Exploring the association between ingestion of foods with higher potential salicylate content and symptom exacerbation in chronic rhinosinusitis. Data from the National Chronic Rhinosinusitis Epidemiology Study

INTRODUCTION

Pharmacological salicylates are known to trigger respiratory exacerbations in patients with Non-Steroidal Exacerbated Respiratory Disease (N-ERD), a specific phenotype of Chronic Rhinosinusitis (CRS) and asthma. The impact of dietary sources of salicylates across subgroups of CRS is not well understood. The hypothesis is that in patients with nasal polyps present, there is likely to be a higher incidence of symptom exacerbation due to dietary salicylates regardless of any known response to pharmacological salicylate.

METHODS

The Chronic Rhinosinusitis Epidemiology Study (CRES) was a questionnaire-based case-control study which sought to characterise the UK CRS population in terms of sociological, economic and medical factors. Using specific questions to examine participant responses relating to symptom exacerbation from food groups thought to be high in salicylate content, this analysis of the CRES database sought to compare an estimate of the prevalence of dietary sensitivity due to food with higher potential salicylate content across patients with CRS with (CRSwNPs) and without nasal polyposis (CRSsNPs) and with allergic fungal rhinosinusitis (AFRS).

RESULTS

The CRSwNPs group were significantly more likely than controls to report symptom exacerbation due to ingestion of food groups with higher potential dietary salicylate content. The same trend was observed amongst CRSsNPs participants to a lesser degree. Reported response to the individual specific food groups wine, nuts, spicy foods, fruit and vegetables demonstrated that a statistically significant proportion of CRSwNPs and AFRS participants reported sensitivity to wine.

CONCLUSIONS

This analysis suggests that there is an association between symptom exacerbation in response to food products with higher potential salicylate content, specifically wine, in CRS patients both with and without nasal polyposis when compared to controls, but especially in the CRSwNPs and AFRS phenotypes. Further studies are needed to detail if this relationship represents a causal relationship to dietary salicylate. The data present the possibility that a wider group of CRS patients may elicit salicylate sensitivity than those with known N-ERD.

Lessons learnt from the diagnosis and antimicrobial management of necrotising (malignant) otitis externa: our experience in a tertiary referral centre

Necrotising otitis externa is an uncommon and aggressive infection of the external auditory canal with a tendency to present in the elderly and immunocompromised patient. We report a series of twenty-five patients admitted to our institution over a four-year period with this diagnosis. We review the diagnosis and antimicrobial management of these cases, and propose a treatment algorithm based on our experience.

Is surgical debridement and topical 5 fluorouracil the optimum treatment for woodworkers' adenocarcinoma of the ethmoid sinuses? A case-controlled study of a 20-year experience

OBJECTIVES

Woodworkers' adenocarcinoma of the ethmoid sinuses is an extremely rare occupational malignancy with a locally aggressive course. Treatment with surgical exenteration and topical 5 fluorouracil (5FU) packs has become standard treatment over the last 10 years in this ENT unit. This study presents level 2 evidence that 5FU provides improved survival over previous management with primary radiotherapy and salvage craniofacial resection.

DESIGN

Retrospective case series with historical control group.

SETTING

District General Hospital.

PARTICIPANTS

The records of 31 consecutive patients with the disease were analysed. Five patients died prior to treatment. One patient was treated with surgery alone and therefore excluded. Twenty-five patients were included in the analysis. Fourteen were treated with primary radiotherapy and 11 with surgery and topical 5FU.

OUTCOME MEASURES

Disease free survival was measured using Kaplan-Meier survival analysis.

RESULTS

Five-year disease free survival improved from 50% with primary radiotherapy to 86% with surgery and 5FU. This improvement is statistically significant (P = 0.03).

CONCLUSION

Topical 5FU treatment improves survival of Woodworker's adenocarcinoma of the ethmoid sinuses. This finding may be useful in the treatment of other locally aggressive sinonasal malignancies.

Silicone Foley catheters outperform latex Foley catheters for post-nasal packing: an in-vitro study

OBJECTIVES

To determine the best Foley catheter and inflation fluid for post-nasal packing.

DESIGN

Experimental study.

SETTING

District General Hospital (Wexham Park Hospital).

MATERIALS

108 latex and 108 silicone catheters were directly compared.

OUTCOME MEASURES

Catheters were analysed according to the inflation fluid instilled and the use of an umbilical clamp. Analysis occurred at 24, 36, 48 and 72 h periods after being placed in humidified incubator at 37 degrees C. The main outcome measure was whether deflation was possible at specified times. The secondary outcome measure was an attempt to identify the failure point in those catheters that failed to deflate.

RESULTS

Air was found to be an unsuitable inflation fluid for either silicone or latex catheters due to a 100% spontaneous deflation rate within a 24-h period. Silicone catheters were found to be 100% reliable when inflated with water or saline, irrespective of the use of a clamp. Latex catheters were unreliable with an overall failure rate of 30%. This high failure rate was related both to the use of an umbilical clamp to secure the catheter and to the use of saline as the inflation medium.

CONCLUSIONS AND RECOMMENDATIONS

Firstly, air should not be used for inflation of catheters unless specified in manufacturer's instructions. Secondly, when Foley catheters are used for post-nasal packing, silicone should be considered the first choice of catheter type. If not available, latex ones may be used but should be inflated with water and secured with a non-crushing clamp at the alar rim.