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Cho EH, Park KH, Kim JH, Kim H, Lee HJ, Wee JH. Side- and Sinus-Specific Relationships between Chronic Rhinosinusitis and Ischemic Stroke Using Imaging Analyses. Diagnostics (Basel) 2024; 14:1266. [PMID: 38928681 PMCID: PMC11203191 DOI: 10.3390/diagnostics14121266] [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: 04/25/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Recent studies have reported chronic rhinosinusitis (CRS) as an independent risk factor for stroke. However, the association with stroke depending on the affected sinuses has not been explored. This study aimed to elucidate the side- and sinus-specific relationship between CRS and ischemic stroke through imaging analyses. We retrospectively reviewed the medical records of patients who were diagnosed with ischemic stroke at a tertiary center. CRS was defined as having a total score of greater than or equal to 4, according to the Lund-Mackay scoring system, through brain magnetic resonance imaging or computed tomography. We investigated the side- and sinus-specific correlation between CRS and ischemic stroke. Subgroup analyses were performed for different age groups. CRS prevalence in patients with ischemic stroke was 18.4%, which was higher than the previously reported prevalence in the general population. Overall, there was no correlation between the directions of the CRS and ischemic stroke (p > 0.05). When each sinus was analyzed, the frontal (Cramer's V = 0.479, p < 0.001), anterior (Cramer's V = 0.396, p < 0.001)/posterior (Cramer's V = 0.300, p = 0.008) ethmoid, and sphenoid (Cramer's V = 0.383, p = 0.005) sinuses showed a statistically significant correlation with the side of stroke, but the maxillary sinus (Cramer's V = 0.138, p = 0.208) did not. In subgroup analyses, a significant right-side correlation between the two diseases was observed in the older-age subgroup (≥65 years old, Cramer's V = 0.142, p = 0.040). Diabetes mellitus (odds ratio = 1.596, 95% confidence interval = 1.204-2.116) was identified as an independent risk factor for having CRS in patients with ischemic stroke. CRS of the frontal, anterior/posterior ethmoid, and sphenoid sinuses has a directional relationship with ischemic stroke. Our results on which sinuses correlate with stroke advocate for the active surveillance of CRS in patients at high risk of ischemic stroke.
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Affiliation(s)
- Eun Hyun Cho
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (E.H.C.); (K.H.P.); (H.K.); (H.-J.L.)
| | - Kyung Hoon Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (E.H.C.); (K.H.P.); (H.K.); (H.-J.L.)
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Heejin Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (E.H.C.); (K.H.P.); (H.K.); (H.-J.L.)
| | - Hyo-Jeong Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (E.H.C.); (K.H.P.); (H.K.); (H.-J.L.)
| | - Jee Hye Wee
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (E.H.C.); (K.H.P.); (H.K.); (H.-J.L.)
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Fiorentino V, Martini M, Galletti C, Pizzimenti C, Franchina M, Ieni A, Fadda G, Galletti B, Tuccari G. The Morphology of Nasal Polyps in Different Age Groups: Histopathological Features. J Pers Med 2024; 14:414. [PMID: 38673041 PMCID: PMC11051558 DOI: 10.3390/jpm14040414] [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: 03/13/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Nasal polyps (NPs) represent the end-stage manifestation of chronic rhinosinusitis (CRS), a relatively common pathological condition encountered in all ages of life. METHODOLOGY The aim of our study was to evaluate the histological features and inflammatory cellular components of NPs in a retrospective cohort (143 cases) of pediatric, adult and elderly populations in order to discuss the possible morphological age-related differences statistically documented. RESULTS In the pediatric group, the inflammatory infiltrate presented many eosinophils mixed with lymphocytes, while in the adult population, lymphocytes and plasma cells were mainly evident, frequently with a perivascular distribution or with the formation of subepithelial lymphoid nodules. In the elderly population, inflammation was less evident and was associated with cavernous-like angecthatic structures with thrombotic stratification. Nearly all morphological findings exhibited statistically significant values among differently aged subgroups. CONCLUSIONS Our results support the presence of histological specificities of NPs at different ages of life, providing new insight into the etiopathogenesis of NPs. The future role of biological therapies, mainly in cases refractory to already available standard medical and surgical treatments, may be analyzed by a prospective study using a larger cohort with a long-term evaluation also in relation to a possible relapse.
