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Results for “Chronic rhinosinusitis”

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At least 19 recordsLinked to original sources
PubMed2002

The role of infection in chronic rhinosinusitis.

Chronic rhinosinusitis is a common condition, yet little is understood about its pathogenesis. Chronic infection traditionally has been considered a significant factor in the etiology and manifestations of chronic rhinosinusitis. Bacteria can be recovered in most cases of chronic rhinosinusitis, most commonly consisting of Staphylococcus species, anaerobes, and in some cases, gram-negative bacteria. Increasing trends toward bacterial resistance have been identified in chronic rhinosinusitis. Recently, a potential role for fungal infection has emerged. A knowledge of the microbiology of chronic rhinosinusitis will help guide treatment, but more research is required to understand further the exact role of infection in the pathophysiology of chronic rhinosinusitis.

Bacterial Infections↗
PubMed2006

The impact of functional endoscopic sinus surgery on symptoms in chronic rhinosinusitis.

Chronic rhinosinusitis restricts the quality of life of millions of involved patients. The aim of the study was to evaluate how functional endoscopic sinus surgery (FESS) modifies symptom profiles in patients with chronic rhinosinusitis. Questionnaires were given to eighty patients with chronic rhinosinusitis, who underwent FESS, to assess typically related symptoms preoperatively and postoperatively. Statistical analyses were performed with the Wilcoxon test. Leading symptoms of chronic rhinosinusitis were nasal obstruction in 93.7% and post nasal discharge in 86.2% of the patients. Furthermore, patients reported anterior nasal discharge in 72.5%, headache in 65% and hyposmia in 62.5% of the patients. One year postoperatively all the symptoms were significantly improved : nasal obstruction in 87%, post nasal discharge in 74.3%, anterior nasal discharge in 70.5%, headache in 59.4% and hyposmia in 58.7% of the patients. Our results showed that FESS is an adequate and effective method in treatment patients with chronic rhinosinusitis. On the other hand, the questionnaire used in the present study was easy to handle for the patients and allowed successful quantification of sinusitis-related symptoms.

Adolescent↗
PubMed1988

Natural immunity to dust mites in patients with chronic rhinosinusitis.

Chronic rhinosinusitis is an extremely common clinical problem of which the etiology is poorly understood. To understand the role of common environmental antigens in this disease, natural immunity to antigens derived from the house dust mite was evaluated in 22 adults with chronic rhinosinusitis and compared to a carefully matched group of patients with chronic asthma or to a group of normal individuals. Allergic reactivity to dust mites was very common in patients with chronic rhinosinusitis, with 68% exhibiting a positive immediate skin test reaction and 41% exhibiting elevated levels of mite-specific serum IgE; 72% of patients with rhinosinusitis also exhibited markedly elevated levels of mite-specific serum IgG, which were present in both mite-allergic and nonallergic patients. IgG titers were much higher in the group with rhinosinusitis than in patients with asthma, whereas allergic reactivity to dust mites was significantly higher in the patients with asthma. Mite-specific immunity was low or absent in the group of normal individuals. These findings demonstrate that natural immunity to dust mites is very common in patients with chronic rhinosinusitis and suggest that immunity to mites may be involved in this syndrome. Furthermore, the data indicate that there may be significant differences in the ability of patients with rhinosinusitis or asthma to produce mite-specific antibodies of the IgG class.

Adult↗
PubMed2005

Algorithms for management of chronic rhinosinusitis.

Chronic rhinosinusitis poses numerous challenges for the practitioner. This article presents strategies for making the diagnosis and managing chronic rhinosinusitis with and without nasal polyposis, and for assessing and managing disease persisting or recur-ring after endoscopic sinus surgery.

Administration, Intranasal↗
PubMed2004

Diagnosis of chronic rhinosinusitis.

Chronic rhinosinusitis is a multifactorial disease defined as inflammation of the nasal cavity and paranasal sinuses with a history of at least 12 weeks in duration. The major symptoms include facial pressure or pain, nasal obstruction, discharge or purulence, and hyposmia or anosmia. The minor symptoms include fever, halitosis, fatigue, and dental pain. Microorganisms play a significant role in the persistence and origination of the inflammatory process, although the exact role of these organisms in the pathogenesis of chronic rhinosinusitis is unclear. The clinical diagnosis relies heavily on the patient history and physical examination, which may include nasal endoscopy and computed tomography. Diagnostic techniques are here reviewed.

