1
|
Di Gioia S, Lucca F, Venditto L, Sandri G, Tommasi N, Cipolli M, Molteni G. Efficacy of Elexacaftor-Tezacaftor-Ivacaftor on chronic rhinosinusitis in cystic fibrosis. Am J Otolaryngol 2024; 45:104236. [PMID: 38417261 DOI: 10.1016/j.amjoto.2024.104236] [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: 10/11/2023] [Revised: 01/15/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
PURPOSE Our work aims to add evidence on the effectiveness of Elexacaftor-Tezacaftor-Ivacaftor on chronic rhinosinusitis in cystic fibrosis. MATERIALS AND METHODS We conducted an observational retrospective cohort study at the Cystic Fibrosis Center of a tertiary care hospital to investigate the effect of Elexacaftor-Tezacaftor-Ivacaftor on chronic rhinosinusitis in cystic fibrosis patients, aged 12 or older. The study's endpoints were the change in the occurrence of acute exacerbations of chronic rhinosinusitis, and the variation of the endoscopic and radiologic findings scored using the Lund-Kennedy endoscopic scale, Lund-Mackay, and modified Lund-Mackay radiologic scales, in patients who underwent both pre-treatment and post-treatment examinations. RESULTS The study population comprised 136 patients, of which 28 underwent both pre-treatment and post-treatment nasal endoscopy and 15 had pre- and post-treatment CT scans. Elexacaftor-Tezacaftor-Ivacaftor provided a significant improvement in chronic rhinosinusitis. The mean number of acute exacerbations of chronic rhinosinusitis per year in the pre-treatment time was 0.55 versus 0.35 during the treatment (p < 0.0021). The Lund-Kennedy scale had a pre-treatment average score of 4.21 points versus 1.5 points after the start of Elexacaftor-Tezacaftor-Ivacaftor (p < 0.0001). The average Lund-Mackay and modified Lund-Mackay scores in the pre-treatment time were respectively 14.6 and 16.45 points; and after the start of the therapy, they became 5.87 and 6.73 (p < 0.0001). CONCLUSION Elexacaftor-Tezacaftor-Ivacaftor was associated with fewer acute exacerbations of chronic rhinosinusitis, and a significant improvement of chronic rhinosinusitis evaluated endoscopically and radiologically. To our knowledge, this is the first study investigating the change in the occurrence of acute exacerbation of chronic rhinosinusitis in patients affected by cystic fibrosis in therapy with Elexacaftor-Tezacaftor-Ivacaftor.
Collapse
Affiliation(s)
- Stefano Di Gioia
- University Hospital of Verona, Section of Otolaryngology-Head and Neck Surgery, Department of Surgical Sciences, 37126 Verona, Italy.
| | - Francesca Lucca
- University Hospital of Verona, Cystic Fibrosis Center, 37126 Verona, Italy
| | - Laura Venditto
- University Hospital of Verona, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, 37126 Verona, Italy
| | - Giulio Sandri
- University of Verona Faculty of Medicine and Surgery, 37124 Verona, Italy
| | - Nicola Tommasi
- University of Verona, Interdepartmental Centre of Economic Documentation (CIDE), 37129 Verona, Italy
| | - Marco Cipolli
- University Hospital of Verona, Cystic Fibrosis Center, 37126 Verona, Italy
| | - Gabriele Molteni
- University Hospital of Verona, Section of Otolaryngology-Head and Neck Surgery, Department of Surgical Sciences, 37126 Verona, Italy
| |
Collapse
|
2
|
Schramm A, Raidt J, Gross A, Böhmer M, Beule AG, Omran H. Molecular defects in primary ciliary dyskinesia are associated with agenesis of the frontal and sphenoid paranasal sinuses and chronic rhinosinusitis. Front Mol Biosci 2023; 10:1258374. [PMID: 37860582 PMCID: PMC10584328 DOI: 10.3389/fmolb.2023.1258374] [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: 07/13/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023] Open
Abstract
Background: Primary ciliary dyskinesia (PCD; MIM 242650) is a rare genetic disorder characterized by malfunction of the motile cilia resulting in reduced mucociliary clearance of the airways. Together with recurring infections of the lower respiratory tract, chronic rhinosinusitis (CRS) is a hallmark symptom of PCD. Data on genotype-phenotype correlations in the upper airways are scarce. Materials and methods: We investigated the prevalence, radiologic severity, and impact on health-related quality of life (HrQoL) of CRS in 58 individuals with genetically confirmed PCD. Subgroup analysis was performed according to the predicted ultrastructural phenotype based on genetic findings. Results: Among 58 individuals harboring pathogenic variants in 22 distinct genes associated with PCD, all were diagnosed with CRS, and 47% underwent sinus surgery. A total of 36 individuals answered a German-adapted version of the 20-item Sinonasal Outcome Test (SNOT-20-GAV) with a mean score of 35.8 ± 17, indicating a remarkably reduced HrQoL. Paranasal sinus imaging of 36 individuals showed moderate-to-severe opacification with an elevated Lund-Mackay Score (LMS) of 10.2 ± 4.4. Bilateral agenesis of frontal sinus (19%) and sphenoid sinus (9.5%) was a frequent finding in individuals aged 16 years or older. Subgroup analysis for predicted ultrastructural phenotypes did not identify differences in HrQoL, extent of sinus opacification, or frequency of aplastic paranasal sinuses. Conclusion: PCD is strongly associated with CRS. The high burden of disease is indicated by decreased HrQoL. Therefore, the upper airways of PCD individuals should be evaluated and managed by ear-nose-throat (ENT) specialists. Genetically determined PCD groups with predicted abnormal versus (near) normal ultrastructure did not differ in disease severity. Further studies are needed to gain evidence-based knowledge of the phenotype and management of upper airway manifestations in PCD. In addition, individuals with agenesis of the frontal and sphenoid paranasal sinuses and chronic respiratory symptoms should be considered for a diagnostic evaluation of PCD.
