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Yong M, Kirubalingam K, Desrosiers MY, Kilty SJ, Thamboo A. Cost-effectiveness analysis of biologics for the treatment of chronic rhinosinusitis with nasal polyps in Canada. Allergy Asthma Clin Immunol 2023; 19:90. [PMID: 37838713 PMCID: PMC10576384 DOI: 10.1186/s13223-023-00823-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 07/13/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Dupilumab, omalizumab, and mepolizumab are the three biologics currently approved for use in CRSwNP in Canada. Despite evidence of efficacy, their cost-effectiveness, which is a key factor influencing prescribing patterns, has not yet been compared to each other. METHODS A cost-effectiveness model using quality-adjusted life years (QALYs) was constructed using a Decision Tree Markov analysis. A third-party healthcare payer perspective and a 10-year time horizon was used. A willingness-to-pay (WTP) threshold of 50,000 Canadian dollars (CAD) per QALY was used to determine cost-effectiveness. Dupilumab, omalizumab, and mepolizumab were each compared to each other. RESULTS Omalizumab was the most cost-effective biologic using current estimates of cost and efficacy in CRSwNP. Using omalizumab as a baseline, dupilumab had an ICER of $235,305/QALY. Mepolizumab was dominated by omalizumab and dupilumab at the current drug prices and estimates of efficacy. Sensitivity analyses determined that when increasing the WTP threshold to $150,000/QALY, dupilumab became cost-effective compared to omalizumab in 22.5% of simulation scenarios. Additionally, altering dosing frequency had a significant effect on cost-effectiveness. CONCLUSION When comparing the relative cost-effectiveness of biologics in recalcitrant CRSwNP, omalizumab currently appears to be the most cost-effective option. Future reductions in drug prices, adjustments to currently approved dosing regimens, better patient selection, and improvements in sinus surgery outcomes will challenge the current cost-effectiveness models and necessitate reassessment as treatments for CRSwNP continue to evolve.
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Affiliation(s)
- Michael Yong
- Division of Otolaryngology, Head and Neck Surgery, University of British Columbia Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V5Z 1Y6, Canada
| | | | - Martin Y Desrosiers
- Department of Otolaryngology, Centre de Recherche du Centre Hospitalier de L'Universite de Montreal, Montreal, QC, Canada
| | - Shaun J Kilty
- Department of Otolaryngology, Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Thamboo
- Division of Otolaryngology, Head and Neck Surgery, University of British Columbia Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V5Z 1Y6, Canada.
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Renteria AE, Valera FCP, Maniakas A, Adam D, Filali-Mouhim A, Ruffin M, Mfuna LE, Brochiero E, Desrosiers MY. Azithromycin Mechanisms of Action in CRS Include Epithelial Barrier Restoration and Type 1 Inflammation Reduction. Otolaryngol Head Neck Surg 2023; 169:1055-1063. [PMID: 37125631 DOI: 10.1002/ohn.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/18/2023] [Accepted: 03/31/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Previous in vitro transcriptomic profiling suggests azithromycin exerts its effects in patients with chronic rhinosinusitis (CRS) via modulation of type 1 inflammation and restoration of epithelial barrier function. We wished to verify these postulated effects using in vitro models of epithelial repair and in vivo transcriptional profiling. STUDY DESIGN Functional effects of azithromycin in CRS were verified using in vitro models of wounding. The mechanism of the effect of azithromycin was assessed in vivo using transcriptomic profiling. SETTING Academic medical center. METHODS Effects of azithromycin on the speed of epithelial repair were verified in a wounding model using primary nasal epithelial cells (pNEC) from CRS patients. Nasal brushings collected pre-and posttreatment during a placebo-controlled trial of azithromycin for CRS patients unresponsive to surgery underwent transcriptomic profiling to identify implicated pathways. RESULTS Administration of azithromycin improved the wound healing rates in CRS pNECs and prevented the negative effect of Staphylococcus aureus on epithelial repair. In vivo, response to azithromycin was associated with downregulation in pathways of type 1 inflammation, and upregulation of pathways implicated in the restoration of the cell cycle. CONCLUSION Restoration of healthy epithelial function may represent a major mode of action of azithromycin in CRS. In vitro models show enhanced epithelial repair, while in vivo transcriptomics shows downregulation of pathways type 1 inflammation accompanied by upregulation of DNA repair and cell-cycle pathways. The maximal effect in patients with high levels of type 1-enhanced inflammation suggests that azithromycin may represent a novel therapeutic option for surgery-unresponsive CRS patients.
