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CT scan of normal sinuses (Tichenor 2006). Note: +, border of maxillary sinus; *, maxillary sinus ostium; C, concha bullosa; CT, computed tomography; E, ethmoid sinuses; IT, inferior turbinate; MT, middle turbinate; S, septum; U, uncinate process.
Source publication
Chronic rhinosinusitis (CRS) is a chronic disease that affects 14.2% of the US adult population. Despite being widespread, little is known about the etiology of CRS. Treatment has been symptomatic and focused on relieving symptoms. Recent investigations into causes of CRS have revealed that most CRS patients have an eosinophilic infiltration of the...
Contexts in source publication
Context 1
... coronal CT scans are indicated in patients with recurrent sinusitis or CRS in order to properly consider treatment options and sequence the steps in the evaluation. In surgical candidates, CT scanning clearly defines the surgical anatomy and the extent of the disease process (Meltzer et al 2004) (Figures 1 and 2). Mucosal thickening, bony changes, or air-fluid levels seen on CT are consistent with CRS ( Benninger et al 2003). ...
Context 2
... the evidence based on our studies, CRS does not require positive allergy testing (ie, less than 50% of our patients had immunologic evidence of allergy). These criteria have been demonstrated to be present in the majority of CRS patients, placing the AFRS subentity into question (Ponikau et al 1999). ...
Citations
... [2][3][4] Aspergillosis is a chronic inflammatory disease of the nasal and paranasal sinus mucosa marked by nasal obstruction, thick nasal discharge, a loss of smell, facial pressure or pain, in a few cases an intense grade of nasal polyposis is also seen. [5,6] Aspergillus sinusitis crops up in normal hosts except invasive and fulminant types are rampant in immunocompromised patients. [7] Invasive form of aspergillosis is measured to be severe and aggressive with gross morbid of soft tissue and bone damage which may be fatal. ...
Nasal mucoadhesive in situ gelling liquid crystalline precursor system (IGFPS) of nystatin was developed for localized treatment of nasal aspergillosis post COVID infection. The stimuli-sensitive sol system comprising of Monoolein (60%w/w), Oleic acid (10%w/w), Dimethyl sulfoxide (15%w/w), Poloxamer 407 (9%w/w), and the drug (2.23%w/w) exhibited a faster sol–gel transformation in situ with good swelling ability. The small angle X-ray scattering study identified the coexistence of Im3m cubic phase with hexagonal closed pack P63/mmc structures. The subzero differential scanning calorimetry studies identified entrapped interphasal water and free water in the gels with confirmation of gelation due to micellization. Mucoadhesive properties of the gel indicate these systems to prolong the residence time at the site of absorption. The gels followed Non-Newtonian flow pattern characteristic of pesudoplastic type. The oscillatory rheology revealed that high complex viscosity and lower tanδ value provided superior adhesiveness and mucoadhesion ability to the gel. The gel exhibited a drug release of 86% at the end of 8h and of Higuchi kinetics with anomalous transport. The IGFPS exhibited better in vitro antifungal activity in comparison to drug solution. The system demonstrated permeation enhancing effect undamaged cilia and no serious histological changes. Post intranasal administration the maximum concentration (11.79 ± 2.31 μg/ml) was realized in 20 min and the curve showed a decline similar to intravenous. The storage stability of the IGFPS was found to be within acceptable limits for stability. Thus, a nasal mucoadhesive in situ gelling fluid liquid crystalline precursor formulation may represent a promising novel alternative for the localized and systemic delivery of nystatin.
... In some cases, local anesthetics of inhaled antibiotics are also used in the treatment of CRS. 12 Using intranasal corticosteroids and washing with hypertonic saline also reduces the symptoms of the disease but the use of anti-histamines in this condition is not recommended except in patients with allergic rhinitis. [13][14] Considering the beginning of treatment in sinusitis with the onset of clinical symptoms that its main treatment is the use of antibiotics and antibiotic resistance is one of the important medical issues. The present study was conducted to investigate the diagnostic value of clinical symptoms and signs for chronic sinusitis by CT-scan in patients admitted to Ardabil city hospital, Iran. ...
