Analysis of Obstruction Site in Obstructive Sleep Apnea Patients Based on Videofluoroscopy

BACKGROUND AND OBJECTIVES: Upper airway obstruction can occur at the soft palate, tongue base, or epiglottis among obstructive sleep apnea (OSA) patients. Detection of these obstruction sites is very important for choosing a treatment modality for OSA. The purpose of this study was to evaluate the obstruction site of OSA patients and its association with mouth opening and head position. SUBJECTS AND METHOD: Forty-eight consecutive patients with suspicion of OSA were enrolled and underwent videofluoroscopy to evaluate the obstruction site, as well as polysomnography. Obstruction site, mouth opening, and head position were evaluated on videofluoroscopy, and their association was analyzed. RESULTS: According to the videofluoroscopy, 47 (97.9%) of 48 patients showed an obstruction in the soft palate, while 24 (50.0%) were located in the tongue base and 14 (29.2%) in the epiglottis. Multiple obstructions were observed in many patients. Mean apnea-hypopnea index was higher among patients with tongue base obstruction (42.3±26.7) compared to those without obstruction (26.4±21.2, p=0.058). However, epiglottis obstruction did not influence apnea-hypopnea index. Mouth opening did not show any association with tongue base obstruction (p=0.564), while head flexion was highly associated (p<0.001). CONCLUSION: Half of patients with OSA have tongue base obstruction, which worsens the apnea-hypopnea index. Head flexion is associated with tongue base obstruction, while mouth opening is not.

Do Eosinophilic Polyps Act as a Reliable Predictor of Olfactory Dysfunction and Postoperative Recovery in Chronic Rhinosinusitis? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was 1) to assess differences in categories of olfactory dysfunction according to the pathological classification of chronic rhinosinusitis with nasal polyp (CRSwNP) patients; 2) to identify the degree of olfaction recovery after endoscopic sinus surgery (ESS); and 3) to identify the factors that predict the changes in olfactory status. SUBJECTS AND METHOD: The sample of the study consisted of patients with CRSwNP who underwent ESS with biopsy from January 2012 to September 2014. Seventy five patients were classified into eosinophilic CRS (ECRS) and non-ECRS groups. During an approximately five-month follow-up, the Korean Version of Sniffin' Sticks test II (KVSS II) was conducted on each patient to examine the difference between the preoperative and postoperative states of olfactory function. RESULTS: The ECRS group showed a statistical significant increase in the postoperative KVSS II scores when compared to the preoperative scores, while the non-ECRS group did not show any statistically significant change. For the anosmia category by KVSS II, the ECRS group showed significantly improved olfactory function test scores for the threshold, discrimination, and identification tests. CONCLUSION: ECRS and preoperative olfactory function status (anosmia) could be predictable factors of postoperative olfactory function.

Clinical Feasibility of Scent Survey for Screening Test for Olfactory Function

BACKGROUND AND OBJECTIVES: The scent survey for screening (SSS) test is a subjective olfactory questionnaire devised for this study. We demonstrated the correlation of the SSS test with other olfactory tests and the efficacy of the SSS test as an olfactory screening test compared to KVSSII. SUBJECTS AND METHOD: A total of 363 patients who visited our ORL outpatient department underwent the SSS test, VAS, and KVSS I and II. The patients were divided into two groups, a group with normal olfactory function and a group with olfactory dysfunction according to the KVSS II test. In each group, the correlations between the olfactory tests were studied, and the cut-off value of the SSS test as a screening test was investigated. RESULTS: There was positive correlation between CCSIT and KVSS I, II, T, D, and I tests and the SSS test in the total group and in the olfactory dysfunction group (p<0.05). The identification test in the KVSS II showed the highest positive correlation. While the cut-off value of normal olfactory function in the KVSS II is 28, the SSS test showed the highest specificity and sensitivity of 74 under an ROC curve. CONCLUSION: The SSS test showed very high correlation with other olfactory tests, especially in an olfactory dysfunction group. This result indicates that the SSS is appropriate as a screening test to select people with olfactory disorder.

