Postoperative care in endoscopic sinus surgery: a critical review.
; ; POIRRIER, Anne-Lise
in Current Opinion in Otolaryngology & Head & Neck Surgery (2017), 25(1), 35-42
PURPOSE OF REVIEW: Chronic rhinosinusitis with and without nasal polyps is a common disease affecting people all over the world. Functional endoscopic sinus surgery (FESS) has become the gold standard ... [more ▼]
PURPOSE OF REVIEW: Chronic rhinosinusitis with and without nasal polyps is a common disease affecting people all over the world. Functional endoscopic sinus surgery (FESS) has become the gold standard treatment for medically refractive disease. Postoperative care is recommended by international leaders as an important part of the patient's management. This article is a critical review and discussion focusing on postoperative care, which is based on expert opinion, clinical studies, randomized controlled trials and meta-analysis studies. RECENT FINDINGS: Postoperative care including nasal rinsing, topical corticosteroids, antibiotics and avoidance of nasal packing are unanimously considered to be the cornerstone of best practice following FESS. However, the effectiveness of in-office nasal debridement is still under debate. SUMMARY: There is a lack of consensus regarding the necessity of performing in-office nasal debridement and the majority of clinicians carry out their postoperative care according to experience and their own preference. This is often determined by the extent of surgery performed, the severity of the postoperative inflammation, as well as being dependent on the patient's discomfort, the time constraints associated with postoperative care and the costs associated with additional appointments. Ideally, nasal debridement should be performed by the operating surgeon under endoscopic control both gently and atraumatically. [less ▲]Detailed reference viewed: 12 (2 ULg)
A prospective 4 year study of the objective and subjective outcomes of 15 patients after dynamic facial reanimation surgery.
; ; et al
in Clinical Otolaryngology (2015)
Facial nerve palsy is a debilitating and life changing event which significantly affects quality of life. This prospective study evaluates outcomes in 15 patients undergoing dynamic facial reanimation ... [more ▼]
Facial nerve palsy is a debilitating and life changing event which significantly affects quality of life. This prospective study evaluates outcomes in 15 patients undergoing dynamic facial reanimation surgery using a modification of the minimally invasive temporalis tendon transposition technique (MIT3) coupled with either static reanimation techniques or synergistic inter-positional/facial-hypoglossal nerve reconstruction techniques. All patients demonstrated significant improvement both objectively and subjectively as measured by the SMILE system and FaCE scale respectively. The MIT3 technique can be used successfully for dynamic reanimation and allows for other techniques to be simultaneously tailored around it. It provides improved functional and quality of life outcomes in patients and affords low morbidity. [less ▲]Detailed reference viewed: 14 (0 ULg)
The need for an objective measure in septorhinoplasty surgery: Are we any closer to finding an answer?
; ; et al
in Clinical Otolaryngology (2015)
OBJECTIVES: To assess the reliability of nasal inspiratory peak flow (NIPF) in providing a clinically accurate objective measure following functional septorhinoplasty by comparing it to the validated ... [more ▼]
OBJECTIVES: To assess the reliability of nasal inspiratory peak flow (NIPF) in providing a clinically accurate objective measure following functional septorhinoplasty by comparing it to the validated disease specific quality of life questionnaire, SNOT-22. Studies so far have demonstrated poor correlation between bilateral NIPF and symptom specific nasal questionnaires following septorhinoplasty.. DESIGN: To perform a prospective comparative analysis between NIPF and the validated disease specific quality of life questionnaire SNOT 22 and to determine if a correlation exists following septorhinoplasty surgery. SETTING: The Royal National Throat Nose and Ear Hospital, London. PARTICIPANTS: A total of 122 patients (78 males, 44 females; mean age 33.5 +/- 12.2 years) were recruited from the senior authors rhinology clinic and underwent functional septorhinoplasty surgery MAIN OUTCOME MEASURES: Pre and post-operative nasal inspiratory peak flow (NIPF) measurements were performed in addition to the completion of three subjective quality of life and symptom assessment tool questionnaires; Sinonasal Outcome Test 22 (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE) and Visual Analogue Scores (VAS: 0-10). RESULTS: The mean pre-operative NIPF was 88.2L/min, and the post-operative value was 101.6L/min and showed a significant improvement following surgery (P = 0.0064). The mean total SNOT-22 score improved significantly from 48.6 to 26.6 (P<0.0001); the NOSE score from 14.1 to 6.6 (P<0.0001); and the VAS blockage score from 6.9 to 3.2 (P<0.0001). All individual domains assessed showed improvements post-operatively but no correlation was found between the NIPF and SNOT-22 score. Equally, we did not find a correlation between NIPF and the symptom specific NOSE questionnaire and the nasal blockage domain on the VAS scale. CONCLUSION: We have demonstrated that NIPF does not correlate with the SNOT 22 disease specific questionnaire, although both outcomes significantly improve post-operatively. At present we are still lacking a clinically accurate objective measure of nasal function for the evaluation of patients undergoing septorhinoplasty surgery. [less ▲]Detailed reference viewed: 16 (0 ULg)
Analyse tridimensionnelle de la voie aérienne supérieure des patients atteints d'un syndrome d'apnées et d'hypopnées obstructives du sommeil par la technique du Cone Beam.
BRUWIER, Annick ; POIRRIER, Anne-Lise ; LIMME, Michel et al
in Revue Médicale de Liège (2014)Detailed reference viewed: 54 (10 ULg)
Validation of the sino-nasal outcome test-23 in septorhinoplasty surgery.
; ; et al
in Rhinology (2014), 52(4), 320-6
BACKGROUND: There has been a great expansion in patient-based outcome measures to face the ever-increasing demand to demonstrate surgical efficacy. However, surgeons have not adopted until now any ... [more ▼]
BACKGROUND: There has been a great expansion in patient-based outcome measures to face the ever-increasing demand to demonstrate surgical efficacy. However, surgeons have not adopted until now any systematic outcome instrument. The 22-item Sino-Nasal Outcome Test (SNOT-22) is a validated sinonasal outcome score in sinonasal and septorhinoplasty surgery but does not measure aesthetic outcome. The aim of this paper is to validate a modification to the Sino-Nasal Outcomes Test-22 (SNOT-22) with a new question regarding the shape of the nose (SNOT-23). METHODOLOGY: We conducted a prospective cohort study on 69 consecutive patients undergoing septorhinoplasty and a control group of healthy volunteers. Reproducibility, responsiveness to treatment, known group differences and validity of the SNOT-23 were analysed. Scores were compared to visual analogue scales, nasal obstruction symptoms evaluation (NOSE) score and nasal inspiratory peak flow. RESULTS: SNOT-23 has good test-retest reliability and is a valid outcome measure for assessing response to surgery especially with regards to shape of the nose and nasal obstruction when compared to other patient reported measures. CONCLUSION: SNOT-23 is a valid and reliable tool that can be easily used in routine clinical practice to assess the functional and aesthetic outcomes from septorhinoplasty surgery. The SNOT-23 could be adopted as a universal, easy to use tool in rhinology clinics for the assessment of response to septorhinoplasty and sinus surgery. [less ▲]Detailed reference viewed: 28 (5 ULg)
Upper airway imaging in sleep-disordered breathing.
POIRRIER, Anne-Lise ; ; Bruwier, Annick et al
in Acta neurologica Belgica (2014)
Our understanding of sleep-disordered breathing has evolved considerably over the past three decades, and clinical techniques of evaluation have progressed tremendously. Myriad imaging techniques are now ... [more ▼]
Our understanding of sleep-disordered breathing has evolved considerably over the past three decades, and clinical techniques of evaluation have progressed tremendously. Myriad imaging techniques are now available for the physician to approach the dynamic features resulting in turbulent airflow, upper airway narrowing or collapse at different levels. Controversy exists in the choice of investigations, probably because the best evaluation should be a combination of different techniques. Physical, radiographic, endoscopic and acoustic evaluations could be integrated to understand the degree and the levels of airway reduction and/or obstruction in a given patient. This review focuses on cost-effective and easily implemented techniques in daily practice, allowing quality assessment of the dynamic anatomy of sleep-disordered breathing: cephalometry, (sleep-)endoscopy and acoustic reflectometry of the upper airway. [less ▲]Detailed reference viewed: 40 (12 ULg)
External nasal valve collapse: validation of novel outcome measurement tool.
