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Albazee E, Alsubaie HM, Alkanderi R, Althaidy M, Alsafar H, Alsaleh S, Abdulrahman S. Platelet-rich plasma following endoscopic sinus surgery in patients with chronic sinusitis: A systematic review and meta-analysis of randomised controlled trials. Clin Otolaryngol 2024. [PMID: 38816910 DOI: 10.1111/coa.14186] [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: 10/07/2023] [Revised: 04/08/2024] [Accepted: 05/12/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION To comprehensively evaluate the reported clinical effectiveness of platelet-rich plasma (PRP) in patients with chronic sinusitis undergoing endoscopic sinus surgery (ESS). METHODS We performed a systematic review and meta-analysis of randomised controlled trials (RCTs). Five digital online databases (PubMed, Scopus, Web of Science, Google Scholar and Cochrane CENTRAL) were searched from inception up to 1st May 2023. Our specific outcomes involved postoperative nasal endoscopy scores measured via Lund-Kennedy score or Meltzer score, olfactory sensation scores and pre-operative anosmia duration. All data were pooled as standardised mean difference (SMD) with a 95% confidence interval (CI), using the RevMan software. RESULTS Six RCTs were included in this systematic review and meta-analysis, with a total of 169 patients. The risk of bias in the included RCTs was low in three RCTs, some concerns in one RCT and high risk in two RCTs. The overall analysis of the postoperative nasal endoscopy scores showed that the PRP group had lower scores compared to the control group (n = 3 RCTs, SMD = -1.19; 95% CI [-1.94, -0.44], p = .002). There was no significant difference between the PRP and control groups regarding anosmia duration (n = 2 RCTs, SMD = 0.21; 95% CI [-0.17, 0.59], p = 0.28) or olfactory sensation scores, despite the PRP group having higher scores (n = 2 RCTs, SMD = 0.53; 95% CI [-0.32, 1.39], p = 0.22). CONCLUSION This study highlights the potential advantages of using PRP as an additional treatment for individuals with chronic sinusitis undergoing ESS. The improvements associated with PRP include facilitating wound healing, reducing inflammation and enhancing surgical outcomes. To optimise the use of PRP in clinical settings, future research should focus on conducting larger trials with standardised protocols.
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Affiliation(s)
- Ebraheem Albazee
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Hemail M Alsubaie
- Otorhinolaryngology-Head and Neck Surgery and Communication Sciences Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Roaa Alkanderi
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Mubarak Althaidy
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Husain Alsafar
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Saad Alsaleh
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Shawkat Abdulrahman
- Department of Otolaryngology-Head & Neck Surgery, Tallaght University Hospital, Dublin, Ireland
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Kokavec A, Zahabi S, Rocha T, Rotenberg BW, Sowerby LJ. Assessing the safety and tolerability of rhinologic surgery under local anesthetic: an 8-year retrospective analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08655-4. [PMID: 38652299 DOI: 10.1007/s00405-024-08655-4] [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: 02/22/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Office-based rhinologic procedures (OBRP) have become widely available in North America due to technological advances and appropriate patient selection. Nevertheless, the literature exploring the safety of these procedures remains limited. The objective of this study was to further evaluate the safety, tolerability and efficacy of these procedures with a more robust sample size to allow for capture of rare events. METHODS A retrospective chart review of all patients who underwent OBRP from May 2015 to March 2023. Information regarding patient demographics, the indication for surgery, wait time, tolerability, intra- and postoperative complications, need for revisions, and type of revision (if applicable) was recorded. RESULTS 1208 patients underwent OBRP during the study period. No patients were excluded. These included turbinoplasties (35%), endoscopic sinus surgeries (ESS) (26%), septoplasties (15%), nasal fracture reductions (7%), and a variety of other procedures. For ESS procedures, the anterior ethmoids and the maxillary sinuses were the most common sinuses treated. 1.1% of procedures were aborted prior to completion. The post-operative complication rate was 3.2%, with 2 major complications (significant bleeding and sepsis) encountered. The mean follow-up overall was 11 months and for ESS it was 15.8 months. CONCLUSION Office-based rhinologic procedures are well tolerated and safe for the appropriate patient and associated with shorter wait-times as well as avoidance of general anesthesia. The complication rates are similar to or lower than previously reported rates for rhinologic surgeries done in the operating room. The low rates of revision surgery also demonstrate the efficacy of these procedures.
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Affiliation(s)
- Andrew Kokavec
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
| | - Sarah Zahabi
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Taciano Rocha
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
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Giombi F, Canali L, Zuppardo J, Pace GM, Pirola F, Ferreli F, Mercante G, Spriano G, Cerasuolo M, Malvezzi L. Psychiatric Burden in Chronic Sinonasal Diseases: A Single-Center Cross-Sectional Observational Study. Cureus 2024; 16:e57471. [PMID: 38699136 PMCID: PMC11065418 DOI: 10.7759/cureus.57471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic rhinosinusitis (CRS) and nasal septum deviation (SD) are two widely diffused clinical conditions in otorhinolaryngology clinical practice. Albeit nasal symptoms are the most commonly referred by patients affected by both conditions, recent evidence has explored the impairment of nasal function beyond its local implication. Indeed, the prevalence of psychiatric disorders, specifically anxiety and depression, was found higher in patients suffering from SD or CRS than in the general population. The aim of this study was to evaluate the psychiatric burden of these conditions in terms of anxiety and depression and to assess its relationship with clinical phenotype and age. METHODS Monocentric cross-sectional observational study. Consecutive patients affected by CRS with or without nasal polyps or by SD were considered eligible. At referral, each patient underwent nasal endoscopy for clinical diagnosis and had to fill in the Hospital Anxiety and Depression Scale (HADS), the Sinonasal Outcome Test-22 (SNOT-22), and the Visual Analogue Scale (VAS) for global nasal symptoms. The population was grouped according to disease and age. RESULTS One hundred fifty patients were enrolled. We observed a statistically significant difference in mean HADS score between patients affected by CRS with nasal polyps and those suffering from CRS without nasal polyps or SD both in the overall population and by age groups. Nevertheless, there was no significant difference in the HADS score between younger patients affected by CRS and SD. The mean HADS score was significantly higher in younger patients affected by SD compared to older. Furthermore, we observed an inverse correlation between age and HADS score in each disease group, statistically significant for SD. On the contrary, in the overall population, HADS score and patient-related outcomes (PROs) were directly correlated. Conclusions: In the era of personalized medicine, our work remarks on the critical impact of anxiety and depression on the quality of life (QoL) of patients affected by sinonasal conditions. According to our results, age affects patient-reported outcomes (PROs) and should, therefore, be enhanced in the therapeutic decision process.
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Affiliation(s)
- Francesco Giombi
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Luca Canali
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Jessica Zuppardo
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Francesca Pirola
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Michele Cerasuolo
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
- Otorhinolaryngology Head and Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Milan, ITA
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
- Otorhinolaryngology Head and Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Milan, ITA
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Ferraiolo PN, Dortas SD, Cruz FCD, Ramos PCDS, Elabras Filho J, Marques MDPC, Valete-Rosalino CM. Development of a mobile app for the evaluation of patients with chronic rhinosinusitis. Braz J Otorhinolaryngol 2024; 90:101375. [PMID: 38237485 PMCID: PMC10828589 DOI: 10.1016/j.bjorl.2023.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE To develop a mobile application with a standardized routine, to be used by general otolaryngologists for evaluating patients with chronic rhinosinusitis. METHODS A systematic review was made to identify outcomes, recommendations and what tests that would be used in the routine evaluation of patients with chronic rhinosinusitis; establish an expert consensus on items to be included in this routine evaluation of patients with chronic rhinosinusitis using the Delphi method; development of an application for use on a mobile device, with the routine evaluation of patients with chronic rhinosinusitis. RESULTS Based on the systematic review, the outcomes used in studies about chronic rhinosinusitis were identified, as well as guidelines recommendations, which showed discrepancies between them. These recommendations and outcomes were presented to specialists in chronic rhinosinusitis, until a consensus was reached. As a result of the Delphi method, the flowchart of the routine evaluation of patients with chronic rhinosinusitis was defined, and then was used for the development of the mobile application. CONCLUSION The creation of the mobile application for evaluating patients with chronic rhinosinusitis followed an adequate methodology of elaboration made by specialists in the field of chronic rhinosinusitis, standardizing the investigation of these patients. LEVEL OF EVIDENCE Level 5.
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Affiliation(s)
- Priscila Novaes Ferraiolo
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil.
| | - Sergio Duarte Dortas
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Imunologia, Rio de Janeiro, RJ, Brazil
| | - Fabiana Chagas da Cruz
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Priscilla Campos de Souza Ramos
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Imunologia, Rio de Janeiro, RJ, Brazil
| | - José Elabras Filho
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Imunologia, Rio de Janeiro, RJ, Brazil
| | - Marise da Penha Costa Marques
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Cláudia Maria Valete-Rosalino
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Otorrinolaringologia e Oftalmologia, Rio de Janeiro, RJ, Brazil; Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brazil
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de Gabory L, Vallet S, Naelten G, Raherison-Semjen C. Seawater nasal wash to reduce symptom duration and viral load in COVID-19 and upper respiratory tract infections: a randomized controlled multicenter trial. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08518-y. [PMID: 38376591 DOI: 10.1007/s00405-024-08518-y] [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: 11/30/2023] [Accepted: 01/29/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE The objective was to assess the efficacy of seawater nasal wash on symptom duration, intranasal viral load, household transmission in COVID-19 and URTIs. METHODS This prospective, randomized, controlled, multicentric, parallel study included 355 mild/moderate COVID-19 and URTI adults with rhinologic symptoms ≤ 48h. Active group performed 4-daily nasal washes with undiluted isotonic seawater versus control group (without nasal wash). Symptoms were self-assessed daily using the WURSS-21 questionnaire for 3 weeks. Viral load was measured by RT-PCR on nasopharyngeal swabs collected on Day 0, Day 5, Day 14 and Day 21. Digital droplet PCR was additionally performed for SARS-CoV-2. RESULTS Overall COVID-19 subjects recovered earlier the ability to accomplish daily activities in the active group (- 1.6 day, p = 0.0487) with earlier improvement of taste (- 2 days, p = 0.0404). COVID-19 subjects with severe nasal symptoms at D0 showed the earliest resolution of anosmia (- 5.2 days, p = 0.0281), post-nasal drip (- 4.1 days, p = 0.0102), face pain/heaviness (- 4.5 days, p = 0.0078), headache (- 3.1 days, p = 0.0195), sore throat (- 3.3 days, p = 0.0319), dyspnea (- 3.1 days, p = 0.0195), chest congestion (- 2.8 days, p = 0.0386) and loss of appetite (- 4.5 days, p = 0.0186) with nasal wash. In URTIs subjects, an earlier resolution of rhinorrhea (- 3.5 days, p = 0.0370), post-nasal drip (- 3.7 days, p = 0.0378), and overall sickness (- 4.3 days, p = 0.0248) was reported with nasal wash. Evolution towards more severe COVID-19 was lower in active vs control, with earlier viral load reduction in youngest subjects (≥ 1.5log10 copies/10000 cells at Day 5: 88.9% vs 62.5%, p = 0.0456). In the active group, a lower percentage of SARS-CoV-2 positive household contacts (0-10.7%) was reported vs controls (3.2-16.1%) among subjects with Delta variant (p = 0.0413). CONCLUSION This trial showed the efficacy and safety of seawater nasal wash in COVID-19 and URTIs. TRIAL REGISTRATION Trial registry ClinicalTrials.gov: NCT04916639. Registration date: 04.06.2021.
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Affiliation(s)
- Ludovic de Gabory
- Department of Otolaryngology (ENT) and Head & Neck Surgery, Bordeaux University Hospital, Bordeaux, France.
- University of Bordeaux, 33000, Bordeaux, France.
| | - Sophie Vallet
- Virology Unit, Brest University Hospital Centre, Brest, France
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Alammar Y, Rousseau S, Desrosiers M, Tewfik MA. The Effect of Corticosteroids on Sinus Microbiota in Chronic Rhinosinusitis Patients with Nasal Polyposis. Am J Rhinol Allergy 2023; 37:638-645. [PMID: 37475202 PMCID: PMC10548776 DOI: 10.1177/19458924231183848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a multifactorial disease with no known single cause, but it is thought that bacteria play a role in the disease process. OBJECTIVE This pilot study aims to assess the longitudinal effect of corticosteroid therapy on sinus microbiota in chronic rhinosinusitis patients with nasal polyposis (CRSwNP). METHODS A longitudinal prospective case-control study was done on patients with CRSwNP and healthy controls. Patients with CRSwNP were randomly allocated to a corticosteroids and antibiotics treatment group (CRSwNP-SA) or a corticosteroid-only treatment group (CRSwNP-S). Data were collected at three-time points (before treatment, 1, and 3 months after treatment). Specimens were cultured and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) was used as a bacterial detection method. RESULTS Data from 29 patients with CRSwNP (16 CRSwNP-SA and 13 CRSwNP-S) was compared to 15 healthy subjects. Patients reported significant symptom improvement initially (1 month), but not in the long-term (3 months). This result was found in both treatment groups, whether or not antibiotics were used. After 3 months from treatment, the prevalence of Corynebacterium genera tended to increase in the CRSwNP-SA, while Staphylococcus and Gram-negative genera (Pseudomonas) tended to increase in the CRSwNP-S. Smoking, aspirin sensitivity, and previous endoscopic sinus surgery were found to be co-factors significantly associated with the response to systemic corticosteroid therapy. CONCLUSION In this pilot study, both treatment options were effective to improve symptoms in the short-term but not in the long-term, and were not linked to any clear sinus microbiota response. As a result, this study supports the avoidance of systemic antibiotics without evidence of active infection.