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Affiliation(s)
- Axel E Renteria
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada
- Département d'Oto-rhino-laryngologie et chirurgie cervico-faciale, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Fabiana C P Valera
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Anastasios Maniakas
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Damien Adam
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada
- Département de Médecine, Université de Montréal, Montréal, Quebec, Canada
| | - Ali Filali-Mouhim
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada
| | - Manon Ruffin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada
| | - Leandra Endam Mfuna
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada
| | - Emmanuelle Brochiero
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada
- Département de Médecine, Université de Montréal, Montréal, Quebec, Canada
| | - Martin Y Desrosiers
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada
- Département d'Oto-rhino-laryngologie et chirurgie cervico-faciale, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
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Zagury-Orly I, Khaouam N, Noujaim J, Desrosiers MY, Maniakas A. The Effect of Radiation and Chemoradiation Therapy on the Head and Neck Mucosal Microbiome: A Review. Front Oncol 2021; 11:784457. [PMID: 34926301 PMCID: PMC8674486 DOI: 10.3389/fonc.2021.784457] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/11/2021] [Indexed: 12/12/2022] Open
Abstract
Radiation (RT) and chemoradiation therapy (CRT) play an essential role in head and neck cancer treatment. However, both cause numerous side effects in the oral cavity, paranasal sinuses, and pharynx, having deleterious consequences on patients’ quality of life. Concomitant with significant advances in radiation oncology, much attention has turned to understanding the role of the microbiome in the pathogenesis of treatment-induced tissue toxicity, to ultimately explore microbiome manipulation as a therapeutic intervention. This review sought to discuss current publications investigating the impact of RT and CRT-induced changes on the head and neck microbiome, using culture-independent molecular methods, and propose opportunities for future directions. Based on 13 studies derived from a MEDLINE, EMBASE, and Web of Science search on November 7, 2021, use of molecular methods has uncovered various phyla and genera in the head and neck microbiome, particularly the oral microbiome, not previously known using culture-based methods. However, limited research has investigated the impact of RT/CRT on subsites other than the oral cavity and none of the studies aimed to examine the relationship between the head and neck microbiome and treatment effectiveness. Findings from this review provide helpful insights on our current understanding of treatment-induced oral mucositis, dental plaque, and caries formation and highlight the need for future research to examine the effect of RT/CRT on the sinonasal and oropharyngeal microbiome. In addition, future research should use larger cohorts, examine the impact of the microbiome on treatment response, and study the effect of manipulating the microbiome to overcome therapy resistance.
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Affiliation(s)
- Ivry Zagury-Orly
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Nader Khaouam
- Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Jonathan Noujaim
- Department of Oncology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Martin Y Desrosiers
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Anastasios Maniakas
- Division of Otolaryngology-Head and Neck Surgery, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Department of Experimental Surgery, McGill University, Montreal, QC, Canada.,Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Bachert C, Han JK, Desrosiers MY, Gevaert P, Heffler E, Hopkins C, Tversky JR, Barker P, Cohen D, Emson C, Martin UJ, Shih VH, Necander S, Kreindler JL, Jison M, Werkström V. Efficacy and safety of benralizumab in chronic rhinosinusitis with nasal polyps: A randomized, placebo-controlled trial. J Allergy Clin Immunol 2021; 149:1309-1317.e12. [PMID: 34599979 DOI: 10.1016/j.jaci.2021.08.030] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/21/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Eosinophilic inflammation has been implicated in the pathogenesis, severity, and treatment responsiveness of chronic rhinosinusitis with nasal polyps (CRSwNP). OBJECTIVE We sought to assess the efficacy and safety of benralizumab-mediated eosinophil depletion for treating CRSwNP. METHODS The phase 3 OSTRO study enrolled patients with severe CRSwNP who were symptomatic despite treatment with intranasal corticosteroids and who had a history of systemic corticosteroid (SCS) use and/or surgery for nasal polyps (NP). Patients were randomized 1:1 to treatment with benralizumab 30 mg or placebo every 4 weeks for the first 3 doses and every 8 weeks thereafter. Coprimary end points were change from baseline to week 40 in NP score (NPS) and patient-reported mean nasal blockage score reported once every 2 weeks. RESULTS The study population comprised 413 randomized patients (207 in the benralizumab group and 206 in the placebo group). Benralizumab significantly improved NPS and nasal blockage score compared to placebo at week 40 (P ≤ .005). Improvements in Sinonasal Outcome Test 22 score at week 40, time to first NP surgery and/or SCS use for NP, and time to first NP surgery were not statistically significant between treatment groups. Nominal significance was obtained for improvement in difficulty in sense of smell score at week 40 (P = .003). Subgroup analyses suggested influences of comorbid asthma, number of NP surgeries, sex, body mass index, and baseline blood eosinophil count on treatment effects. Benralizumab was safe and well tolerated. CONCLUSION Benralizumab, when added to standard-of-care therapy, reduced NPS, decreased nasal blockage, and reduced difficulty with sense of smell compared to placebo in patients with CRSwNP. TRIAL REGISTRATION ClinicalTrials.gov NCT03401229.
