scholarly journals Nasal Nitric Oxide in Chronic Rhinosinusitis with or without Nasal Polyps: A Systematic Review with Meta-Analysis

2020 ◽  
Vol 9 (1) ◽  
pp. 200 ◽  
Author(s):  
Pasquale Ambrosino ◽  
Antonio Molino ◽  
Giorgio Alfredo Spedicato ◽  
Paolo Parrella ◽  
Roberto Formisano ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Chronic Rhinosinusitis ◽  
Regression Models ◽  
Nasal Polyps ◽  
Meta Analysis ◽  
Final Analysis ◽  
Healthy Controls ◽  
Intranasal Corticosteroids ◽  
Nasal Nitric Oxide ◽  
And Control

Background and Aims: There has been a recent growing interest in the role of nasal nitric oxide (nNO) as a biomarker for osteomeatal complex obstruction in paranasal sinus diseases. By using meta-analysis, we systematically reviewed the literature to establish the possible link between nNO concentration and chronic rhinosinusitis with nasal polyps (CRSwNP) or without (CRSsNP). Methods: We systematically searched the EMBASE, PubMed, Scopus, and Web of Science databases for related studies. Differences between controls and cases were reported as standardized mean difference (SMD), with 95% confidence intervals (95% CI), using the random-effects method. Results: We selected 23 articles for the final analysis: 15 with data on 461 CRSwNP patients and 384 healthy controls, 10 with data on 183 CRSsNP patients and 260 controls, and 14 studies on 372 CRSwNP and 297 CRSsNP patients. CRSwNP patients showed significantly lower nNO values when compared to both healthy controls (SMD: −1.495; 95% CI: −2.135, −0.854; p < 0.0001) and CRSsNP patients (SMD: −1.448; 95% CI: −2.046, −0.850; p < 0.0001). Sensitivity and subgroup analyses confirmed the results, which were further refined by regression models. They showed that an increasing aspiration flow is related to a greater difference in nNO levels between cases and control subjects. We also documented lower nNO levels in CRSsNP patients with respect to controls (SMD: −0.696; 95% CI: −1.189, −0.202; p = 0.006), being this result no longer significant when excluding patients in therapy with intranasal corticosteroids. As shown by regression models, the increased Lund–Mackay score indicates a high effect size. Conclusions: nNO levels are significantly lower in CRSwNP, especially when using higher aspiration flows. Additional studies are needed to define one single standardized method and normal reference values for nNO.

Predictive and Diagnostic Value of Nasal Nitric Oxide in Eosinophilic Chronic Rhinosinusitis with Nasal Polyps

2020 ◽  
Vol 181 (11) ◽  
pp. 853-861
Author(s):  
Hao Lv ◽  
Pei-Qiang Liu ◽  
Rong Xiang ◽  
Wei Zhang ◽  
Shi-Ming Chen ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Upper Airway ◽  
Central China ◽  
Clinical Parameters ◽  
Total Ige ◽  
Nasal Nitric Oxide ◽  
Eosinophilic Chronic Rhinosinusitis ◽  
Plasma Cytokines

<b><i>Background:</i></b> A hallmark of eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) is mucosal eosinophil-predominant inflammation. Nasal nitric oxide (nNO) is a known biomarker of eosinophilic inflammation in the upper airway. However, the utility of nNO measurement in the upper airway remains controversial. The present study aimed to compare the use of other clinical parameters with nNO to prediagnose patients with eCRSwNP from Central China. <b><i>Methods:</i></b> From June 2019 to December 2019, 70 patients with CRSwNP undergoing endoscopic sinus surgery and 30 healthy subjects were enrolled. nNO measurements were performed in all of these subjects. Computed tomography scans, full blood count with differential analysis, and determination of total immunoglobulin E (total IgE) and plasma cytokines were performed before surgery. Receiver operating characteristic curves and logistic regression analysis were used to assess the predictive potential of the clinical parameters. <b><i>Results:</i></b> We recruited 24 patients with eCRSwNP and 46 with noneosinophilic CRSwNP (non-eCRSwNP). In patients with eCRSwNP, nNO levels were significantly higher than those in patients with non-eCRSwNP (<i>p</i> &#x3c; 0.0001). Blood eosinophil percentages and counts, total IgE, and CT-derived ethmoid sinus and maxillary sinus ratio (E/M ratio) were all significantly higher compared with those in patients with non-eCRSwNP (<i>p</i> &#x3c; 0.05). To diagnose eCRSwNP, the highest area under the curve (0.803) was determined for nNO. At a cutoff of &#x3e;329 parts per billion (ppb), the sensitivity was 83.30% and the specificity was 71.70%. However, the levels of plasma cytokines Th1/Th2 were not significantly different between the histological types of CRSwNP (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Measurement of nNO is useful for the early diagnosis of eCRSwNP.

scholarly journals Measurement of Nasal Nitric Oxide in Chronic Rhinosinusitis and Its Relationship to Patient-Reported Outcome: A Longitudinal Pilot Study

