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Perić A, Gaćeša D, Kovačević SV, Perić AV, Vojvodić D, Georgiou S, Protopapadakis E, Alevizopoulos K. The effect of nasal douching by hypertonic 2.3 per cent sea water with algae extracts on the concentration of epidermal growth factor, transforming growth factor-α and interleukin-8 in nasal secretions of patients with nasal polyposis following endoscopic surgical treatment. J Laryngol Otol 2024; 138:520-526. [PMID: 38380493 PMCID: PMC11063653 DOI: 10.1017/s0022215123001974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To investigate epidermal growth factor, transforming growth factor-α and interleukin-8 production in nasal mucosa irrigated with hypertonic 2.3 per cent solution with algae extracts, in comparison to 0.9 per cent NaCl during the first two weeks after surgery for nasal polyposis, in relation to symptoms and local findings. METHODS This prospective study included 20 nasal polyposis patients postoperatively irrigated with hypertonic solution and 20 nasal polyposis patients postoperatively irrigated with isotonic solution. We evaluated nasal symptom score, endoscopic score and mediator levels in nasal secretions before and after irrigation. RESULTS Following treatment, nasal symptom score and endoscopic score were significantly lower in the hypertonic solution group (p = 0.023; p < 0.001, respectively). The increase in the epidermal growth factor and the decrease in the transforming growth factor-α and interleukin-8 concentration were higher in the hypertonic group (p < 0.001 for all mediators). CONCLUSION Irrigation with a hypertonic solution was found to be more effective than an isotonic solution in nasal mucosa reparation.
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Affiliation(s)
- Aleksandar Perić
- Department of Otorhinolaryngology, Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia
| | | | - Sandra Vezmar Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University in Belgrade, Belgrade, Serbia
| | - Aneta V. Perić
- Institute for Pharmacy, Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Danilo Vojvodić
- Institute for Medical Research, Division of Clinical and Experimental Immunology, University of Defense, Belgrade, Serbia
| | - Stella Georgiou
- Research and Development Department, Gerolymatos International S.A., Athens, Greece
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Gnanasekaran S, Jayaraj V, V B Y, Selvam MP, Rajendran V. Evaluating the efficacy of nasal irrigation in postoperative functional endoscopic sinus surgery patients: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08535-x. [PMID: 38492009 DOI: 10.1007/s00405-024-08535-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Functional endoscopic sinus surgery (FESS) is a mainstay surgical intervention for chronic rhinosinusitis with nasal polyposis (CRSwNP). Nasal irrigation, particularly with normal saline, is a widely recommended postoperative care modality. This systematic review and meta-analysis aimed to assess the efficacy of various nasal irrigation solutions in postoperative FESS patients. METHODS A comprehensive search was conducted in multiple databases for randomized controlled trials investigating normal saline and various substances for nasal irrigation post-FESS. The systematic review followed PRISMA guidelines, and the meta-analysis used R software for data synthesis. Outcome measures included SNOT-22 and LKES scores. The Cochrane tool was employed to evaluate the potential for bias. RESULTS Results from 14 studies, focusing on six each for SNOT-22 and LKES, revealed a significant reduction in symptoms and endoscopic scores with various solutions compared to normal saline. The meta-analysis using the random-effects model indicated a negative standardized mean difference (SMD) of - 0.69(95% CI [- 1.64; 0.27], p = 0.157) for symptoms and endoscopic scores (SMD = - 0.48, 95% CI [- 1.32; 0.36], z = - 1.12, p = 0.264). Subgroup analyses highlighted budesonide's efficacy over normal saline, but substantial heterogeneity and potential publication bias were noted. CONCLUSION Nasal irrigation with various solutions postoperative FESS patients demonstrated significant improvements in patient-reported symptoms and endoscopic scores compared to normal saline. Budesonide appeared particularly effective. However, high heterogeneity and potential publication bias warrant cautious interpretation. Standardized outcome measures and further research are needed to strengthen the evidence.
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Affiliation(s)
- Sridevi Gnanasekaran
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), (Community Medicine), Room No: 233, Academic Block, Gorakhpur, Uttar Pradesh, 273008, India
| | - Vinothini Jayaraj
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), (Community Medicine), Room No: 233, Academic Block, Gorakhpur, Uttar Pradesh, 273008, India
| | - Yazhini V B
- Department of Otorhinolaryngology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, 580022, India
| | - Mohanraj Palani Selvam
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, 273008, India
| | - Vinoth Rajendran
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), (Community Medicine), Room No: 233, Academic Block, Gorakhpur, Uttar Pradesh, 273008, India.
