluation of suspected ETD. ©2021 ARSAAOA, LLC.
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Affiliation(s)
- Jeffrey M Bergeron
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Sean M Parsel
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Triet M Do
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Graham D Unis
- Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Edward D McCoul
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA.,Department of Otorhinolaryngology, Ochsner Health System, New Orleans, LA
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171
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Lee K, Lee DD, Stevanovic M, Feustal P, Brand A, Pauze D, Wladis EJ. Orbital cellulitis secondary to sinusitis in upstate New York: current incidence, seasonality, severity, management and outcomes. Orbit 2021; 41:199-203. [PMID: 33390058 DOI: 10.1080/01676830.2020.1862246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: While sinusitis carries a seasonal variation, the temporal features of sinusitis-related orbital cellulitis (SRC) are unclear. This study analyzes the incidence, seasonality, management, and outcomes of SRC in northeastern New York.Methods: A retrospective review of 79 patients was performed from January 2008 - December 2018. Cases of orbital cellulitis without comitant sinusitis were excluded. Demographic, radiographic, clinical features, month at presentation, interventions (surgical and nonsurgical), microbiology, and hospitalization duration were recorded. Fisher-exact test, Mann-Whitney test, and Kruskal Wallis test statistical analyses were performed in consultation with our institution's statistician via a dedicated software package (vassarstats.net).Results: 79 patients were admitted for SRC. 25 patients were treated with antibiotics only, 31 underwent orbitotomy exclusively and 23 received combined orbitotomy and functional endoscopic sinus surgery (FESS). Of the 31 patients who underwent orbitotomy only, 8 (26%) returned to the operating room. In contrast, of those who underwent concomitant orbitotomy and FESS, only one patient (4.3%) required re-operation (fisher exact test, p = .021). The median length of stay for the antibiotic-only group (4 days), orbitotomy-only group (6 days), and combined surgery group (5 days) were statistically different (Kruskal Wallis, p = .004, Figure 3). Interestingly, there was no significant relationship of incidence or severity of SRC related to seasonality (fisher-exact test, p = .76).Conclusion: Our findings suggest that cases requiring surgical management for SRC should undergo coinitial orbitotomy with FESS to reduce re-operation rates. Additionally, SRC incidence and severity did not correlate with season.
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Affiliation(s)
- Kathryn Lee
- Lions Eye Institute, Department of Ophthalmology, Albany Medical College, USA
| | | | | | - Paul Feustal
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, USA
| | | | - Denis Pauze
- Department of Emergency Medicine, Albany Medical College, USA
| | - Edward J Wladis
- Albany Medical College, USA.,Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College, USA
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172
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Ramakrishnan VR, Arbet J, Mace JC, Suresh K, Shintani Smith S, Soler ZM, Smith TL. Predicting olfactory loss in chronic rhinosinusitis using machine learning. Chem Senses 2021; 46:bjab042. [PMID: 34473227 PMCID: PMC8558487 DOI: 10.1093/chemse/bjab042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Compare machine learning (ML)-based predictive analytics methods to traditional logistic regression in classification of olfactory dysfunction in chronic rhinosinusitis (CRS-OD) and identify predictors within a large multi-institutional cohort of refractory CRS patients. METHODS Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study were assessed for baseline CRS-OD using a smell identification test (SIT) or brief SIT (bSIT). Four different ML methods were compared to traditional logistic regression for classification of CRS normosmics versus CRS-OD. RESULTS Data were collected for 611 study participants who met inclusion criteria between 2011 April and 2015 July. Thirty-four percent of enrolled patients demonstrated olfactory loss on psychophysical testing. Differences between CRS normosmics and those with smell loss included objective disease measures (CT and endoscopy scores), age, sex, prior surgeries, socioeconomic status, steroid use, polyp presence, asthma, and aspirin sensitivity. Most ML methods performed favorably in terms of predictive ability. Top predictors include factors previously reported in the literature, as well as several socioeconomic factors. CONCLUSION Olfactory dysfunction is a variable phenomenon in CRS patients. ML methods perform well compared to traditional logistic regression in classification of normosmia versus smell loss in CRS, and are able to include numerous risk factors into prediction models. Several actionable features were identified as risk factors for CRS-OD. These results suggest that ML methods may be useful for current understanding and future study of hyposmia secondary to sinonasal disease, the most common cause of persistent olfactory loss in the general population.
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Affiliation(s)
- Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO, USA
| | - Jaron Arbet
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado–Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR, USA
| | - Krithika Suresh
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado–Denver Anschutz Medical Campus, Aurora, CO, USA
| | | | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR, USA
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Al-Thobaiti AD, Hamdi AM, Almalki MAO, Alghamdi WH, Albaz ME, Alshammari AM, Alhamyri FM, Alhmyri BM, Alhmyri SMA, Alhmyri KMA, Al-Harbi AMF. An Overview of sinusitis diagnosis and management approach in PHC. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/loic1sqo98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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174
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Lux CA, Wagner Mackenzie B, Johnston J, Zoing M, Biswas K, Taylor MW, Douglas RG. Antibiotic Treatment for Chronic Rhinosinusitis: Prescription Patterns and Associations With Patient Outcome and the Sinus Microbiota. Front Microbiol 2020; 11:595555. [PMID: 33414772 PMCID: PMC7782326 DOI: 10.3389/fmicb.2020.595555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Chronic rhinosinusitis (CRS) is a common and debilitating inflammatory condition of the sinuses, afflicting 5% of the general population. Although antibiotics are frequently prescribed for the medical management of CRS, there is surprisingly little evidence to support their efficacy. In this study, we aimed to establish associations between medication usage, the sinus microbiota and patients’ clinical outcomes. Methods Antibiotic prescription patterns for the year before sample collection of 156 CRS patients, 45 disease control patients (mostly requiring septoplasty and inferior turbinate reduction) and 35 healthy control subjects were examined and analyzed together with previously published bacterial 16S rRNA gene amplicon data from our group. Results The highest antibiotic usage was observed among the two CRS patient categories. Despite heavy antibiotic usage, CRS patients’ clinical outcomes as indicated by patient questionnaires and radiologic scores were similar to those patients that did not receive any antibiotics. The sinus microbiota was dominated by members of the bacterial genera Corynebacterium and Staphylococcus in all three cohorts. Bacterial community dispersion as measured by principal coordinate analysis was significantly higher in CRS patients compared to healthy control subjects, but not disease control patients. Pairwise comparisons within cohorts revealed differences in the relative 16S rRNA gene sequence abundances of the genera Staphylococcus and Lawsonella between antibiotic users and non-users. However, overall antibiotic effects were minimal and unpredictable. Conclusion The unpredictable effects of antibiotic treatment on the sinus microbiota found in this study, together with the lack of differences in patients’ symptom scores between cohorts, do not support preoperative antibiotic treatment for CRS patients.
