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Penttilä E, Sillanpää S, Vento SI, Myller J, Koskinen A, Hammarén-Malmi S, Laulajainen-Hongisto A, Hytönen M, Lyly A, Lilja M, Kauppi P, Numminen J, Rautiainen M, Sahlman J, Nuutinen M, Toppila-Salmi S, Virkkula P. Eosinophilia, asthma, NERD and the use of oral corticosteroids predict uncontrolled chronic rhinosinusitis with nasal polyps after surgery. Asian Pac J Allergy Immunol 2024; 42:50-60. [PMID: 34542306 DOI: 10.12932/ap-310321-1102] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) is a challenging condition to treat. The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS2020) has the following criteria when considering biological therapy for severe uncontrolled CRSwNP: eosinophilia, need for oral corticosteroids (OCS), symptom score, loss of sense of smell and co-morbid asthma. OBJECTIVE This study aimed at finding associations of baseline factors with uncontrolled CRSwNP after endoscopic sinus surgery (ESS). METHODS Electronic health record data of CRSwNP patients (N = 137) undergoing ESS in 2002-17 were used. Endpoints of uncontrolled CRSwNP were revision ESS, purchased OCS and antibiotic courses during follow up. Baseline factors were chosen based on EPOS2020 and the data available: nasal polyp (NP) eosinophilia, peripheral blood eosinophilia, co-existing asthma and/or non-steroidal anti-inflammatory drug exacerbated respiratory disease (NERD), need for OCS during the previous year, previous ESS, endoscopic NP score, and Lund-Mackay score of sinus computed tomography scans. RESULTS During the follow-up of 10.1 ± 3.1 (mean ± standard deviation) years, 35 (25.5%) individuals underwent revision ESS. The best predictive model was obtained by a sum of baseline (1) blood eosinophilia ≥ 250 cells/≥l and/or NP eosinophilia ≥ 30% (Eos), (2) asthma/NERD, and (3) ≥ 1 OCS/year. It was significantly associated with revision ESS, purchased doctor-prescribed OCS and antibiotic courses during follow-up. CONCLUSIONS We identified similar predictive variables for uncontrolled CRSwNP that are used in the EPOS2020 indications of biological therapy, thus suggesting that these estimates are usable in clinical practice.
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Affiliation(s)
- Elina Penttilä
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Saara Sillanpää
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | | | - Jyri Myller
- Department of Otorhinolaryngology, Päijät-Häme Central Hospital, Lahti, Finland
| | | | | | | | | | - Annina Lyly
- University Hospital, Helsinki, Finland
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Paula Kauppi
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Pulmonary Diseases, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jura Numminen
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Markus Rautiainen
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Johanna Sahlman
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
| | - Mikko Nuutinen
- Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Paula Virkkula
- University Hospital, Helsinki, Finland
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Viitasalo S, Ilmarinen T, Aaltonen LM, Hagström J, Hytönen M, Hammarén-Malmi S, Pietarinen P, Järvenpää P, Kinnari T, Geneid A, Lilja M. Sinonasal inverted papilloma - malignant transformation and non-sinonasal malignancies. Laryngoscope 2023; 133:506-511. [PMID: 35383941 DOI: 10.1002/lary.30128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To assess malignant transformation rate, non-sinonasal malignancies, and factors contributing to recurrence in patients treated for sinonasal inverted papilloma (SNIP). STUDY DESIGN Retrospective study. METHODS We retrospectively reviewed medical records of all patients treated for SNIP (n = 296) between the years 1984-2014 at Helsinki University Hospital. Data from the Finnish Cancer Registry confirmed the number of those patients with sinonasal and non-sinonasal malignancies. RESULTS Only 2 of 296 (0.7%) patients primarily diagnosed with benign SNIP developed sinonasal cancer in a mean follow-up of 5.8 years. The most common non-sinonasal cancer sites were similar to those reported for the whole Finnish population. None of the patients presented with an HPV-associated non-sinonasal malignancy. The recurrence rate among patients who underwent attachment-oriented surgery was significantly lower compared to those operated on with other approaches (40.2% vs. 56.6%, p = 0.006). Dysplasia in SNIP was associated with a higher recurrence rate (p < 0.001). CONCLUSIONS Malignant transformation of SNIP was rare. Patients with SNIP were not prone to HPV-associated non-sinonasal malignancies. Endoscopic resection and attachment-oriented surgery have become predominant approaches in the treatment of SNIP; meanwhile, the total number of SNIP recurrences has decreased. LEVEL OF EVIDENCE 3 Laryngoscope, 133:506-511, 2023.
