Expression of MMP-9 in patients with chronic rhinosinusitis and its correlation with epithelial-mesenchymal transition / 天津医药

Objective To investigate the mechanism of matrix metalloproteinase(MMP)-9 involved in epithelial mesenchymal transformation(EMT)in chronic sinusitis(CRS).Methods The expression of MMP-9 from polypoid middle turbinate tissue was detected by immunohistochemical staining qPCR and Western blot assay in 42 patients with CRS and 8 patients underwent septoplasty.Primary human nasal epithelial cells HNEpc were cultured in vitro and divided into the control group,the TGF-β1 group(5 μg/L TGF-β1 intervention)and the TGF-β1+si-MMP-9 group(transfected with si-MMP-9 and 5 μg/L TGF-β1 intervention).The expression of MMP-9 was detected by cell immunofluorescence staining.Expression levels of TGF-β1,MMP-9 and EMT-related proteins E-cadherin,vimentin and α-SMA were detected by Western blot assay.Results(1)The positive expression rate of MMP-9 was significantly higher in the nasal mucosa of CRS with nasal polyps(CRSwNP)group(54.5%,12/22)than that of the CRS without polyps(25.0%,5/20)group and the control group(12.8%,1/8).The relative expression levels of MMP-9 mRNA and protein in nasal mucosa were higher in the CRSwNP group than those in the CRSsNP group and the control group(P＜0.05).(2)Compared with the control group,the expressions levels of TGF-β1,MMP-9,vimentin and α-SMA were increased in the TGF-β1 group,while the expression of E-cadherin was decreased(P＜0.05).Compared with the TGF-β1 group,expression levels of TGF-β1,MMP-9,vimentin and α-SMA were decreased in the TGF-β1+si-MMP-9 group,and the expression of E-cadherin was increased(P＜0.05).Conclusion The expression of MMP-9 is increased in CRS patients,which may be involved in the development of CRS through the regulation of EMT.

Comparative analysis of curative endoscopic surgery and functional endoscopic surgery in the treatment of EosCRSwNP / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the clinical effect of radical endoscopic sinus surgery(RESS)in the treatment of eosinophilic chronic sinusitis with nasal polyps(EosCRSwNP).METHODS There were 84 EosCRSwNP patients admitted to the Department of Otolaryngology in Tianjin Beichen Hospital from January,2020 to January,2022.They were divided into an observation group(42 cases)and a control group(42 cases)according to the random number table method.The control group and the observation group received functional endoscopic sinus surgery(FESS)and RESS respectively.The nasal visual analogue score(VAS)and Lund-Kennedy score were compared before surgery and in 1,3,and 12 months after surgery,and the olfactory threshold in 6 months before and after surgery,Ciliary clearance rate,ciliary clearance rate,and serum interleukin-1β(IL-1β),IL-35 and squamous cell carcinoma antigen(SCCA)levels were compared between the two groups.The recurrence rates in 12 months between the two groups after surgery.RESULTS The VAS and Lund-Kennedy scores of the observation group were lower than those of the control group in 12 months after surgery(P＜0.01);The olfactory threshold and serum IL-1β in 6 months after surgery,the level of SCCA of the observation group was lower than those of the control group(P＜0.01),and the Cilia clearance speed,the clearance rate and serum IL-35 level were higher than those of the control group(P＜0.01).The recurrence rate in 12 months of the observation group was lower than that of the control group(P＜0.05).CONCLUSION RESS is beneficial for reducing nasal VAS and Lund-Kennedy scores,alleviating nasal inflammation,restoring olfactory and nasal mucosal function,and reducing postoperative recurrence rate.It can be used as the optimal surgical plan for EosCRSwNP.

Orbital subperiosteal abscess secondary to osteomyelitis in a patient with chronic sinusitis

Objective@#To report a case of orbital subperiosteal abscess in a diabetic elderly patient.@*Methods@#This is a case report.@*Results@#A 65-year-old diabetic female consulted for a two-month history of poor vision on both eyes and a palpable mass on the left brow area. The patient previously underwent functional endoscopic sinus surgery and was treated for postoperative systemic infection and several complications including sinusitis, mastoiditis, trigeminal neuralgia, bacterial meningitis, and otitis media. On presentation, best-corrected visual acuity was noted to be no light perception on the right eye and 20/400 on the left eye. She had a relative afferent pupillary defect on the right eye, ophthalmoplegia on both eyes, and inferior displacement and proptosis of the left globe. Magnetic resonance imaging showed subperiosteal abscess on the left superior orbital rim with intraorbital extension. The patient underwent surgery and the culture from the drained abscess yielded Pseudomonas aeruginosa and Enterobacter cloacae. Pathologic examination of the orbital bone sample revealed osteomyelitis.@*Conclusion@#Osteomyelitis of the orbital bone leading to subperiosteal abscess is a complex, multifactorial disease requiring rapid diagnosis and treatment. Complete resolution of the infection must be achieved to decrease the morbidity and mortality of the patient.

