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CONTEXT: The mucociliary clearance system is an important component in the prevention of chronic inflammation of the nasal and paranasal sinus. AIM: The study aims to establish the normal values of mucociliary clearance in our region and to study the variation in mucociliary activity in patients with chronic rhinosinusitis in Ilorin, North-central Nigeria. SETTINGS AND DESIGN: This was a prospective, cross-sectional study using consecutive consenting participants in both the control and study groups carried out at both family medicine and otorhinolaryngology clinics among patients attending the clinics. SUBJECTS AND METHODS: After ethical approval was sought, informed consent was obtained from patients, a modified version of the validated health questionnaire was filled, semi-structured questionnaires were also filled after which patient undergo anterior rhinoscopy, nasal patency test and spirometry was done. The saccharine test has been used to measure nasal-mucociliary clearance time in the past. STATISTICAL ANALYSIS: All information were entered into SPSS version 20 and analysed descriptively, and results were presented in tables and figures. RESULTS: Consecutive consenting 125 patients with rhinosinusitis (study group) and those without rhinosinusitis (control group) underwent naso-mucociliary clearance test. There were 34 males and 91 females with a male:female ratio of 1:2.6 among the study group and 55 males and 70 females with a male:female ratio of 1:1.3 for the control group. The age range was from 18 to 68 years with 18-40 years constituting the modal age group. The mean age for the studied group was 35.7 years while that of the control group was 33.1 years. The mean naso-mucociliary clearance time among the study group was 35.1 min standard deviation (SD = 12.32 ± 1.63), while among the control group, it was 14.8 min (SD = 5.59 ± 0.43). CONCLUSION: Compared to the control group, there was a roughly 200% prolonged increase in the duration of naso-mucociliary clearance time among patients with rhinosinusitis. There was also a positive correlation with increasing age. Future studies comparing the pre-operative and post-operative treatment of rhinosinusitis will contribute to knowledge.
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Depuración Mucociliar , Rinitis , Sinusitis , Humanos , Masculino , Femenino , Nigeria , Adulto , Estudios Transversales , Estudios Prospectivos , Enfermedad Crónica , Persona de Mediana Edad , Adolescente , Adulto Joven , Encuestas y Cuestionarios , Estudios de Casos y Controles , Anciano , Valores de Referencia , RinosinusitisRESUMEN
Background: Yujiang Paidu Decoction (YJPD) has demonstrated clinical efficacy in the treatment of chronic rhinosinusitis. However, the effects and mechanisms of the YJPD on chronic rhinosinusitis with nasal polyps (CRSwNP) remain unclear. Purpose: This study aimed to elucidate the potential mechanism of action of YJPD in the treatment of CRSwNP based on network pharmacology, transcriptomics and experiments. Methods: A CRSwNP mouse model was established using ovalbumin (OVA) and staphylococcus aureus enterotoxin B (SEB) for 12 weeks and the human nasal epithelial cell (HNEpC) model was induced with IL-13 in vitro. Behavioral tests, scanning electron microscopy (SEM), micro-CT and pathological change of nasal tissues were observed to investigate the therapeutic effects of YJPD. Network pharmacology and transcriptomics were launched to explore the pharmacological mechanisms of YJPD in CRSwNP treatment. Finally, an ELISA, immunofluorescence, RT-qPCR, Western blotting and Tunel were performed for validation. Results: Different doses of YJPD intervention effectively alleviated rubbing and sneezing symptoms in CRSwNP mice. Additionally, YJPD significantly reduced abnormal serological markers, structural damage of the nasal mucosa, inflammatory cell infiltration, goblet cell increases, and inhibited OVA-specific IgE levels and the secretion of Th2 cytokines such as IL-4, IL-5, and IL-13. Moreover, transcriptomics and network pharmacology analyses indicated that YJPD may exert anti-inflammatory and anti-apoptotic effects by inhibiting the MAPK/AP-1 signaling pathway. The experimental findings supported this conclusion, which was further corroborated by similar results observed in IL13-induced HNEpCs in vitro. Conclusion: YJPD could alleviate inflammatory status and epithelial apoptosis by inhibiting aberrant activation of MAPK/AP-1 signaling pathway. This finding provides a strong basis for using YJPD as a potential treatment in CRSwNP.
