1
|
Hackenberg S, Renson A, Röseler SM, Baumann I, Topcuoglu MSY, Hebestreit H. Pädiatrische Rhinologie. Laryngorhinootologie 2024; 103:S188-S213. [PMID: 38697148 DOI: 10.1055/a-2178-2957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The following review article highlights key topics in pediatric rhinology that are currently the focus in research and at conferences as well as in the interdisciplinary discussion between otorhinolaryngologists and pediatricians. In particular, congenital malformations such as choanal atresia or nasal dermoid cysts are discussed, followed by statements on the current procedures for sinogenic orbital complications as well as on the diagnosis and therapy of chronic rhinosinusitis in children. Furthermore, updates on the role of the ENT specialist in the care for children with cystic fibrosis and primary ciliary dyskinesia are provided.
Collapse
Affiliation(s)
- Stephan Hackenberg
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Würzburg
| | - Ariane Renson
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Uniklinik RWTH Aachen
| | - Stefani Maria Röseler
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Uniklinik RWTH Aachen
| | - Ingo Baumann
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum Heidelberg
| | | | | |
Collapse
|
2
|
Saltagi MZ, Comer BT, Hughes S, Ting JY, Higgins TS. Diagnostic Criteria of Recurrent Acute Rhinosinusitis: A Systematic Review. Am J Rhinol Allergy 2020; 35:383-390. [PMID: 32954839 DOI: 10.1177/1945892420956871] [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: 11/15/2022]
Abstract
BACKGROUND RARS is a challenging clinical phenomenon that affects many patients, and diagnostic criteria for this condition are not fully characterized in the literature. OBJECTIVE To examine diagnostic criteria for recurrent acute rhinosinusitis (RARS). STUDY DESIGN Systematic review. METHODS Cochrane, PubMed (MEDLINE), clinicaltrials.gov, EMBASE, Google Scholar, and Web of Science databases were queried for articles related to RARS dating from 1990 to present, according to PRISMA statement guidelines. Full text articles pertinent to the diagnostic criteria of RARS were included in this review. Inclusion criteria included articles specifically addressing RARS; studies with 3 or more patients; and articles in English. RESULTS A total of 1022 titles/abstracts potentially related to RARS were identified. Of these, sixty-nine full texts were selected for review, and 22 of these ultimately met inclusion criteria. The level of evidence was generally low. Studies and guidelines have used many different definitions for RARS diagnosis over the years based on symptomatology, physical examination, nasal endoscopy, imaging, and laboratory domains. Clinically important RARS has been defined most commonly as 4 or more discrete episodes of ARS per year, but this frequency is typically based on expert opinion. Additionally, radiologic anatomic associations such as concha bullosa, accessory maxillary os, and narrowed infundibular distance may be associated with RARS. Endoscopic visualization and imaging are sometimes used to confirm the presence of sinus disease during exacerbations of RARS, but there is variability in this practice. CONCLUSION The diagnostic definition for RARS has developed over time and is currently based on low level 4 and 5 evidence. Because of the migratory definition of RARS, comparing inter-study results of RARS management remains difficult, and future studies should aim to follow current expert guidelines on diagnostic criteria of RARS.
Collapse
Affiliation(s)
- Mohamad Z Saltagi
- Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Brett T Comer
- College of Medicine, University of Kentucky, Lexington, Kentucky.,Department of Otolaryngology, University of Kentucky, Lexington, Kentucky
| | - Samuel Hughes
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, Kentucky.,Kentuckiana Ear, Nose & Throat, Louisville, Kentucky
| |
Collapse
|
3
|
Moisan S, Le Nabec A, Quillévéré A, Le Maréchal C, Férec C. Characterization of GJB2 cis-regulatory elements in the DFNB1 locus. Hum Genet 2019; 138:1275-1286. [PMID: 31586237 DOI: 10.1007/s00439-019-02068-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/29/2019] [Indexed: 11/28/2022]
Abstract
Although most disease-causing variants are within coding region of genes, it is now well established that cis-acting regulatory sequences, depending on 3D-chromatin organization, are required for temporal and spatial control of gene expression. Disruptions of such regulatory elements and/or chromatin conformation are likely to play a critical role in human genetic disease. Hence, recurrent monoallelic cases, who present the most common hereditary type of nonsyndromic hearing loss (i.e., DFNB1), carry only one identified pathogenic allele. This strongly suggests the presence of uncharacterized distal cis-acting elements in the missing allele. Here within, we study the spatial organization of a large DFNB1 locus encompassing the gap junction protein beta 2 (GJB2) gene, the most frequently mutated gene in this inherited hearing loss phenotype, with the chromosome conformation capture carbon copy technology (5C). By combining this approach with functional activity reporter assays and mapping of CCCTC-binding factor (CTCF) along the DFNB1 locus, we identify a novel set of cooperating GJB2 cis-acting elements and suggest a DFNB1 three-dimensional looping regulation model.
