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Huang CC, Sun PH, Wu PW, Huang CC, Chang PH, Fu CH, Lee TJ. Computed Tomographic Evaluations in Patients with Empty Nose Syndrome. Laryngoscope 2024; 134:2105-2110. [PMID: 38009472 DOI: 10.1002/lary.31204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE We aimed to evaluate computed tomography (CT) images of patients with empty nose syndrome (ENS), investigate the impact of reconstruction surgery on sinus inflammation, and identify the optimal airspace diameter after surgery. METHODS We conducted a retrospective case series analysis, identifying and enrolling patients with ENS with perioperative CT findings. The clinical characteristics of the participants were collected, and the modified Lund-Mackay (mLM) CT scores were determined. The anterior airspace diameter was evaluated by measuring the distance between the septum and the lateral nasal wall on the coronal plane at the level of the nasolacrimal duct. RESULTS Twenty patients with ENS and perioperative CT images were enrolled. The mean total mLM CT score and all subsite scores showed no significant changes after surgery. The Empty Nose Syndrome 6-item Questionnaire (ENS6Q) score, Sino-nasal Outcome Test-25 (SNOT-25) score, sleep symptoms domain, psychological domain, and empty nose symptoms domain were significantly associated with anterior airspace diameter in the regression analysis. CONCLUSION There was no significant difference in sinus inflammation between preoperative and postoperative CT evaluations. The anterior airspace diameters were significantly associated with ENS6Q and SNOT-25 scores. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2105-2110, 2024.
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Affiliation(s)
- Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ping Hsueh Sun
- Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Che Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsiang Fu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China
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Valdés Hernández MDC, Ferguson KJ, Loon P, Kirkwood G, Zhang JF, Amft N, Ralston SH, Wu YC, Wardlaw JM, Wiseman SJ. Paranasal sinus occupancy assessed from magnetic resonance images-associations with clinical indicators in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2024; 63:149-157. [PMID: 37086435 PMCID: PMC10765137 DOI: 10.1093/rheumatology/kead185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/22/2023] [Accepted: 03/20/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES Nasal, paranasal sinus and mucosal disorders are common symptoms in autoimmune rheumatic diseases. Soft tissue changes and fluid accumulation in the osteomeatal complexes and paranasal sinuses manifest as opaqueness on radiological images which can be assessed using visual scoring and computational methods on CT scans, but their results do not always correlate. Using MRI, we investigate the applicability of different image analysis methods in SLE. METHODS We assessed paranasal sinus opaqueness on MRI from 51 SLE patients, using three visual scoring systems and expert-delineated computational volumes, and examined their association with markers of disease activity, inflammation, endothelial dysfunction and common small vessel disease (SVD) indicators, adjusting for age and sex-at-birth. RESULTS The average paranasal sinus volume occupation was 4.55 (6.47%) [median (interquartile range) = 0.67 (0.25-2.65) ml], mainly in the maxillary and ethmoid sinuses. It was highly correlated with Lund-Mackay (LM) scores modified at 50% opaqueness cut-off (Spearman's ρ: 0.71 maxillary and 0.618 ethmoids, P < 0.001 in all), and with more granular variations of the LM system. The modified LM scores were associated with SVD scores (0: B = 5.078, s.e. = 1.69, P = 0.0026; 2: B = -0.066, s.e. = 0.023, P = 0.0045) and disease activity (anti-dsDNA: B = 4.59, s.e. = 2.22, P = 0.045; SLEDAI 3-7: 2.86 < B < 4.30; 1.38 < s.e. < 1.63; 0.0083 ≤ P ≤ 0.0375). Computationally derived percent opaqueness yielded similar results. CONCLUSION In patients with SLE, MRI computational assessment of sinuses opaqueness and LM scores modified at a 50% cut-off may be useful tools in understanding the relationships among paranasal sinus occupancy, disease activity and SVD markers.
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Affiliation(s)
| | - Karen J Ferguson
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Pearlyn Loon
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Grant Kirkwood
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Jun-Fang Zhang
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nicole Amft
- Rheumatology Clinic, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Stuart H Ralston
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Joanna M Wardlaw
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Stewart J Wiseman
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Sheikh S, Ho ML, Eisner M, Gushue C, Paul G, Holtzlander M, Johnson T, McCoy KS, Lind M. Elexacaftor-Tezacaftor-Ivacaftor Therapy for Chronic Sinus Disease in Cystic Fibrosis. JAMA Otolaryngol Head Neck Surg 2023; 149:1075-1082. [PMID: 37676668 PMCID: PMC10485743 DOI: 10.1001/jamaoto.2023.2701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/10/2023] [Indexed: 09/08/2023]
Abstract
Importance Cystic fibrosis (CF) is a multiorgan genetic disease with progressive upper and lower airway involvement. The effects of CF transmembrane conductance regulator (CFTR) modifier therapies on CF-related upper airway disease, specifically chronic rhinosinusitis (CRS), are not characterized. Objective To determine the outcome of elexacaftor-tezacaftor-ivacaftor (ETI) on CRS as measured by changes in sinus computed tomography (CT) metrics and on clinical parameters in individuals with CF. Design, Setting, and Participants This prospective longitudinal cohort study was conducted at the CF center of a tertiary care hospital between October 1, 2019, and July 31, 2021. A total of 64 participants with CF were included in the analysis. Intervention Sinus CT was obtained within 1 month of initiation of ETI therapy (baseline), and within 1 month of 1 year of ETI therapy. Images were independently analyzed by pulmonology, radiology, and otolaryngology physicians, using the Lund-Mackay and Sheikh-Lind scoring systems. Percent predicted forced expiratory volume in 1 second (ppFEV1), body mass index (BMI), and microbiologic data collected at initiation of ETI therapy and 3-month intervals for 1 year were also measured. Main Outcomes and Measures The study hypothesis was that ETI therapy will improve CRS as measured by changes in sinus CT at initiation and 1 year after ETI therapy and clinical parameters in individuals with CF. Results Among the 64 participants (39 [60.9%] female; median age, 18.5 [IQR, 16.0-28.5] years; 64 [100%] White), improvement in CRS was noted by improvements in sinus CT scans using both sinus CT scoring systems after 1 year of ETI therapy. The reduction in the median total score using the Lund-Mackay sinus CT scoring system (from 5.8 [IQR, 5.0-7.0] to 3.3 [IQR, 2.6-4.2]) and the Sheikh-Lind scoring system (from 3.8 [IQR, 3.0-5.0] to 2.2 [IQR, 2.0-2.5]) was noted. Increases in ppFEV1 and BMI were also observed by 3 months of ETI therapy with persistent improvement through 1 year of treatment. Similarly, after 1 year of ETI therapy, participants with CF had reductions in positivity for Pseudomonas aeruginosa and Staphylococcus aureus in oropharyngeal cultures. Conclusion and Relevance This cohort study found that use of ETI therapy was associated with improved CRS outcomes in participants with CF as quantified by improved sinus CT scans measured by 2 radiographic scoring systems and was also associated with improved clinical outcomes. Despite improvement in CT scan scores, most people with CF continue to have scores that indicate severe sinus disease.
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Affiliation(s)
- Shahid Sheikh
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Mai-Lan Ho
- Nationwide Children’s Hospital, Columbus, Ohio
- Department of Radiology, The Ohio State University College of Medicine, Columbus
| | - Mariah Eisner
- Nationwide Children’s Hospital, Columbus, Ohio
- Biostatistics Resource, Nationwide Children’s Hospital, Columbus, Ohio
| | - Courtney Gushue
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Grace Paul
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Melissa Holtzlander
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Terri Johnson
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Karen S. McCoy
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Meredith Lind
- Nationwide Children’s Hospital, Columbus, Ohio
- Department of Otolaryngology, The Ohio State University College of Medicine, Columbus
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Prajwal Gowda PR, Bai JS, Naik SM, Abhilasha S. Evaluation of Improvement in Chronic Rhinosinusitis After Endoscopic Sinus Surgery Using Sino-Nasal Outcome Test-22 (SNOT22) Symptom Score. Indian J Otolaryngol Head Neck Surg 2023; 75:3337-3343. [PMID: 37974715 PMCID: PMC10646061 DOI: 10.1007/s12070-023-03929-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 11/19/2023] Open
Abstract
Sino-Nasal Outcome Test (SNOT-22) symptom score is the most widely used questionnaire due to its easy interpretation with respect to quality of life (QOL) in patients with chronic rhinosinusitis (CRS). It helps in deciding further treatment plan in patients with refractory CRS despite maximal medical therapy (MMT). Endoscopic sinus surgery (ESS) is suggested in patients not responding to medical treatment. The preoperative and post-operative QOL for patients with CRS is assessed using SNOT-22. To assess SNOT-22 score change in CRS resistant to MMT. This is a longitudinal study conducted from April 2021-September 2022 included patients diagnosed to have CRS, satisfying the inclusion criteria. SNOT-22 for symptom severity assessed at the first visit, 1 week and 12 weeks and after MMT. Patients who failed MMT, posted for ESS. Post-operatively SNOT-22 symptom score re-assessed at 15 days, 1 month, 2 months and 3 months. 56 patients (male-51% and female-49%) who failed to respond to MMT included in the study. The five major troublesome symptoms nasal blockage (92.86%), need to blow nose (75%), facial pressure/pain (53.57%), post nasal discharge (51.79%), and sneezing (42.86%). The mean SNOT-22 symptom score when compared with pre-operatively (69.54 ± 8.973) and after FESS (2.09 ± 1.881) had improved significantly (p < 0.001). CRS is more frequently seen in males aged between 21 and 30 years. The patient-based outcome measures, like SNOT-22 helps to foresee the extent of post- operative improvement. The effective management of CRS is by surgical intervention.