The Effect of Sleep Disordered Breathing on Olfactory Functions: Analysis by Apnea-Hypopnea Index

OBJECTIVES: One hypothesis of obstructive sleep apnea syndrome (OSAS) is that long-standing snoring vibrations and hypoxia of the nerves cause a local neuropathy in the upper airway during sleep. The aim of this study was to investigate olfactory function in subjects comprising snorers and untreated subjects with OSAS, and to correlate data with polysomnographic parameters. METHODS: Sixty-nine patients were evaluated for snoring from January 2010 to December 2013. The mild group (apneahypopnea index [AHI]<15) consisted of 19 subjects, and the moderate-severe group (AHI≥15) consisted of 50 subjects. Exclusion criteria were conductive olfactory dysfunction, previous tonsil or soft palatal surgery, central sleep apnea, and medications that are known to affect peripheral nerves. Nocturnal polysomnography and olfactory function test such as Korean version of Sniffin’s stick test I, II (KVSS I, II) were performed. RESULTS: There was a significant difference in body mass index, average oxygen saturation (SaO2), lowest SaO2, average snoring duration, and KVSS I, II between the two groups. AHI was related to odor threshold score, and average SaO2 was related to odor discrimination score. But, odor identification score showed no relation with AHI and average SaO2 except for age. Average SaO2 and AHI were closely related to the function of smell. CONCLUSION: Hypoxia and low nasal airflow caused by OSAS may have an effect on the olfactory function. On comparison between the two groups, patients with a high AHI, especially those with OSAS, had an olfactory dysfunction. Also, low average oxygen is the main risk factor in determining the olfactory function. In people with OSAS, the possibility of olfactory dysfunction should be considered and an olfactory function test should be performed.

Prevalence of Allergic Disease in Korean Adults: Results from the Korea National Health and Nutrition Examination Survey (2010–2012) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In this study, we evaluated differences in the prevalence of allergic rhinitis, asthma, atopic dermatitis and specific immunoglobuline E (IgE) value for some respiratory antigens in Korean adults. SUBJECTS AND METHOD: The study was conducted using data from the 5th National Health and Nutrition Survey (2010-2012). All subjects who were aged 19 years or older completed questionnaires on asthma, atopic dermatitis and allergic rhinitis. The subjects were first divided into male and female, and then into age groups of 19-29, 30-39, 40-49, 50-59, 60-69, ≥70 each. The lifetime and current prevalence rates for allergic rhinitis, asthma, and atopic dermatitis were calculated for each age group. The total and specific IgE level for Dermatophagoides farinae (DF), cockroach, and dog dander were also calculated. RESULTS: Final participants of 17542 were analyzed for the prevalence rate among the total of 25534 participants. The mean IgE level was calculated from 2028 subjects from the final participants. In asthma, the lifetime prevalence and current prevalence increased with age, but decreased with atopic dermatitis and allergic rhinitis. Total IgE level increased with age, but IgE level of DF reached its peak at 20-29 years, and then decreased rapidly thereafter. There was no clear trend for cockroach and dog dander. CONCLUSION: The prevalence of allergic diseases in adults varies widely by age group. Asthma has a low prevalence after age 20 and gradually increases after age 50. Atopic dermatitis and allergic rhinitis are the most prevalent in their 20s and gradually decrease thereafter.

