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Inoue N, Hirota T, Hatano A, Nakano M, Nakashima D, Nakayama T, Tamari M, Yoshikawa M. Clinical characteristics in Japanese patients with chronic rhinosinusitis who underwent endoscopic sinus surgery. Auris Nasus Larynx 2024; 51:286-294. [PMID: 37839999 DOI: 10.1016/j.anl.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/27/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE There is heterogeneity in the pathophysiology of chronic rhinosinusitis (CRS). Obtaining a detailed understanding of patient profiles in specific regions can provide valuable information not only for clinical practice but also future research plans. The aim of this study was to investigate the characteristics of patients who underwent endoscopic sinus surgery (ESS) for CRS. METHODS This retrospective, single-center study examined the features of 453 patients with CRS who underwent ESS in the Tokyo area of Japan. The study evaluated various factors in patients with CRS including sex and age, the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) score, the recurrence rate of CRS, comorbidities of asthma and/or allergic diseases, and IgE sensitization to 12 inhaled allergens. RESULTS Age-related declines in the sensitization rate to inhaled allergens were observed, and the most notable age-related decrease in specific IgE antibodies was observed for house dust mites (HDM) (p = 8.3 × 10-7). Sensitization to HDM, cat dander, and various types of fungi, including Aspergillus, was frequently observed in the CRS with asthma group, with rates of 54%, 17%, and 17%, respectively. We found that 23% of the patients had recurrence. In the recurrence group, the positive rates of specific IgE antibodies for birch and cat dander were significantly higher than in the no recurrence group. Bronchial asthma was identified as an important factor for recurrence. Among male patients, the recurrence group was younger than the no-recurrence group (p = 0.0032). Severe eosinophilic CRS (ECRS) showed early recurrence after surgery, with over the half of the patients experiencing at least one recurrence within 2 years post-surgery. Among patients with ECRS, the recurrence rate for females was 1.92 times higher than for males. CONCLUSION Our study revealed the influences of age and sex on various clinical phenotypes of CRS patients undergoing ESS. There was a high sensitization rate to cat dander in both the recurrence and asthma groups. Further research on diverse disease etiologies is necessary to improve therapeutic strategies for patients with CRS.
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Affiliation(s)
- Natsuki Inoue
- Department of Otorhinolaryngology, Toho University Graduate School of Medicine, Tokyo, Japan; Department of Otorhinolaryngology, Toho University Ohashi Medical Center, Tokyo, Japan; Division of Molecular Genetics, Research Center for Medical Science, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomomitsu Hirota
- Division of Molecular Genetics, Research Center for Medical Science, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiro Hatano
- Department of Otorhinolaryngology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Mika Nakano
- Department of Otorhinolaryngology, Toho University Graduate School of Medicine, Tokyo, Japan; Department of Otorhinolaryngology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Daiki Nakashima
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tsuguhisa Nakayama
- Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Mayumi Tamari
- Division of Molecular Genetics, Research Center for Medical Science, The Jikei University School of Medicine, Tokyo, Japan.
| | - Mamoru Yoshikawa
- Department of Otorhinolaryngology, Toho University Graduate School of Medicine, Tokyo, Japan; Department of Otorhinolaryngology, Toho University Ohashi Medical Center, Tokyo, Japan.
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Gupta R. Assessment of Correlation Between Disease Specific Quality of Life and Endoscopy Score After 1 Month and 6 Months of Endoscopic Sinus Surgery (ESS) in Patients with Chronic Rhinosinusitis: A Prospective Study. Indian J Otolaryngol Head Neck Surg 2024; 76:112-117. [PMID: 38440529 PMCID: PMC10909020 DOI: 10.1007/s12070-023-04095-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/17/2023] [Indexed: 03/06/2024] Open
Abstract
Rhinosinusitis is a prevalent condition worldwide affecting the developed and the third world countries alike. SNOT-22 is a validated disease-specific questionnaire designed to use in Chronic Rhino Sinusitis (CRS), which means to quantify patients perception of their disease burden. SNOT 22 questionnaire can chart patients nasal as well as psychological symptoms arising due to CRS and very well become marker of individual symptomatic improvement. To study the correlation between disease specific quality of life and endoscopy score after 1 month and 6 months of Endoscopic Sinus Surgery in patients with Chronic Rhinosinusitis. In the present study, ESS surgery showed improvement in Endoscopy score and all the symptoms assessed by SNOT-22. The total percentage of improvement in the SNOT-22 score was 70% after 1 month and 89% at the end of 6 months. We conclude that after the procedure of ESS not only endoscopic evaluation is necessary but also psychological and symptomatic assessment by SNOT 22 is very necessary as nasal and psychological factors were equally decisive for the seeking of the treatment (pharmacological/surgical) by the patient.
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陈 靖, 陈 雯, 罗 新, 黄 雪, 张 雅, 杨 钦. [Artificial intelligence-assisted prediction of olfactory disorders in patients with chronic rhinosinusitis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:871-877;885. [PMID: 38114440 PMCID: PMC10985657 DOI: 10.13201/j.issn.2096-7993.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Indexed: 12/21/2023]
Abstract
Objective:To analyze the influencing factors and perform the prediction of olfactory disorders in patients with chronic rhinosinusitis(CRS) based on artificial intelligence. Methods:The data of 75 patients with CRS who underwent nasal endoscopic surgery from October 2021 to February 2023 in the Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. There were 53 males and 22 females enrolled in the study, with a median age of 42.0 years old. The CRS intelligent microscope interpretation system was used to calculate the proportion of area glands and blood vessels occupy in the pathological sections of each patient, and the absolute value and proportion of eosinophils, lymphocytes, plasma cells and neutrophils. The patients were grouped according to the results of the Sniffin' Sticks smell test, and the clinical baseline data, differences in nasal mucosal histopathological characteristics, laboratory test indicators and sinus CT were compared between the groups. Determine the independent influencing factors of olfactory disorders and receiver operating characteristic curves(ROC) were used to evaluate the performance of the prediction model. Statistical analysis was performed using SPSS 25.0 software. Results:Among the 75 CRS patients, 25 cases(33.3%) had normal olfaction and 50 cases(66.7%) had olfactory disorders. Multivariate Logistic regression analysis showed that tissue eosinophils percentage(OR=1.032, 95%CI 1.002-1.064, P=0.036), Questionnaire of olfactory disorders-Negative statement(QOD-NS)(OR=1.079, 95%CI 1.004-1.160, P=0.040) and Anterior olfactory cleft score(AOCS)(OR=2.672, 95%CI 1.480-4.827, P=0.001) were independent risk factors for olfactory disorders in CRS patients. Further research found that the area under the ROC curve(AUC) of the combined prediction model established by the tissue eosinophil percentage, QOD-NS and AOCS was 0.836(95%CI 0.748-0.924, P<0.001), which is better than the above single factor prediction model in predicting olfactory disorders in CRS. Conclusion:Based on pathological artificial intelligence, tissue eosinophil percentage, QOD-NS and AOCS are independent risk factors for olfactory disorders in CRS patients, and the combination of the three factors has a good predictive effect on CRS olfactory disorders.
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Affiliation(s)
- 靖媛 陈
- 中山大学附属第三医院耳鼻咽喉头颈外科(广州,510630)Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- 中山大学附属第三医院变态反应科Department of Allergy, the Third Affiliated Hospital of Sun Yat-sen University
| | - 雯仪 陈
- 中山大学附属第三医院耳鼻咽喉头颈外科(广州,510630)Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- 中山大学附属第三医院变态反应科Department of Allergy, the Third Affiliated Hospital of Sun Yat-sen University
| | - 新 罗
- 中山大学附属第三医院耳鼻咽喉头颈外科(广州,510630)Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- 中山大学附属第三医院变态反应科Department of Allergy, the Third Affiliated Hospital of Sun Yat-sen University
| | - 雪琨 黄
- 中山大学附属第三医院耳鼻咽喉头颈外科(广州,510630)Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- 中山大学附属第三医院变态反应科Department of Allergy, the Third Affiliated Hospital of Sun Yat-sen University
| | - 雅娜 张
- 中山大学附属第三医院耳鼻咽喉头颈外科(广州,510630)Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- 中山大学附属第三医院变态反应科Department of Allergy, the Third Affiliated Hospital of Sun Yat-sen University
| | - 钦泰 杨
- 中山大学附属第三医院耳鼻咽喉头颈外科(广州,510630)Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- 中山大学附属第三医院变态反应科Department of Allergy, the Third Affiliated Hospital of Sun Yat-sen University
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Yang HH, Paul KC, Cockburn MG, Thompson LK, Cheng MY, Suh JD, Wang MB, Lee JT. Residential Proximity to a Commercial Pesticide Application Site and Risk of Chronic Rhinosinusitis. JAMA Otolaryngol Head Neck Surg 2023; 149:773-780. [PMID: 37440215 PMCID: PMC10346512 DOI: 10.1001/jamaoto.2023.1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/12/2023] [Indexed: 07/14/2023]
Abstract
Importance Environmental and occupational toxicants have been shown to be associated with an increased prevalence of chronic rhinosinusitis (CRS). However, few to no studies have evaluated patients for CRS using objective testing and workup protocols that fulfill guidelines for CRS diagnostic criteria. Furthermore, no study, to our knowledge, has investigated the risks of CRS in the context of residential exposure through proximity to a commercial pesticide application site. Objectives To evaluate associations of residential proximity to a commercial pesticide application site and the prevalence of CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSwoNP). Design, Setting, and Participants This was a retrospective cohort study of patients who presented to a tertiary care institution for rhinology evaluation between March 1, 2018, and December 31, 2022. Main Outcomes and Measures The outcome variable was the clinical diagnosis of CRS (CRSwNP, CRSwoNP, or non-CRS control). Patients' residential addresses were utilized to determine pesticide exposure status based on a validated computational geographic information algorithm based on data from the California Pesticide Use Report System. The dichotomous independent variable of exposure status (exposed or non-exposed) was determined by assessing reports of any pesticide applications within 2000 m of each participant's residence in 2017. Multivariable logistic regressions assessing CRS status and CRS subtypes were conducted with pesticide exposure as the primary covariate of interest. The primary study outcome and measurements as well as study hypothesis were all formulated before data collection. Results Among a total of 310 patients (90 CRSwNP, 90 CRSwoNP, and 130 control), the mean (SD) age was 50 (17) years; 164 (53%) were female. Race and ethnicity information was not considered. Controlling for patient demographic information, smoking history, county of residence, and medical comorbidities, pesticide exposure was associated with an approximately 2.5-fold increase in odds of CRS (adjusted odds ratio, 2.41; 95% CI, 1.49-3.90). Pesticide exposure was associated with similar risks for CRSwNP (adjusted relative risk ratio [aRRR], 2.34; 95% CI, 1.31-4.18) and CRSwoNP (aRRR, 2.42; 95% CI, 1.37-4.30). Conclusions and Relevance The findings of this retrospective cohort study and analysis revealed that residential exposure to commercial pesticide application within a 2000-m buffer was independently associated with an approximately 2.5-fold increase in odds of being diagnosed with CRS. If validated by additional research, this association would have substantial implications for public health.
