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Thunberg U, Saber A, Söderquist B, Hugosson S. Long-Term Clinical Follow-Up of Patients With Chronic Rhinosinusitis. Ann Otol Rhinol Laryngol 2020; 130:504-512. [PMID: 33000628 PMCID: PMC8044630 DOI: 10.1177/0003489420962822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: This study comprised a long-term follow-up of a cohort of patients with chronic rhinosinusitis (CRS) regarding clinical features and symptomatology. Methods: Data from 42 patients with CRS were available from a previous study. Forty of these patients were alive and were contacted for inclusion after approximately 10 years. Patients completed a questionnaire about disease and symptoms, and underwent a clinical examination. Results: Thirty-four patients (85%) responded and could be included and evaluated. For the participants in this follow-up study median length of time between initial inclusion (C1) and follow-up (C2) was 11 years (range: 8-15). In some patients the CRS shifted phenotype over time, from CRS with nasal polyposis to CRS without nasal polyposis or vice versa. The median total visual analogue score for combined sinonasal symptoms for all patients was statistically significantly reduced at follow-up. For individual patients, scores for nasal congestion, nasal discharge, facial pressure, and hyposmia were also statistically significantly reduced. The most frequently reported symptom-relieving treatments were nasal steroids and saline rinsing of the nose. Self-reported general quality of life was statistically significantly improved at C2 compared to C1. Conclusion: At long-term follow-up, symptoms were generally reduced and patients reported an improved quality of life. Patients can be given hope for eventual symptom relief. CRS is a chronic condition that seems to harbor the ability to alter its phenotype after several years. Topical corticosteroids and saline rinsing of the nose should be emphasized, since patients consider these treatments to be of high value.
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Affiliation(s)
- Ulrica Thunberg
- Department of Otorhinolaryngology, Örebro University Hospital, Örebro, Sweden.,Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Amanj Saber
- Department of Otorhinolaryngology, Örebro University Hospital, Örebro, Sweden.,Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Bo Söderquist
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden
| | - Svante Hugosson
- Department of Otorhinolaryngology, Örebro University Hospital, Örebro, Sweden.,Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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2
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Calus L, Van Bruaene N, Bosteels C, Dejonckheere S, Van Zele T, Holtappels G, Bachert C, Gevaert P. Twelve-year follow-up study after endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyposis. Clin Transl Allergy 2019; 9:30. [PMID: 31249662 PMCID: PMC6570859 DOI: 10.1186/s13601-019-0269-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a therapeutic challenge because of the high recurrence rate. Surgical intervention should be considered in patients who fail to improve after medical treatment. We monitored recurrence and revision surgery over 12 years after endoscopic sinus surgery in CRSwNP patients. Methods In this prospective cohort study, 47 patients with CRSwNP, who underwent primary or revision extended endoscopic sinus surgery, were followed. Clinical symptoms and total nasal endoscopic polyp score were evaluated before, 6 years and 12 years after surgery. Results Twelve years after surgery, 38 out of 47 patients (80.9%) were available for examination. There still was a significantly better symptom score and total nasal endoscopic polyp score compared to before surgery (P < 0.001). Within the 12-year follow-up period, 30 out of 38 patients developed recurrent nasal polyps, of which 14 patients underwent additional revision surgery. Comorbid allergic sensitization and tissue IL-5 levels were found to be significant predictors for the need of revision surgery. Conclusions This long-term cohort study, investigating the outcome after surgery in CRSwNP, showed that, despite the low number of patients, 78.9% of patients with CRSwNP were subject to recurrence of the disease and 36.8% to revision surgery over a 12-year period.
