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Lee SE, Ritter E, Nguyen TT, Onuorah PC, Ebert CS, Senior BA, Thorp BD, Kimple AJ. In Vivo Fluticasone Absorption in Surgical Patients. Laryngoscope 2024; 134:1551-1555. [PMID: 37694807 DOI: 10.1002/lary.31050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/18/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Intranasal corticosteroids (INCS) are a treatment mainstay of chronic rhinosinusitis and allergic rhinitis. Current computational models demonstrate that >90% of INCS drug deposition occurs on the head of the inferior turbinate and nasal valve, rather than the actual sinuses. These models do not consider mucociliary clearance which propels mucus posteriorly, nor do they consider the absorption of the drug. The purpose of this study is to better understand the exact anatomical location where INCS are absorbed. METHODS Patients with chronic rhinosinusitis and allergic rhinitis taking fluticasone pre-operatively who were scheduled for functional endoscopic sinus surgery and inferior turbinate reduction, respectively, were recruited. Intra-operative tissue samples were obtained from predetermined locations within the sinonasal cavity. Mass spectrometry was then used to quantify the amount of absorption in each specific anatomic location to determine the largest amount of absorption. RESULTS Eighteen patients were included in our study. The greatest fluticasone absorption levels across the sinonasal anatomy were at the anterior inferior turbinate (5.7 ngl/mL), ethmoid sinus, (4.4 ng/mL), posterior inferior turbinate (3.7 ng/mL), maxillary sinus (1.3 ng/mL), and the sphenoethmoidal recess (0.72 ng/mL) respectively. Absorption was significantly higher in revision surgery compared to surgically naïve patients. CONCLUSIONS Computation fluid dynamic models of the nasal passage are useful models to help predict intranasal particle flow. However, these models do not incorporate or consider the important mucociliary clearance system, leading to absorption of fluticasone throughout the sinonasal cavity far beyond that predicted by these models. LEVEL OF EVIDENCE 2 Laryngoscope, 134:1551-1555, 2024.
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Affiliation(s)
- Saangyoung E Lee
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth Ritter
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tuong T Nguyen
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Princess C Onuorah
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Charles S Ebert
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brent A Senior
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian D Thorp
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam J Kimple
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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2
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Yathavan B, Chhibber T, Steinhauff D, Pulsipher A, Alt JA, Ghandehari H, Jafari P. Matrix-Mediated Delivery of Silver Nanoparticles for Prevention of Staphylococcus aureus and Pseudomonas aeruginosa Biofilm Formation in Chronic Rhinosinusitis. Pharmaceutics 2023; 15:2426. [PMID: 37896186 PMCID: PMC10610389 DOI: 10.3390/pharmaceutics15102426] [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: 09/04/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a chronic health condition affecting the sinonasal cavity. CRS-associated mucosal inflammation leads to sinonasal epithelial cell death and epithelial cell barrier disruption, which may result in recurrent bacterial infections and biofilm formation. For patients who fail medical management and elect endoscopic sinus surgery for disease control, bacterial biofilm formation is particularly detrimental, as it reduces the efficacy of surgical intervention. Effective treatments that prevent biofilm formation in post-operative patients in CRS are currently limited. To address this unmet need, we report the controlled release of silver nanoparticles (AgNps) with silk-elastinlike protein-based polymers (SELPs) to prevent bacterial biofilm formation in CRS. This polymeric network is liquid at room temperature and forms a hydrogel at body temperature, and is hence, capable of conforming to the sinonasal cavity upon administration. SELP hydrogels demonstrated sustained AgNp and silver ion release for the studied period of three days, potent in vitro antibacterial activity against Pseudomonas aeruginosa (**** p < 0.0001) and Staphylococcus aureus (**** p < 0.0001), two of the most commonly virulent bacterial strains observed in patients with post-operative CRS, and high cytocompatibility with human nasal epithelial cells. Antibacterial controlled release platform shows promise for treating patients suffering from prolonged sinonasal cavity infections due to biofilms.
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Affiliation(s)
- Bhuvanesh Yathavan
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT 84112, USA; (B.Y.); (T.C.); (A.P.); (J.A.A.); (H.G.)
- Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA;
| | - Tanya Chhibber
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT 84112, USA; (B.Y.); (T.C.); (A.P.); (J.A.A.); (H.G.)
- Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA;
| | - Douglas Steinhauff
- Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA;
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Abigail Pulsipher
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT 84112, USA; (B.Y.); (T.C.); (A.P.); (J.A.A.); (H.G.)
- Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA;
- Department of Otolaryngology—Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Jeremiah A. Alt
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT 84112, USA; (B.Y.); (T.C.); (A.P.); (J.A.A.); (H.G.)
- Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA;
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
- Department of Otolaryngology—Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Hamidreza Ghandehari
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT 84112, USA; (B.Y.); (T.C.); (A.P.); (J.A.A.); (H.G.)
- Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA;
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
- Department of Otolaryngology—Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Paris Jafari
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT 84112, USA; (B.Y.); (T.C.); (A.P.); (J.A.A.); (H.G.)
- Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA;
- Center for Integrative Genomics, University of Lausanne, 1015 Lausanne, Switzerland
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3
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Chen J, Wang H, Zhang C, Shi L, Zhang Q, Song X, Wang D, Hu L, Yu H, Sun X. Comparative short-term efficacy of endoscopic sinus surgery and biological therapies in chronic rhinosinusitis with nasal polyps: A network meta-analysis. Clin Transl Allergy 2023; 13:e12269. [PMID: 37357547 DOI: 10.1002/clt2.12269] [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: 11/30/2022] [Revised: 04/22/2023] [Accepted: 05/18/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND To compare the safety and efficacy between endoscopic sinus surgery and different biologics in treating chronic rhinosinusitis with nasal polyps in adults by reviewing the existing clinical trials. METHODS Data extraction and risk of bias assessment were conducted by 2 independent reviewers according to the PRISMA recommendations and any disagreement was resolved by a third investigator. Outcomes were measured through a random-effects model. We searched Embase, Web of Science, MEDLINE, Cochrane, and other relevant sources from its inception to April 30, 2022. We included randomized controlled trials(RCTs) involving endoscopic sinus surgery (ESS) or biologics in treating adult patients with chronic rhinosinusitis with nasal polyps. Studies involving other miscellaneous diseases, non-RCT design, and insufficient participants or follow-up were excluded. RESULTS In this systematic review, five RCTs and 1748 patients were included. All the biologics, as well as ESS, could significantly improve key nasal outcomes in CRSwNP both at 6 months and 1 year. Dupilumab exhibited better efficacy than ESS in improving SNOT-22 scores at one year. However, ESS showed superiority over three biologics in improving nasal congestion scores (NCS) at two various time points, except for better efficacy of Dupilumab at 1 year. For the loss of smell scores, a greater improvement was observed in the Dupilumab cohort compared with other biologics and even ESS counterparts. Safety analysis showed no significant difference between the ESS cohort and biologic treatment. CONCLUSIONS In summary, ESS showed comparable improvement in quality of life and symptoms to Omalizumab, Mepolizumab, and Benralizumab. Dupilumab seems to be more effective than ESS in selected items, whereas head-to-head trials and real-world studies are urgent to compare their efficacy. Our findings also showed that biologics could be applied as alternative or adjuvant therapy for uncontrolled severe CRSwNP.
