Journal of Clinical Medicine

Research

Jump to: Review

15 pages, 1295 KiB

Open AccessArticle

Long-Term Clinical Outcomes in Patients with Chronic Rhinosinusitis with Nasal Polyps Associated with Expanded Types of Endoscopic Sinus Surgery

by Daniel Martin-Jimenez, Ramon Moreno-Luna, Amparo Callejon-Leblic, Alfonso del Cuvillo, Charles S. Ebert, Jr., Juan Maza-Solano, Jaime Gonzalez-Garcia, Pedro Infante-Cossio and Serafin Sanchez-Gomez

J. Clin. Med. 2024, 13(3), 866; https://doi.org/10.3390/jcm13030866 - 1 Feb 2024

Viewed by 1143

Abstract

(1) Background: Surgical criteria for chronic rhinosinusitis with nasal polyps (CRSwNP) remain unresolved. This study addresses these discrepancies by comparing the clinical outcomes of expanded–functional endoscopic sinus surgeries (E–FESS) with more-limited FESS (L-FESS). (2) Methods: A database was analyzed retrospectively to compare surgical [...] Read more.

(1) Background: Surgical criteria for chronic rhinosinusitis with nasal polyps (CRSwNP) remain unresolved. This study addresses these discrepancies by comparing the clinical outcomes of expanded–functional endoscopic sinus surgeries (E–FESS) with more-limited FESS (L-FESS). (2) Methods: A database was analyzed retrospectively to compare surgical outcomes in CRSwNP patients who underwent E-FESS versus those subjected to L-FESS. Quality of life, endoscopic and radiological outcomes were compared at the baseline and two years after surgery. The clinical status of the responder was defined when a minimal clinically important difference of 12 points in SNOT-22 change was achieved. (3) Results: A total of 274 patients met the inclusion criteria and were analyzed; 111 underwent E-FESS and 163 were subjected to L-FESS. Both groups exhibited significant clinical improvements, although a greater magnitude of change in SNOT-22 (14.8 ± 4.8, p = 0.002) was shown after E-FESS. Higher significant improvements for endoscopic and radiological scores and lower surgical revision rates were also noted in the E-FESS group. (4) Conclusions: E-FESS provides better clinical outcomes and reduced revision surgery rates when compared to L-FESS in CRSwNP patients two years after surgery, irrespective of any comorbidity. Further randomized prospective studies are needed to comprehensively contrast these results. Full article

(This article belongs to the Special Issue Advances in Treatment and Management of Chronic Rhinosinusitis)

► Show Figures

Figure 1

11 pages, 671 KiB

Open AccessArticle

Real Life Observational Study of Treatment Success of Monoclonal Antibodies for Refractory Chronic Rhinosinusitis with Nasal Polyps

by Kathrin Gerstacker, Manuel Christoph Ketterer, Till Fabian Jakob and Tanja Hildenbrand

J. Clin. Med. 2023, 12(13), 4374; https://doi.org/10.3390/jcm12134374 - 29 Jun 2023

Cited by 2 | Viewed by 1580

Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a mainly type-2-driven inflammatory disease that is often refractory to medical and surgical treatment and characterized by a high rate of recurrence. Monoclonal antibodies have been approved for severe refractory CRSwNP. Randomized controlled trials (RCT) have [...] Read more.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a mainly type-2-driven inflammatory disease that is often refractory to medical and surgical treatment and characterized by a high rate of recurrence. Monoclonal antibodies have been approved for severe refractory CRSwNP. Randomized controlled trials (RCT) have shown significant improvement in objective and subjective parameters. The results of these RCTs cannot necessarily be transferred to daily routine. The purpose of this retrospective study is to evaluate the treatment effects of biologics in patients with CRSwNP in a real-life setting. Patients treated with one of the approved biologics since July 2020 with at least 6 months follow-up were included in the study. Changes in SNOT-22 and nasal polyp score (NPS), as well as subjective change in sense of smell, number of sinus surgeries prior to and during treatment, comorbidities, discontinuation or change of monoclonal antibody and adverse events were evaluated. Thirty-three patients were included in this study. The mean SNOT-22 score and NPS improved significantly. The subjective assessment of sense of smell showed an improvement in 81.8% of patients. The monoclonal antibody had to be changed in seven patients. No severe adverse events occurred during the initiation of the treatment and follow-up. Biologics can be a treatment option in patients with severe refractory CRSwNP, showing significant improvements in quality of life, symptoms and polyp scores in randomized controlled trials and clinical routine with rare complications. Further research is needed to evaluate possible biomarkers, interdose interval prolongation and long-term safety. Full article

