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Gelardi M, Iannuzzi L, De Giosa M, Taliente S, De Candia N, Quaranta N, De Corso E, Seccia V, Ciprandi G. Non-surgical management of chronic rhinosinusitis with nasal polyps based on clinical-cytological grading: a precision medicine-based approach. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:38-45. [PMID: 28374869 PMCID: PMC5384308 DOI: 10.14639/0392-100x-1417] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/16/2016] [Indexed: 01/04/2023]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder that strongly impacts patients' quality of life. CRSwNP is still a challenge for ENT specialists due to its unknown pathogenesis, difficult control and frequent relapse. We tested the hypothesis that a new standardised therapeutic approach based on individual clinical-cytological grading (CCG), may improve control of the disease and prevent the needing for surgery. We analysed 204 patients suffering from bilateral CRSwNP, 145 patients of whom regularly assumed therapy, respecting the planned check-up, and were considered cases; 59 patients were not assuming therapy as indicated and were considered as controls. After five years of standardised treatment, 15 of 145 (10.5%) improved endoscopic staging, 61 of 145 (42%) did not change their endoscopic staging, and 69 of 145 (47.5%) were worse. In the control group, 49 of 59 (83%) were worse by at least two stages (p < 0.05). Patients and controls were stratified basing on clinical and cytological grading as mild, moderate and severe. After patient stratification, in the mild group (n = 27) 92% patients had a constant trend, with no worsening and no need for surgery over a 5-year period, whereas in the mild CCG control group 1 of 59 (1.6%) required surgery (p < 0.05). In moderate GCC (n = 83), 44% of patients did not modify or improve endoscopic staging and 3.6% needed surgery, compared to 13.6% of controls with moderate GCC (p < 0.05). In severe CCG (n = 35), even though no patients achieved significant amelioration of endoscopic grading, 40% of patients were considered as "clinically controlled" and 5.7% of patients underwent surgery, but the percentage was significantly higher (49%) in the control group significant (p = 0.0000). Finally, statistical analyses revealed a clear trend that polyp size increased at a faster rate in the control group than in the treatment group and for each subgroup (low, moderate and severe). The present study suggests a new approach in the management of CRS according to clinical cytological grading that allows defining the grade of CRSwNP severity and to adapt the intensity of treatment. This approach limited the use of systemic corticosteroids to only moderate-severe CRSwNP with a low corticosteroid dosage in comparison with those previously suggested. Our protocol seems to improve the adherence by patients, control of disease and the need for surgery in the long-term.
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Affiliation(s)
- M Gelardi
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - L Iannuzzi
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - M De Giosa
- Department of Mathematics, University of Bari "Aldo Moro", Bari, Italy
| | - S Taliente
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - N De Candia
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - N Quaranta
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - E De Corso
- Otorhinolaryngology, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - V Seccia
- 1st Otorhinolaryngology Unit; Department of Neuroscience, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - G Ciprandi
- Department of Medicine, IRCCS-AOU San Martino-IST, Genoa, Italy
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Chaker AM. [Biologics in Rhinology - Forthcoming Personalized Concepts: the Future Starts Today]. Laryngorhinootologie 2018; 97:S142-S184. [PMID: 29905356 PMCID: PMC6541111 DOI: 10.1055/s-0043-123484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sinunasale Erkrankungen zählen mit zu den häufigsten chronischen Erkrankungen und führen zu einer erheblichen Störung der Lebensqualität, ein komorbides Asthma ist häufig. Trotz leitliniengerechter Therapie ist anzunehmen, dass mind. 20% der Patienten ihre Erkrankungssymptome nicht adäquat kontrollieren können. Neben den etablierten chirurgischen und konservativen Therapieoptionen finden sich nun vielversprechende Therapieansätze, die bspw. mittels therapeutischer Antikörper mechanistisch gezielt in die Pathophysiologie der Erkrankungen eingreifen können. Die Auswahl der geeigneten Patienten durch geeignete Biomarker und die richtige Therapie zum richtigen Stadium der Erkrankung anbieten zu können, ist das Ziel stratifizierter Medizin und eine wichtige Perspektive für die HNO.Chronic diseases of the nose and the paranasal sinuses are most common, frequently associated with bronchial asthma, and result in substantial reduction of quality of life. Despite optimal treatment according to guidelines, approx. 20 % of the patients will report inadequate control of symptoms. Apart from well established surgical and conservative approaches in therapy new therapeutic antibodies are available that aim specifically pathophysiological targets. The optimal allocation of effective therapy for patients using appropriate biomarkers at the most suitable timepoint is the hallmark of stratified medicine and an important perspective in ENT.
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Affiliation(s)
- Adam M. Chaker
- Klinik für Hals-Nasen-Ohrenheilkunde und Zentrum für Allergie und Umwelt, Klinikum rechts der Isar, Technische Universität München
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Gelardi M, De Candia N, Quaranta N, Russo C, Pecoraro P, Mancini M, Luperto P, Lombardo G, Macchi A, Bocciolini C, Ciofalo A, De Corso E, Ciprandi G. The relevance of counseling in patients with nasal polyps. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 36:326-327. [PMID: 27734987 PMCID: PMC5066470 DOI: 10.14639/0392-100x-1315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/23/2016] [Indexed: 11/23/2022]
Affiliation(s)
- M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy
| | - N De Candia
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy
| | - N Quaranta
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy
| | - C Russo
- U.O.C. of Otolaryngology, Ospedale Di Venere, Carbonara di Bari (BA), Italy
| | | | - M Mancini
- Section of Otolaryngology, Azienda Area Vasta Romagna-Riccione, Italy
| | - P Luperto
- Section of Otolaryngology, ASL BR1 Brindisi, Italy
| | - G Lombardo
- Section of Otolaryngology, ASP of Agrigento, Italy
| | - A Macchi
- ORL Clinic University of Insubriae, Varese, Italy
| | - C Bocciolini
- U.O.C. of Otolaryngology Hospital Maggiore of Bologna, Italy
| | - A Ciofalo
- Department of Sensory Organs, Sapienza University of Roma, Italy
| | - E De Corso
- Otorhinolaryngology, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Ciprandi
- Department of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
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