Collapse
Affiliation(s)
- Andre Schramm
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Johanna Raidt
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Anika Gross
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Maik Böhmer
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Achim Georg Beule
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Muenster, Muenster, Germany
| | - Heymut Omran
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
3
|
Alexandru M, Veil R, Rubbo B, Goutaki M, Kim S, Lam YT, Nevoux J, Lucas JS, Papon JF. Ear and upper airway clinical outcome measures for use in primary ciliary dyskinesia research: a scoping review. Eur Respir Rev 2023; 32:220200. [PMID: 37437912 DOI: 10.1183/16000617.0200-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/07/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by pulmonary, otological and sino-nasal manifestations. Well-defined clinical outcome measures are needed in such rare diseases research to improve follow-up and treatments. Pulmonary outcome measures have recently been described. The aim of this study was to identify ear and upper airway outcome measures that could be used for longitudinal follow-up of individuals with PCD. METHODS A scoping review was performed by systematically searching MEDLINE, Embase and Cochrane Database of Systematic Reviews online databases for studies published from January 1996 to March 2022 that included at least 10 adult or paediatric PCD patients and reported ear and upper airway outcomes. RESULTS 33 studies (1794 patients) were included. 10 ear and upper airway outcomes were reported. 17 studies reported audiometry, 16 reported otoscopic findings, and 13 reported rhinoscopic findings and sinus imaging. Health-related quality of life questionnaires were performed in seven studies. There was a high variability in definitions and measurement of outcomes between studies. CONCLUSIONS This scoping review highlights the lack of data regarding ear and upper airway outcomes in PCD. It also reports a high heterogeneity in outcome definitions or measures. We provide well-founded specific suggestions to standardise ear and upper airway outcome definitions and reporting for future PCD research studies.
Collapse
Affiliation(s)
- Mihaela Alexandru
- AP-HP, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Raphaël Veil
- AP-HP, Université Paris-Saclay, Hôpital Bicêtre, Service d'Épidémiologie et Santé Publique, Le Kremlin-Bicêtre, France
| | - Bruna Rubbo
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Clinical and Experimental Science, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Sookyung Kim
- AP-HP, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
| | - Yin Ting Lam
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jérôme Nevoux
- AP-HP, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Clinical and Experimental Science, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jean-François Papon
- AP-HP, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Institut Mondor de Recherche Biomédicale INSERM-UPEC UMR 955, CNRS ERL7000, Créteil, France
| |
Collapse
|
4
|
Eischen E, Gliksman MF, Segarra D, Murtagh RD, Ryan LE, Parasher AK, Tabor MH. Correlation between CT imaging and symptom scores in cystic fibrosis associated chronic sinusitis. Am J Otolaryngol 2023; 44:103858. [DOI: 10.1016/j.amjoto.2023.103858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
|
5
|
Plantier DB, Pilan RRM, Athanazio R, Olm MAK, Gebrim EMS, Voegels RL. Computed Tomography Evaluation of the Paranasal Sinuses in Adults with Primary Ciliary Dyskinesia. Int Arch Otorhinolaryngol 2022; 27:e130-e137. [PMID: 36714901 PMCID: PMC9879656 DOI: 10.1055/s-0042-1749392] [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: 12/14/2021] [Accepted: 03/01/2022] [Indexed: 02/01/2023] Open
Abstract
Introduction Primary ciliary dyskinesia is a rare inherited disease that results in a malfunction of mucociliary clearance and sinonasal complaints. Aplasia/hypoplasia of the frontal and sphenoid sinuses has been described as more frequent in this population. However, to date, no studies have provided a detailed description of computed tomography findings in adult patients with a diagnosis of this condition. Objective To describe the computed tomography (CT) findings of adult patients with primary ciliary dyskinesia. Methods Retrospective observational study of adult patients with primary ciliary dyskinesia who underwent CT. Results Twenty-one adults were included in the study. Aplasia occurred in 38.1% of frontal sinuses and in 14.3% of sphenoid sinuses. Likewise, hypoplasia occurred in 47.6% of the frontal sinuses, in 54.8% of the sphenoid sinuses and in 40.5% of the maxillary sinuses. Furthermore, trabecular loss was identified in 61.9% ethmoidal sinuses. The mean Lund-Mackay score was 13.5. In addition, 9.5% of the patients had concha bullosa, 47.6% had marked bilateral inferior turbinate hypertrophy, 38.1% had marked middle turbinate hypertrophy, and 47.6% had marked septal deviation. Finally, we identified images suggestive of fungus ball, mucocele, osteoma, a possible antrochoanal polyp, and frontal bone erosions. Conclusion The present study provides a detailed description of CT findings in patients with primary ciliary dyskinesia. We also describe abnormalities that must be identified for safer surgical planning and that suggest a diagnosis of primary ciliary dyskinesia if found in patients with a consistent clinical picture.
