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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 -
Indian Journal of Otolaryngology and... Oct 2022This study focused on outcomes of endoscopic posterior nasal neurectomy and turbinate reduction with regard to the common symptoms of allergic and vasomotor rhinitis....
This study focused on outcomes of endoscopic posterior nasal neurectomy and turbinate reduction with regard to the common symptoms of allergic and vasomotor rhinitis. This randomized experimental study conducted between December 2018 to November 2020 included 60 patients, aged 18-50 years with allergic or vasomotor rhinitis with/ without deviated nasal septum of grade 3 and 4, not responding to conservative management. Patients were divided into two groups. 30 patients were operated for Posterior nasal nerve resection and 30 patients underwent turbinate reduction. SNOT 22 (Sino-nasal outcome test) questionnaire was given to every patient and they were asked four major symptoms of nasal obstruction, rhinorrhoea, sneezing and post nasal discharge and were told to rate their symptom in 1 to 5 severity scale before surgery and in postoperative follow up. Mean ± SD(standard deviation) of percentage change in SNOT 22 score in Posterior Nasal Nerve resection was 88.09 ± 4.38 which was significantly higher than turbinate reduction (82.95 ± 5.33) ( value = 0.0001). Distribution of post-operative complications was comparable in turbinate reduction and Posterior Nasal Nerve resection (Both synechia and crusting:10 versus 6.67% respectively) ( value = 1). No patient had bleeding in both groups. Though skill demand is high, posterior nasal neurectomy is highly safe and effective, as there was no bleeding post-operatively in spite of handling the sphenopalatine artery. Symptom relief with this surgery was 88.09% which was significantly higher as compared to submucosal resection of inferior turbinate with microdebrider (82.95%).
PubMed: 36452693
DOI: 10.1007/s12070-021-02690-x -
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 -
American Journal of Rhinology & Allergy Jan 2022Chronic rhinitis is a prevalent condition with a significant impact on quality of life. Posterior nasal nerve and vidian neurectomy are surgical options for treating the...
BACKGROUND
Chronic rhinitis is a prevalent condition with a significant impact on quality of life. Posterior nasal nerve and vidian neurectomy are surgical options for treating the symptoms of chronic rhinitis but are invasive procedures.
OBJECTIVE
To determine the outcomes of patients diagnosed with refractory chronic rhinitis and treated with temperature-controlled radiofrequency neurolysis of the posterior nasal nerve area in a minimally invasive procedure.
METHODS
A prospective, single-arm multicenter study with follow-up through 52 weeks. Eligible adult patients had chronic rhinitis symptoms of at least 6 months duration with inadequate response to at least 4 weeks usage of intranasal steroids and an overall 12-h reflective total nasal symptom score (rTNSS) ≥ 6 with subscores 2 to 3 for rhinorrhea, 1 to 3 for nasal congestion, and 0 to 3 for each of nasal itching and sneezing. Temperature-controlled radiofrequency energy was delivered to the nasal cavity mucosa overlying the posterior nasal nerve region with a novel single-use, disposable, handheld device.
RESULTS
A total of 50 patients were treated (42.0% male; mean age 57.9 ± 11.9 years), and 47 completed the study through 52 weeks. Mean rTNSS significantly improved from 8.5 (95% CI 8.0, 9.0) at baseline to 3.6 (95% CI 3.0, 4.3) at 52 weeks ( < .001), a 57.6% improvement. Similar trends in improvement were noted for rTNSS subscores (rhinorrhea, nasal congestion, itching, sneezing), postnasal drip scores, and chronic cough scores. Subgroup analysis demonstrated the treatment was effective regardless of rhinitis classification (allergic or nonallergic). No serious adverse events with a relationship to the device/procedure occurred.
CONCLUSIONS
Temperature-controlled radiofrequency neurolysis of the posterior nasal nerve area for the treatment of chronic rhinitis is safe and resulted in a durable improvement in the symptoms of chronic rhinitis through a 52-week follow-up. Data suggest that this novel device could be considered a minimally invasive option in the otolaryngologist's armamentarium for the treatment of chronic rhinitis.
