Distribution of topical agents to the paranasal sinuses: an evidence-based review with recommendations.

Background: The objective of this work was to review the literature concerning the distribution of topical therapeutics to the sinuses versus nasal cavity regarding: surgical state, delivery device, head position, and nasal anatomy and to provide evidence-based recommendations.

Methods: A systematic review was conducted using Medline, EMBASE, and Cochrane databases to perform a Medical Subject Heading search of the literature from 1946 until the last week of May 2012. Articles were independently reviewed and graded for level of evidence.

Impact of synechiae after endoscopic sinus surgery on long-term outcomes in chronic rhinosinusitis.

Objectives/hypothesis: Synechiae are one of the most common unwanted outcomes after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). However, there has been scant investigation into the true significance of synechiae formation after ESS. The aim of this study was to evaluate the impact of synechiae formation on health-related quality of life (HRQoL) outcomes after ESS in patients with CRS.

Characterization of B-cell subpopulations in patients with chronic rhinosinusitis.

Background: Recent research suggest that B and plasma cells may play an important role in the pathogenesis of chronic rhinosinusitis with nasal polyposis (CRSwNP). The purpose of this study was to subcharacterize the B cell response in the sinus mucosa of control and CRS patients.

Methods: Representative tissue samples and peripheral blood samples were obtained from controls, CRS without nasal polyps (CRSsNP) and CRSwNP.

Sublingual immunotherapy and quality of life.

Purpose Of Review: Sublingual immunotherapy (SLIT) has been shown to be a new and promising treatment for people with various allergic syndromes. Several studies have examined its efficacy. However, significantly fewer investigations have explored its specific impact on the patient's quality of life (QOL).

Spontaneous cerebrospinal fluid leak and management of intracranial pressure.

Cases of cerebrospinal fluid (CSF) rhinorrhea without a clear etiology are known as spontaneous CSF leaks. Spontaneous CSF leaks most commonly occur in the ethmoid skull base or lateral sphenoid and rarely stop without surgical intervention. This chapter reviews the clinical presentation, diagnostic workup, and treatment of patients with spontaneous CSF rhinorrhea.

The role of fungi in diseases of the nose and sinuses.

Background: Human exposure to fungal elements is inevitable, with normal respiration routinely depositing fungal hyphae within the nose and paranasal sinuses. Fungal species can cause sinonasal disease, with clinical outcomes ranging from mild symptoms to intracranial invasion and death. There has been much debate regarding the precise role fungal species play in sinonasal disease and optimal treatment strategies.

Topical therapies in the management of chronic rhinosinusitis: an evidence-based review with recommendations.

Background: Topical therapies have become an integral component in the management plan for chronic rhinosinusitis (CRS). Several topical therapy strategies have been evaluated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the utilization of topical therapies in the management of CRS.

Adenoid ciliostimulation in children with chronic otitis media.

Objective: Adenoid hypertrophy and chronic adenoiditis are associated with an increased incidence of chronic otitis media. This study intends to determine the relationship between chronic otitis media and dynamic ciliary beat frequency in children undergoing adenoidectomy.

Study Design: Prospective, controlled study.

Evidence-based practice: sublingual immunotherapy for allergic rhinitis.

In this article, the authors review the current evidence regarding the public health and economic impact of allergic rhinitis. Diagnostic methods for allergic disease are discussed as well as certain nuances of allergy skin testing protocols. In addition, the evidence supporting sublingual immunotherapy (SLIT) for allergic rhinitis is reviewed, with subsequent attention to certain subgroups, such as adults and children, seasonal versus perennial allergens, and SLIT efficacy for individual antigens.

A systematic review of the endoscopic repair of cerebrospinal fluid leaks.

Objectives: To provide an up-to-date review of the literature on the safety and efficacy of the endoscopic technique for cerebrospinal (CSF) leak repairs.

Data Sources: PubMed, Medline/Old Medline, and Cochrane Central databases.

Review Methods: Using the above outlined data sources, studies involving the endoscopic repair of CSF leaks were reviewed independently by 2 researchers.

Contamination of sinus irrigation devices: a review of the evidence and clinical relevance.

Background: The use of saline and topical medications in the treatment of chronic rhinosinusitis (CRS) is now common practice among otolaryngologists. Although high-level studies have consistently shown the benefit of saline in symptom improvement of CRS patients, to date, only lower-level evidence exists advocating a benefit of other topical medications.

Methods: Recently, increased interest has emerged surrounding the devices used to deliver such therapies with mounting evidence consistently showing contamination with pathogenic organisms such as Staphylococcus aureus and Pseudomonas aeruginosa.

Vitamin D3 deficiency increases sinus mucosa dendritic cells in pediatric chronic rhinosinusitis with nasal polyps.

Objective: Dendritic cells are professional antigen presenting cells, capable of initiating Th1 or Th2 responses, and have been implicated in the pathogenesis of a number of diseases, including sinusitis. Vitamin D(3) is a steroid hormone that acts on dendritic cells in a manner similar to corticosteroids. Investigators examined whether children with allergic fungal rhinosinusitis (AFRS) or chronic rhinosinusitis with nasal polyposis (CRSwNP) were vitamin D(3) deficient and the relationship of vitamin D(3) deficiency to dendritic cell infiltrate in the sinus mucosa.

Changing trends in sinus and septal surgery, 2007 to 2009.

Background: Sinus surgery remains one of the most commonly performed procedures in the United States, with more than 600,000 patients undergoing sinus operations each year. Advances in our understanding of chronic rhinosinusitis (CRS), as well as the technology used to treat it, has resulted in significant changes in surgical management. The aim of this study was to identify recent changes in the performance and coding of certain endoscopic sinus surgical procedures (ESS) in the hope of generating further discussion and research in this area.

