Episodes Of Acute Rhinosinusitis Research Articles

Гострий риноcинусит у дитячому віці - нове вирішення старої проблеми

Acute inflammation of the mucous membrane of the nose and paranasal sinuses (acute rhinosinusitis (ARS)) is a fairly common pathology in pediatrics and otorhinolaryngology. The aim of the research was to improve the effectiveness of treatment children with ARS by introducing a combination complex of natural plant extracts "Sinudafen" and effervescent isotonic seawater solution "Sparklin" and to investigate the effect of the proposed complex treatment on the frequency of repeated ARS. Materials and methods. The study was conducted between February and December 2023 in two independent centers. The study included 98 patients with signs of ARS. The Main group - 67 patients who received "Sinudafen" and "Sparklin" for 10-14 days, symptomatic and/or etiotropic therapy if necessary. The Control group - 31 patients who received standard therapy. The results. The examination carried out on the 14th day showed that, compared to standard treatment, the patients of the Main group had a statistically significantly lower risk of maintaining such local symptoms of ARS (edema of the mucous membrane and mucous secretions from the nose). With the faster rates of recovery of children in the Main group, the pharmacological load on patients decreased significantly. The use of "Sinudafen" and "Sparklin" in comparison reduced the need to prescribe antibacterial and antiseptic drugs in the acute period. Better clinical dynamics was accompanied by a reduction in the length of hospitalization, the use of "Sinudafen" + "Sparklin" increased the chances of reducing the duration of the acute period within ≤4 days. Conclusions. The use of "Sinudafen" and "Sparklin" complex in the treatment of children with ARS allows for a 3.8-fold increase in the chances of recovery within ≤4 days. The proposed complex treatment reduces the need for antibiotics/anesthetics by 15.8 times and reduces the risk of repeated episodes of ARS by 18.2 times during the 6-month follow-up period. The use of "Sinudafen" with "Sparklin" is characterized by good tolerability, absence of side effects, high adherence, and also reduces the cost of treatment of one episode of ARS by 50%. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Has COVID-19 Changed Pediatric Acute Rhinosinusitis Epidemiology During the First 2 Pandemic Years?

To study national pediatric acute rhinosinusitis (ARS) burden fluctuations before and during the first 2 coronavirus-19 (COVID) years, characterized by alternating lockdown and relaxation periods, the introduction of COVID vaccines, and the emergence of nonalpha COVID variants. This was a cross-sectional, population-based study covering the 3 pre-COVID years and the first 2 COVID years from a big database of the largest Israeli Health Maintenance Organization. For comparison purposes, we explored ARS burden trends with those of urinary tract infection (UTI), which is unrelated to viral diseases. We identified children <15 years presenting with ARS and UTI episodes and categorized them according to their age and presentation date. The average ARS and UTI episodes of the 3 pre-COVID years were used to calculate the incidence rate ratios (IRRs) of the 2 COVID years, analyzed separately. Seasonal variations were explored. We identified 44,483 ARS and 121,263 UTI episodes. There was a substantial reduction in ARS episodes during the COVID years (IRR 0.36, 95% CI: 0.24-0.56, P < 0.001). Although UTI episode rates also decreased during COVID (IRR 0.79, 95% CI: 0.72-0.86, P < 0.001), the reduction in ARS burden was 3-fold higher. The dominant pediatric ARS age group was between 5 and 15 years. The largest decrease in ARS burden was during the first COVID year. ARS episode distribution showed a seasonal fluctuation, with a peak during the summer months during the COVID years. Pediatric ARS burden decreased during the first 2 COVID years. Episode distribution was noted to be year-round.

Direct Costs of Acute Rhinosinusitis in Spain: A Prospective and Observational Study (PROSINUS).

