xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 2021, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22741 by Stanford University, Wiley Online Library on [01/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

331

Orlandi et al.

TABLE IX-3 Evidence for allergy as a contributing factor for CRSsNP Study Year LOE Study Design Study Groups

Clinical Endpoint

Conclusions

DeYoung 569

Conclusions are limited by the paucity of available data. No RCTs. Conflicting evidence on role of allergy in CRSsNP. self-reported atopy in CRSsNP vs controls Korean CRSsNP shows a mixed types 2 and 17 phenotype. predominately type 2 inflammatory endotype. CRSsNP is heterogeneous with a higher frequency of a type 2 inflammatory pattern. heterogeneous inflammatory patterns whichare geographically dependent. CRSsNP have Higher prevalence of CRSsNP has a

Sinus-specific

2014 1

Systematic Review CRSsNP CRSwNP AFRS Systematic Review CRSsNP CRSwNP

outcomes after IT in patients with CRS Relationship between allergy and CRSsNP andCRSwNP 1) atopic comorbidities 2) sinus treatment Immunologic profiling of uncinate process tissue mRNA and protein endoytypic markers Immunologic profiling of nasal mucosal tissue Immunologic profiling of nasal mucosa tissue

Wilson 568

2014 1

CRSsNP and wNP

Khan 195

CRSsNP CRSwNP Control CRSsNP CRSwNP Control CRSsNP CRSwNP CRSsNP CRSwNP Control CRSsNP CRSwNP Controls

2019

2

Multicenter

cross-sectional case control study

Kim 567

2019

2

Cross-sectional

Stevens 61

2019

2

Cross-sectional

Tan 565

2017

2

Cross-sectional

Wang 54

2016

2

Cross-sectional

Stevens 566

2015

2

Cross-sectional

CRSsNP CRSwNP AERD CRSsNP CRSwNP

Immunologic profiling of uncinate process tissue Prevalence of atopy Radiographic disease severity

CRSsNP has a type 2

inflammatory pattern.

Benjamin 185

Atopy was associated with more severe sinus disease in CRSsNP

2019

4

Retrospective case-control

nutrients, which confers additional resistance to conven tional antibiotics. 573 Microbes that would normally be vul nerable to effective antibiotics in the planktonic state are up to 1000 times more resistant in the biofilm state. 574 Anti body action, phagocytosis and complement binding can be equally unsuccessful in this setting. 571 Biofilms in vivo can often be difficult to detect and cul ture. Reliance on conventional growth techniques results in an “enrichment bias” in which the organisms with the fastest growth rates are overrepresented thereby not reflecting the true polymicrobial constituents of in vivo biofilms. 575 Identification of a biofilm-forming pathogen in diseased mucosa therefore requires special techniques to obtain an accurate result. 576 Biosensor molecular detec tion and fluorescent insitu hybridization (FISH) have both proven to be effective. 577,578 Interestingly, a study compar ing FISH to culture technique showed very little overlap in the identities and relative quantities of bacteria detected. 578 At the current time there is no gold standard for identifi cation nor quantification of biofilms invivo nor invitro .

The precise relationship between biofilm formation and CRS pathogenesis is poorly understood, ie, whether biofilms are an early event in some individuals driv ing recalcitrant disease, or whether they are a “late” entity resulting from multiple therapeutic interventions is controversial. 579,580 However, biofilm presence in the sinonasal tract is correlated with recalcitrant CRS, 581 and outcomes after ESS are worse in patients that have evidence of biofilms. 582,583 Specifically, postoper ative symptoms, ongoing inflammation, and recurrent infections were all increased in biofilm-positive surgery patients. 570,584–587 Biofilm formation in CRS may also be associated with increased need for surgical intervention. While around 20% of patients with CRS show biofilm formation, 570 up to 50% of CRS surgical candidates are biofilm-positive. 584 Importantly, biofilms can also be found in control patients without CRS, showing that they are nei ther necessary nor sufficient to cause the pathology. 588 Treatment of biofilm-positive CRS is difficult and therapeutic strategies are far from fully elucidated.