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1.
Clin Interv Aging ; 17: 685-698, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35535364

RESUMO

The proportion of the population over 65 years old continues to grow. Chronic rhinosinusitis is common in this population and causes a reduction in quality of life and an increase in health care utilization. Diagnosis of chronic rhinosinusitis with nasal polyps follows the same principles for elderly patients as in the general population, but the elderly population presents some diagnostic challenges worth considering. Presbynasalis, the anatomic and functional changes of the nose and paranasal sinuses associated with aging must be accounted for when caring for these patients. In addition, polypharmacy and other medical issues that can cause similar symptoms must be considered. Medical therapy is generally similar to the general population but with additional concerns given the propensity for geriatric patients to be on multiple medications and to suffer from multiple medical issues. Sinus surgery should be considered following the same indications as in the general population. While some authors have found higher complication rates in endoscopic sinus surgery, others have found higher rates of success. As always, the risks of surgery must be considered with the possible benefits on a patient-to-patient basis.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Idoso , Doença Crônica , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Qualidade de Vida , Rinite/terapia , Sinusite/complicações , Sinusite/terapia
2.
Pediatr Clin North Am ; 69(2): 275-286, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35337539

RESUMO

Rhinosinusitis is a common diagnosis encountered by providers of all disciplines. Pediatric acute and chronic rhinosinusitis account for up to 2% of the total annual visits to the outpatient clinics and emergency departments. Once correct diagnosis is made, appropriate treatment measures can be initiated. It is important to recognize rhinosinusitis in children due to the potential serious complications and the impact it may have on quality of life of those children. Medical management is the mainstay of treatment, and, fortunately, it is successful in most of those children. When medical management fails, or a complication occurs, surgery may be required.


Assuntos
Rinite , Sinusite , Criança , Doença Crônica , Endoscopia , Humanos , Qualidade de Vida , Rinite/complicações , Rinite/diagnóstico , Rinite/terapia , Sinusite/complicações , Sinusite/diagnóstico , Sinusite/terapia
4.
Int J Pediatr Otorhinolaryngol ; 155: 111065, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35183919

RESUMO

OBJECTIVES: Invasive fungal rhinosinusitis (IFRS) is a potentially fatal disease that affects the severely immunocompromised and requires aggressive treatment. The objective of this study is to better describe predictors of biopsy positivity in patients at high risk of IFRS at a pediatric hospital. METHODS: This was a single-center case-control study of 36 patients (37 total biopsies) ≤ 21 years old with one of five high-risk oncologic/hematologic diagnoses who underwent operative endoscopy for clinical suspicion for IFRS. IFRS positivity was defined histologically. Collected information included patient demographics, primary diagnosis, oncologic relapses, time from diagnosis to biopsy, clinical characteristics, and endoscopic findings. These data were used to create a simple predictive scoring system. RESULTS: 17 patients had biopsy-proven IFRS (IFRS(+)) for an overall incidence of 2.1% in the designated high-risk population. Average time from most recent oncologic development (diagnosis, relapse, or hematopoietic stem-cell transplant) to biopsy in the IFRS(+) group was 2.09 months (SD = 2.26), and 7.28 months in the IFRS(-) group (SD = 9.17) (p = 0.009). Clinical characteristics did not differentiate between IFRS(+) and IFRS(-). Bedside endoscopy performed poorly, as it was interpreted as normal in 42.8% of IFRS(+) and 53.8% of IFRS(-). In contrast, the presence of any positive endoscopic finding intra-operatively was highly specific for IFRS(+) (94%) with moderate sensitivity (70%), and the difference in rate of positivity between groups was statistically significant (p < 0.001). CONCLUSION: Operative endoscopy with biopsy remains the gold-standard to rule-out IFRS in the setting of high clinical suspicion. Time elapsed from most recent oncologic development to clinical concern for IFRS may influence the likelihood of disease, though this requires further study. Clinical symptoms and bedside endoscopy were not predictive and should be used with caution in decision-making.


