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Scheire S, Germonpré S, Mehuys E, Van Tongelen I, De Sutter A, Steurbaut S, Van Hees T, Demarche S, Lahousse L, Gevaert P, Boussery K. Rhinitis Control and Medication Use in a Real-World Sample of Patients With Persistent Rhinitis or Rhinosinusitis: A Community Pharmacy Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1865-1876.e6. [PMID: 38677586 DOI: 10.1016/j.jaip.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Little is known about rhinitis control in real-life, nor about the contribution of treatment-related and patient-related factors. OBJECTIVE This study aimed to examine the level of rhinitis control and rhinitis medication utilization in patients with persistent rhinitis and to identify predictors of rhinitis control. METHODS A cross-sectional observational study was conducted in patients with persistent rhinitis recruited in community pharmacies. Participants completed the Rhinitis Control Assessment Test, a questionnaire on patient/rhinitis characteristics, and rhinitis medication use. A visual analog scale for nasal symptoms was also completed. Pharmacy dispensing data were used to calculate adherence to intranasal glucocorticoids. Nasal spray technique was evaluated using a standardized checklist. Predictors of rhinitis control were explored using a linear regression model. RESULTS A total of 1,514 patients, recruited in 215 pharmacies, participated in the study (mean age 48.7 y, 62% female). Almost 60% exhibited suboptimal rhinitis control (Rhinitis Control Assessment Test ≤ 21 of 30). A 50-mm cut-off on the visual analog scale yielded 78.1% sensitivity to identify suboptimal rhinitis control. Participants most frequently used intranasal glucocorticoids (55.6%) and intranasal decongestants (47.4%). Only 10.3% of current nasal spray users demonstrated perfect technique. More than half (54.8%) of glucocorticoid users were identified as underadherent. Female sex, self-reported nasal hyperreactivity, active asthma, and use of oral/intranasal decongestants or nasal saline were identified as predictors of worse rhinitis control. CONCLUSIONS Suboptimal rhinitis control was common in this real-life sample of persistent rhinitis patients. Improving use of rhinitis medication may be key to increase disease control.
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Affiliation(s)
- Sophie Scheire
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Sophie Germonpré
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Els Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Inge Van Tongelen
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, Centre for Family Medicine, Ghent University, Ghent, Belgium
| | - Stephane Steurbaut
- Centre for Pharmaceutical Research, Department of Clinical Pharmacology and Pharmacotherapy, Vrije Universiteit Brussel, Jette, Belgium
| | | | | | - Lies Lahousse
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Philippe Gevaert
- Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Koen Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
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Li J, Wu H, Xing W, Li X, Han Z, Ji R, Deng Z, Jung M, Sun S, Chung BI, Cardenas A, Langston ME. Air pollution mixture associated with oxidative stress exacerbation and symptoms deterioration in allergic rhinitis patients: Evidence from a panel study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 930:172688. [PMID: 38663627 DOI: 10.1016/j.scitotenv.2024.172688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
With allergic rhinitis (AR) on the rise globally, there has been a growing focus on the role of environmental pollutants in the onset of AR. However, the potential mechanisms by how and which these pollutants exacerbate AR conditions remain unknown. This panel study of 49 patients diagnosed with AR over one year aimed to assess the individual and combined effects of short-term exposure to multiple ambient pollutants on oxidative stress, symptoms, and quality of life among patients with AR. All participants underwent four repeated assessments of health conditions and personal environmental exposures (PM2.5, O3, SO2, and NO2) over warm and cold seasons during 2017-2018. We evaluated two oxidative stress biomarkers (malondialdehyde [MDA], and superoxide dismutase [SOD]) via nasal lavage. We collected information on self-reported symptoms and quality of life using the Rhinitis Symptom Scale (SRS), the Visual Analog Scale (VAS), and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) through in-person interviews. Bayesian kernel machine regression (BKMR) was used to evaluate the joint effects of pollutant mixture and identify key contributors. The results revealed a significant association of the pollutant mixture when all four pollutants were at or above their median levels, with increased oxidative stress. This was evidenced by elevated MDA and reduced SOD. We found a joint detrimental effect of the pollutant mixture on AR symptoms with a strong association with increased SRS scores, but a non-significant positive association with VAS and RQLQ scores. PM2.5, O3, and SO2 presented as the potentially primary contributors to the adverse health effects associated with the pollutant mixture in Taiyuan city. Patients with AR exposed to short-term air pollutant mixture are more likely to have greater nasal symptoms and worse quality of life from increased oxidative stress and reduced antioxidant capacity. Further research is warranted to better elucidate the underlying mechanisms.
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Affiliation(s)
- Jinhui Li
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA.
| | - Haisheng Wu
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Weiwei Xing
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Xin Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Zheshen Han
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Renyue Ji
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Zhengyi Deng
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Minji Jung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Shengzhi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Andres Cardenas
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Marvin E Langston
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Cavaliere C, Loperfido A, Ciofalo A, Di Michele L, Begvarfaj E, Bellocchi G, Bugani M, de Vincentiis M, Greco A, Millarelli S, Plath M, Sculco E, Masieri S. Real-Life Evidence of Mepolizumab Treatment in Chronic Rhinosinusitis with Nasal Polyps: A Multicentric Study. J Clin Med 2024; 13:3575. [PMID: 38930104 PMCID: PMC11204559 DOI: 10.3390/jcm13123575] [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: 05/03/2024] [Revised: 06/14/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The introduction of biological drugs in the management of chronic rhinosinusitis with nasal polyps (CRSwNP) is allowing new and increasingly promising therapeutic options. This manuscript aims to provide a multicenter trial in a real-life setting on Mepolizumab treatment for severe uncontrolled CRSwNP with or without comorbid asthma. Methods: A retrospective data analysis was jointly conducted at the Otolaryngology-Head and Neck Surgery departments of La Sapienza University and San Camillo Forlanini Hospital in Rome. Both institutions participated by sharing clinical information on patients with CRSwNP treated with Mepolizumab. Patients were evaluated before starting Mepolizumab, at six months and at twelve months from the first drug administration. During follow-up visits, patients underwent endoscopic evaluation, quality of life assessment, nasal symptoms assessment, and blood tests to monitor mainly neutrophils, basophils, eosinophils, and IgG, IgA, and IgE assay. Results: Twenty patients affected by CRSwNP and treated with Mepolizumab were enrolled (12 females and 8 males with a mean age of 63.7 years). Sixteen patients (80%) had concomitant asthma. During follow-up, a gradual improvement in nasal polyp score, quality of life and nasal symptoms, assessed by SNOT-22 and VAS and loss of smell measured by olfactory VAS, was found. Regarding blood tests, eosinophils decreased gradually, while other blood parameters showed no statistically significant changes. Conclusions: Mepolizumab has been shown to be effective in the therapeutic management of patients with CRSwNP. Further studies are needed to support our findings and better understand the underlying immune pathways to predict patients' response to biological treatment in CRSwNP.
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Affiliation(s)
- Carlo Cavaliere
- Department of Sense Organs, Sapienza University, 00185 Rome, Italy; (A.C.)
| | - Antonella Loperfido
- Otolaryngology Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy; (A.L.)
| | - Andrea Ciofalo
- Department of Sense Organs, Sapienza University, 00185 Rome, Italy; (A.C.)
| | - Loreta Di Michele
- Department of Pulmonary Interstitial Diseases, San Camillo Forlanini Hospital, 00152 Rome, Italy;
| | - Elona Begvarfaj
- Department of Sense Organs, Sapienza University, 00185 Rome, Italy; (A.C.)
| | - Gianluca Bellocchi
- Otolaryngology Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy; (A.L.)
| | - Marcella Bugani
- Department of Sense Organs, Sapienza University, 00185 Rome, Italy; (A.C.)
| | | | - Antonio Greco
- Department of Sense Organs, Sapienza University, 00185 Rome, Italy; (A.C.)
| | - Stefano Millarelli
- Otolaryngology Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy; (A.L.)
| | - Michaela Plath
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Eleonora Sculco
- Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy;
| | - Simonetta Masieri
- Department of Oral and Maxillofacial Sciences, Sapienza University, 00185 Rome, Italy
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Megow A, Bouras G, Alsuliman Y, Cooksley C, Vyskocil E, Murphy W, Vreugde S, Wormald PJ. Chitogel with deferiprone following endoscopic sinus surgery: improved wound healing and microbiome. Front Surg 2024; 11:1338209. [PMID: 38638142 PMCID: PMC11024462 DOI: 10.3389/fsurg.2024.1338209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/28/2024] [Indexed: 04/20/2024] Open
Abstract
Background Adhesion formation, sinus ostial narrowing, and presence of pathogenic bacteria are associated with poor outcomes following endoscopic sinus surgery (ESS) for chronic rhinosinusitis. Chitogel has been shown to improve wound healing, restore a healthier microbiome, and reduce post-operative infections post ESS. Deferiprone has antibacterial properties and has been shown to reduce adhesion formation. The aim of the study was to assess whether the addition of low concentration deferiprone to Chitogel further improves surgical outcomes following ESS compared with Chitogel alone. Methods In this double-blinded trial, 45 patients undergoing ESS were prospectively recruited. At the end of the surgery, patients were randomised to receive Chitogel alone, Chitogel with 1 mM of deferiprone, or Chitogel with 5 mM of deferiprone to one side of the sinuses (allowing the other side to serve as control). Patients underwent routine follow-ups with symptom questionnaires and nasoendoscopies performed at 2, 6, and 12 weeks post-operatively. Sinus ostial measurements, microbiology, and microbiome swabs from bilateral middle meatuses were collected intraoperatively and at 12 weeks post-operatively. Results A significant improvement in the endoscopic appearance of the sinuses and frontal ostial patency was noted at 12 weeks post-operatively (p < 0.05) in all three treatment groups compared with the control. There was no significant difference noted between patients who received Chitogel alone and those who received Chitogel with 1 or 5 mM deferiprone. Conclusion Chitogel alone, Chitogel with 1 mM deferiprone, and Chitogel with 5 mM deferiprone used following ESS led to a significant improvement in endoscopic appearance of the sinuses and frontal ostial preservation at 12 weeks post-operatively. No significant difference was found with the addition of deferiprone to Chitogel.
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Affiliation(s)
| | | | | | | | | | | | | | - Peter-John Wormald
- Department of Surgery—Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia
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Giombi F, Canali L, Zuppardo J, Pace GM, Pirola F, Ferreli F, Mercante G, Spriano G, Cerasuolo M, Malvezzi L. Psychiatric Burden in Chronic Sinonasal Diseases: A Single-Center Cross-Sectional Observational Study. Cureus 2024; 16:e57471. [PMID: 38699136 PMCID: PMC11065418 DOI: 10.7759/cureus.57471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic rhinosinusitis (CRS) and nasal septum deviation (SD) are two widely diffused clinical conditions in otorhinolaryngology clinical practice. Albeit nasal symptoms are the most commonly referred by patients affected by both conditions, recent evidence has explored the impairment of nasal function beyond its local implication. Indeed, the prevalence of psychiatric disorders, specifically anxiety and depression, was found higher in patients suffering from SD or CRS than in the general population. The aim of this study was to evaluate the psychiatric burden of these conditions in terms of anxiety and depression and to assess its relationship with clinical phenotype and age. METHODS Monocentric cross-sectional observational study. Consecutive patients affected by CRS with or without nasal polyps or by SD were considered eligible. At referral, each patient underwent nasal endoscopy for clinical diagnosis and had to fill in the Hospital Anxiety and Depression Scale (HADS), the Sinonasal Outcome Test-22 (SNOT-22), and the Visual Analogue Scale (VAS) for global nasal symptoms. The population was grouped according to disease and age. RESULTS One hundred fifty patients were enrolled. We observed a statistically significant difference in mean HADS score between patients affected by CRS with nasal polyps and those suffering from CRS without nasal polyps or SD both in the overall population and by age groups. Nevertheless, there was no significant difference in the HADS score between younger patients affected by CRS and SD. The mean HADS score was significantly higher in younger patients affected by SD compared to older. Furthermore, we observed an inverse correlation between age and HADS score in each disease group, statistically significant for SD. On the contrary, in the overall population, HADS score and patient-related outcomes (PROs) were directly correlated. Conclusions: In the era of personalized medicine, our work remarks on the critical impact of anxiety and depression on the quality of life (QoL) of patients affected by sinonasal conditions. According to our results, age affects patient-reported outcomes (PROs) and should, therefore, be enhanced in the therapeutic decision process.
