[Clinical and diagnostic features in the phenotyping of isolated sphenoiditis]. / Kliniko-diagnosticheskie osobennosti pri fenotipirovanii izolirovannogo sfenoidita.

The relevance of the issues of diagnosis and treatment of isolated sphenoiditis (IS) is increasing, due to the widespread introduction into clinical practice of radiation diagnostic methods that allow the diagnosis, including latent forms of IS. Among the chronic forms of IS, polypous-cystic and fungal lesions of the sphenoid sinus (SS) predominate. OBJECTIVE: To study the age, gender and radiological features of SS in patients with IS. MATERIAL AND METHODS: A retrospective observational single-center non-randomized study was conducted - an analysis of the case histories of 56 patients aged 18 to 68 years who were on inpatient treatment at the Semashko Nizhny Novgorod Regional Clinical Hospital (Department of Ear, Throat and Nose Diseases of the Privolzhsky Research Medical University) in the period 2018-2020, by age, gender composition, clinical and radiological manifestations in various forms of IS. RESULTS: The duration of the disease was 59±19 days. Latent forms were detected in 40% of patients. Statistically, the polypous-cystic form of IS was diagnosed more often than the fungal one (z=4.2; p=0.001). The median age of patients with polypous-cystic and fungal IS was 46.5 [35.0; 59.0] years. Evaluation of computed tomograms on the Lund-Mackay scale showed higher values in patients with polypous-cystic IS than in patients with fungal SS lesion (p=0.07). Obstruction of the anastomosis was detected in 38 out of 50 (69.5%) patients with polypous-cystic IS and in 13 out of 50 (92.9%) patients with fungal IS. CONCLUSIONS: Against the background of a significant prevalence of rhinosinusitis, the absolute values of isolated sphenoiditis, even with a relative value of 5% of the total, are very significant. Determining the phenotype of isolated sphenoiditis and their features is very important for building a consistent treatment strategy. Age, gender, clinical and radiological manifestations should form the basis of phenotyping and further construction of a therapeutic and diagnostic algorithm.

Periostin as a Biomarker of Allergic Inflammation in Atopic Bronchial Asthma and Allergic Rhinitis (a Pilot Study).

The involvement of periostin in Th2-dependent allergic inflammation has been documented. However, the significance of periostin as a biomarker of local allergic inflammation in the nasal mucosa (NM) of patients with atopic bronchial asthma (BA) and allergic rhinitis (AR) is yet to be determined. The aim of the study was to determine the presence of periostin and evaluate its role as a non-invasive marker of allergic inflammation in the nasal secretions of children with atopic BA and AR. MATERIALS AND METHODS: In 43 patients aged 4-17 years with atopic BA and AR, the NM was examined using nasal video-endoscopy and (if indicated) computed tomography; the amount of periostin in the nasal secretion was determined by the enzyme immunoassay. RESULTS: Exacerbation of AR was accompanied by a statistically significant increase in the level of periostin in the nasal secretion: up to 0.84 [0.06; 48.79] ng/mg, whereas in remission, that was 0.13 [0.00; 0.36] ng/mg; p=0.04. This value increased progressively as the severity of AR increased from 0.16 [0.00; 0.36] ng/mg in the mild course to 0.20 [0.00; 9.03] ng/mg in AR of moderate severity, and to 10.70 [0.56; 769.20] ng/mg in most severe cases; p=0.048. Hypertrophy or polyposis of the nasal and/or paranasal mucosa was detected in 34.9% (15/43) of the examined patients. The concentration of periostin in the nasal secretion was lower in children without NM hypertrophy: 0.18 [0.001; 4.30] ng/mg vs 0.78 [0.13; 162.10] ng/mg in patients with NM hypertrophy; the differences were close to statistically significant: p=0.051. The level of nasal periostin depended on the clinical form of hypertrophy in the sinonasal mucosa, reaching 0.17 [0.00; 0.32] ng/mg in children with polyposis hyperplasia of NM and 21.6 [10.70; 1516.80] ng/mg - with hypertrophy of the NM in the medial surface of the concha; p=0.02. CONCLUSION: Exacerbation and increased severity of AR in patients with atopic BA are accompanied by an increased level of periostin in the nasal secretion. This allows us to consider the level of nasal periostin as a biomarker of local allergic inflammation in the NM of patients with atopic BA combined with AR. Hypertrophic changes in the sinonasal mucosa are generally accompanied by an increased level of nasal periostin; specifically, this level significantly depends on the clinical form of mucous membrane hypertrophy and requires additional studies.

Effect of Nasal Obstructive Disorders on Sinonasal Symptoms in Children with Different Levels of Bronchial Asthma Control.

Allergic rhinitis (AR) and allergic rhinosinusitis (ARS) are typical upper airway pathologies (UAP) in children with bronchial asthma (BA) frequently accompanied with nasal obstructive diseases (NOD). In order to establish the effect of NOD on correlations between nasal and synonasal symptoms with clinical assessments of asthma control, 82 children, 9.8 [8.9; 10.7] years old, with atopic BA were assessed using ACQ-5 for the BA control level, TNSS for nasal symptoms, and SNOT-20 for synonasal quality of life in combination with rhinovideoendoscopy for NOD. All patients had AR/ARS; in 76.3% (63/82) of children, UAP had a multimorbid character with the presence of NOD. Significant correlations were found between ACQ-5 and TNSS (R=0.40, p < 0.0001) and ACQ-5 and SNOT-20 (R=0.42, p < 0.0001). Correlations between TNSS/ACQ-5 and SNOT-20/ACQ-5 were higher in patients who do not have a combination of AR/ARS with NOD (R=0.67, p=0.0012; R=0.50, p=0.022, resp.) than in patients who have AR/ARS combined with NOD (R=0.30, p=0.015; R=0.26, p=0.04, resp.). Thus, the association of BA control level with the expression of nasal and synonasal symptoms is higher in children who do not have multimorbid UAP.