Prevalence Of Chronic Rhinosinusitis Research Articles

Antibody Deficiency in Chronic Rhinosinusitis: Epidemiology and Burden of Illness

A subset of patients with chronic rhinosinusitis (CRS) has refractory disease. The risk factors for refractory CRS include atopy, a disrupted mucociliary transport system, medical conditions affecting the sinonasal tract mucosa, and immunodeficiency. We review four primary immunodeficiencies reported in individuals with CRS: common variable immune deficiency (CVID), selective IgA deficiency, IgG subclass deficiency, and specific antibody deficiency. We also review treatment options for individuals with both CRS and a concomitant immune defect. There is a high prevalence of CRS in individuals with CVID and selective IgA deficiency. While many reports describe IgG subclass deficiency in individuals with CRS, the clinical relevance of this is unclear. Specific antibody deficiency may play a more significant role in the pathogenesis of refractory CRS. Screening for a primary immunodeficiency should be part of the diagnostic workup of refractory CRS, as its identification may allow for more effective long-term therapeutic options.

Methicillin‐resistant Staphylococcus aureus sinusitis in nonhospitalized patients: A systematic review of prevalence and treatment outcomes

Methicillin-resistant Staphylococcus aureus (MRSA) has been isolated from patients with acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS), although the exact prevalence is unknown. Similarly, the optimal treatment regimen for MRSA sinusitis has not been determined. The aim of this study was to summarize the existing data on prevalence and treatment outcomes for MRSA sinusitis in nonhospitalized patients. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, and Cochrane databases were queried for English-language studies published between 1942 and 2012. Studies were excluded that did not provide quantitative data on the prevalence or treatment of ARS or CRS with MRSA-positive cultures. An itemized assessment of the risk of bias was conducted for each included study. Of 409 studies identified during systematic review, 12 studies met the criteria for analysis. The level of evidence and freedom from bias of these studies were generally low. The prevalence of MRSA among all culture isolates ranged from 0% to 15.9% for ARS and 1.8% to 20.7% for CRS. Six studies reported quantitative treatment outcomes using variable measures, in which resolution of infection ranged from 58.3% to 100%. The treatment regimens were heterogeneous and included single- and multiple-agent therapy with oral, topical, and parental antibiotics. MRSA-positive cultures are found in a small but significant number of cases of ARS and CRS. Treatment of MRSA sinusitis may be effective, although treatment regimens and outcome measures are variable. Prospective studies utilizing standardized parameters are warranted.

Prevalence of chronic rhinosinusitis in Sao Paulo

Studies designed to investigate chronic rhinosinusitis (CRS) epidemiology play an important role to assess population`s distribution and risk factors to result in the development and promotion of public health policies. This study design is a survey carried out with a complex two-stage cluster sampling plan. Personal interviews were carried out with 2,003 individuals. The questionnaire included the epidemiological criteria for CRS. Demographic data, history of physician-diagnosed respiratory diseases (asthma, sinusitis, rhinitis), smoking, family income, educational attainment, and household characteristics were also evaluated. The overall response rate was 93.9% of the households. Mean age was 39.8 +- 21 years; 45.33% were male. The overall prevalence of CRS in the city of Sao Paulo was 5.51%. We found a significant association between diagnosis of CRS and diagnosis of asthma and CRS and diagnosis of rhinitis and a significant association between presence of CRS and belonging to the low-income subgroup. The municipality of Sao Paulo has an urban population of 11 million. According to the present study, the prevalence of CRS is 5.51%, which represents more than 500,000 individuals affected by this condition in the city.

Chronic rhinosinusitis and occupational risk factors among 20‐ to 75‐year‐old Danes—A GA2LEN‐based study

Very little is known about occupational risk factors for chronic rhinosinusitis (CRS). The aim of this study was to evaluate occupational and other potential risk factors for CRS in a Danish population. A cross sectional survey study among 4,554 Danes aged 20-75 years evaluated self-reported symptoms of CRS, asthma, and nasal allergy, along with information on smoking habits and occupation. A total of 3,099 returned completed questionnaires (response rate 68.1%). The overall CRS prevalence was 7.8% with no significant differences related to age or gender. Risk ratio estimates revealed an increased risk of CRS among female blue collar workers compared to female white collar workers. Among men the effect of occupation depended on smoking status. Occupational exposure to gasses, fumes, dust, or smoke increased the overall risk of CRS. CRS was reported approximately four times as often in subjects with asthma and in subjects with nasal allergy. Current smoking doubled the CRS prevalence. CRS prevalence was affected by occupation (blue vs. white collar), but the observed effect depended on gender and smoking status. Exposure to airway irritants (occupational or smoking) increased the CRS prevalence. Studies on larger cohorts are needed to fully assess these tendencies, for example, by more extensive use of Job Exposure Matrix models.

