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Friesen R, Li X, Singh V, Pacheco-Pereira C. Temporomandibular Joint Disorders and Pain Confounders: An Awareness Study. Int Dent J 2024:S0020-6539(24)00204-1. [PMID: 39107151 DOI: 10.1016/j.identj.2024.07.013] [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: 04/23/2024] [Revised: 06/27/2024] [Accepted: 07/16/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES Temporomandibular disorders (TMD) are the most common nonodontogenic cause of orofacial pain, leading to morbidity and impairment. TMD presents a diagnostic challenge due to many aetiologies that exhibit comparable symptoms and refer pain to the temporomandibular joint (TMJ) region. Patients may be referred to dental specialists without accounting for all pain sources. This study aims to identify radiographic confounders (RCs) that can be mistaken for TMD in patients undergoing TMJ assessment using cone-beam computed tomography (CBCT). MATERIALS AND METHODS A review of 369 CBCT oral maxillofacial radiology reports of the TMJ acquired between July 2020 and June 2023 was completed. Pertinent RCs were classified as endodontic lesions, impacted dentition, sinus pathologies, root fractures, soft tissue calcifications, and others. The chi-squared test assessed the significance of the relationship between RCs and patient variables. RESULTS A total of 283 RCs were identified in 202 of the 369 cases (54.7%). The most frequent findings included sinus abnormalities (32.5%), endodontic lesions (15.2%), impacted dentition (12.7%), and elongated/calcified stylohyoid process (9.2%). Significant associations were found between sinus pathologies with TMD signs (P = .009) and gender (P = .001). CONCLUSION Our results indicate that RCs that mimic TMD-related symptoms are prevalent in patients referred for TMJ CBCT imaging. CLINICAL RELEVANCE Clinicians should be aware of these RCs when diagnosing complaints related to the TMJ. We recommend clinicians first obtain dental clearance and investigate all other potential sources of a patient's complaint before initiating referrals to avoid unnecessary costs and delays in patient care.
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Affiliation(s)
- Reid Friesen
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada; Private Practice, Edmonton, Alberta, Canada.
| | - Xiang Li
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Vandana Singh
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada; Private Practice, Edmonton, Alberta, Canada
| | - Camila Pacheco-Pereira
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada; Private Practice, Edmonton, Alberta, Canada
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2
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Han EJ, Liu CM, Fischer JL, Mace JC, Markarian K, Alt JA, Bodner TE, Chowdhury NI, Eshaghian PH, Gao YA, Getz AE, Hwang PH, Khanwalkar A, Kimple AJ, Lee JT, Li DA, Norris M, Nayak JV, Owens C, Patel ZM, Poch K, Schlosser RJ, Smith KA, Smith TL, Soler ZM, Suh JD, Turner GA, Wang MB, Taylor-Cousar JL, Saavedra MT, Beswick DM. Impact of sociodemographic status and sex on chronic rhinosinusitis and olfaction in people with cystic fibrosis. Int Forum Allergy Rhinol 2024. [PMID: 38967583 DOI: 10.1002/alr.23402] [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: 05/27/2024] [Revised: 06/19/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Sociodemographic status (SDS) including race/ethnicity and socioeconomic status as approximated by education, income, and insurance status impact pulmonary disease in people with cystic fibrosis (PwCF). The relationship between SDS and chronic rhinosinusitis (CRS) remains understudied. METHODS In a prospective, multi-institutional study, adult PwCF completed the 22-Question SinoNasal Outcome Test (SNOT-22), Smell Identification Test (SIT), Questionnaire of Olfactory Disorder Negative Statements (QOD-NS), and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Lund-Kennedy scores, sinus computed tomography, and clinical data were collected. Data were analyzed across race/ethnicity, sex, and socioeconomic factors using multivariate regression. RESULTS Seventy-three PwCF participated with a mean age of 34.7 ± 10.9 years and 49 (67.1%) were female. Linear regression identified that elexacaftor/tezacaftor/ivacaftor (ETI) use (β = ‒4.09, 95% confidence interval [CI] [‒6.08, ‒2.11], p < 0.001), female sex (β = ‒2.14, 95% CI [‒4.11, ‒0.17], p = 0.034), and increasing age (β = ‒0.14, 95% CI [‒0.22, ‒0.05], p = 0.003) were associated with lower/better endoscopy scores. Private health insurance (β = 17.76, 95% CI [5.20, 30.32], p = 0.006) and >16 educational years (β = 13.50, 95% CI [2.21, 24.80], p = 0.020) were associated with higher baseline percent predicted forced expiratory volume in one second (ppFEV1). Medicaid/Medicare insurance was associated with worse endoscopy scores, CFQ-R respiratory scores, and ppFEV1 (all p < 0.017), and Hispanic/Latino ethnicity was associated with worse SNOT-22 scores (p = 0.047), prior to adjustment for other cofactors. No other SDS factors were associated with SNOT-22, QOD-NS, or SIT scores. CONCLUSIONS Differences in objective measures of CRS severity exist among PwCF related to sex, age, and ETI use. Variant status and race did not influence patient-reported CRS severity measures or olfaction in this study. Understanding how these factors impact response to treatment may improve care disparities among PwCF. CLINICAL TRIALS NCT04469439.
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Affiliation(s)
- Ethan J Han
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Christine M Liu
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jakob L Fischer
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Karolin Markarian
- CTSI, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, Oregon, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patricia H Eshaghian
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Yuqing A Gao
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Denver, Colorado, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Ashoke Khanwalkar
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Denver, Colorado, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jivianne T Lee
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Douglas A Li
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Meghan Norris
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Cameran Owens
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Grant A Turner
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jennifer L Taylor-Cousar
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Milene T Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Daniel M Beswick
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
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Hur K, Adili A, Tam B, Herrera K, Agarwal A, Rice D, Ference E, Wrobel B, Conley D. Efficacy of a RADA-16 peptide hydrogel versus chitosan-based polymer in improving patient comfort during postoperative debridement: A randomized controlled trial. Int Forum Allergy Rhinol 2024. [PMID: 38932659 DOI: 10.1002/alr.23395] [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: 03/30/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Bioresorbable nasal packing is associated with a decreased incidence of adhesions and bleeding postoperatively after endoscopic sinus surgery (ESS). However, discomfort during postoperative debridement is still a major area of concern for patients. Our objective was to compare the efficacy of a peptide hydrogel to that of a chitosan-based polymer in reducing pain during debridement after ESS. METHODS A prospective, multicenter, randomized, blinded trial was conducted in adults undergoing bilateral total ethmoidectomy for chronic rhinosinusitis. Participants served as their own controls with each subject receiving the hydrogel in a randomized ethmoid cavity and chitosan-based polymer in the contralateral ethmoid cavity. Participants were evaluated at 1, 4, and 12 weeks postoperatively. Pain during debridement as well as endoscopic evaluation of mucosal healing and hemostasis were measured. RESULTS Thirty patients who underwent ESS were included in this trial. During the week 1 postoperative debridement, patients reported significantly less pain on the hydrogel-treated side compared to the chitosan-based polymer-treated side. There were no significant differences in bleeding severity, Lund-Kennedy scores, debridement time, or need for further intervention between the two groups. CONCLUSION This study demonstrated the efficacy of a peptide hydrogel in minimizing pain during postoperative debridement.
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Affiliation(s)
- Kevin Hur
- Rick and Tina Caruso Department of Otolaryngology, Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Amila Adili
- Department of Population and Public Health Sciences, Keck School of Medicine, Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, California, USA
| | - Benjamin Tam
- Rick and Tina Caruso Department of Otolaryngology, Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kevin Herrera
- Rick and Tina Caruso Department of Otolaryngology, Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Aditi Agarwal
- Department of Otolaryngology, Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dale Rice
- Rick and Tina Caruso Department of Otolaryngology, Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Bozena Wrobel
- Rick and Tina Caruso Department of Otolaryngology, Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David Conley
- Department of Otolaryngology, Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Beswick DM, Han EJ, Mace JC, Markarian K, Alt JA, Bodner TE, Chowdhury NI, Eshaghian PH, Getz AE, Hwang PH, Khanwalkar A, Kimple AJ, Lee JT, Li DA, Norris M, Nayak JV, Owens C, Patel Z, Poch K, Schlosser RJ, Smith KA, Smith TL, Soler ZM, Suh JD, Turner G, Wang MB, Taylor-Cousar JL, Saavedra M. Factors that predict pursuing sinus surgery in the era of highly effective modulator therapy. Int Forum Allergy Rhinol 2024; 14:807-818. [PMID: 37725072 DOI: 10.1002/alr.23270] [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: 05/30/2023] [Revised: 07/19/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Comorbid chronic rhinosinusitis (CRS) remains unresolved for many people with cystic fibrosis (PwCF). While highly effective modulator therapy improves quality-of-life and symptom severity, the impact of this intervention and other factors associated with pursuing endoscopic sinus surgery (ESS) remains understudied. METHODS Adult PwCF + CRS were enrolled into a prospective, observational, multi-institutional study. Participants completed validated outcome measures to evaluate respiratory symptom severity, depression, headache, and sleep quality, as well as nasal endoscopy, sinus computed tomography (CT), and olfactory testing. Bivariate comparisons and regression modeling evaluated treatment cofactors, disease characteristics, and outcome measures associated with pursuing ESS. RESULTS Sixty PwCF were analyzed, including 24 (40%) who elected ESS. Pursuing ESS was associated with worse SinoNasal Outcome Test (SNOT-22) total, rhinologic, psychological, and sleep dysfunction domain scores; worse Patient Health Questionnaire-9-Revised depression scores; worse Pittsburgh Sleep Quality Index total scores; worse weight, role, emotion, and eating domain scores on the Cystic Fibrosis Questionnaire-Revised; more severe disease on nasal endoscopy; and lack of modulator therapy (all p < 0.050). Multivariable regression identified that worse SNOT-22 total score was associated with electing ESS (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.02-1.16, p = 0.015) and elexacaftor/tezacaftor/ivacaftor (ETI) treatment (OR 0.04, 95% CI 0.004-0.34, p = 0.004) was associated with pursing medical therapy. CONCLUSIONS Worse sinonasal symptom burden, lack of ETI treatment, sleep quality, depression, and nasal endoscopy scores were associated with electing ESS, while lung disease severity and sinus CT scores were not. ETI use was associated with lower odds of pursuing ESS independent of sinonasal symptom burden.
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Affiliation(s)
- Daniel M Beswick
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Ethan J Han
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Karolin Markarian
- CTSI, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, Oregon, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt Health, Nashville, Tennessee, USA
| | - Patricia H Eshaghian
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Colorado, Denver, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Stanford, California, USA
| | - Ashoke Khanwalkar
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Colorado, Denver, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jivianne T Lee
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Douglas A Li
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Meghan Norris
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Stanford, California, USA
| | - Cameran Owens
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Colorado, Denver, USA
| | - Zara Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Stanford, California, USA
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Grant Turner
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jennifer L Taylor-Cousar
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Milene Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
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Ferraiolo PN, Dortas SD, Cruz FCD, Ramos PCDS, Elabras Filho J, Marques MDPC, Valete-Rosalino CM. Development of a mobile app for the evaluation of patients with chronic rhinosinusitis. Braz J Otorhinolaryngol 2024; 90:101375. [PMID: 38237485 PMCID: PMC10828589 DOI: 10.1016/j.bjorl.2023.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE To develop a mobile application with a standardized routine, to be used by general otolaryngologists for evaluating patients with chronic rhinosinusitis. METHODS A systematic review was made to identify outcomes, recommendations and what tests that would be used in the routine evaluation of patients with chronic rhinosinusitis; establish an expert consensus on items to be included in this routine evaluation of patients with chronic rhinosinusitis using the Delphi method; development of an application for use on a mobile device, with the routine evaluation of patients with chronic rhinosinusitis. RESULTS Based on the systematic review, the outcomes used in studies about chronic rhinosinusitis were identified, as well as guidelines recommendations, which showed discrepancies between them. These recommendations and outcomes were presented to specialists in chronic rhinosinusitis, until a consensus was reached. As a result of the Delphi method, the flowchart of the routine evaluation of patients with chronic rhinosinusitis was defined, and then was used for the development of the mobile application. CONCLUSION The creation of the mobile application for evaluating patients with chronic rhinosinusitis followed an adequate methodology of elaboration made by specialists in the field of chronic rhinosinusitis, standardizing the investigation of these patients. LEVEL OF EVIDENCE Level 5.
