1
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Son S, An HG, Park JS, Kim SH, In SM, Kim JY, Lee S, Cha J, Lee JW, Lee KI. Delta neutrophil index levels can be a good indicator to predict patients with chronic rhinosinusitis who need surgery. EAR, NOSE & THROAT JOURNAL 2024; 103:NP360-NP367. [PMID: 34818928 DOI: 10.1177/01455613211058491] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Predicting the need for surgical treatment among patients with chronic rhinosinusitis (CRS) is challenging. The delta neutrophil index (DNI) has been proposed as a useful laboratory marker of immature granulocytes, which indicates infection or severe inflammation in several diseases. This study evaluated DNI as an early predictor of the need for surgery in patients with CRS. METHODS A total of 117 patients diagnosed with CRS were enrolled in this retrospective and observational study. Medical records, including symptoms data, WBC count, ESR level, LUC count, Lund-Mackay scores, and DNI, were reviewed. The receiver operating characteristic (ROC) curves were analyzed to determine the optimal cut-off values for predicting surgery. RESULTS Among 117 patients, 49 patients (41.9%) needed surgical intervention. The areas under the WBC, ESR, LUC, and DNI ROC curves were .571, .600, .592, and .782, respectively. The optimal cut-off value of DNI to predict surgery was .9%. The prognostic precision of DNI showed that the sensitivity was 59.2% and the specificity was 98.5%. In the analysis of risk factors, DNI levels were significantly associated with surgical intervention (odds ratio, 2.22; 95% confidence interval, 1.48-3.34; P < .01). CONCLUSIONS The level of DNI, which reflects the severity of the disease, may be a useful predictor for determining the need for surgical intervention in patients with CRS. This is the first literature to verify the role of DNI in upper airway disease.
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Affiliation(s)
- Sumin Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Hong Geun An
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Joong Su Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Seung Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Seung Min In
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Jong-Yeup Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, Republic of Korea
- Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Suehyun Lee
- Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Jaehun Cha
- Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Jong Wook Lee
- Department of Laboratory Medicine, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Ki-Il Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, Republic of Korea
- Myunggok Medical Research Institute, Konyang University College of Medicine, Daejeon, Republic of Korea
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2
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van der Lans RJL, Otten JJ, Adriaensen GFJPM, Hoven DR, Benoist LB, Fokkens WJ, Reitsma S. Two-year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months. Allergy 2023; 78:2684-2697. [PMID: 37394895 DOI: 10.1111/all.15796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/29/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Dupilumab is an anti-T2-inflammatory biological registered for chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), indicated by integrated CRS-care pathways when optimal medico-surgical treatment yields insufficient CRS control. This study aims to evaluate long-term results with focus on established therapeutic efficacy while tapering dupilumab. METHODS Real-life, prospective observational cohort study in single tertiary referral center with add-on dupilumab as primary biological treatment in adult (≥18 years) biological-naïve CRSwNP patients per the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS)2020-indication with a 2-year follow-up. Tapering (increasing interdose interval) applied every 24 weeks, conditional to sufficient treatment response and CRS control. RESULTS Mean scores (s.d.) of all co-primary outcomes improved significantly from baseline ( 228) to the 48 ( 214) and 96-weeks ( 99) timepoints: Nasal Polyp Score (0-8) improved from 5,3 (1,9) to 1,4 (1,8) and 1,3 (1,7); SinoNasal Outcome Test (SNOT)-22 (0-110) improved from 53,6 (19,6) to 20,2 (15,4) and 21,2 (15,6); Sniffin'Sticks-12 identification test (0-12; 0-6 anosmia, 7-10 hyposmia, 11-12 normosmia) improved from 3,7 (2,4) to 7,7 (2,9) and 7,3 (3,04); Asthma Control Test (5-25; >19 indicating well-controlled asthma) improved from 18,5 (4,8) to 21,8 (3,8) and 21,4 (3,9). Tapering was feasible in 79,5% of the patients at the 24-weeks timepoint, and in 93,7% and 95,8% at the 48- and 96-weeks timepoints, respectively. One-way repeated-measures ANOVA demonstrated no significant alterations of individual co-primary outcome mean-scores from 24 weeks onward. CONCLUSION This first long-term real-life prospective observational cohort study shows high therapeutic efficacy of dupilumab for severe CRswNP in the first 2 years. Therapeutic efficacy is principally established within 24 weeks and endures while tapering dupilumab conditional to treatment response and CRS control.
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Affiliation(s)
| | - Josje Janna Otten
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Dinand Rienk Hoven
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Linda Berendina Benoist
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wytske Johanna Fokkens
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sietze Reitsma
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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3
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Licari A, Andrenacci B, Di Cicco ME, Leone M, Marseglia GL, Tosca M. Respiratory comorbidities in severe asthma: focus on the pediatric age. Expert Rev Respir Med 2023; 17:1-13. [PMID: 36631726 DOI: 10.1080/17476348.2023.2168261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Asthma comorbidities are a frequent cause of adverse outcomes, such as poor asthma control, frequent asthma attacks, reduced quality of life, and higher healthcare costs. Comorbidities are well-known treatable traits whose proper management can help achieve optimal asthma control. Although multimorbidity is frequent among asthmatics, comorbidities are still a potential cause of misdiagnosis and under or over treatments, and little is known about their impact on severe pediatric asthma. AREAS COVERED We provided a comprehensive, 5-year updated review focusing on the main respiratory comorbidities in severe asthma, particularly in epidemiology, pathogenesis, and current and future therapies. EXPERT OPINION Respiratory comorbidities have unique characteristics in childhood. Their management must be multidisciplinary, age-specific, and integrated. Further longitudinal studies are needed to understand better the mutual interrelation and synergistic effect between asthma and its respiratory comorbidities, the identification of common, treatable risk factors leading to potential asthma prevention, the effectiveness of actual and future target-therapies, and the correlation between long-lasting respiratory comorbidities and poor lung function trajectories.
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Affiliation(s)
- Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Beatrice Andrenacci
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Maria Elisa Di Cicco
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pavia, Italy
| | | | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariangela Tosca
- Allergy Centre, IRCCS G. Gaslini Pediatric Hospital, Genova, Italy
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4
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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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5
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Yim MT, Smith KA, Alt JA, Orlandi RR. The value of endoscopic sinus surgery in chronic rhinosinusitis. Laryngoscope Investig Otolaryngol 2021; 6:58-63. [PMID: 33614930 PMCID: PMC7883602 DOI: 10.1002/lio2.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/25/2020] [Accepted: 01/11/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is a disease with significant impacts at both a societal and personal level. There has been an increase in emphasis on patient-centered care and patient outcomes, with value becoming a commonplace concept in health care systems. This review seeks to better define the value that endoscopic sinus surgery (ESS) provides in the treatment of CRS. DATA SOURCES PubMed literature review. REVIEW METHODS A review of published literature related to ESS and its effects on CRS patients from multiple perspectives (quality outcomes, patient satisfaction, cost-effectiveness) was integrated and analyzed through the viewpoint of a value equation. RESULTS ESS provides long-term quality outcomes in both patient-reported outcome measures (PROMs) as well as in objective metrics for patients refractory to medical therapy. The vast majority undergoing ESS are satisfied both in the short and long-term with their decision to pursue surgery. Treatment of CRS with ESS is generally more cost-effective than continued medical therapy (CMT), especially in refractory patients. Taken together, the combination of improved outcomes as well as patient satisfaction after ESS in relation to the costs of surgery provides significant quantifiable value to CRS patients. CONCLUSION ESS clearly provides value in the treatment of CRS. Understanding both quality and outcome metrics along with patient expectations and priorities will assist providers in generating a more personalized and value-based approach to patients with CRS. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Michael T. Yim
- Department of Otolaryngology – Head and Neck SurgeryLouisiana State University ShreveportShreveportLouisianaUSA
| | - Kristine A. Smith
- Section of Otolaryngology – Head and Neck SurgeryUniversity of ManitobaWinnipegCanada
| | - Jeremiah A. Alt
- Division of Otolaryngology – Head and Neck SurgeryUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Richard R. Orlandi
- Division of Otolaryngology – Head and Neck SurgeryUniversity of Utah HealthSalt Lake CityUtahUSA
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6
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Gallo S, Russo F, Mozzanica F, Preti A, Bandi F, Costantino C, Gera R, Ottaviani F, Castelnuovo P. Prognostic value of the Sinonasal Outcome Test 22 (SNOT-22) in chronic rhinosinusitis. ACTA ACUST UNITED AC 2021; 40:113-121. [PMID: 32469005 PMCID: PMC7256904 DOI: 10.14639/0392-100x-n0364] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 10/27/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Stefania Gallo
- Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi, Varese, Italy.,Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Federico Russo
- Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi, Varese, Italy
| | - Francesco Mozzanica
- Department of Otorhinolaryngology, IRCCS Multimedica, Ospedale San Giuseppe, Milano, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Andrea Preti
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Department of Otorhinolaryngology, IRCCS Multimedica, Ospedale San Giuseppe, Milano, Italy
| | - Francesco Bandi
- Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi, Varese, Italy
| | - Cecilia Costantino
- Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi, Varese, Italy
| | - Roberto Gera
- Department of Otorhinolaryngology, IRCCS Multimedica, Ospedale San Giuseppe, Milano, Italy
| | - Francesco Ottaviani
- Department of Otorhinolaryngology, IRCCS Multimedica, Ospedale San Giuseppe, Milano, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi, Varese, Italy.,Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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7
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Loss of bacterial diversity in the sinuses is associated with lower smell discrimination scores. Sci Rep 2020; 10:16422. [PMID: 33009469 PMCID: PMC7532173 DOI: 10.1038/s41598-020-73396-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022] Open
Abstract
Olfactory impairment affects ~ 20% of the population and has been linked to various serious disorders. Microbes in the nasal cavity play a key role in priming the physiology of the olfactory epithelium and maintaining a normal sense of smell by the host. The aim of this study was to explore the link between olfactory dysfunction and nasal bacterial communities. A total of 162 subjects were recruited for this study from a specialized olfactory dysfunction clinic and placed into one of three groups: anosmia, hyposmia or normosmia. Swabs from the nasal middle meatus were collected from each subject then processed for bacterial 16S rRNA gene sequencing. No overall differences in bacterial diversity or composition were observed between the three cohorts in this study. However, the relative abundances of Corynebacterium spp. and Streptococcus spp. were significantly (p < 0.05) different in subjects with olfactory loss. Furthermore, subjects with deficiencies in discriminating between smells (based on discrimination scores) had a lower bacterial diversity (Simpson’s evenness p < 0.05). While these results are preliminary in nature, potential bacterial biomarkers for olfactory loss were identified. These findings need to be further validated and biologically tested in animal models.