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Affiliation(s)
- Hong-Ho Yang
- David Geffen School of Medicine, University of California, Los Angeles
| | - Kimberly C. Paul
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles
| | - Myles G. Cockburn
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles
| | - Laura K. Thompson
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles
| | | | - Jeffrey D. Suh
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Marilene B. Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Jivianne T. Lee
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles
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Al-Ahmad M, Ali A, Khalaf M, Alterki A, Rodriguez-Bouza T. Comorbid asthma in patients with chronic rhinosinusitis with nasal polyps: did dupilumab make a difference? BMC Pulm Med 2023; 23:266. [PMID: 37464395 DOI: 10.1186/s12890-023-02556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/08/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The clinical heterogeneity of chronic rhinosinusitis (CRS) and bronchial asthma is attributable to different underlying inflammatory profiles. However, the similarity between CRS with nasal polyps (CRSwNP) and type-2 asthma pathophysiology speculates that one biological therapy could affect both comorbidities. Despite dupilumab, a monoclonal antibody that targets IL-4α and IL-13 receptors, being used in patients with nasal polyps and severe asthma, real-life data about its efficacy in improving the quality of life and patient symptoms is still lacking. This study's primary objective was to evaluate dupilumab treatment's effect on the frequency of olfactory symptoms and health-related quality of life tests as measured by the Sino-nasal outcome test (SNOT-22) in patients with NP. The secondary objective was the effect of dupilumab on asthma symptom control as measured by the asthma control test (ACT). METHODS A prospective study was conducted of 166 patients with CRSwNP, with or without asthma. The following variables were collected at baseline and after at least six months of continuous dupilumab therapy; SNOT-22, olfactory symptoms frequency, and ACT score. RESULTS Asthma prevalence in patients with CRSwNP was high (59.63%), and being female with a history of frequent use of oral corticosteroid (OCS) courses and repeated unsuccessful nasal and para-nasal surgeries for polyposis increased the likelihood of having underlying asthma by 2, 1 and 4 times more, respectively. Additionally, being asthmatic required a longer duration of dupilumab treatment. However, both the health-related quality of life and olfactory symptoms improved equally in both groups. CONCLUSION Even with associated comorbid asthma in patients with CRSwNP, treatment with dupilumab could improve the quality of life, olfactory symptoms, and asthma symptom control.
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Affiliation(s)
- Mona Al-Ahmad
- Department of Microbiology, College of Medicine, Kuwait University, Kuwait City, Kuwait.
- Department of Allergy, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait.
| | - Asmaa Ali
- Department of Allergy, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
- Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, China
- Department of Pulmonary Medicine, Abbassia Chest Hospital, Ministry of Health, Cairo, Egypt
| | - Mustafa Khalaf
- Department of Allergy, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Abdulmohsen Alterki
- Department of Otolaryngology, Head and Neck Surgery, Zain and Al Sabah Hospital, Ministry of Health, Kuwait City, Kuwait
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Ghatee MA, Kanannejad Z, Nikaein K, Fallah N, Sabz G. Geo-climatic risk factors for chronic rhinosinusitis in southwest Iran. PLoS One 2023; 18:e0288101. [PMID: 37406025 DOI: 10.1371/journal.pone.0288101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a prevalent and disabling paranasal sinus disease associated with some environmental factors. In this study, we evaluated the effect of geo-climatic factors on CRS in a region of southwest Iran. The study mapped the residency addresses of 232 patients with CRS who lived in Kohgiluyeh and Boyer-Ahmad province and had undergone sinus surgery from 2014 to 2019. The effects of Mean Annual Humidity (MAH), Mean Annual Rainfall (MAR), Mean Annual Temperature (MAT), maximum MAT (maxMAT), minimum MAT (minMAT), Mean Annual Evaporation (MAE), wind, elevation, slope, and land cover were assessed on the occurrence of CRS using Geographical Information System (GIS). Statistical analysis was performed using univariate and multivariate binary logistic regression. Patients came from 55 points including villages, towns, and cities. In univariate analysis, climatic factors including MAT (OR = 0.537), minMAT (OR = 0.764), maxMAT (OR = 0.63), MAR (OR = 0.994), and MAH (OR = 0.626) were significantly related to CRS occurrence. Elevation (OR = 0.999), slope (OR = 0.9), and urban setting (OR = 24.667) were the significant determinants among geographical factors when analyzed independently. The multivariate analysis found maxMAT (OR = 0.5), MAR (OR = 0.994), elevation (OR = 0.998), and urban (OR = 16.8) as significant factors affecting CRS occurrence. The urban setting is the most critical factor affecting CRS disease. Cold and dry areas and low attitude are the other risk factors for CRS in Kohgiluyeh and Boyer-Ahmad province, southwest Iran.
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Affiliation(s)
- Mohammad Amin Ghatee
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
- Department of Parasitology, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zahra Kanannejad
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Koorosh Nikaein
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Niloufar Fallah
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Gholamabbas Sabz
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Wang J, Shen S, Yan B, He Y, Zhang G, Shan C, Yang Q, Qin L, Duan Z, Jiang L, Wang X, Wei X, Wang C, Chen R, Zhang L. Individual exposure of ambient particulate matters and eosinophilic chronic rhinosinusitis with nasal Polyps: Dose-Response, mediation effects and recurrence prediction. ENVIRONMENT INTERNATIONAL 2023; 177:108031. [PMID: 37327504 DOI: 10.1016/j.envint.2023.108031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE We evaluated the association between ambient particulate matter (PM) exposure and eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP), and predicted the CRSwNP recurrence risk using machine learning algorithms. METHODS In total, 1,086 patients with CRSwNP were recruited from nine hospitals in China during 2014-2019. The average annual concentrations of ambient PMs before surgery were assessed using satellite-based daily concentrations of PM2.5 and PM10 for a 1 × 1-km2 area. Linear regression and logistic regression models were used to evaluate the associations of PM exposure with eosinophilia and risks of eosinophilic CRSwNPs. In addition, mediation effect analysis was used to validate the interrelationships of the aforementioned factors. Finally, machine learning algorithms were used to predict the recurrence risks of CRSwNPs. RESULTS There was a significantly increased risk of eosinophilic CRSwNPs with each 10 μg/m3 increase in PMs, with odds ratios (ORs) of 1.039 (95% confidence interval [CI] = 1.007-1.073) for PM10 and 1.058 (95% CI = 1.007- 1.112) for PM2.5. Eosinophils had a significant mediation effect, which accounted for 52% and 35% of the relationships of CRSwNP recurrence with PM10 and PM2.5, respectively. Finally, we developed a naïve Bayesian model to predict the risk of CRSwNP recurrence based on PM exposure, inflammatory data, and patients' demographic factors. CONCLUSIONS Increased PM exposure is associated with an increased risk of eosinophilic CRSwNP in China. Therefore, patients with eosinophilic CRSwNP should reduce PM exposure to mitigate its harmful impacts.
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Affiliation(s)
- Jiajia Wang
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, PR China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, PR China
| | - Shen Shen
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, PR China
| | - Bing Yan
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, PR China
| | - Yunsheng He
- Department of Otolaryngology, Huzhou Central Hospital, Huzhou, PR China
| | - Guoji Zhang
- Department of Otolaryngology, Baoding No.1 Central Hospital, Baoding, PR China
| | - Chunguang Shan
- Department of Otolaryngology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Qintai Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Department of Allergy, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Long Qin
- Department of Otolaryngology, The Second Affiliated Hospital of Baotou Medical College, Baotou, PR China
| | - Zhijian Duan
- Department of Otolaryngology, Hohhot First Hospital, Hohhot, PR China
| | - Luyun Jiang
- Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Xin Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, The People's Hospital of Suzhou New District, Suzhou, PR China
| | - Xin Wei
- Department of Otolaryngology, Hainan General Hospital, Beijing, PR China
| | - Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, PR China; Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Rui Chen
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, PR China; School of Public Health, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, PR China; Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing 100069, PR China.
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, PR China; Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, PR China.
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Nandy D, Goswami S. A Clinical Study of Nasal Polyposis and Comparison of the Different Methods of its Management. Indian J Otolaryngol Head Neck Surg 2023; 75:1116-1121. [PMID: 37206819 PMCID: PMC10188810 DOI: 10.1007/s12070-023-03583-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/16/2023] [Indexed: 03/29/2023] Open
Abstract
This study was done to study incidence, age and sex distribution of chronic rhinosinusitis with nasal polyposis and to study number of patients who required medical management only and how many required both medical and surgical management. Complications of medical and surgical management was also studied. A prospective study was carried out for 18 months. Clinically and radiologically diagnosed cases of chronic rhinosinusitis with nasal polyposis were chosen for the study. Cases of chronic rhinosinusitis without nasal polyposis, with complication and revision cases were excluded. We used SNOTT-22 as a subjective tool and Lund-Mackay score as an objective tool to compare role of medical and surgical management in our study. Total of 45 patients were included in the study in age group 11-45 years, with 26 males and 19 females (male: female = 1.4:1).16 patients (35.6%) improved with medical management only but 29 patients (64.4%) needed surgical management after medical treatment for 6 weeks.6 patients had complication,1 after medical management and 5 in medical plus surgical management group. In our study both medical and surgical management was found equally effective in management of nasal polyposis, in terms of patient satisfaction. In CT scan lower scores were found in patients with surgical management but it did not reflect much on overall SNOTT-22 score. Thus, we should do proper clinical evaluation followed by appropriate medical therapy for patients of chronic rhinosinusitis with nasal polyposis. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03583-x.
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Affiliation(s)
- Deepshikha Nandy
- Department of ENT, Calcutta National Medical College and Hospital, Kolkata, West Bengal India
| | - Saileshwar Goswami
- Department of ENT, Calcutta National Medical College and Hospital, Kolkata, West Bengal India
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Peterson R, Keswani A. The Impact of Social Determinants and Air Pollution on Healthcare Disparities in Chronic Rhinosinusitis With Nasal Polyps. Am J Rhinol Allergy 2023; 37:147-152. [PMID: 36848276 DOI: 10.1177/19458924231153483] [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: 03/01/2023]
Abstract
BACKGROUND/OBJECTIVE Multiple factors affect healthcare disparities in chronic rhinosinusitis (CRS) with and without nasal polyps. These factors include access to care, economic burdens to treatment, and differences in air pollution and air quality. In this paper, we will discuss how socioeconomic status, race, and air pollution burden influence healthcare disparities in the diagnosis and treatment outcomes of chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS A literature search was performed via PubMed for articles related to CRSwNP, healthcare disparities, race, socioeconomic status, and air pollution in September 2022. Original studies from 2016 to 2022, landmark articles, and systematic reviews were included. We summarized these articles to cohesively discuss factors contributing to healthcare disparities in CRSwNP. RESULTS Literary search produced 35 articles. Individual factors such as socioeconomic status, race, and air pollution influence CRSwNP severity and treatment outcomes. Correlations were noted with socioeconomic status, race, and air pollution exposure and CRS severity and post-surgical outcomes. Air pollution exposure was also associated with histopathologic changes in CRSwNP. Lack of access to care was a notable contributor to healthcare disparities in CRS. CONCLUSION Healthcare disparities in the diagnosis and treatment of CRSwNP differentially affect racial minorities and individuals of lower socioeconomic status. Increased air pollution exposure in areas of lower socioeconomic status is a compounding factor. Clinician advocacy for greater healthcare access and reductions in environmental exposures for patients, among other societal changes, may help improve disparities.
