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Shires CB, Boughter JD, Cox S. Multidisciplinary approach to severe intracranial, intraorbital allergic fungal sinusitis. Am J Otolaryngol 2024; 45:104478. [PMID: 39098127 DOI: 10.1016/j.amjoto.2024.104478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 07/27/2024] [Accepted: 07/31/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Allergic fungal sinusitis (AFS) is a form of paranasal mycosis that often involves bone destruction and can extend into the orbit and anterior skull base. Intracranial and intraorbital involvement are published but not both in each included patient of a series. The purpose of the present study was to review cases of extensive AFS with orbital or/and skull base erosion, including the presenting symptoms, patient socioeconomic background, imaging features, surgical technique, and post-operative outcomes. METHODS The records of 30 patients with the histological diagnosis of AFS and both intracranial and intraorbital involvement were reviewed. RESULTS The average age of the patients was 25.2 years. 83 % of patients were male. 70 % were African American. 66 % of patients had Medicaid or were uninsured. Presenting symptoms were headaches (80 %), nasal obstruction (33 %), proptosis (40 %), vision change (23 %), facial pressure (10 %), and decreased sense of smell (7 %). 100 % of patients had bone erosion observed on computerized tomography scans with disease extending intracranially through the anterior skull base or posterior wall of the frontal sinus along with disease that eroded through the lamina papyracea. All patients had failed medical management. All patients underwent surgery by Otolaryngology, Ophthalmology, and Neurosurgery with transnasal endoscopic approaches and orbitotomy. 80 % also underwent a bifrontal craniotomy for removal of intracranial extradural disease with cranialization. 53 % of patients had orbital implants remaining after surgery; 23 % had nasal stents. There were no postoperative cerebrospinal fluid leaks. Average hospital stay was 4.8 days. Preoperatively, 13 % of patients underwent allergy testing. 94 % saw an Allergist postoperatively. 21 % required follow up surgery. CONCLUSIONS A team approach of Otolaryngologists, Ophthalmologists, and Neurosurgeons is recommended for this slowly growing but locally destructive disease. Most patients with AFS will present with headaches and nasal obstruction. While most cases of AFS can be successfully managed with transnasal endoscopic techniques, orbitotomy and craniotomy represents an effective treatment for severe AFS cases with extensive intracranial and intraorbital involvement. This disease is found most commonly in young African American males and in the underinsured.
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Affiliation(s)
| | - John D Boughter
- Department of Anatomy & Neurobiology - University of Tennessee Health Science Center, Memphis, TN, USA
| | - Steven Cox
- My Michigan Ear, Nose & Throat, Midland, MI, USA
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Bashir MBA, Pullerits T, Ekerljung L, Backman H, Wennergren G, Kankaanranta H, Nwaru BI. Socioeconomic status and different forms of rhinitis in Swedish adults. Clin Transl Allergy 2024; 14:e12374. [PMID: 38898553 PMCID: PMC11186741 DOI: 10.1002/clt2.12374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/17/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Rhinitis encompasses diverse forms. Each form has distinct pathophysiology and clinical manifestations and may be influenced by differential risk factors. The association between socioeconomic status (SES) and different forms of rhinitis remains poorly understood. Our aim was to examine SES variations in allergic rhinitis, chronic rhinitis, and chronic rhinosinusitis in adults. METHODS Based on a 2016 postal questionnaire survey within the West Sweden Asthma Study, we analyzed data from 36,213 subjects aged 16-75 years. The measures of SES were levels of education and occupation. Adjusted logistic regression was used to examine associations between SES and the rhinitis outcomes. RESULTS Attaining a secondary school and tertiary education, compared to a primary school, were associated with increased risk of allergic rhinitis (secondary OR 1.33, 95% CI 1.22-1.45; tertiary 1.54, 1.41-1.69) and chronic rhinitis (secondary 1.18, 1.08-1.29; tertiary 1.17, 1.06-1.28). The influence of occupation was consistent with respect to allergic rhinitis. For instance, compared to the lowest occupational skill level, the highest level (OR 1.24, 95% CI 1.04-1.48) and the lower high occupation levels (1.24, 1.04-1.49) were associated with an increased risk of allergic rhinitis. No significant link was found between education and chronic rhinosinusitis or between occupation levels and risk of either chronic rhinitis or chronic rhinosinusitis. CONCLUSION Individuals with higher education and those at higher occupational levels may be at higher risk of having different forms of rhinitis than those at lower education and occupation levels. Assessment of rhinitis burden via SES can be one strategy to develop preventive strategies.
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Affiliation(s)
- Muwada Bashir Awad Bashir
- Krefting Research CentreDepartment of Internal Medicine and Clinical NutritionInstitute of Medicine, University of GothenburgGothenburgSweden
| | - Teet Pullerits
- Krefting Research CentreUniversity of GothenburgGothenburgSweden
- Respiratory Medicine and AllergyDepartment of Internal Medicine & Clinical NutritionInstitute of MedicineUniversity of GothenburgGothenburgSweden
- Section of AllergologySahlgrenska University HospitalGothenburgSweden
| | - Linda Ekerljung
- Krefting Research CentreDepartment of Internal Medicine and Clinical NutritionInstitute of Medicine, University of GothenburgGothenburgSweden
| | - Helena Backman
- Department of Public Health and Clinical MedicineSection of Sustainable Health/the OLIN UnitUmeå UniversityUmeåSweden
| | - Göran Wennergren
- Department of PediatricsUniversity of GothenburgGothenburgSweden
| | - Hannu Kankaanranta
- Krefting Research CentreDepartment of Internal Medicine and Clinical NutritionInstitute of Medicine, University of GothenburgGothenburgSweden
- Department of Respiratory MedicineSeinäjoki Central HospitalSeinäjokiFinland
- Faculty of Medicine and Health TechnologyTampere University Respiratory Research GroupTampere UniversityTampereFinland
| | - Bright I. Nwaru
- Krefting Research CentreDepartment of Internal Medicine and Clinical NutritionInstitute of Medicine, University of GothenburgGothenburgSweden
- Wallenberg Centre for Molecular and Translational MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
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Gutierrez JA, Khan S, Chapurin N, Schlosser RJ, Soler ZM. Factors Impacting Follow-Up Care in Allergic Fungal Rhinosinusitis. Otolaryngol Head Neck Surg 2024; 170:577-585. [PMID: 37925622 DOI: 10.1002/ohn.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVE The purpose of this study was to analyze barriers to medical care and follow-up in patients with allergic fungal rhinosinusitis (AFRS). STUDY DESIGN Cross-sectional questionnaire-based study with retrospective chart review. SETTING Tertiary Medical Center. METHODS Subjects with AFRS and chronic rhinosinusitis with nasal polyps (CRSwNP) were prospectively recruited for completion of the Barriers to Care Questionnaire (BCQ) and formal chart review. RESULTS Fifty-nine AFRS and 51 CRSwNP patients participated. AFRS patients were more likely to be lost to follow-up within 6 months of surgery (35.6% vs 17.7%, P = 0.04) and no-show at least 1 appointment (20.3% vs 5.9%, P = 0.03) compared to CRSwNP patients. Men with AFRS were more likely to have only a single follow-up visit (37.0% vs 3.1%, P < 0.001) and be lost to follow-up (66.7% vs 9.4%, P < 0.001) than women. There were no significant differences in the BCQ between groups; however, rate of questionnaire completion was lower in the AFRS group than the CRS group (62.7% vs 80.4%, P = 0.042). AFRS patients who did not complete the BCQ were more likely to be male (63.6% vs 35.1%, P = 0.034), lost to follow-up (77.3% vs 10.8%, P < 0.0001), and have a single follow-up visit (40.9% vs 5.4%, P < 0.0001). Younger age was associated with increased likelihood of having a single follow-up visit (odds ratio 1.143, 95% CI 1.022-1.276). CONCLUSION Young, male AFRS patients are more frequently lost to follow-up after surgery and less likely to complete questionnaires assessing barriers to care. Further investigation is needed to assess barriers to follow-up in these at-risk groups.
