Efficacy of glucocorticoid stent implantation in ethmoid sinus after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps / 临床耳鼻咽喉头颈外科杂志

Objective:To evaluate the efficacy of glucocorticoid sinus stents implanted 2 weeks after functional endoscopic sinus surgery（FESS） for the treatment of chronic rhinosinusitis with nasal polyps（CRSwNP）. Methods:CRSwNP patients with similar bilateral lesions were randomly divided into two groups, with a stent group of 25 patients and a control group of 24 patients. Patients in the stent group had glucocorticoid sinus stents implanted into the bilateral ethmoid sinuses 2 weeks after FESS, while the control group underwent postoperative debridement only. Follow-up assessments occurred at postoperative weeks 2, 4, 8, and 12. Patients were asked to assess their sensation of nasal symptoms using a 10-point visual analog scale. Efficacy was assessed by endoscopic evaluations. Sinus obstruction, crusting/coagulation, polyp formation, middle turbinate position, adhesions, mucosa epithelialization, and postoperative intervention were assessed as efficacy outcomes. GraphPad Prism 9 was applied for statistical analysis. Results:At 4 and 8 weeks postoperatively, the stent group showed significant improvement in VAS scores of nasal congestion and runny nose compared with the control group（P<0.05）. No significant difference was observed in the VAS scores of head and facial stuffiness, loss of smell, or nasal dryness/crusting between the two groups（P>0.05）. Compared with the control group, the stent group had a lower rate of polypoid formation at 4, 8, and 12 weeks postoperatively. At postoperative week 12, the rate of mucosal epithelialization in the ethmoid cavity was significantly higher in the stent group. During the follow-up, the frequency of postoperative intervention was significantly lower in the stent group than in the control group（P<0.05）. Besides, a lower incidence of middle turbinate lateralization was found in the stent group at 8 and 12 weeks postoperatively. At 8 weeks postoperatively, the stent group had a percentage of adhesion lower than that of the control group（all P<0.05）. Conclusion:Implantation of glucocorticoid sinus stents after FESS can maintain sinus cavity patency, improve the inflammatory status of the operative cavity, reduce postoperative interventions, and promote benign regression of the operative cavity.

Choanal Polyps Originating from Unusual Sites: A Rural Tertiary Care Center Experience

Abstract Introduction Choanal polyps are benign lesions arising from the sinonasal mucosa, extending through the choana into the nasopharynx. Though polyps arising from the maxillary sinus and extending to the choana are common, polyps arising from the sphenoid sinus ostium, posterior part of middle turbinate, and inferior and middle meatus are quite uncommon. Objective To document the site of origin of choanal polyps arising from unusual sites; their clinical, radiological, and histopathological characteristics, as well as diagnostic challenges and management. Methods This retrospective, single-center study included 14 patients aged 16 to 75-years-old with choanal polyps. After obtaining informed consent, their clinical, radiological and surgical details and histopathology reports were reviewed. Patients were followed for at least 6 months after surgery. Results The predominant symptoms were unilateral nasal obstruction (n = 9), snoring, rhinorrhea, and epistaxis. Though anterior rhinoscopy was unremarkable, a mass could be visualized during posterior rhinoscopy in the nasopharynx in 11 patients, and a mass could be directly visualized in the oropharynx in 2 patients. After diagnostic by nasal endoscopy, these polyps were noted to arise from the posterior aspect of the middle meatus (n = 6), middle turbinate (n = 3), posterior septum (n = 3), sphenoid sinus ostium (n = 1), and inferior meatus (n = 1). All patients were managed surgically. The histopathological examination revealed inflammatory polyp (n = 12), actinomycosis (n = 1), and rhinosporidiosis (n = 1). Patients were followed up for 6 to 22 months. We observed no complications or recurrence. Conclusion Diagnostic nasal endoscopy should be performed in all patients presenting with nasal obstruction, to rule out choanal polyps arising from unusual sites. Complete polyp removal and appropriate treatment based on histopathology prevents recurrence.

Intranasal glioma (Nasal heterotopia): A rare cause of nasal polyp in neonates

A 3-month-old boy presented with an intranasal polypoidal mass protruding out of the nostril which was present since birth and growing slowly. The mass was non-pulsatile and soft to firm in consistency. It did not increase in size on coughing, crying, or compression of the jugular vein. Magnetic resonance imaging and contrast-enhanced computed tomography (CT) revealed a lobulated well-circumscribed soft tissue mass in the left nasal cavity with no intracranial communication. Complete surgical excision of the mass was carried out via an intranasal endoscopic approach. Histopathological examination confirmed the diagnosis of intranasal glioma.

