Evaluation of the Quality of Life of Patients Suffering from Chronic Rhinosinusitis in a Hospital Setting in Kinshasa

Background and objective: Chronic rhinosinusitis (CRS), a common disease worldwide, has a major impact on patients’ quality of life (QoL). In recent years, the measurement of health-related QoL has made it possible to assess the patient’s state of health, the severity of the CRS and the treatment. The aim of this study was to assess the QoL of patients with CRS in a hospital setting in Kinshasa. Methods: This was a cross-sectional analytical study conducted from June 2020 to May 2021 in the ENT service of the Kinshasa University Hospital and the Monkole Hospital Center. The study involved 113 patients aged at least 18 years, whose QOL was compared with that of a control group consisting of 100 non-patients. QOL was assessed using the Sino-Nasal Outcome Test (SNOT-22) Questionnaire. Results: The mean age of the patients was 41.0 years (18 - 74 years) and that of the controls was 39.1 years (19 - 77 years). More than half of the participants were university graduates. The median SNOT-22 score was 44 (14 - 78) in patients and 7 (1 - 40) in controls. Compared with subjects without CRS, patients with CRS had significantly higher scores in all four domains of the SNOT-22. Around 9 out of 10 patients had a severely impaired QoL compared with 2 out of 10 controls. Considering mildly impaired QoL, we found that in the otological and sleep domains, scores were not significantly different between patients and controls. In the case of severely impaired QoL, however, only the otological domain showed a non-significant difference in scores between the two groups. Conclusion: CRS is a real public health problem in our environment and significantly alters the QoL of patients suffering from it, with repercussions on their professional productivity;hence the need for better management.

Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps

Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP.Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation:sex,serum eosinophil levels,history of prior surgery,endoscopic scores,and comorbid conditions(asthma and allergic rhinitis).The primary outcome was the rate of post-operative intervention on day 30,and the secondary outcome was the rate of polypoid tissue formation(grades 2–3)on days 14,30,and 90.Results A total of 151 patients with CRSwNP were included in the post-hoc analysis.Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30,with an odds ratio of 23.71(95%CI,2.81,200.16;P=0.004)for the need for post-operative intervention and 19(95%CI,2.20,164.16;P=0.003)for moderate-to-severe polypoid tissue formation.In addition,the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30.Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.Conclusion Comorbid asthma,but not blood eosinophil level,impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.

Socioeconomic Status Impacts the Prognosis of Chronic Rhinosinusitis Treated by Endoscopic Sinus Surgery:An Observational Cohort Study in Northeast China

Objective To explore the association between socioeconomic status(SES)and postoperative outcomes in patients with chronic sinusitis(CRS)after functional endoscopic sinus surgery(ESS).Methods We conducted an observational cohort study of 1,047 patients with CRS undergoing ESS.Discharged patients were followed up to 72 weeks for all-cause recurrence events.Baseline SES was established based on occupation,education level,and family income of the patients 1 year before the operation.Kaplan–Meier method was used to calculate the recovery rate after ESS,and Cox proportional hazards regression analysis was used to evaluate the relationship between SES and prognosis.Results Patients of middle SES had lower unadjusted all-cause recurrence than those of low or high SES;24-week overall recovery rate was 90.4%[95%confidence interval(CI):89.6%–91.2%]in patients of middle SES,13.5%(95%CI:12.8%–14.2%)in patients of low SES,and 31.7%(95%CI:30.7%–32.7%)in patients of high SES(both log-rank P<0.001).After adjustment for covariates,hazard ratios(HRs)were7.69(95%CI:6.17–9.71,Ptrend<0.001)for all-cause recurrence for low SES versus middle SES,and 6.19(95%CI:4.78–7.93,Ptrend<0.001)for middle SES versus high SES.Conclusion Low SES and high SES were more associated with the worse prognosis of CRS patients after ESS than middle SES.

