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The Journal of Allergy and Clinical... 2016Chronic rhinosinusitis with nasal polyps (CRSwNP) is an important clinical entity diagnosed by the presence of both subjective and objective evidence of chronic... (Review)
Review
Chronic rhinosinusitis with nasal polyps (CRSwNP) is an important clinical entity diagnosed by the presence of both subjective and objective evidence of chronic sinonasal inflammation. Symptoms include anterior or posterior rhinorrhea, nasal congestion, hyposmia, and/or facial pressure or pain that last for a duration of more than 12 weeks. Nasal polyps are inflammatory lesions that project into the nasal airway, are typically bilateral, and originate from the ethmoid sinus. Males are more likely to be affected than females, but no specific genetic or environmental factors have been strongly linked to the development of this disorder to date. CRSwNP is frequently associated with asthma and allergic rhinitis, but the cellular and molecular mechanisms that contribute to the clinical symptoms are not fully understood. Defects in the sinonasal epithelial cell barrier, increased exposure to pathogenic and colonized bacteria, and dysregulation of the host immune system are all thought to play prominent roles in disease pathogenesis. Additional studies are needed to further explore the clinical and pathophysiological features of CRSwNP so that biomarkers can be identified and novel advances can be made to improve the treatment and management of this disease.
Topics: Biomarkers; Chronic Disease; Comorbidity; Humans; Nasal Polyps; Rhinitis; Sinusitis
PubMed: 27393770
DOI: 10.1016/j.jaip.2016.04.012 -
Allergy and Asthma Proceedings Nov 2019Rhinosinusitis is defined as inflammation of one or more of the paranasal sinuses and affects approximately 12% of the population. Acute rhinosinusitis is defined as... (Review)
Review
Rhinosinusitis is defined as inflammation of one or more of the paranasal sinuses and affects approximately 12% of the population. Acute rhinosinusitis is defined as symptoms that last < 12 weeks, and chronic rhinosinusitis (CRS) is defined as symptoms that last > 12 weeks. CRS is divided into three groups: CRS with nasal polyps (CRSwNP), CRS without nasal polyps (CRSsNP), and allergic fungal rhinosinusitis. Nasal polyps are inflammatory outgrowths of paranasal sinus mucosa caused by chronic mucosal inflammation and are present in 20% of patients with CRS. Nasal polyps typically present with nasal congestion, nasal obstruction, and anosmia or hyposmia, and occur more frequently in patients with persistent asthma, aspirin-exacerbated respiratory disease (AERD), CRS, and cystic fibrosis. The sinus cavities are lined with pseudostratified ciliated columnar epithelial cells interspersed with mucous goblet cells. Cilia continuously sweep the mucous toward the ostial openings and are important in maintaining the proper environment of the sinus cavities. The frontal, maxillary, and anterior ethmoid sinuses drain into the ostiomeatal unit of the middle meatus. The posterior ethmoid sinuses and superior sphenoid sinuses drain into the sphenoethmoid recess of the superior meatus. Most acute sinus infections are caused by viruses, and, therefore, it is not surprising that the majority of patients improve within 2 weeks without antibiotic treatment. A bacterial infection should be considered if symptoms worsen or fail to improve within 7-10 days. Combining an intranasal corticosteroid with an antibiotic reduces symptoms more effectively than antibiotics alone. Topical nasal steroids are the treatment of choice for nasal polyps. They significantly decrease polyp size, nasal congestion, and rhinorrhea, and increase nasal airflow. Short courses of oral steroids may be needed to reduce polyp size, followed by maintenance therapy with topical steroids. Surgery is reserved for patients in which polyps cause severe obstruction or recurrent sinusitis and for patients for whom medical therapy has failed. Aspirin desensitization may decrease the requirement for polypectomies and sinus surgery in patients with AERD.
Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Bacterial Infections; Chronic Disease; Humans; Nasal Polyps; Rhinitis; Sinusitis
PubMed: 31690375
DOI: 10.2500/aap.2019.40.4252 -
Allergy and Asthma Proceedings Nov 2019Rhinitis is characterized by nasal congestion, rhinorrhea, sneezing, and/or posterior nasal drainage. It affects a significant portion of the population and presents a... (Review)
Review
Rhinitis is characterized by nasal congestion, rhinorrhea, sneezing, and/or posterior nasal drainage. It affects a significant portion of the population and presents a large burden economically and on quality of life. Rhinitis is broadly characterized as allergic and nonallergic, of which nonallergic rhinitis may be divided into inflammatory and noninflammatory etiologies. The inflammatory causes include nonallergic rhinitis with eosinophilia, postinfectious, and rhinitis associated with nasal polyps. The noninflammatory causes include idiopathic nonallergic (vasomotor) rhinitis, medication-induced rhinitis, hormone related (e.g., pregnancy), and systemic disease related. Allergic rhinitis is classified as intermittent or persistent and mild versus moderate-severe. The nasal mucosa is extremely vascular; parasympathetic stimulation promotes an increase in nasal cavity resistance and nasal gland secretion, whereas sympathetic stimulation leads to vasoconstriction. The diagnosis of rhinitis begins with a directed history, particularly noting pattern, chronicity, and triggers of symptoms. Examination of the nasal cavity with attention to appearance of the septum and inferior turbinates is recommended. Skin testing for aeroallergens is helpful in demonstrating the presence or absence of immunoglobulin E antibodies and to differentiate nonallergic from allergic rhinitis. Treatment includes patient education, irritant or allergen avoidance, and pharmacotherapy. Medications used for the treatment of rhinitis include intranasal corticosteroids, oral and intranasal antihistamines, intranasal anticholinergic agents, oral decongestants, and leukotriene receptor antagonists. When used in combination, an intranasal antihistamine spray and nasal steroid provide greater symptomatic relief than monotherapy. Allergen immunotherapy is the only disease-modifying intervention available for allergic rhinitis.
Topics: Desensitization, Immunologic; Diagnosis, Differential; Humans; Immunoglobulin E; Inflammation; Rhinitis; Rhinitis, Allergic
PubMed: 31690374
DOI: 10.2500/aap.2019.40.4251 -
La Revue Du Praticien Mar 2019Nasal Polyposis. Nasal polyposis is a chronic bilateral rhinosinusitis characterized by the development of polyps in the nasal cavities whose prevalence is estimated in... (Review)
Review
Nasal Polyposis. Nasal polyposis is a chronic bilateral rhinosinusitis characterized by the development of polyps in the nasal cavities whose prevalence is estimated in the general population at about 5%. The semiology is dominated by nasal obstruction, posterior rhinorrhea and anosmia. The Widal-Samster triad associates nasal polyposis, asthma, and intolerance to aspirin, sulfites, and NSAIDs. The treatment is medical; it is based on long-term local corticosteroid therapy, and general corticosteroid therapy not exceeding three short annual courses. Surgery was only performed when failures of medical treatment; it is performed by endonasal videosurgery when patients remain uncomfortable with significant symptoms despite the use of at least three short courses of oral corticosteroids per year.
Topics: Adrenal Cortex Hormones; Asthma; Humans; Nasal Obstruction; Nasal Polyps; Sinusitis
PubMed: 30983250
DOI: No ID Found -
Otolaryngologic Clinics of North America Oct 2018Nonallergic rhinitis (NAR) describes chronic symptoms of nasal congestion, obstruction, and rhinorrhea unrelated to a specific allergen based on skin or serum testing.... (Review)
Review
Nonallergic rhinitis (NAR) describes chronic symptoms of nasal congestion, obstruction, and rhinorrhea unrelated to a specific allergen based on skin or serum testing. Vasomotor rhinitis is the most frequent subtype of NAR. Although medical management is the first-line treatment of NAR, there is a role for surgical therapy when medications fail to improve symptoms. Surgical options for NAR include inferior turbinate reduction and botulinum toxin injection as well as more directed targeting of the autonomic nerve supply to the nasal cavity through vidian neurectomy, posterior nasal neurectomy, and cryoablation of the posterior nerve.