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Affiliation(s)
- Yousif Alammar
- Department of Otolaryngology – Head & Neck Surgery, McGill University, Montreal, Canada
- Department of Otolaryngology – Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Simon Rousseau
- The Meakins-Christie Laboratories, Research Institute at McGill University Health Centre, Montreal, Canada
| | - Martin Desrosiers
- Department of Otolaryngology – Head & Neck Surgery, University of Montreal, Montreal, Canada
| | - Marc A. Tewfik
- Department of Otolaryngology – Head & Neck Surgery, McGill University, Montreal, Canada
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Ho B, Kukan S, McIsaac W. Do family medicine residents optimally prescribe antibiotics for common infectious conditions seen in a primary care setting? JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2023; 8:192-200. [PMID: 38058504 PMCID: PMC10697098 DOI: 10.3138/jammi-2022-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/24/2023] [Indexed: 12/08/2023]
Abstract
Background Antimicrobial resistance is a worldwide phenomenon that leads to a significant number of unnecessary deaths and costly hospital admissions. More than 90% of antibiotic use happens in the community and of this, family physicians account for two-thirds of these prescriptions. Our study aims to determine whether family medicine residents are optimally trained in antibiotic prescribing for common infectious conditions seen in a primary care setting. Methods This study is a secondary analysis of a prior study of antimicrobial stewardship in two urban primary care clinics in central Toronto, Ontario. A total of 1099 adult patient visits were included that involved family medicine resident trainees, seen between 2015 and 2016. The main outcome measures were resident antibiotic prescription rates for each condition and expert-recommended prescribing practices, the rate prescriptions were issued as delayed prescriptions, and the use of first-line recommended narrow-spectrum antibiotics. Results Compared to expert-recommended prescribing rates, family medicine residents overprescribed for uncomplicated upper respiratory tract infections (URI) (5.0% [95% CI 2.2% to 9.7%] versus 0% expert recommended) and sinusitis (44.2% [95% CI 32.8% to 55.9%] versus 11%-18% expert range), and under prescribed for pneumonia (53.5% [95% CI 37.7% to 68.8%] versus 100% expert range]). Prescribing rates were within expert recommended ranges for pharyngitis (28.6% [95% CI 16.6% to 43.3%]), bronchitis (3.6% [95% CI 0% to 18.4%]), and cystitis (79.4% [95% CI 70.6% to 86.6%]). Conclusions The antibiotic prescribing practices of family medicine residents during their training programs indicated overprescribing of antibiotics for some common infection presentations. Further study of antibiotic prescribing in primary care training programs across Canada is recommended to determine if future family physicians are learning appropriate antibiotic prescribing practices.
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Affiliation(s)
- Bernard Ho
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Sahana Kukan
- Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Warren McIsaac
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto, Ontario, Canada
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Cui J, Lin W, May BH, Luo Q, Worsnop C, Zhang AL, Guo X, Lu C, Li Y, Xue CC. Orally administered Chinese herbal therapy to assist post-surgical recovery for chronic rhinosinusitis-A systematic review and meta-analysis. PLoS One 2023; 18:e0292138. [PMID: 37797052 PMCID: PMC10553817 DOI: 10.1371/journal.pone.0292138] [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: 05/15/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023] Open
Abstract
This systematic review and meta-analysis aims to: assess the effectiveness and safety of orally administered Chinese herbal medicines (CHMs) as adjuncts to the post-surgical management of chronic rhinosinusitis (CRS); inform clinicians of the current evidence; identify the best available evidence; and suggest directions for further research. Randomised controlled trials (RCTs) were identified from searches of nine databases plus clinical trial registries. Participants were adults and/or children diagnosed with sinusitis or rhinosinusitis, with or without nasal polyps, who had received surgery. Interventions were CHMs used orally following surgery for CRS as additions to conventional post-surgical management. Controls received conventional post-surgical management without CHMs. Studies reported results for Sino-Nasal Outcome Test (SNOT), visual analogue scales (VAS), Lund-Mackay computed tomography score (LM), Lund-Kennedy endoscopic score (LK), mucociliary transport time (MTT), mucociliary transport rate (MTR), mucociliary clearance (MC) or quality of life (QoL). Twenty-one RCTs were included. All used oral CHMs following functional endoscopic sinus surgery (FESS). The pooled results showed no significant difference between groups for SNOT-20 at the end of treatment (EoT) but there was a significant difference at follow up (FU) in favour of additional CHMs. The VAS for total nasal symptoms (VAS-TNS) showed greater improvements in the CHM groups at EoT and FU. Only FU data were reported for LM which showed greater improvement in the CHM groups. LK showed greater improvements at EoT and FU. The measures of mucociliary transport (MTT, MTR, and MC) each showed significantly greater improvement at EoT in the group that received additional CHMs. No study reported QoL. Adverse events were not serious, but reporting was incomplete. The meta-analyses suggested the addition of oral CHMs to conventional management following FESS may improve recovery. However, most studies were not blinded, and substantial heterogeneity was evident in some meta-analyses. Blinded studies are required to further investigate the roles of oral CHMs in post-surgical recovery. Systematic review registration number: The protocol was registered in PROSPERO (CRD42019119586).
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Affiliation(s)
- Jing Cui
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Wenmin Lin
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Brian H. May
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Qiulan Luo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Christopher Worsnop
- Department of Respiratory Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Anthony Lin Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Xinfeng Guo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chuanjian Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yunying Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Charlie C. Xue
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
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Shaikh N, Hoberman A, Shope TR, Jeong JH, Kurs-Lasky M, Martin JM, Bhatnagar S, Muniz GB, Block SL, Andrasko M, Lee MC, Rajakumar K, Wald ER. Identifying Children Likely to Benefit From Antibiotics for Acute Sinusitis: A Randomized Clinical Trial. JAMA 2023; 330:349-358. [PMID: 37490085 PMCID: PMC10370259 DOI: 10.1001/jama.2023.10854] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/01/2023] [Indexed: 07/26/2023]
Abstract
Importance The large overlap between symptoms of acute sinusitis and viral upper respiratory tract infection suggests that certain subgroups of children being diagnosed with acute sinusitis, and subsequently treated with antibiotics, derive little benefit from antibiotic use. Objective To assess if antibiotic therapy could be appropriately withheld in prespecified subgroups. Design, Setting, and Participants Randomized clinical trial including 515 children aged 2 to 11 years diagnosed with acute sinusitis based on clinical criteria. The trial was conducted between February 2016 and April 2022 at primary care offices affiliated with 6 US institutions and was designed to evaluate whether symptom burden differed in subgroups defined by nasopharyngeal Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis on bacterial culture and by the presence of colored nasal discharge. Interventions Oral amoxicillin (90 mg/kg/d) and clavulanate (6.4 mg/kg/d) (n = 254) or placebo (n = 256) for 10 days. Main Outcomes and Measures The primary outcome was symptom burden based on daily symptom scores on a validated scale (range, 0-40) during the 10 days after diagnosis. Secondary outcomes included treatment failure, adverse events including clinically significant diarrhea, and resource use by families. Results Most of the 510 included children were aged 2 to 5 years (64%), male (54%), White (52%), and not Hispanic (89%). The mean symptom scores were significantly lower in children in the amoxicillin and clavulanate group (9.04 [95% CI, 8.71 to 9.37]) compared with those in the placebo group (10.60 [95% CI, 10.27 to 10.93]) (between-group difference, -1.69 [95% CI, -2.07 to -1.31]). The length of time to symptom resolution was significantly lower for children in the antibiotic group (7.0 days) than in the placebo group (9.0 days) (P = .003). Children without nasopharyngeal pathogens detected did not benefit from antibiotic treatment as much as those with pathogens detected; the between-group difference in mean symptom scores was -0.88 (95% CI, -1.63 to -0.12) in those without pathogens detected compared with -1.95 (95% CI, -2.40 to -1.51) in those with pathogens detected. Efficacy did not differ significantly according to whether colored nasal discharge was present (the between-group difference was -1.62 [95% CI, -2.09 to -1.16] for colored nasal discharge vs -1.70 [95% CI, -2.38 to -1.03] for clear nasal discharge; P = .52 for the interaction between treatment group and the presence of colored nasal discharge). Conclusions In children with acute sinusitis, antibiotic treatment had minimal benefit for those without nasopharyngeal bacterial pathogens on presentation, and its effects did not depend on the color of nasal discharge. Testing for specific bacteria on presentation may represent a strategy to reduce antibiotic use in this condition. Trial Registration ClinicalTrials.gov Identifier: NCT02554383.
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Affiliation(s)
- Nader Shaikh
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alejandro Hoberman
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy R. Shope
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jong-Hyeon Jeong
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Marcia Kurs-Lasky
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Judith M. Martin
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sonika Bhatnagar
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gysella B. Muniz
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Melissa Andrasko
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew C. Lee
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kumaravel Rajakumar
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ellen R. Wald
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison
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Ghazizadeh M, Mehrparvar G, Ghazizadeh M. An algorithmic approach to sinonasal evaluation preceding bone marrow transplantation. OTOLARYNGOLOGIA POLSKA 2023; 77:7-13. [PMID: 37772378 DOI: 10.5604/01.3001.0053.4752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
<b>Introduction:</b> The authors conducted this study to review the available resources and prepare an algorithmic approach to pre-transplantation sinonasal evaluation.</br></br> <b>Materials and methods:</b> The sources of data were PubMed, Cochrane databases, and Google Scholar. We searched the available database for English-language studies using the keywords rhinosinusitis, transplantation, post -transplant sinusitis. Studies of all designs were included.</br></br> <b>Results:</b> Thirty-five relevant studies were retrieved from a total of 182 articles. The review of references guided us to 5more publications.</br></br> <b>Discussion:</b> We have proposed an algorithmic approach to sinonasal evaluation before transplantation which can provide a brief but comprehensive assessment of the patients. The evaluation begins with a thorough history and physical examination, including nasal endoscopy with careful attention to objective evidence of inflammation. CT scan should not be considered in all of the cases.</br></br> <b>Conclusion:</b> We have suggested an algorithm to provide a comprehensive and cost-effective way for the evaluation of sinonasal diseases before planned immunosuppression in order to assist in reducing post-transplantation morbidity and mortality.
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Affiliation(s)
- Matin Ghazizadeh
- Department of Otorhinolaryngology Head and Neck Surgery, Taleghani Hospital, Shahid Beheshti Univsity of Medical Sciences, Tehran, Iran
| | - Golfam Mehrparvar
- Department of Otorhinolaryngology Head and Neck Surgery, Imam Hossein Hospital, Shahid Beheshti Univsity of Medical Sciences, Tehran, Iran
| | - Maryam Ghazizadeh
- Department of Hematology- Oncology, Faculty of Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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11
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Hernandez AK, Hummel T. Intranasal trigeminal function in chronic rhinosinusitis: a review. Expert Rev Clin Immunol 2023; 19:921-938. [PMID: 37379521 DOI: 10.1080/1744666x.2023.2231149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) affects 5-12% of the general population with significant effects on quality of life. Chronic inflammation also seems to affect intranasal trigeminal sensitivity. AREAS COVERED A systematic literature search was done in Scopus, Web of Science, and PubMed in February 2023. The review addressed intranasal trigeminal function in patients with CRS and summarized current knowledge on trigeminal function as it relates to the symptoms, assessment, and treatment of CRS. EXPERT OPINION Olfaction and trigeminal function are synergistic and this interaction may contribute to trigeminal dysfunction in CRS. Aside from anatomic blockage through polypoid mucosal changes, trigeminal dysfunction may affect the perception of nasal obstruction in CRS. Upregulated immune defense mechanisms leading to damage of nerve endings, changes in nerve growth factor release or other mechanisms may be responsible for trigeminal dysfunction in CRS. Since the pathophysiology of trigeminal dysfunction in CRS is poorly understood, current treatment recommendations are directed toward the therapy of CRS as an underlying cause, although the effect of surgery and corticosteroids on trigeminal function remains unclear. A standardized and validated trigeminal test that is accessible and easy to use in clinical settings would be beneficial for future studies.
