Multicenter Evaluation on the Safety of Gore-Tex as an Implant in Rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was done to evaluate the safety of Gore-Tex as a nasal implant. Materials and METHOD: A retrospective multicenter study was carried out on 15 surgeons from 11 general hospitals and 4 private practice clinics regarding the safety of the Gore-Tex as a nasal implant. The study involved 853 patients, of whom 656 received primary surgery and 197 revision surgery. Gore-Tex was mainly used as a dorsal implant in a form of sheet or as a reinforced nasal implant. RESULTS: The overall complication rate associated with Gore-Tex was 2.5% (21 cases). Infection was the most common complication (18 cases ; 2.1%) followed by 2 cases of seroma and 1 case of persistent nasal swelling. In 19 out of 21 complication cases, the graft needed removal to control the infection or seroma (91% removal rate). Nine cases of infection developed in both primary cases (1.37%) and in revision cases (4.57%), which suggests a higher association rate between infection and revision cases (p=0.0062). Infection developed within 1 month in 5 cases while 9 cases developed infection after 6 months of operation. Other complications such as aesthetic problems (malpositioning of the implant or dorsal irregularities) were found in 15 cases (1.8%) and hematoma in 1 case. CONCLUSION: The infection rate of Gore-Tex used in rhinoplasty was about 2% and it rose significantly in the revision cases. If infected, almost all of the implanted Gore-Tex needs removal; therefore, we suggest judicious use of Gore-Tex in rhinoplasty.

Anti-Allergic Effects of Aloe Glycoprotein (NY945) on Ovalbumin-Induced Airway Allergy in the Guinea Pig

BACKGROUND AND OBJECTIVES: Aloe is one of the well known substances to decrease inflammation and promote wound healing. Although little is known about its mechanism, recent studies suggest that aloe vera extracts may have the anti-allergic effect by inhibiting the mediator release evoked by mast cell activation. Therefore, we were to investigate the effect of NY945, a glycoprotein fraction of Aloe vera, on nasal mucosa of the ovalbumin (OVA) sensitized guinea pigs. Materials and Methods: Female Dunkin-Hartley guinea pigs were sensitized with intraperitoneal injection and subsequent inhalation of OVA. NY945 was injected intraperitonealy before intranasal challenge of OVA with an ultrasonic nebulizer. Airway resistance, mucosal permeability, histamine concentration in the nasal lavage fluid, the number of mast cells and eosinophils in nasal mucosa and serum level of OVA -specific IgE were evaluated. RESULTS: NY945 effectively inhibited respiratory airway resistance in the sensitized guinea pigs. The concentration of dye into nasal lavage fluid was rapidly increased after OVA instillation and NY945 inhibited the OVA -induced microvascular dye leakage. OVA inhalation to sensitized guinea pig resulted in prominent increase of histamine concentration in the nasal lavage fluid. This response was inhibited by intraperitoneal NY945 injection. It also inhibited accumulation of eosinophils in the nasal mucosa in sensitized guinea pigs. However, there was no change in the serum OVA -specific IgE level between the NY945 treated and control group. CONCLUSION: The data suggest that NY945 inhibits early allergic reaction via inhibition of histamine release and eosinophil infiltration.

Inhibition of Allergic Response by CpG Motif Immunostimulatory Oligodeoxynucleotide in a Murine Model of Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The classic immunotherapy has the inconvenience and the risk of anaphylaxis. Recent reports revealed that immunostimulatory DNA sequences (CpG motif, ISS-ODN) have been shown to act as strong Th1 response-inducing adjuvants and DNA based vaccination might be an effective therapeutic option for the treatment of allergic disease. In our study, we investigated whether ISS-ODN have anti-allergic effect in the mouse rhinitis model of Dermatophagoides farinae (Der f), the most common allergen in Korea. MATERIALS AND METHOD: C57BL/6 mice were sensitized with crude extract of Der f extract. After injection of ISS-ODN, several parameters of allergic response were evaluated. RESULTS: Injection with ISS-ODN suppressed itching symptom, eosinophilic infiltration into nasal mucosa and the splenic T cell proliferation after Der f allergen challenge in the murine model of allergic rhinitis. However, injection with ISS-ODN did not show a detectable Der f-specific IgE suppression. CONCLUSION: Our findings suggested ISS-ODN have an anti-allergic effect in the allergic rhinitis model of Der f allergen. House dust mite allergy can be reduced by the injection with ISS-ODN.

