Special Issue "Prevention, Diagnosis and Management of Chronic Rhinosinusitis"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: closed (31 October 2019).

Special Issue Editor

Prof. Dr. Silviu Albu
Website
Guest Editor
Department of ENT, University of Medicine and Pharmacy Iuliu Hatieganu from Cluj-Napoca, Cluj Napoca, Romania
Interests: sinus surgery; rhinosinusitis; skull base reconstruction; otologic surgery
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Special Issue Information

Dear Colleagues,

Chronic rhinosinusitis (CRS) is a frequently-encountered disease, worldwide, distressing all age groups. Its estimated incidence is 12.3% in the US, 10.9% in Europe and 13% in China. CRS is also a condition leading to a significant decrease in the quality of life of patients. Furthermore, it is documented that CRS is also an economic burden for society: The direct costs related to diagnosis and treatment are estimated to be 8.6 billion dollars, per year, in the United States, and indirect costs related to loss of productivity are also high. Lately, we have expanded our understanding of the heterogeneous nature of CRS. An impressive body of knowledge has been accumulated on the specific roles of genetic susceptibility, different viruses, fungi and bacteria, interaction between local and systemic immunity, biofilms, mucosal and bony alterations. Understanding of the pathogenesis of the disease opens the way for new treatment developments.  Treatments for this disease include medical and surgical approaches. The role of “maximal medical treatment” in CRS is still to be well-defined. In spite of the tremendous advances in the understanding of the disease process and in diagnosis and treatment algorithms, still are encountered “difficult to treat” patients and recalcitrant cases. These are the reasons why this supplement is dedicated to the diagnosis, prevention and management of CRS.

Prof. Dr. Silviu Albu
Guest Editor

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Keywords

  • sinusitis
  • pathology
  • diagnosis
  • management
  • prevention

Published Papers (11 papers)

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Editorial

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Open AccessEditorial
Chronic Rhinosinusitis—An Update on Epidemiology, Pathogenesis and Management
J. Clin. Med. 2020, 9(7), 2285; https://doi.org/10.3390/jcm9072285 - 18 Jul 2020
Abstract
Chronic rhinosinusitis (CRS) is one of the most common chronic medical conditions worldwide, affecting all age groups [...] Full article
(This article belongs to the Special Issue Prevention, Diagnosis and Management of Chronic Rhinosinusitis)