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Affiliation(s)
- Rachel Peterson
- Department of Medicine, 12230Georgetown University School of Medicine, Washington, District of Columbia
| | - Anjeni Keswani
- Division of Allergy/Immunology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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de la Hoz RE, Shohet MR. World Trade Center Health Program best practices for diagnosing and treating chronic rhinosinusitis. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2023; 78:212-215. [PMID: 36660944 PMCID: PMC10353885 DOI: 10.1080/19338244.2023.2169655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
The most frequent adverse physical health effect among World Trade Center Health Program (WTCHP) members is chronic rhinosinusitis (CRS), with some evidence supporting its association with the exposures to dust, gases, and toxicants. We selected the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICARS-RS-2021) as a comprehensive evidence-based guide on best practices for CRS diagnosis and treatment for the WTCHP.
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Affiliation(s)
- Rafael E. de la Hoz
- Division of Occupational and Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael R. Shohet
- Department of Otolaryngology and Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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11
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Thakur P, Gupta V, Nanda MS, Bhatia S. Psychometric Validation of Hindi Version of Sino-Nasal Outcome Test-22. Indian J Otolaryngol Head Neck Surg 2022; 74:1651-1660. [PMID: 36452813 PMCID: PMC9702029 DOI: 10.1007/s12070-021-02808-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022] Open
Abstract
The purpose of this study was assessment of reliability, validity & responsiveness of Hindi version of SNOT 22. 110 cases and controls were recruited in this prospective study. The internal consistency, test-retest reproducibility, construct & criterion validity, and responsiveness of Hindi version of SNOT 22 were assessed. Hindi SNOT 22 showed a good internal consistency (Cronbach's alpha (α) in cases = 0.823 and in controls = 0.868). Physical and Quality of life subscales also showed good internal consistency (α of 0.711 and 0.87 respectively). Test-retest reproducibility using Spearman's rank correlation coefficient (rs) showed very high correlation (rs = 0.939). There was significant difference in scores (p < 0.00001) between cases and controls (46.99 ± 13.97 and 07.58 ± 6.772 respectively). The mean pre and post-operative scores were 53.43 ± 12.241 and 20.50 ± 06.679 respectively with a significant difference (p = 0.000002) and a large effect size (Hedge's g = 2.34). Hindi SNOT 22 showed a moderate correlation with visual analogue scale (rs = 0.663) and a low correlation with Lund Mackay staging (rs = 0.388). The Hindi version of SNOT 22 is a valid, reliable and a responsive patient reported outcome measure instrument for assessment of chronic rhinosinusitis in adults. It retains most of the important characteristics of the source version (SNOT 22). This can be used as a clinical as well as research tool to aid in diagnosis, to assess quality of life as well as monitoring treatment strategies in the field of CRS in Hindi speaking patients. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02808-1.
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Affiliation(s)
- Pooja Thakur
- Department of Otorhinolaryngology and Head & Neck Surgery, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh 173229 India
| | - Vipan Gupta
- Department of Otorhinolaryngology and Head & Neck Surgery, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh 173229 India
| | - Manpreet Singh Nanda
- Department of Otorhinolaryngology and Head & Neck Surgery, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh 173229 India
| | - Shenny Bhatia
- Department of Otorhinolaryngology and Head & Neck Surgery, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh 173229 India
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12
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Sedaghat AR, Kuan EC, Scadding GK. Epidemiology of Chronic Rhinosinusitis: Prevalence and Risk Factors. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1395-1403. [PMID: 35092822 DOI: 10.1016/j.jaip.2022.01.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/30/2021] [Accepted: 01/16/2022] [Indexed: 12/16/2022]
Abstract
Knowledge of chronic rhinosinusitis (CRS) epidemiology may directly impact patient care: aiding patient identification and establishing accurate diagnosis as well as informing treatment decisions. The objective of this review is to summarize the current evidence on the epidemiology of CRS, with a focus on prevalence and risk factors. Although the presence of either symptoms or objective findings alone have yielded CRS prevalence estimates of over 10%, the presence of both-consistent with guideline-based diagnostic criteria for CRS-has suggested that the true prevalence of CRS is consistently less than 5%, with approximately one-third of patients with CRS having nasal polyps, in epidemiologic studies from around the world. In comparison, the prevalence of CRS endotypes-pathophysiologic subclassification of CRS most commonly as related to type 2 or non-type 2 inflammation-has been found to vary significantly by region. The epidemiology of CRS is modified and ultimately determined by risk factors: genetic/hereditary, demographic, environmental, and imparted by predictive pre-/comorbid disease. The understanding of these epidemiologic relationships may help the provider to optimally identify and understand each individual's CRS disease process, thereby improving both diagnosis and treatment.
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Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Edward C Kuan
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine, Orange, Calif
| | - Glenis K Scadding
- Royal National ENT Hospital, University College Hospitals London, London, United Kingdom; Division of Infection and Immunity, University College London, London, United Kingdom
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13
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Jeong SS, Chen T, Nguyen SA, Edwards TS, Schlosser RJ. Correlation of polyp grading scales with patient symptom scores and olfaction in chronic rhinosinusitis: a systematic review and meta-analysis. Rhinology 2022; 0:2995. [PMID: 35438689 DOI: 10.4193/rhin22.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Various nasal polyp (NP) scoring systems have been proposed and used in the literature. However, no single system has been identified as superior. Correlations between NP scoring systems and patient symptoms, quality of life (QOL) or olfaction vary widely. METHODS A systematic search of PubMed, CINAHL, Scopus, and Cochrane Library was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Any study examining endoscopy scores and symptom, QOL or olfaction measures in cross sectional manner or after therapeutic intervention were included. RESULTS This review identified 55 studies for a pooled meta-analysis of Lund-Kennedy (LK-NP) polyp scores (N = 6), Meltzer scores (N = 6), Nasal polyp scores (NPS; N = 19), Total polyp score (TPS; N=8) Lilholdt scores (N = 8), Olfactory cleft endoscopy score (OCES; N =4), Discharge, inflammation, polyp/edema score (DIP; N = 2), and Perioperative sinus endoscopy score (POSE; N = 2). Meta-regression assessed correlations between NP grading systems and SNOT-22, nasal congestion scores, total nasal symptom scores (TNSS), and Smell Identification Test-40 (SIT40). None of the NP grading systems correlated significantly with any symptom, QOL or olfactory metric. In intervention studies of surgery or monoclonal antibody treatment, changes in NPS scores did not correlate with any patient reported outcome measure (PROM) or olfactory outcomes. CONCLUSION Current NP endoscopic scoring systems are not associated with PROMs such as SNOT-22, nasal congestion scores, and TNSS as well as objective measures of olfaction. NP grading systems with improved clinical utility are needed.
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Affiliation(s)
- S S Jeong
- 1 Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA and 2 Albert Einstein College of Medicine, Bronx, NY, USA
| | - T Chen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - S A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - T S Edwards
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - R J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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14
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Leland EM, Vohra V, Seal SM, Zhang Z, Ramanathan M. Environmental air pollution and chronic rhinosinusitis: A systematic review. Laryngoscope Investig Otolaryngol 2022; 7:349-360. [PMID: 35434330 PMCID: PMC9008184 DOI: 10.1002/lio2.774] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/07/2022] Open
Abstract
Objective Chronic rhinosinusitis (CRS) is a highly prevalent and burdensome disease. The pathophysiology is not fully elucidated, but environmental pollutants have been suggested to impact the inflammatory component of the disease process. This review aims to summarize the role of environmental pollution in CRS onset and disease severity. Methods A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were queried in August 2021. Original articles reporting on air pollution exposure in CRS were included. Other forms of sinonasal disease were excluded. Results Literature search produced 11,983 articles, of which 10 met inclusion criteria. Outcomes evaluated included incidence/prevalence, disease severity, quality of life, and histopathologic/microbial changes. Air pollutant exposure was associated with higher odds of CRS, particularly with particulate matter (PM) exposure. Increasing air pollution exposure was also associated with worsened disease severity and detectable histopathologic changes. Impact on quality of life was less clear. Conclusion Air pollution (particularly PM) is correlated with CRS incidence/prevalence and disease severity, with evidence of histopathologic changes in CRS tissue samples. Further research is warranted to better understand the mechanisms by which air pollution components may cause CRS and type 2 inflammation. Level of Evidence 3a Recent evidence suggests a role for air pollution in the onset and severity of CRS, most notably with relation to PM2.5 exposure. This systematic review supports previous in vitro and in vivo models of pollution in CRS. This study further adds to the existing body of literature demonstrating the many negative health impacts of exposure to air pollution, including impacts on upper airway disease, lower airway disease, cardiac disease, and overall morbidity and mortality.