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Affiliation(s)
- Anna Kristina Hernandez
- Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Otolaryngology - Head and Neck Surgery, Philippine General Hospital, University of the Philippines, Manila, Philippines
- Department of Otolaryngology - Head and Neck Surgery, Asian Hospital and Medical Center, Muntinlupa, Philippines
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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12
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Ofei-Palm CNK, Gbadago D, Tetteh R, Koduah A, Ankrah D, Buabeng KO. Advanced pharmacy practice of a doctor of pharmacy student at an allied surgical ward in a hospital in Africa. Heliyon 2023; 9:e17064. [PMID: 37342576 PMCID: PMC10277583 DOI: 10.1016/j.heliyon.2023.e17064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction The pharmacy profession is undergoing transformational change in Ghana. The role of pharmacists has become more patient-focused with increased accountability and responsibility. Aim This study is aimed at reporting the experiential learning on the clinical interventions made and documented at the Allied Surgical Wards of Korle-Bu Teaching Hospital (KBTH).This involves a review of patient's medical records during the Advanced Pharmacy Practice Experience (APPE) learning. One case each from Eye, Ear, Nose, Throat, (ENT) and Dental units' subspecialty were reviewed from October 7, 2019 to November 15, 2019 b y a Pharm D student. Conclusion The student was able to make prompt clinical interventions that contributed to patient care in clinical wards assigned during her clinical clerkship.
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Affiliation(s)
| | - Dorcas Gbadago
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Raymond Tetteh
- Department of Pharmacy Practice, Central University School of Pharmacy, Miotso, Accra, Ghana
| | - Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy University of Ghana, Legon, Accra, Ghana
| | - Daniel Ankrah
- Pharmacy Department, Korle Bu Teaching Hospital, Accra, Ghana
| | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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13
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Hamour AF, Lee JJ, Wasilewski E, Monteiro E, Lee JM, Vescan A, Kotra LP. Murine model for chronic rhinosinusitis: an interventional study. J Otolaryngol Head Neck Surg 2023; 52:32. [PMID: 37098626 PMCID: PMC10131485 DOI: 10.1186/s40463-023-00637-6] [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: 12/01/2022] [Accepted: 03/30/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a complex inflammatory disease of the sinonasal tract. To understand this disease entity and develop targeted treatments, a reproducible animal model is paramount. AIMS/OBJECTIVES To optimize a murine model of eosinophilic CRS by establishing benchmark histological markers and validate its fidelity in evaluating intranasal treatments. MATERIAL AND METHODS Forty-five Balb/c mice were included in the 7-week protocol. Experimental animals (n = 20) were induced a CRS disease state upon receiving intraperitoneal sensitization with ovalbumin (OVA), followed by intranasal OVA with Aspergillus oryzae protease. Analysis of complete blood count with differential, peripheral blood smear, and histological markers from the nasal cavity mucosa were performed. CRS mice were additionally treated with intranasal saline (n = 5) or mometasone (n = 10) and compared with control groups of untreated CRS (n = 5) and healthy (n = 5) mice after week 7. RESULTS Histological analysis of experimental animal nasal mucosa revealed significantly higher levels of eosinophilic tissue infiltration/degranulation, hyaline droplets, Charcot-Leyden crystals, and respiratory epithelial thickness compared to healthy controls. Treatment with mometasone significantly reversed the histopathological changes observed in CRS mice. CONCLUSION AND SIGNIFICANCE This murine model induced substantial local eosinophilic inflammation within sinonasal mucosa, that was reversible with mometasone. This model may be used to evaluate the efficacy of therapeutics designed to target CRS.
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Affiliation(s)
- Amr F Hamour
- Department of Otolaryngology - Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John Jw Lee
- Department of Otolaryngology - Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Ewa Wasilewski
- Centre for Cannabinoid Therapeutics and Centre for Molecular Design and Preformulations, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology - Head and Neck Surgery, Sinai Health System, Toronto, ON, Canada
| | - John M Lee
- Department of Otolaryngology - Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Allan Vescan
- Department of Otolaryngology - Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology - Head and Neck Surgery, Sinai Health System, Toronto, ON, Canada
| | - Lakshmi P Kotra
- Centre for Cannabinoid Therapeutics and Centre for Molecular Design and Preformulations, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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14
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Thamboo AV, Lee M, Bhutani M, Chan C, Chan Y, Chapman KR, Chin CJ, Connors L, Dorscheid D, Ellis AK, Gall RM, Godbout K, Janjua A, Javer A, Kilty S, Kim H, Kirkpatrick G, Lee JM, Leigh R, Lemiere C, Monteiro E, Neighbour H, Keith PK, Philteos G, Quirt J, Rotenberg B, Ruiz JC, Scott JR, Sommer DD, Sowerby L, Tewfik M, Waserman S, Witterick I, Wright ED, Yamashita C, Desrosiers M. Canadian multidisciplinary expert consensus on the use of biologics in upper airways: a Delphi study. J Otolaryngol Head Neck Surg 2023; 52:30. [PMID: 37095527 PMCID: PMC10127402 DOI: 10.1186/s40463-023-00626-9] [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: 12/05/2022] [Accepted: 02/23/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. METHODS A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1-9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures-kappa coefficient ([Formula: see text]) value > 0.61. RESULTS After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. CONCLUSION This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years.
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Affiliation(s)
- Andrew V Thamboo
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, St. Paul Sinus Center, University of British Columbia, 2600-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Melissa Lee
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, St. Paul Sinus Center, University of British Columbia, 2600-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Mohit Bhutani
- Department of Respirology, University of Alberta, Edmonton, AB, Canada
| | - Charles Chan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yvonne Chan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Ken R Chapman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher J Chin
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Lori Connors
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Del Dorscheid
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Richard M Gall
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | | | - Arif Janjua
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, St. Paul Sinus Center, University of British Columbia, 2600-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Amin Javer
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, St. Paul Sinus Center, University of British Columbia, 2600-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shaun Kilty
- Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Harold Kim
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gordon Kirkpatrick
- Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John M Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Richard Leigh
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Catherine Lemiere
- Department of Medicine, CIUSS du Nord de l'île de Montreal, Université de Montreal, Montreal, QC, Canada
| | - Eric Monteiro
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Helen Neighbour
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Paul K Keith
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Jaclyn Quirt
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Brian Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Juan C Ruiz
- Division of Clinical Immunology and Allergy, University of Calgary, Calgary, AB, Canada
| | - John R Scott
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Doron D Sommer
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Leigh Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Marc Tewfik
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Susan Waserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ian Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Erin D Wright
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Cory Yamashita
- Department of Medicine, Western University, London, ON, Canada
| | - Martin Desrosiers
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
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15
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Hu J, Wang L, Ma R. Comparative study of clinical symptoms of chronic rhinosinusitis with nasal polyps patients. Immun Inflamm Dis 2023; 11:e773. [PMID: 36840493 PMCID: PMC9933204 DOI: 10.1002/iid3.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/01/2022] [Accepted: 01/09/2023] [Indexed: 02/18/2023] Open
Abstract
AIM The aim of this study is to explore the clinical characteristics in chronic rhinosinusitis with nasal polyps (CRSwNP) patients with different serum specific IgE (SIgE) and eosinophilic granulocyte infiltration status. METHODS This retrospective observational study included patients diagnosed with CRSwNP and underwent functional endoscopic sinus surgery at the Yinchuan First People's Hospital between June 2019 and June 2021. A total of 192 patients with CRSwNP were included (100 males). The patients were 41.7 ± 15.1 years old. The disease course ranged 4.6-18.2 months. The visual analog scale (VAS) score (p < .001), endoscopic score (p = .014), computerized tomography (CT) score (p < .00) and the sino-nasal outcome Test-22 (SNOT-22) score (p < .001) were significantly different among patients with SIgE-positive combined eosinophilic chronic rhinosinusitis (ECRS), patients with SIgE-positive combined non-ECRS, patients with SIgE-negative combined ECRS, and patients with SIgE-negative combined non-ECRS. RESULTS In pairwise comparison, the VAS score (20.72 ± 2.24 vs. 13.09 ± 1.62, 13.84 ± 1.34, and 12.67 ± 1.20, respectively), endoscopic score (8.09 ± 1.04 vs. 7.06 ± 0.98, 7.69 ± 1.18, and 7.75 ± 1.07, respectively), CT score (13.18 ± 1.66 vs. 8.79 ± 0.88, 11.08 ± 1.12, and 11.08 ± 1.12, respectively), and SNOT-22 score (27.62 ± 2.31 vs. 12.09 ± 1.83, 14.84 ± 1.84, and 12.97 ± 1.50, respectively) was significantly higher in patients with SIgE-positive combined ECRS compared to patients with SIgE-positive combined non-ECRS, patients with SIgE-positive combined non-ECRS (all p < .0083). The VAS score, endoscopic score, and CT score might be higher in CRSwNP patients with SIgE-positive combined ECRS. CONCLUSION In this study, the VAS score, endoscopic score, and CT score were higher in the patients with SIgE-positive combined ECRS. This study might provide a reference for treatment in patients with CRSwNP.
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Affiliation(s)
- Jingmin Hu
- Department of ENTThe First Hospital of YinchuanYinchuanChina
| | - Le Wang
- Department of ENTThe First Hospital of YinchuanYinchuanChina
| | - Ruixia Ma
- Department of ENTThe First Hospital of YinchuanYinchuanChina
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16
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Hidaka H, Ito M, Ikeda R, Kamide Y, Kuroki H, Nakano A, Yoshida H, Takahashi H, Iino Y, Harabuchi Y, Kobayashi H. Clinical practice guidelines for the diagnosis and management of otitis media with effusion (OME) in children in Japan - 2022 update. Auris Nasus Larynx 2022:S0385-8146(22)00232-2. [PMID: 36577619 DOI: 10.1016/j.anl.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022]
Abstract
This is an update of the 2015 Guidelines developed by the Japan Otological Society and Oto-Rhino-Laryngeal Society of Japan defining otitis media with effusion (OME) in children (younger than 12 years old) and describing the disease rate, diagnosis, and method of examination. Recommended therapies that received consensus from the guideline committee were updated in consideration of current therapies used in Japan and based on available evidence. METHOD Regarding the treatment of OME in children, we developed Clinical Questions (CQs) and retrieved documents on each theme, including the definition, disease state, method of diagnosis, and medical treatment. In the previous guidelines, no retrieval expression was used to designate a period of time for literature retrieval. Conversely, a literature search of publications from March 2014 to May 2019 has been added to the JOS 2015 Guidelines. For publication of the CQs, we developed and assigned strengths to recommendations based on the collected evidence. RESULTS OME in children was classified into one group lacking the risk of developing chronic or intractable disease and another group at higher risk (e.g., children with Down syndrome, cleft palate), and recommendations for clinical management, including follow-up, is provided. Information regarding management of children with unilateral OME and intractable cases complicated by adhesive otitis media is also provided. CONCLUSION In clinical management of OME in children, the Japanese Clinical Practice Guidelines recommends management not only of complications of OME itself, such as effusion in the middle ear and pathologic changes in the tympanic membrane, but also pathologic changes in surrounding organs associated with infectious or inflammatory diseases.
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Affiliation(s)
- Hiroshi Hidaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191, Japan.
| | - Makoto Ito
- Department of Pediatric Otolaryngology, Jichi Children's Medical Center Tochigi, Jichi Medical University, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology-Head & Neck Surgery, Iwate Medical University, Japan
| | | | | | - Atsuko Nakano
- Division of Otorhinolaryngology, Chiba Children's Hospital, Japan
| | - Haruo Yoshida
- Department of Otolaryngology Head and Neck Surgery, Nagasaki University School of Medicine, Japan
| | - Haruo Takahashi
- Department of Otolaryngology Head and Neck Surgery, Nagasaki University School of Medicine, Japan
| | - Yukiko Iino
- Department of Otolaryngology, Tokyo-Kita Medical Center, Japan
| | - Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Japan
| | - Hitome Kobayashi
- Department of Otorhinolaryngology, Showa University School of Medicine, Japan
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17
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Chinese herbal therapy in the management of rhinosinusitis-A systematic review and meta-analysis. PLoS One 2022; 17:e0278492. [PMID: 36454862 PMCID: PMC9714754 DOI: 10.1371/journal.pone.0278492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
This systematic review aims to assess the effects and safety of Chinese herbal medicines (CHMs) in the management of rhinosinusitis (RS); inform clinicians of the current state of the evidence; identify the best available evidence; and suggest further directions for research. Five English and four Chinese language databases, and four clinical trial registries were searched. Eligible studies were randomised controlled trials (RCTs). Participants were diagnosed with RS based on established criteria. Test interventions were CHMs administered orally and/or nasally, excluding injections and displacement techniques. Control interventions included placebos, no additional treatment, and conventional non-invasive treatments including pharmacotherapies and/or nasal irrigation, and/or inhalations. Polyposis and post-surgical recovery were excluded. Outcomes were Sino-Nasal Outcome Test (SNOT), visual analogue scales (VAS), Lund-Mackay computed tomography score (LM), Lund-Kennedy Endoscopic score (LK), Mucociliary transport time (MTT), Mucociliary transport rate (MTR), quality of life and adverse events (AEs). Risk of bias used the Cochrane tool. Meta-analysis in Review Manager 5.4.1 used random effects for mean difference (MD) or risk ratio (RR) with 95% confidence intervals. Heterogeneity was assessed as I2. Thirty-four RCTs were included, 30 of chronic RS (CRS) and four of acute RS (ARS). These enrolled 3,752 participants. Five RCTs blinded participants. For CRS, comparisons with placebo showed greater improvements in the CHM groups for SNOT-20 and VAS-TNS (total nasal symptoms). Blinded comparisons with pharmacotherapies showed no differences between groups in the degree of improvement for SNOT-20, VAS-TNS, and LM, suggesting these CHMs had similar effects, at least in the short term. In ARS, pooled results found improved scores on VAS-TNS and LK suggesting a benefit for combining these CHMs with pharmacotherapies. Limitations included inadequacies in study design and methodological reporting, and insufficient reporting of AEs. Heterogeneity in some pooled results precluded strong conclusions. Further well-designed studies are needed to test whether the results are replicable. Systematic review registration number: PROSPERO (CRD42019119586).