Relationship between chronic rhinosinusitis and lower airway diseases: An extensive review

Signifcant links between allergic rhinitis and asthma have been reported, and the united airway disease hypothesis is supported by numerous findings in epidemiologic, physiologic, pathologic, and immunologic studies. The impact of allergic rhinitis on asthma has been esta-blished. On the other hand, the relationship between chronic rhinosinusitis and lung diseases has been under investigation. Chronic rhinosinusitis is a common disease, and the high prevalence of chronic rhinosinusitis in some kinds of lung diseases has been reported. Recent studies suggest that the treatment of chronic rhinosinusitis has beneficial effects in the management of asthma. Here, we present an overview of the current research on the relationship between chronic rhinosinusitis and lower airway diseases including asthma, chronic obstructive pul-monary disease, cystic fibrosis, diffuse panbronchiolitis, primary ciliary dyskinesia, idiopathic bronchiectasis, and allergic bronchopulmonary aspergillosis.

Systematic Review and Meta-analysis of Biyuanshu Oral Liquid in the Treatment of Chronic Rhinosinusitis

[Objectives]The objective was to study the clinical efficacy and safety of Biyuanshu oral liquid in the treatment of chronic rhinosinusitis(CRS).[Methods]Randomized controlled trial was adopted to conduct scientific and standardized assessment on the risk of bias in the included papers.With overall effect and incidence of adverse reactions as indices,meta-analysis was performed,and sensitivity and safety analysis was conducted on the included literature.[Results]A total of 15 papers were included,involving 1489 patients.The efficiency of Biyuanshu oral liquid combined with Western medicine was better than that of Western medicine alone.[Conclusions]Biyuanshu oral liquid is safe and effective in treating chronic rhinosinusitis,and is suitable for patients who are not convenient for surgery.However,as the 15 papers included are all low in quality and there is a certain degree of publication bias,the objectivity of the results is affected to some extent.

Correlation between Radiological Staging of Chronic Rhinosinusitis and Revision of Endoscopic Sinus Surgery

Introduction: Chronic rhinosinusitis (CRS) is an inflammatory condition affecting the sinonasal mucosa with duration of more than 12 weeks. Multifactorial aetiology contributes to its refractoriness. Functional endoscopic sinus surgery (FESS) is the most common surgical technique preferred in CRS not responding to medical management, showing high success rates. However, some failure has been noted, requiring revision FESS. CT (Computed Tomography) is a diagnostic tool for CRS, and aids in improving surgical outcomes. Combined with the Lund-Mackay scoring system, CT can help stage the CRS, predicting the need for revision surgery. Methods: In our paper, we aimed to study the relationship between severity of CRS using radiological staging and revision of functional endoscopic sinus surgery, assessing outcome after at least 1 year of follow-up. There was a single centre retrospective study involving 150 patients selected by random sampling, to study the correlation between the severity of chronic rhinosinusitis and revision of functional endoscopic sinus surgery (FESS). The study was conducted in the ENT department of King Hamad University Hospital, Bahrain for a time period of 6 months. Records were scanned and scored using Lund-Mackay system. Lund Mackay score of 10 and above was considered severe. The relation between increased severity with Lund Mackay score on the CT scan and the need for revision sinus surgeries was then determined. Results and Conclusion: This study concludes that LMS score in CT scans can be used to predict the outcomes of primary FESS procedure and the need for revision surgery in the management of CRS.

Dysregulation of E-cadherin in Chronic Rhinosinusitis with Nasal Polyps

E-cadherin is a key epithelial protein and adhesive molecule. This study detected the E-cadherin expression in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and controls, and analyzed its possible role in the pathogenesis of CRSwNP. The expression of E-cadherin was detected by using Western blotting and immunohistochemistry in controls and patients with CRSwNP. Computed tomography (CT) scan findings were scored. The results showed that the E-cadherin expression was up-regulated in patients with CRSwNP as compared with controls (P=0.039) and the positive staining was predominantly localized on the epithelial cell membrane. E-cadherin level was correlated negatively with Lund-Mackay scores in patients with CRSwNP (r=–0.604, P=0.005). It is suggested that E-cadherin may be involved in the pathogenesis of CRSwNP and correlated with disease severity.

