1
|
Jankowski R, Favier V, Saroul N, Lecanu JB, Nguyen DT, de Gabory L, Verillaud B, Rumeau C, Gallet P, Béquignon E, Vandersteen C, Patron V. Critical review of diagnosis in rhinology and its therapeutical implications. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:271-278. [PMID: 37838600 DOI: 10.1016/j.anorl.2023.10.006] [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: 10/16/2023]
Abstract
Diagnosis in rhinology is currently based on the concept of inflammation (chronic rhinosinusitis [CRS]) or the clinical concept of chronic nasal dysfunction (CND). The complementarity between these two approaches can be discussed by a critical review of the literature structured by the analysis of the fundamental and diagnostic bases and the therapeutic implications linked to each. The concept of CRS is based on the anatomical continuity of the nasal and sinus respiratory mucosa and molecular biology data, seeking to analyze the mechanisms of chronic inflammation and to identify proteins and biomarkers involved in the different supposed endotypes of chronic inflammation of this mucosa. The concept of CND seeks to analyze medical, instrumental or surgical diagnostic and therapeutic strategies, taking account of both inflammatory and non-inflammatory causes impacting the anatomy or physiology of each of the three noses (olfactory, respiratory and sinus) that make up the mid-face sinonasal organ of evolution-development (Evo-Devo) theory. Thus, the concept of CRS offers an endotypic approach, based on biological characterization of mucosal inflammation, while the concept of CND offers a compartmentalized phenotypic and pathophysiological approach to sinonasal diseases. The joint contribution of these two concepts in characterizing nasal functional pathology could in future improve the medical service provided to patients.
Collapse
Affiliation(s)
- R Jankowski
- Service ORL & chirurgie cervico-faciale, hôpital de Brabois, université de Lorraine, CHRU, Nancy, France.
| | - V Favier
- Département ORL, CCF et CMF, hôpital Gui-de-Chauliac, CHU de Montpellier, université Montpellier, Montpellier, France
| | - N Saroul
- Équipe ASMS, service d'oto-rhino-laryngologie et chirurgie cervico-faciale, INRAE, UNH, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - J-B Lecanu
- Service ORL & chirurgie cervico-faciale, institut Arthur-Vernes, Paris, France
| | - D T Nguyen
- Service ORL & chirurgie cervico-faciale, hôpital de Brabois, université de Lorraine, CHRU, Nancy, France
| | - L de Gabory
- Service d'ORL, de chirurgie cervico-faciale et pédiatrique, centre F-X Michelet, hôpital Pellegrin, CHU, université de Bordeaux, Bordeaux, France
| | - B Verillaud
- Service d'ORL, hôpital Lariboisière, AP-HP, Inserm U1131, université Paris Cité, 2, rue Ambroise-Paré, 75010 Paris, France
| | - C Rumeau
- Service ORL & chirurgie cervico-faciale, hôpital de Brabois, université de Lorraine, CHRU, Nancy, France
| | - P Gallet
- Service ORL & chirurgie cervico-faciale, hôpital de Brabois, université de Lorraine, CHRU, Nancy, France
| | - E Béquignon
- Service Orl & chirurgie cervico-faciale, hôpital Henri-Mondor, CHIC Créteil, Créteil, France
| | - C Vandersteen
- Centre hospitalier universitaire, institut universitaire de la face et du cou, université Côte d'Azur, 31, avenue de Valombrose, Alpes-Maritimes, 06100 Nice, France
| | - V Patron
- Service ORL & chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France
| |
Collapse
|
2
|
Fieux M, Carsuzaa F, Nourredine M, Alexandru M, Giroudon C, Bartier S, Legré M, Favier V, Fath L. Surgical and instrumental options for chronic rhinitis: A systematic review and PRISMA meta-analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:279-287. [PMID: 37867008 DOI: 10.1016/j.anorl.2023.10.009] [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: 10/24/2023]
Abstract
BACKGROUND There is no consensus on the role of surgery in the treatment of chronic rhinitis (CR). Should it be considered when nasal symptoms are not controlled by medical treatment? Various targets (turbinates and secretory nerves) and techniques (surgical, laser, cryotherapy, radiofrequency and phototherapy) have been reported, but benefit varies between reports. The aim of this systematic review and meta-analysis was to evaluate results of surgical and instrumental procedures in CR care. METHODS Two systematic reviews of the US National Library of Medicine, Cochrane Library, Web of Science and Embase databases were conducted in October 15, 2021 (registration numbers CRD42021284257 and CRD42021295227). A database watch was performed until submission of the manuscript. The review focuses on total nasal symptom score (TNSS) and quality of life (QoL) after treatment. All controlled studies reporting nasal surgery/instrumental procedures in adult patients with CR were included. RESULTS The database search yielded a total of 5628 articles; after eligibility screening, 2091 patients were included from 21 studies. QoL results favored surgery/instrumental procedures over medical treatment (SMD -1.27; 95% CI [-2.38; -0.16]; I2=97%), as did TNSS (SMD -1.40; 95% CI [-2.30; -0.50]; I2=98%). The small number of studies and their heterogeneity did not allow meta-regression to be performed. CONCLUSION This systematic review supports the use of surgical/instrumental procedures to improve nasal symptom score and QoL of adult patients with CR poorly controlled by medical treatment.
