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Eremeeva KV, Svistushkin VM, Sinkov EV, Mironova AR, Sobolev VP. [Possibilities of using recombinant human deoxyribonuclease I in otorhinolaryngology]. Vestn Otorinolaringol 2023; 88:59-66. [PMID: 37184556 DOI: 10.17116/otorino20228802159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
ANNOTATION Dornase alfa (Pulmozyme, Tigerase) is a purified solution of recombinant human DNase, clinically developed for the treatment of pulmonary diseases in patients with cystic fibrosis (CF). The action of the drug is aimed at destroying the viscous secretion, rich in DNA strands of neutrophils, through their fragmentation, the density of the secretion decreases, and the aeration of the lower respiratory tract improves. The similarity of pathological processes with the formation of viscous exudate on the surface of the mucous membrane in diseases of the upper respiratory tract and ear initiated studies on the use of Dornase alpha in otorhinolaryngology. MATERIAL AND METHODS The analysis of materials of domestic and foreign authors on the effectiveness of the use of the drug Dornase alfa in otorhinolaryngology was carried out. RESULTS The review included 132 patients (10 studies) in whom Dornase alfa was used to treat CF-associated nasal and paranasal sinus diseases. Analysis of the literature revealed only 3 studies, one of which consisted of two parts, examining the effect of Dornase alpha on middle ear exudate: two studies were demonstrated in an animal model; one - in vitro on samples of middle ear effusion which were aspirated through a myringotomy incision from patients with recurrent acute otitis media; and one in clinical 40 patients (40 ears) for hydrolysis of exudate in the tympanostomy tubes. CONCLUSION Analysis of studies on the use of Dornase alfa demonstrates an improvement in clinical symptoms in all patients with CF and chronic rhinosinusitis. In experimental studies on an animal model, as well as in vitro research on exudate from the middle ear, Dornase alfa has demonstrated high efficacy and safety. Dornase alfa is a drug with high potential, further research is needed for wider use in ENT practice, especially in otiatrics.
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Affiliation(s)
- K V Eremeeva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V M Svistushkin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E V Sinkov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A R Mironova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V P Sobolev
- Sechenov First Moscow State Medical University, Moscow, Russia
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2
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Svistushkin VM, Sinkov EV, Nikiforova GN. [Role of topical antibacterial therapy in patients with cystic fibrosis]. Vestn Otorinolaringol 2021; 86:59-66. [PMID: 34499450 DOI: 10.17116/otorino20218604159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cystic fibrosis (cystic fibrosis) is an important medical and social problem. The main clinical manifestations that determine the prognosis and outcome of this disease are changes in the respiratory and digestive systems. In recent years, there has been an understanding of the importance of assessing pathological changes in the nasal cavity and paranasal sinuses in patients with cystic fibrosis. RESEARCH OBJECTIVES Assess the efficacy of topical antibacterial therapy in adult cystic fibrosis patients after surgery on nasal cavity structures and paranasal sinuses. MATERIAL AND METHODS In the clinic for ear, nose and throat diseases at Sechenov University, 46 adult patients with cystic fibrosis and chronic rhinosinusitis were observed; all patients underwent extended endoscopic polysinusotomy. According to clinical studies, Isofra nasal spray is highly effective and safe in the treatment of patients with infectious diseases of the nasal cavity, nasopharynx and paranasal sinuses. FINDINGS The use of Isofra nasal spray (the active ingredient is framycetin sulfate) in our clinic in patients with cystic fibrosis against the background of basic therapy (inhalation with bronchodilators and mucolytics, intranasal topical steroids), had a positive effect on the microbial landscape in the nasal cavity in patients with cystic fibrosis in the postoperative period and allowed to reduce the need for the appointment of systemic antibacterial drugs.
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Affiliation(s)
- V M Svistushkin
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow,Russia
| | - E V Sinkov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow,Russia
| | - G N Nikiforova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow,Russia
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3
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Dadgostar A, Nassiri S, Quon BS, Manji J, Alsalihi S, Javer A. Effect of endoscopic sinus surgery on clinical outcomes in DeltaF508 cystic fibrosis patients. Clin Otolaryngol 2021; 46:941-947. [PMID: 33686728 DOI: 10.1111/coa.13751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 01/22/2021] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is prevalent in the Cystic Fibrosis (CF) population. CRS exacerbations in CF are thought to contribute to pulmonary exacerbations. Literature regarding the impact of endoscopic sinus surgery (ESS) is inconclusive. This study examines rates of lung function decline and pulmonary exacerbation in CF patients who have undergone ESS. DESIGN Retrospective review of medical records. SETTING Academic Hospital. PARTICIPANTS 40 adult CF patients. MAIN OUTCOME MEASURES Rate of lung function decline (% predicted Forced Expiratory Volume in 1 second [ppFEV1 ]), number of pulmonary exacerbations (IV/oral antibiotic therapy ± hospital admission) and total number days hospitalised 2-year postoperatively was collected. CRS patients undergoing ESS were matched to those without ESS by gender, age, and F508del genotype. RESULTS Forty patients (mean age 37.4, 60% male) were reviewed. No significant difference was found between the surgical group and controls in baseline ppFEV1 (72.5% vs. 72.7%, P = .98), 2-year preoperative number of pulmonary exacerbations (3.05 vs. 1.65, P = .10), or Lund-Mackay scores (12.25 vs. 11.55, P = .71). No significant difference was found in 1-year (70.5% vs. 72.8%, P = .84) or 2-year (70.4% vs. 72.6% P = .80) postoperative ppFEV1 and 2-year postoperative pulmonary exacerbations (1.7 vs. 1.45, P = .87). A significant increase was identified in total number days hospitalised postoperatively (4.85, P = .02). In the surgical group, no significant difference was identified between preoperative and postoperative ppFEV1 , 1 year (-2.51%, P = .32) and 2 years after ESS (-3.10%, P = .51), postoperative rate of pulmonary exacerbations (-1.28, P = .11), or in total number days hospitalised (3.74, P = .14). CONCLUSIONS In this study, ESS does not appear to significantly improve ppFEV1 or decrease the number of pulmonary exacerbations postoperatively.
