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.

The Relationship between the Causative Allergens of Allergic Diseases and Environments in Korea Over a 8-Year-Period: Based on Skin Prick Test from 2006 to 2015

BACKGROUND AND OBJECTIVES: The present study evaluated the results of skin prick test using 55 allergens at 20 centers in the Republic of Korea in 2006, 2010, and 2014–2015. The aim was to assess changes in the positive rate of allergens according to temporal, regional, and environmental factors. MATERIALS AND METHODS: In total, 20 hospitals were selected based on the population distribution in the Republic of Korea. A skin prick test panel comprising 55 aeroallergens was distributed to 18 hospitals for this prospective study. The 2006 and 2010 skin prick test results were collected and analyzed retrospectively from 20 hospitals, while the 2014/2015 skin prick test results (from June 2014 to May 2015) were collected prospectively from 18 hospitals. RESULTS: A total of 14,897 SPT test results were analyzed: 4,319 in 2006, 7,431 in 2010, and 1,852 in 2014/2015. The overall rate of skin prick test positivity to more than two allergens was significantly higher in males than females. The positive rates of alder pollens and birch, oak and ragweed pollen positivity were increased in older patients. Several positive rates were increased according to the temperature in spring. The positive rates for beech pollen, birch pollen, hazel pollen, oak pollen, Tyrophagus putrescentiae, mugwort, cat, Acarus siro, Lepidoglyphus destructor and Tyrophagus putrescentiae were significantly increased, while those of Cult rye pollen and dandelion were significantly decreased over the three test periods. The overall positive rate for allergens in Jeju province varied significantly from Seoul and other cities. CONCLUSION: Change in the positive rate of multiple aeroallergens was evaluated in the Republic of Korea over time. Our findings can be used to recommend aeroallergens suitable for inclusion in skin prick test panels in the Republic of Korea and will facilitate further investigation of changes in the patterns of allergic diseases.

A Case of Frontoethmoidal Mucopyocele Combined with Cerebrospinal Fluid Leak and Complicated Tension Pneumocephalus after Marsupialization

After the trauma of frontoethmoidal sinus, post-traumatic mucocele may occur. Surgical removal of the lesions rarely produces cerebrospinal fluid (CSF) leakage and even delayed tension pneumocephalus. We experienced a case of fronto-ethmoid mucocele complicated with peri-operative CSF leakage and post-operative tension pneumocephalus which was improved by conservative treatment. It is imperative to take into account the potential for tension pneumocephalus when a patient suffers from severe headache after sinus surgery.

A Case of Low Grade Osteosarcoma Developing in the Middle Skull Base after Radiotherapy of Adenoid Cystic Carcinoma in the Posterior Nasal Cavity / 대한이비인후과학회지

Adenoid cystic carcinoma arises rarely in the nasal cavity and paranasal sinus. Treatment strategy showing the best survival rate includes surgical excision and adjuvant radiotherapy. There were a few case reports of radiation-induced osteosarcoma from adenoid cystic carcinoma overseas but not in Korea. We experienced a case of radiation-induced low-grade osteosarcoma in the middle skull base including sphenoid bone, which had arisen after 10 years of radiotherapy of adenoid cystic carcinoma. Authors present this case with serial imaging findings and literature review.

Maxillary Sinus Retention Cysts Protruding Into the Inferior Meatus

Although most of the maxillary sinus retention cysts are asymptomatic, a few of them increase in size and cause symptoms. However, they rarely erode bony walls nor protrude into the inferior meatus. I present 2 cases with maxillary sinus retention cysts protruding into the inferior meatus by making a large defect on the medial wall of the maxillary sinus.

