Lund-Mackay Scale Research Articles

Analysis of the Construction of a Predictive Model for Eosinophilic Chronic Rhinosinusitis.

This study aimed to determine indices to diagnose and predict eosinophilic chronic rhinosinusitis (ECRS) during the initial clinic visit. We retrospectively analyzed 116 patients with chronic rhinosinusitis who underwent endoscopic sinus surgery and were classified according to the postoperative pathological diagnosis. General data and various clinical indicators were analyzed, and indicators with statistically significant differences between groups were further incorporated into a multivariate logistic regression to establish a comprehensive prediction model. The receiver operating characteristic (ROC) curve was used to compare the two significant valuable single factors from previous studies, the difference in CT scores between the ethmoid sinus and the sum difference of the maxillary sinus (EM difference) and the absolute value of peripheral blood eosinophil (bEOS), with a comprehensive prediction model. There were significant differences in history of allergic asthma (p < 0.001), visual analog scale (VAS) score (p=0.005), sino-nasal outcome test-22(SNOT-22) scale score (p=0.004), Lund-Mackay scale score (p=0.017), EM difference (p=0.002), percentage of bEOS (%)(p=0.001), and absolute value of bEOS (×109/L) (p=0.000) between the two groups (p< 0.05). The history of allergic disease, VAS and bEOS were screened out and included in the comprehensive prediction model. The area under the curve (AUC) of the comprehensive prediction model (0.804)> the AUC of the absolute value of the bEOS (0.764)>the AUC of the EM difference (0.655). The AUC of the EM difference and the comprehensive prediction model were statistically different (P=0.025). There was no statistical difference between the absolute value of bEOS and the AUC of the comprehensive prediction model. The comprehensive prediction model covering the three aspects of allergic asthma history, VAS score, and bEOS count had the highest AUC compared to the other predictors and had good predictive power for the diagnosis of ECRS.

Comparasion of the anatomic and therapeutic effect of two transsphenoidal approaches under neuroendoscopy

ObjectiveTo compare anatomical parameters, postoperative nasal complications and quality of life of 2 sphenoid sinus approaches (nasal septum approach and transsphenoidal anterior wall approach) via anterior wall by endoscopic surgery. MethodsThe study was anatomic basis research and prospective randomized double-blind (Clinical trials registration number: NFEC-2015-033). Study was performed in 30 dissected heads via 2 approaches. The related anatomic parameters were measured. Another 60 patients with pituitary tumor were randomly divided into 2 groups to receive endoscopic surgery. The selected otolaryngologist and non-operative neurosurgeon common then analyzed preoperative indicators. The therapeutic effect and nasal complications of 2 transsphenoidal approaches were compared by Lund-Kennedy scale, Lund-Mackay scale and SNOT-20 scale. ResultsThe distances between incision and external nostrils of anterior wall in nasal septum approach and transsphenoidal anterior wall approach are 5.19 ± 0.15 versus 6.91 ± 0.14 cm, respectively; maximum angles and ranges of swing in horizontal direction on operative route are 44.77 ± 2.04° versus 38.54 ± 1.40°, and 1.25 ± 0.15 versus 0.59 ± 0.52 cm. The operation time in nasal septum approach group is shorter (61.97 ± 18.123 min) than transsphenoidal anterior wall approach group (89.83 ± 38.515 min); And higher Lund-Kennedy score (2.4737 ± 1.46699 vs 3.8125 ± 1.51520. In addition, 20 Subjective Scoring Scales for Nasal and Paranasal Sinus Outcome (SNOT-20) measurement results indicated nasal septum approach group has less subjective symptoms plague patients' lives. The cerebrospinal fluid leakage, resection of tumor, postoperative endocrine remission rate and postoperative complications occurred in 2 groups have no significant difference. ConclusionEndonasal transsphenoidal via nasal septum-sphenoid sinus approach has characters of less surgery damage, short distance to the outside of the nose, precise location, wider operation space and larger perspective, which is obvious advantages in reducing postoperative nasal complications.

