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Serum Aspergillus fumigatus-Specific IgG as a Complementary Biomarker in Differentiating Endotypes of Chronic Rhinosinusitis: A Study on Its Role and Diagnostic Efficacy in Type 2 Inflammation. 血清曲霉菌特异性 IgG 作为区分慢性鼻炎内型的补充生物标记物:关于其在2型炎症中的作用和诊断效力的研究。
IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-15 DOI: 10.1177/19458924241253937
Pei-Tzu Hung, Hsiang-Sheng Wang, Ta-Jen Lee, Chi-Che Huang, Po-Hung Chang, Yi-Wei Chen, Chia-Hsiang Fu

Background: Aspergillus is one of the most common pathogens causing fungal allergy in the respiratory tract. Serum Aspergillus fumigatus-specific immunoglobulin G (Af-sIgG) levels have been used as a biomarker for the diagnosis and treatment response monitoring in airway allergic diseases such as allergic bronchopulmonary aspergillosis and allergic fungal rhinosinusitis. However, its role in common primary chronic rhinosinusitis (CRS) was unclear.

Objective: This study aims to evaluate whether serum Af-sIgG level could serve as a biomarker for the disease presentation of primary CRS.

Methods: We obtained serum Af-sIgG levels from patients diagnosed as bilateral primary CRS refractory to medical treatment and evaluated the correlations between serum Af-sIgG levels and disease severity in patients with type 2 (T2) and non-T2 CRS.

Results: Patients with T2 CRS exhibited significantly higher serum Af-sIgG levels than non-T2 CRS patients. The cut-off value of serum Af-sIgG in T2 CRS was 20.9 mg/L, with an odds ratio of 3.8 (95% CI 1.17-12.20, P = .026). Furthermore, serum Af-sIgG levels were positively correlated with symptom scores evaluated by the Sino-Nasal Outcome Test-22 (SNOT-22) scores in T2 patients (P = .009). While stratified by SNOT-22 total scores, patients with severe disease had higher serum Af-sIgG levels only in T2 CRS (P = .034). In individual domains of SNOT-22 analysis, serum Af-sIgG levels showed a significant correlation with "ear/facial" symptom scores in the T2 group (P < .001).

Conclusions: Serum Af-sIgG levels may serve as a supplementary objective biomarker that correlates with identification and subjective measurements of T2 CRS, and may be associated with symptoms arising from Eustachian tube dysfunction.

背景:曲霉菌是导致呼吸道真菌过敏的最常见病原体之一。血清曲霉菌特异性免疫球蛋白 G(Af-sIgG)水平已被用作过敏性支气管肺曲霉菌病和过敏性真菌性鼻炎等气道过敏性疾病诊断和治疗反应监测的生物标志物。然而,它在普通原发性慢性鼻炎(CRS)中的作用尚不明确:本研究旨在评估血清 Af-sIgG 水平是否可作为原发性 CRS 疾病表现的生物标志物:我们采集了被诊断为药物治疗难治性双侧原发性CRS患者的血清Af-sIgG水平,并评估了2型(T2)和非T2型CRS患者血清Af-sIgG水平与疾病严重程度之间的相关性:结果:T2型CRS患者的血清Af-sIgG水平明显高于非T2型CRS患者。T2 CRS患者血清Af-sIgG的临界值为20.9 mg/L,几率比为3.8(95% CI 1.17-12.20,P = .026)。此外,在T2患者中,血清Af-sIgG水平与通过Sino-Nasal Outcome Test-22(SNOT-22)评分评估的症状评分呈正相关(P = .009)。根据 SNOT-22 总分进行分层,只有在 T2 CRS 患者中,重症患者的血清 Af-sIgG 水平较高(P = .034)。在 SNOT-22 分析的单个领域中,T2 组血清 Af-sIgG 水平与 "耳/面部 "症状评分有显著相关性(P = 0.009):血清 Af-sIgG 水平可作为一种补充性客观生物标志物,与 T2 CRS 的识别和主观测量结果相关,并可能与咽鼓管功能障碍引起的症状有关。
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引用次数: 0
Prevalence and Magnitude of Olfactory Dysfunction in Allergic Rhinitis. 过敏性鼻炎患者嗅觉功能障碍的发生率和程度
IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-17 DOI: 10.1177/19458924241253642
Marco A Fornazieri, Ellen C D Garcia, Ricardo H Montero, Ricardo Borges, Thiago F P Bezerra, Fábio R Pinna, Richard L Doty, Richard L Voegels

Background: Although allergic rhinitis (AR) can negatively impact the ability to smell, the degree to which this occurs is not clear and prevalence estimates vary among studies. This study had 4 main objectives: (1) To estimate the prevalence and the degree of olfactory dysfunction in AR patients; (2) To compare olfactory perception between AR patients with different persistence and severity of symptoms and determine if olfactory testing may aid in differentiating among Allergic Rhinitis and its Impact on Asthma (ARIA) groups; (3) To determine whether allergic reactions to different allergens differentially impact olfactory function, and (4) Verify possible changes in the olfactory epithelium (OE) caused by AR.

