Pediatric Chronic Rhinosinusitis Patients Research Articles

Microbiome of the Middle Meatus, Tonsils, and Adenoids in Pediatric Chronic Rhinosinusitis.

Pediatric chronic rhinosinusitis (PCRS) is a common condition with a significant impact on quality of life. This study compares the microbiome of pediatric patients with and without chronic rhinosinusitis. Single-center, prospective, quantitative case-control. Metropolitan. Patients undergoing adenoidectomy for PCRS (subjects, n = 20) or obstructive sleep apnea (controls, n = 20) were recruited. 16S ribosomal RNA sequencing was performed on the right middle meatus (MM), adenoid, and palatine tonsil samples from each patient. Alpha diversity was measured by the Simpson's diversity index, beta diversity was measured by the Bray-Curtis dissimilarity index, and the differential abundance of bacteria genera was analyzed. There were 40 adenoid, 40 tonsil, and 37 MM samples analyzed. There was no significant difference in alpha diversity between controls and subjects. Tonsils were significantly more diverse than the adenoids, which were more diverse than the MM (P < .001). There was no difference in bacterial composition between controls and subjects, but the composition of the 3 sites were significantly different (P < .001). The dissimilarity in bacterial composition between the adenoid and MM sites was larger in the control group than in the subject group. There were significant differences in alpha diversity and bacterial composition between the anatomic 3 sites; however, there was no difference between the controls and subjects. The larger dissimilarity in bacterial composition between adenoid and MM sites in controls compared to subjects suggests there may be colonization of the MM by the adenoid in PCRS patients.

Novel prognostic factors for successful treatment of pediatric chronic rhinosinusitis using the sinus and nasal quality of life survey (SN-5H).

Chronic rhinosinusitis (CRS) is strongly associated with significant impairment of quality of life (QoL) in children. The SN-5 questionnaire is an important assessment tool for pediatric CRS. This study aimed to evaluate potential prognostic factors for treatment of pediatric CRS within the Hebrew version of the SN-5 questionnaire. A prospective study in pediatric otolaryngology unit. Patients were treated either surgically or pharmacologically. Following informed consent, parents of pediatric CRS patients completed the translated and validated Hebrew version (SN-5H) prior to treatment and after three months. We analyzed the results of both treatment arms according to success (achieving minimal clinically important difference; MCID). 102 children aged 5-12years and their caregivers participated (74 CRS patients and 28 controls without CRS). SN-5H items scores were significantly higher in CRS patients compared to controls (p < 0.001). Baseline activity scores were higher, while baseline emotional scores were lower in MCID( +) CRS patients, compared to MCID(-) CRS patients (p < 0.05). High emotional stress and low activity scores at baseline were associated with poorer odds to achieve MCID. The SN-5H questionnaire is invaluable tool for assessing pediatric CRS patients. Psychosocial aspects of CRS significantly affect QoL and should be addressed in the office pre-treatment. The SN-5H can aid in highlighting patients in need for further reassurance and psychosocial support to manage expectations, and to improve QoL.

Associations of Microbial Diversity with Age and Other Clinical Variables among Pediatric Chronic Rhinosinusitis (CRS) Patients.

Chronic rhinosinusitis (CRS) is a heterogenous disease that causes persistent paranasal sinus inflammation in children. Microorganisms are thought to contribute to the etiology and progression of CRS. Culture-independent microbiome analysis offers deeper insights into sinonasal microbial diversity and microbe-disease associations than culture-based methods. To date, CRS-related microbiome studies have mostly focused on the adult population, and only one study has characterized the pediatric CRS microbiome. In this study, we analyzed the bacterial diversity of adenoid tissue, adenoid swab, maxillary sinus, and sinus wash samples from 45 pediatric CRS patients recruited from the Johns Hopkins All Children's Hospital (JHACH) in St. Petersburg, FL, USA. The alpha diversity in these samples was associated with baseline nasal steroid use, leukotriene receptor antagonist (LTRA) use, and total serum immunoglobulin (Ig) E (IgE) level. Streptococcus, Moraxella, and Haemophilus spp. were most frequently identified from sinus cultures and the sequenced 16S rRNA gene content. Comparative analyses combining our samples with the samples from the previous microbiome study revealed differentially abundant genera between patients with pediatric CRS and healthy controls, including Cutibacterium and Moraxella. Additionally, the abundances of Streptobacillus and Staphylococcus were consistently correlated with age in both adenoid- and sinus-derived samples. Our study uncovers new associations of alpha diversity with clinical parameters, as well as associations of specific genera with disease status and age, that can be further investigated.