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8
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Li CH, Kaura A, Tan C, Whitcroft KL, Leung TS, Andrews P. Diagnosing nasal obstruction and its common causes using the nasal acoustic device: A pilot study. Laryngoscope Investig Otolaryngol 2020; 5:796-806. [PMID: 32904889 PMCID: PMC7461538 DOI: 10.1002/lio2.445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/06/2020] [Accepted: 07/25/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives There is a need to develop a medical device which can accurately measure normal and abnormal nasal breathing which the patient can better understand in addition to being able to diagnose the cause for their nasal obstruction. The aim is to evaluate the accuracy of the nasal acoustic device (NAD) in diagnosing the common causes for nasal obstruction and diagnosing normal and abnormal (nasal obstruction) nasal breathing. Methods This pilot study recruited 27 patients with allergic rhinitis (AR), chronic rhinosinusitis (CRS), and a deviated nasal septum (DNS) which represents the common causes for NO and 26 controls (with normal nasal breathing). Nasal breathing sounds were recorded by the NAD akin to two small stethoscopes placed over the left and right nasal ala. The novel outcome metrics for the NAD include inspiratory nasal acoustic score (INA) score, expiratory nasal acoustic (ENA) score and the inspiratory nasal obstruction balance index (NOBI). The change in acoustic score following decongestant is key in this diagnostic process. Results Pre‐decongestant ENA score was used to detect the presence of nasal obstruction in patients compared to controls, with a sensitivity of 0.81 (95% CI: 0.66‐0.96) and a specificity of 0.77 (0.54‐1.00). Post‐decongestant percentage change in INA score was used to identify the presence of AR or CRS, with a sensitivity of 0.87 (0.69‐1.00) and specificity of 0.72 (0.55‐0.89) for AR; and a sensitivity of 0.92 (0.75‐1.00) and specificity of 0.69 (0.52‐0.86) for CRS. Post‐decongestant inspiratory NOBI was used to identify DNS, with a sensitivity of 0.77 (0.59‐0.95) and specificity of 0.94 (0.82‐1.00). Conclusion We have demonstrated that the NAD can help distinguish between normal and abnormal nasal breathing and help diagnose AR, CRS, and DNS. Such a device has not been invented and could revolutionize COVID‐19 recovery telemedicine. Level of Evidence Diagnostic accuracy study—Level III.
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Affiliation(s)
- Chia-Hung Li
- Department of Medical Physics and Biomedical Engineering University College London London UK
| | - Anika Kaura
- Department of Rhinology and Facial Plastic Surgery Royal National Throat, Nose and Ear Hospital London UK.,UCL Ear Institute, University College London London UK
| | - Calvin Tan
- Department of Medical Physics and Biomedical Engineering University College London London UK.,UCL Medical School, Faculty of Medical Sciences University College London London UK
| | - Katherine L Whitcroft
- Department of Rhinology and Facial Plastic Surgery Royal National Throat, Nose and Ear Hospital London UK.,UCL Ear Institute, University College London London UK
| | - Terence S Leung
- Department of Medical Physics and Biomedical Engineering University College London London UK
| | - Peter Andrews
- Department of Rhinology and Facial Plastic Surgery Royal National Throat, Nose and Ear Hospital London UK.,UCL Ear Institute, University College London London UK
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9
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Workman AD, Xiao R, Feng A, Gadkaree SK, Quesnel AM, Bleier BS, Scangas GA. Suction mitigation of airborne particulate generated during sinonasal drilling and cautery. Int Forum Allergy Rhinol 2020; 10:1136-1140. [PMID: 32779883 PMCID: PMC7323193 DOI: 10.1002/alr.22644] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 01/21/2023]
Abstract
Background Coronavirus disease 2019 (COVID‐19) has significantly impacted endonasal surgery, and recent experimentation has demonstrated that sinonasal drilling and cautery have significant propensity for airborne particulate generation immediately adjacent to the surgical field. In the present investigation, we assessed nasopharyngeal suctioning as a mitigation strategy to decrease particulate spread during simulated endonasal surgical activity. Methods Airborne particulate generation in the 1‐µm to 10‐µm range was quantified with an optical particle sizer in real‐time during cadaveric‐simulated anterior and posterior endonasal drilling and cautery conditions. To test suction mitigation, experiments were performed both with and without a rigid suction placed in the contralateral nostril, terminating in the nasopharynx. Results Both anterior (medial maxillary wall and nasal septum) and posterior (sphenoid rostrum) drilling produced significant particulate generation in the 1‐µm to 10‐µm range throughout the duration of drilling (p < 0.001) without the use of suction, whereas nasopharyngeal suction use eliminated the detection of generated airborne particulate. A similar effect was seen with nasal cautery, with significant particle generation (p < 0.001) that was reduced to undetectable levels with the use of nasopharyngeal suction. Conclusion The use of nasopharyngeal suctioning via the contralateral nostril minimizes airborne particulate spread during simulated sinonasal drilling and cautery. In the era of COVID‐19, this technique offers an immediately available measure that may increase surgical safety.
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Affiliation(s)
- Alan D Workman
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Harvard Medical School, Boston, MA
| | - Roy Xiao
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Harvard Medical School, Boston, MA
| | - Allen Feng
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Harvard Medical School, Boston, MA
| | - Shekhar K Gadkaree
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Harvard Medical School, Boston, MA
| | - Alicia M Quesnel
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Harvard Medical School, Boston, MA
| | - Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Harvard Medical School, Boston, MA
| | - George A Scangas
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Harvard Medical School, Boston, MA
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10
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Workman AD, Jafari A, Welling DB, Varvares MA, Gray ST, Holbrook EH, Scangas GA, Xiao R, Carter BS, Curry WT, Bleier BS. Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID-19: Risks and Recommendations. Otolaryngol Head Neck Surg 2020; 163:465-470. [PMID: 32452739 PMCID: PMC7251624 DOI: 10.1177/0194599820931805] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE In the era of SARS-CoV-2, the risk of infectious airborne aerosol generation during otolaryngologic procedures has been an area of increasing concern. The objective of this investigation was to quantify airborne aerosol production under clinical and surgical conditions and examine efficacy of mask mitigation strategies. STUDY DESIGN Prospective quantification of airborne aerosol generation during surgical and clinical simulation. SETTING Cadaver laboratory and clinical examination room. SUBJECTS AND METHODS Airborne aerosol quantification with an optical particle sizer was performed in real time during cadaveric simulated endoscopic surgical conditions, including hand instrumentation, microdebrider use, high-speed drilling, and cautery. Aerosol sampling was additionally performed in simulated clinical and diagnostic settings. All clinical and surgical procedures were evaluated for propensity for significant airborne aerosol generation. RESULTS Hand instrumentation and microdebridement did not produce detectable airborne aerosols in the range of 1 to 10 μm. Suction drilling at 12,000 rpm, high-speed drilling (4-mm diamond or cutting burs) at 70,000 rpm, and transnasal cautery generated significant airborne aerosols (P < .001). In clinical simulations, nasal endoscopy (P < .05), speech (P < .01), and sneezing (P < .01) generated 1- to 10-μm airborne aerosols. Significant aerosol escape was seen even with utilization of a standard surgical mask (P < .05). Intact and VENT-modified (valved endoscopy of the nose and throat) N95 respirator use prevented significant airborne aerosol spread. CONCLUSION Transnasal drill and cautery use is associated with significant airborne particulate matter production in the range of 1 to 10 μm under surgical conditions. During simulated clinical activity, airborne aerosol generation was seen during nasal endoscopy, speech, and sneezing. Intact or VENT-modified N95 respirators mitigated airborne aerosol transmission, while standard surgical masks did not.
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Affiliation(s)
- Alan D Workman
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Aria Jafari
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - D Bradley Welling
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Stacey T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Eric H Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - George A Scangas
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Roy Xiao
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Bob S Carter
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William T Curry
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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11
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Liu Z, Chen J, Cheng L, Li H, Liu S, Lou H, Shi J, Sun Y, Wang D, Wang C, Wang X, Wei Y, Wen W, Yang P, Yang Q, Zhang G, Zhang Y, Zhao C, Zhu D, Zhu L, Chen F, Dong Y, Fu Q, Li J, Li Y, Liu C, Liu F, Lu M, Meng Y, Sha J, She W, Shi L, Wang K, Xue J, Yang L, Yin M, Zhang L, Zheng M, Zhou B, Zhang L. Chinese Society of Allergy and Chinese Society of Otorhinolaryngology-Head and Neck Surgery Guideline for Chronic Rhinosinusitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:176-237. [PMID: 32009319 PMCID: PMC6997287 DOI: 10.4168/aair.2020.12.2.176] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/05/2019] [Accepted: 11/13/2019] [Indexed: 02/05/2023]
Abstract
The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines-with a focus on China-will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.
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Affiliation(s)
- Zheng Liu
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianjun Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Cheng
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
| | - Huabin Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Shixi Liu
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Jianbo Shi
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Sun
- Department of Immunology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Dehui Wang
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Xiangdong Wang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Yongxiang Wei
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weiping Wen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Hospital, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pingchang Yang
- Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen, China
| | - Qintai Yang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Gehua Zhang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Changqing Zhao
- Department of Otolaryngology Head and Neck Surgery, The Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Dongdong Zhu
- Department of Otolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Li Zhu
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, China
| | - Fenghong Chen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Dong
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Qingling Fu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingyun Li
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Yanqing Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Chengyao Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Feng Liu
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Meiping Lu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yifan Meng
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Jichao Sha
- Department of Otolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wenyu She
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lili Shi
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kuiji Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Jinmei Xue
- Department of Otolaryngology Head and Neck Surgery, The Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Luoying Yang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min Yin
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
| | - Lichuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ming Zheng
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Bing Zhou
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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12
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Rowan NR, Naclerio RM. Persistence of Sinonasal Disease Despite Mepolizumab. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1550-1555. [PMID: 32032756 DOI: 10.1016/j.jaip.2020.01.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 01/26/2023]
Abstract
The treatment paradigm for the management of chronic rhinosinusitis with nasal polyposis (CRSwNP) is currently undergoing a rapid evolution with the development of monoclonal antibody therapies targeted at type 2 inflammatory pathways. The use of these biologic therapies in asthmatic patients, and more recently, patients with CRSwNP has produced promising results, especially for patients with severe disease. Many questions regarding the appropriate timing of these medications, whether or not these new treatment strategies should be used as a monotherapy or in conjunction with traditional therapies such as sinus surgery, the role of appropriate phenotyping, and identification of biomarkers, remain unanswered. We herein present a case of a patient with severe eosinophilic asthma and comorbid CRSwNP who failed to achieve control of his respiratory symptomology and ultimately progressed to sinus surgery despite treatment with an anti-interleukin 5 monoclonal antibody therapy (mepolizumab). Consideration is given to the mechanistic underpinnings of the reported patient's failure. This case highlights the need for further understanding of the optimal usage of these novel therapeutics in the management of CRSwNP and in the need to better understand the pathophysiology of CRSwNP.
