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1.
Am J Otolaryngol ; 41(1): 102286, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31727332

RESUMO

BACKGROUND: In last years, many attempts were made to recognize chronic rhinosinusitis with nasal polyps (CRSwNP) phenotypes focusing on identifying relevant key pathogenic molecules. Polyps recurrence rate ranges from 4% to 60%, so it's clear that not all clinical and immunologic factors associated with recurrence are known. OBJECTIVE: We investigate the inflammatory profile in patients with long term recurrent and non-recurrent CRSwNPs and if a specific profile is associated with recurrence, comparing eosinophilic, neutrophilic and lymphocytic infiltration, as well as IL-5 and IL-8 expression to long term recurrence rate. METHODS: This prospective study included 44 adult patients with CRSwNP treated with endoscopic sinus surgery between 2008 and 2010. Long term follow-up data (8-10 years) indicated that among 44 patients, 18 (40.1%) experienced long term recurrence of nasal polyposis needing maximal medical treatment or revision surgery. We realized two groups: one with patients who didn't present long term recurrence (26 patients) and another with patients who presented long term recurrence (18 patients) and in both groups eosinophilic, neutrophilic and lymphocytic infiltration and IL-5 and IL-8 expression were measured. RESULTS: The parameters that reached statistical significance (p < 0.05) comparing the two groups were eosinophilic infiltration and IL-5 expression, whereas neutrophilic and lymphocytic infiltration, as IL-8 expression didn't show any significant difference. Asthma and aspirin intolerance seemed significantly more frequent in patients with recurrence, while allergy presented not statistically significant difference between two groups. CONCLUSIONS: We can conclude that high eosinophilic infiltration and high IL-5 expression in CRSwNP correlate with higher rate of long term recurrence, while neutrophilic and lymphocytic infiltration, and IL-8 expression don't correlate with it. These findings provide the opportunity to improve our ability to predict the prognosis of surgical intervention, although it is still needed to explore the optimal predictor of outcome in CRSwNP.


Assuntos
Pólipos Nasais/imunologia , Pólipos Nasais/cirurgia , Rinite/imunologia , Rinite/cirurgia , Sinusite/imunologia , Sinusite/cirurgia , Adolescente , Adulto , Idoso , Biomarcadores/metabolismo , Doença Crônica , Endoscopia , Eosinofilia/imunologia , Feminino , Humanos , Interleucina-5/metabolismo , Interleucina-8/metabolismo , Ativação Linfocitária/imunologia , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Infiltração de Neutrófilos/imunologia , Fenótipo , Valor Preditivo dos Testes , Estudos Prospectivos , Recidiva , Reoperação/estatística & dados numéricos , Rinite/complicações , Sinusite/complicações
2.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(11): 813-818, 2019 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-31795541

RESUMO

Objective: To investigate the prevalence and radiographic characteristics of ethmomaxillary sinus (EMS) in chronic rhinosinusitis (CRS) patients by CT scan, as well as their endoscopic surgical significance in antrostomy. Methods: A retrospective analysis of 111 CRS patients who were prepared for surgery in Department of Otorhinolaryngology Head and Neck Surgery of Peking University People's Hospital from February to December of 2017 was performed. In all CRS patients, 79 patients were bilateral CRS and 32 were unilateral. The patients were divided into two groups according to whether they had history of surgery. Only the sides with CRS were analyzed. There were 98 patients (167 sides) in the non-surgical history group and 13 patients (23 sides) in the surgical history group. The prevalence of EMS in CRS sides in the two groups was counted by analyzing the CT images. The CT image features and anatomical variations associated with EMS in CRS sides in the non-surgical history group were also analyzed. SPSS 22.0 software was used for statistic analysis. Results: The prevalence of EMS in CRS sides was 21.7% (5/23) in the surgical history group and 12.0% (20/167) in the non-surgical history group. No statistically significant difference in the prevalence of EMS was found between the two groups (χ(2)=0.940, P>0.05). The medial-lateral diameters of the EMS ranged from 8.50 to 14.10 mm with an average of (10.38±1.69) mm (Mean±SD). The shape of the bony septum between the EMS and maxillary sinus was divided into three types: convex toward to the EMS (2 sides), convex toward to maxillary sinus (5 sides) and flat (13 sides). The Lund-Mackay (LM) scores of the maxillary sinuses in patients with and without EMS showed no statistically significant difference (1.60±0.50 vs 1.40±0.62, Z=1.285, P>0.05). The EMS obstructed the drainage of maxillary sinus posteriorly, medially and superiorly. All the EMS in diseased sides were dissected endoscopicly to improve drainage. In the non-surgical history group, the EMS coexisting anatomic variations were the Onodi cell (7/20), Haller cell (3/20), concha bullosa (6/20) and maxillary sinus hypoplasia (3/20). Conclusions: There is relatively high prevalence of the EMS in CRS patients. This is adjacent to the orbit, overpneumatizes laterally and obstructs the drainage of the maxillary sinus. Complete dissection of the EMS is helpful to improve the drainage of maxillary sinus.


