Eng Hooi Ooi

Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy

Objectives/Hypothesis Surgical excision is regarded as the treatment of choice for sinonasal inverted papilloma. Resection can be performed endoscopically or through an external approach. Debate exists about which approach to use. The study presents different endoscopic techniques for various tumor locations and reviews the results.

Innate immunity in the paranasal sinuses: a review of nasal host defenses

Background Chronic rhinosinusitis (CRS) is a common inflammatory disorder of the paranasal sinuses. An abnormal host response to common bacterial or fungal pathogens is thought to be an important factor in the disease process. Host sinonasal epithelium plays an important role in initially recognizing the presence of microbes and responding by increasing production of antimicrobial peptides and cytokines, with recruitment of phagocytes and lymphocytes of the adaptive immune system, to eliminate the infection. Recently, the innate immune system and its complex interplay with the adaptive immune system are increasingly being recognized as important in the pathogenesis of chronic inflammatory diseases such as asthma and CRS. Methods Review of recent findings on innate immunity in the pathogenesis of CRS. Results New areas of research into potentially novel therapies for CRS are highlighted in this review, with emphasis on toll-like receptors, antimicrobial peptides (cathelicidins and defensins), and surfactant proteins. Conclusion This review provides an overview of innate immunity in the sinonasal tract and discusses potential use of innate immune peptides as treatments against fungi, biofilms, and superantigens in CRS.

Management of lateral sinus thrombosis: update and literature review.

The management of four cases of lateral sinus thrombosis (LST) over a four-year period at the Royal Darwin Hospital is presented in this retrospective review. The patients were aboriginal and presented with otalgia, otorrhoea and sepsis. Two cases had an associated complication of an otitic hydrocephalus and a subperiosteal abscess. Cholesteatoma was found in three cases. Computed tomography (CT) scan confirmed the LST in three cases. Three patients were anaemic and thrombocytopenic. All patients had positive blood cultures. The organisms were predominantly mixed anaerobes and Bacteroides species. Three patients were managed surgically as a two-stage procedure. One patient was managed as a single-stage procedure with a modified radical mastoidectomy. Therapeutic anticoagulation was utilized in one case. There were no deaths. The prognosis of LST is good if treatment is instituted early with broad-spectrum intravenous antibiotics and surgery. The role of clot removal at surgery and the use of anticoagulation are discussed in this paper.

Nasal mucosa expression of lactoferrin in patients with chronic rhinosinusitis

Objective/Hypothesis: Antimicrobial peptides, such as lactoferrin, are an important component of the innate immune system. They offer the body a first line defense against a wide range of invading pathogens. The diverse antipathogenic action of lactoferrin has been well characterized; however, the role that this peptide plays in chronic conditions such as rhinosinusitis remains largely unknown. This study aims to examine the level of lactoferrin expression in the nasal mucosa of patients with chronic rhinosinusitis (CRS).

Th2 immunological inflammation in allergic fungal sinusitis, nonallergic eosinophilic fungal sinusitis, and chronic rhinosinusitis

Background Noninvasive fungal sinusitis is a heterogenous group of conditions including allergic fungal sinusitis (AFS) and nonallergic eosinophilic fungal sinusitis (NEFS). Th2-mediated cascades have been postulated to be the major inflammatory response in patients with AFS although other mechanisms also may be involved. The detailed mucosal Th2 cytological status of NEFS still has not been studied in great depth. Methods Using a meticulous patient selection algorithm over a 2-year period, infundibular mucosal tissue from patients with AFS, NEFS, chronic rhinosinusitis (CRS), and normal controls was studied (n = 59). Immunohistochemistry for mast cells, eosinophils, and immunoglobulin E (IgE) cells was performed and cell counts per unit area were measured. Results Mast cell, eosinophil, and IgE+ cell numbers were significantly raised in patients with AFS, NEFS, and CRS when compared with controls. There was no significant difference between cell numbers in patients with AFS and NEFS. Conclusion Patients with AFS exhibit a classic Th2 inflammatory response in nasal mucosal tissue with NEFS and CRS patients showing evidence of a similar Th2 cascade, including the presence of IgE+ cells.

