Expert consensus on odontogenic maxillary sinusitis multi-disciplinary treatment.

ABSTARCT: Odontogenic maxillary sinusitis (OMS) is a subtype of maxillary sinusitis (MS). It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion. Due to the lack of unique clinical features, OMS is difficult to distinguish from other types of rhinosinusitis. Besides, the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis. Its current diagnosis and treatment are thus facing great difficulties. The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS. However, this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality. Based on systematically reviewed literature and practical experiences of expert members, our consensus focuses on characteristics, symptoms, classification and diagnosis of OMS, and further put forward multi-disciplinary treatment decisions for OMS, as well as the common treatment complications and relative managements. This consensus aims to increase attention to OMS, and optimize the clinical diagnosis and decision-making of OMS, which finally provides evidence-based options for OMS clinical management.

Short-term postoperative efficacy of steroid-eluting stents for eosinophilic chronic rhinosinusitis with nasal polyps: A randomized clinical trial.

BACKGROUND: Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) is a refractory clinical phenotype with a high symptom burden and relapse rate. Steroid-eluting stents are safe and effective for reducing polyp size, symptom burden, and the need for revision sinus surgery. In this study we aimed to evaluate the efficacy and safety of steroid-eluting stent implantation on the surgical outcomes of patients with ECRSwNP. METHODS: This prospective, multicenter, randomized, intrapatient-controlled trial recruited patients 18 to 65 years of age with ECRSwNP who required surgery. Ninety-eight patients were enrolled and randomly implanted with absorbable steroid-eluting stents containing mometasone furoate in one sinus at the end of surgery. All patients received standard postoperative care and follow-up. The primary outcome was the Lund-Kennedy endoscopic score within 12 weeks postsurgery. Secondary outcomes included nasal symptoms scores, nasal resistance, acoustic rhinometry, nasal nitric oxide levels, 3-dimensional volumetric computed tomography scores, and eosinophil counts in the ethmoid mucosa. RESULTS: Ninety-five patients completed the trial. At postoperative weeks 4, 8, and 12, the Lund-Kennedy scores were significantly lower on the treatment side than on the control side (all p < 0.01). Compared with the treatment side, the control side exhibited higher tissue eosinophilia at week 4 and higher volumetric, nasal obstruction, and total nasal symptom scores at postoperative week 8 (p = 0.011, p = 0.011, p < 0.01, and p = 0.001, respectively). No adrenal cortical suppression or serious side effects were observed. CONCLUSION: Steroid-eluting stents reduce postoperative sinus mucosal edema, and eosinophilic inflammation, with persistent effects after stent disintegration, and are a good supplementary postsurgical treatment in patients with ECRSwNP.

Blood eosinophil count combined with asthma history could predict chronic rhinosinusitis with nasal polyp recurrence.

BACKGROUND: The use of non-invasive clinical markers for predicting CRS recurrence is still not well investigated. OBJECTIVE: The aim of this study was to investigate the comprehensive effects of non-invasive clinical markers on the recurrence of CRS with nasal polyps (CRSwNP). MATERIALS AND METHODS: A total of 346 consecutive CRSwNP patients undergoing endoscopic functional sinus surgery were recruited. The demographic characteristics and clinical parameters were recorded. Machine learning algorithm were used for evaluating the predictive value of asthma history and blood eosinophils percentage. RESULTS: Finally, 313/346 patients completed the study. The average follow-up time was 24 months after the first surgery. For the CRSwNP with asthma patients, the blood eosinophils percentage cut-off value was 3.7%. However, for the CRSwNP without asthma patients, the blood eosinophils percentage cut-off value was high, at 6.9%. CONCLUSION: Combined asthma history and blood eosinophils percentage can predict CRSwNP recurrence, while asthma history can reduce the threshold of blood eosinophils percentage to predict CRSwNP recurrence. SIGNIFICANCE: For the CRS patients, combined asthma history and blood eosinophils percentage can predict recurrence, while asthma history can reduce the threshold of blood eosinophils percentage to predict recurrence.

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.

Particulate Matter 2.5 Causes Deficiency in Barrier Integrity in Human Nasal Epithelial Cells.

