Receptor activator of nuclear factor κB ligand is a biomarker for osteitis of chronic rhinosinusitis

Clinical and immunologic implication of neo-osteogenesis in chronic rhinosinusitis

INTRODUCTION

Chronic rhinosinusitis (CRS) is a multifactorial disease characterized by long-term inflammation of the nasal and sinus passages. Neo-osteogenesis which is a major finding of recalcitrant CRS is clinically related to the disease severity and surgical outcomes of CRS.

AREAS COVERED

The immunological and molecular mechanisms underlying neo-osteogenesis of CRS remain unclear, and many recent studies have suggested the importance of inflammatory mediators secreted by immune cells. This paper provides a broader understanding of neo-osteogenesis in CRS by reviewing recent updates and evidence of the association between CRS pathophysiology and neo-osteogenesis.

EXPERT OPINION

Crosstalk between the bone and mucosa eventually results in refractory CRS. In addition, both eosinophilic and non-eosinophilic CRS cytokines can play a role in neo-osteogenesis and trigger an enhanced CRS-associated immune response. The significance of predicting neo-osteogenesis in advance or during postoperative care could be essential for effectively managing refractory CRS and enhancing the prognosis of CRS patients.

The Impact of Osteitis on Quality of Life in Patients with Chronic Rhinosinusitis

Introduction: Chronic rhinosinusitis (CRS) is a significant health problem worldwide with an estimated prevalence of 5-12% in the general population. Osteitis refers to inflammation of bone characterized by bone remodeling, neo-osteogenesis and thickening of adjacent mucosa. These changes are evidenced by specific radiological appearance on Computerized Tomography (CT) which may be localized or diffuse dependent on extent of disease. Osteitis act as a marker of severity in chronic rhinosinusitis and can significantly affect the patient's Quality of Life (QOL) proportional to its severity. Aim: To analyze the impact of osteitis on quality of life in patients with chronic rhinosinusitis as evidenced by pre-operative Sinonasal Outcome Test-22(SNOT-22) scores. Materials & Methods: 31 patients diagnosed to have chronic rhinosinusitis with co-existing osteitis were enrolled in this study based on computerized tomography scan Paranasal Sinuses (PNS) findings and graded as per the calculated Global Osteitis Scoring Scale. Accordingly, patients were categorised into those without significant osteitis, with mild, moderate and severe osteitis. Baseline quality of life in these patients was assessed using the Sinonasal Outcome Test-22 (SNOT-22) and its association with the severity of osteitis analysed. Results: There is a very strong correlation between severity of osteitis and quality of life in the study population based on the Sinonasal Outcome Test-22 scores (p = 0.000). The mean Global Osteitis score was 21.65 with standard deviation 5.66. Maximum score obtained was 38 and minimum score 14. Conclusion: • Osteitis has a significant impact on quality of life in patients with chronic rhinosinusitis. • Severity of osteitis has a direct relation to quality of life in chronic rhinosinusitis.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

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.

Crosstalk Between Mucosal Inflammation and Bone Metabolism in Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) is a multifactorial and highly heterogeneous upper airway disease that affects approximately 12% of the general population. There is increasing evidence supporting the impact of osteitis on the pathophysiology of CRS. Osteitis is frequently observed in patients with CRS, and is associated with severe sinonasal inflammation and recalcitrant cases. The overlying inflammatory sinonasal mucosa plays a critical role in the initiation of osteitis; however, the underlying molecular mechanisms and functional significance remain unclear. Increasingly many studies have suggested that immune cells play a crucial role in the bone remodeling process in CRS. The purpose of this review is to summarize the current state of knowledge regarding the specific role of sinonasal inflammation in bone remodeling in CRS patients.