Utilization of RNA sequencing to investigate olfactory dysfunction in chronic rhinosinusitis without nasal polyps:A pilot study

Objectives:Prior research on olfactory dysfunction in chronic rhinosinusitis(CRS)has focused on patients with polyps and suggests that direct inflammation of the olfactory cleft mucosa plays a contributory role.The purpose of this study was to evaluate gene expression in superior turbinate mucosal specimens,comparing normosmic and dysosmic CRS patients without polyps(CRSsNP).Methods:Tissue samples were obtained from the superior turbinates of patients with CRSsNP at the time of endoscopic sinus surgery.Samples subsequently underwent RNA sequencing and functional analysis to investigate biological pathways associated with differentially expressed genes between dysosmic(n=7)and normosmic(n=4)patients.Results:Differential gene expression analysis comparing dysosmic and normosmic CRSsNP patients showed upregulation of 563 genes and downregulation of 327 genes.Using stringent criteria for multiple comparisons,one upregulated gene(Immediate Early Response 3[IER3])had an false discovery rate(FDR)correction adjustedP value considered statistically significant(P<0.001,fold change 2.69).Reactome functional analysis revealed eight biological pathways significantly different between dysosmic and normosmic patients(P<0.05,FDR correction)including IL-4 and IL-13 signaling,IL-10 signaling,and rhodopsin-like receptors.Conclusions:RNA sequencing of the superior turbinates in patients with CRSsNP can provide valuable information regarding biological pathways and genes involved in olfactory dysfunction.This study supports literature suggesting that Type 2 inflammation may play a role in olfactory dysfunction in at least some patients with CRSsNP.This study also prompts questions regarding the role of IL-10,rhodopsin-like receptors,andIER3 in the pathogenesis of olfactory dysfunction.

Enhanced oxidative stress is associated with tissue neutrophilia and poor steroid response in chronic rhinosinusitis with nasal polyps

Objective:To analyze the oxidative stress status and its association with tissue neutrophilia and oral steroid response in chronic rhinosinusitis with nasal polyps(CRSwNP)patients.Methods:The levels of total oxidant status(TOS)were detected in the sinonasal tissues by using specific assay kits.Tissue neutrophil was examined by immunohistochemical staining,and oxidant status index(OSI)was evaluated in polyps tissues,and the messenger RNA(mRNA)levels of superoxide dismutase 2(SOD2),aldehyde dehydrogenase 1(ALDH1A1),and microsomal glutathione S‐transferase 1(MGST1)were examined using quantitative real‐time polymerase chain reaction in the sinonasal tissues.The receiver operating characteristics(ROCs)curve of ALDH1A1,MGST1,and SOD2 mRNA levels were evaluated to determine the steroid response of CRSwNP patients.Results:The levels of TOS and OSI were significantly higher in CRSwNP and CRSsNP than in normal controls,and OSI in polyps tissues was positively associated with tissue neutrophilia and poor steroid response.The ALDH1A1,MGST1,and SOD2 mRNA levels showed comparable accuracy as predictors of poor steroid response indicated by the area under the curve.Conclusion:These findings provided evidence that the increased level of oxidative stress contributes to enhanced tissue neutrophilia and poor steroid response in CRSwNP patients.

Clinical and histopathologic features of biofilm-associated chronic rhinosinusitis with nasal polyps in Chinese patients

Background Biofilms have given new insights to the understanding of pathogenesis of chronic rhinosinusitis （CRS）. However, the link between biofilms formation and local inflammatory response remains poorly defined in CRS with nasal polys. The aim of this study was to determine the potential association of the presence of biofilms in the nasal mucosal tissues with clinical features in Chinese patients, which had CRS with nasal polyps （CRSwNP）. Methods A total of 19 patients with CRSwNP and 12 patients with non-CRS were subjected to endoscopic surgery and their nasal mucosal tissue specimens were examined histologically and by scanning electron microscopy （SEM）. Their demographic and clinical features were recorded. Results Thirteen （68.4%） out of the 19 specimens from patients with CRSwNP, but none from control patients, were positive for biofilms that displayed typical characteristics of bacterial and fugal structures. The presence of biofilms in the nasal mucosal tissues was associated with significantly greater values of purulent nasal discharge and preoperative Lund-Kennedy scores, higher levels of serum total IgE and percentages of subjects with endoscopic surgery （ESS） history in patients with CRSwNP, and more severe inflammation in the nasal mucosal tissues of patients with CRSwNP. Conclusion Our study demonstrated the presence of biofilms in the nasal mucosal tissues of many patients, contributing to the understanding of the pathogenic process of CRSwNP in Chinese patients.

