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Fiorentino V, Martini M, Galletti C, Pizzimenti C, Franchina M, Ieni A, Fadda G, Galletti B, Tuccari G. The Morphology of Nasal Polyps in Different Age Groups: Histopathological Features. J Pers Med 2024; 14:414. [PMID: 38673041 PMCID: PMC11051558 DOI: 10.3390/jpm14040414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Nasal polyps (NPs) represent the end-stage manifestation of chronic rhinosinusitis (CRS), a relatively common pathological condition encountered in all ages of life. METHODOLOGY The aim of our study was to evaluate the histological features and inflammatory cellular components of NPs in a retrospective cohort (143 cases) of pediatric, adult and elderly populations in order to discuss the possible morphological age-related differences statistically documented. RESULTS In the pediatric group, the inflammatory infiltrate presented many eosinophils mixed with lymphocytes, while in the adult population, lymphocytes and plasma cells were mainly evident, frequently with a perivascular distribution or with the formation of subepithelial lymphoid nodules. In the elderly population, inflammation was less evident and was associated with cavernous-like angecthatic structures with thrombotic stratification. Nearly all morphological findings exhibited statistically significant values among differently aged subgroups. CONCLUSIONS Our results support the presence of histological specificities of NPs at different ages of life, providing new insight into the etiopathogenesis of NPs. The future role of biological therapies, mainly in cases refractory to already available standard medical and surgical treatments, may be analyzed by a prospective study using a larger cohort with a long-term evaluation also in relation to a possible relapse.
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Affiliation(s)
- Vincenzo Fiorentino
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Maurizio Martini
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Cosimo Galletti
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Cristina Pizzimenti
- Dipartimento di Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Università Degli Studi di Messina, 98122 Messina, Italy;
| | - Mariausilia Franchina
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Antonio Ieni
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Guido Fadda
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Bruno Galletti
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Giovanni Tuccari
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
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Ottaviano G, De Corso E, Saccardo T, D’Auria LM, Zampollo S, D’Agostino G, Mairani E, De Maio G, Scarpa B, Bacci C, Favero V. Effectiveness of Dupilumab in the Treatment of Adult and Older Adult Patients with Severe, Uncontrolled CRSwNP. J Pers Med 2023; 13:1241. [PMID: 37623491 PMCID: PMC10456067 DOI: 10.3390/jpm13081241] [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] [Received: 05/13/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial disease that significantly impacts patients' quality of life. New therapeutic strategies and in particular biologic treatments are now available for these patients. It has been demonstrated that Dupilumab (an anti IL-4/IL-13 biologic drug) is effective in reducing the size of nasal polyps and in improving patients' symptoms and thus, quality of life. No real-world studies examining Dupilamab's efficacy in the elderly with respect to other adult age groups have as yet been carried out. The aim of this multicentric study was to evaluate Dupilumab's efficacy in young-middle adults as opposed to an older adult population affected by severe, uncontrolled CRSwNP. Of the 96 patients included in the study, 22 were 65 years old or older. Significant improvements were observed in all the parameters considered in both age groups after treatment was begun (T0 mean values for SNOT-22 = 58.5 ± 20.3, VAS NO = 7.6 ± 2.2, VAS smell = 8.6 ± 2.1, NPS = 5.6 ± 1.4, PNIF = 101.6 ± 59.4, S'S = 5.1 ± 3.1), T4 mean values for SNOT-22 = 15.1 ± 12.7, VAS NO = 1.7 ± 1.8, VAS smell = 2.4 ± 3, NPS = 1.7 ± 1.7, PNIF = 162.4 ± 43.2, S'S = 10.4 ± 3.7) (p < 0.0001). No differences in the variables considered were observed between the two age groups during the study, with the exception of the Peak Nasal Inspiratory Flow (PNIF), which was marginally higher; this was also the case according to multivariate analyses (p = 0.008) in the young-middle adult group with respect to the elderly one (p = 0.07). At multivariate analyses, asthma and the female sex negatively influenced the PNIF values (p = 0.001 and p = 0.012, respectively). Age negatively influenced the Visual Analog Scale (VAS) for nasal obstruction (p = 0.0032) and Endoscopic Sinus Surgery (ESS) negatively influenced the patents' olfactory performance (p = 0.028) to the same degree in both groups. Dupilumab was found to be effective to the same degree in both age groups. It can be considered a safe and reliable option for the treatment of elderly patients with severe, uncontrolled CRSwNP.
