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Fouda KZ, Eladl HM, Ameer MA, Allam NM. Effect of Adding Physiotherapy Program to the Conservative Medical Therapy on Quality of Life and Pain in Chronic Rhinosinusitis Patients. Ann Rehabil Med 2023; 47:393-402. [PMID: 37907231 PMCID: PMC10620496 DOI: 10.5535/arm.23058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/05/2023] [Accepted: 08/16/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE : To assess the effectiveness of combining physiotherapy techniques with conservative medical treatment in chronic rhinosinusitis (CRS) patients. METHODS : Sixty-eight volunteers with CRS were randomly assigned. Group A received only traditional medical treatment, whereas group B received a physiotherapy program that included pulsed ultrasound therapy, sinus manual drainage techniques, and self-sinus massage technique in addition to traditional medical treatment. Interventions were applied 3 sessions a week for 4 weeks. The rhinosinusitis disability index (RSDI) served as the main outcome indicator for assessing the quality of life, and the secondary outcome measure was the pressure pain threshold (PPT) using a pressure algometer. RESULTS : Wilcoxon signed rank test revealed a significant reduction (p<0.001) in total RSDI values from 71.08±1.13 pretest to 47.14±1.15 posttest for group A, while it decreased from 70.64±1.20 pretreatment to 31.76±1.04 posttreatment for group B; furthermore, Mann-Whitney U-test revealed a significant difference (p<0.001) in total RSDI values between both groups when comparing the change of the pre-post data values, it was 23.94±0.95 for group A and 38.88±0.67 for group B. The independent t-test revealed a highly statistically significant increase (p<0.001) in the PPT values in the experimental group compared to the control group. CONCLUSION : The physiotherapy program which included pulsed ultrasound therapy, sinus manual drainage technique, and self-sinus massage technique in conjunction with conventional medical treatment was more beneficial for enhancing the quality of life and PPT than traditional medical treatment alone in CRS patients.
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Affiliation(s)
- Khaled Z. Fouda
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hadaya M. Eladl
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Science, Jouf University, Sakaka, Kingdom of Saudi Arabia
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Mariam A. Ameer
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Science, Jouf University, Sakaka, Kingdom of Saudi Arabia
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Nesma M. Allam
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Science, Jouf University, Sakaka, Kingdom of Saudi Arabia
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Naghdi S, Ansari NN, Varedi M, Fathali M, Zarrin M, Kashi-Alashti M, HasanNia F. Use of low-level laser therapy for patients with chronic rhinosinusitis: a single-blind, sham-controlled clinical trial. Lasers Med Sci 2022; 38:5. [PMID: 36538169 DOI: 10.1007/s10103-022-03684-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/22/2022] [Indexed: 12/24/2022]
Abstract
Chronic rhinosinusitis (CRS) is one of the most common conditions all over the world. The purpose of this study was to investigate the effects of low-level laser therapy (LLLT) in patients with CRS. Fourteen adult patients with CRS participated in this single-blind, sham-controlled clinical trial (12 male, mean age 40 years). Patients received five successive sessions of sham laser followed by five successive sessions of real laser after 2 days. Ga-Al-As laser of 830 nm in a continuous mode at a power output of 30 mW and energy dose of 1 J was applied on the cheeks and the forehead for the maxillary and frontal sinuses, respectively. Laser was delivered on six points over each sinus, each point for 33 s. Four measurements were taken. The total symptom score (TSS) was calculated as the primary outcome measure. The effects of LLLT on TSS were evaluated by using repeated measure ANOVA. The percentage improvement of real laser and sham laser was compared by Wilcoxon signed ranked test. Cohen's d was used to calculate the effect size. Total symptom score significantly improved after real laser (p = 0.015, Cohen's d = 0.69). The percentage improvement for real laser (34.12 ± 46.43) was significantly better than the sham laser (5.02 ± 37.34, Z = - 2.23, p = 0.026). No significant improvements were observed after sham laser. This study indicates that five-session active LLLT when compared with sham is effective in the treatment of CRS symptoms.
