Rakesh K Chandra

Northwestern University, Evanston, Illinois, United States

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Publications (135)521.66 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Up to 50% of patients with chronic rhinosinusitis (CRS) have comorbid asthma, and we have reported that a subset of CRS patients who have nasal polyps (CRSwNP) have elevated autoantigen-specific antibodies within their nasal polyps (NP). While increases in the prevalence and/or severity of both asthma and autoimmunity in women are well characterized, it is not known whether CRSwNP is more severe or frequent in women than men. We sought to determine whether CRSwNP demonstrated sex-specific differences in frequency and/or severity. Using a retrospectively collected database of tertiary care patients (n = 1393), we evaluated the distribution of sex in patients with CRSwNP with or without comorbid asthma or aspirin hypersensitivity. We further compared the severity of sinus disease between men and women with CRSwNP. Although women comprised 55% of CRS patients without NP (CRSsNP), a significantly smaller proportion of CRSwNP patients were female (38%, P < 0.001). Interestingly, women with CRSwNP were significantly more likely than men to have comorbid asthma (P < 0.001), and 61% of patients with the most severe form of disease (aspirin-exacerbated respiratory disease (CRSwNP plus asthma plus aspirin sensitivity)) were women (P < 0.05). Women with CRSwNP were significantly more likely to have taken oral steroids, and were more likely to have a history of revision surgeries (P < 0.05) compared to men. These data suggest that women with CRSwNP have more severe disease than men in a tertiary care setting. Future studies are needed to elucidate the mechanisms that drive disease severity in men and women, paving the way for the development of personalized treatment strategies for CRSwNP based on sex.
    03/2015; 3(1). DOI:10.1002/iid3.46
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    ABSTRACT: To describe national trends in retropharyngeal abscess (RPA) complicating peritonsillar abscess (PTA) and to determine factors associated with RPA in patients with PTA. Cross-sectional analysis. Nationwide Inpatient Sample, 2003-2010. PTA patients ≥18 years old, with or without RPA, were extracted according to ICD-9-CM codes. The cohort was analyzed with descriptive statistics and multivariate regression modeling to identify factors associated with RPA. Of the 91,647 (95% CI: 86,433-95,449) patients identified with PTA, 885 (1.0%) also had a concurrently coded RPA. The annual rate of concomitant RPA increased from 0.5% (95% CI: 0.3%-0.8%) to 1.4% (95% CI: 1.0%-2.0%) between 2003 and 2010 (P < .001). PTA patients with RPA more frequently underwent tonsillectomy (23.5% vs 11.1%), endotracheal intubation (7.1% vs 1.5%), and mechanical ventilation (13.2% vs 2.0%) than those without RPA (all P < .001). PTA patients with RPA were significantly older (41 vs 34 years old), had a longer hospital stay (6.4 vs 2.5 days), and had more procedures (2.5 vs 0.9) when compared to patients without RPA (all P < .001). Upon multivariate regression analysis, factors associated with RPA included the age groups of 40 to 64 years (odds ratio, 2.256; P < .001) and 65 and older (odds ratio, 2.086; P = .045). Median total charges for PTA inpatients with concomitant RPA were approximately $8700 greater (P < .001) when compared to patients with PTA alone. The incidence of RPA among adult inpatients with PTA is increasing, and patients with RPA have higher in-hospital resource utilization. Further studies may help validate factors predictive of RPA to enable prevention or earlier identification. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
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    ABSTRACT: Objectives/HypothesisVarious intranasal landmarks have been described to aid in the localization of the natural sphenoid sinus ostium. The objectives of this study are to identify the ostium location relative to the skull base and assess the relationships between the location of the ostium and sphenoid disease or pneumatization pattern. DesignDescriptive study. Methods Consecutive Xoran Mini-CAT (Ann Arbor, MI) scans of patients with no history of sinus surgery (n=202) were evaluated. The natural sphenoid ostium was identified in axial, coronal, and sagittal planes. Distances from the planum to the ostium and from the planum to the sinus floor were calculated. Lund-Mackay score and pneumatization pattern were recorded for each sphenoid sinus. ResultsThe mean distance from planum to ostium was 11.22.6 mm (range 4.4-19.2). On average, this encompassed 45.5%10% of the total sphenoid height. ANOVA