Burden of Respiratory Disease in Korea: An Observational Study on Allergic Rhinitis, Asthma, COPD, and Rhinosinusitis

PURPOSE: The Asia-Pacific Burden of Respiratory Diseases (APBORD) study is a cross-sectional, observational one which has used a standard protocol to examine the disease and economic burden of allergic rhinitis (AR), asthma, chronic obstructive pulmonary disorder (COPD), and rhinosinusitis across the Asia-Pacific region. Here, we report on symptoms, healthcare resource use, work impairment, and associated costs in Korea. METHODS: Consecutive participants aged ≥18 years with a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Participants and their treating physician completed a survey detailing respiratory symptoms, healthcare resource use, and work productivity and activity impairment. Costs included direct medical cost and indirect cost associated with lost work productivity. RESULTS: The study enrolled 999 patients. Patients were often diagnosed with multiple respiratory disorders (42.8%), with asthma/AR and AR/rhinosinusitis the most frequently diagnosed combinations. Cough or coughing up phlegm was the primary reason for the medical visit in patients with a primary diagnosis of asthma and COPD, whereas nasal symptoms (watery runny nose, blocked nose, and congestion) were the main reasons in those with AR and rhinosinusitis. The mean annual cost for patients with a respiratory disease was US$8,853 (SD 11,245) per patient. Lost productivity due to presenteeism was the biggest contributor to costs. CONCLUSIONS: Respiratory disease has a significant impact on disease burden in Korea. Treatment strategies for preventing lost work productivity could greatly reduce the economic burden of respiratory disease.

A Case of Unilateral Ashy Dermatosis

Ashy dermatosis, also known as erythema dyschromicum perstans, is a peculiar, slowly progressive, idiopathic dermal melanosis. In most cases, slate gray- to lead-colored patches are symmetrically distributed over the body. Ashy dermatosis with a unilateral distribution is rare. We report a case of unilateral ashy dermatosis in a 27-year-old Korean man.

Regulation of Cytokine and Cyclooxygenase Expression in Palatine Tonsils from Recurrent Tonsillitis in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Prostanoids are converted from arachidonic acid via cyclooxygenase (COX), which has two isoforms, COX-1 and COX-2. It has recently been shown that prostanoids may have a novel role in mediating cytokine release in some cells. We investigated the baseline expression and regulation of interleukin (IL)-6, IL-8, COX-1 and COX-2 in palatine tonsils from pediatric recurrent tonsillitis. MATERIALS AND METHOD: Palatine tonsils were obtained from 12 children with recurrent tonsillitis during elective tonsillectomy and adenoidectomy. Tonsil cells were incubated with culture media only or with proinflammatory cytokines (IL-1beta and TNF-alpha) or inhibitors of transcription (actinomycin D) or translation (cycloheximide). In these groups, IL-6, IL-8, COX-1, COX-2 mRNAs and COX-1, COX-2 proteins were analyzed by reverse transcriptasepolymerase chain reaction and Western blot, respectively. RESULTS: The baseline expressions of IL-6, IL-8, COX-1 and COX-2 mRNAs were detected although tonsillectomy was done in the silent phase without acute infection. The culture of tonsil cells with pro-inflammatory cytokines increased the expression of IL-6, IL-8 and COX-2 mRNAs and COX-2 protein. The expressions of IL-6, IL-8 and COX-2 mRNAs and COX-2 protein induced by pro-inflammatory cytokines was significantly inhibited by actinomycin D, not by cycloheximide. CONCLUSION: Tonsil cells isolated from pediatric recurrent tonsillitis are in constantly inflamed state. The expression of COX-2 mRNA induced by pro-inflammatory cytokines is accompanied by the induction of IL- 6 and IL-8 mRNAs. The regulation of these effects occurs at the transcriptional level. Furthermore, the regulation of cytokines and COX-2 may provide an understanding of mechanism of prostanoids synthesis in chronic tonsillitis.

