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1.
Am J Otolaryngol ; 43(4): 103476, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35567836

RESUMO

BACKGROUND: Preoperative corticosteroids have been shown to improve surgical visibility and intraoperative blood loss for chronic rhinosinusitis with nasal polyposis (CRSwNP) patients undergoing endoscopic sinus surgery (ESS). However, there is no consensus on the optimal dosing regimen. METHODS: A randomized, controlled trial was conducted to compare low, medium, and high dose corticosteroids prior to ESS. Patients with CRSwNP refractory to medical management were randomized to low (N = 8), medium (N = 10), or high (N = 5) dosing regimens of corticosteroids prior to ESS. Baseline disease severity was measured with the 22-item Sino-nasal Outcome Test and Lund-Mackay scores. Modified Lund-Kennedy endoscopic scores (MLKES) were measured at baseline and after corticosteroid treatment. Intraoperative parameters were measured including Boezaart surgical visibility score, intraoperative blood loss, and operative time. RESULTS: Medium dose corticosteroids demonstrated a superior surgical visibility score to low dose and comparable results to high dose, but these results were not significant (p = 0.33). No significant difference was observed between groups for total blood loss (p = 0.15), operative time (p = 0.87), or change in MLKES (p = 0.27). CONCLUSIONS: Current recommendations include the use of preoperative corticosteroids in patients with CRSwNP undergoing ESS, but there is no consensus on dose or duration. We did not find a statistically significant difference in surgical field visibility, intraoperative blood loss, or operative time between different dosing regimens. Further studies are needed to evaluate the efficacy of a low-dose preoperative regimen with the goal of reducing cumulative patient exposure to systemic corticosteroids.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Corticosteroides/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Doença Crônica , Endoscopia/métodos , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/tratamento farmacológico , Pólipos Nasais/cirurgia , Rinite/complicações , Rinite/tratamento farmacológico , Rinite/cirurgia , Sinusite/complicações , Sinusite/tratamento farmacológico , Sinusite/cirurgia , Resultado do Tratamento
2.
Eur Rev Med Pharmacol Sci ; 26(9): 3320-3324, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35587084

RESUMO

OBJECTIVE: Chronic rhinosinusitis (CRS) presents a multifactorial etiology due to interactions between the immune host system and external agents. It can be classified into two phenotypes based on the presence or absence of polypoid neoformation (respectively CRSwNP and CRSsNP). According to EPOS2020, CRS is now classified into two endotypes, eosinophilic (ECRS) and non-eosinophilic (non-ECRS), based on eosinophil tissue count (more than 10 eosinophils per High Power Field, HPF). CASE PRESENTATION: We present the case of a 31-year-old man affected by recalcitrant ECRSwNP and asthma. RESULTS: He was treated with a combination of omalizumab and endoscopic sinus surgery. This combination led to a reduction in blood eosinophils, modified Lund-Kennedy endoscopic score, Lund-Mackay score, and Sino-Nasal Outcome Test (SNOT-22), almost 6 months after surgery. CONCLUSIONS: In this clinical case, omalizumab regulated nasal symptoms for more than a year and with good control of the recalcitrant pattern when combined with ESS.


Assuntos
Asma , Pólipos Nasais , Rinite , Sinusite , Asma/complicações , Asma/tratamento farmacológico , Doença Crônica , Eosinófilos , Humanos , Masculino , Pólipos Nasais/tratamento farmacológico , Pólipos Nasais/cirurgia , Omalizumab/uso terapêutico , Sinusite/tratamento farmacológico , Sinusite/cirurgia , Adulto Jovem
3.
Arch Microbiol ; 204(6): 327, 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35575834

