Journal articles: 'Recalcitrant Chronic Rhinosinusitis'

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Videler, W. J. M., C. Georgalas, D. J. Menger, N. J. M. Freling, C. M. van Drunen, and W. J. Fokkens. "Osteitic bone in recalcitrant chronic rhinosinusitis." Rhinology journal 49, no. 2 (June 1, 2011): 139–47. http://dx.doi.org/10.4193/rhino10.158.

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INTRODUCTION: There is increasing interest in the underlying bone of the paranasal sinuses as an important player in recalcitrant Chronic Rhinosinusitis. Close inspection of CT scans often reveals areas of increased bone density and irregular thickening of the sinus walls. This osteitic bone could at least partly explain, why inflammation of the mucosa persists. METHODS: We searched PubMed for all relevant studies, using the following text words: chronic rhinosinusitis, sinusitis, bone, osteitis, osteomyelitis, histology, and treatment. Cited references of retrieved articles were also examined. RESULTS: Background, available data, potential diagnostic options, treatment implications, and suggestions for future research are discussed. CONCLUSION: Osteitis is associated with CRS, however its role in the pathogenic process is not well defined. More research is needed.

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Woodbury, Kristin, and Berrylin J. Ferguson. "Recalcitrant chronic rhinosinusitis: investigation and management." Current Opinion in Otolaryngology & Head and Neck Surgery 19, no. 1 (February 2011): 1–5. http://dx.doi.org/10.1097/moo.0b013e3283420e92.

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Uyttebroek, Saartje, Jolien Onsea, Willem-Jan Metsemakers, Lieven Dupont, David Devolder, Jeroen Wagemans, Rob Lavigne, Isabel Spriet, and Laura Van Gerven. "The Potential Role of Bacteriophages in the Treatment of Recalcitrant Chronic Rhinosinusitis." Antibiotics 10, no. 6 (June 5, 2021): 675. http://dx.doi.org/10.3390/antibiotics10060675.

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Chronic rhinosinusitis is a common condition affecting 5–12% of the general population worldwide. In a limited number of cases, the disease is recalcitrant to medical and surgical interventions, causing a major impact on physical, social and emotional well-being and increasing pressure on healthcare systems. Biofilm formation and dysbiosis caused by Staphylococcus aureus and Pseudomonas aeruginosa play a role in the pathogenesis of recalcitrant chronic rhinosinusitis. In these cases, a promising treatment alternative is the application of bacteriophages, which are viruses that infect and lyse bacteria. In this review, we appraise the evidence for the use of bacteriophages in the treatment of recalcitrant chronic rhinosinusitis. Additionally, (dis)advantages of bacteriophages and considerations for implementation of phage therapy in otorhinolaryngology practice will be discussed.

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Lau, Aden, Susan Lester, Sophia Moraitis, Judy Ou, Alkis J. Psaltis, Shaun McColl, Maureen Rischmueller, Peter-John Wormald, and Sarah Vreugde. "Tertiary lymphoid organs in recalcitrant chronic rhinosinusitis." Journal of Allergy and Clinical Immunology 139, no. 4 (April 2017): 1371–73. http://dx.doi.org/10.1016/j.jaci.2016.08.052.

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Ramakrishnan, Y., R. C. Shields, M. R. Elbadawey, and J. A. Wilson. "Biofilms in chronic rhinosinusitis: what is new and where next?" Journal of Laryngology & Otology 129, no. 8 (June 29, 2015): 744–51. http://dx.doi.org/10.1017/s0022215115001620.

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AbstractBackground:Chronic rhinosinusitis is a common, heterogeneous condition. An effective means of mitigating disease in chronic rhinosinusitis patients remains elusive. A variety of causes have been implicated, with the biofilm theory gaining increasing prominence.Objective:This article reviews the literature on the role of biofilms in chronic rhinosinusitis, in terms of pathophysiology and with regard to avenues for future treatment.Methods:A systematic review of case series was performed using databases with independently developed search strategies, including Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane library, and Zetoc, in addition to conference proceedings and a manual search of literature, with the last search conducted on 18 January 2014. The search terms included the following, used in various combinations to maximise the yield of articles identified: ‘biofilms’, ‘chronic rhinosinusitis’, ‘DNase’, ‘extracellular DNA’ and ‘biofilm dispersal’.Results:The existing evidence lends further support for the role of biofilms (particularly the Staphylococcus aureus phenotype) in more severe, recalcitrant disease and poorer surgical outcomes.Conclusion:Multimodality treatment, with a shift in paradigm to incorporate anti-biofilm strategies, is likely to form the mainstay of future recalcitrant chronic rhinosinusitis management.

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Kartush, Alison G., Jane K. Schumacher, Rachna Shah, and Monica O. Patadia. "Biologic Agents for the Treatment of Chronic Rhinosinusitis With Nasal Polyps." American Journal of Rhinology & Allergy 33, no. 2 (December 27, 2018): 203–11. http://dx.doi.org/10.1177/1945892418814768.

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Background Chronic rhinosinusitis with nasal polyposis is a complex inflammatory disorder, which is often recalcitrant to medical and surgical management. Recently, biologic agents have been studied as an adjunct treatment for this patient population. Objective The purpose of this study is to examine the role of biologic agents for chronic rhinosinusitis patients by reviewing literature and clinical trials. Methods A comprehensive review of literature and clinical trials—both recently completed and ongoing—was undertaken to examine up-to-date evidence of current biologic therapy and its role in chronic rhinosinusitis patients—including anti-IgE, anti-IL-4, anti-IL-5, anti-IL-13, and GATA-3 DNAzyme. Results Specific biologic agents discussed include omalizumab, reslizumab, mepolizumab, benralizumab, dupilumab, and Hgd40/SB010. Risks, side effects, and administration information are also reviewed. An algorithm for the use of biologics in patients with chronic rhinosinusitis with nasal polyposis is proposed. Conclusion These treatments have promising results and may prove to be an important adjunct for patients with recalcitrant sinus disease.

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Sjogren, Phayvanh P., Noah P. Parker, and Holly C. Boyer. "Retained Drug-eluting Stents and Recalcitrant Chronic Rhinosinusitis: A Case Report." Allergy & Rhinology 4, no. 1 (January 2013): ar.2013.4.0042. http://dx.doi.org/10.2500/ar.2013.4.0042.

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Corticosteroids are the mainstay of treatment for refractory chronic rhinosinusitis. The off-label use of steroid-eluting stents has increasingly gained popularity in functional endoscopic sinus surgery for decreasing postoperative inflammation and synechiae formation. However, there is a paucity of data outlining the safety profile of this device despite its widespread use. This study was designed to report a newly described complication of retained drug-eluting stents from endoscopic sinus surgery for refractory rhinosinusitis. This report highlights a potential risk of the drug-eluting stent in the treatment of recalcitrant rhinosinusitis and the need for further clinical investigations whenever a novel medical device becomes available on the market.

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Vaughn, Andrew, Courtney Shaver, and David Clark. "Association Between Culture and Culture-Independent Microtyping in Recalcitrant Chronic Rhinosinusitis." Ear, Nose & Throat Journal 98, no. 2 (February 2019): 94–97. http://dx.doi.org/10.1177/0145561318823371.