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Affiliation(s)
- Francesco Giombi
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Luca Canali
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Jessica Zuppardo
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Francesca Pirola
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Michele Cerasuolo
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
- Otorhinolaryngology Head and Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Milan, ITA
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
- Otorhinolaryngology Head and Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Milan, ITA
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6
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Maspero JF, Anselmo-Lima W, Bedoya D, Jimenez Chobillón MA, Ospina J, Roithmann R, Sadek Gonzalez A, Silva Rueda R. Management of CRSwNP in Latin America: A multidisciplinary consensus from an expert working group. World Allergy Organ J 2024; 17:100886. [PMID: 38463018 PMCID: PMC10924205 DOI: 10.1016/j.waojou.2024.100886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition of the nasal and paranasal tissues, characterized by the presence of bilateral nasal polyps. While etiology and pathogenetic mechanisms are heterogeneous and complex, in most patients, disease is mediated predominantly through type 2 inflammatory processes. Clinical management is challenging, and a multidisciplinary approach is preferred. Principal treatment approaches are the use of local/systemic corticosteroids and sinonasal surgery, although outcomes can be unsatisfactory. Recent availability of biological therapies targeting underlying inflammatory processes can offer effective treatment options in uncontrolled disease. Specialist guidelines greatly assist clinical decision-making, although as these are chiefly written from a global/international perspective, they may not wholly accommodate disease patterns and clinical practice at a regional level. An expert panel of specialists from Latin America was convened to develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the chief observations and recommendations which can provide guidance for clinicians in the Latin American region.
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Affiliation(s)
| | - Wilma Anselmo-Lima
- Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - David Bedoya
- Department of Otorhinolaryngology, Universidad de Antioquia, Medellin, Colombia
| | | | - Javier Ospina
- Division of Otolaryngology - Sinus and Skull Base Surgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Renato Roithmann
- Universidade Luterana do Brasil, Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Andrés Sadek Gonzalez
- Hospital Angeles del Pedregal, Camino a Santa Teresa 1055, Delegacion Alvaro Obregon, CP10700 Mexico City, Mexico
| | - Ricardo Silva Rueda
- Department of Otorhinolaryngology, Hospital Militar Central, Bogotá, Colombia
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Chong AXJ, Alvarado R, Rimmer J, Campbell RG, Kalish L, Png LH, Harvey RJ. Comparison of Allergen Immunotherapy Alone and in Conjunction With Turbinate Surgery for Nasal Obstruction in Perennial Allergic Rhinitis Patients. Ann Otol Rhinol Laryngol 2024:34894241234593. [PMID: 38414187 DOI: 10.1177/00034894241234593] [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: 02/29/2024]
Abstract
BACKGROUND Nasal obstruction, triggered by allergic rhinitis, often does not resolve with allergen-specific immunotherapy (AIT) alone, thus inferior turbinate reduction surgery (ITR) may be required. This study aims to investigate the impact of combined treatment on nasal obstruction, as evidence is currently limited. METHODOLOGY/PRINCIPAL A retrospective cohort study of perennial allergic rhinitis patients experiencing nasal obstruction and undergoing ≥12 months AIT was conducted. Two groups were derived, those undergoing AIT-with or without an ITR. Patient reported nasal obstruction (evaluated with questionnaires) and nasal airway function (Nasal Peak Inspiratory Flow [NPIF] and Nasal Airflow Resistance [NAR]) were monitored. The change from baseline to 12 months post-treatment in each group were compared. RESULTS A total of 118 patients (33.71 ± 14.43 years, 41.5% female) were recruited, 72% had AIT and 28% AIT&ITR. At baseline, the AIT&ITR group had a higher level of nasal obstruction (>moderate%; 63.6% vs 52.9%, P = .048). Post treatment, AIT&ITR group reported greater reduction in nasal obstruction (>1 category change: 75.8% vs 48.2%, P = .002). Similarly, the AIT&ITR group had greater improvement in nasal function by NPIF (-13.9 ± 110.3 L/minute vs -3.4 ± 78.1 L/minute, P = .049) and NAR (-0.120 ± 0.342 Pa/cm³/second vs -0.093 ± 0.224 Pa/cm³/second, P = .050). CONCLUSIONS Allergic rhinitis patients, with moderate to severe nasal obstruction, who undergo combined AIT&ITR have greater relief of nasal obstruction and improved airflow analysis compared to AIT alone.
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Affiliation(s)
- Amaris Xin Jie Chong
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Janet Rimmer
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Woolcock Institute, University of Sydney, Sydney, Australia
- Faculty of Medicine, Notre Dame University, Sydney, Australia
| | - Raewyn G Campbell
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Otolaryngology, Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Larry Kalish
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Otolaryngology, Head and Neck Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Lu Hui Png
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- Singapore General Hospital, Singapore, Singapore
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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8
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Trecca EMC, Marano PG, Madaro F, Fortunato F, Frisotti DR, Caponio VCA, Vocale M, Cassano M. Impact of obstructive sleep apnea syndrome on olfactory and gustatory capacity. Chem Senses 2024; 49:bjae022. [PMID: 38818785 DOI: 10.1093/chemse/bjae022] [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: 01/27/2023] [Indexed: 06/01/2024] Open
Abstract
Only a few studies have investigated olfactory function in patients with obstructive sleep apnea syndrome (OSAS) using psychophysical testing, and there is a scarcity of data regarding taste evaluation in the existing literature. The primary objectives of this study were to assess both smell and taste in patients with OSAS and to explore the correlation between the severity of symptoms and sensory perception. A total of 85 OSAS patients and a control group comprising 81 subjects were enrolled. Initial assessments included anamnesis, nasal endoscopy, and the completion of questionnaires (Epworth Sleepiness Scale, Visual Analogue Scale, Questionnaire of Olfactory Disorders, and the importance of olfaction questionnaire). The diagnosis of OSAS was confirmed by polysomnography, while nasal airflow was evaluated using rhinomanometry. Olfaction was assessed using the Sniffin' Sticks test, and the Threshold-Discrimination-Identification (TDI) score was calculated. Taste evaluation was conducted in a subgroup of participants (42 patients, 38 controls) using taste strips. The mean TDI score was 31 ± 5.6 for OSAS patients and 35 ± 4.6 for controls, indicating a significant difference (P < 0.001). Similarly, the taste score was 7 ± 3.0 for OSAS patients and 12.6 ± 3.2 for controls (P < 0.001). No correlations were observed between TDI and Apnea Hypopnea Index (AHI) (r = -0.12; P = 0.28), as well as between the taste score and AHI (r = -0.31; P = 0.22). However, a weak but significant correlation between TDI score and Epworth Sleepiness Scale was detected (r = -0.05; P = 0.002). The study revealed a significant decrease in sensory perception among patients with OSAS, though open questions persist about the pathophysiology.
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Affiliation(s)
- Eleonora M C Trecca
- Department of Otorhinolaryngology, University Hospital of Foggia, Head and Neck Surgery, Foggia, Italy
- IRCCS Casa Sollievo Della Sofferenza, Department of Maxillofacial Surgery and Otorhinolaryngology, San Giovanni Rotondo (Foggia), Italy
| | - Pier Gerardo Marano
- Department of Otorhinolaryngology, University Hospital of Foggia, Head and Neck Surgery, Foggia, Italy
| | - Ferruccio Madaro
- "Vito Fazzi" Hospital, Department of Otorhinolaryngology-Head and Neck Surgery, Lecce, Italy
| | - Francesca Fortunato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Daniela R Frisotti
- Department of Physical Medicine and Rehabilitation, University Hospital of Foggia; Foggia, Italy
| | | | - Matteo Vocale
- Department of Otorhinolaryngology, University Hospital of Foggia, Head and Neck Surgery, Foggia, Italy
| | - Michele Cassano
- Department of Otorhinolaryngology, University Hospital of Foggia, Head and Neck Surgery, Foggia, Italy
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9
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Uyttebroek S, Dupont L, Jorissen M, Van Gerven L. Upper Airway Disease in Adults with Cystic Fibrosis in the Era of CFTR Modulators. Laryngoscope 2023; 133:2898-2909. [PMID: 36912358 DOI: 10.1002/lary.30642] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is prevalent in people with cystic fibrosis (PwCF) and is often refractory to treatments. Uncontrolled CRS might negatively impact the lower airways and the quality of life. The aim of this study is to evaluate the burden of cystic fibrosis (CF)-related CRS in the era of CF transmembrane conductance regulator (CFTR) modulators. METHODS Adult PwCF were asked to fill in a questionnaire on sinonasal complaints, they underwent a nasal endoscopy, bacteriological sampling, and a CT scan. Afterwards, these outcome measures were compared between patients treated with and without modulators. RESULTS In the 122 included patients, CRS was present in 83%. CFTR modulators were prescribed in 48% of the patients, with a median of 10 months since the start of the treatment. Subjectively, the median SNOT-22 score was 16/110. Objectively, a median Lund-Kennedy score of 6/12 and modified Lund-Mackay score of 10/24 were observed. No correlation could be found between SNOT-22 score and other outcome measures including endoscopy and radiology. Altogether, 21% of the patients had controlled disease. When comparing patients treated with and without modulators, significantly lower CT scores (p = 0.0018) and less bacterial colonization (p = 0.0082) were observed in patients receiving modulators. CONCLUSION CF-CRS is highly prevalent in our cohort and only the minority of PwCF has a well-controlled disease. A multidisciplinary ENT-pneumology clinic would be beneficial, as there is a high discrepancy between patient-reported symptoms and the extent of the disease. CFTR modulators are promising, as lower CT scores and less bacterial colonization were observed in the modulator group. LEVEL OF EVIDENCE Level 3 Laryngoscope, 133:2898-2909, 2023.
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Affiliation(s)
- Saartje Uyttebroek
- Department of Otorhinolaryngology, Head and Neck surgery, UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Otorhinolarygology, Rhinology Research, KU Leuven, Leuven, Belgium
| | - Lieven Dupont
- Department of Pneumology, UZ Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Respiratory Diseases and Thoracic Surgery, KU Leuven, Leuven, Belgium
| | - Mark Jorissen
- Department of Otorhinolaryngology, Head and Neck surgery, UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Otorhinolarygology, Rhinology Research, KU Leuven, Leuven, Belgium
| | - Laura Van Gerven
- Department of Otorhinolaryngology, Head and Neck surgery, UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Otorhinolarygology, Rhinology Research, KU Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
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10
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Maza-Solano J, Callejon-Leblic A, Martin-Jimenez D, Moreno-Luna R, Gonzalez-Garcia J, Cuvillo A, Sanchez-Gomez S. Omalizumab Treatment in Uncontrolled Asthma and CRSwNP Patients, with Previous Endoscopic Sinus Surgery, to Improve Quality of Life and Endoscopic Outcomes: a Two-Year Real-Life Study. Curr Allergy Asthma Rep 2023; 23:555-566. [PMID: 37644255 DOI: 10.1007/s11882-023-01106-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW Despite molecular underlying advances, limited and divergent data on monoclonal antibodies (mAb) therapy in chronic rhinosinusitis with nasal polyps (CRSwNP) make further analysis necessary. The objective of this study is to evaluate the effect of omalizumab as an adjunct to endoscopic sinus surgery (ESS) on the treatment of CRSwNP under real-life conditions. RECENT FINDINGS Since the introduction of omalizumab, as the first biologic agent for the treatment of diseases such as severe allergic asthma, different studies have demonstrated an effect of omalizumab on CRSwNP, with significant improvements in sinonasal symptoms and endoscopic scores. The high efficacy derived from mAb therapy and the need for ESS prior to mAb recommended by guidelines, has led to compare both therapeutic alternatives, finding discrepancies in their effect on quality of life (QoL) and complementary tests outcomes. Patients with moderate-to-severe asthma with clinical criteria for omalizumab indication, and coexistent CRSwNP disease, were selected for a non-randomized interventional retrospective study into four treatment subgroups. Measures were analyzed and compared between groups and over time at the baseline, 16 weeks and 1 and 2 years after treatment. Omalizumab treatment in patients with previous ESS exhibited an earlier and more pronounced improvement in QoL, symptoms scale and endoscopic findings (nasal polyp score and the bilateral modified Lund-Kennedy) as early from week 16, which improvement persisted for 2 years. A greater mean improvement of 33.4 ± 6.5 (95% CI: 20.3-46.4; p < 0.001) points in sinonasal outcome test 22 (SNOT-22) was associated with ESS at week 16, against omalizumab effect (17.8 ± 7.6 [95% CI: 2.6-33.0]; p = 0.023). At year 2, an improvement in SNOT-22 of 62.6 ± 8.9 (95% CI: 48.4-84.1; p < 0.001) points was exclusively associated with omalizumab. Clinical evidence of the effect of omalizumab added to ESS treatment is provided in this study in the short- and long-term.