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Affiliation(s)
- Lien Calus
- 1Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Nicholas Van Bruaene
- 1Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Cedric Bosteels
- 1Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Sarah Dejonckheere
- 1Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Thibaut Van Zele
- 1Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Gabrielle Holtappels
- 1Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Claus Bachert
- 1Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.,2Division of ENT Diseases, Clintec, Karolinska Institutet, Stockholm, Sweden
| | - Philippe Gevaert
- 1Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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3
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Gendre A, Rives P, Michel G, Boutoille D, Espitalier F, Malard O. Intraoperative bacterial analysis in nasal polyposis: Clinical and functional impact. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:155-160. [PMID: 30876852 DOI: 10.1016/j.anorl.2019.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The impact of Staphylococcus aureus on onset of nasal polyposis has been the focus of numerous studies, but there have been few studies of other germs found in the ethmoid of operated patients or of their impact on post-operative results. MATERIAL AND METHODS All patients undergoing endoscopic radical ethmoidectomy for nasal polyposis in the teaching hospital of Nantes (France) between 2006 and 2016 had intraoperative ethmoid cavity bacterial sampling. Phenotypic characteristics, pre- and post-operative symptoms and endoscopic findings were analyzed. Mann-Whitney tests and Kruskal-Wallis correlation analysis were used to assess clinical/bacteriological correlations. OBJECTIVES The main objective was to describe bacterial colonization of patients undergoing surgery for nasal polyposis, and to assess correlations with phenotypic features, functional results and postoperative clinical course. RESULTS One hundred and seven patients were included. A total of 26% were not infected, 55% mono-infected and 19% multi-infected. In 27.3%, staphylococci were isolated; in 30.5%, isolates were gram-negative bacilli. There were no significant correlations between presence or type of pathogen and symptom profile. CONCLUSION This study confirmed the high rate of pathogenic bacteria in nasal cavities in case of polyposis, with high frequencies of S. aureus but also of gram-negative bacilli, raising the question of their involvement in the inflammatory reactions underlying the nasal polyposis.
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Affiliation(s)
- A Gendre
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, Place A.-Ricordeau, BP 1005, 44093 Nantes Cedex 01, France
| | - P Rives
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, Place A.-Ricordeau, BP 1005, 44093 Nantes Cedex 01, France
| | - G Michel
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, Place A.-Ricordeau, BP 1005, 44093 Nantes Cedex 01, France
| | - D Boutoille
- Service des maladies infectieuses, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, Place A.-Ricordeau, BP 1005, 44093 Nantes Cedex 01, France
| | - F Espitalier
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, Place A.-Ricordeau, BP 1005, 44093 Nantes Cedex 01, France
| | - O Malard
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de Nantes, Hôtel-Dieu, 1, Place A.-Ricordeau, BP 1005, 44093 Nantes Cedex 01, France.
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4
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Benkhatar H, Khettab I, Sultanik P, Laccourreye O, Bonfils P. Mucocele development after endoscopic sinus surgery for nasal polyposis: A long-term analysis. EAR, NOSE & THROAT JOURNAL 2019; 97:284-294. [PMID: 30273428 DOI: 10.1177/014556131809700918] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the present study was to determine the prevalence of long-term mucocele development after functional endoscopic sinus surgery (FESS) for nasal polyposis, to search for a statistical relationship with preoperative variables and to analyze the management of this complication. A retrospective analysis of 153 patients who underwent FESS for nasal polyposis, with a minimum of 7 years of follow-up, was performed. Mucocele diagnosis was based on regular clinical and radiologic evaluation. Univariate and multivariate statistical analysis was performed. The postoperative mucocele rate was 13.1% (20 patients). The mean delay between surgery and mucocele diagnosis was 6.25 years. A high preoperative Lund-Mackay score (>19) was a risk factor for postoperative mucocele (p = 0.04). Asthma and aspirin intolerance did not increase the risk of this complication. Endoscopic marsupialization of mucoceles was successful in 19 patients, with only one recurrent frontal mucocele. One patient required external approaches for two frontal mucoceles. In conclusion, mucocele risk after FESS for nasal polyposis is significant, especially in case of a high preoperative Lund-Mackay score (>19). Long-term clinical follow-up is recommended, imaging being prescribed based on symptoms or abnormal findings on clinical examination. Endoscopic marsupialization is very effective, but frontal mucoceles are more likely to recur.
