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1.
Ophthalmic Plast Reconstr Surg ; 35(6): e134-e136, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31593047

RESUMO

Orbital subperiosteal hemorrhages are usually due to trauma. However, nontraumatic subperiosteal hemorrhages have also been rarely reported. Here, the authors present a 13-year-old boy with Bernard-Soulier syndrome who presented with right orbital subperiosteal hemorrhage causing optic neuropathy which was surgically drained with full visual recovery.The authors describe a case of rare coagulopathy (Bernard-Soulier syndrome) and pansinusitis presenting with nontraumatic subperiosteal hemorrhage.


Assuntos
Síndrome de Bernard-Soulier/complicações , Hemorragia Retrobulbar/etiologia , Sinusite/complicações , Adolescente , Humanos , Masculino , Doenças do Nervo Óptico/etiologia
2.
Rhinology ; 57(5): 375-384, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31576819

RESUMO

BACKGROUND: The aim of this study was to develop a new psychophysical test to assess intranasal trigeminal chemosensory function. METHODOLOGY: The test is similar to the Sniffin’ Sticks test, but using pens impregnated with substances preferentially activating trigeminal afferents. Our test comprises detection threshold, discrimination, identification and lateralization tasks. In a first study, we evaluated healthy controls. In a second study, we evaluated the potential usefulness of this test in patients with rhinological conditions. RESULTS: Study 1: 86 controls were included. Threshold, identification and lateralization performance decreased with age. Test-retest reliability was similar to that of olfactory tests. Study 2: results of the controls group were compared to those of 59 patients (14 allergic rhinitis, 11 chronic rhinosinusitis with nasal polyps (CRSwNP), 9 without nasal polyps (CRSsNP), and 25 with an olfactory disorder (OD)). Controls had 1) lower detection thresholds compared to CRSwNP, CRSsNP and OD, 2) better discrimination and identification scores compared to OD, and 3) better lateralization scores compared to CRSwNP and CRSsNP. CONCLUSIONS: Our test allows to identify age-related changes in trigeminal chemosensory function. Trigeminal function seems to be differently affected in different pathologies. Further studies are necessary to validate our results and evaluate the impact of olfactory co-activation on the observed results.


Assuntos
Pólipos Nasais , Transtornos do Olfato , Rinite , Sinusite , Doença Crônica , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/diagnóstico , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/etiologia , Transtornos do Olfato/psicologia , Reprodutibilidade dos Testes , Rinite/complicações , Rinite/diagnóstico , Sinusite/complicações , Sinusite/diagnóstico , Olfato
3.
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
4.
Rhinology ; 57(6): 430-435, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31545327

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) and asthma, when comorbid, may influence each other’s disease course and decrease quality of life (QOL). Our objective was to determine if poorer asthma control due to CRS symptoms could be a mechanism for decreased QOL in asthmatic CRS patients. METHODS: A total of 120 asthmatic CRS patients were recruited. CRS symptom burden was measured using the 22-item Sinonasal Outcome Test (SNOT-22) and patient-reported CRS symptom control, general health-related QOL was measured using the visual analog scale of the 5-dimensional EuroQol quality of life survey (EQ-5D VAS), and asthma control was measured using the Asthma Control Test (ACT). Association was sought between these outcome measures. A mediation model was created and validated to show that asthma control mediated the association between CRS symptom burden and decreased general health-related QOL. RESULTS: ACT score was associated with SNOT-22, EQ-5D VAS was associated with SNOT-22 score, and EQ-5D VAS was associated with ACT score. A statistically significant mediation effect for ACT score in the association between SNOT-22 and EQ-5D VAS), which represented 22.1% of the total effect of SNOT-22 on EQ-5D VAS, was identified. Similar findings were made for patientreported CRS symptom control instead of SNOT-22 score. CONCLUSIONS: In asthmatic CRS patients, a sizeable portion of CRS impact on QOL is indirectly mediated through the effect of CRS on poorer asthma control which may then drive decreased QOL.