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Affiliation(s)
- Priscila Novaes Ferraiolo
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil.
| | - Sergio Duarte Dortas
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Imunologia, Rio de Janeiro, RJ, Brazil
| | - Fabiana Chagas da Cruz
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Priscilla Campos de Souza Ramos
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Imunologia, Rio de Janeiro, RJ, Brazil
| | - José Elabras Filho
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Imunologia, Rio de Janeiro, RJ, Brazil
| | - Marise da Penha Costa Marques
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Cláudia Maria Valete-Rosalino
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Otorrinolaringologia e Oftalmologia, Rio de Janeiro, RJ, Brazil; Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brazil
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Shu F, Li CX, Zhang F, Peng M, Shi L, Li L, Xiong J, Mu Z, Wang Y, Mao D. Systematic Review and Meta-analysis: Macrolide in the Treatment of Chronic Rhinosinusitis After Endoscopic Sinus Surgery. Otolaryngol Head Neck Surg 2023; 169:1424-1435. [PMID: 37548067 DOI: 10.1002/ohn.461] [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: 02/01/2023] [Revised: 06/06/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of macrolide antibiotics therapy in patients with chronic rhinosinusitis (CRS) receiving endoscopic sinus surgery. DATA SOURCES PubMed, Web of Science, Embase, and Cochrane Library. REVIEW METHODS The electronic databases were comprehensively searched on June 2, 2022, for randomized controlled trials on macrolide antibiotics in the treatment of patients undergoing CRS endoscopic surgery. The primary outcome measures were the sinonasal outcome test (SNOT) score and the visual analog scale (VAS) score. The secondary outcome measures were the nasal endoscopy score (NES), the sinus computed tomography score, and adverse events. RESULTS A total of 8 studies were included, involving 606 patients who used macrolide for a long time. Meta-analysis showed that no significant difference was observed in SNOT (standardized mean difference [SMD] = -0.13; 95% confidence interval [CI]: -0.38 to 0.13, I2 = 0%) and VAS (SMD = -0.10; 95% CI, -0.88 to 0.68, I2 = 81%) between the macrolide and placebo groups. However, macrolide outperformed the placebo in improving NES (SMD = -0.32; 95% CI, -0.62 to -0.03, I2 = 21%). The use of macrolide did not increase the incidence of adverse events. CONCLUSION Long-term use of macrolide after CRS surgery may not significantly improve the quality of life and disease severity of the patients but may play a role in improving postoperative NES in patients with CRS. There is still no sufficient evidence to determine whether the disease phenotype of CRS or the patient's race will affect the efficacy of long-term use of macrolide after CRS.
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Affiliation(s)
- Fu Shu
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, People's Republic of China
| | - Chan-Xiu Li
- Graduate School, Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - Feng Zhang
- Department of Otorhinolaryngology, Yongchuan Chinese Medicine Hospital Affiliated to Chongqing Medical University, Chongqing, People's Republic of China
| | - Mingwei Peng
- College of Pharmaceutical Sciences, Southwest University, Chongqing, People's Republic of China
| | - Lei Shi
- Department of Otorhinolaryngology, The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - Linglong Li
- Department of Otorhinolaryngology, Yongchuan Chinese Medicine Hospital Affiliated to Chongqing Medical University, Chongqing, People's Republic of China
| | - Juan Xiong
- Department of Otorhinolaryngology, Yongchuan Chinese Medicine Hospital Affiliated to Chongqing Medical University, Chongqing, People's Republic of China
| | - Zengyi Mu
- Graduate School, Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China
| | - Yaping Wang
- Department of Otorhinolaryngology, Yongchuan Chinese Medicine Hospital Affiliated to Chongqing Medical University, Chongqing, People's Republic of China
| | - Dehong Mao
- Department of Otorhinolaryngology, Yongchuan Chinese Medicine Hospital Affiliated to Chongqing Medical University, Chongqing, People's Republic of China
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7
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Samargandy S, Grose E, Yip J, Lee JM. Endoscopic sinus surgery outcomes in patients with chronic rhinosinusitis and immunoglobulin deficiencies. J Otolaryngol Head Neck Surg 2023; 52:43. [PMID: 37386535 PMCID: PMC10308710 DOI: 10.1186/s40463-023-00648-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Patients with chronic rhinosinusitis (CRS) and immunoglobulin deficiencies (ID) have more recalcitrant sinonasal disease and a subset of these patients undergo surgical management for their CRS. However, there is a paucity of literature on the surgical outcomes in this patient population and appropriate treatment algorithms for CRS in patients with ID. The objective of this study was to better elucidate the outcomes of endoscopic sinus surgery (ESS) in patients with ID in terms of disease-specific quality-of-life scores and the need for revision surgery. METHODS A case-control study was performed comparing adult patients with ID and healthy controls that had undergone ESS for CRS. Patients were matched based on age, sex, CRS phenotype, and preoperative Lund-Mackay score. The revision surgery rates, time to revision surgery, and changes in sinonasal outcome tests (SNOT-22) were evaluated. RESULTS Thirteen patients with CRS and ID were matched to 26 control patients with CRS. The revision surgery rate for cases and controls was 31% and 12%, respectively, but there was no statistical difference (p > 0.05). There was a clinically meaningful reduction in SNOT-22 scores in both groups from the preoperative to postoperative period [mean of 12 points in patients with ID (p = 0.323) and 25 points in controls (p < 0.001)], however, there was again no significant difference between cases and controls (p > 0.05). CONCLUSION Our data suggests that patients with ID have clinically meaningful improvement in SNOT-22 scores after ESS but may have higher revision rates than immunocompetent patients with CRS. ID are rare disease entities, thus most attempts at studying this cohort would be limited by sample size. Further homogenous data on immunoglobulin deficient patients is required for future meta-analysis to better understand the impact of ESS in patients with ID.
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Affiliation(s)
- Shireen Samargandy
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, 8 Cardinal Carter, Toronto, ON, M5B 1W8, Canada
| | - Elysia Grose
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, 8 Cardinal Carter, Toronto, ON, M5B 1W8, Canada
| | - Jonathan Yip
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, 8 Cardinal Carter, Toronto, ON, M5B 1W8, Canada
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, 8 Cardinal Carter, Toronto, ON, M5B 1W8, Canada.
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Yang HH, Alonso J, Ishiyama A, Gopen QS, Suh JD, Wang MB, Wells C, Wung V, Lee JT. Clinical Predictors of Symptom Improvement Following Eustachian Tube Balloon Dilation. Ann Otol Rhinol Laryngol 2022:34894221129912. [PMID: 36226334 PMCID: PMC10359951 DOI: 10.1177/00034894221129912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to identify clinical predictors of treatment response to Eustachian Tube Balloon Dilation (ETBD) as measured by changes in Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores. METHODS One hundred thirteen patients who underwent ETBD at an institution from 2017 to 2021 completed ETDQ-7 pre- and post-operatively. We conducted multivariable regression analyses with ETDQ-7 normalization (<2.1 post-op), minimum clinically important difference (MCID) (>0.5 pre-op - post-op), and quantitative improvement in ETDQ-7 score as outcome variables. Pre-operative ETDQ-7 score, tympanogram type, chronic otitis media, chronic rhinosinusitis (CRS), inferior turbinate hypertrophy, deviated septum, allergic rhinitis, and rhinorrhea were included as covariates. Models controlled for age, sex, ethnicity, prior ear or sinus surgery, and follow-up duration. RESULTS The mean age was 49 years old. 51% were females, and all patients had pre-operative ETDQ-7 above 2.1. After a mean follow-up period of 13 months, 77% achieved MCID and 37% had normalized. Higher pre-operative ETDQ-7 score was associated with greater ETDQ-7 score improvement (B = 0.60, 95% CI = [0.37, 0.83]) and greater odds of achieving MCID (aOR = 1.65; 95% CI = [1.06, 2.59]). A history of CRS improved chances of achieving MCID (aOR = 4.53; 95% CI = [1.11, 18.55]) and a history of chronic otitis media predicted increased odds of ETDQ-7 normalization (aOR = 2.88; 95% CI = [1.09, 7.58]). CONCLUSIONS Our findings suggest that ETBD was highly effective among patients with pre-operative ETDQ-7 above 2.1. Furthermore, higher pre-operative ETDQ-7 score, CRS, and chronic otitis media predicted more favorable symptomatic benefit from ETBD. These factors may be important to consider when counseling potential candidates for this procedure.
