D. D. D. Dietz de Loos, M. Cornet, W. Fokkens, S. Reitsma
Background: The 22-item Sino-Nasal Outcome Test (SNOT-22) is a widely used questionnaire to measure disease-specific health-related quality of life in patients with chronic rhinosinusitis (CRS). The Dutch version has not been validated yet. Methods: The SNOT-22 was translated through a forward-backward translation technique and validated by a test-retest protocol in CRS patients, a responsiveness analysis in CRS patients treated with dupilumab, while using healthy individuals as controls. Results: The Dutch SNOT-22 showed excellent test-retest properties, good responsiveness to treatment with dupilumab, and a clear distinction between outcomes of CRS patients and healthy controls. Conclusion: The Dutch version of the SNOT-22 is a valid outcome measure in CRS patients.
{"title":"Validation of the Dutch version of the 22-item Sino-Nasal Outcome Test (SNOT-22)","authors":"D. D. D. Dietz de Loos, M. Cornet, W. Fokkens, S. Reitsma","doi":"10.4193/rhinol/22.015","DOIUrl":"https://doi.org/10.4193/rhinol/22.015","url":null,"abstract":"Background: The 22-item Sino-Nasal Outcome Test (SNOT-22) is a widely used questionnaire to measure disease-specific health-related quality of life in patients with chronic rhinosinusitis (CRS). The Dutch version has not been validated yet. Methods: The SNOT-22 was translated through a forward-backward translation technique and validated by a test-retest protocol in CRS patients, a responsiveness analysis in CRS patients treated with dupilumab, while using healthy individuals as controls. Results: The Dutch SNOT-22 showed excellent test-retest properties, good responsiveness to treatment with dupilumab, and a clear distinction between outcomes of CRS patients and healthy controls. Conclusion: The Dutch version of the SNOT-22 is a valid outcome measure in CRS patients.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43655390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: There has been limited study of topical tranexamic acid (TXA) in endoscopic sinus surgery (ESS). We report a pilot study, examining the effects of topical TXA with regards to recovery after ESS. Methods: A pilot double-blind randomized controlled trial was conducted in 30 patients undergoing comprehensive ESS. Patients received either topical TXA or normal saline (NS) for 60 minutes via cotton pledgets at the conclusion of ESS. Patients were followed-up for a duration of 3-months. Results: The mean (95% CI) reduction in 22-item Sino-Nasal Outcome Test (SNOT-22) score at 3 months was 39.5/110 (26.9, 52.0) for TXA and 33.4/110 (24.0, 42.9) for NS (p=0.42). The mean (SD) Modified Lund-Mackay Post-operative Endoscopic (MLMES) score at 3 months was 7.79/100 ±7.70 for TXA and 10.9/100 ±9.35 for NS (p=0.12). TXA had a mean (SD) bleeding score of 4.0 ± 2.33 on day 1 compared to 3.64 ± 2.76 in NS group when measured on a Likert scale (p = 0.89). The mean self-reported time to return to work was 4.67 ± 2.22 days for TXA and 6.87 ± 4.42 for NS (p=0.10). Zero cases of confirmed thromboembolism were seen. Conclusions: Although statistically non-significant differences were observed, data from this pilot study imply that there is merit in a larger study to further assess the effects of topical TXA following ESS. There may be a role for increasing the exposure to topical TXA via a different formulation.