(This article belongs to the Special Issue Advances in Treatment and Management of Chronic Rhinosinusitis)

► Show Figures

Figure 1

14 pages, 1623 KiB

Open AccessArticle

PD-1 and PD-L1 Expression Levels as a Potential Biomarker of Chronic Rhinosinusitis and Head and Neck Cancers

by Katarzyna Malinowska, Andrzej Kowalski, Anna Merecz-Sadowska, Milena Paprocka-Zjawiona, Przemysław Sitarek, Tomasz Kowalczyk and Hanna Zielińska-Bliźniewska

J. Clin. Med. 2023, 12(5), 2033; https://doi.org/10.3390/jcm12052033 - 3 Mar 2023

Cited by 1 | Viewed by 1942

Abstract

Inflammation is an etiological factor of various chronic diseases contributing to more than 50% of worldwide deaths. In this study, we focus on the immunosuppressive role of the programmed death-1 (PD-1) receptor and its ligand (PD-L1) in inflammatory-related diseases, including chronic rhinosinusitis and [...] Read more.

Inflammation is an etiological factor of various chronic diseases contributing to more than 50% of worldwide deaths. In this study, we focus on the immunosuppressive role of the programmed death-1 (PD-1) receptor and its ligand (PD-L1) in inflammatory-related diseases, including chronic rhinosinusitis and head and neck cancers. The study included 304 participants. Of this number, 162 patients had chronic rhinosinusitis with nasal polyps (CRSwNP), 40 patients had head and neck cancer (HNC) and there were 102 healthy subjects. The expression level of the PD-1 and PD-L1 genes in the tissues of the study groups was measured by qPCR and Western blot methods. The associations between the age of the patients and the extent of disease and genes’ expression were evaluated. The study showed a significantly higher mRNA expression of PD-1 and PD-L1 in the tissues of both the CRSwNP and HNC patient groups compared to the healthy group. The severity of CRSwNP significantly correlated with the mRNA expression of PD-1 and PD-L1. Similarly, the age of the NHC patients influenced PD-L1 expression. In addition, a significantly higher level of PD-L1 protein was noticed also for both the CRSwNP and HNC patient groups. The increased expression of PD-1 and PD-L1 may be a potential biomarker of inflammatory-related diseases, including chronic rhinosinusitis and head and neck cancers. Full article

(This article belongs to the Special Issue Advances in Treatment and Management of Chronic Rhinosinusitis)

► Show Figures

Figure 1

11 pages, 607 KiB

Open AccessArticle

The Influence of Endodontic Lesions on The Clinical Evolution of Odontogenic Sinusitis—A Cohort Study

by Marta Aleksandra Kwiatkowska, Kornel Szczygielski, Agnieszka Brociek-Piłczyńska, Aldona Chloupek and Dariusz Jurkiewicz

J. Clin. Med. 2023, 12(3), 1103; https://doi.org/10.3390/jcm12031103 - 31 Jan 2023

Cited by 3 | Viewed by 1719

Abstract

Endodontic disease with formation of periapical lesions (PALs) is one of the most common causes of chronic odontogenic sinusitis (ODS). It requires close collaboration between otolaryngologists and dentists, but the best sequence of management is still unknown. The aim of the present study [...] Read more.

Endodontic disease with formation of periapical lesions (PALs) is one of the most common causes of chronic odontogenic sinusitis (ODS). It requires close collaboration between otolaryngologists and dentists, but the best sequence of management is still unknown. The aim of the present study is to clarify how radiological characteristics of teeth with PALs and previous root-canal treatment (RCT) influence the clinical evolution of the disease and to define the predictive value of its radiological and endoscopic features in determining the need for further surgical intervention. A total of 68 symptomatic patients with ODS with PALs were included in the study. The evaluation was performed by an otolaryngologist and a dentist based on a medical interview, nasal endoscopy, cold pulp testing and tomography images. Patients were prospectively followed for at least 12 months, during which nasal steroids, saline irrigations and RCT were administered. The criteria of disease improvement were: decrease of symptoms, healed sinonasal mucosa in endoscopy and radiological resolution of periapical radiolucency and sinus inflammation. Results showed that 9 (13%) patients improved after conservative treatment and 59 (87%) required further surgical intervention. Patients who improved after medical treatment and RCT were younger (p = 0.043) and had a greater distance from the top of the periapical lesion to the maxillary sinus’ floor (p = 0.003). When expansion of PALs and bone destruction toward the maxillary sinus was observed on radiological imaging (p = 0.041), and when more than one tooth root was affected (p = 0.004), patients were more likely to require surgical intervention. In conclusion, the more roots that are affected and the closer the top of the PAL is to the maxillary sinus’ floor, the greater the possibility of medical treatment and RCT failure. When the bone destruction extends into the maxillary sinus, patients eventually require both tooth extraction and FESS in order to resolve ODS completely. Full article

