Chronic rhinosinusitis:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia, Pa. [u.a.]
Saunders
2009
|
| Series: | Immunology and allergy clinics of North America
29,4 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | xvii S., S. 622 - 748 graph. Darst. |
| ISBN: | 9781437712308 1437712304 |
Staff View
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| 490 | 1 | |a Immunology and allergy clinics of North America |v 29,4 | |
| 650 | 4 | |a Chronic Disease | |
| 650 | 4 | |a Respiratory Tract Infections | |
| 650 | 4 | |a Rhinitis | |
| 650 | 4 | |a Rhinitis |x Treatment | |
| 650 | 4 | |a Sinusitis | |
| 650 | 4 | |a Sinusitis |x Treatment | |
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Record in the Search Index
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| adam_text | Chronic Rhinosinusitis
Contents
Foreword: Chronic Sinusitis
xiii
Rafeul
Alam
Preface
xv
Wytske J. Fokkens
Inflammation in Chronic Rhinosinusitis and Nasal Polyposis
621
Cornells M. van Drunen,
Susanne
Reinartz, Jochem Wigman,
and Wytske J. Fokkens
Inflammation is a defining characteristic of chronic rhinosinusitis and nasal
polyposis. Research had traditionally focused on the role of eosinophils in
the pathogenic mechanisms, but recently more attention has been given to
neutrophils and to different
Т
-lymphocyte subtypes. This article summa¬
rizes current understanding, and discusses opportunities and potential pit¬
falls of inflammation-related research.
Epithelium, Cilia, and Mucus: Their Importance in Chronic Rhinosinusitis
631
Marcelo
В.
Antunes,
David A. Gudis, and Noam A. Cohen
Chronic rhinosinusitis is a common disease resulting from inflammation of
the sinonasal
mucosa.
It has long been recognized that patients with
chronic rhinosinusitis have impaired capacity to clear sinonasal secretions.
However, the cause of this pathologic process is not well understood. In
this article the components of mucoclliary clearance, including cilia,
mucus production, and cilia beat frequency, are reviewed and alterations
of the system discussed regarding contribution to the disease process.
Are
Biofilms
the Answer in the Pathophysiology andTreatment
of Chronic Rhinosinusitis?
645
Shaun J. Kilty and Martin
Y. Desrosiers
Chronic rhinosinusitis is a complex heterogeneous disease. Infection in the
form of
biofilm
may have an important, if not central, role in the mainte¬
nance of the recalcitrant inflammation for this increasingly common
chronic disease. Therefore, the importance of understanding the interac¬
tion of
biofilm
disease with the respiratory
mucosa
is imperative. Novel,
minimally invasive methods of testing for the presence of this form of dis¬
ease will need to become clinically accessible in order for equally innova¬
tive therapies to be widely applicable.
Corticosteroid Treatment in Chronic Rhinosinusitis: The Possibilities and the Limits
657
■Joaquim
Mullol, Andres Obando, Laura Pujols, and Isam Alobid
Chronic rhinosinusitis, including nasal polyps, is an inflammatory disease
of the nose and sinuses. The medical treatment, mainly topical
intranasal
viii Contents
and oral corticosteroids, constitutes its first line of therapy. Long-term
treatment with corticosteroid nasal spray reduces inflammation and nasal
polyp size, and improves nasal symptoms such as nasal blockage, rhinor-
rea, and the loss of smell. Corticosteroid
intranasal
drops may be used
when
intranasal
spray fails to demonstrate efficacy. Short courses of
oral steroids are recommended in severe chronic rhinosinusitis with nasal
polyps or when a rapid symptomatic improvement is needed.
Endoscopìe
sinus surgery is only recommended when the medical treatment fails. In-
tranasal corticosteroids should be continued postoperatively. When using
intranasal
corticosteroids, care should be taken in selected populations
such as children, pregnant women, and elderly patients; especially in
those patients with comorbid conditions such as asthma, in which the
overall steroid intake can be high due to the administration of both intrana-
sal and inhaled corticosteroids.
Aspirin Intolerance: Does Desensitization Alter the Course of the Disease?
669
L. Klimek and O. Pfaar
Intolerance to acetylsalicylic acid and to other nonsteroidal anti-inflamma¬
tory drugs was first described in
1922.
The clinical picture reveals a classic
triad of symptoms: aspirin-induced bronchial asthma, aspirin sensitivity,
and chronic rhinosinusitis with nasal polyps. In many cases, nasal polyps
reveal as the first symptom of ASA sensitivity, indicating that the upper air¬
ways are predominantly involved in the pathogenetic process. The empha¬
sis of this article is on the upper airways of ASA-intolerant patients.