The efficacy and safety of glucocorticoid stent implantation compared with oral glucocorticoid during perioperative period in chronic rhinosinusitis with nasal polyps / 临床耳鼻咽喉头颈外科杂志

Objective:To compare the perioperative efficacy and safety of postoperative oral glucocorticoid and glucocorticoid stent implantation in patients with chronic rhinosinusitis with nasal polyps（CRSwNP） undergoing functional endoscopic sinus surgery（FESS）. Methods:Sixty patients with bilateral CRSwNP with similar degree of lesions were selected and divided into three groups: conventional surgical treatment group（20 cases）, glucocorticoid stent group（20 cases）, and oral glucocorticoid group（20 cases）. All three groups underwent routine FESS, patients in the sinus glucocorticoid stent group receiving sinus glucocorticoid stent placed in the ethmoid sinuses（one on each side） during surgery, and patients in the oral glucocorticoid group received postoperative oral methylprednisolone at a dose of 0.4 mg/kg per day for 7 days, followed by a tapering of 8 mg per week to 8 mg followed by maintenance therapy for 1 week, for a total of 3-4 weeks. Visual analog scale（VAS） scores were used to evaluate nasal congestion, rhinorrhea, olfaction, and facial pressure symptoms before surgery, as well as at 2, 4, 8, and 12 weeks after surgery. Nasal endoscopic Lund-Kennedy scores were recorded, and adverse reactions such as stent detachment, stent-related allergic reactions, sleep disorders, edema, gastrointestinal symptoms, rash/acne, behavioral/cognitive changes, weight gain, limb pain, and infection risk were documented. Results:The nasal congestion symptom scores at 2, 4, 8, and 12 weeks after surgery were significantly lower than those before operationin all three groups, and the differences were statistically significant（P<0.05）. The sinus glucocorticoid stent group exhibited significantly lower nasal congestion symptom scores at 4 and 8 weeks after surgery compared to the conventional surgical treatment group. The rhinorrhea symptom scores at 2, 8, and 12 weeks after surgery were significantly lower than preoperative scores in all three groups. Additionally, the sinus glucocorticoid stent group had significantly lower rhinorrhea scores than the conventional surgical treatment group at 2 weeks postoperatively. Concerning olfaction, the sinus glucocorticoid stent group showed a significant reduction in scores at 12 weeks postoperatively, while the oral glucocorticoid group exhibited significant improvement starting from 8 weeks after surgery. There were no statistically significant differences in nasal congestion, rhinorrhea, facial pressure, and olfaction scores between the sinus glucocorticoid stent and oral glucocorticoid groups at 2, 4, 8, and 12 weeks postoperatively. Nasal endoscopy scores revealed lower polyp scores and edema at 2, 4, 8, and 12 weeks postoperatively for all three groups compared to preoperative scores. The conventional surgical treatment group exhibited a significant reduction in nasal secretion scores starting from 8 weeks after surgery, while both the sinus glucocorticoid stent and oral glucocorticoid groups showed significant reductions starting from 2 weeks postoperatively, with scores significantly lower than those of the conventional surgical treatment group at 2 weeks. Scab/scar scores in the conventional surgical treatment group significantly decreased from 8 weeks after surgery, while both the sinus glucocorticoid stent and oral glucocorticoid groups exhibited significant reductions starting from 4 weeks. No statistically significant differences were observed in endoscopy scores（including polyps, edema, nasal secretion, scars, and scabs） between the sinus glucocorticoid stent and oral glucocorticoid groups at 2, 4, 8, and 12 weeks postoperatively. Regarding adverse reactions, no postoperative complications related to sinus glucocorticoid stent were observed in the sinus glucocorticoid stent group. In the oral glucocorticoid group,1 patient experienced irritability, and 1 patient experienced weight gain. Conclusion:The glucocorticoid stent implantation has comparable effects to oral glucocorticoid in improving postoperative nasal symptoms, reducing nasal mucosal edema, scar formation, and nasal secretion in patients with CRSwNP undergoing FESS, with a better safety profile.

