The Relationship Between Zonulin and Asthma: A Mouse Model Study

Background and Objectives@#Zonulin is a human protein that regulates intercellular tight junctions and increases the permeability of the intestinal epithelium. In light of the increasing focus on zonulin’s role in numerous chronic inflammatory diseases, this study aimed to investigate whether differences exist in serum zonulin levels and bronchial epithelium zonulin expression in vivo between asthma and normal groups, using a mouse model. @*Methods@#Sixteen mice were utilized in this study, divided evenly between the normal and asthma groups. Serum zonulin levels, the expression of zonulin antibody in the bronchial epithelium, and serum cytokine levels were evaluated in both groups. Enzyme-linked immunosorbent assay and RNA in situ hybridization were utilized for the analysis. @*Results@#The asthma group exhibited significantly higher levels of serum zonulin. High zonulin antibody expression was also observed in the bronchial epithelium of the asthma group. Given that our mouse model demonstrated a significant difference in interleukin (IL)-4 and IL-6 between the normal and asthma groups, zonulin may be associated not only with type 2 responses but also with various subtypes of asthma. Further studies are required to investigate this relationship in greater detail. @*Conclusion@#Zonulin may play a role in the complex pathophysiology of asthma and could serve as a biomarker in various asthma-related situations.

A Case of Nasolabial Cyst After Orthognathic Surgery / 대한이비인후과학회지

Nasolabial cyst is a rare, non-odontogenic cyst that occurs in the submucosa of the anterior nasal floor. Its most likely origin is known to be remnants of the nasolacrimal duct. The patient usually comes to the hospital for swelling or pain in the nasolabial area, and the diagnosis is made by combining clinical features, radiologic imaging, and histological test. The most commonly used treatment is surgical excision via sublabial approach. A 40-year-old male, who had undergone maxillary orthognathic surgery for malocclusion 11 years ago, visited our hospital for pain and swelling of the nasolabial folds that had persisted for a year. A large nasolabial cyst with a size of 4.8×3.3×3.1 cm was confirmed on paranasal sinus CT, and surgical excision was performed via sublabial approach. The pathologic finding was a cyst lining consisting of ciliated pseudostratified columnal epithelium and goblet cells, consistent with the characterization of a nasolabial cyst. No recurrence was observed during follow-up for 3 months.

Clinical Usefulness of Trasseptal Transsphenoidal Approach for Pituitary Tumors with Septal Cartilage Removal and Replacement via Modified Killian Incision: Review of 42 Cases

BACKGROUND AND OBJECTIVES: The conventional transseptal transsphenoidal approach can inhibit visualization of the surgical field and may change the shape of external nose. We used the transseptal transsphenoidal technique to remove septal cartilage except the L strut via a modified Killian's incision and preserved the ‘key-stone area.’ The aim of this study was to verify the usefulness of this technique. SUBJECTS AND METHOD: Retrospective analysis was carried out on 42 pituitary tumor patients who received this technique by a single otolaryngologist from March 2005 to March 2012 at Kangbuk Samsung Hospital. RESULTS: The mean patient age at time of surgery was 52 years, and 41 cases were pituitary adenoma and 1 was Rathke's cleft cyst. Three patients had undergone prior surgery; of which 2 used a pterional approach and 1 a transsphenoidal approach. With regard to complication, there were 2 cases of CSF leakage and 5 cases of septal laceration. There were no cases of meningitis, deformity of external nose, septal perforation, anosmia, or sinusitis. In post operation follow up, 25 cases (59.5%) had no residual tumor, while 17 cases (40.5%) had residual tumor. CONCLUSION: This study reveals that transseptal transsphenoidal surgery with septal cartilage removal and a replacement technique for a pituitary tumor are effective, allow easy exposure, and result in a low complication rate.

A Case of Nasal Cavity Foreign Bodies by Inhalation of Polyurethane Foam

Foreign bodies in the nasal cavity are commonly encountered in otorhinolaryngologic practice, particularly among children and mentally handicapped patients. Such foreign bodies include plastic toys, pebbles, seeds, buttons, and many others. Many of these foreign bodies can be easily removed with simple tools. However, some of them adhere to the nasal mucosa, resulting in complications such as necrosis or neurovascular injury of the nasal mucosa. Polyurethane foam in the nasal cavity has never been reported in Korea. Furthermore, the complications caused by polyurethane foam in the nasal cavity have not yet been reported. In this article, we report a man who presented with polyurethane foam that had spread into both nasal cavity and nasopharynx by inhalation and adhered to the nasal cavity and sinuses.

