Immunoglobulin G4-Related Disease Involving the Pterygopalatine Fossa, Mimicking Invasive Aspergillosis: A Case Report and Literature Review

We report a case of Immunoglobulin G4 (IgG4) related disease involving the pterygoplataine fossa. A 83-year-old male presented with left ocular pain and visual disturbance. CT showed an isodense soft tissue lesion in the left pterygopalatine fossa with bony sclerotic changes and erosion. MRI revealed an infiltrative soft tissue mass in the left pterygopalatine fossa as a T2 slightly low signal intensity and heterogeneous enhancement. The patient underwent left ethmoidectomy, and biopsy of the mass was conducted. The histopathological diagnosis was IgG4-related disease. In this case, it was difficult to differentiate invasive aspergillosis, which is common in immunocompromised patients, considering the patient’s clinical history of diabetes mellitus. This report describes the imaging findings of IgG4-related disease mimicking invasive sinusitis such as invasive aspergillosis.

Immunoglobulin G4-Related Disease Involving the Pterygopalatine Fossa, Mimicking Invasive Aspergillosis: A Case Report and Literature Review

We report a case of Immunoglobulin G4 (IgG4) related disease involving the pterygoplataine fossa. A 83-year-old male presented with left ocular pain and visual disturbance. CT showed an isodense soft tissue lesion in the left pterygopalatine fossa with bony sclerotic changes and erosion. MRI revealed an infiltrative soft tissue mass in the left pterygopalatine fossa as a T2 slightly low signal intensity and heterogeneous enhancement. The patient underwent left ethmoidectomy, and biopsy of the mass was conducted. The histopathological diagnosis was IgG4-related disease. In this case, it was difficult to differentiate invasive aspergillosis, which is common in immunocompromised patients, considering the patient’s clinical history of diabetes mellitus. This report describes the imaging findings of IgG4-related disease mimicking invasive sinusitis such as invasive aspergillosis.

Three Cases of Endoscopic Endonasal Optic Nerve Decompression for Nontraumatic Optic Neuropathy / 대한이비인후과학회지

The rate of traumatic or nontraumatic optic neuropathy has increased in recent decades. High dose steroid, surgery and combined treatment are used for management of optic neuropathy. Surgical intervention using an endoscopic intranasal approach is expected to provide a safe and effective method for optic nerve decompression. We present outcomes of three patients with neuropathy who underwent endoscopic optic nerve decompression. Of the three patients, two showed improvement: from hand motion to 0.8 and 0.63, respectively. However, one patient who was not able to perceive light did not improve vision after surgery. The difference between the recovered patients and the patient who did not show improvement may be a result of initial visual acuity. Early diagnosis and prompt surgical management could increase the likelihood of improved visual performance; however, this may be limited to patients whose initial visual acuity is better than light perception.

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.

Comparison of Multiple Allergen Simultaneous Test and ImmunoCAP for the Diagnosis of Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Specific IgE assays are important in the diagnosis and treatment of allergic rhinitis (AR). Among the diagnostic tests of AR, multiple allergen simultaneous test (MAST) and ImmunoCAP have been frequently used as simple, safe, and economical methods. In this study, we compared the diagnostic outcomes of MAST and ImmunoCAP in patients with AR. SUBJECTS AND METHOD: Seventy-eight patients (52 men, 26 women, mean age 34.5 years: range 6–80 years), who have nasal symptoms of allergy and no clinical factors to influence the test results, underwent routine skin prick test (SPT) and MAST, and ImmunoCAP for eight major allergens. The diagnosis of AR was based on the criteria of SPT. The class 1 responses or more were regarded as positive for both MAST and ImmunoCAP. The agreements, sensitivities, and specificities of MAST and ImmunoCAP were evaluated along with the correlation between the two tests. RESULTS: Total agreement rates of MAST and ImmunoCAP amounted to 91.5 and 92.1%, respectively. The overall sensitivity and specificity of MAST were 73.4 and 95.3%, respectively, and those of ImmunoCAP were 81.4 and 94.5%, respectively. The correlations between MAST and ImmunoCAP showed statistical significance for Dermatophagoides pteronyssinus/Dermatophagoides farinae. CONCLUSION: Our study demonstrated the diagnostic usefulness of both MAST and ImmunoCAP in AR, especially for the most prevalent allergens of house dust mites. Moreover, ImmunoCAP, which showed higher sensitivity than MAST, can be effectively used in rhinology clinics.

