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.

Difference according to Interpretation Methods in Allergic Skin Test

BACKGROUND AND OBJECTIVES: The skin prick test is a widely used test that uses three methods (allergen/histamine ratio method, erythema size method, and wheal size method) to interpret the results. However, there has been no comparison of these methods. The aim of this study is to compare the three different interpretation methods and define the relationship among them. SUBJECTS AND METHOD: A total of 139 patients who visited our allergy clinic complaining of nasal symptoms were enrolled. Three interpretation methods were used for defining positivity in the skin prick test, and their results were compared. The validity of each interpretation method was evaluated by total nasal symptom score. RESULTS: Positivity in the skin prick test was reported in 48.2% of patients according to the allergen/histamine ratio method and in 64.0% of patients according to the wheal size method and erythema size method. The proportion of subjects who showed a negative result with the allergen/histamine ratio method but positive results with the wheal size method or erythema size method was 15.8%. This group had a significantly higher total nasal symptom score, especially rhinorrhea and nasal obstruction, than subjects who showed negative results on all three methods. CONCLUSION: When diagnosing allergic rhinitis patients using the skin prick test, the wheal size method and erythema size method should be considered rather than the allergen/histamine ratio method.

Comparison of Patient Satisfaction between Subcutaneous Immunotherapy and Sublingual Immunotherapy in Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Comparative clinical studies of sublingual and subcutaneous treatments have yielded heterogeneous results. In this study, we compared clinical outcomes in patients allergic to house dust mites (HDMs) that received at least 1 year of subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). SUBJECTS AND METHOD: The present study included 120 patients with HDM allergic rhinitis, 54 patients in the SCIT group and 66 patients in the SLIT group. Each patient was asked to answer a set of questionnaire before starting immunotherapy. The questionnaires included the rhinoconjunctivitis quality of life questionnaire (RQLQ) and a patient satisfaction questionnaire. The patients were asked to answer the questions after undergoing at least 1 year of immunotherapy. RESULTS: RQLQ scores collected after immunotherapy in both SCIT and SLIT groups were decreased significantly. However, the SCIT group had a significantly higher decrease in RQLQ scores for non-nose/eye symptoms than the SLIT group (p-value=0.015). There were no differences in other satisfaction scores between the two groups. SCIT improved clinical symptoms faster than SLIT did within 6 months and 1 year (p-value=0.011, p-value=0.045 respectively). CONCLUSION: SCIT is more effective than SLIT in improving non-nose/eye symptoms in patients with allergic rhinitis. SCIT may relieve the symptoms faster than SLIT.

Changes in Clinical Characteristics of the Patients Who Received Endoscopic Sinus Surgery according to 10 Year Temporal Difference: A Retrospective Observational Study

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery (ESS) was introduced to Korea in the 1980s and has since developed rapidly. There have been many changes in ESS over this period. Thus, in this paper, we explore trends in the clinical characteristics of ESS. SUBJECTS AND METHOD: We retrospectively reviewed patients who underwent the ESS at 000 Hospital performed by a single surgeon at a 10-year interval. By comparing 106 patients who underwent ESS in 2003 and 108 patients who underwent ESS in 2013, we investigated changes in ESS in terms of the target group of surgical indications, CT scores, range of operation and complications. RESULTS: With regard to surgical indications, the proportion of patients who underwent surgery due to nasal polyps in 2013 (32.4%) was lower than in 2003 (59.4%), while the proportion of patients undergoing fungal sinusitis surgery in 2013 (13.9%) was higher than in 2003 (0.0%). In terms of preoperative CT evaluation, Lund-Mackay scores for the maxillary sinus, ethmoid sinus, and ostiomeatal unit were lower in 2013 than in 2003. The proportion of ESS performed only in the maxillary sinus in 2013 (20.0%) was higher than in 2003 (10.0%). CONCLUSION: According to this study, the range and extent of sinusitis was favorable in 2013 compared to in 2003. The group of patients requiring treatment for only maxillary sinus disease accounted for a larger proportion of patients in 2013 than in 2003.

