Biofilms and nasal wound healing in postsurgical patients with chronic rhinosinusitis - A review of literature

AbstractChronic rhinosinusitis (CRS), fairly common disease in the field of otorhinolaryngology, is the focal point of thorough study of the pathophysiology and treatment strategies for a favourable evolution of patients with this problem. Although there have been important advances in the treatment of CRS, signs and symptoms still remain long after functional endoscopic sinus surgery (FESS), indicating the persistence of the biofilm infection on the sinus mucosa. This review aims to highlight the relationship between bacterial biofilm and CRS, and also the available treatment strategies of the latter.

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Occupational exposure influences control of disease in patients with chronic rhinosinusitis

Rhinology Journal ◽

10.4193/rhin21.091 ◽

2021 ◽

Vol 59 (4) ◽

pp. 380-386

Author(s):

D.A.E. Dietz de Loos ◽

S. Ronsmans ◽

M.E. Cornet ◽

P.W. Hellings ◽

V. Hox ◽

...

Keyword(s):

Occupational Exposure ◽

Chronic Rhinosinusitis ◽

Nasal Polyps ◽

Conservative Therapy ◽

Cross Sectional Study ◽

Sinus Surgery ◽

Sectional Study ◽

Cross Sectional ◽

Independent Variables ◽

The Relationship

Background: Chronic rhinosinusitis (CRS) is a frequent condition that is treated by endoscopic sinus surgery (ESS) when medical treatment fails. Irritating or sensitizing airborne agents can contribute to uncontrolled CRS. A prior study showed a linear correlation between occupational exposure and the number of ESS. Methods: In this cross-sectional study we tested the hypothesis that occupational exposure is a risk for undergoing ESS. We sent questionnaires enquiring occupational exposure in patients with CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP). An expert assessed blindly the reported work exposures to inhaled agents. The relationship between occupational exposure on undergoing ESS was analysed. Results: Among all patients who underwent ESS (n=343), 30% reported a relevant occupational exposure, which is significantly higher than the 4.8% found among CRS patients that underwent no prior sinus surgery (n=21). Besides occupational exposure, self-reported doctor-diagnosed asthma were independent variables contributing to the chance of undergoing ESS. Conclusion: In our study we confirm occupational exposure as a risk factor for uncontrolled CRS, if defined by undergoing ESS. In CRS patients with uncontrolled symptoms, despite maximal conservative therapy, the clinician should explore the possible contribution of occupational exposure.

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Eosinophilia in the Ethmoid Mucosa and Its Relationship to the Severity of Inflammation in Chronic Rhinosinusitis

American Journal of Rhinology ◽

10.1177/194589240201600301 ◽

2002 ◽

Vol 16 (3) ◽

pp. 131-134 ◽

Cited By ~ 38

Author(s):

Eva Szucs ◽

Saied Ravandi ◽

Anita Goossens ◽

Mieke Beel ◽

Peter A.R. Clement

Keyword(s):

Ct Scan ◽

Chronic Rhinosinusitis ◽

Staging System ◽

Inflammatory Cells ◽

Sinus Surgery ◽

Mucosal Inflammation ◽

Tissue Eosinophilia ◽

Eosinophilic Infiltrate ◽

Preoperative Ct ◽

Sinus Mucosa

Background The aim of this study was to analyze histopathologically mucosal inflammation in patients with chronic rhinosinusitis. In addition, we assessed tissue eosinophilia in relation to the severity of inflammation and to the computer tomographic (CT) findings. Methods Forty-eight pathological sinus mucosa specimens obtained during functional endoscopic sinus surgery were stained by hematoxylin and eosin. Total inflammatory cells and eosinophils were quantified. The preoperative CT scans were scored by the staging system of Lund-MacKay. Results The grade of the eosinophilic infiltration in the diseased sinus mucosa correlated significantly with the severity of the mucosal inflammation. Allergy or asthma had no effect on the proportion of the eosinophilic infiltrate. The CT scan scores assessed by the Lund-MacKay system correlated significantly with the severity of the inflammatory cellular infiltrate. The correlation between the CT scan scores and the eosinophilic infiltrate of the mucosa was close to significant. Conclusion Eosinophilic mucosal inflammation represents the most severe inflammatory changes of the mucosa. Twenty to forty percent of the patients with chronic rhinosinusitis had no eosinophilic inflammation of the mucosa. The CT-staging system of Lund-Mackay correlated with the extent of mucosal inflammation.