Nocturia Improvement With Surgical Correction of Sleep Apnea / 대한배뇨장애요실금학회지

PURPOSE: To evaluate changes in nocturia after surgical correction of obstructive sleep apnea (OSA). METHODS: A total of 66 patients were included in the present study. All had been diagnosed with OSA syndrome by polysomnography and underwent uvulopalatopharyngoplasty (UPPP). Preoperative and postoperative lower urinary tract symptoms (LUTS), quality of life (QoL), and nocturia episodes were evaluated using the International Prostate Symptom Score (IPSS) and overactive bladder symptom score (OABSS) questionnaires. Three months postoperatively, telephone interviews were performed to determine the success of surgery, current LUTS, and nocturia episodes. Patients were divided into surgical success and failure groups. Surgical success was defined as snoring decrease more than 50% based on the patient’s subjective judgment. RESULTS: The response rate was 56% and success rate was 73%. In all patients, nocturia episodes significantly decreased from 1.7±1.1 to 0.8±1.2 (P=0.002). Mean IPSS score, OABSS score, and QoL scores were also significantly improved. The success group showed a significant decrease in nocturia episodes, and total IPSS, OABSS, and QoL scores. However, the failure group did not show significant changes in all parameters. CONCLUSIONS: OSA correction improved nocturia as well as other LUTS. These improvements were not observed in the failure group. This study shows that OSA is a cause of nocturia and that other LUTS and nocturia can be improved by surgical correction of OSA.

Expression of CAIII and Hsp70 Is Increased the Mucous Membrane of the Posterior Commissure in Laryngopharyngeal Reflux Disease

PURPOSE: We tried to evaluate the difference in the expression of carbonic anhydrase (CA) III and heat shock protein (Hsp) 70 between laryngopharyngeal reflux disease (LPRD) and non-LPRD patients. MATERIALS AND METHODS: The study involved 28 patients who underwent laryngeal microsurgery due to benign laryngeal disease from March to August 2008. Reflux symptom index (RSI) and reflux finding score (RFS) were measured for each person, and they were assigned either to the LPRD group (n=10) or non-LPRD group (n=18). Tissue samples were obtained from the mucosa of posterior commissure, and immunohistochemistry (IHC) staining of CAIII and Hsp70 was performed. The IHC scores were measured and compared with clinical features including RSI and RFS. RESULTS: Total 10 patients were assigned as LPRD group, and 18 patients were as control group. The mean IHC score of CAIII and Hsp70 was 1.70+/-1.06 and 1.90+/-0.88, respectively, in LPRD patients, whereas the mean IHC score of CAIII and Hsp70 was 0.78+/-0.73 and 0.94+/-0.87, respectively, in non-LPRD patients. The difference between two groups was statistically significant (p<0.05). CONCLUSION: CAIII and Hsp70 expressions were higher in LPRD patients that in non-LPRD patients, suggesting the possibility as one of biomomarker in LPRD diagnosis.

Natural Course of Allergic and Nonallergic Rhinitis After 2 Years in Korean Children

OBJECTIVES: Allergic and nonallergic rhinitis are very common disease for children, however, little is known about their natural courses in the general population. The purpose is to evaluate the natural course of allergic and nonallergic rhinitis in children. METHODS: We analyzed data from Snoring Child Cohort of 178 children (107 boys and 71 girls). All children entered the study at the age of 7 years (range, 6.5 to 7.4 years). Questionnaires regarding chronic rhinitis, a skin prick test (SPT) for 5 inhalent allergens, and specific IgE for 2 dust mites were administered. Children were classified into 4 groups: allergic rhinitis (rhinitis, positive SPT), nonallergic rhinitis (rhinitis, negative SPT), sensitization only (no rhinitis, positive SPT), and control (no rhinitis, negative SPT). We repeated follow them annually, and analyzed the data of first and third year for this study. RESULTS: Finally, the data of 122 children were analyzed. Among 18 children with allergic rhinitis at 7 years, 13 (72%) became sensitization only after 2 years and 5 (28%) were remained having allergic rhinitis. Five out of 19 children (26%) with nonallergic rhinitis developed into allergic rhinitis and 7 (37%) into control at 9 years. Twenty-four out of 28 children (86%) with sensitization only at 7 years remained the same at 9 years. Among 57 control children at 7 years, 2 (4%) developed into allergic rhinitis, 7 (12%) with nonallergic rhinitis, and 16 (28%) with sensitization only at 9 years. CONCLUSION: The status of chronic rhinitis and allergen sensitization is ever-changing in children.