Assuntos
Seio Etmoidal/diagnóstico por imagem , Seio Maxilar/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Doença Crônica , Endoscopia , Humanos , Procedimentos Cirúrgicos Nasais , Estudos Retrospectivos , Rinite/diagnóstico por imagem , Rinite/cirurgia , Tomografia Computadorizada por Raios X
3.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(11): 850-856, 2019 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-31795547

RESUMO

Objective: To explore the expression of amphiregulin (AREG) in nasal polyps patients with different degrees of eosinophil infiltration, and to analyze the correlation between AREG and tissue remodeling. Methods: Forty-eight patients underwent endoscopic sinus surgery in the Department of Otorhinolaryngology Head and Neck Surgery, Remin Hospital, Wuhan University from July 2017 to August 2018 were recruited, including 40 males and 8 females, aged from 16 to 60 years old. The subjects were divided into three groups: control group (n=14), eosinophilic chronic sinusitis with nasal polyps (ECRSwNP) group (n=19) and noneosinophilic chronic rhinosinusitis with nasal polyps (non-ECRSwNP) group (n=15). The relative expression of AREG in nasal mucosa was detected by Western blot assay and immunohistochemical staining. Tissue remodeling was detected by HE staining, AB-PAS staining and Masson staining. Kruskal-Wallis test was used for comparison among multiple groups, and Spearman correlation analysis was conducted between the expression level of AREG and the related indexes of tissue remodeling. Results: The expression of AREG in ECRSwNP group was significantly higher than that in non-ECRSwNP group and control group (median protein expression of Western blot was 1.592 vs 0.617 vs0.582, all P<0.05). The degree of epithelial injury and goblet cell metaplasia in ECRSwNP group was significantly higher than that in control group (all P<0.05), the percentage of collagen fibrosis area in ECRSwNP group was significantly lower than that in control group (P=0.01). In chronic rhinosinusitis with nasal polyps (CRSwNP) patients, the area of mucous glands was negatively correlated with the expression of AREG (r=-0.616, P<0.05), and the percentage of collagen fibrosis area was negatively correlated with the expression of AREG (r=-0.738, P<0.05). Conclusion: The expression of AREG is higher in ECRSwNP patients, which is related to the process of tissue remodeling.


Assuntos
Anfirregulina/biossíntese , Eosinófilos/metabolismo , Mucosa Nasal/metabolismo , Pólipos Nasais/metabolismo , Rinite/metabolismo , Sinusite/metabolismo , Adolescente , Adulto , Doença Crônica , Feminino , Fibrose/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/patologia , Mucosa Nasal/cirurgia , Pólipos Nasais/patologia , Pólipos Nasais/cirurgia , Rinite/patologia , Rinite/cirurgia , Sinusite/patologia , Sinusite/cirurgia , Adulto Jovem
4.
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 422-426, Out.-Dez. 2019. ilus, tab
Artigo em Inglês | LILACS | ID: biblio-1024327

RESUMO

Introduction: Chronic rhinosinusitis (CRS) is a highly prevalent pathology in our society. Due to the prevalence of this condition and to the persisting symptoms despite an appropriate medical treatment, surgical techniques are often required. Lately, minimal invasive techniques have been described, such as lacrimal diversion devices (LDDs). This technique offers a fast and convenient choice for delivery of sinus irrigation and topical medication. Objective: We aimed to describe our experience with LDDs and evaluate the safety and effectiveness of the procedure in patients with moderate to severe CRS without nasal polyposis (CRSsNP) and persistent symptomatology despite medical therapy. Methods: A total of 7 patients underwent bilateral lacrimal stents placement in the operating room. A retrospective observational study was conducted. The Sino-Nasal Outcome Test-20 (SNOT-20) survey was performed and the score obtained was compared before and 1 month after the procedure. Results: The LDDs were used for an average of 80 days. During the follow-up, only three patients had a mild complication with the device (granuloma in the punctum, obstruction, and early extrusion). The mean baseline SNOT-20 score dropped significantly ( p = 0.015) from 25.85 to 11.57 (mean: - 14.29) 1 month after the procedure. Conclusion: According to our experience and results, the use of LDD is a novel, feasible, and less invasive technique to treat refractory CRS. It reduces the risk of mucosal stripping, provides short-term outcomes, and the surgical procedure does not require advanced training in endoscopic sinus surgery. Moreover, it can be performed in-office under local anesthesia or sedation (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Sinusite/cirurgia , Stents , Rinite/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Aparelho Lacrimal/cirurgia
6.
Rev Med Suisse ; 15(665): 1748-1751, 2019 Oct 02.
Artigo em Francês | MEDLINE | ID: mdl-31580018