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A comparative study between ciliary count and the degree of opacity of paranasal sinus CT scans in chronic sinusitis pre and post FESS

The Journal of Laryngology & Otology ◽

10.1258/002221505775010643 ◽

2005 ◽

Vol 119 (12) ◽

pp. 950-954 ◽

Cited By ~ 5

Author(s):

Ahmed Bassiouny ◽

Mahmoud Abd El Raouf ◽

Ahmed Atef ◽

Safaa Nasr ◽

Soha Talaat ◽

...

Keyword(s):

Ct Scan ◽

Chronic Sinusitis ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Ct Scans ◽

Sinus Disease ◽

Before And After ◽

The Relationship ◽

Radiological Stage ◽

Sinus Mucosa

Objective: To investigate the relationship between the extent of sinus disease in chronic sinusitis as detected radiologically by computed tomography (CT) scan and the population of cilia (ciliary area) both before and after functional endoscopic sinus surgery (FESS). In a simple way this is a trial to statistically prove that the CT scan could be a valid indicator and a mirror of the histological status of the sinus mucosa.Design: Twenty adult patients were enrolled in this study. Radiological extension of the sinus disease was quantitated using the classification proposed by Kennedy in 1992 and the ciliary population was studied using scanning electron microscopy and image analysis softwares.Results and conclusion: The more advanced the sinusitis, as evidenced by CT scans, the more the expected reduction in the ciliary area (CA) and in the ciliary count. But after FESS the degree of ciliary regeneration does not depend statistically on the radiological condition of the sinuses and the degree of opacity prior to intervention, i.e. a statistically valid inverse relationship exists between the radiological stage of sinusitis and the ciliary population pre-operatively but the same relation does not extend to the ciliary population post-operatively.

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Evaluation of Ultrastructural Changes in Paranasal Sinus Mucosa after Functional Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis

American Journal of Rhinology ◽

10.1177/194589240101500402 ◽

2001 ◽

Vol 15 (4) ◽

pp. 225-229 ◽

Cited By ~ 4

Author(s):

Nesil Keleş ◽

Bülent Ahıshalı ◽

Ö. Cenker Ilıcalı ◽

Kemal Değer

Keyword(s):

Chronic Rhinosinusitis ◽

Paranasal Sinus ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Cell Junctions ◽

Sinus Surgery ◽

Ultrastructural Changes ◽

Ciliated Epithelium ◽

Electron Microscopic ◽

Sinus Mucosa

The purpose of this study was to compare the preoperative and postoperative ultrastructural changes of paranasal sinus mucosa in patients treated with functional endoscopic sinus surgery for chronic rhinosinusitis. Twelve patients undergoing functional endoscopic sinus surgery for the treatment of chronic rhinosinusitis were involved. The ethmoid sinus mucosa was sampled during the operation and ∼6 months after the operation. The ciliated epithelium of sinus mucosa was evaluated with transmission electron microscopy. The samples were taken at the Otolaryngology Department of Istanbul University School of Medicine. Electron microscopic study was performed at the Histology and Embryology Department of the same University. Preoperatively, ciliated epithelial cells of the sinus mucosa of the patients showed degenerated ultrastructure with decreased number of cilia, cytoplasmic protrusions, cisternal dilatations of endoplasmic reticulum, and mitochondrial swellings. Remnants of degenerated cells and cellular separations at cell junctions were evident in the diseased epithelium. Goblet cells were frequent along the epithelial lining. Postoperatively, normal architecture and ultrastructure of the ciliated epithelium was restored. These observations showed that unlike other surgical operations, paranasal sinus mucosa can regenerate and the ciliated epithelium can return to normal after functional endoscopic sinus surgery.

