Endoscopic sinus surgery for treatment of kartagener syndrome: a case report

Kartagener syndrome with pectus excavatum and upper lobar bronchiectasis

Primary Ciliary Dyskinesia (PCD) is a rare autosomal recessive disorder caused by impaired ciliary function. The incidence of PCD is 1 in 20,000 births. Kartagener's syndrome (KS), a subtype of PCD, is distinguished by the presence of situs inversus. KS occurs in about 1 in 32,000 to 40,000 births. Characterized by a triad of situs inversus totalis, sinusitis, and typically lower lobe bronchiectasis, Kartagener's syndrome presents with distinct radiological features, which are explored in this case study. We report on an adolescent male with Kartagener's syndrome, manifesting atypical bronchiectasis in the left upper lobe, leading to a bilateral lung transplant, and severe pectus excavatum requiring surgical correction. This case documents a male patient with concurrent Kartagener's syndrome and pectus excavatum, supporting a previously explored, albeit theoretical association between these conditions.

Outcomes of Endoscopic Sinus Surgery for Chronic Rhinosinusitis in Adults with Primary Ciliary Dyskinesia

Introduction  Primary ciliary dyskinesia (PCD) is a rare inherited disease associated with impairment of mucociliary transport and, consequently, with a high incidence of chronic rhinosinusitis. For patients with chronic rhinosinusitis who remain symptomatic despite medical treatment, endoscopic sinus surgery is a safe and effective therapeutic option. However, to date, no studies have been found evaluating the effect of surgery on the quality of life associated with the effect on olfaction and nasal endoscopy findings of patients with primary ciliary dyskinesia and chronic rhinosinusitis. Objective  To describe the effect of endoscopic sinus surgery on the quality of life, on olfaction, and on nasal endoscopy findings of adults with PCD and chronic rhinosinusitis. Methods  Four patients who underwent endoscopic sinus surgery were included. The Sinonasal Outcome Test-22 (SNOT-22) score, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and the Lund-Kennedy score were collected preoperatively and at 3 and 6 months postoperatively. The olfaction as assessed with the University of Pennsylvania Smell Identification Test (UPSIT), which was administered preoperatively and 3 months postoperatively. Results  A total of 4 patients with a mean age of 39.3 years old (3 men and 1 woman) completed the study. All patients showed clinically significant improvement in the SNOT-22, NOSE, and Lund-Kennedy scores at 3 months postoperatively, and this improvement was sustained throughout the follow-up period. However, olfaction did not improve after surgery. Conclusion  The endoscopic sinus surgery treatment of chronic rhinosinusitis in adults with PCD was associated with improvement in quality of life and endoscopic findings. However, no improvement in olfaction was demonstrated. Studies with a larger number of patients and control groups should help confirm these findings.

Clinical and genetic spectrum of primary ciliary dyskinesia in Chinese patients: a systematic review

Background

Primary ciliary dyskinesia (PCD) represents a highly heterogenous disorder with extensive clinical and genetic patterns among populations of different geographic location and ethnic origin. However, data about Chinese patients are limited. We aimed to summarize the clinical and genetic spectrum of Chinese PCD patients based on all available literatures.

Methods

We searched Embase, Pubmed, Web of Science and Chinese databases including CNKI, SinoMed and Wanfang from 1981 to 2021, to identify articles reporting patients with PCD in China, which had included information about transmission electron microscopy and/or genetic testing.

Results

A total of 244 Chinese PCD patients in 52 articles were included. Of these patients, the mean age was 13.1 years, and 55 patients (22.5%) were diagnosed with PCD after 18 years old. Compared with patients diagnosed with PCD in childhood or infancy, patients diagnosed with PCD in adulthood had a higher prevalence of chronic wet cough, sinusitis, Pseudomonas aeruginosa (PA) isolation and radiological bronchiectasis as well as worse lung function. 25 PCD-related genes were identified in 142 patients, and DNAH5, DNAH11, CCDC39 and CCDC40 were the most frequently detected mutations. More than half of genetic variants were loss-of-function mutations, and the majority of these variants were seen only once. Correlations between PCD phenotype, genotype and ciliary ultrastructure were also evidenced.

Conclusions

Diagnostic delay and under-recognition of PCD remain a big issue in China, which contributes to progressive lung disease and PA infection indicating worse outcome. Specialist equipment and expertise are urgently required to facilitate the early diagnosis and treatment of PCD.

Trial registry

PROSPERO; No.: CRD42021257804; URL:www.crd.york.ac.uk/prospero/

Supplementary Information

The online version contains supplementary material available at 10.1186/s13023-022-02427-1.