PURPOSE: The effect of air pollution-related particulate matter (PM) on epithelial barrier function and tight junction (TJ) expression in human nasal mucosa has not been studied to date. This study therefore aimed to assess the direct impact of PM with an aerodynamic diameter less than 2.5 µ (PM2.5) on the barrier function and TJ molecular expression of human nasal epithelial cells. METHODS: Air-liquid interface cultures were established with epithelial cells derived from noninflammatory nasal mucosal tissue collected from patients undergoing paranasal sinus surgery. Confluent cultures were exposed to 50 or 100 µg/mL PM2.5 for up to 72 hours, and assessed for 1) epithelial barrier integrity as measured by transepithelial resistance (TER) and permeability of fluorescein isothiocyanate (FITC) 4 kDa; 2) expression of TJs using real-time quantitative polymerase chain reaction and immunofluorescence staining, and 3) proinflammatory cytokines by luminometric bead array or enzyme-linked immunosorbent assay. RESULTS: Compared to control medium, 50 and/or 100 µg/mL PM2.5-treatment 1) significantly decreased TER and increased FITC permeability, which could not be restored by budesonide pretreatment; 2) significantly decreased the expression of claudin-1 messenger RNA, claudin-1, occludin and ZO-1 protein; and 3) significantly increased production of the cytokines interleukin-8, TIMP metallopeptidase inhibitor 1 and thymic stromal lymphopoietin. CONCLUSIONS: Exposure to PM2.5 may lead to loss of barrier function in human nasal epithelium through decreased expression of TJ proteins and increased release of proinflammatory cytokines. These results suggest an important mechanism of susceptibility to rhinitis and rhinosinusitis in highly PM2.5-polluted areas.

The use of magnetic resonance imaging in differential diagnosis of allergic fungal sinusitis and eosinophilic mucin rhinosinusitis.

BACKGROUND: Allergic fungal sinusitis (AFS) and eosinophilic mucin rhinosinusitis (EMRS) represent pathophysiological variants of sinusitis and have similar clinical features. However, to date, few studies have described the differential diagnosis of AFS and EMRS in detail. We therefore investigated the use of magnetic resonance imaging (MRI) in the differential diagnosis of AFS and EMRS. METHODS: Ninety-three patients (aged 13-75 years) with sinusitis and AFS or EMRS established according to pathological, clinical, or laboratory examinations were enrolled. Each patient was evaluated for demographic and clinical characteristics, fungal-specific immunoglobulin E, peripheral blood eosinophils, histopathology of the sinuses, as well as signal attenuation within the opacified sinuses on computed tomography and MRI scans. RESULTS: Thirty patients presented with AFS and 63 with EMRS. The histopathological characteristics of the secretion and mucosa in the affected sinuses, but not the absolute counts or percentage of blood eosinophils, differed between the 2 groups. The presence of asthma was significantly higher in the EMRS group, whereas allergy to fungi and T2-weighted MRI signal attenuation were significantly increased in the AFS group. CONCLUSIONS: MRI features are key to the differential diagnosis of AFS and EMRS.

Short-term Haze Exposure Predisposes Healthy Volunteers to Nasal Inflammation.

PURPOSE: This study aimed to investigate the impact of short-term haze exposure on nasal inflammation in healthy volunteers. METHODS: Thirty-three healthy university students were assessed for nasal symptoms, nasal patency, upper and lower respiratory tract nitric oxide (NO) as well as inflammatory mediators and neuropeptides in nasal secretions before and after a 5-day haze episode. Peripheral blood mononuclear cells (PBMCs) were stimulated with particulate matter with an aerodynamic diameter of less than 2.5 µm (PM2.5), and cytokines in the supernatants were examined. RESULTS: Mild nasal symptoms were reported by some participants during the haze episode. Objective measures of nasal patency demonstrated that nasal airway resistance was significantly increased from baseline levels, while nasal cavity volume and minimum cross-sectional area were significantly decreased. Similarly, the levels of nasal and exhaled NO, eotaxin, interleukin (IL)-5, chemokine (C-C motif) ligand 17, IL-8, substance P, nerve growth factor and vasoactive intestinal peptides in nasal secretions were significantly increased from baseline values following the haze episode. In contrast, the levels of interferon-γ, IL-10, transforming growth factor-ß and neuropeptide Y were significantly decreased. Incubation with 0.1-10 µg/mL PM2.5 significantly increased release of IL-1ß, IL-4, IL-5, IL-8 and IL-10 from PBMCs. CONCLUSIONS: Short-term haze exposure may lead to nasal inflammation and hypersensitivity in healthy subjects predominantly by Th2 cytokine-mediated immune responses.