Decreased Serum Epinephrine in Children With Positive Skin Prick Test

OBJECTIVES: To evaluate the association between catecholamine levels and skin prick test results among children. METHODS: Two hundred eight first grade children from one elementary school were invited to participate in this study. Skin prick test (SPT) for six allergens (2 house dust mites, cat, dog, mugwort, and pollen mixture) was performed, and patient demographic information was recorded. The parents were surveyed using questionnaires about rhinitis-related symptoms. Finally, venous blood sampling was done to measure catecholamine levels (epinephrine, norepinephrine, and dopamine) by high-performance liquid chromatography. RESULTS: Out of 208 children, 174 (106 boys and 68 girls) enrolled in this study. Ninety-six of the children (55%) had negative SPT (nonsensitization group), while 78 (45%) had a positive SPT to at least one of six allergens (sensitization group). The diagnosis of chronic rhinitis was more prevalent in the sensitization group (35.9%) than nonsensitization group (26.0%), however the finding was not significant (P=0.186). Epinephrine levels were decreased between the sensitization group compared to the nonsensitization group (P=0.004). There was no difference in norepinephrine and dopamine levels (P>0.05). CONCLUSION: Epinephrine levels are lower in children with positive SPT compared to controls, however, the level of the catecholamine was not associated with the presence or absence of rhinitis symptoms.

Comprehensive Comparison between Snoring and Non-Snoring Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Snoring is very common among children; however, there is a controversy regarding its effects on children. The purpose of this study is to identify risk factors and comorbidities associated with the condition collectively. SUBJECTS AND METHOD: 208 children were invited to participate in this study. Parents were surveyed for each child's snoring status, chronic rhinitis, behavior, and the parents' snoring and smoking status. Measurements were taken of each child's height, weight, waist and neck circumference, and blood pressure. X-rays and physical exams were used to record tonsil and adenoid size. All children also received an intelligence test and comprehensive blood test. Results were then compared between snoring and non-snoring children. RESULTS: Among 208 children, 175 participated in the study voluntarily. Out of the participants, 55 were snorers and 120 were non-snorers. Body mass index, neck and waist circumferences, and prevalence of chronic rhinitis were higher among the snorer. Mothers of snoring children snored more frequently. Inattention and impulsivity scores were also higher among snorers than non-snorers. There were no differences of cognition, tonsil or adenoid size, or blood test results between the two. CONCLUSION: There were some differences in physical, family-related, and behavior trait between snoring and non-snoring children.

Olfactory Identification Test Using Familiar Distracters for Koreans

OBJECTIVES: Odors used in an odor identification test should be familiar to the subject, but there are some unfamiliar distracters in Korean version of Sniffin' stick (KVSS) II identification test. In this study, we used the results of the original version of KVSS II identification to modify the KVSS II identification test. METHODS: Eighty-three participants took an original version of KVSS II identification test and a visual analogue scale of subjective odor function. KVSS II identification which has 16 items was performed to choose one out of four odors items. And visual analogue scale was checked from 0 to 10 points of their subjective olfactory function. Two weeks later they took the modified version of KVSS II identification test. Hyposmic or anosmic patients were excluded. RESULTS: The mean score of the original version of KVSS II identification and modified version of KVSS II identification were 11.3 and 12.5, respectively (P<0.05). The KVSS II identification test and subjective olfactory function were positively correlated (r=0.247, P<0.05), as were the modified KVSS II identification test and subjective olfactory function (r=0.329, P<0.05). CONCLUSION: After modification of distracters, KVSS II identification test appears to be suited for assessment of olfactory function.

