Lund-Mackay Staging Research Articles

CT EVALUATION FOR THE EFFICACY OF A UNANI FORMULATION WITH INKEBAB IN THE TREATMENT OF ILTEHAB TAJAWEEFE ANAF MUZMIN

Objective: To establish the efficacy of the oral Unani formulations with inhalation of Kalonji in comparison with the standard control in Iltehab Tajaweefe Anaf Muzmin (Chronic Rhinosinusitis [CRS]) based on the computed tomography (CT) paranasal sinuses (PNS) findings. To provide safe, effective, and economical treatment for Iltehab Tajaweefe Anaf Muzmin. Methods: In this randomized, single-blind, standard-controlled study of 45 patients with CRS, the patients were allocated to two groups. In Group A, patients received Unani oral formulation: Katan (Linum usitatissimum), Filfil siyah (Piper nigrum), and Asl-e-Khalis in a 6 g BD dose with steam inhalation of Kalonji (Nigella sativa) BD and Tab Alaspan 1OD with Karvol Plus inhalation BD in Group B. Statistical data was analyzed using a paired-t test by comparing the total sinus score (TSS) of CT PNS calculated based on the Lund Mackay staging system before and after treatment. Results: The result is statistically significant in Group A in comparison to the non-significant effect in Group B (p<0.05). After treatment, there was a 30% complete resolution of the TSS in CT PNS imaging in group A, in comparison to the 0% complete resolution of the TSS in group B. No adverse effects were reported during the study. Conclusion: The oral Unani formulation with inhalation of Kalonji is safe and has a statistically significant effect on TSS (CTPNS) in patients with CRS in Group A. A multicentric trial of the test drug on a larger sample size for a longer duration is required to establish the efficacy of the Inkebab of Kalonji with oral Unani formulation on patients with CRS.

Imbalance of Follicular Helper and Follicular Regulatory T Cells in Chronic Rhinosinusitis with Nasal Polyps.

Data regarding the imbalance in follicular helper T (Tfh) and follicular regulatory T (Tfr) cell responses in patients having chronic rhinosinusitis with nasal polyps (CRSwNP) is so far limited. Thus, we aimed to assess the changes in circulating Tfh and Tfr in CRSwNP patients. This case-control study included 21 patients having CRSwNP and 20 age and sex-matched healthy blood donors as a control group. Lund-Mackay staging system was used for radiologic scoring of chronic rhinosinusitis. Two milliliters of peripheral blood samples were collected from all participants into EDTA-containing vacutainer tubes to assess the levels of Tfh and Tfr cells using flow cytometry. Patients having CRSwNP did not show significant differences in the percentages of CD4+ T cells and total CD4+CXCR5+ T cells from healthy controls. Meanwhile, levels of both activated circulating Tfh and Tfr showed a marked rise in patients than controls. In addition, a positive correlation was observed between the levels of both activated Tfh and Tfr cells. An imbalance in circulating Tfh/Tfr levels was detected in patients having CRSwNP. A significant rise in the levels of Tfh and Tfr was detected in patients proposing a possible role of this imbalance in disease pathogenesis.

Serial assessment and long-term radiographic evaluation of the maxillary sinus after inferior maxillectomy and soft tissue free flap reconstruction in patients with oral cancer.

This study evaluates serial radiographic changes in the maxillary sinus of patients with oral cancer after an inferior maxillectomy and a soft tissue free flap reconstruction. Fifty-six patients were evaluated between Oct 2005 and Mar 2017 from an institutional database. Preoperative and surveillance imaging was reviewed at set time-points. Maxillary sinus scores were allotted based on a modification of the Lund-MacKay staging system. Patients were evaluated for change in sinus score. A univariate (UV) and multivariate (MV) analysis was performed. There were 53.5% T3/T4 category tumors and 68% received adjuvant treatment. Median follow-up was 24.4 months. Preoperative mean sinus score was 0.27 ± 0.44 and postoperative mean sinus score at 24 months was 1.2 ± 1.3 (p = <0.001). On UV analysis advanced T-stage at 12 months (OR 6.7, 95% CI 1.2-50.3, p = 0.01) and 24 months (OR 5.2, 95% CI 1.03-36.8, p = 0.04) was associated with significantly higher sinus score. On MV analysis, advanced T-stage continued to be associated with increased odds for higher sinus score (OR 4.9, 95% CI 1.1-26.8, p = 0.039). A mild increase in postoperative sinus score is seen in this cohort of patients. Advanced T-stage is associated with increased odds for higher sinus scores.

