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Berrylin J Ferguson

Publications and source records attributed to Berrylin J Ferguson.

At least 19 recordsLinked to original sources
PubMed2006

Differential diagnosis of eosinophilic chronic rhinosinusitis.

Eosinophilic chronic rhinosinusitis (ECRS) encompasses a wide variety of etiologies. To date, a unifying pathophysiologic mechanism remains elusive. Eosinophilia is frequently, but not exclusively, caused by immunoglobulin (Ig)E-mediated hypersensitivity and is dominated by the associated cytokine milieu of Th2 inflammation. The provisional subcategories of ECRS include superantigen-induced eosinophilic chronic rhinosinusitis, allergic fungal sinusitis, nonallergic fungal eosinophilic chronic rhinosinusitis, and aspirin-exacerbated eosinophilic chronic rhinosinusitis. Within each subcategory, recent findings supporting distinct mechanisms that promote eosinophilic infiltration are presented, and, therefore, targeted therapeutic interventions with specific antibacterial, antifungal, or immune modulation may be indicated.

Animals↗
PubMed2006

Rhinosinusitis: developing guidance for clinical trials.

The Rhinosinusitis Initiative was developed by 5 national societies. The current guidance document is an expansion of the 2004 publication "Rhinosinusitis: Establishing definitions for clinical research and patient care" and provides templates for clinical trials in antimicrobial, anti-inflammatory, and symptom-relieving therapies for the following: (1) acute presumed bacterial rhinosinusitis, (2) chronic rhinosinusitis (CRS) without nasal polyps, (3) CRS with nasal polyps, and (4) classic allergic fungal rhinosinusitis. In addition to the templates for clinical trials and proposed study designs, the Rhinosinusitis Initiative has developed 6 appendices, which address (1) health outcomes, (2) nasal endoscopy and staging of CRS, (3) radiologic imaging, (4) microbiology, (5) laboratory measures, and (6) biostatistical methods.

Chronic Disease↗
PubMed2006

Endoscopically directed middle meatal cultures versus maxillary sinus taps in acute bacterial maxillary rhinosinusitis: a meta-analysis.

OBJECTIVE: The aim of this study was to verify the correlation of endoscopically directed middle meatal (EDMM) cultures with maxillary sinus tap and culture (MST) in acute bacterial rhinosinusitis (ABRS). STUDY DESIGN AND METHODS: Meta-analysis of the previous literature, unpublished data, and a prospective trial supported by the Sinus & Allergy Health Partnership. EDMM and MST cultures were obtained and their results compared. Inclusion for both the unpublished and prospective trial as well as prior published literature in the meta-analysis required the studies to compare EDMM versus MST in the acute setting of bacterial rhinosinusitis with both symptomatic and radiologic evidence of ABRS. RESULTS: Three articles and 1 national presentation were identified for inclusion. Additional data from unpublished studies and the prospective trial were combined. The pooled data consisted of 126 patients with 131 culture pairs. For known pathogenic bacteria for ABRS and in comparison to MST, EDMM had a sensitivity of 80.9%, a specificity of 90.5%, a positive predictive value of 82.6%, a negative predictive value of 89.4%, and an overall accuracy of 87.0% (95% confidence interval, 81.3%-92.8%); 70.5% (12/17) of false positive culture pairs were of known pathogens for ABRS that would not be expected to be contaminants. CONCLUSIONS AND SIGNIFICANCE: This meta-analysis shows that EDMM is a highly sensitive and accurate culture method for acute ABRS and may be more sensitive than MST given the presence of pathogenic bacteria not found on antral lavage. EDMM is a viable, and possibly preferred, culture method for determining antimicrobial efficacy and bacterial resistance patterns. EBM RATING: A-1a.

Endoscopy↗
PubMed2006

Acute bacterial rhinosinusitis: a review of U.S. treatment guidelines.

Acute bacterial rhinosinusitis (ABRS) is a common complication of viral upper respiratory tract infections and is associated with a significant socioeconomic burden. Guidelines for the diagnosis and management of ABRS have been produced in association with a number of societies in the United States; these guidelines aim to promote the rational selection of antibiotic therapy to optimize clinical outcomes while minimizing the potential for selection of antibiotic resistance. This article provides an overview of current U.S. guidelines for the treatment of ABRS, focusing on the impact of antibiotic resistance on treatment options.

Anti-Bacterial Agents↗
PubMed2006

Rhinosinusitis: Developing guidance for clinical trials.

