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Advances in Oto-rhino-laryngology

Aria Jafari, Adam S DeConde
Chronic rhinosinusitis with nasal polyps is a heterogeneous disease with a variety of medical and surgical options available to the patient and provider. Consensus statements and recent trends in outcomes research advocate that treatment be driven by patient-reported outcome measures. To this end, there has been increasing sophistication and nuance in both the outcome instruments themselves, as well as the method in which they are collected and interpreted. This is reflected in concepts such as the minimally clinically important difference and domain stratification, which have helped clinicians understand patient motivations and response to treatment...
2016: Advances in Oto-rhino-laryngology
Jessica E Southwood, Todd A Loehrl, David M Poetker
In the standard functional endoscopic sinus surgery (FESS) procedure, the amount of dissection is often determined by the extent of disease with the goal to preserve as much normal mucosa as possible while restoring ventilation and reestablishing mucociliary clearance. A subset of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP), however, may continue to have persistent mucosal inflammatory and aggressive polyp regrowth despite standard FESS and maximal pharmacology therapy, leading to recurrent and recalcitrant disease...
2016: Advances in Oto-rhino-laryngology
Andrew J Thomas, Jeremiah A Alt
Oral therapeutics for chronic rhinosinusitis with nasal polyps (CRSwNP) include oral corticosteroids (OCS), antibiotics, antifungals and anti-leukotrienes. Of these treatments, the strongest evidence exists to support the use of a short course of OCS for treatment of CRSwNP, and OCS are the most consistently recommended oral therapy in practice guidelines. Antibiotics have demonstrated some utility, which appears more likely related to an anti-inflammatory rather than antimicrobial effect. The non-macrolide antibiotics lack sufficient evidence to support their use, though among this class doxycycline has some limited evidence of benefit in CRSwNP...
2016: Advances in Oto-rhino-laryngology
Griffin D Santarelli, Joseph K Han
The use of biomaterials, which include nasal packing and sinus stents, has an evolving role in the postoperative management of patients with chronic rhinosinusitis with polyps. Some of these biomaterials include drug-eluting properties. The usage of biomaterials postoperatively is both surgeon and patient specific. The published literature supports the use of these products and demonstrates the ability to limit swelling, lateralization and reduce polyp regrowth postoperatively. However, there are heterogeneity in both available materials and results that the otolaryngologist must factor in to the decision-making algorithm...
2016: Advances in Oto-rhino-laryngology
Gretchen M Oakley, Richard J Harvey
Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition with heterogeneous pathophysiology. A cornerstone of the management of this condition is the use of anti-inflammatory agents. Corticosteroids are very effective and the most commonly used, but other drugs with immunodulatory activity such as anti-IL5, doxycycline (Th2), and macrolides (anti-neutrophilic/IL8) have been shown to have efficacy. Although systemic corticosteroids have shown benefit in managing this condition, the frequency of use often required in this condition is associated with significant adverse effects...
2016: Advances in Oto-rhino-laryngology
Kristine A Smith, Luke Rudmik
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease of the sinonasal passages. Similar to other chronic inflammatory diseases, an essential component of the long-term control is prolonged medical therapy. To minimize the risk of adverse effects and cumulative complications of systemic medications, topical sinonasal therapy has become the primary strategy for prolonged medical therapy. The objective of this review article is to describe the evidence for the most common topical sinonasal delivery techniques...
2016: Advances in Oto-rhino-laryngology
Ashleigh A Halderman, Andrew P Lane
The inflammatory mechanisms that contribute to chronic rhinosinusitis with nasal polyps (CRSwNP) are complex. In the past, medical options for treating CRSwNP have been limited. Emerging classes of immunomodulators such as omalizumab, anti-leukotrienes, anti-IL-4, anti-IL-5, and recognition of the modulating effects of macrolides have shown promising results in the treatment of CRSwNP. Ultimately, large randomized controlled trials are necessary to establish the efficacy of these medications but for now, the area of medical immunomodulators remains an exciting frontier...
