Presence Of Rhinosinusitis Research Articles

Особенности эндоскопической картины при остром риносинусите у пациентов с посттрансплантационной анемией и нейтропенией

The article presents the results of studying the features of the endoscopic picture of acute rhinosinusitis in patients with anemia and neutropenia, who underwent hematopoietic stem cell transplantation (HSCT). The questions of the influence of the level of hemoglobin on the presence of hyperemia of the mucous membrane of the nasal cavity, as well as the influence of the level of neutrophils on the presence of pus in the exudate in rhinosinusitis, are being studied. The study was carried out based on the Clinic of the Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology, and Transplantation. The study included 49 episodes of rhinosinusitis in HSCT recipients diagnosed in the period from day –7 to day +30 after transplantation. The control group included 46 patients with rhinosinusitis undergoing treatment at the otorhinolaryngology clinic. In the course of the study, the influence of the level of neutrophils on the presence of purulent discharge in rhinosinusitis was established. The threshold value, below which the chances of having pus in the exudate significantly decreased, was 2.6 x 109/l (sensitivity and specificity of the method – 81.6 and 76.1%, respectively). It was also found that hemoglobin level affects the presence of hyperemia of the nasal mucosa. It was shown that at a hemoglobin level less than 119 g/l, the odds of presence of hyperemia of the nasal mucosa significantly decreased (sensitivity 77.6%, specificity 95.5%). Thus, in patients with anemia and neutropenia, one should remember the likelihood of the absence of pus and hyperemia of the nasal mucosa in the presence of rhinosinusitis. These criteria should not be the main ones in such a group of patients, and the diagnosis should be based on the results of an X-ray examination and the presence of other symptoms.

Is Coincidental Rhinosinusitis a Predisposing Factor for Postoperative Central Nervous System Infection After Endoscopic Endonasal Transsphenoidal Surgery?

To investigate the effect of rhinosinusitis in patients who undergo surgery via the endoscopic endonasal transsphenoidal approach (EETSA). The authors retrospectively reviewed the medical records of patients who underwent surgery via the EETSA between February 2009 and November 2016. In total, 505 patients were included in the study. Preoperative paranasal sinus computed tomography, sellar magnetic resonance imaging, and nasal endoscopy were performed for all the patients. Fifteen patients without sphenoid sinusitis underwent surgery with the concomitant transsphenoidal approach and functional endoscopic sinus surgery, and showed no central nervous system (CNS) complication. During surgery via the EETSA, the presence of rhinosinusitis did not significantly affect the incidence of postoperative CNS infection (P = 0.051), except for sphenoid sinusitis (P = 0.003). Conversely, the incidence of postoperative CNS infection was not related significantly to the Lund-Mackay score or tumor size. The risk of CNS infection was 12.151-fold higher in patients with sphenoid sinusitis (95% confidence interval, 3.153-46.827; P ≤ 0.001). Surgery via the EETSA and functional endoscopic sinus surgery can be safely performed together in most patients with rhinosinusitis. However, sphenoid sinus infection appears to be a predisposing factor for postoperative CNS infection. Therefore, a separate surgical procedure for sphenoid lesions should be considered in these patients before the use of the EETSA.

The Nasal NO Response To External Acoustic Energy: A Pilot Study

Acoustic stimulation (humming) facilitates NO diffusion from the paranasal sinuses into the nasal cavity. This acoustic response may be blunted in the presence of rhinosinusitis. To further standardize this test, we evaluated a prototype apparatus that applies external acoustic energy – as an alternative to humming – during negative pressure nasal NO sampling. Non-smoking, non-asthmatic volunteers underwent exhaled NO sampling, followed by nasal NO sampling under three conditions: 1) unstimulated / “quiet” (“Q”); 2) with 128 Hz external acoustic stimulation at low intensity (64 dBA at 30 cm – “S1”); and 3) with acoustic stimulation at moderate intensity (78 dBA at 30 cm – “S2”). Stimulated-to-quiet (S/Q) nasal NO ratios were calculated using mean NO values from the 10 seconds following the initial pressure transient in each recording. A total of 12 subjects (9 females; mean age, 43.7 years) completed the study. Seven subjects gave histories consistent with rhinitis. Individual mean nasal NO levels ranged from 66-182 ppb under quiet conditions, 106-386 ppb with low-amplitude acoustic stimulation, and 122-750 ppb with moderate amplitude. The corresponding values for S/Q ratio ranged from 1.07-2.70 (S1) and from 1.24-7.65 (S2). A paired analysis of nasal NO levels across subjects showed a significant upward trend with increasing applied acoustic energy (p < 0.01). Our results confirm the application of external acoustic stimulation as an alternative to humming in assessing acoustic mixing of gases between the paranasal sinuses and nasal cavity. Use of this procedure may form the basis for a screening test for sinusitis.