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Affiliation(s)
- Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Robert M Naclerio
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md
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13
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Donnell NJ, Marino MJ, Zarka MA, Lal D. Histopathological characteristics of surgical tissue from primary vs recurrent chronic rhinosinusitis with nasal polyposis patients. Laryngoscope Investig Otolaryngol 2020; 5:5-10. [PMID: 32128424 PMCID: PMC7042647 DOI: 10.1002/lio2.358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The histopathological characteristics of primary vs recurrent nasal polyps in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have not been studied comprehensively. Identification of these features may be helpful for prognostication, postoperative management, and consideration of novel eosinophil-targeting biologic therapy. This study investigates the histopathological differences in primary vs recurrent CRSwNP tissue. METHODS Patients undergoing endoscopic sinus surgery for CRSwNP were included if all 13 histopathological and mucin characteristics on a standardized report were available. Histopathology parameters were compared in surgical tissue and mucin from primary vs recurrent CRSwNP. RESULTS Complete structured histopathology reports were available for 96 patients (39 primary polyps and 57 recurrent polyps). Compared to primary polyp tissue, recurrent CRSwNP mucin was significantly more likely to feature eosinophil aggregates (57.9% vs 35.9%; P = .047). Tissue eosinophilia (using a threshold >10 per high power field [HPF]) was not significantly different in primary and recurrent CRSwNP tissue. Other histopathologic parameters and clinical characteristics were similar. CONCLUSION Eosinophil aggregates on histopathology are significantly more likely to be present in recurrent CRSwNP. In the limited series, tissue eosinophilia (>10 per HPF) was not significantly different in primary and recurrent CRSwNP. Therefore, in addition to the study of tissue eosinophilia levels, Rhinologic surgeons should also direct attention to CRSwNP mucin. Mucin eosinophilic aggregates are an independent marker of severe inflammation that is associated more likely with recurrent vs primary polyposis. Further study of this marker may help determine its role of choice of postoperative medical therapies, including anti-eosinophilic biologics. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | - Michael J. Marino
- Department of Otorhinolaryngology ‐ Head & Neck SurgeryMayo ClinicPhoenixArizona
| | | | - Devyani Lal
- Department of Otorhinolaryngology ‐ Head & Neck SurgeryMayo ClinicPhoenixArizona
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14
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Kariya S, Okano M, Higaki T, Makihara S, Tachibana T, Nishizaki K. Long-term treatment with clarithromycin and carbocisteine improves lung function in chronic cough patients with chronic rhinosinusitis. Am J Otolaryngol 2020; 41:102315. [PMID: 31732313 DOI: 10.1016/j.amjoto.2019.102315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Chronic cough is a common complaint. Because the pathophysiology of chronic cough is complicated, the management of chronic cough is challenging. To the best of our knowledge, no previous study has examined the effect of macrolide antibiotics in chronic cough patients with chronic rhinosinusitis. The purpose of this study is to determine the changes in lung function for chronic cough patients with chronic rhinosinusitis who are treated by clarithromycin and carbocisteine. MATERIALS AND METHODS Thirty-two chronic cough patients with chronic rhinosinusitis were recruited. Patients using inhaled corticosteroids and/or a bronchodilator, asthmatic patients, and patients with abnormal findings on auscultation and/or chest X-ray examination were excluded from this study. The patients received low-dose clarithromycin treatment for 3 months. Both before and after the treatment, a computed tomography (CT) scan of the paranasal sinuses, lung function test, peripheral blood test, and sino-nasal outcome test (SNOT-20) were applied. RESULTS Both the lung function and Lund-MacKay CT scores were improved by the long-duration therapy with macrolide antibiotics. The change in obstructive pulmonary function and the improvement of the CT score in each subject were significantly correlated. SNOT scores also improved after the treatment. CONCLUSIONS The macrolide antibiotics treatment has beneficial effects on lung function in non-asthmatic chronic cough patients with normal chest X-ray findings. The improvement of chronic rhinosinusitis may have some role in the lung condition. Upper respiratory tract examination and treatment may be useful for the management of chronic cough.
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Affiliation(s)
- Shin Kariya
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Mitsuhiro Okano
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Otorhinolaryngology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Takaya Higaki
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seiichiro Makihara
- Department of Otolaryngology-Head and Neck Surgery, Kagawa Rosai Hospital, Marugame, Japan
| | | | - Kazunori Nishizaki
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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15
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Fokkens WJ, Lund V, Bachert C, Mullol J, Bjermer L, Bousquet J, Canonica GW, Deneyer L, Desrosiers M, Diamant Z, Han J, Heffler E, Hopkins C, Jankowski R, Joos G, Knill A, Lee J, Lee SE, Mariën G, Pugin B, Senior B, Seys SF, Hellings PW. EUFOREA consensus on biologics for CRSwNP with or without asthma. Allergy 2019; 74:2312-2319. [PMID: 31090937 PMCID: PMC6972984 DOI: 10.1111/all.13875] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/11/2019] [Accepted: 04/14/2019] [Indexed: 12/12/2022]
Abstract
Novel therapies such as type 2 targeting biologics are emerging treatment options for patients with chronic inflammatory respiratory diseases, fulfilling the needs of severely uncontrolled patients. The majority of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and over half of patients with asthma show a type 2 inflammatory signature in sinonasal mucosa and/or lungs. Importantly, both chronic respiratory diseases are frequent comorbidities, ensuring alleviation of both upper and lower airway pathology by systemic biological therapy. Type 2-targeting biologics such as anti-IgE, anti-IL4Rα, anti-IL5, and anti-IL5Rα have entered the market for selected pheno/endotypes of asthma patients and may soon also become available for CRSwNP patients. Given the high prevalence of chronic respiratory diseases and the high cost associated with biologics, patient selection is crucial in order to implement such therapies into chronic respiratory disease care pathways. The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) organized a multidisciplinary Expert Board Meeting to discuss the positioning of biologics into the care pathways for CRSwNP patients with and without comorbid asthma.
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Affiliation(s)
- Wytske J. Fokkens
- Department of OtorhinolaryngologyAmsterdam University Medical Centres, Location AMC AmsterdamAmsterdamThe Netherlands
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
| | - Valerie Lund
- Royal National Throat, Nose and Ear HospitalUniversity College London HospitalsLondonUK
| | - Claus Bachert
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
- Upper Airways Research LaboratoryUniversity of GhentGentBelgium
- Division of ENT Diseases, CLINTECKarolinska Institute, and Department of ENT DiseasesKarolinska University HospitalStockholmSweden
| | - Joaquim Mullol
- Department of Otorhinolaryngology, Hospital ClínicUniversitat de Barcelona, IDIBAPS, CIBERESBarcelona, CataloniaSpain
| | - Leif Bjermer
- Department of Respiratory Medicine and AllergologyLund UniversityLundSweden
| | - Jean Bousquet
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
- Department of Respiratory DiseaseUniversity Hospital Arnaud de VilleneuveMontpellierFrance
| | - Giorgio W. Canonica
- Personalized Medicine, Asthma & Allergy - Humanitas Clinical and Research Center IRCCSRozzano (MI)Italy
- Department of Biomedical ScienceHumanitas UniversityPieve Emanuele (MI)Italy
| | - Lauren Deneyer
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
| | - Martin Desrosiers
- Division of Otolaryngology‐Head & Neck SurgeryUniversity of Montreal Hospital Centre (CHUM)MontrealQuebecCanada
| | - Zuzana Diamant
- Department of Respiratory Medicine and AllergologyLund UniversityLundSweden
- Department of Clinical Pharmacy & Pharmacology and Department of General PracticeUMCG, and QPS‐NLGroningenThe Netherlands
- Department of Respiratory Medicine, First Faculty of MedicineCharles University and Thomayer HospitalPragueCzech Republic
| | - Joseph Han
- Department of Otolaryngology, Head & Neck SurgeryEastern Virginia Medical SchoolNorfolkVirginia
| | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy - Humanitas Clinical and Research Center IRCCSRozzano (MI)Italy
- Department of Biomedical ScienceHumanitas UniversityPieve Emanuele (MI)Italy
| | | | - Roger Jankowski
- ENT DepartmentUniversity Hospital of Nancy, Brabois-ILMNancyFrance
| | - Guy Joos
- Department of Respiratory MedicineGhent University HospitalGentBelgium
| | | | - Jivianne Lee
- Rhinology & Endoscopic Skull Base SurgeryUCLA Department of Head & Neck SurgeryLos AngelesCalifornia
| | - Stella E. Lee
- Division of Sinonasal Disorders and Allergy, Department of Otolaryngology—Head & Neck SurgeryUniversity of Pittsburgh School of MedicinePittsburghPennsylvania, USA
| | - Gert Mariën
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
| | - Benoit Pugin
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
- Department of Microbiology, Immunology and TransplantationAllergy and Clinical Immunology Research GroupLeuvenBelgium
| | - Brent Senior
- Division of Rhinology, Allergy, and Endoscopic Skull Base SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
| | - Sven F. Seys
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
- Department of Microbiology, Immunology and TransplantationAllergy and Clinical Immunology Research GroupLeuvenBelgium
| | - Peter W. Hellings
- Department of OtorhinolaryngologyAmsterdam University Medical Centres, Location AMC AmsterdamAmsterdamThe Netherlands
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)BrusselsBelgium
- Department of Microbiology, Immunology and TransplantationAllergy and Clinical Immunology Research GroupLeuvenBelgium
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity Hospitals LeuvenLeuvenBelgium
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16
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Epperson MV, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Predictors of efficacy for combination oral and topical corticosteroids to treat patients with chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2019; 9:1436-1442. [PMID: 31609091 DOI: 10.1002/alr.22431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/05/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND A short-course oral corticosteroid taper and topical intranasal corticosteroids may be used to maximize the success of medical management for chronic rhinosinusitis with nasal polyps (CRSwNP). In this study, we sought to identify characteristics that would be predictive of efficacy for this combination regimen. METHODS Sixty-four patients with CRS, bilateral polyps, a polyp score of at least 3, and a 22-item Sino-Nasal Outcome Test (SNOT-22) score ≥20 were prospectively enrolled and uniformly treated with a 15-day prednisone taper and twice daily dilute budesonide irrigations. Participants were assessed at enrollment and at follow up, 2 to 5 months later. Clinical and demographic characteristics were assessed at enrollment. At both time points, CRS symptoms were assessed with SNOT-22, and polyp score (range, 0 to 6) was assessed endoscopically. Associations were determined with regression. RESULTS Pretreatment SNOT-22 score (adjusted β = -0.83; 95% CI, -1.08 to -0.58; p < 0.001) and comorbid asthma (adjusted β = 15.75; 95% CI, 4.74 to 26.75; p = 0.007) were associated with a change in SNOT-22 experienced over the study period. Achieving a greater-than-1 minimal clinically important difference (MCID) improvement in SNOT-22 score was also associated with pretreatment SNOT-22 score (adjusted OR = 1.09; 95% CI, 1.04 to 1.14; p < 0.001) and comorbid asthma (adjusted OR = 0.13; 95% CI, 0.03 to 0.72; p = 0.019). SNOT-22 score ≥47 had 81.5% sensitivity and 78.4% specificity to detect patients experiencing 1 MCID improvement. Pretreatment polyp score was not associated with any outcome metric. CONCLUSION In treatment of CRSwNP with prednisone and budesonide irrigations, pretreatment endoscopy was not informative of treatment response. Pretreatment SNOT-22 and comorbid asthma may be more predictive.