Experience of biological therapy in severe forms of chronic rhinosinusitis with nasal polyps in the conditions of regional healthcare

To analyze our own experience, clinical and organizational features of the application of the method of biological therapy in patients with severe forms of recurrent CRSwNP. 25 patients with severe and moderate forms of CRSwNP were examined, who, in a round-the-clock hospital (model CSG 36.018) was treated with Dupilumab, in the form of subcutaneous injections of 300 mg/2 ml 1 every two weeks. The diagnosis was confirmed on the basis of anamnestic data, SNOT-22 quality of life questionnaires, visual endoscopic examination, evaluation of CT data (Lund-Mackay scale), laboratory data. The effectiveness of treatment was monitored after 16 weeks, based on endoscopic examination data, evaluation of CT and SNOT-22 data. In 3 observations, a study of pathomorphological material for tissue eosinophilia was performed. The duration of the course of treatment ranged from 10 to 56 weeks. The most striking clinical effect was observed for signs such as sense of smell and nasal breathing (in some cases-after the first injection). The degree of regression of polyps according to CT and endoscopic examination was more prolonged in time, the same dynamics was observed in the level of total IgE. In a number of patients, the phenomenon of eosinophilia growth was observed against the background of treatment (with regression of clinical symptoms). Pathomorphological examination confirmed a high level of tissue eosinophilia as one of the fundamental signs of Th2 inflammation. One patient with concomitant chronic tubar dysfunction had an improvement in hearing. All patients with AD noted a subjective improvement in disease control (a decrease in the frequency and severity of choking attacks). The cancellation (break in treatment) of treatment was accompanied by a gradual return of symptoms in all patients at various times. Patients who have not achieved an acceptable level of control of CRSwNP,that meets the criteria of Th2 inflammation can be considered as candidates for the use of targeted biological therapy. With strict compliance with the selection criteria, there is a good clinical effect, primarily in relation to nasal symptoms (sense of smell and nasal breathing) and improved control of asthma symptoms.

Взаимосвязь между нарушениями цилиарного аппарата эпителия слизистой оболочки носа и тяжестью синоназальной патологии у детей с хроническим риносинуситом

The aim of this study was to study the relationship between disorders of the ciliary apparatus of the epithelium of the nasal mucosa and the severity of sinonasal pathology in children with chronic rhinosinusitis. 186 children aged 6 to 17 years with a diagnosis of chronic rhinosinusitis were examined. The severity of sinonasal pathology was assessed by the results of computed tomography in accordance with the Lund–Mackay scale. By the method of videocytomorphometry, such parameters: the proportion of cells with mobile cilia (%), cell survival (min), the beat rate of cilia (BCC) (Hz), the length of cilia (microns) were determined. According to the distribution of data, the lowest values of the studied indicators (Q1) are regarded as pronounced violations, while the highest values (Q4) correspond to minor violations. Children with moderate and mild decrease in the proportion of cells with mobile cilia, as well as BCC, were characterized by 17 and 25%, as well as 25 and 37% lower score on the Lund-Mackay scale compared with patients with severe violations of these parameters, respectively. A marked decrease in cell survival and cilia length was also associated with a significant 25% increase in the total score on the Lund–Mackay scale relative to patients with lower severity of ciliary disorders. The gradation based on two parameters, the BCC and the length of the cilia, led to even more pronounced differences between the groups in the total assessment on the Lund–Mackay scale. The data obtained, on the one hand, confirm the role of disorders of the mucociliary apparatus in the pathogenesis of CRS and its progression, while on the other, expand the arsenal of diagnostic tools and predicting the severity of CRS in children.

Rhinological Status of Patients with Nasolacrimal Duct Obstruction

Introduction Studying the state of the nasal cavity and its sinuses and the morphometric parameters of the inferior nasal conchae, as well as a comparative analysis of obtained values in patients with primary (PANDO) and secondary acquired nasolacrimal duct obstruction (SALDO), is relevant. Objective To study the rhinological status of patients with PANDO) and SALDO). Methods The present study was based on the results of computed tomography (CT) dacryocystography in patients with PANDO ( n = 45) and SALDO due to exposure to radioactive iodine ( n = 14). The control group included CT images of paranasal sinuses in patients with no pathology ( n = 49). Rhinological status according to the Newman and Lund-Mackay scales and volume of the inferior nasal conchae were assessed. Statistical processing included nonparametric statistics methods; χ 2 Pearson test; and the Spearman rank correlation method. Results The difference in values of the Newman and Lund-Mackay scales for the tested groups was significant. A significant difference in scores by the Newman scale was revealed when comparing the results of patients with SALDO and PANDO. Comparing the scores by the Lund-Mackay scale, a significant difference was found between the results of patients with SALDO and PANDO and between the results of patients with PANDO and the control group. Conclusion It was demonstrated that the rhinological status of patients with PANDO was worse than that of patients with SALDO and of subjects in the control group. No connection was found between the volume of the inferior nasal conchae and the development of lacrimal duct obstruction.

