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Plath M, Plath K. [Medical examination: Preparation for ENT specialisation : Part 71]. HNO 2024; 72:283-290. [PMID: 38448664 DOI: 10.1007/s00106-024-01439-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 03/08/2024]
Affiliation(s)
- M Plath
- Kopfklinik, Hals‑, Nasen- und Ohrenklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - K Plath
- HNO-Praxis Bensheim, Bensheim, Deutschland
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Comparison of Blood and Tissue Eosinophil Count and Blood IgE in Patients with Chronic Sinusitis and Nasal Polyps. J Immunol Res 2021; 2021:6680676. [PMID: 33628852 PMCID: PMC7889338 DOI: 10.1155/2021/6680676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/17/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background The inflammatory mucosa of the sinus cavities is called sinusitis and is divided into various types based on its appearance and sign. Chronic rhinosinusitis is an inflammatory-infectious disease that involves the frontal, sphenoid, ethmoid, and maxillary sinuses. Chronic sinusitis is a multifactorial disease and the range of causes varies from environmental factors to genetic factors. The purpose of this study was to compare blood and tissue eosinophils and serum IgE levels in patients with chronic sinusitis with nasal polyp in Vali-e-Asr hospital in 1397. Methods In this descriptive-analytical study, the population under study included those with chronic sinusitis referred to Birjand Valiasr Hospital in 1397.3 cc of blood samples were taken 1 day before surgery to evaluate eosinophil counts and serum IgE levels. Also, samples taken from patients during surgery were counted, and then, 100 cells were counted, and eosinophil counts and percentages were calculated. The data were entered into the SPSS software after data collection. Results This study was performed on 70 patients with chronic rhinosinusitis which included 43 men (61.4%) and 27 women (38.6%) with mean age of 39.11 ± 13 13.72 years. There was no significant difference between sex of patients and mean serum IgE level (P < 0.05). The mean percentage of eosinophils in blood samples and tissues of patients with chronic sinusitis was significantly increased with the increase in CT scan (P < 0.05). Conclusions Tissue or blood eosinophilia was not observed in patients with chronic rhinosinusitis. Also, the mean eosinophil percentage of blood and tissue increased significantly in patients with increased scanning computed tomography (P < 0.05).
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Galli M, De Soccio G, Cialente F, Candelori F, Federici FR, Ralli M, De Vincentiis M, Minni A. Chronic maxillary sinusitis of dental origin and oroantral fistula: The results of combined surgical approach in an Italian university hospital. Bosn J Basic Med Sci 2020; 20:524-530. [PMID: 32358949 PMCID: PMC7664789 DOI: 10.17305/bjbms.2020.4748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/29/2020] [Indexed: 12/02/2022] Open
Abstract
Unilateral chronic maxillary sinusitis is a possible complication of odontogenic disease or dental treatment and is mainly due to the development of an oroantral fistula (OAF). The management of chronic maxillary sinusitis of dental origin (CMSDO) requires a combined treatment via endoscopic sinus surgery (ESS) and intraoral surgical treatment of the odontogenic source. The aim of this study is to present the results of our university hospital unit in the treatment and follow-up of a case series of 34 patients treated with a combined surgical approach for CMSDO due to OAF. All patients were treated with ESS combined with an intraoral approach. No intraoperative or immediate postoperative complications were observed; nasal synechia was found in 3 patients (8.82%). The overall success rate after the primary intervention was 94.12%; recurrence was observed in 2 cases (5.88%), both were suffering from diabetes mellitus and were tobacco smokers. Our results confirm that simultaneous surgery with a combination of an intraoral and endoscopic approach can be considered the best strategy for the long-term restoration of normal sinonasal homeostasis in selected patients with chronic odontogenic sinusitis and OAF, guaranteeing an effective treatment with minimal complications in the short and long term.
