Prevalence Of Chronic Sinusitis Research Articles

Inflammatory endotypes of adenoidal hypertrophy based on a cluster analysis of biomarkers

ObjectiveTo identify adenoid inflammatory endotypes based on inflammatory markers, match endotypes to phenotypes, and predict endotypes. MethodsThis cross-sectional study included 72 children with adenoid hypertrophy. Thirteen inflammatory markers and total immunoglobulin E (TIgE) in adenoid tissue were analyzed using Luminex and enzyme-linked immunosorbent assay (ELISA) for performing cluster analysis. Correlation analysis was used to examine the characteristics of each cluster. Receiver operating characteristic (ROC) curve analysis was performed to screen for preoperative characteristic data with predictive value for adenoid inflammation endotype. ResultsThe patients were divided into four clusters. Cluster 1 exhibited non-type 2 signatures with low inflammatory marker concentrations, except for the highest expression of Th1-related cytokines. Cluster 2 showed a non-type 2 endotype with the highest concentration of interleukin (IL)-17A and IL-22. Cluster 3 exhibited moderate type 2 inflammation, with the highest concentration of neutrophil factors. Cluster 4 demonstrated significant type 2 inflammation and moderate neutrophil levels. The proportions of AR and serum TIgE levels increased from clusters 1 to 4, and there was a gradual increase in the prevalence of chronic sinusitis from low to high neutrophilic inflammation. The area under the ROC curve for serum TIgE was higher than those for combined or other separate preoperative characteristics for predicting non-type 2 and type 2 inflammation in the adenoid tissue. ConclusionsThe evaluation of cytokines in adenoid tissue revealed four endotypes. Serum TIgE level was an important indicator of the endotype of adenoid inflammation. Identification of adenoid inflammatory endotypes can facilitate targeted treatment decisions.

Implication of fraction of exhaled nitric oxide and blood eosinophil count in severe asthma

BackgroundSevere asthma is a complex disease with heterogeneous features and involves type 2 airway inflammation, including eosinophil accumulation. Surrogate biomarkers, fraction of exhaled nitric oxide (FeNO) and blood eosinophil count (b-EOS), may predict eosinophilic airway inflammation. Here we investigated clinical characteristics of severe asthma phenotype using a combined analysis of FeNO and b-EOS. MethodsThis retrospective study examined clinical data of patients with severe asthma (N = 107; median age, 64 years) treated at Saitama Medical University Hospital from 2009 to 2016. Thresholds of FeNO and b-EOS for sputum eosinophil ratio ≥2% were determined using receiver operating characteristic curve (ROC) analysis. Clinical characteristics were analyzed after classifying patients into four subgroups according to these thresholds. ResultsOf 39 induced sputum samples examined, ROC area under the curve for predicting sputum eosinophilia was 82.0% (p = 0.001) for b-EOS and 77.0% (p = 0.006) for FeNO at optimal cut-off values of ≥300/μL and ≥25 ppb, respectively. The number of sensitized allergens was higher in the high FeNO/low b-EOS and high FeNO/high b-EOS subgroups (p < 0.05). The prevalence of chronic sinusitis was higher in the low FeNO/high b-EOS and high FeNO/high b-EOS subgroups (p = 0.04). The high FeNO/high b-EOS subgroup included the largest proportion (approximately 40%) of patients experiencing frequent severe exacerbations. Both low FeNO/low b-EOS and high FeNO/low b-EOS subgroups showed less severe exacerbations. ConclusionsCombined evaluation of FeNO and b-EOS can identify patients with frequent exacerbations and stratify the appropriate therapy for type 2 inflammation-predominant severe asthma.

The bitter taste of infection

The human innate immune response to pathogens is complex, and it has been difficult to establish the contribution of epithelial signaling in the prevention of upper respiratory tract infection. The prevalence of chronic sinusitis in the absence of systemic immune defects indicates that there may be local defects in innate immunity associated with such mucosal infections. In this issue of the JCI, Cohen and colleagues investigate the role of the bitter taste receptors in airway epithelial cells, and find that these are critical to sensing the presence of invading pathogens.

SINUS CT FINDINGS IN THE EVALUATION OF 702 CONSECUTIVE PATIENTS WITH CHRONIC COUGH

PURPOSE: Evaluation of chronic cough in pulmonary practice often requires either empiric trials of therapy or testing. The prevalence of chronic sinusitis and the role of CT sinus is debated, with some suggesting it has no role, and others suggesting that it may be a useful test late in an algorithmic approach. Previous recommendations have been based on relatively small series of patients. We wished to evaluate the role of CT sinus in our tertiary referral chronic cough practice.

The clinician's view of sinusitis

Widespread underdiagnosis and inadequate treatment of acute sinusitis may be inferred from the prevalence of chronic sinusitis in the United States. Thus the otolaryngologist's role in the management of sinusitis goes beyond treatment of referred patients. It also includes the responsibility to educate referring physicians in improved diagnostic methods and earlier, more effective forms of therapy. While antral puncture is the sine qua non for determining specific diagnosis, standard radiographs and sound clinical judgment may offer practical alternatives. Early, aggressive antibiotic therapy (with ampicillin, amoxicillin, amoxicillin-clavulanate potassium, or appropriate cephalosporins), plus oral decongestants for symptomatic relief, provides therapeutic efficacy for acute sinusitis and should be considered the initial step toward prevention of chronic sinusitis.

The use of ultrasound as an imaging technique in the diagnosis of sinusitis.

In recent years the high prevalence of chronic sinusitis has been noted in association with bronchial asthma, perennial rhinitis, aspirin sensitivity and on its own. Diagnosis conventionally requires use of radiographs, especially to detect ethmoid and sphenoid sinus disease. To limit radiation exposure, alternative diagnostic tests have been sought. The currently available tests will be reviewed and their advantages and disadvantages will be discussed. One imaging technique, that of A-mode ultrasound, has appeared as a promising adjunct to plain radiographs for diagnosis of maxillary and frontal sinus disease. The data utilizing ultrasound has been mixed and needs to be interpreted with care. This data will be reviewed and guidelines will be presented on the current use of the technique. Data obtained in the author's laboratory comparing the use of A-mode ultrasound and mucosal thickening as seen on plain radiographs will be presented. Further studies using the technique are suggested to better define patients who may be followed on a serial basis. Ultrasound is one of a number of new imaging techniques that are being applied to paranasal sinus disease. Early studies from Europe showed considerable promise, and instruments have been actively marketed in the U.S. before there has been much published experience here. The data are as yet incomplete, and the precise role of ultrasound either as a screening test or as a tool to monitor progress in chronic sinusitis is as yet undetermined.