Long-term Breastfeeding in the Prevention of Allergic Rhinitis: Allergic Rhinitis Cohort Study for Kids (ARCO-Kids Study)

OBJECTIVES: There is a great deal of interest in the possibility that environmental factors may influence the risk of developing allergic rhinitis (AR) in early life. We investigated the simultaneous effects of mode of delivery and duration of breastfeeding on the development of AR in children. METHODS: Data from 1,374 children participating in the Allergic Rhinitis Cohort Study for kids (ARCO-kids study) was analyzed. All subjects were divided into AR or non-allergic rhinitis (NAR) groups. Data on environmental factors, mode of delivery and duration of breastfeeding were collected using a questionnaire. RESULTS: Compared with short-term breastfeeding (<6 months), long-term breastfeeding (≥12 months) was significantly associated with a lower prevalence of AR (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.34 to 0.88). Children in the AR group also had a higher cesarean delivery rate than those in the NAR group (39.1% vs. 32.8%, P=0.05). Regarding the combined effects of mode of delivery and duration of breastfeeding, long-term breastfeeding with a vaginal delivery strongly suppressed the development of AR, compared to short-term breastfeeding with a cesarean delivery (aOR, 0.47; 95% CI, 0.30 to 0.73). CONCLUSION: Long-term breastfeeding (≥12 months) and a vaginal delivery are associated with a lower risk of developing childhood AR.

Chronic Obstructive Pulmonary Disease Is Negatively Related with Nasal Polyp in Middle Aged and Elderly Chronic Rhinosinusitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is known to induce chronic rhinosinusitis (CRS). Nasal polyp, which is frequently found in patients with CRS, seems to have close relationship with COPD, but little is known about its relationship with COPD. In this study, we investigated the relationship between COPD and nasal polyp in middle aged and elderly CRS patients. SUBJECTS AND METHOD: We analyzed the clinical data of 174 patients (age of over 50 years) with CRS. Patients were divided as COPD [forced expiratory volume (FEV1)/forced vital capacity (FVC)<70%, n=30] and non-COPD group (FEV1/FVC≥70%, n=144) according to the pulmonary function test results. Binary logistic regression analysis was used to describe the relationships between clinically relevant factors related to nasal polyp. RESULTS: On logistic regression analysis, no significant relationship was found between age [adjusted odds ratio (AOR): 1.058, 95% confidence interval for the difference (CI)=0.995-1.126, p=0.073], sex AOR: 0.897, 95% CI=0.366-2.415, p=0.897), smoking (AOR: 0.434, 95% CI=0.154-1.219, p=0.113) and obesity (underweight AOR: 3.833, 95% CI=0.781-18.808, p=0.098, overweight AOR: 5.169, 95% CI=0.996-26.814, p=0.051, obese AOR: 2.911, 95% CI=0.335-25.329, p=0.333) with polyp. However, there was a negative correlation between COPD history and nasal polyp with statistical significance (AOR: 0.288, 95% CI=0.102-0.809, p=0.018). CONCLUSION: Our findings suggest that patients with COPD are less likely to have nasal polyp than patients without COPD.

Heterotopic Intestinal Cyst of the Submandibular Gland: A Case Study

Heterotopic gastrointestinal cysts are rarely found in the oral cavity. Most of these cysts are lined with gastric mucosa and involve the tongue. There have been no reported heterotopic intestinal cysts of the submandibular gland that are completely lined with colonic mucosa. An 8-year-old girl presented with an enlarging swelling in the left submandibular area, and a 4-cm unilocular cyst was fully excised. The cyst was completely lined with colonic mucosa that was surrounded by smooth muscle layer, and the lining cells were positive for CDX-2, an intestinal marker, indicating a high degree of differentiation. The pathogenesis remains unclear, but it may be related to the misplacement of embryonic rests within the oral cavity during early fetal development. Although heterotopic intestinal cysts rarely occur in the submandibular gland, they should be considered in the differential diagnosis of facial swellings in the pediatric population.

