1
|
Wise SK, Adappa ND, Chandra RK, Davis GE, Mahdavinia M, Mahmoud R, Messina J, Palmer JN, Patel ZM, Peters AT, Schlosser RJ, Sindwani R, Soler ZM, White AA. EDS-FLU efficacy in patients with chronic rhinosinusitis with or without prior sinus surgery in ReOpen1 and ReOpen2 randomized controlled trials. Int Forum Allergy Rhinol 2024. [PMID: 39186196 DOI: 10.1002/alr.23434] [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: 03/29/2024] [Revised: 07/15/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND The inability of topical medications to reach sinus cavities is a potential reason for lack of efficacy in chronic rhinosinusitis (CRS). One purpose of endoscopic sinus surgery (ESS) is to enable delivery of medications into the sinus cavities. The exhalation delivery system with fluticasone (EDS-FLU; XHANCE) creates unique biomechanics that enable deposition of intranasal corticosteroid into sinuses and sinus drainage pathways but may have differing efficacy in operated versus unoperated sinuses. Two 24-week randomized trials (ReOpen1/2) evaluated EDS-FLU versus EDS-placebo in patients with CRS, stratified by surgical status. METHODS Surgery-naive (n = 332) and prior-surgery (n = 215) patient groups were analyzed as pooled data from ReOpen1/2. Outcome measures (least-squares mean change from baseline) included combined symptom score (CSS) and congestion score at weeks 4, 8, and 12 and average of percentages of opacified volume (APOV) of ethmoid/maxillary sinuses on CT and Sinonasal Outcome Test 22 (SNOT-22) total score at week 24. RESULTS Baseline scores suggested moderate-severe disease: mean CSS = 5.8; APOV = 67.2%. EDS-FLU produced significant improvement versus placebo (p < 0.05): CSS (surgery-naive, -0.68 vs. -1.42; prior ESS, -0.70 vs. -1.87); congestion (surgery-naive, -0.24 vs. -0.59; prior ESS, -0.24 vs. -0.69); and SNOT-22 (surgery-naive, -7.56 vs. -18.30; prior ESS, -10.72 vs. -18.74). Similar results were observed for APOV (p < 0.05). No statistically significant difference was observed between surgery subgroups with either EDS-FLU dose. CONCLUSION EDS-FLU improved symptoms, sinus opacification, and quality of life in patients with CRS with or without prior ESS, suggesting a role for EDS-FLU in both populations.
Collapse
Affiliation(s)
- Sarah K Wise
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nithin D Adappa
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Greg E Davis
- University of Washington, Seattle, Washington, USA
| | | | | | | | - James N Palmer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zara M Patel
- Stanford University School of Medicine, Stanford, California, USA
| | - Anju T Peters
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | | - Zachary M Soler
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | |
Collapse
|
2
|
Peters AT, Tan BK, Stevens WW. Consultation for Chronic Rhinosinusitis With Nasal Polyps and Asthma: Clinical Presentation, Diagnostic Workup, and Treatment Options. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00769-4. [PMID: 39089438 DOI: 10.1016/j.jaip.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/03/2024] [Accepted: 07/19/2024] [Indexed: 08/04/2024]
Abstract
Chronic rhinosinusitis (CRS) is characterized by chronic inflammation of the sinonasal mucosa, affects over 12% of the US population, and costs over $20 billion annually. CRS can be divided into 2 major phenotypes based on whether nasal polyps are present (chronic rhinosinusitis with nasal polyps [CRSwNP]) or absent (chronic rhinosinusitis without nasal polyps). This grand rounds review will discuss the clinical approach to patients with CRSwNP, including typical presentations, workup, and currently available treatment options. Tools that physicians can use to assess subjective sinonasal symptoms, as well as objective measures of disease, will be reviewed. Additional focus will be on recognizing clinical comorbidities commonly associated with CRSwNP, including asthma, bronchiectasis, allergic rhinitis, and nonsteroidal anti-inflammatory drug-exacerbated respiratory disease. Clinical outcomes can be improved by providing a comprehensive approach to evaluating (and managing) patients with CRSwNP.