Pólipo Nasofaríngeo Primário: Apresentação Incomum / Primary Nasopharyngeal Polyp: Uncommon Presentation

Os pólipos inflamatórios não neoplásicos da nasofaringe são patologias raras e de consistência frágil, que normalmente são confundidos com outras lesões desta região. Entre essas, está o nasoangiofibroma, que possui consistência firme e sangra à manipulação. J.I.R.B., 17 anos, sexo masculino, estudante, com história de dor na faringe, com obstrução nasal noturna há 2 meses, associado à queixa de volume na garganta há 1 mês. À inspeção e oroscopia, encontrou-se uma volumosa lesão de aspecto polipoide, projetando-se da orofaringe. A ressonância magnética (RM) revelou lesão volumosa com componentes císticos, hiperintenso em T1 e hipointenso em T2, de aproximadamente 8,0 cm no seu maior diâmetro no corte sagital, que se estendia da nasofaringe até a orofaringe, chegando à região da epiglote. São descritos na literatura vários estudos relatando pólipos nasofaríngeos em felinos, mas apenas um estudo na literatura médica inglesa fala sobre as propriedades clínicas e histológicas dos pólipos inflamatórios primários da nasofaringe humana. Assim, o presente caso tem grande importância, principalmente pela sua raridade, local de acometimento do pólipo inflamatório benigno, bem como o tamanho da lesão. Na abordagem de massas naso e orofaríngeas em jovens e adultos, os pólipos inflamatórios primários fazem parte dos diagnósticos a serem considerados. Apesar do pequeno número de casos, as características radiológicas e patológicas dessa lesão devem ser lembradas, minimizando o risco de serem diagnosticados incorretamente.

Non-neoplastic inflammatory polyps of the nasopharynx are rare pathologies of fragile consistency, which are usually confused with other lesions of this region. Among these, the nasopharyngeal angiofibroma, which has firm consistency and bleeds to manipulation. J.I.R.B., 17 years old, male, student, with a history of pain pharynx, and nocturnal nasal obstruction for 2 months, associated with the complaint of volume in the throat for 1 month. Inspection and oroscopy, a polypoid lesion was found, protruding from the oropharynx. Magnetic resonance imaging (MRI) revealed a massive lesion with cystic, hyperintense components on T1-weighted images and hypointense at T2, approximately 8.0 cm in its largest diameter in the sagittal section, which was out of the nasopharynx to the oropharynx, reaching the epiglottis region. Several studies reporting nasopharyngeal polyps in felines have been described in the literature, but only one study in the English medical literature talks about the clinical and histological properties of the primary inflammatory polyps of the human nasopharynx. Thus, the present case is of great importance mainly, due to its rarity, site of involvement of benign inflammatory polyp, as well as the size of the lesion. In the approach of nasopharynx and oropharyngeal masses in young and adult, the primary inflammatory polyps are part of the diagnoses to be considered. Despite the small number of cases, the radiological and pathological characteristics of this lesion should be remembered, minimizing the risk of being misdiagnosed.

Prospective evaluation of clarithromycin in recurrent chronic rhinosinusitis with nasal polyps / Avaliação prospectiva da claritromicina na rinossinusite crônica com polipose nasossinusal recorrente

Abstract Introduction The antiinflammatory effects of macrolides, especially clarithromycin, have been described in patients with chronic rhinosinusitis without polyps and also other chronic inflammatory airway diseases. There is no consensus in the literature regarding the effectiveness of clarithromycin in patients with chronic rhinosinusitis with sinonasal polyposis and the national literature does not report any prospective studies on the efficacy of clarithromycin in chronic rhinosinusitis in our population. Objective To evaluate the effect of clarithromycin in the adjunctive treatment of recurrent chronic rhinosinusitis with sinonasal polyposis refractory to clinical and surgical treatment. Methods Open prospective study with 52 patients with chronic rhinosinusitis and recurrent sinonasal polyposis. All subjects received nasal lavage with 20 mL 0.9% SS and fluticasone nasal spray, 200 mcg / day, 12/12 h for 12 weeks; and clarithromycin 250 mg 8/8 h for 2 weeks and, thereafter, 12/12 h for 10 weeks. The patients were assessed by SNOT 20, NOSE and Lund-Kennedy scales before, immediately after treatment and 12 weeks after treatment. The patients were also evaluated before treatment with paranasal cavity computed tomography (Lund-Mackay) and serum IgG, IgM, IgA, IgE and eosinophil levels. The outcomes evaluated were: SNOT-20, NOSE and Lund-Kennedy. Results Most patients were women, aged 47 (15) years (median / interquartile range), and 61.5% (32/52) had asthma. All patients completed the follow-up after 12 weeks and 42.3% (22/52) after 24 weeks. Treatment resulted in a quantitative decrease in the SNOT-20 [2.3 (1.6) vs. 1.4 (1.6); Δ = −0.9 (1.1); p < 0.01]; NOSE [65 (64) vs. 20 (63); Δ = −28 (38), p < 0.01] and Lund-Kennedy [11 (05) vs. 07 (05); Δ = −2 (05); p < 0.01] scores. SNOT-20 showed a qualitative improvement (>0.8) in 54% (28/52, p < 0.04) of patients, a group that showed lower IgE level [108 (147) vs. 289 (355), p < 0.01]. The group of patients who completed follow-up 12 weeks after the end of treatment (n = 22) showed no worsening of outcomes. Conclusion Long-term adjuvant use of low-dose clarithromycin for chronic rhinosinusitis patients with recurrent sinonasal polyposis refractory to clinical and surgical treatment has resulted in improved quality of life and nasal endoscopy findings, especially in patients with normal IgE levels. This improvement persisted in the patient group evaluated 12 weeks after the end of the treatment.