Surfactant Protein D Expression in Chronic Rhinosinusitis Patients and Immune Responses In Vitro to Aspergillus and Alternaria in a Nasal Explant Model

Objectives/Hypothesis: Common fungi have been implicated in the pathogenesis of chronic rhinosinusitis (CRS) with eosinophilic mucus (EMCRS). Surfactant protein (SP)‐D plays an important role in the immune response to Aspergillus fumigatus in the lungs. We sought to determine whether SP‐D is expressed in nasal mucosa and investigated the response of SP‐D in vitro to fungal allergens.

Intralesional corticosteroid injection and dilatation provides effective management of subglottic stenosis in Wegener's granulomatosis.

To describe our experience with the use of intralesional corticosteroid injection and dilatation (ILCD) in the management of subglottic stenosis (SGS).

Fungal allergens induce cathelicidin LL-37 expression in chronic rhinosinusitis patients in a nasal explant model

Background Fungus is thought to play an important role in some subgroups of chronic rhinosinusitis (CRS) patients with eosinophilic mucus (EMCRS). The cathelicidin LL-37 is an important innate defense peptide with antimicrobial activity but its responses in CRS and EMCRS patients have not been established. We investigated the innate immune responses of LL-37 in nasal tissue from CRS and EMCRS patients to fungal allergen challenge. Methods The levels of LL-37 produced by nasal tissue and secreted in response to fungal allergen challenge were determined by a nasal tissue explant in vitro model. LL-37 mRNA and protein levels were quantified by real-time reverse-transcriptase–polymerase chain reaction and immunoassay methods. Results LL-37 mRNA expression in CRS, but not EMCRS patients, is significantly upregulated by Aspergillus (mean fourfold increase) and Alternaria (mean sixfold increase) extracts in a dose-response manner (p < 0.001). LL-37 peptide levels in the nasal tissue from CRS patients are increased in response to Alternaria (p < 0.05). In contrast, with EMCRS patients, the expression of LL-37 peptide in nasal tissue is increased with Aspergillus (p < 0.001) but is reduced with Alternaria. We also observed a trend where levels of secreted LL-37 were decreased with higher doses of Alternaria and Aspergillus extracts. Conclusion LL-37 is significantly up-regulated at the mRNA and protein level in CRS patients in response to fungal allergens. However, EMCRS patients do not show increased LL-37 at either the mRNA or the protein level in response to Alternaria.

Response of Peripheral Blood Lymphocytes to Fungal Extracts and Staphylococcal Superantigen B in Chronic Rhinosinusitis

Background: Previous studies have suggested that chronic rhinosinusitis may result from a hypersensitivity response of the nasal mucosa to the presence of fungal antigens or staphylococcal superantigens in the nasal mucus. Both of these groups of antigens are present so frequently in the nasal mucus of patients with chronic rhinosinusitis that their presence together is likely to be a common event.

Canine fossa trephine for the severely diseased maxillary sinus

Background The appropriate surgical approach to the severely diseased maxillary sinus is still debatable. Some advocate creating a wide maxillary antrostomy to allow for increased ventilation and improved delivery of postoperative medication. Others, however, recommend more aggressive surgery with complete clearance of all diseased tissue. The aim of this study was to evaluate the outcome of canine fossa puncture and canine fossa trephine (CFT) for the severely diseased maxillary sinus. Methods A retrospective chart review was performed on 97 patients who underwent a CFT as a part of endoscopic sinus surgery or modified Lothrop procedure. Outcomes were measured in terms of the maxillary sinus endoscopy grade at last follow-up and need for revision surgery. Two groups were formed: those who experienced recurrence of disease and those who were disease free at last follow-up. A comparison was made between the two groups and differences were noted. Results A CFT was performed in 97 patients with nasal polyposis (NP) who had an average number of 2.38 previous sinus surgeries. At an average follow-up of 27.8 months, 80 of the patients were disease free. In 17 patients disease recurred, and 11 of those required revision surgery with a CFT. Those patients who had recurrence of disease tended to be more allergic, have higher Lund-Mackay score, and had an increased number of prior sinus surgeries. In addition, allergic fungal sinusitis was associated with a poorer prognosis after CFT. Conclusion CFT allows for complete clearance of all gross disease in the maxillary sinus. CFT decreases the chance of disease recurrence in patients with severe NP.