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Affiliation(s)
- Claus Bachert
- Upper Airways Research Laboratory, Ghent University, Ghent, Belgium.
| | | | - Martin Y Desrosiers
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Philippe Gevaert
- Upper Airways Research Laboratory, Ghent University, Ghent, Belgium
| | - Enrico Heffler
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy; Humanitas University, Pieve Emanuele, Italy
| | | | | | | | | | - Claire Emson
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Md
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Bachert C, Desrosiers MY, Hellings PW, Laidlaw TM. The Role of Biologics in Chronic Rhinosinusitis with Nasal Polyps. J Allergy Clin Immunol Pract 2020; 9:1099-1106. [PMID: 33227522 DOI: 10.1016/j.jaip.2020.11.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 12/18/2022]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common and heterogeneous inflammatory disease of the upper respiratory tract. This article provides expert opinion and points of view from both allergists and rhinologists who specialize in CRSwNP. Despite the potential value of biomarker-based endotyping to provide guidance regarding optimal care and treatment choices for patients with CRSwNP, current practice is largely not biomarker-based. In general, there is agreement that for patients with symptomatic CRSwNP who have failed a trial of a course of at least 3 months of intranasal steroids and a short course of oral corticosteroids, a surgical intervention will often be the next treatment of choice. Biologics may be considered before an initial surgery in patients with comorbid severe asthma and in those for whom surgery is less available, refused by the patient, or likely to be associated with a higher-than-average complication rate. Biologic use immediately following surgery may be considered in patients who have a history of nasal polyp recurrence within 12 months of a prior surgery. For many patients with recalcitrant disease, a combination of sinus surgery and use of a biologic that is targeted to their precise endotype may be the optimal treatment strategy, though which surgical approach and which biologics are best for each patient are debates that remain ongoing.
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Affiliation(s)
- Claus Bachert
- Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University, Gent, Belgium; First Affiliated Hospital, Sun Yat-sen University, International Airway Research Center, Guangzhou, China; Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden
| | - Martin Y Desrosiers
- Department of Otolaryngology, Centre de Recherche du Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
| | - Peter W Hellings
- Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University, Gent, Belgium; Clinical Division of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Tanya M Laidlaw
- Department of Medicine, Harvard Medical School, the Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass.
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Valera FCP, Ruffin M, Adam D, Maillé É, Ibrahim B, Berube J, Rousseau S, Brochiero E, Desrosiers MY. Staphylococcus aureus impairs sinonasal epithelial repair: Effects in patients with chronic rhinosinusitis with nasal polyps and control subjects. J Allergy Clin Immunol 2018; 143:591-603.e3. [PMID: 29935218 DOI: 10.1016/j.jaci.2018.05.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 05/07/2018] [Accepted: 05/19/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The effect of Staphylococcus aureus on nasal epithelial repair has never been assessed in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). OBJECTIVE This study aimed to determine whether (1) nasal epithelial cell cultures from patients with CRSwNP and control subjects repair differently; (2) S aureus exoproducts compromise nasal epithelial repair; (3) S aureus alters lamellipodial dynamics; and (4) deleterious effects could be counteracted by the Rho-associated coiled-coil kinase inhibitor Y-27632. METHODS Primary nasal epithelial cells (pNECs) collected during surgeries were cultured and injured under 3 conditions: (1) basal conditions, (2) exposed to S aureus exoproducts, and (3) exposed to S aureus exoproducts and Y-27632. Epithelial repair, lamellipodial dynamics, and cytoskeletal organization were assessed. RESULTS Under basal conditions, pNEC cultures from patients with CRSwNP presented significantly lower repair rates and reduced lamellipodial protrusion length and velocity than those from control subjects. S aureus exoproducts significantly decreased repair rates and protrusion dynamics in both control subjects and patients with CRSwNP; however, the effect of S aureus on cell protrusions was more sustained over time in patients with CRSwNP. Under basal conditions, immunofluorescence assays showed significantly reduced percentages of cells with lamellipodia at the wound edge in patients with CRSwNP compared with control subjects. S aureus altered cell polarity and decreased the percentage of cells with lamellipodia in both groups. Finally, Y-27632 prevented the deleterious effects of S aureus exoproducts on CRSwNP repair rates, as well as on lamellipodial dynamics and formation. CONCLUSIONS S aureus exoproducts significantly alter epithelial repair and lamellipodial dynamics on pNECs, and this impairment was more pronounced in patients with CRSwNP. Importantly, Y-27632 restored epithelial repair and lamellipodial dynamics in the presence of S aureus exoproducts.
