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Daramola OO, Lidder AK, Ramli R, Chandra RK, Shintani-Smith S, Conley DB, Kern RC, Tan BK. Patient knowledge and perception of computed tomography scan in the management of chronic rhinosinusitis symptoms. Laryngoscope 2015; 125:791-5. [PMID: 25346013 PMCID: PMC4376556 DOI: 10.1002/lary.24992] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/23/2014] [Accepted: 09/30/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective of this study was to report patients' knowledge and comfort level with computed tomography (CT) imaging for sinus disease and evaluate patient willingness to undergo empiric medical therapy (EMT) versus CT-directed therapy (CTDT). STUDY DESIGN Prospective survey study. METHODS A 22-item survey was administered to patients with nasal/sinus symptoms in a tertiary care rhinology clinic. Questions elicited patient demographics, imaging history, and knowledge/comfort regarding imaging-related radiation exposure. Patients were presented with the theoretical choice of EMT versus CTDT, given the expected positive predictive value, in chronic rhinosinusitis (CRS) management. RESULTS Two hundred patients (52% female, age range 18-83 years) participated. Of these, 85% had symptoms for over 3 months. Only 91 patients (45.5%) were aware that CT imaging involved radiation exposure. Prior CT experience and past sinus surgery (P < .05), but not sex or education level, were associated with increased comfort with CT imaging. Most patients (78%) preferred CTDT over EMT. If a CT sinus was recommended, 77 patients (38.5%) had concerns, of which 26% identified radiation exposure as the leading concern. The majority (70%) were unsure about the relative radiation dose of a conventional CT. CONCLUSIONS Patients with CRS symptoms prefer CTDT over EMT if a diagnosis cannot be established definitively using exam findings. Although most patients deferred to the physician regarding the decision to utilize CT imaging, there is low awareness of CT-related radiation exposure, and a significant minority of patients have radiation-related concerns with regard to medical imaging for nasal and sinus symptoms.
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Kern RC. Historical classics: Editorial. Laryngoscope 2015; 125:773. [PMID: 25773495 DOI: 10.1002/lary.25216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 11/09/2022]
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Jia Y, Yu H, Fernandes SM, Wei Y, Gonzalez-Gil A, Motari MG, Vajn K, Stevens WW, Peters AT, Bochner BS, Kern RC, Schleimer RP, Schnaar RL. Expression of ligands for Siglec-8 and Siglec-9 in human airways and airway cells. J Allergy Clin Immunol 2015; 135:799-810.e7. [PMID: 25747723 PMCID: PMC4355580 DOI: 10.1016/j.jaci.2015.01.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/08/2015] [Accepted: 01/13/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Balanced activation and inhibition of the immune system ensures pathogen clearance while avoiding hyperinflammation. Siglecs, sialic acid-binding proteins found on subsets of immune cells, often inhibit inflammation: Siglec-8 on eosinophils and Siglec-9 on neutrophils engage sialoglycan ligands on airways to diminish ongoing inflammation. The identities of human siglec ligands and their expression during inflammation are largely unknown. OBJECTIVE The histologic distribution, expression, and molecular characteristics of siglec ligands were explored in healthy and inflamed human upper airways and in a cellular model of airway inflammation. METHODS Normal and chronically inflamed upper airway tissues were stained for siglec ligands. The ligands were extracted from normal and inflamed tissues and from human Calu-3 cells for quantitative analysis by means of siglec blotting and isolation by means of siglec capture. RESULTS Siglec-8 ligands were expressed on a subpopulation of submucosal gland cells of human inferior turbinate, whereas Siglec-9 ligands were expressed more broadly (submucosal glands, epithelium, and connective tissue); both were significantly upregulated in patients with chronic rhinosinusitis. Human airway (Calu-3) cells expressed Siglec-9 ligands on mucin 5B (MUC5B) under inflammatory control through the nuclear factor κB pathway, and MUC5B carried sialoglycan ligands of Siglec-9 on human upper airway tissue. CONCLUSION Inflammation results in upregulation of immune-inhibitory Siglec-8 and Siglec-9 sialoglycan ligands on human airways. Siglec-9 ligands are upregulated through the nuclear factor κB pathway, resulting in their enhanced expression on MUC5B. Siglec sialoglycan ligand expression in inflamed cells and tissues may contribute to the control of airway inflammation.