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Affiliation(s)
- Jiani Chen
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Huan Wang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Chen Zhang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Le Shi
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Qianqian Zhang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xiaole Song
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Dehui Wang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Li Hu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Hongmeng Yu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor (2018RU003), Chinese Academy of Medical Sciences, Beijing, China
| | - Xicai Sun
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- High Altitude Rhinology Research Center of Eye & ENT Hospital of Fudan University and People's Hospital of Shigatse City, Shigatse, China
- Department of Otolaryngology, People's Hospital of Shigatse City, Shigatse, China
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4
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Walters ZA, Phillips KM, Previtera MJ, Gray ST, Sedaghat AR. Minimal Radiographic Mucosal Thickness or Opacification Criterion for Sinus-Specific Endoscopic Sinus Surgery for Chronic Rhinosinusitis. Otolaryngol Head Neck Surg 2023. [PMID: 36807128 DOI: 10.1002/ohn.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Primary chronic rhinosinusitis (CRS) is typically a diffuse process and the extent of endoscopic sinus surgery (ESS) performed for medically recalcitrant CRS is impacted by many factors. However, some third-party payors have implemented policies to authorize coverage for ESS in a sinus-by-sinus manner based on a minimal measurement of millimeters of mucosal thickening or sinus opacification in the corresponding sinus that is being surgically addressed. Our objective was to determine whether such policies are based on scientific evidence that in patients with medically recalcitrant CRS, a minimum measurement of mucosal thickening or sinus opacification is a predictor of CRS in that sinus or improved outcomes after ESS on a sinus-by-sinus basis. DATA SOURCES Medline, Embase, Scopus, and Web of Science databases, from inception through May 2022. REVIEW METHODS A systematic review was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS We identified 6070 abstracts which were screened and from which 112 studies ultimately underwent a full-text review. From these studies, we found that none investigated (or provided evidence of) whether any minimal degree of radiographic mucosal thickening or sinus opacification predicted CRS or better outcomes after ESS in a sinus-specific manner. CONCLUSION We were unable to find evidence supporting a minimum millimeter measurement of mucosal thickening or sinus opacification as predictors of CRS or better post-ESS outcomes in a sinus-specific manner in patients with medically recalcitrant CRS. The extent of ESS for CRS should be determined through personalized medical decision-making that considers all patient-specific factors.
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Affiliation(s)
- Zoe A Walters
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Melissa J Previtera
- Health Sciences Library, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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5
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Hong SN, Kim YS, Cha H, Park JA, Kim JK, Oh H, Kim M, Ryu HT, Hong SD, Kim DW. Endotype-related recurrence pattern of chronic rhinosinusitis in revision functional endoscopic sinus surgery. Auris Nasus Larynx 2021; 49:215-221. [PMID: 34312018 DOI: 10.1016/j.anl.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/08/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The recurrence of chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS) is influenced by various factors, potentially including the endotype based on the molecular pathophysiology of CRS. This study investigated differences in the recurrence pattern of CRS by endotype after primary FESS. METHODS This retrospective study enrolled patients who had undergone revision FESS for recurrent CRS. Based on their clinical diagnosis, the patients were divided into two endotype groups: recurrent eosinophilic CRS (rECRS) and recurrent non-eosinophilic CRS (rNECRS). We compared and analyzed preoperative computed tomography (CT) findings, including typical anatomical findings of recurred CRS such as lateralized middle turbinate and retained uncinate process, the sinus where recurrence took place, and previous surgical completeness of the sinuses, between the rECRS and rNECRS groups. RESULTS In total, 142 patients were enrolled (48 rECRS, 94 rNECRS). No significant difference was found in the typical anatomic findings of recurrent CRS between the rECRS and rNECRS groups. The rates of the completeness of previous surgeries was significantly higher in rECRS than in rNECRS(P=.031). Despite the completeness of previous surgeries, the recurrence rate of frontal and ethmoidal sinuses was higher in the rECRS than rNECRS(P=.012, P<.001, respectively). In subgroup analysis according to the severity of ECRS, the number of involved sinuses and the rates of CRS recurrence and surgical completeness in frontal and anterior ethmoidal sinuses increased with ECRS severity. CONCLUSIONS CT findings of revision FESS cases differed by CRS endotype. The rECRS group showed higher recurrence in the frontal and ethmoidal sinuses despite a higher surgical completeness rate. Incomplete surgery was more often found in the rNECRS group.
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Affiliation(s)
- Seung-No Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Boramae Medical Center, Seoul, South Korea
| | - Young Seok Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Boramae Medical Center, Seoul, South Korea
| | - Hyunkyung Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Boramae Medical Center, Seoul, South Korea
| | - Jin-A Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Boramae Medical Center, Seoul, South Korea
| | - Joon Kon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Boramae Medical Center, Seoul, South Korea
| | - Heonjeong Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Boramae Medical Center, Seoul, South Korea
| | - Minju Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Boramae Medical Center, Seoul, South Korea
| | - Hyun Tae Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Boramae Medical Center, Seoul, South Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dae Woo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Boramae Medical Center, Seoul, South Korea.