Expression of Innate Immunity Genes in Epithelial Cells of Hypertrophic Adenoids with and without Pediatric Chronic Rhinosinusitis： A Preliminary Report

Background： Adenoid hypertrophy （AH） is associated with pediatric chronic rhinosinusitis （pCRS）, but its role in the inflammatory process of pCRS is unclear. It is thought that innate immunity gene expression is disrupted in the epithelium of patients with chronic rhinosinusitis （CRS）, including antimicrobial peptides and pattern recognition receptors （PRRs）. The aim of this preliminary study was to detect the expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pCRS to better understand their role in pCRS. Methods： Nine pCRS patients and nine simple AH patients undergoing adenoidectomy were recruited for the study. Adenoidal epithelium was isolated, and real-time quantitative polymerase chain reaction （RT-qPCR） was employed to measure relative expression levels of the following messenger RNAs in hypertrophic adenoid epithelial cells of pediatric patients with and without CRS： Human β-defensin （HBD） 2 and 3, surfactant protein （SP）-A and D, toll-like receptors 1-10, nucleotide-binding oligomerization domain （NOD）-like receptors NOD 1, NOD 2, and NACHT, LRR and PYD domains-containing protein 3, retinoic acid-induced gene 1, melanoma differentiation-associated gene 5, and nuclear factor-riB （NF-KB）. RT-qPCR data from two groups were analyzed by independent sample t-tests and Mann-Whitney U-tests. Results： The relative expression of SP-D in adenoidal epithelium ofpCRS group was significantly lower than that in AH group （pCRS 0.73 ± 0.10 vs. AH 1.21 ±0.15; P = 0.0173, t = 2.654）. The relative expression levels of all tested PRRs and NF-κB, as well as HBD-2, HBD-3, and SP-A, showed no statistically significant differences in isolated adenoidal epithelium between pCRS group and AH group. Conclusions： Down-regulated SP-D levels in adenoidal epithelium may contribute to the development of pCRS. PRRs, however, are unlikely to play a significant role in the inflammatory process ofpCRS.

Effect of Zhu-yuan decoction in patients with chronic rhinosinusitis after functional endoscopic sinus surgery

OBJECTIVE: To investigate the effectiveness and safety of Zhu-yuan decoction(ZYD) in patients after functional endoscopic sinus surgery(FESS).METHODS: A total of 85 patients were randomized into two groups: 44 were treated with intranasal corticosteroids(INC), and 41 were given Chinese herbal medicine(CHM). Patients with chronic rhinosinusitis(CRS) who underwent FESS were prospectively enrolled in the study. Before surgery, they were evaluated by visual analog scale(VAS), nasal endoscopy, computed tomography(CT), and routine blood test. After surgery, they were randomized to take ZYD or INC for 12 weeks and revaluated by VAS; nasal endoscopy at 4, 8, and 12 weeks;and CT at 12 weeks after surgery.RESULTS: In the both groups, VAS and endoscopyscores decreased significantly at 4, 8, and 12 weeks,and CT scores after treatment declined at 12 weeks compared with baseline scores. No significant differences were observed with regard to postoperative VAS, endoscopy, or CT scores between groups.ZYD, combined with surgery, can reduce VAS, nasal endoscopy, and CT scores and has the same efficacy and safety profile as INC in post-FESS management.No fatalities or major adverse events occurred in either group.CONCLUSION: Our findings suggest that ZYD has similar effects and safety profiles in patients after FESS compared with INC.

Acupuncture for chronic rhinosinusitis and related postoperative pain:A systematic review and network meta-analysis