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Stevens WW, Peters AT, Suh L, Norton JE, Kern RC, Conley DB, Chandra RK, Tan BK, Grammer LC, Harris KE, Carter RG, Kato A, Urbanek M, Schleimer RP, Hulse KE. A retrospective, cross-sectional study reveals that women with CRSwNP have more severe disease than men. IMMUNITY INFLAMMATION AND DISEASE 2015; 3:14-22. [PMID: 25866636 PMCID: PMC4386911 DOI: 10.1002/iid3.46] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/21/2014] [Accepted: 12/06/2014] [Indexed: 12/13/2022]
Abstract
Up to 50% of patients with chronic rhinosinusitis (CRS) have comorbid asthma, and we have reported that a subset of CRS patients who have nasal polyps (CRSwNP) have elevated autoantigen-specific antibodies within their nasal polyps (NP). While increases in the prevalence and/or severity of both asthma and autoimmunity in women are well characterized, it is not known whether CRSwNP is more severe or frequent in women than men. We sought to determine whether CRSwNP demonstrated sex-specific differences in frequency and/or severity. Using a retrospectively collected database of tertiary care patients (n = 1393), we evaluated the distribution of sex in patients with CRSwNP with or without comorbid asthma or aspirin hypersensitivity. We further compared the severity of sinus disease between men and women with CRSwNP. Although women comprised 55% of CRS patients without NP (CRSsNP), a significantly smaller proportion of CRSwNP patients were female (38%, P < 0.001). Interestingly, women with CRSwNP were significantly more likely than men to have comorbid asthma (P < 0.001), and 61% of patients with the most severe form of disease (aspirin-exacerbated respiratory disease (CRSwNP plus asthma plus aspirin sensitivity)) were women (P < 0.05). Women with CRSwNP were significantly more likely to have taken oral steroids, and were more likely to have a history of revision surgeries (P < 0.05) compared to men. These data suggest that women with CRSwNP have more severe disease than men in a tertiary care setting. Future studies are needed to elucidate the mechanisms that drive disease severity in men and women, paving the way for the development of personalized treatment strategies for CRSwNP based on sex.
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Min JY, Kern RC, Ocampo CJ, Homma T, Conley DB, Shintani-Smith S, Huang H, Suh L, Norton JE, Hulse KE, Kato A, Schleimer RP, Tan BK. Omeprazole Has Anti-Inflammatory Effects on Type 2 Cytokine-Stimulated Human Airway Epithelial Cells. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stevens WW, Ocampo CJ, Norton JE, Carter RG, Suh L, Grammer LC, Hulse KE, Peters AT, Chandra RK, Conley DB, Kern RC, Tan BK, Schleimer RP. Investigation of Molecular Characteristics of Aspirin Exacerbated Respiratory Disease. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pothoven KL, Norton JE, Suh L, Carter RG, Hulse KE, Rocci E, Gonsalves N, Liu MC, Peters AT, Harris KE, Shintani Smith S, Conley DB, Grammer LC, Kato A, Kern RC, Bryce P, Tan B, Schleimer RP. Oncostatin M Is Elevated in Mucosal Disease and May Mediate Epithelial Barrier Dysfunction in Vivo. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mahdavinia M, Suh LA, Carter RG, Stevens WW, Norton JE, Kato A, Tan BK, Kern RC, Conley DB, Chandra R, Lavin J, Peters AT, Grammer LC, Schleimer RP. Increased noneosinophilic nasal polyps in chronic rhinosinusitis in US second-generation Asians suggest genetic regulation of eosinophilia. J Allergy Clin Immunol 2015; 135:576-9. [PMID: 25312761 PMCID: PMC4323954 DOI: 10.1016/j.jaci.2014.08.031] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/12/2014] [Accepted: 08/14/2014] [Indexed: 12/29/2022]
Abstract
In this study we found a significantly lower eosinophilia in nasal polyps surgically removed from second-generation Asian patients, similar to studies of native-born patients in Asian countries, suggesting the hypothesis that there may be genetic regulation of eosinophilia.