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Affiliation(s)
- Massimo Galli
- Department of Oral and Maxillofacial Science, University Sapienza of Rome, Rome, Italy
| | - Giulia De Soccio
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - Fabrizio Cialente
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | | | | | - Massimo Ralli
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - Marco De Vincentiis
- Department of Oral and Maxillofacial Science, University Sapienza of Rome, Rome, Italy
| | - Antonio Minni
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
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Kirsche H, Klimek L. [ASA-intolerance syndrome and persistent rhinosinusitis : Differential diagnosis and treatment]. HNO 2016; 63:357-63. [PMID: 25929893 DOI: 10.1007/s00106-015-0008-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A differential diagnosis of persistent chronic rhinosinusitis is ASA-intolerance syndrome (AIS), also known as Aspirin®‑exacerbated respiratory disease (AERD), Samter-Trias (Samter's disease, Morbus Widal). Particularly in cases of frequent recurrency of nasal polyps in combination with bronchial asthma and hypersensitivity reactions to acetylsalicylic acid (ASA) and other nonsteroidal anti-inflammatory drugs (NSAR) can often be referred to an underlying AIS. The pathogenesis of this syndrome is attributed to a misallocation of the arachidonic acid metabolism, resulting in an increased leukotriene production. METHODS The diagnosis may be difficult in the early stages of the disease with incomplete triad of symptoms. RESULTS Therapy may consist of paranasal sinuses surgery, drug therapy and adaptive deactivation as the only causal treatment option for patients with AIS. CONCLUSION For adaptive desactivation, positive effects were actually shown even in patients with long-term recurrent or persistent complaints of chronic rhinosinusitis.
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Affiliation(s)
- H Kirsche
- Universitätsklinikum Münster, Klinik für Hals-Nasen-Ohrenheilkunde, Kardinal-von-Galen-Ring 10, 48149, Münster, Deutschland,
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Park SJ, Kook JH, Kim HK, Kang SH, Lim SH, Kim HJ, Kim KW, Kim TH, Lee SH. Macrolides increase the expression of 11β-hydroxysteroid dehydrogenase 1 in human sinonasal epithelium, contributing to glucocorticoid activation in sinonasal mucosa. Br J Pharmacol 2015; 172:5083-95. [PMID: 26228509 DOI: 10.1111/bph.13273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 07/16/2015] [Accepted: 07/27/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND PURPOSE The anti-inflammatory and immunomodulatory effects of macrolides include the ability to decrease mucus secretion and inhibit inflammatory mediators in chronic rhinosinusitis. Nevertheless, their mechanisms of action remain to be determined. Here we have investigated the effects of macrolide antibiotics (clarithromycin, azithromycin and josamycin; representating the 14-, 15- and 16-membered macrolides) on endogenous steroids in human sinonasal epithelial cells and mouse nasal mucosa. EXPERIMENTAL APPROACH The effects of macrolides on the expression of steroid-converting enzymes [11β-hydroxysteroid dehydrogenase (11β-HSD1 and 11β-HSD2)], steroid-synthesizing enzymes (3β-HSD, CYP21, CYP11B1 and CYP11A1) and cortisol levels were assessed in cultured human epithelial cells. In control and adrenalectomized mice , these enzymes and corticosterone levels were evaluated in nasal mucosa and serum after administration of macrolides. KEY RESULTS The expression levels of 3β-HSD, CYP21, 11β-HSD1 and CYP11B1 increased in human epithelial cells treated with clarithromycin and azithromycin, whereas the expression levels of 11β-HSD2 and CYP11A1 were not affected. Josamycin had no effects on the expression of these enzymes. Cortisol levels increased in epithelial cells treated with clarithromycin or azithromycin. The expression of 3β-HSD, CYP11A1, CYP21, CYP11B1 and 11β-HSD1 was upregulated in nasal mucosa of mice treated with clarithromycin or azithromycin, but not in adrenalectomized mice. CONCLUSIONS AND IMPLICATIONS This study provides evidence that 14- and 15-membered macrolide antibiotics may affect the expression of steroid-synthesizing and steroid-converting enzymes in human sinonasal epithelial cells and mouse nasal mucosa, increasing the endogenous cortisol levels in sinonasal mucosa.
