Significance of Eosinophilia in Chronic Rhinosinusitis

Background The purpose of this study was to investigate the impact of serum eosinophilia in the prognosis of chronic rhinosinusitis (CRS). Eosinophils are now considered to play a major role in the pathogenesis of CRS. To date, no study has evaluated the clinical course of patients with CRS and serum eosinophilia. Methods A retrospective chart review of 620 patients who underwent endoscopic sinus surgery (ESS) for CRS was performed. Thirty-one patients (5%) had elevated serum eosinophil counts and served as the study group. Patient charts of the study group and 34 (5%) controls with normal serum eosinophil counts were reviewed for comorbid diseases including asthma, polyps, and allergic fungal sinusitis. The number of ESSs performed and the postoperative recurrence of multiple sinus infections and need for antibiotics, systemic steroids, and antifungal agents were compared. Results A higher proportion of patients with serum eosinophilia had a history of asthma, polyp disease, and allergic fungal sinusitis. Postoperatively, the study group had a statistically significant difference (p < 0.05) as compared with controls with respect to postoperative recurrent sinus infections (94% versus 32%) and polyp disease (35% versus 3%). Statistical difference between study and control groups was also found with respect to the postoperative need for antifungal agents (23% versus 3%), multiple courses of antibiotics (84% versus 32%), and revision ESS (84% versus 24%). Although not statistically significant, a higher proportion of the study group required systemic steroids. Conclusions CRS patients with serum eosinophilia have a worse prognosis when compared with controls. Patients with eosinophilia should be counseled appropriately, and the physician should be aware of the chronicity of disease.

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The Impact of Medical Comorbidities on Patient Satisfaction in Chronic Rhinosinusitis

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211015736 ◽

2021 ◽

pp. 000348942110157

Author(s):

Amarbir S. Gill ◽

Joshua Hwang ◽

Angela M. Beliveau ◽

Jeremiah A. Alt ◽

Edward Bradley Strong ◽

...

Keyword(s):

Patient Satisfaction ◽

Hearing Impairment ◽

Chronic Rhinosinusitis ◽

Medical Comorbidities ◽

Patient Demographics ◽

Significant Difference ◽

Comorbidity Index ◽

The Mean ◽

Therapy Compliance ◽

The Impact

Background: Patient satisfaction has a significant bearing on medical therapy compliance and patient outcomes. The purpose of this study was to (1) describe patient satisfaction, as characterized by the Patient Satisfaction Questionnaire-18 (PSQ-18), in the care of patients with chronic rhinosinusitis (CRS) and (2) analyze the impact of comorbidities on satisfaction using the functional comorbidity index (FCI). Methods: Patient demographics, disease severity measures, and PSQ-18 scores for patients with CRS presenting to a tertiary rhinology clinic between November 2019 and April 2020 were collected and analyzed. FCI was calculated retrospectively using the electronic medical record; individual comorbidities were tabulated. Spearman’s correlations followed by multivariate regression was used to assess the relationship between medical comorbidities and PSQ-18. Results: Sixty-nine patients met criteria for analysis. There were no significant differences in age, gender, and Sinonasal Outcomes Test-22 scores between CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps. There was no significant difference in the mean FCI for patients with CRSwNP versus CRSsNP (5.1 and 4.3, respectively) ( P = .843). Similarly, there was no significant difference in the mean sum PSQ-18 score (78/100 in both) between these cohorts ( P = .148). The mean sum PSQ-18 score was not significantly associated with anxiety ( P = .728), depression ( P = .624), or FCI ( P = .282), but was significantly associated with hearing impairment ( P < .001). Conclusion: Patient satisfaction in the care of CRS is generally high with a diagnosis of comorbid hearing impairment demonstrating a negative association with satisfaction in this cohort.

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Availability of Preoperative Systemic Steroids on Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyposis

Yonsei Medical Journal ◽

10.3349/ymj.2014.55.6.1683 ◽

2014 ◽

Vol 55 (6) ◽

pp. 1683 ◽

Cited By ~ 6

Author(s):

Seok Jin Hong ◽

Jong Kyu Lee ◽

Hyun Sub Lee ◽

Jung Yup Lee ◽

Jung Soo Pyo ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Nasal Polyposis ◽

Sinus Surgery ◽

Systemic Steroids

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Demonstration of Biofilm in Human Bacterial Chronic Rhinosinusitis

American Journal of Rhinology ◽

10.1177/194589240501900506 ◽

2005 ◽

Vol 19 (5) ◽

pp. 452-457 ◽

Cited By ~ 110

Author(s):

Berrylin J. Ferguson ◽

Donna B. Stolz

Keyword(s):

Chronic Rhinosinusitis ◽

Culture Media ◽

Cellular Membrane ◽

Anaerobic Growth ◽

Bacterial Biofilms ◽

Topical Steroids ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Planktonic Bacteria ◽