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Affiliation(s)
- Anali Dadgostar
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
| | - Sepehr Nassiri
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
| | - Bradley S Quon
- Adult Cystic Fibrosis Clinic, University of British Columbia, Vancouver, BC, Canada
| | - Jamil Manji
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada.,Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Salahuddin Alsalihi
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
| | - Amin Javer
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
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4
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Cheng TZ, Choi KJ, Honeybrook AL, Zakare-Fagbamila RT, Gray AL, Snyder LD, Palmer SM, Abi-Hachem R, Jang DW. Decreased Antibiotic Utilization After Sinus Surgery in Cystic Fibrosis Patients With Lung Transplantation. Am J Rhinol Allergy 2019; 33:354-358. [PMID: 30781973 DOI: 10.1177/1945892419830624] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Patients with cystic fibrosis (CF) who have undergone lung transplantation frequently require hospitalizations and antibiotic treatments for respiratory tract infections. Although endoscopic sinus surgery (ESS) improves sinonasal quality of life in CF patients, it is unclear if ESS offers additional benefit in terms of antibiotics for pulmonary infection, hospitalization, and pulmonary function. Objective To determine whether ESS impacts antibiotic use or hospitalizations for pulmonary indications or pulmonary function in CF patients after lung transplantation. Methods This is a single-institution retrospective study of all patients who underwent lung transplantation for CF from 2005 to 2017. Patients who underwent ESS at least 1 year after transplant were included. Paired bivariate analyses were performed to determine whether there was a difference in the frequency and length of hospitalizations for pulmonary indications, number of antibiotic courses (intravenous and oral) for pulmonary exacerbations, and forced expiratory volume in 1 second (FEV1) slope in the 6 months before versus after ESS. Perioperative antibiotics and hospitalizations were not included in the analyses. Least squares regression was utilized to analyze FEV1 trends. Results A total of 20 patients underwent 36 ESS during the study period. There was significantly higher antibiotic utilization in the 6 months before ESS (0.89 ± 1.03) compared to the 6 months after ESS (0.33 ± 0.53) ( P = .002). The frequency and length of hospitalizations, FEV1 slope, and FEV1 trend before and after ESS were not significantly different. Conclusion Our results suggest that ESS is associated with a reduction in the frequency of antibiotic utilization for respiratory tract infections in lung transplant recipients with CF. A prospective study is needed to investigate these relationships further.
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Affiliation(s)
- Tracy Z Cheng
- 1 Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina.,2 School of Medicine, Duke University, Durham, North Carolina
| | - Kevin J Choi
- 1 Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
| | - Adam L Honeybrook
- 1 Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
| | | | - Alice L Gray
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Laurie D Snyder
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina.,4 Duke Clinical Research Institute, Durham, North Carolina
| | - Scott M Palmer
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina.,4 Duke Clinical Research Institute, Durham, North Carolina
| | - Ralph Abi-Hachem
- 1 Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
| | - David W Jang
- 1 Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
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Poddighe D, Brambilla I, Licari A, Marseglia GL. Pediatric rhinosinusitis and asthma. Respir Med 2018; 141:94-99. [PMID: 30053979 DOI: 10.1016/j.rmed.2018.06.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 05/11/2018] [Accepted: 06/18/2018] [Indexed: 12/24/2022]
Abstract
Both asthma and rhinosinusitis are complex and heterogeneous diseases and, importantly, they often coexist: these diseases can be concomitant in 35-65% of affected children, according to different studies. Thus, evaluating this comorbidity in the clinical practice should be paramount. In this review, we focused our discussion on the multiple pathophysiological aspects that may link rhinosinusitis and asthma in the pediatric population. Although rhinosinusitis may exacerbate asthma through several mechanisms occurring by contiguity, actually this aspect seems to be only one component of the complex interplay between upper and lower airways. In particular, the onset of an important and persistent Th2-driven inflammatory process dominated by eosinophils presence at one site of the airways, may release into the bloodstream several cytokines; in their turn, those can lead to the stimulation of the bone marrow, which may function as a systemic amplifier of such an eosinophilic inflammation.
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Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan; Department of Pediatrics, Università Degli Studi, Pavia, Italy.
| | - Ilaria Brambilla
- Department of Pediatrics, Università Degli Studi, Pavia, Italy; Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Licari
- Department of Pediatrics, Università Degli Studi, Pavia, Italy; Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Università Degli Studi, Pavia, Italy; Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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6
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Møller ME, Alanin MC, Grønhøj C, Aanæs K, Høiby N, von Buchwald C. Sinus bacteriology in patients with cystic fibrosis or primary ciliary dyskinesia: A systematic review. Am J Rhinol Allergy 2018; 31:293-298. [PMID: 28859703 DOI: 10.2500/ajra.2017.31.4461] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A correlation exists between the microbial flora of the upper and lower airways in patients with cystic fibrosis (CF) or with primary ciliary dyskinesia (PCD). The sinuses can function as a bacterial reservoir where gram-negative bacteria adapt to the airways and repeatedly are aspirated to and colonize the lungs according to the theory of the united (unified) airways. Whereas the pattern of bacterial flora in the lower airways has been extensively studied, the upper airways have drawn limited attention. OBJECTIVE Our aim was to review the literature that reported bacterial flora in the sinuses and nasal cavities of patients with CF or PCD. METHODS A number of medical literature data bases were systematically searched between January 1960 and July 2016. We applied the following inclusion criteria: a minimum of one case of PCD (or Kartagener syndrome) or CF, and microbiology analyses from the nose or paranasal sinuses. RESULTS We included 46 studies (1823 patients) from 16 countries. Staphylococcus aureus was found in 30% of the noses and sinuses of patients with CF. Other common bacteria found included Pseudomonas aeruginosa, coagulase negative staphylococci, and Haemophilus influenzae. In PCD, H. influenzae was the most common bacteria (28%), followed by Streptococcus pneumoniae and P. aeruginosa. If studies that included nonsurgical swab and blowing samples were excluded, then P. aeruginosa was the most common bacterium in patients with CF (34%) and in patients with PCD (50%), followed by S. aureus and H. influenza. CONCLUSION S. aureus, P. aeruginosa, coagulase negative staphylococci, and H. influenzae dominated in the upper airways of patients with CF. In patients with PCD, H. influenzae, S. pneumoniae, and P. aeruginosa dominated. When studies that included swab and blowing samples were excluded, P. aeruginosa was the most common bacterium in both groups. Direct comparisons among the studies were restricted due to very heterogeneous methods, and a better standardization of procedures and outcomes is needed.
