bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Predictive Factors for Biofilms Presence in Chronic Rhinosinusitis with Polyps
Authors: Bezerra Thiago F. P. , Gebrim Eloisa Marie , De Rezende Pinna Fabio , del Melo Padua Francini Grecco , Saldiva Paulo , Voegels Richard L.
Published: September 2011

Objective

Evaluate predictive factors for the presence of biofilms during sinus surgery for chronic sinusitis with nasal polyps (CRSwP).

Method

Prospective study conducted in a tertiary care center in 2008 to 2009. Patients underwent sinus surgery for CRSwP, and mucosal samples were harvested for scanning electron microscopic. Preoperative data were recorded. Data were considered nonparametric. Mann‐Whitney test and Spearman rank correlation were used.

Results

Biofilms were present in 66.6 % (22/33) of the CRSwNP patients. Both groups had similar age median [Interquartile Range] = 45.0 [15.0] (38‐56) vs 46.5 [27.0] (22‐78) and the same sex distribution (male:female ratio = 1.75). Patients with biofilms had worst Lund‐Kennedy score (6.0[3.0] (3‐10) vs 8.0[3.0] (3‐11), U = 69.5, P =. 44). Although patients with biofilms had worst NOSE and Lund‐Mackay scores and best SNOT‐20 and SNOT‐20(5+) scores, those were not statistically different between groups. There was a strong correlation between preoperative NOSE and SNOT‐20 scores in both groups.

Conclusion

This study showed that biofilms were present in most patients with CRSwNP. Despite the fact that NOSE and Lund‐Mackay scores were worse in patients with biofilms, only Lund‐Kennedy scores shown a significant predictive value to find biofilms intraoperatively.
Atypical Mycobacterium Detection in Refractory Chronic Rhinosinusitis
Authors: Solyar Alla , Lee Annie S. , Lanza Donald C.
Published: September 2011

Objective

Atypical mycobacterium (AM) involvement in refractory chronic rhinosinusitis (CRS) is sought by some surgeons with customary acid‐fast bacilli cultures (AFBC) in the operating room (OR). We evaluate our experience with AM in CRS by describing: 1) associated risk factors, 2) species identified, and 3) frequency of positive cultures in clinic vs OR.

Method

AFBC taken between 2005 and 2010 were identified from microbiology laboratory databases. Charts were reviewed for gender, age, medical history, risk factors for AM, pathogen types, and treatments with statistical comparison using PearsonX2. Benefit of “targeted AFBC” for cases with high clinical suspicion was compared with “customary AFBC” in OR.

Results

Thirty‐one patients were identified with AM, of which 10 had one or more risk factors for AM, including foreign body (n = 4), non‐HIV immune dysfunction (n = 4), and previous chemo‐radiation (n = 4). Six different AM species were identified: most frequently M abscessus (50%), followed by M avium‐intracellulare complex (20%) and M chelonae (17%). “Targeted AFBC” from outpatient setting were positive in 10 out of 190 (5.3%), whereas 10 out of 393 (2.5%) of “customary AFBC” in OR were positive (P =. 09). Macrolide therapy was employed in 16 out of 31 (52%) patients with AM‐associated CRS but was not prescribed in patients with positive “customary AFBC” alone.

Conclusion

AM‐associated CRS is an uncommon condition that can occur in the absence of foreign body or overtly altered innate/adaptive immunity. Management with macrolide therapy, as well as the potential relationships between existence of AM in tap water, AM biofilms, and frequent nasal irrigations, warrant further investigation in refractory CRS.
Case Series with Endoscopic Findings of a Novel Nasal Irrigation Protocol for Refractory Chronic Rhinosinusitis
Authors: Mehra Saral , Chandler Michael , Prasad Mukesh
Published: September 2011

Objective

Present an innovative treatment protocol for refractory chronic rhinosinusitis (CRS) in order for practitioners to 1) learn of a new topical treatment regimen, 2) be able to apply this protocol to their own patients, and 3) understand the proposed mechanism of its action.

Method

Case series of 20 patients with refractory CRS treated with a novel topical sinus regimen that included diluted baby shampoo between June 2009 and June 2010 with analysis of patient, disease, and treatment characteristics. Treatment endpoints include subjective improvement of nasal symptoms and objective improvements on nasal endoscopy.

Results

Our novel treatment protocol involves gentamicin 20 mg per 240 mL (8 ounces), Johnson’s Baby Shampoo 1 drop per 240 mL, and pulmicort respules 1 mg per 240 mL. Patients are advised to use 120 mL via a 240 mL squeeze bottle. We then remove the gentamicin, pulmicort, or both, and track patient progress based on symptomatic improvement and improvements seen on nasal endoscopy. All patients had positive response using this treatment protocol after failed medical and surgical management with a variety of other topical and systemic therapies. Two notable cases are presented with endonasal photos to illustrate the positive response achieved using this treatment protocol.

Conclusion

This novel sinus irrigation treatment protocol is effective in the treatment of CRS as documented by subjective improvements in nasal symptoms as well as significant improvement in nasal endoscopic findings. This protocol is well tolerated by patients and should be considered by otolaryngologists and allergists treating refractory CRS.
CFTR Modulation by the Tobacco Smoke Toxin Acrolein
Authors: Alexander Nathan S. , Skinner Daniel , Sorscher Eric , Zhang Shaoyan , Woodworth Bradford A.
Published: September 2011

Objective

Tobacco‐smoke exposure inhibits transepithelial Cl‐secretion—a major determinant of airway surface liquid hydration and mucociliary clearance (MCC). The objective of the current study was to evaluate the effects of acrolein exposure (a tobacco smoke toxin) on Cl‐transport through the major apical anion channel CFTR in sinonasal epithelium.