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Affiliation(s)
- Madison V Epperson
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA
| | - David S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
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17
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Walker A, Philpott C, Hopkins C. What is the most appropriate treatment for chronic rhinosinusitis? Postgrad Med J 2019; 95:493-496. [DOI: 10.1136/postgradmedj-2019-136519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/22/2019] [Indexed: 12/13/2022]
Abstract
Chronic rhinosinusitis (CRS) is a common, treatable disease that affects approximately 11% of British adults. It places an enormous burden on patients, with significant detriment to their quality of life, and the health service as it consumes vast numbers of both primary and secondary care resources. However, there is considerable variability in treatment strategies and prescribing practices. This review summarises the key recommendations from landmark guidelines in the treatment of CRS and critically appraises the evidence for treatment.
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18
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Fokkens WJ, Reitsma S. Medical algorithms: Management of chronic rhinosinusitis. Allergy 2019; 74:1415-1416. [PMID: 30916791 DOI: 10.1111/all.13797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Wytske J. Fokkens
- Department of Otorhinolarynogology, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Sietze Reitsma
- Department of Otorhinolarynogology, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
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19
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Wang F, Yang Y, Wu Q, Chen H. Histopathologic analysis in chronic rhinosinusitis: Impact on quality of life outcomes. Am J Otolaryngol 2019; 40:423-426. [PMID: 30926262 DOI: 10.1016/j.amjoto.2019.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/20/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study investigates the impact of histopathologic parameters on quality of life outcomes in patients with chronic rhinosinusitis. SETTING Hospital of Zhejiang University. STUDY DESIGN Retrospective analysis of collected data. SUBJECTS AND METHODS One hundred and twenty patients with chronic rhinosinusitis (CRS) who underwent endoscopic sinus surgery were recruited. Clinical features, CT evaluation, pre and postoperative SNOT-22 scores and histopathologic findings were collected. Tissue eosinophils and mucosal remodeling were analyzed relative to clinical features and outcomes 12 months postoperatively. RESULTS Symptom improvement was seen for the entire population. Eosinophilic CRS had significantly worse preoperative and postoperative SNOT-22 scores than non- eosinophilic CRS. Symptom improvement in eosinophilic CRS after surgery was less than that of non-eosinophilic CRS. There was no significant association between preoperative and postoperative SNOT-22 scores and remodeling markers. However, patients with basement membrane thickening showed less reductions of SNOT-22 score postoperatively. CONCLUSIONS Presence of mucosal eosinophilia and basal membrane thickening appear to be the main factors adversely affect the symptom control of surgical intervention. Routine histopathology analysis can provide meaningful information for prognostication of surgical outcome.
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Asthma and Chronic Rhinosinusitis: Diagnosis and Medical Management. Med Sci (Basel) 2019; 7:medsci7040053. [PMID: 30934800 PMCID: PMC6524348 DOI: 10.3390/medsci7040053] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/17/2022] Open
Abstract
Asthma is a prevalent inflammatory condition of the lower airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchial hyperresponsiveness (BHR). Symptomatically, these patients may demonstrate wheezing, breathlessness, chest tightness, and coughing. This disease is a substantial burden to a growing population worldwide that currently exceeds 300 million individuals. This is a condition that is frequently encountered, but often overlooked in the field of otolaryngology. In asthma, comorbid conditions are routinely present and contribute to respiratory symptoms, decreased quality of life, and poorer asthma control. It is associated with otolaryngic diseases of the upper airways including allergic rhinitis (AR) and chronic rhinosinusitis (CRS). These conditions have been linked epidemiologically and pathophysiologically. Presently, they are considered in the context of the unified airway theory, which describes the upper and lower airways as a single functional unit. Thus, it is important for otolaryngologists to understand asthma and its complex relationships to comorbid diseases, in order to provide comprehensive care to these patients. In this article, we review key elements necessary for understanding the evaluation and management of asthma and its interrelatedness to CRS.
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Marino MJ, Luong A, Yao WC, Citardi MJ. Nonpharmacological Relaxation Technology for Office-Based Rhinologic Procedures. ORL J Otorhinolaryngol Relat Spec 2019; 81:48-54. [PMID: 30836361 DOI: 10.1159/000488323] [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: 01/12/2018] [Accepted: 03/12/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Office-based rhinologic procedures are increasingly performed to control costs and enhance patient convenience. Adequate management of pain and anxiety is essential for the technical performance of these procedures, in addition to ensuring patient comfort. Pharmacologic agents are often used to manage anxiety and pain. Nonpharmacological adjuncts may be useful for achieving these effects without oral opioids and benzodiazepines. METHODS Charts of patients who underwent office-based rhinologic procedures with the NuCalm system (Solace Lifesciences, Inc., Wilmonton, DE, USA) in combination with local anesthesia were reviewed. NuCalm is a proprietary system that combines cranial electrotherapy stimulation, neuroacoustic software, light-blocking lenses, and topical γ--aminobutyric acid. Patients rated their pain and anxiety before, during, and after the procedure. RESULTS Twenty-five patients underwent office procedures using the NuCalm system. Preoperative anxiety (2.00) was significantly higher than postoperative anxiety (1.25) according to patient reporting on a 5-point scale (p = 0.005). Preoperative pain (1.83) was not significantly different from intraoperative (2.54) and postoperative pain (2.04, p = 0.054). CONCLUSIONS A variety of office-based rhinologic procedures are technically feasible and can be performed with adequate patient comfort without the use of oral drugs. Adjuncts to pharmacologic agents may enhance pain control and anxiety management and improve patient tolerance of these procedures.
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Affiliation(s)
- Michael J Marino
- Department of Otorhinolaryngology - Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA,
| | - Amber Luong
- Department of Otorhinolaryngology - Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - William C Yao
- Department of Otorhinolaryngology - Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology - Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Ramakrishnan VR, Mace JC, Soler ZM, Smith TL. Is greater antibiotic therapy prior to ESS associated with differences in surgical outcomes in CRS? Laryngoscope 2019; 129:558-566. [PMID: 30582166 PMCID: PMC6402589 DOI: 10.1002/lary.27651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 08/01/2018] [Accepted: 09/04/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Antibiotics have been a mainstay of chronic rhinosinusitis therapy; however, data suggest that antibiotics may also result in several adverse unintended consequences. We aimed to evaluate if greater antibiotic use prior to sinus surgery was associated with differences in surgical outcomes. METHODS Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study were asked to recall systemic antibiotic use in the 90 days prior to endoscopic sinus surgery (ESS). Antibiotic use was examined in relation to demographics, disease characteristics, and outcomes. RESULTS Data were collected for 271 study participants followed for a mean of 14.9 [± 5.1] months across four institutions, with a mean preoperative antibiotic use of 27.8 [± 22.7] days out of the 90 preceding ESS. After ESS, significant improvement (P < 0.001) was reported for patient-reported outcome measures and endoscopy scores for the overall cohort. No bivariate correlation between preoperative antibiotic use and degree of benefit in objective clinical measures (endoscopy, Brief Smell Identification Test) was seen. Increased preoperative antibiotic use was associated with less improvement in 22-item SinoNasal Outcome Test (SNOT-22) and its rhinologic subdomain after ESS. Prevalence of achieving a minimal clinically important difference in overall SNOT-22 symptom scores was lower in those using more preoperative antibiotics, although statistical significance was not reached when adjusting for independent covariates in multivariate modeling. CONCLUSION Higher amounts of previous antibiotic use do not appear to be associated with better ESS outcomes. Specific recommendations for antibiotic use as part of CRS-appropriate medical therapy prior to ESS require further study, particularly given concerns for antibiotic overuse and implications for improving outcomes in the modern healthcare era. LEVEL OF EVIDENCE 2C Laryngoscope, 129:558-566, 2019.
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Affiliation(s)
| | - Jess C. Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
| | - Zachary M. Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Timothy L. Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
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24
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Vlastos I, Gkouskou K, Doulaptsi M, Karatzanis A, Prokopakis EP. Precision Medicine in Rhinosinusitis. Curr Allergy Asthma Rep 2019; 19:12. [PMID: 30793224 DOI: 10.1007/s11882-019-0850-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Our scope is the presentation of research and clinical progresses in relation to precision medicine that are expected to alter our clinical practice in relation to chronic rhinosinusitis (CRS). Current knowledge on phenotypes and endotypes, biomarkers, and clinical markers for diagnosis, medical and surgical therapy, and prognosis is presented as well as the role of precision medicine in United Airway Disease and SCUAD (severe-uncontrolled chronic upper airway inflammation). RECENT FINDINGS Current technological progresses, mostly in relation to molecular biology and information technology, have permitted more detailed pathophysiological assessments and multidimensional approaches in airways diseases. Based on the concept of united airways diseases, new classification schemes, called endotypes, have been proposed for CRS. In addition, novel biological treatments that have been introduced for the treatment of asthma show great promise as well for severe uncontrolled cases of CRS with nasal polyps. Central to this approach are new biomarkers that are being examined in relation to complex bio-clinical traits of CRS. As this narrative review of the aforementioned precision medicine initiatives in relation to CRS advances, a modification of current practice is expected not only for severe chronic upper airways diseases in tertiary centers but also for milder and more common cases that are being encountered in the community.
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Affiliation(s)
- Ioannis Vlastos
- ENT Private Practice, 29 Voreiou Ipeirou str, Athens, Greece
| | - Kalliopi Gkouskou
- Embiodiagnostics Biology Research Company, Melissinon and Damvergidon str, Heraklion, Crete, Greece
| | - Maria Doulaptsi
- Department of Otorhinolaryngology, University Hospital of Crete, A Building 3rd Floor, University avenue, 71110, Heraklion, Crete, Greece
| | - Alexander Karatzanis
- Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Emmanuel P Prokopakis
- Department of Otorhinolaryngology, University Hospital of Crete, A Building 3rd Floor, University avenue, 71110, Heraklion, Crete, Greece. .,Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece.
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25
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Smith KA, Orlandi RR, Oakley G, Meeks H, Curtin K, Alt JA. Long-term revision rates for endoscopic sinus surgery. Int Forum Allergy Rhinol 2018; 9:402-408. [PMID: 30570840 DOI: 10.1002/alr.22264] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/30/2018] [Accepted: 11/03/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Reported revision rates for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) vary significantly. Several investigations examining revision rates for ESS have been limited by duration of follow-up, academic centers, or small surgeon cohorts. The objective of this study was to define the long-term revision rates for ESS and to determine those unique patient factors that increase the risk of revision ESS. METHODS The Utah Population Database was queried for Current Procedural Terminology codes for ESS from 1996 to 2016. Patient demographics and comorbid diagnoses were collected. Revision rates and risk factors for surgery were determined by Cox proportional hazard modeling. RESULTS A total of 29,934 patients were identified, with a mean length of follow-up of 9.7 years. The long-term revision rate was found to be 15.9%. The mean time between surgeries decreased with higher number of revision surgeries. The time between the first and second surgery was 4.39 years and the time between the fourth and fifth surgery decreased to 2.18 years. Female gender, older age at first surgery, nasal polyps, comorbid asthma, allergy, and a family history of CRS all increased the risk of requiring revision surgery (p < 0.001). CONCLUSION The long-term revision rate for ESS exceeds 15% and the time between revision surgeries decreased with each additional surgery being performed. Unique patient factors increased the risk of requiring revision ESS. Understanding patients' risk for revision surgery may help physicians select and counsel patients with CRS undergoing ESS.