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Affiliation(s)
- Giancarlo Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (T.S.); (S.Z.); (E.M.)
| | - Eugenio De Corso
- Department of Otolaryngology, Policlinico Gemelli University Hospital IRCCS, 00168 Rome, Italy; (E.D.C.); (L.M.D.); (G.D.); (G.D.M.)
| | - Tommaso Saccardo
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (T.S.); (S.Z.); (E.M.)
| | - Leandro Maria D’Auria
- Department of Otolaryngology, Policlinico Gemelli University Hospital IRCCS, 00168 Rome, Italy; (E.D.C.); (L.M.D.); (G.D.); (G.D.M.)
| | - Sonny Zampollo
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (T.S.); (S.Z.); (E.M.)
| | - Giuseppe D’Agostino
- Department of Otolaryngology, Policlinico Gemelli University Hospital IRCCS, 00168 Rome, Italy; (E.D.C.); (L.M.D.); (G.D.); (G.D.M.)
| | - Edoardo Mairani
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (T.S.); (S.Z.); (E.M.)
| | - Gabriele De Maio
- Department of Otolaryngology, Policlinico Gemelli University Hospital IRCCS, 00168 Rome, Italy; (E.D.C.); (L.M.D.); (G.D.); (G.D.M.)
| | - Bruno Scarpa
- Department of Statistical Sciences, University of Padova, 35122 Padova, Italy;
| | - Christian Bacci
- Unit of Dentistry, Department of Neurosciences, University of Padua, 35122 Padova, Italy;
| | - Vittorio Favero
- Unit of Maxillofacial Surgery and Dentistry, Head and Neck Department, University of Verona, 37134 Verona, Italy;
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Phenotypes of Chronic Rhinosinusitis and Peripheral Blood Leukocytes Parameters in Elderly Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010126. [PMID: 36676750 PMCID: PMC9863097 DOI: 10.3390/medicina59010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/31/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
Background and Objectives: Chronic rhinosinusitis (CRS) is a common disease that can be differentiated into two phenotypes, with or without polyps (CRSwNP) or CRSsNP), which may be unilateral (UNIL) or bilateral (BIL). CRS may have an impact on absolute neutrophils and lymphocytes count in peripheral blood. The aim of the study was to investigate whether the incidence of a specific CRS phenotype changes with age and to compare the values of neutrophils, lymphocytes and neutrophil-to-lymphocyte ratio in the peripheral blood between groups of patients below and above 65 years of age with different CRS phenotypes. Material and Methods: A total of 235 patients aged 65 and over were examined, including 140 (59.6%) males. The group of patients <65 years of age comprised 160 subjects, including 103 (64.4%) males. In both groups, the sequence of frequency of particular phenotypes was similar: the most common phenotype was bilateral CRSwNP followed by CRSsNP BIL, CRSsNP UNIL, and finally, CRSwNP UNIL. Direct comparisons between determined phenotype in both groups of different ages revealed that, in the group ≥65 years, CRSwNP BIL occurred significantly more often than in the group <65 years of age. In fact, in the <65 group, bilateral CRSsNP was more common. The absolute neutrophils and lymphocytes counts were significantly higher in the whole group of patients with CRS ≥65 years of age and absolute number of neutrophils was higher in ≥65 years of age group with bilateral CRSsNP. Conclusions: The higher number of neutrophils in the whole ≥65 years of age group and in older patients with bilateral CRSsNP may indicate that CRS, despite of phenotype, may be an important source of infection that requires surgical treatment in elderly patients as well.
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Merrill T, Kanaan A. Managing Chronic Rhinosinusitis with Nasal Polyps in the Elderly: Challenges and Solutions. Clin Interv Aging 2022; 17:685-698. [PMID: 35535364 PMCID: PMC9077011 DOI: 10.2147/cia.s279765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
The proportion of the population over 65 years old continues to grow. Chronic rhinosinusitis is common in this population and causes a reduction in quality of life and an increase in health care utilization. Diagnosis of chronic rhinosinusitis with nasal polyps follows the same principles for elderly patients as in the general population, but the elderly population presents some diagnostic challenges worth considering. Presbynasalis, the anatomic and functional changes of the nose and paranasal sinuses associated with aging must be accounted for when caring for these patients. In addition, polypharmacy and other medical issues that can cause similar symptoms must be considered. Medical therapy is generally similar to the general population but with additional concerns given the propensity for geriatric patients to be on multiple medications and to suffer from multiple medical issues. Sinus surgery should be considered following the same indications as in the general population. While some authors have found higher complication rates in endoscopic sinus surgery, others have found higher rates of success. As always, the risks of surgery must be considered with the possible benefits on a patient-to-patient basis.
