Targeted Molecular Therapies in Allergy and Rhinology.

Biologic agents, monoclonal antibodies that target highly-specific molecular pathways of inflammation, are becoming integrated into care pathways for multiple disorders that are relevant in otolaryngology and allergy. These conditions share common inflammatory mechanisms of so-called Type 2 inflammation with dysregulation of immunoglobulin E production and eosinophil and mast cell degranulation leading to tissue damage. Biologic agents are now available for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, eosinophilic granulomatosis with polyangiitis (EGPA), atopic dermatitis (AD), and chronic spontaneous urticaria (CSU).

Intravenous vs oral acetaminophen in sinus surgery: A randomized clinical trial.

Background: Multimodal perioperative analgesia including acetaminophen is recommended by current guidelines. The comparative efficacy of intravenous vs oral acetaminophen in sinus surgery is unknown. We aimed to determine whether intravenous or oral acetaminophen results in superior postoperative analgesia following sinus surgery.

Bevacizumab for Epistaxis in Hereditary Hemorrhagic Telangiectasia: An Evidence-based Review.

Objective Epistaxis is a primary complaint in 90% to 96% of patients with hereditary hemorrhagic telangiectasia (HHT). Numerous surgical and medical treatments aim to decrease the frequency and severity of epistaxis in this patient population. Bevacizumab is a recombinant, humanized monoclonal antibody to vascular endothelial growth factor, an angiogenic factor elevated in HHT.

Medical treatment of epistaxis in hereditary hemorrhagic telangiectasia: an evidence-based review.

Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant hereditary disorder resulting in vascular dysplasia and formation of arteriovenous malformations. Recurrent epistaxis is a hallmark of the disease. An array of medical therapies are used in this patient population, but robust evidence-based recommendations regarding the medical treatment of epistaxis are lacking.

The association of allergic sensitization with radiographic sinus opacification.

Background: The relationship between allergic sensitization and radiographic sinus inflammation remains unclear.

Objectives: To determine whether specific allergen sensitization is correlated with sinonasal radiographic opacification.

Methods: Patients with chronic sinonasal symptoms were selected and included if they had allergy testing and a computed tomography (CT) of the paranasal sinuses.

Correlation between the number of allergen sensitizations and immunoglobulin E: monosensitization vs polysensitization.

Background: The purpose of this study was to determine if total serum immunoglobulin E (IgE) could predict monosensitization compared to polysensitization in patients with allergic rhinitis (AR).

Methods: This was a retrospective study of a cohort of 1073 patients who underwent allergy testing. Differences in total IgE level between unsensitized, monosensitized, and polysensitized subjects were calculated.

Effects of academic exam stress on nasal leukotriene B4 and vascular endothelial growth factor in asthma and health.

Objective: To examine the effect of final exam stress on the concentrations of leukotriene B4 (LTB4) and vascular endothelial growth factor (VEGF) in the upper airways among healthy and asthmatic individuals.

Method: Nasal samples were collected from 12 individuals with asthma and 23 healthy controls early and late in a final exam period, and during a low-stress period in the semester. We determined LTB4 and VEGF concentrations using Enzyme-Linked Immunoassays.

Allergic Fungal Rhinosinusitis and the Unified Airway: the Role of Antifungal Therapy in AFRS.

Allergic fungal sinusitis (AFS) or rhinosinusitis (AFRS) is a form of polypoid chronic rhinosinusitis that is believed to be due to hypersensitivity to fungal antigens. The disease is characterized by type 1 hypersensitivity to fungal allergens, dramatically elevated total serum IgE, accumulation of thick eosinophil-laden mucin with non-invasive fungal hyphae within the paranasal sinuses, nasal polyposis, and sinus bony remodeling. Because of many clinicopathologic similarities to allergic bronchopulmonary aspergillosis (ABPA), these conditions can be considered analogous examples of disease in the unified airway.

AAOA allergy primer: immunodeficiency.

Background: Primary immunodeficiency is rare but should be considered in patients who present to the otolaryngologist with recurrent, severe, or treatment refractory infections.

Methods: Recent literature and consensus statements on immunodeficiency were reviewed for clinically important information of relevance to otolaryngologists.

Results: The most common and most relevant immunodeficiencies are humoral deficiencies with inadequate antibody production or an impairment in the production of specific antibody after antigen exposure.

Current practice trends in allergy: results of a united states survey of otolaryngologists, allergist-immunologists, and primary care physicians.