Computed tomography findings of paranasal sinuses in patients with eosinophilic granulomatosis with polyangiitis: Comparison with other eosinophilic sinus diseases and clinical relevance of their severity

BackgroundAlthough paranasal sinuses are one of the most representative organs affected by eosinophilic granulomatosis with polyangiitis (EGPA), they have not been studied sufficiently. The aim of this study was to compare computed tomography (CT) findings in paranasal sinuses of EGPA with those of other eosinophilic sinus diseases and elucidate the clinical relevance of their severity. MethodsCT findings of paranasal sinuses in EGPA patients prior to therapeutic intervention (n = 30) were evaluated using the Lund–Mackay staging (LMS) system and compared with those of three control diseases [(NSAID-exacerbated respiratory disease (N-ERD), aspirin-tolerant asthma, and eosinophilic chronic rhinosinusitis without asthma (ECRS)]. We divided EGPA patients into three groups based on their LMS scores and examined their association with disease manifestation. ResultsTotal scores of the LMS system in EGPA were significantly lower than those of N-ERD and ECRS without asthma. There was a large variation in total LMS scores in EGPA, suggesting considerable heterogeneity of their sinus lesions. Although EGPA with low LMS system scores showed only minor findings in maxillary and anterior ethmoid regions, those with high LMS system scores were characterized by high scores in the ostiomeatal complex. However, the frequencies of patients with a Five-Factor Score ≥2 and with cardiac involvement were significantly higher for EGPA with low LMS system scores. ConclusionsAlthough paranasal sinus lesions in EGPA were less severe than those of other eosinophilic sinus diseases, their milder CT findings may be associated with a higher frequency of extra-respiratory organ involvement.

Association between Periodontitis and Chronic Rhinosinusitis Involving Maxillary Sinus Measured by Lund Mackay Staging System.

This study aimed to evaluate the association between periodontitis and chronic rhinosinusitis (CRS) via cone-beam-computed tomography (CBCT) using the Lund–Mackay staging system. CBCT images from different departments of the school of dentistry, at Prince Sattam University were evaluated for the presence of rhinosinusitis. All the CBCT scans were exposed for multiple indications, and no patients had a scan exposed solely for this study. The Lund–Mackay staging system was used to measure the CRS in the CBCT. Descriptive statistics for the frequencies and percentages were used to summarize the data. Logistic regression was used to examine the associations between periodontitis and CRS. Each variable was assessed individually by using multivariable analysis. Collinearity issues among the variables were solved to select a limited set of factors using a stepwise variable selection procedure. A total of 399 CBCT images were included in the current research. Logistic regression showed that only gender was significantly associated (p = 0.0001) with the presence of CRS. However, a stepwise variable selection procedure included gender and bone loss as significantly associated with CRS. No significant difference was observed between unilateral vs. bilateral CRS in gender, bone loss, medical status, and periodontitis. However, only gender showed a significant difference in both bilateral vs. no CRS and unilateral vs. no CRS. Periodontitis is not associated with CRS. However, gender has a significant influence on CRS.

