Genetics and Epigenetics of Nasal Polyposis: A Systematic Review

Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and paranasal sinuses that is often associated with nasal polyposis (CRSwNP) in the most severe cases. As in other complex diseases, genetic factors are thought to play an important role in the risk and development of the disease. Environment may also modulate the epigenetic signature in affected patients. In the present systematic review, we aimed to compile all published data on genetic and epigenetic variations in CRSwNP since 2000. We found 104 articles, 24 of which were related to epigenetic studies. We identified more than 150 genetic variants in 99 genes involved in the pathogenesis of nasal polyposis. These were clustered into 8 main networks, linking genes involved in inflammation and immune response (eg, MHC), cytokine genes (eg, TNF), leukotriene metabolism, and the extracellular matrix. A total of 89 miRNAs were also identified; these are associated mainly with biological functions such as the cell cycle, inflammation, and the immune response. We propose a potential relationship between genes and the miRNAs identified that may open new lines of investigation. An in-depth knowledge of gene variants and epigenetic traits could help us to design more tailored treatment for patients with CRSwNP.

[Phobic orthostatic insecurity]

BACKGROUND AND OBJECTIVES

The authors attempt to expand knowledge about a subjective balance disorder they have called phobic orthostatic insecurity, a condition representing the second cause of medical visits (22.3 %) to their ENT and neuro-otology clinic, and attempt to identify relationships with similar conditions described in psychiatry (agoraphobia, somatoform vertigo, and space-phobia) and in neurology (phobic postural vertigo). They also propose a simple diagnostic method and present their therapies and results.

PATIENTS AND METHOD

A total of 151 patients with an indefinite symptomatology of "dizziness" "vertigo" or "insecurity" were evaluated (from 1999 to 2005) by means of a full medical history and an appropriate neurological examination, pharmacological treatments with anxiolytics-antidepressives, a measurement of the degree of depression with the Beck test (a kind of psychiatric benchmark) and with a specific standardized test.

RESULTS

Three symptoms and one exploratory condition, among others, were found in all 151 patients studied; these constitute the four bases for a positive diagnosis. This is confirmed if the treatment achieves total remission (this occurred in 69.53 % of all patients) or a sub-total remission (24.49 %), according to valuation scale for insecurity in all situations.

CONCLUSIONS

The statistical analysis showed a symptomatic concordance within the group analyzed, a syndromic equivalence between patients and satisfactory results with the antidepressive treatments (94 %), thus confirming the diagnostic and aetiopathogenic hypotheses for the disorder and, later, providing a logical method for diagnosis. The authors propose to assimilate this diagnostic protocol (and therapeutic when no specialist psychotherapy teams are available) to most of the psychogenic insecurity syndromes described.