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Role of nasal eosinophilia in pregnancy rhinitis
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Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
METHODS: Retrospective review of four years (2003-2006) of data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Visits were identified using reported diagnostic codes from the International Classification of Disease, 9th revision. They were weighted to provide national estimates of care. Data were analyzed with Pearson chi-squared using SPSS 16.2 Complex Samples Module, taking into account the complex survey design and multiple time periods. RESULTS: A total of 4,617 patient visits for chronic rhinosinusitis were identified, representing 91.2 million national visits. While the majority of visits for all regions involved white patients (83-92%), a significantly higher proportion of CRS visits in the South involved African-Americans as compared to other regions (Pearson X2⫽69, F⫽6.7, df⫽2.8, 2118, p⬍0.01). Significantly less diagnostic services were provided or ordered at the patient visits in the Northeast as compared to the other regions (Pearson X2⫽64.8, F⫽4.0, df⫽4.3, 3247, p⬍0.01). Providers in the Northeast were also significantly less likely to order or renew more than 3 medications at the patient visit (Pearson X2⫽54, F⫽3.1, df⫽2.6, 1930, p⬍0.05). No regional differences were seen in age (mean 35.66, SE 0.782) or gender (female to male ratio 3:2). CONCLUSIONS: Significant regional variations exist for chronic rhinosinusitis in terms of patient characteristics, diagnosis and management. Further research is needed to better understand these important differences and their impact on this disease. Supported by NIH grant #AG04085 (C.M.) Rhinotopic therapy and management of biofilm in CRS Alan Shikani, MD (presenter); Karim Chahine, MD OBJECTIVES: Chronic rhinosinusitis that is refractory to surgery and repeated courses of antibiotics is a complex disease where bacterial biofilms are suspected to play a major role. The objectives of this study are: 1) To identify the role of biofilm in the pathogenesis of refractory chronic rhinosinusitis (CRS) after endoscopic sinus surgery (ESS). 2) To assess the effectiveness of rhinotopic strategy in disrupting biofilm formation and providing long term symptom relief in patients with refractory rhinosinusitis. METHODS: This is a prospective study conducted over a period of two years on twenty patients with CRS that have undergone ESS, and continued to experience persistent or recurrent sinusitis symptoms. Sinus mucosal biopsies were taken before treatment and assessed for bacterial biofilm presence. The patients were treated for 6 weeks with rhinotopic therapy, a multimodality that included hydrotherapy, repetitive mechanical removal of biofilms, and topically nebulized corticosteroids and antibiotics. The patient’s symptoms and endoscopic appearance were scored before, during and after the completion of treatment using the Lund-Kennedy symptom
and endoscopic appearance scores. Mucosal biopsies were repeated to assess for biofilm presence or absence. RESULTS: Bacterial biofilms were present in a large number of patients with refractory sinusitis. Significant improvement in symptoms, endoscopic appearance and biofilm disruption were documented in the majority of patients after therapy. CONCLUSIONS: Bacterial biofilms play an important role in the pathogenesis of refractory CRS. The rhinotopic therapy multimodality approach disrupts biofilms, treats the accompanying inflammatory reaction, and effectively restores sinus homeostatis in this challenging disease. Role of nasal eosinophilia in pregnancy rhinitis Homere Georges Almoutran, MD (presenter); Evanna Francis, MD; Walid Abou Hamad, MD; Maguy Cherfan, MD; Amine Haddad, MD, FRCS OBJECTIVES: 1) Determine the role of nasal eosinophilia in pregnant women experiencing pregnancy rhinitis. 2) Evaluate the effect of potential risk factors on the incidence of this type of rhinitis. METHODS: We conducted a transversal comparative study on a population of 29 consecutive pregnant women, and a control population of 23 non-pregnant women with no history of chronic rhinitis. In the study group, we assessed the presence of pregnancy rhinitis symptoms appearing during the pregnancy and disappearing completely within 2 weeks after delivery. We also assessed the presence of potential pregnancy rhinitis risk factors. Nasal smears with Diff-Quick cytological study were undertaken in the study and control groups. A percentage of eosinophils was attributed to every patient. RESULTS: Incidence of pregnancy rhinitis was 27.58%. The symptoms started at an average of 31 weeks of gestation and lasted for an average of 7.68 weeks. No association was found between pregnancy rhinitis and the risk factors. The mean percentage of eosinophils on nasal smears of pregnant women (4.2%) was significantly higher than that of the non-pregnant women (4.2 v/s1.6%. p⬍0.005). This study failed to show a significant relation between the elevation of eosinophils on nasal smear and the appearance of pregnancy rhinitis symptoms. However there was a significant association between the severity of rhinorrhea and the the percentage of eosinohils. CONCLUSIONS: The incidence of pregnancy rhinitis was similar to the incidences in the literature. Eosinophilic preponderance in the nasal mucosa was proven higher in pregnancy. There was no evidence of any potential risk factor associated. A significant correlation between the severity of rhinorrhea and elevation of nasal mucosa eosinophils was also found. Correlation between this elevation and the appearance of pregnancy rhinitis symptoms was not confirmed by our study.