Resumo Introdução Os efeitos anti-inflamatórios dos macrolídeos são reconhecidos, principalmente da claritromicina para os pacientes com rinossinusite crônica sem pólipos e outras doenças inflamatórias crônicas das vias aéreas em outras populações. Não existe consenso na literatura quanto a sua prescrição para os pacientes de rinossinusite crônica com polipose nasossinusal e a literatura nacional não dispõe de estudos prospectivos sobre a eficácia da claritromicina na rinossinusite crônica em nossa população. Objetivo Avaliar o efeito da claritromicina no tratamento adjuvante da rinossinusite crônica recorrente com polipose nasossinusal refratária ao tratamento clínico e cirúrgico. Método Estudo prospectivo aberto, com 52 pacientes, portadores de rinossinusite crônica com polipose nasossinusal recorrente. Todos os indivíduos receberam lavagem nasal com SF 0,9% 20 mL e fluticasona spray nasal, 200 mcg/dia, 12/12 horas por 12 semanas; e claritromicina 250 mg, de 8/8 horas, por 2 semanas e posteriormente 12/12 horas, por 10 semanas. Os pacientes foram avaliados através do SNOT 20, do NOSE e Lund-Kennedy antes, pós-tratamento imediato e 12 semanas após o tratamento. Os pacientes também foram avaliados antes do tratamento por tomografia computadorizada das cavidades paranasais (Lund-Mackay) e dosagem sérica de IgG, IgM, IgA, IgE e eosinófilos. Os desfechos avaliados foram: SNOT-20, NOSE e Lund-Kennedy. Resultados A maioria dos pacientes era mulher, idade de 47 (15) anos (mediana/intervalo interquartílico) e 61,5% (32/52) portadores de asma. Todos os pacientes completaram o seguimento após 12 semanas e 42,3% (22/52) após 24 semanas. O tratamento resultou em uma diminuição quantitativa do SNOT-20 [2,3 (1,6) vs. 1,4 (1,6); Δ = -0,9 (1,1); p< 0,01]; do NOSE [65 (64) vs. 20 (63); Δ = -28 (38), p< 0,01] e do Lund-Kennedy [11 (05) vs. 07 (05); Δ = -2 (05); p< 0,01]. O SNOT-20 mostrou uma melhoria qualitativa (> 0,8) em 54% (28/52, p< 0,04) dos pacientes, grupo que evidenciou menor nível de IgE [108 (147) vs. 289 (355), p< 0,01]. O grupo de pacientes que completou o seguimento 12 semanas após o término do tratamento (n = 22) não mostrou uma pioria dos desfechos. Conclusão O uso prolongado adjuvante da claritromicina em baixas doses para pacientes com rinossinusite crônica com polipose nasossinusal recorrente refratária ao tratamento clínico e cirúrgico resultou em melhoria na qualidade de vida e endoscopia nasal, principalmente em pacientes com níveis de IgE normal. Essa melhoria se sustentou no grupo de pacientes avaliado 12 semanas após o término do tratamento.

