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Article ; Online: Nasal Obstruction: Overview of Pathophysiology and Presentation of a Clinically Relevant Preoperative Plan for Rhino(Septo)plasty.

Snoeks, Simon / Velasco, Enrique / Talavera, Karel / Hellings, Peter W

2024

Abstract: Impairment of nasal breathing is a highly prevalent and bothersome symptom that affects daily functioning and/or sleep quality. Those surgeons dealing with patients seeking rhinoplasty need to carefully analyze the preoperative nasal breathing capacity ... ...

Abstract	Impairment of nasal breathing is a highly prevalent and bothersome symptom that affects daily functioning and/or sleep quality. Those surgeons dealing with patients seeking rhinoplasty need to carefully analyze the preoperative nasal breathing capacity and predict the positive or even negative impact of rhino(septo)plasty on nasal breathing. Given the lack of correlation between the subjective feeling of suboptimal nasal breathing and the objective measurements of nasal flow and nasal resistance, a critical and mainly clinical evaluation of all anatomical, mucosal, and sensory mechanisms involved in nasal obstruction is mandatory. Indeed, thermo-, mechano-, and chemosensory receptors on the nasal mucosa, airflow, and respiratory dynamics might all contribute to the overall perception of nasal breathing capacity. In this review, we provide an overview of the factors determining suboptimal nasal breathing including different diagnostic and experimental tests that can be performed to evaluate nasal flow and nasal resistance and current limitations in our understanding of the problem of nasal breathing in an individual patient. An algorithm for the preoperative or diagnostic workup for nasal obstruction is included that might be useful as a guide for clinicians dealing with patients seeking nose surgery.
Language	English
Publishing date	2024-01-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	630090-x
ISSN	1098-8793 ; 0736-6825
ISSN (online)	1098-8793
ISSN	0736-6825
DOI	10.1055/s-0043-1777850
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Article: State-of-the-art overview on biological treatment for CRSwNP.

Hellings, P W / Verhoeven, E / Fokkens, W J

Rhinology

2021 Volume 59, Issue 2, Page(s) 151–163

Abstract: Background: The majority of patients with uncontrolled severe CRSwNP, asthma and atopic dermatitis share a similar T helper 2 type inflammation linked to their underlying phenotype. This discovery has triggered new research around treatments targeting ... ...

Abstract	Background: The majority of patients with uncontrolled severe CRSwNP, asthma and atopic dermatitis share a similar T helper 2 type inflammation linked to their underlying phenotype. This discovery has triggered new research around treatments targeting specific cytokines driving inflammation in CRSwNP like IL-4, IL-13, IL-5 and IgE. Biologicals are increasingly tested as additional tre- atment for patients suffering from severe chronic rhinosinusitis with nasal polyps (CRSwNP). Their efficacy has been demonstrated in multiple studies. All studies differ in terms of baseline characteristics of included patients and outcome parameters analysed. Aims: A comparative analysis of the efficacy of reported biologicals for CRSwNP based on the published data for phase 2 and 3 studies. The aim was to provide a comprehensive overview across the different biologicals and outcome parameters. Methods: In a first step we critically selected out of all available phase 2 and 3 clinical trials the ones containing the most rigorous and compatible study designs. Meaning studies that comply with a need for a clear definition of CRSwNP, at least two administra- tion doses, comparable timeframes and the same outcome parameters studied. This assessment was performed using a PRISMA search. We retained 7 studies with significant data for dupilumab, mepolizumab and omalizumab. In a second step the effect-sizes of treatment with those biologicals were compared for the most important outcome parameters both patient relevant (nasal con- gestion, smell loss and SNOT-22 scores) and patient irrelevant (CT scan Lund-Mackay, smell test and nasal polyp scores). Therapy duration of 16 to 25 weeks was chosen for evaluation of efficacy. Results: A direct comparison of efficacy between dupilumab, mepolizumab and omalizumab is challenging given differences in inclusion criteria, outcome parameters and time-points of analyses. We have been able to conclude that effect sizes of dupilumab, mepolizumab and omalizumab seem large enough to reflect a major reduction in symptom burden as experienced by patients suffering from refractory CRSwNP. The effect size of dupilumab on both patient relevant and patient irrelevant parameters of smell loss are clearly significant and reflect the clinical experience of major reduction of smell impairment in treated patients. Conclusion: Despite the heterogeneity of protocols, dosages and time-points of analyses of biological trials in CRSwNP, this over- view highlights outcomes of biological treatment in CRSwNP in a comprehensive way. Real-life registries, comparative trials and/ or endotype-driven treatment plans are needed to provide the answers to the multiple questions that are still open today.
MeSH term(s)	Chronic Disease ; Humans ; Nasal Polyps/complications ; Nasal Polyps/drug therapy ; Omalizumab ; Rhinitis ; Sinusitis
Chemical Substances	Omalizumab (2P471X1Z11)
Language	English
Publishing date	2021-01-18
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	80336-4
ISSN	0300-0729
ISSN	0300-0729
DOI	10.4193/Rhin20.570
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Article: Nasal Obstruction: Overview of Pathophysiology and Presentation of a Clinically Relevant Preoperative Plan for Rhino(Septo)plasty