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Abstract
Nasal airway obstruction is a very common phenomenon that can significantly decrease patients' quality of life. This review article summarizes in an evidence-based fashion the diagnosis and treatment of nasal airway obstruction. The nasal airway may be obstructed at the level of the nasal valve, septum, nasal turbinates, sinonasal mucosa, or nasopharynx. Nasal valve obstruction and septal deviations are usually treated surgically depending on the level of valve obstruction. Isolated turbinate hypertrophy is usually managed medically as part of the treatment of rhinitis, with surgery reserved for cases refractory to medical care. Sinonasal and nasopharyngeal conditions are treated according to the diagnosis.
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19
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Chronic Rhinosinusitis and Alzheimer's Disease-A Possible Role for the Nasal Microbiome in Causing Neurodegeneration in the Elderly. Int J Mol Sci 2021; 22:ijms222011207. [PMID: 34681867 PMCID: PMC8541405 DOI: 10.3390/ijms222011207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 12/25/2022] Open
Abstract
Among millions of sufferers of chronic rhinosinusitis (CRS), the challenge is not only constantly coping with CRS-related symptoms, such as congested nose, sinus pain, and headaches, but also various complications, such as attention difficulties and possible depression. These complications suggest that neural activity in the central nervous system may be altered in those patients, leading to unexpected conditions, such as neurodegeneration in elderly patients. Recently, some studies linked the presence of CRS and cognitive impairments that could further develop into Alzheimer’s disease (AD). AD is the leading cause of dementia in the elderly and is characterised by progressive memory loss, cognitive behavioural deficits, and significant personality changes. The microbiome, especially those in the gut, has been recognised as a human organ and plays an important role in the development of various conditions, including AD. However, less attention has been paid to the microbiome in the nasal cavity. Increased nasal inflammatory responses due to CRS may be an initial event that changes local microbiome homeostasis, which may further affect neuronal integrity in the central nervous system resulting in AD. Evidence suggests a potential of β-amyloid deposition starting in olfactory neurons, which is then expanded from the nasal cavity to the central nervous system. In this paper, we reviewed currently available evidence that suggests this potential mechanism to advise the need to investigate the link between these two conditions.
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Kaski HM, Alakärppä A, Lantto U, Laajala A, Tokola P, Penna T, Ohtonen P, Alho OP. Endoscopic sinus surgery (ESS) to change quality of life for adults with recurrent rhinosinusitis: study protocol for a randomized controlled trial. Trials 2021; 22:606. [PMID: 34496924 PMCID: PMC8424164 DOI: 10.1186/s13063-021-05576-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 08/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endoscopic sinus surgery (ESS) has been used for decades to treat recurrent acute rhinosinusitis episodes (RARS) in adults. RARS results in infectious symptoms, antibiotic courses, sick leaves, and impaired quality of life. Theoretically, the ESS procedure, through improving the drainage of the paranasal sinuses, decreases the symptoms and enhances the quality of life of the RARS patients. Whether this is true has not been reported in a randomized trial yet. METHODS We conduct a single-center, non-blinded, randomized, 6-month, parallel group superiority clinical study including 80 adult participants referred to surgical treatment for RARS. The participants will either have ESS or conservative medical treatment (control group). The primary outcome will be the difference between the mean disease-specific Sinonasal Outcome Test 22 (quality of life questionnaire) change scores (from baseline to 6 months) of ESS and control group. DISCUSSION This study will add significant new information to the effect and harms of ESS procedure in the treatment of adults with RARS. TRIAL REGISTRATION ClinicalTrials.gov NCT04241016 . Registered on 17 January 2020.
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Affiliation(s)
- Heidi M Kaski
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, P.O. Box 5000, FIN-90014, Oulu, Finland. .,PEDEGO Research Unit, University of Oulu, Oulu, Finland. .,Division of Operative Care, Oulu University Hospital, Oulu, Finland.
| | - Antti Alakärppä
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, P.O. Box 5000, FIN-90014, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | - Ulla Lantto
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, P.O. Box 5000, FIN-90014, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | - Aleksi Laajala
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, P.O. Box 5000, FIN-90014, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | - Paulus Tokola
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, P.O. Box 5000, FIN-90014, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | - Tomi Penna
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, P.O. Box 5000, FIN-90014, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | | | - Olli-Pekka Alho
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, P.O. Box 5000, FIN-90014, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Division of Operative Care, Oulu University Hospital, Oulu, Finland
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21
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Stalteri Mastrangelo R, Santesso N, Bognanni A, Darzi A, Karam S, Piggott T, Baldeh T, Schünemann F, Ventresca M, Morgano GP, Moja L, Loeb M, Schunemann H. Consideration of antimicrobial resistance and contextual factors in infectious disease guidelines: a systematic survey. BMJ Open 2021; 11:e046097. [PMID: 34330853 PMCID: PMC8327810 DOI: 10.1136/bmjopen-2020-046097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/14/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Guidelines that include antimicrobial recommendations should explicitly consider contextual factors that influence antimicrobial resistance and their downstream effects on resistance selection. The objectives were to analyse (1) how, and to what extent, tuberculosis, gonorrhoea and respiratory tract infection guidelines are considering antimicrobial resistance; (2) are of acceptable quality and (3) if they can be easily contextualised to fit the needs of specific populations and health systems. METHODS We conducted a systematic review and searched Ovid MEDLINE and Embase from 1 January 2007 to 7 June 2019 for tuberculosis, gonorrhoea and respiratory tract infection guidelines published in English. We also searched guideline databases, key websites and reference lists. We identified guidelines and recommendations that considered contextual factors including antimicrobial resistance, values, resource use, equity, acceptability and feasibility. We assessed quality of the guidelines using the Appraisal of Guidelines for Research and Evaluation II tool focusing on the domains scope and purpose, rigour of development, and editorial independence. RESULTS We screened 10 365 records, of which 74 guidelines met inclusion criteria. Of these guidelines, 39% (n=29/74) met acceptable quality scores. Approximately two-thirds of recommendations considered antimicrobial resistance at the population and/or outcome level. Five of the 29 guidelines reported all factors required for recommendation contextualisation. Equity was the least considered across guidelines. DISCUSSION Relatively few guidelines for highly prevalent infectious diseases are considering resistance at a local level, and many do not consider contextual factors necessary for appropriate antimicrobial use. Improving the quality of guidelines targeting specific regional areas is required. PROSPERO REGISTRATION NUMBER CRD42020145235.
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Affiliation(s)
- Rosa Stalteri Mastrangelo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Antonio Bognanni
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Darzi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Samer Karam
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Tejan Baldeh
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Finn Schünemann
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthew Ventresca
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lorenzo Moja
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Mark Loeb
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Holger Schunemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
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22
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 357] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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23
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Thamboo A, Kilty S, Witterick I, Chan Y, Chin CJ, Janjua A, Javer A, Lee J, Monterio E, Rotenberg B, Scott J, Smith K, Sommer DD, Sowerby L, Tewfik M, Wright E, Desrosiers M. Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis. J Otolaryngol Head Neck Surg 2021; 50:15. [PMID: 33750471 PMCID: PMC7945300 DOI: 10.1186/s40463-021-00493-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent evidence suggests that biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of chronic rhinosinusitis with nasal polyposis (CRSwNP). There remains a population in CRSwNP that despite medical therapy and endoscopic sinus surgery have persistent signs and symptoms of disease. Therefore, biologics, monoclonal antibody agents, could be beneficial therapeutic treatments for these patients. There have been eight randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL-5R, IL-33, and immunoglobulin (Ig)E. However, there are no formal recommendations for the optimal use of biologics in managing Chronic Rhinosinusitis (CRS) within the Canadian health care environment. METHODS A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. 17 fellowship trained rhinologists across Canada evaluated the 28 original statements on a scale of 1-10 and provided comments. A rating within 1-3 indicated disagreement, 8-10 demonstrated agreement and 4-7 represented being neutral towards a statement. All ratings were quantitively reviewed by mean, median, mode, range and standard deviation. Consensus was defined by removing the highest and lowest of the scores and using the "3 point relaxed system". RESULTS After three rounds, a total of 11 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with CRS. CONCLUSION This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of patients with CRS, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years.
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Affiliation(s)
- Andrew Thamboo
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, 2600-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
| | - S Kilty
- Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - I Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Y Chan
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - C J Chin
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - A Janjua
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, 2600-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - A Javer
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, 2600-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - J Lee
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - E Monterio
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - B Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - J Scott
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - K Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - D D Sommer
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - L Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - M Tewfik
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - E Wright
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - M Desrosiers
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'University de Montreal, Montreal, QC, Canada
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24
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Ghorbani J, Goudarzi S, Adimi Naghan P, Nikravesh A, Akhavan S, Afshar A, Abbasi P. Assessment of Quality of Life and the Risk of Obstructive Sleep Apnea in Individuals with Chronic Rhinosinusitis who are Candidate for Functional Endoscopic Sinus Surgery. TANAFFOS 2021; 20:36-42. [PMID: 34394368 PMCID: PMC8355935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/04/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic rhinosinusitis is associated with changes in quality of life (QoL). The present study intended to evaluate the QoL and risk of obstructive sleep apnea in individuals with chronic rhinosinusitis who were candidate for functional endoscopic sinus surgery. To determine the Quality of Life and the risk of sleep apnea in cases with chronic Rhinosinusitis. MATERIALS AND METHODS A total of 100 patients with drug-resistant chronic rhinosinusitis candidate for functional endoscopic sinus surgery referred to the ENT clinic of Masih Daneshvari Hospital, Tehran, Iran were recruited. SNOT-22 and STOP-BANG questionnaires were filled before the surgery. RESULTS The mean SNOT-22 score was 40.44, with a standard deviation of 19.27 (ranged from 1 to 94). Also, according to the STOP-BANG questionnaire, 62% of participants were at increased risk of OSA. Based on the cut-off point of 30 for the SNOT-22 score (either larger or lower than 30), patients were categorized into two groups. Sixty-eight percent of participants were categorized in ≥ 30 SNOT-22 score. Age below 50, female gender, and those at high risk of OSA were associated with lower QoL. CONCLUSION Most patients with chronic rhinosinusitis had a low QoL and were mostly at increased risk of OSA. Being women younger than 50 years and the presence of OSA probably are associated with lower QoL in these patients.
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Affiliation(s)
- Jahangir Ghorbani
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Parisa Adimi Naghan
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Somayeh Akhavan
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Afshar
- School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Abbasi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Nikan Education and Research Center, Tehran, Iran.,Correspondence to: Abbasi P, Address: Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Email address:
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25
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Kovacs AJ, Adappa ND, Kuan EC. Exhalation Delivery Systems for Application of Intranasal Corticosteroids. EAR, NOSE & THROAT JOURNAL 2020; 100:309-313. [PMID: 33305974 DOI: 10.1177/0145561320980194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a common sinonasal disorder which results in significant inflammation in the nasal cavity and paranasal sinuses. Topical nasal steroids play an important role in the treatment of CRS. Exhalation delivery system with fluticasone (EDS-FLU) utilizes a patient's forced exhalation to power the delivery of topical steroids to deeper areas of the nasal cavity and paranasal sinuses most affected by CRS. This review focuses on evidence surrounding the safety and efficacy of the EDS-FLU system. METHODS Literature search was conducted of articles investigating the safety and efficacy of EDS-FLU. Relevant efficacy and safety data were examined and summarized from the studies. RESULTS The efficacy and safety of EDS-FLU in CRS, both with and without polyps, has been established in open-label and placebo-controlled phase 3 trials. There was significant improvement in the cardinal symptoms of CRS and subjective patient-reported outcomes scores. Additionally, there was objective improvement in sinonasal inflammation as measured by polyp grade. Recent studies have also established significant improvement in health status and general quality of life following treatment using EDS-FLU. Emerging data have also examined patients who have previously had endoscopic sinus surgery and on appropriate medical therapy and noted improvement in polyp burden and overall Lund-Kennedy scores after using EDS-FLU. CONCLUSION Exhalation delivery system with fluticasone demonstrates significant results in both patient-oriented outcomes and objective measures of sinonasal inflammation in patients with CRS with and without polyps. Further research is needed to investigate the long-term outcomes of EDS-FLU and to compare the effects of EDS-FLU with ESS. Exhalation delivery system with fluticasone provides an additional effective treatment modality for patients suffering from CRS.