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Affiliation(s)
- Evelyn M. Leland
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA
| | - Varun Vohra
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA
| | - Stella M. Seal
- Welch Medical Library Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Zhenyu Zhang
- Department of Global Health School of Public Health, Peking University Beijing China
- Institute for Global Health and Development Peking University Beijing China
| | - Murugappan Ramanathan
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA
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15
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Yang X, Shen S, Deng Y, Wang C, Zhang L. Air Pollution Exposure Affects Severity and Cellular Endotype of Chronic Rhinosinusitis With Nasal Polyps. Laryngoscope 2021; 132:2103-2110. [PMID: 34870326 DOI: 10.1002/lary.29974] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Air pollution has emerged as an important environmental risk factor for chronic rhinosinusitis (CRS) progression. This study assessed exposure to five types of air pollution (PM2.5/10 , SO2 , NO2 , CO, O3 ) and explored their effects on CRS with nasal polyps (CRSwNP) severity and endotype. STUDY DESIGN Retrospective cohort study. METHODS Air pollution data from monitoring sites in Beijing were obtained to assess individual air pollution exposure. Outcomes of CRSwNP (n = 282) including Lund-Mackay (L-M) score, Lund-Kennedy (L-K) score, visual analogue scale (VAS) score and nasal patency/airflow resistance and so on were measured to analyze correlations with air pollution and compare groups with different exposure types. Multivariable-adjusted binary logistic regression was used to determine potential air pollution risk factors of the endotype of eosinophilic CRSwNP (ECRSwNP). RESULTS Short-term exposures to PM2.5/10 , SO2 , CO, NO2 , and O3 were weak but significantly associated with increased L-M scores. Short-term exposures to PM10 , CO, and NO2 were correlated with increased VAS headache/facial pain scores. The L-M scores of the group of the highest PM2.5 (≥150 μg/m3 ) exposure were significantly higher than those of control group. For each increased unit of the average concentration of PM2.5 , there was a 1.047-fold (95% confidence interval, 1.005-1.091) increased risk of the endotype of ECRSwNP. CONCLUSIONS Air pollution exposure exacerbated CRSwNP severity and PM2.5 could be a risk factor for endotype of ECRSwNP, suggesting the role of air pollution in CRSwNP pathogenesis. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Xiaozhe Yang
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shen Shen
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuzhoujia Deng
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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16
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Velasquez N, Gardiner L, Cheng TZ, Moore JA, Boudreau RM, Presto AA, Lee SE. Relationship between socioeconomic status, exposure to airborne pollutants, and chronic rhinosinusitis disease severity. Int Forum Allergy Rhinol 2021; 12:172-180. [PMID: 34510788 DOI: 10.1002/alr.22884] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/01/2021] [Accepted: 07/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Air pollution directly interacts with airway mucosa, yet little is known about how pollutants affect upper airway inflammation. Studies have shown increased incidence of chronic rhinosinusitis (CRS), rhinitis, and asthma in areas with higher traffic pollution, and these neighborhoods are often associated with lower socioeconomic status (SES). The Area Deprivation Index (ADI) assesses neighborhood-level SES by zip code. The purpose of this study was to assess the relationship between SES and exposure to inhaled pollutants and CRS disease severity. METHODS CRS patients with and without nasal polyps (CRSwNP and CRSsNP, respectively) were identified (total patients = 234; CRSwNP patients = 138; CRSsNP patients = 96). Pollutant concentrations, including particulate matter 2.5 (PM2.5 ), black carbon (BC), and nitrogen dioxide (NO2 ), were measured at 70 sites within the defined countywide sites and used to estimate patient exposures. SES was measured by ADI state deciles. Disease severity metrics included the modified Lund-Mackay score (LMS), the need for systemic steroids, and functional endoscopic sinus surgery (FESS). Associations were analyzed and identified using linear, logistic, and Poisson multivariable regression. RESULTS The distribution of CRSsNP and CRSwNP patients across ADI state deciles was similar. ADI, however, was a predictor of exposure to airborne pollutants (PM2.5 , BC, and NO2 ) with a 1.39%, 2.39%, and 2.49% increase in PM2.5 , BC, and NO2 per increasing decile increment (p < 0.0001), respectively, which demonstrated a direct correlation between deprived neighborhoods and higher levels of exposure to PM2.5 , BC, and NO2 with an increase in pollutant levels per increase in ADI decile. Furthermore, ADI was a predictor for increased steroid treatment. CONCLUSION Lower SES predicted higher exposure to air pollution and increased disease severity in patients with CRS as demonstrated by the increased need for steroid treatment.
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Affiliation(s)
| | - Lauren Gardiner
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Tracy Z Cheng
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - John A Moore
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Albert A Presto
- Center for Atmospheric Particle Studies and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Stella E Lee
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
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17
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Leland EM, Zhang Z, Kelly KM, Ramanathan M. Role of Environmental Air Pollution in Chronic Rhinosinusitis. Curr Allergy Asthma Rep 2021; 21:42. [PMID: 34499234 DOI: 10.1007/s11882-021-01019-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis (CRS) is a highly prevalent disease with large social and financial burdens. The pathophysiology is multifactorial. Environmental pollutants have been suggested to play a role in the inflammatory component of the disease process. RECENT FINDINGS Recent work has focused on exposure to various pollutants, primarily particulate matter (PM). Exposure to environmental pollutants leads to upregulation of inflammatory markers and ciliary dysfunction at the cellular level. Mouse models suggest a role for epithelial barrier dysfunction contributing to inflammatory changes after pollutant exposure. Clinical studies support the role of pollutants contributing to disease severity in certain populations, but the role in CRS incidence or prevalence is less clear. Research is limited by the retrospective nature of most studies. This review focuses on recent advancements in our understanding of the impact of environmental pollutants in CRS, limitations of the available data, and potential opportunities for future studies.
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Affiliation(s)
- Evelyn M Leland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N. Caroline St. JHOC 6263, Baltimore, MD, USA
| | - Zhenyu Zhang
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N. Caroline St. JHOC 6263, Baltimore, MD, USA
| | - Kathleen M Kelly
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N. Caroline St. JHOC 6263, Baltimore, MD, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N. Caroline St. JHOC 6263, Baltimore, MD, USA.
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18
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Increased Prevalence of Upper and Lower Respiratory Disease in Operation Enduring Freedom and Operation Iraqi Freedom US Veterans. J Occup Environ Med 2021; 63:262-264. [PMID: 33350661 DOI: 10.1097/jom.0000000000002114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Veterans of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) were exposed to high levels of pollutants resulting in increased upper and lower respiratory symptoms and morbidity. The purpose of this study is to determine the physician diagnosed prevalence of upper and lower respiratory disease in OEF/OIF veterans. METHODS We queried the Veterans Health Administration Support Service Center database to identify veterans in the Desert Pacific Healthcare Network with International Classification of Diseases 10th Revision diagnoses related to upper respiratory and lower respiratory tract (URT and LRT) diseases and symptoms. Over 100,000 unique veterans were identified. RESULTS OEF/OIF veterans had increased prevalence of both sinonasal disease and LRT pathology compared with non-OEF/OIF veterans. In 2016, 8.79% of OEF/OIF veterans demonstrated lower respiratory disease, which was 3.4 times greater than non-OEF/OIF veterans (P < 0.0001). Similarly, upper respiratory disease was 4.8 times more prevalent in OEF/OIF veterans, with 19.28% diagnosed compared with 3.95% of non-OEF/OIF veterans (P < 0.0001). CONCLUSION This is the first database study that investigates the prevalence of upper airway disease in OEF/OIF veterans. Veterans serving in the post-9/11 era in Afghanistan and Iraq have a significantly increased prevalence of both lower and upper respiratory disease.
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Nam JS, Roh YH, Fahad WA, Noh HE, Ha JG, Yoon JH, Kim CH, Cho HJ. Association between obesity and chronic rhinosinusitis with nasal polyps: a national population-based study. BMJ Open 2021; 11:e047230. [PMID: 34035104 PMCID: PMC8154923 DOI: 10.1136/bmjopen-2020-047230] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES We performed a cross-sectional analysis of data from the nationwide Korea National Health and Nutrition Examination Survey to evaluate the association between obesity and chronic rhinosinusitis with nasal polyps (CRSwNP) or without nasal polyp (CRSsNP). DESIGN Retrospective cross-sectional analysis of health survey data. SETTING Voluntary survey of representative South Korean populations. PARTICIPANTS In total, 32 384 individuals aged 19 years or older with available data on CRS and obesity were included. PRIMARY AND SECONDARY OUTCOME MEASURES Diagnosis of CRSwNP or CRSsNP was performed by trained otolaryngologists through sinus endoscopy and surveys of medical history. General and central obesity was diagnosed using body mass index (BMI) and waist circumference (WC), respectively. METHODS A multivariate logistic regression analysis was used to clarify the association between CRSwNP or CRSsNP and obesity according to BMI and WC. Non-obese individuals were recruited as controls. RESULTS The prevalence of CRSwNP was higher in the general (OR, 1.438; 95% CI, 1.170 to 1.768; p<0.001) and central (OR, 1.251; 95% CI, 1.031 to 1.520; p=0.033) obesity groups than in the control group. Prevalence of CRSsNP was not correlated with obesity. In a logistic regression analysis, olfactory dysfunction (OR, 1.329; 95% CI, 1.137 to 1.553; p<0.001) and purulent discharge (OR, 1.383; 95% CI, 1.193 to 1.603; p<0.001) showed a higher incidence in the central obesity group than in the control group. CONCLUSIONS We demonstrated an association between CRSwNP and general and central obesity. Further investigations on the mechanism underlying this correlation are necessary for an improved understanding of the pathogenesis of CRSwNP.
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Affiliation(s)
- Jae-Sung Nam
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Ho Roh
- Department of Medical Statistics, Yonsei University College of Medicine, Seoul, Korea
| | - Wasan Almazouq Fahad
- Department of Otorhinolaryngology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hae-Eun Noh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Gyun Ha
- Department of Otorhinolaryngology, Yonsei University Yongin Severance Hospital, Yongin, Korea
| | - Joo-Heon Yoon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
- Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
- Korea Mouse Sensory Phenotyping Center, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Hoon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
- Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
- Korea Mouse Sensory Phenotyping Center, Yonsei University College of Medicine, Seoul, Korea
- Taste Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
- Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
- Korea Mouse Sensory Phenotyping Center, Yonsei University College of Medicine, Seoul, Korea
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20
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Wu Q, Chen J, Ren Y, Qiu H, Yuan L, Deng H, Zhang Y, Zheng R, Hong H, Sun Y, Wang X, Huang X, Shao C, Lin H, Han L, Yang Q. Artificial intelligence for cellular phenotyping diagnosis of nasal polyps by whole-slide imaging. EBioMedicine 2021; 66:103336. [PMID: 33857906 PMCID: PMC8050855 DOI: 10.1016/j.ebiom.2021.103336] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background artificial intelligence (AI) for cellular phenotyping diagnosis of nasal polyps by whole-slide imaging (WSI) is lacking. We aim to establish an AI chronic rhinosinusitis evaluation platform 2.0 (AICEP 2.0) to obtain the proportion of inflammatory cells for cellular phenotyping diagnosis of nasal polyps and to explore the clinical significance of different phenotypes of nasal polyps on the WSI. Methods a total of 453 patients were enrolled in our study. For the development of AICEP 2.0, 179 patients (WSIs) were obtained from the Third Affiliated Hospital of Sun Yat-Sen University (3HSYSU) from January 2008 to December 2018. A total of 24,625 patches were automatically extracted from the regions of interest under a 400× HPF by Openslide and the number of inflammatory cells in these patches was counted by two pathologists. For the application of AICEP 2.0 in a prospective cohort, 158 patients aged 14–70 years old with chronic rhinosinusitis with nasal polyps (CRSwNP) who had undergone endoscopic sinus surgery at 3HSYSU from June 2020 to December 2020 were included for preoperative demographic characteristics. For the application of AICEP 2.0 in a retrospective cohort, 116 patients with CRSwNP who had undergone endoscopic sinus surgery from May 2016 to June 2017 were enrolled for the recurrence rate. The proportion of inflammatory cells of these patients on WSI was calculated by our AICEP 2.0. Findings for AICEP 2.0, the mean absolute errors of the ratios of eosinophils, lymphocytes, neutrophils, and plasma cells were 1.64%, 2.13%, 1.06%, and 1.22%, respectively. The four phenotypes of nasal polyps were significantly different in clinical characteristics (including asthma, itching, sneezing, total IgE, peripheral eosinophils%, tissue eosinophils%, tissue neutrophils%, tissue lymphocytes%, tissue plasma cells%, and recurrence rate; P <0.05), but there were no significant differences in age distribution, onset time, total VAS score, Lund-Kennedy score, or Lund-Mackay score. The percentage of peripheral eosinophils was positively correlated with the percentage of tissue eosinophils (r = 0.560, P <0.001) and negatively correlated with tissue lymphocytes% (r = -0.489, P <0.001), tissue neutrophils% (r = -0.225, P = 0.005), and tissue plasma cells% (r = -0.266, P = 0.001) in WSIs.