A Case of Basaloid Squamous Cell Carcinoma Occurring in the Mobile Tongue / 대한이비인후과학회지

Basaloid squamous cell carcinoma is a rare variant of squamous cell carcinoma mainly occurring in the tongue base, hypopharynx, larynx and the mouth floor. Histologically, this tumor has two cell types, the basaloid cell and the squamous cell. Prognosis of this tumor was reported to be worse than that of squamous cell carcinoma due to its aggressive behavior. We experienced a case of basaloid squamous cell carcinoma in the mobile tongue, which had no mucosal involvement.

Two Cases of Lingual Thyroid / 대한이비인후과학회지

The lingual thyroid is the most common manilestation of benign ectopic thyroid tissue, but is still a rare clinical entity. As a result, attempts at management may prove to be rather confusing. It may present with symptoms of dysphagia, upper airway obstruction or even hemorrhage at any time from infancy through adulthood. Therefore, clinical findings, laboratory tests, and radiographic imaging studies should be employed in confirming the diagnosis and appropriate planning treatment, keeing in mind that the primary therapeutic goal is to restore the thyroid function. We report two cases of lingual thyroid gland with the review otliterature.

Evaluation of Clinical Validity of Cross-Cultural Smell Identification Test (CC-SIT) in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The development of a l2-item Cross-Cultural Smell Identification Test (CC-SIT) was based upon items from the University of Pennsylvania Smell Identification Test (UPSIT), The selected CC-SIT items were familiar to most persons from American, European, and Asian cultures. Since there were no reports about its clinical validity for Koreans, we evaluated its identifiability in this study. MATERIALS AND METHODS: The CC-SIT were administered to 30 normal subjects and 32 patients with decreased sense of smell, and compared with those of the Korean K-SIT and buthanol threshold test (BTT), items of which many Koreans are familiar with. RESULTS: In the normal group, the mean percent-correct scores of CC- SIT and K-SIT were 87.5+/-7.8% and 90.5+/-9.7%, respectively. In the patient group, the scores were 48.2+/-14.1 and 49.6+/-10.2%, respectively. The results of CC-SIT showed a high correlation with the K-SIT (gamma=0.822, p < 0.001). CONCLUSION: The CC- SIT can be used as an olfactory identification test for Koreans.

Inhibition of Murine Allergic Response by Monoclonal Interleukin-4 Receptor Antibody

BACKGROUND AND OBJECTIVES: Several strategies were used to control the IgE production by interfering the functional activities of IL-4. However, most of them revealed limited effects to reduction of allergic response. This study was aimed to investigate the effects of interleukin-4 receptor (IL-4R) antibody on allergic response in animal model of allergic rhinitis. MATERIALS AND METHODS: Male BALB/C mice were sensitized with intraperitoneal injection of ovalbumin (OVA). IL-4R antibody was injected intravenously before intranasal challenge of OVA with ultrasonic nebulizer. Allergic symptoms, a number of eosinophils in nasal mucosa and serum level of OVA-specific IgE were evaluated. RESULTS: In IL-4R antibody treated mice, allergic symptom score were decreased (53.5%) than in control mice. The number of eosinophils in nasal mucosa were also reduced (47.4%). However, serum level of OVA-specific IgE were not obviously reduced (14.3%). CONCLUSION: These results suggested that IL-4R antibody has a potential effect for the treatment of allergic rhinitis in vivo.

House Dust Mite Allergic Rhinitis Model in C57BL/6 Mice / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The animal model of allergic rhinitis is important to study the pathophysiology of allergy and to design an effective therapy to ameliorate allergic diseases. Despite of numerous reported animal models of allergic rhinitis, there were few reports of murine model sensitized with house dust mite, which is one of the most common antigen that induce allergic rhinitis. The aim of this study was the establishment of the murine model for house dust mite allergy. MATERIALS AND METHODS: C57BL/6 mice were sensitized with Dermatophagoides farinae (Der f) crude extract in complete Freund's adjuvant and repetitive intranasal instillation of Der f extract a total of 6 times at 1 week intervals (group A). In some mice, allergen was intranasally instilled at 1 week intervals without sensitization of allergen (group B). RESULTS: After allergen challenge, nasal symptoms were significantly increased in group A mice. Histopathologically, the number of eosinophil in nasal mucosa were also significantly increased in group A and B mice. High level of Der f-specific IgE antibody was observed in group A mice, whereas those of group B mice was low. CONCLUSION: Our findings suggested that house dust mite allergy can be developed by systemic sensitization of Der f extract with adjuvant and intranasal instillation of allergen. This is more effective method than local sensitization of allergen only.