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Affiliation(s)
- Maria E Møller
- Department of Otorhinolaryngology- Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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7
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Abuzeid WM, Song C, Fastenberg JH, Fang CH, Ayoub N, Jerschow E, Mohabir PK, Hwang PH. Correlations between cystic fibrosis genotype and sinus disease severity in chronic rhinosinusitis. Laryngoscope 2017; 128:1752-1758. [PMID: 29193105 DOI: 10.1002/lary.27019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/09/2017] [Accepted: 10/24/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Cystic fibrosis (CF) patients commonly develop chronic rhinosinusitis (CRS). The impact of the most common cystic fibrosis transmembrane conductance regulator (CFTR) mutation, F508del, on the severity of sinonasal disease remains inconclusive. The objective of this study is to evaluate the impact of CFTR genotype functional classification on sinonasal disease severity in patients with CRS. METHODS Retrospective chart review of patients with CF who underwent endoscopic sinus surgery for chronic rhinosinusitis from 1998 to 2015. Patients were divided into high- or low-risk genotypes based on standardized CFTR gene functional classification. The primary outcome was the 22-item Sino-Nasal Outcome Test (SNOT-22) score. Secondary outcomes included endoscopic scores, extent of surgery performed, presence of polyposis, number of revision surgeries, and Lund-MacKay computed tomography scores. RESULTS Thirty-eight patients harbored a high-risk CFTR genotype, and 11 had a low-risk genotype. On bivariate analysis, there was no association between CFTR genotype risk stratification and measures of preoperative disease severity or postoperative outcomes. There were no associations between genotype risk stratification and outcome variables on multivariate linear regression, adjusted for age and gender. There were significant improvements in several SNOT-22 subdomains before and after endoscopic sinus surgery (P < 0.05), but the magnitude of improvement was not significantly different on the basis of CFTR genotype risk stratification. CONCLUSION High-risk CFTR genotypes are not associated with worse sinonasal disease severity or postoperative symptom control than low-risk CFTR genotypes after adjusting for confounding factors. LEVEL OF EVIDENCE Level 4. Laryngoscope, 1752-1758, 2018.
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Affiliation(s)
- Waleed M Abuzeid
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Changeun Song
- Department Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, California, U.S.A.,Department of Otolaryngology-Head & Neck Surgery, Seonam University Myongji Hospital, Goyang, South Korea
| | - Judd H Fastenberg
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Noel Ayoub
- Department Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, California, U.S.A
| | - Elina Jerschow
- Department of Medicine-Allergy and Immunology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Paul K Mohabir
- Department of Medicine-Pulmonary and Critical Care, Stanford University Medical Center, Stanford, California, U.S.A
| | - Peter H Hwang
- Department Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, California, U.S.A
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Khalfoun S, Tumin D, Ghossein M, Lind M, Hayes D, Kirkby S. Improved Lung Function after Sinus Surgery in Cystic Fibrosis Patients with Moderate Obstruction. Otolaryngol Head Neck Surg 2017; 158:381-385. [PMID: 29182491 DOI: 10.1177/0194599817739284] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives Cystic fibrosis (CF) is characterized by infection and inflammation of the sinorespiratory tract. Functional endoscopic sinus surgery (FESS) is an option for patients with severe sinusitis. We sought to evaluate pulmonary function testing after FESS in pediatric and adult patients with CF. Study Design Retrospective chart review using data from all patients with CF who underwent FESS from January 2009 to July 2014. Setting Patients were from a single institution. Subjects and Methods Data were extracted for 181 patients and 320 surgeries. Lung function data, including the forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC, were retrieved within 1 year before and after surgery. Mixed-effects regression was used to compare FEV1 trajectories before and after surgery. The effect of surgery was stratified by presurgery FEV1 to compare patients with mild/no lung disease (FEV1 >80%) and moderate/severe lung disease (FEV1 <80%). Results Of the 181 patients reviewed, 131 with primary FESS had FEV1 data. Presurgery average age was 16 years (95% confidence interval [CI], 14.27-17.73), and FEV1 mean was 85% (95% CI, 81.02-88.98). There were 88 patients with FEV1 >80% and 43 patients with FEV1 <80%. For the entire cohort, lung function did not change related to FESS. Among patients with FEV1 <80%, FEV1 declined presurgery by 3.5% per year (95% CI, -6.1% to -0.8%; P = .010), which halted after surgery with these patients, then showing no subsequent change in FEV1 (95% CI, 0.9%-3.7%; P = .240). No benefit was identified for patients with FEV1 >80%. Conclusion Pulmonary function testing improved in patients with moderate/severe lung disease 1 year following FESS. This suggests FESS may benefit pulmonary outcomes.
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Affiliation(s)
- Sabrina Khalfoun
- 1 Division of Pediatrics, Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Dmitry Tumin
- 2 Division of Pediatrics, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Maroun Ghossein
- 3 Division of Pulmonary and Critical Care, Medical College of South Carolina, Charleston, South Carolina, USA
| | - Meredith Lind
- 4 Division of Pediatrics, Section of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Don Hayes
- 1 Division of Pediatrics, Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Stephen Kirkby
- 1 Division of Pediatrics, Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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Kang SH, Meotti CD, Bombardelli K, Piltcher OB, de Tarso Roth Dalcin P. Sinonasal characteristics and quality of life by SNOT-22 in adult patients with cystic fibrosis. Eur Arch Otorhinolaryngol 2016; 274:1873-1882. [DOI: 10.1007/s00405-016-4426-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
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10
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Weber SAT, Iyomasa RM, Corrêa CDC, Florentino WNM, Ferrari GF. Nasal polyposis in cystic fibrosis: follow-up of children and adolescents for a 3-year period. Braz J Otorhinolaryngol 2016; 83:677-682. [PMID: 28277226 PMCID: PMC9449177 DOI: 10.1016/j.bjorl.2016.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 08/23/2016] [Accepted: 09/16/2016] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Nasal polyposis is often found in patients with cystic fibrosis. OBJECTIVE To assess the incidence of nasal polyposis, the response to medical treatment, recurrence and the need for surgical intervention in children and adolescents with cystic fibrosis during a three-year follow-up. METHODS Clinical symptoms (pulmonary, pancreatic insufficiency, malnutrition, nasal obstruction), two positive sweat chloride tests, and genotype findings in 23 patients with cystic fibrosis were analyzed. All patients underwent nasal endoscopy every 12 months from January 2005 to December 2007, to assess the presence and grade of Nasal Polyps. Nasal polyposis, when present, were treated with topical corticosteroids for 6-12 months, with progress being evaluated within the 3 years of follow-up. RESULTS In the first evaluation, nasal polyposis was diagnosed in 30.43% of patients (3 bilateral and 4 unilateral), recurrent pneumonia in 82.6%, pancreatic insufficiency in 87%, and malnutrition in 74%. The presence of nasal polyposis was not associated with chloride values in the sweat, genotype, clinical signs of severity of cystic fibrosis, or nasal symptoms. In the three-year period of follow up, 13 patients (56.52%) had at least one event of polyposis, with the youngest being diagnosed at 32 months of age. Only one patient underwent surgery (polypectomy), and there was one diagnosis of nasopharyngeal carcinoma. CONCLUSION The study showed a high incidence of nasal polyposis. Monitoring through routine endoscopy in patients with cystic fibrosis, even in the absence of nasal symptoms, is highly recommended. The therapy with topical corticosteroids achieved good results. Thus, an interaction between pediatricians and otolaryngologists is necessary.