Background: Clinical practices for the diagnosis and treatment of allergic disease evolve over time in response to a variety of forces. The techniques used by various physician specialties are not clearly defined and may vary from published descriptions or recommendations in the literature.

Methods: This work is a Web-based survey enrolling 250 U.

Other asthma considerations.

Asthma is a heterogeneous syndrome of cough, wheeze, dyspnea, and chest tightness. However, in a subset of patients, these symptoms may indicate a different underlying disease process with variable responsiveness to classic asthma therapies. Disease may progress while practitioners attempt conventional asthma therapy.

Sinonasal manifestations of sarcoidosis: a single institution experience with 38 cases.

Background: Sarcoidosis is a chronic disease process characterized by non-caseating granulomatous inflammation, usually involving the lower respiratory tract. Given the rarity of rhinologic involvement, the objectives of the present study were (1) to describe clinical features, and (2) to review outcomes of rhinologic surgery for sinonasal sarcoidosis.

Methods: Retrospective analysis was performed of patients evaluated at a tertiary care referral center between January 2006 and July 2011.

Ossifying fibroma of the nose and paranasal sinuses.

Background: The purpose of this work was to perform a systematic review regarding ossifying fibroma and its multiple variants of the paranasal sinuses, and to identify any clinical differences between the multiple variants.

Methods: A search of the U.S.

A novel finding on computed tomography in the diagnosis and localization of cerebrospinal fluid leaks without a clear bony defect.

Background: The purpose of this work was to describe a clinical and radiographic pattern of findings that helps localize the site of spontaneous cerebrospinal fluid (CSF) leaks.

Methods: This study was a retrospective review of CSF leaks treated at the University of Texas Southwestern Medical Center from 2000 to 2009. Data collected included demographics, nature of presentation, imaging findings, intraoperative location of skull-base defect, and clinical follow-up.

Topical steroid for chronic rhinosinusitis without polyps.

The "Cochrane Corner" is a quarterly section in the Journal that highlights systematic reviews relevant to otolaryngology-head and neck surgery, with invited commentary to aid clinical decision making. This installment features a Cochrane Review, titled "Topical Steroid for Chronic Rhinosinusitis without Polyps," that finds good evidence to support therapeutic benefits with no increase in adverse events compared with placebo controls.

Prospective evaluation of intraoperative computed tomography imaging for endoscopic sinonasal and skull-base surgery.

Background: The objective of this study was to prospectively evaluate the clinical impact of intraoperative computed tomography (CT) imaging on endoscopic sinonasal and skull base procedures.

Methods: A total of 49 patients were enrolled after informed consent from December 2009 to May 2010. Patients underwent intraoperative volume CT imaging (xCAT, Xoran Technologies, Ann Arbor, MI) at the conclusion of their proposed surgery.

Allergic fungal rhinosinusitis.

Allergic fungal rhinosinusitis is a phenotype of chronic rhinosinusitis with nasal polyposis, characterized by type 1 hypersensitivity to fungi, eosinophilic mucin with fungal hyphae in sinus secretions, and propensity for mucocele formation and bone erosion. Although its differentiation from other forms of chronic polypoid rhinosinusitis with eosinophilic mucin is sometimes problematic, type 1 hypersensitivity is a component of the disease process. Medical and surgical management can be augmented by immunotherapy directed toward the patient's specific allergen sensitivities.

Balloon catheter technology in rhinology: Reviewing the evidence.

Balloon catheter technology (BCT) for management of paranasal sinus inflammatory disease was introduced to otolaryngology in 2005. Since its introduction, BCT has been a subject of considerable controversy with proponents for and against adoption of the technology. Balloon procedures have been promoted as a less invasive alternative to endoscopic sinus surgery that results in reduced pain and quicker recovery.

The patient with "postnasal drip".

Postnasal drip (PND) is a common clinical complaint, yet its physiologic basis and appropriate treatment have been inadequately addressed in the medical literature. PND may be caused by a variety of conditions involving the nose and throat. Often, the symptom is not caused by actual secretions draining from the nose into the pharynx.

Evaluation and management of the patient with "sinus".

The patient with "sinus" is common. However, an accurate diagnosis for a patient's sinus complaints may be elusive. The diagnostic uncertainty with these patients is a result of nonspecific symptoms, subtle or absent physical examination findings, and limited diagnostic testing options.