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Sokoya M, Ramakrishnan VR, Frank DN, Rahkola J, Getz A, Kingdom TT, Kofonow JM, Nguyen Q, Janoff EN. Expression of immunoglobulin D is increased in chronic rhinosinusitis. Ann Allergy Asthma Immunol 2017; 119:317-323.e1. [PMID: 28958373 DOI: 10.1016/j.anai.2017.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/18/2017] [Accepted: 07/23/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Immunoglobulin (Ig) D is largely localized to the upper airway and reacts with colonizing respiratory pathogens. OBJECTIVE To determine whether chronic rhinosinusitis (CRS) is associated with increased IgD expression. METHODS We performed immunofluorescent staining for cytoplasmic IgD, IgA, IgM, and surface plasma cell marker CD138 (syndecan-1) in sinus tissue of patients with CRS with and without nasal polyps (CRSwNP and CRSsNP, respectively) and control subjects without CRS (n = 6 each). Sinonasal mucus antibody levels of patients with CRSwNP or CRSsNP and control subjects were measured by enzyme-linked immunosorbent assay (n = 13, 11, and 9 subjects, respectively). Cells per square millimeter and antibody levels were compared by analysis of variance. Histopathology was performed with sinus tissue from subjects in the 3 groups (n = 6, 8, and 13 subjects respectively). RESULTS Cells expressing cytoplasmic IgD exceeded those with cytoplasmic IgA and IgM and represented most CD138+ plasma cells in the lamina propria. The frequencies of IgD+ plasma cells were significantly higher in patients with CRSsNP and CRSwNP compared with control subjects (P < .01). Only patients with CRSwNP showed increased frequencies of IgM and IgA plasma cells (P < .01). In contrast to high plasma cell frequencies in tissues, the levels of secreted IgD were lower than those of IgA, IgM, and IgG but were highest in the CRSwNP group compared with the other groups (P < .05). CONCLUSION IgD plasma cells are prominent in sinus tissues and are increased in CRS. That IgD protein also shows the lowest concentration of antibodies in secretions suggests that its activity might be targeted to the tissue rather than secretions.
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Affiliation(s)
- Mofiyinfolu Sokoya
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver, Colorado
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver, Colorado
| | - Daniel N Frank
- Division of Infectious Diseases, Mucosal and Vaccine Research Program Colorado, University of Colorado School of Medicine, Denver, Colorado; Microbiome Research Consortium, University of Colorado School of Medicine, Denver, Colorado; University of Colorado School of Medicine and Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Jeremy Rahkola
- Division of Infectious Diseases, Mucosal and Vaccine Research Program Colorado, University of Colorado School of Medicine, Denver, Colorado; University of Colorado School of Medicine and Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Anne Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver, Colorado
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver, Colorado
| | - Jennifer M Kofonow
- Division of Infectious Diseases, Mucosal and Vaccine Research Program Colorado, University of Colorado School of Medicine, Denver, Colorado; Microbiome Research Consortium, University of Colorado School of Medicine, Denver, Colorado
| | - Quyen Nguyen
- University of Colorado School of Medicine and Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Edward N Janoff
- Division of Infectious Diseases, Mucosal and Vaccine Research Program Colorado, University of Colorado School of Medicine, Denver, Colorado; University of Colorado School of Medicine and Denver Veterans Affairs Medical Center, Denver, Colorado.
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402
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Rivero A, Liang J. Anti-IgE and Anti-IL5 Biologic Therapy in the Treatment of Nasal Polyposis: A Systematic Review and Meta-analysis. Ann Otol Rhinol Laryngol 2017; 126:739-747. [PMID: 28918644 DOI: 10.1177/0003489417731782] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the role of biologic therapy on sinonasal symptoms and objective outcomes in chronic rhinosinusitis with nasal polyposis (CRSwNP). METHODS PubMed, OVID MEDLINE, and Cochrane Central were reviewed from 2000 to 2015. Inclusion criteria included English-language studies containing original data on biologic therapy in CRSwNP patients with reported outcome measures. Two investigators independently reviewed all manuscripts and performed quality assessment and quantitative meta-analysis using validated tools. RESULTS Of 495 abstracts identified, 7 studies fulfilled eligibility: 4 randomized control trials (RCT), 1 case-control, and 2 case series. Outcome measures included nasal polyp score (NPS,6), computer tomography score (5), and symptom scores (5). Meta-analysis was performed on 5 studies: Anti-IL5 therapy (mepolizumab/reslizumab) and anti-IgE therapy (omalizumab) demonstrated a standard mean difference of NPS improvement of -0.66 (95% CI, -1.24 to -0.08) and -0.75 (95% CI, -1.93 to 0.44), respectively, between biologic therapy and placebo. Quality assessment indicated a low to moderate risk of bias for the RCTs. CONCLUSION Biologic therapies may prove beneficial in the treatment of recalcitrant nasal polyposis in select populations. In meta-analysis, anti-IL5 therapy demonstrates a reduction in nasal polyp score. Anti-IgE therapy reduces nasal polyp score in patients with severe comorbid asthma. Additional high-level evidence is needed to assess clinical efficacy.
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403
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Multimodal Frequency Treatment for Facial Pain Caused by Chronic Rhinosinusitis: A Pilot Study. SINUSITIS 2017. [DOI: 10.3390/sinusitis2030005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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404
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Gameiro Dos Santos J, Figueirinhas R, Liberal JP, Almeida JC, Sousa J, Falcão A, Vicente C, Paço J, Sousa CA. On ciprofloxacin concentration in chronic rhinosinusitis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:35-41. [PMID: 28859993 DOI: 10.1016/j.otorri.2017.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Considering that all the evidence indicates that chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are distinct entities, the aim of this study was to compare the concentrations obtained in plasma and in sinonasal mucosa with oral and nasal topical ciprofloxacin, in patients with and without nasal polyps, without evaluating the effectiveness of the use of an antibiotic. METHODS Prospective clinical study with single-blind randomization. The population consisted of patients with chronic rhinosinusitis with eligible for endonasal surgery, over 18 years old. It took place between January 2010 and December 2014. A single preoperative dose of ciprofloxacin (oral or nasal topic- spray, gel or drops) was given and samples of plasma and nasal mucosa (inferior turbinate, middle turbinate, ethmoid and maxillary sinus) were collected prior to surgery. The plasma and mucosal ciprofloxacin concentrations were assayed with high performance liquid chromatography (HPLC) with fluorescence detection (FD). RESULTS The oral ciprofloxacin achieved better mucosal concentrations but had a significant plasmatic expression in all patients. None of the topical formulations achieved measurable ciprofloxacin plasmatic levels. Among the topical formulations, the gel had the best mucosal results, despite the existence of polyposis.
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Affiliation(s)
- José Gameiro Dos Santos
- Department of Otolaryngology - Head and Neck Surgery, CHP-Hospital Santo António, Porto, Portugal.
| | - Rosário Figueirinhas
- Department of Otolaryngology - Head and Neck Surgery, CHP-Hospital Santo António, Porto, Portugal
| | - José P Liberal
- Department of Pharmacology, CHP-Hospital Santo António, Porto, Portugal
| | - João C Almeida
- Department of Otolaryngology - Head and Neck Surgery, CHP-Hospital Santo António, Porto, Portugal
| | - Joana Sousa
- Faculdade de Farmácia, Universidade de Coimbra, Coimbra, Portugal
| | - Amílcar Falcão
- Faculdade de Farmácia, Universidade de Coimbra, Coimbra, Portugal
| | - Corália Vicente
- Instituto de Ciência Biomédicas Abel Salazar, Porto, Portugal
| | - João Paço
- Hospital CUF Infante Santo, Lisboa, Portugal
| | - Cecília A Sousa
- Department of Otolaryngology - Head and Neck Surgery, CHP-Hospital Santo António, Porto, Portugal
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405
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Thomas AJ, Pulsipher A, Davis BM, Alt JA. LL-37 causes cell death of human nasal epithelial cells, which is inhibited with a synthetic glycosaminoglycan. PLoS One 2017; 12:e0183542. [PMID: 28837619 PMCID: PMC5570287 DOI: 10.1371/journal.pone.0183542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/07/2017] [Indexed: 11/18/2022] Open
Abstract
LL-37 is an immune peptide that regulates innate and adaptive immune responses in the upper airways. Elevated levels of LL-37 have been linked to cell death and inflammatory diseases, such as chronic rhinosinusitis (CRS). Glycosaminoglycans (GAGs) are polysaccharides that are found on respiratory epithelial cells and serve important roles in mucosal surface repair. Recent findings suggest that a synthetic glycosaminoglycan (GM-0111) can protect against LL-37-induced sinonasal mucosal inflammation and cell death in a murine model of acute RS. Herein, we elucidated the mechanisms by which LL-37 causes sinonasal inflammation and how GM-0111 can prevent these mechanisms. When challenged with LL-37, human nasal epithelial cells (HNEpCs) and mouse macrophages (J774.2) demonstrated increased release of adenosine triphosphate (ATP) and interleukin (IL)-6 and -8, as well as cell death and lysis. These cellular responses were all blocked dose-dependently by pre-treatment with GM-0111. We identified that LL-37-induced cell death is associated with caspase-1 and -8 activation, but not activation of caspase-3/7. These responses were again blocked by GM-0111. Our data suggest that LL-37 causes cellular death of HNEpCs and macrophages through the pro-inflammatory necrotic and/or pyroptotic pathways rather than apoptosis, and that a GM-0111 is capable of inhibiting these pro-inflammatory cellular events.
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Affiliation(s)
- Andrew J. Thomas
- Division of Head and Neck Surgery, Rhinology - Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Abigail Pulsipher
- Division of Head and Neck Surgery, Rhinology - Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- GlycoMira Therapeutics, Salt Lake City, Utah, United States of America
| | - Brock M. Davis
- Division of Head and Neck Surgery, Rhinology - Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Jeremiah A. Alt
- Division of Head and Neck Surgery, Rhinology - Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- GlycoMira Therapeutics, Salt Lake City, Utah, United States of America
- * E-mail:
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406
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Rudmik L, Mattos JL, Stokken JK, Soler ZM, Manes RP, Higgins TS, Setzen M, Lee J, Schneider J. Rhinology-specific priority setting for quality improvement: a modified Delphi study from the Quality Improvement Committee of the American Rhinologic Society. Int Forum Allergy Rhinol 2017; 7:937-944. [PMID: 28799731 DOI: 10.1002/alr.21998] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Improving the quality of healthcare is a complex and resource intensive process. To optimize the allocation of scarce resources, quality improvement (QI) should focus on high-value diseases that will produce the largest improvement in health system performance. Given the breadth and multidisciplinary nature of sinonasal disease management, the purpose of this study was to transparently develop a prioritized list of sinonasal diseases for QI from the perspective of the specialty of rhinology and the American Rhinologic Society (ARS). METHODS The RAND modified Delphi methodology was used to rank the priority of nine sinonasal disease categories from 1 (lowest priority) to 9 (highest priority). Two rounds of ranking along with a teleconference meeting was performed by a panel of 9 experts from the ARS Quality Improvement Committee. RESULTS The final QI-prioritized list of sinonasal diseases are as follows: chronic rhinosinusitis (CRS) (mean score = 8.9), recurrent acute rhinosinusitis (RARS) (mean score = 7.9), sinonasal neoplasms (mean score = 7.0), anatomic nasal obstruction (mean score = 5.9), refractory epistaxis (mean score = 5.2), complicated acute rhinosinusitis (mean score = 5.2), chronic nonallergic rhinitis (mean score = 4.4), orbital disease (mean score = 4.3), uncomplicated acute rhinosinusitis (mean score = 4.1), and allergy/allergic rhinitis (mean score = 3.7). CONCLUSION The three most important disease categories for QI from the perspective of the specialty of rhinology were CRS, RARS, and sinonasal neoplasms. Future studies need to define and validate quality metrics for each of these important disease categories in order to facilitate appropriate measurement and improvement initiatives.