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Affiliation(s)
- Jorge A Gutierrez
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sofia Khan
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nikita Chapurin
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Gutierrez JA, Durrant FG, Nguyen SA, Chapurin N, Schlosser RJ, Soler ZM. Association between Social Determinants of Health and Allergic Fungal Rhinosinusitis: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2023; 169:1101-1113. [PMID: 37293865 DOI: 10.1002/ohn.396] [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: 01/24/2023] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Some previous studies have shown an increased prevalence of allergic fungal rhinosinusitis (AFRS) among young, black patients with poor access to health care; however, results have been mixed. The purpose of this study was to investigate the relationship between social determinants of health and AFRS. DATA SOURCES PubMed, Scopus, CINAHL. REVIEW METHODS A systematic review was performed searching for articles published from date of inception to September 29, 2022. English language articles describing the relationship between social determinants of health (i.e., race, insurance status) and AFRS as compared to chronic rhinosinusitis (CRS) were selected for inclusion. A Meta-analysis of proportions with comparison (Δ) of weighted proportions was conducted. RESULTS A total of 21 articles with 1605 patients were selected for inclusion. The proportion of black patients among AFRS, chronic rhinosinusitis with nasal polyps (CRSwNP), and chronic rhinosinusitis without nasal polyps (CRSsNP) groups was 58.0% [45.3%-70.1%], 23.8% [14.1%-35.2%], and 13.0% [5.1%-24.0%], respectively. This was significantly higher among the AFRS population compared to both the CRSwNP population (Δ34.2% [28.4%-39.6%], p < .0001) and the CRSsNP population (Δ44.9% [38.4%-50.6%], p < .0001). The proportion of patients who were either uninsured or covered by Medicaid among the AFRS, CRSwNP, and CRSsNP populations was 31.5% [25.4%-38.1%], 8.6% [0.7%-23.8%], and 5.0% [0.3%-14.8%], respectively. This was significantly higher among the AFRS group than the CRSwNP group (Δ22.9% [15.3%-31.1%], p < .0001) and the CRSsNP group (Δ26.5% [19.1%-33.4%], p < .0001). CONCLUSION This study confirms that AFRS patients are more likely to be Black and either uninsured or on subsidized insurance than their CRS counterparts.
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Affiliation(s)
- Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Frederick G Durrant
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nikita Chapurin
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Xu T, Guo XT, Zhou YC, Zhou Q, Wang YF. Consideration of the Clinical Diagnosis of Allergic Fungal Sinusitis: A Single-Center Retrospective Study. EAR, NOSE & THROAT JOURNAL 2023:1455613231167247. [PMID: 37019648 DOI: 10.1177/01455613231167247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION Allergic fungal rhinosinusitis (AFRS) is characterized by refractory and high recurrence rate. Improper treatment may lead to repeated recurrence and even serious complications, including vision loss, blindness, and intracranial complications. However, AFRS is easy to be misdiagnosed clinically. OBJECTIVE To ensure early diagnosis, the clinical presentations of patients with AFRS were studied. METHODS Data from patients with sinusitis hospitalized in the First Affiliated Hospital of the University of Science and Technology of China (USTC) from January 2015 to October 2022 were collected. The patients were divided into three groups; group A patients with AFRS, group B patients suspected of AFRS, and group C patients with fungus ball sinusitis (FBS).We retrospectively analyzed the data using IBM SPSS 19.0 to perform the chi-square test and one-way ANOVA test. RESULTS In total, 35 cases of AFRS, 91 cases of suspected AFRS, and 661 cases of FBS were rediagnosed. Compared with FBS patients, AFRS patients were younger, the total IgE, the percentage of eosinophils and basophils in peripheral blood were higher, and the proportion of patients with allergic rhinitis, asthma or hypo olfactory was higher. It had a higher recurrence rate. These results were also observed in the comparison between suspected AFRS patients and FBS patients, but no significant difference was found in the comparison between suspected AFRS patients and suspected AFRS patients. CONCLUSIONS AND SIGNIFICANCE AFRS may be misdiagnosed due to the low detection of fungi. To ensure early diagnosis, we recommend that patients with clinical, radiological, and laboratory features similar to those of AFRS but without evidence of fungal staining be treated according to the treatment criteria of AFRS.
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Affiliation(s)
- Tao Xu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiao-Tao Guo
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yi-Cui Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Qian Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yin-Feng Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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Kim J, Waugh DW, Zaitchik BF, Luong A, Bergmark R, Lam K, Roland L, Levy J, Lee JT, Cho DY, Ramanathan M, Baroody F, Takashima M, O'Brien D, Lin SY, Joe S, Chaaban MR, Butrymowicz A, Smith S, Mullings W, Smith S, Mullings W. Climate change, the environment, and rhinologic disease. Int Forum Allergy Rhinol 2022; 13:865-876. [PMID: 36575965 DOI: 10.1002/alr.23128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/07/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The escalating negative impact of climate change on our environment has the potential to result in significant morbidity of rhinologic diseases. METHODS Evidence based review of examples of rhinologic diseases including allergic and nonallergic rhinitis, chronic rhinosinusitis, and allergic fungal rhinosinusitis was performed. RESULTS The lower socioeconomic population, including historically oppressed groups, will be disproportionately affected. CONCLUSIONS We need a systematic approach to improve healthcare database infrastructure and funding to promote diverse scientific collaboration to address these healthcare needs.
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Affiliation(s)
- Jean Kim
- Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Darryn W Waugh
- Earth and Planetary Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Benjamin F Zaitchik
- Earth and Planetary Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amber Luong
- Otolaryngology-Head and Neck Surgery, McGovern Medical School of University of Texas Health Science Center, Houston, Texas, USA
| | - Regan Bergmark
- Otolaryngology-Head and Neck Surgery, Harvard Medical School and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kent Lam
- Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Lauren Roland
- Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri, USA
| | - Joshua Levy
- Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jivianne T Lee
- Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Do-Yeon Cho
- Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Murugappan Ramanathan
- Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois, USA
| | - Mas Takashima
- Otolaryngology-Head and Neck Surgery, Houston Methodist Research Institute, Houston, Texas, USA
| | - Daniel O'Brien
- Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Y Lin
- Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Stephanie Joe
- Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mohamad R Chaaban
- Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio, USA
| | - Anna Butrymowicz
- Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Stephanie Smith
- Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Warren Mullings
- Otolaryngology-Head and Neck Surgery, Ear, Nose and Throat Department, Kingston Public Hospital, Kingston, Jamaica
| | - Stephanie Smith
- Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Warren Mullings
- Otolaryngology-Head and Neck Surgery, Ear, Nose and Throat Department, Kingston Public Hospital, Kingston, Jamaica
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Salman FM, Dasgupta R, Eldeirawi KM, Nyenhuis SM, Lee VS. Demographic Factors and Comorbid Conditions Related to Health Care Presentation Among Patients With Sinusitis. Am J Rhinol Allergy 2022; 36:884-889. [PMID: 35837693 DOI: 10.1177/19458924221112130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Social determinants of health (SDOH) and comorbid conditions (CMCs) influence the setting of presentation for care; however, few studies have explored this relationship in the context of sinus disease. OBJECTIVE This study aims to characterize the relationship of SDOH and CMCs with acuity of health care presentation setting in adults with sinusitis. METHODS A retrospective analysis based on medical records (demographics, visit types, and ICD-10 codes) of 1842 adult patients presenting with sinusitis to an urban academic medical center was conducted. Chi-square analysis was used to assess bivariate associations of SDOH (age, race/ethnicity, sex, insurance type, and employment status) and CMCs (depression, body mass index [BMI], allergy, and gastroesophageal reflux disease [GERD]) with high-acuity visit types-including emergency department (ED) and inpatient visits. Multivariable binary logistic regression was performed to examine the adjusted associations between SDOH and high-acuity visits. RESULTS The sample's mean age was 46.8 years, with 68.5% females and 31.5% males. In adjusted models, the odds of high-acuity visit presentation was higher for males than females (odds ratio [OR]: 1.57; confidence interval [CI]: 1.22-2.01); non-Hispanic Blacks (OR: 2.21; CI: 1.58-3.09) as well as Hispanics/Latinos (OR: 2.10; CI:1.43-3.08) than Whites; unemployed (OR: 1.90; CI: 1.47-2.46.) than employed. Age was positively associated with high-acuity presentation. While GERD was associated with increased odds of high-acuity presentation (OR: 2.80; CI: 1.64-4.78), BMI, allergy, and depression did not have a statistically significant association with these visit types. These associations were independent of insurance coverage, which was not statistically associated with high-acuity visits. CONCLUSION SDOH and CMCs were associated with high-acuity healthcare presentation in adults with sinusitis. While this study highlights how SDOH affect healthcare usage patterns among people with sinusitis, further investigation is needed to identify and address the causes of these patterns.
