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Jiang RS, Chiang YF, Liang KL. Efficacy and Safety of Xylitol Nasal Irrigation after Functional Endoscopic Sinus Surgery: A Randomized Controlled Study. Biomedicines 2024; 12:1377. [PMID: 38927584 PMCID: PMC11202173 DOI: 10.3390/biomedicines12061377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
Xylitol is considered a naturally occurring antibacterial agent. It is generally believed to enhance the body's own innate bactericidal mechanisms. It also provides anti-adhesive effects against both Streptococcus pneumoniae and Haemophilus influenza. This study was performed to evaluate the efficacy and safety of xylitol nasal irrigation in the postoperative care of functional endoscopic sinus surgery (FESS). Patients with chronic rhinosinusitis who received FESS were recruited and randomly assigned to two groups at one month post-surgery. Thirty-five patients in the xylitol group received 400 mL of 5% xylitol nasal irrigation daily for 2 months, while another 35 in the normal saline (NS) group received 400 mL of NS nasal irrigation daily for 2 months. Prior to FESS, as well as before and after nasal irrigation, sinonasal symptoms were assessed through the 22-item Sino-Nasal Outcome Test Questionnaire. The patients also underwent an endoscopic examination while undergoing nasal function tests, and a cytokine measurement of the nasal lavage and a bacterial culture from the middle meatus were performed. The safety of the nasal irrigation was assessed through any self-reported adverse events, the Eustachian Tube Dysfunction Patient Questionnaire and the eustachian tube function test. The endoscopic scores and olfactory threshold significantly decreased after xylitol irrigation when compared with those before irrigation. The prevalence of Staphylococcus aureus in the nasal secretions also decreased significantly after xylitol irrigation. The amounts of Interleukin-5 and Interleukin-17A were significantly increased in the nasal lavage after xylitol irrigation. No side effects, including those related to eustachian tube function, were seen after nasal irrigation in both groups. Our results showed that xylitol nasal irrigation was both beneficial and safe during the postoperative care of FESS.
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Affiliation(s)
- Rong-San Jiang
- Departments of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- Departments of Otolaryngology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yi-Fang Chiang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Kai-Li Liang
- Departments of Otolaryngology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung-Hsing University, Taichung 40227, Taiwan
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Zasadzińska-Stempniak K, Zajączkiewicz H, Kukwa A. Correlation between Subjective Nasal Patency and Nasal Capacity in Young Adults: A Pilot Study with a Prototype Device-A Nasoorospirometer. J Clin Med 2024; 13:2506. [PMID: 38731035 PMCID: PMC11084303 DOI: 10.3390/jcm13092506] [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: 03/13/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Nasal airway obstruction (NAO) is characterised by high resistance in the nasal cavity with a collapsible and narrowed upper airway and is an integral part of OSA pathophysiology. The literature demonstrates that the identification of high-risk OSA in the young adult population leads to the prevention of later health consequences. A nasoorospirometer is a prototype device that measures nasal capacity during inspiration. The basis for measurement is a Wheatstone bridge and a thermal anemometer. The parameters are recorded via hot wire anemometry (HTA) with velocity measurements in the airflow field. Therefore, this pilot study aimed to test the feasibility of the device by examining a young adult sample. The secondary aim was to determine whether subjective NAO correlates with nasal capacity and whether NAO corresponds with anthropometric parameters and individual risk of OSA. Methods: A group of 31 participants (mean age 24.9 years) underwent a thorough laryngological examination. The nasoorospirometer was used to measure objective NAO (nasal capacity), the NOSE scale was used to gain subjective NAO evaluation, and the Berlin Questionnaire for the risk of OSA. Results: A correlation analysis confirmed no significant associations between the subjective and objective measures (p > 0.05). Higher BMI and neck circumference are associated with lower NAO and higher nasal patency in the population of young adults (r: 0.32-0.45; p < 0.05). The risk of OSA showed no statistically significant association (p > 0.05). Conclusions: We presented three methods of NAO assessment: subjective participant evaluation, objective nasoosopirometry, and objective laryngological assessment. However, the use of a nasoorospirometer with anthropometric measures in young adults needs to be verified in future studies.