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Affiliation(s)
- Tyler Merrill
- University of Arkansas for Medical Sciences, Department of Otolaryngology – Head and Neck Surgery, Little Rock, AR, USA
- Correspondence: Tyler Merrill, University of Arkansas for Medical Sciences, Department of Otolaryngology – Head and Neck Surgery, 4301 W. Markham Street, #543, Little Rock, AR, 72205, USA, Tel +1 (501) 686 5140; +1 (330) 285 1750, Fax +1 (501) 686 8029, Email
| | - Alissa Kanaan
- University of Arkansas for Medical Sciences, Department of Otolaryngology – Head and Neck Surgery, Little Rock, AR, USA
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Sex and age-related differences in chronic rhinosinusitis with nasal polyps electing ESS. Am J Otolaryngol 2022; 43:103342. [PMID: 34971999 DOI: 10.1016/j.amjoto.2021.103342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/15/2021] [Accepted: 12/11/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Sex and age of patients are variables affecting across the board all chronic rhinosinusitis with nasal polyps (CRSwNP) endotypes. The main aim of this investigation was to compare the clinical, laboratory, pathological and prognostic characteristics of CRSwNP in male vs female patients stratified according to age (young-adult [20 years ≤ age ≤ 40 years], and elderly [age ≥ 65 years]). This is the first study that analyzed the association of the above-mentioned features with age and sex combination in CRSwNP electing endoscopic sinus surgery (ESS). MATERIALS AND METHODS One hundred and five consecutive young-adult patients (62 males and 43 females) and 67 elderly patients (44 males and 23 females) with CRSwNP who had undergone ESS were enrolled. RESULTS The recurrence rate resulted associated with the age and sex combination (p = 0.0165). Young-adult males' recurrence rate (29.0%) was higher than young-adult females (11.6%) and elderly males (4.5%). Allergy resulted associated with age and sex combination (p = 0.0158). Young-adult males' allergy rate (50.0%) was higher than elderly males' (29.5%) and elderly females' (13%). Moreover, allergy rate was higher in young-adult females (41.9%) than in elderly females. CONCLUSION Our data suggest the possibility of an interaction between sex and age in the recurrence of nasal polyposis after ESS. More studies are needed to understand the role of sex hormones in pathogenesis and prognosis of CRSwNP.
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Levi L, Reuven Y, Ben-Ner D, Koch N, Gunders-Peleg M, Nachalon Y, Koren I, Hazan A, Nakache G, Reifen E, Soudry E. Safety of Endoscopic Sinus Surgery in the Elderly-Are Octogenarian Patients at a Higher Risk? Am J Rhinol Allergy 2021; 36:91-98. [PMID: 34236249 DOI: 10.1177/19458924211025374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Surgeons are often faced with concerns regarding the risks versus benefits of endoscopic sinus surgery (ESS) in elderly patients. OBJECTIVE To analyze the risk for complications of ESS in the elderly (age ≥70 years) compared to younger patients, with emphasis on octogenarians. METHODS Retrospective review of medical charts of adult patients who underwent ESS at a tertiary referral center during the years 2014 to 2018. RESULTS We compared 128 elderly patients with 276 matched younger patients. In the elderly group mean age was 76 years (range, 70-91 years ). Thirty-one elderly patients were 80 years or older. Surgical complications in the elderly patients were 3.9%. Minor complications were 2.3% and major complications were 1.7%. The surgical complications rate was similar in the younger group (8%, P value: .127). Medical complications were observed in 2.3% comparing to 0.7% in younger patients. Interestingly, age, revision surgery, extent and duration of surgery, and modality of anesthesia were not identified as risk factors. Only ischemic heart disease (IHD) was identified as a risk factor for complications in a multivariate analysis in elderly patients. Comparison of elderly patients younger than 80 years with octogenarians revealed no difference in complication rate between these groups. CONCLUSIONS Overall, ESS was found to be a safe procedure in elderly patients compared to younger patients. Octogenarian patients should not be denied upfront surgery. IHD is a risk factor for complications in elderly patients.
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Affiliation(s)
- Lirit Levi
- 36632Rabin Medical Center, Petah Tikva, Israel
| | | | | | - Noam Koch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Ilan Koren
- 36632Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alain Hazan
- 36632Rabin Medical Center, Petah Tikva, Israel
| | | | - Ella Reifen
- 36632Rabin Medical Center, Petah Tikva, Israel
| | - Ethan Soudry
- 36632Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gardner JR, Campbell JB, Daigle O, King D, Kanaan A. Operative and postoperative outcomes in elderly patients undergoing endoscopic sinus surgery. Eur Arch Otorhinolaryngol 2020; 278:1471-1476. [PMID: 33141253 DOI: 10.1007/s00405-020-06453-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Chronic rhinosinusitis (CRS) is increasingly common in the elderly population (≥ 65 years old). Compared to their younger counterparts, differences exist in the etiology of CRS and outcomes of Endoscopic Sinus Surgery (ESS) for elderly patients. The aim of this study is to determine if differences in surgical outcomes are present between these two patient populations to facilitate patient pre-operative counseling by their healthcare providers. METHODS Retrospective chart review conducted at a single tertiary care center for patients undergoing ESS between June 2014 and June 2019. Patients were classified into two cohorts (adult and elderly) based on age (< 65 and ≥ 65 years old). Demographics, surgical, and postoperative variables were extracted from our institution's electronic medical records. ANOVA and t-test analysis were performed to determine the presence of significant differences between the two cohorts. SNOT-22 scores were used to determine QOL improvements. RESULTS Compared to the adult cohort, elderly patients had significant QOL improvement after surgical treatment (p = 0.001), but had a similar successful response to treatment (p = 0.74). Elderly patients had no difference in the incidence of operative/perioperative complications (p = 0.89) or intraoperative or postoperative bleeding (p = 0.301, p = 0.62), but had an increased incidence of postoperative infection (p = 0.000). CONCLUSION ESS remains an effective treatment modality for the management of CRS, and a safe practice for elderly patients despite the increase in complexity of their medical comorbidities and polypharmacy. QOL improvements are significant, though patient counseling should take into account that improvements may not be as pronounced as in younger patients.