Collapse
Affiliation(s)
- Anju T Peters
- Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Bruce K Tan
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Whitney W Stevens
- Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| |
Collapse
|
3
|
Palmer JN, Adappa ND, Chandra RK, Davis GE, Mahdavinia M, Messina J, Ow RA, Patel ZM, Peters AT, Sacks H, Schlosser RJ, Sindwani R, Soler ZM, White AA, Wise SK, Mahmoud RA. Efficacy of EDS-FLU for Chronic Rhinosinusitis: Two Randomized Controlled Trials (ReOpen1 and ReOpen2). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1049-1061. [PMID: 38244014 DOI: 10.1016/j.jaip.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease. No medications are Food and Drug Administration-approved for the most common form, CRS without nasal polyps (also called "chronic sinusitis"). Novel biomechanics of the exhalation delivery system deliver fluticasone (EDS-FLU; XHANCE) to sinonasal areas above the inferior turbinate, especially sinus drainage pathways not reached by standard-delivery nasal sprays. OBJECTIVE Assess EDS-FLU efficacy for CRS (irrespective of nasal polyps). METHODS Two randomized, EDS-placebo-controlled trials in adults with CRS irrespective of polyps (ReOpen1) or exclusively without polyps (ReOpen2) were conducted at 120 sites in 13 countries. Patients received EDS-FLU 1 or 2 sprays/nostril, or EDS-placebo, twice daily for 24 weeks. Coprimary measures were composite symptom score through week 4 and ethmoid/maxillary sinus percent opacification by computed tomography at week 24. RESULTS ReOpen1 (N = 332) composite symptom score least-squares mean change for EDS-FLU 1 or 2 sprays/nostril versus EDS-placebo was -1.58 and -1.60 versus -0.62 (P < .001, P < .001); ReOpen2 (N = 223), -1.54 and -1.74 versus -0.81 (P = .011, P = .001). In ReOpen1, sinus opacification least-squares mean change for EDS-FLU 1 or 2 sprays/nostril versus EDS-placebo was -5.58 and -6.20 versus -1.60 (P = .045, P = .018), and in ReOpen2, -7.00 and -5.14 versus +1.19 (P < .001, P = .009). Acute disease exacerbations were reduced by 56% to 66% with EDS-FLU versus EDS-placebo (P = .001). There were significant, and similar magnitude, symptom reductions in patients using standard-delivery nasal steroid products just before entering the study (P < .001). Adverse events were similar to standard-delivery intranasal steroids. CONCLUSIONS EDS-FLU is the first nonsurgical treatment demonstrated to reduce symptoms, intrasinus opacification, and exacerbations in replicate randomized clinical trials in CRS, regardless of polyp status.
Collapse
Affiliation(s)
- James N Palmer
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pa.
| | - Nithin D Adappa
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pa
| | | | | | | | | | - Randall A Ow
- Sacramento Ear Nose Throat Medical & Surgical Group, Roseville, Calif
| | - Zara M Patel
- Stanford University School of Medicine, Stanford, Calif
| | - Anju T Peters
- Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | | | | | | | | | - Sarah K Wise
- Emory University School of Medicine, Atlanta, Ga
| | | |
Collapse
|
4
|
Laidlaw TM, White AA. Should Biologics Be Used Before Aspirin Desensitization in Aspirin-Exacerbated Respiratory Disease? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:79-84. [PMID: 37778627 PMCID: PMC10842409 DOI: 10.1016/j.jaip.2023.09.019] [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: 09/05/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
There has been a paradigm shift in the management of aspirin-exacerbated respiratory disease (AERD). It started in 2015 when the first biologic was Food and Drug Administration (FDA) approved for severe eosinophilic asthma. Thus, there emerged a new era in the treatment of patients with type 2-mediated airway diseases. This has led to an increasing number of options for patients, undoubtably a great thing, but has left clinicians without a clear answer for how to balance the therapies that exist for AERD, what to recommend for treatment, and how to best assess the benefits and risks of each therapy. This paper aims to explore these benefits and risks, and to provide a roadmap for future studies.
Collapse
Affiliation(s)
- Tanya M Laidlaw
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Andrew A White
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| |
Collapse
|
5
|
Yardstick for managing cough, part 1: In adults and adolescent patients older than 14 years of age. Ann Allergy Asthma Immunol 2023; 130:379-391. [PMID: 36526233 DOI: 10.1016/j.anai.2022.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Nationwide statistics in the United States and Australia reveal that cough of undifferentiated duration is the most common complaint for which patients of all ages seek medical care in the ambulatory setting. Management of chronic cough is one of the most common reasons for new patient visits to pulmonologists. Because symptomatic cough is such a common problem and so much has been learned about how to diagnose and treat cough of all durations but especially chronic cough, this 2-part yardstick has been written to review in a practical way the latest evidence-based guidelines most of which have been developed from recent high quality systematic reviews on how best to manage cough of all durations in adults, adolescents, and children. In this manuscript, part 1 of the 2-part series, we provide evidence-based, and expert opinion recommendations on the management of chronic cough in adult and adolescent patients (>14 years of age).
