Aaron N. Pearlman

Relationships between severity of chronic rhinosinusitis and nasal polyposis, asthma, and atopy.

Background The effect of comorbid conditions such as asthma and atopy on the severity of chronic rhinosinusitis (CRS) and the presence of nasal polyps (NPs) remains an area of investigation. We sought to elucidate the relationship among these entities. Methods The study population included 106 consecutive patients who were referred to a multidisciplinary, university-based allergy and sinus clinic that underwent computed tomography (CT) scan, skin-prick testing, and had CRS. Data were analyzed to determine Lund-MacKay score (LMS), presence of NPs, asthma status, and sensitivity to seven classes of aeroallergens. Results Skin tests were positive in 52 cases and negative in 54 cases. Although, there was no statistical relationship between LMS and atopic status in the entire group, among the asthmatic subgroup, mean LMS was greater in nonatopic asthmatic patients than in atopic asthmatic patients. Asthmatic patients had a higher LMS than nonasthmatic patients (p < 0.0001). Asthmatic patients were more likely than nonasthmatic patients to have NPs (57.6% versus 25%; p = 0.0015), regardless of atopic status. Mean LMS was higher in NP patients compared with nonpolyp patients (p < 0.0001), independent of atopic status. Mean LMS was not affected by sensitivity to any particular allergen, with the exception of cockroach-allergic patients who were more likely to have an LMS of >10 (p = 0.0236) and had more severe maxillary sinus involvement (p = 0.0391). Conclusion These data indicate a strong relationship between CRS severity, as measured by LMS, and chronic airway inflammatory diseases, asthma, and NPs. The association between LMS and atopic status appears weak. The present study suggests that CRS is an inflammatory disease that occurs independently of systemic IgE-mediated pathways.

Review of current guidelines related to the diagnosis and treatment of rhinosinusitis.

Purpose of reviewRhinosinusitis is one of the most common medical complaints, affecting nearly 31 million US citizens annually. Multiple medical professionals including emergency medicine, internal medicine, allergy, and otolaryngology treat rhinosinusitis, resulting in high-practice variability. This review will discuss recommendations of the 2007 American Academy of Otolaryngology – Head and Neck Surgerys multispecialty panel on evidence based clinical practice guidelines for diagnosis and treatment of rhinosinusitis. Recent findingsThe task force for recommendations defines rhinosinusitis as follows: acute bacterial, viral, chronic, or recurrent acute rhinosinusitis. For acute rhinosinusitis three symptoms are required: purulent nasal discharge with nasal obstruction and/or facial pain-pressure-fullness lasting between 10 days and 4 weeks. For viral rhinosinusitis, imaging is not recommended and treatment is symptomatic. For acute bacterial rhinosinusitis in an otherwise healthy patient, symptomatic relief is recommended including pain control. Amoxicillin is the first-line antibiotic of choice if needed. Radiographic imaging should be considered if an infectious complication is suspected. Chronic rhinosinusitis is likely when symptoms persist for greater than 12 weeks, with computed tomography being the gold standard for diagnostic testing. Nasal endoscopy and allergy/immune testing are also considered. SummaryAccurate diagnosis of rhinosinusitis with recommended treatments should standardize management. However, these recommendations are guidelines and the clinicians judgment is highly important.

The dilemma of midline destructive lesions: a case series and diagnostic review

BACKGROUNDnMidline destructive lesions (MDLs) of the nose are a diagnostic dilemma due to an extensive differential diagnosis and vague presenting signs and symptoms. Etiologies may be neoplastic, autoimmune, traumatic, infectious, or unknown.nnnSTUDY DESIGNnCase series and review of the literature were done.nnnMETHODSnMedical records of 8 patients presenting with an MDL were reviewed.nnnRESULTSnEach patient received nasal endoscopy, computed tomography scan of the sinuses, laboratory workup, culture (aerobes, anaerobes, fungus, and acid-fast bacilli), and biopsy with flow cytometry. Laboratory tests included complete blood count, basic metabolic panel, erythrocyte sedimentation rate, angiotensin-converting enzyme, antineutrophil antibodies, rheumatoid factor, anti-Ro and anti-La antibodies, Epstein-Barr virus antibodies, coccidiomycosis serology, HIV antibodies, fluorescent treponemal antibody absorption, classic antineutrophil cytoplasmic antibodies, perinuclear antineutrophil cytoplasmic antibody, proteinase 3, and myeloperoxidase. Choice of diagnostic study was individualized for each patient. Two patients were diagnosed with natural killer/T-cell lymphoma, 2 were diagnosed with Wegeners granulomatosis, and 4 remained idiopathic, despite the extensive workup. A diagnostic algorithm to aid in the approach to MDLs is presented.nnnCONCLUSIONSnThe diagnosis of MDLs remains difficult but is aided by a systematic approach and familiarity with multiple diagnostic techniques. It is imperative to take multiple tissue specimens from various sites, send them fresh, and communicate suspicion of lymphoma. Despite diagnostic advances and improved understanding of the diseases underlying MDLs, an etiology is often not identified.

Localized amyloidosis of the nasal and paranasal mucosa: a rare pathology

Localized amyloidosis of the nasal and paranasal mucosa: a rare pathology Aaron N. Pearlman, MD⁎, Jill S. Jeffe, MD, Debra L. Zynger, MD, Anjana V. Yeldandi, MD, David B. Conley, MD Department of Otolaryngology—Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL USA Received 16 September 2008

Epidemiology of Nasal Polyps

The prevalence of nasal polyps (NP) in the population has been grossly estimated as 1–4%. An association between NP and allergic rhinitis (AR) is weak, with NP prevalence in patients with AR estimated between 1.5 and 1.7% and this incidence approaches that of the general population. Large cohort studies have revealed a strong association between asthma and NP. The incidence of NP increases with age and is likely the greatest between 40 and 60 years of age. If NP are found in a child, a workup for cystic fibrosis should be conducted. Genetic inheritance has been proposed as a possible etiology of NP but remains unclear. Up to 50% of aspirin insensitive patients have NP and up to 36% of patients with NP may have some form of analgesic insensitivity. Allergic fungal rhinosinusitis is a known underlying pathophysiologic etiology in a subset of CRS patients and is strongly associated with NP. Ethnic and geographic variation has emerged as a potential modifier in NP pathophysiology.

