Jugulotympanic Paraganglioma, Mimicking a Vascular Tumor: A Brief Case Report

Jugulotympanic paragangliomas (JTPs) known as glomus tumors, are neoplasms of variable invasiveness that arise from the paraganglia situated around the jugular bulb or middle ear. We now report a rare case of JTP in an 18-year-old male. Preoperative diagnoses through external auditory canal biopsy and radiologic examination both failed. Even using a frozen section, an informative finding was not obtained because mostly granulation tissue was present along with associated squeezing artifacts. On permanent histologic examination, small cell nests between many ectatic small vessels and fibrotic stroma were seen, and those cells were positive for CD56, synaptophysin and chromogranin. Because JTPs are rare and have rather different histologic findings - higher vascularity, smaller and less uniform tumor cells than other paragangliomas - they are easy to misdiagnose. However, remembering those differences may help the physician avoid missing JTPs.

Jugulotympanic Paraganglioma, Mimicking a Vascular Tumor: A Brief Case Report

Jugulotympanic paragangliomas (JTPs) known as glomus tumors, are neoplasms of variable invasiveness that arise from the paraganglia situated around the jugular bulb or middle ear. We now report a rare case of JTP in an 18-year-old male. Preoperative diagnoses through external auditory canal biopsy and radiologic examination both failed. Even using a frozen section, an informative finding was not obtained because mostly granulation tissue was present along with associated squeezing artifacts. On permanent histologic examination, small cell nests between many ectatic small vessels and fibrotic stroma were seen, and those cells were positive for CD56, synaptophysin and chromogranin. Because JTPs are rare and have rather different histologic findings - higher vascularity, smaller and less uniform tumor cells than other paragangliomas - they are easy to misdiagnose. However, remembering those differences may help the physician avoid missing JTPs.

Clinical Features and Treatment Pattern of Migrainous Vertigo in Korea: A Nationwide Prospective Multicenter Study / 대한평형의학회지

BACKGROUND AND OBJECTIVES It is being increasing recognized that the morbidities of migraine and balance disorders are interrelated. In fact, migrainous vertigo (MV) is one of frequent causes of recurrent vertigo in patients presenting to specialized dizziness clinics. Nevertheless, not many studies have reported clinical manifestations and treatment. Therefore, the aim of study was designed to assess clinical features and treatment patterns by a nationwide multicenter study. MATERIALS AND METHODS Patients between 9 and 74 years of age who visited 17 Korean tertiary referral centers and 1 clinic from February to March 2009 were investigated using two forms of questionnaires. RESULTS Overall, 318 patients with MV were enrolled. MV was responsible for ~8.45% of visits to the specialized dizziness clinics. One hundred seventy-five of these patients had definite MV and were included in assessing the clinical features. Vertigo characteristics of patients with definite MV were various. Vertigo was regularly as sociated with headache in 87% of the patients. The duration of vertigo ranged from seconds to days. For the treatment patterns, an acute and prophylactic therapies were carried in most clinics. There were no differences in either acute or prophylactic therapies between department of neurology and otorhinolaryngology. CONCLUSIONS The results of this study suggest that MV the clinical features of MV also varies in Korea. In addition, most clinics provide similar patterns of practice in treatment for MV. The syndrome of MV deserves further research activity as it is relatively common and clinically relevant.

Unusual Localization of Castleman's Disease: Case Report in the Nasopharynx / 대한이비인후과학회지

Castleman's disease, a benign lymphoproliferative disease of unknown etiology, rarely occurs as a nasopharyngeal mass. Instead, thedisease may appear as a local or generalized tumor-like condition, usually in the mediastinum, andit can also involve both the lymph nodes and non nodal tissue. Since the nasopharyngeal roof is the residence of the pharyngeal tonsil (adenoids), which is rich in lymphoid tissue, the appearance of Castleman's disease is predictable. The presentation is variable and diagnosis is not easy. It may present as an asymptomatic involvement of one lymph node group or as a multicentric disease with systemic feature. Here, we report a 34 year old female patient with histopathologically proven hyaline-vascular type of Castleman's disease, who presented with nasopharyngeal mass and was treated with a complete excision without complication.

