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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.
J Otolaryngol Head Neck Surg ; 51(1): 15, 2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-35428368

RESUMO

BACKGROUND: Complex airway disease such as Chronic Rhinosinusitis with Asthma or Aspirin Exacerbated Respiratory Disease requires a multidisciplinary approach to management and treatment. Many centers in the USA have created collaborative multidisciplinary clinics to support the management of these patients; however, similar structures do not appear to exist in Canada. METHODS: This mixed methods study used a combination of structured interviews and a cross-sectional national survey. Interviewees included members of the Canadian Rhinology Working Group and survey participants were a combination of academic and community Rhinologists, Respirologists and Allergists. All participation was voluntary and selection criteria was based on their involvement in treating complex airway disease. Our objective was to identify the current state of diagnosis and treatment of complex airway patients in Canada between Rhinology, Respirology and Allergy and understand the barriers, challenges and propose solutions to establishing a multidisciplinary airway clinic in Canada. RESULTS: Four Rhinologists participated in qualitative interviews and a convenience sample of 42 specialists through our known network responded to our quantitative survey. From our survey, 54.8% believed multidisciplinary clinics were necessary in the management of complex airway disease, providing better outcomes and cost-savings (69%, 45.2%). Most specialties agreed that history, physical, pulmonary function and skin prick testing was important for diagnosis (92.9%, 92.9%, 88.1%). If clinicians were to participate in a multidisciplinary clinic, they would be willing to forego an average of 14.2% of their mean daily income for that clinic. The ideal clinic location was split between a neutral shared location vs. a Rhinology clinic space (38.1%, 45.2%). CONCLUSIONS: Complex airway diseases are currently managed in subspecialty silos resulting in fragmented care. Our study highlights gaps in management, areas for improvement and support for establishing multidisciplinary complex airway disease clinics in Canada to better treat this population.


Assuntos
Asma Induzida por Aspirina , Sinusite , Canadá , Estudos Transversais , Acesso aos Serviços de Saúde , Humanos , Sinusite/diagnóstico , Sinusite/terapia
3.
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.
Med Mycol ; 60(4)2022 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-35134980

RESUMO

Invasive fungal sinusitis (IFS) is a rare disease that requires careful attention and prompts management due to its high mortality among pediatric patients with hematological malignancies. This is a retrospective analysis of pediatric patients with hematological malignancies treated at Children's Cancer Hospital Egypt 57 357 (CCHE) through the period from 2008 till 2016 with proven IFS. Thirty-four patients were diagnosed with IFS. Five (15%) patients had an invasive rhino-cerebral fungal disease. Mucorales were isolated in 50% (n = 17) patients, Aspergillus in 38% (n = 13) patients, and mixed fungal in 12% (n = 4) patients. Sinuses were the only localized site in (45%). Extra-nasal spread was reported in 20 patients; Sino-pulmonary in 35% (n = 12), sino-cerebral in 15% (n = 5), and sino-orbital in 5% (n = 2) patients. Combined antifungal therapy with surgical debridement was done in 59% of patients with a better outcome when compared to those who received only medical antifungal treatment (P = .01). The overall mortality rate at week 12 was 35% (n = 12), and IFS attributable mortality was 20% (n = 7). IFS with cerebral extension carried the highest mortality rate for both 12-week all-cause (P = .04) and fungal-attributable (P = .01) mortality. Pediatric patients with hematologic malignancies are susceptible to invasive fungal sinusitis (IFS). Surgical debridement, combined with antifungal therapy, improves outcomes among those patients. IFS patients with cerebral extension had a higher risk of mortality. LAY SUMMARY: We studied the characteristics of invasive fungal sinusitis in children with hematological malignancies. Mucormycosis was the most common cause. Surgical debridement, combined with anti-fungal therapy, improves outcomes. Patients with rhino-cerebral fungal disease had a higher risk of mortality.


