Medical and surgical treatment outcomes in patients with chronic rhinosinusitis and immunodeficiency: a systematic review

Abstract

Background Immunodeficiency is a risk factor for recalcitrant chronic rhinosinusitis CRS Currently there is no consensus on effective treatment modalities for immunodeficient CRS patients This review aims to evaluate the existing evidence on the treatment outcomes and its limitations in patients with CRS and immunodeficiency Methods MEDLINE Embase and the Cochrane Central Register of Controlled Trials CENTRAL were searched from inception to April for studies reporting measurable medical or surgical treatment outcomes for adult patients with CRS and underlying primary or secondary immunodeficiency Results Of the articles screened studies met the inclusion criteria prospective double-blind placebocontrolled trials prospective case-control studies prospective cohort studies and case series The high degree of study heterogeneity precluded a meta-analysis Antibiotic monotherapy was not linked with significant improvement in clinical radiographic or endoscopic outcomes Immunoglobulin replacement therapy may potentially reduce the frequency of acute or chronic sinusitis in patients with primary immunodeficiency PID but may not improve their sinonasal symptoms Outcomes from endoscopic sinus surgery ESS were reported in studies which found that surgery was linked with improvement in symptoms disease-specific quality of life endoscopy scores and radiographic scores The average reported ESS revision rate was Conclusion Patients with CRS and immunodeficiency likely benefit from ESS based on the available evidence Data supporting medical therapy in this targeted population is limited overall but there may be a potential role for immunoglobulin therapy in patients with PID and CRS © 2020 ARS-AAOA, LLC.

Peripheral eosinophil count and eosinophil-to-lymphocyte ratio are associated with revision sinus surgery

“…For patients that fail appropriate medical therapy, endoscopic sinus surgery (ESS) represents an appropriate treatment option [1]. However, up to 20% of patients undergoing primary ESS experience persistent post-treatment symptoms and require revision surgery [2][3][4]. The clinical subtype of CRS and other patient-specific factors affect the outcome and success of surgical treatment.…”

Outcome of Immunoglobulin Replacement Therapy in Adults With Rhinosinusitis

“…1 A number of risk factors predispose patients for the development of RARS and AECRS, including primary immunodeficiency disorders (PID). [3][4][5] Recent evidence suggests that PID may have a more important role in the pathogenesis of sinus disease than previously suspected, and humoral immunodeficiency syndromes specifically appear to lead to more resistant disease. 4,6 Two of the most common primary immunodeficiencies, common variable immunodeficiency (CVID), and specific antibody deficiency (SAD), are humoral deficiencies that are particularly wellrepresented in populations with persistent sinus disease.…”

“…4,6 Two of the most common primary immunodeficiencies, common variable immunodeficiency (CVID), and specific antibody deficiency (SAD), are humoral deficiencies that are particularly wellrepresented in populations with persistent sinus disease. 4,5 Treatment options for PID are limited, and involve antibiotic prophylaxis, early culture-directed antibiotic therapy, and immunoglobin (IG) replacement therapy. [3][4][5]7 A recent meta-analysis performed by Samargandy et al in 2020 5 identified only two studies 3,8 that looked at the outcome of IG replacement therapy in CRS.…”

“…4,5 Treatment options for PID are limited, and involve antibiotic prophylaxis, early culture-directed antibiotic therapy, and immunoglobin (IG) replacement therapy. [3][4][5]7 A recent meta-analysis performed by Samargandy et al in 2020 5 identified only two studies 3,8 that looked at the outcome of IG replacement therapy in CRS. These two studies reached opposing conclusions, and both had small number of patients included.…”

Outcome of immunoglobulin replacement therapy in children with rhinosinusitis

“…4 Primary therapies for PID are limited and include antibiotic prophylaxis, early culture-directed antibiotic therapy, and immunoglobin replacement therapy. 5 A recent metaanalysis performed by Samargandy et al 6 in 2020 identified only two studies 7,8 that looked at the outcome of immunoglobin replacement therapy in adults with CRS. We recently showed that adult patients experienced subjective and objective improvement in the number of sinus infections after initiation of immunoglobin replacement therapy.…”