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Surgical Treatment of Paediatric Chronic Rhinosinusitis

Journal of Clinical Medicine ◽

10.3390/jcm8050684 ◽

2019 ◽

Vol 8 (5) ◽

pp. 684 ◽

Cited By ~ 3

Author(s):

Sara Torretta ◽

Claudio Guastella ◽

Tullio Ibba ◽

Michele Gaffuri ◽

Lorenzo Pignataro

Keyword(s):

Surgical Treatment ◽

Chronic Rhinosinusitis ◽

Balloon Catheter ◽

Primary Treatment ◽

Sinus Surgery ◽

Current Evidence ◽

Common Disease ◽

Healthy Children ◽

Older Children ◽

Maximal Medical Therapy

Rhinosinusitis (RS) is a common disease in children, significantly affecting their quality of life. Chronic rhinosinusitis (CRS) is frequently linked to other respiratory diseases, including asthma. Children affected by CRS may be candidates for surgery in the case of failure of maximal medical therapy comprising three to six weeks of broad-spectrum systemic antibiotics with adjunctive therapies. Although endoscopic sinus surgery (ESS) is the surgical treatment of choice in adult patients with CRS, different surgical procedures are scheduled for refractory paediatric CRS and include adenoidectomy, paediatric ESS (PESS), and balloon catheter sinuplasty (BCS). The present paper discusses the indications and limitations of each treatment option in children with CRS. Given the amount of current evidence, it is reasonable to suggest that, in young and otherwise healthy children with refractory CRS, an adenoidectomy (eventually combined with BCS) should be offered as the first-line surgical treatment. Nevertheless, this approach may be considered ineffective in some patients who should be candidates for traditional ESS. In older children, those with asthma, or in the case of peculiar conditions, traditional ESS should be considered as the primary treatment.

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Vestibular Characteristics of Patients with Chronic Rhinosinusitis

OTO Open ◽

10.1177/2473974x18804993 ◽

2018 ◽

Vol 2 (4) ◽

pp. 2473974X1880499

Author(s):

Sabrina Brody-Camp ◽

John A. Risey ◽

Edward D. McCoul

Keyword(s):

Chronic Rhinosinusitis ◽

Preliminary Report ◽

Vestibular Function ◽

Subjective Symptom ◽

Common Disease ◽

Disease Entity ◽

Limited Data ◽

Wide Range ◽

The Relationship ◽

Prospective Database

Chronic rhinosinusitis (CRS) is a common disease entity with symptoms that may extend beyond the sinonasal tract. Limited data exist regarding the relationship between CRS and the vestibular system, and no previous study has investigated the association between objective vestibular findings on videonystagmography (VNG) and the diagnosis of CRS. We analyzed a prospective database of 3078 patients who underwent VNG at our institution over an 8-year period, which included 70 subjects who had a diagnosis of CRS assigned by an otolaryngologist. Overall, the VNG findings for patients with CRS were similar to those of the general population, with 50% exhibiting normal vestibular function. Peripheral lesions were the most common abnormal VNG finding, with a wide range of subjective symptom descriptions. This preliminary report of the prevalence of objective vestibular findings in patients with CRS may form the basis for future study.

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The relationship between endoscopic and radiologic findings and olfactory status of patients with chronic rhinosinusitis with nasal polyps before and after the endoscopic sinus surgery

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-018-5221-z ◽

2018 ◽

Vol 276 (2) ◽

pp. 397-400 ◽

Cited By ~ 1

Author(s):

Mohammadhossein Dadgarnia ◽

Abbasali Rahmani ◽

Mohammadhossein Baradaranfar ◽

Saeid Atighechi ◽

Vahid Zand ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Nasal Polyps ◽

Sinus Surgery ◽

Radiologic Findings ◽

Before And After ◽

The Relationship

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The Relationship between Calcaneal Spur Type and Plantar Fasciitis in Chinese Population

BioMed Research International ◽

10.1155/2020/5679629 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Lei Zhang ◽

Han-wen Cheng ◽

Lu-jing Xiong ◽

Zhang-rong Xia ◽

Meng-yao Zhang ◽

...

