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Brescia G, Frosolini A, Franz L, Daloiso A, Fantin F, Lovato A, de Filippis C, Marioni G. Chronic Otitis Media in Patients with Chronic Rhinosinusitis: A Systematic Review. Medicina (B Aires) 2023; 59:medicina59010123. [PMID: 36676746 PMCID: PMC9867000 DOI: 10.3390/medicina59010123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Introduction: Chronic otitis media (COM) and chronic rhinosinusitis (CRS) are two of the most common otolaryngological disorders. CRS and COM share pathophysiological mechanisms such as bacterial infection, biofilm, and the persistence of the obstruction state of ventilation routes. The purpose of this systematic review was to evaluate all available information on the association between COM and CRS. Methods: The protocol of this investigation was registered on PROSPERO in November 2022. Pubmed, Scopus, Web of Science, and Cochrane databases were systematically searched according to the PRISMA statement. Results: After the application of inclusion-exclusion criteria, four manuscripts with adequate relevance to this topic were included in the review. The study population consisted of 20,867 patients with a diagnosis of CRS, of whom 991 were also diagnosed with COM (4.75%). Conclusions: The included studies have shown that CRS has become significantly associated with COMas: a global inflammatory process that involves the epithelium in both the middle ear and upper airway. The identification of a relationship between CRS and COM may contribute to preventing chronic inflammatory conditions through the early management of the associated disease. Further, carefully designed studies are necessary to demonstrate the relationship between COM and CRS.
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Affiliation(s)
- Giuseppe Brescia
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, 35100 Padova, Italy
- ENT Unit, Surgical Department, Ospedali Riuniti Padova Sud, 35043 Monselice-Padova, Italy
| | - Andrea Frosolini
- Audiology Unit, Department of Neuroscience DNS, University of Padova, 31100 Treviso, Italy
- Maxillofacial Surgery Unit, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
- Correspondence: (A.F.); (G.M.)
| | - Leonardo Franz
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, 35100 Padova, Italy
- Audiology Unit, Department of Neuroscience DNS, University of Padova, 31100 Treviso, Italy
- Guided Therapeutics (GTx) International Scholarship Program, Techna Institute, University Health Network (UHN), Toronto, ON M5G2C4, Canada
| | - Antonio Daloiso
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, 35100 Padova, Italy
| | - Francesco Fantin
- Audiology Unit, Department of Neuroscience DNS, University of Padova, 31100 Treviso, Italy
| | - Andrea Lovato
- Otolaryngology Unit, Vicenza Hospital, 36100 Vicenza, Italy
| | - Cosimo de Filippis
- Audiology Unit, Department of Neuroscience DNS, University of Padova, 31100 Treviso, Italy
| | - Gino Marioni
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, 35100 Padova, Italy
- Correspondence: (A.F.); (G.M.)
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Nielsen NØ, Nørlinger C, Greve T, Klug TE. Cervical suppurative lymphadenitis in children: microbiology, primary sites of infection, and evaluation of antibiotic treatment. Eur Arch Otorhinolaryngol 2021; 279:3053-3062. [PMID: 34623496 DOI: 10.1007/s00405-021-07115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The significant pathogens associated with paediatric cervical suppurative lymphadenitis (CSL) are unclarified, and there is a lack of clinical evaluations of antibiotic regimens in paediatric CSL. We aimed to (1) explore the bacterial findings and the associated primary sites of infection in paediatric cases of CSL and (2) evaluate the clinical outcomes in patients treated with different antibiotic regimens. METHODS All children (< 18 years) treated for non-mycobacterium CSL at the Department of Otorhinolaryngology, Aarhus University Hospital, from 2001 to 2018 were retrospectively evaluated. RESULTS Eighty-five patients were included in the study. The prevalent isolates were S. aureus (57%), S. pyogenes (17%), non-haemolytic streptococci (11%), and F. necrophorum (3%). The primary sites of infection were identified in 30 (35%) patients. The most common sites were the oropharynx (n = 15), the middle ear (n = 10), and the skin (n = 5). All patients were treated with surgical incision and antibiotics. No statistically significant differences were found between patients treated with antibiotics covering streptococci (n = 60) versus antibiotics covering streptococci and S. aureus (n = 25) in terms of duration of hospitalisation (median 4 vs 4 days, p = 0.26), altered antibiotic treatment because of insufficient clinical or biochemical progress (7% vs 12%, p = 0.41), and abscess recurrence (8% vs 12%, p = 0.69). CONCLUSION S. aureus was the predominant pathogen in paediatric CSL at all cervical levels, and even in cases with evidence of primary site infection not normally associated with S. aureus. We were unable to underscore the importance of antibiotic treatment covering S. aureus based on evaluation of the clinical outcomes.
