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2.
Artigo em Chinês | MEDLINE | ID: mdl-33540999

RESUMO

Objective:The aim of this stusy is to study the effect of endoscopic surgery quality on the recurrence of nasal polyps. Methods:A total of 32 patients(64 sides) with recurrent nasal polyps were collected from December 2016 to June 2018, all of which were bilateral type Ⅱ diffuse nasal polyps in stage 3. According to the post-operative pathological results, patients were divided into eosinophilic nasal polyps group(EOS) and non-eosinophilic nasal polyps group(NEOS). All patients underwent sinus CT scan and three-dimensional reconstruction, combined with the sinus CT image performance and intraoperative findings, the quality of the patients' previous endoscopic sinus surgery was analyzed, and the CT L-M scores of sinuses before and after reoperation were compared between the two groups. Endoscopic L-K score, nasal symptoms VAS score, quality of life Snot-20 score. Results:Among 32 patients with recurrent nasal polyps, 17 cases (53.1%) of EOS nasal polyps were confirmed pathologically after surgery, and 15 cases (46.9%) of NEOS nasal polyps were confirmed. After the previous operation, the patient still has 60 sides(93.8%) of ethmoidal cells or ethmoidal septum, 56 sides(87.5%) of bone hyperplasia, 50 sides(78.1%) of bones in frontal recess air-cell or bone air-cell, and nasal cavity adhesion there were 10 sides(15.6%), residual uncinate process 8(12.5%), improper treatment of maxillary sinus ostia or atresia were 6(9.4%), sphenoid sinus not open or atresia were 8(12.5%), nasal septal deviation untreated were 4 cases(12.5%), 1 case(3.1%) had recurrence without ethmoidal cells and residual bone interval. Patients both in the EOS group or the NEOS group were followed up with L-M score, L-K score, VAS score, and Snot-20 score after surgery, the result were significantly improved compared with the preoperative results. After follow-up of 1.5-3 years, 25 cases of polyps were completely controlled and 7 cases were partially controlled. Among them, 2 cases of EOS nasal polyps and asthma patients still had some polypoid changes in local mucosa one year after operation and was currently under medication control. Conclusion:Although the recurrence of nasal polyps is closely related to its intrinsic type, the technique of endoscopic surgery is also an important factor affecting the recurrence of nasal polyps. For patients with bilateral symmetric diffuse nasal polyps, high-quality sinus surgery of first time combined with standardized follow-up can reduce the recurrence rate of nasal polyps and prolong the relapse time.


Assuntos
Pólipos Nasais , Sinusite , Doença Crônica , Endoscopia , Humanos , Pólipos Nasais/cirurgia , Qualidade de Vida , Recidiva
3.
J Laryngol Otol ; 135(2): 147-152, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33593456

RESUMO

OBJECTIVE: Chronic rhinosinusitis is associated with altered mucociliary clearance and olfaction. The study aimed to analyse the reversibility of impairment and endoscopic factors predicting changes in mucociliary clearance and olfactory parameters. METHODS: This prospective study included patients undergoing functional endoscopic sinus surgery for medically refractory chronic rhinosinusitis. Pre- and post-operative measurements of mucociliary clearance, olfactory thresholds, and identification scores were recorded. RESULTS: Of the 96 patients, 65.6 per cent had polyposis and 80.2 per cent underwent primary surgery. Improvements in mucociliary clearance and olfaction scores were seen in all patients, with greater reversibility of impairment in patients with polyposis and in those who underwent revision surgery. The presence of polyps correlated significantly with changes in mucociliary clearance and olfaction. CONCLUSION: The study highlights improvements in mucociliary clearance, olfactory thresholds and identification scores after functional endoscopic sinus surgery in chronic rhinosinusitis with or without nasal polyposis, as well as for primary and revision surgeries. Adequate post-operative care and prevention of polyps recurrence help to improve mucociliary clearance and olfaction scores.


Assuntos
Endoscopia/efeitos adversos , Depuração Mucociliar/fisiologia , Transtornos do Olfato/fisiopatologia , Seios Paranasais/patologia , Sinusite/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Pólipos Nasais/epidemiologia , Pólipos Nasais/cirurgia , Seios Paranasais/diagnóstico por imagem , Período Pós-Operatório , Estudos Prospectivos , Olfato/fisiologia , Tomografia Computadorizada por Raios X/métodos
5.
Am J Otolaryngol ; 42(1): 102795, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33128996

RESUMO

In chronic rhinosinusitis (CRS), endotyping, being based on the pathogenic mechanism, provides a precise picture appropriate for use in clinical practice. Structured histopathological examination of CRS is considered a necessary step in efforts to establish its pathogenesis and improve our endotyping capabilities. Herein we discuss the associations between histopathology and clinical characteristics of CRS patients to assist medical and surgical treatment choices.