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Affiliation(s)
- Sanna Viitasalo
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taru Ilmarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, Helsinki University Hospital, Helsinki, Finland.,Department of Oral Pathology and Radiology, University of Turku, Turku, Finland
| | - Maija Hytönen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sari Hammarén-Malmi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petra Pietarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pia Järvenpää
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Kinnari
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ahmed Geneid
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markus Lilja
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Viitasalo S, Ilmarinen T, Lilja M, Hytönen M, Hammarén-Malmi S, Auvinen E, Hagström J, Dillner J, Aaltonen LM. HPV-Positive Status Is an Independent Factor Associated With Sinonasal Inverted Papilloma Recurrence. Laryngoscope 2021; 132:1714-1718. [PMID: 34694020 DOI: 10.1002/lary.29910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The present study aimed to evaluate human papillomavirus (HPV) occurrence in sinonasal inverted papilloma (SNIP), and to assess factors associated with HPV positivity and SNIP recurrence. STUDY DESIGN Prospective study. METHODS We prospectively collected clinical data and fresh tissue specimens from 90 consecutive patients treated for SNIP at Helsinki University Hospital, between 2015 and 2019. Fourteen patients with recurrent SNIP underwent repeated tumor sampling. All tissue specimens were analyzed for the presence of HPV. Factors associated with SNIP recurrence and HPV positivity were assessed. RESULTS Among 107 SNIP specimens, 14 (13.1%) were positive for low-risk HPV and 6 (5.6%) were positive for high-risk HPV. HPV positivity was associated with an increased risk of recurrence (P = .004). Smoking was significantly associated with HPV positivity in SNIP (P = .01), but a history of HPV-related diseases or patient sexual habits did not correlate with HPV positivity. The recurrence rate was lower among patients with SNIP that underwent an attachment-oriented resection, compared to patients treated without attachment-oriented resections (78.6% vs 25.8%, P < .001). CONCLUSIONS The risk of SNIP recurrence was highly associated with 1) HPV positivity and 2) surgery without an attachment-oriented resection. Oncogenic HPV was rare in SNIP. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Sanna Viitasalo
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taru Ilmarinen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markus Lilja
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maija Hytönen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sari Hammarén-Malmi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eeva Auvinen
- Department of Virology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, University of Helsinki, Helsinki, Finland.,Department of Oral Pathology and Radiology, University of Turku, Turku, Finland
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Lilja MJ, Koskinen A, Virkkula P, Vento SI, Myller J, Hammarén-Malmi S, Laulajainen-Hongisto A, Hytönen M, Mäkitie A, Numminen J, Sillanpää S, Raitiola H, Rautiainen M, Toppila-Salmi SK. Factors Affecting the Control of Chronic Rhinosinusitis With Nasal Polyps: A Comparison in Patients With or Without NERD. Allergy Rhinol (Providence) 2021; 12:21526567211003844. [PMID: 33996192 PMCID: PMC8082978 DOI: 10.1177/21526567211003844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022]
Abstract
Objectives The aim was to compare the control of chronic rhinosinusitis with nasal polyps (CRSwNP) after endoscopic sinus surgery (ESS), in patients with/without nonsteroidal anti-inflammatory drug exacerbated respiratory disease (NERD). Study Desing: A retrospective hospital-based sample of CRSwNP patients with/without NERD with follow-up. Setting Tertiary rhinology centers. Methods Electronic patient record data from 116 CRSwNP patients (46 with NERD and 70 without NERD) undergoing ESS during 2001–17 were studied. Mean follow-up time was 9.9 years (range 1.1–15.3). Endpoints reflecting uncontrolled CRSwNP were revision ESS, and need for rescue/advanced therapy (e.g. antibiotics, oral corticosteroids and/or biological