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Affiliation(s)
- Farhan M Salman
- 14681Department of Otolaryngology, Head and Neck Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Raktima Dasgupta
- Division of Health Policy and Administration, School of Public Health, 14681University of Illinois Chicago, Chicago, IL, USA
| | - Kamal M Eldeirawi
- 14681Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Sharmilee M Nyenhuis
- 123964Department of Pediatrics, Section of Allergy and Immunology, University of Chicago, Chicago, IL, USA
| | - Victoria S Lee
- 14681Department of Otolaryngology, Head and Neck Surgery, University of Illinois Chicago, Chicago, IL, USA
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AlQahtani A, Alim B, Almudhaibery F, Mulafikh D, Almutairi S, Almohanna S, Alfawwaz F. The Impact of Climatic, Socioeconomic, and Geographic Factors on the Prevalence of Allergic Fungal Rhinosinusitis: A Worldwide Ecological Study. Am J Rhinol Allergy 2022; 36:423-431. [PMID: 35187957 DOI: 10.1177/19458924211069226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The prevalence of allergic fungal rhinosinusitis (AFRS) and its associated risk factors have been an issue of debate. Some epidemiological factors have been correlated to the disease prevalence. OBJECTIVES To observe the prevalence pattern of AFRS worldwide and to investigate the effect of specific epidemiological factors on the disease prevalence. METHODS A systematic review was derived from 1983 to December 2018. Data on the prevalence of AFRS were collected from the selected studies. Relevant factors assessing each city's climate, socioeconomics and geography were used to study the association with AFRS prevalence. RESULTS 35 cities across 5 continents were investigated. The worldwide average rate of AFRS in CRS cases is 7.8% (0.2%-26.7%) in which more than half of the investigated cities (57%) had low AFRS prevalence, while the remaining cities had intermediate (11%) and high (32%) prevalence. Cities with higher temperatures were associated with a higher prevalence of AFRS (p-value 0.002), whereas cities with humid continental climate were significantly associated with a low prevalence of AFRS (p-value 0.032). Humidity and wind speed were lower in the cities with higher AFRS prevalence (p-value 0.018 and 0.008, respectively). There were no significant correlations between AFRS prevalence and economic levels, presence of water bodies, rainfall amounts, altitude, and presence of forests. CONCLUSION AFRS has a worldwide distribution pattern with varying prevalence. In this ecological study, we observed a correlation between AFRS prevalence and climatic factors (climate classification, humidity, temperature, and wind speed). Socioeconomic factors should be analyzed on an individual basis for better assessment of the relationship with disease prevalence.
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Affiliation(s)
| | - Bader Alim
- King Fahad Medical City, Riyadh, Saudi Arabia
| | | | | | | | - Saad Almohanna
- Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
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Sedaghat AR, Kuan EC, Scadding GK. Epidemiology of Chronic Rhinosinusitis: Prevalence and Risk Factors. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1395-1403. [PMID: 35092822 DOI: 10.1016/j.jaip.2022.01.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/30/2021] [Accepted: 01/16/2022] [Indexed: 12/16/2022]
Abstract
Knowledge of chronic rhinosinusitis (CRS) epidemiology may directly impact patient care: aiding patient identification and establishing accurate diagnosis as well as informing treatment decisions. The objective of this review is to summarize the current evidence on the epidemiology of CRS, with a focus on prevalence and risk factors. Although the presence of either symptoms or objective findings alone have yielded CRS prevalence estimates of over 10%, the presence of both-consistent with guideline-based diagnostic criteria for CRS-has suggested that the true prevalence of CRS is consistently less than 5%, with approximately one-third of patients with CRS having nasal polyps, in epidemiologic studies from around the world. In comparison, the prevalence of CRS endotypes-pathophysiologic subclassification of CRS most commonly as related to type 2 or non-type 2 inflammation-has been found to vary significantly by region. The epidemiology of CRS is modified and ultimately determined by risk factors: genetic/hereditary, demographic, environmental, and imparted by predictive pre-/comorbid disease. The understanding of these epidemiologic relationships may help the provider to optimally identify and understand each individual's CRS disease process, thereby improving both diagnosis and treatment.
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Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Edward C Kuan
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine, Orange, Calif
| | - Glenis K Scadding
- Royal National ENT Hospital, University College Hospitals London, London, United Kingdom; Division of Infection and Immunity, University College London, London, United Kingdom
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Shih LC, Hsieh BH, Ma JH, Huang SS, Tsou YA, Lin CD, Huang KH, Tai CJ. A comparison of central compartment atopic disease and lateral dominant nasal polyps. Int Forum Allergy Rhinol 2022; 12:1387-1396. [PMID: 35347864 DOI: 10.1002/alr.22996] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/24/2022] [Accepted: 03/07/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The characteristics and surgical outcomes of central compartment atopic disease (CCAD) vary by region and race. Therefore, we aimed to identify the risk factors, symptom severity, and prognosis of CCAD in the Asian population. METHODS This case-control study recruited patients diagnosed with chronic rhinosinusitis with nasal polyps who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. Patients were classified into CCAD and lateral-dominant nasal polyp (LDNP) groups based on endoscopic and computed tomography imaging findings. The demographic data, symptom severity scores, and surgical outcomes of the 2 groups were analyzed. RESULTS Our study included 442 patients (CCAD group: n = 51; LDNP group: n = 391). We found that CCAD was strongly related to both asthma (9.8% vs 3.5%, p = 0.04) and allergic rhinitis symptoms (43.3% vs 26.6%, p = 0.01). Higher eosinophil counts were detected in blood serum (5.8% vs 2.8%, p < 0.01) and histopathologic profiles (57.0 vs 17.3, p < 0.01) among patients with CCAD. Improvements in 22-item Sino-Nasal Outcome Test (SNOT-22) score and mucociliary clearance time (MCT) after surgical intervention revealed that the CCAD group had a better response to FESS (SNOT-22 score: -31.82 vs -22.66, p < 0.01; MCT: -233.06 vs -191.93 seconds, p = 0.03). The revision FESS rate was not different between the 2 groups. CONCLUSION Polyps originating from the central compartment were found to be related to asthma and allergic rhinitis in Taiwanese patients. A higher eosinophil count was suggested in both serum and local nasal tissue from patients with CCAD. FESS serves as an effective treatment for symptom relief in patients with CCAD.
