Analysis of Biofilms in Recurrent Tonsillitis Using Confocal Laser Scanning Microscope and Fluorescent In Situ Hybridization: A Case-Control Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Biofilm is an encased colony of bacteria and the bacteria with-in the biofilm have resistance to antibiotics and the humoral immune system. Biofilm is currently thought to play an important role and to be very refractory to conventional therapeutics. The aim of this study is to analyze the relationship between the biofilm of the tonsil and recurrent tonsillitis with a case-control study. SUBJECTS AND METHOD: This is a case-control study. The case group included 31 patients who had histories of tonsillitis and the control group included 29 volunteers who had no history of tonsillitis. Confocal laser scanning microscopy was performed to identify biofilms. We compared the prevalence rates of biofilm between the 2 groups. Fluorescent in situ hybridization (FISH) was performed to identify bacteria, using probes for S. aureus, S. pyogenes, H. influenzae, S. pneumoniae, and K. pneumonia. RESULTS: In case group, biofilms were found in 22 (71.0%) of 31 and in control group, biofilms were found in 12 (41.4%) of 29. The prevalence rates of biofilm were significantly higher in case group (p=0.036). Twenty nine cases were enrolled in FISH and 12 cases of them were positive for FISH. S. aureus was most commonly identified. CONCLUSION: This study suggests that the biofilms could play a causative role in recurrent tonsillitis, further studies are needed to confirm pathogenic relation between biofilm and recurrent tonsillitis.

The Effect of Asian Sand Dust in Allergic Inflammation of Allergic Mouse / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Asian sand dust (ASD) is known to aggravate the respiratory symptoms in patients with bronchial asthma. However, the effect of ASD in allergic rhinitis is not known. The objective of this study was to investigate whether ASD can activate the allergic inflammation in allergic mouse model. MATERIALS AND METHOD: Forty female BALB/c mice were divided into 4 groups. Group 1 was nebulized with saline and group 2 with ASD. Group 3 was nebulized with ovalbumin (OVA) only and Group 4 with OVA plus ASD after intraperitoneal injection with OVA. The allergic symptom scores were checked. The mouse OVA specific IgE/IgG1, IL-4, IL-5 and IFN-gamma were measured by ELISA. The nasal mucosa was examined for the expression of IL-4 and IL-5 by immunohistochemical stain. RESULTS: The average symptom score was increased in Group 4 compared to Group 3 (p< 0.05). The IgE was significantly increased in Group 4 compared to Group 3 (p< 0.01). The IL-4 level of nasal lavagefluid (NALF) was significantly increased in Group 4 compared to Group 3 (p< 0.05). The IL-5 level showed no significant difference between the Group 3 and Group 4 both in the serum and NALF. The level of IFN-gamma was not changed in NALF. Immunohistochemical staining showed that the positive cells for IL-4 were expressed in epithelial layer and submucous gland and the positive cells were more increased in Group 4 than in Group 3. CONCLUSION: In allergic mouse model, ASD has shown to activate the allergic inflammatory reaction by the stimuli of Th2 cytokineproduction.

The Correlation Study between the Specific IgE for Staphylococcus Aureus Exotoxin and Nasal Mucus Culture in Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There is a reported association between the increased levels of specific IgE and Staphylococcus aureus exotoxins (SE) and eosinophilic inflammation in nasal polyp tissue. However, the role of IgE to SE in allergic rhinitis has not been known definitely. We sought to find whether the specific IgE to SE has a correlation with the allergic rhinitis. SUBJECTS AND METHOD: Nasal mucosa and serum were obtained from 30 patients undergoing submucous turbinectomy of inferior turbinates for allergic rhinitis and 20 control patients undergoing septoplasty. Nasal culture was performed for each patient. Specific IgE levels for S. aureus exotoxin A (SEA), S. aureus exotoxin B (SEB), and toxic shock syndrome toxin 1 (TSST-1) were measured using ImmunoCAP method in both nasal mucosa and serum. RESULTS: The culture rate for S. aureus was 13.3% for allergic rhinitis and 10% for the control. The specific IgE for S. aureus in serum was significantly expressed in allergic rhinitis (30%) compared to in the control (10%). In nasal mucosa of allergic rhinitis patients, the specific IgE has shown higher expression rate (20%) than the control (0%). CONCLUSION: Our results demonstrated that there is a correlation between allergic rhinitis and specific IgE to S. aureus exotoxin in both nasal mucosa and serum. These results suggest that S. aureus exotoxin can act as a traditional allergen and induce the development of allergic rhinitis.