Methods: One hundred thirty-three patients with AR and one hundred controls were tested. The main outcome was the score in University of Pennsylvania Smell Identification Test (UPSIT®). The OE was examined using immunofluorescence markers for neuronal activity, apoptosis, oxidative stress, signal transduction, eosinophils, and epithelial thickness.

Results: Prevalence of olfactory dysfunction in the AR patients was higher (AR: 42.9% vs controls: 9%, P < .001). No difference was found either between intermittent and persistent disease cases (P = .58) or between cases with mild and those with moderate/severe symptomatology (P = .33). Lower olfactory capacity was not associated with the reaction to more (P = .48) or diverse types of allergens (Ps > .05). Although not significant, patients with AR had a greater amount of eosinophilia and a lower amount of cAMP (cyclic adenosine monophosphate) in the OE.

Conclusion: The study highlights a higher prevalence of olfactory dysfunction in AR patients compared to controls, but olfactory testing may not effectively differentiate AR severity or allergen sensitivities. Although trends suggest potential pathophysiological changes in the OE of AR patients, further research is needed to validate these findings.

背景:虽然过敏性鼻炎(AR)会对嗅觉能力产生负面影响,但这种影响的程度尚不明确,而且不同研究对患病率的估计也不尽相同。本研究有四个主要目标:(1)估计 AR 患者嗅觉功能障碍的患病率和程度;(2)比较不同症状持续时间和严重程度的 AR 患者的嗅觉感知,并确定嗅觉测试是否有助于区分过敏性鼻炎及其对哮喘的影响(ARIA)群体;(3)确定对不同过敏原的过敏反应是否会对嗅觉功能产生不同影响;以及(4)验证 AR 可能引起的嗅上皮(OE)变化。研究方法对 133 名 AR 患者和 100 名对照组进行了测试。主要结果是宾夕法尼亚大学嗅觉识别测试(UPSIT®)的得分。使用免疫荧光标记对神经元活动、细胞凋亡、氧化应激、信号转导、嗜酸性粒细胞和上皮厚度进行了检查:结果:AR 患者的嗅觉功能障碍发生率较高(AR:42.9% vs 对照组:9%,P = .58),轻度症状病例和中度/重度症状病例的发生率也较高(P = .33)。嗅觉能力较低与对更多过敏原(P = .48)或不同类型过敏原(Ps > .05)的反应无关。AR患者的嗜酸性粒细胞增多,OE中的cAMP(环磷酸腺苷)含量降低,尽管这两点并不显著:该研究强调,与对照组相比,AR 患者的嗅觉功能障碍发生率更高,但嗅觉测试可能无法有效区分 AR 的严重程度或过敏原敏感性。尽管趋势表明 AR 患者的嗅觉功能可能发生了病理生理变化,但还需要进一步的研究来验证这些发现。
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引用次数: 0
Transcutaneous Retrobulbar Amphotericin B Injection for Invasive Fungal Sinusitis with Orbital Involvement: A Systematic Review. 经皮球后注射两性霉素 B 治疗眼眶受累的侵袭性真菌性鼻窦炎:系统回顾。
IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-21 DOI: 10.1177/19458924241254422
Hasan Abdulbaki, Jacquelyn K Callander, Judd H Fastenberg, Matthew S Russell, M Reza Vagefi, Robert C Kersten, Patricia A Loftus

Background: Orbital involvement of invasive fungal sinusitis (IFS) is an ominous prognostic marker that should prompt rapid intervention. Transcutaneous retrobulbar administration of amphotericin B (TRAMB) is an off-label adjunctive treatment that can increase drug penetrance into diseased orbital tissue. To date, there is a lack of consensus regarding the use of TRAMB for treatment of IFS with orbital involvement.

Objective: This systematic review aims to synthesize the indications, efficacy, and potential complications of TRAMB.

Methods: PubMed, EMBASE, and Web of Science databases were probed for systematic review. Article search was conducted through June 2023 using the keywords "invasive fungal sinusitis," "invasive fungal rhinosinusitis," "rhino-orbital mucormycosis," "rhinosinusitis," "orbital," "retrobulbar," and "amphotericin."

Results: In suitable cases as determined by radiologic and clinical evaluation, TRAMB administration has the potential to improve orbital salvage rates and improve versus stabilize visual acuity. Treatment complications are more likely with deoxycholate than with liposomal amphotericin formulations. The existing literature describing use of TRAMB is limited due to its retrospective nature, but the increase in IFS cases since 2020 due to the COVID pandemic has broadened the literature.