Effects of Middle Meatal Antrostomy on Ciliary Beat Frequency and Histopathology of the Nasal Mucosa in Experimentally Induced Maxillary Sinusitis in Rabbits / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to observe the effects of middle meatal antrostomy (MMA) on ciliary beat frequency (CBF) and histopathology of the nasal mucosa in experimentally induced maxillary sinusitis in rabbits. MATERIALS AND METHOD: Maxillary sinusitis was induced in both maxillary sinuses (MSs) of 30 Pasturella-free New Zealand white rabbits by partially occluding the natural ostium and inoculating with P. aeruginosa. After 4 weeks, the MS and inferior turbinate mucosae were obtained in 5 rabbits. In the remaining 25 rabbits, the ostia were reopened. Five rabbits were sacrificed 2, 4, 6, 8, and 12 weeks after MMA, respectively and the MS and inferior turbinate mucosae were obtained. Another 5 normal rabbits were used as a control group. CBF was measured by video-computerized analysis. Degree of inflammation in histopathology was graded using a 100-point scale of inflammation score. CBF and inflammation score were compared among the 6 experimental and control groups. RESULTS: CBF of the MS mucosa significantly improved after MMA in a time-dependent pattern, but did not reach a normal level even after 12 weeks. CBF of the inferior turbinate mucosa significantly improved after MMA in a time-dependent pattern, and reached a normal level after 12 weeks. Inflammation scores of the MS and inferior turbinate mucosae were significantly decreased after MMA in a time-dependent pattern. However, they did not reach a normal level of the control group even after 12 weeks. CONCLUSION: MMA can improve not only the primary inflammation of the MS mucosa but also functionally and morphologically improve the secondarily developed inflammation of the nasal mucosa in experimentally induced maxillary sinusitis in rabbits.

Effects of Experimentally Induced Maxillary Sinusitis on Ciliary Beat Frequency and Histopathology of the Nasal Mucosa in Rabbits / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although sinusitis is commonly caused by nasal diseases that interfere with ostiomeatal unit, non-rhinogenic sinusitis, for example, post-traumatic or odontogenic, is often encountered. However, it remains unclear whether non-rhinogenic sinusitis affects the function and morphology of the nasal mucosa. The aim of the current study is to observe effects of experimentally induced maxillary sinusitis on ciliary beat frequency and histopathology of the nasal mucosa in rabbits. MATERIALS AND METHOD: Maxillary sinusitis was induced in the right sides of 10 rabbits by partially occluding the natural ostia and inoculating the maxillary sinus with P. aeruginosa. After 4 weeks, the nasal mucosa was obtained from the inferior turbinate and the septum in the right (experimental group) and the left side (control group A). Both sides of the nasal mucosa in another 5 normal rabbits were used as the control group B. Ciliary beat frequency (CBF) was measured by video-computerized analysis and degree of inflammation in histopathology was graded using a 100-point scale of inflammation score. CBF and inflammation score were compared between the three groups. RESULTS: CBFs of the experimental group were significantly lower than those of the control groups A and B. Inflammation scores of the experimental group were significantly higher than those of the control groups. In the experimental group, there were no correlations between CBFs of the maxillary and nasal mucosa, but weak correlations existed between inflammation scores of the maxillary and nasal mucosa. CONCLUSION: Primary maxillary sinusitis can locally induce dysfunction and inflammation of the nasal mucosa.

Conventional, Laser-Assisted and Coblation-Assisted Uvulopalatopharyngoplasty/Uvulopalatoplasty: Their Advantages and Disadvantages / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Uvulopalatopharyngoplasty (UPPP) is performed conventionally with cold knifes and electrocautery under general anesthesia. Although laser-assisted uvulopalatoplasty (LAUP) reduced the need of general anesthesia and bleeding, it still has such problems as severe pain or scar contracture. Coblation electrosurgery is known to be less painful by thermal ablation with low heat. However, comparative studies on the merits and demerits between various surgical techniques are lacking. The aim of this study is to evaluate the advantages and disadvantages of each surgical method by comparing the surgical outcomes between conventional UPPP and Coblation-assisted UPPP (CUPPP), and between LAUP and Coblation-assisted uvulopalatoplasty (CAUP). MATERIALS AND METHOD: Conventional UPPP (N=25) and CUPPP (N=18) were performed on 43 patients with obstructive sleep apnea (OSA), and LAUP (N=21) and CAUP (N=7) on 28 patients with mild OSA or snoring, respectively. Postoperative subjective degrees of apnea, snoring and pain, operation time, amount of intraoperative bleeding and episodes of delayed bleeding were compared between the two groups. RESULTS: Early postoperative pain and intraoperative bleeding were observed less in the CUPPP group than in the conventional UPPP group. Operation time was shorter and intraoperative bleeding was less in the LAUP group than in the CAUP group. Early postoperative pain was less in the CAUP group than in the LAUP group. CONCLUSION: Thorough knowledge regarding advantages and limitations of different UPPP or uvulopalatoplasty methods is required for clinicians to make appropriate use of surgical tools.