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Affiliation(s)
- Christian A Lux
- School of Biological Sciences, University of Auckland, Auckland, New Zealand.,Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Brett Wagner Mackenzie
- Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
| | - James Johnston
- Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Melissa Zoing
- Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Kristi Biswas
- Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Michael W Taylor
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Richard G Douglas
- Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
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175
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Lehmann AE, Raquib AR, Siddiqi SH, Meier J, Durand ML, Gray ST, Holbrook EH. Prophylactic antibiotics after endoscopic sinus surgery for chronic rhinosinusitis: a randomized, double-blind, placebo-controlled noninferiority clinical trial. Int Forum Allergy Rhinol 2020; 11:1047-1055. [PMID: 33340285 DOI: 10.1002/alr.22756] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Surgeons commonly prescribe prophylactic antibiotics after endoscopic sinus surgery (ESS), yet minimal data exist to support this practice. In this study we aimed to assess the impact of post-ESS antibiotics on infection, quality of life (QOL), and endoscopic scores. METHODS This was a randomized, double-blind, placebo-controlled, noninferiority trial comparing amoxicillin-clavulanate vs placebo after ESS (NCT01919411, ClinicalTrials.gov). Adults (N = 77) with chronic rhinosinusitis (CRS) refractory to appropriate medical therapy who underwent ESS were randomized to antibiotics (N = 37) or placebo (N = 40) and followed clinically (mean ± standard deviation: 1.3 ± 0.3 and 8.8 ± 3.9 weeks postoperatively). At baseline and follow-up, QOL was measured with 22-item Sino-Nasal Outcome Test questionnaires and Lund-Kennedy endoscopic scores were evaluated. Outcomes were analyzed with repeated-measures analysis of variance and analysis of covariance and z tests for proportions. RESULTS Placebo was noninferior to antibiotic prophylaxis with regard to postoperative SNOT-22 scores (β = 0.18, 2-tailed p < 0.05). There were no significant differences between the antibiotic and placebo groups in LK score trajectories over time (p = 0.63) or in postoperative infection rates (2.6% vs 2.4%, respectively; p = 0.96). The rate of diarrhea was significantly higher in the antibiotic group (24.3% vs 2.5%; relative risk = 10.8; p = 0.02). CONCLUSION Although statistically underpowered, the results suggest placebo was noninferior to prophylactic antibiotics after ESS for CRS regarding postoperative sinonasal-specific QOL. There were no significant differences in postoperative endoscopic scores or rates of infection, but the rate of diarrhea was significantly higher in the antibiotic group. These findings add to the growing evidence that routine use of prophylactic postoperative antibiotics does not improve outcomes post-ESS and significantly increases the rate of diarrhea.
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Affiliation(s)
- Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Aaishah R Raquib
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Josh Meier
- School of Medicine, University of Nevada, Reno, Reno, NV.,Nevada ENT and Hearing Associates, Reno, NV
| | - Marlene L Durand
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Eric H Holbrook
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
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176
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Wongkaewkhiaw S, Taweechaisupapong S, Thanaviratananich S, Bolscher JGM, Nazmi K, Anutrakunchai C, Chareonsudjai S, Kanthawong S. D-LL-31 enhances biofilm-eradicating effect of currently used antibiotics for chronic rhinosinusitis and its immunomodulatory activity on human lung epithelial cells. PLoS One 2020; 15:e0243315. [PMID: 33326455 PMCID: PMC7743948 DOI: 10.1371/journal.pone.0243315] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a chronic disease that involves long-term inflammation of the nasal cavity and paranasal sinuses. Bacterial biofilms present on the sinus mucosa of certain patients reportedly exhibit resistance against traditional antibiotics, as evidenced by relapse, resulting in severe disease. The aim of this study was to determine the killing activity of human cathelicidin antimicrobial peptides (LL-37, LL-31) and their D-enantiomers (D-LL-37, D-LL-31), alone and in combination with conventional antibiotics (amoxicillin; AMX and tobramycin; TOB), against bacteria grown as biofilm, and to investigate the biological activities of the peptides on human lung epithelial cells. D-LL-31 was the most effective peptide against bacteria under biofilm-stimulating conditions based on IC50 values. The synergistic effect of D-LL-31 with AMX and TOB decreased the IC50 values of antibiotics by 16-fold and could eliminate the biofilm matrix in all tested bacterial strains. D-LL-31 did not cause cytotoxic effects in A549 cells at 25 μM after 24 h of incubation. Moreover, a cytokine array indicated that there was no significant induction of the cytokines involving in immunopathogenesis of CRS in the presence of D-LL-31. However, a tissue-remodeling-associated protein was observed that may prevent the progression of nasal polyposis in CRS patients. Therefore, a combination of D-LL-31 with AMX or TOB may improve the efficacy of currently used antibiotics to kill biofilm-embedded bacteria and eliminate the biofilm matrix. This combination might be clinically applicable for treatment of patients with biofilm-associated CRS.
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Affiliation(s)
- Saharut Wongkaewkhiaw
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Jan G. M. Bolscher
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kamran Nazmi
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Sorujsiri Chareonsudjai
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Biofilm Research Group, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Sakawrat Kanthawong
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Biofilm Research Group, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
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177
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Madaras-Kelly K, Hostler C, Townsend M, Potter EM, Spivak ES, Hall SK, Goetz MB, Nevers M, Ying J, Haaland B, Rovelsky SA, Pontefract B, Fleming-Dutra K, Hicks LA, Samore MH. Impact of Implementation of the Core Elements of Outpatient Antibiotic Stewardship Within Veterans Health Administration Emergency Departments and Primary Care Clinics on Antibiotic Prescribing and Patient Outcomes. Clin Infect Dis 2020; 73:e1126-e1134. [PMID: 33289028 DOI: 10.1093/cid/ciaa1831] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Core Elements of Outpatient Antibiotic Stewardship provide a framework to improve antibiotic use. We report the impact of core elements implementation within Veterans Health Administration sites. METHODS In this quasiexperimental controlled study, effects of an intervention targeting antibiotic prescription for uncomplicated acute respiratory tract infections (ARIs) were assessed. Outcomes included per-visit antibiotic prescribing, treatment appropriateness, ARI revisits, hospitalization, and ARI diagnostic changes over a 3-year pre-implementation period and 1-year post-implementation period. Logistic regression adjusted for covariates (odds ratio [OR], 95% confidence interval [CI]) and a difference-in-differences analysis compared outcomes between intervention and control sites. RESULTS From 2014-2019, there were 16 712 and 51 275 patient visits within 10 intervention and 40 control sites, respectively. Antibiotic prescribing rates pre- and post-implementation within intervention sites were 59.7% and 41.5%, compared to 73.5% and 67.2% within control sites, respectively (difference-in-differences, P < .001). Intervention site pre- and post-implementation OR to receive appropriate therapy increased (OR, 1.67; 95% CI, 1.31-2.14), which remained unchanged within control sites (OR,1.04; 95% CI, .91-1.19). ARI-related return visits post-implementation (-1.3% vs -2.0%; difference-in-differences P = .76) were not different, but all-cause hospitalization was lower within intervention sites (-0.5% vs -0.2%; difference-in-differences P = .02). The OR to diagnose non-specific ARI compared with non-ARI diagnoses increased post-implementation forintervention (OR, 1.27; 95% CI, 1.21 -1.34) but not control (OR, 0.97; 95% CI, .94-1.01) sites. CONCLUSIONS Implementation of the core elements was associated with reduced antibiotic prescribing for RIs and a reduction in hospitalizations. Diagnostic coding changes were observed.