Comparison of Multiple Allergen Simultaneous Test and ImmunoCAP for the Diagnosis of Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Specific IgE assays are important in the diagnosis and treatment of allergic rhinitis (AR). Among the diagnostic tests of AR, multiple allergen simultaneous test (MAST) and ImmunoCAP have been frequently used as simple, safe, and economical methods. In this study, we compared the diagnostic outcomes of MAST and ImmunoCAP in patients with AR.SUBJECTS AND METHOD: Seventy-eight patients (52 men, 26 women, mean age 34.5 years: range 6–80 years), who have nasal symptoms of allergy and no clinical factors to influence the test results, underwent routine skin prick test (SPT) and MAST, and ImmunoCAP for eight major allergens. The diagnosis of AR was based on the criteria of SPT. The class 1 responses or more were regarded as positive for both MAST and ImmunoCAP. The agreements, sensitivities, and specificities of MAST and ImmunoCAP were evaluated along with the correlation between the two tests.@*RESULTS@#Total agreement rates of MAST and ImmunoCAP amounted to 91.5 and 92.1%, respectively. The overall sensitivity and specificity of MAST were 73.4 and 95.3%, respectively, and those of ImmunoCAP were 81.4 and 94.5%, respectively. The correlations between MAST and ImmunoCAP showed statistical significance for Dermatophagoides pteronyssinus/Dermatophagoides farinae.@*CONCLUSION@#Our study demonstrated the diagnostic usefulness of both MAST and ImmunoCAP in AR, especially for the most prevalent allergens of house dust mites. Moreover, ImmunoCAP, which showed higher sensitivity than MAST, can be effectively used in rhinology clinics.

Two Cases of Acute Lymphoblastic Leukemia with an e1a3 BCR-ABL1 Fusion Transcript

No abstract available.

Comparison of Intranasal Ciclesonide, Oral Levocetirizine, and Combination Treatment for Allergic Rhinitis

PURPOSE: To evaluate the efficacy and safety of once-daily ciclesonide in comparison to both levocetirizine alone, and a ciclesonide/levocetirizine combination in patients with seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR). METHODS: Subjects exhibiting moderate to severe allergic rhinitis for longer than 1 year were randomized in an open-label, 3-arm, parallel group, multicenter study. Subjects received 200 microg ciclesonide, 5 mg levocetirizine, or a combination of both. Changes from baseline until the end-of-study visit (2 weeks following) were evaluated by reflective total nasal symptom scores (rTNSSs), reflective total ocular symptom scores (rTOSSs), physician-assessed overall nasal signs and symptoms severity (PANS), and rhinoconjunctivitis quality-of-life questionnaires (RQLQ). RESULTS: Significant improvements in rTNSS, PANS, and RQLQ in the ciclesonide monotherapy group were observed in comparison to the levocetirizine alone group. Three individual symptoms of rTNSS, including runny nose, nasal itching, and congestion, were improved in the ciclesonide-treated group. rTOSS scores for ciclesonide monotherapy improved from baseline, but no superiority over levocetirizine was shown. The absolute score and changes in rTNSS and PANS were positively correlated. Ciclesonide spray was more effective than levocetirizine in reducing nasal symptoms in both SAR and PAR patients. Ciclesonide and levocetrizine were well tolerated alone and in combination. CONCLUSIONS: Our results provide support for an AR and its Impact on Asthma (ARIA) recommendation stipulating that ciclesonide is superior to levocetirizine for the treatment of AR, with tolerable safety. Addition of levocetirizine to ciclesonide did not give further clinical benefit over monotherapy.