Clinical characteristics of odontogenic sinusitis with periapical lesions

IntroductionAlthough the symptoms and radiographic signs may mimic rhinogenic sinusitis, odontogenic sinusitis (OS) with periapical lesions (PALs) is fundamentally an endodontic infection. It is considered to be one of the main causes of OS, especially when presented unilaterally. Despite this routine dental examination is not performed and periapical infection frequently remains undiagnosed by otolaryngologists and radiologists. Material and methodsThis prospective observational study covered a group of 61 patients with symptomatic OS with PAL. Assessment of quality of life was done using the 22-item Sino-Nasal Outcome Test-22 (SNOT-22) and Oral Health-Impact Profile-14 (OHIP-14). Temporal and etiological relationship between the dental cause and sinonasal complication was established among the otolaryngologist and dental specialist based on the clinical symptoms, nasal endoscopy described according to the modified Lund-MacKay scale, computed tomography (CT) scans measured and scored in compliance with Lund- Kennedy, Zinreich and Estrela scales. ResultsOut of 61 patients, 28 (46%) were women and 33 (54%) men. Group median age 49.1 years, ranged from 22.8 to 78.9 years.Total OHIP-14 score was 12.7 ± 11.3, with the highest value obtained in domains describing physical pain (mean 2.9 ± 2.4, median 3) in which the highest score was obtained in item 3 – painful aching in mouth and/or teeth – scored ≥2 by 52.5% of participants. Concerning dental symptoms 11.5% of patients were asymptomatic.Total SNOT-22 score was 40.7 ± 21.1, with the highest value in domains describing nasal symptoms. 23% of patients reported mild, 44.3% moderate and 32.7% severe symptoms.In the endoscopic evaluation 86.8% of cases presented discharge, 73.8% mucosal edema. In 11.5% of cases the polypoid tissues was observed in nasal cavities.The first molar tooth was the most frequently affected with an incidence of 42.6%, followed by the second molar (27.9%).In 33 (48.5%) of cases the inflammatory process caused the discontinuity of the sinus floor, which in 51.5% coexisted with total maxillary sinus opacification.10 teeth (14.7%) had the periapical lesions with a diameter exceeding 8 mm. In case of the multi-rooted teeth, PALs were usually encountered at more than one root (57.4%). Maxillary and ethmoid sinus were affected in 54% of cases and additional frontal sinus involvement in 32.8%. In 69.6% patients, ostiomeatal complex was obstructed. ConclusionsPersistent sinonasal symptoms such as rhinorrhea, post-nasal drip and nose congestion along with dental pain may suggest endodontic nature of OS, especially after previous root-canal treatment. The bigger the PAL is in diameter and the closer to the maxillary sinus, the greater effect on its mucosal involvement and obstruction of ostiomeatal complex is observed. PALs around molar or premolar tooth apexes with coexistence of unilateral sinus opacifications should be noticed and mentioned by radiologists and evaluated by dental specialists in order to refer the patient to further treatment.

Is there a relationship between Lund-Mackay scale, olfactory bulb depth and width, and Keros classification in patients with nasal polyps?

Abstract OBJECTIVE. We investigated the relationship between Lund-Mackay scale, olfactory bulb depth and width, and Keros classification in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). MATERIAL AND METHODS. In this retrospective study, paranasal sinus computed tomography (PNSCT) images of 47 patients with CRSwNP and 47 healthy subjects (control) were evaluated. In the CRSwNP group, PNSCT scans were assessed based on Lund-Mackay scale. In both groups, olfactory fossae (OF) depth and width, and Keros classification were evaluated. RESULTS. The total Lund-Mackay score was 17.1±5.9. There were no significant differences between OF depth and width values of the nasal polyps group and control group. For both groups, Type II Keros was the most detected type; secondly, Keros type I and rarely Keros type III were detected. There was no significant correlation between Lund-Mackay score (All items and total score) and OF depth and width, and Keros type. There were negative correlations between ipsilateral OF depth and width (p&lt;0.05), whereas there were positive correlations between contralateral OF depth and width (p&gt;0.05). Keros type was positively correlated between ipsilateral and contralateral OF depth and Keros type (p&lt;0.05). In older patients, left OF depth and Keros type decreased (p&lt;0.05). CONCLUSION. As a conclusion, there was no correlation between Lund-Mackay score and olfactory fossa dimensions (depth and width). When considering age, one could notice that Keros type decreased in older patients.