Collapse
Affiliation(s)
- Diogo Barreto Plantier
- Department of Otorhinolaringology and Ophthalmology, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil,Address for correspondence Diogo Barreto Plantier, MD Department of Otorhinolaryngology and Ophthalmology, School of Medicine, Universidade de São PauloAv. Dr. Eneas de Carvalho Aguiar, number 255, 6th floor, room 6167, SP, Zip-Code: 05403-000Brazil
| | - Renata R. M. Pilan
- Department of Otorhinolaringology and Ophthalmology, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Rodrigo Athanazio
- Pulmonary Division, Heart Institute, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Mary Anne K. Olm
- Department of Pathology, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Eloisa M. S. Gebrim
- Department of Radiology, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Richard Louis Voegels
- Department of Otorhinolaringology and Ophthalmology, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| |
Collapse
|
6
|
Hallouch O, Marinos J, Thibault F, Vu KN, Chalaoui J, Bourgouin P, Péloquin L, Freire V, Tremblay F, Chartrand-Lefebvre C. Cystic fibrosis in the 21st century: what every radiologist should know. Clin Imaging 2022; 84:118-129. [DOI: 10.1016/j.clinimag.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 11/17/2022]
|
7
|
Magnetic Resonance Imaging Detects Chronic Rhinosinusitis in Infants and Preschool Children with Cystic Fibrosis. Ann Am Thorac Soc 2021; 17:714-723. [PMID: 32142375 DOI: 10.1513/annalsats.201910-777oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Chronic rhinosinusitis (CRS) contributes to disease burden of patients with cystic fibrosis (CF). However, its onset and progression in infants and preschool children with CF remain poorly understood.Objectives: To determine the prevalence and extent of CRS in young children with CF using magnetic resonance imaging (MRI).Methods: MRI was performed in sedation in 67 infants and preschool children with CF (mean age 2.3 ± 2.1 yr; range 0-6 yr) and 30 non-CF control subjects (3.5 ± 2.0 yr; range 0-6 yr). Paranasal sinus dimensions and structural abnormalities, including mucosal swelling; mucopyoceles; and nasal polyps of the maxillary, frontal, sphenoid, and ethmoid sinuses; and, in addition, medial maxillary sinus wall deformation, were assessed using a dedicated CRS MRI scoring system.Results: Pneumatization and dimensions of paranasal sinuses did not differ between the two groups. MRI detected an increased prevalence of mucosal swelling (83% vs. 17%; P < 0.001), mucopyoceles (75% vs. 2%; P < 0.001), polyps (26% vs. 7%; P < 0.001), and maxillary sinus wall deformation (68% vs. 2%; P < 0.001) in infants and preschool children with CF compared with age-matched control subjects. Furthermore, the extent of these abnormalities was also increased with a MRI sum score of 22.9 ± 10.9 in CF compared with 4.5 ± 7.6 in non-CF control subjects (P < 0.001).Conclusions: MRI detected normal dimensions of paranasal sinuses, and a high prevalence and severity of paranasal sinus abnormalities due to CRS in infants and preschool children with CF without radiation exposure. Our results support the development of MRI for sensitive noninvasive diagnosis and monitoring of CRS in young children with CF, and as outcome measures for clinical trials.Clinical trial registered with www.clinicaltrials.gov (NCT00760071).
