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Timothy L. Smith - One of the best experts on this subject based on the ideXlab platform.

  • Chronic Rhinosinusitis and sleep: a contemporary review
    International forum of allergy & rhinology, 2013
    Co-Authors: Jeremiah A. Alt, Timothy L. Smith
    Abstract:

    Background Patients with Chronic Rhinosinusitis (CRS) exhibit centrally mediated behavioral changes commonly referred to as “sickness behavior.” Sleep alteration is a component of sickness behavior which is estimated to affect up to 70 million patients annually. Patients with CRS have poor sleep quality, and little is known about the underlying etiology and pathophysiology. This narrative review aims to further organize and present the current knowledge associating sleep and CRS. Methods A literature search was conducted of the OVID MEDLINE database using key search words including: “Chronic Rhinosinusitis,” “sleep,” “sleep disorders,” and “sleep dysfunction.” Additional keywords “nasal obstruction,” “nasal polyp,” and “fatigue” were identified and used to further delineate relevant articles. Results The articles that specifically addressed sleep and CRS were dissected and presented as follows: (1) Chronic Rhinosinusitis and sleep; (2) Chronic Rhinosinusitis and fatigue; (3) Chronic Rhinosinusitis, nasal obstruction, and sleep; and (4) pathophysiology of sleep in Chronic Rhinosinusitis (cytokines in both sleep and Chronic Rhinosinusitis and their association to the neuroimmune biology of Chronic Rhinosinusitis). Conclusion Patients with CRS have sleep dysfunction that is associated with their disease severity and overall quality of life. The etiology of sleep dysfunction in CRS is most likely multifactorial. Increasing evidence suggests sleep dysfunction in patients with CRS is partly due to the inflammatory disease process, and sleep physiology in patients with CRS may be actively regulated by the inflammatory component of the disease.

  • Miniseminar: Chronic Rhinosinusitis: The impact of allergic rhinitis management
    Otolaryngology–Head and Neck Surgery, 2004
    Co-Authors: Bryan D. Leatherman, Berrylin J. Ferguson, Bradley F. Marple, John H. Krouse, Timothy L. Smith
    Abstract:

    Abstract Chronic Rhinosinusitis is a common medical condition encountered throughout the world. Allergic rhinitis has a high prevalence in the general population and is a condition that affects up to half of patients with Chronic Rhinosinusitis. As the recognized experts in the care of medical problems affecting the nose, otolaryngologists spend a significant portion of their professional time evaluating and managing Chronic Rhinosinusitis. The current miniseminar will investigate the impact of allergic rhinitis on the pathophysiology and optimal management of Chronic Rhinosinusitis. A variety of teaching methods, including lectures, slide presentations, interactive discussions, and reviews of recent literature will be utilized to help the attendee develop a science-based approach to incorporate the management of allergic rhinitis into the treatment of patients with Chronic Rhinosinusitis. First, the updated definition of Chronic Rhinosinusitis, as recently reported by the Chronic Rhinosinusitis Task Force, will be reviewed, emphasizing the clinical and research applications of the definition. The epidemiologies of the 2 conditions will then be discussed, exploring the role of allergic rhinitis in the development and propagation of Chronic Rhinosinusitis. Information will also be presented about possible etiologies of the increasing incidence of allergic rhinitis. After focusing on the relationship of allergic rhinitis and Chronic Rhinosinusitis, the miniseminar will progress to a discussion on the role of evaluation and management of allergic rhinitis in the treatment of Chronic sinusitis. Particular attention will be given to the timing of allergic rhinitis management for patients approaching the need for surgical intervention. This portion will discuss the use of optimal allergy identification and treatment to help avoid the need for primary or repeat surgery, and to improve the long-term outcomes in patients who undergo surgical treatment. The treatments discussed will include allergen avoidance, the latest topical and systemic pharmacotherapy options, and immunotherapy. The last portion of the miniseminar will review the outcomes data published in the recent literature to investigate the value of allergic rhinitis management in the treatment of Chronic Rhinosinusitis. At the conclusion of the miniseminar, the attendee will have received a thorough explanation of the impact of allergic rhinitis on the pathogenesis and treatment of Chronic Rhinosinusitis.

Claire Hopkins - One of the best experts on this subject based on the ideXlab platform.

  • Chronic Rhinosinusitis with Nasal Polyps
    The New England journal of medicine, 2019
    Co-Authors: Claire Hopkins
    Abstract:

    Key Clinical Points Chronic Rhinosinusitis with Nasal Polyps Chronic Rhinosinusitis with nasal polyps typically manifests as nasal obstruction, reduction in sense of smell, nasal discharge, and sle...