Rhinosporidiosis – A Clinical Survey

Background: Rhinosporidiosis is a chronic inflammatory granulomatous disease caused by the organism Rhinosporidiumseeberi. This causal organism was once believed to be a sporozoan, but is now considered to be a fungus. The disease ispresent all over the world except in Australia. However, it is endemic only in India and Sri Lanka; more than 95% of reportedcases are from these two countries. The most common site of manifestation of rhinosporidiosis in man is the nose accountingfor about 70% of cases. Surgical excision remains the mainstay of treatment today even though dapsone and ketoconazolehave been tried to some extent in preventing recurrence after surgery.Aim of the Study: The aim of the study was to study the prevalence, distribution, clinical behavior, results of various forms oftreatment and to provide a baseline clinical data and to supplement information for ongoing studies in the field of rhinosporidiosis.Materials and Methods: A total of 20 patients diagnosed as rhinosporidiosis, who attended the ENT Outpatient Department ofMedical College Hospital, Calicut, during the period from December 1998 to November 1999. Detailed history was recorded andpatients were subjected to thorough otolaryngological examination. Special attention was given to the site of lesions and type ofattachment. Details were also collected with particular reference to bathing habits, occupation, contact with animals, and occurrenceof similar illness in the family or in the neighborhood. Investigations included regular blood and urine and blood grouping. All thepatients underwent surgical excision of the lesions. The diagnosis was confirmed by histopathological examination of specimenobtained postoperatively. 100 mg of dapsone was administered daily (50 mg daily in children), 6 days a week, for a period of 6 months.All patients were reviewed for follow-up at the end of 1 month, 2, 4, and 6 and 9 months and on completion of a year after surgery.Observations and Results: In this study, the average age of patients suffering from rhinosporidiosis was 30.6 ± 2.80 years and theage varied between 8 and 52 years. The sex incidence was as follows: Males 17 (85%), females 3 (15%). Male predominance wasseen in this series and the male to female ratio was 5.66:1. Most of the subjects suffering from rhinosporidiosis were manual laborers7 (35%) out of 20, of which 2 (10%) were agricultural workers. The other major group was students accounting for 5 (25%) out of20 cases. The external appearance of the nose was normal in all patients. Partial nasal obstruction was seen in 13 cases (65%),on the left six, on the right five, and bilateral two cases. The total obstruction was seen in 5 cases (25%) – left two, right two, andbilateral one. Both nasal cavities were patent in only two cases. The vestibule showed the presence of mass in four cases (20%).Conclusions: Rhinosporidiosis is not an uncommon disease encountered in day-to-day ENT practice. The occurrence of thedisease does not bear any relation to the occupation of the patient. The maximum incidence of rhinosporidiosis is seen inthe age group of 21–30 years and males predominate. Rhinosporidiosis is more common in the rural population. There is asignificant association between dip baths in ponds and the occurrence of disease.

Efficacy of Carragelose® Nasal Spray Impregnated Versus Mupirocin Ointment Impregnated Nasal Packs on Mucosal Healing after Endoscopic Sinus Surgery: A Double-Blind, Non-Randomized, Right-Left Side Comparison

@#Objective: To determine the efficacy of carragelose® nasal spray versus mupirocin ointment impregnated nasal packs on postoperative mucosal healing among chronic rhinosinusitis with nasal polyposis (CRSwNP) patients after endoscopic sinus surgery (ESS). Methods: Design: Double-Blind, Non-Randomized, Right-Left Side Comparison Setting: Tertiary Government Training Hospital Participants: Fifteen (15) patients diagnosed with chronic rhinosinusitis with nasal polyposis (CRSwNP) who had ESS were included in the study. Nasal packs (Netcell®) impregnated with carragelose® nasal spray or mupirocin ointment were respectively applied in right and left nostrils. Postoperative mucosal healing was graded by a blinded consultant using the Lund-Kennedy Endoscopic Scoring System and Perioperative Sinus Endoscopy (POSE) scoring system. Results: Six patients (12 nasal sides) completed the study. Comparing nasal packs impregnated with carragelose® nasal spray mupirocin ointment, the carragelose® group had lower Lund- Kennedy median scores than the mupirocin group on the 7th post-operative day; and this was statistically significant (p = .027). There were no significant differences in Lund-Kennedy postoperative scores on days 4 (p = .217), 14 (p = .171) and 28 (p = .151). Conclusion: Carragelose® nasal spray impregnated nasal packs may be comparable with, and may be an alternative to mupirocin ointment impregnated nasal packs in terms of postoperative mucosal healing among ESS patients with CRSwNP.