Conclusions: TRAMB is an effective adjunctive treatment in IFS with mild-to-moderate orbital involvement when used in combination with standard of care debridement, systemic antifungal therapy, and immunosuppression reversal. Prospective longitudinal studies and multi-institutional randomized trials are necessary to determine the definitive utility of TRAMB.

背景:侵袭性真菌性鼻窦炎(IFS)的眼眶受累是一个不祥的预后标志,应迅速采取干预措施。经皮球后注射两性霉素 B(TRAMB)是一种标签外的辅助治疗方法,可增加药物对病变眼眶组织的穿透力。迄今为止,关于使用两性霉素 B 治疗眼眶受累的 IFS 还缺乏共识:本系统综述旨在总结 TRAMB 的适应症、疗效和潜在并发症:方法:对 PubMed、EMBASE 和 Web of Science 数据库进行系统性检索。以 "侵袭性真菌性鼻窦炎"、"侵袭性真菌性鼻窦炎"、"鼻-眶粘液瘤病"、"鼻窦炎"、"眶"、"球后 "和 "两性霉素 "为关键词,对截至 2023 年 6 月的文章进行了检索:在通过放射学和临床评估确定的合适病例中,使用 TRAMB 有可能提高眼眶救治率,改善或稳定视力。与脂质体两性霉素制剂相比,脱氧胆酸盐更容易引起治疗并发症。由于 TRAMB 是回顾性的,因此现有文献对其使用情况的描述有限,但自 2020 年以来,COVID 大流行导致 IFS 病例增加,这扩大了文献的范围:TRAMB与标准护理清创、全身抗真菌治疗和免疫抑制逆转联合使用时,是轻度至中度眼眶受累IFS的有效辅助治疗方法。有必要进行前瞻性纵向研究和多机构随机试验,以确定 TRAMB 的确切效用。
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引用次数: 0
Topical Application of 5-Fluorouracil for the Treatment of Sinonasal Adenocarcinoma and Inverted Papilloma. 局部应用 5-氟尿嘧啶治疗鼻窦腺癌和倒置乳头状瘤。
IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-07 DOI: 10.1177/19458924241260118
Lucy Revercomb, Aman M Patel, Ivan Filimonov, David Lerner, Andrey Filimonov

Background: Sinonasal tumors represent a rare and heterogeneous group of rhinologic neoplasms. Even with advancements in surgical approaches, mortality rates of patients with sinonasal adenocarcinoma (SNAC) have not significantly improved and persistently high rates of recurrence in certain patients with inverted papilloma (IP) are seen. The use of 5-fluorouracil (5-FU) has been successfully described as an adjuvant treatment of SNAC and in the prevention of IP recurrence.

Objective: This review aims to present the current evidence on the management of SNAC and IP with topical 5-FU.

Methods: A three-author independent literature review was conducted to identify research involving the use of topical 5-FU for the treatment of SNAC and IP. A total of nine papers on the treatment of SNAC and IP were collected.

Results: The earliest study looking at the combination of adjuvant low-dose radiation and topical 5-FU for adenocarcinoma of the ethmoid sinus showed a 5-year survival rate of 100%. A follow-up study evaluating a similar protocol reported adjusted disease-free survival at 2, 5, and 10 years of 96%, 87%, and 74%, respectively. Similar results have been demonstrated for adjuvant 5-FU use following endoscopic resection and have even been described in the novel setting of transcutaneous 5-FU delivery following frontal trephination. Topical 5-FU has also been described in the treatment of aggressive IP. The largest case series described the use of 5-FU for eighteen cases and demonstrated only a single recurrence.

Conclusion: The use of topical 5-FU currently represents an underutilized therapeutic modality within the treatment of rhinologic neoplasms. Available literature suggests that neoadjuvant use of topical 5-FU can improve survival and decrease recurrence for SNAC and IP. However, the small sample sizes prevent advocation for routine use in the general population and further research on 5-FU is necessary.

