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Yoo SH, Kim YA, Mo JH. Can EPOS2020 criteria of type 2 inflammation be applied to Asian patients with chronic rhinosinusitis? Acta Otolaryngol 2023; 143:789-795. [PMID: 37837274 DOI: 10.1080/00016489.2023.2264898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND There is a large diversity of mucosal immunologic chronic rhinosinusitis with nasal polyps (CRSwNP) endotypes across Western and Asian patient populations. OBJECTIVES The objective of the study was whether the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 criteria for type 2 inflammation are appropriate for biological use in CRSwNP patients. METHODS A total of 207 participants are enrolled for the study. Retrospective evaluations of the tissues taken during surgery and the patients' clinical features were performed. We investigated whether the criteria described in the EPOS2020 guideline were appropriate based on the criteria for type 2 inflammation identified based on prior studies using receiver-operating characteristic (ROC) analyses. RESULTS The EPOS 2020 criteria are also shown to be an insufficient evaluation approach with low specificity (area under curve [AUC] = 0.645, specificity 8.4%). The authors created a novel scoring method using the total serum IgE level, blood eosinophil percentage, and tissue eosinophil percentage. This novel scoring system (AUC = 0.862, p < .001) fared better in ROC analyses than the EPOS 2020 criteria (AUC = 0.645) and Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis scoring system (AUC = 0.647). CONCLUSIONS AND SIGNIFICANCE A novel standard for type 2 inflammation in Asian CRSwNP patients must be established, as the EPOS 2020 criteria do not appear to be sufficient.
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Affiliation(s)
- Shin Hyuk Yoo
- Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea
| | - Yoon-Ah Kim
- Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea
| | - Ji-Hun Mo
- Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea
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Biological Therapy of Severe Asthma and Nasal Polyps. J Pers Med 2022; 12:jpm12060976. [PMID: 35743760 PMCID: PMC9225008 DOI: 10.3390/jpm12060976] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 01/03/2023] Open
Abstract
Chronic rhinosinusitis is a common disease worldwide and can be categorized into chronic rhinosinusitis with nasal polyps and chronic rhinosinusitis without nasal polyps. Chronic rhinosinusitis with nasal polyps is common in patients with asthma and, particularly, severe asthma. Severe asthma is effectively treated with biologics and the coexistence of severe asthma with chronic rhinosinusitis with nasal polyps presents a phenotype that is more likely to respond to such treatment. In this review, we focus on the link between asthma and nasal polyps, and we review the treatment effect of various monoclonal antibodies in patients with severe asthma and nasal polyps as well as in patients with nasal polyps without asthma or with mild-to-moderate asthma. With the enhancement of our armamentarium with new monoclonal antibodies the right choice of biologic becomes an important target and one that is difficult to achieve due to the lack of comparative head-to-head studies.
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Aldinger JP, Dobyns T, Lam K, Han JK. The role of omalizumab in the treatment of chronic rhinosinusitits with nasal polyposis. Expert Opin Biol Ther 2021; 21:1143-1149. [PMID: 34334061 DOI: 10.1080/14712598.2021.1962282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Chronic rhinosinusitis with nasal polyposis (CRSwNP) poses a significant healthcare challenge, with diminished quality of life for patients and high costs and resource utilization for disease management. The understanding of CRSwNP pathophysiology has progressed with identification of various inflammatory biomarkers and subsequent development of monoclonal antibodies that target the underlying mechanisms of inflammation.Areas covered: Omalizumab is a biologic agent for CRSwNP treatment that targets immunoglobulin (Ig)-E. The US FDA has approved the use of omalizumab as an add-on biologic therapy for nasal polyposis in December 2020. Two Phase III clinical trials, POLYP 1 and POLYP 2, have shown that omalizumab improves both subjective patient-reported outcomes and objective physician-evaluated metrics for CRSwNP. Ongoing studies are still exploring the efficacy, safety, and cost-effectiveness of biologics for CRSwNP.Expert opinion: Biologics will continue develop as a viable management option for CRSwNP. Omalizumab is regarded as a promising addition to current treatment strategies for refractory disease.
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Affiliation(s)
| | - Taylor Dobyns
- Eastern Virginia Medical School, Norfolk, United States
| | - Kent Lam
- Eastern Virginia Medical School, Norfolk, United States
| | - Joseph K Han
- Eastern Virginia Medical School, Norfolk, United States
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Flora M, Perrotta F, Nicolai A, Maffucci R, Pratillo A, Mollica M, Bianco A, Calabrese C. Staphylococcus Aureus in chronic airway diseases: An overview. Respir Med 2019; 155:66-71. [PMID: 31302581 DOI: 10.1016/j.rmed.2019.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/22/2019] [Accepted: 07/05/2019] [Indexed: 02/06/2023]
Abstract
This review investigates about the role of Staphylococcus Aureus (S. aureus) and S. aureus enterotoxins (SEs) in the pathogenesis of several chronic airway diseases. S. aureus is part of normal human flora and may colonize the skin and the upper airways. SEs acting as superantigens can induce an intense T cell activation and through the release of interleukin (IL) - 4, 5, and 13, can promote a polyclonal IgE response and eosinophilic inflammation. S. aureus can damage epithelial cells inducing the release of the so-called "alarmins" responsible of the activation of Type 2 innate lymphoid cells (ILC-2) linked to an IL-5 mediated airway eosinophilic inflammation. SEs sensitization has been recently associated with the eosinophilic endotypes of both nasal polyps and late onset severe asthma. Studies investigating the effect of biological therapies in SEs sensitized patients should be performed in order to better define the role played by S. aureus in the different endotypes of severe asthma and/or chronic rhinosinusitis.