Background: Chronic rhinosinusitis (CRS) refers to inflammatory nasal and para nasal sinuses which last at least 12 weeks. Despite its high prevalence, it is not easy to diagnose, and clinical criteria and simple radiographs are not so sensitive. The aim of this study was to investigate the diagnostic value of clinical symptoms and signs for chronic sinusitis by Ct-scan in patients admitted to Ardabil city hospital, Iran.Methods: This descriptive cross-sectional study has been done on 83 patients with CRS symptoms who referred to ENT of Ardabil city hospital. The necessary checklist included information such as age, gender, clinical symptoms and CT scan findings were completed and analyzed by statistical methods in SPSS version 21.Results: Of all 83 patients, 55.4% were female and most of patients were in age group 30-39 years with 30.1%. Of all patients, 29 (35%) had positive findings in CT scan of which 72.4% were female. The highest rate of sinus involvement was in the ethmoid sinus. The highest positive predicted value was for nose congestion with OR=2.26 and the lowest was for facial pain and toothache each with OR=0.1.Conclusions: In general, clinical symptoms have a small predictive value in the diagnosis of sinusitis and should be evaluated with CT scan findings (15.7%).
... Diagnosis and treatment of this type of rhinosinusitis can play a significant role in reducing the patients' clinical symptoms and adverse consequences of the disease (11). In these patients, relapse is common and resistance to the treatment is frequent. ...
Introduction
Eosinophilic mucin rhinosinusitis is a type of chronic rhinosinusitis (CRS). Diagnosis and treatment of this condition play a significant role in reducing the patients’ clinical symptoms. This type of rhinosinusitis has a higher relapse rate, compared to the other types. This disease is more resistant to treatment and more dependent on corticosteroid therapy, compared to the other types of rhinosinusitis. Regarding this, the present study was designed to evaluate the frequency of eosinophilic mucin rhinosinusitis in patients undergoing sinus surgery in a tertiary referral center and examine some clinical and laboratory characteristics regarding this type of rhinosinusitis.
Materials and Methods
This cross-sectional observational study was performed on patients over the age of 16 years, who were diagnosed with CRS in the otolaryngology clinic of a referral tertiary-level hospital, and were candidates for endoscopic sinus surgery. Based on the detection of eosinophilic mucin, the subjects were divided into two groups of eosinophilic mucin and non-eosinophilic mucin rhinosinusitis (controls). The groups were compared in terms of sino-nasal outcome test (SNOT-22) scores, Lund-Mackay staging scores, osteitis status, immunoglobulin E (IgE) level, and eosinophilia.
Results
In this study, 46 subjects participated, 29 (63%) cases of whom had eosinophilic mucin. The SNOT-22 score and serum IgE level were significantly higher in the eosinophilic mucin group, compared to those in the control group. Osteitis and Lund-Mackay scores were also higher in the eosinophilic mucin group than those in the control group; however, this difference was not statistically significant.
Conclusion
Patients with eosinophilic mucin rhinosinusitis showed a more severe clinical involvement. Seemingly, the Iranian patients have a lower and higher frequency of eosinophilic mucin rhinosinusitis, compared to the patients from the Western countries and East Asia, respectively.
... Given that the surgical removal of obstructing tissues facilitates intranasal irrigation, topical application of AMB solution might be beneficial in the postoperative care of FESS. 23,30 Gerlinger et al. 19 investigated the advantages of post-FESS AMB nasal spray on the prevention of polyp recurrence. They found that after 1-year application of AMB, the symptoms of patients and their quality of life improved over placebo nasal spray controls. ...
Background:
Previous studies have shown controversial results of topical amphotericin B (AMB) nasal irrigation for chronic rhinosinusitis (CRS). The purpose of this study was to evaluate the efficacy of 200 μg/mL AMB nasal irrigation as an adjuvant therapy after functional endoscopic sinus surgery (FESS).