Neoadjuvant intra-arterial chemotherapy combined with radiotherapy and surgery in patients with advanced maxillary sinus cancer

PURPOSE: The optimal treatment of advanced maxillary sinus cancer has been challenging for several decades. Intra-arterial chemotherapy (IAC) for head and neck cancer has been controversial. We have analyzed the long-term outcome of neoadjuvant IAC followed by radiation therapy (RT) and surgery. MATERIALS AND METHODS: Twenty-seven patients with advanced maxillary sinus cancer were treated between 1989 and 2002. Five-fluorouracil (5-FU, 500 mg/m2) was infused intra-arterially, and followed by RT (total 50.4 Gy/28 fractions). A planned surgery was performed 3 to 4 weeks after completion of IAC and RT. RESULTS: At a median follow-up of 77 months (range, 12 to 169 months), the 5-year rates of overall survival in all patients were 63%. The 5-year rates of overall survival of stage T3/T4 patients were 70.0% and 58.8%, respectively. Seven of fourteen patients with disease recurrence had a local recurrence alone. The 5-year actuarial local control rates in patients with stage T3/T4, and in all patients were 20.0%, 32.3%, and 27.4%, respectively. Overall response rate after the completion of IAC and RT was 70.3%. During the follow-up, seven patients (25.9%) showed mild to moderate late complications. The tumor extent (i.e., the involvement of either orbit and/or base of skull) appeared to be related with local recurrence. CONCLUSION: Neoadjuvant IAC with 5-FU followed by RT and surgery may be effective to improve local tumor control in the patients with advanced maxillary sinus cancer. However, local failure was still the major cause of death. Further investigations are required to determine the optimal treatment schedule, radiotherapy techniques and chemotherapy regimens.

Obstructive Sleep Apnea of Achondroplasia Treated With Continuous Positive Airway Pressure

No abstract available.

Comparative Analysis for the Surgical Outcomes of Uvulopalatal Flap and Palatal Muscle Resection in Patients with Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to compare the surgical outcomes of uvulopalatal flap (UPF) and palatal muscle resection (PMR) techniques in the treatment of obstructive sleep apnea (OSA). SUBJECTS AND METHOD: Forty-three consecutive patients (40 men and 3 women) with OSA were included. Only patients with Fujita type I obstruction were enrolled in this study. Patients with macroglossia or retrognathia were excluded from the study. Twenty patients underwent a UPF and twenty-three patients underwent a PMR. In both groups, nasal surgery was performed if necessary. Questionnaires based on Visual Analogue Scale (VAS) about snoring, apnea, morning headache, tiredness, daytime sleepiness and Epworth Sleepiness Scale (ESS) were analyzed before and after each surgical treatment. Preoperative and postoperative polysomnography (PSG) were completed by every patient. RESULTS: In UPF group, every aspect of VAS except morning headache was significantly improved after surgery. In PMR group, every aspect of VAS and ESS were significantly improved after surgery. Comparing the surgical outcomes between two groups, every VAS and ESS showed much better result in PMR than UPF group. In both UPF and PMR group, the mean apnea-hypopnea index decreased significantly after surgery. However, there's no significant difference between two groups in the PSG findings. CONCLUSION: PMR could be a better surgical technique than UPF with respect to subjective outcome although both UPF and PMR are effective surgical techniques for the treatment of OSA with Fujita type I obstruction.

The Integrated Surgical Strategy for Removal of Inverted Papilloma Involving the Maxillary Sinus According to the Site of Tumor Origin / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The objective of this study is to determine the appropriate surgical approach for the resection of inverted papilloma (IP) involving the maxillary sinus (MS) according to the site of tumor origin in the MS. SUBJECTS AND METHOD: Twenty-six patients who underwent surgery from January 2002 to April 2008 for IP originating from the MS were reviewed retrospectively in regard to the type of integrated surgical approach, site of tumor origin in the MS and the follow-up clinical results. RESULTS: Ten cases (38.4%) originated from medial wall of the MS; of these, four EES (endonasal endoscopic surgery), two EMM (endoscopic medial maxillectomy), two EES+CP (canine puncture), and two EES+CLA (Caldwell-Luc's approach) were performed. EES+CP procedure were performed in all three cases (11.5%) of the anterior wall origin. One case (3.8%) that originated from the posterolateral wall was removed by EES+CLA. Four cases (15.3%) originated from the medial-posterolateral wall. Two EES, and one each of EMM and EES+CLA were performed. Three cases (11.5%) originated from the superior-posterolateral wall, of which two cases were removed by EES and the other by EES+CLO (Caldwell-Luc's operation). Two cases of inferior-anterior wall and inferior-posterolateral wall were removed by EES+CLO and EES+CLA, respectively. EES+CLO were performed for three cases of the whole wall origin (11.5%). Two recurrent cases were found in each of EES and EES+CLO. CONCLUSION: IP originated from the MS were successfully managed by EES alone or EES combined with other approaches such as CP, CLA, CLO and EMM. These integrated approaches need to be applied in a gradual manner from less severe to more aggressive cases.