Transmission Electron

Background Bacterial biofilms may explain why some patients with bacterial chronic rhinosinusitis (CRS) improve while on antibiotics but relapse after completion of the antibiotic. In the human host, biofilms exist as a community of bacteria surrounded by a glycocalyx that is adherent to a foreign body or a mucosal surface with impaired host defense. Biofilms generate planktonic, nonadherent bacterial forms that may metastasize infection and generate systemic illness. These planktonic bacteria are susceptible to antibiotics, unlike the adherent biofilm. Methods We reviewed four cases of CRS using transmission electron microscopy (TEM) to assay for typical colony architecture of biofilms. Bacterial communities surrounded by a glycocalyx of inert cellular membrane materials consistent with a biofilm were shown in two patients. Results In the two patients without biofilm, a nonbacterial etiology was discovered (allergic fungal sinusitis) in one and in the other there was scant anaerobic growth on culture and the Gram stain was negative. Culture of the material from the biofilm grew Pseudomonas aeruginosa in both patients. Pseudomonas from the biofilm showed a glycocalyx, not present in Pseudomonas cultured for 72 hours on culture media. Both patients’ symptoms with bacterial biofilms were refractory to culture-directed antibiotics, topical steroids, and nasal lavages. Surgery resulted in cure or significant improvement. Conclusion Biofilms are refractory to antibiotics and often only cured by mechanical debridement. We believe this is the first TEM documentation of bacterial biofilms in CRS in humans.

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Impact of Septal Deviation on Recurrent Chronic Rhinosinusitis after Primary Surgery: A Matched Case-Control Study

Otolaryngology ◽

10.1177/0194599818815106 ◽

2018 ◽

Vol 160 (5) ◽

pp. 922-927

Author(s):

Terence Fu ◽

Daniel Lee ◽

Jonathan Yip ◽

Alisha Jamal ◽

John M. Lee

Keyword(s):

Chronic Rhinosinusitis ◽

Case Control Study ◽

Multivariable Analysis ◽

Case Control ◽

Sinus Surgery ◽

Deviated Nasal Septum ◽

Primary Surgery ◽

Academic Center ◽

The Impact ◽

Control Study

Objective To evaluate the impact of untreated deviated nasal septum (DNS) on recalcitrant chronic rhinosinusitis (CRS) among patients undergoing revision endoscopic sinus surgery (ESS). Study Design Case-control study. Setting Tertiary academic center. Subjects and Methods We performed a retrospective review of 489 patients undergoing revision ESS for CRS at a tertiary academic center. Patients undergoing septoplasty were matched to nonseptoplasty controls based on age and sex. Preoperative Lund-Mackay score (LMS) was compared between cohorts. Linear regression was used to identify predictors of LMS and ostiomeatal complex (OMC) obstruction. Results Thirty-six matched pairs (72 patients) were selected for analysis: 36 undergoing septoplasty and revision ESS and 36 undergoing revision ESS alone. Compared with nonseptoplasty controls, the septoplasty group had a significantly higher average LMS (17.8 vs 14.6, P = .02) and a greater rate of OMC obstruction (89% vs 61%, P < .01). The septoplasty group also had significantly higher opacification scores in the maxillary (1.5 vs 1.2, P = .03) and posterior ethmoid (1.8 vs 1.4, P = .02) sinuses. On multivariable analysis, DNS was an independent predictor of LMS ( P = .02) and OMC obstruction ( P < .01). Conclusion Untreated DNS is associated with radiographic markers of CRS severity among patients undergoing revision ESS and may contribute to the multifactorial pathogenesis of persistent CRS.

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The impact of chronic rhinosinusitis on sleep-disordered breathing

Rhinology Journal ◽

10.4193/rhino15.204 ◽

2016 ◽

Vol 54 (1) ◽

pp. 75-79

Author(s):

Rong-San Jiang ◽

Kai-Li Liang ◽

Chung-Han Hsin ◽

Mao-Chang Sun

Keyword(s):

Sleep Quality ◽

Chronic Rhinosinusitis ◽

Nasal Obstruction ◽

Sleep Disordered Breathing ◽

Sleep Problems ◽

Sleep Apnea Syndrome ◽

Sinus Surgery ◽

Obstructive Sleep ◽

The Impact ◽

Disordered Breathing

Background: The nose plays an important role in sleep quality. Very little is known about sleep problems in patients with chronic rhinosinusitis (CRS). The aim of this study was to investigate the impact of CRS on sleep-disordered breathing. Methodology: CRS patients who underwent functional endoscopic sinus surgery were collected between July 2010 and May 2015. Before surgery, they filled 20-item Sino-Nasal Outcome Test and Epworth Sleepiness Scale questionnaires, were asked about the severity of nasal obstruction, and received acoustic rhinometry, smell test, an endoscopic examination, sinus computed tomography, and a one-night polysomnography. Sleep quality was evaluated in these patients and was correlated with the severity of rhinosinusitis. Results: One hundred and thirty-nine CRS patients were enrolled in the study. Among them, 38.1% complained of daytime sleepiness, and this sleep problem was correlated with the symptom of nasal obstruction. Obstructive sleep apnea syndrome (OSAS) was diagnosed in 64.7% of the patients, but there was no correlation with the severity of rhinosinusitis. Nasal polyps did not worsen sleep problems in the CRS patients. Conclusions: This study showed that CRS patents had a high prevalence of OSAS, and worse OSAS in CRS patients was not correlated with the severity of rhinosinusitis.