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Affiliation(s)
- Karl Madaras-Kelly
- Pharmacy Service, Boise VA Medical Center, Boise, Idaho, USA.,Department of Pharmacy Practice, Pharmacy Practice, College of Pharmacy, Idaho State University, Meridian, Idaho, USA
| | - Christopher Hostler
- Department of Medicine- Hostler (Mary Townsend is Pharmacy Service), Infectious Diseases Section, Durham VA Health Care System, Durham, North Carolina, USA
| | - Mary Townsend
- Department of Medicine- Hostler (Mary Townsend is Pharmacy Service), Infectious Diseases Section, Durham VA Health Care System, Durham, North Carolina, USA
| | - Emily M Potter
- Pharmacy Service, Dwight D. Eisenhower Veterans Affairs Medical Center, Leavenworth, Kansas, USA
| | - Emily S Spivak
- Medicine Service Spivak (Sarah Hall is Primary Care), VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.,Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Sarah K Hall
- Medicine Service Spivak (Sarah Hall is Primary Care), VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.,Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Matthew Bidwell Goetz
- Medicine Service, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA
| | - McKenna Nevers
- Medicine Service Spivak (Sarah Hall is Primary Care), VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.,Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jian Ying
- Medicine Service Spivak (Sarah Hall is Primary Care), VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.,Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Benjamin Haaland
- Medicine Service Spivak (Sarah Hall is Primary Care), VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.,Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | - Katherine Fleming-Dutra
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauri A Hicks
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew H Samore
- Medicine Service Spivak (Sarah Hall is Primary Care), VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.,Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
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178
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Arnold MA, Nicholas B. Impact of clinical practice guidelines: trends in antibiotic prescriptions for acute rhinosinusitis. Int Forum Allergy Rhinol 2020; 11:1012-1014. [PMID: 33275314 DOI: 10.1002/alr.22750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Mark A Arnold
- Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, NY
| | - Brian Nicholas
- Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, NY
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179
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Soler ZM, Schlosser RJ, Mulligan JK, Smith TL, Mace JC, Ramakrishan VR, Norris-Caneda K, Bethard JR, Ball LE. Olfactory cleft mucus proteome in chronic rhinosinusitis: a case-control pilot study. Int Forum Allergy Rhinol 2020; 11:1162-1176. [PMID: 33275311 DOI: 10.1002/alr.22743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Mechanisms of smell loss in chronic rhinosinusitis (CRS) are still unclear and likely multifactorial. Little attention has been given to olfactory cleft (OC) mucus proteins involved in odorant binding and metabolizing enzymes and their potential role in smell loss. METHODS Mucus from the OC was sampled from patients with CRS (n = 20) and controls (n = 10). Liquid chromatography and mass spectrometry were performed, followed by data processing so that protein groups could be identified, quantified, and compared. Hierarchical clustering and bioinformatic analysis were performed on significantly different proteins to explore for enrichment in known biologic pathways. RESULTS A total of 2514 proteins were found in OC mucus from all 30 subjects. Significant differences in protein abundance were found between CRS and controls, including both CRSsNP (n = 351 proteins; log2 fold change range: -3.88 to 6.71) and CRSwNP (n = 298 proteins; log2 fold change range: -4.00 to -6.13). Significant differences were found between patients with normosmia and those with dysosmia (n = 183; log2 fold change range: -3.62 to -2.16) and across groups of interest for a number of odorant binding proteins and metabolizing enzymes. CONCLUSION OC mucous in CRS displays a rich and abundant array of proteins, many of which have been implicated in odorant transport and metabolization in animal studies. Significant differences in the olfactory mucus proteome were seen between CRS subtypes and controls, as well as between those with normal and abnormal olfaction. Further study should confirm these findings and explore the role individual proteins play in odorant transport and metabolization. ©2020 ARSAAOA, LLC.
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Affiliation(s)
- Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.,Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, SC
| | - Jennifer K Mulligan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Vijay R Ramakrishan
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Kim Norris-Caneda
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC
| | - Jennifer R Bethard
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC
| | - Lauren E Ball
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC
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180
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Piromchai P, Puvatanond C, Kirtsreesakul V, Chaiyasate S, Suwanwech T. A multicenter survey on the effectiveness of nasal irrigation devices in rhinosinusitis patients. Laryngoscope Investig Otolaryngol 2020; 5:1003-1010. [PMID: 33364388 PMCID: PMC7752074 DOI: 10.1002/lio2.497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/16/2020] [Accepted: 11/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Nasal irrigation is widely used as an adjunctive treatment for rhinosinusitis. However, there is little information available regarding the efficacy of the devices used in this procedure. The objective of this study was thus to evaluate the effectiveness of nasal irrigation devices based on the experiences of patients with rhinosinusitis. METHODS We conducted a multicenter survey study between November 2017 and December 2019. The questionnaire was developed based on the available literature and expert opinion and submitted to the otolaryngology residents and staff of each center as well as those in their networks. RESULTS Four hundred eighteen patients were enrolled in this study: 76 with acute viral rhinosinusitis (18%), 53 with acute bacterial rhinosinusitis (13%), 156 with chronic rhinosinusitis without nasal polyps (37%), and 133 with chronic rhinosinusitis with nasal polyps (32%). We found that high-volume devices were most effective in helping to clear secretion in patients with acute viral rhinosinusitis, chronic rhinosinusitis without nasal polyps, and acute bacterial rhinosinusitis (P = .017, .009, .002, respectively) and in reducing post-nasal drip in those with acute bacterial rhinosinusitis (P = .040). There were no statistically significant differences among devices in patients with chronic rhinosinusitis with nasal polyps. CONCLUSIONS Nasal irrigation with high-volume devices was an effective treatment for rhinosinusitis and was more effective at clearing nasal secretion and reducing post-nasal drip than that with other types of devices. LEVEL OF EVIDENCE 2C.
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Affiliation(s)
- Patorn Piromchai
- Department of Otorhinolaryngology, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
| | - Charoiboon Puvatanond
- Department of Otorhinolaryngology, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
| | - Virat Kirtsreesakul
- Department of Otolaryngology, Faculty of MedicinePrince of Songkla UniversitySongkhlaThailand
| | - Saisawat Chaiyasate
- Department of Otolaryngology, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Triphoom Suwanwech
- Department of Otorhinolaryngology, Faculty of Medicine, Siriraj HospitalMahidol UniversityBangkokThailand
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181
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Isolated Horner’s Syndrome Secondary To Rhinosinusitis: A Case Report And Literature Review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00165-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Horner’s syndrome (HS) is characterized by unilateral ptosis, ipsilateral miosis with normally reactive pupil, and in some cases, ipsilateral facial anhidrosis.
Case presentation
We report an adult male presenting with ptosis. Neurological examination revealed ptosis and miosis in the right eye. Anhidrosis was not observed, and the patient did not complain about it. Laboratory tests were within normal limits. He had searched a general practitioner because of purulent nasal discharge, nasal obstruction, and anosmia. He was diagnosed with acute rhinosinusitis. Symptomatic treatment was started. The subject had full recovery of the nasal symptoms, but his right upper eyelid was drooping progressively. In the follow-up, after the third month, the patient was recovering from ptosis and miosis. In 1 year, the ptosis was minor with less than 1 mm and miosis was no more observed.