Assuntos
Asma/terapia , Qualidade de Vida , Sinusite/complicações , Asma/diagnóstico , Asma/epidemiologia , Doença Crônica , Comorbidade , Estudos Transversais , Indicadores Básicos de Saúde , Humanos , Estudos Prospectivos , Rinite/epidemiologia , Inquéritos e Questionários
5.
PLoS One ; 14(8): e0220286, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31390351

RESUMO

BACKGROUND: To evaluate the risk of developing optic neuropathy (ON) in patient with both non-surgery and surgery-indicated chronic rhinosinusitis (CRS) via the national health insurance research database in Taiwan. METHODOLOGY/PRINCIPAL FINDINGS: 44,176 Patients with a diagnostic code of CRS was selected, which included 6,678 received functional endoscopic sinus surgery (FESS) regarded as the surgery-indicated CRS. Each individual in the study group was matched to two non-CRS patients by age and gender. The outcome was set as the occurrence of ON according to the diagnostic codes occurred after the index date. Poisson regression was used to calculate the adjusted relative risk (aRR) and conditional Cox proportional model was used to estimate the adjusted hazard ratio (aHR). There were 131 and 144 events of ON occurred in the study group and the control group respectively during the follow-up period. The whole study group, whether received FESS or not, demonstrated both significant aRR and aHR compared to the control group after adjusting demographic data, prominent ocular diseases, and systemic co-morbidities. In addition, both the aRR and aHR were higher in CRS patient received FESS than those with CRS but without FESS management. CONCLUSION: The existence of CRS, especially the surgery-indicated CRS is a significant risk factor for the following ON using multivariable analysis.


Assuntos
Doenças do Nervo Óptico/complicações , Doenças do Nervo Óptico/epidemiologia , Sinusite/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco
6.
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
7.
HNO ; 67(9): 715-730, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31407017

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) is one of the most frequent chronic diseases. Among these patients the prevalence of immune defects is higher than in the healthy general population. METHODS: A selective review of the literature was carried out in PubMed and Medline covering the period between 2008 and 2019. Additionally, recent German publications in journals not listed in the abovementioned databases were analyzed. RESULTS: The diagnostic workflow with respect to the immunodeficiency consists of a detailed anamnesis and physical examination, laboratory tests and the antibody reaction to polysaccharide vaccines and antigens. Beside antibiotic treatment, vaccinations and immunoglobulin replacement are available. Notwithstanding the above, functional endoscopic surgery of the paranasal sinuses should be performed according to guideline recommendations. CONCLUSION: Patients with CRS who do not sufficiently respond to conservative and surgical treatment should be checked for underlying immunodeficiencies.


Assuntos
Doenças do Sistema Imunitário , Seios Paranasais , Rinite , Sinusite , Doença Crônica , Endoscopia , Humanos , Doenças do Sistema Imunitário/complicações , Rinite/complicações , Rinite/imunologia , Sinusite/complicações , Sinusite/imunologia
8.
Acta Otolaryngol ; 139(10): 890-894, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31452425

RESUMO

Background: Allergic rhinitis combined with chronic rhinosinusitis with nasal polyps (ARwCRSwNP) is very common clinically. Conventionally, the treatment for these patients is surgical method for CRSwNP followed by treatment with a nasal steroid spray or other antiallergic drugs to control AR. In recent years, some rhinologists introduced vidian neurectomy (VN) or posterior nasal neurectomy (PNN) into endoscopy to treat refractory AR and reported an encouraging outcome. Furthermore, we explore the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP. Objective: To investigate the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP. Methods: Eighty-five patients with ARwCRSwNP who were admitted to our hospital from November 2016 to July 2018 were enrolled in two groups. Group A underwent conventional functional endoscopic sinusitis surgery (FESS) combined with PNN; group B underwent conventional FESS alone. VAS, RQLQ, SNOT-22 and postoperative nasal endoscopy were used to evaluate the improvement in symptoms and the recurrence of nasal polyps. Results: The experimental group had better control of sneezing (p < .05) and rhinorrhea (p < .01) than the control group. For those who underwent surgery more than 6 months prior in both groups, the recurrence rate was 29.6% (8/27) in the experimental group and 44.4% (8/18) in the control group, and there was no significant difference (χ2 = .483, p = .487). Conclusion: FESS combined with PNN can improve the symptoms of sneezing and rhinorrhea caused by ARwCRSwNP more obviously than FESS alone, but there is no clear statistical advantage of this procedure for improving the overall symptoms and controlling the recurrence of nasal polyps.