RESUMO

Nasal polyposis is a specific phenotype of chronic rhinosinusitis (CRS). Some cases can be managed with topical and infrequent use of systemic steroids, while many patients require surgery. Despite postoperative, regular steroid administration, recurrences may be found especially in patients suffering from Aspirin exacerbated respiratory disease (AERD), a particularly severe form of CRS with polyps, asthma and non-steroid-anti-inflammatory-drug (NSAID) intolerance. We report two cases of difficult-to-treat AERD patients following revision surgery, treated with monoclonal anti-IgE antibody (omalizumab) and successful control of the disease and symptoms. Omalizumab may be a promising alternative in selected cases of CRS with nasal polyps to avoid overuse of systemic steroids and frustrating repetition of paranasal sinus surgeries.


Assuntos
Pólipos Nasais/complicações , Omalizumab/uso terapêutico , Rinite/complicações , Rinite/tratamento farmacológico , Sinusite/complicações , Sinusite/tratamento farmacológico , Doença Crônica , Humanos , Rinite/cirurgia , Sinusite/cirurgia
7.
Eur Arch Otorhinolaryngol ; 276(12): 3373-3381, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31560120

RESUMO

PURPOSE: Recalcitrant chronic rhinosinusitis is a persistent inflammatory condition of the sinonasal mucosa despite adequate medical therapy and sinus surgery. This study aimed to demonstrate the effectiveness and safety of dilute povidone-iodine (PVP-I) sinonasal rinses as an adjunctive therapy. METHODS: Prospective cohort study. Twenty-nine recalcitrant CRS patients with endoscopic evidence of ongoing inflammation and purulent discharge were prescribed 0.08% diluted PVP-I rinses. Changes to endoscopic modified Lund-Kennedy (MLK) scores at 7 weeks post-PVP-I rinsing served as the primary outcome measure. RESULTS: The median MLK-discharge score significantly decreased in all patients by 1.50 points post-PVP-I rinsing (p value < 0.01). The total MLK score significantly decreased in all patients by 1.50 points (p value = 0.01). Up to a 17% reduction in serum inflammatory markers was measured post-PVP-I rinsing. Sinonasal culture revealed a shift from moderate-heavy growth to lighter bacterial growth overall. Subjective SNOT-22 scores significantly improved overall by ≥ 1 minimal clinically important difference (MCID > 12; baseline median = 33; follow-up median = 20; p value < 0.01; n = 22). TSH levels increased non-significantly within normal ranges (baseline median = 1.59 mU/L; follow-up median = 1.92 mU/L; p = 0.10; n = 15). Mucociliary clearance time increased non-significantly within normal ranges (baseline median = 9 min; follow-up median = 10 min; p value = 0.53; n = 17). Olfactory Sniffin'16 scores non-significantly decreased within age-related normal ranges (baseline median = 14; follow-up median = 13; p value = 0.72; n = 18). CONCLUSION: A dilute 0.08% PVP-I sinonasal rinse as an ancillary therapy in recalcitrant CRS significantly reduces signs of infection alongside notable symptom improvement, without affecting thyroid function, mucociliary clearance or olfaction.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Povidona-Iodo/administração & dosagem , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Irrigação Terapêutica , Administração Intranasal , Adulto , Anti-Infecciosos Locais/uso terapêutico , Doença Crônica , Estudos de Coortes , Endoscopia , Feminino , Humanos , Inflamação/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Depuração Mucociliar , Lavagem Nasal , Povidona-Iodo/uso terapêutico , Estudos Prospectivos , Rinite/cirurgia , Índice de Gravidade de Doença , Sinusite/cirurgia , Resultado do Tratamento
8.
Otolaryngol Head Neck Surg ; 161(5): 877-880, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31500503