Does Nasal Polyps Influence on the Location of Nasal Fontanelle? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to evaluate the relationship between the location of the nasal fontanelle and either the chronic rhiosinusitis with nasal polyp in middle meatus (NP) or the chronic maxillary sinusitis (CMS). SUBJECTS AND METHOD: We classified the subjects without any nasal septal deviation (<5degrees) into three groups: the normal control group, the CMS group (CMS without NP) and the NP group (CRS with NP). Both angles of nasal septum and fontanelle were measured by CT imaging and nasal cavities were counted as an individual side. We compared 96 CT scans of normal controls with 79 of CMS groups and 54 of NP groups. In case of discrepancy in the locations of both fontanelles on their CT scans, we reconstructed all the images to identify the fontanelle location. The lateral side on which the fontanelle was actually located was assigned the positive angle and the medial side the negative angle to determine the presence of fontanelle deviation. The normal range of the fontanelle deviation was established by the mean angle obtained from the normal group, which included 50% of each medial and lateral side. RESULTS: The mean angles of the control group, the CMS group and the NP group were 1.34degrees, 3.47degrees, and 6.99degrees, respectively. A statistically significant relationship was noted between the control and NP group (p=0.001), but not between the control and CMS group, CMS and NP group (p=0.237 and 0.051, respectively). CONCLUSION: The nasal polyp in middle meatus influenced on the location of nasal fontanelle to lateral side compared to the normal controls.

Survey of Continuous Positive Airway Pressure Use in Korea

BACKGROUND AND OBJECTIVES: Positive airway pressure (PAP) is the most effective treatment tool for obstructive sleep apnea (OSA), however adherence rate of PAP is known to be very low. The objective of this study is to investigate the adherence rate of PAP in Korea. MATERIAL AND METHOD: We reviewed sales data from a PAP vendor. OSA patients who were referred to this vendor had a chance to experience PAP for a month. After that, patients were supposed to buy PAP or return it. We investigate the rate of patients who bought PAP, and asked the patients who had bought it whether they are still using it or not. We asked the reason to the patients who are not using it anymore. RESULTS: Among 724 OSA patients who used PAP for one month, 256 patients bought PAP and others refused it. We could survey 190 patients among 256 who had bought PAP. Among them, 34 patients did not use PAP anymore. The rest 156 patients said that they are still using it. CONCLUSION: Contrary to our expectation, only a small number of obstructive sleep apnea patients use it. We must be cautious when to prescribe PAP to obstructive sleep apnea patients.

Analysis of Snoring Sound in Obstructive Sleep Apnea Patients Based on Obstruction Site / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The detection of obstruction site is very important for the surgical treatment of obstructive sleep apnea (OSA). Among the various diagnostic modalities for detection that have been tried, an analysis of snoring sound could be a simple and safe alternative. This study evaluates the usefulness of sound analysis in OSA as a detection tool of obstruction site. SUBJECTS AND METHOD: Fifteen patients who had been enrolled for the suspicion of OSA were studied. They were examined by videofluoroscopy and polysomnography to evaluate the obstruction site. During videofluoroscopy, snoring sound was recorded simultaneously. The snoring sound was analyzed by using Matlab program and its sonic characteristics were evaluated on the basis of the results in polysomnography and videofluoroscopy. RESULTS: According to the videofluoroscopy, 5 out of 15 patients showed narrowness only in the soft palate, while the rest of the 10 patients showed narrowness both in the soft palate and tongue base. Most of the snoring sound from the soft palate was of a low tone, under 1000 Hz, while the snoring sound from both soft palate and tongue base showed a high tone band, over 1000 Hz frequently and hump around 10 kHz. There was no specific correlation between apnea-hypopnea index and sonic characteristic. CONCLUSION: The analysis of snoring sound may be a useful tool for detecting the obstruction site in OSA.