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Affiliation(s)
- Fabiana C P Valera
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Division of Otorhinolaryngology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Manon Ruffin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Département de Médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Damien Adam
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Département de Médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Émilie Maillé
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Badr Ibrahim
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Department of Otolaryngology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Julie Berube
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Simon Rousseau
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Emmanuelle Brochiero
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Département de Médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Martin Y Desrosiers
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Department of Otolaryngology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
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Maniakas A, Asmar MH, Renteria Flores AE, Nayan S, Alromaih S, Mfuna Endam L, Desrosiers MY. Staphylococcus aureus on Sinus Culture Is Associated With Recurrence of Chronic Rhinosinusitis After Endoscopic Sinus Surgery. Front Cell Infect Microbiol 2018; 8:150. [PMID: 29868506 PMCID: PMC5962714 DOI: 10.3389/fcimb.2018.00150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/20/2018] [Indexed: 01/20/2023] Open
Abstract
Objectives: Identify whether identification of S. aureus on conventional culture is a predictor of success or failure after ESS followed by budesonide nasal irrigations (BUD) in chronic rhinosinusitis (CRS) patients at high risk of recurrence. Methodology: Prospective clinical trial including 116 patients from a tertiary care center at high-risk of disease recurrence following ESS+BUD. Blood samples, microbial swabs, and SNSS/SNOT-22 were taken on the day of surgery (Visit-1) and 4 months postoperatively (Visit-2). Outcomes were evaluated using symptoms and mucosal status as assessed by the Lund-Kennedy endoscopic score. Results: Seventy-five patients (69.4%) attained SNOT-22 MCID or higher. (Mean = 33.4, range 9–75). Objective documentation of recurrence of disease, as defined by combined endoscopic/symptomatic criteria, was noted in 58/116 patients (50%). Revision surgery was associated with a significantly higher rate of disease recurrence (60.0 vs. 28.0%; p < 0.001). Culture for Staphylococcus aureus was associated with disease recurrence, preoperatively and at 4 months post-surgery (p = 0.020; p < 0.001). This was restricted to post-operative cultures in the revision group (10.0 vs. 48.8%; p < 0.001). Other factors associated with poor outcome included intolerance to non-steroidal anti-inflammatory drugs (NSAID) (p = 0.036). Significantly higher Lund-Kennedy scores in the recurrence groups despite similar symptom intensity, emphasizing the importance of considering objective outcome in addition to patient-reported ones. Conclusion: Patients undergoing revision ESS are at high risk of disease recurrence, even when budesonide irrigations are used post operatively. Presence of S. aureus on culture pre-operatively or at 4 months post-ESS is associated with a negative outcome. This suggests that S. aureus negatively influences outcome, possibly via a number of mechanisms, including interactions with the (i) immune system, (ii) regeneration and repair of the sinus epithelium, or (iii) via interference with the sinus microbiome. This suggests that S. aureus may be a simple and inexpensive biomarker for disease severity and indicates a clear need to better appreciate S. aureus on how it contributes mechanistically to disease development and persistence in order to develop targeted therapeutic strategies.
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Affiliation(s)
- Anastasios Maniakas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marc-Henri Asmar
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Axel E Renteria Flores
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Smriti Nayan
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada.,Department of Surgery, Cambridge Memorial Hospital, Cambridge, ON, Canada
| | - Saud Alromaih
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Leandra Mfuna Endam
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Martin Y Desrosiers
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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Valera FCP, Endam LM, Ibrahim B, Brochiero E, Desrosiers MY. Is there a role for regenerative medicine in chronic rhinosinusitis with nasal polyps? Braz J Otorhinolaryngol 2016; 83:1-2. [PMID: 27887817 PMCID: PMC9444773 DOI: 10.1016/j.bjorl.2016.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Indexed: 12/29/2022] Open
Affiliation(s)
- Fabiana C P Valera
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto (FMRP-USP), Divisão de Otorrinolaringologia, Ribeirão Preto, SP, Brazil
| | - Leandra M Endam
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Department of Otolaryngology, Montréal, Québec, Canada
| | - Badr Ibrahim
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Emmanuelle Brochiero
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Université de Montréal, Department of Medicine, Montréal, Québec, Canada
| | - Martin Y Desrosiers
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Department of Otolaryngology, Montréal, Québec, Canada.
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Rassouli A, Desrosiers MY, Ryan AF, Hamid Q, Tewfik MA. Baseline Characteristics of the Sinonasal Tract in Wild-Type and Innate Immunity Knockout Mice. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813496044a341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: 1)I Investigate the baseline histological characteristics of sinonasal tissue in wild-type mice. 2) Observe the effects of knocking out various genes involved in innate immunity on the inflammatory cell infiltrates and mucosal architecture of murine sinonasal epithelium. Methods: Unchallenged wild-type C57-BL6 mice, as well as knockouts for the innate immunity genes NOD-1, NOD-2, RIP-2, TLR-2 and MYD88, were sacrificed at age of maturity. The heads were decalcified and sinuses serially cut at 5 micrometer thickness. Three sections of the nasal cavity (anterior, mid, and posterior) were selected and examined under H&E and immunohistochemical staining conditions. Goblet cells, basement membrane thickness, neutrophil, macrophages, and eosinophils were evaluated and counted under high-power field and compared using one-way analysis of variance multiple comparison (SPSS 20). Results: Average cell counts per mm2 for wild-type mice were 16.3 +- 1.5 macrophages, 2.0 +- 0.5 neutrophils, 0 eosinophils, and 2152.4 +- 572.4 goblet cells; basement membrane thickness was 3.1 +- 1.5 micro meter. There were no significant differences between the wild-type and the knockout groups. Conclusions: The current study suggests that innate immunity gene knockouts had little effect on the sinonasal epithelium of unchallenged mice. Disruption of innate immune effector genes is not sufficient in and of itself to cause a rhinosinusitis phenotype in mice, but may still cause an inability to mount an appropriate host immune response to microbial pathogens.