Clinical implications of rhinosinusitis detected by preoperative computed tomography for endoscopic endonasal transsphenoidal pituitary surgery

Conclusions: Rhinosinusitis detected by preoperative osteomeatal unit computed tomography (OMU CT) may not increase the incidence of postoperative central nervous system (CNS) infections. Objectives: To evaluate the safety of endoscopic endonasal transsphenoidal pituitary surgery in patients who had rhinosinusitis detected by preoperative OMU CT. Methods: A total of 107 patients who underwent endoscopic endonasal transsphenoidal pituitary surgery were enrolled. The presence of rhinosinusitis and the location of involved sinuses were assessed by preoperative OMU CT. The extent of pituitary tumors was assessed by preoperative sellar MRI. The occurrence of intraoperative cerebrospinal fluid (CSF) leakage and postoperative central nervous system (CNS) complications were analyzed using the medical records. The correlations between these variables and postoperative CNS complications were examined. Results: After pituitary surgery, postoperative CNS complications occurred in four patients (3.7%). Twenty-eight patients (26.2%) had findings of rhinosinusitis on preoperative OMU CT. Of the 28 patients, 8 had rhinosinusitis in the anterior sinuses and 20 in the posterior sinuses. Intraoperative CSF leakage occurred in eight patients (7.5%). The occurrence of intraoperative CSF leakage showed a significant correlation with the incidence of postoperative CNS complications (p = 0.003) but not with the presence of rhinosinusitis (p = 0.134). Although not statistically significant, patients with rhinosinusitis in the posterior ethmoidal and/or sphenoidal sinuses tended to have higher incidences of postoperative CNS complications (p = 0.057).

Clinical Course of Eosinophilic Bronchitis in Children

Purpose:It has been identified that eosinophilic bronchitis (EB) in adults can progress to asthma or fixed airway obstruction. In the present study, we evaluated the clinical course and prognosis of EB in children and their relationship with accompanying rhinosinusitis. Methods:A total of 55 children with EB followed up for over than a year after the diagnosis were enrolled for the present study. We classified the subjects into two groups according to the prognosis and the presence of rhinosinusitis, respectively, and compared them with respect to clini- cal characteristics, eosinophil percentage in induced sputum, fractional exhaled nitric oxide (FeNO) and pulmonary function test. The poor prognostic group was defined as the children with asthma or asthma-like symptoms, or persistent or recurrent chronic cough in the long-term follow-up. Results:The poor prognosis was achieved in 12 children (22%), and 3 children (5%) amongst them were diagnosed with asthma. There were no significant differences in clinical characteristics, eosinophil percentages in induced sputum, FeNO, spirometry and IOS according to the prognosis and the presence of rhinosinusitis. Additionally, the children with rhinosinusitis did not show any poorer outcome than those without rhinosinusitis. Conclusion:There were some limitations of this study for which the relationship between EB and rhinosinusitis in children was evaluated. However, in case of either poor short-term response to inhaled corticosteroids or elevated eosinophilic inflammation in airways or abnormal airway reversibility in impulse oscillometry, the long-term prognosis of EB in children needs to be consi- dered, regardless of the presence of rhinosinusitis. (Pediatr Allergy Respir Dis(Korea) 2012;22: 273-281)

Combined effect of IL‐10 and TGF‐β1 promoter polymorphisms as a risk factor for aspirin‐intolerant asthma and rhinosinusitis