Collapse
|
6
|
Chen CC, Buchheit KM. Endotyping Chronic Rhinosinusitis with Nasal Polyps: Understanding Inflammation Beyond Phenotypes. Am J Rhinol Allergy 2023; 37:132-139. [PMID: 36848270 DOI: 10.1177/19458924221149003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogenous group of inflammatory conditions impacting the nose and paranasal sinuses. Our understanding of the underlying pathobiology of CRSwNP has substantially improved due to ongoing translational research efforts. Advances in treatment options, including targeted respiratory biologic therapy for CRSwNP, allow for more personalized approaches for CRSwNP patient care. Patients with CRSwNP are typically classified to one or more endotype based on the presence of type 1, type 2, and type 3 inflammation. This review will discuss recent advances in our understanding of CRSwNP and how this may impact current and future treatment approaches for patients with CRSwNP.
Collapse
Affiliation(s)
- Chongjia C Chen
- Department of Medicine, Harvard Medical School, the Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, MA, USA
| | - Kathleen M Buchheit
- Department of Medicine, Harvard Medical School, the Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
7
|
Siegel J, Gill N, Ramanathan M, Patadia M. Unified Airway Disease. Otolaryngol Clin North Am 2023; 56:39-53. [DOI: 10.1016/j.otc.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
8
|
Bernstein JA, White AA, Han JK, Lang DM, Elkayam D, Baroody FM. Review of evidence supporting the use of nasal corticosteroid irrigation for chronic rhinosinusitis. Ann Allergy Asthma Immunol 2023; 130:46-57. [PMID: 36116748 DOI: 10.1016/j.anai.2022.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze published reports on the efficacy and safety of CSI in CRS and evaluate the clinical implications of current gaps in evidence. Corticosteroid irrigation (CSI) is commonly used for management of chronic rhinosinusitis (CRS) with nasal polyps; however, such use is not approved by the US Food and Drug Administration (FDA). DATA SOURCES Publications were obtained through PubMed searches through January 2022. STUDY SELECTION Searches were conducted using 2 terms: "chronic rhinosinusitis" or "nasal polyps" as the first term and "corticosteroid irrigation," "steroid nasal lavage," or "sinus rinse" as the second term. We reviewed relevant, peer-reviewed literature (19 original research [9 controlled, 10 uncontrolled trials], 7 reviews, and 1 meta-analysis) reporting safety and efficacy of CSI in patients with CRS. RESULTS Studies were difficult to compare because they used a variety of solution volumes (60 mL to 125 mL per nostril), corticosteroid agents (budesonide, betamethasone, mometasone, or fluticasone), corticosteroid doses, preparation protocols (by compounding pharmacy or by patient), and administration (frequency, time of day, body positioning). It is difficult to determine which parameters might substantially influence clinical effects because studies were generally small, showed marginal benefits, and rarely assessed safety. To date, no studies evaluating CSI have shown statistically significant differences in a type-I error-controlled primary end point over any comparator, possibly owing to small sample sizes. CONCLUSION Designing more robust clinical trials may help determine whether CSI is a valid treatment option. Until more evidence supporting CSI use exists, health care professionals should strongly consider choosing FDA-approved therapies for the treatment of CRS.
Collapse
Affiliation(s)
- Jonathan A Bernstein
- Division of Immunology-Allergy Section, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Andrew A White
- Division of Allergy, Asthma and Immunology, Scripps Clinic, La Jolla, California
| | - Joseph K Han
- Eastern Virginia Medical School, Norfolk, Virginia
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - David Elkayam
- Bellingham Asthma, Allergy and Immunology Clinic, Bellingham, Washington
| | - Fuad M Baroody
- Department of Surgery (Otolaryngology-Head and Neck Surgery) and Pediatrics, University of Chicago Medicine and the Comer Children's Hospital, Chicago, Illinois
| |
Collapse
|
9
|
Lin L, Cheng L. Current and Emerging Treatment Options in Sinus and Nasal Diseases: A Promising Future in the Appropriate Therapies. J Clin Med 2022; 11:jcm11247398. [PMID: 36556014 PMCID: PMC9788022 DOI: 10.3390/jcm11247398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
Chronic rhinosinusitis (CRS) is an inflammatory condition of the nose and paranasal sinuses defined by clinical symptoms, including two or more symptoms, one of which should be either nasal blockage or nasal discharge with or without facial pain/pressure or reduction in/loss of sense of smell [...].