The Rhinosinusitis Initiative was developed by 5 national societies. The current guidance document is an expansion of the 2004 publication, "Rhinosinusitis: Establishing definitions for clinical research and patient care" and provides templates for clinical trials in antimicrobial, anti-inflammatory, and symptom-relieving therapies for the following: (1) acute presumed bacterial rhinosinusitis, (2) chronic rhinosinusitis (CRS) without nasal polyps, (3) CRS with nasal polyps, and (4) classic allergic fungal rhinosinusitis. In addition to the templates for clinical trials and proposed study designs, the Rhinosinusitis Initiative has developed 6 appendices, which address (1) health outcomes, (2) nasal endoscopy and staging of CRS, (3) radiologic imaging, (4) microbiology, (5) laboratory measures, and (6) biostatistical methods.

Chronic Disease↗
PubMed2006

The impact of endoscopic cultures on care in rhinosinusitis.

OBJECTIVES: The objectives of this retrospective, observational study were primarily to analyze endoscopically guided culture results (EGCRs) from an office setting in patients with subclassifications of chronic rhinosinusitis (CRS) and to determine the frequency EGCR-altered patient management; and secondarily to determine whether purulent secretions are more likely to be positive for a bacterial pathogen. METHODS: Consecutive symptomatic patients with nasal secretions not currently on antibiotics were cultured endoscopically. Patients were classified as chronic rhinosinusitis (CRS; n = 41) or acute exacerbation of chronic rhinosinusitis (AECRS; n = 27). Initial therapy was individualized and 32 of 68 (47%) had an antibiotic initiated before availability of the EGCR. Patients were reassessed 2 to 4 days later, and therapy was continued or altered based on clinical course and EGCR. RESULTS: EGCRs were positive in 41 of 68 (60.2%) of all patients. Incidence of positive cultures was not statistically different between CRS (21 of 41 [51%]) and AECRS (20 of 27 [74%]) patients. Initial therapy was changed in 45 of 68 (66%) patients. In 35 of 68 (51.4%), the change was directed by EGCR; in 11 of 77 (14.2%), the change was unsubstantiated by EGCR, and in no cases was an antibiotic initiated inappropriate to EGCR. The frequency of pathogens in the subgroups of CRS and AECRS, respectively, were Staphylococcus aureus (9 of 41 [22%]; 9 of 27 [33%]), acute pathogens (6 of 41 [14.6%], 7 of 27 [25.9%]), and Pseudomonas aeruginosa (5 of 41 [12%], 5 of 27 [18.5%]) and were not statistically different between subgroups. Purulent cultures were not significantly more likely to be Gram stain-positive than nonpurulent cultures (12 of 34 [35%] compared with 6 of 34 [17.6%], respectively; P = .1). Purulent cultures were more likely to be culture-positive (25 of 34 [73.5%]) compared with nonpurulent secretions (17 of 34 [50%]; P < .05). AECRS was significantly more likely to be purulent (21 of 27 cases) compared with CRS (13 of 41 cases, P < .001). CONCLUSION: EGCR directed a change in therapy in 35 of 68 (51.4%) patients with CRS. The pathogens isolated from CRS and AECRS were similar and predominately S. aureus, acute pathogens, and P. aeruginosa. Purulent secretions are more frequently bacteriologically positive than nonpurulent secretions and more common in AECRS than CRS.

Adult↗
PubMed2006

Women in otolaryngology: closing the gender gap.

PURPOSE OF REVIEW: The purpose of this review is to provide a current and historical account of women in otolaryngology, including academic, leadership and subspecialty roles and to review all published studies specific to women in otolaryngology. RECENT FINDINGS: The only comprehensive survey of women in active practice in otolaryngology was conducted in 1998, when women comprised just over 6% of all practicing otolaryngologists in the United States. Women surveyed then had a higher divorce rate (P = 0.001) and fewer children (P < 0.001) and earned 15% less per year than men (values corrected for subspecialty and hours spent working). In a 2002 survey of otolaryngology residents, women were significantly less confident in their surgical skills and preparedness for postresidency practice (P = 0.05). Just 7 years later, in 2005 the number of practicing female otolaryngologists had more than tripled to over 2470 (24%). In 2003, 21% of entering residents were women up from 15.7% in 1993 and 8% in 1980. Of the 90 academic departments of otolaryngology on the American Academy of Otolaryngology - Head and Neck Surgery website, two (2.2%) are currently headed by women. SUMMARY: The percentage of women in otolaryngology is rapidly rising and women now account for over 20% of the specialty. Data from earlier surveys, when women comprised a smaller segment of the specialty showed significant self-perceived differences by gender. Continual monitoring is required and is increasingly important, as women comprise an ever-increasing part of this specialty.

Career Choice↗
PubMed2005

Powered instrumentation and tissue effects in the nose and paranasal sinuses.