A Case of Fungal Infection in the Onodi Cell with Diplopia / 대한이비인후과학회지

The orbital apex syndrome is a very rare complication of fungal sinusitis, as well as of other conditions, and is characterized by blindness, diplopia, proptosis of the eye and ophthalmoplegia. We present a case of diplopia caused by a fungal ball in the Onodi cell. A 62-year-old woman, diagnosed with orbital apex syndrome and suffering from ophthalmalgia and diplopia in the right eye, was presented to our outpatient clinic. Computed tomography showed a soft tissue lesion occupying the right Onodi cell with chronic inflammation. Patients who have an Onodi cell carry a high risk for optic nerve injury, so endoscopic sinus surgery using navigation was performed. Histopathology examination confirmed the diagnosis of a fungal ball. We experienced a rare case of a fungal ball in the Onodi cell, which caused damage to the adjacent cavernous sinus structure and led to diplopia and orbital pain. We present this case with a brief review of these disease entities.

A Case of Retrobulbar Hematoma after Septal Surgery Under General Anesthesia / 대한이비인후과학회지

Retrobulbar hematoma is a rare complication following septal surgery under general anesthesia. Symptoms and physical findings include temporary blindness, ophthalmoplegia, mydriasis, ptosis, proptosis and eyelid ecchymosis. Recently, we experienced a rare case of the right retrobulbar hematoma after septal surgery. At present, there is no literature about the occurrence of retrobulbar hematoma following septal surgery. We hereby present this case with an emphasis on the importance of prevention, identification and management of retrobulbar hematoma.

Long-term Effects of Specific Allergen Immunotherapy Against House Dust Mites in Polysensitized Patients With Allergic Rhinitis

PURPOSE: Allergen-specific immunotherapy is the only currently available treatment to modify the natural history of allergic rhinitis (AR). If patients are polysensitized, it is difficult to identify the allergen causing the allergic symptoms. We evaluated the effectiveness of immunotherapy against house dust mites (HDMs) in AR patients polysensitized to both HDMs and seasonal allergens. METHODS: Thirty AR patients polysensitized to both HDMs and seasonal allergens (group A) and 30 patients sensitized to HDMs only (group B) were enrolled in this study. All subjects who received immunotherapy against HDMs for more than 2 years were evaluated by the multiple allergen simultaneous test (MAST) to determine the specific IgE level in luminescence units, total eosinophil counts in peripheral blood, serum total IgE, total nasal symptom scores, and the rhinoconjunctivitis quality of life questionnaire (RQLQ) before and after immunotherapy. RESULTS: There were no statistical differences in levels of total and specific IgE, or total eosinophil count between the two groups. The total nasal symptom scores, RQLQ and medication scores significantly decreased after immunotherapy in both groups, however no significant differences were noted between the two groups. CONCLUSIONS: We determined that the primary causative allergen of AR in Seoul, Korea is perennial allergens, such as HDMs, rather than seasonal allergens. This study provides a reference for the selection of allergens to use in immunotherapy for polysensitized AR patients living in an urban environment.

The Usefulness of Latex-covered Merocel(R) Packing in Septal Surgery

BACKGROUND AND OBJECTIVES: Nasal packing after nasal surgery is commonly practiced. Merocel(R) is one of the most popular packing material, however it can be associated with significant pain and bleeding on its removal. A prospective study was performed to compare the efficacy and patient tolerance of Merocel(R) and newly designed Latex-covered Merocel(R) (LCM). MATERIALS AND METHOD: Sixty patients underwent septoplasty for septal deviation. Following septoplasty, the patients were randomly allocated into two groups of 30 patients each who underwent insertion of either Merocel(R) or LCM. Patients were asked to record pain levels using a visual analogue scale(VAS) before and after packing removal, and number of analgesic injection were recorded. Resistance and amount of bleeding on packing removal were also recorded. RESULTS: Both nasal packs effectively prevented post-operative bleeding. However the VAS score for nasal pain and numbers of analgesic use before and after packing removal were significantly lower in the LCM group. LCM was removed more smoothly causing significantly less amount of bleeding on removal. CONCLUSION: LCM provides good post-operative hemostasis and its removal is less traumatic and painful for the patients, therefore improving patient's comfort.

