-
European Archives of... May 2022Nasal pathologies are characterized by a symptomatology that hardly allows to distinguish allergic rhinitis (AR), non-allergic rhinitis (NAR), and chronic rhinosinusitis...
PURPOSE
Nasal pathologies are characterized by a symptomatology that hardly allows to distinguish allergic rhinitis (AR), non-allergic rhinitis (NAR), and chronic rhinosinusitis (CRS). Nasal cytology (NC) has shown increasing importance in helping the clinician to differentiate the various phenotypes of rhinitis. NC allows us to evaluate nasal cellularity by distinguishing AR and various types of NAR. The objective of the study is to assess the diagnostic performance of the NC by evaluating its sensitivity, specificity, and predictive value.
METHODS
We recruited 387 patients with persistent rhinitis symptoms, and nasal cytology was performed. The rhinocytogram was obtained by reading for fields and the cellular count was made using quantitative and semi-quantitative grading together.
RESULTS
Two hundred and fifteen patients (55.5%; 38 had acute rhinitis, 24 acute sinusitis, 153 chronic rhinosinusitis) out of 387 referred nasal symptoms. Cytological specimen showed a mean of 94 ± 4% ciliated cells, 29 ± 0.2% mucinous cells, 16 ± 0.1% neutrophils, 11 ± 0.08% eosinophils, 4 ± 0.03 lymphocytes, 4 ± 0.03% mast cells, and 4 ± 0.01% other cells. NC was positive in 271 cases (70%). After revision of medical history, 153 patients (39%) were considered positive for NAR. Test sensibility was 100% (95% CI 97-100), specificity was 49.6% (95% CI 43-56%). Positive predictive value (PPV) was 56% (95% CI 50-62%), and negative predictive value (NPV) was 100% (95% CI 96-100%). The positive likelihood ratio was 1.98 (95% CI 1.75-2.25). Accuracy of the test was 69.5% (95% CI 64.6-74.0%).
CONCLUSION
Our data showed ability to identify the true-positive patients with NAR but a low ability to identify the true-negative patients, with a global accuracy of 69.5%.
Topics: Chronic Disease; Eosinophils; Humans; Nose; Rhinitis; Rhinitis, Allergic; Sinusitis
PubMed: 34414469
DOI: 10.1007/s00405-021-07044-5 -
International Journal of Pediatric... Aug 2021Paediatric rhinosinusitis (PDRS) is commonly used as a synonym for rhinitis within healthcare. Although they may share common symptoms, the pathophysiology does differ;... (Review)
Review
Paediatric rhinosinusitis (PDRS) is commonly used as a synonym for rhinitis within healthcare. Although they may share common symptoms, the pathophysiology does differ; PDRS is the inflammation of the nasal mucosa in addition to the sinuses whereas rhinitis is the inflammation of just nasal mucosa. This review provides a comprehensive overview of the epidemiology, pathophysiology, symptoms, diagnosis and management of PDRS. There is a greater emphasis on the diagnosis and management of PDRS within this review due to a lack of clear guidelines, which can lead to the common misconception that PDRS can be treated indifferently to rhinitis and other upper respiratory conditions. PDRS has detrimental effects on children's current health, long-term health into adulthood and education. Therefore, having a comprehensive guide of PDRS would provide a greater understanding of the condition as well as improved diagnosis and management. This article primarily focuses on the position of Europe and the United Kingdom; however, the recommendations can be applied to other countries as the causes and treatments would not differ significantly.