  • Chronic Rhinosinusitis
    InnovAiT: Education and inspiration for general practice, 2019
    Co-Authors: Emma Dickson, Claire Hopkins
    Abstract:

    Chronic Rhinosinusitis affects 10.9% of the UK adult population, affecting quality of life and with significant economic cost. The aetiology is unknown, and diagnosis can present challenges. It is characterised by inflammation of the nose and paranasal sinuses that leads to nasal obstruction, discharge, facial pain or pressure and loss of smell, persisting for more than 3 months. Nasal cavity examination aids diagnosis. It is subdivided into Chronic Rhinosinusitis with and without nasal polyposis. Nasal corticosteroids and saline irrigation make up current baseline management in primary care, with referral to ENT recommended for those with persistent symptoms. Physicians should be alert to persistent unilateral symptoms and the risk of sino-nasal tumours.

  • Outcome Measures in Chronic Rhinosinusitis
    Current Otorhinolaryngology Reports, 2018
    Co-Authors: Fiona Ting, Claire Hopkins
    Abstract:

    Purpose of Review Chronic Rhinosinusitis (CRS) has a significant impact on the quality of life of patients and is a high cost burden to both society and patients. There is a variety of objective and subjective outcome measures that exist to assess the effectiveness of interventions. We aim to review current outcome measures available. Recent Findings Traditionally, results have focused on objective measures, however, subjective outcome measures are gaining traction as being more important. Outcome measures in Chronic Rhinosinusitis are currently heterogeneous, thus limiting the impact of meta-analysis of past trial results. The development of a core outcome set may standardize the reporting of outcomes in Chronic Rhinosinusitis. Summary We outline the outcome measures currently available and discuss a proposed core outcome set that may facilitate further value of research on interventions for CRS in adults.

Martin Desrosiers - One of the best experts on this subject based on the ideXlab platform.

  • The Neutrophil and Chronic Rhinosinusitis
    Nasal Physiology and Pathophysiology of Nasal Disorders, 2013
    Co-Authors: Martin Desrosiers, Shaun Kilty
    Abstract:

    Descriptions of Chronic Rhinosinusitis (CRS) are frequently characterized by references to the eosinophilia present in CRS and in allergic diseases. However, the focus in assessment of inflammation in Chronic Rhinosinusitis is increasingly shifting away from Th2-dominated mechanisms to a consideration of the contributions by Th1 and Th17 mechanisms as well. This has led to an increased focus of interest in assessment of lymphocyte subpopulations and of cytokines associated with these inflammatory pathways.

  • Algorithms for Management of Chronic Rhinosinusitis
    Otolaryngologic clinics of North America, 2005
    Co-Authors: Mohammed M. Nagi, Martin Desrosiers
    Abstract:

    Chronic Rhinosinusitis poses numerous challenges for the practitioner. This article presents strategies for making the diagnosis and managing Chronic Rhinosinusitis with and without nasal polyposis, and for assessing and managing disease persisting or recur-ring after endoscopic sinus surgery.

  • Refractory Chronic Rhinosinusitis: pathophysiology and management of Chronic Rhinosinusitis persisting after endoscopic sinus surgery
    Current Allergy and Asthma Reports, 2004
    Co-Authors: Martin Desrosiers
    Abstract:

    Refractory Chronic Rhinosinusitis (RCRS) is defined as persistence of signs and symptoms of Chronic Rhinosinusitis, despite technically adequate endoscopic sinus surgery. Rather than a simple, prolonged bout of acute sinusitis, it instead appears to be secondary to an interaction of a susceptible host with the outside environment. Inflammatory responses to colonizing bacteria appear to be responsible for a significant portion of the pathophysiology. Reduction of bacterial load and inflammation of the mucosa play an important role in controlling the disease. Novel treatment strategies, with an emphasis on topical therapies, seem to offer optimal management. In this review, current concepts on the pathophysiology and current therapies available for RCRS are outlined. A practical management strategy based on the author’s personal experience draws upon these concepts, and is detailed in this review of an unusual topic.

Saul Frenkiel - One of the best experts on this subject based on the ideXlab platform.