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Poposki JA, Peterson S, Welch K, Schleimer RP, Hulse KE, Peters AT, Norton J, Suh LA, Carter R, Harris KE, Grammer LC, Tan BK, Chandra RK, Conley DB, Kern RC, Kato A. Elevated presence of myeloid dendritic cells in nasal polyps of patients with chronic rhinosinusitis. Clin Exp Allergy 2015; 45:384-93. [PMID: 25469646 PMCID: PMC4467201 DOI: 10.1111/cea.12471] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 11/23/2014] [Accepted: 11/28/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by Th2 inflammation, the mechanism underlying the onset and amplification of this inflammation has not been fully elucidated. Dendritic cells (DCs) are major antigen-presenting cells, central inducers of adaptive immunity and critical regulators of many inflammatory diseases. However, the presence of DCs in CRS, especially in nasal polyps (NPs), has not been extensively studied. OBJECTIVE The objective of this study was to characterize DC subsets in CRS. METHODS We used real-time PCR to assess the expression of mRNA for markers of myeloid DCs (mDCs; CD1c), plasmacytoid DCs (pDCs; CD303) and Langerhans cells (LCs; CD1a, CD207) in uncinate tissue (UT) from controls and patients with CRS as well as in NP. We assayed the presence of DCs by immunohistochemistry and flow cytometry. RESULTS Compared to UT from control subjects (n = 15) and patients with CRS without NP (CRSsNP) (n = 16) and CRSwNP (n = 17), mRNAs for CD1a and CD1c were significantly elevated in NPs (n = 29). In contrast, CD207 mRNA was not elevated in NPs. Immunohistochemistry showed that CD1c(+) cells but not CD303(+) cells were significantly elevated in NPs compared to control subjects or patients with CRSsNP. Flow cytometric analysis showed that CD1a(+) cells in NPs might be a subset of mDC1s and that CD45(+) CD19(-) CD1c(+) CD11c(+) CD141(-) CD303(-) HLA-DR(+) mDC1s and CD45(+) CD19(-) CD11c(+) CD1c(-) CD141(high) HLA-DR(+) mDC2s were significantly elevated in NPs compared to UT from controls and CRSsNP, but CD45(+) CD11c(-) CD303(+) HLA-DR(+) pDCs were only elevated in NPs compared to control UT. CONCLUSION AND CLINICAL RELEVANCE Myeloid DCs are elevated in CRSwNP, especially in NPs. Myeloid DCs thus may indirectly contribute to the inflammation observed in CRSwNP.