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Affiliation(s)
- Hong-Ho Yang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Jose Alonso
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Akira Ishiyama
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Quinton S Gopen
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Marilene B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Christine Wells
- Office of Advanced Research and Computing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Vivian Wung
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Jivianne T Lee
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
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9
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Klimek L, Förster-Ruhrmann U, Beule AG, Chaker AM, Hagemann J, Klimek F, Casper I, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Olze H, Strieth S, Wrede H, W. Schlenter W, Welkoborsky HJ, Wollenberg B, Bergmann C, Cuevas M, Beutner C, Gröger M, Becker S. Dokumentation von Biologika-Therapien bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP): Dupilumab, Omalizumab und Mepolizumab. ALLERGO JOURNAL 2022; 31:24-39. [PMID: 36092307 PMCID: PMC9441224 DOI: 10.1007/s15007-022-5080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hintergrund: Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der paranasalen Schleimhäute, der als Endotyp meistens eine Typ-2-Inflammation zugrunde liegt. Mittlerweile sind drei Antikörper (Dupilumab, Omalizumab und Mepolizumab) für die Therapie der schweren CRSwNP zugelassen. Eine Dokumentation der Erkrankungsschwere im Behandlungsverlauf ist unverzichtbar. Methoden: In einer Literaturrecherche in Medline, Pubmed sowie den nationalen und internationalen Studien- und Leitlinienregistern und der Cochrane Library wurde die Immunologie der CRSwNP analysiert und die Evidenz zur Wirkung von Dupilumab, Omalizumab und Mepolizumab bei dieser Erkrankung ermittelt. Hieraus wurden drei Positionspapiere durch unsere Autorengruppe erstellt, die Grundlage dieser zusammenfassenden Übersichtsarbeit sind. Ergebnisse: Basierend auf den Angaben aus der internationalen Literatur werden von einem Expertengremium Empfehlungen für die Anwendung von Dupilumab, Omalizumab und Mepolizumab bei CRSwNP im deutschen Gesundheitssystem gegeben. Schlussfolgerung: Dupilumab, Omalizumab und Mepolizumab sind zugelassen für Patienten ab 18 Jahren mit schwerer CRSwNP als Zusatztherapie zu intranasalen Glukokortikosteroiden (INCS), wenn, bei Dupilumab und Mepolizumab, durch eine Therapie mit systemischen Glukokortikosteroiden und/oder chirurgischem Eingriff keine ausreichende Krankheitskontrolle erzielt werden kann. Eine Therapie mit Omalizumab ist angezeigt, wenn eine Therapie mit INCS keine suffiziente Kontrolle der Erkrankung ergibt. Es werden dezidierte Empfehlungen zur Dokumentation der Anwendung im Deutschen Gesundheitssystem gegeben, die auf den hierzu bereits publizierten Positionspapieren unserer Autorengruppe basieren. Zitierweise: Klimek L, Förster-Ruhrmann U, Beule AG, Chaker AM, Hagemann J, Klimek F, Casper I, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Olze H, Strieth S, Wrede H, Schlenter W, Welkoborsky H-J, Wollenberg B, Bergmann C, Cuevas M, Beutner C, Gröger M, Becker S. Indicating biologics for chronic rhinosinusitis with nasal polyps (CRSwNP): Recommendations by German Allergy and ORL-societies AeDA and DGHNO for Dupilumab, Omalizumab and Mepolizumab. Allergo J Int 2022;31:149-60 https://doi.org/10.1007/s40629-022-00220-x
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Affiliation(s)
- Ludger Klimek
- FA für Dermatologie u. Allergologie, Zentrum f. Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden, Germany
| | | | - Achim G. Beule
- Klinik f. Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149 Münster, Germany
| | - Adam M. Chaker
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Klinikum rechts der Isar - TU München, Ismaninger Str. 22, 81675 München, Germany
| | - Jan Hagemann
- Klinik f. Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Felix Klimek
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183 Wiesbaden, Germany
| | - Ingrid Casper
- Zentrum für Rhinologie und Allergologie, GEKA Gesellschaft für Experimentelle und Kliniksche Atemwegsforschung mbH, An den Quellen 10, 65183 Wiesbaden, Germany
| | - Tilman Huppertz
- Klinik f. Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Thomas K. Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm, Ulm, Germany
| | - Stefan Dazert
- Kopf- und Halschirurgie, Klinik für hals-, Nasen- und Ohrenheilkunde, Bleichstr. 16, 44787 Bochum, Germany
| | - Thomas Deitmer
- Deutsche Gesellschaft f. Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V., Friedrich-Wilhelm-Str. 2, 53113 Bonn, Germany
| | - Heidi Olze
- Klinik f. Hals-, Nasen-, Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sebastian Strieth
- Klinik und Poliklinik f. Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Holger Wrede
- Gemeinschaftspraxis Dr. med. H. Wrede & Dr. med. U. Reineke, HNO- und Allergiezentrum Herford, Berliner Straße 6-8, 32052 Herford, Germany
| | - Wolfgang W. Schlenter
- Ärzteverband Deutscher Allergologen e.V., AeDA-Geschäftsstelle, An den Quellen 10, 65183 Wiesbaden, Germany
| | - Hans-Jürgen Welkoborsky
- Klinik f. Hals-, Nasen-, Ohrenheilkunde, KRH Klinikum Nordstadt, Haltenhoffstr. 41 (Haus D), 30167 Hannover, Germany
| | - Barbara Wollenberg
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Klinikum rechts der Isar Technische Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Christoph Bergmann
- HNO im RKM740 interdisziplinäre Facharztklinik, Pariser Straße 83-89, 40549 Düsseldorf, Germany
| | - Mandy Cuevas
- Klinik u. Poliklinik für Hals- Nasen- und Ohrenheilkunde, Univ.-Klinikum Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Germany
| | - Caroline Beutner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Österreich
| | - Moritz Gröger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universität München, München, Germany
| | - Sven Becker
- Universitätsklinik für Hals-, Nasen-, und Ohrenheilkunde, Universitätsklinik Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany
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10
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Klimek L, Olze H, Förster-Ruhrmann U, Beule AG, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Becker S, Klimek F, Zuberbier J, Rudack C, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Bachert C. Positionspapier: Empfehlungen zur Anwendung von Mepolizumab bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC). Laryngorhinootologie 2022; 101:284-294. [PMID: 35168284 DOI: 10.1055/a-1752-8462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the paranasal sinus mucosa with eosinophilic inflammation as the most common endotype. The anti-IL5 antibody mepolizumab was approved for the treatment of severe CRSwNP in the EU in November 2021. METHODS A literature search was performed to analyze the immunology of CRSwNP and determine the available evidence by searching Medline, Pubmed, and the German national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 12/2021 that investigated the effect of mepolizumab in CRSwNP were considered. RESULTS Based on the international literature and previous experience, recommendations for the use of mepolizumab in CRSwNP in the German health care system are given by an expert panel on the basis of a documentation form. CONCLUSIONS Understanding about the immunological basis of CRSwNP opens new non-surgical therapeutic approaches with biologics for patients with severe courses. Mepolizumab is approved since November 2021 for add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP who cannot be adequately controlled with systemic corticosteroids and/or surgical intervention.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - H Olze
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - U Förster-Ruhrmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Bochum
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik u. Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - S Becker
- Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | | | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Main
| | - C Bergmann
- Praxis für Hals-Nasen-Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
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11
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Klimek L, Hagemann J, Welkoborsky HJ, Cuevas M, Casper I, Förster-Rurmann U, Klimek F, Hintschich CA, Huppertz T, Bergmann KC, Tomazic PV, Bergmann C, Becker S. T2-Inflammation bei entzündlichen Atemwegserkrankungen: Grundlage neuer Behandlungsoptionen. Laryngorhinootologie 2021; 101:96-108. [PMID: 34937094 DOI: 10.1055/a-1709-7899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden.,Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz
| | - J Hagemann
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz
| | | | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - I Casper
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | | | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - C A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg
| | - T Huppertz
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz
| | - K-Ch Bergmann
- Klinik für Dermatologie, Venerologie und Allergie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
| | - P V Tomazic
- HNO-Universitätsklinik Graz, Medizinische Universität Graz
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12
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Klimek L, Chaker A, Deitmer T, Plontke SK, Wollenberg B, Bousquet J, Bachert C. [Dupilumab has an additional benefit in treatment of chronic rhinosinusitis with nasal polyps]. HNO 2021; 69:868-877. [PMID: 33738558 PMCID: PMC7971351 DOI: 10.1007/s00106-021-01018-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND For patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) which cannot be controlled by continuous therapy with intranasal corticosteroids (INCS) and systemic corticosteroids and/or surgical treatment, there were no approved curative options for a long time. For CRSwNP treatment with T2-addressing biologics is possible. On October 24, 2019, the European Commission granted extended approval for dupilumab as the first biological agent for treatment of insufficiently controlled severe CRSwNP. The Federal Joint Committee (G‑BA) evaluates the benefits of reimbursable drugs with new active ingredients. This includes assessment of the additional benefit and its therapeutic relevance. METHODS A meta-analysis was performed using individual patient data based on two phase III studies. Both studies examined the safety and efficacy of dupilumab as an add-on therapy to INCS for treatment of CRSwNP in adults inadequately controlled with systemic corticosteroids and/or surgery compared to INCS alone. RESULTS Based on the present data, the G‑BA decided that there is an indication of a considerable additional benefit of dupilumab compared to mometasone furoate. CONCLUSION For patients with severe CRSwNP inadequately controlled with INCS and systemic corticosteroids and/or surgery, there is an indication of a considerable additional benefit for the administration of dupilumab as an add-on therapy to INCS compared to mometasone furoate alone.
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Affiliation(s)
- L Klimek
- Allergiezentrum Rheinland-Pfalz, Universitätsmedizin Mainz, Wiesbaden, Deutschland.
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183, Wiesbaden, Deutschland.
| | - A Chaker
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, TU München, München, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn, Deutschland
| | - S K Plontke
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Halle, Halle, Deutschland
| | - B Wollenberg
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, TU München, München, Deutschland
| | - J Bousquet
- Berlin Institute of Health, Comprehensive Allergy Center, Klinik für Dermatologie, Venerologie und Allergologie, Charité, Universitätsmedizin Berlin, Berlin, Deutschland
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, Frankreich
- INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, Frankreich
- UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, Frankreich
| | - C Bachert
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Gent, Belgien
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13
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Klimek L, Förster-Ruhrmann U, Beule AG, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Olze H, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Becker S, Rudack C, Wagenmann M, Bergmann C, Bachert C. Positionspapier: Empfehlungen zur Anwendung von Omalizumab bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC). Laryngorhinootologie 2021; 100:952-963. [PMID: 34592767 DOI: 10.1055/a-1644-4066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Zusammenfassung
Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der paranasalen Schleimhäute, der als Endotyp meistens eine TH2-Inflammation zugrunde liegt. IgE-Antikörper spielen dabei eine wichtige Rolle. Der anti-IgE-Antikörper Omalizumab wurde im August 2020 für die Therapie der schweren CRSwNP zugelassen.
Methoden In einer Literatursuche wurde die Immunologie der CRSwNP analysiert und die Evidenz zur Wirkung von Omalizumab bei dieser Erkrankung ermittelt durch Recherchen in Medline, Pubmed sowie den nationalen und internationalen Studien- und Leitlinien-Registern und der Cochrane Library.
Ergebnisse Basierend auf diesen Angaben aus der internationalen Literatur werden von einem Expertengremium Empfehlungen für die Anwendung von Omalizumab bei CRSwNP im deutschen Gesundheitssystem gegeben.
Schlussfolgerung Omalizumab ist zugelassen für Patienten ab 18 Jahren mit schwerer chronischer Rhinosinusitis mit Nasenpolypen als Zusatztherapie zu intranasalen Kortikosteroiden (INCS), wenn durch eine Therapie mit INCS keine ausreichende Krankheitskontrolle erzielt werden kann.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | | | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum, St. Elisabeth-Hospital, Bochum
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - H Olze
- Charité - Universitätsmedizin Berlin
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn (UKB)
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Dreieich
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - S Becker
- Hals-, Nasen-, Ohrenklinik und Poliklinik, Universitätsklinik Tübingen
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - M Wagenmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf
| | - C Bergmann
- Praxis für Hals-, Nasen-, Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
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14
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Klimek L, Förster-Ruhrmann U, Becker S, Chaker AM, Strieth S, Hoffmann TK, Dazert S, Deitmer T, Olze H, Glien A, Plontke S, Wrede H, Schlenter WW, Welkoborsky HJ, Wollenberg B, Beule AG, Rudack C, Wagenmann M, Stöver T, Huppertz T, Hagemann J, Bachert C. Positionspapier: Anwendung von Biologika bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP) im deutschen Gesundheitssystem. ALLERGO JOURNAL 2021. [DOI: 10.1007/s15007-021-4872-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Zawawi F, Shapiro AJ, Dell S, Wolter NE, Marchica CL, Knowles MR, Zariwala MA, Leigh MW, Smith M, Gajardo P, Daniel SJ. Otolaryngology Manifestations of Primary Ciliary Dyskinesia: A Multicenter Study. Otolaryngol Head Neck Surg 2021; 166:540-547. [PMID: 34154450 DOI: 10.1177/01945998211019320] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This project aims to prospectively and objectively assess otolaryngological manifestations and quality of life of children with primary ciliary dyskinesia (PCD) and compare these findings with healthy pediatric controls. STUDY DESIGN Cross-sectional. SETTING Two high-volume pediatric PCD specialty centers. METHODS Standardized clinical assessment; Sino-Nasal Outcome Test 22 (SNOT-22); Hearing Environment and Reflection Quality of Life (HEAR-QL); Reflux Symptom Index (RSI); standardized physical examination of the sinonasal, laryngeal, and otological systems; and investigations including pure-tone audiograms (PTAs) and sinonasal cultures were collected. RESULTS Forty-seven children with PCD and 25 control participants were recruited. Children with PCD had more upper airway symptoms than healthy children. They had significantly higher scores in both SNOT-22 and RSI, indicating worse sinonasal and reflux symptoms, with worse quality of life on the HEAR-QL index compared to healthy children (P < .05). Fifty-two percent of children with PCD-related hearing loss were not aware of their hearing deficit that was present on audiological assessment, and only 23% of children who had ventilation tubes had chronic otorrhea, most of which was easily controlled with ototopic drops. Furthermore, although all children with PCD had chronic rhinosinusitis, only 36% of them were using topical nasal treatment. The most common bacteria cultured from the middle meatus were Staphylococcus aureus in 11 of 47 (23%), followed by Streptococcus pneumoniae in 10 of 47 (21%). CONCLUSION This multisite cohort highlights the importance of otolaryngology involvement in the management of children with PCD. More rigorous otolaryngological management may lead to reductions in overall morbidity and improve quality of life for children with PCD.