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Affiliation(s)
- Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Richard R Orlandi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Gretchen Oakley
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Huong Meeks
- Department of Medicine, University of Utah, Salt Lake City, UT.,Pedigree and Population Resource, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Karen Curtin
- Department of Medicine, University of Utah, Salt Lake City, UT.,Pedigree and Population Resource, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
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26
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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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27
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Yip J, Hao W, Eskander A, Lee JM. Wait times for endoscopic sinus surgery influence patient‐reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria. Int Forum Allergy Rhinol 2018; 9:396-401. [DOI: 10.1002/alr.22257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/16/2018] [Accepted: 11/13/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Jonathan Yip
- Division of Rhinology, Department of Otolaryngology–Head and Neck Surgery, St. Michael's HospitalUniversity of Toronto Toronto ON Canada
| | - Weibo Hao
- Division of Rhinology, Department of Otolaryngology–Head and Neck Surgery, St. Michael's HospitalUniversity of Toronto Toronto ON Canada
| | - Antoine Eskander
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron HospitalUniversity of Toronto Toronto ON Canada
| | - John M. Lee
- Division of Rhinology, Department of Otolaryngology–Head and Neck Surgery, St. Michael's HospitalUniversity of Toronto Toronto ON Canada
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28
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Beswick DM, Gray ST, Smith TL. Pharmacological Management of Chronic Rhinosinusitis: Current and Evolving Treatments. Drugs 2018; 77:1713-1721. [PMID: 28853058 DOI: 10.1007/s40265-017-0803-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Chronic rhinosinusitis (CRS) is an inflammatory sinonasal condition with multiple etiologic factors that is associated with a vast economic cost. Treatment is most frequently pharmacologic and has centered on agents that ameliorate inflammation, decrease bacterial or pathogen load, and facilitate egress of mucus or purulence from the sinonasal cavity. Nasal saline irrigations, topical nasal steroids, certain antibiotics, and systemic steroids have shown some efficacy in the management of CRS. Recently, biologic therapeutics that target specific inflammatory pathways associated with subsets of CRS have been developed and evaluated. Early data evaluating these biologic treatments suggest a potential role in treating a subset of CRS with refractory, poorly controlled disease. Additional studies are necessary to identify which patients would benefit most from biologic therapies and to assess the cost of these therapies compared with the benefit they provide. This review describes the pathophysiology of CRS and summarizes both established and novel biologic pharmacologic treatments.
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Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Timothy L Smith
- Department of Otolaryngology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
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29
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Lee JT, DelGaudio J, Orlandi RR. Practice Patterns in Office-Based Rhinology: Survey of the American Rhinologic Society. Am J Rhinol Allergy 2018; 33:26-35. [PMID: 30306790 DOI: 10.1177/1945892418804904] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Recent years have witnessed significant expansion in office-based rhinology. This study assesses practice patterns of the American Rhinologic Society (ARS) membership regarding office-based rhinologic procedures. METHODS A 24-item survey was disseminated to the ARS membership from March 15 to May 31, 2016. RESULTS A total of 157 physicians (11.9%) completed the survey. Office-based rhinologic procedures were performed by 99% of respondents, with sinonasal debridements (99%), polypectomy (77%), and balloon sinus ostial dilation (56%) being the most common. During a typical month, the number of sinonasal debridements was 0-10 in 23%, 11-20 in 34%, 21-30 in 26%, and >30 in 18%. For polypectomy, 57% of the respondents utilized a microdebrider (reusable electric-24%, disposable vacuum-powered-21%, and both-12%), 36% endoscopic forceps, and 7% a combination of both. With respect to balloon ostial dilation, the frontal sinuses were the most frequently addressed (53%) followed by the maxillary (46%) and sphenoid (39%) sinuses. In-office ethmoidectomies, antrostomies, sphenoidotomies, and frontal sinusotomies without the use of the balloon were performed by 35%, 31%, 24%, and 21% of the respondents, respectively. Thirty percent of respondents used steroid-eluting sinus implants and 10% used computer-assisted surgical navigation in the office setting. Overall, 63% of respondents reported that the number of office-based rhinologic procedures they performed had increased over the last 5 years. CONCLUSIONS The present study illustrates the integration of office procedures into rhinologic clinical practice among ARS survey respondents. With ongoing technologic innovations, the scope of office-based rhinology will likely continue to expand in the years to come.
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Affiliation(s)
- Jivianne T Lee
- 1 Department of Head & Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - John DelGaudio
- 2 Department of Otolaryngology-Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Richard R Orlandi
- 3 Division of Otolaryngology-Head & Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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30
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Alt JA, Orlandi RR, Mace JC, Soler ZM, Smith TL. Does Delaying Endoscopic Sinus Surgery Adversely Impact Quality-of-Life Outcomes? Laryngoscope 2018; 129:303-311. [PMID: 30208208 DOI: 10.1002/lary.27473] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/05/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES There is little consensus regarding the prognostic value of symptom duration in predicting clinical disease severity or quality-of-life (QOL) outcomes in patients with chronic rhinosinusitis (CRS). Our objectives were to: 1) determine if patients with longer symptom duration have worse preoperative disease severity and/or QOL, and 2) determine if delayed surgical intervention influences outcomes of endoscopic sinus surgery (ESS). METHODS Patients diagnosed with CRS were prospectively enrolled into a multicenter cohort study and observed 14.7 (standard deviaton {SD} ± 4.8) months on average following primary ESS. Preoperative symptom duration was stratified into short-term (< 12 months), middle-term (12-60 months), and long-term (> 60 months). Disease severity was assessed using endoscopy and computed tomography. Disease-specific QOL was measured with the 22-item Sinonasal Outcome Test (SNOT-22) and Rhinosinusitis Disability Index. Adjusted bivariate and multivariate associations between symptom duration, disease severity, and QOL scores were evaluated. RESULTS One hundred and thirteen patients met inclusion criteria with 35 patients lost to postoperative follow-up. No significant differences in preoperative disease severity or QOL scores were reported between symptom duration subgroups. Participants in the long-term symptom subgroup reported significantly greater mean postoperative improvement on SNOT-22 total scores (n = 28; -36.3[± 22.2]) compared to both short-term (n = 27; -23.4[SD ± 11.3]; P = 0.039) and middle-term (n = 23; -23.5[SD ± 20.1]; P = 0.050) subgroups. Postoperative QOL improvements in the long-term symptom subgroup remained significantly greater (P ≤ 0.036) after multivariate adjustment. CONCLUSIONS Symptom duration was not associated with mean preoperative disease severity or QOL. Patients with long-term symptom duration reported the greatest mean postoperative QOL improvement, suggesting that delayed surgical intervention may not reduce QOL improvements following ESS. LEVEL OF EVIDENCE 2c Laryngoscope, 129:303-311, 2019.
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Affiliation(s)
- Jeremiah A Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Richard R Orlandi
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
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Abstract
PURPOSE OF REVIEW Although chronic rhinosinusitis with nasal polyps, asthma, and allergy share common inflammatory mechanisms, there is no evidence of cause-and-effect relationship. In this review, we present new studies investigating the complex immunology that links these diseases. Advances in new therapies as well as evidence regarding indication and timing of surgery, especially of more complex cases, are highlighted. RECENT FINDINGS New studies have endotyped patients in an effort to describe the exact inflammatory profile of each phenotype, whereas described cytokines seem to play a significant role in amplification of T2 inflammation, directly or via innate lymphoid cells. New mAbs that block specific cytokines of these pathways have been developed and seem to show reduced asthma severity as well as improved sinonasal outcomes. Moreover, it has been shown that operating early in the course of disease leads not only to bigger improvements in SNOT-22 outcomes but also to reduced asthma incidence postoperatively in refractory cases. SUMMARY Applying data from current studies in clinical practice, we could better manage refractory cases with asthma and polyps, both medically and surgically. Treatment has to be patient-centered, and this demands a multidisciplinary-team approach of the airway diseases.
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32
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Azar A, Rank MA, Zarka MA, Chang YH, Lal D. Gender-specific differences in serum immunoglobulin E levels and prevalence of fungus in sinonasal tissue noted in patients with chronic rhinosinusitis who underwent endoscopic sinus surgery. Am J Rhinol Allergy 2018; 31:370-375. [PMID: 29122081 DOI: 10.2500/ajra.2017.31.4471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND We previously presented that women with chronic rhinosinusitis (CRS) who elected endoscopic sinus surgery (ESS) have a higher symptom burden than men. Causes of these gender-based differences warranted further study. OBJECTIVES To study gender differences in another cohort of adult patients with CRS who underwent ESS and to compare key histopathologic and serologic features Methods: Patients with CRS who underwent ESS (from 2011 to 2014) with structured histopathology reports on surgical samples were studied. The 13-item structured histopathology report detailed key metrics of inflammation and the presence of fungal elements. Clinical, 22-item Sino-Nasal Outcome Test (SNOT-22) score, Lund-Mackay computed tomography (CT) score, serologic (immunoglobulin E [IgE] level, absolute eosinophil count) and histopathologic data were compared between male and female patients by using statistical software. RESULTS We studied 130 eligible subjects (mean age, 54.7 years; 49.2% women). Compared with the men, the women had significantly higher preoperative SNOT-22 scores (women, 48.7; men 38.0 [p = 0.004]) but similar CT scores. Serum IgE levels were significantly higher among women versus men (peak, 433.3 versus 190.8 kU/L [p = 0.03]; closest to surgery, 435.0 versus 190.8 kU/L [p = 0.03]). Tissue fungal elements were significantly more prevalent in women versus men (19.0 versus 5.2%; p = 0.02). Up to this point, the analysis was agnostic of clinical details of the subjects. Further analysis was conducted regarding clinical features. Allergic fungal sinusitis (AFS) was found significantly more commonly in the female versus male patients (21.9 versus 9.1%; p = 0.04). Women versus men had a higher prevalence of migraine (19.4 versus 4.6%; p = 0.01) or any primary headache disorders (23.0 versus 6.2%; p = 0.007). CONCLUSION Women who underwent ESS for CRS had higher SNOT-22 symptom burden. Worsened symptomatology may be secondary to a higher prevalence of primary headache disorders in women. However, surgeons should also be aware that female patients with CRS who seek ESS may have a higher prevalence of severe disease endotypes (more tissue fungal elements, elevated serum IgE levels) and phenotypes.