2016: Advances in Oto-rhino-laryngology
Ryan M Carey, Robert J Lee, Noam A Cohen
Taste receptors are well known for their role in communicating information from the tongue to the brain about nutritional value or potential toxicity of ingested substances. More recently, it has been shown that taste receptors are expressed in other locations throughout the body, including the airway, gastrointestinal tract, brain and pancreas. The roles of some 'extraoral' taste receptors are largely unknown, but emerging research suggests that bitter and sweet taste receptors in the airway are capable of sensing bacteria and modulating innate immunity...
2016: Advances in Oto-rhino-laryngology
Arash Shahangian, Rodney J Schlosser
Vitamin D3 (VD3) is a potent immunomodulatory steroid hormone involved in the regulation of numerous host immune cells. Additionally, it may have an important role in host immunity against chronic bacterial infections, as well as in chronic rhinosinusitis. Many factors modulate expression of various enzymes important for production of VD3, local concentration of which may be important for its complex and diverse functions. Here, we explore some of the contributions of VD3 to chronic rhinosinusitis with nasal polyposis and its role as a disease-modifying agent...
2016: Advances in Oto-rhino-laryngology
Do-Yeon Cho, Bradford A Woodworth
In the genetic airway disease cystic fibrosis (CF), deficiency or dysfunction of the cystic fibrosis membrane conductance regulator (CFTR) alters anion transport in respiratory epithelium and consequently disrupts mucociliary clearance. An enriched understanding of the role of CFTR in the maintenance of normal epithelial function has revealed that mild and variable CFTR mutations play a causative role in a number of diseases not classically associated with CF. Furthermore, recent evidence indicates that acquired defects in wild-type CFTR protein processing, endocytic recycling and function can contribute to the pathogenesis of airway diseases, such as chronic obstructive pulmonary disease...
2016: Advances in Oto-rhino-laryngology
Nyall R London, Anuj Tharakan, Murugappan Ramanathan
Allergy has been inferred to contribute to the pathophysiology of chronic rhinosinusitis (CRS) although this role is controversial and the mechanism is debated. Furthermore, the role of aeroallergens in CRS is poorly defined and has been postulated to contribute to CRS through direct penetration in the sinuses or downstream systemic consequences. Common aeroallergens implicated in chronic rhinosinusitis include air pollution/second hand smoke, dust mite and pollen [<citeref rid="ref1">1</citeref>,<citeref rid="ref2">2</citeref>,<citeref rid="ref3">3</citeref>]...
2016: Advances in Oto-rhino-laryngology
Caroline Padro Dietz, Amber Luong
Innate lymphoid cells (ILCs) are a recently discovered subset of innate immune cells that are capable of secreting great amounts of cytokines that have been found to influence effector cell activity. Chronic rhinosinusitis (CRS) in the absence (CRSsNP) or presence (CRSwNP) of nasal polyps has been characterized as type 1- and type 2-skewed, respectively, based on the presence of cytokines characteristic of type 1 and 2 immune responses. Based on the ability of type 1 ILCs to secrete interferon-x03B3;, a type 1 cytokine found elevated in CRSsNP and type 2 ILCs to secrete IL-5 and IL-13, type 2 cytokines found elevated in CRSwNP, it is essential to examine the role that ILCs may play in the pathogenesis of CRS...
2016: Advances in Oto-rhino-laryngology
Jin-Young Min, Kathryn E Hulse, Bruce K Tan
The sinonasal mucosa forms a dynamic immune barrier where epithelial cells and the immune system interact with the inhaled environment and nasal microbiome. Recent studies suggest that B-cells, plasma cells and antibody production are highly activated locally within the nasal mucosa of patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Findings additionally suggest that polyp tissue contains elevated levels of cytokines, chemokines and complement that may drive this profound B-cell response. Currently, the data are conflicting on whether the B-cell response found in the CRSwNP nasal mucosa is antigen-specific, a superantigen response or an expansion of natural antibody responses...
2016: Advances in Oto-rhino-laryngology
Y Song Cheng, Benjamin S Bleier
Permeability glycoprotein (P-gp) is an active efflux membrane transporter that has been researched extensively due to its ability to confer multidrug resistance in a wide range of cancers. P-gp has an impressively broad substrate specificity and is known to interact with hundreds of compounds, including drugs and toxins. This substrate promiscuity is the key to its physiological role, and P-gp is thought to be responsible for extruding xenobiotics and cellular metabolites, as well as maintaining tissue barriers at the blood-brain interface and gastrointestinal epithelium...