POIRRIER, Anne-Lise ; ; et al
in Rhinology (2014), 52(2), 127-32
BACKGROUND: We aim to validate a clinical scoring system of external nasal valve collapse. External nasal valve collapse is a rare and challenging condition. We attempted to simplify the examination of ... [more ▼]
BACKGROUND: We aim to validate a clinical scoring system of external nasal valve collapse. External nasal valve collapse is a rare and challenging condition. We attempted to simplify the examination of the external valve, the surgical planning and the outcome measure. To validate our external valve score, we first assessed its reliability (inter-rater agreement and test-retest repeatability). We secondly considered the clinical relevance by using our scoring system in patients undergoing septorhinoplasty for external valve collapse. METHODOLOGY: For validation, 16 Rhinologists scored patients separately on two occasions. For the clinical relevance, 26 patients with external valve collapse were scored pre- and post-operatively (responsiveness). The external valve score was correlated to peak nasal inspiratory flow. RESULTS: The devised scoring system was reliable (substantial agreement between 16 surgeons with reproducibility over time). All patients in our prospective series showed significant improvement in their external valve score. The quality of life measured by the SNOT-22 tool showed significant improvement after surgery. CONCLUSION: External nasal valve collapse can be diagnosed and graded using this simple scoring system in the outpatient clinic. This paper reinforces the pivotal role of septorhinoplasty surgery in nasal airway reconstruction and the ongoing need to quantify success. [less ▲]Detailed reference viewed: 26 (0 ULg)
French adaptation and validation of the SinoNasal Outcome Test (SNOT)-22: a prospective cohort study on quality of life among 422 subjects.
; ; Lefèbvre, Philippe et al
in Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery (2014)
OBJECTIVES: ENT surgeons are facing an ever-increasing demand to demonstrate their efficacy. The 22-item Sino-Nasal Outcome Test (SNOT-22) is a fully validated and easy-to-use outcome measure in rhinology ... [more ▼]
OBJECTIVES: ENT surgeons are facing an ever-increasing demand to demonstrate their efficacy. The 22-item Sino-Nasal Outcome Test (SNOT-22) is a fully validated and easy-to-use outcome measure in rhinology. Our goal was to translate and validate the SNOT-22 in a cohort of 422 French-speaking subjects. DESIGN, SETTING AND PARTICIPANTS: The French version of the SNOT-22 was obtained by forward and backward translations by 6 independent interpreters. Five experienced rhinologists compared the translations to each other and a group of 12 naive patients selected the most appropriate translation of each item. To evaluate this questionnaire, we conducted a prospective cohort study on 376 rhinological patients and 46 healthy volunteers in 3 University-affiliated teaching Hospitals. MAIN OUTCOME MEASURES: reproducibility (test-retest reliability), internal consistency, known group differences, responsiveness to treatment, validity and correlation to other clinical instruments (visual analogue scale, Nasal Obstruction Symptoms Evaluation score and Lund-Mackay score). RESULTS: The test-retest reliability coefficient was 0.78, indicating a good reliability when administering the instrument on two different occasions. The internal consistency was high with a Cronbach's alpha value of 0.93. Our questionnaire was able to detect differences between rhinological patients and control subjects (p<0.0001) and improved significantly after nose and sinus surgery (p<0.0001), indicating a good responsiveness. There was a relative correlation with visual analogue scale and NOSE score, but no correlation with Lund-Mackay score. CONCLUSION: The SNOT-22 is a reliable and valid tool to assess quality of life in French-speaking patients and correlates well with known indices of disease severity. This article is protected by copyright. All rights reserved. [less ▲]Detailed reference viewed: 54 (3 ULg)
In vivo protection of spiral ganglion neurons by bryostatin 1: preliminary results
POIRRIER, Anne-Lise ; Van Den Ackerveken, Priscilla ; et al
in Advances in Cellular and Molecular Otolaryngology (2013), 1
Background: We aim to demonstrate the effect of bryostatin 1, a macrocyclic lactone that activates protein kinase C, on spiral ganglion neurons (SGNs) of adult guinea pigs deafened by aminoglycoside ... [more ▼]