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Affiliation(s)
- Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Jose L Mattos
- Department of Otolaryngology-Head and Neck Surgery; University of Virginia School of Medicine, Charlotteville, VA
| | - Janalee K Stokken
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN
| | - Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - R Peter Manes
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, KY
| | - Michael Setzen
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY
| | - Jivianne Lee
- Department of Otolaryngology-Head and Neck Surgery University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - John Schneider
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, MO
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407
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Böscke R, Vladar EK, Könnecke M, Hüsing B, Linke R, Pries R, Reiling N, Axelrod JD, Nayak JV, Wollenberg B. Wnt Signaling in Chronic Rhinosinusitis with Nasal Polyps. Am J Respir Cell Mol Biol 2017; 56:575-584. [PMID: 28059551 DOI: 10.1165/rcmb.2016-0024oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The signaling pathways that sustain the disease process of chronic rhinosinusitis with nasal polyps (CRSwNP) remain poorly understood. We sought to determine the expression levels of Wnt signaling genes in CRSwNP and to study the role of the Wnt pathway in inflammation and epithelial remodeling in the nasal mucosa. Microarrays and real time-quantitative polymerase chain reaction comparing gene expression in matched NPs and inferior turbinates revealed that WNT2B, WNT3A, WNT4, WNT7A, WNT7B, and FZD2 were up-regulated and that FZD1, LRP5, LRP6, and WIF1 were down-regulated in NPs. Immunolabeling showed robust expression of Wnt ligands, nuclear β-catenin, and Axin-2 in NP tissue, suggesting that Wnt/β-catenin signaling is activated in NPs. We used primary human nasal epithelial cell (HNEpC) cultures to test the functional consequences of Wnt pathway activation. Monolayer HNEpCs treated with recombinant human WNT (rhWNT) 3A, but not with rhWNT4, had altered epithelial morphology and decreased adhesion, without loss of viability. We found that neither rhWNT3A nor rhWNT4 treatment induced proliferation. The expression and release of inflammatory cytokines IL-6 and granulocyte-macrophage colony-stimulating factor were increased after rhWNT3A exposure of HNEpCs. When differentiated at an air-liquid interface, rhWNT3A- and WNT agonist-, but not rhWNT4-treated HNEpCs, had abnormal epithelial architecture, failed to undergo motile ciliogenesis, and had defective noncanonical Wnt (planar cell polarity) signaling. On the basis of these results, we propose a model in which Wnt/β-catenin signaling sustains mucosal inflammation and leads to a spectrum of changes consistent with those seen during epithelial remodeling in NPs.
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Affiliation(s)
- Robert Böscke
- 1 Department of Otolaryngology, Head and Neck Surgery, University of Lübeck, Lübeck, Germany.,2 Department of Otolaryngology, Head and Neck Surgery, and
| | - Eszter K Vladar
- 3 Department of Pathology, Stanford University School of Medicine, Stanford, California; and
| | - Michael Könnecke
- 1 Department of Otolaryngology, Head and Neck Surgery, University of Lübeck, Lübeck, Germany
| | - Birgit Hüsing
- 1 Department of Otolaryngology, Head and Neck Surgery, University of Lübeck, Lübeck, Germany
| | - Robert Linke
- 1 Department of Otolaryngology, Head and Neck Surgery, University of Lübeck, Lübeck, Germany
| | - Ralph Pries
- 1 Department of Otolaryngology, Head and Neck Surgery, University of Lübeck, Lübeck, Germany
| | - Norbert Reiling
- 4 Division of Microbial Interface Biology, Research Center Borstel, Leibniz Center for Medicine and Biosciences, Borstel, Germany
| | - Jeffrey D Axelrod
- 3 Department of Pathology, Stanford University School of Medicine, Stanford, California; and
| | | | - Barbara Wollenberg
- 1 Department of Otolaryngology, Head and Neck Surgery, University of Lübeck, Lübeck, Germany
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408
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Schlosser RJ, Mulligan JK, Hyer JM, Karnezis TT, Gudis DA, Soler ZM. Mucous Cytokine Levels in Chronic Rhinosinusitis-Associated Olfactory Loss. JAMA Otolaryngol Head Neck Surg 2017; 142:731-7. [PMID: 27228459 DOI: 10.1001/jamaoto.2016.0927] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Olfactory loss is a frequent symptom of patients with chronic rhinosinusitis (CRS), but our understanding of how inflammatory cytokines affect olfaction is limited. OBJECTIVES To examine whether inflammatory cytokines are present in the olfactory cleft and whether they correlate with objective olfaction. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, patients with CRS underwent quantitative olfactory testing using the Sniffin Sticks test to calculate a composite threshold discrimination identification (TDI) score from October 21, 2013, to November 12, 2015. Nasal mucus was collected using a sponge placed in the olfactory cleft for 5 minutes, and Cytometric Bead Array was used to measure secreted immunomodulatory products. Correlations between TDI score and secreted mediators were then calculated. Data analysis was performed from October 15, 2015, to December 17, 2015. MAIN OUTCOMES AND MEASURES Composite TDI scores and mean secreted mediator levels in mucus from the olfactory cleft. RESULTS Thirty-four patients were enrolled (mean [SD] age, 57.3 [15.7] years; female, 21 [61.8%]; white, 26 [76.5]). The TDI scores were lower in patients with CRS with nasal polyps (CRSwNP) than in patients with CRS without nasal polyps (CRSsNP) (difference, 8.7; 95% CI, 2.5-15.0; P = .007). Interleukin (IL) 5 levels were inversely correlated with TDI scores in patients with CRSwNP and those with CRSsNP (mean [SE] β estimate, -46.56 [15.11]; P = .005), whereas IL-6, IL-7, and vascular endothelial growth factor A were positively correlated with TDI scores only in the CRSwNP cohort. Subscale olfactory TDI scores followed similar correlations to composite TDI scores. CONCLUSIONS AND RELEVANCE In this study, inflammatory cytokines were found in mucus collected from the olfactory cleft. Levels of IL-5, in addition to other cytokines, were associated with objective olfactory function. Further inquiry is needed to establish the source of mucous cytokines and establish whether they play a causal role in olfactory loss.
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Affiliation(s)
- Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston2Ralph H. Johnson, Veterans Affairs Medical Center, Charleston, South Carolina
| | - Jennifer K Mulligan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston3Department of Pediatrics, Medical University of South Carolina, Charleston
| | - J Madison Hyer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Tom T Karnezis
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
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409
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Johnson SM, Honeybrook AL, Ramprasad VH, Abi Hachem R, Jang DW. Radiodensity of the Ostiomeatal Complex in Recurrent Acute Rhinosinusitis. Otolaryngol Head Neck Surg 2017; 157:887-890. [PMID: 28675080 DOI: 10.1177/0194599817717682] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Recurrent acute rhinosinusitis (RARS) can be an elusive diagnosis due to the lack of clinical and radiographic findings in between acute episodes. This study aims to identify objective computed tomography (CT) characteristics in RARS. Study Design Case series with chart review. Setting Tertiary academic medical center. Subjects and Methods Patients meeting diagnostic criteria for RARS were identified retrospectively from the senior author's practice. Patients were diagnosed with RARS if they experienced 3 or more episodes of acute sinusitis within the past year with complete resolution of symptoms in between episodes. At least 1 episode was confirmed via CT or endoscopy. CT scans showing prior surgery were excluded. The scans for these patients were compared with those from a normal control group. Bone radiodensity of the entire ostiomeatal complex (OMC), including the ethmoid bulla, middle turbinate, and uncinate, was measured in Hounsfield units. Maximum radiodensity was noted for each side. Results A total of 16 patients meeting inclusion criteria for RARS were compared with 16 healthy patients. The mean Lund-MacKay score was 1.6 in the RARS group and 1.3 in the control group. The maximum radiodensity of the OMC was significantly higher in the RARS group (556) compared with that of the control group (327) ( P < .0001). Conclusion Patients with RARS had significantly greater radiodensity of the OMC compared with those in the control group despite minimal differences in mucosal disease. Radiodensity measurement of the OMC using Hounsfield units may help to identify patients with this elusive diagnosis.
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Affiliation(s)
- Sean M Johnson
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Adam L Honeybrook
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Vaibhav H Ramprasad
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Ralph Abi Hachem
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - David W Jang
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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410
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Yeo NK, Park WJ, Ryu IS, Lim HW, Song YJ. Is Facial or Head Pain Related to the Location of Lesions on Computed Tomography in Chronic Rhinosinusitis? Ann Otol Rhinol Laryngol 2017; 126:589-596. [DOI: 10.1177/0003489417717268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Nam-Kyung Yeo
- Department of Otorhinolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Woo Joo Park
- Department of Family Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - In Sun Ryu
- Department of Otorhinolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Hyun Woo Lim
- Department of Otorhinolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Yong Jin Song
- Department of Otorhinolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
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411
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Ramakrishnan VR. A call for critical examination of endoscopically guided cultures in chronic rhinosinusitis. Int Forum Allergy Rhinol 2017; 7:842-843. [PMID: 28658539 DOI: 10.1002/alr.21965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/06/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Vijay R Ramakrishnan
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO
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412
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Chowdhury NI, Mace JC, Smith TL, Rudmik L. What drives productivity loss in chronic rhinosinusitis? A SNOT-22 subdomain analysis. Laryngoscope 2017; 128:23-30. [PMID: 28600803 DOI: 10.1002/lary.26723] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Previous studies have shown declines in productivity due to chronic rhinosinusitis (CRS) are correlated with disease-specific quality-of-life (QOL) measures. However, it is unclear which symptom domains contribute primarily to productivity loss. This investigation sought to assess the association between CRS-specific QOL subdomain impairment and productivity loss. STUDY DESIGN Prospective, multi-institutional, observational cohort study. METHODS There were 198 patients with refractory CRS enrolled between August 2012 and June 2015. Baseline QOL measures were obtained across five subdomains of the 22-item SinoNasal Outcome Test (SNOT-22). Lost productivity time was determined from patient-reported measures of annual absenteeism, presenteeism, and lost leisure time, and then monetized using annual daily wage rates from the 2012 US National Census and 2013 Department of Labor statistics. RESULTS Productivity losses correlated with impairments in both SNOT-22 psychological dysfunction (Spearman correlation coefficient [Rs] = 0.428, P < .001), and sleep dysfunction domain scores (Rs = 0.355, P < .001). Higher SNOT-22 total scores also significantly correlated with increased monetized productivity losses (Rs = 0.366, P < .001). The mean annual productivity cost was $11,820/patient, whereas patients with comorbid immunodeficiency ($23,285/patient), tobacco use ($23,195/patient), and steroid dependency ($18,910/patient) reported higher than average annual productivity costs. Multivariate linear regression found maximum annual productivity costs in adjusted psychological ($13,300/patient, P < .001) and sleep dysfunction ($9,275/patient, P < .001) domains. CONCLUSIONS Impairments in sleep and psychological SNOT-22 domains correlate with productivity losses. Patients with comorbid immunodeficiency, smoking, and steroid dependency had higher than average productivity losses. Targeted management of psychological and sleep dysfunction in combination with standard symptom control may improve patient-centered care and reduce the annual economic burden of CRS. LEVEL OF EVIDENCE 2c. Laryngoscope, 128:23-30, 2018.