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Affiliation(s)
- Liang-Chun Shih
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Bing-Han Hsieh
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Jia-Hung Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shuang-Shuang Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yung-An Tsou
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Der Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Chih-Jaan Tai
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Department of Health Services Administration, China Medical University, Taichung, Taiwan
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11
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Levine CG, Casiano RR, Lee DJ, Mantero A, Liu XZ, Palacio AM. Chronic Rhinosinusitis Disease Disparity in the South Florida Hispanic Population. Laryngoscope 2021; 131:2659-2665. [PMID: 34254684 DOI: 10.1002/lary.29664] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/28/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The role of social determinants of health in chronic rhinosinusitis (CRS) is poorly characterized. Limited research examining CRS health disparities indicates that minority status is associated with worse CRS. However, many of these studies are retrospective or performed in populations without substantial ethnic minorities. Rhinologists need to characterize existing CRS disease disparities to develop targeted strategies for improving care in these populations. This prospective study assesses preoperative CRS disease burden in South Florida (SFL) Hispanic and non-Hispanic patients and examines potential factors contributing CRS disease disparities. STUDY DESIGN Prospective cohort study. METHODS The prospective cohort study included consecutive patients having primary endoscopic sinus surgery (ESS) for CRS between September 2019 and February 2020 with complete preoperative data. Data were collected in clinic and surgery. Descriptive statistics compare Hispanic and non-Hispanic cohorts. Linear regression adjusts for confounders. Relative risk (RR) compared CRS severity markers. RESULTS Thirty-eight Hispanic and 56 non-Hispanic patients met inclusion criteria. Age, sex, CT scores, insurance payer, and comorbidities were similar between cohorts. Hispanics presented with worse 22-item Sinonasal Outcome Test (SNOT-22) (55; SD = 18) compared to non-Hispanics (37; SD = 22) (P < .001). Hispanics tended to have a higher risk of severe CRS markers, including nasal polyps RR = 2.5 (95% CI: 1.0-5.9), neo-osteogenesis RR = 1.6 (95% CI: 0.5-4.7), extended procedures (i.e., draft III) RR = 2.97 (95% CI: 1.0-9.1), and tissue eosinophilia RR = 1.46 (95% CI: 0.6-3.5). Hispanics reported longer sinonasal symptom duration. CONCLUSIONS SFL hispanic patients presenting for primary ESS have worse sinonasal disease burden. SFL Hispanics have markers of greater CRS severity and report longer delays before receiving CRS care. These factors may contribute to increased sinonasal disease burden in Hispanic patients. LEVEL OF EVIDENCE 3 Laryngoscope, 131:2659-2665, 2021.
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Affiliation(s)
- Corinna G Levine
- Department of Otolaryngology- Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Roy R Casiano
- Department of Otolaryngology- Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - David J Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Alejandro Mantero
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Xue Zhong Liu
- Department of Otolaryngology- Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Ana M Palacio
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
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12
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Suzuki M, Connell J, Psaltis AJ. Pediatric allergic fungal rhinosinusitis: optimizing outcomes. Curr Opin Otolaryngol Head Neck Surg 2021; 29:510-516. [PMID: 34545860 DOI: 10.1097/moo.0000000000000761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Allergic fungal rhinosinusitis (AFRS) is a debilitating condition for children. Despite there being several reviews on this topic in the adult population, there is a paucity of reviews of AFRS in the pediatric literature. This article reviews the recent evidence of pediatric AFRS with the aim to optimize outcomes of pediatric patients with this condition. RECENT FINDINGS AFRS is clinically characterized by nasal polyposis, a type I hypersensitivity to fungal epitopes, very thick eosinophilic mucin, and peripheral eosinophilia. Pediatric AFRS has similar clinical characteristics to that in adults but is thought to have a more aggressive nature, with higher serum immunoglobulin E and more frequently bone erosion and malformation of facial bones. Diagnosis of pediatric AFRS is made by using the Bent and Kuhn's criteria developed for adult AFRS. The mainstay of treatment is surgery followed by postoperative corticosteroids. Adjunctive therapies, including topical/oral antifungal agents, allergen immunotherapy and biologics may improve outcomes in pediatric AFRS, but to date the current evidence is limited. SUMMARY To optimize the outcome of pediatric AFRS, adequate and early diagnosis and treatment are essential. Appropriate and comprehensive endoscopic sinus surgery to open the sinuses, remove the fungal burden of disease and improve access of the sinuses to postoperative topical corticosteroid remains the standard of care.
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Affiliation(s)
- Masanobu Suzuki
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the Department of Surgery, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - James Connell
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the Department of Surgery, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Alkis James Psaltis
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the Department of Surgery, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
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13
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Ma C, Mehta NK, Nguyen SA, Gudis DA, Miglani A, Schlosser RJ. Demographic Variation in Chronic Rhinosinusitis by Subtype and Region: A Systematic Review. Am J Rhinol Allergy 2021; 36:367-377. [PMID: 34825572 DOI: 10.1177/19458924211056294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) describes a heterogenous group of diseases including CRS with (CRSwNP) or without nasal polyps (CRSsNP), aspirin-exacerbated respiratory disease (AERD), and allergic fungal rhinosinusitis (AFRS). It affects 10 to 15% of the US population and is more common in women and White patients. However, these estimates are based on survey and database studies with innate diagnostic inaccuracy. Additionally, few studies report subtype-specific demographics. We explore the demographic differences of CRS in the U.S. by subtype and region. OBJECTIVE To characterize demographic differences between the CRS population and the overall US population, and also between different CRS subtype populations. METHODS We performed a systematic review for articles reporting on US demographics of adults with CRS. Study participants were required to have been diagnosed using consensus criteria. Data on demographics, geographic region, and CRS subtype were analyzed. RESULTS Our study analyzed 31 unique studies representing 8409 patients with 50.7% females and weighted mean age of 48.0 years. Compared to the overall US population, CRS patients were predominantly White (78.5%) and non-Hispanic (94.5%) with under-representation of other races. Grouped by subtype, CRSwNP affected a significantly higher proportion of men (59.8%). AFRS affected a significantly higher proportion of Black patients (53.8%) while CRSsNP was more prevalent in White patients (84.2%). When grouped by region, the South had a significantly higher proportion of female (53%) and Black (17.8%) CRS patients. The West had a significantly higher proportion of Asian (4.5%) and Hispanic (12.3%) patients. CONCLUSIONS Significant demographic differences exist in CRS patients based on subtype and region. These data provide an estimation of the demographic make-up of CRS, but further high-level demographic studies are needed.
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Affiliation(s)
- Cheng Ma
- 2345Medical University of South Carolina, Charleston, South Carolina, USA
| | - Neil K Mehta
- 2345Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- 2345Medical University of South Carolina, Charleston, South Carolina, USA
| | - David A Gudis
- New York-Presbyterian Hospital, 5798Columbia University, New York, New York, USA
| | - Amar Miglani
- 2345Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rodney J Schlosser
- 2345Medical University of South Carolina, Charleston, South Carolina, USA
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14
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Abstract
Allergic fungal sinusitis (AFS) is the most common type of fungal sinus infection. AFS is a robust allergic reaction to inhaled soil fungi that causes sinus inflammation, and the fungal debris then accumulates in the sinus cavities. This accumulation can cause nasal polyps, facial pain and pressure, bone remodeling of the face, and even bone erosion, which can cause damage to the eyes and brain. AFS can also cause thick, sticky nasal mucus and postnasal drip, and it can affect the sense of smell. Most patients with AFS are adolescents who also have chronic symptoms of allergic rhinitis and asthma. Endoscopic sinus surgery to remove the disease and open the sinus cavities is the main treatment approach. Adjuvant immunotherapy is helpful in reducing the inflammatory response and preventing future recurrence of this allergy-mediated condition. [Pediatr Ann. 2021;50(7):e297-e303.].