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Affiliation(s)
- Martina Flora
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy
| | - Fabio Perrotta
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Italy
| | - Ambra Nicolai
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy
| | - Rosalba Maffucci
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy
| | - Anna Pratillo
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy
| | - Mariano Mollica
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy.
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Immunomodulators in chronic rhinosinusitis. World J Otorhinolaryngol Head Neck Surg 2018; 4:186-192. [PMID: 30506050 PMCID: PMC6251964 DOI: 10.1016/j.wjorl.2018.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/27/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To provide new insight into how chronic rhinosinusitis (CRS) is conceptualized and treated with a focus on immunomodulator therapy. Data sources Pubmed, Medline, and Embase. Methods A current review of the evidence is provided for immunomodulators investigated for treatment of CRS with nasal polyps (CRSwNP). Results Biologic therapies targeting IgE, IL-4, IL-5, and IL-13 for the treatment of CRSwNP have shown promise and are currently in phase 3 trials. Anti-immunoglobin E (IgE) therapy with omalizumab was assessed in 6 studies, anti-interleukin (IL)-5 therapy in 3 studies (2 mepolizumab, 1 reslizumab) and anti IL-4/IL-13 (dupilumab) therapy in one study. Studied outcomes varied, but the majority of trials identified clinical benefit of therapy over placebo. Other potential targets include thymic stromal lymphopoetin (TSLP), IL-25, IL-33, and sialic acid-binding immunoglobulin-type lectin (Siglec)-8. Small molecule drugs that target the dysregulation of the immune system in CRS are also being investigated for their immunomodulatory effects on inflammation. Conclusion Immunomodulator therapies for CRS currently in development will likely provide another therapeutic option for patients who have severe disease unresponsive to corticosteroids and surgery. Targeted monoclonal antibody therapies have shown encouraging results and phase 3 trials are underway. IL-4/IL-13 inhibition has shown the most promise to date. Further larger, well-designed trials are needed to improve understanding of these molecules and to offer endotype-driven therapies in the management of CRS. None of these therapeutics have shown long-term immunomodulation when discontinued and therefore further investigation into the pathomechanism of disease continues to be needed.
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Azar A, Rank MA, Zarka MA, Chang YH, Lal D. Gender-specific differences in serum immunoglobulin E levels and prevalence of fungus in sinonasal tissue noted in patients with chronic rhinosinusitis who underwent endoscopic sinus surgery. Am J Rhinol Allergy 2018; 31:370-375. [PMID: 29122081 DOI: 10.2500/ajra.2017.31.4471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND We previously presented that women with chronic rhinosinusitis (CRS) who elected endoscopic sinus surgery (ESS) have a higher symptom burden than men. Causes of these gender-based differences warranted further study. OBJECTIVES To study gender differences in another cohort of adult patients with CRS who underwent ESS and to compare key histopathologic and serologic features Methods: Patients with CRS who underwent ESS (from 2011 to 2014) with structured histopathology reports on surgical samples were studied. The 13-item structured histopathology report detailed key metrics of inflammation and the presence of fungal elements. Clinical, 22-item Sino-Nasal Outcome Test (SNOT-22) score, Lund-Mackay computed tomography (CT) score, serologic (immunoglobulin E [IgE] level, absolute eosinophil count) and histopathologic data were compared between male and female patients by using statistical software. RESULTS We studied 130 eligible subjects (mean age, 54.7 years; 49.2% women). Compared with the men, the women had significantly higher preoperative SNOT-22 scores (women, 48.7; men 38.0 [p = 0.004]) but similar CT scores. Serum IgE levels were significantly higher among women versus men (peak, 433.3 versus 190.8 kU/L [p = 0.03]; closest to surgery, 435.0 versus 190.8 kU/L [p = 0.03]). Tissue fungal elements were significantly more prevalent in women versus men (19.0 versus 5.2%; p = 0.02). Up to this point, the analysis was agnostic of clinical details of the subjects. Further analysis was conducted regarding clinical features. Allergic fungal sinusitis (AFS) was found significantly more commonly in the female versus male patients (21.9 versus 9.1%; p = 0.04). Women versus men had a higher prevalence of migraine (19.4 versus 4.6%; p = 0.01) or any primary headache disorders (23.0 versus 6.2%; p = 0.007). CONCLUSION Women who underwent ESS for CRS had higher SNOT-22 symptom burden. Worsened symptomatology may be secondary to a higher prevalence of primary headache disorders in women. However, surgeons should also be aware that female patients with CRS who seek ESS may have a higher prevalence of severe disease endotypes (more tissue fungal elements, elevated serum IgE levels) and phenotypes.