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Van Roey GA, Vanison CC, Huang H, Kern RC, Chandra RK, Smith SS, Conley DB, Hulse KE, Kato A, Suh L, Carter RG, Schleimer RP, Tan B. Complement Activation in Nasal Tissue of Patients with Chronic Rhinosinusitis. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Qureshi HA, Ference EH, Tan BK, Chandra RK, Kern RC, Smith SS. National Trends in Retropharyngeal Abscess among Adult Inpatients with Peritonsillar Abscess. Otolaryngol Head Neck Surg 2015; 152:661-6. [DOI: 10.1177/0194599814568286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/23/2014] [Indexed: 11/16/2022]
Abstract
Objectives To describe national trends in retropharyngeal abscess (RPA) complicating peritonsillar abscess (PTA) and to determine factors associated with RPA in patients with PTA. Study Design Cross-sectional analysis. Setting Nationwide Inpatient Sample, 2003-2010. Subjects and Methods PTA patients ≥18 years old, with or without RPA, were extracted according to ICD-9-CM codes. The cohort was analyzed with descriptive statistics and multivariate regression modeling to identify factors associated with RPA. Results Of the 91,647 (95% CI: 86,433-95,449) patients identified with PTA, 885 (1.0%) also had a concurrently coded RPA. The annual rate of concomitant RPA increased from 0.5% (95% CI: 0.3%-0.8%) to 1.4% (95% CI: 1.0%-2.0%) between 2003 and 2010 ( P < .001). PTA patients with RPA more frequently underwent tonsillectomy (23.5% vs 11.1%), endotracheal intubation (7.1% vs 1.5%), and mechanical ventilation (13.2% vs 2.0%) than those without RPA (all P < .001). PTA patients with RPA were significantly older (41 vs 34 years old), had a longer hospital stay (6.4 vs 2.5 days), and had more procedures (2.5 vs 0.9) when compared to patients without RPA (all P < .001). Upon multivariate regression analysis, factors associated with RPA included the age groups of 40 to 64 years (odds ratio, 2.256; P < .001) and 65 and older (odds ratio, 2.086; P = .045). Median total charges for PTA inpatients with concomitant RPA were approximately $8700 greater ( P < .001) when compared to patients with PTA alone. Conclusions The incidence of RPA among adult inpatients with PTA is increasing, and patients with RPA have higher in-hospital resource utilization. Further studies may help validate factors predictive of RPA to enable prevention or earlier identification.
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Kashani S, Carr TF, Grammer LC, Schleimer RP, Hulse KE, Kato A, Kern RC, Conley DB, Chandra RK, Tan BK, Peters AT. Clinical characteristics of adults with chronic rhinosinusitis and specific antibody deficiency. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 3:236-42. [PMID: 25609325 DOI: 10.1016/j.jaip.2014.09.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 09/21/2014] [Accepted: 09/22/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Specific antibody deficiency (SAD) involves a deficient response to a polysaccharide vaccine in the setting of normal immunoglobulin G (IgG) levels and chronic infections. Patients with chronic rhinosinusitis (CRS) are often evaluated for SAD. There are limited data that describe patients with CRS and SAD. OBJECTIVE The objective of this study was to better characterize the role of SAD in CRS. METHODS We reviewed electronic records of adults with CRS who were evaluated for immunodeficiency with quantitative Ig levels and pre- and postantibody titers to a pneumococcal polysaccharide vaccine (PPV). RESULTS Fourteen pneumococcal serotypes were determined in 239 subjects from 2002 to 2009. Of these subjects, 64 had adequate protective titers of 1.3 μg/mL or higher in 7 or more serotypes of the 14 serotypes checked; 56 (23%) had less than 7 protective titers post-PPV and were diagnosed with SAD; and 119 had an adequate response to the vaccine with 7 or more serotypes being higher than 1.3 μg/mL (>50% response) and were characterized as "responders." Subjects with SAD received more antibiotic courses relative to responders in the 2 years after immunization (3.19 ± 2.64 vs 2.19 ± 2.24, P < .05). Of 56 subjects with SAD, 10 (17.9%) received Ig replacement therapy. Subjects who received Ig had fewer numbers of protective pneumococcal titers post-PPV and had more pneumonia (40.0%) versus subjects with SAD who did not receive Ig (10.9%). CONCLUSIONS Of the 239 patients with CRS with normal IgG levels evaluated for immunodeficiency, 56 (23.4%) had SAD. A majority of patients with SAD may not need Ig replacement; however, a subset of patients with SAD benefit from Ig replacement.