Background: We aim to demonstrate the effect of bryostatin 1, a macrocyclic lactone that activates protein kinase C, on spiral ganglion neurons (SGNs) of adult guinea pigs deafened by aminoglycoside. Methodology: Twenty-one guinea pigs were deafened by the aminoglycoside gentamicin and then treated by continuous infusion of experimental molecule for 1 month. The experimental molecule was bryostatin 1, artificial perilymph (negative control), or neurotrophins and an apoptosis inhibitor (positive control). Neuronal density in the spiral ganglia was quantified. Results: Bryostatin 1 protected SGNs after a gentamicin challenge. Conclusions: Bryostatin 1 has a neuroprotective effect when administered continuously at low doses in adult guinea pigs. [less ▲]Detailed reference viewed: 27 (7 ULg)
Is the Sino-Nasal Outcome Test-22 a suitable evaluation for septorhinoplasty?
POIRRIER, Anne-Lise ; ; et al
in The Laryngoscope (2013), 123(1), 76-81
OBJECTIVES/HYPOTHESIS: It is becoming increasingly important for clinicians to demonstrate the impact of their interventions. The Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire is a disease-specific ... [more ▼]
OBJECTIVES/HYPOTHESIS: It is becoming increasingly important for clinicians to demonstrate the impact of their interventions. The Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire is a disease-specific questionnaire involving 22 symptoms combining rhinologic issues with general health issues. We evaluated the SNOT-22 score as a quality-of-life outcome measure in septorhinoplasty surgery. STUDY DESIGN: Outcome research. METHODS: We carried out a prospective case series in 76 patients undergoing septorhinoplasty. Their SNOT-22 scores were compared pre- and postoperatively. We also recorded individual symptom scores to study the impact of surgery. To check its reliability, the SNOT-22 score was correlated to patient-reported symptoms on a visual analogue scale. Patients were screened for comorbid conditions. Interactions with the surgical technique and/or with the initial sinonasal disease were sought. RESULTS: The SNOT-22 is a reliable and responsive outcome measure in septorhinoplasty surgery. Septorhinoplasty was especially effective at addressing nasal obstruction, discharge, olfaction, related sleep disturbance, and emotional symptoms such as embarrassment or frustration. Comparison to the visual analogue scale instrument confirmed the outcome measured by the SNOT-22. CONCLUSIONS: The SNOT-22 could be used in routine clinical practice to highlight the impact of nasal disease in each patient and to measure the outcome and the effectiveness of the surgical intervention. [less ▲]Detailed reference viewed: 39 (2 ULg)
Sphenoid sinus fungall ball: a retrospective study over a 10- year period.
; ; et al
in Rhinology (2013), 51(2), 181-8
A fungal ball consists of a dense conglomerate of fungal hyphae growing at the surface of the sinus mucosa without tissue infiltration. The maxillary sinus is by far the most commonly involved paranasal ... [more ▼]
A fungal ball consists of a dense conglomerate of fungal hyphae growing at the surface of the sinus mucosa without tissue infiltration. The maxillary sinus is by far the most commonly involved paranasal sinus cavity followed by the sphenoid sinus. The present study is a retrospective study of 25 consecutive cases treated during the last 10 years in the two hospitals be- longing to the Catholic University of Louvain (CHU Mont-Godinne and UCL Saint Luc). We report the symptomatology, the imaging and discuss the different surgical managements. We conclude that the clinician must have a high index of suspicion when dealing with a unilateral rhinosinusitis persisting despite a maximal and well conducted medical treatment. This is particularly so in elderly women when associated with facial pain and post nasal drip, particularly when the computed tomography shows an unilateral opacity of the sphenoid sinus with or without a sclerosis or an erosion of the bony walls, a polyp in the sphenoethmoidal recess or a hyperdensity mimicking a foreign body. An endonasal endoscopic sphenoidotomy is the treatment of choice in most cases, allowing good ventilation of the sinus and radical removal of all the fungal concretion. A biopsy of the sinus mucosa adjacent to fungal elements is of upmost important to confirm the non- invasiveness of the fungi within the tissue. Antifungal medication is not required in uncomplicated forms. All host factors producing some degree of immunosuppression must be corrected when present and must alert the clinician to rule out any forms of invasive disease. [less ▲]Detailed reference viewed: 22 (0 ULg)
Anatomical variations of the lateral nasal wall: The secondary and accessory middle turbinates.