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Affiliation(s)
- Juan Maza-Solano
- Rhinology Unit, Department of Otolaryngology, University Hospital Virgen Macarena, Seville, Spain
| | - Amparo Callejon-Leblic
- Rhinology Unit, Department of Otolaryngology, University Hospital Virgen Macarena, Seville, Spain
- Biomedical Engineering Group, University of Seville, Seville, Spain
| | - Daniel Martin-Jimenez
- Rhinology Unit, Department of Otolaryngology, University Hospital Virgen Macarena, Seville, Spain.
| | - Ramon Moreno-Luna
- Rhinology Unit, Department of Otolaryngology, University Hospital Virgen Macarena, Seville, Spain
| | - Jaime Gonzalez-Garcia
- Rhinology Unit, Department of Otolaryngology, University Hospital Virgen Macarena, Seville, Spain
| | - Alfonso Cuvillo
- Rhinology and Asthma Unit, ENT Department, Jerez Hospital, Cadiz, Spain
| | - Serafin Sanchez-Gomez
- Rhinology Unit, Department of Otolaryngology, University Hospital Virgen Macarena, Seville, Spain
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11
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Gater A, Tolley C, Williams‐Hall R, Trennery C, Bradley H, Sikirica MV, Nelsen L, Sousa AR, Bratton DJ, Chan R, von Maltzahn R. Patient-Reported Outcome Measures for Severe Recurrent Bilateral Nasal Polyps: Psychometric Evaluation and Content Validity. OTO Open 2023; 7:e84. [PMID: 38130916 PMCID: PMC10733778 DOI: 10.1002/oto2.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/06/2023] [Accepted: 08/14/2023] [Indexed: 12/23/2023] Open
Abstract
Objective To date, no patient-reported outcome measures have been specifically developed to assess pharmacological treatment effect in participants with severe chronic rhinosinusitis (CRS) with recurrent bilateral nasal polyps (NP). These studies aimed to assess (1) the psychometric properties and (2) content validity of Visual Analogue Scales (VAS) assessing NP symptom severity. Study Design (1) Retrospective psychometric validation study using clinical trial data and (2) cross-sectional qualitative patient interview study. Setting (1) Multicentre trial; (2) real-world. Methods (1) Psychometric validation was performed using data from a randomized, double-blind, placebo-controlled, Phase II study (NCT01362244) investigating the effect of mepolizumab in 105 participants with severe, recurrent bilateral NP currently needing polypectomy surgery. (2) Content validity was explored through cognitive debriefing interviews in 27 adults with severe CRS with recurrent bilateral NP who had received NP surgery in the past 10 years (NCT03221192). Results (1) Acceptable reliability, validity, and responsiveness were shown for individual VAS items, although the loss of smell VAS item performed poorly in several analyses, suggesting further evaluation of this item is needed. (2) All individual VAS items were well understood, considered relevant and were consistently interpreted by most participants, providing evidence for their content validity. Conclusion These findings support the use of symptom VAS measures to evaluate disease experience and treatment effect in clinical trials of participants with severe CRS with recurrent bilateral NP.
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Affiliation(s)
- Adam Gater
- Patient‐Centered Outcomes, Adelphi ValuesBollingtonCheshireUK
| | - Chloe Tolley
- Patient‐Centered Outcomes, Adelphi ValuesBollingtonCheshireUK
| | | | - Claire Trennery
- Patient‐Centered Outcomes, Adelphi ValuesBollingtonCheshireUK
| | - Helena Bradley
- Patient‐Centered Outcomes, Adelphi ValuesBollingtonCheshireUK
| | - Mirko V. Sikirica
- Value Evidence and Outcomes, GSKPhiladelphiaPennsylvaniaUSA
- Present address:
Market Access, Janssen Global Services, LLC
| | - Linda Nelsen
- Value Evidence and Outcomes, GSKPhiladelphiaPennsylvaniaUSA
| | - Ana R. Sousa
- Clinical Sciences, Respiratory, GSKBrentfordMiddlesexUK
| | | | - Robert Chan
- Clinical Sciences, Respiratory, GSKBrentfordMiddlesexUK
| | - Robyn von Maltzahn
- Patient Centered Outcomes, Value Evidence and Outcomes, GSKBrentfordMiddlesexUK
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12
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Kim SY, Nam HJ, Byeon JY, Choi HJ. Effectiveness of out-fracture of the inferior turbinate with reduction nasal bone fracture. World J Clin Cases 2023; 11:6374-6382. [PMID: 37900224 PMCID: PMC10601012 DOI: 10.12998/wjcc.v11.i27.6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/28/2023] [Accepted: 08/23/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The nasal bone, being the most protruding bone in the center of the facial bones, is particularly susceptible to damage. Nasal bone fractures can often result in secondary deformation and dysfunction of the nose, including septal fractures. Studies on functional or intra-nasal complications have been rarely reported after nasal bone fracture reduction. AIM To evaluate the severity of nasal obstruction and its improvement following nasal bone fracture reduction using inferior turbinoplasty. METHODS We conducted a retrospective review of data from 50 patients with symptomatic nasal obstruction between January to December 2010. All patients underwent preoperative Computed tomography evaluation, and symptom changes and nasal cavity volume were analyzed using a visual analog scale and acoustic rhinometry before and after surgery. Closed reduction and out-fracture of both inferior turbinates performed by the same surgeon. Treatment outcomes were assessed by comparing changes in the nasal airway volume measured using acoustic rhinometry before and after surgery. The minimal cross-sectional area (MCA) was also analyzed based on the Stranc classification. RESULTS Before reduction, the mean MCA for all cases was 0.59 ± 0.06 cm2, which represented an 11% decrease compared to the average size of a Korean adult (0.65 ± 0.03 cm2). The MCA for frontal impact was 0.60 ± 0.02 cm2 and for lateral impact, it was 0.58 ± 0.03 cm2. After reduction via inferior turbinoplasty, the MCA improved to 0.64 ± 0.04 cm2. CONCLUSION This study suggests that turbinoplasty is helpful in addressing nasal obstruction. Out-fracture of the inferior turbinate is an effective and durable technique that can be easily performed to enlarge the nasal airway with minimal morbidity.
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Affiliation(s)
- Se-Young Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Gumi Hospital, Gumi-si 39371, South Korea
| | - Ha-Jong Nam
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Gumi Hospital, Gumi-si 39371, South Korea
| | - Je-Yeon Byeon
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan-si 31151, South Korea
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan-si 31151, South Korea
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13
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Tepetam FM, Özden Ş, Kılıç FK, Örçen C, Yakut T. Does NSAID exacerbated respiratory disease (N-ERD) accompanying severe asthma affect biological treatment response? Efficacy of omalizumab and mepolizumab in N-ERD. World Allergy Organ J 2023; 16:100817. [PMID: 37771938 PMCID: PMC10522979 DOI: 10.1016/j.waojou.2023.100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/14/2023] [Accepted: 09/02/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction Non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) accompanies severe asthma in about 15% of the patients and may adversely affect the prognosis. Omalizumab and mepolizumab are biologics used in patients with severe asthma. The objective of this study is to assess the respiratory improvements, after these biologics in severe asthmatic patients stratifed by the presence of concomitant Non-erosive reflux disease (N-ERD) and the effect of omalizumab and mepolizumab in severe asthmatics with N-ERD. Material & method The population of this three-center, retrospective, cross-sectional, observational study comprised patients using omalizumab or mepolizumab for severe asthma. Patients administered these biologics for severe asthma were comparatively analyzed for the presence of N-ERD; asthma control test (ACT) scores, number of attacks, and the changes in forced expiratory volume in 1 s (FEV1) were assessed. Subsequently, patients who were found to have N-ERD were analyzed using visual analog scale (VAS) in terms of the changes in their nasal parameters (ie, nasal obstruction, facial pain, anterior-posterior rhinitis, and hyposmia), according to whether they use omalizumab or mepolizumab. Results The use of biologics resulted in a significant improvement in ACT and FEV1 and reduction in attacks in 28 severe asthmatics with N-ERD and 125 without N-ERD. Although both biologics resulted in a significant improvement in the respiratory parameters, omalizumab treatment resulted in a significant improvement in nasal parameters except hyposmia, mepolizumab treatment resulted in a significant improvement only in posterior rhinitis, and nasal obstruction among the nasal parameters. Conclusion This study is the first to address both omalizumab and mepolizumab treatments in severe asthmatics with N-ERD. The improvement in nasal parameters was more pronounced in patients who were administered omalizumab. Large-scale randomized controlled studies are needed to corroborate the findings of this study.
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Affiliation(s)
- Fatma Merve Tepetam
- University of Health Sciences, Süreyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Immunology and Allergy, Istanbul, Turkey
| | - Şeyma Özden
- University of Health Sciences, Süreyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Immunology and Allergy, Istanbul, Turkey
| | - Fatma Kübra Kılıç
- University of Health Sciences, Süreyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonology, Istanbul, Turkey
| | - Cihan Örçen
- University of Health Sciences, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Tuğçe Yakut
- University of Health Sciences, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
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14
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Mehuys E, Lapauw B, T'Sjoen G, Christiaens T, De Sutter A, Steurbaut S, Van Tongelen I, Boussery K. Investigating Levothyroxine Use and Its Association with Thyroid Health in Patients with Hypothyroidism: A Community Pharmacy Study. Thyroid 2023; 33:918-926. [PMID: 37184683 DOI: 10.1089/thy.2023.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background: To gain maximum therapeutic effect while minimizing side effects, it is imperative for patients with hypothyroidism to use their levothyroxine (LT4) correctly, such as adhering to the prescribed regimen. Little is currently known about how patients actually use LT4 in real life. We investigated the use of LT4, as well as the thyroid health (thyrotropin [TSH] and health-related quality of life [HR-QoL]), and evaluated if proper LT4 use is associated with better thyroid health. Methods: A cross-sectional observational study was conducted in a Belgian community sample of adults using LT4 for hypothyroidism since ≥2 years. Participants completed a self-administered questionnaire on patient characteristics, self-reported adherence to LT4, timing of intake, and co-medication. They also completed the thyroid-specific patient-reported outcome (ThyPRO-39) questionnaire, measuring the HR-QoL. Pharmacy dispensing data were used to calculate the medication possession ratio (MPR). Results: We included 856 participants (mean age 61.4 ± 14.3 years, 86% [740/856] females). Approximately one in four participants (138/563) had out-of-range TSH levels. Generally, ThyPRO-39 scores were in the lower part of the range (indicating better HR-QoL), with the scales "emotional susceptibility" and "tiredness" showing the worst scores. Approximately 28% (178/632) of the participants were classified as non-adherent (MPR <80%), corresponding to at least 73 cumulative days per year without LT4 intake. Twenty-five percent (212/854) of participants self-reported non-adherence, with unintentional non-adherence (forgetfulness) most frequently reported (21.9%, 187/854). Only 39% (329/836) of participants complied with the recommendation of ingesting LT4 ≥ 30 minutes before eating. Additionally, 7% (58/856) of participants concurrently used molecules that bind to LT4, without applying the recommended dosing interval. There was no significant correlation between LT4 usage (adherence, timing of intake, and interaction with complex forming drugs) and TSH or HR-QoL. Conclusions: We found that many participants with hypothyroidism did not use their LT4 as effectively as possible, particularly with respect to timing of administration. However, the participants' HR-QoL seemed largely satisfactory, and there was no significant correlation between correctly using LT4 and thyroid health.
