Chronic rhinosinusitis: therapeutic efficacy of anti-inflammatory and antibiotic approaches

Despite the high prevalence of chronic rhinosinusitis (CRS) worldwide, the exact pathogenesis of the disease remains unknown. Even with therapeutic intervention, treatment response is often only partial and frequently ineffective. The inability to define exact disease phenotypes in relation to specific disease mechanisms has led to a broad based approach with both anti-inflammatory and anti-microbial intervention. The clinical efficacy of such current therapeutic strategies is highlighted and the urgent need for further robust therapeutic intervention studies in CRS is discussed in this article.     

鼻-鼻窦黏膜中糖皮质激素受体的研究进展

鼻用糖皮质激素是缓解鼻-鼻窦炎症状的主要药物。近年来,随着对糖皮质激素作用机制研究的不断深入,已经明确糖皮质激素受体（GR）是糖皮质激素发挥生理和药理作用的中介物。作者就GR的基因及其产物GRα和GRβ的表达、调节以及在鼻-鼻窦炎性疾病中的变化与意义作一综述。     

Manifestations of primary vasculitis in the ENT region

The primary ANCA associated vasculitides, Wegener's granulomatosis (WG), Churg Strauss syndrome (CSS) and microscopic polyangiitis (MPA), frequently affect the ENT region. For several reasons WG is of special significance for the otorhinolaryngologist. First, disease activity limited to the upper respiratory tract (localized WG) often proceeds the systemic vasculitis (generalized WG). The early diagnosis therefore has decisive consequences for stage adapted therapy. Second, in most cases (nearly 80%) WG is diagnosed histologically on biopsy specimens from the ENT region. During the initial phase of WG this is of diagnostic relevance, because at this stage the serologic parameters (acute-phase proteins) usually have a normal value and PR3-ANCA is (still) negative in 2/3 of the patients. Third, in many cases recurrences reveal increased activity in the ENT region, or start in this area. Clinically in most cases chronic rhinosinusitis with crusting and epistaxis is seen, sometimes with septal perforation and/or saddle nose. Apart from this there are often unclear middle ear symptoms with recurrent effusions and the inner ear is sometimes also affected. Laryngeal manifestations are typically located in the subglottic area and lead to subglottic stenosis. In the differential diagnosis, diseases in which epitheloid cell granulomas occur, such as sarcoidosis and TBC, need to be considered, but also foreign body granulomas and fungus diseases. Finally malignant tumours, especially malignant lymphomas, have to be ruled out.     

Chronic rhinosinusitis in adults

There is no consensus on diagnostic criteria for chronic rhinosinusitis. By convention, the symptoms of chronic rhinosinusitis are similar to those of acute rhinosinusitis but last more than 8 weeks. Diagnosis is based on history, physical examination, and computed tomography scan of the sinuses or rhinoscopy. Treatment options are numerous and, for the most part, not evidence based. They include antibiotics, nasal or oral corticosteroids, antihistamines, naval lavage, decongestants, immunotherapy, and surgery. Which diagnostic and therapeutic options to exercise when, is the focus of this article.     

老年慢性鼻窦炎鼻息肉患者的围手术期处理

目的探讨大于65岁老年慢性鼻窦炎鼻息肉患者全麻下鼻内镜手术治疗的围手术期处理。方法回顾分析71例行鼻内镜手术的老年鼻窦炎鼻息肉患者的临床资料,将患者分为不伴和伴随慢性疾病的A、B两组。对B组进行充分的术前处理后,行鼻内镜手术。比较A、B组的疗效。结果术后随访6—12个月,A组术后总有效率95．45％,B组为95．92％,二者无统计学上差异（P〉0．05）。术后并发症5例,A组2例,B组3例。结论老年鼻窦炎鼻息肉患者行鼻内镜手术前,评估危险因素,重视并积极给予相应预防性治疗,采取有效的围手术期处理,是取得良好手术效果的关键。     