A Case of Tolosa-Hunt Syndrome Presented with Headache, Ptosis and Vision Loss

Cavernous sinus syndrome (CSS) is defined as the involvement of two or more of the third, fourth, fifth (V1, V2) or sixth cranial nerves or involvement of only one of them in combination with a neuroimaging-confirmed lesion in the cavernous sinus. Some cases of CSS are attributed to Tolosa-Hunt syndrome (THS), an idiopathic inflammatory disease of the cavernous sinus. THS is characterized by painful ophthalmoplegia due to granulomatous inflammation in the cavernous sinus. THS is a diagnosis of exclusion that requires a vigorous series of differential diagnoses, and corticosteroid therapy is known to dramatically resolve clinical findings of THS. We report a case of a patient with painful ophthalmoplegia associated with vision loss, which was suspected to be THS. This patient followed a relatively typical clinical course of THS on steroid pulse therapy. We emphasize the differential diagnosis of THS, its presentation, and treatment.

Availability of Preoperative Systemic Steroids on Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyposis

PURPOSE: To analyze the outcome of endoscopic sinus surgery (ESS) after preoperative systemic steroid (PSS) treatment for chronic rhinosinusitis (CRS) with nasal polyposis (NP) and to investigate and compare clinicopathological factors associated with the outcome. MATERIALS AND METHODS: We performed a retrospective chart review of 468 patients with CRS with NP who underwent primary ESS between January 2005 and October 2011. 124 patients who met the inclusion criteria were included. Beginning from 2008, our clinic administered steroid preoperatively in patients of CRS with NP, thus there were 84 patients with preoperative systemic steroid (PSS group) and another 40 patients without such regimen (no PSS group). To evaluate the outcome after ESS, poor outcome and complication were analyzed according to the following parameters: age, sex, follow-up duration, eosinophilic infiltration, atopy, asthma, Lund-Mackay score, and polyp grade. RESULTS: There was no significant difference in poor outcome rates between the PSS and no PSS group (35.0% vs. 47.6%, p=0.185). There was no significant difference in complication rates between the PSS and no PSS group (10% vs. 6%, p=0.468). As with the multivariate analysis of the clincopathological factors to the poor outcome rate, presence of asthma and eosinophilic infiltration were significantly related (odds ratio as 6.555 and 4.505, respectively), whereas PSS was confirmed as less likely related (odds ratio 0.611). CONCLUSION: Low dose PSS administration does not seem to have an effect on the outcome after ESS in patients who have CRS with NP. Eosinophilic infiltration and presence of asthma are important predictors of surgical outcome.

A Case of Posterior Ischemic Optic Neuropathy after Endoscopic Sinus Surgery / 대한이비인후과학회지

Recently, endoscopic sinus surgery (ESS) has been acknowledged as a standard surgical procedure for the treatment of chronic rhinosinusitis. Orbital complications of varying degrees that may occur during ESS have been widely reported. Blindness, one of the major complications that can occur during or immediately after ESS, is mainly attributed to orbital hematoma or direct injury to the optic nerve. In contrast to such direct mechanical trauma caused during ESS, we report a case of acute loss of vision that followed ESS without a definite cause. A postulated mechanism for idiopathic optic neuropathy is that it is ischema resulted from vasospasm in the branches of ophthalmic artery due to topical use of vasoconstrictive agents. Otorhinolaryngologists should be aware that this condition may occur following an uncomplicated ESS procedure. When loss of sight is diagnosed postoperatively, patients should be given prompt ophthalmological consultation and possible causes should be considered.