RESUMO

OBJECTIVES: Primary ciliary dyskinesia (PCD) is a genetic disorder characterized by abnormal respiratory cilia ultrastructure and/or function causing defective mucociliary clearance. We investigated the extent and severity of rhinosinusitis in a large cohort of children with PCD and explored associations among risk factors, including genotype and sinus disease. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary academic children's hospital. SUBJECTS AND METHODS: A review was conducted with a patient registry at the PCD Foundation Center at our institution. Demographic, imaging, clinical, and operative data were reviewed through the institutional electronic health record system. RESULTS: Fifty-four subjects were identified with mean and median age at diagnosis of 5.2 and 4.0 years. The male:female ratio was 35%:65%. Sinus symptoms were present in 46 (85%) subjects, 22 of whom had chronic rhinosinusitis. Nineteen (35%) subjects underwent operative intervention, consisting of endoscopic sinus surgery (ESS; 16 patients) and maxillary lavage (3 patients). Nineteen subjects underwent adenoidectomy for PCD-related indications. Five sinus-related admissions in 3 subjects were noted during the study period, and no complication of rhinosinusitis occurred in the cohort. Genetic test results were available in 27 subjects, in whom 23 (85%) had biallelic mutations in a PCD gene. Demographic factors, Lund-Mackay score, and PCD genotype were not found to be predictors for ESS or hospitalization in our cohort. CONCLUSION: While rhinosinusitis was common in our PCD cohort, most patients did not require ESS. Since complications of rhinosinusitis were uncommon, we recommend judicious surgical management tailored to the patient's symptoms.


Assuntos
Transtornos da Motilidade Ciliar/complicações , Rinite/epidemiologia , Sinusite/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Transtornos da Motilidade Ciliar/diagnóstico , Transtornos da Motilidade Ciliar/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Rinite/diagnóstico , Rinite/cirurgia , Fatores de Risco , Índice de Gravidade de Doença , Sinusite/diagnóstico , Sinusite/cirurgia
9.
Cir Cir ; 87(S1): 77-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501634

RESUMO

We report an unusual case of a 53-year-old male with fistula, ectropion and lagophthalmos due to lateral frontal rhinosinusitis. Two years ago, he presented soft erythematous swelling at internal epicanthus. A year and a half before, he presented upper eyelid fistula secretion drainage, cicatricial ectropion and lagophthalmos. No otorhinolaryngological or visual discomfort was reported. Ophthalmology performed ectropion surgical repair using skin grafting, with no improvement. They requested magnetic resonance imaging which showed a suggestive image of frontal lateral sinusitis, being transferred to the Otorhinolaryngology service. External and endoscopic nasal surgery was performed, which resolved the sinus pathology with good evolution.


Assuntos
Ectrópio/etiologia , Endoscopia/métodos , Doenças Palpebrais/etiologia , Fístula/etiologia , Sinusite Frontal/complicações , Rinite/complicações , Ectrópio/cirurgia , Doenças Palpebrais/cirurgia , Fístula/cirurgia , Sinusite Frontal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Rinite/cirurgia
10.
J Pak Med Assoc ; 69(Suppl 2)(6): S10-S19, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31369529

RESUMO

Objective: Chronic rhinosinusitis (CRS) is a popular and tiring disease with significant impacts on the economy and on the Health-related Quality of Life (HRQOL) of patients. This study aims to estimate the cost of illness (COI) and to assess the Health-related Quality of Life (HRQOL) in patients with CRS who underwent surgery in Vietnam and to analyse the relationship between socio-demographic characteristics and the COI as well as the HRQOL. Methods: A cross-sectional study was conducted in Ear, Nose, Throat Hospital in Ho Chi Minh City (ENT Hospital HCMC), Vietnam between August and October 2018. The direct medical and non-medical costs, the indirect costs (productivity loss), and the HRQOL of patients with CRS were measured. A subjective assessment of quality of life (QOL) using EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) was used to evaluate the health status of these patients after surgery. Characteristics related with the COI and the HRQOL were identified by multiple regression. Results: A total of 264 inpatients with CRS participated in the study. The mean COI for inpatients with CRS was $812.83 and direct costs accounted for a major proportion (89.32%) of the total cost. In addition, the surgery represented the most significant direct medical cost with 58.57% of the total cost. Most of the patients reported no problems with mobility (89.1%), self-care (93.9%), usual activities (77.2%), and anxiety/depression (64.0%). The mean EQ-5D-5L utility score was 0.76 (SD = 0.17), and the mean Visual Analogue Scale (EQ-VAS) score was 76.57 (SD = 13.34). The results of multiple regression showed that gender, occupations, monthly income, prior surgery and family history of CRS affected the total cost while the HRQOL of patients were related to education, smoking behaviour, exercise behaviour and family history of CRS. Conclusions: This study showed that although endoscopic sinus surgery (ESS) accounted for the largest expense in the COI, this surgical treatment helped to improve the HRQOL in patients with CRS. The findings provided a reference for policy makers in CRS management as well as for adjustment of costs for patients so as to reduce disease burden and to enhance their QOL.