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Affiliation(s)
- Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pich-E-Shemiran, Zip: 11489, Tehran, Iran.
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran.
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pich-E-Shemiran, Zip: 11489, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Varedi
- Epidemiology and Cancer Control Department, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Mojtaba Fathali
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pich-E-Shemiran, Zip: 11489, Tehran, Iran
| | - Milad Zarrin
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pich-E-Shemiran, Zip: 11489, Tehran, Iran
| | - Mina Kashi-Alashti
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pich-E-Shemiran, Zip: 11489, Tehran, Iran
| | - Fatemeh HasanNia
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pich-E-Shemiran, Zip: 11489, Tehran, Iran
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Phillips KM, Roozdar P, Hwang PH. Applications of vibrational energy in the treatment of sinonasal disease: A scoping review. Int Forum Allergy Rhinol 2022; 12:1397-1412. [PMID: 35218159 PMCID: PMC9790470 DOI: 10.1002/alr.22988] [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: 12/21/2021] [Revised: 02/07/2022] [Accepted: 02/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Acoustic energy and vibration therapy are emerging as helpful adjuncts among many disease states. There has been interest in how this technology can either serve as an alternative treatment or enhance delivery of medications to treat pathology within the nasal cavity and paranasal sinuses. Our objective was to perform a scoping review of the state of the science of vibration treatment used in sinonasal disease. METHODS A search of Embase, PubMed, and CINAHL databases was performed in November 2021. Included studies evaluated acoustic energy as a means of treatment in sinonasal diseases. Data points collected included type of technology utilized, disease state treated, and outcomes. RESULTS The initial search identified 2902 studies, of which 44 met inclusion criteria. A wide array of vibrational technology such as ultrasound, sonic aerosols, and phonophoresis, with varying frequency and amplitude were described. Twenty-six studies evaluated the use of acoustic energy to treat sinonasal disease itself, while 18 studies evaluated the use of acoustic energy to facilitate drug delivery to the sinonasal cavity. Outcome measures among studies were highly varied. CONCLUSIONS Vibration technology used in patients with sinonasal pathology has been shown to improve pain, sinonasal symptoms, and radiologic outcome measures in small studies. Given the heterogeneous study populations and outcomes, no conclusion could be reached regarding overall effectiveness of acoustic energy as a primary treatment. Further research is required to study specific treatment indications in larger patient populations to fully understand the potential clinical benefit and to determine optimal therapeutic characteristics of sound energy.
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Affiliation(s)
- Katie M. Phillips
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Cincinnati College of MedicineCincinnatiUSA
| | - Pooya Roozdar
- Department of Otolaryngology—Head and Neck SurgeryStanford University School of MedicineStanfordUSA
| | - Peter H. Hwang
- Department of Otolaryngology—Head and Neck SurgeryStanford University School of MedicineStanfordUSA
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da Silva GS, Dos Santos Isoppo K. Therapeutic ultrasound as a treatment for chronic rhinosinusitis: A systematic review. CLINICAL RESPIRATORY JOURNAL 2021; 15:1275-1285. [PMID: 34423908 DOI: 10.1111/crj.13441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effects of therapeutic ultrasound in symptoms of patients with chronic rhinosinusitis. DATA SOURCE AND STUDY SELECTION Searches were carried out in the MEDLINE (via OVID), SCOPUS, PubMed and Virtual Health Library databases. The study selection is as follows: Pre-experimental and experimental studies in English, Spanish and Portuguese that evaluated the effects of ultrasound on the signs and symptoms of patients with chronic rhinosinusitis were included. After study selection, data extraction, risk of bias and quality assessment, we performed a qualitative description of current data. RESULTS Nine studies were selected, providing 309 participants (20 to 47 volunteers in each study), with an average age of 44.5 years. Three studies had assumed pretest-posttest design, four studies were single-blinded randomized controlled trial and the two studies were double-blinded randomized controlled trial. The modalities of ultrasound investigated were pulsed and continuous, and the studies evaluated the ultrasound effects immediately after one session or after a few sessions of treatment (6, 10 or 15 sessions). The use of ultrasound, in both continuous and pulsed modalities, demonstrated to reduce characteristic signs and symptoms of chronic rhinosinusitis. Despite these results, only two studies had a low risk of bias. A meta-analysis was not possible due to the huge heterogeneity of included studies. CONCLUSIONS Despite ultrasound in continuous and pulsed modalities showing similar positive effects in the treatment of chronic rhinosinusitis, the studies are small, short duration, poor design and with a high risk of bias. Thereby, ultrasound cannot be appointed as a potential adjunct resource to current methods of treating chronic rhinosinusitis until large randomised controlled studies are performed.