Assuntos
Rinite , Sinusite , Adulto , Estudos de Casos e Controles , Criança , Fungos , Hospitais Pediátricos , Humanos , Rinite/terapia , Sinusite/microbiologia , Adulto Jovem
6.
HNO ; 70(1): 79-86, 2022 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-34994808

RESUMO

Chronic rhinosinusitis with (CRwNP) or without (CRsNP) nasal polyps can have a great impact on quality of life. Typical symptoms include nasal obstruction, olfactory dysfunction, nasal discharge, and facial pain or pressure. Diagnostic gold standard is nasal endoscopy followed by CT scan of the paranasal sinuses. Besides first-line treatment with topical or systemically applied glucocorticoids, nasal rinsing, and surgical therapy, monoclonal antibodies have been approved in Germany since 2019.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Doença Crônica , Endoscopia , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/diagnóstico , Pólipos Nasais/terapia , Qualidade de Vida , Rinite/diagnóstico , Rinite/terapia , Sinusite/diagnóstico , Sinusite/terapia
7.
J Allergy Clin Immunol ; 149(3): 854-866, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34973298

RESUMO

Major progress has been achieved in the understanding and clinical practice of chronic rhinosinusitis, with or without nasal polyps. These advances resulted in a better understanding of the pathophysiology, the distribution into subgroups, and consequently in a better management perspective using classical approaches and biologics. Pathomechanisms, endotypes and biomarkers, and finally innovative therapeutic approaches are themes especially for the more severe forms of chronic rhinosinusitis, those with uncontrolled severe nasal polyps. Biologicals against key type 2 cytokines are gaining ground in the long-term treatment approaches of often recurrent nasal polyps, and should be integrated in care pathways making use of classical and innovative treatment pathways. These areas of interest show a fast development and will profoundly change our disease management within a decade.


Assuntos
Produtos Biológicos , Pólipos Nasais , Rinite , Sinusite , Biomarcadores , Doença Crônica , Humanos , Pólipos Nasais/terapia , Rinite/terapia , Sinusite/terapia
8.
J Allergy Clin Immunol Pract ; 10(2): 478-484.e3, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34597850

RESUMO

BACKGROUND: There are no head-to-head studies for patients with aspirin-exacerbated respiratory disease (AERD) comparing any of the 5 Food and Drug Administration-approved respiratory biologic therapies. OBJECTIVE: Explore outcomes in subjects with AERD using biologic therapies in a real-world clinic setting. METHODS: A retrospective pilot study was conducted for subjects with AERD who had been prescribed omalizumab (anti-IgE), mepolizumab (anti-IL-5), reslizumab (anti-IL-5), benralizumab (anti-IL-5 receptor alpha [anti-IL-5Rα]), or dupilumab (anti-IL-4 receptor alpha [anti-IL-4Rα]). Clinical outcomes pre- versus postinitiation of biologic therapy were explored including symptoms, 22-item sino-nasal outcome test scores, systemic corticosteroid and antibiotic prescriptions, and emergency room visits related to AERD. RESULTS: Of the 74 subjects, 58.1% (n = 43) had used 1 biologic, though many (41.9%, n = 31) trialed more than 1 biologic. Of the 50 subjects who had used anti-IL-4Rα therapy, 98% (49 of 50) still had this therapy prescribed at study completion compared with 48.6% (17 of 35) and 26.9% (7 of 26) of those who used anti-IgE and anti-IL-5 and anti-IL-5 receptor alpha (anti-IL-5/IL-5Rα) therapy, respectively. Among those on anti-IL-4Rα therapy, there was a significant reduction in median total 22-item sino-nasal outcome test scores (51 to 19, P = .0002), corticosteroid bursts (2 to 0, P < .0001), and median number of antibiotic courses for respiratory disease (1 to 0, P = .0469) prebiologic versus postbiologic initiation. No statistically significant difference in those outcomes was observed for individuals on anti-IgE or anti-IL-5/IL-5Rα therapy. CONCLUSIONS: Anti-IL-4Rα therapy led to significantly higher rates of clinical improvement in AERD when compared with anti-IL-5/IL-5Rα and anti-IgE biologic therapies. Prospective studies would help clarify best practices for the use of biologic therapies in AERD.