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Affiliation(s)
- Katarzyna Zasadzińska-Stempniak
- Department of Otorhinolaryngology, Head and Neck Diseases, School of Medicine, University of Warmia and Mazury in Olsztyn, al. Warszawska 30, 10-082 Olsztyn, Poland
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Maniaci A, Saibene AM, Calvo-Henriquez C, Vaira L, Radulesco T, Michel J, Chiesa-Estomba C, Sowerby L, Lobo Duro D, Mayo-Yanez M, Maza-Solano J, Lechien JR, La Mantia I, Cocuzza S. Is generative pre-trained transformer artificial intelligence (Chat-GPT) a reliable tool for guidelines synthesis? A preliminary evaluation for biologic CRSwNP therapy. Eur Arch Otorhinolaryngol 2024; 281:2167-2173. [PMID: 38329526 DOI: 10.1007/s00405-024-08464-9] [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: 11/15/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Biologic therapies for Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) have emerged as an auspicious treatment alternative. However, the ideal patient population, dosage, and treatment duration are yet to be well-defined. Moreover, biologic therapy has disadvantages, such as high costs and limited access. The proposal of a novel Artificial Intelligence (AI) algorithm offers an intriguing solution for optimizing decision-making protocols. METHODS The AI algorithm was initially programmed to conduct a systematic literature review searching for the current primary guidelines on biologics' clinical efficacy and safety in treating CRSwNP. The review included a total of 12 studies: 6 systematic reviews, 4 expert consensus guidelines, and 2 surveys. Simultaneously, two independent human researchers conducted a literature search to compare the results. Subsequently, the AI was tasked to critically analyze the identified papers, highlighting strengths and weaknesses, thereby creating a decision-making algorithm and pyramid flow chart. RESULTS The studies evaluated various biologics, including monoclonal antibodies targeting Interleukin-5 (IL-5), IL-4, IL-13, and Immunoglobulin E (IgE), assessing their effectiveness in different patient populations, such as those with comorbid asthma or refractory CRSwNP. Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha subunit, demonstrated significant improvement in nasal symptoms and quality of life in patients with CRSwNP in several randomized controlled trials and systematic reviews. Similarly, mepolizumab and reslizumab, which target IL-5, have also shown efficacy in reducing nasal polyp burden and improving symptoms in patients with CRSwNP, particularly those with comorbid asthma. However, additional studies are required to confirm the long-term efficacy and safety of these biologics in treating CRSwNP. CONCLUSIONS Biologic therapies have surfaced as a promising treatment option for patients with severe or refractory CRSwNP; however, the optimal patient population, dosage, and treatment duration are yet to be defined. The application of AI in decision-making protocols and the creation of therapeutic algorithms for biologic drug selection, could offer fascinating future prospects in the management of CRSwNP.
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Affiliation(s)
- Antonino Maniaci
- Faculty of Medicine and Surgery, "Kore" University of Enna, Enna, Italy.
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Otorhino-Laryngological Societies (YO-IFOS), Paris, France.
| | - Alberto Maria Saibene
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Otorhino-Laryngological Societies (YO-IFOS), Paris, France
- Otolaryngology Unit, Santi Paolo E Carlo Hospital, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Christian Calvo-Henriquez
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Otorhino-Laryngological Societies (YO-IFOS), Paris, France
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Luigi Vaira
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Otorhino-Laryngological Societies (YO-IFOS), Paris, France
- Maxillofacial Surgery Unit, University Hospital of Sassari, Sassari, Italy
| | - Thomas Radulesco
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Otorhino-Laryngological Societies (YO-IFOS), Paris, France
- ENT Surgeon, Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, Aix-Marseille Univesity, 147 Bd Baille, 13005, Marseille, France
| | - Justin Michel
- ENT Surgeon, Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, Aix-Marseille Univesity, 147 Bd Baille, 13005, Marseille, France
| | - Carlos Chiesa-Estomba
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Otorhino-Laryngological Societies (YO-IFOS), Paris, France
- ENT-Head and Neck Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - Leigh Sowerby
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Otorhino-Laryngological Societies (YO-IFOS), Paris, France
