慢性鼻窦炎鼻息肉临床分型分期与疾病分类的标准化

中华医学会耳鼻咽喉科学分会和中华耳鼻咽喉科杂志编辑委员会于1997年在海口制订了“慢性鼻窦炎鼻息肉临床分型分期及内窥镜鼻窦手术疗效评定标准”（简称海口标准）。通过近10年来的临床实践，“海口标准”对规范慢性鼻窦炎、鼻息肉的临床分型，鼻内镜手术疗效的评价，以及在学术交流和临床科研等方面产生了巨大的影响。然而随着医疗卫生信息化的发展，“海口标准”的部分内容已不能完全适应临床工作和医疗卫生信息化的需求。     

Ⅲ型鼻窦炎鼻息肉临床分期探讨以及各期手术疗效分析

目的 探讨不同病变程度的Ⅲ型鼻窦炎鼻息肉内窥镜鼻窦手术的疗效和并发症。方法 将随访6-18个月的104例（208侧）Ⅲ型鼻窦炎鼻息肉依据病史、解剖结构、病变程度的临床上分为3期,并对各期手术临床疗效、并发症进行比较分析。结果 1、2、3期临床总有效率分别为93.06%、82.89%和70.00%;并发症发生率分别为5.56%、14.47%和25.00%。结论 Ⅲ型患者的解剖学改变（窦口鼻道复合体的完整性）及病变程度（肉芽增生及筛窦窦骨质增生）决定了手术的难度、风险及疗效,也应列为临床分期的客观依据。     

鼻内镜下治疗79例慢性鼻窦炎鼻息肉的临床观察

慢性鼻窦炎、鼻息肉是耳鼻咽喉科的常见病、多发病，传统的治疗方法是在额镜下手术，光线弱，或采用鼻外手术，损伤重，并且病变切除不彻底。鼻内镜的临床应用，使慢性鼻窦炎、鼻息肉治疗提高到了一个新的水平。我院自2001年6月～2003年6月期间，施行鼻内镜手术治疗79例慢性鼻窦炎、鼻息肉。现总结、分析如下。     

观察鼻内镜手术治疗慢性鼻窦炎鼻息肉的临床疗效

目的 观察鼻内镜手术治疗慢性鼻窦炎鼻息肉的临床疗效.方法 选取我院60例慢性鼻窦炎鼻息肉患者为研究对象,入选时间段为2015年11月-2020年11月,所有患者均经临床诊断确诊为慢性鼻窦炎鼻息肉.对这60例患者实施鼻内镜手术进行治疗,分析鼻内镜手术治疗慢性鼻窦炎鼻息肉患者的临床疗效.结果 在鼻内镜手术治疗方法的应用下,...     

Treatment of recurrent chronic hyperplastic sinusitis with nasal polyposis

OBJECTIVE: To demonstrate the long-term efficacy of intranasal furosemide, an inhibitor of the sodium chloride cotransporter channel at the basolateral surface of the respiratory epithelial cell, vs no therapeutic intervention vs intranasal mometasone furoate, a corticosteroid, in preventing relapses of chronic hyperplastic sinusitis with nasal polyposis. DESIGN: Randomized prospective controlled study. Patients were examined every 6 months during follow-up (range, 1-9 years). PATIENTS: One hundred seventy patients with bilateral obstructive or minimally obstructive chronic hyperplastic sinusitis with nasal polyposis. INTERVENTION: All patients were surgically treated in the ENT Department, University of Siena Medical School. One month after surgery, group 1 patients (n = 97) started treatment with intranasal furosemide, group 2 (n = 40) received no therapeutic treatment, and group 3 (n = 33) were treated with mometasone. MAIN OUTCOME MEASURES: Clinical and instrumental evaluation of postoperative outcomes. RESULTS: Seventeen (17.5%) of 97 patients in group 1, 12 (30.0%) of 40 patients in group 2, and 8 (24.2%) of 33 patients in group 3 experienced nasal polyposis relapses. We noted a prevalence of early-stage relapse in patients treated with furosemide or mometasone, whereas patients who did not receive any treatment experienced more severe grades of chronic hyperplastic sinusitis with nasal polyposis (P<.005). CONCLUSION: Use of intranasal furosemide represents a valid therapeutic treatment in the prevention of chronic hyperplastic sinusitis with nasal polyposis.     

A superantigen hypothesis for the pathogenesis of chronic hyperplastic sinusitis with massive nasal polyposis

BACKGROUND: The pathogenesis of chronic hyperplastic sinusitis with massive nasal polyposis is still an enigma; however, the molecular biology of this disease is beginning to become unraveled and the proinflammatory cytokines and the message and the product of these cytokines have all been identified in nasal polyps. However, the initial trigger that causes inflammation of the lateral wall of the nose to up-regulate lymphocytes and eosinophils is still unknown. METHODS: Thirteen patients with massive polyposis were studied. The mucus of the nasal cavities surrounding the nasal polyps was studied for both bacterial and fungal species. The lymphocytes of the nasal polyps were extracted and evaluated for the T-cell receptor, particularly, the variable beta region of this receptor. Enterotoxins (superantigens) of the bacteria were studied. Finally, the histopathology of nasal polyps was studied. RESULTS: Fifty-five percent of the patients had toxin-producing Staphylococcus aureus in the nasal mucus adjacent to the polyps. Three different enterotoxins were isolated, including Staphylococcus enterotoxin A, Staphylococcus enterotoxin B, and toxic shock syndrome toxin 1. The variable B specificity for these superantigens was identified also in the polyp lymphocyte T-cell receptor. CONCLUSION: A superantigen hypothesis for massive polyposis is suggested because the most common bacterial species found in the nasal mucus is Staphylococcus aureus. These bacteria produce enterotoxins in all of the cases studied and the corresponding variable beta region of the T-cell receptor also was up-regulated in the polyp lymphocytes in cases studied thus far. These data taken together suggest that the initial injury to the lateral wall of the nose may be the result of toxin-producing Staphylococci. Superantigens (enterotoxins) may up-regulate lymphocytes to produce cytokines that are responsible for the massive up-regulation of lymphocytes, eosinophils, and macrophages, the three most common inflammatory cells found in massive nasal polyposis.     

