Symptoms Of Rhinosinusitis Research Articles

The changes of clinical and histological characteristics of chronic rhinosinusitis in 18 years: Was there an inflammatory pattern shift in southern China?

BackgroundNowadays, the heterogeneity of chronic rhinosinusitis (CRS) has attracted extensive attention. The histological patterns and clinical characteristics may vary greatly in different areas and among different groups of people. Prior studies found a shift from the neutrophilic inflammatory pattern to the eosinophilic inflammatory pattern in Asian cities. This study set out with the aim of investigating the changes that have occurred in the past 18 years of southern China and exploring the causes. MethodsTissues, clinical, and demographic characteristics were obtained from 473 patients (91 in 2000–2001, 170 in 2010–2011, 212 in 2017–2018) who satisfied the criteria of diffuse (bilateral) chronic rhinosinusitis. The clinical characteristics, including the previous history of allergic rhinitis and asthma, and the major symptoms of rhinosinusitis, were collected. Formalin-fixed nasal tissue was obtained from each patient for calculating inflammatory cells. We also performed immunohistochemistry to evaluate the expression levels of eosinophilic cationic protein (ECP), IgE, myeloperoxidase (MPO), and other Type 1, Type 2, and Type 3 related inflammatory cytokines. ResultsThe comorbidity of asthma and atopic disease was higher in 2017–2018 compared to 2000–2001. The histological characteristics revealed a significant increase in tissue eosinophils and decrease in neutrophils in 2017–2018 as compared with 2000–2001. Meanwhile, the proportion of eosinophilic CRS (eCRS) increased significantly from 2000 to 2001 to 2017–2018 (P = 0.03). The tissue eosinophil increase was higher in overweight patients (Body Mass Index, BMI≥24) as compared with non-overweight. There was an increasing trend of ECP, IL-13 and IL-17. Besides, IFN-γ and TNF-α decreased. ConclusionsThere was an eosinophilic shift of diffuse rhinosinusitis inflammatory pattern in southern China over the last 18 years. The proportion of eCRS and difficult-to-treat rhinosinusitis has steadily increased, which is associated with the increase of Type 2, Type 3 cytokines and the decrease of Type 1 cytokines. This study also provided firstly evidence of a strong relationship between overweight and eosinophil shift in the southern Chinese population.

A Pilot Investigation of the Pediatric Nasal Microbiome.

This proof-of-concept study demonstrates that sinonasal microbiome sequencing with suctioned nasal secretions in children is technically feasible. Eighteen children were enrolled: 11 with symptoms of rhinosinusitis and 7 controls. Samples were collected via a sterile flexible respiratory suction catheter into a suction trap. Samples were analyzed with 16S ribosomal RNA sequencing and subsequent phylogenic mapping. The log2-fold differential abundance in class demonstrated significantly higher quantities of bacteria from the classes Negativicutes, Bacilli, Mollicutes, and Alphaproteobacteria as compared with controls, with a false discovery rate-corrected P value <.01 for all 4. The experimental group showed a higher range of alpha diversity than the control group, although none of the measures of alpha diversity showed a statistically significant difference. Overall our study demonstrates that sinonasal microbiome sequencing with suctioned nasal secretions is a readily available and technically feasible alternative for study of the pediatric sinonasal microbiome.

#57: The Clinical Significance of Changes in the Microbial Communities of the Nasal Cavity in Patients with Solid Tumors of Parameningeal Localization During Radiation Therapy

