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Caminati M, Senna G. Biologic Therapy in a Patient with Asthma and Nasal Polyps. J Allergy Clin Immunol Pract 2020; 7:1700-1701. [PMID: 31076065 DOI: 10.1016/j.jaip.2018.11.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Marco Caminati
- Asthma Center and Allergy Unit, Verona University Hospital, Piazzale Scuro, Verona, Italy.
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University Hospital, Piazzale Scuro, Verona, Italy
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Kim D, Kim YH, Kang JH, Park CS. Increased expression of nucleophosmin is associated with the pathophysiology of chronic rhinosinusitis with nasal polyposis. Auris Nasus Larynx 2020; 47:807-813. [PMID: 32139285 DOI: 10.1016/j.anl.2020.02.010] [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] [Received: 09/16/2019] [Revised: 01/31/2020] [Accepted: 02/17/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Nucleophosmin (NPM1) has been suggested to be involved in the pathophysiologic mechanism of inflammatory disorders. We measured the expression level of NPM1 in nasal polyp (NP) tissues of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). We also assessed the correlation between NPM1 expression and other parameters such as eosinophilic infiltration, inflammatory cytokines, and clinical indicators such as Lund-Mackay computed tomography (CT) score. METHODS Thirty patients with CRSwNP were included. We performed pre-operative CT scan to determine Lund-Mackay CT scores. During endoscopic sinus surgery, we harvested NP tissues from patients with CRSwNP. We performed Sirius red staining to evaluate eosinophilia and conducted immunohistochemical staining for NPM1 and real-time PCR for cytokines including interleukin (IL)-5, IL-17A, and IL-32. RESULTS The mRNA expression of NPM1 was significantly up-regulated in eosinophilic NP tissues (RQ 0.58 ± 0.06), compared to non-eosinophilic NP tissues (RQ 0.38 ± 0.08, p < 0.05). In the epithelium of NP tissue, a significant positive correlation was observed between eosinophilic infiltration and NPM1 expression. The expression of NPM1 was significantly correlated with that of IL-5 (r = 0.6229, p = 0.0004), IL-17A (r = 0.5971, p = 0.001), and IL-32 (r = -0.5985, p = 0.0068). There was no significant correlation between the mRNA expression of NPM1 and the Lund-Mackay CT score (Spearman r = -0.2563, p = 0.1879). CONCLUSION Expression of NPM1 was significantly increased in eosinophilic NP tissues from patients with CRSwNP. We observed an association between NPM1 expression and various pro-inflammatory cytokines such as IL-5, IL-17, and IL-32 and eosinophilic infiltration, which is thought to contribute to the pathophysiology of NP.
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Affiliation(s)
- Dana Kim
- Department of Pharmacology and Medicinal Toxicology Research Center, Incheon, South Korea; Hypoxia-Related Diseases Research Center, Inha University School of Medicine, Incheon, South Korea
| | - Young Hyo Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, Inha University School of Medicine, Incheon, Republic of Korea; Inha Institute of Aerospace Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
| | - Ju-Hee Kang
- Department of Pharmacology and Medicinal Toxicology Research Center, Incheon, South Korea; Hypoxia-Related Diseases Research Center, Inha University School of Medicine, Incheon, South Korea
| | - Chang-Shin Park
- Department of Pharmacology and Medicinal Toxicology Research Center, Incheon, South Korea; Hypoxia-Related Diseases Research Center, Inha University School of Medicine, Incheon, South Korea.
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do Amaral JB, Bloise AC, França CN, Perez-Novo C, Machado-Santelli GM, Alencar AM, Pezato R. Alterations in cellular force parameters and cell projections in Nasal polyps-derived fibroblasts. Auris Nasus Larynx 2019; 47:98-104. [PMID: 31272842 DOI: 10.1016/j.anl.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Received: 03/06/2019] [Revised: 06/07/2019] [Accepted: 06/20/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a disease that features a mechanical dysfunction involving chronic inflammation and altered tissue remodeling. In this study, we aim to evaluate the fibroblast morphology and its cellular traction force in primary fibroblasts cell cultures obtained from both healthy individuals (n=7) and patients with CRSwNP (n=8). METHODS Using a Traction-force Microscopy we analyzed parameters of Force/Tension in fibroblasts cultures in both experimental groups. RESULTS The analysis of the Projected Area of Cell revealed that fibroblasts derived from nasal mucosa of healthy individuals have an area on average 39.24% larger than the fibroblasts obtained from the nasal polyp tissue. We also observed that the parameters directly related to the force of the cell, Max Cumulative Force and Net Contractile Moment, presented a high Force/Tension per unit of area in the fibroblasts derived from the healthy nasal mucosa (on average 41% and 52.54% higher than the fibroblasts of the nasal polyp respectively). CONCLUSION Our results demonstrate a cellular mechanism that may be associated with the mechanical dysfunction found in the Nasal Polyp tissue. The weak traction force of nasal polyp-derived fibroblast may, in lower dimensions, impact on the remodeling of nasal mucosa in CRSwNP.
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Affiliation(s)
- Jônatas Bussador do Amaral
- ENT Research Lab., Department of Otorhinolaryngology - Head and Neck Surgery, Federal University of Sao Paulo, Rua Coronel Lisboa, 958, Vila Clementino, São Paulo, SP, 04020-041, Brazil.
| | - Antonio Carlos Bloise
- Institute of Physics, University of Sao Paulo, Rua do Matão, Travessa R Número 187, Cidade Universitária, São Paulo, SP 05508-090, Brazil
| | - Carolina Nunes França
- Universidade Santo Amaro, Pós Graduação em Ciências da Saúde, Rua Enéas de Siqueira Neto, 340 Jardim das Imbuias, São Paulo, SP 04829-300, Brazil
| | - Claudina Perez-Novo
- Laboratory of Proteinchemistry, Proteomics and Epigenetic Signalling Department of Biomedical Sciences, Campus Drie Eiken, building T, first floor Universiteitsplein 1 2610 Wilrijk University of Antwerp, Belgium
| | - Gláucia Maria Machado-Santelli
- Department of Cell and Developmental Biology, Institute of Biomedical Sciences, University of Sao Paulo, Avenida Prof Lineu Prestes, 1524, dade Universitária, Sao Paulo, SP 05508-900, Brazil
| | - Adriano Mesquita Alencar
- Institute of Physics, University of Sao Paulo, Rua do Matão, Travessa R Número 187, Cidade Universitária, São Paulo, SP 05508-090, Brazil
| | - Rogério Pezato
- ENT Research Lab., Department of Otorhinolaryngology - Head and Neck Surgery, Federal University of Sao Paulo, Rua Coronel Lisboa, 958, Vila Clementino, São Paulo, SP, 04020-041, Brazil
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Brescia G, Zanotti C, Parrino D, Barion U, Marioni G. Nasal polyposis pathophysiology: Endotype and phenotype open issues. Am J Otolaryngol 2018; 39:441-444. [PMID: 29550078 DOI: 10.1016/j.amjoto.2018.03.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [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] [Received: 02/22/2018] [Accepted: 03/06/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Endotyping chronic rhinosinusitis with nasal polyps (CRSwNP) poses a challenge for rhinologists nowadays. Phenotyping CRSwNP proved inappropriate as an approach to their classification because of their common clinical features. Endotyping, being based on the pathogenic mechanism, provides a precise picture more appropriate for use in clinical practice. Patients' treatment and follow-up can thus be tailored to cope with the degree of aggressiveness of a specific CRSwNP endotype. The aim of this study was to analyze the available information about the main currently accepted endotypes of CRSwNP; furthermore, we reported and commented evidence regarding some clinical conditions associated with nasal polyposis which could be related with new endotypes. MATERIALS AND METHODS Pubmed and Scopus electronic database were searched. The main available studies about CRSwNP endotyping published predominantly in the last 5 years were critically analyzed. RESULTS The pathophysiological features of some asthma-related CRSwNP (allergic fungal rhinosinusitis, aspirin-exacerbated respiratory disease) are quite well understood, including them among known endotypes of CRSwNP. On the other hand, because of their known pathophysiological mechanisms, some well-known diseases associated with aggressive forms of CRSwNP, such as eosinophilic granulomatosis with polyangiitis, primary ciliary dyskinesia and cystic fibrosis, should be investigated as potentially related with CRSwNP endotypes. CONCLUSIONS CRSwNP comprises several inflammatory endotypes defined by different pathogenic mechanisms. These endotypes correlate with the disease's clinical manifestations and behavior. A thorough understanding of CRSwNP endotypes will enable targeted medical therapies and tailored follow-up protocols.