Topics: Administration, Intranasal; Adult; Aged; Female; Humans; Male; Middle Aged; Prospective Studies; Quality of Life; Rhinitis; Temperature; Treatment Outcome
PubMed: 34382444
DOI: 10.1177/19458924211033400 -
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 -
European Annals of Otorhinolaryngology,... Mar 2010Image-guided surgery (IGS) is extremely useful for anatomic location in at-risk sinus surgery: extensive inflammatory disease, sinus cavity revision, and frontal sinus,... (Review)
Review
Image-guided surgery (IGS) is extremely useful for anatomic location in at-risk sinus surgery: extensive inflammatory disease, sinus cavity revision, and frontal sinus, posterior ethmoid, sphenoid or nasosinal tumor surgery. There are two systems on the market, based on electromagnetic and infrared detection, respectively; optimal functioning depends on calibration. IGS is only a location aid, complementary to and not a substitute for endoscopy. It enables the experienced endonasal surgeon to check the endoscopic location at any time, and provides appreciable "psychological" comfort in what are difficult and sometimes stressful operations, the limits of which are being forever pushed back.
Topics: Calibration; Cerebrospinal Fluid Rhinorrhea; Endoscopes; Equipment Design; Ethmoid Sinus; Frontal Sinus; Humans; Image Processing, Computer-Assisted; Paranasal Sinus Diseases; Paranasal Sinus Neoplasms; Postoperative Complications; Reoperation; Surgery, Computer-Assisted
PubMed: 20822755
DOI: 10.1016/j.anorl.2010.02.009 -
International Archives of... Oct 2022Choanal polyps are benign lesions arising from the sinonasal mucosa, extending through the choana into the nasopharynx. Though polyps arising from the maxillary...
Choanal polyps are benign lesions arising from the sinonasal mucosa, extending through the choana into the nasopharynx. Though polyps arising from the maxillary sinus and extending to the choana are common, polyps arising from the sphenoid sinus ostium, posterior part of middle turbinate, and inferior and middle meatus are quite uncommon. To document the site of origin of choanal polyps arising from unusual sites; their clinical, radiological, and histopathological characteristics, as well as diagnostic challenges and management. This retrospective, single-center study included 14 patients aged 16 to 75-years-old with choanal polyps. After obtaining informed consent, their clinical, radiological and surgical details and histopathology reports were reviewed. Patients were followed for at least 6 months after surgery. The predominant symptoms were unilateral nasal obstruction ( = 9), snoring, rhinorrhea, and epistaxis. Though anterior rhinoscopy was unremarkable, a mass could be visualized during posterior rhinoscopy in the nasopharynx in 11 patients, and a mass could be directly visualized in the oropharynx in 2 patients. After diagnostic by nasal endoscopy, these polyps were noted to arise from the posterior aspect of the middle meatus ( = 6), middle turbinate ( = 3), posterior septum ( = 3), sphenoid sinus ostium ( = 1), and inferior meatus ( = 1). All patients were managed surgically. The histopathological examination revealed inflammatory polyp ( = 12), actinomycosis ( = 1), and rhinosporidiosis ( = 1). Patients were followed up for 6 to 22 months. We observed no complications or recurrence. Diagnostic nasal endoscopy should be performed in all patients presenting with nasal obstruction, to rule out choanal polyps arising from unusual sites. Complete polyp removal and appropriate treatment based on histopathology prevents recurrence.
PubMed: 36405473
DOI: 10.1055/s-0042-1742768 -
Internal Medicine (Tokyo, Japan) 2017
Topics: Cerebrospinal Fluid Rhinorrhea; Cranial Fossa, Posterior; Endoscopy; Humans
PubMed: 28717069
DOI: 10.2169/internalmedicine.56.8744 -
In Vivo (Athens, Greece) 2023Refractory rhinorrhea is common after total laryngectomy (TL). Because botulinum toxin injection and ipratropium bromide nasal spray have shown success in it, suggesting...
BACKGROUND/AIM
Refractory rhinorrhea is common after total laryngectomy (TL). Because botulinum toxin injection and ipratropium bromide nasal spray have shown success in it, suggesting a hyperactive parasympathetic tone may play a role. Therefore, we sought to evaluate whether endoscopic posterior nasal neurectomy (ePNN) to include more nasal secretomotor fibers is a treatment option for laryngectomy-associated rhinorrhea.
