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Behnke J, Dundervill C, Al-Asadi Z, Shahid M, Ramadan HH, Makary CA. Gender Differences in Adults With Chronic Rhinosinusitis: A Scoping Review. Otolaryngol Head Neck Surg 2024; 170:1659-1667. [PMID: 38317564 DOI: 10.1002/ohn.663] [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: 09/26/2023] [Revised: 12/25/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Gender differences in chronic rhinosinusitis (CRS) have been demonstrated in many studies over the last 15 years. The purpose of this scoping review is to investigate the current knowledge on gender differences in CRS and to analyze the gaps in the literature. DATA SOURCES A systematic search of PubMed, Cochrane Library, and Embase databases was performed. REVIEW METHODS This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies that evaluated gender differences in CRS were included in the review. RESULTS Of the 523 abstracts reviewed, a total of 23 studies met the criteria for inclusion. Articles consisted of retrospective and prospective cohort studies. They were divided into 3 categories based on whether they evaluated gender differences in (1) presentation and baseline quality of life, (2) pathophysiology, and/or (3) outcomes of treatment. Eleven studies addressed differences in presentation, 5 addressed differences in pathophysiology, and 10 dealt with differences in outcomes after surgical or medical management. Most of the studies showed worse baseline QoL secondary to CRS in women, with outcome of treatment being similar in both genders. CONCLUSION The experience of CRS appears to vary between genders, with women experiencing a greater subjective burden of disease than men, though with similar outcomes after treatment. Further research is indicated, particularly involving the pathophysiology of CRS, to fully understand the underlying causes of these discrepancies.
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Affiliation(s)
- John Behnke
- Department of Otolaryngology, West Virginia University, Morgantown, Virginia University, USA
| | - Caroline Dundervill
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Zayd Al-Asadi
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Michel Shahid
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Hassan H Ramadan
- Department of Otolaryngology, West Virginia University, Morgantown, Virginia University, USA
| | - Chadi A Makary
- Department of Otolaryngology, West Virginia University, Morgantown, Virginia University, USA
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Ramkumar SP, Brar T, Marks L, Marino MJ, Lal D. Biological sex as a modulator in rhinologic anatomy, physiology, and pathology: A scoping review. Int Forum Allergy Rhinol 2023; 13:1783-1800. [PMID: 36688669 DOI: 10.1002/alr.23135] [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: 09/23/2022] [Revised: 01/06/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Biological sex is increasingly recognized as a critical variable in health care. The authors reviewed the current literature regarding sex-based differences in rhinology to summarize the data and identify critical knowledge gaps. METHODS A scoping review was conducted. Publications reporting sex-based differences in anatomy, physiology, and pathology focusing on disease prevalence, disease burden, and outcomes in rhinology were identified. RESULTS Seventy-five relevant manuscripts were identified. While paranasal sinuses are of similar size at birth, they become larger in males leading to differences in ostium location. Females outperform males in olfactory identification but only in the 18- to 50-year age group. Estrogen and progesterone administration can impact muscarinic and α1 -adrenergic nasal mucosa receptor density. Chronic rhinosinusitis (CRS) and CRS without nasal polyps are more prevalent in females while CRS with nasal polyps is more prevalent in males. CRS symptom burden is higher in females before and after endoscopic sinus surgery; however, no difference in endoscopic sinus surgery utilization was found based on sex. Allergic rhinitis is more common in males before puberty and in females after puberty. Epistaxis is more prevalent in males and postmenopausal females compared with premenopausal females, perhaps from differences in sex-hormonal and hypertension status. In nasopharyngeal carcinoma, the incidence of sinus abnormalities was higher in males than females. CONCLUSIONS Although many sex-based differences exist in rhinology, further research is necessary to offer evidence-based treatment guidelines. Gonadal hormones should be studied as a therapeutic in rhinologic pathology as baseline physiologic differences exist such as those found in nasal mucosa receptor density.