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Affiliation(s)
| | - J. Sarah Bai
- Department of Otorhinolaryngology, The Oxford Medical College, Hospital and RC, Yadavanahalli, Bangalore, Karnataka India
| | - Sudhir M. Naik
- Department of Otorhinolaryngology, The Oxford Medical College, Hospital and RC, Yadavanahalli, Bangalore, Karnataka India
| | - Somashekar Abhilasha
- Department of Otorhinolaryngology, The Oxford Medical College, Hospital and RC, Yadavanahalli, Bangalore, Karnataka India
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Chen T, Chidarala S, Young G, Jeong SS, Nguyen SA, Edwards TS, Schlosser RJ. Association of Sinonasal Computed Tomography Scores to Patient-Reported Outcome Measures: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2023; 168:628-634. [PMID: 35917187 DOI: 10.1177/01945998221114078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To perform a systematic review of proposed sinus computed tomography (CT) scoring systems and determine their association with patient-reported outcome measures (PROMs). DATA SOURCES PubMed, CINAHL, Scopus, and Cochrane Library. REVIEW METHODS A systematic search was conducted following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) for studies describing CT scores and PROMs in patients with chronic rhinosinusitis. RESULTS A total of 144 studies were included. Out of 20,741 patients, 53.6% were male and 55.5% had nasal polyposis. A meta-analysis of correlations revealed a moderate correlation between Lund-McKay (LM) and the 22-item Sinonasal Outcome Test (SNOT-22; r = 0.434, P < .001) and a weaker correlation between LM and the 20-item Sinonasal Outcome Test (SNOT-20; r = 0.257, P = .039). Meta-regression also revealed a weak association between LM and SNOT-20 (n = 25 studies) but no significant associations between Zinreich score and SNOT-22 or LM scores and PROMs, including SNOT-22 (n = 94 studies), Rhinosinusitis Disability Index (n = 25), nasal obstruction visual analog scale (n = 15), Chronic Sinusitis Survey (n = 12), Total Nasal Symptom Score (n = 4), Total Symptom Score (n = 3), and 12-Item Short Form Health Survey (n = 3). CONCLUSION There is essentially little association between radiologic grade and PROMs. CT grading systems with improved clinical utility are needed.
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Affiliation(s)
- Tiffany Chen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shreya Chidarala
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gabrielle Young
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Seth S Jeong
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas S Edwards
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Sainio S, Blomgren K, Koskinen A, Lundberg M. Frontal Sinus Balloon Sinuplasty—Patient Satisfaction and Factors Predicting Reoperation. OTO Open 2023; 7:e23. [PMID: 36998566 PMCID: PMC10046702 DOI: 10.1002/oto2.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 03/30/2023] Open
Abstract
Objective To explore predictive factors of postoperative outcome of frontal sinus balloon dilation. Study Design Retrospective questionnaire study. Setting Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Finland. Methods We reviewed electronic records of all patients who underwent frontal sinus balloon dilatation (successful or attempted) in our clinic from 2008 to 2019. We documented patient characteristics, preoperative imaging results, intraoperative factors, possible complications, and reoperations. Those who underwent frontal sinus balloon sinuplasty were sent a questionnaire regarding their current symptoms and long-term satisfaction with surgery. Results In total, 258 operations (404 frontal sinuses) were reviewed, with a technical success rate of 93.6% (n = 378). The revision rate was 15.7% (n = 38). Previous sinonasal surgery predicted a higher revision rate (p = .004, odds ratio [OR] = 3.03, 95% confidence interval [CI] 1.40-6.56). Patients with hybrid surgery had significantly fewer reoperations compared to the balloon only group (p = .002, OR = 0.33, 95% CI 0.16-0.67). The response rate of the questionnaire was 64.5% (n = 156), of which 88.5% (n = 138) reported a long-term benefit from the balloon sinuplasty. Patient satisfaction was higher (p = .02, OR = 8.26, 95% CI 1.06-64.24) among patients using nasal corticosteroids. Conclusion Technical success rate and patient satisfaction after frontal sinus balloon sinuplasty are high. Balloon sinuplasty seems insufficient in reoperations. A hybrid approach appears to result in fewer reoperations than a balloon only approach.
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Affiliation(s)
- Sara Sainio
- Department of Otorhinolaryngology‐Head and Neck SurgeryHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Karin Blomgren
- HUS Joint ResourcesHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Anni Koskinen
- Department of Otorhinolaryngology‐Head and Neck SurgeryHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Marie Lundberg
- Department of Otorhinolaryngology‐Head and Neck SurgeryHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Department of Clinical Allergy and Immunology, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Bec R, Reynaud-Gaubert M, Arnaud F, Naud R, Dufeu N, Di Bisceglie M, Coiffard B, Gaubert JY, Bermudez J, Habert P. Chest computed tomography improvement in patients with cystic fibrosis treated with elexacaftor-tezacaftor-ivacaftor: Early report. Eur J Radiol 2022; 154:110421. [DOI: 10.1016/j.ejrad.2022.110421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
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Hopkins C, Lee SE, Klimek L, Soler ZM. Clinical Assessment of Chronic Rhinosinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1406-1416. [PMID: 35183784 DOI: 10.1016/j.jaip.2022.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 12/15/2022]
Abstract
Chronic rhinosinusitis (CRS) is a common disease that affects >10% of the adult population in Europe and the United States. It has been delineated phenotypically into CRS without nasal polyps and CRS with nasal polyps. Both have a high disease burden and an overlapping spectrum of symptoms such as nasal obstruction, olfactory dysfunction, facial pain, pressure, and nasal discharge. Primary assessment includes evaluation of patient symptoms and impact on quality of life, nasal endoscopic examination, and imaging. Significant progress has been made in the understanding of CRS pathophysiology. There is a move toward describing CRS in terms of the predominant endotype or inflammatory pattern pathomechanism rather than the traditional classification of patients with and without nasal polyps. An increased elucidation of the disease endotypes, as characterized by their inflammatory pathways and mediators, is leading to a tailored more personalized treatment approach to the different disease subtypes.
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Affiliation(s)
| | - Stella E Lee
- Division of Otolaryngology-Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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Kwiatkowska MA, Szczygielski K, Chloupek A, Szczupak P, Jurkiewicz D. Clinical characteristics of odontogenic sinusitis with periapical lesions. Am J Otolaryngol 2022; 43:103338. [PMID: 34968816 DOI: 10.1016/j.amjoto.2021.103338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/11/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Although the symptoms and radiographic signs may mimic rhinogenic sinusitis, odontogenic sinusitis (OS) with periapical lesions (PALs) is fundamentally an endodontic infection. It is considered to be one of the main causes of OS, especially when presented unilaterally. Despite this routine dental examination is not performed and periapical infection frequently remains undiagnosed by otolaryngologists and radiologists. MATERIAL AND METHODS This prospective observational study covered a group of 61 patients with symptomatic OS with PAL. Assessment of quality of life was done using the 22-item Sino-Nasal Outcome Test-22 (SNOT-22) and Oral Health-Impact Profile-14 (OHIP-14). Temporal and etiological relationship between the dental cause and sinonasal complication was established among the otolaryngologist and dental specialist based on the clinical symptoms, nasal endoscopy described according to the modified Lund-MacKay scale, computed tomography (CT) scans measured and scored in compliance with Lund- Kennedy, Zinreich and Estrela scales. RESULTS Out of 61 patients, 28 (46%) were women and 33 (54%) men. Group median age 49.1 years, ranged from 22.8 to 78.9 years. Total OHIP-14 score was 12.7 ± 11.3, with the highest value obtained in domains describing physical pain (mean 2.9 ± 2.4, median 3) in which the highest score was obtained in item 3 - painful aching in mouth and/or teeth - scored ≥2 by 52.5% of participants. Concerning dental symptoms 11.5% of patients were asymptomatic. Total SNOT-22 score was 40.7 ± 21.1, with the highest value in domains describing nasal symptoms. 23% of patients reported mild, 44.3% moderate and 32.7% severe symptoms. In the endoscopic evaluation 86.8% of cases presented discharge, 73.8% mucosal edema. In 11.5% of cases the polypoid tissues was observed in nasal cavities. The first molar tooth was the most frequently affected with an incidence of 42.6%, followed by the second molar (27.9%). In 33 (48.5%) of cases the inflammatory process caused the discontinuity of the sinus floor, which in 51.5% coexisted with total maxillary sinus opacification. 10 teeth (14.7%) had the periapical lesions with a diameter exceeding 8 mm. In case of the multi-rooted teeth, PALs were usually encountered at more than one root (57.4%). Maxillary and ethmoid sinus were affected in 54% of cases and additional frontal sinus involvement in 32.8%. In 69.6% patients, ostiomeatal complex was obstructed. CONCLUSIONS Persistent sinonasal symptoms such as rhinorrhea, post-nasal drip and nose congestion along with dental pain may suggest endodontic nature of OS, especially after previous root-canal treatment. The bigger the PAL is in diameter and the closer to the maxillary sinus, the greater effect on its mucosal involvement and obstruction of ostiomeatal complex is observed. PALs around molar or premolar tooth apexes with coexistence of unilateral sinus opacifications should be noticed and mentioned by radiologists and evaluated by dental specialists in order to refer the patient to further treatment.
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Cervin A, Rimmer J, Wrobel A, Abelak Y, Brayton L, Kuang Y. Long-acting implantable corticosteroid matrix for chronic rhinosinusitis: Results of LANTERN Phase 2 randomized controlled study. Int Forum Allergy Rhinol 2021; 12:147-159. [PMID: 34534410 PMCID: PMC9292908 DOI: 10.1002/alr.22883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/16/2021] [Accepted: 07/25/2021] [Indexed: 11/25/2022]
Abstract
Background Topical steroids are first‐line treatment for chronic rhinosinusitis (CRS), but fail to provide adequate symptom control for all patients. Designed for medical treatment failures, LYR‐210 is an implantable matrix that locally elutes mometasone furoate to inflamed sinonasal tissue for up to 24 weeks in CRS patients. In an open‐label phase 1 study, LYR‐210 demonstrated clinically relevant improvement in the 22‐item Sino‐Nasal Outcome Test (SNOT‐22). Safety and efficacy of LYR‐210 in CRS were evaluated in the LANTERN Phase 2 study. Methods Sixty‐seven surgically naive adult CRS patients who were inadequately controlled by previous medical management and seeking an alternative treatment enrolled in a multicenter, blinded, controlled, dose‐ranging study. Patients had moderate‐to‐severe disease based on SNOT‐22 and composite 7‐day average scores of the 4 cardinal CRS symptoms (4CS), with diagnosis confirmed by nasal endoscopy and magnetic resonance imaging. Patients were randomized (1:1:1) to saline irrigation–only control or bilateral in‐office administration of LYR‐210 (2500 μg) or LYR‐210 (7500 μg). Safety and efficacy were evaluated over 24 weeks. Results Both LYR‐210 doses were safe and well‐tolerated over the 24‐week treatment period. LYR‐210 demonstrated rapid and durable dose‐dependent symptom improvement based on 4CS and SNOT‐22, with LYR‐210 (7500 μg) achieving statistical significance as early as 8 weeks and out to 24 weeks compared with control. LYR‐210 (7500 μg) reduced rescue treatment use and radiographic ethmoid opacification at week 24. Conclusions LYR‐210 is the first implantable sinonasal treatment to achieve up to 24 weeks of benefit from a single administration in surgically naive CRS patients with and without nasal polyps.