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Hao Y, Zhang F, Mo S, Zhao J, Wang X, Zhao Y, Zhang L. Biomedical Applications of Supramolecular Materials in the Controllable Delivery of Steroids. Front Mol Biosci 2021; 8:700712. [PMID: 34368229 PMCID: PMC8343020 DOI: 10.3389/fmolb.2021.700712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/13/2021] [Indexed: 01/19/2023] Open
Abstract
Glucocorticoids are a class of steroid hormones secreted from the adrenal glands. The strong anti-inflammatory effects make it be one of the most popular and versatile drugs available to treat chronic inflammatory diseases. Additionally, supramolecular materials have been widely exploited in drug delivery, due to their biocompatibility, tunability, and predictability. Thus, steroid-based supramolecular materials and the release of steroids have been applied in the treatment of inflammatory diseases. This mini-review summarized recent advances in supramolecular materials loaded with glucocorticoid drugs in terms of hydrophobic interactions, electrostatic interactions, hydrogen bonding, and π-π stackings. We also discussed and prospected the application of the glucocorticoid drugs-based supramolecular system on chronic rhinosinusitis, multifactorial inflammatory disease of the nasal and paranasal sinuses mucosal membranes. Overall, supramolecular materials can provide an alternative to traditional materials as a novel delivery platform in clinical practice.
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Affiliation(s)
- Yun Hao
- Department of Otolaryngology Head and Neck Surgery, Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Feiyi Zhang
- Institute for Advanced Materials, Jiangsu University, Zhenjiang, China.,State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Shanshan Mo
- State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Jinming Zhao
- Department of Otolaryngology Head and Neck Surgery, Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Xiangdong Wang
- Department of Otolaryngology Head and Neck Surgery, Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Yan Zhao
- Department of Otolaryngology Head and Neck Surgery, Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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7
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Alekseenko S, Karpischenko S, Artyushkin S, Barashkova S, Anikin I. Ciliary function and sinonasal mucosal cytology in pediatric patients with chronic rhinosinusitis during a year after functional endoscopic sinus surgery. Rhinology 2021; 59:319-327. [PMID: 33904535 DOI: 10.4193/rhin20.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of the study is evaluation of ciliary function and mucosal cytology after endoscopic sinus surgery in children with chronic rhinosinusitis (CRS). METHODOLOGY A total of 132 children with CRS who underwent endoscopic sinus surgery, as well as 15 healthy controls were involved in the study. In this follow-up study patients were examined preoperatively, as well as 3, 6, 9, and 12 months after endoscopic sinus surgery. Assessment of ciliary function and sinonasal mucosal cytology was performed using high-speed videomicroscopy. Lund-Kennedy, Lund-Mackay, and sinonasal outcome test 20 (SNOT20) scores were also evaluated. RESULTS Total SNOT-20, Lund-Mackay, and Lund-Kennedy values significantly decreased after sinus surgery. In contrast, ciliary function and mucosal cytology only tended to improve after 6 months. 9 months after surgery the number of ciliated cells, ciliary beat frequency, cell viability, and ciliary length were significantly higher than preoperatively. The most significant improvement of ciliary function and cell height was observed 12 months after operation, whereas epithelial dystrophy and neutrophil infiltration were significantly reduced. CONCLUSIONS Substantial improvement was observed only in a year after surgery, whereas 0 to 3 months after the surgery ciliary function was severely impaired thus predisposing to recurrent sinusitis or other complications.