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Affiliation(s)
- Vincenzo Fiorentino
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Maurizio Martini
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Cosimo Galletti
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Cristina Pizzimenti
- Dipartimento di Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Università Degli Studi di Messina, 98122 Messina, Italy;
| | - Mariausilia Franchina
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Antonio Ieni
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Guido Fadda
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Bruno Galletti
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Giovanni Tuccari
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
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Renteria AE, Maniakas A, Pelletier A, Filali-Mouhim A, Brochiero E, Valera FCP, Adam D, Mfuna LE, Desrosiers M. Utilization of Transcriptomic Profiling to Identify Molecular Markers Predicting Successful Recovery Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis. Otolaryngol Head Neck Surg 2023; 169:1662-1673. [PMID: 37622488 DOI: 10.1002/ohn.482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES Successful recovery from chronic rhinosinusitis (CRS) following endoscopic sinus surgery (ESS) can be characterized by minimal presence of symptoms and absence of disease on endoscopy. However, molecular markers of surgical success remain to be characterized. These could allow for better tailoring of perioperative therapy. This study aims to identify novel molecular markers associated with surgery responsive patient. STUDY DESIGN Prospective cohort study. SETTING Single academic hospital center. METHOD One hundred eighteen consecutive patients with CRS at high risk of recurrence after surgery were followed prospectively following ESS in an academic medical center. Symptomatic and endoscopic outcomes were assessed at 4 months, with success rigorously defined subjectively as minimal or no symptoms (no symptom greater than 1 on an ordinal scale of 0-3) and objectively by the absence of nasal polyposis on sinus cavity endoscopy and Lund-Kennedy endoscopic edema score no greater than 1. Samples were obtained at the time of surgery and at 4-month postoperatively. Changes associated with surgery were determined by gene expression profiling using Affymetrix's Clariom S Human HT arrays. RESULTS Successful ESS was characterized by a mild upregulation in Type 1 inflammation, upregulation of cell cycle progression, and epithelial barrier and proliferation-associated genes and pathways. ESS failure was associated to very high levels of Type 1 inflammation along with downregulation of epithelial barrier function and regeneration genes and pathways. CONCLUSION Successful recovery from ESS involves restoration of epithelial function and regulated activation of Type 1 inflammation. Excessively elevated Type 1 inflammation is associated with epithelial barrier dysfunction.
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Affiliation(s)
- Axel E Renteria
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d'Oto-rhino-laryngologie et chirurgie cervico-faciale du , Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Anastasios Maniakas
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Audrey Pelletier
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Ali Filali-Mouhim
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Emmanuelle Brochiero
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Fabiana C P Valera
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Damien Adam
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Leandra Endam Mfuna
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Martin Desrosiers
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d'Oto-rhino-laryngologie et chirurgie cervico-faciale du , Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
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Brown HJ, Baird AM, Khalife S, Escobedo P, Filip P, Papagiannopoulos P, Gattuso P, Batra P, Tajudeen BA. Histopathological Differences in Adult and Elderly Patients With Chronic Rhinosinusitis. Am J Rhinol Allergy 2023:19458924231172078. [PMID: 37160727 DOI: 10.1177/19458924231172078] [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: 05/11/2023]
Abstract
BACKGROUND Adult and elderly patients with chronic rhinosinusitis (CRS) undergo similar therapeutic management. Few studies have undertaken sinonasal tissue-level comparisons of these groups. This study examines histopathological differences between adults (>18, <65 years) and the elderly (≥65 years) with CRS, with the goal of optimizing medical management. METHODS In a retrospective cohort analysis, demographic factors, comorbidities, and a structured histopathological report of 13 variables were compared across adult and elderly patients with CRS who underwent functional endoscopic sinus surgery. These cohorts of adult and elderly patients included patients with and without nasal polyps (NP). RESULTS Three hundred adult (158 aCRSsNP, 142 aCRSwNP) and 77 elderly (38 eCRSsNP, 39 eCRSwNP) patients were analyzed. Mean age of the adult cohort was 44.4 ± 12.4 years, while that of the elderly cohort was 71.9 ± 5.9 years (P < .001). Significantly more adults compared to elderly individuals demonstrated a positive atopic status (79.7% vs 64.0%, P = .004). Elderly patients exhibited higher rates of comorbid diabetes mellitus than adult patients (21.6% vs 10.3%, P = .009). Adults exhibited more tissue eosinophilia (43.4% vs 28.6%, P = .012) and presence of eosinophil aggregates (25.0% vs 14.3%, P = .029) compared to elderly patients, regardless of NP status. Conversely, the elderly demonstrated significantly more fungal elements (11.7% vs 3.0%, P = .004), and trended toward increased overall inflammation (63.6% vs 55.3%, P = .118) and tissue neutrophilia (35.1% vs 27.3%, P = .117), compared to adults. CONCLUSION Sinonasal tissue of adult and elderly patients with CRS demonstrates clear histopathological differences. Patient comorbidities, in addition to histopathological characterizations, may provide further context for management optimization. LEVEL OF EVIDENCE 2. SHORT SUMMARY Sinonasal tissue samples from adult and elderly patients with CRS demonstrate clear histopathological differences. These patient populations also exhibit unique comorbidities. These distinctions have the potential to inform and optimize management of this condition.
