Shireen Samargandy1, Elysia Grose1, Yvonne Chan1,2, Eric Monteiro1,3, John M Lee1,4, Jonathan Yip1. 1. Division of Rhinology, Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada. 2. Division of Otolaryngology-Head and Neck Surgery, Trillium Health Partners, Mississauga, ON, Canada. 3. Department of Otolaryngology-Head and Neck Surgery, Sinai Health Systems, Toronto, ON, Canada. 4. Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Toronto, ON, Canada.
Abstract
BACKGROUND: Immunodeficiency is a risk factor for recalcitrant chronic rhinosinusitis (CRS). Currently, there is no consensus on effective treatment modalities for immunodeficient CRS patients. This review aims to evaluate the existing evidence on the treatment outcomes and its limitations in patients with CRS and immunodeficiency. METHODS: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to April 2019 for studies reporting measurable medical or surgical treatment outcomes for adult patients with CRS and underlying primary or secondary immunodeficiency. RESULTS: Of the 2459 articles screened, 13 studies met the inclusion criteria: 2 prospective double-blind placebo-controlled trials, 2 prospective case-control studies, 2 prospective cohort studies, and 7 case series. The high degree of study heterogeneity precluded a meta-analysis. Antibiotic monotherapy was not linked with significant improvement in clinical, radiographic, or endoscopic outcomes. Immunoglobulin replacement therapy may potentially reduce the frequency of acute or chronic sinusitis in patients with primary immunodeficiency (PID) but may not improve their sinonasal symptoms. Outcomes from endoscopic sinus surgery (ESS) were reported in 8 studies, which found that surgery was linked with improvement in symptoms, disease-specific quality of life, endoscopy scores, and radiographic scores. The average reported ESS revision rate was 14%. CONCLUSION: Patients with CRS and immunodeficiency likely benefit from ESS based on the available evidence. Data supporting medical therapy in this targeted population is limited overall, but there may be a potential role for immunoglobulin therapy in patients with PID and CRS.
BACKGROUND:Immunodeficiency is a risk factor for recalcitrant chronic rhinosinusitis (CRS). Currently, there is no consensus on effective treatment modalities for immunodeficient CRSpatients. This review aims to evaluate the existing evidence on the treatment outcomes and its limitations in patients with CRS and immunodeficiency. METHODS: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to April 2019 for studies reporting measurable medical or surgical treatment outcomes for adult patients with CRS and underlying primary or secondary immunodeficiency. RESULTS: Of the 2459 articles screened, 13 studies met the inclusion criteria: 2 prospective double-blind placebo-controlled trials, 2 prospective case-control studies, 2 prospective cohort studies, and 7 case series. The high degree of study heterogeneity precluded a meta-analysis. Antibiotic monotherapy was not linked with significant improvement in clinical, radiographic, or endoscopic outcomes. Immunoglobulin replacement therapy may potentially reduce the frequency of acute or chronic sinusitis in patients with primary immunodeficiency (PID) but may not improve their sinonasal symptoms. Outcomes from endoscopic sinus surgery (ESS) were reported in 8 studies, which found that surgery was linked with improvement in symptoms, disease-specific quality of life, endoscopy scores, and radiographic scores. The average reported ESS revision rate was 14%. CONCLUSION:Patients with CRS and immunodeficiency likely benefit from ESS based on the available evidence. Data supporting medical therapy in this targeted population is limited overall, but there may be a potential role for immunoglobulin therapy in patients with PID and CRS.
Authors: Karina Bayer; Selmir Hamidovic; Faris F Brkic; Gerold Besser; Christian A Mueller; David T Liu Journal: Eur Arch Otorhinolaryngol Date: 2022-06-23 Impact factor: 2.503