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Shikani A, Harvey RJ, Wormald PJ, Desrosiers MY, Fakhri S, Ryan MW, Krespi YP. Local Anti-infectives and Anti-inflammatory Therapy. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812449008a82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Al-Mot S, Filali-Mouhim A, Rousseau S, Tardif V, Berthiaume Y, Desrosiers MY, Mfuna-Endam L. Molecular Signatures as a New Classification Scheme for CRS. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811416318a268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: We have identified 2 distinct gene expression patterns (CRS1 and CRS2) in cultured epithelial cells obtained from surgical biopsies in CRS patients with and without nasal polyps (NP), which may better classify this disorder. We wished to compare the cellular infiltrate in CRS when assessed by molecular and clinical phenotypes. Method: Surgical biopsies taken from 20 CRS patients and 10 controls were divided according to their molecular signature as determined from epithelial cell cultures. Immunohistochemistry (IHC) for neutrophil elastase (NE) and major basic protein (MBP) was used to identify neutrophils and eosinophils in the epithelial and submucosal areas. Results: Groups were analyzed statistically using ANOVA and t test to identify significant differences between groups. When biopsies were assessed as function of the clinical phenotypes of CRSwNP compared with CRSsNP, while there were equal increases in the number of eosinophils and neutrophils cells in CRS patients compared with the control subjects, there was no difference between the win and sNP groups. However, when assessed according to molecular signature, while there was an increase in eosinophils in both groups, a significant increase in the number of neutrophils was only seen in the CRS2 group, suggesting a different pathogenic mechanism. Conclusion: This novel expression signature identifies a molecular phenotype of CRS that is characterized by a marked neutrophil infiltration. Assessments of disease mechanism and response to therapy according to molecular, as opposed to clinical, phenotype may identify mechanistic differences which “personalize” our management of individuals with this disease.
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Abstract
Suggestion for a potential genetic basis to chronic rhinosinusitis (CRS) is afforded by degree of inheritability suggested from family and twin studies, existence of CRS in simple mendelian diseases, and development of sinusitis as part of the phenotype of certain gene "knockout" murine models. Genetic association studies are expected to identify novel genes associated with CRS and suggest novel mechanisms implicated in disease development. Although these studies are subject to methodologic difficulties, associations of CRS and polymorphisms in more than 30 genes have been published, with single nucleotide polymorphisms in 3 (IL1A, TNFA, AOAH) replicated. While the individual risk conferred by these single nucleotide polymorphisms remains modest, taken as a group, they suggest an important implication of pathways of innate immune recognition and in regulation of downstream signaling in the development of CRS. In a demonstration of these techniques' potential to identify new targets for research, the authors present a functional investigation of LAMB1, the top-rated gene from a pooling-based genome-wide association study of CRS. Upregulation of gene expression in LAMB1 and associated laminin genes in primary epithelial cells from CRS patients implicates the extracellular matrix in development of CRS and offers a new avenue for further study.
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Affiliation(s)
- Leandra Mfuna-Endam
- Department of Otolaryngology-Head and Neck Surgery, Centre de Recherche du CHUM (CRCHUM), Hôpital Hôtel-Dieu, Université de Montréal, QC, Canada
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Hubin G, Divoy C, Desrosiers MY, Filali-Mouhim A, Mfuna-Endam L. Upregulation of Genes for Innate Immune Signaling and Apoptosis after Surgery for Chronic Rhinosinusitis: Evidence of a Mucosal Immune Dysfunction in CRS? Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811416318a281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Endoscopic sinus surgery (ESS) for chronic rhinosinusitis is a frequently performed surgical procedure. However, the mechanism by which it improves disease is unknown. We wished to determine patterns of changes in gene expression associated with resolution of disease following ESS in order to identify mechanisms implicated in resolution of disease. Method: Twelve patients undergoing ESS for CRS were recruited. An epithelial sample from the frontal sinus was collected using a cytology brush at time of surgery and repeated 3 months after surgery. Microarray analysis of gene expression was performed using the Illumina Human HT-12 Beachip v3. Results: Both single gene expression analysis (using Limma package from Bioconductor software.) and gene set analysis (using Ingenuity Pathway Analysis software) were used to identify implicated genes and pathways (or networks), respectively. All patients resolved CRS with surgery. A total of 4707 genes or transcripts showed significant differential expression changes (pFDR). Healing was associated with increased expression of cytokines and transcription factors in the IL1B signaling pathway (IL8 (FC: 8.56; P = .00027) IL1B (FC: 4.21; P = .0008) NFkBIZ (FC: 2.27; P = .0008), innate immune signaling (IRAKs-1, -2, and -3, CD14, MD2, MyD88), and apoptosis (CASP3, BAK, BID). Conclusion: Resolution of CRS after ESS is characterized by marked upregulation of the IL-1B and innate immune signaling pathways and increased expression of pro-apoptosis genes. This supports the concept that microbial detection and clearance are impaired in CRS, and that strategies increasing immune activation may represent novel therapeutic opportunities.