Imbalance of the eicosanoids leukotrienes and prostaglandins might be
the pathophysiologic key to the disease. The patient s history and chal¬
lenge tests with lysine-aspirin are the diagnostic tools of choice. Apart
from surgical or
pharmacologie
therapy, ASA-desensitization therapy is
the treatment of choice. Various desensitization protocols and routes of
administration are discussed.
Fungus: A Role in Pathophysiology of Chronic Rhinosinusitis, Disease Modifier,
A Treatment Target, or No Role at All?
677
Wytske J. Fokkens, Fenna
Ebbens,
and Cornells M. van Drunen
Fungal spores, due to their ubiquitous nature, are continuously inhaled
and deposited on the airway
mucosa.
This article focuses on the po¬
tential role of fungi in chronic rhinosinusitis (CRS). Five forms of fungal
disease affecting the nose and
paranasal
sinuses have been recog¬
nized:
(1)
acute invasive fungal rhinosinusitis (including rhinocerebral
mucormycosis),
(2)
chronic invasive fungal rhinosinusitis,
(3)
granuloma-
tous invasive fungal rhinosinusitis,
(4)
fungal ball (mycetoma), and
(5)
noninvasive (allergic) fungal rhinosinusitis. There are several potential
deficits in the innate and potentially also acquired immunity of CRS pa¬
tients that might reduce or change their ability to react to fungi. There
are not many arguments to suggest a causative role for fungi in CRS
with or without nasal polyps. However, due to the intrinsic or induced
change in immunity of CRS patients, fungi might have a disease-
modifying role.
Contents ix
Anti-Inflammatory Effects of Macrolides: Applications in Chronic Rhinosinusitis
689
Richard J. Harvey, Ben D. Wailwork, and Valerie J. Lund
The anti-inflammatory effects of macrolides are significant. The clinical im¬
pact on diffuse panbronchiolitis (DPB) has improved
1
0-year survival from
12%
to more than
90%
for these patients. The immunomodulatory activity
of macrolides has been a source of mechanistic research as well as clinical
research in non-DPB inflammatory airway disease. Suppression of neutro-
philic inflammation of the airways has been demonstrated as the most
robust immunomodulatory response from
14-
and 15-membered ring
macrolides. The inhibition of transcription factors, mainly nuclear factor-
кВ
and activator protein
1,
from alterations in intracellular cell signaling
drives this mechanism. The suppression of interleukin-8 to a range of en¬
dogenous and exogenous challenges characterizes the alterations to cyto-
kine production. The inflammatory mechanisms of chronic rhinosinusitis
(CRS) have been a major non-DPB focus. Macrolides have been trialed
in more than
14
prospective trials and are the focus of numerous research
projects. Evidence for a strong clinical effect in CRS is mounting, but re¬
sults may be tempered by researchers inability to characterize the disease
process. Eosinophilic dominated CRS is unlikely to respond, based on cur¬
rent research understanding and data from clinical trials. This article dis¬
cusses the current concepts of macrolides and their application in the
management of CRS.
Chronic Rhinosinusitis in Children: What are the Treatment Options?
705
Arthur W. Wu, Nina
L
Shapiro, and Neil Bhattacharyya
Pediatric
chronic rhinosinusitis, a common problem, has been found to
have a severe impact on the quality of life. As in the case with adult chronic
rhinosinusitis,
pediatric
chronic rhinosinusitis is difficult to treat, with resul¬
tant frequent recurrences and failures. Controversy has existed in the
treatment of chronic rhinosinusitis in children, mirroring the controversy
over the exact etiology of this disorder. Chronic rhinosinusitis may indeed
be a group of diseases with similar presenting features. This article at¬
tempts to delineate treatment options that are both safe and effective for
pediatric
chronic rhinosinusitis.
