Roles of IL-8 in the Pathogenesis of Chronic Rhinosinusitis

Epithelial hyperplasia and mucosal infiltration of leukocytes are common features of chronic rhino sinusitis. The epithelium can produce chemo attractant cytokines that may contribute to leukocyte infiltration in rhino sinusitis. IL-8 is a chemokine that can be produced in large amounts by epithelial cells in response to a variety of stimuli including proinflammatory cytokines, bacteria, fungi, and respiratory viruses. This chemokine is not only a potent chemoattractant for, and activator of, neutrophils, but it is also chemotactic for some subsets of T lymphocytes. Moreover, IL-8 has been reported to serve as a chemoattractant for eosinophils from subjects with allergic disease. Thus it is reasonable to hypothesize that this chemokine could contribute to the pathogenesis of chronic rhino sinusitis. This article reviews the role of IL-8 in the pathogenesis of chronic rhino sinusitis.

Medpor(R)-using Reconstruction of the Orbital Floor Defect Caused by the Maxillary Sinus Mucocele: A Case Report

Mucoceles of the paranasal sinuses are benign, locally expansile cysts filled with mucus and lined by the mucoperiosteum of the involved sinus. Orbital symptoms are characteristic in symptomatic maxillary sinus mucoceles, and patients initially consulted ophthalmologists for eyeball displacement, diplopia, proptosis, enophthalmos, epiphora, and rarely decreased visual acuity. Recently, we experienced a case of maxillary sinus mucocele with the destruction of the orbital floor. The mucocele was treated by marsupialization via intranasal and transantral approach, and the large defect of orbital floor was successfully reconstructed using high-density porous polyethylene (Medpor(R), Porex Surgical Inc, College Park, GA). Accurately positioned Medpor implant was observed in the orbital floor after 48 months postoperatively.

Endoscopic Frontal Sinus Surgery / 대한이비인후과학회지

No abstract available.

A Case of Multifocal Mucosa-associated Lymphoid Tissue Lymphoma Involving Ethmoid Sinus, Hard Palate and Cheek / 대한이비인후과학회지

Mucosa-associated lymphoid tissue (MALT) is a specialized form of lymphiod tissue that may be acquired at sites in response to chronic inflammation. MALT lymphoma is a type of low-grade, B-cell lymphoma within the spectrum of non-Hodgkin's extranodal lymphomas, and may arise within several sites in the head and neck. Because of the differences in the natural history, prognosis, and therapy of MALT lymphoma and other lymphomas, the immunohistochemical and molecular biology studies should be considered in the diagnosis of MALT lymphoma in cases where atypical lymphoid infiltrates into the head and neck. We present a case of advanced staged multifocal MALT lymphoma, which has disseminated into the bone marrow, involving mucosal sites of the ethmoid sinus, hard palate and cheek, but not the gastrointestinal tract, with a review of relevant literature.

A Case of Iatrogenic Subcutaneous Cervicofacial and Mediastinal Emphysema after Catheterization / 대한이비인후과학회지

Subcutaneous cervicofacial and mediastinal emphysema (SCFME) occur with a variety of disease processes. Most cases involve a passive escape of air from the aerodigestive tract into subcutaneous tissues. Even if the presence of SCFME is not in itself dangerous, prompt recognition of the underlying etiology is essential. Catheterization is a common procedure in the otolaryngologic field, but, clinically, SCFME after catheterization is very rare. Recently, we experienced a case of SCFME after catheterization, so we report this rare case with a review of literatures.

Efficacy of Adenoidectomy on Pediatric Chronic Rhinosinusitis

BACKGROUND AND OBJECTIVES: Adenoid vegetation can induce chronic rhinosinusitis in children by obstruction of the nasopharynx or as a reservoir for bacteria. The aim of this study is to determine the efficacy of adenoidectomy in chronic pediatric rhinosinusitis. Materials and Methods: Symptoms of chronic rhinosinusitis were evaluated in 17 patients who underwent an adenoidectomy between November 2001 and July 2002. Patients' age ranged from 4 to 11 years old. Caregivers of the patients were asked about symptoms of chronic rhinosinusitis, which were nasal obstruction, rhinorrhea, postnasal drainage, headache, cough and sputum, by a 10-graded visual analogue scale of 6 items at preoperative and postoperative 2, 3, 4, 5, 6, 8, 10 and 12 weeks, respectively. We assessed the grades of plain radiographic (Waters' view) findings at postoperative 1, 2 and 3 months consecutively. RESULTS: Symptoms of chronic rhinosinusitis were significantly improved following adenoidectomy. Significant improvement of symptom scores began at postoperative 2 weeks on the average. Plain radiographic findings were significantly improved at postoperative 1 month. After postoperative 7 months, 'Cure' was reported in 9 (53%) of 17 patients. Conclusions: In majority of cases, symptoms and radiographic findings of chronic rhinosinusitis in children are improved by adenoidectomy. Adenoidectomy should be considered as a first-line surgical option for pediatric chronic rhino-sinusitis.