therapy) during follow-up. NERD was variable of interest and gender, age, asthma, allergic rhinitis (AR), smoking, Lund-Mackay (LM) score of sinus computed tomography scans previous ESS and baseline total ethmoidectomy were used as covariates. Results Twenty-one (49.7%) NERD patients and 18 (25.7%) non-NERD patients underwent revision ESS within a mean ± SD of 4.3 ± 2.8 and 3.7 ± 2.6 years, respectively (p = .013, by Logrank test). In Cox´s regression models, NERD, female gender, young age, asthma, AR, previous ESS, and lack of total ethmoidectomy were associated with revision-ESS. In adjusted model, only the total ethmoidectomy predicted revision-free survival. In adjusted logistic regression model, there was an insignificant trend that NERD and LM score were associated with the need for rescue/advanced therapy in the follow-up. Conclusions Patients with NERD had higher risk of uncontrolled CRSwNP than patient group without NERD, as measured by revision ESS and/or need for rescue/advanced therapy in the follow-up. In addition, baseline total ethmoidectomy was associated with revision-free survival.
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Affiliation(s)
- Markus Jukka Lilja
- Department of Otorhinolaryngology---Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anni Koskinen
- Department of Otorhinolaryngology---Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Paula Virkkula
- Department of Otorhinolaryngology---Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Seija Inkeri Vento
- Department of Otorhinolaryngology---Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jyri Myller
- Department of Otorhinolaryngology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Sari Hammarén-Malmi
- Department of Otorhinolaryngology---Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anu Laulajainen-Hongisto
- Department of Otorhinolaryngology---Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Maija Hytönen
- Department of Otorhinolaryngology---Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology---Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jura Numminen
- Department of Otorhinolaryngology, University of Tampere, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere, Finland
| | - Saara Sillanpää
- Department of Otorhinolaryngology, University of Tampere, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere, Finland
| | - Hannu Raitiola
- Department of Otorhinolaryngology, University of Tampere, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere, Finland
| | - Markus Rautiainen
- Department of Otorhinolaryngology, University of Tampere, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere, Finland
| | - Sanna Katriina Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Haartman Institute, University of Helsinki, Helsinki, Finland
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Virkkula P, Penttilä E, Vento SI, Myller J, Koskinen A, Hammarén-Malmi S, Laulajainen-Hongisto A, Hytönen M, Lilja M, Numminen J, Sillanpää S, Sahlman J, Toppila-Salmi S. Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis: A Real-World Study. Allergy Rhinol (Providence) 2020; 11:2152656720956596. [PMID: 35141001 PMCID: PMC8819805 DOI: 10.1177/2152656720956596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Developing tools to identify chronic rhinosinusitis with nasal polyps
(CRSwNP) patients requiring surgical treatment would help clinicians treat
patients more effectively. The aim of this retrospective cross-sectional
study was to identify cut-off values for eosinophil percentage, nasal
polyps (NP), and Lund-Mackay (LM) scores that may predict the need for
surgical treatment in Finnish CRSwNP patients. Methods Data of CRSwNP patients (N = 378) undergoing consultation for ESS in 2001–19
were used. Data was collected from patient records and Lund-Mackay scores
were determined from sinus computed tomography scans. The percentage of
eosinophils was microscopically evaluated from the polyp samples available
(n = 81). Associations were analyzed by Mann Whitney U test, and cut-off
values by the area under the receiver operating characteristic curve
(AUROC). Results ESS was performed to 293 (77.5%) of patients. Polyp eosinophilia was
associated significantly with ESS (p = 0.001), whereas peripheral blood
eosinophil count, LM- score and endoscopic NP- score were not (p > 0.05).