Correlation between chronic sinusitis subtypes and basophil levels in peripheral blood / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the clinical correlation between peripheral blood basophil levels and chronic sinusitis （CRS） subtypes. Methods:One hundred and twenty-six patients with CRS and 103 healthy cases from physical examination admitted to the First Affiliated Hospital of Soochow University from January 2021 to October 2022 were retrospectively analyzed. According to the histopathological classification, CRS patients were divided into eosinophilic chronic sinusitis （eCRS） group （47 cases） and non eosinophilic chronic sinusitis （non-eCRS） group （79 cases）. The differences among the three groups in peripheral blood inflammation cell counts, eosinophils-to-basophils ratio（bEBR）, basophils-to-neutrophils ratio（BNR）, basophils-to-lymphocytes ratio（BLR）, basophils-to-monocytes ratio（BMR） were compared, and study the correlation between each index and Lund-Mackay score, and the correlation between basophils in peripheral blood and other inflammatory cells. Results:The counts of basophils in the peripheral blood of the healthy control group, eCRS group and non-eCRS group were 0.03±0.01, 0.04±0.02, 0.03±0.02, respectively, the eosinophils-to-basophils ratio（bEBR） were 5.64±4.22, 8.38±5.95, 4.55±3.90, the basophils-to-neutrophils ratio（BNR） were 0.01±0, 0.01±0.01, 0.01±0.01, and the basophils-to-lymphocytes ratio（BLR） were 0.01±0.01, 0.02±0.01, and 0.02±0.01, respectively, the basophils-to-monocytes ratio（BMR） were 0.08±0.04, 0.11±0.06, and 0.08 ±0.04 respectively. There was a statistically significant difference between eCRS group and healthy control group, non-eCRS group（P<0.01）, while there was no statistically significant difference between non-eCRS group and healthy control group（P>0.05）. Basophil counts （r=0.185 5, P<0.05）, BLR（r=0.226 9, P<0.05）, BMR（r=0.228 1, P<0.01） in patients with CRS were positively correlated with Lund Makey score. In addition, basophils were also positively correlated with eosinophils（r=0.479 2, P<0.01）, lymphocytes（r=0.259 4, P<0.01）, and monocytes（r=0.256 4, P<0.01） in patients with CRS. Conclusion:The peripheral blood basophil count, BLR and BMR were significantly increased in eCRS, and were significantly positively correlated with Lund -Makey score. It has the potential to develop into disease biomarkers and new therapeutic targets of eCRS.

A prospective study of the effect of functional endoscopic sinus surgery on the recovery of olfactory function in patients with chronic rhinosinusitis with nasal polyposis / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the efficacy of functional endoscopic sinus surgery（FESS） in the treatment of olfactory dysfunction in patients with chronic rhinosinusitis with nasal polyps （CRSwNP） , at the same time, it provides an evidence for the prognosis evaluation of olfaction and the clinical application of oERPs to evaluate the plasticity of olfaction cortex. Methods:From October 2021 to October 2022, 45 patients with CRSwNP who underwent FESS nine-step standardized treatment in our department were recruited as the research subjects, divided into 22 patients with eosinophilic CRSwNP（ECRS）and 23 patients with non-eosinophilic CRSwNP（nECRS）. VAS-olfactory dysfunction （VAS-OD） score, SNOT-22 olfactory score, Sniffin' Sticks test and oERPs collection and processing were performed before the operation. All items were evaluated again 3 months after the operation. Results:VAS-OD and SNOT-22 olfactory score were significantly lower in all CRSwNP patients after the operation than those before the operation[F（1, 43） =357.429, P<0.001; F（1, 43） =185.657, P<0.001], the scores of T, D, I and TDI scores in Sniffin' Sticks test were significantly higher than those before the operation[F（1, 43） =126.302, P<0.001; F（1, 43） =311.301, P<0.001; F（1, 43） =131.401, P<0.001; F（1, 43） =295.885, P<0.001]; The decrease of VAS-OD and SNOT-22 olfactory score in the ECRS group was smaller than that in the nECRS group[F（1, 43） =4.825, P=0.033; F（1, 43） =9.916, P=0.003], T, D and TDI scores were significantly lower in nECRS group than those in nECRS group[F（1, 43） =6.719, P=0.013; F（1, 43） =4.890, P=0.032; F（1, 43） =4.469, P=0.040]; There was a positive correlation between preoperative eosinophil-to-lymphocyte ratio（ELR） and SNOT-22 olfactory score and how much it changes（r=0.455, P=0.002; r=-0.414, P=0.005）, a negative correlation between T, TDI score and how much they change respectively（r=-0.431, P=0.003; r=-0.385, P=0.009; r=-0.383, P=0.010; r=-0.316, P=0.035）. The latency of P3 was significantly shorter after operation than that before operation in all CRSwNP patients[F（1, 14） =24.840, P<0.001], however, the amplitude has no significant surgical effect. Conclusion:FESS could significantly improve the olfactory function of CRSwNP patients, while changes in plasticity may occur in the olfactory cortex. In addition, the preoperative peripheral blood eosinophil granulocyte level can predict the postoperative olfactory improvement.