Assuntos
Denervação , Endoscopia , Pólipos Nasais/cirurgia , Rinite Alérgica/complicações , Rinite Alérgica/cirurgia , Sinusite/cirurgia , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Seios Paranasais/inervação , Sinusite/complicações , Resultado do Tratamento
9.
Otolaryngol Head Neck Surg ; 161(5): 764-769, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31453737

RESUMO

OBJECTIVE: While urinary leukotriene E4 (uLTE4) is a validated biomarker for the cysteinyl leukotriene pathway, which is central to the pathophysiology of asthma, atopy, and chronic rhinosinusitis (CRS), the contributions of comorbid asthma and atopy to uLTE4 levels in various CRS subtypes have not been previously characterized. We sought to (1) identify reference values for uLTE4 in subjects with and without CRS and (2) determine how the presence of comorbid atopy and asthma affects uLTE4 levels in CRS. SETTING: Tertiary referral medical center. SUBJECTS AND METHODS: A prospective case-control study was conducted to compare uLTE4 levels between patients with CRS and healthy controls. Urinary LTE4 levels were measured by enzyme immunoassay and were adjusted for urinary creatinine concentrations (pg/mg Cr). Patients with CRS were stratified by the clinical comorbidities to determine normative uLTE4 values for patients with CRS with and without comorbid asthma or atopy. RESULTS: A total of 153 patients (mean age, 47.3; 47.1% female) were included in the study. Patients with CRS demonstrated significantly higher concentrations of uLTE4 than healthy controls (1652 vs 1065 pg/mg Cr, P = .032). Within the group of patients with CRS, comorbid asthma also individually correlated with elevated uLTE4 levels (1597 pg/mg Cr, P = .0098). Patients with CRS who did not have comorbid allergy and asthma, in contrast, did not have statistically higher uLTE4 levels than healthy controls (1142 pg/mg Cr, P = .61). CONCLUSION: Urinary LTE4 serves as a noninvasive measure of the inflammatory state in CRS. Comorbid asthma and atopy contribute to elevated uLTE4 levels in CRS.


Assuntos
Asma/urina , Leucotrieno E4/urina , Rinite/complicações , Rinite/urina , Sinusite/complicações , Sinusite/urina , Adulto , Asma/complicações , Biomarcadores/urina , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
10.
BMC Pulm Med ; 19(1): 154, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426769

RESUMO

BACKGROUND: Atypical manifestations, such as elevated serum immunoglobulin-G4 (IgG4) and extra-pulmonary IgG4 positive plasmacyte infiltration, have been described in patients with eosinophilic granulomatosis with polyangiitis (EGPA), such complicated situation might not be readily differentiated from IgG4-related disease. CASE PRESENTATION: Here, we report an interesting and rare case of EGPA in a 41 year-old male with negative anti-neutrophil cytoplasmic antibodies (ANCAs), which showed abundant pulmonary IgG4-positive plasma cells infiltration and markedly elevated serum IgG4 levels without extra-pulmonary lesions of IgG4-related disease. The clinical characteristics hesitated us whether the diagnosis as EGPA overlapping with IgG4-related lung disease should be concluded because of the absence of storiform fibrosis and obliterative phlebitis with lymphoplasmacytic infiltration. The patient's systemic symptoms, pulmonary lesions, blood eosinophils count / percentage, and serum IgG4 levels were significantly improved with immunosuppressive therapy. CONCLUSIONS: We consider that the overlapping pathogenesis exists in the disease course of EGPA and IgG4-related disease, which may lead to interaction during the course of the diseases. And the utilization of diagnostic criteria for IgG4-related lung disease with the careful differentiation is needed in such cases.


Assuntos
Doenças Autoimunes/complicações , Eosinófilos/patologia , Granulomatose com Poliangiite/complicações , Imunoglobulina G/sangue , Pulmão/patologia , Adulto , Diagnóstico Diferencial , Granulomatose com Poliangiite/tratamento farmacológico , Humanos , Pulmão/diagnóstico por imagem , Masculino , Metilprednisolona/administração & dosagem , Sinusite/complicações , Tomografia Computadorizada por Raios X
11.
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
12.
Artigo em Chinês | MEDLINE | ID: mdl-31446724