A Case of Myoepithelial Carcinoma Originated from Inferior Turbinate / 대한이비인후과학회지

Myoepithelial carcinoma is a rare malignant tumor of the salivary glands with an incidence of less than 1%. Most cases arise in the parotid gland but have also been described in the submandibular gland and in the minor salivary glands. Myoepithelial carcinoma shows almost exclusively tumor cells with myoepithelial differentiation, although epithelial-myoepithelial carcinoma is characterized by a biphasic cell population represented by myoepithelial and ductal epithelial cells. Although myoepithelial carcinoma arising in the maxillary sinus has been reported, there is no report of myoepithelial carcinoma that has originated from inferior turbinate. We report, with a review of literature, a 72-year-old female patient diagnosed as myoepithelial carcinoma that has originated from the inferior turbinate of left nasal cavity.

A Case of Lobular Capillary Hemangioma with Epidural Abscess / 대한이비인후과학회지

Lobular capillary hemangioma (LCH), also known as pyogenic granuloma, is a benign capillary proliferation with a microscopically distinctive lobular architecture that affects the skin and mucous membrane of the oral cavity and nasal region. LCH commonly involves the nasal cavity as a small hypervascular lesion arising from the anterior third of the septum or the lateral wall. Its diagnosis may be difficult in those rare instances of a large LCH that entirely fills the nasal cavity, which can be confused with more aggressive neoplasms such as hemangiopericytoma or angiosarcoma. We report an intriguing case of LCH associated with epidural hematoma presenting as a huge expansile lesion involving the anterior skull base and orbit.

Pneumatization Pattern of the Frontal Recess: Relationship of the Anterior-to-Posterior Length of Frontal Isthmus and/or Frontal Recess with the Volume of Agger Nasi Cell

OBJECTIVES: We analyzed the pneumatization pattern of the frontal recess (FR) in a Korean population. We also determined the correlation between the volume of the agger nasi cell (ANC) and the anterior-to-posterior (A-P) length of the frontal isthmus (FI) and FR. METHODS: Multiplanar paranasal sinus computed tomography (CT) images from 105 patients who underwent endoscopic sinus surgery were reviewed. The prevalence of frontal recess cells (FRCs), thickness of the frontal beak (FB), volume of the ANC, A-P length of the FI, and FR were evaluated. RESULTS: The ANC was identified in 96% of the patients and frontal cells (FCs) in 32% (FC type 1, 24.2%; type 2, 4.2%; type 3, 3.1%; and type 4, 0%). The prevalences of frontal bullar, suprabullar, supraorbital ethmoidal, and interfrontal sinus septal cells were 10%, 7.8%, 3.6%, and 6.8%, respectively. The A-P lengths of the FR and FI were 10.1+/-3.1 and 8.4+/-2.9 mm, respectively. The thickness of the FB was 7.8+/-1.8 mm and the volume of the ANC averaged 394.1+/-240.5 mm3. The thickness of the FB did not correlate with the volume of the ANC. In contrast, the A-P length of the FI and FR were positively correlated with the volume of the ANC. CONCLUSION: ANCs and FCs were found in 96% and 32% of the cases in this series. FC type 4 was not seen. What appeared to be FC4 on conventional CT was identified as FBC from reconstructed parasagittal images. A large ANC increased the A-P length of the FI and FR, regardless of the thickness of the FB.