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Background: Many different etiologies have been proposed to be responsible for the pathogenesis of chronic rhinosinusitis, including dysbiosis of the sinus microbiome. Attempts have recently been made to identify a pathogenic organism via advanced culture mechanisms. The purpose of this study is to use culture-dependent and culture-independent means of microtyping to determine whether any association exists between the quantity and quality of bacteria identified in patients with recalcitrant chronic rhinosinusitis. Methods: Medical records were retrospectively reviewed for patients with a history of revision sinus surgery and persistent symptoms who underwent endoscopically directed culture and underwent quantitative polymerase chain reaction analysis of the 16S ribosomal RNA of bacteria and fungi from February 1, 2014, to January 1, 2017. A total of 21 patients met the inclusion criteria. Medical records were reviewed to determine the number of bacterial isolates and relative abundance of bacteria and fungi on culture and polymerase chain reaction. Results: Using culture-independent techniques of examining purulent secretions in patients with recalcitrant chronic rhinosinusitis, an average of 3.61 isolates were identified per specimen, compared with culture-dependent methods that revealed 2.10 isolates per specimen ( P < .05). The dominant species identified on each culture was rarely the most abundant species identified using polymerase chain reaction techniques. Conclusions: Traditional culture methodologies may fail to identify potential pathogens or the dominant pathogen in patients with recalcitrant chronic rhinosinusitis with acute exacerbations.

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Tan, Neil C. W., Andrew Foreman, Camille Jardeleza, Richard Douglas, Sarah Vreugde, and Peter-John Wormald. "IntracellularStaphylococcus aureus: the Trojan horse of recalcitrant chronic rhinosinusitis?" International Forum of Allergy & Rhinology 3, no. 4 (February 19, 2013): 261–66. http://dx.doi.org/10.1002/alr.21154.

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Szaleniec, Joanna, Andrzej Górski, Maciej Szaleniec, Ryszard Międzybrodzki, Beata Weber-Dąbrowska, Paweł Stręk, and Jacek Składzień. "Can phage therapy solve the problem of recalcitrant chronic rhinosinusitis?" Future Microbiology 12, no. 15 (November 2017): 1427–42. http://dx.doi.org/10.2217/fmb-2017-0073.

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Benninger, Michael S., Raj Sindwani, Chantal E. Holy, and Claire Hopkins. "Impact of medically recalcitrant chronic rhinosinusitis on incidence of asthma." International Forum of Allergy & Rhinology 6, no. 2 (December 1, 2015): 124–29. http://dx.doi.org/10.1002/alr.21652.

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Prokopakis, E. P., I. M. Vlastos, B. J. Ferguson, G. Scadding, H. Kawauchi, C. Georgalas, N. Papadopoulos, and P. W. Hellings. "SCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases." Rhinology journal 52, no. 1 (March 1, 2014): 3–8. http://dx.doi.org/10.4193/rhino13.049.

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Background: Our objective is to present recent research findings on recalcitrant chronic rhinosinusitis (CRS) in relation to "Severe Chronic Upper Airway Disease" (SCUAD). Methodology: Literature review using Medline and Em base databases (search terms 'chronic rhinosinusitis'; "chronic sinusitis" or"Severe Chronic Upper Airway Disease") limited to articles published in the English language. Results: Complex pathophysiological mechanisms characterize various forms of chronic rhinitis and rhinosinusitis (CRS), where inflammation persists in spite of adequate medical treatment. In these cases, a multifactorial etiology often underlies the development of sino-nasal inflammation. The interaction between chronic upper and lower airway inflammation via neurogenic and systemic pathways may complicate the therapy of these patients, and lead to insufficient symptom control. Conclusion: The recently introduced definition of "Severe Chronic Upper Airway Disease" (SCUAD) increases awareness of those patients with persistent inflammation and symptoms despite guideline-driven pharmacologic treatment. The concept of SCUAD may prove helpful in directing research towards clarifying the definition, diagnosis and pathophysiology of rhinitis and rhinosinusitis, their limits and overlap. In this review, a hypothesis on SCUAD immunopathology is also presented.

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Taylor, A., J. Fuzi, A. Sideris, C. Banks, and T. E. Havas. "Non-steroid, non-antibiotic anti-biofilm therapy for the treatment of chronic rhinosinusitis: a systematic review." Journal of Laryngology & Otology 135, no. 3 (March 2021): 196–205. http://dx.doi.org/10.1017/s0022215121000542.

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AbstractObjectiveChronic rhinosinusitis patients with biofilms cultured from their sinonasal cavity have greater symptom burden and risk of recalcitrant disease. A number of non-antibiotic, ‘anti-biofilm’ treatments exist which show anti-biofilm properties in preclinical studies. There is little evidence evaluating their impact on clinical symptom scores in chronic rhinosinusitis.MethodA systematic review was performed to assess the literature regarding the efficacy of non-steroid, non-antibiotic, anti-biofilm specific topical therapies in the treatment of chronic rhinosinusitis. The primary outcome assessed was change in validated patient reported outcome measures before and after anti-biofilm treatment.ResultsThirteen studies assessing the effect of anti-biofilm therapies in chronic rhinosinusitis through validated patient-reported outcome measures were included. Seven different anti-biofilm specific therapies for chronic rhinosinusitis were identified. None of the seven anti-biofilm therapies was identified as being confidently efficacious beyond placebo. Only one therapy (intranasal xylitol) showed a statistically significant reduction in symptom scores compared with placebo in more than one trial.ConclusionRobust evidence supporting the use of various anti-biofilm therapies in chronic rhinosinusitis is lacking. Further high quality, human, in vivo trials studying the effect of anti-biofilm therapies in chronic rhinosinusitis are needed to address the deficiencies of the current evidence base.

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Mullings, Warren, Rikesh Panchmatia, Katrien Samoy, Al-Rahim Habib, Andrew Thamboo, Rami Al-Salman, and Amin Javer. "Topical Povidone-Iodine as an Adjunctive Treatment for Recalcitrant Chronic Rhinosinusitis." European Journal of Rhinology and Allergy 2, no. 2 (October 28, 2019): 45–50. http://dx.doi.org/10.5152/ejra.2019.166.

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Ramanathan, Murugappan, Won-Kyung Lee, and Andrew P. Lane. "Increased Expression of Acidic Mammalian Chitinase in Chronic Rhinosinusitis with Nasal Polyps." American Journal of Rhinology 20, no. 3 (May 2006): 330–35. http://dx.doi.org/10.2500/ajr.2006.20.2869.