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Affiliation(s)
- Se Jin Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Jin Ho Kook
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Gangwon Do, South Korea
| | - Ha Kyun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Sung Hoon Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Sae Hee Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Hyun Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Kyung Won Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Sang Hag Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
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Szabó K, Polyánka H, Kiricsi Á, Révész M, Vóna I, Szabó Z, Bella Z, Kadocsa E, Kemény L, Széll M, Hirschberg A. A conserved linkage group on chromosome 6, the 8.1 ancestral haplotype, is a predisposing factor of chronic rhinosinusitis associated with nasal polyposis in aspirin-sensitive Hungarians. Hum Immunol 2015; 76:858-62. [PMID: 26433033 DOI: 10.1016/j.humimm.2015.09.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 05/10/2014] [Accepted: 09/28/2015] [Indexed: 10/23/2022]
Abstract
Inflammation plays a central role in the pathogenesis of chronic rhinosinusitis (CRS), and TNFα is a key pro-inflammatory cytokine in the pathogenesis of this disease. In our previous studies, we showed that the TNFA -308A allele is a genetic predisposition factor in a subgroup of aspirin-sensitive (ASA+) CRS patients suffering from nasal polyps (NP) in the Hungarian population. To determine whether the TNF -308A allele or the presence of a complex, extended ancestral haplotype (8.1AH) located on chromosome 6 is responsible for the previously observed genetic effect, we performed a case-control study for examining the frequency of 8.1AH carriers in controls and in subgroups of CRS patients. Our novel observations demonstrate that the presence of the 8.1AH may be responsible for the development of severe forms of CRS (CRSwNP, ASA+) and strengthen the clinical observation that CRS patients can be classified into clinically and genetically different subgroups.
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Affiliation(s)
- Kornélia Szabó
- MTA-SZTE Dermatological Research Group, Szeged, Hungary.
| | | | - Ágnes Kiricsi
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Szeged, Hungary
| | - Mónika Révész
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Ida Vóna
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pécs, Faculty of Medicine, Pécs, Hungary
| | - Zsolt Szabó
- Borsod-Abaúj-Zemplén Country Hospital and University Teaching Hospital, Miskolc, Hungary
| | - Zsolt Bella
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Szeged, Hungary
| | - Edit Kadocsa
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Szeged, Hungary
| | - Lajos Kemény
- MTA-SZTE Dermatological Research Group, Szeged, Hungary; Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Márta Széll
- MTA-SZTE Dermatological Research Group, Szeged, Hungary; Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - Andor Hirschberg
- Department of Otorhinolaryngology, St. John's and North-Buda Hospitals, Budapest, Hungary
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Jo HW, Dalgorf DM, Snidvongs K, Sacks R, Harvey RJ. Postoperative irrigation therapy after sinonasal tumor surgery. Am J Rhinol Allergy 2015; 28:169-71. [PMID: 24717955 DOI: 10.2500/ajra.2014.28.4009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sinonasal care after endoscopic tumor resection aims to manage crusting, edema, mucus, and a healing cavity. High-volume irrigations have proved beneficial in this setting. The addition of corticosteroid to the irrigation is used for chronic rhinosinusitis (CRS) in modifying the postsurgical inflammatory response; however, its effect in endoscopic sinonasal tumor resection is unknown. Saline alone versus combination saline and corticosteroid irrigations in postoperative nasal care of sinonasal tumor patients was assessed. METHODS A retrospective cohort of patients postendoscopic endonasal tumor resection was assessed. Patients used 240 mL of saline or 240 mL of saline with 1 mg of betamethasone daily. Nasal symptom scores (NSSs) and the 22-item Sino-Nasal Outcome test (SNOT-22) was recorded 3 months postoperatively. An endoscopic score was made of the area undergoing secondary healing at 3 months by two blinded assessors. RESULTS Fifty-nine patients were assessed (aged 50.1 ± 18.26 years; 36% female subjects). The groups were similar in number (saline n = 31), treatment, and surgical characteristics. The endoscopic scores did not differ between the groups at 3 months. NSS was lower in the saline group (1.0 [interquartile range {IQR}, 3] versus 7.0 [IQR, 9]; p = 0.03) and, similarly, for SNOT-22 (0.24 [IQR, 1] versus 1.09 [IQR, 1]; p = 0.01) compared with the saline with steroid group. CONCLUSION Although corticosteroid irrigations have become routine for managing inflammatory sinus disease at our center, their use after tumor surgery does not appear to be warranted. The inflammatory healing process after tumor surgery differs from CRS inflammation and may explain the observed findings.