Assuntos
Planejamento de Assistência ao Paciente , Rinite/patologia , Rinite/cirurgia , Sinusite/patologia , Sinusite/cirurgia , Corticosteroides/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Asma , Doença Crônica , Endoscopia/métodos , Eosinófilos/patologia , Humanos , Hipersensibilidade , Inflamação , Mucosa Nasal/patologia , Pólipos Nasais/diagnóstico , Pólipos Nasais/tratamento farmacológico , Pólipos Nasais/patologia , Pólipos Nasais/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Rinite/diagnóstico , Rinite/tratamento farmacológico , Sinusite/diagnóstico , Sinusite/tratamento farmacológico
6.
Artigo em Chinês | MEDLINE | ID: mdl-33040503

RESUMO

Objective:To compare the nasal microbiota diversity between chronic rhinosinusitis with nasal polyp(CRSwNP) patients and controls, postoperative recurrent with non-recurrent CRSwNP, in order to provide new sight in CRSwNP treatment and prognosis. Method:Forty-eight patients with CRSwNP were recruited as the experimental group, and 33 patients who underwent FESS and had no sinus inflammatory disease, including nasal septum deviation,inverted papilloma, pituitary adenomas, chronic dacryocystitis,or optical canal fractures, were recruited as control group. High-throughput sequencing of 16S rRNA was used to detect the bacterial communities in the nasal secretion which was collected from middle meatus during the operation. The difference of the microbiota diversity between CRSwNP and controls was compared. Patients with CRSwNP were followed up for 1 year after surgery to observe whether they had relapsed or not, and nasal secretions were collected again for bacterial microbiota detection. The difference between postoperative and preoperative microbiota of the non-recurrent CRSwNP were compared, and the difference between postoperative and preoperative microbiota of the recurrent CRSwNP were compared. Result:One year after surgery, 12 cases of CRSwNP recurred(recurrent rate 25%). The clinical history of the recurrent group was longer than that of the non-recurrent group(P=0.018), and the preoperative CT score(P=0.001), nasal polyp size score(P=0.004) and the severity of postnasal drip symptom(P=0.032) in the recurrent group were significantly higher than non-recurrent group. Comparing the preoperative nasal microbiota of CRSwNP with control, there was no significant difference about the richness, α diversity and ß diversity, but the relative abundance of Actinobacteria(FDR P=0.004) and Corynebacterium(FDR P=0.005) of CRSwNP were significantly lower than that of control. After operation, the relative abundance of Actinobacteria(FDR P=0.012) and Corynebacterium(FDR P=0.003) increased, while the Bacteroidetes(FDR P=0.040) decreased in the non-recurrent CRSwNP; However, there was no change in the nasal bacterial microbiota in the recurrent group. Conclusion:CRSwNP was associated with nasal bacterial dysbiosis, and the postoperative improvement of dysbiosis was correlated with the prognosis of CRSwNP.


Assuntos
Microbiota , Pólipos Nasais , Rinite , Sinusite , Humanos , Pólipos Nasais/cirurgia , Recidiva Local de Neoplasia , Prognóstico , RNA Ribossômico 16S/genética , Sinusite/cirurgia
7.
Arch. argent. pediatr ; 118(5): e491-e494, oct 2020. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1122539

RESUMO

Los pólipos pilosos nasofaríngeos son tumores benignos poco frecuentes. Se presenta el caso de esta patología en una paciente recién nacida, quien presentó cianosis y dificultad respiratoria por obstrucción de la vía aérea superior, durante las primeras 24 horas de vida. La paciente requirió maniobras de reanimación e intubación endotraqueal. Estudios diagnósticos confirmaron la presencia de una masa en la pared lateral de la faringe. Se realizó la extirpación quirúrgica exitosa con evolución satisfactoria de la paciente


