Rhinosinusitis In Adults Research Articles

Patient-reported outcome measures for acute rhinosinusitis in adults and children: a systematic review of the quality of existing instruments

BackgroundAcute rhinosinusitis (ARS) is a self-limiting inflammation of the nose and sinuses caused by viral or bacterial infections that requires primarily symptomatic treatment. Patient-reported outcome measures (PROMs) are suitable tools for the assessment of the effectiveness of remedies for ARS from the patient’s perspective in clinical trials and real-world studies. Data regarding the quality of existing PROMs for ARS are limited.PurposeTo conduct a systematic review of the quality of existing disease-specific PROMs for use in adults and children with ARS according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, and to derive recommendations for use of the identified instruments in future clinical studies.MethodsWe systematically searched PubMed, Web of Science and Embase for studies reporting on the development and/or validation of PROMs for ARS. We assessed the methodological quality of each included study, evaluated the quality of measurement properties per PROM and study, and graded the evidence. Based on the overall evidence, we derived recommendations for use of the instruments.ResultsWe identified four studies on three PROMs measuring symptoms of ARS and quality of life in adults (Sinonasal Outcome Test-16, SNOT-16; Measurement of Acute Rhinosinusitis, MARS; Rhinosinusitis Quality-of-Life Assessment, RhinoQoL). For ARS in children, we identified two studies on two PROMs measuring symptoms of ARS (Pediatric Rhinosinusitis Symptom Scale, PRSS; Sinus Symptom Questionnaire, S5). Our assessment of measurement properties indicates that all instruments require further validation before they can be unrestrictedly recommended for use in future research (COSMIN category B). In particular, there were no content validity studies for any of the identified instruments, but also data on other important measurement properties, e.g., structural validity, are lacking.ConclusionCurrently, no PROM for ARS in adults and children can be unrestrictedly recommended based on the evaluation of their quality. Further validation is required for all identified PROMs. Content validation involving patients and experts should be given priority.Systematic review registrationOSF (https://doi.org/10.17605/OSF.IO/VAP8U).

Comorbidities of chronic rhinosinusitis in children and adults.

Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the nose and paranasal sinuses lasting ≥12weeks. CRS may exist with (CRSwNP) or without (CRSsNP) nasal polyps. The aim was to evaluate conditions associated with CRS in a randomized hospital cohort. We hypothesized that comorbidities and surgical procedures differ between pediatric and adult patients. This study consisted of hospital registry data of a random sample of rhinosinusitis patients (age range 0-89years) with the diagnosis of J32 or J33, correspondingly, registered during outpatient visits from 2005 to 2019 (n=1461). The covariates of interest were collected from electronic health records based on ICD-10 codes and keyword searches. Among pediatric patients (n=104), the relative proportions of CRSsNP and CRSwNP were 86% and 14% respectively. The relative proportions of adult patients (n=1357) with CRSsNP and CRSwNP were 60% and 40%, respectively. The following comorbidities significantly differed (p<0.05) between pediatric and adult populations: allergy, chronic otitis media, and tonsillar diseases. In total, 41 % of the children and 46% of the adults underwent baseline endoscopic sinus surgery (ESS). Additional surgeries of the ear, nose and pharynx were significantly more common among children compared with adults. Risk of revision after baseline ESS was associated (p<0.05) with allergy, asthma, eosinophilia, CRSwNP, immunodeficiency or its suspicion, non-steroidal anti-inflammatory drug exacerbated respiratory disease, and number of any diseases ≥2. Our study showed that comorbidities differ between pediatric and adult rhinosinusitis patients, as allergy, asthma and allergy, chronic otitis media, mental health disorders, and tonsils disease were significantly more prevalent among pediatric patients. Children and adults were equally treated with ESS. Notably, children underwent additional surgery on adenoids and tonsils more frequently. The effectiveness of ESS in multimorbid adults should be assessed at an individual level.