A Clinical Study to Evaluate the Efficacy of Shirovirechana Gana Dravya Siddha Asava Nasya in Dusta Prathishyaya w.s.r to Chronic Sinusitis

The word Prathishyaya indicates recurrent attack and can participate due to minute etiological factors. Prathishyaya can occur as a separate disease entity or symptoms of many systemic diseases or as a complication of other diseases. Prathishyaya if not treated well in early stage and Ahara-Vihara which are harmful for the disease is continued, it leads to a more complicated stage of Prathishyaya i.e., Dusta Prathishyaya. Virechana Nasya which is recommended in Urdwajatrugata Vikaras is indicated in Prathishyaya. For Virechana Nasya- Madhu, Saindhava, Asava, Pitta, Mutra etc drugs has been mentioned by Acharya Vagbhata. So, Asava is prepared by Shirovirechana Gana Dravya as a Prakshepaka Dravyas which possess Katu, Tiktha, Madhura rasa, Laghu and Teekshna Guna, Ushna Veerya, Katu Vipaka and Vata-Kapha shamaka predominantly, which may help in pacify Dusta Prathishyaya. Materials and Methods: A single group study was undertaken in which, 30 patients of Dusta Prathishyaya were randomly selected and were subjected to Asava Nasya - 4 Bindu (2ml) each nostril for 7 days. The patients were assessed with severity of symptoms subjectively and objectively before and after treatment. Data obtained was statistically analysed. Result and Discussion: In overall effect of treatment in Dusta Prathishyaya, out of 30 patients, 3 patients (10%) got moderate improvement, 23 patients (76.6%) got marked improvement and 4 patients (13.33%) got significant improvement. In overall effect of treatment, statistical analysis showed that the mean score which was 6.86 in before treatment was reduced to 4.81 in after treatment and further reduced to 1.86 in follow up, and there is a statistically significant change (P<0.001). Conclusion: The present study showed highly significant results in which the symptoms like Nasa Srava, Nasa Avarodha, Gandha Agnyana, Shirashoola and Shiro Gaurava got reduced and it indicates that the therapeutic effects is mainly achieved by the efficacy of Shirovirechana Gana Dravya Siddha Asava Nasya in Dusta Prathishyaya w.s.r to Chronic Sinusitis.

Cloud of cotton inside the maxillary sinus: A unique case report worth sharing

The maxillary sinus is one of the most important structures present in the vicinity of the oral cavity. Unknowingly, it often gets involved when the environment of dentoalveolar structures of the maxillary unit jeopardize. There are lots of reasons such as trauma, forceful extraction which may change the internal environment of the maxillary sinus, and the balance of its microbial flora. Among them, oroantral communication and oroantral fistula cause chronic sinusitis inevitably. However, this case is unique by virtue due to the formation of chronic sinusitis by the intrusion of a foreign body by the patient himself and followed by the formation of an oroantral fistula after the extraction of an offending tooth.

Chinese Society of Allergy and Chinese Society of Otorhinolaryngology-Head and Neck Surgery Guideline for Chronic Rhinosinusitis

The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines—with a focus on China—will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.

The value of Lund-Mackay score in predicting the effect of simultaneous surgery of chronic dacryocystitis with chronic sinusitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the value of Lund-Mackay score in the surgical treatment of chronic dacryocystitis with chronic sinusitis.<p>METHODS: Totally 92 cases(92 eyes)of chronic sinusitis with chronic dacryocystitis in our hospital from May 2016 to March 2019 were included in the prospective, single-blind study. According to Lund-Mackay score, the patients were divided into three groups: mild(22 cases), moderate(34 cases)and serious(36 cases). Each group was randomly divided into simultaneous operation group and phased operation group. We compared the operative effect and complications of simultaneous and phased operations.<p>RESULTS: In patients with mild and moderate chronic sinusitis combined with chronic dacryocystitis, there was no statistical difference in the efficiency and complications between simultaneous and phased operations(<i>P</i>>0.05). In patients with severe chronic sinusitis combined with chronic dacryocystitis, the efficiency of phased operations was higher than that of the simultaneous surgery(94% <i>vs</i> 61%, <i>P</i><0.05), and the complications were lower than that of the simultaneous surgery(<i>P</i><0.05). <p>CONCLUSION: According to Lund-Mackay score, patients with mild to moderate chronic sinusitis and chronic dacryocystitis are advised to undergo simultaneous surgery, while patients with severe rhinosinusitis are advised to undergo phased surgery.