Collapse
Affiliation(s)
- M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite cedex, France.
| | - F Carsuzaa
- Service ORL, chirurgie cervico-maxillo-faciale et audiophonologie, centre hospitalier universitaire de Poitiers, 86000 Poitiers, France
| | - M Nourredine
- Service de biostatistiques de Lyon, pôle santé publique, hospices civil de Lyon, Lyon, France
| | - M Alexandru
- Service d'ORL et chirurgie cervico-faciale, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Saclay, 78, rue du Général-Leclerc, 94270 le Kremlin-Bicêtre, France
| | - C Giroudon
- Service de la documentation centrale, hospices civils de Lyon, 69424 Lyon cedex, France
| | - S Bartier
- Service d'ORL, de chirurgie cervico-faciale, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France
| | - M Legré
- Service d'ORL et chirurgie cervico-faciale, institut Arthur-Vernes, Paris, France
| | - V Favier
- Département d'ORL, chirurgie cervico-faciale et maxillo-faciale, hôpital Gui-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - L Fath
- Service d'ORL, de chirurgie cervico-faciale, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France
| |
Collapse
|
3
|
Barron M, Nguyen DT, Rumeau C, Jankowski R. Chronic respiratory rhinitis: Toward endoscopic diagnosis of nasal allergy? An observational study. Eur Ann Otorhinolaryngol Head Neck Dis 2022; 139:177-183. [DOI: 10.1016/j.anorl.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
4
|
Jung HJ, Lee JY, Choi YS, Choi HG, Wee JH. Chronic rhinosinusitis and progression of cognitive impairment in dementia. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:147-151. [PMID: 33041243 DOI: 10.1016/j.anorl.2020.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/09/2020] [Accepted: 05/05/2020] [Indexed: 11/29/2022]
Abstract
AIM The relationship between chronic inflammatory disease and cognitive decline is still unclear, but there is increasing evidence to support the role of systemic inflammation. The aim of this study was to investigate if chronic rhinosinusitis (CRS) in dementia or mild cognitive impairment (MCI) is associated with the progression of cognitive decline. MATERIAL AND METHODS We retrospectively reviewed the data of patients who complained of memory impairment, and underwent brain magnetic resonance imaging (MRI) from January 2006 to April 2019. According to the Mini-Mental State Examination (MMSE) score, subjects (n=661) were divided into three groups: dementia (≤17), MCI (18-23), and normal (≥24). CRS was defined as a total score of greater than or equal to 4 according to the Lund-Mackay scoring system using brain MRI. Multiple logistic regression analyses estimated adjusted odds ratio (aOR) for the association between CRS and dementia or MCI. Among the subjects with follow-up MMSE (n=286), a repeated-measures ANOVA was used to assess the difference of changes in MMSE scores between the groups with and without CRS. RESULTS According to the initial MMSE score, there were 221 subjects with dementia, 195 with MCI, and 245 with normal results. CRS was not significantly associated with dementia (aOR=1.519, CI=0.909-2.538, P=0.111), while being suggestively associated with MCI (aOR=1.740, CI=1.041-2.906, P=0.034). The MMSE scores at follow-up decreased further in subjects with CRS than in those without CRS (P=0.009). Especially, in the initial dementia group, there was a significant between-group difference in the MMSE score from baseline to follow-up (13.6±4.3 to 11.1±6.3 in CRS group vs. 13.5±3.3 to 14.4±5.4 in no CRS group, P=0.002). CONCLUSION The result of the present study implies a potential association between CRS and progression of cognitive decline. Physicians should be aware of this possibility in patients with clinically diagnosed CRS.
Collapse
Affiliation(s)
- H-J Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - J-Y Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Y-S Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - H-G Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - J-H Wee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
| |
Collapse
|
5
|
Jankowski R, Rumeau C, Gallet P, Nguyen DT. Nasal polyposis (or chronic olfactory rhinitis). Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:191-196. [PMID: 29661611 DOI: 10.1016/j.anorl.2018.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The concept of chronic rhinosinusitis with or without polyps is founded on the structural and functional unicity of the pituitary mucosa and its united response to environmental aggression by allergens, viruses, bacteria, pollution, etc. The present review sets this concept against the evo-devo three-nose theory, in which nasal polyposis is distinguished as specific to the olfactory nose and in particular to the non-olfactory mucosa of the ethmoid, which is considered to be not a sinus but rather the skull-base bone harboring the olfactory mucosa. The evo-devo approach enables simple and precise positive diagnosis of nasal polyposis and its various clinical forms, improves differential diagnosis by distinguishing chronic diseases of the respiratory nose and those of the paranasal sinuses, hypothesizes an autoimmune origin specifically aimed at olfactory system auto-antigens, and supports the surgical concept of nasalization against that of functional sinus and ostiomeatal-complex surgery. The ventilation function of the sinuses seems minor compared to their production, storage and active release of nitric oxide (NO) serving to oxygenate arterial blood in the pulmonary alveoli. This respiratory function of the paranasal sinuses may indeed be their most important. NO trapped in the ethmoidal spaces also accounts for certain radiographic aspects associated with nasal polyposis.
Collapse
Affiliation(s)
- R Jankowski
- Service d'ORL, chirurgie cervico-faciale, hôpitaux de Brabois, Bât-Louis-Mathieu, CHRU de Nancy, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France
| | - C Rumeau
- Service d'ORL, chirurgie cervico-faciale, hôpitaux de Brabois, Bât-Louis-Mathieu, CHRU de Nancy, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France
| | - P Gallet
- Service d'ORL, chirurgie cervico-faciale, hôpitaux de Brabois, Bât-Louis-Mathieu, CHRU de Nancy, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France
| | - D T Nguyen
- Service d'ORL, chirurgie cervico-faciale, hôpitaux de Brabois, Bât-Louis-Mathieu, CHRU de Nancy, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France.
| |
Collapse
|