Multimodality topical therapy for refractory chronic rhinosinusitis: Our experience in thirteen patients with and twelve patients without nasal polyps

Shikani, Alan H.; Alqudah,; Shikani, Henry J.; Cope, Emily K.; Kirk, Natalie M.; Bergstedt, Dylan T.; Basaraba, Randall J.; Leid, Jeff G.

doi:10.1111/coa.12096

Cited by 12 publications

(15 citation statements)

References 10 publications

(13 reference statements)

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“…Shikani et al 727 randomized 17 patients in a small unblinded trial to a 6-week course of either a combination of nebulized mometasone and culture-directed antibiotics plus weekly endoscopic-guided placement of mometasone and antibiotic-impregnated hydroxyethylcellulose gel or "standard treatment" of oral culture-directed antibiotics and mometasone sprays. Both treatment groups showed equivalent effects, making it difficult to assess the relative impact of corticosteroids vs the antibiotics from this treatment regime, however.…”

Section: Viie1 Crs Management: Saline Irrigationmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

554

888

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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Section: Viie1 Crs Management: Saline Irrigationmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

554

888

View full text Add to dashboard Cite

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“…Both drugs were nebulized concomitantly in two studies from the same team. An improvement was observed at short and long term with the nebulization and it was mainly related to the presence of polyps (18) . The effect disappeared 4 weeks after nasal spray delivery (18) .…”

Section: Effects On Symptomsmentioning

confidence: 89%

“…After duplicates removal, 506 articles were identified and screened. At the end of the process, eight RCT were included in the systematic review (13)(14)(15)(16)(17)(18)(19)(20) . (19) , Total Nasal Symptom Score (15,24) , Lund-Kennedy Score (18) and Sino-Nasal Outcome Test (SNOT-20) (17) .…”

Section: Study Selectionmentioning

confidence: 99%

“…Nasal secretions were obtained in one study and cultured when any signs of purulence were present (22) . Endoscopic evaluations of polyps were performed by the Lund-Mackay score (15) , the Kupferberg grades (15) and the Lund-Kennedy Endoscopic scale (18) .…”

Section: Study Selectionmentioning

confidence: 99%

“…Age ranged from 18 to 89 years. Five studies included patients with previous endoscopic surgery (13,15,16,18,19) . Naso-sinusal polyps were included in 4 studies (13,17,20,21) but only one study evaluated their sizes (20) .…”

Section: Population and Inclusion Criteriamentioning

confidence: 99%

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Clinical efficacy of intranasal drug delivery by nebulization in chronic rhinosinusitis: a systematic review

Reychler

Domachowski

Latiers

et al. 2018

Rhin

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Background: Treatment of chronic rhinosinusitis (CRS) aims to treat the underlying inflammation or infection. Although the optimal modality of administration remains controversial, inhalation route is usually preferred. The aim of this systematic review was to summarize the efficacy of intranasal corticoisteroids or antibiotics delivery by nebulization on symptoms, histology, endoscopy scores, nasal obstruction, clinical outcomes and quality of life in CRS.Method: This systematic review followed the PRISMA guidelines. Randomized controlled, comparative and cohort studies evaluating effects of treatment by nebulization in sinusitis were identified and reviewed from two databases (PubMed and Scopus). Two reviewers independently assessed study quality and reviewed the selected studies.Results: 600 references were retrieved and 12 studies evaluating 377 patients were included in the systematic review. Different devices were used. Efficacy of nasal delivery by nebulization was systematically observed on symptoms and size of polyps and frequently on inflammatory parameters in all studies. The presence of polyps improved the efficacy of the nebulization. This way of delivery appears not convincing regarding antibiotics. Few side effects were noted in the retrieved studies and only for nebulized antibiotics. Conclusions:This systematic review highlighted that based on the present literature nebulization is not better than nasal spray to the delivery of corticosteroids due to the positive results on symptoms, endoscopic appearance and histological outcomes. For antibiotics delivery, the nebulization is not of added value.

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Sinonasal and gastrointestinal bacterial composition and abundance are stable after 1 week of once‐daily oral antibiotic treatment for chronic rhinosinusitis

Siu

Mackenzie

Klingler³

et al. 2021

Int Forum Allergy Rhinol

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Background: Despite the widespread prescription of antibiotics for the treatment of chronic rhinosinusitis (CRS), their efficacy remains uncertain. Limited penetration of systemic antibiotics into the sinonasal mucosa has been reported previously by this group. This study aimed to investigate the short-term effects of antibiotics on the sinus and gut microbiota as well as any relationships these had with drug distribution.Methods: Thirty subjects undergoing functional endoscopic sinus surgery for CRS were randomized to one of three groups: (1) doxycycline (100 mg daily for 7 days); (2) roxithromycin (300 mg daily for 7 days); and (3) control (no antibiotics given). Sinonasal and stool samples collected before and after treatment were analyzed using 16S ribosomal RNA (rRNA) gene-targeted amplicon sequencing and Droplet Digital polymerase chain reaction (PCR) for bacterial community composition and the quantification of bacterial DNA, respectively.Results: There were no significant major bacterial community shifts or changes to bacterial diversity and load following the treatment period in all patient groups. Non-significant trend reductions were observed in gut microbial diversity with antibiotics. For the roxithromycin group, sinonasal bacterial diversity was negatively correlated with serum drug levels and reduced overall compared to controls (p < 0.05). The relative abundance of Staphylococcus ASV129 in sinonasal samples reduced with increasing mucus doxycycline levels (p = 0.01). Conclusion:Antibiotic prescription for CRS should be further investigated because of preliminary evidence of poor sinonasal drug penetration, unproven efficacy, and the potential impact of dysbiosis in the sinuses and off-target sites. Further studies should consider distinguishing the presence of DNA from viable and nonviable bacteria.

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Multimodality topical therapy for refractory chronic rhinosinusitis: Our experience in thirteen patients with and twelve patients without nasal polyps

Cited by 12 publications

References 10 publications

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Clinical efficacy of intranasal drug delivery by nebulization in chronic rhinosinusitis: a systematic review

Sinonasal and gastrointestinal bacterial composition and abundance are stable after 1 week of once‐daily oral antibiotic treatment for chronic rhinosinusitis

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