AUROC values (95% CI) for detecting those needing ESS were for polyp
eosinophilia 0.71 (0.60–0.83), p = 0.001, for LM score 0.59 (0.50–0.67),
p = 0.054; for NP score 0.56 (0.48–0.64), p = 0.17, and for blood eosinophil
count 0.68 (0.46–0.90), p = 0.08. With the threshold value of polyp
eosinophilia (>25%), the sensitivity and specificity were optimal for
detecting the group needing ESS from the group not undergoing ESS. The
cut-off value of blood eosinophil count (>0.26 × 109/L) had
relatively good, yet statistically insignificant (underpowered), predictive
potential. Moderate cut-off values were found for endoscopic LM score
(≥14/24) and NP score (≥4/8). Conclusions Polyp eosinophilia (>25%) predicted ESS among Finnish hospital-level
CRSwNP patients. A future challenge would be to find less invasive and
cost-effective clinical factors predicting uncontrolled CRSwNP.
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Affiliation(s)
- P Virkkula
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - E Penttilä
- Department of Otorhinolaryngology, University of Eastern Finland, Kuopio, Finland.,Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
| | - S I Vento
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Myller
- Department of Otorhinolaryngology, Päijät-Häme Central Hospital, Lahti, Finland
| | - A Koskinen
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - S Hammarén-Malmi
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Laulajainen-Hongisto
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Hytönen
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Lilja
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Numminen
- Department of Otorhinolaryngology, University of Tampere, Tampere, Finland.,Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - S Sillanpää
- Department of Otorhinolaryngology, University of Tampere, Tampere, Finland.,Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - J Sahlman
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
| | - S Toppila-Salmi
- Department of Allergy, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Haartman Institute, University of Helsinki, Helsinki, Finland
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Luukkainen V, Kivekäs I, Hammarén-Malmi S, Rautiainen M, Pöyhönen L, Aarnisalo AA, Jero J, Sinkkonen ST. Balloon Eustachian tuboplasty under local anesthesia: Is it feasible? Laryngoscope 2017; 127:1021-1025. [PMID: 28409844 DOI: 10.1002/lary.26488] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/06/2016] [Accepted: 12/12/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To study whether balloon Eustachian tuboplasty (BET) is a feasible and safe procedure under local anesthesia. STUDY DESIGN Prospective multicenter case-control study. METHODS Patients undergoing either BET (n = 13) or endoscopic sinus surgery (ESS) (n = 12) under local anesthesia, with the possibility of sedation and analgesia, were monitored during the procedure and recovery period for possible adverse effects. After the procedure, the patients responded to a questionnaire assessing their experience. RESULTS No adverse effects were detected in the BET group. Patients in the BET group reported similar Visual Analog Scale scores for pain during the operation as the ESS group (5.0 ± 0.7 vs. 3.2 ± 0.7, mean ± standard error of the mean). However, patients in the BET group experienced more discomfort (4.2 ± 0.6 vs. 2.5 ± 0.3, respectively, P = 0.049). Seventy-seven and 92% of the patients in the BET and ESS groups, respectively, considered the anesthesia and pain relief to be sufficient. Patients from both the BET and ESS groups were almost devoid of pain 1 to 2 hours postoperatively (0.8 ± 0.2 and 1.4 ± 0.3, respectively). In total, 12 of 13 patients in the BET group, and all 12 patients in the ESS group, would choose local anesthesia with sedation and analgesia if they needed to undergo the same procedure again. CONCLUSION BET is a safe and feasible procedure under monitored anesthesia care, including local anesthesia along with sedation and analgesia. There is need for further methodological improvement to reduce pain and discomfort during the operation. LEVEL OF EVIDENCE 4. Laryngoscope, 127:1021-1025, 2017.