背景:鼻窦肿瘤是一种罕见的异质性鼻科肿瘤。即使手术方法不断进步,鼻窦腺癌(SNAC)患者的死亡率也没有明显改善,某些倒置乳头状瘤(IP)患者的复发率一直居高不下。5-氟尿嘧啶(5-FU)作为鼻窦腺癌(SNAC)的辅助治疗和预防倒置乳头状瘤(IP)复发的药物已被成功应用:本综述旨在介绍目前使用 5-FU 局部治疗 SNAC 和 IP 的证据:方法:我们进行了一项由三位作者独立撰写的文献综述,以确定有关使用局部 5-FU 治疗 SNAC 和 IP 的研究。共收集到九篇关于治疗SNAC和IP的论文:最早对乙状窦腺癌联合使用低剂量放射线和局部 5-FU 辅助治疗的研究显示,5 年生存率为 100%。一项评估类似方案的后续研究报告显示,调整后的2年、5年和10年无病生存率分别为96%、87%和74%。内镜切除术后使用 5-FU 辅助治疗也取得了类似的效果,甚至在额部穿刺术后经皮下注射 5-FU 的新方法中也有类似的描述。外用 5-FU 也被用于治疗侵袭性 IP。最大的病例系列描述了 18 例使用 5-FU 的病例,结果显示只有一例复发:结论:目前,局部使用 5-FU 是治疗鼻腔肿瘤的一种未得到充分利用的治疗方式。现有文献表明,局部 5-FU 新辅助治疗可以提高鼻咽癌和鼻咽癌患者的生存率,降低复发率。然而,由于样本量较小,因此无法在普通人群中常规使用,有必要对 5-FU 进行进一步研究。
{"title":"Topical Application of 5-Fluorouracil for the Treatment of Sinonasal Adenocarcinoma and Inverted Papilloma.","authors":"Lucy Revercomb, Aman M Patel, Ivan Filimonov, David Lerner, Andrey Filimonov","doi":"10.1177/19458924241260118","DOIUrl":"10.1177/19458924241260118","url":null,"abstract":"<p><strong>Background: </strong>Sinonasal tumors represent a rare and heterogeneous group of rhinologic neoplasms. Even with advancements in surgical approaches, mortality rates of patients with sinonasal adenocarcinoma (SNAC) have not significantly improved and persistently high rates of recurrence in certain patients with inverted papilloma (IP) are seen. The use of 5-fluorouracil (5-FU) has been successfully described as an adjuvant treatment of SNAC and in the prevention of IP recurrence.</p><p><strong>Objective: </strong>This review aims to present the current evidence on the management of SNAC and IP with topical 5-FU.</p><p><strong>Methods: </strong>A three-author independent literature review was conducted to identify research involving the use of topical 5-FU for the treatment of SNAC and IP. A total of nine papers on the treatment of SNAC and IP were collected.</p><p><strong>Results: </strong>The earliest study looking at the combination of adjuvant low-dose radiation and topical 5-FU for adenocarcinoma of the ethmoid sinus showed a 5-year survival rate of 100%. A follow-up study evaluating a similar protocol reported adjusted disease-free survival at 2, 5, and 10 years of 96%, 87%, and 74%, respectively. Similar results have been demonstrated for adjuvant 5-FU use following endoscopic resection and have even been described in the novel setting of transcutaneous 5-FU delivery following frontal trephination. Topical 5-FU has also been described in the treatment of aggressive IP. The largest case series described the use of 5-FU for eighteen cases and demonstrated only a single recurrence.</p><p><strong>Conclusion: </strong>The use of topical 5-FU currently represents an underutilized therapeutic modality within the treatment of rhinologic neoplasms. Available literature suggests that neoadjuvant use of topical 5-FU can improve survival and decrease recurrence for SNAC and IP. However, the small sample sizes prevent advocation for routine use in the general population and further research on 5-FU is necessary.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"354-360"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141287606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Computed Tomography Signs of Sinonasal Inflammation in Patients with Acute Dacryocystitis. 急性泪囊炎患者鼻窦炎的计算机断层扫描征象
IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-21 DOI: 10.1177/19458924241262098
Yueqi Yu, Guangming Zhou, Xinyu Li, Jinfei Wei, Xiaoyu Ke, Linjuan Wu, Wencan Wu, Bo Yu

Background: Nasal and paranasal sinus abnormalities may be related to nasolacrimal duct obstructive disease but are strongly debated. Data of acute disease stage are lacking.

Objective: The purpose of this study was to determine if there are correlations between radiologic signs of sinus inflammation and acute dacryocystitis (AD).

Methods: This cross-sectional controlled study was conducted at Wenzhou, Zhejiang Province, China from February 2021 to November 2023. Forty-four consecutive patients with AD and 50 consecutive patients with orbital tumors (the control group), who completed preoperative computed tomography scans, were enrolled to evaluate the extent of their inflammatory sinonasal disease by the modified Lund-Mackay score system.

Results: The inflammation signs of the paranasal sinuses (total mean sinus scores, 95% CI [0.00, 2.00]; P < 0.001), namely the anterior ethmoid sinus(95% CI [0.00, 1.00]; P < 0.001), the posterior ethmoid sinus(95% CI [0.00, 0.00]; P = 0.003), the frontal sinus (95% CI [0.00, 0.00]; P = 0.02), and the ostiomeatal complex (P < 0.001) were more extensive in patients with AD when compared with the controls. The disease course was negatively correlated with the anterior ethmoid (P = 0.03) and frontal scores (P = 0.01). The symptom of eyelid swelling was positively correlated with the anterior ethmoid (P = 0.03), ostiomeatal complex (P = 0.004), and total sinus scores (P = 0.005).