Assuntos
Neoplasias Hematológicas , Infecções Fúngicas Invasivas , Mucormicose , Sinusite , Animais , Antifúngicos/uso terapêutico , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/veterinária , Humanos , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/veterinária , Mucormicose/microbiologia , Mucormicose/veterinária , Estudos Retrospectivos , Sinusite/complicações , Sinusite/diagnóstico , Sinusite/terapia , Sinusite/veterinária
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.
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
10.
J Allergy Clin Immunol Pract ; 10(3): 707-715, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34742931

RESUMO

In the last 2 decades, an increasing understanding of pathophysiological mechanisms in chronic rhinosinusitis (CRS) opened an avenue from phenotyping to endotyping, from eosinophilic inflammation to type 2 immunity, and from the ventilation and drainage paradigm to the mucosal concept for therapeutic considerations. With the advent of type 2 endotyping and targeted biomarkers, precise endotype-driven therapeutic options are possible including biologics and adapted surgical approaches. We here aim to focus on the complexity and heterogeneity of the features of CRS endotypes, especially for those with nasal polyps, including its history, latest developments, clinical associations, and endotype-driven solutions. In order to better manage uncontrolled severe CRS in clinical practice, medical decisions based on a profound understanding of the pathology and immunology of this heterogeneous disease, aiding a precision-medicine based approach for patient's treatment, are pivotal.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Biomarcadores , Doença Crônica , Humanos , Sinusite/terapia
11.
Orbit ; 41(2): 199-203, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33390058

RESUMO

PURPOSE: While sinusitis carries a seasonal variation, the temporal features of sinusitis-related orbital cellulitis (SRC) are unclear. This study analyzes the incidence, seasonality, management, and outcomes of SRC in northeastern New York. METHODS: A retrospective review of 79 patients was performed from January 2008 - December 2018. Cases of orbital cellulitis without comitant sinusitis were excluded. Demographic, radiographic, clinical features, month at presentation, interventions (surgical and nonsurgical), microbiology, and hospitalization duration were recorded. Fisher-exact test, Mann-Whitney test, and Kruskal Wallis test statistical analyses were performed in consultation with our institution's statistician via a dedicated software package (vassarstats.net). RESULTS: 79 patients were admitted for SRC. 25 patients were treated with antibiotics only, 31 underwent orbitotomy exclusively and 23 received combined orbitotomy and functional endoscopic sinus surgery (FESS). Of the 31 patients who underwent orbitotomy only, 8 (26%) returned to the operating room. In contrast, of those who underwent concomitant orbitotomy and FESS, only one patient (4.3%) required re-operation (fisher exact test, p = .021). The median length of stay for the antibiotic-only group (4 days), orbitotomy-only group (6 days), and combined surgery group (5 days) were statistically different (Kruskal Wallis, p = .004, Figure 3). Interestingly, there was no significant relationship of incidence or severity of SRC related to seasonality (fisher-exact test, p = .76). CONCLUSION: Our findings suggest that cases requiring surgical management for SRC should undergo coinitial orbitotomy with FESS to reduce re-operation rates. Additionally, SRC incidence and severity did not correlate with season.


Assuntos
Celulite Orbitária , Doenças Orbitárias , Sinusite , Celulite (Flegmão)/complicações , Celulite (Flegmão)/microbiologia , Humanos , Incidência , New York/epidemiologia , Celulite Orbitária/diagnóstico por imagem , Celulite Orbitária/epidemiologia , Celulite Orbitária/etiologia , Doenças Orbitárias/diagnóstico por imagem , Doenças Orbitárias/epidemiologia , Doenças Orbitárias/etiologia , Estudos Retrospectivos , Sinusite/diagnóstico por imagem , Sinusite/epidemiologia , Sinusite/terapia
12.
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
13.
Arch Dis Child Educ Pract Ed ; 107(2): 113-115, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-32933929