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Affiliation(s)
- Hae W Jo
- Applied Medical Research Center, St. Vincent's Hospital and University of New South Wales, Sydney, Australia
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Möller W, Schuschnig U, Bartenstein P, Meyer G, Häussinger K, Schmid O, Becker S. Drug delivery to paranasal sinuses using pulsating aerosols. J Aerosol Med Pulm Drug Deliv 2015; 27:255-63. [PMID: 25084017 DOI: 10.1089/jamp.2013.1071] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is the major disorder of the upper airways, affecting about 10-15% of the total population. Topical treatment regimens show only modest efficacy, because drug delivery to the posterior nose and paranasal sinuses is still a challenge. Therefore, there is a high rate of functional endoscopic sinus surgery in CRS patients. Most nasally administered aerosolized drugs, like nasal pump sprays, are efficiently filtered by the nasal valve and do not reach the posterior nasal cavity and the sinuses, which are poorly ventilated. However, as highlighted in this review, sinus ventilation and paranasal aerosol delivery can be achieved by using pulsating airflow, offering new topical treatment options for nasal disorders. Radioaerosol inhalation and imaging studies in nasal casts and in healthy volunteers have shown 4-6% of the nasally administered dose within the sinuses. In CRS patients, significant aerosol deposition in the sinus cavities was reported before sinus surgery. After surgery, deposition increased to the amount observed in healthy volunteers. In addition, compared with nasal pump sprays, retention kinetics of the radiolabel deposited in the nasal cavity was prolonged, both in healthy volunteers and in CRS patients. These efficiencies may be sufficient for topical aerosol therapies of sinus disorders and, due to the prolonged retention kinetics, may reduce application modes, but have to be proven in future clinical trials. Pulsating aerosols may offer additional new topical treatment options of nasal and sinus disorders before as well as after surgery.
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Affiliation(s)
- Winfried Möller
- 1 Comprehensive Pneumology Center, Institute for Lung Biology and Disease , Helmholtz Zentrum München, Neuherberg, Germany
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Szabó K, Kiricsi Á, Révész M, Vóna I, Szabó Z, Bella Z, Polyánka H, Kadocsa E, Kemény L, Széll M, Hirschberg A. The -308 G>A SNP of TNFA is a factor predisposing to chronic rhinosinusitis associated with nasal polyposis in aspirin-sensitive Hungarian individuals: conclusions of a genetic study with multiple stratifications. Int Immunol 2013; 25:383-8. [PMID: 23446846 DOI: 10.1093/intimm/dxs162] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Single nucleotide polymorphisms (SNPs) of the tumour necrosis factor alpha (TNFα) gene (TNFA) have been extensively studied and shown to be associated with an increased risk of the development of various chronic inflammatory diseases. Inflammation has been demonstrated to play a central role in the pathogenesis of chronic rhinosinusitis (CRS), and TNFα is a key pro-inflammatory cytokine with important functions in these processes. In order to determine whether the well-known TNFA -308 G>A SNP has a role in a genetic predisposition to CRS in the Hungarian population, we analyzed our genomic collection containing control and CRS patient samples in a case-control study, and compared the genotype and allele frequencies. There was no significant difference in the observed genotype or allele frequencies between the controls and the total CRS group. However, after careful stratification of the patient group on the basis of the observed clinical symptoms, we found a significantly higher carriage rate of the rare A allele-containing genotypes among the CRS patients with nasal polyposis (NP) who also exhibited sensitivity to aspirin (acetylsalicylic acid, ASA(+)). It is concluded that genetic variants of the TNFA gene may affect the risk of CRS in a clinically well-defined group of CRSNP(+)ASA(+) patients in the Hungarian population. Our results also emphasize that the group of CRS patients is not homogenous in that patients exhibiting different clinical symptoms exist. Their carried genetic predisposing factors, and as a result, the exact molecular events leading to the development of various forms of CRS, may also differ.
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Kou W, Hu GH, Yao HB, Wang XQ, Shen Y, Kang HY, Hong SL. Regulation of transforming growth factor-β1 activation and expression in the tissue remodeling involved in chronic rhinosinusitis. ORL J Otorhinolaryngol Relat Spec 2012; 74:172-8. [PMID: 22678103 DOI: 10.1159/000338799] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 04/03/2012] [Indexed: 11/19/2022]
Abstract
Transforming growth factor-β1 (TGF-β1) plays a key role in the tissue remodeling processes involved in chronic rhinosinusitis (CRS), with the biological functions of secreted TGF-β1 regulated by multiple proteins. Among these regulators, latency-associated peptide and latent TGF-β-binding protein inhibit TGF-β1 function, whereas different proteases and integrins activate it. Progress in understanding the factors responsible for the bioactivity and expression of TGF-β1 has revealed that the dysregulation of TGF-β1 activation and expression is closely associated with the chronic respiratory inflammatory diseases involved in CRS. This review of the regulation of TGF-β1 activation and expression provides insight into the mechanism responsible for the different CRS subtypes, which will help further the investigation of novel therapy targets for the treatment of CRS.