; POIRRIER, Anne-Lise ; et al
in Clinical anatomy (New York, N.Y.) (2012), 25(3), 340-6
The aim of the current anatomical and clinical study was to audit our cases of patients who presented with secondary and/or accessory middle turbinates during a two-year period. We investigated the ... [more ▼]
The aim of the current anatomical and clinical study was to audit our cases of patients who presented with secondary and/or accessory middle turbinates during a two-year period. We investigated the incidence and the clinical impact of these variations. Twenty-eight patients, 19 males and 9 females with a mean age of 41.5 years, representing different ethnic origins, were diagnosed with double middle turbinates based on endoscopic examination. Of those, 92.8% had a main symptom of refractory frontal headache. A secondary nasal symptom was sensation of blocked nose. Patients who underwent endoscopic surgery (n = 13) for reduction of the extra turbinate, reported significant symptom scores improvement (P < 0.0001) of frontal headache and blocked nose, from means of 9.07 +/- 0.26 and 8.57 +/- 1.39 to 1 +/- 0.31, and 1.42 +/- 0.35, respectively. Our results indicate that double middle turbinates may be encountered in rhinology practice (2%). Clinically they may present with refractory headache and blocked nose. Endoscopic surgical approach seems to be an effective way of improving the symptoms. [less ▲]Detailed reference viewed: 16 (3 ULg)
Retropharyngeal abscess in adults.
; ; POIRRIER, Anne-Lise et al
in Revue de laryngologie - otologie - rhinologie (2012), 133(3), 137-9
OBJECTIVES: Retropharyngeal abscess in adults can be life-threatening. The otolaryngologist is on the front line in making the diagnosis and treatment of this disease. The aim of this study is to review ... [more ▼]
OBJECTIVES: Retropharyngeal abscess in adults can be life-threatening. The otolaryngologist is on the front line in making the diagnosis and treatment of this disease. The aim of this study is to review the clinical features, the diagnostic tools and the management of retropharyngeal abscesses in adults. PATIENTS AND METHODS: Retrospective study of retropharyngeal abscesses in adults admitted in the ENT department from 2005 to 2010. RESULTS: In total 4 patients were included in this study: mean age of 53 years (range 45 to 62 years), sex ration F/M = 3. Cultures obtained from the abscesses identified group A beta-hemolytic streptococci susceptible to amoxicilline-clavulanate in three cases. The treatment consisted in surgical drainage of the collection and intravenous antibiotics. CONCLUSIONS: Retropharyngeal abscesses in adults are critical infections requiring prompt diagnosis and treatment. Computed tomography scan was the crucial tool for the diagnosis, notably to differentiate cellulitis from abscesses. The management includes intravenous broad-spectrum antibiotics associated, if necessary, with surgical drainage in cases of persistent abscess. The outcome is usually good. [less ▲]Detailed reference viewed: 19 (1 ULg)
Sudden sensorineural hearing loss: when ophthalmology meets otolaryngology.