RESUMO

Two previously well Caucasian teenage girls with no significant travel or family history were admitted with sinusitis refractory to treatment with antibiotics. Both had progressive symptoms despite broad-spectrum antibiotics and developed involvement of other systems, ultimately requiring admission to the paediatric intensive care unit (PICU). They were subsequently diagnosed with the same condition and made an excellent recovery.The first girl, 14 years old, originally presented to her general practitioner with a sore throat, nasal congestion, and fever. Despite multiple courses of antibiotics over the following month she presented again multiple times with progressive symptoms including epistaxis, widespread myalgia and arthralgia, difficulty in breathing, haemoptysis, fatigue, and weight loss. Examination on admission found minimal discharge from her right tympanic membrane, ulcerated inferior turbinates with dried blood and yellow mucus in both nasal cavities, swollen tonsils without exudate, and an isolated aphthous ulcer on the tip of her tongue. She had small bilateral cervical lymph nodes. Examination of the cardiovascular system was unremarkable but on respiratory examination there was reduced air entry on the right side. Her abdomen was generally tender but soft with no organomegaly. A week into her admission she developed an oxygen requirement and increased work of breathing requiring intubation and ventilation.The second girl, 13 years old, presented to her local hospital with a 1-day history of epistaxis, right ear pain, and pain and swelling to the right periorbital tissues. Again, despite multiple courses of antibiotics, she had persistent symptoms and subsequently developed fever, fatigue, haemoptysis, and had a syncopal episode. She was admitted to her local district general hospital and, despite initial treatment, deteriorated over the following 2 weeks with persistent fever, new oxygen requirement, deteriorating renal function, and anaemia. She was transferred to a tertiary centre for respiratory support which escalated from Optiflow, through continuous then biphasic positive airway pressure, intubation and ventilation, and ultimately VV-ECMO.The investigations for both patients prior to admission to PICU at our centre are shown in table 1.edpract;107/2/113/T1T1T1Table 1Investigations Case 1 Case 2 Haematology Leucocyte peak (×109/L) 18.3 19.0 Neutrophil peak (×109/L) 15.2 13.7 Lymphocyte peak (×109/L) 3.5 2.3 Eosinophil peak (×109/L) 0.9 2.5 Platelets Normal Normal Haemoglobin nadir (g/L) 79 74 ESR (mm/hour) 104 44 Biochemistry Creatinine peak (umol/L) Normal 153 CRP peak (mg/l) 321 280 ALT (IU/L) 122 Normal Microbiology Nasal swab: Moraxella catarrhalis Ear swab: Pseudomonas aeruginosa Sputum negative for acid-fast bacilli, PCR negative ASOT 1600 IU/ml No growth on blood or urine culture Negative viral throat swab and MCS throat swab No positive microbiology including Monospot, Mantoux and TSpot Urine dipstick On day of admission: 1+pro, 4+Hb, 2+leu, 2+ket One week into admission: 3+pro, 4+Hb, 2+leu, 2+ket Three days prior to admission: 2+Hb, otherwise normal Radiology Echocardiogram: normal CXR at admission: normal CXR after 1 week: see figure 1 CT head: pansinusitis Abdominal USS: mild hepatomegaly, diffusely echogenic kidneys Echocardiogram: normal CT chest at local hospital: see figure 2 CXR on admission to PICU: bilateral consolidation with rounded lucency in right lower zone suggestive of cavity formation ALT, alanine aminotransferase; ASOT, anti-streptolysin O titre; CRP, C-reactive protein; CT, computed tomography; CXR, chest X-ray; ESR, erythrocyte sedimentation rate; Hb, haemoglobin; leu, leucocytes; ket, ketones; MCS, microscopy, culture, and sensitivity; PICU, paediatric intensive care unit; pro, protein; TSpot, measures T lymphocytes primed to Mycobacterium tuberculosis antigens; USS, ultrasound scan. QUESTIONS: Describe findings in figures 1 and 2.Which causes of sinusitis could explain the presentation of both cases?Acute sinusitis following viral upper respiratory tract infection.Bacterial infection.Allergic sinusitis secondary to mould.Underlying diagnosis of cystic fibrosis.Sarcoidosis.Tuberculosis.Granulomatosis with polyangiitis.Samter's triad.Ciliary dysfunction.Immunodeficiency.What investigations should be performed in a child presenting with symptoms of sinusitis?edpract;107/2/113/F1F1F1Figure 1The chest X-ray for case 1, 1 week into her hospital admission.edpract;107/2/113/F2F2F2Figure 2The chest CT for case 2 at her local hospital, prior to transfer. Answers can be found on page XX.


