Chinese Society of Allergy and Chinese Society of Otorhinolaryngology-Head and Neck Surgery Guideline for Chronic Rhinosinusitis

The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines—with a focus on China—will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.

Particulate Matter 2.5 Causes Deficiency in Barrier Integrity in Human Nasal Epithelial Cells

PURPOSE: The effect of air pollution-related particulate matter (PM) on epithelial barrier function and tight junction (TJ) expression in human nasal mucosa has not been studied to date. This study therefore aimed to assess the direct impact of PM with an aerodynamic diameter less than 2.5 μm (PM2.5) on the barrier function and TJ molecular expression of human nasal epithelial cells. METHODS: Air-liquid interface cultures were established with epithelial cells derived from noninflammatory nasal mucosal tissue collected from patients undergoing paranasal sinus surgery. Confluent cultures were exposed to 50 or 100 µg/mL PM2.5 for up to 72 hours, and assessed for 1) epithelial barrier integrity as measured by transepithelial resistance (TER) and permeability of fluorescein isothiocyanate (FITC) 4 kDa; 2) expression of TJs using real-time quantitative polymerase chain reaction and immunofluorescence staining, and 3) proinflammatory cytokines by luminometric bead array or enzyme-linked immunosorbent assay. RESULTS: Compared to control medium, 50 and/or 100 µg/mL PM2.5-treatment 1) significantly decreased TER and increased FITC permeability, which could not be restored by budesonide pretreatment; 2) significantly decreased the expression of claudin-1 messenger RNA, claudin-1, occludin and ZO-1 protein; and 3) significantly increased production of the cytokines interleukin-8, TIMP metallopeptidase inhibitor 1 and thymic stromal lymphopoietin. CONCLUSIONS: Exposure to PM2.5 may lead to loss of barrier function in human nasal epithelium through decreased expression of TJ proteins and increased release of proinflammatory cytokines. These results suggest an important mechanism of susceptibility to rhinitis and rhinosinusitis in highly PM2.5-polluted areas.

Short-term Haze Exposure Predisposes Healthy Volunteers to Nasal Inflammation

PURPOSE: This study aimed to investigate the impact of short-term haze exposure on nasal inflammation in healthy volunteers. METHODS: Thirty-three healthy university students were assessed for nasal symptoms, nasal patency, upper and lower respiratory tract nitric oxide (NO) as well as inflammatory mediators and neuropeptides in nasal secretions before and after a 5-day haze episode. Peripheral blood mononuclear cells (PBMCs) were stimulated with particulate matter with an aerodynamic diameter of less than 2.5 μm (PM(2.5)), and cytokines in the supernatants were examined. RESULTS: Mild nasal symptoms were reported by some participants during the haze episode. Objective measures of nasal patency demonstrated that nasal airway resistance was significantly increased from baseline levels, while nasal cavity volume and minimum cross-sectional area were significantly decreased. Similarly, the levels of nasal and exhaled NO, eotaxin, interleukin (IL)-5, chemokine (C-C motif) ligand 17, IL-8, substance P, nerve growth factor and vasoactive intestinal peptides in nasal secretions were significantly increased from baseline values following the haze episode. In contrast, the levels of interferon-γ, IL-10, transforming growth factor-β and neuropeptide Y were significantly decreased. Incubation with 0.1-10 μg/mL PM(2.5) significantly increased release of IL-1β, IL-4, IL-5, IL-8 and IL-10 from PBMCs. CONCLUSIONS: Short-term haze exposure may lead to nasal inflammation and hypersensitivity in healthy subjects predominantly by Th2 cytokine-mediated immune responses.

Evaluation of preoperative and postoperative structure, function, symptom between two different operations in patients with inferior turbinate hypertrophy / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the clinical outcome of submucosal inferior turbinectomy and outfracture surgery of inferior turbinates. METHODS All patients receiving two different operations were measured by acoustic rhinometry and questionnaire of QOL at preoperative 1 week and postoperative 12 months, seperately. RESULTS Forty-seven patients with inferior turbinate hypertrophy were enrolled in this study. Evaluation of SNOT-20 discovered both surgeries could improve patients' QOL with similar outcome. Preoperative '5 important items' in patients with inferior turbinate hypertrophy were 'lack of a good night's sleep', 'need to blow nose', 'thick nasal discharge', 'fatigue' and 'dizziness'. Postperative '5 important items' were 'postnasal discharge', 'runny nose', 'sneezing', 'reduced concentration' and 'reduced productivity'. Both surgeries could make acoustic rhinometry parameters change obviously, such as minimal cross-sectional area, 0-5 cm nasal volume(NV) and 2-5 cm NV. Furthermore, submucosal inferior turbinectomy produced more volume in nasal cavity than outfacture surgery, (7.28±2.01)cm3 vs (6.01±1.22)cm3, (5.99±1.87)cm3 vs (4.23±1.08)cm3(P<0.05), seperately. There was no correlation between the data of SNOT-20 and acoustic rhinometry. CONCLUSION We recommend outfracture surgery of inferior turbinate as the preferred surgical choice for patients with mild inferior turbinate hypertrophy.