Background:The network meta-analysis system was used to evaluate the efficacy of various acupuncture and moxibustion techniques for chronic rhinosinusitis(CRS)and related postoperative pain.Methods:An electronic search of PubMed,Embase,Web of Science,Cochrane Library,OVID(the Offshore Vessel Inspection Database),CNKI,Wanfang,VIP,and CBM databases was conducted to identify randomised controlled trials on acupuncture and moxibustion for CRS and related postoperative pain from database inception to February 2021.The study included randomised controlled trials(RCTs)published in China and other countries in languages limited to Chinese and English.Primary studies included treated individuals without limitations on age,gender,or nationality and diagnosed as CRS.The total effective rate,visual analogue scale(VAS)score,and symptom and sign score were the primary outcomes.Evidence quality and risk-of-bias were determined.Network meta-analysis was performed.Results:Nineteen articles were included,involving 11 types of intervention measures.The pairwise comparisons showed that both acupuncture therapy combined with drugs(ATD)and sphenopalatine ganglion acupuncture combined with drugs(SGAD)were superior to western medicine(WM)in improving the total effective rate,and ATD was superior to manual acupuncture therapy(MAT),WM,and placebo(PL).In reducing the VAS score,both ATD and SGAD were superior to WM.Point-through-point acupuncture combined with pricking blood therapy(PABT)was superior to MAT.In reducing symptom and sign score,ATD was superior to WM and PL.PABT was superior to MAT.The results of network meta-analysis showed that ATD was superior to MAT,Traditional Chinese medicine(TCM),and WM in improving the total effective rate.In reducing the symptom and sign score,ATD was superior to PL,WM,MAT,and sham acupuncture(SA).PL was superior to MAT,WM,and SA.and PABT was superior to MAT and SA,MAT was superior to WM.There was no significant difference between the intervention measures in reducing the VAS score.The surface under the cumulative ranking curve showed that ATD had the best effect in improving the total effective rate and reducing the VAS and symptom and sign score.Conclusion:ATD was the best method for improving the total effective rate and reducing the VAS and symptom and sign score in the treatment of CRS and related postoperative pain.However,considering the current study quantity and quality,multicentre and high-quality clinical studies with larger sample sizes are needed to verify our findings.

Immunomodulators in chronic rhinosinusitis

Objective::To provide new insight into how chronic rhinosinusitis (CRS) is conceptualized and treated with a focus on immunomodulator therapy.Data sources::Pubmed, Medline, and Embase.Methods::A current review of the evidence is provided for immunomodulators investigated for treatment of CRS with nasal polyps (CRSwNP).Results::Biologic therapies targeting IgE, IL-4, IL-5, and IL-13 for the treatment of CRSwNP have shown promise and are currently in phase 3 trials. Anti-immunoglobin E (IgE) therapy with omalizumab was assessed in 6 studies, anti-interleukin (IL)-5 therapy in 3 studies (2 mepolizumab, 1 reslizumab) and anti IL-4/IL-13 (dupilumab) therapy in one study. Studied outcomes varied, but the majority of trials identified clinical benefit of therapy over placebo. Other potential targets include thymic stromal lymphopoetin (TSLP), IL-25, IL-33, and sialic acidbinding immunoglobulin-type lectin (Siglec)-8. Small molecule drugs that target the dysregulation of the immune system in CRS are also being investigated for their immunomodulatory effects on inflammation.Conclusion::Immunomodulator therapies for CRS currently in development will likely provide another therapeutic option for patients who have severe disease unresponsive to corticosteroids and surgery. Targeted monoclonal antibody therapies have shown encouraging results and phase 3 trials are underway. IL-4/IL-13 inhibition has shown the most promise to date. Further larger, well-designed trials are needed to improve understanding of these molecules and to offer endotype-driven therapies in the management of CRS. None of these therapeutics have shown long-term immunomodulation when discontinued and therefore further investigation into the pathomechanism of disease continues to be needed.

Preoperative and postoperative medical therapies for chronic rhinosinusitis:National surveys among Chinese otolaryngologists

Objective:The aim of this study was to evaluate clinical practice patterns of preoperative and postoperative medical therapies immediately surrounding sinus surgery for chronic rhinosinusitis(CRS)by Chinese otolaryngologists.Methods:Two anonymous web-based surveys of preoperative and postoperative medical therapies were performed.These surveys assessed the frequency of prescription of oral corticosteroids,intranasal corticosteroid sprays,oral antibiotics,nasal saline irrigation,oral antihistamines,nasal antihistamines,anti-leukotriene agents,topical decongestants and oral mucolytics.Results:A total of 304(17.5%)preoperative and 143(23.5%)postoperative questionnaires were completed and returned.Seventy-eight percent,63%and 56%of respondents used preoperative intranasal corticosteroid sprays,oral antibiotics and oral mucolytics“always or often”,respectively.Ninety-four percent,93%,72%and 69%of respondents used postoperative intranasal corticosteroid sprays,nasal saline irrigation,oral antibiotics and oral mucolytics“always or often”,respectively.Oral antihistamines,nasal antihistamines,anti-leukotrienes and topical decongestants were not commonly used preoperatively or postoperatively.Conclusions:Our study demonstrated that current practice patterns of preoperative medical therapies among otolaryngologists are not uniformly based on evidence-based outcomes research.Postoperative oral antibiotics,intranasal corticosteroid sprays,nasal saline irrigation and oral mucolytics are commonly used by a majority of Chinese otolaryngologist for CRS.Practice patterns of postoperative medical therapy reflect recent guidelines.

