Clinical Characteristics and Treatment Outcome of Squamous Cell Carcinoma Associated With Inverted Papilloma: Comparison With Sinonasal de Novo Squamous Cell Carcinoma / 대한이비인후과학회지

Background and Objectives@#Squamous cell carcinoma associated with inverted papilloma (IP+SCC) is different histologically and biologically from sinonasal de novo squamous cell carcinoma (dnSCC). However, few studies have compared the characteristics of patients, behaviors of tumor, and treatment outcome of two different forms of SCC.Subjects and Method We retrospectively reviewed the medical records of 30 patients with IP+SCC and 39 patients with dnSCC who had been treated at Chungnam National University Hospital from 1989 to 2018. Demographics, clinicopathological characteristics, treatment modalities and outcome were analyzed. @*Results@#The mean age, sex ratio, and the proportion of smokers were similar in both groups. On the other hand, the presenting symptoms of each group were somewhat different: nasal symptoms were more frequent in the IP+SCC group, whereas facial symptoms were more frequent in the dnSCC group. Patients with dnSCC showed significantly more advanced T stage, poorer differentiation of cancer cells, and more bone destruction. The upfront method of treatment was surgery in both groups, whereas radiotherapy and chemotherapy were more frequently used as an adjuvant or main treatment in the dnSCC group. Patients with IP+SCC demonstrated better 5-year overall survival and disease-free survival than the dnSCC group. In both groups, patients with the lower T stage had better outcome than those with the higher T stage. The presence of nodal or distant metastasis was an independent, poor prognostic factor for survival regardless of the type of tumor. @*Conclusion@#Although sinonasal IP+SCC and dnSCC are often considered similar diseases, our findings suggest that IP+SCC may represent a less aggressive form of malignancy than dnSCC.

Expression and Role of Calcitonin Gene-Related Peptide in Patients With Chronic Rhinosinusitis With Nasal Polyposis / 대한이비인후과학회지

Background and Objectives@#A recent study revealed that calcitonin gene-related protein (CGRP) plays an important role in inflammatory airway diseases. However, the influence of CGRP on chronic rhinosinusitis (CRS) has not been studied. This study investigated the expression, activity, and potential pathogenic role of CGRP in patients with CRS with nasal polyposis (CRSwNP).Subjects and Method Patients with CRSwNP and control subjects were enrolled. The CRSwNP group was divided according to the presence of eosinophilic polyps and non-eosinophilic polyps. Nasal polyps (NPs) and uncinate tissues (UTs) from patients with CRSwNP and UTs from control subjects were obtained to investigate the expression of α-/β-CGRP and chromogranin A. In addition, the expression patterns of cytokines following exposure to exogenous CGRP were analyzed in dispersed nasal polyp cells (DNPCs) from patients with eosinophilic or non-eosinophilic CRSwNP. The effects of CGRP on lipopolysaccharide (LPS)-induced nuclear factor-kappa light chain enhancer of activated B cells (NF-κB) signaling change were evaluated in THP-1 cells. @*Results@#The expression of α-/β-CGRP and number of CGRP-producing cells were significantly higher in NPs from patients with CRSwNP than in UTs from controls. Exogenous CGRP decreased the expression of inflammatory cytokines and increased that of the anti-inflammatory cytokines in DNPCs from patients with eosinophilic nasal polyps (EPs) and also increased the expression of tissue remodeling-related and anti-inflammatory cytokines in DNPCs from patients with non-eosinophilic nasal polyps (N-EPs). CGRP inhibited the nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor (IκB) phosphorylation and NF-κB translocation in LPS-stimulated M1 macrophages. @*Conclusion@#CGRP expression in NPs may play a significant role in nasal polypogenesis through inflammatory modulation, and it could be a future target to modulate certain aspects of CRSwNP.