Clinical Features and Treatments of Odontogenic Sinusitis

PURPOSE: The aim of this study was to investigate how clinical features such as sex, age, etiologic factors, and presenting symptoms of odontogenic sinusitis are differentiated from other types of sinusitis. Also, this study was designed to find methods for reducing the incidence of odontogenic sinusitis. MATERIALS AND METHODS: A retrospective chart analysis was completed on twenty-seven patients with odontogenic sinusitis. They were all treated at Kangbuk Samsung Hospital between February 2006 and August 2008. The study protocol and informed consent forms were approved by the institutional review boards for human beings at Kangbuk Samsung Hospital. RESULTS: Ten patients (37.0%) had dental implant related complications and 8 (29.6%) had dental extraction related complications. Unilateral purulent nasal discharge was the most common symptom (66.7%). The therapeutic modality included transnasal endoscopic sinus surgery in 19 (70.4%) patients, and a Caldwell-Luc operation in two (7.4%) patients. CONCLUSION: In our study, there was no significant difference in the incidence between genders. The average age of the patients was 42.9 years. The incidence was highest in the fourth decade. There were no significant differences between the symptoms of odontogenic sinusitis and that of other types of sinusitis. However, almost all of the patients with odontogenic sinusitis had unilateral symptoms. Iatrogenic causes, which include dental implants and dental extractions, were the most common etiologic factors related to the development of odontogenic sinusitis. Therefore, a preoperative consultation between a rhinologist and a dentist prior to the dental procedure should be able to reduce the incidence of odontogenic sinusitis.

Comparison of Clinical Characteristics between Primary and Secondary Paranasal Mucoceles

PURPOSE: Paranasal sinus mucocele is a benign, expansile mass which can occur as a result of trauma or spontaneous obstruction of a sinus tract. The purpose of this study was to describe and compare the clinical characteristics of primary mucoceles occurring in patients with no previous sinus surgery history or known cause of mucoceles and secondary mucoceles resulting as a complication following endoscopic sinus surgery or the Caldwell-Luc operation. MATERIALS AND METHODS: We performed a retrospective chart review of 33 cases of primary mucoceles and 60 cases of secondary mucoceles which were diagnosed and surgically corrected between 1996 and 2008. RESULTS: The most common presenting symptoms in primary mucoceles were nasal obstruction (19.4%) and rhinorrhea (17.7%). In secondary mucoceles, the most common symptoms were cheek pain (31.7%) and nasal obstruction (18.3%). The most common origins of primary mucoceles were the ethmoid sinus (45.5%) and the maxillary sinus (18.2%). In secondary mucoceles, the maxillary sinus was the most common site (86%), followed by the ethmoid sinus (7.1%). All patients with secondary mucoceles had a history of sinus surgery. CONCLUSION: The maxillary sinus was the most common site of secondary mucoceles while the ethmoid sinus was the most common origin of primary mucoceles. Cases of secondary mucoceles that occurred following sinus endoscopic surgery developed more frequently in the ethmoid sinus than in those following the Caldwell-Luc procedure, therefore, we suggest that the incidence of maxillary sinus mucoceles in the Asian population would decrease as the rate of endoscopic sinus surgery increases.

Surgical Treatment Using an Allograft Dermal Matrix for Nasal Septal Perforation

PURPOSE: Numerous methods have been utilized to repair nasal septal perforation with varying degrees of success; however, no consensus has been reached on nasoseptal perforation repair. Here, the authors describe a surgical method based on human dermal allograft (Surederm(TM), Hans Biomed Corp. Korea) for the repair of nasal septal perforations. MATERIALS AND METHODS: Eleven patients with a nasal septal perforation were included in this study. The causes of these septal perforations included previous nasal surgery, trauma, foreign body (button battery), and idiopathy. There were several sites of perforation: 9 in the central area, 1 in the posterior-central area, and 1 in the anterior area. An interpositional graft incorporating Surederm(TM) was positioned between bilateral mucoperichondrial flaps using an intranasal approach. A silastic sheet was then left in the nasal septum bilaterally until complete healing had occurred through new nasal mucosa, which took a mean duration of 6 weeks. RESULTS: Outcomes in ten of the eleven patients were successful, with complete septal perforation closure. The remaining perforation, which was caused by a button battery, closed incompletely; however, its initial size of 2cm was reduced to 5mm. CONCLUSION: The described technique has a high success rate and can be performed under local anesthesia without external scarring. In the absence of donor site morbidity, this technique can also be utilized to repair posterior or multiple septal perforations without difficulty.

