Prevalence of asthma, aspirin sensitivity and allergy in chronic rhinosinusitis: data from the UK National Chronic Rhinosinusitis Epidemiology Study.

BACKGROUND: Chronic rhinosinusitis (CRS) is a common disorder associated with other respiratory tract diseases such as asthma and inhalant allergy. However, the prevalence of these co-morbidities varies considerably in the existing medical literature and by phenotype of CRS studied. The study objective was to identify the prevalence of asthma, inhalant allergy and aspirin sensitivity in CRS patients referred to secondary care and establish any differences between CRS phenotypes. METHODS: All participants were diagnosed in secondary care according to international guidelines and invited to complete a questionnaire including details of co-morbidities and allergies. Data were analysed for differences between controls and CRS participants and between phenotypes using chi-squared tests. RESULTS: The final analysis included 1470 study participants: 221 controls, 553 CRS without nasal polyps (CRSsNPs), 651 CRS with nasal polyps (CRSwNPs) and 45 allergic fungal rhinosinusitis (AFRS). The prevalence of asthma was 9.95, 21.16, 46.9 and 73.3% respectively. The prevalence of self-reported confirmed inhalant allergy was 13.1, 20.3, 31.0 and 33.3% respectively; house dust mite allergy was significantly higher in CRSwNPs (16%) compared to CRSsNPs (9%, p < 0.001). The prevalence of self- reported aspirin sensitivity was 2.26, 3.25, 9.61 and 40% respectively. The odds ratio for aspirin sensitivity amongst those with AFRS was 28.8 (CIs 9.9, 83.8) p < 0.001. CONCLUSIONS: The prevalence of asthma and allergy in CRS varies by phenoytype, with CRSwNPs and AFRS having a stronger association with both. Aspirin sensitivity has a highly significant association with AFRS. All of these comorbidities are significantly more prevalent than in non-CRS controls and strengthen the need for a more individualised approach to the combined airway.

The burden of revision sinonasal surgery in the UK-data from the Chronic Rhinosinusitis Epidemiology Study (CRES): a cross-sectional study.

OBJECTIVES: The aim of this study was to investigate the surgical revision rate in patients with chronic rhinosinusitis (CRS) in the UK CRS Epidemiology Study (CRES). Previous evidence from National Sinonasal Audit showed that 1459 patients with CRS demonstrated a surgical revision rate 19.1% at 5 years, with highest rates seen in those with polyps (20.6%). SETTING: Thirty secondary care centres around the UK. PARTICIPANTS: A total of 221 controls and 1249 patients with CRS were recruited to the study including those with polyps (CRSwNPs), without polyps (CRSsNPs) and with allergic fungal rhinosinusitis (AFRS). INTERVENTIONS: Self-administered questionnaire. PRIMARY OUTCOME MEASURE: The need for previous sinonasal surgery. RESULTS: A total of 651 patients with CRSwNPs, 553 with CRSsNPs and 45 with AFRS were included. A total of 396 (57%) patients with CRSwNPs/AFRS reported having undergone previous endoscopic nasal polypectomy (ENP), of which 182 of the 396 (46%) reported having received more than one operation. The mean number of previous surgeries per patient in the revision group was 3.3 (range 2-30) and a mean duration of time of 10 years since the last procedure. The average length of time since their first operation up to inclusion in the study was 15.5 years (range 0-74). Only 27.9% of all patients reporting a prior ENP had received concurrent endoscopic sinus surgery (ESS; n=102). For comparison, surgical rates in patients with CRSsNPs were significantly lower; 13% of cases specifically reported ESS, and of those only 30% reported multiple procedures (χ(2) p<0.001). CONCLUSIONS: This study demonstrated that there is a high burden of both primary and revision surgery in patients with CRS, worst in those with AFRS and least in those with CRSsNPs. The burden of revision surgery appears unchanged in the decade since the Sinonasal Audit.

Angioleiomyoma on the dorsum of the nose excised via an open rhinoplasty approach.

We describe what we believe is the first reported case of an angioleiomyoma on the dorsum of the nose. The patient was a 65-year-old woman who presented with a year-long history of an intermittently recurrent lump on the right side of the dorsum. The lesion was removed via an open rhinoplasty approach. Histologic examination identified it as an angioleiomyoma.

Modern technology-assisted vs conventional tonsillectomy: a meta-analysis of randomized controlled trials.

OBJECTIVE: To systematically review evidence regarding modern technology-assisted tonsillectomy pertaining to operative time, intraoperative and postoperative bleeding, postoperative pain, and other outcomes. DESIGN: A systematic search for randomized controlled trials comparing total tonsillectomies performed using vessel sealing systems (VSS), Harmonic Scalpel (HS), or radiofrequency ablation (ie, Coblation) with the conventional technique of cold steel and/or electrocautery dissection (CS/EC). Estimation of odds ratios and 95% confidence intervals (CIs), weighted mean differences (WMD), or standardized mean difference (SMD), as appropriate. PATIENTS: Thirty-three randomized controlled trials studying a total of 3139 patients were included in this meta-analysis. MAIN OUTCOME MEASURES: Operative time, perioperative and postoperative bleeding, and postoperative pain. RESULTS: For the VSS group compared with the CS/EC group, operative time was significantly shorter (WMD), -4.09 minutes; 95% CI, -7.43 to -0.75 minutes; 760 patients), perioperative bleeding was significantly less (SMD, -1.67; -2.80 to -0.53; 355 patients), and postoperative bleeding was significantly less (odds ratio, 0.28; 0.13 to 0.61; 792 patients). Pain on the first and seventh postoperative days was significantly less in the VSS group (SMD, -1.73; 95% CI, -3.07 to -0.39; 740 patients; and SMD, -1.46; -2.35 to -0.57; 684 patients; respectively). For the HS group compared with the CS/EC group, the only studied outcome that differed significantly was perioperative bleeding, which was significantly less in the HS group (WMD -37.71 mL; 95% CI, -52.98 to -22.43 mL; 535 cases). No difference was noted between the Coblation and CS/EC groups for any of the studied outcomes. CONCLUSIONS: For tonsillectomies, the Coblation and HS techniques do not provide any significant advantage compared with CS/EC. Synthesis of the limited and heterogeneous data regarding VSSs showed a significant benefit in all studied outcomes.