Association of autoimmune disorders with chronic rhinosinusitis in adults

IntroductionIncreasing evidence suggests that autoimmune disorders and their immunomodulating medications may increase the risk of rhinosinusitis compared to rhinitis. GoalTo investigate the association between autoimmune disorders and rhinosinusitis. MethodsWe performed a case-control study of patients referred to West Virginia University from August 2020 to October 2022 for rhinologic complaints. Rhinosinusitis patients were diagnosed with either chronic rhinosinusitis (CRS) or recurrent acute rhinosinusitis (RARS). These patients were compared to non-rhinosinusitis patients. Patients' characteristics, comorbidities, and type of treatment of autoimmune disorders were reviewed. ResultsThe sample consisted of 527 rhinosinusitis [184 CRS without nasal polyps (CRSsNP), 263 CRS with nasal polyps (CRSwNP) and 80 RARS patients] patients and 564 non-rhinosinusitis patients. Patients with rhinosinusitis were more likely to be older, males, have asthma, and have current and past smoking history (all with p-value < 0.05). Autoimmune disorders, primary antibody deficiency, and immunomodulator agents were more common in rhinosinusitis patients (16.5 % vs 9.4 %, OR = 1.9, p < 0.001; 5.1 % vs 0.5 %, OR = 10.1, p < 0.001; and 3.8 % vs 1.1 %, OR = 3.7, p = 0.003 respectively). Multivariate logistic regression adjusting for confounders showed that autoimmune disorders were strongly associated with rhinosinusitis [OR = 1.6, 95 % CI = 1.10–2.48], whereas the immunomodulators did not reach statistical significance [OR = 2.4, 95 % CI = 0.87–6.47]. Subgroup analysis showed the autoimmune disorders did not significantly differ between CRS and RARS groups [OR = 1.0, 95 % CI = 0.5–2.1], or between the CRSsNP and CRSwNP groups [OR = 0.9, 95 % CI = 0.5–1.7]. ConclusionAutoimmune disorders are associated with rhinosinusitis, both CRS and RARS, independently of other risk factors.

A retrospective study of invasive fungal rhinosinusitis in adults for surgical outcomes at tertiary care hospital

Background: An invasive fungal rhinosinusitis is most lethal form of sinusitis. It includes acute and chronic invasive fungal rhinosinusitis. The most lethal fungi are Aspergillous species and mucormycosis, others are Alternaria, P. boydii and Sprothrix. Endoscopic debridement combined with intravenous antifungals are efficacious in management of invasive fungal rhinosinusitis. Methods: Study conducted at department of otorhinolaryngology, GMERS Medical College and Hospital, Sola, Ahmedabad. The period of the study October 2020 to October 2022. Total 100 cases taken. All cases of biopsy proven invasive fungal rhinosinusitis above the age of 18 years are included in this study. Oral and written consent taken from all included patients. A nasal endoscopy followed by KOH mount, magnetic resonance imaging – peripheral nervous system (MRI PNS) done. Results: In our study, 57% patients were surgically treated with functional endoscopic sinus surgery, 23% patients treated with modified Denker’s approach debridement. On basis of MRI PNS, nasal endoscopy and symptomatic improvement of the disease, only 10 patients have recurrence of disease and 90 patients are completely recovered after surgical and medical management. Conclusions: Maintaining high index of suspicion in at risk patient populations, followed by prompt evaluation and management is crucial in suspected invasive fungal rhinosinusitis. Early management with antifungal e.g. Amphotericin B intravenous injections, tab Posaconazole, tab Voriconazole and surgical intervention e.g. FESS, modified Denker’s approach debridement, FESS with middle meatal antrostomy very efficacious in terms of preventing the recurrence and mortality in patients.

Outcomes of Endoscopic Sinus Surgery for Chronic Rhinosinusitis in Adults with Primary Ciliary Dyskinesia.