A Randomized, Multi-Center, Single Blind, Active-Controlled, Matched Pairs Clinical Study to Evaluate Prevention of Adhesion Formation and Safety of HyFence in Patients After Endoscopic Sinus Surgery

OBJECTIVES: Recurrent mucosal disease and anatomic obstruction are commonly cited causes of failed endoscopic sinus surgery (ESS). Hyaluronic acid (HA) has been reported to reduce scarring and to promote wound healing in sinonasal surgery. HyFence is HA stabilized by 1, 4-butandiol diglycidyl ether, which makes it less-water-soluble and highly viscoelastic. The purpose of this study is to examine the anti-adhesion effect of HyFence after ESS compared to that of HA-CMC (Guardix-Sol). METHODS: Seventy-four patients with chronic rhinosinusitis who underwent ESS were included in the study. After the ESS procedure, Merocel was placed in the ethmoidectomized areas of the both sides. Five milliliters of Guardix-Sol was then applied to the Merocel of one side and HyFence LV was applied to the other side. The effect of the agents was evaluated at one, two, and four weeks after surgery by endoscopic examination. The severity of adhesion, edema, infection and complications were evaluated. RESULTS: There was no significant difference in the incidence of postoperative adhesion between the HyFence group and the Guardix-Sol group (P>0.05). Mean postoperative grades of edema and infection showed no significant difference between groups (P>0.05). There was no significant postoperative complications associated with either anti-adhesion agent (P>0.05). CONCLUSION: HyFence has equivalent anti-adhesion effect compared to Guardix-Sol following ESS.

The Serine Protease Inhibitor, 4-(2-aminoethyl) Benzene Sulfonyl Fluoride Hydrochloride, Reduces Allergic Inflammation in a House Dust Mite Allergic Rhinitis Mouse Model

PURPOSE: Serine protease inhibitors are involved in immune development, anti-inflammatory mechanisms, and tissue repair. In the present study, the serine protease inhibitor 4-(2-aminoethyl) benzene sulfonyl fluoride hydrochloride (AEBSF) was evaluated for its prophylactic and therapeutic applications in a mouse model of allergic rhinitis (AR). METHODS: BALB/c mice were divided into 5 groups: contol (CON), Dermatophagoides farinae (Derf), AR mice treated with AEBSF before sensitization (S), AR mice treated with AEBSF after challenge (C), and steroid groups. Derf was used as an allergen. AEBSF was administered before S or after C. Allergic symptom scores, eosinophil counts, proteolytic activity, interferon-gamma, interleukin (IL)-10 levels and serum Derf-specific IgE levels were measured. T-bet, GATA-3, Foxp3, IL-13, and transforming growth factor (TGF)-beta mRNA levels were determined using real-time polymerase chain reaction. CD4+CD25+Foxp3+ T cells were assessed using flow cytometry. RESULTS: Symptom scores, serum Derf-specific IgE levels, GATA-3 mRNA levels, IL-13 mRNA levels, and tissue eosinophil counts decreased in both the S and C groups (P<0.05). Additionally, the percentage of CD4+CD25+Foxp3+ T cells, IL-10 levels, and Foxp3 mRNA levels increased in the S and C groups compared with those in the Derf group (P<0.05). AEBSF treatment decreased the proteolytic activity in the S and C groups (P<0.05). CONCLUSIONS: Prophylactic and therapeutic treatment with AEBSF significantly reduces allergic airway inflammation and can induce regulatory T cells in a murine model of AR.

Changes in c-Fos Expression in the Forced Swimming Test: Common and Distinct Modulation in Rat Brain by Desipramine and Citalopram

Rodents exposed to a 15-min pretest swim in the forced swimming test (FST) exhibit prolonged immobility in a subsequent 5-min test swim, and antidepressant treatment before the test swim reduces immobility. At present, neuronal circuits recruited by antidepressant before the test swim remain unclear, and also less is known about whether antidepressants with different mechanisms of action could influence neural circuits differentially. To reveal the neural circuits associated with antidepressant effect in the FST, we injected desipramine or citalopram 0.5 h, 19 h, and 23 h after the pretest swim and observed changes in c-Fos expression in rats before the test swim, namely 24 h after the pretest swim. Desipramine treatment alone in the absence of pretest swim was without effect, whereas citalopram treatment alone significantly increased the number of c-Fos-like immunoreactive cells in the central nucleus of the amygdala and bed nucleus of the stria terminalis, where this pattern of increase appears to be maintained after the pretest swim. Both desipramine and citalopram treatment after the pretest swim significantly increased the number of c-Fos-like immunoreactive cells in the ventral lateral septum and ventrolateral periaqueductal gray before the test swim. These results suggest that citalopram may affect c-Fos expression in the central nucleus of the amygdala and bed nucleus of the stria terminalis distinctively and raise the possibility that upregulation of c-Fos in the ventral lateral septum and ventrolateral periaqueductal gray before the test swim may be one of the probable common mechanisms underlying antidepressant effect in the FST.