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Affiliation(s)
- Wei Kou
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Fruth K, Goebel G, Koutsimpelas D, Gosepath J, Schmidtmann I, Mann WJ, Brieger J. Low SPINK5 expression in chronic rhinosinusitis. Laryngoscope 2012; 122:1198-204. [PMID: 22570283 DOI: 10.1002/lary.23300] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 02/16/2012] [Accepted: 02/22/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVES/HYPOTHESIS Chronic rhinosinusitis (CRS) is a multifactorial disease that probably arises as a result of genetic diversity and environmental factors. SPINK5 is a serine protease inhibitor, which is supposed to be an important regulator of epithelial barrier maintenance. The role of SPINK5 polymorphisms and expression in CRS, especially in individuals with aspirin intolerance, is unclear. STUDY DESIGN SPINK5 single-nucleotide polymorphisms (SNPs) and SPINK5 expression levels were correlated with CRS without (CRSsNP) and with nasal polyps (CRSwNP), aspirin intolerance, asthma, and allergies. METHODS One hundred four nasal tissue samples, 15 from patients with CRSsNP, 59 from patients with CRSwNP, and 30 from healthy controls of the inferior turbinate, were analyzed for their SPINK5 status. Genotypes of four SPINK5 single nucleotide polymorphism (SNPs; G1258A, G2475T, A2915G, and A1103G), as well as SPINK5 mRNA expression levels, were determined by polymerase chain reaction. RESULTS No correlation between any SPINK5 SNP and CRSsNP, CRSwNP, or allergies and asthma was observed. The heterozygous SNPs G1258A and A1103G were observed more frequently in aspirin-intolerant patients; the homozygous (A/A) genotype of SNP 1258 and the homozygous (G/G) genotype SNP 1103 were less frequent. There was no correlation between the analyzed SNPs and the level of SPINK5 expression. It was noted that in individuals with CRSwNP, aspirin intolerance, and allergies, SPINK5 expression was lowered. CONCLUSIONS G1258A and A1103G polymorphisms are distinctive for the aspirin intolerance syndrome. Lowered SPINK5 expression might be a contributing factor leading to CRS, and appears to be characteristic for patients suffering from aspirin intolerance and from allergies.
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Affiliation(s)
- Kai Fruth
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
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Impact of ozone exposure on prostaglandin release in nasal polyps. Eur Arch Otorhinolaryngol 2011; 269:1623-8. [DOI: 10.1007/s00405-011-1856-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 11/17/2011] [Indexed: 01/24/2023]
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Abstract
PURPOSE OF REVIEW There is a high incidence of nasal disorders, including chronic rhinosinusitis (CRS), affecting about 14% of the total population. Topical treatment regimens show only limited efficacy of drug delivery to the posterior nose and paranasal sinuses. Nevertheless, the primary treatment option of CRS is a combination of topical or systemic steroids, antibiotics and functional endonasal sinus surgery (FESS). RECENT FINDINGS Sinus ventilation and paranasal aerosol deposition can be achieved by using pulsating airflow. Studies using pulsating airflow in nasal casts and in healthy volunteers have shown that up to 8% of the nasally deposited drug can deposit within the sinuses, which could not be achieved using nasal pump sprays. In addition, compared with nasal pump sprays, retention kinetics of the radiolabel deposit in the nose was prolonged. SUMMARY With this efficiency, topical aerosol therapies of sinus disorders can be achieved and, due to the prolonged retention, reduced application modes are possible. This offers new treatment options of sinus-nasal disorders prior or after FESS.