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Rizzi A, Gammeri L, Cordiano R, Valentini M, Centrone M, Marrone S, Inchingolo R, Lohmeyer FM, Cavaliere C, Ria F, Cadoni G, Gangemi S, Nucera E. Therapeutic Strategies to Prevent the Recurrence of Nasal Polyps after Surgical Treatment: An Update and In Vitro Study on Growth Inhibition of Fibroblasts. J Clin Med 2023; 12:jcm12082841. [PMID: 37109177 PMCID: PMC10142691 DOI: 10.3390/jcm12082841] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is the most bothersome phenotype of chronic rhinosinusitis, which is typically characterized by a Type 2 inflammatory reaction, comorbidities and high rates of nasal polyp recurrence, causing severe impact on quality of life. Nasal polyp recurrence rates, defined as the number of patients undergoing revision endoscopic sinus surgery, are 20% within a 5 year period after surgery. The cornerstone of CRSwNP management consists of anti-inflammatory treatment with local corticosteroids. We performed a literature review regarding the therapeutic strategies used to prevent nasal polyp recurrence after surgical treatment. Finally, we report an in vitro study evaluating the efficacy of lysine-acetylsalicylic acid and other non-steroidal anti-inflammatory drugs (ketoprofen and diclofenac) on the proliferation of fibroblasts, obtained from nasal polyp tissue samples. Our study demonstrates that diclofenac, even more so than lysine-acetylsalicylic acid, significantly inhibits fibroblast proliferation and could be considered a valid therapeutic strategy in preventing CRSwNP recurrence.
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Affiliation(s)
- Angela Rizzi
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Luca Gammeri
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Raffaele Cordiano
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Mariagrazia Valentini
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Michele Centrone
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Sabino Marrone
- Otorhinolaryngology Unit, Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Inchingolo
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | | | - Carlo Cavaliere
- Department of Sense Organs, Sapienza University, 00185 Rome, Italy
| | - Francesco Ria
- Section of General Pathology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Department Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 1-8, 00168 Rome, Italy
| | - Gabriella Cadoni
- Otorhinolaryngology Unit, Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Otolaryngology Institute, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Eleonora Nucera
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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The Role of Seawater and Saline Solutions in Treatment of Upper Respiratory Conditions. Mar Drugs 2022; 20:md20050330. [PMID: 35621981 PMCID: PMC9147352 DOI: 10.3390/md20050330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023] Open
Abstract
The history of saline nasal irrigation (SNI) is indeed a long one, beginning from the ancient Ayurvedic practices and gaining a foothold in the west at the beginning of the 20th century. Today, there is a growing number of papers covering the effects of SNI, from in vitro studies to randomized clinical trials and literature overviews. Based on the recommendations of most of the European and American professional associations, seawater, alone or in combination with other preparations, has its place in the treatment of numerous conditions of the upper respiratory tract (URT), primarily chronic (rhino)sinusitis, allergic rhinitis, acute URT infections and postoperative recovery. Additionally, taking into account its multiple mechanisms of action and mounting evidence from recent studies, locally applied seawater preparations may have an important role in the prevention of viral and bacterial infections of the URT. In this review we discuss results published in the past years focusing on seawater preparations and their use in clinical and everyday conditions, since such products provide the benefits of additional ions vs. saline, have an excellent safety profile and are recommended by most professional associations in the field of otorhinolaryngology.
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Chitsuthipakorn W, Kanjanawasee D, Hoang MP, Seresirikachorn K, Snidvongs K. Optimal Device and Regimen of Nasal Saline Treatment for Sinonasal Diseases: Systematic Review. OTO Open 2022; 6:2473974X221105277. [PMID: 35720767 PMCID: PMC9201324 DOI: 10.1177/2473974x221105277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/14/2022] [Indexed: 12/04/2022] Open
Abstract
Objective This review aimed to systematically determine the optimal nasal saline
regimen for different types of sinonasal diseases. Data Sources PubMed, Embase, SCOPUS, Cochrane Library, Web of Science, ClinicalTrials.gov.