CT imaging features of paranasal sinuses in children with primary ciliary dyskinesia

Background Primary ciliary dyskinesia (PCD) causes impaired mucociliary clearance and results in chronic pulmonary and sinonasal symptoms. Objectives To study the CT imaging features of paranasal sinuses in children with PCD. Materials and methods 17 PCD patients ranged from 4 to 13 years, a mean age of 7.9 ± 3.3 years, were included in the final analysis. Patients with non-PCD chronic rhinosinusitis (CRS) who accepted maxillary balloon catheter dilation were included in the control group. Paranasal sinuses CT scans were scored according to the Lund–Mackay staging system. The correlation between age and Lund–Mackay score was analyzed. Results 100% (17/17) had rhinosinusitis, 52.9% (9/17) had lung consolidation, 64.7% (11/17) had atelectasis, 35.3% (6/17) had bronchiectasis, and 47.1% (8/17) had a history of neonatal respiratory distress. The mean Lund–Mackay score of PCD patients was 14.2 ± 3.1, that of non-PCD CRS patients was 14.6 ± 5.5, the difference was not significant (p = .79). There was a significant inverse correlation between age and Lund–Mackay score in PCD patients (r = −0.530, p = .029) but not in non-PCD CRS patients (r = −0.168, p = .519). Conclusion Radiographic severity of rhinosinusitis in PCD patients was similar to the control population but decreased with age. Significance First time to propose radiographic severity of rhinosinusitis in pediatric patients with PCD might decrease with age.

Clinical symptoms of chronic rhinosinusitis with nasal polyps (eosinophilic and non-eosinophilic) are related to sinus computed tomography but not to endoscopic findings

BackgroundIn the clinical assessment of chronic rhinosinusitis with nasal polyps (CRSwNP), evaluation of symptoms, nasoendoscopy findings and sinus computed tomography (CT) scan staging is employed in the management plan. Although prior studies have been done to assess the correlation of the three modalities in CRSwNP, such evaluation in patients with eosinophilic and non-eosinophilic types of CRSwNP requires further investigation. The aim of this study was to correlate the sinus CT scan staging to symptom and endoscopic scores in both types of CRSwNP. Material and methodPatients with CRSwNP were classified into 2 types, eosinophilic and non-eosinophilic. Both types were assessed by Sino-Nasal Outcome Test 22 (SNOT-22) symptom score, nasal endoscopy Lund Kennedy grading (LK) score and sinus CT Lund Mackay (LM) staging score. All three modalities were correlated. ResultsForty-four patients were recruited for this study. There was significant correlation between sinus CT and symptom scores in the eosinophilic (r=.51, p=.031) and the non-eosinophilic (r=.76, p<.001) types. There was no significant correlation between symptom and nasoendoscopic scores in the eosinophilic (r=.12, p=.641) and the non-eosinophilic (r=.22, p=.276) types. There was also no significant correlation between sinus CT and nasoendoscopic scores in the eosinophilic (r=.20, p=.418) and the non-eosinophilic (r=.14, p=.508) types. ConclusionsSinus CT staging correlates well with the symptom score for both the eosinophilic and the non-eosinophilic types of CRSwNP. The good correlation suggests both modalities are a reliable guide for their evaluation and management planning.

Role of mitomycin-C to reduce post FESS adhesion and ostial stenosis

The aim of this study is to determine adhesion formation rate and antrostomy closure rate after the use of Mitomycin-C in patients underwent FESS. This is a prospective case control study conducted at ENT Department Lyari General Hospital, Karachi, Pakistan. Fifty one patients included with diagnosis of bilateral chronic rhinosinusitis or allergic fungal sinusitis and were the surgical candidate, underwent bilateral Functional Endoscopic Sinus Surgery (FESS). The patients were evaluated using Lund-Mackay staging system prior to surgery. At the completion of surgery Mitomycin-c (MMC) was applied in one nasal cavity the other nasal cavity served as a control. Among fifty one patients both nostrils were used hence we have 51 cases and 51 controls. The patients were followed for a minimum period of three months after surgery. Subjective improvement of symptoms were recorded as well as rigid nasoendoscpic examination was also performed regularly. The adhesion formation rate in MMC applied nasal cavities was 11.7% as compared to 64.7% of controls. The middle meatal antrostomy closure rate was 41% and 5% in controls and MMC applied group respectively. Hence mitomycin-c application has shown benefit in reducing post FESS ostial stenosis and adhesion formation between middle turbinate and lateral nasal wall. Application of Mitomycin-C has impact on reducing post FESS adhesion formation and middle meatal antrostomy closure.

