The Relationship of Paranasal Sinus Opacification to Hospital-Acquired Pneumonia in the Neurologic Intensive Care Unit Patient.

Background: The association between intensive care unit (ICU) sinusitis and the development of lower airway infections remains unclear. The objective of this study was to determine the correlation between the development of radiographic sinus opacification and pneumonia in the neurologic ICU setting.

Methods: A retrospective review of head computed tomography or magnetic resonance imaging of 612 patients admitted to the neurocritical care unit at a tertiary care center from April 2013 through April 2014 was performed.

Sinus opacification in the intensive care unit patient.

Objectives/hypothesis: The significance of sinus opacification in intensive care unit (ICU) patients remains uncertain. Our objectives were to determine the baseline incidence and risk factors associated with the development of radiographic sinus abnormalities in the ICU population.

Methods: A retrospective study of head computed tomography scan or magnetic resonance imaging from April 2013 through April 2014 of 612 neurologic ICU patients at the University of Pittsburgh Medical Center Presbyterian Hospital, Pittsburgh, Pennsylvania, was performed.

Predictive factors in patients undergoing endoscopic sinus surgery for odontogenic sinusitis.

Background: Odontogenic sinusitis (OS) presents a therapeutic dilemma. Evidence is lacking whether dental treatment alone is sufficient or whether patients will eventually require endoscopic sinus surgery (ESS). Our aim was to identify predictors of OS patients undergoing ESS.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis.

Background: The body of knowledge regarding rhinosinusitis(RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS).

Methods: Evidence-based reviews with recommendations(EBRRs) were developed for scores of topics, using previously reported methodology.

Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis: A Randomized Clinical Trial.

Importance: Dupilumab has demonstrated efficacy in patients with asthma and atopic dermatitis, which are both type 2 helper T-cell-mediated diseases.

Objective: To assess inhibition of interleukins 4 and 13 with dupilumab in patients with chronic sinusitis and nasal polyposis.

Design, Setting, And Participants: A randomized, double-blind, placebo-controlled parallel-group study conducted at 13 sites in the United States and Europe between August 2013 and August 2014 in 60 adults with chronic sinusitis and nasal polyposis refractory to intranasal corticosteroids with 16 weeks of follow-up.

Clear anterior rhinorrhea in the population.

Background: Clear anterior rhinorrhea is commonly observed in older adults and is widely known as "senile rhinorrhea." Although appreciated in the literature, no studies support that clear rhinorrhea increases with age. Our goal was to determine the prevalence of clear rhinorrhea in adults and the variation between young and old.

Impact of quality improvement measures on the delivery of allergy immunotherapy: a 2-year follow-up.

Background: Anaphylaxis is the most serious potential complication from allergy treatment with subcutaneous immunotherapy (SCIT). Quality measures were developed with the goal to decrease the incidence of complications resulting from SCIT and improve the safety of care provided.

Methods: The incidence and characteristics of anaphylaxis episodes resulting from SCIT was measured between 2008 and 2012 prior to implementation of quality measures including vial verification, vial testing, and standardized training across 6 allergy delivery sites.

Clinical and pathologic characteristics of intranasal abuse of combined opioid-acetaminophen medications.

Background: The nonmedical abuse of prescription opioids via intranasal administration is a growing problem. The objective of this study is to investigate of the typical presentation of intranasal opioid-acetaminophen abuse and outline optimal therapy.

Methods: This study was a retrospective chart review.

Medical management of allergic fungal rhinosinusitis following endoscopic sinus surgery: an evidence-based review and recommendations.

Background: Allergic fungal rhinosinusitis (AFRS) is a subset of polypoid chronic rhinosinusitis that is characterized by the presence of eosinophilic mucin with fungal hyphae within the sinuses and a Type I hypersensitivity to fungi. The treatment of AFRS usually involves surgery in combination with medical therapies to keep the disease in a dormant state. However, what constitutes an optimal medical regimen is still controversial.

Case Report: retained gutta-percha as a cause for persistent maxillary sinusitis and pain.

Dental sources of infection can produce acute and chronic maxillary sinusitis. In some cases, the source of the infection may be related to the presence of endodontic materials in the oral cavity. In this article, we report a case of retained gutta-percha in the maxillary sinus resulting in chronic sinusitis.

Defining quality metrics and improving safety and outcome in allergy care.

Background: The delivery of allergy immunotherapy in the otolaryngology office is variable and lacks standardization. Quality metrics encompasses the measurement of factors associated with good patient-centered care. These factors have yet to be defined in the delivery of allergy immunotherapy.