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Affiliation(s)
- Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Luke Rudmik
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
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413
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E Gelera J, Ojar D, Lim JH, Wee JH, Kim JW, Rhee CS. Radiographic Changes of the Nasal Septal Body Among Patients With Sinonasal Diseases. Clin Exp Otorhinolaryngol 2017; 10:338-343. [PMID: 28602068 PMCID: PMC5678036 DOI: 10.21053/ceo.2017.00080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/11/2017] [Accepted: 05/15/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES This study aims to determine the anatomical changes occurring in the nasal septal body (NSB) among patients with sinonasal disease and compares the measurements obtained from patients without sinonasal disease. METHODS This was a retrospective study involving review of 405 (93 without and 212 with sinonasal disease) plain paranasal sinus computed tomography (PNS CT) on coronal view at a tertiary training hospital, which was done consecutively from January 2014 to December 2015. NSB measurements from 3 areas were done: anterior part (A), located anterior and superior to inferior turbinate; middle or widest (M) part, located anterior to middle turbinate and superior to inferior turbinate and posterior (P) part, located within the anterior 1/3 of middle turbinate not going beyond the crista galli. Posterior part of septum (sP) was measured at the area of horizontal attachment of middle turbinate to the lateral nasal wall and superior turbinate to represent the less vasoactive part of the septum. Demographic data and NSB diameters were also analyzed. RESULTS The mean NSB diameter measurements were significantly larger among the diseased group (disease vs. control; A: 6.88 mm vs. 5.92 mm, P=0.001; M: 12.74 mm vs. 10.47 mm, P=0.001; P: 8.35 mm vs. 6.79 mm, P=0.001). A similar observation in sP part (3.35 mm vs. 2.54 mm, P=0.014) was noted. When grouped by age, among the control group, older subjects had considerable decrease in NSB size in all points of measurements except for sP (P>0.05). Such reduction in size is noticeable for those in their 4th, 5th, 6th, and 7th decades of life. For the diseased group, a trend of increasing NSB and sP size was noted as the subjects are getting older. However, only the anterior part (A) of NSB reached statistical significance (P=0.016). CONCLUSION With aging we expect nasal mucosal atrophy among normal subjects. However, patients with chronic sinonasal disease showed thickened nasal mucosa. Further study for the reversibility of thickened mucosa is needed.
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Affiliation(s)
- January E Gelera
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Devendra Ojar
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyun Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Hye Wee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.,Research Center for Sensory Organs, Seoul National University Medical Research Center, Seoul, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
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414
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Bakshi SS. Letter to the editor. Oral Maxillofac Surg 2017; 21:371. [PMID: 28577128 DOI: 10.1007/s10006-017-0634-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Satvinder Singh Bakshi
- Department of ENT and Head & Neck Surgery, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Pondicherry, 607402, India. .,, House Number B2, Shree Pushpa Complex, 15th Bharathi Street, Ananda Nagar, Pondicherry, 605009, India.
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415
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Hoehle LP, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. A contemporary analysis of clinical and demographic factors of chronic rhinosinusitis patients and their association with disease severity. Ir J Med Sci 2017; 187:215-221. [PMID: 28560517 DOI: 10.1007/s11845-017-1639-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/20/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is highly prevalent, significantly decreases quality of life and leads to tremendous health care costs every year. No recent study has characterised the prevalence of potentially CRS-modifying patient characteristics and simultaneously shown their impact on CRS severity. AIMS We sought to determine the prevalence of potential clinical and demographic CRS-modifying characteristics and their associations with CRS symptom severity in a large contemporary cohort of CRS patients. METHODS Retrospective review of CRS patients who visited our rhinology clinics between February 2016 and February 2017 was conducted. CRS symptom severity was measured using the 22-item Sinonasal Outcomes Test (SNOT-22) questionnaire, which all patients received. Association was sought between SNOT-22 score (as dependent variable) and patients' clinical and demographic characteristics using linear regression. RESULTS Of the 572 included patients, the mean age was 51.1 years (SD = 15.8) and the mean SNOT-22 score was 34.3 (SD = 22.6). Prevalence of granulomatous diseases, immunodeficiency and cystic fibrosis were each approximately 5%. Prevalence of aeroallergen hypersensitivity was 42.3% and prevalence of asthma was 27.8%. More severe CRS symptomatology was associated with smoking tobacco (adjusted β = 5.47, p = 0.034) and comorbid asthma (adjusted β = 12.02, p < 0.001), whilst less severe symptomatology was associated with older age (adjusted β = -0.23, p = 0.002) and diagnosis of cystic fibrosis (adjusted β = -11.87, p = 0.009). CONCLUSIONS In a contemporary cohort of CRS patients, prevalence of disease-modifying comorbidities ranged from approximately 5 to over 40%. Smoking tobacco and asthma were associated with more severe CRS symptomatology, whilst older age and diagnosis of cystic fibrosis were associated with less severe CRS symptomatology.
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Affiliation(s)
- L P Hoehle
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - K M Phillips
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - D S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - A R Sedaghat
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA. .,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. .,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, MA, USA.
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416
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Levy JM, Mace JC, Bodner TE, Alt JA, Smith TL. Defining the minimal clinically important difference for olfactory outcomes in the surgical treatment of chronic rhinosinusitis. Int Forum Allergy Rhinol 2017; 7:821-826. [PMID: 28556611 DOI: 10.1002/alr.21964] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/20/2017] [Accepted: 05/04/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Olfactory dysfunction is a common and defining symptom of chronic rhinosinusitis (CRS). Many measures of olfactory dysfunction in CRS are limited by scoring criteria defined within general populations with interpretations of statistical significance to infer clinically meaningful improvement. In this investigation we define a minimal clinically important difference (MCID) for the Brief Smell Identification Test (BSIT) in CRS patients electing endoscopic sinus surgery (ESS). METHODS A multicenter cohort of 290 adult patients electing ESS for medically recalcitrant CRS were prospectively enrolled between March 2011 and June 2015 and completed BSIT evaluations before and after ESS. Distribution and anchor-based analytic approaches were utilized to define MCID values of the BSIT across patient cofactors. RESULTS A total of 92 (∽32%) patients were found to have preoperative olfactory dysfunction (BSIT <9), significantly associated with nasal polyposis (χ2 = 35.0; p < 0.001). The effect-size distribution-based approach identified 1.0 as a MCID criterion value between "small" and "medium" effect (range, 0.61-1.52) overall. Significant mean postoperative change (ΔM) was reported for patients with olfactory dysfunction (ΔM = 2.28; p < 0.001), both with (n = 54; ΔM = 2.52; p < 0.001) and without (n = 38; ΔM = 1.95; p < 0.001) nasal polyposis, significantly exceeding the MCID criterion. Anchor-based approaches with regression modeling confirmed associations between MCID values and postoperative changes to olfactory-specific survey responses (p < 0.001). CONCLUSION Clinically meaningful change in BSIT scores may be defined as an absolute value difference of at least 1.0 unit for heterogeneous patients electing ESS for CRS. Significantly exceeding this criterion may be restricted to CRS patients with baseline olfactory dysfunction, regardless of nasal polyposis.
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Affiliation(s)
- Joshua M Levy
- Department of Otolaryngology-Head &, Neck Surgery, Sinus, Nasal &, Allergy Center, Emory University School of Medicine, Atlanta, GA
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health &, Science University, Portland, OR
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, OR
| | - Jeremiah A Alt
- Department of Surgery, Division of Otolaryngology-Head &, Neck Surgery, University of Utah, Salt Lake City, UT
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health &, Science University, Portland, OR
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417
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Nishioka GJ. Modified In-Office Maxillary Balloon Sinus Dilation for Post-Procedure Sinus Monitoring and Access. Int Arch Otorhinolaryngol 2017; 22:68-72. [PMID: 29371901 PMCID: PMC5783689 DOI: 10.1055/s-0037-1601562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 01/25/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction
As experience grows with in-office balloon sinus dilation (BSD) procedures, technique modifications will evolve to meet specific needs. The major disadvantage with the maxillary BSD procedure is that the intact uncinate process prevents visualization of and instrument access into the maxillary sinus both intraoperatively and postoperatively. Combining a partial or complete uncinectomy procedure with maxillary BSD could be beneficial in selected patients with certain maxillary sinus problems.
Objective
The primary objective of this study was to see if, in selected patients, combining an uncinectomy and maxillary sinus BSD together allowed visualization of and access to the maxillary sinus cavity at the time of the procedure and at follow-up visits.
Method
A chart review was completed for BSD cases performed from 2013 through mid-2015 identifying patients who underwent partial or complete uncinectomy with in-office maxillary sinus BSD. A total of 14 patients were identified, with 26 sinuses treated. The data collected included: difficulty or problems in performing an uncinectomy with the maxillary sinus BSD; visualization and access to the maxillary sinus cavity both intraoperatively and at follow-up visits; and occurrence of complications or late adverse sequelae. All patients completed a minimum 6-month follow-up.
Results
Combined uncinectomy and maxillary sinus BSD procedures were easily completed for all patients without complications, and no late adverse sequelae were encountered. The maxillary sinuses could be visualized and accessed, if needed, intraoperatively and at all follow-up visits.
Conclusions
In selected subsets of maxillary sinus conditions this procedure modification can provide significant benefits. A case is presented for illustration.
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Affiliation(s)
- Gary J Nishioka
- Department of Otolaryngology, Willamette Ear Nose Throat, Salem, Oregon, United States
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418
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Scott JR, Ernst HMJ, Rotenberg BW, Rudmik L, Sowerby LJ. Oral corticosteroid prescribing habits for rhinosinusitis: The American Rhinologic Society membership. Am J Rhinol Allergy 2017; 31:22-26. [PMID: 28234148 DOI: 10.2500/ajra.2017.31.4396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND In the field of otolaryngology, oral corticosteroids (OCS) are widely prescribed for rhinosinusitis. Although there is evidence in the literature regarding specific OCS dosing protocols, it is not known to what extent these recommendations are being followed. OBJECTIVE To examine the current state of OCS prescribing habits for rhinosinusitis by American Rhinologic Society members. METHODS An anonymous online survey was sent to all American Rhinologic Society members. Dosing, frequency, tapering, and overall prescribing habits for OCS were assessed in chronic rhinosinusitis with polyposis (CRSwP) and in chronic rhinosinusitis without polyposis and acute bacterial rhinosinusitis. The CRSwP group was subdivided into aspirin-exacerbated respiratory disease, allergic fungal sinusitis, and not otherwise specified. Results were compared with current guidelines. Descriptive statistics were used to analyze data. RESULTS Ninety-three surveys were completed (response rate, 12.9%). Prednisone was the most common OCS prescribed. In the CRSwP-aspirin-exacerbated respiratory disease group (n = 86), the median starting dose was 60 mg (range, 4-80 mg) and the average duration was 8 days (range, 2-28 days). In the CRSwP-allergic fungal sinusitis group (n = 81), the median starting dose was 50 mg (range, 20-60 mg), and the average duration was 6 days (range, 2-35 days). In the CRSwP-not otherwise specified group (n = 84), the median starting dose was 50 mg (range, 20-80 mg) and the average duration was 5 days (range, 1-21 days). OCS were prescribed for chronic rhinosinusitis without polyposis and acute bacterial rhinosinusitis by 66.0 and 62.4% of respondents, respectively. CONCLUSION Significant heterogeneity existed in OCS prescribing habits for rhinosinusitis. Discrepancies were observed between survey results and evidence-based recommendations. Developing standardized OCS treatment protocols for rhinosinusitis may improve the quality of care by optimizing clinical outcomes and reducing the risk of complications.
