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Mucosal remodeling and reversibility in chronic rhinosinusitis

Mucosal remodeling and reversibility in chronic rhinosinusitis REVIEW URRENT Mucosal remodeling and reversibility in chronic PINION rhinosinusitis Ahmed Bassiouni, Philip G. Chen, and Peter-John Wormald Purpose of review Evidence suggests that some structural changes caused by mucosal remodeling may be primarily irreversible, which theoretically challenges the current management model of chronic rhinosinusitis (CRS). The relationship between inflammation and remodeling in the mucosa remains complex, yet better understanding of involved pathways holds potential clinical implications. This article reviews the controversies as well as current applications from the literature. Recent findings First, the relationship between inflammation and remodeling is a complex one involving multiple pathways, with evidence suggesting that remodeling is not a simple fibrotic end-stage process secondary to long- standing inflammation. Second, anti-inflammatory approaches alone are probably not successful in reversing changes such as collagen deposition, indicating that early treatment might be crucial for preventing disease progression. Third, a dysfunctional sinus remains a pure clinical/surgical phenomenon with lack of histological characterization. Fourth, maximal/extensive surgical techniques are advocated for patients with severe disease or dysfunctional sinuses. Summary Reversibility of remodeling holds implications for the management of CRS. Although clinical applications (both medical and surgical) exist, further research is required for solidifying current evidence as well as exploring new http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Opinion in Allergy and Clinical Immunology Wolters Kluwer Health

Mucosal remodeling and reversibility in chronic rhinosinusitis

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Copyright
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
ISSN
1528-4050
eISSN
1473-6322
DOI
10.1097/ACI.0b013e32835ad09e
pmid
23222070
Publisher site
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Abstract

REVIEW URRENT Mucosal remodeling and reversibility in chronic PINION rhinosinusitis Ahmed Bassiouni, Philip G. Chen, and Peter-John Wormald Purpose of review Evidence suggests that some structural changes caused by mucosal remodeling may be primarily irreversible, which theoretically challenges the current management model of chronic rhinosinusitis (CRS). The relationship between inflammation and remodeling in the mucosa remains complex, yet better understanding of involved pathways holds potential clinical implications. This article reviews the controversies as well as current applications from the literature. Recent findings First, the relationship between inflammation and remodeling is a complex one involving multiple pathways, with evidence suggesting that remodeling is not a simple fibrotic end-stage process secondary to long- standing inflammation. Second, anti-inflammatory approaches alone are probably not successful in reversing changes such as collagen deposition, indicating that early treatment might be crucial for preventing disease progression. Third, a dysfunctional sinus remains a pure clinical/surgical phenomenon with lack of histological characterization. Fourth, maximal/extensive surgical techniques are advocated for patients with severe disease or dysfunctional sinuses. Summary Reversibility of remodeling holds implications for the management of CRS. Although clinical applications (both medical and surgical) exist, further research is required for solidifying current evidence as well as exploring new

Journal

Current Opinion in Allergy and Clinical Immunology – Wolters Kluwer Health

Published: Feb 1, 2013

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