A Novel Powered Nasal Irrigation After Endoscopic Sinus Surgery in Patients With Chronic Rhinosinusitis: A Preliminary Study / 대한이비인후과학회지

Background and Objectives@#We aimed to compare the efficacy of a novel powered irrigation system with that of the manual bottle-squeeze method for postoperative healing after endoscopic sinonasal surgery (ESS).Subjects and Method In this prospective randomized clinical trial, 29 patients were enrolled for nasal irrigation (NI) with either NOSSHA® (Womens Care Co., Ltd.) powered irrigation system (NOSSHA® group, n=14) or manual irrigation (control group, n=15). Objective findings were evaluated using the modified Lund-Kennedy scores. Subjective outcomes were assessed using the total nasal endoscopic score (TNES), total nasal symptom score (TNSS), visual analog scale (VAS), and quality of life (QOL) questionnaires in each group at baseline, and 1, 2, 4, 6, and 8 weeks after ESS. We compared the postoperative changes between both groups. @*Results@#The mean TNES of patients were significantly higher in the NOSSHA® group than in the control group (p=0.015); however, the improvement in TNES was achieved 2 weeks earlier in the NOSSHA® group. The improvement in TNES (p<0.001) and TNSS (p<0.001) was statistically significant in both groups. The improvement in QOL was statistically significant in the NOSSHA® (p<0.001) and control group (p=0.007). The improvement in the TNSS and QOL was earlier in the NOSSHA® group by 4 and 7 weeks, respectively; no early improvement occurred in the NOSSHA® group for the VAS score. @*Conclusion@#We validated the usefulness of postoperative NI using a powered device, which may be useful for patients who cannot tolerate manual NI.

Popularization of Medical Information / 대한의료정보학회지

Objectives@#Despite the popularization of technology and the high penetration rate of smartphones and mobile devices, differences exist in the accessibility, utilization capabilities, and quality of technology depending on users’ characteristics. Since these discrepancies can threaten health information equity, popularization of medical information is essential. This review article examines domestic and international cases of popularization of medical information, and discusses the related issues, expectations, and practical measures to achieve the popularization of medical information. @*Methods@#In this study, medical information was categorized as Electronic Health Records/Electronic Medical Records (EHR/EMRs; hospital-driven medical information), personal health records (PHRs; user-driven medical information), and patient-generated health data (PGHD; user-generated medical information [outside hospitals]). This article reviewed the domestic and international use status, acceptance rates, and use cases for each type of medical information. Issues and expectations about policies and cases related to the popularization of medical information were also described, and finally, practical measures to accomplish the popularization of medical information were discussed. @*Results@#To achieve the popularization of medical information, the following measures should be considered: engaging health consumers to participate in the early stages of information production, cultivating digital literacy, producing easy-to-use and interesting medical content, visualizing health information, and creating a medical thesaurus. @*Conclusions@#Healthcare providers should make regular efforts to popularize medical information. The popularization of medical information is an essential process to achieve health equity and digital health equity.

Popularization of Medical Information / 대한의료정보학회지

Objectives@#Despite the popularization of technology and the high penetration rate of smartphones and mobile devices, differences exist in the accessibility, utilization capabilities, and quality of technology depending on users’ characteristics. Since these discrepancies can threaten health information equity, popularization of medical information is essential. This review article examines domestic and international cases of popularization of medical information, and discusses the related issues, expectations, and practical measures to achieve the popularization of medical information. @*Methods@#In this study, medical information was categorized as Electronic Health Records/Electronic Medical Records (EHR/EMRs; hospital-driven medical information), personal health records (PHRs; user-driven medical information), and patient-generated health data (PGHD; user-generated medical information [outside hospitals]). This article reviewed the domestic and international use status, acceptance rates, and use cases for each type of medical information. Issues and expectations about policies and cases related to the popularization of medical information were also described, and finally, practical measures to accomplish the popularization of medical information were discussed. @*Results@#To achieve the popularization of medical information, the following measures should be considered: engaging health consumers to participate in the early stages of information production, cultivating digital literacy, producing easy-to-use and interesting medical content, visualizing health information, and creating a medical thesaurus. @*Conclusions@#Healthcare providers should make regular efforts to popularize medical information. The popularization of medical information is an essential process to achieve health equity and digital health equity.