Research

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Open AccessArticle
Maxillary Antrostomy Patency Following Intraoperative Use of Spray Cryotherapy
J. Clin. Med. 2020, 9(1), 88; https://doi.org/10.3390/jcm9010088 - 29 Dec 2019
Cited by 1
Abstract
Objectives/Hypothesis: Stenosis of the middle meatus antrostomy (MMA) represents a major cause of recurrent disease following endoscopic sinus surgery (ESS). Various strategies have been developed to prevent the occurrence of MMA stenosis. The aim of the present study was to evaluate [...] Read more.
Objectives/Hypothesis: Stenosis of the middle meatus antrostomy (MMA) represents a major cause of recurrent disease following endoscopic sinus surgery (ESS). Various strategies have been developed to prevent the occurrence of MMA stenosis. The aim of the present study was to evaluate the effects of spray cryotherapy (SC) on nasal wound healing following ESS. Methods: This is a prospective within-subject, randomized, and controlled trial. Twenty-six patients submitted to bilateral ESS with chronic rhinosinusitis without polyps were included. Following surgery, patients were randomized to receive SC on one side and saline contralaterally. Outcomes were represented by MMA diameter and area, histology of nasal mucosa, and nasal symptoms. Variables were assessed at 3 and 12 months postoperatively. Results: The MMA size in the SC group at 3 and 12 months (area—0.578 ± 0.1025 cm2, diameter—0.645 ± 0.1024 cm; 0.605 ± 0.1891 cm2, 0.624 ± 0.0961 cm, respectively) was significantly larger (p = 0.000) than in the control group. Histology established that cell infiltration, goblet cells, edema, and epithelial hyperplasia were prominent and persistent in the control side compared to the SC side. Nasal obstruction and discharge were significantly improved in the SC group compared to the control group. Conclusion: SC is a promising therapy following ESS, since it precludes MMA stenosis and decreases inflammation, edema, and goblet cell hyperplasia. Full article
(This article belongs to the Special Issue Prevention, Diagnosis and Management of Chronic Rhinosinusitis)
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Open AccessArticle
Microbiota Dysbiosis in Fungal Rhinosinusitis
J. Clin. Med. 2019, 8(11), 1973; https://doi.org/10.3390/jcm8111973 - 14 Nov 2019
Cited by 2
Abstract
Fungal rhinosinusitis is a unique phenotype of chronic rhinosinusitis with unique clinical and histological characteristics. The role of bacterial microbiota in various phenotypes chronic rhinosinusitis is not thoroughly understood. Therefore, we conducted 16s rRNA amplification sequencing to determine differences in bacterial communities between [...] Read more.
Fungal rhinosinusitis is a unique phenotype of chronic rhinosinusitis with unique clinical and histological characteristics. The role of bacterial microbiota in various phenotypes chronic rhinosinusitis is not thoroughly understood. Therefore, we conducted 16s rRNA amplification sequencing to determine differences in bacterial communities between phenotypes (fungal vs. non- fungal) and anatomical sites (middle meatus vs. nasopharynx). Endoscope-guided swabs were used to collect samples from the middle meatus and nasopharynx of seven consecutive patients with fungal and 18 consecutive patients with non-fungal rhinosinusitis. DNA was extracted and investigated through 16S rRNA amplification. Among samples from the middle meatus, Shannon diversity was significantly lower in those from the fungal rhinosinusitis group (p = 0.029). However, no significant differences in diversity were noted between nasopharynx samples (p = 0.85). Fungal rhinosinusitis samples exhibited a distinct distribution of taxon relative abundance, which involved not only the absence of rhinosinusitis-associated commensal Corynebacterium and Fusobacterium in the middle meatus but also a significant increase in Haemophilus prevalence and abundance. This is the first study to compare bacterial communities in fungal and non-fungal rhinosinusitis samples. Our findings demonstrated that bacterial community dysbiosis was more apparent in fungal rhinosinusitis samples and was limited to the middle meatus. Full article
(This article belongs to the Special Issue Prevention, Diagnosis and Management of Chronic Rhinosinusitis)
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Open AccessArticle
The Effects of Postoperative Astaxanthin Administration on Nasal Mucosa Wound Healing
