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Wu SS, Hung TH, Liao PS, Tsou YA, Hung YT, Lin CD, Tai CJ, Shen TC, Shih LC. Chronic Rhinosinusitis and Premorbid Gastrointestinal Tract Diseases: A Population-Based Case-Control Study. EAR, NOSE & THROAT JOURNAL 2023:1455613231218143. [PMID: 38105251 DOI: 10.1177/01455613231218143] [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: 12/19/2023] Open
Abstract
Objectives: The primary aim was to determine the prevalence of gastrointestinal diseases in patients with chronic rhinosinusitis (CRS), utilizing the National Health Insurance Research Database (NHIRD) in Taiwan. Several studies have supported the existence of distinct immune patterns between the Asian and Western populations in CRS patients. Through the population-based case-control study, we could compare the differences between various regions and provide further treatment strategies for subsequent studies in Asian CRS patients. The secondary aim was to assess whether different types of CRS influence the correlation with specific GI diseases. Understanding how different phenotypes or endotypes of CRS may relate to distinct GI disease patterns could provide valuable insights into the underlying mechanisms and potential shared pathways between these conditions. Methods: We use the NHIRD in Taiwan. Newly diagnosed patients with CRS were selected between January 1, 2001 and December 31, 2017 as the case group, and the controls were defined as individuals without a history of CRS. Patients with CRS were divided into two groups: with nasal polyps and without nasal polyps. We also separated GI tract diseases into four groups based on their different pathophysiologies. Results: This study included 356,245 participants (CRS: 71,249 and control: 284,996). The results showed that CRS was significantly associated with some specific GI tract diseases, including acute/chronic hepatitis B, gastroesophageal reflux disease (GERD) with/without esophagitis, achalasia of cardia, peptic/gastrojejunal ulcer, Crohn's disease, and ulcerative colitis. In addition, when CRS was subcategorized into chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP), GERD with esophagitis and peptic ulcer were significantly associated with CRSsNP. Conclusions: A significant association between CRS and premorbid GI tract diseases has been identified. Remarkably, GERD with esophagitis and peptic ulcer were significantly associated with CRSsNP. The underlying mechanisms require further investigation and may lead to new treatments for CRS. Researchers can further investigate the mechanisms by referring to our classification method to determine the implications for diagnosis and treatment.
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Affiliation(s)
- Sen-Sen Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Tzu-Hsun Hung
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Shao Liao
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yung-An Tsou
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Tung Hung
- School of Medicine, China Medical University, Taichung, Taiwan
- Management office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Der Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Jaan Tai
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Te-Chun Shen
- School of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Liang-Chun Shih
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
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2
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Pourmehran O, Zarei K, Pourchez J, Vreugde S, Psaltis A, Wormald PJ. Advancements in acoustic drug delivery for paranasal sinuses: A comprehensive review. Int J Pharm 2023; 644:123277. [PMID: 37516215 DOI: 10.1016/j.ijpharm.2023.123277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
Chronic rhinosinusitis (CRS) impacts patients' quality of life and healthcare costs. Traditional methods of drug delivery, such as nasal sprays and irrigation, have limited effectiveness. Acoustic Drug Delivery (ADD) using a nebulizer offers targeted delivery of drug to the sinuses, which may improve the treatment of CRS. This review examines the influence of aerosol particle characteristics, aero-acoustic parameters, inlet flow conditions, and acoustic waves on sinus drug delivery. Key findings reveal that smaller particles improve the ADD efficiency, whereas larger sizes or increased density impair it. The oscillation amplitude of the air plug in the ostium is crucial for the ADD efficiency. Introducing acoustic waves at the NC-sinus system's resonance frequency improves aerosol deposition within sinuses. Future research should address advanced models, optimizing particle characteristics, investigating novel acoustic waveforms, incorporating patient-specific anatomy, and evaluating long-term safety and efficacy. Tackling these challenges, ADD could offer more effective and targeted treatments for sinus-related conditions such as CRS.
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Affiliation(s)
- Oveis Pourmehran
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia.
| | - Kavan Zarei
- Faculty of Mechanical Engineering, Tarbiat Modares University, Tehran, Iran
| | - Jeremie Pourchez
- Mines Saint-Etienne, Université Jean Monnet Saint-Etienne, INSERM, Sainbiose U1059, Centre CIS, F-42023 Saint-Etienne, France
| | - Sarah Vreugde
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia
| | - Alkis Psaltis
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia
| | - Peter-John Wormald
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia.