Choanal Polyps Originating from the Ethmoid Sinus: Ethmochoanal Polyps? / 대한이비인후과학회지

Sinochoanal polyp is an inflammatory polyp that originates in the paranasal sinus, passes through a sinus ostium, and extends into the choana. While antrochoanal polyp is the most common type of sinochoanal polyp, sphenochoanal polyp is rare and ethmochoanal polyp is extremely more rare to find. To minimize postsurgical recurrence, it is essential to completely remove the polyp together with the base of its origin. We have recently experienced and successfully managed three cases of ethmochoanal polyp by endoscopic sinus surgery. It was difficult to histologically differentiate ethmochoanal polyp from sinonasal polyps associated with chronic rhinosinusitis. For this reason, ethmochoanal polyp should be suspected and completely removed together with the base of its origin when a large polyp originates from the ethmoid sinus and extends into the choana. Now we report three cases of ethmochoanal polyp with a brief review of the related literatures.

Repair of Nasal Septal Perforation by Intranasal Approach Using a Free Composite Graft of the Auricular Cartilage and the Temporalis Muscle Fascia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aims of this study are to introduce an intranasal repair technique of nasal septal perforation using a free composite graft of the auricular cartilage and the temporalis muscle fascia and to determine its efficacy by evaluating the treatment outcome. MATERIALS AND METHOD: Nine symptomatic patients (7 males and 2 females, aged 23 to 66 years) with nasal septal perforation were included in this study. They were all refractory to conservative treatments and they underwent surgery. Preoperative symptoms, etiology, size and location of septal perforations, and postoperative improvement of symptoms and perforations were retrospectively evaluated with a mean follow-up period of 21.7 months. RESULTS: Preoperative symptoms included nasal obstruction, crust formation, rhinorrhea, epistaxis and foul odor. Septal perforation was assumed to have resulted in three patients from septal surgery, trauma and idiopathic causes, respectively. In all patients, the perforation size was 20 mm or less (mean: 12.2x8.4 mm) in diameter and located at the cartilagenous portion, not near the nasal dorsum. The perforations were completely repaired in 6 of 9 patients after surgery. Perforations of 1 and 3 mm in diameter remained in 2 and 1 of the 3 patients showing incomplete closure, respectively. However, clinical symptoms disappeared in 8 of 9 (88.9%) patients, postoperatively. CONCLUSION: This technique may be an effective method for the repair of nasal septal perforation when the perforation is not located near the nasal dorsum and that its size is 20 mm or less in diameter, as the technique offers a cosmetic advantage and produces a satisfactory postoperative outcome by obviating difficulty in intranasal suture.

Laser-Assisted versus Coblation-Assisted Partial Turbinoplasty: Comparison by Their Postoperative Outcome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Conventional turbinoplasty and laser-assisted partial turbinoplasty (LAPT) are commonly performed to control nasal obstruction secondary to inferior turbinate hypertrophy. Coblation, one of radiofrequency electrosurgeries, has recently been introduced as a new treatment modality for turbinate surgery. The aim of the current study is to compare the postoperative outcome of Coblation-assisted partial turbinoplasty (CAPT) with that of LAPT. MATERIALS AND METHOD: Forty-one patients with nasal obstruction due to inferior turbinate hypertrophy refractory to medical therapy were prospectively evaluated with a follow-up period of 6 months. Twenty-one patients (42 sides) were treated with LAPT, and 20 patients (39 sides) with CAPT. Postoperative changes in degree of nasal obstruction, minimal cross-sectional area (MCA) and nasal volume from the nostril to 5 cm posteriorly (V5), operation time, duration of crust formation, operation-associated pain, intraoperative bleeding and episodes of delayed bleeding were compared between the two surgical methods. RESULTS: Crust was formed for a shorter postoperative period and operation-associated pain was less in the LAPT group. Nasal patency (MCA and V5) was more improved and operation time was shorter in the CAPT group. However, there were no significant differences in improvement of nasal obstruction and operation-associated bleeding between the two groups. CONCLUSION: Thorough knowledge of advantages and limitations of LAPT and CAPT is required for clinicians to make appropriate use of surgical tools for the given patient characteristics and medical environment.

