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Shariati A, Vesal S, Khoshbayan A, Goudarzi P, Darban-Sarokhalil D, Razavi S, Didehdar M, Chegini Z. Novel strategies for inhibition of bacterial biofilm in chronic rhinosinusitis. J Appl Microbiol 2021; 132:2531-2546. [PMID: 34856045 DOI: 10.1111/jam.15398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/18/2021] [Accepted: 11/29/2021] [Indexed: 12/27/2022]
Abstract
An important role has been recently reported for bacterial biofilm in the pathophysiology of chronic diseases, such as chronic rhinosinusitis (CRS). CRS, affecting sinonasal mucosa, is a persistent inflammatory condition with a high prevalence around the world. Although the exact pathological mechanism of this disease has not been elicited yet, biofilm formation is known to lead to a more significant symptom burden and major objective clinical indicators. The high prevalence of multidrug-resistant bacteria has severely restricted the application of antibiotics in recent years. Furthermore, systemic antibiotic therapy, on top of its insufficient concentration to eradicate bacteria in the sinonasal biofilm, often causes toxicity, antibiotic resistance, and an effect on the natural microbiota, in patients. Thus, coming up with alternative therapeutic options instead of systemic antibiotic therapy is emphasized in the treatment of bacterial biofilm in CRS patients. The use of topical antibiotic therapy and antibiotic eluting sinus stents that induce higher antibiotic concentration, and decrease side effects could be helpful. Besides, recent research recognized that various natural products, nitric oxide, and bacteriophage therapy, in addition to the hindered biofilm formation, could degrade the established bacterial biofilm. However, despite these improvements, new antibacterial agents and CRS biofilm interactions are complicated and need extensive research. Finally, most studies were performed in vitro, and more preclinical animal models and human studies are required to confirm the collected data. The present review is specifically discussing potential therapeutic strategies for the treatment of bacterial biofilm in CRS patients.
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Affiliation(s)
- Aref Shariati
- Molecular and Medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran
| | - Soheil Vesal
- Department of Molecular Genetics, Faculty of Basic Sciences and Advanced Technologies in Biology, University of Science and Culture, Tehran, Iran
| | - Amin Khoshbayan
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parnian Goudarzi
- Department of Microbiology and Microbial Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Davood Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Razavi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Didehdar
- Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Chegini
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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[Guideline for "rhinosinusitis"-long version : S2k guideline of the German College of General Practitioners and Family Physicians and the German Society for Oto-Rhino-Laryngology, Head and Neck Surgery]. HNO 2019; 66:38-74. [PMID: 28861645 DOI: 10.1007/s00106-017-0401-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Kim SM. Definition and management of odontogenic maxillary sinusitis. Maxillofac Plast Reconstr Surg 2019; 41:13. [PMID: 30989083 PMCID: PMC6439010 DOI: 10.1186/s40902-019-0196-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Maxillary sinusitis of odontogenic origin, also known as maxillary sinusitis of dental origin or odontogenic maxillary sinusitis (OMS), is a common disease in dental, otorhinolaryngologic, allergic, general, and maxillofacial contexts. Despite being a well-known disease entity, many cases are referred to otorhinolaryngologists by both doctors and dentists. Thus, early detection and initial diagnosis often fail to detect its odontogenic origin. Main body We searched recent databases including MEDLINE (PubMed), Embase, and the Cochrane Library using keyword combinations of "odontogenic," "odontogenic infection," "dental origin," "tooth origin," "sinusitis," "maxillary sinus," "maxillary sinusitis," "odontogenic maxillary sinusitis," "Caldwell Luc Procedure (CLP)," "rhinosinusitis," "functional endoscopic sinus surgery (FESS)," "modified endoscopy-assisted maxillary sinus surgery (MESS)," and "paranasal sinus." Aside from the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) trial, there have been very few randomized controlled trials examining OMS. We summarized the resulting data based on our diverse clinical experiences. Conclusion To promote the most efficient and accurate management of OMS, this article summarizes the clinical features of rhinosinusitis compared with OMS and the pathogenesis, microbiology, diagnosis, and results of prompt consolidated management of OMS that prevent anticipated complications. The true origin of odontogenic infections is also reviewed.