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Affiliation(s)
- Gustavo Silveira da Silva
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Nakhostin-Ansari A, Nazem A, Nakhostin Ansari N, Fathali M, Naghdi S, Hasson S. Effects of pulsed ultrasound on olfactory dysfunction in patients with chronic rhinosinusitis: A pilot study. Complement Ther Clin Pract 2021; 44:101409. [PMID: 34116364 DOI: 10.1016/j.ctcp.2021.101409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND and purpose. Olfactory dysfunction is a common symptom of chronic rhinosinusitis (CRS). This study aimed to evaluate the effects of therapeutic pulsed ultrasound (PUS) on olfactory dysfunction in patients with CRS. MATERIALS AND METHODS Patients with CRS underwent treatment with PUS for 10 sessions, three days a week. The outcome measures were the Smell Identification Test (SIT) and 20-item Sino-Nasal Outcome Test (SNOT-20). RESULTS Fifteen patients (9 male, mean age 48.9 ± 9.7 years) with disease duration of 55.13 ± 65.4 months participated. Analyses showed olfactory dysfunction was completely resolved (Cohen's d = 5.62). The SNOT-20 scores showed significant improvement of CRS symptoms after treatment (Cohen's d = 1.55). Effects remained at one-month follow-up. CONCLUSION Therapeutic PUS improved the olfactory dysfunction and sino-nasal symptoms in patients with CRS. The PUS can be considered as a promising strategy to target chronic rhinosinusitis.
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Affiliation(s)
- Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Atieh Nazem
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran; Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Fathali
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran; Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran.
| | - Scott Hasson
- Department of Physical Therapy, Augusta University, Augusta, GA, USA
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Shen MD, Guo LR, Li YW, Gao RT, Sui X, Du Z, Xu LQ, Shi HY, Ni YY, Zhang X, Pang Y, Zhang W, Yu TZ, Li F. Role of the active cycle of breathing technique combined with phonophoresis for the treatment of patients with chronic obstructive pulmonary disease (COPD): study protocol for a preliminary randomized controlled trial. Trials 2021; 22:228. [PMID: 33757568 PMCID: PMC7988997 DOI: 10.1186/s13063-021-05184-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 03/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by coughing, the production of excess sputum, and dyspnea. Patients with excessively thick sputum may have frequent attacks or develop more serious disease. The guidelines recommend airway clearance for patients with excessive sputum who are hospitalized with COPD. The active cycle of breathing technique is the most common non-pharmacological airway clearance technique used by physiotherapists. However, the effectiveness of the technique is not always guaranteed. Active cycle of breathing techniques require the initial dilution of the sputum, usually by inhalation drugs, which may have limited effects. Recent studies have found that phonophoresis decreases inflammation, suggesting the potential of the combined usage of active cycle of breathing techniques and phonophoresis. Therefore, the aim of this study is to explore the effectiveness and safety of combining active cycle of breathing technique and phonophoresis in treating COPD patients. METHODS AND ANALYSIS We propose a single-blind randomized controlled trial using 75 hospitalized patients diagnosed with COPD with excessive sputum production. The patients will be divided into three groups. The intervention group will receive active cycle of breathing techniques combined with phonophoresis. The two comparison groups will be treated with active cycle of breathing techniques and phonophoresis, respectively. The program will be implemented daily for 1 week. The primary outcomes will be changes in sputum viscosity and production, lung function, and pulse oximetry. Secondary outcomes include the assessment of COPD and anxiety, measured by the COPD Assessment Test scale and the Anxiety Inventory for Respiratory Disease, respectively; self-satisfaction; the degree of cooperation; and the length of hospital stay. All outcome measures, with the exception of sputum production and additional secondary outcomes, will be assessed at the commencement of the study and after 1 week's intervention. Analysis of variance will be used to investigate differences between the groups, and a p-value of less than 0.05 (two-tailed) will be considered statistically significant. DISCUSSION This study introduces a combination of active cycle of breathing techniques and phonophoresis to explore the impact of these interventions on patients hospitalized with COPD. If this combined intervention is shown to be effective, it may prove to be a better treatment for patients with COPD. TRIAL REGISTRATION The trial was registered prospectively on the Chinese Clinical Trial Registry on 24 December 2019.ClinicalTrials.gov ChiCTR1900028506 . Registered on December 2019.