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Affiliation(s)
- Giuseppe Brescia
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy.
| | - Claudia Zanotti
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Daniela Parrino
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Umberto Barion
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Gino Marioni
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
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Park SK, Jin SY, Yeon SH, Lee SB, Xu J, Yoon YH, Rha KS, Kim YM. Role of Toll-like receptor 9 signaling on activation of nasal polyp-derived fibroblasts and its association with nasal polypogenesis. Int Forum Allergy Rhinol 2018; 8:1001-1012. [PMID: 29901280 DOI: 10.1002/alr.22155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/10/2018] [Accepted: 05/14/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nasal polyposis is characterized by persistent inflammation and remodeling in sinonasal mucosa. Toll-like receptor 9 (TLR9) is a DNA receptor of the innate immune system that plays a pivotal role in fibrosis and inflammatory responses. The aim of this study is to explore the expression, activity, and potential pathogenic role of TLR9 signaling in tissue remodeling in nasal polyp-derived fibroblasts (NPDFs). METHODS Fibrotic and inflammatory responses elicited by type A CpG oligonucleotides were examined in the NPDFs by a combination of real-time quantitative polymerase chain reaction, Western blot analysis, enzyme-linked immunosorbent assay, and immunofluorescence staining. For these experiments, the NPDFs were stimulated with different TLR9 agonists (CpG A and B) and blocked with inhibitors (MyD88 inhibitor and chloroquine). RESULTS TLR9 expression was significantly higher in nasal polyposis (NP) tissues compared to control or chronic rhinosinusitis (CRS) mucosa. In the NPDFs, TLR9 showed intracellular localization and expression of TLR9 was increased after treatment with CpG A. CpG A increased production of α-smooth muscle actin (α-SMA), fibronectin, and matrix metalloproteinases (MMPs) (MMP1, MMP2, and MMP9) in the NPDFs, while MyD88 inhibitor and chloroquine, which are known to block the TLR9 signaling pathway, inhibited their production. CpG A also produced type I interferons (IFN-α and IFN-β), which were inhibited by MyD88 inhibitor. CONCLUSION Our data indicates that CpG A-induced fibroblast activation and cytokine production were mediated via TLR9 stimulation in NPDFs. Disrupting this process with an inhibitor targeting TLR9 or its downstream signaling pathways could represent a novel approach to CRS with NP (CRSwNP) therapy.
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Affiliation(s)
- Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
| | - Soung Yong Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sun Hee Yeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sung Bok Lee
- Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jun Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Yanbian University Hospital, Yanji, China
| | - Young Hoon Yoon
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ki Sang Rha
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
| | - Yong Min Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
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Winblad L, Larsen CG, Håkansson K, Abrahamsen B, von Buchwald C. The risk of osteoporosis in oral steroid treatment for nasal polyposis: a systematic review. Rhinology 2017; 55:195-201. [PMID: 28492609 DOI: 10.4193/rhino15.367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/02/2023]
Abstract
BACKGROUND Systemic glucocorticoids are often used in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), and osteoporosis is a well-known complication to steroid treatment, associated with significant morbidity. Nevertheless, the burden of steroid induced osteoporosis is unknown in patients with CRSwNP. We aimed to assess the risk of acquiring osteoporosis caused by oral steroids in patients with CRSwNP, and provide recommendations on future research and guidelines. METHODOLOGY Cochrane Review Database, EMBASE, Ovid Medline, and PubMed were searched for studies including adult patients with CRSwNP treated with oral steroids. Outcomes were Bone Mineral Density (BMD) and prevalence of fractures in relation to dose and duration of oral steroids. In addition, we reviewed general guidelines for treatment with oral steroids. RESULTS We identified two studies (n=243) that met the inclusion criteria. Doses and durations of oral steroids were over 5 mg/day for more than 3 months and 1 mg/kg body weight/day for 6 to 10 days for 4 or more courses/year. The prevalence of low bone mass was 39% and 61%, respectively. It was not possible to quantify the overall risk of osteoporosis induced by oral steroids from the studies. No studies evaluated prevalence of fracture. CONCLUSIONS Registry studies and randomized controlled trials would be needed to assess the risk of osteoporosis in CRSwNP patients and future guidelines should include recommendations regarding preventive treatment and recommendations on doses and durations of oral steroids.
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Affiliation(s)
- L Winblad
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - C G Larsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - K Håkansson
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - B Abrahamsen
- Department of Medicine, Holbaek Hospital, DK-4300 Holbaek, Odense Patient Data Explorative Network, University of Southern Denmark and Odense University Hospital, DK-5000 Odense C, Denmark
| | - C von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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Minwegen F, Thomas JP, Bernal-Sprekelsen M, Dazert S, Minovi A. Predictive value of disease severity on self-reported rating and quantitative measures of olfactory function outcomes after primary endoscopic sinus surgery. A prospective study. Rhinology 2017; 52:437-43. [PMID: 25479229 DOI: 10.4193/rhino14.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This prospective study investigates the influence of primary Endoscopic Sinus Surgery (ESS) in patients with chronic rhinosinusitis (CRS) on olfactory function and on the patients' quality of life. We assess the role of preoperative disease severity measured by computed tomography (CT) scan in predicting outcome. METHODOLOGY Adults undergoing ESS were examined preoperatively (n=92) and five months postoperatively. Coronal CT scans were evaluated referencing the Lund Mackay (LM) system. On the basis of the LM score, the collective was divided into two groups. We performed the olfactory test "Sniffin' Sticks" and handed out the specific health-related quality of life questionnaire SNOT-20. RESULTS We could demonstrate that olfactory function of patients with strong opacification on CT scans improved by an average of 2.49 points more than olfactory function of patients with less severe disease. In terms of the self-reported rating of smell, the degree of amelioration differed significantly. Both groups showed an improvement in quality of life irrespective of severity of disease. CONCLUSION Mean olfactory function of patients with a high degree of disease in CT scan improved more than that of patients with less opacification on CT scan. Patient's subjective perception of smell impairment was in line with these findings.
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Uz U, Günhan K, Yılmaz H, Ünlü H. The evaluation of pattern and quality of sleep in patients with chronic rhinosinusitis with nasal polyps. Auris Nasus Larynx 2017; 44:708-712. [PMID: 28442168 DOI: 10.1016/j.anl.2017.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Received: 08/16/2016] [Revised: 12/06/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The goal of this study is to evaluate the impact of chronic rhinosinusitis with nasal polyps (CRSwNP) on sleep pattern and sleep quality before and after functional endoscopic sinus surgery using subjective and objective parameters. METHODS Twenty-two patients with CRSwNP were evaluated. All subjects underwent assessment by nasal endoscopy, rhinomanometry and computed tomography. Sleep pattern and sleep quality were evaluated by Pittsburgh sleep quality index (PSQI) and polysomnography (PSG). All patients were reassessed 6 months after surgery. RESULTS Nasal resistance decreased after the surgery (p<0.001). Postoperative PSQI scores were significantly lower than preoperative scores (p<0.001). The preoperative mean values of total apnea index and apnea-hypopnea index were 25.4 and 13.3, respectively. After surgery, the total apnea and apnea-hypopnea index had decreased significantly to 7.8 and 11.2, respectively (p=0.009 and 0.019, respectively). CONCLUSION In patients with CRSwNP, functional endoscopic sinus surgery significantly ameliorates sleep pattern and sleep quality. CRSwNP may be a predisposing factor for sleep related respiratory disorders.
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Affiliation(s)
- Uzdan Uz
- Department of Otorhinolaryngology, Bayindir Government Hospital, 35840, Bayindir, Izmir, Turkey.
| | - Kıvanç Günhan
- Department of Otorhinolaryngology, Celal Bayar University, 45010, Uncubozkoy, Manisa, Turkey
| | - Hikmet Yılmaz
- Department of Neurology, Celal Bayar University, 45010, Uncubozkoy, Manisa, Turkey
| | - Halis Ünlü
- Department of Otorhinolaryngology, Ekol Hospital, 35640, Çigli, İzmir, Turkey
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Xu J, Han R, Kim DW, Mo JH, Jin Y, Rha KS, Kim YM. Role of Interleukin-10 on Nasal Polypogenesis in Patients with Chronic Rhinosinusitis with Nasal Polyps. PLoS One 2016; 11:e0161013. [PMID: 27584662 PMCID: PMC5008817 DOI: 10.1371/journal.pone.0161013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/28/2016] [Indexed: 01/28/2023] Open
Abstract
Background and Objectives Interleukin 10 (IL-10) is a potent anti-inflammatory cytokine. The dysregulation of IL-10 is associated with an enhanced immunopathologic response to infection, as well as with an increased risk for developing numerous autoimmune diseases. In this study, we investigated IL-10 expression in chronic rhinosinusitis with nasal polyps (CRSwNP) and assessed the possible role of IL-10 in the pathogenesis of CRSwNP. Materials and Methods Thirty-five patients with CRSwNP, 12 patients with chronic rhinosinusitis without NP (CRSsNP) and 10 control subjects were enrolled in this study. NP tissues and uncinated tissues (UT) were collected for analysis. Dispersed NP cells (DNPCs) were cultured in the presence or absence of IL-25 and IL-10, and a flow cytometric assay was performed to identify the constitutive cell populations of the DNPCs. Murine NP (n = 18) models were used for the in vivo experiments. Real-time PCR, immunohistochemistry, western blotting analysis and ELISA were performed to measure the expression levels of the selected inflammatory cytokines and inflammation-associated molecules. Results The mRNA expression levels of IL-10, IL-5, IL-17A, IL-25 and interferon gamma (IFN-γ) were significantly higher in the NP tissues than in the UT tissues. Strong positive correlations were observed between IL-10 and a variety of inflammatory cytokines (IL-5, IL-17A, IL-25, IFN-γ) and inflammation-associated molecules (B-cell activating factor; BAFF, CD19). Other than the IL-25 to IL-10 ratio, the expression ratios of the other measured inflammatory cytokines to IL-10 were significantly lower in the CRSwNP group than in the CRSsNP or control groups. Administrating IL-25 into the cultured DNPCs significantly increased the production of IL-10, but administrating IL-10 had no effect on the production of IL-25. Conclusion Increased expression of IL-10, IL-10 related inflammatory cytokine, and IL-10 related B cell activation indicated that IL-10, a potent anti-inflammatory cytokine, has a pivotal role in the pathogenesis of CRSwNPs.