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Jeong WJ, Lee CH, Cho SH, Rhee CS. Eosinophilic allergic polyp: a clinically oriented concept of nasal polyp. Otolaryngol Head Neck Surg 2010; 144:241-6. [PMID: 21493424 DOI: 10.1177/0194599810391738] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Tissue eosinophilia is a hallmark of nasal polyposis. However, there is no universally accepted definition for eosinophilic nasal polyp. The aims of this study were to histologically analyze the inflammatory cell population in the nasal polyp and propose the concept of eosinophilic allergic polyp (EAP), a simple and objective concept that would be clinically and practically valuable. STUDY DESIGN A cohort study with histological analysis of tissue sections and chart review. SETTING A tertiary university hospital. SUBJECTS AND METHODS Nasal polyp tissues were harvested during routine endoscopic sinus surgery from a cohort of 118 patients. Total number of inflammatory cells, including eosinophils, was counted. The presence of allergy and asthma was assessed, which was then correlated with the histologic findings. To determine a criterion for EAP, a receiver operating characteristic curve was used to identify the best cutoff point, which was further validated by comparing the eosinophil proportion in each group with reference to the clinical parameters. RESULTS Eosinophil accounted for an average of 18.7% of all inflammatory cells. The proportion of nasal polyps with at least 1 or more eosinophil infiltration accounted for 90.7% of all nasal polyps. When the concept of EAP was applied, a tissue eosinophil count of 11% was found to be significant and clinically most useful. Using this criterion, the proportion of EAP among nasal polyps was 62.7%. CONCLUSION The authors suggest a tissue eosinophil proportion of more than 11% as a criterion for EAP, a clinically useful concept of nasal polyp that bears good correlation with asthma and allergy.
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Affiliation(s)
- Woo-Jin Jeong
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
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Möller W, Münzing W, Canis M. Clinical potential of pulsating aerosol for sinus drug delivery. Expert Opin Drug Deliv 2010; 7:1239-45. [PMID: 20874262 DOI: 10.1517/17425247.2010.523078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is a high incidence of nasal disorders including chronic rhinosinusitis (CRS), affecting ∼ 14% of the total population. However, a topical treatment regimen shows only modest efficacy, and drug delivery to the posterior nose, osteomeatal area, and paranasal sinuses is still a challenge. Therefore, the primary treatment option of CRS is functional endonasal sinus surgery (FESS). Most nasally administered aerosolized drugs are efficiently filtered by the nasal valve and do not reach the sinuses, the site of chronic inflammation. Sinus ventilation, nasal and paranasal aerosol deposition can be achieved by using a pulsating airflow, offering new topical treatment options for nasal disorders. Inhalation studies in nasal casts and in healthy volunteers have shown up to 8% of the nasally deposited drug within the sinuses, which could not be achieved using nasal pump sprays. In addition, compared with nasal pump sprays, retention kinetics of the radiolabel deposit in the nose was prolonged by about a factor of five. With this efficiency, topical aerosol therapies of sinus disorders can be achieved and, owing to the prolonged retention, reduced application modes are possible. This offers new treatment options of sinus-nasal disorders in comparison with or after FESS.
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Affiliation(s)
- Winfried Möller
- Institute for Lung Biology and Disease, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstrasse 1, Neuherberg, Germany.
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Möller W, Schuschnig U, Khadem Saba G, Meyer G, Junge-Hülsing B, Keller M, Häussinger K. Pulsating aerosols for drug delivery to the sinuses in healthy volunteers. Otolaryngol Head Neck Surg 2010; 142:382-8. [PMID: 20172385 DOI: 10.1016/j.otohns.2009.12.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 11/02/2009] [Accepted: 12/10/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Approximately 10 to 15 percent of the European and U.S. population have chronic rhinosinusitis, but effective treatment remains a challenge. There has been limited success using topical drug delivery to the nose and the paranasal cavities/sinuses, in part because most nasally administered aerosol drug formulations are efficiently filtered at the nasal valve and fail to reach the osteomeatal area and sinuses. STUDY DESIGN Feasibility study. SETTING Nuclear medicine department. SUBJECTS AND METHODS Pulsating airflows were applied to the nasal cavity and sinus ventilation was studied in five healthy human volunteers using dynamic (81m)Kr-gas gamma camera imaging. Furthermore, deposition and retention of (99m)Tc-DTPA radiolabeled aerosols delivered by nasal pump sprays or by pulsating aerosols was assessed in each volunteer over a 24-hour period. RESULTS Only the pulsating airflow demonstrated efficient (81m)Kr-gas ventilation of the paranasal sinuses. No drug was deposited into the sinuses using nasal pump sprays, but up to 6.5 percent of the nasally administered drug was deposited into the sinuses using pulsating airflow. Clearance kinetics of the drug was reduced after pulsating aerosol delivery compared to nasal pump sprays. Residence time of the drug at the site of deposition was up to three-fold longer with pulsating aerosol delivery than with nasal pump sprays. CONCLUSION Our data support the hypothesis that topical drug delivery in relevant quantities to the nose and osteomeatal areas, including the paranasal sinuses, is possible using pulsating airflows. Furthermore, the frequency of drug applications may be reduced due to a delayed clearance and longer residence time.