Discussion
A few cases of HS secondary to a sinus infection have been reported in the literature. To the authors’ knowledge, there are only two case reports of individuals who developed sinusitis and Horner’s syndrome. The present case is the first to present isolated HS features. Our report suggests that sinusitis should be listed as a probable cause of isolated Horner’s syndrome. Moreover, patients presenting with this presentation probably have a good prognosis.
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182
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Little RE, Alt JA, Ramakrishnan VR, Platt MP, Schlosser RJ, Storck KA, Soler ZM. Objective sleep measures after endoscopic sinus surgery in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2020; 11:1056-1063. [PMID: 33226190 DOI: 10.1002/alr.22738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Poor sleep quality is common in chronic rhinosinusitis (CRS). Prior studies have demonstrated improvements in patient-reported measures of sleep quality following endoscopic sinus surgery (ESS). The purpose of this study was to evaluate the effect of ESS on objective sleep parameters and identify any associations between specific objective measures and patient characteristics, comorbidities, and patient-reported outcome measures (PROMs). METHODS Adults with CRS undergoing ESS were prospectively enrolled from 4 centers across North America. Any subject previously diagnosed with a known primary sleep disorder was excluded. Objective sleep indices were recorded using a portable sleep diagnostic device preoperatively and postoperatively. Patient-reported outcome instruments were completed including the Pittsburgh Sleep Quality Index (PSQI) and the 22-item Sino-Nasal Outcome Test (SNOT-22). RESULTS Thirty-six patients (mean age 47 years, 56% male) completed baseline and postoperative sleep studies with mean ± standard deviation (SD) follow-up 9.6 ± 7.7 months. Mean PSQI and SNOT-22 before and after ESS was 10.2 ± 3.9 vs 7.8 ± 4.4 (p = 0.001); and 54.6 ± 14.6 vs 28.5 ± 15.3 (p < 0.001), respectively. Total sleep time, sleep latency, and awakenings after sleep onset did not change following ESS (all p > 0.5) despite improvements in PSQI and SNOT-22. Changes in PSQI did not correlate with comorbidities or objective sleep indices (all p > 0.1). CONCLUSION In this multicenter prospective cohort, objective sleep indices were not improved following ESS for CRS despite significant improvements in patient-reported sleep quality and CRS-specific QOL.
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Affiliation(s)
- Ryan E Little
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Geisel School of Medicine at Dartmouth, NH, Lebanon
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO
| | - Michael P Platt
- Department of Otolaryngology-Head and Neck Surgery, Boston University, Boston, MA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Kristina A Storck
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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183
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Hung LY, Tanaka Y, Herbine K, Pastore C, Singh B, Ferguson A, Vora N, Douglas B, Zullo K, Behrens EM, Li Hui Tan T, Kohanski MA, Bryce P, Lin C, Kambayashi T, Reed DR, Brown BL, Cohen NA, Herbert DR. Cellular context of IL-33 expression dictates impact on anti-helminth immunity. Sci Immunol 2020; 5:5/53/eabc6259. [PMID: 33188058 DOI: 10.1126/sciimmunol.abc6259] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
Interleukin-33 (IL-33) is a pleiotropic cytokine that can promote type 2 inflammation but also drives immunoregulation through Foxp3+Treg expansion. How IL-33 is exported from cells to serve this dual role in immunosuppression and inflammation remains unclear. Here, we demonstrate that the biological consequences of IL-33 activity are dictated by its cellular source. Whereas IL-33 derived from epithelial cells stimulates group 2 innate lymphoid cell (ILC2)-driven type 2 immunity and parasite clearance, we report that IL-33 derived from myeloid antigen-presenting cells (APCs) suppresses host-protective inflammatory responses. Conditional deletion of IL-33 in CD11c-expressing cells resulted in lowered numbers of intestinal Foxp3+Treg cells that express the transcription factor GATA3 and the IL-33 receptor ST2, causing elevated IL-5 and IL-13 production and accelerated anti-helminth immunity. We demonstrate that cell-intrinsic IL-33 promoted mouse dendritic cells (DCs) to express the pore-forming protein perforin-2, which may function as a conduit on the plasma membrane facilitating IL-33 export. Lack of perforin-2 in DCs blocked the proliferative expansion of the ST2+Foxp3+Treg subset. We propose that perforin-2 can provide a plasma membrane conduit in DCs that promotes the export of IL-33, contributing to mucosal immunoregulation under steady-state and infectious conditions.
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Affiliation(s)
- Li-Yin Hung
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yukinori Tanaka
- Department of Dental Anesthesiology and Pain Management, Tohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Karl Herbine
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Christopher Pastore
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brenal Singh
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Annabel Ferguson
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nisha Vora
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Bonnie Douglas
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kelly Zullo
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Edward M Behrens
- Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Tiffany Li Hui Tan
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Paul Bryce
- Immunology and Inflammation Therapeutic Area, Sanofi US, Cambridge, MA 02319, USA
| | - Cailu Lin
- Monell Chemical Senses Center, Philadelphia, PA 19104, USA
| | - Taku Kambayashi
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Breann L Brown
- Department of Biochemistry, Center for Structural Biology, Vanderbilt University, Nashville, TN 37232, USA
| | - Noam A Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA 19104, USA.,Monell Chemical Senses Center, Philadelphia, PA 19104, USA.,Michael J. Crescenz Veterans Affairs Medical Center Surgical Service, Philadelphia, PA 19104, USA
| | - De'Broski R Herbert
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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184
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Zhou AS, Prince AA, Maxfield AZ, Corrales CE, Shin JJ. Sinonasal Outcome Scores and Imaging: A Concurrent Assessment of Factors Influencing Their Association. Otolaryngol Head Neck Surg 2020; 165:215-222. [PMID: 33170758 DOI: 10.1177/0194599820972672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The overall discriminatory ability of validated instrument scores for computed tomography (CT) findings of chronic rhinosinusitis has limitations and may be modified by multiple factors. To support optimal methods for assessment, we studied which factors could influence this relationship, including the concurrent impact of multiple discrete CT scoring mechanisms, colocalized imaging findings, and nasal comorbid conditions. STUDY DESIGN Observational outcomes study. SETTING Academic medical center. METHODS Patients with sinonasal complaints who completed the 22-item Sinonasal Outcome Test (SNOT-22) and underwent CT were included. Multivariate ordinal regression was utilized to assess associations. CT data were quantified with the Lund-Mackay system, Zinreich system, and a direct measure of maximal mucosal thickness. The impact of incidental findings (mucous retention cysts, periapical dental disease) and nasal comorbid conditions was also assessed. RESULTS A total of 233 patients were included. SNOT-22 nasal scores were significantly associated with CT results when those with incidental findings were excluded, regardless of the radiologic scoring mechanism utilized: Lund-Mackay regression coefficient, 0.321 (P = .046); Zinreich, 0.340 (P = .033); and maximum mucosal thickness, 0.316 (P = .040). This relationship subsided when incidental findings were present. SNOT-22 overall scores, sleep scores, and psychological domain scores had no significant association with imaging results, regardless of radiologic scoring system utilized. Nasal comorbid conditions had inconsistent associations. CONCLUSIONS SNOT-22 nasal domain scores were associated with all 3 radiologic scoring systems when incidental findings were absent but not when they were present. Delineating the presence or absence of these colocalized findings affected the relationship between SNOT-22 scores and radiological results, beyond other concurrent factors.