Snoeks, Simon / Velasco, Enrique / Talavera, Karel / Hellings, Peter W.

Facial Plastic Surgery

(Nasal Airway Evaluation)

2024

Series title	Nasal Airway Evaluation
Abstract	Impairment of nasal breathing is a highly prevalent and bothersome symptom that affects daily functioning and/or sleep quality. Those surgeons dealing with patients seeking rhinoplasty need to carefully analyze the preoperative nasal breathing capacity and predict the positive or even negative impact of rhino(septo)plasty on nasal breathing. Given the lack of correlation between the subjective feeling of suboptimal nasal breathing and the objective measurements of nasal flow and nasal resistance, a critical and mainly clinical evaluation of all anatomical, mucosal, and sensory mechanisms involved in nasal obstruction is mandatory. Indeed, thermo-, mechano-, and chemosensory receptors on the nasal mucosa, airflow, and respiratory dynamics might all contribute to the overall perception of nasal breathing capacity. In this review, we provide an overview of the factors determining suboptimal nasal breathing including different diagnostic and experimental tests that can be performed to evaluate nasal flow and nasal resistance and current limitations in our understanding of the problem of nasal breathing in an individual patient. An algorithm for the preoperative or diagnostic workup for nasal obstruction is included that might be useful as a guide for clinicians dealing with patients seeking nose surgery.
Keywords	nasal obstruction ; preoperative evaluation ; rhinoplasty
Language	English
Publishing date	2024-01-15
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	630090-x
ISSN	1098-8793 ; 0736-6825
ISSN (online)	1098-8793
ISSN	0736-6825
DOI	10.1055/s-0043-1777850
Database	Thieme publisher's database

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Article: Nasal hyperreactivity in allergic rhinitis and chronic rhinosinusitis with polyps: a role for neuronal pathways.

Backaert, W / Steelant, B / Wils, T / Qian, Z / Dilissen, E / Jonckheere, A-C / Boonen, B / Jorissen, M / Schrijvers, R / Bullens, M A / Talavera, K / Hellings, P W / Van Gerven, L

Rhinology

2024

Abstract: Background: Nasal hyperreactivity (NHR) is prevalent in all chronic upper airway inflammatory phenotypes, including allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP). Although NHR in patients with non-allergic rhinitis is ... ...

Abstract	Background: Nasal hyperreactivity (NHR) is prevalent in all chronic upper airway inflammatory phenotypes, including allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP). Although NHR in patients with non-allergic rhinitis is mediated by neuronal pathways, AR and CRSwNP are mainly characterized by type 2 inflammation. Methods: Eighteen healthy controls and 45 patients with symptomatic AR/CRSwNP underwent a cold, dry air (CDA) provocation test for objective diagnosis of NHR. Before and after, questionnaires were filled out and nasal secretions and biopsies were collected. Markers for neurogenic inflammation (substance P, calcitonin gene-related peptide, neurokinin A), epithelial activation (IL-33), and histamine were measured in secretions by ELISA; and expression of neuronal markers PGP9.5, TRPV1, and TRPM8 was studied in biopsies by RT-q-PCR. Effects of histamine on TRPV1/A1 were studied with Ca2+-imaging using murine trigeminal neurons. Results: CDA-provocation reduced peak nasal inspiratory flow (PNIF) of patients with subjective NHR but not of non-NHR controls/ patients (p.
Language	English
Publishing date	2024-02-19
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	80336-4
ISSN	0300-0729
ISSN	0300-0729
DOI	10.4193/Rhin23.287
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Article: Fluticasone propionate suppresses the SARS-CoV-2 induced increase in respiratory epithelial permeability in vitro.

