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1.
Artigo em Chinês | MEDLINE | ID: mdl-38563173

RESUMO

Objective:After selecting NCF2 based on bioinformatics, clinical experiments were conducted to verify the expression of NCF2 in chronic rhinosinusitis with nasal polyps to study its correlation. Methods:The differentially expressed genes(DEGs) between CRSwNP and non-CRS patients were explored using the CRS-related dataset from the gene expression omnibus GEO database. The weighted gene co-expression network(WGCNA) was used for cluster analysis. The expression and cell distribution of NCF2 in the tissues were determined by single gene enrichment analysis(GSEA), immune inflammatory infiltration analysis, and principal component(PCA) analysis. The expression degree of NCF2 in the tissues of the subjects was determined by immunohistochemistry, and the percentage of EOS in the peripheral blood of the subjects was detected and the correlation was analyzed. EOS in the tissues of the subjects were counted under a microscope and compared. Results:①The Venn diagram was obtained by crossing the module with the highest correlation between DEGs and WGCNA to determine the core gene NCF2. ②GSEA analysis showed that NCF2 was significantly related to the immunological processes such as allogeneic rejection and asthma. ③The area under the ROC curve was 1, indicating that NCF2 had diagnostic value for CRSwNP. ④NCF2 was highly expressed in nasal polyps, mainly distributed in monocytes and eosinophils. ⑤HE staining showed that the number of EOS in ECRSwNP tissues and the percentage of eosinophils in peripheral blood were higher than those in nonECRSwNP and control groups. ⑥The immunohistochemistry results showed that NCF2 was significantly expressed in the nasal polyps of ECRSwNP patients, which was higher than that in the nasal mucosa of nonECRSwNP group and control group. ⑦The expression of NCF2 in tissues was positively correlated with EOS count in ECRSwNP group and EOS expression in peripheral blood. Conclusion:The expression of NCF2 is increased in eosinophilic chronic rhinosinusitis with nasal polyps, and it is significantly correlated with the expression of eosinophils in peripheral blood and tissues, suggesting that NCF2 may be used as a basis for the intrinsic classification of ECRSwNP and a reference index for clinical diagnosis and treatment.


Assuntos
Pólipos Nasais , Rinite , Rinossinusite , Sinusite , Humanos , Pólipos Nasais/metabolismo , Rinite/cirurgia , Correlação de Dados , Sinusite/cirurgia , Eosinófilos/metabolismo , Doença Crônica , NADPH Oxidases
2.
Int J Pediatr Otorhinolaryngol ; 179: 111898, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38452513

RESUMO

BACKGROUND AND PURPOSE: Olfactory dysfunction (OD) commonly occurs in patients with sinonasal dysfunction, but the prevalence and severity of olfactory issues in adolescents with cystic fibrosis (AwCF) is unclear. OD may contribute to dietary deficiencies and exacerbate nutritional challenges. We sought to review literature on the effectiveness of medical and surgical management of sinonasal symptoms in AwCF and the associated impact on olfactory function. METHODS: We performed a systematic literature search of PubMed, Embase, Web of Science, and Ebsco CINAHL from 1980 to 2022 per PRISMA-ScR protocols to conduct a scoping review in an effort to compile data on study design, patient demographics, clinical characteristics and outcomes, along with risk of bias. RESULTS: Of 368 abstracts, 3 articles exclusively evaluated AwCF for a total of 34 patients. Two studies evaluated endoscopic sinus surgery (ESS) and dornase alfa. An additional 6 articles were included for mixed pediatric and adult CF populations totaling 313 patients. Interventions included ESS, elexacaftor-tezacaftor-ivacaftor (ETI), ivacaftor, saline, dornase alfa, hyaluronic acid, and hyaluronic acid-tobramycin combination. Outcome measures included subjective assessment of OD using non-validated (4/9) and validated (4/9) surveys, and psychophysical (1/9) smell testing. Studies evaluating ESS, FESS, dornase alfa, ivacaftor, and both hypertonic and isotonic saline reported statistically significant improvement in OD, whereas ETI failed to improve OD despite improvement in other quality of life measures. CONCLUSIONS: There is limited data regarding the impact of medical and surgical interventions on olfaction for AwCF. Assessment of olfaction was often limited to subjective and qualitative self-report. We suggest that tracking of olfactory outcomes with psychophysical testing is critical in this population with dietary challenges and weight management issues.


Assuntos
Aminofenóis , Fibrose Cística , Quinolonas , Rinite , Rinossinusite , Sinusite , Adulto , Adolescente , Humanos , Criança , Fibrose Cística/complicações , Olfato , Qualidade de Vida , Ácido Hialurônico , Sinusite/complicações , Sinusite/diagnóstico , Sinusite/cirurgia , Doença Crônica , Rinite/complicações , Rinite/diagnóstico , Rinite/cirurgia
3.
Am J Rhinol Allergy ; 38(3): 178-184, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38444214

