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Bhattacharya D, Becker BT, Behrendt F, Beyersdorff D, Petersen E, Petersen M, Cheng B, Eggert D, Betz C, Schlaefer A, Hoffmann AS. Computer-Aided Diagnosis of Maxillary Sinus Anomalies: Validation and Clinical Correlation. Laryngoscope 2024. [PMID: 38520698 DOI: 10.1002/lary.31413] [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: 01/11/2024] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Computer aided diagnostics (CAD) systems can automate the differentiation of maxillary sinus (MS) with and without opacification, simplifying the typically laborious process and aiding in clinical insight discovery within large cohorts. METHODS This study uses Hamburg City Health Study (HCHS) a large, prospective, long-term, population-based cohort study of participants between 45 and 74 years of age. We develop a CAD system using an ensemble of 3D Convolutional Neural Network (CNN) to analyze cranial MRIs, distinguishing MS with opacifications (polyps, cysts, mucosal thickening) from MS without opacifications. The system is used to find correlations of participants with and without MS opacifications with clinical data (smoking, alcohol, BMI, asthma, bronchitis, sex, age, leukocyte count, C-reactive protein, allergies). RESULTS The evaluation metrics of CAD system (Area Under Receiver Operator Characteristic: 0.95, sensitivity: 0.85, specificity: 0.90) demonstrated the effectiveness of our approach. MS with opacification group exhibited higher alcohol consumption, higher BMI, higher incidence of intrinsic asthma and extrinsic asthma. Male sex had higher prevalence of MS opacifications. Participants with MS opacifications had higher incidence of hay fever and house dust allergy but lower incidence of bee/wasp venom allergy. CONCLUSION The study demonstrates a 3D CNN's ability to distinguish MS with and without opacifications, improving automated diagnosis and aiding in correlating clinical data in population studies. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Debayan Bhattacharya
- Institute of Medical Technology and Intelligent Systems, Technische Universitaet Hamburg, Hamburg, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Tobias Becker
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Finn Behrendt
- Institute of Medical Technology and Intelligent Systems, Technische Universitaet Hamburg, Hamburg, Germany
| | - Dirk Beyersdorff
- Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elina Petersen
- Population Health Research Department, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dennis Eggert
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Betz
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Schlaefer
- Institute of Medical Technology and Intelligent Systems, Technische Universitaet Hamburg, Hamburg, Germany
| | - Anna Sophie Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Shin YH, Kim HS, Lee EK, Kim YJ, Lee HS, Jang PS, Kim YH, Chun YH, Yoon JS, Kim HH, Koh YY, Kim JT. Eosinophil-related markers and total immunoglobulin E as a predictive marker for antibiotic response in chronic rhinosinusitis. Ann Saudi Med 2015; 35:312-7. [PMID: 26497712 PMCID: PMC6074215 DOI: 10.5144/0256-4947.2015.312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic rhinosinusitis (CRS) is a commonly diagnosed disease that has a significant impact on a child's quality of life. However, no useful biomarker is available to identify antibiotic-responsive CRS. We determined the significance of eosinophil-related markers and total IgE levels in childhood CRS with regard to antibiotic response. DESIGN AND SETTING This was a case-control study of patients admitted to Uijeongbu St. Mary's Hospital between November 2010 and November 2011 and diagnosed with CRS. PATIENTS AND METHODS In this analytical cross-sectional study, we identified children whose symptoms and radiologic abnormalities did not resolve after 12 weeks despite appropriate antibiotics (non-responder CRS group), children whose symptoms and radiologic abnormalities resolved after 12 weeks with appropriate antibiotics (responder CRS group), and healthy controls selected from clinic patients. Skin prick tests were performed along with serum total IgE, total eosinophil count (TEC), serum eosinophil cationic protein (ECP) level, and ImmunoCAP analysis for common allergens. RESULTS This study included 36 responders, 22 nonresponders and 22 healthy controls. The prevalence of allergic diseases, atopy, and a family history of allergic diseases were significantly higher in the non-responder group than in the responder and control groups. TEC, ECP, and total IgE levels were significantly higher in the non-responder group than in the responder and control groups (all P < .05). Multiple linear regression analysis showed that no response to appropriate antibiotics and TEC was positively associated with ECP concentration. CONCLUSION These findings suggest that there is a high prevalence of allergic diseases in the non-responder group, that the TEC and ECP levels in the non-responder group are significantly higher than those in the responder group and controls, and that no response to antibiotics may be due to eosinophilic inflammation. The measurement of serum ECP may be useful in monitoring the progress of childhood CRS with regard to antibiotic response.
