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.

The association of Leptospermum honey with cytokine expression in the sinonasal epithelium of chronic rhinosinusitis patients

Objective:To identify the differences in cytokine expression between sinonasal tissue from patients treated with Leptospermum (Manuka) honey (LH) irrigation versus normal saline irrigation twice-daily for twelve weeks following sinus surgery (FESS).Methods:Forty-six CRS patients were recruited.Sinus tissue biopsies were collected during FESS and then at 5 and 12 weeks postoperatively during the course of treatment.A multiplex cytokine assay quantified the abundance of 17 cytokines in biopsied tissue.Cytokine expression fold-change was analyzed between each time point using a robust linear regression model and compared between the two treatment groups.Results:Compared to the saline irrigation group,five cytokines were differently expressed (CI =95%) in sinonasal tissue obtained from subjects in the LH irrigation group during the 12-week treatment period.Cytokines IL-6 (P =0.0400),IL-8 (P =0.0398),MCP-1 (P =0.0284),and MIP-1β (P =0.016) were significantly increased in the LH irrigation group compared to the saline irrigation group.IL-13 was significantly increased in the saline irrigation group compared to the LH group (P =0.0086).Conclusion:LH may potentially act to modulate the expression of IL-6,IL-8,IL-13,MCP-1 and MIP-1β in sinonasal tissue.

Surveillance tools for detection of recurrent nasopharyngeal carcinoma: An evidence-based review and recommendations

Objective: Nasopharyngeal carcinomas (NPC) are tumors arising from epithelium of the nasopharynx. The 5-year survival rate of primary NPC is 80% with significant risks of recurrence. The objective here is to provide an evidence-based systemic review of the diagnostic value of different modalities in detecting local, regional, and distal recurrent NPC, as well as the associated costs with these modalities.Methods: MEDLINE, EMBASE, and the Cochrane review database were queried. Two hundred and twenty-three abstracts were generated using the inclusion criteria: patients >18 years of age;histopathological reference standard;and modalities pertaining to imaging or microbiology.Results: Twenty-four manuscripts fulfilled the inclusion criteria and 5 surveillance tools identified: endoscopy, MR, FDG-PET, Tc-99m MIBI and201TI SPECT, and EBV DNA.Conclusions: For local surveillance, endoscopy is the gold standard recommendation, with increased efficacy if Narrow Band Imaging or contact endoscopy are utilized. MRI and FDG-PET is also recommended to help with local to distal spread;however, Tc-99m MIBI and201TI SPECT are options as well. EBV DNA is recommended as a cheap and accessible adjunct surveillance tool if an available as an option.