Assuntos
Efeitos Psicossociais da Doença , Procedimentos Cirúrgicos Otorrinolaringológicos/economia , Qualidade de Vida , Rinite/economia , Sinusite/economia , Adolescente , Adulto , Idoso , Doença Crônica , Estudos Transversais , Escolaridade , Endoscopia , Exercício Físico , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Ocupações , Rinite/fisiopatologia , Rinite/cirurgia , Fatores Sexuais , Sinusite/fisiopatologia , Sinusite/cirurgia , Fumar , Vietnã , Adulto Jovem
11.
Braz J Otorhinolaryngol ; 85(6): 780-787, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31400958

RESUMO

INTRODUCTION: Chronic rhinosinusitis can lead to poor sleep quality in affected individuals. Endoscopic nasal surgery has been indicated for patients with chronic rhinosinusitis, resulting in improved quality of life, but it is still unknown if there is a similar improvement in sleep quality after the surgical procedure. OBJECTIVE: To estimate the sleep quality of patients with chronic rhinosinusitis after undergoing endoscopic sinus surgery. METHODS: The literature search was conducted in the indexed databases PubMed, Embase, Lilacs, SciELO, Google Scholar, Web of Science, Scopus, Database of Thesis and Dissertations of CAPES, Cochrane Library, Clinical Trials and in the grey literature. It included studies that reported the sleep quality of patients with chronic rhinosinusitis after undergoing endoscopic sinus surgery based on questionnaires assessing quality of life. Two researchers independently conducted the study selection and extraction. The random effects model was chosen to conduct the meta-analysis that was performed using the statistical package STATA, version 11. RESULTS: Overall, 4 studies and 509 subjects were included in the systematic review. Improved sleep quality was observed in 90% of the patients. There was an improvement (on average, from 57% to 67%) in each of the five symptoms related to sleep quality. The results of the meta-analysis revealed high heterogeneity. CONCLUSIONS: This review shows that a large percentage of patients report improved sleep quality after endoscopic sinus surgery.


Assuntos
Endoscopia/métodos , Rinite/cirurgia , Sinusite/cirurgia , Sono/fisiologia , Doença Crônica , Humanos , Pólipos Nasais/cirurgia , Procedimentos Cirúrgicos Nasais , Qualidade de Vida , Inquéritos e Questionários
12.
Eur Arch Otorhinolaryngol ; 276(11): 3095-3104, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31363901

RESUMO

PURPOSE: Intense bleeding of the surgical field is a potential factor influencing success of functional endoscopic sinus surgery (FESS). Hypotensive anesthesia with α2 intravenous agonists reduces intraoperative bleeding, but which is the best agent is unknown. The main objective of this trial was to compare the current standard adjuvant drug for hypotensive anesthesia, clonidine, with the recently available alternative dexmedetomidine. METHODS: A randomized clinical trial compared the efficacy of clonidine and dexmedetomidine during FESS. Treatment was open label for the anesthesiologist and operating surgeon, but blind for an external evaluator who evaluated video-recorded surgeries. A Boezaart scale was assessed every 30 min during FESS until surgery completion. Main end-point was the proportion of patients with mean Boezaart scores > 2 (heavy bleeding) by external blinded evaluator. Secondary end-points included other bleeding parameters, surgery duration, hemodynamic measures and surgical complications. RESULTS: 94 patients were randomized. There were no significant differences in the proportion of patients with mean Boezaart scores > 2 in clonidine (42.6%) and dexmedetomidine (42.6%). Consistently, no differences were observed in secondary variables of bleeding, duration or complications. Small differences in mean heart rate were observed that might reflect different pharmacological profiles of the products, but are of uncertain clinical relevance. CONCLUSIONS: No significant differences were observed between clonidine and dexmedetomidine when used as anesthetic adjuvants in the reduction of surgical bleeding in FESS. A longer experience with clonidine and its lower costs suggest it may be a preferable option as an adjuvant for hypotensive anesthesia.