RESUMO

BACKGROUND: Central compartment atopic disease (CCAD) is a recently described variant of chronic rhinosinusitis (CRS) strongly associated with atopy. The association between central compartment disease (CCD) and inhalant allergy is not well established in South-East Asia, where perennial allergic rhinitis is common. OBJECTIVES: The primary objective was to evaluate endoscopic and radiologic CCD as predictors of perennial allergen sensitization in primary CRS. The secondary objective was to compare clinical characteristics of CCAD with other CRS subtypes (CRSwNP and CRSsNP). METHODS: A retrospective study of consecutive patients with primary CRS who underwent endoscopic sinus surgery at our institution was performed. Allergen sensitization was confirmed by skin or serum testing. Endoscopy records and computed tomography scans of paranasal sinuses were reviewed for CCD. The diagnostic accuracy of endoscopic and radiologic CCD in predicting atopy was calculated. RESULTS: There were 104 patients (43 CCAD, 30 CRSwNP and 31 CRSsNP). Endoscopic CCD was significantly associated with aeroallergen sensitization (odds ratio (OR) 3.99, 95% confidence interval (CI) 1.65-9.67, P = 0.002). Endoscopic CCD predicted atopy with 57% sensitivity, 72% specificity, 69% positive predictive value and positive likelihood ratio of 2.05. Radiologic CCD was not associated with aeroallergen sensitization (OR 0.728, 95%CI 0.292-1.82, P = 0.496). There were more CCAD patients who reported hyposmia (86% vs 42%, P < 0.001) and had anosmia on olfactory testing than CRSsNP (65% vs 14%, P = 0.015). The prevalence of atopy was significantly higher in CCAD than CRSwNP and CRSsNP (70% vs 37% and 42%, P = 0.015 and P = 0.05, respectively). Median serum total immunoglobulin E was higher in CCAD (283 IU/ml) and CRSwNP (127 IU/ml) than CRSsNP (27 IU/ml, P = 0.006 and P = 0.042, respectively). CONCLUSIONS: Endoscopic CCD was a better predictor of inhalant allergy than radiologic CCD in primary CRS, in a locale of perennial allergic rhinitis.


Assuntos
Hipersensibilidade Imediata , Pólipos Nasais , Rinite Alérgica , Rinite , Rinossinusite , Sinusite , Humanos , Alérgenos , Rinite/diagnóstico , Rinite/epidemiologia , Rinite/cirurgia , Estudos Retrospectivos , Sinusite/cirurgia , Endoscopia , Rinite Alérgica/epidemiologia , Doença Crônica , Pólipos Nasais/cirurgia
4.
Am J Rhinol Allergy ; 38(3): 159-168, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38454786

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) is one of the most common health disorders in humans and has a major impact on health-related quality of life (HRQoL). Of the many factors contributing to the etiology of CRS, less is known about the correlation between CRS and bacterial biofilms and their impact on HRQoL. OBJECTIVE: The aim of this prospective study was to investigate the relationship between biofilm-producing bacteria and patients' objective findings and HRQoL. METHODS: Forty-eight patients with CRSwNP were enrolled in a 12-month prospective study. The Lund-Mackay (LM) CT and endoscopic Lund-Kennedy (LK) scores were obtained before endoscopic sinus surgery (ESS), and patients completed the HRQoL instruments: the 22-item Sinonasal Outcome Test (SNOT-22), the 36-item Short Questionnaire (SF-36), and the visual analog scale (VAS). A sinus culture was obtained at ESS, bacteria were isolated, and in vitro quantification of the biofilm was performed. The LK score and HRQoL were determined postoperatively at months 1, 3, 6, and 12. RESULTS: The most common bacterial isolates in patients with CRSwNP were Staphylococcus aureus (28%), coagulase-negative staphylococci (52%), and Pseudomonas aeruginosa (8%). Preoperatively, the highest LM and LK scores were found in patients with strong biofilm producers. Postoperative LK scores were significantly reduced in all patients. Postoperative VAS scores were significantly reduced from month 1 to month 12 postoperatively. Patients with strong biofilm producers had significantly worse nasal blockage, secretion, headache, facial pressure and pain, and loss of smell preoperatively, compared to patients with low biofilm producers. The most significant reduction in preoperative scores SNOT-22 and SF-36 (excluding physical functioning) was seen in patients with S. aureus and P. aeruginosa. CONCLUSIONS: Patients with strong biofilm producers had higher LK and LM scores preoperatively, and greater improvement in LK and HRQoL scores postoperatively. Microbiologic surveillance of all CRS patients is recommended.


Assuntos
Pólipos Nasais , Rinite , Rinossinusite , Sinusite , Humanos , Estudos Prospectivos , Qualidade de Vida , Staphylococcus aureus , Rinite/cirurgia , Rinite/epidemiologia , Sinusite/cirurgia , Sinusite/epidemiologia , Pólipos Nasais/cirurgia , Pólipos Nasais/epidemiologia , Doença Crônica , Endoscopia , Biofilmes , Bactérias , Resultado do Tratamento
5.
Am J Rhinol Allergy ; 38(3): 169-177, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38456692