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Affiliation(s)
- Faisal Zawawi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Adam J Shapiro
- Division of Pediatric Respiratory Medicine, McGill University Health Centre Research Institute, Montreal Children's Hospital McGill University, Montreal, Quebec, Canada
| | - Sharon Dell
- Department of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cinzia L Marchica
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Michael R Knowles
- Department of Medicine, Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Maimoona A Zariwala
- Department of Pathology and Laboratory Medicine, Marsico Lung Institute, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Margaret W Leigh
- Department of Pediatrics, Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Mariana Smith
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Pilar Gajardo
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology, Hospital de Niños Luis Calvo Mackenna, Universidad de Chile, Clínica Las Condes, Santiago, Chile
| | - Sam J Daniel
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
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16
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Blight BJ, Gill AS, Sumsion JS, Pollard CE, Ashby S, Oakley GM, Alt JA, Pulsipher A. Cell Adhesion Molecules are Upregulated and May Drive Inflammation in Chronic Rhinosinusitis with Nasal Polyposis. J Asthma Allergy 2021; 14:585-593. [PMID: 34079296 PMCID: PMC8166329 DOI: 10.2147/jaa.s307197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Chronic rhinosinusitis with nasal polyps (CRSwNP) is predominantly characterized by eosinophil- and T helper 2 cell (Th2)-biased inflammation. Integrins and intercellular adhesion molecules (ICAMs) are superfamilies of cell adhesion molecules (CAMs) that facilitate the recruitment and trafficking of immune cells and have been implicated in coordinating eosinophil and Th2 cell adhesion and signaling in asthma. The roles of CAMs in CRSwNP, however, remain poorly understood. The purpose of this study was to characterize the systemic and local expression of CAMs and identify which CAMs are potentially involved in CRSwNP pathology. Materials and Methods A prospective observational study was conducted using peripheral blood and anterior ethmoid tissues of patients with CRSwNP (n=32) and controls (n=15). Multiplex gene analysis and Pearson correlations were performed to identify associations between systemically and locally expressed CAMs. Based on the gene expression results, immunohistochemical evaluation and quantification of cells expressing integrins ITGAM, ITGAX, and ITGB2, as well as ICAM-3 in sinonasal tissues were conducted to compare local protein expression patterns. Results Integrin and ICAM genes were significantly elevated in the blood (p<0.001 to p<0.05) and sinuses (p<0.0003 to p<0.05) of patients with CRSwNP compared to controls. Strong positive correlations of genes expressed in the blood (p<0.01 to p<0.05) and sinuses (p<0.01) were observed between ITGAM, ITGAX, ITGB2, and ICAM3. ITGAM-, ITGB2-, ICAM-3-, and ICAM-3/ITGB2-positive cell counts were significantly increased in CRSwNP compared to controls (p<0.0001 to p<0.04), and a positive correlation between ICAM-3/ITGB2- and ITGAM-positive cell counts was observed (p<0.02). Conclusion The systemic and local expression of ITGAM, ITGB2, and ICAM-3 is significantly upregulated in CRSwNP, suggesting that integrin complex ITGAM/ITGB2 and ICAM-3 serve a potential role in inflammation-mediated signaling in CRSwNP.
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Affiliation(s)
- Brennan J Blight
- Division of Otolaryngology-Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Amarbir S Gill
- Division of Otolaryngology-Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jorgen S Sumsion
- Division of Otolaryngology-Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Chelsea E Pollard
- Division of Otolaryngology-Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Shaelene Ashby
- Division of Otolaryngology-Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Gretchen M Oakley
- Division of Otolaryngology-Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Abigail Pulsipher
- Division of Otolaryngology-Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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17
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Jappe U, Beckert H, Bergmann KC, Gülsen A, Klimek L, Philipp S, Pickert J, Rauber-Ellinghaus MM, Renz H, Taube C, Treudler R, Wagenmann M, Werfel T, Worm M, Zuberbier T. Biologics for atopic diseases: Indication, side effect management, and new developments. Allergol Select 2021; 5:1-25. [PMID: 33426426 PMCID: PMC7787364 DOI: 10.5414/alx02197e] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/23/2020] [Indexed: 12/17/2022] Open
Abstract
With the advent of biologicals, more and more therapeutics are available that specifically address specific switch points in the pathomechanism of immunologically dominated diseases. Thus, the focus of diagnostics and therapy (precision medicine) is more on the individual disease characteristics of the individual patient. Regarding the different phenotypes of atopic diseases, severe asthma was the first entity for which biologicals were approved, followed by urticaria, and finally atopic dermatitis and chronic rhinosinusitis with nasal polyps. Experience in the treatment of severe bronchial asthma has shown that the intensity of the response to biological therapy depends on the quality of clinical and immunological phenotyping of the patients. This also applies to different diseases of the atopic form, as patients can suffer from several atopic diseases at the same time, each with different characteristics. Biologics are already emerging that may represent a suitable therapy for allergic bronchial asthma, which often occurs together with severe neurodermatitis, and chronic rhinosinusitis with nasal polyps. In practice, however, the question of possible combinations of biologicals for the therapy of complex clinical pictures of individual patients is increasingly arising. In doing so, the side effect profile must be taken into account, including hypersensitivity reactions, whose diagnostic and logistical management must aim at a safe and efficient therapy of the underlying disease. Increased attention must also be paid to biological therapy in pregnancy and planned (predictable) vaccinations as well as existing infections, such as SARS-CoV-2 infection. Before starting a biological therapy, the immune status should be checked with regard to chronic viral and bacterial infections and, if necessary, the vaccination status should be refreshed or missing vaccinations should be made up for before starting therapy. Currently, reliable data on the effect of biologicals on the immunological situation of SARS-CoV-2 infection and COVID-19 are not available. Therefore, research and development of suitable diagnostic methods for detection of immunologically caused side effects as well as detection of potential therapy responders and non-responders is of great importance.
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Affiliation(s)
- Uta Jappe
- Research Group Clinical and Molecular Allergology of the Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL)
- Interdisciplinary Allergy Outpatient Clinic, Medical Clinic III, University of Lübeck
| | - Hendrik Beckert
- Department of Pulmonary Medicine, University Hospital Essen – Ruhrlandklinik, Essen
| | - Karl-Christian Bergmann
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
| | - Askin Gülsen
- Interdisciplinary Allergy Outpatient Clinic, Medical Clinic III, University of Lübeck
| | | | - Sandra Philipp
- Dermatology practice Dr. Markus Friedrich/Dr. Sandra Philipp, Oranienburg
| | - Julia Pickert
- Department of Dermatology and Allergology, University Hospital Gießen and Marburg, Marburg site
| | | | - Harald Renz
- Department of Medicine, Institute of Laboratory Medicine and Pathobiochemistry – Molecular Diagnostics, Member of the German Centre for Lung Research (DZL), Philipps-University, Marburg
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen – Ruhrlandklinik, Essen
| | - Regina Treudler
- Leipzig Comprehensive Allergy Center LICA-CAC, Department of Dermatology, Venereology and Allergology, University of Leipzig
| | - Martin Wagenmann
- Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover
| | - Margita Worm
- Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Torsten Zuberbier
- Department of Dermatology and Allergy, Charité Universitätsmedizin, Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany
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18
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Klimek L, Beule AG, Förster-Ruhrmann U, Becker S, Chaker A, Huppertz T, Hagemann J, Hoffmann TK, Dazert S, Deitmer T, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Olze H, Rudack C, Sperl A, Casper I, Dietz A, Wagenmann M, Zuberbier T, Bergmann KC, Bedbrook A, Bousquet J, Bachert C. Positionspapier: Hinweise zur Patienteninformation und -aufklärung vor Anwendung von Biologika bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP) – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC) – Teil 1: Dupilumab. Laryngorhinootologie 2020; 99:761-766. [PMID: 32858751 DOI: 10.1055/a-1240-9304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
ZusammenfassungHintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der nasalen und paranasalen Schleimhaut, der oftmals eine Typ-2-Inflammation zugrunde liegt. Durch die Entwicklung von Biologika, die in diese Entzündungsmechanismen eingreifen können, steht eine neuartige Therapiemöglichkeit zur Verfügung.Methoden Auf Grundlage des aktuellen Wissensstandes zur Immunologie der CRSwNP und der Wirkung von Biologika sowie deren mögliche unerwünschte Wirkungen werden Empfehlungen für die Patienteninformation entwickelt.Ergebnisse Basierend auf der internationalen Literatur und bisherigen Erfahrungen hat ein Expertengremium Empfehlungen für die Patienteninformation und -aufklärung zur Anwendung von Biologika bei CRSwNP entwickelt und auf dieser Grundlage einen Aufklärungsbogen erstellt.Schlussfolgerung Die Information und Einwilligung des Patienten ist vor der Verordnung bzw. Verabreichung von Biologika erforderlich. Das vorliegende Positionspapier enthält wichtige Informationen hierzu und einen Vorschlag für eine Patienteninformation.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - A G Beule
- Kliniken für Hals-, Nasen- und Ohrenheilkunde, Universitätskliniken Münster und Greifswald
| | - U Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin, Berlin
| | - S Becker
- Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsklinik Tübingen
| | - A Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Bochum
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Dreieich
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München
| | - H Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin, Berlin
| | - C Rudack
- Kliniken für Hals-, Nasen- und Ohrenheilkunde, Universitätskliniken Münster und Greifswald
| | - A Sperl
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - I Casper
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - A Dietz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Leipzig
| | - M Wagenmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Düsseldorf
| | - T Zuberbier
- Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin
| | - K C Bergmann
- Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin
| | - A Bedbrook
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, Frankreich
| | - J Bousquet
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, Frankreich.,INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif.,Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, Frankreich.,Berlin Institute of Health, Comprehensive Allergy Center, Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
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19
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Bhatt AA, Donaldson AM, Olomu OU, Gupta V, Sandhu SJS. Can Diffusion-Weighted Imaging Serve as an Imaging Biomarker for Acute Bacterial Rhinosinusitis? Cureus 2020; 12:e9893. [PMID: 32968559 PMCID: PMC7502418 DOI: 10.7759/cureus.9893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022] Open
Abstract
Acute rhinosinusitis is defined as symptomatic inflammation of the mucosal lining of the nasal cavity and paranasal sinuses lasting less than four weeks. It is most commonly secondary to viral infection but is often challenging to distinguish from bacterial etiologies. Even with recommendations from several specialty societies, there continues to be a frequent practice of overprescribing oral antibiotics for acute rhinosinusitis, thus leading to multidrug-resistant organisms, and rendering oral medication useless when actually clinically warranted. We observed a potential non-invasive imaging biomarker that could predict which patients would benefit from anti-microbial therapy. Often computed tomography (CT) imaging is obtained by the provider before consultation with the otolaryngologist, sometimes leading to unnecessary radiation to the patient. In addition, there are no clear CT findings to make the diagnosis of acute rhinosinusitis. The diagnosis is challenging for all clinicians involved, and therefore, additional signs on other imaging modalities would be helpful. We present a series of four patients with incidentally discovered culture-positive acute rhinosinusitis. Patients with incidentally discovered culture-positive acute rhinosinusitis were found to also have magnetic resonance imaging (MRI) that showed corresponding restricted diffusion on diffusion-weighted imaging (DWI). An imaging biomarker for acute bacterial rhinosinusitis may improve the appropriate use of antibiotic therapy. DWI MRI should be further investigated as a potential candidate screening modality.
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20
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Cascio F, Basile GA, Debes Felippu AW, Debes Felippu AW, Trimarchi F, Militi D, Portaro S, Bramanti A. A dental implant dislocated in the ethmoidal sinus: A case report. Heliyon 2020; 6:e03977. [PMID: 32490230 PMCID: PMC7260438 DOI: 10.1016/j.heliyon.2020.e03977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/06/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022] Open
Abstract
Maxillary sinusitis can represent a rare complication of dental implants of endodontic materials impinging in the maxillary sinuses. The effects of anatomical variants of paranasal sinuses on pathophysiological and clinical manifestations of dental sinusitis are poorly understood. Herein, we present a case of dislocation of a dental implant in the ethmoidal sinus in a 63-years old man with bilateral accessory maxillary orifice. This anatomical variation, by providing an additional way for the drainage of mucus in the maxillary sinus, could have allowed the dislocation of the implant in the ethmoidal sinus without causing mucus stagnation and consequent sinusitis, leading to a unusual clinical presentation. .