Collapse
|
8
|
Maggiore G, Pietragalla M, De Amicis C, Nardi C, Bruno C, Gallo O, Bonasera L, Perrone A, Cavallo A, Colagrande S, Taccetti G, Locatello LG. The Risks of Complications During Endoscopic Sinus Surgery in Cystic Fibrosis Patients: An Anatomical and Endoscopic Study. Laryngoscope 2021; 131:E2481-E2489. [PMID: 33464574 DOI: 10.1002/lary.29404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE/HYPOTHESIS An increasing proportion of adult cystic fibrosis (CF) patients is being referred to endoscopic sinus surgery (ESS) in order to relieve the symptoms of chronic rhinosinusitis (CRS). Given that CFTR mutations profoundly alter sinonasal development, we want to explore the relationship between their peculiar surgical anatomy and the risk of postoperative complications. STUDY DESIGN Retrospective case-control study. METHODS Paranasal sinuses CT scans of 103 CF adult patients with CRS were compared to those belonging to a cohort of 100 non-CF adult patients to explore their anatomical differences. Secondly, CF and non-CF patients who received primary/revision ESS were analyzed in order to assess their preoperative CT scan in terms of surgically relevant variants, and according to the CLOSE checklist. Surgical outcomes were statistically compared in order to explore the differences between groups. RESULTS CF group presented more frequently with smaller and less pneumatized paranasal sinuses and a higher Lund-Mckay score compared with controls. No anatomical differences emerged in terms of genotype stratification. Non-CF CRS patients undergoing ESS showed a significantly deeper olfactory fossa and a more frequent supraorbital pneumatization compared to CF patients (P < .001 and P = .031, respectively). Whereas this latter group underwent more often aggressive surgical procedures (P = .001), no difference in terms of postoperative adverse events was found (P = .620). CONCLUSIONS Despite receiving more often aggressive ESS procedures, adult CF patients do not show an increased risk of postoperative complication and this may be linked to a different proportion of anatomical and surgically-relevant variants. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2481-E2489, 2021.
Collapse
Affiliation(s)
| | - Michele Pietragalla
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Christian De Amicis
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Cosimo Nardi
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Luigi Bonasera
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Anna Perrone
- Department of Radiology, Anna Meyer Children's University Hospital, Florence, Italy
| | - Annalisa Cavallo
- Department of Infectious and Tropical Diseases, Careggi University Hospital, Florence, Italy
| | - Stefano Colagrande
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Giovanni Taccetti
- Cystic Fibrosis Center, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
| | | |
Collapse
|
9
|
Pappa AK, Sullivan KM, Lopez EM, Adams KN, Zanation AM, Ebert CS, Thorp BD, Senior BA, Leigh MW, Knowles MR, Kimple AJ. Sinus Development and Pneumatization in a Primary Ciliary Dyskinesia Cohort. Am J Rhinol Allergy 2020; 35:72-76. [PMID: 32551925 PMCID: PMC7750665 DOI: 10.1177/1945892420933175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Primary ciliary dyskinesia (PCD) is a genetically diverse disease which
causes impaired mucociliary clearance, and results in pulmonary, otologic,
and rhinologic disease in affected patients. Genetic mutations in multiple
genes impair the ability of patients to clear mucous from the lungs, middle
ear, and sinonasal cavity and lead to chronic pulmonary and sinonasal
symptoms. Methods We identified 17 PCD patients who had available CT scans. Volumes for
bilateral maxillary, sphenoid, and frontal sinuses were calculated. A
control population of patients who had preoperative CT scans for endoscopic
endonasal resection of skull base pathology without sinonasal cavity
involvement was also identified. Results The mean age of PCD was 33 and ranged from 13 to 54 years. Patients were age-
and gender-matched to a control group that underwent resection of anterior
skull-base tumors and had a mean age of 35 that ranged between 17–53 years
old. The volumes for all thee sinus cavities were significantly smaller
(p < 0.007) compared to the control population. The average Lund-Mackay
score was 10.6 in the PCD cohort (range 6–16) in comparison to an average of
0.7 in the control cohort (range 0–2). Conclusions Overall sinus volumes were smaller in patients with PCD compared to our
control population. Future studies will be aimed at understanding defects in
sinus development as a function of specific genetic mutations in PCD
patients. Ultimately, a better understanding of the underlying
pathophysiology of PCD will allow us to identify the optimal treatment
practices for this unique patient group.