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Affiliation(s)
- Qingwu Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Jianning Chen
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Yong Ren
- Artificial Intelligence Innovation Center, Research Institute of Tsinghua, Pearl River Delta, Guangzhou 510735, China; Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China
| | - Huijun Qiu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Lianxiong Yuan
- Department of Science and Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Huiyi Deng
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Yana Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Rui Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Haiyu Hong
- Department of Otolaryngology-Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519020, China
| | - Yueqi Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China
| | - Xinyue Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Xuekun Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Chunkui Shao
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Lanqing Han
- Artificial Intelligence Innovation Center, Research Institute of Tsinghua, Pearl River Delta, Guangzhou 510735, China.
| | - Qintai Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China.
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21
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Fokkens W, Van Der Lans R, Reitsma S. Dupilumab for the treatment of chronic rhinosinusitis with nasal polyposis. Expert Opin Biol Ther 2021; 21:575-585. [PMID: 33724109 DOI: 10.1080/14712598.2021.1901881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) affects 1-2.5% of the population and is associated with significant adverse effects on quality of life (QoL). CRSwNP is strongly correlated with (late onset) asthma with 30-70% of the CRSwNP patients having asthma. Health-care spending in rhinosinusitis is high, especially because of indirect costs.Areas covered: In the last years, the recognition of endotyping as an essential presumption to precision medicine has significantly changed the integrated care pathways in the treatment of chronic rhinosinusitis. Dupilumab is the first biological available for the treatment of CRswNP, since late 2019. Treatment with dupilumab results in a significant improvement of QoL (measured as SNOT-22), rhinosinusitis disease severity, symptoms of rhinosinusitis, and especially sense of smell, nasal polyp score, Lund-Mackay CT score, and asthma outcomes (ACQ5 and FEV1) compared to placebo.Expert opinion: At this moment, the high cost of the treatment requires careful patient selection and within the EUFOREA and EPOS2020 context, experts have tried to give guidance based on today's data. We now need trials evaluating which patients benefit most from treatment with biologicals and in which patients the treatment is cost-effective.
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Affiliation(s)
- Wytske Fokkens
- Otolaryngologist, Epidemiologist, Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, North Holland, AZ, Netherlands
| | - Rik Van Der Lans
- Otolaryngologist, Epidemiologist, Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, North Holland, AZ, Netherlands
| | - Sietze Reitsma
- Otolaryngologist, Epidemiologist, Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, North Holland, AZ, Netherlands
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22
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Park SK, Yeon SH, Choi MR, Choi SH, Lee SB, Rha KS, Kim YM. Urban Particulate Matters May Affect Endoplasmic Reticulum Stress and Tight Junction Disruption in Nasal Epithelial Cells. Am J Rhinol Allergy 2021; 35:817-829. [PMID: 33736454 DOI: 10.1177/19458924211004006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Exposure to airborne urban particulate matter (UPM) has been closely related to the development and aggravation of respiratory disease, including sinonasal disorders. OBJECTIVE The aims of this study were to investigate the effect of UPM on nasal epithelial tight junctions (TJs) and mucosal barrier function and delineate the underlying mechanism by using both in vitro and in vivo models. METHODS In this study, human nasal epithelial cells (hNECs) and BALB/c mice were exposed to UPMs. UPM 1648a and 1649 b were employed. TJ and endoplasmic reticulum (ER) stress marker expression was measured using western blot analysis and immunofluorescence. TJ integrity and nasal epithelial barrier function were evaluated by transepithelial electric resistance (TER) and paracellular flux. In addition, the effects of N-acetyl-L-cysteine (NAC) on UPM-induced nasal epithelial cells were investigated. RESULTS UPM significantly impaired the nasal epithelial barrier, as demonstrated by decreased protein expression of TJ and ER stress markers in human nasal epithelial cells. This finding was in parallel to reduced transepithelial electrical resistance and increased fluorescein isothiocyanate-dextran permeability. Pretreatment with NAC decreased the degree of UPM-mediated ER stress and restored nasal epithelial barrier disruption in human nasal epithelial cells (hNEC) and the nasal mucosa of experimental animals. CONCLUSION These data suggest that UPMs may induce nasal epithelial barrier dysfunction by targeting TJs and ER stress could be related in this process. Based on these results, we suggest that suppression of this process with an inhibitor targeting ER stress responses could represent a novel promising therapeutic target in UPM-induced sinonasal disease.
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Affiliation(s)
- Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Sun Hee Yeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Mi-Ra Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea.,Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Seung Hyeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea.,Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Sung Bok Lee
- Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Ki-Sang Rha
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Yong Min Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea.,Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
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23
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 374] [Impact Index Per Article: 124.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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24
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Won HR, Jung SN, Yeo MK, Yi S, Liu L, Lim MA, Oh C, Kang YE, Chang JW, Rha KS, Koo BS. Effect of Urban Particulate Matter on Vocal Fold Fibrosis through the MAPK/NF-κB Signaling Pathway. Int J Mol Sci 2020; 21:ijms21186643. [PMID: 32927894 PMCID: PMC7555340 DOI: 10.3390/ijms21186643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/25/2022] Open
Abstract
Particulate matter (PM) is an environmental exposure factor that adversely affects human health. PM is a risk factor for various diseases. However, the mechanism by which PM affects the vocal folds (VF) has not yet been evaluated. Thus, we investigated the cytotoxic effects of PM on human vocal fold fibroblasts (hVFF) and the underlying signaling pathways. hVFF were isolated from human VF. The effect of PM on hVFF, and the underlying mechanism, were analyzed using Western blot, quantitative real-time polymerase chain reaction, and flow cytometry. In addition, a histological evaluation was performed in animal experiments. Cell proliferation decreased after the PM treatment. PM increased the expression of interleukin (IL)-6 and IL-1β. The generation of reactive oxygen species (ROS) in PM-treated hVFF and subsequent activation of the mitogen-activated protein kinase (MAPK) and nuclear factor-κB (NF-κB) pathways were confirmed. Furthermore, PM increased the expression of fibrosis-related markers and induced the accumulation of collagen in the extracellular matrix. As a result, PM exposure significantly enhances the inflammatory response on VF through the ROS-mediated activation of the MAPK and NF-κB signaling pathways. In addition, PM promotes differentiation into myofibroblasts and induces fibrosis. These results suggest that PM triggers an inflammatory reaction through ROS production and causes VF fibrosis.
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Affiliation(s)
- Ho-Ryun Won
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon 35015, Korea; (H.-R.W.); (S.-N.J.); (M.A.L.); (J.W.C.)
| | - Seung-Nam Jung
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon 35015, Korea; (H.-R.W.); (S.-N.J.); (M.A.L.); (J.W.C.)
| | - Min-Kyung Yeo
- Department of Pathology, College of Medicine, Chungnam National University, Daejeon 35015, Korea;
| | - Shinae Yi
- Department of Endocrinology and Metabolism, College of Medicine, Chungnam National University, Daejeon 35015, Korea; (S.Y.); (Y.E.K.)
| | - Lihua Liu
- Department of Medical Science, College of Medicine, Chungnam National University, Daejeon 35015, Korea; (L.L.); (C.O.)
| | - Mi Ae Lim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon 35015, Korea; (H.-R.W.); (S.-N.J.); (M.A.L.); (J.W.C.)
| | - Chan Oh
- Department of Medical Science, College of Medicine, Chungnam National University, Daejeon 35015, Korea; (L.L.); (C.O.)
| | - Yea Eun Kang
- Department of Endocrinology and Metabolism, College of Medicine, Chungnam National University, Daejeon 35015, Korea; (S.Y.); (Y.E.K.)
| | - Jae Won Chang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon 35015, Korea; (H.-R.W.); (S.-N.J.); (M.A.L.); (J.W.C.)
| | - Ki Sang Rha
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon 35015, Korea; (H.-R.W.); (S.-N.J.); (M.A.L.); (J.W.C.)
- Correspondence: (K.S.R.); (B.S.K.); Tel.: +82-42-280-7691 (K.S.R.); +82-42-280-7690 (B.S.K.)
| | - Bon Seok Koo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon 35015, Korea; (H.-R.W.); (S.-N.J.); (M.A.L.); (J.W.C.)
- Correspondence: (K.S.R.); (B.S.K.); Tel.: +82-42-280-7691 (K.S.R.); +82-42-280-7690 (B.S.K.)
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25
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Schwarzbach HL, Mady LJ, Lee SE. What is the Role of Air Pollution in Chronic Rhinosinusitis? Immunol Allergy Clin North Am 2020; 40:215-222. [DOI: 10.1016/j.iac.2019.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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26
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Shakhova EG. [Comparative study of the efficacy of combined nasal topical drug and topical decongestants in the treatment of acute rhinosinusitis]. Vestn Otorinolaringol 2020; 85:46-50. [PMID: 32885637 DOI: 10.17116/otorino20208504146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate the efficacy of the drug Frinozol (nasal spray phenylephrinein 0.25% + cetirizine 0.25%) comparison with Rinostop Extra (nasal spray oxymetazoline 0.05%) in relation to nasal symptoms of rhinosinusitis, evaluated on rating scales, when using these drugs intranasally for 7 days in patients with acute viral and post-viral rhinosinusitis of mild (VAS 0-3) and moderate (VAS 3-7). PATIENTS AND METHODS The randomized open-label study included 60 ambulatory patients (men and women aged 18 to 60 years) with a verified diagnosis of acute rhinosinusitis (ARS) lasting no more than 120 hours. 1 group of patients took Frinozol (nasal spray phenylephrinein 0.25% + cetirizine 0.25%) for 2 sprays per each nostril 3 times a day for 7 days; 2 group - Rinostop Extra (nasal spray oxymetazoline 0.05%) at the same dose and the therapy regimen. We evaluated 3 visits (day 1, day 3, and day 7) with an ENT examination on each of them; questionnaires on the 1st and 3rd visits of nasal symptoms (nasal obstruction, rhinorrhea, hyposmia) on the visual analog scale (VAS) and Clinical Global Impression Scale-CGI. Active anterior rhinomanometry (AAR) was performed on the 1st, 2nd and 3rd visits using the PTS-14P-01 rhinomanometer Rinolan before and 20 minutes after the use of the drugs Frinozol and oxymetazoline 0.05%.