Changes of Alpha1-Antitrypsin Levels in Allergen-induced Nasal Inflammation

OBJECTIVES: Alpha1-antitrypsin (AAT) is the main inhibitor of human neutrophil elastase, and plays a role in counteracting the tissue damage caused by elastase in local inflammatory conditions. The study evaluated the involvement of AAT in nasal allergic inflammation. METHODS: Forty subjects with mono-sensitization to Dermatophagoides pteronyssinus (Dpt) were enrolled. Twenty allergic rhinitis patients frequently complained of nasal symptoms such as rhinorrhea, stuffiness, sneezing, and showed positive responses to the nasal provocation test (NPT) with Dpt (Group I). The other 20 asymptomatic patients showed sensitization to Dpt but negative NPT (Group II). The levels of AAT, eosinophil cationic protein (ECP), and Dpt-specific IgA antibodies were measured in the nasal lavage fluids (NLFs), collected at baseline, 10 minutes, 30 minutes, 3 hours, and 6 hours after the NPT. Nasal mucosa AAT expression was evaluated with immunohistochemical staining from Group I and Group II. RESULTS: At baseline, only the Dpt-specific IgA level was significantly increased in the NLFs of Group I compared with Group II, while ECP and AAT levels were not significantly different between two groups. After Dpt provocation, AAT, ECP, and Dpt-specific IgA levels were significantly increased in the NLFs of Group I during the early and late responses. The protein expression level of AAT was mostly found in the infiltrating inflammatory cells of the nasal mucosa, which was significantly increased in Group I compared to Group II. CONCLUSION: The increment of AAT showed a close relationship with the activation of eosinophils induced by allergen-specific IgA in the NLFs of patients with allergic rhinitis after allergen stimulation. These findings implicate AAT in allergen-induced nasal inflammation.

Changes of Alpha1-Antitrypsin Levels in Allergen-induced Nasal Inflammation

OBJECTIVES: Alpha1-antitrypsin (AAT) is the main inhibitor of human neutrophil elastase, and plays a role in counteracting the tissue damage caused by elastase in local inflammatory conditions. The study evaluated the involvement of AAT in nasal allergic inflammation. METHODS: Forty subjects with mono-sensitization to Dermatophagoides pteronyssinus (Dpt) were enrolled. Twenty allergic rhinitis patients frequently complained of nasal symptoms such as rhinorrhea, stuffiness, sneezing, and showed positive responses to the nasal provocation test (NPT) with Dpt (Group I). The other 20 asymptomatic patients showed sensitization to Dpt but negative NPT (Group II). The levels of AAT, eosinophil cationic protein (ECP), and Dpt-specific IgA antibodies were measured in the nasal lavage fluids (NLFs), collected at baseline, 10 minutes, 30 minutes, 3 hours, and 6 hours after the NPT. Nasal mucosa AAT expression was evaluated with immunohistochemical staining from Group I and Group II. RESULTS: At baseline, only the Dpt-specific IgA level was significantly increased in the NLFs of Group I compared with Group II, while ECP and AAT levels were not significantly different between two groups. After Dpt provocation, AAT, ECP, and Dpt-specific IgA levels were significantly increased in the NLFs of Group I during the early and late responses. The protein expression level of AAT was mostly found in the infiltrating inflammatory cells of the nasal mucosa, which was significantly increased in Group I compared to Group II. CONCLUSION: The increment of AAT showed a close relationship with the activation of eosinophils induced by allergen-specific IgA in the NLFs of patients with allergic rhinitis after allergen stimulation. These findings implicate AAT in allergen-induced nasal inflammation.

Usefulness of Berlin and STOP Questionnaires as a Screening Test for Sleep Apnea in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although obstructive sleep apnea is common, it has often gone undiagnosed in primary care encounters until now, with no validated screening tool of obstructive sleep apnea (OSA) for Korean patients. The aim of this study was to investigate the usefulness of Berlin questionnaire (Berlin Q) and STOP questionnaire (STOP Q) as a screening test for sleep apnea for the Korean patients. SUBJECTS AND METHOD: We administered Berlin Q and STOP Q to 106 patients who received a full night polysomnography. We investigated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each questionnaire according to patients' severity by apnea hypopnea index (AHI). RESULTS: Results were categorized according to AHI severity using cut-off points of AHI greater than 5, 15, and 30. The sensitivity and specificity of the Berlin Q were 69, 72, 78% and 41, 43, 39%, respectively. NPV and PPV of Berlin Q were 0.20, 0.43, 0.74 and 0.86, 0.72, 0.43, respectively. The sensitivity and specificity of the STOP Q was 97, 97, 98% and 35, 20, 12%, respectively. NPV and PPV for STOP Q were 0.67, 0.78, 0.89 and were 0.89, 0.71, 0.40, respectively. CONCLUSION: Our results indicate that STOP Q shows higher sensitivity than Berlin Q with similar specificity. Therefore, STOP Q is a more convenient and better means than Berlin Q to screen patients for obstructive sleep apnea.