Introduction Primary ciliary dyskinesia (PCD) is a rare inherited disease associated with impairment of mucociliary transport and, consequently, with a high incidence of chronic rhinosinusitis. For patients with chronic rhinosinusitis who remain symptomatic despite medical treatment, endoscopic sinus surgery is a safe and effective therapeutic option. However, to date, no studies have been found evaluating the effect of surgery on the quality of life associated with the effect on olfaction and nasal endoscopy findings of patients with primary ciliary dyskinesia and chronic rhinosinusitis. Objective To describe the effect of endoscopic sinus surgery on the quality of life, on olfaction, and on nasal endoscopy findings of adults with PCD and chronic rhinosinusitis. Methods Four patients who underwent endoscopic sinus surgery were included. The Sinonasal Outcome Test-22 (SNOT-22) score, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and the Lund-Kennedy score were collected preoperatively and at 3 and 6 months postoperatively. The olfaction as assessed with the University of Pennsylvania Smell Identification Test (UPSIT), which was administered preoperatively and 3 months postoperatively. Results A total of 4 patients with a mean age of 39.3 years old (3 men and 1 woman) completed the study. All patients showed clinically significant improvement in the SNOT-22, NOSE, and Lund-Kennedy scores at 3 months postoperatively, and this improvement was sustained throughout the follow-up period. However, olfaction did not improve after surgery. Conclusion The endoscopic sinus surgery treatment of chronic rhinosinusitis in adults with PCD was associated with improvement in quality of life and endoscopic findings. However, no improvement in olfaction was demonstrated. Studies with a larger number of patients and control groups should help confirm these findings.

CLINCO-MICROBIOLOGICAL PROFILE OF RHINOSINUSITIS IN ADULTS

Introduction: Rhinosinusitis is the condition in which sinonasal mucosa inside the paranasal sinuses gets inamed and its clinical manifestation is represented by various sinonasal and extra-nasal symptoms. Hence, the present study was planned with an aim to study the clinic-microbial prole of rhinosinusitis in adults. This cross-sectional analytical study included 300 rhi Methodology: nosinusitis patients. Detailed clinical and demographic data were collected. All the patients underwent plain radiography to assess the sinus involvement. Nasal endoscopy was performed in all the cases. During nasal endoscopy, nasal swabs were collected from all the patients. For all the culture positive cases, antibiotic susceptibility assessment was done. The majority of cultures (61.3%) were negative for pathogens. 34% ha Results: d a positive bacterial pathogen culture, while 4.7% had a positive fungal culture. Methicillin-resistant Staphylococcus aureus (MRSA) was the most prevalent gramme-positive isolate (55.9%). Simultaneously, Citrobacter spp. (3.9%) was the most prevalent gramme-negative isolate. Candida spp. accounted for 71.4% of the fourteen positive fungal specimens, while Aspergillus avus accounted for the remaining 28.6%. The majority of patients were only administered antibiotics. Cefoperazone-Sulbactam, Linezolid, Piperacillin-tazobactam, Cefritaxeone, Tobramycin, Meropenem, and Clindamycin exhibited one hundred percent sensitivity. The three most resistant antibiotics used in more than half specimen were Tetracycline (60.7%), Erythromycin (17.4%) and Penicillin (13.7%) respectively. The most prevalent organism causing rhinosinusitis was Conclusion: found to be Staphylococcus aureus and most sensitive antibiotics were Cefoperazone-Sulbactam, Linezolid, Piperacillin-tazobactam, Cefritaxeone, Tobramycin, Meropenem, and Clindamycin.

The importance of herbal medications in the treatment of rhinosinusitis in adults and children: an example of a five-ingredient herbal medicine

This review paper presents current recommendations for the treatment of acute and chronic rhinosinusitis according to theEuropean Position Paper on Rhinosinusitis and Nasal Polyps 2020, EPOS 2020. A particularly important and new element ofthese recommendations is to emphasize the role of phytotherapy as a rational treatment method, documented by a randomized,double-blind placebo-controlled trial (DBPC). An example of rational phytotherapy of rhinosinusitis is the BNO 1016 formulationrecommended in EPOS 2020, known under the trade name of Sinupret. Each of the pharmaceutical forms of BNO 1016 coatedtablets (powdered drug; dry extract) and oral drops (ethanol extract), is produced on the basis of the same combination of5 herbal substances such as: gentian root (Gentianae radix), primrose flower (Primulae flos), sorrel herb (Rumicis herba),elderflower (Sambuci flos) and verbena herb (Verbenae herba). BNO 1016 has the status of a drug with well-establishedtherapeutic use, with efficacy and safety confirmed in numerous clinical and preclinical studies. Used in the treatment of acuteuncomplicated rhinosinusitis BNO 1016 has antiviral, secretolytic, anti-inflammatory and antibacterial effects confirmed inpharmacological studies. Importantly, the drug Sinupret can be used in different age groups and therapeutic regimens (monoand polytherapy), at any stage of sinusitis from cold disease to bacterial rhinosinusitis (in combination with other drugs).