RESUMO

BACKGROUND: Budesonide high-volume saline irrigations (HVSIs) are routinely used to treat chronic rhinosinusitis (CRS) due to improved sinonasal delivery and efficacy compared to intranasal corticosteroid sprays. The off-label use of budesonide is assumed to be safe, with several studies suggesting the systemically absorbed dose of budesonide HVSI is low. However, the actual budesonide dose retained in the sinonasal cavity following HVSI is unknown. The objective of this study was to quantify the retained dose of budesonide after HVSI. METHODS: Adult patients diagnosed with CRS who had undergone endoscopic sinus surgery (ESS) and were prescribed budesonide HVSI were enrolled into a prospective, observational cohort study. Patients performed budesonide HVSI (0.5 mg dose) under supervision in an outpatient clinic, and irrigation effluent was collected. High-performance liquid chromatography was employed to determine the dose of budesonide retained after HVSI. RESULTS: Twenty-four patients met inclusion criteria. The average corrected retained dose of budesonide across the cohort was 0.171 ± 0.087 mg (37.9% of administered budesonide). Increased time from ESS significantly impacted the measured retained dose, with those 3 months post-ESS retaining 27.4% of administered budesonide (P = .0004). CONCLUSION: The retained dose of budesonide in patients with CRS after HVSI was found to be significantly higher than previously estimated and decreased with time post-ESS. Given that budesonide HVSI is a cornerstone of care in CRS, defining the retained dose and the potential systemic implications is critical to understanding the safety of budesonide HVSI.


Assuntos
Rinite , Rinossinusite , Sinusite , Adulto , Humanos , Budesonida/uso terapêutico , Estudos Prospectivos , Rinite/cirurgia , Rinite/tratamento farmacológico , Sinusite/cirurgia , Sinusite/tratamento farmacológico , Solução Salina/uso terapêutico , Resultado do Tratamento , Doença Crônica
6.
Ann Otol Rhinol Laryngol ; 133(5): 485-489, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38344993

RESUMO

BACKGROUND: Commonly used endoscopic nasal polyp grading scales have been shown to correlate poorly with symptom scores and quality of life metrics. The recently described Postoperative Polyp Scale (POPS) is a grading system that more accurately characterizes polyp recurrence in postoperative sinus cavities by describing incremental recurrence in relation to the surgically opened sinus cavities. OBJECTIVE: The objective of this study was to determine if the POPS correlated with sinonasal symptoms. METHODS: CRSwNP patients were prospectively administered SNOT-22 questionnaires and graded according to the POPS starting at their 1-month postoperative appointments. Total POPS scores (sum of each side) and Max POPS score (larger value of left and right) were correlated with SNOT-22 total scores and subdomains using Kendall correlation testing. RESULTS: A total of 127 patients were enrolled in the study. Both Total POPS or Max POPS were significantly correlated to the SNOT-22 total score (P < .001, P < .001), Rhinologic (P < .001, P < .001), Extra-Nasal Rhinologic (P < .001, P < .001), Ear/Facial (P < .001, P < .001), and Psychologic (P = .028, P = .017) subdomains. Kendall's tau indicated strong correlation (≥0.3) with Rhinologic subdomain, moderate correlation (.21-.29) with Extra-Nasal Rhinologic and Ear/Facial subdomains, and weak correlation (.1-.19) with Psychologic subdomain. CONCLUSION: Previous endoscopic nasal polyp grading scales poorly correlate with symptoms and patient reported outcome measures. The new POPS moderately correlates with the total SNOT-22 score and strongly correlates with the Rhinologic subdomain, indicating that it may have good potential as a tool to evaluate postoperative CRSwNP patients.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Humanos , Sinusite/cirurgia , Pólipos Nasais/diagnóstico , Pólipos Nasais/cirurgia , Qualidade de Vida , Rinite/cirurgia , Doença Crônica , Endoscopia
7.
Dan Med J ; 71(2)2024 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-38314735

RESUMO

INTRODUCTION: Optimal care for patients with simultaneous chronic rhinosinusitis (CRS) and asthma is often complicated due to interaction between these conditions. This study depicts the lack of attention to asthma within the otorhinolaryngological field, and the relationship between CRS and asthma, including the risk of revision surgery in such patients. METHODS: A retrospective cohort study was conducted on patients undergoing functional endoscopic sinus surgery (FESS) because of CRS with nasal polyps (CRSwNP) and without nasal polyps in a five-year period. Patients were examined for adherence to guidelines, asthma, revision FESS, allergies and septo-/turbinoplasty. Results were compared to international reports. RESULTS: A total of 589 patients had FESS because of CRS of whom 203 (34.5%) had co-existing asthma. A higher risk of asthma (relative risk (RR) = 1.82 (95% confidence interval (CI): 1.29-2.56), p less-than 0.001) and revision FESS (RR = 2.20 (95% CI: 1.33-3.65), p less-than 0.001) was found in patients with CRSwNP. Attention to asthma was poor in patients with no asthma diagnosis before referral. CONCLUSIONS: Asthma was lower in the study population than in the literature. Danish national guidelines on CRS management are insufficient regarding attention to asthma. Results call attention to the need for more multidisciplinary team management. FUNDING: None. TRIAL REGISTRATION: Not relevant.