Comparisons of Three Indicators for Frey's Syndrome: Subjective Symptoms, Minor's Starch Iodine Test, and Infrared Thermography

OBJECTIVES: To correlate Frey's syndrome with subjective symptoms, Minor's starch iodine test results, and infrared thermography measurements, and to discuss the utility of thermography as a quantitative diagnostic method. METHODS: This study included 59 patients who underwent unilateral parotidectomy. A subjective clinical questionnaire and an objective Minor's starch iodine test were performed to evaluate the incidence of Frey's syndrome. Infrared thermography was performed, and the subjects were divided into seven groups according to the temperature differences between operated and unoperated sites. The thermal differences were correlated with the results from Minor's starch iodine test and the subjective symptoms questionnaire. RESULTS: Of the 59 patients, 20 patients (33.9%) reported subjective symptoms after eating; 30 patients (50.8%) tested positive for Minor's starch iodine test, 19 patients (63.3%) of which reported subjective symptoms. Of the 29 patients who were negative for the iodine test, 2 patients (6.9%) reported subjective symptoms. Thus, subjective symptoms were well correlated with Minor's starch iodine test (r=0.589, P<0.001). As the thermal differences with infrared thermography increased, the number of patients with subjective symptoms increased (chi2=22.5, P<0.001). Using infrared thermography, the mean temperature difference in the positive group for the iodine test was 0.82degrees C+/-0.26degrees C, and that in the negative group was 0.10degrees C+/-0.47degrees C. With increased thermal differences, more patients showed positivity in the iodine test (chi2=29.9, P<0.001). CONCLUSION: Subjective symptoms, Minor's starch iodine test, and infrared thermography are well correlated with one another. Quantitative thermography provides clues for the wide variation in the incidence of Frey's syndrome, and could be a useful method for diagnosing and studying Frey's syndrome.

Primary Extracranial Meningioma Presenting as a Cheek Mass

Meningioma is well known as common disease of the central nervous system, whereas primary extracranial meningioma is rare, representing 1% to 2% of all meningiomas. We have experienced a case of primary extracranial meningioma presenting as a right cheek mass. The tumor was completely excised via a right lateral rhinotomy incision. Histopathologic examination confirmed the diagnosis of primary extracranial meningioma.

A Case of Maxillary Sinusitis after Sinus Floor Augmentation / 대한이비인후과학회지

Sinus floor augmentation is essential for successful dental implantation in patients with alveolar bone height less than 10 mm. However, maxillary sinusitis has been reported to occur in 8-20% of patients after sinus floor augmentation. We present a case of maxillary sinusitis due to sequestrum of bone cement fragment into the maxillary sinus ostium after sinus floor augmentation.

Endoscopic Versus Traditional Craniofacial Resection for Patients with Sinonasal Tumors Involving the Anterior Skull Base

OBJECTIVES: With the advent of microdebriders and image guidance systems, endoscope-assisted surgery is now more widely used for the treatment of tumors involving the base of the skull. The aim of this study was to analyze the clinical features of tumors involving the anterior skull base and to evaluate the treatment outcomes according to the surgical approach, which included the traditional craniofacial resection (TCFR) and the endoscopic craniofacial resection with craniotomy (ECFR). METHODS: Forty-six patients who underwent craniofacial resection from 1989 through 2006 at Seoul National University Hospital and Seoul National University Bundang Hospital were included in this study. Demographics, histology, surgical management, surgical outcomes, complications, and morbidity were analyzed. RESULTS: The number of malignant and benign lesions was 40 and 6 cases respectively. The most common diagnosis was olfactory neuroblastoma occurring in 41% of the cases followed by squamous cell carcinoma and malignant melanoma. Thirty-six patients underwent TCFR, while ECFR was performed with or without adjunctive chemotherapy or radiotherapy in 10 patients. The overall five-year survival rate for patients with malignant tumors of the anterior skull base was 47.4%. Out of 19 patients with olfactory neuroblastomas, 10 patients had TCFR and six among them died of their disease. Nine patients underwent ECFR, and none of them died of their disease. The ECFR group had lower morbidity and cosmetic deformity than did the TCFR group. CONCLUSION: The ECFR may be considered as an alternative option for the treatment of selected tumors with anterior skull base invasion. This approach offers the advantages of avoiding facial incisions with comparable treatment results.