PURPOSE OF REVIEW: The technologic cornerstones of endoscopic sinus surgery initially rested on the endoscope and CT scanning. In the mid-1990s, the advent of powered instrumentation, in particular the microdebrider, advanced the surgeon's ability to treat polypoid disease, sinus and nasal disease in a bleeding field, choanal atresia, antral choanal polyps, and inferior turbinate hypertrophy. This review evaluates both positive and negative tissue effects secondary to powered instrumentation. RECENT FINDINGS: Recent reports of deleterious outcomes with powered instrumentation require a reevaluation of the role of powered instrumentation and consideration of factors that lead to injury. The rapidity of injury makes the powered instrument especially dangerous in inexperienced hands. One third of participants in a recent survey were unaware that powered instruments could be involved in orbital injury and half were unaware that cranial injuries could be secondary to powered instrumentation. SUMMARY: Microdebriders will continue to advance the field of endoscopic surgery, providing clearer operative fields and causing less tissue trauma in experienced hands. However, the severity of complications, including the potential for rapidly aspirating orbital and cerebral contents when laminae are violated, must be appreciated and respected.

Debridement↗
PubMed2004

Influences of allergic rhinitis on sleep.

BACKGROUND: Allergic rhinitis is classically characterized by sneezing, pruritus, rhinorrhea, and nasal congestion. These symptoms can lead to impaired nocturnal sleep, and this impairment results in daytime fatigue and somnolence, reducing both learning and work efficiency and decreasing quality of life. STUDY DESIGN: In addition, the mediators of AR, including histamine, leukotrienes, cytokines, and prostaglandins, may play a role in sleep regulation and, thus, may be directly involved in this impairment independent of nasal obstruction. Recumbency and/or diurnal variation augments turbinate swelling, causing nasal blockage during nocturnal sleep. Medications directed toward reversal of nasal congestion often concomitantly work through suppression of inflammatory mediators and constitute the primary therapy for sleep disturbance associated with allergic rhinitis. Some pharmaceutical interventions that reduce nasal congestion have adverse effects on sleep. Decongestants effectively reduce nasal congestion but frequently produce stimulatory effects and even insomnia. Antihistamines reduce sneezing and pruritus, but are less effective in relieving congestion. Earlier, "first-generation" antihistamines are associated with significant sedation. They also have anticholinergic properties, which can cause dry mouth and make mouth breathing even more uncomfortable in the allergic individual with nasal obstruction. The absence of anticholinergic properties in second-generation, largely nonsedating antihistamines limits their efficacy in rhinorrhea. Azelastine, a topical antihistamine, significantly reduces rhinorrhea and congestion and improves subjective sleep quality, but is also associated with increased sedation. Intranasal corticosteroids and oral leukotriene receptor antagonists effectively reduce rhinorrhea, congestion, and inflammatory mediators. CONCLUSIONS: The efficacy of these medications at improving subjective sleep quality has been established through multiple randomized, double-blind, placebo-controlled clinical trials.

Humans↗
PubMed2004

Comparison of Multi-Test II skin prick testing to intradermal dilutional testing.

OBJECTIVES/HYPOTHESIS: Intradermal dilutional testing (IDT) has been considered more sensitive than prick testing for detecting low-level allergies. Multi-Test II is one of the most sensitive and reproducible prick testing methods available. This study compares Multi-Test II prick testing with IDT. DESIGN: Retrospective chart review and data analysis on patients who had allergy testing with both Multi-Test II and IDT. SETTING: Outpatient allergy clinic in the otolaryngology department of an academic tertiary care medical center. POPULATION: Forty adult patients had complete allergy testing with both Multi-Test II and IDT for a standard panel of twelve antigens between January 2002 and April 2002. INTERVENTION: Analysis and comparison of test results on Multi-Test II and IDT for each antigen separately and across all antigen tests together. RESULTS: Forty patients had complete testing for all antigens during the time period for the study. Six of these patients did not react to the positive control on Multi-Test II and were eliminated from the main analysis. Of the 34 patients included in the main analysis, all were positive for at least one antigen on IDT; one half (17/34) were negative for all antigens on Multi-Test II. A significantly greater number of patients were positive on IDT than Multi-Test II for all antigens except dog (P < 0.05). There was a statistically significant correlation between IDT endpoint and Multi-Test II score for several antigens (P < 0.05). Of 408 total antigen tests performed, 339 (83.1%) were negative on Multi-Test II. Of these 339 negative Multi-Test II tests, 148 (43.7%) were negative on IDT and 191 (56.3%) were positive on IDT; 174/339 (51.3%) had an IDT endpoint of 2 or 3 and 17/339 (5.0%) had an IDT endpoint > or = 4. A significantly greater number of antigen tests were positive on IDT than on Multi-Test II (P < 0.001). The overall Spearman correlation coefficient between IDT endpoint and Multi-Test II score was 0.370 (P < 0.001). CONCLUSION: Patients were more likely to have a positive test on IDT than on Multi-Test II. IDT therefore may be a more sensitive testing technique for inhalant allergies than Multi-Test II prick testing. In addition, Multi-Test II score may not be a good predictor of IDT endpoint. Although a statistically significant correlation is demonstrated between Multi-Test II score and IDT endpoint, the correlation coefficient is low enough that clinical application may not always be safe or appropriate. The clinical significance of positive IDT results in the presence of negative Multi-Test II results is not known.