Decreased nasal nitric oxide levels: A potential marker of decreased olfactory discrimination in chronic rhinosinusitis.

AbstractObjectiveThis study aimed to investigate the association of nasal nitric oxide and olfactory function.MethodA cross-sectional study was performed in 117 adults, including 91 patients with chronic rhinosinusitis and 26 healthy controls. Scores on the 22-item Sino-Nasal Outcomes Test, Lund-Mackay scale and Lund-Kennedy scale were recorded to assess severity of disease. All participants were screened for common inhaled and food allergens. Nasal nitric oxide and fractional exhaled nitric oxide testing, acoustic rhinometry and anterior rhinomanometry testing were performed to measure nasal function. The validated Sniffin’ Sticks test battery was used to assess olfactory function.ResultsHigher nasal nitric oxide was an independent protective factor for odour discrimination and odour threshold in participants with chronic rhinosinusitis after adjusting for age, gender, drinking, smoking, 22-item Sino-Nasal Outcomes Test, Lund-Mackay score, Lund-Kennedy score, immunoglobulin E and the second minimal cross-sectional area by acoustic rhinometry. Nasal nitric oxide also showed high discrimination in predicting impaired odour discrimination. In addition, nasal nitric oxide was lower in older participants, those with higher Lund-Mackay or Lund-Kennedy scores and higher with elevated total serum immunoglobulin E concentrations above a threshold of 0.35 kU/l.ConclusionHigher nasal nitric oxide is associated with better odour discrimination in chronic rhinosinusitis and is modulated by age, degree of allergy and severity of chronic rhinosinusitis.

Impacts of sinonasal polyposis on ventilatory pulmonary function pre and post functional endoscopic sinus surgery

Background: the upper and lower airway form one contagious functional unit and exposed to same similar inflammatory stimuli that support hypothesis disease in one part could reflect or manifest on another.Objective:to assess the effects of sinonasal polyposis on ventilatory function tests pre and post functional endoscopic sinus surgery (FESS).Methodology: This Interventional study was carried out on 30 patients presented with chronic rhinosinusitis with nasal polyposis. All patients subjected to assessment of nasal obstruction scale (NOSE), nasal endoscopic examination, Lund MacKay CT score and PFT before and three months after FESS.Results: there was significant decrease of 2 items of NOSE scale (nasal obstruction and trouble sleeping), endoscopic examination score, and Lund MacKay CT score, with significant increase of PFT (FEV1FVC ratio, FEV1 %, FVC % and FEF 25-75%) three months post-operatively compared to preoperative values (p-value < 0.001). In the preoperative period 73.3% have obstructive PFT while in the post-operative period only 36.6% have obstructive pattern in PFT (p =0.004). By using multivariate logistic regression analysis, the most significant predictive factors of abnormal PFT in patients with sinonasal polyposis were right CT Lund MacKay scale (B= 0.74, p =0.014), left CT Lund MacKay scale (B= 0.56, p = 0.01), and total Lund MacKay CT score (0.4, p= 0.01). Conclusions: the sinonasal polyposis have negative effects in PFTs that improved after FESS. The predictive factor for reduced PFTs in patients with sinonasal polyposis is Lund MacKay CT score.

Relationship between the Severity of Inflammatory Changes in Chronic Sinusitis and the Level of Vitamin D before and after the FESS Procedure.