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Affiliation(s)
- Anders Cervin
- University of Queensland Centre for Clinical ResearchRoyal Brisbane & Women's Hospital CampusHerstonQLDAustralia
| | - Joanne Rimmer
- Monash Health and Department of SurgeryMonash UniversityMelbourneVICAustralia
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Zhou AS, Prince AA, Maxfield AZ, Corrales CE, Shin JJ. Sinonasal Outcome Scores and Imaging: A Concurrent Assessment of Factors Influencing Their Association. Otolaryngol Head Neck Surg 2020; 165:215-222. [PMID: 33170758 DOI: 10.1177/0194599820972672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The overall discriminatory ability of validated instrument scores for computed tomography (CT) findings of chronic rhinosinusitis has limitations and may be modified by multiple factors. To support optimal methods for assessment, we studied which factors could influence this relationship, including the concurrent impact of multiple discrete CT scoring mechanisms, colocalized imaging findings, and nasal comorbid conditions. STUDY DESIGN Observational outcomes study. SETTING Academic medical center. METHODS Patients with sinonasal complaints who completed the 22-item Sinonasal Outcome Test (SNOT-22) and underwent CT were included. Multivariate ordinal regression was utilized to assess associations. CT data were quantified with the Lund-Mackay system, Zinreich system, and a direct measure of maximal mucosal thickness. The impact of incidental findings (mucous retention cysts, periapical dental disease) and nasal comorbid conditions was also assessed. RESULTS A total of 233 patients were included. SNOT-22 nasal scores were significantly associated with CT results when those with incidental findings were excluded, regardless of the radiologic scoring mechanism utilized: Lund-Mackay regression coefficient, 0.321 (P = .046); Zinreich, 0.340 (P = .033); and maximum mucosal thickness, 0.316 (P = .040). This relationship subsided when incidental findings were present. SNOT-22 overall scores, sleep scores, and psychological domain scores had no significant association with imaging results, regardless of radiologic scoring system utilized. Nasal comorbid conditions had inconsistent associations. CONCLUSIONS SNOT-22 nasal domain scores were associated with all 3 radiologic scoring systems when incidental findings were absent but not when they were present. Delineating the presence or absence of these colocalized findings affected the relationship between SNOT-22 scores and radiological results, beyond other concurrent factors.
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Affiliation(s)
- Allen S Zhou
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony A Prince
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Alice Z Maxfield
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - C Eduardo Corrales
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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12
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Schilling AL, Kulahci Y, Moore J, Wang EW, Lee SE, Little SR. A thermoresponsive hydrogel system for long-acting corticosteroid delivery into the paranasal sinuses. J Control Release 2020; 330:889-897. [PMID: 33157189 DOI: 10.1016/j.jconrel.2020.10.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/16/2022]
Abstract
Delivering localized treatment to the paranasal sinuses for diseases such as chronic rhinosinusitis (CRS) is particularly challenging because of the small natural openings leading from the sinuses that can be further obstructed by presence of inflammation. As such, oral steroids, topical nasal sprays or irrigation, and surgery can be utilized to treat persistent sinonasal inflammation, but there exists a need for post-operative options for long-term steroid delivery to prevent disease recurrence. In the present study, a Thermogel, Extended-release Microsphere-based-delivery to the Paranasal Sinuses (TEMPS) is developed with the corticosteroid mometasone furoate. Specifically, the bioactive steroid is released for 4 weeks from poly(lactic-co-glycolic acid) (PLGA) microspheres embedded in a poly(N-isopropylacrylamide) (p-NIPAAm)-based hydrogel. The temperature-responsive system undergoes a reversible sol-gel transition at 34-35 °C such that it can be applied as a liquid at ambient temperature, conforming to the sinonasal epithelium as it gels. In a rabbit model of CRS, TEMPS was maintained in rabbit sinuses and effectively reduced sinonasal inflammation as characterized by micro-computed tomography and histopathology analysis. Ultimately, the combination of controlled release microspheres with a thermoresponsive hydrogel provides flexibility for encapsulating therapeutics in a reversible and conforming system for localized delivery to the sinuses.
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Affiliation(s)
- Andrea L Schilling
- Department of Chemical Engineering, University of Pittsburgh, 940 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA, 15213, United States of America
| | - Yalcin Kulahci
- Department of Chemical Engineering, University of Pittsburgh, 940 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA, 15213, United States of America
| | - John Moore
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, 1400 Locust Street, Suite 2100, Pittsburgh, PA 15219, United States of America
| | - Eric W Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, 1400 Locust Street, Suite 2100, Pittsburgh, PA 15219, United States of America
| | - Stella E Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, 1400 Locust Street, Suite 2100, Pittsburgh, PA 15219, United States of America
| | - Steven R Little
- Department of Chemical Engineering, University of Pittsburgh, 940 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA, 15213, United States of America; Department of Bioengineering, University of Pittsburgh, 302 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA 15213, United States of America; Department of Clinical and Translational Science, University of Pittsburgh, Forbes Tower, Suite 7057, Pittsburgh, PA 15213, United States of America; McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219, United States of America; Department of Immunology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, United States of America; Department of Pharmaceutical Science, University of Pittsburgh, 3501 Terrace Street, Pittsburgh, PA 15213, United States of America.
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13
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Naclerio R, Baroody F, Bachert C, Bleier B, Borish L, Brittain E, Chupp G, Fisher A, Fokkens W, Gevaert P, Kennedy D, Kim J, Laidlaw TM, Lee JJ, Piccirillo JF, Pinto JM, Roland LT, Schleimer RP, Schlosser RJ, Schwaninger JM, Smith TL, Tan BK, Tan M, Toskala E, Wenzel S, Togias A. Clinical Research Needs for the Management of Chronic Rhinosinusitis with Nasal Polyps in the New Era of Biologics: A National Institute of Allergy and Infectious Diseases Workshop. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:1532-1549.e1. [PMID: 32142964 PMCID: PMC8177483 DOI: 10.1016/j.jaip.2020.02.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 12/11/2022]
Abstract
The development of biologics targeting various aspects of type 2 inflammation for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) will provide clinicians with powerful tools to help treat these patients. However, other therapies are also available, and positioning of biologics in a management algorithm will require comparative trials. In November 2019, the National Institute of Allergy and Infectious Diseases convened a workshop to consider potential future trial designs. Workshop participants represented a wide spectrum of clinical specialties, including otolaryngology, allergy, and pulmonary medicine, as well as expertise in CRSwNP pathophysiology and in trial methodology and statistics. The workshop discussed the current state of knowledge in CRSwNP and considered the advantages and disadvantages of various clinical trial or observational study designs and various clinical outcomes. The output from this workshop, which is presented in this report, will hopefully provide investigators with adequate information and ideas to design future studies and answer critical clinical questions. It will also help clinicians understand the current state of the management of CRSwNP and its gaps and be more able to interpret the new information to come.
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Affiliation(s)
| | | | | | - Benjamin Bleier
- Harvard Medical School, Massachusetts Eye and Ear, Department of Otolaryngology, Boston, Mass
| | | | - Erica Brittain
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | | | - Anat Fisher
- University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Jean Kim
- Johns Hopkins University, Baltimore, Md
| | - Tanya M Laidlaw
- Harvard Medical School, Brigham and Women's Hospital, Division of Allergy and Clinical Immunology, Boston, Mass
| | | | | | | | - Lauren T Roland
- University of California-San Francisco, San Francisco, Calif
| | | | | | - Julie M Schwaninger
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | | | | | - Ming Tan
- Georgetown University, Washington, DC
| | | | | | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
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14
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Stölzel K, Szczepek AJ, Olze H, Koß S, Minet O, Zabarylo U. Digital diaphanoscopy of the maxillary sinuses: A revival of optical diagnosis for rhinosinusitis. Am J Otolaryngol 2020; 41:102444. [PMID: 32127210 DOI: 10.1016/j.amjoto.2020.102444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE The non-invasive diagnosis of acute rhinosinusitis (ARS) remains an unresolved problem of modern otolaryngology. Analog diaphanoscopy of reduced transillumination (shading) could be enhanced by a digital image processing of the maxillary sinuses. By this means, the limited ergonomics of this safe and low-cost method can be overcome, and merits renewed the investigation. Here, we compared the diagnostic sensitivity and specificity of digital diaphanoscopy and computed tomography (CT) in detecting shading in the maxillary sinus. MATERIALS AND METHODS We examined 103 adults using both digital diaphanoscopy of the maxillary sinus and native-phase cranial CT. We developed a scoring system for investigation of shading in the maxillary sinus using diaphanoscopy and compared the sensitivity and specificity with that of CT. Also, we documented a follow-up of acute rhinosinusitis. RESULTS In diagnosing shading in the maxillary sinus, digital diaphanoscopy had a sensitivity of 86% and a specificity of 88%. Digital diaphanoscopy can be used not only in the screening of ARS but also for documentation of its course. CONCLUSION This study supports the role of modern digital diaphanoscopy in the diagnosis of shading in the maxillary sinus, especially in patients with ARS when CT imaging is not recommended. The ergonomics of analog diaphanoscopy could be significantly improved for physicians and patients by the implementation of modern hardware and software components. Further development of the technique and the use of several discrete wavelengths will improve this method's sensitivity and specificity.