Abstract Background Immunosuppressive therapy places pediatric patients at risk of developing life-threatening sinonasal infections. Radiation-induced rhinitis is poorly studied and considered in clinical practice. Recognition of the unique microbial cultures of the nasal cavity and their antimicrobial susceptibility is of great importance when selecting antimicrobial therapy. Radiation therapy can affect nasal cavity microbiota. Despite considerable research, the pathogenesis of rhinitis remains poorly understood. Materials and Methods The study included 10 patients (boys 6; girls 4). Of them, the number of patients with rhabdomyosarcoma is 6 patients (60%), nasopharyngeal cancer 3 (30%), and hemangiopericytoma 1 (10%). The average age is 12.4 g. The observation period is 9–18 months. Tumors were localized in the nasopharynx 30%, paranasal sinuses on the one hand 50%, and on both sides 20%. Chemotherapy (ChT) included 8–16 courses. Radiation therapy (RT) was carried out after 4–6 courses, SOD 40–50 Gy. Examination of the otorhinolaryngologist and endoscopic examination of the nasal cavity were performed for all patients before and after the completion of special treatment. Standard microbial culture studies are carried out before (T0), in the middle of the course of radiation therapy (RT) (T1), and at the end (T2) RT. A repeat study microbial culture 12 months after completion of RT (T3). An analysis of the results will be compared with clinical data. Results All patients showed symptoms of chronic rhinosinusitis before the start of special treatment. Clinically determined: hyperemia and swelling of the mucosa of the lower and middle turbinates in 100% of cases, unilateral mucopurulent and purulent discharge in 70%, and bilateral in 30%. Complications and concomitant pathology were diagnosed in the form of dysfunction of the auditory tube in 30%, signs of tubo otitis in 60%, unilateral catarrhal otitis media in 10% of cases. During the bacteriological examination of a nasal swab against the background of chemotherapy, bacteria of the family Staphylococcaceae and Streptococcaceae with the same purity of 30%, fungi of the genus Candida in 20%, H. parainfluenzae and Corynebacterium amycolatum were equally divided in 10% of cases. Symptoms of exacerbation of chronic inflammation were detected in 100% of patients after 18–24 Gy was added to the tumor. After 3 months the completion treatment, gram-negative bacteria were obtained in smears: Enterobacter cloacae in 30%, Pseudomonas aeruginosa in 20%, Acinetobacter species in 10%, and mixed flora (Staphylococcus haemolyticus and Staphylococcus haemolyticus MRS), in 10% of patients. Conclusion Clinical manifestations of chronic rhinosinusitis accompany the growth of malignant tumors of the nasopharynx and paranasal sinuses. An increase in the concentration of pathogenic and conditionally pathogenic bacteria in the nasal cavity during CRT reflects a decrease in nonspecific immunity and the general immune resistance of the body.

Clinical and immunological efficiency of bacteriophage in technique of delayed prescribing of antibiotics in patients with acute post-viral rhinosinusitis

Topicality: Acute Rhinosinusitis can be characterised as acute bacterial rhinosinusitis just in about 0,5 - 2% of the number of viral one and only such patients need prescription of antibiotics. At the same time, antibacterial therapy is prescribed in from 54% to 77% cases of Acute Rhinosinusitis. To reduce the number of unreasonable prescriptions, the strategy of delayed prescribing of antibioticsis the forward-looking one. Aim: to evaluate the level of IgА and sIgA in patients with post-viral RS and estimate the clinical and immunological efficiency of polyvalent bacteriophage in technique of delayed prescribing of antibiotics in comparison with the patients receiving standard APVRS therapy. Material and methods: 155 adult patients with acute post-viral RS participated in the trial who were given either standard therapy or polyvalent bacteriophage in addition to the standard therapy. In conjunction with the treatment, the IgА and sIgA levels were evaluated and their comparison with clinical dynamics was undertaken. Evaluation criteria: decrease in intensity of disease symptoms evaluated in accordance with MSS scale system during each visit in comparison with the 1st visit, antibiotic prescribing frequency, dynamics of changes of serum and secretory IgА levels. Results and discussion: The use of polyvalent bacteriophagein addition to the standard therapy of acute post-viral rhinosinusitisas a part of technique of delayed prescribing of antibiotics ensures clinically significant, faster dynamics of regression of typical clinical symptoms of post-viral rhinosinusitis: rhinorrhea, nasal congestion and post-nasal drip in comparison with the control group (p&lt;0.05). Positive dynamics of clinical symptomatology is followed by the fair increase of IgА and sIgA levels (p&lt;0.005), in comparison with the level before treatment and the control group. The statistically significant difference between the control group and the intervention one in IgА and sIgA indicators is associated with fairly higher (by 20%) rate of prescribing of antibiotics in the control group. Conclusion: polyvalent bacteriophage is a safe and effective medication for additional treatment of acute post-viral rhinosinusitis intended to improve indicators of systemic and local immunity and reduce the rate of use of antibiotics. The inclusion of the medication into the treatment regimen could be recommended to the patients as a part of technique of delayed prescribing of antibiotics.

Effectiveness of Personalized Low Salicylate Diet in the Management of Salicylates Hypersensitive Patients: Interventional Study.