The incidence of acute rhinosinusitis (ARS) is high throughout the world. Although diagnosis is clinical and disease course is mostly self-limiting, diagnostic tools and medications are overused by physicians, thus increasing the direct medical costs of the disease. Objective: The aim of the PROSINUS study was to quantify the direct medical costs of management of ARS in Spain. We performed a prospective observational study of 1610 patients with a clinical diagnosis of nonbacterial, uncomplicated ARS. According to the duration of symptoms by the European Position Paper on Rhinosinusitis and Nasal Polyps, patients were classified as having viral or postviral ARS with different levels of severity. Direct medical costs were calculated based on medical visits, use of diagnostic tools, and medications prescribed. Overall, the mean (SD) direct medical costs per episode were €322.3 (301.2) vs €441.1 (344.3) for viral and postviral ARS episodes, respectively (P<.001). When viral and postviral disease were compared, the medical costs per episode were €245.0 (265.4) vs €328.4 (301.9) for medical visits (P<.001), €38.1 (64.0) vs €61.9 (78.8) for diagnostic tools (P<.001), and €39.2 (25.9) vs €50.8 (25.3) for medications prescribed (P<.001). The direct medical costs of postviral ARS episodes were higher than those of viral episodes (common cold). Uncomplicated nonbacterial ARS represents an important socioeconomic burden owing to the excessive number of medical visits, use of diagnostic tools, and medications prescribed.

Endoscopic sinus surgery (ESS) to change quality of life for adults with recurrent rhinosinusitis: study protocol for a randomized controlled trial

BackgroundEndoscopic sinus surgery (ESS) has been used for decades to treat recurrent acute rhinosinusitis episodes (RARS) in adults. RARS results in infectious symptoms, antibiotic courses, sick leaves, and impaired quality of life. Theoretically, the ESS procedure, through improving the drainage of the paranasal sinuses, decreases the symptoms and enhances the quality of life of the RARS patients. Whether this is true has not been reported in a randomized trial yet.MethodsWe conduct a single-center, non-blinded, randomized, 6-month, parallel group superiority clinical study including 80 adult participants referred to surgical treatment for RARS. The participants will either have ESS or conservative medical treatment (control group). The primary outcome will be the difference between the mean disease-specific Sinonasal Outcome Test 22 (quality of life questionnaire) change scores (from baseline to 6 months) of ESS and control group.DiscussionThis study will add significant new information to the effect and harms of ESS procedure in the treatment of adults with RARS.Trial registrationClinicalTrials.govNCT04241016. Registered on 17 January 2020

Effects of the Traditional Mediterranean Diet in Childhood Recurrent Acute Rhinosinusitis

Introduction: There are more and more studies that demonstrate the anti-inflammatory effects of the traditional Mediterranean diet (TMD). The aim of the study was to assess the effects of an intervention with the TMD in patients with recurrent acute and chronic rhinosinusitis. Material and Methods: We performed a pretest–posttest comparison study in 114 patients (56 girls and 58 boys) aged one to five years who had three or more acute rhinosinusitis episodes in the period of 1 year. They were included for a year in the nutritional program “Learning to eat from the Mediterranean”. The anthropometric, clinical, and therapeutic characteristics were studied. Results: All the studied indicators showed a positive and statistically significant evolution. Of the patients, 53.5% did not have any episode of acute rhinosinusitis, and 26.3% had only one, compared to the 3.37 they had on average in the previous year. The use of antibiotics decreased by 87.6%. The degree of satisfaction of the families was very high. The Mediterranean Diet Quality Index (KIDMED) that assesses the quality of the TMD rose from 7.7 to 11 points. Conclusions: The adoption of the TMD could have promising effects in the prevention and treatment of recurrent acute and chronic rhinosinusitis, limiting the pharmacological and surgical intervention in many of these patients.