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3
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Imoto Y, Ueki S, Kato Y, Yoshida K, Morikawa T, Kimura Y, Kidoguchi M, Tsutsumiuchi T, Koyama K, Adachi N, Ito Y, Ogi K, Sakashita M, Yamada T, Schleimer RP, Takabayashi T, Fujieda S. Elevated Serum Leptin Levels in Patients With Eosinophilic Chronic Rhinosinusitis. Front Pharmacol 2022; 12:793607. [PMID: 35046816 PMCID: PMC8762296 DOI: 10.3389/fphar.2021.793607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Eosinophilic chronic sinusitis (ECRS) is a subtype of CRS with nasal polyps (CRSwNP) that is frequently comorbid with asthma. Notably, ECRS patients often show a high recurrence of NPs after surgical resection. Leptin is a hormone produced by adipocytes that has been implicated in airway inflammatory diseases. However, to date, the role of leptin in ECRS has not been investigated. Objective: To determine whether the serum levels of leptin are altered in patients with ECRS. Methods: In total, 40 patients with ECRS, 15 patients with non-eosinophilic CRS (non-ECRS), and 12 individuals without CRS (control) were included in this study. Patient's serum leptin levels were assessed, and the number of eosinophils in their NPs were measured through a histological evaluation of the three densest areas with cellular infiltrate beneath the epithelial surface. Finally, nasal fibroblast cultures established from NPs were stimulated with varying concentrations of recombinant leptin in vitro to determine whether leptin affects eotaxin-3 (Chemokine (C-C motif) ligand 26 :26: CCL26) expression. Results: The serum leptin levels in both the ECRS and non-ECRS groups were significantly higher than those in the control subjects (p < 0.0001 vs. ECRS; p < 0.05 vs. non-ECRS). Furthermore, ECRS patients displayed significantly elevated serum leptin levels compared to non-ECRS patients (p < 0.001), although there was no difference in body mass index between the groups. Notably, serum leptin levels were correlated with the proportion of eosinophils in peripheral blood (r = 0.3575, p < 0.01) and the number of eosinophils in NPs (r = 0.5109, p < 0.0001). Serum leptin levels were also correlated with eotaxin-3 mRNA expression in NPs (r = 0.5374, p < 0.01). Finally, leptin significantly augmented eotaxin-3 expression in nasal fibroblasts established in vitro from NPs in a leptin receptor-dependent manner (p < 0.05). Conclusion: Leptin levels are elevated in ECRS patients and may both promote and indicate the severity of ECRS as well as systemic type 2-biased inflammatory responses. Combined, these data indicate that circulating leptin may play a significant role in the development of eosinophilic inflammation in NPs.
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Affiliation(s)
- Yoshimasa Imoto
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yukinori Kato
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kanako Yoshida
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Taiyo Morikawa
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yukihiro Kimura
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masanori Kidoguchi
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Toshiki Tsutsumiuchi
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Keisuke Koyama
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Naoto Adachi
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yumi Ito
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kazuhiro Ogi
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masafumi Sakashita
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takechiyo Yamada
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Akita University, Akita, Japan
| | - Robert P. Schleimer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Tetsuji Takabayashi
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shigeharu Fujieda
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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4
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Tai J, Han MS, Kwak J, Kim TH. Association Between Microbiota and Nasal Mucosal Diseases in terms of Immunity. Int J Mol Sci 2021; 22:4744. [PMID: 33947066 PMCID: PMC8124637 DOI: 10.3390/ijms22094744] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 12/23/2022] Open
Abstract
The pathogenesis of nasal inflammatory diseases is related to various factors such as anatomical structure, heredity, and environment. The nasal microbiota play a key role in coordinating immune system functions. Dysfunction of the microbiota has a significant impact on the occurrence and development of nasal inflammation. This review will introduce the positive and negative roles of microbiota involved in immunity surrounding nasal mucosal diseases such as chronic sinusitis and allergic rhinitis. In addition, we will also introduce recent developments in DNA sequencing, metabolomics, and proteomics combined with computation-based bioinformatics.