Paranasal sinus melanoma masquerading as chronic sinusitis and nasal polyposis

Malignant melanoma of the nose and paranasal sinuses can be a devastating disease, typically presenting at an advanced stage, with a 5-year survival rate ranging between 20 and 30%. It is an uncommon process, often misdiagnosed both clinically and pathologically. We present the case of an 80-year-old man who had a 2-month history of progressively worsening left-sided epistaxis and nasal obstruction. Radiographic evidence indicated the presence of soft tissue in the left maxillary sinus and nasal cavity resembling massive nasal polyposis and chronic fungal sinusitis. Magnetic resonance imaging was not performed because the patient had a pacemaker. After endoscopic debridement of the soft-tissue mass, frozen-section analysis detected no evidence of tumor. The final pathologic diagnosis was malignant melanoma. Otolaryngologists should be familiar with the difficulties inherent in the diagnosis and management of sinonasal melanomas.     

Superantigen hypothesis for the early development of chronic hyperplastic sinusitis with massive nasal polyposis

PURPOSE OF REVIEW: The pathogenesis, pathophysiology, and immunobiology of chronic hyperplastic sinusitis with massive nasal polyposis are starting to become unraveled. Allergy, viral infection, bacterial infection, fungal infection, and environmental pollution have all been suggested as possible initial triggers that may upregulate inflammation of the lateral wall of the nose to develop nasal polyposis. The purpose of this review is to present data from our laboratory that suggest that one of the possible early events in the development of inflammation of the lateral wall of the nose in chronic hyperplastic sinusitis with massive nasal polyposis is the production of exotoxins from Staphylococcus aureus. The exotoxins may act as superantigens and cause activation and clonal expansion of lymphocytes with specific Vbeta regions, resulting in massive cytokine production. RECENT FINDINGS: Recent published studies suggest that S. aureus is the most common organism isolated from the mucus adjacent to massive nasal polyposis. Staphylococci produce exotoxins. These exotoxins, sometimes known as enterotoxins, include SEA, SEB, and TSST-1. These exotoxins are capable of acting as superantigens and therefore, reacting with T lymphocytes with specific Vbetas in the lateral wall of the nose. Thereafter, it is possible that these lymphocytes are stimulated to produce both TH1 and TH2 cytokines, which have also been demonstrated in the nasal polyp. The consequence of these findings may be the upregulation and increased survival of eosinophils in the nasal polyp. SUMMARY: Staphylococcus aureus is present in the mucin adjacent to nasal polyps in about 60 to 70% of cases of massive nasal polyposis. These organism, as studied up to the present, always produce exotoxins, which may act as superantigens, causing activation and clonal expansion of lymphocytes with specific Vbeta region in the lateral wall of the nose. The present review suggests that activation of these lymphocytes produce both TH1 and TH2 cytokines. The potential damage to the nasal mucosa from eosinophils is briefly discussed. Theoretically, topical antibiotics to suppress the colonization of S. aureus may be a logical approach to downregulate the production of superantigen in the lateral wall of the nose after appropriate endoscopic sinus surgery.     

Evaluation of methods for endoscopic staging of nasal polyposis

Endoscopy is needed for reliable evaluation of the treatment of nasal polyposis. In this study, we compared the reproducibility of various score systems for staging nasal polyposis and the inter-individual variations between investigators. The mass of the polyps was assessed by five methods, three new techniques (numbers 1, 2 and 3) and two established ones (numbers 4 and 5). These were: 1, lateral imaging projecting the extension of the polyps by drawing on a schematic picture of the lateral wall of each nasal cavity; 2, assessment of polyp obstruction estimating the proportion of the total nasal cavity volume occupied by polyps; 3, nasal airway patency--determining the relationship between the patient's patent airway lumen and an imaginary maximal nasal airway lumen; 4, a score system with four steps ad modum Lildholdt et al.--determining their relationship to fixed anatomical landmarks; and 5, a score system with three steps ad modum Lund and Mackay--determining their relationship to the middle meatus. High correlations were found between the first and the second assessments by a given investigator with all five methods used to score nasal polyposis. High correlations were also shown between the various methods. When three investigators examined a given patient, there were no significant differences between the investigators using score systems 1, 3 and 4. However, with score systems 2 and 5, there was insufficient agreement between the investigators. The patient's symptom of nasal blockage was not a good indicator of the size of the polyps, especially as regards small polyps. Two of the best methods tested (1 and 4) were selected for further clinical studies regarding evaluation of the sensitivity of score systems to detect changes in polyp size during treatment.