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Affiliation(s)
- J Reed Gardner
- Division of Rhinology and Allergy, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences (UAMS), 4301 W Markham St # 543, Little Rock, AR, 72205, USA
| | - Jessica B Campbell
- Division of Rhinology and Allergy, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences (UAMS), 4301 W Markham St # 543, Little Rock, AR, 72205, USA
| | - Olivia Daigle
- Division of Rhinology and Allergy, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences (UAMS), 4301 W Markham St # 543, Little Rock, AR, 72205, USA
| | - Deanne King
- Division of Rhinology and Allergy, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences (UAMS), 4301 W Markham St # 543, Little Rock, AR, 72205, USA
| | - Alissa Kanaan
- Division of Rhinology and Allergy, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences (UAMS), 4301 W Markham St # 543, Little Rock, AR, 72205, USA.
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Chen S, Zhou A, Emmanuel B, Thomas K, Guiang H. Systematic literature review of the epidemiology and clinical burden of chronic rhinosinusitis with nasal polyposis. Curr Med Res Opin 2020; 36:1897-1911. [PMID: 32847417 DOI: 10.1080/03007995.2020.1815682] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We conducted a systematic literature review (SLR) to determine the epidemiology and clinical burden of chronic rhinosinusitis with nasal polyps (CRSwNP) and to describe how the addition of biologics has affected outcomes for patients with CRSwNP. METHODS The SLR adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Embase, MEDLINE, and Evidence-Based Medicine Reviews databases were searched using OVID. Relevant studies published between 1 January 2008 and 8 February 2019, for epidemiology, and 1 January 2008 and 16 February 2019, for clinical burden, and relevant conference abstracts from 1 January 2017 to 7 March 2019, for epidemiology and 1 January 2017-16 February 2019 for clinical burden were included. RESULTS For the epidemiology and clinical burden SLR, 147 and 119 records, respectively, met the inclusion criteria. We found the prevalence of CRSwNP was 1-2.6% and was greater in men. Asthma, allergy, and allergic rhinitis were the most common comorbidities identified. Reported risk factors included asthma, gene polymorphisms, age, and eosinophilia. Studies indicated that dupilumab, mepolizumab, and omalizumab each improved different clinical outcomes. Non-biologics (drugs such as corticosteroids or antibiotics, surgery, or aspirin desensitization) improved clinical outcomes as well. CONCLUSIONS CRSwNP is fairly prevalent in the general population. Despite the significant efficacy of existing treatments, several unmet needs remain. The high burden of uncontrolled symptoms, frequent recurrence of nasal polyps after surgery, and long-term adverse effects of oral corticosteroids indicate that new therapies addressing these unmet needs should be developed. Although data on biologics from randomized controlled trials look promising, the efficacy of biologics in the real world has yet to be established. The SLR of the epidemiology and clinical burden of CRSwNP revealed key gaps in the literature. There was a paucity of prevalence data across many geographic areas, and no prevalence projections could be determined. Studies showed varying efficacy of non-biologics and no studies directly compared biologics for efficacy. Data regarding clinical efficacy of agents for eosinophilic CRSwNP or severe CRSwNP were lacking, and these patient populations would be served by more trials.