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Background Chitin is an abundant polysaccharide found in fungi, insects, and parasitic nematodes. Innate immune host defense against chitin-containing pathogens include production of chitinases. In human lower airways, acidic mammalian chitinase (AMCase) is produced in epithelial cells via a Th2-specific, IL-13–dependent pathway, and may act as an inflammatory mediator in asthma. The role of AMCase in chronic rhinosinusitis (CRS) has not been studied previously. Methods Eleven controls and 22 subjects with medically recalcitrant CRS were prospectively enrolled before undergoing endoscopic sinus surgery. RNA was extracted from surgically obtained ethmoid mucosa, and real-time PCR was used to determine expression of AMCase, eotaxin, and IL-13. Subjects were followed for at least 6 months postoperatively to assess for polyp recurrence. Based on the presence or absence of polyps, the subjects were classified as either recalcitrant or responsive to therapy. Results AMCase mRNA was detected in the sinus mucosa of 72% of control subjects and in 72% of patients with eosinophilic CRS with nasal polyps (CRSwNP). The expression of AMCase was significantly greater in recalcitrant CRSwNP than it was in treatment-responsive CRSwNP. There was no significant difference in IL-13 expression between these two groups. Conclusion AMCase may be an important mediator in the pathogenesis of Th2 inflammatory diseases of the respiratory tract. Failure of medical and surgical therapy in CRSwNP is associated with significantly increased expression of AMCase, but not the Th2 cytokines IL-13 and eotaxin. Additional studies are needed to determine the potential of AMCase as a therapeutic target in CRSwNP.

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Videler, W. J. M., K. van Hee, S. M. Reinartz, C. Georgalas, F. W. van der Meulen, and W. J. Fokkens. "Long-term low-dose antibiotics in recalcitrant chronic rhinosinusitis: a retrospective analysis." Rhinology journal 50, no. 1 (March 1, 2012): 45–55. http://dx.doi.org/10.4193/rhino11.123.

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Introduction: In recalcitrant Chronic RhinoSinusitis (CRS) treatment with intranasal corticosteroids, short-term antibiotics and even sinus surgery is frequently insufficient. Long-term low-dose administration of antibiotics has been suggested as a treatment option in these patients. We analysed the outpatient clinic population treated with different long-term low-dose antibiotics at the AMC Amsterdam. Patients and methods: Eligible patients, who were treated with trimethoprim-sulfamethoxazole or macrolides, were retrospectively identified from our outpatient clinic in 2009. The two main outcome measures were sinonasal complaints and nasal endoscopic findings. A 5-point grading scale was used to score the results compared with the pre-treatment situation. This was measured at several time-points during, and after the antibiotic course, and at the end of the follow-up term. Results: Seventy-six patients were included, 53 per cent had asthma and all of them had undergone sinus surgery. Seventy-eight per cent showed improvement of the symptoms, and 84 per cent demonstrated improvement of the sinonasal mucosa at the end of the course. No significant difference was found between the trimethoprim-sulfamethoxazole and macrolide group. Discussion: Long-term low-dose treatment with antibiotics seems to improve CRS symptoms and the appearance of the sinonasal mucosa on nasal endoscopy. However, at this stage, strong conclusions are immature because no placebo-group has been included. Despite increasing use of long-term low-dose treatment of recalcitrant CRS in referral centres, hard clinical evidence is lacking. More research is urgently required.

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Uren, Brent, Alkis Psaltis, and Peter-John Wormald. "Nasal Lavage With Mupirocin for the Treatment of Surgically Recalcitrant Chronic Rhinosinusitis." Laryngoscope 118, no. 9 (September 2008): 1677–80. http://dx.doi.org/10.1097/mlg.0b013e31817aec47.

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Suh, Jeffrey D. "Treatment of Recalcitrant Chronic Rhinosinusitis With Integrative East-West MedicineA Pilot Study." Archives of Otolaryngology–Head & Neck Surgery 138, no. 3 (March 1, 2012): 294. http://dx.doi.org/10.1001/archoto.2011.1489.

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Liu, Cindy M., Katerina Soldanova, Lora Nordstrom, Michael G. Dwan, Owain L. Moss, Tania L. Contente-Cuomo, Paul Keim, Lance B. Price, and Andrew P. Lane. "Medical therapy reduces microbiota diversity and evenness in surgically recalcitrant chronic rhinosinusitis." International Forum of Allergy & Rhinology 3, no. 10 (July 10, 2013): 775–81. http://dx.doi.org/10.1002/alr.21195.

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Shaghayegh, Gohar, Clare Cooksley, Mahnaz Ramezanpour, Peter-John Wormald, Alkis James Psaltis, and Sarah Vreugde. "Chronic Rhinosinusitis, S. aureus Biofilm and Secreted Products, Inflammatory Responses, and Disease Severity." Biomedicines 10, no. 6 (June 9, 2022): 1362. http://dx.doi.org/10.3390/biomedicines10061362.

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Chronic rhinosinusitis (CRS) is a persistent inflammation of the nasal cavity and paranasal sinuses associated with tissue remodelling, dysfunction of the sinuses’ natural defence mechanisms, and induction of different inflammatory clusters. The etiopathogenesis of CRS remains elusive, and both environmental factors, such as bacterial biofilms and the host’s general condition, are thought to play a role. Bacterial biofilms have significant clinical relevance due to their potential to cause resistance to antimicrobial therapy and host defenses. Despite substantial medical advances, some CRS patients suffer from recalcitrant disease that is unresponsive to medical and surgical treatments. Those patients often have nasal polyps with tissue eosinophilia, S. aureus-dominant mucosal biofilm, comorbid asthma, and a severely compromised quality of life. This review aims to summarise the contemporary knowledge of inflammatory cells/pathways in CRS, the role of bacterial biofilm, and their impact on the severity of the disease. Here, an emphasis is placed on S. aureus biofilm and its secreted products. A better understanding of these factors might offer important diagnostic and therapeutic perceptions for recalcitrant disease.

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Shin, Seung-Heon, Mi-Kyung Ye, Dong-Won Lee, and Sang-Yen Geum. "Immunopathologic Role of Fungi in Chronic Rhinosinusitis." International Journal of Molecular Sciences 24, no. 3 (January 25, 2023): 2366. http://dx.doi.org/10.3390/ijms24032366.

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Airborne fungi are ubiquitous in the environment and are commonly associated with airway inflammatory diseases. The innate immune defense system eliminates most inhaled fungi. However, some influence the development of chronic rhinosinusitis. Fungal CRS is thought of as not a common disease, and its incidence increases over time. Fungi are present in CRS patients and in healthy sinonasal mucosa. Although the immunological mechanisms have not been entirely explained, CRS patients may exhibit different immune responses than healthy people against airborne fungi. Fungi can induce Th1 and Th2 immune responses. In CRS, Th2-related immune responses against fungi are associated with pattern recognition receptors in nasal epithelial cells, the production of inflammatory cytokines and chemokines from nasal epithelial cells, and interaction with innate type 2 cells, lymphocytes, and inflammatory cells. Fungi also interact with neutrophils and eosinophils and induce neutrophil extracellular traps (NETs) and eosinophil extracellular traps (EETs). NETs and EETs are associated with antifungal properties and aggravation of chronic inflammation in CRS by releasing intracellular granule proteins. Fungal and bacterial biofilms are commonly found in CRS and may support chronic and recalcitrant CRS infection. The fungal–bacterial interaction in the sinonasal mucosa could affect the survival and virulence of fungi and bacteria and host immune responses. The interaction between the mycobiome and microbiome may also influence the host immune response, impacting local inflammation and chronicity. Although the exact immunopathologic role of fungi in the pathogenesis of CRS is not completely understood, they contribute to the development of sinonasal inflammatory responses in CRS.