Collapse
Affiliation(s)
- Andrew K Pappa
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelli M Sullivan
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin M Lopez
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine N Adams
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Adam M Zanation
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Margaret W Leigh
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mike R Knowles
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
10
|
Okafor S, Kelly KM, Halderman AA. Management of Sinusitis in the Cystic Fibrosis Patient. Immunol Allergy Clin North Am 2020; 40:371-383. [DOI: 10.1016/j.iac.2019.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
11
|
Critical Evaluation of Sinonasal Disease in 64 Adults with Primary Ciliary Dyskinesia. J Clin Med 2019; 8:jcm8050619. [PMID: 31067752 PMCID: PMC6571605 DOI: 10.3390/jcm8050619] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/23/2019] [Accepted: 05/01/2019] [Indexed: 11/25/2022] Open
Abstract
To date, no study precisely described ear, nose and throat (ENT) disease in adults with primary ciliary dyskinesia (PCD) and its relationship with ciliary function/ultrastructure. A retrospective study of standardized ENT data (exam, audiogram, sinus Computed tomography (CT), and bacteriology) was conducted in 64 adults with confirmed PCD who were followed in two ENT reference centers. Rhinorrhoea and hearing loss were the main symptoms. Symptom scores were higher in older patients. Nasal endoscopy was abnormal in all patients except one, showing nasal polyps in one-third of the patients and stagnant nasal mucus secretions in 87.5% of the patients. Sinus CT opacities were mainly incomplete and showed one-third of the patients with sinus hypoplasia and/or agenesis. Middle meatus mainly grew Haemophilus influenzae, Streptoccocus pneumoniae and Pseudomonas aeruginosa. Otitis media with effusion (OME), which is constant in childhood, was diagnosed in less than one-quarter of the patients. In two-thirds of the patients, audiogram showed hearing loss that was sensorineural in half of the patients. ENT disease severity was not correlated with ciliary function and ultrastructure, but the presence of OME was significantly associated with a forced expiratory volume (FEV1) < 70%. Rhinosinusitis is the most common clinical feature of PCD in adults, while OME is less frequent. The presence of active OME in adults with PCD could be a severity marker of lung function and lead to closer monitoring.
Collapse
|
12
|
Surgical Management of Chronic Rhinosinusitis in Cystic Fibrosis. Med Sci (Basel) 2019; 7:medsci7040057. [PMID: 30959944 PMCID: PMC6524042 DOI: 10.3390/medsci7040057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 12/13/2022] Open
Abstract
Cystic fibrosis patients frequently develop chronic rhinosinusitis as a result of their propensity to form inspissated mucus and impairment of mucociliary clearance. They exhibit variable symptom burden even in the setting of positive radiographic and endoscopic findings. Current evidence suggests a positive effect of managing sinonasal disease on pulmonary health. Topical antimicrobial and mucolytic therapies are frequently required to manage the disease with surgery reserved for refractory cases. Endoscopic sinus surgery has been demonstrated to be safe and efficacious in controlling symptoms of chronic rhinosinusitis in patients with comorbid cystic fibrosis. However, the impact of surgery on pulmonary health remains an active area of investigation. In addition, a growing body of research has suggested a more extended surgical approach creating large sinonasal cavities with gravity-dependent drainage pathways, followed by adjuvant medical therapies, as an ideal strategy to optimally control disease and prevent pulmonary exacerbations. In this manuscript, we provide an up-to-date review of current evidence in the surgical management of chronic rhinosinusitis in cystic fibrosis patients.
Collapse
|
13
|
Safi C, Zheng Z, Dimango E, Keating C, Gudis DA. Chronic Rhinosinusitis in Cystic Fibrosis: Diagnosis and Medical Management. Med Sci (Basel) 2019; 7:E32. [PMID: 30813317 PMCID: PMC6410165 DOI: 10.3390/medsci7020032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 11/16/2022] Open
Abstract
Chronic rhinosinusitis (CRS) is nearly ubiquitous in patients with cystic fibrosis (CF). CF CRS is a challenging entity to define, diagnose, and treat, as patients often have severe refractory sinus disease in addition to complex medical comorbidities. The purpose of this article is to review the literature on the medical management of CF CRS and determine how to best identify, diagnose, and manage CF CRS. Ultimately, the treatment of these patients requires a multi-disciplinary approach involving the pulmonologist and otolaryngologist.
Collapse
Affiliation(s)
- Chetan Safi
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center; New York, NY 10032, USA.
| | - Zhong Zheng
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center; New York, NY 10032, USA.
| | - Emily Dimango
- Department of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center; New York, NY 10032, USA.
| | - Claire Keating
- Department of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center; New York, NY 10032, USA.
