scholarly journals Chronic rhinosinusitis in adult patients with cystic fibrosis: clinical manifestation and therapeutic approaches

2019 ◽  
Vol 29 (3) ◽  
pp. 311-320
Author(s):  
G. L. Shumkova ◽  
E. L. Amelina ◽  
V. M. Svistushkin ◽  
E. V. Sin’kov ◽  
S. A. Krasovskiy ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Surgical Treatment ◽  
Treatment Group ◽  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyps ◽  
Adult Patients ◽  
Sinus Surgery ◽  
Markers Of Inflammation

The aim of this study was to evaluate prevalence of chronic rhinosinusitis (CRS) and nasal polyps in adult patients with cystic fibrosis (CF) in Russian Federation. Additionally, we investigated the clinical course of CRS and developed the optimal therapeutic strategy.Methods. Three hundred and forty eight CF patients were involved in the study. Physical examination, computed tomography (CT) of paranasal sinuses and audiometry, if needed, were used. CRS and bilateral nasal polyps were diagnosed in 28 patients. Nasal endoscopy, SNOT-20 questionnaire, rhinomanometry, micro - biological examination of sputum and mucus from paranasal sinuses (obtained during puncture or surgery), spirometry, and measurement of serum markers of inflammation were used. Endoscopic sinus surgery was used in 14 patients (the group 1) and others were treated non-surgically (the group 2). Both group were treated during 6 months using intranasal mometasone, mucolytics and antibiotics via PARI SINUSTM nebulizer.Results. An improvement in symptoms, CT signs, rhinomanometry parameters and endoscopic signs was seen in both groups after treatment and was more prominent in the surgical treatment group compared to the non-surgical treatment group. Bacterial load reduction in nasal sinuses, decrease in the rate of pulmonary disease exacerbations, and an improvement in oxygen blood saturation were found in the surgical treatment group only. Treatment of CRS did not affect lung function, sputum microbiology and serum inflammatory markers.Conclusion. Endoscopic sinus surgery followed by intranasal mucolytics and antibacterials is an effective and well-tolerated treatment in adult CF patients with CRS. 

scholarly journals Anatomy of Nasal Cavity and Paranasal Sinuses; Surgical Perspective

2020 ◽  
Vol 63 (5) ◽  
pp. 189-198
Author(s):  
Seung-Kyu Chung
Keyword(s):  
Surgical Treatment ◽  
Medical Treatment ◽  
Nasal Cavity ◽  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Endoscopic Sinus Surgery ◽  
Treatment Method ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery

Endoscopic sinus surgery is a treatment method for chronic rhinosinusitis not controlled with medical treatment. It had started with functional endoscopic sinus surgery and the concept of reboot approach was introduced recently. For safe surgical treatment, understanding the anatomy especially personal variations between well-known structures is important. The practical points of surgical concept during endoscopic sinus surgery was suggested.

scholarly journals Defining appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis: a RAND/UCLA appropriateness study

2016 ◽  
Vol 54 (2) ◽  
pp. 117-128
Author(s):  
Luke Rudmik ◽  
Zachary M. Soler ◽  
Claire Hopkins ◽  
Rodney J. Schlosser ◽  
Anju Peters ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Treatment Option ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyps ◽  
Adult Patients ◽  
Sinus Surgery ◽  
Intranasal Corticosteroid ◽  
Appropriateness Criteria ◽  
Short Course ◽  
Snot 22

Introduction: Appropriate indications for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) are currently poorly defined. The lack of clear surgical indications for ESS likely contributes to the large geographic variation in surgical rates and contributes to reduced quality of care. The objective of this study was to define appropriateness criteria for ESS during management of adult patients with uncomplicated CRS. Methods: The RAND/UCLA appropriateness methodology was performed. An international, multi-disciplinary panel of 10 experts in CRS was formed and completed two rounds of a modified Delphi ranking process along with a face-to-face meeting. Results: A total of 624 clinical scenarios were ranked, 312 scenarios each for CRS with and CRS without nasal polyps. For adult patients with uncomplicated CRS with nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus a short-course of systemic corticosteroid with a post-treatment total SNOT-22 score ≥ 20. For adult patients with uncomplicated CRS without nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus either a short-course of a broad spectrum/culture-directed systemic antibiotic or the use of a prolonged course of systemic low-dose anti-inflammatory antibiotic with a post-treatment total SNOT-22 score ≥ 20. Conclusion: This study has developed and reported of list of appropriateness criteria to offer ESS as a treatment option during management of uncomplicated adult CRS. The extent or technique of ESS was not addressed in this study and will depend on surgeon and patient factors. Furthermore, these criteria are the minimal threshold to make ESS a treatment option and do not imply that all patients meeting these criteria require surgery. The decision to perform ESS should be made after an informed patient makes a preference-sensitive decision to proceed with surgery. Applying these appropriateness criteria for ESS may optimize patient selection, reduce the incidence of unwarranted surgery, and assist clinicians in providing high quality, patient-centered care to patients with CRS.