Method

Primary murine nasal septal (MNSE, wild type, and transgenic CFTR‐/‐) and human sinonasal epithelial (HSNE) cultures were exposed to acrolein in Ussing chambers, and effects on Cl‐secretion were investigated using pharmacologic manipulation. Cellular cAMP signaling and cytotoxicity were also investigated.

Results

Acrolein‐stimulated Cl‐secretion (ΔISC ‐ change in short‐circuit current in µA/cm2) at low concentrations (100 µM, 15.8 ± 2.2 vs 2.4 ± 0.8 (control); p‐transport at 300 µM (13.3 ± 1.2 vs 19.9 ± 1.0; p‐secretion was solely reliant upon the presence of CFTR (confirmed in transgenic CFTR ‐/‐ MNSE), but independent of cAMP signaling. Inhibition at higher concentrations was not secondary to cellular cytotoxicity, indicating direct effects on the CFTR.

Conclusion

Decreased MCC is a major contributing feature to chronic rhinosinusitis. The present study demonstrated that acrolein has complex but direct interactions with CFTR. Robust inhibition of Cl‐transport at higher concentrations indicates the potential contribution of this toxin to decreased MCC in individuals with chronic tobacco smoke exposure.
Chronic Facial Pain and Blood Serotonin: A Pilot Study
Authors: Agius Adrian M. , Muscsat Richard , Jones Nick
Published: September 2011

Objective

To study whole blood serotonin levels in patients with chronic mid‐facial segmental pain and to compare with normal matched controls. Peripheral blood serotonin is stored almost exclusively in platelets, which reflect intra‐neuronal serotonin. In chronic facial pain, low intraneuronal serotonin may cause dysfunction of descending serotonergic inhibition of nociceptive pathways.

Method

Thirty patients with chronic tension‐type facial pain according to International Headache Society criteria and 30 matched controls were studied. Patients were symptomatic for at least 3 months, had normal nasoendoscopy, and had normal CT sinuses/brain. Other causes of pain, such as facial migraine, trigeminal neuralgia, or TMJ dysfunction, were excluded.

Results

Patients with chronic facial pain tended to have normal peripheral blood serotonin levels. There was no significant difference in serotonin levels between patients and controls.

Conclusion

This study does not provide evidence of serotonergic dysfunction in chronic tension‐type facial pain. Dysfunction of other inhibitory descending pathways, such as noradrenergic pathways, may play a significant role in the development of chronic tension‐type facial pain.
Correlation of Clinical History and Physical Examination to Positive CT Findings for Nonpolypoid Paranasal Sinus Disease
Authors: Rassouli Alipasha , Al Rasheed Abdulaziz , Tewfik Marc A.
Published: September 2011

Objective

Chronic rhinosinusitis affects a significant portion of the population and is one of the most common reasons for otolaryngology visits. Computed tomography (CT) has become the main modality of investigation. Given the significant paucity in evidence, associated radiation exposure, and economic burden, clinical guidelines regarding CT investigation are needed.

Method

Prospective investigation correlating presenting symptoms and positive CT outcomes that affected subsequent management in 80 consecutive patients without nasal polyps. A questionnaire of paranasal sinus disease symptoms was completed prior to imaging, and findings from rigid nasendoscopy were recorded. CT sinuses were subsequently graded using the Lund‐Mackay scoring system.

Results

The symptom most closely correlated was facial pressure, and the symptom least correlated was postnasal drip. Positive predictive values of each of the symptoms assessed as well as physical findings will be detailed.

Conclusion

Clinical guidelines can play an important role in directing the radiologic investigation for paranasal sinus disease, decreasing radiation exposure, and economic burden on healthcare.
Effect of Berberine on Nasal Polyp‐derived Fibroblast
Authors: Park Il‐Ho , Choi Hyuk , Lee Heung‐Man , Kim Yong‐Dae
Published: September 2011

Objective

Berberine is a compound isolated from medicinal herbs such as coptidis rhizoma. Berberine has been reported with diverse pharmacological effects. Nasal polyps are a common chronic inflammatory disease of nasal mucosa. In this study, we investigated the effect of berberine on myofibroblast differentiation in nasal polyp‐derived fibroblast (NPDF).

Method

NPDFs were prepared with and without berberine before TGF‐beta1 treatment. The mRNA expressions of alpha‐SMA was determined by RT‐PCR. The expression of alpha‐SMA protein and Phosphorylation of Smad2/3, ERK, p38, JNK, c‐fos was determined by western blotting and or immunocytochemistry. The amount of total collagen production was analyzed by SirCol assay.

Results

We observed that berberine inhibited the expression of alpha‐SMA and total soluble collagen in a dose dependent manner. The TGF‐β1‐induced expression of pERK, p38, and AP‐1 were decreased by berberine.

Conclusion

Berberine abrogates TGF‐beta1‐induced myofibroblast differentiation by inhibition of Akt, MAPK phosphorylation, and AP‐1 activation. These findings offer a mechanism for the antifibrotic effects of berberine and a therapeutic point in the treatment for nasal polyps.
Effects of Total Intravenous Anesthesia vs Inhalational Anesthesia in Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Randomized Controlled Study
Authors: Gomez‐Rivera Fernando , Cattano Davide , Ramaswamy Uma , Citardi Martin , Fakhri Samer , Luong Amber , Man Li‐Xing
Published: September 2011

Objective

Compare anesthesia with sevoflurane/remifentanyl (SR) to total intravenous anesthesia with propofol/remifentanyl (PR) in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis in the following parameters: 1) effects on blood flow to the mucosa; 2) amount of blood loss; and 3) surgical field visualization score (SFS).