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Affiliation(s)
- Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Ali M Baird
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Sarah Khalife
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Pedro Escobedo
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Peter Filip
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Pete Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
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5
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Wang X, Chen Y, Zhu X, Zhou Y, Su H, Zhao Y. Associations of Alcohol Consumption with the Risk and Surgical Outcomes of Chronic Rhinosinusitis in China: a case‐control study. Clin Otolaryngol 2022; 47:664-671. [DOI: 10.1111/coa.13970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/21/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Xueping Wang
- From the Department of Otolaryngology Head and Neck Surgery The First Affiliated Hospital of Zhengzhou University Zhengzhou Henan People's Republic of China
| | - Yibin Chen
- From the Department of Obstetrics and Gynecology The First Affiliated Hospital of Zhengzhou University Zhengzhou Henan People's Republic of China
| | - Xiaoyuan Zhu
- From the Department of Otolaryngology Head and Neck Surgery The First Affiliated Hospital of Zhengzhou University Zhengzhou Henan People's Republic of China
| | - Yandong Zhou
- From the Department of Otolaryngology Head and Neck Surgery The First Affiliated Hospital of Zhengzhou University Zhengzhou Henan People's Republic of China
| | - Hongxia Su
- From the Department of Obstetrics and Gynecology The First Affiliated Hospital of Zhengzhou University Zhengzhou Henan People's Republic of China
| | - Yulin Zhao
- From the Department of Otolaryngology Head and Neck Surgery The First Affiliated Hospital of Zhengzhou University Zhengzhou Henan People's Republic of China
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Merrill T, Kanaan A. Managing Chronic Rhinosinusitis with Nasal Polyps in the Elderly: Challenges and Solutions. Clin Interv Aging 2022; 17:685-698. [PMID: 35535364 PMCID: PMC9077011 DOI: 10.2147/cia.s279765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
The proportion of the population over 65 years old continues to grow. Chronic rhinosinusitis is common in this population and causes a reduction in quality of life and an increase in health care utilization. Diagnosis of chronic rhinosinusitis with nasal polyps follows the same principles for elderly patients as in the general population, but the elderly population presents some diagnostic challenges worth considering. Presbynasalis, the anatomic and functional changes of the nose and paranasal sinuses associated with aging must be accounted for when caring for these patients. In addition, polypharmacy and other medical issues that can cause similar symptoms must be considered. Medical therapy is generally similar to the general population but with additional concerns given the propensity for geriatric patients to be on multiple medications and to suffer from multiple medical issues. Sinus surgery should be considered following the same indications as in the general population. While some authors have found higher complication rates in endoscopic sinus surgery, others have found higher rates of success. As always, the risks of surgery must be considered with the possible benefits on a patient-to-patient basis.
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Affiliation(s)
- Tyler Merrill
- University of Arkansas for Medical Sciences, Department of Otolaryngology – Head and Neck Surgery, Little Rock, AR, USA
- Correspondence: Tyler Merrill, University of Arkansas for Medical Sciences, Department of Otolaryngology – Head and Neck Surgery, 4301 W. Markham Street, #543, Little Rock, AR, 72205, USA, Tel +1 (501) 686 5140; +1 (330) 285 1750, Fax +1 (501) 686 8029, Email
| | - Alissa Kanaan
- University of Arkansas for Medical Sciences, Department of Otolaryngology – Head and Neck Surgery, Little Rock, AR, USA
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Huntley KS, Raber J, Fine L, Bernstein JA. Influence of the Microbiome on Chronic Rhinosinusitis With and Without Polyps: An Evolving Discussion. FRONTIERS IN ALLERGY 2021; 2:737086. [PMID: 35386978 PMCID: PMC8974788 DOI: 10.3389/falgy.2021.737086] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
Chronic rhinosinusitis (CRS) is widely prevalent within the population and often leads to decreased quality of life, among other related health complications. CRS has classically been stratified by the presence of nasal polyps (CRSwNP) or the absence nasal polyps (CRSsNP). Management of these conditions remains a challenge as investigators continue to uncover potential etiologies and therapeutic targets. Recently, attention has been given to the sinunasal microbiota as both an inciting and protective influence of CRS development. The healthy sinunasal microbiologic environment is largely composed of bacteria, with the most frequent strains including Staphylococcus aureus, Streptococcus epidermidis, and Corynebacterium genera. Disruptions in this milieu, particularly increases in S. aureus concentration, have been hypothesized to perpetuate both Th1 and Th2 inflammatory changes within the nasal mucosa, leading to CRS exacerbation and potential polyp formation. Other contributors to the sinunasal microbiota include fungi, viruses, and bacteriophages which may directly contribute to underlying inflammation or impact bacterial prevalence. Modifiable risk factors, such as smoking, have also been linked to microbiota alterations. Research interest in CRS continues to expand, and thus the goal of this review is to provide clinicians and investigators alike with a current discussion on the microbiologic influence on CRS development, particularly with respect to the expression of various phenotypes. Although this subject is rapidly evolving, a greater understanding of these potential factors may lead to novel research and targeted therapies for this often difficult to treat condition.
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Affiliation(s)
- Kyle S. Huntley
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Joshua Raber
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Lauren Fine
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Jonathan A. Bernstein
- Department of Internal Medicine, Division of Immunology/Allergy Section, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- *Correspondence: Jonathan A. Bernstein
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Lechien JR, Carroll TL, Bobin F, Muls V, Rodriguez A, Horoi M, Dequanter D, Crevier-Buchman L, Hans S, Saussez S. Influence of Age and Sex on Clinical and Therapeutic Features of Laryngopharyngeal Reflux. Otolaryngol Head Neck Surg 2021; 166:468-476. [PMID: 34154447 DOI: 10.1177/01945998211020284] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To explore the influence of age and sex on the clinical presentation and therapeutic response of patients with laryngopharyngeal reflux (LPR). STUDY DESIGN Prospective study. SETTING Prospective multicenter study of 271 patients with a diagnosis of LPR confirmed by impedance-pH monitoring. METHODS Patients were prescribed 6 months of diet changes and a combination of pantoprazole and/or alginate depending on the results of their impedance-pH results. The Reflux Symptom Score (RSS) and Reflux Sign Assessment (RSA) were collected at baseline and at 3 and 6 months posttreatment. Data were explored according to sex and age. RESULTS A total of 237 patients completed the evaluations (138 females). On the RSS, patients of the oldest group (>60 years) had lower symptom scores (throat pain, ear pain, odynophagia, chest pain, tongue burning, nausea, halitosis, and indigestion) and lower quality-of-life scores than younger individuals. RSS and RSA outcomes significantly improved from pretreatment to 3 months posttreatment in all groups. Scores on the RSS and RSA continued to improve from 3 to 6 months posttreatment in the elderly group. Females with LPR had a higher score on the RSS at baseline as compared with males. On the RSS, scores significantly improved after 3 months in males and females; however, they continued to improve from 3 to 6 months in the female group. CONCLUSION Age and sex may influence the clinical presentation and pre- to posttreatment evolution of symptoms and findings. Age and sex differences could be considered in future therapeutic approaches to guide more effective personalized treatment plans for patients with LPR.