(This article belongs to the Special Issue Advances in Treatment and Management of Chronic Rhinosinusitis)

► Show Figures

Figure 1

5 pages, 260 KiB

Open AccessArticle

Availability of Readable Online Spanish Rhinosinusitis Outcome Measures

by Saangyoung E. Lee, Zainab Farzal, Adam J. Kimple, Ramón Moreno-Luna, Brent A. Senior, Brian D. Thorp and Charles S. Ebert

J. Clin. Med. 2022, 11(24), 7364; https://doi.org/10.3390/jcm11247364 - 12 Dec 2022

Viewed by 856

Abstract

Background: Patient-reported outcome measures (PROMs) are useful instruments that give providers insight into patients’ experiences with disease by quantifying the symptoms that matter most to patients. Results of these questionnaires can help guide management in chronic rhinosinusitis. However, these tools are often developed [...] Read more.

Background: Patient-reported outcome measures (PROMs) are useful instruments that give providers insight into patients’ experiences with disease by quantifying the symptoms that matter most to patients. Results of these questionnaires can help guide management in chronic rhinosinusitis. However, these tools are often developed for native English speakers, which disadvantages others, who already have a language barrier to care. The aim of this study is to evaluate accessibility and readability of Spanish PROMs used to evaluate rhinosinusitis. Methods: Three Spanish readability measures, Gilliam, Peña & Mountain; SOL; and Fernandez-Huerta were used to evaluate PROMs utilized for rhinosinusitis. PROMs with sixth-grade readability level or easier were considered to meet health literacy recommendations. Results: Four Spanish PROMs utilized in assessment of rhinosinusitis were identified and evaluated. Cuestionario Español de Calidad de Vida en Rinitis (ESPRINT-15) was the most readable PROM and met readability recommendations in two of three measures. Nasal Obstruction Symptom Evaluation met suggested levels in one measure. The remainder of readability scores were more difficult than recommended. Conclusion: PROMs are powerful clinical tools that help patients communicate their symptoms and self-advocate. For providers to gain accurate and useful information, these measures should be written at appropriate readability levels. Most Spanish PROMs used for assessment of rhinosinusitis were above recommended readability. Development of future PROMs should ensure appropriate readability levels to provide good patient-centered care for our primarily Spanish speaking patients. Full article

(This article belongs to the Special Issue Advances in Treatment and Management of Chronic Rhinosinusitis)

10 pages, 816 KiB

Open AccessArticle

Relationship between Chronic Rhinosinusitis and the Incidence of Head and Neck Cancer: A National Population-Based Study

by Kyung-Do Han, Sang-Hyun Park, Sumin Son, Seung-Ho Kim, Ikhee Kim, Jong-Yeup Kim, Seung-Min In, Yeon-Soo Kim and Ki-Il Lee

J. Clin. Med. 2022, 11(18), 5316; https://doi.org/10.3390/jcm11185316 - 9 Sep 2022

Cited by 1 | Viewed by 1354

Abstract

We analyzed the relationship between chronic rhinosinusitis (CRS) and the incidence of head and neck cancers (HNCs) in a Korean adult population. This retrospective cohort study included data from the Korean National Health Insurance Service database. Adjustments were made to minimize risk variables [...] Read more.

We analyzed the relationship between chronic rhinosinusitis (CRS) and the incidence of head and neck cancers (HNCs) in a Korean adult population. This retrospective cohort study included data from the Korean National Health Insurance Service database. Adjustments were made to minimize risk variables for sex, age, diabetes, hypertension, dyslipidemia, and rhinitis between the two groups. The primary endpoint was newly diagnosed HNC between January 2009 and December 2018. Among 1,337,120 subjects in the Korean National Health Insurance Service database, data from 324,774 diagnosed with CRS (CRS group) and 649,548 control subjects (control group) were selected. Patients with CRS exhibited a statistically significant greater risk for nasal cavity/paranasal sinus cancer, hypopharynx/larynx cancer, and thyroid cancer compared with the control group. In the CRS group, the adjusted hazard ratios for nasal cavity/paranasal sinus cancer were 1.809 (95% confidence interval (CI) 1.085–3.016), 1.343 (95% CI 1.031–1.748) for hypopharynx and larynx cancer, and 1.116 (95% CI 1.063–1.173) for thyroid cancer. CRS was associated with a higher incidence of HNCs. Therefore, physicians should carefully consider the possibility of HNC progression and implement therapeutic strategies to minimize the impact of these diseases. Full article

