Sinonasal Outcomes After Endoscopic Sinus Surgery in Asthmatic Patients With Nasal Polyps: A Difference Between Aspirin‐Tolerant and Aspirin‐Induced Asthma?

Objectives/Hypothesis: Aspirin‐sensitivity, asthma, and nasal polyposis (NP) comprise the clinical entity of Samter's triad. The aim of this study is to report the sinonasal outcomes of endoscopic sinus surgery (ESS) in treating NP in asthmatic patients, comparing aspirin‐induced asthmatic (AIA) patients with aspirin‐tolerant asthmatics (ATA). Study Design: Retrospective chart review. Methods: The records of 66 patients with NP and asthma were retrospectively reviewed. Forty‐one AIA patients were compared with 25 ATA patients. For each patient, a Lund‐Mackay computed tomography (CT) score of the preoperative scans and the available postoperative CT scans in a period of 18 months were calculated and used as primary endpoint. Sinonasal improvement assessed by patients and reported with a symptoms scale was used as the secondary endpoint for the comparison immediately before surgery and 6 months and 12 months following ESS. Results: Preoperative CT scores in AIA patients compared with ATA patients were significantly higher 19 (standard deviation, 4.82) vs. 14 (standard deviation, 6.8), respectively (P = .006). This difference was sustained for the available postoperative CT scans (P < .0001). During the period of 18 months follow‐up, 63.4% of AIA patients vs. 96% of ATA patients had CT improvement with a statistically significant difference between the two groups (P = .003). At 6 months following ESS, 63.4% of AIA patients vs. 56% of ATA patients had symptomatic improvement. At 12 months, 68.3% of AIA patients vs. 60% of ATA patients had symptomatic improvement, with no significant difference between the two groups. Conclusion: AIA patients had more extensive sinonasal disease than ATA patients. Both groups showed statistically significant improvement in sinonasal outcomes after ESS. The difference between the two groups was statistically significant for patients' CT improvement with worse CT scores being seen in AIA patients.     

The role of anti-IgE immunoglobulin therapy in nasal polyposis: a pilot study

BACKGROUND: Although the etiology of nasal polyposis (NP) remains unknown, emerging evidence showing elevated local IgE levels and eosinophilic infiltration suggests an allergic etiology. Given this evidence, this pilot study examined whether anti-IgE therapy is efficacious in the treatment of NP. METHODS: Data were retrospectively collected on two groups of patients with atopic asthma and NP who underwent endoscopic sinus surgery (ESS), including a control group (n=4) and an anti-IgE treatment group (n=4), who received the anti-IgE agent, omalizumab, postoperatively. Both groups were evaluated by sinus computed tomography (CT) and nasal endoscopic examination, and comparisons were made between the groups with respect to differences in the recurrence of NP after ESS. RESULTS: Collectively, the subjects showed a direct relationship between NP severity and pretreatment total serum IgE levels. Preoperatively, there were no differences between the groups with regard to their total serum IgE levels, sinus CT scores, and endoscopically determined NP scores. Relative to corresponding preoperative values, there was no significant improvement in the sinus CT scores in either treatment group postoperatively. In contrast, relative to preoperative values, the nasal polyp scores significantly improved in the anti-IgE group, whereas the control group showed no significant improvement. CONCLUSION: This pilot study provides new evidence establishing that (1) endoscopic NP severity directly correlates to total serum IgE levels and (2) inclusion of anti-IgE therapy in the postpolypectomy management of atopic asthmatic individuals may reduce the severity of NP recurrence.     