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Affiliation(s)
- Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Otorhinolaryngological Societies, Paris, France.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otolaryngology-Head Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Department of Otolaryngology-Head Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Thomas L Carroll
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Francois Bobin
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Otorhinolaryngological Societies, Paris, France.,Polyclinique Elsan de Poitiers, Poitiers, France
| | - Vinciane Muls
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Otorhinolaryngological Societies, Paris, France.,Department of Gastroenterology, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandra Rodriguez
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Otorhinolaryngological Societies, Paris, France.,Department of Otolaryngology-Head Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Mihaela Horoi
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Otorhinolaryngological Societies, Paris, France.,Department of Otolaryngology-Head Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Didier Dequanter
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Otorhinolaryngological Societies, Paris, France.,Department of Otolaryngology-Head Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lise Crevier-Buchman
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Otorhinolaryngological Societies, Paris, France.,Department of Otolaryngology-Head Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Stéphane Hans
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Otorhinolaryngological Societies, Paris, France.,Department of Otolaryngology-Head Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Otorhinolaryngological Societies, Paris, France.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otolaryngology-Head Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
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Zagólski OM, Gorzędowski P, Stręk P. [Results of inferior nasal turbinate reduction in old and very old patients with chronic rhinitis]. Laryngorhinootologie 2021; 100:460-466. [PMID: 32823369 DOI: 10.1055/a-1226-6960] [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: 10/23/2022]
Abstract
BACKGROUND Symptoms of chronic rhinitis in old and very old populations may result from isolated hyperplasia of nasal inferior turbinates. Turbinoplasty is a possible method of treatment in these individuals. However, preoperative concerns are associated with their poor general condition: tendency to epistaxis, treatment with anticoagulants, hypertension, and less effective healing. OBJECTIVE The aim of this study was to determine differences in results of turbinoplasty obtained in old and very old individuals with chronic rhinitis, compared to young and otherwise healthy patients. MATERIAL AND METHODS We analyzed records of 130 patients with hyperplasia of the inferior turbinates, who had undergone bipolar diathermy turbinoplasty: 82 individuals aged 18-59 (mean = 33.8; SD = 10.2), 30 patients aged 60-74 (mean = 66.0; SD = 3.7) and 18 participants aged 75 + years (mean = 85.3; SD = 6.5). The patients were questioned about the intensity of their symptoms before and one month after the surgery, using the SNOT-20 questionnaire. The duration of wound healing and satisfaction scores were also noted. RESULTS Nasal patency, nasal discharge and post-nasal drip improved in old and very old patients, similarly as in the young ones. Olfactory and taste function improved significantly more in young individuals. Postoperative healing time was significantly longer in very old patients. CONCLUSIONS Some results of turbinoplasty in old and very old patients were significantly worse than in young ones.
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Affiliation(s)
- Olaf M Zagólski
- Otorhinolaryngology, St. John Grande's Hospital, Kraków, Poland
| | | | - Paweł Stręk
- Abteilung für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik der Jagiellonen-Universität, Kraków, Poland
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10
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JEICAN II, TROMBITAS V, CRIVII C, DUMITRU M, ALUAȘ Maria, DOGARU G, GHEBAN D, JUNIE LM, ALBU S. Rehabilitation of patients with chronic rhinosinusitis after functional endoscopic sinus surgery. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. In the case of many patients with chronic rhinosinusitis (CRS), antibiotic and steroid therapies fail, and surgery is required. The recovery of patients after surgery equally depends on the postoperative behavior of each individual patient. The paper presents the outcomes of recovery after functional endoscopic sinus surgery (FESS) in a group of 74 patients.
Methods. The study was conducted in patients undergoing surgical treatment by FESS, performed by the same surgeon. For the development of the statistical database, the clinical records were collected by the same investigator.
Results. On the day of surgery and on the first postoperative day, 72.9% of patients reported facial pain, 41.8% nausea, 9.4% nasal bleeding, 8.8% vomiting. At 6 months postoperatively, 71.6% of patients estimated that they had a better quality of life than before surgery, 64.8% mentioned an improvement of olfaction as an effect, and 6.7% developed septal turbinate synechiae.
Conclusions. No major complications were identified in the recovery of CRS patients after FESS. Postoperative facial pain was less well tolerated by young patients (18-35 years old). The improvement of smell and the increase of disease-specific quality of life are the most relevant results of recovery after FESS mentioned by the patients included in our study. The otorhinolaryngologist and the family doctor play an important role in the education of patients regarding the importance of treatment with mineral and thermal waters in post-FESS recovery.