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Kilty SJ, Bossé Y, Cormier C, Endam LM, Desrosiers MY. Polymorphisms in the SERPINA1 (Alpha-1-Antitrypsin) Gene are Associated with Severe Chronic Rhinosinusitis Unresponsive to Medical Therapy. Am J Rhinol Allergy 2010; 24:e4-9. [DOI: 10.2500/ajra.2010.24.3429] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Alpha-1-antitrypsin (AAT) is a serine protease inhibitor that blocks the protease, neutrophil elastase. Previous population studies have suggested that heterozygote status for the AAT gene (SERPINA1) is a risk factor for chronic rhinosinusitis with nasal polyposis (CRSwNP). This implies a potential genetic predisposition to CRS tied to AAT deficiency. The purpose of this study was to investigate the association between single nucleotide polymorphisms (SNPs) in the SERPINA1 gene and CRS. Methods DNA extracted from a population of 206 patients diagnosed with CRSwNPs and 196 postal code–matched controls was used. A maximally informative set of tagging SNPs from SERPINA1 on chromosome 14q were selected from the HapMap data set (International HapMap Consortium, Nature 437:1299–1320, 2005) and genotyped on the Sequenom platform (Sequenom, San Diego, CA). Results Successful genotyping was performed for 32 of 33 SNPs. Two SNPs (rs1243168 and rs4900229) located upstream of the SERPINA1gene, were associated with CRS. Individuals homozygous (TT)for these SNPs had an increased probability of having CRS with an odds ratio of 5.95 and 1.49, respectively. Subgroup analysis according to severity of disease identified each SNP to be increasingly common in individuals as disease severity increased (p < 0.001). These individuals were also less likely to be responsive to medical therapy (p < 0.001). Conclusions Polymorphisms of the SERPINA1 gene are associated with clinically severe CRS. These results, from a small subset of individuals with CRS, suggest that defects in AAT may be implicated in a subset of individuals unresponsive to conventional therapy and suggests that alternate therapies may be required for their management.
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Affiliation(s)
- Shaun J. Kilty
- The Department of Otolaryngology, Hôpital Hôtel–Dieu de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Yohan Bossé
- Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Quebec City, Quebec Canada
- Laval University Hospital Research Center (CRCHUL), Quebec City, Quebec, Canada
| | - Chantale Cormier
- The Department of Otolaryngology, Hôpital Hôtel–Dieu de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Leandra Mfuna Endam
- The Department of Otolaryngology, Hôpital Hôtel–Dieu de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Martin Y. Desrosiers
- The Department of Otolaryngology, Hôpital Hôtel–Dieu de Montréal, Université de Montréal, Montreal, Quebec, Canada
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
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Kilty SJ, Desrosiers MY. Chronic sinusitis and alpha1-antitrypsin deficiency: potential role for protease in rhinosinusitis? J Otolaryngol Head Neck Surg 2008; 37:E179-E182. [PMID: 19128694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Shaun J Kilty
- Department of Otolaryngology, Hotel-Dieu de Montreal, Montreal, Quebec
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Abstract
The earliest description of a bacterial biofilm is likely centuries old. However, only in the past few decades has a wealth of knowledge developed pertaining to this bacterial form of existence. Biofilms have been implicated mainly in chronic disease states, and the current available treatment modalities for infection have demonstrated limited efficacy against bacteria in this form. There is evidence associating bacterial biofilm formation in chronic infections of the upper airway, and therefore we examine the possible role of a bacterial biofilm in chronic rhinosinusitis while drawing parallels with recent data from other bodily regions. Lastly, directions for contemporary biofilm research are reviewed and highlighted in terms of their application to chronic rhinosinusitis.
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Affiliation(s)
- Shaun J Kilty
- Pavilion Hôtel-Dieu, 3840, Rue St. Urbain, Montreal, Quebec, Canada
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Desrosiers MY, Kilty SJ. Treatment alternatives for chronic rhinosinusitis persisting after ESS: what to do when antibiotics, steroids and surgery fail. Rhinology 2008; 46:3-14. [PMID: 18444486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND It is estimated that over 500,000 individuals in the United States currently suffer from chronic rhinosinusitis (CRS), which has persisted or recurred despite maximal medical therapy and endoscopic sinus surgery (ESS). Management of these individuals remains uncertain, as recent published guidelines on CRS do not extend to this population. OBJECTIVE Our objective is to provide a framework for the management of patients who fail standard therapy for CRS while providing recommendations based on the strength of the evidence for alternative medical therapies that can be used for the treatment of recurrent CRS. This guideline targets ENT physicians and allergists managing this increasingly frequent clinical situation and attempts to assist them in selecting from the increasing array of potential therapies available. To this end, factors contributing to the pathophysiology of post-ESS CRS are reviewed to identify method of action of existing and potential therapies and recommendations are made for their use. RESULTS Given the accessibility of the sinus cavities after ESS, topical therapies are privileged. Saline spray or irrigation is recommended for all patients. Corticosteroids in oral or topical forms are recommended for controlling the inflammatory component, while the use of a short term course of oral or topical antibiotics are recommended mainly for the treatment of exacerbations. Long-term therapy with oral macrolides is also recommended as an alternative therapy. Desensitization with acetylsalicylic acid (ASA) for individuals with documented ASA sensitivity is recommended where available, while revision surgery, anti-leukotriene agents and intravenous immunoglobulins are options in management in selected patients. Antifungal therapy is not recommended. No recommendations for potentially experimental strategies are made in the absence of published experience and safety data in human subjects.