Martens, K / Vanhulle, E / Viskens, A-S / Hellings, P W / Vermeire, K

Rhinology

2022 Volume 61, Issue 2, Page(s) 161–169

Abstract: Background: Disruption of the nasal epithelial barrier is believed to play a role in Coronavirus Disease-2019 (COVID-19) outcomes. Fluticasone propionate has been shown to restore the nasal epithelial barrier in allergic rhinitis to the level of healthy ...

Abstract	Background: Disruption of the nasal epithelial barrier is believed to play a role in Coronavirus Disease-2019 (COVID-19) outcomes. Fluticasone propionate has been shown to restore the nasal epithelial barrier in allergic rhinitis to the level of healthy controls. The therapeutic potential of nasal steroid sprays in COVID-19 has recently been reported. However, further insight into the mode of action is warranted. Objectives: To explore the in vitro mechanisms of the preventive potential of fluticasone propionate in SARS-CoV-2 infection. Methods: Human air liquid interface cultures of Calu-3 cells and primary nasal epithelial cells isolated from healthy donors were used to investigate the preventive effect of fluticasone propionate on SARS-CoV-2 induced barrier disruption, virus replication and ACE2 expression. Results: 48 hours pre-treatment with fluticasone propionate prevented the SARS-CoV-2 induced increase in fluorescein isothiocyanate-dextran 4 kDa permeability and reduced infection with SARS-CoV-2. Pre-treatment with fluticasone propionate also decreased ACE2 expression in SARS-CoV-2 infected Calu-3 cells. Conclusion: Fluticasone propionate pre-treatment prevented SARS-CoV-2 increased epithelial permeability, reduced ACE2 expression and SARS-CoV-2 infection, underscoring the therapeutic potential of fluticasone propionate in the context of COVID-19.
MeSH term(s)	Humans ; Fluticasone/pharmacology ; Fluticasone/therapeutic use ; Anti-Inflammatory Agents ; SARS-CoV-2 ; Angiotensin-Converting Enzyme 2 ; Androstadienes/pharmacology ; Androstadienes/therapeutic use ; COVID-19 ; Nasal Sprays ; Permeability
Chemical Substances	Fluticasone (CUT2W21N7U) ; Anti-Inflammatory Agents ; Angiotensin-Converting Enzyme 2 (EC 3.4.17.23) ; Androstadienes ; Nasal Sprays
Language	English
Publishing date	2022-12-07
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	80336-4
ISSN	0300-0729
ISSN	0300-0729
DOI	10.4193/Rhin22.223
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Article ; Online: Nasal polyp syndrome: a patient-centred term for CRSwNP by EUFOREA.

Teeling, T / Djouder, C / Laurens, H / Preyra, J H / Shire, C M E / Van Staeyen, E / Conti, D M / Scadding, G K / Hellings, P W

Frontiers in allergy

2024 Volume 5, Page(s) 1372919

Abstract: Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a chronic inflammatory disease of the nose and paranasal sinus cavities that significantly affects well-being and social function, particularly in young adults and middle-aged populations. CRSwNP is a ... ...

Abstract	Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a chronic inflammatory disease of the nose and paranasal sinus cavities that significantly affects well-being and social function, particularly in young adults and middle-aged populations. CRSwNP is a common health condition in the Western world, with an estimated prevalence of 3%. Despite worldwide evidence-based treatment guidelines such as the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 and the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) chronic rhinosinusitis (CRS) pocket guide, a significant number of patients remain undiagnosed and/or uncontrolled with repeated oral corticosteroids (OCS) treatments and/or (multiple) endoscopic sinus surgeries (ESS).
Language	English
Publishing date	2024-03-20
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-6101
ISSN (online)	2673-6101
DOI	10.3389/falgy.2024.1372919
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Article: Occupational exposure influences control of disease in patients with chronic rhinosinusitis.

