Preoperative Management of Chronic Rhinosinusitis Prior to Office Balloon Sinus Dilation: A 2011–2014 MarketScan® Analysis

2019 ◽  
Vol 33 (4) ◽  
pp. 347-353 ◽  
Author(s):  
David W. Jang ◽  
Cecily Abraham ◽  
Derek D. Cyr ◽  
Kristine Schulz ◽  
Ralph Abi Hachem ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Practice Patterns ◽  
Sinus Surgery ◽  
Ct Scans ◽  
Administrative Database ◽  
Control Group ◽  
Topical Steroids ◽  
Preoperative Period ◽  
Office Visits ◽  
Preoperative Management

Background In-office balloon sinus dilation (BSD) has recently gained popularity as a surgical treatment option for chronic rhinosinusitis (CRS). However, utilization, indications, and practice patterns surrounding in-office BSD remain unclear. Objective The purpose of this study was to use a large national administrative database to assess preoperative management of CRS prior to in-office BSD. Methods Patients undergoing standalone in-office BSD from 2011 to 2014 were identified on MarketScan and compared to a control group undergoing functional endoscopic sinus surgery (FESS). Visits to the otolaryngologist, number of computed tomography (CT) scans, number of antibiotic and steroid prescriptions, and duration of time from first visit to procedure were compared. Results When compared to the FESS group, the in-office BSD group overall had fewer office visits (2.0 vs 2.2), CT scans (1.0 vs 1.1), prescriptions for antibiotics (2.0 vs 2.2), prescriptions for systemic steroids (1.5 vs 1.8), and topical steroids (1.4 vs 1.5) in the preoperative period. They also had a shorter mean duration of time between first visit and CT scan (17.5 vs 21.4 days) as well as between first visit and procedure (55.0 vs 67.8 days). All of these findings were statistically significant. Conclusion In-office BSD for CRS was overall associated with less intense management in the preoperative period when compared to FESS. Such differences may reflect ongoing shifts in practice patterns and need to be further investigated.

scholarly journals JAK2 Phosphorylation Signals and Their Associated Cytokines Involved in Chronic Rhinosinusitis with Nasal Polyps and Correlated with Disease Severity

Biomolecules ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1059
Author(s):  
Yu-Tsai Lin ◽  
Wei-Chih Chen ◽  
Ming-Hsien Tsai ◽  
Jing-Ying Chen ◽  
Chih-Yen Chien ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Disease Severity ◽  
Nasal Polyps ◽  
Inflammatory Diseases ◽  
Janus Kinase ◽  
Sinus Surgery ◽  
Control Group ◽  
Jak2 Inhibitor ◽  
Ifn Γ ◽  
Snot 22

Janus kinase 2 (JAK2) is a member of the JAK family that transduces cytokine-mediated signals via the JAKs/STATs (signal transducer and activator of transcription proteins) pathway, which plays an important role in many inflammatory diseases. This study investigates the association of p-JAK2 and JAK2-associated cytokines from nasal polyp (NP) tissue with disease severity, and evaluates the p-JAK2-mediated STATs in chronic rhinosinusitis (CRS) with NP. Sixty-one CRSwNP patients with nasal polyps undergoing endoscopic sinus surgery were enrolled, while the turbinate tissues from 26 nasal obstruction patients were examined as the control group. Elevated levels of p-JAK2 were detected in CRSwNP, and significantly correlated with scores of disease severity (LMK-CT, TPS, and SNOT-22). Expressions of the JAK2-associated cytokines, such as IL-5, IL-6, IL-13, G-CSF, and IFN-γ were significantly higher in CRSwNP than in the controls, while the levels of IL-5, IL-6, IL-13, or G-CSF had positive correlation with scores of disease severity. Moreover, markedly increased expression of p-STAT3 in CRSwNP was observed relative to the control. Taken together, these data showed that the JAK2-associated cytokines including IL-6 and G-CSF may stimulate JAK2 phosphorylation to activate p-STAT3, indicating an association with disease severity and supporting its development of JAK2 inhibitor as a potential therapeutic agent for CRS.