Radiofrequency-Assisted Uvulopalatoplasty with Tonsillectomy for the Treatment of Mild to Moderate Obstructive Sleep Apnea

BACKGROUND AND OBJECTIVES: In radiofrequency surgery, energy is usually delivered to the submucosal tissue of the palate through a special probe in order to reduce the volume and rigidity (palatal channeling). However, the same probe can be used to make cuts in the free edge of the soft palate, as in laser-assisted uvulopalatoplasty [radiofrequency-assisted uvulopalatoplasty (RAUP)]. The objective of the current study was to evaluate the role of RAUP with tonsillectomy for the treatment of mild or moderate obstructive sleep apnea (OSA). MATERIALS AND METHODS: Eighty-two patients with mild to moderate obstructive sleep apnea (5< or =AHI<30, BMI<30) were included in this clinical trial. All patients received RAUP with tonsillectomy. Patients were followed for six months and were asked to respond to a questionnaire regarding standard visual analogue score pattern. Assessment was performed prior to the surgery and was repeated six month postoperatively. Visual analogue scores were measured for the parameters of pain, speech deficits, dysphagia and snoring (according to the partner). The Epworth sleepiness scale (ESS) was also utilized. Polysomnography was conducted preoperatively and was repeated six months postoperatively. RESULTS: There were significant differences in improvement of snoring, ESS and AHI before and after the procedure, and the success rate of the surgical treatment was 62%. Postoperative pain, speech disturbance, dysphagia were decreased two weeks after the operation. CONCLUSION: The results of the study suggest that RAUP with tonsillectomy is an effective treatment for patients with mild to moderate obstructive sleep apnea.

Role of Th17 Cell and Autoimmunity in Chronic Obstructive Pulmonary Disease

The molecular mechanisms involved in the pathogenesis of chronic obstructive pulmonary disease (COPD) are poorly defined. Accumulating evidences indicate that chronic inflammatory responses and adaptive immunity play important roles in the development and progression of the disease. Recently, it has been shown that IL-17 producing CD4 T cells, named Th17 cells, which have been implicated in the pathogenesis of several inflammatory and autoimmune diseases, are involved in airway inflammation and COPD. In addition, we and others suggest that autoimmunity may play a critical role in the pathogenesis of COPD. Here, we will review the current understanding of roles of Th17 cells and autoimmune responses in COPD.

The Effect of the Combined Use of Immunotherapy and Topical Steroid on the Quality of Life in Allergic Rhinitis Patients

BACKGROUND AND OBJECTIVES: The management of allergic rhinitis includes allergen avoidance, pharmacotherapy, and immunotherapy. Only a few studies have compared the clinical efficacy of the two treatments. We conducted a study to compare the efficacy of immunotherapy (IT), a topical steroid (TS), and combined therapy (IT+TS) in allergic rhinitis. MATERIALS AND METHODS: The three groups (IT:11 patients, TS:ten patients, IT+TS:ten patients) were treated for six months and were evaluated using questionnaires and a physical exam before and after treatment. RESULT: Overall symptoms were reduced after six months of treatment in all groups. In the IT+TS group, signs and symptoms diminished more than those in the IT or TS groups. Difference in skin test sensitivity among the groups was not statistically significant. CONCLUSION: Combined use of immunotherapy and a topical steroid was more effective than either therapy alone in reducing the signs and symptoms of allergic rhinitis.

Correlation between the Severity of Obstructive Sleep Apnea and Heart Rate Variability Indices