Clinical insights into appropriate choice of antimicrobials for acute respiratory tract infections

Australia has relatively high rates of antibiotic prescribing in the community. The aim of this study was to identify clinical insights regarding antibiotic prescribing choices for the management of common upper respiratory tract infections through analysis of anonymised primary care electronic medical records (EMRs). EMR data relating to 1926 antimicrobial prescriptions for tonsillitis, pharyngitis and acute rhinosinusitis in adults and acute otitis media (AOM) in children were extracted from 11 general practices in Victoria and analysed for consistency with Australian Therapeutic Guidelines recommendations. The analysis suggests that underdosing of amoxicillin for AOM in children, prescription of phenoxymethylpenicillin at doses not consistent with Therapeutic Guidelines recommendations for tonsillitis and pharyngitis in adults,and potential overprescription of antibiotics for patients with acute rhinosinusitis are not infrequent ingeneral practice. Anonymised EMR data provide an opportunity to analyse antibiotic prescribing practices at scale and provide insights relevant to clinical practice.

Prevalence, quality of life and risk factors of chronic rhinosinusitis in adults in Kingdom of Saudi Arabia 2021

Background: Chronic rhinosinusitis is one of the most prevalent chronic diseases worldwide, affecting all age groups. It is a condition leading to a significant decrease in the quality of life of patients, and requires a specific treatment approach. This study aims to assess the prevalence, quality of life and risk factors of chronic rhinosinusitis in order to develop and promote public health, wellbeing and awareness. Methodology: This is a cross-sectional study which was conducted in the Kingdom of Saudi Arabia, from August to October 2021. We collected the data using a validated, self-administrated online sinonasal outcome test (SNOT-22) questionnaire in Arabic. The questionnaire was distributed through social media and aimed to assess the prevalence and risk factors of chronic rhinosinusitis in the Kingdom of Saudi Arabia in 2021. Results: In the current study, we collected data from 4963 individuals in Saudi Arabia who responded to to our questionnaire. Participants had a mean age of 31.99 (SD=11.59) years old, 62.0% were females and 92.9% were Saudis. Among the total sample, the prevalence of chronic rhinosinusitis (CRS) was 22.5%. The prevalence of CRS was significantly lower in patients aged between 18-29 years old (19.4%) compared with the 30-49 age group (27.1%) and 50-69 age group (23.2%) (P=0.000). Moreover, we found that the prevalence of CRS was significantly higher among females (24.0% vs 20.2%, P=0.002) and among Saudis compared to non-Saudis (22.9% vs 17.6%, P=0.022). Furthermore, there was a significant reduction in the quality of life among patients with CRS where the mean score of SNOT-22 was 44.04 (SD=25.38) compared with 26.82 (SD=26.35) in non-patients. Conclusion: The current study revealed a high prevalence of CRS among individuals in Saudi Arabia especially among older females, those with chronic conditions and those who had been exposed to different risk factors such as smoking. Moreover, CRS was found to have a significantly negative impact on the quality of life for those participants diagnosed with the condition. Keywords: Quality of life, chronic sinusitis, adults, Saudi Arabia