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Affiliation(s)
- Hakim Benkhatar
- ORL, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
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5
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Lisan Q, Rubin F, Bonfils P, Villeneuve A. Otitis media with effusion in nasal polyposis and outcomes following surgery: A longitudinal observational study. Clin Otolaryngol 2018; 43:1522-1527. [PMID: 30058276 DOI: 10.1111/coa.13201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/02/2018] [Accepted: 07/25/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In patients with nasal polyposis (NP), otitis media with effusion (OME) seems to be a marker of severity of the inflammatory process occurring in those patients. The aim was to assess whether OME could represent a marker of resistance to the surgical treatment of NP. DESIGN Longitudinal observational cohort study including patients between January 1991 and January 2017. Mean follow-up was 7.4 years. SETTING Tertiary-care hospital centre. PARTICIPANTS Patients with NP who underwent surgery (radical bilateral sphenoethmoidectomy). MAIN OUTCOME MEASURES Four outcomes reflecting resistance to the surgical treatment: a clinical score of rhinologic symptoms, the mean number of systemic corticosteroids treatment per year, the recurrence rate of polyps and the rate of reoperation. RESULTS A total of 266 patients were included (63.9% of men, mean age 48 years). In multivariate linear mixed-effects regression, when compared to patients without OME, patients with OME presented a similar clinical score of symptoms (coefficient 0.09, 95% confidence interval (CI) -0.25 to 0.06, P-value = 0.24) and a borderline higher mean number of systemic corticosteroids treatments per year (coefficient 0.11, 95% CI 0.003-0.23, P-value = 0.04). In multivariate Cox regression analyses, patients with OME had a similar reoperation rate than patients without OME (hazard ratio (HR) 0.29, 95% CI 0.06-1.50) and a similar recurrence rate of polyps (HR 0.59, 95% CI 0.23-1.53). CONCLUSION In patients with NP, OME is not a marker of surgical resistance. Those patients should be managed similarly than patients without, and similar outcomes following surgery should be expected.
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Affiliation(s)
- Q Lisan
- Faculty of Medicine, Paris Descartes University, Paris, France.,Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France.,Department of Epidemiology, INSERM, UMR-S970, Paris, France
| | - F Rubin
- Faculty of Medicine, Paris Descartes University, Paris, France.,Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France
| | - P Bonfils
- Faculty of Medicine, Paris Descartes University, Paris, France.,Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France.,CNRS, IRBA, UMR 8257, Paris Descartes University, Paris, France
| | - A Villeneuve
- Faculty of Medicine, Paris Descartes University, Paris, France.,Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France
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6
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Gelardi M, Iannuzzi L, De Giosa M, Taliente S, De Candia N, Quaranta N, De Corso E, Seccia V, Ciprandi G. Non-surgical management of chronic rhinosinusitis with nasal polyps based on clinical-cytological grading: a precision medicine-based approach. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:38-45. [PMID: 28374869 PMCID: PMC5384308 DOI: 10.14639/0392-100x-1417] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/16/2016] [Indexed: 01/04/2023]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder that strongly impacts patients' quality of life. CRSwNP is still a challenge for ENT specialists due to its unknown pathogenesis, difficult control and frequent relapse. We tested the hypothesis that a new standardised therapeutic approach based on individual clinical-cytological grading (CCG), may improve control of the disease and prevent the needing for surgery. We analysed 204 patients suffering from bilateral CRSwNP, 145 patients of whom regularly assumed therapy, respecting the planned check-up, and were considered cases; 59 patients were not assuming therapy as indicated and were considered as controls. After five years of standardised treatment, 15 of 145 (10.5%) improved endoscopic staging, 61 of 145 (42%) did not change their endoscopic staging, and 69 of 145 (47.5%) were worse. In the control group, 49 of 59 (83%) were worse by at least two stages (p < 0.05). Patients and controls were stratified basing on clinical and cytological grading as mild, moderate and severe. After patient stratification, in the mild group (n = 27) 92% patients had a constant trend, with no worsening and no need for surgery over a 5-year period, whereas in the mild CCG control group 1 of 59 (1.6%) required surgery (p < 0.05). In moderate GCC (n = 83), 44% of patients did not modify or improve endoscopic staging and 3.6% needed surgery, compared to 13.6% of controls with moderate GCC (p < 0.05). In severe CCG (n = 35), even though no patients achieved significant amelioration of endoscopic grading, 40% of patients were considered as "clinically controlled" and 5.7% of patients underwent surgery, but the percentage was significantly higher (49%) in the control group significant (p = 0.0000). Finally, statistical analyses revealed a clear trend that polyp size increased at a faster rate in the control group than in the treatment group and for each subgroup (low, moderate and severe). The present study suggests a new approach in the management of CRS according to clinical cytological grading that allows defining the grade of CRSwNP severity and to adapt the intensity of treatment. This approach limited the use of systemic corticosteroids to only moderate-severe CRSwNP with a low corticosteroid dosage in comparison with those previously suggested. Our protocol seems to improve the adherence by patients, control of disease and the need for surgery in the long-term.
