Tissue eosinophilia in chronic rhinosinusitis (CRS) is a marker of inflammatory disorders recalcitrant to surgical intervention. Eosinophilic chronic rhinosinusitis (ECRS) is traditionally associated with asthma, polyps, aspirin sensitivity, high serum eosinophilia, and elevated immunoglobulin E (IgE). However, patients with ECRS may not present with these associations and there is a need to establish other surrogate markers. The objective of the study was to determine the associations between the histopathology, serology, and clinical characteristics in CRS patients.A cross-sectional study was undertaken of CRS patients undergoing surgery. Tissue eosinophilia and other pathological features were compared to traditional surrogate features of ECRS, as well as to symptoms, and to radiologic and endoscopic scores.A total of 51 patients were assessed (47% female, mean age 46.6 ± 4.1 years). High tissue eosinophilia (>10 per high-power field [HPF]) was more prominent in polyps (84%) (χ(2) = 25.76; p < 0.01) but was also seen in nonpolyp patients (19%). Asthma was not associated with high tissue eosinophilia (p = 0.60), with 43% of nonasthmatics demonstrating high tissue eosinophilia. Serum eosinophilia predicted high tissue eosinophilia at >0.30 × 10(9)/L or 4.4% of leukocytes (sensitivity 52%, specificity 87%, receiver operating characteristic [ROC] p = 0.001), with low negative predictive value. Serum IgE was nonpredictive (p = 0.08).The diagnosis of ECRS has unique prognostic implications. Traditional features of the ECRS phenotype are not necessarily reliable markers for the presence of tissue eosinophilia. Serum eosinophilia may be a good surrogate marker of tissue eosinophilia but of limited use. The routine use of structured histopathology reporting in CRS is suggested, to allow for the diagnosis of ECRS and to identify other prognostic markers.
Objective Although image‐guided surgery (IGS) is considered a valuable tool, its impact on perioperative morbidity for endoscopic sinus surgery (ESS) remains unclear. The evidence from reported literature is systematically reviewed with meta‐analysis. Data Sources MEDLINE (1946 to September 14, 2012, week 2) and EMBASE (1974 to September 14, 2012, week 37). Review Methods MEDLINE and EMBASE were searched using a search strategy for publications on IGS during ESS that reported original data on perioperative morbidity. PRISMA (Preferred Reporting Items for Systematic reviews and Meta‐Analyses) guidelines were followed. Both comparative cohort studies with non‐IGS cases and case series were included. Primary outcome was major and total complications. Secondary outcomes were specific orbital and intracranial injury, major hemorrhage, ability to complete the operation, and revision surgery. The incidence of these events was defined as dichotomous variables and expressed as a risk ratio (RR) in a fixed‐effects model. Results In total, 2586 articles fulfilled the search, producing 55 included studies. Fourteen were comparative cohorts of IGS and non‐IGS sinus surgical patient populations used for meta‐analysis. Among the cohorts, major complications were more common in the non‐IGS group (RR = 0.48; 95% confidence interval [CI], 0.28‐0.82; P =. 007). Total complications were greater in the non‐IGS group (RR = 0.66; 95% CI, 0.47‐0.94; P =. 02). All other outcomes did not reach significance on meta‐analysis. Conclusion Contrary to current review articles on the topic of IGS use during ESS, there is evidence from published studies that the use of IGS for sinus surgery, within selected populations, is associated with a lower risk of major and total complications compared with non‐IGS sinus surgery.
