Background In perennial allergic rhinitis (PAR), the skin-prick test (SPT) is a good diagnostic tool to identify the specific allergens. A nasal provocation test (NPT) is used to identify allergens and to confirm the diagnosis. The aim of this study was to determine the optimal cutoff values of symptom and peak nasal inspiratory flow (PNIF) changes after dust-mite NPT for predicting PAR. We also studied the relationship of the changes of symptoms in NPT and the wheal size of SPT. Methods One hundred five patients with perennial rhinitis underwent the NPT to Dermatophagoides pteronyssinus and the SPT. The NPT was assessed by changes in symptoms and PNIF. The optimal cutoff values of the symptoms score and PNIF changes after the NPT for predicting the SPT were determined using a receiver operating characteristic (ROC) curve. The relationship of the wheal sizes of SPT and the changes from the NPT were analyzed. Results Forty-eight patients had a positive SPT to D. pteronyssinus, of whom 33 patients had a positive NPT by increases of the symptom score. Twenty patients had a positive NPT by decreases of PNIF. The area under the ROC curve was 0.85 for symptom score changes and it was 0.612 for PNIF changes. There was a significant correlation between the wheal size of the SPT and symptom changes in the NPT. Conclusion Nasal provocation is a valuable test to confirm the diagnosis of D. pteronyssinus allergy, especially when the wheal from the SPT is small. The symptom change after the house-dust mite NPT is better than the PNIF change for predicting the PAR.
Surgical masks and N95 filtering facepiece respirators (FFRs) prevent the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and protect medical personnel. Increased demands for surgical masks and N95 FFRs during the coronavirus disease 2019 (COVID-19) pandemic has resulted in the shortage crisis. However, there is no standard protocol for safe reuse of the N95 FFRs. In this systematic review, we aimed to evaluate the effectiveness of existing decontamination methods of surgical masks and N95 FFRs and provide evidence-based recommendations for selecting an appropriate decontamination method.
Clinicians rely on clinical presentations to select therapeutic agents for acute bacterial rhinosinusitis. Streptococcus pneumoniae and Haemophilus influenzae are common in acute bacterial rhinosinusitis. Drug resistant Streptococcus pneumoniae and Haemophilus influenzae require different antibiotics.This study aimed to evaluate the associations between clinical features of acute bacterial rhinosinusitis and pathogenic bacteria.Sixty-four patients with acute bacterial rhinosinusitis were enrolled. Clinical features including nasal obstruction, discolored discharge, facial pain, smell disturbance, fever and laboratory findings of patients with acute bacterial rhinosinusitis were collected. The bacterial cultures of endoscopic middle meatal swabs were used as a reference.Serum C-reactive protein level elevation correlated with the bacterial species (p=0.03), by which was increased in 80.0% of Haemophilus influenzae rhinosinusitis and 57.1% of Streptococcus pneumoniae rhinosinusitis. The elevated C-reactive protein was the significant predictor for Haemophilus influenzae rhinosinusitis with the Odds Ratio of 18.06 (95% CI 2.36-138.20). The sensitivity of serum C-reactive protein level elevation for diagnosing Haemophilus influenzae rhinosinusitis was 0.80 (95% CI 0.49-0.94).Elevation of serum C-reactive protein level was associated with and predicted acute bacterial rhinosinusitis caused by Haemophilus influenzae.