Increased expression of pendrin in eosinophilic chronic rhinosinusitis with nasal polyps / Expressão aumentada de pendrina na rinossinusite crônica eosinofílica com pólipos

Abstract Introduction: Chronic rhinosinusitis with nasal polyps is a heterogeneous disease and appropriate diagnostic algorithms in individual cases are necessary for effective medical treatment. Objective: The purpose of this study was to clarify the relationship between the pendrin expression of nasal polyps and clinical and pathological characteristic features of eosinophilic chronic rhinosinusitis. Methods: A total of 68 patients were classified into eosinophilic chronic rhinosinusitis or non-eosinophilic chronic rhinosinusitis groups according to the degree of eosinophilic infiltration into the nasal polyps. Clinical, hematological, and immunohistochemical analyses were performed and statistically compared between both groups. Results: Thirty-eight were classified into eosinophilic chronic rhinosinusitis and 30 into non-eosinophilic chronic rhinosinusitis groups. There were no significant differences in age distribution, sex ratio, prevalence of asthma, or any other complications between the groups. The mean Lund-Mackay score and the number of serum eosinophils was significantly higher in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis groups. The pendrin expression was more frequently detected in the epithelial surface layer of nasal polyps in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis groups. In addition, mucin 5AC was more widely expressed in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis. Conclusion: Increased expression of pendrin and mucin 5AC in the nasal polyps would be associated with development of eosinophilic chronic rhinosinusitis. This finding could allow the development of a novel therapeutic agent targeted specifically to patients with eosinophilic chronic rhinosinusitis.

Resumo Introdução: A rinossinusite crônica com pólipos nasais é uma doença heterogênea e algoritmos diagnósticos apropriados em casos individuais são necessários para um tratamento médico eficaz. Objetivo: O objetivo deste estudo foi esclarecer a relação entre a expressão da pendrina de pólipos nasais e propriedades clínicas e patológicas características da rinossinusite crônica eosinofílica. Método: Um total de 68 pacientes foram classificados como tendo rinossinusite crônica eosinofílica ou rinossinusite crônica não eosinofílica de acordo com o grau de infiltração eosinofílica nos pólipos nasais. Análises clínicas, hematológicas e imunohistoquímicas foram realizadas e comparadas estatisticamente entre os dois grupos. Resultados: Entre os pacientes, 38 apresentavam rinossinusite crônica eosinofílica e constituíram o grupo 1; 30 tinham rinossinusite crônica não eosinofílica e constituíram o grupo 2. Não houve diferenças significantes na distribuição etária, razão entre os sexos, prevalência de asma ou qualquer outra complicação entre os grupos. O escore médio de Lund-Mackay e o número de eosinófilos séricos foram significantemente maiores no grupo com rinossinusite crônica eosinofílica do que no grupo com rinossinusite crônica não eosinofílica. A expressão da pendrina foi mais frequentemente detectada na camada epitelial superficial dos pólipos nasais na rinossinusite crônica eosinofílica do que no grupo com rinossinusite crônica não eosinofílica. Além disso, mucina 5AC foi mais amplamente expressa na rinossinusite crônica eosinofílica do que na rinossinusite crônica não eosinofílica. Conclusão: O aumento da expressão da pendrina e mucina 5AC nos pólipos nasais estaria associado ao desenvolvimento de rinossinusite crônica eosinofílica. Esse achado pode permitir o desenvolvimento de um novo agente terapêutico voltado especificamente para pacientes com rinossinusite crônica eosinofílica.

Neutrophils as a Protagonist and Target in Chronic Rhinosinusitis

Neutrophils have traditionally been acknowledged as the first immune cells that are recruited to inflamed tissues during acute inflammation. By contrast, their importance in the context of chronic inflammation has been studied in less depth. Neutrophils can be recruited and are largely present in the nasal mucosa of patients with chronic rhinosinusitis (CRS) both in Asians and in Caucasians. Increased infiltration of neutrophils in patients with CRS has been linked to poor corticosteroid response and disease prognosis. Meanwhile, tissue neutrophils may possess specific phenotypic features distinguishing them from resting blood counterparts and are endowed with particular functions, such as cytokines and chemokines production, thus may contribute to the pathogenesis of CRS. This review aims to summarize our current understanding of the pathophysiologic mechanisms of CRS, with a focus on the roles of neutrophils. We discuss recruitment, function, and regulation of neutrophils in CRS and outline the potential therapeutic strategies targeting neutrophils.