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Affiliation(s)
- M. D. Shen
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
| | - L. R. Guo
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
| | - Y. W. Li
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
| | - R. T. Gao
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
| | - X. Sui
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
| | - Z. Du
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
| | - L. Q. Xu
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
| | - H. Y. Shi
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
| | - Y. Y. Ni
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
| | - X. Zhang
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
| | - Y. Pang
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
| | - W. Zhang
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
| | - T. Z. Yu
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
| | - F. Li
- School of Nursing, Jilin University, No 965, Xin Jiang Avenue, Changchun, 130000 Jilin Province China
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Filgueira YA, Holanda VN, Fonseca FLA, Feder D. Effects of nasal aspiration by the Proetz® method in pediatric patients with sinusitis. Rev Assoc Med Bras (1992) 2020; 66:1503-1508. [PMID: 33295400 DOI: 10.1590/1806-9282.66.11.1503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To characterize the effects of nasal aspiration with Proetz® in peak nasal inspiratory flow (PNIF) in pediatric sinusitis (PS) patients with nasal obstruction. METHODS This is a non-randomized descriptive-analytical clinical trial with a quantitative approach. The sample comprised 30 children. Initially, the PNIF was measured and the Visual Analogical Scale (VAS) was used for nasal obstruction, followed by the nasal aspiration procedure. The SNOT-22 questionnaire was applied to the legal guardian of each child, and one week later, it was reapplied for the sake of follow-up. RESULTS 16 (53.3%) patients were females and 14 (46.7%) were males, with an average age of 6.4±1.8 years (between 4 and 10 years of age). Analyses of the VAS for obstruction before the intervention revealed that 10 of the participants (33.3%) presented moderate levels, and 20 of them (66.7%) severe levels. However, after the Proetz® method was applied, all the samples (n=30) had mild levels. The PNIF significantly increased after the technique was used, with an improvement of 23.4% in mean values. There was no significant correlation between the VAS and the PNIF. CONCLUSION Nasal aspiration with the Proetz® method significantly improved the clinical condition of sinusitis patients with nasal obstruction according to the visual analogical scale, the PNIF, and the SNOT-22 questionnaire. No correlation between the VAS and the PNIF could be found. The study confirms the importance of non-pharmacological interventions in the treatment of sinusitis in children, thus resulting in an improvement in their quality of life.