MANAGEMENT OF CHRONIC SINUSITIS THROUGH ALTERNATE RECHANA AND SNEHANA NASYA - REPORT FROM A PILOT STUDY

Chronic sinusitis is the chronic inflammatory condition affecting the paranasal sinuses. It may be correlated to Dushta pratisyāya in Ayurveda, which is a Kapha predominant disease affecting jatṟuṛdhva bhāgā which needs teekshna virecana nasya for its management. Vāgbhaṭācārya opines that except for vātika rogas, nasya should be done as ekāhāntara (alternate day) i.e., with a gap of one day in between. But according to Cakṟadatta commentary, ekāhāntara nasya is to be done with virecana nasya and snehana nasya on alternate days. For virecana nasya, Tuḷasi patṟa svarasa (Ocimum sanctum Linn.) and for snehana nasya, Aṇutaila were selected. A patient aged 43 years diagnosed with adult rhinosinusitis diagnostic criteria was taken for the study and was given ekāhāntara nasya with Tuḷasi patṟa svarasa and Aṇutaila for 7 days. During follow up period Pathyākṣadhātṟyādi kaṣāya was given for 15 days. Samyak nasya lakṣaṇa and Event evaluation scales were assessed on each day of nasya and Scale for scoring of symptoms, Rhinosinusitis Disability Index and Visual Analogue Scale were assessed before trial, after trial and after follow up. After the course of treatment 100% improvement was found in the Scale for scoring of symptoms, Rhinosinusitis Disability Index and Visual Analogue Scale. Keywords: Case report, Ekāhāntara (alternate day) nasya, Tuḷasipatṟasvarasa, Aṇutaila, Chronic sinusitis

Sense of smell disorders in family physician practice

A properly functioning sense of smell recognizes both food and danger and provides sensory input. Sense of smell is lost and/or impaired in diseases accompanied by impaired nasal patency such as chronic rhinosinusitis with or without nasal polyps, allergic rhinitis, respiratory infections including acute rhinosinusitis. In the case of rhinosinusitis in adults, olfactory impairment is one of the four main symptoms of the disease. They can also be caused by damage to the olfactory neuron, e.g. in the course of a viral infection. Loss of smell and/or taste reported by patients with COVID-19 may be a diagnostic hint. Modern intranasal glucocorticosteroids are used to treat olfactory disturbances and loss of smell caused by nasal patency impairment (or accompanying diseases with nasal patency impairment).

Are oral steroids effective in the management of chronic rhinosinusitis in adults?

Are oral steroids effective in the management of chronic rhinosinusitis in adults?

Fungus ball of the maxillary sinus: clinical and diagnostic characteristics

Abstract Fungus ball of the maxillary sinus (FBMS) is the most common form of chronic fungal rhinosinusitis in adults. It is a condition of old age, usually with unilateral involvement, and with female preponderance. It is especially described in immunocompetent individuals and is characterized by a slow and benign evolution. Although the etiology, pathogenesis and natural history of fungal rhino-sinusitis have been studied extensively, they are far from being fully understood. The clinical presentation and endoscopic findings in patients with fungus ball of the maxillary sinus are nonspecific, often identical to those of chronic bacterial rhinosinusitis and the cultures are often negative. Imaging evaluation by CT scan suggests, by characteristic signs, a correct diagnosis, which is then correlated with the histological identification of fungal hyphae. Microbiological, histopathological and mycological examinations of nasal secretion established with certainty a variety of bacteria (70%) and fungi (61.7%) in a group of 60 patients with FBMS included in a three-year study. The most commonly detected bacterial floras were Staphylococcus aureus, Citrobacter Koseri, Haemophilus influenzae, Pseudomonas aeruginosa, Moraxella catarrhalis and Klebsiella oxytoca. On culture media, the most common fungal agents were Aspergillus fumigatus and Aspergillus flavus.

Accuracy of signs, symptoms and blood tests for diagnosing acute bacterial rhinosinusitis and CT-confirmed acute rhinosinusitis in adults: protocol of an individual patient data meta-analysis

IntroductionThis protocol outlines a diagnostic individual patient data (IPD) meta-analysis aimed at developing simple prediction models based on readily available signs, symptoms and blood tests to accurately predict acute bacterial...

Association of serum vitamin D with Chronic RhinoSinusitis in adults residing at high altitudes.