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Affiliation(s)
- Antoine Azar
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
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Rivero A, Liang J. Anti-IgE and Anti-IL5 Biologic Therapy in the Treatment of Nasal Polyposis: A Systematic Review and Meta-analysis. Ann Otol Rhinol Laryngol 2017; 126:739-747. [PMID: 28918644 DOI: 10.1177/0003489417731782] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the role of biologic therapy on sinonasal symptoms and objective outcomes in chronic rhinosinusitis with nasal polyposis (CRSwNP). METHODS PubMed, OVID MEDLINE, and Cochrane Central were reviewed from 2000 to 2015. Inclusion criteria included English-language studies containing original data on biologic therapy in CRSwNP patients with reported outcome measures. Two investigators independently reviewed all manuscripts and performed quality assessment and quantitative meta-analysis using validated tools. RESULTS Of 495 abstracts identified, 7 studies fulfilled eligibility: 4 randomized control trials (RCT), 1 case-control, and 2 case series. Outcome measures included nasal polyp score (NPS,6), computer tomography score (5), and symptom scores (5). Meta-analysis was performed on 5 studies: Anti-IL5 therapy (mepolizumab/reslizumab) and anti-IgE therapy (omalizumab) demonstrated a standard mean difference of NPS improvement of -0.66 (95% CI, -1.24 to -0.08) and -0.75 (95% CI, -1.93 to 0.44), respectively, between biologic therapy and placebo. Quality assessment indicated a low to moderate risk of bias for the RCTs. CONCLUSION Biologic therapies may prove beneficial in the treatment of recalcitrant nasal polyposis in select populations. In meta-analysis, anti-IL5 therapy demonstrates a reduction in nasal polyp score. Anti-IgE therapy reduces nasal polyp score in patients with severe comorbid asthma. Additional high-level evidence is needed to assess clinical efficacy.
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Schipke JD, Cleveland S, Drees M. Sphenoid sinus barotrauma in diving: case series and review of the literature. Res Sports Med 2017; 26:124-137. [PMID: 28797173 DOI: 10.1080/15438627.2017.1365292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
About 50% of scuba divers have suffered from barotrauma of the ears and about one-third from barotrauma of paranasal sinuses. The sphenoid sinuses are rarely involved. Vital structures, as internal carotid artery and optic nerve, adjoin the sphenoid sinus. Thus, barotrauma could lead to serious neurologic disorders, including blindness. After searching the literature (Medline) and other sources (Internet), we present some cases of sphenoid sinus barotrauma, because these injuries may be underreported and misdiagnosed due to the lack of awareness and knowledge. Therefore, information is provided, e.g. on anatomical and pathophysiological features. Divers and physicians should have in mind that occasional headache during or after diving sometimes signals serious neurological disorders like vision loss. We show that injuries can develop from both negative and positive pressures in the sinuses. Because visual recovery depends on prompt diagnosis and proper therapy, physicians like otolaryngologists, ophthalmologists and neurologists need to closely collaborate.
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Affiliation(s)
- Jochen D Schipke
- a Research Group Experimental Surgery , University Hospital Düsseldorf , Düsseldorf , Germany
| | - Sinclair Cleveland
- b Institute of Neuro- and Sensory Physiology , Heinrich Heine Universität Düsseldorf , Düsseldorf , Germany
| | - Markus Drees
- c Medical Office for Otorhinolaryngology and Diving Medicine , Wetzlar , Germany
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Hull BP, Chandra RK. Refractory Chronic Rhinosinusitis with Nasal Polyposis. Otolaryngol Clin North Am 2017; 50:61-81. [PMID: 27888916 DOI: 10.1016/j.otc.2016.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic rhinosinusitis with nasal polyposis (CRSwNP) represents a subset of chronic sinusitis with various causes. Some forms of the disease are driven by allergy, often in association with asthma. Refractory CRSwNP can be associated with cystic fibrosis and other clinical syndromes. More recent literature is presented regarding roles of innate immunity and superantigens. Effective treatment of CRSwNP requires careful endoscopic sinus surgery followed by an individualized treatment plan that often includes oral and topical steroids. Recidivism of polyps is common, and patients require long-term follow-up.
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Affiliation(s)
- Benjamin P Hull
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University, 1215 21st Ave S, 7209 MCE-S, Nashville, TN 37232-8605, USA
| | - Rakesh K Chandra
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University, 1215 21st Ave S, 7209 MCE-S, Nashville, TN 37232-8605, USA.
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Batra PS, Tong L, Citardi MJ. Analysis of comorbidities and objective parameters in refractory chronic rhinosinusitis. Laryngoscope 2014; 123 Suppl 7:S1-11. [PMID: 24122826 DOI: 10.1002/lary.24418] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 08/10/2013] [Accepted: 08/28/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective of this study was to construct the clinical profile of patients with chronic rhinosinusitis (CRS) with/without polyposis undergoing revision sinus surgery and to evaluate the relationship of polyposis, asthma, acetylsalicylic acid (aspirin) (ASA) sensitivity, inhalant allergies, and previous sinus surgery on disease severity as measured by objective parameters. STUDY DESIGN Cross-sectional study. METHODS Two-hundred twenty-five patients were accrued at a tertiary care academic center. Categorical factors recorded included presence of polyps, asthma, inhalant allergy, and ASA sensitivity. Continuous variables assessed included mean number of previous sinus surgeries, Lund-Kennedy endoscopy score, Lund-Mackay computed tomography (CT) score, absolute eosinophil count (AEC), and total immunoglobulin E (tIgE) level. Statistical analysis was performed to analyze the impact of polyposis, asthma, inhalant allergy, and ASA sensitivity on objective parameters. The mean number of previous surgeries was also correlated with objective parameters. RESULTS The mean age was 50.1 years with a male:female ratio of 1.1:1. The overall prevalence of polyposis, asthma, inhalant allergy, and ASA sensitivity was 56.4%, 48.4%, 38.7%, and 16.0%, respectively. The mean endoscopy and CT scores were 9.0 (± 4.0) and 11.4 (± 5.8), respectively. The mean AEC and tIgE were 0.4 k/μL (± 0.4) and 161.4 IU/mL (± 251.4). The mean number of previous endoscopic sinus surgeries was 1.8. Patients with CRS with polyposis had a statistically significant increase in presence of asthma (odds ratio [OR]: 7.5, P < .0001), inhalant allergy (OR: 3.6, P < .0001), and ASA sensitivity (OR: 78.6, P < .0001). Patients with polyposis had a statistically significant increase in endoscopy score (P < .0001), CT score (P < .0001), AEC (P < .0001), and tIgE (P = .0002). Patients with asthma had a statistically significant increase in endoscopy (P < .0001) and CT scores (P < .0001), AEC (P < .0001), and tIgE (P = .0002). Patients with inhalant allergy had a statistically significant increase in endoscopy (P = .0069), CT scores (P = .0017), and tIgE (P = .0084) but not AEC (P = .1492). Patients with ASA sensitivity had a statistically significant increase in endoscopy score (P < .0001), CT score (P < .0001), and AEC (P = .003) but not tIgE level (P = .186). The number of previous surgeries had a statistically significant correlation with endoscopy (P = .006) and CT scores (P = .03) but not AEC (P = .48) or tIgE (P = .66). CONCLUSIONS The current analysis constructed the clinical profile of the recalcitrant CRS patient undergoing revision sinus surgery. In general, this patient group has a high prevalence of polyposis, asthma, inhalant allergy, ASA sensitivity, and elevated disease burden as measured by objective measures. The polyp phenotype signifies statistically higher prevalence of associated comorbidities and greater objective disease severity. The presence of asthma, inhalant allergy, and ASA sensitivity also predicts statistically higher disease burden. The endoscopy and CT scores statistically correlate with the number of previous surgeries. LEVEL OF EVIDENCE 4 Laryngoscope, 123:E1-E11, 2013.