Validation of Embletta for Diagnosis of Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Overnight polysomnography (PSG) in a sleep laboratory is the standard method of confirming the diagnosis of obstructive sleep apnea (OSA). However, PSG is expensive, time-consuming, uneasily accessible and labor-intensive, so many patients need a more convenient tool that is ambulatory. The aim of this study was to investigate the usefulness of Embletta by comparing the respiratory parameters derived from Embletta with those of PSG. SUBJECTS AND METHOD: PSG and Embletta sleep study were performed for 42 patients prospectively. Respiratory parameters, such as apnea index (AI), hypopnea index (HI), apnea-hypopnea index (AHI), and oxygen parameters, such as lowest oxygen saturation (LSAT), mean oxygen saturation (MSAT), and oxygen desaturation index (ODI) were measured automatically from Embletta and by hand from PSG. All parameters of Embletta were compared with those of PSG. In addition, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for Embletta were calculated for the diagnosis of OSA. RESULTS: Most of the respiratory parameters and the oxygen parameters were well correlated between PSG and Embletta and the correlation coefficients were well correlated and statistically significant as well. The sensitivity, specificity, PPV, and NPV were 90%, 75%, 0.9, and 0.75, respectively, for Embletta for the diagnosis of OSA. CONCLUSION: Embletta might be clinically useful as a screening device of OSA patients based on its high correlation to PSG and positive predictive value.

Changes of Taste Function after Palatopharyngeal Surgery in Obstructive Sleep Apnea Syndrome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Postoperative taste changes after uvulopalatopharyngoplasty (UPPP) is regarded as an unusual and minor complication. This study aims to evaluate the objective changes of taste threshold according to time course and subjective symptoms change. MATERIALS AND METHOD: With 45 patients who underwent UPPP and 35 patients who underwent nasal surgery as control group, we have prospectively studied postoperative taste changes using a questionnaire, and an electrogustometer (EGM) with regard to symptoms at 7th, 28th days after the surgery. EGM was measured at 5 areas. Also, we have checked pre-operatively about the serum level of zinc. RESULTS: With EGM, the threshold of taste was increased at 7th days after the surgery (p<0.05), but recovered 28th days after the surgery at the posterior part of the tongue in the UPPP group. There were no significant changes in subjective taste dysfunction, smell dysfunction, tongue sensory abnormality, and dysgeusia. CONCLUSION: Taste changes after UPPP was transient and they disappeared within the 1st postoperative month. There were no patients who complained of subjective taste dysfunction, dysgeusia, tongue sensory abnormality after UPPP.

Clinical and Polysomnographic Characteristics in Rapid Eye Movement-Related Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To evaluate the clinical and polysomnographic features of rapid eye movement (REM)-related obstructive sleep apnea (OSA). SUBJECTS AND METHOD: 185 consecutive OSA patients were classified as having REM and non- REM OSA. Subjective symptoms, anthropometric and polysomnographic characteristics between REM OSAS and non-REM OSAS patients were compared. RESULTS: Thirty-eight of the 185 patients (20.5%) were classified as REM OSA, and 147 patients (79.5%) were classified as non-REM OSA. Ninety five percent of the REM OSA patients belonged to the mild or moderate OSA group. The dominant occurrence of apnea and hypopnea in REM sleep did notseem to affect subjective symptoms and daytime sleepiness. Anthropometric and polysomnographic features did not help to differentiate REM OSA from non-REM OSA. CONCLUSION: REM OSA may not be a separate and specific disease entity of OSA.

