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Current Pulmonology Reports
Published in: Current Pulmonology Reports 4/2014

01-12-2014 | Respiratory Infections (C Daley, Section Editor)

Management of chronic rhinosinusitis

Authors: Anne E. Getz, Todd T. Kingdom

Published in: Current Pulmonology Reports | Issue 4/2014

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Abstract

Chronic rhinosinusitis (CRS) is a prevalent inflammatory disorder of the paranasal mucosa, which encompasses a complex and heterogeneous disease population with variable pathophysiologic, host, and environmental etiologies. Due to this variability and an evolving understanding of its underlying etiology, successful medical and surgical management cannot be standardized and remains challenging. Medical management remains the first line strategy for this chronic condition with no known cure. Surgical therapy remains an important adjunct intervention when medical therapy fails to control the disease adequately. An up-to-date review of evidence-based recommendations, as well as emerging treatment strategies in the management of CRS follows.
Literature
1.
Akdis CA, Bachert C, Cingi C, Dykewicz MS, et al. Endotypes and phenotypes of chronic rhinosinusitis: A PRACTALL document of the European Academy of Allergy and Immunology and the American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol. 2013;131:1479–90.PubMedCentralPubMedCrossRef
2.••
Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;3:1–298. This is a critical appraisal of the CRS literature written by leaders in the field according to evidence-based guidelines.
3.
Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. Otolaryngol Head Neck Surg. 2004;131(6 Suppl):S31–80.
4.
5.
Xaubet A, Mullol J, Lopez E, et al. Comparison of the role of nasal polyp and normal nasal mucosal epithelial cells on in vitro eosinophil survival. Clin Exp Allergy. 1994;24:307–17.PubMedCrossRef
6.
Mullol J, Xaubet A, Gaya A, et al. Cytokine gene expression and release from epithelial cells. A comparison study between healthy nasal mucosa and nasal polyps. Clin Exp Allergy. 1995;25:607–15.PubMedCrossRef
7.
Hissaria P, Smith W, Wormald PJ, et al. Short course of systemic steroinds in sinonasal polyposisL a double-blind randomized placebo-controlled trial with evaluation of outcome measures. J Allergy Clin Immunol. 2006;118:128–33.PubMedCrossRef
8.
Kroflic B, Coer A, Baudoin T, Kalogjera L. Topical furosemide versus oral steroid in preoperative management of nasal polyposis. Eur Arch Otorhinolaryngol. 2006;263:767–71.PubMedCrossRef
9.
Van Zele T, Gevaert P, Holtappels G, et al. Oral steroids and doxycycline: two different approaches to treat nasal polyps. J Allergy Clin Immunol. 2010;125:1069–76.PubMedCrossRef
10.
Kirtsreesakul V, Wongsritrang K, Ruttanaphol S. Clinical efficacy of a short course of systemic steroids in nasal polyposis. Rhinology. 2011;49:525–32.PubMed
11.
Vaidyanathan S, Barnes M, Williamson P, et al. Treatment of chronic rhinosinusitis with nasal polyposis with oral steroids followed by topical steroids: a randomized trial. Ann Intern Med. 2011;154:293–302.PubMedCrossRef
12.
Poetker DM, Jakubowski LA, Lal D, Hwang PH, Wright ED, Smith TL. Oral corticosteroids in the management of chronic rhinosinusitis with and without nasal polyps: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2013;3:104–20.PubMedCrossRef
13.
Lal D, Hwang PH. Oral corticosteroid therapy in chronic rhinosinusitis without polyposis: a systematic review. Int Forum Allergy Rhinol. 2011;1:136–43.PubMedCrossRef
14.