Keywords: chronic rhinosinusitis, endoscopic sinus surgery, FESS, rehabilitation, ERAS protocols,
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Affiliation(s)
- Ionuț Isaia JEICAN
- [1] Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Cluj-Napoca, Romania [2] Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Veronica TROMBITAS
- [1] Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Cluj-Napoca, Romania
| | - Carmen CRIVII
- [2] Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai DUMITRU
- [3] Department of Head and Neck Surgery and Otorhinolaryngology, University Emergency Hospital, Bucharest, Romania [4] Department of Anatomy and Embryology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - ALUAȘ Maria
- [5] Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriela DOGARU
- [6] Department of Rehabilitation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan GHEBAN
- [7] Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lia Monica JUNIE
- [8] Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Silviu ALBU
- Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Cluj-Napoca, Romania
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11
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Renteria AE, Maniakas A, Mfuna LE, Asmar MH, Gonzalez E, Desrosiers M. Low-dose and long-term azithromycin significantly decreases Staphylococcus aureus in the microbiome of refractory CRS patients. Int Forum Allergy Rhinol 2020; 11:93-105. [PMID: 32713109 DOI: 10.1002/alr.22653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 06/01/2020] [Accepted: 06/25/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The sinonasal microbiome is believed to play an important role in the pathophysiology of refractory chronic rhinosinusitis (CRS). We evaluated changes in the microbiome following a 4-month course of low-dose azithromycin. Assessing microbiome alterations following such a treatment may help identify underlying mechanisms of this drug. METHODS A total of 48 adults with refractory CRS were enrolled in a double-blind, randomized, placebo-controlled trial. Patients were randomized to 250 mg of azithromycin or placebo 3 times weekly for 4 months. During this time, daily budesonide saline irrigations were continued. Sinonasal swabs were collected by endoscopically-assisted method prior to treatment initiation and at the end of it, and sent for 16S ribosomal RNA gene sequencing. High-resolution ANCHOR pipeline was used to infer and annotate putative species. The 2 patient groups were compared using DESeq2 differential abundance analysis. RESULTS From initiation to the end of azithromycin treatment, patients showed a significant difference in beta diversity analysis (p = 0.0004) along with a significant decrease in 71 different operational taxonomic units (OTUs) of Staphylococcus aureus (false discovery rate [FDR] < 0.05) obtained from the differential abundance analysis. This was not observed in placebo-treated patients. By the end of treatments, azithromycin-treated patients had a significant decrease in 29 different OTUs of S. aureus (FDR < 0.05) when compared to placebo. CONCLUSION A 4-month course of 250 mg of azithromycin 3 times weekly in patients with refractory CRS significantly decreases S. aureus abundance in the sinonasal microbiome. Considering the pathogenic role of S. aureus in the refractory CRS population, azithromycin may constitute an additional therapeutic option to help control this disease.
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Affiliation(s)
- Axel E Renteria
- Centre de Recherche du Centre Hospitalier, de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Département d'oto-rhino-laryngologie et chirurgie cervico-faciale du centre hospitalier, de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Anastasios Maniakas
- Centre de Recherche du Centre Hospitalier, de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Département d'oto-rhino-laryngologie et chirurgie cervico-faciale du centre hospitalier, de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leandra Endam Mfuna
- Centre de Recherche du Centre Hospitalier, de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Marc-Henri Asmar
- Centre de Recherche du Centre Hospitalier, de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Emmanuel Gonzalez
- Canadian Centre for Computational Genomics (C3G), Department of Human Genetics, McGill University, Montréal, QC, Canada.,Microbiome Research Platform, McGill Interdisciplinary Initiative in Infection and Immunity (MI4), Genome Centre, McGill University, Montréal, QC, Canada
| | - Martin Desrosiers
- Centre de Recherche du Centre Hospitalier, de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Département d'oto-rhino-laryngologie et chirurgie cervico-faciale du centre hospitalier, de l'Université de Montréal (CHUM), Montréal, QC, Canada
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12
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Spillinger A, Low CM, Smith BM, Stokken JK, O'Brien EK, Choby G. Presentation and outcomes of chronic rhinosinusitis following liver and kidney transplant. World J Otorhinolaryngol Head Neck Surg 2020; 7:139-145. [PMID: 33997724 PMCID: PMC8103524 DOI: 10.1016/j.wjorl.2020.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective This study aims to describe presenting characteristics of patients diagnosed with non-invasive chronic rhinosinusitis (CRS) following liver or kidney transplant and determine factors associated with disease-related complications, selection of endoscopic sinus surgery (ESS), and disease resolution in this population. Study design Retrospective chart review. Setting An academic tertiary care center (Mayo Clinic, Rochester, Minnesota). Subjects and methods Liver and kidney transplant recipients evaluated by Mayo Clinic otolaryngologists for CRS between 1998 and 2018 were identified. Univariate and multivariate logistic regression analyses were used to determine patient factors and treatment modalities associated with developing complications, selection of ESS, and disease resolution. Results Fifty-seven patients met inclusion criteria. No patients developed intraorbital or intracranial complications of their CRS. Multivariate modeling demonstrated that the presence of polyps (P = 0.036) was associated with undergoing ESS within one year of presentation. A higher Lund–Mackay (LM) computed tomography score (P = 0.023) and older age (P = 0.018) were significantly associated with decreased disease resolution. No other factors were significantly associated with the use of endoscopic sinus surgery within one year of otolaryngology presentation or resolution of CRS in this cohort. Conclusion The risk of developing CRS-related intraorbital or intracranial complications in this immunecompromised patient cohort may be lower than originally thought. For liver- and kidney-recipients stable on immunosuppressive medication for many years, prognostic factors for CRS may mirror those for immunocompetent patients.