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Affiliation(s)
- Allen S Zhou
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony A Prince
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Alice Z Maxfield
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - C Eduardo Corrales
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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185
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Schilling AL, Kulahci Y, Moore J, Wang EW, Lee SE, Little SR. A thermoresponsive hydrogel system for long-acting corticosteroid delivery into the paranasal sinuses. J Control Release 2020; 330:889-897. [PMID: 33157189 DOI: 10.1016/j.jconrel.2020.10.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/16/2022]
Abstract
Delivering localized treatment to the paranasal sinuses for diseases such as chronic rhinosinusitis (CRS) is particularly challenging because of the small natural openings leading from the sinuses that can be further obstructed by presence of inflammation. As such, oral steroids, topical nasal sprays or irrigation, and surgery can be utilized to treat persistent sinonasal inflammation, but there exists a need for post-operative options for long-term steroid delivery to prevent disease recurrence. In the present study, a Thermogel, Extended-release Microsphere-based-delivery to the Paranasal Sinuses (TEMPS) is developed with the corticosteroid mometasone furoate. Specifically, the bioactive steroid is released for 4 weeks from poly(lactic-co-glycolic acid) (PLGA) microspheres embedded in a poly(N-isopropylacrylamide) (p-NIPAAm)-based hydrogel. The temperature-responsive system undergoes a reversible sol-gel transition at 34-35 °C such that it can be applied as a liquid at ambient temperature, conforming to the sinonasal epithelium as it gels. In a rabbit model of CRS, TEMPS was maintained in rabbit sinuses and effectively reduced sinonasal inflammation as characterized by micro-computed tomography and histopathology analysis. Ultimately, the combination of controlled release microspheres with a thermoresponsive hydrogel provides flexibility for encapsulating therapeutics in a reversible and conforming system for localized delivery to the sinuses.
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Affiliation(s)
- Andrea L Schilling
- Department of Chemical Engineering, University of Pittsburgh, 940 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA, 15213, United States of America
| | - Yalcin Kulahci
- Department of Chemical Engineering, University of Pittsburgh, 940 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA, 15213, United States of America
| | - John Moore
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, 1400 Locust Street, Suite 2100, Pittsburgh, PA 15219, United States of America
| | - Eric W Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, 1400 Locust Street, Suite 2100, Pittsburgh, PA 15219, United States of America
| | - Stella E Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, 1400 Locust Street, Suite 2100, Pittsburgh, PA 15219, United States of America
| | - Steven R Little
- Department of Chemical Engineering, University of Pittsburgh, 940 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA, 15213, United States of America; Department of Bioengineering, University of Pittsburgh, 302 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA 15213, United States of America; Department of Clinical and Translational Science, University of Pittsburgh, Forbes Tower, Suite 7057, Pittsburgh, PA 15213, United States of America; McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219, United States of America; Department of Immunology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, United States of America; Department of Pharmaceutical Science, University of Pittsburgh, 3501 Terrace Street, Pittsburgh, PA 15213, United States of America.
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186
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Nosulya EV, Kunelskaya NL, Kim IA. [Systemic and local antibiotic therapy for acute sinusitis]. Vestn Otorinolaringol 2020; 85:40-43. [PMID: 33140932 DOI: 10.17116/otorino20208505140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of the study was to summarize data on modern antibiotic therapy for acute sinusitis, the role and place of topical antibacterial drugs, in particular Fluimucil-Antibiotic, in modern treatment strategies for this disease. METHODS Search in the PUBMED electronic database (articles and related abstracts) for the keywords «acute sinusitis", «antibiotics», «thiamphenicol glycinate acetylcysteine» «biofilm», «respiratory tract infection», «N-acetylcysteine». RESULTS The published research results indicate the high antibacterial activity of the Fluimucil-Antibiotic, in particular, for the topical drug use in the form of inhalations, applications, irrigation, and instillations. The published research results indicate a wide spectrum of antimicrobial action of Fluimucil-Antibiotic, its ability to destroy biofilms and prevent their formation, good pharmacokinetics, safety, which makes it possible to consider it as a potential treatment option for acute sinusitis in everyday practice.
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Affiliation(s)
- E V Nosulya
- Research Clinical Institute of Otorinolaryngology named after. L.I. Sverzhevsky, Moscow, Russia
| | - N L Kunelskaya
- Research Clinical Institute of Otorinolaryngology named after. L.I. Sverzhevsky, Moscow, Russia.,N.I. Pirogov Russian National Research Medical University, Moscow, Russia
| | - I A Kim
- National Medical Research Center of Otorhinolaryngology of the Federal Medical and Biological Agency, Moscow, Russia
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187
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Gilani S, Bhattacharyya N. The Potential Protective Effects of Statins in Chronic Rhinosinusitis: A Case-Control Study. Laryngoscope 2020; 131:E1431-E1433. [PMID: 33140862 DOI: 10.1002/lary.29219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the potential protective effect of prior statin use on the subsequent diagnosis of chronic rhinosinusitis (CRS). STUDY DESIGN Retrospective, case-control. METHODS Electronic medical records for all patients seen in the otolaryngology clinic in 2019 and receiving a diagnosis of CRS were reviewed for the presence or absence of active prior statin use within 365 days of the visit. Similarly, prior statin use in a control group of patients without any diagnosis of CRS was also determined. Statin exposure in CRS patients was compared to statin exposure in control patients with 1:2 matching on age and sex with chi-square and odds ratios were computed. RESULTS In 2019, 3655 patients (mean age, 52.9 years, 56.4% female) were identified with a diagnosis of chronic rhinosinusitis versus 41,636 patients without any diagnosis of CRS. All chronic rhinosinusitis patients were successfully matched to 7310 controls. 6.3% of CRS patients (229 patients) had prior statin use, versus 8.5% (624 patients) of control patients. The average mean duration of statin use prior to visit was not significantly different between CRS and control patients (mean days, 202.3 days versus 205.6 days, respectively; P = .697). The presence of a statin medication in use was associated with a significant protective effect against a subsequent diagnosis of CRS with and odds ratio for CRS diagnosis of 0.716 (95% confidence interval, 0.612-0.838) in those patients taking a statin medication (P < .001). CONCLUSIONS The use of a statin medication was associated with a significant reduction in subsequent diagnosis of chronic rhinosinusitis. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E1431-E1433, 2021.