Assuntos
Hemoptise , Sinusite , Adolescente , Antibacterianos/uso terapêutico , Criança , Epistaxe , Fadiga , Feminino , Humanos , Oxigênio , Dor , Sinusite/diagnóstico , Sinusite/terapia
14.
Int Forum Allergy Rhinol ; 12(2): 181-190, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34448372

RESUMO

BACKGROUND: Hypoxia due to closure at the ostiomeatal complex is widely considered one of the major pathogenic mechanisms leading to chronic inflammation in chronic rhinosinusitis (CRS). The objective of this study was to develop and characterize an oxygen-generating biomaterial (OGB) as an innovative treatment strategy for CRS. METHODS: An OGB was fabricated by coating hydrophobic beeswax (BW, 15mg or 30mg) on the surface of calcium peroxide - catalase complex (CPO-CA, 30mg) and characterized using scanning electron microscopy (SEM). In vitro releases of both oxygen and hydrogen peroxide (H2 O2 ) were spectrophotometrically quantified, and cytotoxicity in human sinonasal epithelial cells (HSNECs) was evaluated. The influence of OGB on transepithelial Cl- secretion was also determined by pharmacologically manipulating HSNECs, cultured under hypoxic conditions, in Ussing chambers. RESULTS: Three groups of OGBs: (1) CPO only; (2) CPO coated with CA and BW (1:1 ratio, CPO-CA(1)-BW(1)); and (3) CPO coated with CA and BW (1:0.5 ratio, CPO-CA(1)-BW(0.5) were analyzed for accumulated oxygen release over 7 days: highest release (mmol/mg) was observed in CPO-CA(1)-BW(1) = 0.11 ± 0.003, followed by CPO-CA(1)-BW(0.5) = 0.08 ± 0.010, and CPO = 0.05 ± 0.004 (p < 0.0001). H2 O2 production (mM) was significantly higher in CPO (1.87 ± 0.50) compared to CPO-CA (1)-BW(1) (0.00 ± 0.00) (p < 0.001) after 24 h. CPO-CA(1)-BW(1) showed significantly reduced cytotoxicity and increased Cl- transport compared to the CPO group. CONCLUSION: A novel OGB (CPO-CA-BW complex) exhibited sustained oxygen release over 7 days without significant cytotoxicity after 24 h in vitro. Preclinical studies evaluating the efficacy of OGB in CRS are warranted, especially for potential therapy in an obstruction-based CRS model.


Assuntos
Materiais Biocompatíveis , Sinusite , Materiais Biocompatíveis/uso terapêutico , Células Epiteliais , Humanos , Hipóxia , Oxigênio , Sinusite/terapia
15.
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
16.
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
17.
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
18.
Otolaryngol Head Neck Surg ; 166(3): 540-547, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34154450

RESUMO

OBJECTIVE: This project aims to prospectively and objectively assess otolaryngological manifestations and quality of life of children with primary ciliary dyskinesia (PCD) and compare these findings with healthy pediatric controls. STUDY DESIGN: Cross-sectional. SETTING: Two high-volume pediatric PCD specialty centers. METHODS: Standardized clinical assessment; Sino-Nasal Outcome Test 22 (SNOT-22); Hearing Environment and Reflection Quality of Life (HEAR-QL); Reflux Symptom Index (RSI); standardized physical examination of the sinonasal, laryngeal, and otological systems; and investigations including pure-tone audiograms (PTAs) and sinonasal cultures were collected. RESULTS: Forty-seven children with PCD and 25 control participants were recruited. Children with PCD had more upper airway symptoms than healthy children. They had significantly higher scores in both SNOT-22 and RSI, indicating worse sinonasal and reflux symptoms, with worse quality of life on the HEAR-QL index compared to healthy children (P < .05). Fifty-two percent of children with PCD-related hearing loss were not aware of their hearing deficit that was present on audiological assessment, and only 23% of children who had ventilation tubes had chronic otorrhea, most of which was easily controlled with ototopic drops. Furthermore, although all children with PCD had chronic rhinosinusitis, only 36% of them were using topical nasal treatment. The most common bacteria cultured from the middle meatus were Staphylococcus aureus in 11 of 47 (23%), followed by Streptococcus pneumoniae in 10 of 47 (21%). CONCLUSION: This multisite cohort highlights the importance of otolaryngology involvement in the management of children with PCD. More rigorous otolaryngological management may lead to reductions in overall morbidity and improve quality of life for children with PCD.


Assuntos
Transtornos da Motilidade Ciliar , Otolaringologia , Sinusite , Criança , Transtornos da Motilidade Ciliar/diagnóstico , Estudos Transversais , Humanos , Qualidade de Vida , Sinusite/terapia
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