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Affiliation(s)
- Katharina Stölzel
- Department of Otolaryngology, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Agnieszka J Szczepek
- Department of Otolaryngology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Heidi Olze
- Department of Otolaryngology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Koß
- Department of Otolaryngology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Olaf Minet
- Laboratory of Medical Physics/Optical Diagnostics, Center for Diagnostic and Interventional Radiology and Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Urszula Zabarylo
- BIH Berlin-Brandenburg Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Berlin, Germany
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Chowdhury N, Smith TL, Beswick DM. Measuring Success in the Treatment of Patients with Chronic Rhinosinusitis. Immunol Allergy Clin North Am 2020; 40:265-279. [DOI: 10.1016/j.iac.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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16
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Chowdhury NI, Smith TL, Chandra RK, Turner JH. Automated classification of osteomeatal complex inflammation on computed tomography using convolutional neural networks. Int Forum Allergy Rhinol 2019; 9:46-52. [PMID: 30098123 PMCID: PMC6318014 DOI: 10.1002/alr.22196] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/08/2018] [Accepted: 07/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Convolutional neural networks (CNNs) are advanced artificial intelligence algorithms well suited to image classification tasks with variable features. These have been used to great effect in various real-world applications including handwriting recognition, face detection, image search, and fraud prevention. We sought to retrain a robust CNN with coronal computed tomography (CT) images to classify osteomeatal complex (OMC) occlusion and assess the performance of this technology with rhinologic data. METHODS The Google Inception-V3 CNN trained with 1.28 million images was used as the base model. Preoperative coronal sections through the OMC were obtained from 239 patients enrolled in 2 prospective chronic rhinosinusitis (CRS) outcomes studies, labeled according to OMC status, and mirrored to obtain a set of 956 images. Using this data, the classification layer of Inception-V3 was retrained in Python using a transfer learning method to adapt the CNN to the task of interpreting sinonasal CT images. RESULTS The retrained neural network achieved 85% classification accuracy for OMC occlusion, with a 95% confidence interval for algorithm accuracy of 78% to 92%. Receiver operating characteristic (ROC) curve analysis on the test set confirmed good classification ability of the CNN with an area under the ROC curve (AUC) of 0.87, significantly different than both random guessing and a dominant classifier that predicts the most common class (p < 0.0001). CONCLUSION Current state-of-the-art CNNs may be able to learn clinically relevant information from 2-dimensional sinonasal CT images with minimal supervision. Future work will extend this approach to 3-dimensional images in order to further refine this technology for possible clinical applications.
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Affiliation(s)
- Naweed I. Chowdhury
- Vanderbilt University School of Medicine, Otolaryngology & Head and Neck Surgery, Nashville, TN., USA
| | - Timothy L. Smith
- Oregon Health & Science University, Department of Otolaryngology-Head & Neck Surgery, Portland, OR., USA
| | - Rakesh K. Chandra
- Vanderbilt University School of Medicine, Otolaryngology & Head and Neck Surgery, Nashville, TN., USA
| | - Justin H. Turner
- Vanderbilt University School of Medicine, Otolaryngology & Head and Neck Surgery, Nashville, TN., USA
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17
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Valtonen O, Bizaki A, Kivekäs I, Rautiainen M. Three-Dimensional Volumetric Evaluation of the Maxillary Sinuses in Chronic Rhinosinusitis Surgery. Ann Otol Rhinol Laryngol 2018; 127:931-936. [PMID: 30244583 DOI: 10.1177/0003489418801386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION: The objective of this study was to ascertain whether the 3-dimensional volumetric measurement method could be used for the evaluation of operative treatment results in patients with chronic rhinosinusitis. METHODS: A total of 61 adult patients with chronic rhinosinusitis were analyzed. Cone-beam computed tomographic images of the paranasal sinuses were examined preoperatively and at 12 months postoperatively. The results were compared using the Sino-Nasal Outcome Test (SNOT-22) and the Lund-Mackay (LM) and Zinreich modified staging systems. RESULTS: The mean change in pneumatized volumes in the maxillary sinuses after operative treatment per patient was 2.0 ± 7.5 cm3 ( P = .146). The median for volumetric change was 0.97 cm3 (range, -11.6 to 33.6 cm3). Both the LM and Zinreich modified LM staging systems showed no change in 32 of 61 patients (53%). The alterations in patients' maxillary sinuses measured using the volumetric measurement method correlated well with changes in Zinreich's modified LM staging (-0.77, P < .01). CONCLUSIONS: The 3D volumetric method is more sensitive in detecting small alterations in pneumatized volumes of the maxillary sinuses than Zinreich's modified LM staging and LM staging. The method correlates better with Zinreich's modified LM staging than with LM staging.
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Affiliation(s)
- Olli Valtonen
- 1 Department of Ear and Oral Diseases, Tampere University Hospital and Department of Otorhinolaryngology, University of Tampere, Tampere, Finland
| | - Argyro Bizaki
- 1 Department of Ear and Oral Diseases, Tampere University Hospital and Department of Otorhinolaryngology, University of Tampere, Tampere, Finland
| | - Ilkka Kivekäs
- 1 Department of Ear and Oral Diseases, Tampere University Hospital and Department of Otorhinolaryngology, University of Tampere, Tampere, Finland
| | - Markus Rautiainen
- 1 Department of Ear and Oral Diseases, Tampere University Hospital and Department of Otorhinolaryngology, University of Tampere, Tampere, Finland
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18
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Lehman DA, Casiano RR, Polak M. Reliability of the University of Miami Chronic Rhinosinusitis Staging System. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240602000103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The aim of this study was to determine the interrater reliability and correlation between computed tomography (CT) and endoscopic components of the University of Miami (UM) Chronic Rhinosinusitis Staging System (UMCRSS), a comprehensive staging system for chronic rhinosinusitis (CRS). Methods A prospective analysis of 55 patients undergoing endoscopic sinus surgery for CRS was performed. The population consisted of 28 men and 27 women, with a mean age of 45.9 years. All patients underwent staging, via the CT and endoscopic components of the UMCRSS in the operating room, by three examiners. The reliability of the system and all of its components was determined by K-coefficient analysis, comparing the data from all three examiners. Correlation between the CT and endoscopic arms was analyzed by Pearson's product moment coefficient. Results Interrater reliability for the CT arm (κ = 0.83) and endoscopic arm (κ = 0.74 for the revision population, and κ = 0.72 for the primary surgery population) were found to be significant. Endoscopic staging established significant correlation with CT staging (Pearson's r2 = 0.40; p < 0.0001 overall, 0.57, p < 0.0001 for revision, and 0.42, p < 0.0001 for primary cases). Conclusion The UMCRSS is a comprehensive and reliable staging system with very strong and positive correlation between the CT and endoscopic components.
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Affiliation(s)
- David A. Lehman
- Department of Otolaryngology, University of Miami School of Medicine, Miami, Florida
| | - Roy R. Casiano
- Department of Otolaryngology, University of Miami School of Medicine, Miami, Florida
| | - Marek Polak
- Department of Otolaryngology, University of Miami School of Medicine, Miami, Florida
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Kirsch CF, Bykowski J, Aulino JM, Berger KL, Choudhri AF, Conley DB, Luttrull MD, Nunez D, Shah LM, Sharma A, Shetty VS, Subramaniam RM, Symko SC, Cornelius RS. ACR Appropriateness Criteria ® Sinonasal Disease. J Am Coll Radiol 2017; 14:S550-S559. [DOI: 10.1016/j.jacr.2017.08.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 01/09/2023]
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20
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Szczygielski K, Galusza B, Rapiejko P, Klopotek M, Jurkiewicz D. A six-month analysis of frontal sinus drainage pathway in patients with frontal sinusitis after balloon sinuplasty. Acta Otolaryngol 2017; 137:968-974. [PMID: 28301960 DOI: 10.1080/00016489.2017.1300941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The balloon catheter has been used for a decade to dilate paranasal sinus outflow tracts. The question is: how wide and how durable is the dilation of drainage pathways in patients in long-term observations after this procedure? OBJECTIVE The objective of our study was to observe the changes occurring in the frontal sinus drainage pathway (FSDP) in patients with frontal sinusitis at least 6 months after surgery using balloon catheters in an isolated procedure. MATERIALS AND METHODS We analyzed and measured the FSDP width on computed tomography (CT) of 23 images before and after the use of balloon catheters. We also assessed mucosal changes using Zinreich's scale, and symptom improvements with the Sino-Nasal Outcome Test (SNOT-20). RESULTS A statistically significant difference in the width of the FSDP was found before and after sinuplasty in the study group (p ≤ .0016). On average, the FSDP increased by 24.1%. Clinically meaningful and statistically significant (p ≤ .0002) symptom improvement as indicated by the mean SNOT-20 score was observed. Mucosal changes were also statistically significant (p ≤ .0018) after surgery. CONCLUSION The findings at least 6 months after follow-up indicated that the use of balloon catheters in an isolated procedure allowed durable modeling of FSDP and was associated with radiological and clinical improvements.
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Affiliation(s)
- Kornel Szczygielski
- Department of Otolaryngology, Division of Cranio- Maxillo- Facial Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Barbara Galusza
- Department of Otolaryngology, Division of Cranio- Maxillo- Facial Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Rapiejko
- Department of Otolaryngology, Division of Cranio- Maxillo- Facial Surgery, Military Institute of Medicine, Warsaw, Poland
| | | | - Dariusz Jurkiewicz
- Department of Otolaryngology, Division of Cranio- Maxillo- Facial Surgery, Military Institute of Medicine, Warsaw, Poland
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21
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Lockwood P. CT sinus and facial bones reporting by radiographers: findings of an accredited postgraduate programme. Dentomaxillofac Radiol 2017; 46:20160440. [PMID: 28267931 DOI: 10.1259/dmfr.20160440] [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: 01/27/2023] Open
Abstract
OBJECTIVES The aim of this study was to compare the observer performance of a cohort of radiographers in reporting CT sinus and facial bone investigations against a reference standard and alternative comparator of summary data from peer-reviewed literature. METHODS The participants (n = 6) completed a 9-month part-time distance learning training programme prior to reporting an examination bank (n = 25 cases) from a retrospectively collected and anonymized digital imaging and communications in medicine archive of CT examinations with referral histories and clinical reports. A literature search was performed to identify an additional alternative comparison reference standard from studies reporting observer performance data in CT sinus and facial bone investigations of both trauma and sinus pathology (target conditions). The data analyses used to measure observer performance and determine differences between the cohort and the reference standards used statistical assessment models including accuracy, sensitivity, specificity, kappa (κ) and summary receiver-operating characteristic curves with estimated area under the curve (AUC). RESULTS The cohort of radiographer sensitivity was 97.5%, specificity 93.6% and accuracy 95%, with p < 0.000, and a κ = 0.9121 score of agreement. The mean radiographer AUC was 0.9822. The summary reported data of the alternative literature reference standard comparator were AUC 0.9533 for sinus and 0.9374 for trauma. CONCLUSIONS The results suggest that this cohort of radiographers at the end of a period training in CT sinus and facial bones are able to clinically report comparably high standards.