Die chronische Rhinosinusitis in Europa – eine Zusammenfassung epidemiologischer Arbeiten von GA²LEN

Purpose of review: Chronic rhinosinusitis (CRS) is a common health problem with impact on general health and significant medical costs. To date, no pan-European epidemiological study has been undertaken and prevalence data for Europe were unavailable. GA(2)LEN network of excellence has developed a questionnaire, the GA(2)LEN survey to assess the presence of CRS and its association with asthma in epidemiological studies using the European Position Paper on Rhinosinusitis and nasal Polyps (EP3OS) diagnostic criteria. Recently, first data were published and the results are summarized in this review. Recent findings: Information was obtained from 57,128 responders living in 19 centers of 12 countries. The overall prevalence of CRS by EP3OS criteria was 10.9%. CRS was more common in smokers than in nonsmokers. The prevalence of self-reported physician-diagnosed CRS within centers was highly correlated with the prevalence of EP3OS-diagnosed CRS. Symptom-based CRS was significantly associated with positive endoscopy in non-allergic subjects, and with self-reported doctor-diagnosed CRS in all subjects. In all centers, there was a strong association of asthma with CRS at all ages. The association with asthma was stronger in those reporting both CRS and allergic rhinitis. Conclusion: Using the GA(2)LEN survey, a mean prevalence of 10% with a considerable geographical variation in adults in Europe could be demonstrated. Smoking was associated with having CRS in all parts of Europe. Symptom-based definition of CRS, according to the epidemiological part of the EP3OS criteria, was suitable for the assessment of geographic variation in prevalence of CRS. The strong and independent associations between asthma and both allergic rhinitis and CRS are important for better understanding of these conditions and their interdependence and may lead to better management in the future.

Chronic Rhinosinusitis, Race, and Ethnicity

Little is known regarding the epidemiology of chronic rhinosinusitis (CRS) in racial and ethnic minorities in the United States. This study was designed to comprehensively evaluate the current prevalence of CRS across various treatment settings to identify possible disparities in health care access and use between racial and ethnic populations. The National Health Interview Survey (NHIS), National Ambulatory Medical Care Survey (NAMCS), and National Hospital Ambulatory Medical Care Survey (NHAMCS) database registries were extracted to identify the national prevalence of CRS in race/ethnic populations and resource use in ambulatory care settings. Systematic literature review identified studies reporting treatment outcomes in minority patients electing endoscopic sinus surgery (ESS). Data were supplemented using a multi-institutional cohort of patients undergoing surgical treatment. National survey data suggest CRS is a significant health condition for all major race/ethnic groups in the United States, accounting for a sizable portion of office, emergency, and outpatient visits. Differences in insurance status, work absenteeism, and resource use were found between race/ethnic groups. Despite its prevalence, few published studies include information regarding minority patients with CRS. Most (90%) cohort studies did not provide details of race/ethnicity for ESS outcomes. Prospective cohort analysis indicated that minority surgical patients accounted for only 18%, when compared with national census estimates (35%). CRS is an important health condition for all major race/ethnic groups in the United States. Significant differences may exist across racial and ethnic categories with regard to CRS health status and health care use. Given current demographic shifts in the United States, specific attention should be given to understanding CRS within the context of racial and ethnic populations. Public clinical trial registration (www.clinicaltrials.gov) I.D. No. NCT00799097.

