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Sinusitis, Volume 2, Issue 1 (March 2017) – 3 articles

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Article
Eosinophilia and Quality of Life in Patients Receiving a Bioabsorbable Steroid-Eluting Implant during Endoscopic Sinus Surgery
by Jason D. Pou, Charles A. Riley, Kiranya E. Tipirneni, Anna K. Bareiss and Edward D. McCoul
Sinusitis 2017, 2(1), 3; https://doi.org/10.3390/sinusitis2010003 - 8 Mar 2017
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Abstract
Introduction: Bioabsorbable steroid-eluting implants are available as an adjunct for endoscopic sinus surgery (ESS) in the treatment of chronic rhinosinusitis (CRS). It is unclear which patients are most likely to benefit from this technology. We sought to determine if the severity of preoperative [...] Read more.
Introduction: Bioabsorbable steroid-eluting implants are available as an adjunct for endoscopic sinus surgery (ESS) in the treatment of chronic rhinosinusitis (CRS). It is unclear which patients are most likely to benefit from this technology. We sought to determine if the severity of preoperative sinonasal inflammation influences the postoperative changes in patient-reported quality of life (QOL) and endoscopic appearance following ESS with implant placement; Methods: Consecutive adult patients undergoing ESS for CRS with ethmoidectomy and placement of a steroid-eluting implant over an 18-month period were prospectively included for study. Pre-operative sinus computed tomography (CT) opacification was evaluated using the Lund-Mackay score (LMS). Sinonasal Outcome Test (SNOT-22) scores and Lund-Kennedy endoscopic scores (LKES) for each patient were collected preoperatively and at three- and six-month intervals postoperatively. Serum eosinophilia (>6.0% on peripheral smear) and sinus tissue eosinophilia were recorded; Results: One hundred and thirty-six patients were included for analysis. Of these, 36.7% had polyposis, 15.4% had serum eosinophilia and 64.0% had tissue eosinophilia. The mean (standard deviation) SNOT-22 score was 45.5 (19.4) preoperatively, which improved postoperatively to 18.8 (14.1) at three months (p < 0.001) and 16.5 (14.0) at six months (p < 0.001). Similar results were found when stratified by the presence of polyposis, serum eosinophilia, tissue eosinophilia or high-grade CT findings (LMS > 6). Higher baseline LKES was observed for patients with eosinophilia or high-grade LMS, but these differences normalized at six months postoperatively; Conclusions: Patient-reported QOL and endoscopic appearance show improvement six months after placement of a steroid-eluting implant during ESS, irrespective of the presence of polyposis or eosinophilia. Full article
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Case Report
Rhabdomyosarcoma of the Paranasal Sinuses Initially Diagnosed as Acute Sinusitis
by Amanda E. Dilger, Alexander L. Schneider, John Cramer and Stephanie Shintani Smith
Sinusitis 2017, 2(1), 2; https://doi.org/10.3390/sinusitis2010002 - 4 Feb 2017
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Abstract
Rhabdomyosarcoma (RMS) is an uncommon soft tissue malignancy that is typically found in the pediatric population. Here we describe a rare case of widely metastatic alveolar RMS of the right paranasal sinuses in an adult woman who presented with several months of unilateral [...] Read more.
Rhabdomyosarcoma (RMS) is an uncommon soft tissue malignancy that is typically found in the pediatric population. Here we describe a rare case of widely metastatic alveolar RMS of the right paranasal sinuses in an adult woman who presented with several months of unilateral sinus symptoms that was initially misdiagnosed as acute sinusitis. A middle-aged female presented with two months of right sinus pressure and unilateral epistaxis. She had previously been diagnosed with acute sinusitis and was treated with antibiotics without improvement. Nasal endoscopy demonstrated a fungating right nasal cavity mass. On computed tomography scan (CT), she was found to have metastatic disease in the mediastinum, lungs, bones, pancreas, and right ovary. Pathology of the nasal cavity mass was consistent with alveolar RMS. The patient initially responded well to chemotherapy, but subsequently developed brain and leptomeningeal metastases. This case of sinonasal rhabdomyosarcoma is unique in the extent of metastatic disease at the time of diagnosis and the initial misdiagnosis despite concerning unilateral symptoms and imaging. This thus highlights the importance of maintaining a high index of suspicion for malignancy in patients with unilateral sinus symptoms. Full article
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Review
A Systematic Review of the Treatment of Chronic Rhinosinusitis in Adults with Primary Ciliary Dyskinesia
by Jacob P. Brunner, Charles A. Riley and Edward D. McCoul
Sinusitis 2017, 2(1), 1; https://doi.org/10.3390/sinusitis2010001 - 26 Jan 2017
Cited by 2 | Viewed by 5980
Abstract
Background: Primary ciliary dyskinesia (PCD) may be an underlying factor in some cases of refractory chronic rhinosinusitis (CRS). However, clinical management of this condition is not well defined. This systematic review examines the available evidence for the diagnosis and management of CRS in [...] Read more.
Background: Primary ciliary dyskinesia (PCD) may be an underlying factor in some cases of refractory chronic rhinosinusitis (CRS). However, clinical management of this condition is not well defined. This systematic review examines the available evidence for the diagnosis and management of CRS in adults with PCD. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Pubmed, EMBASE, and Cochrane database were queried for studies pertinent to treatment of PCD in adults. Two investigators performed eligibility assessment for inclusion or exclusion in a standardized manner. Results: Of the 278 articles identified, six studies met the criteria for analysis. These studies had a predominately low level of evidence. Medical therapy included oral antibiotics and nasal saline rinses. Endoscopic sinus surgery (ESS) was described in three of six studies. Outcomes measures were limited and included non-validated questionnaires, subjective reporting of CRS symptoms, and decreased preciptins against pseudomonas following ESS. Recommendation for a standardized therapeutic strategy was not possible with the available literature. Conclusion: A paucity of evidence is available to guide the treatment of PCD in the adult population. Further prospective studies are needed to determine the optimal diagnostic and management strategy for this condition. Full article
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