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Affiliation(s)
- Yaskara Amorim Filgueira
- Departamento de Fisioterapia, Centro Universitário Doutor Leão Sampaio - Unileão, Juazeiro do Norte, CE, Brasil
| | | | | | - David Feder
- Centro Universitário Saúde ABC, Santo André, SP, Brasil
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Griffin AS, Cabot P, Wallwork B, Panizza B. Alternative therapies for chronic rhinosinusitis: A review. EAR, NOSE & THROAT JOURNAL 2020:145561320939415. [PMID: 33023328 DOI: 10.1177/0145561320939415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The use of alternative medicine in chronic rhinosinus-itis (CRS) continues to increase in popularity, for the most part without meeting the burden of being based on sound clinical evidence. New and emerging treat-ments, both natural and developed, are numerous, and it remains a challenge for otolaryngologists as well as general practitioners to keep up to date with these therapies and their efficacy. In this systematic review, we discuss a number of alternative therapies for CRS, their proposed physiologic mechanisms, and evidence supporting their use. This analysis is based on our re-view of the English-language literature on alternative therapies for CRS (we did not include any therapies that are already recommended by accepted profession-al bodies). Data collection was performed using the PubMed database (not restricted to MEDLINE due to the nature of the subject matter), the Cochrane data-bases, and bibliography searches. We found that while many of the alternative therapies we reviewed might have a firm basis in science, they lack any clinical ev-idence to support their use specifically for CRS. Some emerging therapies, such as therapeutic ultrasonog-raphy and phonophoresis, show some promise, based on a growing body of positive evidence. In addition, the use of baby shampoo, thyme honey, and bromelain additives to saline lavage in CRS are all supported by clinical evidence, as is Sinupret, an oral preparation that contains echinacea. However, higher levels of ev-idence gleaned from large, well-designed, prospective, randomized, controlled trials are needed before any of these therapies can be recommended.
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Affiliation(s)
- Aaron S Griffin
- From the Pharmacy Australia Centre of Excellence, School of Pharmacy, University of Queensland, Woolloongabba, Queensland, Australia
- Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital, Woolloongabba
| | - Peter Cabot
- From the Pharmacy Australia Centre of Excellence, School of Pharmacy, University of Queensland, Woolloongabba, Queensland, Australia
| | - Ben Wallwork
- From the Pharmacy Australia Centre of Excellence, School of Pharmacy, University of Queensland, Woolloongabba, Queensland, Australia
- Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital, Woolloongabba
| | - Ben Panizza
- From the Pharmacy Australia Centre of Excellence, School of Pharmacy, University of Queensland, Woolloongabba, Queensland, Australia
- Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital, Woolloongabba
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Nakhostin Ansari N, Naghdi S, Hasson S. NanoRehab: from macro to 10 -9 realm - an editorial. Physiother Theory Pract 2019; 35:505-506. [PMID: 30686092 DOI: 10.1080/09593985.2019.1573588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Noureddin Nakhostin Ansari
- a Department of Physiotherapy , School of Rehabilitation, Tehran University of Medical Sciences , Tehran , Iran
- b Sports Medicine Research Center, Neuroscience Institute , Tehran University of Medical Sciences , Tehran , Iran
- c Neuromusculoskeletal Research Center , Iran University of Medical Sciences , Tehran , Iran
| | - Soofia Naghdi
- a Department of Physiotherapy , School of Rehabilitation, Tehran University of Medical Sciences , Tehran , Iran
- b Sports Medicine Research Center, Neuroscience Institute , Tehran University of Medical Sciences , Tehran , Iran
- c Neuromusculoskeletal Research Center , Iran University of Medical Sciences , Tehran , Iran
| | - Scott Hasson
- d Department of Physical Therapy , Augusta University , Augusta , GA , USA
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Maina IW, Patel NN, Cohen NA. Understanding the Role of Biofilms and Superantigens in Chronic Rhinosinusitis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018; 6:253-262. [PMID: 30859016 PMCID: PMC6407876 DOI: 10.1007/s40136-018-0212-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW This review explores recent discoveries in our understanding of how biofilms and superantigens contribute to the pathogenesis of chronic rhinosinusitis (CRS). It also examines clinical implications and novel treatment approaches for biofilm associated CRS. RECENT FINDINGS While the role of biofilms in CRS has been studied for 14 years, research interest has now turned toward elucidating new methods of biofilm detection, microbial diversity, and novel treatment approaches. Recent studies on biofilm superantigens aim to clarify the immunological mechanisms of upper airway inflammation, particularly the type-2 response seen in nasal polyposis. SUMMARY Biofilms are a topic of research interest for their role in the pathogenesis of chronic rhinosinusitis, particularly when they elute superantigens. New studies on this topic focus on the molecular and cellular mechanisms at play.
