Altered Sinonasal Ciliary Dynamics in Chronic Rhinosinusitis

Chen, Bei; Shaari, Jeffrey; Claire, Steven Eau; Palmer, James N.; Chiu, Alexander G.; Kennedy, David W.; Cohen, Noam A.

doi:10.2500/ajr.2006.20.2870

Cited by 85 publications

(75 citation statements)

References 43 publications

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“…494 Although there does not seem to be a detectable difference between baseline CBF in CRS patients and control patients, cilia from CRS patients show an attenuated response to substances that reliably increase CBF in controls. 564,565 This blunted response to ciliostimulatory substances may underlie the perpetuation of pathology in CRS. Pathogens such as P. aeruginosa, H. influenzae, Streptococcus pneumoniae, and S. aureus secrete toxins that directly suppress ciliary motion.…”

Section: Discussionmentioning

confidence: 99%

“…This baseline increase is not observed in CRSsNP explants. 564 Chronically increased CBF has a potential consequence of downregulating endogenous stimulatory pathways, and the cell loses responsiveness to natural CBF stimulants and cannot be modulated normally. 495 Epithelial damage in CRSwNP has also been associated with squamous metaplasia, and abnormal or absent cilia are often associated with this metaplastic change.…”

Section: Viiic1h Crswnp Pathophysiologymentioning

confidence: 99%

See 1 more Smart Citation

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

Self Cite

557

888

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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Section: Discussionmentioning

confidence: 99%

Section: Viiic1h Crswnp Pathophysiologymentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

Self Cite

557

888

View full text Add to dashboard Cite

show abstract

“…In addition to direct ciliary loss, cilia surviving the microbial and/or inflammatory insults appear to not function normally. Although the literature is conflicting regarding CBF and its changes in patients with CRS, [49][50][51][52][53] recent work has suggested that a subset of patients with CRS have a blunted ciliary response to environmental stimuli 54 that is reversible once the tissue is removed from the infected or inflamed sinonasal environment. 55 This finding suggests that local exogenous factors can negatively modulate the ciliary dynamic response to stimuli.…”

Section: Acquired Cilia Dysfunctionmentioning

confidence: 99%

Acquired Cilia Dysfunction in Chronic Rhinosinusitis

Gudis

Zhao

Cohen

2012

Am J Rhinol�Allergy

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161

136

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Background: Cilia are complex and powerful cellular structures of the respiratory mucosa that play a critical role in airway defense. Respiratory epithelium is lined with cilia that perform an integrated and coordinated mechanism called mucociliary clearance. Mucociliary clearance is the process by which cilia transport the mucus blanket overlying respiratory mucosa to the gastrointestinal tract for ingestion. It is the primary means by which the airway clears pathogens, allergens, debris, and toxins. The complex structure and regulatory mechanisms that dictate the form and function of normal cilia are not entirely understood, but it is clear that ciliary dysfunction results in impaired respiratory defense.Methods: A literature review of the current knowledge of cilia dysfunction in chronic rhinosinsusitis was conducted.Results: Ciliary dysfunction may be primary, the result of genetic mutations resulting in abnormal cilia structure, or, more commonly, secondary, the result of environmental, infectious, or inflammatory stimuli that disrupt normal motility or coordination. Patients with chronic rhinosinusitis (CRS) have been found to have impaired mucociliary clearance. Many biochemical, environmental, and mechanical stimuli have been shown to influence ciliary beat frequency, and common microbial pathogens of respiratory mucosa such as Pseudomonas aeruginosa and Haemophilus influenzae have developed toxins that appear to interrupt normal mucociliary function. Furthermore, inflammatory mediators known to be present in patients with CRS appear to impair secondarily mucociliary clearance. Conclusion:The goal of this article is to summarize the recent developments in the understanding of cilia dysfunction and mucociliary clearance in CRS.

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“…To understand the need to define chronic sinusitis as a collection of heterogeneous diseases with varying causes. 4. To recognize distinct presentations of chronic sinus diseases, including distinguishing their clinical presentations, cellular and molecular characteristics, genetic differences, and current treatment options for each.…”

mentioning

confidence: 99%