Medical interventions for chronic rhinosinusitis in cystic fibrosis

Karanth, Tulasi Kota; Karanth, Veena Kota Laxminarayan Kl; Ward, Bryan K.; Woodworth, Bradford A.; Karanth, Laxminarayan

doi:10.1002/14651858.cd012979.pub2

Cited by 11 publications

(10 citation statements)

References 60 publications

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“…Medical intervention, normally comprising long‐term combinations of oral and topical treatment, remains the first step in managing CRS in CF patients. Consensus recommendations for medical treatment are lacking, as a 2019 Cochrane Review failed to identify any studies that met the inclusion criteria of randomized trials of medical interventions compared to each other or to placebo 2374 . Given the improving life expectancy for patients with CF, there is a growing need for sound clinical research that can guide our decisions for medical treatment of CRS in this population.…”

Section: Special Considerations In Rhinosinusitismentioning

confidence: 99%

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

463

479

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I. Executive Summary Background The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS.

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Section: Special Considerations In Rhinosinusitismentioning

confidence: 99%

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

463

479

View full text Add to dashboard Cite

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“…This chronic inflammatory state promotes an increase of local neutrophils and finally a formation of neutrophil-predominant nasal polyps. 14,15 Nasal polyposis was present only in the living children of our study. We can suppose that in some time, during the course of the disease, it must occur a proper inflammatory condition for polyposis development.…”

Section: Discussionmentioning

confidence: 53%

Impact of the different mutations in the cystic fibrosis gene in children with chronic rhinosinusitis

Ferreira¹,

Moura²,

Amorim³

et al. 2019

JOENTR

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Background: Cystic fibrosis (CF) is a worldwide disease occurring mostly in caucasians. It is an autosomal recessive disorder that leads to a malfunction of CF transmembrane conductance regulator (CFTR). These mutations cause an ionic disorder on the body fluids and a modification on its consistency. Affects multiple parts of the body and rhinosinusitis is a common manifestation of the upper airway affection. Material and methods: This retrospective study performed a statistical analysis of the prevelence of chronic rhinosinusitis with polyposis, genotipe and mortality in 30 children under 18 years with cystic fibrosis followed in the CF unit of Coimbra University Hospital. Results: The mean age of this study was 12,9 years. Phenylalanine deletion at position 508 (F508delF508del) was the most prevalent genotype (66,7%). Females patients had an higher prevalence of morbidities, however male patients had an higher mortality rate 20% comparing to 6,7%. Nasal polyposis was present only in the living ones with F508delF508del genotype. ENT (ear, nouse and throut) symptons and an abnormal ENT examination were mostly observed in F508delF508del genotype. Conclusions: CF is a lifelong disease that requires long-term surveillance and compliance. The involvement of the lower airway is prevalent in young chlidren. The uper airway symptoms becomes more important with disease progression. Nasal poliposis is prevalent on the older ones with F508delF508del genotype. In this kind of patients with persistent symptoms, who have failed medical management, are often considered appropriate candidates for functional endoscopic surgery.

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“…Patients have poor ciliary mucus clearance and develop a thick stagnant mucus layer related to defective CFTR transport. Bacteria can penetrate deep into this layer where the environment is more hypoxic and form biofilms 4 . Perhaps our results would have been more successful if the topical therapy was used during sinus surgery or after thorough endoscopic debridement.…”

Section: Discussionmentioning

confidence: 81%

Manuka honey versus saline sinus irrigation in the treatment of cystic fibrosis‐associated chronic rhinosinusitis: A randomised pilot trial

Lee

Humphreys

Purcell

et al. 2020

Clinical Otolaryngology

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Objectives: Manuka honey attacks biofilms, which contribute to bacterial persistence in cystic fibrosis sinusitis. The primary objective was to determine feasibility of investigating manuka honey as an irrigation treatment for cystic fibrosis sinusitis and secondarily to assess the treatment's preliminary effectiveness. Design: Prospective, single-blinded (clinician only), randomised, parallel two-arm pilot trial. Setting: Tertiary rhinology clinic. Participants: Subjects had recalcitrant cystic fibrosis sinusitis and previous sinus surgery. They received manuka honey or saline sinus irrigations twice daily for 30 days. Main Outcome Measures: Main outcomes were recruitment/retention rates and tolerability. Preliminary effectiveness was assessed based on quality-of-life Sinonasal Outcome Test-22 and Lund-Kennedy endoscopic change scores and post-treatment culture negativity. Results: Over 10 months, 13 subjects were enrolled, and 77% (10/13) were included in the analysis. Manuka honey irrigations were well-tolerated. The quality-of-life change score was clinically significant for manuka honey (−9 [−14,−6]) but not saline (−5 [−9,−1]), although the difference was not statistically significant (P = .29). Lund-Kennedy endoscopic change score was significantly better for manuka honey (−3 [−5,−3]) versus saline (0 [0,0]) (P = .006). There was no difference in post-treatment culture negativity between manuka honey (1/5, 20%) and saline (0/5, 0%) (P = 1.00). Conclusions: Manuka honey irrigations were well tolerated, and retention rates were high. Preliminary data showed that manuka honey achieved a clinically important difference in quality-of-life score and a significantly better endoscopic outcome. Microbiological control was difficult to achieve. A future definitive trial would require multi-institutional recruitment. How to cite this article: Lee VS, Humphreys IM, Purcell PL, Davis GE. Manuka honey versus saline sinus irrigation in the treatment of cystic fibrosis-associated chronic rhinosinusitis: A randomised pilot trial.

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Medical interventions for chronic rhinosinusitis in cystic fibrosis

Cited by 11 publications

References 60 publications

International consensus statement on allergy and rhinology: rhinosinusitis 2021

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Impact of the different mutations in the cystic fibrosis gene in children with chronic rhinosinusitis

Manuka honey versus saline sinus irrigation in the treatment of cystic fibrosis‐associated chronic rhinosinusitis: A randomised pilot trial

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