Dietz de Loos, D A E / Ronsmans, S / Cornet, M E / Hellings, P W / Hox, V / Fokkens, W J / Reitsma, S

Rhinology

2021 Volume 59, Issue 4, Page(s) 380–386

Abstract: Background: Chronic rhinosinusitis (CRS) is a frequent condition that is treated by endoscopic sinus surgery (ESS) when medical treatment fails. Irritating or sensitizing airborne agents can contribute to uncontrolled CRS. A prior study showed a linear ... ...

Abstract	Background: Chronic rhinosinusitis (CRS) is a frequent condition that is treated by endoscopic sinus surgery (ESS) when medical treatment fails. Irritating or sensitizing airborne agents can contribute to uncontrolled CRS. A prior study showed a linear correlation between occupational exposure and the number of ESS. Methods: In this cross-sectional study we tested the hypothesis that occupational exposure is a risk for undergoing ESS. We sent questionnaires enquiring occupational exposure in patients with CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP). An expert assessed blindly the reported work exposures to inhaled agents. The relationship between occupational exposure on undergoing ESS was analysed. Results: Among all patients who underwent ESS (n=343), 30% reported a relevant occupational exposure, which is significantly higher than the 4.8% found among CRS patients that underwent no prior sinus surgery (n=21). Besides occupational exposure, self-reported doctor-diagnosed asthma were independent variables contributing to the chance of undergoing ESS. Conclusion: In our study we confirm occupational exposure as a risk factor for uncontrolled CRS, if defined by undergoing ESS. In CRS patients with uncontrolled symptoms, despite maximal conservative therapy, the clinician should explore the possible contribution of occupational exposure.
MeSH term(s)	Chronic Disease ; Cross-Sectional Studies ; Endoscopy ; Humans ; Nasal Polyps/complications ; Occupational Exposure/adverse effects ; Rhinitis/epidemiology ; Sinusitis
Language	English
Publishing date	2021-07-19
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	80336-4
ISSN	0300-0729
ISSN	0300-0729
DOI	10.4193/Rhin21.091
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Article: Reasons for rejection of rhinoplasty seeking patients: a multicentre observational study.

De Greve, G / Adriaensen, G F J P M / Constantinidis, J / Prokopakis, E / Lekakis, G / Hellings, P W

Rhinology

2021 Volume 62, Issue 1, Page(s) 82–87

Abstract: Background: To date, research on preoperative patient selection has mainly focused on patient personality, with body dysmorphic disorder (BDD) being the most studied. Despite the many reasons for not planning a rhinoplasty, no data are available on the ... ...

Abstract	Background: To date, research on preoperative patient selection has mainly focused on patient personality, with body dysmorphic disorder (BDD) being the most studied. Despite the many reasons for not planning a rhinoplasty, no data are available on the nature of these reasons. Our aim is to conduct a multicentre international observational study on the reasons for rejection of patients seeking rhinoplasty in 5 tertiary rhinoplasty care centres. Methods: Surgeons documented the reasons for not scheduling a rhinoplasty in consecutive patients who consulted them between January 2021 and March 2022 using a predefined list of reasons for rejection. Surgeons were also asked to report on the patient attitudes after rejection, and about the advice given to patients in the event of refusal. Results: 186 patients seeking rhinoplasty were included. Multiple reasons for rejection were present in 76% of patients, with a mean of 2.9 reasons for rejection per patient. Overall, patient-related factors were most frequently associated with rejection (64.3%), followed by nose-related factors (28.4%), surgeon-related factors (6.0 %) and surgery-related factors (1.3%). The presence of severe BDD symptoms was reported in only 11.3% of the rejected patients. Patients rejected for rhinoplasty were advised to reconsider the surgery (32.8 %) and/or were referred to another surgeon (32.8%). No further action was taken in 39.8% of the patients. Of the patients who were rejected, most had a neutral (39.2 %) or positive (37.1 %) attitude in relation to the lack of rhinoplasty planning. Conclusion: This study highlights the variety of reasons for which patients seeking rhinoplasty are not considered good candidates for a rhinoplasty, with patient-related factors being more prevalent than nose-related and other factors. Increasing awareness on the impact of adequate patient selection for rhinoplasty may contribute to better outcomes in rhinoplasty.
MeSH term(s)	Humans ; Rhinoplasty ; Nose ; Patient Satisfaction ; Surveys and Questionnaires
Language	English
Publishing date	2021-03-18
Publishing country	Netherlands
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	80336-4
ISSN	0300-0729
ISSN	0300-0729
DOI	10.4193/Rhin22.378
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Article ; Online: Pre-asthma: a useful concept for prevention and disease-modification? A EUFOREA paper. Part 1-allergic asthma.