Origin site-based staging system of sinonasal inverted papilloma for application to endoscopic sinus surgery.

BACKGROUND: We aimed to assess the recurrence risk of sinonasal inverted papillomas (SNIPs), based on a staging system developed according to the originating site of SNIP. METHODS: A total of 200 patients with SNIP were enrolled, and a staging system was developed based on the originating sites and corresponding recurrence rates of tumor in the patients. In the verification phase, 675 patients with SNIPs were enrolled as above, and the originating sites of the SNIPs were confirmed by an endoscopic sinus surgery. Cluster analysis was performed to determine the stage for each SNIP. RESULTS: Overall, 608 patients completed the study. SNIP recurrence rates for stages 1-4 were 0 (n = 43), 4.0% (n = 420), 13.4% (n = 134), 36.4% (n = 11), respectively (total = 6.4%). CONCLUSIONS: The origin site-based classification of SNIP may aid surgeons in selecting appropriate endoscopic surgical approaches to minimize the risk of recurrence.

Endotypes of chronic rhinitis: A cluster analysis study.

BACKGROUND: Chronic rhinitis (CR) is currently regarded as a syndrome, which presents as several endotypes. The aim of this study was to identify the CR endotype clusters and investigate the inflammatory patterns associated with the different endotypes. METHODS: A total of 259 CR patients and 20 control subjects were enrolled in this prospective study. Twelve clinical variables were analyzed using cluster analysis and five inflammatory variables were measured to investigate the inflammatory patterns associated with the different clusters. RESULTS: Six endotype clusters of CR were defined in the Chinese CR patients. Patients in cluster 1 (38.6%) were diagnosed as allergic rhinitis (AR) without asthma, and in cluster 2 (13.5%) as AR with asthma, with all demonstrating positive results for local eosinophils and high levels of local and serum IgE. Similarly, patients in cluster 3 (18.6%) were diagnosed as nonallergic rhinitis with eosinophilia syndrome (NARES) without asthma and in cluster 5 (5.0%) as NARES with asthma, with all demonstrating positive results for local eosinophils, and negative results for both local and serum IgE. Patients in cluster 4 (4.6%) were diagnosed as local allergic rhinitis and showed positive results for local eosinophils and local IgE, but negative results for serum IgE, whereas patients in cluster 6 (19.7%) were diagnosed as idiopathic rhinitis because of high symptoms scores, but negative findings for local eosinophils, local IgE, and serum IgE. CONCLUSIONS: Chinese CR patients may be clustered into six endotypes with different inflammatory patterns, which may help in delivering individualized treatment.

Sphenopalatine Ganglion Acupuncture Improves Nasal Ventilation and Modulates Autonomic Nervous Activity in Healthy Volunteers: A Randomized Controlled Study.

The study aimed to assess the effects of Sphenopalatine ganglion (SPG) acupuncture on nasal ventilation function and autonomic nervous system in health volunteers. 39 healthy subjects were randomly assigned to either active SPG acupuncture group (AA group) or sham-SPG acupuncture group (SA group). All subjects were assessed for self-reported nasal ventilation, nasal patency (nasal airway resistance (NAR) and nasal cavity volume (NCV), exhaled nasal nitric oxide (nNO), and neuropeptides (substance P(SP), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY)) in nasal secretions at baseline, 30 minutes, 2 hours, and 24 hours after acupuncture. Significantly more subjects in AA group reported improvements in nasal ventilation at all time points after acupuncture, compared to SA group. NAR and NCV were also significantly lower in AA group than SA group. The level of nNO in AA group was significantly decreased after 24 hours compared to SA group. The level of NPY was significantly increased in AA group at 30 minutes and 2 hours compared to baseline and SA group. The levels of SP and VIP were not significantly different in the two groups. We concluded that SPG acupuncture could help to improve nasal ventilation by increasing sympathetic nerve excitability in healthy volunteers.