Vocal Analysis Related to Changes in Frequency of Pure Tone Auditory Feedback

PURPOSE: Many studies have shown that subjects show a change of vocal fundamental frequency (F0) when phonating subjects hear their vocal pitch feedback shifted upward or downward. This study was performed to demonstrate whether vocal parameters [F0, intensity, jitter, shimmer, and noise to harmonic ratio (NHR)] in normal males respond to changes in frequency of pure tone masking. MATERIALS and METHODS: Twenty healthy male subjects participated in this study. Subjects vocalized /a/ vowel sounds while listening to a pitch- shift pure tone through headphones (upward pitch-shift in succession: 1kHz to 2kHz and 1kHz to 4kHz at 50dB or 80dB, respectively, downward pitch-shift in succession: 1kHz to 250Hz and 1kH to 500Hz at 50dB or 80dB, respectively). RESULTS: Vocal intensity, F0, was increased, whereas jitter was decreased as the pitch of pure tone was shifted upward. However, there was no correlation between shimmer and NHR with pitch-shift feedback for pure tones. Unlike vocal pitch- shift feedback in other studies, upward pitch-shift feedback of pure tones caused the vocal F0 and intensity to change in the same direction as pitch-shift. CONCLUSION: The results of this study demonstrated that auditory kinesthetic feedback is affected by pitch-shift in pure tone.

A Comparision of Surepath(TM) Liquid-Based Smear with a Conventional Smear for Cervicovaginal Cytology-with Reference to a Histological Diagnosis / 대한세포병리학회지

This study was performed to compare Surepath(TM) liquid-based smear and a conventional cervicovaginal smear with reference to a histological diagnosis. A hybrid capture test (HCII) was also performed and analyzed. We collected matched cases for cervicovaginal cytology- histology: 207 cases for conventional cytology (CC) and 199 cases for liquid-based cytology (LBC). HCII was performed in 254 patients. When a cytological diagnosis of ASCUS or above (ASCUS+) is classified as positive and a histological diagnosis of LSIL+ is classified as positive, the sensitivity and specificity for LBC was 91.7% and 75.9%, respectively and the sensitivity and specificity for CC was 62.6% and 96.1%, respectively. When a cytological and histological diagnosis of LSIL+ is classified as positive, the sensitivity and specificity for LBC was 77.5 and 96.6%, respectively and the sensitivity and specificity for CC was 49.7% and 100%, respectively. When a histological diagnosis of LSIL+ is classified as positive, the sensitivity and specificity for HCII was 78.9% and 78.1%, respectively. The concordance ratio between the cytological and histological diagnosis was 80.4% (kappa=76.0) for LBC and 56.5% (kappa=55.1) for CC. LBC is more sensitive and less specific then CC, as a cytological cutoff level of ASCUS, but more sensitive and equally specific, as a cytological cutoff level LSIL or HSIL. LBC is more reliable with a high concordance ratio between the cytological and histological diagnosis.

Recurrence Rates of Nasal Polyps after Endoscopic Sinus Surgery in regards to Underlying Allergic Rhinitis and Asthma

BACKGROUND AND OBJECTIVES: Nasal polyp is a disease of the mucous membranes in the nose and the paranasal sinuses that develops as a reaction to a variety of stimuli including allergens and various microbes. The etiology and formation of nasal polyp are still unclear and have been debated for many years. The objective of the present study is to investigate the correlation among allergic rhinitis, asthma and recurrent nasal polyps. MATERIALS AND METHODS: We conducted a retrospective review of patients with severe nasal polyps who underwent endoscopic sinus surgery. Patients who had a minimum Lund- MacKay score of 16 and a minimum of 12 months of follow-up were included in the analysis. Data collection included demographics, presence of asthma or documented allergic rhinitis, recurrence rates, and follow up. RESULTS: Three hundred and forty one records were reviewed. Two hundred and forty-three (71.3%) patients had no underlying asthma and allergic rhinitis. Seventy-nine (32.5%) patients among them developed recurrent nasal polyps. Seventy-two (21.1%) patients had documented allergic rhinitis without asthma. Twenty-one (29.2%) patients among them developed recurrent nasal polyps. Fifteen (4.4%) patients had both asthma and allergic rhinitis. Eight (53.3%) patients among them developed recurrent nasal polyps. Eleven (3.3%) patients had asthma without allergic rhinitis. Six (54.6%) patients among them developed recurrent nasal polyps. CONCLUSION: Knowing recurrence rates after endoscopic sinus surgery for nasal polyps in regards to underlying asthma and allergic rhinitis is clinically significant. In our study, the presence of asthma significantly correlated with higher recurrence (p<0.05). But, the presence of allergy was not statistically significant.