Methods:
Patients with CRS who had received FESS for treatment were recruited and assigned to 1 of 2 groups at random at 1 month postsurgery. In the AMB group patients received nasal irrigation with 200 μg/mL of AMB for 2 months on a daily basis. In the control group normal saline irrigation was given instead. Before FESS and before and after nasal irrigation, patients' sinonasal symptoms were assessed through a questionnaire that was a Taiwanese version of the 22-item Sino-Nasal Outcome Test (TWSNOT-22). In addition, patients received endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and bacterial cultures obtained from their middle meati.
Results:
A total of 73 patients completed the study between December 2014 and January 2017. Among them, 37 received nasal irrigation with AMB solution, and 36 with saline. In the AMB group, scores of TWSNOT-22 dropped significantly after irrigation compared with before (p = 0.005). In the control group, TWSNOT-22 scores did not changed after irrigation (p = 0.451). However, there were no significant differences in TWSNOT-22, endoscopic score, smell test, saccharine transit test, and bacterial culture rate after irrigation between 2 groups.
Conclusion:
Our study showed that in post-FESS care, nasal irrigation with 200 μg/mL of AMB did not provide additional benefit compared with saline irrigation.
... As a manifestation of the inflammatory process, nasal polyps may develop. Normally CRS is treated pharmacologically with intranasal administration of corticosteroids and antihistamine [105]. Interestingly, a real-life clinical practice and randomized control provided evidences that the addition of montelukast therapy to the treatment regimen significantly improved the clinical symptoms of CRS, including nasal discharge and blockage, headache, and daily activity. ...
Introduction: Montelukast is recommended for the treatment of asthma, exercise -induced bronchospasm and allergic rhinitis. Several trials demonstrated potential therapeutic effects in other respiratory conditions, and different animal-model-based studies explored potential pharmacological actions in non-respiratory conditions.
Areas covered: Clinical investigations on the pharmacotherapeutic effects of montelukast, in addition to in-vivo studies on animal models of non-respiratory diseases.
The data discussed in this review were mainly obtained from clinical randomized trials, real-life studies, and studies based on animal models as approve of concept. As a condition, all of the discussed articles were published in journals cited by Pubmed.
Expert commentary: The current clinical data are in favor of montelukast use in the management of chronic asthma as an add-on or alternative therapy to the inhaled corticosteroids. Further clinical trials are required to confirm the effectiveness and feasibility of montelukast for the treatment of conditions other than the current clinical indications.
... [25,26] Amphotericin B is a natural polyene antifungal agent which binds to ergosterol, a component of cell wall of most fungi, leading to formation of ion channels and cell death; it may also act secondarily through oxidative damage to fungal cell membrane through creation of free radicals from its own oxidation. [27] It is hypothesised that topical intranasal application of Amphotericin B can decrease the fungal load in sinonasal region, thereby decreasing the local eosinophilic inflammatory reaction to fungal antigens seen in many chronic rhinosinusitis with or without sinonasal polyposis patients. [28,29] Amphotericin B is poorly absorbed through the gut when ingested orally, therefore there is little or no potential for systematic exposure to the drug when administered by the topical intranasal route. ...
INTRODUCTION
Sinonasal polyposis, one of the most common inflammatory mass lesions of the nose affecting up to 40% of the population.
They present with nasal obstruction, anosmia, rhinorrhoea, post-nasal drip, and less commonly headache. Their aetiology
remains unclear, but they are known to have associations with allergy, asthma, infection, fungus, cystic fibrosis, and aspirin
sensitivity. Strong genetic factors are implicated in the pathogenesis of SNP, but genetic and molecular alterations required for
its development and progression are still unclear. Management of SNP involves a combination of conservative treatment and
surgical treatment. There is good evidence for the use of corticosteroids (systematic and topical), both as primary treatment
and as postoperative prophylaxis against recurrence, but the prolonged course of the disease and adverse effect of systematic
steroid limits their use. Surgical treatment has been refined significantly over the past 20 years with the advent of endoscopic
sinus surgery and, in general, is reserved for cases refractory to medical treatment. Recurrence of the polyposis is common with
severe disease recurring in up to 10% of patients. Over the last two decades, increasing insights in the pathophysiology of nasal
polyposis opens prospective for new pharmacological treatment options, with eosinophilic inflammation, IgE, fungi and
staphylococcus aureus as potential targets. A better understanding of the pathophysiology underlying the persistent
inflammatory state in SNP is necessary to ultimately develop novel pharmacotherapeutic approaches. Here, we present the
newer treatment options available for better control and possibly cure of the disease.