Assessment of nasal airflow and pain, safety and cost of an improvised nasal airway (nasogastric) tube after endoscopic sinus surgery

@#Objective: To compare subjective nasal airflow and overall pain score (as well as safety and added cost of) using an improvised nasal airway tube (nasogastric tube) versus nasal packing after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyposis (CRSwNP). Methods: Design: Quasi - Experimental Prospective Cohort Study Setting: Tertiary Government Training Hospital Participants: Twenty-six (26) consecutive patients aged 18 to 77 years old diagnosed with CRSwNP who underwent ESS were alternately assigned to an experimental group (A) of 13, where an improvised nasal airway (nasogastric) tube was placed in addition to the nasal pack or a control group (B) of 13 with nasal packing alone. Results: There was a significant difference in subjective nasal airflow between experimental (A) and control (B) groups during the immediate postoperative period where the mean subjective airflow was 8.07 and 0.00 over 10.00, respectively. No significant difference was noted between the groups in terms of age, gender, severity of polyposis and overall pain score. No complications such as bleeding, Toxic Shock Syndrome, vestibular or alar injury and septal necrosis were noted immediately post-op and after one week follow-up in both groups. An approximate cost of PhP 25 was added to group A. Conclusion: An improvised nasal airway using a nasogastric tube provides adequate airflow without additional pain in the immediate postoperative period. It is safe to use and an affordable option for patients in need of nasal airway stents residing in areas where a preformed nasal packing with incorporated tube stent is not available.

The value of Lund-Mackay score in predicting the effect of simultaneous surgery of chronic dacryocystitis with chronic sinusitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the value of Lund-Mackay score in the surgical treatment of chronic dacryocystitis with chronic sinusitis.<p>METHODS: Totally 92 cases(92 eyes)of chronic sinusitis with chronic dacryocystitis in our hospital from May 2016 to March 2019 were included in the prospective, single-blind study. According to Lund-Mackay score, the patients were divided into three groups: mild(22 cases), moderate(34 cases)and serious(36 cases). Each group was randomly divided into simultaneous operation group and phased operation group. We compared the operative effect and complications of simultaneous and phased operations.<p>RESULTS: In patients with mild and moderate chronic sinusitis combined with chronic dacryocystitis, there was no statistical difference in the efficiency and complications between simultaneous and phased operations(<i>P</i>>0.05). In patients with severe chronic sinusitis combined with chronic dacryocystitis, the efficiency of phased operations was higher than that of the simultaneous surgery(94% <i>vs</i> 61%, <i>P</i><0.05), and the complications were lower than that of the simultaneous surgery(<i>P</i><0.05). <p>CONCLUSION: According to Lund-Mackay score, patients with mild to moderate chronic sinusitis and chronic dacryocystitis are advised to undergo simultaneous surgery, while patients with severe rhinosinusitis are advised to undergo phased surgery.

Effect Of Sigrubeejaarka Nasya In Chronic Sinusitis - A Clinical Study

Chronic sinusitis, defined as an inflammatory process that involves the paranasal sinuses and persists for 12 weeks or longer. The conventional treatment is either conservative or surgical. Since this ailment is of a chronic nature, simple conservative management will not be sufficient for a cure. Even though the surgery is effective, there is chance of recurrence and morbidity. The clinical picture of chronic sinusitis shows the predominance of Kaphavata dosha in Jatrurdhwa. Sigru is a single drug having Thikshna ushna guna and Vatakaphahara properties and is included in Sirovirechana group. Arkaprakasa written by Ravana illustrates a large number of Arkas (distillates) which is found to be very effective and harmless and Sigrubeeja Arka nasya indicated in Siroroga was selected for the study. Methods: The study design was interventional pre and post evaluation without control and sample size fixed as 30 patients. The data collection was done with case proforma, symptomatic scoring using VAS scale, Nasal Signs and Symptoms Score (NSSS), and X-ray PNS. Selected patients were subjected to Nasyakarma with Sigrubeeja arka for a period of 7 days. Assessments were done prior to the commencement of intervention and on 15th, 30th, 60th day of follow up. Statistical analysis was done using Wilcoxon Signed Rank test. Result: Change in outcome variables like headache, nasal obstruction, nasal discharge, loss of smell, and postnasal drip, showed significant results. Conclusion: Sigrubeejaarka was found to be effective in chronic sinusitis.