Topics: Cryosurgery; Denervation; Humans; Nasal Cavity; Nasal Obstruction; Nasal Surgical Procedures; Randomized Controlled Trials as Topic; Rhinitis, Vasomotor; Turbinates
PubMed: 29937065
DOI: 10.1016/j.otc.2018.05.010 -
Current Allergy and Asthma Reports Nov 2019Occupational rhinitis (OR), an inflammatory disease of the nose, refers to any nasal symptoms reported to be work-related. The purpose of this review is to provide a... (Review)
Review
PURPOSE OF REVIEW
Occupational rhinitis (OR), an inflammatory disease of the nose, refers to any nasal symptoms reported to be work-related. The purpose of this review is to provide a current overview of the classification, diagnosis, and treatment of OR.
RECENT FINDINGS
Occupational rhinitis (OR) can further be classified into allergic or non-allergic depending on the causative agent(s) and pathogenesis. Presenting symptoms are similar to non-OR including nasal congestion, anterior and posterior rhinorrhea, sneezing, and nasal itching. Despite its high prevalence in a spectrum of workplaces, OR is under reported as it is often considered a nuisance rather than a potential precursor to occupational asthma (OA). The diagnosis of OR is obfuscated as it is difficult to determine if this condition was caused by environmental determinants in or outside the workplace. Furthermore, workers may have a pre-existing history of allergic or non-allergic rhinitis leading the clinician and worker to overlook inciting agents in the workplace. In this case, a diagnosis of OR is still possible depending on the exposures but must be differentiated from work-exacerbated rhinitis. Further complicating the diagnosis of OR is the lack of evidence-based research focused on this condition as it is often trivialized due to the perception that it has an insignificant impact on the worker's health. The reality is that OR can have a significant impact on the worker's quality of life and is associated with a number of comorbidities including occupational asthma, recurrent sinusitis, headaches, eustachian tube dysfunction, and sleep disorders similar to non-occupational rhinitis. However, one significant difference between these disorders is that workers diagnosed with OR are eligible for worker's compensation. Treatment of OR involves avoidance of the inciting agent(s) and medications similar to those used to treat non-OR conditions. This review summarizes recent progresses on the etiology, risk factors, diagnosis, and therapy of OR. In addition, suggested areas of further research with potential targets for modifications in the workplace environment as well as therapeutic interventions will be discussed.
Topics: Humans; Occupational Diseases; Rhinitis; Risk Factors
PubMed: 31776689
DOI: 10.1007/s11882-019-0892-0 -
The Journal of the American Osteopathic... May 2020Historically, osteopathic principles have focused on the appropriate drainage of cranial structures to relieve symptoms of rhinitis, which include nasal congestion,...
Historically, osteopathic principles have focused on the appropriate drainage of cranial structures to relieve symptoms of rhinitis, which include nasal congestion, anterior/posterior rhinorrhea, sneezing, and itching. Allergic rhinitis is primarily an aberrant immunologic reaction caused by cytokines secreted from lymphocytes that traverse the lymphatic pathway throughout the body. Several studies have documented that, when manipulated, the lymphatic system enhanced the motion of these lymphocytes to important immune structures in both human and animal models. Additionally, modulation of both sympathetic and parasympathetic outflow has been found either to inhibit or enhance secretion and/or drainage of important allergic sites. Osteopathic approaches to rhinitis play an effective role in the comprehensive management of rhinitis, and techniques based on these approaches are therapeutic options for rhinitis. This article provides an up-to-date literature review about the management of rhinitis using the 5 models of osteopathic medicine: biomechanical, respiratory-circulatory, metabolic, neurologic, and behavioral.
Topics: Animals; Cytokines; Humans; Nasal Obstruction; Osteopathic Medicine; Rhinitis; Rhinitis, Allergic
PubMed: 32337569
DOI: 10.7556/jaoa.2020.054 -
Neuroimaging Clinics of North America Aug 2014Basilar skull fractures are a relatively frequent occurrence in significant head trauma, and their detection is important, as even linear nondisplaced fractures can be... (Review)
Review
Basilar skull fractures are a relatively frequent occurrence in significant head trauma, and their detection is important, as even linear nondisplaced fractures can be associated with critical complications. The management of skull base fractures depends on the location and extent of these associated complications. This article reviews skull base anatomy; morphology of the common fracture patterns within the anterior, central, and posterior skull base; associated complications; imaging findings; and possible pitfalls in imaging of skull base trauma.