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Affiliation(s)
- Antoine Azar
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
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33
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Thamboo A, Rathor A, Borchard NA, Nayak JV, Hwang PH, Patel ZM. Precision medicine: why surgeons deviate from "appropriateness criteria" in the management of chronic rhinosinusitis and effects on outcomes. Int Forum Allergy Rhinol 2018; 8:1389-1394. [PMID: 29999595 DOI: 10.1002/alr.22184] [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] [Received: 03/02/2018] [Revised: 06/08/2018] [Accepted: 06/20/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND In uncomplicated chronic rhinosinusitis (CRS), a consensus regarding appropriate medical therapy (AMT) before surgical intervention has been published in the form of "appropriateness criteria" for endoscopic sinus surgery (ESS). We sought to determine why tertiary surgeons may deviate from the suggested criteria and evaluated whether those deviations result in change in outcomes. METHODS Patients with uncomplicated CRS were prospectively enrolled over the course of 1 year. The 22-item Sino-Nasal Outcomes Test (SNOT-22), a general health outcome out of 100, and a physician form, indicating management pathway and decision making, was completed at each visit over a 6-month follow-up period. A descriptive analysis was used to quantify reasons for veering from the "appropriateness criteria," and repeated linear regression modeling was used to measure whether compliance impacted SNOT-22, general health, and Lund-Kennedy (LK) scores over the period of study. RESULTS One hundred fifty-five patients were enrolled. Sixty-eight percent followed the appropriate management pathway based on their presentation and the suggested criteria. Disparate reasons were documented for deviation in the other 32%, and, despite establishing several predictive categories, "other" was the most common reason, with various explanations well documented. SNOT-22, general health, and LK scores were not statistically impacted by compliancy status (p > 0.05). CONCLUSION The suggested "appropriateness criteria" predict a management pathway for the majority of CRS patients. However, in a tertiary sinus center, surgeons may deviate from that model with a significant minority of their patients, for multiple reasons, without causing a change in outcomes.
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Affiliation(s)
- Andrew Thamboo
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA.,Department of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Aakanksha Rathor
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Nicole A Borchard
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Jayakar V Nayak
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Peter H Hwang
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Zara M Patel
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA
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Philpott CM, Erskine S, Hopkins C, Kumar N, Anari S, Kara N, Sunkaraneni S, Ray J, Clark A, Wilson A, Erskine S, Philpott C, Clark A, Hopkins C, Robertson A, Ahmed S, Kara N, Carrie S, Sunkaraneni V, Ray J, Anari S, Jervis P, Panesaar J, Farboud A, Kumar N, Cathcart R, Almeyda R, Khalil H, Prinsley P, Mansell N, Salam M, Hobson J, Woods J, Coombes E. Prevalence of asthma, aspirin sensitivity and allergy in chronic rhinosinusitis: data from the UK National Chronic Rhinosinusitis Epidemiology Study. Respir Res 2018; 19:129. [PMID: 29945606 PMCID: PMC6020303 DOI: 10.1186/s12931-018-0823-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/08/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a common disorder associated with other respiratory tract diseases such as asthma and inhalant allergy. However, the prevalence of these co-morbidities varies considerably in the existing medical literature and by phenotype of CRS studied. The study objective was to identify the prevalence of asthma, inhalant allergy and aspirin sensitivity in CRS patients referred to secondary care and establish any differences between CRS phenotypes. METHODS All participants were diagnosed in secondary care according to international guidelines and invited to complete a questionnaire including details of co-morbidities and allergies. Data were analysed for differences between controls and CRS participants and between phenotypes using chi-squared tests. RESULTS The final analysis included 1470 study participants: 221 controls, 553 CRS without nasal polyps (CRSsNPs), 651 CRS with nasal polyps (CRSwNPs) and 45 allergic fungal rhinosinusitis (AFRS). The prevalence of asthma was 9.95, 21.16, 46.9 and 73.3% respectively. The prevalence of self-reported confirmed inhalant allergy was 13.1, 20.3, 31.0 and 33.3% respectively; house dust mite allergy was significantly higher in CRSwNPs (16%) compared to CRSsNPs (9%, p < 0.001). The prevalence of self- reported aspirin sensitivity was 2.26, 3.25, 9.61 and 40% respectively. The odds ratio for aspirin sensitivity amongst those with AFRS was 28.8 (CIs 9.9, 83.8) p < 0.001. CONCLUSIONS The prevalence of asthma and allergy in CRS varies by phenoytype, with CRSwNPs and AFRS having a stronger association with both. Aspirin sensitivity has a highly significant association with AFRS. All of these comorbidities are significantly more prevalent than in non-CRS controls and strengthen the need for a more individualised approach to the combined airway.
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Affiliation(s)
- Carl M Philpott
- James Paget University Hospital NHS Foundation Trust, Gorleston, UK. .,Rhinology and Olfactology, University of East Anglia, Norwich, UK.
| | - Sally Erskine
- James Paget University Hospital NHS Foundation Trust, Gorleston, UK
| | | | - Nirmal Kumar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Shahram Anari
- Heart of England NHS Foundation Trust, Birmingham, UK
| | | | | | - Jaydip Ray
- Sheffield Teaching Hospitals, Sheffield, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK
| | - Andrew Wilson
- Norwich Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK
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Evaluation of a Dermoplasty Technique for the Control on Nasal Polyps. Indian J Otolaryngol Head Neck Surg 2018; 71:1343-1350. [PMID: 31750175 DOI: 10.1007/s12070-018-1414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/28/2018] [Indexed: 10/16/2022] Open
Abstract
To evaluate the efficacy of a dermoplasty technique in controlling nasal polyps comparing to the conventional endoscopic approach. Prospective observational study Tertiary private hospital. Twenty-nine patients underwent surgery for replacement of the middle meatus mucosa with skin. Some patients (41.4%) suffered from allergies, 44.8% from asthma, and 27.6% from aspirin intolerance. Polyps were staged according to the Lildholdt system, and patients completed a sino-nasal outcome test (SNOT-22) pre and post-operatively. Also, patients were interrogated as for medication relevant to the nose received pre and post-operatively. In twenty-six patients dermoplasty was applied in one nostril while the contralateral was treated with the conventional endoscopic technique allowing us to compare the two techniques in the same patient. Median follow-up period was 1.2 years (IQR 0.8, 2.0; range 0.4-5.8). Median drop in SNOT-22 score was 38.2 percentage units. Patients (79.3%) controlled symptoms by topical corticosteroids for 2.5-3 months per year at most. Seventy percent (70.8%) reported improvement in subjective olfaction. Results compare favorably to those reported in the literature after functional endoscopic approach. Lildholdt stage dropped post-operatively on both sides but significantly more (p value < 0.001) on the dermoplasty side comparing to the conventional endoscopic side. Dermoplasty appears to outbalance the conventional endoscopic removal of polyps and clearance of paranasal sinuses. No matter how extensive the removal of endonasal tissue, it is not sufficient for controlling nasal polyps unless mucosa is prevented from recovering the denuded areas by the use of a skin graft.
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Le PT, Soler ZM, Jones R, Mattos JL, Nguyen SA, Schlosser RJ. Systematic Review and Meta-analysis of SNOT-22 Outcomes after Surgery for Chronic Rhinosinusitis with Nasal Polyposis. Otolaryngol Head Neck Surg 2018; 159:414-423. [PMID: 29712509 DOI: 10.1177/0194599818773065] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective Wide variation exists regarding reported outcomes after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). This study seeks to combine data across studies to generate a summary measure and explore factors that might lead to variation. Data Sources OVID Medline, Scopus, EbscoHost, Database of Abstracts and Reviews of Effects, Health Technology Assessment, and National Health Service Economic Evaluation Database. Review Methods A search was performed following the PRISMA guidelines. Two independent researchers conducted a search using the mentioned data sources. Studies published before August 29, 2016, that involved ESS to treat CRSwNP were included. Mean changes in Sinonasal Outcome Test-22 (SNOT-22) scores were determined through metaregression of the following independent variables: publication year, sex, age, allergy status, asthma, tobacco use, prior surgery, follow-up length, and preoperative SNOT-22. Results Fifteen articles with 3048 patients treated with ESS met inclusion criteria. Pooled analyses of SNOT-22 scores revealed a mean change of 23.0 points (95% CI, 20.2-25.8; P < .001). A metaregression of patient factor effects on the mean change of SNOT-22 scores demonstrated that age ( r = 0.71, P = .01), asthma ( r = 0.21, P = .01), prior ESS ( r = 0.29, P = .01), and preoperative SNOT-22 score ( r = 0.4, P < .01) correlated with greater improvement in SNOT-22 scores. Tobacco use ( r = -0.91, P = .01) and longer lengths of follow-up ( r = -0.45, P < .01) were associated with less improvement in SNOT-22 scores. Conclusions Quality-of-life outcomes are significantly improved after ESS among patients with CRSwNP. Patient-specific factors may affect the degree of SNOT-22 change after surgery.
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Affiliation(s)
- Phong T Le
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zachary M Soler
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rabun Jones
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jose L Mattos
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,2 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Shaun A Nguyen
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rodney J Schlosser
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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John Staniorski C, Price CPE, Weibman AR, Welch KC, Conley DB, Shintani-Smith S, Stevens WW, Peters AT, Grammer L, Lidder AK, Schleimer RP, Kern RC, Tan BK. Asthma onset pattern and patient outcomes in a chronic rhinosinusitis population. Int Forum Allergy Rhinol 2018; 8:495-503. [PMID: 29316300 DOI: 10.1002/alr.22064] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/29/2017] [Accepted: 10/25/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is strongly associated with comorbid asthma. This study compares early-onset and late-onset asthma in a CRS population using patient-reported and clinical characteristics. METHODS At enrollment into a clinical registry, CRS patients completed the 22-item Sino-Nasal Outcome Test (SNOT-22), Asthma Control Test (ACT), mini-Asthma Quality of Life Questionnaire (miniAQLQ), the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29), and medication use questionnaires. Patients also reported comorbid asthma and age at first asthma diagnosis. Early-onset (<18 years) and late-onset (>18 years) asthma groups were defined. Analysis of variance (ANOVA), chi-square, and Kruskal-Wallis tests were used to compare patient responses. RESULTS A total of 199 non-asthmatic (56.1%), 71 early-onset asthmatic (20.0%), and 85 late-onset asthmatic (23.9%) CRS patients completed the survey. Body mass index (BMI) was significantly higher in late-onset asthmatic (p = 0.046) while age, gender, race, and smoking history did not differ with time of asthma onset. SNOT-22, ACT, and miniAQLQ were not different between asthma groups, but late-onset asthmatics had significantly lower physical function than non-asthmatics (p = 0.008). Compared to non-asthmatics, late-onset asthmatics showed increased rates of nasal polyps (p < 0.001), higher Lund-Mackay scores (p = 0.005), and had received more oral steroid courses (p < 0.001) and endoscopic surgeries (p = 0.008) for CRS management. Late-onset asthmatics compared to early-onset asthmatics showed increased nasal polyposis (p = 0.011) and oral steroid courses for CRS (p = 0.003). CONCLUSION While CRS-specific and asthma-specific patient-reported outcome measures (PROMs) were not significantly different among groups, CRS patients with late-onset asthma had poorer physical function, more frequent nasal polyposis, and required increased treatment for CRS. Late-onset asthma may predict more severe disease in CRS.
