A Comparison of Sphenoid Sinus Osteoneogenesis in Aspirin-Exacerbated Respiratory Disease

Background Aspirin-exacerbated respiratory disease (AERD) is characterized by excessive leukotriene production, diffuse polyp burden and osteitic bone changes. These bony changes have not been previously characterized. Objective The aim of this radiographic study is to characterize the bony changes noted on computed tomography (CT) scans of the sphenoid sinus in patients with AERD compared to other diseased sinonasal inflammatory states and non-diseased controls. Methods A retrospective review of 43 patients with clinically confirmed AERD were included and compared to 22 non-diseased, 9 allergic fungal sinusitis, and 43 chronic rhinosinusitis controls (23 without polyps and 18 with polyps). Comparative measurements were performed using fine-cut CT scans. Sites of comparison were the intersinus septum, the left and right lateral sphenoid wall, the roof, and left and right floor of the sphenoid sinus. Standardized measurements were averaged by two separate rhinologists. Results Patients with AERD had an average statistically significant increase in bone thickness compared to healthy and diseased controls in nearly every site with the most pronounced changes in the intersinus septum (p < 0.05). Conclusion Patients with AERD have significantly increased thickness of the sphenoid bone compared to control groups with the most pronounced difference in the intersinus septum. These findings may help clinicians increase suspicion for a diagnosis of AERD who clinically have diffuse nasal polyposis.

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Oral Corticosteroid Prescribing Habits for Rhinosinusitis: The American Rhinologic Society Membership

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2017.31.4396 ◽

2017 ◽

Vol 31 (1) ◽

pp. 22-26 ◽

Cited By ~ 9

Author(s):

John R. Scott ◽

Hannah M. J. Ernst ◽

Brian W. Rotenberg ◽

Luke Rudmik ◽

Leigh J. Sowerby

Keyword(s):

Chronic Rhinosinusitis ◽

Respiratory Disease ◽

Average Duration ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Prescribing Habits ◽

Not Otherwise Specified ◽

Aspirin Exacerbated Respiratory Disease ◽

Starting Dose ◽

Acute Bacterial Rhinosinusitis

Background In the field of otolaryngology, oral corticosteroids (OCS) are widely prescribed for rhinosinusitis. Although there is evidence in the literature regarding specific OCS dosing protocols, it is not known to what extent these recommendations are being followed. Objective To examine the current state of OCS prescribing habits for rhinosinusitis by American Rhinologic Society members. Methods An anonymous online survey was sent to all American Rhinologic Society members. Dosing, frequency, tapering, and overall prescribing habits for OCS were assessed in chronic rhinosinusitis with polyposis (CRSwP) and in chronic rhinosinusitis without polyposis and acute bacterial rhinosinusitis. The CRSwP group was subdivided into aspirin-exacerbated respiratory disease, allergic fungal sinusitis, and not otherwise specified. Results were compared with current guidelines. Descriptive statistics were used to analyze data. Results Ninety-three surveys were completed (response rate, 12.9%). Prednisone was the most common OCS prescribed. In the CRSwP-aspirin-exacerbated respiratory disease group (n = 86), the median starting dose was 60 mg (range, 4-80 mg) and the average duration was 8 days (range, 2-28 days). In the CRSwP-allergic fungal sinusitis group (n = 81), the median starting dose was 50 mg (range, 20-60 mg), and the average duration was 6 days (range, 2-35 days). In the CRSwP-not otherwise specified group (n = 84), the median starting dose was 50 mg (range, 20-80 mg) and the average duration was 5 days (range, 1-21 days). OCS were prescribed for chronic rhinosinusitis without polyposis and acute bacterial rhinosinusitis by 66.0 and 62.4% of respondents, respectively. Conclusion Significant heterogeneity existed in OCS prescribing habits for rhinosinusitis. Discrepancies were observed between survey results and evidence-based recommendations. Developing standardized OCS treatment protocols for rhinosinusitis may improve the quality of care by optimizing clinical outcomes and reducing the risk of complications.