  • Advances in the Surgical Management of Chronic Rhinosinusitis
    Allergy Asthma & Clinical Immunology, 2004
    Co-Authors: Erin D Wright, Saul Frenkiel
    Abstract:

    The surgical management of Chronic Rhinosinusitis has evolved considerably in the last decade. We currently have a more refined understanding of the various disease entities that make up the generic diagnosis of Chronic Rhinosinusitis. This has led to the development of more sophisticated medical and surgical therapy for the different entities. Failure of maximal medical therapy leads to the consideration of surgical intervention with the general intent of improving the patient's quality of life. Recent technical innovations such as mucosa-preserving instrumentation and image guidance systems for intraoperative localization have given surgeons increased confidence and enabled more complete and effective surgical management of Chronic Rhinosinusitis, particularly in revision surgeries or in the presence of distorted landmarks. Improved packing materials and refinement of postoperative care are active areas of investigation and innovation that, it is hoped, will also translate into improved patient care.

James A. Stankiewicz - One of the best experts on this subject based on the ideXlab platform.

  • Nasal amphotericin irrigation in Chronic Rhinosinusitis.
    Current opinion in otolaryngology & head and neck surgery, 2008
    Co-Authors: James A. Stankiewicz, Brandon K Musgrave, Joseph M. Scianna
    Abstract:

    PURPOSE OF REVIEW: To review the literature on the use of amphotericin irrigation for the treatment of Chronic Rhinosinusitis. RECENT FINDINGS: Although the etiology of acute Rhinosinusitis is usually bacterial in nature, the exact etiology of Chronic Rhinosinusitis is unclear. Recent literature reports pointed to fungal colonization as a likely pathogenesis. It was hypothesized that a nonallergic eosinophilic immunoglobulin response to these fungi by the host was the cause of the symptoms, not a fungal invasion into the mucosa. The paper reviews the most recent articles investigating the use of amphotericin irrigation, as well as sprays and oral medications, of the nasal and sinus mucosa in patients with Chronic Rhinosinusitis. SUMMARY: The use of amphotericin for patients with Chronic Rhinosinusitis is not substantiated by the majority of publications. Although some studies found improvement on radiographic images, the symptoms of the disorder were not improved even with fungal eradication. Further studies need to be carried out to determine if changes in dosage, treatment time or route of administration could improve results.

  • Endoscopic and imaging techniques in the diagnosis of Chronic Rhinosinusitis.
    Current allergy and asthma reports, 2003
    Co-Authors: James A. Stankiewicz
    Abstract:

    The definition of Chronic Rhinosinusitis globally applies to any patient who has nasal and/or sinus inflammatory disease for a period of more than 3 months, provided the patient has particular signs and symptoms. However, to treat Chronic Rhinosinusitis appropriately, specific etiologies must be diagnostically ruled in or out. Chronic Rhinosinusitis can be complex, because there are several factors involved in its causation. Endoscopy and imaging can play a role in helping to lead to a more specific diagnosis, allowing more targeted treatment.

  • Nasal endoscopy and the definition and diagnosis of Chronic Rhinosinusitis
    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2002
    Co-Authors: James A. Stankiewicz, James M. Chow
    Abstract:

    Objectives: Although endoscopy has been shown by a few authors to be a valuable tool for the diagnosis of Chronic Rhinosinusitis, its true role in the evaluation of the patient with Chronic Rhinosinusitis has not been elucidated. The current definition of Chronic Rhinosinusitis is a symptom-based definition, and objective testing such as endoscopy or computed tomography (CT) is not included. However, the current treatment paradigm for Chronic Rhinosinusitis is dependent on the definition for diagnosis. Patients are treated with 4 weeks of antibiotics and decongestant/antihistamines/steroids based on the definition. This study aims to evaluate in a prospective fashion the place of endoscopy in the diagnosis of Chronic Rhinosinusitis. Study Design: A group of 78 patients meeting the definition of Chronic Rhinosinusitis were subjected to same-day endoscopy and CT scanning. Results: Seventeen (22%) of 78 patients had positive endoscopic and CT results. There were 20 (26%) of 78 patients with negative endoscopic and positive CT results. Six (8%) patients had positive endoscopic and negative CT results, and 35 (45%) had negative endoscopic and negative CT results. Overall, 37 (47%) patients had positive CT results, and 41 (53%) patients had negative CT results. Endoscopy showing the presence of purulence, nasal polyps, or watery congested mucosa correlated well with CT results. Negative endoscopy correlated with CT results in 65% of patients. Conclusion: The use of endoscopy to corroborate the diagnosis in nonpolypoid or nonpurulent Rhinosinusitis in previously unoperated patients is questioned. Patients who meet the subjective definition of Chronic Rhinosinusitis should have a high degree of sensitivity and specificity with endoscopy or CT. The fact this is not the case questions the accuracy of the definition and the treatment paradigm. Significance: According to this study, positive endoscopic results correlated well with CT, and negative endoscopic results correlated in 71% of patients with negative CT results. (Otolaryngol Head Neck Surg 2002;126:623-627.)