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Affiliation(s)
- Junhu Tai
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul 02841, Korea
| | - Mun Soo Han
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul 02841, Korea
| | - Jiwon Kwak
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul 02841, Korea
| | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul 02841, Korea
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5
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Shih LC, Hsieh HH, Tsay GJ, Lee IT, Tsou YA, Lin CL, Shen TC, Bau DT, Tai CJ, Lin CD, Tsai MH. Chronic rhinosinusitis and premorbid autoimmune diseases: a population-based case-control study. Sci Rep 2020; 10:18635. [PMID: 33122743 PMCID: PMC7596473 DOI: 10.1038/s41598-020-75815-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
Evidence shows that chronic rhinosinusitis (CRS) is associated with prior presence of autoimmune diseases; however, large-scale population-based studies in the literature are limited. We conducted a population-based case–control study investigating the association between CRS and premorbid autoimmune diseases by using the National Health Insurance Research Database in Taiwan. The CRS group included adult patients newly diagnosed with CRS between 2001 and 2013. The date of diagnosis was defined as the index date. The comparison group included individuals without CRS, with 1:4 frequency matching for gender, age, and index year. Premorbid diseases were forward traced to 1996. Univariate and multivariate logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals. The CRS group consisted of 30,611 patients, and the comparison group consisted of 122,444 individuals. Patients with CRS had a higher significant association with premorbid autoimmune diseases (adjusted OR 1.39 [1.28–1.50]). Specifically, patients with CRS had a higher significant association with ankylosing spondylitis, polymyositis, psoriasis, rheumatoid arthritis, sicca syndrome, and systemic lupus erythematosus (adjusted OR 1.49 [1.34–1.67], 3.47 [1.12–10.8], 1.22 [1.04–1.43], 1.60 [1.31–1.96], 2.10 [1.63–2.72], and 1.69 [1.26–2.25]). In subgroup analysis, CRS with and without nasal polyps demonstrated a significant association with premorbid autoimmune diseases (adjusted OR 1.34 [1.14–1.58] and 1.50 [1.38–1.62]). In addition, CRS with fungal and non-fungal infections also demonstrated a significant association with premorbid autoimmune diseases (adjusted OR 2.02 [1.72–2.49] and 1.39 [1.28–1.51]). In conclusion, a significant association between CRS and premorbid autoimmune diseases has been identified. These underlying mechanisms need further investigation.
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Affiliation(s)
- Liang-Chun Shih
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, 40447, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, 40447, Taiwan.,Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Hua-Hsin Hsieh
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Gregory J Tsay
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Ivan T Lee
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Yung-An Tsou
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, 40447, Taiwan.,School of Medicine, China Medical University, Taichung, 40447, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Te-Chun Shen
- Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, 40447, Taiwan. .,School of Medicine, China Medical University, Taichung, 40447, Taiwan. .,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Rode, Taichung, 40447, Taiwan.
| | - Da-Tian Bau
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, 40447, Taiwan.,Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Chih-Jaan Tai
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, 40447, Taiwan.,School of Medicine, China Medical University, Taichung, 40447, Taiwan
| | - Chia-Der Lin
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, 40447, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, 40447, Taiwan.,School of Medicine, China Medical University, Taichung, 40447, Taiwan
| | - Ming-Hsui Tsai
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, 40447, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, 40447, Taiwan.,School of Medicine, China Medical University, Taichung, 40447, Taiwan
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6
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Lin YH, Lin CL, Kao CH. Adults with inflammatory bowel disease are at a greater risk of developing chronic rhinosinusitis: A nationwide population-based study. Clin Otolaryngol 2020; 46:196-205. [PMID: 32886858 DOI: 10.1111/coa.13647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/07/2020] [Accepted: 08/23/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Both inflammatory bowel disease (IBD) and chronic rhinosinusitis (CRS) are characterised by dysregulated immune responses. Though previous studies have demonstrated the coexistence of IBD and CRS, investigations of their association using large sets of epidemiologic data are lacking. METHODS We examined IBD and the subsequent risk of CRS in a nationwide setting. For 1 January 2000 to 31 December 2010, we identified in the National Health Insurance Dataset of Taiwan a total of 8313 patients over the age of 20 years with IBD. We randomly extracted 33 252 cases without IBD to create a comparison group matching patients by age, sex and index year. Cumulative incidences were obtained using the Kaplan-Meier method, and we calculated risk estimates for the development of CRS using the Cox proportional hazards model. RESULTS In 295 007 person-years, we identified 521 (1.25%) cases of IBD. The IBD cohort had a 1.26-fold (95% confidence interval [CI], 1.17-1.35) greater risk of developing CRS than the comparison group; for ulcerative colitis, it was 1.73-fold (95% CI, 1.48-2.05) and for Crohn's disease it was 1.20-fold (95% CI = 1.11-1.29). Subsequent analysis stratified by age revealed that the risk was highest among the population with IBD aged 50 to 64 years (adjusted hazard ratio = 1.37; 95% CI, 1.18-1.59). A follow-up-specific analysis demonstrated that the risk appeared to be highest with a follow-up duration of less than 2 years. CONCLUSION The present analysis indicates that personal history of IBD, especially the phenotype ulcerative colitis, is associated with increased risk of subsequent CRS.