J. Clin. Med. 2019, 8(11), 1941; https://doi.org/10.3390/jcm8111941 - 11 Nov 2019
Cited by 1
Abstract
Background: Wound healing of the nasal mucosa after endoscopic sinus surgery (ESS) is frequently complicated by scaring and consequently recurrences are encountered. Methods of optimizing results have been sought. In the present study we evaluated the effects of a powerful antioxidant, astaxanthin, on [...] Read more.
Background: Wound healing of the nasal mucosa after endoscopic sinus surgery (ESS) is frequently complicated by scaring and consequently recurrences are encountered. Methods of optimizing results have been sought. In the present study we evaluated the effects of a powerful antioxidant, astaxanthin, on nasal mucosa healing after surgery, comparing it to the extensively studied properties of dexamethasone. Materials and Methods: 63 Wistar rats were used. The nasal mucosa from one side was damaged employing the brushing method. They were randomly divided into three experimental groups, one treated with astaxanthin, the second treated with dexamethasone and the third one acted as the control and was given normal saline. The rats were killed on days 5, 14 and 28 following injury. We observed the temporal evolution of the wound healing process and quantified the results by assessing four parameters: the epithelial thickness index (ETI), the subepithelial thickness index (STI), the goblet cell count and the subepithelial fibrosis index (SFI). Results: At 28 days, the ETI was significantly lower in the astaxanthin group (p < 0.05) compared to the other two groups. The STI was also lower in the astaxanthin group (p < 0.05), but comparable to the dexamethasone group at 28 days. The goblet cell count was higher in the astaxanthin group. The SFI had similar results in both dexamethasone and astaxanthin groups, with lower values compared to the control group. In the astaxanthin group there was no synechia formation. Conclusion: Astaxanthin given in the post injury period significantly decreases fibrosis, inhibits synechia development and significantly decreases subepithelial fibrosis. Moreover, it has no general or local toxic effects. Full article
(This article belongs to the Special Issue Prevention, Diagnosis and Management of Chronic Rhinosinusitis)
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Open AccessArticle
Recent Trends in Bacteriology of Adult Patients with Chronic Rhinosinusitis
J. Clin. Med. 2019, 8(11), 1889; https://doi.org/10.3390/jcm8111889 - 06 Nov 2019
Cited by 1
Abstract
This study aimed to identify trends in bacteria isolated from Korean adults with chronic rhinosinusitis (CRS). Enrolled were CRS patients who underwent sinus bacterial culture during endoscopic sinus surgery between 2007–2008, 2011–2012, and 2017–2018 (n = 510). Patients’ clinical characteristics, bacterial culture [...] Read more.
This study aimed to identify trends in bacteria isolated from Korean adults with chronic rhinosinusitis (CRS). Enrolled were CRS patients who underwent sinus bacterial culture during endoscopic sinus surgery between 2007–2008, 2011–2012, and 2017–2018 (n = 510). Patients’ clinical characteristics, bacterial culture results, and antibiotic resistance were reviewed. The bacteria isolation rate was 76.3% (73.9% for CRS with nasal polyps and 82.8% for CRS without nasal polyps; p = 0.038). In total, 650 strains were isolated, the most common was Coagulase Negative Staphylococci (CNS) (28.0%), followed by Streptococcus species (12.2%), Propionibacterium species (8.0%), Corynebacterium species (7.5%), Staphylococcus aureus (6.2%), Haemophilus species (5.7%), Klebsiella species (5.1%), and Pseudomonas aeruginosa (4.2%). Furthermore, an analysis of the bacterial trends in the three groups showed significant increases over time for the isolation of CNS (p = 0.006), Klebsiella (p = 0.002), and P. aeruginosa (p = 0.007) and extended-spectrum beta-lactamase (ESBL) producing Klebsiella (p < 0.001) and Enterobacter (p = 0.007) species in terms of antibiotics resistance. This study demonstrates that the frequency of CNS, Klebsiella, and P. aeruginosa in CRS patients and the ESBL-producing Klebsiella and Enterobacter species has significantly increased in CRS patients over the last decade. Full article
(This article belongs to the Special Issue Prevention, Diagnosis and Management of Chronic Rhinosinusitis)
Open AccessArticle