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Affiliation(s)
| | - Hwan Soo Kim
- Jintack Kim MD, PhD, Department of Pediatrics, School of Medicine,, The Catholic University of Korea, 222,, Banpo-daero, Seocho-gu, Seoul 137-701,, Republic of Korea, T: +82-31-820-3017;, F: +82-31-821-3108,
| | | | - Young Joo Kim
- Jintack Kim MD, PhD, Department of Pediatrics, School of Medicine,, The Catholic University of Korea, 222,, Banpo-daero, Seocho-gu, Seoul 137-701,, Republic of Korea, T: +82-31-820-3017;, F: +82-31-821-3108,
| | | | | | - Young-Hoon Kim
- Jintack Kim MD, PhD, Department of Pediatrics, School of Medicine,, The Catholic University of Korea, 222,, Banpo-daero, Seocho-gu, Seoul 137-701,, Republic of Korea, T: +82-31-820-3017;, F: +82-31-821-3108,
| | | | | | - Hyun Hee Kim
- Jintack Kim MD, PhD, Department of Pediatrics, School of Medicine,, The Catholic University of Korea, 222,, Banpo-daero, Seocho-gu, Seoul 137-701,, Republic of Korea, T: +82-31-820-3017;, F: +82-31-821-3108,
| | | | - Jin Tack Kim
- Jintack Kim MD, PhD, Department of Pediatrics, School of Medicine,, The Catholic University of Korea, 222,, Banpo-daero, Seocho-gu, Seoul 137-701,, Republic of Korea, T: +82-31-820-3017;, F: +82-31-821-3108,
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Georgalas C, Vlastos I, Picavet V, van Drunen C, Garas G, Prokopakis E. Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation. Allergy 2014; 69:828-33. [PMID: 24815699 DOI: 10.1111/all.12413] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2014] [Indexed: 01/30/2023]
Abstract
The relationship between allergic rhinitis and chronic rhinosinusitis has been assessed in a number of observational and experimental studies. In this review, we attempt their synthesis and evaluation using the modified Bradford Hill guidelines for causation. Although there is no proof of causation, especially in the pediatric literature, an evaluation of underlying allergies is recommended at least as an initial measure of symptoms relief.
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Affiliation(s)
- C. Georgalas
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - I. Vlastos
- Department of Otorhinolaryngology; University of Crete School of Medicine; Heraklio Crete Greece
| | - V. Picavet
- Department of Otorhinolaryngology; University Hospital Ulm; Ulm Germany
| | - C. van Drunen
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - G. Garas
- Department of Otorhinolaryngology and Head & Neck Surgery; Queens Medical Centre; Nottingham University Hospitals; Nottingham UK
| | - E. Prokopakis
- Department of Otorhinolaryngology; University of Crete School of Medicine; Heraklio Crete Greece
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One airway: Biomarkers of protection from upper and lower airway injury after World Trade Center exposure. Respir Med 2013; 108:162-70. [PMID: 24290899 DOI: 10.1016/j.rmed.2013.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/25/2013] [Accepted: 11/03/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Firefighters exposed to World Trade Center (WTC) dust have developed chronic rhinosinusitis (CRS) and abnormal forced expiratory volume in 1 s (FEV1). Overlapping but distinct immune responses may be responsible for the clinical manifestations of upper and lower airway injury. We investigated whether a panel of inflammatory cytokines, either associated or not associated with WTC-LI, can predict future chronic rhinosinusitis disease and its severity. METHODS Serum obtained within six months of 9/11/2001 from 179 WTC exposed firefighters presenting for subspecialty evaluation prior to 3/2008 was assayed for 39 cytokines. The main outcomes were medically managed CRS (N = 62) and more severe CRS cases requiring sinus surgery (N = 14). We tested biomarker-CRS severity association using ordinal logistic regression analysis. RESULTS Increasing serum IL-6, IL-8, GRO and neutrophil concentration reduced the risk of CRS progression. Conversely, increasing TNF-α increased the risk of progression. In a multivariable model adjusted for exposure intensity, increasing IL-6, TNF-α and neutrophil concentration remained significant predictors of progression. Elevated IL-6 levels and neutrophil counts also reduced the risk of abnormal FEV1 but in contrast to CRS, increased TNF-α did not increase the risk of abnormal FEV1. CONCLUSIONS Our study demonstrates both independent and overlapping biomarker associations with upper and lower respiratory injury, and suggests that the innate immune response may play a protective role against CRS and abnormal lung function in those with WTC exposure.