A pilot prospective prevalence study of chronic rhinosinusitis associated with inflammatory bowel disease

Background:Inflammatory bowel disease(IBD)is characterized by chronic inflammation of the gastrointestinal tract.Extra-intestinal manifestations such as pulmonary diseases have been reported.Chronic rhinosinusitis(CRS),an inflammatory condition of the sinonasal mucosa,has been associated with several lung diseases.Given the relationship between lung and intestinal pathologies,and lung and sinus pathologies,we aimed to determine the prevalence of IBD among CRS patients.Methods:Pilot prevalence study.Ninety-two CRS patients were screened for IBD symptoms from October 2018 to January 2020.Patient-reported disease symptoms and overall quality of life were evaluated using the Sino-Nasal Outcome Test 22(SNOT-22),Short Inflammatory Bowel Disease Questionnaire(SIBDQ),and EuroQol 5 Dimension 5 Level(EQ-5D-5L)questionnaires.The Modified Lund-Kennedy(MLK)endoscopic and Lund-Mackay(LM)grading systems were used to confirm CRS diagnoses.Individuals who reported subjective symptoms of IBD were referred to a gastroenterologist clinic for further diagnostics.Results:Twenty of the 92(20.2%,95%CI:12.6%-29.8%)CRS patients reported symptoms of IBD and four individuals(4.26%,95%CI:1.17%-10.50%)were sub-sequently diagnosed with IBD.Compared to patients without IBD symptoms(n=72),those with symptoms(n=20)reported significantly worse SNOT-22(P=0.002),SIBDQ(P<0.05),and EQ-5D-3L(P=0.0063)scores.However,these patients did not exhibit significantly different MLK(P=0.81)or LM(P=0.04)scores.Conclusion:The prevalence of IBD may be elevated among individuals with CRS relative to the general Canadian population.This pilot study suggests that CRS with IBD is associated with lower quality of life.Further cross-sectional studies with larger sample sizes are required.

Presentation and outcomes of chronic rhinosinusitis following liver and kidney transplant

non-invasive chronic rhinosinusitis(CRS)following liver or kidney transplant and determine factors associated with disease-related complications,selection of endoscopic sinus surgery(ESS),and disease resolution in this population.Study design:Retrospective chart review.Setting:An academic tertiary care center(Mayo Clinic,Rochester,Minnesota).Subjects and methods:Liver and kidney transplant recipients evaluated by Mayo Clinic otolaryngologists for CRS between 1998 and 2018 were identified.Univariate and multivariate logistic regression analyses were used to determine patient factors and treatment modalities associated with developing complications,selection of ESS,and disease resolution.Results:Fifty-seven patients met inclusion criteria.No patients developed intraorbital or intracranial complications of their CRS.Multivariate modeling demonstrated that the presence of polyps(P=0.036)was associated with undergoing ESS within one year of presentation.A higher Lund-Mackay(LM)computed tomography score(P=0.023)and older age(P=0.018)were significantly associated with decreased disease resolution.No other factors were significantly associated with the use of endoscopic sinus surgery within one year of otolaryngology presentation or resolution of CRS in this cohort.Conclusion:The risk of developing CRS-related intraorbital or intracranial complications in this immunecompromised patient cohort may be lower than originally thought.For liver-and kidney-recipients stable on immunosuppressive medication for many years,prognostic factors for CRS may mirror those for immunocompetent patients.

