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
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TABLE XV-1 Research needs Category
Research Need
Diagnosis of CRS Treatable Traits
Validation of biosignatures of discreet CRS endotypes
Discovery of biomarkers that directly respond to targeted therapeutics and may predict efficacy Development of formulations specifically designed to optimize mucosal distribution, stability, and absorption Define composition, duration, and response rate to AMT, through well controlled clinical trials Execution of sham-controlled studies using validated PROMS, clinically relevant objective endpoints, cost-benefit analyses SARS-CoV-2 anosmia pathogenesis, rhinologic aerosol generating procedure risk, and how to deliver elective rhinologic care during pandemic conditions.
Topical Therapeutics
Appropriate Medical Therapy
Interventional Strategies
COVID-19
inflammatory systems throughout the body. 2454 Multidis ciplinary collaboration will become ever more important to maximize these opportunities however, through the shar ing of knowledge across and between fields, the future of rhinology knows no limits. XV.F COVID-19 and Rhinology The COVID-19 pandemic has impacted the field of rhi nology in direct and unexpected ways. Some of the earli est reports regarding the SARS-CoV-2 virus suggested sig nificant infection rates among Otolaryngologists, 2455 par ticularly high nasal/nasopharyngeal viral loads in even asymptomatic patients, 2 and prolonged viral persistence in air. 2456 Later data emerged suggesting anosmia as an early and prevalent symptom of COVID-19. 3,115,2457–2459 Conse quently, the COVID-19 pandemic has raised additional knowledge gaps including the pathogenesis of SARS-CoV 2 related anosmia, the aerosolization 123 and infectious transmission risk of common rhinologic procedures, and the impact of delay of elective rhinologic care on patient outcomes. COVID-19 Editors’ Note: Coronavirus disease 2019 (COVID-19) is a rapidly emerging topic and new data are constantly becom ing available. This section was completed in early September 2020. The COVID-19 pandemic, caused by the virus SARS CoV-2, has heightened awareness and necessitated mod ifications to the workup and management of sinonasal pathologies including CRS. XVI CRS Management in the Context of
XVI.A Risk of COVID-19 for a CRS Patient The relative viral susceptibility of a CRS patient remains unclear but thus far, there is no evidence that CRS patients are at increased risk for infection. Nasal expression of the SARS-CoV-2 receptor, angiotensin-converting enzyme 2 (ACE2), does not appear to be increased in CRS sub jects. Compared to healthy controls, 1 study found no difference in ACE2 expression in CRS patients with or without polyps, 2460 while others found decreased ACE2 expression in cases of nasal polyposis and eosinophilic inflammation. 2461–2463 On the other hand, neutrophilic inflammation driven by IFN γ is associated with upregu lated ACE2 expression. 2461,2464 At this time, the correla tion between ACE2 expression and susceptibility to infec tion remains theoretical. Clinically, CRS subjects main tained on topical steroids and biologic therapy against type 2 inflammation have not demonstrated higher risks of infection. 2462 XVI.B Risk of COVID-19 for a Healthcare Provider Treating a CRS Patient Given the high viral burden found on nasal mucosal surfaces, 2 the field of otolaryngology has carefully assessed the risks of viral transmission between patient and health care provider. Diagnostic endonasal procedures are consid ered high risk as they have been shown to produce signif icant airborne aerosols, 127,2465 can induce cough/sneeze, require unmasking, and occur within an enclosed space in close proximity to the patient. While their spe cific designation as an aerosol-generating procedure (AGP) remains controversial, these features have all been shown to be associated with infectious transmission in
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