The Effect of Atopy on the Incidence of Osteitis in Patients with Chronic Rhinosinusitis.

BackgroundAtopy may not contribute directly to the pathogenesis of chronic rhinosinusitis (CRS) and could be a coexisting disease, but it may play a disease-modifying role in CRS. The aim of this study was to determine the effect of atopy on the incidence of osteitis in patients with CRS.MethodsA cross-sectional study at a tertiary center was conducted. Computed tomography of paranasal sinuses (CTPNS) of 75 CRS patients was analyzed. Skin prick test was used to determine the atopy among the CRS patients. The evaluation consisted of symptom score, Lund–Kennedy endoscopic score and CTPNS assessment by Lund Mackay (LM) staging system and Global Osteitis Scoring Scale (GOSS).ResultsAbout 54.7% of CRS patients had atopy (n=41), and 64% (n=48) had osteitis changes. No significant difference (p>0.05) was found for symptom and endoscopic scores in atopic and non-atopic CRS. Atopic and non-atopic CRS patients demonstrated comparable LM and GOSS scores (both p>0.05). Logistic regression analysis revealed that gender, nasal polyps and bronchial asthma were significantly associated with the incidence of osteitis. Significant correlation was found between LM and GOSS scores in atopic CRS (r=0.81, p<0.05). Correspondingly, both scores were found to be significantly correlated in non-atopic CRS (r=0.74, p<0.05).ConclusionAtopic sensitization has no effect on the incidence and severity of osteitis in patients with CRS. The present study suggests that osteitis occurs independently from the atopic pathway.

Post-Irradiation Sinus Mucosa Disease in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Proton Therapy.

Simple SummaryChronic rhinosinusitis (CRS) is a common treatment complication in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. In this study, we aimed to investigate the incidence and severity of CRS in NPC patients who underwent intensity-modulated proton therapy (IMPT) by evaluating the sinus mucosa change in imaging studies, and we compared these patients with those who underwent volume-modulated arc therapy (VMAT). This was a retrospective case–control study in which 53 and 54 patients were treated with IMPT and VMAT, respectively. We noted that patients in the IMPT group had a significantly lower incidence and decreased severity of sinus mucosa abnormality than those with VMAT. Better and faster recovery of sinonasal function after radiotherapy in the IMPT group was also observed. IMPT techniques deposit the bulk of their radiation doses in highly confined areas, allowing lower exposure of non-target organs during irradiation, which results in more sinonasal mucosa being retained.In the past decade, patients with nasopharyngeal cancer (NPC) have been deemed candidates for proton radiotherapy, due to the large and comprehensive target volumes and the necessity for the retention of the surrounding healthy tissues. In this study, we aimed to compare the incidence and severity of post-irradiation sinusitis by detecting sinus mucosa diseases (SMDs) via the magnetic resonance imaging (MRI) of patients with NPC after intensity-modulated proton therapy (IMPT) and volume-modulated arc therapy (VMAT). A total of 53 patients in the IMPT group and 54 patients in the VMAT group were enrolled in this study. There were significantly lower endoscopic scores and Lund–Mackay staging scores determined from MRI scans in the IMPT group during different follow-up periods. For the most vulnerable sinuses, the incidence and severity of SMD were the highest during the third post-radiotherapy month in both groups. These decreased steadily, and there was no significant increase in the incidence and severity of SMD during the second post-radiotherapy year in the IMPT group. Our data show that NPC patients with IMPT have a significantly lower incidence and decreased severity of SMD than those with VMAT. A better and faster recovery of sinonasal function after radiotherapy in the IMPT group was also observed.