Efficacy of Polylactic-Co-Glycolic Acid Plate as a Graft Material in Septorhinoplasty / 대한이비인후과학회지

Background and Objectives@#Polylactic-co-glycolic acid (PLGA) plate has been recognized for its biocompatibility and biomechanical properties and used widely in various clinical fields. The aim of this study was to evaluate the usefulness and reliability of PLGA plate as a graft material in septorhinoplasty.Subjects and Method Medical records were retrospectively analyzed for patients who underwent septorhinoplasty including extracorporeal septoplasty from January 2017 to June 2020. We evaluated demographics, diagnosis, operation techniques, and complications of PLGA plate as a graft material used in these patients. @*Results@#A total of 33 patients were enrolled in this study. Twenty-eight were male and 5 were female. The median age was 32 years old. The follow-up period after surgery was 6-32 months, and the mean follow-up period was 18.03 months. The PLGA plate was used in unilateral spreader graft (n=17), bilateral spreader graft (n=10), batten graft (n=3), strengthening of septal extension graft (n=2) and columellar strut graft (n=3), and fixing L-strut during extracorporeal septoplasty (n=12). During the follow-up period, no patient experienced extrusion or exposure of the grafts. Mild complications, such as redness of the columella skin, granulation in the marginal incision site, and pain on the nasal dorsum were observed in three patients; these complications were temporary and patients improved with conservative treatments. @*Conclusion@#The PLGA plate may be a useful graft material in correcting deviated nose especially when the harvested septal cartilage is insufficient and if used carefully in limited locations such as L-strut and columella.

Clinical Analysis of 382 Sinonasal Inverted Papilloma Cases Treated at A Single Tertiary Medical Center

Background and Objectives@#Sinonasal inverted papilloma (IP) is a benign tumor with a locally aggressive nature and a propensity to recur. Many risk factors for recurrence have been reported, but they are still controversial. The aim of this study was to comprehensively assess the demographic data, clinical features, and potential risk factors for recurrence of IP.Subjects and Method: This work is a retrospective review of 382 patients diagnosed with and treated for sinonasal inverted papilloma between 1986 and 2017 at a single tertiary medical center. Demographic data, presence of associated malignancy, information about previous surgeries, tumor location, Krouse stage, surgical approach, follow-up duration, and data on recurrence were obtained. @*Results@#In our study, 31 of 382 cases (8.1%) were associated with malignancy. Mean age was significantly higher in patients with associated malignancy compared to the benign IP group. Of the 351 benign cases, 263 (74.9%) were primary, and 88 (25.1%) were revision cases (residual or recurrent disease). Although the proportion of patients with high Krouse stage or multifocal involvement was high in the revision cases, there was no significant difference in recurrence rate. The 226 patients with a minimum follow-up of 1 year were included for recurrence analysis. Recurrence rate was significantly higher in the conventional surgery group (17.4%) compared to that of the endoscopic and combined surgery groups (8.1% and 3.6%, respectively). Also, the recurrence group showed significantly larger proportion of patients with high Krouse stage and multifocal involvement. @*Conclusion@#Risk factors for recurrence of IP found in this study are comparable to those previously published. Generally, the factors associated with recurrence of IP were prior surgery, clinical stage, involved site, and surgical approach. Therefore, surgeons should always consider these risk factors to reduce the chance of recurrence.

Nucleotide-Binding Oligomerization Domain-Like Receptor 3 Inflammasome Inhibition by MCC950 Reduces the Lipopolysaccharide-Induced Interleukin-1β in Cultured Dispersed Nasal Polyp Cells / 대한이비인후과학회지

Background and Objectives@#The nucleotide-binding oligomerization domain-like receptor (NLRP) 3 is known as a member of the NLR family, and it has been confirmed that the NLRP3 inflammasome is associated with various diseases such as asthma, inflammatory bowel disease, metabolic disorders and multiple sclerosis, as well as other auto-immune and auto-inflammatory diseases. However, the role of NLRP3 in chronic rhinosinusitis with nasal polyps (CRSwNP) has not yet been explored.Subjects and Method Forty-four specimens of nasal polyps and 25 specimens of uncinate processes were collected from patients with chronic rhinosinusitis with nasal polyps, and 25 specimens of uncinate tissues were collected from patients who underwent other rhino-surgeries. The western blot assay was employed to analyze the expression of NLRP3; interleukin (IL)-1β and IL-17A were detected using immunohistochemistry and real-time polymerase chain reaction. The production of lipopolysaccharide (LPS) induced IL-1β and IL-17A with or without the NLRP3 inflammasome inhibitor (MCC950) was measured using an enzyme linked immunosorbent assay in cultured dispersed nasal polyp cells. @*Results@#NLRP3 showed a high level of expression in nasal polyps than in the control group (p<0.01). The expression of IL-1β and IL-17A was significantly higher in nasal polyps in the CRSwNP group than in the control group (p<0.05). LPS-induced production of IL-1β was significantly suppressed by treatment with the NLRP3 inflammasome inhibitor (p<0.05). @*Conclusion@#The NLRP3 inflammasome plays an essential role in the pathogenesis of CRSwNP, and thus MCC950 can be considered a prospective therapeutic for NLRP3 inflammasome-mediated inflammation in nasal polyps. Our data provide new evidence that IL-17A is involved in inflammasome-associated inflammation in nasal polyps.