(This article belongs to the Special Issue Advances in Treatment and Management of Chronic Rhinosinusitis)

► Show Figures

Figure 1

Review

Jump to: Research

14 pages, 458 KiB

Open AccessReview

The Role of Corticosteroid Nasal Irrigations in the Management of Chronic Rhinosinusitis: A State-of-the-Art Systematic Review

by Christian Calvo-Henriquez, Jaime Viera-Artiles, Miguel Rodriguez-Iglesias, Paula Rodriguez-Rivas, Antonino Maniaci, Miguel Mayo Yáñez, Gabriel Martínez-Capoccioni and Isam Alobid

J. Clin. Med. 2023, 12(10), 3605; https://doi.org/10.3390/jcm12103605 - 22 May 2023

Cited by 3 | Viewed by 1836

Abstract

Chronic rhinosinusitis (CRS) is a highly prevalent condition. CRS is usually managed with intranasal corticosteroids, useful both before as well as after endoscopic sinus surgery (ESS). However, the greatest drawback of these low-volume sprays is the inadequate delivery into the paranasal sinuses, even [...] Read more.

Chronic rhinosinusitis (CRS) is a highly prevalent condition. CRS is usually managed with intranasal corticosteroids, useful both before as well as after endoscopic sinus surgery (ESS). However, the greatest drawback of these low-volume sprays is the inadequate delivery into the paranasal sinuses, even after ESS. Recent studies have shown that high-volume steroid nasal rinse (HSNR) has a significantly better penetration of the paranasal sinuses. The purpose of this state-of-the-art review is to systematically overview the current literature about the role of nasal rinses with steroids in CRS. Four authors examined four databases (Embase, Pubmed, Scielo, Cochrane). This review identified 23 studies answering 5 research questions. It included 1182 participants, 722 cases, and 460 controls. Available evidence suggests a potential positive effect of HSNR, which seems to be higher in CRS with nasal polyps. More well-designed studies are needed in order to obtain solid conclusions. The evidence is solid regarding the safety of this treatment modality in the short and long-term. We expect that this lack of severe negative effects will facilitate the acceptance of this treatment modality and the development of future studies. Full article

(This article belongs to the Special Issue Advances in Treatment and Management of Chronic Rhinosinusitis)

► Show Figures

Figure 1

9 pages, 1317 KiB

Open AccessReview

Diagnostic Value of Middle Meatal Cultures versus Maxillary Sinus Culture in Acute and Chronic Sinusitis: A Systematic Review and Meta-Analysis

by Do Hyun Kim, Sung Won Kim, Mohammed Abdullah Basurrah and Se Hwan Hwang

J. Clin. Med. 2022, 11(20), 6069; https://doi.org/10.3390/jcm11206069 - 14 Oct 2022

Viewed by 1349

Abstract

Background: To assess the diagnostic utility of middle meatal culture (MMC) in patients with acute and chronic sinusitis; Methods: Six databases were thoroughly reviewed up to March 2022. Sensitivity, specificity, and negative and positive predictive values were extracted. Methodological quality was evaluated using [...] Read more.

Background: To assess the diagnostic utility of middle meatal culture (MMC) in patients with acute and chronic sinusitis; Methods: Six databases were thoroughly reviewed up to March 2022. Sensitivity, specificity, and negative and positive predictive values were extracted. Methodological quality was evaluated using the QUADAS-2 instrument; Results: Fifteen reports were analyzed. MMC results exhibited a significant correlation (r = 0.7590, 95% confidence interval [CI] [0.6855; 0.8172], p < 0.0001) with those of maxillary sinus puncture. The diagnostic odds ratio (DOR) of MMC (reference = maxillary sinus culture) was 8.5475 [3.9238; 18.6199]. The area under the summary receiver operating characteristic curve was 0.761. The sensitivity and specificity of MMC were 0.7759 [0.6744; 0.8526] and 0.7514 [0.6110; 0.8534], respectively. We performed subgroup analysis based on age (children vs. adults), duration of disease (acute vs. chronic), and specimen collection method (biopsy, swabs, suction tips). The DORs, specificities, and negative and positive predictive values varied significantly. Diagnostic accuracy was highest for children and individuals with chronic disease, and when samples were collected via suction.; Conclusions: MMC provided fair diagnostic accuracy in patients with acute or chronic sinusitis. Although some institutional differences were evident, the middle meatal and maxillary sinus culture results were similar. Full article

(This article belongs to the Special Issue Advances in Treatment and Management of Chronic Rhinosinusitis)

► Show Figures