scholarly journals Rectal Staphylococcus aureus Carriage and Recurrence After Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyps: A Prospective Cohort Study

2021 ◽  
pp. 014556132110197
Author(s):  
Yue Peng ◽  
Zhao Liu ◽  
Zhijian Yu ◽  
Aiwu Lu ◽  
Tao Zhang
Keyword(s):  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Regression Model ◽  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Prospective Cohort ◽  
Multivariate Regression ◽  
Nasal Polyps ◽  
Sinus Surgery ◽  
Multivariate Regression Model

Objective: Chronic rhinosinusitis with nasal polyps (CRSwNPs) remains a major challenge due to its high recurrence rate after endoscopic sinus surgery (ESS). We aimed to investigate the risk factors of recurrence among patients who underwent ESS for Chronic rhinosinusitis (CRS). Methods: Prospective cohort study including 391 cases in a single institution receiving ESS were included for analysis from 2014 and 2017. Baseline characteristics including rectal Staphylococcus aureus ( S aureus) carriage in patients receiving ESS for CRSwNPs. The primary outcome was the recurrence of CRSwNPs. Multivariate regression model was established to identify independently predictive factors for recurrence. Results: Overall, 142 (36.3%) cases with recurrence within 2 years after ESS were observed in this study. After variable selection, multivariate regression model consisted of 4 variables including asthma (odds ratio [OR] = 3.41; P < .001), nonsteroidal anti-inflammatory drug allergy (OR = 2.27; P = .005), previous ESS (OR = 3.64; P < .001), and preoperative carriage of S aureus in rectum (OR = 2.34; P = .001). Conclusions: Based on our results, surgeons could predict certain groups of patients who are at high risk for recurrence after ESS. Rectal carriage of S aureus is more statistically related to the recurrence of CRSwNP after ESS compared with skin and nasal carriage.

“In-Office Balloon Sinus Ostial Dilation with Concurrent Antiplatelet and Anticoagulant Therapy for Chronic Rhinosinusitis without Nasal Polyps”

2019 ◽  
Vol 129 (3) ◽  
pp. 280-286
Author(s):  
Thomas S. Higgins ◽  
Bülent Öcal ◽  
Ridwan Adams ◽  
Arthur W. Wu
Keyword(s):  
Antiplatelet Therapy ◽  
Chronic Rhinosinusitis ◽  
Anticoagulant Therapy ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyps ◽  
Sinus Surgery ◽  
Bleeding Events ◽  
Safe Alternative ◽  
Systemic Complications ◽  
Snot 22

Objective: Functional endoscopic sinus surgery (FESS) and balloon sinus ostial dilation (BSD) are well-recognized minimally invasive surgical treatments for chronic rhinosinusitis without nasal polyps (CRSsNP) refractory symptoms to medical therapy. Patients on antiplatelet and anticoagulant therapies (AAT) usually are recommended to discontinue their medications around the period of endoscopic sinus surgery. The goal of this study is to assess the clinical experience of BSD in CRSsNP patients with concurrent anticoagulant or antiplatelet therapy. Methods: A review of prospectively-collected clinical data from October 2012 to March 2017 were used to perform a cohort study of subjects with CRSsNP who met criteria for surgical intervention while on antiplatelet and anticoagulant therapy. Data were collected on demographics, details of the procedures, type of AAT used, pre- and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores, and complications. Results: Thirty-five patients underwent in-office BSD while on antiplatelet and/or anticoagulant therapy. The mean difference in pre- and postoperative SNOT-22 scores of 9.9 (SD 14.4, P < .001) was both statistically significant and exceeded the minimal clinically important difference of 8.9. Absorbable nasal packing was used for persistent bleeding immediately post-procedure in two patients. Intraoperative bleeding was associated with aspirin 325 mg and warfarin. FESS was required for further management of chronic sinusitis in four patients after anticoagulant/antiplatelet therapy could be discontinued. There were no systemic complications. None of the patients experienced significant bleeding events postoperatively after leaving the office. Conclusion: In-office BSD appears to be a safe alternative to endoscopic sinus surgery in select patients who cannot discontinue antiplatelet and anticoagulant therapy. Levels of Evidence: IV

