Nasal spray adherence after sinus surgery: problems and predictors.

OBJECTIVES: To assess patient adherence to nasal spray regimens after endoscopic sinus surgery (ESS) and to study factors that predict adherence. METHODS: A three-arm, randomized, blinded, controlled trial was conducted at a tertiary care academic hospital, studied via a prospective longitudinal survey, of 60 consecutive chronic rhinosinusitis patients managed with ESS and started on one of three postoperative nasal spray regimens. Structured telephone interviews were conducted after surgery over a 12-month period using a validated questionnaire that assessed both spray adherence and barriers to adherence. Patient demographics, time post-ESS, preoperative Sino-Nasal Outcome Test (SNOT) scores, Lund-Mackay scores, adherence risk factors, and polyp grades were used as covariates with logistic regression. RESULTS: Overall, 57.4% of patients were nonadherent. Logistic regression showed that preoperative SNOT scores (p = .018, 95% CI = 0.84-0.98), time post-ESS (p = .016, 95% CI = 1.02-1.22), and the presence of an adherence risk factor (p = .03, 95% CI = 1.18-26.99) significantly predicted whether a patient was adherent and correctly classified 70.4% of all patients. Age, gender, and nasal spray regimen did not predict adherence (p > .05). CONCLUSION: The majority of patients were nonadherent to post-ESS nasal sprays, irrespective of which nasal spray regimen they were on. Preoperative SNOT scores, time post-ESS, and the presence of an adherence risk factor predicted adherence. With this knowledge, otolaryngologists can selectively employ strategies to improve adherence in high-risk patients and possibly improve ESS outcomes.

Postoperative care for Samter's triad patients undergoing endoscopic sinus surgery: a double-blinded, randomized controlled trial.

OBJECTIVES/HYPOTHESIS: Evidence is lacking to guide the postoperative management of Samter's triad patients with chronic rhinosinusitis with polyposis (CRSwP) undergoing endoscopic sinus surgery (ESS). The purpose of this study was to compare three different standardized medication regimens prescribed to these patients after ESS. STUDY DESIGN: Three-arm, randomized, double-blinded, controlled trial. METHODS: Patients with Samter's triad undergoing ESS were postoperatively randomized into three medication regimens, those being saline irrigation alone (control group A), saline irrigation plus separate budesonide nasal spray (group B), and saline irrigation mixed with budesonide nasal spray (group C). Outcome measures were Sino-Nasal Outcome Test scores, Lund-Mackay computed tomography scores, and Lund-Kennedy endoscopic scores taken at preoperative baseline, and then at 6 months and 1 year postoperatively. Side effect profiles were also measured (adrenocorticotropic hormone blood level ranges and intraocular pressure at the same interval points). Analysis of variance and χ(2) analyses were conducted using a Bonferroni correction method and routine descriptive statistics. Inter- and intragroup comparisons were made. RESULTS: Sixty subjects were recruited. All groups were equivalent at baseline in all outcomes. All intragroup analyses showed statistically and clinically significant improvement in disease status as compared to baseline (P < .0167), with a sustained but lessened improvement at 1 year. However, no statistically or clinically significant differences were observed between groups at any time point (P > .05). There was no treatment effect noted. CONCLUSIONS: In this study, nasal steroids did not confer any additional benefit over saline alone as post-ESS care for the Samter's triad CRSwP patient population.

Silica-based multimodal/multifunctional nanoparticles for bioimaging and biosensing applications.

In the last decade, the field of nanoparticle (NP) technology has attracted immense interest in bioimaging and biosensing research. This technology has demonstrated its capability in obtaining sensitive data in a noninvasive manner, promising a breakthrough in early-stage cancer diagnosis, stem cell tracking, drug delivery, pathogen detection and gene delivery in the near future. However, successful and wide application of this technology relies greatly on robust NP engineering and synthesis methodologies. The NP development steps involve design, synthesis, surface modification and bioconjugation. Each of these steps is critical in determining the overall performance of NPs. It is desirable to obtain NPs that are highly sensitive, stable, imageable, biocompatible and targetable. It is also desirable to obtain multimodal/multifunctional NPs that will enable imaging/sensing of the target using multiple imaging/sensing modalities. In this review, we focus on silica NPs that have been developed for biosensing applications and silica-based multimodal/multifunctional NPs for bioimaging applications.

Safety of budesonide in saline sinonasal irrigations in the management of chronic rhinosinusitis with polyposis: lack of significant adrenal suppression.

OBJECTIVE: To evaluate the potential for hypothalamic-pituitary-adrenal (HPA) axis suppression by budesonide nasal irrigations in the treatment of refractory chronic rhinosinusitis with polyposis (CRSwP). STUDY DESIGN: Retrospective, descriptive review of patient charts. SETTING: Tertiary care rhinology practice in an academic teaching hospital. PATIENTS: Eighteen adult subjects with CRSwP refractory to conservative medical therapy. METHODS: The charts of consecutive patients identified as being treated with topical budesonide in saline for nasal irrigation from January to October 2006 were reviewed. In all cases, pre- and posttreatment morning cortisol levels had been measured following at least 8 weeks of uninterrupted therapy. In addition, a subset of patients who continued therapy longer than 8 weeks had undergone the more sensitive adrenocorticotropic hormone (ACTH) stimulation test. RESULTS: All pre- and posttreatment morning cortisol levels were within the normal range. For an 8-week treatment period, there was no evidence of HPA axis suppression (p=.4171). For patients who continued treatment beyond 8 weeks, ACTH stimulation did not detect HPA axis suppression. Furthermore, there were no issues with compliance or acceptability, nor were any adverse side effects reported. CONCLUSION: Budesonide in saline sinonasal irrigation for the treatment of refractory CRSwP does not cause HPA axis suppression. The efficacy of this higher dose of steroid delivered locally would benefit from further study.

Monitoring of peanut-allergic patients with peanut-specific IgE.

Peanut allergy affects approximately 1% of the population. Double-blind placebo-controlled food challenges are gold standard for diagnosis. Serum peanut-specific IgE (PN-IgE) is used in clinical practice as an additional diagnostic and monitoring tool. The purpose of this study was to characterize the clinical features of a peanut-allergic patient's cohort and determine the optimum frequency of measuring PN-IgE to predict the outcome of future peanut challenges. Retrospective chart review was performed of peanut-allergic patients followed up and serially tested for PN-IgE with a qualitative antibody fluorescent-enzyme immunoassay performed at the Immunology Laboratory, London Health Sciences Center, from 1997 to 2004. One hundred eighteen patients (median age at first reaction to peanut, 1.5 years; median baseline PN-IgE, 18.75) were reviewed. Younger age at first reaction and first PN-IgE measurement predicted slower decline of PN-IgE values (p < 0.001 and p = 0.044). At 2 and 5 years post-initial measurement, 12.9 and 66%, respectively, of all patients had a significant decrease of PN-IgE values. Twenty percent of the patients experienced elevation of PN-IgE levels during follow-up. For most patients with significant history of reaction to peanuts and positive skin-prick test, it is probably adequate to measure serum PN-IgE levels every 3-5 years to screen for development of tolerance and predict the outcome of future peanut challenges. More frequent measurements might be considered in older patients with lower initial PN-IgE levels.