A Novel Powered Nasal Irrigation After Endoscopic Sinus Surgery in Patients With Chronic Rhinosinusitis: A Preliminary Study / 대한이비인후과학회지

Background and Objectives@#We aimed to compare the efficacy of a novel powered irrigation system with that of the manual bottle-squeeze method for postoperative healing after endoscopic sinonasal surgery (ESS).Subjects and Method In this prospective randomized clinical trial, 29 patients were enrolled for nasal irrigation (NI) with either NOSSHA® (Womens Care Co., Ltd.) powered irrigation system (NOSSHA® group, n=14) or manual irrigation (control group, n=15). Objective findings were evaluated using the modified Lund-Kennedy scores. Subjective outcomes were assessed using the total nasal endoscopic score (TNES), total nasal symptom score (TNSS), visual analog scale (VAS), and quality of life (QOL) questionnaires in each group at baseline, and 1, 2, 4, 6, and 8 weeks after ESS. We compared the postoperative changes between both groups. @*Results@#The mean TNES of patients were significantly higher in the NOSSHA® group than in the control group (p=0.015); however, the improvement in TNES was achieved 2 weeks earlier in the NOSSHA® group. The improvement in TNES (p<0.001) and TNSS (p<0.001) was statistically significant in both groups. The improvement in QOL was statistically significant in the NOSSHA® (p<0.001) and control group (p=0.007). The improvement in the TNSS and QOL was earlier in the NOSSHA® group by 4 and 7 weeks, respectively; no early improvement occurred in the NOSSHA® group for the VAS score. @*Conclusion@#We validated the usefulness of postoperative NI using a powered device, which may be useful for patients who cannot tolerate manual NI.

Practical Review of Biologics in Chronic Rhinosinusitis With Nasal Polyps

Well-characterized in chronic rhinosinusitis, type 2 inflammation is frequently associated with nasal polyps, comorbid asthma, and nonsteroidal anti-inflammatory drug hypersensitivity. Despite medical and surgical treatment, it recurs in a significant proportion of patients. Thus, severe uncontrolled type 2 chronic rhinosinusitis with nasal polyps is the most difficult-to-treat phenotype of chronic rhinosinusitis. Recently, dupilumab, a monoclonal antibody against IL-4 receptor α, and omalizumab, a monoclonal antibody against immunoglobulin E, were approved for patients with chronic rhinosinusitis with nasal polyps in the United States, Europe, and Korea. Therefore, rhinologists should understand novel biologics and their use. Here, we provide a literature review of several biologics with their indications, effectiveness, and safety.

Practical Recommendation of COVID-19 for Otorhinolaryngologists

Otorhinolaryngologic symptoms such as cough, rhinorrhea, anosmia, ageusia, and fever can precede development of COVID-19. Otolaryngologists are vulnerable to potential COVID-19 infection because early cases of COVID-19 have been asymptomatic or show mild manifestations. Otolaryngologists should wear adequate personal protective equipment (PPE) according as location or situation. PPE includes medical masks, goggles, and fluid-resistant gown and gloves. Authors provide clinical recommendations based on PPE for otorhinolaryngologists during the COVID-19 pandemic. In addition, we reviewed the literature related to clinical guidelines of foreign otorhinolaryngology societies with regard to COVID-19.

Clinical Reviews of COVID-19 for Otorhinolaryngologists

The novel SARS-CoV-2 virus that causes COVID-19 has emerged rapidly and the virus has caused a global pandemic since it was first diagnosed in December 2019. SARS-CoV-2 is the seventh virus associated with human transmission among corona viruses. Otorhinolaryngologists could be vulnerable to this viral transmission due to the high viral load in the nasal cavity and nasopharynx. Hence, it is essential to understand the novel COVID-19 from the perspective of otorhinolaryngologists. We provide literature reviews of previous human coronaviruses and the novel COVID-19 with clinical hallmarks, diagnostic approaches, and possible treatment options. Further study is necessary to elucidate viral features and standardize treatment protocols with curable anti-viral agents and vaccines.

