Chronic Rhinosinusitis: The mucosal concept

Description

Chronic rhinosinusitis (CRS) is one of the most common health care complaints, with the prevalence of 5-12% worldwide. This book aims to present the new findings in mechanism, diagnosis and management of this widespread condition to clinical practitioners. All practical information about CRS is compiled; therefore busy clinicians would not have to perform exhaustive literature studies to diagnose CRS. This book firstly presents the advances in the understanding of epidemiology, genetics, mechanisms, phenotypes, and immunology of this disorder. In the following chapters, details in clinical diagnosis of CRS are summarized, especially clinical characteristics in paediatric CRS. Later chapters introduce medical, surgical, and innovative treatments of CRS, with brief case studies. The role of allergies, asthma, allergic fungal rhinosinusitis, and systemic diseases are also discussed. With the illustrative figures, this book is a comprehensive and quick reference to otolaryngologists, paediatricians, family care physicians, allergists, professional clinical staff, and medical students. Preface Contents Contributors 1: Introduction 2: Epidemiology 2.1 Introduction 2.2 Variations in the Worldwide Prevalence of CRS 2.3 Risk Factors for CRS 2.4 Translation into Future Daily Practice References 3: Quality of Life and Psychological Burden 3.1 Introduction 3.2 Psychometric Properties 3.2.1 Validity 3.2.2 Reliability 3.2.2.1 Test–Retest 3.2.2.2 Internal Consistency 3.2.3 Responsiveness 3.3 Patient Reported Outcomes (PRO) in CRS 3.3.1 Generic Questionnaires 3.3.2 Specific Questionnaires 3.3.2.1 SNOT-22: A Measure of Severity 3.3.2.2 SNOT-22: A Measure of Response to Medical Treatment 3.3.2.3 SNOT-22: A Measure of Response to Surgical Treatment 3.3.2.4 SNOT-22: A Measure of Response to Biologic Treatment 3.4 Translation into the Future Daily Practice References 4: Genetics and Epigenetics 4.1 Heritability of CRS 4.2 Genetics of CRS 4.2.1 Candidate Gene Association Studies of CRS 4.2.2 Genome-Wide Association Studies of CRS 4.3 Epigenetics of CRS 4.3.1 DNA Methylation in CRS 4.3.2 Histone Modifications in CRS 4.3.3 Noncoding RNA in CRS 4.4 Translation into Future Daily Practice References 5: Involvement of the Immune System in Airways Disease 5.1 Conclusions References 6: T Cells and Group 2 Innate Lymphoid Cells 2 6.1 Introduction 6.2 Inflammatory Endotypes of CRS 6.3 Type 2 Cytokine-Induced Inflammation in Nasal Polyps 6.4 Th2 Cells 6.5 ILC2s 6.6 ILC2-Th2 Interaction in NPs 6.7 Conclusion and Translation into Future Daily Practice References 7: B Cells and Plasma Cells 7.1 Introduction 7.2 B Cell 7.2.1 B Cell Development 7.2.2 B Cell Activation-Response to Antigen 7.2.3 Role of B Cells and Plasma Cells in CRS 7.3 CRSsNP 7.4 CRSwNP 7.4.1 Elevated B Cell Population in CRSwNP 7.4.2 Activation Mechanisms 7.5 Antibodies and Class Switching 7.5.1 Class Switching 7.5.2 Autoreactive Antibodies 7.5.3 IgE to Staphylococcus aureus 7.6 Conclusion References B Cell Glossary of Terms 8: Eosinophils 8.1 Clinical Manifestations and Diagnosis of Eosinophilic CRS 8.2 Eosinophil Development, Chemotaxis, and Activation in CRS 8.3 Functions of Eosinophils in CRS 8.3.1 Effector Functions 8.3.2 Extracellular Trap Formation and Charcot–Leyden Crystal Deposition 8.3.3 Other Roles of Eosinophils 8.4 Treatment Considerations 8.5 Translation into