• Home
  • Practice Focus
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
    • How I Do It
    • TRIO Best Practices
  • Business of Medicine
    • Health Policy
    • Legal Matters
    • Practice Management
    • Tech Talk
    • AI
  • Literature Reviews
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Career
    • Medical Education
    • Professional Development
    • Resident Focus
  • ENT Perspectives
    • ENT Expressions
    • Everyday Ethics
    • From TRIO
    • The Great Debate
    • Letter From the Editor
    • Rx: Wellness
    • The Voice
    • Viewpoint
  • TRIO Resources
    • Triological Society
    • The Laryngoscope
    • Laryngoscope Investigative Otolaryngology
    • TRIO Combined Sections Meetings
    • COSM
    • Related Otolaryngology Events
  • Search

Integrated Approach Key to Evaluating Recalcitrant Rhinosinusitis Patients

by John Austin • November 1, 2006

  • Tweet
  • Email
Print-Friendly Version

Contact the Editor ENToday welcomes your feedback about our publication! Contact us using the information below: ENToday@lwwny.com

You Might Also Like

  • Panel Debates when to Use an Endoscopic Approach to Sinus Surgery
  • Toward Better Outcomes: Avoid revision surgeries in chronic rhinosinusitis patients
  • What Is the Role of Long-Term Macrolide Therapy in the Treatment of Recalcitrant Chronic Rhinosinusitis?
  • Report May Change Diagnosis, Management of Chronic Rhinosinusitis
Explore This Issue
November 2006

TORONTO-Despite the evolution of endoscopic sinus surgery and a growing understanding of the pathophysiologic mechanisms of chronic rhinosinusitis (CRS), it remains a prevalent health care problem, afflicting approximately 30 million Americans.

To discuss some of the most recent advances and information in the evaluation and treatment of CRS, several noted experts in the field gathered to share their expertise and compare notes at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) annual meeting.

Evaluating the Patient

Peter H. Hwang, MD

Peter H. Hwang, MD

When we look at patients with chronic rhinosinusitis, we really need to understand that the etiology may be multifactorial, said Pete S. Batra, MD, of the Cleveland Clinic. Certainly, surgery may play a role, but there are many other potential causative factors that we need to think about-immunodeficiency, for example.

Dr. Batra cited a study from the University of Iowa, in which researchers looked at their hard core population-patients who had undergone at least three previous surgeries. They found that 40% of those patients were anergic to delayed hypersensitivity tests, with 18% having low IgG levels and 16.7 % having low IgA levels.

Most interesting in that study is that almost 10 percent of them were diagnosed with common variable immunodeficiency and 6.2 percent had selective IgA deficiency-an incidence much higher than would be expected in the general population.

So if you’re going to work this up, you should think about getting quantitative immunoglobulins and also IgG subclasses, Dr. Batra said. You need vaccination and antibody responses to protein and polysaccharide antigens, and HIV if clinically indicated. If this is a workup you don’t feel comfortable performing yourself, it’s perfectly appropriate to recruit an immunologist. And that’s going to be especially critical if you’re going to consider any kind of immunoglobulin infusions.

Then there’s primary ciliary dyskinesia (PCD) to think about, Dr. Batra continued. These patients will universally have sinusitis and most of them will have recurrent otitis as well, he said. You’ll see bronchiectasis in about 83 percent and half of them will have the classic finding of situs inversus.

However, if you’re going to think about PCD, he advised, you have to recruit a pathologist with some interest and some experience in this who can work it up for you.

What I do is have them come to the clinic and do the brushing with a bronchoscopy brush, Dr. Batra said. We’ll brush the middle turbinate and then give them the specimen, which they’ll take directly to the lab where they can do dynamic studies.

Pages: 1 2 3 4 5 | Single Page

Filed Under: Departments, Medical Education, Practice Focus, Rhinology Tagged With: diagnosis, functional endoscopic sinus surgery, infections, outcomes, research, rhinosinusitis, Sinusitis, surgery, techniques, treatmentIssue: November 2006

You Might Also Like:

  • Panel Debates when to Use an Endoscopic Approach to Sinus Surgery
  • Toward Better Outcomes: Avoid revision surgeries in chronic rhinosinusitis patients
  • What Is the Role of Long-Term Macrolide Therapy in the Treatment of Recalcitrant Chronic Rhinosinusitis?
  • Report May Change Diagnosis, Management of Chronic Rhinosinusitis

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

The Triological SocietyENTtoday is a publication of The Triological Society.

Polls

Have you invented or patented something that betters the field of otolaryngology?

View Results

Loading ... Loading ...
  • Polls Archive

Top Articles for Residents

  • Applications Open for Resident Members of ENTtoday Edit Board
  • How To Provide Helpful Feedback To Residents
  • Call for Resident Bowl Questions
  • New Standardized Otolaryngology Curriculum Launching July 1 Should Be Valuable Resource For Physicians Around The World
  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • Otolaryngologists Are Still Debating the Effectiveness of Tongue Tie Treatment

    • The Road Less Traveled—at Least by Otolaryngologists

    • The Best Site for Pediatric TT Placement: OR or Office?

    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?

    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?

    • Is Middle Ear Pressure Affected by Continuous Positive Airway Pressure Use?

    • Otolaryngologists Are Still Debating the Effectiveness of Tongue Tie Treatment

    • Complications for When Physicians Change a Maiden Name

    • Leaky Pipes—Time to Focus on Our Foundations
    • You Are Among Friends: The Value Of Being In A Group
    • How To: Full Endoscopic Procedures of Total Parotidectomy
    • How To: Does Intralesional Steroid Injection Effectively Mitigate Vocal Fold Scarring in a Rabbit Model?
    • What Is the Optimal Anticoagulation in HGNS Surgery in Patients with High-Risk Cardiac Comorbidities?

Follow Us

  • Contact Us
  • About Us
  • Advertise
  • The Triological Society
  • The Laryngoscope
  • Laryngoscope Investigative Otolaryngology
  • Privacy Policy
  • Terms of Use
  • Cookies

Wiley

Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1559-4939