Adolescent↗
PubMed2004

Efficacy and safety of oral telithromycin once daily for 5 days versus moxifloxacin once daily for 10 days in the treatment of acute bacterial rhinosinusitis.

OBJECTIVE: To compare the clinical and bacteriologic efficacy and safety of short-duration treatment with telithromycin given for 5 days with moxifloxacin given for 10 days in adults with acute bacterial rhinosinusitis (ABRS). STUDY DESIGN: In this prospective, double-blind, parallel-group, randomized, multicenter study, adult patients (N = 349) with ABRS were randomized to oral telithromycin (800 mg once daily for 5 days) or to oral moxifloxacin (400 mg once daily for 10 days) and followed for 31 to 36 days. Clinical outcome was determined by the investigator at the posttherapy/test of cure (TOC) visit. Bacteriologic outcome was determined by comparing cultures taken at the pretreatment visit with cultures obtained at the posttherapy/TOC visit. The primary objective was to demonstrate equivalence of clinical cure rates in the per-protocol population between treatment groups at the posttherapy/TOC visit. RESULTS: Clinical success at TOC (primary endpoint) was achieved in 87.4% of patients in the telithromycin group compared with 86.9% for moxifloxacin (per-protocol patients; 0.5% difference between treatment groups; 95% confidence interval [CI], -8.1, 9.2; P = 0.8930). The bacteriologic success rates were 94.1% and 93.9%, respectively (0.2% difference between treatment groups; 95% CI, -14.2, 14.5; P = 0.9734). Overall treatment-emergent adverse events for both drugs (mostly gastrointestinal) were mild to moderate in intensity. CONCLUSION AND SIGNIFICANCE: The clinical and bacteriologic efficacy of telithromycin 800 mg once daily for 5 days was equivalent to that of moxifloxacin 400 mg once daily for 10 days, establishing telithromycin as an important treatment option for ABRS.

Acute Disease↗
PubMed2004

Categorization of eosinophilic chronic rhinosinusitis.

PURPOSE OF REVIEW: The presence of eosinophilia histopathologically in sinusitis is frequently associated with greater disease objectively and a decreased likelihood of surgical success. Eosinophilic chronic rhinosinusitis encompasses a wide variety of etiologies and associations that can be grouped under this umbrella term. In addition, this term can be further divided into those patients with no polyps and those with polyps. The purpose of this review is to detail the epidemiology of eosinophilic chronic rhinosinusitis, to define known and potential subcategories, and to discuss targeted therapeutic interventions. Eosinophilia is frequently, but not exclusively, caused by IgE-mediated hypersensitivity and is dominated by the associated cytokine milieu of Th2 inflammation. Thus, allergic rhinitis or allergy is a subcategory and not synonymous with eosinophilic chronic rhinosinusitis. RECENT FINDINGS: Recent findings supporting mechanisms that promote eosinophilic infiltration are discussed and include the following subcategories: super antigen-induced eosinophilic chronic rhinosinusitis, allergic fungal sinusitis, nonallergic fungal eosinophilic chronic rhinosinusitis, and aspirin-exacerbated eosinophilic chronic rhinosinusitis. Undoubtedly there are other mechanisms and categorizations of eosinophilic chronic rhinosinusitis as yet unknown. It is possible, and in fact probable, that some patients may have overlapping mechanisms for eosinophilia. Corticosteroid therapy is an important treatment across all eosinophilic disorders and a profoundly potent but nonspecific antiinflammatory agent. Within each subcategory a specific antibacterial, antifungal, or immune modulation may be indicated. SUMMARY: The subcategories of eosinophilic chronic rhinosinusitis are discussed in light of recent findings and treatment recommendations.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed2003

New horizons in the management of allergy.

Over the last year, the understanding of early childhood allergen exposures and their impact on the development of allergy has radically changed. This article reviews these epidemiologic discoveries, although they have not yet led to therapeutic initiatives.

Complementary Therapies↗