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Affiliation(s)
- John R Scott
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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419
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Almashraqi AA, Ahmed EA, Mohamed NS, Barngkgei IH, Elsherbini NA, Halboub ES. Evaluation of different low-dose multidetector CT and cone beam CT protocols in maxillary sinus imaging: part I-an in vitro study. Dentomaxillofac Radiol 2017; 46:20160323. [PMID: 28266870 DOI: 10.1259/dmfr.20160323] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This in vitro study aimed to assess radiation dose and image quality of different low-dose multidetector CT (MDCT) and CBCT imaging protocols in comparison with the standard MDCT protocol for maxillary sinus imaging. METHODS Effective dose (E) and image quality of 10 MDCT (changing effective milliampere second starting from 141.3 EmAs to 20 EmAs) and 3 CBCT protocols (changing milliampere second and voxel size) were assessed throughout scanning an anthropomorphic head and neck Alderson Rando phantom. E values were calculated using thermoluminescent dosemeters (TLDs) fixed at 6 sensitive organs (14 sites) on the Rando phantom. Image quality was assessed objectively (by calculating the standard deviation values of the radiographic density of water) and subjectively (by assessing the diagnostic image quality using a four-graded scale: 1 = very good, 2 = good, 3 = acceptable and 4 = unacceptable). RESULTS Two MDCT protocols (120 kV/32 EmA and 120 kV/25 EmA) had lower radiation doses with statistically significant differences (p < 0.001) compared with that of the standard MDCT protocol (120 kV/141.3 EmA), and they preserved a good diagnostic image quality. One CBCT protocol (120 kV/20 mA) had a reasonable radiation dose and good image quality. There were no statistically significant differences between the above-mentioned lower dose MDCT and CBCT protocols (p > 0.05) with respect to the radiation dose and image quality. CONCLUSIONS The low-dose MDCT and CBCT protocols are viable methods for maxillary sinus examination as evaluated using the above-mentioned phantom that yield a good diagnostic image quality using E approximately 7 and 11 times lower than that of the standard MDCT, respectively. These findings were evaluated in the in vivo part of this project.
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Affiliation(s)
- Abeer A Almashraqi
- 1 Department of Oral Radiology, Faculty of Dentistry, Ibb University, Ibb, Yemen.,2 Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Eman A Ahmed
- 3 Department of Oral and Maxillofacial Radiology, College of Oral and Dental Medicine, Cairo University, Cairo, Egypt.,4 Department of Oral and Maxillofacial Radiology, Faculty of Oral and Dental Surgery, Misr University for Science and Technology, Giza, Egypt
| | - Nashwa S Mohamed
- 3 Department of Oral and Maxillofacial Radiology, College of Oral and Dental Medicine, Cairo University, Cairo, Egypt.,5 Department of Oral and Maxillofacial Radiology, Faculty of Oral and Dental Medicine, Misr International University, Cairo, Egypt
| | - Imad H Barngkgei
- 6 Department of Oral Medicine, Faculty of Dentistry, Damascus University, Damascus, Syria.,7 Department of Oral Medicine, Faculty of Dentistry, Syrian Private University, Damascus, Syria
| | - Nader A Elsherbini
- 8 Department of Medical Radiation Physics, Kasr Al-Aini Center of Oncology and Nuclear Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Esam S Halboub
- 2 Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia.,9 Department of Oral Medicine and Diagnosis, Faculty of Dentistry, Sana'a University, Sana'a, Yemen
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420
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Ramakrishnan VR, Mace JC, Soler ZM, Smith TL. Examination of high-antibiotic users in a multi-institutional cohort of chronic rhinosinusitis patients. Int Forum Allergy Rhinol 2017; 7:343-351. [PMID: 28084683 PMCID: PMC5386802 DOI: 10.1002/alr.21903] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/21/2016] [Accepted: 12/05/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND In addition to known concerns regarding antibiotic overuse, recent research indicates that excessive antibiotic use is associated with poorer long-term health. Given that rhinosinusitis is the leading condition accounting for antibiotic prescriptions in the ambulatory setting, we aimed to evaluate characteristics associated with greater antibiotic use in chronic rhinosinusitis (CRS). METHODS Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study evaluating treatment outcomes were included in this analysis. Study participants were asked to report the number of days out of the previous 90 days that systemic antibiotics were taken for sinus disease. Patient demographics, disease characteristics, and measures of disease severity were evaluated. RESULTS A total of 561 patients from 4 institutions were included in the analysis, with mean antibiotic use of 17.4 ± 22.4 out of the prior 90 days. No differences between antibiotic-use groups were found for objective measures of disease severity (computed tomography [CT], endoscopy, Brief Smell Identification Test [BSIT] scores), however, increased patient-reported symptom burden (22-item Sino-Nasal Outcome Test [SNOT-22], Rhinosinusitis Disability Index [RSDI]) was associated with more antibiotic use. Patients reporting the most antibiotic use were older (p = 0.004) but no ethnic or gender differences were seen. Comorbid diagnoses of allergy, asthma, diabetes, depression, or fibromyalgia were not associated with increased antibiotic use. In accordance with literature recommendations, CRS with nasal polyps (CRSwNP) patients were less likely to have used antibiotics. Endoscopic sinus surgery (ESS) significantly decreased antibiotic use. CONCLUSION Variability in antibiotic use in CRS appears to be driven by symptom burden, independent of objective measures of disease severity, patient demographics, and presence of comorbid disease. Clear guidelines are essential to define appropriate antibiotic use in CRS.
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Affiliation(s)
| | - Jess C. Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
| | - Zachary M. Soler
- 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
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421
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Levy JM, Mace JC, Smith TL, Soler ZM. Influence of interpersonal traits on patient outcomes in the treatment of chronic rhinosinusitis. Int Forum Allergy Rhinol 2017; 7:414-420. [PMID: 27863156 PMCID: PMC5386794 DOI: 10.1002/alr.21886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/21/2016] [Accepted: 10/25/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) measure health states in chronic rhinosinusitis (CRS) and have become the dominant metrics of treatment outcomes. Interpersonal traits (IPTs) are patient-specific factors that include personality type, perceived social support, and trust in physicians. The association of IPTs on treatment outcomes among patients with CRS has not been described previously, and IPTs may represent major clinical factors influencing treatment outcomes. METHODS Adult patients electing medical or surgical treatment for recalcitrant CRS were prospectively enrolled into a multi-institutional, observational outcomes study. Validated measures of IPTs, including the Big Five Inventory-10 Short Version (BFI-10), Multidimensional Scale of Perceived Social Support (MSPSS), and the Trust in Physician Scale (TPS), were completed and compared with PROMs, which included the 22-item SinoNasal Outcome Test (SNOT-22), the Medical Outcomes Study Short Form-6D (SF-6D), and the Patient Health Questionnaire-2 (PHQ-2). RESULTS Three hundred fifty-four participants were included and followed for an average (± standard deviation) of 16.3 (±4.8) months. Significant within-subject improvement in mean PROM scores was reported (all p <0.001). No association was detected between PROM score improvement and baseline BFI-10 or MSPSS scores (p > 0.050). Significant, but weak, absolute correlations were reported between baseline TPS scores and improvement in SNOT-22, SF-6D, and PHQ-2 total scores (p < 0.050; r ≤ 0.138). CONCLUSION Personality type and perceived social support do not associate with improvement after treatment for CRS. However, increased trust in physicians is weakly associated with greater posttreatment improvement. Further study is needed to examine the relationship between physician trust, patient satisfaction, and treatment outcomes among patients with CRS.
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Affiliation(s)
- Joshua M. Levy
- Department of Otolaryngology-Head & Neck Surgery, Division of Rhinology & Anterior Skull Base, Emory University, Atlanta, GA., USA
| | - Jess C. Mace
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health & Science University, Portland, OR., USA
| | - Timothy L. Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health & Science University, Portland, OR., USA
| | - Zachary M. Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC., USA
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422
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Saini AT, Govindaraj S. Evaluation and Decision Making in Frontal Sinus Surgery. Otolaryngol Clin North Am 2017; 49:911-25. [PMID: 27450615 DOI: 10.1016/j.otc.2016.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Management of frontal sinusitis can be challenging for even the most experienced otolaryngologists. A thorough understanding of the anatomy and pathophysiology of the frontal sinus is essential to properly manage disease affecting the frontal sinus. Being able to distinguish acute viral from acute bacterial and acute from chronic sinusitis is crucial because these distinctions guide appropriate management. Nasal endoscopy can confirm diagnosis, and radiologic imaging, including computed tomography and MRI, is often a necessary adjunct that aids in determining appropriate therapeutic decisions. One must be aware of the many procedures used in the surgical treatment of frontal sinusitis.
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Affiliation(s)
- Alok T Saini
- Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Satish Govindaraj
- Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.
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423
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DeConde AS, Smith TL. Outcomes After Frontal Sinus Surgery: An Evidence-Based Review. Otolaryngol Clin North Am 2017; 49:1019-33. [PMID: 27450618 DOI: 10.1016/j.otc.2016.03.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Endoscopic sinus surgery is an effective intervention at improving quality of life for patients with medically refractory chronic rhinosinusitis. The evidence supporting frontal sinusotomy is limited to single institution case series. However, the data for Draf IIa frontal sinusotomy do demonstrate that most patients experience lasting frontal sinus patency on postoperative endoscopic examination and improvements in quality of life. Salvage endoscopic frontal sinus surgery via a Draf III shows high rates of neo-ostium patency and subjective improvements in symptoms at a 2-year time point in case series.
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Affiliation(s)
- Adam S DeConde
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, 200 W Arbor Dr., MC 8895, San Diego, CA 92103-8895, USA
| | - Timothy L Smith
- Division of Rhinology, Sinus, and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Sinus Center, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, PV-01, Portland, OR 97239, USA.
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424
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Abstract
Aspirin-exacerbated respiratory disease (AERD) is characterized by the triad of asthma, sinonasal polyposis, and aspirin intolerance. The hallmark of the disease is baseline overproduction of cysteinyl leukotrienes via the 5-lipoxygenase pathway, exacerbated by ingestion of aspirin. Patients with AERD have high rates of recidivistic polyposis following sinus surgery, although the improvement in quality of life following surgery is similar to aspirin-tolerant patients. The diagnosis is secured by a positive aspirin provocation test, usually administered by a medical allergist. Aspirin therapy is a unique treatment consideration for patients with AERD.
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Affiliation(s)
- Evan S Walgama
- Department of Otolaryngology/Head and Neck Surgery, Stanford School of Medicine, Stanford Sinus Center, 801 Welch Road, Palo Alto, CA 94304, USA
| | - Peter H Hwang
- Department of Otolaryngology/Head and Neck Surgery, Stanford School of Medicine, Stanford Sinus Center, 801 Welch Road, Palo Alto, CA 94304, USA.
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425
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Abstract
Bacterial pathogens and microbiome alterations can contribute to the initiation and propagation of mucosal inflammation in chronic rhinosinusitis (CRS). In this article, the authors review the clinical and research implications of key pathogens, discuss the role of the microbiome, and connect bacteria to mechanisms of mucosal immunity relevant in CRS.