Vascular Leiomyoma of the Nasal Floor: The Risk of Misdiagnosis

Heat-Killed Saccharomyces cerevisiae, A Dectin-1 Agonist, Selectively Induces IgG4 Production by Human B Cells

Dectin-1 is a major receptor that recognizes fungal cell wall β-glucan. We previously reported that heat-killed Saccharomyces cerevisiae (HKSC), a Dectin-1 agonist, selectively induces IgG1 class switching in mouse B cells. Dectin-1 is also expressed on human B cells; however, Dectin-1 function in human B cells remains unknown. This study aimed to investigate the direct effect of in vitro stimulation using HKSC on Ig class switching in human B cells. HKSC selectively induced the expression of germline γ4 transcripts (GLTγ4) by human B cell line 2E2, and HKSC significantly augmented GLTγ4 promoter activity. Moreover, HKSC selectively enhanced GLTγ4 expression and IgG4 production by anti-CD40-activated human tonsillar resting B cells. Thus, these results suggest that Dectin-1 maybe involved in selective IgG4 class switching by human B cells.

A Case of Saddle Nose Deformity Caused by Electrocautery of Nasal Septum / 대한이비인후과학회지

Electrocautery of nasal septum is a very common treatment of epistaxis in Otorhinolaryngology. However, serious complications of electrocautery are rare. We encountered a 52-year-old female patient who presented with nosebleeds. A definite focus of bleeding was identified by nasal endoscopy, thus electrocautery by bipolar diathermy was performed in the area of Kisselbach's plexus of nasal septum. There were no abnormal findings in the nasal septum during the three weeks of outpatient visit. However, the patient noticed a depression near the tip of her nose 12 weeks later. Saddle nose deformity after electrocautery has not yet reported in the literature. Therefore, we present this case with a brief review of literature.

What kind of feedback do medical students want? / 한국의학교육

PURPOSE: Feedback in medical education is as important as developing the curriculum and choosing the right method of instruction. This study measured three overarching areas: student satisfaction rates with academic feedback, the type and helpfulness of the feedback, and the types of feedback that students want. METHODS: In December 2013, 166 students answered a student survey that consisted of 26 items. The survey asked questions on their experiences with the overall feedback that was given the previous semester, the satisfaction rate, the type of feedback that was received, the helpfulness of the feedback, and the types of feedback that were desired after examinations and learning tasks. RESULTS: Overall, 35% of the students were satisfied with the feedback that they received in the previous semester. Students wanted more systematic (61.4%) and timely feedback (30.1%). The types of feedback that were most desired were "written comment feedback from the teacher" (51.8%) for learning tasks and "item difficulty, percentile ranks feedback" for examinations (62.0%). CONCLUSION: Students found the current feedback to be helpful, but the lack of feedback that students desired indicates that we must provide more systematic feedback in a more timely manner.

Effect of adenotonsillar hypertrophy on right ventricle function in children / 소아과

PURPOSE: Chronic upper airway obstruction causes hypoxemic pulmonary vasoconstriction, which may lead to right ventricle (RV) dysfunction. Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction in children. Therefore, we aimed to evaluate RV function in children with ATH. METHODS: Twenty-one children (male/female, 15/6; mean age, 92.3~39.0 months; age range, 4-15 years) with ATH and 21 healthy age- and gender-matched controls were included in this study. Tricuspid annular plane systolic excursion and RV myocardial performance index were measured by transthoracic echocardiography. Further, the plasma level of N-terminal of probrain natriuretic peptide (NT-proBNP), an indicator of RV function, was determined. RESULTS: The snoring-tiredness during daytime-observed apnea-high blood pressure (STOP) questionnaire was completed by the patients' parents, and loud snoring was noted in the ATH group. The plasma NT-proBNP level was significantly higher in the ATH group than that in the controls (66.44+/-37.63 pg/mL vs. 27.85+/-8.89 pg/mL, P=0.001). The echocardiographic parameters were not significantly different between the groups. CONCLUSION: We were unable to confirm the significance of echocardiographic evidence of RV dysfunction in the management of children with ATH. However, the plasma NT-proBNP level was significantly higher in the ATH group than that in the control, suggesting that chronic airway obstruction in children may carry a risk for cardiac dysfunction. Therefore, more patients should be examined using transthoracic echocardiography. In addition, pediatricians and otolaryngologists should consider cardiologic aspects during the management of children with severe ATH.