The last search was on December 6, 2021. Review Methods Study selection was done by 2 independent authors. Randomized controlled
trials and meta-analyses were included. The effects of nasal saline
treatment through various devices, saline tonicities, and buffer statuses
were evaluated in patients with allergic and nonallergic rhinitis, acute and
chronic rhinosinusitis (CRS), CRS with cystic fibrosis, and postoperative
care, including septoplasty/turbinoplasty and endoscopic sinus surgery. Results Sixty-nine studies were included: 10 meta-analyses and 59 randomized
controlled trials. For allergic rhinitis, large-volume devices (≥60 mL) were
effective for treating adults, while low-volume devices (5-59 mL) were
effective for children. Isotonic saline was preferred over hypertonic saline
due to fewer adverse events. For acute rhinosinusitis, saline irrigation was
beneficial in children, but it was an option for adults. Large-volume
devices were more effective, especially in the common cold subgroup. For
CRS, large-volume devices were effective for adults, but saline drop was the
only regimen that had available data in children. Buffered isotonic saline
was more tolerable than nonbuffered or hypertonic saline. The data for CRS
with cystic fibrosis and nonallergic rhinitis were limited. For
postoperative care, buffered isotonic saline delivered by large-volume
devices was effective. Conclusion Nasal saline treatment is recommended for treating most sinonasal diseases.
Optimal delivery methods for each condition should be considered to achieve
therapeutic effects of saline treatment.
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Affiliation(s)
- Wirach Chitsuthipakorn
- Center of Excellence in Otolaryngology–Head and Neck Surgery, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
| | - Dichapong Kanjanawasee
- Center of Research Excellence in Allergy and Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Biodesign Innovation Center, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Minh P. Hoang
- Department of Otolaryngology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kachorn Seresirikachorn
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Svistushkin VM, Nikiforova GN, Shevchik EA, Zolotova AV. [Improving of the nasal cavity mucous membrane restoration efficiency of the after rhinosurgical interventions]. Vestn Otorinolaringol 2021; 86:63-69. [PMID: 34783476 DOI: 10.17116/otorino20218605163] [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: 11/17/2022]
Abstract
The article discusses aspects of the use of irrigation therapy after surgical interventions on intranasal structures, in particular, the features of using the Aqua Maris Leyka device in comparison with traditional methods of nasal cavity care in this group of patients. The use of the Adriatic Sea salt solution for nasal lavage Aqua Maris using a special device in the postoperative period leads to an earlier subsidence of reactive postoperative changes in the nasal cavity, a decrease in edema, an increase of reparative processes. This is evidenced by the dynamics of clinical signs and the results of cytological examination of smears-prints from the nasal cavity. During the irrigation of the nasal cavity using the Aqua Maris Leyka device, the liquid is supplied by gravity, without additional pressure, ensuring safety and uniform irrigation of all parts of the nasal cavity with saline solution, which is especially important in the presence of reactive changes in the postoperative period.
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Affiliation(s)
- V M Svistushkin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - G N Nikiforova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E A Shevchik
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Zolotova
- Sechenov First Moscow State Medical University, Moscow, Russia
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7
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Borish L, Baroody FM, Kim MS, Lieberman JA, Peters A, Stevens WW, Bernstein JA. Yardstick for the medical management of chronic rhinosinusitis. Ann Allergy Asthma Immunol 2021; 128:118-128. [PMID: 34687874 DOI: 10.1016/j.anai.2021.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 02/07/2023]
Abstract
Chronic rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses defined by classic symptoms, imaging findings, or endoscopic findings. There are a growing number of emerging pharmacologic therapies being evaluated to treat patients with CRS, some of which have gained indication status in the United States. There have not been updated treatment guidelines published in the United States however since 2014. This document is meant to serve as an updated expert consensus document for the pharmacologic management of patients with CRS. We review available data focusing on prospective clinical trials on oral and intranasal corticosteroids, nasal irrigation, biologics, antibiotics, and allergy immunotherapy for CRS both with and without nasal polyposis, including specific therapies for aspirin-exacerbated respiratory disease-associated CRS and allergic fungal CRS. There are multiple options to treat CRS, and clinicians should be knowledgeable on the efficacy and risks of these available therapies. Allergists-immunologists now have various therapies available to treat patients with CRS.