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Affiliation(s)
| | - Anna Zhou
- EVERSANA, Burlington, Ontario, Canada
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Locatello LG, Comini LV, Bettiol A, Vannacci A, Spinelli G, Mannelli G. A model to predict postoperative complications for otorhinolaryngology and maxillofacial surgery procedures in elderly patients. Eur Arch Otorhinolaryngol 2020; 277:3459-3467. [PMID: 32494949 DOI: 10.1007/s00405-020-06084-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/22/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE All kinds of ear, nose, and throat and maxillofacial surgery (ENT/MFS) procedures are being increasingly performed in the elderly although old age is a major risk factor for increased postoperative complications. With only scarce evidence on the topic, surgeons are asked to critically evaluate their procedures' indications and outcomes to balance the treatment risks and benefits. Our primary aim was to identify predictive factors for surgical outcomes in this setting and to create a predictive model for a tailored risk assessment. METHODS We analyzed a case series of 435 patients from an institutional clinical database at our academic tertiary care center. Multivariate logistic regression was used to identify all possible covariates and nomograms using stepwise backward method were generated. The performance was assessed by calibration curves and c-index. RESULTS Overall complication rate was 18.3% within the first 30 days and the need for re-intervention was 5.9%. For those under general anesthesia, we identified specific risk factors and developed three risk-predicting models of overall, early, and late complications. All of the nomograms showed satisfactory accuracy with a c-index of 0.83, 0.75, 0.86, and 0.82, respectively. CONCLUSION Using clinical preoperative variables, we constructed a model for predicting major adverse events in ENT/MFS patients. In our experience, patients over 65 showed a non-negligible risk for postoperative complications depending on several factors. Such tools might help in decision-making, by increasing the risk-awareness of clinicians, to better address peri-operative and post-operative care of these patients.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
| | - Lara Valentina Comini
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Alessandra Bettiol
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Giuseppe Spinelli
- Department of Maxillofacial Surgery, Careggi University Hospital, Largo Brambilla, 3, Florence, 50134, Italy
| | - Giuditta Mannelli
- Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Casale M, Costantino A, Sabatino L, Luchena A, Moffa A, Cassano M, Rinaldi V, Baptista PM. Minimally invasive surgery under local anaesthesia for chronic rhinosinusitis with nasal polyps: our experience in older adults. J Laryngol Otol 2020; 134:1-5. [PMID: 32046795 DOI: 10.1017/s0022215120000304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This paper aims to report our experience with a minimally invasive surgical procedure for the treatment of chronic rhinosinusitis with nasal polyps, performed in a day-surgery setting under local anaesthesia. METHODS A retrospective study of 30 patients with chronic rhinosinusitis with nasal polyps was conducted. Sino-Nasal Outcome Test 22 and modified Lund-Kennedy scores were collected. Intra- and post-operative pain was evaluated using a 10-point visual analogue scale. RESULTS The mean Sino-Nasal Outcome Test 22 score decreased from 41.8 ± 15.8 pre-operatively to 13.3 ± 9.5 post-operatively (p < 0.001). Accordingly, the mean endoscopic score decreased from 6.8 ± 1.8 to 0.2 ± 0.7 (p < 0.001). The mean intra-operative pain score was 2.9 ± 3.2, and 29 patients (96.7 per cent) reported no pain in the post-operative period (visual analogue scale score = 0). CONCLUSION Our study confirms that minimally invasive surgery represents a safe, repeatable procedure that results in remarkable subjective and objective improvement, without intra- and post-operative pain or discomfort.
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Affiliation(s)
- M Casale
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - A Costantino
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - L Sabatino
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - A Luchena
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - A Moffa
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
- Department of Otolaryngology, University of Foggia, Italy
| | - M Cassano
- Department of Otolaryngology, University of Foggia, Italy
| | - V Rinaldi
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - P M Baptista
- Department of Otolaryngology, University Clinic of Navarra, Pamplona, Spain
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Brescia G, Alessandrini L, Parrino D, Franz L, Barion U, Marioni G. Emerging Contribution of Histopathology to Our Understanding of Chronic Rhinosinusitis Endotypes: Tissue Eosinophil Count and Aggregates. Am J Rhinol Allergy 2019; 34:122-126. [PMID: 31564111 DOI: 10.1177/1945892419878322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Giuseppe Brescia
- Otolaryngology Section, Department of Neuroscience, Padova University, Padova, Italy
| | | | - Daniela Parrino
- Otolaryngology Section, Department of Neuroscience, Padova University, Padova, Italy
| | - Leonardo Franz
- Otolaryngology Section, Department of Neuroscience, Padova University, Padova, Italy
| | - Umberto Barion
- Otolaryngology Section, Department of Neuroscience, Padova University, Padova, Italy
| | - Gino Marioni
- Otolaryngology Section, Department of Neuroscience, Padova University, Padova, Italy
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12
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Crosby DL, Jones J, Palmer JN, Cohen NA, Kohanski MA, Adappa ND. Impact of age on outcomes following endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 9:1456-1461. [PMID: 31557428 DOI: 10.1002/alr.22444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/15/2019] [Accepted: 08/29/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a common condition that affects people of all ages and negatively impacts quality of life. The goal of this study was to identify differences in outcomes by age following endoscopic sinus surgery (ESS) for CRS utilizing 22-item Sino-Nasal Outcome Test (SNOT-22) scores. METHODS Data from 1252 adult CRS patients electing to undergo ESS (2007-2018) were collected retrospectively. The median age of 50 years was used to divide the data into 2 groups for comparison of the impact of age on SNOT-22 scores at 0, 3, and 6 months after surgery. Changes in SNOT-22 scores were analyzed using a mixed models analysis. RESULTS After adjusting for gender, race, polyp status, and number of prior ESSs, patients younger than 50 years had a higher mean pre-ESS SNOT-22 score (44.0) compared to those of at least 50 years of age (38.9). Among patients younger than 50 years, SNOT-22 scores declined by 20.7 points at 3 months post-ESS and 16.1 points at 6 months post-ESS. The rate of change between the dichotomized age groups was not significantly different at 3 and 6 months post-ESS (p = 0.7952 and p = 0.1057, respectively). CONCLUSION Both age groups showed significant and durable improvement in SNOT-22 scores after ESS. Patients younger than 50 years of age have higher pre-ESS SNOT-22 scores, but converge to the same SNOT-22 scores by 3 months post-ESS. The rate of change of SNOT-22 scores is not different between those younger than 50 years and those of at least 50 years.