The Relationship between Ciliary Beat Frequency and Maxillary Sinus Mucosal Hypertrophy on Computed Tomography in Patients with Chronic Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was designed to investigate the relationship between the sinus mucosal hypertrophy and ciliary beat frequency (CBF) in patients with chronic sinusitis in vitro. MATERIALS AND METHODS: In 14 patients with chronic sinusitis, mucosal samples were obtained from the superior, inferior, and lateral walls of the maxillary sinus. Using a video-computerized analysis technique, we measured two parameters for ciliary activity at five different sites selected randomly from each sample=the ciliated area (%) showing CBF equal to or higher than 10 Hz (A10) and the weighted frequency (Fw). Mucosal hypertrophy of the maxillary sinus was calculated using a computer program on CT scans. RESULTS: A(>or=10) and Fw were 91% and 11.3 Hz in control group, respectively, whereas they were 47% and 9.1 Hz in chronic sinusitis group, respectively (p=0.03). There was a significant inverse correlation between A(>or=10) or Fw and mucosal hypertrophy of the maxillary sinus (p=0.001). CONCLUSION: The results of this study suggest that the severity of mucosal hypertrophy on CT scan may correlate with the ciliary activity.

Expression and Role of Adhesion Molecules in the Nasal Mucosa of the Rat with Experimentally Induced Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Airway allergic reactions are induced by infiltrating inflammatory cells into the human airway tissues through interactions between vascular endothelial cells, inflammatory mediators and adhesion molecules. Accordingly, it is important to study the role of adhesion molecules for the evaluation of pathophysiology of allergy. The aim of this study is to investigate the effect of monoclonal antibodies against intercellular adhesion molecule-1 (ICAM-1) and leukocyte function associated molecule-1 (LFA-1) on the pathophysiology of allergy in ovalbumin-sensitized rats. MATERIALS AND METHODS: We developed an allergy model in rat using the intraperitoneal injection and intranasal nebulization of ovalbumine solution. We evaluated in vivo effects of ICAM-1 and LFA-1 monoclonal antibodies on the expression of ICAM-1 and LFA-1 in ovalbumin sensitized rats. RESULTS: Nasal symptoms after allergen challenge were significantly suppressed and the number of eosinophil in nasal mucosa were significantly inhibited by the treatment of adhesion molecule antibodies. Anti-ICAM-1 and anti-LFA-1 monoclonal antibodies suppressed the expression of ICAM-1 and LFA-1 in nasal mucosa of ovalbumin-sensitized rats. CONCLUSION: It is suggested that allergy can be managed by a useful treatment method using adhesion molecule antibody.

Ciliary Activity and Electron Microscopic Structure according to the Levels of Respiratory Tract in the Mouse, Rat and Guinea Pig

Few studies have attempted a systematic comparison of ciliary beat frequency (CBF) and ciliary ultrastructure across different species and different levels of the respiratory tract. The aim of this study was to observe the CBF and ciliary ultrastructure of mice, rats and guinea pigs according to varying sites of the respiratory tract. Balb/c mice, Wistar rats and Dunkin-Hartley guinea pigs were used. We measured CBF using a video-computerized analysis technique at the middle of the maxilloturbinal, the nasopharynx, the upper trachea and the main bronchus in vitro. Ciliary length and the proportion of ciliated epithelium were assessed with scanning electron microscopy (SEM). In the rat, CBF was lower in the main bronchus (9.7+/-0.4 Hz) than at other sites, but there was no difference in CBF values across different airway sites in mice and guinea pigs. The CBF in the main bronchus was higher in guinea pigs than in rats and mice. SEM showed that the cilia of the rat were significantly shorter in the upper trachea and the main bronchus than in the maxilloturbinal and the nasopharynx. The respiratory epithelia of guinea pigs were more ciliated than those of mice and rats, especially in the upper trachea and the main bronchus. The guinea pig may be a superior experimental animal for ciliary function studies because the guinea pig has a less variable CBF and more uniform distribution of ciliated cells along different levels of the airway. These results provide valuable data relevant to ciliary functional studies using animal models.

