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Yong M, Kirubalingam K, Desrosiers MY, Kilty SJ, Thamboo A. Cost-effectiveness analysis of biologics for the treatment of chronic rhinosinusitis with nasal polyps in Canada. Allergy Asthma Clin Immunol 2023; 19:90. [PMID: 37838713 PMCID: PMC10576384 DOI: 10.1186/s13223-023-00823-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 07/13/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Dupilumab, omalizumab, and mepolizumab are the three biologics currently approved for use in CRSwNP in Canada. Despite evidence of efficacy, their cost-effectiveness, which is a key factor influencing prescribing patterns, has not yet been compared to each other. METHODS A cost-effectiveness model using quality-adjusted life years (QALYs) was constructed using a Decision Tree Markov analysis. A third-party healthcare payer perspective and a 10-year time horizon was used. A willingness-to-pay (WTP) threshold of 50,000 Canadian dollars (CAD) per QALY was used to determine cost-effectiveness. Dupilumab, omalizumab, and mepolizumab were each compared to each other. RESULTS Omalizumab was the most cost-effective biologic using current estimates of cost and efficacy in CRSwNP. Using omalizumab as a baseline, dupilumab had an ICER of $235,305/QALY. Mepolizumab was dominated by omalizumab and dupilumab at the current drug prices and estimates of efficacy. Sensitivity analyses determined that when increasing the WTP threshold to $150,000/QALY, dupilumab became cost-effective compared to omalizumab in 22.5% of simulation scenarios. Additionally, altering dosing frequency had a significant effect on cost-effectiveness. CONCLUSION When comparing the relative cost-effectiveness of biologics in recalcitrant CRSwNP, omalizumab currently appears to be the most cost-effective option. Future reductions in drug prices, adjustments to currently approved dosing regimens, better patient selection, and improvements in sinus surgery outcomes will challenge the current cost-effectiveness models and necessitate reassessment as treatments for CRSwNP continue to evolve.
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Affiliation(s)
- Michael Yong
- Division of Otolaryngology, Head and Neck Surgery, University of British Columbia Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V5Z 1Y6, Canada
| | | | - Martin Y Desrosiers
- Department of Otolaryngology, Centre de Recherche du Centre Hospitalier de L'Universite de Montreal, Montreal, QC, Canada
| | - Shaun J Kilty
- Department of Otolaryngology, Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Thamboo
- Division of Otolaryngology, Head and Neck Surgery, University of British Columbia Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V5Z 1Y6, Canada.
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Liu Y, Xing Z, Geng C, Liu Y, Cao J, Yang Y, Pan T, Yu L. Use of peripheral blood eosinophils to guide post-operative glucocorticoid therapy in patients with chronic rhinosinusitis with nasal polyps: a randomised, controlled trial. J Laryngol Otol 2023; 137:890-901. [PMID: 36444128 DOI: 10.1017/s0022215122002481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to explore the utility of the eosinophil percentage in peripheral blood for guiding post-operative glucocorticoid therapy in patients with chronic rhinosinusitis with nasal polyps. METHODS Forty-four patients with chronic rhinosinusitis with nasal polyps underwent functional endoscopic sinus surgery and were randomly divided into two groups. Patients in the standard treatment group used oral and nasal spray glucocorticoids. In the biomarker treatment group, patients with peripheral blood eosinophil percentage values less than 3.05 per cent did not receive glucocorticoid treatment, whereas patients with values 3.05 per cent or above were part of the standard treatment group. Visual Analogue Scale, Sino-Nasal Outcome Test-22 scores, endoscopic Lund-Kennedy scores, eosinophils, interleukin-5 and eosinophil cationic protein in peripheral blood, and nasal secretions were measured. RESULTS After functional endoscopic sinus surgery, the Visual Analogue Scale, Sino-Nasal Outcome Test-22 and Lund-Kennedy scores were significantly reduced in both groups; there were no significant differences in those indicators between the groups during the three follow-up visits. CONCLUSION Peripheral blood eosinophil percentage offers a potential biomarker to guide post-operative glucocorticoid therapy in patients with chronic rhinosinusitis with nasal polyps.
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Affiliation(s)
- Y Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Z Xing
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - C Geng
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Y Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - J Cao
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Y Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - T Pan
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - L Yu
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Peking University, Beijing, China
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3
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Rozendorn N, Warman M, Zloczower E, Mansour J, Yakirevitch A. Significance of nasal septal deviation among patients with antrochoanal polyp. J Laryngol Otol 2023; 137:921-924. [PMID: 36515175 DOI: 10.1017/s0022215122002614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to examine the association between nasal septal deviation and antrochoanal polyp. METHODS This was a retrospective review of medical records and imaging of patients who underwent endoscopic sino-nasal surgery for antrochoanal polyp. RESULTS Forty-eight patients operated on for antrochoanal polyp between 2009 and 2019 were eligible for the study. The median age was 32 years, and 52.1 per cent were male. Antrochoanal polyp was diagnosed equally in the right and left nasal cavities. Septal deviation was present in 77 per cent of such cases. In 44 per cent of septal deviation cases, the antrochoanal polyp was ipsilateral to the deviation, which was not statistically significant. The type of deviation according to the Mladina classification was not correlated with the laterality of septal deviation and antrochoanal polyp. CONCLUSION The laterality of the septal deviation was not found to be correlated with that of the antrochoanal polyp. Therefore, performing routine septoplasty during antrochoanal polyp surgery is unnecessary unless the deviation interferes with the complete extraction of the polyp.
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Affiliation(s)
- N Rozendorn
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - M Warman
- Department of Otolaryngology - Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - E Zloczower
- Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - J Mansour
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - A Yakirevitch
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
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4
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Pendolino AL, Bandino F, Navaratnam A, Ross T, Qureishi A, Randhawa P, Andrews P. The role of large cavity sinus surgery in the management of chronic rhinosinusitis in non-steroidal anti-inflammatory drug exacerbated respiratory disease: a single-centre experience and long-term outcomes. J Laryngol Otol 2023; 137:883-889. [PMID: 36443933 DOI: 10.1017/s0022215122002468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to discuss the role of large cavity functional endoscopic sinus surgery in the management of chronic rhinosinusitis with nasal polyps in patients with non-steroidal anti-inflammatory drug exacerbated respiratory disease. METHODS This was a retrospective review of patients undergoing large cavity functional endoscopic sinus surgery for non-steroidal anti-inflammatory drug exacerbated respiratory disease from January 2016 to March 2022. Population characteristics, pre- and post-operative number of functional endoscopic sinus surgical procedures, endoscopic polyp grade, Lund-Mackay score and nasal symptoms were recorded. RESULTS Thirteen consecutive patients with a median age of 47 years were included. They all failed maximal medical treatment and/or conservative functional endoscopic sinus surgery and underwent large cavity sinus surgery followed by post-operative maximal medical therapy. All patients showed an improvement in nasal symptoms with improved Lund-Mackay scores post-operatively. The median length of follow up was 1.5 years. CONCLUSION Large cavity functional endoscopic sinus surgery seems to halt the progression of chronic rhinosinusitis with nasal polyps in non-steroidal anti-inflammatory drug exacerbated respiratory disease. In this case series, large cavity functional endoscopic sinus surgery combined with optimal post-operative medical treatment appeared to switch off chronic rhinosinusitis with nasal polyps in patients with non-steroidal anti-inflammatory drug exacerbated respiratory disease.