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Affiliation(s)
- Ivy W Maina
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Neil N Patel
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Noam A Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
- Monell Chemical Senses Center, Philadelphia, PA
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Dkhar LK, Bartley J, White D, Seyfoddin A. Intranasal drug delivery devices and interventions associated with post-operative endoscopic sinus surgery. Pharm Dev Technol 2017; 23:282-294. [DOI: 10.1080/10837450.2017.1389956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Lari K. Dkhar
- Drug Delivery Research Group, School of Science, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Jim Bartley
- Bio Design Lab, School of Engineering, Auckland University of Technology, Auckland, New Zealand
- Counties Manukau District Health Board, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - David White
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Ali Seyfoddin
- Drug Delivery Research Group, School of Science, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Bio Design Lab, School of Engineering, Auckland University of Technology, Auckland, New Zealand
- School of Interprofessional Health Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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12
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Multimodal Frequency Treatment for Facial Pain Caused by Chronic Rhinosinusitis: A Pilot Study. SINUSITIS 2017. [DOI: 10.3390/sinusitis2030005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Head K, Chong LY, Piromchai P, Hopkins C, Philpott C, Schilder AGM, Burton MJ. Systemic and topical antibiotics for chronic rhinosinusitis. Cochrane Database Syst Rev 2016; 4:CD011994. [PMID: 27113482 PMCID: PMC8763400 DOI: 10.1002/14651858.cd011994.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and is characterised by inflammation of the lining of the nose and paranasal sinuses leading to nasal blockage, nasal discharge, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. Systemic and topical antibiotics are used with the aim of eliminating infection in the short term (and some to reduce inflammation in the long term), in order to normalise nasal mucus and improve symptoms. OBJECTIVES To assess the effects of systemic and topical antibiotics in people with chronic rhinosinusitis. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; CENTRAL (2015, Issue 8); MEDLINE; EMBASE; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 29 September 2015. SELECTION CRITERIA Randomised controlled trials (RCTs) with a follow-up period of at least three months comparing systemic or topical antibiotic treatment to (a) placebo or (b) no treatment or (c) other pharmacological interventions. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcomes were disease-specific health-related quality of life (HRQL), patient-reported disease severity and the commonest adverse event - gastrointestinal disturbance. Secondary outcomes included general HRQL, endoscopic nasal polyp score, computerised tomography (CT) scan score and the adverse events of suspected allergic reaction (rash or skin irritation) and anaphylaxis or other very serious reactions. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS We included five RCTs (293 participants), all of which compared systemic antibiotics with placebo or another pharmacological intervention.The varying study characteristics made comparison difficult. Four studies recruited only adults and one only children. Three used macrolide, one tetracycline and one a cephalosporin-type antibiotic. Three recruited only patients with chronic rhinosinusitis without nasal polyps, one recruited patients with chronic rhinosinusitis with nasal polyps and one had a mixed population. Three followed up patients for 10 to 12 weeks after treatment had finished. Systemic antibiotics versus placebo Three studies compared antibiotics with placebo (176 participants).One study (64 participants, without polyps) reported disease-specific HRQL using the SNOT-20 (0 to 5, 0 = best quality of life). At the end of treatment (three months) the SNOT-20 score was lower in the group receiving macrolide antibiotics than the placebo group (mean difference (MD) -0.54 points, 95% confidence interval (CI) -0.98 to -0.10), corresponding to a moderate effect size favouring antibiotics (moderate quality evidence). Three months after treatment, it is uncertain if there was a difference