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Medicamentos Herbarios Chinos , Pólipos Nasales , Farmacología en Red , Rinitis , Sinusitis , Animales , Sinusitis/tratamiento farmacológico , Medicamentos Herbarios Chinos/farmacología , Medicamentos Herbarios Chinos/química , Ratones , Pólipos Nasales/tratamiento farmacológico , Pólipos Nasales/patología , Enfermedad Crónica , Humanos , Rinitis/tratamiento farmacológico , Rinitis/metabolismo , Rinitis/patología , Transcriptoma/efectos de los fármacos , Modelos Animales de Enfermedad , Ratones Endogámicos BALB C , Masculino , Relación Dosis-Respuesta a Droga , Células Cultivadas , RinosinusitisRESUMEN
Chronic rhinosinusitis with nasal polyps (CRSwNP) significantly impacts quality of life and often presents therapeutic challenges, with biologics like dupilumab showing promise in managing severe, uncontrolled cases. The aim of this study was to assess the influence of overweight on the effectiveness of dupilumab in patients with uncontrolled CRSwNP. This retrospective study analyzed treatment outcomes of 75 CRSwNP patients receiving dupilumab, categorizing them into underweight/normal-weight (BMI ≤ 24.9 kg/m2) and overweight/obese (BMI ≥ 25 kg/m2) groups. Outcome measures included changes in nasal polyp score (NPS) and sinonasal outcome test (SNOT-22) scores. Results demonstrated that the underweight/normal-weight group experienced significantly greater improvements in NPS and a higher rate of total NPS improvement compared to the overweight/obese group. While SNOT-22 scores improved in both groups, no significant differences were observed. Among patients with comorbid asthma, the underweight/normal-weight subgroup also showed significantly better outcomes, including greater reductions in both NPS and SNOT-22 scores. Multiple regression analysis identified BMI as an independent prognostic factor for NPS outcomes. The findings suggest that overweight/obesity adversely affects the response to dupilumab in CRSwNP, emphasizing the need for personalized treatment strategies considering BMI.
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Anticuerpos Monoclonales Humanizados , Índice de Masa Corporal , Pólipos Nasales , Sobrepeso , Rinitis , Sinusitis , Humanos , Pólipos Nasales/tratamiento farmacológico , Pólipos Nasales/complicaciones , Masculino , Femenino , Sinusitis/tratamiento farmacológico , Sinusitis/complicaciones , Anticuerpos Monoclonales Humanizados/uso terapéutico , Estudios Retrospectivos , Persona de Mediana Edad , Rinitis/tratamiento farmacológico , Rinitis/complicaciones , Enfermedad Crónica , Sobrepeso/complicaciones , Sobrepeso/tratamiento farmacológico , Adulto , Resultado del Tratamiento , Obesidad/complicaciones , Obesidad/tratamiento farmacológico , Anciano , Calidad de Vida , RinosinusitisRESUMEN
The relationship between obstructive sleep apnea (OSA) and chronic rhinosinusitis (CRS) has not yet been fully elucidated. Therefore, the objective of this study was to evaluate the connection between OSA risk and CRS by investigating associations between the STOP-Bang questionnaire and presence of CRS in a nationwide, population-based study. This is a cross-sectional study based on the Korean National Health and Nutrition Examination Survey (KNHANES). We evaluated 10,081 subjects who completed both the STOP-Bang and CRS-related questionnaires. Among the total subjects, 390 (3.9%) were CRS patients. The median STOP-Bang score was 3.0 [2.0; 4.0] in CRS patients, compared to 2.0 [1.0; 3.0] in subjects without CRS. In a low-risk group according to the STOP-Bang questionnaire, 3.1% of subjects were CRS patients. However, a gradual increase was observed among different risk groups. In the higher risk group, CRS patients accounted for 5.3% (P < 0.001). Among the four main symptoms of CRS (nasal obstruction, nasal discharge, facial pain/pressure, and decreased sense of smell), nasal obstruction (4.1 to 7.3%) and a decreased sense of smell (1.9 to 3.3%) increased with higher STOP-Bang scores. This study found that the proportion of patients with CRS was significantly higher in the group at a higher STOP-Bang score in the general population. Among symptoms of CRS, nasal obstruction and anosmia were found to be associated with an increased STOP-Bang score.