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Affiliation(s)
- Thad W Vickery
- University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado, 12631 East 17th Avenue, B205, Aurora, CO 80045, USA.
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426
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DeConde AS, Smith TL. Classification of Chronic Rhinosinusitis-Working Toward Personalized Diagnosis. Otolaryngol Clin North Am 2017; 50:1-12. [PMID: 27888907 DOI: 10.1016/j.otc.2016.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
An estimated 4.5% of total US health care dollars have been devoted to mitigating chronic rhinosinusitis. The most recalcitrant of these patients undergo surgery, which fails to improve symptoms in approximately 25% of patients. Recent advances in informational, microbiomic, and genomic analysis have introduced the first set of tools that patients, physicians, politicians, and payers can apply to better forecast which patients will respond favorably to endoscopic sinus surgery. This article summarizes the forces driving the application of personalized medicine to CRS and how new advances can be applied to clinical practice.
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Affiliation(s)
- Adam S DeConde
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, 200 W. Arbor, #8895, San Diego, CA 92103, USA
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Oregon Sinus Center, Oregon Health and Science University, 3181 South West Sam Jackson Park Road, PV-01, Portland, OR 97239, USA.
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427
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Orlandi R, Hopkins C, Philpott C, Rosenfeld RM. Cochrane Corner: Extracts from The Cochrane Library. Otolaryngol Head Neck Surg 2017; 156:397-402. [PMID: 28248603 DOI: 10.1177/0194599816680605] [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
The Cochrane Corner is a section in the journal that highlights systematic reviews relevant to otolaryngology-head and neck surgery, with invited commentary to aid clinical decision making. This installment features a pair of related Cochrane Reviews on intranasal steroids for chronic rhinosinusitis, which identify low- to moderate-quality evidence for a beneficial effect on overall symptoms, nasal congestion, and rhinorrhea. There is no evidence, however, to suggest superiority of any particular steroid preparation or drug delivery system. The related expert commentary should help clinicians make the best treatment decisions based on the studies and outcomes identified in these Cochrane Reviews.
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Affiliation(s)
| | - Clair Hopkins
- 2 King's Health Partners Clinical Academic Groups, King's College, London, UK
| | - Carl Philpott
- 3 Norwich Medical School and James Paget University Hospital, Norwich, UK
| | - Richard M Rosenfeld
- 4 Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York, USA
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428
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Ushkalova EA, Zyryanov SK, Shvarts GY. [The use of intranasal glucocorticosteroids in the treatment of rhinosinusitis: Focus on mometasone furoate]. Vestn Otorinolaringol 2017; 81:59-66. [PMID: 27876741 DOI: 10.17116/otorino201681559-66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The authors discuss the mechanism of action, effectiveness, and safety of intranasal glucocorticosteroids (inGCS) used to treat acute, recurrent and chronic rhinosinusitis (RS). The last version of the European guidelines concerning the application of inGCS assigns the highest level of evidence-Ia and the highest strength of recommendations-A to these medications when applied for the treatment of acute and polypoid rhinosinusitis. Moreover, they acquire the status of the agents of choice for the therapy of chronic RS without polyps. Mometasone furoate is one of the best explored preparations of this group of medicines. It is possessed of favourable pharmacodynamic and pharmacokinetic properties when prescribed for local application. The new mometasone furoate preparation in the form of an intranasal spray Dezrinit produced by "Teva" Ltd. was registered in the Russian Federation. In a comparative randomized clinical trial (RCT), the preparation was shown to be an equivalent to the Nasonex spray.
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Affiliation(s)
- E A Ushkalova
- Russian University of People's Friendship, Moscow, Russia, 117198
| | - S K Zyryanov
- Russian University of People's Friendship, Moscow, Russia, 117198
| | - G Ya Shvarts
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 11999; 'Teva' Ltd., Moscow, Russia, 115054
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429
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Schlosser RJ, Smith TL, Mace J, Soler ZM. Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis. Allergy 2017; 72:483-491. [PMID: 27638398 DOI: 10.1111/all.13048] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with chronic rhinosinusitis (CRS) often have comorbid asthma. Prior studies have not examined the impact of CRS or endoscopic sinus surgery (ESS) upon asthma quality of life (QOL) and asthma control using validated outcome metrics. METHODS Patients with CRS, both with and without polyps, and comorbid asthma completed the Mini Asthma QOL Questionnaire (miniAQLQ) and Asthma Control Test (ACT) at baseline and 6 months postoperatively as part of a multi-institutional, prospective study. RESULTS Baseline metrics were available on 86 patients. Patients undergoing ESS reported improved miniAQLQ [0.5 (SD ±1.1), 95% CI: 0.2-0.7; P = 0.002] and ACT scores [1.3 (±4.1), 95% CI: 0.2-2.4; P = 0.025]. Uncontrolled baseline asthma (ACT < 20) was present in 51% of patients undergoing ESS. In uncontrolled patients, ESS resulted in a minimal clinically important difference 57% of the time for miniAQLQ scores (≥0.5 points) and 50% of the time for ACT scores (≥3.0 points). After adjustment with linear regression, baseline miniAQLQ scores were worse in patients with comorbid allergy (P = 0.045) and chronic obstructive pulmonary disease (COPD; P = 0.015). Adjusted baseline ACT scores were worse in patients with COPD (P = 0.004). Covariates associated with changes in miniAQLQ scores after ESS were pre-operative corticosteroid dependency (P = 0.011) and change in total SNOT-22 score (P = 0.010). Covariate associated with significantly less improvement in ACT scores was obstructive sleep apnea (P = 0.016). CONCLUSIONS Patients with CRS often present with uncontrolled asthma, and ESS improves both miniAQLQ and ACT. Approximately half of patients with uncontrolled asthma improve after ESS, yet there are few CRS-specific factors associated with asthma QOL or control or ESS outcomes.
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Affiliation(s)
- R. J. Schlosser
- Department of Otolaryngology - Head and Neck Surgery; Medical University of South Carolina; Charleston SC USA
| | - T. L. Smith
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health Sciences University; Portland OR USA
| | - J. Mace
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health Sciences University; Portland OR USA
| | - Z. M. Soler
- Department of Otolaryngology - Head and Neck Surgery; Medical University of South Carolina; Charleston SC USA
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430
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Ordemann AG, Stanford JK, Sullivan DC, Reed JM. Can contaminated water be rendered safe for nasal saline irrigations? Laryngoscope 2017; 127:1513-1519. [DOI: 10.1002/lary.26538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Allison G. Ordemann
- Department of Otolaryngology and Communicative Sciences; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - James K. Stanford
- Department of Otolaryngology and Communicative Sciences; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Donna C. Sullivan
- Department of Microbiology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - J. Mark Reed
- Department of Otolaryngology and Communicative Sciences; University of Mississippi Medical Center; Jackson Mississippi U.S.A
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431
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Renteria AE, Mfuna Endam L, Desrosiers M. Do Aging Factors Influence the Clinical Presentation and Management of Chronic Rhinosinusitis? Otolaryngol Head Neck Surg 2017; 156:598-605. [PMID: 28195747 DOI: 10.1177/0194599817691258] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective/Hypothesis Chronic rhinosinusitis (CRS) is a complex inflammatory disease of the upper respiratory airways resulting from the dysregulation of immunity and epithelial defenses. More recently, the contribution of an altered nasal microbiome to the development of CRS has also been proposed. However, the impact of aging on the development of CRS has been long overlooked. Here we propose, in a hypothesis piece, that aging can influence the physiopathology of CRS and its subsequent management in an elderly population. Data Sources We summarize the recent literature findings supporting that elderly patients with CRS could be a distinct population from those with adult CRS and might require different or adjunct therapeutic approaches. Methods Review of recent literature of the effect of aging and its possible effects in CRS using 3 different databases. Conclusions Age-dependent decrease in the levels of the S100 family proteins involved in epithelial proliferation, repair, and defenses combined with chronic inflammation might lead to an increased risk of abnormal microbial colonization and loss of microbiota diversity. Ultimately, these changes could have the potential to alter the physiopathology of CRS in the elderly. Implications Unlike in adults, in whom CRS Th2-skewed responses with eosinophilia are thought to play a critical role, in aging populations, a microbiome and epithelial barrier dysfunctions may instead be the pivotal agents of disease development and persistence. This supports that therapies for elderly patients may require a different management or additional targeted therapies to control the disease. Prospective studies, however, are necessary to validate this concept.
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Affiliation(s)
- Axel E Renteria
- 1 Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Leandra Mfuna Endam
- 1 Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Martin Desrosiers
- 1 Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,2 Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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432
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Chapurin N, Pynnonen MA, Roberts R, Schulz K, Shin JJ, Witsell DL, Parham K, Langman A, Carpenter D, Vambutas A, Nguyen-Huynh A, Wolfley A, Lee WT. CHEER National Study of Chronic Rhinosinusitis Practice Patterns: Disease Comorbidities and Factors Associated with Surgery. Otolaryngol Head Neck Surg 2017; 156:751-756. [PMID: 28195023 DOI: 10.1177/0194599817691476] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives (1) Describe national patterns of chronic rhinosinusitis (CRS) care across academic and community practices. (2) Determine the prevalence of comorbid disorders in CRS patients, including nasal polyposis, allergic rhinitis, asthma, and cystic fibrosis. (3) Identify demographic, clinical, and practice type factors associated with endoscopic sinus surgery (ESS). Study Design Multisite cross-sectional study. Setting Otolaryngology's national research network CHEER (Creating Healthcare Excellence through Education and Research). Subjects and Methods A total of 17,828 adult patients with CRS were identified, of which 10,434 were seen at community practices (59%, n = 8 sites) and 7394 at academic practices (41%, n = 10 sites). Multivariate logistic regression was used to evaluate the association between demographic, practice type, and clinical factors and the odds of a patient undergoing ESS. Results The average age was 50.4 years; 59.5% of patients were female; and 88.3% were Caucasian. The prevalence of comorbid diseases was as follows: allergic rhinitis (35.1%), nasal polyposis (13.3%), asthma (4.4%), and cystic fibrosis (0.2%). In addition, 24.8% of patients at academic centers underwent ESS, as compared with 12.3% at community sites. In multivariate analyses, nasal polyposis (odds ratio [OR], 4.28), cystic fibrosis (OR, 2.42), and academic site type (OR, 1.86) were associated with ESS ( P < .001), while adjusting for other factors. Conclusions We describe practice patterns of CRS care, as well as demographic and clinical factors associated with ESS. This is the first study of practice patterns in CRS utilizing the CHEER network and may be used to guide future research.