To evaluate the association of serum vitamin D levels with chronic rhinosinusitis (CRS) in population residing at high altitudes and to assess its correlation with severity of CRS. A prospective case-control study comparing vitamin D in 60 cases (30 with nasal polyposis and 30 without) and 31 controls was carried out. Correlation of vitamin D with severity of disease (Lund Mackay CT/LMS and endoscopic Lund Kennedy scores/LKS) was assessed using Spearman's correlation (rs). Logistic regression analysis using vitamin D and confounding factors (Age and gender only, as other variables like smoking, bronchial asthma were exclusion criteria) as dependent and CRS (presence/absence) as independent variable, was also conducted. A significantly lower vitamin D levels were found in CRS (14.60 ± 7.68ng/ml), CRSwNP (13.70 ± 7.88ng/ml) and CRSsNP (15.49 ± 7.50ng/ml), when compared to controls (29.36 ± 7.49ng/ml). Non allergic cases when compared with controls, showed significantly lower vitamin D levels (13.91 ± 6.78 compared to 29.36 ± 7.49ng/ml). LMS and LKS in CRS showed a moderate correlation with vitamin D (rs: -0.604 for LMS, rs: -0.595 for LKS). Logistic regression analysis showed vitamin D levels (Odds-Ratio 0.783) to be an independent predictive factor of CRS. A significantly lower vitamin D level is associated with CRS, irrespective of presence or absence of nasal polyposis in adults residing at high altitudes. Vitamin D is an independent predictive factor for CRS. There is an inverse moderate correlation of severity of CRS with vitamin D.

Pediatric Versus Adult Chronic Rhinosinusitis.

Pediatric and adult chronic rhinosinusitis (CRS) have some similarities but a number of differences. This article reviews the similarities and differences between pediatric and adult CRS. Rhinosinusitis is an inflammatory disease of the nose and the paranasal sinuses. In adults, inflammation in CRS without polyps (CRSsNP) mainly manifests with T-helper 1 lymphocytes while in CRS with polyps (CRSwNP) manifests with T-helper 2 lymphocytes and eosinophilic inflammation. In children, CRS inflammation manifests with neutrophils, macrophages, and lymphocytes. The associations between the ostiomeatal complex occlusion and CRS are revealed in adults but are not so evident in children. Although the relationship between the CRS and allergic rhinitis is still controversial, recent findings have shown an association between allergen sensitization and a specific group of adults with rhinosinusitis. Intranasal corticosteroids and saline constitute the first-line of medical treatment for both pediatric and adult rhinosinusitis. Low-dose macrolides are used for immunomodulatory activities and beneficial effects to adult patients with CRSsNP were demonstrated by recent meta-analyses. For surgical treatment, adenoidectomy is a key strategy to eradicate mature biofilms in pediatric CRS and effective in treating children with CRS regardless of the adenoid size. Although endoscopic sinus surgery has been proven to improve quality of life outcomes in adult CRS, it should be only considered in the pediatric CRS after failure of adenoidectomy. Pediatric and adult CRS are different in many aspects, including immunopathogenesis and management. Investigations should be considered in specific cases. After failure of medical treatments, endoscopic sinus surgery is recommended for adults, while adenoidectomy is primarily considered for children.

Intranasal glucocorticosteroids for the complex treatment of patients with chronic diseases of the nose and paranasal sinuses

Intriduction. Chronic rhinitis and rhinosinusitis noticeably deteriorate the patients’ quality of life and lead to the accompanying upper airway pathology development. The main purpose of treatment of this group of patients is to decrease severity of symptoms and the second one to prevent complications. The optimal therapy will help patients to maintain their lifestyle. Intranasal glucocorticosteroids are first-line drugs to treat acute rhinosinusitis or exacerbations of chronic rhinosinusitis in adults (including the elderly) and adolescents aged 12 years and older as an auxiliary therapeutic agent if treated by antibiotics, and to treat acute rhinosinusitis with mild to moderate symptoms without signs of severe bacterial infection. In the number of trials, mometasone furoate effectiveness in regard to decreasing of prominent symptoms with no side effects development has been shown.Objective: this article reviews available data on the effectiveness of intranasal corticosteroids – mometasone furoate – in the treatment of different forms of chronic inflammatory diseases of the nose and paranasal sinuses.Methods: information for this review was identified through a RISC and MEDLINE databases applying key words.Conclusions: based on the available data, treatment of chronic rhinosinusites and rhinitis should be initiated by conservative therapy. Summarizing information from the available literature we can conclude that treatment by mometasone furoate improve quality of life decreasing clinical symptoms of chronic rhinosinusitis and rhinitis.

Characteristics of Atypical Orbital Complications of Sinusitis.