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Affiliation(s)
- Paul Lockwood
- Allied Health Department, Canterbury Christ Church University, Chatham, UK
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Abstract
While most patients with inflammatory rhinosinusitis are successfully diagnosed clinically, imaging is indicated in patients with recurrent or chronic sinusitis, atypical symptoms and complicated acute sinusitis. Non-enhanced high resolution, thin section computed tomography (CT) is the reference standard in evaluating such patients. It provides superb anatomical details and enables a fairly accurate diagnosis and delineation of the disease, addressing all concerns of the endoscopic surgeon prior to intervention. Contrast MR imaging is preferred for assessing intraorbital or intracranial complications. The radiologist must have a systematic approach to sinonasal CT and generate a clinically relevant report that impacts patient management.
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Affiliation(s)
- Varsha M Joshi
- Department of CT and MRI, Vijaya Diagnostics, Hyderabad, Telangana 500034, India; Visiting Consultant, Department of Imaging Tata Medical Center, Kolkata, India.
| | - Rima Sansi
- Department of CT and MRI, Vijaya Diagnostics, Hyderabad, Telangana 500034, India
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Sheikh SI, Handly B, Ryan-Wenger NA, Hayes D, Kirkby SE, McCoy KS, Lind M. Novel Computed Tomography Scoring System for Sinus Disease in Adults With Cystic Fibrosis. Ann Otol Rhinol Laryngol 2016; 125:838-43. [PMID: 27357973 DOI: 10.1177/0003489416656645] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is no easy to use scoring system for computed tomography (CT) scans of the sinuses that is specific to cystic fibrosis (CF). We propose a simple and easily implemented scoring system to quantify severity of sinus disease in adults with CF. STUDY DESIGN Case series with chart review. SETTING Academic tertiary-care referral center. SUBJECTS Sixty-nine adult patients with CF and 50 age-matched controls. METHODS We validated a scoring system for CF sinus disease. The CT scans were interpreted by 3 physicians on 2 separate sittings. Parameters include maxillary opacification, nasal obstruction, lateral nasal wall displacement, uncinate process absence/demineralization, and presence/absence of mucocele. RESULTS Patients with CF aged 21 to 30 years (mean = 24.7 ± 2.49). In CF cohort (n = 69), intrarater reliability for the 10 CT categories ranged from .70 to 1.00. Twenty-six (87%) were in the excellent range, and the remaining 4 (13%) were evaluated as good. In the non-CF cohort (n = 50), reliabilities ranged from .44 to 1.00. Twenty-seven (90%) were in the excellent range. For interrater reliability, in the CF cohort, 10 CT categories across the 3 raters ranged from .55 to 1.00. Excellent reliability was achieved in 15 (50%) of the observations. In the non-CF cohort, reliabilities ranged from .44 to 1.00. CONCLUSION A novel and easy to use CT scoring system for CF sinus disease in adults was validated with inter- and intrarater reliability. This new CF sinus disease-specific scoring system can be used by clinicians, surgeons, and radiologists.
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Affiliation(s)
- Shahid I Sheikh
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brian Handly
- Radiology, The Ohio State University College of Medicine, Columbus, Ohio, USA Radiological Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nancy A Ryan-Wenger
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Don Hayes
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Stephen E Kirkby
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Karen S McCoy
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Meredith Lind
- Otolaryngology, The Ohio State University College of Medicine, Columbus, Ohio, USA Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, USA
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Kabeya Y, Kato K, Tomita M, Katsuki T, Oikawa Y, Shimada A. Higher Body Mass Index and Increased Prevalence of Paranasal Sinus Disease. J Epidemiol 2016; 26:258-63. [PMID: 26830349 PMCID: PMC4848324 DOI: 10.2188/jea.je20150134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background We hypothesized that higher body mass index (BMI) was associated with increased prevalence of paranasal sinus disease and examined the hypothesis in Japanese adults. Methods This was a cross-sectional study including 1350 Japanese adults aged 40 years or more who participated in a health check-up program focusing on brain diseases and metabolic syndrome. Participants were divided into quartiles of BMI levels. Paranasal sinus disease was confirmed by a head MRI scan. The association between BMI and paranasal sinus disease was examined using logistic regression analysis, which was adjusted for age, sex, waist:hip ratio, hemoglobin A1c, systolic blood pressure, smoking status, alcohol intake, and white blood cell count. Results Of the 1350 participants, 151 (11.2%) had paranasal sinus disease. In relation to those in the lowest quartile of BMI, the odds ratios of having the disease among those in the 2nd, 3rd, and 4th quartiles of BMI were 1.89 (95% confidence interval [CI], 1.03–3.48), 2.26 (95% CI, 1.20–4.23) and 2.26 (95% CI, 1.14–4.51), respectively. When BMI was analysed as a continuous variable, an increase of one unit in BMI was significantly associated with increased odds of having the disease, with an OR of 1.08 (95% CI, 1.01–1.16). Conclusions The present study suggests that patients with higher BMI are more likely to have paranasal sinus disease.
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Affiliation(s)
- Yusuke Kabeya
- Division of General Internal Medicine, Department of Internal Medicine, Tokai University Hachioji Hospital
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Takano K, Abe A, Yajima R, Kakuki T, Jitsukawa S, Nomura K, Himi T. Clinical Evaluation of Sinonasal Lesions in Patients With Immunoglobulin G4-Related Disease. Ann Otol Rhinol Laryngol 2015; 124:965-71. [DOI: 10.1177/0003489415593557] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: Immunoglobulin G4-related disease (IgG4-RD) is a systemic disease entity characterized by elevated serum IgG4 and extensive IgG4-positive plasma cell infiltration of various organs. Patients with IgG4-RD show nasal manifestations with chronic rhinosinusitis. The objective of this study was to evaluate the clinical characteristics of sinonasal lesions in patients with IgG4-RD. Methods: We evaluated radiological findings of sinonasal lesions in 79 patients with IgG4-RD who were divided into 3 groups according to severity. We also compared serological findings, including serum IgG4 and IgE levels, and eosinophil counts. Results: Rhinosinusitis was found in 41 patients (51.9%). Although there were no significant differences in the serum IgG4 and IgE levels of the groups, there was a significant increase in eosinophil counts (445 ± 311.9/mm3) in Group C. Furthermore, 14 of the 41 patients with rhinosinusitis (34.1%) showed improvement after prednisolone administration. Patients with IgG4-RD and serum eosinophilia tend to also have sinonasal lesions. Conclusions: Rhinosinusitis is common in patients with IgG4-RD, and its pathogenesis can be similar to eosinophilic chronic rhinosinusitis.
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Affiliation(s)
- Kenichi Takano
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ayumi Abe
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ryoto Yajima
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takuya Kakuki
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Sumito Jitsukawa
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kazuaki Nomura
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuo Himi
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 2015; 152:S1-S39. [PMID: 25832968 DOI: 10.1177/0194599815572097] [Citation(s) in RCA: 481] [Impact Index Per Article: 53.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This update of a 2007 guideline from the American Academy of Otolaryngology--Head and Neck Surgery Foundation provides evidence-based recommendations to manage adult rhinosinusitis, defined as symptomatic inflammation of the paranasal sinuses and nasal cavity. Changes from the prior guideline include a consumer added to the update group, evidence from 42 new systematic reviews, enhanced information on patient education and counseling, a new algorithm to clarify action statement relationships, expanded opportunities for watchful waiting (without antibiotic therapy) as initial therapy of acute bacterial rhinosinusitis (ABRS), and 3 new recommendations for managing chronic rhinosinusitis (CRS). PURPOSE The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing adult rhinosinusitis and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy for adult rhinosinusitis, promote appropriate use of ancillary tests to confirm diagnosis and guide management, and promote judicious use of systemic and topical therapy, which includes radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia. ACTION STATEMENTS The update group made strong recommendations that clinicians (1) should distinguish presumed ABRS from acute rhinosinusitis (ARS) caused by viral upper respiratory infections and noninfectious conditions and (2) should confirm a clinical diagnosis of CRS with objective documentation of sinonasal inflammation, which may be accomplished using anterior rhinoscopy, nasal endoscopy, or computed tomography. The update group made recommendations that clinicians (1) should either offer watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated ABRS; (2) should prescribe amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days (if a decision is made to treat ABRS with an antibiotic); (3) should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications if the patient worsens or fails to improve with the initial management option by 7 days after diagnosis or worsens during the initial management; (4) should distinguish CRS and recurrent ARS from isolated episodes of ABRS and other causes of sinonasal symptoms; (5) should assess the patient with CRS or recurrent ARS for multiple chronic conditions that would modify management, such as asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia; (6) should confirm the presence or absence of nasal polyps in a patient with CRS; and (7) should recommend saline nasal irrigation, topical intranasal corticosteroids, or both for symptom relief of CRS. The update group stated as options that clinicians may (1) recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation for symptomatic relief of viral rhinosinusitis; (2) recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation) for symptomatic relief of ABRS; and (3) obtain testing for allergy and immune function in evaluating a patient with CRS or recurrent ARS. The update group made recommendations that clinicians (1) should not obtain radiographic imaging for patients who meet diagnostic criteria for ARS, unless a complication or alternative diagnosis is suspected, and (2) should not prescribe topical or systemic antifungal therapy for patients with CRS.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, School of Medicine, St Louis, Missouri, USA
| | | | - Itzhak Brook
- Department of Pediatrics, Georgetown University, Washington, DC, USA
| | - Kaparaboyna Ashok Kumar
- Department of Family Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
| | - Maggie Kramper
- Department of Otolaryngology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Richard R Orlandi
- Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James N Palmer
- Department Otolaryngology, University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Zara M Patel
- Department of Otolaryngology Head & Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Anju Peters
- Department of Internal Medicine, Northwestern University Allergy Division, Chicago, Illinois, USA
| | - Sandra A Walsh
- Consumers United for Evidence-Based Healthcare, Davis, California, USA
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Garneau J, Ramirez M, Armato SG, Sensakovic WF, Ford MK, Poon CS, Ginat DT, Starkey A, Baroody FM, Pinto JM. Computer-assisted staging of chronic rhinosinusitis correlates with symptoms. Int Forum Allergy Rhinol 2015; 5:637-642. [PMID: 25854318 DOI: 10.1002/alr.21499] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/28/2014] [Accepted: 01/01/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Lund-Mackay (LM) staging system for chronic rhinosinusitis (CRS) does not correlate with clinical parameters, likely due to its coarse scale. We developed a "Modified Lund Mackay" (MLM) system, which uses a three-dimensional (3D), computerized method to quantify the volume of mucosal inflammation in the sinuses, and sought to determine whether the MLM would correlate with symptoms and disease-specific quality of life. METHODS We obtained Total Nasal Symptom Score (TNSS) and 22-item Sino-Nasal Outcome Test (SNOT-22) data from 55 adult subjects immediately prior to sinus imaging. The volume of each sinus occupied by mucosal inflammation was measured using MATLAB algorithms created using customized, image analysis software after manual outlining of each sinus. Linear regression was used to model the relationship between the MLM and the SNOT-22 and TNSS. Correlation between the LM and MLM was tested using Spearman's rank correlation coefficient. RESULTS Adjusting for age, gender, and smoking, a higher symptom burden was associated with increased sinonasal inflammation as captured by the MLM (β = 0.453, p < 0.013). As expected due to the differences in scales, the LM and MLM scores were significantly different (p < 0.011). No association between MLM and SNOT-22 scores was found. CONCLUSION The MLM is one of the first imaging-based scoring systems that correlates with sinonasal symptoms. Further development of this custom software, including full automation and validation in larger samples, may yield a biomarker with great utility for both treatment of patients and outcomes assessment in clinical trials.