Surgery of Inverted Papilloma of the Maxillary Sinus via Translacrimal Approach—Long-Term Outcome and Literature Review
J. Clin. Med. 2019, 8(11), 1873; https://doi.org/10.3390/jcm8111873 - 05 Nov 2019
Cited by 5
Abstract
There are several differential diagnoses of unilateral sinus disease. One of these is inverted papilloma (IP) of the maxillary sinus, which is a common benign tumor with a substantial rate of malignant transformation. In general, endoscopic endonasal techniques for addressing the tumor are [...] Read more.
There are several differential diagnoses of unilateral sinus disease. One of these is inverted papilloma (IP) of the maxillary sinus, which is a common benign tumor with a substantial rate of malignant transformation. In general, endoscopic endonasal techniques for addressing the tumor are favored nowadays instead of classical external approaches. The aim of this retrospective study was to investigate the long-term outcome of inverted papilloma treated endoscopically via the prelacrimal approach. We reviewed 17 patients with primary or recurrent IP of the maxillary sinus that were treated via the prelacrimal endoscopic endonasal technique. After a median follow-up period of 45.9 months (3.8 years), none of the 17 included patients showed signs of recurrent disease and no serious complications were reported. Hypoesthesia of the incisors was reported by four patients and was resolved with time in one. All of the maxillary sinuses could be fully visualized with the flexible endoscope. IP is an important differential diagnosis in the clinical finding of unilateral nasal polypoid lesions. The prelacrimal approach is an effective and safe method in the treatment of IP with limited patient morbidity. Full article
(This article belongs to the Special Issue Prevention, Diagnosis and Management of Chronic Rhinosinusitis)
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Open AccessArticle
Arginase Isoform Expression in Chronic Rhinosinusitis
J. Clin. Med. 2019, 8(11), 1809; https://doi.org/10.3390/jcm8111809 - 01 Nov 2019
Cited by 4
Abstract
Nitric oxide (NO) has emerged as an important regulator of upper airway inflammation, mainly as part of the local naso-sinusal defense mechanisms. Increased arginase activity can reduce NO levels by decreasing the availability of its precursor, L-arginine. Chronic rhinosinusitis (CRS) has been associated [...] Read more.
Nitric oxide (NO) has emerged as an important regulator of upper airway inflammation, mainly as part of the local naso-sinusal defense mechanisms. Increased arginase activity can reduce NO levels by decreasing the availability of its precursor, L-arginine. Chronic rhinosinusitis (CRS) has been associated with low levels of nasal nitric oxide (nNO). Thus, the present study investigates the activity of arginase I (ARG1) and II (ARG2) in CRS and its possible involvement in the pathogenesis of this disease. Under endoscopic view, tissue samples of pathologic (n = 36) and normal (n = 29) rhinosinusal mucosa were collected. Arginase I and II mRNA levels were measured using real-time PCR. Our results showed low arginase I activity in all samples. The levels of ARG2 were significantly higher in patients with chronic rhinosinusitis compared to the control group (fold regulation (FR) 2.22 ± 0.42 vs. 1.31 ± 0.21, p = 0.016). Increased ARG2 expression was found in patients with CRS without nasal polyposis (FR 3.14 ± 1.16 vs. 1.31 ± 0.21, p = 0.0175), in non-allergic CRS (FR 2.55 ± 0.52 vs. 1.31 ± 0.21, p = 0.005), and non-asthmatic CRS (FR 2.42 ± 0.57 vs. 1.31 ± 0.21, p = 0.028). These findings suggest that the upregulation of ARG2 may play a role in the pathology of a distinctive phenotype of CRS. Full article
(This article belongs to the Special Issue Prevention, Diagnosis and Management of Chronic Rhinosinusitis)
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Open AccessArticle
Sub-Inhibitory Clindamycin and Azithromycin reduce S. aureus Exoprotein Induced Toxicity, Inflammation, Barrier Disruption and Invasion
J. Clin. Med. 2019, 8(10), 1617; https://doi.org/10.3390/jcm8101617 - 04 Oct 2019
Cited by 2
Abstract
Background: Chronic rhinosinusitis (CRS) is defined as a chronic inflammation of the nose and paranasal sinus mucosa associated with relapsing infections—particularly with S. aureus. Long-term treatments with protein synthesis inhibitor antibiotics have been proposed to reduce inflammation in the context chronic severe inflammatory [...] Read more.