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Affiliation(s)
- Nicolai Østergaard Nielsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.
| | - Christian Nørlinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
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Türk B, Korkut A, Soytaş P, Kaya K, Vanli E, Turgut S. The radiologic evaluation of adenoid hypertrophy and the presence of sinusitis in pediatric patients with chronic otitis media. INDIAN JOURNAL OF OTOLOGY 2019. [DOI: 10.4103/indianjotol.indianjotol_128_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Szaleniec J, Górski A, Szaleniec M, Międzybrodzki R, Weber-Dąbrowska B, Stręk P, Składzień J. Can phage therapy solve the problem of recalcitrant chronic rhinosinusitis? Future Microbiol 2017; 12:1427-1442. [PMID: 29027819 DOI: 10.2217/fmb-2017-0073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic rhinosinusitis (CRS) affects 5-15% of the global population. In some patients, the infectious exacerbations of the disease are recalcitrant to medical treatment and surgery. These cases are probably associated with the presence of bacterial biofilms. Bacteriophage (phage) therapy seems to be a promising antibiofilm strategy. The efficacy of phage therapy in sinonasal infections has been demonstrated both in vitro and in animal models. In the past, phage preparations were also administered to humans with CRS with favorable outcomes and no significant side effects. Very recently, the safety and efficacy of phage therapy in otolaryngological infections has been demonstrated in pioneer Phase I/II clinical trials. This review addresses the potential of phage therapy to treat CRS. We also discuss issues that require further research.
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Affiliation(s)
- Joanna Szaleniec
- Department of Otolaryngology, Jagiellonian University Medical College, Sniadeckich 2, 31-531 Krakow, Poland
| | - Andrzej Górski
- Institute of Immunology & Experimental Therapy, Polish Academy of Sciences, Weigla 12, 53-114 Wroclaw, Poland.,Transplantation Institute, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland
| | - Maciej Szaleniec
- Jerzy Haber Institute of Catalysis & Surface Chemistry, Polish Academy of Sciences, Niezapominajek 8, 30-239 Krakow, Poland
| | - Ryszard Międzybrodzki
- Institute of Immunology & Experimental Therapy, Polish Academy of Sciences, Weigla 12, 53-114 Wroclaw, Poland.,Transplantation Institute, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland
| | - Beata Weber-Dąbrowska
- Institute of Immunology & Experimental Therapy, Polish Academy of Sciences, Weigla 12, 53-114 Wroclaw, Poland
| | - Paweł Stręk
- Department of Otolaryngology, Jagiellonian University Medical College, Sniadeckich 2, 31-531 Krakow, Poland
| | - Jacek Składzień
- Department of Otolaryngology, Jagiellonian University Medical College, Sniadeckich 2, 31-531 Krakow, Poland
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Chronic rhinosinusitis with nasal polyps is associated with chronic otitis media in the elderly. Eur Arch Otorhinolaryngol 2016; 274:1463-1470. [DOI: 10.1007/s00405-016-4363-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
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[Consensus document on the aetiology, diagnosis and treatment of sinusitis]. An Pediatr (Barc) 2013; 79:330.e1-330.e12. [PMID: 23764206 DOI: 10.1016/j.anpedi.2013.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 04/25/2013] [Indexed: 11/20/2022] Open
Abstract
The Spanish National Consensus (Spanish Society of Pediatric Infectious Diseases, Spanish Association of Primary Care Pediatrics, Spanish Society of Pediatric Outpatient and Primary Care, Spanish Society of Otorhinolaryngology and Cervical-Facial Pathology) on Sinusitis is presented. Rhinosinusitis is a difficult to diagnose and often unrecognised disease. The document discusses the aetiology, the clinical signs and symptoms, and the diagnostic criteria. A proposal for treatment is made based on the epidemiological situation in our country. Oral amoxicillin is the treatment of choice (80mg/kg/day divided every 8hours). Alternative treatment is proposed in special cases and when amoxicillin is not sufficient. The main complications are reviewed.