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center; New York, NY 10032, USA.
| |
Collapse
|
14
|
Halderman AA, Lee S, London NR, Day A, Jain R, Moore JA, Lin SY. Impact of high- versus low-risk genotype on sinonasal radiographic disease in cystic fibrosis. Laryngoscope 2018; 129:788-793. [PMID: 30549259 DOI: 10.1002/lary.27595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Understanding of how specific mutations impact the cystic fibrosis transmembrane conductance regulator (CFTR) protein has given rise to the classification of CF patients into low-risk and high-risk genotypes. Few prior studies have investigated differences in sinonasal disease between low-risk and high-risk CF genotypes. This multi-institutional review aimed to evaluate radiographic sinus disease severity based on genotype. METHODS A review was conducted on adult patients with CF evaluated between 2005 to 2017 at three academic institutions. Data including age, gender, CFTR mutation, and presence of a maxillofacial/sinus computed tomography scan was collected. A modified Lund-Mackay score (MLMS) was assigned to each scan, and the presence of sinus aplasia or hypoplasia was determined. Patients were further grouped depending on genotype into low- or high-risk for comparison. RESULTS A total of 126 patients were included with 99 patients in the high-risk and 21 in the low-risk groups. The high-risk group had significantly higher MLMS than the low-risk group (mean 13.88 vs. 8.06, P < 0.0001, 95% CI -8.196 to -3.462) The rate of frontal (P < 0.01), maxillary (P = 0.04), and sphenoid (P < 0.001) hypoplasia/aplasia was significantly higher in high-risk patients compared to low-risk. CONCLUSION This is one of the largest studies to date evaluating the impact of CF genotype on paranasal sinus development and disease. Genotype appears to impact sinonasal disease severity and also potentially paranasal sinus cavity development to a degree, although the exact mechanism is unknown. LEVEL OF EVIDENCE 4 Laryngoscope, 129:788-793, 2019.
Collapse
Affiliation(s)
| | - Stella Lee
- Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nyall R London
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| | - Andrew Day
- Department of Otolaryngology Head and Neck Surgery, Dallas, Texas
| | - Raksha Jain
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern, Dallas, Texas
| | - John A Moore
- Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandra Y Lin
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| |
Collapse
|
15
|
Multisystem Imaging Findings of Cystic Fibrosis in Adults: Recognizing Typical and Atypical Patterns of Disease. AJR Am J Roentgenol 2017. [DOI: 10.2214/ajr.16.17462] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
16
|
Hamilos DL. Chronic Rhinosinusitis in Patients with Cystic Fibrosis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:605-12. [DOI: 10.1016/j.jaip.2016.04.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 12/01/2022]
|
17
|
CT-abnormalities, bacteriology and symptoms of sinonasal disease in children with Cystic Fibrosis. J Cyst Fibros 2016; 15:816-824. [PMID: 27049043 DOI: 10.1016/j.jcf.2016.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/04/2016] [Accepted: 03/05/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Sinonasal pathology in adults with Cystic Fibrosis (CF) is common but the extent of CT-abnormalities and symptoms of sinonasal disease in children with CF and the age of onset are less frequently studied. METHODS In this observational, cross-sectional study 58 children with CF from two CF centres were included. All subjects completed a questionnaire regarding sinonasal symptoms, underwent a CT scan of the paranasal sinuses, and in each subject a culture of the upper airways was performed. Subjects were divided in 6 age cohorts (0-2, 3-5, 6-8, 9-11, 12-14 and 15-17years) and were divided into severe and mild CF based on their CFTR mutation. Opacification of the sinonasal system of the subjects was compared with opacification on MRI-scans of an age-matched control group without CF. RESULTS Most frequently reported symptoms were nasal obstruction and posterior/anterior nasal discharge. Opacification was abundant in every age cohort of the study group and was significantly more compared to the control group. In patients with severe CF the opacification was higher than subjects with mild CF. Upper airway cultures showed predominantly Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa. CONCLUSION CT-abnormalities indicating sinonasal disease and symptoms are present from shortly after birth which may argue for a thorough examination of the upper airways in children with CF.
Collapse
|
18
|
Do BA, Lands LC, Mascarella MA, Fanous A, Saint-Martin C, Manoukian JJ, Nguyen LHP. Lund-Mackay and modified Lund-Mackay score for sinus surgery in children with cystic fibrosis. Int J Pediatr Otorhinolaryngol 2015; 79:1341-5. [PMID: 26115934 DOI: 10.1016/j.ijporl.2015.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 06/02/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with cystic fibrosis (CF) frequently present with severe sinonasal disease often requiring radiologic imaging and surgical intervention. Few studies have focused on the relationship between radiologic scoring systems and the need for sinus surgery in this population. The objective of this study is to evaluate the Lund-Mackay (LM) and modified Lund-Mackay (m-LM) scoring systems in predicting the need for sinus surgery or revision surgery in patients with CF. METHODS We performed a retrospective chart review of CF patients undergoing computed tomography (CT) sinus imaging at a tertiary care pediatric hospital from 1995 to 2008. Patient scans were scored using both the LM and m-LM systems and compared to the rate of sinus surgery or revision surgery. Receiver-operator characteristics curves (ROC) were used to analyze the radiological scoring systems. RESULTS A total of 41 children with CF were included in the study. The mean LM score for patients undergoing surgery was 17.3 (±3.1) compared to 11.5 (±6.2) for those treated medically (p<0.01). For the m-LM, the mean score of patients undergoing surgery was 20.3 (±3.5) and 13.5 (±7.3) for those medically treated (p<0.01). Using a ROC curve with a threshold score of 13 for the LM, the sensitivity was 89.3% (95% CI of 72-98) and specificity of 69.2% (95% CI of 39-91). At an optimal score of 19, the m-LM system produced a sensitivity of 67.7% (95% CI of 48-84) and specificity of 84.6% (95% CI of 55-98). CONCLUSION The modified Lund-Mackay score provides a high specificity while the Lund-Mackay score a high sensitivity for CF patients who required sinus surgery. The combination of both radiologic scoring systems can potentially predict the need for surgery in this population.