Endoscopic Removal of the Antral Portion of Antrochoanal Polyp by Powered Instrumentation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aims of the current study are to reintroduce a surgical technique for endoscopic removal of the antral portion of antrochoanal polyp (ACP) by powered instrumentation and to determine its efficacy by evaluating the outcome of the patients. MATERIALS AND METHOD: A prospective study was performed in 28 patients undergoing endoscopic sinus surgery for ACP by the author's surgical technique. Improvements of clinical symptoms and endoscopic and computed tomographic findings were evaluated postoperatively with a follow-up period ranging from 12 to 52 months. All symptom scores on a 100 mm visual analog scale before operation were compared with those obtained at the last visit after operation. Postoperative endoscopic and computed tomographic findings were graded using a three-point scale ranging from 0 to 2. In the surgical technique, the antral portion of ACP was identified through the enlarged ostium under intranasal endoscopy and removed by a blade of powered instrumentation that was inserted through the canine fossa. RESULTS: Symptom scores were all significantly reduced postoperatively. All but one patient showed improvement in clinical symptoms and endoscopic and computed tomographic findings during the follow-up period. There were no major complications specific to this technique. CONCLUSION: This technique provides an attractive alternative to other methods for removing the antral portion of ACP and is associated with excellent outcomes and the minimal morbidities rate.

Regulation of Cytokine Gene Expression in Nasal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The etiology and pathogenesis of nasal polyp are still ill-defined and have been debated for many years. Recently, the identification and localization of mRNA of cytokines, chemokines, and growth factors that may be involved in the formation of nasal polyp have been studied. But, transcription factors that control the expressions of cytokines have not been studied. The purpose of this study is to investigate IL-12 and IL-4 mRNA in the polyps of the patients with allergy-associated and nonallergy-associated chronic sinusitis and compared it with controls. IL-12 receptor and IRF-1, c-maf and GATA-3 which are transcription factors of IFN-gamma, IL-4 and IL-5, respectively were also studied. MATERIALS AND METHOD: Nasal polyp tissues were surgically obtained from two groups of patients with chronic sinusitis: those who had allergic rhinitis (n=) and those without allergy (n=3). The normal nasal mucosa from inferior turbinate were obtained from normal subjects. IL-12p35, IL-12p40, IL-12Rbeta2, IRF-1, IL-4, GATA-3 and c-maf mRNA expression were analysed by means of the reverse transcription and polymerase chain reaction and southern blot in three groups. RESULTS: The expression of IL-12p40, IL-12Rbeta2, IRF-1 mRNA were significantly higher in the nonallergic polyp group than in the control group (p<0.05). GATA-3 mRNA was significantly expressed in allergic polyp group than in the control group (p<0.05). CONCLUSION: These results suggest IL-12, IL-12Rbeta2 and IRF-1 may be involved in nonallergic polyp formation. GATA-3 may contribute to allergic polyp formation.

Intranasal Transethmoid Approach to the Sphenoid Sinus Ostium in Endoscopic Sinus Surgery: A Safe Technique Using the Superior Turbinate As a Key Landmark / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Identification of the natural ostium verifies the safest entry to the sphenoid sinus (SS) in endoscopic sinus surgery (ESS). In order not to destabilize the middle turbinate (MT), new techniques have recently been introduced on transethmoid approaches to the SS ostium after ethmoidectomy. The aims of this study are to introduce an intranasal transethmoid approach to the SS ostium for sphenoidotomy using the superior turbinate (ST) as a key landmark without destabilization of the MT in ESS for chronic sinusitis with concurrent sphenoiditis and to determine its efficacy by evaluating the outcome of the patients. MATERIALS AND METHODS: Fifty-three chronic sinusitis patients (37 males and 16 females, aged 14 to 63 years) with concurrent sphenoiditis in one or both SSs and their 75 SSs were included in this study. Sphenoidotomy was performed in all patients. The SS ostium was identified just medial to the ST remnant. Number of SSs where the ostium was identified was determined, and surgical complications were evaluated. To assess olfactory changes, a butanol threshold test was performed before and after the surgery. RESULTS: The SS ostium was identified in 73 (97.3%) of the 75 SSs. The preoperative threshold (3.9+/-3.0) in the butanol test significantly improved to 5.1+/-2.5 after the operation in the 75 nasal sides. Olfactory function of only 3 (4.0%) sides worsened after surgery. There were no major complications in all patients. Conclusion: This technique may be an effective and safe approach to the SS ostium in ESS for chronic sinusitis with concurrent sphenoiditis without destabilization of the MT.