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Antibiotic susceptibility of Moraxella catarrhalis biofilms in a continuous flow model. Diagn Microbiol Infect Dis 2012; 74:394-8. [DOI: 10.1016/j.diagmicrobio.2012.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 08/09/2012] [Accepted: 08/20/2012] [Indexed: 11/23/2022]
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Lee DH, Shin JH, Lee DC. Three-dimensional morphometric analysis of paranasal sinuses and mastoid air cell system using computed tomography in pediatric population. Int J Pediatr Otorhinolaryngol 2012; 76:1642-6. [PMID: 22901462 DOI: 10.1016/j.ijporl.2012.07.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/24/2012] [Accepted: 07/27/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the volumetric relationship between the mastoid air cell (MAC) and paranasal sinus (PNS) in the pediatric population using three-dimensional reconstruction and the analysis technique of CT. STUDY DESIGN Retrospective cross-sectional study was conducted at a university-based, secondary referral hospital. METHODS PNS CT imaging data of 62 children (40 boys and 22 girls; mean age=13.4 ± 4.0 years) was reconstructed to the three-dimensional model with the surface-rendering algorithm (lower threshold of -1024 HU and upper threshold of -318 HU), and subsequently measuring the volume of the three PNSs (frontal, maxillary and sphenoid) and MAC. Hierarchical linear regression analysis was used to control the effect of age. RESULTS Controlling the effect of age, no significant linear regression relationship was found between the volume of MAC and PNSs. It was observed that PNSs and MAC showed a significant linear relationship with age. The regression slopes of PNSs were larger than that of MAC, especially the growth of maxillary and sphenoid sinuses was faster and larger than that of the frontal sinus and MAC. As the coefficient of determination was extremely small, the aging process itself could not effectively explain the volume variation of PNSs and MAC. CONCLUSION No interaction was observed in the pneumatization of the three PNSs (frontal, maxillary, and sphenoid) and MAC. It was found that the growths of PNSs and MAC are influenced by age. Further, maxillary and sphenoid sinuses tend to grow faster and become larger than the frontal sinus and mastoid air cell system. Thus, it is verified that environmental factors could be involved in the postnatal pneumatization process of the PNSs and MAC, which might influence MAC to a greater extent than the PNSs.
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Affiliation(s)
- Dong-Hee Lee
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea.
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Abstract
Chronic rhinosinusitis (CRS) is a rather common disease in children, but its symptoms are often subtle and non-specific and this may result in overlooking a correct diagnosis. In turn, a missed diagnosis of CRS prevents a correct management to be performed and is associated with uneffective investigations and improper treatments. Actually, when CRS symptoms, which are mainly nasal congestion and obstruction, nasal discharge, facial pain, cough, and halitosis, are correctly assessed, the clinical diagnosis of CRS may be achieved, and confirmation may be obtained by imaging criteria or nasal fibroendoscopy. In imaging, computed tomography (CT) is the first choice technique for the evaluation of CRS and is able to provide an anatomic road map when surgery is required. Magnetic resonance imaging (MRI) of the sinuses, orbits, and brain should be performed whenever extensive or multiple complications of sinusitis are suspected. Also for middle ear disorders, CT is the first choice because it detects opacification of the middle ear cavity and mastoid cells, presence of fluids or debris, and allows the ossicular chain and the cortical bone of the mastoid to be evaluated. Another important diagnostic issue is the need to look for disorders that are frequently associated with CRS, such as obstructive sleep apnea syndrome (OSAS), that has some recognized risk factors in adenotonsillar hypertrophy, craniofacial anomalies, obesity, and neuromuscular disorders. Other associated disorders requiring investigation are recurrent or persistent otitis media and difficult asthma.
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Affiliation(s)
- Gualtiero Leo
- Pediatric Allergy and Respiratory Pathophysiology Unit, Buzzi Children's Hospital, Istituti Clinici di Perfezionamento, Via Castelvetro 32, Milan, Italy.
