JOURNAL OF THE MEDICAL ASSOCTATION OF THAILAND, Feb 15, 2021
Background: Some chronic rhinosinusitis with nasal polyps patients undergoing endoscopic sinus su... more Background: Some chronic rhinosinusitis with nasal polyps patients undergoing endoscopic sinus surgery (ESS) have unfavorable results despite proper postoperative treatments including oral and topical steroids. Steroid-impregnated absorbable nasal dressing has been shown to improve outcomes of the surgery. In some clinical practices, budesonide-impregnated nasal dressing is used together with perioperative oral steroid but the additional benefits of it are still unknown. Objective: To determine whether budesonide-impregnated nasal dressing had any benefits following ESS when a short course of oral steroid was given in perioperative period. Materials and Methods: The present study was a prospective, double-blinded, randomized, placebo-controlled study conducted in tertiary care hospital. Eighteen consecutive patients (36 nostrils) with chronic rhinosinusitis with nasal polyps underwent bilateral ESS were enrolled. At the end of the surgery for each patient, one side of the ethmoid cavity and middle meatus was randomly given polyurethane foam soaked with 2 mL of budesonide inhalation solution (0.5 mg/2 mL) (budesonide side), while the contralateral side received 2 mL of normal saline-soaked polyurethane foam (control side). Postoperative care included a short course of oral steroid and budesonide nasal irrigations. Single assessor blinded to the randomize allocation evaluated mucosal inflammation and wound healing at 2 and 4 weeks after surgery using Perioperative Sinus Endoscopy (POSE) score. Results: A total of 36 nostrils were randomized into two groups: 18 to the budesonide side and 18 to the control side. All of them were analyzed. The preoperative Lund-Mackay computed tomography score did not show a significant difference between the groups. There was no significant difference in POSE score between budesonide and control sides at 2 and 4 weeks after surgery. Conclusion: Budesonide-impregnated polyurethane foam did not provide additional benefits on mucosal inflammation and wound healing in the patients who underwent ESS and received a short course of oral steroid perioperatively. Keywords: Chronic rhinosinusitis, Nasal polyps, Nasal dressing/packing, Budesonide, Endoscopic sinus surgery
BACKGROUND: Low-dose macrolides (LDM) are anti-inflammatory agents with antineutrophilic activity... more BACKGROUND: Low-dose macrolides (LDM) are anti-inflammatory agents with antineutrophilic activity, but patient selection for LDM therapy in treating chronic rhinosinusitis (CRS) is controversial. This study aimed to assess factors which predict LDM responders. METHODOLOGY: A prospective cohort study was performed. Patients with CRS received roxithromycin (150 mg) once daily for 12 weeks. Nasal secretions and serology were collected. Nine predictors for LDM response were assessed: nasal secretion IgE, nasal secretion IL-5, serum IgE, serum eosinophils, serum neutrophils, nasal polyps, asthma, allergy, and aspirin hypersensitivity, using receiver-operating curve analysis and multivariable logistic regression. Macrolide responders were those with sino-nasal outcome test-22 improvement, symptoms visual analogue scale decreased to ≤5, and no rescue medication. RESULTS: One hundred CRS patients (mean age 47.4±14.1 years, 45% male) were enrolled. Univariable logistic regression showed loca...
Otolaryngology-Head and Neck Surgery, Dec 21, 2010
ObjectiveIntranasal corticosteroids (INCS) are first‐line medications for moderate to severe alle... more ObjectiveIntranasal corticosteroids (INCS) are first‐line medications for moderate to severe allergic rhinitis (AR). Patients who have had nasal congestion for many years often develop inferior turbinate (IT) hypertrophy. Some patients are refractory to INCS yet decline to receive allergen‐specific immunotherapy. IT reduction is then indicated. There have been very few studies evaluating the allergic biomarker changes after IT reduction in AR. This study aimed to determine the effect of potassium titanyl–phosphate (KTP) laser IT surgery on eosinophil influx after challenge with dust mites.Study DesignA randomized prospective controlled study.SettingTertiary academic rhinology clinic.Subjects and MethodsThirty‐five house dust mite AR patients were randomly assigned to receive either INCS or KTP laser IT surgery. On the first visit, 2 nasal lavages prior to and 6 hours after challenge with Dermatophagiodes pteronyssinus were performed before receiving treatment. On the second visit, 3 months after treatment, the same procedures were repeated. No antiallergic medications were allowed for 2 weeks before each visit. Net changes in eosinophil numbers in the lavages were compared at baseline and 3 months after treatment and between the 2 treatments.ResultsTreatment with KTP laser IT surgery resulted in a significant reduction in eosinophil influx after nasal challenge (P =. 013), whereas such a reduction was not shown in the control. However, the net changes in the percentage of eosinophils were not different between the 2 groups at either visit.ConclusionKTP laser IT surgery reduces eosinophil influx after nasal challenge in perennial AR.
