Sublingual Immunotherapy in Asian Children: 2-Year Follow-Up Results

BACKGROUNDS: House-dust mites are the main cause of allergic rhinitis in Asia, for which immunotherapy (SLIT) is a currently accepted treatment. However, few studies have evaluated the efficiency of SLIT on Asian children with allergic rhinitis for a period longer than one year. The aim of this study was to investigate the efficacy and safety of SLIT for Asian children with allergic rhinitis due to house-dust mites over a 2-year period. MATERIALS AND METHODS: This study included 65 patients who had allergic rhinitis due to Dermatophagoides pteronyssinus and Dermatophagoides farinae. All patients were treated with SLIT (Staloral(R)). Symptom scores and quality of life were evaluated by using questionnaires over two years. The medication score was assessed monthly by a diary medication card and serologic tests were evaluated before and two years after the start of treatment. Adverse effects and dropout rates were also investigated. RESULTS: All nasal and non-nasal symptoms and quality of life were significantly improved after two years of treatment. Furthermore, the total medication score decreased significantly and the serologic tests showed a significant change two years after the start of SLIT. Although minor adverse effects were reported, no systemic reactions were observed. The dropout rate was 40%. CONCLUSION: SLIT is an efficient and safe therapeutic tool for a period of two years in Asian children with allergic rhinitis to house-dust mites.

Effect of Prostaglandin E2 on Vascular Endothelial Growth Factor Production in Nasal Polyp Fibroblasts

PURPOSE: Angiogenesis is involved in the pathogenesis of chronic rhinosinusitis with nasal polyps. We aimed to investigate the effects of prostaglandin E2 (PGE2) on vascular endothelial growth factor (VEGF) production, the role of E-prostanoid (EP) 4 receptors, and the signal transduction pathway mediating VEGF production in nasal polyp-derived fibroblasts (NPDFs). METHODS: Eight primary NPDF cultures were established from nasal polyps, which were incubated with or without PGE2. Reverse transcription-polymerase chain reaction amplification of EP receptors (EP1, EP2, EP3, and EP4) and immunofluorescence staining for VEGF production were performed. VEGF production via the cyclic adenosine monophosphate (cAMP)-dependent protein kinase A (PKA) and phosphatidylinositol 3-kinase (PI3K) pathways was evaluated by enzyme-linked immunosorbent assay. RESULTS: All EP receptors were expressed in NPDFs. PGE2 significantly increased VEGF production concentration- and time dependently, and VEGF production was regulated by an EP4 receptor. Activation of intracellular cAMP regulated VEGF production. VEGF production was decreased by PKA and PI3K inhibitors via intracellular cAMP. CONCLUSIONS: PGE2 stimulates VEGF production via the EP4 receptor in NPDFs. These results indicate that PGE2-induced VEGF production is mediated, at least partially, through cAMP-dependent signaling pathways. Therapies targeting the EP4 receptor may be effective in inhibiting the development of nasal polyps.

A Case of Parathyroidectomy of Supernumerary Parathyroid Glands Using Intraoperative IPTH Monitoring / 대한이비인후과학회지

The incidence of hyperparathyroidism has slowly increased recently with routine measurement of serum calcium and increasing awareness of the disease by the public. Despite the availability of expert surgeons and preoperative imaging investigations, some patients are re-operated for persistent or recurrent hyperparathyroidism. The main cause of re-operation is the presence of ectopic parathyroid gland or supernumerary parathyroid gland. Supernumerary parathyroid glands are more frequently described in the secondary hyperparathyroidism than in the primary hyperparathyroidism cases, especially in surgery for renal hyperparathytroidism. The intraoperative measurement of intact parathyroid hormone (iPTH) provides the surgeon with a quantitative test that predicts the postoperative serum calcium level and can justify early closure or further exploration for hyperfunctioning parathyroid gland. We present a case of parathyroidectomy of supernumerary parathyroid glands by monitoring intraoperative iPTH in patients with secondary hyperparathyroidism.

Clinical Analysis of Deep Neck Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Deep neck infection may still be lethal especially when life-threatening complications occur. The objective of this study is to clarify the therapeutic module for deep neck infection and analyze epidemiologic characteristics, clinical course, microorganisms and site of infections. SUBJECTS AND METHOD: We retrospectively reviewed the medical charts of 98 patients who were confirmed with deep neck infection and who received treatment at the Soonchunhyang University Hospital between 2000 and 2009. We analyzed the data for deep neck infection using the statistical tools like t-test and Spearman's coefficient of correlation. RESULTS: The parapharyngeal space was the most commonly involved space in deep neck infection. The most common pathogen was Streptococcus. The most common underlying disease was Diabetes mellitus. CONCLUSION: Statistical dada showed that there was no significant correlation between the hospitalization period and deep neck infection.

Clinical Analysis of Cholesterol Granuloma in the Middle Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Cholesterol granuloma is often observed in middle ear surgeries. In the clinic, it can be found in a normal ear, but also as a recurrent serous otitis media in non-responding medical therapy. The purpose of this study is to analyze the clinical characteristics of cholesterol granuloma with or without cholesteatoma. SUBJECTS AND METHOD: We performed a retrospective study of 40 patients who underwent tympanomastoidectomy between January, 2000 and January, 2009 for cholesterol granuloma. We divided patients into a non-cholesteatoma group and a cholesteatoma group and observed the following clinical manifestations: initial symptom findings, ear drum findings, preoperative audiogram, postoperative audiogram, operative technique and operative findings. RESULTS: Cholesterol granuloma was found in 10.2% of 393 cases (40 cases) who underwent chronic otitis media surgery. Of these, 5.3% (21 cases) was diagnosed with non-cholesteatoma group and 4.8% (19 cases) was diagnosed in the cholesteatoma group. Chief complaints were the difficulty of hearing in the non-cholesteatoma group and otorrhea in the cholesteatoma group. Ear drums were nearly retracted and perforated in both groups, although the cholesteatoma group had more damaged ear drum. Distinctive features of hearing were the conductive type with a moderate degree and ossicular destruction showed missing or eroded incus. Major sites of cholesterol granuloma were antrum, air cells and epitympanum. CONCLUSION: Although ear drum was relatively preserved in the non-cholesteatoma group of cholesterol granuloma, the hearing level and the degree of ossicular destruction were not so much different between the two groups. Therefore, a complete removal of cholesterol granuloma and ossiculoplasty should be considered for better hearing restoration.

A Case of Vestibular Schwannoma Mimicking Acute Labyrinthitis / 대한평형의학회지

Acute labyrinthitis is clinically characterized by cochlear symptom like sudden hearing loss, tinnitus and aural fullness and vestibular symptom like vertigo and spontaneous nystagmus. Several disease entities may mimic labyrinthitis when the disease does not manifest its own characteristic findings. We present the case of a 43-year-old female patient who was suffering from the acute vertigo and sudden hearing loss in her right ear. The speech discrimination score in right side was 24% and brain magnetic resonance imagine revealed a mass in internal auditory canal and minimally extending cerebellopontine angle. Removal of mass was performed via translabyrinthine approach and rapid vestibular compensation was accomplished after surgery.