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Affiliation(s)
- Els Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Thierry Christiaens
- Unit of Clinical Pharmacology, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, Centre for Family Medicine, Ghent University, Ghent, Belgium
| | - Stephane Steurbaut
- Centre for Pharmaceutical Research, Research Group of Clinical Pharmacology and Clinical Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
- Department of Hospital Pharmacy, UZ Brussel, Jette, Belgium
| | - Inge Van Tongelen
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Koen Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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15
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Li X, Li J, Xu X, She W, Wang C, Zhang Y, Zhang L. Direct economic burden 1 year postoperation in Chinese adult patients with chronic rhinosinusitis with nasal polyps. Expert Rev Clin Immunol 2023; 19:1419-1425. [PMID: 37555515 DOI: 10.1080/1744666x.2023.2246660] [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: 01/03/2023] [Revised: 07/06/2023] [Accepted: 08/07/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) remains a common and challenging clinical entity, and its economic burden has not been well described in China thus far. METHODS A total of 101 CRSwNP patients who underwent endoscopic sinus surgery were included to investigate direct costs in the first year post-surgery. Costs for outpatient visits, medication use, and examination costs were obtained from the Hospital Information System, and differences were compared between subgroups. Multiple linear regression analysis was adopted to investigate the main influencing factors on annual total direct costs for CRSwNP patients. RESULTS Ninety-two subjects completed the study. The individual mean total direct cost for a CRSwNP patient 1 year post-surgery was $742.4. The largest contributors were pharmacy costs ($580.2), followed by examination costs ($108.1) and outpatient visits ($54.1). Total direct costs were higher in subgroups of patients with uncontrolled clinical status, asthma comorbidity, and eosinophilic CRSwNP compared to their counterparts. The main influencing factors were clinical control status (P = 0.016) and asthma comorbidity (P = 0.035). CONCLUSIONS The individual mean total direct cost of CRSwNP in 1-year post-surgery was $742.4. Clinical control status and asthma comorbidity influence these costs and are therefore important in guiding health resources allocation for CRSwNP management.
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Affiliation(s)
- Xian Li
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jingyun Li
- Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Xu Xu
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Wenyu She
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Yuan Zhang
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
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16
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Matti E, Maiorano E, Nacu B, Luceri A, Sovardi F, Siragusa V, Ferrauto A, Spinozzi G, Olivieri C, Benazzo M, Pagella F. Silicone septal splint for recurrent epistaxis in HHT patients: experience of a national referral centre. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S28-S33. [PMID: 37698097 PMCID: PMC10159634 DOI: 10.14639/0392-100x-suppl.1-43-2023-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 09/13/2023]
Abstract
Objective To report our experience in the use of silicone septal splint for recurrent severe epistaxis in hereditary haemorrhagic telangiectasia patients (HHT). Methods This is a descriptive analysis carried out at the Otorhinolaryngology Department of Fondazione IRCCS Policlinico San Matteo in Pavia, a reference centre for the treatment and diagnosis of HHT. We retrospectively evaluated HHT patients who underwent silicone septal splint positioning after the endoscopic surgical treatment of epistaxis from 2000 to 2022. Results Of the 506 patients surgically treated in the period of analysis, 74 patients underwent silicone septal splint positioning and 37 were post-operatively interviewed. With a mean of 2.4 previous surgical treatments and a mean epistaxis severity of 7.38, the majority of patients presented with septal perforation (71.6%). On average, patients maintained the splint in place for 54.5 months, with a good tolerability and a significant reduction in epistaxis severity, need for blood transfusion and improvement of haemoglobin levels. Conclusions In HHT patients with recurrent severe epistaxis and with septal perforation, the placement of septal splints offers a useful additional strategy in the management of nosebleeds.
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Affiliation(s)
- Elina Matti
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eugenia Maiorano
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Bogdan Nacu
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Andrea Luceri
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Fabio Sovardi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vera Siragusa
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
| | | | - Giuseppe Spinozzi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carla Olivieri
- Molecular Medicine Department, General Biology and Medical Genetics Unit, University of Pavia, Pavia, Italy
| | - Marco Benazzo
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Fabio Pagella
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
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17
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Chan R, Stewart K, Misirovs R, Lipworth B. Patient-Reported Outcomes with Benralizumab in Patients with Severe Eosinophilic Asthma and Severe Chronic Rhinosinusitis with Nasal Polyps. SINUSITIS 2023. [DOI: 10.3390/sinusitis7010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) and severe eosinophilic asthma (SEA) are common comorbidities characterised by type 2 inflammation associated with increased expression of interleukin 5. Methods: Eight patients with SEA and severe CRSwNP attended the Scottish Centre for Respiratory Research as part of a clinical trial (EudraCT number 2019-003763-22). Following an initial 4-week run-in period (baseline) when patients took their usual inhaled and intranasal corticosteroid treatment for SEA and CRSwNP, they all received subcutaneous benralizumab 30 mg q4w for 12 weeks. Results: Following 12 weeks of benralizumab, no significant differences were detected in nasal global symptom visual analogue score (VAS), hyposmia VAS, total nasal symptom score, or peak nasal inspiratory flow. In contrast, Asthma Control Questionnaire significantly improved along with near-complete depletion of peripheral blood eosinophils by 99%, while eosinophil-derived neurotoxin fell by 72%. Conclusions: Greater improvements in patient-reported outcomes related to asthma were observed than with CRSwNP in response to benralizumab.
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18
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Dietz de Loos DAE, Cornet ME, Hopkins C, Fokkens WJ, Reitsma S. Measuring control of disease in Chronic Rhinosinusitis; assessing the correlation between SinoNasal Outcome Test-22 and Visual Analogue Scale item scores. Rhinology 2023; 61:39-46. [PMID: 36240497 DOI: 10.4193/rhin21.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND In chronic rhinosinusitis (CRS), aim of treatment is control of disease. EPOS2020 suggests the use of visual analogue scale (VAS) measurements on several symptoms. We aim to determine if individual VAS items can be replaced by widely used SinoNasal Outcome Test-22 (SNOT-22) items when determining control of disease, to avoid using double measurements and to stimulate its use in clinical practice. METHODS Analyses were made on correlations between individual SNOT-22 scores and symptom-specific questions from consecutive patients with CRS visiting our tertiary referral rhinologic clinic for the first time. RESULTS 157 CRS patients were included. Correlations of individual items were strong (r greater than 0.8). Best parity in sensitivity, specificity, positive predicting value, negative predicting value, odds ratio and Receiver Operating Characteristic curves were found in individual item score of VAS greater than 5 and SNOT item-score. This cut off is valid for measuring control of disease, combining several nasal, facial pain and sleep symptoms (controlled, partially controlled and uncontrolled). CONCLUSION There is strong correlation between individual items measured as SNOT or VAS. For the definition of CRS disease control, as proposed in EPOS2020, the use of symptoms specific SNOT 23 is predictive of VAS greater than 5.
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Affiliation(s)
- D A E Dietz de Loos
- Department of Otorhinolaryngology, Isala Hospital, Zwolle, The Netherlands; Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - M E Cornet
- Department of Otorhinolaryngology, Alrijne Hospital, Leiden, The Netherlands
| | - C Hopkins
- Department of Otorhinolaryngology, Guys and St Thomas Hospitals NHS Trust, London, United Kingdom
| | - W J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - S Reitsma
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
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Pedersen CK, Haase C, Aanaes K, von Buchwald C, Backer V. An update on patient reported outcomes in type 2 inflammation airway disease. Curr Opin Allergy Clin Immunol 2023; 23:1-8. [PMID: 36378110 DOI: 10.1097/aci.0000000000000873] [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: 11/16/2022]
Abstract
PURPOSE OF REVIEW Patient reported outcome measures (PROMs) play an important role in assessing so-called global airway disease caused by type-2 inflammation, not only in terms of patients' perspective on symptoms and treatment/side-effect, but they can also serve as a measure of disease control, and not least as an indicator of possible coexisting comorbidity otherwise unrecognized. The objective of this review was to investigate any newly developed PROMs for global airway disease and to give an overview of the most commonly used PROMs in the management of global airway disease. RECENT FINDINGS The Standard Tests for Asthma, Allergic Rhinitis and Rhinosinusitis (STARR-15) is a recently developed PROM aimed to raise clinicians' awareness of coexisting type-2 inflammation disease. Strengths of the STARR-15 is that is quick and symptom-centered, i.e. items are not specifically aimed at a disease the patients might not be aware they have. The STARR-15 has, however, not yet been validated, so details of responsiveness and reproducibility are yet to be determined. SUMMARY PROMs are a quick and cheap way to assess patient perspectives in global airway disease, and can play an important role in unveiling otherwise overlooked co-existing double disease.
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Affiliation(s)
- Christian Korsgaard Pedersen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital Rigshospitalet, Denmark
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20
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De Sousa Machado A, Sousa F, Silva A, Meireles L. Visual Analog Scale and Olfactory Objective Tests in Hyposmia Patients: Is There a Link? Cureus 2023; 15:e34712. [PMID: 36909088 PMCID: PMC9996390 DOI: 10.7759/cureus.34712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Olfactory dysfunction (OD) is often a devaluated sensorial affection. The objective evaluation of this dysfunction does not evaluate its compromise in patients' daily life. It is unclear to what extent there is a correlation between the objective evaluation of OD and patient-reported impairment. Objective We aim to search if Sniffin Sticks® correlates with the Visual Analog Scale (VAS) of Hyposmia Symptoms, and therefore if it is a useful method for clinical use. Methods A prospective study was carried out to evaluate and compare consecutive patients who had olfactory impairment due to COVID-19 that were referred to an otolaryngology office. The variables evaluated were gender, age, co-morbidities, and olfactory thresholds (measured according to Sniffin Sticks®). Patients were also enquired about their sense of impairment according to VAS from 1 (worst possible) to 10 (best possible). Statistical analysis was performed using SPSS (IBM SPSS Statistics 26). Normal distribution was checked using both skewness and kurtosis and Kolmogorov-Smirnov tests. Pearson correlation test was used to seek a correlation between VAS and olfactory thresholds. All reported p-values are two-tailed, with a p-value ≤ 0.05 indicating statistical significance. Results Our sample of 47 patients was composed of 30 females (63.8%) and 17 females (36.2%). We found a mean variation between olfactory thresholds before and after the intervention of 3.91±2.466, and an average improvement of 2.29±2.93 in the visual analog scale for subjective evaluation of olfactory impairment. According to the Pearson correlation test, with 95% confidence, there is evidence to claim a moderate association (0.512) between an improvement in olfactory thresholds and VAS (p=0.05). Conclusions There was a moderate correlation between ratings and measures of olfactory function. On an individual basis, there were remarkable differences between measures and ratings of olfactory function. VAS should be considered in the evaluation of the hyposmic patient, due to its simplicity and quick applicability.
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Affiliation(s)
- André De Sousa Machado
- Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Porto, PRT.,Faculty of Health Sciences, University of Beira Interior, Covilha, PRT
| | - Francisco Sousa
- Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Ana Silva
- Otolaryngology, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Luís Meireles
- Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Porto, PRT
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21
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Young K, Bulosan H, Kejriwal S, Liang J, Wu AW, Tang DM, Birkeland AC, Steele TO. Efficacy of Cryoablation on Chronic Rhinitis Management: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2023:19458924231152331. [PMID: 36691694 DOI: 10.1177/19458924231152331] [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: 01/25/2023]
Abstract
BACKGROUND ClariFix for posterior nasal nerve ablation has been approved for use since 2017, and this is the first study attempting to synthesize and assess the efficacy of this new device on the management of chronic rhinitis. OBJECTIVE The primary objective of this meta-analysis is to assess the efficacy of ClariFix in the symptomatic management of patients with chronic rhinitis. The main outcome measure is the mean difference in the reflective total nasal symptom score (rTNSS). METHODS A systematic search of Pubmed/Medline, Web of Science, and EBSCOhost was conducted from inception to May 2022. Peer-reviewed clinical trials reporting postcryotherapy rTNSS at both 1- and 3-month intervals for patients with chronic rhinitis were included. A random-effects model was utilized for meta-analysis. Study heterogeneity, bias, and overall quality were all assessed. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The primary outcome measures included mean differences in rTNSS from baseline to both 1- and 3-month postoperative time points. Secondary measures included other questionnaires including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). RESULTS There were 5 studies that met the criteria (247 individuals). The pooled rTNSS mean difference from baseline to 1 and 3 months postoperatively was found to be -3.48 points (95% CI: -3.73 to -3.23, I2 = 0.13). and -3.50 (95% CI: -3.71 to -3.29, I2 = 0.00), respectively. The mean difference from baseline to 3 months postoperatively regarding the RQLQ was found to be -1.53 (95% CI: -1.74 to -1.31, I2 = 0.00). The most common adverse effects included facial or surgical site pain (40.4%), followed by headache (18.2%), oral numbness (11.1%), and sinusitis (4.0%). CONCLUSIONS The findings of this systematic review suggest that cryoablation with Clarifix is an effective treatment modality for chronic rhinitis. However, higher-quality randomized controlled trials will need to be performed to affirm the findings of this study.