Ki67 Antigen as a Predictive Factor for Prognosis of Sinonasal Mucosal Melanoma

OBJECTIVES: Sinonasal mucosal melanoma is a rare and aggressive disease. The aim of this study was to analyze the clinical features of patients with sinonasal mucosal melanoma and to determine the role of Ki67 antigen as a predictor of prognosis in sinonasal mucosal melanoma. METHODS: This was a retrospective case- series study at a single institution, an academic tertiary referral center. From 1995 to 2007, 27 patients with sinonasal mucosal melanoma were reviewed retrospectively, and the expression of Ki67 antigen was assessed by immunohistochemistry. RESULTS: The overall 5-yr survival rate was 33.9%. No significant differences were observed in 5-yr survival according to age, sex, stage, or the presence of melanin. The rates of local failure, regional failure, and distant failure were 37.0%, 14.8%, and 11.1%, respectively. Patients with spindle or mixed cell types had better prognoses than those with other cell types. At a cut-off value of 35%, patients with lower Ki67 scores showed better survival than those with higher Ki67 scores. CONCLUSION: The presence of spindle or mixed cell types may indicate a better prognosis than other cell types. Ki67 immunostaining may be a useful predictor of prognosis in patients with mucosal malignant melanoma of the sinonasal tract.

Fibrous Dysplasia Involving Paranasal Sinuses / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fibrous dysplasia of the paranasal sinus is rare. It is usually secondary to the extension of disease from adjacent bones and rarely limited to the sinuses. The purpose of this study is to get an improved appreciation of the clinical features and courses of fibrous dysplasia involving paranasal sinuses. SUBJECTS AND METHOD: Medical records of 15 patients diagnosed as fibrous dysplasia involving paranasal sinuses from 1990 to 2004 were reviewed retrospectively. Clinical informations including age of diagnosis, presenting symptoms, radiographic findings, treatment and clinical outcome for each patient were analyzed. The male to female ratio was 7 : 8. Their ages ranged from 7 to 68 with the median of 32. Seven patients were younger than 30 years old at presentation. RESULTS: The most common complaint was headache followed by facial swelling. The mean duration of illness was 11 months. In the findings of CT, eight patients belonged to the sclerotic type, six to the pagetoid type, and one the tocystic type. Eight patients were polyostotic while the others were monostotic. The most commonly involved sinus was the sphenoid sinus followed by ethmoid sinus. Seven patients who had facial swelling, exophthalmos or nasal obstruction underwent surgery, and in four of them, the lesion was in progression or recurred. Lesions in eight patients who were older than 30 years old and had no symptoms except headache did not progress thereafter. CONCLUSION: The progression of fibrous dysplasia stops when the bony growth is completed. Thus, if the patients are diagnosed with fibrous dysplasia over the age of 30 and do not have specific symptoms, there may be no need for surgical treatment.

Clinical Manifestation and Treatment Outcomes of Nasal Cavity & Ethmoid Sinus Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to evaluate the clinical manifestation and treatment outcome of the nasal cavity squamous cell carcinoma (SCC) and compared its survival rate with that of the maxillary sinus (MS) SCC. SUBJECTS AND METHOD: Thirty two patients who were diagnosed as nasal cavity SCC or ethmoid sinus SCC between 1984 and 2005 were selected. These patients were referred to as the intranasal (IN) SCC group. Ten prognostic factors were evaluated in terms of survival rate and recurrence. The survival rate of 61 patients who were diagnosed as MS SCC was compared with that of the IN SCC. RESULTS: Chief complaints of the patients with IN SCC were nasal obstruction (40.4%), epistaxis (25.0%), and rhinorrhea (13.5%). The 5 year survival rate of IN SCC was 44.6% and the 5 year disease free survival rate was 27.7%. The most important prognostic factor was T stage (p<.001). The 5 year survival rate of MS SCC was 55.4%, and it was statistically not different from that of the IN SCC (p=.472). In the T1, T2, T3 stages, the 5-year-survival rate of the IN SCC was similar to that of MS SCC (p=.637). But in the T4 stage, IN SCC tended to have a worse prognosis (p=.074). CONCLUSION: The prognosis of IN SCC was similar to that of the MS SCC. However, MS SCCs were detected in a more advanced stage and T4 stage of the IN SCC had a worse prognosis compared to the same stage of MS SCC.