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15
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Philpott C, Ta NH, Hopkins C, Ray J, Ahmed S, Almeyda R, Kara N, Carrie S, Erskine SE, Cathcart R, Sunkaraneni V, Robertson A, Anari S, Kumar BN, Clark A. Socioeconomic, comorbidity, lifestyle, and quality of life comparisons between chronic rhinosinusitis phenotypes. Laryngoscope 2021; 131:2179-2186. [PMID: 33769590 DOI: 10.1002/lary.29527] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/11/2021] [Accepted: 03/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous group of inflammatory sinonasal disorders with key defining symptoms, but traditionally separated into phenotypes by clinical/endoscopic findings. It is not known whether the two phenotypes have differing socioeconomic, comorbidity, and lifestyle differences. This analysis of the Chronic Rhinosinusitis Epidemiology Study (CRES) database sought to analyze any key differences in the socioeconomic variables between those with CRS with nasal polyps (CRSwNPs) and those without nasal polyps (CRSsNPs). We also sought to analyze differences in comorbidities, lifestyle, and quality of life. METHODS Patients with a confirmed diagnosis of CRS in secondary and tertiary care outpatient settings in the UK were invited to participate in a questionnaire-based case-control study. Variables included demographics, socioeconomic factors, comorbidities, lifestyle factors, and health-related quality of life (HRQoL) (level 3 evidence). RESULTS A total of 1204 patients' data were analyzed: 553 CRSsNP and 651 CRSwNP participants. The key socioeconomic variables did not demonstrate any notable differences, nor did lifestyle variables other than alcohol consumption being higher in those with CRSwNP (P = .032), but the latter was not significant after adjusting for age and sex. Aside from confirmation of asthma being more common in CRSwNP, it was notable that this group complained less of upper respiratory tract infections (URTIs), and CRSsNP participants showed evidence of worse HRQoL scores in respect of body pain (P = .001). CONCLUSIONS Patients with CRSwNP experience higher rates of asthma and lower rates of URTIs; patients with CRSsNP have worse body pain scores. Otherwise, there are no demonstrable significant socioeconomic, comorbidity, lifestyle, or quality of life differences between the two phenotypes. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Carl Philpott
- James Paget University Hospital NHS Foundation Trust, Gorleston, UK
- Norwich Medical School, University of East Anglia, Norfolk, UK
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Ngan Hong Ta
- Norwich Medical School, University of East Anglia, Norfolk, UK
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | | | | | | | | | - Sally E Erskine
- Norwich Medical School, University of East Anglia, Norfolk, UK
| | | | | | | | | | | | - Allan Clark
- Norwich Medical School, University of East Anglia, Norfolk, UK
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16
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Lo RM, Liu AY, Valdez TA, Gernez Y. Dupilumab use in recalcitrant allergic fungal rhinosinusitis. Ann Allergy Asthma Immunol 2020; 125:617-619. [PMID: 32707161 DOI: 10.1016/j.anai.2020.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Rachelle M Lo
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics Stanford University School of Medicine, Stanford, California.
| | - Anne Y Liu
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics Stanford University School of Medicine, Stanford, California; Division of Infectious Diseases, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Tulio A Valdez
- Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Yael Gernez
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics Stanford University School of Medicine, Stanford, California
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17
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Rowan NR, Storck KA, Schlosser RJ, Soler ZM. The Role of Home Fungal Exposure in Allergic Fungal Rhinosinusitis. Am J Rhinol Allergy 2020; 34:784-791. [PMID: 32539434 DOI: 10.1177/1945892420930953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Allergic fungal rhinosinusitis (AFRS) is disproportionately identified in patients of low socioeconomic status living in warm, humid climates, and is thought to occur in response to environmental fungal species. OBJECTIVE We hypothesized that micro-geographic differences in fungal exposure contribute to the pathogenesis of AFRS, and compared home fungal exposure of patients with AFRS to normative data and controls. METHODS Comprehensive prospective enrollment and data capture was completed in 70 patients. Patients with AFRS were compared to a control population with chronic rhinosinusitis with nasal polyposis (CRSwNP) and comorbid atopy. Comprehensive demographics, 22-item sino-nasal outcomes test (SNOT-22) questionnaires, and endoscopy scores were compiled. Using a test strip collection system, a home fungal assessment was completed for each patient, along with detailed questions related to home condition. RESULTS Patients with AFRS were more likely to be younger (p<.001), African American (p<.001), from a lower income bracket (p < .012), and less likely to own their home (p < .001). There were no differences in prior surgeries (p=.432), endoscopy scores (p = .409) or SNOT-22 scores (p = .110) between the groups. There were no differences in overall fungal counts between patients with AFRS and controls (p = .981). AFRS patients had a higher prevalence of Basidiospores than controls (p = .034). CONCLUSION This study failed to detect differences in total home fungal exposure levels between those with AFRS and atopic CRSwNP, despite differences in socioeconomic status. This suggests that absolute fungal levels may not be the primary driver in development of AFRS, or that the fungal detection strategies utilized were not representative of patients' overall fungal exposure.
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Affiliation(s)
- Nicholas R Rowan
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristina A Storck
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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18
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Tyler MA, Luong AU. Current Concepts in the Management of Allergic Fungal Rhinosinusitis. Immunol Allergy Clin North Am 2020; 40:345-359. [PMID: 32278456 DOI: 10.1016/j.iac.2019.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Allergic fungal rhinosinusitis (AFRS) represents a subtype of chronic rhinosinusitis with nasal polyposis that exhibits a unique, often striking clinical presentation. Since its initial description more than a quarter century ago, a more sophisticated understanding of the pathophysiology of AFRS has been achieved and significant advancements in improving clinical outcomes made. This review focuses on the latest developments involving the pathophysiology and clinical management of this fascinating disease.
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Affiliation(s)
- Matthew A Tyler
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical School, 516 Delaware Street Southeast, # 8A, Minneapolis, MN 55455, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Texas Sinus Institute, 6431 Fannin Street, MSB 5.036, Houston, TX 77030, USA; Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA.
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19
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Cheng KJ, Zhou ML, Liu YC, Zhou SH. Allergic fungal rhinosinusitis accompanied by allergic bronchopulmonary aspergillosis: A case report and literature review. World J Clin Cases 2019; 7:3821-3831. [PMID: 31799310 PMCID: PMC6887612 DOI: 10.12998/wjcc.v7.i22.3821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/30/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Concomitant allergic fungal rhinosinusitis (AFRS) and allergic bronchopulmonary aspergillosis (ABPA) are extremely rare, with no more than 20 cases reported in the English literature.
CASE SUMMARY A 52-year-old female patient complained of right-sided nasal obstruction, rhinorrhea, sneezing, epistaxis, and hyposmia for a period of around 5 mo. Nasal examination detected paleness and edema of the nasal mucous membrane and a polyp in the right middle meatus. A computed tomography (CT) scan of the sinuses revealed a ground-glass opacity filling the right maxillary and ethmoid sinuses, along with bone absorption in the medial wall of the right maxillary sinus. Magnetic resonance images were obtained with T1-weighted, T2-weighted, and gadolinium-enhanced T1-weighted sequences. A well-defined mass, located in the right maxillary and ethmoid sinuses and displaying obvious hypointense features, was observed on both T1- and T2-weighted images, with peripheral enhancement on gadolinium-enhanced T1-weighted images. The patient also has a 20-year history of cough and dyspnea. Chest CT revealed columned and cystiform bronchiectasis in the bilateral bronchus, surrounded by a large number of spotted and funicular high-density lesions. The level of serum total IgE was > 5000 kU/L. Serum IgE levels related to house dust and aspergillus showed a positive result, with the values being 3.5 kU/L and 1.2 kU/L. We performed functional endoscopic sinus surgery under local anesthesia. After surgery, topical glucocorticoids and saline irrigation were applied in the nasal cavity until the present time. An oral glucocorticoid (methylprednisolone 16 mg/d) and antifungal agent (itraconazole 200 mg/d) were also used for a period of 4 wk. Montelukast was prescribed at 10 mg/d until the present time. An endoscopic examination showed that the patient was recovering well at 3 mo after surgery.