Acupuncture at the sphenopalatine ganglion for the treatment of patients with moderate-to-severe allergic rhinitis / 国际中医中药杂志

Objective To assess the clinical efficacy of acupuncture at the sphenopalatine ganglion for the treatment of patients with moderate to severe allergic rhinitis.Methods 42 cases of moderate to severe allergic rhinitis patients in Otorhinolaryngology clinic of Tongren Hospital between August 2012 to November 2013 were randomized into a treatment group and a control group. The treatment group was treated by acupuncturing sphenopalatine ganglion, once per week, altogether 4 times. The control group was treated by acupuncturingFengchi(GB20),Baihui(GV20),Yingxiang(GV29),Shangxing(GV23),Taiyang(EX-HN5), Quchi(LI11) andZusanli (ST36) was used in the control group, 3 times per week for 4 weeks. The changes of the Total Nasal Symptoms Score (TNSS) and the Total Non-Nasal Symptom Score (TNNSS) were evaluated before and after treatment. The Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was used to evaluate the quality of life.Results One week after treatment, the scores of TNSS, TNNSS and RQLQ in both groups were significantly improved than before the treatment (treatment group: 5.0[4.0, 6.0]vs. 9.0[7.0, 10.0], 1.0[1.0, 1.5]vs. 3.0[3.0, 3.0], 44.0[35.5, 50.0]vs. 60.0[53.5,75.0]; control group: 6.0[5.5, 8.0]vs. 10.0[8.5, 10.1], 2.0[2.0, 3.0]vs. 3.00[3.0, 3.0], 50.0[45.5, 58.0]vs.43.0[27.0, 48.0]; allP<0.01); the scores of TNSS, TNNSS and RQLQ 1 week after treatment in the treatment group were significantly improved than those in the control group. The scores of TNSS(2.0[1.0, 3.0]vs. 3.0[2.0, 4.5]), TNNSS(1.0[0.0, 1.0]vs.2.0[2.0, 3.0]) and RQLQ(24.0[19.0, 29.0]vs. 43.0[27.0, 48.5])4 week after treatment in the treatment group were significantly improved than those in the control group(allP<0.01).Conclusions Acupuncture at the sphenopalatine ganglion could relieve the symptoms and improve the quality of life in patients with moderate to severe allergic rhinitis, and show more rapid and persistent therapeutic effect. It may be superior to the common acupuncture.

Prevalence of Allergic Rhinitis Among Adults in Urban and Rural Areas of China: A Population-Based Cross-Sectional Survey

PURPOSE: The aim of the present study was to compare the prevalence of self-reported and confirmable allergic rhinitis (AR) with positive skin prick test (SPT) results among adults living in urban and rural areas of China. METHODS: Adults from a community in Beijing and a village in Baoding were selected as representative urban and rural dwellers, respectively. All eligible residents were enrolled from the population register and received a face-to-face interview using modified validated questionnaires. Equal sets of randomly selected self-reporting AR-positive and AR-negative participants who responded to the questionnaires were also investigated using skin prick tests. RESULTS: A total of 803 participants in the rural area and a total of 1,499 participants in the urban area completed the questionnaires, with response rates being 75.9% and 81.5% respectively. The prevalence of self-reported AR of the rural area (19.1%) was significantly higher than that of the urban area (13.5%). The elementary school of educational level increased the risk of having AR (adjusted OR=2.198, 95% CI=1.072-2.236) .The positive SPT rates among subjects with self-reported AR in the rural and urban areas were 32.5% and 53.3%, respectively; the confirmable AR prevalence of 6.2% and 7.2% among the rural and urban adults, respectively. CONCLUSIONS: The prevalence of confirmable AR is similar between rural and urban areas in China, although there is a higher prevalence of self-reported AR in the former.

The ciliary beat frequency of human nasal epithelium in vitro / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the valuable information for studying human nasal mucociliary transport system by measuring the nasal ciliary beat frequency(CBF)in vitro.METHODS CBF of cultured human nasal epithelial cells was measured by highspeed digital microscopy in HBSS.RESULTS CBF of nasal epithelial cells from inferior turbinate and uncinate process of same patient has no significant difference in vitro(t=-0.087,P=0.931).CBF of normal mucosa and uncinate process from patients of sinusitis has no significant difference in vitro(t=0.419,P=0.678).CONCLUSION CBF of nasal mucosa of sinusitis can replace the CBF of normal nasal mucosa in vitro for for nasal ciliary movement studying.Because the mucosa of uncinate process is easier to obtain,it can replace the mucosa of inferior turbinate for cell culture in vitro.

Preparation of rat tail collagen and a cell culture model of human nasal epithelial cells / 中国耳鼻咽喉头颈外科

OBJECTIVE To establish a cell culture of human nasal epithelial cells on glass cover slides coated with rat tail collagen and explore a method to research human mucociliary system. METHODS The rat tail collagen and collagen coated cover slides were prepared for explant culture of human nasal epithelial cells. RESULTS The collagen on cover slides must be thin and ? at. It was about 1mm thick. The cultured epithelial cells were monolayer and polygonal cells. There was tight junction between the cells. Ciliary beat frequency of different cilia was equal on the same cell,and it was also equal of on cells from uncinate process and inferior turbinate. CONCLUSION This successful cell culture model of human nasal epithelail cell could be helpful to research the physiology and function of human nasal mucociliary system.

An explant outgrowth culture system for airway ciliated cells / 中国耳鼻咽喉头颈外科

OBJECTIVE To develop an explant outgrowth culture system for airway ciliated cells and explore the usefulness of the system.METHODS Mucosal specimens from rabbit tracheal epithelium were seeded into collagen-coated cover-slips. After 7 days,the specimens were characterized by Photo- contrast microscopy,transmission and Scanning electron microscope. They were also examined with hematoxylin-eosin staining and mucin-5AC immunohistochemistry. Ciliary beat frequency was measured with high-speed digital microscopy. RESULTS Many ciliated cells with good viability and goblet cells were found in the culture system. Immunohistochemistry analysis revealed that mucin- 5AC antibody labeled mainly in the goblet cells.The ciliated cells were differentiated well detected by electron microscope. At (30?1)℃,the basal ciliary beat frequency was (13.2?0.9) Hz. CONCLUSION The method may be useful in establishing a culture system for ciliated cells and the system will be suitable for the long-term studies of mucociliary transport system.