Method

A total of 23 adults undergoing endoscopic sinus surgery for chronic rhinosinusitis within a 6‐month period were randomized to receive SR or PR. The SFS was based on the Boezaart scale. Sinonasal mucosa blood flow was measured by optical rhinometry (OR). Blood loss was recovered with the Neptune Waste Management System.

Results

The groups were evenly distributed, with similar clinical characteristics and Lund‐Mackay score. Median blood loss was 105 cc in the PR group and 180 cc in the SR group (P =. 15). The length of surgery was 134 minutes in the PR group and 177 minutes in the SR group (P =. 19). The average SFS was 1.6 in the PR group and 2.0 in the SR group (P =. 22). OR showed a decrease in blood flow to ‐0.1 OR units from the beginning of surgery in the PR group compared with ‐0.4 OR units in the SR group (P =. 02).

Conclusion

Our preliminary results suggest that PR appears to be associated clinically to a decreased blood loss, improved surgical field visualization, and decreased operative time in endoscopic sinus surgery. We showed however that blood flow to the nasal cavity appears to be increased with TIVA.
Endoscopic DCR in Children
Authors: de Souza Chris , Nisar Jayesh
Published: September 2011

Objective

Evaluation of results of endoscopic DCR in children.

Method

A total of 39 children (aged 5‐14 years) had undergone first time endoscopic DCR. A total of 37 had undergone removal of the medial wall of the lacrimal sac. Two children with lacrimal sac fistula on the face had undergone stenting. Parameters of success: No epiphora, patency of neofistula, and no attacks of dacryocystitis.

Results

A total of 37 children who had undergone endoscopic DCR had large lacrimal sacs (LS) and had undergone removal of the medial wall of the LS. Of these, 34 experienced success. Three patients got blocked within 2 weeks and refused revision surgery. Two patients had undergone stenting, as they had fistulae on the face over the LS. Stents were removed for both after 2 months after the fistula healed. But both got blocked again and refused revision surgery.

Conclusion

Endoscopic DCR is a safe procedure in children and is associated with a high degree of success. Fistulae over the lacrimal sac would indicate that stenting is necessary and should not be removed if the sac is to be patent.
Endoscopic Hypophysectomy
Authors: Papaspyrou Spyros , Sakkas Damianos , Siggounas Evangelos , Stranjalis George
Published: September 2011

Objective

Endoscopic endonasal hypophysectomy constitutes a challenge and an opportunity for the otolaryngologist. In the past 15 years, 246 hypophysectomies have been performed in cooperation with the neurosurgical department of our hospital.

Method

For the first 182 hypophysectomies a sublabial approach was performed with the use of a microscope. Subsequently, 22 hypophysectomies were performed with a combined approach (sublabial microscope‐endoscope assisted). Lastly, for the most recent 42 hypophysectomies, an endonasal endoscopic 4‐hands technique was applied.

Results

With all 3 techniques, the success rate did not significantly differ. Complication rate (hemorrhage, cerebrospinal fluid leak) was significantly lower in the endoscopic technique. Hospital stay was also significantly lower in the endoscopic technique.

Conclusion

The advantages of endoscopic approach are: less traumatic, faster, panoramic view, angle‐view with the use of different endoscopes, and possibility to explore the sella for residual tumor at the end of operation. Its disadvantages are the lack of three‐dimensional view and the need for an assistant to hold the endoscope.
Endoscopic Management of Meningiomas
Authors: Naidoo Yuresh , Padhye Vikram , Wormald Peter J.
Published: September 2011

Objective

Evaluate the management of meningiomas surgically resected via an endoscopic transnasal approach by the South Australian Endoscopic Skull Base Unit in South Australia since 2004. The safety and efficacy of the procedure and areas for further refinement and improvement are analyzed.

Method

Retrospective case series of 16 consecutive patients who underwent endoscopic transnasal resection of anterior skull base meningiomas in South Australia between 2004 and 2010.

Results

Preoperative symptoms, tumor size, tumor location, intraoperative time, intraoperative complications, defect closure techniques, postoperative complications, and length of hospital stay were assessed and compared. The results achieved by this unit are comparable with the published literature.

Conclusion

Anterior cranial fossa meningiomas can be safely removed endonasally and offer significant advantages over the traditional transcranial approach.
Endoscopic Surgery for Fronto‐Ethmoidal Mucoceles: A Fifteen Year Experience
Authors: Dhepnorrarat Rataphol Chris , Subramaniam Somasundaram , Sethi Dharambir Singh
Published: September 2011

Objective

1) Understand the factors affecting outcomes in surgery for fronto‐ethmoidal mucocoeles (FEM). 2) Add to the senior author’s experience to the existing literature regarding the management of FEM.

Method

A retrospective study of patients treated by the senior author from 1995 to 2010 was undertaken. A patient database was used to identify those who had endoscopic surgery for FEM. Patient notes and operative records were reviewed and assessed for variables that may affect outcome after surgery.

Results

A total of 40 patients underwent 44 endoscopic procedures for treatment of FEM. The mean age was 46.3 years, and mean follow‐up time was 74.9 months. Two patients (5%) had head trauma as an etiological factor. A total of 28 Draf IIa procedures, 13 Draf IIb, and 3 Draf III procedures were performed. Three patients had surgery combined with open approaches. Two patients had bilateral surgery, and 2 patients required revision surgery: one for restenosis after a Draf IIa procedure (1/28) and one for disease recurrence. Stenosis was found in a further 3 patients who had Draf IIb surgery (3/13).