Future Daily Practice References 9: Neutrophils 9.1 Clinical Manifestations of Neutrophilia in CRS 9.2 Neutrophil Recruitment and Activation in CRS 9.3 Functions of Neutrophils in CRS 9.4 Antibacterial Defense 9.5 Immune Regulation and Tissue Remodeling 9.6 Therapeutic Implications 9.7 Translation into Future Daily Practice References 10: Remodeling Features 10.1 Introduction 10.2 The Features of Tissue Remodeling in Different Types of CRS 10.3 The Mechanism of Tissue Remodeling in CRS 10.4 Correlation Between Tissue Remodeling and Inflammation Patterns in CRS 10.5 Conclusion References 11: Nasal Mucociliary Clearance 11.1 Introduction 11.2 Components of Mucociliary Clearance 11.3 Measurement of Mucociliary Clearance 11.4 Assessment of Ciliary Structure and Function 11.5 Mucociliary Clearance in Chronic Rhinosinusitis 11.6 Summary References 12: Sinonasal Epithelium 12.1 Introduction 12.2 Multiple Epithelial Barrier Layers and Their Functions 12.2.1 The Supraepithelial Barrier 12.2.2 The Epithelial Cilia 12.2.3 Junctional Proteins and the Tightness of the Epithelial Cells 12.3 Interaction of the Epithelium and the Adaptive Immune System 12.3.1 Epithelial Cytokines 12.3.2 The Link Between Layers of Epithelial Barrier 12.3.3 Translation of the Mechanistic Knowledge into Daily Practice References 13: Microbiology 13.1 Introduction 13.2 Bacterial Microbiota in CRS 13.3 Virome 13.4 Mycobiome 13.5 Interplay Between the Immune System and Microbes 13.6 Conclusions 13.7 Implications of Microbiome Equilibrium for Medical Practice References 14: Staphylococcus aureus and Its Proteins 14.1 Interaction Between S. aureus and the Host 14.2 Colonization 14.3 Superantigens 14.4 S. aureus Proteases 14.5 δ-Toxin 14.6 Why Does S. aureus Drive Allergy? 14.7 Translation into Future Daily Practice References 15: Viruses 15.1 Introduction 15.1.1 Epidemiology 15.2 Mechanisms 15.3 Antiviral Therapy 15.4 Translation into Future Daily Practice References 16: Environmental and Allergic Triggers 16.1 Introduction 16.2 Environmental Triggers of CRS 16.3 Allergic Triggers of CRS 16.4 Conclusions References 17: Dysfunctional Immune Regulatory System 17.1 Introduction 17.2 Immune Regulatory System 17.2.1 Congenital Immune System in Nasal Mucosa 17.2.2 Acquired Immune System in Nasal Mucosa 17.3 Dysfunctional Immune Regulation in Rhinosinusitis 17.3.1 Epithelial Dysfunction in CRS 17.3.2 Innate and Adaptive Inflammatory Responses Underlying the Pathogenesis of CRS 17.3.3 Eosinophilia and CRS 17.4 Restoration of Immune Regulation in Rhinosinusitis 17.4.1 The Regulatory Mechanism of Immune Dysregulation of CRS by Immunomodulators 17.4.2 The Regulatory Mechanism of Immune Dysregulation of CRS by Antibacterial Drugs 17.4.3 The Regulatory Mechanism of Antihistamine and Leukotriene Receptor Antagonism on Immune Dysregulation of CRS 17.4.4 The Regulatory Mechanism of Saline Irrigations on Immune Dysregulation of CRS 17.5 Conclusion References 18: Chronic Rhinosinusitis with and Without Nasal Polyps 18.1 Introduction 18.2 Definition and Epidemiology 18.3 History and Physical Examination 18.3.1 History 18.3.2 Nasal Endoscopy 18.3.3 Imaging 18.4 Phenotypes of CRS 18.5 CRS Without Nasal Polyposis (CRSsNP) 18.6 CRS with Nasal Polyposis (CRSwNP) 18.7 Exogenous Factors in CRSwNP 18.7.1 Fungus 18.7.2 Bacteria and the Microbiome 18.7.3 Staphylococcus aureus Enterotoxin 18.7.4 Biofilms 18.7.5 Host Factors in