Immunoglobulin E and Transcription Factor in Adenoid of Children with Allergy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Immunoglobulin E (IgE) production in adenoid has been debated and the role of adenoid in development of allergy remains largely unknown. To examine the production of local IgE in adenoid involved with IgE-mediated sensitization, we evaluated IgE production and the expression of the transcription factor B cell leukemia/lymphoma-6 (BCL-6) and B lymphocyte inducer of maturation program 1 (Blimp-1) in adenoids. SUBJECTS AND METHOD: Ten children with allergic rhinitis (AR) and ten children without any history of AR were enrolled. Immunohistochemical studies of adenoid for IgE, BCL-6 and Blimp-1 were performed. RESULTS: IgE was stained mainly in the germinal center and submucosal area and the stainingscores of antibody to IgE did not differ signigicantly between children with AR and control. BCL- 6 was mainly stained in mucosa and germinal center and Blimp-1 in mucosa. The scores of antibody to BCL-6 and Blimp-1 in children with AR and control did not show significant differences. CONCLUSION: We found that allergic rhinitis was not involved in the production of IgE nor the expression of the transcription factor BCL-6 and Blimp-1 in adenoid

Hearing Threshold of Korean Adolescents Associated with the Use of Personal Music Players

PURPOSE: Hearing loss can lead to a number of disabilities and can reduce quality of life. Noise-induced hearing losses have become more common among adolescents due to increased exposure to personal music players. We, therefore, investigated the use of personal music player among Korean adolescents and the relationship between hearing threshold and usage pattern of portable music players. MATERIALS AND METHODS: A total of 490 adolescents were interviewed personally regarding their use of portable music players, including the time and type of player and the type of headphone used. Pure tone audiometry was performed in each subject. RESULTS: Of the 490 subjects, 462 (94.3%) used personal music players and most of them have used the personal music player for 1-3 hours per day during 1-3 years. The most common type of portable music player was the MP3 player, and the most common type of headphone was the earphone (insert type). Significant elevations of hearing threshold were observed in males, in adolescents who had used portable music players for over 5 years, for those over 15 years in cumulative period and in those who had used earphones. CONCLUSION: Portable music players can have a deleterious effect on hearing threshold in adolescents. To preserve hearing, adolescents should avoid using portable music players for long periods of time and should avoid using earphones.

Bacteriology of Chronic Otitis Media: Changing of Detection Rate of Methicillin-Resistant Staphylococcus Aureus and Pseudomonas Aeruginosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic suppurative otitis media is one of the most common diseases in the otologic field. Along with development and widespread use of antibiotics, the kinds of pathogenic microorganisms and their resistance to antibiotics have been changed. It is thus significant to know the current trend of species and resistance rates of pathogens for choosing appropriate antibiotics. To investigate the current bacteriology of chronic suppurative otitis media and compare the current results with previous results. SUBJECTS AND METHOD: A retrospective study about chronic otitis media patients with otorrhea was performed from Jan, 2000 to Dec, 2005. RESULTS: The most commonly identified pathogenic bacterium was methicillin-resistant Staphylococcus aureus (MRSA). The next frequent pathogenic organisms were Pseudomonas, Coagulase (-) Staphylococcus (CNS) and methicillin-sensitive Staphylococcus aureus (MSSA). CONCLUSION: There was difference between the results of the present study and previous results regarding pathogenic organisms and antibiotics-sensitivity. Continuous and periodic surveillance about pathogens and antibiotics resistance is necessary to guide appropriate antibacterial therapy.

Relationship between Effusion Bacteria and Concentrations of Immunoglobulin in Effusion Fluid in Recurrent Otitis Media with Effusion Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Upper respiratory infections and host immunity against infection may be important in the pathophysiology of otitis media effusion (OME) in children with as yet undeveloped Eustachian tubes. So, we measured Ig concentrations in effusion fluid and serum, and examined their relationship with the presence of bacteria in effusion fluid, as determined by the conventional culture methods and PCR. SUBJECTS AND METHOD: Middle ear effusion was collected from 61 OME patients who had undergone ventilation tube insertion. Bacteria in effusion fluid were detected by standard bacterial culture and polymerase chain reaction. Middle ear fluid immunoglobulins in the OME prone group and OME non-prone group were evaluated. RESULTS: The level of IgA in the otits media prone group was significantly lower than in the otitis media non-prone group, but there was no significant difference in the level of IgG, IgM between two groups (p<0.05). Bacteria detection rate were 59% in the prone group and 50% in the non-prone group. The level of IgA in the bacterial detection group was signifi-cantly lower than that of the non-detection group (p<0.05). CONCLUSION: These results suggest that IgA seems to be important in the protection of bacterial growth and local immunity in the middle ear and may be related to the chronicity or relapse of OME.