Collapse
Affiliation(s)
- Bao Anh Do
- McGill University, Faculty of Medicine, Montreal, QC, Canada
| | - Larry C Lands
- Division of Peadiatric Respiratory Medicine, McGill University, Montreal, QC, Canada
| | - Marco A Mascarella
- Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada.
| | - Amanda Fanous
- Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | | | - John J Manoukian
- Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada.
| |
Collapse
|
19
|
Peters AT, Spector S, Hsu J, Hamilos DL, Baroody FM, Chandra RK, Grammer LC, Kennedy DW, Cohen NA, Kaliner MA, Wald ER, Karagianis A, Slavin RG. Diagnosis and management of rhinosinusitis: a practice parameter update. Ann Allergy Asthma Immunol 2015; 113:347-85. [PMID: 25256029 DOI: 10.1016/j.anai.2014.07.025] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023]
|
20
|
Ferril GR, Nick JA, Getz AE, Barham HP, Saavedra MT, Taylor-Cousar JL, Nichols DP, Curran-Everett D, Kingdom TT, Ramakrishnan VR. Comparison of radiographic and clinical characteristics of low-risk and high-risk cystic fibrosis genotypes. Int Forum Allergy Rhinol 2014; 4:915-20. [PMID: 25224556 DOI: 10.1002/alr.21412] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/13/2014] [Accepted: 08/05/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with cystic fibrosis (CF) exhibit a wide range of disease severity, and can be broadly stratified into high-risk and low-risk groups based on cystic fibrosis transmembrane conductance regulator (CFTR) mutation class. Patients with a low-risk genotype are often diagnosed as adults, with milder disease and lower sweat chloride values. The aim of the current study was to better understand radiographic and clinical characteristics of sinus disease in adult CF patients within this risk category. METHODS Adult CF patients were retrospectively compared to a control group of patients with chronic rhinosinusitis. CF diagnostic testing and pulmonary characteristics were compared between high-risk and low-risk CF groups, and sinus CT findings were compared among all 3 groups. RESULTS When comparing CF cohorts (n = 25 and 30, respectively), earlier age at diagnosis (p < 0.001), higher sweat chloride values (p < 0.001), lower forced expiratory volume in 1 second (FEV1 ) values (p < 0.001), and a higher prevalence of pulmonary infection with Pseudomonas aeruginosa (p = 0.001) were found in the high-risk genotype group. A significantly increased incidence of sinus hypoplasia/aplasia and bony sclerosis was seen when comparing both CF groups to the control cohort (n = 30), as well as when comparing the high-risk and low-risk CF genotype cohorts. CONCLUSION The current study describes clinicopathologic findings of sinus disease in adult CF patients in the context of genotype severity. Our data demonstrate that while patients within a low-risk genotype cohort have generally milder lung disease, they retain classic radiographic findings of CF sinus disease that can help raise the index of suspicion for undiagnosed CF.
Collapse
Affiliation(s)
- Geoffrey R Ferril
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
|
22
|
Kang SH, Piltcher OB, Dalcin PDTR. Sinonasal alterations in computed tomography scans in cystic fibrosis: a literature review of observational studies. Int Forum Allergy Rhinol 2014; 4:223-31. [PMID: 24415497 DOI: 10.1002/alr.21266] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/14/2013] [Accepted: 11/19/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Almost all cystic fibrosis (CF) patients reveal upper airway involvement in computed tomography (CT) scans. Sinonasal pathology has become a challenging issue because there are few studies to guide appropriate management. The objective of this study was to provide information about paranasal sinus CT manifestations in CF patients, mainly in adulthood. METHODS We performed a literature review of descriptive studies about CT sinonasal findings in CF patients using the following databases: MEDLINE, EMBASE, Web of Science, LILACS, Scielo, and Cochrane. RESULTS Eighteen articles were included in this review. There was a high variability in methodological aspects for most of the studies. The most prevalent findings reported were opacification of sinuses, presence of frontal and sphenoidal aplasia or hypoplasia, underdevelopment of paranasal sinuses, and medial bulging of the lateral nasal wall in CT scans. CONCLUSION There are few studies in the CF adult population regarding sinonasal CT alterations. Many studies report specific pathological features in CF upper airways that could help in the diagnosis of doubtful cases.