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Affiliation(s)
- A L Pendolino
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, United Kingdom
- Ear Institute, University College London, United Kingdom
| | - F Bandino
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, United Kingdom
| | - A Navaratnam
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, United Kingdom
| | - T Ross
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, United Kingdom
| | - A Qureishi
- ENT Department, Oxford University Hospital, United Kingdom
| | - P Randhawa
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, United Kingdom
| | - P Andrews
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, United Kingdom
- Ear Institute, University College London, United Kingdom
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Whittaker JD, Baker E, Kumar S, Collingwood R, West M, Lee PK. Do variations in nasal irrigation recipes and storage effect the risk of bacterial contamination? - ERRATUM. J Laryngol Otol 2023; 137:942-944. [PMID: 37293799 DOI: 10.1017/s0022215123001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Whittaker JD, Baker E, Kumar S, Collingwood R, West M, Lee PK. Do variations in nasal irrigation recipes and storage effect the risk of bacterial contamination? J Laryngol Otol 2023; 137:794-798. [PMID: 36503557 DOI: 10.1017/s0022215122002559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Make-at-home nasal irrigation solutions are often recommended for treating chronic rhinosinusitis. Many patients will store pre-made solution for convenient use. This study investigated the microbiological properties of differing recipes and storage temperatures. METHOD Three irrigation recipes (containing sodium chloride, sodium bicarbonate and sucrose) were stored at 5oC and 22oC. Further samples were inoculated with Staphylococcus aureus and Pseudomonas aeruginosa. Sampling and culturing were conducted at intervals from day 0-12 to examine for bacterial presence or persistence. RESULTS No significant bacterial growth was detected in any control solution stored at 5oC. Saline solutions remained relatively bacterial free, with poor survival of inoculated bacteria, which may be related to either lower pH or lower osmolality. Storing at room temperature increased the risk of contamination in control samples, particularly from pseudomonas. CONCLUSION If refrigerated, pre-made nasal irrigation solutions can be stored safely for up to 12 days without risking cross-contamination to irrigation equipment or patients.
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Affiliation(s)
- J D Whittaker
- ENT, Walsall Manor Hospital, Walsall Healthcare NHS Trust, UK
| | - E Baker
- Microbiology, Queen's Hospital Burton, University Hospital of Derby and Burton NHS Trust, Burton-on-Trent, UK
| | - S Kumar
- ENT, Leicester Royal Infirmary, University Hospital of Leicester NHS Trust, UK
| | - R Collingwood
- Microbiology, Queen's Hospital Burton, University Hospital of Derby and Burton NHS Trust, Burton-on-Trent, UK
| | - M West
- Microbiology, Queen's Hospital Burton, University Hospital of Derby and Burton NHS Trust, Burton-on-Trent, UK
| | - P K Lee
- ENT, Queen's Hospital Burton, University Hospital of Derby and Burton NHS Trust, Burton-on-Trent, UK
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do Amaral JB, David AG, Mello L, Bachi ALL, Voegels RL, Thamboo A, Pezato R. Impact of Chronic Rhinosinusitis with Nasal Polyposis on IL-12 and IL-8. Iran J Otorhinolaryngol 2023; 35:21-27. [PMID: 36721412 PMCID: PMC9872264 DOI: 10.22038/ijorl.2022.53663.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/08/2022] [Indexed: 02/02/2023]
Abstract
Introduction The pathophysiology of Chronic Rhinosinusitis is coordinated by distinct inflammatory reactions in different individuals. Inflammatory environments with a predominance of Th2 lymphocytes tend also to be rich in eosinophils. These environments are common during the formation of nasal polyps associated with aspirin intolerance, which is also marked by an increase in inflammatory mediators, especially IL-4, IL-5, and IL-13. Despite the significance of these inflammatory mediators, the relevance of IL-12 subunits' presence within eosinophilic nasal polyps, however, has been less studied. The current study aims to evaluate the presence of IL-12 subunits, IL-12p40 and IL-12p70, in eosinophilic nasal polyps and their correlations with IL-8 presence. Materials and Methods We compared the concentrations of IL-8, IL12p40, and IL12p70 among samples of eosinophilic nasal polypoid tissue, eosinophilic nasal polypoid tissue associated with aspirin intolerance, and healthy nasal mucosa, using an indirect immunoassay (ELISA) kit. Results When compared to healthy nasal mucosa, there was a lower concentration of IL-8 in Chronic Rhinosinusitis with Nasal Polyp (CRSwNP) tissue. Aspirin Intolerant polypoid tissue also presented a lower concentration of IL-12 subunits compared to healthy nasal mucosa. There was no significant correlation between IL-8 and IL-12 in the eosinophilic polypoid conditions. Conclusion In CRSwNP, there is a reduction in IL-8 and IL-12 subunits compared to control, with a lack of correlation between IL-12 and IL-8. The lack of correlation can be justified by a type two inflammatory storm environment.
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Affiliation(s)
- Janatas Bussador do Amaral
- ENT Research Lab. Department of Otorhinolaryngology-Head and Neck Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil.,Corresponding Author: ENT Research Lab. Department of Otorhinolaryngology –Head and Neck Surgery, Federal University of Sao Paulo. Rua Pedro de Toledo 781, 1o andar, sala 3 - Vila Clementino - Sao Paulo - SP - Brazil CEP 04039-032. E-mail:
| | - Andrea Goldwasser David
- ENT Research Lab. Department of Otorhinolaryngology-Head and Neck Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Luciane Mello
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Federal da Lagoa, Rio de Janeiro, Brazil.
| | - Andre Luis Lacerda Bachi
- ENT Research Lab. Department of Otorhinolaryngology-Head and Neck Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil.,Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), Sao Paulo, Brazil.
| | - Richard Louis Voegels
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
| | - Andrew Thamboo
- Division of Rhinology, University of British Columbia, Vancouver, Canada.
| | - Rogério Pezato
- ENT Research Lab. Department of Otorhinolaryngology-Head and Neck Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil.,Department of Ophthalmology and Otorhinolaryngology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
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Chan D, Ooi E, Khalid O. A systematic review and meta-analysis of the role of doxycycline in chronic rhinosinusitis. J Laryngol Otol 2022; 137:474-483. [PMID: 35919933 DOI: 10.1017/s0022215122001803] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this systematic review and meta-analysis was to evaluate the role of doxycycline in the management of chronic rhinosinusitis. METHOD This was a systematic review using Ovid Medline, Cinahl, Scopus and Cochrane and was limited to meta-analyses, systematic reviews and randomised, clinical trials. A combination of the following search terms was used: 'sinusitis', 'nasal polyps', 'doxycycline' and 'tetracycline'. Raw means and standard deviations were extracted from the included studies. The meta-analysis was performed using mean differences of pre- versus post-doxycycline treatment. RESULTS A total of 279 studies were screened, of which 5 studies met the criteria (all randomised, controlled trials published between 2010 and 2021). The interventions, endpoints and measured outcomes varied across all studies. Meta-analysis performed on pre- versus post-doxycycline treatment for Sino-Nasal Outcome Test-22, nasal polyp scores and symptom scores did not yield statistically significant results. CONCLUSION This review identified a small number of high-quality studies on the use of doxycycline in chronic rhinosinusitis. There does not seem to be convincing evidence for the routine use of doxycycline in patients with chronic rhinosinusitis. Further research may try to identify certain phenotypes of chronic rhinosinusitis that may better respond to doxycycline.