Temporal Changes of the Calcium-binding Proteins in the Medial Vestibular Nucleus following Unilateral Labyrinthectomy in Rats

Calcium (Ca2+) is an intracellular second messenger associated with neuronal plasticity of the central nervous system. The calcium-binding proteins regulate the Ca2+-mediated signals in the cytoplasm and buffer the calcium concentration. This study examined temporal changes of three calcium-binding proteins (calretinin, calbindin and parvalbumin) in the medial vestibular nucleus (MVN) during vestibular compensation after unilateral labyrinthectomy (UL) in rats. Rats underwent UL, and the changes in the expression of these proteins at 2, 6, 12, 24, 48, and 72 h were examined by immunofluorescence staining. The expression levels of all three proteins increased immediately after UL and returned to the control level by 48 h. However, the level of calretinin showed changes different from the other two proteins, being expressed at significantly higher level in the contralateral MVN than in the ipsilateral MVN 2 h after UL, whereas the other two proteins showed similar expression levels in both the ipsilateral and contralateral MVN. These results suggest that the calcium binding proteins have some protective activity against the increased Ca2+ levels in the MVN. In particular, calretinin might be more responsive to neuronal activity than calbindin or parvalbumin.

Comparison of Facial Nerve Paralysis in Adults and Children

PURPOSE: Facial nerve injury can occur in the regions ranging from the cerebral cortex to the motor end plate in the face, and from many causes including trauma, viral infection, and idiopathic factors. Facial nerve paralysis in children, however, may differ from that in adults. We, therefore, evaluated its etiology and recovery rate in children and adults. MATERIALS AND METHODS: We retrospectively evaluated the records of 975 patients, ranging in age from 0 to 88 years, who displayed facial palsy at Kyung Hee Medical Center between January 1986 and July 2005. RESULTS: The most frequent causes of facial palsy in adults were Bell's palsy (54.9%), infection (26.8%), trauma (5.9%), iatrogenic (2.0%), and tumors (1.8%), whereas the most frequent causes of facial palsy in children were Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), and leukemia (1.3%). Recovery rates in adults were 91.4% for Bell's palsy, 89.0% for infection, and 64.3% for trauma, whereas recovery rates in children were 93.1% for Bell's palsy, 90.9% for infection, and 42.9% for trauma. CONCLUSION: These results show that causes of facial palsy are similar in adults and children, and recovery rates in adults and children are not significantly different.

Toll-like Receptors 2 and 4 and Their Mutations in Patients with Otitis Media and Middle Ear Effusion

OBJECTIVES: Toll-like receptors (TLRs) detect microbial infections and they can directly induce innate host defense responses. TLR 2 has been shown to be primarily involved in the recognition of peptidoglycans and lipoteichoic acid of gram positive bacteria. TLR 4 recognizes lipopolysaccharides and lipoteichoic acids from both gram-negative and gram-positive bacteria. Both mutations lead a reduced capacity to elicit inflammation and they increase the risk for gram-positive and negative infections. This study was performed to investigate the expressions of TLR 2 and 4 and their mutations in patients suffering with otitis media and middle ear effusion. METHODS: Middle ear fluid samples were collected from 40 otitis media effusion (OME) patients who had ventilating tubesinserted. Bacteria in the effusion fluid were detected by standard bacterial culture. The secreted IgG, IgA and IgM were measured by Enzyme-linked immunosorbent assay. TLR 2 and 4 were assessed by performing RT-PCR. The genomic DNA from each patient was isolated from the middle ear fluid samples that were collected from 60 OME patients, and the presence of mutations was determined by performing restriction digestion and DNA sequencing analysis. RESULTS: Among the 40 middle ear fluid samples, bacteria were detected in 13 middle ear fluid samples. The amounts of IgM, IgA, and IgG were 151.20+/-60.94 ng/mL, 21.59+/-7.96 ng/mL and 11.55+/-16.98 ng/mL, respectively. TLR 2 and 4 were expressed in the middle ear fluid and the expression of TLR 2 was higher than that of TLR 4. However, there was no correlation between the expressions of TLR 2 and 4, and the concentration of immunoglobulin or the presence of bacteria (P>0.05). There ware no mutations of TLR 2 (Arg753Gln, Arg677Trp) and TLR 4 (Asp299Gly, Thr399Ile). CONCLUSION: TLR 2 and 4 were expressed in all the middle ear fluid samples of OME, but the mutations of TLR 2 and 4 were not detected. TLR 2 and 4 may play a vital role in the immunological responses of patients with OME.