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Affiliation(s)
- Filippo Cascio
- Department of Otorhinolaryngology, Papardo Hospital, Messina, Italy
| | - Gianpaolo Antonio Basile
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Italy
| | | | | | - Fabio Trimarchi
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Italy
| | - David Militi
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
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Rawl JW, McQuitty RA, Khan MH, Reichert LK, Kuo YF, Chaaban MR. Comparison of steroid-releasing stents vs nonabsorbable packing as middle meatal spacers. Int Forum Allergy Rhinol 2019; 10:328-333. [PMID: 31742932 DOI: 10.1002/alr.22492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND A randomized controlled trial was held to compare nonabsorbable packs to steroid-eluting absorbable stents as middle meatal spacers after endoscopic sinus surgery in patients with chronic rhinosinusitis (CRS). METHODS CRS patients were randomly assigned to receive either nonabsorbable Merocel packs wrapped in non-latex glove material (packing type A) or Propel steroid eluting stents (packing type B). Twenty-two-item Sino-Nasal Outcome Test (SNOT-22) scores were collected preoperatively and postoperatively during the initial 4 debridements up to 3 months. Recording of the nasal endoscopy was also collected during all postoperative visits. In addition, Lund-Kennedy scores and middle turbinate lateralization scores, using a new visual analogue scale, were compared between the 2 types of packing. RESULTS Forty CRS patients were prospectively enrolled in this institutional review board (IRB)-approved study. Patients with packing type A had significantly lower middle turbinate lateralization scores at their first (∼10 days) postoperative visit (p = 0.02 and p = 0.04, for left and right sides, respectively). This difference disappeared by later postoperative visits (from 20 days to 3 months). Overall, patients receiving packing type A had significant lower SNOT-22 scores at 20 days postsurgery (p = 0.05). This difference also disappeared at 1 and 3 months postoperation. There were no statistically significant differences in Lund-Kennedy scores. CONCLUSION In this study, nonabsorbable packing materials showed significant superior middle meatal spacing capacities as evidenced by greater middle turbinate medialization capability at the first postoperative visit. Additionally, patients with this type of packing saw improvements in their SNOT-22 scores at the 20-day postoperative visit. This study showed that there was no significant improvement in postoperative outcomes with drug-eluting stents when compared to nonabsorbable packing.
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Affiliation(s)
- Jordan W Rawl
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX
| | - Robert A McQuitty
- University of Texas Medical Branch School of Medicine, Galveston, TX
| | - Mashfee H Khan
- University of Texas Medical Branch School of Medicine, Galveston, TX
| | - Lara K Reichert
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Mohamad R Chaaban
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX
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Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is one of the most frequent chronic diseases. Among these patients the prevalence of immune defects is higher than in the healthy general population. METHODS A selective review of the literature was carried out in PubMed and Medline covering the period between 2008 and 2019. Additionally, recent German publications in journals not listed in the abovementioned databases were analyzed. RESULTS The diagnostic workflow with respect to the immunodeficiency consists of a detailed anamnesis and physical examination, laboratory tests and the antibody reaction to polysaccharide vaccines and antigens. Beside antibiotic treatment, vaccinations and immunoglobulin replacement are available. Notwithstanding the above, functional endoscopic surgery of the paranasal sinuses should be performed according to guideline recommendations. CONCLUSION Patients with CRS who do not sufficiently respond to conservative and surgical treatment should be checked for underlying immunodeficiencies.
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23
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[Immunology of chronic rhinosinusitis with nasal polyps as a basis for treatment with biologicals]. HNO 2019; 67:15-26. [PMID: 30167718 DOI: 10.1007/s00106-018-0557-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous and multifactorial inflammation of the nasal and paranasal mucosa. Until now, no internationally standardized classification could be developed. In most cases, CRS is phenotypically classified according to chronic rhinosinusitis with (CRScNP) and without nasal polyps (CRSsNP). However, recent studies could show that there are numerous endotypes within these phenotypes based on different inflammatory mechanisms. This review describes the important immunological mechanisms of CRScNP and highlights modern treatment options with biologicals directly addressing particular immunological processes. METHODS Current knowledge on immunological and molecular processes of CRS, particularly CRScNP, was extracted from Medline, PubMed, national and international study- and guideline-registers, and the Cochrane library by a systematic review of the literature. RESULTS Based on current literature, various immunological mechanisms for CRS and CRScNP could be identified. Relevant studies for the treatment of eosinophilic conditions such as asthma or CRScNP are presented and, if available, results of these studies are discussed. CONCLUSION The growing insight into the underlying immunological mechanisms of CRScNP could pave the way for new personalized treatment options such as biologicals in the future.
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24
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Ramakrishnan VR, Mace JC, Soler ZM, Smith TL. Is greater antibiotic therapy prior to ESS associated with differences in surgical outcomes in CRS? Laryngoscope 2019; 129:558-566. [PMID: 30582166 PMCID: PMC6402589 DOI: 10.1002/lary.27651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 08/01/2018] [Accepted: 09/04/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Antibiotics have been a mainstay of chronic rhinosinusitis therapy; however, data suggest that antibiotics may also result in several adverse unintended consequences. We aimed to evaluate if greater antibiotic use prior to sinus surgery was associated with differences in surgical outcomes. METHODS Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study were asked to recall systemic antibiotic use in the 90 days prior to endoscopic sinus surgery (ESS). Antibiotic use was examined in relation to demographics, disease characteristics, and outcomes. RESULTS Data were collected for 271 study participants followed for a mean of 14.9 [± 5.1] months across four institutions, with a mean preoperative antibiotic use of 27.8 [± 22.7] days out of the 90 preceding ESS. After ESS, significant improvement (P < 0.001) was reported for patient-reported outcome measures and endoscopy scores for the overall cohort. No bivariate correlation between preoperative antibiotic use and degree of benefit in objective clinical measures (endoscopy, Brief Smell Identification Test) was seen. Increased preoperative antibiotic use was associated with less improvement in 22-item SinoNasal Outcome Test (SNOT-22) and its rhinologic subdomain after ESS. Prevalence of achieving a minimal clinically important difference in overall SNOT-22 symptom scores was lower in those using more preoperative antibiotics, although statistical significance was not reached when adjusting for independent covariates in multivariate modeling. CONCLUSION Higher amounts of previous antibiotic use do not appear to be associated with better ESS outcomes. Specific recommendations for antibiotic use as part of CRS-appropriate medical therapy prior to ESS require further study, particularly given concerns for antibiotic overuse and implications for improving outcomes in the modern healthcare era. LEVEL OF EVIDENCE 2C Laryngoscope, 129:558-566, 2019.
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Affiliation(s)
| | - Jess C. Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
| | - Zachary M. Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Timothy L. Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
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Yip J, Hao W, Eskander A, Lee JM. Wait times for endoscopic sinus surgery influence patient‐reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria. Int Forum Allergy Rhinol 2018; 9:396-401. [DOI: 10.1002/alr.22257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/16/2018] [Accepted: 11/13/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Jonathan Yip
- Division of Rhinology, Department of Otolaryngology–Head and Neck Surgery, St. Michael's HospitalUniversity of Toronto Toronto ON Canada
| | - Weibo Hao
- Division of Rhinology, Department of Otolaryngology–Head and Neck Surgery, St. Michael's HospitalUniversity of Toronto Toronto ON Canada
| | - Antoine Eskander
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron HospitalUniversity of Toronto Toronto ON Canada
| | - John M. Lee
- Division of Rhinology, Department of Otolaryngology–Head and Neck Surgery, St. Michael's HospitalUniversity of Toronto Toronto ON Canada
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Schulz KA, Esmati E, Godley FA, Hill CL, Monfared A, Teixido M, Tucci DL, Witsell DL. Patterns of Migraine Disease in Otolaryngology: A CHEER Network Study. Otolaryngol Head Neck Surg 2018; 159:42-50. [DOI: 10.1177/0194599818764387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective To evaluate the prevalence of migraine disease in an otolaryngologic cohort and migraine-related otologic and sinonasal symptoms in this population. Study Design Cross-sectional study utilizing the CHEER (Creating Healthcare Excellence through Education and Research) network for recruitment. Setting Patients were recruited in a cross-sectional and pragmatic manner in 14 CHEER sites between June 2015 and March 2017 (9 academic, 5 community based). Subjects and Methods Patients were included if they were aged ≥18 years and seen for any concern that was not head and neck cancer. Patients with any history of brain abnormality or headaches that began within 2 weeks of a medical illness, trauma, or head injury were excluded. Patients were screened for migraine with a validated instrument. If they screened positive on the Migraine Assessment Tool (MAT+), the subjects also filled out validated and custom questionnaires for sinonasal, otologic, and migraine-specific symptoms. Results Of 1458 patients screened, 235 (16.1%) screened positive for migraine (MAT+), which is higher than general population (13%, P < .001). The MAT+ group was significantly younger (47.2 vs 55.6 years of age, P < .001) and predominantly women (80.0% vs 55.9%, P < .001). The MAT+ cohort commonly reported ear- and sinus-related symptoms, such as tinnitus (70.5%), ear pressure (61.9%), balance problems (82%), facial pressure (85%), and rhinorrhea (49.9%). There were significantly higher levels of sinus burden with higher levels of dizziness handicap, Jonckheere-Terpstra test = 11,573.00, z = 7.471, P < .001. Conclusion Migraine disease has a higher prevalence in an otolaryngologic cohort than in the general population, presenting with a high rate of sinonasal and otologic symptoms that may be due to or exacerbated by migraines.
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Affiliation(s)
- Kristine A. Schulz
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Elnaz Esmati
- Department of Otolaryngology, George Washington University, Washington, DC, USA
| | | | - Claude L. Hill
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Ashkan Monfared
- Department of Otolaryngology, George Washington University, Washington, DC, USA
| | - Michael Teixido
- Association of Migraine Disorders, North Kingstown, Rhode Island, USA
| | - Debara L. Tucci
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - David L. Witsell
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Könnecke M, Klimek L, Mullol J, Gevaert P, Wollenberg B. Subtypisierung der Polyposis nasi: Phänotypen, Endotypen und Komorbiditäten. ALLERGO JOURNAL 2018. [DOI: 10.1007/s15007-018-1542-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Koennecke M, Klimek L, Mullol J, Gevaert P, Wollenberg B. Subtyping of polyposis nasi: phenotypes, endotypes and comorbidities. ALLERGO JOURNAL INTERNATIONAL 2018; 27:56-65. [PMID: 29564208 PMCID: PMC5842507 DOI: 10.1007/s40629-017-0048-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/12/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous, multifactorial inflammatory disease of the nasal and paranasal mucosa. It has not been possible to date to develop an internationally standardized, uniform classification for this disorder. A phenotype classification according to CRS with (CRSwNP) and without polyposis (CRSsNP) is usually made. However, a large number of studies have shown that there are also different endotypes of CRS within these phenotypes, with different pathophysiologies of chronic inflammation of the nasal mucosa. This review describes the central immunological processes in nasal polyps, as well as the impact of related diseases on the inflammatory profile of nasal polyps. MATERIALS AND METHODS The current knowledge on the immunological and molecular processes of CRS, in particular CRSwNP and its classification into specific endotypes, was put together by means of a structured literature search in Medline, PubMed, the national and international guideline registers, and the Cochrane Library. RESULTS Based on the current literature, the different immunological processes in CRS and nasal polyps were elaborated and a graphical representation in the form of an immunological network developed. In addition, different inflammatory profiles can be found in CRSwNP depending on related diseases, such as bronchial asthma, cystic fibrosis (CF), or NASID-Exacerbated Respiratory Disease (N‑ERD). CONCLUSION The identification of different endotypes of CRSwNP may help to improve diagnostics and develop novel individual treatment approaches in CRSwNP.