A Case of Nasal Cavity Neurilemmoma Diagnosed by S-100 Protein / 대한이비인후과학회지

Neurilmomma is a benign tumor which originate from the neuroectodermal Schwann cell of cranial, intraspinal, peripheral and autonomic nerve sheath. Although these tumors have been reported to occur throughout the body, the highest incidence, accounting for 25% to 45% of all cases, has been reported in the head and neck area. Except the acoustic neurilemmoma which is the most common in the otolaryngologic fields, neurilemmoma originating from the nasal cavity and paranasal sinus is very rare (about 4%). Recently, the authors have experienced a case of neurilemmoma of nasal cavity and thus presents the clinical and radiolographic findings along with a review of the literature.

The Role of Allergy in the Severity of Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although allergic rhinitis is one of the most common factors associated with the development of chronic rhinosinusitis, the role of allergy in the severity of chronic rhinosinusitis was not well defined. This study is aimed to determine whether the allergy or factors such as nasal polyp, asthma, aspirin sensitivity can induce more extensive chronic rhinosinusitis, and to determine whether the severity of chronic rhinosinusitis depends on the severity of allergy. MATERIALS AND METHODS: A total of 98 chronic rhinosinusitis patients who underwent endoscopic sinus surgery were evaluated. The severity of chronic rhinosinusitis was assessed by CT scores and symptom scores. An allergic prick test, MAST (Multiple-antigen simultaneous test), the total IgE, and a serum eosinophil count were evaluated for diagnosis and assessment of the severity of allergy. Influences of another factors such as nasal polyp, asthma, and aspirin sensitivity to the severity of chronic rhinosinusitis were evaluated. RESULTS: Although the symptom scores of allergic chronic rhinosinusitis patients were greater than those of non-allergic chronic rhinosinusitis patients, there were no CT score differences between the two groups. Differences in the CT scores and symptom scores in allergic chronic rhinosinusitis patients according to the severity of allergy were statistically insignificant. Nasal polyp, asthma, and aspirin sensitivity did not induce more severe chronic rhinosinusitis. CONCLUSION: Allergy may be associated with the development of chronic rhinosinusitis, but the severity of allergy is not correlated to the severity of chronic rhinosinusitis.

The Clinical Significance of Lund-Mackay CT Staging System in Assessing the Severity of Chronic Rhinosinusitis / 대한이비인후과학회지

Backgrounds and Objectives : Although the sinus CT (computed tomography) scan has emerged as the preferred method for assessing the extent of chronic rhinosinusitis, the relationship between sinus CT findings and symptom severity in chronic rhinosinusitis has not been established yet. The Lund-Mackay CT staging systems were known as one of the most prevalent methods in assessing the severity of chronic rhinosinusitis. We aimed to determine the relationship between the severity of the Lund- Mackay CT scores and symptom severity, and to determine the relationship between the laterality and symptom severity in chronic rhinosinusitis. MATERIALS AND METHODS: 108 patients who fit the eligiblity and exclusion criteria were evaluated. We scored each CT scan on the Lund-Mackay system and let the patients complete the questionnaires for the rhinosinusitis symptoms. The correlation between the CT scores and the severity of patients' symptoms was assessed. Then, we divided the patients into 4 groups according to the grades of CT scores. And in each group, we subgrouped them according to the CT score differences between the right and left sides. Statistical analyses of symptom scores between subgroups in each group were performed. RESULTS: The CT scores graded by the Lund-Mackay system and symptom scores were correlated significantly (rho=0.365, p< or = 0.0001). According to the laterality of chronic rhinosinusitis, there were no statistically significant differences between CT scores and symptom scores in the subgroups of each group. CONCLUSION: The CT score by the Lund-Mackay system was correlated with the patients-based reports of symptom severity regardless of the laterality of chronic rhinosinusitis. We therefore recommend that the Lund-Mackay system to be adopted as the standard method of measuring the extent of chronic rhinosinusitis.

