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Macchi A, Giorli A, Cantone E, Carlotta Pipolo G, Arnone F, Barbone U, Bertazzoni G, Bianchini C, Ciofalo A, Cipolla F, De Massimi A, De Vita C, Di Lieto C, Ghidini A, Govoni M, Gramellini G, Maselli Del Giudice A, Ottaviano G, Seccia V, Sireci F, Sollini G, Staffieri C, Gallo S, Heffler E, Mantia IL, De Corso E, Canevari FR, Lombardo N, Malvezzi L, Orietti G, Pasquini E, Presutti L, Monti G. Sense of smell in chronic rhinosinusitis: A multicentric study on 811 patients. Front Allergy 2023; 4:1083964. [PMID: 37152304 PMCID: PMC10160403 DOI: 10.3389/falgy.2023.1083964] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/28/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction The impairment of the sense of smell is often related to chronic rhinosinusitis (CRS) with or without nasal polyps (CRSwNP, CRSsNP). CRSwNP is a frequent condition that drastically worsens the quality of life of those affected; it has a higher prevalence than CRSsNP. CRSwNP patients experience severe loss of smell with earlier presentation and are more likely to experience recurrence of their symptoms, often requiring revision surgery. Methods The present study performed a multicentric data collection, enrolling 811 patients with CRS divided according to the inflammatory endotype (Type 2 and non-Type 2). All patients were referred for nasal endoscopy for the assessment of nasal polyposis using nasal polyp score (NPS); Sniffin' Sticks olfactory test were performed to measure olfactory function, and SNOT-22 (22-item sinonasal outcome test) questionnaire was used to assess patients' quality of life; allergic status was evaluated with skin prick test and nasal cytology completed the evaluation when available. Results Data showed that Type 2 inflammation is more common than non-type 2 (656 patients versus 155) and patients suffer from worse quality of life and nasal polyp score. Moreover, 86.1% of patients with Type 2 CRSwNP were affected by a dysfunction of the sense of smell while it involved a lesser percentage of non-Type 2 patients. Indeed, these data give us new information about type-2 inflammation patients' characteristics. Discussion The present study confirms that olfactory function weights on patients' QoL and it represents an important therapeutic goal that can also improve patients' compliance when achieved. In a future - and present - perspective of rhinological precision medicine, an impairment of the sense of smell could help the clinician to characterize patients better and to choose the best treatment available.
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Affiliation(s)
- Alberto Macchi
- ENT Clinic Asst Sette Laghi – University of Insubria, Varese, Italy
| | | | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat. Federico II University, NaplesItaly
| | - Giorgia Carlotta Pipolo
- Otorhinolaryngology Unit ASST Santi Paolo e Carlo Hospital. Department of Health Sciences, University of Milan, Milan, Italy
| | - Flavio Arnone
- Otorhinolaryngology Unit ASST Santi Paolo e Carlo Hospital. Department of Health Sciences, University of Milan, Milan, Italy
| | | | | | | | - Andrea Ciofalo
- Ent Department, Azienda Ospedaliera Universitaria S.Anna, Ferrara, Italy
| | - Federica Cipolla
- Unit of Otorhinolaryngology – IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alessio De Massimi
- Istituto di ORL, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Carla De Vita
- SS ORL San Vito al Tagliamento – Azienda Sanitaria Friuli Occidentale, S. Vito al Tagliamento, Italy
| | - Cristina Di Lieto
- SS ORL San Vito al Tagliamento – Azienda Sanitaria Friuli Occidentale, S. Vito al Tagliamento, Italy
| | | | - Marco Govoni
- ENT Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | | | | | - Veronica Seccia
- UOC Azienda Ospedaliero Universitaria Mater Domini, Catanzaro, Italy
| | | | - Giacomo Sollini
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero Universitaria Policlinico di Sant’Orsola, Bologna, Italy
| | | | - Stefania Gallo
- ENT Clinic Asst Sette Laghi – University of Insubria, Varese, Italy
| | | | - Ignazio La Mantia
- Unit of Otorhinolaryngology – IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Frank Rikki Canevari
- Otorhinolaryngology Section, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND) University of Palermo, Palermo, Italy
| | | | | | - Gabriele Orietti
- ENT Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | - Livio Presutti
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero Universitaria Policlinico di Sant’Orsola, Bologna, Italy
| | - Giulia Monti
- ENT Unit Bari Adria Trani, Bari, Italy
- Correspondence: Giulia Monti
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De Vita C, Sollini G, Zoli M, Mazzatenta D, Pasquini E. When is a multidisciplinary approach required in management of intracranial complications of sinonasal inflammatory disorders? ACTA ACUST UNITED AC 2021; 41:S67-S75. [PMID: 34060522 PMCID: PMC8172114 DOI: 10.14639/0392-100x-suppl.1-41-2021-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/31/2021] [Indexed: 11/23/2022]
Abstract
Intracranial complications of sinonasal inflammatory disorders are relatively unusual but can cause significant morbidity and mortality. They often occur in patients with comorbid disorders and immunocompromised but also people without risk factors can be affected. Intracranial complications of acute rhinosinusitis are rare, probably due to oral antibiotics availability, but are less predictable as they often occur in immunocompetent patients without comorbidity. Their management requires a multidisciplinary approach to plan and customize the therapeutic treatment. Intracranial complications of chronic rhinosinusitis are more predictable as they occur often in immunocompromised patient with particularly risk factors. For this reason, a multidisciplinary approach it’s important for treatment and mostly for prevention. The aim of this paper is to present an overview of different multidisciplinary management of intracranial complications of sinonasal inflammatory disorders according to their etiology and severity.