New Landmark for the Endoscopic Endonasal Transsphenoidal Approach of Pituitary Surgery

OBJECTIVE: To clarify the anatomical correlations of the sphenoid sinus with surrounding structures in the normal Korean population, and to identify surgical landmarks for safe sellar floor dissection in the anterior skull base by endoscopy and microscopy. METHODS: We reviewed the 196 brain magnetic resonance imaging findings showing a normal appearance, and measured the distances between anatomical landmarks. RESULTS: The mean distances from the base of the columella to the anterior wall of the sphenoid sinus and the sellar floor were 69.71+/-4.25 mm and 86.26+/-4.57 mm, respectively in the over 15 age group, and showed the smallest degree of variation among the measurements. The mean angles between the floor of the nasal cavity and the straight line connecting the base of the columella and the sellar floor were 29.45+/-3.25degrees and 24.75+/-4.00degrees in the over 15 and under 15 age groups, respectively. The mean values of both distances and angles increased with age until 15 years after which no further increases were evident. There were no significant differences in the measurements between males and females or among subjects with different degrees of pneumatization in the over 15 age group. CONCLUSION: The distances from the base of the columella to the sellar floor and the anterior wall of the sphenoid sinus, which were consistent among individuals, could be used as a surgical indicator to investigate the sellar floor in endoscopic or microscopic transsphenoidal approaches.

Anatomical Analysis of Intraorbital Structures Regarding Sinus Surgery Using Multiplanar Reconstruction of Computed Tomography Scans

OBJECTIVES: This study aimed to investigate the anatomy of the intraorbital structures regarding to endoscopic sinus surgery and external frontal sinus surgery analyzing computer tomography (CT) scans. METHODS: The CT scans of 100 patients were retrospectively evaluated. The anatomic relationships between the intraorbital structures and paranasal structures were measured using multiplanar reconstruction of the CT scan. RESULTS: The mean distances from the medial orbital floor (MOF) to the intraorbital structures were measured at the depth of the anterior ethmoid (AE), basal lamella (BL), and midportion of posterior ethmoid (PE) in the coronal planes respectively. The mean distances from the MOF to the medial rectus muscle and inferior rectus muscle at the depth of AE were approximately 8 mm and those distances in the BL and PE decreased rapidly. The mean distances from the MOF to the infraorbital nerve at the depth of the AE and BL were approximately more than 10 mm. The mean distances from the vertical axis, which passed through the MOF, to the superior oblique muscle and optic nerve at the depth of the PE were approximately 5 mm medially and 1 mm laterally. In addition, the mean distance from the midline to the trochlea of the superior oblique muscle was approximately 15 mm. CONCLUSIONS: Those measurements provide spatial information on the placements of the extraocular muscles within the orbit. The measurements will contribute to the avoidance of orbital complications during sinus surgery.

A Clinical Analysis of Revision Endoscopic Sinus Surgery: Single-Center 10-Year Experience

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery (ESS) has become a popular procedure for treating chronic sinusitis. Despite recent developments in medical and surgical techniques, primary ESS can still fail. Although revision ESS is one solution to the problem of recurrent sinusitis, revision surgery is stressful for patients and otolaryngologists. Therefore, we examined the causes of ESS failure and sought to find ways to prevent the failure of primary ESS. MATERIALS AND METHODS: All patients who underwent revision ESS in our department between April 2003 and March 2012 were studied retrospectively. RESULTS: During this period, revision ESS was performed 40 times to treat chronic sinusitis. We analyzed the preoperative computed tomographic (CT) findings of primary and revision ESS cases using the Lund-Mackay and Kennedy CT staging scores to compare disease severity. In our cases, the failure of ESS was not affected by the extent of disease, asthma, or allergy. Polyposis was the only useful predictor of revision ESS. CONCLUSION: Polyposis is an important predictor of revision ESS. We recommend that patients be followed frequently and carefully, especially those with polyps.