RESUMO

Recent studies have established the possible role of microbiota in developing various diseases. In this regard, attention has shifted to the evaluation of microbiota changes in the paranasal sinuses and its relationship to chronic rhinosinusitis (CRS), especially CRS with nasal polyposis (CRSwNP). This study aimed to examine the bacterial communities of the sphenoidal sinus in Iranian patients with and without CRS. The investigation included 36 subjects, including 18 patients with CRSwNP who underwent Functional Endoscopic Sinus Surgery (FESS) and 18 non-CRS patients who underwent Endoscopic Endonasal Approach (EEA) for pituitary adenoma. The surgeries were performed under general anesthesia, and the sphenoidal sinus was sampled using sterile rayon-tipped swabs coated with a sheet. TaqMan quantitative real-time polymerase chain reaction (qPCR) method (the 16S rDNA gene from bacteria) was used for detection of bacterial communities in different samples. Staphylococcus haemolyticus and Pseudomonas aeruginosa were significantly more prevalent in CRS patients than non-CRS patients (P value ≤ 0.05). However, no significant difference in the frequency of Corynebacterium spp. and Staphylococcus aureus was observed between the two groups, and no Streptococcus pneumoniae or Haemophilus influenza species were isolated from any of the samples. The current study's findings indicated a significant difference in the frequency of certain bacterial species in patients with CRS vs. non-CRS patients. By establishing a link between microbial burden and CRS, it is possible to develop effective treatments or even prevent disorders in this body area.


Assuntos
Seios Paranasais , Rinite , Sinusite , Bactérias , Doença Crônica , Humanos , Irã (Geográfico)/epidemiologia , Seios Paranasais/microbiologia , Seios Paranasais/cirurgia , RNA Ribossômico 16S/genética , Rinite/microbiologia , Rinite/cirurgia , Sinusite/microbiologia , Sinusite/cirurgia
4.
J Coll Physicians Surg Pak ; 32(5): 618-622, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35546698

RESUMO

OBJECTIVE: To investigate the clinical efficacy of single Vidian neurectomy (sVN) in the treatment of chronic rhinosinusitis with nasal polyps and allergic rhinitis (CRSwNP &AR). STUDY DESIGN: Descriptive study.   Place and Duration of Study: Otolaryngology-Head &Neck Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China, February 2016 to February 2019. METHODOLOGY: Patients meeting the diagnostic criteria for AR and CRSwNP confirmed after assessment by an ENT physician; moderately severe and persistent AR, aged ≥18 years to ≤70 years; and testing positive for sIgE and were regularly treated with medications for three months or more before surgery with unsatisfactory symptom control. Exclusion criteria were patients with acute exacerbations of sinusitis or fungal sinusitis combined with nasal polyps, intolerant to aspirin, acute infection or sinus tumours; contraindications to general anaesthetic surgery or oral corticosteroids; and those who have received allergen immunotherapy, corticosteroids and antihistamines within one year. The relevant epidemiological data were collected, including IgE level, VAS, RQLQ, and the Lund-Kennedy scores, to assess patients' clinical symptoms and quality of life before and after surgery. RESULTS: Fifty-five patients were followed up for two years after surgery, and statistical analysis was performed using SPSS version 25.0. It was found that VAS scores, RQLQ scores, and Lund-Kennedy scores of the patients who underwent sVN were significantly lower at six months (all p <0.01), one year (all p <0.01, and two years all p <0.01) after surgery compared with those before surgery. CONCLUSION: sVN has better efficacy in patients with CRSwNP&AR, has the potential to reduce its recurrence rate, and seems to be a safe and effective treatment. KEY WORDS: Chronic rhinosinusitis with nasal polyps, Allergic rhinitis, Eosinophilic chronic rhinosinusitis with nasal polyps, Single Vidian neurectomy, Clinical efficacy.


Assuntos
Pólipos Nasais , Rinite Alérgica , Rinite , Sinusite , Adolescente , Corticosteroides , Adulto , Doença Crônica , Denervação , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Qualidade de Vida , Rinite/complicações , Rinite/cirurgia , Rinite Alérgica/complicações , Rinite Alérgica/cirurgia , Sinusite/complicações , Sinusite/cirurgia , Resultado do Tratamento
5.
Mediators Inflamm ; 2022: 9155080, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35633657