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Zeng M, Long XB, Cui YH, Liu Z. Comparison of efficacy of mometasone furoate versus clarithromycin in the treatment of chronic rhinosinusitis without nasal polyps in Chinese adults. Am J Rhinol Allergy 2012; 25:e203-7. [PMID: 22185725 DOI: 10.2500/ajra.2011.25.3728] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although both nasal steroids and macrolide antibiotics have been recommended for the treatment of chronic rhinosinusitis without nasal polyps (CRSsNPs), whether there is any difference in their clinical efficacy remains unexplored. In addition, few studies have investigated their clinical efficacy in a Chinese population living in China, who present distinct inflammatory patterns compared with white patients in western countries. This study compares the efficacy of mometasone furoate and clarithromycin treatment in CRSsNP in Chinese adults in a preliminary prospective, open-label, randomized trial. METHODS Forty-three CRSsNP patients were randomized to receive mometasone furoate nasal spray at 200 μg (n = 21) or clarithromycin tablet at 250 mg (n = 22) once daily for 12 weeks. Patients were assessed before the treatment and after 4, 8, and 12 weeks after treatment. Subjective symptoms were scored on a visual analog scale. Endoscopy physical findings were scored according to Lanza-Kennedy scoring system. Moreover, smoking and atopic status and coexistence of allergic rhinitis (AR) and asthma were recorded. RESULTS Before the treatment, no significant difference in symptoms and nasal endoscopic physical findings were found between mometasone furoate and clarithromycin group. As early as 4 weeks after dosing, a significant reduction of total symptom scores, nasal obstruction, headache, rhinorrhea and overall burden scores, and mucosal swelling and nasal discharge scores were observed in both groups. No significant difference in symptom or endoscopic scores was observed between these two groups at any posttreatment observation time point. The coexistence of AR was correlated with lower scores of mucosal edema and nasal secretion in the mometasone furoate group after 12-week treatment. CONCLUSION Mometasone furoate and clarithromycin show a comparable clinical effect for CRSsNPs in Chinese adults. Mometasone furoate is more effective in improving edema and secretion for CRSsNP patients with concomitant AR.
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Affiliation(s)
- Ming Zeng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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Baroody FM, Mucha SM, deTineo M, Naclerio RM. Evidence of Maxillary Sinus Inflammation in Seasonal Allergic Rhinitis. Otolaryngol Head Neck Surg 2012; 146:880-6. [DOI: 10.1177/0194599811435972] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Allergic rhinitis has been frequently associated with both acute and chronic sinusitis. Previous studies have shown an influx of eosinophils into the maxillary sinus after nasal challenge with allergen. The objective of this study was to determine, in humans, if the development of seasonal allergic inflammation, secondary to natural allergen exposure, leads to similar inflammation within the maxillary sinus. Study Design. Prospective, longitudinal study. Setting. Academic medical center and research laboratory. Subjects and Methods. Eighteen subjects were evaluated in and out of the ragweed allergy season using subjective measures (nasal symptoms, quality of life), nasal secretory response to methacholine challenge, and evaluation of biomarkers in nasal and sinus lavages. Results. The subjects became symptomatic during the season and reported worse quality of life and increased nasal reactivity to methacholine. The total number of eosinophils obtained by nasal lavage during the season (median= 35,691) was significantly higher compared with out of season (median = 2811, P ≤ .02). Similarly, there were significantly more eosinophils, albeit to a lesser magnitude, in the maxillary sinus during the season (median = 4248) compared with the out-of-season samples (median = 370, P ≤ .02). Conclusion. The authors provide evidence that natural exposure to pollen during an individual’s allergy season leads to both nasal and sinus inflammation, strengthening the association between allergic rhinitis and sinusitis. The mechanism of this inflammatory response needs to be elucidated.