There have been a few reports confirming that vitamin D (VD3) deficiency increases inflammation in the paranasal sinuses. The work brings new information that, despite the presence of inflammation before surgery, patients with higher vitamin D levels had less inflammation, and this has been proven on three levels. We show that vitamin D levels clearly correlate with the severity of the disease in chronic sinusitis. These results have been confirmed in imaging studies (Lund MacKay scale), endoscopy (Lund-Kennedy scale) and in the SNOT 20 questionnaire. 40 patients suffering from chronic sinusitis were divided into two equal groups: group 1: with less severe radiological changes (10 or less points on the Lund-Mackay scale), group 2: with a more advanced form (>10 points). The relationship between VD3 and the severity of the disease (clinical and nasal endoscopy) was assessed. The mean VD3 level in patients in group 2 before surgery was lower (23.01 ng/mL) than in group 1 (28.02 ng/mL) (p < 0.05). They presented a higher degree of advanced changes in all the above scales, i.e., before the SNOT 20 procedure, the mean was: group 1: 30.33, group 2: 31.80 (p < NS); Lund-Kennedy: group 1: 3.21, group 2: 6.30 (p < 0.05). After surgery an increase in VD3 levels was observed in both study groups: in group 1 to the value of 37.98 ng/mL (p < 0.002) and in group 2 to 27.67 ng/mL (p < 0.004). Lower VD3 levels were found in patients with a higher stage of the disease. Reduction of inflammation increases the level of VD3 and reduces subjective and objective symptoms of chronic inflammation.

Assessment of the severity of chronic sinusitis in children with cystic fibrosis using the Lund-Mackay Score depending on genotype

Introduction. Chronic sinusitis affects most patients with cystic fibrosis (CF). The Lund-Mackay (LM) scale is an objective tool allowing for easy assessment of the severity of lesions in sinuses observed in computed tomography (CT). The link between clinical picture, image results and CFTR gene mutations is not well evaluated. Aim. To specify the correlation of the severity of lesions found in computed tomography and the CFTR gene mutation type causing an underlying disease in children with cystic fibrosis. Material and methods. Data of the children with cystic fibrosis who underwent CT between 2016-2018 at the Department of Paediatric Otolaryngology of the Medical University of Warsaw was analysed. The following factors were taken into account: age, sex and CFTR gene mutation type. Each CT was assessed using the basic and modified Lund-Mackay Score (LMS and MLMS). The study was retrospective. Results. 34 children, 16 girls and 18 boys aged between 3 and 17 years (median age ? 10 years), were enrolled to the study at the time of CT. LMS median was 17 (range 2-23), and MLMS ? 18 (range 2-24), and their difference was statistically significant. 16 patients were F508del homozygous. Severe CFTR mutation in both alleles was observed in 28 patients, and mild mutation was found in at least one allele in 6 patients. LMS median in the group of patients with severe mutation was 17.5, and in the group of patients with mild mutation ? 14.5. MLMS median was 18 and 14.5, respectively. The difference was statistically significant for both LMS and MLMS. No statistically significant correlation was found between the LMS and MLMS results and sex. The weak positive correlation between LMS and MLMS and patient’s age was not statistically significant. Hypoplasia or aplasia of one or more paranasal sinuses was observed in 11 children (32%). Conclusions. The score on the modified Lund-Mackay scale is higher than the score on the basic LMS scale in children with cystic fibrosis. The group of patients with a severe CFTR gene mutation has higher scores for both LMS and MLMS than the group with a mild mutation. Due to frequent sinus aplasia in children with cystic fibrosis, the use of the modified Lund-Mackay scale allows for error avoidance when comparing CT results of different patients.

Impact of reslizumab on the course of chronic rhinosinusitis in patients with eosinophilic asthma

To evaluate the therapeutic potential of reslizumab-humanized anti-IL-5 monoclonal antibody for the treatment of CRS with polyps in patients with severe asthma. We investigated the cases of 9 patients with severe asthma treated with intravenous reslizumab at a dose of 3 mg per 1 kg of weight with regularity once in 4 weeks. The presence of CRS with polyps was revealed in 7 of 9 patients, SCT scanning of the paranasal sinuses indicated changes in all the patients, 2 patients had symptoms of chronic non-allergic rhinitis (NARES).The treatment effectiveness control was carried out after 6 months from the beginning of the treatment by the dynamics of nasal symptoms (SNOT-22), endoscopic image of the nose, total polyp score (TPS), changes in the SCT of the paranasal sinuses on the Lund-Mackay scale, rhinocytogram, the content of eosinophilic cationic protein in the blood, the level of systemic eosinophilia. The effectiveness of asthma control was assessed by the reduction of the frequency of asthma exacerbations, the need for systemic corticosteroids, spirometry data and Asthma Control Test (ACT) results. Along with a marked improvement in asthma control, 8 out of 9 patients displayed clinical, endoscopic, radiological signs of weakening of nasal symptoms. More significant improvement in asthma control was achieved in patients having CRS with polyps. In the group of patients having CRS with polyps, it was possible to detect anamnestic presence of NARES symptoms in the early stages of the disease. This indicates that NARES can be a precursor to the development of eosinophilic, non-IgE-induced asthma and nasal polyps. Treatment with reslizumab in patients with eosinophilic asthma and concomitant CRS with polyps and chronic non-allergic rhinitis (NARES) leads not only to improved control of asthma symptoms, but also to a significant regression of nasal symptoms.