Impact of endoscopic sinus surgery on otologic symptoms associated with chronic rhinosinusitis

Objective:To evaluate improvements in otologic symptoms after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS),and identify differences in symptoms,if any,between CRS patients with (CRSwNP) and without (CRSsNP) nasal polyposis.Material and methods:This is a prospective multi-center observational cohort study.Adults with medically recalcitrant CRS who elected ESS were enrolled in a prospective,multicenter,observational cohort study between March,2011 and October,2014.Preoperative evaluation of subjects included assessment of clinical characteristics,measures of disease severity,and quality of life evaluation using the 22-item SinoNasal Outcome Test (SNOT-22).Postoperative improvement in otologic symptoms (ear fullness,dizziness,ear pain) scores were evaluated and compared between CRSwNP and CRSsNP subgroups.Results:Three hundred and ninety-five study patients completed both preoperative and postoperative evaluations,with an average follow-up of 13.9 months after ESS.The prevalence of patients reporting at least one otologic symptom preoperatively (87％) significantly decreased after ESS (63％,P ＜ 0.001).Significant postoperative improvement across all otologic scores was also reported (P ＜ 0.001).Relative mean improvement in otologic symptom severity was similar for both CRSwNP and CRSsNP,except patients with CRSwNP reported significantly greater postoperative improvement in ear fullness compared to CRSsNP (54％ vs.41％,P =0.039).A total of 61％,44％,and 43％ of patients reported experiencing improvement in 'ear fullness','dizziness' and 'ear pain',respectively.Conclusion:Sinus surgery significantly improves otologic symptoms associated with CRS.CRSwNP patients reported slightly greater relief of ear fullness than CRSsNP patients following ESS.

The Endonasal Endoscopic Management of Paranasal Sinuses Mucoceles

Introduction: Paranasal sinuses mucoceles are benign, epithelial lined, mucus filled lesions, causing destruction of the adjacent sinus walls, and with further gradual extension to adjacent structures, serious morbidities and mortalities may occur. Objective: To emphasize on the efficacy of endonasal endoscopic marsupialization in the treatment of paranasal sinus mucoceles. Method: Retrospective descriptive study on paranasal sinus mucocele cases operated on endoscopically by the author (AAM), in the 10-year-period from to 2009-2019. Result: Total of 23 cases were included, 16 were males and 7 females, age ranging between 14 - 76 years, with a mean age of 45 years Location of mucoceles varied between: Frontal 7 cases (30%), Fronto-ethmoidal 6 cases (26%), Isolated Ethmoidal accounted for 3 cases (13%), sphenoidal 4 cases (17%), maxillary were 3 cases (13%) all of the 23 cases underwent endonasal endoscopic complete marsupialization, none of them required combination with external approach in-spite of different locations and complications, with no recurrence in a mean follow up period of 2.4 years. Conclusion: Endonasal endoscopic approach is a safe, efficient approach in the treatment of most paranasal sinus mucocele case in their different presentations and locations.

Reproducibility of 3 mm-Slice-Thick Reconstruction of Paranasal Sinus Computed Tomography Scans

Background: After the failure of medical treatment, the surgery of chronic rhinosinusitis (CRS) is planned according to endoscopic and paranasal sinus computed tomography (CT) findings. Objective: The aim of this prospective study was to evaluate whether this study method might be eligible in studies aiming at radiation dose reduction. Sinus CT scans were chosen as a model because of the high variation of the radiological anatomy of surgically important sinonasal structures. We hypothesized that 3 mm-slice-thick reconstruction CT had poor reproducibility. Methods: 59 CRS patients underwent routine multi-detector sinus CT (CTMD). CT3mm was reconstructed from CTMD data-sets. Lund-Mackay (LM) scores and 43 other structural parameters were analyzed blinded. Agreement was studied between CTMD and CT3mm (intra-observer reproducibility), and between three observers (inter-observer reproducibility) by using Cohen’s kappa. Results: The inter-observer agreement was moderate (kappa 0.4 - 0.6, p < 0.01) in the majority of structures of CT3mm scans. The intra-observer reproducibility of CT3mm scans was very good in most structures, however, it was poor in important structures such as frontal and spheno-ethmoid recess, lamina papyracae, and location of optic nerve or anterior ethmoidal artery. The grade of surgeon’s confidence of CT3mm in comparison to CTMD was lower (kappa 0.2 - 0.4, P < 0.05). Conclusion: This methodology might have some use in studies aiming at radiation dose reduction. As was expected, 3 mm-slice-thick reconstruction CT had poor reproducibility and surgeon’s confidence. More recent methods such as cone beam computed tomography scans have nowadays more relevant dose reduction potential.