Difference of Polysomnographic, Anthropometric, Physical and Radiologic Findings in an Obstructive Sleep Apnea Syndrome Patient with Excessive Daytime Sleepiness

BACKGROUND AND OBJECTIVES: Excessive daytime sleepiness (EDS) is a well-known consequence of the obstructive sleep apnea syndrome (OSAS) and can be the cause of several psycho-social problems. The objective degree of EDS measured by the multiple sleep latency test is not correlated with the subjective degree of EDS. We examined EDS according to Epworth sleepiness scale (ESS) in OSAS and evaluated the difference between EDS group and non-EDS group. MATERIALS AND METHODS: One hundred sixteen patients diagnosed with OSAS and prepared for surgical treatment were evaluated for this study. They were divided between EDS and non-EDS groups by a Korean version of ESS questionnaire. Also, they were given a physical examination and checked for anthropometric parameters, factors related with respiration and sleep architecture during sleep. Then, we measured the difference of sleep parameters between the EDS group and non-EDS group and found correlated factors of sleep with EDS measured by ESS. RESULT: There were no significant differences in the physical examination, anthropometric factors and sleep architecture between the EDS group and non-EDS group. Only the parameters of arousal (arousal with respiration, total arousal) were different between the two groups. ESS score showed a correlation with parameters of arousal, apnea index and apnea-hypopnea index with weak correlation efficiency. CONCLUSION: The parameters related with arousal revealed that there was a difference between the EDS group and non-EDS group. Some parameters including apnea, apnea-hypopnea index showed a correlation with ESS score. It suggests that EDS could develop and be aggravated by sleep fragmentation occurring from OSAS.

Significance of Peripheral Eosinophilia and Allergic Rhinitis in Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis (CRS) frequently coexists with allergic rhinitis (AR) and nasal polyp. The eosinophil is known to play a pivotal role in allergic reaction and chronic inflammation of respiratory epithelium in paranasal sinus. Therefore, we evaluated the peripheral eosinophilia (PE) in patients with CRS and then investigated its relationship with the AR. We also investigated the correlation of the prevalence of nasal polyp with the incidence of nasal polyp and the severity of PNS CT scoring. SUBJECTS AND METHOD: One hundred and three CRS patients who had persisting symptoms more than 3 months and were refractory to medical management were enrolled. Thirty-six patients with AR only were selected on the basis of allergy rhinitis workup and PNS CT. PE was defined as eosinophil count of more than 4% of the peripheral differential blood count. The scoring system of PNS CT imaging was adopted from Ikeda, et al. RESULTS: CRS with AR had the higher prevalence of PE and nasal polyp (p=0.005 and p=0.046, respectively) than non-AR. CRS with AR had the higher prevalence rate of PE than AR (p=0.001). PE was not related with the prevalence of nasal polyp in the presence of CRS with AR. Peripheral eosinophil partition rate also did not correlate with severity of PNS CT score, irrespective of AR. There was no statistical difference in PNS CT score between AR group and non-AR group, either. CONCLUSION: CRS with AR may be associated with nasal polyp and PE but PE itself had no relationship with the disease severity on PNS CT and prevalence of nasal polyp in the presence of CRS.

Relationship between Symptom Scores and Quality of Life before and after Endoscopic Sinus Surgery: Comparison between RSDI and SF-36v2(TM) Questionnaire / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In recent years, the emphasis on medical care has shifted from symptom scores and objective test results to the patient-centered assesment of effect of disease or response to treatment. So, we compared, before and after endoscopic sinus surgery (ESS), the relationship between 7 nasal symptom scores and quality of life scores measured with RSDI and the SF-36v2(TM) questionnaires, which have been verified by many articles. SUBJECTS AND METHOD: Subjects were 50 patients diagnosed as chronic sinusitis and who underwent ESS from November 2005 to Oct 2006. Patients filled out two questionnaires and checked a visual analogue scale at admission for surgery, and at 2, 4, 8 and 32 weeks postoperatively. Two questionnaires are the Rhinosinusitis Disability Index (RSDI) questionnaire, the SF-36v2(TM) questionnaire, and the visual analogue scale (VAS) is composed of nasal obstruction, rhinorrhea, postnasal drip, sneezing, cough, headache and facial pain. So, we compared each score of the SF-36v2(TM) (PCS and MCS) and RSDI with symptom scores of VAS. RESULTS: In comparing the scores of the RSDI with the symptom scores of VAS, statistically significant relationship was noted with respect to nasal obstruction, headache, and rhinorrhea continuously. But in comparing the scores of the SF-36v2(TM) (PCS and MCS) with the symptom scores of VAS, no statistically significant relationships was observed. CONCLUSION: With respect to the relationship between the quality of life after ESS and symptom severity, RSDI was found to be more effective than SF-36v2(TM). However, because results showed up differently in the two different kinds of questionnaire, it is important that we should use several different verified questionnaires in order to assess patient-centred response to ESS.