Nasopharyngeal hairy polyps are rare benign tumors. We present a newborn case with a hairy polyp mass causing cyanosis and respiratory distress due to obstruction of the upper airway during the first 24 hours of life. The patient required resuscitation and endotracheal intubation. Diagnostic studies confirmed the presence of a mass in the lateral pharyngeal wall. Surgical treatment and removal of the mass was performed with satisfactory evolution of the patient


Assuntos
Humanos , Feminino , Recém-Nascido , Pólipos Nasais/diagnóstico por imagem , Ressuscitação , Pólipos Nasais/cirurgia , Doenças Nasofaríngeas , Cianose , Obstrução das Vias Respiratórias , Intubação Intratraqueal , Neoplasias
9.
Am J Otolaryngol ; 41(5): 102554, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32521299

RESUMO

PURPOSE: Nasal douching is commonly used as a postoperative management strategy for chronic rhinosinusitis with nasal polyps (CRSwNP). Few studies to date have compared the effectiveness of nasal douching in CRSwNP phenotypes after endoscopic sinus surgery (ESS). We evaluated the efficacy of seawater types in eosinophilic CRSwNP (ECRSwNP) and noneosinophilic CRSwNP (nonECRSwNP) after ESS. METHODS: Patients with bilateral CRSwNP who had undergone ESS were blindly randomized to receive buffered hypertonic seawater (BHS) (n = 48) or physiological seawater (PS) (n = 45). CRSwNP patients were stratified by phenotypes (ECRSwNP and nonECRSwNP) retrospectively according to whether tissue eosinophils exceeded 10%. Follow-up evaluations were conducted at 2, 8, 16, and 24 weeks after surgery. Evaluations included the 22-item Sino-Nasal Outcome Test (SNOT-22), visual analog scale (VAS), Lund-Kennedy endoscopic score (LKES), saccharine clearance time (SCT), and adverse events. RESULTS: All of the patients experienced significant improvements in SNOT-22 scores, VAS scores, and LKES over time. BHS resulted in better improvement of LEKS and SCT relative to PS at 8 weeks postoperatively. Mucosal edema formation was significantly reduced with less crusting among HBS recipients at 8 weeks. After stratification, only patients in the nonECRSwNP + BHS subgroup showed a significant improvement in LEKS and SCT at 8 weeks postoperatively. Side effect profiles were not significantly different among the groups. CONCLUSIONS: BHS has a better inhibitory effect on mucosal edema and crusting during the early postoperative care period of CRSwNP. Among all of the patients, nonECRSwNP patients showed a significant improvement in LEKS and SCT at 8 weeks.


Assuntos
Seio Etmoidal/cirurgia , Soluções Isotônicas/administração & dosagem , Pólipos Nasais/cirurgia , Pólipos Nasais/terapia , Cuidados Pós-Operatórios/métodos , Rinite/cirurgia , Rinite/terapia , Solução Salina Hipertônica/administração & dosagem , Sinusite/cirurgia , Sinusite/terapia , Irrigação Terapêutica/métodos , Adulto , Tampões (Química) , Doença Crônica , Método Duplo-Cego , Edema/prevenção & controle , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal , Pólipos Nasais/complicações , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Doenças dos Seios Paranasais/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Rinite/complicações , Sinusite/complicações , Resultado do Tratamento
10.
HNO ; 68(8): 623-636, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32556468

RESUMO

Unilateral diseases of the maxillary sinus are among the most common rhinologic diagnoses. The diversity of these diseases can represent a challenge for the treating physician. The spectrum ranges from harmless maxillary sinus cysts that seldom require treatment, to highly aggressive malignant tumors. Special attention should be given to the management of inverted papilloma. These benign tumors are characterized by high recurrence rates and the potential for malignant transformation. The key to minimizing recurrence is precise surgical intervention. Other unilateral maxillary sinus diseases such as the antrochoanal polyp and the fungus ball (aspergilloma) are also discussed in depth.