The risk of cardiovascular disease is known to be increased in obstructive sleep apnea syndrome (OSAS). Its mechanism can be explained by the observation that the sympathetic tone increases due to repetitive apneas accompanied by hypoxias and arousals during sleep. Heart rate variability (HRV) representing cardiac autonomic function is mediated by respiratory sinus arrhythmia, baroreflexrelated fluctuation, and thermoregulation-related fluctuation. We evaluated the heart rate variability of OSAS patients during night to assess their relationship with the severity of the symptoms. We studied overnight polysomnographies of 59 male untreated OSAS patients with moderate to severe symptoms (mean age 45.4+/- 11.7 yr, apnea-hypopnea index [AHI]=43.2+/-23.4 events per hour, and AHI >15). Moderate (mean age 47.1+/-9.4 yr, AHI=15-30, n=22) and severe (mean age 44.5 +/-12.9 yr, AHI >30, n=37) OSAS patients were compared for the indices derived from time and frequency domain analysis of HRV, AHI, oxygen desaturation event index (ODI), arousal index (ArI), and sleep parameters. As a result, the severe OSAS group showed higher mean powers of total frequency (TF) (p=0.012), very low frequency (VLF) (p= 0.038), and low frequency (LF) (p=0.002) than the moderate OSAS group. The LF/HF ratio (p=0.005) was higher in the severe group compared to that of the moderate group. On the time domain analysis, the HRV triangular index (p=0.026) of severe OSAS group was significantly higher. AHI was correlated best with the LF/HF ratio (r(p)=0.610, p<0.001) of all the HRV indices. According to the results, the frequency domain indices tended to reveal the difference between the groups better than time domain indices. Especially the LF/HF ratio was thought to be the most useful parameter to estimate the degree of AHI in OSAS patients.

Comparison of Low Resolution Electromagnetic Tomography Imaging Between Subjects With Mild and Severe Obstructive Sleep Apnea Syndrome: A Preliminary Study

OBJECTIVE: The purpose of this study was to identify the regions of the brain associated with recurrent nocturnal chronic hypoxic episodes in patients with untreated obstructive sleep apnea syndrome (OSAS) using low-resolution electromagnetic tomography (LORETA) and quantitative electroencephalography (QEEG). METHODS: Nocturnal polysomnograph (NPSG) and subsequent morning electroencephalograph (EEG) were measured in 20 subjects with OSAS. Mild (n=10 ages 39.5+/-12.1 years) and severe (n=10 ages 41.7+/-13.6 years) right-handed male OSAS subjects were selected by interview and questionnaires including the NPSG, Beck Depression Inventory, Beck Anxiety Inventory, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index. The LORETA and QEEG were compared between the severe and mild OSAS groups by frequency bands (delta 1-3 Hz, theta 4-7 Hz, alpha 8-12 Hz, beta1 13-18 Hz, beta2 19-21 Hz, beta3 22-30 Hz, and total 1-30 Hz) made by spectral analysis during resting with the eyes closed. RESULTS: The LORETA analysis showed decreased alpha activity at the right posterior cingulate gyrus (Brodmann area 23) in cases with severe OSAS compared to mild OSAS (p<0.05). For the QEEG, the absolute power of the alpha activity (8-12 Hz) was decreased in P3 (p=0.047), PZ (p=0.039) and O2 (p=0.04) in cases with severe OSAS compared to mild OSAS cases. The LORETA and QEEG analyses had similar results with regard to band, activation and location. CONCLUSION: The decreased activity of the alpha frequency in the right posterior cingulate gyrus, in patients with severe OSAS compared to those with mild OSAS, suggests that chronic repeated short-term hypoxia during sleep, in OSAS, could provoke cortical brain dysfunction associated with cognitive dysfunction such as memory and attention.

Clinical Analysis of the Etiology of Korean Olfactory Disorders / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study examined the causes and epidemiologic factors of smell loss in Koreans using the Korean Version of the Sniffin' Sticks Test and compared the results with cases of foreign countries. SUBJECTS AND METHOD: The data of 386 patients who visited clinics complaining of smell loss were retrospectively analyzed with medical charts. RESULTS: Idiopathic, upper respiratory tract infection, trauma, nasal and paranasal sinus disease were the major causes of smell loss in this study. The distribution of gender and age, severity of smell loss, association of smell loss with allergies and nasal polyps were discussed in detail. CONCLUSION: The proportion of each cause observed in this study was different compared with the results of other domestic reports of nasal and paranasal sinus disease, but came out similar to the results of foreign studies.