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Affiliation(s)
- Jun Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Yanbian University Hospital, Yanji, China
| | - Ruining Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Yanbian University Hospital, Yanji, China
| | - Dae Woo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Hun Mo
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Chonan, Korea
| | - Yongde Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Yanbian University Hospital, Yanji, China
| | - Ki-Sang Rha
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
| | - Yong Min Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
- * E-mail:
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Karlidağ T, Ilhan N, Kaygusuz I, Keles E, Yalçin S, Yildiz M. Roles of Free Radicals, Nitric Oxide, and Scavenging Enzymes in Nasal Polyp Development. Ann Otol Rhinol Laryngol 2016; 114:122-6. [PMID: 15757191 DOI: 10.1177/000348940511400207] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/16/2022]
Abstract
The aim of this study was to investigate the role of nitric oxide (NO), free oxygen radicals, and scavenging enzymes in the development of nasal polyp (NP) disease. This study included 41 patients who underwent endoscopic surgery because of NPs. Control specimens were taken from the inferior turbinate of 32 patients who underwent septoplasty. The levels of malondialdehyde (MDA), NO, and superoxide dismutase (SOD) were measured in intraoperative specimens of polyp tissue and turbinate mucosa. The levels of tissue NO were 191.06 ± 26.62 μmol/mg of protein in patients with NPs and 145.30 ± 19.19 μmol/mg of protein (p < .001) in the control group. The levels of MDA in the study and control groups were 12.47 ± 2.12 nmol/mg and 8.83 ± 1.08 nmol/mg (p < .01), respectively. The levels of SOD in the study and control groups were 50.77 ± 14.74 U/mg and 77.93 ± 15.31 U/mg (p < .001), respectively. It was determined that the levels of MDA in plasma and erythrocytes were higher in the patients with NPs than in the control group (p < .05). The levels of NO in plasma and erythrocytes in both groups were similar. The levels of SOD in plasma and erythrocytes were lower in patients with NPs than in the control group (p > .05). Increases in the levels of tissue MDA and NO and decreases in scavenging enzymes in patients with NPs as compared to control groups may indicate the presence of free radical damage in patients with nasal NPs. New studies are needed to clarify the efficacy of using antioxidants in the treatment of NPs.
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Affiliation(s)
- Turgut Karlidağ
- Department of Otorhinolaryngologyz) and Biochemistry, Medical Faculty, Firat University, Elaziğ, Turkey
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Li X, Tao Y, Li X. Expression of MMP-9/TIMP-2 in nasal polyps and its functional implications. Int J Clin Exp Pathol 2015; 8:14556-14561. [PMID: 26823777 PMCID: PMC4713563] [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] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/28/2015] [Indexed: 06/05/2023]
Abstract
Nasal polyps (NP) involve tissue repair and structural remodel, both of which require the extracellular matrix. Matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) are known regulators for tissue reconstruction. This study therefore aimed to analyze the expressional profile of MMP-9 and TIMP-2 in NP patients, with further investigation of their roles in pathogenesis. A total of 60 NP tissue samples (including 15 type I, 21 type II and 24 type III) were collected from surgeries in our hospital, in addition to 6 normal ethmoid sinus mucosa samples. The mRNA and protein expression levels of MMP-9/TIMP-2 were quantified by real-time PCR and Western blotting, respectively. Serum levels were also checked by enzyme-linked immunosorbent assay (ELISA). Both mRNA and protein levels of MMP-9 in NP tissues or serum were significantly elevated compared to those in control ones (P<0.05) while the TIMP-2 expression was suppressed (P<0.05). In patients with more advanced stage, MMP-9 expression was further elevated, with lowered TIMP-2 levels (P<0.05 in both cases). Pathogenesis and progression of NP is closely related with elevated MMP-9 and suppressed TIMP-2 expression, suggesting the role of those factors as indexes for evaluating NP stage. Our results also provide evidences for further studies of pathogenesis and drug targets of NP.
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Affiliation(s)
- Xuechang Li
- Department of Otolaryngolgogy, Qilu Hospital of Shandong UniversityJinan 250012, China
- Department of Otorhinolaryngology, Weifang People’s HospitalWeifang 261041, Shandong, China
| | - Yanli Tao
- Department of Otorhinolaryngology, Weifang People’s HospitalWeifang 261041, Shandong, China
| | - Xuezhong Li
- Department of Otolaryngolgogy, Qilu Hospital of Shandong UniversityJinan 250012, China
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Liu Y. [Study on the correlation between the severity of chronic rhinosinusitis and bronchial asthma and pulmonary function]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 29:1206-1208. [PMID: 26540926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the correlation between the severity of patients with rhinitis-nasosinusitis and the bronchial asthma and the pulmonary function. METHOD Sixty-four cases of patients with rhinitis-nasosinusitis and 53 cases of patients with chronic sinusitis from June 2012 to September 2013 were randomly selected, and the patients were divided into group of rhinitis-nasosinusitis with nasal polyps and group of chronic sinusitis according to disease species, and analyzed the correlation between the severity of the deseases and the changes of the pulmonary function respectively for the patients of two groups by using Spearman method. RESULT The incidence of asthma for patients with different levels of sinusitis and nasal polyps seemed no significant difference (P > 0.05); the incidence of allergic rhinitis also seemed no significant difference (P > 0.05); the incidence of asthma for patients with different lesion range of sinusitis and nasal polyps seemed no significant difference (P > 0.05); the incidence of allergic rhinitis also seemed no significant different (P < 0.05). The conditions of the patients with different levels of sinusitis and nasal polyps were directly related to the reduction of pulmonary function (r = 2.431, P < 0.05); The conditions of the patients with different lesion range of sinusitis were directly related to the reduction of pulmonary function (r = 2.641, P < 0.05). CONCLUSION There was some correlation between the severity of patients with rhinitis-nasosinusitis and the bronchial asthma and the condition of pulmonary function of patients.
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Zhang G, Zhang J, Shi W, Sun P, Lin P. [Relationship between allergic factors and eosinophilic nasal polyps]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 29:1098-1100. [PMID: 26514000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the effects of allergic factores in eosinophilic nasal polyps. METHOD Clinical characters of 67 eosinophilic nasal polyps patients and 26 lymphocyte nasal polyps patients were restrospeetively analyzed. Allergic factors, allergens and nasal anatomic variations were compared between two groups. RESULT Allergic factors are proned to present in eosinophilic nasal polyps group compared with lymphocyte nasal polyps group; The positive rates of allergen skin test between eosinophilic nasal polyps group and lymphocyte nasal polyps group showed significant difference; Allergens in eosinophilic nasal polyps group are different from lymphocyte nasal polyps group; Nasal anatomic variations are different between two groups. CONCLUSION Different pathogenesis maybe exist in different pathological type nasal polyps. Allergic factors are closely relative to eosinophilic nasal polyps and nasal anatomic variations play a more important role in the formation of lymhocyte nasal polyps.
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Pezato R, Voegels RL, Pinto Bezerra TF, Perez-Novo C, Stamm AC, Gregorio LC. Mechanical disfunction in the mucosal oedema formation of patients with nasal polyps. Rhinology 2014; 52:162-6. [PMID: 24932629 DOI: 10.4193/rhino13.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nasal polyposis (NP) is characterized by an anomalous tissue growth with oedema and a lack of extracellular matrix. In this study, we investigated whether a mechanical disfunction of the forces that act in oedema formation is present in NP. METHODS We compared the interstitial hydrostatic pressure behaviour during a saline solution infusion between healthy nasal mucosa (inferior and middle turbinate from 10 patients) and inflamed nasal mucosa from NP patients (inferior, middle turbinate and a nasal polyp from 6 patients). We used Controlled Disc Stimulation equipment to compare the curve Pressure/Volume created during the saline solution infusion. RESULTS The pressure at 0.2 ml infusion was lower in the middle turbinate of NP patients than in the middle turbinate of control patients. The lowest P/V mean assessed was in the polypoid tissue. CONCLUSIONS The interstitial hydrostatic pressure showed different behaviour during liquid infusion in nasal mucosa from NP patients when compared with healthy nasal mucosa. This study allows us to cogitate on a new pathophysiological mechanism contributing to the development of the NP.
