Chronic rhinosinusitis

2019 ◽  
Vol 13 (4) ◽  
pp. 199-206
Author(s):  
Emma Dickson ◽  
Claire Hopkins
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyposis ◽  
Adult Population ◽  
Economic Cost ◽  
Saline Irrigation ◽  
Persistent Symptoms ◽  
Nose And Paranasal Sinuses ◽  
The Uk ◽  
Aids Diagnosis

Chronic rhinosinusitis affects 10.9% of the UK adult population, affecting quality of life and with significant economic cost. The aetiology is unknown, and diagnosis can present challenges. It is characterised by inflammation of the nose and paranasal sinuses that leads to nasal obstruction, discharge, facial pain or pressure and loss of smell, persisting for more than 3 months. Nasal cavity examination aids diagnosis. It is subdivided into chronic rhinosinusitis with and without nasal polyposis. Nasal corticosteroids and saline irrigation make up current baseline management in primary care, with referral to ENT recommended for those with persistent symptoms. Physicians should be alert to persistent unilateral symptoms and the risk of sino-nasal tumours.

scholarly journals Mucosal Eosinophilia and Neutrophilia Are Not Associated With QOL or Olfactory Function in Chronic Rhinosinusitis

2021 ◽  
pp. 194589242098743
Author(s):  
Nyssa F. Farrell ◽  
Jess C. Mace ◽  
David A. Sauer ◽  
Andrew J. Thomas ◽  
Mathew Geltzeiler ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyposis ◽  
Cross Sectional Study ◽  
Olfactory Function ◽  
Sinus Surgery ◽  
Small Subset ◽  
Cross Sectional ◽  
Snot 22

Background Chronic rhinosinusitis (CRS) is often differentiated by histopathologic phenotypes (eosinophilic versus neutrophilic), which may impact disease severity measures and outcomes. As such, it has been suggested that counts of cellular elements be included as part of a standard pathological report following endoscopic sinus surgery (ESS). Objectives This cross-sectional study evaluated associations of mucosal eosinophilia and neutrophilia with measures of quality-of-life (QoL) and olfactory function. Methods Patients with medically refractory CRS completed the SNOT-22 survey and Brief Smell Identification Test (BSIT) at enrollment. In addition, baseline Lund-Mackay computed tomography (CT) and Lund-Kennedy endoscopy scores were collected. Ethmoid mucosa was biopsied during ESS and reviewed using microscopy to quantify densest infiltrate of eosinophils or neutrophils per high-powered-field (HPF). Eosinophilic CRS (eCRS) and neutrophilic CRS (nCRS), both with and without nasal polyposis (NP), were compared across SNOT-22 and BSIT scores. Results 77/168 patients demonstrated mucosal eosinophilia (eCRS) while a total of 42/168 patients demonstrated mucosal neutrophilia (nCRS). After adjusting for polyp status, 35/168 had eCRSsNP, 42/168 eCRSwNP, 75/168 non-eCRSsNP, 16/168 non-eCRSwNP. Additionally, 22/161 were noted to have nCRSsNP, 20/161 nCRSwNP, 84/161 non-nCRSwNP, and 35/161 non-nCRSsNP. A small subset of patients demonstrated both eosinophilia and neutrophilia: 14 CRSwNP and 7 CRSsNP. When evaluating average Lund-Mackay Scores (LMS), significant differences existed between non-eCRSsNP and eCRSsNP (p = 0.006). However, after controlling for nasal polyps, eosinophilia did not significantly associate with differences in the Lund-Kennedy Score. Neutrophilia did not significantly associate with any changes in LMS or LKS after controlling for NP. Eosinophilic and neutrophilic histopathologic subtypes did not significantly associate with differences in baseline SNOT-22 or BSIT measures after controlling for NP. Conclusion Neither the presence of mucosal eosinophilia nor mucosal neutrophilia demonstrated significant associations with SNOT-22 quality-of-life or BSIT olfactory function scores when controlling for comorbid nasal polyposis.

scholarly journals Supporting patients with long-term catheterisation to reduce risk of catheter-associated urinary tract infection

2019 ◽  
Vol 28 (9) ◽  
pp. S4-S17 ◽  
Author(s):  
Anna Waskiewicz ◽  
Obrey Alexis ◽  
Deborah Cross
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Fluid Intake ◽  
Adult Population ◽  
Personal Hygiene ◽  
Reduce Risk ◽  
The Uk