Bacterial Infections↗
PubMed2005

Maximal medical therapy for chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is widely recognized as one of the most common, if not the most common, chronic disease entities. This article discusses CRS without nasal polyposis. The discussion of maximal medical therapy concentrates on the best available evidence from published clinical trials.

Adrenal Cortex Hormones↗
PubMed2005

Granulomatous diseases and chronic rhinosinusitis.

Chronic rhinosinusitis often fails to respond to standard medical or surgical treatment. In some of these cases, the underlying disease may be a chronic granulomatous process that requires aggressive topical, local, and in some instances, systemic therapy. Diseases that can present in this manner include autoimmune vasculitis, sarcoidosis, indolent infections, neoplastic processes, and various other miscellaneous conditions. This article reviews the typical presentations for some of these unusual conditions and discusses the appropriate evaluations that will lead to clinical identification and effective medical management.

Chronic Disease↗
PubMed2006

Hypoxia induced chemokine expression in nasal epithelial cells: development of an in vitro model for chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is defined as an inflammatory condition involving the paranasal sinuses and the lining of the nasal passages that persists longer than 12 weeks. It is one of the most common chronic diseases today, affecting up to 15% of the adult population in the Western world with a dramatic increase in prevalence. One hallmark of chronic inflammation in CRS is the predominance of eosinophils and T lymphocytes in the inflamed tissue. We pursued the hypothesis that the blockage of the paranasal sinuses induces hypoxic conditions, which subsequently lead to the induction of chemotactic activity, attracting inflammatory cells. To this end, we established an in vitro model by showing that hypoxia is able to induce the release of chemokines in nasal epithelial cells. Furthermore, we show that this induction leads to the migration of eosinophils and neutrophils. Finally, we demonstrated the applicability of this in vitro model by showing its sensitivity to the glucocorticoid dexamethasone, which is used in the clinical situation. These results suggest that this nasal epithelial cell culture model may allow the evaluation of novel anti-inflammatory compounds for the treatment of CRS directly on the relevant target cells in vitro. This approach may result in replacing and refining animal experimentation in the screening of new therapeutics for CRS.

Cells, Cultured↗
PubMed2006

Evolution of medical management of chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a surprisingly common, poorly defined, and notoriously difficult-to-treat disease. It has a complex pathophysiology that often, but not always, involves nasal or paranasal sinus infection. Anatomic variations that predispose the sinuses to obstruction may play a role, but are unusual sole causes of chronic disease. Other possible causative factors include allergic or nonallergic inflammation, mucociliary dysfunction, aspirin intolerance (Samter's triad), immunodeficiency, and cystic fibrosis. Although a majority of patients achieve long-term relief from CRS after successful endoscopic sinus surgery, a significant proportion do not, and are likely to benefit from sustained postsurgical medical therapy. Medical therapy for CRS may include treatment with corticosteroids, antibiotics, antifungal agents, antihistamines, leukotriene modifiers, nasal decongestants, mucolytics, and nasal irrigations. The selection of appropriate medical therapy is based on endoscopic evaluation, sinus cultures, and symptoms. Computed tomography, the imaging standard for evaluation of the sinuses, provides information about the extent and distribution of mucosal disease beyond what is visible endoscopically. Because it fails to provide information on the origin of the mucosal changes, computed tomography provides limited information to guide medical therapy.