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Affiliation(s)
- Yu-Hsuan Lin
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Otolaryngology, Head and Neck surgery, National Defense Medical Center, Taipei, Taiwan
| | - Cheng Li Lin
- Management Office for Health Data, Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
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7
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The impact of geometrical parameters on acoustically driven drug delivery to maxillary sinuses. Biomech Model Mechanobiol 2019; 19:557-575. [PMID: 31573057 DOI: 10.1007/s10237-019-01230-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
Acoustically driven nebulized drug delivery (acoustic aerosol delivery) is the most efficient noninvasive technique for drug delivery to maxillary sinuses (MS). This method is based on the oscillation of the air plug inside the ostium to transport drug particles from the nasal cavity (NC) to the MS. The larger the wavelength of the air plug oscillation in the ostium, the greater the penetration of drug particles to the MS. However, using this technique, the maximum drug delivery efficiency achieved to date is 5%, which means 95% of the aerosolized drugs do not enter the MS and are wasted. Since the largest amplitude of the air plug oscillation occurs at its resonance frequency, to achieve an improved MS drug delivery efficiency, it is important to determine the resonance frequency of the nose-sinus combination accurately. This paper aims to investigate the impact of geometrical parameters on the resonance frequency of the nose-sinus model. Both experimental and computational acoustic models, along with the theoretical analysis, were conducted to determine the resonance frequency of an idealized nose-sinus model. The computational modeling was carried out using computational fluid dynamics (CFD) and finite element analysis (FEA), whereas in the analytical solution, the mathematical relationships developed for a conventional Helmholtz resonator were employed. A series of experiments were also conducted to measure the resonance frequency of a realistic NC-MS combination. The results demonstrated a good agreement between the experimental and CFD modeling, while the FEA and theoretical analysis showed a significant deviation from the experimental data. Also, it was shown that the resonance frequency of the idealized nose-sinus model increases by up to twofold with increasing the ostium diameter from 3 to 9 mm; however, it has an inverse relationship with the ostium length and sinus volume. It was also reported that the resonance frequency of the nose-sinus model is independent of the NC width and MS shape.