Expression of Toll-like Receptors 2 and 4 and Immunoglobulins in Children wih Recurrent Otitis Media with Effusion

BACKGROUND: Toll-like receptors (TLRs) detect microbial infection and can directly induce innate host defense responses, which are thought to play critical roles in protecting the tubotympanum from infection. However, little is known about the relationship between TLRs, which are related to innate immunity, and immunoglobulins, which are related to adaptive immunity, in recurrent otitis media with effusion (OME). We therefore investigated the expression of TLR2 and TLR4 and immunoglobulin in children with OME. METHODS: The study population consisted of 72 children with OME, 31 with more than 4 episodes in 12 months or more than 3 episodes in 6 months (otitis-prone group), and 41 with fewer than 3 episodes in 12 months (non-otitis prone group). The expression in middle ear effusion of TLR2 and TLR4 mRNA, as determined by Real time- -polymerase chain reaction (RT-PCR), and the concentrations of IgG, IgA, and IgM, as determined by Enzyme-linked immunosorbent assay(ELISA), were compared between the two groups. RESULTS: Expression of TLR2 and TLR4 mRNA was lower in the otitis prone than in the non-otitis prone group, but the difference was not statistically significant (p>0.05). Between group differences in the concentrations of IgG, IgA and IgM in effusion fluid were not significant (p>0.05), and there were no correlations between immunoglobulin concentration and the expression of TLR2 and TLR4. CONCLUSION: Although there was a trend toward lower expression of TLR2 and TLR4 in the otitis-prone group, the differences, and those in immunoglobulin concentration, did not differ significantly between the otitis-prone and non-prone groups.

A Case of Cylindrical Cell Papilloma Originated from Sphenoid Sinus / 대한이비인후과학회지

Cylindrical cell papilloma, the rarest among papillomas of the sinonasal tract, are subdivided into inverted papilloma, fungiform papilloma and cylindrical cell papilloma. It is characterized by proliferative, multi-layered columnar cells and has the clinical features of an inverted papilloma. It usually originates from the lateral nasal wall and sinuses (mainly maxillary and ethmoid sinus). With a review of literature, we report a case of a 47-year-old male with cylindrical cell papilloma originating from the sphenoid sinus, which has been removed by an endoscopic approach.

Usefulness of Botulinum Toxin Injection in Rehabilitation of Facial Paralysis: Improving Mouth Angle Asymmetry / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A number of surgical procedures exist to improve facial symmetry for patients with facial paralysis. Whereas static symmetry is often improved, dynamic asymmetry frequently persists because of the imbalance of complex coordinated movements of facial expression. The paralyzed face is often distorted by the excessive pull of the normal contralateral face during emotional expression. We report the use of botulinum toxin in patients with facial paralysis to improve lower facial asymmetry by limiting the excessive pull of contralateral face. SUBJECTS AND METHOD: Ten adult patients with unilateral facial paralysis were included in this study. Patients had injections at contralateral facial muscle which were zygomaticus major, levator labii superioris and depressor angularis orii. The effectiveness of the botulinum toxin injections on facial symmerty and patient appreciation of this were assessed by measuring the level difference of both mouth angles and difference in the distance from the midline to both mouth angles before and 1 month after injection. Also patients were asked to fill up the questionnaire about the magnitude of effect and any related side effects of injection at 1 month follow up. RESULTS: Botox injection decreased the level difference of both mouth angle and difference of distance from midline to both mouth angles in patients with unilateral facial paralysis at full-denture smiling. Five of ten patients were reported as moderate to marked improvement in expressive facial asymmetry after botulinum toxin injection into normal lower face. CONCLUSION: Botulinum toxin injection is a useful ancillary technique for improving dynamic facial asymmetry of the paralyzed face.