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Affiliation(s)
- M Gelardi
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - L Iannuzzi
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - M De Giosa
- Department of Mathematics, University of Bari "Aldo Moro", Bari, Italy
| | - S Taliente
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - N De Candia
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - N Quaranta
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - E De Corso
- Otorhinolaryngology, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - V Seccia
- 1st Otorhinolaryngology Unit; Department of Neuroscience, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - G Ciprandi
- Department of Medicine, IRCCS-AOU San Martino-IST, Genoa, Italy
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7
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Benkhatar H, Khettab I, Sultanik P, Laccourreye O, Bonfils P. Frontal sinus revision rate after nasal polyposis surgery including frontal recess clearance and middle turbinectomy: A long-term analysis. Auris Nasus Larynx 2017; 45:740-746. [PMID: 29150349 DOI: 10.1016/j.anl.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 10/21/2017] [Accepted: 11/06/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the frontal sinus revision rate after nasal polyposis (NP) surgery including frontal recess clearance (FRC) and middle turbinectomy (MT), to search for predictive factors and to analyse surgical management. METHODS Longitudinal analysis of 153 patients who consecutively underwent bilateral sphenoethmoidectomy with FRC and MT for NP with a minimum follow-up of 7 years. Decision of revision surgery was made in case of medically refractory chronic frontal sinusitis or frontal mucocele. Univariate and multivariate analysis incorporating clinical and radiological variables were performed. RESULTS The frontal sinus revision rate was 6.5% (10/153). The mean time between the initial procedure and revision surgery was 3 years, 10 months. Osteitis around the frontal sinus outflow tract (FSOT) was associated with a higher risk of frontal sinus revision surgery (p=0.01). Asthma and aspirin intolerance did not increase the risk, as well as frontal sinus ostium diameter or residual frontoethmoid cells. Among revised patients, 60% required multiple procedures and 70% required frontal sinus ostium enlargement. CONCLUSIONS Our long-term study reports that NP surgery including FRC and MT is associated with a low frontal sinus revision rate (6.5%). Patients developing osteitis around the FSOT have a higher risk of frontal sinus revision surgery. As mucosal damage can lead to osteitis, FSOT mucosa should be preserved during initial NP surgery. However, as multiple procedures are common among NP patients requiring frontal sinus revision, frontal sinus ostium enlargement should be considered during first revision in the hope of reducing the need of further revisions.
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Affiliation(s)
- Hakim Benkhatar
- ENT - Head and Neck Surgery Department, European Hospital Georges Pompidou, AP-HP, Paris, France; Faculty of Medicine Paris Descartes, University Paris V, Paris, France.
| | - Idir Khettab
- Department of Radiology, European Hospital Georges Pompidou, AP-HP, Paris, France
| | - Philippe Sultanik
- Faculty of Medicine Paris Descartes, University Paris V, Paris, France
| | - Ollivier Laccourreye
- ENT - Head and Neck Surgery Department, European Hospital Georges Pompidou, AP-HP, Paris, France; Faculty of Medicine Paris Descartes, University Paris V, Paris, France
| | - Pierre Bonfils
- ENT - Head and Neck Surgery Department, European Hospital Georges Pompidou, AP-HP, Paris, France; Faculty of Medicine Paris Descartes, University Paris V, Paris, France
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8
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Baradaranfar MH, Ahmadi ZS, Dadgarnia MH, Bemanian MH, Atighechi S, Karimi G, Halvani A, Behniafard N, Baradaranfar A, Meybodi TE. Comparison of the effect of endoscopic sinus surgery versus medical therapy on olfaction in nasal polyposis. Eur Arch Otorhinolaryngol 2013; 271:311-6. [PMID: 23700266 DOI: 10.1007/s00405-013-2553-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 05/03/2013] [Indexed: 11/30/2022]
Abstract
Chronic rhinosinusitis is a common inflammatory condition in western countries. Nasal polyposis has different symptoms such as nasal obstruction, anterior or posterior nasal drip, reduced sense of smell, and facial pain. Medical and endoscopic treatments are the two main treatments for nasal polyposis. Our aim was to compare the efficacy of different methods on olfactory function. This is a non-randomized clinical trial study that was done on 60 patients who were divided into two groups (medical and surgical). Patients were matched based on age, history of smoking, and the severity of obstruction. The radiologist score of Lund-Mackay staging system was used to match patients in two arms of the trial based on the severity of nasal obstruction. Patients in surgery groups underwent functional endoscopic sinus surgery under general anesthesia and then received Fluticasone propionate nasal spray for 8 weeks (400 mcg bd). Patients in the medical group were only prescribed with Fluticasone propionate with the same duration and same dose as mentioned. As a result of treatment protocol, both medical and surgical group experienced improvement in olfactory function but statistical analyses revealed that surgery resulted in better resolution of symptoms. Our observation revealed that combined treatment had a better effect than medical treatment in restoring olfaction in patients with nasal polyposis.