Особливості ураження ЛОР-органів у дітей з синдромом Дауна

Objective: сlinical relevance and prevalence of ENT diseases in children with Down syndrome (DS) of Ukrainian, according to a survey of their parents. Analyze educational work among primary care physicians. Materials and methods. During 2019, 137 respondents, who were parents of children with Down syndrome, were surveyed. Аge varied from 3 months to 18 years. Results. Scheduled medical examinations in ENT doctors have the ability to conduct 81% of families with children with DS. 72.3% of the interviewed had their hearing assessed, of whom 19% had their hearing checked annually. 27.7% of children with DS do not have a hearing test. A significant proportion (81%) of parents of children with DS did not offer to assess the child's hearing. Acute otitis media is more commonly recorded at the age of 1 to 5 years. Surgical treatment for otitis media was performed in 7.2% of patients (tympano puncture/tympanocentesisin 5.1%; performed more than 2 times in 0.7%; middle ear bypass grafting in 1.5%). Acute bacterial rhinosinusitis was noted in 40.9% of children with DS, of which 82.1% had more than 3 episodes of acute rhinosinusitis during their lifetime. Allergies were reported in 34.3%. Obstructive sleep apnea is noted by 26.3%. 70.8% of parents observe their baby's shortness of breath, snoring. As for surgery: adenotomy was performed in 20.5%, of which 1.5% of children performed more than 1 time. Adenotomy is planned in 30% of the respondents. Tonsillectomy was performed in 1.5%, with 0.7% planned for the near future. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the parents and patients was obtained for conducting the studies. No conflict of interest was declared by the authors. Keywords: Down syndrome, ENT pathology, ENT organs, children, adolescents.

Hypertonic seawater solution with brown algae extract Ascophillum nodosum in the treatment of acute rhinosinusitis

The article presents modern approaches to the modulation of cellular factors of innate immunity, oxidative stress factors when using a hypertonic seawater solution withAscophillum nodosumbrown algae extract (NaCl 15 g/l) in patients with acute rhinosinusitis.Characteristics of the children and research methods. The authors examined 102 children aged from 5 to 8 years, with a history of more than 5 episodes of acute rhinosinusitis per year. We evaluated the quantitative and qualitative composition of neutrophilic granulocytes in washes from the mucous membrane of the nasal cavity, the production of reactive oxygen species (ROS) by neutrophilic granulocytes, the content of lipid peroxidation products, enzymes of the antioxidant system – superoxide dismutase and catalase in nasal washes.Results.The authors found that the nasal spray of a hypertonic seawater solution withAscophillum nodosumbrown algae extract helps to normalize clinical picture, reduce number of relapses, restore functional and metabolic status of neutrophils of the nasal mucosa surface, restore balance of lipid peroxidation factors, antioxidant sustem enzymes – superoxide dismutase and catalase.

Antibiotics in chronic rhinosinusitis: A brief synopsis of literatures

Sinusitis is an inflammation or else infection of the nose and paranasal sinuses. These cavities are adjacent, and any provocative or transferrable process that touches one also communicates and contaminates others. Consequently, the important entity in this regard to remember that the befitting locution is: rhinosinusitis preferably apart from sinusitis. Chronic sinusitis, more accurately termed chronic rhinosinusitis (CRS), is diagnosed more often than acute rhinosinusitis (ARS). Rhinosinusitis is founded on the four key symptoms of 'obstruction, drainage, smell loss and facial pain or pressure' in both ARS and CRS. CRS relates to a progressive upsurge in healthcare exploitation, expenses and healthcare cost remains high. It has been estimated that widespread antimicrobials prescribing and use for CRS cost in the USA was more than the US $150 million to 2.4 billion per year and in the UK, it is about ≤10 million, which finally promotes antimicrobial resistance (AMR). Multiple meta-analyses revealed that the respiratory fluoroquinolones (specifically moxifloxacin, levofloxacin and gatifloxacin) were not able to establish superiority to β-lactams and other classes of antimicrobials for the management of ARS regarding the efficacy and ADR. Thereafter, three additional meta-analyses revealed that there were no corroboration and affirmation of superior efficacy, usefulness and lower adverse effects observed with any definite group of antibiotics in sinusitis. The current understanding regarding the pathophysiology of CRS microbial infection cannot be established, and antimicrobials role should be dedicated in the management ARS episodes or their contagious impediments, and the choice of antimicrobials should be channeled by optimally obtained on endoscopic sinus culture.

The role of infection and antibiotics in chronic rhinosinusitis.