Efficiency of Short-term Admission Medical Records in Patients with Common Otolaryngologic Diseases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A more simple medical record form has been needed for a more qualified and cost-effective health care. A short-term admission medical record (SAMR) is a standard fill-in-the-blank form on the patients' conditions for common otolaryngologic diseases. The aim of this study is to determine the efficiency of the SAMRs. MATERIALS AND METHOD: Nineteen doctors who had residency training in the Department of Otolaryngology of Ewha Womans University Mokdong Hospital from the year 1995 through 2000 were included in this study. Questionnaires consisted of 11 comparative questions: the subjects were instructed to express their degrees of satisfaction with conventional medical records (CMRs) and SAMRs on a 100mm visual analogue scale for each question. The degrees of satisfaction with SAMRs were compared to those with CMRs. RESULTS: There were no statistically significant differences in the degrees of satisfaction between the two types of records for accurate evaluation of patients' condition, efficient communication between medical and paramedical personnels, and the value of verified records in the medicolegal conflicts and insurance claims. However, the degrees of satisfaction with SAMRs were higher than those with CMRs for communication between doctors, the value in medical research, time-saving, simplicity, paper-saving and their convertibility into electronic medical records. CONCLUSION: SAMRs provides patients of common otolaryngologic diseases with not only the necessary conditions of medical records, but also the basis of computer-based patient records. In addition, SAMRs may be also be more cost-effective than CMRs.

Effects of External Nasal Dilators on Nasal Respiration and Patency in Patients with Deformity of the Nasal Septum by Mladina ClaSSIFICATION: An Acoustic Rhinometric Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The external nasal dilator (END) was designed to improve nasal respiration by expanding the nasal valve area and authors have proven in previous reports that the END improves nasal respiration and patency in patient with DSN. The present study attempts to assess the different effects of the END on nasal respiration and patency in DSN patients with dysfunction of the nasal valve area and in those with dysfunction of some other areas. MATERIALS AND METHODS: Fourty-six male patients (ages 18-49, average age 31.5) without any other nasal or sinus disease and who are not classified as Mladina types 1, 4 or 7 were used as subjects. The type of DSN was determined by Mladina classification. Those with dysfunction of the nasal valve area (Type 2) were classited as Group A and those with dysfunction of some other anatomical area as Group B (Type 3, 5, 6). The subjective sensation of nasal respiration, average minimum cross-sectional area (MCA) and nasal volume (V5: nasal volume from 0-5 cm) of all subjects were assessed and compared before and after the application of an END. RESULTS: Subjective sensation of nasal respiration, MCA and V, improved sign ificantly in both groups after the application of an END, but there were no significant differences between the two groups. CONCLUSION: Although an F,ND significantly improves nasal respiration and patency, this effect does not show any significant differences between patients with dysfunction of the nasal valve area and those with dysfunction of some other anatomical areas. This is because ENDs equally affect all Types of septal deformity.