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Affiliation(s)
- Sapideh Gilani
- Division of Otolaryngology, Department of Surgery, University of California School of Medicine, San Diego, California, U.S.A
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188
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Galli M, De Soccio G, Cialente F, Candelori F, Federici FR, Ralli M, De Vincentiis M, Minni A. Chronic maxillary sinusitis of dental origin and oroantral fistula: The results of combined surgical approach in an Italian university hospital. Bosn J Basic Med Sci 2020; 20:524-530. [PMID: 32358949 PMCID: PMC7664789 DOI: 10.17305/bjbms.2020.4748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/29/2020] [Indexed: 12/02/2022] Open
Abstract
Unilateral chronic maxillary sinusitis is a possible complication of odontogenic disease or dental treatment and is mainly due to the development of an oroantral fistula (OAF). The management of chronic maxillary sinusitis of dental origin (CMSDO) requires a combined treatment via endoscopic sinus surgery (ESS) and intraoral surgical treatment of the odontogenic source. The aim of this study is to present the results of our university hospital unit in the treatment and follow-up of a case series of 34 patients treated with a combined surgical approach for CMSDO due to OAF. All patients were treated with ESS combined with an intraoral approach. No intraoperative or immediate postoperative complications were observed; nasal synechia was found in 3 patients (8.82%). The overall success rate after the primary intervention was 94.12%; recurrence was observed in 2 cases (5.88%), both were suffering from diabetes mellitus and were tobacco smokers. Our results confirm that simultaneous surgery with a combination of an intraoral and endoscopic approach can be considered the best strategy for the long-term restoration of normal sinonasal homeostasis in selected patients with chronic odontogenic sinusitis and OAF, guaranteeing an effective treatment with minimal complications in the short and long term.
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Affiliation(s)
- Massimo Galli
- Department of Oral and Maxillofacial Science, University Sapienza of Rome, Rome, Italy
| | - Giulia De Soccio
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - Fabrizio Cialente
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | | | | | - Massimo Ralli
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - Marco De Vincentiis
- Department of Oral and Maxillofacial Science, University Sapienza of Rome, Rome, Italy
| | - Antonio Minni
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
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189
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Khurana N, Pulsipher A, Jedrzkiewicz J, Ashby S, Pollard CE, Ghandehari H, Alt JA. Inflammation-driven vascular dysregulation in chronic rhinosinusitis. Int Forum Allergy Rhinol 2020; 11:976-983. [PMID: 33135871 DOI: 10.1002/alr.22723] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/24/2020] [Accepted: 10/13/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Altered neovascularity is typically observed in chronic inflammatory diseases with overlapping pathophysiology to that observed in chronic rhinosinusitis (CRS). However, characterization of these inflammatory-induced vascular-mediated changes in CRS is limited. Understanding the underlying vascular changes in CRS will allow for strategic design and development of new drug-delivery technologies that exploit vascular permeability for increased extravasation into the target sinonasal tissues. METHODS Patients with CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) and non-CRS controls were enrolled in this prospective, observational study. The extent of angiogenesis in tissue was characterized using immunohistochemical and multiplex gene expression analyses. Vascular permeability, interendothelial junction structures, and endothelial barrier morphology were evaluated using transmission electron microscopy. RESULTS Sinonasal vascularity was increased significantly in CRSsNP and CRSwNP (p < 0.05) when compared with controls, as assessed by enumerating the platelet endothelial cell adhesion molecule (PECAM-1)-positive blood vessels. Pro-angiogenic gene expression, including PECAM1 and platelet-activating factor receptor, was elevated significantly in patients with CRSwNP when compared with controls (p < 0.05). The fenestration sizes between endothelial cells (17-280 nm) were larger in CRSwNP compared with CRSsNP (10-33 nm) patients and controls (4-12 nm). Global thinning of the endothelial cell lining was observed in CRS patients but not in controls. CONCLUSION Significant increases in vascularity, the pro-angiogenic gene, and protein expression and blood vessel morphogenesis were observed in CRS patients compared with controls. In addition, fenestration sizes between interendothelial junction structures were larger in CRS patients than in controls, suggesting inflammation-driven vascular dysregulation in CRS pathology.
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Affiliation(s)
- Nitish Khurana
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT.,Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT
| | - Abigail Pulsipher
- Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT.,Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | | | - Shaelene Ashby
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Chelsea E Pollard
- Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT.,Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Hamidreza Ghandehari
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT.,Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT.,Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT
| | - Jeremiah A Alt
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT.,Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT.,Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT
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190
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Patel R, Clarkson E. Implant Surgery Update for the General Practitioner: Dealing with Common Postimplant Surgery Complications. Dent Clin North Am 2020; 65:125-134. [PMID: 33213706 DOI: 10.1016/j.cden.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
It is essential for practitioners who place dental implants to be able to diagnose and treat common complications or know when to refer to a specialist. Common complications can include nerve injuries, infections, sinus membrane perforations, and edema. This article discusses these complications, incidence rates, tips to avoid common complications, and management options when a patient returns with a complication.
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Affiliation(s)
- Rinil Patel
- NYC Health + Hospitals/Woodhull, 760 Broadway, Room 2C-320, Brooklyn, NY 11206, USA.
| | - Earl Clarkson
- NYC Health + Hospitals/Woodhull, 760 Broadway, Room 2C-320, Brooklyn, NY 11206, USA
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191
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Shukairy MK, Burmeister C, Ko AB, Craig JR. Recognizing odontogenic sinusitis: A national survey of otolaryngology chief residents. Am J Otolaryngol 2020; 41:102635. [PMID: 32653733 DOI: 10.1016/j.amjoto.2020.102635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Odontogenic sinusitis is underrepresented in sinusitis literature as well as in the otolaryngology teaching curriculum sponsored by the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngologists and residents in training may therefore have a decreased awareness of the condition. The objective of this study was to survey otolaryngology chief residents toward the ends of their training to determine how often they considered odontogenic sinusitis as a cause of unilateral sinus disease. MATERIALS AND METHODS An online REDCap survey was conducted from December 2018 to January 2019. Online surveys were emailed to 119 Otolaryngology residency program directors in the United States of America, which were then forwarded to their chief residents. Surveys included 3 demographic and 4 clinical questions. Clinical questions included 3 computed tomography-based questions requiring either differential diagnoses or most likely diagnosis, and 1 question on residents' perceived prevalence of odontogenic sinusitis as a cause of unilateral sinus opacification. Answer choices were tabulated and compared based on geographic region and post-residency career plans. RESULTS Of 293 chief residents emailed, 94 completed the survey (32.1%). While answer choices on imaging-based questions varied, odontogenic sinusitis was generally underrecognized. Approximately 70% of residents felt odontogenic sinusitis represented 0%-40% of unilateral sinus opacification. There were no statistically significant differences in answers based on geographic distribution or post-residency career plans. CONCLUSIONS Otolaryngology chief residents recognized odontogenic sinusitis with variable accuracy on imaging, and generally underestimated its prevalence as a cause of unilateral sinus opacification. Efforts should be made to teach otolaryngology residents about odontogenic sinusitis.