When Surgery, Antibiotics, and Steroids Fail to Resolve Chronic Rhinosinusitis
719
Berryl/n J. Ferguson, Bradley A. Otto, and Harsh/ta Pant
This article examines the modalities in the treatment of chronic rhinosinu¬
sitis (CRS). A correct diagnosis is the first requirement in the successful
management of CRS. CRS-directed therapy might fail if the actual cause
of symptoms is nonsinogenic. Nasal endoscopy and sinus computed to¬
mography are the primary modalities used in the diagnosis of sinusitis. Al¬
lergy and gastroesophageal reflux, may not directly cause sinusitis, but
they frequently mimic the symptoms of sinusitis. Therapy can include
avoidance of allergens and desensitization in the former and
antireflux
therapy in the latter. Underlying systemic causes of refractory sinusitis in¬
clude immunodeficiency and systemic granulomatous and eosinophilic
syndromes. Correct diagnosis is essential to directed therapy. Patients
Contents
with aspirin exacerbated respiratory disease may benefit from aspirin de-
sensitization. Optimization of mucociliary clearance can be augmented
with nasal
lavage
and mucolytics. Additional nonsteroidal antiinflammatory
modalities include use of the leukotriene modulators, montelukast and zi-
leuton. Patients with elevated IgE may benefit from omallzumab (anti-lgE);
however, cost constraints restrict use to those patients who have severe
asthma. This article also includes management strategies beyond the
usual antibiotics, steroids, and sinus surgery. Once immunodeficiency
and confounding local mimics of sinusitis are addressed, additional inter¬
ventions should be tried separately initially to assess the individual pa¬
tient s response to therapy.
Rhinosinusitis and the Lower Airways
733
Peter W.
Hellings
and Greet Hens
The interaction between upper and lower airway disease has been recog¬
nized for centuries, with recent studies showing a direct link between up¬
per and airway inflammation in allergic patients. The mechanisms
underlying the interaction between nasal and bronchial inflammation
have primarily been studied in allergic disease, showing systemic immune
activation after allergen inhalation, induction of inflammation at a distance,
and a negative impact of nasal inflammation on bronchial homeostasis.
Therefore, allergic rhinitis and asthma are considered part of the global air¬
way allergy syndrome. Besides allergy, other inflammatory conditions
such as the common cold, acute rhinosinusitis, and chronic rhinosinusitis
are associated with lower airway disease. Chronic sinus disease with or
without nasal polyps are frequently found in patients with asthma and
chronic obstructive pulmonary disease with improvement of bronchial
symptoms and respiratory function by adequate medical and surgical ther¬
apy for rhinosinusitis. The resolution of sinonasal inflammation and hence
sinonasal functions by medical or surgical treatment is considered respon¬
sible for the beneficial effect of treatment on bronchial disease. This article
aims at providing a comprehensive overview of the current knowledge on
the interaction between common cold, acute and chronic rhinosinusitis,
and lower airway biology.
Index
741
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| spelling | Chronic rhinosinusitis Guest ed.: Wytske J. Fokkens Philadelphia, Pa. [u.a.] Saunders 2009 xvii S., S. 622 - 748 graph. Darst. txt rdacontent n rdamedia nc rdacarrier Immunology and allergy clinics of North America 29,4 Chronic Disease Respiratory Tract Infections Rhinitis Rhinitis Treatment Sinusitis Sinusitis Treatment Chronische Krankheit (DE-588)4010176-9 gnd rswk-swf Nasennebenhöhlenentzündung (DE-588)4171186-5 gnd rswk-swf Nasennebenhöhlenentzündung (DE-588)4171186-5 s Chronische Krankheit (DE-588)4010176-9 s DE-604 Fokkens, Wytske J. Sonstige (DE-588)140148191 oth Immunology and allergy clinics of North America 29,4 (DE-604)BV000645505 29,4 Digitalisierung UB Regensburg application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=018770421&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Chronic rhinosinusitis Immunology and allergy clinics of North America Chronic Disease Respiratory Tract Infections Rhinitis Rhinitis Treatment Sinusitis Sinusitis Treatment Chronische Krankheit (DE-588)4010176-9 gnd Nasennebenhöhlenentzündung (DE-588)4171186-5 gnd |
| subject_GND | (DE-588)4010176-9 (DE-588)4171186-5 |
| title | Chronic rhinosinusitis |
| title_auth | Chronic rhinosinusitis |
| title_exact_search | Chronic rhinosinusitis |
| title_full | Chronic rhinosinusitis Guest ed.: Wytske J. Fokkens |
| title_fullStr | Chronic rhinosinusitis Guest ed.: Wytske J. Fokkens |
| title_full_unstemmed | Chronic rhinosinusitis Guest ed.: Wytske J. Fokkens |
| title_short | Chronic rhinosinusitis |
| title_sort | chronic rhinosinusitis |
| topic | Chronic Disease Respiratory Tract Infections Rhinitis Rhinitis Treatment Sinusitis Sinusitis Treatment Chronische Krankheit (DE-588)4010176-9 gnd Nasennebenhöhlenentzündung (DE-588)4171186-5 gnd |
| topic_facet | Chronic Disease Respiratory Tract Infections Rhinitis Rhinitis Treatment Sinusitis Sinusitis Treatment Chronische Krankheit Nasennebenhöhlenentzündung |
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