Impact on Quality of Life after Treatment with Proton Pump Inhibitor in Laryngopharyngeal Reflux / 대한이비인후과학회지

Background and Objectives@#Several studies have assessed the impact of laryngopharyngeal reflux disease (LPRD) on the health-related quality of life (HR-QoL), showing significant impairment of HR-QoL. This study aims to assess the impact of proton pump inhibitor (PPI) treatment of LPRDs to enhance HR-QoL.Subjects and Method We prospectively collected data from LPRD patients from April 2017 to July 2019. Patients who have reflux symptom index (RSI) of ≥13 or reflux finding score (RFS) of ≥7 were enrolled in this study. We assessed HR-QoL using a questionnaire with EORTC QLQ-H&N35, -C30 on the first visit. Patients were treated with PPI (Ilaprazole 20 mg/day) on their visits at 4, 8, and 12 weeks. RSI and RFS were measured at each visit and HR-QoL was reevaluated on the last visit. @*Results@#Ninety-five patients completed the 3-months follow-up and were enrolled in this study. Female : male ratio was 71:24 and the mean age was 57.0±11.9 (27-80). The initial RSI and RFS were 16.3±8.8 and 12.6±2.9, respectively, but were changed to 11.1±9.7 and 9.7±2.6 (p<0.001 in both) at 12 weeks after the treatment. Global health status/QoL, speech problem, dry mouth, and coughing were significantly improved. @*Conclusion@#PPI administration is effective in treating LPRD, where effects begin to appear at 4 weeks after treatment. HR-QoL was also improved in patients who have RSI improvement.

Correlation between Ambulatory 24 Hour Dual Probe pH Monitoring and Reflux Finding Score, Reflux Symptom Index in the Laryngopharyngeal Reflux / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A 24-hour ambulatory dual probe for pH monitoring is the most specific and sensitive test for laryngopharyngeal reflux (LPR) disease. However, the use of this probe is not well tolerated in some patients due to discomfort and the invasive nature of the procedure. Thus, the diagnosis of LPR is usually made according to symptomatic responses to empirical treatment using a proton-pump inhibitor for patients with high score of reflux symptom index (RSI) and reflux finding score (RFS). The aim of this study is to evaluate the relationship between the RSI and RFS and pH monitoring using a 24-hour ambulatory dual probe, and determine the role of RSI and RFS in the diagnosis of LPR. SUBJECTS AND METHOD: We studied 100 patients who underwent pH monitoring using a 24-hour dual probe because of laryngopharyngeal reflux related symptoms or laryngoscopic findings. The various parameters of the 24-hour dual probe pH monitoring were compared with the scores of RSI and RFS. RESULTS: In 24-hour dual probe pH monitoring, 64 of 100 patients tested positive for LPR. The mean of RSI score was significantly higher in the positive LPR group than in the negative group. However, RFS did not differ between the two groups. RSI scores were significantly associated with the reflux number in the upright position of the 24-hour dual probe pH monitoring. There was no correlation between RFS and the parameters of the 24-hour dual probe pH monitoring. CONCLUSION: RSI can be a reliable diagnostic tool for laryngopharyngeal reflux disease instead of the 24-hour ambulatory dual probe pH monitoring.

A Case of Simultaneous Orbital Cellulitis and Intracranial Complication

PURPOSE: To report a case of simultaneous orbital cellulitis and intracranial complications of acute sinusitis in a young patient. CASE SUMMARY: The 11-year-old male presented with a one-day history of left periorbital erythematous swelling, fever and headache. He was diagnosed with acute sinusitis at the department of otorhinolaryngology, and endoscopic sinus drainage of pus was performed. However, the patient's symptoms did not improve. The next day, a subdural abscess was found on brain computed tomography. He was treated by external drainage of the periosteal abscess via a subbrow incision and systemic antibiotics, as well as anticonvulsant medication. CONCLUSIONS: Twenty days after external drainage and beginning systemic antibiotics and anticonvulsant treatment, he was discharged with improved orbital cellulitis symptoms and a resolved subdural abscess.