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Nagouas C, Bastier PL, De Gabory L. Respiratory epithelial adenomatoid hamartomas and olfactory function. Rev Laryngol Otol Rhinol (Bord) 2014; 135:191-195. [PMID: 26521367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Respiratory epithelial adenomatoid hamartoma can occur alone or associated with several diseases with very different pathological processes. Our hypothesis is that REAH is a non-specific reaction of the nose when olfaction is impaired. MATERIAL AND METHOD This is a retrospective study including all patients with HERA operated in an academic ENT department. Data analysis focused on the pre and post-operative olfaction, corticosteroids consumption, histological results of the polyps, the evolution of the disease allowing a comparison of HERA with or without polyps and comparison of data literature. RESULTS 28 patients suffered from REAH of which 18 are associated with polyps. Nineteen patients had inflammatory disease with a 9 year interval between initial diagnosis and surgery of REAH. Olfactory function was improved after surgery (p < 0.01). The cell content of the polyps showed eosinophilic infiltration in 8 patients which 6 were correlated with inflammatory disease. Lymphoplasmacytic infiltration was present in 10 patients which 8 were correlated with inflammatory disease. Nasal corticosteroid consumption decreased after surgery (p < 0.02). The mean follow-up after surgery was 34 ± 43 months. Polyp recurrence rate was 11% (3 patients), and 0% for REAH. CONCLUSION In most cases, olfactory function, cellular infiltration and polyp recurrence rate are not correlated with the pathophysiological inflammatory processes that coincides with REAH. Therefore, the co-existence of nasal polyposis with REAH is probably overestimated.
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Mihalj H, Loncar MB, Mihalj M, Zubcić Z, Vceva A, Bujak M, Males J, Marić A. Influence of allergy and bacterial colonization on the quality of life in nasal polyposis patients. Coll Antropol 2013; 37:1139-1146. [PMID: 24611326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Allergies and bacterial colonization are frequently found in patients with chronic rhinosinuitis with nasal polyposis (CRSwNP). The aim of this study was to identify patients with allergy and present microorganisms in ethmoid sinus among the patients with refractory CRSwNP undergoing surgical treatment at the University Hospital Centre Osijek, and to compare their life quality, defined by SNOT-20 analysis (sinonasal outcome test) to the rest of patients, and a control group consisting of patients undergoing septoplasty but free of allergy and/or CRS. An additional aim was to identify specific types and strains of microorganisms (bacteria and fungi) found in these patients, in order to compare them to other reports, and to revise the empirical antimicrobial therapy. In this paper we demonstrate a high incidence of bacterial colonization (83.3%) among CRSwNP patients. As in previous studies, gram positive aerobes were the most frequently isolated bacteria and all of them were covered by specific antibiotics given before the specimen collection. Allergy was found in only 20% of these patients, who presented with a reduced quality of life when compared to the control group and CRSwNP without allergy. Significantly more frequent dominant symptoms in these patients were cough, frustration and irritation. In the line with this finding is the objective assessment by endoscopy (Malm score) that showed more prominent nasal polyposis in allergy patients.
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Affiliation(s)
- Hrvoje Mihalj
- University Josip Juray Strossmayer, University Hospital Centre Osijek, Department of Otorhinolaryngology and Head and Neck Surgery, Osijek, Croatia.
| | - Mirela Baus Loncar
- Institute, Ruder Bosković, Department of Molecular medicine, Zagreb, Croatia
| | - Martina Mihalj
- University Josip Juray Strossmayer, School of Medicine, Department of Physiology and Immunology, Osijek, Croatia
| | - Zeljko Zubcić
- University Josip Juray Strossmayer, University Hospital Centre Osijek, Department of Otorhinolaryngology and Head and Neck Surgery, Osijek, Croatia
| | - Andrijana Vceva
- University Josip Juray Strossmayer, University Hospital Centre Osijek, Department of Otorhinolaryngology and Head and Neck Surgery, Osijek, Croatia
| | - Maro Bujak
- Institute, Ruder Bosković, Department of Molecular medicine, Zagreb, Croatia
| | - Josip Males
- University Josip Juray Strossmayer, University Hospital Centre Osijek, Department of Otorhinolaryngology and Head and Neck Surgery, Osijek, Croatia
| | - Andela Marić
- University Josip Juray Strossmayer, School of Medicine, Department of Anatomy and neuroscience, Osijek, Croatia
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Abstract
BACKGROUND Many studies in literature point out that inflammation related to nasal polyp is mostly dependent on eosinophils and their inflammatory products. Beside eosinophils, platelets may have a role in nasal polyp development. Platelets are involved in haemostasis, tissue repairing and inflammation. However, to our knowledge, there are no reports in the literature that study the association between platelet parameters and nasal polyps. SUBJECTS AND METHODS Forty-three patients with nasal polyps and forty-nine healthy controls were enrolled in the study, retrospectively. Laboratory data of patients with nasal polyp were obtained at the time of diagnosis. RESULTS There were no statistically significant differences between the two groups in terms of white blood count, haemoglobin, haematocrit and platelet count. The mean platelet volume (MPV) value of the nasal polyp group was significantly lower than the control group (p = 0.025). Mean eosinophil count was significantly elevated in the nasal polyp group compared to the control group (p < 0.001). CONCLUSIONS Reduction in MPV may be an indicator for nasal polyp formation. Further studies with a larger study population are needed to detect the possible correlation between eosinophil count and MPV values in patients with nasal polyps.
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Affiliation(s)
- G Aktas
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey.
| | - M Sit
- Department of General Surgery, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - H Tekce
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - A Alcelik
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - H Savli
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - T Simsek
- Department of Otolaryngology, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - E Ozmen
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - A Z Isci
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - T Apuhan
- Department of Otolaryngology, Abant Izzet Baysal University Hospital, Bolu, Turkey
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Gu X, Ye P, Chen FY, Chen YL, Yang Y, Zhang LQ, Shi L. [Clinical significance of pulmonary function test in patients with chronic rhinosinusitis with nasal polyps]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013; 48:244-247. [PMID: 23755793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the incidence and severity of pulmonary function impairment in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS In this prospective study, fifty-six patients with bilateral CRSwNP who were scheduled for functional endoscopic sinus surgery during a period from March to June 2010 in the Department of Otolaryngology of Qilu Hospital, were recruited in this study. Routine medical and rhinological examinations such as nasal endoscopy, sinus CT scan, and skin prick tests (SPT) for common inhalant and food allergens, and cytological examination of the paraffin-embedded NP tissues were performed together with a full assessment of the pulmonary functions. RESULTS Based on the pulmonary function tests, the rate of patients showing bronchial hyperresponsiveness (BHR), asthma, and abnormal pulmonery functions were 37.5%, 44.6%, and 53.6%. In patients who did not have a history of lower airway symptoms, the rate of abnormal pulmonary functions was 50.0%, the rate of BHR was 43.2%. There was an increased rate of BHR, asthma and abnormal pulmonary functions in patients with a higher polyp grading score or Lund Mackay CT scan score (polyp grading score: χ(2) were 8.077, 3.989 and 7.445, P < 0.01 or < 0.05. CT scan score: χ(2) were 3.863, 5.380 and 4.309; 4.293, 4.293 and 4.572; 10.572, 13.504 and 13.295, P < 0.01 or < 0.05). The rate of BHR and asthma in patients with positive SPT were higher (P < 0.05). In patients with eosinophils hyperplasia in nasal polyps, the rate of BHR, asthma and abnormal pulmonary functions were higher (χ(2) were 4.065, 5.217 and 3.376, P < 0.05 or P < 0.01). CONCLUSIONS There is a high risk of developing lower airway diseases in patients with CRSwNP.
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Affiliation(s)
- Xiao Gu
- Department of Otorhinolaryngology, Linyi People's Hospital, Linyi 276000, China
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De Régloix S, Baumont L, Lisan Q, Raynal M, Lepage P, Pons Y. [Nasal polyposis and olfactory function: results of the surgical treatment]. Rev Laryngol Otol Rhinol (Bord) 2013; 134:145-148. [PMID: 24974407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Hyposmia is a common cause of functional complaint in patients with nasal polyposis. The aim of the current study was to report the olfactory functional results after sinus surgery. MATERIALS AND METHODS A systematic review of the scientific literature was achieved in the Pubmed database. RESULTS Overall, 10 series published between 1989 and 2013, involving 959 patients, were selected. The surgery for nasal polyposis, adjuvant medical treatment, may allow olfactory improvement. The results are even better than surgery is as wide as possible and the evolutionary stage is low.
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Ciprandi G, Capasso M, Tosca M, Salpietro C, Salpietro A, Marseglia G, Miraglia del Giudice M, La Rosa M. Rhinitis and lung function in asthmatic children. Clin Exp Allergy 2012; 42:481-2. [PMID: 22356146 DOI: 10.1111/j.1365-2222.2011.03908.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Bobacheva TI. [The treatment of chronic polypous rhinosinusitis in the postoperative period with low doses of clarithromycin]. Vestn Otorinolaringol 2012:68-72. [PMID: 23011378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of this work was to study efficacy and safety of long-term low-dose clarithromycin therapy of chronic polypous rhinosinusitis during 6 months after endoscopic polyposinusotomy. 112 patients aged 25-65 yr were randomized in groups 7 days after surgery. Those in group 1 (n=66) received topic corticosteroid treatment in combination with clarithromycin (250 mg/day for 3 mo). The use of clarithromycin significantly decreased the number of clinical symptoms and improved quality of life. CT examination showed significant reduction in the frequency of relapses, episodes of acute respiratory viral infections, and their bacterial complications. All these effects persisted for 3 mo after withdrawal of clarithromycin.