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Rinitis , Sinusitis , Apnea Obstructiva del Sueño , Humanos , Sinusitis/complicaciones , Sinusitis/epidemiología , Apnea Obstructiva del Sueño/epidemiología , Apnea Obstructiva del Sueño/complicaciones , Masculino , Femenino , Persona de Mediana Edad , Enfermedad Crónica , Rinitis/epidemiología , Rinitis/complicaciones , Adulto , Estudios Transversales , Factores de Riesgo , República de Corea/epidemiología , Encuestas y Cuestionarios , Anciano , RinosinusitisRESUMEN
Type 2 airway inflammation (T2AI), driven by type 2 innate lymphoid and CD4+ T helper 2 cells, leads to various diseases and conditions, such as chronic rhinosinusitis with nasal polyps, allergic rhinitis, and asthma. Emerging evidence suggests the involvement of extracellular vesicles (EVs) in these diseases. In this review, we describe the immunological T2AI pathogenic mechanisms, outline EV characteristics, and highlight their applications in the diagnosis and treatment of T2AI. An extensive literature search was conducted using appropriate strategies to identify relevant articles from various online databases. EVs in various biological samples showed disease-specific characteristics for chronic rhinosinusitis with nasal polyps, allergic rhinitis, and asthma, with some demonstrating therapeutic effects against these conditions. However, most studies have been limited to in vitro and animal models, highlighting the need for further clinical research on the diagnostic and therapeutic applications of EVs.
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Vesículas Extracelulares , Células Th2 , Vesículas Extracelulares/metabolismo , Vesículas Extracelulares/inmunología , Humanos , Células Th2/inmunología , Células Th2/metabolismo , Animales , Asma/inmunología , Asma/metabolismo , Asma/terapia , Inflamación/inmunología , Inflamación/metabolismo , Inflamación/patología , Sinusitis/inmunología , Sinusitis/metabolismo , Sinusitis/patología , Sinusitis/terapia , Rinitis Alérgica/inmunología , Rinitis Alérgica/metabolismo , Rinitis Alérgica/terapia , Pólipos Nasales/inmunología , Pólipos Nasales/terapia , Pólipos Nasales/metabolismo , Pólipos Nasales/patología , Rinitis/inmunología , Rinitis/terapia , Rinitis/metabolismo , Rinitis/patologíaRESUMEN
This study aimed to investigate the impact of different types of nasal inflammation on the regulation of entry-associated genes of respiratory viruses, including severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), Middle East respiratory syndrome coronavirus (MERS-CoV), human coronavirus 229E (HCoV-229E), and influenza virus, in the nasal epithelium. Subjects were classified into three groups: control, eosinophilic chronic rhinosinusitis (ECRS), and noneosinophilic CRS (NECRS) groups. Angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine subtype 2 (TMPRSS2), alanyl aminopeptidase (ANPEP), dipeptidyl peptidase 4 (DPP4), and beta-galactoside alpha-2,6-sialyltransferase 1 (ST6GAL1), and beta-galactoside alpha-2,3-sialyltransferase 4 (ST3GAL4) were selected as key entry-associated genes for SARS-CoV-2, HCoV-229E, MERS-CoV, and influenza, respectively, and were evaluated. Brushing samples obtained from each group and human nasal epithelial cells cultured using an air-liquid interface system were treated for 7 days with typical inflammatory cytokines and analyzed using real-time polymerase chain reaction. Western blot analysis and confocal microscopy were performed. The entry-associated genes showed distinct regulation patterns in response to each interleukin-4 (IL-4), interleukin-13 (IL-13), tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ). Specifically, ACE2 significantly decreased in type 2 cytokines (IL-4 and IL-13), while TMPRSS2 significantly decreased in type 1 cytokines (TNF-α and IFN-γ). ANPEP significantly decreased in both types of cytokines. Remarkably, DPP4 significantly increased in type 2 cytokines and decreased in type 1 cytokines. Moreover, ST6GAL1 and ST3GAL4 significantly increased in type 2 cytokines and decreased in type 1 cytokines, particularly IFN-γ. These findings were supported by western blot analysis and confocal imaging results, especially for ACE2 and DPP4. The findings regarding differential regulation suggest that patients with ECRS, primarily mediated by type 2 inflammation, may have lower susceptibility to SARS-CoV-2 and HCoV-229E infections but higher susceptibility to MERS-CoV and influenza infections.