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Affiliation(s)
- Veera Luukkainen
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Sari Hammarén-Malmi
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Markus Rautiainen
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Leena Pöyhönen
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Antti A Aarnisalo
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jussi Jero
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Saku T Sinkkonen
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Koskinen A, Penttilä M, Myller J, Hammarén-Malmi S, Silvola J, Haahtela T, Hytönen M, Toppila-Salmi S. Endoscopic sinus surgery might reduce exacerbations and symptoms more than balloon sinuplasty. Am J Rhinol Allergy 2013; 26:e150-6. [PMID: 23232189 DOI: 10.2500/ajra.2012.26.3828] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Endoscopic sinus surgery (ESS) is considered after medical therapy failure of chronic rhinosinusitis (CRS). The balloon sinuplasty dilates the natural ostium without moving mucosa or bone. It still lacks evidence from randomized controlled trials. The aim of this retrospective controlled study was to compare the symptom outcomes after maxillary sinus surgery with either the ESS or the balloon sinuplasty technique. No previous or additional sinonasal operations were accepted. METHODS Two hundred eight patients with CRS without nasal polyps underwent either balloon sinuplasty or ESS. The patients who met with the inclusion criteria (n = 45 in ESS group and n = 40 in balloon group) replied to a questionnaire of history factors, exacerbations, and a visual analog scale (VAS) scoring of the change in symptoms, on average 28 ± 6 (mean ± SD) months postoperatively. RESULTS The groups were identical in the response rate (64%), patient characteristics, and the improvement in all of the asked symptoms. Patients with CRS-related comorbidity and/or present occupational exposure had a statistically significantly better symptom reduction after ESS than after balloon sinusotomy. Moreover, the balloon sinusotomy group reported a statistically significant higher number of maxillary sinus punctures and antibiotic courses during the last 12 months. CONCLUSION ESS might be superior to balloon sinuplasty, especially in patients with risk factors. There is a need to perform more controlled studies on the treatment choices of CRS.
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Affiliation(s)
- Anni Koskinen
- Helsinki University Central Hospital, Skin and Allergy Hospital, Helsinki, Finland
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8
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Mattila PS, Hammarén-Malmi S, Saxen H, Kaijalainen T, Käyhty H, Tarkkanen J. Adenoidectomy in young children and serum IgG antibodies to pneumococcal surface protein A and choline binding protein A. Int J Pediatr Otorhinolaryngol 2012; 76:1569-74. [PMID: 22835927 DOI: 10.1016/j.ijporl.2012.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We have previously reported that surgical removal of the nasopharyngeal adenoid in young children resulted in increased risk of nasopharyngeal colonization by pneumococci. We now investigated whether adenoidectomy influences the development of serum IgG antibodies to pneumococcal choline-binding protein A (CbpA) and pneumococcal surface protein A (PspA). METHODS Altogether 217 children aged 12-48 months who had recurrent or persistent otitis media were randomized to undergo or not to undergo adenoidectomy. All the children underwent insertion of tympanostomy tubes. 166 children were followed-up for 3 years. The main outcome measures were concentrations of serum IgG antibodies to CbpA and PspA three years after randomization. Nasopharyngeal colonization by pneumococci was assessed 1, 2, and 3 years after randomization. RESULTS Adenoidectomy decreased concentrations of CbpA antibodies by ca. 25% independently of the observed increase in pneumococcal carriage (OR of log(10) transformed concentrations 0.74, 95% CI 0.58-0.94, P=0.016). Concentrations of PspA antibodies were lower and they seemed not to be influenced by adenoidectomy. CONCLUSIONS Adenoidectomy in young children causes a small but detectable impairment in the development of serum IgG antibodies to pneumococcal CbpA. The adenoid seems to have a role in augmenting systemic immunity against pneumococci.
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Affiliation(s)
- Petri S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Finland.