Altered Mitochondrial Functions and Morphologies in Epithelial Cells Are Associated With Pathogenesis of Chronic Rhinosinusitis With Nasal Polyps

Purpose@#Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex inflammatory disease of the nasal and paranasal sinus mucosa. The disease is associated with mitochondrial dysfunction, structural changes in the mitochondria, and reactive oxygen species (ROS) generation. This study investigated whether there are functional and morphological changes in the mitochondria in the epithelial cells of nasal polyps (NPs) and Staphylococcus aureus enterotoxin B (SEB)-stimulated nasal epithelial cells. @*Methods@#In all, 30 patients with CRSwNP and 15 healthy subjects were enrolled. Mitochondrial ROS (mtROS) and changes in mitochondrial functions and structures were investigated in the uncinate tissue (UT) of healthy controls, the UT or NPs of CRSwNP patients, and human nasal epithelial cells with or without SEB stimulation. @*Results@#Oxidative phosphorylation complexes showed various responses following SEB stimulation in the nasal epithelial cells, and their expressions were significantly higher in the NPs of patients with CRSwNP than in the UT of controls. Generation of mtROS was increased following SEB exposure in nasal epithelial cells and was reduced by pretreatment with MitoTEMPO, which is used as an mtROS scavenger. In the tissues, mtROS was significantly increased in the NPs of CRSwNP patients compared to the UT of controls or CRSwNP patients. The expressions of fusion- and fission-related molecules were also significantly higher in SEB-exposed nasal epithelial cells than in non-exposed cells. In tissues, the expression of fission (fission mediator protein 1)- and fusion (membrane and mitofusin-1, and optic atrophy protein 1)-related molecules was significantly higher in the NPs of CRSwNP patients than in UT of controls or CRSwNP patients. Transmission electron microscopy revealed elongated mitochondria in SEB-exposed nasal epithelial cells and epithelial cells of NPs. @*Conclusions@#Production of mtROS, disrupted mitochondrial function, and structural changes in nasal epithelial cells might be involved in the pathogenesis of CRSwNP.

Altered Mitochondrial Functions and Morphologies in Epithelial Cells Are Associated With Pathogenesis of Chronic Rhinosinusitis With Nasal Polyps

Purpose@#Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex inflammatory disease of the nasal and paranasal sinus mucosa. The disease is associated with mitochondrial dysfunction, structural changes in the mitochondria, and reactive oxygen species (ROS) generation. This study investigated whether there are functional and morphological changes in the mitochondria in the epithelial cells of nasal polyps (NPs) and Staphylococcus aureus enterotoxin B (SEB)-stimulated nasal epithelial cells. @*Methods@#In all, 30 patients with CRSwNP and 15 healthy subjects were enrolled. Mitochondrial ROS (mtROS) and changes in mitochondrial functions and structures were investigated in the uncinate tissue (UT) of healthy controls, the UT or NPs of CRSwNP patients, and human nasal epithelial cells with or without SEB stimulation. @*Results@#Oxidative phosphorylation complexes showed various responses following SEB stimulation in the nasal epithelial cells, and their expressions were significantly higher in the NPs of patients with CRSwNP than in the UT of controls. Generation of mtROS was increased following SEB exposure in nasal epithelial cells and was reduced by pretreatment with MitoTEMPO, which is used as an mtROS scavenger. In the tissues, mtROS was significantly increased in the NPs of CRSwNP patients compared to the UT of controls or CRSwNP patients. The expressions of fusion- and fission-related molecules were also significantly higher in SEB-exposed nasal epithelial cells than in non-exposed cells. In tissues, the expression of fission (fission mediator protein 1)- and fusion (membrane and mitofusin-1, and optic atrophy protein 1)-related molecules was significantly higher in the NPs of CRSwNP patients than in UT of controls or CRSwNP patients. Transmission electron microscopy revealed elongated mitochondria in SEB-exposed nasal epithelial cells and epithelial cells of NPs. @*Conclusions@#Production of mtROS, disrupted mitochondrial function, and structural changes in nasal epithelial cells might be involved in the pathogenesis of CRSwNP.