RESUMO

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disease with high heterogeneity and postoperative recidivation. The IL-33/ST2 axis is known to be involved in Th2 immune responses. This study is aimed at exploring levels of serum IL-33 and soluble ST2 (sST2) in CRSwNP patients and their potential for predicting CRSwNP endotypes and postoperative recurrence. Methods: The present study recruited 149 CRSwNP patients, 80 of whom were noneosinophilic (neCRSwNP) and 69 eosinophilic (eCRSwNP), as well as 60 healthy controls (HCs). Serum samples were collected from all participants, and sST2 and IL-33 concentrations were measured using ELISA. Multivariate analysis, receiver operating characteristic (ROC) curves, and Kaplan-Meier curves were used to evaluate the value of serum sST2 and IL-33 levels in distinguishing CRSwNP endotypes and predicting postoperative recurrence. Results: The levels of serum sST2 and IL-33 in CRSwNP patients were significantly higher than those in HCs, especially in the eCRSwNP group. Increased sST2 and IL-33 levels were associated with eosinophil counts and percentages in both tissue and blood. Multivariate regression and ROC curve analysis showed that serum sST2 and IL-33 exhibited potential for distinguishing CRSwNP endotypes, and the combination of serum IL-33 and sST2 showed even more predictive power. Finally, 124 CRSwNP patients completed the entire 3-year follow-up. Multivariate analysis and Kaplan-Meier curves showed that serum sST2 and IL-33 levels were associated with recurrence; serum sST2 and IL-33 each exhibited potential for predicting postoperative recurrence, and combining serum sST2 and IL-33 exhibited better accuracy and practicability. Conclusion: Our results suggested that serum sST2 and IL-33 levels were upregulated in CRSwNP patients and related to the degree of mucosal eosinophil infiltration and postoperative recurrence. Serum sST2 and IL-33 might serve as objective biomarkers for distinguishing phenotypes and predicting recurrence in CRSwNP, and their combined use outperformed either marker alone.


Assuntos
Interleucina-33 , Pólipos Nasais , Rinite , Sinusite , Biomarcadores/sangue , Doença Crônica , Eosinófilos/patologia , Humanos , Interleucina-33/sangue , Pólipos Nasais/sangue , Rinite/sangue , Rinite/cirurgia , Sinusite/sangue , Sinusite/cirurgia
6.
JAMA Otolaryngol Head Neck Surg ; 148(6): 507-514, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35511170

RESUMO

Importance: The distance traveled by patients for medical care is associated with patient outcomes (ie, distance bias) and is a limitation in outcomes research. However, to date, distance bias has not been examined in rhinologic studies. Objective: To evaluate the association of distance traveled by a cohort of patients with chronic rhinosinusitis with baseline disease severity and treatment outcomes. Design, Setting, and Participants: A total of 505 patients with chronic rhinosinusitis were prospectively enrolled in a multi-institutional, cross-sectional study in academic tertiary care centers between April 2011 and January 2020. Participants self-selected continued appropriate medical therapy or endoscopic sinus surgery. The 22-item Sinonasal Outcome Test (SNOT-22) and Medical Outcomes Study Short Form 6-D (SF-6D) health utility value scores were recorded at enrollment and follow-up. Data on the distances traveled by patients to the medical centers, based on residence zip codes, and medical comorbid conditions were collected. Exposures: Distance traveled by patient to obtain rhinologic care. Main Outcomes and Measures: SNOT-22 and SF-6D scores. Scores for SNOT-22 range from 0 to 110; and for SF-6D, from 0.0 to 1.0. Higher SNOT-22 total scores indicate worse overall symptom severity. Higher SF-6D scores indicate better overall health utility; 1.0 represents perfect health and 0.0 represents death. Results: The median age for the 505 participants was 56.0 years (IQR, 41.0-64.0 years), 261 were men (51.7%), 457 were White (90.5%), and 13 were Hispanic or Latino (2.6%). These categories were collected according to criteria described and required by the National Institutes of Health and therefore do not equal the entire cohort. Patients traveled a median distance of 31.6 miles (50.6 km) (IQR, 12.2-114.5 miles [19.5-183.2 km]). Baseline (r = 0.00; 95% CI, 0.00-0.18) and posttreatment (r = 0.01; 95% CI, -0.07 to 0.10) SNOT-22 scores, as well as baseline (r = -0.12; 95% CI, -0.21 to -0.04) and posttreatment (r = 0.07; 95% CI, -0.02 to 0.16) SF-6D scores, were not associated with distance. There was no clinically meaningful correlation between distance traveled and mean comorbidity burden. Nevertheless, patients with a history of endoscopic sinus surgery were more likely to travel longer distances to obtain care (Cliff delta = 0.28; 95% CI, 0.19-0.38). Conclusions and Relevance: Although this cross-sectional study found that some patients appear more willing to travel longer distances for chronic rhinosinusitis care, results suggest that distance traveled to academic tertiary care centers was not associated with disease severity, outcomes, or comorbidity burden. These findings argue for greater generalizability of study results across various cohorts independent of distance traveled to obtain rhinologic care. Trial Registration: ClinicalTrials.gov Identifier: NCT02720653.