Scadding, G K / McDonald, M / Backer, V / Scadding, G / Bernal-Sprekelsen, M / Conti, D M / De Corso, E / Diamant, Z / Gray, C / Hopkins, C / Jesenak, M / Johansen, P / Kappen, J / Mullol, J / Price, D / Quirce, S / Reitsma, S / Salmi, S / Senior, B /

Thyssen, J P / Wahn, U / Hellings, P W

Frontiers in allergy

2024 Volume 4, Page(s) 1291185

Abstract: Asthma, which affects some 300 million people worldwide and caused 455,000 deaths in 2019, is a significant burden to suffers and to society. It is the most common chronic disease in children and represents one of the major causes for years lived with ... ...

Abstract	Asthma, which affects some 300 million people worldwide and caused 455,000 deaths in 2019, is a significant burden to suffers and to society. It is the most common chronic disease in children and represents one of the major causes for years lived with disability. Significant efforts are made by organizations such as WHO in improving the diagnosis, treatment and monitoring of asthma. However asthma prevention has been less studied. Currently there is a concept of pre- diabetes which allows a reduction in full blown diabetes if diet and exercise are undertaken. Similar predictive states are found in Alzheimer's and Parkinson's diseases. In this paper we explore the possibilities for asthma prevention, both at population level and also investigate the possibility of defining a state of pre-asthma, in which intensive treatment could reduce progression to asthma. Since asthma is a heterogeneous condition, this paper is concerned with allergic asthma. A subsequent one will deal with late onset eosinophilic asthma.
Language	English
Publishing date	2024-01-30
Publishing country	Switzerland
Document type	Journal Article ; Review
ISSN	2673-6101
ISSN (online)	2673-6101
DOI	10.3389/falgy.2023.1291185
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Article ; Online: Epithelial and sensory mechanisms of nasal hyperreactivity.

Velasco, Enrique / Delicado-Miralles, Miguel / Hellings, Peter W / Gallar, Juana / Van Gerven, Laura / Talavera, Karel

Allergy

2022 Volume 77, Issue 5, Page(s) 1450–1463

Abstract: Nasal hyperreactivity" is a key feature in various phenotypes of upper airway diseases, whereby reactions of the nasal epithelium to diverse chemical and physical stimuli are exacerbated. In this review, we illustrate how nasal hyperreactivity can ... ...

Abstract	"Nasal hyperreactivity" is a key feature in various phenotypes of upper airway diseases, whereby reactions of the nasal epithelium to diverse chemical and physical stimuli are exacerbated. In this review, we illustrate how nasal hyperreactivity can result from at least three types of mechanisms: (1) impaired barrier function, (2) hypersensitivity to external and endogenous stimuli, and (3) potentiation of efferent systems. We describe the known molecular basis of hyperreactivity related to the functional impairment of epithelial cells and somatosensory innervation, and indicate that the thermal, chemical, and mechanical sensors determining hyperreactivity in humans remain to be identified. We delineate research directions that may provide new insights into nasal hyperreactivity associated with rhinitis/rhinosinusitis pathophysiology and therapeutics. The elucidation of the molecular mechanisms underlying nasal hyperreactivity is essential for the treatment of rhinitis according to the precepts of precision medicine.
MeSH term(s)	Humans ; Hypersensitivity ; Nasal Mucosa ; Rhinitis/etiology ; Sinusitis
Language	English
Publishing date	2022-02-26
Publishing country	Denmark
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	391933-x
ISSN	1398-9995 ; 0105-4538
ISSN (online)	1398-9995
ISSN	0105-4538
DOI	10.1111/all.15259
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