Topics: Cerebrospinal Fluid Rhinorrhea; Humans; Skull Base; Skull Fracture, Basilar; Tomography, X-Ray Computed
PubMed: 25086806
DOI: 10.1016/j.nic.2014.03.001 -
American Journal of Rhinology & Allergy 2015Vasomotor rhinitis (VMR) is one of the most prevalent forms of nonallergic rhinitis. In the past, when maximal medical therapy failed, surgical options were limited.... (Review)
Review
BACKGROUND
Vasomotor rhinitis (VMR) is one of the most prevalent forms of nonallergic rhinitis. In the past, when maximal medical therapy failed, surgical options were limited. Vidian neurectomy (VN) was one option; however, it was fraught with complications and limited success. The advent of endoscopic sinus surgery revitalized interest in surgical procedures for VMR. This study was designed to review the available literature and assess the safety and efficacy of surgery on the vidian and posterior nasal nerves for treatment of VMR and when possible, compare the different approaches to one another in regard to safety and efficacy.
METHODS
A systematic review was performed of English language articles using Ovid and PubMed. Search terms included "endoscopic vidian neurectomy," "vidian neurectomy," "endoscopic posterior nasal neurectomy" (EPNN), and "posterior nasal neurectomy." Only clinical trials performed on humans with safety and or efficacy data were included. Independent extraction of articles by two authors using predefined data fields was performed. Safety defined by complication rates and efficacy defined as objective improvement on outcomes scores along with the overall length of benefit were the primary measures of treatment effect. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement for reporting systematic reviews was followed.
RESULTS
In comparison with open VN, endoscopic techniques were not associated with any long-term sequelae. Rhinorrhea and nasal obstruction were shown to improve after endoscopic VN (EVN) and the benefits were maintained for several years after surgery.
CONCLUSION
EVN is well tolerated, safe, and effective in a majority of patients. Overall, the literature has shown that the endoscopic approach is associated with less morbidity than the traditional transantral approach. Currently, no literature exists on the effect of EPNN in patients with vasomotor rhinitis and further study is needed to elucidate the efficacy of this procedure in this subset of patients.
Topics: Clinical Trials as Topic; Endoscopy; Humans; Maxillary Nerve; Maxillary Sinus; Nasal Obstruction; Neuralgia; Rhinitis, Vasomotor; Treatment Outcome
PubMed: 25785754
DOI: 10.2500/ajra.2015.29.4141 -
Indian Journal of Otolaryngology and... Mar 2020Allergic rhinitis is a common disorder that affects several patients annually and the hallmark symptoms are nasal obstruction, rhinorrhea and sneezing which...
Allergic rhinitis is a common disorder that affects several patients annually and the hallmark symptoms are nasal obstruction, rhinorrhea and sneezing which significantly impacts the quality of life. Many surgical options exist for the treatment of allergic rhinitis which is directed primarily addressing the nasal obstructive component. The purpose of this review article is to highlight newer surgical options in the management of patients with nasal allergy. Surgical modalities such as endoscopic resection of the posterior nasal nerve and senior author's own mini inferior turbinoplasty tunnelling technique for patients with nasal allergy is described here. Most of the literature has focused on medical management for patients with allergic rhinitis. Endoscopic Posterior Nasal neurectomy combined with mini inferior turbinoplasty has good overall significant improvement in nasal allergy symptom scores by 60-80%. Although no single modality has evolved as the gold standard for the surgical management of allergic rhinitis. The main stay of surgical intervention targets the inferior turbinate and posterior nasal nerve which is the parasympathetic supply to the nose causing rhinorrhea. This combined technique provides consistent, robust results with long-term relief of nasal symptoms due to allergic and vasomotor rhinitis without additional risk of complication.
PubMed: 32158670
DOI: 10.1007/s12070-019-01772-1