Conclusion: Inflammatory sinus disease was found to be more frequent in patients with AD, which was gradually alleviated with the prolongation of the disease course. The mutual spread of inflammation particularly in the acute course may play an important role in lacrimal duct obstructive disease.

背景:鼻腔和副鼻窦异常可能与鼻泪管阻塞性疾病有关,但对此存在激烈的争论。目前还缺乏急性疾病阶段的数据:本研究的目的是确定鼻窦炎的放射学征象与急性泪囊炎(AD)之间是否存在相关性:这项横断面对照研究于 2021 年 2 月至 2023 年 11 月在中国浙江省温州市进行。方法:这项横断面对照研究于 2021 年 2 月至 2023 年 11 月在中国浙江温州进行,研究对象为完成术前计算机断层扫描的 44 例连续性急性泪囊炎患者和 50 例连续性眼眶肿瘤患者(对照组),采用改良的 Lund-Mackay 评分系统评估其鼻窦炎性疾病的程度:副鼻窦(平均鼻窦总分,95% CI [0.00,2.00];P P P = 0.003)、额窦(95% CI [0.00,0.00];P = 0.02)、骨骺复合体(P P = 0.03)和额叶评分(P = 0.01)的炎症体征。眼睑肿胀症状与乙状前窦(P = 0.03)、蝶窦复合体(P = 0.004)和总窦评分(P = 0.005)呈正相关:结论:炎症性鼻窦疾病在 AD 患者中更为常见,并随着病程的延长而逐渐缓解。炎症的相互蔓延,尤其是在急性期,可能在泪道阻塞性疾病中起着重要作用。
{"title":"Computed Tomography Signs of Sinonasal Inflammation in Patients with Acute Dacryocystitis.","authors":"Yueqi Yu, Guangming Zhou, Xinyu Li, Jinfei Wei, Xiaoyu Ke, Linjuan Wu, Wencan Wu, Bo Yu","doi":"10.1177/19458924241262098","DOIUrl":"10.1177/19458924241262098","url":null,"abstract":"<p><strong>Background: </strong>Nasal and paranasal sinus abnormalities may be related to nasolacrimal duct obstructive disease but are strongly debated. Data of acute disease stage are lacking.</p><p><strong>Objective: </strong>The purpose of this study was to determine if there are correlations between radiologic signs of sinus inflammation and acute dacryocystitis (AD).</p><p><strong>Methods: </strong>This cross-sectional controlled study was conducted at Wenzhou, Zhejiang Province, China from February 2021 to November 2023. Forty-four consecutive patients with AD and 50 consecutive patients with orbital tumors (the control group), who completed preoperative computed tomography scans, were enrolled to evaluate the extent of their inflammatory sinonasal disease by the modified Lund-Mackay score system.</p><p><strong>Results: </strong>The inflammation signs of the paranasal sinuses (total mean sinus scores, 95% CI [0.00, 2.00]; <i>P </i>< 0.001), namely the anterior ethmoid sinus(95% CI [0.00, 1.00]; <i>P </i>< 0.001), the posterior ethmoid sinus(95% CI [0.00, 0.00]; <i>P </i>= 0.003), the frontal sinus (95% CI [0.00, 0.00]; <i>P </i>= 0.02), and the ostiomeatal complex (<i>P </i>< 0.001) were more extensive in patients with AD when compared with the controls. The disease course was negatively correlated with the anterior ethmoid (<i>P </i>= 0.03) and frontal scores (<i>P </i>= 0.01). The symptom of eyelid swelling was positively correlated with the anterior ethmoid (<i>P </i>= 0.03), ostiomeatal complex (<i>P </i>= 0.004), and total sinus scores (<i>P </i>= 0.005).</p><p><strong>Conclusion: </strong>Inflammatory sinus disease was found to be more frequent in patients with AD, which was gradually alleviated with the prolongation of the disease course. The mutual spread of inflammation particularly in the acute course may play an important role in lacrimal duct obstructive disease.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"333-338"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Odontogenic Maxillary Sinusitis Microbiology Compared With Chronic Rhinosinusitis: A Meta-Analysis. 牙源性上颌窦炎微生物学与慢性鼻窦炎的比较:一项 Meta 分析。
IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-17 DOI: 10.1177/19458924241259333
Chang Lu, Yue Zhao, Yicheng Qin, Xi Zhang, Xiaozhe Yang, Yan Zhao, Xiangdong Wang, Jiang Lin

Background: Subtypes of sinusitis have different symptoms and prognoses due to different pathogens. Odontogenic maxillary sinusitis (OMS) mainly occurs unilaterally and is different from chronic rhinosinusitis (CRS) usually occurring bilaterally in terms of clinical characteristics. However, comprehensive microbiological comparisons between OMS and CRS have never been systematically conducted and most comparisons are methodologically biased. This study aims to provide a comprehensive analysis of the microbiology associated with OMS and CRS through a meta-analysis approach in order to provide evidence for differential diagnosis of OMS and CRS from a microbiological perspective.

