A Clinical Study of Different Modalities for the Management of Chronic Maxillary Sinusitis

Background: Chronic maxillary sinusitis is a very common presentation in otorhinolaryngology clinics. It has diverse aetiology and varied symptoms at presentation. Its treatment requires a comprehensive approach for successful outcomes. We in the present study tried to evaluate the aetiology of chronic maxillary sinusitis and outcomes of treatment of chronic maxillary sinusitis. Methods: Patients presenting with clinical features of Chronic rhinosinusitis of all age groups and sexes were included in the study. The patients were subjected to general examination from head to toe which included the examination of the Respiratory system and cardiovascular system. ENT examination along with head neck was done. X-Ray (Water's view), C.T Scan PNSCoronal, and Sagittal sections for selected patients. Results: Antibiotics, antihistamines, decongestants, steam inhalations, and in some cases intranasal steroids (Budesonide, Beclomethasone, Fluticasone). Surgery: Antral wash n=16 cases, Intranasal Antrostomy n=2 cases, Caldwell Luc n=2 cases, Maxillary sinoscope n=2 cases, FESS n=38 cases involvinguncinectomy, middle meatal antrostomy, anterior ethmoidectomy, posterior ethmoidectomy, sphenoidotomy, frontal sinus infundibulotomy, and polypectomy. Conclusion: The commonest organism responsible was streptococcus pneumoniae. Improvement in the diagnostic techniques and availability of nasal endoscopy and CT scan which can show clearly the anatomy of osteomeatal complex has led to better management of the disease. Nasal endoscopes have allowed a meticulous delicate removal of the diseased mucosa which preserving the normal mucosa and structures consequently the postoperative complications are very few and most of the cases get relief from the symptoms of the disease

Nasal Steroids Use in the Prevention of Symptomatizing Adenoid Regrowth after Adenoidectomy

Background Regrowth of the adenoids is a well-recognized entity. Intranasal steroids for children with adenoid vegetation can provide an alternative to revision surgery. Objective To assess the ol' using nasal steroids to prevent recurrence of adenoid hypertrophy and related symptoms after adenoidectomy. Methods Controlled clinical trial. One hundred patients after adenoidectomy were divided randomly into 2 groups. Group I were patients performing surgery on odd days of the month received postoperative intranasal steroid [fluticasone propionate (50 mcg/metered dose per nostril per day)] and Group Il were patients performing surgery on even days of the month received intranasal saline spray starting at postoperative week 2 after wound healing. Both medications will be adninistrated for 8 weeks postoperatively. Patients will be followed up for minimum of 6 months by using modified SNOT Score to suit children in reporting the degree of the symptoms and i!' needed nasopharyngeal lateral X-rays. Results Highly significant difference between both groups after 6 months postoperatively. Conclusion The use of intranasal steroids may obtain successful results in children to prevent adenoid regrowth and recurrence of related nasal symptoms after adenoidectomy. The most appropriate drug, the most efficient dose, and optimal treatment duration need to be investigated and determined.

Relation between score for allergic rhinitis and immunoglobulin-E levels in the local population

<p class="abstract"><strong>Background:</strong> Allergic rhinitis (AR) is the most prevalent atopic disease in the world. It involves clinical hypersensitivity of the nasal mucosa to foreign substances mediated through immunoglobulin E antibodies. The quantitative Score for allergic rhinitis (SFAR) ranging between 0 and 16 has been in use from 2002.</p><p class="abstract"><strong>Methods:</strong> 240 patients diagnosed with Persistent allergic rhinitis (PAR) were taken to be part of the study after proper consent irrespective of the severity of symptoms. Each patient filled out the SFAR form before the treatment commenced. Serum IgE levels were noted and treatment was started which included oral and topical antihistamines, oral leukotriene receptor antagonists along with intranasal steroids. The IgE values were assessed along with the SFAR values side by side to look for any association. </p><p class="abstract"><strong>Results:</strong> It was noted that the individuals with identified triggers of allergy and those with a positive family history of allergy had a considerable higher IgE value as compared to those who did not. The ones with a trigger identified as a cause had a 54.88% higher IgE value. The ones with positive family history had 47.12% higher IgE than the ones without a history of allergy.</p><p class="abstract"><strong>Conclusions:</strong> Patients with well-defined trigger agents of allergy and positive family history of allergy are at a higher risk as they have a higher IgE value. They should be advised regular follow-ups and be monitored closely.</p>