CONCLUSION Since different specialists treat ABPA and AFRS, their coexistence may be overlooked. AFRS accompanied by ABPA requires surgical therapy combined with medical control to improve the symptoms.
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Affiliation(s)
- Ke-Jia Cheng
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Min-Li Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Yong-Cai Liu
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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20
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Mostafa BE, Fadel M, Mohammed MA, Hamdi TAH, Askoura AM. Omalizumab versus intranasal steroids in the post-operative management of patients with allergic fungal rhinosinusitis. Eur Arch Otorhinolaryngol 2019; 277:121-128. [DOI: 10.1007/s00405-019-05650-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/12/2019] [Indexed: 02/06/2023]
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21
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Dykewicz MS, Rodrigues JM, Slavin RG. Allergic fungal rhinosinusitis. J Allergy Clin Immunol 2019; 142:341-351. [PMID: 30080526 DOI: 10.1016/j.jaci.2018.06.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 02/06/2023]
Abstract
Allergic fungal rhinosinusitis (AFRS) is a subset of chronic rhinosinusitis with nasal polyps (CRSwNP) characterized by antifungal IgE sensitivity, eosinophil-rich mucus (ie, allergic mucin), and characteristic computed tomographic and magnetic resonance imaging findings in paranasal sinuses. AFRS develops in immunocompetent patients, with occurrence influenced by climate, geography, and several identified host factors. Molecular pathways and immune responses driving AFRS are still being delineated, but prominent adaptive and more recently recognized innate type 2 immune responses are important, many similar to those established in patients with other forms of CRSwNP. It is unclear whether AFRS represents merely a more extreme expression of pathways important in patients with CRSwNP or whether there are other disordered immune responses that would define a distinct endotype or endotypes. Although AFRS and allergic bronchopulmonary aspergillosis share some analogous immune mechanisms, the 2 conditions do not occur commonly in the same patient. Treatment of AFRS almost always requires surgical debridement of the involved sinuses. Oral corticosteroids decrease recurrence after surgery, but other adjunctive pharmacologic agents, including topical and oral antifungal agents, do not have a firm evidence basis for use. There is good rationale for use of biologic agents that target eosinophilic inflammation or other type 2 responses, but studies in patients with AFRS are required.
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Affiliation(s)
- Mark S Dykewicz
- Section of Allergy and Immunology, Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Mo.
| | - Jonathan M Rodrigues
- Allergy and Immunology, Sanford Health, and the Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Bismarck, ND
| | - Raymond G Slavin
- Section of Allergy and Immunology, Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Mo
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22
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Park SK, Park KW, Mo JH, Baek BJ, Shim WS, Jung HJ, Kim YM, Rha KS. Clinicopathological and Radiological Features of Chronic Rhinosinusitis with Eosinophilic Mucin in Chungcheong Province of Korea. Mycopathologia 2019; 184:423-431. [DOI: 10.1007/s11046-019-00340-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/16/2019] [Indexed: 12/18/2022]
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23
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Tyler MA, Luong AU. Current understanding of allergic fungal rhinosinusitis. World J Otorhinolaryngol Head Neck Surg 2018; 4:179-185. [PMID: 30506049 PMCID: PMC6251961 DOI: 10.1016/j.wjorl.2018.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/13/2018] [Indexed: 01/12/2023] Open
Abstract
Studying the pathophysiology of allergic fungal rhinosinusitis (AFRS) has proved challenging. While this clinical entity is easily distinguishable based on the clinical criteria set forth by Bent and Kuhn twenty-five years ago, studies examining type 2 inflammatory profiles in AFRS can make it seem more alike other CRS subtypes than it is different. Still, evolving research seems to clearly delineate this subtype from others in CRS. This review will critically evaluate the evolution of research examining the pathophysiology of AFRS and will conclude with a summary of the special considerations in the management of this fascinating disease.
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Affiliation(s)
- Matthew A Tyler
- McGovern Medical School at the University of Texas Health Science Center, Department of Otorhinolaryngology-Head & Neck Surgery, Houston, TX 77030, USA
| | - Amber U Luong
- McGovern Medical School at the University of Texas Health Science Center, Department of Otorhinolaryngology-Head & Neck Surgery, Houston, TX 77030, USA.,McGovern Medical School at the University of Texas Health Science Center, Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, Houston, TX 77030, USA
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24
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Samuelson MB, Chandra RK, Turner JH, Russell PT, Francis DO. The relationship between social determinants of health and utilization of tertiary rhinology care. Am J Rhinol Allergy 2018; 31:376-381. [PMID: 29122082 DOI: 10.2500/ajra.2017.31.4476] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) has a high prevalence and significant cost and quality of life implications. Many types of practitioners care for patients with rhinosinusitis; however, patients with chronic or complicated conditions are often referred for tertiary rhinology services. It is unclear how social determinants of health affect access and utilization of these services. A better understanding of social barriers to tertiary rhinology care is needed to reduce health care disparities and improve health outcomes. The aim of the present study was to measure whether income, insurance status, race, and education affect utilization of tertiary rhinology care. METHODS All adult patients diagnosed with CRS by rhinologists at a single tertiary care hospital were identified (2010-2014). Patient characteristics (age, gender, race, insurance status) were compared with population-level data from the hospital and from Davidson County, Tennessee, which includes Nashville. Rhinology utilization rates were calculated for each ZIP code within the county. The association between determinants of health (race, insurance status, education, median income) and tertiary rhinology utilization were measured by using multivariable regression analyses. RESULTS A total of 1341 unique patients with CRS (median age, 50 years; 55% women, 80% white, 82% with private insurance) from Davidson County used tertiary rhinology services. These patients were significantly older and more likely to be female, white, and privately insured than patients seen hospital-wide or among the population of Davidson County (p < 0.001). Utilization rates were higher in ZIP codes with a lower proportion of minorities, a higher median income, and higher rates of private insurance and college education. However, in adjusted analysis, only attainment of a college education was independently associated with utilization of tertiary rhinology services. Utilization was 4% higher for every 1% increase in college-educated population (coefficient 0.04 [95% CI, 0.01-0.07]; p = 0.01). CONCLUSION Results of this study indicated that some social determinants of health (race, income, educational level, insurance status) do affect utilization of tertiary rhinology services. Higher utilization among those with higher income and educational attainment are contradictory to the data, which indicated that lower socioeconomic status was associated with a higher CRS rate. Further study is required to understand the disparities in rhinology utilization rates.
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Affiliation(s)
- Madeleine B Samuelson
- Division of Rhinology, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Azar A, Rank MA, Zarka MA, Chang YH, Lal D. Gender-specific differences in serum immunoglobulin E levels and prevalence of fungus in sinonasal tissue noted in patients with chronic rhinosinusitis who underwent endoscopic sinus surgery. Am J Rhinol Allergy 2018; 31:370-375. [PMID: 29122081 DOI: 10.2500/ajra.2017.31.4471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND We previously presented that women with chronic rhinosinusitis (CRS) who elected endoscopic sinus surgery (ESS) have a higher symptom burden than men. Causes of these gender-based differences warranted further study. OBJECTIVES To study gender differences in another cohort of adult patients with CRS who underwent ESS and to compare key histopathologic and serologic features Methods: Patients with CRS who underwent ESS (from 2011 to 2014) with structured histopathology reports on surgical samples were studied. The 13-item structured histopathology report detailed key metrics of inflammation and the presence of fungal elements. Clinical, 22-item Sino-Nasal Outcome Test (SNOT-22) score, Lund-Mackay computed tomography (CT) score, serologic (immunoglobulin E [IgE] level, absolute eosinophil count) and histopathologic data were compared between male and female patients by using statistical software. RESULTS We studied 130 eligible subjects (mean age, 54.7 years; 49.2% women). Compared with the men, the women had significantly higher preoperative SNOT-22 scores (women, 48.7; men 38.0 [p = 0.004]) but similar CT scores. Serum IgE levels were significantly higher among women versus men (peak, 433.3 versus 190.8 kU/L [p = 0.03]; closest to surgery, 435.0 versus 190.8 kU/L [p = 0.03]). Tissue fungal elements were significantly more prevalent in women versus men (19.0 versus 5.2%; p = 0.02). Up to this point, the analysis was agnostic of clinical details of the subjects. Further analysis was conducted regarding clinical features. Allergic fungal sinusitis (AFS) was found significantly more commonly in the female versus male patients (21.9 versus 9.1%; p = 0.04). Women versus men had a higher prevalence of migraine (19.4 versus 4.6%; p = 0.01) or any primary headache disorders (23.0 versus 6.2%; p = 0.007). CONCLUSION Women who underwent ESS for CRS had higher SNOT-22 symptom burden. Worsened symptomatology may be secondary to a higher prevalence of primary headache disorders in women. However, surgeons should also be aware that female patients with CRS who seek ESS may have a higher prevalence of severe disease endotypes (more tissue fungal elements, elevated serum IgE levels) and phenotypes.