Collapse
Affiliation(s)
- Stéphanie Moisan
- Laboratoire de Génétique Moléculaire et d'Histocompatibilité, CHRU de Brest, Bretagne, Brest, France. .,Univ Brest, Inserm, EFS UMR 1078, GGB, 29200, Brest, France.
| | - Anaïs Le Nabec
- Univ Brest, Inserm, EFS UMR 1078, GGB, 29200, Brest, France
| | | | - Cédric Le Maréchal
- Laboratoire de Génétique Moléculaire et d'Histocompatibilité, CHRU de Brest, Bretagne, Brest, France.,Univ Brest, Inserm, EFS UMR 1078, GGB, 29200, Brest, France
| | - Claude Férec
- Laboratoire de Génétique Moléculaire et d'Histocompatibilité, CHRU de Brest, Bretagne, Brest, France. .,Univ Brest, Inserm, EFS UMR 1078, GGB, 29200, Brest, France.
| |
Collapse
|
4
|
Synchronized roles of pannexin and connexin in nasal mucosal epithelia. Eur Arch Otorhinolaryngol 2018; 275:1657-1661. [PMID: 29574598 PMCID: PMC5951895 DOI: 10.1007/s00405-018-4947-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/20/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nasal mucosal epithelial cells express connexins, the prototypical gap junction proteins, and pannexins, a new family of channel proteins homologous to the invertebrate gap junction proteins. The physiological and pathophysiological roles of these transmembrane proteins in nasal mucosa are largely still unknown. PURPOSE Pannexins participate in ATP release into the extracellular space in various tissues, and ATP plays important roles in mucociliary clearance, especially by regulating ciliary beat activity. Therefore, we focused on the functional relationship between connexins, pannexin-1, ATP release, and mucociliary clearance in nasal epithelia. RESULTS AND CONCLUSIONS Connexins participate in the generation of intercellular calcium waves, in which calcium-mediated signaling responses spread to contiguous cells through the gap junction formed by connexins to transmit calcium signaling throughout the airway epithelium. Pannexins in the nasal mucosa may contribute to not only ciliary beat modulation via ATP release, but also regulation of mucus blanket components via H2O efflux. The synchronized roles of pannexin and connexin may provide a new insight into effective mucociliary clearance systems in nasal mucosa.
Collapse
|
5
|
Kim R, Chang G, Hu R, Phillips A, Douglas R. Connexin gap junction channels and chronic rhinosinusitis. Int Forum Allergy Rhinol 2016; 6:611-7. [PMID: 26919292 DOI: 10.1002/alr.21717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/04/2015] [Accepted: 12/15/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Gap junction channels are formed by connexin (Cx) proteins. These channels facilitate communication between adjacent cells, and some have been implicated in acute and chronic inflammation. We investigated whether altered connexin expression could be associated with the inflammatory changes of the sinonasal mucosa that characterize chronic rhinosinusitis (CRS). Our aims were first to screen normal sinus mucosa to determine the expression profile of the connexin family of genes, and second to compare the level of expression of 3 key connexins (Cx26, Cx30, and Cx43) in CRS and normal sinus mucosa. These 3 connexins have been implicated in lower airway epithelial cell repair, as well as chronic and acute cutaneous wounds. METHODS Sinus mucosa biopsies were taken from 11 patients with CRS undergoing sinus surgery and from 7 controls with normal sinuses undergoing transnasal pituitary surgery. Gene expression study of the connexin family was performed using polymerase chain reaction (PCR). Subsequent targeted quantitative analyses were done using quantitative real-time PCR (qPCR) and fluorescent immunohistochemistry (IHC). RESULTS A total of 16 different connexin genes were expressed in the normal mucosa including Cx26, Cx30, and Cx43. The qPCR demonstrated increased abundance of Cx26 (p = 0.005), Cx30 (p = 0.07), and Cx43 (p = 0.04) in CRS compared to control mucosa. IHC confirmed significantly higher levels of Cx43 in CRS (p < 0.001). CONCLUSION The majority of the connexin family is expressed in normal sinus mucosa. Expression of 3 selected connexins was found elevated in CRS mucosa. Connexin gap junction modulation may offer a novel therapeutic target for CRS.