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Affiliation(s)
- Michael Koennecke
- Lübeck Campus, Department of Otorhinolaryngology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Joaquim Mullol
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, CIBERES Spain
| | - Philippe Gevaert
- Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - Barbara Wollenberg
- Lübeck Campus, Department of Otorhinolaryngology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Klimek L, Koennecke M, Mullol J, Hellings PW, Wang D, Fokkens W, Gevaert P, Wollenberg B. A possible role of stem cells in nasal polyposis. Allergy 2017; 72:1868-1873. [PMID: 28599061 DOI: 10.1111/all.13221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 12/21/2022]
Abstract
Since its discovery, the understanding of stem/progenitor cells raised dramatically in the last decade. Their regenerative potential is important to develop new therapeutic applications, but the identification advanced much faster than our understanding of stem/progenitor cells. In nasal polyposis, little is known about stem cells/progenitor cells and their ability. However, the further characterization of stem cells/progenitor cells may provide new treatment options for combating nasal polyposis. This review highlights the knowledge of the current literature about stem cells/progenitor cells in nasal polyposis and how this may be exploited in the development of novel treatment strategies.
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Affiliation(s)
- L. Klimek
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - M. Koennecke
- Department of Otorhinolaryngology; University Hospital Schleswig-Holstein; Lübeck Germany
| | - J. Mullol
- Rhinology Unit and Smell Clinic; Department of Otorhinolaryngology; Hospital Clinic; IDIBAPS; Universitat de Barcelona, CIBERES; Barcelona Catalonia Spain
| | - P. W. Hellings
- Department of Otorhinolaryngology; University Hospitals Leuven; Leuven Belgium
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam The Netherlands
| | - D.Y. Wang
- Department of Otolaryngology; National University of Singapore; Singapore
| | - W. Fokkens
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam The Netherlands
| | - P. Gevaert
- Department of Otorhinolaryngology; Ghent University; Ghent Belgium
| | - B. Wollenberg
- Department of Otorhinolaryngology; University Hospital Schleswig-Holstein; Lübeck Germany
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Soler ZM, Jones R, Le P, Rudmik L, Mattos JL, Nguyen SA, Schlosser RJ. Sino-Nasal outcome test-22 outcomes after sinus surgery: A systematic review and meta-analysis. Laryngoscope 2017; 128:581-592. [PMID: 29164622 DOI: 10.1002/lary.27008] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/15/2017] [Accepted: 10/19/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS The goal of the study was to perform a systematic review with meta-analysis to determine the mean change in the 22-item Sino-Nasal Outcome Test (SNOT-22) across patients who have had endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) in the literature. METHODS A literature search was performed to identify studies that assessed SNOT-22 scores before and after ESS in adult patients with CRS. A random effects model with inverse variance weighting was used to generate the mean change after surgery, along with the forest plot and 95% confidence interval (CI). The impact of patient-specific factors across studies was assessed using a mixed-effects meta-regression. RESULTS The final study list included 40 unique patient cohorts published from 2008 to 2016. All studies showed a statistically significant change in mean SNOT-22 scores between baseline and postoperative time points (P < .001), ranging from 12.7 to 44.8, at an average follow-up of 10.6 months. The summary change in mean SNOT-22 across all studies was 24.4 (95% CI: 22.0-26.8). After forward, step-wise multivariate modeling, studies with higher mean preoperative SNOT-22 score and higher asthma prevalence were associated with greater changes in SNOT-22 score after ESS, whereas studies with longer mean follow-up had smaller changes in SNOT-22 score. CONCLUSIONS Studies evaluating quality-of-life outcomes after sinus surgery using the SNOT-22 instrument universally show significant improvement after ESS. Across the published literature, the magnitude of change is quite variable and appears to be influenced by a number of factors including baseline SNOT-22 score, asthma prevalence, and length of follow-up. Laryngoscope, 128:581-592, 2018.
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Affiliation(s)
- Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Rabun Jones
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Phong Le
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jose L Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Kirsch CF, Bykowski J, Aulino JM, Berger KL, Choudhri AF, Conley DB, Luttrull MD, Nunez D, Shah LM, Sharma A, Shetty VS, Subramaniam RM, Symko SC, Cornelius RS. ACR Appropriateness Criteria ® Sinonasal Disease. J Am Coll Radiol 2017; 14:S550-S559. [DOI: 10.1016/j.jacr.2017.08.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 01/09/2023]
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Yousof AM, Awada OG, Abdel Fattah MT, Ahmada SF. Pulmonary function tests in patients with chronic rhinosinusitis and the effect of surgery. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2017. [DOI: 10.4103/ejb.ejb_91_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Scangas GA, Remenschneider AK, Bleier BS, Holbrook EH, Gray ST, Metson RB. Does the Timing of Middle Turbinate Resection Influence Quality-of-Life Outcomes for Patients with Chronic Rhinosinusitis? Otolaryngol Head Neck Surg 2017; 157:874-879. [DOI: 10.1177/0194599817706929] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To evaluate the impact of bilateral middle turbinate resection (BMTR) on patient-reported quality of life following primary and revision endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Study Design Prospective cohort study. Setting Tertiary care center. Subjects and Methods Patients with CRS who were recruited from 11 otolaryngologic practices completed the Sino-Nasal Outcome Test–22, Chronic Sinusitis Survey, and EuroQol 5-Dimension questionnaires at baseline, as well as 3 and 12 months after ESS. In the primary ESS cohort (n = 406), patients who underwent BMTR (n = 78) at the time of surgery were compared with patients (n = 328) whose middle turbinates were preserved. In the revision ESS cohort (n = 363), a similar comparison was made between patients who did (n = 64) and did not (n = 299) undergo BMTR. Results Sino-Nasal Outcome Test–22, Chronic Sinusitis Survey, and EuroQol 5-Dimension scores showed similar improvements for both the turbinate resection and preservation cohorts at 3 months ( P < .001) and 12 months ( P < .001) after surgery. For patients who underwent revision surgery, the performance of BMTR resulted in greater improvement in Chronic Sinusitis Survey scores at 1 year as compared with the turbinate preservation group (change from baseline: 28.1 vs 20.7, respectively; P = .026). History of tobacco use and the presence of nasal polyps did not affect clinical outcomes at any time point. Conclusion Patients who underwent BMTR during primary and revision sinus surgery reported similar benefits in quality-of-life outcomes 1 year after surgery. In select patients undergoing revision sinus surgery, the performance of BMTR results in improved disease-specific quality of life.
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Affiliation(s)
- George A. Scangas
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Aaron K. Remenschneider
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Benjamin S. Bleier
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Eric H. Holbrook
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Stacey T. Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Ralph B. Metson
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Cope EK, Goldberg AN, Pletcher SD, Lynch SV. Compositionally and functionally distinct sinus microbiota in chronic rhinosinusitis patients have immunological and clinically divergent consequences. MICROBIOME 2017; 5:53. [PMID: 28494786 PMCID: PMC5427582 DOI: 10.1186/s40168-017-0266-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/18/2017] [Indexed: 05/07/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by persistent sinonasal inflammation and sinus microbiome dysbiosis. The basis of this heterogeneity is poorly understood. We sought to address the hypothesis that a limited number of compositionally distinct pathogenic bacterial microbiota exist in CRS patients and invoke discrete immune responses and clinical phenotypes in CRS patients. RESULTS Sinus brushings from patients with CRS (n = 59) and healthy individuals (n = 10) collected during endoscopic sinus surgery were analyzed using 16S rRNA gene sequencing, predicted metagenomics, and RNA profiling of the mucosal immune response. We show that CRS patients cluster into distinct sub-groups (DSI-III), each defined by specific pattern of bacterial co-colonization (permutational multivariate analysis of variance (PERMANOVA); p = 0.001, r 2 = 0.318). Each sub-group was typically dominated by a pathogenic family: Streptococcaceae (DSI), Pseudomonadaceae (DSII), Corynebacteriaceae [DSIII(a)], or Staphylococcaceae [DSIII(b)]. Each pathogenic microbiota was predicted to be functionally distinct (PERMANOVA; p = 0.005, r 2 = 0.217) and encode uniquely enriched gene pathways including ansamycin biosynthesis (DSI), tryptophan metabolism (DSII), two-component response [DSIII(b)], and the PPAR-γ signaling pathway [DSIII(a)]. Each is also associated with significantly distinct host immune responses; DSI, II, and III(b) invoked a variety of pro-inflammatory, TH1 responses, while DSIII(a), which exhibited significantly increased incidence of nasal polyps (Fisher's exact; p = 0.034, relative risk = 2.16), primarily induced IL-5 expression (Kruskal Wallis; q = 0.045). CONCLUSIONS A large proportion of CRS patient heterogeneity may be explained by the composition of their sinus bacterial microbiota and related host immune response-features which may inform strategies for tailored therapy in this patient population.
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Affiliation(s)
- Emily K. Cope
- Department of Otolaryngology, University of California, San Francisco, CA 94143 USA
- Present Address: Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ 86011 USA
| | - Andrew N. Goldberg
- Department of Otolaryngology, University of California, San Francisco, CA 94143 USA
| | - Steven D. Pletcher
- Department of Otolaryngology, University of California, San Francisco, CA 94143 USA
| | - Susan V. Lynch
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA 94143 USA
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Ramakrishnan VR, Mace JC, Soler ZM, Smith TL. Examination of high-antibiotic users in a multi-institutional cohort of chronic rhinosinusitis patients. Int Forum Allergy Rhinol 2017; 7:343-351. [PMID: 28084683 PMCID: PMC5386802 DOI: 10.1002/alr.21903] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/21/2016] [Accepted: 12/05/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND In addition to known concerns regarding antibiotic overuse, recent research indicates that excessive antibiotic use is associated with poorer long-term health. Given that rhinosinusitis is the leading condition accounting for antibiotic prescriptions in the ambulatory setting, we aimed to evaluate characteristics associated with greater antibiotic use in chronic rhinosinusitis (CRS). METHODS Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study evaluating treatment outcomes were included in this analysis. Study participants were asked to report the number of days out of the previous 90 days that systemic antibiotics were taken for sinus disease. Patient demographics, disease characteristics, and measures of disease severity were evaluated. RESULTS A total of 561 patients from 4 institutions were included in the analysis, with mean antibiotic use of 17.4 ± 22.4 out of the prior 90 days. No differences between antibiotic-use groups were found for objective measures of disease severity (computed tomography [CT], endoscopy, Brief Smell Identification Test [BSIT] scores), however, increased patient-reported symptom burden (22-item Sino-Nasal Outcome Test [SNOT-22], Rhinosinusitis Disability Index [RSDI]) was associated with more antibiotic use. Patients reporting the most antibiotic use were older (p = 0.004) but no ethnic or gender differences were seen. Comorbid diagnoses of allergy, asthma, diabetes, depression, or fibromyalgia were not associated with increased antibiotic use. In accordance with literature recommendations, CRS with nasal polyps (CRSwNP) patients were less likely to have used antibiotics. Endoscopic sinus surgery (ESS) significantly decreased antibiotic use. CONCLUSION Variability in antibiotic use in CRS appears to be driven by symptom burden, independent of objective measures of disease severity, patient demographics, and presence of comorbid disease. Clear guidelines are essential to define appropriate antibiotic use in CRS.