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8
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Imoto Y, Kato A, Takabayashi T, Stevens W, Norton JE, Suh LA, Carter RG, Weibman AR, Hulse KE, Harris KE, Peters AT, Grammer LC, Tan BK, Welch K, Shintani-Smith S, Conley DB, Kern RC, Fujieda S, Schleimer RP. Increased thrombin-activatable fibrinolysis inhibitor levels in patients with chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol 2019; 144:1566-1574.e6. [PMID: 31562871 DOI: 10.1016/j.jaci.2019.08.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/02/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous chronic inflammatory disease subdivided based on the presence or absence of nasal polyps (NPs). Histologic features of chronic rhinosinusitis with nasal polyps (CRSwNP) include inflammatory cell infiltration and excessive fibrin deposition in NPs. Thrombin-activatable fibrinolysis inhibitor (TAFI) is an enzyme that plays an antifibrinolytic role in the body. The significance of TAFI has been documented in patients with chronic inflammatory diseases, including chronic lung disease; however, it has not been evaluated in the pathogenesis of NPs. OBJECTIVE The objective of this study was to evaluate the potential role of TAFI in the pathogenesis of NPs. METHODS Nasal lavage fluid was collected from control subjects and patients with CRS. We measured levels of thrombin/anti-thrombin complex (TATc) and TAFI protein using an ELISA. RESULTS TATc levels in nasal lavage fluid were significantly increased in patients with CRSwNP and patients with chronic rhinosinusitis without nasal polyps (CRSsNP) compared with control subjects, and TAFI levels in nasal lavage fluid were also significantly increased in patients with CRSwNP compared with those in control subjects and patients with CRSsNP. There was a significant correlation between TATc and TAFI levels in nasal lavage fluid. Interestingly, patients with CRS and asthma showed increased TATc and TAFI levels in nasal lavage fluid compared with those in patients with CRS without asthma, especially patients with CRSwNP. CONCLUSIONS Increased TATc and TAFI levels in nasal passages of patients with CRSwNP might participate in fibrin deposition in NPs and might play a role in the pathogenesis of CRSwNP and asthma.
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Affiliation(s)
- Yoshimasa Imoto
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
| | - Atsushi Kato
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Tetsuji Takabayashi
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Whitney Stevens
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - James E Norton
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Lydia A Suh
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Roderick G Carter
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ava R Weibman
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Kathryn E Hulse
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Kathleen E Harris
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Leslie C Grammer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Bruce K Tan
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Kevin Welch
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - David B Conley
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert C Kern
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Shigeharu Fujieda
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Robert P Schleimer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
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9
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Mohamad S, Hamid SSA, Azlina A, Md Shukri N. Association of IL-1 gene polymorphisms with chronic rhinosinusitis with and without nasal polyp. Asia Pac Allergy 2019; 9:e22. [PMID: 31384577 PMCID: PMC6676066 DOI: 10.5415/apallergy.2019.9.e22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/04/2019] [Indexed: 11/11/2022] Open
Abstract
Background Chronic rhinosinusitis (CRS) is one of the most common and complex chronic inflammatory disease of sinonasal mucosa. Even though the pathogenesis of CRS is multifactorial and still unclear, the role of cytokines especially interleukin-1 (IL-1) is being investigated worldwide in different population because of varying results obtained. Objective To study the association of IL-1 (A and B) gene polymorphisms with chronic rhinosinusitis with nasal polyp (CRSwNP) and without nasal polyp (CRSsNP), and other factors related. Methods This is a case-controlled study which include a total of 138 subjects recruited from Otorhinolaryngology-Head and Neck Surgery clinic in Hospital Universiti Sains Malaysia. Genotyping of the IL-1A (+4845G, +4845T) and IL-1B (−511C, −511T) were performed with restriction fragment length polymorphism analysis. Results There was a statistical significant association between IL-1B (−511C, −511T) polymorphism with CRSwNP and CRSsNP (p < 0.001). The CT genotype of IL-1B was markedly increased in CRSwNP subjects (52.2%). However, there was no significant association found between IL-1A (+4845G, +4845T) with CRSwNP and CRSsNP (p = 0.093). No association was found in factors related to CRS, which included asthma, atopy, allergy, aspirin sensitivity, and family history of nasal polyp (p value of 0.382, 0.382, 0.144, >0.95, and 0.254, respectively). Conclusion This study indicates an association of IL-1B (−511C, −511T) polymorphism with CRSwNP and CRSsNP in our population, hence there is a possibility of IL-1B involvement in modulating pathogenesis of CRS. There was no significant association of IL-1A (+4845G, +4845T) polymorphism with CRSwNP and CRSsNP, and other factors related.