Adrenal Cortex Hormones↗
PubMed2006

Pathogenesis of chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a heterogenous disorder and represents a major public health problem. Although insights into the pathophysiology of CRS have largely expanded over the last two decades, the exact etiology and mechanism of persistence is still unrevealed. CRS is a multifactorial disease, and, with variable evidence, impaired ostial patency, mucociliary impairment, allergy, bacterial or fungal infection (or triggering), immunocompromised state, and environmental and genetic factors have been suggested to be associated or risk factors. Pathomechanisms in CRS are better understood currently, allowing us to characterize and differentiate the heterogeneous pathology of chronic sinonasal inflammation based on histopathology, inflammatory pattern, cytokine profile, and remodeling processes. In nasal polyposis (NP), but not CRS without NP, an abundant eosinophilic inflammation and local immunoglobulin E production could be demonstrated, and Staphylococcus-derived superantigens may at least modulate disease severity and expression. These findings question the current assumption that NP is a subgroup of CRS, but suggest that CRS and NP should probably be considered as distinct disease entities.

Cytokines↗
PubMed2004

Pathogenesis of chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a multifactorial disease. Predisposing factors can be divided into environmental and non-host factors, such as pollution, viral infections, smoking, fungus, and bacteria; general host factors, including genetic factors and immune deficiency; and local host factors, including persistent focal inflammation within the ostiomeatal complex. Evidence suggests that the underlying bone in the ostiomeatal complex is actively involved in the disease process of CRS. The evidence concerning a broad range of predisposing factors for CRS is reviewed.

Animals↗
PubMed2006

Natural treatment of chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is one of the most common long-term illnesses in the United States, affecting approximately 14 percent of the population. CRS is a challenging condition to treat, partly due to its multifaceted, poorly understood pathophysiology. Treatment goals include maintaining open drainage and decreasing inflammation while improving tissue integrity and limiting causative factors. This review covers the etiology, pathology, and diagnosis of CRS, as well as mainstream and alternative treatments. Discussion of alternative therapeutics includes nutrients and botanicals (ascorbic acid, bromelain, N-acetylcysteine, quercetin, undecylenic acid, and Urtica dioica and other herbal medicines) and procedures (nasal irrigation and naso-sympatico treatments). The influences of diet and air quality on CRS are also discussed.

Chronic Disease↗
PubMed2004

[Topical comments on chronic rhinosinusitis].

Chronic rhinosinusitis (CRS) is defined as a group of illnesses that is characterized by inflammation of the nose and paranasal sinus mucous membranes that lasts at least twelve weeks. In Europe and the U.S.A., CRS is one of the most widespread illnesses, with incidence and prevalence on the increase. There are various potential causes and triggering factors for CRS; likewise, the symptoms from individual to individual can be very different. Up until now, there has been a dearth of evidence-based studies on conservative drug treatments for CRS. For many patients with years of recurring inflammation attacks, the operative correction is often the only therapeutic option. The minimally invasive functional paranasal sinus surgery has achieved good and, also, long term therapeutic responses.

Chronic Disease↗
PubMed2006

The role of ubiquitous airborne fungi in chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a confusing disease for both allergists and otorhinolaryngologists, partly because of its poorly understood pathophysiology and partly because of its limited treatment options. Several recent reports have provided evidence for a better understanding of the etiology and the relationship of CRS to airborne fungi-especially to Alternaria. First, the development of novel methods enables detection of certain fungi in mucus from the nasal and paranasal sinus cavities. Second, a non-IgE-mediated immunological mechanism for reactivity of patients with CRS to certain common fungi has been described. Third, these fungi are surrounded by eosinophils in vivo, suggesting that they are targeted by eosinophils. Finally, the preliminary results of studies using antifungal agents to treat patients with CRS are promising. Overall, these recent discoveries provide a logical mechanism for the pathophysiology of CRS, and they also suggest promising avenues for treatment of CRS with antifungal agents.

Air Microbiology↗
PubMed2005

The role of ubiquitous airborne fungi in chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a confusing disease for both allergists and otorhinolaryngologists, partially due to its poorly understood pathophysiology and partially due to its limited treatment options. Several recent reports now provide evidence for a better understanding of the etiology and the relationship of CRS to airborne fungi, especially to Alternaria. First, the development of novel methods enables detection of certain fungi in mucus from the nasal and paranasal sinus cavities. Second, a non-immunoglobulin E-mediated immunologic mechanism for reactivity of CRS patients to certain common fungi has been described. Third, these fungi are surrounded by eosinophils in vivo, suggesting that they are targeted by eosinophils. Fourth, the preliminary results of studies using antifungal agents to treat patients with CRS are promising. Overall, these recent discoveries provide a logical mechanism for the pathophysiology of CRS, and they also suggest promising avenues for treatment of CRS with antifungal agents.