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Affiliation(s)
- D Chan
- Department of Otorhinolaryngology, Flinders Medical Centre, Adelaide, Australia
| | - E Ooi
- Department of Otorhinolaryngology, Flinders Medical Centre, Adelaide, Australia
| | - O Khalid
- Department of Otorhinolaryngology, Flinders Medical Centre, Adelaide, Australia
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Faramarzi M, Ghaffari Darab M, Jafari A, Salehpour H, Janipour M, Roosta S, Keshavarz K. Is it Effective and Cost-saving to Send all Tonsillectomy Specimens for Histopathological Examinations? Iran J Otorhinolaryngol 2022; 34:35-44. [PMID: 35145934 PMCID: PMC8801011 DOI: 10.22038/ijorl.2021.57235.2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/10/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The present study aimed to investigate the necessity or unnecessity of sending all tonsillectomy specimens for pathological examinations in Shiraz, Iran; moreover, it examined malignancies, cost-saving, causes, and the ways to prevent sending all specimens. MATERIALS AND METHODS In the first retrospective phase of the study, a checklist was used to gather demographic, clinical, and cost information of 18,437 tonsillectomy specimens during 2004-2018 in Shiraz, Iran. In order to estimate the cost of each pathology specimen, the cost components, including human resources costs and consumables, were collected in the private and public sectors separately and divided by the number of cases performed. Finally, the financial burden resulting from these services (in the study centers) was calculated by multiplying each item's cost by the total number of these services. RESULTS Out of the total 18,437 histopathology specimens examined, only 118 (0.64%) samples were identified with unusual diagnoses, of which 66 (56%) cases had malignant tumors, and the remaining 52 (44%) samples included benign tumors (n=41), infections (n=2), and other problems (n=9). The second phase results also indicated that according to the ear, nose, and throat experts, the rules and regulations governing the country's health system and the suspicion of tumors were the main reasons for sending tonsil specimens for pathological examinations. Generally, the annual cost-saving rates in the studied public and private centers were $87,919 and $179,530 purchasing power parity, respectively. CONCLUSIONS According to the results, sending tonsillectomy specimens should only be limited to nonroutine ones for economic-clinical reasons.
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Affiliation(s)
- Mohammad Faramarzi
- Otolaryngology Research Centre, Department of Otolaryngology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohsen Ghaffari Darab
- Joint doctoral student with Deakin University (Australia) and University of Bayreuth (Germany), Researcher at Institute for Medical Management and Health Sciences (IMG)
| | - Abdosaleh Jafari
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hatam Salehpour
- Otolaryngology Research Centre, Department of Otolaryngology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Masoud Janipour
- Otolaryngology Research Centre, Department of Otolaryngology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Sareh Roosta
- MSc in Biostatistics, MA in General Psychology, Otolaryngology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Khosro Keshavarz
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. ,Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Corresponding Author: Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. E-mail:
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Dharmarajan H, Falade O, Lee SE, Wang EW. Outcomes of Dupilumab Treatment versus Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyps. Int Forum Allergy Rhinol 2021; 12:986-995. [PMID: 34919344 DOI: 10.1002/alr.22951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/06/2021] [Revised: 11/22/2021] [Accepted: 12/14/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Outside of the SINUS-24 and SINUS-52 trials, there is limited data on the efficacy of dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The objective was to compare dupilumab to functional endoscopic sinus surgery (FESS) in CRSwNP patients by assessing the change in nasal polyp and SNOT-22 scores post-intervention. METHODS A retrospective matched cohort study compared 54 CRSwNP patients treated with dupilumab to 54 CRSwNP patients who underwent FESS with both cohorts treated with topical corticosteroids. The primary endpoints were change in NPS and change in overall SNOT-22 score. Secondary endpoints were change in SNOT-22 domain scores and change in SNOT-22 olfaction score. RESULTS FESS patients had a greater improvement in NPS (5.18 ± 2.01) compared to dupilumab patients (4.27 ± 1.98, p=0.02). There was no significant difference in terms of the change in overall SNOT-22 score. Dupilumab patients had greater improvement in the extra-nasal rhinologic SNOT-22 domain scores (4.87 ± 3.91) compared to FESS patients (2.93 ± 4.32, p=0.02). There was a greater improvement in the SNOT-22 olfaction scores for dupilumab patients (2.35 ± 2.17) compared to FESS patients (1.48 ± 2.24, p=0.04). Dupilumab patients were followed on average for 12.20 months and FESS patients for 17.90 months. CONCLUSIONS Overall, both therapies are effective at reducing symptoms in patients with CRSwNP by SNOT-22. Dupilumab patients reported improved olfaction and decreased cough, post-nasal drainage, and thick nasal drainage as compared to FESS patients while FESS patients had a greater reduction in polyp burden. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Harish Dharmarajan
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Oluleke Falade
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Stella E Lee
- Division of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Abstract
OBJECTIVE This study aimed to assess the quality and readability of websites on chronic rhinosinusitis. METHODS A total of 180 results from 3 different search engines regarding 'chronic rhinosinusitis', 'sinusitis' and 'sinus infections' were analysed for readability using the Flesch-Kincaid Grade Level, Flesch Reading Ease Score and Gunning Fog Index. The Discern tool was used to approximate information quality. RESULTS From 180 total searches, 69 unique websites were identified. These had an average Flesch-Kincaid Grade Level of 9.75 (95 per cent confidence interval = 9.12-10.4), a Flesch Reading Ease Score of 45.0 (41.0-49.0) and a Gunning Fog Index of 13.7 (12.9-14.4), which equates to the average reading level of a college or university student. Discern scores were variable but consistently showed good-quality information. CONCLUSION Chronic rhinosinusitis information is of a high quality but is for a reading level higher than that of the average adult. Standardising patient information should ensure adequate comprehension and improve patient compliance.