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Citocinas , Mucosa Nasal , Internalización del Virus , Humanos , Citocinas/genética , Citocinas/metabolismo , Mucosa Nasal/virología , Adulto , Masculino , Femenino , Persona de Mediana Edad , Enzima Convertidora de Angiotensina 2/genética , Enzima Convertidora de Angiotensina 2/metabolismo , Sinusitis/virología , Sinusitis/genética , Sinusitis/inmunología , SARS-CoV-2/inmunología , Rinitis/virología , Rinitis/genética , Rinitis/inmunología , Regulación de la Expresión Génica , Serina Endopeptidasas/genética , Serina Endopeptidasas/metabolismo , COVID-19/inmunología , COVID-19/virología , Coronavirus Humano 229E/genética , Dipeptidil Peptidasa 4/genética , Dipeptidil Peptidasa 4/metabolismo , Coronavirus del Síndrome Respiratorio de Oriente Medio/genética , Coronavirus del Síndrome Respiratorio de Oriente Medio/inmunologíaRESUMEN
BACKGROUND: Acute rhinosinusitis (ARS) is a self-limiting inflammation of the nose and sinuses caused by viral or bacterial infections that requires primarily symptomatic treatment. Patient-reported outcome measures (PROMs) are suitable tools for the assessment of the effectiveness of remedies for ARS from the patient's perspective in clinical trials and real-world studies. Data regarding the quality of existing PROMs for ARS are limited. PURPOSE: To conduct a systematic review of the quality of existing disease-specific PROMs for use in adults and children with ARS according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, and to derive recommendations for use of the identified instruments in future clinical studies. METHODS: We systematically searched PubMed, Web of Science and Embase for studies reporting on the development and/or validation of PROMs for ARS. We assessed the methodological quality of each included study, evaluated the quality of measurement properties per PROM and study, and graded the evidence. Based on the overall evidence, we derived recommendations for use of the instruments. RESULTS: We identified four studies on three PROMs measuring symptoms of ARS and quality of life in adults (Sinonasal Outcome Test-16, SNOT-16; Measurement of Acute Rhinosinusitis, MARS; Rhinosinusitis Quality-of-Life Assessment, RhinoQoL). For ARS in children, we identified two studies on two PROMs measuring symptoms of ARS (Pediatric Rhinosinusitis Symptom Scale, PRSS; Sinus Symptom Questionnaire, S5). Our assessment of measurement properties indicates that all instruments require further validation before they can be unrestrictedly recommended for use in future research (COSMIN category B). In particular, there were no content validity studies for any of the identified instruments, but also data on other important measurement properties, e.g., structural validity, are lacking. CONCLUSION: Currently, no PROM for ARS in adults and children can be unrestrictedly recommended based on the evaluation of their quality. Further validation is required for all identified PROMs. Content validation involving patients and experts should be given priority. SYSTEMATIC REVIEW REGISTRATION: OSF ( https://doi.org/10.17605/OSF.IO/VAP8U ).
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Medición de Resultados Informados por el Paciente , Calidad de Vida , Rinitis , Sinusitis , Humanos , Sinusitis/terapia , Rinitis/terapia , Niño , Adulto , Enfermedad Aguda , Encuestas y Cuestionarios , RinosinusitisRESUMEN
The abducens nerve, which is vulnerable because of its complex anatomy at the skull base, is seldom affected by acute or severe sphenoid sinusitis. Notably, abducens nerve palsy following asymptomatic chronic rhinosinusitis (CRS) in a healthy young individual after a mild upper respiratory infection (URI) remains undocumented in the literature. Herein, we report a case of acute unilateral abducens neuropathy in a healthy 35-year-old woman with CRS in the ipsilateral sphenoid sinus, following a mild URI 2 weeks earlier. She presented with sudden-onset diplopia, was afebrile, and had normal serum inflammatory biomarkers. Comprehensive ophthalmological and neurological exams revealed no abnormalities except limited lateral gaze in the left eye. Imaging revealed mucosal swelling on the hyperpneumatized left sphenoid sinus, which thinned the clivus and positioned the inflamed mucosa close to the Dorello's canal, likely facilitating the spread of inflammation to the ipsilateral abducens nerve. Urgent endoscopic sinus surgery combined with systemic corticosteroids and antibiotics led to complete resolution by postoperative day 10. The present case demonstrates acute abducens nerve neuropathy from URI-induced exacerbation of sphenoid sinus CRS with specific anatomical predispositions.