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Affiliation(s)
- Antoine Azar
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
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Di Marco L, Pujo K, Molly D, Boibieux A, Ltaïef-Boudrigua A. [Allergic fungal rhinosinusitis: A diagnosis to evoke]. Presse Med 2018; 47:625-638. [PMID: 30041846 DOI: 10.1016/j.lpm.2018.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/08/2017] [Accepted: 04/04/2018] [Indexed: 10/28/2022] Open
Abstract
Among fungal infections of the nasal sinuses, allergic fungal rhinosinusitis is a recently described, relatively rare and little known pathology. Its diagnosis is based on: clinical criteria (it occurs in young immunocompetent patients, often associated with bilateral nasosinusal polyposis); pathological criteria (allergic mucin: eosinophilic mucus without invasion of the sinusal mucosa and observation of fungal hyphae on surgical samples); biological criteria (hypereosinophilia, total and specific antifungal IgE); and radiological criteria. The combination of tomodensitometry (heterogeneous hyperdense and diffuse filling of nasosinusal cavities with expanded borders and a distended appearance of the bony wall), and MRI scan (extensive character and lesional signal [hypo and asignal T1 and T2], and cerebriform aspect of the fungal process) strongly suggests the diagnosis. It is important to distinguish the most typical forms, as well as unusual forms of allergic fungal rhinosinusitis. Main differential diagnoses are represented by other forms of fungal nasosinusal infections with different treatment and prognosis.
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Affiliation(s)
- Lucy Di Marco
- Radiologie neuro-ORL et ostéo-articulaire, hôpital Edouard-Herriot, pavillon B, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
| | - Kevin Pujo
- Centre hospitalier de Valence, service d'ORL et chirurgie cervical faciale, 179, boulevard Maréchal-Juin, 26000 Valence, France
| | - Damien Molly
- Plateau technique de biologie, service d'anatomie et cytologie pathologiques, 2, rue Angélique-Ducoudray, 21079 Dijon, France
| | - André Boibieux
- Hôpital de la Croix-Rousse, maladies infectieuses et tropicales, 103, Grande-Rue de la Croix-Rousse, 69004 Lyon, France
| | - Aicha Ltaïef-Boudrigua
- Radiologie neuro-ORL et ostéo-articulaire, hôpital Edouard-Herriot, pavillon B, 5, place d'Arsonval, 69437 Lyon cedex 03, France
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Otolaryngology-Related Disorders in Underserved Populations, Otolaryngology Training and Workforce Considerations in North America. Otolaryngol Clin North Am 2018; 51:685-695. [DOI: 10.1016/j.otc.2018.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Geramas I, Terzakis D, Hatzimanolis E, Georgalas C. Social Factors in the Development of Chronic Rhinosinusitis: a Systematic Review. Curr Allergy Asthma Rep 2018; 18:7. [PMID: 29450659 DOI: 10.1007/s11882-018-0763-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW In an era where prevention is paramount, understanding social factors for chronic rhinosinusitis (CRS) may facilitate preventive interventions that mitigate risk factors associated with the initiation or progression of the disease. RECENT FINDINGS Both passive and active smoking are clearly and unequivocally associated with both the incidence and the severity of rhinosinusitis, while there an increasing body of evidence linking social deprivation and low socioeconomic status with rhinosinusitis and its complications. However, overall, only a handful of studies were longitudinal, while the available studies suffer from lack of standardized definitions of rhinosinusitis. In this systematic review, we assessed the available evidence linking CRS with social factors, such as socioeconomic status and class, educational status, family status, living and working location and conditions, and use of toxins or recreational drugs as well as exercise and diet. Thirty studies from 1995 onwards fulfilled our inclusion criteria and were used for this review. Social deprivation and low socioeconomic level seem to be directly associated with rhinosinusitis, as there are pollutants in living or working environment. A clear and direct association between smoking (both active and passive) and rhinosinusitis was also shown. However, the link between rhinosinusitis and education level, and exercise and diet, if any, seems to be more complex.
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Affiliation(s)
- I Geramas
- Endoscopic Skull Base Centre Athens, Hygeia Hospital, 4 Erythrou Stavrou Str. & Kifisias Av., 151 23, Marousi, Athens, Greece
| | - D Terzakis
- Endoscopic Skull Base Centre Athens, Hygeia Hospital, 4 Erythrou Stavrou Str. & Kifisias Av., 151 23, Marousi, Athens, Greece
| | - E Hatzimanolis
- Department of Head and Neck Surgery, Hygeia Hospital, 4 Erythrou Stavrou Str. & Kifisias Av., 151 23, Marousi, Athens, Greece
| | - C Georgalas
- Endoscopic Skull Base Centre Athens, Hygeia Hospital, 4 Erythrou Stavrou Str. & Kifisias Av., 151 23, Marousi, Athens, Greece.
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Codispoti CD, Tapke DE, LoSavio PS, Batra PS, Mahdavinia M. Living in lower income zip codes is associated with more severe chronic rhinosinusitis. Ann Allergy Asthma Immunol 2017; 120:207-209. [PMID: 29290514 DOI: 10.1016/j.anai.2017.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Christopher D Codispoti
- Department of Immunology and Microbiology, Allergy/Immunology Section, Rush University Medical Center, Chicago, Illinois.
| | - David E Tapke
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Phillip S LoSavio
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Mahboobeh Mahdavinia
- Department of Immunology and Microbiology, Allergy/Immunology Section, Rush University Medical Center, Chicago, Illinois
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Halderman AA, Tully LJ. The Role of Allergy in Chronic Rhinosinusitis. Otolaryngol Clin North Am 2017; 50:1077-1090. [DOI: 10.1016/j.otc.2017.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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AlQahtani A, Alshaikh N, Alzarei A, Musleh A, Alamri A, Alqahtani A, Alfawwaz F, Alshammari F, Aloulah M, Marglani O, Alsaleh S, Alandejani T, Mokarbesh H. Contralateral sinus involvement of surgically treated unilateral allergic fungal rhinosinusitis. Eur Arch Otorhinolaryngol 2017; 274:3097-3101. [PMID: 28501959 DOI: 10.1007/s00405-017-4604-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
Recurrence of allergic fungal rhinosinusitis (AFRS) is well recognized. However, there is scarcity in the literature describing involvement of the non-diseased sinuses. We aimed to evaluate the recurrence forms of unilateral AFRS as well as to study the possible predictor factors of developing the disease in the contralateral side. Patients with exclusive unilateral AFRS from (2010 to 2015) were enrolled in multi-institutional case-control study. All patients were evaluated after endoscopic sinus surgery for recurrence. Patient's records were reviewed for demographics, medical treatment, and clinical, radiological, and surgical data. A total of 68 patients were identified. Delayed contralateral involvement after the initial surgery was found in 30.8% with mean duration of recurrence 16.9 months. A significant association was found with the presence of pre-operative contralateral symptoms and signs of inflammation (OR 3.49, 95% CI 1.19-10.22, p value 0.02). Post-operative use of budesonide irrigation was associated with less contralateral involvement (OR 0.11, 95% CI 0.01-0.87, p value 0.01). Association of other variables like: comorbidities, perioperative use of systemic steroid, radiological signs, extent of surgery, additional surgery to the contralateral side, and post-operative use of systemic steroids did not show statistical significance. Involvement of the contralateral sinuses in 30% of unilateral AFRS cases is considered significant. The non-diseased sinuses should be involved in the routine endoscopic examination and post-operative treatment. Further studies are necessary to investigate the possibility of prophylactic surgical intervention of the non-diseased sinuses.