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Heffler E, Saccheri F, Bartezaghi M, Canonica GW. Effectiveness of omalizumab in patients with severe allergic asthma with and without chronic rhinosinusitis with nasal polyps: a PROXIMA study post hoc analysis. Clin Transl Allergy 2020; 10:25. [PMID: 32607141 PMCID: PMC7318524 DOI: 10.1186/s13601-020-00330-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/11/2020] [Indexed: 12/17/2022] Open
Abstract
Background A significant proportion of patients with severe asthma may also suffer from nasal polyposis, which is commonly defined as chronic rhinosinusitis with nasal polyps (CRSwNP), the presence of which may adversely affect asthma treatment outcomes. The biologic agent omalizumab is effective as add-on therapy in patients with severe allergic asthma. The aim of this post hoc analysis of the PROXIMA study was to compare the efficacy of omalizumab between patients with severe allergic asthma, with and without comorbid CRSwNP. Methods PROXIMA was a prospective observational 2-part study conducted in Italy in adult patients with severe allergic asthma, where, in the second part, patients eligible for add-on omalizumab initiated treatment for 12 months. Patient baseline data such as comorbidities and history of exacerbations were collected. Outcomes were asthma control (Asthma Control Questionnaire [ACQ]), lung function (forced expiratory volume in 1 s [FEV1]) and exacerbation rate. The post hoc analysis compared these outcomes between the cohort with comorbid CRSwNP and the cohort without CRSwNP. Results Of 123 patients included in this analysis, 17 (13.8%) were in the CRSwNP cohort. There was no significant difference between cohorts in baseline clinical characteristics or in change from baseline at 12 months in ACQ values, % of predicted FEV1 or annual asthma exacerbation rate, although results were numerically in favor of the CRSwNP cohort versus the non-CRSwNP cohort. The proportion of patients who achieved an improvement in all three outcomes was numerically greater in the CRSwNP cohort (35.7% vs 23.0%). Conclusions In an observational real-world setting, add-on omalizumab for severe allergic asthma was effective in improving asthma control, lung function and in reducing exacerbations, including in those patients with CRSwNP.
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Affiliation(s)
- Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Mi Italy
| | - Fabiana Saccheri
- Medical & Scientific Department, Novartis Farma SpA, Origgio, Italy
| | - Marta Bartezaghi
- Medical & Scientific Department, Novartis Farma SpA, Origgio, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Mi Italy
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Bequignon E, Mangin D, Bécaud J, Pasquier J, Angely C, Bottier M, Escudier E, Isabey D, Filoche M, Louis B, Papon JF, Coste A. Pathogenesis of chronic rhinosinusitis with nasal polyps: role of IL-6 in airway epithelial cell dysfunction. J Transl Med 2020; 18:136. [PMID: 32209102 PMCID: PMC7092549 DOI: 10.1186/s12967-020-02309-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by an alteration in airway epithelial cell functions including barrier function, wound repair mechanisms, mucociliary clearance. The mechanisms leading to epithelial cell dysfunction in nasal polyps (NPs) remain poorly understood. Our hypothesis was that among the inflammatory cytokines involved in NPs, IL-6 could alter epithelial repair mechanisms and mucociliary clearance. The aim of this study was to evaluate the in vitro effects of IL-6 on epithelial repair mechanisms in a wound repair model and on ciliary beating in primary cultures of Human Nasal Epithelial Cells (HNEC). Methods Primary cultures of HNEC taken from 38 patients during surgical procedures for CRSwNP were used in an in vitro model of wound healing. Effects of increasing concentrations of IL-6 (1 ng/mL, 10 ng/mL, and 100 ng/mL) and other ILs (IL-5, IL-9, IL-10) on wound closure kinetics were compared to cultures without IL-modulation. After wound closure, the differentiation process was characterized under basal conditions and after IL supplementation using cytokeratin-14, MUC5AC, and βIV tubulin as immunomarkers of basal, mucus, and ciliated cells, respectively. The ciliated edges of primary cultures were analyzed on IL-6 modulation by digital high-speed video-microscopy to measure: ciliary beating frequency (CBF), ciliary length, relative ciliary density, metachronal wavelength and the ciliary beating efficiency index. Results Our results showed that: (i) IL-6 accelerated airway wound repair in vitro, with a dose–response effect whereas no effect was observed after other ILs-stimulation. After 24 h, 79% of wounded wells with IL6-100 were fully repaired, vs 46% in the IL6-10 group, 28% in the IL6-1 group and 15% in the control group; (ii) specific migration analyses of closed wound at late repair stage (Day 12) showed IL-6 had the highest migration compared with other ILs (iii) The study of the IL-6 effect on ciliary function showed that CBF and metachronal wave increased but without significant modifications of ciliary density, length of cilia and efficiency index. Conclusion The up-regulated epithelial cell proliferation observed in polyps could be induced by IL-6 in the case of prior epithelial damage. IL-6 could be a major cytokine in NP physiopathology.
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Affiliation(s)
- Emilie Bequignon
- Service d'Oto-Rhino-Laryngologie et de Chirurgie cervico-faciale, AP-HP, Hôpital Henri Mondor et Centre Hospitalier Intercommunal de Créteil, 94010, Créteil, France. .,INSERM, U955, Equipe 13, Faculte de Medecine, 8 rue du General Sarrail, 94010, Créteil, France. .,Faculté de Médecine, Université Paris-Est, 94010, Créteil, France. .,CNRS ERL 7000, 94010, Créteil, France.