A Comparison of the Therapeutic Effects of Powder and Aerosolized Budesonide in the Treatment of Perennial Allergic Rhinitis

The aims of this study are to compare the efficacy and side effects of intranasal budesonide as a dry powder and as a freonpropelled pressurized aerosol in the treatment of perennial allergic rhinitis and to assess the difference in compliance with the powder and aerosol. The study design was a randomized, double-blind crossover between two treatment groups over a six-week period. Twelve patients with symptomatic perennial allergic rhinitis received 400 microgram of intranasal budesonide administered daily as two puffs/nostril/day of the drug delivered by a freon-propelled aerosol for the first three weeks and as one inhalation/nostril/day of the pure drug powder for the next three weeks. Fourteen adults with allergic rhinitis received the drug in the reverse sequence. Patients recorded daily symptoms on diaries, and, at each clinic visit, adverse effects were recorded. Compliance with the powder and with the aerosol was also evaluated. During the six weeks, there were significant improvements in symptoms in both treatment groups, and the differences in efficacy and compliance with the medication between the two groups were not significant. Adverse effects included headaches, epistaxis, and nasal dryness ; however, they were not serious and equally distributed in the two groups. We conclude that powder and aerosolized budesonide improve the symptoms of perennial allergic rhinitis significantly with little difference in efficacy, side effects, and preference.

A Comparison of the Therapeutic Effects of Powder and Aerosolized Budesonide in the Treatment of Perennial Allergic Rhinitis

The aims of this study are to compare the efficacy and side effects of intranasal budesonide as a dry powder and as a freonpropelled pressurized aerosol in the treatment of perennial allergic rhinitis and to assess the difference in compliance with the powder and aerosol. The study design was a randomized, double-blind crossover between two treatment groups over a six-week period. Twelve patients with symptomatic perennial allergic rhinitis received 400 microgram of intranasal budesonide administered daily as two puffs/nostril/day of the drug delivered by a freon-propelled aerosol for the first three weeks and as one inhalation/nostril/day of the pure drug powder for the next three weeks. Fourteen adults with allergic rhinitis received the drug in the reverse sequence. Patients recorded daily symptoms on diaries, and, at each clinic visit, adverse effects were recorded. Compliance with the powder and with the aerosol was also evaluated. During the six weeks, there were significant improvements in symptoms in both treatment groups, and the differences in efficacy and compliance with the medication between the two groups were not significant. Adverse effects included headaches, epistaxis, and nasal dryness ; however, they were not serious and equally distributed in the two groups. We conclude that powder and aerosolized budesonide improve the symptoms of perennial allergic rhinitis significantly with little difference in efficacy, side effects, and preference.

Changes Produced by Different Concentrations of Inflammatory Cytokines in the Proliferation and Ciliary Movement of Human Respiratory Epithelial Cells

The aim of this study was to determine the effects of cytokines IL-1beta, TNF-alpha, and TGF-beta on the proliferation and ciliary beat frequency (CBF) of human nasal epithelial cells (HNECs) in vitro. Subcultured HNECs were incubated in a medium containing recombinant human (rh) cytokines rhIL-1beta rhTNF-alpha and rhTGF-beta at concentrations of 0.01 ng/ml, 0.1 ng/ml, 1 ng/ml, 10 ng/ml, and 100 ng/ml. After a two-day incubation with these cytokines, daily cell proliferation was measured by MTT assay for six days. The CBF was measured at concentrations of 1 ng/ml of rhIL-1beta 10 ng/ml of TNF-alpha and 1 ng/ml of TGF-beta solutions. While rhIL-1beta inhibited proliferation of HNECs in concentration-dependent and time-dependent manners, rhTNF-alpha stimulated HNEC growth at concentrations ranging from 0.01 ng/ml to 10 ng/ml in concentration-dependent and time-dependent manners. In contrast, rhTGF-beta inhibited HNEC growth irrespective of concentration and incubation time. The CBF of the human nasal ciliated epithelial cells increased after the addition of rhIL-1beta and rhTNF-alpha The CBF increased progressively for four hours after the addition of rhIL-1beta and rhTNF-alpha The increased CBF continued for 24 hours and decreased after two days. However, no variation of the CBF was observed after the addition of rhTGF-beta regardless of concentration or incubation time. The results of this study suggest that during acute inflammation, IL-1beta TNF-alpha and TGF-beta may have important roles in the repair and defense mechanism of the human nasal epithelium by regulating the proliferation and CBF of nasal epithelial cells.