Salicylic acid and its derivatives (including acetylsalicylic acid/aspirin) are popular in medicine. They also occur naturally in many food products. The aim of the study was to investigate the effect of the personalized low salicylate diet (PLSD) on the reduction of asthma, rhinosinusitis and urticaria symptoms in patients with hypersensitivity to aspirin (ASA) or nonsteroidal anti-inflammatory drugs (NSAIDs). To achieve the research goal, a prospective, nonrandomized, baseline-controlled intervention study was conducted. Thirty patients diagnosed with NSAIDs hypersensitivity, who despite pharmacotherapy had symptoms of hypersensitivity, were included in the study. The PLSD was recommended for all participants for a period of two to four weeks. The intensity of subjectively declared symptoms of asthma, rhinosinusitis and urticaria were measured before and after dietary intervention, using, respectively, the asthma control test (ACT), the sino-nasal outcome test (SNOT-22) and the four-item itch questionnaire (FIIQ). Diet adherence and salicylate intake were measured by a 3-day food record. The severity of symptoms improved significantly after the intervention. The median of the ACT score was 24 scores before and 25 after the dietary intervention (p < 0.002), the median of the SNOT-22 score was 25 before and 13 after a dietary intervention (p < 0.0002) and the median of the FIIQ score was 5 before and 0 after a dietary intervention (p < 0.0002). The intake of salicylates decreased from 0.79 mg/day (before intervention) to 0.15 mg/day (p < 0.001) (during intervention). Although the usefulness of a low salicylate diet in the treatment of salicylate hypersensitivity is controversial, the results of our study indicate that the PLSD may have a positive effect in reducing symptoms of salicylate hypersensitivity and could be an additional tool supporting the therapy of these patients.

Biologics for chronic rhinosinusitis.

This living systematic review is one of several Cochrane Reviews evaluating the medical management of patients with chronic rhinosinusitis. Chronic rhinosinusitis is common. Itis characterised by inflammation of the nasal and sinus linings,nasal blockage, rhinorrhoea, facial pressure/pain and loss of sense of smell. It occurs with or without nasal polyps. 'Biologics' are medicinal products produced by a biological process.Monoclonal antibodies are one type, already evaluated in other inflammatory conditions (e.g.asthma and atopic dermatitis). To assess the effects of biologics for the treatment of chronic rhinosinusitis. The Cochrane ENT Information Specialist searched the Cochrane ENT Register; CENTRAL (2020, Issue 9); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished studies. The date of the search was 28 September 2020. Randomised controlled trials (RCTs) with at least three months follow-upcomparing biologics (monoclonal antibodies) against placebo/no treatment in patients with chronic rhinosinusitis. We used standard Cochrane methodological procedures. Our primary outcomes were disease-specific health-related quality of life (HRQL), disease severity and serious adverse events (SAEs). The secondary outcomes were avoidance of surgery, extent of disease (measured by endoscopic or computerised tomography (CT) score), generic HRQL and adverse effects (nasopharyngitis, including sore throat). We used GRADE to assess the certainty of the evidence for each outcome. We included 10 studies. Of 1262 adult participants, 1260 had severe chronic rhinosinusitis with nasal polyps; 43% to 100% ofparticipants also had asthma. Three biologics, with different targets, were evaluated: dupilumab, mepolizumab and omalizumab. All of the studies were sponsored or supported by industry. For this update (2021) we have included two new studies, including 265 participants, which reported data relating to omalizumab. Anti-IL-4Rα mAb (dupilumab)versus placebo/no treatment (all receiving intranasal steroids) Three studies (784 participants) evaluated dupilumab. Disease-specific HRQL wasmeasured with the SNOT-22 (a 22-item questionnaire, with a score range of 0 to 110;minimal clinically important difference (MCID) 8.9 points). At 24 weeks, dupilumab results in a large reduction (improvement) in the SNOT-22 score (mean difference (MD) -19.61, 95% confidence interval (CI) -22.54 to -16.69; 3 studies; 784 participants; high certainty). At between 16 and 52 weeks of follow-up, dupilumab probably results in a large reduction in disease severity, as measured by a 0- to 10-point visual analogue scale (VAS) (MD -3.00, 95% CI -3.47 to -2.53; 3 studies; 784 participants; moderate certainty). This is a global symptom score, including all aspects of chronic rhinosinusitis symptoms. At between 16 and 52 weeks of follow-up, dupilumab may result in a reduction in serious adverse events compared to placebo (5.9% versus 12.5%, risk ratio (RR) 0.47, 95% CI 0.29 to 0.76; 3 studies, 782 participants; low certainty). Anti-IL-5 mAb (mepolizumab)versus placebo/no treatment (all receiving intranasal steroids) Two studies (137 participants) evaluated mepolizumab. Disease-specific HRQLwas measured with the SNOT-22. At 25 weeks, the SNOT-22 score may be reduced (improved) in participants receivingmepolizumab (MD -13.26 points, 95% CI -22.08to -4.44; 1 study; 105 participants; low certainty; MCID 8.9). It is very uncertain whether there is a difference in disease severity at 25 weeks:ona 0- to 10-point VAS, disease severity was -2.03 lower in those receiving mepolizumab(95% CI -3.65 to -0.41; 1 study;72 participants; very low certainty). It is very uncertain if there is a difference in the number of serious adverse events at between 25 and 40 weeks (1.4% versus 0%; RR 1.57, 95% CI 0.07 to 35.46; 2 studies; 135 participants, very low certainty). Anti-IgE mAb (omalizumab)versus placebo/no treatment (all receivingintranasal steroids) Five studies (329 participants) evaluated omalizumab. Disease-specific HRQL was measured with the SNOT-22. At 24 weeks omalizumab probably results in a large reduction in SNOT-22 score (MD -15.62, 95% CI -19.79 to -11.45; 2 studies; 265 participants; moderate certainty; MCID 8.9). We did not identify any evidence for overall disease severity. It is very uncertain whether omalizumab affects the number of serious adverse events, with follow-up between 20 and 26 weeks (0.8% versus 2.5%, RR 0.32, 95% CI 0.05 to 2.00; 5 studies; 329 participants; very low certainty). Almost all of the participants in the included studies had nasal polyps (99.8%) and all were using topical nasal steroids for their chronic rhinosinusitis symptoms. Inthese patients, dupilumab improves disease-specific HRQL compared to placebo. It probably also results in a reduction in disease severity, and may result in a reduction in the number of serious adverse events. Mepolizumab may improve disease-specific HRQL.Itis very uncertain if there is a difference in disease severity or the number of serious adverse events. Omalizumab probably improves disease-specific HRQL compared to placebo. It is very uncertain if there is a difference in the number of serious adverse events. There was no evidence regarding the effect of omalizumab on disease severity (using global scores that address all symptoms of chronic rhinosinusitis).