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Affiliation(s)
- Pete S Batra
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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O'Connell BP, Schlosser RJ, Wentzel JL, Nagel W, Mulligan JK. Systemic monocyte-derived dendritic cells and associated Th2 skewing in chronic rhinosinusitis. Otolaryngol Head Neck Surg 2013; 150:312-20. [PMID: 24367054 DOI: 10.1177/0194599813516277] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Monocyte-derived dendritic cells (moDCs) are antigen-presenting cells capable of directing immune responses toward T-helper 1 (Th1) or T-helper 2 (Th2) phenotypes. The systemic profile of moDCs and their association with Th1/Th2 skewing in chronic rhinosinusitis (CRS) is unclear. The purpose of this study is to characterize circulating moDCs in controls, CRS without nasal polyps (CRSsNP), and CRS with nasal polyps (CRSwNP) and correlate moDCs with Th1/Th2 skewing, mucosal inflammation on computed tomography (CT), and quality of life (QoL). STUDY DESIGN Cross-sectional study. SETTING Tertiary care hospital. SUBJECTS Blood was drawn from control (n = 12), CRSsNP (n = 18), and CRSwNP (n = 15) patients during endoscopic sinus surgery. METHODS Peripheral blood moDCs were analyzed with flow cytometry for expression of HLA-DR, CD209, and CD14. Th1 and Th2 cells were identified by CXCR3 and CCR8 expression, respectively. Lund-Mackay CT scores were assigned by blinded graders. Sino-Nasal Outcome Test 22 (SNOT-22) surveys were completed by patients before surgery. RESULTS CRSsNP and CRSwNP displayed elevations in systemic moDCs compared with controls. In CRSwNP, systemic Th2 skewing was observed and circulating CD4+ Th2 cells correlated with percent moDCs. MoDCs strongly correlated with higher Lund-Mackay CT scores in CRSsNP but not in CRSwNP. No relationship between moDCs and SNOT-22 scores was observed for either subset of CRS. CONCLUSION These data support that CRSwNP and CRSsNP display alterations in systemic immune profiles. CRSwNP is characterized by significant elevations in circulating moDCs, which is associated with systemic Th2-biased inflammation. Circulating moDCs are associated with mucosal inflammation on CT imaging in CRSsNP. No association between moDCs and QoL is evident in either CRS subset.
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Affiliation(s)
- Brendan P O'Connell
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Ghaderi M. How Closely Related are Allergic Rhinitis, Asthma, and Chronic Sinusitis? EAR, NOSE & THROAT JOURNAL 2013. [DOI: 10.1177/014556131309200902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mahmoud Ghaderi
- Clinical Professor Department of Otolaryngology-Head and Neck Surgery-Philadelphia College of Osteopathic Medicine Springfield, Pennsylvania Adjunct Clinical Professor Department of Otolaryngology-Head and Neck Surgery Drexel University College of Medicine Philadelphia
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Mori E, Matsuwaki Y, Mitsuyama C, Okushi T, Nakajima T, Moriyama H. Risk factors for olfactory dysfunction in chronic rhinosinusitis. Auris Nasus Larynx 2013; 40:465-9. [PMID: 23422234 DOI: 10.1016/j.anl.2012.12.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/06/2012] [Accepted: 01/11/2013] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Although risk factors for olfactory dysfunction in patients with chronic rhinosinusitis (CRS) have been examined, most studies did not distinguish between classified eosinophilic chronic rhinosinusitis (ECRS) and noneosinophilic chronic rhinosinusitis (NECRS). The incidence of eosinophilic disease in Japan differs from that in the West. Thus, when olfaction in CRS is investigated, ECRS and NECRS should be examined separately. In the present study, we examined the clinical characteristics associated with olfactory dysfunction in Japanese patients with ECRS and NECRS enrolled in a large multicenter, prospective cohort study. METHODS Olfactory examination results, demographic data, clinical factors, and comorbidity data were analyzed for 418 patients with CRS at 3 tertiary care centers. We used T&T olfactometry, intravenous olfactory test (the Alinamin test) and Likert scale to assess subjects' olfactory function. Data were analyzed with univariate and multivariate analyses. RESULTS Olfactory dysfunction was more severe and more prevalent in ECRS than in NECRS. We found that olfactory cleft polyps (odds ratio [OR], 3.24), ethmoid opacification (OR, 2.64), asthma (OR, 2.29), current smoking (OR, 1.74) and age ≥50 years (OR, 1.66) were associated with olfactory dysfunction in CRS. Ethmoid opacification (OR, 3.09) and olfactory cleft polyps (OR, 3.05) were associated with olfactory dysfunction in NECRS. Olfactory cleft polyps (OR, 3.98), current smoking (OR, 2.67), IgE ≥400IU/ml (OR, 2.65), ethmoid opacification (OR, 2.51), and asthma (OR, 2.34) were associated with olfactory dysfunction in ECRS. CONCLUSIONS Olfactory dysfunction was more severe and prevalent in ECRS than in NECRS. Physician should pay attention to these clinical findings to diagnose olfactory dysfunction, especially in ECRS, and should provide appropriate explanation, guidance, and care. In addition, smokers should be advised to stop smoking to help prevent olfactory dysfunction.