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Affiliation(s)
- Fuad M. Baroody
- Section of Otolaryngology–Head and Neck Surgery, The Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Samantha M. Mucha
- Section of Otolaryngology–Head and Neck Surgery, The Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Marcy deTineo
- Section of Otolaryngology–Head and Neck Surgery, The Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Robert M. Naclerio
- Section of Otolaryngology–Head and Neck Surgery, The Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
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Yoshimura K, Kawata R, Haruna S, Moriyama H, Hirakawa K, Fujieda S, Masuyama K, Takenaka H. Clinical epidemiological study of 553 patients with chronic rhinosinusitis in Japan. Allergol Int 2011; 60:491-6. [PMID: 21778815 DOI: 10.2332/allergolint.10-oa-0234] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 03/04/2011] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The relationship between chronic rhinosinusitis (CRS) and asthma has been known for a long time. However, no large studies on the relationship between CRS and lower airway diseases have been reported to date in Japan. Additionally, eosinophilic chronic rhinosinusitis (ECRS) in Japan is considered to be a subgroup of CRS with nasal polyps (CRSwNP) characterized by eosinophil-dominant inflammation. However, the diagnostic criteria of ECRS have not been established. METHODS To investigate clinical and epidemiological features of patients with CRS from the aspect of their associations with lower airway diseases, 553 patients with CRS who visited one of six local university hospitals were examined and interviewed. Local eosinophilic infiltration was evaluated pathologically by examining NPs. RESULTS The prevalences of olfactory dysfunction (OD) in the patients with nasal polyps (NPs) and those without NPs were 57.0% and 13.7%, respectively (p < 0.0001). The prevalence of asthma in all patients was 23.1%. Furthermore, the prevalences of NPs and OD in the patients with asthma and those without asthma were 81.0% and 50.1% (p < 0.0001) and 64.2% and 35.7% (p < 0.0001), respectively. 97.4% of the patients with asthma had ≥ 15% mucosal eosinophils, and 87.9% of the patients without asthma had <15% mucosal eosinophils. CONCLUSIONS Similar to the relationship between nasal allergy and asthma, CRSwNP may be applicable to the concept of "one airway, one disease".
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8
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Choi SH, Han MY, Ahn YM, Park YM, Kim CK, Kim HH, Koh YY, Rha YH. Predisposing factors associated with chronic and recurrent rhinosinusitis in childhood. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 4:80-4. [PMID: 22379602 PMCID: PMC3283797 DOI: 10.4168/aair.2012.4.2.80] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 08/16/2011] [Accepted: 09/20/2011] [Indexed: 11/25/2022]
Abstract
Purpose There is currently no information regarding predisposing factors for chronic and recurrent rhinosinusitis (RS), although these are considered to be multifactorial in origin, and allergic diseases contribute to their pathogenesis. We evaluated the predisposing factors that may be associated with chronic and recurrent RS. Methods In this prospective study, we examined patients with RS younger than 13 years of age, diagnosed with RS at six tertiary referral hospitals in Korea between October and December, 2006. Demographic and clinical data related to RS were recorded and analyzed. Results In total, 296 patients were recruited. Acute RS was the most frequent type: 56.4% of the patients had acute RS. The prevalences of other types of RS, in descending order, were chronic RS (18.9%), subacute RS (13.2%), and recurrent RS (11.5%). Factors associated with recurrent RS were similar to those of chronic RS. Patients with chronic and recurrent RS were significantly older than those with acute and subacute RS. The prevalences of allergic rhinitis, atopy, and asthma were significantly higher in patients with chronic and recurrent RS than those with acute and subacute RS. Conclusions An association between atopy and chronic/recurrent RS, compared to acute and subacute RS, suggests a possible causal link.
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Affiliation(s)
- Sun-Hee Choi
- Department of Pediatrics, College of Medicine, Kyung Hee University, Seoul, Korea
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9
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Payne SC, Borish L, Steinke JW. Genetics and phenotyping in chronic sinusitis. J Allergy Clin Immunol 2011; 128:710-20; quiz 721-2. [PMID: 21704364 DOI: 10.1016/j.jaci.2011.05.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/06/2011] [Accepted: 05/10/2011] [Indexed: 01/21/2023]
Abstract
Chronic sinusitis with nasal polyposis historically has been treated as a single monolithic clinical disorder. Just as asthma is now accepted as numerous heterogeneous diseases, chronic sinusitis should also be viewed as comprising several diseases with varying causes, with each one characterized by distinct histologic and gene and protein expression patterns. This includes recognition of the need to define these diseases based on the presence or absence of an eosinophilic infiltrate but also on additional distinctions based on unique agents that drive their development and perpetuation. As a collection of heterogeneous diseases, proper differential diagnosis is required to delineate appropriate therapeutic intervention. This review will focus on recognized distinct presentations of chronic sinus disease, including distinguishing the clinical presentations, cellular and molecular characteristics, genetic differences, and current treatment options for each.