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Affiliation(s)
- Aviv Spillinger
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Christopher M Low
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Byron M Smith
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, 55905, USA
| | - Janalee K Stokken
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Erin K O'Brien
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, 55905, USA
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13
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Janzen-Senn I, Schuon RA, Tavassol F, Lenarz T, Paasche G. Dimensions and position of the Eustachian tube in Humans. PLoS One 2020; 15:e0232655. [PMID: 32365086 PMCID: PMC7197768 DOI: 10.1371/journal.pone.0232655] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 04/20/2020] [Indexed: 01/16/2023] Open
Abstract
Eustachian tube (ET) dysfunction is one of the causes for chronic otitis media. To develop new therapies such as stents to facilitate middle ear ventilation, a better knowledge on dimensions and positions of the ET in individual patients is necessary. Cone beam CT scans of 143 patients were retrospectively investigated. Parameters such as lengths of the ET and its cartilaginous and bony parts, diameters, angles as well as distance of the ostium from the nasal conchae were determined and evaluated for side, gender and age specific differences. The average length of the cartilaginous and bony tubes was smaller in women than men. The average deviation from the horizontal plane was 1.7° larger on the left side (35.4°) compared to the right side (33.7°). Tools to manipulate the ET or to insert stents into the ET should cover angles from at least 42° to 64°. The distance of the pharyngeal orifices from the conchae nasalis inferior increased with age, becoming most prominent above 70 years of age. This investigation provides necessary information to develop stents for human application and tools for safe positioning of the stents.
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Affiliation(s)
- Ida Janzen-Senn
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Robert A. Schuon
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Frank Tavassol
- Hannover Medical School, Clinic for Cranio-Maxillo-Facial Surgery, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Hannover Medical School, Hearing4all Cluster of Excellence, Hannover, Germany
| | - Gerrit Paasche
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Hannover Medical School, Hearing4all Cluster of Excellence, Hannover, Germany
- * E-mail:
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14
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Casale M, Costantino A, Sabatino L, Luchena A, Moffa A, Cassano M, Rinaldi V, Baptista PM. Minimally invasive surgery under local anaesthesia for chronic rhinosinusitis with nasal polyps: our experience in older adults. J Laryngol Otol 2020; 134:1-5. [PMID: 32046795 DOI: 10.1017/s0022215120000304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This paper aims to report our experience with a minimally invasive surgical procedure for the treatment of chronic rhinosinusitis with nasal polyps, performed in a day-surgery setting under local anaesthesia. METHODS A retrospective study of 30 patients with chronic rhinosinusitis with nasal polyps was conducted. Sino-Nasal Outcome Test 22 and modified Lund-Kennedy scores were collected. Intra- and post-operative pain was evaluated using a 10-point visual analogue scale. RESULTS The mean Sino-Nasal Outcome Test 22 score decreased from 41.8 ± 15.8 pre-operatively to 13.3 ± 9.5 post-operatively (p < 0.001). Accordingly, the mean endoscopic score decreased from 6.8 ± 1.8 to 0.2 ± 0.7 (p < 0.001). The mean intra-operative pain score was 2.9 ± 3.2, and 29 patients (96.7 per cent) reported no pain in the post-operative period (visual analogue scale score = 0). CONCLUSION Our study confirms that minimally invasive surgery represents a safe, repeatable procedure that results in remarkable subjective and objective improvement, without intra- and post-operative pain or discomfort.
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Affiliation(s)
- M Casale
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - A Costantino
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - L Sabatino
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - A Luchena
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - A Moffa
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
- Department of Otolaryngology, University of Foggia, Italy
| | - M Cassano
- Department of Otolaryngology, University of Foggia, Italy
| | - V Rinaldi
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - P M Baptista
- Department of Otolaryngology, University Clinic of Navarra, Pamplona, Spain
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15
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Yancey KL, Lowery AS, Chandra RK, Chowdhury NI, Turner JH. Advanced age adversely affects chronic rhinosinusitis surgical outcomes. Int Forum Allergy Rhinol 2019; 9:1125-1134. [PMID: 31454179 PMCID: PMC6773466 DOI: 10.1002/alr.22404] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient-specific and disease-specific factors shape the course of chronic rhinosinusitis (CRS) and its response to treatment, with optimal management involving interventions tailored to these factors. Recent evidence suggests CRS inflammatory signatures depend on age. The objective of this study was to determine whether age also influences quality-of-life (QOL) and postoperative outcomes. METHODS Retrospective analysis of prospectively collected QOL data from 403 adults with medically refractory CRS who underwent functional endoscopic sinus surgery (FESS) at a tertiary care medical center between 2014 and 2018 was undertaken. Total and subdomain scores from the 22-item Sino-Nasal Outcome Test (SNOT-22) and the Short Form 8 Health Survey (SF-8) measure of general health completed at preoperative and postoperative visits were reviewed. RESULTS Patients were divided into young (18 to 39 years, n = 100), middle-aged (40 to 59 years, n = 172), and elderly (≥60 years, n = 131) groups. Baseline total SNOT-22 scores differed between groups (p = 0.01), with middle-aged patients having the highest symptom burden and elderly patients having the lowest. Similar patterns were observed for SNOT-22 subdomains. Elderly patients reported smaller improvements and were less likely to achieve a minimally important clinical difference. CRS patients had worse SF-8 scores compared to the general population, and elderly patients were the least likely to match population norms following surgery. Age was an independent predictor of QOL outcomes after FESS. CONCLUSION Age may play a significant role in CRS pathophysiology, symptom burden, and surgical outcomes. Elderly patients report smaller improvements in disease-specific and general health QOL after surgery. CRS management in the elderly population should incorporate age-dependent differences in symptom burden and expectations into treatment algorithms.