Office-Based Sinus Surgery for Cystic Fibrosis Chronic Rhinosinusitis

ORL ◽  
2020 ◽  
pp. 1-4
Author(s):  
Daniel B. Spielman ◽  
David A. Gudis
Keyword(s):  
Cystic Fibrosis ◽  
Mechanical Ventilation ◽  
Chronic Rhinosinusitis ◽  
Local Anesthesia ◽  
Endoscopic Sinus Surgery ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Sinus Surgery ◽  
Office Setting

<b><i>Objective:</i></b> Chronic rhinosinusitis (CRS) is nearly ubiquitous in the cystic fibrosis (CF) population, and many patients require multiple endoscopic sinus surgeries throughout their lifetime. Recent studies have demonstrated the profound pulmonary and systemic health benefits of comprehensive CRS treatment. Both endotracheal intubation with mechanical ventilation and inpatient hospital care represent significant risks for CF patients. The goal of this study is to evaluate the safety and feasibility of performing revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia to decrease the need for mechanical ventilation and inpatient hospitalization. <b><i>Methods:</i></b> This is a prospective cohort study conducted at a tertiary care academic medical center with a CF Foundation-accredited care center. Patients with CF and refractory CRS despite prior surgery and medical therapy were eligible for inclusion. Comprehensive revision ESS was performed in the office using only local anesthesia. <b><i>Results:</i></b> Five patients were enrolled and underwent revision endoscopic sinus surgery without complication. The average preoperative Sinonasal-Outcome Test-22 score was 52.0 ± 12.1 and the average preoperative Lund-Mackay score was 15.2 ± 3.8. No patients requested aborting the procedure early due to pain, discomfort, or any other reason. No subjects required prolonged observation or postoperative hospital admission. <b><i>Conclusion:</i></b> This prospective pilot study is the first to demonstrate the safety and feasibility of performing comprehensive revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia.

Increased Serum Periostin Levels and Eosinophils in Nasal Polyps Are Associated with the Preventive Effect of Endoscopic Sinus Surgery for Asthma Exacerbations in Chronic Rhinosinusitis Patients

2020 ◽  
Vol 181 (11) ◽  
pp. 862-870
Author(s):  
Yoshihiro Kanemitsu ◽  
Ryota Kurokawa ◽  
Junya Ono ◽  
Kensuke Fukumitsu ◽  
Norihisa Takeda ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Eosinophil Count ◽  
Nasal Polyps ◽  
Sinus Surgery ◽  
Blood Eosinophil ◽  
Preventive Effect ◽  
Blood Eosinophil Count ◽  
Asthma Exacerbations ◽  
Serum Periostin

<b><i>Background:</i></b> Eosinophilic nasal polyps (NPs) are associated with the presence of asthma in chronic rhinosinusitis (CRS) patients. Serum periostin has been considered a relevant biomarker for unified airway diseases. <b><i>Objective:</i></b> To determine the utility of biomarkers including serum periostin that reflects reduction of exacerbations of comorbid asthma in CRS patients. <b><i>Methods:</i></b> We prospectively recruited 56 CRS patients who were subjected to undergo endoscopic sinus surgery (ESS) (20 with asthma) between October 2015 and December 2017 and followed them for 1 year after ESS. Blood eosinophil count, serum periostin, and fractional nitric oxide (FeNO) were measured at enrollment. How these type 2-driven biomarkers reflect comorbid asthma was determined using receiver operating characteristic (ROC) analysis. The frequency of asthma exacerbations during 1 year was counted both before and after ESS. Associations between preoperative biomarkers including eosinophils in NPs and asthma exacerbations were evaluated. <b><i>Results:</i></b> Blood eosinophil count, FeNO, and serum periostin levels were significantly higher in CRS patients with asthma than in those without (<i>p</i> &#x3c; 0.01 for all) and discriminated comorbid asthma among CRS patients (<i>p</i> &#x3c; 0.05; AUC &#x3e; 0.80 for all). The increased preoperative serum periostin correlated with lower absolute number of postoperative exacerbations (ρ = −0.49, <i>p</i> = 0.03) and its relative reduction after ESS (ρ = 0.53, <i>p</i> = 0.03) in asthmatic patients. Increased eosinophils in NPs were also associated with reduced asthma exacerbations. <b><i>Conclusion:</i></b> Preoperative increased serum periostin and eosinophils in NPs are associated with the preventive effect of ESS for asthma exacerbations in CRS patients comorbid with asthma.

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