Balloon sinuplasty in one-day surgery.

IntroductionBalloon sinus dilation is becoming an increasingly common procedure, finding a niche as an invaluable tool in endoscopic sinus surgery.AimTo assess the effectiveness of balloon sinus dilation (BSD) in 1-day surgery in patients with chronic rhinosinusitis without polyps based on our own experience.Material and methodsThe study group consisted of 9 patients. The Lund-Mackay scale for computed tomography of the paranasal sinuses was assessed prior to surgery. Endoscopy was performed on the basis of the Lund-Kennedy scale and patients were asked to perform the SNOT-22 survey. Two patients underwent balloon sinuplasty under general and seven under local anaesthesia.ResultsTwelve maxillary and eight frontal sinuses were widened (four attempts were unsuccessful). The SNOT-22 survey was assessed the day after surgery (average of 8 points) and a month after surgery (average of 15.5 points).ConclusionsBSD only allows widening of the ostia of the maxillary, frontal and sphenoid sinuses. BSD offers shorter post-surgical recovery, and a more rapid return to work because of its less invasive and less traumatic nature.

Correlation of Serum Vitamin D Levels with Chronic Rhinosinusitis Disease Severity.

Introduction:The present study was conducted to investigate the association between the serum vitamin D levels and severity of disease in chronic rhino sinusitis (CRS) patients.Materials and Methods:This prospective cross-sectional study was conducted on a total of 93 patients suffering from chronic rhino sinusitis with nasal polyposis (CRS w NP). Serum level of 25-hydroxyvitamin D was detected using a simple blood test. A22-item questionnaire, namely the sinonasal outcome test-22 (SNOT-22), was used to assess the subjective disease severity and patients' quality of life. In addition, the radiographic signs of the disease severity were evaluated using the Lund-Mackay Scale (LMS).Results:The mean age and serum vitamin D level of the patients were measured at 37.7±13.6 years and 24.6±16.9 ng/ml, respectively. Moreover, the mean of LMS and SNOT-22 scores were calculated at 14.2±11.2 and 40.8±17.6, respectively. There was a negative correlation between the SNOT-22 and serum levels of vitamin D (P=0.034). Similarly, LMS and serum vitamin D levels were correlated negatively (P=0.027). Furthermore, the results revealed a direct relationship between LMS and SNOT-22 (P<0.0001).Conclusion:According to the obtained results, there was a significant relationship between the serum vitamin D levels and severity of disease in patients with CRS w NP. Therefore, serum vitamin D levels could be added to the routine workup of the patients suffering from CRS w NP.

New approach to treatment of polypous rhinosinusitis

Polypous rhinosinusitis (PRS) is a hardly treatable disease due to the unknown etiology and recurrent course. Standard treatment regimens are aimed at removing polyps and reducing the activity of inflammation, while little attention is paid to pathogenesis factors such as oxidative stress and mucociliary insufficiency. To improve the combined treatment of PRS. The study involved 98 patients (50 people - the study group, 48 people - control group). The structure of the comorbid pathology of patients in the control group was selected so as to correspond to the pathology in the study group. Patients of both groups received combined treatment, including surgical treatment in accordance with the FESS principles, followed by the prescription of 200 mcg mometasone furoate in each half of the nose for 6 months. The treatment of patients of the study group also included the drug N-acetylcysteine - 3 ml (300 mg) in each maxillary sinus intrasurgicaly, then 600 mg orally in the morning after meals for 6 months. Survey methods included a questionnaire survey using the SNOT-22 questionnaire, the prevalence of the polypous process was assessed by endoscopy (Claus Bachert scale) and CT (Lund-Mackay scale), and mucociliary function was also evaluated by performing a saccharin test. The results were compared with each other before surgery and after 6, 12 and 24 months after surgery. Patients who have been taking N-acetylcysteine for a long time have a more pronounced and long-term improvement in their general condition (according to SNOT-22, an average by 1.7 times, p<0.05) compared with patients in the control group. Also, the frequency of relapses decreases and the effectiveness of surgical treatment increases (according to the Lund-Mackey scale - 5.02 in the experimental group and 10.75 in the control; according to S. Bachert - 1 point and 3 points, respectively). Long-term use of N-acetylcysteine in PRS increases the effectiveness of surgical treatment, reduces the frequency of relapses, and also improves the general condition of patients.