171 Augmentation of cxcl10 Expression in Nasal Fibroblasts Derived from Patients With Recalcitrant Chronic Rhinosinusitis Associated With Bronchial Asthma

BackgroundThe prevalence of chronic rhinosinusitis (CRS) that is refractory to traditional therapy appears to be increasing, and CRS that is refractory to traditional therapy tends to be associated with bronchial asthma (BA), especially, aspirin-intolerant asthma (AIA). After viral infections, patients with CRS associated with BA usually experience exacerbations of their CRS symptoms, including nasal polyposis, in comparison with CRS patients without BA. Alternatively tissue fibroblasts as an important component of the epithelial mesenchymal trophic unit play a key role in maintaining tissue homeostasis and may also have the potential to contribute to disease pathogenesis through their contribution to inflammatory responses. On the basis of these findings, we hypothesized that CRS patients with BA are more susceptible to inflammation of the nasal and paranasal mucosa depending on the antiviral response of nasal fibroblasts.MethodsTissue specimens were obtained from the nasal polyps of 3 groups of CRS patients, a group that did not have BA (CRS-NA group), a group with aspirin-tolerant asthma (CRS-ATA group), and a group with AIA (CRS-AIA group). Nasal polyp fibroblasts (NPFs) were isolated from the specimens and stimulated with poly I: C. By using a DNA microarray and performing a hierarchical clustering analysis we were able to identify a cluster containing genes that were up-regulated after poly I: C stimulation. To confirm the results of the analysis data, we used quantitative real-time PCR (qRT-PCR) and an enzyme-linked immunoadsorbent assay (ELISA).ResultsExpression of IFN-inducible protein 10 (IP-10)/CXCL10 transcript was higher in the NPFs of the CRS-AIA group and CRS-ATA group than in the CRS-NA group and control group. These findings were confirmed by qRT-PCR and ELISA.ConclusionsThe results of this study suggest that the increased poly I:C-induced CXCL10 expression in NPFs derived from the CRS patients with BA is involved in susceptible to T helper (Th)1-type immune response in the nasal and paranasal mucosa by viral infection compared with CRS patients without BA.

Prevalence and Risk Factors of Chronic Rhinosinusitis in Korea

Objective: Chronic rhinosinusitis (CRS) is one of the most common inflammatory diseases with multiple etiologies. Despite its high prevalence, risk factors influencing its prevalence have not been thoroughly revealed. Therefore, we investigated the prevalence and risk factors of CRS in Korea. Method: The 4,098 subjects that participated in the Korea National Health & Nutrition Examination Survey were included in the study. Risk factors were categorized into socio-demographic and personal medical factors. Univariate and multivariate analysis were performed to identify significant risk factors of CRS. Results: The prevalence of CRS in Korea was 6.95%. Among socio-demographic factors, male sex, old age, and heavy stress were significantly related with CRS. Influenza vaccination, septal deviation, and persistent allergic rhinitis were significant personal medical risk factors of CRS. Among these risk factors, persistent/moderate to severe allergic rhinitis was proven to be the most significant risk factor for CRS at the population level. Conclusion: Even though the prevalence and risk factors vary according to time, place, and diagnostic criteria, periodic epidemiologic study on CRS is necessary to reduce socioeconomic expenditure and establish an improved national health care policy.

Rhinitis phenotypes correlate with different symptom presentation and risk factor patterns of asthma

Asthma and rhinitis frequently coexist, but no population study has previously determined the relationship between nasal comorbidities and symptom expression and risk factors of asthma. In 2008, a postal questionnaire on respiratory health was sent to 30,000 randomly selected subjects aged 16-75 years in West Sweden; 29218 could be traced and 18,087 (62%) responded. The questionnaire included questions on asthma, rhinitis, chronic rhinosinusitis, respiratory symptoms and possible determinants. Prevalence of allergic rhinitis in asthma was 63.9% and of asthma in allergic rhinitis 19.8%. Prevalence of chronic rhinosinusitis in asthma was 8.4% and of asthma in chronic rhinosinusitis 24.4%. Asthma subjects with chronic rhinitis, or chronic rhinosinusitis, had more symptoms of asthma and bronchitis than those without rhinitis (p < 0.001). There was an obvious trend of higher ORs for various environmental exposures including occupational exposure to dust, gases and fumes (OR 2.32 vs. OR 1.44), visible mould at home (OR 1.72 vs. OR 1.27) and water damage at home (OR 1.82 vs. OR 1.06) for asthma with chronic rhinosinusitis than for asthma with allergic rhinitis. Family history of allergy yielded a higher OR for asthma with allergic rhinitis than with asthma with chronic rhinosinusitis (OR 7.15 vs. OR 4.48). Considerable overlap between asthma and nasal comorbidities was documented, confirming a close relationship between nasal disease and asthma. Allergic rhinitis, chronic rhinitis and chronic rhinosinusitis were associated with different risk factor patterns and symptom expression of asthma. Thus, different nasal comorbidities may reflect different phenotypes of asthma.