scholarly journals Expression of Matrix Metalloproteinases and Their Tissue Inhibitors in Chronic Rhinosinusitis With Nasal Polyps: Etiopathogenesis and Recurrence

2020 ◽  
pp. 014556131989663
Author(s):  
Germano Guerra ◽  
Domenico Testa ◽  
Francesco Antonio Salzano ◽  
Domenico Tafuri ◽  
Eleonora Hay ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Matrix Metalloproteinases ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Polymerase Chain Reaction Analysis ◽  
Sinus Surgery ◽  
Control Group ◽  
Nonallergic Rhinitis ◽  
Tissue Inhibitors ◽  
Immunologic Diseases

Chronic rhinosinusitis with nasal polyps is a multifactorial disease of the nasal and paranasal sinus mucosa and it includes, as comorbidities, anatomic and morphologic alterations, allergic rhinitis, and immunologic diseases. We investigated matrix metalloproteinases (MMP-2, MMP-7, and MMP-9) and their tissue inhibitors (TIMP-1 and TIMP-2) concentration in different etiopathogenetical groups of patients with nasal polyposis (NP) in relation to recurrence after sinonasal surgery. The study group consisted of 45 patients with NP (those with allergic rhinitis, nonallergic rhinitis and asthma or nonallergic rhinitis, and obstruction of osteomeatal complex [OMC]) who underwent endonasal sinus surgery. We also collected 10 patients who underwent septoplasty as control. Immunohistochemistry of nasal mucosa fragments, Western blotting, and polymerase chain reaction analysis showed increased MMPs levels (MMP-9 more than MMP-2 and MMP-7) and decreased tissue inhibitors of MMPs levels (TIMP-1 less than TIMP-2), in patients with chronic rhinosinusitis with nasal polyps compared with control group, in particular in patients with nonallergic rhinitis and asthma compared to those with allergic rhinitis and nonallergic rhinitis and obstruction of OMC. We observed a higher risk of recurrence in patients with nonallergic rhinitis and asthma than in those with allergic rhinitis and nonallergic rhinitis and obstruction of OMC after 36 months from surgery. In this research, we evaluated pathogenesis of NP related to MMPs and their inhibitors concentrations in polypoid tissue.

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

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.

scholarly journals Maximal Medical Therapy for Chronic Rhinosinusitis: A Survey of Chinese Otolaryngologists

2019 ◽  
Vol 99 (3) ◽  
pp. 159-164
Author(s):  
Zhenxiao Huang ◽  
Jingying Ma ◽  
Yan Sun ◽  
Bing Zhou
Keyword(s):  
Chronic Rhinosinusitis ◽  
Medical Therapy ◽  
Practice Patterns ◽  
Demographic Data ◽  
Sinus Surgery ◽  
Oral Antibiotics ◽  
Intranasal Corticosteroid ◽  
Saline Irrigation ◽  
Frequency Of Use ◽  
Maximal Medical Therapy

The aim of the present study was to evaluate the clinical practice patterns in maximal medical therapy (MMT) before endoscopic sinus surgery for chronic rhinosinusitis (CRS) by Chinese otolaryngologists. An anonymous web-based survey of MMT was performed. This survey assessed types of therapies, the frequency of use, duration of use, and demographic data of respondents. A total of 134 (26.8%) questionnaires were completed and returned. The majority (62.69%) of respondents would consider surgery less than 3 months after commencing MMT, 33.58% would wait 3 to 6 months. Intranasal corticosteroid sprays, saline irrigation, oral antibiotics, oral mucolytics, and oral Chinese herbals were the most commonly used therapies and listed as “often (>70%)”. Macrolides were most commonly antibiotics prescribed among the clinicians surveyed (51.49%). Intranasal corticosteroid sprays, oral antibiotics, oral mucolytics, nasal saline irrigations, and oral Chinese herbals are most commonly prescribed by the majority of Chinese otolaryngologists as MMT for CRS. Current practice patterns of MMT among Chinese otolaryngologists are not uniformly based on evidence-based guidelines.

scholarly journals Relationship of vitamin D3 deficiency and chronic rhinosinusitis with nasal and sinus polyposis in patients referring to the Department of Ear, Nose, and Throat Diseases Department of Vali-asr Hospital in Brigand, Iran