Topics: Adult; Child; Chronic Disease; Europe; Humans; Nasal Polyps; Rhinitis; Sinusitis; United Kingdom
PubMed: 34118486
DOI: 10.1016/j.ijporl.2021.110786 -
Expert Opinion on Pharmacotherapy Mar 2020: Rhinosinusitis is an extremely prevalent condition with significant health-care expenditure and socio-economic burden. Although symptomatically patients with acute and... (Review)
Review
: Rhinosinusitis is an extremely prevalent condition with significant health-care expenditure and socio-economic burden. Although symptomatically patients with acute and chronic rhinosinusitis present similarly, the underlying pathogenesis of these conditions is different.: This perspective discusses the various treatment options for both acute and chronic rhinosinusitis and examines some of the challenges in choosing appropriate pharmacotherapy. It examines the evidence supporting the commonly used agents including saline irrigations, topical and oral corticosteroids and antibiotics and makes recommendations based on the highest level of evidence available. Furthermore, the role or precision medicine and emerging therapies such as biologics are discussed.: Despite being commonly prescribed, the evidence supporting the routine use of oral antibiotics for CRS and the majority of ARS is lacking. The authors suggest judicious use of these medications after clear consideration of the indications. Topical intranasal corticosteroids and saline irrigations remain a safe and effective treatment for rhinosinusitis and should be considered as first-line therapy. In patients who fail to respond to appropriate treatment, therapy should be escalated after consultation and review by a specialist.
Topics: Administration, Intranasal; Administration, Oral; Adrenal Cortex Hormones; Anti-Bacterial Agents; Chronic Disease; Humans; Precision Medicine; Rhinitis; Sinusitis; Treatment Outcome
PubMed: 31971445
DOI: 10.1080/14656566.2020.1717467 -
Immunology and Allergy Clinics of North... Aug 2019There is an important link between the upper and lower respiratory tracts whereby inflammation in one environment can influence the other. In acute rhinosinusitis,... (Review)
Review
There is an important link between the upper and lower respiratory tracts whereby inflammation in one environment can influence the other. In acute rhinosinusitis, pathogen exposures are the primary driver for inflammation in the nose, which can exacerbate asthma. In chronic rhinosinusitis, a disease clinically associated with asthma, the inflammation observed is likely from a combination of an impaired epithelial barrier, dysregulated immune response, and potentially infection (or colonization) by specific pathogens. This review explores the associations between rhinosinusitis and asthma, with particular emphasis placed on the role of infections and inflammation.
Topics: Acute Disease; Asthma; Chronic Disease; Humans; Inflammation; Sinusitis
PubMed: 31284929
DOI: 10.1016/j.iac.2019.03.008 -
Journal of Neuroimaging : Official... Jul 2022The purpose is to provide a comprehensive report describing the clinical and imaging features of Coronavirus disease 2019 (COVID-19)-related acute invasive fungal...
BACKGROUND AND PURPOSE
The purpose is to provide a comprehensive report describing the clinical and imaging features of Coronavirus disease 2019 (COVID-19)-related acute invasive fungal sinusitis (AIFS) and associated comorbidities.
METHODS
A retrospective study was conducted on 25 patients (12 males and 13 females, mean age of 53.9±9.1 years). All patients had positive polymerase chain reaction test for COVID-19 and histopathological proof of AIFS. Patients underwent computed tomography (CT) and magnetic resonance examinations to assess sinonasal, orbital, and cranial spread.
RESULTS
The most prevalent comorbidity among the study cohort was diabetes mellitus (DM). Twenty-one patients (84%) were diagnosed in the post-COVID-19 period after hospital discharge, with a mean interval of 19.1±9.2 days. Steroid treatment was given to 19 patients (76%). Orbital manifestations were the presenting symptoms in all patients, followed by facial edema, nasal discharge, and neurological symptoms. Sinonasal involvement ranged from mucosal thickening to complete sinus opacification by a predominant isodensity on CT, low T1, and high T2 signal intensity with variable enhancement patterns. Twenty-four patients had a unilateral orbital extension, and 12 patients showed signs of intracranial extension. Bone involvement was detected in 16 patients (64%). Follow-up scans in 18 patients (72%) showed rapid progression of the disease. Eight patients (32%) died, six from neurological complications and two from severe respiratory failure.
CONCLUSION
Steroids, DM, and severe COVID-19 are the major risk factors of AIFS in the post-COVID-19 era. Imaging scans in all patients revealed different sinonasal, facial, orbital features, and intracranial involvement with rapid progression of the findings on follow-up scans.
Topics: Adult; COVID-19; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sinusitis; Tomography, X-Ray Computed
PubMed: 35043509
DOI: 10.1111/jon.12967 -
Clinical Infectious Diseases : An... Oct 2019Acute bacterial sinusitis is a frequent complication of viral upper respiratory infection (URI). We describe the clinical and virologic features of URIs that remain...
