Special Issue "Chronic Rhinosinusitis and Concomitant Medical Disorders"

A special issue of Medical Sciences (ISSN 2076-3271).

Deadline for manuscript submissions: closed (20 January 2019)

Special Issue Editor

Guest Editor
Dr. David Gudis

Columbia University Medical Center, Department of Otolaryngology-Head and Neck Surgery, New York, United States
Website | E-Mail
Interests: Otolaryngology; sinonasal conditions; pulmonary disease; cystic fibrosis; asthma

Special Issue Information

Dear Colleagues,

It is with great pleasure and enthusiasm that we present to you this Special Issue of Medical Sciences. In this issue, we present a comprehensive and contemporary review of the medical comorbidities that contribute to chronic rhinosinusitis, and, conversely, how our interventions as otolaryngologists can in turn impact those systemic conditions. Our understanding of chronic rhinosinusitis has evolved tremendously over the last two decades. As we have learned, chronic rhinosinusitis—a chronic inflammatory condition of the nasal cavity and paranasal sinuses—is often a local inflammatory response to a systemic or mucosal disorder. The underlying systemic medical conditions not only influence the presentation and diagnosis of chronic rhinosinusitis, but also modify the patients’ response to medical and surgical interventions. Chronic rhinosinusitis associated with cystic fibrosis, for example, is a disorder quite distinct from that associated with aspirin-exacerbated respiratory disease. A clear understanding of the nuances that distinguish these unique and challenging disorders is critical for the practicing otolaryngologist. Equally important, however, is a clear understanding of the powerful benefits that our interventions as otolaryngologists can have for our patients’ rhinologic and systemic health. Knowing that our rhinologic interventions might spare an asthma patient a trip to an emergency room, or reduce lung infections in a cystic fibrosis patient, makes this a very exciting time to be a rhinologist. We hope you enjoy this Special Issue of Medical Sciences.

Dr. David Gudis
Guest Editor

Manuscript Submission Information

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Keywords

  • rhinosinusitis
  • asthma
  • unified airway
  • nasal polyposis
  • cystic fibrosis
  • co-morbidities

Published Papers (7 papers)

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Research

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Open AccessArticle
Eosinophilic Upper Airway Inflammation in a Murine Model Using an Adoptive Transfer System Induces Hyposmia and Epithelial Layer Injury with Convex Lesions
Med. Sci. 2019, 7(2), 22; https://doi.org/10.3390/medsci7020022
Received: 18 January 2019 / Revised: 28 January 2019 / Accepted: 30 January 2019 / Published: 5 February 2019
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Abstract
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a refractory upper airway disease, accompanied mainly by eosinophilia and/or asthma. In addition, the disease correlates with a high rate of hyposmia, following a marked infiltration of eosinophils into the inflamed site, the paranasal sinus. [...] Read more.
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a refractory upper airway disease, accompanied mainly by eosinophilia and/or asthma. In addition, the disease correlates with a high rate of hyposmia, following a marked infiltration of eosinophils into the inflamed site, the paranasal sinus. Although eosinophils are known to contribute to the development of hyposmia and CRSwNP pathology, the underlying mechanisms remain unclear. This study aimed to investigate whether eosinophilic upper airway inflammation induces hyposmia and CRSwNP in a murine model using an adoptive transfer system. Methods: To induce eosinophilic rhinosinusitis, splenocytes, including a high proportion (over 50%) of activated eosinophils (SPLhEos), were collected from interleukin-5 transgenic mice following double intraperitoneal injections of antigens, such as ovalbumin, house dust mite, or fungus. Activated SPLhEos with corresponding antigens were then transferred into the nasal cavity of recipient mice, which were sensitized and challenged by the corresponding antigen four times per week. Olfactory function, histopathological, and computed tomography (CT) analyses were performed 2 days after the final transfer of eosinophils. Results: Hyposmia was induced significantly in mice that received SPLhEos transfer compared with healthy and allergic mice, but it did not promote morphological alteration of the paranasal sinus. Pathological analysis revealed that epithelial layer injury and metaplasia similar to polyps, with prominent eosinophil infiltration, was induced in recipient tissue. However, there was no nasal polyp development with interstitial edema that was similar to those recognized in human chronic rhinosinusitis. Conclusions: This study supports the previously unsuspected contribution of eosinophils to CRS development in the murine model and suggests that murine-activated eosinophilic splenocytes contribute to the development of hyposmia due to more mucosal inflammation than physical airway obstruction and epithelial layer injury with convex lesions. Full article
(This article belongs to the Special Issue Chronic Rhinosinusitis and Concomitant Medical Disorders)
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Review