Assuntos
Asma , Pólipos Nasais , Rinite , Rinossinusite , Sinusite , Humanos , Estudos Retrospectivos , Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Pólipos Nasais/epidemiologia , Rinite/complicações , Rinite/cirurgia , Rinite/epidemiologia , Sinusite/complicações , Sinusite/cirurgia , Endoscopia , Asma/complicações , Asma/epidemiologia , Doença Crônica
8.
J Laryngol Otol ; 138(6): 638-641, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38230421

RESUMO

OBJECTIVE: Rhinosinusitis is one of the most common reasons for a visit to otolaryngology clinics. Some patients are candidates for sinus surgery. Infiltration of 1:100 000 adrenaline in the pterygopalatine fossa was studied, with the aim of evaluating the effect on bleeding in the surgical field. METHODS: This double-blind clinical trial was conducted in 2021-2022 on 40 candidates for endoscopic sinus surgery. For each patient, one side of the pterygopalatine fossa was randomly selected to be infiltrated with a vasoconstrictor. Surgical field bleeding on each side was evaluated. RESULTS: Blood loss was 35.8 ± 20.9 ml in the study group and 38.4 ± 23.7 ml for the control group, with no statistically significant difference between groups (p = 0.49). In addition, there was no difference between the two groups in terms of the surgical field based on Boezaart scores. CONCLUSION: Although there are some recommendations on the usage of vasoconstrictors via the pterygopalatine foramen, debate remains.


Assuntos
Perda Sanguínea Cirúrgica , Endoscopia , Epinefrina , Fossa Pterigopalatina , Sinusite , Vasoconstritores , Humanos , Epinefrina/administração & dosagem , Epinefrina/efeitos adversos , Método Duplo-Cego , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Endoscopia/métodos , Endoscopia/efeitos adversos , Doença Crônica , Masculino , Feminino , Fossa Pterigopalatina/cirurgia , Vasoconstritores/administração & dosagem , Sinusite/cirurgia , Pessoa de Meia-Idade , Adulto , Rinite/cirurgia
9.
Eur Arch Otorhinolaryngol ; 281(5): 2451-2462, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38189966

RESUMO

OBJECTIVES: To evaluate its effect of an evidence-based nursing program for nasal irrigation after endoscopic sinus surgery in patients with chronic rhinosinusitis (CRS). METHODS: A total of 66 patients with CRS were randomly divided into two groups, for which the experimental group received evidence-based nasal irrigation nursing, and the control group received conventional nursing. Differences in Sino-Nasal Outcome Test-20 (SNOT-20), visual analogue scale (VAS), Lund-Mackay CT, Endoscopic Lund Kennedy Score (LKES) and overall efficacy were assessed between the two groups. RESULTS: 2, 4 and 12 weeks after the intervention, the scores of SNOT-20, VAS, Lund-Mackay CT and LKES in the two groups were significantly lower than those before the surgery (P < 0.05). Compared with the control group, the scores were significantly lower in the experimental group (P < 0.05). 12 weeks after the intervention, the overall effective rate of treatment in the experimental group was 90.62%, while the control group was 16.43%, but the difference was not statistically significant in treatment effect (P > 0.05). CONCLUSIONS: The implementation of nasal irrigation evidence-based nursing program for patients with CRS after endoscopic sinus surgery can promote postoperative nasal mucosal recovery, improve treatment efficiency, and help improve patient comfort, quality of life and other subjective feelings. TRIAL REGISTRATION: The study was registered retrospectively with reference number ChiCTR2300075484 on 06/09/2023, available at: https://www.chictr.org.cn .


Assuntos
Pólipos Nasais , Rinite , Rinossinusite , Sinusite , Humanos , Qualidade de Vida , Enfermagem Baseada em Evidências , Estudos Retrospectivos , Rinite/cirurgia , Sinusite/cirurgia , Lavagem Nasal , Endoscopia , Doença Crônica , Resultado do Tratamento , Pólipos Nasais/cirurgia
10.
Eur Arch Otorhinolaryngol ; 281(6): 3005-3015, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38233691

RESUMO

OBJECTIVES: TAM receptors (TYRO3, AXL, and MER) play important roles in inflammatory responses, but their effects in chronic rhinosinusitis with nasal polyps (CRSwNP) remain elucidated. We aim to evaluate the values of TAM receptors in disease severity and postoperative recurrence of CRSwNP. METHODS: We initially enrolled 160 patients with CRSwNP who were treated with functional endoscopic sinus surgery (FESS) and postoperative recurrence was evaluated during the follow-up period. Circulating TAM receptor levels were detected by enzyme-linked immunosorbent assay (ELISA), and tissue expressions were measured by real-time polymerase chain reaction (RT-PCR) and immunohistochemical (IHC). The relationships between TAM receptor levels and postoperative recurrence were examined. RESULTS: A total of 150 patients completed the follow-up schedule, 49 patients experienced postoperative recurrence and the remaining 101 patients were non-recurrent. In recurrent CRSwNP patients, serum levels of TAM receptors were increased compared to those in non-recurrent patients and were positively correlated with disease severity scores (P < 0.05). Circulating TYRO3 and MER were identified as potential predictors of postoperative recurrence based on receiver operating characteristics (ROC) and Kaplan-Meier plots (P < 0.05). Furthermore, tissue TAM receptor levels, as determined by both RT-PCR and IHC, were enhanced in the recurrent group than in the non-recurrent group (P < 0.05) and were predictive of postoperative recurrence (P < 0.05). Interestingly, circulating TYRO3 and MER concentrations, as well as tissue TYRO3 expression, were found to be significantly increased in patients who experienced postoperative recurrence (P < 0.05). IHC images from the same patients revealed that TAM expressions were enhanced in the recurrent tissues compared to their baseline tissue levels. CONCLUSIONS: Our laboratory results demonstrated that TAM receptors were increased in recurrent CRSwNP patients and associated with postoperative recurrence. Moreover, the new laboratory findings suggested that measuring circulating levels of TAM receptors might serve as a promising new approach to assess disease progression and predict the risk of postoperative recurrence.