; ; et al
in B-ENT (2012), 8(2), 135-9
OBJECTIVES: Sudden sensorineural hearing loss is a perplexing entity in otology. Susac's syndrome (also called retinocochleocerebral vasculopathy) is a rare disorder that consists of microangiopathy of ... [more ▼]
OBJECTIVES: Sudden sensorineural hearing loss is a perplexing entity in otology. Susac's syndrome (also called retinocochleocerebral vasculopathy) is a rare disorder that consists of microangiopathy of the brain, retina, and inner ear, and usually affects women in young adulthood. We describe the clinical aspects, radiographic findings, and management of one such case. CASE REPORT: A 30-year-old woman was admitted to the hospital because of sudden onset of bilateral deafness and headache. During her hospitalization, she developed discrete right hemiparesis and hypoesthesia. RESULTS: Magnetic resonance imaging revealed multiple signal hyperintensities and atrophy of the corpus callosum. The differential diagnosis was a myelinating condition, such as multiple sclerosis or acute demyelinating encephalomyelitis. CONCLUSION: Retinal fluorescein angiography helped the diagnosis of Susac's syndrome. [less ▲]Detailed reference viewed: 35 (0 ULg)
Contribution of postero-anterior cephalometry in obstructive sleep apnea.
POIRRIER, Anne-Lise ; ; et al
in The Laryngoscope (2012), 122(10), 2350-4
OBJECTIVES/HYPOTHESIS: Lateral cephalometry has been widely used to characterize facial and maxillary morphology in obstructive sleep apnea (OSA) patients. It is a useful tool to assess orthodontic and ... [more ▼]
OBJECTIVES/HYPOTHESIS: Lateral cephalometry has been widely used to characterize facial and maxillary morphology in obstructive sleep apnea (OSA) patients. It is a useful tool to assess orthodontic and maxillofacial procedures, but transverse dimensions of the airway (e.g., nasal framework) have not been well described yet by cephalometry. We explored whether postero-anterior cephalometry could refine the analysis of the facial morphology, with a special attention paid to nasal morphology. We validated cephalometric measurements relevant to the diagnosis of OSA. STUDY DESIGN: Controlled study. METHODS: We explored postero-anterior and lateral cephalometric bony structures in OSA patients and in control subjects to determine which were predictive of an association with OSA. Healthy volunteers paired for age and sex to OSA patients underwent polysomnography and cephalometry. Data were analyzed by Shapiro-Wilk, Fisher, Wilcoxon, and paired t tests where appropriate. RESULTS: Nasal fossae and maxillary bone proportions were positively and independently associated with the absence of OSA. Measurements of maxillary width, nasal fossae angle, and anterior skull base contributed to the characterization of OSA patients. CONCLUSIONS: Postero-anterior cephalometry is an easy, rapid, informative, and reliable technique, which is complementary to the lateral cephalometry in the assessment of OSA patients. Our study may also suggest the negative impact of the nasal resistance on the upper airway resistance in sleep disorders. [less ▲]Detailed reference viewed: 33 (6 ULg)
Cystic dilation of the distal end of the nasolacrimal duct: underrated cause of epiphora in adults and its endoscopic treatment.
; POIRRIER, Anne-Lise ; et al
in Rhinology (2012), 50(4), 436-41
Epiphora is a frequent reason for ophthalmologic consultation. Among the multiple causes, obstructions of the lacrimal excretory system are common. Sacal and postsacal obstructions are much more frequent ... [more ▼]
Epiphora is a frequent reason for ophthalmologic consultation. Among the multiple causes, obstructions of the lacrimal excretory system are common. Sacal and postsacal obstructions are much more frequent than presacal obstructions. Obstruction at the level of the Hasner's valve is rare and likely underestimated. The authors report the clinical history and the imaging of 3 patients with a cystic dilation of the distal end of the nasolacrimal duct (NLD). These patients were easily managed by an ENT surgeon. In one case, the surgery consisted of an endonasal DCR where in the 2 other cases, a marsupialisation of the cystic expansion of the nasolacrimal duct was successfully performed with the micro- debrider. The authors review the world literature on this specific topic. They conclude that a coronal sinus CT scan and an inferior meatus endoscopy should be included in the ophthalmologic work-up performed in all cases of low obstruction of the lacrimal system. When there is a dilation of the distal end of the NLD the marsupialisation of the cystic expansion in the inferior meatus is the option of treatment instead of performing a DCR. ENTs must play a role in the assessment and treatment of low obstructions of the lacrimal excretory system. [less ▲]Detailed reference viewed: 26 (0 ULg)
Proinflammatory Cytokines Induce Bronchial Hyperplasia and Squamous Metaplasia in Smokers: Implications for chronic obstructive pulmonary disease therapy.