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Open AccessReview
Surgical Management of Chronic Rhinosinusitis in Cystic Fibrosis
Med. Sci. 2019, 7(4), 57; https://doi.org/10.3390/medsci7040057
Received: 16 January 2019 / Revised: 29 March 2019 / Accepted: 5 April 2019 / Published: 7 April 2019
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Abstract
Cystic fibrosis patients frequently develop chronic rhinosinusitis as a result of their propensity to form inspissated mucus and impairment of mucociliary clearance. They exhibit variable symptom burden even in the setting of positive radiographic and endoscopic findings. Current evidence suggests a positive effect [...] Read more.
Cystic fibrosis patients frequently develop chronic rhinosinusitis as a result of their propensity to form inspissated mucus and impairment of mucociliary clearance. They exhibit variable symptom burden even in the setting of positive radiographic and endoscopic findings. Current evidence suggests a positive effect of managing sinonasal disease on pulmonary health. Topical antimicrobial and mucolytic therapies are frequently required to manage the disease with surgery reserved for refractory cases. Endoscopic sinus surgery has been demonstrated to be safe and efficacious in controlling symptoms of chronic rhinosinusitis in patients with comorbid cystic fibrosis. However, the impact of surgery on pulmonary health remains an active area of investigation. In addition, a growing body of research has suggested a more extended surgical approach creating large sinonasal cavities with gravity-dependent drainage pathways, followed by adjuvant medical therapies, as an ideal strategy to optimally control disease and prevent pulmonary exacerbations. In this manuscript, we provide an up-to-date review of current evidence in the surgical management of chronic rhinosinusitis in cystic fibrosis patients. Full article
(This article belongs to the Special Issue Chronic Rhinosinusitis and Concomitant Medical Disorders)
Open AccessReview
Asthma and Chronic Rhinosinusitis: Diagnosis and Medical Management
Med. Sci. 2019, 7(4), 53; https://doi.org/10.3390/medsci7040053
Received: 21 January 2019 / Revised: 21 March 2019 / Accepted: 22 March 2019 / Published: 27 March 2019
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Abstract
Asthma is a prevalent inflammatory condition of the lower airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchial hyperresponsiveness (BHR). Symptomatically, these patients may demonstrate wheezing, breathlessness, chest tightness, and coughing. This disease is a substantial burden to a growing [...] Read more.
Asthma is a prevalent inflammatory condition of the lower airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchial hyperresponsiveness (BHR). Symptomatically, these patients may demonstrate wheezing, breathlessness, chest tightness, and coughing. This disease is a substantial burden to a growing population worldwide that currently exceeds 300 million individuals. This is a condition that is frequently encountered, but often overlooked in the field of otolaryngology. In asthma, comorbid conditions are routinely present and contribute to respiratory symptoms, decreased quality of life, and poorer asthma control. It is associated with otolaryngic diseases of the upper airways including allergic rhinitis (AR) and chronic rhinosinusitis (CRS). These conditions have been linked epidemiologically and pathophysiologically. Presently, they are considered in the context of the unified airway theory, which describes the upper and lower airways as a single functional unit. Thus, it is important for otolaryngologists to understand asthma and its complex relationships to comorbid diseases, in order to provide comprehensive care to these patients. In this article, we review key elements necessary for understanding the evaluation and management of asthma and its interrelatedness to CRS. Full article
(This article belongs to the Special Issue Chronic Rhinosinusitis and Concomitant Medical Disorders)
Open AccessReview
Aspirin Exacerbated Respiratory Disease: Epidemiology, Pathophysiology, and Management
Med. Sci. 2019, 7(3), 45; https://doi.org/10.3390/medsci7030045
Received: 19 January 2019 / Revised: 11 March 2019 / Accepted: 11 March 2019 / Published: 17 March 2019
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Abstract
The correlation between aspirin sensitivity, asthma, and nasal polyposis was recognized in the early 20th century. Today, this classic triad of symptoms, eponymously named Samter’s Triad, is known as aspirin exacerbated respiratory disease (AERD). Aspirin exacerbated respiratory disease affects approximately 0.3–0.9% of the [...] Read more.