Prescribing intranasal steroids in HIV-positive patients: systematic review of the literature

Background There are significant drug–drug interactions between human immunodeficiency virus antiretroviral therapy and intranasal steroids, leading to high serum concentrations of iatrogenic steroids and subsequently Cushing's syndrome. Method All articles in the literature on cases of intranasal steroid and antiretroviral therapy interactions were reviewed. Full-length manuscripts were analysed and the relevant data were extracted. Results A literature search and further cross-referencing yielded a total of seven reports on drug–drug interactions of intranasal corticosteroids and human immunodeficiency virus protease inhibitors, published between 1999 and 2019. Conclusion The use of potent steroids metabolised via CYP3A4, such as fluticasone and budesonide, are not recommended for patients taking ritonavir or cobicistat. Mometasone should be used cautiously with ritonavir because of pharmacokinetic similarities to fluticasone. There was a delayed onset of symptoms in many cases, most likely due to the relatively lower systemic bioavailability of intranasal fluticasone.

National Quality Evaluation of Medication Use for Pediatric Otitis Media With Effusion

Objectives: Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear without the presentation of signs or symptoms of acute ear infection. The point prevalence of OME reaches as high as 60% in children younger than 2 years of age. We used the National Health Insurance Research Database (NHIRD) to investigate the use of medication in children with OME before receiving ventilation tube insertion (VTI). Methods: Data of pediatric patients (age ≤ 12 years) who had OME and received VTI from January 1, 2011, to December 30, 2012, were retrieved from the Taiwan NHIRD. We surveyed the use of 4 medications to understand whether health care providers achieved the standards of medication use recommended by clinical practice guidelines. Results: This study examines the factors affecting the use of medication for pediatric OME. Overall, according to the study’s operational definitions, the use of systemic antibiotics was most common (59.9%), followed by systemic antihistamines (23.4%), systemic steroids (8.8%), and intranasal steroids (9.6%). Systemic antibiotics use was associated with 12 factors. Ten of the 12 factors increase the use of systemic antibiotics, including namely age (age > 2 years), comorbidities, teaching hospital, and community hospital. In contrast, namely catastrophic illness and watchful waiting are the 2 factors that decrease systemic antibiotics use. For the use of systemic antihistamines, systemic steroids, and intranasal steroids were related to 6, 5, and 2 factors, respectively. Conclusions: The rate of drug use differs from the rate of use recommended by commonly used clinical practice guidelines. We found that the higher the number of factors that influenced the patients’ drug use, the higher the rate of drug use. According to these results, drafting a treatment guideline for OME patients in accordance with current clinical practices in Taiwan is highly recommended.

Biological therapy of chronic rhinosinusitis

The aim of this paper is to present an up-to-date information about therapeutical options in chronic rhinosinusitis with nasal polyps. First choice therapy is a long term regular application of intranasal steroids in combination with salinic solution douches. If this treatment is not eff ective enough, then the pulses of systemic steroids are indicated. If the sufficient control of the disease is not achieved, then surgery is a therapeutic choice; it means functional endoscopic sinus surgery in the extent corresponding to the extension of the sinus disease. However, there remains a certain group of patients in whom the results with this treatment are not optimal. The type 2 immunopathological response affects relevantly the course of the disease. Nowadays, the research is done in this field. Specific agents, which are able to block circulating inflammatory mediators or bind receptors for these mediators are developed and studied. The results of the studies having been completed by now are promising. Keywords: biological therapy – chronic rhinosinusitis – nasal polyps – dupilumab – immunoglobulin E – interleukin