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Affiliation(s)
| | | | | | | | - Megan K Ford
- Department of Radiology, The University of Chicago
| | - Colin S Poon
- Department of Radiology, The University of Chicago
| | | | - Adam Starkey
- Department of Radiology, The University of Chicago
| | - Fuad M Baroody
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago
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Mori A, Nakayama T, Tsukidate T, Hirabayashi H, Haruna S. [Comparison of B-mode ultrasonography and computed tomography in the evaluation of maxillary sinusitis in pediatric patients]. ACTA ACUST UNITED AC 2014; 117:26-33. [PMID: 24601097 DOI: 10.3950/jibiinkoka.117.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The use of ultrasonography in the diagnosis of maxillary sinusitis in pediatric patients has been reported recently because of the improvement of the accuracy of ultrasound technology. We thus compared B-mode ultrasonography and computed tomography in the diagnosis of maxillary sinusitis in pediatric patients. Thirty-six maxillary sinuses in 18 patients (10 females, 8 males, ages ranging from 7-15 years with an average age of 10.4 years) were examined. Ultrasonography of the maxillary sinus was performed in the horizontal and the vertical direction. Paranasal computed tomography and B-mode ultrasonography were performed within a few days. In some of these patients the maxillary sinuses were examined with a fiberscope. Sensitivity, specificity, false-positive, false-negative, positive predictive value and negative predictive value of B-mode ultrasonography compared with computed tomography were 92.6%, 100%, 0%, 7.4%, 100% and 81.8%, respectively. It appeared that ultrasonography was more sensitive than X-ray imaging, because the sensitivity and specificity of X-ray imaging of the maxillary sinus in pediatric patients compared with CT was reportedly 70-80%. A meaningful correlation of ultrasonography and CT was accepted as an assessment of desease severity. There are some problems with diagnosis by ultrasonography. There is no differentiation of mucosal thicking, cyst and discharge and imaging are less useful in pediatric patients. Because of these reasons, clinical sign and views in the nose are important for a correct diagnosis in pediatric patients. Furthermore, the most suitable age range to diagnose maxillary sinusitis correctly in pediatric patients must be examined.
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Affiliation(s)
- Aya Mori
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Dokkyo Medical, Tochigi
| | - Tsuguhisa Nakayama
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Dokkyo Medical, Tochigi
| | | | - Hideki Hirabayashi
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Dokkyo Medical, Tochigi
| | - Shinichi Haruna
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Dokkyo Medical, Tochigi
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Likness MM, Pallanch JF, Sherris DA, Kita H, Mashtare TL, Ponikau JU. Computed tomography scans as an objective measure of disease severity in chronic rhinosinusitis. Otolaryngol Head Neck Surg 2013; 150:305-11. [PMID: 24301090 DOI: 10.1177/0194599813513881] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES A truly objective method of measuring disease severity in chronic rhinosinusitis (CRS) has only recently existed. We evaluated computed tomography (CT) scans of CRS patients using this novel objective 3D computerized system and compared results with a novel 2D computerized analysis of a single coronal slice through the osteomeatal complex (OMC) and subjective methods including Lund-Mackay and Zinreich's modified Lund-Mackay. STUDY DESIGN Prospective multicenter study. SETTING Two academic tertiary referral centers. SUBJECTS AND METHODS Forty-six adults with a diagnosis of CRS underwent CT examination and received an intramuscular triamcinolone injection, dosage weight dependent, followed by CT scan 4 to 5 weeks later. Recruitment lasted 21 months. Scans were evaluated with all 4 scoring methods over 5 months. RESULTS The Lin's concordance class correlation (CCC) of the OMC method revealed the best correlation to the 3D volumetric computerized values (0.915), followed by the Zinreich (0.904) and Lund-Mackay methods (0.824). Posttreatment results demonstrated that both the OMC (0.824) and Zinreich's (0.778) methods had strong agreement with the 3D volumetric methods and were very sensitive to change, whereas the Lund-Mackay (0.545) had only moderate agreement. CONCLUSION Computerized CT analysis provides the most comprehensive, objective, and reproducible method of measuring disease severity and is very sensitive to change induced by treatment intervention. A 2D coronal image through the OMC provides a valid, user-friendly method of assessing CRS and is representative of CRS severity in all sinuses. Zinreich's subjective method correlated well overall, but the Lund-Mackay method lagged behind in disease representation and sensitivity to change.
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Affiliation(s)
- Micah M Likness
- State University of New York at Buffalo, Department of Otolaryngology, Buffalo, New York, USA
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Pallanch J, Yu L, Delone D, Robb R, Holmes DR, Camp J, Edwards P, McCollough CH, Ponikau J, Dearking A, Lane J, Primak A, Shinkle A, Hagan J, Frigas E, Ocel JJ, Tombers N, Siwani R, Orme N, Reed K, Jerath N, Dhillon R, Kita H. Three-dimensional volumetric computed tomographic scoring as an objective outcome measure for chronic rhinosinusitis: clinical correlations and comparison to Lund-Mackay scoring. Int Forum Allergy Rhinol 2013; 3:963-72. [PMID: 24106202 PMCID: PMC3971423 DOI: 10.1002/alr.21219] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/28/2013] [Accepted: 08/01/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND We aimed to test the hypothesis that three-dimensional (3D) volume-based scoring of computed tomography (CT) images of the paranasal sinuses was superior to Lund-Mackay CT scoring of disease severity in chronic rhinosinusitis (CRS). We determined correlation between changes in CT scores (using each scoring system) with changes in other measures of disease severity (symptoms, endoscopic scoring, and quality of life) in patients with CRS treated with triamcinolone. METHODS The study group comprised 48 adult subjects with CRS. Baseline symptoms and quality of life were assessed. Endoscopy and CT scans were performed. Patients received a single systemic dose of intramuscular triamcinolone and were reevaluated 1 month later. Strengths of the correlations between changes in CT scores and changes in CRS signs and symptoms and quality of life were determined. RESULTS We observed some variability in degree of improvement for the different symptom, endoscopic, and quality-of-life parameters after treatment. Improvement of parameters was significantly correlated with improvement in CT disease score using both CT scoring methods. However, volumetric CT scoring had greater correlation with these parameters than Lund-Mackay scoring. CONCLUSION Volumetric scoring exhibited higher degree of correlation than Lund-Mackay scoring when comparing improvement in CT score with improvement in score for symptoms, endoscopic exam, and quality of life in this group of patients who received beneficial medical treatment for CRS.