Comparison of simulated cone beam computed tomography to conventional helical computed tomography for imaging of rhinosinusitis.

Objectives/hypothesis: Cone beam computed tomography (CBCT) has emerged as a low radiation dose alternative to traditional computed tomography (CT) to evaluate the paranasal sinuses. The purpose of our study was to determine how often clinically important findings would be missed if CBCT was used routinely for sinus imaging.

Study Design: Retrospective review.

Identifying asthma triggers.

Asthma has many triggers including rhinosinusitis; allergy; irritants; medications (aspirin in aspirin-exacerbated respiratory disease); and obesity. Paradoxic vocal fold dysfunction mimics asthma and may be present along with asthma. This article reviews each of these triggers, outlining methods of recognizing the trigger and then its management.

Confounding factors in rhinological research.

Purpose Of Review: Basic science studies directed at understanding the inflammatory mechanisms in chronic rhinosinusitis (CRS) are increasing, yet their relevance to the underlying disease process is often conflicting and confounded by the enrollment of a heterogeneous CRS population. This review is aimed at exploring the issues affecting the basic science mucosal studies of CRS patients, with special attention to the inclusion criteria for CRS and the control group, and the site from which the mucosal tissue sample is obtained.

Recent Findings: A common confounding factor is an inadequate documentation of selection criteria for patients, controls, and tissue sites examined.

Subcutaneous immunotherapy for allergic rhinitis: an evidence based review of the recent literature with recommendations.

Background: Allergic rhinitis is a common allergic disease with increasing prevalence in Western Societies. Medical therapy is first line treatment, and is aimed at reducing symptoms of immunoglobulin E (IgE)-mediated inflammation of the nasal passages. In patients with disease refractory to medical therapy, subcutaneous immunotherapy is an option.

Chronic rhinosinusitis: observation or treatment.

Purpose Of Review: Several treatment options have been proposed for chronic rhinosinusitis (CRS). Our purpose is to present a protocol/tool to treat patient symptoms, which is initially independent of assessment for presence of CRS.

Recent Findings: This protocol is called the Rational Patient Experiment (RPE), and its concept is largely based on the fact that CRS is overrepresented in incidence based on surveys, because symptoms of CRS are nonspecific and overlap multiple other disorders.

Evidence for primary laryngeal inhalant allergy: a randomized, double-blinded crossover study.

Background: Despite anecdotal reports, no controlled studies to date link allergen exposure with a change in vocal function or dysphonia. The aim of this study was to determine whether allergen exposure in susceptible individuals impairs vocal function.

Methods: The study was a prospective, double-blind, placebo-controlled study in which subjects serve as their own controls.

Use of nasopharyngeal culture to determine appropriateness of antibiotic therapy in acute bacterial rhinosinusitis.

Background: Rhinosinusitis is one of the top 5 diagnoses for which an antibiotic is prescribed, often without a clear bacterial etiology. This study evaluated whether nasopharyngeal culture and gram stain could serve as a surrogate for endoscopically obtained middle meatal cultures in directing appropriate therapy for acute bacterial rhinosinusitis (ABRS). This study also investigated the utility of a rapid sinus test screen in differentiating bacterial from nonbacterial rhinosinusitis.

Clinical consensus statement: appropriate use of computed tomography for paranasal sinus disease.

Objective: To develop a consensus statement on the appropriate use of computed tomography (CT) for paranasal sinus disease.

Subjects And Methods: A modified Delphi method was used to refine expert opinion and reach consensus by the panel.

Results: After 3 full Delphi rounds, 33 items reached consensus and 16 statements were dropped because of not reaching consensus or redundancy.

Categorizing nasal polyps by severity and controller therapy.

Objective: To analyze a new categorization of chronic rhinosinusitis with nasal polyposis (CRSwNP) according to severity and controller therapy, modified from the 2007 stepwise treatment for asthma.

Design: Prospective categorization of 50 new or established patients over a 3-month period.

Setting: Tertiary center of Hôtel-Dieu de France Hospital, Beirut, Lebanon.

Bilateral sinonasal polyposis in a patient with unilateral choanal atresia.

Sinonasal polyposis is a disorder of hyperplastic mucosal inflammation that subsequently leads to the development of smooth, pale, non-neoplastic masses. The theories on its pathogenesis are diverse and remain debated within the medical community. A distinct, widely accepted, and unifying theory is absent, and probably unrealistic given the varying possible causes.