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Lam K, Conley DB, Liu K, Kern RC, Tan BK, Richter CP. Effect of ionic compositions in nasal irrigations on human olfactory thresholds. Laryngoscope 2014; 125:E50-6. [PMID: 25267347 DOI: 10.1002/lary.24941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/13/2014] [Accepted: 09/02/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Nasal irrigations are commonly employed to promote nasal hygiene in the treatment of various sinonasal conditions. Few studies have evaluated how the ionic composition of irrigation solutions affects olfactory performance. The purpose of this study was to determine the dose responsiveness of human olfactory thresholds for each of the following ions: potassium, sodium, and calcium. STUDY DESIGN Prospective translational study. METHODS Irrigation solutions with variable potassium, sodium, and calcium were tested in 25 healthy human participants. Six potassium concentrations (range, 2-10 mM), six sodium concentrations (range, 73.7-113.7 mM), and three calcium concentrations (range, 0.44-0.64 mM) were used. Before and immediately following irrigations, olfactory thresholds were determined using the Sniffin' Sticks test. Differences in olfactory threshold scores before and after irrigations were compared to assess the effect of ionic composition on olfactory sensitivity. RESULTS Physiologic concentrations of potassium, sodium, and calcium at 5.7, 89.5, and 0.54 mM, respectively, did not significantly change olfactory thresholds. Variations in both potassium and sodium concentrations demonstrated statistically significant dose-dependent elevations in olfactory thresholds (P < .05). Only the calcium concentration that was lower than the physiologic level led to significant elevations in olfactory thresholds. CONCLUSIONS Different potassium and sodium concentrations in irrigation solutions provide distinctive dose-dependent shifts in olfactory thresholds. Calcium concentrations also elevate olfactory thresholds, but calcium plays a less significant role than potassium and sodium in modulating olfactory thresholds. These results highlight the importance of the intranasal ionic microenvironment in olfactory physiology and suggest that optimal ionic concentrations in irrigation solutions exist to preserve olfactory function. LEVEL OF EVIDENCE NA.
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Han JK, Forwith KD, Smith TL, Kern RC, Brown WJ, Miller SK, Ow RA, Poetker DM, Karanfilov B, Matheny KE, Stambaugh J, Gawlicka AK. RESOLVE: a randomized, controlled, blinded study of bioabsorbable steroid-eluting sinus implants for in-office treatment of recurrent sinonasal polyposis. Int Forum Allergy Rhinol 2014; 4:861-70. [PMID: 25266981 DOI: 10.1002/alr.21426] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 08/26/2014] [Accepted: 09/02/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients with recurrent sinonasal polyposis after endoscopic sinus surgery (ESS) have limited treatment options. This study evaluated the safety and efficacy of a bioabsorbable steroid-eluting implant with 1350 μg of mometasone furoate for its ability to dilate obstructed ethmoid sinuses, reduce polyposis, and reestablish sinus patency. METHODS This was a randomized, controlled, blinded study including 100 patients chronic rhinosinusitis with nasal polyposis (CRSwNP) refractory to medical therapy and considered candidates for revision ESS. Follow-up included endoscopic grading by investigators and patient-reported outcomes. RESULTS Treated patients (n = 53; age as mean ± standard deviation [SD] 47.8 ± 12.6 years; 55% male) underwent in-office bilateral placement. Control patients (n = 47; age 51.6 ± 13.1 years; 66% male) underwent a sham procedure. At 3 months, treated patients experienced a significant reduction in bilateral polyp grade (p = 0.0269) and ethmoid sinus obstruction (p = 0.0001) compared to controls. Treated patients also experienced a 2-fold improvement in the mean nasal obstruction/congestion score (-1.33 ± 1.47 vs -0.67 ± 1.45; p = 0.1365). This improvement reached statistical significance (p = 0.025) in patients with greater polyp burden (grade ≥2 bilaterally; n = 74). At 3 months, 53% of treated patients compared to only 23% of controls were no longer indicated for repeat ESS. There was no serious adverse event or clinically significant increases in intraocular pressure or cataract formation. CONCLUSION The symptomatic improvement and statistically significant reduction in polyp grade and ethmoid sinus obstruction supported the efficacy of the steroid-eluting implant for in-office treatment of CRS patient with recurrent polyposis after ESS. The study results demonstrated that the steroid-eluting implant represents a safe and effective alternative to current management for this patient population.