ABSTRACTSuccessful COVID-19 prevention requires additional measures beyond vaccination, social di... more ABSTRACTSuccessful COVID-19 prevention requires additional measures beyond vaccination, social distancing, and masking. A nasal spray solution containing human IgG1 antibodies against SARS-CoV-2 (COVITRAP™) was developed to strengthen other COVID-19 preventive arsenals. Here, we evaluated its pseudovirus neutralization potencies, preclinical and clinical safety profiles, and intranasal SARS-CoV-2 inhibitory effects in healthy volunteers (NCT05358873). COVITRAP™ exhibited broadly potent neutralizing activities against SARS-CoV-2 with PVNT50 values ranging from 0.0035 to 3.1997 μg/ml for the following variants of concern (ranked from lowest to highest): Alpha, Beta, Gamma, Ancestral, Delta, Omicron BA.1, Omicron BA.2, Omicron BA.4/5, and Omicron BA.2.75. It demonstrated satisfactory preclinical safety profiles based on evaluations of in vitro cytotoxicity, skin sensitization, intracutaneous reactivity, and systemic toxicity. Its intranasal administration in rats did not yield any dete...
Journal of the Medical Association of Thailand, 2021
Background: Some chronic rhinosinusitis with nasal polyps patients undergoing endoscopic sinus su... more Background: Some chronic rhinosinusitis with nasal polyps patients undergoing endoscopic sinus surgery (ESS) have unfavorable results despite proper postoperative treatments including oral and topical steroids. Steroid-impregnated absorbable nasal dressing has been shown to improve outcomes of the surgery. In some clinical practices, budesonide-impregnated nasal dressing is used together with perioperative oral steroid but the additional benefits of it are still unknown. Objective: To determine whether budesonide-impregnated nasal dressing had any benefits following ESS when a short course of oral steroid was given in perioperative period. Materials and Methods: The present study was a prospective, double-blinded, randomized, placebo-controlled study conducted in tertiary care hospital. Eighteen consecutive patients (36 nostrils) with chronic rhinosinusitis with nasal polyps underwent bilateral ESS were enrolled. At the end of the surgery for each patient, one side of the ethmoid ca...
This study aims to assess the appropriate site for diagnosing eosinophilic chronic rhinosinusitis... more This study aims to assess the appropriate site for diagnosing eosinophilic chronic rhinosinusitis (ECRS) by histopathology. Patients with chronic rhinosinusitis with polyps (CRSwNP) were enrolled. Specimens were collected from polyp apex, polyp pedicle, polyp scraping and ethmoid mucosa. Number of tissue eosinophil of the four samples was assessed with intrapersonal comparison for diagnosing ECRS. Correlations with clinical characteristics of ECRS were assessed for each site. Results showed that thirty patients with CRSwNP were enrolled. Polyp apex, polyp pedicle and ethmoid mucosa gave similar results for diagnosing ECRS in 16 patients (53.3%). Median tissue eosinophil was greater in polyp apex (84, IQR: 34-194) and polyp pedicle (96, IQR: 80-320) than ethmoid mucosa (21, IQR: 10-220), p=0.04. Sensitivity for diagnosing ECRS were 100% (95%CI: 47.8 - 100) for polyp apex, 60% (95%CI: 14.7 - 94.7) for polyp pedicle, 80% (95%CI: 28.4 – 99.5) for ethmoid mucosa. Correlations with asthma...
Background: At present, there is no consensus for optimal orbital infection management in invasiv... more Background: At present, there is no consensus for optimal orbital infection management in invasive fungal rhinosinusitis patients. This is the first retrospective cohort study aimed to determine efficacy and side effects of the retrobulbar amphotericin B injection for orbital management in invasive fungal rhinosinusitis patients. Methodology: A retrospective chart review was conducted from 2005 to 2020. Thirty-six patients (forty-two orbits) diagnosed with invasive fungal rhinosinusitis with orbital invasion, treated with or without retrobulbar amphotericin B injection, were included in the study. Results: There were a total of 36 patients in the study, 12 patients received retrobulbar amphotericin B injection and 24 did not. There was no significant difference in orbital exenteration and death between two groups. Visual acuity change at the 3rd month was significantly better in the exposure group. There was a significant difference in the overall clinical outcome at 3rd month and 1...