RESUMO

Objective:To evaluate the effect of surgery on olfactory function in patients with chronic rhinosinusitis with nasal polyps(CRSwNP) by subjective and objective olfactory tests. Method:This was a retrospective study. Forty patients with CRSwNP who underwent endoscopic sinus surgery(ESS) from 2015 to 2017 in Beijing Anzhen Hospital were enrolled. Postoperative time was 6-46 months. The patients were followed up in October 2018 and examined using Sniffin' sticks olfactory test and olfactory event-related potentials (oERP). The polyps collected during surgery were performed to eosinophil count and percentage calculation. They were divided into eosinophilic CRSwNP(ECRS) and non-eosinophilic CRSwNP(NECRS). The subjective and objective olfactory functions between the two groups were compared before and after surgery respectively and the paired T test was performed between the postoperative and the preoperative Sniffin' sticks olfactory test. Covariance analysis was used to adjust the effect of different postoperative time on postoperative olfactory recovery. Result:There were 21(52.5%) ECRS and 19(47.5%) NECRS patients of the 40 patients with nasal polyps. There was statistical difference in the posterior ethmoid score and the posterior olfactory cleft score of CT. According to the criterion of total TDI increased more than 5.5, olfactory function in 21(52.5%) patients had improved. In addition, there was a significant improvement in olfactory function in ECRS group either in unilateral T/TDI or bilateral T/D/TDI, but only unilateral T/TDI increased in NECRS group. There was no significant difference in Sniffin' sticks olfactory test between the two groups, but there was a statistically significant difference in the latency of oERP after surgery. Conclusion:ESS could improve olfactory function in patients with CRSwNP by more than 50%. Bilateral olfactory improvement in ECRS was better than that in NECRS, but olfactory function in postoperative ECRS was still lower than that in NECRS. oERP can more objectively and accurately reflect the severity of olfactory disorders associated with eosinophilic inflammation.


Assuntos
Endoscopia , Pólipos Nasais/cirurgia , Seios Paranasais/cirurgia , Rinite/complicações , Sinusite/complicações , Olfato , Doença Crônica , Humanos , Estudos Retrospectivos
13.
Allergol Int ; 68(4): 515-520, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31257167

RESUMO

BACKGROUND: Asthma often coexists with chronic rhinosinusitis (CRS). Recent studies revealed that sinus inflammation in asthmatic patients was related to eosinophilic inflammation. However, the relationship between the severity of CRS and four different sputum inflammatory phenotypes as defined by the proportion of eosinophils and neutrophils is unknown. The aim of this study was to examine the impact of the severity of CRS on lower airway and systemic inflammation in asthmatic patients. METHODS: We enrolled 57 adult asthmatic patients who underwent sinus computed tomography (CT). The severity of CRS was evaluated by the Lund-Mackay score (LMS). The induced sputum inflammatory phenotype was defined by eosinophils (≥/<2%) and neutrophils (≥/<60%). Peripheral blood mononuclear cells (PBMC) were collected to examine cytokine productions. RESULTS: The median LMS of subjects was 6 (interquartile range, 0-11.5). The sputum inflammatory cell phenotype was categorized as paucicellular (n = 14), neutrophilic (n = 11), eosinophilic (n = 20), or mixed (n = 12). LMS was positively correlated with the percentage of blood eosinophils, sputum eosinophils, and mean fluorescence intensity (MFI) of IL-5 on CD4+ T cells. In the severe CRS group (LMS, 12-24), the number of mixed cellular phenotypes was higher than that in the group without CRS (LMS, 0-4) and mild-to-moderate CRS group (LMS, 5-11). CONCLUSIONS: In asthmatic patients with severe CRS, the proportion of the mixed cellular inflammatory phenotype was increased as well as eosinophilic inflammation.


Assuntos
Asma/complicações , Asma/patologia , Rinite/complicações , Sinusite/complicações , Idoso , Asma/diagnóstico por imagem , Asma/metabolismo , Biomarcadores , Eosinofilia/patologia , Feminino , Humanos , Imunofenotipagem , Contagem de Leucócitos , Linfócitos/imunologia , Linfócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Neutrófilos/imunologia , Neutrófilos/metabolismo , Neutrófilos/patologia , Fenótipo , Rinite/diagnóstico , Índice de Gravidade de Doença , Sinusite/diagnóstico , Tomografia Computadorizada por Raios X
14.
Immunol Allergy Clin North Am ; 39(3): 403-415, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31284929

RESUMO

There is an important link between the upper and lower respiratory tracts whereby inflammation in one environment can influence the other. In acute rhinosinusitis, pathogen exposures are the primary driver for inflammation in the nose, which can exacerbate asthma. In chronic rhinosinusitis, a disease clinically associated with asthma, the inflammation observed is likely from a combination of an impaired epithelial barrier, dysregulated immune response, and potentially infection (or colonization) by specific pathogens. This review explores the associations between rhinosinusitis and asthma, with particular emphasis placed on the role of infections and inflammation.