Assuntos
Anestesia/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Clonidina , Dexmedetomidina , Endoscopia , Seios Paranasais/cirurgia , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/efeitos adversos , Doença Crônica , Clonidina/administração & dosagem , Clonidina/efeitos adversos , Dexmedetomidina/administração & dosagem , Dexmedetomidina/efeitos adversos , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/cirurgia , Duração da Cirurgia , Rinite/cirurgia , Sinusite/cirurgia , Resultado do Tratamento
13.
Acta Otolaryngol ; 139(10): 881-889, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31438745

RESUMO

Background: Olfactory dysfunction in eosinophilic chronic rhinosinusitis (ECRS) is poorly understood. Objective: To compare olfactory mucosal injury due to eosinophil infiltration in ECRS with postoperative olfactory function. Methods: Seventeen ECRS patients (ECRS group) and 18 bilateral rhinosinusitis (non-ECRS group) patients were compared. At 3 and 12 months post-endoscopic sinus surgery (ESS), all patients were evaluated for subjective symptoms (nasal obstruction, nasal discharge and olfactory dysfunction), endoscopic nasal findings, CT score and T&T olfactometer recognition threshold test. The eosinophil count, OMP-positive cells and epithelial erosion in olfactory mucosa collected during ESS were compared with the postoperative olfactory function. Results: The non-ECRS group showed significant improvement in all clinical findings at 3 and 12 months, but the ECRS group showed worsening of the olfactory dysfunction symptoms and T&T olfactometer recognition threshold at 12 months because of recurrence of sinusitis. The groups differed significantly in the ΔT&T value (i.e. pre-ESS T&T recognition threshold - post-ESS T&T recognition threshold) at both 3 and 12 months, and the degree of olfactory improvement differed. Histologically, the ECRS group showed significantly more eosinophils, fewer OMP-positive cells and greater epithelial erosion than the non-ECRS group. Conclusions: Eosinophilic inflammation was thought to cause olfactory mucosal injury/dysfunction.


Assuntos
Endoscopia , Eosinofilia/complicações , Transtornos do Olfato/etiologia , Transtornos do Olfato/patologia , Rinite/cirurgia , Sinusite/cirurgia , Adolescente , Adulto , Doença Crônica , Eosinofilia/patologia , Feminino , Humanos , Masculino , Mucosa Olfatória/patologia , Estudos Retrospectivos , Rinite/complicações , Rinite/patologia , Sinusite/complicações , Sinusite/patologia , Resultado do Tratamento , Adulto Jovem
14.
Artigo em Chinês | MEDLINE | ID: mdl-31446723

RESUMO

Objective:The aim of this study is to investigate the clinical control status and quality of life of patients with chronic sinusitis and asthma after endoscopic surgery. Method:A prospective study of 36 patients with chronic rhinosinusitis and asthma who had endoscopic surgery. All patients underwent standardized drug therapy before operation. After evaluation by the respiratory and anesthesiologists, they were admitted to the hospital for endoscopic surgery. The patients were closely monitored during the operation, and the patients were observed and recorded. Self-control was performed to compare the observational indexes of the patients for half a year and one year after surgery. Result:①The Asthma Control Scale (ACT) score showed that the proportion of complete control of asthma increased from 8.33% before surgery to 30.56% in the first half of the year and 27.78% in 1 year, which was significantly improved (P<0.05). ②Asthma Quality of Life Questionnaire(AQLQ) showedthatthe indicators of postoperative quality except the response to the stimulus, limited activity, asthma symptoms, psychological status and concern for their own health are all have statistically significant (P<0.05). ③In the first half of the year, there were 47.22%, in 1 year, 41.67% of the patients had improved asthma medication. There was no difference between the two groups (P>0.05). ④The exhaled nitric oxide index was decreased in the first half of the year and in the first year after operation. ⑤There was no significant change in lung function indexes before and after operation (P>0.05). Conclusion:In patients with chronic sinusitis and asthma, under the comprehensive treatment of endoscopic surgery, improving the quality of life of patients can also improve the control of asthma symptoms and medication, control the development of asthma, and have a positive effect on clinical efficacy.


Assuntos
Asma/cirurgia , Endoscopia , Qualidade de Vida , Rinite/cirurgia , Sinusite/cirurgia , Doença Crônica , Humanos , Estudos Prospectivos
15.
Acta Otolaryngol ; 139(10): 876-880, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31460819