2019 ◽  
pp. 014556131988062 ◽  
Author(s):  
Cecilia Alexandersson ◽  
Lisa Tuomi ◽  
Anna-Carin Olin
Keyword(s):  
Nitric Oxide ◽  
Chronic Rhinosinusitis ◽  
Statistical Significance ◽  
Measurement Techniques ◽  
Control Group ◽  
Healthy Controls ◽  
Nasal Nitric Oxide ◽  
Patient Reported ◽  
Significant Change ◽  
Snot 22

Objective: To assess whether nasal nitric oxide (nNO) levels differ between healthy and sick sinuses in chronic rhinosinusitis (CRS). A secondary aim was to assess whether nNO levels change after treatment of CRS and whether there is an association with radiological findings or symptoms. Method: Three groups of 12 participants each were examined: patients with CRS without polyposis (CRS group), patients with symptoms of CRS but radiologically normal sinuses (symptoms-only), and healthy controls. Measurements of nNO were carried out using aspiration method and humming maneuver. All participants completed the Sino-Nasal Outcome Test (SNOT-22). A second nNO measurement was done after treatment in the CRS group (n = 9) and the healthy control group (n = 12). Results: Nasal NO did not differ between any of the groups with any of the measurement techniques. There was a trend toward lower nNO values in the CRS group compared with the symptoms-only group and healthy controls, but it did not reach statistical significance. The SNOT-22 demonstrated inferior values for the CRS and symptoms-only groups compared with the healthy controls. At follow-up, no statistically significant change was found for the nNO measurements in either group. Conclusion: Irrespective of occluded or open ostiomeatal complexes, no statistically significant differences in nNO were found in CRS compared with healthy controls using aspiration and humming methods. Treatment of CRS improved sinus patency without accompanying a significant change in nNO. This study can therefore not conclude that nNO can be used as a diagnostic tool for CRS without polyposis.

scholarly journals Nasal nitric oxide screening for primary ciliary dyskinesia: systematic review and meta-analysis

2014 ◽  
Vol 44 (6) ◽  
pp. 1589-1599 ◽  
Author(s):  
Samuel A. Collins ◽  
Kerry Gove ◽  
Woolf Walker ◽  
Jane S.A. Lucas
Keyword(s):  
Nitric Oxide ◽  
Systematic Review ◽  
Primary Ciliary Dyskinesia ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Breath Hold ◽  
Healthy Controls ◽  
Tidal Breathing ◽  
Nasal Nitric Oxide ◽  
Ciliary Dyskinesia

Nasal nitric oxide (nNO) concentrations are low in patients with primary ciliary dyskinesia (PCD) providing a noninvasive screening test.We conducted a systematic review of the literature to examine the utility of nNO in screening for PCD, in particular 1) different respiratory manoeuvres during sampling (velum closure, tidal breathing, etc.), 2) accuracy in screening young/uncooperative children, 3) stationary versus portable analysers, and 4) nNO in “atypical” PCD.96 papers were assessed according to modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria and 22 were included in this review.Meta-analysis of 11 studies comparing nNO during a velum closure breath hold gave a mean±sd nNO of 19.4±18.6 nL·min-1 in PCD (n = 478) and 265.0±118.9 nL·min-1 in healthy controls (n = 338). Weighted mean difference for PCD versus healthy controls was 231.1 nL·min-1 (95% CI 193.3–268.9; n = 338) and 114.1 nL·min-1 (95% CI 101.5–126.8; n = 415) for PCD versus cystic fibrosis. Five studies of nNO measurement during tidal breathing demonstrated that this is an acceptable manoeuvre in young children where velum closure is not possible, but the discriminatory value was reduced. Four small studies of portable NO analysers suggest these are reliable tools for screening for PCD. However, nNO must be interpreted alongside clinical suspicion. Future studies should focus on standardising sampling techniques and reporting.

scholarly journals Exhaled and nasal nitric oxide in chronic rhinosinusitis patients with nasal polyps in primary care

2018 ◽  
Vol 56 (1) ◽  
pp. 59-64 ◽  
Author(s):  
M. Frendo ◽  
K. Hakansson ◽  
S. Schwer ◽  
A.T. Ravn ◽  
H. Meteran ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Primary Care ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Nasal Nitric Oxide

Correlation between culture-identified bacteria in the middle nasal meatus and CT score in patients with chronic rhinosinusitis

2014 ◽  
Vol 63 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Barbora Uhliarova ◽  
Renata Karnisova ◽  
Martin Svec ◽  
Andrea Calkovska
Keyword(s):  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Nasal Polyps ◽  
Pathogenic Bacteria ◽  
Bacterial Species ◽  
Severe Form ◽  
Healthy Controls ◽  
Endoscopic Control ◽  
And Control ◽  
Middle Nasal Meatus