Exhaled inflammatory markers in aspirin-induced asthma syndrome

BACKGROUND: Interleukin (IL)-4 and IL-6, respectively, markers of neutrophilic and eosinophilic inflammation, were analyzed in nasal and oral exhaled breath condensate to understand the inflammation of upper and lower airways in subjects with aspirin-induced asthma (AIA) syndrome, evaluating possible differences between AIA and the single pathological conditions included in AIA syndrome. METHODS: Twelve patients with AIA, 17 patients with mild asthma (MA), 12 patients with nasal polyposis (NP), 11 patients with mild asthma + nasal polyposis (MA + NP), and 10 healthy subjects (HSs) were enrolled. Nasal and oral exhaled IL-4 and IL-6 were measured by enzyme immunoassay kit. RESULTS: Higher levels of nasal and oral exhaled IL-4 and IL-6 were observed in AIA compared with MA, NP, MA + NP, and HSs. Moreover, a positive correlation was identified between nasal exhaled IL-4 and IL-6 and, respectively, the number of neutrophils and eosinophils and in nasal scraping. CONCLUSION: The concentration of eosinophilic and neutrophilic markers in upper and lower airways of subjects with AIA syndrome is higher compared with HS and subjects with MA, NP, and MA + NP.     

Effects of Sinus Surgery on Asthma in Aspirin Triad Patients

The aspirin triad (nasal polyposis, asthma and sensitivity to aspirin) is a well-recognized clinical entity, also known as aspirin-induced asthma (AIA). The sinusitis associated with AIA is often difficult to treat and aggravates the asthmatic symptoms. In order to evaluate the surgical treatment of sinusitis in AIA, 22 patients who underwent sinus surgery were studied. Twenty patients (90.9%) got any relief of their asthma symptoms from sinus surgery. Postoperative pulmonary function test 1 year after surgery showed statistically significant improvement over the preoperative one. Three of 5 patients (60%) who used systemic steroids were able to eliminate or reduce their dosages. Also, 8 of 17 patients (47.1%) who were using inhaled topical steroids reduced their dosages and statistical analysis showed a significant difference in the doses of topical steroid used before and after surgery. Subjective evaluation of 20 patients (90.9%) indicated that the sinus surgery was effective for their asthma condition; showing from mild to marked improvement. For AIA patients aggravated by sinus disease, we recommend sinus surgery to improve the quality of life.     

Effects of sinus surgery on asthma in aspirin triad patients.

The aspirin triad (nasal polyposis, asthma and sensitivity to aspirin) is a well-recognized clinical entity, also known as aspirin-induced asthma (AIA). The sinusitis associated with AIA is often difficult to treat and aggravates the asthmatic symptoms. In order to evaluate the surgical treatment of sinusitis in AIA, 22 patients who underwent sinus surgery were studied. Twenty patients (90.9%) got any relief of their asthma symptoms from sinus surgery. Postoperative pulmonary function test 1 year after surgery showed statistically significant improvement over the preoperative one. Three of 5 patients (60%) who used systemic steroids were able to eliminate or reduce their dosages. Also, 8 of 17 patients (47.1%) who were using inhaled topical steroids reduced their dosages and statistical analysis showed a significant difference in the doses of topical steroid used before and after surgery. Subjective evaluation of 20 patients (90.9%) indicated that the sinus surgery was effective for their asthma condition; showing from mild to marked improvement. For AIA patients aggravated by sinus disease, we recommend sinus surgery to improve the quality of life.     

Outcomes of endoscopic sinus surgery in chronic sinusitis cases complicated/ not complicated by bronchial asthma and eosinophilic infiltration of the sinus mucosa

BACKGROUND: Intractable sinusitis is, in most cases, complicated by bronchial asthma and severe eosinophilic infiltration of the sinus mucosa. Our aim here was to study the postoperative outcomes of chronic sinusitis complicated/not complicated by bronchial asthma and of cases with eosinophilic sinusitis/non-eosinophilic sinusitis. METHODS: We conducted a prospective analysis of the outcome of 180 patients with or without bronchial asthma and eosinophilic infiltration who underwent endoscopic sinus surgery (ESS) for chronic sinusitis. The patients were divided into four groups by the presence/absence of asthma and presence/absence of eosinophilic infiltration of the sinus mucosa. One surgeon performed the ESS, and all the groups received the same postoperative treatment. RESULTS: The outcomes of ESS were significantly worse in the cases complicated by eosinophilic sinusitis and asthma, especially in relation to the incidence of smell disturbances and the endonasal findings. Patients suffering from chronic sinusitis without asthma showed good improvement following ESS. There was no significant differences in the outcome after ESS between cases of eosinophilic sinusitis and those with non-eosinophilic sinusitis among the patients without asthma. CONCLUSIONS: We contend that eosinophilic sinusitis without asthma may not represent intractable sinusitis. We wish to emphasize that complication by     