Assuntos
Asma Induzida por Aspirina , Pólipos Nasais , Rinite , Aspirina/uso terapêutico , Asma Induzida por Aspirina/terapia , Terapia Biológica , Doença Crônica , Humanos , Pólipos Nasais/tratamento farmacológico , Projetos Piloto , Estudos Prospectivos , Estudos Retrospectivos , Rinite/terapia
9.
Int Arch Allergy Immunol ; 183(2): 186-200, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34673641

RESUMO

BACKGROUND: Specific drugs and/or immunotherapies are widely used to treat allergies, but drug-induced adverse effects recently led to explore new additional strategies. We studied whether a probiotic preparation (iPROB®; Anallergo SpA, Florence, Italy) is effective in allergic patients and the mechanisms underlying clinical outcomes. METHODS: Eligible patients (n = 28), all suffering from allergic rhinitis with/without bronchial asthma, were consecutively recruited at the Allergology Medical Unit (Novara, Italy) and treated with this probiotic. From each patient, we collected blood and stool samples at the baseline, after 60 days of probiotic supplementation, and after 60 days from probiotic discontinuation. In each blood sample, the percentage of hematopoietic stem cells, eosinophils, and basophils was measured by FACS. To analyze stool microbiota composition, genomic DNA was extracted, bacterial 16S DNA libraries sequenced by Illumina platform (Miseq), and raw sequences processed. Generated data were statistically analyzed. RESULTS: Probiotic-treated patients showed a significant decrease in Average Rhinitis Total Symptom Score (d = -10.5714), and Visual Analog Scale (d = -2.00) clinical indices, as well as important improvements in quality of life. In whole blood, a significant reduction in the percentage of activated eosinophils and basophils was determined, and this effect persisted after specific cell stimulation. Consistently, the serum levels of IL-4 and IL-5 decreased after probiotic treatment, suggesting a reduction in the Th2 cytokine profile. In addition, microbiome genomic analysis (n = 6) showed an increase in microbiome biodiversity, which positively correlates with clinical and cellular data. CONCLUSION: Present study suggests that iPROB® preparation has clinical/biological properties to be a valid add-on supplementation in allergic patients with asthma and rhinitis.


Assuntos
Asma/diagnóstico , Asma/etiologia , Asma/terapia , Rinite/diagnóstico , Rinite/etiologia , Rinite/terapia , Adulto , Biomarcadores , Citocinas/metabolismo , Gerenciamento Clínico , Suscetibilidade a Doenças , Feminino , Humanos , Imunidade , Imunofenotipagem , Contagem de Leucócitos , Masculino , Metagenômica/métodos , Microbiota , Pessoa de Meia-Idade , Projetos Piloto , Probióticos/uso terapêutico , Prognóstico , Resultado do Tratamento , Adulto Jovem
10.
Otolaryngol Head Neck Surg ; 166(3): 565-571, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34126810

RESUMO

OBJECTIVE: The management of chronic rhinosinusitis (CRS) by a nonotolaryngologist prior to otolaryngology referral is an important component of the patient care pathway. The purpose of this study is to characterize CRS management during this period and to identify areas of quality improvement. STUDY DESIGN: Retrospective review of a national claims database. SETTING: Academic institution. METHODS: Data were analyzed from the IBM Health MarketScan Research Databases (2013-2017). Patients with 3-year enrollment data were identified who were initially diagnosed with CRS by a nonotolaryngologist and subsequently seen by an otolaryngologist. Management of CRS by the nonotolaryngologist was assessed in terms of duration, demographics, health care resource utilization, and health care expenditure. RESULTS: A total of 51,273 patients met inclusion criteria. The median length of the referral period was 142 days, with variations according to geography. Patients with a delayed referral period had higher health care resource utilization in terms of visits for CRS (mean, 1.8 vs 1.2), total visits (mean, 12.6 vs 3.9), and medication prescriptions (especially antibiotics; mean, 5.8 vs 2.1). Health care expenditure was almost twice as high for the delayed referral group (mean, $986 vs $571), mainly due to CRS-related medication costs (mean, $578 vs $214). CONCLUSION: Our findings suggest that there are wide variations in how CRS is managed prior to referral to an otolaryngologist. The dissemination of clinical practice guidelines to primary care providers may help to increase efficiency of CRS care and offers a unique opportunity for quality improvement that extends beyond the bounds of our own specialty.