The aim of this study was to compare bacteriological findings in the middle nasal meatus in patients with chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) and healthy controls, and to investigate the correlation between the prevalence of culture-identified bacteria and the severity of sinus disease. Bacterial culture was performed using a swab from the middle nasal meatus under endoscopic control in 72 patients with CRSwNP, 25 patients with CRSsNP and 59 healthy controls. Computed tomography (CT) scans were graded for severity using the Lund–Mackay scoring system. Patients with more severe forms of CRS with and without nasal polyps had significantly higher rates of pathogenic bacteria in the middle nasal meatus compared with patients with lower CT scores of the paranasal sinuses. There were no significant differences in bacterial species among CRSwNP, CRSsNP and control patients. These results demonstrate, for the first time, that colonization by pathogenic bacteria in patients with CRSwNP and CRSsNP is associated with a more severe form of the disease, as assessed by a pre-operative CT scan of the paranasal sinuses. The results suggest a role for bacterial infection in the pathogenesis of CRS. However, bacteria do not appear to play a role in the development of nasal polyposis in patients with CRS.

scholarly journals Efficacy and safety of omalizumab in chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e047344
Author(s):  
Qingwu Wu ◽  
Lianxiong Yuan ◽  
Huijun Qiu ◽  
Xinyue Wang ◽  
Xuekun Huang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Chronic Rhinosinusitis ◽  
Randomised Controlled Trials ◽  
Nasal Polyps ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomised Controlled

ObjectivesTo assess the efficacy and safety of omalizumab for chronic rhinosinusitis with nasal polyps (CRSwNP) and to identify evidence gaps that will guide future research on omalizumab for CRSwNP.DesignSystematic review and meta-analysis.Data sourcesA comprehensive search was performed in PubMed, Embase, Web of Science and the Cochrane Library on 13 October 2020.Eligibility criteriaRandomised controlled trials (RCTs) comparing omalizumab with placebo, given for at least 16 weeks in adult patients with CRSwNP.Data extraction and synthesisTwo independent authors screened search results, extracted data and assessed studies using the Cochrane risk of bias tool. Data were pooled using the inverse-variance method and expressed as mean differences (MDs) with 95% CIs. Heterogeneity was assessed by the χ2 test and the I2 statistic.ResultsA total of four RCTs involving 303 participants were identified. When comparing omalizumab to placebo, there was a significant difference in Nasal Polyps Score (MD=−1.20; 95% CI −1.48 to −0.92), Nasal Congestion Score (MD=−0.67; 95% CI −0.86 to −0.48), Sino-Nasal Outcome Test-22 (MD=−15.62; 95% CI −19.79 to −11.45), Total Nasal Symptom Score (MD=−1.84; 95% CI −2.43 to −1.25) and reduced need for surgery (risk ratio (RR)=5.61; 95% CI 1.99 to 15.81). Furthermore, there was no difference in the risk of serious adverse events ((RR=1.40; 95% CI 0.29 to 6.80), adverse events (RR=0.83; 95% CI 0.60 to 1.15) and rescue systemic corticosteroid (RR=0.52; 95% CI 0.17 to 1.61).ConclusionsThis was the first meta-analysis that identified omalizumab significantly improved endoscopic, clinical and patient-reported outcomes in adults with moderate to severe CRSwNP and it was safe and well tolerated.PROSPERO registration numberCRD42020207639.

scholarly journals Association between methylation in nasal epithelial TSLP gene and chronic rhinosinusitis with nasal polyps

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Jingyun Li ◽  
Jian Jiao ◽  
Yunbo Gao ◽  
Yuan Zhang ◽  
Luo Zhang
Keyword(s):  
Dna Methylation ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Inferior Turbinate ◽  
Nasal Resistance ◽  
Total Ige ◽  
Control Subjects ◽  
Human Nasal Epithelial Cells ◽  
Serum Total Ige ◽  
And Control

Abstract Background This study was performed to determine whether there was any association between abnormal DNA methylation of a thymic stromal lymphopoietin (TSLP) locus and pathogenesis of chronic rhinosinusitis (CRS). Methods A total of 48 CRS patients with nasal polyps (CRSwNP), 28 CRS patients without nasal polyps (CRSsNP) and 21 control subjects were enrolled into the study; and evaluated for serum total IgE level, olfactory score and nasal resistance. Samples were obtained from nasal polyps of CRSwNP patients, ethmoid mucosae of CRSsNP patients and inferior turbinate (IT) mucosa of control subjects during surgery, and used to isolate purified primary human nasal epithelial cells (HNECs). Genomic DNA was extracted from purified primary HNECs of each subject and DNA methylation ratios for a selected region of the TSLP gene were screened the using MassARRAY EpiTYPER. Results A total of 17 CpG units were analyzed; of which two CpG units (CpG3 and 22:23:24) had increased methylation ratios in the CRSwNP patients compared to the CRSsNP and control subjects after correction for false discovery rate (FDR) (Q < 0.1). The methylation ratios at both CpG3 and CpG22:23:24 units were positively correlated with olfactory score (r = 0.41, P = 0.0001; r = 0.25, P = 0.021) and unilateral nasal resistance at 75 Pa (r = 0.24, P = 0.04; r = 0.24, P = 0.036) and 150 Pa (r = 0.34, P = 0.004; r = 0.25, P = 0.031). Total nasal resistance at 75 Pa/150 Pa or serum total IgE levels were not correlated with the methylation ratios at either CpG unit. Conclusions Increased DNA methylation at the TSLP locus is likely to be associated with CRSwNP pathogenesis; however these findings need to be confirmed in larger multicentre group studies.

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