The Relationship Between Temporal Bone Pneumatization Pattern and Sinus Mucosal Thickness Grading on Computed Tomography Scans of Paranasal Sinuses.

The relationship between temporal bone pneumatization (TBP) pattern and sinus mucous thickness grading on computed tomography scans of paranasal sinuses was investigated. In this cross-sectional study, a total of 200 temporal bones and paranasal sinuses were evaluated in CT scans of 100 patients with chronic sinusitis (CRS). The mucosal thickness of paranasal sinuses was classified into two groups (0-6 and 7-12) according to the Lund-Mackay (LM) staging system. Also, pneumatization patterns of petrous apex and perilabyrinthine regions were classified according to Jadvah et al. method. Data were analyzed using Chi-square and Fisher's exact tests. The most common pneumatization pattern in the petrous apex was pattern A (49.5%) and in the perilabyrinthine region was pattern B (50%). In the petrous apex, the highest frequencies of pattern A (51.7%) and pattern C (24.6%), among other pneumatization patterns, were found in score range of 7-12 and 0-6, respectively, which was statistically significant (P = 0.017). Although in the perilabyrinthine region, the highest frequencies of pattern A (24.1%) and pattern C (32.7%) were in LM score ranges of 7-12 and 0-6, respectively, no significant difference was found (P = 0.589). The petrous apex pneumatization decreases with an increase in the severity of CRS, which can be in response to the eustachian tube dysfunction and common pathogens with CRS. A similar relationship was also found in the perilabyrinthine region, although it was not statistically significant. No significant relationship between TBP and severity of CRS was found in the age and sex groups.

Clinical symptoms of chronic rhinosinusitis with nasal polyps (eosinophilic and non-eosinophilic) are related to sinus computed tomography but not to endoscopic findings

BackgroundIn the clinical assessment of chronic rhinosinusitis with nasal polyps (CRSwNP), evaluation of symptoms, nasoendoscopy findings and sinus computed tomography (CT) scan staging is employed in the management plan. Although prior studies have been done to assess the correlation of the three modalities in CRSwNP, such evaluation in patients with eosinophilic and non-eosinophilic types of CRSwNP requires further investigation. The aim of this study was to correlate the sinus CT scan staging to symptom and endoscopic scores in both types of CRSwNP. Material and methodPatients with CRSwNP were classified into 2 types, eosinophilic and non-eosinophilic. Both types were assessed by Sino-Nasal Outcome Test 22 (SNOT-22) symptom score, nasal endoscopy Lund Kennedy grading (LK) score and sinus CT Lund Mackay (LM) staging score. All three modalities were correlated. ResultsForty-four patients were recruited for this study. There was significant correlation between sinus CT and symptom scores in the eosinophilic (r=.51, p=.031) and the non-eosinophilic (r=.76, p<.001) types. There was no significant correlation between symptom and nasoendoscopic scores in the eosinophilic (r=.12, p=.641) and the non-eosinophilic (r=.22, p=.276) types. There was also no significant correlation between sinus CT and nasoendoscopic scores in the eosinophilic (r=.20, p=.418) and the non-eosinophilic (r=.14, p=.508) types. ConclusionsSinus CT staging correlates well with the symptom score for both the eosinophilic and the non-eosinophilic types of CRSwNP. The good correlation suggests both modalities are a reliable guide for their evaluation and management planning.

Prevalence and Clinical Significance of Radiographic Sinus Disease on Preoperative Computed Tomography Imaging in the Endoscopic Skull Base Surgery Population.