The impact of air pollution on allergic rhinitis

Recently, air pollution has become more and more severe globally and has decreased the quality of life significantly in subjects with or without allergic diseases. Air pollution more severely affects patients with allergic diseases, including allergic rhinitis (AR); therefore, it could devastate quality of life. Many epidemiological studies have shown that air pollutants increased outpatient clinic visits as well as the prevalence/severity of AR and decreased quality of life in patients with AR. Traffic-related air pollution also increases the severity and occurrence rate of AR, and heavy traffic is also associated with an increased prevalence of AR. Immunologically, air pollutants increase airway inflammation and mucin production by triggering the generation of reactive oxygen species and inducing the nucleotide-binding domain, leucine-rich repeat protein 3 inflammasome and apoptosis. Since air pollution affects both the upper and lower airways and is known to be a risk factor for AR, proper diagnosis and treatment should be applied. In this review article, we will address several epidemiological and clinical studies about the effects of air pollution on AR, mechanisms by which air pollutants aggravate AR, and treatment of AR triggered by air pollutant.

Strain-Specific Differences in House Dust Mite (Dermatophagoides farinae)-Induced Mouse Models of Allergic Rhinitis

Objectives@#. Limited information is available regarding strain-related differences in mouse models of allergic rhinitis induced by Dermatophagoides farinae (Der f1). In this study, we compared differences between two mouse strains and determined the optimal dose of Der f1 for allergic rhinitis mouse models. @*Methods@#. Forty-eight mice were assigned to the following six groups (n=8 per group): group A (control, BALB/c), group B (Der f1-sensitized BALB/c, 25 µg), group C (Der f1-sensitized BALB/c, 100 µg), group D (control, C57BL/6), group E (Der f1-sensitized C57BL/6, 25 µg), and group F (Der f1-sensitized C57BL/6, 100 µg). Allergic inflammation was induced with Der f1 and alum sensitization, followed by an intranasal challenge with Der f1. Rubbing and sneezing scores, eosinophil and neutrophil infiltration, and immunoglobulin, cytokine, and chemokine levels in the nasal mucosa and from splenocyte cultures were assessed. @*Results@#. Rubbing and sneezing scores were higher in groups B, C, E, and F than in groups A and D, with a similar pattern in both strains (i.e., group B vs. E and group C vs. F). Serum immunoglobulin levels were significantly elevated compared to the control in groups B and C, but not in groups E and F. Eosinophil and neutrophil infiltration increased (all P0.05). BALB/c mice (group B) showed a greater elevation of splenic interleukin (IL)-4 (P<0.01), IL-5 (P<0.01), and IL-6 levels (P<0.05) and nasal IL-4 mRNA levels (P<0.001) than the C57BL/6 mice (group E). Interestingly, mice treated with 100 µg Der f1 showed a weaker allergic response than those treated with 25 µg. @*Conclusion@#. We found 25 µg to be a more appropriate dose for Der f1 sensitization. BALB/c mice are more biased toward a Th2 response and are a more suitable model for allergic rhinitis than C57BL/6 mice. This study provides information on the appropriate choice of a mouse model for allergic rhinitis.

Vascular Leiomyoma of the Nasal Floor: The Risk of Misdiagnosis

Effectiveness of Rapidrhino® Packing in Patients Who Visited Emergency Room due to Anterior Epistaxis