with posthoc Tukey analysis revealed that the ostium was closer to the planum in sinuses with sellar (P=0.05) or presellar (P=0.02) pneumatization, compared to those with postsellar pneumatization. There was no significant relationship between the ostium location and degree of sinus disease. There was a significant difference in the pneumatization pattern between males and females (P=.04). More males had postsellar pneumatization than expected, and more females had sellar pneumatization than expected. Conclusions The natural ostium of the sphenoid sinus is located at approximately the midpoint of the sphenoid face. Nevertheless, significant variability can be observed based on the pneumatization pattern. Surgeons should recognize that the ostium may be closer to the skull base when the sinus is less pneumatized. Level of Evidence4. Laryngoscope, 125:75-79, 2015
    The Laryngoscope 01/2015; 125(1). DOI:10.1002/lary.24393 · 2.03 Impact Factor
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    ABSTRACT: Objectives/HypothesisTo assess relevant variations in the anatomical course of the infraorbital nerve (ION). This understanding may reduce the risk of surgical injury.MethodsA total of 100 consecutive computed-tomography sinus studies obtained in a tertiary referral center were reviewed, and measurements were made of the 200 IONs. Anatomic variants were classified into three types based on the degree to which (if any) the nerve's course descended from the maxillary roof into the sinus lumen.ResultsA total of 60.5% of IONs were entirely contained within the sinus roof. In 27.0%, the nerve canal descended below the roof but remained juxtaposed to it. In 12.5%, the ION descended into the sinus lumen. The proportion of IONs descending into the sinus significantly increased to 27.7% when an infraorbital ethmoid cell was present (chi-square P < 0.001) and to 50% when the nerve was contained within a lamella of such a cell (chi-square P < 0.001). Descended nerves terminated in a foramen located an average of 11.9 ± 2.5 mm below the infraorbital rim, significantly further below the orbit than nondescended nerves (t test P < 0.001). Descended nerves were located a mean distance of 8.6 ± 2.9 mm below the sinus roof and traversed the sinus lumen diagonally for a mean length of 15.4 ± 3.1 mm.Conclusions Descent of the ION into the maxillary sinus is a common anatomic variant that is more prevalent in the setting of an ipsilateral infraorbital ethmoid cell. Descended nerves are associated with the foramen significantly further below the inferior orbital rim than those of nondescended nerves. These observations may help surgeons avoid iatrogenic ION injury.Level of EvidenceN/A. Laryngoscope, 2015
    The Laryngoscope 01/2015; DOI:10.1002/lary.25089 · 2.03 Impact Factor
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    ABSTRACT: Although chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by Th2 inflammation, the mechanism underlying the onset and amplification of this inflammation has not been fully elucidated. Dendritic cells (DCs) are major antigen presenting cells, central inducers of adaptive immunity and critical regulators of many inflammatory diseases. However, the presence of DCs in CRS, especially in nasal polyps (NPs), has not been extensively studied. The objective of this study was to characterize DC subsets in CRS. We used real-time PCR to assess the expression of mRNA for markers of myeloid DCs (mDCs; CD1c), plasmacytoid DCs (pDCs; CD303) and Langerhans cells (LCs; CD1a, CD207) in uncinate tissue (UT) from controls and patients with CRS as well as in NP. We assayed the presence of DCs by immunohistochemistry and flow cytometry. Compared to UT from control subjects (n=15) and patients with CRS without NP (CRSsNP) (n=16) and CRSwNP (n=17), mRNAs for CD1a and CD1c were significantly elevated in NPs (n=29). In contrast, CD207 mRNA was not elevated in NPs. Immunohistochemistry showed that CD1c(+) cells but not CD303(+) cells were significantly elevated in NPs compared to control subjects or patients with CRSsNP. Flow cytometric analysis showed that CD1a(+) cells in NPs might be a subset of mDC1s, and that CD45(+) CD19(-) CD1c(+) CD11c(+) CD141(-) CD303(-) HLA-DR(+) mDC1s and CD45(+) CD19(-) CD11c(+) CD1c(-) CD141(high) mDC2s were significantly elevated in NPs compared to UT from controls and CRSsNP, but CD45(+) CD11c(-) CD303(+) HLA-DR(+) pDCs were only elevated in NPs compared to control UT. Myeloid DCs are elevated in CRSwNP, especially in NPs. Myeloid DCs thus may indirectly contribute to the inflammation observed in CRSwNP. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical & Experimental Allergy 12/2014; DOI:10.1111/cea.12471 · 4.32 Impact Factor