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Enfermedades del Nervio Abducens , Infecciones del Sistema Respiratorio , Sinusitis del Esfenoides , Humanos , Femenino , Enfermedades del Nervio Abducens/etiología , Enfermedades del Nervio Abducens/diagnóstico , Adulto , Sinusitis del Esfenoides/complicaciones , Sinusitis del Esfenoides/cirugía , Sinusitis del Esfenoides/diagnóstico , Enfermedad Crónica , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/etiología , Rinitis/complicaciones , Rinitis/cirugía , Rinitis/diagnóstico , Antibacterianos/uso terapéutico , Endoscopía , Sinusitis/complicaciones , Sinusitis/diagnóstico , Sinusitis/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Neutrophil infiltration plays a key role in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). However, pertinent mechanisms remain poorly elucidated. Here, we obtained the data from gene expression omnibus (GEO) and gene set enrichment analysis (GSEA) to identify and validate neutrophil-associated hub genes in CRSwNP. We found that four neutrophil-associated hub genes, namely ICAM1, IL-1ß, TYROBP, and BCL2A1, were markedly upregulated and positively correlated with neutrophil infiltration levels in patients with CRSwNP. Subsequently, this was confirmed by real-time quantitative PCR. In conclusion, we identified the role of neutrophil infiltration in the pathophysiology of CRSwNP, which may be the potential targets for the diagnosis and treatment of CRSwNP.
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Pólipos Nasales , Neutrófilos , Rinitis , Sinusitis , Pólipos Nasales/genética , Humanos , Sinusitis/genética , Rinitis/genética , Neutrófilos/metabolismo , Enfermedad Crónica , Interleucina-1beta/genética , Molécula 1 de Adhesión Intercelular/genética , Infiltración Neutrófila/genética , Masculino , Femenino , Perfilación de la Expresión Génica , RinosinusitisRESUMEN
OBJECTIVE: The frontal sinus remains a challenging site for irrigation due to its position relative to the nostril and ethmoid sinus. This study aims to summarize the necessary factors for efficient irrigation of the frontal sinus after endoscopic sinus surgery (ESS) among patients with chronic rhinosinusitis (CRS). METHODS: Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic literature review was conducted on PubMed, Scopus, and Cochrane databases to identify studies assessing the effect of frontal sinus irrigation in patients with CRS, cadaver models, or 3D-printed models of the sinonasal cavity after ESS. RESULTS: Of the initial 206 abstracts reviewed, 18 full-text articles were included. The degree of the frontal sinus ostium opening after ESS was found to be associated with the efficacy of frontal sinus irrigation. More extensive frontal sinus surgeries tended to increase frontal sinus penetration. A Draf IIA procedure was identified as the minimum standard to achieve sufficient irrigation in the frontal sinus. Due to decreased backpressure in the nasal passage, increasing septectomy in Draf III did not significantly improve irrigation delivery. Squeeze bottles achieved significantly higher irrigation flow in the frontal sinus than syringes and pulsating devices. Large-volume irrigation devices provided better irrigation for the frontal sinus by entering or flushing the entire frontal sinus. The head position influenced the frontal sinus irrigation by altering the ostia position relative to fluid flow and vertical height of the frontal sinus during irrigation. While the vertex down head position was likely to enhance frontal sinus irrigation, the comfort of the head position and patient compliance should be considered. CONCLUSION: Elements for optimization of frontal sinus irrigation are a minimum of a Draf IlA procedure for frontal sinus dissection, use of large-volume irrigation, and vertex down head positioning. Developing comfortable head positions with high frontal sinus irrigation efficiency would increase patient compliance and improve outcomes. LEVEL OF EVIDENCE: NA.
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Endoscopía , Seno Frontal , Rinitis , Sinusitis , Irrigación Terapéutica , Humanos , Seno Frontal/cirugía , Endoscopía/métodos , Rinitis/cirugía , Sinusitis/cirugía , Enfermedad CrónicaRESUMEN
Evidence on the link of long-term exposure to ozone (O3) with childhood asthma, rhinitis, conjunctivitis and eczema is inconclusive. We did a population-based cross-sectional survey, including 177,888 children from 173 primary and middle schools in 14 Chinese cities. A satellite-based spatiotemporal model was employed to assess four-year average O3 exposure at both residential and school locations. Information on asthma, allergic rhinitis, eczema and conjunctivitis was collected by a standard questionnaire developed by the American Thoracic Society. We used generalized non-linear and linear mixed models to test the associations. We observed linear exposure-response associations between O3 and all outcomes. The odds ratios of doctor-diagnosed asthma, rhinitis, eczema, and conjunctivitis associated with per interquartile increment in home-school O3 concentration were 1.31 (95 % confidence interval [CI]: 1.28, 1.34), 1.25 (95 %CI: 1.23, 1.28), 1.19 (95 %CI: 1.16, 1.21), and 1.28 (95 %CI: 1.21, 1.34), respectively. Similar associations were observed for asthma-related outcomes including current asthma, wheeze, current wheeze, persistent phlegm, and persistent cough. Moreover, stronger associations were observed among children who were aged > 12 years, physically inactive, and exposed to higher temperature. In conclusion, long-term O3 exposure was associated with higher risks of asthma, allergic rhinitis, conjunctivitis and eczema in children.
