Pulmonary aspiration of sinus secretions in patients with cystic fibrosis

Nelson, Jacob L.; Karempelis, Peter; Dunitz, Jordan M.; Hunter, Ryan C.; Boyer, Holly

doi:10.1002/alr.22043

Cited by 15 publications

(11 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6,9,11,[13][14][15][16] Furthermore, the unified airway hypothesis suggests that treating bacterial infection in the upper airway can also decrease bacterial burden in the lungs. [17][18][19] Since pulmonary infection is associated with increased mortality in lung transplant patients, ESS may improve clinical outcomes by decreasing the overall bacterial burden of the upper and lower airways. 20 However, the clinical impact of ESS on pulmonary status is still unclear.…”

Section: Introductionmentioning

confidence: 99%

Decreased Antibiotic Utilization After Sinus Surgery in Cystic Fibrosis Patients With Lung Transplantation

Cheng

Choi

Honeybrook

et al. 2019

Am J Rhinol�Allergy

View full text Add to dashboard Cite

Background Patients with cystic fibrosis (CF) who have undergone lung transplantation frequently require hospitalizations and antibiotic treatments for respiratory tract infections. Although endoscopic sinus surgery (ESS) improves sinonasal quality of life in CF patients, it is unclear if ESS offers additional benefit in terms of antibiotics for pulmonary infection, hospitalization, and pulmonary function. Objective To determine whether ESS impacts antibiotic use or hospitalizations for pulmonary indications or pulmonary function in CF patients after lung transplantation. Methods This is a single-institution retrospective study of all patients who underwent lung transplantation for CF from 2005 to 2017. Patients who underwent ESS at least 1 year after transplant were included. Paired bivariate analyses were performed to determine whether there was a difference in the frequency and length of hospitalizations for pulmonary indications, number of antibiotic courses (intravenous and oral) for pulmonary exacerbations, and forced expiratory volume in 1 second (FEV1) slope in the 6 months before versus after ESS. Perioperative antibiotics and hospitalizations were not included in the analyses. Least squares regression was utilized to analyze FEV1 trends. Results A total of 20 patients underwent 36 ESS during the study period. There was significantly higher antibiotic utilization in the 6 months before ESS (0.89 ± 1.03) compared to the 6 months after ESS (0.33 ± 0.53) ( P = .002). The frequency and length of hospitalizations, FEV1 slope, and FEV1 trend before and after ESS were not significantly different. Conclusion Our results suggest that ESS is associated with a reduction in the frequency of antibiotic utilization for respiratory tract infections in lung transplant recipients with CF. A prospective study is needed to investigate these relationships further.

show abstract

Section: Introductionmentioning

confidence: 99%

Decreased Antibiotic Utilization After Sinus Surgery in Cystic Fibrosis Patients With Lung Transplantation

Cheng

Choi

Honeybrook

et al. 2019

Am J Rhinol�Allergy

View full text Add to dashboard Cite

show abstract

“…This case series discusses six patients who presented with pneumonitis‐related pulmonary symptoms caused by chronic cerebrospinal fluid fistulas and aspiration, a novel relationship that has not been previously discussed outside the author's first case report 16 . Although this is the first case series to report reversible chronic aspiration‐induced pneumonitis in the context of spontaneous skull‐base defects, previous studies show that sinonasal secretions aspiration can lead to aspiration pneumonitis 17,18 . We aim to underscore the importance of this potentially underdiagnosed entity, as the nonspecific presentation of headache with flu‐like symptoms in the setting of rhinorrhea often leads to a protracted diagnosis or in one of our patients surgical intervention for biopsy 1,5,9 .…”

Section: Discussionmentioning

confidence: 82%

Chronic Aspiration Pneumonitis Caused by Spontaneous Cerebrospinal Fluid Fistulae of the Skull Base