Impact of age on presentation of chronic rhinosinusitis and outcomes of endoscopic sinus surgery

BACKGROUND: As the population ages, the mean age of patients with chronic rhinosinusitis (CRS) likely will increase as will the frequency of endoscopic sinus surgery (ESS) in the older population. The purpose of this study was to compare symptom presentation, CT scores, endoscopy scores, and quality of life (QOL) measures in patients >60 years of age as compared with younger patients. METHODS: A prospective cohort of 18 patients >60 years and 121 patients < or =60 years undergoing ESS for CRS were studied. Patient factors, symptom severity, and CT scores were examined preoperatively. Endoscopy and QOL scores were compared pre- and postoperatively between the two groups. RESULTS: The prevalence of allergies, polyps, asthma, aspirin sensitivity, and revision surgery was similar in each age group. There was no statistically significant difference in the visual analog scale scores of symptom severity in each age group. Older patients had scores that were similar to younger patients with regard to CT (13.11 versus 11.63; p = 0.419), preoperative endoscopy (8.22 versus 7.96; p = 0.828), postoperative endoscopy (3.06 versus 4.82; p = 0.100), and change in endoscopy (-5.17 versus -3.15; p = 0.083). Older patients had similar preoperative, postoperative, and change scores when compared with younger patients on the Rhinosinusitis Disability Index (-15.33 versus -20.63; p = 0.318) and Chronic Sinusitis Survey (14.35 versus 23.11; p = 0.126). CONCLUSION: Older patients with CRS present with symptoms and patient factors that are comparable with younger patients and have a similar degree of improvement on endoscopy scores and QOL measures after ESS.     

Recurrence rates after endoscopic sinus surgery for massive sinus polyposis

BACKGROUND AND OBJECTIVES: Most studies on outcome after endoscopic sinus surgery (ESS) include patients with varying degrees of disease severity. Recurrence rates cited by those studies may not apply to the subset of patients with severe polyposis. Our aim is to provide reference information for recurrence rates and need for revision surgery in patients with severe disease. STUDY DESIGN, PATIENTS, AND METHODS: Review of patients with severe polyposis with a minimum Lund-McKay score of 16 and with a Kennedy computed tomography stage 3 or 4. Data collection included demographics, presence of asthma or documented allergy, history of previous surgery, extent of surgery, preoperative and postoperative management, recurrence rates, revision surgery rates, and follow-up. RESULTS: One hundred and eighteen records were reviewed. Fifty-nine (50%) patients had asthma, and 93 (79%) had documented allergy. All patients required extensive bilateral nasal polypectomy, complete anterior and posterior ethmoidectomy, and maxillary sinusotomy. One hundred (85%) also had frontal or sphenoid sinusotomy. Follow-up ranged from 12 to 168 (median 40) months. Seventy-one (60%) developed recurrent polyposis. Fifty-five (47%) were advised to undergo revision surgery, and 32 (27%) underwent surgery. History of previous sinus surgery or asthma predicted higher recurrence (P <.005, P <.001) and revision surgery rates (P =.02, P <.001). History of allergy also predicted recurrence and need for revision (P <.001, P <.001). CONCLUSIONS: Recurrence rates after ESS for severe polyposis are significant. In our study, patients with asthma are at higher risk of recurrence.     