| | - David Mangin
- Service d'Oto-Rhino-Laryngologie et de Chirurgie cervico-faciale, AP-HP, Hôpital Henri Mondor et Centre Hospitalier Intercommunal de Créteil, 94010, Créteil, France.,INSERM, U955, Equipe 13, Faculte de Medecine, 8 rue du General Sarrail, 94010, Créteil, France.,Faculté de Médecine, Université Paris-Est, 94010, Créteil, France.,CNRS ERL 7000, 94010, Créteil, France
| | - Justine Bécaud
- Service d'Oto-Rhino-Laryngologie et de Chirurgie cervico-faciale, AP-HP, Hôpital Henri Mondor et Centre Hospitalier Intercommunal de Créteil, 94010, Créteil, France.,INSERM, U955, Equipe 13, Faculte de Medecine, 8 rue du General Sarrail, 94010, Créteil, France.,Faculté de Médecine, Université Paris-Est, 94010, Créteil, France.,CNRS ERL 7000, 94010, Créteil, France
| | - Jennifer Pasquier
- Nice Breast Institute, 06000, Nice, France.,Stem Cell & Microenvironment Laboratory, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Christelle Angely
- INSERM, U955, Equipe 13, Faculte de Medecine, 8 rue du General Sarrail, 94010, Créteil, France.,Faculté de Médecine, Université Paris-Est, 94010, Créteil, France.,CNRS ERL 7000, 94010, Créteil, France
| | - Mathieu Bottier
- INSERM, U955, Equipe 13, Faculte de Medecine, 8 rue du General Sarrail, 94010, Créteil, France.,Faculté de Médecine, Université Paris-Est, 94010, Créteil, France.,CNRS ERL 7000, 94010, Créteil, France
| | - Estelle Escudier
- Inserm U933, Paris, France.,Université Pierre et Marie Curie, Paris, France.,Service de génétique et d'embryologie médicale, AP-HP Hôpital Armand-Trousseau, Paris, France
| | - Daniel Isabey
- INSERM, U955, Equipe 13, Faculte de Medecine, 8 rue du General Sarrail, 94010, Créteil, France.,Faculté de Médecine, Université Paris-Est, 94010, Créteil, France.,CNRS ERL 7000, 94010, Créteil, France
| | - Marcel Filoche
- INSERM, U955, Equipe 13, Faculte de Medecine, 8 rue du General Sarrail, 94010, Créteil, France.,Faculté de Médecine, Université Paris-Est, 94010, Créteil, France.,CNRS ERL 7000, 94010, Créteil, France
| | - Bruno Louis
- INSERM, U955, Equipe 13, Faculte de Medecine, 8 rue du General Sarrail, 94010, Créteil, France.,Faculté de Médecine, Université Paris-Est, 94010, Créteil, France.,CNRS ERL 7000, 94010, Créteil, France
| | - Jean-François Papon
- INSERM, U955, Equipe 13, Faculte de Medecine, 8 rue du General Sarrail, 94010, Créteil, France.,CNRS ERL 7000, 94010, Créteil, France.,Service d'Oto-Rhino-Laryngologie et de Chirurgie cervico-faciale, AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France.,Faculté de Médecine, Université Paris-Sud, 94275, Le Kremlin-Bicêtre, France
| | - André Coste
- Service d'Oto-Rhino-Laryngologie et de Chirurgie cervico-faciale, AP-HP, Hôpital Henri Mondor et Centre Hospitalier Intercommunal de Créteil, 94010, Créteil, France.,INSERM, U955, Equipe 13, Faculte de Medecine, 8 rue du General Sarrail, 94010, Créteil, France.,Faculté de Médecine, Université Paris-Est, 94010, Créteil, France.,CNRS ERL 7000, 94010, Créteil, France
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Casale M, Costantino A, Sabatino L, Luchena A, Moffa A, Cassano M, Rinaldi V, Baptista PM. Minimally invasive surgery under local anaesthesia for chronic rhinosinusitis with nasal polyps: our experience in older adults. J Laryngol Otol 2020; 134:1-5. [PMID: 32046795 DOI: 10.1017/s0022215120000304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This paper aims to report our experience with a minimally invasive surgical procedure for the treatment of chronic rhinosinusitis with nasal polyps, performed in a day-surgery setting under local anaesthesia. METHODS A retrospective study of 30 patients with chronic rhinosinusitis with nasal polyps was conducted. Sino-Nasal Outcome Test 22 and modified Lund-Kennedy scores were collected. Intra- and post-operative pain was evaluated using a 10-point visual analogue scale. RESULTS The mean Sino-Nasal Outcome Test 22 score decreased from 41.8 ± 15.8 pre-operatively to 13.3 ± 9.5 post-operatively (p < 0.001). Accordingly, the mean endoscopic score decreased from 6.8 ± 1.8 to 0.2 ± 0.7 (p < 0.001). The mean intra-operative pain score was 2.9 ± 3.2, and 29 patients (96.7 per cent) reported no pain in the post-operative period (visual analogue scale score = 0). CONCLUSION Our study confirms that minimally invasive surgery represents a safe, repeatable procedure that results in remarkable subjective and objective improvement, without intra- and post-operative pain or discomfort.
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Affiliation(s)
- M Casale
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - A Costantino
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - L Sabatino
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - A Luchena
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - A Moffa
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
- Department of Otolaryngology, University of Foggia, Italy
| | - M Cassano
- Department of Otolaryngology, University of Foggia, Italy
| | - V Rinaldi
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - P M Baptista
- Department of Otolaryngology, University Clinic of Navarra, Pamplona, Spain
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15
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Senturk E, Yildirim YS, Ozturan O, Tekkeli SEK, Kiziltaş MV. Melatonin deficiency at tissue level: a possible aetiological factor in nasal polyposis. J Laryngol Otol 2019; 133:600-3. [PMID: 31232258 DOI: 10.1017/S0022215119001312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether melatonin is involved in the pathogenesis of nasal polyposis. METHOD This study included 29 patients with nasal polyposis and undergoing functional endoscopic sinus surgery. As a control group, 26 patients who had been operated on for a deviated nasal septum and concha bullosa were enrolled. Samples were taken from the nasal polyp tissue and from the resected middle concha bullosa mucosa of the control group. Serum samples were taken from all patients. RESULTS It was found that the tissue and serum melatonin levels in the nasal polyp group were significantly lower compared with the tissue and serum melatonin levels in the control group. CONCLUSION In nasal polyposis, the melatonin level in the serum and tissue is lower than in individuals without polyposis. This deficiency may play a role in the pathogenesis of nasal polyposis.
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16
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Coates ML, Carrie S. A local safety standard for invasive procedures for out-patient endonasal procedures performed under local anaesthetic: a template from Newcastle upon Tyne hospitals. J Laryngol Otol 2019; 133:441-4. [PMID: 31038097 DOI: 10.1017/S0022215119000781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In November 2017, a working feasibility analysis commenced of a local anaesthetic endonasal procedures out-patient clinic service at Freeman Hospital, Newcastle upon Tyne. Fundamental to introducing an innovative ambulatory out-patient practice is the development of a novel local safety standard for invasive procedures to support this service. OBJECTIVE This paper presents the new safety standard developed for this purpose and implemented in our institution. CONCLUSION Increasingly, there is a shift toward ambulatory services, directed by patient choice, technological advances and the opportunity for cost savings. It is hoped that this local safety standard for invasive procedures will provide a useful template for those considering implementing ambulatory endonasal services, or other novel procedures, within the specialty of ENT.
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17
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Faghih Habibi A, Gerami H, Banan R, Kazemnezhad Leily E, Khoshkhat P, Alaie Alamouti H, Nemati S. Serum 25-Hydroxy Vitamin D in Chronic Rhinosinusitis with and Without Nasal Polyposis: A Case-Control Study. Iran J Otorhinolaryngol 2019; 31:19-24. [PMID: 30783595 PMCID: PMC6368985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) with and without nasal polyposis is a chronic inflammatory disease of the sinuses and nasal mucosa. Recent evidence has indicated a relationship between serum 25-hydroxyl vitamin D (OH-VitD) deficiency and CRS. Regarding this, the present study aimed to compare the serum level of 25-OH-VitD in CRS patients with and without nasal polyposis and control groups. MATERIALS AND METHODS This study was conducted on 117 adult subjects in three groups of CRS with nasal polyposis (CRSwNP; n=32), CRS without nasal polyposis (CRSsNP; n=35), and healthy controls (n=50). The mean level of serum 25-OH-VitD in the three groups was measured by means of enzyme- linked immunosorbent assay. The data were analyzed using SPSS software (version 18). RESULTS Mean serum levels of 25-OH-VitD in CRSwNP, CRSsNP, and control groups were 12.52, 15.54, and 22.04 ng/ml, respectively. There was a significant difference between the case and control groups in terms of 25-OH-VitD level (P=0.0001). However, no significant difference was observed between the CRSwNP and CRSsNP groups in this regard (P=0.464). The women had a VitD deficiency odds ratio (OR) of 2.47, compared with men (OR=2.47, 95% CI=1.04-5.86). The OR of VitD deficiency with aging was obtained as 0.957 (95% CI=0.925-0.989). In this regard, older patients had a lower probability of VitD deficiency, compared to younger patients. CONCLUSION As the findings indicated, serum 25-OH-VitD was significantly lower in CRS patients, compared with that in the non-CRS subjects.