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine, Western University, London, UK
| | - David Lobo Duro
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Otorhino-Laryngological Societies (YO-IFOS), Paris, France
- Rhinology, Endoscopic Sinus and Skull Base Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Valdecilla Biomedical Research Institute, IDIVAL, Santander, Spain
| | - Miguel Mayo-Yanez
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Otorhino-Laryngological Societies (YO-IFOS), Paris, France
- Department of Otorhinolaryngology, A Coruña University Hospital Complex, 15006, A Coruña, Spain
| | - Juan Maza-Solano
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Otorhino-Laryngological Societies (YO-IFOS), Paris, France
- Servicio de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla. Hospital Quirónsalud Sagrado Corazón, Seville. Departamento de Cirugía, Universidad de Sevilla, Seville, Spain
| | - Jerome Rene Lechien
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Otorhino-Laryngological Societies (YO-IFOS), Paris, France
- Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Ignazio La Mantia
- Deparment of Medical, Surgical Sciences and Advanced Technologies G.F.Ingrassia, University of Catania, 95123, Catania, Italy
| | - Salvatore Cocuzza
- Deparment of Medical, Surgical Sciences and Advanced Technologies G.F.Ingrassia, University of Catania, 95123, Catania, Italy
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Calvanese L, Fabbris C, Brescia G, Di Pasquale Fiasca VM, Deretti A, Finozzi F, Franz L, Frigo AC, Marioni G. Polyps' Extension and Recurrence in Different Endotypes of Chronic Rhinosinusitis: A Series of 449 Consecutive Patients. J Clin Med 2024; 13:1125. [PMID: 38398437 PMCID: PMC10889470 DOI: 10.3390/jcm13041125] [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: 12/29/2023] [Revised: 02/03/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Different inflammatory endotypes reflect the heterogeneity of chronic rhinosinusitis with nasal polyps' (CRSwNPs) clinical presentation. This retrospective study aimed to analyze the distribution of polyps in nasal cavities and paranasal sinuses to establish a possible association between CRSwNP endotypes, prognosis, and polyps' extension. This study included 449 adult patients who underwent endoscopic sinus surgery for CRSwNPs between 2009 and 2022. Patients were categorized based on the number of paranasal sinuses involved by polyps. Statistical analyses, including Cox regression, were performed to identify associations between demographic, clinical, and histopathological factors and disease recurrence. CRSwNP patients were stratified into four groups based on the extent of polyp involvement. Asthma and acetylsalicylic acid (ASA) sensitivity were associated with more sinuses involved (p-values = 0.0003 and 0.0037, respectively). Blood eosinophil counts increased with the number of sinuses affected (p-value < 0.0001). The distribution of eosinophilic and non-eosinophilic histotypes varied significantly among these groups (p-value < 0.0001). The risk of CRSwNP recurrence was higher in patients with asthma, higher basophil percentages, and eosinophilic histotype (p-value 0.0104, 0.0001, 0.0118, and 0.0104, respectively). This study suggests a positive association between the number of paranasal sinuses involved by polyps and the severity of CRSwNPs, particularly in patients with eosinophilic histotype, asthma, and ASA sensitivity.
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Affiliation(s)
- Leonardo Calvanese
- ENT Unit, Department of Surgery, Ospedali Riuniti Padova Sud, 35043 Monselice, Italy; (L.C.); (C.F.)
| | - Cristoforo Fabbris
- ENT Unit, Department of Surgery, Ospedali Riuniti Padova Sud, 35043 Monselice, Italy; (L.C.); (C.F.)
- Department of Medicine DIMED, Padova University, 35100 Padova, Italy
| | - Giuseppe Brescia
- ENT Unit, Department of Surgery, Ospedali Riuniti Padova Sud, 35043 Monselice, Italy; (L.C.); (C.F.)
| | | | - Alessandra Deretti
- Section of Otolaryngology, Department of Neuroscience DNS, Padova University, 35100 Padova, Italy; (V.M.D.P.F.); (A.D.); (F.F.)
| | - Francesco Finozzi
- Section of Otolaryngology, Department of Neuroscience DNS, Padova University, 35100 Padova, Italy; (V.M.D.P.F.); (A.D.); (F.F.)
| | - Leonardo Franz
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, Padova University, 31100 Treviso, Italy; (L.F.); (G.M.)
| | - Anna Chiara Frigo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Padova University, 35100 Padova, Italy;
| | - Gino Marioni
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, Padova University, 31100 Treviso, Italy; (L.F.); (G.M.)
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