{"title":"A double-blind pilot randomized controlled trial of topical tranexamic acid after sinus surgery","authors":"A. R. Kumar, A. Wood","doi":"10.4193/rhinol/22.011","DOIUrl":"https://doi.org/10.4193/rhinol/22.011","url":null,"abstract":"Background: There has been limited study of topical tranexamic acid (TXA) in endoscopic sinus surgery (ESS). We report a pilot study, examining the effects of topical TXA with regards to recovery after ESS. Methods: A pilot double-blind randomized controlled trial was conducted in 30 patients undergoing comprehensive ESS. Patients received either topical TXA or normal saline (NS) for 60 minutes via cotton pledgets at the conclusion of ESS. Patients were followed-up for a duration of 3-months. Results: The mean (95% CI) reduction in 22-item Sino-Nasal Outcome Test (SNOT-22) score at 3 months was 39.5/110 (26.9, 52.0) for TXA and 33.4/110 (24.0, 42.9) for NS (p=0.42). The mean (SD) Modified Lund-Mackay Post-operative Endoscopic (MLMES) score at 3 months was 7.79/100 ±7.70 for TXA and 10.9/100 ±9.35 for NS (p=0.12). TXA had a mean (SD) bleeding score of 4.0 ± 2.33 on day 1 compared to 3.64 ± 2.76 in NS group when measured on a Likert scale (p = 0.89). The mean self-reported time to return to work was 4.67 ± 2.22 days for TXA and 6.87 ± 4.42 for NS (p=0.10). Zero cases of confirmed thromboembolism were seen. Conclusions: Although statistically non-significant differences were observed, data from this pilot study imply that there is merit in a larger study to further assess the effects of topical TXA following ESS. There may be a role for increasing the exposure to topical TXA via a different formulation.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46129634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Zinreich, T. Smith, F. Kuhn, S. Márquez, M. Solaiyappan, W. Hosemann
Objective: Our objective is to provide observations demonstrated with 3Dimensional Computed x-ray Stereoscopic Imaging (3DCTSI) in the evaluation of the anterior ethmoid and frontal sinus development from birth to age 18. Methods: This is a retrospective evaluation of patient’s CT studies performed over a fifteen-year period, reported as normal studies, and included 53 patients (142 sides) from birth to age 18. Results: At birth, there are two spaces covered by folds, the uncinate and bulla lamellae. The spaces communicate with the Middle Meatus (MM) through the emerging ethmoid infundibulum (EI) and the retrobulbar recess space (RBRS). In the first month after birth, an expansile and breakdown developmental phase blend and continue throughout the growth into the teenage years. The 3D images reveal dark lamellar structures, on the surface of the medial lamina papyracea as well as bridging the broken spatial outlines. The dark lamellae represent the mucosal lamina propria, in unossified lamellae and are the origin of permanent spatial walls. From ages 4 to 18 years, initially, the frontal recess (FR) and later the MM penetrate into the cancellous frontal bone creating the frontal Sinus (FS), the frontal septum (FS), Inter-Frontal Sinus Septal Cell (IFSSC), as well as the Fronto-Ethmoidal and Frontal Bulla Spaces. Conclusion: 3DCTSI is the first intuitive imaging modality to reveal the microanatomical development of the anterior ethmoid and frontal sinus anatomy.
{"title":"3D CT stereoscopic imaging: observations of the frontal and anterior ethmoid sinuses development from birth to early adulthood","authors":"S. Zinreich, T. Smith, F. Kuhn, S. Márquez, M. Solaiyappan, W. Hosemann","doi":"10.4193/rhinol/22.005","DOIUrl":"https://doi.org/10.4193/rhinol/22.005","url":null,"abstract":"Objective: Our objective is to provide observations demonstrated with 3Dimensional Computed x-ray Stereoscopic Imaging (3DCTSI) in the evaluation of the anterior ethmoid and frontal sinus development from birth to age 18. Methods: This is a retrospective evaluation of patient’s CT studies performed over a fifteen-year period, reported as normal studies, and included 53 patients (142 sides) from birth to age 18. Results: At birth, there are two spaces covered by folds, the uncinate and bulla lamellae. The spaces communicate with the Middle Meatus (MM) through the emerging ethmoid infundibulum (EI) and the retrobulbar recess space (RBRS). In the first month after birth, an expansile and breakdown developmental phase blend and continue throughout the growth into the teenage years. The 3D images reveal dark lamellar structures, on the surface of the medial lamina papyracea as well as bridging the broken spatial outlines. The dark lamellae represent the mucosal lamina propria, in unossified lamellae and are the origin of permanent spatial walls. From ages 4 to 18 years, initially, the frontal recess (FR) and later the MM penetrate into the cancellous frontal bone creating the frontal Sinus (FS), the frontal septum (FS), Inter-Frontal Sinus Septal Cell (IFSSC), as well as the Fronto-Ethmoidal and Frontal Bulla Spaces. Conclusion: 3DCTSI is the first intuitive imaging modality to reveal the microanatomical development of the anterior ethmoid and frontal sinus anatomy.