Assuntos
Asma/etiologia , Inflamação/complicações , Sinusite/complicações , Doença Aguda , Asma/diagnóstico , Doença Crônica , Humanos , Inflamação/diagnóstico , Inflamação/etiologia , Sinusite/diagnóstico , Sinusite/etiologia
15.
Medicina (Kaunas) ; 55(7)2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31277327

RESUMO

A 56-year-old man with severe asthma underwent bronchial thermoplasty (BT). However, his asthma exacerbated and hypereosinophilia developed 2 months later, thus necessitating oral corticosteroid (OCS) therapy. Six months after BT, a diagnosis of severe asthma with eosinophilic chronic rhinosinusitis (ECRS) was made and benralizumab treatment was initiated; the blood eosinophil count subsequently decreased and lung function improved, thereby permitting OCS dose tapering. Surprisingly, benralizumab both reduced nasal polyps and ameliorated ECRS. Thus, benralizumab may be a useful drug for the rapid treatment of severe asthma with ECRS, especially in patients with hypereosinophilia.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Asma/tratamento farmacológico , Eosinofilia/tratamento farmacológico , Sinusite/tratamento farmacológico , Anticorpos Monoclonais Humanizados/farmacologia , Asma/complicações , Termoplastia Brônquica/métodos , Progressão da Doença , Eosinofilia/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Sinusite/complicações
16.
Rhinology ; 57(5): 343-351, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31318362

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) significantly affects health-related quality of life (HRQoL). Few multinational observational studies have evaluated the impact of CRS with nasal polyps (CRSwNP) on patients’ HRQoL. This study aimed to assess HRQoL outcomes (including analyses by disease severity and impact of comorbidities and refractory disease) in CRSwNP patients from a large European database. METHODOLOGY: Data were analysed from the Global Allergy and Asthma European Network (GALEN) Rhinosinusitis Cohort, including sociodemographic data, patient-reported disease severity (visual analogue scale), and scores on the 36-Item ShortForm Health Survey (SF-36) questionnaire. Differences in mean SF-36 scores were evaluated between patients with CRSwNP and population norms and between subgroups of interest (disease severity, comorbidity, and refractory disease, defined by a history of sinonasal surgery). RESULTS: Patients with CRSwNP (N = 445) had significantly lower mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores vs population norms, demonstrating that CRSwNP negatively affects HRQoL. The presence of comorbidities affected HRQoL, as shown by significant differences in PCS scores in patients with asthma or non-steroidal antiinflammatory drug-exacerbated respiratory disease, compared with patients without asthma. Patients with moderate-to-severe disease had significantly lower PCS scores than patients with mild disease. Severe disease had a significant impact on MCS score. History of surgery had a clinically meaningful negative effect on HRQoL compared with no history of surgery. CONCLUSIONS: CRSwNP patients have significantly lower HRQoL compared with population norms. The impact is greater in patients with greater disease severity, comorbidities, or refractory disease.


Assuntos
Pólipos Nasais , Qualidade de Vida , Rinite , Sinusite , Doença Crônica , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/terapia , Rinite/complicações , Rinite/terapia , Sinusite/complicações , Sinusite/terapia
18.
Eur Arch Otorhinolaryngol ; 276(10): 2827-2833, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31325032

