Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, AZ.
Department of Pediatrics, University of Arizona College of Medicine, Tucson, AZ.
Int Forum Allergy Rhinol. 2019 Jan;9(1):30-38. doi: 10.1002/alr.22224. Epub 2018 Oct 25.
The optimal maxillary antrostomy size to surgically treat sinusitis is not well known. In this study, we examined clinical metrics of disease severity and symptom scores, measured secreted inflammatory markers, and characterized the sinus microbiome to determine if there were significant differences in outcome between different maxillary ostial sizes.
Prospective randomized, single-blinded clinical trial enrolling 12 individuals diagnosed with recurrent acute or chronic rhinosinusitis. Each patient was blinded and randomized to receive minimal maxillary ostial dilation via balloon sinuplasty on 1 side vs a mega-antrostomy on the contralateral side. Data collected included symptom scores (20-item Sino-Nasal Outcome Test [SNOT-20]), endoscopy, and radiologic Lund-Mackay scores. During surgery and at their postoperative visit swabs were obtained from each maxillary sinus, and 16S DNA and inflammatory cytokine levels analyzed. The use of each patient as their own control allowed us to minimize confounding variables.
There was statistically significant improvement in SNOT-20 symptom scores postoperatively in all patients. There were no significant differences between maxillary ostial size in postoperative endoscopy scores, cytokine profile, or bacterial burden. There were statistically significant differences in relative postoperative abundance of Staphylococcus, Lactococcus, and Cyanobacteria between the mega-antrostomy and mini-antrostomy.
The method used in surgical maxillary antrostomies had no effect on endoscopy scores or cytokine profiles. Microbiome analysis determined significant differences between the different antrostomy sizes in postoperative Staphylococcus, Lactococcus, and Cyanobacteria abundance. The clinical significance of these changes in the sinus microbiome are not known but may be a result of increased access to postoperative sinonasal irrigations.
治疗鼻窦炎的最佳上颌窦口大小尚不清楚。在这项研究中，我们检查了疾病严重程度的临床指标和症状评分，测量了分泌的炎症标志物，并对鼻窦微生物组进行了特征描述，以确定不同上颌窦口大小之间的治疗结果是否存在显著差异。
前瞻性随机、单盲临床试验纳入 12 名被诊断为复发性急性或慢性鼻-鼻窦炎的患者。每位患者均接受了单侧球囊鼻旁窦切开术（minimal maxillary ostial dilation via balloon sinuplasty）或对侧 mega 上颌窦口切开术（mega-antrostomy）的治疗，且均处于盲态。收集的数据包括症状评分（20 项鼻-鼻窦炎结局测试量表[SNOT-20]）、内镜检查和放射学 Lund-Mackay 评分。手术过程中和术后随访时，从每个上颌窦中获取拭子，并分析 16S DNA 和炎症细胞因子水平。每位患者均作为自身对照，从而使混杂变量最小化。
所有患者的 SNOT-20 症状评分在术后均有统计学显著改善。术后内镜评分、细胞因子谱或细菌负荷在两种上颌窦口大小之间无显著差异。 mega 上颌窦口切开术和 mini 上颌窦口切开术后，葡萄球菌、乳球菌和蓝细菌的相对丰度存在统计学显著差异。
手术上颌窦口切开术的方法对内镜评分或细胞因子谱没有影响。微生物组分析确定了不同上颌窦口大小之间术后葡萄球菌、乳球菌和蓝细菌丰度的显著差异。鼻窦微生物组中这些变化的临床意义尚不清楚，但可能是由于术后鼻-鼻窦冲洗的机会增加所致。