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Affiliation(s)
- Eri Mori
- Department of Otorhinolaryngology, Jikei University, School of Medicine, Tokyo, Japan.
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Ono N, Kase K, Homma H, Kusunoki T, Ikeda K. Maxillary sinus infundibulum narrowing influences sinus abnormalities in spite of the presence or absence of allergy. Acta Otolaryngol 2011; 131:1193-7. [PMID: 21846296 DOI: 10.3109/00016489.2011.584904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Maxillary sinus abnormalities were demonstrated to be associated with maxillary sinus infundibulum narrowing as well as nasal airflow resistance secondary to nonspecific nasal inflammation. OBJECTIVES There is no consensus regarding the pathogenetic roles of allergy and anatomic variations in sinus mucosa abnormalities. We investigated the correlation between allergy and anatomic variations in sinus abnormalities in chronic rhinitis patients in the presence or absence of allergy. METHODS In all, 148 adult patients with allergic rhinitis (AR) and non-allergic rhinitis (NAR) were enrolled. Opacification of sinuses, the size of the maxillary sinus infundibulum, Haller cells, and concha bullosa were evaluated based on computed tomography (CT) images. Simultaneously, nasal airflow resistance was measured. RESULTS The AR group comprising 105 patients showed maxillary sinus opacification in 45 patients. In the NAR group including 43 patients, soft tissue opacification was observed in 13 patients. There was no significant difference in the incidence of sinus opacification between the AR and NAR groups. Both nasal resistance and the infundibulum size in both the AR and NAR groups with sinus opacification showed significant differences from those without sinus abnormalities. The presence of concha bullosa influenced the sinus opacification in both the AR and NAR groups.
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Affiliation(s)
- Noritsugu Ono
- Department of Otorhinolaryngology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Mehta V, Campeau NG, Kita H, Hagan JB. Blood and sputum eosinophil levels in asthma and their relationship to sinus computed tomographic findings. Mayo Clin Proc 2008; 83:671-8. [PMID: 18533084 PMCID: PMC2824564 DOI: 10.4065/83.6.671] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the relationship among blood and sputum eosinophil levels, sinus mucosal thickening, and osteitis in patients with asthma. PATIENTS AND METHODS We conducted an observational study of 201 patients with asthma who underwent sinus computed tomographic (CT) imaging and induced sputum analysis at Mayo Clinic's site in Rochester, MN, from November 1, 2000, through December 31, 2005. Sinus CT scans were reviewed by an investigator blinded to patients' identity and chart information (J.B.H.) to assess for mucosal thickening. Each scan was assigned a CT score based on the Lund-Mackay staging scale. Approximately 20% of the scans were reviewed at random by a radiologist (N.G.C.) to ensure quality control. Bone changes consistent with osteitis were ascertained from radiology reports. Lung function was measured, and sputum was analyzed by conventional methods. RESULTS Sinus CT scans revealed abnormalities in 136 (68%) of the 201 study patients. Severe mucosal thickening (CT score, > or = 12) was found in 60 patients (30%) and osteitis in 18 patients (9%). There was a positive correlation between CT scores and eosinophil levels in both peripheral blood (rho=0.45; 95% confidence interval, 0.33-0.56; P<.001) and induced sputum (rho=0.46; 95% confidence interval, 0.34-0.57; P<.001). Further, elevated blood and sputum eosinophil levels were associated with the presence of osteitis on CT scan and previous sinus surgery. CONCLUSION Blood and sputum eosinophil levels in patients with asthma are directly correlated with sinus mucosal thickening and are associated with osteitis, lending further support to the hypothesis that asthma and chronic rhinosinusitis are mediated by similar inflammatory processes.
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Affiliation(s)
- Vinay Mehta
- Center for Allergy, Asthma and Immunology, Creighton University, Omaha, NE, USA
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Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LTT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FER, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8-160. [PMID: 18331513 DOI: 10.1111/j.1398-9995.2007.01620.x] [Citation(s) in RCA: 3008] [Impact Index Per Article: 188.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
MESH Headings
- Adolescent
- Asthma/epidemiology
- Asthma/etiology
- Asthma/therapy
- Child
- Global Health
- Humans
- Prevalence
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Risk Factors
- World Health Organization
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Affiliation(s)
- J Bousquet
- University Hospital and INSERM, Hôpital Arnaud de Villeneuve, Montpellier, France
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Affiliation(s)
- Kim W Ah-See
- Department of Otolaryngology, Head, and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN.