Assuntos
Rinite , Sinusite , Adulto , Doença Crônica , Estudos Transversais , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Rinite/cirurgia , Sinusite/cirurgia
7.
Am J Otolaryngol ; 43(4): 103471, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35636084

RESUMO

PURPOSE: The purpose of this study is to characterize deficits in olfactory-specific and sinonasal-specific QoL after total laryngectomy (TL) with validated patient reported outcome measures. METHODS: Thirty patients who had a TL were prospectively enrolled. Patient demographics, as well as scores from the Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and the Sino-nasal Outcome Test-22 (SNOT-22) were collected. Univariate analysis was performed to assess associations between patient characteristics and QoL scores. RESULTS: The average QOD-NS score was 37.9 ± 11.4 (<38.5 is considered abnormal) and average SNOT-22 score was 32.0 ± 3.8 (>20 indicates a moderate/severe impact on QoL). The abnormal QOD-NS group had a greater percentage of former smokers compared to the normal group (77.8% vs. 58.1%; P = 0.56) and more median days from surgery compared to the normal group (904 vs. 477 days; P = 0.24). CONCLUSIONS: Olfactory dysfunction associated with TL results in blunting of olfactory-specific QoL.


Assuntos
Transtornos do Olfato , Rinite , Sinusite , Doença Crônica , Humanos , Laringectomia/efeitos adversos , Transtornos do Olfato/etiologia , Qualidade de Vida , Rinite/cirurgia , Sinusite/cirurgia , Olfato , Inquéritos e Questionários
8.
Am J Otolaryngol ; 43(4): 103478, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35561429

RESUMO

PURPOSE: Chronic Rhinosinusitis (CRS) can be accompanied by asthma and, rarely by chronic obstructive pulmonary disease (COPD). Functional endoscopic sinus surgery (FESS) is the most common surgical approach for CRS which also improves asthma symptoms, but little is known about its effects on COPD. This study investigates the effects of FESS on COPD and asthma symptoms in CRS patients referred to a university hospital in northern Iran. MATERIALS AND METHODS: In a prospective study, patients with COPD or asthma and CRS who were candidates for FESS underwent endoscopic examination, spirometry, and evaluation of symptoms of CRS, COPD, and asthma before, and 2 and 6 months after FESS. Statistical analyzes were performed using SPSS software version 21 and the level of significance was considered as P < 0.05. RESULTS: Eighty-two CRS patients (45 with asthma/ mean age: 49.24 ± 12.75 years and 37 patients with COPD/ mean age: 61.43 ± 6.93 years) enrolled. In asthmatic patients, the mean FEV1 and FVC, and ACT (Asthma Control Test) score increased significantly after FESS (P < 0.001). In COPD cases, spirometry indices decreased, but CAT (COPD Assessment Test) score improved significantly (from 15.70 to 32.11) after FESS (P < 0.001). The mean SNOT score in both groups was significantly reduced. CONCLUSIONS: In CRS patients with COPD, FESS improves the condition of SNOT-22 and CAT, although does not increase spirometry parameters. In asthmatic patients, FESS improves pulmonary function and asthma symptoms. So both patient groups (i.e. CRS with COPD and with asthma) will benefit from FESS.