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Affiliation(s)
- Ali Faghih Habibi
- Rhino-Sinus, Ear, and Skull base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgury, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Hooshang Gerami
- Rhino-Sinus, Ear, and Skull base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgury, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Rahmatollah Banan
- Rhino-Sinus, Ear, and Skull base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgury, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Ehsan Kazemnezhad Leily
- Rhino-Sinus, Ear, and Skull base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgury, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Parsa Khoshkhat
- International Campus, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hooman Alaie Alamouti
- Rhino-Sinus, Ear, and Skull base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgury, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Shadman Nemati
- Rhino-Sinus, Ear, and Skull base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgury, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.,Corresponding Author: Rhino- sinus, Ear and Skull base Diseases Research Center, Amiralmomenin University Hospital, 17 Shahrivar Ave. Rasht, Iran. post code: 41396-37459, E-mail: ,
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18
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Ekinci A. The effects of systemic steroid therapy on macrophage migration inhibitory factor concentrations in patients with nasal polyps. J Laryngol Otol 2018; 132:891-5. [PMID: 30270817 DOI: 10.1017/S0022215118001652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study aimed to compare serum macrophage migration inhibitory factor concentrations before and after oral steroid therapy in nasal polyps patients, and determine whether there is a difference between pre-treatment macrophage migration inhibitory factor concentrations and healthy individuals. METHODS The study included 24 patients with nasal polyps and 25 healthy individuals. The patient group received 1 mg/kg oral steroid. RESULTS The mean macrophage migration inhibitory factor concentration before oral steroid therapy was 3889.79 pg/ml in the patient group and 2334.52 pg/ml in the control group. Macrophage migration inhibitory factor concentrations were statistically significantly higher in the pre-oral steroid therapy patient group than in the control group (p = 0.017). The mean pre- and post-oral steroid therapy serum macrophage migration inhibitory factor concentrations were 3889.79 pg/ml and 2451.25 pg/ml, respectively. The reduction in macrophage migration inhibitory factor concentrations was statistically significant (p = 0.010). CONCLUSION These findings suggest that concentrations of macrophage migration inhibitory factor may play a role in the pathogenesis of nasal polyps.
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Ismi O, Kara T, Polat G, Bobusoglu O, Vayısoglu Y, Gorur K, Ozcan C. Is there any effect of neurotrophin-3 on the pathogenesis of non-allergic nasal polyps? J Laryngol Otol 2018; 132:724-8. [PMID: 29974835 DOI: 10.1017/S0022215118000981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Although the role of neurotrophins such as nerve growth factor and brain-derived neurotrophic factor in nasal polyps development has been studied, the contribution of neurotrophin-3 has not been evaluated yet. This study aimed to investigate the possible role of neurotrophin-3 in nasal polyps pathogenesis. METHODS The study group comprised 70 non-allergic nasal polyps patients and the control group consisted of 53 patients with middle turbinate concha bullosa. Specimens were taken, during surgery, from the ethmoid sinus nasal polyps in the nasal polyps group and from the lateral part of the middle turbinate concha bullosa in the control group. Tissue and serum levels of neurotrophin-3 were assessed by immunohistochemistry and enzyme-linked immunosorbent assay, respectively. RESULTS Nasal polyps patients had higher tissue neurotrophin-3 scores (p < 0.001). There was no statistically significant difference between groups regarding serum neurotrophin-3 levels (p = 0.417). Tissue neurotrophin-3 staining scores in the nasal polyps group had no statistically significant correlation with Lund-Mackay scores (p = 0.792). CONCLUSION Neurotrophin-3 may have a local effect in nasal polyps pathogenesis, without joining systemic circulation.
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Montaño-Velázquez BB, Lara-Sánchez DA, Orozco-Sánchez A, García-Vázquez FJ, Mora-Campos MR, Jáuregui-Renaud K. Sex difference in counts of α4 and α7 nicotinic acetylcholine receptors in the nasal polyps of adults with or without exposure to tobacco smoke. J Laryngol Otol 2018; 132:596-9. [PMID: 29888694 DOI: 10.1017/S0022215118000373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess counts of α4 and α7 nicotinic acetylcholine receptors in nasal polyps of adults with or without long-term exposure to cigarette tobacco smoke. METHODS Twenty-two patients with and 22 patients without exposure to cigarette tobacco smoke participated in the study. After endoscopic polypectomy, the fragments of the nasal polyps were analysed by immunohistochemistry. RESULTS Compared to patients with no exposure, patients with exposure showed higher counts of α4 and α7 nicotinic acetylcholine receptors (t-test, p 0.05). CONCLUSION Exposure to cigarette tobacco smoke may induce increased counts of α4 and α7 nicotinic acetylcholine receptors in nasal polyps of adults, with lower counts in males than females without exposure to tobacco smoke.
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Abstract
Samter’s triad (ST) is a well-known disease characterized by the triad of bronchial asthma, nasal polyps, and aspirin intolerance. Over the past few years, a rapid development in the knowledge of the pathogenesis and clinical characteristics of ST has happened. The aim of this paper is to review the recent investigations on the pathophysiological mechanisms and genetic background, diagnosis, and different therapeutic options of ST to advance our understanding of the mechanism and the therapeutic control of ST. As concern for ST increase, more application of aspirin desensitization will be required to manage this disease successfully. There is also a need for continued research efforts in pathophysiology, treatment, and possible prevention.
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Affiliation(s)
- Sung-Dong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Kyu-Sup Cho
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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22
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Ickrath P, Kleinsasser N, Ding X, Ginzkey C, Beyersdorf N, Kerkau T, Hagen R, Hackenberg S. Impact and Modulations of Peripheral and Edaphic B Cell Subpopulations in Chronic Rhinosinusitis With Nasal Polyposis. Clin Exp Otorhinolaryngol 2018; 11:133-140. [PMID: 29409312 PMCID: PMC5951070 DOI: 10.21053/ceo.2017.01389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 11/22/2022] Open
Abstract
Objectives The pathophysiological mechanisms of chronic rhinosinusitis with nasal polyposis (CRSwNP) still are discussed controversially. Regulatory B cells (Breg) are responsible for the suppression of T cell activity: deficiencies for Breg have been demonstrated to contribute to autoimmune disorders, e.g., systemic lupus erythematosus. In order to evaluate the influence of B cell subpopulations, especially Breg, on the etiology of this disease, the aim of this study was to characterize subpopulations of peripheral and edaphic B cells in CRSwNP. Methods Polypoid tissue and blood samples were collected from 10 patients undergoing paranasal sinus surgery and lymphocytes were analyzed by multicolor flow cytometry. Results There was a significantly lower frequency of B cells in nasal polyps compared to peripheral blood mononuclear cells (PBMC) in patients with CRSwNP. Mature resting B cells were the main population within B cells in PBMC, and memory B cells in nasal polyps. Remarkably, Breg and mature B cells significantly decreased in nasal polyps compared to PBMC. Memory B cells significantly increased and represented the main subpopulation in nasal polyps in patients with CRSwNP. Conclusion In this study a detailed contemporary characterization of B cell subpopulations in patients with CRSwNP is presented. The influence of edaphic B cells could play a key role in the maintenance of this chronic infectious disease.