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Contaminantes Atmosféricos , Asma , Ciudades , Conjuntivitis , Eccema , Ozono , Rinitis , Humanos , Ozono/análisis , Ozono/toxicidad , Niño , China/epidemiología , Asma/epidemiología , Asma/inducido químicamente , Eccema/epidemiología , Eccema/inducido químicamente , Masculino , Femenino , Rinitis/epidemiología , Rinitis/inducido químicamente , Contaminantes Atmosféricos/toxicidad , Contaminantes Atmosféricos/análisis , Conjuntivitis/inducido químicamente , Conjuntivitis/epidemiología , Estudios Transversales , Exposición a Riesgos Ambientales/efectos adversos , AdolescenteRESUMEN
The article discusses the experience of complex therapy of rhinitis and sinusitis in children of various age groups, confirming the effectiveness of the combined effects of local thermotherapy, pulsed red light and low-frequency magnetic field. This combination of physical factors has an anti-inflammatory, decongestant, stimulating local cellular activity effect and helps to increase the effectiveness and reduce the overall treatment time for these diseases. The purpose of the study is to evaluate the effectiveness of the combined use of heat, red spectrum phototherapy and magnetic field in the treatment of children with rhinitis and sinusitis. Materials and methods. The observation included 30 children with rhinitis and 40 children with sinusitis aged 2-18 years, receiving combined physiotherapy procedures as part of the main treatment. Results and its discussion. The positive effect of the combined effects of thermotherapy, pulsed light radiation in the red range and low-frequency magnetic field on clinical symptoms and functional indicators of nasal breathing in children with rhinitis and sinusitis has been confirmed. Conclusions. The use of a course of procedures combined with the effects of local thermotherapy, pulsed red light and low-frequency magnetic field against the background of the main treatment helps to increase the effectiveness of the treatment of respiratory infections of the upper respiratory tract in children of various age groups.
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Sinusitis , Humanos , Niño , Masculino , Femenino , Preescolar , Adolescente , Resultado del Tratamiento , Sinusitis/terapia , Rinitis/terapia , Infecciones del Sistema Respiratorio/terapia , Hipertermia Inducida/métodos , Magnetoterapia/métodos , Terapia CombinadaRESUMEN
BACKGROUND: Altered biosynthesis of eicosanoids is linked to type 2 inflammation in chronic rhinosinusitis with nasal polyps (CRSwNP), but their role in recalcitrant NPs is unclear. OBJECTIVES: We sought to identify endotypes that are linked to recalcitrant CRSwNP, based on eicosanoids, their biosynthetic enzymes, and receptors as well as cytokines and the presence of eosinophils and mast cells in recurrent NPs. METHODS: Mucosal tissue collected at the time of sinus surgery from 54 patients with CRSwNP and 12 non-CRS controls were analysed for leukotriene (LT) E4, prostaglandin (PG) D2, 15(S)-hydroxyeicosatetraenoic acid (15(S)-HETE) and 17 cytokines with ELISAs and Bio-Plex immunoassays. Patient subgroups were identified by cluster analysis and the probability of NP recurrence were tested with logistic regression analyses. Gene expressions were analysed with qPCR. Tryptase and eosinophil-derived neurotoxin (EDN) were measured with ELISAs as indications of the presence of mast cells and eosinophils, respectively. RESULTS: Clustering of patients showed that an inflammatory signature characterised by elevated LTE4, PGD2, 15(S)-HETE and IL-13 was associated with NP recurrence. Previous NP surgery as well as aspirin-exacerbated respiratory disease were significantly more common among these patients. Expression of cyclooxygenase 1 was the only gene associated with NP recurrence. Levels of EDN, but not tryptase, were significantly higher in patients with recurrent NPs. CONCLUSION: Distinguishing endotypes that include LTE4, PGD2, 15HETE and conventional biomarkers of type 2 inflammation could help predict recurrent nasal polyposis and thus identify cases of recalcitrant CRSwNP.