Histopathologic differences between adult and pediatric patients with chronic rhinosinusitis.

Adult and pediatric patients with chronic rhinosinusitis (CRS) may have differing philosophies in therapeutic management. Few studies have examined sinonasal tissue-level comparisons of these groups. This study examines histopathologic differences between children and adults with CRS, with the goal of understanding disease pathogenesis and optimizing medical management for both populations. In a retrospective cohort of CRS patients who underwent functional endoscopic sinus surgery (FESS), demographic factors, pertinent comorbidities, and a structured histopathologic report of 13 variables were compared across pediatric and adult CRS patients with and without nasal polyps (pCRSwNP, pCRSsNP, aCRSwNP, aCRSsNP, respectively). A total of 378 adult (181 aCRSsNP, 197 aCRSwNP) and 50 pediatric (28 pCRSsNP, 22 pCRSwNP) patients were analyzed. Significantly more children compared with adults had a comorbid asthma diagnosis (64.5% vs. 37.2%, p=0.003). Adults with CRS exhibited significantly more tissue neutrophilia (28.9% vs. 12.0%, p=0.006), basement membrane thickening (70.3% vs. 44.0%, p<0.001), subepithelial edema (61% vs. 30.0%, p<0.001), squamous metaplasia (22.0%vs. 4.0%, p<0.001), and eosinophil aggregates (22.8%vs. 4.0%, p<0.001) than children with CRS. The majority (66.5%) of adult CRS patients exhibited a lymphoplasmacytic-predominant inflammatory background, whereas the majority (57.8%) of children with CRS exhibited a lymphocyte-predominant inflammatory background. Sinonasal tissue of adult and pediatric CRS patients demonstrates clear histopathologic differences. Our findings provide insight into differing pathophysiology, which may enable optimization of targeted therapies for patients in each of these unique clinical groups.

A Survey on the Management of Chronic Rhinosinusitis in the Korean Rhinologic Society

Background and Objectives: There are several diagnostic and therapeutic modalities for chronic rhinosinusitis (CRS), but specific guidelines have not been developed for Koreans. This study sought to evaluate and report CRS practice patterns of members of the Korean Rhinologic Society.Materials and Method: An anonymous survey including 32 items was conducted from August to September 2015. The survey items were categorized into three parts: general information, diagnosis and treatment of CRS, and endoscopic sinus surgery.Results: A total of 267 members participated in this survey. Almost half of the respondents (41.9%) were in their 40s and 42.7% had 10-20 years of experience. A total of 61.8% were private practitioners, while the rest worked in hospitals (38.2%). The prevalence rate of acute rhinosinusitis was higher in private clinics compared to hospitals (p&lt;0.001). Intranasal steroids and saline irrigation were more commonly prescribed among hospital doctors compared to private practitioners (p&lt;0.001). Amoxicillin/clavulanic acid was the drug of choice for adult and pediatric CRS patients among private practitioners. However, hospital doctors preferred macrolides for adult CRS patients and third-generation cephalosporins for pediatric CRS patients. Most private clinics performed surgery under local anesthesia (90.8%), while those in a hospital setting preferred general anesthesia (78.4%). Revision surgery rates were higher in hospitals compared to private clinics (p&lt;0.001).Conclusion: There were significant variations in CRS practice patterns between private clinics and hospitals. For effective and standardized diagnosis and management of CRS, appropriate local guidelines are needed.

Low-dose macrolides for treating pediatric rhinosinusitis: A retrospective study and literature review.

The effects of low-dose macrolide (LDM) therapy on pediatric chronic rhinosinusitis (CRS) patients are unknown. This study aimed to assess the effectiveness of LDM for treating pediatric refractory CRS. A retrospective study was conducted by a medical chart review. Pediatric CRS patients (age <15 years) who received LDM after standard medical treatments failure between 2013 and 2019 were identified. The LDM treatments with any macrolide agents, doses, and regimens were included. Any co-interventions were allowed. Duration of the LDM therapy was ≥6 weeks. Outcomes were the total nasal symptoms by the visual analogue scale (TNS), presence of individual symptoms, physician-assessment nasal discharge and adverse events. Six patients (67% male, mean age 7±3.4 years) were assessed. All patients had failed to intranasal steroids and nasal saline irrigation but continued. The addition of LDM significantly improved TNS (mean difference ± standard deviation 5.83 ± 1.33; 95% confidence interval 4.44–7.23, p< 0.001). At the end of treatment, the numbers of patients with individual symptoms were decreased: nasal obstruction (100%–67%), rhinorrhea (83%–50%), hyposmia (50%–0%), cough (100%–33%), and physician-assessment thick mucoid discharge (33%–0%). No patients had facial pain. One patient reported mild tolerable nausea. Preliminary findings of this study showed some beneficial effects of LDM added to intranasal steroids and nasal saline irrigation in pediatric CRS after standard treatments failure. The beneficial effects included the improvements of the TNS and individual nasal symptoms and decrease in thick mucoid discharge.