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Affiliation(s)
| | - Jess C. Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
| | - Zachary M. Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Timothy L. Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
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Ayoub N, Thamboo A, Habib AR, Nayak JV, Hwang PH. Determinants and outcomes of upfront surgery versus medical therapy for chronic rhinosinusitis in cystic fibrosis. Int Forum Allergy Rhinol 2017; 7:450-458. [DOI: 10.1002/alr.21912] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/29/2016] [Accepted: 12/13/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Noel Ayoub
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Andrew Thamboo
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Al-Rahim Habib
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Jayakar V. Nayak
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Peter H. Hwang
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
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Anderson M, Stokken J, Sanford T, Aurora R, Sindwani R. A systematic review of the sinonasal microbiome in chronic rhinosinusitis. Am J Rhinol Allergy 2017; 30:161-6. [PMID: 27216345 DOI: 10.2500/ajra.2016.30.4320] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The interaction between the host and microorganisms in chronic rhinosinusitis (CRS) is poorly understood and is a growing area of interest. More recently, methodologies have been developed to assess the microbiome without the use of culture by analyzing the bacterial 16S ribosomal RNA gene. We reviewed the microbiome literature to better understand the role of microbes in CRS. METHODS Systematic review of studies that used the 16S ribosomal RNA gene deep sequencing. RESULTS Nine publications met the search criteria. Eight studies evaluated the microbiome in controls (total, 83 subjects; range, 3-28 per study), whereas six of the studies included patients with CRS (total, 121 patients; range, 7-43 per study). Various sequencing techniques, primers, sample sites, and extraction methods were used. Of the articles that specified the number of taxa in controls, an average of 1587 taxa were identified (range, 911-2330). Significant heterogeneity was noted among the studies; however, Firmicutes, Actinobacteria, and Bacteroides phyla were identified in every sample of control patients and patients with CRS. Three of the studies showed enrichment to some degree of Staphylococcus aureus in patients with CRS. The total bacterial burden in CRS was similar to the controls. One study demonstrated a decrease in diversity, whereas other studies did not show any changes in CRS when compared with controls. CONCLUSION Although there are common phyla present in both control patients and patients with CRS, no consistent enrichment of any particular taxon was identified. Our findings indicated that there was no clear single causative microbe in CRS. More studies are needed to better understand the significance of the host interaction with the microbiome and the role it plays in CRS.
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Affiliation(s)
- Martin Anderson
- Department of Otolaryngology, Saint Louis University, St Louis, Missouri, USA
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Mercieca L, Pullicino R, Camilleri K, Abela R, Mangion SA, Cassar J, Zammit M, Gatt C, Deguara C, Barbara C, Fsadni P, Montefort S. Continuous Positive Airway Pressure: Is it a route for infection in those with Obstructive Sleep Apnoea? ACTA ACUST UNITED AC 2017; 10:28-34. [PMID: 28966735 PMCID: PMC5611769 DOI: 10.5935/1984-0063.20170005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnoea (OSA), with limited data about the prevalence of respiratory infections and microbial colonization in these patients. OBJECTIVES The aim of this study was to determine if CPAP use is associated with respiratory infections and to identify the organisms that colonize or infect these patients. METHOD A retrospective, case-controlled study in patients diagnosed with OSA was carried out. 137 patients were recruited and interviewed using a questionnaire. A nasal swab was taken from each patient. Patients using CPAP machines had swabs taken from masks and humidifiers. RESULTS 66 (48.2%) patients received CPAP treatment with 60.6% of them having a heated humidifier. 78.8% were male, with the majority using a full face mask (63.6%). No significant difference was seen in the prevalence of rhinosinusitis, lower respiratory tract infections and hospital admissions for pneumonia between CPAP and non-CPAP treated patients. The presence of a humidifier did not influence the prevalence of infections. Commensal flora was predominantly cultured from nasal swabs from both patient groups. Coagulase Negative Staphylococci and Diphtheroids were the main organisms cultured from masks and humidifiers respectively. CONCLUSIONS This study shows that the use of CPAP, choice of mask and humidifier have no significant impact on the prevalence of infections and micro-organisms isolated. This is very reassuring to the physician prescribing CPAP therapy and users.
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Affiliation(s)
- Liam Mercieca
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | | | - Kyra Camilleri
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Rodianne Abela
- Bacteriology Laboratory, Pathology Department, Mater Dei Hospital, Msida, Malta
| | | | - Julian Cassar
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Matthew Zammit
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Christine Gatt
- Bacteriology Laboratory, Pathology Department, Mater Dei Hospital, Msida, Malta
| | | | - Christopher Barbara
- Bacteriology Laboratory, Pathology Department, Mater Dei Hospital, Msida, Malta
| | - Peter Fsadni
- Department of Medicine, Mater Dei Hospital, Msida, Malta
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Mercieca L, Pullicino R, Camilleri K, Abela R, Mangion SA, Cassar J, Zammit M, Gatt C, Deguara C, Barbara C, Fsadni P, Montefort S. Continuous positive airway pressure: Is it a route for infection in those with Obstructive Sleep Apnoea? Sleep Sci 2017. [DOI: 10.1016/j.slsci.2016.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Schlosser RJ, Storck K, Cortese BM, Uhde TW, Rudmik L, Soler ZM. Depression in chronic rhinosinusitis: A controlled cohort study. Am J Rhinol Allergy 2016; 30:128-33. [PMID: 26980393 DOI: 10.2500/ajra.2016.30.4290] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression in patients with chronic rhinosinusitis (CRS) is underdiagnosed but significantly impacts treatment outcomes and health care utilization. OBJECTIVE To compare undiagnosed depression in a CRS cohort with a healthy, non-CRS control cohort. METHODS A case-control study of patients with symptomatic CRS and a non-CRS control cohort was performed. Demographic and comorbidity factors were correlated to depression-specific outcomes by using the Beck Depression Inventory II (BDI). RESULTS We enrolled 42 patients with CRS and 88 control patients with no history of CRS. Physician-diagnosed depression was equivalent in CRS and control patients (6% and 9%, respectively). BDI-detected depression was higher among patients with CRS compared with controls (31% versus 14.8%, respectively; p = 0.031). BDI scores were higher in patients with CRS even when controlling for comorbid asthma, allergy, and aspirin sensitivity. When examined by polyp status, the patients without polyps had more depression than did the controls (38% versus 14.8%; p = 0.048). The somatic subscale scores of the BDI were worse in patients with CRS (p = 0.004), whereas the cognitive subscale trended toward significance (p = 0.081). CONCLUSION Depression may be more common in CRS than previously recognized, especially in patients without polyps. Somatic subscale scores of the BDI are increased in CRS and may impact future treatment outcomes.
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Affiliation(s)
- Rodney J Schlosser
- Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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Lee VS, Humphreys IM, Purcell PL, Davis GE. Manuka honey sinus irrigation for the treatment of chronic rhinosinusitis: a randomized controlled trial. Int Forum Allergy Rhinol 2016; 7:365-372. [PMID: 27935259 DOI: 10.1002/alr.21898] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/04/2016] [Accepted: 11/15/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Manuka honey (MH) has been shown in vitro to be effective against biofilm-producing bacteria. This study assessed the effectiveness of MH for patients with active chronic rhinosinusitis (CRS) and prior sinus surgery. METHODS This prospective single-blinded (clinician only) randomized controlled trial recruited patients with active CRS and prior sinus surgery. Patients received either MH or saline (SAL) sinus irrigations twice daily for 30 days and were offered oral antibiotics and/or oral/topical steroids as indicated. Outcomes were 22-item Sino-Nasal Outcome Test (SNOT-22) change score (primary), culture negativity, and Lund-Kennedy endoscopic change score. RESULTS Forty-two patients were analyzed (MH, n = 20; SAL, n = 22). The SNOT-22 change score achieved a clinically significant improvement in both groups but was similar between MH (median [interquartile range]: -12 [-20, -1]) and SAL (-12.5 [-22, -6]) (p = 0.57). Culture negativity was better on MH (8/19, 42%) compared to SAL (4/21, 19%), nearing statistical significance (p = 0.11). Lund-Kennedy endoscopic change score improved in both groups but was not statistically better on MH (-3 [-5, 0]) compared to SAL (-1 [-2, 0]) (p = 0.20). For patients not receiving oral antibiotics/steroids, culture negativity was statistically better on MH (5/10, 50%) compared to SAL (0/6, 0%) (p = 0.04). MH was well-tolerated. No adverse events were reported. CONCLUSION In patients with active CRS and prior sinus surgery, both MH and SAL improved outcomes, but there was no statistically significant difference between these groups. However, in the subset that did not receive oral antibiotics/steroids, culture negativity was statistically better on MH, suggesting that MH alone may be effective for acute exacerbations of CRS.
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Affiliation(s)
- Victoria S Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
| | - Patricia L Purcell
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
| | - Greg E Davis
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
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Rosenfeld RM, Singer M, Jones S. Systematic review of antimicrobial therapy in patients with acute rhinosinusitis. Otolaryngol Head Neck Surg 2016; 137:S32-45. [PMID: 17761282 DOI: 10.1016/j.otohns.2007.06.724] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Revised: 06/09/2007] [Accepted: 06/12/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the natural history of acute rhinosinusitis and the impact of antimicrobial therapy on clinical outcomes. DATA SOURCES MEDLINE and Cochrane Trial Registry through February 2007 combined with manual review of retrieved article bibliographies. REVIEW METHODS Systematic review and random-effects meta-analysis of double-blind, randomized, controlled trials comparing placebo vs oral antimicrobial for initial therapy of uncomplicated acute rhinosinusitis in patients aged 12 years or older. RESULTS Thirteen trials met inclusion criteria and had data suitable for pooling. Clinical cure occurred in 8% of patients who received placebo after 3 to 5 days, rising to 35% by 7 to 12 days and 45% by 14 to 15 days. Antimicrobials increased cure rates at 7 to 12 days, with an absolute rate difference of 15% (95% CI, 4%-25%). Clinical improvement occurred in 30% of patients who received placebo after 3 to 5 days, rising to 73% by 7 to 12 days and 14 to 15 days. Antimicrobials increased improvement rates at 7 to 12 days by 14% (95% CI, 1%-28%) and at 14 to 15 days by 7% (95% CI, 2%-13%). Diarrhea and adverse events were about 80% more common in patients who received antimicrobials (P < 0.03). CONCLUSIONS Over 70% of patients with acute rhinosinusitis are improved after 7 days, with or without antimicrobial therapy. About 7 patients must be treated to achieve one additional positive outcome at 7 to 12 days above and beyond spontaneous resolution. Generalizability of results is limited because nearly all trials involved a primary care setting and some trials excluded patients with severe illness.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, State University of New York Downstate Medical Center and The Long Island College Hospital, Brooklyn, NY 11201-5514, USA.
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Amali A, Saedi B, Rahavi-Ezabadi S, Ghazavi H, Hassanpoor N. Long-term postoperative azithromycin in patients with chronic rhinosinusitis: A randomized clinical trial. Am J Rhinol Allergy 2016; 29:421-4. [PMID: 26637580 DOI: 10.2500/ajra.2015.29.4244] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is recognized as a common disease that imposes a big burden on the health system worldwide. There is ongoing evidence of the anti-inflammatory effect of long-term macrolide in the management of patients with CRS. OBJECTIVE The aim of this randomized clinical trial was to evaluate the efficacy of long-term consumption of low-dose azithromycin after functional endoscopic sinus surgery. METHODS Sixty-six patients who fulfilled the inclusion criteria were randomly divided into intervention and control groups. The subjects received the standard conventional treatment (fluticasone nasal spray plus normal saline solution irrigation) or the conventional treatment plus 250 mg of azithromycin on a daily basis for 3 months. Evaluation was made based on the 22-item Sino-Nasal Outcome Test (SNOT-22) immediately before surgery and 3 months after surgery. RESULTS The intervention group showed a statistically significant improvement in SNOT-22 scores after the treatment and a higher percentage change after 3 months of therapy compared with the control group. A significant correlation was found between the percentage change of SNOT-22 scores and smoking in the placebo group. Lund-Mackay scores, patient age, and the duration of symptoms had no significant correlation with the percentage change. CONCLUSION Treatment with long-term low-dose azithromycin in combination with the conventional therapy could statistically reduce the recurrence rate of CRS symptoms after functional endoscopic sinus surgery, but there was not sufficient evidence to support clinical significance of azithromycin at the investigated dose. Further larger scale trials, along with a longer follow-up period, is needed to evaluate the effectiveness of the therapy.