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Affiliation(s)
- John Pallanch
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Lifeng Yu
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - David Delone
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Rich Robb
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - David R. Holmes
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Jon Camp
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Phil Edwards
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Cynthia H. McCollough
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Jens Ponikau
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Amy Dearking
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - John Lane
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Andrew Primak
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Aaron Shinkle
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - John Hagan
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Evangelo Frigas
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Joseph J. Ocel
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Nicole Tombers
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Rizwan Siwani
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Nicholas Orme
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Kurtis Reed
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Nivedita Jerath
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Robinder Dhillon
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
| | - Hirohito Kita
- Department of Otorhinolaryngology–Head and Neck Surgery (Drs Pallanch and Dearking, and Ms Tombers), Department of Radiology (Drs DeLone, Yu, Lane, and McCollough), Department of Physiology and Biomedical Engineering (Messrs Camp and Edwards, and Drs Holmes and Robb), Division of Allergic Diseases (Drs Hagan, Frigas and Kita), and Department of Immunology (Dr Kita), Department of Pediatric and Adolescent Medicine (Dr. Siwani), Department of Cardiovascular Diseases (Dr. Orme), Department of Dermatologic Surgery (Dr. Reed), Mayo Clinic, Rochester, Minnesota. University of Alabama, Birmingham (Dr. Shinkle); Radiologists of North Iowa, Mason City, Iowa (Dr. Ocel); University of Buffalo, Buffalo, New York (Dr. Ponikau); Siemens Corporation: (Dr. Primak); Wayne State University: (Dr. Dhillon); University of Iowa: (Dr. Jerath)
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Möller W, Schuschnig U, Celik G, Münzing W, Bartenstein P, Häussinger K, Kreyling WG, Knoch M, Canis M, Becker S. Topical drug delivery in chronic rhinosinusitis patients before and after sinus surgery using pulsating aerosols. PLoS One 2013; 8:e74991. [PMID: 24040372 PMCID: PMC3770586 DOI: 10.1371/journal.pone.0074991] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 08/08/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is a common chronic disease of the upper airways and has considerable impact on quality of life. Topical delivery of drugs to the paranasal sinuses is challenging, therefore the rate of surgery is high. This study investigates the delivery efficiency of a pulsating aerosol in comparison to a nasal pump spray to the sinuses and the nose in healthy volunteers and in CRS patients before and after sinus surgery. METHODS (99m)Tc-DTPA pulsating aerosols were applied in eleven CRSsNP patients without nasal polyps before and after sinus surgery. In addition, pulsating aerosols were studied in comparison to nasal pump sprays in eleven healthy volunteers. Total nasal and frontal, maxillary and sphenoidal sinus aerosol deposition and lung penetration were assessed by anterior and lateral planar gamma camera imaging. RESULTS In healthy volunteers nasal pump sprays resulted in 100% nasal, non-significant sinus and lung deposition, while pulsating aerosols resulted 61.3+/-8.6% nasal deposition and 38.7% exit the other nostril. 9.7+/-2.0 % of the nasal dose penetrated into maxillary and sphenoidal sinuses. In CRS patients, total nasal deposition was 56.7+/-13.3% and 46.7+/-12.7% before and after sinus surgery, respectively (p<0.01). Accordingly, maxillary and sphenoidal sinus deposition was 4.8+/-2.2% and 8.2+/-3.8% of the nasal dose (p<0.01). Neither in healthy volunteers nor in CRS patients there was significant dose in the frontal sinuses. CONCLUSION In contrast to nasal pump sprays, pulsating aerosols can deliver significant doses into posterior nasal spaces and paranasal sinuses, providing alternative therapy options before and after sinus surgery. Patients with chronic lung diseases based on clearance dysfunction may also benefit from pulsating aerosols, since these diseases also manifest in the upper airways.
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Affiliation(s)
- Winfried Möller
- Institute for Lung Biology and Disease (iLBD), Helmholtz Zentrum München, Neuherberg, Germany
| | | | - Gülnaz Celik
- Institute for Lung Biology and Disease (iLBD), Helmholtz Zentrum München, Neuherberg, Germany
| | - Wolfgang Münzing
- Department of Nuclear Medicine, LMU Medical Center Grosshadern, München, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, LMU Medical Center Grosshadern, München, Germany
| | - Karl Häussinger
- Department of Pulmonary Medicine, Asklepios Hospital, München-Gauting, Gauting, Germany
| | - Wolfgang G. Kreyling
- Institute for Lung Biology and Disease (iLBD), Helmholtz Zentrum München, Neuherberg, Germany
| | - Martin Knoch
- BU Pharma, PARI Pharma GmbH, Gräfelfing, Germany
| | - Martin Canis
- Department for Otolaryngology, University Göttingen Medical Center, Göttingen, Germany
| | - Sven Becker
- Department of Otolaryngology, Head and Neck Surgery, LMU Medical Center Grosshadern, München, Germany
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Nazri M, Bux SI, Tengku-Kamalden TF, Ng KH, Sun Z. Incidental detection of sinus mucosal abnormalities on CT and MRI imaging of the head. Quant Imaging Med Surg 2013; 3:82-8. [PMID: 23630655 DOI: 10.3978/j.issn.2223-4292.2013.03.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/27/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate the prevalence of incidental sinus abnormalities on CT and MRI imaging of the head, and identify if there is any correlation between patient symptomatology and image findings. MATERIALS AND METHODS One hundred and fifteen patients who underwent head CT or MRI for
non-sinus related indications were included in this study, with image findings being analysed based on the Lund-Mackay Grading System (LMS). These were compared with their symptomatology based on the SNAQ-11 questionnaire. Two reviewers who were blinded to the patients' SNAQ-11 scores analysed the images. Patients were also referred to an ENT surgeon for anterior rhinoscopy in an attempt to seek a correlation between symptomatology and/or imaging findings against clinical assessment. RESULTS The prevalence of incidental sinus abnormalities is between 14.8% and 37% for CT and 29.5% and 85.2% for MRI, depending upon the cutoff LMS used. There was no significant difference in the incidence rate between the different age groups or genders. Asymptomatic patients had a significantly lower incidence rate of sinus mucosal abnormalities (8.2-57.1%) when compared to the symptomatic patients (33.3-66.7%) (P<0.01). A significant correlation was found between the MRI sinus findings and patients' symptoms (r=0.59, P<0.001) with no correlation demonstrated in the CT group. The mean LM score for the patients with clinical sinusitis was 6.2, while the normal patients had a mean LM score of 2.2. CONCLUSIONS MRI is more sensitive than CT to detect sinus mucosal abnormalities. A significant correlation is noticed between MRI findings and patients' symptomatology.
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Affiliation(s)
- Mohammad Nazri
- University of Malaya Research and Imaging Centre (UMRIC), University of Malaya, 50603 Kuala Lumpur, Malaysia; ; Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, 50603, Malaysia
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33
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Cornelius RS, Martin J, Wippold FJ, Aiken AH, Angtuaco EJ, Berger KL, Brown DC, Davis PC, McConnell CT, Mechtler LL, Nussenbaum B, Roth CJ, Seidenwurm DJ. ACR Appropriateness Criteria Sinonasal Disease. J Am Coll Radiol 2013; 10:241-6. [DOI: 10.1016/j.jacr.2013.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
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Brüllmann DD, Schmidtmann I, Hornstein S, Schulze RK. Correlation of cone beam computed tomography (CBCT) findings in the maxillary sinus with dental diagnoses: a retrospective cross-sectional study. Clin Oral Investig 2011; 16:1023-9. [PMID: 21968552 DOI: 10.1007/s00784-011-0620-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 09/15/2011] [Indexed: 11/25/2022]
Abstract
This study was conducted to assess the coincidence of mucosal hyperplasia in the maxillary sinus and related clinical diagnoses of posterior maxillary teeth found in cone beam computed tomography (CBCT) scans. A total of 204 patients who underwent CBCT examinations between 2006 and 2008 were evaluated retrospectively. Clinical and CBCT findings were correlated using patient records. Absolute frequencies, odds ratios (OR), and 95% confidence intervals (95% CI) were calculated for statistical evaluations. There was a pronounced association between periodontitis and radiological signs of sinusitis. Basal mucosal wall thickening was more likely in patients with decayed and non-vital teeth compared to patients with sound teeth (OR = 5.2; 95% CI = 1.2-23.1). Basal mucosal wall thickening was also more likely than total mucosal thickening (OR = 10.4; 95% CI = 2.6-42.2). Patients with decayed and endodontically treated teeth were more likely to exhibit involvement of the basal wall (OR = 9.2; 95% CI = 3.3-25.2) than were patients with healthy teeth. CBCT examinations revealed a correlation between basal mucosal thickening in the maxillary sinus and decayed posterior maxillary teeth or periodontitis. Chronic symptoms involving the sinuses are one of the most common reasons for patients to consult physicians. One reason for chronic orofacial pain is the prevalence of undiagnosed sinus conditions.
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Affiliation(s)
- Dan Dominik Brüllmann
- Department of Oral Surgery, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
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McKinlay L, Vaidyanathan S, Williamson PA, Lipworth BJ. Nasal nitric oxide as a measure of osteomeatal complex patency in nasal polyps. Ann Allergy Asthma Immunol 2011; 107:179-80. [PMID: 21802027 DOI: 10.1016/j.anai.2011.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/27/2011] [Accepted: 05/02/2011] [Indexed: 11/25/2022]
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Meltzer EO, Hamilos DL. Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clin Proc 2011; 86:427-43. [PMID: 21490181 PMCID: PMC3084646 DOI: 10.4065/mcp.2010.0392] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Rhinosinusitis (RS) affects approximately 1 in 7 adults in the United States, and its effect on quality of life, productivity, and finances is substantial. During the past 10 years, several expert panels from authoritative bodies have published evidence-based guidelines for the diagnosis and management of RS and its subtypes, including acute viral RS, acute bacterial RS, chronic RS (CRS) without nasal polyposis, CRS with nasal polyposis, and allergic fungal RS. This review examines and compares the recommendations of the Rhinosinusitis Initiative, the Joint Task Force on Practice Parameters, the Clinical Practice Guideline: Adult Sinusitis, the European Position Paper on Rhinosinusitis and Nasal Polyps 2007, and the British Society for Allergy and Clinical Immunology. Points of consensus and divergent opinions expressed in these guidelines regarding classification, diagnosis, and management of adults with acute RS (ARS) and CRS and their various subtypes are highlighted for the practicing clinician. Key points of agreement regarding therapy in the guidelines for ARS include the efficacy of symptomatic treatment, such as intranasal corticosteroids, and the importance of reducing the unnecessary use of antibiotics in ARS; however, guidelines do not agree precisely regarding when antibiotics should be considered as a reasonable treatment strategy. Although the guidelines diverge markedly on the management of CRS, the diagnostic utility of nasal airway examination is acknowledged by all. Important and relevant data from MEDLINE-indexed articles published since the most recent guidelines were issued are also considered, and needs for future research are discussed.
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Affiliation(s)
- Eli O Meltzer
- Allergy and Asthma Medical Group and Research Center, 9610 Granite Ridge Dr, Ste B, San Diego, CA 92123, USA.