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Affiliation(s)
- Sakinah Mohamad
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Suzina Sheikh Ab Hamid
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ahmad Azlina
- Basic Science and Oral Biology Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Norasnieda Md Shukri
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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10
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Zum Einfluss von psychischen Komorbiditäten auf die Lebensqualität von Patienten mit einer chronischen Rhinosinusitis. HNO 2019; 67:534-541. [DOI: 10.1007/s00106-019-0658-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Abstract
BACKGROUND Few data exist on the prevalence of comorbid mental disorders among ENT patients. This investigation aimed to assess the prevalence of two disorders frequent in our society, namely depression and anxiety, in patients of an ENT outpatient clinic. PATIENTS AND METHODS During a 2‑week period, 101 consecutive patients were interviewed with the Beck Depression Inventory-II (BDI II) and Beck Anxiety Inventory (BAI) screening aids. RESULTS Of 97 evaluated tests, 38% contained indications of a psychiatric problem or mental comorbidity. The proportion of moderate and severe depressive syndromes, anxiety disorders, and combined disorders was only 11.3%. There were no significant differences between genders or in terms of acute vs. chronic ENT diseases. The highest frequency of pathological test results was observed in the group of patients with cochleovestibular disorders. An astoundingly high number of conspicuous test results were seen in patients with trivial diseases and disorders, as well as among those with chronic obstructive disorders of the nose and sinuses. CONCLUSION The finding of a considerable prevalence of psychiatric comorbidities among ENT patients represents important information for the treating physician. BDI II and BAI were found to be reliable and easy to apply in the outpatient clinic.
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Affiliation(s)
- D Kleemann
- HNO-Klinik und Klinik für Psychiatrie, Psychotherapie und Psychosomatische Medizin, MediClin-Müritz-Klinikum Waren/Röbel (Müritz), Weinbergstr. 19, 17192, Waren (Müritz), Deutschland. .,HNO-Praxisgemeinschaft Drs. Haug/Kleemann, Waren (Müritz), Deutschland.
| | - A Kresin
- HNO-Klinik und Klinik für Psychiatrie, Psychotherapie und Psychosomatische Medizin, MediClin-Müritz-Klinikum Waren/Röbel (Müritz), Weinbergstr. 19, 17192, Waren (Müritz), Deutschland
| | - H Kleemann
- Fachbereiche Psychologie, Psychotherapiewissenschaften, Sigmund-Freud-Universität Wien, Wien, Österreich
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Cho SH, Kim DW, Gevaert P. Chronic Rhinosinusitis without Nasal Polyps. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 4:575-82. [PMID: 27393771 DOI: 10.1016/j.jaip.2016.04.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/30/2016] [Accepted: 04/28/2016] [Indexed: 12/11/2022]
Abstract
Chronic rhinosinusitis without nasal polyps (CRSsNP) is more prevalent than chronic rhinosinusitis with nasal polyps (CRSwNP). Certain diseases predispose to whereas others are associated with CRSsNP. Predisposing diseases include allergic and nonallergic upper and lower airway diseases, epithelial cell disorders, immunodeficiencies, autoimmune diseases, and some infectious diseases. In addition, environmental and host factors, examples of which include smoking, a higher incidence of abnormal biofilms, and innate immune defects, play a role in the pathogenesis of this disease. CRSsNP is characterized by histologic abnormalities, including basement membrane thickening (fibrosis) and goblet cell hyperplasia. Neutrophils and several chemokines, TGF-β and C-X-C motif chemokine ligand (CXCL)-8, play a role in CRSsNP remodeling. However, there are conflicting data about CRSsNP endotypes, for example, whether it is characterized by neutrophilia or eosinophilia or both. In spite of advancements and the understanding of the pathogenesis of this disease, additional study is necessary to better comprehend its underlying mechanisms, endotypes, and evidence-based treatment strategies.
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Affiliation(s)
- Seong Ho Cho
- Division of Allergy-Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla.
| | - Dae Woo Kim
- Division of Allergy-Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla; Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Philippe Gevaert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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13
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Mehri MR, Feyzabadi Z. Is there a relationship between sinusitis and psychological disorders? Med Hypotheses 2016; 97:31-33. [PMID: 27876125 DOI: 10.1016/j.mehy.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/28/2016] [Accepted: 10/01/2016] [Indexed: 10/20/2022]
Abstract
Chronic rhinosinusitis refers to inflammation of the nasal and sinuses mucosa and the main criteria for diagnosis of this disease related to the nasal cavity or the facial area. According to several reports based on the relationship of this disease with mental disorders, psychological issues are missing in the criteria of chronic rhinosinusitis diagnosis. In this study the etiology and clinical symptoms of the disease were studied by searching scientific databases and authentic Iranian Medicine books such as Avicenna's book The Canon of Medicine (Al-Qanun fi't-Tibb) that now taught in medicine schools of the Traditional East Asian; the results of this study showed that rhinosinusitis accompaniment with psychological symptoms are listed in abundance not only in old books but also in scientific literature before 1928 but after the discovery of antibiotics and extreme attention in the context of physiopathological assignment of diseases to pathogens, this relationship has been weakened. Given the positive results of recent studies on rhinosinusitis accompaniment with psychological disorders it is suggested that more studies are needed to explore the relationship between chronic rhinosinusitis and psychological diseases and, if necessary, to be included in the diagnostic criteria as a diagnostic standard.