CRSwNP 18.7.6 Immune Barrier Function 18.7.7 Eicosanoid Hypothesis 18.8 Comprehensive Overview of CRSwNP 18.9 Summary References 19: Allergic Fungal Sinusitis 19.1 Introduction 19.2 Pathophysiology 19.3 Epidemiology and Microbiology 19.4 Clinical Presentation 19.5 Diagnostic Criteria 19.5.1 Eosinophilic Mucin 19.6 Radiologic Features 19.7 Treatment 19.8 Prognosis 19.9 Unanswered Questions About AFS References 20: Type 2 Immune Reactions and Consequences References 21: Regional Difference References 22: Multimorbidities 22.1 Introduction 22.2 Allergic Rhinitis 22.3 Asthma 22.4 Non-Steroidal Anti-Inflammatory Drug (NSAID): Exacerbated Respiratory Disease 22.5 Gastroesophageal Reflux 22.6 Chronic Pulmonary Obstructive Disease 22.7 Bronchiectasis 22.8 Translation into Future Daily Practice References 23: Clinical Diagnosis and Phenotypes 23.1 Aspirin-Exacerbated Respiratory Disease 23.1.1 Clinical Presentation and Diagnosis 23.2 Allergic Fungal Rhinosinusitis 23.2.1 Clinical Presentation and Diagnosis 23.3 Eosinophilic Granulomatosis with Polyangiitis 23.3.1 Clinical Presentation and Diagnosis 23.4 Cystic Fibrosis 23.4.1 Clinical Presentation and Diagnosis 23.5 Odontogenic Rhinosinusitis 23.5.1 Clinical Presentation and Diagnosis 23.6 Immunodeficiency 23.6.1 Clinical Presentation and Diagnosis 23.7 Primary Ciliary Dyskinesia 23.7.1 Clinical Presentation and Diagnosis 23.8 Conclusion References 24: Imaging the Anatomic Landmarks for Safe FESS 24.1 Introduction 24.2 The Use of Imaging to Provide a “Roadmap” for FESS 24.3 CT Data Acquisition and Technique 24.4 The CT Evaluation of Nasal and Paranasal Sinus Anatomy for FESS, According to the Specific Surgical Plan, Which Follows the Four Lamellae Principle 24.5 Uncinectomy 24.6 Anterior Ethmoidectomy 24.7 Ethmoid Skull Base Height 24.8 Sphenoidotomy 24.9 Frontal Recess/Sinusotomy 24.10 Conclusion References 25: Olfactory Function Assessment 25.1 Introduction 25.2 Subjective Smell Tests 25.2.1 Screening Tests 25.2.2 Smell Identification Tests 25.2.3 Smell Tests in Children 25.2.4 Threshold Tests 25.2.5 Objective Smell Tests 25.3 Translation into Future Daily Practice References 26: Local and Systemic Biomarkers 26.1 Question-Based Selection of Nasal Biologic Samples and Its Optimal Collecting Techniques (Table 26.1) 26.2 Correlation Between Local and Systemic Biomarkers 26.3 Biomarkers for Endotype Identification 26.4 Biomarkers to Monitor Therapeutic Responses 26.5 Future Multi-omics Biomarkers in Precision Medicine References 27: Benign Tumors of the Nose and Sinuses 27.1 Osteoma is the Most Common Benign Sinonasal Tumor 27.2 Juvenile Angiofibroma 27.3 Schwannomas 27.4 (Acquired) Lobular Capillary Hemangioma (Pyogenic Granuloma) References 28: Sinonasal Inverted Papilloma 28.1 Introduction 28.2 Etiology 28.3 Clinical Features 28.4 Pathology 28.5 Imaging 28.6 Conclusions References 29: Malignant Tumors of the Nose and Sinuses References 30: Pediatric Chronic Rhinosinusitis: View from Europe 30.1 Prevalence of Pediatric Chronic Rhinosinusitis 30.2 Quality of Life 30.3 Development of the Sinuses 30.4 Clinical Diagnosis and Definition of PCRS 30.4.1 Definition 30.4.2 Diagnostic Tools 30.5 Predisposing Factors 30.5.1 Anatomical Factors in PCRS 30.5.2 Environmental Factors 30.5.3 Comorbid Diseases in PCRS 30.5.4 Cystic Fibrosis and PCD 30.6 Pathophysiology 30.6.1 Genetics 30.6.2 Inflammatory Mechanisms 30.6.3 Bacteriology 30.7 