Clinical Features and Treatment Outcomes of Mucosal Malignant Melanomas of Nasal Cavity and Paranasal Sinuses / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucosal malignant melanoma of the nasal cavity and paranasal sinuses is an uncommon tumor with poorer prognosis compared with its cutaneous counterpart. The purpose of this study is to investigate the clinical features and treatment outcomes of mucosal malignant melanoma of the nasal cavity and paranasal sinuses. SUBJECTS AND METHOD: Eighteen patients who were diagnosed and treated as mucosal malignant melanoma of nasal cavity and paranasal sinuses from 1995 to 2004 were included. Male to female ratio was 10 to 8. Their ages ranged from 43 to 87 years with median of 62 years. The medical records were reviewed retrospectively with respect to presenting symptoms, stage, treatment modalities and outcome. RESULT: The most common symptoms were epistaxis and nasal obstruction. The mean duration of symptom was 4.2 months. Commonly involved sites were middle turbinate, inferior turbinate, maxillary sinus and ethmoid sinus. Eight cases belonged to stage I, nine cases to stage II and only one case to stage III. Among them, seventeen patients underwent surgery with or without radiotherapy and immunotherapy. Of the seventeen patients who underwent surgery, twelve had recurrence and the mean period for recurrence was 8.2 months. During the follow-up periods, five had distant metastases. Five-year survival rate was 27.2% and the survival rates according to age, sex, tumor size and stage were not statistically significant. CONCLUSION: Mucosal malignant melanomas of the nasal cavity and paranasal sinuses developed commonly in the 6th to 8th decades. Epistaxis and nasal obstruction were the most common presenting symptoms. Almost all cases belonged to the stage I or II and the mainstay of the treatment was surgery. However, it was associated with frequent recurrences and a poor prognosis.

Ciliary Movement in Nasal Epithelial Cells

The mucociliary system of the airway is composed of cilia, mucus and periciliary fluid, and plays an important role in airway defense by eliminating inhaled particles. Efficient mucociliary activity is essential for maintaining the normal physiologic functions of the nasal cavity and paranasal sinuses. The overall propulsive effect of the mucus blanket depends upon the arrangement of cilia, the ciliary beat frequency (CBF), and their metachronal relationships (or ciliary wave disorder [CWD]). This article reviews the mechanism of CBF.

Effects of Corticosteroid on Expression of IL-18 in the Airway Mucosa of Allergic Rhinitis Mouse Model

Background: This study aimed to investigate the release and response of IL-18 to steroid treatment in the allergic rhinitis (AR) mouse model. MATERIALS AND METHODS: BALB/c mice were sensitized systematically using an intraperitoneal ovalbumin (OVA) injection and locally by OVA inhalation. The steroid treatment group had an intraperitoneal dexamethasone injection. Symptom scores, eosinophil counts in nasal septal mucosa, and IL-18 concentrations in nasal and lung lavage fluid were analyzed. RESULTS: The symptom scores and eosinophil counts of the negative control and steroid treatment groups were significantly lower than those of the positive control group (p<.01). Meanwhile IL-18 concentrations of nasal lavage fluid of the three groups were not significantly different (56.68+/-9.57, 63.39+/-8.93, and 64.47+/-6.83 pg/mL, repectively). IL-18 concentration of lung lavage fluid was significantly different between the positive control and steroid treatment groups (430.75+/-154.54 and 69.94+/-14.26pg/mL respectively, p=.028). CONCLUSION: In this study, IL-18 concentration increased not in the nasal lavage fluid but in the lung lavage fluid in AR mouse model. The increased IL-18 concentration decreased after the steroid therapy. This result suggests that the role of IL-18 in the pathogenesis of AR may be different from that of asthma.

Analysis of the Treatment Outcomes of Obstructive Sleep Apnea Syndrome according to the Friedman Staging System / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In 2002, Friedman et al. suggested a clinical staging system of obstructive sleep disorder patients based on palate position, tonsil size, and body mass index. The purpose of this study was to compare the treatment outcomes of uvulopalatopharyngoplasty (UPPP) and coblation assisted uvulopalatopharyngoplasty (CAUP) according to the Friedman staging system. SUBJECTS AND METHOD: Fifty patients with obstructive sleep apnea who underwent UPPP or CAUP were included. Apnea index (AI), Respiratory distress index (RDI), and Body-mass index (BMI) of preoperative polysomnography were measured. The questionnaires about snoring, apnea, and Epworth sleepiness scale (ESS) were taken by the patients and their bed partners before and after operation. All patients were stratified according to the Friedman staging system. RESULTS: Stage II patients were most common (41 cases, 82%). There was no difference in preoperative polysomnography parameters among stages. Preoperative polysomnography was decisive parameters on the determination of operative modality. UPPP was more effective than CAUP for symptom of sleep apnea with high success rate of 92.7%. CONCLUSION: In stage II, the success rates of sleep apnea and snoring were 80.4% and 63.4%. Though UPPP showed better success rate in treating sleep apnea, the success rate of CAUP in treating snoring was comparable to that of UPPP. CAUP is a good alternative to UPPP in treating snoring.

