Ahmed Bassiouni

Association between Group 2 Innate Lymphoid Cells enrichment, nasal polyps and allergy in Chronic Rhinosinusitis

Group 2 innate lymphoid cells (ILC2s) were shown to be involved in the initiation and coordination of Th2‐type immune responses in allergic disease animal models. Recently, ILC2s enrichment was noted in chronic rhinosinusitis (CRS) patients; however, the role of ILC2s in coordinating the Th2 response in CRS remains to be elucidated. Here, we characterize the ILC2 compartment in CRS by investigating the correlations between ILC2s, Th2 cells and Th2 cytokines expression in CRS patients.

Long-term outcomes for the endoscopic modified Lothrop/Draf III procedure: a 10-year review.

To detail the long‐term outcomes of the endoscopic modified Lothrop procedure (EMLP) (also know as Draf III/frontal drillout) and identify key risk factors for failure.

When FESS fails: The inflammatory load hypothesis in refractory chronic rhinosinusitis†

Through recent advances in research, our understanding of chronic rhinosinusitis (CRS) has evolved to consider it as an inflammatory condition of the mucosa brought about by multiple factors. However, surgical management is still ruled by the classical concepts of functional endoscopic sinus surgery (FESS), which emphasizes the importance of ostial obstruction and sinus ventilation. These concepts fail to provide sufficient explanation for the presence of a subset of patients with refractory CRS who fail to respond to conventional FESS. Recent outcome studies have shown that high‐grade mucosal inflammation often results in a poor outcome and that this patient group may show improved results with more radical surgery. This review examines the “inflammatory load hypothesis” as a possible explanation. We hypothesize that the grade of the inflammation is the most important predictor of long‐term outcomes. Surgery, therefore, has a significant role not only in reestablishing ventilation, but also with removing the inflammatory load in the affected sinuses. We suspect that in these severely diseased patients, a more radical removal of local proinflammatory factors during surgery may improve patient outcomes.

Role of frontal sinus surgery in nasal polyp recurrence

Patients with aggressive nasal polyp recurrence form an important subgroup of patients with refractory sinus disease. The objectives of this study were to establish patterns of polyp recurrence and evaluate the effect of frontal sinus surgery (Draf 2a vs. Draf 3) on polyp recurrence.

Sinonasal Microbiome Sampling: A Comparison of Techniques

Background The role of the sino-nasal microbiome in CRS remains unclear. We hypothesized that the bacteria within mucosal-associated biofilms may be different from the more superficial-lying, free-floating bacteria in the sinuses and that this may impact on the microbiome results obtained. This study investigates whether there is a significant difference in the microbiota of a sinonasal mucosal tissue sample versus a swab sample. Methods Cross-sectional study with paired design. Mucosal biopsy and swab samples were obtained intra-operatively from the ethmoid sinuses of 6 patients with CRS. Extracted DNA was sequenced on a Roche-454 sequencer using 16S-rRNA gene targeted primers. Data were analyzed using QIIME 1.8 software package. Results At a maximum subsampling depth of 1,100 reads, the mean observed species richness was 33.3 species (30.6 for swab, versus 36 for mucosa; p > 0.05). There was no significant difference in phylogenetic and non-phylogenetic alpha diversity metrics (Faith’s PD_Whole_Tree and Shannon’s index) between the two sampling methods (p > 0.05). The type of sample also had no significant effect on phylogenetic and non-phylogenetic beta diversity metrics (Unifrac and Bray-Curtis; p > 0.05). Conclusion We observed no significant difference between the microbiota of mucosal tissue and swab samples. This suggests that less invasive swab samples are representative of the sinonasal mucosa microbiome and can be used for future sinonasal microbiome studies.

The bacteriology of chronic rhinosinusitis and the pre-eminence of Staphylococcus aureus in revision patients

The role of bacteria in the etiopathogenesis of chronic rhinosinusitis (CRS) remains an area of interest. The impact of surgery and factors such as the presence of polyps, asthma, and aspirin sensitivity on the bacterial state are poorly understood. To determine the effect of these factors, this study examines the culture results from a large cohort of CRS patients.

Long-term outcomes in primary powered endoscopic dacryocystorhinostomy

Aim To assess the long-term anatomical and functional outcomes of primary powered endoscopic dacryocystorhinostomy (DCR). Methods Retrospective review of all primary powered endoscopic DCRs performed over a 10-year period from 2003 to 2012. A minimum of 12 months follow-up after stent removal was required for inclusion into this study. Patient records were reviewed for demographic data, clinical and surgical profiles, adjunctive procedures, complications and success rates at last follow-up. Anatomical success was defined as a patent ostium on irrigation, and functional success as free flow of dye into ostium, and resolution of epiphora. Results Ninety powered endoscopic DCRs were performed on 69 patients. The mean age at surgery was 58.7 years (range 4–91 years). All patients presented with epiphora. 50.7% (35/69) patients underwent adjunctive endonasal procedures. The mean follow up was 21.8 months (range: 12–103 months). No intraoperative complications were noted. Postoperative complications noted included postoperative bleeding, ostium granuloma and membrane over internal common opening in one patient each. At last follow-up, the final anatomical success was achieved in 97.7% and functional success in 95.5% of the cases. Conclusions Powered endoscopic DCR is a safe procedure and offers excellent long-term results. Adjunctive endonasal procedures should be performed where indicated.

Long-term results after primary frontal sinus surgery

The objectives of this study were to evaluate the long‐term frontal ostium patency rate and symptom improvement in patients undergoing primary endoscopic frontal sinusotomy (Draf 2A) and to assess the impact of patient factors, disease factors, and frontal ostium size on surgical outcomes.

Probiotic manipulation of the chronic rhinosinusitis microbiome

Staphylococcus aureus (SA) is a key pathogenic component of the chronic rhinosinusitis (CRS) microbiome and is associated with increased disease severity and poor postoperative outcomes. Probiotic treatments potentially offer a novel approach to the management of pathogenic bacteria in these recalcitrant patients through supporting a healthy community of commensal species. This study aims to investigate the probiotic properties of Staphylococcus epidermidis (SE) against SA in a mouse model of sinusitis.

Does mucosal remodeling in chronic rhinosinusitis result in irreversible mucosal disease

Mucosal remodeling in the sinuses is a recently described phenomenon in which the mucosa undergoes potentially irreversible changes as a result of ongoing underlying inflammatory processes. Research into remodeling that occurs in the bronchial airways in asthmatic patients has led to modification of asthma treatment guidelines. However, remodeling in the sinuses has still not led to changes in current medical or surgical management of chronic rhinosinusitis. Upper airway remodeling constitutes a new area of research that poses many unanswered clinical questions and may potentially alter the management of patients with severe chronic rhinosinusitis.Laryngoscope, 122:225–229, 2012