A Prospective Study on Association Between Deviated Nasal Septum and Sinusitis in a Tertiary Care Teaching Hospital

Background: Chronic sinusitis (CS) is an extremely prevalent disorder. It affects up to two percent of the world population. It has a significant impact on the quality of life of people [2]. Basically, the word “sinusitis‟ refers to a group of disorders characterized by inflammation of mucosa of nose and paranasal sinuses. Deviated Nasal septum is one of the most common disorder that presents up to 62% of the population. Its role in the pathogenesis of chronic sinusitis remains uncertain. Methods: Two groups were included in this study .Each group had 30 cases with Midline nasal septum & Deviated nasal septum. This study conducted in the Department. of ENT, Saraswathi Institute of Medical Sciences, Hapur. The duration of the study was over a period of six month. Results: We were studied two groups, 30 cases involved in group I of Midline nasal septum and in group II 30 cases involved with Deviated nasal septum. In this study we showed symptom & sign of rhinoscopy. In the group I, 14 cases had congested nasal mucosa followed by 10 cases of nasal discharge, 4 cases of inferior turbinate hypertrophy & 2 cases of Middle turbinate hypertrophy. Conclusions: that management of chronic maxillary sinusitis should include simultaneous treatment of any anatomical variation. For treating chronic sinusitis along with deviated nasal septum, nowadays treatment of choice is Septoplasty along with Functional Endoscopic Sinus Surgery (FESS). FESS technique is used for managing sinus infection and ostial obstruction.

Síndrome de Kartagener / Kartagener Syndrome

Introducción: El síndrome de Kartagener es una variación clínica de la discinesia ciliar primaria, se caracteriza por la triada clásica de sinusitis crónica, bronquiectasia y situs inversus (total o parcial), catalogada como enfermedad rara de herencia autosómica recesiva. Objetivo: Analizar las manifestaciones clínicas, análisis complementarios y tratamiento de los pacientes diagnosticados con síndrome de Kartagener en la República del Ecuador. Presentación de caso: Paciente femenina, de nacionalidad ecuatoriana, con manifestaciones clínicas de la tríada del síndrome de Kartagener y rasgo de infertilidad, con antecedente de sinusitis crónica desde 14 años de edad. Los estudios imagenológicos de rayos X de tórax y tomografía axial computarizada de tórax y senos paranasales confirmaron las manifestaciones de síndrome de Kartagener, que representa el séptimo caso reportado en el país. Se analizaronn las características clínicas de la serie de siete casos reportados en el Ecuador hasta el presente, correspondiente al período 2015-2018 y exámenes complementarios realizados para el diagnóstico de certeza y diferencial. Conclusiones: Se presentó el séptimo caso de síndrome de Kartagener diagnosticado en el Ecuador y se analizó la serie de una totalidad de 7 pacientes reportados en el país entre 2015-2018(AU)

Introduction: Kartagener syndrome is a clinical variation of primary ciliary dyskinesia, characterized by the classic triad of chronic sinusitis, bronchiectasis and situs inversus (total or partial), classified as a rare autosomal recessive inheritance disease. Objective: To analyze the clinical manifestations, complementary tests and treatment of patients diagnosed with Kartagener syndrome in the Republic of Ecuador. Case presentation: Female patient, of Ecuadorian nationality, with clinical manifestations of the Kartagener syndrome triad and infertility trait, with a history of chronic sinusitis since 14 years of age. Imaging studies of thorax, x-rays and computed tomography of chest and paranasal sinuses confirmed the manifestations of Kartagener syndrome, which represents the seventh case reported in the country. Respiratory evolution and therapeutic management are exposed. In this context, we analyze the clinical characteristics of the series of seven cases reported in Ecuador up to the present, corresponding to the period 2015-2018 and complementary tests performed for the certainty and differential diagnosis. Conclusions: The seventh case of Kartagener syndrome diagnosed in Ecuador is presented, and the series of a totality of 7 patients reported in the country between 2015-2018 is analyzed(AU)

Clinical effect of ostimeatal complex surgery on chronic sinusitis under nasal endoscope / 中国基层医药