BACKGROUND
Acute bacterial sinusitis is a frequent complication of viral upper respiratory infection (URI). We describe the clinical and virologic features of URIs that remain uncomplicated and those that precede an episode of sinusitis. We hypothesize that certain viruses are more likely to lead to acute sinusitis, and we compare viruses identified at the time of diagnosis of sinusitis with those identified early in the URI.
METHODS
Children aged 48-96 months were followed longitudinally for 1 year. Nasal samples were obtained at surveillance visits, on Day 3-4 of the URI, and on Day 10, when sinusitis was diagnosed. Molecular diagnostic testing was performed on nasal washes for common respiratory viruses and pathogenic bacteria. A standardized score was used to quantify symptom severity.
RESULTS
We evaluated 519 URIs, and 37 illnesses in 31 patients met the criteria for sinusitis. Respiratory syncytial virus was detected more frequently in URI visits that led to sinusitis, compared to in uncomplicated URIs (10.8% vs 3.4%; P = .05). New viruses were detected in 29% of sinusitis episodes, and their pattern was different than those patterns observed at surveillance. The median number of URIs per subject per year was 1 (range 0-9) in uncomplicated URI subjects and 3 (range 1-9) in sinusitis subjects (P < .001).
CONCLUSIONS
Children who developed sinusitis experienced more frequent URIs, compared to children whose URIs remained uncomplicated. When nasal samples were obtained on the day of diagnosis of acute sinusitis, nearly 30% of children had a new virus identified, suggesting that some children deemed to have sinusitis were experiencing sequential viral infections.
Topics: Acute Disease; Bacteria; Bacterial Infections; Child; Child, Preschool; Female; Humans; Longitudinal Studies; Male; Nose; Respiratory Tract Infections; Sinusitis; Virus Diseases; Viruses
PubMed: 30649261
DOI: 10.1093/cid/ciz023 -
The Journal of Antimicrobial... Sep 2023To investigate complication rates of acute sinusitis in general practice, and whether antibiotic prescribing had an impact on complication rate.
OBJECTIVES
To investigate complication rates of acute sinusitis in general practice, and whether antibiotic prescribing had an impact on complication rate.
METHODS
All adult patients diagnosed with sinusitis in Norwegian general practice between 1 July 2012 and 30 June 2019 were included. GP consultation data from the Norwegian Control and Payment for Health Reimbursements Database were linked with antibiotic prescriptions (Norwegian Prescription Database) and hospital admissions (Norwegian Patient Registry). Main outcomes were sinusitis-related hospitalizations and severe complications within 30 days. Logistic regression was used to estimate associations between antibiotic prescriptions, prespecified risk factors, individual GP prescribing quintile, and outcomes.
RESULTS
A total of 711 069 episodes of acute sinusitis in 415 781 patients were identified. During the study period, both annual episode rate (from 30.2 to 21.2 per 1000 inhabitants) and antibiotic prescription rate (63.3% to 46.5%; P < 0.001) decreased. Yearly hospitalization rate was stable at 10.0 cases per 10 000 sinusitis episodes and the corresponding rate of severe complications was 3.2, with no yearly change (P = 0.765). Antibiotic prescribing was associated with increased risk of hospitalization [adjusted OR 1.8 (95% CI 1.5-2.1)] but not with severe complications. Individual GP prescribing quintile was not associated with any of the outcomes, whereas risk factors such as previous drug abuse, or head injury, skull surgery or malformations, and being immunocompromised were significantly associated with increased risk of both outcomes.
CONCLUSIONS
Severe complications of acute sinusitis were rare and no protective effect of high prescribing practice among GPs was found. Recommendations to further reduce antibiotic prescribing are generally encouraged, except for high-risk groups.