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Hansen, F. S., P. G. Djupesland, and W. J. Fokkens. "Preliminary efficacy of fluticasone delivered by a novel device in recalcitrant chronic rhinosinusitis." Rhinology journal 48, no. 3 (September 1, 2010): 292–99. http://dx.doi.org/10.4193/rhino09.178.

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Objective: To assess whether delivery of fluticasone propionate using a novel bi-directional delivery device (Opt-FP) offers therapeutic benefits in patients with chronic rhinosinusitis (CRS). Methods: A prospective, single centre, randomized, double-blind, placebo (PBO)-controlled, parallel group study was conducted in adult subjects (n=20) with CRS without nasal polyps or only cobblestoned mucosa. Subjects received Opt-FP 400 µg or placebo twice daily for 12 weeks (n=10/group). Outcome measures included symptom scores, RSOM-31, CRS VAS, nasendoscopy, peak nasal inspiratory flow (PNIF) and magnetic resonance imaging (MRI). Results: Endoscopy score for oedema showed a highly significant and progressive improvement (12 weeks (median scores): Opt-FP -4.0, PBO -1.0, p=0.015). PNIF increased significantly during Opt-FP treatment compared to placebo (4 weeks: p=0.006; 8 weeks: p=0.03). After 12 weeks MRI scores in the Opt-FP group improved against baseline (p=0.039) and a non-significant trend was seen versus placebo. The nasal RSOM-31 subscale was significantly improved with Opt-FP treatment (4 weeks: p<0.009, 8 weeks: p<0.016, 12 weeks: NS). Sense of smell, nasal discomfort and combined score were all significantly improved (p<0.05). The Opt-FP was well tolerated. Conclusions: The OptiNose breath-actuated bi-directional delivery device administering fluticasone propionate (400 µg b.i.d.) is an effective and well tolerated treatment for recalcitrant CRS.

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Hill, Jennifer L., Alexander G. Chiu, and Tara F. Carr. "Changes in Sinus Bacterial Culture Following Mupirocin Treatment in Surgically Recalcitrant Chronic Rhinosinusitis." Journal of Allergy and Clinical Immunology 135, no. 2 (February 2015): AB54. http://dx.doi.org/10.1016/j.jaci.2014.12.1108.

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Peng, Tiffany, Vikash K. Modi, and Aaron N. Pearlman. "Recalcitrant chronic rhinosinusitis in the setting of fucosidosis, a rare lysosomal storage disorder." International Journal of Pediatric Otorhinolaryngology 103 (December 2017): 5–9. http://dx.doi.org/10.1016/j.ijporl.2017.09.019.

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Carr, Tara F., Jennifer L. Hill, Alex Chiu, and Eugene H. Chang. "Alteration in Bacterial Culture After Treatment With Topical Mupirocin for Recalcitrant Chronic Rhinosinusitis." JAMA Otolaryngology–Head & Neck Surgery 142, no. 2 (February 1, 2016): 138. http://dx.doi.org/10.1001/jamaoto.2015.3059.

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Mfuna Endam, Leandra, Yohan Bossé, Chantale Cormier, Pierre Boisvert, Louis-Philippe Boulet, Thomas J. Hudson, and Martin Desrosiers. "Polymorphisms in the IL22RA1 Gene and Chronic Rhinosinusitis." Otolaryngology–Head and Neck Surgery 139, no. 2_suppl (August 2008): P79—P80. http://dx.doi.org/10.1016/j.otohns.2008.05.256.

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Objective Recently, a pooling-based genome wide association (pGWAS) scan idenfied the interleukin-22 receptor alpha 1 (IL22RA1) gene as a promising candidate for chronic rhinosinusitis (CRS). The relevance of this gene in CRS is also substantiated by previous biological studies 1) that stimulation of the gene product increases the innate immune responses in some inflammatory diseases, and 2) a reduced level of the gene transcript in patients with recalcitrant CRS with nasal polyposis. We explore whether single nucleotide polymorphisms (SNPs) in the IL22RA1 gene are associated with CRS. Methods DNA extracted from a population of 206 patients with severe CRS and 196 postal-code matched controls was used. The 23 tagging SNPs in the IL22RA1 gene were selected from positive results in the pGWAS and completed with tagging SNPs from the CEU HapMap dataset and genotyped in our population. The haploview software was used to determine association. Results 22 SNPs were genotyped successfully with a genotype distribution in agreement with the Hardy-Weinberg equilibrium. Seven (rs10751768, rs10794665, rs16829225, rs3936073, rs4292900, rs4648936, rs7418238) out of 22 genotyped-SNPs were significantly associated with CRS (p-value: 0.0009 to 0.0337; OR: 1.44 to 1.76). Conclusions Polymorphisms in the IL22RA1 gene are associated with severe CRS. This may help better understand the pathophysiology of CRS and identify new targets for therapy. Replication in a second population with CRS is in progress to validate these findings.

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Kounis, Nicholas G., George D. Soufras, and George Hahalis. "Stent Hypersensitivity and Infection in Sinus Cavities." Allergy & Rhinology 4, no. 3 (January 2013): ar.2013.4.0071. http://dx.doi.org/10.2500/ar.2013.4.0071.

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Persistent mucosal inflammation, granulation tissue formation, hypersensitivity, and multifactorial infection are newly described complications of retained drug-eluting stents from endoscopic sinus surgery for refractory rhinosinusitis. In an important report published in Allergy and Rhinology, a 45-year-old male patient suffering from recalcitrant chronic rhinosinusitis underwent functional endoscopic sinus surgery and was found, for the first time, to have steroid-eluting catheters that were inadvertently left in the ethmoid and frontal sinuses. The retained catheters had caused persistent mucosal inflammation and formation of granulation tissue denoting hypersensitivity reaction. These consequences had induced perpetuation of symptoms of chronic rhinosinusitis. Meticulous removal of the retained stents with the nitinol wings from inflamed tissues of the frontal, ethmoidal, and sphenoethmoidal recesses in which they were completely imbedded was successfully performed without polypoid regrowth. Cultures of specimens taken from both left and right stents showed heavy growth of Stenotrophomonas maltophilia and moderate growth of Klebsiella oxytoca, coagulase negative Staphylococcus, and beta-hemolytic Streptococcus anginosus. Fungal infection was not detected. The current knowledge and experience regarding stent hypersensitivity and infection in relation with the use of stents in sinus cavities is reviewed.

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Tyler, Matthew A., Caroline J. Padro Dietz, Chris B. Russell, Martin J. Citardi, Shervin Assassi, Jun Ying, and Amber U. Luong. "Distinguishing Molecular Features of Allergic Fungal Rhinosinusitis." Otolaryngology–Head and Neck Surgery 159, no. 1 (March 27, 2018): 185–93. http://dx.doi.org/10.1177/0194599818764349.