Herfs, Michael ; Hubert, Pascale ; POIRRIER, Anne-Lise et al
in American Journal of Respiratory Cell and Molecular Biology (2012), 47(1), 67-79
Tracheobronchial squamous metaplasia is common in smokers and is associated with both airway obstruction in chronic obstructive pulmonary disease (COPD) and increased risk of lung cancer. Whereas this ... [more ▼]
Tracheobronchial squamous metaplasia is common in smokers and is associated with both airway obstruction in chronic obstructive pulmonary disease (COPD) and increased risk of lung cancer. Whereas this reversible epithelial replacement is almost always observed in association with chronic inflammation, the role of inflammatory mediators in the pathogenesis of squamous metaplasia is still unclear. In the present study, we investigated the implication of cigarette smoke-mediated pro-inflammatory cytokine up-regulation in the development and treatment of tracheobronchial epithelial hyperplasia and squamous metaplasia. By using immunohistological techniques, we showed a higher epithelial expression of TNFalpha, IL-1beta and IL-6 as well as an activation of NF-kappaB and AP-1/MAPK signalling pathways in the respiratory tract of smoking patients compared to the normal ciliated epithelium of non-smoking patients. In addition, we demonstrated that these signalling pathways strongly influence the proliferation and the differentiation state of in vitro generated normal human airway epithelial basal cells. Finally, we exposed mice to cigarette smoke for 16 weeks and demonstrated that anti-TNFalpha (etanercept), anti-IL-1beta (anakinra) and/or anti-IL-6R (tocilizumab) therapies significantly reduced epithelial hyperplasia and squamous metaplasia development. These data highlight the importance of soluble inflammatory mediators in the pathogenesis of tracheobronchial squamous metaplasia. Therefore, administration of pro-inflammatory cytokine antagonists may have clinical application in the management of COPD patients. [less ▲]Detailed reference viewed: 87 (22 ULg)
Actual Concepts in Rhinosinusitis: A Review of Clinical Presentations, Inflammatory Pathways, Cytokine Profiles, Remodeling, and Management
; POIRRIER, Anne-Lise ; et al
in Current Allergy and Asthma Reports (2011), 11(2), 146-162
Rhinosinusitis (RS) is a heterogeneous group of diseases. It is a significant and increasing health problem that affects about 15% of the population in Western countries. It has a substantial impact on ... [more ▼]
Rhinosinusitis (RS) is a heterogeneous group of diseases. It is a significant and increasing health problem that affects about 15% of the population in Western countries. It has a substantial impact on patients' health-related quality of life and daily functioning and represents a huge financial burden to society and the health care system as a result of the direct and indirect costs. In addition, RS is not well-understood, and little is known about the etiology and pathophysiology. In the past decade, many papers have been published that have changed our understanding of RS. RS is commonly classified into acute and chronic RS based on symptom duration. In acute RS, an inflammatory reaction initiated by a viral infection characterizes most uncomplicated, mild to moderate cases. Therefore, the first line of treatment for these cases are intranasal steroids and not antibiotics. In severe and complicated cases, antibiotics combined with topical steroids remain the treatment of choice. On the other hand, chronic RS is actually subdivided into two distinct entities (chronic rhinosinusitis with and without polyps), as growing evidence indicates that these entities have specific inflammatory pathways and cytokine profiles. The authors review recent data regarding the clinical presentations, cytokine profiles, tissue remodeling, and modalities of treatment for each form of RS. [less ▲]Detailed reference viewed: 21 (6 ULg)