Prevalence of allergic rhinitis among adults in urban and rural areas of china: a population-based cross-sectional survey.

PURPOSE: The aim of the present study was to compare the prevalence of self-reported and confirmable allergic rhinitis (AR) with positive skin prick test (SPT) results among adults living in urban and rural areas of China. METHODS: Adults from a community in Beijing and a village in Baoding were selected as representative urban and rural dwellers, respectively. All eligible residents were enrolled from the population register and received a face-to-face interview using modified validated questionnaires. Equal sets of randomly selected self-reporting AR-positive and AR-negative participants who responded to the questionnaires were also investigated using skin prick tests. RESULTS: A total of 803 participants in the rural area and a total of 1,499 participants in the urban area completed the questionnaires, with response rates being 75.9% and 81.5% respectively. The prevalence of self-reported AR of the rural area (19.1%) was significantly higher than that of the urban area (13.5%). The elementary school of educational level increased the risk of having AR (adjusted OR=2.198, 95% CI=1.072-2.236) .The positive SPT rates among subjects with self-reported AR in the rural and urban areas were 32.5% and 53.3%, respectively; the confirmable AR prevalence of 6.2% and 7.2% among the rural and urban adults, respectively. CONCLUSIONS: The prevalence of confirmable AR is similar between rural and urban areas in China, although there is a higher prevalence of self-reported AR in the former.

A randomized controlled trial to assess adherence to allergic rhinitis treatment following a daily short message service (SMS) via the mobile phone.

BACKGROUND: Short message service (SMS) has been suggested as an effective method to improve adherence to medical therapy in some chronic diseases. However, data on the effects of SMS interventions to allergic rhinitis (AR) treatment is limited at present. We aimed to assess whether a daily SMS reminder could improve AR patients' adherence to medication and treatment outcomes. METHODS: Fifty outpatients with AR were randomized to either receive (SMS group) or not (control group) a daily SMS reminder on their cell phone to take intranasal corticosteroid treatment for 30 days. The primary study outcomes were self-reported adherence to medication, clinic attendance rate, and severity of AR symptoms using a visual analogue scale (VAS). Secondary outcomes were changes in nasal patency (minimum cross-sectional area, nasal cavity volume, and nasal airway resistance) and exhaled nasal nitric oxide levels. RESULTS: Self-reported adherence to medication in the SMS group (15/25, 60%), was significantly higher than in the control group (7/25, 28%, p = 0.02). Similarly, the clinic attendance rate in the SMS group (72%) was significantly higher than in the control group (40%, p = 0.02). Although the VAS score improved significantly from baseline in both study groups, the improvement in the SMS group was significantly greater than in the control group (4.38 ± 4.38 vs. 8.74 ± 6.54, p = 0.031). No significant differences were observed between the two groups for the secondary outcomes. CONCLUSIONS: A daily SMS reminder may be an effective intervention to improve adherence to medication and treatment outcomes in AR patients.

[Effects of oxymetazoline hydrochloride on ex vivo human nasal cilia movement measured with high-speed digital microscopy].

OBJECTIVE: To investigate the effects of oxymetazoline hydrochloride on ex vivo human nasal cilia movement. METHODS: Ciliary beat frequency (CBF) of cultured human nasal epithelial cells was measured by high-speed digital microscopy in HBSS and oxymetazoline hydrochloride of different concentrations in 20 minutes. RESULTS; CBF of cultured nasal epithelial cells in HBSS and 0.25 g/L oxymetazoline hydrochloride did not show significant changes in 20 minutes (F = 0.098, P = 1.00). However, in 0.50 g/L and 1.00 g/L oxymetazoline hydrochloride, CBF increased slightly in 3 -4 minutes and reached the apex, then decreased gradually. At the end of observation, CBF showed no significant difference in 0.50 g/L, (F = 2.94, P = 0.05) but there was a significant lower CBF in 1.00 g/L. In the first 3 minutes, the CBF in 2.00 g/L oxymetazoline hydrochloride was stable, and then slowed gradually. After 16 minutes, there was significant difference. In initial, the highest normalized CBF of each group showed no significant difference. However, the lowest normalized CBF of 1.00 and 2.00 g/L oxymetazoline hydrochloride showed a significant difference with HBSS, 0.25 and 0.50 g/L oxymetazoline hydrochloride. CONCLUSIONS: Oxymetazoline had a concentration-dependent inhibitory effect on cultured human nasal CBF from 0.25 to 2.00 g/L. The inhibitory effect increased with the concentration going up. Oxymetazoline hydrochloride of 0.50 g/L might be the optimal choice for clinical application.