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Objective Allergic fungal rhinosinusitis (AFRS) is a clinical subtype of chronic rhinosinusitis with nasal polyps (CRSwNP), characterized by eosinophilic mucin, evidence of fungal elements within the mucin, fungal-specific type I hypersensitivity, and characteristic computed tomography findings. It remains controversial whether AFRS represents a disease with a unique pathophysiology from chronic rhinosinusitis or is merely a severe form of CRSwNP. The goal of this study was to identify molecular features unique to AFRS. Study Design Cross-sectional case-control. Setting Single academic tertiary referral institution. Subjects and Methods Subjects included 86 patients undergoing endoscopic sinus surgery: CRSwNP (n = 34), AFRS (n = 37), and healthy controls (n = 15). Pathway and correlation analyses were performed with whole-genome microarray data for study patients undergoing surgery for recalcitrant chronic rhinosinusitis. Our findings were confirmed with quantitative polymerase chain reaction and immunohistochemical studies. Results AFRS was uniquely characterized by a pronounced association with adaptive T helper 2–associated immune gene expression. AFRS exhibited altered expression of proteins associated with secretory salivary peptides—namely, histatin, a peptide with known antifungal activity in the oral cavity. Furthermore, the expression of histatins correlated negatively with that of type 2 inflammatory mediators. We confirm the decreased expression of histatins in AFRS when compared with CRSwNP by quantitative polymerase chain reaction and localized its expression to a submucosal cell population. Conclusion There exist clear molecular profiles that distinguish AFRS from CRSwNP. This divergence translates into an altered ability to control fungal growth and may in part explain some of the phenotypical differences between CRSwNP and AFRS.

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Evans, Martin Oman, and Christopher Albert Coop. "Novel Treatment of Allergic Fungal Sinusitis Using Omalizumab." Allergy & Rhinology 5, no. 3 (January 2014): ar.2014.5.0098. http://dx.doi.org/10.2500/ar.2014.5.0098.

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A case report of recalcitrant allergic fungal sinusitis (AFS) refractory to systemic corticosteroids and multiple functional endoscopic sinus surgeries (FESSs) treated with anti-IgE antibody omalizumab is reported. AFS is often classified with chronic rhinosinusitis (CRS). Although similar symptoms are among the two diseases, AFS has a unique pathophysiology. Patients with AFS demonstrate type 1 hypersensitivity to fungal allergens, increased total serum IgE, increased CD8+ T-cell prevalence, and IL-4 and IL-5 response. Omalizumab should be considered in the treatment of AFS.

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Kvarantan, Aigerim, Vedran Balta, Neven Zarkovic, Tea Horvat, Tea Vukovic, Kamelija Zarkovic, and Livije Kalogjera. "Association between aryl hydrocarbon receptor and 4-hydroxynonenal in oxidative stress-mediated chronic rhinosinusitis with nasal polyps." European Journal of Inflammation 19 (January 2021): 205873922110656. http://dx.doi.org/10.1177/20587392211065613.

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Objective Сhronic rhinosinusitis with nasal polyps (CRSwNPs) is a distinct entity within the chronic rhinosinusitis group of diseases, which are chronic upper airway diseases with several pheno- and endotypes. Oxidative stress plays an important role in the pathogenesis of CRSwNPs. The aim was to assess the association between expression of the aryl hydrocarbon receptor (AhR) and 4-hydroxynonenal (4-HNE) in patients with CRSwNPs. Methods The study included 26 patients who underwent endoscopic sinus surgery: Fourteen patients with CRSwNPs, and 12 controls with healthy sinus mucosa. Expression of AhR and 4-HNE was assessed in tissue samples using immunohistochemistry. The level of 4-HNE in serum samples was measured using the ELISA assay. Total oxidative capacity (TOC) was assessed by measuring the peroxidase activity. Results Higher levels of 4-HNE expression were observed in tissues (3, range 1–3 vs. 0, range 0–0 p<0.001) and serum (27.7±11.5 vs 9.8±7.7 pmol/mg, p < 0.001) samples of CRSwNPs patients, as compared to healthy controls. Higher expression of AhR was found in inflammatory cells (plasma cells, lymphocytes, eosinopholes) of CRSwNPs patients, compared to controls (3, range 1–3 vs. 2, range 1–2, p = 0.001). There were no differences in TOC across groups (0.0285±0.0207 vs 0.02, 978±0.0197 µM H2O2 eq., p = 0.848). Patients with bronchial asthma (57%) had abundant eosinophil in tissue samples. Patients with recalcitrant CRSwNPs had higher 4-HNE serum levels, compared to non-recalcitrant cases (27.3 vs 24.2 pmol/mg, p = 0.339). Conclusion Patients suffering from CRSwNPs have oxidative stress–mediated overexpression of AhR, which is linked to a chronic inflammatory response in the paranasal sinus tissues.

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Qualliotine, Jesse R., Aria Jafari, Sarek Shen, Jeffrey D. Bernstein, and Adam S. DeConde. "Concha Bullosa Affects Baseline and Postoperative Quality-of-Life Measures in Surgically Managed Chronic Rhinosinusitis." American Journal of Rhinology & Allergy 34, no. 2 (October 11, 2019): 162–69. http://dx.doi.org/10.1177/1945892419881836.

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Background Concha bullosa (CB) is a prevalent anatomic variant and frequent surgical target in endoscopic sinus surgery (ESS). However, whether CB impacts quality-of-life (QOL) in chronic rhinosinusitis (CRS) is not well established. The purpose of this study was to investigate baseline and post-ESS QOL differences in patients with medically recalcitrant CRS with and without CB. Methods Demographic and surgical characteristics, baseline and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores for 137 patients with CRS who underwent primary ESS at our institution were recorded. Computed tomography (CT) scans were reviewed for Lund–Mackay score and presence of CB. Multiplanar CT was used to measure CB dimensions and estimate volume. Multivariable analysis was performed to identify differences in SNOT-22 overall and symptom-domain scores between patients with upper quartile (≥0.8 mL) CB and without CB. Results CB was found in 37% of patients with mean volume of 0.67 mL. There were no significant differences in distribution of clinicodemographic variables by large CB status. At baseline, large CB was associated with higher SNOT-22 extranasal-rhinologic domain score (9.8 vs 6.0, P < .01). Following ESS, patients with large CB reported greater improvement in SNOT-22 extranasal-rhinologic domain score (multivariable mean absolute improvement 3.8, P = .01; relative 56% vs 30%). Conclusion Patients with medically recalcitrant CRS and concomitant large CB have higher SNOT-22 extranasal-rhinologic domain scores at baseline, but also report greater intradomain improvement exceeding the subdomain’s mean clinically important difference. To our knowledge, this is the first demonstration that CB has a clinically significant impact on QOL in CRS, and surgical intervention may be helpful to address these symptoms.

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Amedee, Ronald G. "A randomized trial of mupirocin sinonasal rinses versus saline in surgically recalcitrant staphylococcal chronic rhinosinusitis." American Journal of Rhinology and Allergy 28, no. 1 (January 1, 2014): 87. http://dx.doi.org/10.2500/194589214809820479.

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Amedee, Ronald G., and John M. Carter. "A Randomized Trial of Mupirocin Sinonasal Rinses versus Saline in Surgically Recalcitrant Staphylococcal Chronic Rhinosinusitis." American Journal of Rhinology & Allergy 28, no. 1 (January 2014): 87. http://dx.doi.org/10.1177/194589241402800101.

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Barac, Aleksandra, Marina Pekmezovic, Vesna Tomic Spiric, Aleksandar Trivic, Jelena Marinkovic, Sandra Pekic, and Valentina Arsic Arsenijevic. "Chronic rhinosinusitis: association of recalcitrant nasal polyposis and fungal finding in polyp’s single-cell suspension." European Archives of Oto-Rhino-Laryngology 272, no. 12 (January 29, 2015): 3727–34. http://dx.doi.org/10.1007/s00405-015-3511-2.