What do faculties need most in a faculty development program? / 한국의학교육

PURPOSE: This study examined two overarching topics: to what extent do faculties acknowledge class readiness, execution of lessons, and evaluation of the session; and what core content should be strengthened in a medical school faculty development program? METHODS: In November 2012, 37 faculties completed a detailed survey on the needs of medical school faculty development programs. The 14-item survey assessed the importance, operational frequency, difficulty in accomplishment, class readiness, execution of teaching, and evaluation of the session. RESULTS: Faculties were aware of the importance of class readiness, execution of teaching, and evaluation of the session but had a low level of accomplishment with regard to execution of the instruction and evaluation of the session. Four subitems of session evaluation were considered very important but showed low operational frequency, high difficulty in accomplishment, and low accomplishment ability. The successful discussion class item had the lowest operational frequency and accomplishment ability. The core contents that should be strengthened in medical school faculty development programs are diagnose students' class readiness (prior knowledge) (35.5%) and providing class session with suitable level/content (32.3%). CONCLUSION: Before designing faculty development programs, a needs assessment is useful in providing more tailored content for the faculty.

The Study of pH in Nasal Secretion in Normal and Chronic Rhinosinusitis

BACKGROUND AND OBJECTIVES: Nasal mucosal pH have a direct effect on the alteration of the physio-chemical characteristics of the nasal mucosa. Previous studies have reported the normal mucosal pH to be within the range of 5.3-7.0, mucosal pH with sinusitis to be within 6.8-7.6 and mucosal pH with rhinitis to be within 7.2-8.3. However, no consideration was paid to the conditions that influence the pH and there were no measured pH value by different methods. This study was therefore designed with the latest trend method in pH measurement with the purpose of evaluating pH in nasal secretion and creating an objective parameter for a beneficial manifestation of mucosa. MATERIALS AND METHODS: We measured the pH values from 30 normal control group (group 1), 30 patients with chronic sinusitis (group 2), and 30 patients with allergic rhinitis (group 3). Nasal secretion was obtained through filter paper absorption method and, using a micro pH electrode with pH meter, pH was measured in nasal secretion. RESULTS: pH in nasal secretion in this study was higher than the nasal mucosal pH from previously reported studies. pH values in nasal secretion showed a significant difference between three groups (group 1:7.86, group2:8.06, group 3:8.24) in this study (p<0.01). CONCLUSION: The measurement of pH in nasal secretion seems to be a useful parameter for monitoring and assessing the state of nasal mucosa. And we recommend this study as a method for obtaining an objective parameter for pH measurement in nasal cavity.

An Airway Tube for Minimizing Nasal Obstruction Following Intranasal Packing

BACKGROUND AND OBJECTIVES: Nasal packing after nasal surgery is commonly practiced for various purposes including hemostasis, stabilization of nasal structure, and synechia prevention. However, the use of nasal packing has led to the development of uncomfortable symptoms such as nasal obstruction. In this study, therefore, we have devised a new method of nasal packing involving the use of an airway tube for reducing nasal obstruction and discomforts in association with post-surgical nasal obstruction. Materials and METHODS: An airway tube was made by cutting the distal end of a 1cc syringe. It was inserted between the nasal septum and the packing material. Nasal cavities of 20 patients (Group 1) who underwent nasal surgery were packed using packing materials and the devised airway tubes following nasal surgery. We evaluated the symptoms of nasal obstruction after the postoperative nasal packing in this study group and compared them with those of the 20 patients (Group 2) who received packing with existing merocel nasal stents and 20 patients (Group 3) who were given packing with only merocel without airway tubes after nasal surgery. RESULT: In this study, nasal obstruction and discomforts in association with post-surgical nasal obstruction were significantly improved among patients given packing material and devised airway tubes (Group 1) comparative to other patient groups. CONCLUSION: Devised airway tube is useful in minimizing the symptoms of nasal obstruction and discomforts as well as in reducing surgical expense.

Clinical Significance of Nasal Secretory Proteins in Chronic Sinonasal Diseases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many studies report changes in the expressions of nasal secretory proteins which play important roles in the evaluation of sinonasal mucosal status. The biomarkers in nasal secretions provide valuable information on pathophysiological status of the rhinosinusitis. We have monitored the level and ratio of nasal secretion markers, especially secretory IgA (sIgA) and lactoferrin as markers of sinonasal submucosal glands to evaluate mucosal status for chronic sinonasal diseases and allergic rhinitis. SUBJECTS AND METHOD: Samples were obtained with the filter paper absorption method from 20 normal healthy controls (Group I), 20 patients with chronic rhinosinusitis (Group II), 20 patients with allergic rhinitis (Group III), 20 normalized persons of chronic rhinosinusitis patients treated with antibiotics, previously (Group IV). We estimated concentrations of sIgA and lactoferrin determined by enzyme-linked immunosorbent assay method. RESULTS: The concentration of sIgA and lactoferrin in nasal secretion showed a significant difference between the control group and other groups (p<0.05). The sIgA/lactoferrin ratio was more highly significant in the normal group and normalized in chronic rhinosinusitis patients treated with antibiotics (Group IV) than other groups (p<0.05). CONCLUSION: In this study, sIgA and lactoferrin are useful secretion markers and the levels of sIgA, lactoferrin and sIgA/lactoferrin ratios in nasal secretions seem to be very useful parameters for monitoring and assessing the conditions of the sinonasal mucosal diseases.