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Affiliation(s)
- Nikita Chapurin
- 1 Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Melissa A Pynnonen
- 2 Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rhonda Roberts
- 3 Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Kristine Schulz
- 1 Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer J Shin
- 4 Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - David L Witsell
- 1 Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Kourosh Parham
- 5 Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Alan Langman
- 6 Department of Otolaryngology, University of Washington, Seattle, Washington, USA
| | - David Carpenter
- 1 Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrea Vambutas
- 7 Department of Otolaryngology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Anh Nguyen-Huynh
- 8 Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Anne Wolfley
- 3 Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Walter T Lee
- 1 Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
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433
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Libman H, Brockmeyer DM, Gold HS. Should We Prescribe Antibiotics to This Patient With Persistent Upper Respiratory Symptoms?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2017; 166:201-208. [PMID: 28166559 DOI: 10.7326/m16-2766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The American College of Physicians (ACP) and the Centers for Disease Control and Prevention (CDC) recently published advice for high-value care on the appropriate use of antibiotics for acute respiratory tract infections. They conducted a narrative literature review of evidence for antibiotic use in this setting that included recent clinical guidelines from professional societies supplemented by randomized, controlled trials; meta-analyses; and systematic reviews. They concluded that clinicians should reserve antibiotic treatment for acute rhinosinusitis in patients with persistent symptoms for more than 10 days, high fever and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or worsening symptoms after a typical viral illness that lasted 5 days and had initially improved ("double-sickening"). In this Grand Rounds, 2 prominent clinicians debate whether to initiate antibiotic treatment in a 62-year-old man with a history of recurrent sinusitis who presents with persistent upper respiratory symptoms. They review the data on which the ACP/CDC recommendations are based and discuss the potential benefits and risks, as well as the challenges and controversies, of prescribing antibiotic therapy in this setting.
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434
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Barshak MB, Durand ML. The role of infection and antibiotics in chronic rhinosinusitis. Laryngoscope Investig Otolaryngol 2017; 2:36-42. [PMID: 28894821 PMCID: PMC5510277 DOI: 10.1002/lio2.61] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To review the current understanding of the role of infection and antibiotics in chronic rhinosinusitis. REVIEW METHODS PubMed literature search. RESULTS Chronic rhinosinusitis (CRS) in adults is an inflammatory condition and the role of infection is unclear. Biofilms are present in both CRS and normal patients so their role in CRS is unknown. Sinus cultures in CRS demonstrate a mixture of aerobic and anaerobic bacteria but may be hard to interpret due to contaminating nasal flora. Staphylococcus aureus is common in CRS patients but also present in 20-30% of nasal cultures in the normal population; eradicating this organism did not lead to symptom improvement versus placebo in a randomized controlled trial (RCT). In CRS patients who develop an episode of acute rhinosinusitis (ARS), bacteria typical of ARS can generally be cultured and require short-course treatment. For CRS, topical antibacterial or antifungal agents have shown no benefit over placebo in RCTs, although RCTs of topical antibacterial agents have been small. Oral macrolides and doxycycline, antibiotics with anti-inflammatory properties, are the only systemic antibiotics that have been evaluated in RCTs. One RCT found 3 weeks of doxycycline beneficial in patients with polyps but follow up was short (<3 months); RCTs of prolonged macrolide therapy have produced mixed results, and most show no benefit after cessation of therapy. Long-term antibiotic therapy may produce side effects and select increasingly resistant flora. The American Academy of Otolaryngology-Head and Neck Surgery guidelines recommend against treatment of CRS with antifungal agents but do not comment on the role of antibacterial treatment. CONCLUSION The role of infection in CRS is unknown, and the only well-defined role for antibiotics is for treatment of ARS episodes or their infectious complications. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Miriam Baron Barshak
- Massachusetts General Hospital and Massachusetts Eye and Ear InfirmaryBostonMassachusetts
| | - Marlene L. Durand
- Massachusetts General Hospital and Massachusetts Eye and Ear InfirmaryBostonMassachusetts
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435
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Kohli P, Naik AN, Harruff EE, Nguyen SA, Schlosser RJ, Soler ZM. The prevalence of olfactory dysfunction in chronic rhinosinusitis. Laryngoscope 2017; 127:309-320. [PMID: 27873345 PMCID: PMC5258829 DOI: 10.1002/lary.26316] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Many studies have reported that olfactory dysfunction frequently occurs in chronic rhinosinusitis (CRS) populations; however, the prevalence and degree of olfactory loss has not been systematically studied. The aims of this study were to use combined data to report the prevalence of olfactory dysfunction and to calculate weighted averages of olfactory test scores in CRS patients. DATA SOURCES A search was conducted in PubMed and Scopus, following the methods of Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. REVIEW METHODS Studies reporting the prevalence of olfactory dysfunction using objective measures or olfactory test scores using validated scales were included. RESULTS A total of 47 articles were included in a systematic review and 35 in the pooled data analysis. The prevalence of olfactory dysfunction in chronic rhinosinusitis was found to be 30.0% using the Brief Smell Identification Test, 67.0% using the 40-item Smell Identification Test, and 78.2% using the total Sniffin' Sticks score. Weighted averages ± standard deviation of olfactory test scores were 25.96 ± 7.11 using the 40-item Smell Identification Test, 8.60 ± 2.81 using the Brief Smell Identification Test, 21.96 ± 8.88 using total Sniffin' Sticks score, 5.65 ± 1.51 using Sniffin' Sticks-Threshold, 9.21 ± 4.63 using Sniffin' Sticks-Discrimination, 9.47 ± 3.92 using Sniffin' Sticks-Identification, and 8.90 ± 5.14 using the Questionnaire for Olfactory Disorders-Negative Statements. CONCLUSIONS In CRS populations, a significant percentage of patients experience olfactory dysfunction, and mean olfactory scores are within the dysosmic range. Laryngoscope, 2016 127:309-320, 2017.
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Affiliation(s)
- Preeti Kohli
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Akash N. Naik
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - E. Emily Harruff
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A. Nguyen
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rodney J. Schlosser
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Surgery, Ralph H. Johnson, VA Medical Center, Charleston, SC, USA
| | - Zachary M. Soler
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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436
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Thamboo A, Patel ZM. Office Procedures in Refractory Chronic Rhinosinusitis. Otolaryngol Clin North Am 2017; 50:113-128. [DOI: 10.1016/j.otc.2016.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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437
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Mion ODG, Mello JFD, Dutra DL, Andrade NAD, Almeida WLDC, Anselmo-Lima WT, Filho LLB, Carvalho E Castro JD, Guimarães REDS, Lessa MM, Maniglia SF, Meireles RC, Nakanishi M, Pignatari SSN, Roithmann R, Romano FR, Santos RDP, Santos MCJD, Tamashiro E. Position statement of the Brazilian Academy of Rhinology on the use of antihistamines, antileukotrienes, and oral corticosteroids in the treatment of inflammatory sinonasal diseases. Braz J Otorhinolaryngol 2017; 83:215-227. [PMID: 28216249 PMCID: PMC9442683 DOI: 10.1016/j.bjorl.2017.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 12/21/2016] [Indexed: 12/12/2022] Open
Abstract
Introduction Inflammatory conditions of the nose and paranasal sinuses are very prevalent in the general population, resulting in marked loss of quality of life in affected patients, as well as significant work, leisure, and social activity losses. These patients require specific and specialized treatment. A wide range of oral medications are available. Objective The present document is aimed to clarify, for professionals treating patients with inflammatory sinonasal diseases, both specialists and general practitioners, specific oral therapies in noninfectious nasal inflammatory conditions. Methods The methodology used to create this article included the search for the key words: oral corticosteroids, antihistamines, antileukotrienes, rhinitis, rhinosinusitis in the MEDLINE and EMBASE databases in the last 5 years. Since no relevant article was found for the text on the subject of interest in the last 5 years, the search was extended for another 5 years, and so on, according to the authors’ needs. Results Relevant literature was found regarding the use of antihistamines, antileukotrienes and oral corticosteroids in these conditions. The Brazilian Academy of Rhinology emphasizes, after extensive discussion by the collegiate, key points in the treatment with these drugs. Conclusion There is support in the literature for the use of these drugs; however, final considerations about the role of each of them have been made.
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Affiliation(s)
- Olavo de Godoy Mion
- Universidade de São Paulo (USP), Disciplina de Otorrinolaringologia, São Paulo, SP, Brazil.
| | | | - Daniel Lorena Dutra
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Nilvano Alves de Andrade
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | | | - Wilma Teresinha Anselmo-Lima
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Otorrinolaringologia, Ribeirão Preto, SP, Brazil
| | | | | | - Roberto Eustáquio Dos Santos Guimarães
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Belo Horizonte, MG, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Marcus Miranda Lessa
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Disciplina de Otorrinolaringologia, Salvador, BA, Brazil
| | - Sérgio Fabrício Maniglia
- Hospital Instituto Paranaense de Otorrinolaringologia, Centro de Rinite e Alergia, Curitiba, PR, Brazil
| | | | - Márcio Nakanishi
- Universidade de São Paulo (USP), Disciplina de Otorrinolaringologia, São Paulo, SP, Brazil; Universidade de Brasília (UnB), Faculdade de Medicina, Brasília, DF, Brazil
| | | | - Renato Roithmann
- Universidade Luterana do Brasil (ULBRA), Faculdade de Medicina, Otorrinolaringologia, Canoas, RS, Brazil; Mount Sinai Hospital, Department of Othorhinolaryngology, Toronto, Canada
| | - Fabrizio Ricci Romano
- Universidade de São Paulo (USP), Faculdade de Medicina, Ciências, São Paulo, SP, Brazil
| | | | - Marco César Jorge Dos Santos
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Edwin Tamashiro
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
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438
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Ong KY, Lim WC, Ooi SM, Loh ZH, Kong MC, Chan LW, Heng PWS. Stability of a novel corticosteroid nasal irrigation solution: betamethasone 17-valerate added to extemporaneously prepared nasal irrigation solutions. Int Forum Allergy Rhinol 2017; 7:494-501. [PMID: 28092126 DOI: 10.1002/alr.21907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/03/2016] [Accepted: 12/13/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND There are no commercially available nasal irrigation solutions containing corticosteroids. Instead, such preparations are extemporaneously prepared by adding existing corticosteroid formulations to nasal irrigation solutions. The stability of the corticosteroid betamethasone 17-valerate (B17V), in nasal irrigation solutions of different compositions and pH and stored under different temperatures, was studied to determine the optimal choice of solution and storage conditions. METHODS Triplicate extemporaneous preparations made with B17V were prepared by adding a predetermined volume of B17V lotion to each nasal irrigation solution: normal saline (NS), sodium bicarbonate (NaHCO3 ) powder dissolved in tap water, and a commercially available powder mixture (FLO Sinus Care Powder), dissolved in tap water or pre-boiled tap water. Preparations were stored at 30°C and 4°C. Sampling was carried out at 0, 1, 2, 6, and 24 hours. The concentrations of B17V and its degradation compound, betamethasone 21-valerate (B21V), were determined by high-performance liquid chromatography. RESULTS Preparations stored at 30°C contained a lower amount of B17V and higher amount of B21V than those stored at 4°C. B17V stability in nasal irrigation solutions decreased in the following order: NS, FLO in fresh tap water, FLO in pre-boiled tap water, and NaHCO3 . The degradation rate of B17V increased with higher storage temperature and higher pH. CONCLUSION B17V is most stable when added to NS and least stable in NaHCO3 solution. FLO solution prepared with either cooled boiled water or tap water is an alternative if administered immediately. Storage at 4°C can better preserve stability of B17V, over a period of 24 hours.
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Affiliation(s)
- Kheng Yong Ong
- Department of Pharmacy, Singapore General Hospital, Singapore.,Allergy Centre, Singapore General Hospital, Singapore
| | - Wei Ching Lim
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Shing Ming Ooi
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Zhi Hui Loh
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Ming Chai Kong
- Department of Pharmacy, Singapore General Hospital, Singapore.,Allergy Centre, Singapore General Hospital, Singapore
| | - Lai Wah Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Paul Wan Sia Heng
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
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439
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Nasal Irrigation as Treatment in Sinonasal Symptoms Relief: A Review of Its Efficacy and Clinical Applications. Indian J Otolaryngol Head Neck Surg 2017; 71:1718-1726. [PMID: 31763232 DOI: 10.1007/s12070-017-1070-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022] Open
Abstract
Nasal irrigations have been used for centuries without any scientific data to determine its efficacy. Despite their widespread use, much confusion exist about the mechanism of action, preparation, indications and therapeutic advantage of nasal irrigations. Anecdotal evidence and poorly controlled studies add to the confusion. Recent evidence provides strong scientific justification of the benefits and advantages of using nasal irrigations in sinonasal symptoms relief. The present review of the evidence based literature highlights its efficacy and clinical applications.