We assessed associations of potential factors with orbital complications in acute rhinosinusitis ... more We assessed associations of potential factors with orbital complications in acute rhinosinusitis (ARS) patients.
Dysphagia was assessed using VFSS (recommendation quantified as 0, normal; 1, nectar thick; 2, ne... more Dysphagia was assessed using VFSS (recommendation quantified as 0, normal; 1, nectar thick; 2, nectar plus; 3, honey thick; 4, pureed; and 5, nil per os) and a modified SWAL-QOL instrument consisting of 7 domains whose scores were averaged to yield an overall score ranging from 0 (worst) to 100 (best). Patients were also administered a generic QOL instrument: the Infant/Toddler QOL (ITQOL) questionnaire (age <6 years) or Child Health Questionnaire (age 6-18 years). Linear regression and Pearson correlation analyses were used to quantify the relationships between measures. Results: A total of 167 patients (61% male, mean age 3.3 ± 3.5 years, 83% age <6 years) completed the VFSS and QOL questionnaires. The overall SWAL-QOL score was significantly associated with VFSS-recommended thickness (β = –3.4, P = .03), multiple ITQOL scales (Physical Abilities [r = .63, P < .001], Behavior [r = .60, P < .001], Parental Impact– Time [r = .68, P < .001]) and multiple Child Health Q...
Background:Intra-operative bleeding diminishes visualisation during functional endoscopic sinus s... more Background:Intra-operative bleeding diminishes visualisation during functional endoscopic sinus surgery and can cause unfavourable outcomes. Dexmedetomidine is a potent alpha-2 agonist, with sympatholytic effects. This systematic review aimed to assess whether dexmedetomidine decreases intra-operative bleeding and improves operative field quality.Methods:All randomised, controlled trials that assessed the ability of dexmedetomidine to provide good operative fields for functional endoscopic sinus surgery were identified from Medline and Embase. The outcomes of interest were: operative field quality, intra-operative bleeding, operative time and adverse events.Results:Five studies (254 patients) met the inclusion criteria. When compared to saline, dexmedetomidine improved the quality of the operative field. The operative time was similar between groups. When compared to other drugs, dexmedetomidine was as effective as esmolol and remifentanil. There were no adverse incidents.Conclusion...
JOURNAL OF THE MEDICAL ASSOCTATION OF THAILAND, Feb 15, 2021
Background: Some chronic rhinosinusitis with nasal polyps patients undergoing endoscopic sinus su... more Background: Some chronic rhinosinusitis with nasal polyps patients undergoing endoscopic sinus surgery (ESS) have unfavorable results despite proper postoperative treatments including oral and topical steroids. Steroid-impregnated absorbable nasal dressing has been shown to improve outcomes of the surgery. In some clinical practices, budesonide-impregnated nasal dressing is used together with perioperative oral steroid but the additional benefits of it are still unknown. Objective: To determine whether budesonide-impregnated nasal dressing had any benefits following ESS when a short course of oral steroid was given in perioperative period. Materials and Methods: The present study was a prospective, double-blinded, randomized, placebo-controlled study conducted in tertiary care hospital. Eighteen consecutive patients (36 nostrils) with chronic rhinosinusitis with nasal polyps underwent bilateral ESS were enrolled. At the end of the surgery for each patient, one side of the ethmoid cavity and middle meatus was randomly given polyurethane foam soaked with 2 mL of budesonide inhalation solution (0.5 mg/2 mL) (budesonide side), while the contralateral side received 2 mL of normal saline-soaked polyurethane foam (control side). Postoperative care included a short course of oral steroid and budesonide nasal irrigations. Single assessor blinded to the randomize allocation evaluated mucosal inflammation and wound healing at 2 and 4 weeks after surgery using Perioperative Sinus Endoscopy (POSE) score. Results: A total of 36 nostrils were randomized into two groups: 18 to the budesonide side and 18 to the control side. All of them were analyzed. The preoperative Lund-Mackay computed tomography score did not show a significant difference between the groups. There was no significant difference in POSE score between budesonide and control sides at 2 and 4 weeks after surgery. Conclusion: Budesonide-impregnated polyurethane foam did not provide additional benefits on mucosal inflammation and wound healing in the patients who underwent ESS and received a short course of oral steroid perioperatively. Keywords: Chronic rhinosinusitis, Nasal polyps, Nasal dressing/packing, Budesonide, Endoscopic sinus surgery
BACKGROUND: Low-dose macrolides (LDM) are anti-inflammatory agents with antineutrophilic activity... more BACKGROUND: Low-dose macrolides (LDM) are anti-inflammatory agents with antineutrophilic activity, but patient selection for LDM therapy in treating chronic rhinosinusitis (CRS) is controversial. This study aimed to assess factors which predict LDM responders. METHODOLOGY: A prospective cohort study was performed. Patients with CRS received roxithromycin (150 mg) once daily for 12 weeks. Nasal secretions and serology were collected. Nine predictors for LDM response were assessed: nasal secretion IgE, nasal secretion IL-5, serum IgE, serum eosinophils, serum neutrophils, nasal polyps, asthma, allergy, and aspirin hypersensitivity, using receiver-operating curve analysis and multivariable logistic regression. Macrolide responders were those with sino-nasal outcome test-22 improvement, symptoms visual analogue scale decreased to ≤5, and no rescue medication. RESULTS: One hundred CRS patients (mean age 47.4±14.1 years, 45% male) were enrolled. Univariable logistic regression showed loca...