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Affiliation(s)
- Mohammad Hossein Baradaranfar
- Department of Otolaryngology, Head and Neck Surgery, Rhinology Research Center, Shahid Sadoughi University of Medical Science and Health Services, Yazd, Iran,
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9
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Abstract
Olfaction is an essential chemosensory system in the living world. Although less appreciated in humans, smell impairment significantly affects many aspects of quality of life. Smell disorders may be caused by an impaired nasal airway or by lesions in the olfactory system, leading to reduced or distorted smell perception. The most common causes of smell disorders are aging, upper respiratory tract infection, sinonasal disease, and head trauma. Recovery is rarely complete. Counseling is important in progressive or severe smell loss. In patients with distorted smell perception, antidepressant medication is sometimes necessary. Best response to treatment is achieved for nasal obstruction and sinonasal inflammatory disease. Treatment of olfactory impairment caused by sinonasal disease includes medication with topical and systemic steroids, or surgery for refractory cases. Although there are reports that surgical resection of olfactory neurons may lead to reinnervation and recovery of smell, adequate treatment of the smell loss remains an unmet need.
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Affiliation(s)
- Livije Kalogjera
- Zagreb School of Medicine, Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Centre, "Sestre Milosrdnice", Vinogradska 29, 10000, Zagreb, Croatia,
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10
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Ayçiçek A, Kahveci OK, Miman MC, Duran A, Yıldız H. Combined Medical and Surgical Therapy Improves Olfaction in Patients with Nasal Polyposis. ACTA ACUST UNITED AC 2012; 74:110-5. [DOI: 10.1159/000336738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 01/02/2012] [Indexed: 11/19/2022]
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Yaman H, Alkan N, Yilmaz S, Koc S, Belada A. Is routine histopathological analysis of nasal polyposis specimens necessary? Eur Arch Otorhinolaryngol 2011; 268:1013-5. [PMID: 21331779 DOI: 10.1007/s00405-011-1534-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Abstract
Our objective is to evaluate the incidence of unexpected pathologies in routine nasal polyposis specimens and necessity for histopathological evaluation of nasal polyps. A retrospective chart review of all patients who underwent nasal polyposis surgery between January 2004 and June 2010 were reviewed. The patients were divided into two groups. Group 1 consisted of patients with bilateral nasal polyposis. Group 2 consisted of patients with unilateral nasal polyposis. One hundred and seventeen patients (81 male, 36 female) were involved in this study. The mean age was 44.9 ± 17.7 years, ranging between 18 and 72 years. Group 1 consisted of bilateral nasal polyposis specimens. Eighty-five patients were identified with bilateral nasal polyposis. From these 85 patients, no specimens present any evidence of occult pathology on histopathological examination. Group 2 consisted of unilateral nasal polyposis specimens. There were two cases of allergic fungal sinusitis, two of inverting papilloma, one of mucocele, one of plasmacytoma, one of hemangioma, one of esthesioneuroblastoma, and one of schwannoma. Final histopathology of the remaining 23 patients was consistent with inflammation and/or nasal polyposis. We think that in cases of unilateral polyps histopathological examination of the entire material is mandatory. However, routine histological examination of bilateral nasal polyposis may possibly not be necessary in cases where the clinical assessment very clearly has not disclosed any unusual or suspicious signs.