Assuntos
Otolaringologia , Rinite , Sinusite , Doença Crônica , Humanos , Melhoria de Qualidade , Encaminhamento e Consulta , Rinite/diagnóstico , Rinite/terapia , Sinusite/diagnóstico , Sinusite/terapia
11.
Clin Rev Allergy Immunol ; 62(1): 90-102, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33496939

RESUMO

Eosinophils are often considered as the pathologic landmark of chronic rhinosinusitis with nasal polyps (CRSwNP). Many studies emphasize their pivotal role in mucosal remodeling by their innate action via cytotoxic proteins degranulation. Eosinophil nasal recruitment from the bloodstream through endothelium diapedeses requires the intricate action between the nasal epithelium, epithelial cell-activated type 2 innate lymphoid cells, and adaptive immune cells secreting alarmins, cytokines, and specific chemokines. This immune pathway refers to a T-helper 2 (T2)-driven lymphocyte response, often considered as the main inflammatory process in CRSwNP in western countries. The release of T2 cytokines, among which interleukin (IL)-4, IL-5, and IL-13, fundamentally contributes to this immune response. New biologic agents capable of blocking T2 cytokines have been developed in the field of eosinophil-associated diseases, shifting the paradigm of treatment for patients with CRSwNP. The first part of this review describes each step of the eosinophil journey from hematopoietic stem cell maturation to nasal mucosa homing. The different eosinophil activation processes and their inflammatory functions are also described. This is followed by a discussion on currently available biologic therapies in CRSwNP with a specific focus on eosinophilic response. Beyond an eosinophil-blocking strategy, a cluster analysis of specific T2 biomarkers could be required to best predict the response to such biologic therapies in the future.


Assuntos
Pólipos Nasais , Rinite , Terapia Biológica , Doença Crônica , Eosinófilos , Humanos , Imunidade Inata , Linfócitos , Mucosa Nasal , Pólipos Nasais/terapia , Rinite/complicações , Rinite/terapia
12.
Int Forum Allergy Rhinol ; 12(1): 51-61, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34355872

RESUMO

BACKGROUND: The purpose of this study was to test whether cryotherapy is superior to a sham procedure for reducing symptoms of chronic rhinitis. METHODS: This study was a prospective, multicenter, 1:1 randomized, sham-controlled, patient-blinded trial. The predetermined sample size was 61 participants per arm. Adults with moderate/severe symptoms of chronic rhinitis who were candidates for cryotherapy under local anesthesia were enrolled. Participants were required to have minimum reflective Total Nasal Symptom Scores (rTNSSs) of 4 for total, 2 for rhinorrhea, and 1 for nasal congestion. Follow-up visits occurred at 30 and 90 days postprocedure. Patient-reported outcome measures included the rTNSS, standardized Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ(S)], and Nasal Obstruction Symptom Evaluation (NOSE) questionnaires. Adverse events were also recorded. The primary endpoint was the comparison between the treatment and sham arms for the percentage of responders at 90 days. Responders were defined as participants with a 30% or greater reduction in rTNSS relative to baseline. RESULTS: Twelve US investigational centers enrolled 133 participants. The primary endpoint analysis included 127 participants (64 active, 63 sham) with 90-day results. The treatment arm was superior at the 90-day follow-up with 73.4% (47 of 64) responders compared with 36.5% (23 of 63) in the sham arm (p < 0.001). There were greater improvements in the rTNSS, RQLQ(S), and NOSE scores for the active arm over the sham arm at the 90-day follow-up (p < 0.001). One serious procedure-related adverse event of anxiety/panic attack was reported. CONCLUSION: Cryotherapy is superior to a sham procedure for improving chronic rhinitis symptoms and patient quality of life.


Assuntos
Rinite , Adulto , Crioterapia , Humanos , Estudos Prospectivos , Qualidade de Vida , Rinite/terapia , Resultado do Tratamento
13.
J Laryngol Otol ; 136(3): 229-236, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34465402

RESUMO

OBJECTIVE: This study aimed to compare the effectiveness of pharmacological therapy with and without direct maxillary sinus saline irrigation for the management of chronic rhinosinusitis without polyps. METHODS: In this prospective randomised controlled trial, 39 non-operated patients were randomly assigned to be treated with direct maxillary sinus saline irrigation in conjunction with systemic antibiotics and topical sprays (n = 24) or with pharmacological therapy alone (n = 15). Endoscopy, Sino-Nasal Outcome Test and Lund-MacKay computed tomography scores were obtained before, six weeks after and one to two years after treatment. RESULTS: Post-treatment Lund-Mackay computed tomography scores were significantly improved in both cohorts, with no inter-cohort difference identified. Post-treatment nasal endoscopy scores were significantly improved in the study group but were similar to those measured in the control group. The Sino-Nasal Outcome Test-20 results showed improvement in both cohorts, with no difference between treatment arms. CONCLUSION: Maxillary sinus puncture and irrigation with saline, combined with pharmacological treatment improves endoscopic findings in patients with chronic rhinosinusitis without polyps, but has no beneficial effect on symptoms and imaging findings over conservative treatment alone.