Background: Chronic rhinosinusitis (CRS) is defined as a chronic inflammation of the nose and paranasal sinus mucosa associated with relapsing infections—particularly with S. aureus. Long-term treatments with protein synthesis inhibitor antibiotics have been proposed to reduce inflammation in the context chronic severe inflammatory airway pathologies, including CRS. This study assessed the effect of subinhibitory clindamycin and azithromycin on S. aureus exoprotein induced inflammation, toxicity and invasiveness. Methods: S. aureus ATCC51650 and two clinical isolates grown in planktonic and biofilm form were treated with subinhibitory clindamycin and azithromycin. Exoproteins were collected and applied to primary human nasal epithelial cells (HNECs) in monolayers and at air-liquid interface. This was followed by lactate dehydrogenase (LDH), enzyme-linked immunosorbent assay (ELISA), Transepithelial Electrical Resistance (TEER) and paracellular permeability assays to assess the effect on cell toxicity, inflammatory cytokine production and mucosal barrier structure and function, respectively. The effect of these treatments was tested as well on the S. aureus invasiveness of HNECs. Results: Subinhibitory clindamycin reduced S. aureus exoprotein production in planktonic and biofilm form, thereby blocking exoprotein-induced toxicity, reversing its detrimental effects on mucosal barrier structure and function and modulating its inflammatory properties. Sub-inhibitory azithromycin had similar effects—albeit to a lesser extent. Furthermore, clindamycin—but not azithromycin—treated S. aureus lost its invasive capacity of HNECs. Conclusion: Subinhibitory clindamycin and azithromycin reduce S. aureus exoprotein production, thereby modulating the inflammatory cascade by reducing exoprotein-induced toxicity, inflammation, mucosal barrier disruption and invasiveness. Full article
(This article belongs to the Special Issue Prevention, Diagnosis and Management of Chronic Rhinosinusitis)
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Open AccessArticle
Follow-Up and Management of Chronic Rhinosinusitis in Adults with Primary Ciliary Dyskinesia: Review and Experience of Our Reference Centers
J. Clin. Med. 2019, 8(9), 1495; https://doi.org/10.3390/jcm8091495 - 19 Sep 2019
Cited by 1
Abstract
Chronic rhinosinusitis is the foremost manifestation in adult patients with primary ciliary dyskinesia (PCD). We present a retrospective series of 41 adult patients with a confirmed diagnosis of PCD followed in our reference centers. As part of the diagnostic work up in our [...] Read more.
Chronic rhinosinusitis is the foremost manifestation in adult patients with primary ciliary dyskinesia (PCD). We present a retrospective series of 41 adult patients with a confirmed diagnosis of PCD followed in our reference centers. As part of the diagnostic work up in our centers, sinus computed tomography scans (CTs) are systematically performed. All patients also undergo a sampling of purulent secretions sampled from the middle meatus under endoscopic view for bacteriological analysis. In our series, CT opacities were consistent in all the patients, as well as mainly partial and located in ethmoid cells (100% of patients) and in maxillary sinuses (85.4% of patients), and stayed stable over time. In the 31 patients who had purulent secretions, bacteriological culture showed at least one bacterium in 83.9% (n = 26). There was no significant difference in positive cultures for Pseudomonas aeruginosa in patients >40 years old versus those <40 (p = 0.17; Fisher). Surgical management was performed in only 19% of patients in order to improve sinonasal mechanical drainage. Our data support the hypothesis that the sinuses can be considered as a bacterial reservoir. From this retrospective study, we have introduced several changes into our routine clinical practice in our reference centers. Based on our analyses, medical and surgical treatments benefit from incorporating bacteriological information and sinonasal symptoms much more than CT scan evaluation alone. All patients now undergo systematically an annual simultaneous bacteriological sampling of the middle meatus and sputum to follow the relationship between ENT and lung disease and to help to antibiotic therapy strategy. Full article
(This article belongs to the Special Issue Prevention, Diagnosis and Management of Chronic Rhinosinusitis)