Conclusion

The current series represents one of the largest for the endoscopic management of FEM. Endoscopic approaches are suitable for all but the most lateral of mucocoeles. The most common complication, restenosis of the frontal recess, was more likely following Draf IIb procedures (23%) than Draf IIa (3.6%) procedures.
Endoscopic vs Transfacial Removal of Sinusal Adenocarcinoma
Authors: Vergez Sebastien , Decotte Anne , Lepage Benoit , De Bonnecaze Guillaume , Martin‐Dupont Nathalie , Serrano Elie
Published: September 2011

Objective

Compare the overall survival, recurrence‐free survival, and complication rates between 2 comparable groups of patients operated by an endoscopic or a transfacial resection of a sinonasal adenocarcinoma.

Method

A first group of 24 patients with a sinonasal adenocarcinoma recently operated endoscopically (« ENDO », 1999‐2009) is compared to another group of 24 patients operated anteriorly by a transfacial approach (lateral rhinotomy “LR” 1993‐2007). In this retrospective study, we included patients who would have had in 2010 an endoscopic resection.

Results

Groups were comparable in terms of age and sex (P =. 49) and tumoral stages with 13T1‐T2/11T3‐T4 in the group ENDO and 12T1‐T2/12T3‐T4 in the group LR (P =. 77). a total of 43 out of 48 patients have had a postoperative radiation therapy. The mean follow‐up was respectively of 27 and 82 months for the groups ENDO and LR. After 27 months, the overall survival curves were not significantly different. The recurrence‐free rates were equally similar in both groups (P =. 71). The median duration of hospitalization was significantly shorter in the ENDO group (4 vs 8 days, P <. 0001). The rate of early complications was strictly identical in both groups (3/24).

Conclusion

The endoscopic approach is an effective treatment in selected cases of sinonasal adenocarcinomas. Early oncological outcome and morbidity are comparable to a transfacial approach. Hospitalization was significantly reduced and skin scars avoided. This procedure is less invasive but requires an optimal preoperative imaging protocol and an experienced surgical team.
Epinastine Hydrochloride for Pediatric Allergic Rhinitis
Authors: Hara Hirotaka , Sugahara Kazuma , Hashimoto Makoto , Yamashita Hiroshi
Published: September 2011

Objective

1) Prospectively evaluate the effectiveness of epinastine hydrochloride (EH) for pediatric outpatients with sleep‐disordered breathing (SDB) symptoms caused by allergic rhinitis (AR); 2) Assess the quality of life (QOL) of those children prior to and following treatment with oral EH.

Method

Pediatric AR outpatients (19; boys, 9; girls, 10; average age, 5.6 years [SD = 1. 4]) with SDB symptoms were recruited. They were all treated with oral EH for 4 weeks. Before and after the 4‐week treatment period, the otolaryngological findings and OSA‐18 scores were collected for each participant.

Results

Epinastine hydrochloride significantly improved the swelling of the inferior nasal turbinate mucosa and decreased the quantity of nasal discharge. The initial total mean OSA‐18 score was 58.5, whereas the total score reduced to 22.8 after oral epinastine hydrochloride treatment.

Conclusion

Epinastine hydrochloride therapy demonstrated positive clinical effects on both nasal findings and the QOL of pediatric outpatients with symptoms of SDB caused by allergic rhinitis. Epinastine hydrochloride therapy may improve nasal findings and QOL in pediatric outpatients with SDB symptoms.
FESS Does Not Improve Lung Function in Cystic Fibrosis
Authors: Sajan Javad A. , Kempainen Robert , Rimell Frank L.
Published: September 2011

Objective

Functional endoscopic sinus surgery (FESS) provides symptomatic relief of sinus disease in patients with CF (cystic fibrosis), but it is unclear whether it has beneficial effects on lung disease in this population. This study assessed the effect of FESS on the respiratory status of adult CF patients.

Method

We performed a retrospective chart review at a tertiary medical center encompassing 32 adult CF patients who underwent 45 operative cases. Outcome measures were the effect of FESS on the rate of decline in lung function, intravenous antibiotic use, and hospitalization for pulmonary exacerbation.

Results

FESS was performed in 32 patients encompassing maxillary antrostomy, ethmoidectomy, frontal sinusotomy, sphenoidectomy, and polypectomy. The rate of decline in FEV1 and FVC were not significantly different in the 12 months before and after FESS. FESS did not reduce days hospitalized or days on intravenous antibiotics for a respiratory exacerbation in the pre‐ vs postoperative period. Limiting the analysis to the 30 surgeries that were performed in patients with concomitant respiratory symptoms did not significantly alter the results. Covariates of importance in CF, including CFTR genotype, gender, or microbiology, did not affect the study results.

Conclusion

FESS does not improve pulmonary status of adults with cystic fibrosis. These results suggest the routine use of FESS to address lung disease progression in CF patients may not be warranted.
Massive Flap Donor Sites and Vacuum‐Assisted Closure Devices
Authors: Skoner Judith Marie , Banks Caroline A. , Schmedes Gregg W.
Published: September 2011

Objective

Determine the effect of vacuum assisted closure (VAC) on massive scapular and latissimus dorsi free flap donor site morbidity, when used over a closed incision line under great tension.

Method

Patients who underwent complex head and neck reconstruction with scapular fasciocutaneous/osteocutaneous and latissimus dorsi myocutaneous free flaps between the years of 2006 and 2010 at a tertiary academic referral center were identified and a retrospective chart review was performed.

Results

Seventy patients who underwent scapular or latissimus dorsi free flap reconstruction were identified. Those with and those without VAC over the closed incision line were identified. The method of application of the VAC dressing was performed by the same team at one institution. None of these patients required skin grafting, and only 1 patient had donor site breakdown secondarily requiring wound care and VAC replacement and 1 patient had an asymptomatic seroma; all others with VAC treatment over the closed incision line were without donor site complications.