Assuntos
Asma , Doença Pulmonar Obstrutiva Crônica , Rinite , Sinusite , Asma/complicações , Doença Crônica , Endoscopia , Humanos , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/cirurgia , Rinite/complicações , Rinite/cirurgia , Sinusite/complicações , Sinusite/cirurgia
11.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 36(5): 335-337;342, 2022 May.
Artigo em Chinês | MEDLINE | ID: mdl-35483681

RESUMO

Objective:Explore the significance of ultrastructural differences in tissue engineering, 3D printing, and rhinoplasty. Methods: 32 specimens (8 vomers, 8 perpendicular plates of ethmoid bone, 8 maxillary nasal crests, and 8 septal cartilage) of the nasal septum from patients with a nasal deviated septum and chronic sinusitis undergoing septoplasty were selected and examined using scanning electron microscopy. Results: The nasal septum of patients of different ages behaves similarly under the scanning electron microscope, and the bones of different parts of the nasal septum have similarities and differences. Conclusion:By observing the scanning electron micrograph of the nasal septum and analyzing the surface ultrastructure, it provides important information for the development of tissue engineering, assists in the refined modeling of 3D printing technology, and provides more ideal restoration materials for clinical operations.


Assuntos
Rinoplastia , Sinusite , Cartilagem , Humanos , Microscopia Eletrônica de Varredura , Septo Nasal/cirurgia , Sinusite/cirurgia
12.
Mediators Inflamm ; 2022: 7338692, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35431654

RESUMO

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common upper airway inflammatory disease with a high postoperative recurrence rate. This study is aimed at exploring the expression of B cell-activating factor (BAFF) in CRSwNP and its association with postoperative recurrence. Methods: A total of 80 CRSwNP patients, including 40 primary CRSwNP patients and 40 recurrent CRSwNP patients, 40 chronic rhinosinusitis without nasal polyps (CRSsNP) patients, and 40 healthy controls (HC) were enrolled in this study, and the serum and tissue samples were collected. The circulating and tissue BAFF expressions were detected by enzyme-linked immunosorbent assay reverse transcription-polymerase chain reaction and immunohistochemistry. Their clinical values for predicting postoperative recurrence of CRSwNP were evaluated. Results: We determined serum levels of BAFF were remarkably increased in the CRSwNP group than the CRSsNP and HC groups (P < 0.05), and higher concentrations of BAFF were associated with peripheral eosinophil percentage (r = 0.614, P < 0.001). The serum BAFF concentrations were significantly higher in the recurrent CRSwNP group in comparison with the primary group (P < 0.05). Multivariate analysis and receiver operating characteristic (ROC) curve presented that serum BAFF levels were associated with the postoperative recurrence in CRSwNP patients (P < 0.05). Moreover, tissue BAFF levels were significantly increased in the CRSwNP group than the HC group, especially in the recurrent CRSwNP group (P < 0.05), and enhanced BAFF RNA expressions were correlated with serum BAFF levels (r = 0.703, P < 0.001). Conclusion: Our results elucidated that the BAFF expression was enhanced in CRSwNP patients and associated with postoperative recurrence. BAFF could be a serologic biomarker for predicting postoperative recurrence in CRSwNP patients.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Doença Crônica , Eosinófilos/metabolismo , Humanos , Interleucina-4 , Pólipos Nasais/cirurgia , Rinite/cirurgia , Sinusite/cirurgia
13.
BMJ Open ; 12(4): e053436, 2022 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-35459663

RESUMO

INTRODUCTION: Endoscopic sinus surgery (ESS) is a current procedure for treating patients with chronic rhinosinusitis (CRS). Image-guided surgery (IGS) for ESS may help reduce complications and improve precision. However, it is uncertain in which cases IGS is beneficial. This work aims to compare ESS with and without IGS in patients with CRS. METHODS AND ANALYSIS: PubMed, Embase, Scopus, Web of Science, Scielo, Cochrane Central Register of Controlled Trials, CINAHL, LILACS and Clinicaltrials.gov will be searched for reported clinical trials comparing the quality of life and perioperative outcomes of ESS with and without navigation. The search is planned for 20 April 2022. Three independent authors will select eligible articles and extract their data. The risk of bias will be assessed using the Cochrane Handbook for Systematic Reviews of Interventions. The Grading of Recommendation Assessment, Development and Evaluation method will evaluate the strength of the evidence. Data synthesis will be performed using the Review Manager software V.5.4.1. To assess heterogeneity, I2 statistics will be computed. Additionally, meta-analysis will be performed if the included studies are sufficiently homogenous. ETHICS AND DISSEMINATION: This study reviews published data, and thus it is not necessary to obtain ethical approval. The findings of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020214791.