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192
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Zojaji R, Kerachi M, Imani MM, Zojaji SH, Shomeiri S. Increased Rate of Sexual Dysfunction by Increased Severity of Nasal Obstruction in Patients With Chronic Rhinosinusitis. Ann Otol Rhinol Laryngol 2020; 130:706-711. [PMID: 33111542 DOI: 10.1177/0003489420967698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is a common chronic respiratory disorder. This study aimed to investigate the relation between nasal obstruction and sexual dysfunction in men with CRS. METHODS In this case-control study, 100 married men aged 19 to 48 years with CRS and 56 healthy married men were selected, consecutively. For assessment of nasal obstruction severity NOSE scale (Nasal Obstruction Symptom Evaluation) was used and IIEF (International Index of Erectile Function) inventory was used to assess sexual function. RESULTS Mean age of patients with CRS and controls was 33.25 ± 6.5 and 30.58 ± 7.12 years, respectively. Nasal obstruction was moderate in 70% of patients and 95% of patients had some degrees of erectile dysfunction. A significant association was found between nasal obstruction severity and sexual function and by increasing severity of nasal obstruction, sexual function decreased significantly in CRS patients. Sexual function in total (IIEF score) and in its domains, except for sexual desire, were significantly higher in control group (P < .05). CONCLUSION There is significant inverse association between severity of nasal obstruction and sexual function. Sexual function decreases with increasing severity of nasal obstruction in CRS. CRS patients also have lower sexual function scores than healthy control males.
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Affiliation(s)
- Ramin Zojaji
- Department of Otorhinolaryngology, Islamic Azad University, Mashhad Branch, Mashhad, Iran.,ENT Department, St. Joseph Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mahnaz Kerachi
- Department of Otorhinolaryngology, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | | | - Seyedeh H Zojaji
- Science Department, Ryerson University, Toronto, Ontario, Canada
| | - Soheil Shomeiri
- Department of Internal Medicine, School of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran
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193
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Zhu K, Born DW, Dilli E. Secondary Headache: Current Update. Headache 2020; 60:2654-2664. [PMID: 33078413 DOI: 10.1111/head.13986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this paper is to review some of the causes of secondary headache particularly focusing on the subcategories of secondary headache in the International Classification of Headache Disorders, 3rd edition, the clinical features of these headaches, and their associated features and management. OVERVIEW Headache attributed to trauma or injury to the head and/or neck, headache attributed to cranial or cervical vascular disorder, headache attributed to non-vascular intracranial disorder, headache attributed to a substance or its withdrawal, headache attributed to infection, headache attributed to disorder of homeostasis, and headache or facial pain attributed to disorder of the cranium, neck, eye, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure are discussed in this paper. DISCUSSION Headache is a common symptom of multiple medical conditions. Although a minority of headache patients have a secondary basis for their headaches, it is important to identify clinical features of secondary headache disorders including both the headache and non-headache features of the condition, diagnose the secondary etiology correctly, and treat them appropriately.
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Affiliation(s)
- Kai Zhu
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Dawson W Born
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Esma Dilli
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
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194
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Schlosser RJ, Smith TL, Mace JC, Alt J, Beswick DM, Mattos JL, Payne S, Ramakrishnan VR, Soler ZM. Factors driving olfactory loss in patients with chronic rhinosinusitis: a case control study. Int Forum Allergy Rhinol 2020; 10:7-14. [PMID: 31899859 DOI: 10.1002/alr.22445] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/06/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Olfactory dysfunction (OD) in chronic rhinosinusitis (CRS) is common. It is likely that numerous factors such as sex, race, age, allergies, asthma, smoking, and other comorbidities play a role in CRS-related OD. In order to determine which aspects of OD are due solely to CRS and which are associated with other confounders, control populations are needed to allow appropriate risk assessments. METHODS Prospective, multi-institutional enrollment of patients with CRS and control subjects without CRS was performed. Demographic information, comorbidities, and olfactory testing (Sniffin' Sticks) of threshold (T), discrimination (D), and identification (I) scores (TDI) was collected. RESULTS A total of 224 patients with CRS and 164 control subjects were enrolled. Olfaction was worse in CRS patients compared to controls (mean ± standard deviation (SD) TDI = 22.4 ± 9.5 vs 28.8 ± 7.0, respectively, p < 0.001). Only 27% of CRS patients were normosmic compared to 49% of controls (p < 0.001). When stratifying by nasal polyp (NP) status, CRSwNP patients had significant impairments in TDI, T, D, and I compared to controls with mean differences of 11.2, 3.3, 3.5, and 4.4 points, respectively (all p < 0.001). In contrast, CRSsNP patients only had impaired T when compared to controls with a mean difference of 2.2 points (p < 0.001). Multivariate modeling of TDI scoring showed that OD was driven by polyps, asthma, diabetes, and age. CRSsNP was not independently associated with worse TDI scores. CONCLUSION OD in CRS patients is multifactorial. Independent drivers appear to be polyp status, asthma, diabetes, and age. OD in patients with CRSsNP is similar to controls with the exception of impaired thresholds.
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Affiliation(s)
- Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
| | - Jeremiah Alt
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Denver, CO
| | - Jose L Mattos
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA
| | - Spencer Payne
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Denver, CO
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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195
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Elevated S100A9 expression in chronic rhinosinusitis coincides with elevated MMP production and proliferation in vitro. Sci Rep 2020; 10:16350. [PMID: 33005006 PMCID: PMC7530678 DOI: 10.1038/s41598-020-73480-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/17/2020] [Indexed: 12/28/2022] Open
Abstract
Chronic rhinosinusitis (CRS) is a common condition associated with inflammation and tissue remodeling of the nose and paranasal sinuses, frequently occurring with nasal polyps and allergies. Here we investigate inflammation and the protease profile in nasal tissues and plasma from control non-CRS patients and CRS patients. Gene expression for several cytokines, proteases, and antiproteases was quantified in nasal tissue from non-CRS and CRS subjects with nasal polyps. Elevated expression of S100A9, IL1A, MMP3, MMP7, MMP11, MMP25, MMP28, and CTSK was observed in tissue from CRS subjects with nasal polyps compared to control tissue. Tissue protein analysis confirmed elevated levels of these targets compared to controls, and increased MMP3 and MMP7 observed in CRS subjects with nasal polyps compared to CRS subjects without polyps. Plasma concentrations of MMP3 and MMP7 were elevated in the CRS groups compared to controls. The nasal cell line, CCL-30, was exposed to S100A9 protein, resulting in increased MMP3, MMP7, and CTSK gene expression and elevated proliferation. Silencing MMP3 significantly reduced S100A9-mediated cell proliferation. Therefore, the elevated expression of S100A9 and MMPs are observed in CRS nasal tissue and S100A9 stimulated MMP3 responses to contribute to elevated nasal cell proliferation.