Nasality Changes With Age in Normal Korean-Speaking Adults

OBJECTIVES: This study was performed to investigate the effects of aging on nasality and the influence of age-related changes in nasal cavity volume and nasal patency on nasality. METHODS: A total of 180 healthy Korean-speaking adult volunteers, who had no nasal or voice-related complaints, were enrolled in this study. Nasometry, acoustic rhinometry, and rhinomanometry were performed to obtain the nasalance score, nasal cavity volume, and nasal resistance, respectively. Changes in these parameters with age were analyzed. RESULTS: Nasal cavity volume increased significantly, and nasal resistance decreased significantly, with age. The nasalance scores for the nasal passage and oronasal passage decreased significantly with age, while there were no age-related changes in nasalance scores for the oral passage. CONCLUSION: Nasalance scores for the passages containing nasal consonants decreased with age although significant increases were observed in nasal cavity volume and nasal patency with age. Therefore, the age-related decreases in nasalance scores may result from factors other than changes in the nasal cavity.

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.

Role of Interleukin-10-Expressing B Cells on the Pathophysiology of Chronic Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many kinds of inflammatory cells and cytokines are suggested to be related with pathophysiology of chronic rhinosinusitis with nasal polyp (CRSwNP), but its mechanism is not yet fully understood. In particular, little is known about the function and role of Interleukin-10 (IL-10) producing regulatory B cells. The aim of this study was to investigate the presence and function of B cells, especially IL-10-producing regulatory B cells, in the nasal polyp (NP) and nasal mucosa. SUBJECTS AND METHOD: Twenty patients with CRSwNP, 10 patients with chronic rhinosinusitis without nasal polyp (CRSsNP) and 10 control subjects were enrolled in this study. NP tissues and uncinate tissues were collected for analysis. Real-time polymerase chain reaction (RT-PCR), immunohistochemistry were performed to measure the expression levels of the selected inflammatory cytokines and inflammation-associated molecules. RESULTS: In the mucosal tissues of CRSsNP patients, the number of IL-10+ B cells was significantly lower than that of NP and control mucosa of CRSwNP patients. The number of IL-10+ B cells was significantly increased in the eosinophilic NP, non-eosinohilic NP, CRSsNP, and control groups. There was a significant positive correlation between the number of IL-10+ B cells and B cell activating factor (BAFF). CONCLUSION: The expression of IL-10+ B cells and BAFF was significantly increased in CRSwNP patients compared to CRSsNP patients and control mucosal tissues, and IL-10+ B cells were more significantly increased in eosinophilic tissues. These results indicate that regulatory B cells are involved in the pathophysiology of eosinophilic NP and that BAFF contributes to the production of regulatory B cells.

Nasalance Changes after Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to examine the effect of endoscopic sinus surgery (ESS) on nasalance in patients with chronic rhinosinusitis (CRS). SUBJECTS AND METHOD: Eighty-one CRS patients were enrolled. The nasalance scores for oral, oro-nasal, and nasal passages were measured by nasometry and the nasal cavity volume was measured by acoustic rhinometry before and at 1 and 3 months after ESS. We divided the patients into four groups according to the following surgical interventions employed: unilateral anterior ethmoidectomy (group I), bilateral anterior ethmoidectomy (group II), bilateral total ethmoidectomy (group III), and bilateral pansinus surgery (group IV). We also divided the patients into three groups according to the CT scoring system and polyp grading system. RESULTS: In group III and IV, the nasalance scores for all passages and nasal cavity volume were significantly increased after ESS but did not return to its preoperative level at 3 months after surgery. However, there were no significant changes in nasalance scores or in the nasal cavity volume in group I. Similarly, there were no significant changes in nasalance scores in the mild group (CT scoring system) or no polyp group, whereas the nasalance scores were significantly increased postoperatively in the moderate to severe groups (CT scoring system), and in groups that have nasal polyp group. CONCLUSION: The nasalance scores and nasal cavity volumes were increased after ESS and remained unchanged until postoperative 3 months. Postoperative changes in nasalance scores were more remarkable in patients who had more severe disease and who underwent more extensive surgery.