Objective To analyze the clinical effect of ostimeatal complex surgery on chronic sinusitis under nasal endoscope.Methods A total of 270 patients with chronic sinusitis treated in Huzhou Central Hospital from March 2014 to May 2017 were selected.The patients were randomly divided into control group and observation group according to the digital table,with 135 cases in each group.The observation group received ostimeatal complex surgery under nasal endoscope.The control group was treated with local excision,local glucocorticoid injection,and maxillary sinus puncture and irrigation. The patients were followed up for 6 months after surgery, the clinical effect was observed.The life quality of patients was evaluated with 36-items short form health survey (SF-36) and sino-nasal outcome test-20 (SNOT-20).Results At the last follow-up,the cure rate of the observation group was 84.4% , the improvement rate was 13.3% , the cure rate of the control group was 45.2% , and the improvement rate was 20.0%.The clinical efficacy of the observation group was significantly better than that of the control group ( Z =7.291,P<0.001).Three months after treatment,the physiological role score[(69.5 ± 14.1) points] and general health score [(62.9 ± 11.4) points], the total score of 20 items [( 15.5 ± 3.4 ) points] and 5 items [( 8.1 ± 3.7)points] of SNOT-20 scale in the observation group were significantly improved (t=4.881,5.102,20.283, 14.360,all P<0.05).The scores of physiological function,physiological role,body pain,vigor,social function,emotional role,mental health and general health in the observation group were (86.8 ± 11.5) points,(81.0 ± 12.1) points, (82.8 ± 12.7)points,(70.4 ± 11.0)points,(84.5 ± 13.0) points,(73.4 ± 11.6) points,(87.0 ± 12.4)points and (68.7 ± 16.4)points,which were significantly better than those in the control group [(83.8 ± 11.4)points,(69.5 ± 12.4)points,(78.5 ± 13.1) points,(68.4 ± 11.9) points,(74.4 ± 11.7) points,(67.4 ± 11.9) points,(78.9 ± 12.3)points and (64.3 ± 12.9) points],the differences were statistically significant (t =2.153,7.712,2.738, 2.012,6.710,4.195,5.388,2.450,all P<0.05).There were no statistically significant differences in the score of 20 general items and the score of 5 items compared with those at 3 months (all P>0.05).Conclusion The clinical effect of ostimeatal complex surgery on chronic sinusitis under nasal endoscope is satisfactory.The overall symptoms and quality of life of the patients returned to normal,but the 5 major problems such as nasal mucus,mucus nose,bad sleep at night,nasal discharge backstreaming and inattention have not been solved thoroughly.

The Effect of Long-Term Follow up on Outcome of Pediatric Endoscopic Sinus Surgery

BACKGROUND AND OBJECTIVES: Chronic pediatric sinusitis continues to be a challenging problem to otolaryngologists and has been reported to show worse prognosis than that of adults. However, most studies were performed with short-term follow-up. In this study, we aimed to assess the clinical outcome of pediatric endoscopic sinus surgery (ESS) with a longer follow-up and to determine the effect of age on postoperative outcome. SUBJECTS AND METHOD: A retrospective analysis was performed on pediatric patients than 15 years with ESS younger from 2005 to 2014 in a tertiary referral hospital. All patients completed a questionnaire regarding symptoms before to from 1 to 9 years after surgery. Telephone survey was performed to evaluate symptoms including nasal obstruction, nasal discharge, PND, and headache at 1 to 9 years after surgery. RESULTS: Seventy-one pediatric patients with bilateral chronic sinusitis were treated with ESS. They showed gradual symptom improvement from 5 year after surgery for the following: nasal obstruction (p=0.032), PND (p=0.005), and headache (p=0.048). However, there was improvement in rhinorrhea after 9 years (p=0.042). In addition, when analyzed in terms of age, the outcome was poor in children younger than 13 years (p=0.003) compared with the older age group. Multivariate analysis showed that preoperative nasal obstruction was dependent on AR, and postoperative symptoms were dependent on presence of AR and involuntary smoking. Nasal discharge was dependent on presence of AR and involuntary smoking preoperatively and postoperatively. These suggest the importance of AR and involuntary smoking as risk factors for prognosis. CONCLUSION: Chronic pediatric sinusitis showed gradual improvement after ESS and should be more carefully monitored on a long-term basis. We should keep in mind that long-term follow-up is needed for pediatric ESS cases.

Impact of ambroxol hydrochloride and dexamethasone by nasal spray inhalation on efficacy and serum IL-5 and IL-12 levels after endoscopic sinus surgery in treating chronic sinusitis / 重庆医学

Objective To investigate the clinical effect of using ambroxol hydrochloride and dexamethasone by nasal spray inhalation after endoscopic sinus surgery in treating chronic sinusitis.Methods One hundred and forty patients with chronic sinusitis receiving endoscopic sinus surgery in our hospital from January 2014 to December 2014 were selected as the research subjects.After surgery,the control group was given dexamethasone nasal spray inhalation,while the observation group was given ambroxol hydrochloride and dexamethasone by nasal spray inhalation.The curative efficacy,the score of visual analogue scale(VAS) was adopted to evaluate the subjective symptoms severity and the nasal endoscopy and CT examination results were evaluated by the Lund-Kennedy score.The serum levels of IL-5 and IL-12 were detected in the two groups.Results All cases were successful completed surgery and no severe adverse reactions appeared after surgery.The observation group had a total effective rate of 97.1 ％,which was signif icantly higher than 88.6 ％ in the control group,the difference was statistically significant(P＜0.05).In the aspects of sinusitis related symptoms after operation,compared with the control group,the VAS scores of nasal discharge,nasal obstruction,cheek pain,headache and hyposmia in the observation group were significantly decreased,the difference was statistically significant(P＜0.05).In the postoperative re-examination process,the score of assessment of nasal endoscopic score and paranasal sinuses CT score in the observation group were significantly decreased,the difference was statistically significant(P＜0.05).In the serological indicator determination,serum levels of IL-5 and IL-12 after treatment in the observation group were significantly lower than those in the control group,the difference was statistically significant(P＜0.05).Conclusion Using ambroxol hydrochloride combined with dexamethasone by nasal spray inhalation after endoscopic sinus surgery has good efficacy in treating chronic sinusitis,can decrease serum levels of IL-5 and IL-12.