A Case of Pituitary Metastasis from Breast Cancer That Presented as Left Visual Disturbance

Tumors that metastasize to the pituitary gland are unusual, and are typically seen in elderly patients with diffuse malignant disease. The most common metastases to the pituitary are from primary breast and lung cancers. We report a 65-year-old woman with pituitary metastasis from breast cancer who presented with recent-onset left progressive deterioration of visual acuity and visual field. The clinical diagnosis was made after brain and sellar magnetic resonance imaging showed a large sellar mass compressing the optic chiasm and invading the pituitary stalk. An otorhinolaryngology and neurosurgery team removed the tumor via a transsphenoidal approach, and this procedure obtained symptomatic relief. Postoperatively, metastasis from breast invasive ductal adenocarcinoma was confirmed histologically. We report this unusual case with a review of the relevant literature.

Skin Prick Testing of Patients with Allergic Rhinitis and/or Asthma: a Study in Catholic Medical Center, Korea

BACKGROUND AND OBJECTIVES: Allergic rhinitis is closely related to asthma. The skin prick test is an essential diagnostic tool for allergic disease. We evaluated differences in skin sensitization patterns between groups of patients with allergic rhinitis or asthma, or allergic rhinitis with asthma, in Korea. MATERIALS AND METHODS: From 2000 to 2009, patients with positive results from skin prick testing were divided into three groups: allergic rhinitis (AR), allergic asthma (AS), and allergic rhinitis with allergic asthma (AR+AS). We analyzed demographic data, rhinitis and asthma symptoms, and sensitization patterns. RESULTS: The most common aeroallergen was the house dust mite. The age distributions of the three disease groups differed significantly. Sensitization number, sensitization index, and atopy index were all significantly higher among the AR+AS group than among the AR or AS groups. CONCLUSION: Patients with allergic rhinitis with high numbers of skin sensitizations or intensive positivities should be considered to have concomitant asthma or to be at high risk for asthma development.

Association between apolipoprotein E genotype, chronic liver disease, and hepatitis B virus

BACKGROUND/AIMS: Apolipoprotein E (ApoE) plays an important role in regulating lipid and lipoprotein metabolism, and ApoE genotypes are known to affect plasma lipoprotein concentrations. We investigated whether ApoE genotype determines the disease outcome in hepatitis B virus (HBV)-infected individuals, and verified the association between ApoE genotype and the occurrence of hepatocellular carcinoma (HCC) in patients with chronic liver diseases of various etiologies. METHODS: This hospital-based, case-controlled study enrolled 156 subjects (47 healthy controls, 50 HBV-related liver cirrhosis patients, and 59 HCC patients). ApoE genotypes were determined using PCR-based ApoE genotyping kits. The biological significance of ApoE genotype was verified by measuring serum ApoE levels using an ELISA kits. RESULTS: The epsilon3 allele was the most common allele, with allele frequencies among the entire cohort of 5.8%, 84.3%, and 9.9% for the epsilon2, epsilon3, and epsilon4 alleles, respectively. Significantly more of those patients carrying the epsilon3/3 genotype had developed liver cirrhosis compared to the control subjects. Being an ApoE4 carrier was associated with a lower probability of developing liver cirrhosis. The allele frequencies and genotype distribution of ApoE did not differ significantly between the liver cirrhosis and HCC patients. The serum level of ApoE was significantly higher in patients with liver cirrhosis than in the healthy controls, but did not differ significantly with the ApoE genotype. CONCLUSIONS: The ApoE epsilon3/3 genotype frequency was higher in patients with HBV-associated liver cirrhosis than in the controls.