Medical Treatment 30.8 Surgery for PCRS 30.8.1 Adenoidectomy, Sinus Irrigation, and Balloon Sinuplasty 30.8.2 Functional Endoscopic Sinus Surgery 30.9 Translation into Future Daily Practice References 31: Pediatric Chronic Sinusitis: View from China 31.1 Introduction 31.2 Clinical Characteristics in Children 31.2.1 Definition 31.2.2 Symptoms 31.2.3 Physical Examination 31.2.4 Diagnostic Tests 31.2.5 Imaging 31.3 Treatment (Essentials of Pediatric Endoscopic Surgery and Medicine) and Prognosis 31.3.1 Introduction 31.3.2 Medical Treatment of Chronic Rhinosinusitis in Children 31.3.3 Surgical Treatment 31.4 Prognosis 31.5 Conclusions References 32: Wegener’s Granulomatosis 32.1 Introduction 32.2 Pathogenesis 32.3 Clinical Manifestations 32.4 Diagnosis 32.5 Treatment 32.6 Summary References 33: IgG4-Related Disorders 33.1 Introduction 33.2 Pathogenesis 33.2.1 Genetic Phenotypes 33.2.2 Autoimmunity 33.2.3 Environment 33.2.4 Allergy 33.3 Clinical Features 33.3.1 Symptoms 33.3.2 Imaging Features 33.3.3 Laboratory Examinations 33.3.4 Histopathological Features 33.3.5 Diagnostic Criteria 33.4 Treatment 33.5 Translation into Future Daily Practice References 34: Eosinophilic Granulomatosis with Polyangiitis 34.1 Pathogenesis 34.2 Pathology 34.3 Main Clinical Manifestations 34.4 Laboratory Findings 34.5 Diagnosis 34.6 Treatment References 35: Oral Corticosteroids 35.1 Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) 35.2 Chronic Rhinosinusitis Without Nasal Polyps (CRSsNP) 35.3 The Dose of Oral Corticosteroid in Chronic Rhinosinusitis 35.4 Risks of Oral Corticosteroid 35.5 Bone Metabolism 35.6 Adrenal Suppression 35.7 Gastrointestinal 35.8 Others 35.9 Translation into the Future Daily Practice References 36: Nasal Spray Corticosteroids 36.1 Mechanism 36.2 Efficacy 36.3 Safety 36.4 Limits References 37: Nebulization Corticosteroids 37.1 History, Categories, and Principle of Nebulization 37.2 Mechanisms Underlying Efficacy of Steroid Nebulization in the Treatment of CRS 37.3 The Efficacy and Safety of Steroid Nebulization in CRS 37.4 Nebulization of Other Drugs in CRS 37.5 Translation into the Future Daily Practice References 38: Steroid-Eluting Stent Placement 38.1 Introduction 38.2 Review of Steroid-Eluting Stents 38.3 Efficacy of Steroid-Eluting Stents 38.4 Safety of Steroid-Eluting Stents 38.5 Use of Stents in the Frontal Sinus Ostia 38.6 Conclusions and Future Perspectives References 39: Steroid Infiltrated Packing Materials 39.1 Translation into Future Daily Practice References 40: Corticosteroids Resistance 40.1 Introduction 40.2 Mechanism 40.3 Treatment References 41: Leukotriene Receptor Antagonists 41.1 Translation into Practice References 42: Antihistamine 42.1 Conclusions References 43: Antibiotics 43.1 Introduction 43.2 Antibiotics Treatment Strategies for Patients with CRS 43.3 Elimination of Bacterial Infections During Acute Exacerbations of CRS with Antibiotics 43.4 Control of Persistent Inflammation During Chronic Phase of CRS with Antibiotics 43.5 Combination with Other Non-antibiotic Medical Treatment: Add Treatment Benefit or Similar Efficacy 43.6 Antibiotics, After Endoscopic Sinus Surgery: Achieve Long-Term Surgical Outcome 43.7 Side Effects of Antibiotics 43.8 Conclusions 43.9 Implications for Medical Practice References 44: Decongestant and Nasal Irrigation 44.1 Decongestant 44.2 Nasal Irrigation 44.3 For Future Daily Practice References 45: Probiotics, Bacterial Lysates, and Proton Pump Inhibitors 45.1 Introduction 45.2 Microbiota Dysbiosis in the Pathogenesis of CRS 45.3 Probiotics in the Treatment of CRS 45.4 Bacterial Lysates in the Treatment of CRS 45.5 Proton Pump Inhibitors (PPIs) in the Treatment of CRS 45.6 Conclusions References 46: Impact of Endotyping on the Indication for Surgery References 47: Surgical Procedures 47.1 Introduction 47.2 Preoperative Evaluation 47.3 Endoscopic Sinus Surgery: Surgical Approach 47.3.1 Initial Assessment and Exposure 47.3.1.1 Nasal Endoscopy 47.3.1.2 Septoplasty 47.3.1.3 Concha Bullosa Resection 47.3.2 Performing ESS 47.3.2.1 Uncinectomy 47.3.2.2 Maxillary Antrostomy 47.3.2.3 Ethmoidectomy 47.3.2.4 Sphenoid Sinusotomy 47.3.2.5 Frontal Sinusotomy 47.4 Conclusion References 48: Reboot Surgery References 49: Complications of Endoscopic Sinus Surgery 49.1 Causes of Complications in ESS 49.2 Classification of Complications in ESS 49.2.1 Orbital Complications 49.2.1.1 Lamina Papyracea Injury and Orbital Fat Exposure 49.2.1.2 Intraorbital Hematoma 49.2.1.3 Eye Muscle Injury 49.2.1.4 Optic Nerve Injury 49.2.2 Intracranial Complications 49.2.2.1 Cerebrospinal Fluid (CSF) Leakage 49.2.2.2 Carotid Injury 49.2.3 Postoperative Complications 49.2.3.1 Intracranial Infection 49.2.3.2 Epistaxis 49.2.3.3 Cavity Synechiae 49.2.3.4 Secondary Lacrimal Duct Obstruction 49.2.3.5 Secondary Sinusitis 49.2.3.6 Bone Remodeling 49.3 Conclusions References 50: Peri-operative Management 50.1 Introduction 50.2 Preoperative Objective Assessment by Endoscopy and CT Scan 50.3 Preoperative Control of General Conditions Such as Hypertension, Diabetes, Coagulation Dysfunction, and Asthma 50.4 Bacteriology Before Surgery 50.5 Biopsy Before Surgery 50.6 Postoperative Management of Nasal Packs 50.7 Postoperative Douching 50.8 Follow-Up and Postoperative Endoscopic Reexamination 50.9 Follow-Up and Postoperative Evaluation References 51: Surgery Outcome and Predictors 51.1 Symptoms and Quality of Life Improvement and Prediction 51.2 Polyp Recurrence and Revision Surgery and Prediction 51.3 Difficult-to-Treat CRS and Uncontrolled Disease and Prediction References 52: Biologics in Chronic Rhinosinusitis with Nasal Polyps 52.1 Anti-IL5 Strategies 52.2 Anti-IgE 52.3 Anti-IL-4 Receptor Alpha Antagonism 52.4 Biologics in Clinical Practice References 53: Integrated Care Pathways 53.1 Definitions: How to Define Uncontrolled Severe Type 2 CRSwNP with Comorbid Disease? 53.1.1 The EUFOREA Group Agreed on the Following Definitions 53.1.2 Endotyping in Uncontrolled Severe CRSwNP Based on Clinical Signs and Biomarkers 53.1.3 Sinus Surgery or a Biologic Approach, or a Combination of Both? 53.2 Evaluation of Efficacy vs. Adverse Events/Complications for Surgery and Biologics 53.2.1 Efficacy of Biologics in Phase 3 Trials 53.2.2 Efficacy of Surgery from Available Literature 53.2.3 AEs in Phase 3 Trials with Biologics 53.2.4 Complications of Sinus Surgery 53.2.5 The Patient Perspective on Biologics 53.3 Specific Considerations for Biologics 53.4 Limitations for the Selection of a Biologic Drug 53.5 Evaluation of the Clinical Response to a Biologic Within 6 Months of Treatment: “Continue or Stop” Rules 53.6 “Continue or Stop” Rules 53.7 The Treatment Response Has Been Verified Within 6 Months 53.8 Treatment Evaluation After 12 Months 53.9 Approach in Patients with CRSwNP and Asthma/N-ERD References 54: Unmet Needs Index