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47595015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The purpose of this study was to assess the time-effect of clarithromycin on the inflammatory response in chronic rhinosinusitis (CRS), to further explore the use of macrolides in cell culture as a model for CRS, and its action on the immune system. Methodology: The time effect of clarithromycin on several cytokines was examined for IL-1β, IL-4, IL-5, IL-8 and GM-CSF. Samples prior and post-incubation were assessed, as well as samples collected 24h following removal of clarithromycin to determine if any immunomodulatory effect persisted. Cytokines were quantified using ProcartaPlexTM assays. Results: Of the 5 cytokines assessed, only IL-1β and IL-8 production were significantly inhibited at 4h. Increased levels of IL-4 were observed at 72 hours of incubation and returned to near baseline levels after its removal. IL-8 showed the most time-dependent relationship with clarithromycin. No differences between the expression of IL-5 and GM-CSF were found. Conclusions: The present work suggests a specific and dose-dependent impact of clarithromycin on the inflammatory response in CRS. Moreover, the immunomodulatory effects of clarithromycin on the cytokines IL-4 and IL-8 varied depending on length of exposure to clarithromycin. Further studies to further establish the relationship between length of exposure and cytokine expression, and with additional “actors” in CRS pathophysiology should be considered. This may enable us in the future to determine appropriate duration of macrolide therapy in patients with CRS.
{"title":"Time-dependent effect of clarithromycin on pro-inflammatory cytokines in CRS","authors":"A. Pratas, Z. Shaida, J. Gavrilovic, C. Philpott","doi":"10.4193/rhinol/21.051","DOIUrl":"https://doi.org/10.4193/rhinol/21.051","url":null,"abstract":"Background: The purpose of this study was to assess the time-effect of clarithromycin on the inflammatory response in chronic rhinosinusitis (CRS), to further explore the use of macrolides in cell culture as a model for CRS, and its action on the immune system. Methodology: The time effect of clarithromycin on several cytokines was examined for IL-1β, IL-4, IL-5, IL-8 and GM-CSF. Samples prior and post-incubation were assessed, as well as samples collected 24h following removal of clarithromycin to determine if any immunomodulatory effect persisted. Cytokines were quantified using ProcartaPlexTM assays. Results: Of the 5 cytokines assessed, only IL-1β and IL-8 production were significantly inhibited at 4h. Increased levels of IL-4 were observed at 72 hours of incubation and returned to near baseline levels after its removal. IL-8 showed the most time-dependent relationship with clarithromycin. No differences between the expression of IL-5 and GM-CSF were found. Conclusions: The present work suggests a specific and dose-dependent impact of clarithromycin on the inflammatory response in CRS. Moreover, the immunomodulatory effects of clarithromycin on the cytokines IL-4 and IL-8 varied depending on length of exposure to clarithromycin. Further studies to further establish the relationship between length of exposure and cytokine expression, and with additional “actors” in CRS pathophysiology should be considered. This may enable us in the future to determine appropriate duration of macrolide therapy in patients with CRS.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48509543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Sublingual immunotherapy (SLIT) can be delivered via tablets (SLIT-T) or aqueous drops (SLIT-D). SLIT-D dosing recommendations using North American extracts were published in 2015. We review the 2015 recommendations in the context of recent research, and compare and contrast dosing, efficacy, safety, adherence, and cost of SLIT-T and SLIT-D for allergic rhinoconjunctivitis (ARC) in North America. Methods: Randomized controlled trials (RCT) of SLIT-D and SLIT-T trials were identified by a systematic PubMed search through March 1, 2022. Results: Dose-finding studies have been conducted for all approved SLIT-T; efficacy in North American populations was demonstrated in 11 RCTs. Approved SLIT-T are uniform internationally. Few dose-finding studies for SLIT-D have been conducted using North American extracts; efficacy was demonstrated in 2 RCTs. Extrapolation of dosing from SLIT-D studies conducted with extracts from other geographic regions is unreliable. Since the 2015 SLIT-D dosing recommendations, no new RCTs of SLIT-D have been conducted with North American extracts, whereas 6 SLIT-T RCTs have since been conducted in North America. Local allergic reactions are the most common adverse events with SLIT-T and SLIT-D, but both can induce systemic allergic reactions. Adherence to SLIT-D and SLIT-T remains a challenge. Patients must pay for SLIT-D directly, whereas SLIT-T is usually covered by insurance. Conclusion: As part of shared decision-making, patients should be informed about the scientific evidence supporting the use of SLIT-T and SLIT-D for ARC.