Endoscopic skull base surgery (ESBS) provides a safe, minimally invasive approach to treat benign and malignant skull base lesions. The significance of concomitant sinonasal pathology on imaging in patients undergoing ESBS and its effect on perioperative management is not well described. We sought to identify the prevalence and clinical significance of incidentally found radiographic sinus disease on preoperative imaging in patients undergoing ESBS and provide a protocol for management of these patients. A retrospective chart review was performed of consecutive patients who underwent ESBS from January 1, 2016 to June 30, 2018. Preoperative computed tomography (CT) scans were reviewed and scored using the Lund-Mackay (LM) staging system. Preoperative nasal endoscopy findings were analyzed. Any preoperative treatment based on these findings and changes in intraoperative management were examined. A total of 156 patients (81 women, 74 men) who underwent ESBS were reviewed. The average LM score was 2 ± 2.7 (range: 0-12). A total of 94 patients (60.3%) had evidence of radiographic sinus disease (LM score > 0) and 23 patients (14.7%) had presence of sphenoid sinus disease. Seven patients (4.5%) were treated preoperatively based on CT and/or nasal endoscopy findings. All patients who received preoperative treatment had evidence of sinus disease on imaging with an average score of 4.7 and were evaluated and treated within 1-2 weeks prior to ESBS. One patient had ESBS postponed until endoscopic sinus surgery was performed for extensive chronic rhinosinusitis (CRS) findings on imaging. A review of preoperative imaging in patients undergoing ESBS can help identify concurrent sinonasal disease, which has the potential to alter preoperative as well as intraoperative management in these patients. We report a diligent but conservative approach for the treatment of concomitant CRS in the ESBS population with decision for preoperative treatment guided by various factors.

Does Middle Meatal Antrostomy Prevent the Onset of Maxillary Sinusitis After Zygomatic Implant Placement?

To evaluate the role of middle meatal antrostomy in preventing the onset of maxillary sinusitis after placement of zygomatic implants. We hypothesized that middle meatal antrostomy might reduce the incidence of this complication. A prospective longitudinal study was performed of patients who had undergone placement of 4 zygomatic implants and concurrent middle meatal antrostomy with an endoscopic approach at the maxillofacial surgery unit of Verona University. The radiological results of the maxillary sinuses were evaluated on computed tomography scans performed 12months after surgery using the Lund-Mackay staging system. Clinical symptoms were evaluated both preoperatively and 12months after surgery using the Sino-Nasal Outcome Test-20 (SNOT-20). Intraoperative violation of the Schneiderian membrane was also assessed. The outcomes from the present study were compared with historical controls. The sample included 13 patients, 26 maxillary sinuses with negative radiologic findings of sinonasal pathologic features, and 52 zygomatic implants. A moderate increase was found in radiologic findings of sinonasal pathologic features postoperatively compared with preoperatively, with mucosal hypertrophy in 3 maxillary sinuses (11.5%). The incidence and severity of mucosal hypertrophy was significantly lower than the outcomes of the historical controls. The average preoperative SNOT-20 score was 13.45, and thepostoperative SNOT-20 score was 1.18. The Schneiderian membrane was pierced in 13 sinuses in9patients. Shrinkage of the ostiomeatal complex seems to play a fundamental role in the onset of sinonasal pathologic features after zygomatic implant placement compared with implant-related causes. Although functional endoscopic sinus surgery is a supplementary surgical method in implant placement, it seems to provide statistically significant improvement in the health of the sinonasal system. Perforation of the Schneiderian membrane does not appear to correlate with the onset of sinus opacification and sinonasal symptoms.

Sinonasal Disease in Total Laryngectomy Patients.