Assuntos
Pólipos Nasais , Papiloma Invertido , Doenças dos Seios Paranasais , Endoscopia , Humanos , Seio Maxilar , Pólipos Nasais/diagnóstico , Pólipos Nasais/cirurgia , Recidiva Local de Neoplasia , Papiloma Invertido/diagnóstico , Papiloma Invertido/cirurgia , Doenças dos Seios Paranasais/diagnóstico , Doenças dos Seios Paranasais/cirurgia
11.
Ann Otol Rhinol Laryngol ; 129(12): 1153-1162, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32517494

RESUMO

OBJECTIVES: To determine the utility of Second-look endoscopy with debridement (SLED) after functional endoscopic sinus surgery (ESS) in pediatric cystic fibrosis (CF) patients. To compare outcomes in pediatric CF patients undergoing sinus surgery for chronic sinusitis with or without SLED. To describe findings present at the time of SLED. METHODS: Retrospective chart review of 61 ESS procedures performed at a tertiary care pediatric center from 2013 to 2016. Data collected included demographics, SLED findings, and 6-month pre-/postoperative disease specific outcomes including incidence of sinonasal and pulmonary exacerbations and revisions. RESULTS: Sixty-one cases were reviewed. SLED was performed in 38 cases on average 22.4 days postoperatively. Average preoperative Lund-Mackay score was 14.9 and 14.8 among patients undergoing ESS with and without SLED, respectively. Pre-/postoperative intranasal steroid use and extent of surgery performed was similar among all patients. At the time of SLED, rates of synechiae, polyps and maxillary antrostomy obstruction were 26.3%, 23.7%, and 7.9%, respectively. The incidence and number of days to onset of postoperative sinonasal exacerbations requiring antibiotic therapy within 6 months of ESS were 1.0 (SD 1.0) and 85 days (SD 45.7); and 1.3 (SD 1.0) and 80.4 days (SD 40.5) for patients undergoing ESS with and without SLED, respectively (P value .33). The number of days to first pulmonary exacerbation was 113.9 (SD 45.5) and 47.4 (SD 34.1) among SLED and non-SLED patients, respectively (P value .01). No significant difference was observed in revision rates and time to revision ESS (30% and overall average 1.4 years, respectively). CONCLUSION: The utility of SLED among pediatric CF patients remains unclear. While debridement did not have a significant impact on sinonasal exacerbations or revision rates, pulmonary exacerbations for patients undergoing SLED were delayed. Further studies are needed to clarify the impact of SLED.


Assuntos
Fibrose Cística/complicações , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Rinite/cirurgia , Cirurgia de Second-Look/métodos , Sinusite/cirurgia , Adolescente , Criança , Pré-Escolar , Doença Crônica , Desbridamento/métodos , Endoscopia/métodos , Feminino , Humanos , Masculino , Seio Maxilar/cirurgia , Pólipos Nasais/epidemiologia , Pólipos Nasais/cirurgia , Seios Paranasais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Rinite/complicações , Sinusite/complicações , Aderências Teciduais/epidemiologia , Aderências Teciduais/cirurgia
12.
Ann Otol Rhinol Laryngol ; 129(12): 1174-1185, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32525399

RESUMO

OBJECTIVES: Changes in airflow dynamics after nasal surgery may have implications on voice quality. Multiple studies have evaluated the impact of nasal surgery on voice using heterogeneous outcome measures. We aim to systematically review the impact of nasal surgery on voice quality. METHODS: Our study design was a systematic review with meta-analyses. A literature search of PubMed, Ovid, Cochrane from 1997 to 2017 was performed. Inclusion criteria included English language studies containing original data on nasal surgery and voice. Two investigators independently reviewed all manuscripts and performed a comprehensive quality assessment. Meta-analysis was completed on quantitative voice measurements. RESULTS: Of 463 identified, 19 studies with 692 patients fulfilled eligibility. Nasal surgeries performed included endoscopic sinus surgery (11/20), septoplasty (11/20), rhinoplasty (2/20), and turbinate reduction (2/20). Voice outcomes measured included nasalance (8/20), fundamental frequency (11/20), jitter (10/20), shimmer (10/20), harmonic to noise ratio (HRN) (8/20), formants (5/20), and voice handicap index (VHI) (4/20). Voice examinations were assessed preoperatively and 1 to 30 months postoperatively. Meta-analysis revealed statistically significant changes in nasalance, (P < .01) 1 month postoperatively; there was no significant difference in nasalance at 6 months postoperatively. All other variables analyzed revealed no statistically significant differences. Five of nine studies showed majority of patients did not notice subjective change in voice after surgery, but with high heterogeneity of measurements. CONCLUSIONS: There may be a short-term increase in nasalance that resolves at longer follow-up, but there seem to be no other objective changes in voice. There may be subjective changes after surgery, but require further study to evaluate.