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Jervis-Bardy, Joshua, Samuel Boase, Alkis Psaltis, Andrew Foreman, and Peter-John Wormald. "A randomized trial of mupirocin sinonasal rinses versus saline in surgically recalcitrant staphylococcal chronic rhinosinusitis." Laryngoscope 122, no. 10 (August 2, 2012): 2148–53. http://dx.doi.org/10.1002/lary.23486.

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Kilty, Shaun J., Corliss Best, Stephanie Santucci, Andrea Lasso, and William Yang. "Self-Reported Improvement for Chronic Rhinosinusitis Major Symptoms in Patients Treated with Omalizumab." Journal of Respiration 1, no. 1 (July 8, 2020): 1–7. http://dx.doi.org/10.3390/jor1010001.

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Objective: To evaluate the clinical effect of omalizumab therapy on the symptoms of patients with chronic rhinosinusitis (CRS). Methods: This cross-sectional study evaluated CRS major symptom improvement in patients with CRS on omalizumab therapy and patients who met omalizumab therapy indications, but could not access coverage for omalizumab. Changes in overall chronic rhinosinusitis symptom burden and each of the major symptoms of CRS were rated on a 10 cm visual analogue scale (VAS). The Mann–Whitney test was used to compare the symptom improvement between groups. Results: Omalizumab therapy provided a mean overall symptom improvement of 69.5% (individual symptom improvement: facial pain 78.5%, nasal obstruction 69.8%, rhinorrhea 56.2%, and olfaction 55.8%). For the control group, mean overall symptom improvement since omalizumab screening was 16.8% (individual symptom improvement: rhinorrhea 16.4%, nasal obstruction 15.3%, no improvement in facial pain or olfaction). Overall, and for each major symptom, improvement was significantly greater for omalizumab treated patients (p < 0.05). Conclusion: Omalizumab treatment provided significant improvement in every major clinical symptom of CRS in the treated cohort of patients with recalcitrant CRS, in comparison to the control cohort. A well-designed randomized clinical trial is needed to further assess the efficacy and safety of omalizumab treatment for CRS.

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Lilja, M. J., P. Virkkula, S. Hammaren-Malmi, A. Laulajainen-Hongisto, L. Hafren, P. Kauppi, J. Sahlman, W. J. Fokkens, S. Reitsma, and S. K. Toppila-Salmi. "The extent of endoscopic sinus surgery in patients with severe chronic rhinosinusitis with nasal polyps (AirGOs Operative)." Rhinology Online 4, no. 4 (August 23, 2021): 154–60. http://dx.doi.org/10.4193/rhinol/21.029.

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Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nose and paranasal sinuses characterized by intense inflammation, decreased health-related quality of life (HRQoL), and in severe cases high frequency of co-morbidities and recurrence despite treatment. Conservative treatment consists of nasal lavage, intranasal corticosteroids, and courses of oral corticosteroids, and antibiotics in exacerbations. Endoscopic sinus surgery (ESS) and/or biological therapy is considered if appropriate conservative treatment is not sufficient. The optimal extent of ESS in recalcitrant CRSwNP is not known. The aim of this randomized controlled trial is to evaluate and compare the efficacy and safety of limited ESS with partial ethmoidectomy with extended ESS with total ethmoidectomy in patients with severe CRSwNP. Methods: AirGOs Operative is a randomized controlled trial. It is an investigator-driven multicenter trial led by Helsinki University Hospital. The two surgery arms are compared. The primary outcome is the change in the SNOT-22 score at the 12-month follow-up. Secondary outcomes include the change in the SNOT-22 score at 24-months follow-up, the changes in polyp score, Lund-Mackay (LM) CT score, health-related quality of life (HRQoL), loss of productivity, nasal patency (peak nasal inspiratory flow (PNIF) ± acoustic rhinometry (ARM), olfaction test (Sniffin’ Sticks, identification), lung function (spirometry and PEF) and findings in pathological analysis at 12/24-months follow-up. Discussion: AirGOs Operative trial will lead to a better understanding of the optimal extent of ethmoidectomy in the treatment of recalcitrant severe CRSwNP.

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Belsky, Michael A., Erica Corredera, Hridesh Banerjee, John Moore, Li Wang, Lawrence P. Kane, and Stella E. Lee. "Association of Mast Cell Burden and TIM-3 Expression with Recalcitrant Chronic Rhinosinusitis with Nasal Polyps." Annals of Otology, Rhinology & Laryngology 130, no. 9 (February 12, 2021): 1069–77. http://dx.doi.org/10.1177/0003489421995038.

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Objectives: Previous work showed that higher polyp mast cell load correlated with worse postoperative endoscopic appearance in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Polyp epithelial mast cells showed increased expression of T-cell/transmembrane immunoglobulin and mucin domain protein 3 (TIM-3), a receptor that promotes mast cell activation and cytokine production. In this study, CRSwNP patients were followed post-operatively to investigate whether mast cell burden or TIM-3 expression among mast cells can predict recalcitrant disease. Methods: Nasal polyp specimens were obtained via functional endoscopic sinus surgery (FESS) and separated into epithelial and stromal layers via enzymatic digestion. Mast cells and TIM-3-expressing mast cells were identified via flow cytometry. Mann-Whitney U tests and Cox proportional hazard models assessed whether mast cell burden and TIM-3 expression were associated with clinical outcomes, including earlier recurrence of polypoid edema and need for treatment with steroids. Results: Twenty-three patients with CRSwNP were studied and followed for 6 months after undergoing FESS. Higher mast cell levels were associated with earlier recurrence of polypoid edema: epithelial HR = 1.283 ( P = .02), stromal HR = 1.103 ( P = .02). Percent of mast cells expressing TIM-3 in epithelial or stromal layers was not significantly associated with earlier recurrence of polypoid edema. Mast cell burden and TIM-3+ expression were not significantly associated with need for future treatment with steroids post-FESS. Conclusions: Mast cell load in polyp epithelium and stroma may predict a more refractory postoperative course for CRSwNP patients. The role of TIM-3 in the chronic inflammatory state seen in CRSwNP remains unclear.

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Reh, Douglas D., Yadong Wang, Murugappan Ramanathan, and Andrew P. Lane. "Treatment-Recalcitrant Chronic Rhinosinusitis with Polyps is Associated with Altered Epithelial Cell Expression of Interleukin-33." American Journal of Rhinology & Allergy 24, no. 2 (March 2010): 105–9. http://dx.doi.org/10.2500/ajra.2010.24.3446.

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Sindwani, R. "What is the Role of Long-Term Macrolide Therapy in the Treatment of Recalcitrant Chronic Rhinosinusitis?" Yearbook of Otolaryngology-Head and Neck Surgery 2010 (January 2010): 215–16. http://dx.doi.org/10.1016/s1041-892x(10)79649-9.