The role of house dust mite immunotherapy in Indonesian children with chronic rhinosinusitis allergy: A randomized control trial

BackgroundChronic rhinosinusitis allergy (CRA) is a disease that is commonly found in children and is mostly caused by allergy to house dust mites (HDM). The use of HDM immunotherapy can be considered in children with allergies. ObjectivesAnalyzing the impact of mite immunotherapy on disease burden in Indonesian children with CRA. MethodsA randomized control trial study was conducted to participants in 2 groups, namely the immunotherapy group (n = 25) and the non-immunotherapy group (n = 25). Participants were given HDM immunotherapy for 14 weeks, which was given once per week. Participants during therapy were evaluated for rhinosinusitis symptoms and measured their immunity status (specific IgE), sleep quality (SDSC), quality of life (SN5), and family coping (F-COPES) pre-post therapy. Statistical analysis used in this study included paired t-test, Wilcoxon test, independent t-test, or Mann Whitney test with p < 0.05. ResultsThe value of specific IgE in the immunotherapy group was 4.12 ± 7.75 kU/l (pre-test) and 1.52 ± 2.42 kU/l (post-test; p < 0.001), while in the non-immunotherapy group was 1.47 ± 3.28 kU/l (pre-test) and 1.18 ± 2.81 kU/l (post-test; p = 0.317). The SDSC value in the immunotherapy group was 42.16 ± 2.75 (pre-test) and 30.32 ± 3.22 (post-test; p < 0.001), while in the non-immunotherapy group was 41.92 ± 2.75 (pre-test) and 41.84 ± 2.87 (post-test; p = 0.987). The F-COPES value in the immunotherapy group was 101.56 ± 5.78 (pre-test) and 105.20 ± 4.31 (post-test; p = 0.015), while in the non-immunotherapy group was 100.36 ± 9.63 (pre-test) and 99.96 ± 9.98 (post-test; p = 0.224). The SN-5 value in the immunotherapy group was 30.04 ± 2.78 (pre-test) and 11.00 ± 2.33 (post-test; p < 0.001), while in the non-immunotherapy group was 30.04 ± 2.78 (pre-test) and 30.04 ± 2.78 (post-test; p = 0.767). There was a significant comparison between the immunotherapy group and the non-immunotherapy group on the specific IgE (p = 0.013), SDSC (p < 0.001), and SN-5 (p < 0.001) values. Meanwhile, there was no significant difference in the F-COPES value (p = 0.129). ConclusionsThe administration of HDM immunotherapy can improve the participant's immunity, quality of life, and sleep disorder.

Mepolizumab reduces disease symptoms for Patients with Chronic Rhinosinusitis with Nasal Polyps: Data from the SYNAPSE study

Assess efficacy of 4-weekly add-on mepolizumab 100 mg SC on patient reported symptoms of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Co-primary endpoints of change from baseline in endoscopic NP score and nasal obstruction visual analogue scale (VAS) score have been previously reported.

Baicalin Ameliorates Inflammatory Response in a Mouse Model of Rhinosinusitis via Regulating the Treg/Th17 Balance.