Assuntos
Qualidade de Vida , Sinusite , Doença Crônica , Endoscopia , Humanos , Metanálise como Assunto , Sinusite/cirurgia , Revisões Sistemáticas como Assunto
14.
Eur Arch Otorhinolaryngol ; 279(7): 3519-3523, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35488906

RESUMO

PURPOSE: The aim of this study was to investigate the possible role of raftlin (RFTN) in chronic rhinosinusitis with nasal polyps (CRSwNP). There is no study in the literature investigating the role of RFTN in the pathogenesis of CRSwNP. METHODS: The present study was designed as a case-control study and conducted between 25.09.2020 and 01.01.2022. CRSwNP and control groups were formed in the study. Serum and tissue samples were taken from each patient in the study and their RFTN levels were measured. While nasal polyps were used for tissue samples in the CRSwNP group, middle meatus mucosa obtained during concha bullosa surgery was used in the control group. RESULTS: The control group included 31 patients (8 female, 23 male) and the CRSwNP group included 49 patients (14 female, 35 male). The mean age of the control group was 40.42 ± 9.99 years, while the mean age of the CRSwNP group was 43.47 ± 10.19 years. When the groups are compared in terms of gender and age, there were no statistically significant differences (p = 0.78, p = 0.19, respectively). The serum RFTN levels in the control and CRSwNP groups were 7.85 ± 10.87 ng/ml, and 7.02 ± 8.59 ng/ml, respectively (p = 0.45). The tissue RFTN levels in the control group and CRSwNP group were 87.15 ± 69.91 ng/ml, and 66.50 ± 17.10 ng/ml, respectively (p = 0.04, statistically significant). CONCLUSION: RFTN deficiency in nasal polyp tissue may be one of the reasons for the development of CRSwNP. Further studies are needed to elucidate the role of RFTN in CRSwNP.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Adulto , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Pólipos Nasais/patologia , Pólipos Nasais/cirurgia , Rinite/complicações , Rinite/cirurgia , Sinusite/complicações , Sinusite/patologia , Sinusite/cirurgia
15.
Pediatr Neurosurg ; 57(3): 213-221, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35398851

RESUMO

BACKGROUND: Minimally invasive approaches to the anterior cranial fossa have evolved over the past few decades. The management of frontal epidural abscesses (EDAs) secondary to diffuse sinusitis in the pediatric population using minimally invasive techniques is scarcely reported in the literature. Herein, we report the utilization of a minimally invasive eyebrow approach for multidisciplinary concurrent evacuation of frontal EDA secondary to diffuse sinusitis and trephination of the frontal sinus in three pediatric patients. CASE REPORTS: Three pediatric patients presented to the emergency room with severe headaches, visual changes, somnolence, and significant facial and periorbital swelling. Imaging revealed diffuse sinusitis with focal frontal epidural extension. In all cases, progressive clinical deterioration along with the radiographic findings mandated urgent surgical intervention. The eyebrow approach allowed for concomitant evacuation of the frontal EDA and trephination of the frontal sinus followed by functional endoscopic sinus surgery in the same setting. All patients tolerated the procedure well with complete resolution of their symptoms at the completion of antibiotic therapy and complete resolution of the EDA. CONCLUSION: The eyebrow approach is a minimally invasive technique that should be considered as part of the armamentarium in the management of select EDA in the pediatric population. It allows for multidisciplinary collaboration between neurosurgeons and otolaryngologists for concomitant evacuation of the EDA and trephination of the frontal sinus. This approach is a feasible, safe, and effective minimally invasive technique that can be employed for the management of EDA secondary to diffuse sinusitis in the pediatric population.