Otolaryngology-Head and Neck Surgery, Dec 21, 2010
ObjectiveIntranasal corticosteroids (INCS) are first‐line medications for moderate to severe alle... more ObjectiveIntranasal corticosteroids (INCS) are first‐line medications for moderate to severe allergic rhinitis (AR). Patients who have had nasal congestion for many years often develop inferior turbinate (IT) hypertrophy. Some patients are refractory to INCS yet decline to receive allergen‐specific immunotherapy. IT reduction is then indicated. There have been very few studies evaluating the allergic biomarker changes after IT reduction in AR. This study aimed to determine the effect of potassium titanyl–phosphate (KTP) laser IT surgery on eosinophil influx after challenge with dust mites.Study DesignA randomized prospective controlled study.SettingTertiary academic rhinology clinic.Subjects and MethodsThirty‐five house dust mite AR patients were randomly assigned to receive either INCS or KTP laser IT surgery. On the first visit, 2 nasal lavages prior to and 6 hours after challenge with Dermatophagiodes pteronyssinus were performed before receiving treatment. On the second visit, 3 months after treatment, the same procedures were repeated. No antiallergic medications were allowed for 2 weeks before each visit. Net changes in eosinophil numbers in the lavages were compared at baseline and 3 months after treatment and between the 2 treatments.ResultsTreatment with KTP laser IT surgery resulted in a significant reduction in eosinophil influx after nasal challenge (P =. 013), whereas such a reduction was not shown in the control. However, the net changes in the percentage of eosinophils were not different between the 2 groups at either visit.ConclusionKTP laser IT surgery reduces eosinophil influx after nasal challenge in perennial AR.
ABSTRACTSuccessful COVID-19 prevention requires additional measures beyond vaccination, social di... more ABSTRACTSuccessful COVID-19 prevention requires additional measures beyond vaccination, social distancing, and masking. A nasal spray solution containing human IgG1 antibodies against SARS-CoV-2 (COVITRAP™) was developed to strengthen other COVID-19 preventive arsenals. Here, we evaluated its pseudovirus neutralization potencies, preclinical and clinical safety profiles, and intranasal SARS-CoV-2 inhibitory effects in healthy volunteers (NCT05358873). COVITRAP™ exhibited broadly potent neutralizing activities against SARS-CoV-2 with PVNT50 values ranging from 0.0035 to 3.1997 μg/ml for the following variants of concern (ranked from lowest to highest): Alpha, Beta, Gamma, Ancestral, Delta, Omicron BA.1, Omicron BA.2, Omicron BA.4/5, and Omicron BA.2.75. It demonstrated satisfactory preclinical safety profiles based on evaluations of in vitro cytotoxicity, skin sensitization, intracutaneous reactivity, and systemic toxicity. Its intranasal administration in rats did not yield any dete...
Journal of the Medical Association of Thailand, 2021
Background: Some chronic rhinosinusitis with nasal polyps patients undergoing endoscopic sinus su... more Background: Some chronic rhinosinusitis with nasal polyps patients undergoing endoscopic sinus surgery (ESS) have unfavorable results despite proper postoperative treatments including oral and topical steroids. Steroid-impregnated absorbable nasal dressing has been shown to improve outcomes of the surgery. In some clinical practices, budesonide-impregnated nasal dressing is used together with perioperative oral steroid but the additional benefits of it are still unknown. Objective: To determine whether budesonide-impregnated nasal dressing had any benefits following ESS when a short course of oral steroid was given in perioperative period. Materials and Methods: The present study was a prospective, double-blinded, randomized, placebo-controlled study conducted in tertiary care hospital. Eighteen consecutive patients (36 nostrils) with chronic rhinosinusitis with nasal polyps underwent bilateral ESS were enrolled. At the end of the surgery for each patient, one side of the ethmoid ca...