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Affiliation(s)
- Silke Anna Theresa Weber
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Medicina de Botucatu, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Botucatu, SP, Brazil.
| | - Renata Mizusaki Iyomasa
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Medicina de Botucatu, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Botucatu, SP, Brazil
| | - Camila de Castro Corrêa
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Medicina de Botucatu, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Botucatu, SP, Brazil
| | - Wellington Novais Mafra Florentino
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Medicina de Botucatu, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Botucatu, SP, Brazil
| | - Giesela Fleischer Ferrari
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Medicina de Botucatu, Departamento de Pediatria, Botucatu, SP, Brazil
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Beule A. Epidemiology of chronic rhinosinusitis, selected risk factors, comorbidities, and economic burden. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc11. [PMID: 26770285 PMCID: PMC4702060 DOI: 10.3205/cto000126] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic rhinosinusitis (CRS) is a relevant and prevalent medical condition in Germany, Europe and the world. If analysed in detail, the prevalence of CRS shows regional and temporary variety. In this review, currently available data regarding the prevalence of CRS is therefore sorted by country and/or region, time point of data collection and the CRS-definition employed. Risk factors like smoking and gastroesophageal reflux are discussed regarding their influence on CRS prevalence. Moreover, comorbidities of CRS, like asthma, conditions of the cardiovascular system and depression are listed and their influence on CRS is discussed. Furthermore, data on CRS prevalence in special cohorts, like immunocompromised patients, are presented. To estimate the economic burden of CRS, current data e.g. from Germany and the USA are included in this review.
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Affiliation(s)
- Achim Beule
- ENT Department, University of Greifswald, Germany
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12
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Kang SH, Dalcin PDTR, Piltcher OB, Migliavacca RDO. Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment. J Bras Pneumol 2015; 41:65-76. [PMID: 25750676 PMCID: PMC4350827 DOI: 10.1590/s1806-37132015000100009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/06/2014] [Indexed: 01/17/2023] Open
Abstract
Although cystic fibrosis (CF) is an irreversible genetic disease, advances in treatment have increased the life expectancy of CF patients. Upper airway involvement, which is mainly due to pathological changes in the paranasal sinuses, is prevalent in CF patients, although many are only mildly symptomatic (with few symptoms). The objective of this literature review was to discuss the pathophysiology and current therapeutic management of chronic rhinosinusitis (CRS) in CF patients. The review was based on current evidence, which was classified in accordance with the Oxford Centre for Evidence-Based Medicine criteria. When symptomatic, CRS with nasal polyps can affect quality of life and can lead to pulmonary exacerbations, given that the paranasal sinuses can be colonized with pathogenic bacteria, especially Pseudomonas aeruginosa. Infection with P. aeruginosa plays a crucial role in morbidity and mortality after lung transplantation in CF patients. Although clinical treatment of the upper airways is recommended as initial management, this recommendation is often extrapolated from studies of CRS in the general population. When sinonasal disease is refractory to noninvasive therapy, surgery is indicated. Further studies are needed in order to gain a better understanding of upper airway involvement and improve the management of CRS in CF patients, with the objective of preserving lung function and avoiding unnecessary invasive procedures.
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Affiliation(s)
- Suzie Hyeona Kang
- Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil. Graduate Program in Pulmonology, Federal University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil
| | - Paulo de Tarso Roth Dalcin
- Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil. Graduate Program in Pulmonology, Federal University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil
| | - Otavio Bejzman Piltcher
- Federal University of Rio Grande do Sul, School of Medicine, Department of Ophthalmology and Otolaryngology, Porto Alegre, Brazil. Department of Ophthalmology and Otolaryngology, Federal University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil
| | - Raphaella de Oliveira Migliavacca
- Federal University of Rio Grande do Sul, School of Medicine, Department of Otolaryngology and Head & Neck Surgery, Porto Alegre, Brazil. Department of Otolaryngology and Head & Neck Surgery, Federal University of Rio Grande do Sul School of Medicine Hospital de Clínicas, Porto Alegre, Brazil
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Hong SN, Kim DW. Medical treatment according to phenotypes of chronic rhinosinusitis. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.3.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Seung-No Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Woo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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14
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Sinonasal manifestations of cystic fibrosis: A correlation between genotype and phenotype? J Cyst Fibros 2014; 13:442-8. [DOI: 10.1016/j.jcf.2013.10.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/11/2013] [Accepted: 10/21/2013] [Indexed: 12/26/2022]
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15
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Mainz JG, Schien C, Schiller I, Schädlich K, Koitschev A, Koitschev C, Riethmüller J, Graepler-Mainka U, Wiedemann B, Beck JF. Sinonasal inhalation of dornase alfa administered by vibrating aerosol to cystic fibrosis patients: a double-blind placebo-controlled cross-over trial. J Cyst Fibros 2014; 13:461-70. [PMID: 24594542 DOI: 10.1016/j.jcf.2014.02.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/07/2014] [Accepted: 02/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic rhinosinusitis significantly impairs CF patients' quality of life and overall health. The Pari-Sinus™ device delivers vibrating aerosol effectively to paranasal sinuses. After a small pilot study to assess sinonasal inhalation of dornase alfa and placebo (isotonic saline) on potential sinonasal outcome measures, we present the subsequent prospective double-blind placebo-controlled crossover-trial. METHODS 23 CF patients were randomised to inhale either dornase alfa or isotonic saline for 28 days with the Pari-Sinus™ and after 28 days (wash-out) crossed over to the alternative treatment. The primary outcome parameter was primary nasal symptom score in the disease-specific quality of life Sino-Nasal Outcome-Test-20 (SNOT-20: nasal obstruction/sneezing/runny nose/thick nasal discharge/reduced smelling). RESULTS Primary nasal symptoms improved significantly with dornase alfa compared with no treatment, while small improvements with isotonic saline did not reach significance. SNOT-20 overall scores improved significantly after dornase alfa compared with isotonic saline (p=0.017). Additionally, sinonasal dornase alfa but not isotonic saline significantly improved pulmonary function (FEF75-25: p=0.021). CONCLUSION Vibrating sinonasal inhalation of dornase alfa reduces rhinosinusitis symptoms in CF.