Keyword(s):

Chinese Population ◽

Plantar Fasciitis ◽

Treatment Strategies ◽

Common Disease ◽

Type I ◽

X Rays ◽

Type Ii ◽

Type Iii ◽

Vas Scores ◽

The Relationship

Plantar heel pain is a common disease with a high incidence in different races. It significantly reduced the quality of life of patients. However, the cause of PHP is still controversial and there were varieties of physiological factors associated with PHP. The most common pathological factor in the population was plantar fasciitis. Some existing research studies had found a correlation between calcaneal spurs and plantar fasciitis, and this study had found the correlation in Chinese population. It is invaluable not only to understand the relationship between different types of plantar calcaneal spurs and plantar fasciitis but also to identify the most appropriate treatment strategies. A total of 71 patients with calcaneal spurs were chosen from the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. All 71 patients had completed X-rays and MRI scans; then, surgeons had removed their plantar calcaneal spurs. After surgery, all patients were followed up for 12 months; their prognosis was tested by the VAS and AOFAS scores. Type II (29, 40.8%) had the highest incidence in Chinese population, followed with type I (24, 33.8%) and type III (18, 25.4%). Preoperative VAS scores showed that type II (7.72±1.10) was significantly higher than the other two types (P<0.001). Postoperative VAS scores of type II were higher than those of type I and type III (P<0.001). Postoperative AOFAS scores of type II were the lowest (P<0.001). Researchers had proved that type II was more likely to cause PF.

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Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00493-2 ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Andrew Thamboo ◽

S. Kilty ◽

I. Witterick ◽

Y. Chan ◽

C. J. Chin ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Biologic Therapy ◽

Clinical Signs ◽

Signs And Symptoms ◽

White Paper ◽

Sinus Surgery ◽

Health Care Environment ◽

Double Blind ◽

Inflammatory Pathway

Abstract Background Recent evidence suggests that biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of chronic rhinosinusitis with nasal polyposis (CRSwNP). There remains a population in CRSwNP that despite medical therapy and endoscopic sinus surgery have persistent signs and symptoms of disease. Therefore, biologics, monoclonal antibody agents, could be beneficial therapeutic treatments for these patients. There have been eight randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL-5R, IL-33, and immunoglobulin (Ig)E. However, there are no formal recommendations for the optimal use of biologics in managing Chronic Rhinosinusitis (CRS) within the Canadian health care environment. Methods A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. 17 fellowship trained rhinologists across Canada evaluated the 28 original statements on a scale of 1–10 and provided comments. A rating within 1–3 indicated disagreement, 8–10 demonstrated agreement and 4–7 represented being neutral towards a statement. All ratings were quantitively reviewed by mean, median, mode, range and standard deviation. Consensus was defined by removing the highest and lowest of the scores and using the “3 point relaxed system”. Results After three rounds, a total of 11 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with CRS. Conclusion This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of patients with CRS, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. Graphical abstract

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A comparative study and correlation between preoperative computed tomogram and endoscopic sinus surgery in chronic rhinosinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194943 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1652

Author(s):

Mithra Sara John ◽

N. Gopinathan Pillai

Keyword(s):

Ct Scan ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Scoring System ◽

Pearson Correlation ◽

Middle Turbinate ◽

Sinus Surgery ◽

Common Disease ◽

Nasal Discharge ◽

Excellent Correlation

Background: Chronic rhinosinusitis (CRS) with its classical symptoms of nasal obstruction, nasal discharge, and headache is relatively a common disease in otorhinolaryngology practice. The objectives of the present study was to correlate the operative findings in such patients with the CT findings, using the Perioperative sinus endoscopy (POSE) scoring system and to correlate the maximum scores obtained in the POSE scoring system and Lund-Mackay scoring system.Methods: A prospective study was conducted from January 2014 to March 2015 in 50 patients suffering from chronic rhinosinusitis who underwent endoscopic sinus surgery in the age group of 36-60 years of age. Results: Agger nasi cells were the most common wandering ethmoid cell detected (90%) followed by various types of frontal cells (54%), Haller cells (26%) and least commonly Onodi cells (12%). Almost perfect agreement was obtained for rest of the criteria which included middle turbinate status, ethmoid cavity mucosal edema and ethmoid cavity polypoid change. Lund-Mackay scoring system was used to score findings in the CT scan and POSE scoring system used to score peroperative findings in the study and this study reveals excellent correlation (Pearson correlation value of 0.879).Conclusions: Novel POSE scoring is a new entity which has the potential to be a valid system to score preoperative and perioperative findings. In the current study POSE scoring shows excellent correlation with Lund Mackay scoring which is an established scoring system used in the evaluation CT scan.

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