TOMOGRAPHIC EVALUATION OF THE PARANASAL SINUSES AFTER THE LE FORT I OSTEOTOMY

Objective This study evaluated paranasal sinus abnormalities in patients submitted to orthognathic surgery using the Le Fort I osteotomy by evaluating tomographic features. Study Design The methodology consisted of the use of cone beam computed tomography (CBCT) for evaluating the maxillary sinus volume, detection, and diagnosis of anatomic defects. In addition, the paranasal sinuses were also classified according to the Lund-Mackay scale. All the aspects evaluated were performed in 3 times: preoperative (T0), postoperative of up to 30 days (T1), and postoperative of at least 5 months to 1 year (T2). Statistical analysis was performed using analysis of variance (ANOVA) and Student t test for non-paired samples. Results It is noted that the decrease in the air volume of the paranasal sinuses and increase of the values in the scale of Lund-Mackay are present only significantly in T1 in relation to T0 and T2 with P Conclusions It is concluded that the surgery does not present a risk for increasing tomographic aspects of rhinosinusitis in the paranasal sinuses after the late follow-up.

Anti-immunoglobulin E therapy: is it a valid option for the management of chronic rhinosinusitis with nasal polyposis?

ObjectivesTo evaluate the efficacy of omalizumab (OMA) therapy for patients with chronic rhinosinusitis with nasal polyposis as a sole therapeutic line versus traditional therapy.Patients and methodsEighty-six patients were randomly divided into two equal groups: study patients received OMA [0.016 mg/kg/immunoglobulin E (IgE) (IU/ml)] therapy only and control patients received conventional therapy. All patients completed a questionnaire to determine the total subjective score (TSS), who underwent rigid nasal endoscopy for endoscopic scoring according to the Lund-Kennedy scoring system, had paranasal sinuses computed tomographic (CT) imaging for scoring according to the Lund-Mackay scale, and estimation of pretreatment serum IgE levels. Study outcomes included the therapeutic effect determined as more than 50% decrease of TSS with improvement on endoscopic findings, recurrence rate, and frequency of decision; shift to surgery or repeat the trial of OMA therapy.ResultsSerum IgE level positively correlated with TSS and endoscopic and CT scores. Seventeen patients had successful response without recurrence with significantly lower TSS in the study versus control patients. Twenty-seven patients had recurrence after primary successful outcome with significantly lower TSS in study than control patients and significantly longer duration till recurrence with OMA than conventional therapy. Forty-two patients showed no response to the first session of therapy. Nineteen study patients with recurrent manifestations received a second session of OMA therapy; 11 had successful response, five patients had rerecurrence, and three patients failed to respond. Surgery-sparing effect is significantly higher with OMA than conventional therapy (46.5 vs. 18.6%). Endoscopic and CT scores of total patients, at the end of follow-up, were nonsignificantly lower in control while they were significantly lower in the study group.ConclusionOMA significantly superiorly improved the outcome of conservative treatment of chronic rhinosinusitis with nasal polyposis than conventional with higher surgery-sparing rate. The second session of OMA minimized the recurrence rate of manifestations.