It has been known that interleukin (IL)-10 promoter polymorphisms at -1082A/G, -819T/C and -592A/C, may influence IL-10 expression and associate with asthma. Interleukin-10 facilitates the regulatory function of transforming growth factor (TGF)-beta. The goal of this study was to investigate a gene-gene interaction between IL-10 and TGF-beta1 polymorphisms in Korean asthmatics with aspirin hypersensitivity. Single-nucleotide polymorphism genotyping of IL-10 and TGF-beta1 genes was performed and the functional effect of the IL-10 polymorphisms was analysed applying a luciferase reporter assay and an electrophoretic mobility shift assay. Among the patients with asthma, polymorphism at -1082A/G was significantly associated with the phenotype of aspirin-intolerant asthma, AIA (P = 0.007, P(c) = 0.021). Moreover, a synergistic effect between the TGF-beta1-509C/T and IL-10-1082A/G polymorphisms on the phenotype of AIA was noted; when stratified by the presence of rhinosinusitis, the frequency of rare alleles (the CT or TT genotype of TGF-beta1-509C/T and AG or GG genotype of IL-10-1082A/G) was significantly higher in the patients with AIA (15.2%) when compared with those with ATA (6.3%, P = 0.031; odds ratio 4.111; 95% confidence interval 1.504-11.235). In an in vitro functional assay, the -1082G reporter plasmid exhibited significantly greater promoter activity when compared with the -1082A construct in Jurkat T cells (P = 0.011). Moreover, we found that the transcription factor Myc-associated zinc-finger protein preferentially bound the -1082G allele. Our results suggest that IL-10 promoter polymorphisms contribute to the development of AIA and that rhinosinusitis may interact genetically with TGF-beta1.

Endoscopic sinus surgery and asthma outcomes

Introduction: Chronic rhinosinusitis (CRS) is often associated with bronchial asthma, and the presence of rhinosinusitis aggravates asthma course, although well-controlled studies to support such a statement are lacking. More convincing evidence for a sinobronchial relationship comes from observations that the clinical course of asthma improves after medical treatment of concurrent rhinosinusitis. Furthermore, patients with asthma may be unresponsive to therapy until coexisting sinus disease is successfully treated. Endoscopic sinus surgery (ESS) has been suggested to have favorable effects on associated bronchial asthma, thus reducing the need for long-term asthma medications in patients with sinusitis and asthma. Unfortunately, most studies addressing this problem are retrospective and poorly controlled; thus, evidence for a causal relationship between sinusitis and asthma is not clear cut. In a subpopulation of patients with asthma and rhinosinusitis, aspirin (ASA) and other NSAIDs induce acute asthmatic and nasal symptoms. Patients with ASAexacerbated respiratory disease typically suffer from a particularly severe form of asthma. High recurrence of nasal polyps and the frequent need for sinus surgery are characteristic of this group of patients. Previous studies have not provided equivocal evidence for greater clinical benefi t of endoscopic nasal surgery on asthma outcomes in ASA-sensitive versus ASA-tolerant asthmatics.

Phenotypes of Adult Bronchiectasis: Onset of Productive Cough in Childhood and Adulthood

Bronchiectasis is a heterogeneous disorder with a large number of etiologic factors. The main symptom is a chronic productive cough. The aim of this study was to describe the phenotypes of patients with bronchiectasis who had developed a chronic productive cough in childhood (before 16 years of age) compared with those who had developed a productive cough as adults. One hundred and eighty-two subjects with bronchiectasis diagnosed by computed tomography scanning were studied. Subjects all had a detailed clinical review and assessment of potential etiologic factors performed by the investigators. There were 107 (59%) subjects who developed a chronic productive cough in childhood and 75 (41%) subjects who developed a chronic productive cough in adulthood. There were significant differences in a number of parameters between the two groups including duration of cough, frequency of exacerbations, presence of rhinosinusitis, crackles on examination and lung function. The adult group could be further divided into those who had developed a cough whilst smoking and those who had no obvious relationship with smoking. In conclusion there were a number of significant differences between the child onset and adult onset group that may reflect different phenotypes of bronchiectasis.