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Affiliation(s)
- Winfried Möller
- Institute for Lung Biology and Disease, Helmholtz Zentrum München-German Research Center for Environmental Health, Gauting, Germany.
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Heinrich UR, Selivanova O, Schmidtmann I, Feltens R, Brieger J, Mann WJ. Noise exposure alters cyclooxygenase 1 (COX-1) and 5-lipoxygenase (5-LO) expression in the guinea pig cochlea. Acta Otolaryngol 2010. [DOI: 10.3109/00016480903168066] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zang HR, Wang T, Li YC, Zhang SZ, Fan EZ, Han DM. Value of nasal mucosa congestion index in choosing treatment strategies for chronic rhinosinusitis. Acta Otolaryngol 2009; 129:1237-41. [PMID: 19863318 DOI: 10.3109/00016480802609590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The mucosa compliance in lesions is determined by the congestion index, enabling us to determine whether the patient is sensitive to pharmacotherapy and to choose surgical management rationally. OBJECTIVE To explore the correlation between the nasal mucosa congestion index and tissue remodeling in chronic rhinosinusitis (CRS) and to provide objective evidence for clinical choice of therapeutic methods. PATIENTS AND METHODS Forty-four patients with CRS who underwent nasal endoscopic surgery were enrolled in the study. The congestion indexes of the nasal mucosa were measured using an acoustic rhinometer and specimens were taken from the uncinate process mucosa to evaluate vascular density and degree of fibrosis. The correlations were statistically analyzed. RESULTS There was an inverse correlation between the congestion index and degree of fibrosis (r=- 0.522, p=0.00) and a direct correlation between the congestion index and vascular density (r=0.838, p=0.00) in nasal mucosa. There was a significant correlation between the congestion index and the combination of degree of fibrosis and vascular density with a determination coefficient (R(2)) of 0.778.
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Affiliation(s)
- Hong-Rui Zang
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, China
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Park SY, Shin MG, Kim HR, Oh JY, Kim SH, Shin JH, Cho YB, Suh SP, Ryang DW. Alteration of mitochondrial DNA sequence and copy number in nasal polyp tissue. Mitochondrion 2009; 9:318-25. [PMID: 19426839 DOI: 10.1016/j.mito.2009.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Revised: 04/02/2009] [Accepted: 04/29/2009] [Indexed: 11/19/2022]
Abstract
This study was designed to investigate the possibility that mtDNA mutations might arise in inflammatory or chronically damaged nasal polyp tissue from 23 patients. Thirteen patients (57%) displayed nasal polyp tissue-specific mtDNA mutations in the hypervariable segment of the control region and cytochrome b gene, which were not found in the corresponding blood cells and/or adjacent normal tissue. Nasal polyp tissue-specific length heteroplasmic mutations were also detected in nucleotide position (np) 303-315 homopolymeric poly C track (39%), np 514-523 CA repeats (17%) and np 16184-16193 poly C track (30%). The average mtDNA copy number was about three times higher in nasal polyp tissue than in the corresponding peripheral blood cells and adjacent non-polyp tissues. The level of reactive oxygen species (ROS) was significantly higher in the nasal polyp tissues compared to those from the corresponding samples. High level of ROS in nasal polyp tissue may contribute to development of mtDNA mutations, which may play a crucial role in the vicious cycle of pathophysiology of nasal polyps.
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Affiliation(s)
- Sang-Young Park
- Department of Laboratory Medicine and Molecular Genetics, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, 160 Ilsimri, Hwasun-eup, Hwasun-gun, Jeollanam-do 519-809, South Korea
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Bumm K, Bohr C, Bozzato A, Wurm J. Weichteilnavigation im Kopf-Hals-Bereich und navigierte Fremdkörperentfernung. HNO 2008; 57:1016-22. [DOI: 10.1007/s00106-008-1779-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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[Analgesic intolerance (AI). Key position of ENT physicians for early detection of this condition]. HNO 2008; 56:443-50; quiz 451. [PMID: 18389300 DOI: 10.1007/s00106-008-1701-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The clinical manifestation of analgesic intolerance (AI) is frequently associated with symptoms examined by ear-nose-throat (ENT) specialists. The prevalence of AI is reported in the literature to be 0.6-2.5%. Even though there are no concluding results concerning its pathogenesis, an altered arachidonic acid metabolism is most likely the underlying pathomechanism. The symptoms include chronic rhinosinusitis with nasal polyps, asthma, gastrointestinal ulcers, angioedema, and urticaria. Clinical reactions after ingestion of nonsteroidal anti-inflammatory-drugs (NSAIDs) are often obvious in the progress of disease. In order to initiate early therapy and therefore prevent the progress of disease, the diagnosis of AI should occur before the complete picture of AI is obvious. Adaptive desensitization is currently the single causal therapy. Frequency of endonasal revision surgery is reduced after desensitization; severe asthma and reactions after ingestion of NSAIDs are avoided. ENT specialists are particularly in a key position for early detection of AI.