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196
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Chen Z, Cai Z, Zhu C, Song X, Qin Y, Zhu M, Zhang T, Cui W, Tang H, Zheng H. Injectable and Self-Healing Hydrogel with Anti-Bacterial and Anti-Inflammatory Properties for Acute Bacterial Rhinosinusitis with Micro Invasive Treatment. Adv Healthc Mater 2020; 9:e2001032. [PMID: 32902190 DOI: 10.1002/adhm.202001032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/09/2020] [Indexed: 12/11/2022]
Abstract
Systemic antibiotic therapy is the main treatment for acute bacterial rhinosinusitis (ABRS). However, this treatment often causes side effects of dizziness, diarrhea, and drug resistance. In this study, a new polyethylene glycol hydrogel (PEG-H) treatment model is developed to achieve sustained release of drugs at the locality while avoiding those adverse effects. The PEG-H is composed of 4-arm-PEG-SH and silver ions through a high affinity and dynamic reversible coordination bond between the thiol and silver ion. In the initial test, PEG-H is loaded with Clarithromycin (CAM-Lips@Hydrogel) or Clarithromycin and Budesonide liposomes (CAM+BUD-Lips@Hydrogel). The results show that PEG-H maintains the characteristics of self-healing, biodegradability, moderate swelling rate, injectibility and sustained drug release. In in vivo studies, the hydrogel is injected into the maxillary sinus of ABRS rabbit models. In both a single or combined load, the hydrogel not only plays an effective role as an anti-bacterial, but also inhibits inflammatory response of local sinus mucosa. In addition, no other side effects are observed in the ABRS rabbit model through behavioral observation and drug sensitivity tests. Therefore, the injectable self-healing hydrogel with anti-bacterial and anti-inflammatory properties provides a new micro invasive therapeutic method for the clinical treatment of ABRS.
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Affiliation(s)
- Zhengming Chen
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Zhengwei Cai
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases Shanghai Institute of Traumatology and Orthopaedics Ruijin Hospital Shanghai Jiao Tong University School of Medicine 197 Ruijin 2nd Road Shanghai 200025 P. R. China
| | - Chengjing Zhu
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Xianmin Song
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Yanghua Qin
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Minhui Zhu
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Tao Zhang
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Wenguo Cui
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases Shanghai Institute of Traumatology and Orthopaedics Ruijin Hospital Shanghai Jiao Tong University School of Medicine 197 Ruijin 2nd Road Shanghai 200025 P. R. China
| | - Haihong Tang
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Hongliang Zheng
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
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197
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Chen J, Larson ED, Anderson CB, Agarwal P, Frank DN, Kinnamon SC, Ramakrishnan VR. Expression of Bitter Taste Receptors and Solitary Chemosensory Cell Markers in the Human Sinonasal Cavity. Chem Senses 2020; 44:483-495. [PMID: 31231752 DOI: 10.1093/chemse/bjz042] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Some bitter taste receptors (TAS2R gene products) are expressed in the human sinonasal cavity and may function to detect airborne irritants. The expression of all 25 human bitter taste receptors and their location within the upper airway is not yet clear. The aim of this study is to characterize the presence and distribution of TAS2R transcripts and solitary chemosensory cells (SCCs) in different locations of the human sinonasal cavity. Biopsies were obtained from human subjects at up to 4 different sinonasal anatomic sites. PCR, microarray, and qRT-PCR were used to examine gene transcript expression. The 25 human bitter taste receptors as well as the sweet/umami receptor subunit, TAS1R3, and canonical taste signaling effectors are expressed in sinonasal tissue. All 25 human bitter taste receptors are expressed in the human upper airway, and expression of these gene products was higher in the ethmoid sinus than nasal cavity locations. Fluorescent in situ hybridization demonstrates that epithelial TRPM5 and TAS2R38 are expressed in a rare cell population compared with multiciliated cells, and at times, consistent with SCC morphology. Secondary analysis of published human sinus single-cell RNAseq data did not uncover TAS2R or canonical taste transduction transcripts in multiciliated cells. These findings indicate that the sinus has higher expression of SCC markers than the nasal cavity in chronic rhinosinusitis patients, comprising a rare cell type. Biopsies obtained from the ethmoid sinus may serve as the best location for study of human upper airway taste receptors and SCCs.
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Affiliation(s)
- Jingguo Chen
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China.,Department of Otolaryngology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Eric D Larson
- Department of Otolaryngology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.,Rocky Mountain Taste and Smell Center, Aurora, CO, USA
| | - Catherine B Anderson
- Department of Otolaryngology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.,Rocky Mountain Taste and Smell Center, Aurora, CO, USA
| | | | - Daniel N Frank
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sue C Kinnamon
- Department of Otolaryngology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.,Rocky Mountain Taste and Smell Center, Aurora, CO, USA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.,Rocky Mountain Taste and Smell Center, Aurora, CO, USA
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Role of Telemedicine for Facio-Odontogenic Pain Management During COVID-19 Pandemic. J Maxillofac Oral Surg 2020; 20:409-413. [PMID: 33013083 PMCID: PMC7518091 DOI: 10.1007/s12663-020-01449-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/16/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction As the COVID-19 pandemic is increasingly griping the world, the entire landscape of existing patient management needs to be changed to avoid spread of Corona virus. In cases of emergencies, there is no option other than getting in-person consultations with doctors. But, in non-emergency patients, telemedicine can serve as a boon. Material and methods In this article, we have tried to summarize the rules, regulations and protocols in accordance with government guidelines along with practical management for urgencies in dento-/oro-facial pains. Conclusion If used wisely and as per recommendations, telemedicine is a very useful tool in the present COVID-19 pandemic, to avoid spread of infection to patients as well as health care workers.
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Abstract
PURPOSE OF REVIEW To explain our current understanding of headache attributed to rhinosinusitis, an often inappropriately diagnosed secondary headache. RECENT FINDINGS Recent studies have shown that headache attributed to rhinosinusitis is often over-diagnosed in patients who actually have primary headache disorders, most commonly migraine. Failure to recognize and treat rhinosinusitis, however, can have devastating consequences. Abnormalities of the sinuses may also be treatable by surgical means, which may provide headache relief in appropriately selected patients. SUMMARY It is important for the practicing physician to understand how rhinosinusitis fits into the differential diagnosis of headache, both to avoid overdiagnosis in patients with primary headache, and to avoid underdiagnosis in patients with serious sinus disease.
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Abstract
PURPOSE OF REVIEW Intranasal corticosteroid sprays have been available as over-the-counter (OTC) medications since 2013. As such, clinicians need to be up-to-date with the risks and the safety of INS, as patients may have concerns and detailed questions. The following is a review of the recent medical literature regarding the safety profile, adverse reactions, and special populations using INS. RECENT FINDINGS The latest research on intranasal steroid sprays (INS) continue to confirm that INS rarely have significant local side effects, such as severe and persistent epistaxis. Recent studies looking at systemic side effects such as hypothalamic pituitary axis suppression, growth effects, and ocular effects do not indicate any new concerns nor have found significant differences from the past literature. The use of combination INS and topical antihistamine medications did not reveal any new safety issues. Use of INS with topical decongestants found some limited effects of tachyphylaxis and rebound congestion. Studies continue to support the use of newer INS for children and continued monitoring of growth in this population. The HIV population should avoid use of INS with the prescription of ritonavir, given demonstration of adrenal suppression. This updated perspective has found that newer generation INS should be used at the lowest effective dose for the selected population, that clinicians can inform patients using the OTC INS preparations that there are very few safety concerns, and that regular follow-up visits can provide further reassurance with physical examinations and address patient's questions. Future research regarding the safety of INS should study newer preparations when developed and if used in combination with other topical agents.
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