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Wise MT, Hagaman DD. An immunological approach to chronic and recurrent sinusitis. Curr Opin Otolaryngol Head Neck Surg 2007; 15:10-7. [PMID: 17211177 DOI: 10.1097/moo.0b013e328011bcbf] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Sinusitis is an illness that is often successfully treated by primary care physicians. Recurrent or chronic rhinosinusitis, however, can be frustrating for patients as well as primary care and subspecialty providers. The present review details the approach to recurrent or chronic sinusitis. We give a broad overview of the workup of chronic rhinosinusitis, focusing on immune deficiency, an often overlooked but clinically important aspect of the sinusitis workup. RECENT FINDINGS Immune deficiency is prevalent in patients with recurrent or chronic sinus disease. An immunologic workup, as well as a workup for other chronic treatable diseases, should be undertaken before sinus surgery or in patients who have been unresponsive to surgery. This approach can enhance visualization during surgery, minimize postoperative complications, improve surgical outcomes, and possibly obviate the need for surgery altogether. SUMMARY Elucidating the cause of recurrent or refractory sinus disease can be challenging. Allergic disease should be evaluated and treated early in the process. An immunologic evaluation should be performed and uncommon causes of sinus inflammation should be addressed later in the course to reduce inflammation either to avoid surgery or improve surgical outcomes.
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Affiliation(s)
- Marshall T Wise
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Lal D, Baroody FM, Weitzel EK, deTineo M, Naclerio RM. Total IgE levels do not change 1 year after endoscopic sinus surgery in patients with chronic rhinosinusitis. Int Arch Allergy Immunol 2005; 139:146-8. [PMID: 16374024 DOI: 10.1159/000090390] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Accepted: 10/06/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Total IgE levels positively correlate with the amount of mucosal thickening on sinus CT scans. Our objective was to investigate whether the levels of total serum IgE decreased 1 year after endoscopic sinus surgery in patients with chronic rhinosinusitis, suggesting that the total IgE was influenced by the sinus disease. METHODS 55 patients about to undergo endoscopic sinus surgery for chronic rhinosinusitis were enrolled in a prospective clinical study. All patients had preoperative sinus computerized tomography (CT) scans and levels of total serum IgE measured before surgery and 1 year postoperatively. RESULTS Preoperative total IgE levels showed a significant correlation with the extent of disease on sinus CT (r(s) = 0.413, p = 0.002). Total serum IgE levels did not show any statistically significant change from the preoperative values when measured 1 year postoperatively (324.25 +/- 217.30 ng/ml vs. 326.35 +/- 204.50 ng/ml; p = 0.61). CONCLUSIONS The levels of total serum IgE do not change after sinus surgery for chronic rhinosinusitis. IgE levels in chronic rhinosinusitis may reflect a systemic factor in disease pathogenesis, and are probably not related to the amount of local inflammation within the sinuses.
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Affiliation(s)
- Devyani Lal
- Section of Otolaryngology-Head and Neck Surgery, Pritzker School of Medicine, University of Chicago, IL 60637, USA
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Ponte EV, Lima F, Aguiar GF, Goyana F, Santos MBD, Cruz ÁA. Alterações tomográficas de seios paranasais em pacientes adultos com rinite alérgica. J Bras Pneumol 2005. [DOI: 10.1590/s1806-37132005000500010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Determinar, através de análise de tomografia computadorizada, a freqüência de envolvimento dos seios paranasais em pacientes com rinite alérgica. MÉTODOS: Foram selecionados 60 pacientes ambulatoriais com diagnóstico de rinite alérgica e queixa de obstrução nasal. Os pacientes foram submetidos a rinoscopia anterior, aplicação de questionários para avaliação da intensidade dos sintomas, testes cutâneos para aeroalérgenos e tomografia computadorizada de seios paranasais. Foi utilizado o escore de Lund para caracterização do envolvimento tomográfico dos seios paranasais. RESULTADOS: Alteração tomográfica de seios paranasais ocorreu em 31 pacientes (52%). O somatório do maior diâmetro das reações cutâneas para aeroalérgenos, a intensidade dos sintomas de rinite e os achados à rinoscopia anterior não foram diferentes entre os pacientes com ou sem alteração tomográfica de seios paranasais. Todos os pacientes com envolvimento de seios paranasais apresentavam alterações em complexos osteomeatais, enquanto que apenas 11 pacientes sem envolvimento de seios paranasais apresentavam esta alteração (38%) (p < 0,01). CONCLUSÃO: A freqüência de alterações tomográficas dos seios paranasais nesta amostra de indivíduos adultos com rinite alérgica foi elevada e não se correlacionou com a intensidade dos sintomas nem com a reação cutânea a alérgenos, mas apenas com imagens de obstrução em complexo osteomeatal.
