RESUMEN
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the mucous membranes of the nose and sinuses. Eosinophilic inflammation is described as a common endotype. The anti-IL5 antibody mepolizumab was approved in November 2021 as an add-on therapy to intranasal glucocorticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps when systemic glucocorticosteroids or surgery do not provide adequate disease control. While national and international recommendations exist for the use of mepolizumab in CRSwNP, it has not yet been adequately specified how this therapy is to be monitored, what follow-up documentation is necessary, and when it should be terminated if necessary. METHODS: A literature search was performed to analyze previous data on the treatment of CRSwNP with mepolizumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 10/2022 were considered. RESULTS: Based on the international literature and previous experience by an expert panel, recommendations for follow-up, adherence to therapy intervals and possible therapy breaks, as well as termination of therapy when using mepolizumab for the indication CRSwNP in the German health care system are given on the basis of a documentation sheet. CONCLUSIONS: Understanding the immunological basis of CRSwNP opens up new non-surgical therapeutic approaches with biologics for patients with severe, uncontrolled courses. Here, we provide recommendations for follow-up, adherence to therapy intervals, possible therapy pauses, or discontinuation of therapy when mepolizumab is used as add-on therapy with intranasal glucocorticosteroids to treat adult patients with severe CRSwNP that cannot be adequately controlled with systemic glucocorticosteroids and/or surgical intervention.
Asunto(s)
Medicina Ambiental , Pólipos Nasales , Procedimientos Quírurgicos Nasales , Rinitis , Sinusitis , Adulto , Humanos , Rinitis/tratamiento farmacológico , Enfermedad Crónica , Sinusitis/tratamiento farmacológico , Atención a la SaludRESUMEN
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the paranasal sinus mucosa with eosinophilic inflammation as the most common endotype. The anti-IL5 antibody mepolizumab was approved for the treatment of severe CRSwNP in the EU in November 2021. METHODS: A literature search was performed to analyze the immunology of CRSwNP and determine the available evidence by searching Medline, Pubmed, and the German national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 12/2021 that investigated the effect of mepolizumab in CRSwNP were considered. RESULTS: Based on the international literature and previous experience, recommendations for the use of mepolizumab in CRSwNP in the German health care system are given by an expert panel on the basis of a documentation form. CONCLUSIONS: Understanding about the immunological basis of CRSwNP opens new non-surgical therapeutic approaches with biologics for patients with severe courses. Mepolizumab is approved since November 2021 for add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP who cannot be adequately controlled with systemic corticosteroids and/or surgical intervention.
Asunto(s)
Medicina Ambiental , Pólipos Nasales , Procedimientos Quírurgicos Nasales , Otolaringología , Rinitis , Sinusitis , Corticoesteroides/uso terapéutico , Adulto , Alergólogos , Anticuerpos Monoclonales Humanizados , Enfermedad Crónica , Atención a la Salud , Humanos , Pólipos Nasales/terapia , Rinitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológicoRESUMEN
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the nasal and paranasal mucosa. A Type-2 inflammation is described as the most common endotype. Since October 2019 the anti-IL-4/-IL-13 antibody dupilumab has been approved in Germany as an add-on therapy to intranasal corticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps, when systemic corticosteroids alone or surgery do not provide adequate disease control. While recommendations for the use of dupilumab in CRSwNP exist at both national and international levels, until now it has not been adequately established, how therapy should be monitored and when it should be discontinued in the German Health Care System. METHODS: A literature search was performed analyzing previous data on the treatment of CRSwNP with dupilumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to 05/2022 were included. RESULTS: Based on international literature and previous experience, recommendations are given by an expert panel for follow-up and possible therapy breaks, therapy intervals or termination of therapy when using dupilumab for the indication CRSwNP in the German health care system based on a documentation form. CONCLUSIONS: Understanding the immunological basis of CRSwNP opens new non-surgical therapy approaches with biologics for patients with severe courses. The authors give recommendations for follow-up, possible therapy breaks, therapy intervals and a termination for dupilumab treatment as add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP that cannot be adequately controlled with systemic corticosteroids and/or surgical intervention.