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Affiliation(s)
- Larry Borish
- Department of Medicine, Asthma and Allergic Disease Center, The University of Virginia, Charlottesville, Virginia
| | - Fuad M Baroody
- Department of Surgery (Otolaryngology-Head and Neck Surgery) and Pediatrics, The University of Chicago Medicine and the Comer Children's Hospital, Chicago, Illinois
| | - Margaret S Kim
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jay A Lieberman
- Division of Pulmonology, Allergy, & Immunology, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Anju Peters
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Whitney W Stevens
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan A Bernstein
- Division of Immunology-Allergy Section, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Joy N, Jacob J, Kurien R, Varghese L, Rabi S, Rupa V. Effect of Silver Nitrate Cauterisation of Nasal Mucosa on Quality-of-Life and Histology in Patients with Intractable Chronic Rhinitis. Indian J Otolaryngol Head Neck Surg 2021; 74:1615-1622. [PMID: 34336632 PMCID: PMC8316537 DOI: 10.1007/s12070-021-02773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/18/2021] [Indexed: 11/24/2022] Open
Abstract
Patients with chronic rhinitis causing intractable sneezing which is non-responsive to conventional medication require alternative therapies. The aim of the study was to ascertain the effect of topical 10% silver nitrate solution on the inferior turbinate mucosa as well as quality of life in such patients. Patients with severe chronic rhinitis who failed conventional therapy had application of 10% silver nitrate solution to inferior turbinate mucosa. The number of sneezes/day and mini Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score was noted before and 8 to 16 weeks after treatment. Pre- and post treatment turbinate biopsies were performed to assess histological changes. At baseline, 67 patients had a mean of 36.6 sneezes/day and mean mini RQLQ score of 4.0 ± 0.7. Pre-treatment biopsies showed epithelial denudation and hyalinization of basement membrane. Following 10% silver nitrate application, 64/67 (95.5%) patients showed significant reduction in number of sneezes both at 1 week (p < 0.001) and 8-16 weeks (mean = 5.5 ± 7.8; p < 0.001). Post- treatment mean global mini RQLQ score was also significantly reduced (mean = 1.3 ± 1.1; p < 0.001). A single application was sufficient in 70.1% patients. There were no complications. Squamous metaplasia (p = 0.005) and epithelial hyperplasia (p = 0.013) as well as epithelial and basement membrane restoration occurred following therapy. 10% silver nitrate solution application is an effective and safe office- based procedure which significantly reduces sneezing improves QoL with corresponding histological changes.
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Affiliation(s)
- Nedha Joy
- Departments of Otorhinolaryngology, Christian Medical College, Vellore, 632004 India
| | - Jenny Jacob
- Departments of Anatomy, Christian Medical College, Vellore, India
| | - Regi Kurien
- Departments of Otorhinolaryngology, Christian Medical College, Vellore, 632004 India
| | - Lalee Varghese
- Departments of Otorhinolaryngology, Christian Medical College, Vellore, 632004 India
| | - Suganthy Rabi
- Departments of Anatomy, Christian Medical College, Vellore, India
| | - V Rupa
- Departments of Otorhinolaryngology, Christian Medical College, Vellore, 632004 India
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JEICAN II, TROMBITAS V, CRIVII C, DUMITRU M, ALUAȘ Maria, DOGARU G, GHEBAN D, JUNIE LM, ALBU S. Rehabilitation of patients with chronic rhinosinusitis after functional endoscopic sinus surgery. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. In the case of many patients with chronic rhinosinusitis (CRS), antibiotic and steroid therapies fail, and surgery is required. The recovery of patients after surgery equally depends on the postoperative behavior of each individual patient. The paper presents the outcomes of recovery after functional endoscopic sinus surgery (FESS) in a group of 74 patients.
Methods. The study was conducted in patients undergoing surgical treatment by FESS, performed by the same surgeon. For the development of the statistical database, the clinical records were collected by the same investigator.
Results. On the day of surgery and on the first postoperative day, 72.9% of patients reported facial pain, 41.8% nausea, 9.4% nasal bleeding, 8.8% vomiting. At 6 months postoperatively, 71.6% of patients estimated that they had a better quality of life than before surgery, 64.8% mentioned an improvement of olfaction as an effect, and 6.7% developed septal turbinate synechiae.
Conclusions. No major complications were identified in the recovery of CRS patients after FESS. Postoperative facial pain was less well tolerated by young patients (18-35 years old). The improvement of smell and the increase of disease-specific quality of life are the most relevant results of recovery after FESS mentioned by the patients included in our study. The otorhinolaryngologist and the family doctor play an important role in the education of patients regarding the importance of treatment with mineral and thermal waters in post-FESS recovery.