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Affiliation(s)
- Spencer C Payne
- Asthma and Allergic Disease Center, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22903, USA
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10
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Abstract
Over the past 10 years, there has been increasing recognition of the interaction between the upper and lower airways in patients with a variety of infectious and inflammatory illnesses, including allergic rhinitis, rhinosinusitis, and asthma. Epidemiologic and mechanistic links have been proposed to demonstrate these relationships and to offer possible etiologic explanations to account for these observations. Among patients with upper respiratory illnesses, cough can be seen as a common symptom, both from the direct influences of upper airway inflammation, which incite reflex changes and bronchospasm, and from the exacerbation of associated pulmonary processes, such as asthma. Despite this increasing awareness of interaction between the upper and lower airways, the influence of both upstream and downstream respiratory inflammatory processes on laryngeal pathophysiology has not been extensively studied. Research suggests, however, that both direct stimulatory effects on the larynx and secondary effects of mucus production and mucus trafficking can create a range of laryngeal symptoms, including cough. This review discusses the interaction of the upper and lower airway in respiratory disease, and focuses on the effect of these respiratory processes on laryngeal inflammation, function, and symptoms.
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11
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Myller JP, Toppila-Salmi SK, Toppila EM, Torkkeli TVM, Numminen JEA, Renkonen RLO, Rautiainen MEP. Mucosal eosinophils and l-selectin ligands are associated with invasive and noninvasive sinus surgery outcomes. Am J Rhinol Allergy 2009; 23:21-7. [PMID: 19379607 DOI: 10.2500/ajra.2009.23.3250] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is characterized by persistent inflammation of the nasal and paranasal mucosa with numerous emigrated leukocytes. L-Selectin on leukocytes and its endothelial glycosylated ligands initiate leukocyte infiltration into inflamed tissues. Endoscopic sinus surgery (ESS) is the major approach for restoring sinus physiology after failure of conservative therapy; however, the effect of enlarging the maxillary sinus ostium is still unknown. Here, we compared two histological markers of local inflammation, the number of mucosal eosinophils, and the expression of endothelial L-selectin ligands, with clinical outcomes after enlarging or saving the maxillary sinus ostium. METHODS Twenty-three patients with CRS underwent uncinectomy on one side and additional middle meatal antrostomy on the other side. Maxillary sinus mucosa biopsy specimens from these patients and nine healthy subjects were taken for immunohistochemical evaluations of the number of mucosal eosinophils and endothelial L-Selectin ligands. Also, symptoms and mucociliary clearance were measured. RESULTS The postoperative reduction of the endothelial L-Selectin ligands was independent of the operation technique. There was a correlation between postoperative number of mucosal eosinophils and symptom score, which was also independent of the surgical technique. The postoperative decrease of mucosal eosinophils, as well as the correlation of the intraoperative eosinophils with the postoperative symptom score, was found only on antrostomy side. CONCLUSION ESS decreases the expression of endothelial L-Selectin ligands, which might lead to decreased eosinophil traffic into maxillary sinus mucosa, putatively more when enlarging the maxillary sinus ostium. Both intra- and postoperative low number of eosinophils seem to be indicators of good subjective recovery.
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Affiliation(s)
- Jyri P Myller
- Department of Clinical Medicine University of Tampere, Tampere, Finland
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Leung RS, Katial R. The Diagnosis and Management of Acute and Chronic Sinusitis. Prim Care 2008; 35:11-24, v-vi. [DOI: 10.1016/j.pop.2007.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Chronic sinusitis comprises numerous disorders characterized by inflammation, mucous gland hyperplasia, and remodeling. Chronic hyperplastic eosinophilic sinusitis (CHES) is characterized by unrestrained proliferation of eosinophils, Th2-like lymphocytes, fibroblasts, goblet cells, and mast cells. The pathology of CHES is similar to that of asthma, and it is frequently diagnosed in association with asthma. It has been reported that exacerbations of CHES occur temporally with worsening of asthma; however, in the absence of well-controlled studies, this linkage remains unproven. In this article, the potential mechanisms linking these two diseases are examined.
