Filter Paper Test to Assess Nasal Hyperreactivity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We can evaluate nasal hyperreactivity with histamine challenge test (HCT) or metacholine test. In 1981, a simple and reproducible technique using filter paper to collect nasal secretion was introduced. We revised this technique to assess nasal hyperreactivity. The basic concept of the test is that filter paper in the nose acts as a mechanical stimulus to the nasal mucosa, and causes nasal secretion, which is absorbed in the filter paper. The aim of this study was to present filter paper test (FPT) as an objective assessment of nasal hyperreactivity in allergic patients. We compared the sensitivity and the specificity of FPT with HCT, and also evaluated the validity of FPT in assessing the changes of nasal hyperreactivity. SUBJECTS AND METHOD: For FPT, a folded strip of filter paper in 50X6 mm was placed between the septum and the inferior turbinate, and the wetted strip was weighed after 10 minutes. For HCT, a paper disk, saturated with histamine solution (1 mg/ml) was placed on the anterior end of the inferior turbinate, and the number of sneezing was counted per minute. Twenty nine patients with allergic rhinitis and hyperreactive nasal symptoms and 20 normal subjects were included in the study. Fourteen out of the 29 hyperreactive and allergic rhinitis patients were subjected to the evaluation of changes in the amount of nasal secretion. RESULTS: For FPT, sensitivity was 65.5% and specificity was 95%, whereas for HCT, the sensitivity was 69% and specificity was 95%. After systemic steroid treatment, the amount of nasal secretion was decreased significantly. CONCLUSION: FPT showed almost the same sensitivity and the specificity compared to HCT, and appeared to be a valid test to assess the nasal hyperreactivity. These findings imply that FPT is technically easy and reliable, and a valid test to assess nasal hyperreactivity in allergic patients.

Sudden deafness caused by acute anterior inferior cerebellar artery infarction : A case report / 대한이비인후과학회지

A rare case, 49 year old man, of cerebellar infarction with occurrence of the sudden deafness was reported. On the otoneurological examination, hearing test and calroric test showed deafness and 19% vestibular hypofunction on the right side respectively. Mild vertigo was noticed, but spontaneous nystagmus was not observed. Cerebellar function test was intact. Magnetic resonance imaging (MRI) showed the acute cerebellar infarction in the area of the anterior inferior cerebellar artery (AICA) on the right side. After 7 days heparinization treatment, hearing threshold was much improved. An early recovery of hearing loss may be attributable to the recanalized circulation disturbance or the developement of collateral circulation.

A Case of Acute Coalescent Mastoiditis with Otogenic Cerebellar Abscess due to Acute Otitis Media / 대한이비인후과학회지

The incidence of a surgical mastoiditis developing from acute otitis meida (AOM) has been decreased, But otitis media should still be considered a potentially dangerous disease because the clinical course is less predictable now than in the past. Significant and life-threatening complications may occur, including acute coalescent mastoiditis, intracranial complications, facial paralysis, subperiosteal abscess, etc. Incidence of otogenic cerebellar abscess has decreased, But the mortality rate in the literature is still high. There have been no reports in the Korean literature on acute coalescent mastoiditis with otogenic cerebellar abscess due to acute otitis media, but recently, we encountered a patient experiencing an acute coalecent mastoiditis, a supparative labyrinthitis and an otogenic cerebellar abscess due to acute otitis media all at the same time. Although the patient was treated with parenteral antibiotics, mastoidectomy, labyrinthectomy, and excision of the abscess via craniotomy, he passed away on the 62nd days after craniotomy. We report this case with a review of literature.