Chronic rhinosinusitis in Europe - an underestimated disease. A GA2LEN study

Chronic rhinosinusitis (CRS) is a common health problem, with significant medical costs and impact on general health. Even so, prevalence figures for Europe are unavailable. In this study, conducted by the GA²LEN network of excellence, the European Position Paper on Rhinosinusitis and nasal Polyps (EP³OS) diagnostic criteria are applied to estimate variation in the prevalence of Chronic rhinosinusitis (CRS) for Europe. A postal questionnaire was sent to a random sample of adults aged 15-75 years in 19 centres in Europe. Participants reported symptoms of CRS, and doctor diagnosed CRS, allergic rhinitis, age, gender and smoking history. Definition of CRS was based on the EP³OS diagnostic criteria: the presence of more than two of the symptoms: (i) nasal blockage, (ii) nasal discharge, (iii) facial pain/pressure or (iv) reduction in sense of smell, for >12 weeks in the past year--with at least one symptom being nasal blockage or discharge. Information was obtained from 57,128 responders living in 19 centres in 12 countries. The overall prevalence of CRS by EP³OS criteria was 10.9% (range 6.9-27.1). CRS was more common in smokers than in nonsmokers (OR 1.7: 95% CI 1.6-1.9). The prevalence of self-reported physician-diagnosed CRS within centres was highly correlated with the prevalence of EP³OS-diagnosed CRS. This is the first European international multicentre prevalence study of CRS. In this multicentre survey of adults in Europe, about one in ten participants had CRS with marked geographical variation. Smoking was associated with having CRS in all parts of Europe.

Prevalence and Risk Factors of Chronic Rhinosinusitis in Korea

Chronic rhinosinusitis (CRS) is one of the most common inflammatory diseases with multiple etiologies. Despite its high prevalence, risk factors influencing its prevalence have not been thoroughly revealed. Therefore, we investigated the prevalence and risk factors of CRS in Korea. The 4098 subjects that participated in the Korea National Health and Nutrition Examination Survey were included in the study. Risk factors were categorized into sociodemographic and personal medical factors. Univariate and multivariate analyses were performed to identify significant risk factors of CRS. In addition, population attributable risks of the significant factors were calculated to estimate the effect on the population level. The prevalence of CRS in Korea was 6.95%. Among sociodemographic factors, male sex, old age, and heavy stress were significantly related with CRS. Influenza vaccination, septal deviation, and persistent allergic rhinitis were significant personal medical risk factors of CRS. Among these risk factors, persistent/moderate to severe allergic rhinitis was proven to be the most significant risk factor for CRS at the population level. Although the prevalence and risk factors vary according to time, place, and diagnostic criteria, periodic epidemiological study on CRS is necessary to reduce socioeconomic expenditure and establish an improved national health care policy.

Cost Burden of Chronic Rhinosinusitis

To quantify the cost burden and utilization of health care for chronic rhinosinusitis (CRS). Historical cohort study. Academic medical centers. Medical claims data from 2003 to 2008 were analyzed. Patients were defined as having chronic sinus disease if they had a minimum of 2 CRS-related diagnoses with either computed tomography scanning or endoscopy performed between diagnoses. The prevalence and costs of CRS from the payer perspective (reimbursements) were determined. More than 4.4 million patients with an average of 3.1 years of eligibility and at least 1 diagnosis of acute rhinosinusitis (ARS) or CRS were studied. A total of 5.5% (95% confidence interval [CI], 5.4%-5.6%) of those with ARS were diagnosed with CRS in the subsequent 4 years. Among patients with chronic disease, after 12 months, 39% were still consuming care for CRS, and after 24 months, nearly 28% were still doing so. Of the CRS patients whose diagnosis was confirmed with endoscopy or radiology, 46.2% underwent endoscopic sinus surgery (ESS). In the year prior to ESS, patient care costs averaged $2449 ($2341-$2556). The ESS procedure plus 45-day postprocedure debridement and medical therapy costs averaged $7726 ($7554-$7898). In the year following the 45-day postprocedure period, consumption dropped by $885 (P < .0001). In the second year following ESS, therapy costs dropped an additional $446 (P < .0001). A significant proportion of CRS patients require ongoing treatment of their sinus disease for years. Sinus surgery appears to reduce consumption of rhinosinusitis-related health care, but costs related to the procedure are significant.