ObjectiveTo review the current understanding of the role of infection and antibiotics in chronic rhinosinusitis.Review methodsPubMed literature searchResultsChronic rhinosinusitis (CRS) in adults is an inflammatory condition and the role of infection is unclear. Biofilms are present in both CRS and normal patients so their role in CRS is unknown. Sinus cultures in CRS demonstrate a mixture of aerobic and anaerobic bacteria but may be hard to interpret due to contaminating nasal flora. Staphylococcus aureus is common in CRS patients but also present in 20‐30% of nasal cultures in the normal population; eradicating this organism did not lead to symptom improvement versus placebo in a randomized controlled trial (RCT). In CRS patients who develop an episode of acute rhinosinusitis (ARS), bacteria typical of ARS can generally be cultured and require short‐course treatment. For CRS, topical antibacterial or antifungal agents have shown no benefit over placebo in RCTs, although RCTs of topical antibacterial agents have been small. Oral macrolides and doxycycline, antibiotics with anti‐inflammatory properties, are the only systemic antibiotics that have been evaluated in RCTs. One RCT found 3 weeks of doxycycline beneficial in patients with polyps but follow up was short (<3 months); RCTs of prolonged macrolide therapy have produced mixed results, and most show no benefit after cessation of therapy. Long‐term antibiotic therapy may produce side effects and select increasingly resistant flora. The American Academy of Otolaryngology—Head and Neck Surgery guidelines recommend against treatment of CRS with antifungal agents but do not comment on the role of antibacterial treatment.ConclusionThe role of infection in CRS is unknown, and the only well‐defined role for antibiotics is for treatment of ARS episodes or their infectious complications.Level of EvidenceN/A.

Middle Meatus Bacteriology of Acute Rhinosinusitis in Patients after Irradiation of Nasopharynx

Patients who undergo radiotherapy for nasopharyngeal carcinoma (NPC) tend to suffer from rhinosinusitis because irradiation causes damage to sinonasal tissue; however, their bacteriology is lacking in the literature. The aim of this study was to determine the bacteriology and antibiotic resistance in acute rhinosinusitis (ARS) of these patients. We collected nasal purulent discharge for bacteriology and antibiotic susceptibility tests in irradiated NPC patients with ARS. Middle meatus discharge was aspirated for culture with endoscopic assistance. A total of 33 episodes of ARS were documented in 25 patients. Staphylococcus aureus comprised 42% of all aerobes. Thirty-six percents of aerobic isolates were Gram-negative bacilli. Peptostreptococcus micros and Veillonella spp were the most frequently isolated anaerobes. The bacteriology in irradiated NPC patients with ARS was distinctive in the following: first, the most common pathogen was S. aureus; second, frequently isolated Gram-negative bacilli and anaerobes; and third, polymicrobial infections. The beta-lactamase-producing pathogens were highly prevalent.

Moxifloxacin versus levofloxacin for treatment of acute rhinosinusitis: a retrospective database analysis of treatment duration, outcomes, and charges

ABSTRACTObjective: Antibiotics are clinically indicated for acute bacterial rhinosinusitis, but they may be prescribed inappropriately. This retrospective study examined how labeled recommendations for duration of moxifloxacin and levofloxacin treatment of acute bacterial rhinosinusitis compare with real-world practice, and compared the failure and recurrence rates, and associated charges.Methods and main outcome measures: The PharMetrics Patient-Centric claims database was searched over a 3‐year period for episodes of acute rhinosinusitis treated within 5 days with moxifloxacin or levofloxacin. The duration of antibiotic treatment prescribed was compared with the labeled recommendation. Failure rates (a second antibiotic claim to treat acute rhinosinusitis within 30 days of the first claim), recurrence rates (subsequent antibiotic claims to treat any rhinosinusitis more than 30 days after the original or second [in the case of failure] claim), and treatment charges from the perspective of the payer (health insurer) were also compared using multivariate analysis.Results: The initial duration prescribed of moxifloxacin was shorter than for levofloxacin (–1.65 days, p < 0.0001), reflecting the shorter labeled recommendation (10 days versus 10–14 days). The durations of monotherapy (–2.06 days, p < 0.0001) and of all antibiotic treatment (–1.97 days, p < 0.0001) were also significantly shorter for episodes treated initially with moxifloxacin. The odds ratio for treatment failure (0.718; 95% confidence interval = 0.598–0.863; p = 0.0004) and the hazard ratio for recurrence (0.652; p = 0.0005) were both significantly lower for moxifloxacin than for levofloxacin, and resulted in lower total treatment charges (–$37.94 ± 13.65; p = 0.0055).Conclusion: The shorter treatment durations seen for moxifloxacin in this database of real-world care reflect the label-recommended duration for acute rhinosinusitis. Despite this shorter duration of therapy, moxifloxacin resulted in better outcomes than levofloxacin in terms of the risk of treatment failure and recurrence. In addition, the total charges were lower for patients treated with moxifloxacin.