Assessment of Olfactory Function after Endoscopic Sinus Surgery in Chronic Rhinosinusitis Patients and Clinical Validity of Cross-Cultrual Smell Identification Test / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery (ESS) improves olfactory dysfunction due to chronic rhinosinusitis. Cross-Cultural Smell Identification test (CC-SIT) is known to be one of the useful methods to assess the olfactory dysfunction. We assessed the influence of ESS on olfactory function by using symptom scores and CC-SIT, and determined the clinical validity of CC-SIT. MATERIALS AND METHODS: 151 patients with chronic rhinosinusitis who had received ESS were evaluated. Prior to and three months following the surgery, each patient was requested to mark a 5-point scale ranging from normosmia to anosmia. Preoperative and postoperative CC-SITs were performed for 20 patients who complained of olfactory dysfunction. To evaluate the clinical validity of CC-SIT, we assessed the correlations between CC-SIT scores, symptom scores and CT scores using the Lund-Mackay CT scoring system. RESULTS: There were a significant decrease in the symptom scores and an increase in the CC-SIT scores after ESS. However, normosmia was achieved in only 38.5% (25/65) of the patients determined by symptom scores and 23.5% (4/17) by CC-SITs. There were significant correlations between CC-SIT scores, symptom scores and CT scores (r=-0.416, r=-0.357, r=0.510, p<0.05). CONCLUSION: Although the average postoperative olfactory ability after ESS was in the hyposmic range, ESS could improve the olfactory ability in patients with chronic rhinosinusitis. The 5-point scale and the CC-SIT scores reflected well the severity of olfactory dysfunction in patients with chronic rhinosinusitis, and therefore, we recommend them as convenient and practical tools to assess olfactory ability before and after ESS.

Transoral Endoscopic Adenoidectomy with the Microdebrider / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgeons have tried various methods of adenoidectomy from the conventional transoral ad- enoidectomy using curettes or adenotomes to the newly developed transnasal endoscopic adenoidectomy using microdebriders. However, surgeons still face a great difficulty in achieving complete adenoidectomy due to the unfavorable anatomic structure and a narrow operating field. This study aims to introduce and try to establish a better way of performing transoral endoscopic adenoidectomy using microdebriders. MATERIALS AND METHODS: Thirty patients who underwent transoral endoscopic adenoidectomy using rnicrodebriders were prospectively randomized. Skull lateral radiographs and endoscopic photographs were obtained to analyze the surgical outcome of transoral endoscopic adenoidectomy using a microdebrider. RESULTS: There were no specific postoperative complications such as hemorrhage or infection. Nasal obstruction disappeared within 7 postoperative days, and mouth breathing and snoring were simultaneously improved. CONCLUSION: Transoral endoscopic adenoidectomy using a microdebrider can be considered as one of the most effective methods for more complete adenoidectomy to relieve nasal obstruction and to reduce mouth breathing and snoring.

Expression of Inducible Nitric Oxide Synthase and Its Steroid Effect in TDI-Induced Nasal Hyperreactive Guinea Pigs / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) in exhaled air is elevated in allergy. Topical corticosteroid therapy which has been shown to reduce airway inflammation is associated with reduction in exhaled levels of NO in allergy. The aim of this study is to investigate the induction of inducible nitric oxide synthase (iNOS) and the effect of steroid on the expression of iNOS in the nasal mucosa of TDI (toluene diisecyanate)-induced nasal hyperreactive guinea pig. MATERIALS AND METHODS: We developed an allergy model in guinea pigs using the intranasal application of TDI, We evaluated the iNOS expression and in vivo effects of triamcinolone on the expression of iNOS and infiltration of eosinophil in TDI-sensitized guinea pigs by immunohistochemical stain. RESULTS: Nasal symptoms were significantly suppressed and the number of eosinophils in the nasal mucosa were significantly inhibited by the treatment of triamcinolone. Immunoreactivity to iNOS was localized to ciliated cells of epithelium, vascular endothelial cells, secretory cells of nasal glands and some inflammatory cells in the mucosa of the control group. High expression of iNOS in the nasal mucosa of the TDI-sensitized group was demonstrated, and it was suppressed by triamcinolone therapy. CONCLUSION: These results show that increased expression of iNOS may contribute to allergic inflammation and the antiinflammatory effect of steroid in allergy is partly mediated by the reduction of iNOS expression.