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Affiliation(s)
- Jochen G Mainz
- Department of Paediatrics, CF-Center, Jena University Hospital, Kochstraße 2, 07745 Jena, Germany.
| | - Claudia Schien
- Department of Paediatrics, CF-Center, Jena University Hospital, Kochstraße 2, 07745 Jena, Germany
| | - Isabella Schiller
- Department of Paediatrics, CF-Center, Jena University Hospital, Kochstraße 2, 07745 Jena, Germany
| | - Katja Schädlich
- Department of Paediatrics, CF-Center, Jena University Hospital, Kochstraße 2, 07745 Jena, Germany
| | - Assen Koitschev
- Department of Paediatric Otorhinolaryngology, Olgahospital, Stuttgart, Bismarckstraße 8, 70176 Stuttgart, Germany
| | - Christiane Koitschev
- Department of Otorhinolaryngology, University Hospital, Tübingen, Elfriede-Aulhorn-Str. 5, 72076 Tübingen, Germany
| | - Joachim Riethmüller
- Department of Paediatrics, University Children's Hospital, Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Uta Graepler-Mainka
- Department of Paediatrics, University Children's Hospital, Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Bärbel Wiedemann
- Department of Medical Informatics and Biometrics, Technical University Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - James F Beck
- Department of Paediatrics, CF-Center, Jena University Hospital, Kochstraße 2, 07745 Jena, Germany
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Collaco JM, Morrow CB, Green DM, Cutting GR, Mogayzel PJ. Environmental allergies and respiratory morbidities in cystic fibrosis. Pediatr Pulmonol 2013; 48:857-64. [PMID: 23143815 PMCID: PMC3572264 DOI: 10.1002/ppul.22700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 07/14/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is characterized by recurrent respiratory infections and progressive lung disease. Although environmental factors account for 50% of the variation in CF lung function, few specific exposures have been identified. Studies using small study samples focusing on environmental allergies in CF have had inconsistent results. Our objective was to examine the role of environmental allergies in upper and lower respiratory tract morbidities in CF. METHODS A total of 1,321 subjects with CF were recruited through the U.S. CF Twin-Sibling Study. Questionnaires were used to determine the presence/absence of environmental allergies. Questionnaires, chart review, and U.S. CF Foundation Patient Registry data were used to track outcomes. RESULTS Within the study sample 14% reported environmental allergies. Environmental allergies were associated with a higher risk of sinus disease (adjusted OR: 2.68; P < 0.001) and nasal polyps (adjusted OR: 1.74; P = 0.003). Environmental allergies were also associated with a more rapid decline in lung function (additional -1.1%/year; P = 0.001). However, allergies were associated with a later median age of acquisition of Pseudomonas aeruginosa (6.6 years vs. 4.4 years; log rank P = 0.027). The reported use of common allergy medications, anti-histamines and leukotriene inhibitors, did not alter the frequency of respiratory morbidities. CONCLUSIONS Environmental allergies are associated with an increased risk of sinus disease and nasal polyps and a more rapid decline in CF lung function, but may have a protective effect against the acquisition of P. aeruginosa. Prospective studies are needed to confirm these associations which have implications for more aggressive management of allergies.
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Affiliation(s)
- Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, Maryland 21287, USA.
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17
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Chronic infection with Pseudomonas aeruginosa in cystic fibrosis: a risk factor for nasal polyposis after lung transplantation. Transplantation 2013; 95:1548-53. [PMID: 23624545 DOI: 10.1097/tp.0b013e31829282cd] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nasal polyposis (NP) is common in cystic fibrosis (CF) patients. The prevalence of the CF phenotype with NP after lung transplantation (LTx) is unknown. Risk factors for the development of NP after LTx are not well described. METHODS CF patients with LTx at our center between November 1992 and December 2009 were included. They were regularly investigated with nasal endoscopy and aspiration of sinus secretions with microbiological evaluation. Patients with and without development of NP were compared along the following parameters: gender, age, dF508, diabetes, acute rejection, NP at LTx, and microbiology of the sinuses before and after LTx. A multivariate Cox regression analysis was performed. RESULTS The study included 94 patients; 21 were excluded because of incomplete data. Thirty-five (48%) of the remaining 73 patients developed NP. Mean time to diagnosis of NP was 4.2 (2.9-5.6) years after LTx. Prevalence of NP was 11% after the first year and 18%, 33%, and 44% after the first 2, 5, and 10 years, respectively. Patients with posttransplantation NP were younger, had NP before LTx, and were chronically infected with Pseudomonas aeruginosa (PA) in the nose. Multivariate analysis demonstrated that chronic infection with PA was the only significant risk factor for the development of nasal polyps after LTx (hazards ratio, 7.2; 95% confidence interval, 2.1-24.2; P=0.001). CONCLUSIONS In contrast to pretransplantation patients, NP is more common after LTx. Development of NP occurs throughout the whole observation time. Chronic sinonasal PA infection seems to be the only significant risk factor for NP after LTx.
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Mainz JG, Koitschev A. Pathogenesis and management of nasal polyposis in cystic fibrosis. Curr Allergy Asthma Rep 2013; 12:163-74. [PMID: 22350539 DOI: 10.1007/s11882-012-0250-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Beginning in preschool age, during their lives, up to 50% of cystic fibrosis (CF) patients experience obstructing nasal polyposis (NP), which is rare in non-CF children. Pathogenetic factors of NP in general and especially in CF are still obscure. However, defective epithelial ion transport from mucosal glands plays a central role in CF, and viscous secretions impair mucociliary clearance, promoting chronic pathogen colonization and neutrophil-dominated chronic inflammation. Presently, CF-NP is not curable but can be clinically stabilized, though the large variety of proposed treatment modalities indicates a lack of standardization and of evidence of treatment efficacy. When conservative measures are exhausted, surgical intervention combining individually adapted endoscopic sinus surgery and supportive conservative treatment is performed. Topical steroids, approved as the gold standard for non-CF NP, may be beneficial, but they are discussed to be less effective in neutrophilic inflammation, and CF-specific antimicrobial and mucolytic therapy, as is true of all treatment modalities, urgently requires evaluation by controlled clinical trials within interdisciplinary networks.