RESUMO

PURPOSE: The effects of nasal obstruction in patients with chronic rhinosinusitis (CRS) are associated with depressed mood. We sought to validate this finding by determining whether improvement in nasal obstruction would translate to improvement in depressed mood. METHODS: This was a prospective observational study of 150 patients undergoing medical management for CRS. Data were collected at two timepoints: enrollment and a subsequent follow-up visit 3-12 months later. Impact of nasal obstruction was measured using the Nasal Obstruction Symptom Evaluation (NOSE) instrument and depressed mood was measured using the 2-item Patient Health Questionnaire (PHQ-2). Sinonasal symptoms associated with CRS were also measured using the 22-item Sinonasal Outcome Test (SNOT-22). Clinical and demographic characteristics were collected. The relationship between changes in PHQ-2 and NOSE scores was determined with correlation and linear regression. RESULTS: Change in PHQ-2 score was significantly correlated with change in NOSE score (ρ = 0.30, p < 0.001). After controlling for covariates, change in PHQ-2 score was associated with change in NOSE score (adjusted linear regression coefficient [ß] = 0.014, 95% CI 0.006-0.022, p = 0.001). We confirmed these relationships, finding that change in PHQ-2 was associated (adjusted ß = 0.037, 95% CI 0.013-0.061, p = 0.003) with change in the nasal subdomain score of the SNOT-22. Improvement in NOSE score by greater than 22 points was predictive of improvement in PHQ-2 score with sensitivity 54.5% and 83.8% specificity (p < 0.001). CONCLUSION: These results provide evidence that improvements in nasal manifestations/symptoms of CRS translate to significant improvements in mood.


Assuntos
Depressão , Obstrução Nasal , Rinite , Sinusite , Doença Crônica , Depressão/etiologia , Depressão/fisiopatologia , Depressão/prevenção & controle , Feminino , Humanos , Masculino , Conduta do Tratamento Medicamentoso , Pessoa de Meia-Idade , Obstrução Nasal/tratamento farmacológico , Obstrução Nasal/etiologia , Obstrução Nasal/psicologia , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Rinite/complicações , Rinite/fisiopatologia , Sinusite/complicações , Sinusite/fisiopatologia , Avaliação de Sintomas/métodos , Estados Unidos
19.
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
20.
Otolaryngol Head Neck Surg ; 161(5): 890-896, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31359836

RESUMO

OBJECTIVE: Acute exacerbation of chronic rhinosinusitis (AECRS) is associated with significant quality-of-life decreases. We sought to determine characteristics associated with an exacerbation-prone phenotype in chronic rhinosinusitis (CRS). STUDY DESIGN: Cross-sectional. SETTING: Tertiary care rhinology clinic. SUBJECTS: Patients with CRS (N = 209). METHODS: Patient-reported number of sinus infections, CRS-related antibiotics, and CRS-related oral corticosteroids taken in the last 12 months were used as metrics for AECRS frequency. Sinonasal symptom burden was assessed with the 22-item Sinonasal Outcome Test (SNOT-22). Ninety patients reporting 0 for all AECRS metrics were considered to have had no AECRS in the prior 12 months. A total of 119 patients reported >3 on at least 1 AECRS metric and were considered as having an exacerbation-prone phenotype. Characteristics associated with patients with an exacerbation-prone phenotype were identified with exploratory regression analysis. RESULTS: An exacerbation-prone phenotype was positively associated with comorbid asthma (adjusted odds ratio [ORadj] = 3.68, 95% CI: 1.42-9.50, P = .007) and SNOT-22 (ORadj = 1.06, 95% CI: 1.04-1.09, P < .001). Polyps were negatively associated (ORadj = 0.27, 95% CI: 0.11-0.68, P = .005) with an exacerbation-prone phenotype. SNOT-22 score ≥24 identified patients with an exacerbation-prone phenotype with a sensitivity of 93.3% and a specificity of 57.8%. Having either a SNOT-22 score ≥24 with a nasal subdomain score ≥12 or a SNOT-22 score ≥24 with an ear/facial discomfort subdomain score ≥3 provided >80% sensitivity and specificity for detecting patients prone to exacerbation. CONCLUSIONS: In total, these results point to a CRS exacerbation-prone phenotype characterized by high sinonasal disease burden with comorbid asthma but interestingly without polyps.


Assuntos
Rinite/complicações , Sinusite/complicações , Exacerbação dos Sintomas , Doença Aguda , Corticosteroides/uso terapêutico , Adulto , Idoso , Antibacterianos/uso terapêutico , Asma/complicações , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Rinite/diagnóstico , Rinite/terapia , Sensibilidade e Especificidade , Sinusite/diagnóstico , Sinusite/terapia , Avaliação de Sintomas
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