{"title":"Delivery options for sublingual immunotherapy for allergic rhinoconjunctivitis: clinical considerations for North America","authors":"K. Lam, J. M. Pinto, S.E. Lee, K. Rance, H. Nolte","doi":"10.4193/rhinol/22.002","DOIUrl":"https://doi.org/10.4193/rhinol/22.002","url":null,"abstract":"Background: Sublingual immunotherapy (SLIT) can be delivered via tablets (SLIT-T) or aqueous drops (SLIT-D). SLIT-D dosing recommendations using North American extracts were published in 2015. We review the 2015 recommendations in the context of recent research, and compare and contrast dosing, efficacy, safety, adherence, and cost of SLIT-T and SLIT-D for allergic rhinoconjunctivitis (ARC) in North America. Methods: Randomized controlled trials (RCT) of SLIT-D and SLIT-T trials were identified by a systematic PubMed search through March 1, 2022. Results: Dose-finding studies have been conducted for all approved SLIT-T; efficacy in North American populations was demonstrated in 11 RCTs. Approved SLIT-T are uniform internationally. Few dose-finding studies for SLIT-D have been conducted using North American extracts; efficacy was demonstrated in 2 RCTs. Extrapolation of dosing from SLIT-D studies conducted with extracts from other geographic regions is unreliable. Since the 2015 SLIT-D dosing recommendations, no new RCTs of SLIT-D have been conducted with North American extracts, whereas 6 SLIT-T RCTs have since been conducted in North America. Local allergic reactions are the most common adverse events with SLIT-T and SLIT-D, but both can induce systemic allergic reactions. Adherence to SLIT-D and SLIT-T remains a challenge. Patients must pay for SLIT-D directly, whereas SLIT-T is usually covered by insurance. Conclusion: As part of shared decision-making, patients should be informed about the scientific evidence supporting the use of SLIT-T and SLIT-D for ARC.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44735007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Eustachian tube dysfunction (ETD) has been associated with inflammatory conditions (1). Many studies have identified a high prevalence of ETD in patients with chronic rhinosinusitis (CRS) (2). However, there is a paucity of higher-level evidence assessing the impact of endoscopic sinus surgery (ESS) on patients with ETD concurrent disease. Methods: Systematic review and meta-analysis of non-randomised studies on the impact of ESS on ETD in patients with CRS, based on the eustachian tube dysfunction questionnaire (ETDQ-7) scores. PRISMA guidelines were followed according to a priori study protocol (PROSPERO Registration number: CRD42021245677). A random-effects model was employed. Results: 21 results were obtained using our search strategy. Four studies met our inclusion criteria. 501 patients were identified in the included studies. The prevalence of ETD in CRS patients in our review was 55.1%. Pooled estimates showed a statistically significant reduction in ETDQ-7 scores. Conclusions: The evidence to date suggests there is a high prevalence of concurrent ETD in CRS patients, the symptoms of which improved following ESS for CRS in this patient group. However, the current evidence base is comprised of uncontrolled case series. High-quality, randomised controlled studies with long-term follow-up are lacking.