More than 90 000 of the UK adult population are estimated to have a urinary catheter, with 24% likely to develop symptoms of catheter-associated urinary tract infection (CAUTI). The consequences of having a CAUTI are reduced quality of life, risk of hospitalisation and increased mortality. The authors undertook a literature review of primary research studies to identify how nurses could support patients to maintain effective catheter care to reduce the risk of CAUTI. Four themes emerged: education, knowledge, empowerment and communication. The authors therefore conclude that consistent knowledge, clear communication and treating patients as partners in the decision-making process can help build trust and allow empower patients. This will enable patients to make safe and healthy decisions about their catheter, particularly with regard to personal hygiene and optimal fluid intake, to reducing the risk of CAUTI.

scholarly journals A Study on the Efficacy of Saline Nasal Irrigation in Chronic Rhinosinusitis

2021 ◽  
Vol 10 (30) ◽  
pp. 2266-2270
Author(s):  
Rachana Ramachandran ◽  
Santhi Thankappan Pillai
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Post Treatment ◽  
Oral Drug ◽  
P Value ◽  
Saline Irrigation ◽  
Nasal Irrigation ◽  
Significant Difference ◽  
Chronic Rhino Sinusitis

BACKGROUND The objective of this study was to test as to whether daily saline nasal irrigation improved sinus symptoms in adult subjects with chronic rhino sinusitis, and also study the safety of saline irrigation, incidence of any complication and improvement in quality of life in these patients. METHODS This was a prospective observational study conducted between two groups of patients at Government TD Medical College, Alappuzha. Patients who satisfied the criteria for diagnosing chronic rhino sinusitis were included in the study. The first group was given saline nasal irrigation with oral drug therapy while the second group was put on oral drugs alone. Each subject was given a pretested, structured questionnaire. Along with socio-demographic information, the questionnaire also contained queries of quality of life measure, compliance of nasal irrigation and adverse effects following its use. RESULTS The pre-treatment scores and post treatment scores were analysed and the results were statistically significant with P values of < 0.001 in all. 77 % of the patients in the saline irrigation group were strictly using saline nasal irrigation which meant a satisfactory compliance and the improvement in post treatment scores was statistically highly significant with a P value of < 0.001. Also there was a statistically significant difference between the mean pre-test and post test scores of the two groups with P value of < 0.001 and t value of 51.942 using the paired t test. CONCLUSIONS Chronic rhinosinusitis has a major negative impact on the healthcare and economy of not only the patients but also of the society. Saline nasal irrigation is an effective yet easy method of therapy in alleviating the symptoms of chronic rhinosinusitis and improving the quality of life in these chronic sufferers. KEY WORDS Chronic Rhinosinusitis, Saline Nasal Irrigation, Quality of Life, Economic Burden

scholarly journals Study of the effect of balloon sinuplasty in patients with rhinosinusitis

2020 ◽  
Vol 6 (11) ◽  
pp. 2007
Author(s):  
Tanya Singh ◽  
Arjun Singh ◽  
Sarbjeet Singh
Keyword(s):  
Chronic Rhinosinusitis ◽  
Sinus Surgery ◽  
Saline Irrigation ◽  
Balloon Sinuplasty ◽  
Positive Biopsy ◽  
Intravenous Antibiotics ◽  
Nasal Steroids ◽  
Frontal Sinuses ◽  
A New Technique

<p class="abstract"><strong>Background:</strong> A new technique which has revolutionized sinus surgery recently is balloon sinuplasty. The vast majority of patients with chronic rhinosinusitis improve with medical management, including antibiotics, saline irrigation, nasal steroids, antihistamines, allergy therapy, and asthma control. This study was conducted to study the effect of balloon sinuplasty in patients affected with rhinosinusitis.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted in all the patients visiting our hospital. Medical treatment included oral and sometimes intravenous antibiotics, nasal steroids, decongestants, systemic steroids, and allergy management. Those who had a positive biopsy were excluded from this study. The selected cohort of 20 patients, were prepared for balloon sinuplasty surgery in the same way as for conventional functional endoscopic sinus surgery (FESS) and were operated by our surgical team.  </p><p class="abstract"><strong>Results:</strong> 20 patients were included in the study, 70% men and aged 30±12 years. Sinuplasty was performed in 32 sinuses of 20 patients (22 maxillary, 4 sphenoid and 8 frontal sinuses).</p><p class="abstract"><strong>Conclusions:</strong> Sinuplasty with balloon catheterization is effective in reducing symptoms and improving quality of life in selected patients with chronic rhinosinusitis. The results are beyond reported symptoms and confirm the benefit of balloon sinuplasty.</p><p class="abstract"> </p>

scholarly journals Evaluation of the medical and surgical management of chronic rhinosinusitis with polyposis