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Affiliation(s)
| | | | - Matteo Zoli
- Center of Pituitary & Endoscopic Skull Base Surgery IRCCS Neuroscienze di Bologna, Italy
| | - Diego Mazzatenta
- Center of Pituitary & Endoscopic Skull Base Surgery IRCCS Neuroscienze di Bologna, Italy
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De Corso E, Settimi S, Tricarico L, Mele DA, Mastrapasqua RF, Di Cesare T, Salvati A, Trozzi L, De Vita C, Romanello M, Paludetti G, Galli J. Predictors of Disease Control After Endoscopic Sinus Surgery Plus Long-Term Local Corticosteroids in CRSwNP. Am J Rhinol Allergy 2020; 35:77-85. [PMID: 32564684 DOI: 10.1177/1945892420936196] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND in the era of new biological agents it is important to identify patients who may benefit from conventional therapies such as endoscopic sinus surgery (ESS) plus long-term local corticosteroids from those with patterns of inflammation that are more difficult to control post-operatively and who may benefit from other therapies. OBJECTIVE determine if preoperative assessment of type and grade of inflammation and clinical factors can predict disease control with ESS plus long-term local corticosteroids in chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS Eighty patients treated with ESS plus mometasone-furoate 200 μg BID for CRSwNP and followed for at least 1 year were enrolled (November 2017-December 2018) in this prospective observational study. Type and grade of inflammation were evaluated preoperatively by nasal cytology. Based on cellular pattern, patients were grouped as neutrophilic (n = 20), eosinophilic (n = 38), or mixed eosinophil-neutrophilic (n = 22). SNOT-22 and Lund-Kennedy Endoscopic Score were evaluated at baseline and at 3, 6, 9, and 12 months after surgery and used to define disease control. RESULTS The cumulative probability of remaining free of significant modification of endoscopic score (Lund-Kennedy Endoscopic Score >2) at 3, 6, 9, and 12 months was 0.84, 0.76, 0.71, and 0.68, respectively. At 12-month postoperative evaluation good disease control was observed in 54 of 80 patients (67.5%). Compared to those with good post-operative disease control, those with poor control had a significantly higher pre-operative mean count of eosinophils and neutrophils (p < 0.05). The preoperative inflammatory pattern was associated with relative risk of poor control: neutrophilia (RR: 3.10; CI:1.24-7.71), eosinophilia (RR:8.42; CI:2.72-15.12), and mixed eosinophilic and neutrophilic (RR:25.11; CI:19.41-30.01). We also confirmed that asthma, allergy, blood eosinophilia, and ASA triad could predict poor control. CONCLUSIONS The type and load of inflammation evaluated preoperatively and selected clinical factors can predict poor control of CRSwNP treated with ESS and local corticosteroids.