Topics: Adult; Humans; Cohort Studies; Respiratory Tract Infections; Sinusitis; Anti-Bacterial Agents; General Practice; Drug Prescriptions; Acute Disease; Practice Patterns, Physicians'; Registries
PubMed: 37486144
DOI: 10.1093/jac/dkad227 -
Cleveland Clinic Journal of Medicine Jul 2020Acute, uncomplicated rhinosinusitis is a clinical diagnosis. Imaging should only be used in the case of complicated sinus infections, recurrent or chronic sinus disease,... (Review)
Review
Acute, uncomplicated rhinosinusitis is a clinical diagnosis. Imaging should only be used in the case of complicated sinus infections, recurrent or chronic sinus disease, or in surgical planning. The authors discuss key features of complicated and uncomplicated rhinosinusitis, management, and recommendations on the use of imaging in diagnosis.
Topics: Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Radiography; Rhinitis; Sinusitis; Tomography, X-Ray Computed
PubMed: 32737049
DOI: 10.3949/ccjm.87a.19092 -
Otolaryngology--head and Neck Surgery :... Oct 2023Investigate incidence and natural history of otologic and sinonasal disease associated with 22q11.2 deletion syndrome.
OBJECTIVE
Investigate incidence and natural history of otologic and sinonasal disease associated with 22q11.2 deletion syndrome.
STUDY DESIGN
Case series.
SETTING
Tertiary care children's hospital.
METHODS
Charts from consecutive children born 2000 to 2018 with a diagnosis of 22q11.2 deletion, DiGeorge, or velocardiofacial syndrome based on the International Classification of Diseases (ICD)-9 and ICD-10 codes were reviewed. Otologic and rhinologic diagnoses and surgeries and immune and microbiologic laboratory findings were collected from the medical record.
RESULTS
After the exclusion of patients with no 22q11.2 deletion (n = 101), otologic care at an outside hospital (n = 59), and loss to follow-up prior to 3 years of age (n = 22), 128 were included. Males comprised 80 (62.5%) patients, 115 (89.8%) were white, and the median age at genetic confirmation of 22q11.2 deletion was 119 days (range 0 days to 14.6 years). Recurrent acute otitis media (RAOM), chronic otitis media with effusion, chronic rhinosinusitis, and recurrent acute sinusitis were diagnosed in 54 (42.2%), 37 (28.9%), 10 (7.8%), and 8 (6.3%), respectively. Tympanostomy tubes were placed in 49 (38.3%). Adenoidectomy and sinus surgery were performed in 38 (29.7%) and 4 (3.1%), respectively. Neither immunoglobulin nor cluster of differentiation deficiency increased the odds of RAOM diagnosis, tympanostomy tube placement, or chronic/recurrent sinusitis. Methicillin-resistant Staphylococcus aureus was the most common organism in sinus cultures (4/13, 30.8%). Streptococcus pneumonia dominated otorrhea cultures (11/21, 52.4%).
CONCLUSION
Approximately half of children with 22q11.2 deletion may experience otologic disease that often requires surgical management. Future studies will utilize a larger cohort to examine the role of immunodeficiency in otologic and rhinologic disease in this population.
Topics: Child; Male; Humans; Infant, Newborn; Female; DiGeorge Syndrome; Methicillin-Resistant Staphylococcus aureus; Otitis Media; Ear Diseases; Sinusitis; Middle Ear Ventilation
PubMed: 36950877
DOI: 10.1002/ohn.331 -
Vestnik Otorinolaringologii 2021To analyze and summarize data on terminology, etiology, diagnostic criteria for acute sinusitis.
OBJECTIVE
To analyze and summarize data on terminology, etiology, diagnostic criteria for acute sinusitis.
DATA SOURCES
Publications (articles and related abstracts) submitted to the PubMed database. The choice of material was carried out, according to the keywords: cold, acute viral sinusitis, acute bacterial sinusitis, post-viral sinusitis, acute respiratory viral infection, diagnosis of acute sinusitis.
RESULTS
The published research results indicate the existence of certain disagreements regarding the terminology, diagnostic criteria, indications for diagnostic studies in acute sinusitis. The data on the etiology, pathogenesis, and diagnostic features of acute sinusitis are presented in the current guidelines, reviews and publications of the results of clinical trials.
Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Humans; Respiratory Tract Infections; Sinusitis; Virus Diseases
PubMed: 34269028
DOI: 10.17116/otorino20218603172