Treatment of Nasopharyngeal Angiofibroma: Results According to the Surgical Modalities / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many surgical techniques are used for the treatment of nasopharyngeal angiofibroma (NAF). This study aimed to analyze the clinical features of NAF and treatment results according to the surgical modalities. MATERIALS AND METHODS: Twenty-five patients with NAF treated at Seoul National University Hospital from January 1990 through December 2004, were analyzed retrospectively by treatment modalities. RESULTS: According to the Sesson staging system, there were 9 patients with type I, 14 with type II, and 2 with type III. Of the 24 patients treated with surgery, there were 7 cases with pure endoscopic surgery and 17 cases with external approaches including 3 transpalatal approach, 5 midfacial degloving approach, 7 transantral approach, and 2 Le Fort I approach. Endoscope-assisted surgery was performed in 6 out of 17 cases who were treated with external approaches. Until 1996, external approaches were conducted in 12 out of 13 cases. Since 1997, pure endoscopic surgery was the most common approach, with 7 out of 12 cases, and it was applied especially in cases below stage IIA. Endoscopeassisted surgery was adjunct to all external techniques since 1997, with 5 out of 5 cases, and it was even applied in advanced cases over stage IIB . All 25 cases were treated successfully without any recurrence or mortality with surgery or radiation therapy. CONCLUSION: Treatment outcomes of pure endoscopic surgery are acceptable compared to those of traditional external approaches with reduced invasiveness and morbidity if proper selection is made depending on the tumor extent. Endoscope-assisted surgery can be helpful in all external approaches to improve visualization, even in advanced lesions.

Isolated Sphenoid Sinus Lesion: A Clinical Analysis of 56 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Isolated lesions of the sphenoid sinus are a rare disease entity that occurs after a wide use of antibiotics. This lesion may have severe complications such as cranial nerve palsies due to its deep location in the skull. The use of endoscopic surgery for the sphenoid sinus has become popular for its several advantages. We report our experiences of 56 case-isolated sphenoid lesions with a review of articles. SUBJECTS AND METHOD: Fifty-six patients with isolated sphenoid lesions who were treated at Seoul National University Hospital from January 1985 through December 2003 were analyzed. Patients who have lesions confined to the sphenoid sinus on radiologic images (CT or MRI) were included. A retrospective chart review was performed with respect to the patient's symptom, pathology and surgical outcome. RESULTS: Thirty-nine of 56 cases were inflammatory lesions, 8 neoplastic lesions, and 9 fibrous dysplasias. Headache was the most common symptom (66%), followed by nasal symptoms such as nasal obstruction and postnasal drip. Ophthalmologic symptoms were observed in 14 cases. Endoscopic transnasal sphenoidotomy was perforemd in 33 of 39 cases of inflammatory diseases. Symptoms were completely improved in 32 cases after the operation and ophthalmologic symptoms were nearly all improved in all cases. CONCLUSION: The wide use of CT and MRI has increased the detection of isolated lesions of the sphenoid sinus. Complications like cranial nerve palsies were uncommon unlike from the reports that came out in the country. Primary physicians must rule out isolated lesions of the sphenoid to account for intractable headaches.

Traumatic Perilymphatic Fistula Presenting with Direction-Changing Positional Nystagmus

Diagnosis of perilymphatic fistula (PLF) is considered in the patient presenting hearing loss associated with ataxia after penetrating injury of the tympanic membrane. PLF accompanies mixed type hearing loss and paralytic nystagmus. If audiovestibular symptoms and signs are not definite for those patients, in whom PLF is highly suspicious, they can be induced by affected ear down position. The direction of nystagmus induced by position change was reported either toward or away from the affected ear. But the direction changing nature has not been noted in the previous literature. We report on a case of traumatic PLF presented with direction changing positional nystagmus and discuss the possible mechanism involved in this case