PURPOSE: Although there are many treatment options for managing epistaxis, little is known about their outcomes in the emergency department (ED). In this study, we evaluated the management of epistaxis, especially comparing the efficacy between Rapidrhino® and Merocel®. METHODS: A retrospective review of patients with epistaxis visiting the ED between January 2010 and June 2016 was performed. Haemostatic properties of packs were initially measured in the ED, and after the removal of packs in the otorhinolaryngology clinic. Subgroup analyses were performed in a similar fashion for patients receiving and not receiving anticoagulants or the antiplatelet. RESULTS: The initial success rates for Rapidrhino® and Merocel® were both high (90.3%, 86.3%, respectively). Rebleeding rates for Rapidrhino® and Merocel® were 41.4% and 56.3%, respectively. Overall, there was a significant difference between the two types of packs in recurrence (p=0.032). Particularly, in patients with anticoagulants, the initial success rates of Rapidrhino® were higher than that of Merocel® (88.6%, 76.2%, respectively, p=0.222). The rebleeding rate of Rapidrhino® was much lower than that of Merocel® (54.3%, 85.7%, respectively, p=0.016). In the Rapidrhino® group, the rebleeding rate varied according to the packing removal date (p=0.001). CONCLUSION: Rapidrhino® and Merocel® are equally effective in the initial arrest of epistaxis in the ED. Rapidrhino® may be more effective in controlling haemorrage on removal, particularly in patients with anticoagulants. Patients with epistaxis could be treated with Rapidrhino® in the ED, which could be removed in the outpatient clinic one day later.

Therapeutic Effect of Combination Treatment of Antihistamine and Montelukast in Allergic Rhinitis

BACKGROUND: Montelukast is a type 1 cysteinyl-leukotrienes receptor antagonist that has been widely used in allergic disease. However, the effect of combination of leukotriene receptor antagonist and antihistamine is controversial. The aim of this study was to compare the effect of combination treatment of montelukast and antihistamine, fexofenadine, over antihistamine alone in patients with allergic rhinitis (AR). SUBJECTS AND METHODS: Retrospective chart review of 60 patients with AR was undertaken. Patients were classified into combination group (montelukast and fexofenadine, n=28) and antihistamine only group (fexofenadine, n=32) according to treatment modalities. Questionnaire survey was performed and allergic symptoms (VAS scale, 5pointscale), and SNOT (sinonasal outcome test)-20 score were obtained before and after the treatment. RESULTS: Mean follow-up duration was 6.7+/-4.6weeks. There was no significant difference in demographic data between two groups. Allergic symptoms and SNOT-20 score(nasal, QOL domain) were improved significantly in both groups after the treatment (all p 0.05, respectively). CONCLUSION: A combination treatment of montelukast and fexofenadine showed more efficacies in nasal obstruction than single fexofenadine treatment in patients with AR. Therefore, montelukast could be used effectively with antihistamine in patients with AR complaining nasal congestion.

Seasonal Specificity of Seasonal Allergens and Validation of the ARIA Classification in Korea

PURPOSE: In Korea, tree pollens are known to be prevalent in spring, grass pollens in summer and weed pollens in autumn. However, few studies have revealed their seasonal specificity for allergic rhinitis symptoms. An ARIA (Allergic Rhinitis and its Impact on Asthma) classification of allergic rhinitis was recently introduced and its clinical validation has not been well proved. The aim of this study was to evaluate the seasonal specificity of seasonal allergens and to validate the ARIA classification with the conventional seasonal and perennial allergic rhinitis (SAR/PAR) classification. METHODS: Two hundred twenty six patients with allergic rhinitis were included in this study. The patients were classified according to the sensitized allergens and the ARIA classifications. A questionnaire survey was performed and the data on the seasonal symptom score, the severity of symptoms and the SNOT (sinonasal outcome test)-20 score was obtained and the data was analyzed and compared between the conventional SAR/PAR classification and the ARIA classification. RESULTS: Seasonal pollens (tree, grass, weed) were not specific to the pollen peak season and the patients' symptoms were severe during spring and autumn regardless of the offending pollens. More than 60% of the patients with SAR showed persistent symptoms and 33% of the patients with perennial allergic rhinitis (PAR) had intermittent symptoms, showing the lack of association between the SAR/PAR/PAR+SAR classification and the ARIA classification. The ARIA classification showed better association not only with the symptomatic score, but also with the SNOT-20 score, which showed better validity than the conventional SAR/PAR classifications. CONCLUSIONS: Seasonal pollens were not specific to their season of prevalence in terms of the severity of symptoms, and the ARIA classification showed better representation of allergic symptoms and quality of life (SNOT-20 score) than did the SAR/PAR classification.