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Affiliation(s)
- Kurtis Young
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
| | - Hannah Bulosan
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Sameer Kejriwal
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Jonathan Liang
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Northern California, Oakland, California, USA
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dennis M Tang
- Department of Otolaryngology-Head and Neck Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
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22
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Mimmi S, Lombardo N, Maisano D, Piazzetta G, Pelaia C, Pelaia G, Greco M, Foti D, Dattilo V, Iaccino E. Spotlight on a Short-Time Treatment with the IL-4/IL-13 Receptor Blocker in Patients with CRSwNP: microRNAs Modulations and Preliminary Clinical Evidence. Genes (Basel) 2022; 13:genes13122366. [PMID: 36553635 PMCID: PMC9777725 DOI: 10.3390/genes13122366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Already used for the treatment of some allergic and inflammatory diseases, such as asthma or atopic dermatitis, dupilumab has also been approved as add-on therapy for patients with CRSwNP, and it could represent the keystone to reducing the remission time as well as to improve healing and quality of life. On the other hand, the role of miRNAs as potential biomarkers of immune modulation is emerging. We analyzed the effects of a short-time treatment with dupilumab in patients with CRSwNP, analyzing the immune response modification as well as miRNAs modulations. First, in this early observation stage, all patients experienced remarkable improvement and were clinically stable. Indeed, we observed a significant decrease in CD4+ T cells and a significant reduction in total IgE (p < 0.05) and serum IL-8 levels (p < 0.01), indicating a reduction in the general inflammatory condition. In addition, we analyzed a panel of about 200 circulating miRNAs. After treatment, we noted a significant downregulation of hsa-mir-25-3p (p-value = 0.02415) and hsa-mir-185-5p (p-value = 0.04547), two miRNAs involved in the proliferation, inflammation, and dug-resistance, in accordance with the clinical status of patients. All these preliminary data aimed to identify new biomarkers of prognosis, identifiable with non-invasive procedures for patients. Further, these patients are still under observation, and others with different levels of responsiveness to treatment need to be enrolled to increase the statistical data.
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Affiliation(s)
- Selena Mimmi
- Department of Experimental and Clinical Medicine, University “Magna Græcia”, 88100 Catanzaro, Italy
| | - Nicola Lombardo
- Otolaryngology Head and Neck Surgery, Department Medical and Surgical Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy
| | - Domenico Maisano
- Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Correspondence: (D.M.); (E.I.)
| | - Giovanna Piazzetta
- Otolaryngology Head and Neck Surgery, Department Medical and Surgical Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy
| | - Corrado Pelaia
- Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Marta Greco
- Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Daniela Foti
- Department of Experimental and Clinical Medicine, University “Magna Græcia”, 88100 Catanzaro, Italy
| | - Vincenzo Dattilo
- Department of Experimental and Clinical Medicine, University “Magna Græcia”, 88100 Catanzaro, Italy
| | - Enrico Iaccino
- Department of Experimental and Clinical Medicine, University “Magna Græcia”, 88100 Catanzaro, Italy
- Correspondence: (D.M.); (E.I.)
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23
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Viskens AS, Wils T, Van Bulck P, Cools L, Vanderveken O, Hellings PW. Multiple reasons underlaying uncontrolled disease in the majority of chronic rhinosinusitis patients. FRONTIERS IN ALLERGY 2022; 3:1048385. [PMID: 36583193 PMCID: PMC9792505 DOI: 10.3389/falgy.2022.1048385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
Background Up to 40% of patients with chronic rhinosinusitis (CRS) remain uncontrolled despite guidelines of care being available, with an enormous socio-economic impact. The reasons for uncontrolled disease can be arbitrarily divided into disease-related, diagnosis-related, treatment-related, and patient-related factors. The relative contribution of each factor in uncontrolled CRS remains speculative. This explorative study aimed at determining the factors responsible for uncontrolled CRS in a tertiary care center, thereby identifying the most commons reasons for uncontrolled disease in CRS. Methods Patients with uncontrolled CRS (n = 187) were asked to fill out a questionnaire and underwent a clinical examination at the outpatient clinic of the University Hospital of Leuven, Belgium. Two independent physicians evaluated the (multiple) reason(s) for uncontrolled disease. Results In uncontrolled CRS, 66% of patients showed two or more reasons for uncontrolled disease according to the physicians' evaluation. Disease-related factors (70%) were most often considered the reason for uncontrolled disease, followed by treatment- (45%), patient- (42%), and diagnosis- (32%) related factors. Conclusion In case of uncontrolled CRS, the different contributing factors to the uncontrolled nature need to be carefully addressed during diagnostic and therapeutic actions in order to define strategies to improve CRS care. Most uncontrolled CRS patients have multiple reasons contributing to their disease status, with disease-related factors being the most common factor.
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Affiliation(s)
- An-Sofie Viskens
- Laboratory of Allergy and Clinical Immunology Research Unit, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tine Wils
- Laboratory of Allergy and Clinical Immunology Research Unit, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Pauline Van Bulck
- Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Leuven, Belgium
| | - Leen Cools
- Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Leuven, Belgium
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium,Department of Ear-Nose-Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Peter W. Hellings
- Laboratory of Allergy and Clinical Immunology Research Unit, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Leuven, Belgium,Department of Otolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands,Upper Airways Research Laboratory, Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium,Correspondence: Peter Hellings
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24
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Megow A, Alsuliman Y, Bouras G, Menberu M, Vyskocil E, Vreugde S, Wormald P. Chitogel following endoscopic sinus surgery promotes a healthy microbiome and reduces postoperative infections. Int Forum Allergy Rhinol 2022; 12:1362-1376. [PMID: 35319832 PMCID: PMC9790547 DOI: 10.1002/alr.23001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Postoperative infections following endoscopic sinus surgery (ESS) impair wound healing and lead to poor outcomes. The aim of this study is to assess the effectiveness of Chitogel to reduce postoperative infections and restore a healthy microbiome following ESS. METHODS In this double-blinded randomized control trial, 25 patients undergoing ESS were prospectively recruited. At the end of surgery, patients were randomized to receive Chitogel to one side of the sinuses (allowing the other side to serve as control). Patients underwent routine follow-up with nasoendoscopies performed at 2, 6, and 12 weeks postoperatively. Sinus ostial measurements, microbiology, and microbiome swabs from bilateral sides were collected intraoperatively and at 12 weeks postoperatively. Additional swabs were collected if infection was present. RESULTS Improved endoscopic appearance of the sinuses (p = 0.03) and ostial patency were noted on the Chitogel side compared with control at 12 weeks (p < 0.001). A significant decrease in infections on the Chitogel side (12.0%) compared with control (52.0%) (p = 0.005) was evident. Following the use of Chitogel, there was a significant increase in the combined relative abundance of commensals Corynebacterium and Cutibacterium (Propionibacterium) from 30.15% at baseline to 46.62% at 12 weeks compared with control (47.18% to 40.79%) (p.adj = 0.01). CONCLUSION Chitogel significantly improved both the nasoendoscopic appearance of the sinuses and sinus ostial patency at 12 weeks postoperatively. Chitogel used following ESS helps restore an improved microbiome resulting in an increase in the relative abundance of commensals Corynebacterium and Cutibacterium (Propionibacterium). A significant decrease in postoperative infections was noted following use of Chitogel.
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Affiliation(s)
- Anna Megow
- Department of Surgery ‐ OtolaryngologyHead and Neck SurgeryUniversity of AdelaideSouth AustraliaAustralia
| | - Yazeed Alsuliman
- Department of Surgery ‐ OtolaryngologyHead and Neck SurgeryUniversity of AdelaideSouth AustraliaAustralia
| | - George Bouras
- Department of Surgery ‐ OtolaryngologyHead and Neck SurgeryUniversity of AdelaideSouth AustraliaAustralia
| | - Martha Menberu
- Department of Surgery ‐ OtolaryngologyHead and Neck SurgeryUniversity of AdelaideSouth AustraliaAustralia
| | - Erich Vyskocil
- Department of Surgery ‐ OtolaryngologyHead and Neck SurgeryUniversity of AdelaideSouth AustraliaAustralia
| | - Sarah Vreugde
- Department of Surgery ‐ OtolaryngologyHead and Neck SurgeryUniversity of AdelaideSouth AustraliaAustralia
| | - Peter‐John Wormald
- Department of Surgery ‐ OtolaryngologyHead and Neck SurgeryUniversity of AdelaideSouth AustraliaAustralia
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25
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Ottaviano G, Pendolino AL, Scarpa B, Torsello M, Sartori D, Savietto E, Cantone E, Nicolai P. Correlations between Peak Nasal Inspiratory Flow, Acoustic Rhinometry, 4-Phase Rhinomanometry and Reported Nasal Symptoms. J Pers Med 2022; 12:jpm12091513. [PMID: 36143298 PMCID: PMC9502950 DOI: 10.3390/jpm12091513] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Rhinomanometry, acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) are popular methods for nasal patency evaluation. The aim of the present study was to compare these three methods with the reported nasal symptoms to determine the best diagnostic tool to assess nasal obstruction. Methods: 101 subjects were evaluated using PNIF, 4-phase rhinomanometry (4PR), AR, Visual Analogue Scale for nasal obstruction (VAS-NO) and Sino-Nasal Outcome Test (SNOT-22). Correlations among PNIF, 4PR, AR, VAS-NO and SNOT-22 were obtained. Results: VAS-NO and SNOT-22 were moderately correlated with each other (r = 0.54, p < 0.001). 4PR was moderately correlated with PNIF (r = −0.31, p = 0.0016) and AR (r = −0.5, p < 0.001). VAS-NO was mildly correlated with PNIF (r = −0.29, p = 0.0034). SNOT-22 was moderately correlated with PNIF (r = −0.31, p = 0.0017). After dividing the population into symptomatic and asymptomatic subjects, based on their VAS-NO score, the former showed significantly lower PNIF values (p = 0.009) and higher 4PR values (p = 0.013) compared to the latter ones. Conclusion: PNIF and 4PR showed a significant moderate correlation with each other, but PNIF showed a significant correlation (weak-moderate) with the reported nasal symptom scores.
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Affiliation(s)
- Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35121 Padova, Italy
- Correspondence: ; Tel.: +39-(0)49-8214470; Fax: +39-(0)49-8213113
| | - Alfonso Luca Pendolino
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London WC1E 6DG, UK
- Ear Institute, University College London, London WC1X 8EE, UK
| | - Bruno Scarpa
- Department of Statistical Sciences and Department of Mathematics Tullio Levi-Civita, University of Padova, 35128 Padova, Italy
| | - Miriam Torsello
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35121 Padova, Italy
| | - Daniele Sartori
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35121 Padova, Italy
| | - Enrico Savietto
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35121 Padova, Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat, Federico II University, 80131 Naples, Italy
| | - Piero Nicolai
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35121 Padova, Italy
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26
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Sedaghat A, Singerman K, Phillips K. Discordance of chronic rhinosinusitis disease control between EPOS guidelines and patient perspectives identifies utility of patient-rated control assessment. Rhinology 2022; 60:444-452. [DOI: 10.4193/rhin22.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: The objective of this study was to determine concordance of patient-reported chronic rhinosinusitis (CRS) disease control with CRS disease control assessed according to European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) criteria. Methods: In 421 participants, CRS disease control was determined using EPOS criteria which include the burden of 5 symptoms measured on a binary scale, use of rescue medications in the prior 6 months and presence of diseased mucosa on nasal endoscopy. Symptom severity was also assessed using a visual analogue scale (VAS). Participants rated their CRS disease control as “controlled”, “partly controlled” or “uncontrolled”. Results: Patient-reported and EPOS-based CRS disease control ratings agreed for 49.6% of participants. Amongst cases of disagreement, EPOS guidelines assessed worse CRS disease control relative to 92.9% of patients. Facial pain/pressure and impaired sense of smell distinctly associated with patient agreement with EPOS guidelines on having “uncontrolled” CRS. Higher VAS symptom scores were associated with worse patient-reported CRS disease control (i.e., agreeing with EPOS guidelines). Removal of the nasal endoscopy criterion improved agreement between patients’ and EPOS control assessments, and replacement of this criterion with patient-reported control further aligned EPOS guidelines with patient perspectives. Conclusions: EPOS guidelines regularly assess worse CRS control than assessed by patients. The lack of more gradated symptom severity criteria and inclusion of nasal endoscopy may contribute to discordance of EPOS guidelines with patient-reported CRS control. Replacement of nasal endoscopy findings with a measure of patient-reported CRS disease control better aligns EPOS CRS disease control guidelines with patients’ perspectives.