Total laryngectomy (TL) results in complete abolition of nasal airflow, with notable pathologic alterations of the intranasal mucosa, mucociliary clearance, and nasal cycle. Despite these observed morphological changes, it remains unclear whether this subpopulation of patients experiences clinically significant sinonasal disease. The goal of this study was to identify rhinosinusitis in TL patients using radiographic imaging. An Institutional Review Board-approved retrospective review (January 2005-July 2017) identified 50 patients who underwent radiographic imaging before and after TL. The Lund-Mackay Staging System (LM) was applied to 197 surveillance computed tomography scans. Surveyed patients also underwent investigation of current sinonasal symptomatology using the SNOT-22 questionnaire. Simple linear regression was modeled to LM scores; tests of statistical significance were estimated via the method of Kenward and Roger. The mean age was 62.4 years, with a 5:1 male-to-female ratio. The mean SNOT-22 score was 27.4 (range, 5-33). A median of 3 scans was obtained, 49% within 12 months after TL. The mean (± standard deviation) postoperative LM score was 2.7 ± 3.97 points (range, 0-19). For every 1 month after TL, postoperative LM was +0.01 point (P = .49). Conversely, for every +1 point in preoperative LM, postoperative LM was +1.08 points (P < .001). Two patients required functional endoscopic sinus surgery after TL for persistent sinonasal disease. Preoperative sinonasal disease burden likely plays an important role in the development of clinically significant rhinosinusitis in TL patients. Correlating radiographic findings to validated outcome measures remains a critical aspect of determining optimal surgical candidates; this arena is still under investigation in this unique patient cohort.

LUND-MACKAY STAGING COMPARED WITH A SINO-NASAL QUALITY OF LIFE TOOL (SNOT)

Background Computed tomography (CT) is the imaging modality of choice for evaluating disease of the paranasal sinuses.1 The Lund-Mackay staging system measures stages of chronic rhinosinusitis (CRS). The sino-nasal outcome test (SNOT) covers a range of health-related quality of life problems associated with sinus disease, including physical problems, functional limitations, and emotional consequences.2 Both tools were found to be reliable and valid.2,3 Objective The objective of this study was to determine a relationship between quantitative measures (Lund-Mackay) and a qualitative tool (SNOT). Materials and Methods Institutional review board approval was granted, and 300 patients who had previously undergone CBCT imaging studies were invited to participate. Lund-Mackay scoring was assessed for completely clear, partly opaque, or completely opaque sinuses visualized on CBCT examinations. The SNOT consists of 20 questions pertaining to rhinologic symptoms and psychological function. All patients signed an informed consent form before taking the survey. Using ordinal scales from 0 to 5, patient symptoms were scored for both rhinologic and psychological function: no problem = 0; very mild problem = 1; mild or slight problem = 2; moderate problem = 3; severe problem = 4; and, finally, problem as bad as can be = 5. Higher scores represent worse symptoms and poorer quality of life. The American Society of Anesthesiologists (ASA) and seasons categories were also collected.4 Results Seven (63.6%) males and 4 (36.82%) females participated in the survey. Mean age of the patients was 55.82 ± 17.9. The Mann-Whitney test was used to compare the median result for the survey questions. Patients’ response for “Wake up at night?” was significant (P = .012). Spearman rho correlation showed age as being highly correlated to sinusitis (r = 0.894; P = .0001). Discussion Because both the Lund-McKay system and the SNOT have been demonstrated to be effective for assessment of sinus disease, the Lund-McKay staging system may be appropriate for quantitative assessment where imaging is otherwise required. The SNOT can be used for correlation of patients’ qualitative experiences.

Effect of nasally exhaling budesonide/formoterol dry powder inhaled at "fast" inspiratory flow on eosinophilic chronic rhinosinusitis .