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Affiliation(s)
- Alexander J Kovacs
- Department of Otolaryngology-Head and Neck Surgery, 8788University of California, Irvine, CA, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, 8788University of California, Irvine, CA, USA
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26
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Endam LM, Alromaih S, Gonzalez E, Madrenas J, Cousineau B, Renteria AE, Desrosiers M. Intranasal Application of Lactococcus lactis W136 Is Safe in Chronic Rhinosinusitis Patients With Previous Sinus Surgery. Front Cell Infect Microbiol 2020; 10:440. [PMID: 33154953 PMCID: PMC7586919 DOI: 10.3389/fcimb.2020.00440] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/16/2020] [Indexed: 12/21/2022] Open
Abstract
Objective: Modulation of the dysbiotic gut microbiome with “healthy” bacteria via a stool transplant or supplementation is increasingly practiced, however this approach has not been explored in the nasal passages. We wished to verify whether Lactococcus lactis W136 (L. lactis W136) bacteria could be safely applied via irrigation to the nasal and sinus passages in individuals with chronic rhinosinusitis (CRS) with previous undergone endoscopic sinus surgery, and whether this was accompanied by bacterial community flora modification. Study Design: Prospective open-label pilot trial of safety and feasibility. Setting: Academic tertiary hospital center. Subjects and Methods: Twenty-four patients with CRS refractory to previous medical and surgical therapy received a 14-day course of BID sinus irrigations containing 1.2 × 109 CFU live L. lactis W136. Patients were monitored for safety using questionnaire, sinus endoscopy, otoscopy, UPSIT-40 smell testing, and endoscopically-obtained conventional sinus culture and a swab for 16S microbiome profiling. Results: All 24 patients receiving at least one treatment successfully completed treatment. L. lactis W136 probiotic treatment was safe, with no major adverse events or new infections. Treatment was associated with improvement in sinus symptoms, QOL, and mucosal scores, which remained improved during the subsequent 14-day observation period. Microbiome changes associated with treatment were limited to an increase of the pathobiont Dolosigranulum pigrum, a bacteria identified as potentially beneficial in the upper airways. Subgroup analysis suggested differences in microbiomes and responses for CRSsNP and CRSwNP phenotypes, but these did not attain significance. Conclusion: Intranasal irrigation of live L. lactis W136 bacteria to patients with refractory chronic rhinosinusitis was safe, and was associated with effects on symptoms, mucosal aspect and microbiome composition. Intranasal bacteria may thus find a role as a treatment strategy for CRS. Clinical Trials Registration:www.ClinicalTrials.gov. identifier: NCT04048174.
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Affiliation(s)
- Leandra Mfuna Endam
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Saud Alromaih
- Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Emmanuel Gonzalez
- Department of Microbiology and Immunology, Microbiome and Disease Tolerance Centre (MDTC), McGill University, Montreal, QC, Canada
| | - Joaquin Madrenas
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Benoit Cousineau
- Department of Microbiology and Immunology, Microbiome and Disease Tolerance Centre (MDTC), McGill University, Montreal, QC, Canada
| | - Axel E Renteria
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Martin Desrosiers
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.,Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
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Maniakas A, Asmar MH, Renteria AE, Nayan S, Alromaih S, Endam LM, Sampalis JS, Desrosiers M. Azithromycin in high-risk, refractory chronic rhinosinusitus after endoscopic sinus surgery and corticosteroid irrigations: a double-blind, randomized, placebo-controlled trial. Int Forum Allergy Rhinol 2020; 11:747-754. [PMID: 32929891 DOI: 10.1002/alr.22691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Refractory chronic rhinosinusitis (CRS) remains a significant burden for patients, often leaving them with few therapeutic options that provide low-morbidity, long-term, and meaningful symptomatologic and endoscopic disease improvement. Macrolides have long been thought to offer both an immunomodulatory and antimicrobial effect. Our objective was to evaluate the efficacy of low-dose, long-term azithromycin in a carefully selected high-risk population failing appropriate medical therapy of budesonide nasal irrigations (BNIs) and endoscopic sinus surgery (ESS). METHODS A double-blind, randomized, placebo-controlled trial was completed in a single tertiary-care center assessing the addition of 250 mg azithromycin, 3 times per week for 16 weeks, in adults failing ESS and high-volume BNIs. Associated comorbidities, as well as symptomatologic, microbiologic, and serologic values, were systematically collected. RESULTS A total of 128 patients were enrolled and underwent ESS followed by BNI. At the 4-month post-ESS visit, 48 patients showed disease persistence and were randomized to azithromycin or placebo. Overall, azithromycin, when compared with placebo, did not show a statistically significant difference in disease clearance (54% vs 33%, respectively; p = 0.146), although patients with disease clearance who were on azithromycin showed significantly better 22-item Sino-Nasal Outcome Test score improvements than patients on placebo (18 vs -0.9, respectively; p = 0.046). In a subgroup analysis excluding aspirin-exacerbated respiratory disease (AERD) patients, azithromycin significantly improved disease clearance when compared with placebo (71% vs 35%, respectively; p = 0.031), with a number needed to treat of 3 (2.8). CONCLUSION Low-dose azithromycin is a therapeutic option with few side effects. Its use can show favorable clinical outcomes in this difficult-to-treat population, especially if patients are AERD-negative.
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Affiliation(s)
- Anastasios Maniakas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Division of Experimental Surgery, McGill University, Montréal, Québec, Canada
- Division of Otolaryngology-Head & Neck Surgery, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | - Marc-Henri Asmar
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Axel Eluid Renteria
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Smriti Nayan
- Division of Otolaryngology-Head & Neck Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Cambridge Memorial Hospital, Cambridge, Ontario, Canada
| | - Saud Alromaih
- Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Leandra Mfuna Endam
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - John Sam Sampalis
- Division of Experimental Surgery, McGill University, Montréal, Québec, Canada
- Medical Affairs, JSS Medical Research, Montréal, Québec, Canada
| | - Martin Desrosiers
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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Baruah B, Gupta A, Kumar A, Kumar A. The role of oral vitamin D3 supplementation in the treatment of Chronic Rhinosinusitis in adults with Vitamin D deficiency. J Family Med Prim Care 2020; 9:2877-2879. [PMID: 32984142 PMCID: PMC7491765 DOI: 10.4103/jfmpc.jfmpc_448_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/25/2020] [Accepted: 05/08/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Chronic Rhinosinusitis (CRS) is a chronic inflammatory disorder of the mucosal lining of the nose and paranasal sinuses. The ability of Vitamin D (VD3) to augment innate and adaptive immune responses has sparked interest in its immunologic role in the treatment of CRS. In this study, the incidence of vitamin D deficiency in CRS patients was compared to normal population and the beneficial role of Vitamin D supplementation in its treatment was also evaluated. Materials and Methods: It is a retrospective 1-year study of 200 CRS patients with Vitamin D deficiency. The patients were divided into two groups, i.e. 100 patients were given oral Vitamin D supplements and the other group of 100 patients were treated as placebo. Both Vitamin D levels and the Total Nasal Symptom Score (TNSS) were assessed at the start and end of the study period. Results: Of the 200 subjects with CRS, 100 were given oral vitamin D supplementation in the form of Cholecalciferol 60000IU weekly once for 3 months and the other group were treated with placebo. Before the treatment, the average level of serum Vitamin D was 12.31 ng/ml. After 3 months, it increased significantly to 29.71 ng/ml. Similarly, the pretreatment TNSS score was on average 11.92. After 3 months, the scores fell by an average of 10.65 points, a significant statistical difference (P < 0.05). Conclusion: There is a higher prevalence of vitamin D deficiency in CRS patients and that vitamin D supplementation in these patients went a long way in alleviating their symptoms.
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Affiliation(s)
- Binayak Baruah
- Department of ENT, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Ajay Gupta
- Department of ENT, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Abhijit Kumar
- Department of ENT, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Alok Kumar
- Department of ENT, Tata Main Hospital, Jamshedpur, Jharkhand, India
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29
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Grose E, Lee DJ, Yip J, Cottrell J, Sykes J, Lee JK, Lee JM. Surgical outcomes in aspirin-exacerbated respiratory disease without aspirin desensitization. Int Forum Allergy Rhinol 2020; 10:1149-1157. [PMID: 32558318 DOI: 10.1002/alr.22626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/21/2020] [Accepted: 05/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Aspirin-exacerbated respiratory disease (AERD) represents a severe endotype of chronic rhinosinusitis with nasal polyposis. Although aspirin desensitization (AD) has emerged as an effective therapeutic option, the natural history of AERD without AD remains unclear. METHODS A retrospective review was conducted of AERD patients who underwent endoscopic sinus surgery (ESS) without AD between 2010 and 2019. The primary outcomes were revision surgery rate and time to revision surgery. Secondary outcomes included changes in 22-item Sino-Nasal Outcome Test (SNOT-22) scores and Lund-Kennedy endoscopy scores (LKES). A subgroup analysis was performed for patients on monoclonal antibody therapy (MAT). RESULTS Of 141 patients, 37 (26.2%) underwent revision ESS with a median time to revision of 3.3 (interquartile range [IQR], 2.2-4.9) years. The probability of remaining free of revision surgery at 1, 3, and 5 years was: 98.2% (95% confidence interval [CI], 95.7-100.0%), 78.8% (95% CI, 70.2-88.4%), and 44.8% (95% CI, 32.4-62.1%), respectively. SNOT-22 scores decreased by 34 (IQR, 18-52) points at 6 months and 27 (IQR, 20-46) points at 1 year postoperatively. In the revision cohort, the decrease in SNOT-22 score was not sustained at 1 year postoperatively. No difference was found in time to revision compared with those without MAT (p = 0.23). CONCLUSION A significant proportion of AERD patients benefit from ESS and medical therapy alone without AD. This study presents preliminary results on the impact of MAT on surgical outcomes as it is limited by the small sample size. Further research on the use of MAT in AERD is needed.
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Affiliation(s)
- Elysia Grose
- Division of Rhinology, Department of Otolaryngology-Head & Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Daniel J Lee
- Division of Rhinology, Department of Otolaryngology-Head & Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Jonathan Yip
- Division of Rhinology, Department of Otolaryngology-Head & Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Justin Cottrell
- Division of Rhinology, Department of Otolaryngology-Head & Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Jenna Sykes
- Adult Cystic Fibrosis Centre, Department of Respirology, St. Michael's Hospital, Toronto, ON, Canada
| | - Jason K Lee
- Toronto Allergists, Toronto, ON, Canada.,Evidence Based Medical Educator, Toronto, ON, Canada
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology-Head & Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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30
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Arnstead N, Chan Y, Kilty S, Ganeshathasan R, Rahmani A, Monteiro E. Choosing Wisely Canada rhinology recommendations. J Otolaryngol Head Neck Surg 2020; 49:10. [PMID: 32111259 PMCID: PMC7049188 DOI: 10.1186/s40463-020-00406-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/18/2020] [Indexed: 11/17/2022] Open
Abstract
The Choosing Wisely Canada campaign is an initiative that aims to involve physicians and patients in collaborative decision making to avoid unnecessary tests and treatments. The Rhinology Subspecialty Group of the Canadian Society of Otolaryngology – Head & Neck Surgery developed a list of five evidence-based recommendations for the management of acute rhinosinusitis and nasal fractures: (1) don’t prescribe antibiotics to patients with acute sinusitis who do not meet the diagnostic criteria for acute bacterial rhinosinusitis; (2) don’t order a CT scan for uncomplicated acute rhinosinusitis; (3) don’t order plain film sinus x-rays; (4) don’t swab the nasal cavity as part of the work up for rhinosinusitis; and (5) don’t order a plain film x-ray in the evaluation of nasal fractures.
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Affiliation(s)
- Neil Arnstead
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, C. David Naylor Building, Suite 120, 6 Queen's Park Crescent West, Toronto, ON, M5S 3H2, Canada.
| | - Yvonne Chan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Trillium Health Partners, Suite 102-101 Queensway West, Missisauga, ON, L5B 2P7, Canada
| | - Shaun Kilty
- Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, The Ottawa Hospital Civic Campus, 737 Parkdale Avenue, Room 259, Ottawa, ON, K1Y 1J8, Canada
| | - Ragavan Ganeshathasan
- Department of Family Medicine, University of Western Ontario, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Armin Rahmani
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Mount Sinai Hospital, 600 University Avenue, Suite 404, Toronto, ON, M5G 1X5, Canada
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What is the evidence for fluticasone exhalation delivery system in chronic rhinosinusitis? Curr Opin Otolaryngol Head Neck Surg 2020; 28:14-17. [DOI: 10.1097/moo.0000000000000597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Kuan EC, Kovacs AJ, Workman AD, Bosso JV, Adappa ND. Efficacy of fluticasone exhalation delivery system in the management of chronic rhinosinusitis: what is the evidence? Int Forum Allergy Rhinol 2020; 9:S16-S21. [PMID: 31087635 DOI: 10.1002/alr.22340] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/09/2019] [Accepted: 03/22/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intranasal steroids have become part of the mainstay in the long-term management of chronic rhinosinusitis. A long-standing problem remains in efficient and easy-to-use delivery of topical corticosteroids to the nasal mucosa. Currently available means of intranasal steroid delivery include sprays, which are generally limited to treating the anterior nasal cavity, and rinses, which are not FDA-approved for this indication. The exhalation delivery system is a novel method of delivering fluticasone to the deeper areas within the nasal cavities, including the posterior nasal cavity and middle and superior meatuses. METHODS Comprehensive literature review. RESULTS Recent large scale studies have suggested its efficacy and safety in the use of patients with both chronic sinusitis with polyposis and without polyps. Specifically, studies have demonstrated decreased Sinonasal Outcome Test scores of 20 points following treatment, as well as improvement of polyp grade by 1 or more point in more than 60% of patients. Furthermore, among patients with nasal polyps, there was approximately 60-70% decreased indication for surgery following EDS-FLU use. CONCLUSION EDS-FLU is an important adjunct therapy for sinonasal inflammatory disease.