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Affiliation(s)
- Martin Y Desrosiers
- The Department of Otolaryngology, Hôpital Hôtel-Dieu, Université de Montreal, Montreal, Quebec, Canada.
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18
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Lane A, Daniel S, Tewfik MA, Bossé Y, Hudson T, Desrosiers MY, Vallee-Smejda S. 11:10: TLR Signalling Gene Polymorphisms in Chronic Rhinosinusitis. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duval M, Desrosiers MY. 08:02 AM: Guidelines for Acute Rhinosinusitis: Impact on Antibiotic Use. Otolaryngol Head Neck Surg 2006. [DOI: 10.1016/j.otohns.2006.06.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Abstract
Chronic rhinosinusitis poses numerous challenges for the practitioner. This article presents strategies for making the diagnosis and managing chronic rhinosinusitis with and without nasal polyposis, and for assessing and managing disease persisting or recur-ring after endoscopic sinus surgery.
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Affiliation(s)
- Mohammed M Nagi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, 6th Floor, McIntyre Medical Sciences Building, 3655 Promenade Sir William Osler, Montréal, QC H3G 1Y6, Canada
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Cloutier JF, Desrosiers MY. Evaluating the Reproducibility of Sinus Lavages with a Saline Solution Administered Directly in the Maxillary Sinus of Patients after Endoscopic Sinus Surgery. ACTA ACUST UNITED AC 2004; 33:366-9. [PMID: 15971652 DOI: 10.2310/7070.2004.03121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Chronic sinusitis is recognized as having a strong inflammatory component, and failures of endoscopic sinus surgery (ESS) are frequently attributed to persistent inflammation. A test that would allow rhinologists to evaluate the inflammatory state of a patient's sinuses would be helpful to evaluate cases refractory to therapy, determine appropriate medical therapy, and monitor the response to therapy. OBJECTIVES The goal of this preliminary research is to assess the optimal method of collection and the reproducibility and specificity of sinus lavages. METHOD Twelve patients who had undergone ESS were recruited. They were divided into two groups according to the persistence of their symptoms and the recurrence of acute sinusitis after ESS. The subjects were seen twice. Three successive lavages were collected from each maxillary sinus and were analyzed by cell count. RESULTS Intrasession cell counts were most reproducible (Spearman rank correlation .7 for eosinophils and .6 for neutrophils) for the second lavage. Intersession cell counts were highly reproducible for eosinophils (r = .7) for the second lavage. The two-tailed t-test did not reveal any statistically significant differences between the good and the poor outcome groups. CONCLUSION Assessment of eosinophil cell counts on sinus lavage is a feasible and reproducible method to evaluate the inflammatory state of a patient's sinuses in patients who have undergone ESS.
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Affiliation(s)
- Jean-François Cloutier
- Service d'otorhino-laryngologie, Centre Hospitalier de l'Université de Montreal, pavilion Hôtel-Dieu, Université de Montreal, Montreal, Quebec
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22
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Abstract
Although serious sequelae of endoscopic sinus surgery are infrequent, more commonplace surgical management often involves the control of mucosal bleeding. This study was conducted to assess the efficacy of an elastoviscous hylan gel as a postsurgical wound dressing for promotion of hemostasis. Twenty patients with a diagnosis of chronic sinusitis were evaluated. In randomized fashion, the gel dressing was placed into one operated cavity while the contralateral side served as the control. The results indicated that hylan gel was effective in stilling postsurgical bleeding, particularly in the fulminant polyposis cases who had a larger and more exposed cavity. These early results indicate a potential benefit of a gel dressing for hemostasis when used at the conclusion of the operative procedure. In addition, other parameters were evaluated in this study, including prevention of postoperative adhesions and the effect on mucosal healing. These parameters showed a positive result compared with the control group.