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440
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Yoon YK, Park CS, Kim JW, Hwang K, Lee SY, Kim TH, Park DY, Kim HJ, Kim DY, Lee HJ, Shin HY, You YK, Park DA, Kim SW. Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections. Infect Chemother 2017; 49:326-352. [PMID: 29299900 PMCID: PMC5754344 DOI: 10.3947/ic.2017.49.4.326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Indexed: 12/20/2022] Open
Abstract
These guidelines were developed as part of the 2016 Policy Research Servicing Project by the Korea Centers for Disease Control and Prevention. A multidisciplinary approach was taken to formulate this guideline to provide practical information about the diagnosis and treatment of adults with acute upper respiratory tract infection, with the ultimate aim to promote the appropriate use of antibiotics. The formulation of this guideline was based on a systematic literature review and analysis of the latest research findings to facilitate evidence-based practice, and focused on key questions to help clinicians obtain solutions to clinical questions that may arise during the care of a patient. These guidelines mainly cover the subjects on the assessment of antibiotic indications and appropriate selection of antibiotics for adult patients with acute pharyngotonsillitis or acute sinusitis.
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Affiliation(s)
- Young Kyung Yoon
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chan Soon Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Wook Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Kyurin Hwang
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Sei Young Lee
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Do Yang Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Hyun Jun Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Dong Young Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Hyun Jong Lee
- Korean Association of Otorhinolaryngologists, Seoul, Korea
| | - Hyun Young Shin
- Korean Association of Family Medicine, Seoul, Korea.,Department of Family Medicine, Myongji Hospital, Seonam University, College of Medicine, Goyang, Korea
| | - Yong Kyu You
- Korean Medical Practitioners Association, Seoul, Korea.,Department of Internal Medicine, Nammoon Medical Clinic, Seoul, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Shin Woo Kim
- Korean Society of Infectious Diseases, Seoul, Korea.,Korean Society for Chemotherapy, Seoul, Korea.,Department of Internal Medicine, Kungpook National University, School of Medicine, Daegu, Korea.
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Di Luca M, Navari E, Esin S, Menichini M, Barnini S, Trampuz A, Casani A, Batoni G. Detection of Biofilms in Biopsies from Chronic Rhinosinusitis Patients: In Vitro Biofilm Forming Ability and Antimicrobial Susceptibility Testing in Biofilm Mode of Growth of Isolated Bacteria. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1057:1-27. [PMID: 28389992 DOI: 10.1007/5584_2017_34] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic rhinosinusitis (CRS) is the most common illness among chronic disorders that remains poorly understood from a pathogenic standpoint and has a significant impact on patient quality of life, as well as healthcare costs. Despite being widespread, little is known about the etiology of the CRS. Recent evidence, showing the presence of biofilms within the paranasal sinuses, suggests a role for biofilm in the pathogenesis. To elucidate the role of biofilm in the pathogenesis of CRS, we assessed the presence of biofilm at the infection site and the ability of the aerobic flora isolated from CRS patients to form biofilm in vitro. For selected bacterial strains the susceptibility profiles to antibiotics in biofilm condition was also evaluated.Staphylococci represented the majority of the isolates obtained from the infection site, with S. epidermidis being the most frequently isolated species. Other isolates were represented by Enterobacteriaceae or by species present in the oral flora. Confocal laser scanning microscopy (CLSM) of the mucosal biopsies taken from patients with CRS revealed the presence of biofilm in the majority of the samples. Strains isolated from the specific infection site of the CRS patients were able to form biofilm in vitro at moderate or high levels, when tested in optimized conditions. No biofilm was observed by CLSM in the biopsies from control patients, although the same biopsies were positive for staphylococci in microbiological culture analysis. Drug-susceptibility tests demonstrated that the susceptibility profile of planktonic bacteria differs from that of sessile bacteria in biofilms.
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Affiliation(s)
- Mariagrazia Di Luca
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa, Italy. .,NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Pisa, Italy. .,Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin, Berlin, Germany.
| | - Elena Navari
- Department of Medical and Surgical Pathology, Otorhinolaryngology Unit, Pisa University Hospital, Pisa, Italy
| | - Semih Esin
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa, Italy.,Microbiology Unit, Pisa University Hospital, Pisa, Italy
| | - Melissa Menichini
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa, Italy.,Microbiology Unit, Pisa University Hospital, Pisa, Italy
| | - Simona Barnini
- Microbiology Unit, Pisa University Hospital, Pisa, Italy
| | - Andrej Trampuz
- Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin, Berlin, Germany.,Center for Musculoskeletal Surgery, Septic Unit Charité-Universitätsmedizin, Berlin, Germany
| | - Augusto Casani
- Department of Medical and Surgical Pathology, Otorhinolaryngology Unit, Pisa University Hospital, Pisa, Italy
| | - Giovanna Batoni
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa, Italy.,Microbiology Unit, Pisa University Hospital, Pisa, Italy
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443
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Kroll H, Hom J, Ahuja N, Smith C(D, Wintermark M. R-SCAN: Imaging for Uncomplicated Acute Rhinosinusitis. J Am Coll Radiol 2017; 14:82-83.e1. [DOI: 10.1016/j.jacr.2016.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 08/16/2016] [Accepted: 08/19/2016] [Indexed: 10/20/2022]
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444
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Chang EH, Willis AL, McCrary HC, Noutsios GT, Le CH, Chiu AG, Mansfield CJ, Reed DR, Brooks SG, Adappa ND, Palmer JN, Cohen NG, Stern DA, Guerra S, Martinez FD. Association between the CDHR3 rs6967330 risk allele and chronic rhinosinusitis. J Allergy Clin Immunol 2016; 139:1990-1992.e2. [PMID: 27923563 DOI: 10.1016/j.jaci.2016.10.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/15/2016] [Accepted: 10/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Eugene H Chang
- Department of Otolaryngology, University of Arizona, Tucson, Ariz.
| | - Amanda L Willis
- Department of Otolaryngology, University of Arizona, Tucson, Ariz
| | - Hilary C McCrary
- Department of Otolaryngology, University of Arizona, Tucson, Ariz
| | | | - Christopher H Le
- Department of Otolaryngology, University of Arizona, Tucson, Ariz
| | - Alexander G Chiu
- Department of Otolaryngology, University of Arizona, Tucson, Ariz
| | | | | | - Steven G Brooks
- Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pa
| | - Nithin D Adappa
- Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pa
| | - James N Palmer
- Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pa
| | - Noam G Cohen
- Monell Chemical Senses Center, Philadelphia, Pa; Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pa; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pa
| | - Debra A Stern
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | - Stefano Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
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445
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Hsu CL, Wang TC, Shen TC, Huang YJ, Lin CL, Sung FC. Risk of depression in patients with chronic rhinosinusitis: A nationwide population-based retrospective cohort study. J Affect Disord 2016; 206:294-299. [PMID: 27643962 DOI: 10.1016/j.jad.2016.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/01/2016] [Accepted: 09/08/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Depression is prevalent in patients with chronic rhinosinusitis (CRS). However, no population-based study has ever investigated this relationship. We used nationwide population insurance data to conduct a retrospective cohort study to evaluate the subsequent risk of depression among patients with CRS. METHODS We used the National Health Insurance Research Database (NHIRD) of Taiwan identified 15,371 CRS patients diagnosed during 2000-2010. The non-CRS group consisted of 61,484 individuals without CRS frequency matched by sex, age, and the year of diagnosis. The occurrence of depression was monitored until the end of 2011. The hazard ratios (HRs) of depression were estimated using the Cox proportional hazards model after adjusting for demographic characteristics and comorbidities. RESULTS The overall incidence of depression was 77% higher in the CRS group than in the non-CRS group (8.25 vs. 4.66/1000 person-years, p<0.001), with an adjusted HR of 1.56 (95% confidence interval=1.43-1.70). Further data analyses revealed that the adjusted HRs of depression in the CRS group compared with the non-CRS group by sex, age, urbanization level, monthly income, occupation category, and comorbidity were all significant. However, there was no difference in incidences of depression between CRS patients with and without surgical treatment (8.31 vs. 8.24/1000 person-years). CONCLUSION The present study suggests that patients with CRS are at an increased risk of depression, compared with those without CRS. Therefore, we should pay attention to the psychiatric status of these patients and provide adequate support for them.
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Affiliation(s)
- Che-Lun Hsu
- Department of Otolaryngology, Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Tang-Chuan Wang
- Department of Otolaryngology, Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Te-Chun Shen
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
| | - Yu-Jhen Huang
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan; Mahidol University Faculty of Public Health, Bangkok, Thailand.
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446
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Lidder AK, Detwiller KY, Price CPE, Kern RC, Conley DB, Shintani-Smith S, Welch KC, Chandra RK, Peters AT, Grammer LC, Man LX, Schleimer RP, Tan BK. Evaluating metrics of responsiveness using patient-reported outcome measures in chronic rhinosinusitis. Int Forum Allergy Rhinol 2016; 7:128-134. [PMID: 28177596 DOI: 10.1002/alr.21866] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/11/2016] [Accepted: 09/22/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Responsiveness, or sensitivity to clinical change, is important when selecting patient-reported outcome measures (PROMs) for research and clinical applications. This study compares responsiveness of PROMs used in chronic rhinosinusitis (CRS) to inform the future development of a highly responsive instrument that accurately portrays CRS patients' symptom experiences. METHODS Adult CRS patients initiating medical therapy (MT; n = 143) or undergoing endoscopic sinus surgery after failing MT (ESS; n = 123) completed the 22-item Sino-Nasal Outcome Test (SNOT-22), European Position Statement on Rhinosinusitis (EPOS) visual analog scale (VAS), and 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) at baseline and 3 months after treatment. Cohen's d and paired t statistics were used to evaluate the responsiveness of each measure. RESULTS Fifty-two (36.4%) subjects and 42 (34.1%) subjects in the MT and ESS groups, respectively, completed baseline and 3-month questionnaires. Subjects with and without 3-month data were similar with respect to baseline demographics, VAS scores, and SNOT-22 scores (p > 0.05). In MT patients, CRS-specific measures, like VAS (d = -0.58, p < 0.01; t = -1.81, p > 0.05) and SNOT-22 (d = -0.70, p < 0.01; t = -3.29, p < 0.05) scores, were more responsive than PROMIS-29 general health domains (p > 0.05 for Cohen's d). In ESS patients, VAS (d = -1.97; t = -9.63, both p < 0.01) and SNOT-22 (d = -1.56; t = -9.99, both p < 0.01) scores were similarly more responsive, although changes in PROMIS-29 domains of Fatigue (d = -0.82, p = 0.01; t = -4.63, p < 0.01), Sleep Disturbance (d = -0.83; t = -3.77, both p < 0.01), and Pain Intensity (d = -1.0; t = -5.67, both p < 0.01) were significant. All 22 individual SNOT-22 items differed significantly after surgery, whereas only 8 items were consistently responsive after MT. CONCLUSIONS For both MT and ESS patients, CRS-specific PROMs are more responsive to posttreatment clinical changes than general health measures. Still, the SNOT-22 contains items that likely decrease its overall responsiveness. Our findings also indicate that existing PROMs had a greater response to ESS than MT.