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Gelardi M, Marchisio P, Caimmi D, Incorvaia C, Albertario G, Bianchini S, Caimmi S, Celani C, Esposito S, Fattizzo M, Fiorella ML, Frati F, Labò E, Leo G, Licari A, Marseglia A, Piacentini E, Pignataro L, Quaranta N, Tenconi R, Torretta S, Marseglia GL, Principi N. Pathophysiology, favoring factors, and associated disorders in otorhinosinusology. Pediatr Allergy Immunol 2012; 23 Suppl 22:5-16. [PMID: 22762848 DOI: 10.1111/j.1399-3038.2012.01323.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The pathogenesis of rhinosinusitis (RS) is related to inflammation, caused by infections in the acute form of the disease but also by other agents in the chronic forms. Cytology allows to evaluate the defensive components, such as hair cells and muciparous cells, while the presence in the nasal mucosa of eosinophils, mast cells, bacteria and/or fungal hyphae, or spores indicates the nasal pathology. The anatomic and physiologic characteristics of the otorhinosinusal system account for the frequent concomitant involvement of the different components. The pivotal pathophysiologic sites are the ostiomeatal complex, the spheno-ethmoidal recess, and the Eustachian tube. The latter is the link with acute otitis media (AOM), which is the most common disease in infants and children and has major medical, social, and economic effects. Moreover, because of the strict relationship between upper and lower airways, nasal sinus disease may contribute to asthma and sinusitis may be considered as an independent factor associated with frequent severe asthma exacerbations. Concerning the role of allergy, the available data do not permit to attribute a central role to atopy in sinusitis and thus allergy testing should not be a routine procedure, while an allergologic evaluation may be indicated in children with OM, especially when they have concomitant rhinitis.
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Affiliation(s)
- Matteo Gelardi
- Department of Ophtalmology and Otolaryngology, Otolaryngology Clinic, University of Bari, Bari, Italy
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Paleari D, Rossi GA, Nicolini G, Olivieri D. Ambroxol: a multifaceted molecule with additional therapeutic potentials in respiratory disorders of childhood. Expert Opin Drug Discov 2011; 6:1203-14. [PMID: 22646987 DOI: 10.1517/17460441.2011.629646] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Mucoactive drugs are currently used to cleanse the respiratory tract following disturbance of the normal mucociliary clearance due to mucous hyperproduction and/or modification of its physicochemical characteristics. However, in addition to possessing the ability to perform specific actions on airway secretion, these compounds have the capability to modulate the mechanisms involved in abnormal secretions. Indeed, over the years, in the postmarketing phase, a large number of studies have been published showing interesting pharmacological activities in addition to their secretagogue activity. AREAS COVERED This article collates available data on ambroxol (2-amino-3,5-dibromo-N-[trans-4-hydroxycyclohexyl]benzylamine), a metabolite of bromhexine, used as a secretagogue in the treatment of childhood airway diseases. This article goes beyond the mucoactive aspects of the drug covering its multiple pharmacological properties. EXPERT OPINION The non-mucoactive functions exhibited by the compound may provide beneficial effects on airway structure and function in health and disease. Beyond the mucokinetic and secretagogue effects, ambroxol showed great antioxidant, anti-inflammatory, local anesthetic and surfactant synthesis stimulatory activities. Moreover, some antiviral and antibacterial activities were shown. These findings may better explain the clinical results observed in a variety of airway disorders and suggest additional therapeutic potential. Further studies are needed to better define the clinical relevance of these non-mucolytic activities.
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Affiliation(s)
- Davide Paleari
- Medical Department , Chiesi Farmaceutici , Parma , Italy
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Liu YCC, Post JC. Biofilms in pediatric respiratory and related infections. Curr Allergy Asthma Rep 2009; 9:449-55. [PMID: 19814917 DOI: 10.1007/s11882-009-0066-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Bacteria can grow as free-floating, planktonic bacteria or complex communities called biofilms. Biofilms promote bacterial growth and diversity and offer bacteria unique environments, including aerobic and anaerobic layers, that facilitate resistance to antimicrobial therapies. Respiratory and related structures provide ideal environments for the development of bacterial biofilms, which predispose patients to recurrent and chronic infections. Biofilms are important for the persistence of chronic rhinosinusitis, pulmonary infections in cystic fibrosis, chronic otitis media, and device-related infections. Antimicrobial therapy that is proven effective against planktonic bacteria is often insufficiently effective against the defenses of biofilms. Furthermore, biofilms modify themselves following exposure to antimicrobial therapy, thus developing increased resistance. Understanding the nature of biofilms in common pediatric infections is essential to comprehending the expected course of bacterial illness and identifying treatments that are most likely to be beneficial against more resistant biofilms.
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