Methods: The databases PubMed and CNKI were searched from their inception to July 2023. A random-effects model was employed to derive the pooled prevalence estimates of the identified bacterial species or genera.

Results: The 17 represented studies included 6 concerning OMS, 12 concerning CRS, and 4 concerning normal sinus, yielding 191, 610, and 92 samples, respectively. Though not statistically significant, the prevalence of Peptostreptococcus and Prevotella was generally higher in OMS compared to CRS. Notably, Fusobacterium was identified as the only genus with a significantly higher prevalence in OMS compared to CRS.

Conclusion: Fusobacterium was significantly more prevalent in OMS compared with CRS, while Staphylococcus aureus was more prevalent in CRS than in OMS. Such differences in bacterial profile may partly explain the distinct pathology observed and contribute to the development of novel strategies for diagnosis and therapeutic interventions in OMS.

背景:由于病原体不同,鼻窦炎的亚型具有不同的症状和预后。牙源性上颌窦炎(OMS)主要发生在单侧,与通常发生在双侧的慢性鼻窦炎(CRS)在临床特征上有所不同。然而,OMS 和 CRS 之间的全面微生物学比较从未系统地进行过,而且大多数比较在方法上存在偏差。本研究旨在通过荟萃分析方法对与 OMS 和 CRS 相关的微生物学进行全面分析,以便从微生物学角度为 OMS 和 CRS 的鉴别诊断提供证据:方法:对PubMed和CNKI数据库从开始到2023年7月进行了检索。结果:17 项代表性研究中有 6 项涉及 OMS 和 CRS:17项代表性研究中,6项涉及OMS,12项涉及CRS,4项涉及正常鼻窦,分别获得191、610和92个样本。尽管没有统计学意义,但与 CRS 相比,OMS 中肽链球菌和普雷沃茨菌的感染率普遍较高。值得注意的是,与 CRS 相比,镰刀菌是唯一一个在 OMS 中流行率明显较高的菌属:结论:与 CRS 相比,镰刀菌在 OMS 中的流行率明显更高,而金黄色葡萄球菌在 CRS 中的流行率则高于 OMS。细菌谱的这种差异可部分解释所观察到的不同病理现象,并有助于开发新的 OMS 诊断和治疗干预策略。
{"title":"Odontogenic Maxillary Sinusitis Microbiology Compared With Chronic Rhinosinusitis: A Meta-Analysis.","authors":"Chang Lu, Yue Zhao, Yicheng Qin, Xi Zhang, Xiaozhe Yang, Yan Zhao, Xiangdong Wang, Jiang Lin","doi":"10.1177/19458924241259333","DOIUrl":"10.1177/19458924241259333","url":null,"abstract":"<p><strong>Background: </strong>Subtypes of sinusitis have different symptoms and prognoses due to different pathogens. Odontogenic maxillary sinusitis (OMS) mainly occurs unilaterally and is different from chronic rhinosinusitis (CRS) usually occurring bilaterally in terms of clinical characteristics. However, comprehensive microbiological comparisons between OMS and CRS have never been systematically conducted and most comparisons are methodologically biased. This study aims to provide a comprehensive analysis of the microbiology associated with OMS and CRS through a meta-analysis approach in order to provide evidence for differential diagnosis of OMS and CRS from a microbiological perspective.</p><p><strong>Methods: </strong>The databases PubMed and CNKI were searched from their inception to July 2023. A random-effects model was employed to derive the pooled prevalence estimates of the identified bacterial species or genera.</p><p><strong>Results: </strong>The 17 represented studies included 6 concerning OMS, 12 concerning CRS, and 4 concerning normal sinus, yielding 191, 610, and 92 samples, respectively. Though not statistically significant, the prevalence of <i>Peptostreptococcus</i> and <i>Prevotella</i> was generally higher in OMS compared to CRS. Notably, <i>Fusobacterium</i> was identified as the only genus with a significantly higher prevalence in OMS compared to CRS.</p><p><strong>Conclusion: </strong><i>Fusobacterium</i> was significantly more prevalent in OMS compared with CRS, while <i>Staphylococcus aureus</i> was more prevalent in CRS than in OMS. Such differences in bacterial profile may partly explain the distinct pathology observed and contribute to the development of novel strategies for diagnosis and therapeutic interventions in OMS.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"324-332"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141330221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Management of the Nasolacrimal Duct in Expanded Endoscopic Approaches to the Maxillary Sinus: A Systematic Review with Evidence-based Recommendations. 上颌窦扩大内窥镜方法中的鼻泪管管理:系统回顾与循证建议》。
IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-27 DOI: 10.1177/19458924241249802
Neal Rajan Godse, Satyan Sreenath, Brian C Lobo, Raj Sindwani

Background: Utilizing expanded endoscopic approaches to the maxillary sinus for the endonasal management of a variety of tumors is increasing in popularity. The nasolacrimal duct (NLD) may be injured inadvertantly or need to be removed during tumor resection or to augment visualization. Management of the NLD can take the form of transection alone, transection with stenting, or performing a formal dacryocystorhinostomy to avoid postoperative sequelae of injury. The purpose of this study was to review the literature and determine the optimal management of the NLD during expanded maxillary sinus approaches.