Effect of Manuka Honey on Transforming Growth Factor Beta-1-Induced Extracelluar Matrix Production in Nasal Polyp Derived Fibroblasts / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Manuka honey has anti-microbial, anti-inflammatory, and anti-proliferative action with a high concentration of methylglyoxal compound. It is also effective in killing Staphylococcus aureus biofilm and effective for the acute exacerbation of chronic rhinosinusitis. The aim of this study was to determine the anti-fibrotic effect of manuka honey in nasal polyp fibroblasts. MATERIALS AND METHOD: Primary nasal fibroblasts were isolated from nasal polyps and treated with transforming growth factor-beta 1 (TGF-β1). To determine the anti-fibrotic effect of manuka honey, fibroblasts were pre-treated with various concentration of the honey. Reverse transcription-polymerase chain reaction and western blot analysis were then performed to determine α-smooth muscle actin (α-SMA), collagen type I, and matrix metalloproteinase-9 (MMP-9) messenger ribonucleic acid (mRNA) expression and protein production in nasal polyp fibroblasts. Phosphorylated Smad (pSmad) 2/3 and phosphorylated adenosine monophosphate-activated protein kinase (pAMPK) were then determined by western blotting. RESULTS: TGF-β1 stimulation increased α-SMA, collagen type I, and MMP-9 mRNA expression and protein production in nasal polyp fibroblasts. Manuka honey effectively suppressed α-SMA, collagen type I, and MMP-9 mRNA expression and protein production. Its inhibitory role on TGF-β1 induced myofibroblast differentiation and its extracellular matrix production was associated with Smad2/3 and AMPK pathway. CONCLUSION: Manuka honey can inhibit TGF-β1 induced myofibroblast differentiation, collagen type I, and MMP-9 production in nasal fibroblasts. These results suggest that manuka honey might be a useful candidate for the inhibition of nasal polyp formation if further studies in vivo were accompanied.

Two Cases of Recurrent Nasal Polyps in Siblings-Woakes' Syndrome / 대한이비인후과학회지

Woakes' syndrome is a group of disease which include recurrent nasal polyps resulting in the broadening of the nasal pyramid, the onset of hypoplasia of frontal sinus and bronchiectasis, as well as the production of mucous discharge. Children and young adults are mostly susceptible to Woakes' syndrome due to the plasticity of the bone. Even though the exact etiology is unknown, genetic factor is thought to be influential because it is often diagnosed in siblings. Otolaryngologically, the mainstream method of removing nasal polyp by endoscopic sinus surgery as well as topical or systemic treatment can be helpful. We report two siblings who visited our clinic both complaining of nasal obstruction. The patients presented with recurrent nasal polyps and showed signs of bronchiectasis, which led to the diagnosis of Woakes' syndrome. These rare cases are presented here with a review of related literature.

Comparison Between Signature Cytokines of Nasal Tissues in Subtypes of Chronic Rhinosinusitis

PURPOSE: Endotype in chronic rhinosinusitis (CRS) has been established in the last decade. However, the exact immunologic profile of CRS still has controversy because it has a considerable immunologic heterogeneity. Therefore, we investigated various inflammatory mediators according to different nasal tissues in chronic rhinosinusitis and compared them within the same subject. METHODS: We collected uncinate process mucosa (UP) and nasal polyp (NP) tissues from controls, CRS without NP (CRSsNP) and CRS with NP (CRSwNP). Expression levels of 28 inflammatory mediators including T helper (Th) 1, Th2, Th17, proinflammatory cytokines and remodeling markers were determined by multiplex immunoassay and were analyzed using paired tests as well as principal component analysis (PCA) to investigate endotype in each subtype of CRS. RESULTS: Signature inflammatory mediators are interleukin (IL)-5, C-C motif chemokine ligand (CCL)-24, monocyte chemoattractant protein (MCP)-4, and vascular cell adhesion molecule (VCAM)-1 in eosinophilic NP, whereas IL-17A, IL-1β, and matrix metallopeptidase (MMP)-9 were detected as signature inflammatory markers in non-eosinophilic NP. Despite differences in inflammatory cytokine profile between eosinophilic and non-eosinophilic NP, the common upregulation of IL-5, CCL-11, IL-23, IL-2Rα, VCAM-1, MMP-3 and MMP-9 were shown in NP compared to UP within the same subject. In the PCA, we observed that Th2 immune response was helpful in discriminating between nasal tissues in subtypes of CRS and that there was a partial overlap between non-eosinophilic NP and eosinophilic NP in terms of Th2 mediators. CONCLUSIONS: Commonly upregulated mediators in NP were Th2-associated, compared with UP regardless of CRS subtypes, whereas signature markers were distinct in each NP subtype. These findings imply that Th2 inflammatory responses may play a role in the development of NP regardless of CRSwNP subtypes.

A Case of Fibromyxoma Mistaken as an Antrochoanal Polyp

Fibromyxomas are uncommon, tenaciously infiltrative neoplasms that infrequently appear in the facial bones and paranasal sinuses. The neoplasms are slow growing and result in expansion of the surrounding bony cortices. In the present study, we report an extremely rare case of antrochoanal fibromyxoma that occluded the ostiomeatal complex and originated from the maxillary sinus inferior wall. Initially, the neoplasm was suspected to be a nasal polyp. However, after endoscopic sinus surgery, the neoplasm was diagnosed as fibromyxoma based on histopathology.