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27
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De Prado Gomez L, Khan AH, Peters AT, Bachert C, Wagenmann M, Heffler E, Hopkins C, Hellings PW, Zhang M, Xing J, Rowe P, Jacob-Nara JA. Efficacy and Safety of Dupilumab Versus Omalizumab in Chronic Rhinosinusitis With Nasal Polyps and Asthma: EVEREST Trial Design. Am J Rhinol Allergy 2022; 36:788-795. [PMID: 35837739 DOI: 10.1177/19458924221112211] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma are chronic type 2 inflammatory diseases that are frequently associated with each other. Dupilumab inhibits the dual signaling pathways of interleukin (IL)-4 and IL-13, which are key and central drivers of type 2 inflammation in CRSwNP. Omalizumab blocks the action of immunoglobulin E. Head-to-head studies are required to investigate the comparative efficacy and safety of these interventions. EVEREST (EValuating trEatment RESponses of dupilumab vs omalizumab in Type 2 patients) trial is designed to evaluate whether the efficacy of dupilumab is superior to omalizumab in treating patients with CRSwNP and comorbid asthma (ClinicalTrials.gov Identifiers: NCT04998604). OBJECTIVE Here, we describe the EVEREST study design to compare the efficacy and safety of dupilumab compared to omalizumab over 24 weeks of treatment in patients with severe CRSwNP and comorbid asthma. METHODS EVEREST is a global, phase 4 multicenter, randomized (1:1), double-blind, active-controlled trial. Approximately 422 adult patients with severe CRSwNP, symptoms of nasal congestion and loss of smell, and coexisting asthma will be recruited across 15 countries. The primary objective is to assess the efficacy of dupilumab compared to omalizumab in reducing the nasal polyp size and improving the sense of smell. The key secondary objectives are to evaluate the comparative efficacy in improving CRSwNP symptoms (eg, nasal congestion) and lung function. The safety will be evaluated in terms of treatment-emergent adverse events (AEs), serious AEs, and AEs of special interest. CONCLUSIONS EVEREST is the first head-to-head trial assessing the comparative efficacy and safety of 2 biologics in patients with severe CRSwNP and comorbid asthma. The study will provide evidence to help optimize treatment plans for patients that suffer from severe CRSwNP and comorbid asthma.
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Affiliation(s)
| | | | - Anju T Peters
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Peter W Hellings
- 26656Ghent University, Ghent, Belgium.,University Hospitals Leuven, Leuven, Belgium
| | - Mei Zhang
- Sanofi, Bridgewater, New Jersey, USA
| | - Jun Xing
- Sanofi, Bridgewater, New Jersey, USA
| | - Paul Rowe
- Sanofi, Bridgewater, New Jersey, USA
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28
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Zielińska-Bliźniewska H, Paprocka-Zjawiona M, Merecz-Sadowska A, Zajdel R, Bliźniewska-Kowalska K, Malinowska K. Serum IL-5, POSTN and IL-33 levels in chronic rhinosinusitis with nasal polyposis correlate with clinical severity. BMC Immunol 2022; 23:33. [PMID: 35752781 PMCID: PMC9233770 DOI: 10.1186/s12865-022-00507-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a group of heterogeneous diseases characterized by epithelial inflammation and tissue eosinophilic infiltration. IL-5, POSTN, and IL-33 are important factors that act as chemoattractants for eosinophils, and a tissue-remodeling protein positively correlated with eosinophils in blood and mediators of eosinophilic infiltration. The aim of the study was to determine the expression of IL-5, POSTN and IL-33, at the gene and protein levels, in eosinophilic CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP), and to correlate this expression with clinical severity. MATERIALS AND METHODS The study included 40 CRSwNP patients and 53 CRSsNP patients and 40 control subjects. The expression of IL-5, POSTN and IL-33 mRNA was determined in sinonasal mucosal samples and in nasal polyp tissue by real-time PCR. Protein levels in the serum of CRSwNP patients were measured by ELISA. Computed tomography was evaluated according to Lund-Mackay scores, and visual analog scale scores were assessed. RESULTS NP tissue demonstrated significantly higher IL-5 and POSTN mRNA expression than the sinonasal tissue in the CRSsNP and CRSwNP groups. CRS groups demonstrated elevated IL-33 mRNA expression in comparison to controls irrespective of the presence of NP. No correlation was found between IL-5, POSTN and IL-33 mRNA expression and disease severity. CRSwNP group demonstrated significantly higher serum IL-5, POSTN and IL-33 protein levels than controls, and this corresponds to disease severity. CONCLUSION Serum IL-5, POSTN and IL-33 levels may be important markers for classification of eosinophilic CRSwNP patients, along with disease severity.
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Affiliation(s)
| | - Milena Paprocka-Zjawiona
- Department of Allergology and Respiratory Rehabilitation, Medical University of Lodz, 90-725, Lodz, Poland
| | - Anna Merecz-Sadowska
- Department of Computer Science in Economics, University of Lodz, 90-214, Lodz, Poland.
| | - Radosław Zajdel
- Department of Computer Science in Economics, University of Lodz, 90-214, Lodz, Poland
| | | | - Katarzyna Malinowska
- Department of Allergology and Respiratory Rehabilitation, Medical University of Lodz, 90-725, Lodz, Poland
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29
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Mullol J, Azar A, Buchheit KM, Hopkins C, Bernstein JA. Chronic Rhinosinusitis With Nasal Polyps: Quality of Life in the Biologics Era. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1434-1453.e9. [PMID: 35306180 DOI: 10.1016/j.jaip.2022.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
Chronic rhinosinusitis (CRS) affects up to 12% of the general population and is traditionally divided into two main phenotypic subsets, based on the presence of nasal polyps (CRSwNP) or their absence. It is well-established that many patients with CRSwNP report poor quality of life (QoL), which is further compromised by comorbidities (eg, asthma, bronchiectasis, aspirin-exacerbated respiratory disease). Chronic rhinosinusitis CRS with nasal polyps is managed with a combination of medical therapy and surgical interventions, and biologics are emerging as a promising new treatment option for patients with inadequate response to the standard of care. A range of patient-reported outcome measures have been used to assess QoL for patients with CRSwNP in clinical trials, including disease-specific questionnaires (eg, Sino-Nasal Outcome Test-22) and generic ones (eg, Short Form-36). Significantly impaired QoL has been identified as a criterion for the indication to use biologics in patients with CRSwNP. This review summarizes clinical evidence (2010-2021) on QoL outcomes with currently available treatments for CRSwNP and assesses the improvement in QoL after biologic treatments, especially for patients with comorbidities reported in interventional studies (randomized controlled trials and real-world experience).
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Affiliation(s)
- Joaquim Mullol
- Clinical and Experimental Respiratory Immunoallergy, Hospital Clinic Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universidad de Barcelona, Centro Investigación Biomédica En Red Enfermedades Respiratorias, Barcelona, Spain.
| | - Antoine Azar
- Division of Allergy and Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, Md
| | - Kathleen M Buchheit
- AERD Center, Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Claire Hopkins
- Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Jonathan A Bernstein
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Pérez‐Herrera LC, Ordoñez‐Cerón S, Moreno‐López S, Peñaranda D, García E, Peñaranda A. Impact of the COVID‐19 national lockdown in the allergic rhinitis symptoms in patients treated with immunotherapy at two allergy referral centers in Bogotá, Colombia. Laryngoscope Investig Otolaryngol 2022; 7:305-315. [PMID: 35434342 PMCID: PMC9008185 DOI: 10.1002/lio2.738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/20/2021] [Accepted: 01/01/2022] [Indexed: 12/13/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Lucia C. Pérez‐Herrera
- Otolaryngology and Allergology Research groups Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ‐ORL) Bogotá Colombia
- School of Medicine Universidad de Los Andes Bogotá Colombia
| | - Sebastián Ordoñez‐Cerón
- Otolaryngology and Allergology Research groups Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ‐ORL) Bogotá Colombia
- School of Medicine Universidad de Los Andes Bogotá Colombia
| | - Sergio Moreno‐López
- Otolaryngology and Allergology Research groups Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ‐ORL) Bogotá Colombia
- School of Medicine Universidad de Los Andes Bogotá Colombia
| | - Daniel Peñaranda
- Otolaryngology Section Fundación Universitaria de Ciencias de la Salud Bogotá Colombia
| | - Elizabeth García
- Otolaryngology and Allergology Research groups Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ‐ORL) Bogotá Colombia
- School of Medicine Universidad de Los Andes Bogotá Colombia
- Allergy Section, Department of Pediatrics Fundación Santa Fe de Bogotá Bogotá Colombia
| | - Augusto Peñaranda
- Otolaryngology and Allergology Research groups Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ‐ORL) Bogotá Colombia
- School of Medicine Universidad de Los Andes Bogotá Colombia
- Department of Otolaryngology Fundación Santa Fe de Bogotá Bogotá Colombia
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Guven SG, Gorgulu Y. The impact of preoperative psychological characteristics on postoperative satisfaction and quality of life in patients undergoing septoplasty and inferior turbinate ablation surgery. Eur Arch Otorhinolaryngol 2022; 279:4007-4015. [PMID: 35122128 DOI: 10.1007/s00405-022-07286-x] [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] [Received: 11/17/2021] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the effect of preoperative mental state on postoperative satisfaction and quality of life in patients undergoing septoplasty and inferior turbinate ablation surgery. METHODS A total of 41 patients who underwent septoplasty and inferior turbinate ablation surgery due to nasal congestion were included in the study. Patients were asked to complete the Mental Symptoms Checklist Revised (SCL-90 R), World Health Organization Quality of Life Scale-Short Form (WHOQoL-BREF-TR), and Visual Analogue Scale (VAS) tests before and after their surgery. The surgical procedure for all patients was performed by a single ear-nose-throat physician. The preoperative and postoperative test results were then compared. RESULTS A significant decrease was noted in the postoperative SCL-90 R somatization (p < 0.001), additional items (p = 0.001), and global severity index (GSI) (p = 0.002) scores; a significant increase was observed in the postoperative WHOQoL-BREF-TR physical health score (p = 0.029); and a significant decrease was seen in the postoperative VAS scores (p < 0.001). The preoperative SCL-90 R GSI showed a negative correlation with the postoperative WHOQoL-BREF-TR total score and a significant positive correlation with the postoperative VAS scores (p < 0.05 for all). There was a significant difference between those with a postoperative VAS score of ≤ 2 and > 2 in terms of GSI and all preoperative SCL-90 R subscale scores, except for the additional items subscale. Increased preoperative psychological symptoms reported by the patients were associated with a lower perception of postoperative quality of life. CONCLUSION The preoperative mental state of patients undergoing septoplasty and inferior turbinate ablation surgery affects postoperative satisfaction and quality of life. In addition, the recognition of this parameter may contribute to the treatment management of these patients and the legal protection of physicians.