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Affiliation(s)
- E G Shakhova
- Volgograd State Medical University, Volgograd, Russia
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27
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Velasquez N, Moore JA, Boudreau RM, Mady LJ, Lee SE. Association of air pollutants, airborne occupational exposures, and chronic rhinosinusitis disease severity. Int Forum Allergy Rhinol 2019; 10:175-182. [PMID: 31661614 DOI: 10.1002/alr.22477] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 09/16/2019] [Accepted: 10/16/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous work has shown that chronic rhinosinusitis (CRS) severity may be associated with particulate matter 2.5 (PM2.5 ) and black carbon (BC) in CRS patients without nasal polyps (CRSsNP). Data regarding occupational exposures, however, are lacking. We assessed the impact of PM2.5 , BC, as well as occupational airborne exposure on CRS disease severity. METHODS Patients with CRS with nasal polyps (CRSwNP), CRSsNP, and aspirin-exacerbated respiratory disease (AERD) were identified from an institutionwide database. Spatial modeling from 37 pollutant monitoring sites in Allegheny County was used to estimate exposures. Patient occupations using the 2010 Standard Occupation Classification (SOC10) and airborne occupation exposures to vapors, gases, dusts, fumes, fibers and mists (VGDFFiM) or diesel fumes were recorded. Disease severity was measured by modified Lund-Mackay score (LMS), systemic corticosteroid therapy, and incidence of functional endoscopic sinus surgery (FESS). RESULTS Two hundred thirty-four patients were included (CRSwNP, n = 113; CRSsNP, n = 96; AERD, n = 25). The prevalence of AERD among those with CRSwNP was 18%. Patients exposed to VGDFFiM or diesel fumes required higher steroid doses vs nonexposed patients (p = 0.015 and p = 0.03, respectively); patients with VGDFFiM levels >5% were more likely to undergo FESS vs nonexposed patients (p = 0.0378). There was no difference in PM2.5 and BC with regard to disease severity and FESS between CRSwNP, CRSsNP, and AERD patients. Steroid use was significantly higher in CRSwNP and AERD vs CRSsNP (p = 0.001). LMS was significantly higher in AERD as compared with CRSwNP and CRSsNP (p = 0.001). CONCLUSION Occupational airborne exposure to VGDFFiM correlated with increased prevalence of FESS and need for corticosteroids in CRS patients. There was no difference in PM2.5 and BC levels and disease severity outcome measures between CRS subtypes in this subset.
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Affiliation(s)
| | - John A Moore
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Leila J Mady
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Stella E Lee
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
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28
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Feleszko W, Marengo R, Vieira AS, Ratajczak K, Mayorga Butrón JL. Immunity-targeted approaches to the management of chronic and recurrent upper respiratory tract disorders in children. Clin Otolaryngol 2019; 44:502-510. [PMID: 30920131 PMCID: PMC6850198 DOI: 10.1111/coa.13335] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/07/2019] [Accepted: 03/24/2019] [Indexed: 02/06/2023]
Abstract
Background Upper respiratory tract infections (URTIs), including rhinitis, nasopharyngitis, tonsillitis and otitis media (OM), comprise of 88% of total respiratory infections, especially in children. Therefore effective prevention and treatment of RTIs remain a high priority worldwide. Preclinical and clinical data highlight the rationale for the use and effectiveness of immunity‐targeted approaches, including targeted immunisations and non‐specific immunomodulation in the prevention and management of recurrent upper RTIs. Objective of review The idea of this review was to summarise the current evidence and address key questions concerning the use of conservative and immunity‐targeted approaches to recurrent and chronic URTIs, with a focus on the paediatric population. Search strategy/Evaluation method Literature searches were conducted in March 2017 and updated in September 2017 using: Academic Search Complete; CENTRAL; Health Source: Nursing/Academic Edition; MEDLINE; clinicaltrials.gov; and Cochrane databases. In total, 84 articles were retrieved and reviewed. Two independent researchers focused on primary and secondary endpoints in systematic reviews, meta‐analyses and randomised, controlled trials, using immunity‐directed strategies as the control group or within a subpopulation of larger studies. Existing guidelines and interventional/observational studies on novel applications were also included. Results Children are particularly susceptible to RTIs due to the relative immaturity of their immune systems, as well as other potential predisposing factors such as day care attendance and/or toxic environmental factors (eg increased pathogenic microbial exposure and air pollutants). Recurrent URTIs can affect otherwise healthy children, leading to clinical sequelae and complications, including the development of chronic conditions or the need for surgery. Available pre‐clinical and clinical data highlight the rationale for the use and effectiveness of immunity‐targeted approaches, including targeted immunisations (flu and pneumococcal vaccines) and non‐specific immunomodulation (bacterial lysates), in the prevention and management of recurrent croup, tonsillitis, otitis media, recurrent acute rhinosinusitis and chronic rhinosinusitis. Conclusions In this review, we summarise the current evidence and provide data demonstrating that some immunity‐targeted strategies, including vaccination and immunomodulation, have proved effective in the treatment and prevention of recurrent and chronic URTIs in children.
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Affiliation(s)
- Wojciech Feleszko
- Department of Paediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Warsaw, Poland
| | - Ricardo Marengo
- Department of Otorhinolaryngology and Audiology, CEMIC Institute, Buenos Aires, Argentina
| | | | - Karol Ratajczak
- Department of Paediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Warsaw, Poland
| | - José Luis Mayorga Butrón
- Department of Otorhinolaryngology, National Institute of Pediatrics, Cuicuilco, Mexico.,Master of Science Program, Postgraduate Unit, Faculty of Medicine, National University of Mexico, Cuicuilco, Mexico
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Alekseenko SI, Skalny AV, Ajsuvakova OP, Skalnaya MG, Notova SV, Tinkov AA. Mucociliary transport as a link between chronic rhinosinusitis and trace element dysbalance. Med Hypotheses 2019; 127:5-10. [PMID: 31088648 DOI: 10.1016/j.mehy.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/01/2019] [Accepted: 03/20/2019] [Indexed: 12/21/2022]
Abstract
Chronis rhinosinusitis is considered as a widespread public health issue with a prevalence of 10%. The disease significantly reduces quality of life and increases the risk of cardiovascular diseases as well as certain forms of cancer. Alteration of mucociliary clearance frequently observed in the patients and plays a significant role in disease pathogenesis. Certain studies have demonstrated that patients with chronic rhinosinusitis are characterized by significant reduction of essential trace elements and toxic metal overload. However, the particular mechanisms of the role of trace element dysbalance in chronic rhinosinusitis are unclear. We hypothesize that exposure to toxic trace elements (arsenic, nickel, cadmium) damages ciliary mucosal epithelium thus affecting mucociliary transport. In turn, altered mucociliary transport results in reduced removal of the inhaled metal-containing particles from nasal mucosa leading to their absorption and further aggravation of toxicity. Essential trace elements (zinc, selenium) play a significant role in regulation of mucociliary transport and immunity, thus their deficiency (either dietary or due to antagonism with toxic metals) may be associated with impaired functions and increased toxic metal toxicity. Therefore, a vicious circle involving metal accumulation and toxicity, essential element deficiency, impairment of mucociliary transport and metal particle removal, resulting in further accumulation of metals and aggravation of toxic effects is formed. The present hypothesis is supported by the findings on the impact of trace elements especially zinc and arsenic on mucociliary clearance, the role of mucociliary transport in heavy metal particles elimination from the airways, trace element dysbalance in chronic rhinosinusitis, as well as toxic and essential metal antagonism. The data from hypothesis testing and its verification may be used for development of therapeutic approach for management of chronic rhinosinusitis. Particularly, the use of essential elements (zinc, selenium) may reduce toxic metal toxicity thus destroying the vicious circle of heavy metal exposure, toxicity, alteration of mucociliary clearance, and aggravation of chronic rhinosinusitis. Essential element supplementation may be considered as a tool for management of chronic refractory rhinosinusitis. In addition, analysis of essential and toxic trace element status may provide an additional diagnostic approach to risk assessment of chronic rhinosinusitis in highly polluted environments.
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Affiliation(s)
- Svetlana I Alekseenko
- K. A. Raukhfuss Children's Municipal Multidisciplinary Clinical Center of High Medical Technologies, St. Petersburg, Russia; Mechnikov North-West State Medical University, St Petersburg, Russia
| | - Anatoly V Skalny
- Yaroslavl State University, Yaroslavl, Russia; Peoples' Friendship University of Russia (RUDN University), Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Olga P Ajsuvakova
- Yaroslavl State University, Yaroslavl, Russia; Peoples' Friendship University of Russia (RUDN University), Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Margarita G Skalnaya
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Svetlana V Notova
- Federal Research Centre of Biological Systems and Agro-technologies of the Russian Academy of Sciences, Orenburg, Russia; Orenburg State University, Orenburg, Russia
| | - Alexey A Tinkov
- Yaroslavl State University, Yaroslavl, Russia; Peoples' Friendship University of Russia (RUDN University), Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
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London NR, Lina I, Ramanathan M. Aeroallergens, air pollutants, and chronic rhinitis and rhinosinusitis. World J Otorhinolaryngol Head Neck Surg 2018; 4:209-215. [PMID: 30506053 PMCID: PMC6251962 DOI: 10.1016/j.wjorl.2018.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/27/2018] [Indexed: 12/15/2022] Open
Abstract
Chronic rhinitis and rhinosinusitis are among the most common conditions worldwide with significant morbidity and decreased quality of life. Although the pathogenesis of these conditions is multifactorial, there has been increasing evidence for the role of environmental factors such as aeroallergens and air pollutants as initiating or exacerbating factors. This review will outline the current literature focusing on the role of aeroallergens and air pollution in the pathogenesis of chronic sinonasal inflammatory conditions.
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Affiliation(s)
| | | | - Murugappan Ramanathan
- Johns Hopkins Department of Otolaryngology – Head and Neck Surgery, Baltimore, MD 21287, USA
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Lee DC, Choi H, Oh JM, Hong Y, Jeong SH, Kim CS, Kim DK, Cho WK, Kim SW, Kim SW, Cho JH, Lee J. The effect of urban particulate matter on cultured human nasal fibroblasts. Int Forum Allergy Rhinol 2018; 8:993-1000. [PMID: 29979839 DOI: 10.1002/alr.22167] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Exposure to urban particulate matter (UPM) has been linked to aggravation of various health problems. Although the effects of UPM on the lower respiratory tract have been extensively studied, more research is required on the impact of UPM on the upper respiratory tract and the underlying mechanisms. Thus, we investigated the cytotoxic effects of UPM on cultured human nasal fibroblasts, the underlying signaling pathways involved, and changes in cytokine levels. METHODS Human turbinate tissue specimens were collected during partial turbinectomies performed on 6 patients, and then cultured. The effect of UPM on nasal fibroblast viability was explored. Real-time reverse transcription-polymerase chain reaction was used to measure the mRNA levels of genes encoding cytokines and chemokines (interleukin [IL]-4, IL-6, IL-8, and tumor necrosis factor-α) before and after 24 hours of UPM treatment. Enzyme-linked immunosorbent assays were employed to measure IL-6 and IL-8 levels. The status of the p38 and nuclear factor (NF)-κB signaling pathways was analyzed by Western blotting. RESULTS UPM reduced cell viability in a dose-dependent manner and increased IL-6 and IL-8 expression at both the mRNA and protein levels. UPM induced the phosphorylation of p38 and NF-κB p65; inhibitors of the actions of these proteins repressed phosphorylation and the expression of IL-6 and IL-8. CONCLUSION UPM induced IL-6 and IL-8 expression by fibroblasts via p38 and NF-κB classical signaling, suggesting that UPM can induce or aggravate allergic and/or chronic rhinitis.