... Chronic rhinosinusitis (CRS) is characterized by severe inflammation of the sinus mucosa leading to blockage of the nasal passageway and the accumulation of mucus and pathogens in the nose and paranasal sinuses [1,2]. CRS affects around 1.9 million Australians [3] and puts a large financial burden on health care systems [4]. ...
Cytokine mediated changes in paracellular permeability contribute to a multitude of pathological conditions including chronic rhinosinusitis (CRS). The purpose of this study was to investigate the effect of interferons and of Th1, Th2, and Th17 cytokines on respiratory epithelium barrier function. Cytokines and interferons were applied to the basolateral side of air-liquid interface (ALI) cultures of primary human nasal epithelial cells (HNECs) from CRS with nasal polyp patients. Transepithelial electrical resistance (TEER) and permeability of FITC-conjugated dextrans were measured over time. Additionally, the expression of the tight junction protein Zona Occludens-1 (ZO-1) was examined via immunofluorescence. Data was analysed using ANOVA, followed by Tukey HSD post hoc test. Our results showed that application of interferons and of Th1 or Th2 cytokines did not affect the mucosal barrier function. In contrast, the Th17 cytokines IL-17, IL-22, and IL-26 showed a significant disruption of the epithelial barrier, evidenced by a loss of TEER, increased paracellular permeability of FITC-dextrans, and discontinuous ZO-1 immunolocalisation. These results indicate that Th17 cytokines may contribute to the development of CRSwNP by promoting a leaky mucosal barrier.
... 29,32,33 To counter this argument, recent evidence would support antifungals in the appropriate patient group (identified by the Bent and Kuhn or modified Bent and Kuhn criteria). 34,35 Similarly, some patients have also responded to alternative treatments, such as Manuka honey, which has proven antifungal properties. 9,36 Differences between AFRS and CRSsNP SNOT-22 scores in the AFRS group improved significantly when compared with the reference group of CRSsNP in this study, which may reflect different disease burdens and/or pathophysiology because the latter are likely to have ostiomeatal complex occlusion as a key factor. ...
Background:
Given the differences in pathophysiology between allergic fungal rhinosinusitis (AFRS) and other chronic rhinosinusitis (CRS) subgroups, it remains unclear about whether these patients respond differently to a combination of surgical and medical treatments.
Objective:
To evaluate differences in quality-of-life (QoL) outcomes for a cohort of patients who underwent endoscopic sinus surgery (ESS) for CRS.
Methods:
This retrospective review included patients with CRS who underwent ESS between 2010 and 2013. QoL was measured by using the 22-item Sino-Nasal Outcome Test (SNOT-22). Variables collected included baseline demographics, SNOT-22 scores before ESS and at 1, 3, 6, 9, and 12 months after ESS. Groups tested were CRS with nasal polyposis, CRS without nasal polyposis (CRSsNP), and patients with AFRS. A linear mixed- effects regression model was used to calculate the adjusted mean QoL differences.
Results:
Among the 250 patients included, 61.6% had CRS with nasal polyposis (n = 154), 28.8% had CRSsNP (n = 72), and 9.6% had AFRS (n = 24). Significant differences were seen in SNOT-22 scores between pre- and postoperative visits and between the etiologic subgroups (p < 0.001). Multivariate analysis revealed significantly greater improvement in QoL for patients with AFRS in comparison with those with CRSsNP at the 9-month follow-up (change in SNOT-22 score, 22.6 [95% confidence interval, 1.2-44.1]; p < 0.0) and the 12-month follow-up (change in SNOT-22 score, 20.2 [95% confidence interval, 0.5-39.9]; p < 0.04).
Conclusions:
Patients with AFRS experienced a more-prolonged QoL benefit from surgical and targeted medical intervention compared with those with CRSsNP, which may reflect the severity of inflammation that they presented with compared with other CRS subtypes.