Dubin M, Liu C, Lin S, Senior B. American Rhinologic Society member survey on “maximal medical therapy” for chronic rhinosinusitis. Am J Rhinol. 2007;21:483–8.PubMedCrossRef
15.
Rudmik L, Hoy M, Schlosser RJ, et al. Topical therapies in the management of chronic rhinosinuitis: an evidence-based review of recommendations. Int Forum Allergy Rhinol. 2013;2:281–98.CrossRef
16.•
Orlandi RR, Smith TL, Marple BF, et al. Update on evidence-based reviews with recommendations in adult chronic rhinosinusitis. Inter Forum Allergy Rhinol. 2014;Supp 1:S1-S15. This is an executive summary of current evidence-based literature in the management of CRS.
17.
Rotenberg BW, Zhang I, Arra I, Payton KB. Postoperative care for Samter’s triad patients undergoing endoscopic sinus surgery: a double-blinded, randomized controlled trial. Laryngoscope. 2011;121:2702–5.PubMedCrossRef
18.
Pynnonen MA, Mukerji SS, Kim HM, et al. Nasal saline for shronic sinonasal symptoms: a randomized controlled trial. Arch Otolaryngol Head Neck Surg. 2007;133:1115–20.PubMedCrossRef
19.
Liang KL, Su MC, Tseng HC, et al. Impact of pulsatile nasal saline irrigation on the prognosis of functional endoscopic sinus surgery. J Otolaryngol Head Neck Surg. 2008;37:148–52.PubMed
20.
Hamilos DL. Host-microbial interactions in patients with chronic rhinosinusitis. J Allergy Clin Immunol. 2014;133:640–53.PubMedCrossRef
21.
Ponikau JU, Sherris DA, Kita H. The role of ubiquitous airborne fungi in chronic rhinosinusitis. Clin Allergy Immunol. 2007;20:177–84.PubMed
22.
Orlandi RR, Marple BF. Fungus and chronic rhinosinusitis: weighing the evidence. Otolaryngol Head Neck Surg. 2010;143:611–3.PubMedCrossRef
23.
Braun H, Stammberger H, Buzina W, Freudenschuss K, Lackner A. Beham A [Incidence and detection of fungi and eosinophilic granulocytes in chronic rhinosinusitis]. Laryngorhinootologie. 2003;82:330–40.PubMedCrossRef
24.
Gosepath J, Brieger J, Vlachtsis K, Mann WJ. Fungal DNA is present in tissue specimens of patients with chronic rhinosinusitis. Am J Rhinol. 2004;18:9–13.PubMed
25.
Healy DY, Leid JG, Sanderson AR, Hunsaker DH. Biofilms with fungi in chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2008;138:641–7.PubMedCrossRef
26.
Ba L, Zhang N, Meng J, Zhang J, Lin P, Zhou P, et al. The association between bacterial colonization and inflammatory patterns in Chinese chronic rhinosinusitis patients with nasal polyps. Allergy. 2011;66:1296–303.PubMedCrossRef
27.
Corriveau MN, Zhang N, Holtappels G, Van Roy N, Bachert C. Detection of Staphyloccocus aureus in nasal tissue with peptide nucleic acid-fluorescence in suit hybridization. Am J Rhinol Allergy. 2009;23:461–5.PubMedCrossRef
28.
29.
Feazel LM, Frank DN, Ramakrishnan VR. Update on bacterial detection methods in chronic rhinosinusitis: Implications for clinicians and research scientists. Int Forum Allergy Rhinol. 2011. p. 451–9.
30.
Feazel LM, Robertson CE, Ramakrishnan VR, Frank DN. Microbiome complexity and Staphylococcus aureus in chronic rhinosinusitis. Laryngoscope. 2012;122:467–72.PubMedCentralPubMedCrossRef
31.
Kaszuba S, Stewart M. Medical management and diagnosis of chronic rhinosinusitis: survey of treatment patterns by United States otolaryngologists. Am J Rhinol. 2006;20:186–90.PubMed
32.
Dubin MG, Kuhn FA, Melroy CT. Radiographic resolution of chronic rhinosinusitis without polyposis after 6 weeks vs 3 weeks of oral antibiotics. Ann Allergy Asthma Immunol. 2007;98:32–5.PubMedCrossRef
33.
Sylvester DC, Carr S, Nix P. Maximal medical therapy for chronic rhinosinusitis: a survey of otolaryngology consultants in the United Kingdom. Int Forum Allergy Rhinol. 2013;3:129–32.PubMedCrossRef