Assuntos
Pólipos Nasais , Receptores Proteína Tirosina Quinases , Recidiva , Rinite , Sinusite , Humanos , Sinusite/cirurgia , Sinusite/complicações , Sinusite/metabolismo , Sinusite/sangue , Pólipos Nasais/cirurgia , Pólipos Nasais/metabolismo , Pólipos Nasais/complicações , Masculino , Feminino , Rinite/cirurgia , Rinite/metabolismo , Rinite/complicações , Rinite/sangue , Doença Crônica , Adulto , Pessoa de Meia-Idade , Receptores Proteína Tirosina Quinases/genética , Receptores Proteína Tirosina Quinases/metabolismo , Imuno-Histoquímica , Reação em Cadeia da Polimerase em Tempo Real , Ensaio de Imunoadsorção Enzimática , Índice de Gravidade de Doença , Receptor Tirosina Quinase Axl , Proteínas Proto-Oncogênicas/genética , Endoscopia , Período Pós-Operatório , Rinossinusite
11.
Laryngoscope ; 134(3): 1003-1004, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38214424

RESUMO

There is currently interest regarding CRSsNP patients with refractory symptomatology following functional endoscopic sinus surgery, and which of these patients can derive benefit from low-dose macrolide therapy. In the present study, we analyze a cohort of over fifty CRSsNP patients on macrolide therapy; structured histopathological findings at the time of surgery were analyzed against the success of macrolide treatment. Independently, fibrosis, absence of squamous metaplasia, absence of eosinophilia, presence of neutrophilic infiltrate, and lymphoplasmocytic predominance were all associated with objective success of macrolide treatment; these findings may allow clinicians to more appropriately select patients for this therapy.


Assuntos
Eosinofilia , Pólipos Nasais , Rinite , Sinusite , Humanos , Sinusite/cirurgia , Rinite/cirurgia , Macrolídeos/uso terapêutico , Doença Crônica , Eosinofilia/complicações , Antibacterianos/uso terapêutico , Pólipos Nasais/complicações
12.
Am J Rhinol Allergy ; 38(2): 92-101, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38192070

RESUMO

BACKGROUND: Despite advances in surgical techniques, recurrence rates after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) remain high and difficult to predict. OBJECTIVE: This study aimed to evaluate the potential role of microRNA 125b (miR-125b) in predicting disease evolution following ESS. METHODS: We conducted a prospective study including patients undergoing first ESS for CRSwNP in our department between January 2020 and November 2021. We determined miR-125b levels from nasal polyps and pursued a standardized follow-up for at least 18 months for each patient. RESULTS: A total of 86 patients were included in the study. Higher postoperative endoscopy scores were associated with more severe disease at presentation on computed tomography scan, presence of concomitant asthma, and higher values of miR-125b. Even after multivariate repeated measures analysis and adjustments for confounders, miR-125b remained statistically significant. Moreover, miR-125 was the most important factor in predicting disease evolution at 18 months. CONCLUSION: A clear, robust relation between nasal polyp control evaluated through objective measures and miR-125b values was observed. This finding indicates the potential role of miR-125b in predicting the course of the disease following ESS.


Assuntos
MicroRNAs , Pólipos Nasais , Rinite , Rinossinusite , Sinusite , Humanos , Pólipos Nasais/complicações , Estudos Prospectivos , Rinite/cirurgia , Sinusite/cirurgia , Endoscopia/métodos , Doença Crônica , Resultado do Tratamento
13.
Braz J Otorhinolaryngol ; 90(2): 101371, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38070374

RESUMO

OBJECTIVES: Metabolic Syndrome (MetS) has been established as a significant factor in the pathogenesis of numerous chronic inflammatory conditions. However, its role in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is unknown. This study aims to investigate the association between MetS, its components, and the risk of postoperative recurrence in Chinese patients with CRSwNP. METHODS: A retrospective cohort study was conducted on CRSwNP patients who underwent endoscopic sinus surgery in our hospital. Patients were divided into MetS and non-MetS groups, and the clinical characteristics and recurrence rates were compared. All CRSwNP patients were followed up for more than 2-years and further categorized into non-recurrent and recurrent groups. Binary logistic regression analyses were performed to examine the effects of MetS and its components on the risk of postoperative recurrence. RESULTS: A total of 555 CRSwNP patients were enrolled in the present study, 157 patients were included in the MetS group and 398 patients were categorized into the non-MetS group. The recurrence rate in the MetS group was significantly higher compared to the non-MetS group (p < 0.05). The rate of MetS, overweight or obesity, hyperglycemia and dyslipidemia were higher in the recurrent group in comparison with the non-recurrent group (p < 0.05). Multivariate logistic regression analysis suggested that MetS, overweight or obesity, hyperglycemia, dyslipidemia, and accompanying allergic rhinitis were associated with the risk of postoperative recurrence of CRSwNP (p < 0.05). Moreover, adjusted and unadjusted regression models showed that MetS was an independent risk factor for postoperative recurrence of CRSwNP, and the risk increased with more components of MetS included (p < 0.05). CONCLUSION: Our findings revealed that MetS independently increased the risk of postoperative recurrence in patients with CRSwNP, with the risk escalating as the number of MetS components increased. Moreover, accompanying allergic rhinitis was also demonstrated to be a potential risk factor for CRSwNP recurrence. LEVEL OF EVIDENCE: Level 4.