Orbital complications of rhinosinusitis in adults are scarcely discussed in the literature. We defined atypical orbital complications as those without typical orbital invasion and not classified by the Chandler classification. These complications present as visual loss of diplopia without soft tissue swelling, pain, or computed tomography images of an orbital abscess. The objective of this study was to review our experience with the management of atypical orbital complications of rhinosinusitis and to identify key factors in the characteristics of these patients. A retrospective case series review was conducted from 2015 to 2019 in a tertiary referral center, which included all patients with rhinosinusitis and orbital complications. Five patients were identified with atypical complications in the orbital area. Two of the 5 patients exhibited vision loss without any other symptoms. Two patients showed diplopia with or without ptosis. One patient had a headache and ptosis. Complete recovery was noted in 4 of the 5 patients after endoscopic sinus surgery. With future studies, new surgical criteria, including retinal destruction, location of the sinusitis, the onset of ophthalmological symptoms, and culture results may be added to the classical surgical criteria to manage orbital complications of paranasal sinus infection cases.

Healthcare utilisation, follow-up of guidelines and practice variation on rhinosinusitis in adults: A healthcare reimbursement claims study in The Netherlands.

ObjectivesTo provide insight into healthcare utilisation of rhinosinusitis, compare data with clinical practice guideline recommendations and assess practice variation.DesignAnonymised data from claims reimbursement registries of healthcare insurers were analysed, from 1 January 2016 until 31 December 2016.SettingSecondary and tertiary care in the Netherlands.ParticipantsPatients ≥18 years with diagnostic code “sinusitis.”Main outcome measuresHealthcare utilisation (prevalence, co‐morbidity, diagnostic testing, surgery), costs, comparison with guideline recommendation, practice variation.ResultsWe identified 56 825 patients, prevalence was 0.4%. Costs were € 45 979 554—that is 0.2% of total hospital‐related care costs (€21 831.3 × 106). Most patients were <75 years, with a slight female preponderance. 29% had comorbidities (usually COPD/asthma). 9% underwent skin prick testing, 61% nasal endoscopy, 2% X‐ray and 51% CT. Surgery rate was 16%, mostly in daycare. Nearly, all surgical procedures were performed endonasally and concerned the maxillary and/or ethmoid sinus. Seven recommendations (25%) could be (partially) compared to the distribution of claims data. Except for endoscopy, healthcare utilisation patterns were in line with guideline recommendations. We compared results for three geographical regions and found generally corresponding rates of diagnostic testing and surgery.ConclusionPrevalence was lower than reported previously. Within the boundaries of guideline recommendations, we encountered acceptable variation in healthcare utilisation in Dutch hospitals. Health reimbursement claims data can provide insight into healthcare utilisation, but they do not allow evaluation of the quality and outcomes of care, and therefore, results should be interpreted with caution.

The role of oral vitamin D3 supplementation in the treatment of Chronic Rhinosinusitis in adults with Vitamin D deficiency.

Background:Chronic Rhinosinusitis (CRS) is a chronic inflammatory disorder of the mucosal lining of the nose and paranasal sinuses. The ability of Vitamin D (VD3) to augment innate and adaptive immune responses has sparked interest in its immunologic role in the treatment of CRS. In this study, the incidence of vitamin D deficiency in CRS patients was compared to normal population and the beneficial role of Vitamin D supplementation in its treatment was also evaluated.Materials and Methods:It is a retrospective 1-year study of 200 CRS patients with Vitamin D deficiency. The patients were divided into two groups, i.e. 100 patients were given oral Vitamin D supplements and the other group of 100 patients were treated as placebo. Both Vitamin D levels and the Total Nasal Symptom Score (TNSS) were assessed at the start and end of the study period.Results:Of the 200 subjects with CRS, 100 were given oral vitamin D supplementation in the form of Cholecalciferol 60000IU weekly once for 3 months and the other group were treated with placebo. Before the treatment, the average level of serum Vitamin D was 12.31 ng/ml. After 3 months, it increased significantly to 29.71 ng/ml. Similarly, the pretreatment TNSS score was on average 11.92. After 3 months, the scores fell by an average of 10.65 points, a significant statistical difference (P < 0.05).Conclusion:There is a higher prevalence of vitamin D deficiency in CRS patients and that vitamin D supplementation in these patients went a long way in alleviating their symptoms.