The Feasibility of Using Automated Distortion Product Otoacoustic Emission (DPOAE) as a Screening Auditory Function Test of Workers in a Noisy Environment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Automated DPOAE (Distortion product otoacoustic emission) was tested on workers exposed to a noisy environmnent to determine its feasibility as a screening test for noise-induced hearing loss. SUBJECTS AND METHOD: Sensitivity and specificity were analyzed for in both automated DPOAE and Pure tone audiometry conducted on 300 subjects working in a noisy environment. Of these subjects, a subgroup of 40 workers who were available for a follow-up study underwent the same experiment again a year later, and the results were compared with the first one. RESULTS: In terms of the frequency of automated DPOAE, it was noted that it showed 91% sensitivity with a 9% false negative rate. The pass rate according to the period of service indicated statistical significance, although the results of a 1 year follow-up experiment did not indicate statistical significance. CONCLUSION: The automated DPOAE seems feasible to use as a screening test when frequency and adjusted reference criteria are considered.

Histologic Change of the Septal Cartilage with the Respect to Trauma History and Age at the Trauma in Nasal Septal Deviation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The histologic difference of the traumatic nasal septal cartilage from that of non-traumatic has not been extensively studied. The aim of this study was to identify histologic difference in the nasal septal cartilage between traumatic and non-traumatic nasal septal deviation and to find its implication for surgical intervention. SUBJECTS AND METHOD: Nasal septal cartilage was obtained from 23 patients who had undergone septoplasty or septorhinoplasty for the nasal septal deviation. The septal cartilage without trauma (7 patients, Group I) and with the history of the trauma at the age under 10-15 years old (8 patients, Group II), and over 25 years old (8 patients, Group III) between May 2003 to February 2005 were included in this study. An approximately 1 x 1 cm sized piece of the septal cartilage was harvested from the site deviated the most. The histologic difference of the septal cartilage by hematoxylineosin staining under a light microscope was performed. RESULTS: The chondrocyte densities were significantly higher in the convex side than in the concave side of the septal cartilage in Group I, II, III. Especially, the increased chondrocyte ratio (convex/concave) were more evident in the septal cartilage traumatized at the age of 10 to 15 years, and the cartilage plate was thicker than the other groups (p<0.001). Also, dystrophic changes of the chondrocytes as representing the chondrocyte differentiation and chondroblast ratio (convex/concave) were significantly higher in the group II than in the other groups (p<0.005). CONCLUSION: This study demonstrated that age dependent changes in septal cartilage with nasal trauma showed distinctive histologic characteristics. We suggest that these observations will help determine surgical treatment modality for cases of nasal septal deviations with and without trauma.

A Case of Empty Sella Syndrome with Cerebrospinal Fluid Rhinorrhea / 대한이비인후과학회지

The empty sella syndrome is defined as the intrasella herniation of the chiasmal cistern resulting from a congenitally incompetent diaphragma sellae. In idiopathic or primary empty sella syndrome, sella remodelling occurs as a result of an anatomical variation in the diaphragma sella. The secondary empty sella syndrome occurs following surgery or irradiation of an intrasellar lesion. Empty sella syndrome is known to be rarely associated with Cerebrospinal fluid (CSF) rhinorrhea. We experienced a case of secondary empty sella symdrome with CSF rhinorrhea in a 56-year old female who complained of persistent rhinorrhea through the roof of the sphenoid sinus after brain surgery due to meningioma. The CSF rhinorrhea was treated successfully with transseptal trans-sphenoidal approach.

A Case of Collagen Graft for Patulous Eustachian Tube / 대한이비인후과학회지

The patulous eustachian tube is not a common otorhinolaryngological disease, for which a standard therapy is not established yet. It is considered benign, but symptoms affecting the patient should not be overlooked or ignored. Using an acellular dermal graft (Collagen), we gained positive results in treating a patient, and thus report this case with a review of the literature.