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Biomarcadores , Ácidos Hidroxieicosatetraenoicos , Leucotrieno E4 , Pólipos Nasales , Prostaglandina D2 , Recurrencia , Rinitis , Sinusitis , Humanos , Sinusitis/metabolismo , Sinusitis/patología , Sinusitis/cirugía , Sinusitis/diagnóstico , Pólipos Nasales/metabolismo , Pólipos Nasales/patología , Pólipos Nasales/cirugía , Pólipos Nasales/genética , Femenino , Masculino , Leucotrieno E4/metabolismo , Persona de Mediana Edad , Enfermedad Crónica , Ácidos Hidroxieicosatetraenoicos/metabolismo , Adulto , Rinitis/metabolismo , Rinitis/patología , Rinitis/diagnóstico , Rinitis/cirugía , Biomarcadores/metabolismo , Prostaglandina D2/metabolismo , Pronóstico , Mucosa Nasal/metabolismo , Mucosa Nasal/patología , Eosinófilos/metabolismo , Eosinófilos/patología , Mastocitos/metabolismo , Mastocitos/patología , RinosinusitisRESUMEN
We report a case series of severe complications following rhinosinusitis in the winter season 2022/2023 at the Franz-Lust Hospital for children and adolescents. Due to the severity of these complications in children with suspected complicated rhinosinusitis/orbital phlegmona, an immediate interdisciplinary approach is mandatory to prevent long-term sequelae. In addition, during this time period, we observed the unusual occurrrence of a number of invasive streptococcal infections in this age cohort.
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Inmunocompetencia , Rinitis , Estaciones del Año , Sinusitis , Infecciones Estreptocócicas , Humanos , Niño , Adolescente , Femenino , Masculino , Sinusitis/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Rinitis/diagnóstico , Austria , Colaboración Intersectorial , Comunicación Interdisciplinaria , Estudios TransversalesAsunto(s)
Proteómica , Sinusitis , Sinusitis/terapia , Sinusitis/metabolismo , Sinusitis/genética , Humanos , Enfermedad Crónica , Proteómica/métodos , Genómica/métodos , Metabolómica/métodos , Rinitis/terapia , Rinitis/genética , Rinitis/metabolismo , Epigenómica/métodos , Medicina de Precisión/métodos , Transcriptoma , Rinosinusitis , MultiómicaRESUMEN
Chronic rhinosinusitis (CRS) is a complex inflammatory condition affecting the nasal and paranasal sinus mucosa. Gastroesophageal reflux disease (GERD) has been implicated as a potential exacerbating factor in CRS, but the specific endoscopic features of nasopharyngeal pathology in this context remain poorly understood. Background and Objectives: Chronic rhinosinusitis is a multifactorial disease with various underlying etiologies, including inflammation, anatomical factors, and environmental triggers. While gastroesophageal reflux disease has been suggested as a potential contributor to chronic rhinosinusitis, the specific endoscopic features indicative of nasopharyngeal pathology in CRS patients with GERD symptoms have not been clearly elucidated. Our aim is to identify specific endoscopic features of nasopharyngeal pathology in patients with CRS associated with GERD symptoms and to propose a method for assessing the influence of gastroesophageal reflux disease on the mucosal layer of the nose and nasopharynx. Materials and Methods: We conducted a cross-sectional observational study involving 521 adult patients presenting with symptoms suggestive of CRS. From this cohort, 95 patients with the highest scores on the Reflux Symptom Index (RSI) and Reflux Symptom Score-12 (RSS-12) questionnaires were selected as the main group. Endoscopic examinations were performed to assess the nasal and nasopharyngeal mucosa. Results: Our study revealed significant alterations in the nasopharyngeal mucosa of patients with CRS associated with GERD symptoms. Increased vascularity of the nasopharyngeal mucosa was observed in 91 patients (95.7%), while hypertrophy was noted in 83 patients (87.4%). Mucus was present in the nasopharynx of 77 patients (81.1%), exhibiting varying characteristics of color and consistency. Asymmetric hypertrophy of the oropharyngeal mucosa was noted in 62 patients (65.3%). Conclusions: We propose a method for assessing the influence of gastroesophageal reflux disease on the mucosal layer of the nose and nasopharynx, which may aid in diagnostic and management decisions. Further research is warranted to explore the potential impact of GERD symptoms on the course and severity of CRS exacerbations.