Significance of Fine-Needle Aspiration Cytology and Frozen Section Biopsy of Thyroid Nodules / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although fine needle aspiration (FNA) cytology is a safe, simple and relatively accurate procedure, satisfactory samples cannot be obtained in about 10-20% of cases and there is also difficulty in differentiating between benign and malignant lesions in follicular neoplasm. Authors have compared preoperative FNA results and frozen section biopsy with permanent histologic findings and evaluated the significance of FNA cytology and frozen section biopsy in the diagnosis of thyroid nodules. MATERIALS AND METHODS: The medical records of 136 patients who underwent FNA cytology and thyroidectomy from October 1, 1993 to September 30, 1998 at the department of Otolaryngology and General Surgery of Ewha Womans University Mokdong Hospital were retrospectively analyzed. RESULTS: Among the 136 patients who received FNA, there were 75 cases (55.1%) diagnosed as benign, 30(22.1%) as malignant, 13(9.6%) as suspicion of malignant and 18(13.2%) as unsatisfactory. Sensitivity of FNA was 77.1%, the specificity 91.4%, and the accuracy 85.6%. Frozen section biopsy was performed in 118 patients and the sensitivity and specificity rate was 78.3% and 100%, respectively. CONCLUSION: FNA cytology has a high sensitivity (77.1%) and specificity (91.4%) rate. It is therefore a valuable initial procedure for diagnosing thyroid nodules and reducing unnecessary extensive surgery. When FNA yields a diagnosis of follicular neoplasm, frozen section biopsy having a specificity rate of 100% is an important step in determining the extent of operation.

A Study of Non-Convective Factor of Caloric Nystagmus in Relationship between Head Position and Maximal Slow Phase Eye Velocity / 대한이비인후과학회지

Background and OBJECTIVE: There are strong evidences that the caloric nystagmus may be due to non-convective factors in addition to the widely accepted Barany's convection theory. The influence of non-convective factor on the caloric nystagmus was interpreted by measuring the maximal slow phase eye velocity according to the head position. MATERIALS AND METHODS: In 18 normal ears, the maximal slow phase eye velocity of the cold caloric nystagmus was measured at five (-15degrees, 05degrees, 305degrees, 455degrees, 605degrees) different head positions. RESULTS: The sine value of the angle of the lateral semicircular canal (LSCC) plotted against the maximal slow phase velocity showed linear relationship without crossing the zero point in linear regression analysis. CONCLUSION: Maximal slow phase eye velocity shows linear relationship with the sine value of the angle of the LSCC. Compared with the curve expected by the convective factor, the curve in this study was biased by a constant amount (about 20%), which can be attributed to non-convective factor.

Effects of Preservation of the Lamina Propria of the Maxillary Sinus Mucosa on Mucosal Regeneration in Experimentally Induced Maxillary Sinusitis with Polyposis in Rabbits / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It remains unclear whether the lamina propria (LP) of the sinus mucosa should be preserved in the management of the paranasal sinuses with severely diseased mucosa. The aim of this study is to evaluate the effects of preservation of the LP of the maxillary sinus (MS) mucosa on mucosal regeneration in maxillary sinusitis with polyposis in rabbits. MATERIALS AND METHODS: Maxillary sinusitis with polyposis was induced in 180 of the 190 MSs in 95 rabbits and, from these, 10 MSs were used as control. After 4 weeks, the ostia were reopened and 180 MSs were divided into 3 groups according to the following different procedures on the MSs; preservation of the whole mucoperiosteum without removal of polyps and polypoid mucosa (group A), complete removal of the whole mucoperiosteum (group B), and preservation of part of the LP and the periosteum with removal of polyps and polypoid mucosal surface (group C). Each of the experimental groups was explored after 0, 2, 4, 6, 8 and 12 weeks, respectively. Changes of mucociliary transport (MCT) speed, ciliary beat frequency (CBF), and inflammation score in histopathology were evaluated. RESULTS: Eight and/or 12 weeks after the procedures, there were significant improvements in MCT speed, CBF and inflammation score of the group C, compared with those of the group A and/or the group B. CONCLUSION: Preservation of the LP and the periosteum with removal of only polyps and polypoid mucosal surface may be more beneficial to mucosal regeneration than preservation or complete removal of the whole mucoperiosteum including polyps and polypoid mucosa in the surgical management of maxillary sinusitis even though the MS mucosa was severely diseased.