The importance of smell in patients with bronchiectasis

The aim of the study was to evaluate the sense of smell in patients with bronchiectasis. Prospective controlled study was performed on 91 patients with bronchiectasis. Bronchiectasis patients were sub-classified depending on: the presence of chronic rhinosinusitis, with or without nasal polyps, and the bronchiectasis ethiology. Olfactory function was evaluated by means of the Barcelona Smell Test (BAST-24) olfactometry for detection, identification, and forced choice for the first and fifth cranial nerve dependent odours in comparison to a group of 120 healthy volunteers. Most patients with bronchiectasis (80.2%) satisfied EP(3)OS criteria of chronic rhinosinusitis (CRS), and 26.4% presented nasal polyps (NP). Smell detection, identification, and forced choice tests were significantly (p<0.001) worse in bronchiectasis patients than healthy controls for both the 1st and 5th CN. Among subgroups, patients with CRS presented a significant (p<0.05) reduction in smell detection compared to both healthy controls and patients without CRS. Patients with both CRS and NP presented a significant (p<0.01) reduction in both smell detection and forced choice compared to patients with CRS and without NP. Patients with bronchiectasis and primary humoral immunodeficiency had a poorer smell detection (p<0.001) and forced choice (p<0.001) compared with post-infective and idiopathic bronchiectasis patients. Patients with bronchiectasis have a moderate loss of smell with a higher impairment in patients with CRS, being maximal in patients with NP. Patients with immunodeficiency bronchiectasis showed high prevalence of CRS, and therefore marked impairment on the sense of smell. The mechanism could be explained through a mixed ethiology (obstruction/inflammation).

Reliability of EP3OS symptom criteria and nasal endoscopy in the assessment of chronic rhinosinusitis – a GA2LEN study

The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic, endoscopic, and radiologic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies, the definition is based on symptoms only. We aimed to assess the reliability and validity of a symptom-based definition of CRS using data from the GA(2) LEN European survey. On two separate occasions, 1700 subjects from 11 centers provided information on symptoms of CRS, allergic rhinitis, and asthma. CRS was defined by the epidemiological EP3OS symptom criteria. The difference in prevalence of CRS between two study points, the standardized absolute repeatability, and the chance-corrected repeatability (kappa) were determined. In two centers, 342 participants underwent nasal endoscopy. The association of symptom-based CRS with endoscopy and self-reported doctor-diagnosed CRS was assessed. There was a decrease in prevalence of CRS between the two study phases, and this was consistent across all centers (-3.0%, 95% CI: -5.0 to -1.0%, I(2) = 0). There was fair to moderate agreement between the two occasions (kappa = 39.6). Symptom-based CRS was significantly associated with positive endoscopy in nonallergic subjects, and with self-reported doctor-diagnosed CRS in all subjects, irrespective of the presence of allergic rhinitis. Our findings suggest that a symptom-based definition of CRS, according to the epidemiological part of the EP3OS criteria, has a moderate reliability over time, is stable between study centers, is not influenced by the presence of allergic rhinitis, and is suitable for the assessment of geographic variation in prevalence of CRS.