Effect of Nasal Septoturbinoplasty on Nasality or Acoustic Parameters / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to compare the nasality and acoustic variables of control subjects and those of patients with deviated nasal septum (DNS), preoperatively and postoperatively. SUBJECTS AND METHOD: Twenty patients who underwent septoturbinoplasty (DNS group) and ten control subjects (control group) who did not complain of nasal obstruction or did not show any anatomic or pathologic abnormality were selected. Performed for these subjects were acoustic rhinometry, rhinomanometry, nasality test and long-term average spectrum analysis of nasal sound sentence. Data were collected and analyzed prior to and 4 weeks after the surgery. RESULTS: In DNS group, the volume of nasal cavity was significantly increased and the nasal resistance was decreased significantly after operation. There were no statistically significant differences in the nasality of all sentences in the DNS group compared to those in the preoperative and the postoperative group. However, alternations of several acoustic variables in the final consonant were detected. CONCLUSION: Alternation of nasality and acoustic variables was observed after septoturbinoplasty, however, the changes of nasal resistance have been shown to contribute to the results.

A Huge Dacryolith Presenting as a Mass of the Inferior Meatus / 대한이비인후과학회지

A dacryolith is a concretion within the lacrimal drainage system. Although it may cause intermittent epiphora without inflammation, dacryoliths are often underlying contributors to recurrent or chronic dacryocystitis. It may occur anywhere along the lacrimal drainage system, albeit most commonly in the lacrimal sac. We report an interesting case of a dacryolith presenting as a mass of inferior meatus, which was managed via endonasal endoscopic approach.

Analysis of Nasalance in Patients with Chronic Rhinosinusitis

BACKGROUND AND OBJECTIVES: This study was designed to compare the nasalance between chronic rhinosinusitis (CRS) patients and normal controls and to determine the correlation of nasalance with nasal volume, nasal resistance, CT score, and polyp score in CRS patients. MATERIALS AND METHODS: This study enrolled 150 CRS patients and 154 normal adults. All subjects underwent acoustic rhinometry and rhinomanometry. Nasalance scores were measured with the nasometer. All CRS patients were graded according to the Lund-Mackay CT staging system and the degree of nasal polyp. RESULTS: Nasal volume was decreased and nasal resistance was increased in CRS patients compared with normal controls. However, the nasalance scores for oro-nasal and nasal passages were significantly higher in CRS patients compared with normal controls. In CRS patients, the nasalance score for the nasal passage showed positive correlation with nasal volume and negative correlation with nasal resistance and Lund-Mackay CT score. However, no significant correlation was found between nasalance score and endoscopic polyp score. CONCLUSION: Contrary to expectations, nasalance was increased in CRS patients despite decreased nasal volume and increased nasal resistance. Thus, nasal resonance likely depends on a multitude of factors other than changes in the sinonasal cavity.

Categorization and Clinicopathological Features of Chronic Rhinosinusitis With Eosinophilic Mucin in a Korean Population