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Ooi, Mian Li, Arvind Jothin, Catherine Bennett, Eng H. Ooi, Sarah Vreugde, Alkis J. Psaltis, and Peter‐John Wormald. "Manuka honey sinus irrigations in recalcitrant chronic rhinosinusitis: phase 1 randomized, single‐blinded, placebo‐controlled trial." International Forum of Allergy & Rhinology 9, no. 12 (August 28, 2019): 1470–77. http://dx.doi.org/10.1002/alr.22423.

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Soler, Zachary M., and Timothy L. Smith. "What is the role of long-term macrolide therapy in the treatment of recalcitrant chronic rhinosinusitis?" Laryngoscope 119, no. 11 (November 2009): 2083–84. http://dx.doi.org/10.1002/lary.20739.

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Shkorbotun, Ya V. "Comparison of the Frequency of Detection of Some Radiological Signs in Chronic Maxillary Sinusіtis of Fungal and Non-Fungal Origin." Ukraïnsʹkij žurnal medicini, bìologìï ta sportu 5, no. 6 (December 12, 2020): 202–7. http://dx.doi.org/10.26693/jmbs05.06.202.

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The one of the most informative method of preoperative diagnosis of fungal paranasal sinuses is computed tomography. The radiological marker that allows to identify chronic sinusitis of fungal origin is an eclipse with hyperintensive inclusions. The sensitivity of this criterion for fungal ball is about 80%. In addition, a sign of recalcitrant chronic sinusitis is the presence of reactive changes in the bone wall of the sinus – "osteitis". The purpose of the work was to study the frequency of radiological signs of osteitis and areas of increased radiological density in the maxillary sinuses of the patients with chronic sinusitis of fungal and non-fungal etiology, to clarify the diagnostic significance of these symptoms in the differential diagnostics. Material and methods. The results of a retrospective study of computer tomography data of 60 people with chronic rhinosinusitis (intraoperative was verified fungal ball in the maxillary sinus space of 30 patients, other 30 patient had no signs of fungal etiology). Results and discussion. In patients with chronic rhinosinusitis of non-fungal nature, hyperintensive inclusions in the sinus were found in 13.3%, and signs of osteitis were detected in 36.7%, which was significantly less common than in patients with fungal processes, 83.3% and 80,0% respectively (p <0,05). The presence of both of the radiological symptoms was observed in 63.3% of patients from the group of chronic rhinosinusitis in the presence of a fungal body in the space of the sinus and in 6.7% of cases the chronic rhinosinusitis of non-fungal etiology. The severity of osteitis according to KOS, in patients with a fungal body in the sinus was 0.71 ± 0.15 points, and 0.55 ± 0.2 points in patients without a fungus. The pathogenesis of osteitis in the cases of sinusitis with fungal origin is a violation of bone trophism, which develops due to periostitis after the influence of biologically active substances secreted by the fungus. The increase of radiation density in areas of osteitis indicates the predominance of osteogenesis over osteolysis in the inflammatory focus of the bone wall of the maxillary sinus. Conclusion. The frequency of detecting radiological signs of osteitis in patients with chronic rhinosinusitis of the maxillary sinus with fungal bodies was 80%, that was comparable to the frequency of detecting hyperintense inclusions in the lumen of the sinus in these patients (83.3%), and was significantly more than in patients with chronic sinusitis nonfungal etiology. The presence of radiological signs of osteitis of the bone wall of the maxillary sinus in computed tomography should be regarded as an additional symptom in the differential diagnosis of maxillary sinusitis of fungal origin

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Malvezzi, Luca, Francesca Pirola, Armando De Virgilio, and Enrico Heffler. "Long-lasting clinical, radiological and immunological remission of severe nasal polyposis by means of ‘reboot’ surgery." BMJ Case Reports 13, no. 4 (April 2020): e233726. http://dx.doi.org/10.1136/bcr-2019-233726.

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A 68-year-old woman with a long history of relapsing chronic rhinosinusitis with nasal polyps (CRSwNP) underwent a complete reboot surgery and nasal biopsy prior to and after surgery. Remarkable improvement of symptoms and no signs of mucosal oedema and no complaints of initially worsening nasal functions were still present 12 months after reboot surgery. Biopsy demonstrated an outstanding reduction in eosinophilic infiltration and re-epithelisation of nasal mucosa with normal features after reboot approach compared with previous surgeries. Therefore, reboot approach may become an effective instrument in plurioperated patients with CRSwNP who suffer from a nasal condition that is recalcitrant to pharmacological therapies and is unsatisfactorily treated by standard surgical techniques.

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Endam, Leandra Mfuna, Yohan Bossé, Abdelali Filali-Mouhim, Chantale Cormier, Pierre Boisvert, Louis-Philippe Boulet, Thomas J. Hudson, and Martin Desrosiers. "Polymorphisms in the interleukin-22 receptor alpha-1 gene are associated with severe chronic rhinosinusitis." Otolaryngology–Head and Neck Surgery 140, no. 5 (May 2009): 741–47. http://dx.doi.org/10.1016/j.otohns.2008.12.058.

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Rationale: Stimulation of interleukin-22 receptor alpha-1 (IL22RA1) was reported to increase the innate immune responses in inflammatory diseases. Moreover, a reduced level of IL22RA1 was found in patients with recalcitrant CRS with nasal polyps. Objective: To explore association between single nucleotide polymorphisms (SNPs) in IL22RA1 and severe CRS. Methods: We extracted DNA from 206 cases with severe CRS and 196 postal code–matched controls. Twenty-three SNPs in the IL22RA1 gene were selected from the pooling-based genome-wide association study and from the CEU HapMap dataset and genotyped. PLINK software was used to determine association. Results: After Bonferroni correction, three SNPs (rs4292900 Pnom = 0.0006, OR = 1.757; rs4648936 Pnom = 0.0011, OR = 1.716; rs16829225 Pnom = 0.0014, OR = 1.977) show significant differences in allelic frequencies between cases and controls. Conclusion: Polymorphisms in IL22RA1 are associated with severe CRS. Replication and functional studies are involved to better understand the mechanism by which these polymorphisms contribute to the pathogenesis of CRS.

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Luukkainen, A., J. Numminen, M. Rautiainen, A. Julkunen, H. Huhtala, J. Lampi, A. Markkola, et al. "Association Between Endoscopic, Radiologic and Patient-reported Chronic Rhinosinusitis with Nasal Polyps." Open Allergy Journal 10, no. 1 (May 31, 2019): 1–8. http://dx.doi.org/10.2174/1874838401910010001.

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Objectives: Chronic Rhinosinusitis without Nasal Polyps (CRSsNP) and with Nasal Polyps (CRSwNP) affect 10% and 1-4% of the general population respectively. Early detection and treatment of CRSwNP might prevent recalcitrant disease forms. The aim of this prospective controlled study was to evaluate association between endoscopic, radiologic, and self-reported CRSwNP, and a family history in defining CRSwNP. Methods: This study involved 73 CRS patients aged 18 years or over undergoing CRS-surgical consultation at the Tampere University Hospital. Data of sinus Computed Tomography (CT) scans and nasal endoscopy was obtained from patient records. Sixty controls ±allergic rhinitis underwent clinical examination. All subjects filled a questionnaire. Associations were analyzed by Chi square and adjusted regression models. The predictive performance of various parameters was assessed using the Area Under the Receiver Operating Characteristic curve (AUROC). Results: A total of 33% of CRSwNP patients reported not having Nasal Polyps (NPs), while 18% of CRSsNP patients reported having NPs (p < 0.001). Radiologic Nasal Polyp (NP) score differentiated CRSwNP from CRSsNP with an AUROC of 0.95 (95% CI 0.91-1.00). The AUROC value for Lund-Mackay (LM) score was 0.84 (0.75-0.94). Positive family history of NP did not differ significantly between CRS and control groups. Family history of allergy or asthma was given with certainty, whereas CRS patients had uncertainty of reporting NPs in family compared to controls (adjusted OR=6.02, 95% CI 1.98-18.30, p = 0.002). Conclusion: Our findings suggest that in situations where nasal endoscopy cannot be performed, early detection of CRSwNP could result from information obtained from sinus CT scans and patients, in comparison to family history which has lower predictive value. However validation studies with larger sample sizes are still needed.