Effects of ephedrine on human nasal ciliary beat frequency.

The purpose of this study was to investigate the effects of ephedrine, an alpha,beta-adrenoceptor agonist, on the regulation of human nasal ciliary beat frequency (CBF). Changes in (cultured) human nasal CBF in response to 0.25, 0.5, 1.0 and 2.0% ephedrine were quantified by using high-speed (240 frames per second) digital microscopy combined with a beat-by-beat CBF analysis. At approximately 25 degrees C, we found that ephedrine induces an instant and moderate increase in human nasal CBF followed by an inhibitory response. With concentrations ranging from 0.25 to 2.0%, while the increment is independent of ephedrine concentration, the inhibitory effect is dependent on the concentration of ephedrine. Based on these results we propose that the clinically used concentration of ephedrine, 0.5%, has maximum stimulatory effect without obvious inhibitory effect on (cultured) human nasal CBF.

Effect of oxymetazoline on healthy human nasal ciliary beat frequency measured with high-speed digital microscopy and mucociliary transport time.

OBJECTIVES: We investigated the effects of oxymetazoline hydrochloride on the regulation of healthy human nasal ciliary beat frequency (CBF) and its influence on nasal mucociliary transport time (MTT). METHODS: Changes in (cultured) human nasal CBF in response to increasing concentrations of oxymetazoline within 20 minutes were quantified by use of high-speed digital microscopy. Moreover, the MTT before and after application of 0.05% oxymetazoline was determined by use of the saccharin test. RESULTS: Whereas no statistically significant difference was identified when compared to basal CBF at the concentration of 0.025% or 0.05%, both 0.10% and 0.20% oxymetazoline induced a significantly lower CBF at the end of the observation period. The decrement induced by 0.20% oxymetazoline appeared earlier. At concentrations ranging from 0.025% to 0.20%, the inhibitory effect was dependent on the concentration of oxymetazoline. In addition, the use of 0.05% oxymetazoline increased the mean (+/- SD) human nasal MTT from 474 +/- 21 seconds to 572 +/- 41 seconds (n = 29). CONCLUSIONS: The clinical concentration of oxymetazoline, 0.05%, has no obvious inhibitory effect on human nasal CBF in vitro. The increased MTT caused by 0.05% oxymetazoline in vivo is within the normal range.

[Anatomical and computed tomographic analysis of the interaction between uncinate process and agger nasi cells].

OBJECTIVE: To investigate the anatomical interaction between uncinate process and agger nasi cell to better understand the anatomy of the frontal sinus drainage pathway by endoscopy, spiral computed tomography (CT) and sectioning. METHODS: Twenty-one skeletal skulls (forty-two sides) and one cadaver head (two sides) were studied by spiral CT together with endoscopy and collodion embedded thin sectioning at coronal plane. The sections with the thickness of 100 microm were stained with hemotoxylin and eosin. RESULTS: Under endoscopy, a leaflet of bone to the middle turbinate, which is given off by uncinate process, forms the anterior insertion of the middle turbinate onto the lateral nasal wall. The middle portion of the uncinate process attached to the frontal process of the maxilla in all of the skeletal nasal cavities, as well as the lacrimal bone in 78.6% of the skeletal nasal cavities. On CT scans, the agger nasi cell is present in 90.5% of the skeletal nasal cavities. While the lateral wall of the agger nasi cell is formed by lacrimal bone, the medial wall of the agger nasi cell is formed by uncinate process. And the anterior wall is formed by the frontal process of the maxilla. The superior portion of the uncinate process forms the medial, posterior and top wall of the agger nasi cells. The superior portion of the uncinate extends into the frontal recess and may insert into lamina papyracea (33.3%), skull base (9.5%), middle turbinate, combination of these (57.2%). CONCLUSIONS: The agger nasi cell is the key that unlocks the frontal recess.