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    ABSTRACT: Specific antibody deficiency (SAD) involves a deficient response to a polysaccharide vaccine in the setting of normal immunoglobulin G (IgG) levels and chronic infections. Patients with chronic rhinosinusitis (CRS) are often evaluated for SAD. There are limited data that describe patients with CRS and SAD. The objective of this study was to better characterize the role of SAD in CRS. We reviewed electronic records of adults with CRS who were evaluated for immunodeficiency with quantitative Ig levels and pre- and postantibody titers to a pneumococcal polysaccharide vaccine (PPV). Fourteen pneumococcal serotypes were determined in 239 subjects from 2002 to 2009. Of these subjects, 64 had adequate protective titers of 1.3 μg/mL or higher in 7 or more serotypes of the 14 serotypes checked; 56 (23%) had less than 7 protective titers post-PPV and were diagnosed with SAD; and 119 had an adequate response to the vaccine with 7 or more serotypes being higher than 1.3 μg/mL (>50% response) and were characterized as "responders." Subjects with SAD received more antibiotic courses relative to responders in the 2 years after immunization (3.19 ± 2.64 vs 2.19 ± 2.24, P < .05). Of 56 subjects with SAD, 10 (17.9%) received Ig replacement therapy. Subjects who received Ig had fewer numbers of protective pneumococcal titers post-PPV and had more pneumonia (40.0%) versus subjects with SAD who did not receive Ig (10.9%). Of the 239 patients with CRS with normal IgG levels evaluated for immunodeficiency, 56 (23.4%) had SAD. A majority of patients with SAD may not need Ig replacement; however, a subset of patients with SAD benefit from Ig replacement. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
  • Journal of Allergy and Clinical Immunology 10/2014; 135(2). DOI:10.1016/j.jaci.2014.08.031 · 11.25 Impact Factor
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    ABSTRACT: Objectives/HypothesisThe objective of this study was to report patients' knowledge and comfort level with computed tomography (CT) imaging for sinus disease and evaluate patient willingness to undergo empiric medical therapy (EMT) versus CT-directed therapy (CTDT).Study DesignProspective survey study.MethodsA 22-item survey was administered to patients with nasal/sinus symptoms in a tertiary care rhinology clinic. Questions elicited patient demographics, imaging history, and knowledge/comfort regarding imaging-related radiation exposure. Patients were presented with the theoretical choice of EMT versus CTDT, given the expected positive predictive value, in chronic rhinosinusitis (CRS) management.ResultsTwo hundred patients (52% female, age range 18–83 years) participated. Of these, 85% had symptoms for over 3 months. Only 91 patients (45.5%) were aware that CT imaging involved radiation exposure. Prior CT experience and past sinus surgery (P < .05), but not sex or education level, were associated with increased comfort with CT imaging. Most patients (78%) preferred CTDT over EMT. If a CT sinus was recommended, 77 patients (38.5%) had concerns, of which 26% identified radiation exposure as the leading concern. The majority (70%) were unsure about the relative radiation dose of a conventional CT.Conclusions Patients with CRS symptoms prefer CTDT over EMT if a diagnosis cannot be established definitively using exam findings. Although most patients deferred to the physician regarding the decision to utilize CT imaging, there is low awareness of CT-related radiation exposure, and a significant minority of patients have radiation-related concerns with regard to medical imaging for nasal and sinus symptoms.Level of Evidence4. Laryngoscope, 2014
    The Laryngoscope 10/2014; DOI:10.1002/lary.24992 · 2.03 Impact Factor
  • Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 10/2014; 113(4):347-85. DOI:10.1016/j.anai.2014.07.025 · 2.75 Impact Factor
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    ABSTRACT: Program Description: Although our understanding of chronic rhinosinusitis (CRS) has improved, patients prove to be a diagnostic and therapeutic challenge. The variability in presentation contributes to the difficulty in providing effective medical and/or surgical therapy for each patient, and straightforward, all-encompassing guidelines are lacking. As more innovative treatments arise, choices available to otolaryngologists become overwhelming. The purpose of this miniseminar is to provide a stepwise approach to the overall management of CRS patients. The panelists will cover aspects of patient care including evaluation and diagnosis, tailored medical management, surgical choice and optimization, and postoperative management.