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Affiliation(s)
- John W Steinke
- Asthma and Allergic Diseases Center, Beirne Carter Center for Immunology Research, University of Virginia Health System, Charlottesville, VA 22908-1355, USA.
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Smart BA. The impact of allergic and nonallergic rhinitis on pediatric sinusitis. Curr Allergy Asthma Rep 2006; 6:221-7. [PMID: 16579872 DOI: 10.1007/s11882-006-0038-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There is a great deal of published evidence that there is a relationship between both allergic and nonallergic rhinitis and sinusitis in both pediatric and adult patients. The relationship between rhinitis and sinusitis may involve inflammation in one compartment leading to secondary inflammation in the other compartment, such as in the case of rhinitis leading to obstruction of the osteomeatal complex. The relationship may also involve individual manifestations of a shared process, such as allergic disease. A better understanding of the relationship between rhinitis and sinusitis may significantly influence the treatment of these common and important conditions.
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Affiliation(s)
- Brian A Smart
- Asthma and Allergy Center, DuPage Medical Group, 454 Pennsylvania Avenue, Glen Ellyn, IL 60137, USA.
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Peters-Golden M, Gleason MM, Togias A. Cysteinyl leukotrienes: multi-functional mediators in allergic rhinitis. Clin Exp Allergy 2006; 36:689-703. [PMID: 16776669 PMCID: PMC1569601 DOI: 10.1111/j.1365-2222.2006.02498.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cysteinyl leukotrienes (CysLTs) are a family of inflammatory lipid mediators synthesized from arachidonic acid by a variety of cells, including mast cells, eosinophils, basophils, and macrophages. This article reviews the data for the role of CysLTs as multi-functional mediators in allergic rhinitis (AR). We review the evidence that: (1) CysLTs are released from inflammatory cells that participate in AR, (2) receptors for CysLTs are located in nasal tissue, (3) CysLTs are increased in patients with AR and are released following allergen exposure, (4) administration of CysLTs reproduces the symptoms of AR, (5) CysLTs play roles in the maturation, as well as tissue recruitment, of inflammatory cells, and (6) a complex inter-regulation between CysLTs and a variety of other inflammatory mediators exists.
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Smart BA. Is rhinosinusitis a cause of asthma? Clin Rev Allergy Immunol 2006; 30:153-64. [PMID: 16785587 DOI: 10.1385/criai:30:3:153] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 01/31/2023]
Abstract
There is a great deal of evidence of an association between rhinosinusitis and asthma. However, it is less clear whether rhinosinusitis is a direct trigger for asthma or the two conditions are simply manifestations of a common underlying process. Evidence for a role for rhinosinusitis as a trigger for asthma includes many examples of improvement in asthma once concomitant rhinosinusitis is treated medically or surgically. Possible mechanisms for this relationship include naso-pharyngo-bronchial reflexes, postnasal drip, abnormal breathing, and the local production of inflammatory mediators that trigger pulmonary inflammation via the bone marrow. On the other hand, evidence exists that rhinosinusitis and asthma are manifestations of a common process. For example, there are similarities between the histopathological changes in the epithelium in chronic rhinosinusitis and asthma. The bone marrow may provide the link between the upper and lower airways in creating a common disease. A second possible mechanism for a common disease is response to staphylococcal enterotoxins. Although evidence exists to suggest that rhinosinusitis either triggers asthma or represents a local manifestation of a shared disorder, the key to reconciling this apparent controversy is to consider that rhinosinusitis is not just a single, uniform disease. Current evidence suggests that rhinosinusitis with neither polyps nor eosinophilic inflammation acts as a direct trigger for asthma, whereas rhinosinusitis with both polyps and eosinophilic inflammation shares underlying mechanisms with asthma. Clearly, however, there is considerable overlap between the different, complex mechanisms that link rhinosinusitis to asthma.
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Affiliation(s)
- Brian A Smart
- Asthma and Allergy Center, DuPage Medical Group, Glen Ellyn, IL, USA.