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Affiliation(s)
- Shreya P Ramkumar
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Tripti Brar
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Lisa Marks
- Division of Education, Department of Library Services, Mayo Clinic, Phoenix, Arizona, USA
| | - Michael J Marino
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Devyani Lal
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
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Wolf JS, Papadimitriou JC, Morales RE, Califano JA, Kline NL, Bhatnagar K, Hebert AM, Taylor RJ. The association of active and passive tobacco smoke exposure with chronic rhinosinusitis symptom severity: A cross-sectional study. Int Forum Allergy Rhinol 2021; 12:278-285. [PMID: 34510792 DOI: 10.1002/alr.22887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) causes a great deal of morbidity. There are a multitude of causal factors, though their precise contribution to symptom severity has yet to be defined. We hypothesized that exposure to both primary and secondhand tobacco smoke would correlate with more severe symptoms of CRS. METHODS This is a prospective cross-sectional study performed at an academic tertiary care medical center from 2010 to 2013. A total of 85 consecutive patients with chronic sinusitis were screened; 70 with medically refractory CRS requiring functional Endoscopic sinus surgery (FESS) were enrolled. Recent tobacco exposure was assessed using serum cotinine levels. Sinonasal mucosa was biopsied to assess ciliary architecture. Demographics, medical history, tobacco and environmental exposures, and computed tomography (CT) imaging were also collected. Two quality of life (QOL) surveys were administered: one disease specific, Sinonasal Outcomes Test-20 (SNOT-20), and one general, Short Form-12 (SF-12). Results were correlated with the aforementioned exposures. RESULTS The 70 patients had an average age of 46 years, and 42% were male. Variables that correlated with worse SNOT-20 scores included serum cotinine (r = 0.43, p = 0.002), number of cigarettes smoked daily (r = 0.27, p = 0.03), and number of secondhand cigarettes exposed to per day (r = 0.29, p = 0.04). There were no significant correlations between SNOT-20 scores and Lund-MacKay or axonemal ultrastructural abnormalities (AUA)-ciliary scores. The two five-variable models best predicted disease-specific QOL. CONCLUSIONS Increased amounts of serum cotinine and primary and secondhand smoke exposure were associated with worse sinonasal QOL. This study establishes an objective relationship between smoke exposure and patient-perceived severity of CRS, emphasizing the importance of tobacco cessation counseling as part of management.
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Affiliation(s)
- Jeffrey S Wolf
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John C Papadimitriou
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robert E Morales
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Joseph A Califano
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, California, USA
| | - Neila L Kline
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kavita Bhatnagar
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrea M Hebert
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Taylor
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Borrelli M, Hopp ML, Desales A, Ting JY, Illing EA, Higgins TS, Wu AW. Gender-related differences in outcomes after endoscopic sinus surgery. Int Forum Allergy Rhinol 2020; 11:949-952. [PMID: 33275321 DOI: 10.1002/alr.22749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Michela Borrelli
- Cedars-Sinai Sinus Center, Los Angeles, CA.,Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Martin L Hopp
- Cedars-Sinai Sinus Center, Los Angeles, CA.,Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Alexis Desales
- Cedars-Sinai Sinus Center, Los Angeles, CA.,Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jonathan Y Ting
- Department of Otolaryngology, Indiana University Health, Indianapolis, IN
| | - Elisa A Illing
- Department of Otolaryngology, Indiana University Health, Indianapolis, IN
| | - Thomas S Higgins
- Department of Otolaryngology, University of Louisville School of Medicine, Louisville, KY
| | - Arthur W Wu