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Affiliation(s)
- Selis Gulseven Guven
- Department of Otorhinolaryngology, Head and Neck Surgery, Çorlu State Hospital, Çorlu, Tekirdağ, Turkey. .,Department of Otorhinolaryngology, Head and Neck Surgery, Trakya University Faculty of Medicine, 22030, Edirne, Turkey.
| | - Yasemin Gorgulu
- Department of Psychiatry, Trakya University Faculty of Medicine, Edirne, Turkey
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Hashem-Dabaghian F, Ali Azimi S, Bahrami M, Latifi SA, Enayati A, Qaraaty M. Effect of Lavender ( Lavandula angustifolia L.) syrup on olfactory dysfunction in COVID-19 infection: A pilot controlled clinical trial. AVICENNA JOURNAL OF PHYTOMEDICINE 2022; 12:1-7. [PMID: 35145890 PMCID: PMC8801216 DOI: 10.22038/ajp.2021.18420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/15/2021] [Accepted: 05/22/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The effect of lavender syrup on COVID-19-induced olfactory dysfunction (OD) has been assessed in this study. MATERIALS AND METHODS This pilot clinical trial was conducted in Gonbad-E-Kavoos (Golestan province, Iran). Twenty-three outpatients with COVID-19 and OD in lavender group took 9 ml of lavender syrup/bid for 3 weeks along with the standard COVID-19 treatments and 20 patients in control group took only standard COVID-19 treatments. The severity of OD was assessed by the visual analogue scale (VAS). Data analysis was performed by Friedman and Mann-Whitney tests using SPSS software. RESULTS The mean± standard deviation of age was 36.6±9.1, and 42.6±10.4 years (p=0.05), and the duration of symptoms was 7.4±3.5, and 7.5±3.4 days (p=0.98) in the lavender and control group, respectively. The VAS score for OD decreased from 6.8±3.04 to 0.26±0.86 in the lavender group and from 5.3±3.4 to 1±2.61 in the control group. Although, VAS for OD was significantly decreased in both groups (p<0.001), the amount of VAS decrease was 6.6±2.9 scores in the lavender group, and 4.3±4 in the control group (p=0.03). No side effects were observed in the lavender group. CONCLUSION The present study showed that lavender syrup is an effective treatment for COVID-19-induced OD. It is suggested to conduct further studies with larger sample size.
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Affiliation(s)
- Fataneh Hashem-Dabaghian
- Research Institute for Islamic and Complementary Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sadegh Ali Azimi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Seied-Amirhossein Latifi
- Traditional and Complementary Medicine Research Center,Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Ayesheh Enayati
- Ischemic research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Marzieh Qaraaty
- Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran ,Corresponding Author: Tel: +98-1732452651, Fax: +98-1732543614,
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Nordström A, Jangard M, Svedberg M, Kullenberg H, Ryott M, Kumlin M. Hot saline irrigation in comparison to nasal packing after sinus surgery. Laryngoscope Investig Otolaryngol 2021; 6:1267-1274. [PMID: 34938861 PMCID: PMC8665458 DOI: 10.1002/lio2.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/20/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Previous studies have shown that hot saline solution (HSS) nasal irrigation is effective against nasal bleeding and is used to treat nasal hemorrhage. In a pilot study, we evaluated hot saline nasal irrigation in comparison to a routinely used nasal packing in terms of self-reported complications and mucosal healing after functional endoscopic sinus surgery. METHODS Patients undergoing surgery for bilateral chronic rhinosinusitis received polyvinyl acetate (PVA) nasal packing in the left nostril, and the right nostril was rinsed with 47°C sterile saline immediately after surgery. Patients' experiences of pain, bleeding, and other types of uncomfortable experiences were measured using a visual analog scale for each nostril before, during, and immediately after nasal packing removal. Two weeks post-surgery, the assessments were repeated including an endoscopic evaluation of the mucosa by the surgeon. RESULTS Twenty-seven patients completed the study. Prior to removal of the packing, the patients experienced significantly more pain and other uncomfortable experiences in the nostril treated with nasal packing, as compared to the nostril solely rinsed with hot saline. After removal, patients reported significantly more uncomfortable experiences from the packing treated nostril. Two weeks post-surgery, no difference in mucosal healing was observed between the two nostrils. CONCLUSIONS The results from this study indicate that irrigation with HSS could be an alternative postoperative treatment to conventional PVA nasal packing. Hot saline irrigation may contribute to patients experiencing improved control of postoperative bleeding, pain, and less suffering of other causes as well as health-economic benefits, without affecting the mucosal healing up to 2 weeks post-surgery. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Axel Nordström
- Department of Health Promotion ScienceSophiahemmet UniversityStockholmSweden
| | - Mattias Jangard
- Department of OtorhinolaryngologySophiahemmet HospitalStockholmSweden
| | - Marie Svedberg
- Department of Health Promotion ScienceSophiahemmet UniversityStockholmSweden
| | - Helena Kullenberg
- Department of Health Promotion ScienceSophiahemmet UniversityStockholmSweden
| | - Michael Ryott
- Department of OtorhinolaryngologySophiahemmet HospitalStockholmSweden
| | - Maria Kumlin
- Department of Health Promotion ScienceSophiahemmet UniversityStockholmSweden
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Lauriello M, di Marco GP, Necozione S, Tucci C, Pasqua M, Rizzo G, Eibenstein A. Effects of liposomal nasal spray with vitamins A and E on allergic rhinitis. ACTA ACUST UNITED AC 2021; 40:217-223. [PMID: 32773784 PMCID: PMC7416366 DOI: 10.14639/0392-100x-n0357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 10/27/2019] [Indexed: 12/13/2022]
Abstract
The aim of this study was to investigate the relationship between nasal obstruction and nasal cytology in patients with allergic rhinitis (AR) treated with a liposomal based nasal spray containing vitamins A and E. This is a prospective double-blind, controlled study. A total of 106 patients with AR, who rejected anti-allergic therapy, were randomly divided into two groups: G (study group, n = 53) received liposomal nasal spray and C (control group, n = 53) received 0.9% sodium chloride solution nasal spray. Both nasal sprays were applied two times a day, in the morning and at night, in both nasal cavities. The study lasted for 30 days. The first ENT evaluation was performed the first day (T0) and the second evaluation was performed at the end of the study (T1). Symptoms (SNOT-22 test with VAS) and signs (nasal cytology) of both groups were recorded at T0 and T1. Liposomal nasal spray was effective in improving both nasal symptoms and cytology in patients suffering from perennial AR. Treatment with liposomal nasal spray with vitamins A and E was followed by a significant improvement of VAS scale (p < 0.0001), a significant decrease in SNOT-22 (p < 0.0001) and a significant decrease in inflammatory cell count (p < 0.0001). In conclusion, our study provides evidence that liposomal nasal spray improves the nasal symptoms of AR. The patients were compliant to this therapy because of limited side effects. The reduction in inflammatory cells count was remarkable and confirmed the close association between eosinophil infiltration and nasal airflow impairment. These results may have implications for clinical practice.
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Affiliation(s)
- Maria Lauriello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | | | - Stefano Necozione
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - Cinzia Tucci
- Speciality School of ENT, University of Tor Vergata, Roma, Italy
| | - Marina Pasqua
- Speciality School of ENT, University of Tor Vergata, Roma, Italy
| | | | - Alberto Eibenstein
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
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Peric A, Gacesa D, Barac A, Peric A. A Herbal Formula in the Therapy of Acute Postviral Rhinosinusitis. Turk Arch Otorhinolaryngol 2021; 59:33-42. [PMID: 33912859 PMCID: PMC8054925 DOI: 10.4274/tao.2020.6098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/12/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To assess the effects and adverse events of preparation Sinulan forte® containing extracts of five medicinal plants in comparison to mometasone furoate nasal spray (MFNS) in therapy of acute postviral rhinosinusitis (APRS). Methods We included 46 APRS patients in this prospective investigation and randomized to two groups. The patients in group 1 (n=23) received MFNS 200 μg two times/day for ten days, and patients in group 2 (n=23) received Sinulan forte®, tablets 225 mg per os, two times/day also for ten days. We evaluated the total symptom score (TSS), the separate scores for individual symptoms (nasal congestion, rhinorrhea, postnasal discharge, facial pain, impaired sense of smell), the quality-of-life outcome, and the findings from nasal endoscopy (edema of the nasal mucosa, nasal secretion) prior and after the therapy. Results Significantly lower absolute post-treatment scores and better relative improvement were identified for TSS, nasal congestion, facial pain, loss of the sense of smell, edema of the mucosa and nasal secretion in patients receiving herbal preparation (group 2). However, lower absolute post-treatment score and better relative improvement were found for rhinorrhea and postnasal drip in group 1. Clinically important differences were found regarding the TSS and endoscopic findings, with no adverse effects in group 2, but in group 1 two patients had mild nasal bleeding and two had sensation of dryness in the nasal mucosa. Conclusion Herbal product Sinulan forte® can be a safe and effective treatment for APRS. Our results suggest no adverse events of this herbal preparation in comparison to intranasal corticosteroid spray therapy.
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Affiliation(s)
- Aleksandar Peric
- Department of Otorhinolaryngology, Military Medical Academy Faculty of Medicine, University of Defence, Belgrade, Serbia
| | - Dejan Gacesa
- Ear Nose and Throat Hospital "Doctor Zutic", Belgrade, Serbia
| | - Aleksandra Barac
- Department of Infectious and Tropical Diseases, Belgrade University School of Medicine, Belgrade, Serbia
| | - Aneta Peric
- Institute of Pharmacy, Military Medical Academy Faculty of Medicine, University of Defence, Belgrade, Serbia
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Seys SF, De Bont S, Fokkens WJ, Bachert C, Alobid I, Bernal‐Sprekelsen M, Bjermer L, Callebaut I, Cardell L, Carrie S, Castelnuovo P, Cathcart R, Constantinidis J, Cools L, Cornet M, Clement G, Cox T, Delsupehe L, Correia‐de‐Sousa J, Deneyer L, De Vos G, Diamant Z, Doulaptsi M, Gane S, Gevaert P, Hopkins C, Hox V, Hummel T, Hosemann W, Jacobs R, Jorissen M, Kjeldsen A, Landis BN, Lemmens W, Leunig A, Lund V, Mariën G, Mullol J, Onerci M, Palkonen S, Proano I, Prokopakis E, Ryan D, Riechelmann H, Sahlstrand‐Johnson P, Salmi‐Toppila S, Segboer C, Speleman K, Steinsvik A, Surda P, Tomazic P, Vanderveken O, Van Gerven L, Van Zele T, Verfaillie J, Verhaeghe B, Vierstraete K, Vlaminck S, Wagenmann M, Pugin B, Hellings PW. Real-life assessment of chronic rhinosinusitis patients using mobile technology: The mySinusitisCoach project by EUFOREA. Allergy 2020; 75:2867-2878. [PMID: 32424899 PMCID: PMC7687134 DOI: 10.1111/all.14408] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/27/2020] [Accepted: 04/03/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a chronic inflammatory disease associated with a substantial personal and socioeconomic burden. Monitoring of patient-reported outcomes by mobile technology offers the possibility to better understand real-life burden of CRS. METHODS This study reports on the cross-sectional evaluation of data of 626 users of mySinusitisCoach (mSC), a mobile application for CRS patients. Patient characteristics of mSC users were analysed as well as the level of disease control based on VAS global rhinosinusitis symptom score and adapted EPOS criteria. RESULTS The mSC cohort represents a heterogeneous group of CRS patients with a diverse pattern of major symptoms. Approximately half of patients reported nasal polyps. 47.3% of all CRS patients were uncontrolled based on evaluation of VAS global rhinosinusitis symptom score compared to 40.9% based on adapted EPOS criteria. The impact of CRS on sleep quality and daily life activities was significantly higher in uncontrolled versus well-controlled patients. Half of patients had a history of FESS (functional endoscopic sinus surgery) and reported lower symptom severity compared to patients without a history of FESS, except for patients with a history of more than 3 procedures. Patients with a history of FESS reported higher VAS levels for impaired smell. CONCLUSION Real-life data confirm the high disease burden in uncontrolled CRS patients, clearly impacting quality of life. Sinus surgery improves patient-reported outcomes, but not in patients with a history of more than 3 procedures. Mobile technology opens a new era of real-life monitoring, supporting the evolution of care towards precision medicine.