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Sagit M, Cetinkaya S, Dogan M, Bayram A, Vurdem UE, Somdas MA. Mean platelet volume in patients with nasal polyposis. B-ENT 2012; 8:269-272. [PMID: 23409556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE To investigate whether mean platelet volume (MPV) levels rise in patients with nasal polyposis (NP) and whether higher MPV levels are correlated to the extension of polyps in these patients. MATERIALS AND METHODS This study included 50 patients with NP and 40 age- and sex-matched healthy subjects as controls. The Lund-Mackay staging system was used to assess paranasal sinus computed tomography (CT) scans in patients with NP, and paranasal sinus CT scores were recorded. MPV was measured in a blood sample collected in EDTA tubes and was also used for whole blood counts in all patients. The Mann-Whitney U-test and Student's t-test were used to compare the results of the two groups. RESULTS NP patients had higher MPV levels than the control group (9.60 +/- 1.06 fl and 8.77 +/- 0.88 fl, p < 0.001 respectively). However, there was no significant correlation between MPV and paranasal sinus CT scores. CONCLUSION To our knowledge, this is the first study to investigate MPV levels in patients with NP. Our results suggest that MPV, a determinant of platelet activation, is elevated in patients with NP. Increased platelet activation may be related to an increase in cardiovascular risk in patients with NP.
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Affiliation(s)
- M Sagit
- Department of ENT, Kayseri Training and Research Hospital.
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Nordin S, Blomqvist EH, Olsson P, Stjärne P, Ehnhage A. Effects of smell loss on daily life and adopted coping strategies in patients with nasal polyposis with asthma. Acta Otolaryngol 2011; 131:826-32. [PMID: 21595508 DOI: 10.3109/00016489.2010.539625] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [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: 11/13/2022]
Abstract
CONCLUSIONS Results from prior studies of quality of life (QoL) in heterogeneous patient groups (regarding disorder type and etiology) with olfactory disorders may be useful also for understanding QoL in homogeneous patient groups. Diagnosis and treatment of smell loss should be given high priority in polyposis with asthma, and coping strategies can be suggested to these patients. OBJECTIVES To investigate the effects of smell loss on daily life and coping strategies in patients with smell loss without dysosmia and with nasal polyposis with asthma as the only primary etiology, and to compare these results with those from a prior study of a patient group with heterogeneous olfactory disorders and etiology. METHODS Fifty patients with smell loss and with nasal polyposis and asthma responded to questions about consequences of smell loss, QoL, psychological well-being and distress, and coping strategies. RESULTS Negative consequences of smell loss, associated risks, and diminished food enjoyment were commonly reported, and various aspects of QoL were rated as being deteriorated. Psychological well-being was found to be poorer than normal, and use of both problem- and emotion-focused strategies was common. The results from this homogeneous patient group are very similar to those previously obtained from a heterogeneous group.
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Affiliation(s)
- Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden.
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Krysko O, Holtappels G, Zhang N, Kubica M, Deswarte K, Derycke L, Claeys S, Hammad H, Brusselle GG, Vandenabeele P, Krysko DV, Bachert C. Alternatively activated macrophages and impaired phagocytosis of S. aureus in chronic rhinosinusitis. Allergy 2011; 66:396-403. [PMID: 20973804 DOI: 10.1111/j.1398-9995.2010.02498.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [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: 01/01/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by biased Th2 inflammation and CRS without nasal polyps (CRSsNP) by a Th1 immune response. Colonization by Staphylococcus aureus is increased in CRSwNP. We aimed to determine macrophage phenotypes in nasal mucosa of CRSwNP and CRSsNP and to examine phagocytosis of S. aureus in these pathologies. METHODS Macrophage phenotyping was performed by immunohistochemical staining on nasal mucosa sections from 28 patients; in addition flow cytometry analysis was performed. Tissue homogenate protein levels of IFN-γ, IL-5, IL-6, IL-1β, TGF-β, eosinophil cationic protein (ECP) and total IgE were analyzed and correlated with macrophage subtypes. Phagocytosis of S. aureus was analyzed by flow cytometry. Survival of S. aureus in Thp1 cells in the presence of polarizing cytokines was studied in vitro. RESULTS By immunohistochemical analysis more M2 macrophages were present in CRSwNP than in CRSsNP. This also was positively correlated with increased levels of IL-5, ECP and locally produced IgE and decreased levels of IL-6, IL-1β and IFN-γ. FACS analysis of dissociated nasal tissue confirmed the presence of increased numbers of M2 macrophages (CD206(+) HLADR(+) CD14(+) CD11c(+) CD20(-) ) in CRSwNP as compared to controls, while the number of M1 macrophages (CD206(-) HLADR(+) CD14(+) CD11c(int) CD16(-) CD20(-) ) was not different. Phagocytosis of S. aureus by human tissue derived macrophages was reduced in CRSwNP as compared to macrophages from the control inferior turbinates. CONCLUSIONS Decreased phagocytosis of S. aureus and an M2 activation phenotype in CRSwNP could potentially contribute to persistence of chronic inflammation in CRSwNP.
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Affiliation(s)
- O Krysko
- The Upper Airway Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, Ghent, Belgium.
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Smirnov IV, Vishniakov VV. [The olfactory function in the patients suffering from polypous rhinosinusitis following endoscopic surgery on paranasal sinuses]. Vestn Otorinolaringol 2011:19-21. [PMID: 22334917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this study, we examined and treated 50 patients presenting with polypous rhinosinusitis. In all of them, the endoscopic surgical intervention was preceded by estimation of the olfactory function. The examination was repeated within 1, 3, and 6 months after the operation. Endoscopic surgery had positive outcome; however, its beneficial effect was compromised in the patients suffering from polypous rhinosinusitis during a long period and having the history of surgical intervention in the nasal cavity in the past. The best results of the treatment were obtained in the patients having olfactory dysfunction for less than 10 years and in the previously untreated ones. It is concluded that endoscopic rhinosurgical treatment produced positive results in all the 50 patients.
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Malinvaud D, Halimi P, Bonfils P. Pneumosinus dilatans associated with nasal polyposis. B-ENT 2011; 7:283-287. [PMID: 22338242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE Pneumosinus dilatans (PSD) and pneumocele involve the expansion of one or more paranasal sinuses. We present the first cases of frontal PSD and pneumocele associated with nasal polyposis. We also attempt to explain the development of these rare pathologies through this unexpected association. METHODS Two cases are described. A 31-year-old man presented with chronic rhinosinusitis for many years and a left frontal protrusion. Physical examination found nasal polyposis and CT scan showed an abnormally enlarged left frontal sinus without bone destruction. The second patient was a 17-year-old man who presented with a left frontal protrusion and orbital encroachment associated with chronic rhinosinusitis. Physical examination also found nasal polyposis and CT scan showed an abnormally enlarged left frontal sinus with focal thinning of the bony sinus walls. DISCUSSION Focal or generalized thinning of the bony sinus walls differentiates pneumocele from PSD; otherwise, these two entities share the same physiopathological and clinical courses. Many explanations have been proposed for their development including increases in intra-sinus pressure, weakening of bone by tumor invasion, intracranial hypotension, spontaneous drainage of a mucocele, and congenital or hormonal causes. Yet, its physiopathology remains unknown. These two cases support the pressure mechanism of development.
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Affiliation(s)
- D Malinvaud
- Department of ENT and Auditory Research Laboratory, Formation Associée Claude Bernard and CNRS UMR 8194, Hôpital Européen Georges Pompidou, Faculté Paris V, Universitê René Descartes, Paris, France.
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Mullol J, Callejas FB, Méndez-Arancibia E, Fuentes M, Alobid I, Martínez-Antón A, Valero A, Picado C, Roca-Ferrer J. Montelukast reduces eosinophilic inflammation by inhibiting both epithelial cell cytokine secretion (GM-CSF, IL-6, IL-8) and eosinophil survival. J BIOL REG HOMEOS AG 2010; 24:403-411. [PMID: 21122279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Leukotriene receptor antagonists, such as montelukast (MK), are currently used to treat rhinitis and asthma, but their anti-inflammatory role in eosinophil inflammation is not well understood. The aim of this study is to investigate the effect of MK on an in vitro model of upper-airway eosinophil inflammation by reducing pro-inflammatory cytokines from both nasal mucosa (NM) and polyp (NP) epithelial cells and reducing eosinophil survival primed by epithelial cell secretions. Epithelial cells were stimulated with fetal bovine serum (FBS) with or without MK for 24 hours, and cytokine concentrations in epithelial secretions were measured by ELISA. After incubating peripheral blood eosinophils with epithelial cell-conditioned media (ECM) with or without MK up to 3 days, eosinophil survival was assessed by Trypan blue dye exclusion. Results are expressed as mean±SEM of cytokine concentration (percent of control) or eosinophil survival (percent). Epithelial cell stimulation increased GM-CSF, IL-6, IL-8, and sICAM-1 secretion in both NM and NP. MK had a significant inhibitory effect on FBS-induced GM-CSF, IL-6, and IL-8 secretion, but not sICAM-1, in both NM and NP. MK also showed an inhibitory effect (p<0.05) on ECM-induced eosinophil survival from both NM (from 10(-5)M to 10(-7)M, n=7) and NP (at 10(-5)M, n=7), after 3 days of incubation. These anti-inflammatory effects on epithelial cell cytokine secretion and on eosinophil survival suggest that montelukast may contribute to the reduction of eosinophilic inflammation in upper-airway inflammatory diseases such as rhinitis and nasal polyposis.