Otolaryngology Manifestations of Primary Ciliary Dyskinesia: A Multicenter Study

OBJECTIVE

This project aims to prospectively and objectively assess otolaryngological manifestations and quality of life of children with primary ciliary dyskinesia (PCD) and compare these findings with healthy pediatric controls.

STUDY DESIGN

Cross-sectional.

SETTING

Two high-volume pediatric PCD specialty centers.

METHODS

Standardized clinical assessment; Sino-Nasal Outcome Test 22 (SNOT-22); Hearing Environment and Reflection Quality of Life (HEAR-QL); Reflux Symptom Index (RSI); standardized physical examination of the sinonasal, laryngeal, and otological systems; and investigations including pure-tone audiograms (PTAs) and sinonasal cultures were collected.

RESULTS

Forty-seven children with PCD and 25 control participants were recruited. Children with PCD had more upper airway symptoms than healthy children. They had significantly higher scores in both SNOT-22 and RSI, indicating worse sinonasal and reflux symptoms, with worse quality of life on the HEAR-QL index compared to healthy children (P < .05). Fifty-two percent of children with PCD-related hearing loss were not aware of their hearing deficit that was present on audiological assessment, and only 23% of children who had ventilation tubes had chronic otorrhea, most of which was easily controlled with ototopic drops. Furthermore, although all children with PCD had chronic rhinosinusitis, only 36% of them were using topical nasal treatment. The most common bacteria cultured from the middle meatus were Staphylococcus aureus in 11 of 47 (23%), followed by Streptococcus pneumoniae in 10 of 47 (21%).

CONCLUSION

This multisite cohort highlights the importance of otolaryngology involvement in the management of children with PCD. More rigorous otolaryngological management may lead to reductions in overall morbidity and improve quality of life for children with PCD.

Kartagener syndrome: A case report

Kartagener syndrome is a rare, autosomal recessive genetic disorder that causes defects in the action of ciliary movement, comprises of triad situs inversus, chronic sinusitis, and bronchiectasis. We present the case of a 3-year-old boy with repeated respiratory infections and pneumonic infections presenting with acute respiratory failure. He was diagnosed with Kartagener syndrome based on his clinical presentation and imaging features. The current diagnosis was consistent with severe acute bronchitis. He was managed initially with conventional medical therapy, but he didn’t respond and was transferred immediately to the pediatric intensive care unit where noninvasive ventilation was administered. He had shown significant predictors of early noninvasive ventilation failure and was mechanically ventilated, after which, he was disconnected from the ventilator and discharged without complications. In patients presenting with recurrent upper and lower respiratory tract infections, Kartagener syndrome should always be kept in mind. The correct diagnosis of this disorder in early life is very important to prevent complications and improve patients’ quality of life.

Effects of functional endoscopic sinus surgery on the treatment of bronchiectasis combined with chronic rhino-sinusitis

CONCLUSION

Idiopathic bronchiectasis is closely associated with chronic rhino-sinusitis. It can effectively control bronchiectasic symptoms to treat chronic rhino-sinusitis by FESS in the cases with bronchiectasis and chronic rhino-sinusitis.

OBJECTIVE

To explore the effect of functional endoscopic sinus surgery (FESS) on the treatment of bronchiectasis combined with chronic rhino-sinusitis.

METHODS

In this study, a total of 161 cases with bronchiectasis and chronic rhino-sinusitis were divided into medication group and operation group according to the therapeutic method for chronic rhino-sinusitis selected by them. For the treatment of chronic rhino-sinusitis, the cases in the operation group received FESS, but in the medication group cases took drugs alone. The score of clinical symptoms for bronchiectasis, forced expiratory volume in one second (FEV1), SNOT-22 score, and Lund-Mackay score were evaluated for all cases before and after treatment, respectively, and then the value changes in the score of clinical symptoms, FEV1, SNOT-22 score, and Lund-Mackay score between both time points were calculated. The frequency of acute exacerbation for bronchiectasis was also recorded within the 6-month follow-up.

RESULTS

In this study, 58.9% of cases with bronchiectasis had chronic rhino-sinusitis. Follow-up lasted 6 months. Compared with pre-therapy, post-therapy score of clinical symptoms, SNOT-22 score, and Lund-Mackay score were all significantly decreased (all p < 0.05), but post-therapy FEV1 failed to significantly improve (p > 0.05) in both groups. During the 6-month follow-up, the frequency of acute exacerbation was significantly less in the operation group than in the medication group (p < 0.01). Post-treatment score of clinical symptoms (p < 0.01), SNOT-22 score (p < 0.05), and Lund-Mackay score (p < 0.05) also were all significantly less in the operation group than in the medication group. However, there was no significant difference in post-therapy FEV1 between the two groups (p > 0.05).