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Affiliation(s)
- Huseyin Yaman
- Department of Otorhinolaryngology, Duzce Medical Faculty, Duzce University, Duzce, Turkey.
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12
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Day N, Mainardi JL, Malinvaud D, Bonfils P. [Bacteriological study of ethmoid specimens from patients with nasal polyposis after ethmoidal surgery]. ACTA ACUST UNITED AC 2009; 126:196-202. [PMID: 19595291 DOI: 10.1016/j.aorl.2009.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 06/08/2009] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the bacteriological and clinical findings in ethmoid specimens from patients with nasal polyposis after radical ethmoidal surgery. PATIENTS AND METHODS From June to November 2008, 60 patients were prospectively included. For each patient, two samples for each ethmoidal cavity were taken. Aerobic and anaerobic bacterial cultures and fungal cultures were processed and the antibiotic susceptibility was evaluated for each isolated bacterial strain. RESULTS Pathogenic bacteria were isolated in 48 patients (80%) including predominantly Staphylococcus aureus (60%) or a Gram-negative bacterium. The microorganisms were nearly all susceptible to antibiotics, including the aminoglycosides. No correlation between the presence of pathogenic bacteria and the clinical status of the patients was found. CONCLUSION In this study, a great number of patients was colonized with pathogenic bacteria. However, the presence of pathogenic bacteria was not correlated with the clinical status of the patients.
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Affiliation(s)
- N Day
- Service de microbiologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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13
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Hirt R, Paulsen F, Neumann K, Knipping S. [Immunocytochemical detection of caspase 3 in various diseases of human nasal mucosa]. HNO 2009; 57:466-72. [PMID: 19387597 DOI: 10.1007/s00106-009-1905-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inflammatory processes play a central role in the pathogenesis of chronic rhinosinusitis (CRS), however, the impact of apoptosis in CRS in unclear. The aim of this study was a comparison of caspase 3 activity, a key enzyme in the apoptosis cascade, in samples of nasal tissue from patients with different types of rhinosinusitis. MATERIAL AND METHODS Immunohistochemical analyses were carried out to detect caspase 3 in samples of nasal tissue from patients with CRS and nasal polyps (NP), allergic rhinitis (AR), rhinitis medicamentosa (RM) and atrophic rhinitis. RESULTS Evidence of increased apoptosis was found in the epithelium, submucosal glands and blood vessels in NP samples. Samples of RM showed strong caspase 3 activity in the endothelial cells and the lamina muscularis of blood vessels. In atrophic rhinitis the epithelium and subepithelial glands showed increased caspase 3 activity. In samples of patients with allergic rhinitis caspase 3 activity could not be detected. CONCLUSIONS Activated apoptosis seems to play an important role in the pathogenesis of different types of rhinosinusitis. Further investigations on the induction of caspase 3 are necessary for the development of new therapeutic strategies to influence the regulation of apoptosis.
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Affiliation(s)
- R Hirt
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau, Deutschland
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Complaints of olfactory disorders: epidemiology, assessment and clinical implications. Curr Opin Allergy Clin Immunol 2008; 8:10-5. [PMID: 18188011 DOI: 10.1097/aci.0b013e3282f3f473] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Recent studies illuminate the difficulties that patients with olfactory disorder face in daily life, which underlines the need to understand its prevalence, and to diagnose and treat these patients. The purpose of the present review is to characterize olfactory disorders and describe associated complaints, present recent insights into epidemiology, suggest procedures to assess these disorders, and discuss clinical implications. RECENT FINDINGS A compilation of previous and new studies of olfactory disorders suggests associated complaints of poor quality of life, depression, and various specific consequences. Epidemiological studies show that loss in odor sensitivity is common in both general and clinical populations, whereas dysosmia is less common in general populations but frequent in clinical populations. The most common etiologies are post-upper respiratory infection, nasal/sinus disease and head trauma. SUMMARY Procedures to diagnose olfactory disorders and to identify etiologies are available. Depending on etiology, certain types of treatment are often successful, such as endoscopic sinus surgery and corticosteroid administration in nasal/sinus disease. In post-upper respiratory infection and head trauma, spontaneous recovery is fairly high. In any case, it is advisable to counsel the patient with regards to strategies to cope with olfactory disorders.