Quantitative Evaluation of Efficacy of Systemic Steroid Therapy for the Patients with Olfactory Disturbance / 대한이비인후과학회지

OBJECTIVES: This study quantifies the efficacy of a short-term systemic steroid therapy in the patients with anosmia or hyposmia using the butanol threshold test (BTT) and the visual analogue scale (VAS). MATERIALS AND METHOD: Thirty patients with anosmia or hyposmia were included in this study from June 1996 through April 1997. The patients were divided into inflammatory and noninflammatory groups depending on the etiology. We evaluated the patients before and after the systemic steroid admi-nistration using both BTT and VAS. RESULTS: Overall improvements of olfactory function was observed upto 70% by BTT and 53% by VAS, and the therapeutic effect of steroid on olfactory malfunction was statistically significant (p=0.0001). Improvements in the olfaction was measured by BTT, which correlated strongly with the measurements by VAS with statistical significance (r=0.77578, p=0.0001). The inflammatory group showed better steroid response (83%) than the noninflammatory group (61%), but there was no statistical significance. CONCLUSION: The systemic steroid administration may be effective in the treatment of olfactory disturbance with a good correlation between BTT and VAS.

Epithelial-Myoepithelial Carcinoma of the Salivary Glands: Clinical Aspects and Treatment Outcome / 대한이비인후과학회지

BACKGROUND: The epithelial-myoepithelial carcinoma(EMC) of major and minor salivary glands is a low grade malignancy which shows frequent local recurrence. OBJECTIVES: The aim of this study was to define the clinical feature and treatment outcome of EMC of major and minor salivary glands. MATERIALS AND METHODS: Nine cases of EMC of major and minor salivary glands were reviewed retrospectively. RESULTS: The clinical course varied from slowly growing painless mass to the mass associated with facial nerve paralysis, bleeding or bone desutruction. Local recurrence was observed in 3 cases(33%) at 3, 10 and 11 months after primary resection, but no metastasis to periglandular, cervical lymph nodes or distant site occurred in our series including three recurrences. One of three recurrent patients died due to local extension of the tumor. Other two patients with recurrent tumors were successfully treated with revision operation and survived more than 2, 6 years without disease, respectively so far. Preoperatively these tumors were usually regarded as benign salivary gland tumor in CT scan except for the cases showing bone destruction. Atypical cells on fine needle aspiration cytology/frozen biopsy coupled with benign looking CT finding suggested low grade malignancy in which case EMC should be considered a differential diagnosis. Pathologic diagnosis was frequently confused with other high grade carcinoma rather than low grade carcinoma or benign tumor. This resulted in unnecessary postoperative radiotherapy, but clinically aggressive recurrent cases recurred despite radiotherapy. No malignant cells were found in clinically enlarged lymph nodes, and we have to retain positve attitude toward surgical management of advanced or recurrent EMC keeping in mind that recurrent tumor may inherit different tumor bilogy. CONCLUSION: Although epithelial-myoepithelial carcinoma is a rare salivary gland tumor, otolaryngologists should be aware of its existence because this low grade malignancy can cause diagnostic confusion during workup and also frequently be misdiagnosed as other high grade salivary malignancy in clinically aggressive form.

Ciliary Activity of Upper Airway Epithelial Cells of Rats with Experimentally Induced Allergic Rhinitis

OBJECTIVES: The aim of this study was to investigate whether the ciliary activity of respiratory epithelium is affected in allergic rhinitis. METHODS: Twenty Wistar rats were divided into an unsensitized control group and sensitized allergic group. The sensitized group was immunized intraperitoneally with ovalbumin, followed by intranasal administration of ovalbumin. Allergy was determined by an increase in nasal symptoms, the number of tissue eosinophils and a positive result to a passive cutaneous anaphylaxis (PCA) test. Nasal, nasopharyneal, tracheal, and bronchial epithelial cells were obtained from both the control and allergic groups. Ciliary beat frequency (CBF) was measured using a video-computerized analysis technique in vitro. We compared the CBF of two groups in each site. We also evaluated the findings of the nasal mucosa of both groups with an scanning electron microscope. RESULTS: In vitro CBF measurement demonstrated that the CBF of the control and allergic groups did not differ significantly (p>0.05). CONCLUSION: CBF is not affected by respiratory allergy.