Assuntos
Antibacterianos/uso terapêutico , Seio Maxilar , Descongestionantes Nasais/uso terapêutico , Lavagem Nasal , Rinite/terapia , Sinusite/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sprays Nasais , Estudos Prospectivos , Solução Salina/uso terapêutico , Resultado do Tratamento , Adulto Jovem
14.
Allergy ; 77(3): 812-826, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34473358

RESUMO

Chronic rhinosinusitis (CRS) is a common clinical syndrome that produces significant morbidity and costs to our health system. The study of CRS has progressed from an era focused on phenotype to include endotype-based information. Phenotypic classification has identified clinical heterogeneity in CRS based on endoscopically observed features such as presence of nasal polyps, presence of comorbid or systemic diseases, and timing of disease onset. More recently, laboratory-based findings have established CRS endotype based upon specific mechanisms or molecular biomarkers. Understanding the basis of widespread heterogeneity in the manifestations of CRS is advanced by findings that the three main endotypes, Type 1, 2, and 3, orchestrate the expression of three distinct large sets of genes. The development and use of improved methods of endotyping disease in the clinic are ushering in an expansion of the use of biological therapies targeting Type 2 inflammation now and perhaps other inflammatory endotypes in the near future. The purpose of this review is to discuss the phenotypic and endotypic heterogeneity of CRS from the perspective of advancing the understanding of the pathogenesis and improvement of treatment approaches and outcomes.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Doença Crônica , Humanos , Inflamação , Pólipos Nasais/etiologia , Pólipos Nasais/terapia , Fenótipo , Rinite/etiologia , Rinite/terapia , Sinusite/etiologia , Sinusite/terapia
15.
Eur Arch Otorhinolaryngol ; 279(1): 1-24, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34296343

RESUMO

PURPOSE: Chronic rhinosinusitis (CRS) is observed in almost 100% of patients with cystic fibrosis (CF). CF-related CRS treatment is extremely challenging because of the underlying genetic defect leading to its development. CRS in CF is often refractory to standard therapy, while recurrences after surgical treatment are inevitable in the majority of patients. This study provides a precise review of the current knowledge regarding possible therapeutic options for CF-related CRS. METHODS: The Medline and Web of Science databases were searched without a time limit using the terms "cystic fibrosis" in conjunction with "otorhinolaryngological manifestation", "rhinology" and "sinusitis". RESULTS: Precise guidelines for CF-induced CRS therapy are lacking due to the lack of large cohort randomized controlled trials. None of the existing therapeutic agents has already been recommended for CRS in CF. Therapy targeting the underlying genetic defect, intranasal dornase alfa administration, and topical delivery of colistin and tobramycin showed promising results in CF-related CRS therapy. Besides the potential effectiveness of nasal steroids, strong recommendations for their usage in CF have not been provided yet. Systemic corticosteroid usage is controversial due to its potential negative influence on pulmonary disease. Ibuprofen revealed some positive effects on CF-related CRS in molecular and small cohort studies. Intranasal irrigation with saline solutions could relieve sinonasal symptoms. Nasal decongestants are not recommended. Endoscopic sinus surgery is the first-line surgical option for refractory CRS. Extensive surgical approaches should be considered as they could improve long-term outcomes in CRS. CONCLUSION: Further studies are warranted to establish consensus for CF-related CRS therapy.


Assuntos
Fibrose Cística , Rinite , Sinusite , Doença Crônica , Fibrose Cística/complicações , Fibrose Cística/terapia , Humanos , Descongestionantes Nasais/uso terapêutico , Rinite/tratamento farmacológico , Rinite/terapia , Sinusite/complicações , Sinusite/terapia
17.
Ugeskr Laeger ; 184(10)2022 03 07.
Artigo em Dinamarquês | MEDLINE | ID: mdl-35315753