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Affiliation(s)
| | - Caroline P E Price
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ava R Weibman
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kevin C Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David B Conley
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stephanie Shintani-Smith
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Whitney W Stevens
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anju T Peters
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leslie Grammer
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alcina K Lidder
- University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | - Robert P Schleimer
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.,Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bruce K Tan
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Hellings PW, Borrelli D, Pietikainen S, Agache I, Akdis C, Bachert C, Bewick M, Botjes E, Constantinidis J, Fokkens W, Haahtela T, Hopkins C, Illario M, Joos G, Lund V, Muraro A, Pugin B, Seys S, Somekh D, Stjärne P, Valiulis A, Valovirta E, Bousquet J. European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases: report of the European Union Parliament Summit (29 March 2017). Clin Transl Allergy 2017; 7:49. [PMID: 29299230 PMCID: PMC5745781 DOI: 10.1186/s13601-017-0186-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/15/2017] [Indexed: 01/19/2023] Open
Abstract
On March 29, 2017, a European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases (CRD) was organized by the European Forum for Research and Education in Allergy and Airway Diseases. The event took place in the European Parliament of Brussels and was hosted by MEP David Borrelli and MEP Sirpa Pietikainen. The aim of the Summit was to correspond to the needs of the European Commission and of patients suffering from CRD to join forces in Europe for the prevention and self-management. Delegates of the European Rhinologic Society, European Respiratory Society, European Academy of Allergy and Clinical Immunology, European Academy of Paediatrics, and European Patients Organization EFA all lectured on their vision and action plan to join forces in achieving adequate prevention and self-management of CRD in the context of Precision Medicine. Recent data highlight the preventive capacity of education on optimal care pathways for CRD. Self-management and patient empowerment can be achieved by novel educational on-line materials and by novel mobile health tools enabling patients and doctors to monitor and optimally treat CRDs based on the level of control. This report summarizes the contributions of the representatives of different European academic stakeholders in the field of CRD.
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Affiliation(s)
- Peter W. Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, KU Leuven, Louvain, Belgium
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - David Borrelli
- Italian Member of the European Parliament, EFDD Group, Brussels, Belgium
| | | | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Cezmi Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Christine Kühne - Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | | | - Erna Botjes
- EFA - European Federation of Allergy and Airways Diseases Patients’ Associations, Brussels, Belgium
| | - Jannis Constantinidis
- 1st Department of ORL, Head and Neck Surgery, Aristotle University, Thessaloníki, Greece
| | - Wytske Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Claire Hopkins
- ENT Department, Guy’s and St Thomas’ Hospitals, London, UK
| | - Maddalena Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
| | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Valerie Lund
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals, London, UK
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - Benoit Pugin
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - Sven Seys
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
- Lab of Clinical Immunology, Department of Immunology and Microbiology, KU Leuven, Brussels, Belgium
| | - David Somekh
- European Health Futures Forum (EHFF), Isle of Wright, UK
| | - Pär Stjärne
- Rhinology Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Arunas Valiulis
- Vilnius University Clinic of Children’s Diseases and Public Health Institute, Vilnius, Lithuania
- European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Allergology, Univ. of Turku, and Allergy Clinic, Terveystalo, Turku, Finland
| | - Jean Bousquet
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
- INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Villejuif, Montigny le Bretonneux, France
- EUFOREA aisbl, 132, Ave. Brand Whitlock, 1200 Brussels, Belgium
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Sundaresan AS, Hirsch AG, Young AJ, Pollak J, Tan BK, Schleimer RP, Kern RC, Kennedy TL, Greene JS, Stewart WF, Bandeen-Roche K, Schwartz BS. Longitudinal Evaluation of Chronic Rhinosinusitis Symptoms in a Population-Based Sample. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:1327-1335.e3. [PMID: 29133225 DOI: 10.1016/j.jaip.2017.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/03/2017] [Accepted: 10/12/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a prevalent and disabling condition of the nose and sinuses. The natural history of CRS symptoms in a general population sample has not been previously studied. OBJECTIVE In a general population-based sample from Pennsylvania, we used 2 questionnaires mailed 6 months apart to estimate the prevalence of, and identify predictors for, stability or change in symptoms over time. METHODS We mailed the baseline and 6-month follow-up questionnaires to 23,700 primary care patients and 7,801 baseline responders, respectively. We categorized nasal and sinus symptoms using European Position Paper on Rhinosinusitis (EPOS) epidemiologic criteria. We defined 6 symptom groups over time on the basis of the presence of CRS symptoms at baseline and follow-up. We performed multivariable survey logistic regression controlling for confounding variables comparing persistent versus nonpersistent, recurrent versus stable past, and incident versus never. RESULTS There were 4,966 responders at follow-up: 558 had persistent symptoms, 190 recurrent symptoms, and 83 new symptoms meeting EPOS criteria for CRS. The prevalence of persistent symptoms was 4.8% (95% CI, 3.8-5.8), whereas the annual cumulative incidence of new symptoms was 1.9% and of recurrent symptoms was 3.2%. More severe symptoms at baseline were associated with persistence, whereas minor symptoms, allergies, and multiple treatments were associated with the development of new symptoms. CONCLUSIONS Less than half with nasal and sinus symptoms meeting CRS EPOS criteria in our general, regional population had symptom persistence over time, with symptom profiles at baseline and age of onset being strongly associated with stability of symptoms.
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Affiliation(s)
- Agnes S Sundaresan
- Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, Pa.
| | - Annemarie G Hirsch
- Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, Pa
| | - Amanda J Young
- Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, Pa
| | - Jonathan Pollak
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Bruce K Tan
- Department of Otolaryngology Head and Neck Surgery and the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert P Schleimer
- Department of Otolaryngology Head and Neck Surgery and the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert C Kern
- Department of Otolaryngology Head and Neck Surgery and the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Thomas L Kennedy
- Department of Otolaryngology/Head and Neck/Facial Plastic Surgery, Geisinger Health System, Danville, Pa
| | - J Scott Greene
- Department of Otolaryngology/Head and Neck/Facial Plastic Surgery, Geisinger Health System, Danville, Pa
| | | | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Brian S Schwartz
- Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, Pa; Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
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40
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Ghadersohi S, Tan BK. Contemporary Pharmacotherapy for Allergic Rhinitis and Chronic Rhinosinusitis. Otolaryngol Clin North Am 2017; 50:1135-1151. [PMID: 28964532 DOI: 10.1016/j.otc.2017.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) are chronic conditions causing nasal inflammation. CRS is increasingly recognized as a chronic inflammatory process rather than a chronic infection. Although the primary initiating factors in CRS remain unclear, AR is driven by IgE-mediated hypersensitivity to environmental allergens. Understanding the underlying inflammatory pathways and disease endotypes are driving innovation toward novel pharmacotherapies targeting critical mediators implicated in CRS and AR, including IL-4, IL-13, IL-5, IgE, and epithelial initiators IL-33 and TSLP. Extensive investigations are needed to determine the role, timing, predictive prognostic factors and long-term safety and efficacy of these agents.
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Affiliation(s)
- Saied Ghadersohi
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, 676 North Saint Clair Suite #1325, Chicago, IL 60611, USA
| | - Bruce K Tan
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, 676 North Saint Clair Suite #1325, Chicago, IL 60611, USA.
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41
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Newton E, Janjua A, Lai E, Liu G, Crump T, Sutherland JM. The impact of surgical wait time on patient reported outcomes in sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol 2017; 7:1156-1161. [DOI: 10.1002/alr.22018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 08/25/2017] [Accepted: 09/02/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Ethan Newton
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of British Columbia; Vancouver BC Canada
| | - Arif Janjua
- Rhinology and Skull Base Surgery, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of British Columbia; Vancouver BC Canada
| | - Ernest Lai
- Centre for Health Services and Policy Research; University of British Columbia; Vancouver BC Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research; University of British Columbia; Vancouver BC Canada
| | - Trafford Crump
- Department of Surgery; University of Calgary; Calgary AB Canada
| | - Jason M. Sutherland
- Centre for Health Services and Policy Research; University of British Columbia; Vancouver BC Canada
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42
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Hellings PW, Fokkens WJ, Bachert C, Akdis CA, Bieber T, Agache I, Bernal-Sprekelsen M, Canonica GW, Gevaert P, Joos G, Lund V, Muraro A, Onerci M, Zuberbier T, Pugin B, Seys SF, Bousquet J. Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis - A EUFOREA-ARIA-EPOS-AIRWAYS ICP statement. Allergy 2017; 72:1297-1305. [PMID: 28306159 DOI: 10.1111/all.13162] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 12/20/2022]
Abstract
Precision medicine (PM) is increasingly recognized as the way forward for optimizing patient care. Introduced in the field of oncology, it is now considered of major interest in other medical domains like allergy and chronic airway diseases, which face an urgent need to improve the level of disease control, enhance patient satisfaction and increase effectiveness of preventive interventions. The combination of personalized care, prediction of treatment success, prevention of disease and patient participation in the elaboration of the treatment plan is expected to substantially improve the therapeutic approach for individuals suffering from chronic disabling conditions. Given the emerging data on the impact of patient stratification on treatment outcomes, European and American regulatory bodies support the principles of PM and its potential advantage over current treatment strategies. The aim of the current document was to propose a consensus on the position and gradual implementation of the principles of PM within existing adult treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS). At the time of diagnosis, prediction of success of the initiated treatment and patient participation in the decision of the treatment plan can be implemented. The second-level approach ideally involves strategies to prevent progression of disease, in addition to prediction of success of therapy, and patient participation in the long-term therapeutic strategy. Endotype-driven treatment is part of a personalized approach and should be positioned at the tertiary level of care, given the efforts needed for its implementation and the high cost of molecular diagnosis and biological treatment.