Buchanan

Sizdahkhani

et al. 2020

The Laryngoscope

View full text Add to dashboard Cite

Objectives/Hypothesis Spontaneous cerebrospinal fluid (CSF) leaks of the skull base are associated with obesity, multiparity, and elevated intracranial pressure. Although spontaneous CSF leaks often present with rhinorrhea, they can be an underdiagnosed cause of chronic aspiration pneumonitis, a complication that has not been previously reported in detail. Study Design Retrospective case series. Methods The authors retrospectively reviewed all patients undergoing surgical repair of CSF fistulae at the University of Southern California between 2011 and 2018 to identify those presenting with pulmonary symptoms including dyspnea, aspiration, chronic cough, and shortness of breath caused by chronic noniatrogenic CSF pneumonitis. Results Symptomatic chronic pneumonitis was evident in six of 20 patients with spontaneous CSF rhinorrhea. Five women (mean body mass index = 36) had CSF leaks arising from the fovea ethmoidalis (n = 4) and lateral sphenoid region (n = 1). One man had a middle fossa floor dehiscence draining through the eustachian tube. All patients had bilateral ground‐glass opacities in their lungs on computed tomography imaging that were attributed to spontaneous CSF fistulae arising from noniatrogenic skull base defects, and one patient underwent a biopsy of a lung lesion at another hospital showing chronic bronchiolitis and adjacent peribronchiolar metaplasia. Five patients underwent endoscopic endonasal repair using an autologous fascial graft and pedicled nasoseptal flap, and one underwent craniotomy for repair. All patients underwent successful repair with no complications or evidence of recurrence. Upon repair of the spontaneous CSF leaks, both pneumonitis symptoms and ground‐glass opacities on imaging resolved in all six cases. Conclusions Skull base CSF fistulae should be considered as a reversible cause of chronic pneumonitis that is not alleviated or worsens with standard treatment. Level of Evidence 4 Laryngoscope, 131:462–466, 2021

show abstract

“…CSF rhinorrhea can be considered as a cause of chronic pneumonitis despite the lack of direct evidence [ 8 ]. A controlled clinical trial has shown that sinonasal secretions can be transferred to the lungs whether in patients with cystic fibrosis or healthy subjects [ 9 ]. In this case, meningoencephalocele is located in the lateral wall of sphenoidal sinus and leads to persistent CSF rhinorrhea.…”

Section: Discussionmentioning

confidence: 99%

An uncommon etiological factor for aspiration pneumonitis caused by spontaneous sphenoid sinus meningoencephalocele with cerebrospinal fluid rhinorrhea: a case report

et al. 2021

View full text Add to dashboard Cite

Background Aspiration pneumonitis is an inflammatory disease of the lungs which is difficult to diagnose accurately. Large-volume aspiration of oropharyngeal or gastric contents is essential for the development of aspiration pneumonitis. The role of cerebrospinal fluid (CSF) rhinorrhea is often underestimated as a rare etiological factor for aspiration in the diagnosis process of aspiration pneumonitis. Case presentation We present a case of a patient with 4 weeks of right-sided watery rhinorrhea accompanied by intermittent postnasal drip and dry cough as the main symptoms. Combined with clinical symptoms, imaging examination of the sinuses, and laboratory examination of nasal secretions, she was initially diagnosed as spontaneous sphenoid sinus meningoencephalocele with CSF rhinorrhea, and intraoperative endoscopic findings and postoperative pathology also confirmed this diagnosis. Her chest computed tomography showed multiple flocculent ground glass density shadows in both lungs on admission. The patient underwent endoscopic resection of meningoencephalocele and repair of skull base defect after she was ruled out of viral pneumonitis. Symptoms of rhinorrhea and dry cough disappeared, and pneumonitis was improved 1 week after surgery and cured 2 months after surgery. Persistent CSF rhinorrhea caused by spontaneous sphenoid sinus meningoencephalocele was eventually found to be a major etiology for aspiration pneumonitis although the absence of typical symptoms and well-defined risk factors for aspiration, such as dysphagia, impaired cough reflex and reflux diseases. Conclusions We report a rare case of aspiration pneumonitis caused by spontaneous sphenoid sinus meningoencephalocele with CSF rhinorrhea, which can bring more attention and understanding to the uncommon etiology for aspiration, so as to make more accurate diagnosis of the disease and early surgical treatment.

show abstract

Pulmonary aspiration of sinus secretions in patients with cystic fibrosis

Cited by 15 publications

References 11 publications

Decreased Antibiotic Utilization After Sinus Surgery in Cystic Fibrosis Patients With Lung Transplantation

Decreased Antibiotic Utilization After Sinus Surgery in Cystic Fibrosis Patients With Lung Transplantation

Chronic Aspiration Pneumonitis Caused by Spontaneous Cerebrospinal Fluid Fistulae of the Skull Base

An uncommon etiological factor for aspiration pneumonitis caused by spontaneous sphenoid sinus meningoencephalocele with cerebrospinal fluid rhinorrhea: a case report

Contact Info

Product

Resources

About