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9
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Mattila PS, Hammarén-Malmi S, Saxen H, Kaijalainen T, Käyhty H, Tarkkanen J. Adenoidectomy and nasopharyngeal carriage of Streptococcus pneumoniae in young children. Arch Dis Child 2010; 95:696-702. [PMID: 20504840 DOI: 10.1136/adc.2009.165654] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The effect of adenoidectomy on nasopharyngeal colonisation of pathogens has not previously been evaluated. The authors studied the effect of adenoidectomy on nasopharyngeal colonisation by bacteria causing otitis media and the effect of adenoidectomy on the development of pneumococcal capsular polysaccharide antibodies. DESIGN Randomised controlled study. SETTING Tertiary care centre. PATIENTS 217 children aged 12-48 months who had recurrent or persistent otitis media were randomised. 166 children were followed up for 3 years. INTERVENTION Random allocation to undergo adenoidectomy or not to undergo adenoidectomy. All the children underwent insertion of tympanostomy tubes. MAIN OUTCOME MEASURES Nasopharyngeal colonisation by pneumococci, Haemophilus influenzae and Moraxella catarrhalis 1, 2 and 3 years after randomisation. Serum IgG antibodies against pneumococcal capsular polysaccharide serotypes 6B, 14, 19F and 23F 3 years after randomisation. RESULTS After the first year of randomisation adenoidectomy increased nasopharyngeal carriage of pneumococci (RR, 1.47; 95% CI 1.04 to 2.07) but it did not influence the carriage of H influenzae or M catarrhalis. Among carriers of serotype 6B pneumococci, adenoidectomy resulted in lower concentrations of pneumococcal serotype 6B polysaccharide antibodies (ratio of geometric means of antibody concentrations, 0.37; 95% CI 0.16 to 0.85). Concentrations of serotype 14, 19F and 23F antibodies seemed not to be influenced by adenoidectomy. Despite this, adenoidectomy resulted in a significant increase in nasopharyngeal carriage of serotype 19F pneumococci. CONCLUSIONS Adenoidectomy increases the risk of nasopharyngeal carriage of pneumococci in children younger than 4 years of age. This may be independent of the development of serum IgG capsular polysaccharide antibodies.
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Affiliation(s)
- Petri S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Finland.
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Malmberg LP, Pelkonen AS, Mattila PS, Hammarén-Malmi S, Mäkelä MJ. Exhaled nitric oxide and exercise-induced bronchoconstriction in young wheezy children - interactions with atopy. Pediatr Allergy Immunol 2009; 20:673-8. [PMID: 19496956 DOI: 10.1111/j.1399-3038.2009.00858.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The association between exercise-induced bronchoconstriction (EIB) and exhaled nitric oxide (FE(NO)) has not been investigated in young children with atopic or non-atopic wheeze, two different phenotypes of asthma in the early childhood. Steroid naïve 3- to 7-yr-old children with recent wheeze (n = 84) and age-matched control subjects without respiratory symptoms (n = 71) underwent exercise challenge test, measurement of FE(NO) and skin prick testing (SPT). EIB was assessed by using impulse oscillometry, and FE(NO) by standard online technique. Although FE(NO) levels were highest in atopic patients with EIB, both atopic and non-atopic wheezy children with EIB showed higher FE(NO) than atopic and non-atopic control subjects, respectively. In atopic wheezy children, a significant relationship between FE(NO) and the severity of EIB was found (r = 0.44, p = 0.0004), and FE(NO) was significantly predictive of EIB. No clear association between FE(NO) and EIB or predictive value was found in non-atopic wheezy children. Both atopic and non-atopic young wheezy children with EIB show increased FE(NO) levels. However, the association between the severity of EIB and FE(NO) is present and FE(NO) significantly predictive of EIB only in atopic subjects, suggesting different interaction between bronchial responsiveness and airway inflammation in non-atopic wheeze.
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Affiliation(s)
- L Pekka Malmberg
- Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland.
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Mattila PS, Hammarén-Malmi S, Pelkonen AS, Malmberg LP, Mäkelä MJ, Saxen H, Tarkkanen J. Effect of adenoidectomy on respiratory function: a randomised prospective study. Arch Dis Child 2009; 94:366-70. [PMID: 19131420 DOI: 10.1136/adc.2008.145664] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Risk of childhood asthma is increased in children with recurrent otitis media. This may be associated with recurrent respiratory tract infections in these children, but the role of adenoidectomy, a frequent operation during childhood, is unknown. Therefore, the role of adenoidectomy in the development of atopy and respiratory function changes characteristic of asthma was evaluated. DESIGN Randomised controlled study. SETTING Tertiary care centre. PATIENTS 166 children aged 12-48 months who had recurrent or persistent otitis media and who were followed-up for 3 years after randomisation. INTERVENTION Randomisation to undergo insertion of tympanostomy tubes with or without adenoidectomy. MAIN OUTCOME MEASURES The primary outcome measure was exercise-induced bronchoconstriction as evaluated by impulse oscillometry. The secondary outcome measures were bronchial inflammation as evaluated by exhaled nitric oxide and atopy as evaluated by skin prick tests. During the 3-year follow-up period otitis media episodes were documented in patient diaries. RESULTS Adenoidectomy did not significantly influence baseline lung function, exercise-induced bronchoconstriction, exhaled nitric oxide concentration, the development of positive skin prick tests, or doctor-diagnosed asthma. Adenoidectomy did not significantly prevent otitis media. Recurrent otitis media (>or=4 episodes) during the first follow-up year was associated with an abnormal exercise-induced bronchoconstriction (OR 6.62, 95% CI 1.27 to 34) and an elevated exhaled nitric oxide concentration (OR 3.26, 95% CI 0.98 to 10.8) regardless of adenoidectomy. CONCLUSIONS Adenoidectomy did not promote asthma or allergy. Recurrent respiratory tract infections during early childhood are associated with the risk of bronchial hyper-reactivity.