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Affiliation(s)
- Dana L Crosby
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL.,Division of Otolaryngology-Head and Neck Surgery, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jeb Jones
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medicine, Philadelphia, PA
| | - Noam A Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medicine, Philadelphia, PA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medicine, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medicine, Philadelphia, PA
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13
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Song WJ, Lee JH, Won HK, Bachert C. Chronic Rhinosinusitis with Nasal Polyps in Older Adults: Clinical Presentation, Pathophysiology, and Comorbidity. Curr Allergy Asthma Rep 2019; 19:46. [PMID: 31486905 DOI: 10.1007/s11882-019-0880-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis and nasal polyps (CRSwNP) is a common condition that significantly affects patients' life. This work aims to provide an up-to-date overview of CRSwNP in older adults, focusing on its aging-related clinical presentations, pathophysiology, and comorbidity associations including asthma. RECENT FINDINGS Recent large population-based studies using nasal endoscopy have shown that CRSwNP is a mostly late-onset disease. Age-related changes in physiologic functions, including nasal epithelial barrier dysfunction, may underlie the incidence and different clinical presentations of CRSwNP in older adults. However, there is still a paucity of evidence on the effect of aging on phenotypes and endotypes of CRSwNP. Meanwhile, late-onset asthma is a major comorbid condition in patients with CRSwNP; they frequently present with type 2 inflammatory signatures that are refractory to conventional treatments when they are comorbid. However, as they are more commonly non-atopic, causative factors other than classical atopic sensitization, such as Staphylococcus aureus specific IgE sensitization, are suggested to drive the type 2 inflammation. There are additional comorbidity associations in older patients with CRSwNP, including those with chronic otitis media and head and neck malignancy. Age is a major determinant for the incidence and clinical presentations of CRSwNP. Given the heterogeneity in phenotypes and endotypes, longitudinal investigations are warranted to elucidate the effects of aging on CRSwNP.
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Affiliation(s)
- Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Ha-Kyeong Won
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Claus Bachert
- Upper Airways Research Laboratory, Ghent University Hospital, Ghent, Belgium
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14
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Brescia G, Sfriso P, Marioni G. Role of blood inflammatory cells in chronic rhinosinusitis with nasal polyps. Acta Otolaryngol 2019; 139:48-51. [PMID: 30686139 DOI: 10.1080/00016489.2018.1538567] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND/OBJECTIVE The pathophysiological and prognostic role of blood inflammatory cells in chronic rhinosinusitis with nasal polyps (CRSwNP) emerging from recent studies was investigated. MATERIAL AND METHODS The main available evidence and largely-recent publications were critically analyzed. RESULTS Several authors reported a direct association between blood eosinophilia and CRSwNP recurrence rates. In some large series, a direct association between recurrent CRSwNP and blood basophil values emerged too. CRSwNP patients' blood eosinophil and basophil values were strongly related. It was also found that preoperative neutrophil-to-lymphocyte, eosinophil-to-lymphocyte, and basophil-to-lymphocyte ratios were significantly higher in patients who experienced a disease relapse than in those who did not. In histologically-confirmed eosinophilic-type CRSwNP treated with endoscopic sinus surgery, mean blood eosinophil values dropped significantly from before to after the surgical procedure. CONCLUSIONS/SIGNIFICANCE CRSwNP endotypes have different inflammatory profiles reflected in the relative proportions of different types of blood cells. The available data support the theory that blood eosinophil and basophil levels should be included in the routine preoperative work-up of CRSwNP patients in order to give patients accurate prognostic information, adopt rational follow-up protocols after surgery, and provide dedicated postoperative medical treatments.