OBJECTIVES: Chronic rhinosinusitis (CRS) with eosinophilic mucin is relatively rare in Korea. We categorized CRS patients with characteristic eosinophilic mucin into several groups and compared the groups based on their clinicopathological features. METHODS: In total, 52 CRS patients with eosinophilic mucin were enrolled. Based on the presence or absence of an allergy (A) to a fungus or fungal element (F) in the mucin, the patients were divided into four groups: allergic fungal rhinosinusitis (AFRS, A+F+), AFRS-like sinusitis (A+F-), eosinophilic fungal rhinosinusitis (EFRS, A-F+), and eosinophilic mucin rhinosinusitis (EMRS, A-F-). Clinical and immunological variables were compared between the groups. RESULTS: There were 13 patients in the AFRS group, 13 in the EFRS group, and 26 in the EMRS group. No patient was assigned to the AFRS-like sinusitis group. The AFRS group showed a significantly higher association with allergic rhinitis than did the EFRS and EMRS groups. The mean total serum IgE level in the AFRS patients was significantly higher than in the EFRS and EMRS patients. While 7.7% of the patients with AFRS and EFRS were asthmatic, 65.4% of the patients with EMRS had bronchial asthma. In the AFRS and EFRS groups, 31% had bilateral disease, in contrast to 100% of EMRS patients with bilateral disease. The prevalence of high attenuation areas by computed tomography was significantly higher in the AFRS group than in the EMRS group, and the mean Hounsfield unit values of the areas of high attenuation in the AFRS patients were significantly greater than those in the EMRS patients. CONCLUSION: AFRS is believed to be an allergic response to colonizing fungi in atopic individuals. In EFRS, local allergies to fungi may play a role in the pathogenesis of the disease. EMRS is thought to be unconnected with fungal allergies.

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.

Life-Threatening Upper Airway Obstruction Caused by Delayed Hematoma Occurring 8 Days Post-Thyroidectomy

Due to modern methods, thyroid surgery is generally considered quite safe. However, post-thyroidectomy hematomas, although rare, can be life-threatening and unpredictable complications of thyroid surgery. Most postthyroidectomy hematomas occur within 24 hours of surgery, with delayed hematomas occurring after one post-operative week being exceedingly rare. Herein, we report a case of delayed post-thyroidectomy hematoma with respiratory distress occurring on the eighth post-operative day in a patient who was not taking anticoagulants and had no hematologic diseases. Although most bleeding occurs within 24 hours, caution should be used even in such patients who are considered low-risk.

A Case of Allergic Fungal Rhinosinusitis with Concurrently Occuring Fungus Ball

Allergic fungal rhinosinusitis (AFRS) is a noninvasive fungal infection of the paranasal sinuses that are usually seen in young immunocompetent patients with atopy and/or asthma. Fungus balls can grow in moist cavities of the paranasal sinuses of a host with normal immunologic status. Cases of AFRS with concurrent fungus balls is very rare. We present a case of a patient who had AFRS on one side of the paranasal sinus and allergic fungal sinusitis on the other side. A 51-year-old female with atopy presented with a few-year history of nasal obstruction and rhinorrhea, as well as a history of high-dose systemic steroid therapy. The patient had nasal polyps and showed an elevated level of total IgE and positive MAST to fungal antigens. Endoscopic sinus surgery was performed. Allergic mucin from the right maxillary sinus contained sheets of eosinophils and Charcot-Leyden crystals. Also, a clay-like dark brown material from the left maxillary sinus was revealed to be a fungus ball.

Clinical Characteristics and Expression Pattern of IL-33 and IL-25 According to Histologic Classification in Chronic Rhinosinusitis with Nasal Polyposis

BACKGROUND AND OBJECTIVES: Many kinds of inflammatory cells and cytokines are suggested to be related to the pathophysiology of chronic rhinosinusitis with nasal polyposis (CRSwNP), but not yet fully understood. The objectives of this study were to classify CRSwNP patients according to histologic features and to reveal the roles of IL-33 and IL-25, on the pathophysiology of CRSwNP. MATERIALS AND METHOD: CRSwNP patients (n=122) were divided into 3 groups according to the type of nasal polyp; eosinophilic polyp (EP, n=38), neutrophilic polyp (NeuP, n=15) and non-eosinophilic non-neutrophilic polyp (NENN, n=63) groups. Clinical features and the expressions of IL-25 and IL-33 were evaluated among the groups. RESULTS: The EP group showed many clinical features that were different from the other groups: increased prevalence of asthma and olfactory dysfunction, increased percentage of blood eosinophils, increased E/M ratio, and poor postoperative outcomes such as recurrent polyposis and the need for frequent use of oral steroids. Numbers of IL-33 and IL-25 positive cells were significantly higher in the EP group compared with the other groups in the lamina propria (p=0.001). CONCLUSION: These results suggest that patients with an eosinophilic polyp are clinically and pathogenetically different from patients with other types of polyps, and IL-25 and IL-33 are associated with the pathogenesis of chronic rhinosinusitis with eosinophilic polyps.