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Affiliation(s)
- Soung Min Kim
- Oral and Maxillofacial Microvascular Reconstruction LAB, Ghana Health Service, Brong Ahafo Regional Hospital, P.O. Box 27, Sunyani, Brong Ahafo Ghana.,2Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
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Abstract
BACKGROUND Nasal polyposis is a benign hyperplastic growth of nasal mucosa. There is a paucity of evidence on the prevalence and incidence of nasal polyposis. Although nasal polyps can be asymptomatic, they can cause a spectrum of nasal problems including nasal obstruction, rhinorrhoea, nasal congestion, anosmia resulting in ageusia. Nasal polyps are mostly associated with chronic rhinosinusitis, The current management of chronic rhinosinusitis with nasal polyps is controversial and is not curative. METHODS A Medline search was conducted, using the keywords 'rhinosinusitis', 'sinusitis', 'classification' and ''aetiology. FINDINGS The current treatment of nasal polyposis in chronic rhinosinusitis with nasal polyps is still challenging. Emerging research through endotypes profiling aims to better understand the complexities of this heterogeneous disease to personalise treatment and provide a cure. Randomised controlled trials aim to provide robust evidence for current management options.
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Affiliation(s)
- NH Ta
- Norfolk and Norwich University Hospital, Norwich Medical School, University of East Anglia, Norwich, UK
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Maina IW, Patel NN, Cohen NA. Understanding the Role of Biofilms and Superantigens in Chronic Rhinosinusitis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018; 6:253-262. [PMID: 30859016 PMCID: PMC6407876 DOI: 10.1007/s40136-018-0212-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW This review explores recent discoveries in our understanding of how biofilms and superantigens contribute to the pathogenesis of chronic rhinosinusitis (CRS). It also examines clinical implications and novel treatment approaches for biofilm associated CRS. RECENT FINDINGS While the role of biofilms in CRS has been studied for 14 years, research interest has now turned toward elucidating new methods of biofilm detection, microbial diversity, and novel treatment approaches. Recent studies on biofilm superantigens aim to clarify the immunological mechanisms of upper airway inflammation, particularly the type-2 response seen in nasal polyposis. SUMMARY Biofilms are a topic of research interest for their role in the pathogenesis of chronic rhinosinusitis, particularly when they elute superantigens. New studies on this topic focus on the molecular and cellular mechanisms at play.
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Affiliation(s)
- Ivy W Maina
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Neil N Patel
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Noam A Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
- Monell Chemical Senses Center, Philadelphia, PA
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6
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Dunn NM, Katial RK. Chronic Rhinosinusitis and Aspirin-Exacerbated Respiratory Disease. Immunol Allergy Clin North Am 2017; 36:503-14. [PMID: 27401622 DOI: 10.1016/j.iac.2016.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients with severe asthma and concomitant chronic rhinosinusitis often have severe, refractory upper and lower airway inflammation. This inflammation has been proposed to be similar throughout the upper and lower airways leading to the unified airways concept. This article reviews chronic rhinosinusitis with and without nasal polyps, and the subgroup with aspirin-exacerbated respiratory disease, while focusing on the relationship with asthma. Additionally, diagnosis and treatment with current and newer therapies are discussed.
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Affiliation(s)
- Neha M Dunn
- Department of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Rohit K Katial
- Department of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
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The effectiveness of topical colloidal silver in recalcitrant chronic rhinosinusitis: a randomized crossover control trial. J Otolaryngol Head Neck Surg 2017; 46:64. [PMID: 29178954 PMCID: PMC5702207 DOI: 10.1186/s40463-017-0241-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Recalcitrant chronic rhinosinusitis without polyposis (CRSsP) is a challenging condition to manage as traditional medical therapies and surgery fail to provide satisfactory clinical improvements. Colloidal silver (CS), a widely used naturopathic agent, has recently shown anti-biofilm properties both in vitro and within a rhinosinusitis animal model. To date, no trials involving humans have been published in world literature. The purpose of this study was to assess the efficacy of CS as a topical nasal spray in patients with refractory CRSsP. Methods A prospective cohort study was conducted using a convenience sample of 20 randomized patients with crossover methodology, comparing nasal sprays with CS versus saline. Patients sprayed twice daily for six weeks with the first intervention and then switched to the second for the next six weeks, with measurements made at baseline and each time point. Primary outcomes were changes in SNOT-22 and Lund-Kennedy (LK) endoscopic scores. All analysis was non-parametric and was conducted using STATA 14. Results Twenty-two patients were enrolled in the study with 20 completing the entire protocol. Mean 6-week change in SNOT-22 scores were −2.8 and 1.0 for saline and CS, respectively (p = 0.373). Similarly, mean 6-week change in LK scores were −1.4 and −1.1 for saline and CS, respectively (p = 0.794). Significant period effects were observed with the SNOT-22 score between the randomized groups. No participants experienced negative health effects directly attributable to the administration of intranasal CS. Conclusion Commercially available CS nasal spray did not demonstrate any meaningful subjective or objective improvements in patients with recalcitrant CRSsP. Trial registration NCT02403479. Registered on March 1, 2015.