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Affiliation(s)
- Jochen G Mainz
- Cystic Fibrosis Center, Department of Paediatrics, Paediatric Pulmonology, Jena University Hospital, Jena, Germany.
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19
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Qiu QH, Xu MM, Han H, Chen SH. Clinical survey and analysis of Chinese patients with family history of nasal polyposis. Acta Otolaryngol 2013. [PMID: 23190383 DOI: 10.3109/00016489.2012.749519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Nasal polyposis (NP) is frequently found to run in families. Earlier onset of the condition strongly suggested the genetic basis for the development of NP and implied that it might be a genetic disease involving multiple genes. OBJECTIVE The etiology and pathogenesis of NP remain largely unknown, although it is assumed to be associated with allergic reaction and infection. The reported familial cases suggested hereditary factors existing in NP. The purpose of this study was to determine whether a hereditary factor could be implicated in NP. METHODS A total of 418 NP patients admitted to our department were questioned concerning the existence of familial history (parents, siblings or children) and other accompanying diseases. RESULTS In all, 253 cases were successfully followed up. Among these, 44 cases (17.4%) were confirmed to have a familial history of NP, most (59.1%) of which had two immediate family members with a positive family history, with the distribution significantly greater among first-degree and second-degree relatives. Patients with familial NP reported an earlier onset (mean age = 27.7 years) than the sporadic group (mean age = 32.7 years, t = 2.133, p < 0.05). No statistical significance was found when both groups were associated with fungal and allergic diseases.
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Affiliation(s)
- Qian-Hui Qiu
- Department of Otolaryngology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China.
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20
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Nasal polyposis in lung transplant recipients with cystic fibrosis. J Cyst Fibros 2012; 12:266-70. [PMID: 22998935 DOI: 10.1016/j.jcf.2012.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 07/14/2012] [Accepted: 08/17/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyposis is common in patients with cystic fibrosis (CF). There are still many open questions regarding factors related to this condition. Furthermore, the prevalence of nasal polyposis and its implications for the outcomes in lung transplant recipients with cystic fibrosis are unknown. METHODS All CF patients who underwent lung transplantation at our centre between November 1992 and December 2009 were included. Nasal polyp status was determined endoscopically at time sinus surgery and its relationships to gender, age at lung transplantation, Liou raw score, body mass index, FEV1%predicted, diabetes mellitus, pre-transplant pseudomonas colonisation of the sinuses and the lungs, pre-transplant corticosteroid use and type of mutation of the CFTR gene were analysed. The post-transplant survival times and the incidence of bronchiolitis obliterans syndrome in patients with or without nasal polyposis were compared. RESULTS Nasal polyps were found in 19% (17 patients) of the 89 lung transplant recipients, whose data was available for statistical analysis. None of the factors analysed was related to the nasal polyp status. The post-transplant survival times and the incidence of bronchiolitis obliterans syndrome did not significantly differ between patients with or without nasal polyposis. CONCLUSIONS CF-related nasal polyposis occurs in a relevant fraction of lung transplant recipients. A specific effect of nasal polyposis on post-transplant outcome could not be confirmed. Nevertheless, there was a trend to NP recurrence in patients with post-transplant sinonasal pseudomonas colonisation and is a tendency of less chronic rejection in CF patients with nasal polyps.
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Sih T, Godinho R, Franco LP, Piltcher O. Cystic Fibrosis: Brazilian ENT Experience. Int J Otolaryngol 2012; 2012:204696. [PMID: 22611403 PMCID: PMC3352582 DOI: 10.1155/2012/204696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 01/09/2012] [Accepted: 01/30/2012] [Indexed: 12/02/2022] Open
Abstract
Most published studies about Cystic Fibrosis (CF) are European or North American. There are still few publications about the characteristics of fibrocystic populations in developing countries. The incidence of cystic fibrosis (CF) in Brazil varies among different regions (1 : 10,000 in Minas Gerais, 1 : 9,500 in Paraná, 1 : 8,700 in Santa Catarina, and 1 : 1600 in Rio Grande do Sul). The prevalence of the DF508 mutation also varies according to population: 33% in Sao Paulo, 49% in Rio Grande do Sul, 27% in Santa Catarina, and 52% in Minas Gerais. Cough and nasal obstruction are the most common symptoms. The variation in nasal polyposis prevalence may be explained by population genotypic characteristics in a country that spans a continent. Findings on nasal endoscopy and computed tomography (CT) have better correlation than do this information compared with surgical and clinical history. Microbiologic studies suggest a high level of early contamination of the airways. Sensorineural hearing loss (SNHL) occurs in these patients as a result of ototoxic antibiotics. The data compiled in this paper is useful, but also lead to the general agreement that more research would be welcome due to the unique characteristics of this country.
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Affiliation(s)
- Tania Sih
- Faculty of Medicine, Laboratório de Investigações Médicas (LIM), Number 40, Universidade de São Paulo, São Paulo, Rua Mato Grosso, 306/1511, 01239-040 São Paulo, SP, Brazil
| | - Ricardo Godinho
- Health and Biological Sciences Institute, Department of Medicine, Pontifical Catholic University of Minas Gerais-PUC Minas, Rua Dr Chassim 208, 35700-018 Sete Lagoas, MG, Brazil
| | - Leticia Paiva Franco
- Department of Otorhinolaryngology, School of Medicine, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 180, 30000-000 Belo Horizonte, MG, Brazil
| | - Otávio Piltcher
- Department of Otorhinolaryngology, College of Medicine, Universidade Federal do Rio Grande do Sul, Avenida Bento Gonçalves 8083, Casa 2, 91540-000 Porto Alegre, MG, Brazil
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Schraven SP, Wehrmann M, Wagner W, Blumenstock G, Koitschev A. Prevalence and histopathology of chronic polypoid sinusitis in pediatric patients with cystic fibrosis. J Cyst Fibros 2011; 10:181-6. [PMID: 21296035 DOI: 10.1016/j.jcf.2011.01.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic sinusitis is almost invariably a feature of cystic fibrosis. However, data on the endoscopically confirmed prevalence of chronic polypoid sinusitis (CPS) and its histological features are limited. METHODS Single centre prospective observational study. Unselected pediatric CF patients (n=81; ≤ 18 years) were endoscopically assessed for the prevalence of CPS. Sixteen of these underwent sinus surgery. The surgically obtained sinus specimens were compared to sinus specimen of non-CF-patients undergoing sinus surgery (n=61), using conventional histology and immunohistochemistry. RESULTS The prevalence of endoscopically confirmed CPS increased with age from 19% in infants younger than six years reaching 45% in adolescents. In CF patients, histology typically showed dilated glandular ducts and a predominance of mucous glands. The number of plasma cells and mast cells but not of eosinophils was significantly elevated compared to non-CF patients. CONCLUSION Prevalence of CPS in pediatric CF patients increases with age. Our findings indicate that chronic bacterial infection rather than allergic mechanisms may forward this pathology.