Collapse
Affiliation(s)
- Suzie Hyeona Kang
- Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | |
Collapse
|
23
|
Abstract
Although a variety of theories have been proposed about functions of the paranasal sinuses, not one is clear today. Nonetheless, paranasal sinus–related diseases are associated with a high rate of morbidities. Therefore, it is essential to identify the structure and pathophysiology of the paranasal sinuses. Computed tomography (CT) is a valuable tool displaying anatomic variations and diseases. Because paranasal sinus development is a complex and long-lasting process, there are great structural variations between individuals. Several degrees and combinations of aplasias and hypoplasias have been reported; however, there is only one case of total paranasal sinus aplasia in the literature. Here, we present the second case of total paranasal sinus aplasia. Paranasal sinus development, functions of the paranasal sinuses, and the role of CT were evaluated.
Collapse
Affiliation(s)
- Hakan Korkmaz
- Department of Otorhinolaryngology Head and Neck Surgery, Ordu University Medical School, Education and Research Hospital, Ordu, Turkey
| | | |
Collapse
|
24
|
Rozsasi A, Heinemann A, Keck T. Cyclooxygenase 2 and lipoxin A₄ in nasal polyps in cystic fibrosis. Am J Rhinol Allergy 2012; 25:e251-4. [PMID: 22185734 DOI: 10.2500/ajra.2011.25.3726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The etiology of nasal polyps (NPs) and sinusitis in cystic fibrosis (CF) patients is still unknown. This study investigates the presence of cyclooxygenase 2 (COX-2) and lipoxin A(4) (LXA(4)) in epithelial cultures derived from NPs and turbinates in patients with CF and without CF. METHODS NPs and turbinates were evaluated from eight CF patients with obstructing NPs undergoing sinus surgery. NPs and tissue from the hypertrophic inferior turbinate from 14 patients without history of CF undergoing sinus surgery served as control specimens. After tissue culturing, the presence of COX-2 protein and LXA(4) (ELISA) was detected in CF polyps and turbinates and compared with that of the control group. RESULTS COX-2 and LXA(4) were detectable in tissue specimens of all CF patients and control patients. COX-2 was highest in CF polyps, but the difference was not significant compared with CF turbinates or polyps and turbinates of patients not suffering from CF. LXA(4), however, was significantly higher in CF NPs compared with CF turbinate tissue. Compared with NPs of patients not having CF disease, CF polyps showed markedly higher concentrations of LXA(4). CONCLUSION LXA(4) is significantly elevated in CF NPs, whereas COX-2 is only slightly increased. The present data support the concept that LXA(4) plays an important role in CF nasal polyposis. Chronic infection in nasal polyposis and, because of inflammation, induced COX-2 in CF NPs may be related to increased LXA(4). The suspected interaction of COX-2 and LXA(4) needs further investigation.
Collapse
Affiliation(s)
- Ajnacska Rozsasi
- Department of Otorhinolaryngology, Head, Neck, and Facial Plastic Surgery, Elisabethinen Hospital, Academic Hospital of Medical University of Graz, Graz, Austria.
| | | | | |
Collapse
|
25
|
Adibelli ZH, Songu M, Adibelli H. Paranasal sinus development in children: A magnetic resonance imaging analysis. Am J Rhinol Allergy 2011; 25:30-5. [PMID: 21711972 DOI: 10.2500/ajra.2011.25.3552] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The anatomy of the paranasal sinus is significantly different between adults and children, and surgeons must be aware of these differences to safely perform pediatric functional endoscopic sinus surgery. The purpose of this study was to determine the normal dimensions of the paranasal sinuses during development using magnetic resonance imaging (MRI) data compiled from the largest cohort to date. METHODS The records of 2025 children, aged 0-18 years, who underwent cranial MRI, were examined retrospectively and 1452 patients with no history of sinus disease were included in the study. Coronal, axial, and sagittal images were used to measure the dimensions of the frontal, maxillary, ethmoid, and sphenoid sinuses, and the sinus volume index was measured. Patients were divided into 10 cohorts based on their age at the time of the scan. RESULTS No difference between left and right one-dimensional measurements and volume indexes for the maxillary, sphenoid, ethmoid, and frontal sinuses was observed in any age group. Initial signs of pneumatization were observed at birth for the maxillary and ethmoid sinuses, at 9 months for sphenoid sinus, and after the age of 5 years for the frontal sinus. CONCLUSION These results will help physicians correlate the clinical and radiographic findings of pediatric patients who are being evaluated for sinus disease and potential surgical intervention. Knowledge of the variations in the size of the paranasal sinuses is essential for determining the significance of incidental findings.
Collapse
|