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Affiliation(s)
- Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Alexander J Kovacs
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Alan D Workman
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - John V Bosso
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
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Kaper NM, van der Heijden GJMG, Cuijpers SH, Stokroos RJ, Aarts MCJ. A comparison of international clinical practice guidelines on adult chronic rhinosinusitis shows considerable variability of recommendations for diagnosis and treatment. Eur Arch Otorhinolaryngol 2019; 277:659-668. [DOI: 10.1007/s00405-019-05752-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/28/2019] [Indexed: 02/06/2023]
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Kaczmarek M, Wasicka K, Tin-Tsen Chou J, Popowicz P, Rzetelska Z, Łagiedo-Żelazowska M, Piwowarczyk K, Leszczyńska M. NK cells in patients with chronic rhinosinusitis show decreased maturity and limited expression of functional receptors. Immunobiology 2019; 225:151890. [PMID: 31883750 DOI: 10.1016/j.imbio.2019.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022]
Abstract
Chronic rhinosinusitis is an inflammatory process of the mucous membrane of the nasal cavity and paranasal sinuses, presenting with two phenotypes that differ in symptoms and inflammatory profiles: either with or without polyps. Natural killer (NK) cells are involved in both the innate and acquired immune response, and their function may be limited under pathological conditions, leading to polyp formation. We determined NK cell involvement and maturity in chronic rhinosinusitis, by determining the percentage of NK cells in polyps, nasal mucosa, and in the peripheral blood. Material was obtained from 49 patients with chronic rhinosinusitis (36 with polyps, 13 without polyps), and 15 control patients. Flow cytometry was used to immunophenotype NK cells, and the expression of selected functional receptors was evaluated. NK cells were found to be increased in polyp tissue versus peripheral blood and nasal mucosa. NK cell maturation differed significantly with predominance of a cytotoxic phenotype (CD11b+/27-) in peripheral blood, compared with a regulatory/tolerogenic phenotype (CD11+/-/ 27+) in tissue material. These findings demonstrate the involvement of NK cells in the inflammatory process of chronic rhinosinusitis. Decreased expression of activating receptors in the analyzed groups may also indicate the presence of modifying agents. Disorders of the maturation process of NK cells may be an important element in the etiopathogenesis of chronic rhinosinusitis with and without polyps.
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Affiliation(s)
- Mariusz Kaczmarek
- Dept. of Immunology, Poznan University of Medical Sciences, Rokietnicka 5d St. Poznan, Poland
| | - Karolina Wasicka
- Dept. of Immunology, Poznan University of Medical Sciences, Rokietnicka 5d St. Poznan, Poland
| | - Jadzia Tin-Tsen Chou
- Dept. of Immunology, Poznan University of Medical Sciences, Rokietnicka 5d St. Poznan, Poland; Dept. of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49 St. Poznan, Poland
| | - Patrycja Popowicz
- Dept. of Immunology, Poznan University of Medical Sciences, Rokietnicka 5d St. Poznan, Poland; Dept. of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49 St. Poznan, Poland.
| | - Zuzanna Rzetelska
- Dept. of Immunology, Poznan University of Medical Sciences, Rokietnicka 5d St. Poznan, Poland
| | | | - Krzysztof Piwowarczyk
- Dept. of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49 St. Poznan, Poland
| | - Małgorzata Leszczyńska
- Dept. of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49 St. Poznan, Poland
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Sumaily I, Alarifi I, Alsuwaidan R, Alsiwat L, Alsaleh S. Impact of Nasal Irrigation With Iodized Table Salt Solution on Mucociliary Clearance: Proof-of-Concept Randomized Control Trial. Am J Rhinol Allergy 2019; 34:276-279. [PMID: 31789056 DOI: 10.1177/1945892419892172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Saline nasal irrigation is a common recommendation shared between the majority of clinical guidelines for sinusitis and rhinitis in adults and children. Studies involving homemade saline have typically involved the use of noniodized salt. However, the literature does not contain any descriptions for the use of iodized table salt in homemade saline solutions. Objectives To study the usefulness of iodized salt in homemade saline and its impact on mucociliary clearance (MCC). Methods Only healthy volunteers were enrolled in this randomized controlled trial. The sinonasal outcome test (SNOT)-22 and rhinoscopy were used to rule out any clinical evidence of sinusitis or rhinitis in the enrolled subjects. The saccharine clearance time (SCT) was used to evaluate MCC at baseline. Each candidate received 2 different nasal wash solutions—one containing iodized salt and the other containing noniodized salt—on different days. Visual analog scale pain scores were recorded while using each type of nasal wash. The SCT was assessed after each wash. Results Thirty-eight healthy candidates (18 men and 20 women) were enrolled in the study. All subjects were in their 30s. The mean baseline SCT was 10.92 minutes. The use of the noniodized salt solution led to a nonsignificant change ( P = .139) in mean SCT (9.68 min). In contrast, a significant change ( P = .035) was observed in mean SCT after the use of the iodized salt solution (9.06 min). However, the mean postirrigation SCT was not significantly different between solutions ( P = .31). No significant differences were observed in pain/discomfort experience between solutions. Conclusion MCC improved with both solutions. Interestingly, the improvement was significant, when the iodized salt nasal irrigation solution was used. This finding contradicts the conventional recommendation against the use of iodized salt in nasal rinse solution. Moreover, this solution was well tolerated. Further studies regarding the long-term safety are recommended.
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Affiliation(s)
- Ibrahim Sumaily
- Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Alarifi
- Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Raseel Alsuwaidan
- Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lojain Alsiwat
- Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Mengko SK, Soemantri RD, Juniati SH. Correlation Between Objective Evaluation Result of Nasal Congestion and Life Quality in Patients with Acute Rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2019; 71:1929-1934. [PMID: 31763270 PMCID: PMC6848427 DOI: 10.1007/s12070-018-1333-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/28/2018] [Indexed: 11/28/2022] Open
Abstract
Rhinosinusitis is an inflammatory process involving the nasal mucosa and paranasal sinuses. Rhinitis and sinusitis generally occur simultaneously and thus the current terminology used is rhinosinusitis. The blind nose can negatively affect the overall quality of life including the physical or emotional condition of the sufferer and disruption to work or school (reduced productivity and difficulty in concentrating). To analyse correlation between objective evaluation results of nasal congestion through NIPF and life quality based on sinonasal outcome Test-20 score in patients with acute rhinosinusitis. The study was conducted at Otolaryngology Outpatient Clinic at Dr. Soetomo General Hospital Surabaya. The time of study began in July 2011 until the minimum sample size was met. The sample of the study was patients diagnosed with acute rhinosinusitis treated at Otolaryngology Outpatient Clinic at Dr. Soetomo General Hospital Surabaya and meet the research criteria. Based on statistical analysis with Spearman rank correlation test, correlation between NIPF value and SNOT-20 score on 16 samples got correlation coefficient-0.310 and p = 0.243. The scatter diagram showed the NIPF value variables and the SNOT-20 scores being scattered in uneven spots and erratic patterns. This indicated that an objective evaluation of nasal congestion based on NIPF and subjective assessment of quality of life based on SNOT-20 score was not obtained correlation (p > 0.05). The results of the objective nasal obstruction examination based on Nasal Inspiratory Peak Flow have no correlation with subjective subjective assessment of quality of life based on Sino-Nasal Outcome Test-20 score in patients with acute rhinosinusitis.
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Affiliation(s)
- Steward Keneddy Mengko
- Department of Otolaryngology, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Roestiniadi Djoko Soemantri
- Department of Otolaryngology, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Sri Herawati Juniati
- Department of Otolaryngology, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Hospital, Surabaya, Indonesia
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de Gabory L, Kérimian M, Baux Y, Boisson N, Bordenave L. Computational fluid dynamics simulation to compare large volume irrigation and continuous spraying during nasal irrigation. Int Forum Allergy Rhinol 2019; 10:41-48. [PMID: 31589813 DOI: 10.1002/alr.22458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/06/2019] [Accepted: 09/20/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Nasal irrigation is now widely recognized as a treatment for chronic rhinosinusitis and during the postoperative period. However, there are no guidelines for performing irrigation. This study used computational fluid dynamics (CFD) simulation objective physical parameters to optimize and increase the efficiency of nasal irrigation and to compare large-volume, manual, and gravity pressure irrigation vs small-volume continuous spraying. METHODS A 3-dimensional (3D) sinonasal model was constructed from a healthy adult high-resolution computed tomography (CT) scan. The 3D nasal model was constructed using a tetrahedral and hex-dominant mesh grid with TGRID™ 16 (ANSYS Inc., Villeurbanne, France) software. A structured hex mesh was created inside the domain using the Hexcore meshing method. The final mesh had a total of 9.6 × 106 cells with an average size of 0.29 mm3 , or an average volume of 2.42 × 10-2 mm3 . Navier-Stokes equations were resolved with the standard k - ε model. RESULTS Large-volume irrigation (15 mL/s) covered all zones (136 to 310 cm2 ) rapidly with strong shear stress and prolonged contact time (310 mPa 3.26 seconds for gravity mode and 280 mPa 3.35 seconds for manual pressure mode). Continuous spraying (3 mL/second) covered all areas (76 to 310 cm2 ) but with far less volume, more slowly, with low shear stress (50 mPa), and with shorter contact time (1.84 seconds). The surface wetted by time in contact was 135.4, 113.9, and 46.6 cm2 for gravity, manual pressure mode, and continuous spraying, respectively. CONCLUSION CFD simulation visualizes the circulation of water during nasal irrigation and makes it possible to determine objective parameters to decide which mode of irrigation may be used.
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Affiliation(s)
- Ludovic de Gabory
- Ear, Nose, and Throat (ENT) Department, Centre Hospitalier Universitaire [CHU] Hôpital Pellegrin, University Hospital of Bordeaux, Bordeaux, France.,CIC 14-01 IT, University Hospital of Bordeaux, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Mélodie Kérimian
- Ear, Nose, and Throat (ENT) Department, Centre Hospitalier Universitaire [CHU] Hôpital Pellegrin, University Hospital of Bordeaux, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Yannick Baux
- Computational Fluid Dynamic Unit, OptiFluides, Villeurbanne, France
| | - Nicolas Boisson
- Computational Fluid Dynamic Unit, OptiFluides, Villeurbanne, France
| | - Laurence Bordenave
- CIC 14-01 IT, University Hospital of Bordeaux, Bordeaux, France.,University of Bordeaux, Bordeaux, France.,Bioingéniérie Tissulaire, INSERM, U1026, Bordeaux, France
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Panchmatia R, Payandeh J, Al-Salman R, Kakande E, Habib AR, Mullings W, Javer AR. The efficacy of diluted topical povidone-iodine rinses in the management of recalcitrant chronic rhinosinusitis: a prospective cohort study. Eur Arch Otorhinolaryngol 2019; 276:3373-3381. [PMID: 31560120 DOI: 10.1007/s00405-019-05628-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 08/31/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Recalcitrant chronic rhinosinusitis is a persistent inflammatory condition of the sinonasal mucosa despite adequate medical therapy and sinus surgery. This study aimed to demonstrate the effectiveness and safety of dilute povidone-iodine (PVP-I) sinonasal rinses as an adjunctive therapy. METHODS Prospective cohort study. Twenty-nine recalcitrant CRS patients with endoscopic evidence of ongoing inflammation and purulent discharge were prescribed 0.08% diluted PVP-I rinses. Changes to endoscopic modified Lund-Kennedy (MLK) scores at 7 weeks post-PVP-I rinsing served as the primary outcome measure. RESULTS The median MLK-discharge score significantly decreased in all patients by 1.50 points post-PVP-I rinsing (p value < 0.01). The total MLK score significantly decreased in all patients by 1.50 points (p value = 0.01). Up to a 17% reduction in serum inflammatory markers was measured post-PVP-I rinsing. Sinonasal culture revealed a shift from moderate-heavy growth to lighter bacterial growth overall. Subjective SNOT-22 scores significantly improved overall by ≥ 1 minimal clinically important difference (MCID > 12; baseline median = 33; follow-up median = 20; p value < 0.01; n = 22). TSH levels increased non-significantly within normal ranges (baseline median = 1.59 mU/L; follow-up median = 1.92 mU/L; p = 0.10; n = 15). Mucociliary clearance time increased non-significantly within normal ranges (baseline median = 9 min; follow-up median = 10 min; p value = 0.53; n = 17). Olfactory Sniffin'16 scores non-significantly decreased within age-related normal ranges (baseline median = 14; follow-up median = 13; p value = 0.72; n = 18). CONCLUSION A dilute 0.08% PVP-I sinonasal rinse as an ancillary therapy in recalcitrant CRS significantly reduces signs of infection alongside notable symptom improvement, without affecting thyroid function, mucociliary clearance or olfaction.