2016 ◽  
Author(s):  
Neetu Modgil
Keyword(s):  
Medical Treatment ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyposis ◽  
Visual Analogue Score ◽  
Nasal Endoscopy ◽  
Polyp Size ◽  
Effective Measure ◽  
Continue Medical ◽  
Saccharine Test

<p class="abstract"><strong>Background:</strong> Chronic rhinosinusitis (CRS) is a group of disorders characterized by inflammation of the mucosa of the nose and paranasal sinuses of at least 12 consecutive weeks duration. Surgical intervention may be required if severe symptoms of obstruction and infection prove medical treatment to be ineffective. Little is known about the outcomes of patients electing to continue medical management or the comparative effectiveness of continued medical therapy with FESS.</p><p class="abstract"><strong>Methods:</strong> The study was conducted on 126 adult patients in the age group of 18-55 who fulfilled the CRS criteria with nasal polyposis. All patients were medically treated for the CRS, and observed after 3 weeks. In case the treatment was not effective; they were scheduled for FESS intervention and further observed after another 6 weeks. The improvement of the patients was measured by Visual analogue score, nasal endoscopy score and saccharine test.  </p><p class="abstract"><strong>Results:</strong> Males between 41-50 were the most common patients with CRS. There was a significant improvement in the VAS score, nasal endoscopy score after 3 weeks of medical treatment. In 88% of patients the saccharine score was normal showing that this was not an effective measure for assessing the improvement.</p><p><strong>Conclusions:</strong> Medical treatment was found to be sufficient to treat most symptoms of CRS with nasal polyposis (grade 1 and 2). Surgery should only be done in refractory cases. Selection of those patients who will benefit from surgery should be based on the patient’s symptoms and not on the examiner’s polyp score. Quality of life is not proportional to polyp size (Upto grade 2).</p>

Dupilumab as Add-on Therapy for Chronic Rhinosinusitis With Nasal Polyposis in Aspirin Exacerbated Respiratory Disease

2020 ◽  
pp. 194589242096196
Author(s):  
S. Shahzad Mustafa ◽  
Karthik Vadamalai ◽  
Bryan Scott ◽  
Allison Ramsey
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Respiratory Disease ◽  
Nasal Polyposis ◽  
Total Serum ◽  
Life Questionnaire ◽  
Median Baseline ◽  
Aspirin Exacerbated Respiratory Disease ◽  
Snot 22

Background Aspirin-exacerbated respiratory disease (AERD) affects 7% of asthmatics. Usual therapies are inadequate for asthma and/or nasal polyposis, leading to decreased quality of life. Objective Our objective was to evaluate the efficacy of dupilumab in AERD patients with uncontrolled, chronic rhinosinusitis with nasal polyposis (CRSwNP). Methods Patients 18 years and older with a physician diagnosis of AERD and sino-nasal outcome test 22 (SNOT 22) score ≥19 despite standard medical therapy were eligible for the study. Patients received one month of placebo dosing, followed by 6 months of dupilumab. Patients were blinded to the order of therapy. Wilcoxon-paired rank sum test was used to compare study outcomes at baseline and the completion of the study. Results Ten patients completed the study. The median baseline SNOT 22 score improved from 46 [IQR: 34 to 64.8] to 9.5 [IQR: 2.5 to 19] after 6 months of therapy (p = 0.0050). The median baseline Lund MacKay score improved from 21.5 [IQR: 17 to 23.3] to 4 [IQR: 1.2 to 6] after 6 months of therapy (p = 0.0050). There was also improvement in the following secondary outcomes: asthma control test (ACT), mini asthma quality of life questionnaire (AQLQ), and University of Pennsylvania Smell Identification test (UPSIT). Exhaled nitric oxide (FeNO), total serum IgE, 24-hour urinary leukotriene E4, and serum thymus and activation regulated cytokine (TARC) also decreased. There were no significant study-related adverse events. Conclusion Dupilumab was highly effective as add-on therapy for CRSwNP in AERD, improving patient-reported outcomes, sinus opacification, and markers of T2 inflammation.