RESUMO

Diseases of the upper and lower airways are commonly described as global airway disease, which shares basic inflammatory mechanisms, and airway comobidity is frequently found. The prevalence of chronic rhinosinusitis (CRS) is 5-12%, characterised as CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP). Inflammation in CRSwNP is often type 2, whereas CRSsNP often involves non-type 2. New monoclonal antibodies towards type-2 inflammation have been launched internationally to treat refractory severe CRSwNP, with effect on polyps, congestions and smell, as well as quality of life. This review gives a summary of the current treatment modalities.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Doença Crônica , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/diagnóstico , Pólipos Nasais/terapia , Qualidade de Vida , Rinite/complicações , Rinite/diagnóstico , Rinite/terapia , Sinusite/complicações , Sinusite/diagnóstico , Sinusite/terapia
18.
Am J Otolaryngol ; 43(1): 103264, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34653953

RESUMO

OBJECTIVES: To evaluate the efficacy of hypochlorous acid (HOCl) nasal spray as an adjuvant therapy after functional endoscopic sinus surgery (FESS). MATERIAL AND METHODS: Patients with chronic rhinosinusitis who had received FESS for treatment were recruited and assigned to one of two groups at random at one month post-surgery. In the HOCl group, patients received 0.02% HOCl nasal spray three times a day for two months. In the control group, normal saline (NS) nasal irrigation was given. Before FESS and before and after nasal spray or irrigation, patients completed the Taiwanese version of the 22-item Sino-Nasal Outcome Test (TWSNOT-22). In addition, patients received endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and bacterial cultures obtained from their middle meatus. RESULTS: Seventy-eight patients completed the study. Among them, 41 received HOCl nasal spray, and 37 received NS irrigation. Endoscopic score significantly decreased after 2-month HOCl nasal spray (p = 0.036). TWSNOT-22 score also decreased, although insignificantly (p = 0.285). In contrast, TWSNOT-22 score significantly decreased after NS nasal irrigation (p = 0.017), but endoscopic score did not significantly decrease (p = 0.142). CONCLUSIONS: Our results showed that HOCl nasal spray had a similar effect to that of NS nasal irrigation in post-FESS care. It can be an alternative of NS nasal irrigation for its convenient application.


Assuntos
Ácido Hipocloroso/administração & dosagem , Seios Paranasais/cirurgia , Cuidados Pós-Operatórios/métodos , Rinite/terapia , Sinusite/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Doença Crônica , Terapia Combinada , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lavagem Nasal/métodos , Sprays Nasais , Rinometria Acústica , Solução Salina , Resultado do Tratamento , Adulto Jovem
19.
Medicine (Baltimore) ; 100(44): e27675, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34871247

RESUMO

ABSTRACT: The study aims to evaluate previous management of CRSwNP patients in Universiti Kebangsaan Malaysia Medical Center (UKMMC) against a developed CP.Chronic rhinosinusitis with nasal polyposis (CRSwNP) has high economic burden and impacts patient's quality of life. Implementation of clinical pathway (CP) can standardize care while optimizing resources.Analytical cross-sectionalThis study utilized medical records of 103 CRSwNP patients at UKMMC otorhinolaryngology clinic from 2010 to 2015. Patients were divided into groups who underwent or did not undergo surgery. Information was obtained regarding sociodemographic, follow-ups, pharmaceutical regimes, and treatment cost. Cost analysis was done using top-down analysis and activity-based costing and CP was formulated. Cost was calculated using year 2020 rates to adjust for inflation. (United States Dollars [USD]1 = Ringgit Malaysia [RM] 4.2015)Study showed non-CP patients were undertreated compared to CP. This affects clinical outcomes as optimal treatment demanded by CP was not achieved. Total cost for non-CP, non-surgery patients were lower (USD660) compared to CP (USD780) due to under treatment and shorter follow-ups. Meanwhile, total cost for non-CP surgery patients were higher (USD3600) compared to CP (USD2706) due to longer visit durations and hospital stays. Non-CP surgery group underwent lengthy follow-up duration (20.7 months) prior to operation compared to 12 months expected in CP.Study showed non-CP patients were undertreated compared to CP. We identified aspects which resulted in resource wastage and unnecessary burden to our healthcare system. This study enables development of a written CP by fine-tuning various aspects of CP which could be applied to our future practice.


Assuntos
Efeitos Psicossociais da Doença , Pólipos Nasais/terapia , Rinite/terapia , Sinusite/terapia , Adulto , Idoso , Doença Crônica , Procedimentos Clínicos , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Pólipos Nasais/epidemiologia , Qualidade de Vida , Rinite/epidemiologia , Perfil de Impacto da Doença , Sinusite/epidemiologia
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