Results of Combined Multispecialty Endoscopic Dacryocystorhinostomy

Abstract Objective: To characterize the pre- and post-operative findings in patients undergoing endoscopic dacryocystorhinostomy (eDCR) performed jointly by ophthalmologists and otolaryngologists. Methods: Retrospective case series consisting of all the patients who underwent eDCR for nasolacrimal duct obstruction at New York Presbyterian Hospital/Weill Cornell Medical College between the 2009–2012 academic years. Patients were followed post-operatively for at least six months. The primary endpoint assessed in this study was symptom recurrence (epiphora). Results: A total of 20 patients (25 total cases) underwent eDCR within the study interval. Of the 25 cases, 7 (28.0%) represented reoperations due to recurrent symptoms. All 20 patients in the study exhibited sinus pathology, as determined during a pre-operative otolaryngology assessment. As a result, 16 of these patients (80.0%) underwent concurrent sinonasal surgery at the time of eDCR. The success rate in cases without prior DCR was 83.3% (15/18). Only 57.1% of revision cases (4/7) reported resolution of epiphora following surgery. Conclusion: While a joint approach to eDCR did not appear to significantly improve efficacy, it offered the advantage of having an otolaryngologist assess and treat concurrent sinonasal pathology, which was seen in every patient in our series. Given our findings, as well as the technical difficulty often associated with the procedure, there may be great utility in performing eDCR in conjunction with an otolaryngologist.

Community‐acquired methicillin‐resistant Staphylococcus aureus nasal abscesses in a lower socioeconomic urban population

To determine the prevalence of community‐acquired methicillin‐resistant S. aureus (CA‐MRSA) and methicillin‐sensitive S. aureus (MSSA) nasal abscesses in a lower socioeconomic status urban population over a 5‐year period.

Respiratory epithelial adenomatoid hamartomas: An increasingly common diagnosis in the setting of nasal polyps.

Background Respiratory epithelial adenomatoid hamartomas (REAH) are benign nose neoplasms found in the nasal cavity and sinuses. Symptoms include anosmia, nasal obstruction, facial pressure, and rhinorrhea. Although previously thought to be rare, these tumors are being increasingly recognized on pathology in patients undergoing endoscopic sinus surgery. However, REAH is difficult to diagnose before surgery because it may mimic other entities, such as nasal polyps or inverted papilloma, and is often found incidentally only after surgery. Objective The aims of this study were to (1) add an additional case series of REAH to the literature, (2) report unique imaging findings on computed tomography and magnetic resonance imaging, and (3) pool and summarize all available data from existing publications. Methods Retrospective chart review from years 2004 to 2015 and a literature review Results Twenty-three cases were found in our case series, which included 12 men (52%) and 11 women (48%), with a mean age of 59 years. No cases were found before 2007. Lund-Mackay scores were comparable with those found in chronic rhinosinusitis without nasal polyposis. Imaging consistently demonstrated a discoid-shaped mass at the olfactory cleft. Fifty previous publications were found (4 prospective, 11 retrospective studies, 9 case series, 26 cases reports), which included 660 patients diagnosed with REAH. Pooled data revealed a mean age of 54 years (range, 9–86 years) and a male to female ratio of 3:2. Conclusion The results of our study further refined the average age at which REAH diagnosis occurs as 54 years old, although it may occur at any age. There is a clear male-to-female predominance (3:2). In addition, olfactory cleft widening and discoid soft tissue at the olfactory cleft are hallmark radiographic findings. The vast majority of published cases occurred during the past 4 years, which indicated increased recognition of REAH.

Chronic lymphocytic leukemia of the oropharyngeal cavity and paranasal sinuses: a case series and literature review

Chronic lymphocytic leukemia (CLL) is an indolent B‐lineage neoplasm responsible for 30% of all leukemias. The median age of onset is 67 years with a male predominance of 2:1. Localized infiltration in the oropharynx and paranasal sinuses is exceptionally rare. The aims of this study were (1) to add an additional case series of CLL with involvement of the oropharynx and paranasal sinuses to the literature and (2) to determine incidence and demographic data.

Does long-term success from endoscopic DCR correlate with early post-operative reduction in tearing?

PURPOSEnThe purpose of the study was to determine the association between early post-operative improvement in tearing and the long-term success rate of endoscopic dacryocystorhinostomy (eDCR).nnnMETHODSnA retrospective review of consecutive patients who underwent eDCR and were followed up for at least 6u202fmonths at our institution from January 2010 to December 2017 was performed.nnnRESULTSn47 cases(39 patients) of eDCR met the inclusion and exclusion criteria during this time period. Mean follow up after the surgery was 12.5u202f±u202f8u202fmonths. In 45 out of 47 (96%) cases post-operative improvement in epiphora within 2u202fweeks of surgery, or lack thereof, correlated with long-term success or failure of the procedure. There were only 2 cases in which the patients felt improvement in tearing at the initial post-operative visit and the tearing recurred in the late post-operative period (>6u202fmonths).nnnCONCLUSIONSnThere is a strong association between the early initial post-operative assessment of tearing resolution and the long-term result of eDCR.