RESUMO

Background: Rhinosinusitis may cause serious complications, such as secondary orbital infections, resulting in expansion and erosion of process through the orbital wall. Aims: The aim is to evaluate long-term outcome of ESS in patients suffered from endocrine ophthalmopathy and orbital complications of rhinosinusitis. Material and methods: Thirteen patients with loss of vision, endocrine ophthalmopathy and orbital complication of rhinosinusitis were treated by ESS. Preoperative and postoperative vision was rated by best-corrected visual acuity (BCVA) testing. Nine (69%) have been reinvestigated after 6 years by ophthalmology examination and 10-point scale for assessment of clinical symptoms. Results: The mean BCVA significantly increased after surgery comparing to results before surgery (0.84, 0.62; respectively) (p = .007). The mean values of 10-point scale for subjective assessment of symptoms 6 years after surgery were: headache 2.11, sinonasal pressure 1.72, subjective estimation of vision quality on the affected eye was 7.33 and olfaction 7.66. None of the patients developed impairment of vision loss in postoperative period. Conclusions: Long-term outcome of ESS showed decreased symptoms in patients who had endocrine ophthalmopathy and orbital complication of rhinosinusitis. Significance: ESS has numerous advantages for patients with orbital complication and vision loss comparing to conservative treatment and should be considered even in abscess absence.


Assuntos
Endoscopia , Rinite/complicações , Rinite/cirurgia , Sinusite/complicações , Sinusite/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Oftalmopatia de Graves/etiologia , Oftalmopatia de Graves/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/etiologia , Doenças Orbitárias/cirurgia , Estudos Retrospectivos , Avaliação de Sintomas , Resultado do Tratamento
16.
Ann Otol Rhinol Laryngol ; 128(12): 1129-1133, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31315428

RESUMO

OBJECTIVES: Functional endoscopic sinus surgery (FESS) is a standard treatment modality for patients with chronic rhinosinusitis (CRS) who have failed appropriate medical therapy. However, FESS entails modification of the upper airway tract that may alter phonatory resonance and produce voice changes. The effects of FESS on postoperative voice characteristics in patients with CRS have yet to be quantitatively assessed. METHODS: Patients with severe CRS who underwent FESS at a tertiary care referral center between May and October 2017 were prospectively enrolled. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the Voice Handicap Index (VHI) were used to quantitatively evaluate voice characteristics and quality of life, respectively. Preoperative and postoperative CAPE-V and VHI scores were compared with postoperative scores for each patient. Sino-Nasal Outcome Test (SNOT-22) scores were also obtained to assess changes in patient symptoms. RESULTS: 18 CRS patients undergoing FESS were enrolled. The average preoperative Lund-Mackay score was 14, indicating baseline severe CRS. Postoperative assessments demonstrated a statistically significant decrease in CAPE-V (45-27, p = .005) and VHI (10-4.7, p < .001) scores. These correlated with a statistically significant decrease in SNOT-22 scores (42-13, p < .001). CONCLUSIONS: Patients with CRS experience a significant improvement in voice characteristics and vocal quality of life following FESS. Furthermore, this appears to correlate with a significant decrease in self-reported disease severity. These findings may augment the discussion of potential benefits of FESS to a new potential domain for voice quality.


Assuntos
Endoscopia , Rinite/cirurgia , Sinusite/cirurgia , Qualidade da Voz , Adulto , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Rinite/complicações , Autorrelato , Sinusite/complicações , Resultado do Tratamento
17.
Otolaryngol Clin North Am ; 52(5): 875-890, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31353137

RESUMO

Although there have been many advances in new tools and procedures for endonasal sinus surgery in children, the management and care for pediatric chronic rhinosinusitis has remained relatively unchanged. However, there have been advances in skull base surgery and tumor removal and new knowledge about perioperative concerns in children. This article discusses the role and risks of endoscopic sinus surgery, the use of balloon sinuplasty in children, management of complicated rhinosinusitis, and advances in skull base tumors and choanal atresia repair.


Assuntos
Procedimentos Cirúrgicos Nasais/tendências , Seios Paranasais/cirurgia , Rinite/cirurgia , Sinusite/cirurgia , Cateterismo/métodos , Criança , Atresia das Cóanas/cirurgia , Doença Crônica , Endoscopia/métodos , Humanos , Neoplasias da Base do Crânio/cirurgia , Tomografia Computadorizada por Raios X
18.
Otolaryngol Head Neck Surg ; 161(4): 683-687, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31184274