{"title":"Impact of endoscopic sinus surgery on Eustachian tube dysfunction in patients with chronic rhinosinusitis: systematic review and meta-analysis","authors":"O. Rotimi, N. Mohamed, K. Steele, P. Bowles","doi":"10.4193/rhinol/22.007","DOIUrl":"https://doi.org/10.4193/rhinol/22.007","url":null,"abstract":"Background: Eustachian tube dysfunction (ETD) has been associated with inflammatory conditions (1). Many studies have identified a high prevalence of ETD in patients with chronic rhinosinusitis (CRS) (2). However, there is a paucity of higher-level evidence assessing the impact of endoscopic sinus surgery (ESS) on patients with ETD concurrent disease. Methods: Systematic review and meta-analysis of non-randomised studies on the impact of ESS on ETD in patients with CRS, based on the eustachian tube dysfunction questionnaire (ETDQ-7) scores. PRISMA guidelines were followed according to a priori study protocol (PROSPERO Registration number: CRD42021245677). A random-effects model was employed. Results: 21 results were obtained using our search strategy. Four studies met our inclusion criteria. 501 patients were identified in the included studies. The prevalence of ETD in CRS patients in our review was 55.1%. Pooled estimates showed a statistically significant reduction in ETDQ-7 scores. Conclusions: The evidence to date suggests there is a high prevalence of concurrent ETD in CRS patients, the symptoms of which improved following ESS for CRS in this patient group. However, the current evidence base is comprised of uncontrolled case series. High-quality, randomised controlled studies with long-term follow-up are lacking.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47242264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Challis, M. Baptista, R. Ragupathy, C.K. Lee, A. Wood
Background: Oral antibiotics are commonly prescribed after endoscopic sinus surgery (ESS) despite minimal clinical data supporting this practice. We aim to assess the effect of post-ESS doxycycline on clinical outcomes and on the diversity and composition of the sinonasal microbiome. Methods: Samples from the middle meatus were collected from twelve patients undergoing ESS to treat chronic rhinosinusitis. Patients were double-blind randomised to receive either oral doxycycline or placebo in the post-operative period. Further samples were collected at two weeks and three months post-operatively. The sinonasal microbiome was characterized using 16S ribosomal RNA (rRNA) gene amplicon sequencing. SNOT-22 scores, Lund Mackay scores, and Modified Lund Mackay Endoscopic Scores (MLMES) were collected. Results: After ESS, bacterial diversity increased while SNOT-22 score decreased for both treatments. Microbiome composition diverged between treatments, and random forest analysis identified nine taxa that may distinguish treatment groups. There was no significant difference in SNOT-22 score, 3-month MLMES or bacterial diversity between the placebo and doxycycline groups. The trends for all of these measures favour placebo. Conclusion: In this pilot study, we detected no significant difference between placebo and antibiotic treatments in clinical outcome. As patient symptoms improved after ESS, we detected a concurrent increase in the diversity of the sinonasal microbiome. Our data highlight the need for and facilitate the design of future larger studies to explore the relationship between prophylactic antibiotics and post-ESS recovery.
{"title":"A pilot randomised controlled trial of oral doxycycline after endoscopic sinus surgery and its effects on the sinonasal microbiome","authors":"J. Challis, M. Baptista, R. Ragupathy, C.K. Lee, A. Wood","doi":"10.4193/rhinol/22.004","DOIUrl":"https://doi.org/10.4193/rhinol/22.004","url":null,"abstract":"Background: Oral antibiotics are commonly prescribed after endoscopic sinus surgery (ESS) despite minimal clinical data supporting this practice. We aim to assess the effect of post-ESS doxycycline on clinical outcomes and on the diversity and composition of the sinonasal microbiome. Methods: Samples from the middle meatus were collected from twelve patients undergoing ESS to treat chronic rhinosinusitis. Patients were double-blind randomised to receive either oral doxycycline or placebo in the post-operative period. Further samples were collected at two weeks and three months post-operatively. The sinonasal microbiome was characterized using 16S ribosomal RNA (rRNA) gene amplicon sequencing. SNOT-22 scores, Lund Mackay scores, and Modified Lund Mackay Endoscopic Scores (MLMES) were collected. Results: After ESS, bacterial diversity increased while SNOT-22 score decreased for both treatments. Microbiome composition diverged between treatments, and random forest analysis identified nine taxa that may distinguish treatment groups. There was no significant difference in SNOT-22 score, 3-month MLMES or bacterial diversity between the placebo and doxycycline groups. The trends for all of these measures favour placebo. Conclusion: In this pilot study, we detected no significant difference between placebo and antibiotic treatments in clinical outcome. As patient symptoms improved after ESS, we detected a concurrent increase in the diversity of the sinonasal microbiome. Our data highlight the need for and facilitate the design of future larger studies to explore the relationship between prophylactic antibiotics and post-ESS recovery.