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Affiliation(s)
- J Mullol
- Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Catalonia.
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Alobid I. Nasal polyposis, sense of smell, and surgery. Rhinology 2010; 48:377-378. [PMID: 21049649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Isam Alobid
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic i Universitari, Barcelona, Spain.
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Abstract
BACKGROUND The prevalence of airway inflammatory disorders keeps rising; its pathogenic mechanism is still not fully understood. OBJECTIVE The present study aimed to investigate the role of muscarinic receptor (M receptor) in regulating the immune cell activity in nasal mucosa by using surgical removed nasal mucosa from patients with nasal polyposis (NP) as a study platform. METHODS Human nasal mucosal sample was collected from inferior turbinectomy of 86 patients with NP or/and allergic rhinitis. Expression of tumor necrosis factor alpha (TNF-alpha), M receptor, OX40 ligand was measured in nasal mucosa by enzyme-linked immunosorbent assay, flow cytometry, and Western blotting assay. RESULTS When compared with non-NP (nNP) nasal mucosa, contents of TNF-alpha and TNF-alpha+ cells markedly increased in NP nasal mucosa; immune staining colocalized M3 receptor+ and TNF-alpha+ cells in NP nasal mucosa; exposure of isolated CD4+ T cells to methacholine induced the release of TNF-alpha. We also found CD11c+/M3 receptor+ cells in NP nasal mucosa. Methacholine increased the expression of OX40L in dendritic cells. Staphylococcal (S) aureus and S. enterotoxin B (SEB) were detected in NP nasal mucosa. Exposure of dendritic cells or naïve CD4+ T cells to SEB initiated the expression of M3 receptor at mRNA and protein levels. CONCLUSIONS The present data demonstrate that parasympathetic activity has the capacity to activate dendritic cells to release OX40 ligand, the latter induces CD4+ T cells to produce IL-4 and TNF-alpha that may further contribute to the pathogenesis of NP.
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Affiliation(s)
- T Liu
- Department of Otolaryngology, Head & Neck Surgery, the First Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
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Perić A, Vojvodić D, Radulović V, Miljanović O. Cytokine levels in nasal secretions in asthmatic and nonasthmatic patients with nasal polyposis. Kulak Burun Bogaz Ihtis Derg 2010; 20:111-117. [PMID: 20465535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The aim of this study was to compare the cytokine levels of subjects with nasal polyps (NP) and comorbid asthma and NP patients without asthma. PATIENTS AND METHODS Thirty patients with NP (15 asthmatic and 15 nonasthmatic) were included in this prospective study. Nasal secretion samples were collected from the nasal cavities of all subjects. The levels of eleven cytokines (TNF-alpha, TNF-beta, IL-1beta, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, and IFN-gamma) were measured using flow cytometric method. RESULTS The concentrations of Th2 cytokines IL-5, IL-6 and IL-10 were significantly higher in patients with NP and asthma compared with subjects with NP without asthma. IFN-gamma, IL-4, IL-6 and IL-10 levels were found significantly higher in allergic patients with NP and asthma compared with those without asthma. In nonallergic patients with NP and asthma, the concentrations of TNF-alpha, IL-5 and IL-6 were significantly higher than in nonallergic patients with NP without asthma. CONCLUSION Our results showed that the presence of Th2 cytokines, especially IL-5 and IL-6 in patients with NP and asthma is a prominent feature that relates to increased eosinophilic inflammation. We also found significant influence of asthma and allergy on the cytokine profiles in nasal secretions of patients with NP.
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Affiliation(s)
- Aleksandar Perić
- Clinic for Otorhinolaryngology, Department of Rhinology, Military Medical Academy, Belgrade, Serbia.
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Lee HM, Kang HJ, Park HH, Hong SC, Kim JK, Cho JH. Effect of peroxisome proliferator-activated receptor gamma agonists on myofibroblast differentiation and collagen production in nasal polyp-derived fibroblasts. Ann Otol Rhinol Laryngol 2009; 118:721-7. [PMID: 19894400 DOI: 10.1177/000348940911801007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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: 11/15/2022]
Abstract
OBJECTIVES We investigated the effect of transforming growth factor-beta1 (TGF-beta1) on the differentiation of nasal polyp-derived fibroblasts (NPDFs) and on their production of collagen, and investigated the effect of peroxisome proliferator-activated receptor gamma (PPARgamma) agonists on the effects of TGF-beta1. METHODS Primary fibroblast lines were established from 5 human nasal polyp tissues. We activated the NPDFs with TGF-beta1 and exposed them to the PPARy agonists ciglitazone and 15-deoxy-Delta-prostaglandin J2. The expression of alpha-smooth muscle actin (alpha-SMA) and collagen was measured by reverse transcriptase-polymerase chain reactions, immunocytochemical staining, and collagen assays. RESULTS The treatment with TGF-beta1 increased the expression of alpha-SMA and collagen, and expression was markedly attenuated by the PPARy agonists. CONCLUSIONS PPARy agonists inhibit the differentiation of TGF-beta1-activated NPDFs and their production of collagen.
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Affiliation(s)
- Heung-Man Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, Korea
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33
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Guglielmo M, Gulotta C, Mancini F, Sacchi M, Tarantini F. Recalcitrant nasal polyposis: achievement of total remission following treatment with omalizumab. J Investig Allergol Clin Immunol 2009; 19:158-159. [PMID: 19476021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- M Guglielmo
- Department of Pulmonology - Respiratory Pathophysiology, AOU San Luigi Gonzaga, Orbassano, Italy
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34
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Shi J, Fan Y, Xu R, Zuo K, Cheng L, Xu G, Li H. Characterizing T-cell phenotypes in nasal polyposis in Chinese patients. J Investig Allergol Clin Immunol 2009; 19:276-282. [PMID: 19639723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Nasal polyposis has different etiologies in Western and Eastern countries. Furthermore, its pathogenesis is still poorly understood. OBJECTIVE To determine the T-cell phenotypes involved in nasal polyposis in Chinese patients. METHODS Twenty-four Chinese patients with nasal polyps were studied. CD4, CD8, Foxp3, and interleukin (IL) 17 were analyzed by immunohistochemical staining. Expression of T-bet, GATA-3, Foxp3, and RORgammat mRNA was detected by real-time polymerase chain reaction. The levels of T-cell cytokines (IL-4, IL-5, interferon [IFN] gamma, IL-10, IL-17, and transforming growth factor [TGF] beta) were determined using enzyme-linked immunosorbent assay, and serum immunoglobulin (Ig) E levels were measured using the UNICAP system. RESULTS Increased expression of CD4+ and CD8+ and decreased expression of Foxp3 and IL-17 were detected in nasal polyps compared with control tissue. Furthermore, expression of T-bet and GATA-3 mRNA was upregulated, whereas Foxp3 mRNA expression was markedly downregulated. Furthermore, increased levels of IFN-gamma, IL-4 and IL-5 and decreased levels of IL-10 and TGF-beta were found in nasal polyps. There was no association between Staphylococcus aureus exotoxin (SAE)-specific IgE and T regulatory cell (Treg) insufficiency in nasal polyps. CONCLUSIONS Our findings demonstrate that excessive infiltration of CD4+ and CD8+ T cells in nasal polyps may be associated with expression of Foxp3+ by Tregs but not with SAEs in Chinese patients.
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Affiliation(s)
- J Shi
- Allergy and Cancer Center, Otorhinolarygology Hospital of The First Affiliated Hospital of Sun Yat-sen University, and Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, China
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35
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Abstract
Cysteinyl leukotrienes (CysLTs: leukotrienes C(4), D(4), and E(4)) have long been implicated in the pathogenesis of asthma and several allergic diseases. LTE(4) has been identified as a major metabolite of LTC(4), and urinary LTE(4) (U-LTE(4)) is considered as the most reliable analytic parameter for monitoring the endogenous synthesis of CysLTs. From recent studies on the U-LTE(4) associated with adult stable asthma we identified four factors for hyperleukotrieneuria, namely, aspirin intolerance, eosinophilic nasal polyposis (ENP), vasculitis, and severe asthma. In ENP, there is prominent infiltration of eosinophils in the sinus and polyp tissues, which is linked to adult asthma and aspirin sensitivity, and ENP is the most important factor for the overproduction of CysLTs in asthmatics. We also demonstrated that anaphylaxis and eosinophilic pneumonia (EP) are associated with a marked increase in the U-LTE(4) concentration. Under these disease conditions, U-LTE(4) may be one of the candidate biomarkers. Moreover, the changes in U-LTE(4) concentrations may provide valuable information concerning therapeutic targets.