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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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Abstract
Rhinitis is often seen as posing a small burden. However, rhinitis is a complex disease that is underpinned by a plethora of different mechanisms and causes. Rhinitis is frequently associated with other comorbid conditions but, by itself, is a source of considerable morbidity for patients and creates a significant financial burden on health systems worldwide. This article approaches this condition from both a phenotypic and mechanistic standpoint, focusing on the complexity of characterizing these subtypes. Developing a clearer demarcation of the currently obscure rhinitis phenotypes and endotypes will substantially improve their future prevention and treatment.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Centre of Paediatrics and Child Health, Institute of Human Development, University of Manchester, Oxford Road, Manchester M13 9WL, UK; Department of Pediatric Immunology, Royal Manchester Children's Hospital, Central Manchester University Hospitals Trust, Oxford Road, Manchester M13 9WL, UK; Allergy Department, 2nd University Pediatrics Clinic, University of Athens, Aglaia Kyriakou Childrens Hospital, Thivon & Livadeias, Athens 11527, Greece.
| | - George V Guibas
- Centre of Paediatrics and Child Health, Institute of Human Development, University of Manchester, Oxford Road, Manchester M13 9WL, UK; Department of Pediatric Immunology, Royal Manchester Children's Hospital, Central Manchester University Hospitals Trust, Oxford Road, Manchester M13 9WL, UK
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Taschieri S, Torretta S, Corbella S, Del Fabbro M, Francetti L, Lolato A, Capaccio P. Pathophysiology of sinusitis of odontogenic origin. ACTA ACUST UNITED AC 2015; 8. [DOI: 10.1111/jicd.12202] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/15/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
| | - Sara Torretta
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Stefano Corbella
- Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
| | - Alessandra Lolato
- Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
| | - Pasquale Capaccio
- Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
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Biofilm formation by clinical isolates and its relevance to clinical infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 830:1-28. [PMID: 25366218 DOI: 10.1007/978-3-319-11038-7_1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Reports of biofilms have increased exponentially in the scientific literature over the past two decades, yet the vast majority of these are basic science investigations with limited clinical relevance. Biofilm studies involving clinical isolates are most often surveys of isolate collections, but suffer from lack of standardization in methodologies for producing and assessing biofilms. In contrast, more informative clinical studies correlating biofilm formation to patient data have infrequently been reported. In this chapter, biofilm surveys of clinical isolates of aerobic and anaerobic bacteria, mycobacteria, and Candida are reviewed, as well as those pertaining to the unique situation of cystic fibrosis. In addition, the influence of host components on in vitro biofilm formation, as well as published studies documenting the clinical impact of biofilms in human infections, are presented.
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Nazzari E, Torretta S, Pignataro L, Marchisio P, Esposito S. Role of biofilm in children with recurrent upper respiratory tract infections. Eur J Clin Microbiol Infect Dis 2014; 34:421-9. [PMID: 25318897 DOI: 10.1007/s10096-014-2261-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/06/2014] [Indexed: 12/30/2022]
Abstract
Recurrent respiratory tract infections (RRTIs) are very common in children and a major challenge for pediatricians. In the last few years, bacterial biofilms have been linked to RRTIs and antibiotic resistance, and have raised serious concerns regarding the therapeutic management of recurrent middle ear diseases, chronic rhinosinusitis, and recurrent pharyngotonsillitis. This paper aims to review the new insights into biofilm-related upper respiratory tract infections in children and possible therapeutic strategies. It focuses on the clinical implications for recurrent disease and on studies in pediatric patients. Analysis of the literature showed that the involvement of bacterial biofilm in recurrent upper airway tract infections is an emerging problem that may lead to serious concerns about infection control. Despite the large amount of research within this field, detailed insight into the complex structure of bacterial biofilms and the ultrastructural and biochemical mechanisms responsible for its evasion of the immune system and resistance to treatments is currently lacking. In the future, additional emphasis should be placed on biofilm management as a component of therapeutic strategies. This goal can be attained by finding feasible methods for detecting biofilms in vivo and identifying effective methods for administering treatments that eradicate preexisting bacterial biofilms or hinder bacterial adhesion to respiratory cells.