Clinical Analysis of Facial Palsy in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Facial palsy in children is uncommon, but not rare. Most patients with facial palsy are idiopathic, as in Bell's palsy. Nevertheless, other more serious causes should be carefully excluded before Bell's palsy is diagnosed. We tried to characterize the causes, treatment methods, and the recovery rate of facial palsy in children. SUBJCETS AND METHOD: Between January 1986 and July 2005, we examined 157 patients who presented with facial palsy in Kyunghee University Hospital. The patients' ages ranged from 0 to 15. RESULTS: The highest age groups were children in their school period. The causes of facial palsy in children were in the order of following frequences : Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), leukemia (1.3%), facial burn (0.6%), iatrogenic (0.6%). Treatment methods according to causes were steroid, antiviral, antibiotics, acupuncture, myringotomy, facial nerve decompression, and nerve graft. The recovery rate was 93.1% in Bell's palsy, 100% in birth trauma, 100% in acute otitis media, 83.3% in herpes zoster oticus, 33.3% in temporal bone fracture, and 50% in cerebral contusion. CONCLUSION: Facial palsy in children results from variable causes in the order of Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), leukemia (1.3%), facial burn (0.6%), and iatrogenic (0.6%). There were variable treatment methods according to different causes and many of the children had acupuncture. Facial palsy caused by birth trauma and acute otitis media had satisfactory recovery rates in all cases, whereas Bell's palsy patients showed 93.1% satisfactory recovery and trauma patients 33.3%.

Expression of Cytokines in Coculture Model with Epithelial Cells and Fibroblasts of Nasal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal polyposis is a chronic inflammatory disease characterized histologically by edematous fluid with sparse fibrous cells, few mucous glands and proliferation of stromal and epithelial cells. There have been many studies done separately about epithelial cells, fibroblasts, and other inflammatory cells in nasal polyps. However, there is no usable study model for the cell-to-cell interaction. Therefore, we tried to make a new model for the study of nasal polyp by coculture of epithelial cells and fibroblasts. SUBJECTS AND METHOD: Nasal polyp was collected during endoscopic sinus surgery. Almost half of them were used for epithelial cell culture and the remaining portion was used for fibroblast culture in the same polyp. Using a transwell insert, fibroblasts were placed in the bottom and epithelial cells were placed on the insert, respectively. RNA were isolated both from epithelial cells and fibroblasts of 12, 24, and 48 hours' coculture. The expressions of IL-8, IL-6, and eotaxin from cocultured cells were compared with cells that were cultured alone by semiquantitative RT-PCR. RESULTS: IL-8 was highly expressed in fibroblasts than in epithelial cells, especially in cocultured cells. The expression of IL-6 in fibroblasts was much higher than in epithelial cells, especially in cocultured fibroblasts. Eotaxin is weakly expressed in fibroblasts but not in epithelial cells. CONCLUSION: These findings indicate that cocultured cells show different expression of the mRNA of various cytokines compared with cultured cells alone. And this coculture system may be more ideal than the mono-cell culture system for the study of cell-to-cell interactions and to reveal the pathogenesis of nasal polyposis.

A Case of Congenital Cholesteatoma : Combined with Ossicular Anomaly / 대한이비인후과학회지

Congenital middle ear cholesteatoma is presented as a pearl-like-material behind an intact tympanic membrane. Congenital cholesteatoma can be associated with other congenital anomalies, especially ossicular anomalies. The patient was a 10-year-old male with incidentally known hearing disturbance with intact tympanic membrane. The pure tone average through air conduction of his left ear was 55dB. During exploratory tympanotomy, congenital cholesteatoma was found in the middle ear cavity in a scattered pattern and fibrous stapes was located below the oval window with an intact stapedial footplate. We removed cholesteatoma matrix and performed ossiculoplasty with total ossicular replacement prosthesis (TORP). After 1 month, the postoperative pure tone average through air conduction of the left ear was 33dB. We report one case of congenital middle ear cholesteatoma with congenital ossicular anomaly with a review of the related literature.