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Affiliation(s)
- Masami Taniguchi
- Clinical Research Center, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan.
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36
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Zuckerman JD, Lee WY, DelGaudio JM, Moore CE, Nava P, Nusrat A, Parkos CA. Pathophysiology of nasal polyposis: the role of desmosomal junctions. Am J Rhinol 2008; 22:589-97. [PMID: 19178795 DOI: 10.2500/ajr.2008.22.3235] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Many mucosal inflammatory conditions are associated with alterations in epithelial intercellular junctions and barrier function; however, little is known about the role of intercellular junctions in inflammatory diseases of the upper airways. In this study, we examined nasal polyps for altered intercellular junctions and protein expression. METHODS Biopsy specimens of nasal polyps and normal tissue were obtained intraoperatively from 11 patients and 6 controls. Tissue was analyzed for expression of intercellular junctional proteins by immunofluorescence. In parallel, cultured human bronchial epithelial (HBE) cells were treated with tumor necrosis factor (TNF) alpha, interferon (IFN) gamma, and IL-13 to simulate inflammatory conditions followed by assessment for changes in junctional proteins by immunofluorescence and Western blot. RESULTS Of the intercellular junctional proteins analyzed, including proteins comprising tight and adherens junctions, the only alterations observed were in desmosomal proteins in nasal polyp epithelium compared with normal controls. Specifically, expression of desmosomal proteins DSG2 and DSG3 were significantly decreased in polyps versus controls (0.53 pixel/microm2 versus 1.09 pixel/microm2 [p = 0.009], and 0.29 pixel/microm2 versus 1.11 pixel/microm2 [p = 0.0078], respectively). In vitro experiments involving exposure of cultured HBE cells with inflammatory cytokines revealed that TNF-alpha treatment resulted in internalization and decreased expression of DSG2 by immunofluorescence and Western blotting. Treatment with IFN-gamma resulted in increased expression of DSG2 and evidence of protein cleavage by Western blot. IL-13 exposure resulted in down-regulation of DSG2 expression and evidence of protein cleavage. CONCLUSION These results indicate that nasal polyps express decreased levels of DSG2 and DSG3 components of desmosomal junctions. This is likely linked to the mucosal inflammatory response. Exposure of a respiratory cell line to Th1/Th2 cytokines results in similar expressional alterations in DSG2, suggesting protein internalization and cleavage. We speculate that weakened desmosomal junctions in nasal mucosa secondary to inflammatory cytokines may contribute to the formation of nasal polyposis.
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Affiliation(s)
- Jodi D Zuckerman
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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37
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Alobid I, Bernal-Sprekelsen M, Mullol J. Chronic rhinosinusitis and nasal polyps: the role of generic and specific questionnaires on assessing its impact on patient's quality of life. Allergy 2008; 63:1267-79. [PMID: 18782106 DOI: 10.1111/j.1398-9995.2008.01828.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [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: 02/04/2023]
Abstract
Chronic rhinosinusitis (CRS) including nasal polyps is a chronic inflammatory disease of the nasal and paranasal sinus mucosa that, despite differing hypotheses of its cause, remains poorly understood. Primary symptoms are nasal blockage, loss of smell, rhinorrhea, and facial pain or pressure. Chronic rhinosinusitis causes significant physical symptoms, has a negative impact on quality of life (QoL), and can substantially impair daily functioning. A global evaluation of patients must include, together with nasal symptoms, nasal endoscopy, and CT scan, the measurement of QoL. To assess QoL in CRS, specific and generic questionnaires may be used. Chronic rhinosinusitis has a considerable impact on a patient's QoL but comorbidities, such as asthma and atopy, have an accumulative negative effect. Both medical and surgical treatments lead to a similar improvement on the QoL of CRS and nasal polyp patients.
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Affiliation(s)
- I Alobid
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i Universitari, Barcelona, Spain
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38
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Abstract
CONCLUSION Bronchial hyperresponsiveness (BHR) is not a risk factor for surgery in patients with nasal polyposis (NP). OBJECTIVE Management of NP should be primarily medical, and surgery should not be envisaged before a trial of dual steroid therapy. In patients with severe NP resistant to a strict medical treatment, endoscopic sinus surgery is performed, but no prognostic factor for efficacy of surgery is obvious. Some authors suggest that asthma could be a major risk for ineffectiveness of surgery. The aim of this study was to evaluate whether the presence of BHR can be considered a risk factor for ineffectiveness of surgery. SUBJECTS AND METHODS Surgery (with associated medical treatment) was evaluated over a mean follow-up period of 74 months. A total of 63 subjects without and 131 subjects with BHR were operated according to a standardized protocol. RESULTS The present study shows that combined surgery and corticosteroid therapy is effective in the treatment of severe NP, producing significant and long-term improvements in symptoms and in the size of nasal polyps. BHR did not influence the outcome. Moreover, the mean amount of prednisolone and beclomethasone necessary after surgery was similar in the two groups.
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Affiliation(s)
- Pierre Bonfils
- Department of Oto-Rhino-Laryngology - Head Neck Surgery, European Hospital Georges Pompidou, University Paris-Descartes, School of Medicine, Paris, France.
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39
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Abstract
Endoscopic sinus surgery (ESS) remains the treatment of choice for medically refractory chronic rhinosinusitis (CRS) with or without nasal polyposis (NP). ESS has undergone review, reassessment, and substantial refinement. Several advances (eg, powered instrumentation, image guidance, adjunctive intraoperative procedures) have expanded the scope of cases amenable to ESS, decreased operative time and intraoperative blood loss, and improved safety. Procoagulant nasal/sinus packing and refinements of technique have decreased the need for postoperative removal of packing, thus decreasing morbidity. Methods to reduce synechia formation (ie, mitomycin-c) have been explored, with mixed results. Novel methods of sinusotomy (eg, balloon catheter dilatation of the sinus ostia) have had limited but interesting short-term results. We can expect further advances in ESS with better patient outcomes. However, continued elucidation of the underlying pathophysiology of CRS and NP are essential to long-term improvement.
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Affiliation(s)
- Neil Bhattacharyya
- Harvard Medical School, Division of Otolaryngology, Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02115, USA.
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40
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Abstract
Chronic rhinosinusitis (CRS) is presently classified into two subgroups: CRS without and CRS with nasal polyps. A variety of inflammatory mediators, including cytokines and chemokines, as well as adhesion molecules and matrix metalloproteinases, are upregulated in both subgroups of CRS; remodeling is also observed in both. However, there are also characteristic differences. Whereas CRS without nasal polyps has more neutrophilic infiltration, in CRS with nasal polyps (especially when associated with allergy/asthma) eosinophil infiltration is strikingly increased. Although several features of remodeling (eg, squamous metaplasia, basement membrane thickening, collagen deposition, hyperplasia of mucous glands, and goblet cells) are features seen in both subgroups of CRS, epithelial shedding as observed in asthma is not seen in either subgroup. Furthermore, pseudocyst formation seen in CRS with nasal polyps is not seen in CRS without nasal polyps.
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Affiliation(s)
- Ruby Pawankar
- Department of Otolaryngology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo 113-8603, Japan. pawankar_ruby/
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41
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Dong Z, Yu RL. [Medical treatment of nasal polyps and its future]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2007; 42:397-400. [PMID: 17629020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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42
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Toledano A, González E, Rodríguez G, Galindo N. The validity of CCCRC test in patients with nasal polyposis. Rhinology 2007; 45:54-8. [PMID: 17432071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Both the Connecticut Chemosensory Clinical Research Center (CCCRC) test and Cross Cultural Smell Identification Test (CC-SIT) are used to assess the sense of smell in patients all over the world. Our aim is to know whether the CCCRC test is a valid olfactory test in comparison with CC-SIT. Therefore, we have done a prospective study in 60 adult patients with nasal polyposis to compare the validity of CCCRC with UPSIT. We used the CCCRC olfactory test made up of a threshold and suprathreshold test while CC-SIT relies solely upon suprathreshold measurement. We determined the specificity, sensitivity, positive predictive value and negative predictive value for patients suffering nasal polyposis with the CCCRC test. The validity index was 95% and accuracy rate was 8%. We determined unit cost and the reliability of the CCCRC test. For patients with nasal polyposis: the sensitivity was 86%; the specificity was 94%; the positive predictive value was 93% and the negative predictive value was 88%. The reliability was 92%. The unit cost of the CCCRC was 5.60 euro. The CCCRC test is a valid test in comparison with CC-SIT. CCCRC is cheap and can be used in routine clinical settings.
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Affiliation(s)
- Adolfo Toledano
- Department of Rhinology, Fundación Hospital Alcorcón, Madrid, Spain.
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43
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Passali D, Bellussi L. [Revision of the European Position Paper on Rhinosinusitis and Nasal Polyposis (EP3OS) with particular attention to acute and recurrent rhinosinusitis]. Acta Otorhinolaryngol Ital 2007; 27:1-21. [PMID: 17702374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- D Passali
- Clinica ORL, Università di Siena, Italy.