Methods: A systematic review of Ovid, Embase, Medline, and Cochrane databases was performed to identify studies involving expanded approaches to the maxillary sinus and that explicitly reported the status of the NLD and postoperative outcomes.

Results: Nineteen studies were included in the analysis and divided into two groups: NLD-preserving (n = 9 studies; n = 191 patients in aggregate) and NLD-involving (n = 10 studies; n = 296 patients in aggregate). In the NLD-preserving subgroup, one patient out of a subgroup aggregate of 191 patients (0.5%) developed epiphora. In the NLD-involving subgroup, sharp transection alone was the most common method of NLD removal and was associated with a low rate of epiphora (study rates: 0 to 18.2%; aggregated subgroup rate: 7.0%, 21 / 296). Spontaneous resolution of symptoms was common (60%-100% cases).

Conclusions: The NLD should be preserved when feasible from an exposure and tumor-control perspective. When pathology or approach requires the removal of the NLD, rates of persistent epiphora are very low, regardless of surgical technique. When expanded maxillary approaches are employed, particularly for benign tumors, and require removal of the NLD, sharp transection is the simplest method of removal, provides a low rate of postoperative epiphora, and is supported by the available literature.

背景:利用上颌窦扩大内窥镜方法进行各种肿瘤的鼻内镜治疗越来越受欢迎。鼻泪管(NLD)可能会不慎损伤,或在肿瘤切除过程中需要切除,或为了增强可视性而切除。对鼻泪管的处理可以采取单独横断、横断加支架或进行正式的泪囊鼻腔造口术以避免术后损伤后遗症。本研究的目的是回顾文献,确定上颌窦扩张术中 NLD 的最佳处理方法:方法:对 Ovid、Embase、Medline 和 Cochrane 数据库进行了系统性回顾,以确定涉及上颌窦扩大入路且明确报告了 NLD 状况和术后结果的研究:结果:19 项研究被纳入分析,并分为两组:NLD保留组(9项研究,共191名患者)和NLD涉及组(10项研究,共296名患者)。在 NLD 保护亚组中,191 名患者中有一名患者(0.5%)出现了眼睑外翻。在涉及 NLD 的亚组中,单纯的锐性横切是最常见的 NLD 切除方法,与较低的上睑下垂发生率相关(研究比率:0 至 18.2%;亚组总比率:7.0%,21/296)。症状的自然缓解很常见(60%-100% 的病例):结论:从暴露和肿瘤控制的角度来看,在可行的情况下应保留 NLD。结论:从暴露和肿瘤控制的角度来看,在可行的情况下应保留 NLD。当病理或方法要求切除 NLD 时,无论采用哪种手术技术,持续性上睑下垂的发生率都很低。当采用上颌扩大切口时,尤其是良性肿瘤,需要切除 NLD 时,锐性横切是最简单的切除方法,术后上睑下垂的发生率很低,并得到现有文献的支持。
{"title":"Management of the Nasolacrimal Duct in Expanded Endoscopic Approaches to the Maxillary Sinus: A Systematic Review with Evidence-based Recommendations.","authors":"Neal Rajan Godse, Satyan Sreenath, Brian C Lobo, Raj Sindwani","doi":"10.1177/19458924241249802","DOIUrl":"10.1177/19458924241249802","url":null,"abstract":"<p><strong>Background: </strong>Utilizing expanded endoscopic approaches to the maxillary sinus for the endonasal management of a variety of tumors is increasing in popularity. The nasolacrimal duct (NLD) may be injured inadvertantly or need to be removed during tumor resection or to augment visualization. Management of the NLD can take the form of transection alone, transection with stenting, or performing a formal dacryocystorhinostomy to avoid postoperative sequelae of injury. The purpose of this study was to review the literature and determine the optimal management of the NLD during expanded maxillary sinus approaches.</p><p><strong>Methods: </strong>A systematic review of Ovid, Embase, Medline, and Cochrane databases was performed to identify studies involving expanded approaches to the maxillary sinus and that explicitly reported the status of the NLD and postoperative outcomes.</p><p><strong>Results: </strong>Nineteen studies were included in the analysis and divided into two groups: NLD-preserving (n = 9 studies; n = 191 patients in aggregate) and NLD-involving (n = 10 studies; n = 296 patients in aggregate). In the NLD-preserving subgroup, one patient out of a subgroup aggregate of 191 patients (0.5%) developed epiphora. In the NLD-involving subgroup, sharp transection alone was the most common method of NLD removal and was associated with a low rate of epiphora (study rates: 0 to 18.2%; aggregated subgroup rate: 7.0%, 21 / 296). Spontaneous resolution of symptoms was common (60%-100% cases).</p><p><strong>Conclusions: </strong>The NLD should be preserved when feasible from an exposure and tumor-control perspective. When pathology or approach requires the removal of the NLD, rates of persistent epiphora are very low, regardless of surgical technique. When expanded maxillary approaches are employed, particularly for benign tumors, and require removal of the NLD, sharp transection is the simplest method of removal, provides a low rate of postoperative epiphora, and is supported by the available literature.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"282-293"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
"Knowledge Is an Unending Adventure at the Edge of Uncertainty." Jacob Bronowski. "知识是在不确定性边缘无休止的探险"雅各布-布朗诺夫斯基
IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 DOI: 10.1177/19458924241277484
John Schneider
{"title":"\"Knowledge Is an Unending Adventure at the Edge of Uncertainty.\" Jacob Bronowski.","authors":"John Schneider","doi":"10.1177/19458924241277484","DOIUrl":"https://doi.org/10.1177/19458924241277484","url":null,"abstract":"","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"38 5","pages":"280-281"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Multi-Institutional Analysis of Insurance Denial Patterns Within Rhinology. 鼻科拒绝保险模式的多机构分析。
IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-07-01 Epub Date: 2024-03-28 DOI: 10.1177/19458924241242856
Tyler A Janz, Najm S Khan, Aatin K Dhanda, Masayoshi Takashima, Arthur W Wu, Dennis M Tang, Thomas S Higgins, Murugappan Ramanathan, Omar G Ahmed