Rhinosinusitis is a global health problem affecting millions of people around the world. Baicalin is a bioactive compound isolated from medicinal plant Scutellaria baicalensis Georgi. The present study aims to investigate potential effects of baicalin on clinicopathological changes in nasal/sinus mucosa in a mouse model. A mouse model of sinonasal inflammation induced by high dose of ovalbumin was applied to evaluate effects of baicalin. Rhinosinusitis symptoms, histopathological features, levels of histamine, immunoglobulin E (IgE), IL-17A, IL-10, and balance of regulatory T cell (Treg)/T-helper 17 (Th17) responses were examined. Baicalin significantly relieved rhinosinusitis symptoms in mice, reduced histopathological changes, and suppressed serum levels of histamine and IgE in a dose-dependent manner. In lymphocytes of mice, baicalin modulated balance of Treg/Th17 proportions by attenuating Th17 cells and enhancing Treg cells, respectively. The serum IL-17A was decreased and IL-10 was increased in mice treated by baicalin. In addition, baicalin promoted levels of Smad protein 3 (p-Smad3) and forkhead box P3 (FOXP3) to promote Treg cells while suppressed levels of p-Stat3 and retineic-acid-receptor-related orphan nuclear receptor γt (RORγt) to inhibit Th17 cells. These data demonstrate that baicalin effectively ameliorates sinonasal inflammation in a mouse model by recovering the immunological balance of Treg/Th17 responses. Our finding highlights the potential value of baicalin for the treatment of rhinosinusitis.

The impact of treatment under subterraneotherapy conditions at the Wieliczka Salt Mine Health Resort on the symptoms of diseases of the nose and paranasal sinuses

Introduction: Chronic rhinosinusitis is an important disease of the upper respiratory system which substantially reduces patient quality of life and the methods of symptomatic treatment are tremendously limited. &lt;br/&gt;&lt;br/&gt;Aim: The aim of this study was to evaluate the next therapeutic option which is a combination of respiratory rehabilitation and subterraneotherapy. &lt;br/&gt;&lt;br/&gt;Material and methods: The study covered 57 patients of whom 15 were men and 42 women. The average age of patients was 60 +/- 10.87 (standard deviation). 44 patients finished 15 days of therapy which covers full-time treatment. The average age of these patients was 59.7 +/- 11.6 (standard deviation). &lt;br/&gt;&lt;br/&gt;Results: In the study group, there was a statistically significant reduction among all analyzed symptoms of chronic rhinosinusitis. The general severity of symptoms decreased from 5.66 cm to 2.57 cm (p &lt; 0.001), blockade/congestion of the nose from 5.49 to 2.23 cm (p &lt; 0.001), anterior nasal discharge from 5.33 cm to 2.5 cm (p &lt; 0.001), posterior nasal discharge from 6.04 cm to 2.71 cm (p &lt; 0.001), facial pain/pressure from 3.43 cm to 1.45 cm (p &lt; 0.001), headache from 3.73 cm to 1.19 cm (p &lt; 0.001) and reduction or loss of smell from 4.17 cm to 1.94 cm (p &lt; 0.001). &lt;br/&gt;&lt;br/&gt;Conclusions: Such a notable improvement in all analyzed symptoms led us to conclude that respiratory rehabilitation, especially such conducted in adequate climatic conditions, should be a valuable therapeutic option in the symptomatic treatment of patients with chronic rhinosinusitis.

The Risks of Complications During Endoscopic Sinus Surgery in Cystic Fibrosis Patients: An Anatomical and Endoscopic Study.

An increasing proportion of adult cystic fibrosis (CF) patients is being referred to endoscopic sinus surgery (ESS) in order to relieve the symptoms of chronic rhinosinusitis (CRS). Given that CFTR mutations profoundly alter sinonasal development, we want to explore the relationship between their peculiar surgical anatomy and the risk of postoperative complications. Retrospective case-control study. Paranasal sinuses CT scans of 103 CF adult patients with CRS were compared to those belonging to a cohort of 100 non-CF adult patients to explore their anatomical differences. Secondly, CF and non-CF patients who received primary/revision ESS were analyzed in order to assess their preoperative CT scan in terms of surgically relevant variants, and according to the CLOSE checklist. Surgical outcomes were statistically compared in order to explore the differences between groups. CF group presented more frequently with smaller and less pneumatized paranasal sinuses and a higher Lund-Mckay score compared with controls. No anatomical differences emerged in terms of genotype stratification. Non-CF CRS patients undergoing ESS showed a significantly deeper olfactory fossa and a more frequent supraorbital pneumatization compared to CF patients (P < .001 and P=.031, respectively). Whereas this latter group underwent more often aggressive surgical procedures (P=.001), no difference in terms of postoperative adverse events was found (P=.620). Despite receiving more often aggressive ESS procedures, adult CF patients do not show an increased risk of postoperative complication and this may be linked to a different proportion of anatomical and surgically-relevant variants. 4 Laryngoscope, 131:E2481-E2489, 2021.