Effects of External Nasal Dilators on Nasal Respiration and Patency in Patients with Deformity of the Nasal Septum: An Acoustic Rhinometric Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Some types of deformities of the nasal septum (DNSs) interfere with the nasal valve function. External nasal dilators (ENDs) were developed to improve the nasal airway by mechanically dilating the nasal valve. The aim of this study is to evaluate the effects of ENDs on nasal respiration and patency in patients with DNS. MATERIALS AND METHODS: Fifty-four patients with DNS (37 males and 17 females, aged 18 to 46 years) without other sinonasal diseases were included in this study. All subjects were required to assess their own sensation of nasal respiration on a 100 mm visual analog scale. Minimal cross-sectional areas (MCAs) and volumes of 0 to 5 cm from the nostril (V 5s) of both nasal cavities were measured by acoustic rhinometry, respectively. All measurements before application of an END were compared with those 5 minutes after application. RESULTS: The subjective sensation of nasal respiration improved significantly after application of an END in both male and female. The END increased MCA and V5 significantly in both sexes. However, there were no significant correlations between changes in the subjective and objective parameters. CONCLUSION: ENDs offer an effective, nonsurgical therapeutic approach in the management of DNS by improving nasal respiration and by increasing MCA and nasal cavity volume. However, it should be kept in mind that this improvement in nasal patency does not always coincide with the improvement in subjective sensation of nasal respiration.

Experimentally Induced Polyps in the Rabbit Maxillary Sinuses: Effects of Different Bacterial Infections with or without Mechanical Trauma on Polyp Formation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many studies have been made on sinonasal polyps to elucidate their pathogenesis, definition and treatment. However, recently reported animal polyp studies provided only a few comparative results of polyp formation under various conditions. The aim of this study is to develop an animal model of polyps that is more suitable for further polyp studies by semi-quantitatively analyzing the effects of different bacterial infections with or without mechanical trauma to the rabbit maxillary sinus (MS) mucosa on polyp formation. MATERIALS AND METHODS: The natural ostia of the right MSs were occluded in 40 Pasteurella-free New Zealand white rabbits. The left MSs were used as control. All rabbits were divided into four groups according to different manipulations on the right MSs; Streptococcus pneumoniae was inoculated without brushing the mucosa (group A) and with brushing (group B), Pseudomonas aeruginosa was inoculated without brushing (group C) and with brushing (group D). After four weeks, macroscopic polyps and light microscopic polyps and/or polypoid mucosa were semi-quantitatively analyzed. RESULTS: The number of macroscopic polyps per sinus of group A was significantly smaller than those of groups B, C and D. Microscopic examination revealed significantly higher levels of polyps and/or polypoid mucosa in group B than in group A, but significantly lower levels in group B than in groups C and D. CONCLUSION: P. aeruginosa infection of the rabbit MS proved more beneficial to polyp formation than S. pneumoniae infection, regardless of mechanical trauma to the sinus mucosa. However, for the inoculation of MS with S. pneumoniae, it was more beneficial to poly induction if the mucosa was mechanically traumatized.

Effects of External Nasal Dilators on Snoring and Obstructive Sleep Apnea in Korean Adults: A Polysomnographic Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It was reported that external nasal dilators (ENDs) can reduce snoring and obstructive sleep apnea (OSA) in white people by dilating the nasal valve area and then, improving nasal breathing. However, there are no available data on Asians, whose geometry of nasal cavities is different from that of white people. The aim of this study is to evaluate the effects of ENDs on snoring and OSA in Korean adults. MATERIALS AND METHODS: Twelve simple snorers (3 female and 9 males, aged 19 to 44 years) and 35 OSA patients (35 males, aged 22 to 65 years) without nasal diseases were included in this study. Polysomnography including measurement of snoring intensity was performed at two separate nights, one with and the other without an END. Averaged maximum snoring intensity, apnea index (AI), respiratory disturbance index (RDI), ratio of deep sleep (stage 3 and 4) to total sleep time, and minimum arterial oxygen saturation (SaO2) with and without an END were measured and compared. RESULTS: Snoring intensity was reduced in 6 (50.0%) of 12 simple snorers and 16 (45.7%) of 35 OSA patients. In overall, snoring improved significantly in both groups. In OSA patients, AI and RDI improved significantly, but ratio of deep sleep time and minimum SaO2 did not. There were no significant correlations between change of snoring intensity and change of AI or RDI in OSA patients. CONCLUSION: These results suggest that ENDs are helpful to improvement of snoring and respiration during sleep, but the sleep stages remain almost unchanged by ENDs in Korean adults with snoring and/or OSA.