2016: Advances in Oto-rhino-laryngology
Christopher Le, Hilary C McCrary, Eugene Chang
Cystic fibrosis (CF) is an autosomal recessive genetic disorder caused by mutations in the CF transmembrane conductance regulator gene(CFTR) resulting in impaired ion transport. Nearly all people with CF will develop chronic rhino-sinusitis (CRS) and present with the characteristic viscous mucus, impaired mucociliary clearance and chronic inflammation/infection of the sinonasal cavity. While some individuals with CF can appear relatively asymptomatic in terms of their sinus disease, commonly reported symptoms include anosmia, headache, facial pain, nasal obstruction, chronic congestion and nasal discharge...
2016: Advances in Oto-rhino-laryngology
Kai Fruth, Jan Gosepath
Aspirin exacerbated respiratory disease (AERD) has been defined as a non-steroidal anti-inflammatory drug (NSAID)-triggered hypersensitivity, non-allergic bronchial asthma and chronic rhinosinusitis (CRS) with nasal polyps. The underlying pathophysiology of AERD is not completely understood so far. An altered arachidonic acid metabolism and dysregulated enzyme activity are regarded to be causal. AERD is characterized by recalcitrant CRS with recurrent nasal polyps after sinus surgery, accompanied by difficult to treat bronchial asthma and adverse reaction after NSAID ingestion such as nasal blockage, itching, laryngospasm and severe asthma attacks...
2016: Advances in Oto-rhino-laryngology
Patricia A Loftus, Sarah K Wise
Allergic fungal rhinosinusitis (AFRS) is the most common form of fungal sinusitis in the United States. Its pathophysiological basis is associated with a predisposed person's type I IgE-mediated allergic response to inhaled mold spores that are ubiquitous in the environment. AFRS is a well-recognized type of chronic, recurrent, and non-invasive hypertrophic sinus disease that affects immunocompetent hosts, most commonly young African American males. There are 5 main criteria used for the diagnosis of AFRS, one being the presence of nasal polyposis...
2016: Advances in Oto-rhino-laryngology
Nyall R London, Douglas D Reh
Nasal polyps are semi-translucent mucosal outgrowths of the paranasal sinuses which typically arise in the setting of chronic rhinosinusitis (CRS). Nasal polyps are also associated with asthma, aspirin sensitivity, cystic fibrosis and allergic fungal rhinosinusitis (AFS). The majority of nasal polyps are bilateral and characterized by tissue edema and eosinophil infiltration. Patients with nasal polyps often present with complaints including nasal obstruction, congestion, rhinorrhea or altered sense of smell...
2016: Advances in Oto-rhino-laryngology
Ryuta Kamekura, Keiji Yamashita, Sumito Jitsukawa, Tomonori Nagaya, Fumie Ito, Shingo Ichimiya, Tetsuo Himi
Recently, the prevalence of allergic rhinitis has been dramatically increasing worldwide. As conventional therapies for allergic rhinitis, such as antihistamines, leukotriene receptor antagonists, nasal sprays and allergen immunotherapy, have limitations, the development of new drugs is required. Recent studies have revealed that epithelial cell-derived cytokines, including thymic stromal lymphopoietin, interleukin (IL)-25 and IL-33, are able to control immune cells, such as dendritic cells and T cells, thereby acting as 'master switches' in allergic disease...
2016: Advances in Oto-rhino-laryngology
Noriko Ogasawara, Kenichi Takano, Tomoko Shintani, Etsuko Saikawa, Nozomi Takahashi, Fumie Ito, Tetsuo Himi
More than 20 years have passed since cochlear implantation (CI) was first introduced in Japan. We began CI at the Sapporo Medical University Hospital in 1988; since then, up to the first half of 2015, we have performed CI on 280 ears. In patients aged less than and those aged over 18 years, 121 and 159 ears, respectively, have undergone surgery. This report presents typical cases of CI, such as an adult case, a bilateral case, a case where both hearing and vision were impaired, a pediatric case, a case with multiple handicaps, a case with a genetic mutation leading to severe hearing loss, and a complicated case...
2016: Advances in Oto-rhino-laryngology
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