34.
Kikuchi S, Susaki H, Aoki A, Ito O, Nomura Y. Clinical effect of long-term low dose erythromycin therapy for chronic sinusitis. Pr Otorhinolaryngol. 1991;84:41–7.
35.
Wallwork B, Coman W, Mackay-Sim A, Greiff L, Cervin A. A double-blind, randomized, placebo-controlled trial of macrolide in the treatment of chronic rhinosinusitis. Laryngoscope. 2006;116:189–93.PubMedCrossRef
36.••
Soler ZM, Oyer SL, Kern RC, Senior BAM, Kountakis SE, Marple BF, et al. Antimicrobials and chronic rhinosinusitis with or without polyposis in adults: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2013;3:31–47. This evidence-based review critically assesses the available evidence for use of antibiotics in CRS. Given that antibiotics are the most frequently prescribed medication for this prevalent disease, a thorough knowledge of the evidence to support this practice pattern is vital. PubMedCrossRef
37.
Van Zele T, Gevaert P, Holtappels G, Beule A, Wormald PJ, Mayr S, et al. Oral steroids and doxycycline: Two different approaches to treat nasal polyps. J Allergy Clin Immunol. 2010;125.
38.
Dellamonica P, Choutet P, Lejeune JM, Lucht F, Morgon A, Pessey JJ, et al. Efficacy and tolerance of cefotiam hexetil in the super-infected chronic sinusitis. A randomized, double-blind study in comparison with cefixime. Annales d’oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris. 1994 p. 217–22.
39.
Legent F, Bordure P, Beauvillain C, Berche P. A double-blind comparison of ciprofloxacin and amoxycillin/clavulanic acid in the treatment of chronic sinusitis. Chemotherapy. 1994 p. 8–15.
40.
Huck W, Reed BD, Nielsen RW, Ferguson RT, Gray DW, Lund GK, et al. Cefaclor vs amoxicillin in the treatment of acute, recurrent, and chronic sinusitis. Archives of family medicine. 1993 p. 497–503.
41.
Anand V, Levine H, Friedman M, et al. Intravenous antibiotics for refractory rhinosinusitis in nonsurgical patients: preliminary findings of a prospective study. Am J Rhinol. 2003;17:363–8.PubMed
42.
Fowler KC, Duncavage JA, Murray JJ, Tanner S. Chronic sinusitis and intravenous antibiotic therapy: resolution, recurrence, and adverse events. J Allergy Clin Immunol. 2003;111:S85.CrossRef
43.
Sacks PL, Harvey RJ, Rimmer J, Gallagher RM, Sacks R. Antifungal therapy in the treatment of chronic rhinosinusitis: a meta-analysis. Am J Rhinol Allergy. 2012;26:141–7.PubMedCentralPubMedCrossRef
44.
Brandtzaeg P, Fjellanger I, Gjeruldsen ST. Localization of immunoglobulins in human nasal mucosa. Immunochemistry. 1967;4:57–60.PubMedCrossRef
45.
Van Zele T, Gevaert P, Holtappels G, van Cauwenberge P, Bachert C. Local immunoglogulin production in nasal polyposis is modulated by superantigens. Clin Exp Allergy. 2007;37:1840–7.PubMedCrossRef
46.
Bachert C, van Zele T, Gevaert P, De Schrijver L, Van Cauwenberge P. Superantigens and nasal polyps. Curr Allergy Asthma Rep. 2003;3:523–31.PubMedCrossRef
47.
Scleimer RP, Kato A, Peters A, Conley D, Kim J, Liu MC, et al. Epithelium, inflammation, and the immunity of the upper airways of humans: studies in chronic rhinosinusitis. Proc Am Thorac Soc. 2009;6:288–94.CrossRef
48.
Bachert C, Zhang N. Chronic rhinosinusitis and asthma: novel understanding of the role of IgE “above atopy”. J Intern Med. 2012;272:133–43.PubMedCrossRef
49.
50.
Van Zele T, Claeys S, Gevaert P, van Maele G, Holtappels G, van Cauwenberge P, et al. Differentiation of chronic sinus disease by measurement of inflammatory mediators. Allergy. 2006;61:1280–9.PubMedCrossRef
51.