Prevalence Of Inverted Papilloma In A Teritiary Hospital

Inverted papilloma is a benign tumour of nasal cavity arising from lateral wall of nose, septum or anywhere in nasal cavity and sinuses. Pathogenesis is unknown even though many causes are explained like viral infection by HPV, HSV, chronic rhinosinusitis. These have capacity of malignant transformation 10 to 15%.Epstein–Barr virus (EBV), smoking, occupational, environmental and industrial exposures, cell cycle related proteins, angiogenic factors and chronic inflammation.Aims : To findout prevalence of inverted papilloma among nasal massesTo evaluate the sex incidence among these casesTo know symptomatology compared to other nasal massesMethods –ASRAM Medical College, Eluru, Dept of ENT.This is a prospective study over 2 years period ( 2015 Sept to 2017 August)Sample size – total no of 50 cases with nasal mass was studiedMethodology – All the patients having nasal masses were taken for the study. All the malignant masses were excluded from the study. Thorough clinical examination and investigations were done and data were analyzed.Results • The incidence of nasal mass to be higher in Males (58%). Especially males majority seen in inverted papilloma (5cases) and 1 female.nd• Most common nasal mass is nasal polyp,followed by 2most common is inverted papilloma.

Electrophysiological assessment of the concentration and attention in patient with nasal polyposis

BACKGROUND: Nasal polyposis is a chronic disease presenting with nasal obstruction as the most frequent complaint. It has been documented that nasal polyposis results in deterioration of quality of life and disturbances of sleep. However, remarkable consequences of nasal polyposis such as psychological and cognitive outcomes are relatively poorly studied. OBJECTIVE: The aim of the present study was to evaluate whether there is an impairment of concentration and attention in nasal polyposis patients due to hypoxia caused by nasal obstruction. METHODS: This cross-sectional, case-control study was carried out on 30 male patients with nasal polyps and 30 healthy subjects serving as controls. Participant ages were 41.6 ± 10.2 years in the nasal polyps group and 41.3 ± 6.2 in the control group. All participants underwent systemic, neurological, and otorhinolaryngological examinations together with routine hematological and biochemical tests. Patients with nasal polyposis had bilateral complete obstruction of nasal cavity. P300 component of electroencephalography-derived event related potentials were used to monitor concentration and attention. Nasal polyposis and control groups were compared in terms of amplitude and latency of P300. RESULTS: There were significant differences between control and nasal polyposis groups in terms of latency of P300 (p 0.05). CONCLUSION: Results of the current study indicate that hypoxia due to complete nasal obstruction may result in impairment of attention and concentration in nasal polyposis patients. Assessment of patients with P300 latency subcomponent can be a useful diagnostic tool to detect cognitive and psychological consequences.

The Effectiveness of Budesonide Nasal Irrigation After Endoscopic Sinus Surgery in Chronic Rhinosinusitis With Asthma

OBJECTIVES: Budesonide nasal irrigation was introduced recently for postoperative management of patients with chronic rhinosinusitis. The safety and therapeutic effectiveness of this procedure is becoming accepted by many physicians. The objective of this study was to evaluate the efficacy of postoperative steroid irrigation in patients with chronic rhinosinusitis and asthma. METHODS: This prospective study involved 12 chronic rhinosinusitis patients with nasal polyps and asthma who received oral steroid treatment for recurring or worsening disease. The 22-item Sinonasal Outcomes Test (SNOT-22) and Lund-Kennedy endoscopy scores were checked before nasal budesonide irrigation, and 1, 2, 4, and 6 months after irrigation. We also calculated the total amount of oral steroids and inhaled steroids in the 6 months before irrigation and the 6 months after it. RESULTS: The mean SNOT-22 score improved from 30.8±14.4 before irrigation to 14.2±8.7 after 6 months of irrigation (P=0.030). The endoscopy score also improved from 7.4±4.7 before irrigation to 2.2±2.7 after 6 months (P<0.001). The total amount of oral steroid was decreased from 397.8±97.6 mg over the 6 months before irrigation to 72.7±99.7 mg over the 6 months after irrigation (P<0.001). CONCLUSION: Nasal irrigation with budesonide is an effective postoperative treatment for chronic rhinosinusitis with asthma, which recurs frequently, reducing the oral steroid intake.