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Smith SS, Ference EH, Evans CT, Tan BK, Kern RC, Chandra RK. The prevalence of bacterial infection in acute rhinosinusitis: a Systematic review and meta-analysis. Laryngoscope 2014; 125:57-69. [PMID: 24723427 DOI: 10.1002/lary.24709] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/24/2014] [Accepted: 04/07/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVES/HYPOTHESIS To systematically assess the prevalence of bacterial infection in adults with acute rhinosinusitis (ARS). METHODS Electronic databases were systematically searched for relevant studies published up to June 2012. RESULTS Twenty-nine articles, evaluating a total of 9,595 patients with a clinical diagnosis of ARS, were included in the study. Of these, 14 (48%) studies required radiographic confirmation of sinusitis, one study (3%) required evidence of purulence, 10 studies (35%) required both for inclusion in the study population, and four studies (14%) required neither. The random effects model estimate of prevalence of bacterial growth on all cultures was 53.7% (CI 48.4%-59.0%), ranging from 52.5% (CI 46.7%-58.3%) in studies requiring radiographic confirmation of sinusitis to 61.1% (CI 54.0%-68.1%) in studies requiring neither radiographic evidence nor purulence on exam. Studies that obtained cultures from antral swab had a prevalence of bacterial growth of 61.0% (CI 54.7%-67.2%), whereas those utilizing endoscopic meatal sampling had a prevalence of 32.9% (CI 19.0%-46.8%). CONCLUSIONS Few studies evaluate the recovery of bacteria via culture in adults with a diagnosis of ABRS or ARS based on clinical criteria alone. With radiographic and/or endoscopic confirmation, antral puncture and endoscopically guided cultures produce positive bacterial cultures in approximately one-half of patients. Opportunities exist to improve diagnostic accuracy for bacterial infection in ARS.
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Hernandez D, Hulse KE, Norton JE, Tan BK, Kern RC, Schleimer RP. Local Immunoglobulin Class Switch Recombination in Chronic Rhinosinusitis with Nasal Polyposis. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is characterized by B cell inflammation. We sought to determine whether immunoglobulin class switch recombination (CSR) occurred locally within polyps and to quantify the expression of proteins involved in regulating CSR. Germline transcripts (GLTs) are produced during CSR, and activation-induced cytidine deaminase (AICD) is an enzyme that is required for CSR. Thus, GLT and AICD expression can be used as markers for CSR. Methods: Polyp (n = 12-37), tonsil (n = 7), and uncinate tissue (UT) from patients with CRSwNP (n = 9), CRSsNP (n = 10), and normal controls (n = 11-12) were collected. Quantitative reverse transcriptase polymerase chain reaction for GAPDH, GUSB (housekeeping genes), AICD, IL-15, iNOS, BAFF, and A1, A2, G1, G4, and E GLT was performed using cDNA from tissue. Relative expression was calculated in relation to a housekeeping gene. Results: AICD expression was significantly increased in tonsils compared with all other groups ( P < .05), and polyp AICD expression was significantly elevated compared with UTwNP and UTsNP ( P < .01). Tonsils expressed significantly more A2 GLT than all other groups ( P < .05). E GLT was significantly increased in polyps versus UTnl ( P < .05). G1 GLT was increased in polyps compared with all other groups ( P < .05 vs UTwNP). G4 GLT was also increased in polyps compared with all other tissues, but this did not reach significance. Only IL-15 showed significantly increased expression in polyps versus UTnl and UTwNP ( P < .01). Conclusions: These results suggest that local CSR is occurring in polyps of patients with CRSwNP.
