Eustachian tube symptoms are frequent in chronic rhinosinusitis and respond well to endoscopic sinus surgery

Maniakas, Anastasios; Desrosiers, Martin; Asmar, Marc‐Henri; Falasi, M Al; Endam, Léandra Mfuna; Hopkins, Claire; Philpott, Carl; Erskine, Sally; Smith, R. A.; Kilty, Shaun

doi:10.4193/rhin17.165

Cited by 18 publications

(35 citation statements)

References 1 publication

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“…This has been confirmed recently in a combined multi-centre cohort of 131 patients with CRS based on responses to the SNOT-22 questions on ear fullness and ear pain (16) . Therefore, the classification of ETD as a "minor" symptom of rhinosinusitis should be re-evaluated.…”

Section: Discussionmentioning

confidence: 63%

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Investigation of the incidence of Eustachian tube dysfunction in patients with sinonasal disease

Rennie¹,

Gutiérrez²,

Darby³

et al. 2018

RHINOL

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Background: Rhinosinusitis is characterised by inflammation affecting the respiratory mucosa of the nose and sinuses. Since the Eustachian tube and the middle ear cavity are also lined by the same mucosa, it is likely that the pathophysiological processes that give rise to rhinosinusitis will also affect these areas. Eustachian tube dysfunction (ETD) is a common condition, but it is often dismissed as a "minor" symptom in rhinology patients. Objective:The aim of this study was to determine the frequency of otologic symptoms in patients attending the rhinology clinic.The seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7), a validated disease-specific instrument was used to assess symptoms with respect to ETD7.Study design: 119 patients attending the rhinology outpatient clinic completed ETDQ-7, a SNOT 22 and had their PNIF measured. Results:The results showed a significantly higher rate of ETD (p<0.01 paired t-test) in the rhinology patients (mean score 3.1, SD 1.64) as compared to a control population (mean 1.3, SD 0.3). Conclusion:Eustachian tube dysfunction is more common in rhinology patients then the general population, and within the rhinology population. The classification of this as a "minor" symptom of rhinosinusitis should be re-evaluated and the effect of treatment of sinonasal disease on ETD needs to be investigated.

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Section: Discussionmentioning

confidence: 63%

“…The mean (standard deviation) overall score was 2.8 (1.6) for the rhinology patients nus surgery (17) . Maniakas et al also confirmed that for most CRS patients, ETD symptoms will decrease post-endoscopic sinus surgery to a level comparable with a non-CRS population (16) .…”

Section: Resultsmentioning

confidence: 84%

Investigation of the incidence of Eustachian tube dysfunction in patients with sinonasal disease

Rennie¹,

Gutiérrez²,

Darby³

et al. 2018

RHINOL

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“…The mechanism of development of ear effusion is unknown but may be related to other factors than probiotic administration, such as (i) deterioration of pre-existing Eustachian tube dysfunction and/or upper respiratory tract disease following withdrawal of therapy or (ii) performance of nasal irrigation. ET dysfunction is frequent in CRS patients particularly in those with severe disease (Stoikes and Dutton, 2005 ; Maniakas et al, 2018 ) and may deteriorate following withdrawal of CRS medication. This concept is supported by a recent clinical trial of 60 patients treated with Dupilumab or placebo for CRSwNP where otitis media developed in a patient in the untreated placebo group treated only saline irrigation (Bachert et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Intranasal Application of Lactococcus lactis W136 Is Safe in Chronic Rhinosinusitis Patients With Previous Sinus Surgery

Endam

Alromaih

González

et al. 2020

Front. Cell. Infect. Microbiol.