Current management of acute bacterial rhinosinusitis and the role of moxifloxacin.

Episodes of acute rhinosinusitis are common among adults and are associated with a significant amount of morbidity. The symptoms of rhinosinusitis are nasal drainage, congestion, and sinus pressure. A bacterial sinus infection is more likely if these symptoms worsen after 5–7 days or do not improve after 10–14 days. The majority of bacterial episodes have been associated with Streptococcus pneumoniae and Haemophilus influenzae. In the current era of increasing resistance to β-lactams and macrolides, treatment guidelines have been formulated worldwide to assist clinicians in the selection of antibacterials. According to one model, the following antibacterials are most likely to provide desired outcomes (90%–92% predicted clinical efficacy) for adults: respiratory fluoroquinolones (i.e., moxifloxacin, gatifloxacin, and levofloxacin), ceftriaxone, and high-dose amoxicillin-clavulanate (4 g of amoxicillin/day and 250 mg of clavulanate/day). Although the role of the fluoroquinolones in the treatment of this condition is evolving, fluoroquinolones are often recommended as second-line therapy or as first-line therapy for selected patients (e.g., those who received antibacterials in the previous 4–6 weeks or adults with moderate-to-severe disease).

Chronic Recurrent Rhinosinusitis: Disease Severity and Clinical Characterization

The objective was to clinically characterize and determine disease severity parameters for chronic recurrent rhinosinusitis (CRRS). Prospective. A consecutive series of adult patients undergoing evaluation for CRRS was prospectively evaluated. Patients with four or more acute rhinosinusitis episodes in the previous calendar year with an absence of symptoms between episodes were considered as manifesting CRRS. Symptom severity and disease data from the Rhinosinusitis Symptom Inventory was obtained, as well as Lund staging information from the paranasal sinus CT scan. The Lund staging scores for patients with CRRS were compared with a control group of patients without CRRS. Symptom domain scores and disease severity parameters were compared between the CRRS group and a third group of patients with chronic persistent rhinosinusitis. In all, 30 patients met inclusion criteria for the diagnosis of CRRS. Mean age was 40.9 years with a 3:1 female preponderance. The mean Lund score for patients with CRRS was 3.79. Patients with CRRS failed to demonstrate a statistically different Lund score from control patients (mean Lund score, 4.26 [P = .538]). Symptom severity scores according to Rhinosinusitis Symptom Inventory domains were largely similar for the nasal, facial, and total symptom domains between patients with CRRS versus chronic persistent rhinosinusitis. However, patients with CRRS demonstrated statistically significant increases in oropharyngeal and systemic symptom domain scores. Patients with CRRS also had significant increases in number of antibiotic courses (4.8 vs. 2.9 [P < .001]) and number of missed workdays (8.8 vs. 4.6 d [P = .046]) attributable to rhinosinusitis. Chronic recurrent rhinosinusitis is a distinct form of chronic rhinosinusitis differing somewhat from chronic persistent rhinosinusitis. However, patients with CRRS still experience significant symptoms associated with this diagnosis, which results in significant medication usage and workplace impact.