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Qureshi HA, Tan BK, Chandra RK, Kern RC, Smith SS. National Trends and Associated Factors of Retropharyngeal Abscess among Adult Inpatients with Peritonsillar Abscess. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: (1) Describe national trends in retropharyngeal abscess (RPA) complicating peritonsillar abscess (PTA). (2) Determine factors associated with RPA in patients with PTA. Methods: Years 2003 to 2010 of the Nationwide Inpatient Sample (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality) were queried for PTA (ICD-9 code: 475) and RPA (ICD-9 code: 478.24) in adult patients (age ≥18 years old). The cohort was analyzed using descriptive statistics and multivariate regression modeling to identify factors associated with RPA. Results: Of the 90,941 (95% confidence interval [CI]: 86,433-95,449) patients identified with PTA, 885 (1.0%) also had a concurrently coded RPA. The annual rate of concomitant RPA doubled ( P < .001) from 0.5% (95% CI: 0.3%-0.8%) to 1.4% (95% CI: 1.0%-2.0%) between 2003 and 2010. Patients with RPA were more likely to undergo tonsillectomy (23.5% vs 11.1%) and mechanical ventilation (13.2% vs 2.0%) than those without RPA (all P < .001). RPA patients were significantly (all P < .001) older (41 vs 34 years old), had a longer hospital stay (6.4 vs 2.5 days), and had more procedures (2.5 vs 0.9) compared with patients without RPA. Upon multivariate regression analysis, factors associated with RPA included age groups 40 to 64 years (odds ratio [OR] = 2.073, P < .001), 65 years and older (OR = 2.148, P = .021), and teaching hospital (OR = 1.838, P < .001). When controlling for age, sex, and hospital characteristics, general linear modeling demonstrated that RPA accounted for $27,240 ( P < .001) in excess total charges per patient. Conclusions: The incidence of RPA among adult inpatients with PTA is increasing, and patients with RPA have higher in-hospital resource utilization. Further studies may help validate factors predictive of RPA to enable earlier identification.
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Qureshi HA, Tan BK, Chandra RK, Kern RC, Smith SS. National Trends and Associated Factors of Endotracheal Intubation among Adult Inpatients with Peritonsillar Abscess. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: (1) Describe national trends in peritonsillar abscess (PTA) requiring endotracheal intubation (ETI). (2) Determine factors associated with ETI in patients with PTA. Methods: Years 2003 to 2010 of the Nationwide Inpatient Sample (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality) were queried for PTA (ICD-9 code: 475) and ETI (ICD-9 code: 96.04) in adult patients (age ≥18 years old). Descriptive statistics and multivariate regression modeling were employed to identify factors associated with ETI. Results: From 2003 to 2010, 90,941 (95% CI:86, 433-95, 449) admissions associated with a PTA were identified, of which 1357 (1.5%) underwent ETI. These patients had a higher prevalence of concurrently coded sepsis (7.3% vs 1.2%), severe sepsis (13.0% vs 0.2%), and death (7.9% vs 0.1%) compared with patients without ETI. Intubated patients were significantly (all P < .001) older (45 vs 34 years old), had a longer hospital stay (10.8 vs 2.4 days), and had more procedures (5.4 vs 0.9). Multivariate regression analysis displayed factors associated with intubation included age group 65 and older (odds ratio [OR] = 6.408, P < .001), transfer from another hospital (OR = 2.917, P = .029), alcohol abuse (OR = 6.445, P < .001), anemia (OR = 2.957, P = .002), and obesity (OR = 3.301, P < .001). When controlling for age, sex, hospital characteristics, and number of procedures, general linear modeling demonstrated intubation accounted for $24,374 ( P < .001) in excess total charges per patient. Overall charges for admissions with ETI accounted for $123 million over the study period. Conclusions: Patients with PTA undergoing ETI have worse in-hospital outcomes along with higher hospital charges. This study identifies characteristics of a PTA patient in whom clinicians should be wary of respiratory decompensation.