... It has been postulated that surgical removal of obstructing tissue allows better access for the use of intranasal AMB to prevent and minimize rhinosinusitis recurrence. 13 Therefore, intranasal AMB might be beneficial in postoperative care after FESS. Several studies applied intranasal AMB in patients after FESS. ...
Background
Fungus-driven inflammation is proposed to play an important role in the pathogenesis of chronic rhinosinusitis (CRS). Previous studies evaluated the efficacy of intranasal amphotericin B (AMB) in the treatment of patients with CRS, but the results were controversial. The purpose of this study was to evaluate the efficacy of 100 pg/mL of AMB nasal irrigation as postoperative care after functional endoscopic sinus surgery (FESS).
Methods
Patients with CRS who received FESS for treatment were recruited and randomly assigned to two groups at 1 month after surgery. Patients in the AMB group received 100 pg/mL of AMB nasal irrigation daily for 2 months, and those in the normal saline (NS) group received NS solution nasal irrigation daily for 2 months. Pre-FESS, pre-irrigation, and postirrigation sinonasal symptoms were assessed by questionnaires, and the patients received endoscopic examination, acoustic rhinometry, smell test, and saccharine transit test.
Results
Seventy-seven patients were enrolled between June 2012 and December 2014. Among the patients who completed the study, 38 received AMB irrigation, and 39 received NS solution irrigation. Although all the patients reported improvement after irrigation, there was no difference in outcome between patients who received AMB and those who received NS solution.
Conclusion
Our study showed that nasal irrigation with 100 pg/mL of AMB did not confer a greater benefit than that of NS solution nasal irrigation in post-FESS care.
... Plain radiographs are of limited value in evaluating patients, however it is still being utilized in resource poor settings like ours [9,11]; but the most preferred imaging modality is Computed Tomographic (CT) scan, Magnetic resonance Imaging (MRI) [9,[11][12]. The aim of every Otorhinolaryngologist, after making a diagnosis of rhinosinusitis is to come up with a treatment plan for the patient, which ranged from avoidance of identified allergens, antibiotics, anti-fungals; and sometimes resorting to surgical management [12][13][14]. Complications may arise from the pathology or mode of treatment adopted [15][16][17][18][19]. ...
... Rhinosinusitis is a devastating disease because it affects the quality of life of the sufferer, and also impacts psychological wellbeing and daily functioning [14]. In this study, no gender difference was found, as the Mal / Female ratio approaches unity. ...
Background: Rhinosinusitis is an inflammatory and infectious process affecting the nasal cavities and the paranasal sinuses. Objective: To evaluate the clinical profile and management of chronic rhinosinusitis in a resource poor country in sub-Sahara Africa. Methods: This was a 5-year retrospective study of patients managed for clinically and radiologically diagnosed chronic rhinosinusitis with/without nasal polyposis at National Ear Care Centre Kaduna, Nigeria. Patients' medical records were reviewed for relevant data which included demographics, clinical presentations, nasal cytology and radiologic reports and treatments. The data were collated and analysed using simple descriptive statistics. Results: There were 570 patients, 283 (49.65%) males and 287 (50.35%) females. Their age ranged from 18-80 (mean = 36.19± 12.23) with the majority (64.38%) in the second and third decades of life. The duration of symptoms ranged from 4-28 weeks with an average occurrence of 110 new cases per year. The main clinical presentations were were rhinorrhea in 478 (83.86%), nasal blockage in 413 (72.46%), excessive sneezing in 345 (60.53%), itchiness of ENT in 392 (58.0%) and nasal polyps in 8(1.40%). Allergy was the cause in 384 (64.43%) patients and microbiologic studies showed that 6 (1.05%) were fungi. Maxillary antral mucosal thickening and engorged inferior turbinates were the commonest radiological features. All our patients had medical treatments but only 43 (7.5%) patients who failed medical therapy had surgical treatment: bilateral inferior meatal antrostomy 21(48.83%); intranasal polypectomy 3(6.97%), frontoethmoidectomy 1 (2.33%), and FESS 17(39.53%). Conclusion: The clinical profile of chronic rhinosinusitis