Conclusion

Vacuum‐assisted closure is a safe technique in the postoperative management of massive back free flap donor sites closed under great tension, and may eliminate the need for skin grafting. In our study, data suggests this approach decreases seroma formation and secondary wound breakdown.
Functional Endoscopic Sinus Surgery (FESS) Alone vs FESS and Balloon Sinuplasty: A Comparative Outcome Analysis in a Pediatric Population with Chronic Rhinosinusitis
Authors: Thottam Prasad John , Sirigiri Ranga R. , Madgy David N. , Haupert Michael S. , Saraiya Sonal , Belenky Walter M. , Dworkin James
Published: September 2011

Objective

Chronic rhinosinusitis (CRS) is a common disease afflicting children. For those affected, conventional FESS and balloon sinuplasty are surgical options for those refractory to medical management. Our objective was to evaluate whether the addition of balloon sinuplasty would improve the treatment outcome in children who undergo FESS for CRS.

Method

A 2‐group, retrospective blinded chart review comparing 11 pediatric patients who underwent balloon sinuplasty to 15 undergoing FESS from 2007 to 2010 at the Detroit Medical Center. Preoperative CT scans as well as pre‐ and postoperative sinus symptoms and medications were compared. All group data were compared using 1‐tailed independent t tests.

Results

Mean age at the time of procedure was 8.74 (SD = 4.2 years; range, 2‐19 years). Both groups had similar presurgical Lund‐Mackay CT CRS scores (FESS: mean = 9.33, SD = 4.7; Balloon: mean = 10.5, t = ‐.61, p =. 55). Analyses identified posttreatment differences in symptom reduction and needed intervention between the 2 groups. Postoperatively patients who underwent balloon sinuplasty reported fewer headaches (t = 2.51, P =. 01), less postnasal drip (t = 1.88, P =. 04), and reduced sinus congestion (t = 2.05, P =. 03). A comparison of the amount of topical steroidal/saline and antibiotic use identified a reduction in the amount of topicals used in children who received balloon treatment (t = 2.66, P =. 007) and a reduction of antibiotic use (t = 1.79, P =. 04).

Conclusion

Balloon sinuplasty directed at the frontal and maxillary sinuses resulted in better outcomes than those with traditional FESS techniques. Balloon sinuplasty patients had less sinus symptoms, required less antibiotics, and required less topical nasal steroids postoperatively. Preservation of the native anatomy in balloon sinuplasty may play a role in these findings.
Gene Expression of MMP‐1, MMP‐2, MMP‐9, and TIMP‐1 in Nasal Polyps
Authors: Anselmo‐Lima Wilma T. , da Silva Joao S. , Malinsky Rafael , Küpper Daniel , Tamashiro Edwin , Valera Fabiana
Published: September 2011

Objective

Edema in nasal polyps (NP) is related to extracellular matrix degeneration, which is regulated by MMPs (matrix metalloproteinases) and their inhibitor, TIMP. Several studies relate MMP and TIMP expression to airway inflammatory diseases. The purpose of this study was to evaluate which is MMP and TIMP expression in Brazilian NP.

Method

Thirty NPs were compared with 19 controls. MMP1, MMP2, MMP9, and TIMP1 mRNAs expression was evaluated by RQTPCR. Also, PCR results were correlated to extensiveness of disease. PCR data were analyzed through Student t test, and the correlation between PCR and clinical results was performed by Spearman test.

Results

NPs presented significantly higher expression of MMP‐1 (9.79 ± 12.62 for NP vs 1.38 ± 1.21 for middle turbinates, P vs 0.83 ± 0.61 for middle turbinates, P vs 90 ± 0.56 for middle turbinates, P <. 05). TIMP‐1 expression was detected neither in NP nor in middle turbinates. There was no correlation between clinical findings and gene expression.

Conclusion

Brazilian NP presented higher expression of all the 3 studied MMPs (MMP1, MMP2, and MMP9), but not of TIMP1. This pattern is very similar to that observed for NP in the literature. There is no correlation between gene expression and extensiveness of the disease.
Gene Transfer in Respiratory Epithelium Using Synthetic Vectors and Folic Acid Receptor
Authors: Mornet Emmanuel , Lacroix Candice , Potard Gael , Montier Tristan , Gauvin Yves , Marianowski Remi
Published: September 2011

Objective

Synthetic vectors may be an interesting alternative way compared with viral vectors. They are potentially less toxic and immunogenic. However, synthetic vectors use an aspecific electrostatic recognition. Cellular targeting is one of the major conditions for development of efficient synthetic vectors for gene therapy.

Method

A neutral colipid derived from archaebacteria with acid folic ligand was developed and associated with cationic lipid vector. Its efficiency was tested on human respiratory epithelium cell culture.

Results

Safe respiratory epithelium offer few targets for gene transfer. Indeed, using lectin for specific gene transfer is difficult because of numerous different oligosaccharides patterns. We studied the interest of folic acid receptor as a target for gene transfer. These receptors are sparsely represented on this epithelium but have a great affinity. We demonstrated a specific gene transfer using a competitive inhibition by free folic acid in media. For a healthy human respiratory cell line, this new vector is more efficient and less toxic than lipofectamin.

Conclusion

Despite a small presence on human respiratory epithelium, folic acid receptor is a pertinent target for nonviral gene transfer. This vector is to be tested on animals. Such a targeting will increase gene transfer because of low electrostatic disturbance. Neutral vector may decrease toxicity.
Identifying a Surgical Threshold for Recurrent Rhinosinusitis: A Productivity Based Health Economics Model
Authors: Leung Randy , Tan Bruce , Conley David , Chandra Rakesh K. , Kern Robert
Published: September 2011

Objective

The management of recurrent acute bacterial rhinosinusitis (RARS) remains a controversial subject. Distinguishing RARS from viral upper respiratory infection (URI) is difficult, and when to consider surgery is unclear. This study seeks to identify a threshold number of infections where the benefit of surgery balances the lost productivity from RARS.