RESUMO

OBJECTIVE: Balloon sinuplasty (BS) is a surgical management option in the treatment of chronic rhinosinusitis. The purpose of this study was to examine BS utilization among children with a national database. STUDY DESIGN: Retrospective review. SETTING: National pediatric database. SUBJECTS AND METHODS: All cases of children aged ≤18 years who underwent BS or traditional endoscopic sinus surgery (ESS) 5 years before and after the introduction of BS billing codes were studied with the Pediatric Health Information System database. We evaluated overall trends, demographics, performing physicians, readmissions, and cost data. RESULTS: A total of 14,079 patients met inclusion criteria: 13,555 underwent traditional ESS and 524 had a BS procedure. There was no significant increase in BS rates between 2011 and 2016. BS was more commonly performed among younger children than ESS (median age [interquartile range], 6 years [4-10] vs 9 years [6-13]; P < .001). There were 23 (4.4%) readmissions within 30 days in the balloon cohort versus 474 (3.5%) in the ESS cohort. The median cost of balloon maxillary antrostomy (US $6560 [$5420-$8250]) was higher than that of traditional maxillary antrostomy (US $5630 [$4130-$7700], P < .001). Physicians who performed BS had a larger volume of ESS procedures when compared with those who did not perform BS. CONCLUSION: Rates of BS performance in the pediatric population have not increased over time. Results showed no difference in readmission rates between BS and ESS. BS was associated with higher costs as compared with ESS. The role of BS in the pediatric chronic rhinosinusitis population remains unclear.


Assuntos
Cateterismo/estatística & dados numéricos , Endoscopia/estatística & dados numéricos , Cirurgia Endoscópica por Orifício Natural/estatística & dados numéricos , Rinite/cirurgia , Sinusite/cirurgia , Adolescente , Cateterismo/métodos , Criança , Pré-Escolar , Doença Crônica , Bases de Dados Factuais , Dilatação/métodos , Dilatação/estatística & dados numéricos , Endoscopia/métodos , Feminino , Humanos , Masculino , Seios Paranasais/cirurgia , Estudos Retrospectivos , Estados Unidos
19.
Eur Arch Otorhinolaryngol ; 276(7): 1995-1999, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31161361

RESUMO

BACKGROUND: Bleeding during functional endoscopic sinus surgery always been a challenge for the quality of surgical field for surgeons. This study aimed to evaluate the effect of local nasal desmopressin premedication on blood loss and the quality of surgical field in functional endoscopic sinus surgery. METHODS: This study was conducted on 90 patients with chronic rhinosinusitis who were candidate for endoscopic sinus surgery. They were randomly assigned to two study groups. One group received a single puff of local desmopressin (10 µg) in each side of nasal cavity 30 min before the surgery and the other received normal saline instead. Blood loss and the quality surgical field were determined in 15, 30, 60 and 90 min during the surgery (scoring by BOEZAART grading system). All data were analyzed. RESULTS: Blood loss was significantly lesser in the desmopressin group (mean ± SD, 16.289 ± 5.605 ml) than in the control group (24.289 ± 5.2722 ml, P < 0.001).Surgeons were more satisfied with the surgical field in the desmopressin group than control group in all cutoff points (15, 30, 60, and 90 min during the surgery, P < 0.001). No side effects were observed using local desmopressin. CONCLUSIONS: Premedication with local desmopressin can reduce bleeding effectively and clear the surgical field during functional endoscopic sinus surgery.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Desamino Arginina Vasopressina/administração & dosagem , Endoscopia , Rinite/cirurgia , Sinusite/cirurgia , Adulto , Doença Crônica , Monitoramento de Medicamentos/métodos , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Hemostáticos/administração & dosagem , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Pessoa de Meia-Idade , Pré-Medicação/métodos , Resultado do Tratamento
20.
J Laryngol Otol ; 133(8): 678-684, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31218991

RESUMO

OBJECTIVE: This study aimed to determine the predictors of disease progression after functional endoscopic sinus surgery in patients with chronic rhinosinusitis. METHOD: A total of 281 adult chronic rhinosinusitis patients who underwent primary bilateral functional endoscopic sinus surgery between 2007 and 2017 and had at least 12 months of follow-up endoscopic evaluation were examined. Patients were divided into eosinophilic (n = 205) and non-eosinophilic chronic rhinosinusitis groups (n = 76). In order to determine adverse factors, post-operative endoscopic appearance scores were analysed in relation to the pre- and intra-operative findings using multiple regression analyses. RESULTS: The post-operative course of eosinophilic cases deteriorated over time, like the early period for non-eosinophilic cases. Frontal sinus polyps recurred early in eosinophilic chronic rhinosinusitis. Multivariate analyses indicated young adulthood, asthma, high computed tomography score and frontal sinus polyps as significant adverse predictors. CONCLUSION: Early, appropriate estimation of sinonasal conditions appears to be crucial for successful surgical management of chronic rhinosinusitis.


Assuntos
Eosinófilos/metabolismo , Seio Frontal/patologia , Rinite/cirurgia , Sinusite/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Rinite/sangue , Rinite/diagnóstico , Fatores de Risco , Sinusite/sangue , Sinusite/diagnóstico , Adulto Jovem
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