Trans-Inferior Turbinate Approach for Endoscopic Sphenopalatine Artery Ligation

BACKGROUND AND OBJECTIVES: With the recent development of endoscopic nasal surgery, endoscopic sphenopalatine artery ligation allows for secure control of posterior epistaxis with considerably low recurrence and complications. Surgical approaches to the sphenopalatine foramen to ligate the sphenopalatine artery are transantral, intranasal, and transseptal. However, the procedures have considerable limitations. Therefore, we have revised the transturbinal approach, which was described by Togawa for intranasal vidian neurectomy in 1977, to ligate the sphenopalatine artery in two patients of intractable posterior epistaxis, and describe our technique of the trans-inferior turbinate approach for endoscopic sphenopalatine artery ligation. SURGICAL TECHNIQUE: A longitudinal incision is made along the lower border of the inferior turbinate, and the mucoperiosteal flaps are developed to the lateral nasal wall. The posterior two-thirds of the inferior turbinate bone is removed from the lateral nasal wall. The posterior lateral nasal artery on the upper flap is positively identified, and followed to the posterior end of the middle turbinate bone. The sphenopalatine foramen can be localized after removing the posterior end of the middle turbinate bone, and the sphenopalatine artery is ligated with hemoclips or divided with bipolar electrocautery. RESULTS: With the trans-inferior turbinate approach, it was possible to identify and ligate the sphenopalatine artery and its branches in the sphenopalatine foramen with no immediate or delayed complications. CONCLUSION: The trans-inferior turbinate approach provides unobscured surgical access to the posterior nasal cavity, and enough working space for endoscopic manipulation. The posterior lateral nasal artery is a reliable surgical landmark leading to the sphenopalatine foramen.

Enhancement of Microvascular Leakage in the Nasal Mucosa after Re-exposure to Capsaicin in a Rat Model Challenged/Rechallenged with Capsaicin

It has been suggested that the role of neurogenic inflammation is to protect the airway from various noxious irritants in inhaled air. Repeated exposure to various irritating stimuli has become very common in daily life. However, the process that occurs in neurogenic inflammation after repeated exposure to irritating stimuli is not yet clearly understood. The aim of this study was to investigate the changes of microvascular leakage in the airways after re-exposure to capsaicin in an experiment using a rat model challenged/rechallenged with capsaicin. Twenty-four Sprague-Dawley rats were divided into four groups : a capsaicin-challenged group (10 microgram/kg of capsaicin, intravenous, n=6) and three capsaicin-rechallenged groups (10 microgram/kg of capsaicin, intravenous, n=6 in each group) corresponding to time intervals of 1, 3, or 6 hours after capsaicin-challenge. The amount of microvascular leakage in the nasal mucosa and trachea of the animal in each group was measured with extravasation of Evans blue dye (30 mg/kg, intravenous) using a spectrophotometer. In the nasal mucosa, a significant enhancement of microvascular leakage with capsaicin-rechallenge was observed at 3 hours after capsaicin-challenge (AVOVAR, * : p<0.01). However, there was no significant changes in the trachea. In conclusion, the protective mechanisms against repeated irritating stimuli in the nasal mucosa and trachea are different. After exposure to a noxious irritant, the airway defense mechanism mediated by an axon reflex in the nose may be up- regulated, while that in the trachea may not be changed.

Retrospective Analysis of Acute Laryngeal Trauma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute laryngeal trauma is a very rare injury. Controversy still exists in regards to its proper management. The aim of this study was to present clinical findings and management of acute laryngeal trauma. MATERIALS AND METHODS:We analyzed medical records of 15 patients with acute laryngeal trauma from 1987 to 1997 retrospectively. RESULTS: The most common cause of injury was traffic accident. Hoarseness (93.3 %), odynophagia (86.7 %), subcutaneous emphysema (60.0 %) were the common presenting symptoms and thyroid cartilage was the most common site of fracture. The correlation between dyspnea (p=0.03) and subcutaneous emphysema (p=0.08) and major injury was high. Esophageal examination was performed on 11 patients and revealed no injury. All four patients with vocal cord palsy and minor injury findings improved. Patients with major injury showed bad results of airway and voice, and result of voice was worse that of airway. CONCLUSION: If presenting symptoms are emphysema and dyspnea, major injury should be considered. Routine esophageal examination may be skipped in blunt minor injury. Vocal cord palsy with minor injury finding may not be an operative indication in blunt injury.