Assuntos
Dislipidemias , Hiperglicemia , Síndrome Metabólica , Pólipos Nasais , Rinite Alérgica , Rinite , Rinossinusite , Sinusite , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Rinite/complicações , Rinite/cirurgia , Síndrome Metabólica/complicações , Estudos Retrospectivos , Sobrepeso/complicações , Sinusite/complicações , Sinusite/cirurgia , Rinite Alérgica/complicações , Obesidade/complicações , Dislipidemias/complicações , Hiperglicemia/complicações , Doença Crônica , Recidiva
14.
Laryngoscope ; 134(3): 1054-1062, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37606305

RESUMO

OBJECTIVES: Dysbiosis of the sinonasal microbiome has been implicated in the pathogenesis of chronic rhinosinusitis (CRS). However, the mycobiome remains largely understudied, and microbial alterations associated with specific CRS subtypes have yet to be delineated. The objective of this study is to investigate the fungal and bacterial microbiome of sinus mucosa in CRS patients with and without nasal polyposis (CRSwNP and CRSsNP) versus healthy controls. METHODS: Sinus mucosa was obtained from 92 patients (31 CRSsNP, 31 CRSwNP, and 30 controls) undergoing endoscopic sinus/skull base surgery. Data regarding demographics, Lund-MacKay scores, and histopathology were collected. Fungal and bacterial microbiome analysis was performed utilizing internal transcribed spacer amplicon and 16S rRNA sequencing. RESULTS: Beta diversity of the sinonasal mycobiome differed significantly between CRS and controls (p = 0.001) and between CRSwNP and controls (p = 0.049), but not between CRSwNP and CRSsNP (p = 0.32) nor between CRSsNP and controls (p = 0.06). With respect to the bacterial microbiome, significantly lower alpha diversity was observed between CRS and controls (p < 0.001), CRSwNP versus controls (p < 0.001), and CRSsNP versus controls (p < 0.001). Beta diversity was also significantly different at the genus level between CRSwNP and CRSsNP (p = 0.019), CRSwNP and controls (p = 0.002)), and CRSsNP and controls (p < 0.001). However, alpha and beta diversity did not differ significantly between CRS patients with/without eosinophils or correlate with Lund-MacKay scores. CONCLUSIONS: Differences in mycobiota diversity in CRS patients in comparison with controls suggest that alterations in the mycobiome may contribute to disease pathogenesis. Our findings also confirmed that diminished diversity among bacterial communities is associated with CRS and that significant differences are present in microbial composition between CRSwNP and CRSsNP. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:1054-1062, 2024.


Assuntos
Microbiota , Pólipos Nasais , Rinite , Rinossinusite , Sinusite , Humanos , Rinite/cirurgia , RNA Ribossômico 16S/genética , Doença Crônica , Sinusite/cirurgia , Pólipos Nasais/complicações , Bactérias/genética , Mucosa/patologia
15.
Eur Arch Otorhinolaryngol ; 281(1): 207-217, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37589753

RESUMO

PURPOSE: Endoscopic sinus surgery (ESS) is now frequently used to treat chronic sinusitis with nasal polyps (CRSwNP), but postoperative recurrence plagues many patients. We aimed to assess the value of the systemic inflammation response index (SIRI) and the systemic immune-inflammatory index (SII) for the prediction of postoperative recurrence in patients with CRSwNP. METHODS: A total of 143 patients with CRSwNP and 76 age- and sex-matched healthy subjects were enrolled. Patients were divided into the recurrence group and the non-recurrence group according to the recurrence of CRSwNP. Univariate and multivariate analyses showed independent risk factors for the recurrence. A receiver operating characteristic curve analysis was conducted to assess the predictive accuracy of the variables and determine the optimal cut-off values. Finally, a survival analysis was conducted. RESULTS: Univariate analysis revealed that age, sex, CRP, EOS, SIRI, SII, NLR, ELR, and Lund-Mackay CT scores were significant predictors of the recurrence of CRSwNP. Multivariate analysis confirmed that SIRI (OR = 1.310, p < 0.001) and Lund-Mackay CT scores (OR = 1.396, p < 0.001) were independent predictors. SIRI (AUC = 0.761, 95% CI: 0.685-0.836) had a certain value in predicting the recurrence of CRSwNP. CONCLUSION: SIRI is a potential predictive marker of the postoperative recurrence of CRSwNP.