Assuntos
Sobrancelhas , Sinusite , Abscesso , Criança , Craniotomia/métodos , Humanos , Sinusite/complicações , Sinusite/diagnóstico por imagem , Sinusite/cirurgia
16.
PLoS One ; 17(4): e0267146, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35486626

RESUMO

BACKGROUND: Revision endoscopic sinus surgery (ESS) is often considered for chronic rhinosinusitis (CRS) if maximal conservative treatment and baseline ESS prove insufficient. Emerging research outlines the risk factors of revision ESS. However, accurately predicting revision ESS at the individual level remains uncertain. This study aims to examine the prediction accuracy of revision ESS and to identify the effects of risk factors at the individual level. METHODS: We collected demographic and clinical variables from the electronic health records of 767 surgical CRS patients ≥16 years of age. Revision ESS was performed on 111 (14.5%) patients. The prediction accuracy of revision ESS was examined by training and validating different machine learning models, while the effects of variables were analysed using the Shapley values and partial dependence plots. RESULTS: The logistic regression, gradient boosting and random forest classifiers performed similarly in predicting revision ESS. Area under the receiving operating characteristic curve (AUROC) values were 0.744, 0.741 and 0.730, respectively, using data collected from the baseline visit until six months after baseline ESS. The length of time during which data were collected improved the prediction performance. For data collection times of 0, 3, 6 and 12 months after baseline ESS, AUROC values for the logistic regression were 0.682, 0.715, 0.744 and 0.784, respectively. The number of visits before or after baseline ESS, the number of days from the baseline visit to the baseline ESS, patient age, CRS with nasal polyps (CRSwNP), asthma, non-steroidal anti-inflammatory drug exacerbated respiratory disease and immunodeficiency or suspicion of it all associated with revision ESS. Patient age and number of visits before baseline ESS carried non-linear effects for predictions. CONCLUSIONS: Intelligent data analysis identified important predictors of revision ESS at the individual level, such as the frequency of clinical visits, patient age, Type 2 high diseases and immunodeficiency or a suspicion of it.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Doença Crônica , Humanos , Aprendizado de Máquina , Pólipos Nasais/diagnóstico , Pólipos Nasais/cirurgia , Reoperação , Rinite/cirurgia , Sinusite/cirurgia
17.
Niger J Clin Pract ; 25(3): 376-378, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35295064

RESUMO

Many anatomical variations of the middle turbinate (MT), including pneumatized, paradoxically curved, bifurcate, trifurcate, secondary, and accessory, have been described. The most common is pneumatized MT (concha bullosa), but other less common variations may also impact the outcome of clinical management. Anatomical variations of the MT, particularly with a concomitant deviated nasal septum, tend to obstruct the middle meatus leading to disruption of the normal sinus drainage and worsening the symptoms of rhinosinusitis. By recognizing the unique anatomical variant by endoscopy or imaging will help us to improve the management. We report an endoscopic presentation of a rare accessory MT.


Assuntos
Sinusite , Conchas Nasais , Endoscopia , Humanos , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Tomografia Computadorizada por Raios X , Conchas Nasais/diagnóstico por imagem , Conchas Nasais/cirurgia
18.
Int J Pediatr Otorhinolaryngol ; 156: 111093, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35272257

RESUMO

OBJECTIVE: Intracranial complications of sinusitis and acute otitis media (AOM) are rare but life-threatening events. In children with suppurative intracranial complications, concurrent neurosurgical and otolaryngological (ORL) intervention has been recommended to optimize outcomes. The aim of this study was to investigate outcomes following concurrent neurosurgical and ORL intervention. METHODS: A retrospective cohort study of children undergoing neurosurgical intervention for intracranial complications of sinusitis or AOM in two neurosurgical centres in Ireland was conducted. RESULTS: 65 children were identified. Mean age was 11.9 years. The most prevalent symptoms were headache, pyrexia, altered level of consciousness, facial swelling, and vomiting. Subdural empyema (n = 24, 36.9%) and extradural abscess (n = 17, 26.2%) were the most common complications. 54 underwent same admission ORL intervention; 47 (87%) were performed concurrently or earlier. For rhinogenic infections, 35 (64.8%) underwent endoscopic sinus surgery (ESS), 13 (24.1%) underwent frontal sinus trephine, and 5 (9.3%) underwent maxillary sinus washout alone. For otogenic infections, 10 (90.9%) underwent mastoidectomy and 7 (63.6%) underwent tympanostomy tube placement. 19 (29.2%) had post-operative neurological deficits, of which 2 (3.1%) were permanent. Streptococcus intermedius was the most common pathogen (n = 30, 46.2%). Concurrent intervention reduced the prevalence of residual collection (p = 0.018) and the need for revision neurosurgical intervention (p = 0.039) for sinogenic complications. The same trends did not achieve statistical significance for the otogenic group. Mortality was 0%. CONCLUSION: Intracranial complications of sinusitis and AOM are best managed in a specialist centre with multidisciplinary input. Concurrent ORL and neurosurgical intervention reduces abscess recurrence and requirement for revision neurosurgery in sinogenic complications and should represent the standard of care. ESS is the ORL modality of choice in experienced hands.