Open AccessArticle
Critical Evaluation of Sinonasal Disease in 64 Adults with Primary Ciliary Dyskinesia
J. Clin. Med. 2019, 8(5), 619; https://doi.org/10.3390/jcm8050619 - 07 May 2019
Cited by 8
Abstract
To date, no study precisely described ear, nose and throat (ENT) disease in adults with primary ciliary dyskinesia (PCD) and its relationship with ciliary function/ultrastructure. A retrospective study of standardized ENT data (exam, audiogram, sinus Computed tomography (CT), and bacteriology) was conducted in [...] Read more.
To date, no study precisely described ear, nose and throat (ENT) disease in adults with primary ciliary dyskinesia (PCD) and its relationship with ciliary function/ultrastructure. A retrospective study of standardized ENT data (exam, audiogram, sinus Computed tomography (CT), and bacteriology) was conducted in 64 adults with confirmed PCD who were followed in two ENT reference centers. Rhinorrhoea and hearing loss were the main symptoms. Symptom scores were higher in older patients. Nasal endoscopy was abnormal in all patients except one, showing nasal polyps in one-third of the patients and stagnant nasal mucus secretions in 87.5% of the patients. Sinus CT opacities were mainly incomplete and showed one-third of the patients with sinus hypoplasia and/or agenesis. Middle meatus mainly grew Haemophilus influenzae, Streptoccocus pneumoniae and Pseudomonas aeruginosa. Otitis media with effusion (OME), which is constant in childhood, was diagnosed in less than one-quarter of the patients. In two-thirds of the patients, audiogram showed hearing loss that was sensorineural in half of the patients. ENT disease severity was not correlated with ciliary function and ultrastructure, but the presence of OME was significantly associated with a forced expiratory volume (FEV1) < 70%. Rhinosinusitis is the most common clinical feature of PCD in adults, while OME is less frequent. The presence of active OME in adults with PCD could be a severity marker of lung function and lead to closer monitoring. Full article
(This article belongs to the Special Issue Prevention, Diagnosis and Management of Chronic Rhinosinusitis)
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Open AccessArticle
Real-World Database Examining the Association between Sjögren’s Syndrome and Chronic Rhinosinusitis
J. Clin. Med. 2019, 8(2), 155; https://doi.org/10.3390/jcm8020155 - 30 Jan 2019
Cited by 10
Abstract
Objective: To investigate the risk of chronic rhinosinusitis (CRS) among patients with Sjögren’s syndrome (SS). Method: A total of 18,723 patients diagnosed with SS between 1997 and 2011 were retrospectively analyzed. Moreover, 59,568 patients without SS were matched to patients with SS at [...] Read more.
Objective: To investigate the risk of chronic rhinosinusitis (CRS) among patients with Sjögren’s syndrome (SS). Method: A total of 18,723 patients diagnosed with SS between 1997 and 2011 were retrospectively analyzed. Moreover, 59,568 patients without SS were matched to patients with SS at a 1:4 ratio on the basis of sex, age, urbanization level, income level, and the comorbidities of rhinitis and nasal sepal deviation. Patients were followed up until death or the end of the study period (31 December, 2013). The primary outcome was the occurrence of CRS. Results: The cumulative incidence of CRS was significantly higher in patients with SS than in those without SS (p < 0.001). The adjusted Cox proportional hazard model showed that patients with SS had a significantly higher incidence of CRS (hazard ratio, 2.51; 95% confidence interval, 2.22–2.84; p < 0.001). Sensitivity and subgroup analyses demonstrated SS was an independent risk factor for CRS. The dosage of intranasal corticosteroid spray used was not different between the SS and non-SS groups. Fewer patients with CRS in the SS group underwent sinus surgery (82/407 (20.2%)) than those in the non-SS group (179/667 (26.8%)) and this finding was statistically significant (p = 0.013). The number of operations did not differ significantly between patients with CRS in the SS and non-SS groups. Conclusions: SS is an independent risk factor for CRS. Our study extends the disease spectrum and prompts physicians to be aware of potential CRS occurrence after SS. Full article
(This article belongs to the Special Issue Prevention, Diagnosis and Management of Chronic Rhinosinusitis)
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