Influence of polyps on outcomes after endoscopic sinus surgery

OBJECTIVE: To determine clinical and comparative outcomes for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) with polyposis. METHODS: Two cohorts of adult patients with refractory CRS with and without nasal polyps were prospectively studied before and after ESS (minimum follow-up, 12 months) with the Rhinosinusitis Symptom Inventory (RSI). For the non-polyp and polyp cohorts, RSI symptom domains and medical resource utilization were compared in the preoperative and postoperative states. Corresponding effect sizes were computed and compared between cohorts to determine the effect of polyps on prognosis after ESS. RESULTS: A total of 165 non-polyp and 86 polyp patients were enrolled. Polyps were more common in female patients (2:1, P = .025); age (mean, 42.9 years) and follow-up (18.5 months) were similar between groups. Lund scores were significantly higher for polyp patients (13.7, SD 4.8) vs. non-polyp patients (8.1, SD 5.3, P < .001). At baseline, polyp patients reported lower symptom scores for facial, oropharyngeal, and systemic RSI symptom domains (all P < .012); nasal and total symptom domains were similar between groups. Both non-polyp and polyp groups obtained significant symptomatic benefit from ESS with effect sizes for RSI symptom domain improvements ranging from 0.89 to 1.38 and 0.43 to 1.19, respectively (all P < .001). There were no significant differences between groups in symptomatic improvement, excepting oropharyngeal symptoms (better improvement in non-polyp group, P = .024). Non-polyp patients decreased medical resource consumption more significantly than did polyp patients. CONCLUSIONS: Both non-polyp and polyp patients derive similar clinically significant symptomatic improvement after ESS. These similarities suggest that polyp patients do not necessarily have a poorer symptomatic outcome after ESS.     

Predictive factors and outcomes in endoscopic sinus surgery for chronic rhinosinusitis

PURPOSE: To assess objective and quality of life (QOL) outcomes before and after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS) and to determine preoperative factors that predict surgical outcome in these patients. METHODS: One hundred nineteen adult patients with CRS and a mean follow-up of 1.4 +/- 0.35 years were evaluated prospectively including the following patient factors: prior sinus surgery, polyps, asthma, acetylsalicylic acid intolerance (ASA), smoking, allergy, depression, and sex. Computed tomography (CT), endoscopy, and QOL assessment was performed. Predictive value of patient factors was determined based on change in endoscopy and QOL scores after ESS. RESULTS: Objective outcomes: preoperative CT scores were significantly worse in patients with polyps, asthma, and ASA, whereas CT score was unaffected by prior sinus surgery, smoking, allergy, depression, and sex. Patients with CRS demonstrated significant improvement on nasal endoscopy after ESS, but preoperative, postoperative, and change in scores were affected by certain patient factors. Endoscopy scores were significantly worse in patients with prior sinus surgery, polyps, asthma, and ASA, but these patients also experienced the greatest improvement in endoscopy scores. Smokers and patients with depression had the least change in endoscopy scores. QOL outcomes: patients with CRS experienced improvement in QOL after ESS. Pre- and postoperative QOL was positively affected by polyps and adversely affected by ASA, depression, and female sex, but these groups still experienced significant improvement in QOL scores. Pre- and postoperative QOL was unaffected by prior sinus surgery, asthma, smoking, and allergies, and all of these groups experienced significant improvement in QOL scores. Factors predictive of outcome: ASA and depression were predictive of worse outcome. Preoperative CT scores approached significance as being predictive of outcome. CONCLUSION: Surgical management of CRS was associated with significant improvement on objective and QOL measures; however, specific patient factors, in particular ASA and depression, predict poorer outcome. Preoperative CT may be a predictor of endoscopic and QOL outcome and deserves further study.     

