Understanding the pattern of illness can lead to more accurate diagnosis of causative and contributive factors in the disease and should ultimately translate to more effective therapies. First is the greater appreciation for the role of eosinophilic Th2-type inflammation as a central feature not just in nasal polyps but more broadly in chronic rhinosinusitis. Complementing these findings are studies showing a high prevalence of sinus disease in patients with allergic rhinitis. Surgical treatment of patients with refractory migraine headaches and intranasal contact points. Kennedy, Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, F. Am J Rhinol 2007 Jan-Feb; 21 1 :19—26.
Chest 2000; 117 5 Suppl. Chandra, Alexander Chiu, Martin J. Economic implications of chronic sinusitis. These changes did not resolve even after treatment. These effects have important and direct parallels to rhinosinusitis, however no definitive studies have been performed in this area.
He conducts clinical research on the pathogenesis of allergic asthma and new biologic treatments for nasal polyposis. This model was also used to examine the relationship between allergy and rhinosinusitis 220. A comparison of morphological effects on the rabbit nasal and sinus mucosa after surgical denervation and topical capsaicin application. Healthcare expenditures for sinusitis in 1996: contributions of asthma, rhinitis, and other airway disorders. Hypertrophic and hyperplastic changes of mucussecreting epithelial cells in rat airways: assessment using a novel, rapid, and simple technique. Human nasal host defense and sinusitis. Kempuraj D, Frydas S, Conti P, et al.
Mucins are long chain proteins that may be anchored in the membrane transmembrane mucins 1, 3A, 3B, 4, 12, 17 , or secreted into the gel or sol phases. Other effects include reduced mucociliary clearance 48. Fourth, direct toxic effects on the sinonasal epithelium represent another mechanism leading to the development of disease in the sinonasal tract. J Health Econom 1996; 5:1—30. The effects of smoking on the airway mucosa of the lungs have been better studied than those on the nasal epithelium; a detailed review of these studies is beyond the scope of this chapter. Adinoff, Claus Bachert, Larry Borish, Vernon M.
V Anand, New York Presbyterian Hospital, New York, New York, J. Additionally, these models also suffer from a lack of immunologic reagents and genetically modified animals. Plasma and immunoglobulins, and cytoskeletal and transmembrane proteins each contributed about one third of the total proteins detected in this proteome. However, the role of some of the low-virulence bacteria, such as S. Allergic and Respiratory Disease in Sports Medicine, edited by John M. The sources of the proteins contained within the combined nasal and sinusitis proteome are depicted in Figure 4. A cycle of such effects may lead to a chronic inflammatory state.
Armed with this information plus the clinical framework outlined in this chapter, a stepwise medical evaluation and treatment strategy will be presented in Chapter 19. A clinical and pathologic study of chronic sinusitis: the role of the eosinophil. Rhinosinusitis is increasing in prevalence and incidence, and has been estimated to affect approximately 31 million patients in the United States each year. Tan, Elina Toskala, Richard Voegels, De Yun Wang, Erik K. Polyps see Preliminary Data have few glands or vessels, but many eosinophils in an edematous tissue matrix.
Arch Otolaryngol Head Neck Surg 1997; 123:1175. To mimic the clinical problem of foreign bodies causing rhinosinusitis in patients, the effects of nasotracheal and nasogastric tubes have also been studied 212,213. Water influx and evaporation will increase the concentration of salts and other nonvolatile plasma components within the polyp matrix. Ann Allergy Asthma Immunol 2004; 93:288—92. The transmembrane mucins are important for intercellular and matrix interactions. Lund Professorial Unit, Institute of Laryngology and Otology, University College London, London, U. There has been an evolving consensus that the different phenotypes of chronic rhinosinusitis, namely chronic rhinosinusitis without nasal polyps, chronic rhinosinusitis with nasal polyps, and allergic fungal rhinosinusitis, represent distinct clinical syndromes and pathologic processes.
The lipocalin superfamily of lipid-binding proteins contains important components of the innate immune system 126. Over half of pigmented Prevotella, Porphyromonas, and Fusobacterium spp. Javer, Robert Kern, Stilianos Kountakis, Marek L. During the study, the most common treatments used were intranasal steroids 73% , intranasal saline 46% , and oral or intranasal antihistamines 35%. J Epidemiol Community Health 1999; 53:440—1.
Inflammatory cells as well as epithelial cells in nasal polyps express vascular endothelial growth factor. Respiratory tract mucins: structure and expression patterns. Techniques for outcomes research in chronic sinusitis. Members of the oral flora with interfering capability e. The secret lives of the pathogenic mycobacteria.