Assuntos
Pólipos Nasais/cirurgia , Procedimentos Cirúrgicos Nasais , Rinite/cirurgia , Sinusite/cirurgia , Qualidade da Voz , Doença Crônica , Humanos , Septo Nasal/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos , Seios Paranasais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Rinoplastia , Resultado do Tratamento , Conchas Nasais/cirurgia
15.
HNO ; 68(8): 573-580, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32405682

RESUMO

Until the 1990s, radical sinus surgery was considered a standard procedure for maxillary sinus diseases, but it is no longer favored due to the high morbidity. Today, functional endoscopic sinus surgery (FESS) is considered the gold standard in sinus surgery. Modifications of surgical approaches also allow access to regions of the maxillary sinus that were previously difficult to reach. Depending on anatomy and pathology, different methods for widening the maxillary ostium can be selected. In type I sinusotomy, the natural ostium is widened dorsally by a maximum of 1 cm. Sinusotomy type II involves widening the natural ostium up to a maximum diameter of 2 cm. In sinusotomy type III, the natural ostium is widened dorsally to the posterior wall of the maxillary sinus and caudally to the base of the inferior turbinate. Beside the prelacrimal approach, more invasive approaches are the medial maxillectomy, in which the dorsal part of the inferior turbinate and the adjacent medial wall of the maxillary sinus is resected, as well as its modifications "mega antrostomy" and "extended maxillary antrostomy." Correct selection of the size of the maxillary sinus window is prerequisite for successful treatment and long-term postoperative success. Isolated purulent maxillary sinusitis can usually be treated by a type I sinusotomy. Sinusotomy type II addresses nasal polyps with involvement of the mucosa of the ostium, recurrent stenosis after previous surgery, chronic maxillary sinusitis due to cystic fibrosis, and purulent maxillary sinusitis with involvement of other adjacent sinuses. Sinusotomy type III is required for choanal polyps with attachment to the floor of the maxillary sinus, for extensive polyposis and fungal sinusitis, and for inverted papilloma. Particularly for (recurrent) disease and extensive interventions in the maxillary sinus, medial maxillectomy or a modification thereof may be required.


Assuntos
Seio Maxilar , Sinusite Maxilar , Pólipos Nasais , Doenças dos Seios Paranasais , Sinusite , Endoscopia , Humanos , Seio Maxilar/cirurgia , Sinusite Maxilar/cirurgia , Pólipos Nasais/cirurgia , Doenças dos Seios Paranasais/cirurgia , Sinusite/cirurgia
16.
Rhinology ; 58(3): 208-212, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32441709

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) is a common chronic inflammatory disease. Endoscopic sinus surgery is recommended as a standard method when medical treatment fails. The effectiveness of various complementary surgical methods such as endoscopic partial middle-turbinectomy is controversial in the improvement of CRS symptoms in these patients. This study aimed to investigate the effect of endoscopic partial middle-turbinectomy on the quality of life (QOL) of patients with chronic rhinosinusitis and nasal polyps (CRSwNP) in Iran. METHOD: Ninety patients with CRSwNP of grades 3 and 4 were randomly assigned to either an intervention (45 patients) or control group (45 patients). In the control group, endoscopic sinus surgery without middle turbinectomy was performed and in the intervention group, endoscopic partial middle-turbinectomy was performed in addition to endoscopic sinus surgery. To evaluate the outcomes, the SNOT-22 QOL questionnaire was used, and the results were analyzed using SPSS version 24. RESULTS: Most of the patients were male and had a mean age of 39 years. The mean SNOT-22 QOL questionnaire scores were 49.13 ± 16.72 and 52.51 ± 16.95 before surgery in the control and intervention groups respectively, which did not show any significant difference. In contrast, after endoscopic surgery these scores changed to 28.46 ± 12.38 and 11.13 ± 5.55 in the control and intervention groups, respectively and there was a significant difference between both groups. Although there was a significant improvement in both groups, the patients in the intervention group experienced more improvement than the control group (41.4 (± 16.46)) vs 30.7 (±18.27), respectively CONCLUSION: According to this study, it appears that the use of endoscopic partial middle-turbinectomy in addition to endoscopic sinus surgery improves CRS symptoms and the QOL of patients compared with endoscopic sinus surgery alone.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Adulto , Doença Crônica , Endoscopia , Humanos , Irã (Geográfico) , Masculino , Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Qualidade de Vida , Rinite/cirurgia , Sinusite/cirurgia , Resultado do Tratamento
17.
Am J Med Sci ; 360(2): 137-145, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32423746