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Piette V, Bousquet C, Kvedariene V, Dhivert-Donnadieu H, Crampette L, Senac JP, Bousquet J, Demoly P. Sinus CT scans and mediator release in nasal secretions after nasal challenge with cypress pollens. Allergy 2004; 59:863-8. [PMID: 15230820 DOI: 10.1111/j.1398-9995.2004.00509.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Involvement of paranasal sinuses has been suggested in allergic rhinitis but not clearly demonstrated. AIMS To investigate the relationship between intermittent allergic rhinitis and computerized tomography (CT). METHODS Twenty patients with intermittent rhinitis and sensitized to cypress pollens underwent unilateral nasal provocation tests (NPTs) using increasing concentrations of cypress pollens out of the pollen season. Sinus CT-scans were carried out just before a NPT and 24 h later. Nasal lavage was carried out just before a NPT, 30 min after a positive challenge and again 24 h later. Leucotriene C4/D4, intracellular adhesion molecule-1 and eosinophil cationic protein were measured in nasal secretions. RESULTS Thirteen patients (65%) showed an alteration in their CT-scans after allergen challenge. Ten of them showed sinus changes controlateral to their allergenic provocation. Radiological changes mainly affected the osteomeatal complex and the ethmoid sinuses. Pre-existing abnormalities (13 of 20 cases) mainly concerned the maxillary sinuses. There was no correlation between CT-scan abnormalities and levels of mediators released in nasal secretions. CONCLUSIONS We have shown that nasal allergen challenge can produce radiological changes in the paranasal sinuses. This mainly concerned the ethmoid sinuses.
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Affiliation(s)
- V Piette
- Maladies Respiratoires, INSERMU454, IFR3, Hôpital Arnaud de Villeneuve, CHU Montpellier, 34295 Montpellier Cedex 5, France
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Abstract
Recently, an expanded view of inflammatory disease of the nose and paranasal sinuses, an improved understanding of the functional anatomy of this region, and the development of more sophisticated methods for examining inflammation have led to subtle changes in the field of rhinology. Careful review of the literature suggests that a number of disparate disease processes may serve as cofactors leading to the ultimate development of inflammatory nasal/paranasal sinus disease. Evaluation of cellular infiltrates and inflammatory mediators associated with various forms of rhinologic disease reveals significant overlap among many diseases that were previously thought to be separate disease processes. Further, epidemiologic studies suggest that diseases such as allergic rhinitis may be associated with the development of various forms of rhinosinusitis, and its treatment may impact the ultimate treatment for these diseases. It is becoming increasingly apparent that the contemporary rhinologist can no longer rely simply on either technical surgical skills or cognitive nonsurgical skills alone to treat these patients. Instead, to be most effective, rhinologists must synthesize diagnostic and treatment plans, using all aspects of this field of medicine.
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Affiliation(s)
- Bradley F Marple
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9035, USA.
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Benninger MS, Ferguson BJ, Hadley JA, Hamilos DL, Jacobs M, Kennedy DW, Lanza DC, Marple BF, Osguthorpe JD, Stankiewicz JA, Anon J, Denneny J, Emanuel I, Levine H. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg 2003; 129:S1-32. [PMID: 12958561 DOI: 10.1016/s0194-5998(03)01397-4] [Citation(s) in RCA: 530] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michael S Benninger
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI 48202, USA.
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Alho OP, Karttunen TJ, Karttunen R, Tuokko H, Koskela M, Suramo I, Uhari M. Subjects with allergic rhinitis show signs of more severely impaired paranasal sinus functioning during viral colds than nonallergic subjects. Allergy 2003; 58:767-71. [PMID: 12859556 DOI: 10.1034/j.1398-9995.2003.00252.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Viral cold is thought to be the major contributing factor in the pathogenesis of sinusitis, as it causes ostiomeatal obstruction. The aim was to evaluate whether paranasal sinus functioning during viral colds is similar in subjects with and without allergic rhinitis. METHODS Forty-eight volunteers were examined during an early (2-4 days) natural cold and again 3 weeks later. The examinations included computed tomography (CT) scans, nasal mucosal biopsies, and viral and bacterial specimens. Subjects with positive skin prick tests and persistent or intermittent rhinitis were considered to have allergic immunoglobulin E (IgE)-mediated rhinitis. In addition, specific IgE antibodies to staphylococcal enterotoxin B (SEB) were measured. RESULTS Nine subjects (19%) had allergic rhinitis. The allergic subjects were significantly more often IgE sensitized to SEB than the nonallergic subjects (33%vs 3%, P = 0.02). Viral etiology of the cold was identified in 32 (67%) subjects. The subjects with allergic rhinitis had significantly higher CT scores compared with nonallergic subjects during the colds (median (range) scores 16 (6-22) vs 6 (0-17), P = 0.004). In both groups, the median scores declined markedly during convalescence, but the difference remained significant (P = 0.009). Among the allergic subjects, those who were IgE sensitized to SEB tended to have the highest CT scores [median (range) 16 (16-22)]. Total serum IgE and the nasal subepithelial eosinophil counts correlated with the CT scores during the cold (rs = 0.38, P = 0.008 and rs = 0.46, P = 0.001, respectively). CONCLUSIONS Subjects with allergic IgE-mediated rhinitis had more severe paranasal sinus changes in CT scans than nonallergic subjects during viral colds. These changes indicate impaired sinus functioning and may increase the risk of bacterial sinusitis.