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Affiliation(s)
- P S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland.
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Malmberg LP, Mäkelä MJ, Mattila PS, Hammarén-Malmi S, Pelkonen AS. Exercise-induced changes in respiratory impedance in young wheezy children and nonatopic controls. Pediatr Pulmonol 2008; 43:538-44. [PMID: 18433041 DOI: 10.1002/ppul.20805] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Exercise-induced bronchoconstriction (EIB) is a specific sign of active asthma, but its assessment in young children may be difficult with lung function techniques requiring active cooperation. The aim of the study was to assess the normal pattern of exercise-induced responses of respiratory impedance by using impulse oscillometry (IOS), and to investigate how these responses discriminate wheezy children from control subjects. IOS measurements were performed in a consecutive sample of wheezy children aged 3-7 years (n = 130) and in an aged matched control group of nonatopic children without respiratory symptoms (n = 79) before and after a free running test. After exercise, wheezy children showed significantly larger responses in respiratory resistance (Rrs5), reactance (Xrs5), and the resonance frequency (Fr) than the control subjects. In the control group, the upper 95% confidence limit of the maximal change was 32.5% for Rrs5, 85.7% for Xrs5, and 53.1% for Fr. By using analysis of receiver operating characteristics, the change in Rrs5 distinguished the wheezy children from the control subjects more effectively than change in Xrs5 or Fr. In wheezy children, the response was significantly effected by the outdoor temperature and exercise intensity in terms of maximum heart rate. In conclusion, an increase of 35% in Rrs5 after a free running test can be regarded as an abnormal response. Wheezy children show an enhanced airway response, which is clearly distinguishable from the control subjects. IOS is a feasible method to detect EIB in young children.
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Affiliation(s)
- L Pekka Malmberg
- Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland.
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Hammarén-Malmi S, Saxen H, Tarkkanen J, Mattila PS. Passive smoking after tympanostomy and risk of recurrent acute otitis media. Int J Pediatr Otorhinolaryngol 2007; 71:1305-10. [PMID: 17582514 DOI: 10.1016/j.ijporl.2007.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 05/09/2007] [Accepted: 05/14/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Exposure to environmental tobacco smoke has been reported to be a risk factor for childhood otitis media. The effect of parental smoking on the risk of otitis media after the insertion of tympanostomy tubes is unknown. We evaluated the effect of parental smoking on the risk of recurrent otitis media in children who had received tympanostomy tubes. METHODS We enrolled 217 children aged 1-4 years who underwent insertion of tympanostomy tubes because of middle ear disease. The children were followed-up for 12 months. Otitis media episodes were recorded in patient diaries by primary care physicians. Parental smoking habits were assessed by a questionnaire at the start of the trial and after the 12 month follow-up had ended. The main outcome measure was risk of recurrent otitis media as defined by four or more otitis media episodes after tympanostomy. Altogether 198 children completed the follow-up. RESULTS Maternal smoking was associated with a highly increased risk of recurrent acute otitis media (OR 4.15, 95% CI 1.45-11.9) after the insertion of tympanostomy tubes. CONCLUSION Exposure to passive smoking is associated with four-fold risk of recurrent otitis media after tympanostomy. This finding should be used to encourage parents to stop smoking even after the insertion of tympanostomy tubes to their children.