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Affiliation(s)
- Kristen L Yancey
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Anne S Lowery
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
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16
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Song WJ, Lee JH, Won HK, Bachert C. Chronic Rhinosinusitis with Nasal Polyps in Older Adults: Clinical Presentation, Pathophysiology, and Comorbidity. Curr Allergy Asthma Rep 2019; 19:46. [PMID: 31486905 DOI: 10.1007/s11882-019-0880-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis and nasal polyps (CRSwNP) is a common condition that significantly affects patients' life. This work aims to provide an up-to-date overview of CRSwNP in older adults, focusing on its aging-related clinical presentations, pathophysiology, and comorbidity associations including asthma. RECENT FINDINGS Recent large population-based studies using nasal endoscopy have shown that CRSwNP is a mostly late-onset disease. Age-related changes in physiologic functions, including nasal epithelial barrier dysfunction, may underlie the incidence and different clinical presentations of CRSwNP in older adults. However, there is still a paucity of evidence on the effect of aging on phenotypes and endotypes of CRSwNP. Meanwhile, late-onset asthma is a major comorbid condition in patients with CRSwNP; they frequently present with type 2 inflammatory signatures that are refractory to conventional treatments when they are comorbid. However, as they are more commonly non-atopic, causative factors other than classical atopic sensitization, such as Staphylococcus aureus specific IgE sensitization, are suggested to drive the type 2 inflammation. There are additional comorbidity associations in older patients with CRSwNP, including those with chronic otitis media and head and neck malignancy. Age is a major determinant for the incidence and clinical presentations of CRSwNP. Given the heterogeneity in phenotypes and endotypes, longitudinal investigations are warranted to elucidate the effects of aging on CRSwNP.
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Affiliation(s)
- Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Ha-Kyeong Won
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Claus Bachert
- Upper Airways Research Laboratory, Ghent University Hospital, Ghent, Belgium
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17
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Ganjaei KG, Soler ZM, Mappus ED, Worley ML, Rowan NR, Garcia GJM, Matthews LJ, Dubno JR, Eckert MA, Schlosser RJ. Radiologic changes in the aging nasal cavity. Rhinology 2019; 57:117-124. [PMID: 30352446 DOI: 10.4193/rhin18.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND With an aging population, it is important to understand age-related anatomic changes in the nasal cavity and cribriform plate (CP) that may have clinical implications. METHODOLOGY Computed tomography (CT) scans obtained for non-rhinologic conditions were divided into a young cohort (N=35, 18-34 years old) and an older adult cohort (N=32, 80-99 years old). Intranasal airspace volumes and bony anatomy of the CP were manually segmented using OsiriX software. The CP was assessed for mean Hounsfield Units (HU) and percentage of olfactory foramina. Deformation based morphometry (DBM) was then performed on the same cohort and correlated with manual measurements. RESULTS Individual nasal cavity volumes increased 17-75% with age. Regression analysis of all scans revealed age to be the predominant variable influencing intranasal volume differences when controlling for sex and head size. Mean HU of the CP negatively correlated with age. No age-related differences in bone stenosis of olfactory foramina were identified. Automated DBM measurements of intranasal volumes, as well as CP and zygoma mean HU correlated with manual measurements. CONCLUSION Older subjects have a global increase in intranasal volumes and diffuse bone density loss in the CP. The clinical impact of age-related anatomic changes in the nasal cavity and CP requires further investigation.
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Affiliation(s)
- Kimia G Ganjaei
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC; Rutgers Robert Wood Johnson Medical School, Piscataway, NJ United States
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States
| | - Elliott D Mappus
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States
| | - Mitchell L Worley
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States
| | - Guilherme J M Garcia
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Lois J Matthews
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States
| | - Mark A Eckert
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States
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18
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Hwang CS, Lee HS, Kim SN, Kim JH, Park DJ, Kim KS. Prevalence and Risk Factors of Chronic Rhinosinusitis in the Elderly Population of Korea. Am J Rhinol Allergy 2018; 33:240-246. [PMID: 30482036 DOI: 10.1177/1945892418813822] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although a significant number of the clinical features and pathophysiologic mechanisms of chronic rhinosinusitis (CRS) have been described, only a few studies have been published on characterization of CRS in the field of aging. OBJECTIVE We investigated the prevalence and risk factors of CRS in elderly (≥65 years old) Koreans using large-scale nationwide epidemiological data and compared the risk factors of elderly with those of younger adult participants (19-64 years old). METHODS Data from 25 529 participants who completed the 2008-2012 Korean National Health and Nutrition Examination Survey were analyzed. Diagnosis of CRS was done according to the EP3OS 2012 guideline for epidemiologic study. Risk factors of CRS were compared in the aspects of sociodemographics, general health behaviors, clinical characteristics, and comorbidities of participants. RESULTS The prevalence of CRS was significantly higher in 5590 elderly than in 19 939 younger adults (6.55% vs 5.69%; P = .016. Some variables of socioeconomic status and mental health in the adult group were associated with increased risk of CRS but did not show association in the elderly group. We observed a significant association between CRS prevalence and comorbid allergic rhinitis, asthma, and atopic dermatitis in both groups ( P < .05). However, in the elderly group, the associations were significantly weaker with regard to allergic rhinitis ( P-interaction = .03) and asthma ( P-interaction = .002). CONCLUSION These results suggest that elderly populations have distinct pathophysiology and clinical presentations from adult CRS, and management for elderly patients with CRS may require different or additional therapeutic approaches.