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Affiliation(s)
- Saul Frenkiel
- Department of Otolaryngology, McGill University, Montreal, Quebec
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23
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Lavigne F, Desrosiers MY, Blacquiere M, Dube N, Vaillancourt P, Tulic M, Eiden J, Hamid QA. Effect of AIC (AmbA 1 immunostimulatory oligonucleotide conjugate) on nasal allergen challenge and inflammatory response to seasonal ragweed exposure. J Allergy Clin Immunol 2002. [DOI: 10.1016/s0091-6749(02)81749-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Martinez JA, Desrosiers MY, Desrosiers S, Khemici E, Blaquiere M. Evaluation of nasal responses to Fel D1 by acoustic rhinometry as a test of cat allergy. J Allergy Clin Immunol 2002. [DOI: 10.1016/s0091-6749(02)81393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Desrosiers MY, Lavigne F, Blaquiere M, Dube N, Eiden J, Hamid QA. Effect of AIC (Amb a 1 immunostimulatory oligonucleotide conjugate) on nasal allergen challenge and clinical response to seasonal ragweed exposure. J Allergy Clin Immunol 2002. [DOI: 10.1016/s0091-6749(02)81740-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Desrosiers MY, Salas-Prato M. Treatment of chronic rhinosinusitis refractory to other treatments with topical antibiotic therapy delivered by means of a large-particle nebulizer: results of a controlled trial. Otolaryngol Head Neck Surg 2001; 125:265-9. [PMID: 11555764 DOI: 10.1067/mhn.2001.117410] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study the efficacy of nebulized topical saline-tobramycin solution in patients with chronic rhinosinusitis refractory to medical and surgical therapy. STUDY DESIGN AND SETTING Twenty patients in whom endoscopic sinus surgery failed to relieve symptoms entered a randomized, double-blind trial of tobramycin-saline solution or saline-only solution administered thrice daily to the nasal passages by means of a large-particle nebulizer apparatus for 4 weeks, followed by a 4-week observation period. Outcome measures of symptoms, quality of life, and endoscopic aspect of sinus mucosa were assessed. RESULTS Both treatments were well tolerated and produced equivalent improvement in symptoms, quality of life, and mucosal aspect. Treatment with the tobramycin-saline solution gave more rapid improvement of pain, but led to the development of nasal congestion. CONCLUSION Therapy with a 4-week course of large-particle nebulized aerosol therapy improves symptomatology and objective parameters of rhinosinusitis in patients refractory to surgical and medical therapies. Addition of tobramycin appears of minimal benefit. The mechanism of this effect is unexplained. SIGNIFICANCE Large-particle nebulized aerosol therapy may offer a safe and effective management alternative for patients with refractory rhinosinusitis.
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Affiliation(s)
- M Y Desrosiers
- Department of Otolaryngology and Allergy, The Montreal General Hospital, McGill University Health Center, Quebec, Canada.
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Abstract
OBJECTIVE Rhinosinusitis is a common disease affecting 135 per 1,000 population. The cost and the impact on quality of life of this disease are considerable. Health care delivery for a particular disease is evaluated through the health impact of the disease, outcomes of treatments, and their costs. This article reviews our experience with rhinosinusitis and its impact on health, as measured using a generic quality of life instrument, the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36), in a selected patient population. Outcomes of treatments will be introduced, and the economic impact of chronic rhinosinusitis based on a U.S. study will be discussed. MATERIAL AND METHODS One hundred and ten patients (divided into three subgroups: recurrent acute rhinosinusitis, chronic rhinosinusitis, and nasal polyposis) completed the SF-36 survey on the day of the diagnostic visit in the outpatient sinus clinics of two hospitals. RESULTS The scores of the SF-36, in chronic rhinosinusitis, are compared with the normative values of a healthy U.S. population showing statistically significant differences in seven of eight domains. A comparison of the scores of chronic rhinosinusitis with a U.S. study on chronic rhinosinusitis shows statistically significant differences in five of eight domains. A comparison of the scores in the three diagnostic subgroups shows a statistical significance in two domains: bodily pain and vitality are more affected in recurrent acute and chronic rhinosinusitis. CONCLUSIONS Chronic rhinosinusitis affects the quality of life of patients with rhinosinusitis and represents an important health burden. Some differences are noted with the U.S. chronic rhinosinusitis population. Recurrent acute and chronic rhinosinusitis seem to have more impact on vitality and bodily pain than nasal polyposis.
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Affiliation(s)
- D G Durr
- Department of Surgery, Centre Hospitalier Anna-Laberge, Châteauguay, Quebec
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29
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Desrosiers MY, Lecours S. Nasal provocation testing for tea-induced occupational rhinitis. Otolaryngol Head Neck Surg 1999. [DOI: 10.1016/s0194-5998(99)80133-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Desrosiers MY, Salasprato M. Treatment of ESS failures with nebulized topical antibiotics. Otolaryngol Head Neck Surg 1999. [DOI: 10.1016/s0194-5998(99)80301-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Durr DG, Desrosiers MY, Dassa C. Quality of life in patients with rhinosinusitis. J Otolaryngol 1999; 28:108-11. [PMID: 10212880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- D G Durr
- Department of Otolaryngology, Pavillon Hôtel-Dieu, Centre Hospitalier de l'Université de Montréal
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