Relationship between pain-related comorbidities and quality of life in patients with symptoms of chronic rhinosinusitis

IntroductionFacial pain is a common manifestation of sinonasal disease but may be due to a variety of other conditions. Misattribution of pain to chronic rhinosinusitis may result in worse quality of life in populations both with and without objective evidence of sinonasal disease. The purpose of this study was to determine if there is an association between pain-related comorbidities and worse chronic rhinosinusitis specific quality of life in patients with and without objective evidence of sinonasal inflammation. MethodsRetrospective cohort study of 299 patients meeting diagnostic criteria for sinusitis evaluated at a tertiary academic medical center from 2017 to 2018. Objective evidence was measured using the Lund-Kennedy and Lund-MacKay scoring systems; for the purposes of this study a score >3 on either scale was considered indicative of disease. Quality of life was determined by the rhinosinusitis disability index. ResultsA total of 191 patients were included in the study, with an average age of 52.7. (SD=15.3). The average Lund-Kennedy and Lund-MacKay scores were 4.7 and 8.3, respectively. The average rhinosinusitis disability index was 32.1. When stratified by the presence of pain-related comorbidities, there was no significant difference in Lund-Kennedy (p = 0.203), Lund-MacKay (p = 0.101), or rhinosinusitis disability index (p = 0.421). ConclusionAlthough prior studies have suggested a correlation between the presence of pain-related comorbidities and worse chronic rhinosinusitis specific quality of life, this relationship was not evident within the current cohort of patients. The relationship between pain and sinusitis specific quality of life is likely complex and requires further research to fully elucidate.

Smell and Taste Impairment in a Nationwide Sample of US Adults With Chronic Rhinosinusitis Symptoms.

ObjectiveTo estimate the prevalence of objectively confirmed olfactory and gustatory dysfunction in US adults reporting chronic rhinosinusitis (CRS) symptoms in a nationally representative database.Study DesignCross-sectional epidemiologic analysis.SettingData were analyzed from the smell and taste component of the 2013-2014 NHANES data set (National Health and Nutrition Examination Survey).MethodsIndividuals reporting the presence of ≥2 cardinal CRS symptoms (nasal blockage, sinus pain, discolored mucus, and dysosmia) were identified as patients with a potential diagnosis of CRS. Associations were examined between the presence of CRS symptoms and both self-reported and objectively measured smell and taste.ResultsOne-third (33%) of adults who have ≥2 CRS symptoms report subjective olfactory impairment, though only 18% of these adults have quantifiable olfactory dysfunction on objective testing. Of these adults, 27% report subjective taste impairment, but just 17% have quantifiable gustatory dysfunction on objective testing. The presence of ≥2 CRS symptoms was not significantly associated with objective olfactory or gustatory dysfunction, although the individual symptoms of subjective dysosmia and discolored mucus were associated with objectively confirmed olfactory dysfunction.ConclusionThe prevalence of objective olfactory and gustatory dysfunction was higher among adults reporting the presence of ≥2 CRS symptoms, but the differences were not statistically significant. Specific sinonasal symptoms, including discolored mucus and subjective smell dysfunction, were significantly associated with objective smell impairment.

Comparative efficacy of various treatment regimens for children 2-5 years old with symptoms of acute viral rhinosinusitis

In an open, randomized prospective comparative clinical study in parallel groups of patients with a diagnosis of acute respiratory infection, acute rhinosinusitis, 107 children aged 4-5 years took part. The purpose of this study was to compare the effectiveness of various treatment regimens for acute viral rhinosinusitis in children. We compared the treatment effectiveness of acute viral rhinosinusitis using the herbal medicine Sinupret in the form of oral drops, standard treatment and standard treatment supplemented with topical antibacterial drugs. The objectivity of treatment effectiveness evaluation was based on the complaints' dynamics, the changes' presence in the mucous membrane of the nasal cavity within 10 days: at the initial visit, after 3 days, on the 7th and 10th days after the initial examination. A follow-up visit was also scheduled for the 14th day. The analysis of the obtained data revealed that the Sinupret usage in the complex treatment of children with viral etiology acute rhinosinusitis contributes to a more pronounced positive symptoms' dynamics compared to children who did not receive Sinupret. Sinupret eliminates mucostasis, which contributes to a faster restoration of the drainage and ventilation function of the auditory tube, restores mucociliary clearance, improves the condition and well-being of children, improves the effectiveness of therapy and shortens the treatment time.

Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis

BackgroundRecent evidence suggests that biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of chronic rhinosinusitis with nasal polyposis (CRSwNP). There remains a population in CRSwNP that despite medical therapy and endoscopic sinus surgery have persistent signs and symptoms of disease. Therefore, biologics, monoclonal antibody agents, could be beneficial therapeutic treatments for these patients. There have been eight randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL-5R, IL-33, and immunoglobulin (Ig)E. However, there are no formal recommendations for the optimal use of biologics in managing Chronic Rhinosinusitis (CRS) within the Canadian health care environment.MethodsA Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. 17 fellowship trained rhinologists across Canada evaluated the 28 original statements on a scale of 1–10 and provided comments. A rating within 1–3 indicated disagreement, 8–10 demonstrated agreement and 4–7 represented being neutral towards a statement. All ratings were quantitively reviewed by mean, median, mode, range and standard deviation. Consensus was defined by removing the highest and lowest of the scores and using the “3 point relaxed system”.ResultsAfter three rounds, a total of 11 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with CRS.ConclusionThis white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of patients with CRS, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years.Graphical abstract

An Overview of sinusitis diagnosis and management approach in PHC

Background: Sinusitis is the inflammation of the lining mucosa of the air sinuses. It is classified into chronic and acute rhinosinusitis. Symptoms of rhinosinusitis include facial pain, congestion, and headache. As this disease is widely common, the family physician should be aware of the updates in terms of diagnosis, treatment, and warning signs. Objectives: The study aimed to review the literature reviewing rhinosinusitis, its etiology, risk factors, clinical presentation, diagnosis, and man

Распространенность острых воспалительных оториноларингологических заболеваний у реципиентов трансплантации гемопоэтических стволовых клеток

The article presents the results of a study of the prevalence of acute (exacerbation of chronic) otorhinolaryngological pathology at the stages of hematopoietic stem cell transplantation (HSCT). The frequency of the studied pathology was assessed at the stage of pre-transplant screening, at the stage before graft engraftment and at the stage after graft engraftment up to 180 days. The study included 1129 cases of HSCT performed at the Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation from January 2017 to December 2019. The median age of the patients was 27 years (min – 0,36, max – 73,22). Allogeneic HSCT was performed in 784 (69,4%) cases, autologous HSCT in 345 (30,6%) cases. The power of the study was 0,95. A comparative analysis using the Pearson χ2 criterion revealed that infectious complications were significantly more frequent with allo-HSCT than with auto-HSCT, both at the stage before engraftment (χ2 = 21.8 at p &lt;0.0001) and at the stage after graft engraftment (χ2 = 224,78 at p &lt; 0.0001). It was also shown that acute symptoms of rhinosinusitis prevailed at all stages of HSCT, reaching 5,3% (95% CI 5.0% – 5,6%) at the stage before transplantation, 3,01% (95% CI 2, 8% – 3,2%) at the stage before engraftment, and 8,13% (95% CI 7,67% – 8,60%) at the stage after engraftment. At the stage before engraftment, rhinosinusitis competed with the diagnosis of acute pharyngitis, with a frequency of 34 (36,17%) and 33 (35,11%), respectively. Acute rhinosinusitis, acute rhinitis, and strep throat were the most common diagnoses at all three stages assessed. The rest of the acute inflammatory otorhinolaryngological diagnoses were observed in less than 2% of cases each. Establishing the frequency of acute otorhinolaryngological pathology at the stages of HSCT; understanding the most relevant nosologies. This allows us to focus on further study of the factors of their development, prevention and treatment.

Olfactory Dysfunction is not a Determinant Of Patient-Reported Chronic Rhinosinusitis Disease Control.