The correlation between aspirin sensitivity, asthma, and nasal polyposis was recognized in the early 20th century. Today, this classic triad of symptoms, eponymously named Samter’s Triad, is known as aspirin exacerbated respiratory disease (AERD). Aspirin exacerbated respiratory disease affects approximately 0.3–0.9% of the general population in the USA and approximately 7% of asthmatic patients. The management of AERD is challenging as no single modality has proven to have high rates of symptom control. Consequently, disease management typically involves a multimodality approach across both medical and surgical disciplines. This review describes the epidemiology of AERD and the current state-of-the-art as it relates to the underlying pathophysiologic mechanisms of this disease process. A significant proportion of the review is focused on the appropriate diagnostic workup for AERD patients including the utility of aspirin provocation testing. The spectrum of medical treatments, including aspirin desensitization and recently introduced immunotherapies, are discussed in detail. Furthermore, surgical approaches to disease control, including advanced endoscopic techniques, are reviewed and treatment outcomes presented. Full article
(This article belongs to the Special Issue Chronic Rhinosinusitis and Concomitant Medical Disorders)
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Open AccessReview
The Role of the Adenoids in Pediatric Chronic Rhinosinusitis
Med. Sci. 2019, 7(2), 35; https://doi.org/10.3390/medsci7020035
Received: 21 January 2019 / Revised: 17 February 2019 / Accepted: 21 February 2019 / Published: 25 February 2019
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Abstract
There are several mechanisms by which the adenoids contribute to pediatric chronic rhinosinusitis (PCRS), particularly with children aged 12 years and younger. Understanding the role that the adenoids play in PCRS is crucial when attempting to treat these patients. A literature review was [...] Read more.
There are several mechanisms by which the adenoids contribute to pediatric chronic rhinosinusitis (PCRS), particularly with children aged 12 years and younger. Understanding the role that the adenoids play in PCRS is crucial when attempting to treat these patients. A literature review was performed to address this problem and provide information surrounding this topic. This review will provide a better understanding of how adenoids contribute to PCRS, and also of the medical and surgical treatment options. Full article
(This article belongs to the Special Issue Chronic Rhinosinusitis and Concomitant Medical Disorders)
Open AccessReview
Chronic Rhinosinusitis in Cystic Fibrosis: Diagnosis and Medical Management
Med. Sci. 2019, 7(2), 32; https://doi.org/10.3390/medsci7020032
Received: 20 January 2019 / Revised: 17 February 2019 / Accepted: 18 February 2019 / Published: 22 February 2019
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Abstract
Chronic rhinosinusitis (CRS) is nearly ubiquitous in patients with cystic fibrosis (CF). CF CRS is a challenging entity to define, diagnose, and treat, as patients often have severe refractory sinus disease in addition to complex medical comorbidities. The purpose of this article is [...] Read more.
Chronic rhinosinusitis (CRS) is nearly ubiquitous in patients with cystic fibrosis (CF). CF CRS is a challenging entity to define, diagnose, and treat, as patients often have severe refractory sinus disease in addition to complex medical comorbidities. The purpose of this article is to review the literature on the medical management of CF CRS and determine how to best identify, diagnose, and manage CF CRS. Ultimately, the treatment of these patients requires a multi-disciplinary approach involving the pulmonologist and otolaryngologist. Full article
(This article belongs to the Special Issue Chronic Rhinosinusitis and Concomitant Medical Disorders)
Open AccessReview
Chronic Rhinosinusitis: Does Allergy Play a Role?
Med. Sci. 2019, 7(2), 30; https://doi.org/10.3390/medsci7020030
Received: 13 January 2019 / Revised: 2 February 2019 / Accepted: 12 February 2019 / Published: 18 February 2019
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Abstract
A few chronic rhinosinusitis (CRS) variants have demonstrated a strong association with environmental allergy, including allergic fungal rhinosinusitis (AFRS) and central compartment atopic disease (CCAD). However, the overall relationship between CRS and allergy remains poorly defined. The goal of this review is to [...] Read more.
A few chronic rhinosinusitis (CRS) variants have demonstrated a strong association with environmental allergy, including allergic fungal rhinosinusitis (AFRS) and central compartment atopic disease (CCAD). However, the overall relationship between CRS and allergy remains poorly defined. The goal of this review is to evaluate the relationship between CRS and allergy with a focus on specific CRS variants. Full article
(This article belongs to the Special Issue Chronic Rhinosinusitis and Concomitant Medical Disorders)
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