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Borish L, Rosenwasser L, Steinke JW. Fungi in chronic hyperplastic eosinophilic sinusitis: reasonable doubt. Clin Rev Allergy Immunol 2006; 30:195-204. [PMID: 16785590 DOI: 10.1385/criai:30:3:195] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 01/03/2023]
Abstract
Chronic hyperplastic eosinophilic sinusitis (CHES) is a T-helper (Th)2-like, lymphocyteinitiated, eosinophil-rich inflammatory disease. The complex immune interactions required to orchestrate these processes begin with the presentation of antigen by mature dendritic cells to Th lymphocytes that display the appropriate antigen-specific T-cell receptor. The objective of sinus research must be to identify and target that antigen; this will lead to the cure for this condition. This article reviews numerous models that may be responsible for the pathophysiology of this disorder, including putative roles for allergens, bacteria, and bacterial-derived superantigens, as well as recent interest in fungal-derived antigens. Additionally, we speculate that whatever the inciting cause of CHES may be, it is plausible that once initiated, cellular differentiation pathways may lead to the development of an antigen-independent permanent phase. More than one of these may be valid in different subjects and, furthermore, this list almost assuredly does not explain all cases of CHES. The concept that fungal antigens colonizing the sinuses are responsible for CHES represents an intriguing, but unproven, hypothesis. Presently, the case for the fungus remains circumstantial. The case for fungi will be proved only with definitive proof that T-cells within the sinuses are actively responding to fungal antigens present in the sinus and with the further demonstration that removal of those fungal antigens ameliorates the disease.
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Affiliation(s)
- Larry Borish
- Asthma and Allergic Disease Center, Beirne Carter Center for Immunology Research, University of Virginia Health System, Charlottesville, VA, USA.
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Barekzi E, Roman J, Hise K, Georas S, Steinke JW. Lysophosphatidic acid stimulates inflammatory cascade in airway epithelial cells. Prostaglandins Leukot Essent Fatty Acids 2006; 74:357-63. [PMID: 16725318 DOI: 10.1016/j.plefa.2006.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Accepted: 03/12/2006] [Indexed: 11/24/2022]
Abstract
Nasal polyps are benign outgrowths originating from the anterior ethmoid and maxillary sinuses. The events leading to polyp formation are unknown but evidence points to damage of the mucousal epithelium. Lysophosphatidic acid (LPA) is a water-soluble phospholipid that has been implicated in the development of allergic inflammation. We hypothesized LPA may be an important mediator in the initiation and maintenance of the inflammatory milieu of the polyp. Data was compared from unstimulated lung epithelial and when possible nasal polyp-derived epithelial cells with LPA stimulated cells. LPA receptors 1 and 2 were constitutively expressed on lung and nasal polyp-derived epithelial cells and receptor mRNA expression was decreased upon stimulation with IL-13 and IFN-gamma. When cells were treated with LPA, cellular proliferation was stimulated 2.2 fold. Supernatants from LPA stimulated cells displayed decreases in the levels of VEGF, GM-CSF, and TNF-alpha at 24h which returned to normal or increased at 48h. Our results suggest epithelial cells undergo rapid proliferation in response to LPA resulting in a transient decrease in inflammatory cytokines followed by an upregulation of these cytokines that could lead to increased inflammation.
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Affiliation(s)
- Elizabeth Barekzi
- Asthma and Allergic Disease Center, Beirne Carter Center for Immunology, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
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Smart BA. Pediatric Rhinosinusitis and Its Relationship to Asthma and Allergic Rhinitis. ACTA ACUST UNITED AC 2005. [DOI: 10.1089/pai.2005.18.88] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Rhinosinusitis is a common disease in patients of all age groups. Rhinosinusitis arises from a variety of infectious and inflammatory mechanisms. There is ample evidence that rhinosinusitis can directly influence asthma. There is also growing evidence that rhinosinusitis may be associated with asthma as different manifestations of the same disorder. A great deal of future research is required to fully elucidate the different mechanisms whereby rhinosinusitis influences or associates with asthma, but it is clear that rhinosinusitis needs to be considered in patients with severe or refractory asthma.
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Affiliation(s)
- Brian A Smart
- Asthma and Allergy Center, DuPage Medical Group, 454 Pennsylvania Ave. Glen Ellyn, IL 60137, USA.