Dose quantification of topical drug delivery to the paranasal sinuses by fluorescein luminosity calculation.

Background: Our group has previously described a novel method of objectively quantifying the temporospatial distribution of sinonasal irrigation in a nonanesthetized patient. The purpose of this study is to refine this technique to provide an accurate method of determining concentration of dose delivery as well.

Methods: An endoscope at a fixed position within 2 dissected cadaveric heads was used to image 4 subsites under blue light.

Impact of topical nasal steroid therapy on symptoms of nasal polyposis: a meta-analysis.

Objectives/hypothesis: Topical steroid therapy is an important strategy in the management of chronic rhinosinusitis (CRS) with nasal polyposis. The objective of this study was to determine the impact of topical steroid therapy on nasal symptoms in patients with nasal polyposis.

Study Design: Systematic review with meta-analysis using standardized methodology.

Subcutaneous and sublingual immunotherapy for allergic rhinitis: what is the evidence?

Background: Increasing interest in sublingual immunotherapy (SLIT) among practitioners and patients has resulted in numerous publications and clinical trials in recent years. With the clinical growth of SLIT, discussions of its efficacy, safety, and immunologic effects have intensified, as have comparisons to subcutaneous immunotherapy (SCIT). In the United States, SCIT has been the traditional form of immunotherapy for inhalant allergy and is the only immunotherapy method approved by the U.

Primary human sinonasal epithelial cell culture model for topical drug delivery in patients with chronic rhinosinusitis with nasal polyposis.

Objectives: The primary human sinonasal epithelial cell culture (HSNEC) allows for in-vitro modelling of mucosal responses to topical therapy. Cultures grown from healthy donors may underestimate changes in individuals with chronic sinonasal disease thereby yielding inaccurate results with respect to this large patient population. The purpose of this study was to analyse HSNECs derived from patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) to determine whether expected disease dependent variables salient to topical drug delivery persist in culture.

Temporospatial quantification of fluorescein-labeled sinonasal irrigation delivery.

Background: Treatment of sinonasal disease is predicated on the delivery and retention of the agent at the desired location. Despite multiple distribution studies, there remains a need for a method capable quantifying not only the site and amount of agent deposition but the rate of clearance as well.

Methods: Five patients underwent endoscopic image capture of 3 subsites over 15 minutes following fluorescein-dyed irrigation using a squeeze bottle, nasal saline spray, or nasal gel spray.

Increased presence of dendritic cells and dendritic cell chemokines in the sinus mucosa of chronic rhinosinusitis with nasal polyps and allergic fungal rhinosinusitis.

Background: The aim of this study was to determine if there is a link between local dendritic cells (DCs) and various subtypes of chronic rhinosinusitis (CRS): CRS with nasal polyposis (CRSwNP), CRS without nasal polyposis (CRSsNP), and allergic fungal rhinosinusitis (AFRS). Once DC presence was established we considered possible mechanisms for DC recruitment to the sinuses.

Methods: Biopsy specimens were taken from the osteomeatal complex during endoscopic sinus surgery in patients with AFRS (n ≥ 5), CRSsNP (n ≥ 6), and CRSwNP (n ≥ 6).

Human sinonasal epithelial cells direct dendritic function and T-cell T helper 1/T helper 2 skewing following Aspergillus exposure.

Background: In lower airway disease such as asthma, epithelial cells have been shown to be potent regulators of dendritic cell (DC) functions. However, it is unclear how human sinonasal epithelial cells (HSNECs) from patients with sinusitis regulate DC functions. Therefore, in these studies we investigated the ability of Aspergillus fumigatus exposed HSNECs to regulate DC antigen uptake, maturation, and direction of T-cell T helper 1 (Th1)/Th2 skewing.

Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study.

Background: Evidence evaluating the comparative effectiveness of various treatments for chronic rhinosinusitis (CRS) is insufficient. This study evaluates outcomes in patients who failed initial medical management and elect a subsequent treatment option, either continued medical management or endoscopic sinus surgery (ESS) coupled with continued medical management.

Methods: Adult subjects were prospectively enrolled into a nonrandomized, multi-institutional cohort.

Endoscopic anatomy of the postganglionic pterygopalatine innervation of the posterolateral nasal mucosa.

Background: Recent anatomic dissections have redefined the sinonasal parasympathetic pathway suggesting that individual rami project from the pterygopalatine ganglion (PPG) to innervate the nasal mucosa via multiple small nerve fascicles. The purpose of this study is correlate these anatomic descriptions with endoscopic findings and to define the pattern and location of the posterolateral neurovascular rami.

Methods: Eight cadaver heads were utilized for a total of 16 individual sides.

Cigarette smoke inhibits dynamic ciliary beat frequency in pediatric adenoid explants.

Objective: Environmental tobacco smoke exposure in children increases the incidence of upper respiratory infections, chronic sinusitis, and chronic otitis media. This study investigated the effects of ex vivo and in vitro smoke exposure on dynamic ciliary beat frequency (CBF) in pediatric adenoid explants.

Study Design: Blinded and controlled prospective study.

Modified endoscopic medial maxillectomy for recalcitrant chronic maxillary sinusitis.

Background: Modified endoscopic medial maxillectomy (MEMM) is an accepted alternative treatment for benign sinonasal neoplasms. Its use as definitive treatment for inflammatory disease of the maxillary sinus has yet to be adequately explored. We evaluate the efficacy of MEMM for chronic maxillary sinusitis and attempt to identify factors that predispose patients for failure.