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
METHODS: Retrospective review of four years (2003-2006) of data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Visits were identified using reported diagnostic codes from the International Classification of Disease, 9th revision. They were weighted to provide national estimates of care. Data were analyzed with Pearson chi-squared using SPSS 16.2 Complex Samples Module, taking into account the complex survey design and multiple time periods. RESULTS: A total of 4,617 patient visits for chronic rhinosinusitis were identified, representing 91.2 million national visits. While the majority of visits for all regions involved white patients (83-92%), a significantly higher proportion of CRS visits in the South involved African-Americans as compared to other regions (Pearson X2⫽69, F⫽6.7, df⫽2.8, 2118, p⬍0.01). Significantly less diagnostic services were provided or ordered at the patient visits in the Northeast as compared to the other regions (Pearson X2⫽64.8, F⫽4.0, df⫽4.3, 3247, p⬍0.01). Providers in the Northeast were also significantly less likely to order or renew more than 3 medications at the patient visit (Pearson X2⫽54, F⫽3.1, df⫽2.6, 1930, p⬍0.05). No regional differences were seen in age (mean 35.66, SE 0.782) or gender (female to male ratio 3:2). CONCLUSIONS: Significant regional variations exist for chronic rhinosinusitis in terms of patient characteristics, diagnosis and management. Further research is needed to better understand these important differences and their impact on this disease. Supported by NIH grant #AG04085 (C.M.) Rhinotopic therapy and management of biofilm in CRS Alan Shikani, MD (presenter); Karim Chahine, MD OBJECTIVES: Chronic rhinosinusitis that is refractory to surgery and repeated courses of antibiotics is a complex disease where bacterial biofilms are suspected to play a major role. The objectives of this study are: 1) To identify the role of biofilm in the pathogenesis of refractory chronic rhinosinusitis (CRS) after endoscopic sinus surgery (ESS). 2) To assess the effectiveness of rhinotopic strategy in disrupting biofilm formation and providing long term symptom relief in patients with refractory rhinosinusitis. METHODS: This is a prospective study conducted over a period of two years on twenty patients with CRS that have undergone ESS, and continued to experience persistent or recurrent sinusitis symptoms. Sinus mucosal biopsies were taken before treatment and assessed for bacterial biofilm presence. The patients were treated for 6 weeks with rhinotopic therapy, a multimodality that included hydrotherapy, repetitive mechanical removal of biofilms, and topically nebulized corticosteroids and antibiotics. The patient’s symptoms and endoscopic appearance were scored before, during and after the completion of treatment using the Lund-Kennedy symptom
and endoscopic appearance scores. Mucosal biopsies were repeated to assess for biofilm presence or absence. RESULTS: Bacterial biofilms were present in a large number of patients with refractory sinusitis. Significant improvement in symptoms, endoscopic appearance and biofilm disruption were documented in the majority of patients after therapy. CONCLUSIONS: Bacterial biofilms play an important role in the pathogenesis of refractory CRS. The rhinotopic therapy multimodality approach disrupts biofilms, treats the accompanying inflammatory reaction, and effectively restores sinus homeostatis in this challenging disease. Role of nasal eosinophilia in pregnancy rhinitis Homere Georges Almoutran, MD (presenter); Evanna Francis, MD; Walid Abou Hamad, MD; Maguy Cherfan, MD; Amine Haddad, MD, FRCS OBJECTIVES: 1) Determine the role of nasal eosinophilia in pregnant women experiencing pregnancy rhinitis. 2) Evaluate the effect of potential risk factors on the incidence of this type of rhinitis. METHODS: We conducted a transversal comparative study on a population of 29 consecutive pregnant women, and a control population of 23 non-pregnant women with no history of chronic rhinitis. In the study group, we assessed the presence of pregnancy rhinitis symptoms appearing during the pregnancy and disappearing completely within 2 weeks after delivery. We also assessed the presence of potential pregnancy rhinitis risk factors. Nasal smears with Diff-Quick cytological study were undertaken in the study and control groups. A percentage of eosinophils was attributed to every patient. RESULTS: Incidence of pregnancy rhinitis was 27.58%. The symptoms started at an average of 31 weeks of gestation and lasted for an average of 7.68 weeks. No association was found between pregnancy rhinitis and the risk factors. The mean percentage of eosinophils on nasal smears of pregnant women (4.2%) was significantly higher than that of the non-pregnant women (4.2 v/s1.6%. p⬍0.005). This study failed to show a significant relation between the elevation of eosinophils on nasal smear and the appearance of pregnancy rhinitis symptoms. However there was a significant association between the severity of rhinorrhea and the the percentage of eosinohils. CONCLUSIONS: The incidence of pregnancy rhinitis was similar to the incidences in the literature. Eosinophilic preponderance in the nasal mucosa was proven higher in pregnancy. There was no evidence of any potential risk factor associated. A significant correlation between the severity of rhinorrhea and elevation of nasal mucosa eosinophils was also found. Correlation between this elevation and the appearance of pregnancy rhinitis symptoms was not confirmed by our study.