Long‐term outcome of once daily nasal irrigation for the treatment of pediatric chronic rhinosinusitis

Chronic rhinosinusitis(CRS) results in significant morbidity and health care expenditure. Safety and efficacy of nasal irrigation use in the treatment of pediatric CRS have been demonstrated, but long-term outcomes are unknown. We reviewed characteristics and treatment outcomes after 6 weeks of once daily nasal irrigation in pediatric CRS based on computed tomography (CT) scans, and summarized parental reports of subsequent use of nasal irrigation for recurring symptoms Retrospective cohort study and cross-sectional survey. Review and survey of 144 pediatric CRS patients diagnosed between July 2003 and January 2012. One hundred four patients were reviewed. Mean age was 8.0 years, and 65.4% were male. Presenting symptoms included congestion (95.2%), cough (79.8%), rhinorrhea (60.6%), headache (48.1%), and fatigue (40.4%). Comorbidities included positive allergy test (50%), asthma (57.3%), and gastroesophageal reflux disease (28.2%). After 6 weeks, 57.7% of patients reported complete resolution of symptoms. Reductions in Lund-Mackay CT scores were 4.14 and 4.38 on the left and right sides, respectively (P < .001). Of the 54 parents who completed the prospective surveys, 53.7% reported using irrigation again in the past 12 months (median = 1, interquartile range = 3). Only nine patients underwent functional endoscopic sinus surgery (FESS) after the initial 6 weeks. Patients requiring FESS were, on average, 3.6 years older than those who did not receive FESS (P = 0.0005). Median length of follow-up was 48 months (range = 20-113). There were no significant differences in age, Lund-MacKay score changes, and symptom resolution proportions between those who completed the survey and those who did not. Nasal irrigation is effective as a first-line treatment for pediatric CRS and subsequent nasal symptoms, and reduces the need for FESS and CT imaging. 2b.

Immunological investigation in the adenoid tissues from children with chronic rhinosinusitis

Objective Chronic rhinosinusitis (CRS) is characterized by persistent inflammation and tissue remodeling of the nasal mucosa. Adenoidectomy is an effective surgical treatment in pediatric CRS. To evaluate the effect of pediatric CRS on the severity and characteristics of adenoid inflammation, the authors evaluated the expressions of inflammatory cell activation markers and tissue remodeling in adenoid tissues associated with cytokines tissue-remodeling-associated cytokines in adenoid tissues. Study Design and Setting A prospective controlled study on 40 pediatric patients admitting for adenotonsillectomy. Subjects and Methods Immunoassays were performed on adenoid tissues homogenates from 16 children with CRS and from 24 children without CRS to quantify the levels of inflammatory cell activation markers, such as soluble interleukin (IL)-2 receptor (sIL-2R), soluble CD23 (sCD23), IL-6, eosinophilic cationic protein (ECP), and tryptase, and the levels of cytokines associated with tissue remodeling, such as transforming growth factor (TGF)-β1, matrix metalloproteinase (MMP) 2 and 9, and tissue inhibitor of metalloproteinase (TIMP)-1. Results The mean levels (the ratio to albumin level) of sIL-2R, TGF-β1, MMP-2, MMP-9, and TIMP-1 were significantly higher in adenoid tissues of patients with CRS (27.31 ± 30.32, 4894.65 ± 2388.77, 500.13 ± 604.59, and 23.06 ± 10.37, respectively) than those without it (16.27 ± 10.93, 2635.51 ± 1448.63, 120.87 ± 321.50, 16.74 ± 11.10, and 7.39 ± 3.12, respectively; all P < 0.05). Regarding the severity of CRS, ECP level was significantly higher in patients with severe CRS than in those with mild to moderate CRS ( P = 0.033). Conclusions Adenoid tissues in pediatric CRS patients had higher levels of tissue-remodeling–associated cytokines, which may explain the relationship between pediatric CRS and adenoid inflammation.