Collapse
Affiliation(s)
- Raymond Kim
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - George Chang
- Faculty of Medical and Health Science, and School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - Rebecca Hu
- Faculty of Medical and Health Science, and School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - Anthony Phillips
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Faculty of Medical and Health Science, and School of Biological Sciences, The University of Auckland, Auckland, New Zealand.,CoDa Therapeutics Inc, Auckland, New Zealand
| | - Richard Douglas
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
6
|
Sedaghat AR, Cunningham MJ, Busaba NY. Connexin 32 and 43 mutations: do they play a role in chronic rhinosinusitis? Am J Otolaryngol 2014; 35:33-6. [PMID: 24119489 DOI: 10.1016/j.amjoto.2013.08.008] [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] [Received: 07/10/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Dysfunction of the sinonasal epithelium may contribute to the pathogenesis of chronic rhinosinusitis (CRS) including recurrent acute rhinosinusitis (RARS). Mutations in connexin 32 and 43 proteins have been associated with a number of human diseases. The objective of this study is to investigate the role of mutations in connexin 32 or connexin 43 genes in CRS and RARS. METHODS Prospective case series of 19 patients with CRS and /or RARS. Clinical and demographic factors were noted and buccal swabs were collected for DNA sequencing of connexin 32 and connexin 43 genes. RESULTS One patient was found to have a conservative V193I mutation in the connexin 32 gene. Connexin 43 mutations were found in two patients - a silent R239R mutation and an AAA insertion after the stop codon in the 3' UTR. None of these mutations are associated with any known diseases or predicted to lead to protein dysfunction. CONCLUSION Mutations in connexin 32 or 43 genes in patients with CRS, including RARS, appear to be rare. The etiologic role of connexin mutations in chromic rhinosinusitis is suspect, and routine sequencing for connexin mutations in patients with RARS or CRS is not cost effective.
Collapse
Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | | | | |
Collapse
|
7
|
Hsu J, Avila PC, Kern RC, Hayes MG, Schleimer RP, Pinto JM. Genetics of chronic rhinosinusitis: state of the field and directions forward. J Allergy Clin Immunol 2013; 131:977-93, 993.e1-5. [PMID: 23540616 PMCID: PMC3715963 DOI: 10.1016/j.jaci.2013.01.028] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 01/15/2023]
Abstract
The cause of chronic rhinosinusitis (CRS) remains unclear. Study of the genetic susceptibility to CRS might be a valuable strategy to understand the pathogenesis of this burdensome disorder. The purpose of this review is to critically evaluate the current literature regarding the genetics of CRS in a comprehensive fashion. The most promising findings from candidate gene studies include the cystic fibrosis transmembrane conductance regulator gene (CFTR), as well as genes involved in antigen presentation, innate and adaptive immune responses, tissue remodeling, and arachidonic acid metabolism. We also review the few hypothesis-independent genetic studies of CRS (ie, linkage analysis and pooling-based genome-wide association studies). Interpretation of the current literature is limited by challenges with study design, sparse replication, few functional correlates of associated polymorphisms, and inadequate examination of linkage disequilibrium or expression quantitative trait loci for reported associations. Given the relationship of CRS to other airway disorders with well-characterized genetic components (eg, asthma), study of the genetics of CRS deserves increased attention and investment, including the organization of large, detailed, and collaborative studies to advance knowledge of the mechanisms that underlie this disorder.
Collapse
Affiliation(s)
- Joy Hsu
- Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL 60637, USA
| | | | | | | | | | | |
Collapse
|
8
|
James AL, Chadha NK, Papsin BC, Stockley TL. Pediatric cholesteatoma and variants in the gene encoding connexin 26. Laryngoscope 2010; 120:183-7. [PMID: 19877196 DOI: 10.1002/lary.20649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Connexin 26 is a gap junction protein encoded by the GJB2 gene. It is expressed in cholesteatoma, and mutations cause proliferative skin disorders and sensorineural hearing loss (SNHL). Deletions of GJB6, which encodes connexin 30, cause SNHL in a digenic manner with a heterozygous GJB2 mutation. We hypothesize that GJB2 and GJB6 mutations might influence the development of cholesteatoma. STUDY DESIGN Prospective observational study to identify GJB mutations in pediatric cholesteatoma. METHODS Peripheral blood samples from 98 children with cholesteatoma were screened for mutations in the GJB2 gene by direct sequencing of the coding region (exon 2 and the intron/exon boundary). Deletions of the GJB6 gene were tested using multiple ligation probe amplification methods. GJB status was compared with other populations and patient age and extent of cholesteatoma at presentation. RESULTS Fourteen children had at least one GJB2 variant (14%). Of these, three had two variants. Two of the variants were neutral polymorphisms. One child with the GJB2 genotype 35delG/35delG also had SNHL. No correlation was found between GJB2 status and patient age or cholesteatoma severity at presentation. No GJB6 deletions were found. CONCLUSIONS GJB2 gene variants are present in a minority of children with cholesteatoma, but may be more common than in normal populations. It is conceivable that alterations of connexin 26 expression could contribute to the multifactorial disease process in cholesteatoma by modifying the cell-to-cell communication that is important in proliferation and migration of keratinocytes.
Collapse
Affiliation(s)
- Adrian L James
- Department of Otolaryngology, The Hospital for Sick Children, Ontario, Canada.
| | | | | | | |
Collapse
|