2021 ◽  
pp. 99-104
Keyword(s):  
Vitamin D ◽  
Chronic Rhinosinusitis ◽  
Vitamin D3 ◽  
Sinus Surgery ◽  
Control Group ◽  
Case Group ◽  
Significant Difference ◽  
Relationship Of ◽  
Vitamin D3 Deficiency ◽  
Nose And Throat

Introduction: Chronic rhinosinusitis may require referral to an ear, nose, and throat specialist for possible endoscopic sinus surgery if medical management fails. Vitamin D is one of the essential vitamins for the body that is effective in inflammatory processes. Therefore, it seems necessary to confirm the association between the deficiency of this vitamin and the occurrence of chronic rhinosinusitis with nasal polyposis. This study aimed to determine the relationship of vitamin D3 deficiency and chronic rhinosinusitis with nasal and sinus polyposis in patients referring to the Otorhinolaryngology Department of Valiasr Hospital, Birjand, Iran, in 2017. Methods: A case-control study was performed on individuals, including a group of patients with rhinosinusitis and a control group (n=20 each), referring to the Department of Ear, Nose, and Throat Diseases Department of Vali-asr Hospital. Among patients diagnosed with chronic rhinosinusitis, the cases that had polyps on endoscopic examination were included in the study. After completing the consent form, venous blood samples (10cc) were collected from the patients in fasting conditions. The electrochemical luminescence method was used for measuring the level of serum vitamin D. A questionnaire containing demographic information and clinical findings was completed by reviewing the patients' records. Data analysis was performed in SPSS software (Version. 22)using Chi-square and Mann-Whitney U-tests. Results: The mean and median scores of vitamin D level were obtained at14.13±12.99 and 10.25 in the case group, and 18.72±9.29 and 18.77 in the control group, respectively. The level of vitamin D was significantly higher in the control group than in the chronic group (P=0.04). In the case group, 16 (80%) patients lacked vitamin D and 3 patients had an insufficient level of vitamin D. In the control group, 13 (65%) patients lacked vitamin D and 4 cases had an insufficient level of vitamin D. There was no significant difference in vitamin D levels between the two groups (P=0.61). No significant difference was observed between the two clinical symptoms. Conclusion: It was revealed that the lack of vitamin D was likely to be an effective factor in the rhinosinusitis disease; therefore, proceedings need to be taken to cure the deficiency of this vitamin.

Damage to Ciliated Epithelium in Chronic Rhinosinusitis: What is the Role of Bacterial Biofilms?

2008 ◽  
Vol 117 (12) ◽  
pp. 902-908 ◽  
Author(s):  
Jacopo Galli ◽  
Lea Calò ◽  
Fausta Ardito ◽  
Micaela Imperiali ◽  
Ezio Bassotti ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Chronic Rhinosinusitis ◽  
Sinus Surgery ◽  
Bacterial Biofilms ◽  
Control Group ◽  
Bacterial Cultures ◽  
Electron Microscopy Analysis ◽  
Microscopy Analysis ◽  
Scanning Electron

Objectives: We assess the association between the presence of biofilms and cilial damage in patients with chronic rhinosinusitis (CRS), describe the microorganisms associated with samples that exhibited cilial loss and biofilms, and demonstrate the absence of ciliary injury and biofilms in similarly prepared “normal” controls. Methods: We examined samples of ethmoid mucosa obtained from 24 patients who underwent functional endoscopic sinus surgery for CRS. Samples from a control group (20 healthy subjects) were also examined. The specimens were divided into 2 fragments; the first was processed for bacterial cultures, and the second was subjected to scanning electron microscopy. Statistical analysis was performed. Results: All CRS samples had positive bacterial cultures. The scanning electron microscopy analysis showed bacterial biofilms in 10 of the 24 specimens. A marked destruction of the epithelium was observed in samples positive for biofilms (p < 0.001), and the presence of Haemophilus influenzae was associated with ciliary abnormalities (partial damage in 55.6% and absence of cilia in 50%; p = 0.041). Conclusions: The high percentage of biofilms in our specimens confirms the association between biofilms and CRS. Our data support the hypothesis that biofilm formation represents the latter phase of an inflammatory process that leads to complete epithelial destruction.