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Affiliation(s)
- E Nazzari
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda no. 9, 20122, Milan, Italy
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Korkmaz H, Ocal B, Tatar EC, Tatar I, Ozdek A, Saylam G, Celik HH. Biofilms in chronic rhinosinusitis with polyps: is eradication possible? Eur Arch Otorhinolaryngol 2014; 271:2695-702. [PMID: 24510176 DOI: 10.1007/s00405-013-2756-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/02/2013] [Indexed: 10/25/2022]
Abstract
The objective of the study was to reveal if mometasone furoate nasal spray as monotherapy or combined with long-term oral clarithromycin have influence on biofilms in chronic rhinosinusitis with polyps. The study is a randomized controlled trial in a tertiary referral hospital. Thirty-four patients with chronic rhinosinusitis completed the study. In the first group, 19 patients received mometasone furoate nasal spray 200 μg once daily for 8 weeks. In the second group, 15 patients received oral clarithromycin 500 mg twice daily for 2 weeks and continued once daily 250 mg tablet for subsequent 6 weeks, plus mometasone furoate. Scanning electron microscopy was the primary outcome measure. Secondary outcome measures included computerized tomography and sinonasal outcome test-20 items. Mucosal biofilms were detected in 23 of 34 (68%) patients on pretreatment polyp samples. After the treatment, biofilms disappeared in 1 of 11 patients in the first group, whereas the eradication of biofilms was evident in 6 of 12 (50%) patients in the second group. Tomography scores improved in eight patients of each group (42.1 and 53.4%, respectively). The comparison of improvements did not reveal significant difference between the groups. The overall symptom scores improved compared to the baseline levels. The mean changes of -8.8421 and -11.4000 in the first and second group, respectively, were not statistically different. Adding long-term low-dose oral macrolides to nasal steroids was effective in the eradication of biofilm. However, we were not able to demonstrate that combined therapy was superior in terms of the improvement in tomography and symptom scores.
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Affiliation(s)
- Hakan Korkmaz
- Department of Otolaryngology, Yıldırım Beyazıt University Medical School, Ankara, Turkey
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14
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Colloidal silver: a novel treatment forStaphylococcus aureusbiofilms? Int Forum Allergy Rhinol 2014; 4:171-5. [DOI: 10.1002/alr.21259] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 10/13/2013] [Accepted: 10/22/2013] [Indexed: 11/07/2022]
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Goggin R, Jardeleza C, Wormald PJ, Vreugde S. Corticosteroids directly reduceStaphylococcus aureusbiofilm growth: An in vitro study. Laryngoscope 2013; 124:602-7. [DOI: 10.1002/lary.24322] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/30/2013] [Accepted: 06/30/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Rachel Goggin
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; Queen Elizabeth Hospital and the University of Adelaide; Adelaide South Australia Australia
| | - Camille Jardeleza
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; Queen Elizabeth Hospital and the University of Adelaide; Adelaide South Australia Australia
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; Queen Elizabeth Hospital and the University of Adelaide; Adelaide South Australia Australia
| | - Sarah Vreugde
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; Queen Elizabeth Hospital and the University of Adelaide; Adelaide South Australia Australia
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Abstract
Chronic rhinosinusitis (CRS) affects nearly 37 million people in the United States each year and accounts for approximately $6 billion in direct and indirect health care costs. Despite its prevalence and significant impact, little is known about its exact cause and pathophysiology, and significant controversy remains regarding appropriate treatment options. Basic science research, however, has shown recent promise toward improving understanding of the innate and environmental factors underlying the pathophysiology of CRS. The hope is that this will also lead to advances in treatment for children adversely affected by this common yet complicated disease.
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Affiliation(s)
- Austin S Rose
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7070, USA.
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17
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Current world literature. Curr Opin Allergy Clin Immunol 2013; 13:119-24. [PMID: 23242117 DOI: 10.1097/aci.0b013e32835cb509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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