A Case of Actinomycosis in Nasal Cavity

Actinomycosis is a rare form of disease which is caused by Actinomyces such as A. israelii and A. bovis. These anaerobic gram-positive organisms may take the form of an acute or a subacute disease progression. Only a few cases of actinomycosis in the nasal cavity have been reported previously. Actinomycosis is difficult to diagnose because of the fastidious nature of the organism in culture and a general lack of familiarity with the disease. In this paper, we report a case of actinomycosis presenting nasal cavity mass without prior mucosal trauma. Our patient had endonasal endoscopic removal of infected tissue and was treated with 2 days of intravenous antibiotics and 3 weeks of oral antibiotics therapy without any evidence of recurrence.

A Clinical Analysis of Psychogenic Hearing Loss Presenting as Sudden Deafness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden deafness results from, in most cases, lack an apparent cause. However viral infection, vascular occlusion, cochlear membrane rupture, and others are known to be associated with this disease. In this study, we observed incidence, etiology, audiologic, psychiatric, and clinical aspect of psychogenic sudden deafness through retrospective chart review and analysis of patients who are thought to have had sudden deafness from psychogenic causes and stressor. SUBJECTS AND METHOD: We reviewed the records of 277 patients who had been admitted to the Department of Otolaryngology, Kangbuk Samsung hospital, from January 1997 to July 2003, under the initial diagnosis of idiopathic sudden hearing loss. RESULTS: In patients' medical history, there were 9 patients who had association between sudden onset of hearing loss and psychogenic causes and stressor. And there were 4 patients who had preexisting psycho-pathologic condition. Among these patients, a joint study with psychiatrist classified 7 psychogenic sudden deafness patients (2.5%) who has been ruled out organic causes and showed discrepancy between pure tone audiometry and ABR. In distribution ratio, there were 2 males and 5 females, 4 patients were in their 10's, 1 in 20's, and 2 in 40's (24 years old in average), 3 bilaterals, and 4 unilaterals. In hearing test, there were 4 patients with severe to profound hearing loss at 71 dB or higher, 2 patients with moderately severe hearing loss ranged from 56 to 70 dB, and 1 patient with moderate hearing loss from 41 to 56 dB. Hearing ability of all these patients were partially or completely recovered by treatment including steroid injection and joint psychotherapy with psychiatrist. CONCLUSION: About 2.5% of sudden deafness patients were psychogenic sudden deafness patients, and the results showed distinctive features for each of audiologic, psychiatric, and clinical characteristics. The recovery rate and prognosis were better in patients who had cure and diagnosis under consult with department of psychiatry and accurate audiometry.

Endoscopic Diagnosis and Treatment of Isolated Sphenoid Sinus Lesions

Isolated sphenoid sinus disease is a rare entity. Because of its close vicinity to important and vulnerable structures of the skull base, early diagnosis and treatments are needed. We aimed to characterize the clinical features of isolated sphenoid sinus lesions and to assess the outcome of endoscopic sphenoid sinus surgery. We reviewed the records of patients retrospectively from July 1994 to May 2004. 17 cases with disease of the isolated sphenoid sinus that has undergone endoscopic sinus surgery were studied. The pathology spectrum included 7 cases of isolated chronic sphenoid sinusitis, 4 fungal sinusitis, 2 mucoceles, 1 inverted papilloma, 3 malignant tumors. Except 3 cases of malignant tumors, 14 cases were cured by endoscopic sinus surgery without complication. Diagnostic nasal endoscopy procedures and imaging techniques are of great value for an early and precise diagnosis. Endoscopic sphenoid sinus surgery is safe and effective for treating isolated sphenoid sinus lesions.