Method

An economic model was constructed using literature‐reported medical and surgical response rates, as well as measures of quality of life and productivity. This data was utilized to estimate event frequency thresholds for which surgery would be beneficial.

Results

Time lost for the perioperative period balances out lost productivity from RARS exacerbations when patients suffer from 6 episodes/year (range, 2.9‐16.8) or 3 episodes/year (range, 1.5‐8.4) over 2 years, or 2 episodes per year (range, 1‐5.6) over 3 years. Because of possible confusion with URIs, we propose an approach similar to that adopted by the Rhinosinusitis Task Force. The average number of viral URIs suffered by adults annually is approximately 2 (1.4‐2.3). Thus, we suggest adding 2 to the above calculated thresholds, prior to considering surgery.

Conclusion

In terms of lost productivity, surgery should be considered when patients suffer from 8, 5, or 4 RARS episodes per year for the past 1, 2, or 3 years, respectively. Discussion with the patient must include a rational consideration of the burden of disease and overall patient quality of life.
Impact of Nasal Drug Delivery System on Mucociliary Clearance
Authors: Schuschnig Uwe , Khadem‐Saba Gülnaz , Häussinger Karl , Canis Martin , Becker Sven , Keller Manfred , Möller Winfried
Published: September 2011

Objective

Aerosolized drugs are predominantly delivered by nasal sprays, but they target the anterior nose only, and the administered drug is rapidly cleared. Studies with pulsating aerosols showed improved sinonasal deposition. This study compared clearance kinetics and cumulative dose after nasal spray and pulsating aerosol delivery.

Method

Open label deposition study in 15 healthy volunteers using radiolabeled pulsating aerosols generated by a Vibrent nebulizer in comparison to nasal pump sprays. Nasal deposition and retention was assessed by gamma camera imaging at various time intervals over 24‐hours in the entire nose and in specified ROIs.

Results

Nasal pump spray vs pulsating aerosol application resulted in a nasal deposition of 100% vs 70 ± 16%.

Conclusion

As found in earlier studies, nasal clearance of pulsating aerosols is significantly retarded compared with nasal sprays, causing prolonged drug residence time in the nose. Our data suggest that this effect may be related to the small droplet size and pulsations rather than deposition in certain nasal regions.
Molecular Basis of Tobacco Induced Bacterial Biofilms
Authors: Antunes Marcelo B. , Zhu Jun , Goldstein Natalia , Liu Zhi , Palmer James , Cohen Noam A.
Published: September 2011

Objective

Tobacco smoke exposure has been correlated to recalcitrant chronic rhinosinustis. Prior work has demonstrated tobacco smoke mediated sinonasal biofilm formation. Thus our objectives were: 1) Construct a series of reporter constructs for pseudomonas biofilm forming genes. 2) Determine which biofilm forming genes are regulated by tobacco smoke.

Method

Promoter regions of 6 genes involved in pseudomonas biofilm formation (LasI, LasR, RhlA, PilF, FlgK, and AlgC) were subcloned into the luciferase reporter plasmid pMini‐CTX‐Lux. Subcloning was confirmed with PCR with subsequent conjugation into Pseudomonas (PAO1). Each subclone was then challenged with serial tobacco smoke exposure and luciferase activity quantified.

Results

Elevated levels of luminescence, indicating specific promoter activation was identified after daily tobacco‐smoke exposure in the LasI, PilF, FlgK, and AlgC genes. The promoter activation of these genes was significantly elevated (P <. 05) after 2 consecutive exposures with no additional activation following a third exposure (Kruskall‐Wallis non‐parametric test). The level of promoter activation of the LasB gene was not affected by tobacco smoke exposure, while the RhlA gene decreased progressively by daily exposure.

Conclusion

Utilizing the luciferase reporter construct mLuxI we demonstrate activation of several key biofilm forming genes by exposure to tobacco smoke. This confirms our prior finding that tobacco smoke induces biofilms in sinonasal microbes. Interestingly, not all biofilm pathways interrogated demonstrated activation, suggesting unique tobacco mediated biofilm forming pathways in pseudomonas.
Molecular Signatures as a New Classification Scheme for CRS
Authors: Al‐Mot Sawsan , Filali‐Mouhim Ali , Rousseau Simon , Tardif Valerie , Berthiaume Yves , Desrosiers Martin Y. , Mfuna‐Endam Leandra
Published: September 2011

Objective

We have identified 2 distinct gene expression patterns (CRS1 and CRS2) in cultured epithelial cells obtained from surgical biopsies in CRS patients with and without nasal polyps (NP), which may better classify this disorder. We wished to compare the cellular infiltrate in CRS when assessed by molecular and clinical phenotypes.

Method

Surgical biopsies taken from 20 CRS patients and 10 controls were divided according to their molecular signature as determined from epithelial cell cultures. Immunohistochemistry (IHC) for neutrophil elastase (NE) and major basic protein (MBP) was used to identify neutrophils and eosinophils in the epithelial and submucosal areas.

Results

Groups were analyzed statistically using ANOVA and t test to identify significant differences between groups. When biopsies were assessed as function of the clinical phenotypes of CRSwNP compared with CRSsNP, while there were equal increases in the number of eosinophils and neutrophils cells in CRS patients compared with the control subjects, there was no difference between the win and sNP groups. However, when assessed according to molecular signature, while there was an increase in eosinophils in both groups, a significant increase in the number of neutrophils was only seen in the CRS2 group, suggesting a different pathogenic mechanism.