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Affiliation(s)
- Abdulaziz AlQahtani
- Department of Otolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - N Alshaikh
- Department of Otolaryngology Head and Neck Surgery, Dammam Medical Complex, Dammam, Saudi Arabia
| | - A Alzarei
- Department of Otolaryngology Head and Neck Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - A Musleh
- Department of Otolaryngology Head and Neck Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - A Alamri
- Department of Otolaryngology Head and Neck Surgery, King Salman Hospital, Riyadh, Saudi Arabia
| | - A Alqahtani
- Department of Otolaryngology Head and Neck Surgery, Khamis Mushait General Hospital, Khamis Mushite, Saudi Arabia
| | - F Alfawwaz
- Department of Otolaryngology Head and Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - F Alshammari
- Department of Otolaryngology Head and Neck Surgery, King Khalid Hospital, Hail, Saudi Arabia
| | - M Aloulah
- Department of Otolaryngology Head and Neck Surgery, King Saud University Medical City, King Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - O Marglani
- Department of Otolaryngology Head and Neck Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - S Alsaleh
- Department of Otolaryngology Head and Neck Surgery, King Saud University Medical City, King Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - T Alandejani
- Department of Otolaryngology Head and Neck Surgery, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - H Mokarbesh
- Department of Otolaryngology Head and Neck Surgery, Prince Mohammed bin Naser Hospital, Jazan, Saudi Arabia
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Lemos-Rodriguez AM, Farzal Z, Sreenath SB, Thorp BD, Senior BA, Zanation AM, Ebert CS. The impact of total immunoglobulin E levels on outcomes of maximal medical therapy for chronic rhinosinusitis. ALLERGY & RHINOLOGY (PROVIDENCE, R.I.) 2017; 8:5-12. [PMID: 28381321 PMCID: PMC5380453 DOI: 10.2500/ar.2017.8.0188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The goal of this project was to evaluate the impact of immunoglobulin E (IgE) levels on outcomes in patients with chronic rhinosinusitis (CRS) who received maximal medical therapy (MMT). STUDY DESIGN Prospective cohort study. METHODS Thirty-eight patients who underwent MMT for CRS were assigned to three different cohorts based on their IgE levels: low IgE (<25 IU), moderate (>25 to <149 IU), and high (≥150 IU). The primary outcome evaluated was MMT failure with a surgical recommendation within each IgE cohort. Secondary outcomes included changes in pre- and post-MMT scores for the Rhinosinusitis Disability Index, Chronic Sinusitis Survey, and computed tomography-based Lund-Mackay evaluation. The cohorts were substratified based on the presence of nasal polyps and nasal allergies. RESULTS No significant difference was found when MMT failure was compared between the cohorts in terms of quality of life. When substratified based on the presence of nasal polyps and nasal allergies, there was no significant difference between the cohorts. In the high-IgE cohort, all patients regardless of presence of nasal polyps and nasal allergic disease, frequently failed MMT and were recommended for surgery. CONCLUSIONS Overall, IgE levels did not seem to have a significant effect on the quality of life or outcomes of MMT in the patients with CRS. However, the presence of nasal allergies regardless of IgE levels seemed to result in more frequent recommendations for surgery after MMT. In the patients with higher-IgE levels (≥150 IU), MMT seemed to fail at high rates with or without the presence of polyps or allergic disease.
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Affiliation(s)
- Ana M. Lemos-Rodriguez
- From the Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Zainab Farzal
- From the Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Satyan B. Sreenath
- From the Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian D. Thorp
- From the Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brent A. Senior
- From the Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Adam M. Zanation
- From the Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles S. Ebert
- From the Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Chakrabarti A, Kaur H. Allergic Aspergillus Rhinosinusitis. J Fungi (Basel) 2016; 2:E32. [PMID: 29376948 PMCID: PMC5715928 DOI: 10.3390/jof2040032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 12/19/2022] Open
Abstract
Allergic fungal rhinosinusitis (AFRS) is a unique variety of chronic polypoid rhinosinusitis usually in atopic individuals, characterized by presence of eosinophilic mucin and fungal hyphae in paranasal sinuses without invasion into surrounding mucosa. It has emerged as an important disease involving a large population across the world with geographic variation in incidence and epidemiology. The disease is surrounded by controversies regarding its definition and etiopathogenesis. A working group on "Fungal Sinusitis" under the International Society for Human and Animal Mycology (ISHAM) addressed some of those issues, but many questions remain unanswered. The descriptions of "eosinophilic fungal rhinosinusitis" (EFRS), "eosinophilic mucin rhinosinusitis" (EMRS) and mucosal invasion by hyphae in few patients have increased the problem to delineate the disease. Various hypotheses exist for etiopathogenesis of AFRS with considerable overlap, though recent extensive studies have made certain in depth understanding. The diagnosis of AFRS is a multi-disciplinary approach including the imaging, histopathology, mycology and immunological investigations. Though there is no uniform management protocol for AFRS, surgical clearing of the sinuses with steroid therapy are commonly practiced. The role of antifungal agents, leukotriene antagonists and immunomodulators is still questionable. The present review covers the controversies, recent advances in pathogenesis, diagnosis, and management of AFRS.
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Affiliation(s)
- Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
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Hoyt AE, Borish L, Gurrola J, Payne S. Allergic Fungal Rhinosinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:599-604. [DOI: 10.1016/j.jaip.2016.03.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 12/17/2022]
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Rodrigues J, Caruthers C, Azmeh R, Dykewicz MS, Slavin RG, Knutsen AP. The spectrum of allergic fungal diseases of the upper and lower airways. Expert Rev Clin Immunol 2016; 12:531-50. [PMID: 26776889 DOI: 10.1586/1744666x.2016.1142874] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fungi cause a wide spectrum of fungal diseases of the upper and lower airways. There are three main phyla involved in allergic fungal disease: (1) Ascomycota (2) Basidiomycota (3) Zygomycota. Allergic fungal rhinosinusitis (AFRS) causes chronic rhinosinusitis symptoms and is caused predominantly by Aspergillus fumigatus in India and Bipolaris in the United States. The recommended treatment approach for AFRS is surgical intervention and systemic steroids. Allergic bronchopulmonary aspergillosis (APBA) is most commonly diagnosed in patients with asthma or cystic fibrosis. Long term systemic steroids are the mainstay treatment option for ABPA with the addition of an antifungal medication. Fungal sensitization or exposure increases a patient's risk of developing severe asthma and has been termed severe asthma associated with fungal sensitivity (SAFS). Investigating for triggers and causes of a patient's asthma should be sought to decrease worsening progression of the disease.
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Affiliation(s)
| | - Carrie Caruthers
- a Allergy & Immunology , Saint Louis University , St. Louis , MO , USA
| | - Roua Azmeh
- a Allergy & Immunology , Saint Louis University , St. Louis , MO , USA
| | - Mark S Dykewicz
- a Allergy & Immunology , Saint Louis University , St. Louis , MO , USA
| | - Raymond G Slavin
- a Allergy & Immunology , Saint Louis University , St. Louis , MO , USA
| | - Alan P Knutsen
- a Allergy & Immunology , Saint Louis University , St. Louis , MO , USA
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