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Affiliation(s)
- Dong Chang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyunsu Choi
- Clinical Research Institute, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
| | - Jeong-Min Oh
- Clinical Research Institute, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
| | - Yupyo Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su Hee Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Choung Soo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Kee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Kyung Cho
- Department of Ophthalmology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Won Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Whan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Hee Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joohyung Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Prevalence and Risk Factors of MRI Abnormality Which Was Suspected as Sinusitis in Japanese Middle-Aged and Elderly Community Dwellers. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4096845. [PMID: 30009169 PMCID: PMC6020666 DOI: 10.1155/2018/4096845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/17/2018] [Indexed: 01/28/2023]
Abstract
The aims of this study were to determine the prevalence of MRI abnormalities which were suspected as sinusitis in community-dwelling middle-aged and elderly Japanese and to identify risk factors for the MRI abnormality. Brain magnetic resonance imaging (MRI) data from the National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA) were used for the analysis. Among the 2330 subjects in the NILS-LSA, 1933 participants were categorized as having no MRI abnormality or MRI abnormality using the Lund-Mackay (LM) score. The mean LM score of the participants was 0.88±1.92, and 144 (7.4%) participants had MRI abnormalities which were suspected as sinusitis when it was classified as an LM score greater than or equal to 4. The prevalence of MRI abnormality was significantly higher in participants of older age and the male sex, in participants with obesity, hypertension, bronchial asthma, chronic bronchitis, gout, or hyperuricemia and in ex- or current smokers. A multivariate logistic regression revealed that older age (odds ratio [OR] = 1.17), obesity (OR = 1.54), a smoking habit (OR = 1.71), history of asthma (OR = 3.77), and chronic bronchitis (OR = 2.66) were significant risk factors for MRI abnormality.
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Prevalence and Determinants of Sinus Problems in Farm and Non-Farm Populations of Rural Saskatchewan, Canada. SINUSITIS 2018. [DOI: 10.3390/sinusitis3010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hoffmans R, Wagemakers A, van Drunen C, Hellings P, Fokkens W. Acute and chronic rhinosinusitis and allergic rhinitis in relation to comorbidity, ethnicity and environment. PLoS One 2018; 13:e0192330. [PMID: 29401486 PMCID: PMC5798836 DOI: 10.1371/journal.pone.0192330] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 01/21/2018] [Indexed: 11/18/2022] Open
Abstract
Background This study was conducted to assess the effect of comorbidity, ethnicity, occupation, smoking and place of residence on allergic rhinitis (AR), acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS). Methods A GA2LEN (The Global Allergy and Asthma European Network) screening questionnaire was sent to a random sample of the Dutch population (n = 16700) in three different areas of the Netherlands. Results Fifty percent (8347) of the questionnaires sent were returned. A total of 29% respondents (27–31% in different areas) met the criteria for AR, 18% (17–21%) for ARS and 16% (13–18%) for CRS. Risk factors for AR were itchy rash, eczema, adverse response after taking a painkiller, asthma, CRS and ARS. Moreover, the risk of AR was twice as low for full-time housewives/househusbands than for people with jobs. The risk of ARS or CRS was significantly higher in respondents with a doctor’s diagnosis of CRS, AR, itchy rash or smoking. The risk of CRS was also significantly higher in respondents with an adverse response after taking painkillers, active smoking or asthma. Caucasians are generally less likely to have AR or CRS than Latin-Americans, Hindustani and African-Creoles, and more likely to have ARS than Asian, Hindustani, Mediterranean and African-Creoles. Conclusions This study found shared and distinct risk factors for AR, ARS and CRS and therefore provides support for the belief that they have shared symptoms but are different diseases with different aetiologies.
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Affiliation(s)
- Ruth Hoffmans
- Academic Medical Centre, Amsterdam, The Netherlands
- * E-mail:
| | | | | | - Peter Hellings
- Academic Medical Centre, Amsterdam, The Netherlands
- UZ Leuven, Leuven, Belgium
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Blood Eosinophils and World Trade Center Exposure Predict Surgery in Chronic Rhinosinusitis. A 13.5-Year Longitudinal Study. Ann Am Thorac Soc 2018; 13:1253-61. [PMID: 27096198 DOI: 10.1513/annalsats.201511-742oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The World Trade Center (WTC) collapse generated caustic airborne particulates that caused chronic rhinosinusitis in exposed Fire Department of New York firefighters. Surgery was performed when symptoms remained uncontrolled despite medical management. OBJECTIVES To identify predictors of surgical intervention for chronic rhinosinusitis in firefighters exposed to airborne irritants at the WTC collapse site. METHODS We assessed in 8,227 firefighters with WTC exposure between September 11, 2001 (9/11), and September 25, 2001, including WTC-site arrival time, months of rescue and recovery work, and eosinophil concentration measured between 9/11 and March 10, 2003. We assessed the association of serum cytokines and immunoglobulins with eosinophil concentration and surgery for rhinosinusitis in 112 surgical cases and 376 control subjects with serum available from the first 6 months after exposure to the WTC collapse site. MEASUREMENTS AND MAIN RESULTS Between 9/11 and March 10, 2015, the surgery rate was 0.47 cases per 100 person-years. In the first 18 months post-9/11, surgical patients had higher mean blood eosinophil levels than study cohort patients (219 ± 155 vs. 191 ± 134; P < 0.0001). Increased surgery risk was associated with increasing blood eosinophil counts (hazard ratio [HR], 1.12 per 100 cells/μl; 95% confidence interval [CI], 1.07-1.17; P < 0.001); arriving at the WTC site on 9/11 or September 12, 2001 (HR, 1.43; 95% CI, 1.04-1.99; P = 0.03); and working 6 months or longer at the WTC site (HR, 1.48; 95% CI, 1.14-1.93; P < 0.01). Median blood eosinophil levels for surgical patients were above levels for the cohort in all 18-month intervals March 11, 2000, through March 10, 2015, using 51,163 measurements representing 97,733 person-years of observation. Increasing age, increasing IL-17A, and low IgA in serum from 2001 to 2002 predicted blood eosinophil concentration in surgical patients but not in control subjects (R(2) = 0.26, P < 0.0001; vs. R(2) = 0.008, P = 0.56). CONCLUSIONS Increasing blood eosinophil concentration predicts surgical intervention for chronic rhinosinusitis, particularly in those with intense acute and prolonged exposure to airborne irritants. WTC-exposed Fire Department of New York firefighters who underwent irritant-associated sinus surgery are immunologically different from the cohort. Surgical patients have a higher blood eosinophil levels that is associated with mediators of mucosal immunity.
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Codispoti CD, Tapke DE, LoSavio PS, Batra PS, Mahdavinia M. Living in lower income zip codes is associated with more severe chronic rhinosinusitis. Ann Allergy Asthma Immunol 2017; 120:207-209. [PMID: 29290514 DOI: 10.1016/j.anai.2017.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Christopher D Codispoti
- Department of Immunology and Microbiology, Allergy/Immunology Section, Rush University Medical Center, Chicago, Illinois.
| | - David E Tapke
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Phillip S LoSavio
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Mahboobeh Mahdavinia
- Department of Immunology and Microbiology, Allergy/Immunology Section, Rush University Medical Center, Chicago, Illinois
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Mady LJ, Schwarzbach HL, Moore JA, Boudreau RM, Tripathy S, Kinnee E, Dodson ZM, Willson TJ, Clougherty JE, Lee SE. Air pollutants may be environmental risk factors in chronic rhinosinusitis disease progression. Int Forum Allergy Rhinol 2017; 8:377-384. [PMID: 29210519 DOI: 10.1002/alr.22052] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/23/2017] [Accepted: 11/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the role of environmental exposures in the pathophysiology of chronic rhinosinusitis (CRS). In this study, we measured the impact of air pollutants (particulate matter 2.5 [PM2.5 ] and black carbon [BC]) on CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP). METHODS Spatial modeling from pollutant monitoring sites was used to estimate exposures surrounding residences for patients meeting inclusion criteria (total patients, n = 234; CRSsNP, n = 96; CRSwNP, n = 138). Disease severity outcome measures included modified Lund-Mackay score (LMS), systemic steroids, number of functional endoscopic sinus surgeries (FESS), and 22-item Sino-Nasal Outcome Test (SNOT-22) score. PM2.5 and BC exposures were correlated with outcome measures. RESULTS Mean PM2.5 and BC findings were not significantly different between CRSwNP and CRSsNP patients or patients with and without asthma. Among those with CRSsNP, PM2.5 was significantly associated with undergoing FESS. For each unit increase in PM2.5 , there was a 1.89-fold increased risk in the proportion of CRSsNP patients who required further surgery (p = 0.015). This association was not identified in CRSwNP patients (p = 0.445). BC was also significantly associated with SNOT-22 score in the CRSsNP group. For each 0.1-unit increase in BC, there was a 7.97-unit increase in SNOT-22 (p = 0.008). A similar, although not significant, increase in SNOT-22 was found with increasing BC in the CRSwNP group (p = 0.728). CONCLUSION Air pollutants correlate with CRS symptom severity that may be influenced by exposure levels, with a more pronounced impact on CRSsNP patients. This study is the first to demonstrate the possible role of inhalant pollutants in CRS phenotypes, addressing a critical knowledge gap in environmental risk factors for disease progression.
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Affiliation(s)
- Leila J Mady
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | | | - John A Moore
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Boudreau
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | | | | | | | - Thomas J Willson
- Uniformed Services University of the Health Sciences, Department of Otolaryngology, San Antonio Military Medical Center, San Antonio, TX
| | | | - Stella E Lee
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
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Ramanathan M, London NR, Tharakan A, Surya N, Sussan TE, Rao X, Lin SY, Toskala E, Rajagopalan S, Biswal S. Airborne Particulate Matter Induces Nonallergic Eosinophilic Sinonasal Inflammation in Mice. Am J Respir Cell Mol Biol 2017; 57:59-65. [PMID: 28245149 DOI: 10.1165/rcmb.2016-0351oc] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Exposure to airborne particulate matter (PM) has been linked to aggravation of respiratory symptoms, increased risk of cardiovascular disease, and all-cause mortality. Although the health effects of PM on the lower pulmonary airway have been extensively studied, little is known regarding the impact of chronic PM exposure on the upper sinonasal airway. We sought to test the impact of chronic airborne PM exposure on the upper respiratory system in vivo. Mice were subjected, by inhalation, to concentrated fine (2.5 μm) PM 6 h/d, 5 d/wk, for 16 weeks. Mean airborne fine PM concentration was 60.92 μm/m3, a concentration of fine PM lower than that reported in some major global cities. Mice were then killed and analyzed for evidence of inflammation and barrier breakdown compared with control mice. Evidence of the destructive effects of chronic airborne PM on sinonasal health in vivo, including proinflammatory cytokine release, and macrophage and neutrophil inflammatory cell accumulation was observed. A significant increase in epithelial barrier dysfunction was observed, as assessed by serum albumin accumulation in nasal airway lavage fluid, as well as decreased expression of adhesion molecules, including claudin-1 and epithelial cadherin. A significant increase in eosinophilic inflammation, including increased IL-13, eotaxin-1, and eosinophil accumulation, was also observed. Collectively, although largely observational, these studies demonstrate the destructive effects of chronic airborne PM exposure on the sinonasal airway barrier disruption and nonallergic eosinophilic inflammation in mice.