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Affiliation(s)
- Mohammad Reza Mehri
- School of Traditional and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zohre Feyzabadi
- School of Traditional and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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14
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Lam K, Kern RC, Luong A. Is there a future for biologics in the management of chronic rhinosinusitis? Int Forum Allergy Rhinol 2016; 6:935-42. [PMID: 27103607 PMCID: PMC5012929 DOI: 10.1002/alr.21780] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 02/22/2016] [Accepted: 03/08/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory condition of the sinonasal mucosa consisting of poorly defined subtypes and characterized by variable clinical manifestations, responses to therapy, and underlying pathophysiologies. In the related disorder of asthma, progress has been made in defining disease subtypes on both clinical and pathophysiologic levels, facilitating the development of targeted biologic pharmacotherapy. The potential role of these drugs for the management of CRS will be reviewed. The objective of this work is to highlight the emerging therapeutic targets in CRS in light of evolving treatment options for asthma and enhanced understandings of the clinical manifestations and pathophysiology of CRS. METHODS This article is a review of recent studies regarding current and future advances in biomarker-directed therapies in the medical treatment of CRS. RESULTS Various biologic therapies used in the management of asthma have demonstrated clinical promise for CRS, particularly within the CRS with nasal polyposis (CRSwNP) phenotype. Several randomized, double-blind, placebo-controlled studies increasingly support the targeting of immunoglobulin E (IgE) and interleukin (IL)-5 pathways to improve outcome measures in CRSwNP patients. The IL-4/IL-13 pathway and other type 2 inflammatory pathways have also shown potential as targets for CRSwNP, but all pathways require further investigation. CONCLUSION Recalcitrant CRS in the United States and Europe is most commonly associated with nasal polyposis and a type 2 cytokine skewing in the tissue, resulting in tissue infiltration of eosinophils, mast cells, and basophils. Targeting biomarkers of the associated type 2 pathways may be a practical treatment option for recalcitrant CRSwNP in the future.
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Affiliation(s)
- Kent Lam
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at, The University of Texas Health Science Center at Houston, Houston, TX
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amber Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at, The University of Texas Health Science Center at Houston, Houston, TX.
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15
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Rosenthal PA, Lundy KC, Massoglia DP, Payne EH, Gilbert G, Gebregziabher M. Incidental paranasal sinusitis on routine brain magnetic resonance scans: association with atherosclerosis. Int Forum Allergy Rhinol 2016; 6:1253-1263. [PMID: 27509266 DOI: 10.1002/alr.21824] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/17/2016] [Accepted: 06/19/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Incidental paranasal sinusitis (IPS) is common on imaging for non-sinusitis disorders, usually without symptoms or obstructive features, and possibly arising from periodontitis (PD). PD associations with atherosclerosis have been widely reported. We test if IPS may also be associated with atherosclerosis. METHODS IPS was scored retrospectively in a random sample of 180 magnetic resonance (MR) brain scans and compared with chart review for atherosclerosis (all subtypes), rhinosinusitis, and related factors (smoking, asthma, and relevant surgery). IPS was scored out of 30, from all sinuses, with maxillary sinuses weighted double volumetrically. Significant IPS (Sig IPS) was designated as 6 or more out of 30. Bivariate logistic regression was used to test for associations of Sig IPS to the clinical data, with multivariate analysis then testing for potential confounders. RESULTS A total of 173 subjects were analyzed (7 exclusions). MR indications included suspected acute/prior stroke (22.0%). Sig IPS found in 20 (11.6%). Positive histories for atherosclerosis were cerebral, 57 (32.9%); coronary, 48 (27.7%); and peripheral arterial disease, 14 (8.1%). IPS ≥6 was strongly associated with cerebrovascular disease (odds ratio [OR] 6.0, p < 0.001), and less robustly to smoking (OR 2.9, p = 0.07) and rhinosinusitis (OR 2.4, p = 0.09). No associations with coronary or peripheral artery diseases were found. After controlling for smoking and rhinosinusitis, yielding significant subclinical sinusitis, the link of Sig IPS to cerebrovascular disease persisted (modified OR 5.2, p = 0.002). CONCLUSION Significant incidental sinusitis, which is mostly subclinical sinusitis, is associated with cerebrovascular disease but not other atheroscleroses. This suggests possible common causation of both by PD.