Mycoplasma pneumoniaeandChlamydophila pneumoniae: a comparative study in patients with nasal polyposis and healthy controls

2015 ◽  
Vol 129 (9) ◽  
pp. 865-869 ◽  
Author(s):  
D G Ioannidis ◽  
V A Lachanas ◽  
Z Florou ◽  
J G Bizakis ◽  
E Petinaki ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Real Time ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Inferior Turbinate ◽  
Sinus Surgery ◽  
Control Group ◽  
Chain Reaction ◽  
Tissue Samples ◽  
Polymerase Chain

AbstractIntroduction:The role played byMycoplasma pneumoniaeandChlamydophila pneumoniaein the pathogenesis of chronic rhinosinusitis with nasal polyps has been the object of ongoing debate. We used real-time polymerase chain reaction to investigate the prevalence of both microorganisms in the nasal tissue samples of patients and controls.Methods:We extracted DNA from nasal polyp samples obtained during functional endoscopic sinus surgery and the inferior turbinate samples of controls undergoing septoplasty. We used the highly sensitive real-time polymerase chain reaction to detect the presence ofM pneumoniaeandC pneumoniaeDNA.Results:Patients with chronic rhinosinusitis with nasal polyps consisted of 62 individuals (39 men; mean age 51 years); the control group consisted of 24 individuals (13 men; mean age 45 years). All samples from both groups were negative forM pneumoniaeandC pneumoniaeDNA.Conclusion:We have demonstrated that the likelihood ofM pneumoniaeandC pneumoniaeacting as an ongoing inflammatory stimulus in chronic rhinosinusitis with nasal polyps is slim.

The Effect of Middle Turbinate Resection upon the Frontal Sinus

1995 ◽  
Vol 9 (4) ◽  
pp. 191-196 ◽  
Author(s):  
Paul B. Swanson ◽  
Donald C. Lanza ◽  
Eugenia M. Vining ◽  
David W. Kennedy
Keyword(s):  
Frontal Sinus ◽  
Statistical Difference ◽  
Severe Disease ◽  
Middle Turbinate ◽  
Sinus Surgery ◽  
Ct Scans ◽  
Control Group ◽  
Case Group ◽  
Frontal Sinusitis ◽  
Frontal Recess

Diversity of opinion exists among otolaryngologists regarding the importance of preserving the middle turbinate during sinus surgery. The purpose of this study is to determine whether or not middle turbinate resection has a bearing upon postoperative disease within the frontal sinus. In this retrospective analysis of 110 consecutive patients with chronic or recurrent acute sinusitis, 69 (case group) had previous middle turbinectomy and 41 patients (control group) had intact middle turbinate after prior sinus surgery. In 42 patients, CT scans were scored and defined as having either mild-moderate or severe disease. Frontal sinusitis seen on CT scan was present in 75% (30 of 40) of case sides and 45% (9 of 20) of control sides, and this difference was significant (P < 0.05). The height of middle turbinate resection was measured, and there was no statistical difference in frontal sinusitis between patients with high and low resection. Therefore, this work does not support the concept that middle turbinate resection results in a lower incidence of frontal recess disease.

scholarly journals Chronic Rhinosinusitis without Nasal Polyps in Asian Patients Shows Mixed Inflammatory Patterns and Neutrophil-Related Disease Severity

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Dae Woo Kim ◽  
Kyoung Mi Eun ◽  
Eun Youn Roh ◽  
Sue Shin ◽  
Dong-Kyu Kim
Keyword(s):  
Immune Response ◽  
Chronic Rhinosinusitis ◽  
Inflammatory Mediators ◽  
Nasal Polyps ◽  
Uncinate Process ◽  
Sinus Surgery ◽  
Individual Treatment ◽  
Control Group ◽  
Disease Extent ◽  
Asian Patients