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Affiliation(s)
- Murugappan Ramanathan
- 1 Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland
| | - Nyall R London
- 1 Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland
| | - Anuj Tharakan
- 1 Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland
| | - Nitya Surya
- 1 Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland
| | - Thomas E Sussan
- 2 Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Xiaoquan Rao
- 3 Cardiovascular Research Institute, Case Western Reserve School of Medicine, Cleveland, Ohio, and
| | - Sandra Y Lin
- 1 Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland
| | - Elina Toskala
- 4 Temple University Department of Otolaryngology-Head and Neck Surgery, Philadelphia, Pennsylvania
| | - Sanjay Rajagopalan
- 3 Cardiovascular Research Institute, Case Western Reserve School of Medicine, Cleveland, Ohio, and
| | - Shyam Biswal
- 2 Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Juan F, Ayiheng Q, Yuqin F, Hua Z, Jun Y, Bin H. Risk Factors of Chronic Rhinosinusitis After Functional Endoscopic Sinus Surgery. Med Sci Monit 2017; 23:1064-1068. [PMID: 28242868 PMCID: PMC5341909 DOI: 10.12659/msm.900421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinical data of 288 chronic rhinosinusitis patients were retrospectively analyzed to investigate the risk factors of clinical prognosis, aiming to provide clinical evidence for the diagnosis and treatment of chronic rhinosinusitis. MATERIAL AND METHODS A total of 288 patients diagnosed with chronic rhinosinusitis in the Department of Otolaryngology of the First Affiliated Hospital of Xinjiang Medical University were recruited. Among all participants, 177 were male and 111 were female, aged from 22 to 83 years, (52±14) years on average. Subsequent follow-up was conducted to evaluate surgical efficacy. Influencing factors of clinical prognosis were analyzed by univariate and multivariate logistic regression analyses. RESULTS After functional endoscopic sinus surgery by Messerklinger technique, 187 (64.9%) patients were fully recovered, 72 (25.0%) presented with improvement, and 28 (10.1%) were untreated. Univariate logistic regression analysis revealed that 11 variables were correlated with the clinical prognosis of chronic rhinosinusitis. Multivariate logistic regression analysis demonstrated that age, history of allergic rhinitis, severity of dysosmia, history of nasosinusitis surgery, and long-term use of nasal decongestant were the risk factors, whereas comprehensive therapy after surgery was a protective factor. CONCLUSIONS More emphasis should be placed upon the factors associated with the clinical prognosis of patients with chronic rhinosinusitis following undergoing endoscopic sinus surgery, offering consolidated evidence for the prevention and treatment of chronic rhinosinusitis.
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Affiliation(s)
- Feng Juan
- Department of Otorhinolaryngology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Qukuerhan Ayiheng
- Department of Otorhinolaryngology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Fan Yuqin
- Department of Otorhinolaryngology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Zhang Hua
- Department of Otorhinolaryngology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yong Jun
- Department of Otorhinolaryngology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Hu Bin
- Department of Otorhinolaryngology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
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Tustin AW, Hirsch AG, Rasmussen SG, Casey JA, Bandeen-Roche K, Schwartz BS. Associations between Unconventional Natural Gas Development and Nasal and Sinus, Migraine Headache, and Fatigue Symptoms in Pennsylvania. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:189-197. [PMID: 27561132 PMCID: PMC5289909 DOI: 10.1289/ehp281] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 07/29/2016] [Accepted: 07/31/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUND Unconventional natural gas development (UNGD) produces environmental contaminants and psychosocial stressors. Despite these concerns, few studies have evaluated the health effects of UNGD. OBJECTIVES We investigated associations between UNGD activity and symptoms in a cross-sectional study in Pennsylvania. METHODS We mailed a self-administered questionnaire to 23,700 adult patients of the Geisinger Clinic. Using standardized and validated questionnaire items, we identified respondents with chronic rhinosinusitis (CRS), migraine headache, and fatigue symptoms. We created a summary UNGD activity metric that incorporated well phase, location, total depth, daily gas production and inverse distance-squared to patient residences. We used logistic regression, weighted for sampling and response rates, to assess associations between quartiles of UNGD activity and outcomes, both alone and in combination. RESULTS The response rate was 33%. Of 7,785 study participants, 1,850 (24%) had current CRS symptoms, 1,765 (23%) had migraine headache, and 1,930 (25%) had higher levels of fatigue. Among individuals who met criteria for two or more outcomes, adjusted odds ratios for the highest quartile of UNGD activity compared with the lowest were [OR (95% CI)] 1.49 (0.78, 2.85) for CRS plus migraine, 1.88 (1.08, 3.25) for CRS plus fatigue, 1.95 (1.18, 3.21) for migraine plus fatigue, and 1.84 (1.08, 3.14) for all three outcomes together. Significant associations were also present in some models of single outcomes. CONCLUSIONS This study provides evidence that UNGD is associated with nasal and sinus, migraine headache, and fatigue symptoms in a general population representative sample. Citation: Tustin AW, Hirsch AG, Rasmussen SG, Casey JA, Bandeen-Roche K, Schwartz BS. 2017. Associations between unconventional natural gas development and nasal and sinus, migraine headache, and fatigue symptoms in Pennsylvania. Environ Health Perspect 125:189-197; http://dx.doi.org/10.1289/EHP281.
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Affiliation(s)
- Aaron W. Tustin
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Annemarie G. Hirsch
- Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA
| | - Sara G. Rasmussen
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joan A. Casey
- Robert Wood Johnson Health and Society Scholars Program, University of California, San Francisco, San Francisco and University of California, Berkeley, Berkeley, California, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brian S. Schwartz
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Kern R. IFAR 2017. Int Forum Allergy Rhinol 2017; 7:5-6. [DOI: 10.1002/alr.21900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) is a broad clinical syndrome linked by mucosal inflammation. Primary treatment modalities are corticosteroids and antibiotics with surgery an option for failures, but the level of supporting evidence is generally low. The primary reason is that CRS is a symptom complex and not a specific disease. Areas covered: The primary treatment modalities for CRS are corticosteroids, antibiotics and surgery. Corticosteroids, which have very broad anti-inflammatory properties, also have the strongest evidence for efficacy. Antibiotics are likely effective in a subpopulation of patients but the various phenotypes and endotypes that make up CRS have thus far been poorly defined. Early surgery as well as biologics may also be more efficacious and cost effective in some phenotypes as well. Expert commentary: A better understanding of the inflammatory pathways that drive CRS will permit investigators to separate patient groups. This will allow for clinical trials that target specific subpopulations and more personalized therapy for CRS patients in the future.
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Affiliation(s)
- Nsangou Ghogomu
- a Feinberg School of Medicine, Department of Otolaryngology, Head and Neck Surgery , Northwestern University , Chicago , IL , USA
| | - Robert Kern
- a Feinberg School of Medicine, Department of Otolaryngology, Head and Neck Surgery , Northwestern University , Chicago , IL , USA
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Gao WX, Ou CQ, Fang SB, Sun YQ, Zhang H, Cheng L, Wang YJ, Zhu DD, Lv W, Liu SX, Li PZ, Xu G, Shi J, Fu QL. Occupational and environmental risk factors for chronic rhinosinusitis in China: a multicentre cross-sectional study. Respir Res 2016; 17:54. [PMID: 27184027 PMCID: PMC4869304 DOI: 10.1186/s12931-016-0366-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 04/19/2016] [Indexed: 02/05/2023] Open
Abstract
Background Chronic rhinosinusitis (CRS) is defined as a condition of inflammation in the paranasal sinus mucosa persisting for more than 12 weeks. We previously reported that the prevalence of CRS was about 8 % in China. Here, we aim to investigate the occupational and environmental risk factors associated with CRS. Methods Data were collected from seven Chinese cities: Urumqi, Changchun, Beijing, Wuhan, Chengdu, Huaian and Guangzhou. CRS was diagnosed according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) document. Participants were asked to complete a standardized questionnaire, which was developed by the Global Allergy and Asthma European Network (GA2LEN) project and covered sociodemographic characteristics, CRS-related symptoms and occupational and environmental exposures. We evaluated the association between CRS and various occupational and environmental factors using odds ratios (ORs) and 95 % confidence intervals (95 % CIs). Results The total study population consisted of 10,633 subjects, 850 (7.99 %) of whom were defined as having CRS according to the EP3OS criteria. We found that there were significant associations between occupational and environmental factors and CRS. Specifically, having a clearance-related job, occupational exposure to dust, occupational exposure to poisonous gas, a pet at home or carpet at home or at the workplace were risk factors for CRS. Additionally, the method used to keep warm in winter, the duration of time spent using air conditioning in summer and the frequency of exposure to mouldy or damp environments were significantly different in subjects with and without CRS. Conclusions Our data showed that some occupational and environmental exposures are strongly associated with CRS, which aids in understanding the epidemiology of CRS.
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Affiliation(s)
- Wen-Xiang Gao
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, Guangdong, 510080, China
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Shu-Bin Fang
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, Guangdong, 510080, China
| | - Yue-Qi Sun
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, Guangdong, 510080, China
| | - Hua Zhang
- Department of Otorhinolaryngology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Lei Cheng
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yan-Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dong-Dong Zhu
- Department of Otolaryngology Head and Neck, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Wei Lv
- Department of Otolaryngology, Peking Union Medical College Hospital, Beijing, China
| | - Shi-Xi Liu
- Department of Otorhinolaryngology, West China Hospital of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - P Z Li
- Department of Otorhinolaryngology, Affiliated Huai'an First People's Hospital, Nanjing Medical University, Huaian, Jiangsu, China
| | - Geng Xu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, Guangdong, 510080, China
| | - Jianbo Shi
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, Guangdong, 510080, China.
| | - Qing-Ling Fu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, Guangdong, 510080, China.
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Poetker DM. Editorial. Int Forum Allergy Rhinol 2016; 5:979-80. [PMID: 26769091 DOI: 10.1002/alr.21676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bakshi SS. In reference to "Medical therapy vs surgery for recurrent acute rhinosinusitis". Int Forum Allergy Rhinol 2015; 5:1185. [PMID: 26446406 DOI: 10.1002/alr.21663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 09/11/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Satvinder Singh Bakshi
- Department of ENT and Head and Neck Surgery, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Pondicherry, India
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