Squamous Metaplasia and BCL-6 in Pediatric Adenoid Accompanied by Otitis Media with Effusion

PURPOSE: Deterioration of local immunity in the adenoids may make them vulnerable to infection by microorganisms, resulting in otitis media with effusion. To determine the factors associated with this condition, we evaluated adenoid size, mucosal barrier, squamous changes of ciliated epithelium, IgA secretion, and BCL-6 expression in adenoids. MATERIALS AND METHODS: Seventeen children diagnosed with otitis media with effusion (OME group) and 20 children without any history of OME (control group) were enrolled. Their adenoids were sized by lateral view X-ray and stained with hematoxylin and eosin to detect squamous metaplasia. The adenoids were also stained with cytokeratin to evaluate mucosal barriers, and with anti- IgA antibody and anti- BCL-6 antibody to determine expression of IgA and BCL-6. RESULTS: The OME group showed greater incidence of squamous metaplasia, fewer ciliated cells, and lower expression of BCL-6 (p 0.05). IgA secretion and adenoid size were the same for the OME and the control groups. CONCLUSION: These results suggest that increased squamous metaplasia and lower BCL-6 expression in adenoids may be associated with increased susceptibility to OME.

Decreased Serum Immunoglobulin in Recurrent Otitis Media with Effusion

BACKGROUND: Defective or immature antibody responses to pathogens in children may explain the increased susceptibility to acute otitis media. However, there is no study in Korea patients whether a correlation exists between otitis media with effusion and the levels of serum immunoglobulins, IgG subclasses, IgA, IgM and IgE. METHODS: 45 children with otitis media with effusion more than 4 episodes in 12 months or 3 episodes in 6 months, 62 children with otitis media with effusion less than 3 episodes in 12 months and 102 children for control group took part in the study at the Department of Otorhinolaryngology of the KyungHee University from May 2004 to Feburary 2007. Serum immunoglobulin levels were determined by nephelometry. And then the relationship between otitis media with effusion and serum immunoglobulin level was evaluated. RESULTS: In otitis media prone group, serum IgG1, IgG2, IgG4, and IgA level was lower than those level of control group, it was significantly decreased (p0.05). CONCLUSION: Lower immunoglobulins in children with otitis media with effusion suggest a generalized decreased antibody responses. Lower levels of serum IgG1, IgG2, IgG4, and IgA may be related with chronicity or intractability of otitis media with effusion.

Local Immunity of Pediatric Adenoid with Allergic Rhinitis & Sinusitis

BACKGROUND: Chronic rhino-sinusitis and persistent allergic rhinitis is often cited as risk factor for developing adenoid hypertrophy or adenoiditis, but this relationship has not been studied extensively. In this study, we evaluated the mucosal barrier, squamous changes of ciliated epithelium, IgA secretion and BCL-6 expression in adenoids, and adenoid size. METHODS: Six children with allergic rhinitis and sinusitis, nine children with only allergic rhinitis, nine children with only sinusitis and six children without any history of allergic rhinitis and sinusitis were enrolled. H-E stain of adenoid for squamous metaplasia, immunohistochemical study of adenoid for IgA and BCL-6, cytokeratin stain for evaluation of mucosal barrier and lateral view X-ray for adenoid size were performed. ANOVA test was used in the analysis and data showing p value of less than 0.05 were considered significant. RESULTS: The number of ciliated cells had tendency to be decreased and squamous metaplasia had tendency to be increased in three experimental groups (p>0.05). Deterioration of mucosal barrier had tendency to be detected in three experimental groups than control group (p>0.05). BCL-6 had tendency to be increased and IgA secretion had tendency to be decreased in three experimental groups (p>0.05). There is no difference in adenoid size between three experimental groups and control group. CONCLUSION: Despite the expectation that adenoid would be affectecd by allergic rhinitis and rhino-sinusitis, we found no evidence for influence of adenoid immunity.