Clinical Value of ApneaLink(TM) in the Diagnosis of Obstructive Sleep Apnea Syndrome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Overnight polysomnography (PSG) in a sleep laboratory is the standard method of confirming the diagnosis of obstructive sleep apnea (OSA). However, PSG is expensive, time-consuming, uneasily accessible and labor-intensive, thus the need for ambulatory screening tests. The aim of this study was to find out the usefulness of ApneaLink(TM) by comparing respiratory parameters derived from ApneaLink(TM) with those of PSG. SUBJECTS AND METHOD: A prospective study was undertaken using 40 patients for whom polysomnography and ApneaLink(TM) were performed. Apnea index (AI), hypopnea index (HI), and apnea-hypopnea index (AHI) from ApneaLink(TM) were obtained automatically and those from PSG were scored. All parameters were compared between PSG and ApneaLink(TM). RESULTS: The correlation coefficience of AI, HI, and AHI, which are all attainable by both PSG and ApneaLink(TM), were 0.73, 0.53, and 0.78, respectively. The results of PSG and ApneaLink(TM) showed no statistical difference. The positive predictive value was 0.9, sensitivity 91% and specificity 73% in ApneaLink(TM). CONCLUSION: ApneaLink(TM) might be clinically useful as a screening device of OSA and as a follow-up study of patients after surgery based on its high correlation with PSG and positive predictive value.

Analysis of Preoperative Consultations of Patients With Snoring and Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Obstructive Sleep Apnea (OSA) is well known as a risk factor in the hypertension, cardiovascular and cerebrovascular diseases and other metabolic diseases. Therefore, preoperative evaluation in OSA patients is very important to discover comorbid diseases and other risk factors for anesthesia and surgery itself. We tried to find out the incidence of consultation to other department and incidence of risk factors. SUBJECTS AND METHOD: 195 patients who received surgery due to OSA and snoring were included. We analyzed consultation history to other department for evaluation of risk in surgery and anesthesia, by going through past medical history, laboratory tests, chest radiographs, and electrocardiograms, etc., in the medical records. RESULTS: 38.5% (75 patients) of the patients were consulted to other department. The causes of consultation were liver problems, abnormal chest PA, hypertension, diabetes mellitus, etc., in the order of frequency. Only 17 patients were newly diagnosed by consultation. The rate of consultation was significantly correlated with the severity of OSA by apneahypopnea index and minimal oxygen saturation. CONCLUSION: The patients with OSA need several consultations for evaluation of operative and anesthetic risk, especially in the severe OSA. Therefore, OSA patients should be evaluated precisely, and managed carefully.

Impact of Symptomatic Allergic Rhinitis on Attention and Development of Personality and Behavior in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Allergic rhinitis reduces the quality of life as a result of suffering from symptoms and possibly of impaired cognition and performance. The difference in attention and development of personality and behavior between the symptomatic children group and normal children was evaluated to delineate more clearly the impact of allergic rhinitis on children. SUBJECTS AND METHOD: The comparison of allergic symptoms, attentiveness, cognitive function, development of personality and behaviors as well as the parenting style of 38 patients with symptomatic allergic rhinitis and 31 healthy controls were matched for intelligence, age and sex. The clinical analysis was carried out by a pediatric psychologist who interpreted the results. RESULTS: A defective frontal lobe function and decreased constant concentration were observed in allergic rhinitis group. There was a significant decrease in verbal development and performance development in the allergic rhinitis group. Parents of allergic rhinitis group were found to have said some swear words or hurt child's feeling by using bad language. CONCLUSION: Allergic rhinitis group was more deteriorated compared to the control group in regards to attentiveness, frontal lobe function, verbal and performance development, thus we can say that allergic rhinitis can affect attention, cognitive function and personality development of the child.