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Arens R, Sin S, Willen S, Bent J, Parikh SR, Freeman K, Wootton DM, McDonough JM, Shifteh K. Rhino-sinus involvement in children with obstructive sleep apnea syndrome. Pediatr Pulmonol 2010; 45:993-8. [PMID: 20648667 DOI: 10.1002/ppul.21284] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Obstructive sleep apnea syndrome (OSAS) is commonly associated with adenotonsillar hypertrophy. We hypothesized that respiratory perturbations extend to other regions of the upper respiratory tract in such children, particularly to rhino-sinus regions. STUDY DESIGN A prospective case control study using Magnetic Resonance Imaging (MRI) of the upper airway and surrounding tissues of OSAS and controls. Magnetic resonance imaging was used to evaluate radiographic changes within the: paranasal sinuses, middle ear and mastoid air cells, and the nasal passages. RESULTS We studied 54 OSAS (age 5.7 ± 3.0 years) and 54 controls (age 6.2 ± 2.0 years, P = NS). Children with OSAS had significantly more opacification of: maxillary sinuses (P < 0.05), sphenoid sinuses (P < 0.01), and mastoid air cells (P < 0.01). They also had significantly more: middle ear effusions, (P < 0.001), prominence of inferior nasal turbinate(s) (P < 0.05), and deviation of the nasal septum (P < 0.05). CONCLUSIONS Childhood OSAS is associated with a wide range of upper respiratory tract perturbations and is not limited to adenoid and tonsillar hypertrophy.
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Affiliation(s)
- Raanan Arens
- Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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Stelmach R, Junior SAD, Figueiredo CM, Uezumi K, Genu AM, Carvalho-Pinto RM, Cukier A. Chronic rhinosinusitis in allergic asthmatic patients: radiography versus low-dose computed tomography evaluation. J Asthma 2010; 47:599-603. [PMID: 20615165 DOI: 10.3109/02770903.2010.481339] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Chronic rhinosinusitis (CRS) is a risk factor for asthma exacerbations and is associated with greater clinical severity. Discrepancies may exist between CRS clinical diagnosis and data from paranasal sinus (PS) X-ray or computed tomography (CT) scans. The objective was to compare PS involvement using low-dose CT and plain X-ray in allergic asthmatic patients with rhinitis. METHODS Patients underwent PS radiography in the frontal and mentonian positions and low-dose CT consisting of six to eight coronal scans performed on the central region of the sphenoidal, ethmoidal, maxillary, and frontal sinuses. Possible results for each sinus were a normal aspect or the presence of mucosal thickening, opacification, and/or air-fluid level. RESULTS Eighty-five (93.4%) of 91 study patients had radiological changes on radiography or CT. In only six (6.6%) were both tests normal. The maxillary was the most involved sinus by both methods. Simultaneous PS abnormalities were observed in 40.5% on X-ray and 56.7% on CT. For the frontal, ethmoidal, and sphenoidal sinuses, the proportion of normal results differed significantly between X-ray and CT: 80.2% versus 89%, 76.9% versus 63.7% and 96.7% versus 70.3%, respectively (p <.05). Agreement was over 70% for the maxillary and frontal sinuses. CT also provided a better diagnosis of air-fluid level changes than X-ray. CONCLUSIONS Low-dose CT significantly showed larger number of normal PS results and diagnosed more severe PS lesions. As the determination of true sinus severity lesion impacts in asthma control, low-dose CT may replace PS plain X-ray and conventional CT to support better clinical decisions.
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Affiliation(s)
- Rafael Stelmach
- Pulmonary Division - InCor, University of São Paulo Medical School, São Paulo, Brazil.
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39
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Diallo O, Jissendi P, Napon C, Lougué-Sorgho LC, Bamouni A, Zoungrana R, Dao A, Méda N, Cissé R, Ouoba K, Drabo YJ. [Invasive rhinosinusitis complicating poorly controlled diabetes in a teenager]. J Neuroradiol 2009; 37:197-9. [PMID: 19959234 DOI: 10.1016/j.neurad.2009.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 10/01/2009] [Indexed: 11/16/2022]
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Thwin M, Weitzel EK, McMains KC, Athanasiadis T, Psaltis A, Field J, Wormald PJ. Validating the Use of Report-Derived Lund-MacKay Scores. Am J Rhinol Allergy 2009; 23:33-5. [DOI: 10.2500/ajra.2009.23.3255] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The Lund-MacKay score (LMS) is the standard for communicating radiological extent of chronic rhinosinusitis in research. However, retrospective analyses are often hindered by a substantial lack of radiological data. Calculating LMS from radiologists’ reports may overcome this but has not been formally validated. Methods Twenty South Australian and 20 Texan patients with varying degrees of sinus disease were randomly chosen to undergo analysis. CT-derived LMSs were calculated directly by two expert rhinologists at each institution and compared with scores derived solely from accompanying radiology reports by two blinded reviewers. Results The total LMS obtained via the expert rhinologists correlated very highly with that obtained from radiology reports (Spearman rank correlation, 0.75-0.88; p < 0.001). However, when individual sinuses were specifically analyzed, the correlation was highly variable. Conclusion The results show that in both South Australian and Texan tertiary rhinology centers, radiologists’ reports can be reliably used to calculate the total LMS.
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Affiliation(s)
- May Thwin
- University of Adelaide, Adelaide, South Australia
| | - Erik Kent Weitzel
- University of Adelaide and Flinders University, Adelaide, South Australia
| | | | | | - Alkis Psaltis
- University of Adelaide and Flinders University, Adelaide, South Australia
| | - John Field
- University of Adelaide, Adelaide, South Australia
| | - Peter-John Wormald
- University of Adelaide and Flinders University, Adelaide, South Australia
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Huang BY, Lloyd KM, DelGaudio JM, Jablonowski E, Hudgins PA. Failed Endoscopic Sinus Surgery: Spectrum of CT Findings in the Frontal Recess. Radiographics 2009; 29:177-95. [DOI: 10.1148/rg.291085118] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Watelet JBH, Eloy PH, van Cauwenberge PB. Drug management in chronic rhinosinusitis: identification of the needs. Ther Clin Risk Manag 2007; 3:47-57. [PMID: 18360615 PMCID: PMC1936288 DOI: 10.2147/tcrm.2007.3.1.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Chronic rhinosinusitis (CRS) is a group of multifactorial diseases characterized by inflammation of the mucosa of the nose and paranasal sinuses with a history of at least 12 weeks of persistent symptoms despite maximal medical therapy. The precise role played by infection and immunoglobin E (IgE)-mediated hypersensitivity remains unclear. Diagnosis of CRS is based upon medical history, nasal endoscopy and computed tomography scan of the sinuses. The CRS with polyps visible in the middle meatus must be distinguished from the CRS without polyps. Based on the current knowledge about the pathogenesis of CRS, it is admitted that an optimal medical treatment must consider all favorizing factors and control efficaciously the inflammation process. In case of failure of medical treatment, endoscopic sinus surgery should be proposed. However, some well-validated data and scientific evidences are missing, even for the most frequently used medications. After a review of the actual definitions and classifications, a short description of the current knowledge about pathogenesis of CRS is provided in order to justify the actual therapeutic rationales and identify the needs for an effective treatment of CRS.
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Abstract
This article discusses the benefits and drawbacks of MR imaging and computed tomography as they relate to sinus disease.
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Affiliation(s)
- Barton F Branstetter
- University of Pittsburgh, 200 Lothrop Street, PUH D132, Pittsburgh, PA 15213, USA.
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Eggesbø HB. Radiological imaging of inflammatory lesions in the nasal cavity and paranasal sinuses. Eur Radiol 2006; 16:872-88. [PMID: 16391905 DOI: 10.1007/s00330-005-0068-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 10/09/2005] [Accepted: 10/14/2005] [Indexed: 10/25/2022]
Abstract
Paranasal sinus development and pneumatisation variants are described, and rhinosinusitis and different patterns of inflammatory sinonasal diseases are reviewed. Other inflammatory sinonasal diseases, e.g., fungal sinusitis, mucocele, pyocele and sinonasal manifestations in systemic diseases, are briefly described. Computed tomography (CT) is the primary modality in diagnosing and mapping suspected inflammatory sinonasal disease. Magnetic resonance (MR) imaging is complementary to CT if fungal sinusitis, pyocele or malignancy are suspected.
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Affiliation(s)
- H B Eggesbø
- Department of Radiology, Aker University Hospital, Oslo, Norway.
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Costa Carvalho BT, Nagao AT, Arslanian C, Carneiro Sampaio MMS, Naspitz CK, Sorensen RU, Leiva L, Solé D. Immunological evaluation of allergic respiratory children with recurrent sinusitis. Pediatr Allergy Immunol 2005; 16:534-8. [PMID: 16176402 DOI: 10.1111/j.1399-3038.2005.00303.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to evaluate humoral immunity of allergic respiratory children with chronic/recurrent sinusitis. Twenty-seven allergic respiratory (persistent mild/moderate asthma and persistent allergic rhinitis) children (7-15-year old) with chronic or recurrent sinusitis were evaluated. Patients had symptoms and abnormal computer tomography scan even after two adequate treatments (long-lasting antibiotics, decongestants, and short-term oral corticosteroids). clinical examination, sweat test, total blood cell count, measurement of serum levels of: total and specific IgE, immunoglobulins (G, M, A), IgG subclasses, antibodies to Haemophilus influenza type b (IgG anti-Ps Hib) and pneumococcal serotypes (IgG anti-Ps 1, 3, 5, 6B, 9V, and 14) before and after active immunization (Act-Hib and Pneumo23, Aventis Pasteur SA, Lyon, France), Rubella neutralizing antibody titers and human immunodeficiency virus antibodies. Specific IgE to inhalant allergens higher than class III were observed in 24/27 patients. One patient had IgA plus IgG2 deficiency and other an IgG3 deficiency. Eight and 12 of 27 patients had IgG2 and IgG3 serum levels below 2.5th percentile, respectively. Immunological responses to protein and polysaccharide antigens were normal in all patients. Although our patients have been appropriately treated of their allergic diseases, they persisted with chronic/recurrent sinusitis and 60% of them had a documented osteomeatal complex blockade. In spite of the diagnosis of IgA plus IgG2 deficiency and an isolated IgG3 deficiency, in all patients an adequate response to Ps antigens was observed. Primary and/or secondary humoral immunodeficiency seems not to be the main cause of chronic/recurrent sinusitis in patients with respiratory allergic disease.
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Affiliation(s)
- Beatriz T Costa Carvalho
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics. Federal University of São Paulo-Escola Paulista de Medicina, São Paulo, Brazil.
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