鼻内镜手术对成人慢性鼻-鼻窦炎伴哮喘患者疗效的影响

目的　分析并探讨鼻内镜手术对成人慢性鼻-鼻窦炎（chronic rhinosinusitis,CRS）伴哮喘患者疗效的影响。方法　采用前瞻性对照分组设计,对我院诊断为CRS并接受鼻内镜手术治疗的325例患者依入组标准选择92例患者进行跟踪随访,于术前、术后评估所有患者鼻部和哮喘各指标变化情况。结果　共92例完成3个月随访,90例完成12个月随访。鼻内镜手术后鼻部总体症状和鼻塞、流涕的视觉模拟量表评分以及鼻内镜Lund-Kennedy评分均明显改善,喷嚏、嗅功能、头面部疼痛视觉模拟量表评分结果也有不同程度改善。伴哮喘患者鼻内镜手术后哮喘控制测试评分在术后明显升高,而肺功能各指标变化无统计学差异。结论　以鼻内镜手术为中心的综合治疗对成人CRS伴哮喘患者的鼻部症状改善和减少用药量有显著作用;短期内鼻内镜手术对提高哮喘患者哮喘控制水平和减少哮喘用药量有积极作用。     

Histopathologic characteristics of chronic sinusitis with bronchial asthma

CONCLUSION: These findings suggest that patients with both sinusitis and asthma present the histopathologic characteristic of a marked chronic inflammatory reaction, and that eosinophil infiltration may play a significant role in this marked inflammation of the sinus mucosa. OBJECTIVE: Chronic sinusitis and bronchial asthma are known to be closely related. However, the appearance of the mucosa in chronic sinusitis patients with asthma is somewhat different from that in patients without asthma. MATERIAL AND METHODS. We compared the sinus mucosal histopathologies of asthmatic patients with those of non-asthmatic patients. Fifty-three sinusitis patients with a diagnosis of asthma and 54 sinusitis patients without asthma, who served as controls, were enrolled in the study. All of these patients underwent endoscopic sinus surgery. The following seven light microscopic findings were compared in the asthmatic and non-asthmatic groups: the thickness of the basement membrane, goblet cell hyperplasia, subepithelial edema, submucous gland formation, eosinophil infiltration, lymphocyte infiltration and polymorphonuclear leukocyte infiltration. In addition, we explored a possible link between asthma and sinusitis by comparing the following factors in asthmatic and non-asthmatic patients: the presence of allergy, the degree of preoperative polyposis and the extent of preoperative disease as scored by means of ostiomeatal unit CT findings. RESULTS: No statistically significant differences were found between the two groups in terms of the presence of allergy, the degree of preoperative polyposis or the extent of preoperative disease. Basement membrane thickening, goblet cell hyperplasia and eosinophil infiltration were more prominent in the asthmatic compared to the non-asthmatic group (p <0.05).     

慢性鼻-鼻窦炎伴支气管哮喘患者内镜手术综合治疗疗效观察

目的 研究以内镜手术为主的综合治疗对慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)伴支气管哮喘患者的疗效.方法 2006年9月至2009年3月共收治CRS伴支气管哮喘患者25例,行内镜鼻窦手术,围手术期使用鼻内糖皮质激素、口服大环内酯类抗生素、鼻腔冲洗等治疗.分别于术前、术后1年、3年对临床疗效进行评估.CRS疗效评估的指标为视觉模拟量表(visual analogue scale,VAS)、患者自评及鼻内镜Lund-Kennedy评分,哮喘评估指标为哮喘控制量表评分和分级、用药量和肺功能.结果 术后1年随访23例(92%),术后3年随访12例(48%).CRS疗效:整体症状的VAS评分术后1年为(3.20±2.19)分((x)±s,以下同),术后3年为(3.79±2.32)分,分别较术前[(8 12±0.60)分]有显著改善(P值均为0.000),术后1年、3年之间差异无统计学意义(P=0.851);鼻内镜Lund-Kennedy评分术后1年为(4.35±3.21)分,3年为(5.50±2 64)分,分别较术前[(9.80±2.10)分]有显著改善(P值均为0.000),术后1年、3年之间差异无统计学意义(P=0.606).支气管哮喘疗效:哮喘控制量表评分术前为(21.96±2.16)分,术后1年为(23.61±1.94)分,术后3年为(22 33±3 47)分,行双向方差分析,三者之间差异无统计学意义(F=2.871,P=0 065);术后1年14例患者哮喘用药不变,术后3年9例患者哮喘用药不变;第1秒用力呼气容积与用力肺活量的比值术前为74.68±11.09,术后1年为73.27±12.27,术后3年为73.50±7.87,三者之间差异无统计学意义(F=0.076,P>0.05).结论 以内镜手术为主的综合治疗对CRS伴哮喘患者疗效显著且持久,但治愈者极少;哮喘临床控制水平、用药量和肺功能均保持稳定.