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Affiliation(s)
- Rikesh Panchmatia
- Division of Otolaryngology, St. Paul's Sinus Centre, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Payandeh
- Division of Otolaryngology, St. Paul's Sinus Centre, University of British Columbia, Vancouver, BC, Canada
| | - Rami Al-Salman
- Division of Otolaryngology, St. Paul's Sinus Centre, University of British Columbia, Vancouver, BC, Canada
| | - Emily Kakande
- Division of Otolaryngology, St. Paul's Sinus Centre, University of British Columbia, Vancouver, BC, Canada
| | - Al-Rahim Habib
- Division of Otolaryngology, St. Paul's Sinus Centre, University of British Columbia, Vancouver, BC, Canada
| | - Warren Mullings
- Division of Otolaryngology, St. Paul's Sinus Centre, University of British Columbia, Vancouver, BC, Canada
| | - Amin R Javer
- Division of Otolaryngology, St. Paul's Sinus Centre, University of British Columbia, Vancouver, BC, Canada.
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Taziki MH, Azarhoush R, Taziki MM, Naghavi-Alhosseini M, Javid N, Davoodi H. Correlation Between HMGB1 and TLR4 Expression in Sinonasal Mucosa in Patients With Chronic Rhinosinusitis. EAR, NOSE & THROAT JOURNAL 2019; 98:599-605. [PMID: 31238737 DOI: 10.1177/0145561319858915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is one of the most common inflammations in the upper airway. Despite the wide prevalence of CRS, the pathogenesis of this disease is poorly understood. Several components of the innate immune system may play a significant role in CRS, including Toll-like receptor 4 (TLR4), TLR9, and high-mobility group box 1 protein (HMGB1). This study was conducted to determine the expression of TLR4, TLR9, HMGB1, and pNFκ-B p65 in paraffin-embedded blocks of patients with CRS with nasal polyps compared with those of the control group. METHODS Twenty-six formalin-fixed, paraffin-embedded samples from patients with confirmed CRS and 26 patients undergoing septoplasty due to anatomic variations and no other inflammatory nasal diseases as the control group were assessed. Expression patterns of HMGB1, TLR9, TLR4, and pNFκ-B p65 genes were examined using real-time quantitative reverse transcription polymerase chain reaction (Real-Time qRT-PCR). Statistical analyses were performed with SPSS and analyzed using unpaired 2-tailed t tests or 1-way analysis of variance. RESULTS Real-time PCR showed that the expression level of HMGB1 messenger RNA was significantly increased in the tissues of patients with CRS compared with controls (P < .05). The other 3 genes were also upregulated in the patients, but were not significant compared with control. Analysis of the Pearson correlation coefficient (r) revealed a significant positive correlation between HMGB1 and TLR4 (r = 0.79, P < .05) in patients and negative correlation between TLR4 and NfκB in the control group (r = 0.94; P < .05). CONCLUSIONS Both HMGB1 and TLR4 are increased in the paranasal sinus mucosa of patients with CRS. These results suggest a possible contribution of HMGB1 and its internal receptor (TLR4) in the pathophysiology of CRS.
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Affiliation(s)
- Mohammad Hossein Taziki
- Clinical Research Development Unit (CRDU), 5 Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ramin Azarhoush
- Department of Pathology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | | | | | - Naeme Javid
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Homa Davoodi
- Department of Immunology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
- Cancer Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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40
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[Guideline for "rhinosinusitis"-long version : S2k guideline of the German College of General Practitioners and Family Physicians and the German Society for Oto-Rhino-Laryngology, Head and Neck Surgery]. HNO 2019; 66:38-74. [PMID: 28861645 DOI: 10.1007/s00106-017-0401-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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41
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Alsaffar H, Sowerby L, Rotenberg BW. Postoperative Nasal Debridement after Endoscopic Sinus Surgery: A Randomized Controlled Trial. Ann Otol Rhinol Laryngol 2019. [DOI: 10.1177/000348941312201007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hussain Alsaffar
- Department of Otolaryngology–Head and Neck Surgery, St Joseph's Health Care London, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Leigh Sowerby
- Department of Otolaryngology–Head and Neck Surgery, St Joseph's Health Care London, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Brian W. Rotenberg
- Department of Otolaryngology–Head and Neck Surgery, St Joseph's Health Care London, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Kaper NM, Aarts MCJ, van Benthem PPG, van der Heijden GJMG. Otolaryngologists adhere to evidence-based guidelines for chronic rhinosinusitis. Eur Arch Otorhinolaryngol 2019; 276:1101-1108. [PMID: 30683991 PMCID: PMC6426812 DOI: 10.1007/s00405-019-05289-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess awareness of, opinion about and adherence to evidence-based guidelines on chronic rhinosinusitis among Dutch Otolaryngologists. METHODS We assessed implementation of two guidelines, one Dutch and one European, that are both intended for diagnosis and treatment of patients with chronic rhinosinusitis. We invited 485 Otolaryngologists to fill out a questionnaire and report on their opinion on and adherence to the guidelines. The adherence was further tested by 4 clinical case scenarios, derived from guideline recommendations. RESULTS 166 (34%) completed the questionnaire. 99% of the respondents was aware of one or both guidelines. Most respondents (90%) consider the guidelines as directing or supportive for their clinical practice based on the clinical case scenarios, between 62 and 99% of the respondents act according to guidelines. Concerning diagnosis, CT-imaging is performed more and allergy testing less than recommended. Where multiple treatment options are recommended, the responses are more heterogeneous as a result of this. Nonetheless, high recommended treatment was chosen more often. Otolaryngologists were reluctant in surgical treatment as a first option, which is according to the guidelines. CONCLUSIONS Overall, both the EPOS and CBO guideline are well known among Dutch Otolaryngologists and 90% indicates that the guideline is important in their daily practice. Adherence to the guidelines is sufficient to high. If multiple treatment or diagnostic options are recommended this leads to a more heterogeneous response pattern. Recommendations with a high grade of recommendation were followed up most often.
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Affiliation(s)
- N M Kaper
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - M C J Aarts
- Department of Otolaryngology, Jeroen Bosch Hospital, s' Hertogenbosch, The Netherlands
| | - P P G van Benthem
- Department of Otolaryngology, Head and Neck Surgery, LUMC, University of Leiden, Leiden, The Netherlands
| | - G J M G van der Heijden
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
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Vaughn A, Shaver C, Clark D. Association Between Culture and Culture-Independent Microtyping in Recalcitrant Chronic Rhinosinusitis. EAR, NOSE & THROAT JOURNAL 2019; 98:94-97. [PMID: 30813804 DOI: 10.1177/0145561318823371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Many different etiologies have been proposed to be responsible for the pathogenesis of chronic rhinosinusitis, including dysbiosis of the sinus microbiome. Attempts have recently been made to identify a pathogenic organism via advanced culture mechanisms. The purpose of this study is to use culture-dependent and culture-independent means of microtyping to determine whether any association exists between the quantity and quality of bacteria identified in patients with recalcitrant chronic rhinosinusitis. METHODS: Medical records were retrospectively reviewed for patients with a history of revision sinus surgery and persistent symptoms who underwent endoscopically directed culture and underwent quantitative polymerase chain reaction analysis of the 16S ribosomal RNA of bacteria and fungi from February 1, 2014, to January 1, 2017. A total of 21 patients met the inclusion criteria. Medical records were reviewed to determine the number of bacterial isolates and relative abundance of bacteria and fungi on culture and polymerase chain reaction. RESULTS: Using culture-independent techniques of examining purulent secretions in patients with recalcitrant chronic rhinosinusitis, an average of 3.61 isolates were identified per specimen, compared with culture-dependent methods that revealed 2.10 isolates per specimen ( P < .05). The dominant species identified on each culture was rarely the most abundant species identified using polymerase chain reaction techniques. CONCLUSIONS: Traditional culture methodologies may fail to identify potential pathogens or the dominant pathogen in patients with recalcitrant chronic rhinosinusitis with acute exacerbations.
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Affiliation(s)
- Andrew Vaughn
- 1 Department of Surgery, Scott & White Medical Center-Temple, Division of Otolaryngology, Temple, TX, USA.,2 Texas A&M College of Medicine, TX, USA
| | | | - David Clark
- 1 Department of Surgery, Scott & White Medical Center-Temple, Division of Otolaryngology, Temple, TX, USA.,2 Texas A&M College of Medicine, TX, USA
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Belcher R, Virgin F. The Role of the Adenoids in Pediatric Chronic Rhinosinusitis. Med Sci (Basel) 2019; 7:medsci7020035. [PMID: 30823617 PMCID: PMC6410137 DOI: 10.3390/medsci7020035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/17/2019] [Accepted: 02/21/2019] [Indexed: 12/31/2022] Open
Abstract
There are several mechanisms by which the adenoids contribute to pediatric chronic rhinosinusitis (PCRS), particularly with children aged 12 years and younger. Understanding the role that the adenoids play in PCRS is crucial when attempting to treat these patients. A literature review was performed to address this problem and provide information surrounding this topic. This review will provide a better understanding of how adenoids contribute to PCRS, and also of the medical and surgical treatment options.
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Affiliation(s)
- Ryan Belcher
- Department of Otolaryngology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN 37235, USA.
| | - Frank Virgin
- Department of Otolaryngology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN 37235, USA.
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Faghih Habibi A, Gerami H, Banan R, Kazemnezhad Leily E, Khoshkhat P, Alaie Alamouti H, Nemati S. Serum 25-Hydroxy Vitamin D in Chronic Rhinosinusitis with and Without Nasal Polyposis: A Case-Control Study. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2019; 31:19-24. [PMID: 30783595 PMCID: PMC6368985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) with and without nasal polyposis is a chronic inflammatory disease of the sinuses and nasal mucosa. Recent evidence has indicated a relationship between serum 25-hydroxyl vitamin D (OH-VitD) deficiency and CRS. Regarding this, the present study aimed to compare the serum level of 25-OH-VitD in CRS patients with and without nasal polyposis and control groups. MATERIALS AND METHODS This study was conducted on 117 adult subjects in three groups of CRS with nasal polyposis (CRSwNP; n=32), CRS without nasal polyposis (CRSsNP; n=35), and healthy controls (n=50). The mean level of serum 25-OH-VitD in the three groups was measured by means of enzyme- linked immunosorbent assay. The data were analyzed using SPSS software (version 18). RESULTS Mean serum levels of 25-OH-VitD in CRSwNP, CRSsNP, and control groups were 12.52, 15.54, and 22.04 ng/ml, respectively. There was a significant difference between the case and control groups in terms of 25-OH-VitD level (P=0.0001). However, no significant difference was observed between the CRSwNP and CRSsNP groups in this regard (P=0.464). The women had a VitD deficiency odds ratio (OR) of 2.47, compared with men (OR=2.47, 95% CI=1.04-5.86). The OR of VitD deficiency with aging was obtained as 0.957 (95% CI=0.925-0.989). In this regard, older patients had a lower probability of VitD deficiency, compared to younger patients. CONCLUSION As the findings indicated, serum 25-OH-VitD was significantly lower in CRS patients, compared with that in the non-CRS subjects.
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Affiliation(s)
- Ali Faghih Habibi
- Rhino-Sinus, Ear, and Skull base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgury, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Hooshang Gerami
- Rhino-Sinus, Ear, and Skull base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgury, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Rahmatollah Banan
- Rhino-Sinus, Ear, and Skull base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgury, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Ehsan Kazemnezhad Leily
- Rhino-Sinus, Ear, and Skull base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgury, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Parsa Khoshkhat
- International Campus, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hooman Alaie Alamouti
- Rhino-Sinus, Ear, and Skull base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgury, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Shadman Nemati
- Rhino-Sinus, Ear, and Skull base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgury, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.,Corresponding Author: Rhino- sinus, Ear and Skull base Diseases Research Center, Amiralmomenin University Hospital, 17 Shahrivar Ave. Rasht, Iran. post code: 41396-37459, E-mail: ,
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Vennik J, Eyles C, Thomas M, Hopkins C, Little P, Blackshaw H, Schilder A, Boardman J, Philpott CM. Management strategies for chronic rhinosinusitis: a qualitative study of GP and ENT specialist views of current practice in the UK. BMJ Open 2018; 8:e022643. [PMID: 30573482 PMCID: PMC6303610 DOI: 10.1136/bmjopen-2018-022643] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To explore general practitioner (GP) and ears, nose and throat (ENT) specialist perspectives of current treatment strategies for chronic rhinosinusitis (CRS) and care pathways through primary and secondary care. DESIGN Semi-structured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic Rhinosinusitis) SETTING: Primary care and secondary care ENT outpatient clinics in the UK. PARTICIPANTS Twelve GPs and 9 ENT specialists consented to in-depth telephone interviews. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis. MAIN OUTCOME MEASURES Healthcare professional views of management options and care pathways for CRS. RESULTS GPs describe themselves as confident in recognising CRS, with the exception of assessing nasal polyps. In contrast, specialists report common missed diagnoses (eg, allergy; chronic headache) when patients are referred to ENT clinics, and attribute this to the limited ENT training of GPs. Steroid nasal sprays provide the foundation of treatment in primary care, although local prescribing restrictions can affect treatment choice and poor adherence is perceived to be the causes of inadequate symptom control. Symptom severity, poor response to medical treatment and patient pressure drive referral, although there is uncertainty about optimal timing. Treatment decisions in secondary care are based on disease severity, polyp status, prior medical treatment and patient choice, but there is major uncertainty about the place of longer courses of antibiotics and the use of oral steroids. Surgery is regarded as an important treatment option for patients with severe symptoms or with nasal polyps, although timing of surgery remains unclear, and the uncertainty about net long-term benefits of surgery makes balancing of benefits and risks more difficult. CONCLUSIONS Clinicians are uncertain about best management of patients with CRS in both primary and secondary care and practice is varied. An integrated care pathway for CRS is needed to improve patient management and timely referral.