    Otolaryngology Head and Neck Surgery 09/2014; 151(1 Suppl):P25-P25. DOI:10.1177/0194599814538403a79 · 1.72 Impact Factor
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    ABSTRACT: Objectives: (1) Describe national trends in peritonsillar abscess (PTA) requiring endotracheal intubation (ETI). (2) Determine factors associated with ETI in patients with PTA.
    Otolaryngology Head and Neck Surgery 09/2014; 151(1 Suppl):P151-P151. DOI:10.1177/0194599814541629a46 · 1.72 Impact Factor
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    ABSTRACT: Objectives: (1) Describe national trends in retropharyngeal abscess (RPA) complicating peritonsillar abscess (PTA). (2) Determine factors associated with RPA in patients with PTA.
    Otolaryngology Head and Neck Surgery 09/2014; 151(1 Suppl):P43-P44. DOI:10.1177/0194599814541627a48 · 1.72 Impact Factor
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    ABSTRACT: Objectives/HypothesisTo study the utilization of balloon catheter dilation (BCD) compared to traditional endoscopic sinus surgery (ESS) Study DesignCross-sectional analysis Methods Cases identified by Current Procedural Terminology codes as BCD (2,717) or traditional ESS (31,059) were extracted from the State Ambulatory Surgery Databases 2011 for California, Florida, Maryland, and New York. Patient demographics, surgical center and surgeon volume, mean charge, and operating room (OR) time were compared. ResultsThere were 33,776 patients who underwent sinus surgery in the included states in 2011. Of these, 4.6% of maxillary, 5.6% of sphenoid, and 13.9% of frontal procedures were performed using BCD. Adjusted analyses found increased use of BCD in patients with chronic diseases(P<.001). Patients who had limited sinus surgery were less likely to have BCD compared to patients who had all four sinuses instrumented (P<.001). Surgeons who performed a medium (odds ratio 1.38 [1.14-1.65]) or high (odds ratio 1.71 [1.42-2.07]) volume of ESSs were more likely to use BCD compared to those who performed a low volume (P<.001). However, among surgeons who utilized BCD, there was a minimal relationship between the percentage of surgeries performed with BCD and the surgeon's total number of cases (R-2=0.055). Compared to traditional ESS, the median charges for maxillary/ethmoid procedures (mini-ESS) involving BCD were approximately $4,500 (P<.001) and maxillary/ethmoid/sphenoid/frontal procedures (pan-ESS) were approximately $2,950 (P=.003) greater, whereas the median OR time involving BCD was 8 minutes less for mini-ESS procedures(P=.01) but not statistically different for pan-ESS procedures (P=.58). Conclusions In the study sample, balloon technology was used in 8.0% of ESS cases in 2011. Procedures using BCD were on average more expensive compared to traditional ESS procedures, with minimal decrease in OR time. Level of Evidence2c Laryngoscope, 125:49-56, 2015
    The Laryngoscope 09/2014; 125(1). DOI:10.1002/lary.24901 · 2.03 Impact Factor
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    ABSTRACT: Objectives. To study the utilization of balloon catheter dilation (BCD) compared to traditional endoscopic surgery (ESS) in pediatric patients. Study Design. Cross-sectional analysis. Setting. Hospital and freestanding ambulatory surgery centers in California, Florida, Maryland, and New York Subjects. Patients less than 18 years who underwent BCD(316) or ESS(2346), as identified by CPT codes from the State Ambulatory Surgery Databases 2011. Methods. Patient and facility demographics, mean charges, and operating room time were examined using bivariate and multivariate analyses. Results. A total of 2662 children underwent surgery, with BCD used in 10.6% of maxillary, 8.4% of sphenoid, and 11.8% of frontal procedures. Adjusted analysis found that children with asthma, allergic rhinitis (AR), GERD, or concomitant adenoidectomy were more likely to have BCD compared to patients without these comorbidities, asthma odds ratio (OR) = 1.94 (95% CI, 1.84-3.41), AR OR = 1.77 (95% CI, 1.03-3.07), GERD OR = 2.79 (95% CI, .59-4.90), or without adenoidectomy OR = 2.50 (95% CI, 1.84-3.41). Patients with cystic fibrosis were less likely to have BCD, OR = 0.33 (95% CI , 0.11-0.95). Median charges for patients undergoing maxillary antrostomy alone by BCD (P = .042) or with adenoidectomy (P < .001) were approximately $2100 and $4200 greater than the median of patients undergoing those procedures with ESS. However, operating room time was similar (P = .81) between patients undergoing maxillary antrostomy, regardless of whether BCD was used, but was longer (P < .001) in those undergoing maxillary antrostomy and adenoidectomy when BCD was utilized. Conclusions. BCD was used in 11.9% of pediatric sinus surgery and had higher average charges with no decrease in OR time compared to procedures that only utilized ESS. Future research is necessary to evaluate whether BCD may lead to improved outcomes and eventually decreased operating room time for pediatric patients with chronic rhinosinusitis.