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Jiang N, Kern RC, Altman KW. Histopathological evaluation of chronic rhinosinusitis: a critical review. Am J Rhinol Allergy 2014; 27:396-402. [PMID: 24119603 DOI: 10.2500/ajra.2013.27.3916] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) consists of a constellation of symptoms, including facial pressure/pain, hyposmia, rhinorrhea, and nasal congestion. On histopathological evaluation, the disease can be divided into pathophysiologically distinct subgroups. This study systematically reviews the literature regarding the unique histopathological findings of the various subtypes of CRS to determine the potential diagnostic value of performing tissue analysis of CRS specimens beyond routine hematoxylin and eosin (H&E) staining. METHODS A PubMed search was untaken to identify articles that evaluated the histopathological features of CRS. Six hundred fifty-four relevant articles were identified and after application of specific exclusion criteria, 71 articles were further reviewed in detail. RESULTS All articles included analysis of tissue samples from in-office biopsies or intraoperative specimens of patients who underwent sinus surgery. CRS was often further divided into subgroups and compared with each other and with a control group. The subgroups included CRS with and without nasal polyps, asthmatic and nonasthmatic patients, and with and without eosinophilia. Distinct inflammatory mediators were found for the different subgroups. Twenty-eight articles evaluated these inflammatory markers for their potential value as prognostic indicators. CONCLUSION CRS is a heterogeneous disease based on its histopathological findings. Information that is obtainable from light microscopy, but typically goes unreported, can serve as valuable prognostic indictors. However, routine H&E staining is suboptimal in distinguishing among the various subgroups of CRS. Assessment of specific inflammatory mediators in sinus mucosa specimens may help provide prognostic information and guide more tailored treatment for the individual patient.
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Orlandi RR, Smith TL, Marple BF, Harvey RJ, Hwang PH, Kern RC, Kingdom TT, Luong A, Rudmik L, Senior BA, Toskala E, Kennedy DW. Update on evidence-based reviews with recommendations in adult chronic rhinosinusitis. Int Forum Allergy Rhinol 2014; 4 Suppl 1:S1-S15. [DOI: 10.1002/alr.21344] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/04/2014] [Accepted: 04/14/2014] [Indexed: 11/09/2022]
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Mahdavinia M, Carter RG, Ocampo CJ, Stevens W, Kato A, Tan BK, Kern RC, Conley DB, Chandra R, Hulse KE, Suh LA, Norton JE, Peters AT, Grammer LC, Schwartz LB, Schleimer RP. Basophils are elevated in nasal polyps of patients with chronic rhinosinusitis without aspirin sensitivity. J Allergy Clin Immunol 2014; 133:1759-63. [PMID: 24636088 DOI: 10.1016/j.jaci.2013.12.1092] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 12/09/2013] [Accepted: 12/31/2013] [Indexed: 02/06/2023]
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Tan BK, Kern RC, Schleimer RP, Schwartz BS. Chronic rhinosinusitis: the unrecognized epidemic. Am J Respir Crit Care Med 2014; 188:1275-7. [PMID: 24289768 DOI: 10.1164/rccm.201308-1500ed] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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148
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Pothoven KL, Norton J, Ocampo C, Suh L, Carter R, Hulse KE, Seshadri S, Tan BK, Chandra R, Peters AT, Harris KE, Conley D, Grammer LC, Kern RC, Schleimer RP. Oncostatin M Is Elevated In Chronic Rhinosinusitis and Decreases Barrier Function In Human Airway Epithelium. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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149
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Stevens WW, Peters AT, Hulse KE, Grammer LC, Hsu J, Avila PC, Norton J, Suh L, Chandra R, Conley D, Kern RC, Tan BK, Schleimer RP. The Prevalence Of AERD In a Tertiary Care Center. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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150
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Kato A, Keswani A, Kim J, Poposki J, Peterson S, Suh L, Norton J, Peters AT, Hulse KE, Grammer LC, Tan BK, Chandra R, Conley D, Jaen J, Schall T, Kern RC, Schleimer RP. Post-Translational Modification By Serine Proteases Controls The CCL23 Activity In Nasal Polyps Of Chronic Rhinosinusitis. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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