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Affiliation(s)
- Amin Amali
- Otorhinolaryngology Head and Neck Surgery Department, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Savvateeva DM, Svistushkin VM, Averbukh VM, Dzhafarova MZ. [The silent sinus syndrome in the patients presenting with the uncinate process apposed to the orbital wall]. Vestn Otorinolaringol 2016; 80:10-13. [PMID: 26978744 DOI: 10.17116/otorino201580610-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of the present study was to analyze the frequency of the silent sinus syndrome (SSS) based on the results of computed tomography of the paranasal sinuses (PNS) in the patients presenting with the uncinate process (UP) apposed to the orbital wall. The study included 35 patients with the uncinate process apposed to the orbital wall who had been operated in the Clinic of ENT Diseases of I.M. Sechenov First Moscow State Medical University. The examination of the nasal cavity with the use of computed tomography and PNS endoscopy revealed the silent sinus syndrome in 14 patients. Ten of them had endoscopically confirmed type 2 hypoplasia of maxillary sinuses (MS). This finding suggests the necessity of computed tomography of paranasal sinuses in the patients with this condition in order to exclude the diagnosis of silent sinus syndrome even in the absence of exophthalmos. All the patients included in the present study underwent endoscopic surgery on maxillary sinuses that resulted in the adequate widening of the ostium and comprehensive sanation of the sinuses.
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Affiliation(s)
- D M Savvateeva
- I.M. Sechenov First Moscow State Medical University, Russian Ministry of Health, Moscow, Russia, 119991
| | - V M Svistushkin
- I.M. Sechenov First Moscow State Medical University, Russian Ministry of Health, Moscow, Russia, 119991
| | - V M Averbukh
- Federal Research and Clinical Centre of Otorhinolaryngology, Russian Federal Medico-Biological Agency, Moscow, Russia, 123182
| | - M Z Dzhafarova
- Federal Research and Clinical Centre of Otorhinolaryngology, Russian Federal Medico-Biological Agency, Moscow, Russia, 123182
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Bergmark RW, Sedaghat AR. Antibiotic prescription for acute rhinosinusitis: Emergency departments versus primary care providers. Laryngoscope 2016; 126:2439-2444. [DOI: 10.1002/lary.26001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/18/2016] [Accepted: 03/03/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Regan W. Bergmark
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston Massachusetts U.S.A
| | - Ahmad R. Sedaghat
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston Massachusetts U.S.A
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Benninger MS, Holy CE, Trask DK. Acute Rhinosinusitis: Prescription Patterns in a Real-World Setting. Otolaryngol Head Neck Surg 2016; 154:957-62. [PMID: 26932952 DOI: 10.1177/0194599816630310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/12/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Understand real-world prescription patterns for patients presenting with a first diagnosis of ARS and evaluate adherence to published medical guidelines. STUDY DESIGN Retrospective administrative database analysis. SETTING US-based outpatient settings. METHODS From a US claims database (MarketScan), 99,033 patients were identified with acute rhinosinusitis (ARS) in 2012 ("index"), with a complete medical and prescription history for 12 months preindex and 18 months postindex and no diagnoses of asthma or chronic rhinosinusitis. Of these, a random 10,000-patient sample was generated matched for age and sex to the initial cohort. Prescriptions and procedures at index, as well as complications up to 12 months postindex, were analyzed. RESULTS Nearly 90% of all patients received a prescription at index. Antibiotics were prescribed for 84.8% patients, followed by antitussives (16.2% for adults, 6.2% for pediatrics), nasal corticosteroids (15.5% adults, 7.5% for pediatrics), and systemic corticosteroids (10.3% for adults, 5.5% for pediatrics), with 49% adults and 29% children receiving >1 medication at first visit. Macrolides were the most frequently prescribed antibiotics (35.6% adults, 28.6% pediatrics), followed by amoxicillin/clavulanate and amoxicillin. Within 12 months of index, 3 patients presented with meningitis and 3 with orbital cellulitis. CONCLUSION Significant variability in ARS treatment was observed, highlighting the need for heightened awareness of existing guidelines.
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Passali D, Cingi C, Cambi J, Passali F, Muluk NB, Bellussi ML. A survey on chronic rhinosinusitis: opinions from experts of 50 countries. Eur Arch Otorhinolaryngol 2016; 273:2097-109. [PMID: 26742909 DOI: 10.1007/s00405-015-3880-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/23/2015] [Indexed: 11/26/2022]
Abstract
Chronic rhinosinusitis (CRS) is a very prevalent inflammatory disease. Treatments vary in different countries. In the present study, we explored the approaches of physicians in 50 countries. In this cross-sectional study, a rhinosinusitis survey (RSS) was completed by Honorary and Corresponding Members (otorhinolaryngologists) of the Italian Society of Rhinology. In 79.1 % of the 50 countries, the proportion of patients suffering from CRS was 15 %. Nasal symptoms were more intense in winter (46 % of countries), and spring and autumn (22 %). The most common symptoms were nasal obstruction (86 %), postnasal drip (82 %) and headache (52 %). The most common investigative modalities in the assessment of CRS are paranasal sinus CT, fiberoptic endoscopy, and anterior rhinoscopy. CRS patients were principally treated by otorhinolaryngologists (70 %). Medical treatments included nasal corticosteroids (90 %), nasal washes (68 %), and nasal decongestants (32 %). In 88 % of countries, more than 50 %, or "about 50 %", of all patients reported subjective symptom improvement after treatment. In most of the countries, surgery was required by 20-35 % of all CRS patients. During post-surgery follow-up, nasal washes (90 %), nasal corticosteroids (76 %), and systemic antibiotics (32 %) were prescribed. In 20-40 % of all patients, CRS was associated with nasal polyps. In such patients, the medical treatment options were nasal corticosteroids (90 %), systemic corticosteroids (50 %), nasal washes (46 %), and systemic antibiotics (34 %). Treatment of CRS patients varies in different countries. Paranasal sinus CT is the most common investigative modality in the assessment of CRS, and nasal corticosteroids are the first-line treatment, in the absence or presence of nasal polyps.
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Affiliation(s)
- Desiderio Passali
- Department for ORL Head and Neck Surgery, University of Siena, Siena, Italy
| | - Cemal Cingi
- Department for ORL Head and Neck Surgery, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey
| | - Jacopo Cambi
- Department for ORL Head and Neck Surgery, University of Siena, Siena, Italy
| | | | - Nuray Bayar Muluk
- Department for ORL Head and Neck Surgery, Faculty of Medicine, Kırıkkale University, Kirikkale, Turkey.
- , Birlik Mahallesi, Zirvekent 2. Etap Sitesi, C-3 Blok, No: 6-3/43, 06610, Çankaya/Ankara, Turkey.
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El Rassi E, Mace JC, Steele TO, Alt JA, Smith TL. Improvements in sleep-related symptoms after endoscopic sinus surgery in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2015; 6:414-22. [PMID: 26678684 DOI: 10.1002/alr.21682] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/06/2015] [Accepted: 10/19/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sleep impairment is highly prevalent in patients with chronic rhinosinusitis (CRS). Although endoscopic sinus surgery (ESS) has been shown to improve overall patient-reported sleep quality, the postoperative impact on individual sleep symptoms remains unclear. METHODS Patients with medically-recalcitrant CRS who elected to undergo ESS were prospectively enrolled into a multi-institutional, observational cohort study. Sleep-related symptom severity and treatment outcomes were assessed using the sleep domain questions within the 22-item Sino-Nasal Outcome Test (SNOT-22). RESULTS A total of 334 participants met criteria and were followed postoperatively for an average of 14.5 ± 4.9 months (mean ± standard deviation [SD]). Mean SNOT-22 sleep domain scores improved from 13.7 ± 6.8 to 7.7 ± 6.6 (p < 0.001). Significant mean relative improvements were reported for "difficulty falling asleep" (45%; p < 0.001), "waking up at night" (40%; p < 0.001), "lack of a good night's sleep" (43%; p < 0.001), "waking up tired" (40%; p < 0.001), and "fatigue" (42%; p < 0.001) scores. A total of 66% of study participants reported postoperative improvement in "lack of a good night's sleep," "waking up tired," and "fatigue"; 62% reported improvement in "waking up at night"; and 58% reported improvement in "difficulty falling asleep." CONCLUSION Patients with CRS report significant and sustained improvements following ESS in common sleep-related symptoms as assessed by the SNOT-22 sleep domain. Despite these significant improvements, some degree of persistent postoperative sleep impairment was reported. Further study is necessary to determine what factors are associated with continued sleep dysfunction after sinus surgery.
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Affiliation(s)
- Edward El Rassi
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University, Portland, OR
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University, Portland, OR
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA
| | - Jeremiah A Alt
- Division of Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University, Portland, OR
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Park DY, Lee EJ, Kim JH, Kim YS, Jung CM, Kim KS. Correlation between symptoms and objective findings may improve the symptom-based diagnosis of chronic rhinosinusitis for primary care and epidemiological studies. BMJ Open 2015; 5:e009541. [PMID: 26674502 PMCID: PMC4691778 DOI: 10.1136/bmjopen-2015-009541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND In primary care and epidemiological studies of chronic rhinosinusitis (CRS), symptom-based diagnosis is common, yet limited, because endoscopic and radiological signs are not considered. OBJECTIVES To evaluate the correlation between symptoms and objective findings of CRS to improve its symptom-based diagnosis for primary care and epidemiological studies by using data from a large-scale nationwide epidemiological study, the Korean National Health and Nutrition Examination Survey (KNHANES). DESIGN Cross-sectional study. SETTING Data from 2008 to 2012 KNHANES. PARTICIPANTS 29,225 Adults aged >19 years. OUTCOME MEASURES Questionnaires targeted two major (nasal blockage and anterior/posterior nasal drip) and two minor (facial pain/pressure and reduction or loss of smell) symptoms. Nasal polyps or mucopurulent discharge from the middle meatus was defined as positive endoscopic findings for diagnosing CRS. RESULTS Of the four symptoms, reduction or loss of smell was the symptom most significantly related to positive endoscopic findings in multivariable analysis (OR=1.936 (95% CI 1.604 to 2.337)). The combinations of symptoms showed higher ORs than individual symptoms and combinations of reduction or loss of smell with other symptoms were statistically more reliable for positive endoscopic findings than other combinations. CONCLUSIONS Our results show that reduction or loss of smell was the symptom most significantly related to positive nasal endoscopic findings. Therefore, symptom-based diagnosis of CRS can be improved by considering reduction or loss of smell as an important symptom for positive endoscopic findings of CRS.
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Affiliation(s)
- Do-Yang Park
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
- Department of Medicine, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Eun Jung Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoo Suk Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chan Min Jung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Su Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Dautremont JF, Rudmik L. When are we operating for chronic rhinosinusitis? A systematic review of maximal medical therapy protocols prior to endoscopic sinus surgery. Int Forum Allergy Rhinol 2015; 5:1095-103. [PMID: 26201538 DOI: 10.1002/alr.21601] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/05/2015] [Accepted: 06/18/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic sinus surgery (ESS) is considered a therapeutic option after failure of maximal medical therapy (MMT) for chronic rhinosinusitis (CRS). There is currently no consensus on the definition of MMT. The objective of this systematic review is to describe the various MMT criteria employed prior to considering ESS. METHODS A systematic review was performed using the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were adults with CRS based on guideline diagnostic criteria, enrolled to undergo ESS, and study publication within the last 5 years (January 1, 2009, to December 30, 2014). Studies were excluded if the study population included non-CRS indications for ESS. Primary outcome was the MMT criteria employed prior to considering a patient a candidate for ESS. A subgroup analysis was performed based on polyp status. RESULTS Of 387 reviewed studies, 21% reported MMT criteria. When reported, criteria included topical nasal corticosteroids (91% of studies) for a mean of 8 ± 8 weeks, oral antibiotics (89%) for 23 ± 8 days, systemic corticosteroids (61%) for 18 ± 12 days, saline irrigations (39%), oral antihistamines (11%), oral mucolytics (10%), and topical/oral decongestants (10%). CONCLUSION A minority of studies report MMT criteria used as the indication for ESS. When reported, the majority included an 8-week course of topical intranasal corticosteroids and 3-week course of oral antibiotics. Use of systemic corticosteroids did not differ based on polyp status. Because of variation in current MMT criteria, there is a need to develop standardized indications for ESS that will work to improve the appropriateness of care for patients with.
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Affiliation(s)
- Jon F Dautremont
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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