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Objective: Modulation of the dysbiotic gut microbiome with “healthy” bacteria via a stool transplant or supplementation is increasingly practiced, however this approach has not been explored in the nasal passages. We wished to verify whether Lactococcus lactis W136 ( L. lactis W136) bacteria could be safely applied via irrigation to the nasal and sinus passages in individuals with chronic rhinosinusitis (CRS) with previous undergone endoscopic sinus surgery, and whether this was accompanied by bacterial community flora modification. Study Design: Prospective open-label pilot trial of safety and feasibility. Setting: Academic tertiary hospital center. Subjects and Methods: Twenty-four patients with CRS refractory to previous medical and surgical therapy received a 14-day course of BID sinus irrigations containing 1.2 × 10 9 CFU live L. lactis W136 . Patients were monitored for safety using questionnaire, sinus endoscopy, otoscopy, UPSIT-40 smell testing, and endoscopically-obtained conventional sinus culture and a swab for 16S microbiome profiling. Results: All 24 patients receiving at least one treatment successfully completed treatment. L. lactis W136 probiotic treatment was safe, with no major adverse events or new infections. Treatment was associated with improvement in sinus symptoms, QOL, and mucosal scores, which remained improved during the subsequent 14-day observation period. Microbiome changes associated with treatment were limited to an increase of the pathobiont Dolosigranulum pigrum , a bacteria identified as potentially beneficial in the upper airways. Subgroup analysis suggested differences in microbiomes and responses for CRSsNP and CRSwNP phenotypes, but these did not attain significance. Conclusion: Intranasal irrigation of live L. lactis W136 bacteria to patients with refractory chronic rhinosinusitis was safe, and was associated with effects on symptoms, mucosal aspect and microbiome composition. Intranasal bacteria may thus find a role as a treatment strategy for CRS. Clinical Trials Registration: www.ClinicalTrials.gov . identifier: NCT04048174.

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“…Recently, SNOT‐22 subdomain score analyses (rhinologic, extranasal rhinologic, ear/facial, psychological, and sleep symptom) have been presented in the literature . One recent publication, discussing the individual ear‐related symptom scores on the SNOT‐22 questionnaire, reported statistically significant differences pre‐ and post‐ESS . Nonetheless, the MCID in these single symptom score analyses has not been studied to date.…”

Section: Discussionmentioning

confidence: 99%

Role of inferior turbinate reduction in the quality of life of patients undergoing endoscopic sinus surgery for chronic rhinosinusitis

Soudry

Mace

Smith

et al. 2019

Int Forum Allergy Rhinol

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Background The impact on quality of life (QoL) of bilateral inferior turbinate reduction (BITR) performed in the setting of endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) has been a point of controversy. The aim of this study was to determine whether addition of BITR to ESS is associated with improved QoL when compared with ESS alone. Methods This study presented findings a multi‐institutional, retrospective analysis of a prospective open cohort of patients electing ESS for failed medical management of CRS. QoL parameters were compared between patients who underwent ESS alone vs those who underwent ESS with BITR. Results A total of 571 patients with CRS who elected to undergo ESS were identified. Sixty‐one of these patients also underwent concurrent BITR, whereas 510 patients underwent ESS without BITR. Mean length of follow‐up was 15.1 months. Comparison between baseline and last postoperative QoL, olfaction, and endoscopic scores revealed significant improvement in both groups. Overall, BITR surgery was not significantly associated with clinically significant incremental improvement in QoL in either the polyp or non‐polyp group. Nevertheless, statistically significant improvement was noted for the nasal congestion/blockage symptom in polyp patients (p = 0.006) and in primary surgery patients (p = 0.027) who underwent BITR. Conclusion BITR in the setting of ESS for CRS is not associated with significant incremental improvement in overall QoL vs ESS alone. However, BITR in polyp and primary surgery patients undergoing ESS appears to offer a significant incremental improvement in nasal congestion/blockage symptoms compared with ESS alone. Future studies are warranted to better corroborate these findings.

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Eustachian tube symptoms are frequent in chronic rhinosinusitis and respond well to endoscopic sinus surgery

Cited by 18 publications

References 1 publication

Investigation of the incidence of Eustachian tube dysfunction in patients with sinonasal disease

Investigation of the incidence of Eustachian tube dysfunction in patients with sinonasal disease

Intranasal Application of Lactococcus lactis W136 Is Safe in Chronic Rhinosinusitis Patients With Previous Sinus Surgery

Role of inferior turbinate reduction in the quality of life of patients undergoing endoscopic sinus surgery for chronic rhinosinusitis

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