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Affiliation(s)
- Sari Hammarén-Malmi
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland
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Abstract
Although exposure to infectious agents and parental smoking are known to influence the overall risk of otitis media, these risk factors do not appear to be linked with the tendency to develop chronic otitis media with effusion (COME) instead of recurrent acute otitis media (RAOM). The genetic inflammatory response type of the child appears to influence the risk of persistent middle ear effusion in COME. Two different clinical presentations of childhood otitis media are encountered: RAOM; and COME, which is associated with persistent effusion in the middle ear. The objective of this study was to assess putative factors that may regulate the development of persistent middle ear effusion in COME. In total, 159 children with RAOM and their parents (n=304), and 55 children with COME and their parents (n=110) were evaluated. All the children with COME or RAOM were aged <4 years. There was no difference in the frequency of attendance at day care outside the home, number of siblings or parental smoking between children with RAOM and those with COME. The frequency of parental allergy and asthma was lower among children with COME than those with RAOM.
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Affiliation(s)
- S Hammarén-Malmi
- Department of Otorhinolaryngology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Hammarén-Malmi S, Saxen H, Tarkkanen J, Mattila PS. Adenoidectomy does not significantly reduce the incidence of otitis media in conjunction with the insertion of tympanostomy tubes in children who are younger than 4 years: a randomized trial. Pediatrics 2005; 116:185-9. [PMID: 15995051 DOI: 10.1542/peds.2004-2253] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of adenoidectomy in reducing the incidence of otitis media among children who are younger than 4 years and receive tympanostomy tubes. METHODS A randomized trial was conducted at a tertiary center clinic. A total of 217 children who were aged 12 to 48 months and had recurrent acute otitis media (>3 episodes during the past 6 months) or chronic otitis media with effusion, no obstructive symptoms as a result of adenoid enlargement, and no previous surgical intervention were enrolled in the study. Adenoidectomy in conjunction with the insertion of tympanostomy tubes or insertion of tympanostomy tubes without adenoidectomy was studied. The number of otitis media episodes during the follow-up period of 12 months was measured. RESULTS During the follow-up, the mean number of otitis media episodes was 1.7 among children who underwent adenoidectomy with concurrent insertion of tympanostomy tubes and 1.4 among children who received tympanostomy tubes only. The risk for recurrent otitis media (>or=3 episodes) could not be reduced by adenoidectomy (odds ratio: 1.66; 95% confidence interval: 0.80-3.46). CONCLUSION Adenoidectomy does not significantly reduce the incidence of acute otitis media in otitis prone children who are younger than 4 years and receive tympanostomy tubes.
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Affiliation(s)
- Sari Hammarén-Malmi
- Department of Otorhinolaryngology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Abstract
The objective of the study was to evaluate the risk of asthma in children who had undergone an adenoidectomy, an operation frequently performed on children with glue ear or recurrent otitis media. Two surveys were carried out, a nation-wide questionnaire returned by 483 individuals (survey A) and a survey of hospital discharge records involving 1616 children who had undergone an adenoidectomy and 161 control children who had undergone probing of the nasolacrimal duct due to congenital obstruction (survey B). The questionnaire (survey A) showed that an adenoidectomy before the age of 4 years was associated with asthma (OR 3.19, 95% CI 1.25; 8.13) and with allergy to animal dust (OR 2.50, 95% CI 1.27; 4.95). In survey B, asthma diagnosis was retrieved from the national asthma register. It showed also that adenoidectomy at an early age was associated with an increased risk of asthma (OR 6.74, 95% CI 2.99; 15.2). There was an association between asthma and adenoidectomy, even before adenoidectomy had actually been performed. The risk of asthma was highest among children who had had adenoidectomy because of recurrent otitis media. The observed association between an adenoidectomy and asthma may be explained by an underlying factor predisposing to both recurrent otitis media and asthma.
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Affiliation(s)
- Petri S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland.
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