Abstract:
BACKGROUND:Diagnostic strategies employed for cases of cerebrospinal fluid (CSF) rhinorrhea vary widely due to limited evidence-based guidance. METHODS:A systematic review of the literature was performed using PubMed, EMBASE, and Cochrane databases from January 1990 through September 2014, to examine 9 diagnostic and localization modalities for CSF rhinorrhea. Benefit-harm assessments, value judgments and recommendations were made based on the available evidence. Study exclusion criteria were language other than English, pre-1990 studies, case reports, and nonrhinologic leak. All authors agreed on recommendations through an iterative process. RESULTS:We reviewed 68 studies examining 9 practices pertinent to the diagnosis of CSF rhinorrhea, with a highest aggregate grade of evidence of C. The literature does not support the use of the ring sign, glucose testing, radionuclide cisternography (RNC), or computed tomography cisternography (CTC) for identification of CSF leak. Beta-2 transferrin is the most reliable confirmatory test for CSF leak. High-resolution CT (HRCT) is then recommended as the first-line study for localization. Magnetic resonance cisternography (MRC) should be used for CSF leak identification as a second line for each of these if beta-2 transferrin is not available or if HRCT is ambiguous. Intrathecal fluorescein (IF) may also be of benefit in certain clinical scenarios. CONCLUSION:Despite relatively low levels of evidence, recommendations for the diagnosis and management of CSF rhinorrhea can be made based on the current literature. Higher-level studies are needed to better determine optimal diagnostic and clinical management approaches.
journal_name
Int Forum Allergy Rhinoljournal_title
International forum of allergy & rhinologyauthors
Oakley GM,Alt JA,Schlosser RJ,Harvey RJ,Orlandi RRdoi
10.1002/alr.21637subject
Has Abstractpub_date
2016-01-01 00:00:00pages
8-16issue
1eissn
2042-6976issn
2042-6984journal_volume
6pub_type
杂志文章,评审abstract:BACKGROUND:Endoscopic sinus surgery (ESS) enjoys high success rates, but repopulation with pathogenic bacteria is 1 of the hallmarks of poorer outcomes. There are many hypothesized sources of repopulating bacteria; however, this process remains largely unexplored. This study examined changes in the sinus microbiome aft...
journal_title:International forum of allergy & rhinology
pub_type: 临床试验,杂志文章
doi:10.1002/alr.21630
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Olfactory inflammation in chronic rhinosinusitis (CRS) is associated with cytokines that may result in the death of olfactory sensory neurons. The principal signaling molecules involved in the apoptotic pathway are c-Jun N-terminal kinases (JNK). Although the JNK pathway has emerged as a key player in progra...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.22053
更新日期:2018-03-01 00:00:00
abstract:BACKGROUND:Osteitis is a feature of chronic rhinosinusitis (CRS) and often associated with recalcitrant disease. Radiological characteristics of osteitic sinus changes are commonly reported in practice but the clinical and pathologic significance is poorly defined. The objective of this study was to correlate the Kenne...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.21113
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND:Trefoil factor family (TFF) peptides are mucin-associated secretory products that are produced in the airways and gastrointestinal tract. These peptides appear to play an important role in mucosal healing and epithelial protection and are overexpressed in chronically inflamed gastrointestinal tissues. We hyp...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.21334
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:The purpose of this work was to describe a clinical and radiographic pattern of findings that helps localize the site of spontaneous cerebrospinal fluid (CSF) leaks. METHODS:This study was a retrospective review of CSF leaks treated at the University of Texas Southwestern Medical Center from 2000 to 2009. D...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.21048
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:The histological features of osteitis in chronic rhinosinusitis (CRS) in animal studies induced by bacterial inoculation into maxillary sinuses revealed inflammatory involvement of the underlying bone matrix and/or the Haversian system; however, human studies do not mention these findings. The objective of t...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.21291
更新日期:2014-05-01 00:00:00
abstract:BACKGROUND:Requests from researchers for olfactory mucosal biopsies are increasing as a result of advances in the fields of neuroscience and stem cell biology. Published studies report variable rates of success in obtaining true olfactory tissue, often below 50%. In cases where biopsies are not obtained carefully and c...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.21711
更新日期:2016-06-01 00:00:00
abstract:BACKGROUND:Current clinical classifications of chronic rhinosinusitis (CRS) have been largely defined based upon preconceived notions of factors thought to be important, such as polyp or eosinophil status. Unfortunately, these classification systems have little correlation with symptom severity or treatment outcomes. U...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章,多中心研究
doi:10.1002/alr.21496
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:Nasal steroids are a critical part of the management of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) after endoscopic sinus surgery (ESS). Increasingly, practitioners are using budesonide respules delivered to the sinonasal cavities, which is an off-label use, in lieu of traditional nas...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章,随机对照试验
doi:10.1002/alr.21688
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:The aim of this study was to demonstrate how direct electrical stimulation can activate the olfactory bulb after denervation of the olfactory nerve input. METHODS:Sprague-Dawley rats (n = 5) were anesthetized and olfactory bulbs exposed. Olfactory nerves were transected by passing a Teflon blade between the...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.22133
更新日期:2018-05-02 00:00:00
abstract:BACKGROUND:The endoscopic modified Lothrop procedure (EMLP) is commonly performed in recalcitrant frontal sinusitis, in part to achieve better penetration of medicated irrigations postoperatively. Although EMLP requires a septectomy for exposure, it is unknown whether septectomy size affects delivery of irrigations. In...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.22158
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:Odontogenic sinusitis (OS) presents a therapeutic dilemma. Evidence is lacking whether dental treatment alone is sufficient or whether patients will eventually require endoscopic sinus surgery (ESS). Our aim was to identify predictors of OS patients undergoing ESS. METHODS:Retrospective review performed of ...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.21736
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:The ciprofloxacin-coated sinus stent (CSS) has unique therapeutic potential to deliver antibiotics to the sinuses. The objective of this study is to evaluate the efficacy of the CSS stent in eliminating Pseudomonas aeruginosa infection in a rabbit model of sinusitis. METHODS:A ciprofloxacin-eluting sinus st...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.22081