Chronic rhinosinusitis in the setting of other chronic inflammatory diseases

Objectives The objectives of the study were to determine the prevalence of chronic rhinosinusitis (CRS) overall and its 2 phenotypic variants, CRS with and without polyposis (NP), in patients with chronic inflammatory comorbidities including autoimmune disorders, inflammatory bowel disease, and atopic dermatitis. These findings were compared with data in patients with asthma. Patients with hypertension were also used as a reference group to estimate the incidence of CRS in a group with regular medical follow-up. Study design A retrospective, cross-sectional query of a large tertiary care electronic medical record database was performed. Results Electronic medical record database prevalence of CRS in patients with hypertension was 4.4%. The prevalence of CRS was 18% in asthma ( P < .0001), 7% in atopic dermatitis, 3.5% in inflammatory bowel disease, and ranged from 1.4% to 5.9% in autoimmune disorders. The frequency of CRS patients exhibiting the NP phenotype was similarly low in patients with autoimmune disease and hypertension, but was significantly greater in patients with asthma ( P < .0001), inflammatory bowel disease ( P = .033), and atopic dermatitis ( P = .049), Conclusions These findings suggest similar prevalence of overall CRS in patients with autoimmune disease and inflammatory bowel disease, and background rates as estimated by observations in hypertension patients. Inflammatory bowel disease and atopic dermatitis patients with CRS exhibit some skewing toward the NP phenotype, as do asthmatics, where this association is well known.

Evaluating the diagnosis of chronic rhinosinusitis based on clinical guidelines and endoscopy

Objective To validate the diagnosis of chronic rhinosinusitis (CRS) according to recent clinical practice guidelines and determine the added utility of nasal endoscopy. Study Design Prospective diagnostic cohort study. Setting Academic medical center. Subjects and Methods A consecutive series of adult patients presenting for evaluation of CRS were prospectively studied with the use of the rhinosinusitis symptom inventory (RSI), nasal endoscopy, and sinus computed tomography (CT). Symptom scores were tabulated from the RSI. Nasal endoscopy was performed to evaluate for purulence or polyps. Sinus CT scans were scored with the Lund system, with the reviewers blinded to the RSI scores and endoscopic findings. The clinical diagnosis of CRS was determined on the basis of the published adult sinusitis guideline criteria and compared with the diagnostic gold standard, CT. Results A total of 202 patients were studied. The prevalence of CRS was 39.6 percent, as defined by CT (Lund score ≥ 4). For symptom criteria alone, the sensitivity, specificity, positive predictive value, and negative predictive value were 88.7, 12.3, 39.9, and 62.5 percent, respectively, for CRS ( P = 0.82). The addition of endoscopic findings to symptom criteria significantly improved the specificity, predictive value, and negative predictive value to 84.1, 66.0, and 70.3 percent ( P < 0.0001). The odds ratio of a true diagnosis of CRS improved from 1.1 to 4.6 (95% confidence interval, 2.3-9.2). Sensitivity analysis adjusting symptom severity did not significantly alter diagnostic accuracy. Conclusion In patients meeting current guideline symptom criteria for CRS, the addition of nasal endoscopy improves diagnostic accuracy and should be emphasized as an early diagnostic tool. Diagnostic endoscopy may help reduce the use of CT, reducing costs and radiation exposure.

Related survey of 8～11-year-ld children with allergic rhinitis and chronic rhinosinusitis in shijing street of baiyun district of guangzhou

Objective To investigate the epidemic features of 8-11-year- old childern with allergic rhnitis(AR) and chronic rhinosinusitis(CRS),the related-risk factors and the correlation between them in Shijing Street of Baiyun District of Guangzhou.Methods A questionnaire survey on AR and CRS was conducted for children aged from 8 to 11 during the time from June,2008 to May,2009.Survey was divided into two stages:first,questionnaire survey phase,and then patients suspected as AR and CRS received specialist examinations.A total of 1649 questionnaires were issued.Results 1432 papers were effective,and the prevalence of AR was 9.4%. There were no significant differences between males and females.Being sensitive to Asthma,sotne drugs and foods.Patients were also affected by the dwelling conditions and family aggregation.The prevalence of CRS was 9.1%.There were no significant differences between males and females.Chronic rhino-sinusitis of risk factors for sinusitis.allergic.the upper and lower respiratory tract infectionsjiving environment and chronic nose were closely related to sinusitis.Conclusions This provides a path to know the epidemic features of children with AR and CRS in Shijing Street of Baiyun District of Guangzhou and supports epirlemiologir materials to prevent and treat the AR and CRS. Key words: Child; Allergic sinusitis; Epidemiology

Balloon Sinuplasty™: balloon-catheter dilation of paranasal sinus ostia for chronic rhinosinusitis