Paranasal computed tomography results in asthma patients: Association between sinus sites and allergen types

Chronic rhinosinusitis (CRS) is a common comorbidity of asthma. The aim of this study was to investigate the relationships between the presence of rhinosinusitis, sinus site involvement, and total computed tomography (CT) sinus scores and the presence of allergy, allergen type, and severity of disease. Asthma patients (128 subjects), consisting of 57 allergic and 71 nonallergic patients, were included in the study. Presence of rhinosinusitis and sinus scores were evaluated by CT. CRS was determined in 45 (78.9%) allergic asthma patients and 44 (62.0%) nonallergic asthma patients (p<0.05). Ethmoid sinus involvement was higher among allergic asthma patients compared with nonallergic patients (68.4% versus 43.7%; p=0.005). House-dust mite allergy (71.4% versus 46.5%; p=0.008) and pollen allergy (73.5% versus 47.9%; p=0.01) showed positive correlations with ethmoid sinus involvement. No correlation was found between severity of disease and mean total CT sinus scores (p>0.05). The present study has shown the prevalence of chronic sinusitis to be higher in patients with allergic asthma, particularly in patients allergic to house-dust mites and pollens, with no correlation between severity of disease and presence of CRS. Investigating chronic sinusitis together with allergen sensitivity early in asthma diagnosis may contribute positively to patient treatment.

Association between a TGF β1 promoter polymorphism and rhinosinusitis in aspirin-intolerant asthmatic patients

Rhinosinusitis is highly associated with aspirin-intolerant asthma (AIA). The risk of aspirin intolerance is higher in people with rhinosinusitis than in those without it. Recently, the role of transforming growth factor beta1 (TGFbeta1) in the pathogenesis of chronic rhinosinusitis has come under investigation. The goal of this study was to evaluate the association of TGFbeta1 gene polymorphism with an AIA phenotype in the Korean population. A promoter polymorphism of the TGFbeta1 gene, TGFbeta1-509C>T, and a coding polymorphism (L10P), were genotyped in 203 patients with AIA, 324 patients with aspirin-tolerant asthma (ATA), and 456 normal controls (NC). Serum TGFbeta1 levels were determined by ELISA. The TGFbeta1-509C>T polymorphism was not significantly associated with the AIA phenotype; however, a significant association with the prevalence of rhinosinusitis in AIA (P=0.012), but not in ATA (P>0.05), was observed. When stratified by the presence of rhinosinusitis, the frequency of T allele carriers (CT or TT genotype) of TGFbeta1-509C>T was significantly higher in AIA (87.1%) compared to ATA (52.9%, P<0.001, OR=6.0, 95% CI=3.3-11.1). In addition, AIA patients carrying the TGFbeta1-509T allele showed a lower serum TGFbeta1 level compared to AIA patients carrying the TGFbeta1-509 CC genotype, especially when stratified by the presence of rhinosinusitis (P=0.002). Our results show that the TGFbeta1 polymorphisms are not associated with the AIA phenotype in the Korean population, but may contribute to the development of the AIA phenotype with rhinosinusitis.

Severe asthma: definition and mechanisms.

Severe asthma: definition and mechanisms.

Isocyanate-induced occupational asthma: challenge and immunologic studies.

Isocyanate is the most prevalent agent in occupational asthma(OA) in Korea. We analyzed 43 toluene diisocyanate(TDI) induced OA patients of whom 81% were found to be spray painters. The bronchial sensitivity of all subjects was confirmed by TDI-bronchial challenge test. Serum-specific IgE antibodies to isocyanate-human serum albumin(HSA) conjugate were detected by RAST technique(Pharmacia, Sweden). Bronchial challenge test results revealed 21(57%) early, 5 late only, 4 dual, and 12 atypical responders(5 prolonged immediate, 6 square-shaped, 1 progressive). Four(9%) subjects had negative results on the methacholine bronchial challenge test. High levels of serum specific IgE antibody to isocyanate-HSA were found in 17(40%) patients. The prevalence of a specific IgE antibody was not associated with a type of TDI-bronchial challenge test response, smoking and atopic status, presence of rhino-sinusitis and systemic symptoms, or a degree of airway hyperresponsiveness to methacholine(p > 0.05). The period of latency, ranging from 3 to 132 months, was significantly longer in high specific IgE responders (p < 0.05). These data suggest that 40% of isocyanate-induced occupational asthma patients had high specific IgE antibody to isocyanate-HSA conjugate. The presence of specific IgE antibody does not seem to correlate with clinical parameters.