A Case of Amelanotic Malignant Melanoma Misconceived as Nasal Polyp / 대한이비인후과학회지

Mucosal malignant melanomas (MM) within the nose and paranasal sinuses are rare, representing 1-3% of MM and 3-4% of malignant sinonasal tumors. The incidence of amelanotic MM with primary lesions in the sinonasal cavity is also extremely rare. The absence of pigmentation in the tumor may result in diagnostic confusion. Amelanotic MM may masquerade as a variety of other conditions leading to a delay in the diagnosis and worsen the prognosis. In this report, we present, along a brief review of the literature, an interesting case of amelanotic MM misconceived as a nasal polyp. Although paranasal MRI and endoscopy showed no evidence of remnant mass after surgery, positron emission tomography/computed tomography (PET/CT) image showed an area of increaed fluorodeoxyglucose (FDG) uptake.

A Case of Giant Cell Granuloma of Maxillary Sinus: Long-Term Follow-Up / 대한이비인후과학회지

Giant cell granuloma is an uncommon bony lesion in the head and neck region that most commonly affects the maxilla and mandible. Although it is a benign disease process, it can also be locally destructive. The most common treatment for giant cell granuloma is surgery, ranging from simple curettage to resection. More recently, nonsurgical treatments have been reported. Systemic calcitonin and intralesional glucocorticosteroids have shown varying degrees of success and, when successful, have reduced the necessity for major reconstructive surgery, thus preventing any large surgical defects. We report a case of giant cell granuloma of the maxilla that responded favorably to treatment with surgical excision, followed by intralesional injection of steroid.

Analysis of Otorhinolaryngologic Disease in Patients with Human Immunodeficiency Virus Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As human immunodeficiency virus (HIV) infection increases in prevalence and new medical therapies prolong the survival of HIV-infected patients, otolaryngologists will see a larger number of patients with head and neck manifestations of HIV infection. The aims of study were to evaluate the various otorhinolaryngologic diseases and to analyze the useful markers for predicting immune function in HIV-infected patients. SUBJECTS AND METHOD: Of 380 HIV-infected patients, 40 patients (10.5% ; 39 males and 1 female, age ranging from 23 to 55) were referred to otorhinolaryngologists. Spectrum of disease and correlation between various surrogate markers (HIV RNA, leukocyte count, neutrophil, lymphocyte, CD3, CD4, CD8 T cell percentage and count, CD4/CD8 ratio) and risk of infectious otorhinolaryngologic diseases were analyzed. RESULTS: Thirty-three patients (82.5%) were infectious, 6 patients (15.0%) had non-infectious diseases and 1 patient (2.5%) malignancy. In otologic diseases, acute otitis media and chronic otitis media were frequently found in the mentioned order. In rhinologic diseases, rhinosinusitis and vestibulitis were frequently found in the mentioned order, with one primary extra nodal non-Hodgkin's lymphoma. In laryngologic diseases, pharyngolaryngitis, oral candidiasis, stomatitis were frequently found. In the surrogate markers of immune function, CD4 percentage, CD4 count and CD4/CD8 ratio were found significantly lower in the infectious diseases than in the non-infectious disease. CONCLUSION: Of HIV-infected patients, 10.5% had seen an otolaryngologist, and the majority had infectious diseases. The risk of infectious diseases was strongly correlated with the CD4 percentage, count and CD4/CD8 ratio.

Inverted Papilloma of the Sinonasal Cavity: The Surgical Strategy of Endoscopic Management Based on the Site of Attachment

The refinement of the endoscopic techniques and development of sophisticated surgical instrumentation has lead to a progressive evolution from external to endoscopic approaches for management of sinonasal inverted papilloma (IP). The golden rule for endoscopic surgery of IP involving the sinonasal cavity is complete resection of the tumor, especially complete extirpation of the tumor attachment or origin area. Preoperative radiologic images using by computed tomography and magnetic resonance could not afford exact information of tumor attachment. Only intraoperative endoscopic findings can provide the precise tumor attachment in the sinonasal cavity. The surgical strategy should be focused on the tumor attachment so that the approach should be different based on the site of attachment in each sinus. And the approach should be minimally invasive fashion. Endoscopic surgery has strong advantage in cases with IP originating from the ethmoid and sphenoid sinus compared to "headlight" surgery era. Integrated approach could be applied in cases with IP originating from the frontal and maxillary sinus.