between groups.One study (33 participants, with polyps) provided information on gastrointestinal disturbances and suspected allergic reaction (rash or skin irritation) after a short course of tetracycline antibiotic compared with placebo. We are very uncertain if antibiotics were associated with an increase in gastrointestinal disturbances (risk ratio (RR) 1.36, 95% CI 0.22 to 8.50) or skin irritation (RR 6.67, 95% CI 0.34 to 128.86) (very low quality evidence). Systemic antibiotics plus saline irrigation and intranasal corticosteroids versus placebo plus saline irrigation and intranasal corticosteroids One study (60 participants, some with and some without polyps) compared a three-month course of macrolide antibiotic with placebo; all participants also used saline irrigation and 70% used intranasal corticosteroids. Disease-specific HRQL was reported using SNOT-22 (0 to 110, 0 = best quality of life). Data were difficult to interpret (highly skewed and baseline imbalances) and it is unclear if there was an important difference at any time point (low quality evidence). To assess patient-reported disease severity participants rated the effect of treatment on a five-point scale (-2 for "desperately worse" to 2 for "cured") at the end of treatment (three months). For improvement in symptoms there was no difference between the antibiotics and placebo groups; the RR was 1.50 (95% CI 0.81 to 2.79; very low quality evidence), although there were also slightly more people who felt worse after treatment in the antibiotics group. There was no demonstrable difference in the rate of gastrointestinal disturbances between the groups (RR 1.07, 95% CI 0.16 to 7.10). General HRQL was measured using the SF-36. The authors stated that there was no difference between groups at the end of treatment (12 weeks) or two weeks later. Systemic antibiotics versus intranasal corticosteroids One study (43 participants, without polyps) compared a three-month course of macrolide antibiotic with intranasal corticosteroids. Patient-reported disease severity was assessed using a composite symptom score (0 to 40; 0 = no symptoms). It is very uncertain if there was a difference as patient-reported disease severity was similar between groups (MD -0.32, 95% CI -2.11 to 1.47; low quality evidence). Systemic antibiotics versus oral corticosteroids One study (28 participants, with polyps) compared a short course of tetracycline antibiotic (unclear duration, ˜20 days) with a 20-day course of oral corticosteroids. We were unable to extract data on any of the primary efficacy outcomes. It is uncertain if there was a difference ingastrointestinal disturbances (RR 1.00, 95% CI 0.16 to 6.14) or skin irritation (RR 2.00, 95% CI 0.20 to 19.62) as the results for these outcomes were similar between groups (very low quality evidence). AUTHORS' CONCLUSIONS We found very little evidence that systemic antibiotics are effective in patients with chronic rhinosinusitis. We did find moderate quality evidence of a modest improvement in disease-specific quality of life in adults with chronic rhinosinusitis without polyps receiving three months of a macrolide antibiotic. The size of improvement was moderate (0.5 points on a five-point scale) and only seen at the end of the three-month treatment; by three months later no difference was found.Despite a general understanding that antibiotics can be associated with adverse effects, including gastrointestinal disturbances, the results in this review were very uncertain because the studies were small and few events were reported.No RCTs of topical antibiotics met the inclusion criteria.More research in this area, particularly evaluating longer-term outcomes and adverse effects, is required.
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Affiliation(s)
- Karen Head
- UK Cochrane CentreSummertown Pavilion18 ‐ 24 Middle WayOxfordUK
| | - Lee Yee Chong
- UK Cochrane CentreSummertown Pavilion18 ‐ 24 Middle WayOxfordUK
| | - Patorn Piromchai
- Faculty of Medicine, Khon Kaen UniversityDepartment of OtorhinolaryngologyKhon KaenThailand
| | - Claire Hopkins
- Guy's HospitalENT DepartmentGerat Maze PondLondonUKSE1 9RT
| | - Carl Philpott
- Norwich Medical School, University of East AngliaDepartment of MedicineNorwichUKNR4 7TJ
| | - Anne GM Schilder
- Faculty of Brain Sciences, University College LondonevidENT, Ear Institute330 Grays Inn RoadLondonUKWC1X 8DA
| | - Martin J Burton
- UK Cochrane CentreSummertown Pavilion18 ‐ 24 Middle WayOxfordUK
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