- Cedars-Sinai Sinus Center, Los Angeles, CA.,Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
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Almuslehi MSM, Sen MK, Shortland PJ, Mahns DA, Coorssen JR. CD8 T-cell Recruitment Into the Central Nervous System of Cuprizone-Fed Mice: Relevance to Modeling the Etiology of Multiple Sclerosis. Front Cell Neurosci 2020; 14:43. [PMID: 32210765 PMCID: PMC7076139 DOI: 10.3389/fncel.2020.00043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/14/2020] [Indexed: 11/24/2022] Open
Abstract
Cuprizone (CPZ)-feeding in mice induces atrophy of peripheral immune organs (thymus and spleen) and suppresses T-cell levels, thereby limiting its use as a model for studying the effects of the immune system in demyelinating diseases such as Multiple Sclerosis (MS). To investigate whether castration (Cx) can protect the peripheral immune organs from CPZ-induced atrophy and enable T-cell recruitment into the central nervous system (CNS) following a breach of the blood-brain barrier (BBB), three related studies were carried out. In Study 1, Cx prevented the dose-dependent reductions (0.1% < 0.2% CPZ) in thymic and splenic weight, size of the thymic medulla and splenic white pulp, and CD4 and CD8 (CD4/8) levels remained comparable to gonadally intact (Gi) control males. Importantly, 0.1% and 0.2% CPZ were equipotent at inducing central demyelination and glial activation. In Study 2, combining Cx with 0.1% CPZ-feeding and BBB disruption with pertussis toxin (PT) enhanced CD8+ T-cell recruitment into the CNS. The increased CD8+ T-cell level observed in the parenchyma of the cerebrum, cerebellum, brainstem and spinal cord were confirmed by flow cytometry and western blot analyses of CNS tissue. In Study 3, PT+0.1% CPZ-feeding to Gi female mice resulted in similar effects on the peripheral immune organs, CNS demyelination, and gliosis comparable to Gi males, indicating that testosterone levels alone were not responsible for the immune response seen in Study 2. The combination of Cx+0.1% CPZ-feeding+PT indicates that CPZ-induced demyelination can trigger an “inside-out” immune response when the peripheral immune system is spared and may provide a better model to study the initiating events in demyelinating conditions such as MS.
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Affiliation(s)
- Mohammed S M Almuslehi
- School of Medicine, Western Sydney University, Penrith, NSW, Australia.,Department of Physiology, College of Veterinary Medicine, Diyala University, Diyala, Iraq
| | - Monokesh K Sen
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Peter J Shortland
- School of Science, Western Sydney University, Penrith, NSW, Australia
| | - David A Mahns
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Jens R Coorssen
- Department of Health Sciences, Faculty of Applied Health Sciences, St. Catharines, ON, Canada.,Department of Biological Sciences, Faculty of Mathematics and Science, Brock University, St. Catharines, ON, Canada
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Marino MJ, Garcia JO, Zarka MA, Lal D. Inflammatory cell predominance and patterns in chronic rhinosinusitis with and without nasal polyposis patients. Laryngoscope Investig Otolaryngol 2019; 4:573-577. [PMID: 31890873 PMCID: PMC6929577 DOI: 10.1002/lio2.328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/23/2019] [Accepted: 10/30/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES There is interest in identifying chronic rhinosinusitis (CRS) endotypes that align pathophysiology with clinical observation and outcomes. CRS with polyps (CRSwNP) has classically been studied with reference to tissue eosinophilia, but the role of other cellular infiltrates remains uncharacterized. No particular tissue prognosticators have been described for CRS without nasal polyps (CRSsNP). Predominance of leukocytes seen in surgical tissue may be useful for differentiating CRS subtypes, severity of inflammation, and outcomes. METHODS Structured histopathology reports were examined for 277 patients undergoing endoscopic sinus surgery for CRSwNP (n = 115), CRSsNP (n = 141), and recurrent acute rhinosinusitis (RARS, n = 21). Inflammatory predominance was examined for associations with nasal polyposis, asthma, allergic rhinitis, aspirin exacerbated respiratory disease (AERD), immune deficiency, preoperative Lund-Mackay score, and outcome (SNOT-22 score change). RESULTS In order of frequency, the prevalence of predominant inflammatory patterns accounting for 93.5% of CRS patients were: lymphoplasmocytic (n = 111), lymphocytic (n = 74), eosinophilic (n = 50), and lymphoplasmocytic with eosinophilic (n = 24). Eosinophilic predominance was 97.4% specific for nasal polyps (95% confidence interval [CI], 93.4%-99.3%), although sensitivity was 43.4% (95% CI, 33.8%-53.4%). The absence of eosinophilic predominance was 100% sensitive for RARS (95% CI, 82.4%-100%), however specificity was 30.8% (95% CI 25.1%-37.1%). There were no significant differences in preoperative SNOT-22 scores or change postoperatively. CONCLUSIONS Eosinophilic inflammatory predominance was predictive for nasal polyps and against RARS. Nevertheless, the majority of CRSwNP patients had a different inflammatory predominance, demonstrating heterogeneity in CRS, even among patients with nasal polyps. Symptomatic outcomes were not associated with inflammatory predominance through 12 months follow up. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | - J. Omar Garcia
- Department of OtorhinolaryngologyMayo ClinicPhoenixArizona
| | | | - Devyani Lal
- Department of OtorhinolaryngologyMayo ClinicPhoenixArizona
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Marino MJ, Garcia JO, Zarka M, Lal D. A structured histopathology-based analysis of surgical outcomes in chronic rhinosinusitis with and without nasal polyps. Laryngoscope Investig Otolaryngol 2019; 4:497-503. [PMID: 31637292 PMCID: PMC6793607 DOI: 10.1002/lio2.303] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/22/2019] [Accepted: 08/06/2019] [Indexed: 12/11/2022] Open
Abstract
Objectives Structured histopathology reporting has been recently described for detailing immunopathological characteristics of chronic rhinosinusitis (CRS), and can be utilized for subtyping CRS and personalizing management. This study scrutinized elements of structured histopathology to identify characteristics that prognosticate outcomes following endoscopic sinus surgery (ESS) for CRS patients with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). Methods Outcomes following ESS were measured using the patient‐reported 22‐item sinonasal outcome test (SNOT‐22). Changes in total SNOT‐22 scores at 6 and 12 months postoperatively were analyzed. Thirteen parameters reported in structured histopathology of sinus surgical tissue were studied for association with outcomes postsurgery. The overall cohort of all CRS patients was studied, along with subgroup analyses of CRSwNP and CRSsNP patients. Results In the entire CRS cohort (n = 171), eosinophil count >10 per high power field (HPF) was associated with greater improvement in SNOT‐22 scores at 6 months post‐ESS (P = .039). At 12 months follow‐up, no histopathological characteristic was associated with change in total SNOT‐22 score. In the CRSwNP (n = 66) subgroup, the presence of fibrosis (P = .006) and eosinophil count ≤10 per HPF (P = .025) were associated with less favorable changes in SNOT‐22 scores at 12 months follow‐up. Fibrosis remained statistically significant in multivariable analysis (P = .007). Conclusions At 6 months post‐ESS, tissue eosinophilia is associated with significantly higher improvement in SNOT‐22 scores, but this difference is diluted by 12 months. Fibrosis was associated with less favorable outcomes in SNOT‐22 scores for CRSwNP patients at 12 months and may be a prognosticator for poorer long‐term outcomes. Level of Evidence 4
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Affiliation(s)
- Michael J Marino
- Department of Otorhinolaryngology Mayo Clinic Phoenix Arizona U.S.A
| | - J Omar Garcia
- Department of Otorhinolaryngology Mayo Clinic Phoenix Arizona U.S.A
| | - Matthew Zarka
- Division of Laboratory Medicine Mayo Clinic Phoenix Arizona U.S.A
| | - Devyani Lal
- Department of Otorhinolaryngology Mayo Clinic Phoenix Arizona U.S.A
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Psaltis AJ. Beyond Borders and Sinuses: Rhinology and Allergy Research on a World Stage. Am J Rhinol Allergy 2017. [DOI: 10.2500/ajra.2017.31.4493] [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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