Assuntos
Abscesso Encefálico , Empiema Subdural , Abscesso Epidural , Otite Média , Sinusite , Abscesso Encefálico/complicações , Abscesso Encefálico/cirurgia , Criança , Empiema Subdural/complicações , Empiema Subdural/cirurgia , Abscesso Epidural/cirurgia , Humanos , Otite Média/complicações , Estudos Retrospectivos , Sinusite/complicações , Sinusite/cirurgia , Supuração
19.
J Healthc Eng ; 2022: 4140682, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35295169

RESUMO

In this article, we have explored the effects of endoscopic sinus surgery together with budesonide treatment on nasal function and serum inflammatory factors on patients with chronic sinusitis. We retrospectively analyzed 120 patients with chronic sinusitis who were admitted to our hospital from March 2018 to March 2021 and were eligible for this study. They were separated into 2 groups according to different treatments, that is, the control group (treated with endoscopic surgery alone) of 58 cases and observation group (treated with endoscopic sinus surgery combined with budesonide) with 62 cases. Treatment efficacy, surgical status, overall symptom score before and after treatment, nasal mucociliary clearance function, serum eosinophils (EOS), serum immunoglobulin E (IgE), serum inflammatory factors, and occurrence of adverse reactions of both groups were recorded and compared. Total effective rate in the observation group presented strikingly more positive compared with that among patients in control group (P<0.05), as well as the data recorded in terms of operation time, blood loss during surgery and postoperative improvement time of patients (P<0.05). Overall symptom score, nasal mucociliary clearance, EOS, IgE and serum inflammatory factors in both groups were improved notably after treatment, while the observation group held a more obvious improvement. And it also had a markedly lower incidence of adverse reaction (P<0.05). Endoscopic sinus surgery combined with budesonide in the treatment of chronic sinusitis could effectively improve the clinical symptoms of patients, reestablish the function of the nasal cavity and improve their inflammation level. Meanwhile, it was of high safety and is worthy of clinical promotion.


Assuntos
Cavidade Nasal , Sinusite , Budesonida/uso terapêutico , Doença Crônica , Endoscopia , Humanos , Imunoglobulina E/uso terapêutico , Inflamação/tratamento farmacológico , Estudos Retrospectivos , Sinusite/tratamento farmacológico , Sinusite/cirurgia
20.
Acta Otorhinolaryngol Ital ; 42(1): 63-74, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35292788

RESUMO

Objective: Evaluate computed tomography (CT) signs that predict need for revision endoscopic sinus surgery (ESS) of chronic rhinosinusitis (CRS). Methods: CRS patients (n = 48) underwent routine sinus CT scans and baseline ESS in 2006-2011. Lund-Mackay (LM) scores and 43 other CT signs were analysed blinded from both sides. Patients filled in a questionnaire during the day of CT scanning. Follow-up data were collected from hospital records until January 2018. Associations were analysed by Fisher's exact, Mann Whitney U, Kaplan-Meier method with logrank test and Cox's proportional hazard model. Results: Total LM score was not significantly associated with the need for revision ESS. The best predictive model was a sum of CT signs of non-detectable anatomy of inferior/middle turbinates, obstructed frontal recess, and previous sinus surgery. Using these CT findings, we formed a Radiological Score (RS) (min-max, 0-3 points). Having at least one RS point was significantly associated with the need for revision ESS during the average follow-up of 10.7 years (p = 0.008, Logrank test). Conclusion: We identified a radiologic score that was able to predict the need for revision ESS, which is probably useful in predicting CRS outcomes.


Assuntos
Seio Frontal , Sinusite , Endoscopia/métodos , Humanos , Reoperação , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Tomografia Computadorizada por Raios X
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