The Effect of Antileukotrienes on the Results of Postoperative Treatment of Paranasal Sinuses in Patients with Non-Steroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease

Background: Based on endoscopic examination, chronic rhinosinusitis (CRS) is divided into chronic inflammation with (CRSwNP) or without nasal polyps (CRSsNP). On the basis of the pathomechanism of inflammation, CRS is divided into endotypes. Eosinophilic CRSwNP with coexisting bronchial asthma and hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is a real therapeutic challenge. Aim: Comparative analysis of the results of treatment of patients with CRSwNP, bronchial asthma, or hypersensitivity to NSAIDs (NSAID-exacerbated respiratory disease, NERD), using antileukotrienes (leukotriene receptor antagonists, LTRAs) or intranasal glucocorticoids or both drugs together after endoscopic sinus surgery (ESS). Material and Methods: 33 patients (11 male, 33%) with NERD divided into three groups treated with LTRAs or intranasal glucocorticoids or both drugs together were assessed in terms of general well-being, state of pathological changes, and olfactory disorders using the following tools: Sino-Nasal Outcome Test, Visual Analogue Scale, Brief Identification Smell Test, and Lund-Kennedy score before and at 12 months after surgery. CT assessments were made prior to surgery using the Lund-MacKay scale. Results: Comparable efficacy of treatment with nasal steroids and antileukotrienes was found after 12 months of observation of patients. Conclusions: The results suggest comparable efficacy of treatment with nasal steroids and antileukotrienes in patients with NERD after ESS. Treatment with montelukast and mometasone has not been shown to be superior to both drugs administered separately.

Эффективность эндоскопической риносинусохирургии при антрохоанальных полипах в детском возрасте

Antrochoanal polyps (ACP) are benign tumors, mainly originating from the maxillary sinus. The incidence in children is high – up to 35% of all chronic polypous rhinosinusitis. Endoscopic examination of the nasal cavity and computed tomography of the paranasal sinuses (PS CT) are generally used for ACP diagnostics. The medical treatment of ACP is deemed ineffective. Multiple options have been proposed for surgical treatment of ACP, including those used in children. In recent years, the role of FESS in the surgical treatment of ACP has increased. This paper provides an analysis of the efficacy of surgical treatment of 50 children with ACP at the period of 2012-2018 at Children’s Municipal Multidisciplinary Clinical Center for High Medical Technologies named after K. A. Rauhfus. All patients were operated on using endoscopic endonasal access. 40 children (80%) underwent combined access surgery. The efficacy analysis was carried out according to sino-nasal outcome test SNOT-20 (GAV), Lund-Kennedy endoscopic evaluation scores, Lund-Mackay computed tomography results evaluation scale. Our results showed the statistically significant association of improvement of all symptoms according to SNOT-20 (GAV) scale (p &lt; 0,05) after FESS. Moreover, the analysis of nasal endoscopy results showed the pronounced positive changes in the parameters of the „discharge“ and „mucosal edema“ in the postoperative period according to Lund-Kennedy scale (p &lt; 0,05). A statistically significant association of improvement of PS CT signs according to Lund-Mackay scale after FESS is also observed. The most significant changes were observed in the maxillary sinuses, anterior and posterior ethmoid cells, as well as in the osteomeatal complex on both sides, on average by –1 point (p &lt; 0,05). Therefore, FESS has proven its efficacy at ACP in children.

Residual exhaled nitric oxide elevation in asthmatics is associated with eosinophilic chronic rhinosinusitis

Objective: Eosinophilic chronic rhinosinusitis (ECRS) is as a subgroup of chronic rhinosinusitis (CRS) with nasal polyps. ECRS is a refractory disease closely related to bronchial asthma. Fractionated exhaled nitric oxide (FeNO) levels were reportedly elevated in some asthmatics with CRS after adequate treatment, suggesting that residual eosinophilic airway inflammation or ECRS might affect FeNO levels. Methods: To investigate the association between asthma with ECRS and FeNO levels, we examined FeNO levels in 133 asthmatics (99 with ECRS and 34 without ECRS) and 13 patients with ECRS without asthma. The severity of asthma was defined by the Global Initiative for Asthma guidelines and that of sinusitis was evaluated by the sinus CT score based on the Lund–Mackay scale. Results and conclusions: FeNO levels were elevated even in well-controlled asthmatics with ECRS, whereas asthmatics without ECRS and ECRS patients without asthma did not have high FeNO levels (>50 ppb). Although FeNO levels were not correlated with asthma severity, they were positively correlated with the sinus CT score. In asthmatics with ECRS, patients with higher FeNO levels had more severe ECRS and asthma. There is a possibility of having comorbid ECRS, particularly in asthmatics with high FeNO levels even after adequate treatment, including ICS, suggesting that asthma and ECRS may be closely associated as one airway disease with eosinophilic inflammation. Continual awareness of the coexistent ECRS is ideally recommended for asthmatics with high FeNO levels.