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43410818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Landsberg, S. Schneider, M. Masalha, A. Margulis, M. Guindy, J. Luckman
Background: Sinus CT is the imaging technique of choice for planning endoscopic sinus surgery (ESS). Although MRI has a better soft tissue demonstration, it is not commonly used for ESS due to suboptimal bone demonstration. We hypothesised that adjustment of certain MRI parameters, would allow better demonstration of bones and enable the surgeon to adequately identify surgical landmarks. Methodology: Twenty patients identified as candidates for ESS underwent CT and adjusted MRI exams of the paranasal sinuses (40 in total). rhinologist and a neuroradiologist independently compared and graded 46 bony structures (23 on each side) in each patient's CT and MRI. Overall, 920 anatomical structures were graded by each observer (1840 structures in total). Statistical analysis included overall and per variable grading distribution for each observer, and overall agreement. Results: MRI images were equal, or superior to CT for assessing paranasal anatomy in 66.8% and 86.4% of structures evaluated by the rhinologist and neuroradiologist, respectively. Overall agreement between observers (77%) was moderate. Conclusion: The rhinologist prefers CT demonstration of bony structures, while the neuroradiologist prefers MRI. Still, with the MRI protocol used in this study, according to both, most bony structures are well demonstrated by MRI.
{"title":"Comparison of CT and adjusted MRI for evaluating paranasal sinuses surgical key landmarks","authors":"R. Landsberg, S. Schneider, M. Masalha, A. Margulis, M. Guindy, J. Luckman","doi":"10.4193/rhinol/21.022","DOIUrl":"https://doi.org/10.4193/rhinol/21.022","url":null,"abstract":"Background: Sinus CT is the imaging technique of choice for planning endoscopic sinus surgery (ESS). Although MRI has a better soft tissue demonstration, it is not commonly used for ESS due to suboptimal bone demonstration. We hypothesised that adjustment of certain MRI parameters, would allow better demonstration of bones and enable the surgeon to adequately identify surgical landmarks. Methodology: Twenty patients identified as candidates for ESS underwent CT and adjusted MRI exams of the paranasal sinuses (40 in total). rhinologist and a neuroradiologist independently compared and graded 46 bony structures (23 on each side) in each patient's CT and MRI. Overall, 920 anatomical structures were graded by each observer (1840 structures in total). Statistical analysis included overall and per variable grading distribution for each observer, and overall agreement. Results: MRI images were equal, or superior to CT for assessing paranasal anatomy in 66.8% and 86.4% of structures evaluated by the rhinologist and neuroradiologist, respectively. Overall agreement between observers (77%) was moderate. Conclusion: The rhinologist prefers CT demonstration of bony structures, while the neuroradiologist prefers MRI. Still, with the MRI protocol used in this study, according to both, most bony structures are well demonstrated by MRI.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47014429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Loss of smell and taste is one of the early and sensitive symptoms of COVID-19 that usually improves over time. Post-COVID-19 phantosmia, a smell distorted sensation without the presence of odorants, has deleterious and long-lasting effects on the patient's quality of life. We aimed to present our experience with phantosmia. Case presentations: We report a description of a series of eleven cases (age of 29 ± 9 years, and 54.5% females) of post-COVID-19 phantosmia without any other comorbidity, and the effects of combined treatment modalities (olfactory training, nasal irrigation with budesonide and oral prednisolone) on self-perceived improvement in phantosmia. Conclusions: We postulate that the combined 10 days oral prednisolone, smell training, and nasal irrigation for three months improved post-COVID-19 phantosmia assessed as post vs. pre self-perceived improvement, although this was not aimed at as a treatment since it was not compared to untreated controls.