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Affiliation(s)
- P. W. Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery; UZ Leuven; Leuven Belgium
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
- Department of Otorhinolaryngology-Head and Neck Surgery; Upper Airways Research Laboratory; Ghent University; Ghent Belgium
| | - W. J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
| | - C. Bachert
- Department of Otorhinolaryngology-Head and Neck Surgery; Upper Airways Research Laboratory; Ghent University; Ghent Belgium
- Department of Otorhinolaryngology; Karolinska Institute; Stockholm Sweden
| | - C. A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); Christine-Kühne Center for Allergy Research and Education; University of Zurich; Davos Switzerland
| | - T. Bieber
- Department of Dermatology and Allergy; Christine Kühne-Center for Allergy Research and Education; Friedrich-Wilhelms-University; Bonn Germany
| | - I. Agache
- Faculty of Medicine; Transylvania University; Brasov Romania
| | - M. Bernal-Sprekelsen
- Department of Otorhinolaryngology; Hospital Clínic Universitari; Barcelona Spain
| | - G. W. Canonica
- Department of Biomedical Science; Personalized Medicine Clinic Asthma & Allergy; Humanitas Clinical and Research Center; Humanitas University - Rozzano (Milano); Rozzano Italy
| | - P. Gevaert
- Department of Otorhinolaryngology-Head and Neck Surgery; Upper Airways Research Laboratory; Ghent University; Ghent Belgium
| | - G. Joos
- Department of Respiratory Medicine; Ghent University; Ghent Belgium
| | - V. Lund
- Royal National Throat, Nose and Ear Hospital; University College London Hospitals; London UK
| | - A. Muraro
- Department of Women and Child Health; Food Allergy Referral Centre Veneto Region; Padua General University Hospital; Padua Italy
| | - M. Onerci
- Department of Otorhinolaryngology Head and Neck Surgery; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - T. Zuberbier
- Department of Dermatology and Allergy; Comprehensive Allergy-Centre-Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - B. Pugin
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA); Brussels Belgium
| | - S. F. Seys
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA); Brussels Belgium
- Department of Immunology and Microbiology; Laboratory of Clinical Immunology; KU Leuven; Leuven Belgium
| | - J. Bousquet
- Department of Respiratory Disease; University Hospital Arnaud de Villeneuve; Montpellier France
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Adriaensen GFJPM, Lim KH, Fokkens WJ. Safety and efficacy of a bioabsorbable fluticasone propionate-eluting sinus dressing in postoperative management of endoscopic sinus surgery: a randomized clinical trial. Int Forum Allergy Rhinol 2017; 7:813-820. [PMID: 28558147 DOI: 10.1002/alr.21963] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Postoperative wound healing after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS) is an important factor in procedural success. Local steroids and separation of opposing mucosa are commonly implemented to optimize healing. A bioabsorbable, fluticasone propionate (FP)-eluting implant, SinuBand FP, was assessed for its safety and efficacy when used in patients with CRS and nasal polyps, who were indicated for ESS including bilateral anterior and posterior ethmoidectomy. METHODS A first-in-human, randomized, partially double-blind, single-tertiary-referral-center, controlled trial enrolling 30 patients receiving 2 of 3 treatments (1 per sinus, intrapatient control): SinuBand FP, SinuBand (without FP), or standard nasal pack (Merocel®). Primary outcome measures were local safety, ocular safety (intraocular pressure [IOP], lens opacity), and 24-hour urine cortisol. Secondary measures (evaluated by independent review of postoperative video endoscopies) were ethmoid inflammation, polyp score, adhesion formation, and Lund-Kennedy score. Patient-reported outcomes of postoperative pain, nasal congestion, and nasal discharge were collected. RESULTS Of 30 enrolled patients (used for safety analysis), 27 patients completed the trial. SinuBand FP showed local safety, ocular safety, and no significant change in 24-hour urine cortisol. SinuBand FP showed a trend to do better concerning inflammation. Concerning polyp score SinuBand FP did significantly better compared to Merocel (p = 0.03). No significance compared to SinuBand without corticosteroids (p = 0.97). Adhesions were comparable across treatments. Patient reported pain was nominally lower in the SinuBand group. CONCLUSION SinuBand FP was well tolerated and showed evidence of efficacy. A larger study is needed to further evaluate and confirm the benefits of SinuBand FP.
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Affiliation(s)
- Gwijde F J P M Adriaensen
- Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Keng-Hua Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Analysis and Results of Endoscopic Sinus Surgery in Chronic Rhinosinusitis With Polyps. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.otoeng.2017.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Current Philosophy in the Surgery for Chronic Rhinosinusitis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017. [DOI: 10.1007/s40136-017-0147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schlosser RJ, Smith TL, Mace J, Soler ZM. Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis. Allergy 2017; 72:483-491. [PMID: 27638398 DOI: 10.1111/all.13048] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with chronic rhinosinusitis (CRS) often have comorbid asthma. Prior studies have not examined the impact of CRS or endoscopic sinus surgery (ESS) upon asthma quality of life (QOL) and asthma control using validated outcome metrics. METHODS Patients with CRS, both with and without polyps, and comorbid asthma completed the Mini Asthma QOL Questionnaire (miniAQLQ) and Asthma Control Test (ACT) at baseline and 6 months postoperatively as part of a multi-institutional, prospective study. RESULTS Baseline metrics were available on 86 patients. Patients undergoing ESS reported improved miniAQLQ [0.5 (SD ±1.1), 95% CI: 0.2-0.7; P = 0.002] and ACT scores [1.3 (±4.1), 95% CI: 0.2-2.4; P = 0.025]. Uncontrolled baseline asthma (ACT < 20) was present in 51% of patients undergoing ESS. In uncontrolled patients, ESS resulted in a minimal clinically important difference 57% of the time for miniAQLQ scores (≥0.5 points) and 50% of the time for ACT scores (≥3.0 points). After adjustment with linear regression, baseline miniAQLQ scores were worse in patients with comorbid allergy (P = 0.045) and chronic obstructive pulmonary disease (COPD; P = 0.015). Adjusted baseline ACT scores were worse in patients with COPD (P = 0.004). Covariates associated with changes in miniAQLQ scores after ESS were pre-operative corticosteroid dependency (P = 0.011) and change in total SNOT-22 score (P = 0.010). Covariate associated with significantly less improvement in ACT scores was obstructive sleep apnea (P = 0.016). CONCLUSIONS Patients with CRS often present with uncontrolled asthma, and ESS improves both miniAQLQ and ACT. Approximately half of patients with uncontrolled asthma improve after ESS, yet there are few CRS-specific factors associated with asthma QOL or control or ESS outcomes.
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Affiliation(s)
- R. J. Schlosser
- Department of Otolaryngology - Head and Neck Surgery; Medical University of South Carolina; Charleston SC USA
| | - T. L. Smith
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health Sciences University; Portland OR USA
| | - J. Mace
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health Sciences University; Portland OR USA
| | - Z. M. Soler
- Department of Otolaryngology - Head and Neck Surgery; Medical University of South Carolina; Charleston SC USA
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Frendø M, Håkansson K, Schwer S, Rix I, Ravn AT, Backer V, von Buchwald C. Asthma in ear, nose, and throat primary care patients with chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy 2017; 30:67-71. [PMID: 27216338 DOI: 10.2500/ajra.2016.30.4304] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder associated with asthma. This association is well described in patients with CRSwNP undergoing endoscopic sinus surgery (ESS); however, some patients are never referred for surgery, and the frequency of asthma in this group is largely unknown. OBJECTIVE To determine the frequency of asthma in patients with CRSwNP treated in a primary care (PC) setting who have never been referred for surgery and to compare this with ESS patients. METHODS Fifty-seven patients with CRSwNP who had never undergone ESS were prospectively recruited from nine PC ear, nose, and throat clinics in the Copenhagen area. CRSwNP was diagnosed according to the European Position Paper on Chronic Rhinosinusitis and Nasal Polyps; severity was assessed by using a visual analog scale. Allergy, lung function, and asthma tests (reversibility to β2-agonist, peak expiratory flow variability, and mannitol challenge) were performed. Findings were compared with our previously published data from patients with CRSwNP referred for surgery. RESULTS Asthma was diagnosed in 25 patients (44%) based on respiratory symptoms and a positive asthma test; of these, 12 (48%) had undiagnosed asthma prior to study onset. Furthermore, when using the same methods, we found a lower frequency of asthma in PC patients compared with ESS patients (44% versus 65%, p = 0.04). CONCLUSION A high prevalence of asthma in PC patients with CRSwNP was found. Frequently, asthma was undiagnosed. However, asthma was significantly less prevalent in PC patients compared with patients referred for ESS. The frequent concomitance of asthma, i.e., united airways disease, in PC patients calls for closer collaboration between ear, nose, and throat specialists, and asthma specialists.
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Affiliation(s)
- Martin Frendø
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Lourijsen ES, de Borgie CAJM, Vleming M, Fokkens WJ. Endoscopic sinus surgery in adult patients with chronic rhinosinusitis with nasal polyps (PolypESS): study protocol for a randomised controlled trial. Trials 2017; 18:39. [PMID: 28114954 PMCID: PMC5259992 DOI: 10.1186/s13063-016-1728-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/23/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps is a chronic disease frequently seen in otorhinolaryngological practice. Along with its chronic disease burden it creates high societal costs. Therapy consists of long-term use of medication and, if insufficient, endoscopic sinus surgery. No consensus exists on the right timing and extent of disease that warrants surgery. Furthermore, there is lack of clinical knowledge about the benefit of surgery over medication only. The current trial evaluates the clinical effectiveness and cost-effectiveness of endoscopic sinus surgery in addition to drug treatment versus medication exclusively in the adult patient group with nasal polyps. METHODS A prospective, multicentre, superiority, randomised controlled (PolypESS) trial in 238 patients aged 18 years or older selected for primary or revision endoscopic sinus surgery by the otorhinolaryngologist was designed. Patients will be randomised to either endoscopic sinus surgery in addition to medication or medical therapy only. Relevant data will be collected prior to randomisation, at baseline and 3, 6, 12, 18 and 24 months after start of treatment. Complete follow-up will be 24 months. Primary outcome is disease-specific Health-related Quality of Life quantified by the SNOT-22 after 12-month follow-up. Secondary outcomes are generic Health-related Quality of Life, cost-effectiveness, objective signs of disease and adverse effects of treatment. Subgroup analyses will be performed to verify whether treatment effects differ among patient phenotypes. DISCUSSION The PolypESS trial will investigate tailored care in adult patients with chronic rhinosinusitis with nasal polyps and will result in improved clinical pathways to help to determine in which circumstances to perform surgery. TRIAL REGISTRATION Dutch Trial Register, NTR4978 . Registered on 27 November 2014.
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Affiliation(s)
- Evelijn S. Lourijsen
- Department of Otorhinolaryngology, Academic Medical Centre, Meibergdreef 9, 1105 SZ Amsterdam, The Netherlands
| | | | - Marleen Vleming
- Department of Otorhinolaryngology, Flevo Hospital, Hospitaalweg 1, 1315 RA Almere, The Netherlands
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Meibergdreef 9, 1105 SZ Amsterdam, The Netherlands
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Schlosser RJ. Editorial. Int Forum Allergy Rhinol 2016; 6:1111-1112. [PMID: 27808483 DOI: 10.1002/alr.21868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Soni-Jaiswal A, Philpott C, Hopkins C. The impact of commissioning for rhinosinusitis in England. Clin Otolaryngol 2016; 40:639-45. [PMID: 25851163 DOI: 10.1111/coa.12430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the compliance of clinical commissioning groups (CCGs) in England with the ENT-UK rhinosinusitis commissioning guide produced in collaboration with the Royal College of Surgeons England and the National Institute of Clinical Excellence. We also aimed to assess the ease of accessibility of data from CCGs. DESIGN Audit of compliance of English CCGs with the ENT-UK rhinosinusitis commissioning guide. SETTING CCGs in England PARTICIPANTS A total of 58 of the 221 CCGs in England were included and chosen because they were the first CCGs authorised by NHS England, or alternately, the CCGs forecasted to have a deficit in their first year of operation. Their websites were reviewed; when information was not easily accessible, a freedom of information request was submitted to the relevant CCG. MAIN OUTCOME MEASURES Compliance with commissioning guidelines for rhinosinusitis. RESULTS Thirteen percent of CCGs had restrictive referral criteria in place, largely unrelated to published evidence-based guidance. The routine use of multiple courses of oral steroids, prescription of antibiotics, CT scanning within primary care, and delaying referral for a year, prior to referral to a specialist were recommended against published advice. CONCLUSIONS Restricting access to surgery may contribute to poorer outcomes and a decrease in the patient's quality of life. This is against the NHS constitution and is open to legal challenge. We encourage all ENT surgeons to review policies of their local CCG and engage with commissioners to ensure that their patients have evidence-based care.
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Affiliation(s)
| | - C Philpott
- James Paget University Hospital, Great Yarmouth, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - C Hopkins
- Guys and St Thomas' Hospital, London, UK.,King's College, London, UK
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