Balloon Catheter Dilation in Pediatric Chronic Rhinosinusitis: A Meta-analysis

2020 ◽  
Vol 34 (5) ◽  
pp. 694-702 ◽  
Author(s):  
Vijay A. Patel ◽  
Daniel C. O’Brien ◽  
Jad Ramadan ◽  
Michele M. Carr
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Standard Treatment ◽  
Meta Analysis ◽  
Balloon Catheter ◽  
Balloon Dilation ◽  
Saline Irrigation ◽  
Treatment Regimens ◽  
Significant Difference

Background Paranasal sinus balloon catheter dilation (BCD) represents a tool that has been shown to be safe in the management of pediatric chronic rhinosinusitis (pCRS); however, its efficacy compared to standard treatment regimens has not been well established. Objective The purpose of this meta-analysis was to evaluate the clinical utility of BCD in pCRS. Methods Articles reporting BCD for pCRS in patients under 18 years of age were identified via the following search terms: sinusitis OR rhinosinusitis AND balloon dilatation OR balloon dilation OR balloon sinuplasty OR sinuplasty AND adolescent OR children OR infant OR pediatric OR toddler. The primary outcome analyzed includes quality of life improvement as measured via Sinus and Nasal Quality of Life Survey (SN-5) or Sino-nasal Outcome Test (SNOT-22) scores. Results Eighty studies were abstracted; 10 studies were included for final qualitative analysis after dual investigator screening. Three studies described BCD with surgical controls, including adenoidectomy, saline irrigation, or maxillary antrostomy. Noninferiority was not demonstrated (ie, BCD is inferior) in 2 of 3 studies. Pooled analysis utilizing a random effects model revealed a decreased effect size yet no statistically significant difference between BCD and standard operative techniques as measured by quality of life measures ( g = −0.04, I2 = 41%). Conclusion This work highlights a lack of published evidence regarding the role of BCD in pCRS. Two of the 3 included studies demonstrated the inferiority of BCD when compared to other standard surgical interventions, whereas meta-analysis was unable to detect any statistically significant difference between standard treatment regimens. Future scientific investigations are necessary to assess the comparative effectiveness of BCD in pCRS.

Dupilumab in the treatment of chronic rhinosinusitis with nasal polyposis

Immunotherapy ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 111-121 ◽  
Author(s):  
John V Boyle ◽  
Kent Lam ◽  
Joseph K Han
Keyword(s):  
Chronic Rhinosinusitis ◽  
Patient Reported Outcomes ◽  
Nasal Polyposis ◽  
Biologic Therapy ◽  
Patient Reported ◽  
The Us ◽  
Us Fda ◽  
Underlying Mechanisms ◽  
Novel Agent

Chronic rhinosinusitis with nasal polyposis (CRSwNP) imparts a significant healthcare challenge, resulting in diminished quality of life for patients and high costs with resource utilization for disease management. Understanding of CRSwNP pathophysiology has progressively evolved and the identification of various inflammatory biomarkers has led to the development of monoclonal antibodies that target the underlying mechanisms of inflammation. Dupilumab, which targets IL-4 and IL-13 signaling, serves as a novel agent for CRSwNP treatment. Three clinical trials, NCT01920893, SINUS-24 and SINUS-52, have shown that dupilumab improves both subjective patient-reported outcomes and objective physician-evaluated metrics for CRSwNP. The favorable findings have resulted in approval by the US FDA in June 2019 as the first biologic therapy for CRSwNP.

Too Few Dentists? Workforce Planning 1996–2036

2000 ◽  
Vol os7 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Graham Try
Keyword(s):  
Gender Differences ◽  
Adult Population ◽  
Workforce Planning ◽  
Policy Options ◽  
Older Population ◽  
Forecasting Models ◽  
Future Treatments ◽  
The Uk

The development and use of forecasting models can stimulate the debate on workforce planning for dentists by improving the quality of the data available, by providing a framework within which the debate can be conducted and by providing a means whereby the effects of different trends and policy options can be measured in a consistent way. The number of dentists on the Dentists Register aged under 60 years may well fall over the 40 years between 1996–2036, while the proportion of female dentists is likely to grow from under 30% to almost 50%. If the present gender differences in dentists’ output persist, the effective ‘whole-time equivalent’ (WTE) size of the dentist workforce could fall by 15%. While future patterns of disease and the efficacy of future treatments are difficult to predict, the demand for dentistry is very likely to increase, given the forecast ageing of the UK population. The number of people aged 65–74 years could increase by 50% to eight million and those over 75 years by 70% towards seven million. Further, almost of all of this greatly increased older population will have retained some of their own teeth. The edentulous adult population was 37% in 1968 and might fall to less than 5% by 2036. These trends taken together could increase the number of courses of treatment per WTE dentist by as much as 40% over these 40 years. Such modelling can help to reduce the degree of uncertainty in future workforce planning.

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