{"title":"Characterization, treatment modalities, and self-perceived improvement of post-COVID-19 phantosmia: a case series of eleven patients","authors":"A. N. Alrasheedi","doi":"10.4193/rhinol/22.003","DOIUrl":"https://doi.org/10.4193/rhinol/22.003","url":null,"abstract":"Background: Loss of smell and taste is one of the early and sensitive symptoms of COVID-19 that usually improves over time. Post-COVID-19 phantosmia, a smell distorted sensation without the presence of odorants, has deleterious and long-lasting effects on the patient's quality of life. We aimed to present our experience with phantosmia. Case presentations: We report a description of a series of eleven cases (age of 29 ± 9 years, and 54.5% females) of post-COVID-19 phantosmia without any other comorbidity, and the effects of combined treatment modalities (olfactory training, nasal irrigation with budesonide and oral prednisolone) on self-perceived improvement in phantosmia. Conclusions: We postulate that the combined 10 days oral prednisolone, smell training, and nasal irrigation for three months improved post-COVID-19 phantosmia assessed as post vs. pre self-perceived improvement, although this was not aimed at as a treatment since it was not compared to untreated controls.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41536505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Sharma, A. Rana, V. Sharma, A. Mehrotra, H. Babu, S. Gupta, R. Singh, A. Tyagi, N. Sethi, P. Bhatt, V. Yadav, P. Chopra, D. Upadhyay
Background: Studies showed olfactory disturbances in COVID patients. This has attracted focus of clinicians as an easy clinical screening tool in suspected population. Material and methods: 70 mild and moderate category COVID-19 RT-PCR positive patients, more than 10 years of age were tested on day of admission for olfaction with serial dilution of n-butanol and asked to grade severity of their olfactory dysfunction according to visual analogue score from 1-10. Results: Fatigue 42 (93.33%), sore throat 37 (82.22%), fever 36 (80%) and dyspnea 23 (51.11%) were the most common symptoms in moderate patients. Diabetes, hypertension and allergy were the three prominent risk factors. At time of admission, n-butanol diagnosed 20 patients having olfactory dysfunction compared to 11 by VAS. Patients tend to grade their dysfunction higher on VAS whereas the n-butanol test classified their olfactory dysfunction lower. Viral load and high CRP were not found to be significantly related with olfactory dysfunction. d-Dimer and LDH levels were found statistically associated with higher grading of olfactory dysfunction detected by n-butanol. Conclusion: The majority of cases developed hyposmia before they were admitted to hospital even before they realized that they were having hyposmia as revealed by n-butanol testing. We should go for objective tests of olfaction.
{"title":"Clinical correlation and assessment of olfactory dysfunction with n-butanol in COVID-19 patients: our experience","authors":"R. Sharma, A. Rana, V. Sharma, A. Mehrotra, H. Babu, S. Gupta, R. Singh, A. Tyagi, N. Sethi, P. Bhatt, V. Yadav, P. Chopra, D. Upadhyay","doi":"10.4193/rhinol/21.055","DOIUrl":"https://doi.org/10.4193/rhinol/21.055","url":null,"abstract":"Background: Studies showed olfactory disturbances in COVID patients. This has attracted focus of clinicians as an easy clinical screening tool in suspected population. Material and methods: 70 mild and moderate category COVID-19 RT-PCR positive patients, more than 10 years of age were tested on day of admission for olfaction with serial dilution of n-butanol and asked to grade severity of their olfactory dysfunction according to visual analogue score from 1-10. Results: Fatigue 42 (93.33%), sore throat 37 (82.22%), fever 36 (80%) and dyspnea 23 (51.11%) were the most common symptoms in moderate patients. Diabetes, hypertension and allergy were the three prominent risk factors. At time of admission, n-butanol diagnosed 20 patients having olfactory dysfunction compared to 11 by VAS. Patients tend to grade their dysfunction higher on VAS whereas the n-butanol test classified their olfactory dysfunction lower. Viral load and high CRP were not found to be significantly related with olfactory dysfunction. d-Dimer and LDH levels were found statistically associated with higher grading of olfactory dysfunction detected by n-butanol. Conclusion: The majority of cases developed hyposmia before they were admitted to hospital even before they realized that they were having hyposmia as revealed by n-butanol testing. We should go for objective tests of olfaction.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70416798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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