More than 100 million patients worldwide suffer from chronic rhinosinusitis, and a considerable amount of money has been spent on research and treatments by healthcare providers. In the northern hemisphere, damp, temperate climates, along with higher concentrations of pollen, are associated with a higher prevalence of chronic rhinosinusitis. Owing to its persistent nature, the disease can become a significant cause of morbidity. If untreated, it can reduce quality of life and productivity. When medical treatment is not effective, surgery may offer an excellent outcome. Although functional endoscopic surgery has proven to be effective, many cases could be managed medically. Recent research has suggested that optimal medical treatment is as effective as surgery in patients with chronic rhinosinusitis at the end of 1 year. Balloon Sinuplasty™ (Acclarent, Inc., CA, USA) is a new technique in the management of sinusitis and is a hotly debated topic. It is a delicate, minimally invasive tool, and early research demonstrates promising outcomes in terms of safety and effectiveness. This novel technique has been approved by the US FDA. Recently, NICE raised no concerns regarding its safety and efficacy but will continue to review this procedure.

United airways again: high prevalence of rhinosinusitis and nasal polyps in bronchiectasis

Although various relationships between the lower and upper airways have been found, the association of bronchiectasis with chronic rhinosinusitis and nasal polyps has not been thoroughly evaluated. This study was undertaken to examine the association of idiopathic and postinfective bronchiectasis with chronic rhinosinusitis and nasal polyposis. In a prospective study, 56 patients with idiopathic and 32 with postinfective bronchiectasis were evaluated for chronic rhinosinusitis and nasal polyposis by using EP(3)OS criteria and assessing: symptoms score, nasal endoscopy, sinonasal and chest CT scan, nasal and lung function and nasal and exhaled NO. Most bronchiectasis patients (77%) satisfied the EP(3)OS criteria for chronic rhinosinusitis, with anterior (98.5%) and posterior (91%) rhinorrhea and nasal congestion (90%) being the major symptoms. Patients presented maxillary, ethmoidal and ostiomeatal complex occupancy with a total CT score of 8.4 +/- 0.4 (0-24). Using endoscopy, nasal polyps with a moderate score of 1.6 +/- 0.1 (0-3) were found in 25% of patients. Nasal NO was significantly lower in patients with nasal polyposis (347 +/- 62 ppb) than in those without them (683 +/- 76 ppb; P < 0.001), and inversely correlated (R = -0.36; P < 0.01) with the ostiomeatal complex occupancy. In the chest CT scan, patients with chronic rhinosinusitis showed a higher bronchiectasis severity score (7.2 +/- 0.5; P < 0.001) than patients without (3.7 +/- 0.7). The prevalence of chronic rhinosinusitis, nasal polyps and other outcomes were similar in idiopathic and postinfective bronchiectasis. The frequent association of chronic rhinosinusitis and nasal polyposis with idiopathic and postinfective BQ supports the united airways concept, and it suggests that the two type of bronchiectasis share common etiopathogenic mechanisms.

Chronic rhinosinusitis in HIV-infected patients: radiological and clinical evaluation

The advent of protease inhibitors, which enhances the survival rate of HIV-infected individuals, leads patients to search for otorhinolaryngologists, as 40-70% of them may present some sort of otorhinolaryngological disorder. We aimed at comparing the CT scan findings and the nasosinusal complaints of HIV-infected and AIDS patients with clinical diagnosis of chronic rhinosinusitis. The literature on the subject is revised and discussed. Clinical prospective with transversal cohort. Prospectively, 39 patients with chronic rhinosinusitis, in use of antiretroviral therapy, were included in the present study and divided into two groups: patients with diagnosis of AIDS (group I) and those infected by HIV (group II). Clinical and laboratorial assessments, with CD4+ cell count and CT evaluation, were performed and compared among groups I and II. Group I and II presented mean CD4+ cell count of 118 cells/10-9l and 377 cells/10-9l, respectively. Comparison of the tomographic findings by the Lund-Mackay staging system presented a score of 12 for group I and 5.63 (pd" 0.001) for group II. Fever and postnasal discharge were more prevalent in group I (pd" 0.001). In our Service, prevalence of chronic rhinosinusitis in HIV-infected patients was 12%. AIDS patients had a higher incidence of fever and postnasal discharge than those of group II. Moreover, extensive radiological findings were prevalent in patients with AIDS (group I) than in HIV-infected individuals (group II).