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Affiliation(s)
- Alcina K Lidder
- University of Rochester School of Medicine and DentistryUniversity of Rochester Medical Center, Rochester, NY
| | - Kara Y Detwiller
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Caroline P E Price
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert C Kern
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David B Conley
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Kevin C Welch
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rakesh K Chandra
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
| | - Anju T Peters
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leslie C Grammer
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Li-Xing Man
- University of Rochester School of Medicine and DentistryUniversity of Rochester Medical Center, Rochester, NY.,Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, Rochester, NY
| | - Robert P Schleimer
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bruce K Tan
- University of Rochester School of Medicine and DentistryUniversity of Rochester Medical Center, Rochester, NY
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Steele TO, Mace JC, Dedhia R, Rudmik L, Smith TL, Alt JA. Health utility values for patients with recurrent acute rhinosinusitis undergoing endoscopic sinus surgery: a nested case control study. Int Forum Allergy Rhinol 2016; 6:1182-1187. [PMID: 27309906 PMCID: PMC5096975 DOI: 10.1002/alr.21809] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/12/2016] [Accepted: 05/18/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Health utility scores quantify an individual's valuation of particular health states and are vital components of health economic studies and cost-effectiveness research. We sought to characterize health utility values for patients with recurrent acute rhinosinusitis (RARS) both before and after endoscopic sinus surgery (ESS), as well as compare health utility to chronic rhinosinusitis without nasal polyposis (CRSsNP). METHODS Patients with RARS (n = 20) and CRSsNP (n = 20) undergoing ESS were enrolled as part of a longitudinal, observational, prospective cohort. Case patients diagnosed with RARS were age- and gender-matched to controls with CRSsNP using a nested case-control design at a 1:1 ratio. Health utility was measured using the Medical Outcomes Study Short Form-6D (SF-6D) survey. RESULTS Patients with RARS were followed for an average of 14.0 ± 6.1 (mean ± standard deviation) months compared to an average of 14.4 ± 5.3 months for CRSsNP controls (p = 0.779). Mean preoperative SF-6D health utility scores were statistically comparable between RARS (0.71 ± 0.14) and CRSsNP (0.66 ± 0.12; p = 0.341). Both patients with RARS and CRSsNP reported significant postoperative improvement in SF-6D scores from 0.71 ± 0.14 to 0.79 ± 0.13 (p = 0.031) and from 0.66 ± 0.12 to 0.77 ± 0.13 (p = 0.004), respectively. No difference in last postoperative SF-6D scores were found between RARS and CRSsNP (p = 0.583) or in the average magnitude of postoperative improvement (0.08 ± 0.16 vs 0.11 ± 0.13; p = 0.620). CONCLUSION Patients with RARS and CRSsNP report significant impairment in health utility as measured by the SF-6D. ESS significantly improves health utility in patients with RARS and CRSsNP to near normative values. These data will help inform future economic analysis and cost-effectiveness research.
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Affiliation(s)
- Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Jess C Mace
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Raj Dedhia
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Timothy L Smith
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR.
| | - Jeremiah A Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
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448
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Autio TJ, Koskenkorva T, Leino TK, Koivunen P, Alho OP. Longitudinal analysis of inflammatory biomarkers during acute rhinosinusitis. Laryngoscope 2016; 127:E55-E61. [PMID: 27753120 PMCID: PMC7165676 DOI: 10.1002/lary.26344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 08/15/2016] [Accepted: 09/01/2016] [Indexed: 11/16/2022]
Abstract
Objective To illuminate the pathophysiology of acute rhinosinusitis (ARS) with sequential monitoring of inflammatory biomarkers during an ARS episode and to clarify their diagnostic usability in bacterial ARS. Study Design Inception cohort study with 50 conscripts with ARS. Methods We collected peripheral blood high‐sensitive C‐reactive protein (hs‐CRP), white blood cell (WBC), procalcitonin, and nasal nitric oxide (nNO) counts at 2 to 3 and 9 to 10 days of symptoms during an ARS episode. We simultaneously gathered various clinical parameters and microbiological samples. Bacterial ARS was confirmed with a positive culture of sinus aspirate. Results Reciprocal correlations and a significant change in biomarker levels between the two visits suggest that ARS involves a local and systemic inflammatory response that was strongest at 2 to 3 days. High‐sensitive CRP and nNO reflected responses best (52% had increased CRP levels at 2–3 days; 66% had decreased nNO levels). White blood cell and procalcitonin counts rarely exceeded the reference range. Increased local and systemic inflammatory response were linked to multiple, adenoviral, or influenza A viral etiology or the detection of bacterial ARS. Local response correlated with imaging findings of wide paranasal sinus involvement and ostiomeatal complex occlusion. At 9 to 10 days, elevated (≥ 11 mg/L) and moderately elevated (≥ 49 mg/L) hs‐CRP predicted bacterial ARS well (likelihood ratio [LR]+ 3.3 and LR+ 15.8, respectively), but the sensitivity for both findings remained low. Conclusion Acute rhinosinusitis (particularly bacterial ARS) involves a local and systemic inflammatory response that is strongest at the beginning of symptoms. Elevated hs‐CRP supports the diagnosis of bacterial ARS. Level of Evidence 4. Laryngoscope, 2016 127:E55–E61, 2017
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Affiliation(s)
- Timo J Autio
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu
| | - Timo Koskenkorva
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu
| | - Tuomo K Leino
- Air Force Command Finland, Finnish Defense Forces, Tikkakoski, Finland
| | - Petri Koivunen
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu
| | - Olli-Pekka Alho
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu
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449
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Ong KY, Yap E, May Fen Chia Y, Tay HY, Ting P, Chan SY, Kwan YH. Impact of Community-Based Cardiac Rehabilitation on Clinical Parameters of Patients with Cardiovascular Diseases. ASEAN HEART JOURNAL : OFFICIAL JOURNAL OF THE ASEAN FEDERATION OF CARDIOLOGY 2016; 24:5. [PMID: 27795963 PMCID: PMC5061824 DOI: 10.7603/s40602-016-0005-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) programmes have been shown to improve patient outcomes, but vary widely in their components. The impact of Singapore's CR programme on clinical outcomes is currently not known. OBJECTIVE To evaluate the effects of a community-based CR programme on important clinical parameters in patients with cardiovascular disease in Singapore. METHOD A retrospective cohort study was conducted. Cardiovascular patients who had completed a hospital-based CR programme were included. Patients who continued with community-based CR (n = 94) during the period of 2009-2013 were compared with patients who received regular care (n = 157). Changes in clinical and physical examination parameters between baseline and one-year post follow-up were analyzed. Within-group differences were compared using the paired t-test, while multivariate linear regression was used to compare the changes in the various parameters between the intervention and control groups. The primary outcome measure was low density lipoprotein (LDL) levels. RESULTS Patients in the intervention group had significant lowering of LDL (2.5 to 2.2 mmol/L, p<0.01), while the control group's LDL increased (2.2 to 2.4 mmol/L, p<0.01). The intervention group had greater improvements in LDL (-0.3 vs. +0.2 mmol/L, p<0.01), triglycerides (-0.1 vs. +0.1 mmol/L, p=0.01), total cholesterol (-0.3 vs. +0.3 mmol/L, p<0.01), fasting blood glucose (-0.5 vs. +0.3 mmol/L, p<0.01), systolic blood pressure (-3.2 vs. +5 mmHg, p<0.01) and diastolic blood pressure (-2.6 vs. +2.8 mmHg, p<0.01). CONCLUSION The community-based CR programme in Singapore is associated with improvements in several cardiovascular clinical parameters and may be of benefit to cardiovascular patients.
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Affiliation(s)
- Kheng Yong Ong
- Department of Pharmacy, Singapore General Hospital, Republic of Singapore, Singapore
| | - Elise Yap
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore, Singapore
| | - Yvonne May Fen Chia
- Duke-NUS Medical School, 8 College Road, Republic of Singapore, 169857 Singapore
| | - Hung Yong Tay
- Heart Wellness Centre, Singapore Heart Foundation, Republic of Singapore, Singapore
| | - Peter Ting
- Department of Cardiology, National Heart Centre Singapore, Republic of Singapore, Singapore
| | - Sui Yung Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore, Singapore
| | - Yu Heng Kwan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Republic of Singapore, 169857 Singapore
- Heart Wellness Centre, Singapore Heart Foundation, Republic of Singapore, Singapore
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450
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Schlosser RJ, Hyer JM, Smith TL, Mace JC, Cortese BM, Uhde TW, Rudmik L, Soler ZM. Depression-Specific Outcomes After Treatment of Chronic Rhinosinusitis. JAMA Otolaryngol Head Neck Surg 2016; 142:370-6. [PMID: 26967171 DOI: 10.1001/jamaoto.2015.3810] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Depression is frequently undiagnosed in patients with chronic rhinosinusitis (CRS) and affects quality of life, productivity, and health care use. OBJECTIVE To examine depression-specific outcomes after medical or surgical treatment of CRS. DESIGN, SETTING, AND PARTICIPANTS A multi-institutional, prospective study of patients with refractory CRS treated at tertiary academic rhinology centers was performed from March 1, 2011, to November 1, 2015. Data analysis was performed from October 1, 2015, to November 1, 2015. INTERVENTIONS Patients self-selected to undergo continued medical management or endoscopic sinus surgery for refractory CRS. MAIN OUTCOMES AND MEASURES Patients completed the 22-item Sinonasal Outcome Test (SNOT22), Rhinosinusitis Disability Index (RSDI), Pittsburgh Sleep Quality Index (PSQI), and missed productivity and medication use questionnaires before and at least 6 months after treatment. Computed tomography and endoscopy scoring were performed with reviewers masked to patient-reported data. Depression-specific outcomes were recorded using the 2-item Patient Health Questionnaire (PHQ2). RESULTS Baseline data were available on 685 patients, with 167 (24.4%) having depression according to the PHQ2 scores. The mean (SD) age of the patients was 50.5 (15.0) years, and 332 (48.4%) were male. Revision surgery status was the only baseline factor associated with depression (53.9% vs 38.0%, P < .001). Patients with depression had worse baseline SNOT22 (mean, 64.5 vs 47.6), PSQI (mean, 12.8 vs 8.4), productivity (mean, 22.8 vs 5.2 days missed), and medication use scores for oral antibiotics (mean, 23.8 vs 14.8) and oral corticosteroids (mean, 17.8 vs 9.9) (P < .001 for all). Medical and surgical treatments had similar outcomes for patients with depression with mean improvement in the PHQ2 scores from 3.96 to 1.91 (P < .001), and 110 of 167 patients (65.9%) categorized as having depression at baseline were categorized as not having depression after treatment. Improvements in the PHQ2 scores were associated with improvements in the SNOT22, PSQI, oral antibiotic use, and productivity scores (P ≤ .001 for all). CONCLUSIONS AND RELEVANCE Depression is a common comorbidity in patients with CRS and affects numerous quality-of-life and health care outcomes. There are few objective baseline factors to aid physicians in identifying depression in patients with CRS. Medical and surgical treatments for CRS improve depression and related clinical outcomes.
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Affiliation(s)
- Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - J Madison Hyer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Bernadette M Cortese
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Thomas W Uhde
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
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