Abstract：

Objective To evaluate the efficacy of endoscopic sinus surgery (ESS)-based on multidisciplinary treatment for patients with chronic rhinosinusitis ( CRS) and asthma. Methods The study included 25 CRS patients with asthma who received ESS from September 2006 to March 2009, besides surgery, who also used corticosteroid nasal spray, oral macrolide antibiotics and nasal irrigation perioperatively. Evaluation was performed before ESS, 1 year and 3 years post-ESS. Evaluation index included visual analogue scale(VAS) and endoscopy Lund-Kennedy assessment for CRS, and asthma control test (ACT) and pulmonary function tests for asthma. Results Twenty-three (92% ) patients were followed up for 12 months. Twelve (48% ) of them were followed up for 36 months. CRS efficacy: VAS of general symptom significantly improved after ESS compared to pre-ESS (8. 12 ±0. 60, (x) ±s) , after 1 year (3. 20 ±2. 19) and 3 year (3.79 ±2.32) follow up(both P =0.000). There was no statistic difference between 1 year and 3 year follow up (P = 0. 851). Endoscopy Lund-Kennedy score significantly improved in postESS after 1 year (4.35 ±3.21) and 3 year (5.50 ±2. 64) follow up compared to pre-ESS(9. 80 ±2. 10,both P = 0. 000 ) , and there was no difference between 1 year and 3 year follow up (P = 0. 606 ). Asthma efficacy: ACT pre-ESS, 1 year and 3 year were 21. 96 ± 2. 16, 23.61 ±1.94 and 22. 33 ±3.47, without statistic difference ( F = 2. 871, P = 0. 065 ). Pulmonary function showed no significant change after surgery (Pre-ESS 74.68 ± 11.09, 1 year 73.27 ± 12.27, 3 year 73.50 ± 7.87, F = 0.076, P > 0.05).Conclusions ESS improves CRS with asthma significantly and persistently. Asthma control level, antiasthma drug dose and pulmonary function remain stable after ESS.     

Clinical characteristics of chronic rhinosinusitis with asthma

OBJECTIVE: This study was directed at identifying clinical features of chronic rhinosinusitis with asthma, and examining the differences of the postoperative outcomes in asthmatics and nonasthmatics. STUDY DESIGN AND SETTING: Twenty-one asthmatic and 77 nonasthmatic patients who underwent functional endoscopic sinus surgery (FESS) were entered into the study. The following six parameters were determined in asthmatic and nonasthmatic groups; the presence of allergy, previous sinus surgery, severity of preoperative rhinosinusitis symptoms, improvements in postoperative rhinosinusitis symptoms, preoperative disease extent, and postoperative endoscopic outcomes. RESULTS: Symptom scores improved significantly in both asthmatics and nonasthmatics postoperatively, and asthmatics exhibited significantly worse postoperative endoscopic outcomes compared with nonasthmatics. No difference was found in other parameters between two groups. Multivariate analysis revealed asthma continues to be an independent predictor of success. CONCLUSIONS: The present study found that chronic rhinosinusitis in asthmatics showed worse postoperative outcomes than in nonasthmatics, and every attempt should be made for the improvement of surgical results in these patients.     