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Affiliation(s)
- Chi Sang Hwang
- 1 Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Hye Sun Lee
- 2 Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Si Nae Kim
- 2 Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hyung Kim
- 3 Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong-Joon Park
- 1 Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Kyung-Su Kim
- 3 Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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19
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Abstract
The microbiome is defined as the total of cellular microorganisms of baczerial, viral or e. g., parasite origin living on the surface of a body. Within the anatomical areas of otorhinolaryngology, a significant divergence and variance can be demonstrated. For ear, nose, throat, larynx and cutis different interactions of microbiome and common factors like age, diet and live style factors (e. g., smoking) have been detected in recent years. Besides, new insights hint at a passible pathognomic role of the microbiome towards diseases in the ENT area. This review article resumes the present findings of this rapidly devloping scientific area.
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Affiliation(s)
- Achim G Beule
- HNO-Uniklinik Münster.,Klinik und Poliklinik für Hals-Nasen-Ohrenkrankheiten der Universitätsmedizin Greifswald
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20
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Neri M, Sansone L, Pietrasanta L, Kisialiou A, Cabano E, Martini M, Russo MA, Ugolini D, Tafani M, Bonassi S. Gene and protein expression of CXCR4 in adult and elderly patients with chronic rhinitis, pharyngitis or sinusitis undergoing thermal water nasal inhalations. IMMUNITY & AGEING 2018; 15:10. [PMID: 29497453 PMCID: PMC5828426 DOI: 10.1186/s12979-018-0114-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/06/2018] [Indexed: 01/01/2023]
Abstract
Background Chronic rhinitis, pharyngitis and sinusitis are common health problems with a significant impact on public health, and are suspected to be influenced by ageing factors. Nasal inhalation with thermal water may be used to reduce symptoms, inflammation and drug intake. A pre-post clinical study was conducted in 183 consecutive adult and elderly patients with chronic rhinitis, pharyngitis or sinusitis, to evaluate whether thermal water nasal inhalations could improve their symptoms, clinical signs and rhinomanometry measurements, and influence inflammatory biomarkers levels in nasal epithelial cells. Results Participants profile revealed that they were aged on average (mean age and SD 60.6 ± 15.2 years, median 65, range 20–86, 86 aged ≤ 65 years (47%), 96 aged > 65 years (53%)) and extremely concerned about wellbeing. Older age was associated with better compliance to inhalation treatment. Total symptom and clinical evaluation scores were significantly ameliorated after treatment (p < 0.001), with no substantial difference according to age, while rhinomanometry results were inconsistent. Persistence of symptom improvement was confirmed at phone follow up 1 year later (n = 74). The training set of 48 inflammatory genes (40 patients) revealed a strong increase of CXCR4 gene expression after nasal inhalations, confirmed both in the validation set (143 patients; 1.2 ± 0.68 vs 3.3 ± 1.2; p < 0.0001) and by evaluation of CXCR4 protein expression (40 patients; 1.0 ± 0.39 vs 2.6 ± 0.66; p < 0.0001). CXCR4 expression was consistently changed in patients with rhinitis, pharyngitis or sinusitis. The increase was smaller in current smokers compared to non-smokers. Results were substantially unchanged when comparing aged subjects (≥ 65 years) or the eldest quartile (≥ 71 years) to the others. Other genes showed weaker variations (e.g. FLT1 was reduced only in patients with sinusitis). Conclusions These results confirm the clinical impact of thermal water nasal inhalations on upper respiratory diseases both in adults and elders, and emphasize the role of genes activating tissue repair and inflammatory pathways. Future studies should evaluate CXCR4 as possible therapeutic target or response predictor in patients with chronic rhinitis, pharyngitis or sinusitis. Trial registration Communication to Italian Ministry of Health - ICPOM 000461. Registered 10/11/2014. Electronic supplementary material The online version of this article (10.1186/s12979-018-0114-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monica Neri
- 1Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166 Rome, Italy
| | - Luigi Sansone
- 2Department of Cellular and Molecular Pathology, IRCCS San Raffaele Pisana, Rome, Italy.,3Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Luisa Pietrasanta
- Terme di Genova, Genoa, Italy.,Terme di Acqui, AcquiTerme (AL), Italy
| | - Aliaksei Kisialiou
- 1Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166 Rome, Italy
| | | | - Marina Martini
- Terme di Genova, Genoa, Italy.,Terme di Acqui, AcquiTerme (AL), Italy
| | | | | | - Marco Tafani
- 2Department of Cellular and Molecular Pathology, IRCCS San Raffaele Pisana, Rome, Italy.,3Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Stefano Bonassi
- 1Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166 Rome, Italy.,9Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy
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