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Doulaptsi M, Steelant B, Prokopakis E, Ierodiakonou D, Tsinaslanidou Z, Cools L, Pugin B, Milioni A, Van Gerven L, Fokkens WJ, Constantinidis J, Hellings PW. Prevalence and impact of nasal hyperreactivity in chronic rhinosinusitis. Allergy 2020; 75:1768-1771. [PMID: 31989627 DOI: 10.1111/all.14199] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/18/2019] [Accepted: 01/08/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Maria Doulaptsi
- Department of Microbiology & Immunology Allergy and Clinical Immunology Research Unit KU Leuven Leuven Belgium
- Department of Otorhinolaryngology, Head-Neck Surgery University of Crete School of Medicine Heraklion Greece
| | - Brecht Steelant
- Department of Microbiology & Immunology Allergy and Clinical Immunology Research Unit KU Leuven Leuven Belgium
| | - Emmanuel Prokopakis
- Department of Otorhinolaryngology, Head-Neck Surgery University of Crete School of Medicine Heraklion Greece
| | - Despo Ierodiakonou
- Department of Social Medicine Faculty of Medicine University of Crete Heraklion Greece
| | - Zinovia Tsinaslanidou
- 1st Department of Otorhinolaryngology, Head and Neck Surgery AHEPA HospitalAristotle University of Thessaloniki Thessaloniki Greece
| | - Leen Cools
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery University Hospitals Leuven Leuven Belgium
| | - Benoit Pugin
- Department of Microbiology & Immunology Allergy and Clinical Immunology Research Unit KU Leuven Leuven Belgium
| | - Athanasia Milioni
- Department of Otorhinolaryngology, Head-Neck Surgery University of Crete School of Medicine Heraklion Greece
| | - Laura Van Gerven
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery University Hospitals Leuven Leuven Belgium
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Academic Medical Center Amsterdam The Netherlands
| | | | - Peter W. Hellings
- Department of Microbiology & Immunology Allergy and Clinical Immunology Research Unit KU Leuven Leuven Belgium
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery University Hospitals Leuven Leuven Belgium
- Department of Otorhinolaryngology Academic Medical Center Amsterdam The Netherlands
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Passali D, Bellussi LM, Damiani V, Tosca MA, Motta G, Ciprandi G. Chronic rhinosinusitis with nasal polyposis: the role of personalized and integrated medicine. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:11-18. [PMID: 32073556 PMCID: PMC7947745 DOI: 10.23750/abm.v91i1-s.9243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 02/06/2023]
Abstract
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a frequent disorder. From a clinical and an immunopathological point of view, different phenotypes and endotypes have been identified. The frequent comorbidity with asthma allowed to pave the way to the use of biological agents for the treatment of CRSwNP. Biological agents are targeted to antagonize IgE, interleukin (IL) 4, IL-5, and IL-13 at present. However, a correct and appropriate workup is mandatory, mainly concerning the exact definition of the specific pheno-endotype. The preliminary outcomes are promising, even though there is a need for well-established indications, criteria of responsiveness, duration, and safety. On the other hand, this personalized medicine could be fruitfully integrated with gold-standard medications, such as intranasal corticosteroids. As CRSwNP is a chronic disorder, treatment should be long-lasting, so complementary anti-inflammatory treatments could be opportunely integrated and/or alternated to steroids. (www.actabiomedica.it)
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Affiliation(s)
| | | | | | | | - Gaetano Motta
- ENT Department, University Luigi Vanvitelli, Naples, Italy.
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Psaltis AJ, Vyskocil E. What are the challenges in choosing pharmacotherapy for rhinosinusitis? Expert Opin Pharmacother 2020; 21:427-433. [DOI: 10.1080/14656566.2020.1717467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alkis J Psaltis
- Department of Otorhinolaryngology, Head and Neck Surgery, The Queen Elizabeth Hospital, Adelaide, Australia
- Department of Surgery, University of Adelaide, Adelaide, Australia
| | - Erich Vyskocil
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
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Lin L, Dai F, Ren G, Wei J, Chen Z, Tang X. Efficacy of lianhuaqingwen granules in the management of chronic rhinosinusitis without nasal polyps. Am J Otolaryngol 2020; 41:102311. [PMID: 31732300 DOI: 10.1016/j.amjoto.2019.102311] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/27/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is a complicated disease with clinical symptoms that are impacted by the absence or presence of nasal polyps (CRSsNP or CRSwNP). Understanding of the different treatments of CRS is very significant in selecting appropriate therapies and preventing exacerbation relevant to this chronic inflammation. This study was aimed to evaluate the effect of Chinese traditional medicine lianhuaqingwen granules on CRSsNP. MATERIALS AND METHODS CRSsNP patients were enrolled and randomized into placebo or lianhuaqingwen (LHQW) granules treatment group (placebo or LHQW group). Their clinical symptoms were scored using Visual Analog Scale (VAS) and Sino-Nasal Outcome Test (SNOT)-22. Nitric oxide (NO) from nasal cavity and sinus and nasal resistance were also examined. Then, nasal biopsy samples and nasal lavage fluid (NLF) were obtained from these patients, and histologic characteristics of nasal mucosa and T cell subpopulations patterns in the NLF were evaluated. Finally, inflammatory mediators in the NLF were assessed in both groups. RESULTS One hundred and forty patients with CRSsNP finished this one-month study. VAS and SNOT-22 scores and nasal resistance were all decreased distinctly after the treatment of LHQW, but not after placebo. However, the nasal NO concentration was increased in LHQW administration group in comparison with placebo group. There were significant differences in above parameters between these two treatments. Histologic changes in nasal mucosa were improved only in LHQW group. CD4+ and CD8+ T cells were all downregulated in the LHQW treatment group, but not in placebo group. Inflammatory mediators from the NLF were decreased in LHQW treatment group compared to placebo group. Furthermore, there were significant changes between these two groups in CD4+ and CD8+ T cell subpopulations and concentrations of inflammatory substances. CONCLUSION These findings demonstrate that LHQW granules treatment may control the inflammation in nasal mucosa and result in the improvement of CRSsNP. This Chinese medicine might become a promising therapy in the management of this disease.
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Affiliation(s)
- Lin Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital North of Fudan University, Shanghai, China.
| | - Fei Dai
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital North of Fudan University, Shanghai, China
| | - Guoqiang Ren
- Department of Pathology, Huashan Hospital North of Fudan University, Shanghai, China
| | - Jinjin Wei
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital North of Fudan University, Shanghai, China
| | - Zheng Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital North of Fudan University, Shanghai, China
| | - Xinyue Tang
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital North of Fudan University, Shanghai, China
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Bousquet J, Akdis CA, Grattan C, Eigenmann PA, Hoffmann‐Sommergruber K, Agache I, Jutel M. Highlights and recent developments in airway diseases in EAACI journals (2018). Allergy 2019; 74:2329-2341. [PMID: 31573676 DOI: 10.1111/all.14068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022]
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI) supports three journals: Allergy, Pediatric Allergy and Immunology, and Clinical and Translational Allergy. EAACI's major goals include supporting the promotion of health, in which the prevention of allergy and asthma plays a critical role, and disseminating the knowledge of allergic disease to all stakeholders. In 2018, the remarkable progress in the identification of basic mechanisms of allergic and respiratory diseases as well as the translation of these findings into clinical practice were observed. Last year's highlights include publication of EAACI guidelines for allergen immunotherapy, many EAACI Position Papers covering important aspects for the specialty, better understanding of molecular and cellular mechanisms, identification of biomarkers for disease prediction and progress monitoring, novel prevention and intervention studies, elucidation of mechanisms of multimorbidities, introduction of new drugs to the clinics, recently completed phase three clinical studies, and publication of a large number of allergen immunotherapy studies and meta-analyses.
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Affiliation(s)
- Jean Bousquet
- Fondation partenariale FMC VIA‐LR MACVIA‐France Montpellier France
- INSERM U 1168 VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches Villejuif France
- UMR‐S 1168 Université Versailles St‐Quentin‐en‐Yvelines Montigny le Bretonneux France
- EUFOREA Brussels Belgium
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Clive Grattan
- St John's Institute of Dermatology Guy's Hospital London UK
| | | | | | - Ioana Agache
- Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University Brasov Brasov Romania
| | - Marek Jutel
- Department of Clinical Immunology ALL‐MED Medical Research Institute Wroclaw Medical University Wrocław Poland
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Lauriello M, Di Rubbo V, Sinatti G, Pasqua M, Tucci C, di Marco GP, Necozione S, Eibenstein A. Correlation Between SNOT-22, Nasal Cytology, and Mood Disorders in Patients With Allergic Rhinitis Treated With a Liposomal Nasal Spray. ALLERGY & RHINOLOGY 2019; 10:2152656719866809. [PMID: 31413887 PMCID: PMC6676260 DOI: 10.1177/2152656719866809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with allergic rhinitis (AR) can suffer from mood disorders. The aim of this study was to investigate the clinical effect of a liposomal nasal spray (LN) containing vitamins A and E on the nasal mucosa in patients suffering from AR who had refused any type of anti-allergic treatment. For this purpose, the results of nasal cytology, Visual Analog Scale (VAS), Sino-Nasal Outcome Test-22 (SNOT-22), and Hospital Anxiety and Depression Scale (HADS) test were analyzed. Moreover, we evaluated the relationship between SNOT-22 and nasal cytology and between nasal symptoms and HADS scores. Statistical analysis revealed a significant decrease of scores at T1 in the LN treatment group as concerns VAS, SNOT-22, HADS-Anxiety test and a remarkable reduction of inflammatory cells detected with nasal cytology. Our study showed that higher levels of SNOT-22 corresponded to a higher level of HADS-Anxiety. The mechanisms underlying this relationship in AR patients are currently unknown, but we can suppose that improving mucosal trophism may contribute to the decrease of nasal symptoms and anxiety scores. The improvement of nasal symptoms, as measured by SNOT-22, was significantly correlated with the objective results of nasal cytology. These relationships between SNOT-22 and nasal cytology and between anxiety and cytology were investigated for the first time in our research.
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Affiliation(s)
- Maria Lauriello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Vittoria Di Rubbo
- Specialty School of ENT, University of Rome Tor Vergata, Rome, Italy
| | - Gaia Sinatti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marina Pasqua
- Specialty School of ENT, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Tucci
- Specialty School of ENT, University of Rome Tor Vergata, Rome, Italy
| | | | - Stefano Necozione
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Eibenstein
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Vlastos I, Gkouskou K, Doulaptsi M, Karatzanis A, Prokopakis EP. Precision Medicine in Rhinosinusitis. Curr Allergy Asthma Rep 2019; 19:12. [PMID: 30793224 DOI: 10.1007/s11882-019-0850-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Our scope is the presentation of research and clinical progresses in relation to precision medicine that are expected to alter our clinical practice in relation to chronic rhinosinusitis (CRS). Current knowledge on phenotypes and endotypes, biomarkers, and clinical markers for diagnosis, medical and surgical therapy, and prognosis is presented as well as the role of precision medicine in United Airway Disease and SCUAD (severe-uncontrolled chronic upper airway inflammation). RECENT FINDINGS Current technological progresses, mostly in relation to molecular biology and information technology, have permitted more detailed pathophysiological assessments and multidimensional approaches in airways diseases. Based on the concept of united airways diseases, new classification schemes, called endotypes, have been proposed for CRS. In addition, novel biological treatments that have been introduced for the treatment of asthma show great promise as well for severe uncontrolled cases of CRS with nasal polyps. Central to this approach are new biomarkers that are being examined in relation to complex bio-clinical traits of CRS. As this narrative review of the aforementioned precision medicine initiatives in relation to CRS advances, a modification of current practice is expected not only for severe chronic upper airways diseases in tertiary centers but also for milder and more common cases that are being encountered in the community.
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Affiliation(s)
- Ioannis Vlastos
- ENT Private Practice, 29 Voreiou Ipeirou str, Athens, Greece
| | - Kalliopi Gkouskou
- Embiodiagnostics Biology Research Company, Melissinon and Damvergidon str, Heraklion, Crete, Greece
| | - Maria Doulaptsi
- Department of Otorhinolaryngology, University Hospital of Crete, A Building 3rd Floor, University avenue, 71110, Heraklion, Crete, Greece
| | - Alexander Karatzanis
- Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Emmanuel P Prokopakis
- Department of Otorhinolaryngology, University Hospital of Crete, A Building 3rd Floor, University avenue, 71110, Heraklion, Crete, Greece. .,Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece.
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