The Impact of Nasal Polyposis on Olfactory Dysfunction in Chronic Rhinosinusitis

BACKGROUND AND OBJECTIVES: Olfactory disturbance is a major sinonasal symptom of chronic rhinosinusitis (CRS) with nasal polyps (NP). The aim of this study was to investigate the relationship between the severity of nasal polyposis and olfactory dysfunction in CRS. SUBJECTS AND METHOD: A total of 277 subjects with CRS were included in this study. All participants were divided into four groups according to the size and degree of the nasal polyposis: the control group (no polyp; n=79); NP (nasal polyp) group I (both or unilateral simple polyposis; n=85); NP group II (unilateral diffuse polyposis; n=66); and NP group III (bilateral diffuse polyposis; n=47). We analyzed the relationships between the severity of nasal polyposis and olfactory dysfunction using both the Korean Version of the “Sniffin'Sticks” test (KVSS Test) II and the Questionnaire of Olfactory Disorders (QOD). RESULTS: The KVSS Test II TDI score was significantly decreased in the bilateral diffuse polyposis group (NP group III=15.62±13.39) compared to the other polyp groups [control group=25.04±9.67 (p<0.001); NP group I=21.67±11.18 (p=0.005); NP group II=21.51±10.85 (p=0.008)]. However, there were no significant differences in the KVSS Test II TDI score between the control group and NP groups I and II. For the QOD_NS score, only NP group III (11.51±9.87) had significantly increased values compared to the control group [8.42±12.27 (p=0.015)]. CONCLUSION: These results suggest that bilateral diffuse nasal polyposis is related to significant olfactory dysfunction in CRS.

Gene Expression Profiling in Nasal Polyp / 中国医科大学学报

Objective To analyze the gene expression profiles of nasal polyp and gene expression differences between the nasal polyp and normal nasal mucosa.Methods Total RNA from nasal polyp tissues was purified and synthesized into double-stranded cDNA.The cDNA was labeled and hybridized in a NimbleGen hybridization chamber.The slides were scanned using the Axon GenePix 4000B microarray scanner.Scanned images were analyzed using NimbleScan software.The probes and gene levels were standardized and calculated.Results Compared with normal nasal mucosa tissues,expression of 2.22％ (1 000/45 033) of genes was up-regulated in all cases of nasal polyp tissues,while 2.49％ (1 123/45 033) of genes were down-regulated in all cases of nasal polyp tissues.We found genes related to the ribosome,proteasome,citrate cycle (TCA cycle),bladder cancer,non-small cell lung cancer,glioma,endometrial cancer,protein processing in the endoplasmic reticulum,chronic myeloid leukemia,and glutathione metabolism were up-regulated.Genes related to olfactory transduction,natural killer cell-mediated cytotoxicity,metabolism of xenobiotics by cytochrome P450,drug metabolism-cytochrome P450,antigen processing and presentation,malaria,graft-versus-host disease,retinol metabolism,linoleic acid metabolism,and pentose and glucuronate interconversions were down-regulated.Conclusion Multiple genes or pathways may be involved in the occurrence and development of nasal polyp.Gene expression profiling provides insight into the mechanism of nasal polyp development.

A Case of Adenocarcinoma of the Nasopharynx / 대한이비인후과학회지

The major pathological type of the nasopharyngeal carcinoma is squamous cell carcinoma; on the other hand, adenocarcinoma of the nasopharynx is extremely rare. We report a case of a 68-year old male presenting a nasopharynx mass, which was revealed as adenocarcinoma, which could not be specified as any transoral tumor resection. Additional radiotherapy was applied. There is no evidence of recurrence during the seven years of follow-up.

The cutoff point of chronic nasal sinusitiswith nasal polyps classified by the tissue eosinophils / 安徽医科大学学报

Objective To study the cutoff point of chronic nasal sinusitis with nasal polyps(CRSwNP) classified by the tissue eosinophils(Eos).Methods 140 CRSwNP patients were enrolled in this study.The data of their clinical feature were collectted before surgery.Mucosal specimens were assessed for the presence of tissue eosinophil cells.Follow up and record the data at 3 months and 6 months after surgery.Results When the tissue Eos grouped by 50/HPF, the VAS, nasal sinus CT ,endoscopic preoperative score,and the endoscopic postoperative score at 3 months and 6 months showed significant difference(P<0.05).The tissue Eos between skin prick test(SPT) positive group and SPT negative group showed no significant difference.The tissues Eos was sighificantly correlated with the peripheral Eos(ρ=0.459,0.473,P<0.01).Conclusion The most meaningful cutoff point may be 50 Eos/HPF nearby to distinguish ECRS and non-ECRS(taken nasal polyps,by random HPF).Allergic factors may have no effect or little effect on the increase in Eos of nasal polyps in patients with CRSwNP;peripheral blood Eos may be an indicator of the level of Eos in tissues.