Conclusion

This novel expression signature identifies a molecular phenotype of CRS that is characterized by a marked neutrophil infiltration. Assessments of disease mechanism and response to therapy according to molecular, as opposed to clinical, phenotype may identify mechanistic differences which “personalize” our management of individuals with this disease.
NovaGen Reduces Adhesions In Vitro and in 2 In Vivo Models
Authors: Das Subinoy , Medina Jennifer G. , Steinke John W.
Published: September 2011

Objective

Adhesion formation is a negative outcome of sinus surgery and common cause for revision surgery. Chitosan has been approved by the Food and Drug Administration for use in hemorrhage control. We hypothesized that a chitosan‐based compound may be beneficial in sinus surgery for reduction in adhesion formation.

Method

NovaGen, a sprayable‐gel formulation consisting of chitosan and starch derivatives was developed. To support a premarket submission to the FDA of a medical device, we examined efficacy of adhesion reduction by NovaGen in vitro, in an experimental rabbit peritoneal adhesion model and an experimental sheep sinus adhesion model.

Results

In an experimental wound migration model of cultured human fibroblasts, NovaGen led to significant inhibition of fibroblast migration at 24.

Conclusion

NovaGen, a novel, chitosan‐based compound, reduced cultured human fibroblast migration, reduced adhesions by 75% in a rabbit model, reduced adhesions by 70% in a sheep sinus adhesion model, and demonstrated no discernible side effects. These data support NovaGen’s novel use in human sinus surgery for hemostasis and reduction in adhesion formation.
Ophthalmic Manifestations of PNS Disease: A Grading System
Authors: Al Dousary Surayie H. , Al Anazy Fatma H.
Published: September 2011

Objective

The most currently used grading system for the orbital inflammatory complications secondary to sinusitis (Chandler classifications) does not cover the most common ophthalmic manifestations of the paranasal sinus diseases, allergic fungal sinusitis and chronic paranasal sinus disease. We propose a clinical grading system that encompasses (inflammatory and non‐inflammatory).

Method

Thirty patients with ophthalmic manifestations due to paranasal sinus disease were graded according to the following: anatomic disturbance like proptosis (grade I); mild functional involvement in the form of epiphora, ophthalmoplegia, diplopia, ptoses (grade II); orbital infection (grade III); and visual impairment with or without orbital infection (grade IV).

Results

The ages ranged from 8 to 65 years with a mean of 30 years. Fifteen patients had orbital proptosis (grade I); 10 bilateral and 5 unilateral. Eleven patients had mild functional disturbance (grade II); 5 had epiphora, 3 had diplopia, and 2 had ptosis. Eight patients had orbital infection (grade III), and 5 patients had a visual loss (grade IV); 2 with orbital infection and 3 with mucocele and allergic fungal sinusitis. The main cause of the ophthalmic manifestation is allergic fungal sinusitis followed by chronic rhinosinusitis. The urgency of the surgical intervention is proportional to the grade degree.

Conclusion

This clinical grading system categorizes the ophthalmic manifestations due to paranasal sinus diseases; inflammatory and non‐inflammatory pathology. The higher the grade of ophthalmic involvement the more urgent the need of surgical intervention. Allergic fungal sinusitis is the most common cause followed by chronic rhinosinusitis, with a ratio of 2:1.
Preoperative Planning Using 3D Reconstructions and Virtual Endoscopy for Location of the Frontal Sinus
Authors: Nogueira Joao‐Flavio , Cruz Daniel N.
Published: September 2011

Objective

Demonstrate the production of 3D reconstructions from CTs of patients and compare them to the surgery’s actual endoscopic images.

Method

Prospective study. The CTs files of 10 patients were reconstructed with a specific program. The reconstructions were performed before the surgeries, and a virtual endoscopy was made. The actual endoscopic images of the recess and frontal sinus region were compared to the virtual images.

Results

The 3D reconstruction and virtual endoscopy were made in 10 patients submitted to the surgery. The virtual images had a large resemblance with the actual surgical images.

Conclusion

With relatively simple tools and a personal computer, we demonstrated the possibility to generate 3D reconstructions and virtual endoscopies.
Biofilm Presence vs Postoperative Outcomes in Chronic Rhinosinusitis with Polyps
Authors: Bezerra Thiago F. P. , Gebrim Eloisa M. , De Rezende Pinna Fabio , del Melo Padua Francini G. , Saldiva Paulo , Voegels Richard L.
Published: September 2011

Objective

Evaluate the role of biofilms on sinus surgery outcomes of patients with chronic rhinosinusitis with nasal polyps (CRSwP).

Method

Prospective study conducted in a tertiary care center among 2008‐10. Patients underwent sinus surgery for CRSwNP, and mucosal samples were harvested for scanning electron microscopic. Preoperative and postoperative (followed up to 12 months) data were recorded. Data were considered nonparametric. Mann‐Whitney test and Spearman rank correlation were used.

Results

This was the first report to analyze the effect of biofilms only in patients with CRSwNP. Biofilms were present in 67.9 % (19/28) of the CRSwNP patients. Both groups had similar age median (Interquartile‐Range = 45.0[15.0] vs 46.5[27.0]). Patients with biofilms had better Lund‐Kennedy outcome (‐3[5] vs ‐1[2], U = 46.0, P =. 036). These patients had worst outcomes in SNOT‐20 (‐0.75[1.15] vs ‐1.30[1.32], U = 69.0, P =. 21) and similar outcomes in NOSE (‐55.0[50.0] vs ‐60.0[50.0], U = 81.0, P =. 67) and Lund‐Mackay (‐4[5] vs ‐4[4], U = 75.5, P =. 49). There was a correlation among QoL outcome scores in both groups, and between NOSE and Lund‐Mackay outcomes scores in the biofilms group. (Spearman’s rank).