Zhang N, Van Zele T, Perez-Novo C, Van Bruaene N, Holtappels G, DeRuyck N, et al. Different types of T-effector cells orchestrate mucosal inflammation in chronic sinus disease. J Allergy Clin Immunol. 2008;122:961–8.PubMedCrossRef
52.
Gevaert P, Van Bruaene N, Cattaert T, et al. Mepolizumab, a humanized andti-IL-5 mAb, as a treatment option for severe nasal polyposis. J Allergy Clin Immunol. 2011;128:989–95.PubMedCrossRef
53.
Gevaert P, Lang-Loidolt D, Lackner A, et al. Nasal IL-5 levels determine the response to anti-IL-5 treatment in patients with nasal polyps. J Allergy Clin Immunol. 2006;118:1122–41.CrossRef
54.
Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States. Natl Health Stat Rep. 2009;28:1–25.
55.
Baguley C, Brownlow A, Yeung K, Pratt E, et al. The fate of chronic rhinosinusitis suffers after maximal medical therapy. Int Forum Allergy Rhinol. 2014;4:525–32.PubMedCrossRef
56.
Kennedy DW. Prognostic factors, outcomes, and staging in ethmoid sinus surgery. Laryngoscope. 1992;102:1–18.PubMed
57.
58.
Smith TL, Batra PS, Seiden AM, Hannely M. Evidence supporting endoscopic sinus surgery in the management of adult chronic rhinosinusitis: a systematic review. Am J Rhinol. 2005;19:537–43.PubMed
59.
Soler ZM, Smith TL. Quality of life outcomes after functional endoscopic sinus surgery. Otolaryngol Clin N Am. 2010;43:605–12.CrossRef
60.
Khalil HS, Nunez DA. Functional endoscopic sinus surgery for chronic rhinosinusitis. Cochrane Database Syst Rev. 2006;19, CD004458.
61.
Smith TL, Kern RC, Palmer JN, Schlosser R, et al. Medical therapy vs. surgery for chronic rhinosinusitis: a prospective, multi-institutional study. Int Forum Allergy Rhinol. 2011;1:235–41.PubMedCrossRef
62.
Smith TL, Litvack JR, Hwang PH, Loehrl TA, et al. Determinates of outcomes of sinus surgery: a multi-institutional prospective cohort study. Otolaryngol Head Neck Surg. 2010;142:55–63.PubMedCentralPubMedCrossRef
63.
Soler ZM, Sauer D, Mace J, Smith TL. Impact of mucosal eosinophils and nasal polyposis on quality-of-life outcomes after sinus surgery. Otolaryngol Head Neck Surg. 2010;142:64–71.PubMedCentralPubMedCrossRef
64.
Smith TL, Kern RC, Palmer JN, Schlosser R, et al. Medical therapy vs. surgery for chronic rhinosinusitis: a prospective, multi-institutional study with 1-year follow-up. Int Forum Allergy Rhinol. 2013;3:4–9.PubMedCrossRef
65.
Vashishta R, Soler ZM, Nguyen SA, Schlosser RJ. A systematic review and meta-analysis of asthma outcomes following endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2013;3:788–94.PubMedCrossRef
66.
Bhattacharyya N. Incremental health care utilization and expenditures for chronic rhinosinusitis in the United States. Annals Otol Rhinol Laryngol. 2011;120:423–7.CrossRef
67.
Soler ZM, Wittenberg E, Schlosser RJ, Mace JC, Smith TL. Health State utility values in patients undergoing endoscopic sinus surgery. Laryngoscope. 2011;121:2672–8.PubMedCentralPubMedCrossRef
68.
Rudmik L, Mace J, Soler ZM, Smith TL. Long-term utility outcomes in patients undergoing endoscopic sinus surgery. Laryngoscope. 2014;124:19–23.PubMedCrossRef
69.
Rudmik L, Soler ZM, Mace JC, Schlosser RJ, Smith TL. Economic evaluation of endoscopic sinus surgery versus continued medical therapy for refractory chronic rhinosinusitis. Laryngoscope (in press). 2014.
70.
Metadata
Title
Management of chronic rhinosinusitis
Authors
Anne E. Getz
Todd T. Kingdom
Publication date
01-12-2014
Publisher
Springer US
Published in
Current Pulmonology Reports / Issue 4/2014
Electronic ISSN: 2199-2428
DOI
https://doi.org/10.1007/s13665-014-0091-3

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