RESUMO

BACKGROUND: At present, the effect of operation intervention on pulmonary function is not clear in patients with allergic rhinitis and chronic rhinosinusitis with nasal polyps (AR&CRSwNP). This study was conducted to investigate the effect of vidian neurectomy on pulmonary function and airway hyperresponsiveness (AHR) in patients with AR&CRSwNP. METHODS: The incidences of AHR, bronchial asthma (BA) and pulmonary function impairment in 112 patients with AR&CRSwNP were investigated. Subsequently, we evaluated the outcome of vidian neurectomy and its effect on pulmonary function and AHR. Furthermore, we explored the correlation between postoperative level of eosinophilic cationic protein (ECP) and the changes of pulmonary function indices or dose of methacholine. RESULTS: In this study, the incidences of pulmonary function impairment, bronchial asthma, and AHR in patients with AR&CRSwNP were 61.61%, 69.64%, and 66.96%, respectively. Particularly, vidian neurectomy effectively alleviated nasal symptoms, improved pulmonary function, and reduced AHR in AR&CRSwNP patients. Furthermore, the postoperative level of ECP, IgE, Interleukin-4 and Interleukin-IL-5 was dramatically decreased, and there was an obvious inverse correlation between ECP level and pulmonary function index or dose of methacholine. CONCLUSIONS: Vidian neurectomy is effective in alleviating nasal symptoms, improving pulmonary function, and reducing the risk of AHR of patients with AR&CRSwNP by decreasing the level of ECP.


Assuntos
Denervação/métodos , Gânglio Geniculado/cirurgia , Pólipos Nasais/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Rinite Alérgica/cirurgia , Sinusite/cirurgia , Adulto , Hiper-Reatividade Brônquica/imunologia , Hiper-Reatividade Brônquica/fisiopatologia , Testes de Provocação Brônquica , Doença Crônica , Proteína Catiônica de Eosinófilo/imunologia , Feminino , Volume Expiratório Forçado , Humanos , Imunoglobulina E/imunologia , Interleucina-4/imunologia , Interleucina-5/imunologia , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/imunologia , Pólipos Nasais/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Hipersensibilidade Respiratória/imunologia , Hipersensibilidade Respiratória/fisiopatologia , Rinite Alérgica/imunologia , Rinite Alérgica/fisiopatologia , Sinusite/imunologia , Sinusite/fisiopatologia , Resultado do Tratamento , Capacidade Vital
18.
Value Health ; 23(5): 632-641, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32389229

RESUMO

OBJECTIVES: To qualitatively explore patient experiences of severe, recurrent, bilateral nasal polyps (NP). METHODS: A targeted literature review of published qualitative studies and online blogs describing patient experiences of NP was conducted. Semistructured concept elicitation interviews were conducted in the United States and Germany with participants ≥18 years with severe, recurrent, bilateral NP to explore their symptom experience and impacts on health-related quality of life (HRQoL; NCT03221192). A subset of 10 participants reported symptoms and impacts using a smartphone or tablet application (app) over a 10-day period. RESULTS: A paucity of qualitative evidence regarding patient experience of NP was identified from the literature or blog review. Twenty-seven participant interviews were conducted. Thirty-six symptoms were identified, including 7 primary symptoms (nasal congestion [n = 27 of 27], breathing difficulties [n = 27 of 27], postnasal drip [n = 25 of 27], runny nose [n = 24 of 27], head/facial pressure [n = 23 of 27], loss of smell [n = 23 of 27], loss of taste [n = 22 of 27]) and 29 secondary symptoms (the most common were mucus/catarrh and nose bleeds [both n = 20 of 27]). Most symptoms were reported to vary both within and between days. Sixty impacts of severe NP were reported, including impacts on sleep (n = 22 of 27), physical functioning (n = 21 of 27), activities of daily living (n = 21 of 27), emotional well-being (n = 27 of 27), treatment (n = 23 of 27), social life (n = 26 of 27), and work (n = 19 of 27). Symptoms/impacts reported using the app were consistent with interview findings, although new symptoms were identified (ear pain, throat pain, nasal scabs, and nasal burning). These results supported the development of a conceptual model outlining concepts related to symptoms, impacts, and treatment of NP. CONCLUSIONS: Severe, recurrent, bilateral NP are associated with a range of symptoms that have significant detrimental impact on HRQoL.