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44
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Majima Y. [Remodeling of the upper airways]. Arerugi 2007; 56:24-30. [PMID: 17272954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Yuichi Majima
- Department of Otorhinolaryngology-Head Neck surgery, Mie University Graduate School of Medicine.
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45
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Shin SH, Lee YH, Jeon CH. Protease-dependent activation of nasal polyp epithelial cells by airborne fungi leads to migration of eosinophils and neutrophils. Acta Otolaryngol 2006; 126:1286-94. [PMID: 17101590 DOI: 10.1080/00016480500395179] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [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: 10/24/2022]
Abstract
CONCLUSIONS Proteases in fungi interact with nasal epithelial cells and enhance the production of inflammatory cytokines in vitro. These cytokines induced the migration of eosinophils and neutrophils. Protease-activated receptors (PARs) might also play a role in the process of epithelial cell activation. OBJECTIVE The nasal epithelium is the first barrier encountered by airborne allergens and an active participant in airway inflammation. Fungi have been increasingly recognized as important pathogens in sinusitis and consist of several allergenic proteins. MATERIALS AND METHODS Nasal polyp epithelial cells were obtained from patients and stimulated with Alternaria, Aspergillus, and Cladosporium. Interleukin-8 (IL-8), granulocyte-macrophage colony stimulating factor (GM-CSF), and regulated on activation normal T expressed and secreted (RANTES) were measured to determine the activation of epithelial cells. Reverse transcriptase-polymerase chain reaction test (RT-PCR) for PAR mRNA expression in nasal epithelial cells was performed. Eosinophil and neutrophil migration was induced with nasal polyp epithelial cells conditioned media (HPECM). RESULTS Fungi enhanced the production of chemical mediators from nasal epithelial cells. When nasal epithelial cells were activated with fungi, PAR2 and PAR3 mRNAs were more strongly expressed than in nonactivated cells. Eosinophil migration was induced by RANTES and eotaxin, and neutrophil migration was induced by IL-8 in HPECM.
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Affiliation(s)
- Seung-Heon Shin
- Department of Otolaryngology, School of Medicine, Catholic University of Daegu, Daegu, Korea.
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46
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Abstract
PURPOSE OF REVIEW Disorders of the sense of smell can result through hundreds of different processes, but most commonly occur from upper-respiratory-tract infections, trauma, and chronic rhinosinusitis. RECENT DEVELOPMENTS Research in the basic science of olfaction has progressed rapidly with powerful new molecular discoveries; however, our ability to treat these disorders remains limited. In clinical olfaction we are just realizing the broader existence of the sensory dysfunction in our population. We are discovering associations between neurodegenerative disorders and smell function that may allow us to identify these disorders earlier in the disease process. We are also challenging our previous categorization schemes and realizing that many etiologies cross the traditional conductive and neuro-sensory divisions. SUMMARY Currently, aside from the possible therapeutic potential of systemic steroids, we have no effective treatment for the most common causes of olfactory loss. Recent advances in the basic science of olfaction provides us with an opportunity to develop new and novel clinical studies in an attempt at improving the quality of life for many of these patients.
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Affiliation(s)
- Eric H Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, Massachusetts 02114, USA.
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47
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Abstract
PURPOSE OF REVIEW Some time ago, a link between upper and lower respiratory disease was described, which gave rise to the concept of 'united airways disease'. This concept primarily refers to the well established link between allergic rhinitis and asthma, but it also covers a possible link between sinus disease and asthma (allergic or nonallergic) and other lower airway disease. RECENT FINDINGS The current classification of chronic rhinosinusitis (CRS) includes disease without and with nasal polyps, which are considered subgroups of CRS. Different patterns of inflammatory and regulatory cytokines (involving distinguishable T-helper lymphocyte populations) and of remodelling markers, however, were recently described to differentiate nasal polyposis from CRS, yielding two discrete entities. These patterns resemble those of lower airway diseases, such as asthma and chronic obstructive pulmonary disease, and suggest a common aetiological/pathogenetic background. Whereas the link between nasal polyps and asthma is well established (indeed, asthma improves after medical or surgical treatment of sinus disease), that between CRS and lower airway disease is not well understood. Recently, Staphylococcus aureus enterotoxins, acting as superantigens, were identified as a possible link between nasal polyps and asthma, resulting in severe disease manifestations in both upper and lower airways. SUMMARY The role played by sinus disease in asthma is only partially understood, largely because of deficits in the clinical classification and in basic knowledge of pathophysiological pathways. Recent research into upper airway and sinus inflammation and remodelling may reveal new perspectives and lead to a classification of sinus disease, which will facilitate appropriate clinical and epidemiological studies.
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Affiliation(s)
- Claus Bachert
- Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium.
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48
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Guilemany JM, Alobid I, Angrill J, Ballesteros F, Bernal-Sprekelsen M, Picado C, Mullol J. The impact of bronchiectasis associated to sinonasal disease on quality of life. Respir Med 2006; 100:1997-2003. [PMID: 16581240 DOI: 10.1016/j.rmed.2006.02.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Revised: 01/25/2006] [Accepted: 02/19/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bronchiectasis (BQs) is an uncommon disease with the potential to cause devastating complications. All patients with BQs have cough and chronic sputum production that may have a great impact on patient's quality of life. Upper airway symptoms are also frequent in patients with BQs. Associations between upper and lower airways diseases have been demonstrated in allergic rhinitis and asthma, nasal polyposis and asthma, chronic obstructive lung disease and chronic rhinosinusitis. OBJECTIVE (1) To investigate the impact of bronchiectasis and nasal symptoms on quality of life. (2) To evaluate the added impact of nasal polyposis on quality of life in patients with BQs. METHODS Sixty patients with bronchiectasis and upper airway symptoms were included. Patients were evaluated for nasal symptoms, nasal polyp size by endoscopy, and quality of life using the SF-36 generic questionnaire. RESULTS In comparison with the Spanish general population, patients with BQs had worse scores in all SF-36 domains (P<0.05). Males reported significantly higher quality of life scores on physical functioning and social functioning than females did. Although the age, pulmonary function, presence of nasal polyps, upper airway symptoms, tobacco smoking history, and disease duration was similar between them. Males with BQs had worse quality of life than males from the Spanish general population on body pain, general health, and vitality (P<0.05). Females with BQs had worse quality of life than females from the Spanish general population on physical function, body pain, general health, vitality, social function, and emotional role (P<0.05). Nasal polyps were found in 25 (41.6%) of 60 patients with BQs. No significant differences were observed on quality of life outcomes between patients with BQs with and without nasal polyposis. CONCLUSION These results suggest that BQs has a considerable impact on quality of life while nasal polyposis has no additional impact on the quality of life of patients with BQs.
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Affiliation(s)
- J M Guilemany
- Rhinology Unit, Department of Otorhinolaryngology, Hospital Clinic de Barcelona, ENT, Barcelona, Spain.
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49
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Alobid I, Benitez P, Pujols L, Maldonado M, Bernal-Sprekelsen M, Morello A, Picado C, Mullol J. Severe nasal polyposis and its impact on quality of life. The effect of a short course of oral steroids followed by long-term intranasal steroid treatment. Rhinology 2006; 44:8-13. [PMID: 16550943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVES Nasal polyposis is not a life-threatening disorder but has a great impact on the quality of life. Steroids constitute the first line of treatment of nasal polyps. The aims of this study were to evaluate the quality of life in nasal polyp patients after: (1) a short course of oral steroids; and (2) a long-term treatment with intranasal steroids. METHODS Patients with severe nasal polyps received either oral prednisone (n = 60) or no steroid treatment (control group, n = 18) for 2 weeks. Patients treated with steroids were also followed-up and evaluated after 12, 24, and 48 additional weeks with intranasal budesonide treatment. RESULTS Patients with nasal polyps showed worse scores on all SF-36 domains, except for physical functioning, compared to the Spanish general population. After two weeks, patients treated with oral prednisone demonstrated a significant improvement (p < 0.05) in all impaired QoL domains compared to both control group and baseline. The mental component summary (51.0 +/- 1.2, p < 0.05) and physical component summary (51.0 +/- 0.9, p < 0.05) were improved compared to both control group and baseline. The improvement of all SF-36 domains was sustained by intranasal budesonida (p < 0.05) after 12, 24, and 48 weeks. Nasal obstruction, sense of smell, and polyp size also improved after both the oral short course and the intranasal long-term steroids treatment (p < 0.05). CONCLUSION These results suggest that the treatment with a short-course of oral steroids improves the quality of life of patients with severe nasal polyps and that this effect is maintained by a long-term treatment with intranasal steroids.
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Affiliation(s)
- Isam Alobid
- Rhinology Unit, Department of Otorhinolaryngology (ICEMEQ), Hospital Clinic, Universitat de Barcelona, Spain
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50
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Okooye BCC, Onotai LO. Clinical photographic quiz. Nasal polyposis, inverted papilloma, sino-nasal tumour, rhinoscleroma. Niger J Med 2006; 15:94, 101. [PMID: 16649466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Affiliation(s)
- B C C Okooye
- Department of ENT Surgery, University of Port Harcourt Teaching Hospital, Nigeria
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