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Eosinophil infiltration of nasal polyps in patients with nasal polyposis: role in clinical evolution after medical and surgical treatment. The Journal of Laryngology & Otology 2008; 123:509-16. [DOI: 10.1017/s0022215108002429] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:In patients with severe nasal polyposis resistant to strict medical treatment, surgery is indicated, but no prognostic factors for surgery efficacy have yet been determined. Some authors suggest that eosinophilic infiltration of nasal polyps could indicate a risk of surgical ineffectiveness.Methods:Surgical plus medical treatment was evaluated over a mean follow-up period of 64 months. One hundred and forty-four subjects were separated into two groups: those with eosinophilic infiltration of >50 per cent (n = 73); and those with ≤50 per cent infiltration (n = 71).Results:Combined surgery and corticosteroid therapy was effective in the treatment of severe nasal polyposis. No significant difference was found between the two groups in terms of control of nasal obstruction and sense of smell loss. However, a significant difference was found in terms of control of posterior rhinorrhoea (p = 0.01).Conclusion:Eosinophilic infiltration influences the outcome of nasal polyposis surgery, mainly regarding control of posterior rhinorrhoea. It could be considered as a risk factor for surgery in patients with nasal polyposis.
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Bonfils >P, Tavernier L, Abdel Rahman H, Mimoun M, Malinvaud D. Evaluation of combined medical and surgical treatment in nasal polyposis - III. Correlation between symptoms and CT scores before and after surgery for nasal polyposis. Acta Otolaryngol 2008; 128:318-23. [PMID: 17917840 DOI: 10.1080/00016480701551760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSION Computed tomography (CT) in nasal polyposis (NP) patients has three functions before any treatment. CT provides objective evidence of the disease and precise topography of the disease, and is an indicator of the disease severity. After functional endoscopic sinus surgery (FESS), CT is an indicator of the residual disease severity and permits detection of asymptomatic mucoceles. OBJECTIVE NP affects nearly 4% of the population. CT has become the examination of choice for the exploration of NP. FESS is accepted for NP treatment in the setting of failure of medical management. The aim of this study was to find out whether any correlation exists between symptom severity and CT scan score before and after FESS. PATIENTS AND METHODS A total of 114 CT scans were performed in NP patients without contrast medium before and after FESS (mean follow-up 5 years), and were scored according to the Lund-MacKay system. RESULTS Lund-MacKay scores before treatment ranged from 8 to 24. There was a correlation between symptom and CT scores before any treatment. Postoperative Lund-MacKay scores ranged from 0 to 24. There was a correlation between symptom and CT scores after surgery. There was no correlation between postoperative symptom and baseline CT scores. Eleven asymptomatic mucoceles were found.
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Bonfils P, Malinvaud D. Influence of allergy in patients with nasal polyposis after endoscopic sinus surgery. Acta Otolaryngol 2008; 128:186-92. [PMID: 17851917 DOI: 10.1080/00016480701387165] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSION Allergy does not modify the symptoms and steroid consumption (oral and local) of nasal polyposis (NP) patients after functional endoscopic sinus surgery (FESS). OBJECTIVES To assess the role of allergy in the evolution after FESS of patients presenting with the diagnosis of NP. PATIENTS AND METHODS This was a prospective study of 63 consecutive patients with NP (57% males, mean age 45.8 years), who were analyzed to detect whether the results of a surgical treatment of NP were influenced by the presence of positive allergic tests (Phadiatop). Three nasal criteria were scored: nasal obstruction, posterior rhinorrhea, and the loss of smell. The frequency of asthma was evaluated. Medical treatment of NP after FESS consisted of washing of the nasal cavities, steroid spray, and oral steroid administration. The amount of consumption of steroids (prednisolone and beclomethasone) was studied. RESULTS Decrease of all nasal symptoms was not statistically different in the two groups of patients with and without allergy. Cumulative consumption of prednisolone and beclomethasone after surgery was similar in the two groups.
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Affiliation(s)
- Pierre Bonfils
- Department of ENT-Head and Neck Surgery, European Hospital Georges Pompidou Faculty of Medicine, University Paris-Descartes, Paris, France.
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