Assuntos
Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Qualidade de Vida , Recidiva , Rinite/complicações , Sinusite/complicações , Atividades Cotidianas , Adulto , Feminino , Alemanha , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/tratamento farmacológico , Pesquisa Qualitativa , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Esteroides/administração & dosagem , Esteroides/efeitos adversos , Estados Unidos
19.
Rhinology ; 58(2): 126-135, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31904028

RESUMO

BACKGROUND: Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma have poorer outcomes after functional endoscopic sinus surgery (FESS) and higher recurrence rate. The aim of present study was to investigate the long-term clinical outcomes of extended surgical strategies for patients with recurrent CRSwNP and asthma. METHODS: Eighty-one patients with CRSwNP and asthma were enrolled in this 5-year prospective study. They were randomly assigned to undergo FESS, radical endoscopic sinus surgery (RESS), or RESS+Draf 3 surgery. Disease severity and clinical outcomes were evaluated using symptoms scoring, endoscopic scoring system, computed tomography staging system, sinus-specific quality of life scores, tissue and peripheral blood eosinophil percentage, and pulmonary function tests. Baseline, 1-year, 3-year, and 5-year follow-up data were compared among the groups. RESULTS: RESS and RESS+Draf 3 strategies yielded better short-term (1 year) outcomes than did FESS. FESS had a higher short-term recurrence rate, although recurrence rates were similarly high (95.6 - 96.1%) in all the groups at 5 years postoperatively. RESS and RESS+Draf 3 yielded a lower long-term revision surgery rate and a longer time to recurrence post-surgery than FESS, which was negatively correlated with tissue and peripheral blood eosinophil percentage. CONCLUSIONS: CRSwNP with asthma is a systemic disease that inevitably recurs. Radical surgery prolongs recurrence time and improves olfaction, rhinorrhea, and quality of life in the short-term. Combining Draf 3 with RESS did not yield better clinical outcomes than RESS alone; thus, although RESS alone appears to be the best option, these findings need to be confirmed in further studies involving more patients, longer follow-up duration and stricter standardized medication use especially the adequate steroid irrigations.


Assuntos
Asma/complicações , Endoscopia/métodos , Pólipos Nasais/cirurgia , Rinite/cirurgia , Sinusite/cirurgia , Doença Crônica , Humanos , Pólipos Nasais/complicações , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos
20.
Isr Med Assoc J ; 22(1): 48-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927806

RESUMO

BACKGROUND: Nasal polyps are three-dimensional structures arising from the mucosa of the upper airway. Due to their complexity, the reliability of single-layer cell cultures and animal systems as research models is limited. OBJECTIVES: To evaluate the feasibility of an ex vivo organ culture of human polyps, preserving tissue structure and function. METHODS: Nasal polyps were excised during routine endoscopic sinus surgery for chronic rhinosinusitis and polyposis. Fresh tissue samples were used for pathological evaluation and for the preparation of 250-500 µm sections, which were incubated in culture media. Tissue viability was assessed by visualisation of cilia motility, measurement of glucose uptake, and an infectivity assay. Cytokine secretion was evaluated by enzyme-linked immunosorbent assay and real-time polymerase chain reaction before and after the introduction of steroids. RESULTS: Polyp tissue viability was retained for 2-3 days as demonstrated by cilia motility, glucose uptake and preserved cellular composition. Tissue samples maintained their capacity to respond to infection by herpes simplex virus 1 and adenovirus. Introduction of dexamethasone to cultured tissue samples led to suppression of interferon-g production. CONCLUSIONS: The ex vivo nasal polyp organ culture reproduces the physiological, metabolic, and cellular features of nasal polyps. Furthermore, it shows a preserved capacity for viral infection and response to drugs. This system is a useful tool for the investigation nasal-polyps and for the development of novel therapies.


Assuntos
Pólipos Nasais/diagnóstico , Técnicas de Cultura de Órgãos/métodos , Adulto , Quimiocinas/metabolismo , Citocinas/metabolismo , Glucose/metabolismo , Humanos , Pólipos Nasais/metabolismo , Pólipos Nasais/patologia , Pólipos Nasais/cirurgia , Reação em Cadeia da Polimerase em Tempo Real
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