Keywords: chronic rhinosinusitis, endoscopic sinus surgery, FESS, rehabilitation, ERAS protocols,
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Affiliation(s)
- Ionuț Isaia JEICAN
- [1] Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Cluj-Napoca, Romania [2] Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Veronica TROMBITAS
- [1] Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Cluj-Napoca, Romania
| | - Carmen CRIVII
- [2] Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai DUMITRU
- [3] Department of Head and Neck Surgery and Otorhinolaryngology, University Emergency Hospital, Bucharest, Romania [4] Department of Anatomy and Embryology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - ALUAȘ Maria
- [5] Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriela DOGARU
- [6] Department of Rehabilitation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan GHEBAN
- [7] Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lia Monica JUNIE
- [8] Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Silviu ALBU
- Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Cluj-Napoca, Romania
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 357] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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11
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Tai J, Lee K, Kim TH. Current Perspective on Nasal Delivery Systems for Chronic Rhinosinusitis. Pharmaceutics 2021; 13:246. [PMID: 33578812 PMCID: PMC7916625 DOI: 10.3390/pharmaceutics13020246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic rhinosinusitis is an upper respiratory disease during which topical drug treatment via the nasal cavity is the most actively utilized therapeutic strategy. In addition to steroids, antibiotics, and antifungal agents, which are widely used in clinical practice, research on novel topical agents to improve the bacterial biofilm or mucociliary clearance remains ongoing. Moreover, owing to the complex structure of the nasal cavity, the effects of nasal drug delivery vary depending on factors related to delivery fluid dynamics, including device, volume, and compounds. In this article, we review methods and compounds that have been applied to chronic rhinosinusitis management and introduce recent advances and future perspectives in nasal drug delivery for upper respiratory diseases.
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Affiliation(s)
| | | | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul 02841, Korea; (J.T.); (K.L.)
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12
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Appropriate extent of surgery for aspirin-exacerbated respiratory disease. World J Otorhinolaryngol Head Neck Surg 2020; 6:235-240. [PMID: 33336179 PMCID: PMC7729211 DOI: 10.1016/j.wjorl.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/19/2020] [Accepted: 07/24/2020] [Indexed: 11/20/2022] Open
Abstract
The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease (AERD), who present with the clinical triad of chronic rhinosinusitis with nasal polyposis (CRSwNP), bronchial asthma, and aspirin/nonsteroidal anti-inflammatory drug intolerance. To further define the effectiveness of sinus surgery in treating AERD patients, this review article discusses current evidence regarding outcomes associated with more extensive surgery, the benefits of frontal sinus surgery on polyposis, and the role of Draf III intervention. Numerous studies suggest that Draf III frontal sinusotomy may be an efficacious early intervention due to increased neo-ostial patency and subsequent distribution of topical therapies. Future studies that further investigate the efficacy and safety of extensive surgery in AERD patients are warranted.
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Wang J, Shen L, Huang ZQ, Luo Q, Li MY, Tu JH, Han M, Ye J. Efficacy of buffered hypertonic seawater in different phenotypes of chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery: a randomized double-blind study. Am J Otolaryngol 2020; 41:102554. [PMID: 32521299 DOI: 10.1016/j.amjoto.2020.102554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Nasal douching is commonly used as a postoperative management strategy for chronic rhinosinusitis with nasal polyps (CRSwNP). Few studies to date have compared the effectiveness of nasal douching in CRSwNP phenotypes after endoscopic sinus surgery (ESS). We evaluated the efficacy of seawater types in eosinophilic CRSwNP (ECRSwNP) and noneosinophilic CRSwNP (nonECRSwNP) after ESS. METHODS Patients with bilateral CRSwNP who had undergone ESS were blindly randomized to receive buffered hypertonic seawater (BHS) (n = 48) or physiological seawater (PS) (n = 45). CRSwNP patients were stratified by phenotypes (ECRSwNP and nonECRSwNP) retrospectively according to whether tissue eosinophils exceeded 10%. Follow-up evaluations were conducted at 2, 8, 16, and 24 weeks after surgery. Evaluations included the 22-item Sino-Nasal Outcome Test (SNOT-22), visual analog scale (VAS), Lund-Kennedy endoscopic score (LKES), saccharine clearance time (SCT), and adverse events. RESULTS All of the patients experienced significant improvements in SNOT-22 scores, VAS scores, and LKES over time. BHS resulted in better improvement of LEKS and SCT relative to PS at 8 weeks postoperatively. Mucosal edema formation was significantly reduced with less crusting among HBS recipients at 8 weeks. After stratification, only patients in the nonECRSwNP + BHS subgroup showed a significant improvement in LEKS and SCT at 8 weeks postoperatively. Side effect profiles were not significantly different among the groups. CONCLUSIONS BHS has a better inhibitory effect on mucosal edema and crusting during the early postoperative care period of CRSwNP. Among all of the patients, nonECRSwNP patients showed a significant improvement in LEKS and SCT at 8 weeks.
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