A Case of Primary Olfactory Neuroblastoma of the Sphenoid Sinus

Olfactory neuroblastoma is a rare malignant tumor of the nasal cavity arising from the olfactory neuroepithelium. It usually present as a polypoid mass in the superior nasal cavity including the cribriform plate, superior turbinate, and superior portion of nasal septum. The development of olfactory neuroblastoma outside of the region, in which olfactory epithelium exists, is exceedingly rare. In this report, we present an interesting case of an isolated sphenoid sinus olfactory neuroblastoma with a brief review of the literature.

A Case of Immature Teratoma of the Nasal Cavity in Infant: Results of 10 Years Follow-Up / 대한이비인후과학회지

Teratomas are rare congenital neoplasms that arise from pluripotent cells. Teratomas of the head and neck are exceedingly rare and are usually present in the neonatal period. Immature teratomas account for less than 1% of all germ cell malignancies and the incidence in the nasal cavity is very rare. We report, with a review of literature, of an immature teratoma in the nasal cavity. A 5-month-old female presented with a right nasal cavity tumor associated with nasal obstruction and recurrent epistaxis. Endoscopic removal was done by minimally external alotomy approach. Tumor had originated from the roof of the nasal cavity & ethmoid sinus, and the nasal septum was deviated to the left side due to expansile mass. At follow-up, 10 years after operation, there was no evidence of recurrence; no severe nasal septum deviation nor atrophy of inferior turbinate was observed.

The Surgical Approach for Removal of Inverted Papilloma Originating from the Frontal Sinus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The surgical approach for the removal of inverted papilloma (IP) involving the frontal sinus (FS) depends on the site of tumor origin. This study was designed to determine the appropriate surgical approach according to the site of origin in the FS. SUBJECTS AND METHOD: Eleven patients with IPs originating from the FS, who had surgery at the department of ORL-HNS, Pusan National University Hospital from 1998 to 2007, were retrospectively reviewed for the site of tumor origin, surgical approach, recurrence, mode of reoperation, and complications. The mean age was 53.8 years with a male-to-female ratio of 7:4. The average follow-up duration was 35.7 months. RESULTS: The sites of tumor origin were the whole wall (2/11), medial wall (3/11), intersinus septal cell (2/11), lateral wall (1/11), posterior wall (1/11), anterior wall (1/11) and diffuse whole wall with invasion into the opposite sinus (1/11). In the two cases with whole wall involvement, one was treated by an osteoplastic frontal sinus surgery (OPF) and the other by a modified endoscopic Lothrop operation (MEL). The case with diffuse anterior wall origin was treated by OPF. For the two cases with the intersinus septal cell origin, one was reoperated using MEL after recurrence and the other was initially treated with MEL. A recurrent case with the lateral wall origin was reoperated by MEL. IPs originating from the posterior or medial wall were successfully managed by endoscopic surgery /c or /s trephination. CONCLUSION: IPs originating from the FS were successfully managed by the integrated endoscopic-assisted approach to the FS. Especially, MEL was a safe and effective alternative treatment to OPF for IPs originating from the FS.

Analysis of Structural Changes of the Inferior Turbinate in Patients with Deviated Nasal Septum by Using Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Compensatory hypertrophy of the inferior turbinate is frequently observed in case of nasal septal deviation. In case of surgical treatment, some advocate that septoplasty must be accompanied by reduction of inferior turbinate. So, the authors analyzed the structural change of the inferior turbinate in nasal septal deviation using the CT scan. SUBJECTS AND METHOD: The CT films of 154 patients who had undergone septoplasty were reviewed retrospectively. All subjects had only Cshaped septal deviation and had no abnormality. Inferior turbinate was divided equally into three portions as anterior, middle and posterior portions. The thickness of mucosa and bone of the inferior turbinate and the degree of inferior conchal bone medialization were measured. RESULTS: In the anterior and middle portion, the degree of medialization at concave side of inferior conchal bone was significantly increased compared to the convex side. In addition, the thickness of bone and mucosa at the concave side was significantly thicker than those of the convex side (p<0.05). However, no significant differences were found in the posterior portion. CONCLUSION: In the nasal septal deviation, the degree of medialization of inferior conchal bone and the thickness of bone and mucosa at the concave side were significantly greater than those of the convex side in the anterior and middle portion.