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Toppila-Salmi SK, Myller JP, Torkkeli TVM, Muhonen JV, Renkonen JA, Rautiainen ME, Renkonen RLO. Endothelial L-selectin ligands in sinus mucosa during chronic maxillary rhinosinusitis. Am J Respir Crit Care Med 2005; 171:1350-7. [PMID: 15764731 DOI: 10.1164/rccm.200406-775oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE Chronic rhinosinusitis is characterized by persistent inflammation of the nasal and paranasal mucosa with numerous emigrated leukocytes. L-selectin on leukocytes and its endothelial glycosylated ligands initiate organ-specific leukocyte infiltration into inflamed tissues. OBJECTIVES The purpose of this study was to evaluate the endothelial expression of functionally active endothelial L-selectin ligands, sulfated sialyl Lewis x, in maxillary sinus mucosa from patients with chronic rhinosinusitis and from normal control subjects. METHODS Maxillary sinus mucosa specimens (116) were obtained surgically and immunohistochemically stained with monoclonal antibodies detecting sialyl Lewis x or sulfated extended core 1 lactosamines. The severity of the inflammation was determined by intraoperative endoscopic findings, computed tomography scans, and histopathologic assessment of the specimens. MEASUREMENTS AND MAIN RESULTS The percentage of vessels expressing endothelial sulfated sialyl Lewis x epitopes increased during chronic rhinosinusitis compared with uninflamed control tissue, especially in patients with additional allergic rhinitis, and decreased in specimens from aspirin-intolerant patients with preoperative oral corticosteroid treatment. In addition, the expression level of endothelial sulfated sialyl Lewis x epitopes and the number of mucosal eosinophils correlated with the severity of the inflammation, and decreased in specimens taken 9 months postoperatively compared with intraoperative samples, especially in patients with intranasal corticosteroid treatment. CONCLUSIONS Our results suggest that functionally active L-selectin ligands might guide leukocyte traffic into maxillary sinus mucosa preferentially in patients with severe findings of chronic maxillary rhinosinusitis, thus leading to aggravation of the inflammation.
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Affiliation(s)
- Sanna K Toppila-Salmi
- Department of Eye, Ear and Oral Diseases, Tampere University Hospital and University of Tampere, Tampere, Helsinki
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Amrol D, Murray JJ. Alternative medical treatment strategies for chronic hyperplastic eosinophilic sinusitis. Curr Opin Otolaryngol Head Neck Surg 2005; 13:55-9. [PMID: 15654217 DOI: 10.1097/00020840-200502000-00013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis (CRS) is one of the most common chronic illnesses in the United States. Although CRS has been viewed traditionally as an infectious disease, treatment focused on antibiotics and surgery has not infrequently provided disappointing results. RECENT FINDINGS Recently much of CRS has been shown to be an eosinophilic inflammatory disease and new anti-inflammatory treatments are being studied. SUMMARY This review discusses medical management for chronic hyperplastic eosinophilic sinusitis, including antifungal treatment, low-dose macrolide treatment, antilipid mediator therapy, and new immune-modifying treatments.
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Affiliation(s)
- David Amrol
- Division of Allergy and Immunology, Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
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Baptist AP, Tang TS, Duan L, Baldwin JL. Elective rotations and their impact on resident and faculty decision making. TEACHING AND LEARNING IN MEDICINE 2005; 17:332-6. [PMID: 16197319 DOI: 10.1207/s15328015tlm1704_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Restrictions on resident-duty work hours have led to fewer opportunities to participate in elective rotations. PURPOSE To investigate the potential impact of elective rotations on resident and faculty physicians using allergy/immunology (A/I) as a model. METHODS A questionnaire was sent to 375 primary care physicians. It assessed demographic information, training background, A/I-referral history and intentions, and perceived knowledge of A/I-specific issues. RESULTS A total of 228 surveys were returned. Resident physicians who were more senior in their training or who had taken an A/I rotation were more likely to have referred a patient to A/I in the past, more likely to refer a patient to A/I for chronic sinusitis, and more likely to report a greater knowledge of A/I topics. Faculty physicians with a history of an A/I rotation were more likely to feel knowledgeable about A/I topics. CONCLUSION Elective rotations are positively correlated with perceived knowledge, referral intentions, and past history of referrals.
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Affiliation(s)
- Alan P Baptist
- Department of Internal Medicine, Division of Allergy/Immunology, University of Michigan, Ann Arbor, Michigan 48201, USA.
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