Budesonide (BUD)/formoterol (FM) dry powder inhaler has a feature that the fine particle fraction output is dependent on users' inspiratory flow rate. The aim of this study was to assess the amount of nasally exhaled BUD/FM inhaled in the different inspiratory flow rate. We also examined the effect of nasal exhalation of BUD/FM dry powder inhaled on radiographic evidence of sinonasal inflammation in asthmatic patients with eosinophilic chronic rhinosinusitis (ECRS). The quantitative amount of nasally exhaled BUD/FM was analyzed by high-performance liquid chromatography in 3 healthy subjects. We retrospectively evaluated the effect of nasal exhalation of BUD/FM dry powder inhaled at &gt;60L/min on radiographic evidence of sinonasal inflammation, which was assessed according to the Lund-Mackay staging (LMS) system, in 7 consecutive patients with asthma and ECRS. The amount of nasally exhaled BUD in the setting of inhaling BUD/FM dry powder inhaler at 60L/min (subject 1: 25.8ng/mL; subject 2: 37.3ng/mL; subject 3: 30.0ng/mL) was high compared to at 30L/min (subject1: 9.3ng/mL; subject 2: 4.1ng/mL; subject 3: 9.2ng/mL) in each healthy subject. Nasal exhalation of BUD/FM dry powder significantly reduced total (p=0.018) and ethmoid LMS scores (p=0.0077). Nasal exhalation technique of BUD/FM dry powder inhaled at "fast" inspiratory flow has a potential of simultaneously treating asthma and ECRS. .

Eosinophilic Mucin Rhinosinusitis in Iranian Patients Undergoing Endoscopic Sinus Surgery.

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. 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. 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. 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.

Three-Dimensional Volumetric Evaluation of the Maxillary Sinuses in Chronic Rhinosinusitis Surgery.

The objective of this study was to ascertain whether the 3-dimensional volumetric measurement method could be used for the evaluation of operative treatment results in patients with chronic rhinosinusitis. A total of 61 adult patients with chronic rhinosinusitis were analyzed. Cone-beam computed tomographic images of the paranasal sinuses were examined preoperatively and at 12 months postoperatively. The results were compared using the Sino-Nasal Outcome Test (SNOT-22) and the Lund-Mackay (LM) and Zinreich modified staging systems. The mean change in pneumatized volumes in the maxillary sinuses after operative treatment per patient was 2.0 ± 7.5 cm3 ( P = .146). The median for volumetric change was 0.97 cm3 (range, -11.6 to 33.6 cm3). Both the LM and Zinreich modified LM staging systems showed no change in 32 of 61 patients (53%). The alterations in patients' maxillary sinuses measured using the volumetric measurement method correlated well with changes in Zinreich's modified LM staging (-0.77, P < .01). The 3D volumetric method is more sensitive in detecting small alterations in pneumatized volumes of the maxillary sinuses than Zinreich's modified LM staging and LM staging. The method correlates better with Zinreich's modified LM staging than with LM staging.

Chronic otitis media with effusion in chronic sinusitis with polyps.

The relationship between otitis media with effusion (OME) and chronic rhinosinusitis with nasal polyposis (CRSwNP) remains unclear. We conducted a cross-sectional study of 80 consecutively presenting patients-42 males and 38 females, aged 15 to 76 years (median: 48)-who were diagnosed with CRSwNP. Our aim was to ascertain the prevalence of OME in CRSwNP patients, to determine whether the severity of CRSwNP affected OME, and to identify risk factors for OME in CRSwNP patients. The severity of CRSwNP was assessed on the basis of nasal symptoms, endoscopic nasal examinations, and Lund-Mackay staging scores. In addition to demographic data, we obtained information on each patient's history of otitis, otoscopic findings, and the results of pure-tone audiometry and tympanometry. We then compared the data between CRSwNP patients with OME (n = 20) and those without (n = 60). In the OME group, a conductive hearing loss was present in 16 patients (80.0%); all patients in the control group had normal hearing. With regard to symptoms, only rhinorrhea appeared to be more common in patients with OME than in those without, although the difference was not statistically significant. We found no significant difference in nasal polyposis grades between the two groups. Also, we found no correlations between the risk of OME and previous surgical treatment, asthma, allergy, aspirin intolerance, aspirin and/or NSAID intolerance, aspirin and/or sulfite intolerance, and aspirin-exacerbated respiratory disease. Based on our findings, we conclude that OME occurs frequently during the evolution of CRSwNP, even when the nasal disease is well controlled. This finding suggests the possible presence, in OME and/or CRSwNP, of a global inflammatory process that involves the epithelium in both the middle ear and upper airway.