Asunto(s)
Pólipos Nasales , Rinitis , Sinusitis , Adulto , Humanos , Pólipos Nasales/tratamiento farmacológico , Rinitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Enfermedad Crónica , Corticoesteroides/uso terapéutico , Atención a la Salud , DocumentaciónAsunto(s)
Medicina Ambiental , Pólipos Nasales , Procedimientos Quírurgicos Nasales , Sinusitis , Humanos , OmalizumabAsunto(s)
Productos Biológicos , Medicina , Pólipos Nasales , Anticuerpos Monoclonales Humanizados , HumanosAsunto(s)
Betacoronavirus , Infecciones por Coronavirus , Pandemias , Neumonía Viral , COVID-19 , Desensibilización Inmunológica , Humanos , SARS-CoV-2RESUMEN
Diagnostic A- and B-mode ultrasonography is used for detection of paranasal sinus disease. Various cases of maxillary, frontal and ethmoidal sinus pathology demonstrate the indication and limitations for this new method. Differential diagnostic of an opacified antrum is possible changing gain control and patients head position during examination.
Asunto(s)
Enfermedades de los Senos Paranasales/diagnóstico , Ultrasonografía , Niño , Diagnóstico Diferencial , Senos Etmoidales/patología , Femenino , Seno Frontal/patología , Humanos , Seno Maxilar/patología , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Neoplasias de los Senos Paranasales/diagnóstico , Embarazo , Radiografía , Sinusitis/diagnósticoRESUMEN
The intranasal test was made on 100 patients with possible allergy to house dust, house dust mite and fungi. The results of 64 patients could be discussed. Till now a nasal obstruction with arhinomanometric flow-volume diminution of 20% after application of allergene was considered as a positive provocation. This procedure seems to give too many false positive results. A new method to evaluate the rhinoma nometric results was elaborated.
Asunto(s)
Pruebas de Provocación Nasal , Hipersensibilidad Respiratoria/diagnóstico , HumanosRESUMEN
Nasal ventilation can be ascertained with the aid of rhinomanometry. In fact, even a trivial nasal allergic reaction can be detected through the use of the intranasal provocation test, coupled with rhinomanometrics. The different rhinomanometric measurement procedures, including determination of active and passive rhinomanometry, will be discussed in the following article. The advantages and disadvantages of each will be elaborated. The application of the active rhinomanometry however, invites not only certain technical errors but errors of method as well. These will be individually discussed in more detail.
Asunto(s)
Pruebas de Provocación Nasal , Falla de Equipo , Humanos , Manometría , Mucosa Nasal/fisiopatologíaRESUMEN
There are several methods presently in use serving to check the result of the intranasal provocation test. There are simple procedures such as rhinoscopy and cotton swabs as well as technically more cumbersome ones, such as rhinomanumetry. The FEV1 of the nose is a simple method used to evaluate the intranasal provocation test. The results obtained after allergy exposition are objective and reliable. This technique is equally as good as the above mentioned ones, and is not as expensive.
Asunto(s)
Volumen Espiratorio Forzado , Pruebas de Provocación Nasal , Rinitis Alérgica Estacional/diagnóstico , Obstrucción de las Vías Aéreas/diagnóstico , Diagnóstico Diferencial , HumanosRESUMEN
The Intranasal Test was made on 100 patients with possible allergy to house dust, house dust mite and fungi. The results of 64 patients could be discussed. Till now a nasal obstruction with a rhinomanometric flow-volume diminution of 20% after application of allergen was considered as a positive provocation. This procedure seems to give too many false positive results. A new method to evaluate the rhinomanometric results was elaborated.
Asunto(s)
Obstrucción de las Vías Aéreas/diagnóstico , Manometría/métodos , Pruebas de Provocación Nasal , Rinitis Alérgica Perenne/diagnóstico , Resistencia de las Vías Respiratorias , Humanos , Ventilación PulmonarRESUMEN
In the past 20 years we have operated on 187 patients for tracheal stenoses. Dilatation, tracheopexy with ring support, sleeve resection, and the gutter procedure are described. In recent years we have replaced open treatment of the tracheal gutter with our closed method. After expanding the posterior wall, the anterior tracheal wall is closed with a myocutaneous island flap, rib cartilage or a myomucosal flap. The merits of the different methods are discussed. Dilatation of the trachea and reconstruction of the anterior tracheal wall over a silicone tube in a one stage procedure creates a sturdy trachea, which is better able to resist scar contracture and pressure from the soft parts of the neck than an open U-shaped gutter. The number of operations and days of treatment per patient are materially reduced by the closed method.
Asunto(s)
Laringoestenosis/cirugía , Estenosis Traqueal/cirugía , Adolescente , Adulto , Anciano , Cerámica , Niño , Preescolar , Dilatación/métodos , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Prótesis e Implantes , Colgajos Quirúrgicos , TraqueotomíaRESUMEN
Many allergic patients who are subsequently treated by bronchopulmonary specialists present first to otolaryngologists who should be able to recognize the initial symptoms of systemic allergy. The various diseases which require full allergy investigation are reviewed, based on a survey of the literature.