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:Despite considerable research, the pathogenesis of chronic rhinosinusitis (CRS) remains poorly understood. Potential microbial roles in the etiology or progression of CRS have long been hypothesized, yet few specific associations have been identified. In this study we investigate associations between pattern...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.21871
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:Chronic sinusitis is universal in cystic fibrosis (CF) and our current treatments are ineffective in reversing sinus disease. The objective of this work was to determine if increasing CF transmembrane conductance regulator (CFTR) activity by ivacaftor could treat CF sinus disease and assess its effect on pri...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.21440
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:Endoscopic repair of anterior skull-base defects has become the gold standard for management of cerebrospinal fluid (CSF) rhinorrhea. Both improved techniques and adjuvant therapies have led to accepted success rates of greater than 90%. As management has evolved, shorter hospitalizations have been required ...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.21810
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:The incidence of adverse sequelae related to trauma of cranial nerve V2 (V2) and the Vidian nerve (VN) during endoscopic pterygoid recess repair (PRR) of lateral sphenoid encephalocele is insufficiently reported in the medical literature. As part of our quality assessment and improvement program we sought to...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.22448
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:The objective of this work was to better understand variations in perioperative management in endoscopic endonasal skull-base surgery (EESBS) and to identify trends in management based upon the practice patterns of North American Skull Base Society (NASBS) members. METHODS:A 29-question survey evaluating pe...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.22066
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Over 45 million Americans suffer from recurrent headaches, and an estimated $11.9 million was spent on doctor's visits for rhinogenic pain last year. Sphenopalatine blocks have been described for various facial pain syndromes, but their use and the type of blockade agents remain controversial. The objective ...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.21035
更新日期:2012-07-01 00:00:00
abstract:BACKGROUND:Chronic rhinosinusitis (CRS) is a local inflammatory process driven by eosinophils. Mucosal eosinophil count (MEC) has previously been demonstrated to be a reliable indicator of disease severity. We aim to evaluate use of MEC in guiding medical management of CRS after functional endoscopic sinus surgery (FES...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.22517
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:The treatment of the middle turbinate (MT) during endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) remains a contentious issue with arguments both for and against its resection. The purpose of this study was to examine the clinical impact of partial MT resection (PMTR) during ESS, paying parti...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.22127
更新日期:2018-04-06 00:00:00
abstract:BACKGROUND:Aspirin-exacerbated respiratory disease (AERD) is a recalcitrant inflammatory disorder defined by asthma, nasal polyposis, and sensitivity to cyclooxygenase-1 inhibitors. The timeline and course of disease progression is unclear. METHODS:The Truven MarketScan Database, a large American health insurance clai...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.22412
更新日期:2019-12-01 00:00:00
abstract:BACKGROUND:The lateral nasal wall (LNW) flap provides vascularized endonasal reconstruction primarily in revision surgery. Although the harvesting technique and reconstructive surface have been reported, the arterial supply to the LNW flap and its clinical implications is not well defined. This study presents anatomica...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.22534
更新日期:2020-05-01 00:00:00
abstract:BACKGROUND:Patients with chronic rhinosinusitis (CRS) exhibit centrally mediated behavioral changes commonly referred to as "sickness behavior." Sleep alteration is a component of sickness behavior which is estimated to affect up to 70 million patients annually. Patients with CRS have poor sleep quality, and little is ...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章,评审
doi:10.1002/alr.21217
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:Social determinants of health can have a substantial impact on treatment outcomes. Prior study has shown that socioeconomic status influences the likelihood of improvement in quality-of-life (QOL) following endoscopic sinus surgery (ESS). However, the impact of socioeconomic factors on changes in productivit...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章,多中心研究
doi:10.1002/alr.22374
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Oral steroids are commonly used in the management of chronic rhinosinusitis (CRS) with and without nasal polyps (CRSwNP and CRSsNP, respectively). Past reports have included evaluation of the evidence for the use of oral steroids in CRS subtypes. However, a review with evidence-based recommendations for all ...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章,评审
doi:10.1002/alr.21072
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:The goal of this study was to develop and evaluate the impact of an aviation-style challenge and response sinus surgery-specific checklist on potential safety and equipment issues during sinus surgery at a tertiary academic health center. The secondary goal was to assess the potential impact of use of the ch...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.22106
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:Asthma is a chronic inflammatory disease of the lower airway that is commonly encountered by the otolaryngologist. This article provides information on how to recognize patients with asthma and discuss issues related to diagnosis, treatment, and continued management within the context of current guidelines. ...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章,评审
doi:10.1002/alr.21386
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:Cystic fibrosis (CF) is caused by a misfunctional CF transmembrane conductance regulator (CFTR) protein, which is believed to contributes to the regulation of the airway surface liquid (ASL) pH. This study investigated acid and base secretion in freshly excised human nasal tissues from CF patients homozygous...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.20028
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:To describe our clinical experience in 218 consecutive patients undergoing endoscopic back-and-forth septoplasty (EBFS), examining surgical indications, technique, and follow-up. METHODS:From January 2005 to November 2008, 218 patients underwent EBFS at the Department of Otorhinolaryngology, San Raffaele Ho...
journal_title:International forum of allergy & rhinology
pub_type: 杂志文章
doi:10.1002/alr.20100
更新日期:2012-01-01 00:00:00