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Affiliation(s)
- Pascal Ickrath
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Norbert Kleinsasser
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Xin Ding
- Institute for Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany
| | - Christian Ginzkey
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery "Otto Körner", University Medical Center Rostock, Rostock, Germany
| | - Niklas Beyersdorf
- Institute for Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany
| | - Thomas Kerkau
- Institute for Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Stephan Hackenberg
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Wuerzburg, Germany
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Bae CH, Na HG, Choi YS, Song SY, Kim YD. Clusterin Induces MUC5AC Expression via Activation of NF-κB in Human Airway Epithelial Cells. Clin Exp Otorhinolaryngol 2018; 11:124-132. [PMID: 29316784 PMCID: PMC5951062 DOI: 10.21053/ceo.2017.00493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 10/08/2017] [Accepted: 11/10/2017] [Indexed: 01/08/2023] Open
Abstract
Objectives Clusterin (CLU) is known as apolipoprotein J, and has three isoforms with different biological functions. CLU is associated with various diseases such as Alzheimer disease, atherosclerosis, and some malignancies. Recent studies report an association of CLU with inflammation and immune response in inflammatory airway diseases. However, the effect of CLU on mucin secretion of airway epithelial cells has not yet been understood. Therefore, the effect and brief signaling pathway of CLU on MUC5AC (as a major secreted mucin) expression were investigated in human airway epithelial cells. Methods In the tissues of nasal polyp and normal inferior turbinate, the presence of MUC5AC and CLU was investigated using immunohistochemical stain and Western blot analysis. In mucin-producing human NCI-H292 airway epithelial cells and primary cultures of normal nasal epithelial cells, the effect and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathway of CLU on MUC5AC expression were investigated using immunohistochemical stain, reverse transcription-polymerase chain reaction, real-time polymerase chain reaction, enzyme immunoassay, and Western blot analysis. Results In the nasal polyps, MUC5AC and CLU were abundantly present in the epithelium on immunohistochemical stain, and nuclear CLU (nCLU) was strongly detected on Western blot analysis. In human NCI-H292 airway epithelial cells or the primary cultures of normal nasal epithelial cells, recombinant nCLU increased MUC5AC expression, and significantly activated phosphorylation of NF-κB. And BAY 11-7085 (a specific NF-κB inhibitor) and knockdown of NF-κB by NF-κB siRNA (small interfering RNA) significantly attenuated recombinant nCLU-induced MUC5AC expression. Conclusion These results suggest that nCLU induces MUC5AC expression via the activation of NF-κB signaling pathway in human airway epithelial cells.
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Affiliation(s)
- Chang Hoon Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Hyung Gyun Na
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Si-Youn Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Yong-Dae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea.,Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Korea
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Kavanagh FG, Hasan W, Smyth DA, Fenton JE. Polyps, grommets and eosinophilic granulomatosis with polyangiitis. J Laryngol Otol 2018; 132:236-9. [PMID: 29310745 DOI: 10.1017/S0022215117002444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore the link between nasal polyposis, refractory otitis media with effusion and eosinophilic granulomatosis with polyangiitis. METHODS A retrospective observational study was carried out of patients diagnosed with refractory otitis media with effusion necessitating grommet insertion and who had nasal polyps. Patients were evaluated to determine if they fulfilled the diagnostic criteria of eosinophilic granulomatosis with polyangiitis. RESULTS Sixteen patients (10 males and 6 females) were identified. The mean age of grommet insertion was 45.4 years. The mean number of grommets inserted per patient was 1.6. The mean number of nasal polypectomies was 1.7. All 16 patients had paranasal sinus abnormalities and otitis media with effusion, 14 had asthma, 9 had serological eosinophilia and 7 had extravascular eosinophilia. Nine patients met the diagnostic criteria for eosinophilic granulomatosis with polyangiitis. CONCLUSION The co-presence of nasal polyps and resistant otitis media with effusion should raise the possibility of eosinophilic granulomatosis with polyangiitis.
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Zhao QL, Yu L, Zhi LL, Jin P, Zi XX, Zhao L, Li A, Tu YY, Shi L, Zhang HP. The relationship between lung function and the clinical and histopathological features in Chinese patients with nasal polyps. J Laryngol Otol 2017; 131:880-8. [PMID: 28807078 DOI: 10.1017/S0022215117001657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate lung function in Chinese patients suffering from chronic rhinosinusitis with nasal polyps and examine its association with histopathological features. METHODS The lung function of 99 patients with nasal polyps was measured. Haematoxylin and eosin and immunohistochemistry staining were performed to evaluate any inflammatory cells and epithelial tissue remodelling. RESULTS Predicted maximal expiratory flow rate at 25 per cent vital capacity was reduced (p < 0.05) in epithelial hyperplasia, and predicted maximal expiratory flow rate at 50 per cent vital capacity was reduced (p < 0.05) in goblet cell hyperplasia. Both peripheral blood eosinophilia and tissue eosinophilia nasal polyps manifested significantly reduced: forced expiratory volume in 1 second/forced vital capacity ratio, predicted maximal expiratory flow rate at 25, 50 and 75 per cent of vital capacity, and predicted maximal mid-expiratory flow. Peripheral blood eosinophils were negatively correlated with predicted maximal expiratory flow rate at 25 and 50 per cent of vital capacity, and predicted maximal mid-expiratory flow. Eosinophils in tissue were negatively correlated with all lung function parameters investigated except predicted forced vital capacity. CONCLUSION Clinicians should be aware of lung function decline in nasal polyps patients, especially in those with tissue eosinophilia.
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Wood AJ, Zhou L, Wilkinson S, Douglas RG. Effectiveness of extensive sinus surgery with post-operative medical management for chronic rhinosinusitis. J Laryngol Otol 2017; 131:S19-24. [PMID: 28215205 DOI: 10.1017/S0022215116009361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To prospectively assess treatment outcomes of chronic rhinosinusitis patients undergoing functional endoscopic sinus surgery and post-operative medical treatment over a prolonged follow-up period. METHODS Patients undergoing functional endoscopic sinus surgery in the tertiary referral practice of a single surgeon were studied prospectively. Symptoms were scored by patients pre-operatively and over a minimum follow-up period of 12 months. RESULTS The study comprised 200 non-consecutive patients. The median pre-operative symptom score was 16 (out of a maximum of 25) (95 per cent confidence interval = 15 to 17). Symptom scores reduced to a median of 7 (95 per cent confidence interval = 6 to 8) after 12 months of follow up (p < 0.0001). The median symptom score improved for all symptoms and across all patient subgroups. CONCLUSION Extensive functional endoscopic sinus surgery offers significant and durable symptom improvement in patients with chronic rhinosinusitis refractory to medical treatment. This improvement extends to all patient subgroups. Prolonged medical therapy is recommended after functional endoscopic sinus surgery.