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Affiliation(s)
- Giuseppe Brescia
- Department of Neuroscience DNS, University of Padova, Padova, Italy
| | - Paolo Sfriso
- Unit of Rheumotology, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Gino Marioni
- Department of Neuroscience DNS, University of Padova, Padova, Italy
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15
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Yang P, Chen S, Zhong G, Kong W, Wang Y. Agonist of PPAR-γ Reduced Epithelial-Mesenchymal Transition in Eosinophilic Chronic Rhinosinusitis with Nasal Polyps via Inhibition of High Mobility Group Box1. Int J Med Sci 2019; 16:1631-1641. [PMID: 31839751 PMCID: PMC6909805 DOI: 10.7150/ijms.35936] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/29/2019] [Indexed: 12/13/2022] Open
Abstract
Epithelial-mesenchymal transition (EMT) has been reported to occur in eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP). Among the cytokines that cause EMT, high mobility group box 1 (HMGB1) has been shown to give rise to EMT in airway epithelial cells. However, the mechanism of HMGB1-induced EMT in ECRSwNP is unknown. We explored the mechanism and possible inhibitor. Immunohistochemistry (IHC), immunofluorescence (IF), and western blot assay were used to detect the expression and location of HMGB1, peroxisome proliferator-activated receptor-γ (PPAR-γ), and EMT markers in eighteen ECRSwNP and twelve normal nasal mucosa tissues. Epithelial cells isolated from ECRSwNP were cultured with various doses of recombinant human HMGB1 (rhHMGB1) to study the expression of PPAR-γ, and EMT markers. Additionally, the ligand of PPAR-γ was incubated with epithelial cells to interfere with the effects of lipopolysaccharide (LPS) or rhHMGB1 to explore the effect on expression of HMGB1 and EMT markers. These results suggest that HMGB1 was highly expressed in ECRSwNP compared with its expression in control tissues, and EMT was also found highly in ECRSwNP compared with control tissues. Moreover, the cytoplasmic accumulation of HMGB1 in ECRSwNP was obvious compared with normal tissues. We also found dose-dependent induction by rhHMGB1 of up-regulation of N-cadherin and vimentin and down-regulation of ZO-1 and E-cadherin in epithelial cells isolated from ECRSwNP. The agonist of PPAR-γ not only reduced release of HMGB1 induced by LPS, but also reversed the EMT. The protective role of PPAR-γ also appeared in cells that had been incubated with rhHMGB1. In the current study, we discovered that the agonist of PPAR-γ has a potential role in inhibited HMGB1-induced EMT in ECRSwNP. The agonist of PPAR-γ may contribute to inhabit epithelial cells to become mesenchymal-like cells which play an important role in the pathogenesis of ECRSwNP.
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Affiliation(s)
- Pingli Yang
- Department of otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Department of otorhinolaryngology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, 832000, China
| | - Shan Chen
- Department of otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Gang Zhong
- Department of otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Weijia Kong
- Department of otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Institutes of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yanjun Wang
- Department of otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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16
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Hwang CS, Lee HS, Kim SN, Kim JH, Park DJ, Kim KS. Prevalence and Risk Factors of Chronic Rhinosinusitis in the Elderly Population of Korea. Am J Rhinol Allergy 2018; 33:240-246. [PMID: 30482036 DOI: 10.1177/1945892418813822] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although a significant number of the clinical features and pathophysiologic mechanisms of chronic rhinosinusitis (CRS) have been described, only a few studies have been published on characterization of CRS in the field of aging. OBJECTIVE We investigated the prevalence and risk factors of CRS in elderly (≥65 years old) Koreans using large-scale nationwide epidemiological data and compared the risk factors of elderly with those of younger adult participants (19-64 years old). METHODS Data from 25 529 participants who completed the 2008-2012 Korean National Health and Nutrition Examination Survey were analyzed. Diagnosis of CRS was done according to the EP3OS 2012 guideline for epidemiologic study. Risk factors of CRS were compared in the aspects of sociodemographics, general health behaviors, clinical characteristics, and comorbidities of participants. RESULTS The prevalence of CRS was significantly higher in 5590 elderly than in 19 939 younger adults (6.55% vs 5.69%; P = .016. Some variables of socioeconomic status and mental health in the adult group were associated with increased risk of CRS but did not show association in the elderly group. We observed a significant association between CRS prevalence and comorbid allergic rhinitis, asthma, and atopic dermatitis in both groups ( P < .05). However, in the elderly group, the associations were significantly weaker with regard to allergic rhinitis ( P-interaction = .03) and asthma ( P-interaction = .002). CONCLUSION These results suggest that elderly populations have distinct pathophysiology and clinical presentations from adult CRS, and management for elderly patients with CRS may require different or additional therapeutic approaches.