The peak nasal inspiratory flow (PNIF) is used as an outcome measure in post-treatment clinical and research evaluation. It is simple and cost effective. The validity of the use as a screening tool has never been assessedTo assess its validity and to define the cut-off point of determining the nasal obstructionThe nasal patency of 141 ambulatory subjects with or without sino-nasal diseases was measured by the PNIF and active anterior rhinomanometry. Inclusion criteria was all subjects aged 18 to 75-years-old, sinonasal diseases/ symptoms(nasal congestion, nasal discharge, nasal polyp, deviated nasal septum, nasal tumor inferior turbinate hypertrophy, sinusitis, and allergic rhinitis), instant sensation of nasal obstruction, and nasal endoscopy finding were recorded. All subjects signed written consent. Compared with the active anterior rhinomanometry as the gold standard, the sensitivity, specificity, likelihood ratio, positive predictive value, and negative predictive value of the PNIF was analyzed. The cut-off point of nasal obstruction was defined from the Receiver Operating Characteristic curve analysis. The agreement between the PNIF and the stuffiness and between the PNIF and the presence of sino-nasal diseases were assessed by using Kappa.With the cut-off point of 90 L/min, the sensitivity of the peak nasal inspiratory flow was 0.87 (0.753-0.989). The specificity was 0.52 (0.429-0.617). The negative predictive value was 0.93 (0.872-0.997). The positive predictive value was 0.34 (0.237-0.446). The likelihood ratio was 1.81 (1.438-2.318). The mean of the PNIF in normal subjects was 97.11 +/- 31.15. The agreement between the PNIF and the instant sensation of nasal blockage was 0.14 (-0.024-0.321) and the agreement between the PNIF and the sino-nasal diseases was 0.09 (-0.083-0.265).The PNIF regarding the cut-off point of 90 L/min, revealed good sensitivity and high negative predictive value but it had low specificity and low positive predictive value. The nasal peak flow did not agree well with the subjects' symptoms of blockage and sino-nasal diseases.
There is controversy of creating the drainage lumen in endoscopic sinus surgery for diffuse nasal polyposis.To compare the patency rate of drainage lumen between large middle meatal antrostomy and undisturbed maxillary ostium in endoscopic sinus surgery for nasal polyposis.Department of Otolaryngology, King Chulalongkorn Memorial Hospital.Randomized double-blind control trial.Patients diagnosed at the King Chulalongorn hospital who had chronic maxillary sinusitis developed by nasal polyposis.Sixty patients who had similar degree of bilateral nasal polyps and chronic maxillary sinusitis were enrolled. The sides of which each surgical technique would be applied were randomized by simple randomization. The patients did not know which treatment technique was applied to which side of the nose. The evaluator evaluated the objective endoscopic examination from the recorded videotape of each side separately at the third month till one year after surgery without notifying the patients.The patency rate of a large middle meatal antrostomy was 71.7 per cent-85 per cent compared to 61.7 per cent-65 per cent of the undisturbed maxillary ostium. There was a statistically significant difference only in early phase evaluation between the two surgical techniques (p-value = 0.002). Thirty-six of 60 cases (60%) had good results with adequate drainage lumens, no infection and no recurrent polyps at the final evaluation. Early and small nasal polyps (grade I polyp) was the main correlation factor to the success of endoscopic sinus surgery for nasal polyposis (p-value = 0.017). The occlusion of the drainage system after surgery was mainly from recurrent polyps.The large middle antrostomy group had a better statistically significant patency rate than undisturbed maxillary ostium only in the early phase after surgery. Recurrent polyp was the main cause of stenosis. Early surgical intervention of the small nasal polyposis had a better result compared to large diffuse nasal polyps.
BACKGROUND: Low-dose macrolides (LDM) are anti-inflammatory agents with antineutrophilic activity, but patient selection for LDM therapy in treating chronic rhinosinusitis (CRS) is controversial. This study aimed to assess factors which predict LDM responders. METHODOLOGY: A prospective cohort study was performed. Patients with CRS received roxithromycin (150 mg) once daily for 12 weeks. Nasal secretions and serology were collected. Nine predictors for LDM response were assessed: nasal secretion IgE, nasal secretion IL-5, serum IgE, serum eosinophils, serum neutrophils, nasal polyps, asthma, allergy, and aspirin hypersensitivity, using receiver-operating curve analysis and multivariable logistic regression. Macrolide responders were those with sino-nasal outcome test-22 improvement, symptoms visual analogue scale decreased to ≤5, and no rescue medication. RESULTS: One hundred CRS patients (mean age 47.4±14.1 years, 45% male) were enrolled. Univariable logistic regression showed local total IgE less than 5.21; and serum eosinophils less than 2.2% associated with macrolide response. Multivariate models showed local total IgE maintained an independent association with macrolide response, with an ability to discriminate between responders and non-responders of 63%. Serum total IgE, nasal secretion IL-5, serum neutrophil, nasal polyp, asthma, allergy, and aspirin hypersensitivity showed no association with LDM response. CONCLUSIONS: Low total IgE level in the nasal secretion but not in the serum, predict LDM response.