Computed tomographic assessment of chronic rhinosinusitis with asthma

BACKGROUND: The purpose of this study was to investigate differences in the extent of disease in patients with chronic rhinosinusitis (CRS) both with and without asthma. METHODS: Medical records and computed tomographic (CT) scans of 48 consecutive asthmatic patients and 523 nonasthmatic patients with CRS between April 1995 and December 2001 were reviewed, retrospectively. Each sinus in the ostiomeatal complex CT scans was assigned a score of 0-2 according to the extent of disease using the Lund-Mackay scoring system, and the ratios of the score of each sinus to the total score were analyzed for the difference between the asthmatic and nonasthmatic groups. A Mann-Whitney test was used for statistical evaluation, with p < 0.05 accepted as statistically significant. RESULTS: The ratios of ethmoid sinus score to total score were higher in asthmatic patients than in nonasthmatic patients (p < 0.001), and the ratios of the score of maxillary sinus to total score were lower in asthmatic patients than in nonasthmatic patients (p < 0.001). CONCLUSION: Our study shows that the ethmoid sinus is the preferred site of CRS in patients with coexisting asthma.     

慢性鼻窦炎鼻息肉合并支气管哮喘患者鼻窦内镜术后对支气管哮喘疗效的影响

目的观察鼻窦内镜术(endoscopic sinu ssurgery，ESS)对慢性鼻窦炎伴支气管哮喘患者哮喘发作的影响。方法对210例慢性鼻窦炎患者施行ESS术，其中伴有支气管哮喘病史者42例(20．0％)。210例患者均于术前、术后采用酶联免疫吸附测定法(ELISA)检测外周血单个核细胞(PBMC)培养上清液中的白细胞介素4(IL-4)，干扰素γ(IFN-γ)，可溶性白细胞介素2受体(sIL-2R)和可溶性IgE低亲和力受体(solube CD23，sCD23)的含量，并与20例正常对照组进行比较。通过主观和客观标准评定42例患者哮喘发作及对皮质类固醇的耐受状况，并对术后患者进行为期1年(10例)和3年(32例)的随访。结果鼻窦炎合并支气管哮喘患者术前PBMC培养上清液中IL-4，sIL-2R、sCD23含量较对照组显著升高，而IFN-γ含量较对照组显著减少。术后IL-4、sIL-2R、sCD23含量较对照组显著降低，而IFN-γ含量显著增高。术后哮喘改善水平由随访术后1年的45％提高到术后3年的70％。42例中32例(76％)哮喘发作次数明显减少，术前长期服用类固醇的2l例中，14例(67％)减少了对口服类固醇的使用。结论ESS对慢性鼻窦炎伴支气管哮喘患者的治疗有较满意的远期疗效。ESS能调节IL-4、IFN-γ sIL-2R、sCD23水平，降低哮喘的发作频率和对类固醇的依赖。     

Nasal polyposis, bronchial asthma and analgesic intolerance

A retrospective case-control study was conducted in 1042 arbitrarily selected bronchial asthma patients (197 patients with AIA and 845 controls with normal analgesic tolerance). Two thirds of all AIA patients reported one or more diseases in the region of the upper airways. Quite different from the control group, highly significant coincidence of AIA with nasal polyposis (42.6%), paranasal sinus diseases (39%), and chronic rhinitis (42,1%) was recorded in the AIA patients. AIA was characterized by stronger inclination to recurrence of nasal polyps and more frequent negative impact of polypectomy upon the course of asthma. The classical triad of "intrinsic asthma - nasal polyps - analgesic intolerance" was established in 39% of the AIA patients. The pathogenetic factors causing the association of asthma with polyps and the even more strongly association of AIA with polyps are still unknown. The presumed pathogenetic relationship between chronic hyperplastic alterations in the upper airways and the phenomenon of AIA might be caused by disorders in phospholid metabolism (liberation of arachidonic acid, lipoxygenase products, radical mechanisms).     