Clinical Analysis of Factors Affecting on Treatment of Deep Neck Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The treatment of deep neck infection is antibiotic therapy followed by surgery when it is indicated. There is no detailed guideline for the treatment according to clinical feature or extension of infection. So the purpose of this study is to find out factors affecting the treatment of deep neck infection in the point of clinical feature, laboratorial study and CT finding. SUBJECTS AND METHOD: We have conducted a retrospective study of 67 patients that had been seen between January 2005 and July 2007. We divided patients into a non-surgical group and a surgical group, analyzed clinical informations and laboratorial tests between the two groups, and studied the relations between lesion size, degree of infection and treatment method. RESULTS: There were significant differences between the non-surgically treated and surgically treated groups. The latter group presented with older age, larger lesion, more numbers of involved spaces, highly elevated WBC counts, more decreased in protein counts and had longer treatment period prior to hospitalization than the former group. Also, the size of the affected lesion was bigger, the incidence of abscess formation higher and required surgical treatment more often. CONCLUSION: Surgical management has an advantage when the lesion size is more than 7 cm, even if it presents an incomplete abscess. If the laboratory study reveals highly sustained WBC counts after proper antibiotic therapy and low protein counts, more aggressive treatment should be considered, especially for old patients.

The Correlation Study between the Specific IgE for Staphylococcus Aureus Exotoxin and Nasal Mucus Culture in Chronic Rhinosinusitis with Nasal Polyposis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Staphylococcus aureus (S. aureus) exotoxins (SE) have been implicated in the pathogenesis of chronic sinusitis with nasal polyposis (CRSwNP). The aim of this study was to identify the contribution of S. aureus exotoxin as allergen in the development of nasal polyp. MATERIALS AND METHOD: Nasal polyp and serum were obtained from 30 patients who underwent endoscopic sinus surgery for CRSwNP and 10 control turbinate mucosae were used. Nasal culture was done for each patients. Specific IgE levels for S. aureus exotoxin A (SEA), S. aureus exotoxin B (SEB), and toxic shock syndrome toxin 1 (TSST-1) were measured using ImmunoCAP method in nasal tissue and serum. The patients were divided into three groups : A, nasal polyp (+)/culture (+) ; B, nasal polyp (+)/culture (-) ; C, nasal polyp (-)/culture (-). RESULTS: The culture for S. aureus was 27% in CRSwNP when compared to 10% in control. The specific IgE for S. aureus in serum was significantly expressed in nasal polyp (30%) compared to control (0%). Also the Group A showed a significant high rate of specific IgE (63%) compared to Group B (18%) and Group C (0%) in serum. In nasal polyp tissue, the specific IgE has showed no specific difference between nasal polyp (7%) and control (10%). However, it was also increased in Group A (25%), compared to Group B (0%) and Group C (11%). CONCLUSION: Our results demonstrated that there was a correlation between nasal polyp and specific IgE levels to S. aureus exotoxin. These results suggest that S. aureus exotoxin can act as a traditional allergen and induce the inflammatory reaction in CRSwNP. Background and Objectives : Staphylococcus aureus (S. aureus) exotoxins (SE) have been implicated in the pathogenesis of chronic sinusitis with nasal polyposis (CRSwNP). The aim of this study was to identify the contribution of S. aureus exotoxin as allergen in the development of nasal polyp.