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Affiliation(s)
- Chi Sang Hwang
- 1 Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Hye Sun Lee
- 2 Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Si Nae Kim
- 2 Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hyung Kim
- 3 Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong-Joon Park
- 1 Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Kyung-Su Kim
- 3 Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Spantideas N, Bougea A, Drosou E, Assimakopoulos D. The Role of Allergy in Phonation. J Voice 2018; 33:811.e19-811.e27. [PMID: 30145066 DOI: 10.1016/j.jvoice.2018.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/21/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Allergies are among the most common chronic conditions worldwide affecting 10%-30% of adult individuals and 40% of children. Phonation can be affected by different allergic conditions in various ways. The role of allergy in phonation has been under-researched and poorly understood and the respective literature is poor. Several studies have investigated the role of certain allergic diseases in phonation. In this review, we tried to include all allergic conditions that can affect voice production. METHODS We conducted a bibliography review looking for allergic conditions that can affect phonation. Allergic asthma, allergic laryngitis, allergic rhinitis and sinusitis, oral allergy syndrome, and angioedema were included in our search. RESULTS The literature on the impact of allergy in phonation remains poor and many key questions concerning basic information for epidemiology, pathophysiology, and larynx pathology in allergic patients with phonation problems still remain unanswered. CONCLUSIONS The role of allergy in voice production remains underinvestigated and many basic questions still remain open. Further research is needed to improve our understanding for these very common conditions.
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Affiliation(s)
| | | | - Eirini Drosou
- Athens Speech Language and Swallowing Institute, Athens, Greece
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18
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Brescia G, Barion U, Marioni G. Authors Reply. Am J Rhinol Allergy 2017. [DOI: 10.1177/194589217820500063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Casale M, Sabatino L, Salvinelli F. Letter to the Editor: Sinonasal Polyposis Recurrence Rate and Quality of Life in the Elderly. Am J Rhinol Allergy 2017; 31:2. [DOI: 10.2500/ajra.2017.31.4409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Brescia G, Barion U, Zanotti C, Giacomelli L, Martini A, Marioni G. The prognostic role of serum eosinophil and basophil levels in sinonasal polyposis. Int Forum Allergy Rhinol 2016; 7:261-267. [PMID: 27992119 DOI: 10.1002/alr.21885] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/19/2016] [Accepted: 10/25/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Predicting which patients are at a higher risk for recurrent chronic rhinosinusitis with nasal polyps (CRSwNP) is one of the most challenging problems in clinical rhinology. A direct association between CRSwNP recurrence rates and serum eosinophil and basophil counts was reported. This study aimed to identify best-fitting cutoffs for binarizing preoperative serum eosinophils and basophils (counts/percentages) for prognostic purposes in cases of CRSwNP recurrence after surgery. A secondary endpoint was to distinguish said cutoffs for prognosticating recurrence in subcohorts of patients with histologically diagnosed eosinophilic/non-eosinophilic CRSwNP. METHODS A retrospective study was performed on 280 patients (127 eosinophilic and 153 non-eosinophilic CRSwNP) examining the prognostic role of serum eosinophil and basophil levels. RESULTS For all patients examined, mean preoperative serum eosinophil and basophil levels were significantly higher in patients whose CRSwNP recurred. Patients with eosinophil counts ≥0.24 cells × 109 /L and percentages ≥3.7% had odds ratios (ORs) of 2.57 and 2.19 for recurrence; patients with basophil counts ≥0.03 cells × 109 /L and percentages ≥0.5% had ORs of 2.19 and 2.24, respectively. Among histologically eosinophilic CRSwNP patients, mean eosinophils and basophils (counts/percentages) were significantly higher in cases that recurred. Serum eosinophil and basophil values were directly correlated. The recurrence odds were OR 2.52 for high eosinophils (≥5.9%), and OR 2.52 and 2.69 for high basophils (≥0.04 cells × 109 /L and ≥0.5%, respectively). CONCLUSION High serum eosinophil and basophil values should be further investigated because they could pinpoint patients at higher risk of eosinophilic-type CRSwNP recurrence. These preliminary results support the increasing interest in the role of basophils in CRSwNP.
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Affiliation(s)
- Giuseppe Brescia
- Department of Neurosciences (DNS), Otolaryngology Section, Padova University, Padova, Italy
| | - Umberto Barion
- Department of Neurosciences (DNS), Otolaryngology Section, Padova University, Padova, Italy
| | - Claudia Zanotti
- Department of Neurosciences (DNS), Otolaryngology Section, Padova University, Padova, Italy
| | | | - Alessandro Martini
- Department of Neurosciences (DNS), Otolaryngology Section, Padova University, Padova, Italy
| | - Gino Marioni
- Department of Neurosciences (DNS), Otolaryngology Section, Padova University, Padova, Italy
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Woodard TD. Reality bites: The establishment of accountable care organizations in otolaryngology. Am J Rhinol Allergy 2016; 30:317-8. [PMID: 27657895 PMCID: PMC5013234 DOI: 10.2500/ajra.2016.30.4375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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