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MESH Headings
- Adult
- Common Cold/complications
- Common Cold/virology
- Female
- Humans
- Immunoglobulin E/blood
- Male
- Nasal Mucosa/pathology
- Paranasal Sinuses/diagnostic imaging
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnostic imaging
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/pathology
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnostic imaging
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/pathology
- Sinusitis/etiology
- Tomography, X-Ray Computed
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Affiliation(s)
- O-P Alho
- Department of Otorhinolaryngology, University of Oulu, Finland
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Peters EJ, Hatley TK, Crater SE, Phillips CD, Platts-Mills TAE, Borish L. Sinus computed tomography scan and markers of inflammation in vocal cord dysfunction and asthma. Ann Allergy Asthma Immunol 2003; 90:316-22. [PMID: 12669895 PMCID: PMC1283080 DOI: 10.1016/s1081-1206(10)61800-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND The inappropriate closure of the vocal cords is characteristic of vocal cord dysfunction (VCD). These patients present with wheezing and frequently receive a misdiagnosis of asthma. OBJECTIVE To demonstrate the ability of computed tomography (CT) scored for the presence and extent of sinus disease and markers of inflammation to distinguish patients with VCD from patients with asthma. METHODS Comparisons of 13 patients with VCD were made to 77 patients presenting to the emergency room with acute asthma, 31 non-acute asthmatic patients, and 65 nonasthmatic controls. Evaluation consisted of exhaled nitric oxide gas (eNO), circulating eosinophils, and total serum immunoglobulin (Ig)E, as well as the sinus CT scan. RESULTS Extensive sinus CT changes were present in 23 of 74 acute asthmatic patients, 5 of 29 non-acute asthmatic patients, and 2 of 59 nonasthmatic controls. In addition, absolute eosinophil counts, eNO, and total IgE were significantly elevated among the asthmatic patients. Sinus symptoms reported by questionnaire did not predict sinus CT findings. Among the patients with VCD, none had extensive sinus disease. They also had normal eNO, low IgE, and normal eosinophil count. Five of the patients presenting to the emergency room who were identified as acute asthmatic were identified with VCD by laryngoscopy and were all characterized by the absence of significant inflammation on their sinus CT scan, low IgE, and normal eosinophil count. CONCLUSIONS Among patients presenting with intermittent or reversible airway obstruction, patients with VCD can be distinguished from asthma by minimum or absence of inflammation in their sinuses as shown by CT scan. Clinical symptom scores are not predictive of presence or extent of sinus disease in most cases.
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Affiliation(s)
| | | | | | | | | | - Larry Borish
- Requests for reprints should be addressed to: Larry Borish, MD, Box 801355, University of Virginia Health System, Charlottesville, VA 22908-1355, E-mail:
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de Benedictis FM, del Giudice MM, Severini S, Bonifazi F. Rhinitis, sinusitis and asthma: one linked airway disease. Paediatr Respir Rev 2001; 2:358-64. [PMID: 12052308 DOI: 10.1053/prrv.2001.0172] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Understanding the relationship between upper and lower airways has greatly increased through epidemiological and pharmacological studies. Scientific evidence supports the concept that rhinosinusitis and asthma may be the expression of an inflammatory process which appears in different sites of the respiratory tract at different times. The implications are not only academic but are important for diagnostic and therapeutic purposes.
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Affiliation(s)
- F M de Benedictis
- Department of Pediatric Medicine, Children's Hospital 'Salesi' Ancona, Italy.
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Loesel LS. Immunopathologic study of chronic sinusitis: a proposal for atopic and non-atopic IgE-activated mast cell allergic inflammation. Ann Otol Rhinol Laryngol 2001; 110:447-52. [PMID: 11372929 DOI: 10.1177/000348940111000510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Paranasal sinus mucosa was examined in this study for mast cell membrane-bound IgE. The study material was from 54 patients identified in hospital records as having one of the following diagnoses: chronic sinusitis, chronic sinusitis with asthma, or chronic sinusitis with associated nasal polyps. Formalin-fixed tissue samples taken during endoscopic sinus surgery were routinely processed and examined with hematoxylin and eosin stains. Additional sectioned tissue was analyzed by fluorescence microscopy for mast cells after the use of anti-IgE and anti-tryptase antisera; 45% of the cases of chronic sinusitis, 50% of the cases of chronic sinusitis with polyposis, and 69% of the cases of chronic sinusitis with asthma exhibited 10 or more IgE-positive mast cells in the sinus mucosa. Significant numbers of individuals with chronic sinusitis have coexistent allergic disorders. Some individuals in this study who were not allergic by hospital record review also manifested IgE-positive mast cells in the sinus mucosa; a basis for this finding is proposed.
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Affiliation(s)
- L S Loesel
- Department of Pathology, Munson Medical Center, Traverse City, Michigan 49684, USA
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Maximal medical management of chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2000. [DOI: 10.1097/00020840-200002000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ramadan HH, Fornelli R, Ortiz AO, Rodman S. Correlation of allergy and severity of sinus disease. AMERICAN JOURNAL OF RHINOLOGY 1999; 13:345-7. [PMID: 10582111 DOI: 10.2500/105065899781367500] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Allergy is an important consideration in the evaluation of patients with rhinosinusitis. Several studies have addressed staging systems for rhinosinusitis based on the extent of disease present on computed tomography (CT) scanning. The severity and extent of sinus disease present on CT imaging helps guide decisions regarding medical and surgical treatment options. This study evaluates the severity of sinus disease in allergic and nonallergic patients. A total of 42 patients at our institution underwent both modified RAST and coronal sinus CT scan in the evaluation of their rhinosinusitis symptoms. A single, blinded staff neuroradiologist staged all 42 CT scans using the Lund-Mackay staging system. None of the patients had undergone sinus surgery. Age, sex, co-morbidities, asthma, smoking, RAST score, total IgE, and CT staging score were analyzed. Allergic patients were found to have a higher CT scan score (mean score = 12) when compared to nonallergic patients (mean score = 6), indicating more extensive sinus disease (p = 0.03). We conclude that allergy is a significant factor in the development of rhinosinusitis, and allergic patients are more likely to demonstrate advanced disease on CT scan when compared to nonallergic patients.
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Affiliation(s)
- H H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown 26506-9200, USA
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