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Hyperprolactinemia Secondary to Allergic Fungal Sinusitis Compressing the Pituitary Gland

Case Reports in Otolaryngology ◽

10.1155/2016/7260707 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3

Author(s):

Nikita Chapurin ◽

Cynthia Wang ◽

David M. Steinberg ◽

David W. Jang

Keyword(s):

Pituitary Gland ◽

Sphenoid Sinus ◽

Sinus Surgery ◽

Definitive Treatment ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Pituitary Dysfunction ◽

Normal Thyroid Function ◽

First Case ◽

The Right

Objective. We aim to describe the first case in the literature of allergic fungal sinusitis (AFS) presenting with hyperprolactinemia due to compression of the pituitary gland.Case Presentation. A 37-year-old female presented with bilateral galactorrhea and occipital headaches of several weeks. Workup revealed elevated prolactin of 94.4, negative pregnancy test, and normal thyroid function. MRI and CT demonstrated a 5.0 × 2.7 × 2.5 cm heterogeneous expansile mass in the right sphenoid sinus with no pituitary adenoma as originally suspected. Patient was placed on cabergoline for symptomatic control until definitive treatment.Results. The patient underwent right endoscopic sphenoidotomy, which revealed nasal polyps and fungal debris in the sphenoid sinus, consistent with AFS. There was bony erosion of the sella and clivus. Pathology and microbiology were consistent with allergic fungal sinusitis caused byCurvulariaspecies. Prolactin levels normalized four weeks after surgery with resolution of symptoms.Conclusion. Functional endoscopic sinus surgery alone was able to reverse the patient’s pituitary dysfunction. To our knowledge, this is the first case of AFS presenting as hyperprolactinemia due to pituitary compression.

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Allergic fungal sinusitis with extensive bone erosion of the clivus presenting with diplopia

The Journal of Laryngology & Otology ◽

10.1017/s0022215108003459 ◽

2008 ◽

Vol 123 (7) ◽

pp. 817-819 ◽

Cited By ~ 5

Author(s):

S D Reitzen ◽

R A Lebowitz ◽

J B Jacobs

Keyword(s):

Sphenoid Sinus ◽

Bone Erosion ◽

Nasal Congestion ◽

Clinical Findings ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Anatomical Structures ◽

History Of ◽

Cranial Fossa ◽

Bony Erosion

AbstractObjective:We report a case of allergic fungal sinusitis causing bone erosion and diplopia.Case report:A 43-year-old man presented with a four-month history of increased nasal congestion and progressive diplopia. Clinical examination revealed bilateral nasal polyposis and a right lateral gaze deficit, consistent with a VIth cranial nerve palsy. Computed tomography of the paranasal sinuses demonstrated a large sellar mass with extensive bony erosion and both supra- and infra-sellar extension. An endoscopic approach to the sphenoid sinus, clivus and posterior cranial fossa with image guidance was performed, enabling surgical treatment involving nasal polypectomy, wide marsupialisation of the sphenoid sinus and removal of the extensive allergic fungal mucin. The patient awoke from anaesthesia with complete resolution of his diplopia.Conclusion:Otolaryngologists should be aware that approximately 20 per cent of patients with allergic fungal sinusitis demonstrate paranasal sinus expansion and bone erosion involving surrounding anatomical structures. Such patients may have clinical findings involving the orbit and cranial vault.

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Bedeutung der allergologischen Abklärung bei Asthma und COPD

Therapeutische Umschau ◽

10.1024/0040-5930/a000512 ◽

2014 ◽

Vol 71 (5) ◽

pp. 267-274

Author(s):

Judith A. Schneider Spence ◽

Andreas J. Bircher ◽

Kathrin Scherer Hofmeier

Keyword(s):

Respiratory Disease ◽

Asthma Bronchiale ◽

Aspirin Exacerbated Respiratory Disease ◽

Work Up

Während eine allergologische Abklärung im Work-Up eines Asthma bronchiale inbegriffen sein sollte, wird die chronisch obstruktive Pneumopathie nicht spontan mit einer atopischen Diathese in Zusammenhang gebracht. Anamnese, Klinik, das Vorhandensein weiterer atopischer Krankheiten sowie Prickteste und die serologische Messung von spezifischen IgE-Antikörpern geben Hinweise auf eine allergische Genese einer akuten oder chronischen Lungenkrankheit. Der Stickoxidwert in der Ausatemluft (FeNO-Messung) kann durch die Infiltration von Eosinophilen in die Bronchialwand beim allergischen Phänotyp des Asthma bronchiale erhöht sein (TH2-gewichteter Phänotyp). Eine Abhängigkeit der Beschwerden vom Arbeitsplatz muss evaluiert werden. Neben dem allergischen Typ des Asthma bronchiale soll auch an eine Aspirin-exacerbated-respiratory disease (AERD) gedacht werden. Aufgrund der überlappenden pathophysiologischen Grundlagen und der Symptomatik zwischen Asthma bronchiale und der chronisch obstruktiven Pneumopathie ist die Zuweisung zum Allergologen allenfalls auch bei einem COPD-Patienten indiziert.

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