Abstract Introduction: Clinicians rely on clinical presentations to select therapeutic agents for acute bacterial rhinosinusitis. Streptococcus pneumoniae and Haemophilus influenzae are common in acute bacterial rhinosinusitis. Drug resistant Streptococcus pneumoniae and Haemophilus influenzae require different antibiotics. Objective: This study aimed to evaluate the associations between clinical features of acute bacterial rhinosinusitis and pathogenic bacteria. Methods: Sixty-four patients with acute bacterial rhinosinusitis were enrolled. Clinical features including nasal obstruction, discolored discharge, facial pain, smell disturbance, fever and laboratory findings of patients with acute bacterial rhinosinusitis were collected. The bacterial cultures of endoscopic middle meatal swabs were used as a reference. Results: Serum C-reactive protein level elevation correlated with the bacterial species (p = 0.03), by which was increased in 80.0% of Haemophilus influenzae rhinosinusitis and 57.1% of Streptococcus pneumoniae rhinosinusitis. The elevated C-reactive protein was the significant predictor for Haemophilus influenzae rhinosinusitis with the Odds Ratio of 18.06 (95% CI 2.36-138.20). The sensitivity of serum C-reactive protein level elevation for diagnosing Haemophilus influenzae rhinosinusitis was 0.80 (95% CI 0.49-0.94). Conclusion: Elevation of serum C-reactive protein level was associated with and predicted acute bacterial rhinosinusitis caused by Haemophilus influenzae.
Objective: To compare the accuracy of Limited CT with the Full CT as the standard evaluation for inflammatory disease of PNS and the identification of anatomical variations. Methods: From Full CT of PNS, Limited CT were retrieved. Computerized tomographic scans were performed for the preoperative planning of endoscopic sinus surgery (ESS) in 3 tertiary care university hospitals in Thailand. The two types of examinations were reviewed independently and in random order by two experienced radiologists. Using Full CT as the standard, the accuracy of Limited CT were evaluated for 1) the radiologic staging of rhinosinusitis (Lund-Mckay scoring system) and 2) the anatomic variations which are an important landmark for surgical operations in rhinosinusitis. Results: Totally 132 patients were included. Two hundred and sixty four half-faces were reviewed. Lund-McKay radiographic sinus staging system showed 97-99% specificity except for the ostiomeatal complex region. Regarding anatomic variation, Limited CT was able to yield accurate results for the frontal cell type II-IV, Haller cell, Agger nasi cell, paradoxical middle turbinate, concha bullosa and the protrusion of the optic nerve. Conclusion: Limited CT can be used as a surgical roadmap for the cases with the anterior group of sinus involvement. It may be utilized for surgical planning of chronic CRS involving the anterior group of sinuses. For the posterior group of sinuses, it may not yield enough accuracy and the standard Full CT should be requested to prevent erroneous estimation.
In perennial allergic rhinitis (PAR), the skin-prick test (SPT) is a good diagnostic tool to identify the specific allergens. A nasal provocation test (NPT) is used to identify allergens and to confirm the diagnosis. The aim of this study was to determine the optimal cutoff values of symptom and peak nasal inspiratory flow (PNIF) changes after dust-mite NPT for predicting PAR. We also studied the relationship of the changes of symptoms in NPT and the wheal size of SPT.One hundred five patients with perennial rhinitis underwent the NPT to Dermatophagoides pteronyssinus and the SPT. The NPT was assessed by changes in symptoms and PNIF. The optimal cutoff values of the symptoms score and PNIF changes after the NPT for predicting the SPT were determined using a receiver operating characteristic (ROC) curve. The relationship of the wheal sizes of SPT and the changes from the NPT were analyzed.Forty-eight patients had a positive SPT to D. pteronyssinus, of whom 33 patients had a positive NPT by increases of the symptom score. Twenty patients had a positive NPT by decreases of PNIF. The area under the ROC curve was 0.85 for symptom score changes and it was 0.612 for PNIF changes. There was a significant correlation between the wheal size of the SPT and symptom changes in the NPT.Nasal provocation is a valuable test to confirm the diagnosis of D. pteronyssinus allergy, especially when the wheal from the SPT is small. The symptom change after the house-dust mite NPT is better than the PNIF change for predicting the PAR.