This study aims to assess the appropriate site for diagnosing eosinophilic chronic rhinosinusitis... more This study aims to assess the appropriate site for diagnosing eosinophilic chronic rhinosinusitis (ECRS) by histopathology. Patients with chronic rhinosinusitis with polyps (CRSwNP) were enrolled. Specimens were collected from polyp apex, polyp pedicle, polyp scraping and ethmoid mucosa. Number of tissue eosinophil of the four samples was assessed with intrapersonal comparison for diagnosing ECRS. Correlations with clinical characteristics of ECRS were assessed for each site. Results showed that thirty patients with CRSwNP were enrolled. Polyp apex, polyp pedicle and ethmoid mucosa gave similar results for diagnosing ECRS in 16 patients (53.3%). Median tissue eosinophil was greater in polyp apex (84, IQR: 34-194) and polyp pedicle (96, IQR: 80-320) than ethmoid mucosa (21, IQR: 10-220), p=0.04. Sensitivity for diagnosing ECRS were 100% (95%CI: 47.8 - 100) for polyp apex, 60% (95%CI: 14.7 - 94.7) for polyp pedicle, 80% (95%CI: 28.4 – 99.5) for ethmoid mucosa. Correlations with asthma...
Background: At present, there is no consensus for optimal orbital infection management in invasiv... more Background: At present, there is no consensus for optimal orbital infection management in invasive fungal rhinosinusitis patients. This is the first retrospective cohort study aimed to determine efficacy and side effects of the retrobulbar amphotericin B injection for orbital management in invasive fungal rhinosinusitis patients. Methodology: A retrospective chart review was conducted from 2005 to 2020. Thirty-six patients (forty-two orbits) diagnosed with invasive fungal rhinosinusitis with orbital invasion, treated with or without retrobulbar amphotericin B injection, were included in the study. Results: There were a total of 36 patients in the study, 12 patients received retrobulbar amphotericin B injection and 24 did not. There was no significant difference in orbital exenteration and death between two groups. Visual acuity change at the 3rd month was significantly better in the exposure group. There was a significant difference in the overall clinical outcome at 3rd month and 1...
We assessed associations of potential factors with orbital complications in acute rhinosinusitis ... more We assessed associations of potential factors with orbital complications in acute rhinosinusitis (ARS) patients.
Dysphagia was assessed using VFSS (recommendation quantified as 0, normal; 1, nectar thick; 2, ne... more Dysphagia was assessed using VFSS (recommendation quantified as 0, normal; 1, nectar thick; 2, nectar plus; 3, honey thick; 4, pureed; and 5, nil per os) and a modified SWAL-QOL instrument consisting of 7 domains whose scores were averaged to yield an overall score ranging from 0 (worst) to 100 (best). Patients were also administered a generic QOL instrument: the Infant/Toddler QOL (ITQOL) questionnaire (age <6 years) or Child Health Questionnaire (age 6-18 years). Linear regression and Pearson correlation analyses were used to quantify the relationships between measures. Results: A total of 167 patients (61% male, mean age 3.3 ± 3.5 years, 83% age <6 years) completed the VFSS and QOL questionnaires. The overall SWAL-QOL score was significantly associated with VFSS-recommended thickness (β = –3.4, P = .03), multiple ITQOL scales (Physical Abilities [r = .63, P < .001], Behavior [r = .60, P < .001], Parental Impact– Time [r = .68, P < .001]) and multiple Child Health Q...
Background:Intra-operative bleeding diminishes visualisation during functional endoscopic sinus s... more Background:Intra-operative bleeding diminishes visualisation during functional endoscopic sinus surgery and can cause unfavourable outcomes. Dexmedetomidine is a potent alpha-2 agonist, with sympatholytic effects. This systematic review aimed to assess whether dexmedetomidine decreases intra-operative bleeding and improves operative field quality.Methods:All randomised, controlled trials that assessed the ability of dexmedetomidine to provide good operative fields for functional endoscopic sinus surgery were identified from Medline and Embase. The outcomes of interest were: operative field quality, intra-operative bleeding, operative time and adverse events.Results:Five studies (254 patients) met the inclusion criteria. When compared to saline, dexmedetomidine improved the quality of the operative field. The operative time was similar between groups. When compared to other drugs, dexmedetomidine was as effective as esmolol and remifentanil. There were no adverse incidents.Conclusion...
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