Evaluation of laryngeal findings in users of inhaled steroids

The objective of the prospective study is to examine the laryngeal changes by laryngeal videostroboscopy and electromyography (EMG) regarding new-onset dysphonia in asthmatic patients taking inhaled corticosteroids (ICS). Laryngeal changes and electrophysiological status of the laryngeal muscles were evaluated by these methods in 12 patients both at the time of presentation of dysphonia and after cessation of therapy. Laryngeal changes of our patients were mucosal edema, erythema, thickening, adduction deficit, nodule and irregularity in videostroboscopy. Significant correlations were found between laryngeal pathology and dosage and duration of ICS therapy. We detected myopathy by EMG in most of the patients. Also, EMG revealed that cricothyroid muscle was much more affected than thyroarytenoid muscle. In conclusion, we consider that steroid myopathy or mucosal inflammatory theory alone is not sufficient to explain the etiopathogenesis of dysphonia in asthmatic patients taking ICS. The laryngeal mucosal changes were detected by laryngeal videostroboscopic examination in some asthmatic patients, with dysphonia using ICS, and/or laryngeal myopathy was found by laryngeal EMG in some of them in this study. Thus, various factors may have role simultaneously in the occurrence of dysphonia.     

Laryngopharyngeal reflux in chronic rhinosinusitis patients and the role of endoscopic sinus surgery

ObjectivesLatest literature proposes laryngopharyngeal reflux (LPR) as the underlying contributory factor for chronic inflammation in both upper and lower airways. In this study, we investigated LPR symptoms and signs of CRS patients and the various factors on their LPR symptoms and signs. We also evaluated the effect of the LPR symptoms and signs of CRS patients after endoscopic sinus surgery (ESS).MethodsWe performed a retrospective analysis from 91 patients who underwent primary ESS. They were assessed for LPR symptoms with Reflux Symptom Index (RSI) and Reflux Finding Scores (RFS) before ESS. Sino-Nasal Outcome Test (SNOT)-22, Lund–Mackay (LM) scoring system, and Lund-Kennedy (LK) scoring system were evaluated for CRS severity. They had to fulfill SNOT-22, RSI, and RFS at 6 months after surgery.ResultsNasal polyps, smoking, asthma, allergy, LM scores and LK scores didn't have significant correlations with preoperative RSI and RFS (P > .05 for all). RSI had significant correlations with SNOT-22 preoperatively and postoperatively (P < .05 for all). RFS had a significant correlation with postoperative SNOT-22 (P = 0.034). RSI and RFS decreased significantly more after ESS (P < 0.001 for both). Smoking had a significant effect on the postoperative RFS (P = 0.003). Non-smoker showed significantly lower scores of postoperative RFS (P = .0.003).ConclusionOur study suggests that subjective CRS symptoms were related with subjective LPR symptoms and ESS was effective in reducing signs and symptoms of LPR in CRS patients. Especially, smoking was associated with less improvement of laryngoscopic findings after ESS.     

Prognostic factors of pediatric endoscopic sinus surgery

OBJECTIVE: Pediatric endoscopic sinus surgery (ESS) is performed for refractory cases of rhinosinusitis that do not respond to medical management. However, few studies have been reported for the prognostic factors affecting the outcomes of pediatric ESS. The aim of this study was to investigate the prognostic factors affecting the outcomes of pediatric ESS. MATERIALS AND METHOD: Medical records of 97 pediatric patients who had undergone ESS from February 1995 to October 2003 were reviewed retrospectively. We classified the patients into two groups based on outcome, i.e., either good or poor, according to the postoperative endoscopic findings. Then univariate and multivariate analyses were performed to compare the following nine characteristics between the good and poor outcome groups: the presence of allergy, bronchial asthma, adenotonsillar hypertrophy, history of previous sinus surgery, presence of a smoker in the family, degree of polyposis, preoperative disease extent scored by CT scan findings, blood eosinophil count, and eosinophil infiltration in the nasal mucosa. RESULT: The overall success rate was 70% based on the objective postoperative endoscopic finding. Statistical differences were found between the good and poor groups in terms of the degree of preoperative polyposis and CT staging in univariate analysis, whilst in multivariate logistic regression analysis severe polyposis and indirect smoking predicted poor outcome after pediatric ESS. CONCLUSION: Pediatric ESS with severe polyposis, high CT rhinosinusitis staging, or indirect smoking predisposes to a poorer outcome. This needs to be taken into consideration when performing ESS for children.