Collapse
Affiliation(s)
- Lin Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai 200040, China
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
- Correspondence:
| |
Collapse
|
10
|
Rank MA, Shaker MS. Biologics for chronic rhinosinusitis with nasal polyposis: What should we do now without direct comparison trials? Ann Allergy Asthma Immunol 2022; 129:136-137. [PMID: 35878958 DOI: 10.1016/j.anai.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Matthew A Rank
- Mayo Clinic in Arizona, Phoenix and Scottsdale, Arizona.
| | - Marcus S Shaker
- Dartmouth Geisel School of Medicine and Dartmouth Hitchcock Medical Center, Section of Allergy, Lebanon, New Hampshire
| |
Collapse
|
11
|
Yang Y, Sun Y, Xiang F, Zhang M, Fu L, Zhang Q. Efficacy and safety of traditional Chinese medicine nasal irrigation on chronic rhinosinusitis recovery after endoscopic sinus surgery: A protocol for a systematic review and meta-analysis. PLoS One 2022; 17:e0272371. [PMID: 35913939 PMCID: PMC9342793 DOI: 10.1371/journal.pone.0272371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Continuous comprehensive treatment is still needed after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) to promote the recovery of sinus mucosal morphology and function. Traditional Chinese medicine (TCM) nasal irrigation is a promising external treatment of TCM, but at present, the application of TCM nasal irrigation after ESS for CRS has not been recommended by the guidelines. Therefore, this article aims to develop a systematic overview and meta-analysis protocol to assess the effectiveness and safety of Chinese herbal nasal rinse for CRS recovery after ESS.
Methods
Seven databases shall be retrieved from their inception until December 2021. Eligible randomized controlled trials will be covered in the study. The outcome indicators of the survey will consist of efficacy, visual analogue scale score, Lund-Kennedy score for nasal endoscopy, Lund-Mackay score for sinus computed tomography and other secondary outcome indicators. The selection of literature, extraction of data, and methodological quality evaluation of literature shall be conducted by two researchers separately. If there is any dispute, it can be discussed and solved by a third researcher. Review Manager 5.3 software will be applied to data analysis.
Results
The article will make a detailed research programme to explore the efficacy and safety of TCM nasal irrigation on CRS recovery after ESS.
Conclusion
This protocol is suitable for evaluating the effectiveness and safety of TCM nasal rinse for CRS recovery after ESS, and can provide corresponding evidence-based medical evidence.
Systematic review registration
Open Science Framework Registration DOI: 10.17605/OSF.IO/ZV73Q.
Collapse
Affiliation(s)
- Yepeng Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
| | - Yaning Sun
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
| | - Feng Xiang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
| | - Min Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
| | - Li Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
| | - Qinxiu Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- World Health Organization Collaborating Centre, CHN-56, Chengdu, Sichuan Province, P.R. China
- * E-mail:
| |
Collapse
|
12
|
The Role of Allergen-Specific Immunotherapy in ENT Diseases: A Systematic Review. J Pers Med 2022; 12:jpm12060946. [PMID: 35743730 PMCID: PMC9224998 DOI: 10.3390/jpm12060946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 12/16/2022] Open
Abstract
Previous studies have demonstrated that both subcutaneous (SCIT) and sublingual specific immunotherapy (SLIT) are effective in treating allergic rhinitis (AR). Further studies have evaluated the efficacy of allergen-specific immunotherapy (AIT) on different ear, nose, and throat (ENT) manifestations, in which allergy might have an etiopathogenetic role, such as local allergic rhinitis (LAR), rhinosinusitis (RS), otitis media (OM), and adenotonsillar (AT) disease. Nevertheless, the management of allergy in ENT diseases is still debated. To the best of our knowledge, this is the first systematic review assessing the efficacy of AIT in ENT diseases aside from AR. Literature data confirmed that AIT might be an effective therapeutic option in LAR, although its effect is restricted to studies with short-term follow-up. Furthermore, previous research demonstrated that AIT may improve symptoms and surgical outcomes of chronic rhinosinusitis when used as an adjunctive treatment. Few studies supported the hypothesis that AIT may exert positive therapeutic effects on recurrent upper airway infections as adenotonsillar disease. Finally, some clinical observations suggested that AIT may add some benefits in the management of otitis media with effusion (OME). The results of this systematic review allow us to conclude that the efficacy of AIT in ENT disorders has been only slightly investigated and additional studies are needed.
Collapse
|