Conclusion

This study showed that biofilms were present in most patients with CRSwNP, and these patients have less improvement of QoL. Moreover, the best endoscopic improvement may reflect a worse clinical preoperative status. Although CRSwNP is not caused by biofilms, it could act as an aggravating factor to the clinical picture of these patients.
Revision Endoscopic Dacryocystorhinostomy
Authors: de Souza Chris , Nisar Jayesh
Published: September 2011

Objective

Evaluate results following revision of failed endoscopic dacryocystorhinostomy (DCR).

Method

A total of 422 patients underwent endoscopic DCR unsuccessfully. Of these, 177 underwent revision endoscopic DCR. A total of 167 patients underwent removal of the medial wall of the lacrimal sac. Ten had silastic stents inserted. Parameters of success were resolution of epiphora, no further attacks of dacryocystitis, and patency of neofistula.

Results

Of the 167 patients undergoing removal of the medial wall of the lacrimal sac, 121 patients were patent following surgery. The remaining 46 got blocked again within 10 days of surgery. A total of 31 underwent a third surgery and were patent. Fifteen were lost to follow‐up. Ten patients were found to have an atrophic lacrimal sac, required stenting, and were patent. None of the patients undergoing revision DCR had the medial wall of the lacrimal sac removed in the previous surgery. The procedures done on these patients previously were exposure of the lacrimal sac and drainage.

Conclusion

Revision of failed endoscopic DCR can still produce good results. A very large osteotomy and removal of the medial wall of the lacrimal sac are associated with good results.
Role of Itraconazole in Sinonasal Polyposis
Authors: Ravikumar Arunachalam , Kumar Prasanna
Published: September 2011

Objective

1) Diagnose fungal disease in sinonasal polyposis. 2) Compare the clinical outcome of patients with sinonasal polyposis treated with and without itraconazole.

Method

Two‐year, randomized case controlled study in university hospital. Thirty patients with sinonasal polyposis. Random allocation to study and control group. All underwent nasal endoscopy, CT PNS, Nasal swab for fungal smear and culture. Study group received itraconazole, per oral for 2 and 4 weeks pre‐ and postoperative period.

Results

A total of 60% of preoperative nasal swab were KOH positive for fungal hyphae. Both groups presented with headache and nasal obstruction. Wormald classification was used to grade polyps, edema, and discharge. Fungus was isolated in 46% of study and 34% of control group; the predominant fungus grown was Aspergillus flavus. Histopathology showed 66% inflammatory polyps and 44% allergic polyps. Statistical analysis and comparison of control and study group showed significantly lower clinical scores in study (itraconazole) group (P <. 002) at 6 months posttreatment. The Lund Mackay score for CT scan did not show significant difference.

Conclusion

Fungal disease co‐exists in a majority of patients with sinonasal polyposis. It is not known if it is a causative factor. Itraconazole was found to improve the clinical outcome in patients treated for sinonasal polyposis. No untoward side effects of the drug was identified in our study.
Symptoms and Signs from the Nose and Sinuses in Asthmatics
Authors: Thorstensen Wenche Moe , Fossland Nils P. W. , Sue‐Chu Malcom , Bugten Vegard , Steinsvaag Sverre K.
Published: September 2011

Objective

The United Airways Disease hypothesis suggests a link between upper and lower airways in asthmatics. However, there is a need to know more about nose and sinus related quality of life, sinonasal symptoms, and objective nasal air flow in asthmatics compared with healthy individuals.

Method

One hundred asthmatics and 96 nonasthmatic controls underwent a prospective controlled survey from June 2009 to December 2010. Symptoms, quality of life, and nasal airflow were assessed on Visual Analogue Scales (VAS, 0‐100), Sino‐Nasal‐Outcome‐Test (SNOT‐20), and Peak Nasal Inspiratory Flow (PNIF), respectively.

Results

Asthmatics (male/female 41/59; mean age, 44.1 years; range, 19‐64 years) reported significantly more symptoms of nasal obstruction [mean VAS 38mm (SD 26) vs 9 mm (SD 12), P <. 001] than controls (male/female 43/53; mean age, 41 years; range, 20‐65 years). PNIF was significantly lower in asthmatics than controls [mean PNIF 85 l/min (SD 24) vs 102 l/min (SD 19), P <. 001].

Conclusion

This study provides further evidence of the clinical importance of the upper airway in the diagnostic and therapeutic management of asthmatic patients.
Orbital Volume Differences: Indication for Surgery in Blow Out Fractures
Authors: Alinasab Babak , Stjärne Pär
Published: September 2011

Objective

In orbital floor fractures, the estimation of the herniated orbital content in the maxillary sinus has traditionally been the dividing line between surgical and nonsurgical management. We wanted to evaluate whether a relative change in volume would function as an indicator for surgical vs nonsurgical treatment of orbital floor fractures.

Method

This was a follow‐up study in patients with untreated unilateral isolated orbital floor fractures admitted to our department from March 2003 to April 2007. The volume of the orbital contentwas calculated digitally from the patients’ CT scans at the time of their injury. 18 norms were included as controls.

Results

Five of 23 patients showed 2 to 4 mm enophthalmus, and only 3 of them had intermittent diplopia. No statistical correlation was found between the herniated volume and enophthalmus. No statistical correlation supporting the supposition that 1 mL herniated orbital content would result in 1mm enophthalmus was found.

Conclusion

The relative volume change between the fractured and nonfractured orbit in an individual does not appear to be a useful criterion for surgery. The importance of the herniated orbital tissue for the development of enophthalmus is unclear.