PATIENTS AND METHODS
Laryngectomized patients with persistent rhinorrhea who underwent ePNN at both the middle and inferior meatus were enrolled. We evaluated the changes in 2-week Total Nasal Symptoms Score (TNSS) and rhinorrhea subscore over 6 and 12 months post ePNN treatment, as well as self-rated rhinorrhea using the visual analogue scale (VAS) at pretreatment and 12 months post-treatment. Adverse events, post-procedure medication reliance, and patient satisfaction were recorded.
RESULTS
Five males (mean age, 62.4 years) with elapsed time from TL of 97.56±89.91 months were identified. ePNN significantly improved the average rhinorrhea subscore of TNSS at six months (p=0.037, Wilcoxon sign-rank test) and twelve months (p=0.047) compared to baseline. There were marginally significant improvements between baseline and at 12 months for overall TNSS (6.60±2.30 to 2.00±1.22, p=0.056) and VAS for rhinorrhea (7.80±0.84 to 2.00±1.58, p=0.062). No adverse event was reported, and four patients had excellent outcomes.
CONCLUSION
Endoscopic posterior nasal neurectomy is a safe and efficient alternative treatment for laryngectomy-associated rhinorrhea, with lasting improvement over one year. However, a large-scale study with more comprehensive measurements is needed to verify its long-term efficacy.
Topics: Male; Humans; Middle Aged; Laryngectomy; Feasibility Studies; Ipratropium; Rhinorrhea; Denervation
PubMed: 37905635
DOI: 10.21873/invivo.13373 -
Journal of Neurosciences in Rural... 2022The objectives of the study were to study the analysis of outcomes after endoscopic endonasal transsphenoidal surgery (EETSS) in acromegaly in terms of surgical...
OBJECTIVES
The objectives of the study were to study the analysis of outcomes after endoscopic endonasal transsphenoidal surgery (EETSS) in acromegaly in terms of surgical complications, clinical improvement, endocrinological remission, achievement of prognostically critical growth hormone (GH) level, and requirement of additional treatment.
MATERIALS AND METHODS
The study included 28 acromegaly patients, who underwent EETSS. A 2010 consensus criterion was used for defining remission. Assessment of prognostically critical GH level (random value <2.5 ng/ml), the extent of resection and additional treatment, was done at post-operative week (POW) 12.
RESULTS
All adenomas were macroadenomas; with a mean volume of 16.34 cm (range, 0.4-99 cm). Most adenomas had high-grade extensions. Most common suprasellar, infrasellar, anterior, and posterior extension grades were 3 ( = 13), 1 ( = 16), 1 ( = 14), and 0 ( = 20), respectively. Knosp Grade 3 was common on both sides (right, = 9 and left, = 8). One patient had already been operated on with EETSS, 1.5 years back from current surgery. Sixteen patients were on hormonal support, preoperatively. Four patients died during follow-up. Post-operative common complications were diabetes insipidus (DI, = 18), cerebrospinal fluid rhinorrhea ( = 10), surgical site hematoma ( = 3), meningitis ( = 3), hydrocephalus ( = 2), and syndrome of inappropriate antidiuretic hormone ( = 1). The mean hospital stay was 11.62 days and 12.17 months were the mean follow-up period. At 12 POW, no improvement was seen in body enlargement and visual complaints, but all other complaints improved significantly except perspiration. Adenomas were decreased in all extensions except posterior and mean adenoma volume was reduced from 16.34 cm to 2.92 cm after surgery. Sub-total resection (STR, = 10), near-total resection (NTR, = 7), gross-total resection (GTR, = 5), and partial resection (PR, = 2) were achieved. Endocrinological remission and prognostically critical GH levels were attained in 29.17% ( = 7) and 66.67% ( = 16), respectively. NTR, GTR, STR, and PR were associated with 57.14%, 40%, 10%, and 0% endocrinological remission, respectively. Additional treatment was required in a total of 17 patients, three in GTR, nine in STR, three in NTR, and two in PR. Ten were treated with Gamma Knife radiosurgery along with medical treatment and seven with medical treatment alone.
CONCLUSION
A successful EETSS can reduce adenoma volume to achieve clinical improvement, endocrinologic remission, and prognostically critical GH level with some complications related to surgery. Pre-operative larger volume and higher extension grades affect these outcomes adversely.
PubMed: 36743751
DOI: 10.25259/JNRP-2022-3-28-R1-(2453)