Pre- and Post-transfusion Testing for Hepatitis B Virus Surface Antigen and Antibody in Blood Recipients: A Single-Institution Experience in an Area of High Endemicity

BACKGROUND: Hepatitis B remains the most common transfusion-transmitted viral infection. We explored the current status of pre-transfusion screening and post-transfusion follow-up testing for hepatitis B virus (HBV) surface antigen (HBsAg) and antibodies (anti-HBs) in blood recipients from an area of high HBV endemicity. METHODS: A total of 7,780 blood recipients were transfused with at least 1 unit of blood component at a single university hospital in Korea between January 2006 and December 2009. Their medical records were reviewed, and their demographic and transfusion-related data were analyzed. RESULTS: Pre-transfusion HBsAg and anti-HBs levels were tested in 77.6% (6,037/7,780) of the recipients. The results varied widely according to recipient age. In all, 32.8% (1,982/6,037) of the recipients who were tested had dual negative pre-transfusion results for HBsAg and anti-HBs and, therefore, were at increased risk of HBV transmission. Post-transfusion follow-up testing for HBsAg and/or anti-HBs was performed in 22% (436/1,982) of the increased-risk group. CONCLUSIONS: Our data show that current transfusion-related laboratory testing practice is not sufficient to properly investigate possible post-transfusion infections. Routine laboratory tests, including HBsAg and anti-HBs, should be recommended in transfusion guidelines.

What is the Relationship between the Localization of Maxillary Fungal Balls and Intranasal Anatomic Variations?

OBJECTIVES: Although the mechanisms underlying the initiation and maintenance of inflammation in unilateral maxillary fungal balls (FBs) are poorly understood, the relationship between intranasal anatomy and maxillary FB is thought to play an important role. The aim of this study was to investigate the relationship between anatomic variations and FB. METHODS: We enrolled 140 patients who were composed of 56 patients with FB, 56 patients with unilateral chronic rhinosinusitis (CRS), and 28 patients with no sinus disease. Computed tomography scans were retrospectively analyzed to identify and compare the associated nasal anatomic abnormalities. To measure the volume of the nasal cavity and middle meatus, computed tomography scans were reconstructed into three-dimensional images. RESULTS: The relatively larger volume of the middle meatus was associated with the localization of the FB in contrast with the CRS. However, the nasal-cavity volume, nasal valve area, and nasal septal deviation were not significantly associated with localization of FB. The mean volumetric and areal measurements such as nasal cavity, middle meatus, and nasal valve in FB-ipsilateral sides were not significantly different from those in contralateral sides as well as other groups. CONCLUSION: The middle meatus bears the major part of the inspiratory nasal airflow, and its volume may influence the occurrence of FB.

Polysomnographic Parameters Related to the Successful Treatment of Oral Appliance in Patients with Sleep-Disordered Breathing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The use of oral appliances has recently risen as an effective alternative treatment methods for patients with simple snoring or mild to moderate obstructive sleep apnea, who prefer oral appliances to continuous positive airway pressure (CPAP) or who are unable to tolerate CPAP therapy. The objective of this study was to identify which polysomnographic parameters are related to the successful use of oral appliances in patients with sleep-disordered breathing. SUBJECTS AND METHOD: We performed a retrospective study of 29 subjects with sleep-disordered breathing and prescribed the use of an oral appliance. To determine which polysomnographic parameters were related to responsiveness to oral appliances, differences in responder rates were assessed according to apnea severity, sleep position, rapid eye movement-stage dependency, body mass index (BMI) and nasal surgery history. RESULTS: Twenty-one of 29 patients showed improved respiratory disturbance index after oral-appliance treatment. Responder rates of patients with mild, moderate, and severe sleep-disordered breathing were 72.3%, 80%, and 62.5%, respectively. Responder rates among position-dependent and non-position dependent groups were 85% and 44.4%, respectively. When grouping into overweight and normal weight groups according to BMI, responder rates were 69.57% and 83.3%, respectively. The responder rate for 24 patients who had undergone septoturbinoplasty was 75%, whereas it was 60% for the non-surgery group. CONCLUSION: Oral appliance therapy is confirmed to be useful for patients with simple snoring or mild to moderate sleep apnea, or position dependent sleep apnea, and those who have normal weight and low nasal resistance.Oral appliance therapy is confirmed to be useful for patients with simple snoring or mild to moderate sleep apnea, or position dependent sleep apnea, and those who have normal weight and low nasal resistance.