As a cardinal symptom of chronic rhinosinusitis (CRS), hyposmia has been recommended to be assessed as a component of CRS disease control. Herein we determine the significance of hyposmia in CRS in the context of nasal obstruction and drainage symptoms. Prospective, cross-sectional METHODS: Cross-sectional study of 308 CRS patients (102 CRSwNP, 206 CRSsNP) without prior endoscopic sinus surgery. The burden of nasal obstruction and hyposmia were assessed using the corresponding item scores on the 22-item Sinonasal Outcome Test (SNOT-22). Burden of nasal discharge was assessed using the mean of "thick nasal discharge" and "thick post-nasal discharge" SNOT-22 item scores. Patients were all asked to rate their CRS symptom control as "not at all," "a little," "somewhat," "very," or "completely." In CRSwNP, only 4.9% had a hyposmia score > 1 with nasal obstruction and drainage scores less than or equal to 1. In CRSsNP, only 1.9% had a hyposmia score > 1 with nasal obstruction and drainage scores less than or equal to 1. On univariate association, CRS symptom control was significantly associated with nasal obstruction, hyposmia, and drainage in both CRSwNP and CRSsNP (P < .05 in all cases). Using multivariable regression to account for all nasal symptoms, only nasal obstruction and nasal discharge scores (but not hyposmia) were significantly associated with CRS symptom control. Hyposmia rarely occurs without nasal obstruction or nasal drainage, and may therefore be redundant to assess for CRS disease control. Moreover, hyposmia was not associated with patient-reported CRS symptom control when accounting for the burden of nasal obstruction and drainage. 3 Laryngoscope, 131:E2116-E2120, 2021.

Aspirin-Exacerbated Respiratory Disease: Association Between Patient-Reported Sinus and Asthma Morbidity

The association between sinonasal and pulmonary symptoms in aspirin-exacerbated respiratory disease is not fully established. To characterize sinonasal and asthma symptomatology, and to determine whether reported sinonasal symptoms predict asthma severity. Prospectively collected data from an aspirin-exacerbated respiratory disease registry cohort were included from 2013 to 2018. Sinonasal symptomatology measured by Sino-Nasal Outcomes Test (SNOT) 22-item total scores was used as the predictor variable, with Asthma Control Test (ACT) scores and percent predicted FEV1 (FEV1% predicted) as primary outcomes. All instances of paired data on the same date were used. ACT score was also evaluated with FEV1% predicted as the outcome. Mixed effects regression was completed. From 1065 aspirin-exacerbated respiratory disease registry subjects (mean age, 48.1 ± 12.8 years; 68.0% females, 29.8% males), mean SNOT-22 score was 42.3 ± 24.12 (n= 1307 observations from 869 subjects), mean ACT score was 19.4 ± 5.2 (n= 1511 observations from 931 subjects), and mean FEV1% predicted was 82.8 ± 19.6 (n= 777 observations from 307 subjects). SNOT-22 score significantly predicted ACT scores (P < .0001, 1185 paired observations from 845 subjects) and FEV1% predicted (P= .018, 485 observations from 246 subjects). Any 10-point increase in SNOT-22 score was associated with a 0.87-point decrease in ACT score and a 0.75% decrease in FEV1% predicted. Any 1-point increase in ACT score was associated with a 1.0% increase in FEV1% predicted (P < .0001, 616 observations from 269 subjects). The most severe SNOT-22 symptoms were sense of smell/taste and blockage/congestion of nose. SNOT-22 scores significantly predict ACT scores and FEV1% predicted, and ACT scores significantly predict FEV1% predicted. This study demonstrates an association between patient-reported rhinosinusitis and asthma symptom severity and subjective and objective measures of asthma severity.

Highlights of prescribing herbal medicines in the complex therapy of acute rhinosinusitis

Today, acute rhinosinusitis is one of the most common infectious diseases in the world. Usually, acute rhinosinusitis develops against the background of acute respiratory viral infection caused by influenza viruses, parainfluenza, respiratory syncytial virus, adenoviruses, or rhinoviruses. At the same time, in 1–2% of cases, the course of acute respiratory viral infection is complicated by bacterial sinusitis. At the same time, in 1–2% of cases, the course of acute respiratory viral infection is complicated by bacterial sinusitis. Considering the stages of the process, it is extremely important to adequately prescribe therapy at the onset of acute respiratory viral infection before the development of symptoms of acute rhinosinusitis, since the prognosis largely depends on its effectiveness. Treatment of acute rhinosinusitis is aimed at relieving the symptoms of the disease, improving aeration of the nasal cavity and paranasal sinuses, restoring the functions of mucociliary transport, and in the case of bacterial agent attachment, at the eradication of the pathogen. Such problems are solved through complex therapy, including irrigation measures, decongestants, topical glucocorticosteroids, and antibiotics if indicated. To improve the function of mucociliary transport the standard therapy of acute rhinosinusitis is combined with herbal medicines, which have a mucoactive, secretomotor, secretolytic and anti-inflammatory effects. The article presents data on the pharmacokinetics and pharmacodynamics of the drug Sinupret, the results of experimental studies and clinical studies that prove the high effectiveness and safety of the drug in the complex treatment of acute rhinosinusitis. One of the important advantages of using the herbal drug Sinupret is an increase the effectiveness of antibiotic therapy, which allows for a faster recovery in bacterial sinusitis, and moreover in cases of acute post-viral sinusitis, Sinupret can be used as monotherapy.