    Otolaryngology Head and Neck Surgery 08/2014; 151(5). DOI:10.1177/0194599814545442 · 1.72 Impact Factor
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    The Journal of allergy and clinical immunology 05/2014; 133(5):1503-1503.e4. DOI:10.1016/j.jaci.2014.03.022 · 12.05 Impact Factor
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    ABSTRACT: Objectives/HypothesisTo systematically assess the prevalence of bacterial infection in adults with acute rhinosinusitis (ARS). Methods Electronic databases were systematically searched for relevant studies published up to June 2012. ResultsTwenty-nine articles, evaluating a total of 9,595 patients with a clinical diagnosis of ARS, were included in the study. Of these, 14 (48%) studies required radiographic confirmation of sinusitis, one study (3%) required evidence of purulence, 10 studies (35%) required both for inclusion in the study population, and four studies (14%) required neither. The random effects model estimate of prevalence of bacterial growth on all cultures was 53.7% (CI 48.4%-59.0%), ranging from 52.5% (CI 46.7%-58.3%) in studies requiring radiographic confirmation of sinusitis to 61.1% (CI 54.0%-68.1%) in studies requiring neither radiographic evidence nor purulence on exam. Studies that obtained cultures from antral swab had a prevalence of bacterial growth of 61.0% (CI 54.7%-67.2%), whereas those utilizing endoscopic meatal sampling had a prevalence of 32.9% (CI 19.0%-46.8%). Conclusions Few studies evaluate the recovery of bacteria via culture in adults with a diagnosis of ABRS or ARS based on clinical criteria alone. With radiographic and/or endoscopic confirmation, antral puncture and endoscopically guided cultures produce positive bacterial cultures in approximately one-half of patients. Opportunities exist to improve diagnostic accuracy for bacterial infection in ARS. Laryngoscope, 125:57-69, 2015
    The Laryngoscope 04/2014; 125(1). DOI:10.1002/lary.24709 · 2.03 Impact Factor
  • The Journal of allergy and clinical immunology 03/2014; 133(6). DOI:10.1016/j.jaci.2013.12.1092 · 12.05 Impact Factor
  • Journal of Allergy and Clinical Immunology 02/2014; 133(2):AB168. DOI:10.1016/j.jaci.2013.12.606 · 11.25 Impact Factor
  • Journal of Allergy and Clinical Immunology 02/2014; 133(2):AB130. DOI:10.1016/j.jaci.2013.12.484 · 11.25 Impact Factor
  • Journal of Allergy and Clinical Immunology 02/2014; 133(2):AB169. DOI:10.1016/j.jaci.2013.12.607 · 11.25 Impact Factor

Publication Stats

1k Citations
521.66 Total Impact Points

Institutions

  • 2001–2015
    • Northwestern University
      • Department of Otolaryngology - Head and Neck Surgery
      Evanston, Illinois, United States
    • Children's Memorial Hospital
      Chicago, Illinois, United States
  • 2014
    • Vanderbilt University
      Nashville, Michigan, United States
  • 2013
    • University of Fukui
      • Division of Otorhinolaryngology Head & Neck Surgery
      Hukui, Fukui, Japan
  • 2011–2012
    • Northwestern Memorial Hospital
      Chicago, Illinois, United States
    • University of Toronto
      • Department of Otolaryngology - Head and Neck Surgery
      Toronto, Ontario, Canada
  • 2009–2010
    • University of Illinois at Chicago
      • Department of Otolaryngology (Chicago)
      Chicago, Illinois, United States
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 2004–2009
    • The University of Tennessee Health Science Center
      • Department of Otolaryngology
      Memphis, TN, United States
    • University of Tennessee
      • Otolaryngology - Head and Neck Surgery
      Knoxville, Tennessee, United States
    • Hospital of the University of Pennsylvania
      • Department of Otorhinolaryngology - Head and Neck Surgery
      Philadelphia, Pennsylvania, United States
  • 2002
    • The University of Chicago Medical Center
      Chicago, Illinois, United States