Expert Opinion on Biological Treatment of Chronic Rhinosinusitis with Nasal Polyps in the Gulf Region.

Chronic rhinosinusitis (CRS) is defined as the inflammation of nose and paranasal sinuses, affecting the patients' quality of life and productivity. Chronic rhinosinusitis with nasal polyps (CRSwNP) is a principal clinical entity confirmed by the existence of chronic sinonasal inflammation and is characterized by anterior or posterior rhinorrhea, nasal congestion, hyposmia and/or facial pressure or facial pain. Several epidemiologic studies have revealed wide variations in the incidence of CRS among regions globally ranging from 4.6% to 12%. The Gulf countries are also witnessing an unprecedented burden of CRSwNP. According to the current clinical guidelines, glucocorticosteroids and antibiotics are the principal pharmacotherapeutic approaches. Endoscopic sinus surgery is recommended for those who have failed maximal pharmacotherapy. Recently, biologics are considered as an alternative best approach due to the complications associated with medical therapy and surgery. However, precise data on the clinical position of biologic agents in the management of CRSwNP in the Gulf region is not available. The present review article addresses the current diagnostic and management approaches for CRSwNP and also emphasizes the role of emerging biologics in the current treatment strategies for CRSwNP in the Gulf region. Further, a consensus protocol was convened to rationalize the guideline recommendations, strategize the best practices with biologics, and develop clinical practice guidelines for all primary-care specialists in the Gulf region. The consensus-based report will be a useful reference tool for primary-care physicians in primary-healthcare settings, regarding the appropriate time for the initiation of biological treatment in the Gulf region.

Cone beam CT paranasal sinuses versus standard multidetector and low dose multidetector CT studies.

UNLABELLED: Cone-beam computed tomography (CBCT) is a promising modality for quick outpatient imaging with lower radiation dose and less metal artifact when compared to conventional CT (MDCT) scans. This article will be providing evidence on the diagnostic and treatment-planning applications of CBCT in sinus imaging, mainly, in patients with chronic sinusitis for surgical planning, which retrospectively assessed 21 patients over a period of one year at Queen Elisabeth Hospital, Birmingham, UK. The main objective was to compare the absorbed dose of radiation from CBCT and conventional CT, and to compare the clarity and image quality for important structures in sinus anatomy in patients with sinus disease meriting CT scan imaging. Results of the mean effective dose of twenty-one consecutive CBCTs of paranasal sinuses were 0.27 mSv (range 0.05-0.48 mSv). This dose was approximately 40% lower when compared to a similar cohort of standard MDCT examinations and 30% lower when compared to low dose sinus CT scans. The visualization of high-contrast bone morphology on CBCT was comparable to standard sinus CT, allowing clear delineation of the principal surgically relevant osseous structures. Soft tissue visibility was however limited. We concluded that, CBCT scan provides a fast and efficient alternative to conventional CT with substantial radiation dose reduction and low dose MDCT techniques. However for more advanced sinus disease, conventional CT scan is preferable. OBJECTIVES: The main objective was to compare the absorbed dose in the cone beam computed tomography (CBCT) and conventional CT and to compare the clarity and image quality for important structures in sinus anatomy. DESIGN: Retrospective scan review. SETTING: We compared both the image characteristics and the effective dose used in CBCT and conventional MDCT sinus imaging, performed at Queen Elizabeth Hospital Birmingham over a 1 year period. PARTICIPANTS: Patient with sinus disease meriting CT scan imaging. MAIN OUTCOME MEASURE: Comparison of effective dose exposure and image quality. RESULTS: The mean effective dose of twenty one consecutive CBCTs of paranasal sinuses performed in our institution over a one year period was 0.27 mSv (range 0.05-0.48 mSv). The dose was approximately 40% lower when compared to a similar cohort of standard MDCT examinations and 30% lower when compared to low dose sinus CT scans. The visualization of high-contrast bone morphology on CBCT was comparable to standard sinus CT, allowing clear delineation of the principal surgically relevant osseous structures. Soft tissue visibility was however limited. CONCLUSION: Cone beam CT scan is a quick and efficient alternative to conventional CT with substantial radiation dose reduction over conventional and low dose MDCT techniques. However for more advanced sinus disease, conventional CT scan is preferable.

Impact of osteotomies and structural grafts in the management of severe twisted or deviated nasal deformity: a critical analysis of 179 patients with open rhinoplasty.

The aim of this study was to analyze the long term impact of different surgical techniques especially osteotomies and structural grafts especially spreader grafts in terms of functional and aesthetic outcomes in cases of severely deviated nose deformities using open structure rhinoplasty. Retrospective chart reviews of two hundred consecutive patients who underwent corrective rhinoplasty during the period between January 2009 and December 2010 for deviated nasal deformity were performed. Those cases which were done with closed approach (21) were excluded from the study. Analysis included 179 patients, with 136 males and 43 females, and 79.9% had history of trauma pre-operatively. Follow-up period was 6-24months out of which 88.4% were satisfied with the surgery results functionally and aesthetically. There was a statistical significant correlation between omitting osteotomy or using unilateral osteotomy and risk of recurrence or remnant deformity (p value 0.006). Similarly there was also a statistically significant relation between recurrence and placement of unilateral or bilateral spreader graft (p value 0.47). Our results of open approach are considered excellent. There is a significant relation between use of procedures like selection of osteotomies and non-use of spreader graft and the possibility of recurrence. Open structure approach provides improved functional and aesthetic results.