Outcomes of Transnasal Endoscopic Sinus Surgery in 86 Cases of Non-invasive Fungal Sinusitis

This study was conducted to review the clinical features of fungal sinusitis and to evaluate the effectiveness of transnasal endoscopic sinus surgery as a primary surgical method for treating fungal sinusitis. Eighty five patients (86 cases) who were treated for fungal sinusitis with transnasal endoscopic sinus surgery between 1993 and 2004 were retrospectively analyzed by reviewing their profile, which included clinical feature, surgical techniques, operative findings postoperative results and complications. All patients were adults consisting of 30 males and 55 females. All cases were treated successfully by transnasal endoscopic sinus surgery. No recurrence and postoperative complication were observed. However, in 18 cases, fungal debries were observed when sinus irrigation was done at primary follow-up. In these cases, fungal debris disappeared at postoperative 1.7weeks (average) and no recurrence was observed. Transnasal endoscopic sinus surgery is successful method in the treatment of non-invasive fungal sinusitis.

The Changes of Voice Quality Following Laryngeal Microsurgery for Vocal Polyp and Nodule / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Vocal polyps and nodules are representative chronic benign laryngeal diseases, and voice overuse, misuse, and abuse are felt by most authors to be the primary causative factors. Treatment options for vocal polyps and nodules in general include voice therapy by a speech-language pathologist and laryngeal microsurgery. The purpose of this study was to determine the changes in voice quality of a group of patients diagnosed with vocal polyp or vocal nodule before and after microlaryngeal surgery. MATERIALS AND METHOD: The following patients groups were studied prior to and 2 weeks after surgery: thirty-eight males, ages 27 to 62, and twenty five females, ages 23 to 47, with vocal polyp: three males, ages 29 to 38, and twenty eight females, ages 21 to 49, with vocal nodules. Voice recordings of the first sentence of a standardized paragraph "San Chaek" were performed for acoustic analyses. The recorded samples were analyzed on the Kay CSL model 4300B using Visi-Pitch II program. For the sentence, mean speaking fundamental frequency (F0), mean jitter and mean shimmer were analyzed. RESULTS: For the polyps, male patients showed decreased mean F0 (119.28 Hz), compared to the preoperative value (125.86 Hz) (p<0.05), and female patients showed increased mean F0 (197.52 Hz), compared to the preoperative value (190.07 Hz) (p=0.06). Mean jitter and shimmer improved in both males and females 2 weeks after surgery compared to their preoperative value (p<0.01). For the nodules, male patients showed decreased mean F0 (136.24 Hz) compared to the preoperative value (138.68 Hz), and female patients showed increased mean F0 (199.98 Hz) compared to the preoperative value (192.61 Hz) (p<0.05). Mean jitter and shimmer improved in both males and females 2 weeks after the surgery compared to their preoperative value. CONCLUSION: The acoustic output generally improved after laryngeal microsurgery as evidenced by the more appropriate mean F0 and reduced level of vocal perturbation. And, mean F0 showed different changes between males and female. Further research needs to be pursued on what this changes of mean F0 mean.

Analysis of Recurrence after Endoscopic Dacryocystorhinostomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic intranasal dacryocystorhinostomy (DCR) has been used as a primary treatment of lacrimal obstruction and for revision of conventional dacryocystorhinostomy. The objective of this research is to look for the cause of DCR failure. MATERIALS AND METHOD: The endoscopic revision procedures were performed on 20 patients with recurrent epiphora after endoscopic DCR with anterior and posterior sac approach from 1995 to 2001. A retrospective review of 20 endoscopic revision procedures was done. RESULTS: Sixteen patients (80%) with recurrent epiphora showed granulation on intranasal opening. Most (14 of 16) began to show granulation at 6 postoperative weeks. The most common site of granulation formation was superior to intranasal opening. CONCLUSION: Because granulation formation was the most common cause of failure, it is important to extubate a silicone tube at 6 postoperative weeks.

Endoscopic Dacryocystorhinostomy for the Treatment of Lacrimal Sac Abscess

In the past, the treatments for acute dacryocystitis with abscess formation were warm compression, systemic and topical antibiotics, and drainage of the abscess, if fluctuation occurs. Acute dacryocystitis with abscess formation is rarely primary, but often secondary to distal obstruction or extension of contiguous inflammation. After resolution of acute infection, evaluation and treatment of the underlying cause should be initiated. Recent reports have demonstrated that endoscopic dacryocystorhinostomy is an effective treatment for acute dacryocystitis associated with nasolacrimal duct obstruction. We experienced a case of acute dacryocystitis with lacrimal sac abscess formation. Drainage of lacrimal sac abscess was safely accomplished with endoscopic dacryocystorhinostomy. The patient had an excellent postoperative course without recurrence.