The Impact of Nasal Polyposis on Olfactory Dysfunction in Chronic Rhinosinusitis

BACKGROUND AND OBJECTIVES: Olfactory disturbance is a major sinonasal symptom of chronic rhinosinusitis (CRS) with nasal polyps (NP). The aim of this study was to investigate the relationship between the severity of nasal polyposis and olfactory dysfunction in CRS. SUBJECTS AND METHOD: A total of 277 subjects with CRS were included in this study. All participants were divided into four groups according to the size and degree of the nasal polyposis: the control group (no polyp; n=79); NP (nasal polyp) group I (both or unilateral simple polyposis; n=85); NP group II (unilateral diffuse polyposis; n=66); and NP group III (bilateral diffuse polyposis; n=47). We analyzed the relationships between the severity of nasal polyposis and olfactory dysfunction using both the Korean Version of the “Sniffin'Sticks” test (KVSS Test) II and the Questionnaire of Olfactory Disorders (QOD). RESULTS: The KVSS Test II TDI score was significantly decreased in the bilateral diffuse polyposis group (NP group III=15.62±13.39) compared to the other polyp groups [control group=25.04±9.67 (p<0.001); NP group I=21.67±11.18 (p=0.005); NP group II=21.51±10.85 (p=0.008)]. However, there were no significant differences in the KVSS Test II TDI score between the control group and NP groups I and II. For the QOD_NS score, only NP group III (11.51±9.87) had significantly increased values compared to the control group [8.42±12.27 (p=0.015)]. CONCLUSION: These results suggest that bilateral diffuse nasal polyposis is related to significant olfactory dysfunction in CRS.

Two Cases of Pediatric Obstructive Hypoventilation Managed with Upper Airway Surgery

Sleep-disordered breathing in children can include habitual snoring, obstructive hypoventilation, upper airway resistance syndrome, and obstructive sleep apnea. Obstructive hypoventilation in children is characterized by CO₂ retention caused by prolonged partial upper airway obstruction during sleep. To date, there have been few studies regarding the clinical significance and management strategies in pediatric obstructive hypoventilation, although it is a unique feature of pediatric sleep-disordered breathing. In this report, we describe two cases of obstructive hypoventilation that demonstrated improvement following upper airway surgery. These results suggest that upper airway surgery could be an additional treatment modality in obstructive hypoventilation.

The Relationship between Obstructive Sleep Apnea and Metabolic Syndrome in Adult

BACKGROUND AND OBJECTIVES: The prevalence of obstructive sleep apnea (OSA) and metabolic syndrome (MS) is increasing and those have been recognized as potential risk factors for cardiovascular disease in adults. The aim of this study is to investigate the association between obstructive sleep apnea syndrome and metabolic syndrome. MATERIALS AND METHODS: We enrolled 127 adults who were evaluated as having OSA. Each subject underwent overnight polysomnography to identify OSA based on the apnea-hypopnea index (AHI); OSA was diagnosed when AHI≥5, and subjects with AHI<5 were classified as the control group. MS was defined according to the Adult Treatment Panel (ATP) III criteria. RESULTS: Among 127 participants, 105 subjects were diagnosed with OSA. The mean age and smoker percentage showed differences between the OSA and control group. The prevalence of MS was significantly higher in the OSA group compared to the control group. As the severity of OSA increases, the prevalence of MS also increase. CONCLUSIONS: The MS is significantly related to the OSA in adults. Therefore, we suggest that patient with OSA should be screened to identify the presence of MS.

Upregulation of Prostasin in Nasal Polyps

OBJECTIVES/HYPOTHESIS: Prostasin is a protease that activates epithelial sodium channels (ENaC), which mediate Na+ absorption across epithelial surfaces. Human nasal polyps absorb more ENaC-mediated Na+ than normal mucosa. We investigated the expression and distribution of prostasin in normal mucosa and nasal polyp. STUDY DESIGN: This was a controlled, prospective study. METHODS: The distribution patterns and levels of expression of prostasin in normal sinus mucosa and nasal polyps were evaluated using real-time polymerase chain reaction (PCR), immunohistochemical staining and western blotting. RESULTS: Real-time PCR revealed that the mRNA expression of prostasin was higher in nasal polyps than in normal sinus mucosa. The expression of prostasin was faint in immunohistochemical staining of superficial epithelial cells and submucosal glandular epithelial cells of normal sinus mucosa, but was intense in superficial epithelial cells and submucosal glandular epithelial cells in nasal polyps. Inflammatory cells infiltrating into the nasal mucosa also showed prostasin immunoreactivity in nasal polyps. Western blot analysis with prostasin antiserum detected prostasin protein in normal sinus mucosa and nasal polyps. The expression levels of prostasin were increased in nasal polyps compared with normal sinus mucosa. CONCLUSIONS: The levels of expression of prostasin were upregulated in nasal polyps compared to normal sinus mucosa, suggesting a role in the pathogenesis of nasal polyps. However, the exact pathophysiologic function of prostasin in nasal epithelium warrants further investigation.