Chronic rhinosinusitis (CRS) shows heterogeneous immunologic features. Western studies revealed that CRS without nasal polyps (CRSsNP) showed a predominantly type 1 immune response and CRS with nasal polyps (CRSwNP) was characterized by type 2 immune response; however, the detailed immunologic profile of CRSsNP in Asian patients has not been thoroughly investigated. Therefore, we investigated the inflammatory endotypes of CRSsNP in Asian patients. Patients with CRSsNP (N=57), patients with CRSwNP (N=13), and a control group (N=10), who underwent endoscopic sinus surgery, were enrolled; uncinate process (UP) tissues were harvested from all patients. Homogenates were prepared from the UP of each group, and immunologic profiles were analyzed, including major cytokines (32 inflammatory mediators). When comparing the UPs between groups, CRSsNP patients showed higher levels of Th2 cytokines (IL-4 and IL-13), eosinophilic chemokines (CCL-11 and CCL-24), ECP, and total IgE expression than control subjects. In addition, several neutrophilic markers (IL-1α, IL-6, IL-8, CXCL-1, CXCL-2, and MPO), IL-17A, IL-22, and TNF-α were dominant in CRSsNP patients. Among these inflammatory mediators, IL-17A showed higher expression levels in CRSsNP patients than in the control group and CRSwNP patients. However, IFN-γ expression was not significantly elevated in CRSsNP patients. The levels of neutrophil-associated cytokines were well correlated with each other; of which, CXCL2, IL-8, and MMP-9/TIMP-1 levels were significantly correlated with disease extent (r=0.338, r=0.317, and r=0.424, respectively). However, the levels of eosinophil-associated cytokines showed little correlation with each other and were not correlated with disease extent. Our study revealed that Asian CRSsNP patients showed a mixed (types 2 and 17) immune response, but neutrophil-related markers were dominant and associated with disease extent. Knowledge of this immunologic feature may help clinicians make better individual treatment decisions for Asian CRSsNP patients.

scholarly journals Topical Steroids in Rhinosinusitis and Intraoperative Bleeding: More Harm Than Good?

2019 ◽  
Vol 99 (6) ◽  
pp. 388-394
Author(s):  
Giancarlo Tirelli ◽  
Umberto Lucangelo ◽  
Giovanni Sartori ◽  
Maria Cristina Da Mosto ◽  
Paolo Boscolo-Rizzo ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operation Time ◽  
Treated Group ◽  
Sinus Surgery ◽  
Control Group ◽  
Topical Steroids ◽  
Intraoperative Bleeding ◽  
Fibrous Stroma ◽  
Preoperative Administration ◽  
Snot 22

The aim of this study was to assess whether the chronic preoperative administration of intranasal corticosteroids (INCs) in chronic rhinosinusitis with/without nasal polyposis (CRSwNP/CRSsNP, respectively) could significantly influence bleeding during functional endoscopic sinus surgery (FESS). We prospectively enrolled 109 patients (56 CRSwNP and 53 CRSsNP) candidate for FESS who underwent clinical evaluation and anamnestic data collection. They were allocated to 2 groups depending on whether or not they were chronic INC users, as declared at their first medical evaluation: chronic “INC users” represented the treated group, while “INC nonusers” formed the control group. Lund-Mackay and American Society of Anesthesiology (ASA) scores, blood loss expressed both in milliliters and using the Boezaart scale, operation time in minutes, pre- and postoperative 22-item Sino Nasal Outcome Scores (SNOT-22) were collected. Each sample underwent histopathological evaluation. The results showed that anamnestic information, Lund-Mackay, and SNOT-22 scores were similar between the 2 groups ( P > .05). The average blood loss expressed in milliliters and operative time were slightly, but not significantly, higher in the INC user group, while the Boezaart scores proved significantly higher in the INC users ( P = .038). No differences emerged between CRSwNP and CRSsNP within each group in terms of bleeding. The pathologist described common features in the majority (78%) of INC group samples: ectatic venules embedded in a fibrous stroma and hypertrophy of the arterial muscular layer. In our experience, despite the presence of NP, chronic preoperative administration of INCs was associated with increased intraoperative bleeding according the Boezaart scale although objective recordings of blood loss were not statistically different between the INC users and nonusers.

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