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Affiliation(s)
- Sebastian P Schraven
- University of Tuebingen, Department of Otolaryngology, Elfriede-Aulhorn-Straße, Germany.
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23
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Franco LP, Camargos PAM, Becker HMG, Guimarães RES. Nasal endoscopic evaluation of children and adolescents with cystic fibrosis. Braz J Otorhinolaryngol 2010; 75:806-13. [PMID: 20209279 PMCID: PMC9446041 DOI: 10.1016/s1808-8694(15)30541-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 06/22/2009] [Indexed: 01/04/2023] Open
Abstract
The main otorhinolaryngological manifestations of CF are chronic rhinosinusitis and nasal polyposis, with different clinical presentations. Aim To characterize children and adolescents with cystic fibrosis through a questionnaire, an ENT clinical examination and nasal endoscopy. Study design Cross-sectional clinical descriptive. Material and Method Assessment of 100 children and adolescents with cystic fibrosis through a specific questionnaire, ENT physical examination, nasal endoscopy and endoscopic staging of nasal polyps. Results The most frequent symptoms were: cough (45%), oral breathing (44%), sleep disorders (42%) and nasal obstruction (37%). Twenty-eight patients (28%) had purulent nasal discharge, and 41% had medial bulging of the nasal lateral wall. Nasal polyps were identified in only 14% of cases, none were obstructing. Conclusion The questionnaire, clinical examination and especially nasal endoscopy lead to a detailed assessment of the nasal characteristics of children and adolescents with cystic fibrosis. Some findings were discordant with the literature, particularly the low prevalence of nasal polyps, and appear to be related to specific characteristics of the population studied. The best characterization of this group of patients, from the ENT standpoint, contributes to an appropriate multidisciplinary approach.
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Kern RC, Conley DB, Walsh W, Chandra R, Kato A, Tripathi-Peters A, Grammer LC, Schleimer RP. Perspectives on the etiology of chronic rhinosinusitis: an immune barrier hypothesis. AMERICAN JOURNAL OF RHINOLOGY 2008; 22:549-59. [PMID: 18786300 PMCID: PMC2802263 DOI: 10.2500/ajr.2008.22.3228] [Citation(s) in RCA: 219] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) has been defined as persistent symptomatic inflammation of the nasal and sinus mucosa resulting from the interaction of multiple host and environmental factors. Recent studies have implicated Alternaria fungi or toxigenic Staphylococcus aureus as critical agents in CRS pathogenesis. The emphasis on environmental agents in CRS etiology has focused interest toward elimination of those agents as the prime mechanism of therapy. This viewpoint is in marked contrast to the current perspective on some other chronic inflammatory epithelial disorders that afflict the skin, lungs, and gut, wherein host factors are believed to predispose to disease expression in the presence of ubiquitous environmental agents. METHODS The current review evaluates CRS etiology from this perspective and considers that CRS develops, in part, as an outcome of a dysfunctional host response. Specifically, evidence from our laboratory and others will be reviewed indicating that CRS is associated with a failure of the mechanical and immunologic barriers across the nasal mucosa. The hypothesis would further propose that genetic and epigenetic variation predisposes susceptible individuals to barrier failure in the presence of environmental stress leading to CRS. RESULTS From this unifying perspective, bacteria and fungi are seen as disease modifiers rather than primary etiologic agents. CONCLUSION The goal is to place concepts of CRS pathophysiology in a framework consistent with a current understanding of chronic inflammation in general and epithelial disease in particular.
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Affiliation(s)
- Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Abstract
Paranasal and sinus disease is present in almost every patient with cystic fibrosis. However, symptoms are rarely reported. Some aspects including polyposis and microbial flora change with patient age. Endoscopy and computerised tomography have broadened our understanding of how this disease affects the sinuses, including an increased recognition of polyposis than previously thought and identification of several disease specific entities such as abnormalities of the lateral nasal wall and uncinate process. Few randomised, controlled trials evaluating medical or surgical treatments of CF sinus disease exist. Sinus surgery may provide some benefit, though there are no established selection criteria for appropriate candidates. A link between sinus disease and lower respiratory tract function may contribute to general health and survival following lung transplantation. Complications of sinonasal disease in CF are rare and include mucoceles and periorbital abscesses.
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Affiliation(s)
- John M Robertson
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas 77030, USA
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Weber SAT, Ferrari GF. Incidência e evolução da polipose nasal em crianças e adolescentes com fibrose cística. ACTA ACUST UNITED AC 2008. [DOI: 10.1590/s0034-72992008000100003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A polipose nasal é manifestação clínica de alerta para investigação de fibrose cística (FC). OBJETIVO: Avaliar incidência de pólipos nasais em crianças e adolescentes com FC, sua associação com idade, sexo, sintomas clínicos, achados laboratoriais e genótipo, e sua evolução com corticoterapia tópica. CASUÍSTICA E MÉTODOS: Foram avaliados sintomas clínicos, níveis de cloro no suor e mutações genéticas de 23 pacientes com FC. A polipose nasal foi investigada por exame endoscópico e quando presente, o paciente recebeu 6 meses de tratamento com corticosteróide tópico e foi realizada nova endoscopia depois. Para análise estatística utilizou-se média, desvio padrão e Teste de Fisher. RESULTADOS: 39,1% dos pacientes apresentaram polipose nasal (cinco bilateral, quatro unilateral), todos com mais de seis anos, 82,6%, pneumonias recorrentes, 87%, insuficiência pancreática e 74%, desnutrição. Não houve associação entre polipose e nível de cloro no suor, genótipo, fenótipo clínico e sintomas nasais. Houve melhora da polipose com tratamento clínico em sete pacientes, com regressão completa em seis. CONCLUSÃO: O estudo mostrou elevada incidência de polipose em crianças com FC, sendo encontrada em todos os espectros de gravidade clínica, mesmo na ausência de sintomas nasais. O tratamento com corticosteróide tópico mostrou-se eficaz. A interação de pneumopediatra e do otorrinolaringologista é fundamental para diagnóstico e seguimento.