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Real-world evidence analysis of the impact of steroid-eluting implants on healthcare resource use among chronic rhinosinusitis patients undergoing sinus surgery

Current Medical Research and Opinion ◽

10.1080/03007995.2021.2022874 ◽

2021 ◽

pp. 1-12

Author(s):

Veena Hoffman ◽

Kathleen M. Mortimer ◽

Kyra Mulder ◽

Ia Topuria ◽

Richard Gliklich ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Resource Use ◽

Real World ◽

Healthcare Resource ◽

Sinus Surgery ◽

Healthcare Resource Use ◽

Real World Evidence ◽

Evidence Analysis ◽

The Impact

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The Development of Dry Eye Disease after Surgery-Indicated Chronic Rhinosinusitis: A Population-Based Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17113829 ◽

2020 ◽

Vol 17 (11) ◽

pp. 3829

Author(s):

Chia-Yi Lee ◽

Kun-Lin Yang ◽

Chi-Chin Sun ◽

Jing-Yang Huang ◽

Hung-Chih Chen ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Dry Eye ◽

Dry Eye Disease ◽

Sinus Surgery ◽

Eye Disease ◽

Cumulative Probability ◽

Control Group ◽

Study Group ◽

Diagnostic Code ◽

Research Database

We aim to evaluate the risk of dry eye disease (DED) occurrence in patients with surgery-indicated chronic rhinosinusitis (CRS) via the national health insurance research database in Taiwan. After exclusion, patients with a diagnostic code of CRS and had received functional endoscopic sinus surgery (FESS) were regarded as having surgery-indicated CRS and enrolled in the study group, then each patient in the study group was age- and gender-matched to four non-CRS patients that served as the control group. The outcome was considered as the development of DED and Cox proportional hazard regression was used for the statistical analysis, which involved multiple potential risk factors of DED. A total of 6076 patients with surgery-indicated CRS that received FESS and another 24,304 non-CRS individuals were enrolled after exclusion. There were 317 and 770 DED events in the study group and the control group during the 16-year follow-up interval, and the study group demonstrated a significantly higher adjusted hazard ratio (1490, 95% confidence intervals (CI): 1.303-1.702) of DED development compared to the control group in the multivariable analysis. In addition, the cumulative probability analysis illustrated a positive correlation of DED occurrence and the disease period of surgery-indicated CRS (p < 0.0001). In the subgroup analysis, both genders revealed a higher but not significant incidence of developing DED in the study group. In conclusion, the existence of surgery-indicated CRS will increase the risk of developing DED, which correlated to the disease interval.

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A 10-Year Follow-Up of a Randomized Prospective Study of 2 Treatments for Chronic Rhinosinusitis Without Nasal Polyps and Investigation of the Impact of Gastroeosophageal Reflux Disease in the Resistance to Treatment

Ear Nose & Throat Journal ◽

10.1177/0145561319892460 ◽

2019 ◽

pp. 014556131989246

Author(s):

Jerome R. Lechien ◽

Gersende Debie ◽

Virginie Mahillon ◽

Marie-Paule Thill ◽

Alexandra Rodriguez ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Chronic Rhinosinusitis ◽

Reflux Disease ◽

Nasal Polyps ◽

Sinus Surgery ◽

Amoxicillin Clavulanate ◽

The Impact

Objectives: To compare the 2 long-term medical strategies in chronic rhinosinusitis without nasal polyps (CRSnNP) and to identify the role of gastroesophageal reflux disease (GERD) and Helicobacter pylori as factors of treatment failure. Material and Methods: Fifty-seven patients with CRSnNP were randomized into 2 therapeutic groups. The first group was treated with 4 weeks of amoxicillin/clavulanate and a short course of oral steroids. The second group received 8 weeks of clarithromycin. Sinonasal Outcome Test-20 (SNOT-20) and Lund and Mackay scores were assessed at baseline and after treatment, and GERD Health-Related Quality of Life (GERD-HRQL) questionnaire was evaluated in all patients. Patients with a GERD-HRQL score >8 received esogastroscopy and H pylori detection. Patients were followed during a 10-year period for clinical course and GERD evolution. The 10-year evolution of patients was described in terms of recurrence, medical, and surgical treatments. Results: Thirty-seven patients completed the study; SNOT-20 and Lund and Mackay scores similarly improved in both groups. Amoxicillin/clavulanate group had significantly more adverse reactions than the clarithromycin group (P = .03). After the therapeutic course, 35% (amoxicillin/clavulanate) and 41% (clarithromycin) of patients needed functional endoscopic sinus surgery (FESS). During the long-term follow-up, 54% (amoxicillin/clavulanate) and 40% (clarithromycin) of patients had late CRSnNP recurrence; FESS was performed in less than 15% of cases of recurrence. Gastroesophageal reflux disease complaint’s severity was associated with late recurrence of CRSnNP. Conclusion: Amoxicillin/clavulanate and clarithromycin would be competitive treatments for CRSnNP. Gastroesophageal reflux disease seems to be a negative factor for treatment response and recurrence.

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