Therapeutic options for reducing sleep impairment in allergic rhinitis,rhinosinusitis, and nasal polyposis

ABSTRACT

Background: Patients with inflammatory disorders of the upper airways, such as allergic rhinitis, rhinosinusitis, and nasal polyposis, often have significant sleep disturbances. Poor sleep can lead to fatigue, daytime somnolence, impaired daytime functioning as reflected in lower levels of productivity at work or school, and a reduced quality of life. Although the exact mechanisms by which these inflammatory nasal conditions disturb sleep is not fully understood, congestion appears to be a key factor and is generally the most common and bothersome symptom for patients with these conditions. Successful therapy should improve patients’ sleep and well-being without introducing any negative effects on sleep.

Scope of literature search: Literature searches of Medline, Embase, and abstracts from medical/scientific conferences were conducted for the period of 1995 through mid-2006 for primary and review articles and conference presentations about sleep disturbance related to allergic rhinitis, rhinosinusitis, and nasal polyposis. These searches also sought to identify articles examining how treatments for those diseases improved sleep and, consequently, patients’ quality of life. Surveys of the impact of congestion on patients’ quality of life and their sleep also were consulted. Clinical studies were selected for discussion if they were randomized, double-blind, and placebo-controlled. Limitations of this review include the absence of any direct comparisons of the effectiveness of different drugs on improving sleep and shortcomings in the statistical methods of the patient surveys.

Findings: Intranasal corticosteroids (INSs) are the most effective medication for reducing congestion in patients with inflammatory nasal conditions. There is a growing amount of evidence that a reduction in congestion with INSs is associated with improved sleep, reduced daytime sleepiness, and enhanced patient quality of life.

Conclusion: Relief of sleep impairment associated with inflammatory disorders of the nose and sinuses can be addressed with INS therapy.     

腺样体切除术治疗小儿慢性鼻窦炎98例分析

目的：探讨腺样体切除在小儿慢性鼻窦炎治疗中的作用。方法：收治小儿慢性鼻窦炎患者98例,均接受腺样体切除术,回顾分析临床资料。结果：随访半年,参照1997年海口会议鼻窦炎疗效判断标准,98例中治愈64例（65.3%）,好转29例（29.6%）,无效5例（5.1%）,术中无任何并发症,总有效率94.9%。结论：Ⅰ型、Ⅱ型1期、Ⅱ型2期的小儿慢性鼻窦炎的治疗以切除阻塞鼻腔通气的腺样体为主,配合积极的内科治疗可以达到治愈小儿慢性鼻窦炎的目的。Ⅱ型3期及Ⅲ型患者应行鼻内镜下鼻窦手术加腺样体切除术。     

Correlation of Nasal Nitric Oxide Measurement with Computed Tomography Findings in Chronic Rhinosinusitis

Nitric oxide (NO) is a biological messenger produced by mammalian cells serving various functions including regulation of blood flow, platelet function, immunity, and neurotransmission. The paranasal sinuses and nasal mucosa are a major source of exhaled NO. The aim of the study is to compare the nasal NO (nNO) levels in patients with chronic rhinosinusitis with those of common cold patients and controls and to correlate CT scores with nNO levels. The nasal concentration of NO was measured by electroluminescence in 13 healthy volunteers, in 13 patients suffering from common cold and 13 patients with chronic rhinosinusitis. The concentration of NO was correlated with symptom scores, endoscopic findings and CT findings. The measured levels of NO did not differ between healthy volunteers and common cold patients, but they were significantly lower in patients suffering from chronic rhinosinusitis. As NO is a regulator of mucociliary activity and has bacteriostatic and antiviral effects, the decreased concentration of nNO in patients suffering from sinusitis suggests that lack of NO may contribute to the pathogenesis of this disease. Thus, nNO, which is easily measured, provides a valuable non-invasive objective measure of chronic rhinosinusitis.