Curative efifcacy of Desloratadine Citrate Disodium in combination with endoscopic sinus surgery and its effects on serum TIgE, ECP and inlfammatory factors in patients with chronic sinusitis / 中国内镜杂志

Objective To observe and analyze curative efficacy of Desloratadine Citrate Disodium in combination with endoscopic sinus surgery and its effects on serum TIgE, ECP and inlfammatory factors in patients with chronic sinusitis.Methods 90 patients with chronic sinusitis who received therapy in our hospital from January 2015 to June 2016 were collected as research objects to be randomly divided into the control group and the observation group equally. The control group was given endoscopic sinus surgery, and the observation group was given Desloratadine Citrate Disodium in combination with endoscopic sinus surgery. Then, visual analogue scale (VAS) was applied to assess the severity of subjective symptoms of the disease. Three months after the surgery, the curative efifcacy, scores of visual analogue scale (VAS) relfecting clinical symptoms, levels of serum TIgE, ECP and inlfammatory factors were compared between the two groups.Results All patients undergone successful surgery. The observation group had a total therapeutic efifciency ratio of 95.6%, which was signiifcantly higher than that of 82.2% in the control group (P < 0.05). In comparison with the control group, the observation group had lower VAS scores of nasal discharge, nasal obstruction, cheek pain, headache, hyposmia [(1.84 ± 0.89) vs (3.12 ± 1.03) points, (1.87 ± 0.81) vs (2.55 ± 1.14) points, (1.24 ± 0.86) vs (1.88 ± 0.79) points, (1.15 ± 0.54) vs (1.97 ± 0.83) points, (1.84 ± 0.73) vs (2.18 ± 0.84) points], lower levels of serum TIgE, ECP [(58.62 ± 7.36) vs (64.39 ± 7.18) kU/L, (4.25 ± 0.84) vs (5.01 ± 1.07) ng/L)] and inflammatory factors of TNF-α, IL-6, IL-8 [(1.27 ± 0.46) vs (2.62 ± 0.53) ng/ml, (5.13 ± 1.24) vs (9.54 ± 2.23) pg/ml, (282.63 ± 32.42) vs (315.84 ± 35.89) ng/L)] with statistical differences (allP < 0.05).Conclusion Desloratadine Citrate Disodium in combination with endoscopic sinus surgery is effective for chronic sinusitis, which can signiifcantly relieve clinical symptoms, reduce levels of serum TIgE, ECP and alleviate inlfammatory reaction.

Clinical efficacy and safety of clarithromycin combined with fragrant chrysanthemum capsule in patients with chronic sinusitis / 中国生化药物杂志

Objective To observe the effect of clarithromycin combined with fragrant chrysanthemum capsule in chronic sinusitis.MethodsFrom May 2014 to September 2016 in our hospital received chronic sinusitis in 106 cases were randomly divided into test and control group two, 53 cases each.The experimental group was combined with clarithromycin and Xiangju capsule, control group was treated with clarithromycin.Two changes of sinus CT score of observation group, compared with the drug safety index.ResultsSinus CT after treatment in the experimental group was (2.64±0.53), control group (4.52±0.46), the test group was significantly lower than the control group, the difference was statistically significant (P< 0.05).The experimental group total effective rate, sinus CT score total effective rate were 96.23%, 94.34%, were significantly higher than the control group (66.04%, 64.15%), the difference was statistically significant (P< 0.05).Two groups of incidence of adverse drug reactions had no statistically significant difference.The main symptoms after treatment points were significantly lower than the control group, the difference was statistically significant (P< 0.05).ConclusionBased on the conventional clarithromycin in the treatment of chronic sinusitis, the patients were treated with Xiangju capsule treatment, is conducive to the improvement of sinus CT score, and can improve the clinical efficacy, and also does not increase the side effects of drugs, which is worthy of reference.