Air Microbiology↗
PubMed2005

Fungus culture and PCR in nasal lavage samples of patients with chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) affects approximately 15 % of the adult population in industrialized countries. Fungi have been recognized as important pathogens in CRS in the immunocompromised host. Recently, fungi have been detected in more than 90 % of nasal lavages (NLs) in immunocompetent patients with CRS. Employing NLs of immunocompetent patients with CRS in the present study, the detection rates for fungi by culture techniques were compared with the results of different fungus-specific PCR assays. Standard fungal cultures were performed on NLs from 77 patients with CRS. NLs were also tested for the presence of fungal DNA by a panfungal assay with and without specific probes for Candida spp. and Aspergillus spp./Penicillium spp., and an Aspergillus-specific nested PCR assay. Nineteen of the 77 samples (25 %) grew fungi. Fungus-specific DNA was detected in 34 of 77 NLs (44 %). Twelve samples were positive for both culture and panfungal PCR, whereas seven specimens grew fungi in culture, but were negative in panfungal PCR, and an additional seven samples were positive in panfungal PCR, but negative in culture. The combination of culture and all employed PCR assays detected fungi in 39 patients (50 %). This study demonstrated that PCR and conventional culture techniques could be complementary diagnostic techniques to detect fungi in nasal specimens from CRS patients.

Adult↗
PubMed2006

Gastroesophageal reflux disease (GERD), extraesophageal reflux (EER) and recurrent chronic rhinosinusitis.

Chronic polypoid rhinosinusitis (CRS) is a common disease, affecting approximately 16% of the adult population in the US every year. In addition to many well known predisposing factors, an association with reflux disease is hypothesized. Such an association might explain the recurrence of polyposis in the face of improved surgical techniques and postsurgical treatment of CRS. At present it is unclear whether extraesophageal reflux directly injures the sinus mucosa, whether gastroesophageal reflux leads to vagus-mediated neuroinflammatory changes, or whether both mechanisms occur separately or simultaneously. In patients suffering from recurrent CRS (n=20) and healthy volunteers (n=20), ambulatory 24 h two channel pH testing was performed. The number of reflux events, the fraction of the total time during which pH was below 4, and the reflux area index (RAI) were determined in the esophagus as well as in the hypopharynx. Patients with recurrent CRS had significantly more reflux events in the esophagus and the fraction of pH<4 and the RAI were increased up to 10-fold compared to healthy volunteers. In contrast to the esophagus, these differences were not observed in the hypopharynx. Recurrent CRS is often associated with GERD but not with EER. Recurrent disease or prolonged recovery after surgery should raise the suspicion of reflux disease as a possible triggering factor. Because GERD itself cannot be diagnosed by laryngoscopy, and because of the subjectivity of symptoms such as heartburn, the otolaryngologist should consider double-probe pH testing as the diagnostic procedure of choice.

Adult↗
PubMed2000

Analysis of aerobic bacterial strains found in chronic rhinosinusitis using the polymerase chain reaction.

INTRODUCTION: Rhinosinusitis is a common disease affecting an estimated 14% of the population. Although there is general agreement in the literature regarding acute rhinosinusitis, chronic rhinosinusitis is not as well studied, and no consensus has been reached regarding the bacterial etiology. The goal of this study was to test chronic rhinosinusitis mucosal specimens using the polymerase chain reaction (PCR) for aerobic bacterial content and to compare the results with standard culture data. RESULTS: Routine culture samples grew 50% aerobic bacteria, whereas PCR detected 62% aerobic bacteria contamination. CONCLUSION: PCR detected more bacteria in mucosal samples than in standard culture, but standard culture of this mucosa reflects the general aerobic bacteria found in chronic rhinosinusitis, with no predominant species of aerobic bacteria. SIGNIFICANCE: The analysis of chronic rhinosinusitis mucosa with the PCR method should give a more accurate picture of the bacteria found in chronic rhinosinusitis so that proper therapy can be instituted.

Adolescent↗