Assuntos
Pólipos Nasais , Rinite , Rinossinusite , Sinusite , Humanos , Estudos Retrospectivos , Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Pólipos Nasais/epidemiologia , Rinite/complicações , Rinite/cirurgia , Rinite/epidemiologia , Sinusite/complicações , Sinusite/cirurgia , Sinusite/epidemiologia , Doença Crônica , Inflamação , China/epidemiologia
16.
J Laryngol Otol ; 138(4): 361-366, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37993118

RESUMO

OBJECTIVE: To review the literature comparing functional endoscopic sinus surgery to dupilumab for the treatment of chronic rhinosinusitis with nasal polyps, in terms of symptom control, cost-effectiveness and complications. METHOD: A literature review was conducted using PubMed, ScienceDirect and Cochrane databases. Data were extracted manually. RESULTS: A total of six papers relevant to the main objective were found. CONCLUSION: Chronic rhinosinusitis with nasal polyps has a significant impact on patients' quality of life. Both functional endoscopic sinus surgery and dupilumab achieve comparable disease control and result in good symptom relief. Dupilumab is far more expensive than functional endoscopic sinus surgery and is not considered cost-effective for the time being. This is expected to change after 10 years when the drug patent expires. More research is needed to compare the complications of both treatment modalities.


Assuntos
Produtos Biológicos , Pólipos Nasais , Rinite , Rinossinusite , Sinusite , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/tratamento farmacológico , Pólipos Nasais/cirurgia , Produtos Biológicos/uso terapêutico , Qualidade de Vida , Rinite/complicações , Rinite/tratamento farmacológico , Rinite/cirurgia , Sinusite/complicações , Sinusite/tratamento farmacológico , Sinusite/cirurgia , Doença Crônica
17.
Rhinology ; 62(2): 192-201, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-37942939

RESUMO

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterised by inflammatory mucosa and polyp formation in the paranasal sinuses. The study's primary objective was to evaluate the outcomes of postoperative oral corticosteroid (OCS) in treating patients with bilateral CRSwNP. The secondary objective was to determine whether preoperative serum IgE levels (sIgE)and/or blood eosinophil count (BEC) correlate with postoperative outcomes following OCS use. METHODS: Patients with bilateral CRSwNP (n=236) who underwent endoscopic sinus surgery (ESS) were randomly assigned to receive 15 mg OCS twice daily or a placebo for 2 weeks. We investigated the treatment effects based on the subjective visual analogue scale (VAS), Sino-Nasal Outcome Test 22 (SNOT-22), and objective Lund-Kennedy Endoscopy Score (LKES) over 6 months; subgroups were stratified preoperatively as follows: sIgE <150 IU/mL, sIgE>=150 IU/mL, BEC <0.39x10(9) cells/L, and BEC>=0.39x10(9) cells/L. RESULTS: A total of 193 participants completed the study up to the 6-month follow-up; no apparent linear relationship was noted between sIgE and BEC. No significant differences in scores were noted upon assessment of the VAS, SNOT-22, and LKES among the follow-up timepoints in the primary analysis. However, in the primary or subgroup analyses with sIgE or BEC, significant differences in the longitudinal scores of sleep dysfunction were observed at the 1-month follow-up. CONCLUSION: Postoperative OCS did not significantly affect bilateral CRSwNP outcomes. sIgE levels and BEC may not be surrogate predictive biomarkers to assess the role of postoperative OCS use. OCS may increase the risk of transient sleep disturbance.


Assuntos
Pólipos Nasais , Rinite , Rinossinusite , Sinusite , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Eosinófilos , Rinite/complicações , Rinite/tratamento farmacológico , Rinite/cirurgia , Sinusite/complicações , Sinusite/tratamento farmacológico , Sinusite/cirurgia , Corticosteroides/uso terapêutico , Imunoglobulina E , Doença Crônica , Endoscopia , Resultado do Tratamento
18.
Otolaryngol Head Neck Surg ; 170(3): 937-943, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38091372

RESUMO

OBJECTIVES: To develop and assess the validity of a novel allergy-specific domain for the 22-item sino-nasal outcomes test (SNOT-22), to provide a new tool that efficiently quantifies the impact of allergic rhinitis (AR) concurrent with chronic rhinosinusitis. STUDY DESIGN: Prospective validation study. SETTING: Tertiary care hospital and community-based clinic. METHODS: Proposed items were developed based on clinician and patient input, and further assessed via factor analysis and for internal consistency (n = 1987). Items were then additionally assessed for convergent and discriminant validity (n = 415), applying data from concurrent completions of the Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE), Mini-Rhinoconjunctivitis Quality-of-Life Questionnaire (MiniRQLQ), and validated global health assessments. Assessments of intra-rater reliability, responsiveness to change, and qualitative input were also performed. RESULTS: Factor analysis demonstrated that proposed allergy items mapped to a single domain. Items were internally consistent (Cronbach α: 0.80 within domain, 0.91 within all SNOT). In assessments of convergent validity, domain scores were associated with MiniRQLQ (Spearman's ρ: 0.46, 95% confidence interval [CI]: 0.30-0.59) and NOSE scores (0.36, 95% CI: 0.27-0.44). The novel items also discriminated among clinical states: a 1-point increase in domain score was associated with an 8.32 (95% CI: 5.43-12.75) increase in the odds of prompting a visit for allergy-related symptoms and a 1.52 (95% CI: 1.13-2.05) increase in the odds of positive allergy testing. Intra-rater reliability was substantial (Cohen's κ: 0.8, 95% CI: 0.8-0.9), and responsiveness to change was demonstrated (mean difference: -0.6, 95% CI: -0.8 to -0.4). CONCLUSIONS: This novel domain is a valid, efficient measure of AR alongside rhinosinusitis.