The Diagnosis of Laryngopharyngeal Reflux: The Role of Esophageal Mucosal Biopsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The reflux symptoms, laryngoscopic findings and 24-hour dual-probe pH monitoring are main diagnostic tools for laryngopharyngeal reflux disease. In particular, 24-hour dual-probe pH monitoring is the most specific and sensitive test, but some patients tend to fail the test due to discomfort. Eosinophilia in the esophageal mucosa may be diagnostic of gastroesophageal reflux disease, but esophageal biopsy has rarely been studied in laryngopharyngeal reflux. In this study, to discover another or alternative diagnostic tools that might help in the diagnosis of laryngopharyngeal reflux, we investigated the significance of esophageal mucosal biopsy in patients with laryngopharyngeal reflux symptoms. SUBJECTS AND METHOD: The study group consisted of 110 patients with laryngopharyngeal reflux symptoms and all patients were evaluated by 24 hour dual probe pH monitoring. The results of the 24 hour dual probe pH monitoring was compared with reflux symptom index (RSI), reflux finding score (RFS), gastroesophagoscopic findings, esophagogram and esophageal mucosal biopsy. RESULTS: In 61 of the 110 patients, laryngopharyngeal reflux were confirmed by 24 hour dual probe pH monitoring. The mean RSI and RFS of the laryngopharyngeal reflux group was higher (7.3+/-2.5, 6.0+/-3.9) than those of the group without laryngopharyngeal reflux (6.3+/-3.5, 4.6+/-2.9). Intraepithelial eosinophils in proximal esophageal biopsy was correlated with laryngopharyngeal reflux by 24-hour dual-probe pH monitoring. CONCLUSION: Esophageal mucosal biopsy is a reliable diagnostic test for laryngopharyngeal reflux and it could be used for patients who tend to fail 24-hour dual-probe pH monitoring due to discomfort.

Two Cases of Organized Hematoma of Maxillary Sinus with Bone Erosion

An organized hematoma in the maxillary sinus can be formed by organizing procedure of hematoma in the unaerated maxillary sinus. It is a rare disorder of unknown etiology. Clinical symptoms, signs, and radiologic appearance of the hematoma mimick tumors at the initial diagnosis. An expansile organized hematoma in the maxillary sinus may induce erosion or destruction of the maxillary bony wall. Therefore, it may be difficult to distinguish such lesion from malignant tumors. We report two cases of an organized hematoma in the maxillary sinus presenting with erosion of the maxillary sinus wall with a brief review of the literature.

Polymorphism of the Transporters Associated with Antigen Processing 1 (TAP1) Gene in Korean Patients with Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Antigen peptides are actively transported across the endoplasmic reticulum by the transporters associated with antigen processing (TAP) and presented to self-restricted cytotoxic T lymphocytes by the HLA class I molecules. Polymorphisms in TAP genes could influence the selection of peptides that bind to class I molecules. We designed a case-control study to investigate the frequencies of TAP1 gene in control group and allergic rhinitis group, to analyze the association of TAP1 polymorphism with allergic rhinitis, and to compare the frequencies of TAP1 haplotypes among the various ethnic groups. SUBJECTS AND METHOD: TAP1 genotyping were performed for 110 Korean allergic rhinitis patients and 107 healthy controls. TAP1 polymorphic residues at codon 333 and 637 were found using amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). RESULTS: The frequencies of Ile/Ile and Ile/Val genotypes at TAP1 codon 333 were 74.5%, 23.7% in allergic rhinitis, and 50.5%, 49.5% in controls, respectively. The odds ratio of Ile/Val was 0.43 (95%CI, 0.24-0.80) in relation to Ile/Ile (p=0.001). The frequencies of Asp/Asp and Asp/Gly genotypes at TAP1 codon 637 were 69.0%, 27.3% in allergic rhinitis, and 51.4%, 46.7% in controls, respectively. The odds ratio of Asp/Gly was 0.43 (95%CI, 0.24-0.80) in relation to Asp/Asp (p=0.011). CONCLUSION: TAP1 gene polymorphism may be an important factor for the pathogenesis of allergic rhinitis and it could determine the individual susceptibility of allergic rhinitis in the Korean population.

Relationship between CT Scores and Pathologic Findings in Chronic Sinusitis: The Indicators of Severity in Chronic Inflammation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic sinusitis is a common disease in otolaryngology, but its pathologic mechanism has not been clearly known. Also, the evaluation method for the severity of chronic sinusitis is not established. The aim of this study was to analyze possible factors associated with the correlation between the radiological and pathological severity of chronic sinusitis. In addition, we assessed the profiles of inflammatory cells in the sinus mucosa and peripheral blood eosinophils in relation to the overall pathologic grades and OMU CT findings. SUBJECTS AND METHOD: Fifty specimens of pathologic sinus mucosa, obtained during endoscopic sinus surgery were stained with hematoxylin and eosin. Total inflammatory cells, plasma cells, neutrophils, lymphocytes and eosinophils were quantified. The preoperative OMU CT scans were scored by the staging system of Lund-Mackay. Also, the preoperative percentage of eosinophils in peripheral white blood cells were obtained with the complete blood count with differentiation. RESULTS: The count of total inflammatory cells, lymphocytes and eosinophils infiltrated in the diseased sinus mucosa correlated significantly with the severity of the pathologic grades and OMU CT scores. In addition, the CT scores assessed by Lund-Mackay system correlated significantly with the severity of the pathologic grades. CONCLUSION: The important indicators of the severity of the chronic inflammation in chronic sinusitis were OMU CT scores, overall pathologic grades, and total inflammatory cells, lymphocytes and eosinophils infiltrated in sinus mucosa.