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Li QC, Cheng KJ, Wang F, Zhou SH. Role of atopy in chronic rhinosinusitis with nasal polyps: does an atopic condition affect the severity and recurrence of disease? J Laryngol Otol 2016; 130:640-4. [PMID: 27268094 DOI: 10.1017/S0022215116008112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of atopy in chronic rhinosinusitis is unclear: it is particularly controversial in chronic rhinosinusitis with nasal polyps. METHODS A prospective study of 210 patients with chronic rhinosinusitis with nasal polyps was performed. Patient demographics, visual analogue scale scores, Lund-Kennedy endoscopy scores, Lund-Mackay computed tomography scores, serum total immunoglobulin E levels, serum eosinophil cationic protein (ECP) levels and Phadiatop test findings were analysed. RESULTS There were no significant differences in age, sex, visual analogue scale score, Lund-Mackay computed tomography score, total serum immunoglobulin E level, serum ECP level or Phadiatop test results between patients with primary and recurrent chronic rhinosinusitis with nasal polyps. A total of 99 patients (47 per cent) had positive atopy tests. No significant differences in sex, visual analogue scale score, Lund-Kennedy endoscopy score, Lund-Mackay computed tomography score or recurrence rates were found between atopic and non-atopic patients; however, atopic patients were significantly younger than non-atopic patients. Atopy status did not correlate with disease severity. CONCLUSION There was no association between atopy status and either disease severity or recurrence in patients with chronic rhinosinusitis with nasal polyps, although atopic patients were younger than non-atopic patients.
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Emtiazi M, Jokar S, Sadeghmanesh R. Nasal Polyp in Iranian Traditional Medicine & Conventional Medicine. Iran J Med Sci 2016; 41:S44. [PMID: 27840510 PMCID: PMC5103552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND The prevalence of nasal polyp in the population has been estimated to be 0.5-4%. It is noticed that nasal polyp could have a negative impact on the patient's quality of life and indubitably exert a substantial cost on the society. It is observed that, in some cases, complete cure may not be achieved and relapse can occur. In Iranian traditional medicine (ITM), nasal polyp is called "bawaseer e anff" and ITM offers several treatments for it. METHODS In this review article the definition, signs, symptoms, and treatments of nasal polyp in conventional and traditional medicine are investigated and compared. The Canon of Medicine of Avicenna, liber Medicinalis Almansor of Rhazez, Tohfe Khani, and Makhazen Alta'lim were studied for ITM. Additionally, Google Scholar and PubMed were searched for conventional medicine. RESULTS The current common treatment for nasal polyp is by applying corticosteroids (locally or orally) and surgery. Definition, signs, symptoms, and prognosis (considering color, shape, consistency) of nasal polyp are described in ITM and its treatments (depending on the kind of polyp and the time from its incidence) are oral or local administration of drugs and using physical manipulations such as phlebotomy, leech therapy, and surgery. CONCLUSION According to the same definition of nasal polyp and "bawaseer e anff" in the texts, a combination of traditional and conventional treatments could be helpful in order to reduce relapse, surgery indications, and usage of corticosteroids.
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Affiliation(s)
- M. Emtiazi
- The School of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Ardakan, Yazd, Iran
| | - S.Z. Jokar
- The School of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Ardakan, Yazd, Iran
| | - R. Sadeghmanesh
- Department of Otolaryngology, Head and Neck Surgery, Rhinology Research Center, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
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Olivier F, George M, Leuba D, Monnier P, Friedrich JP. Long-term outcomes following functional endoscopic sinus surgery in Samter's triad. J Laryngol Otol 2015; 129:548-52. [PMID: 26074257 DOI: 10.1017/S0022215115000353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to assess the long-term outcome of functional endoscopic sinus surgery for Samter's triad patients using an objective visual analogue scale and nasal endoscopy. METHOD Using a retrospective database, 33 Samter's triad patients who underwent functional endoscopic sinus surgery were evaluated pre- and post-operatively between 1987 and 2007 in Hospital of La Chaux-de-Fonds, Switzerland. RESULTS A total of 33 patients participated in the study, and the mean follow-up period was 11.6 years (range 1.2-20 years). Patients were divided into two groups based on visual analogue scale scores of the five parameters with the greatest difference in intensity of symptoms between the beginning and end of follow up. Group 1 included patients with a mean visual analogue scale score of 6 and below at the end of follow up and group 2 included patients with a mean visual analogue scale score of more than 6. The only statistically significant difference noted between the two groups was the endonasal findings: stage III-IV polyposis was present in 1 out of 24 patients (4 per cent) in group 1 and in 5 out of 9 patients (56 per cent) in group 2. CONCLUSION The results of our study indicate that functional endoscopic sinus surgery helps stabilise disease progression. Stage III-IV polyposis had a significant adverse effect on long-term outcome.
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Abstract
OBJECTIVE Sinonasal tumors are a highly heterogeneous group of tumors that account for less than 1% of all cancers. Precise diagnosis is essential because the natural history, treatment, and prognosis vary for different neoplasms. We reviewed 610 cases of sinonasal lesions to understand this entity better. METHODS A total of 610 sinonasal biopsies/specimens were received over a period of 10 years (2004-14). All the samples were processed and stained with hematoxylin and eosin. Special staining for microorganisms and immunohistochemistry were performed where indicated. RESULTS Benign lesions were 72% with nasal polyp being the most common. Malignant lesions made up 21.2% of lesions with nasopharyngeal carcinoma being the most common while 7.7% cases were inflammatory/non-neoplastic. The most common cause for this was fungal sinusitis. The maxillary sinus was the most frequently involved site in all the lesions (62%). The average age of presentation was 40 years old, and the male to female ratio was 3:1 in those with benign tumors. The average age of presentation in the malignant and inflammatory group were 45 and 43 years, respectively, with an almost equal sex ratio in both categories. Computed tomography and magnetic resonance imaging scans were done in virtually all cases to assess the extent of the tumor as well as bony destruction. Local recurrence was the most frequent cause of treatment failure. CONCLUSION Tumors of the nasal cavity are often grouped with those in the paranasal sinuses. Benign tumors constituted approximately 75% of tumors in our hospital. Squamous cell carcinoma was the most common malignancy of this region. These tumors need to be studied closely and accurately because their proximity to vital structures pose significant challenges for their treatment and may be the source of significant patient morbidity.
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Affiliation(s)
- Nadia Shirazi
- Departments of Pathology, Swami Rama Himalayan University, Dehradun, India
| | - Sampan S Bist
- Ear, Nose, and Throat Department, Swami Rama Himalayan University, Dehradun, India
| | - Thamarai N Selvi
- Departments of Pathology, Swami Rama Himalayan University, Dehradun, India
| | - Meena Harsh
- Departments of Pathology, Swami Rama Himalayan University, Dehradun, India
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