Background: Obtaining insurance approval is a necessary component of healthcare in the United States and denials of these claims have been estimated to result in a loss of 3% to 5% of revenue.

Objective: Examine the trends in insurance denials for rhinological procedures.

Methods: A retrospective review of deidentified financial data of patients who were treated by participating physicians across 3 institutions from January 1, 2021, to June 30, 2023. The data was queried for rhinological and non-rhinological procedures via CPT codes. Cumulative insurance denials were calculated and stratified by procedure and insurance type. Write-offs were dollar amounts associated with final denials.

Results: A sample of 102,984 procedures and visits revealed a final denial rate between 2.2% and 2.9% across institutions (p = .72). The top three rhinological procedures for final write-offs were: nasal endoscopy (16.24%, $111,836.87), nasal debridement or polypectomy (6.48%, $79,457.51), and destruction of intranasal lesion (2.11%, $56,932.20). The write-off percentage for each procedure was highest among commercial insurance payers as opposed to Medicare or Medicaid.

Conclusion: Final denial rates of rhinology procedures ranged between 2% and 3%. Common procedures such as nasal endoscopy and nasal debridement are among the highest written-off procedures. Insurance denials can lead to notable revenue loss. Rhinology practices must continue to remain knowledgeable of the changes and effects of insurance reimbursement on their practice.

背景:在美国,获得保险批准是医疗保健的必要组成部分,据估计,拒绝保险理赔会导致 3% 至 5% 的收入损失:研究鼻科手术保险拒赔的趋势:方法:对 3 家机构的参与医生在 2021 年 1 月 1 日至 2023 年 6 月 30 日期间治疗的患者的去身份财务数据进行回顾性审查。通过 CPT 编码查询鼻科和非鼻科手术数据。计算了累计保险拒付率,并按手术和保险类型进行了分层。注销是指与最终拒付相关的金额:在 102,984 例手术和就诊样本中,各机构的最终拒付率介于 2.2% 和 2.9% 之间(p = .72)。最终核销率最高的三种鼻科手术分别是:鼻内窥镜检查(16.24%,111836.87 美元)、鼻腔清创术或息肉切除术(6.48%,79457.51 美元)和鼻内病变破坏(2.11%,56932.20 美元)。与医疗保险或医疗补助相比,商业保险支付者对每项手术的核销比例最高:结论:鼻科手术的最终拒付率介于 2% 与 3% 之间。鼻内窥镜检查和鼻腔清创术等常见手术是注销率最高的手术之一。保险拒付会导致显著的收入损失。鼻科诊所必须继续了解保险报销的变化和对诊所的影响。
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引用次数: 0
Thoughts on the Surprising Effect of Priming on 22-Item Sino-Nasal Outcome Test (SNOT-22) Results. 关于引物对 22 项中鼻结果测试 (SNOT-22) 结果的惊人影响的思考。
IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-07-01 Epub Date: 2024-03-20 DOI: 10.1177/19458924241240846
Nathan Yang, Adam Waytz, Zachary M Soler, Jonathan B Overdevest, David A Gudis
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引用次数: 0
期刊
American Journal of Rhinology & Allergy
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