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Affiliation(s)
- Eugenio De Corso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Settimi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Laura Tricarico
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Antonio Salvati
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucrezia Trozzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carla De Vita
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Matteo Romanello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Paludetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jacopo Galli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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De Corso E, Anzivino R, Galli J, Baroni S, Di Nardo W, De Vita C, Salvati A, Autilio C, Settimi S, Mele D, Paludetti G, Mullol J. Antileukotrienes improve naso-ocular symptoms and biomarkers in patients with NARES and asthma. Laryngoscope 2018; 129:551-557. [PMID: 30478909 DOI: 10.1002/lary.27576] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/09/2018] [Accepted: 08/24/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of our study was to analyze the montelukast effectiveness in improving oculonasal symptoms, patient-reported outcomes (PROs), and eosinophilic biomarkers in patients with nonallergic rhinitis eosinophilic syndrome (NARES). METHODS We enrolled prospectively 80 symptomatic patients treated with 10 mg once a day of montelukast in monotherapy for 2 months. All patients were investigated before and after treatment. Nasal symptoms (nasal obstruction, rhinorrhoea, sneezing, nasal itching), ocular symptoms (redness/puffiness, watery eyes), and other PROs (olfactory dysfunction, difficulty going to sleep, nighttime awakenings, and nasal congestion on awakening) were scored by visual analogic scale. The following clinical scores were assessed: Total Nasal Symptom Score (T4NSS), Total Ocular Symptom Score (T2OSS), Total Symptom Score of Patient-Reported Outcomes (TSS-PROs), and a Composite Symptoms Score (CSS). Patients were classified as responders when a reduction of at least 50% of the CSS was observed. Before and after treatment, the eosinophilic biomarkers in nasal lavage were analyzed: nasal eosinophilia (number of eosinophils per high power field), eotaxin-1 and eotaxin-2. RESULTS After treatment, significant reductions were observed for all the symptom scores. Forty-two of 78 patients were considered responders. A significant reduction of eosinophils in nasal mucosa and of levels of eotaxin-1 and eotaxin-2 in nasal lavage were observed after treatment in responder patients. Patients with asthma had an increased probability to be responders. CONCLUSION NARES patients may benefit from treatment with montelukast. In particular, the presence of concomitant asthma may be predictive of a greater efficacy. LEVEL OF EVIDENCE 2 Laryngoscope, 129:551-557, 2019.
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Affiliation(s)
- Eugenio De Corso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Anzivino
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jacopo Galli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Baroni
- Department of Diagnostic and Laboratory Medicine-Institute of Biochemistry and Clinical Biochemistry
| | - Walter Di Nardo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carla De Vita
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Salvati
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Autilio
- Department of Biochemistry, Faculty of Biology and Research Institute Hospital 12 the Octubre, Complutense University, Madrid, Spain
| | - Stefano Settimi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Mele
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Paludetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento Neurolgiche e della Testa e del Collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES Barcelona, Catalonia, Spain
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De Corso E, Lucidi D, Battista M, Romanello M, De Vita C, Baroni S, Autilio C, Galli J, Paludetti G. Prognostic value of nasal cytology and clinical factors in nasal polyps development in patients at risk: can the beginning predict the end? Int Forum Allergy Rhinol 2017; 7:861-867. [PMID: 28665504 DOI: 10.1002/alr.21979] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 05/12/2017] [Accepted: 05/30/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND We evaluated the prognostic value of nasal cytology and clinical factors in predicting nasal polyp (NP) development in patients with history of nonallergic chronic sinonasal inflammation. METHODS This was a retrospective case-control study of 295 patients followed at our institution for a mean of 85.70 ± 19.41 months. According to the inclusion criteria we enrolled 84 cases with persistent eosinophilic nonallergic sinonasal inflammation (group A) and 106 cases with neutrophilic inflammation (group B), both without evidence of NPs at the baseline. We considered as controls 105 patients affected by nonallergic noninfectious vasomotor rhinitis without evidence of inflammation at nasal cytology (group C). Patients were checked every 6 months for NPs. Temporal analyses was performed by Kaplan-Mayer curves and odds ratios were evaluated by logistic regression analyses. RESULTS The percentage of patients that developed NPs was higher in group A (29/84 [34.52%]) than in group B (17/106 [16.03%]) and group C (5/104 [4.7%]) (p < 0.05). Logistic regression analyses showed that eosinophilic patients had a higher risk of NP development over the years than neutrophilic patients compared to controls (odds ratio [OR], 10.55 vs 3.2). We also demonstrated that hypereosinophilia, asthma, and aspirin intolerance may increase the OR differently in eosinophilic patients. CONCLUSION Our data suggest that early identification of inflammatory patterns and associated clinical factors in patients affected by chronic nonallergic sinonasal inflammation have a prognostic value that can help to identify patients with different risks of NP development. Our data confirm that detection of nasal eosinophilic inflammation represents an early marker for identification of a more aggressive inflammatory phenotype.
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Affiliation(s)
- Eugenio De Corso
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - Daniela Lucidi
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - Mariapina Battista
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - Matteo Romanello
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - Carla De Vita
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - Silvia Baroni
- Department of Diagnostic and Laboratory Medicine, Institute of Biochemistry and Clinical Biochemistry, Catholic University School of Medicine and Surgery, Rome, Italy
| | - Chiara Autilio
- Department of Diagnostic and Laboratory Medicine, Institute of Biochemistry and Clinical Biochemistry, Catholic University School of Medicine and Surgery, Rome, Italy
| | - Jacopo Galli
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - Gaetano Paludetti
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
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