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Raman, Anish, Peter Papagiannopoulos, Hannah N. Kuhar, Paolo Gattuso, Pete S. Batra, and Bobby A. Tajudeen. "Histopathologic Features of Chronic Sinusitis Precipitated by Odontogenic Infection." American Journal of Rhinology & Allergy 33, no. 2 (November 15, 2018): 113–20. http://dx.doi.org/10.1177/1945892418811210.

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Background Chronic rhinosinusitis (CRS) is a heterogeneous disease process that can arise in the context of odontogenic disease from the maxillary teeth. The histopathologic features of odontogenic CRS (CRSo) have yet to be determined and may have important implications on disease management and need for escalation of therapy. Objectives The objectives of this study are to characterize the histopathologic features of CRSo and determine whether the inflammatory profile of CRSo contributes to its recalcitrance to medical therapy and need for surgery in a subset of patients with this disease. Methods A structured histopathology report was used to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). Histopathology variables, Lund–Mackay scores (LMS), and Sinonasal Outcome Test-22 scores were compared among CRSo patients, CRS without nasal polyps (CRSsNP) patients, and CRS with nasal polyps (CRSwNP) patients. Results Twenty-three CRSo, 38 CRSwNP, and 53 CRSsNP patients who underwent FESS were analyzed. Compared to CRSsNP, CRSo exhibited increased moderate–severe inflammation (73.9% vs 41.5%, P < .009). Compared to CRSwNP, CRSo had decreased squamous metaplasia (0.0% vs 18.4%, P < .03) and decreased fibrosis (26.1% vs 63.2%, P < .005). Eosinophilia was prevalent in CRSo but to a lesser extent than in CRSwNP (39.1% vs 63.2%, P < .05). CRSo cases had significantly lower mean LMS compared to CRSwNP (7.83 ± 2.77 vs12.18 ± 6.77, P < .005). Conclusion CRSo exhibits histopathologic features similar to those of CRSsNP with more severe inflammation. Moreover, eosinophilia, which is not typically considered to coexist with CRSo, was present in a large portion of CRSo patients. These findings may help explain at the inflammatory level why select cases of CRSo may be recalcitrant to medical and dental therapy.

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Salvador, Pedro, Catarina Lombo, Francisco Moreira da Silva, and Rui Fonseca. "Chronic rhinosinusitis with nasal polyps: predictive factors for recurrence and revision surgery." International Journal of Otorhinolaryngology and Head and Neck Surgery 6, no. 12 (November 24, 2020): 2165. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20205054.

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Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition which may have a significant impact on quality of life. Endoscopic sinus surgery (ESS) is indicated for patients refractory to maximal medical treatment and presents high recurrence and revision surgery rates. Aim of the study was to evaluate ESS outcome in CRSwNP management and to assess independent predictive factors for recurrence and revision surgery.Methods: Retrospective medical chart review of patients who underwent ESS for recalcitrant CRSwNP, from January 2013 to December 2017, with a minimum follow-up time of 12 months. Results: This study enrolled 132 patients, 62.1% of whom were males, with a mean age of 43.4±11.5 years. Asthma was the most common comorbidity (39.4%, n=52) and aspirin exacerbated respiratory disease (AERD) was present in 9.8% (n=12) of the study population. We found a recurrence rate of 34.1% (n=45) and 9% (n=12) of patients required revision surgery. Multivariate analysis identified as independent variables of recurrence (95% CI): a history of asthma (OR=8.81, CI 3.87-20.03; p<0.001) and a severe Lund-Mackay score (17-24) (OR=5.85, CI 2.73-12.51; p=0.001). Revision surgery was related to a severe endoscopic Lund-Kennedy score at presentation (OR=4.05, CI 1.91-8.01, p=0.001).Conclusions: CRSwNP presents a high tendency to recur after ESS. Asthma, severe sinus opacification and severe endoscopic score are poor prognostic factors that hallmark a more aggressive disease. A more extensive surgical procedure and/or middle turbinate resection with a rigorous postoperative compliance should be considered to improve long term results.

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Palanisamy, Karthikeyan, Lakshmi Vaid, Neelima Gupta, Rumpa Saha, and Usha Rani Singh. "Clinical and histopathological impact of biofilm in chronic rhinosinusitis with nasal polyps." International Journal of Otorhinolaryngology and Head and Neck Surgery 7, no. 1 (December 24, 2020): 73. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20205623.

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Background: Presence of biofilms in sinus mucosa of patients with chronic rhinosinusitis (CRS) remains controversial. Literature shows that biofilms may contribute to the recalcitrant nature of CRS and unfavourable outcome following surgery. This study was performed to evaluate the prevalence of biofilm and its clinical and histopathological impact in patients with chronic rhinosinusitis with nasal polyps (CRSwNP)Methods: 41 patients of CRSwNP (study group) were included. SNOT-20(sinonasal outcome test-20) score, radiological and endoscopic findings of these patients were evaluated preoperatively. Sinonasal polypoidal tissues removed during surgery were studied for the presence of biofilm and evaluated histopathologically. Postoperatively SNOT-20 score and endoscopic finding were recorded. 41 patients undergoing septoplasty for deviated nasal septum (control group) were also included in the study. Sinonasal mucosal samples of these patients were analysed for the presence of biofilm. Results: 29 out of 41 (70.73%) samples in study group and 9 out of 41 (21.9%) samples in control group were positive for biofilm. We found a significant impact in preoperative SNOT-20 symptom scores in biofilm positive study group. But there is no significant impact in preoprerative endoscopic scores, radiological scores and postoperative SNOT-20 scores and endoscopic scores in study group patients irrespective of biofilm status.Conclusions: Prevalence of biofilm in patients with CRSwNP was higher than normal population. Biofilms plays a major role in preoperative symptomatology. But biofilms have no endoscopic, radiological, and histopathological impact in CRSwNP. It was concluded that apart from biofilms, host and other environmental factors plays a major role in the pathogenesis of CRSwNP.

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Levy, Joshua M., and Timothy L. Smith. "Is aspirin desensitization indicated for the treatment recalcitrant chronic rhinosinusitis with nasal polyposis in aspirin-exacerbated respiratory disease?" Laryngoscope 127, no. 4 (November 4, 2016): 776–77. http://dx.doi.org/10.1002/lary.26377.

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Journal articles on the topic 'Recalcitrant Chronic Rhinosinusitis'

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