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Weber SAT, Ferrari GF. Incidence and evolution of nasal polyps in children and adolescents with cystic fibrosis. Braz J Otorhinolaryngol 2008; 74:16-20. [PMID: 18392496 PMCID: PMC9450666 DOI: 10.1016/s1808-8694(15)30745-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 02/10/2007] [Indexed: 11/28/2022] Open
Abstract
Nasal polyps are a clinical sign of alert for investigating Cystic Fibrosis (CF). Aims To study the incidence of nasal polyps in children and adolescents with cystic fibrosis, its possible association with age, gender, clinical manifestations, genotype and sweat chlorine level, and its evolution with topical steroid therapy. Methods Clinical symptoms, sweat chlorine level and genotype were studied in 23 cystic fibrosis patients. Nasal polyps were diagnosed by nasal endoscopy and treated with topical steroids during 6 months, followed by a second nasal endoscopy. Fisher test was used for statistical analysis. Results Nasal polyps were found in 39.1% of the patients (five bilateral, four unilateral), all older than six years, recurrent pneumonia in 82.6%, pancreatic insufficiency in 87% and malnutrition in 74%. No association was seen between nasal polyps and sweat chlorine level, genotype, clinical sings of severity and nasal symptoms. Seven patients improved in their nasal polyps with topical steroids, six showed complete resolution. Conclusion The study showed a high incidence of nasal polyps in older children, who span the entire range of clinical severity, even in the absence of clinical nasal symptoms. Topical steroid therapy showed good results. An interaction among pediatricians and otolaryngologists is necessary for diagnosis and follow-up.
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Kostuch M, Klatka J, Semczuk A, Wojcierowski J, Kulczycki L, Oleszczuk J. Analysis of most common CFTR mutations in patients affected by nasal polyps. Eur Arch Otorhinolaryngol 2005; 262:982-6. [PMID: 16075239 DOI: 10.1007/s00405-005-0927-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Accepted: 01/11/2005] [Indexed: 11/27/2022]
Abstract
Nasal polyps, a chronic inflammatory disease occurring in the nose and para-nasal sinuses, result from several different causes, including cystic fibrosis (CF). Forty-four patients affected by nasal polyps were admitted to the Department of Otolaryngology, Lublin University School of Medicine, Lublin, Poland, and screened for the most-commonly identified CFTR mutations [DeltaF508, G542X, N1303 K, 1717-1 (G to A), W1282X, G551D, R553X and DeltaI507] by applying the INNO-LIPA CF2 test strips. None of the patients had symptoms that allowed for the diagnosis of CF, including the negative sweat test. We detected 5 of 44 (11.4%) carriers of the CFTR mutations. All patients positive for this test were heterozygous carriers of DeltaF508. In the control group, only 1 of 70 (1.4%) cases showed DeltaF508 heterozygosity. The frequency of DeltaF508 mutation herein reported was significantly higher than in the control group (P = 0.0312) and in the general Polish population as well (P = 0.0059). Our data suggest that a heterozygous manifestation of the DeltaF508 may exist in a selected group of patients affected by nasal polyps, who have no other clinical features of CF.
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Affiliation(s)
- Marzena Kostuch
- Department of Obstetrics and Perinatology, Lublin University School of Medicine, Poland
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Claeys S, Van Hoecke H, Holtappels G, Gevaert P, De Belder T, Verhasselt B, Van Cauwenberge P, Bachert C. Nasal polyps in patients with and without cystic fibrosis: a differentiation by innate markers and inflammatory mediators. Clin Exp Allergy 2005; 35:467-72. [PMID: 15836755 DOI: 10.1111/j.1365-2222.2005.02215.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The dysfunction of the mucosal interface of the upper respiratory tract in cystic fibrosis (CF) patients is clinically visible by the development of nasal polyps (NP) at a young age. Innate defence markers and inflammatory mediators in NP from patients with CF were compared with non-cystic fibrosis nasal polyps (non-CF-NP) to determine a possible different immunological background in macroscopically similar tissue. METHODS Surgical samples were obtained from patients with non-CF-NP, cystic fibrosis patients with nasal polyps (CF-NP) and control patients (CO). With real time PCR, the mRNA expression of human beta defensins (HBD) 2 and 3, toll-like receptors (TLR) 2 and 4 and the macrophage mannose receptor (MMR) were measured. On homogenates of the surgical samples eotaxin, myeloperoxidase (MPO), IL-5 and IL-8 protein content was measured using commercial ELISA kits; IgE and eosinophilic cationic protein (ECP) were measured by the Unicap system. RESULTS In CF-NP we found a statistically significant higher mRNA expression of HBD 2 compared with non-CF-NP and CO and of TLR 2 compared with non-CF-NP. In the non-CF-NP group, MMR mRNA expression was significantly elevated compared with CO and CF-NP. For TLR 4 mRNA expression no statistically significant differences were found between groups. IL-5 was below detection level in all CO and CF-NP, but was measurable in 80% of the non-CF-NP. MPO and IL-8 concentrations were significantly higher in CF-NP compared with CO and non-CF-NP, whereas ECP, eotaxin and IgE were significantly higher in the non-CF-NP group. CONCLUSIONS We here demonstrate that CF-NP and non-CF-NP not only differ in terms of inflammatory mediator profile, but also in terms of innate markers.
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Affiliation(s)
- S Claeys
- Upper airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Belgium.
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Pawłowska-Góral K, Gierek T, Majzel K, Wardas P, Wardas M. Glycosoaminoglycans in nasal polyps. Acta Otolaryngol 2005; 125:177-9. [PMID: 15880949 DOI: 10.1080/00016480410017116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CONCLUSION The qualitative and quantitative compositions of GAGs were comparable in all the polyps examined. OBJECTIVE Glycosoaminoglycans (GAGs) are an integral component of proteoglycans, which are constituents of connective tissue. The qualitative and quantitative compositions of GAGs occurring in proteoglycans determine their biological role. In this work, individual fractions of GAGs occurring in nasal polyps were isolated and estimated. MATERIAL AND METHODS Polyps were obtained over a 2-year period from 31 patients (18 males, 13 females; age range 28-70 years) who underwent polypectomy and evaluated using routine histopathology. RESULTS The amount of hyaluronic acid in nasal polyps was high, the amounts of dermatane sulphate and chondroitine-6-sulphate were slightly lower and the amounts of chondroitine-4-sulphate, heparin, heparan sulphate and keratan sulphate were the lowest.
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