Assuntos
Obstrução Nasal , Rinite Alérgica , Rinite , Sinusite , Humanos , Rinite/diagnóstico , Rinite/cirurgia , Reprodutibilidade dos Testes , Sinusite/diagnóstico , Sinusite/cirurgia , Qualidade de Vida , Rinite Alérgica/diagnóstico , Inquéritos e Questionários , Doença Crônica
19.
Eur Arch Otorhinolaryngol ; 281(3): 1325-1330, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37966539

RESUMO

OBJECTIVE: To assess the efficacy of newly designed butterfly splint with special technique for middle turbinate stabilization in preventing adhesion following bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). STUDY DESIGN: Prospective, double-blind, randomized controlled. SETTING: University hospitals. METHODS: Following ESS, in cases of traumatized and/or unstable middle turbinates, newly designed butterfly plastic splint was randomly inserted in the middle meatus of one nasal side, while no splint was inserted in the other (control). Patients were followed up on after 1 week, 1 month, and 6 months. Endoscopic examination and a visual analog scale were used to evaluate each side of the nasal cavity for adhesion, crusting, pus, pain, nasal obstruction, and nasal discharge. RESULTS: Thirty patients (60 nasal sides) were included. For all investigated parameters, there was no significant difference between the splinted and non-splinted sides at the first week visit. Adhesion was found significantly less in the splinted sides (3%) than the non-splinted sides (27%) after 1 month (P = 0.038). The adhesion rate in the splinted sides remained 3% at the 3 month follow-up visit, however, in the non-splinted sides, the rate increased up to 30% (P = 0.007). Throughout the follow-up visits, all other investigated parameters remained statistically insignificant between both sides. CONCLUSIONS: The newly designed butterfly plastic splints to avoid middle turbinate adhesion is safe and effective in both reducing middle meatal adhesion with low complication rate in CRSwNP patients undergoing ESS and middle turbinate stabilization in its intermediate position.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Humanos , Doença Crônica , Endoscopia/métodos , Pólipos Nasais/cirurgia , Estudos Prospectivos , Rinite/complicações , Rinite/cirurgia , Sinusite/complicações , Sinusite/cirurgia , Contenções , Conchas Nasais/cirurgia , Conchas Nasais/patologia
20.
Auris Nasus Larynx ; 51(2): 286-294, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37839999

RESUMO

OBJECTIVE: There is heterogeneity in the pathophysiology of chronic rhinosinusitis (CRS). Obtaining a detailed understanding of patient profiles in specific regions can provide valuable information not only for clinical practice but also future research plans. The aim of this study was to investigate the characteristics of patients who underwent endoscopic sinus surgery (ESS) for CRS. METHODS: This retrospective, single-center study examined the features of 453 patients with CRS who underwent ESS in the Tokyo area of Japan. The study evaluated various factors in patients with CRS including sex and age, the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) score, the recurrence rate of CRS, comorbidities of asthma and/or allergic diseases, and IgE sensitization to 12 inhaled allergens. RESULTS: Age-related declines in the sensitization rate to inhaled allergens were observed, and the most notable age-related decrease in specific IgE antibodies was observed for house dust mites (HDM) (p = 8.3 × 10-7). Sensitization to HDM, cat dander, and various types of fungi, including Aspergillus, was frequently observed in the CRS with asthma group, with rates of 54%, 17%, and 17%, respectively. We found that 23% of the patients had recurrence. In the recurrence group, the positive rates of specific IgE antibodies for birch and cat dander were significantly higher than in the no recurrence group. Bronchial asthma was identified as an important factor for recurrence. Among male patients, the recurrence group was younger than the no-recurrence group (p = 0.0032). Severe eosinophilic CRS (ECRS) showed early recurrence after surgery, with over the half of the patients experiencing at least one recurrence within 2 years post-surgery. Among patients with ECRS, the recurrence rate for females was 1.92 times higher than for males. CONCLUSION: Our study revealed the influences of age and sex on various clinical phenotypes of CRS patients undergoing ESS. There was a high sensitization rate to cat dander in both the recurrence and asthma groups. Further research on diverse disease etiologies is necessary to improve therapeutic strategies for patients with CRS.


Assuntos
Asma , Pólipos Nasais , Rinite , Rinossinusite , Sinusite , Feminino , Humanos , Masculino , Japão/epidemiologia , Estudos Retrospectivos , Rinite/epidemiologia , Rinite/cirurgia , Sinusite/epidemiologia , Sinusite/cirurgia , Alérgenos , Imunoglobulina E , Asma/epidemiologia , Doença Crônica , Pólipos Nasais/epidemiologia , Pólipos Nasais/cirurgia , Endoscopia
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