Analysis of the Development of the Nasal Septum according to Age and Gender Using MRI

OBJECTIVES: This study was designed to evaluate the normal development of the nasal septum in Koreans using sagittal MRI for the valuable clinical information on septal procedures. METHODS: Two hundred eighty patients who had their whole nasal septum visualized in the midline sagittal view were selected among the 3,904 patients with brain MRI from January, 2004 to December, 2006 at Dankook University Hospital. The patients who had a history of nasal septal surgery or nasal trauma were excluded. Following parameters are calculated and analyzed: lengths of bony and cartilage dorsum and septal cartilage-nasal bone overlap, total septal area, septal cartilage area and, the proportion of the cartilage area to septal area and the maximal harvestable cartilage for grafting were calculated using the PAC(TM) program. RESULTS: All the parameters were increased until adolescence. Thereafter, bony dorsal length, cartilage dorsal length, total dorsal length, total septal area and maximal harvestable cartilage for grafting have not changed significantly with age, while SC-NB overlap length, septal cartilage area, and proportion of the cartilage area to the total septal area were significantly decreased with age. The SC-NB overlap length was positively correlated with the septal cartilage area and the proportion of the cartilage area to the total septal area. CONCLUSION: The small septal cartilage area and its proportion to the total septal area were significantly correlated with a short overlap length of the septal cartilage under the nasal bone. Septal procedures should be carefully performed in the elderly due to the risk of incurring saddle nose.

The Difference between Clinical and Pathophysiologic Recovery according to Recovery Periods in Experimental Maxillary Sinusitis of Rabbit / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was designed to investigate the difference between clinical and pathophysiologic recovery by comparing the recovery periods in the rabbit sinusitis model. MATERIALS AND METHOD: A synthetic sponge was inserted into the right-side nasal cavities of 15 rabbits. After 2 weeks, the maxillary sinusitis was induced and confirmed by computed tomography (CT) scan. The opacification in CT scan was graded, and the mucosa was harvested from the maxillary sinus. Ciliary beat frequency (CBF) was measured for evaluating mucosal function. Light microscopic, scanning and transmission electron microscopic (SEM & TEM) examinations were performed. Histopathologic findings in microscopic examinations were scored in a semiquantitative measure. Each examination was performed at the time of re-opening of maxillary sinus ostium, 4 weeks and 8 weeks after re-opening of maxillary sinus ostium. RESULTS: The sinus opacification in CT scan and ciliary regeneration in SEM showed significant improvement 8 weeks after re-opening of maxillary sinus ostium. But CBF, tissue inflammation score and ciliary wave disorder were not improved significantly 8 weeks after re-opening of maxillary sinus ostium. CONCLUSION: Clinical, functional and histopathologic recoveries from sinusitis require different periods of time. Incomplete functional and histopathologic recoveries can be the cause of relapse or recurrence of sinusitis. Therefore, close follow-up will be necessary after clinical resolution of sinusitis.

ROS Formation and the Mechanism of Photodynamic Therapy Using 9-Hydroxypheophorbide-a on AMC-HN3 Human Head and Neck Carcinoma Cell Line / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: During PDT, photosensitizer accumulates in the cell and irradiation forms ROS. ROS leads to activation of apoptoticpathway and cell death. Elevated intracellular calcium is known to play important role in apoptotic pathway. There are two type of ROS formation. The type of ROS formation differs in type of photosensitizers. We designed the experiment to define the relationship of ROS and cell death in PDT. MATERIALS AND METHOD: AMC-HN3 cells were cultured. Using a CaspACE assay kit, we measured caspases-3 activity after PDT. We also observed intra-cellular calcium concentrations using confocal microscopy (calcium green-1 stain) after PDT. To determine which type of reaction occursduring ROS formation, MTT assay was performed. RESULTS: Confocal microscopy showed that ROS had formed at the site of photosensitizer formation after PDT. After PDT, intracellular calcium increased. MTT assay showed more viability increase in blocking type II reaction. Caspase assay showed highest level after 4hrs. CONCLUSION: ROS is formed at the site photosentizer formation after PDT. Type II reaction was the main type of ROS formation. Apoptosis was main pathway of cell death in low dose of photosensitizer after PDT.