Asunto(s)
Endoscopía , Reflujo Gastroesofágico , Rinitis , Sinusitis , Humanos , Reflujo Gastroesofágico/complicaciones , Sinusitis/complicaciones , Femenino , Masculino , Persona de Mediana Edad , Adulto , Enfermedad Crónica , Rinitis/complicaciones , Estudios Transversales , Endoscopía/métodos , Anciano , Nasofaringe/patología , Nasofaringe/fisiopatología , RinosinusitisRESUMEN
Recently developed optogenetic technology, which allows high-fidelity control of neuronal activity, has been applied to investigate the neural circuits underlying sensory processing and behavior. The nasal cavity is innervated by the olfactory nerve and trigeminal nerve, which are closely related to common symptoms of rhinitis, such as impairment of smell, itching, and sneezing. The olfactory system has an amazing ability to distinguish thousands of odorant molecules at trace levels. However, there are many issues in olfactory sensing mechanisms that need to be addressed. Optogenetics offers a novel technical approach to solve this dilemma. Therefore, we review the recent advances in olfactory optogenetics to clarify the mechanisms of chemical sensing, which may help identify the mechanism of dysfunction and suggest possible treatments for impaired smell. Additionally, in rhinitis patients, alterations in the other nerve (trigeminal nerve) that innervates the nasal cavity can lead to hyperresponsiveness to various nociceptive stimuli and central sensitization, causing frequent and persistent itching and sneezing. In the last several years, the application of optogenetics in regulating nociceptive receptors, which are distributed in sensory nerve endings, and amino acid receptors, which are distributed in vital brain regions, to alleviate overreaction to nociceptive stimuli, has gained significant attention. Therefore, we focus on the progress in optogenetics and its application in neuromodulation of nociceptive stimuli and discuss the potential clinical translation for treating rhinitis in the future.
Asunto(s)
Optogenética , Optogenética/métodos , Humanos , Animales , Olfato/fisiología , Nariz/fisiología , Nervio Trigémino/fisiología , Nervio Trigémino/fisiopatología , Rinitis/terapia , Rinitis/fisiopatología , Nervio Olfatorio/fisiología , Cavidad Nasal/fisiologíaRESUMEN
The respiratory tract, from the nose to the lung, behaves as an anatomical and pathophysiological unit under a holistic model. Lower airway abnormalities, such as bronchial hyperresponsiveness, reduced lung function and inflammation of the bronchial mucosa without clinical expression, have been observed in patients with rhinitis without asthma. These would be the consequence of a common systemic inflammatory phenomenon with simultaneous impact on the nose and lung. For unknown reasons, these patients do not exhibit a full clinical expression, which could mean an increased risk of developing asthma. In this review we address the frequency and characteristics of existing pulmonary abnormalities in children and adolescents with chronic rhinitis that derive from our previous research and, more recently, within the project "Allergic Respiratory Disease: The United Airway Concept" supported by the Universidad Católica de Córdoba, and a comparative analysis with the evidence provided by other authors in the medical literature.
El aparato respiratorio, desde la nariz al pulmón, se comporta como una unidad anatómica y fisiopatológica bajo un modelo holístico. Se han observado alteraciones pulmonares sin traducción clínica en pacientes con rinitis sin asma, que se manifiestan como hiperreactividad bronquial, reducción de la función pulmonar e inflamación bronquial. Estas serían consecuencia de un fenómeno inflamatorio sistémico con impacto simultáneo en nariz y pulmón, que por razones desconocidas no tiene una expresión clínica completa, pero que podrían significar un mayor riesgo de desarrollo de asma. En esta revisión abordamos la frecuencia y características de las anormalidades pulmonares existentes en niños y adolescentes con rinitis crónica derivadas de nuestras investigaciones previas y, más recientemente, del proyecto "Enfermedad Alérgica Respiratoria: El Concepto de Unidad de la Vía Aérea", línea de investigación acreditada por la Universidad Católica de Córdoba y un análisis comparativo con las evidencias aportadas por otros autores en la literatura médica.