Background When a standard dose of intranasal corticosteroid (INCS) fails to control symptoms of allergic rhinitis (AR), a double dose of INCS is optional. This systematic review aimed to assess the effects of double‐dose INCS. Methods Literature searches were performed using MEDLINE and EMBASE. Randomized controlled trials that studied the effects of double‐dose INCS vs standard‐dose INCS for treating patients with AR were included. Data from the included studies were extracted and collected for meta‐analyses. The outcomes were nasal symptoms, ocular symptoms, and adverse events. Results Twelve studies (4166 patients) met the inclusion criteria. There were 5 pediatric studies (1868 patients), 5 adult studies (1414 patients), and 2 studies with mixed populations (884 patients). The meta‐analysis results in adult patients favored the effects of double‐dose INCS on: total nasal symptom score (standardized mean difference [SMD] −0.25; 95% confidence interval [CI], −0.41 to −0.08; 4 studies; 568 patients) and total ocular symptom score (SMD −0.27; 95% CI, −0.52 to −0.03; 1 study; 259 patients). The meta‐analysis results in pediatric patients did not show the difference between groups on total nasal symptom score (SMD −0.16; 95% CI, −0.40 to 0.07; 3 studies; 801 patients). The meta‐analysis of ocular symptom score in pediatric patients had insufficient data. There were no differences between groups on adverse events. Conclusion Double‐dose INCS showed better improvement in nasal and ocular symptoms in adult patients with AR when compared to the standard dose. These beneficial effects were not seen in the pediatric population. Adverse events between groups were not different.
Background Endoscopic sinus surgery (ESS) can increase the health utility score (HUS) of patients with chronic rhinosinusitis (CRS) who require the surgery. HUS varies depending on the geographical or living environment. HUS in CRS has never been evaluated in Thailand. The objective of this study was to evaluate the HUS of Thai patients with CRS before and after ESS through multiple approaches. Methods Thai patients (age ≥ 18) with CRS scheduled for ESS were enrolled in this prospective study. The preoperative (baseline) demographics, 22‐items sinonasal outcome test, endoscopic score, and CT score were recorded. The HUS was evaluated using four methods: the EuroQoL‐5 Dimension‐5 level (EQ‐5D‐5L), Visual Analog Scale (VAS), Standard gamble (SG), and Time trade‐off (TTO); at baseline, three months and six months post‐operation. Results Data from 60 patients were analyzed. The mean baseline HUS scores by EQ‐5D‐5L, VAS, SG, and TTO were 0.75, 0.65, 0.79, and 0.85, respectively. The postoperative HUS significantly improved to 0.96, 0.91, 0.96, 0.97 at three months, and 0.97, 0.92, 0.97, and 0.98 at six months, respectively. ESS raised the HUS by 0.12–0.27 points. Among the four methods, VAS showed the lowest HUS at all time points. Conclusion The preoperative HUS in Thai patients with CRS generally increased to near‐perfect values after the ESS. The increase in HUS reflecting the improved general quality of life, was demonstrated at three and up to six months after ESS. Level of Evidence 4 Laryngoscope , 134:2070–2076, 2024
Abstract Background Botulinum toxin type A (BTX‐A) is a potential treatment for chronic rhinitis. This study aimed to assess the effectiveness and safety of BTX‐A in treating patients with chronic rhinitis. Methods Systematic searches of MEDLINE, Scopus, and EMBASE databases were performed. Randomized controlled trials (RCTs) that assessed the efficacy of BTX‐A in allergic rhinitis and/or nonallergic rhinitis patients, compared with either placebo or active treatment, were included. The outcomes were total nasal symptom (TNSS), disease‐specific quality of life (QOL), and adverse events. Results Nine RCTs (340 patients) met the eligibility criteria. Compared with placebo, the ≤ 12‐week effects favored BTX‐A injection on TNSS (standardized mean difference [SMD] ‐2.22, 95% confidence interval [CI] ‐3.27 to ‐1.17, p < 0.01, four RCTs). Beneficial effects > 12 weeks over placebo (MD ‐9.69, 95% CI ‐11.29 to ‐8.09, p < 0.01, one RCT) were demonstrated up to 24 weeks. However, the benefits were not shown on nasal congestion and individual nasal symptoms. Compared with active comparators (triamcinolone injection, ipratropium bromide, and cetirizine), there was no difference in the < 12‐week effect between groups on TNSS. There was no difference between BTX‐A and cetirizine on QOL (one RCT). The > 12‐week effects on TNSS and individual nasal symptoms favored BTX‐A over triamcinolone injection (one RCT). The risk ratio of adverse events favored BTX‐A over cetirizine (one RCT). Conclusions BTX‐A improved TNSS and QOL in patients with chronic rhinitis. These effects were demonstrated up to 24 weeks post treatment. BTX‐A was safe, well tolerated, and may be considered in patients who are refractory to current standard‐of‐care therapies.
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