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Impact of Perioperative Systemic Steroids on Surgical Outcomes in Patients With Chronic Rhinosinusitis With Polyposis: Evaluation With the Novel Perioperative Sinus Endoscopy (POSE) Scoring System. Laryngoscope 2007; 117:1-28. [DOI: 10.1097/mlg.0b013e31814842f8] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Mostov PD. Treating the immunocompetent patient who presents with an upper respiratory infection: pharyngitis, sinusitis, and bronchitis. Prim Care 2007; 34:39-58. [PMID: 17481984 PMCID: PMC7119313 DOI: 10.1016/j.pop.2006.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Perry D Mostov
- Department of Family Medicine, The Ohio State University, OSU Family Practice at Worthington, 445 East Dublin Granville Road, Worthington, OH 43085, USA.
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Bhattacharyya N. Progress in surgical management of chronic rhinosinusitis and nasal polyposis. Curr Allergy Asthma Rep 2007; 7:216-20. [PMID: 17448334 DOI: 10.1007/s11882-007-0075-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endoscopic sinus surgery (ESS) remains the treatment of choice for medically refractory chronic rhinosinusitis (CRS) with or without nasal polyposis (NP). ESS has undergone review, reassessment, and substantial refinement. Several advances (eg, powered instrumentation, image guidance, adjunctive intraoperative procedures) have expanded the scope of cases amenable to ESS, decreased operative time and intraoperative blood loss, and improved safety. Procoagulant nasal/sinus packing and refinements of technique have decreased the need for postoperative removal of packing, thus decreasing morbidity. Methods to reduce synechia formation (ie, mitomycin-c) have been explored, with mixed results. Novel methods of sinusotomy (eg, balloon catheter dilatation of the sinus ostia) have had limited but interesting short-term results. We can expect further advances in ESS with better patient outcomes. However, continued elucidation of the underlying pathophysiology of CRS and NP are essential to long-term improvement.
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Affiliation(s)
- Neil Bhattacharyya
- Harvard Medical School, Division of Otolaryngology, Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02115, USA.
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Kim SSY, Wong ECK, Kalish L, Craig JC. Topical steroids for nasal polyps. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2007. [DOI: 10.1002/14651858.cd006549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
PURPOSE OF REVIEW Patients with advanced head and neck cancer are being treated with chemo-radiotherapy, and life is being prolonged, with or without persistent disease, for longer than was previously. Hypercalcaemia may present in patients with advanced or disseminated head and neck cancer, and, as such, these patients may present to a larger variety of clinicians for advice concerning their symptoms and illness. Modes of presentation of hypercalcaemia and treatment strategies are reviewed. RECENT FINDINGS There were previously few large series of head and neck cancer patients diagnosed with hypercalcaemia, which may or may not have been related to their cancer being treated. Investigations, by way of blood/serum calcium level, may identify such patients. Patients with cancer-related hypercalcaemia have a poor prognosis, but many may respond temporarily to treatment when offered, with an improvement of their quality of life and death. SUMMARY Hypercalcaemia should and must be considered in all patients who have or possibly have a diagnosis of a head and neck cancer and who present unwell with symptoms of fatigue, lethargy and somnolence. Investigation must include serum calcium (corrected for serum albumin binding) and parathyroid hormone level. Patients may be treated by a combination of rehydration and bisulphonate therapy until the serum calcium is reduced to a level below 3 mmol/l. The majority of patients diagnosed with hypercalcaemia due to head and neck malignancy die of their diseases in the short term, but some may enjoy a prolongation of life with reasonable quality if diagnosed and treated aggressively.
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Affiliation(s)
- Patrick J Bradley
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Nottingham, UK.
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