Long-term evaluation after endoscopic sinus surgery for chronic pediatric sinusitis with polyps

Antibiofilm and Quorum Sensing Inhibition (QSI) Potential of Lagerstroemia speciosa Leaves Extract

Disruption of quorum sensing pathway of pathogenic microbes is considered as novel approach to fight against infectious diseases. The current study was planned to evaluate the antibiofilm and quorum sensing inhibitory potential of Lagerstroemia speciosa. Antibacterial and antibiofilm potential of L. speciosa extracts was determined through agar well diffusion and crystal violet assay against sinusitis isolates, that is, Staphylococcus aureus, Enterococcus faecalis, Proteus mirabilis, and Klebsiella pneumoniae, while quorum sensing inhibition efficacy of L. speciosa extracts was determined through violacein inhibition assay using Chromobacterium pseudoviolaceum as bacterial model. The methanolic extract of L. speciosa presented the highest antimicrobial activity against E. faecalis and antibiofilm activity against K. pneumoniae (77.42 ± 1.51%), while n-hexane extract was found to be least active against all tested bacterial strains. Quorum sensing inhibition activity of L. speciosa extracts against C. pseudoviolaceum showed significant dose-dependent inhibition in violacein production by different concentrations of methanolic extract. Furthermore, none of the extracts of L. speciosa showed any hemolytic activity against human RBCs and hold considerable thrombolytic potential in comparison to streptokinase (75.9 ± .46%). In conclusion, findings suggest that L. speciosa leaves are excellent source of phytochemicals with potent antibiofilm and quorum sensing inhibition potential.

Clinical features and management of antrochoanal polyps in children: Cues from a clinical series of 58 patients

OBJECTIVE

To review the clinical features of pediatric patients affected by antrochoanal polyps (ACPs) and surgically treated at three University settings.

METHODS

Retrospective study. The present research includes the clinical data of subjects affected by ACPs, aged <18 years and referred to three ENT Departments, between January 1st 2003 and September 30th 2016. All patients underwent nasal endoscopy and sinonasal imaging; all subjects have been treated surgically.

RESULTS

Fifty-eight patients underwent functional endoscopic sinus surgery (FESS) for ACPs removal, under general anesthesia. There were no major intraoperative complications. Recurrence occurred in 12 cases (20.5%).

CONCLUSIONS

FESS was the first-choice treatment for APCs in the present series; our recurrence rate was similar to that of other reports available in literature. Recurrences of ACPs in children still represent a clinical challenge; it is likely that an improved comprehension of ACPs biology could help in better understanding the pathophysiology of this disease.

Recurrences of surgery for antrochoanal polyps in children: A systematic review

OBJECTIVES

The main purpose was to evaluate the recurrence rate after surgery for antrochoanal polyps (ACPs) in children; secondly, we have analyzed the rate of recurrence for different types of surgery and the risk factors involved.

METHODS

We performed a systematic review searching PubMed and MEDLINE databases including English-language published studies from June 1989 to October 2017 regarding surgical treatment of ACPs in children.

RESULTS

We included thirteen studies, eight were retrospective and five prospective, with 285 participants, the mean rate of recurrence after ACPs surgery was 15.0% (95% CI:11.0-20.0). Functional endoscopic sinus surgery (FESS) was the main type of surgery used for primary cases (75.4%) followed by the combined approach i.e. FESS with a transcanine sinusoscopy or mini Caldwell-Luc (14%), the Caldwell-Luc (CWL) (8%) and simple polypectomy (SP) (2.8%). Our analysis has demonstrated a significant reduction of recurrences using the combined approach 0% (95% CI: 0.0-8.0) compared with FESS 17.7% (95% CI: 12.8-23.4) or SP 50% (95% CI:15.7-84.3) (p < .05) but no significant differences with CWL 9.1% (95% CI: 1.1-29.2) and others surgical approaches (p > .05). The analysis of the possible risk factors involved in recurrences are inconclusive.

CONCLUSION

Recurrences of ACPs in children are still high. The endoscopic sinus surgery is considered the first choice for primary treatment, whilst the external approach may be a valid option in case of recurrence. It seems that the combined approach could reduce recurrence rates in selected patients that cannot be completely managed with endoscopy.

