Eosinophilic rhinosinusitis is not a disease of ostiomeatal occlusion

Snidvongs, Kornkiat; Chin, David; Sacks, Raymond; Earls, Peter; Harvey, Richard J.

doi:10.1002/lary.23721

Cited by 67 publications

(60 citation statements)

References 18 publications

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“…In contrast, ostiomeatal obstruction is much more common in CRSsNPs, and therefore ESS which addresses this may well achieve long-term benefits. This contrasts to one previous study19 which found no difference in recurrence rates between those with and without polyps. It is not clear at this time whether the high revision rates seen in CRSwNPs simply reflect the chronic nature of the condition and the limitations of current medical management, or whether there are operative variables that may be improved in order to reduce the ongoing burden of revision surgery.…”

Section: Discussioncontrasting

confidence: 99%

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

et al. 2015

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ObjectivesThe 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%).SettingThirty secondary care centres around the UK.ParticipantsA 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).InterventionsSelf-administered questionnaire.Primary outcome measureThe need for previous sinonasal surgery.ResultsA 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 (χ2 p<0.001).ConclusionsThis 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.

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Section: Discussioncontrasting

confidence: 99%

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

et al. 2015

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“…It has been hypothesized that occlusion of the osteomeatal complex may lead to gas resorption of the sinuses with painful negative pressures, 23 yet most subjects with CRS have an open osteomeatal complex. 24 Patients’ observations that pain and pressure is postural may reflect painful dilatation of vessels; 25 however, postural pain is also observed in subjects with simply tension type headache. 25 Local inflammatory mediators can excite nerves locally within the sinonasal mucosa directly illiciting pain.…”

Section: Discussionmentioning

confidence: 99%

Characterization of facial pain associated with chronic rhinosinusitis using validated pain evaluation instruments

DeConde

Mace

Ashby

et al. 2015

Int Forum Allergy Rhinol

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Background Prior investigations into facial pain associated with chronic rhinosinusitis (CRS) have yielded important results, but have yet to utilize pain-specific outcome measures. This study seeks to characterize facial pain associated with CRS using validated pain-specific instruments. Methods Adults with CRS were enrolled into a prospective, cross-sectional study along with control participants presenting with non-CRS diagnoses. Facial pain was characterized in both groups using the Brief Pain Inventory Short Form (BPI-SF) and the Short-Form McGill Pain Questionnaire (SF-MPQ). CRS-specific measures of disease were measured including the Sinonasal Outcome Test-22 (SNOT-22), nasal endoscopy, and computed tomography scoring. Results Patients were comprised of CRS with nasal polyposis (CRSwNP; n=25), CRS without nasal polyposis (CRSsNP; n=30), and control participants (n=8). Subjects with CRSwNP and CRSsNP were less likely to be pain free than controls (16.0%, 6.7% and 62.5% respectively, p=0.001) and carried greater burden of pain as measured by the BPI-SF and SF-MPQ than controls (p=0.002 and p=0.017, respectively). Pain in CRS was most commonly located around the eyes and characterized as ‘throbbing’ and ‘aching’. Nasal polyp status was not associated with differences in character, severity, or location of pain. Conclusions Subjects with CRS have a greater burden of facial pain relative to control subjects across several standardized pain measures. Further, facial pain in CRS significantly correlated to QOL and CRS-specific disease severity measures. Study across larger cohorts using standardized pain measures is warranted to clarify the association of facial pain with chronic rhinosinusitis.

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“…Surgical intervention is therefore essential for the treatment of chronic frontal sinusitis, however, there is a growing evidence base that emphasizes the importance of also understanding the pathophysiology of chronic rhinosinusitis [3]. …”

Section: Introductionmentioning

confidence: 99%

IL-5 and IL-6 are increased in the frontal recess of eosinophilic chronic rhinosinusitis patients

Kubota

Takeno

Taruya

et al. 2017

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundEosinophilic chronic frontal sinusitis is difficult to treat compared with non-eosinophilic sinusitis because of recurring inflammation and polyp formation in the frontal recess after the post-operative follow-up period. Studying inflammatory mediators in the frontal recess of eosinophilic chronic rhinosinusitis (ECRS) patients and non-eosinophilic chronic rhinosinusitis (non-ECRS) patients may lead to a better understanding of the pathogenesis of chronic frontal sinusitis.MethodsHomogenates of sinonasal mucosa from 20 non-ECRS patients and 36 ECRS patients were measured for levels of transforming growth factor (TGF)-β, interleukin (IL)-5, IL-6, and inducible nitric oxide synthase (iNOS) using real-time RT-PCR and TaqMan gene expression assays. Sinonasal mucosal specimens were obtained from the frontal recess, ethmoid sinus, and nasal polyp separately.ResultsThe expression of IL-5 was significantly elevated in all sinonasal regions tested in the ECRS group, but absent in non-ECRS patients. Furthermore, the ECRS patients showed significantly increased levels of IL-5 in the frontal recess mucosa compared with ethmoid sinus mucosa. IL-6 was also significantly increased in the frontal recess mucosa compared with ethmoid sinus mucosa and nasal polyps in these patients. There were no significant differences in the levels of TGF-β or iNOS between the ECRS and non-ECRS groups in any sinonasal region tested.ConclusionsThis study is the first to characterize the cytokine milieu in the frontal recess of ECRS patients. We should keep these cytokine profiles in mind when we treat ECRS patients with frontal sinusitis.

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Eosinophilic rhinosinusitis is not a disease of ostiomeatal occlusion

Abstract: 3b.

Cited by 67 publications

References 18 publications

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

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

Characterization of facial pain associated with chronic rhinosinusitis using validated pain evaluation instruments

IL-5 and IL-6 are increased in the frontal recess of eosinophilic chronic rhinosinusitis patients

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