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Affiliation(s)
- S Alekseenko
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia; I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russia; K.A. Raukhfus Childrens City Multidisciplinary Clinical Center for High Medical Technologies, St. Petersburg, Russia
| | - S Karpischenko
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia; K.A. Raukhfus Childrens City Multidisciplinary Clinical Center for High Medical Technologies, St. Petersburg, Russia; First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - S Artyushkin
- I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - S Barashkova
- K.A. Raukhfus Childrens City Multidisciplinary Clinical Center for High Medical Technologies, St. Petersburg, Russia; National Center of morphological diagnostic, St. Petersburg, Russia
| | - I Anikin
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia; K.A. Raukhfus Childrens City Multidisciplinary Clinical Center for High Medical Technologies, St. Petersburg, Russia
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8
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 390] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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9
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The use of modified Silastic nasal splints as frontal sinus stents: a technical note. The Journal of Laryngology & Otology 2020; 134:270-271. [PMID: 32122421 DOI: 10.1017/s0022215120000456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Endoscopic frontal sinus surgery is frequently complicated by post-operative stenosis and obstruction of the frontal sinus outflow tract, resulting in recurrent disease. Frontal sinus stents may help prevent re-occlusion of the frontal neo-ostia. OBJECTIVE This paper presents a simple and cost-effective approach to frontal sinus stenting using modified Silastic nasal splints. RESULTS AND CONCLUSION The current technique provides an effective, reliable and inexpensive method for achieving post-operative frontal sinus outflow tract patency.
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Biologics for chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol 2020; 145:725-739. [DOI: 10.1016/j.jaci.2020.01.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/14/2022]
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Sharbel D, Li M, Unsal AA, Tadros SY, Lee J, Biddinger P, Holmes T, Kountakis SE. Use of mucosal eosinophil count as a guide in the management of chronic rhinosinusitis. Int Forum Allergy Rhinol 2020; 10:474-480. [DOI: 10.1002/alr.22517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/13/2019] [Accepted: 12/10/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Daniel Sharbel
- Department of Otolaryngology–Head and Neck SurgeryMedical College of Georgia at Augusta University Augusta GA
| | - Mingsi Li
- Department of Otolaryngology–Head and Neck SurgeryMedical College of Georgia at Augusta University Augusta GA
| | - Aykut A. Unsal
- Department of Otolaryngology–Head and Neck SurgeryDrexel University College of Medicine Philadelphia PA
| | - Sandra Y. Tadros
- Department of Otolaryngology–Head and Neck SurgeryNew York University Langone Health New York City NY
| | - Jason Lee
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Kansas Medical Center Kansas City KS
| | - Paul Biddinger
- Department of PathologyMedical College of Georgia at Augusta University Augusta GA
| | - Thomas Holmes
- Department of Otolaryngology–Head and Neck SurgeryMedical College of Georgia at Augusta University Augusta GA
| | - Stilianos E. Kountakis
- Department of Otolaryngology–Head and Neck SurgeryMedical College of Georgia at Augusta University Augusta GA
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Microbiota Composition and the Integration of Exogenous and Endogenous Signals in Reactive Nasal Inflammation. J Immunol Res 2018; 2018:2724951. [PMID: 29967798 PMCID: PMC6008798 DOI: 10.1155/2018/2724951] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/09/2018] [Accepted: 04/19/2018] [Indexed: 02/06/2023] Open
Abstract
The prevalence of reactive nasal inflammatory conditions, for example, allergic rhinitis and chronic rhinosinusitis, is steadily increasing in parallel with significant environmental changes worldwide. Allergens and as yet undefined environmental agents may trigger these conditions via the involvement of host intrinsic factors, including the innate and adaptive immune system, the nasal epithelium, and the nasal nervous system. The critical role of the nasal microbiota in coordinating these components has emerged in recent studies documenting a significant association between microbial composition and the onset and progression of allergic or nonallergic inflammation. It is now clear that the local microbiota is a major player in the development of the mucosa-associated lymphoid tissue and in the regulation of such adaptive responses as IgA production and the function of effector and regulatory T cells. Microbial components also play a major role in the regulation of epithelial barrier functions, including mucus production and the control of paracellular transport across tight junctions. Bacterial components, including lipopolysaccharide, have also been shown to induce or amplify neuroinflammatory responses by engaging specific nociceptors. Finally, bacterial products may promote tissue remodeling processes, including nasal polyp formation, by interacting with formyl peptide receptors and inducing the expression of angiogenic factors and matrix-degrading enzymes.
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