Transnasal Prelacrimal Recess Approach for Recurrent Antrachoanal Polyp

PURPOSE

To assess the effectiveness and usefulness of transnasal prelacrimal recess approach (TPRA) in patients with recurrent antrochoanal polyps.

METHODS

Twelve patients with antrochoanal polyp recurrence underwent surgery with a transnasal endoscopic prelacrimal recess approach. Success for visualization of the origin of the polyps, surgical complications, and recurrence was evaluated.

RESULTS

Transnasal prelacrimal recess approach was successful in 83% of the patients (10/12); polyps that originated from a posterior location (2 patients) were excised using the middle meatal approach. Nasolacrimal duct injury occurred in 2 patients but neither had epiphora postoperatively. Three patients (3/12; 25%) had synechia formation between the lateral nasal wall and septum just superior to the inferior turbinate. One of the 3 patients (1/12; 8.3%) with synechia was symptomatic and required surgical treatment under local anesthesia. During a mean follow-up period of 14.2 months (range, 8-21 months) no recurrence had developed.

CONCLUSION

In experienced hands, TPRA is a novel, reliable, and useful method for the treatment of recurrent antrochoanal polyps. It ensures good exploration of the maxillary antrum and easy access to the polyp origin on the maxillary wall without the need of additional approaches.

Effect of distribution of nasal polyps in ostiomeatal complex on long-term outcomes after endoscopic surgery

The objective of the study was to elucidate the characteristics of spatial distribution of nasal polyps in the ostiomeatal complex (OMC) and the corresponding correlation with long-term quality of life in patients who underwent endoscopic sinus surgery. 107 patients with unilateral or bilateral nasal polyps who had undergone functional endoscopic sinus surgery from September 2009 to June 2010 were enrolled in this study. Distribution of nasal polyps in the study subjects was documented. Long-term quality of life assessment was carried out at 1-year after surgery by SNOT-20 analysis. Observation of a total of 214 sides of rhinal cavities revealed that nasal polyps were distributed inside the OMC at 573 sites out of the total 635 sites (90.2 %), and predominantly distributed at the middle turbinate, the ethmoid sinus, the middle meatus, the uncinate process, the maxillary sinus, and the ethmoid bulla and significantly differed from the nasal polyps which were found outside the OMC (P < 0.01). Statistical analysis indicated that pre-operative Sinonasal Outcome Test 20 (SNOT-20) scores and 1-year post-operative scores were statistically significant (P < 0.05). The score changes of the left maxillary sinus, both sides ethmoid bulla were significant, respectively (P < 0.05). Nasal polyps predominantly distribute in the OMC. The differences among the sites of nasal polyps do not significantly impact the long-term score for quality of life except for the maxillary sinus and ethmoid bulla.

Pediatric chronic rhinosinusitis: when should we operate?

PURPOSE OF REVIEW

The timing and role of surgery in the management of pediatric chronic rhinosinusitis (pCRS) remains unclear. This review attempts to summarize the existing literature regarding this topic.

RECENT FINDINGS

pCRS is a complex clinical syndrome that results from multiple potential causes. Multimodal medical therapy is the accepted primary treatment. Adenoidectomy continues to be the appropriate first-line surgical therapy, and the addition of antral lavage or balloon dilation to this procedure may improve outcomes. Functional endoscopic sinus surgery (FESS) in children is safe and effective in relieving symptoms in the majority of patients. Failure to respond to maximal medical therapy continues to be a commonly cited, although poorly defined, requisite for proceeding to surgery. Recent literature has been focused on the outcomes after FESS rather than specifically defining when this intervention should be considered. Nevertheless, the literature seems to continue to support FESS in children with persistent symptoms despite adenoidectomy and appropriate medical treatment for pCRS. As the symptoms of chronic rhinosinusitis (CRS) may result from multiple underlying causes, clinicians must understand that the role and timing of surgery may vary with particular patients' disease.

SUMMARY

Surgical management of CRS in children continues to be a frequent topic of study in the otolaryngology literature. As recent research tends to be focused on outcomes after surgery, further prospective studies comparing surgical versus nonsurgical treatment of CRS will likely be required to better define indications for proceeding to surgery at all.