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Affiliation(s)
| | | | | | - Elizabeth H Payne
- Ralph H. Johnson VA Medical Center, Bee Street, Charleston, SC.,Medical University of South Carolina, Charleston, SC.,The Emmes Corporation in Rockville, MD
| | - Gregory Gilbert
- Ralph H. Johnson VA Medical Center, Bee Street, Charleston, SC
| | - Mulugeta Gebregziabher
- Ralph H. Johnson VA Medical Center, Bee Street, Charleston, SC.,Medical University of South Carolina, Charleston, SC
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Abstract
PURPOSE OF REVIEW To review the recent literature on risk factors for chronic rhinosinusitis (CRS) with an emphasis on genetic, comorbid diseases and environmental factors associated with CRS. Through identifying potential risk factors for CRS, we aim to glean insights into the underlying pathogenic mechanisms essential for developing effective therapeutic strategies. RECENT FINDINGS Recent findings demonstrate that genetics and comorbid medical conditions including airway diseases, gastroesophageal reflux disease, inflammatory and autoimmune diseases, and various demographic and environmental factors are associated with having a CRS diagnosis. Limitations of current studies include variable application of disease definitions, lack of prospective longitudinal studies and a disproportionate focus on tertiary care populations. SUMMARY CRS has a broad spectrum of associations ranging from genetics to comorbid diseases and environmental factors. These predisposing factors may provide valuable information for possible designing of therapeutic and preventive interventions. However, to better understand whether these associations cause CRS, further studies are needed to independently replicate findings, establish temporal relationships between exposure and disease onset, evaluate the influence of exposure dose on disease severity, and to understand the biological effects of these risk factors in the context of CRS.
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Southwood JE, Hoekzema CR, Samuels TL, Wells C, Poetker DM, Johnston N, Loehrl TA. The Impact of Pepsin on Human Nasal Epithelial Cells In Vitro. Ann Otol Rhinol Laryngol 2015; 124:957-64. [DOI: 10.1177/0003489415593556] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To describe potential mechanisms by which pepsin induces inflammation in refractive chronic rhinosinusitis (CRS). Our hypothesis was that pepsin induces mitochondrial damage and cytokine expression in human nasal epithelial cells (HNEpC) in vitro. Methods: Western blot was used to detect pepsin in sinus lavages from patients with CRS and controls. The HNEpC cells were treated with pepsin (pH 7; 0.1 mg/mL) for 1 or 16 hours and routine electron microscopy (EM) and MTT assay were performed. Cytokine ELISA was performed on media collected from HNEpC cells 16 hours following a 1-hour pepsin treatment. Results: Pepsin was detected in sinus lavages from 4 out of 6 CRS patients and 0 out of 3 controls. The EM showed mitochondrial damage in pepsin-treated HNEpC cells but not in control cells. The MTT assay demonstrated reduced mitochondrial activity in pepsin-treated HNEpC cells compared to controls ( P < .001). Pepsin increased IL-1A ( P = .003) and IL-6 ( P = .04) expression in HNEpC cells. Conclusions: Pepsin in sinus lavages from patients with CRS is consistent with previous studies. This study reveals the damaging effect of pepsin on mitochondria in nasal epithelial cells in vitro. Cytokines previously associated with CRS were elevated following pepsin treatment of HNEpC cells in vitro. These results demonstrate mechanisms by which pepsin may potentiate CRS.
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Affiliation(s)
- Jessica E. Southwood
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Craig R. Hoekzema
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tina L. Samuels
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Clive Wells
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David M. Poetker
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nikki Johnston
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Todd A. Loehrl
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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