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Affiliation(s)
- Jane Vennik
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Caroline Eyles
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mike Thomas
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Paul Little
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | | | - Jim Boardman
- Fifth Sense: the charity of people with smell and taste disorders, Chinnor, Oxfordshire, UK
| | - Carl M Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
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Asmar MH, Gaudreau A, Maniakas A, Mfuna Endam L, Desrosiers M. An Evaluation of SPARC Protein as a Serum Biomarker of Chronic Rhinosinusitis. Otolaryngol Head Neck Surg 2018; 160:158-164. [PMID: 30274534 DOI: 10.1177/0194599818801888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Precision medicine initiatives for chronic rhinosinusitis (CRS) management suggest tailoring treatment to the patient's individual disease profile; however, serum biomarkers for evaluation of disease activity or predicting response to therapy are lacking in CRS. Epithelial-to-mesenchymal transition (EMT) has been described as a component of barrier dysfunction in CRS. SPARC (secreted protein acidic and rich in cysteine) is a marker of EMT that has previously been identified in sinus epithelium by gene expression profiling. We wished to determine if SPARC could represent a serum biomarker for CRS by verifying (1) if SPARC could be detected in serum, (2) whether levels were sensitive to disease burden reduction following surgery, and (3) if it could predict response to therapy. STUDY DESIGN Prospective. SETTING Tertiary care center. SUBJECTS Patients with CRS undergoing endoscopic sinus surgery (ESS). METHODS Twenty-six patients undergoing ESS for CRS were prospectively recruited. Serum was collected at the time of surgery and 4 months following ESS and SPARC level measured using enzyme-linked immunosorbent assay. Postoperative outcome was characterized as "remission" or "unfavorable" based on symptomatology and endoscopy. RESULTS SPARC could be detected and measured in serum in all subjects. Following ESS, SPARC levels decreased by 33% ( P = .005) but did not predict evolution at 4 months postsurgery ( P = .94). CONCLUSION SPARC may be an interesting serum biomarker of disease activity in CRS, as it can be reliably measured and decreases following successful reduction of disease burden after surgery. However, it does not predict post-ESS evolution, suggesting that the link between EMT and outcome is not linear.
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Affiliation(s)
- Marc-Henri Asmar
- 1 University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, QC, Canada
| | - Annie Gaudreau
- 1 University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, QC, Canada.,2 Division of Otolaryngology-Head & Neck Surgery, University of Montreal Hospital Centre (CHUM), Montreal, QC, Canada
| | - Anastasios Maniakas
- 1 University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, QC, Canada.,2 Division of Otolaryngology-Head & Neck Surgery, University of Montreal Hospital Centre (CHUM), Montreal, QC, Canada
| | - Leandra Mfuna Endam
- 1 University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, QC, Canada
| | - Martin Desrosiers
- 1 University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, QC, Canada.,2 Division of Otolaryngology-Head & Neck Surgery, University of Montreal Hospital Centre (CHUM), Montreal, QC, Canada
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Singer A, Kosowan L, Katz A, Jolin-Dahel K, Appel K, Lix LM. Prescribing and testing by primary care providers to assess adherence to the Choosing Wisely Canada recommendations: a retrospective cohort study. CMAJ Open 2018; 6:E603-E610. [PMID: 30530720 PMCID: PMC6287976 DOI: 10.9778/cmajo.20180053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Choosing Wisely Canada is an initiative to reduce overprescribing and overtesting. This study assessed adherence to 4 Choosing Wisely Canada recommendations for interventions commonly performed in primary care: (a) antibiotic prescriptions for infections that are probably viral in origin, (b) routine vitamin D tests in low-risk adults, (c) annual screening blood tests and (d) prescriptions of antipsychotic medication to treat symptoms of dementia. METHODS We conducted a retrospective cohort study of data from the electronic medical records of patients who had an encounter between 2014 and 2016 with a participating Manitoba Primary Care Research Network primary care provider in Manitoba, Canada. Patient encounter data were reviewed for prescribing and testing practices. Descriptive statistics and multivariable models assessed associations between patient and provider characteristics and rates of prescribing and testing. RESULTS Data for 164 195 patients from 230 providers were included in the study. Sixteen percent (n = 25 629) of patients had an encounter that involved potentially unnecessary diagnostic testing and treatment. A minority of providers contributed to above-average rates of prescribing and testing: 29% (n = 69) of providers prescribed antibiotics for a viral indication,11% (n = 24) prescribed an antipsychotic to a patient diagnosed with dementia, 9% (n = 24) ordered prostate-specific antigen tests and 14% (n = 34) ordered vitamin D tests at above-average rates, respectively. Patient and provider characteristics were associated with each of the prescribing and testing practices assessed. INTERPRETATION This study demonstrated that fewer than 30% of primary care providers contributed to interventions in direct contradiction to Choosing Wisely Canada recommendations. Improvement strategies specific to each prescription or testing recommendation should target specific providers to prevent patient harm and reduce unnecessary health care spending.
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Affiliation(s)
- Alexander Singer
- Departments of Family Medicine (Singer, Kosowan, Katz, Jolin-Dahel, Appel) and Community Health Sciences (Katz, Lix), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Manitoba Primary Care Research Network (Singer); Manitoba Centre for Health Policy (Katz), Winnipeg, Man.; Centre Medical Seine (Jolin-Dahel), Ste. Anne, Man.; Seven Oaks Hospital (Appel), Winnipeg, Man
| | - Leanne Kosowan
- Departments of Family Medicine (Singer, Kosowan, Katz, Jolin-Dahel, Appel) and Community Health Sciences (Katz, Lix), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Manitoba Primary Care Research Network (Singer); Manitoba Centre for Health Policy (Katz), Winnipeg, Man.; Centre Medical Seine (Jolin-Dahel), Ste. Anne, Man.; Seven Oaks Hospital (Appel), Winnipeg, Man.
| | - Alan Katz
- Departments of Family Medicine (Singer, Kosowan, Katz, Jolin-Dahel, Appel) and Community Health Sciences (Katz, Lix), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Manitoba Primary Care Research Network (Singer); Manitoba Centre for Health Policy (Katz), Winnipeg, Man.; Centre Medical Seine (Jolin-Dahel), Ste. Anne, Man.; Seven Oaks Hospital (Appel), Winnipeg, Man
| | - Kheira Jolin-Dahel
- Departments of Family Medicine (Singer, Kosowan, Katz, Jolin-Dahel, Appel) and Community Health Sciences (Katz, Lix), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Manitoba Primary Care Research Network (Singer); Manitoba Centre for Health Policy (Katz), Winnipeg, Man.; Centre Medical Seine (Jolin-Dahel), Ste. Anne, Man.; Seven Oaks Hospital (Appel), Winnipeg, Man
| | - Karen Appel
- Departments of Family Medicine (Singer, Kosowan, Katz, Jolin-Dahel, Appel) and Community Health Sciences (Katz, Lix), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Manitoba Primary Care Research Network (Singer); Manitoba Centre for Health Policy (Katz), Winnipeg, Man.; Centre Medical Seine (Jolin-Dahel), Ste. Anne, Man.; Seven Oaks Hospital (Appel), Winnipeg, Man
| | - Lisa M Lix
- Departments of Family Medicine (Singer, Kosowan, Katz, Jolin-Dahel, Appel) and Community Health Sciences (Katz, Lix), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Manitoba Primary Care Research Network (Singer); Manitoba Centre for Health Policy (Katz), Winnipeg, Man.; Centre Medical Seine (Jolin-Dahel), Ste. Anne, Man.; Seven Oaks Hospital (Appel), Winnipeg, Man
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49
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Manji J, Thamboo A, Sunkaraneni V, Singh A, Tebbutt S, Garnis C, Javer A. The association of Leptospermum honey with cytokine expression in the sinonasal epithelium of chronic rhinosinusitis patients. World J Otorhinolaryngol Head Neck Surg 2018; 5:19-25. [PMID: 30775697 PMCID: PMC6364513 DOI: 10.1016/j.wjorl.2018.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/06/2018] [Accepted: 07/18/2018] [Indexed: 01/09/2023] Open
Abstract
Objective To identify the differences in cytokine expression between sinonasal tissue from patients treated with Leptospermum (Manuka) honey (LH) irrigation versus normal saline irrigation twice-daily for twelve weeks following sinus surgery (FESS). Methods Forty-six CRS patients were recruited. Sinus tissue biopsies were collected during FESS and then at 5 and 12 weeks postoperatively during the course of treatment. A multi-plex cytokine assay quantified the abundance of 17 cytokines in biopsied tissue. Cytokine expression fold-change was analyzed between each time point using a robust linear regression model and compared between the two treatment groups. Results Compared to the saline irrigation group, five cytokines were differently expressed (CI = 95%) in sinonasal tissue obtained from subjects in the LH irrigation group during the 12-week treatment period. Cytokines IL-6 (P = 0.0400), IL-8 (P = 0.0398), MCP-1 (P = 0.0284), and MIP-1β (P = 0.016) were significantly increased in the LH irrigation group compared to the saline irrigation group. IL-13 was significantly increased in the saline irrigation group compared to the LH group (P = 0.0086). Conclusion LH may potentially act to modulate the expression of IL-6, IL-8, IL-13, MCP-1 and MIP-1β in sinonasal tissue.
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Affiliation(s)
- Jamil Manji
- St. Paul's Sinus Centre, Division of Otolaryngology, Department of Surgery, St. Paul's Sinus Centre, Vancouver, BC, Canada.,BC Cancer Research Centre, Division of Otolaryngology, Department of Surgery, Vancouver, BC, Canada
| | - Andrew Thamboo
- St. Paul's Sinus Centre, Division of Otolaryngology, Department of Surgery, St. Paul's Sinus Centre, Vancouver, BC, Canada
| | - Vishnu Sunkaraneni
- St. Paul's Sinus Centre, Division of Otolaryngology, Department of Surgery, St. Paul's Sinus Centre, Vancouver, BC, Canada.,Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Amrit Singh
- PROOF Centre of Excellence, St. Paul's Hospital, Vancouver, BC, Canada.,James Hogg Research Centre, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Scott Tebbutt
- PROOF Centre of Excellence, St. Paul's Hospital, Vancouver, BC, Canada.,James Hogg Research Centre, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Cathie Garnis
- BC Cancer Research Centre, Division of Otolaryngology, Department of Surgery, Vancouver, BC, Canada
| | - Amin Javer
- St. Paul's Sinus Centre, Division of Otolaryngology, Department of Surgery, St. Paul's Sinus Centre, Vancouver, BC, Canada
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50
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Mattos JL, Soler ZM, Rudmik L, Manes PR, Higgins TS, Lee J, Schneider J, Setzen M, Parasher AK, Smith TL, Stokken JK. A framework for quality measurement in the presurgical care of chronic rhinosinusitis: a review from the Quality Improvement Committee of the American Rhinologic Society. Int Forum Allergy Rhinol 2018; 8:1380-1388. [DOI: 10.1002/alr.22154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/23/2018] [Accepted: 05/14/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Jose L. Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; University of Virginia; Charlottesville VA
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary AB Canada
| | - Peter R. Manes
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery; Yale School of Medicine; New Haven CT
| | - Thomas S. Higgins
- Department of Otolaryngology-Head and Neck Surgery; University of Louisville; Louisville KY
| | - Jivianne Lee
- Department of Otolaryngology-Head and Neck Surgery University of California; Los Angeles David Geffen School of Medicine; Los Angeles CA
| | - John Schneider
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis MO
| | - Michael Setzen
- Department of Otolaryngology-Head and Neck Surgery; Weill Cornell University, College of Medicine; New York NY
| | - Arjun K. Parasher
- Department of Otolaryngology-Head and Neck Surgery; University of South Florida; Tampa FL
| | - Timothy L. Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University; Portland OR
| | - Janalee K. Stokken
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic, Rochester; MN
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