A Case of 73-Year-Old Male with Chronic Invasive Fungal Sinusitis Mimicking Sino-Nasal Malignancy / 대한이비인후과학회지

Fungal sinusitis is a sinus infection caused by fungal species, most of which are aspergillus species. They can be classified mainly into two groups, invasive fungal sinusitis and non-invasive fungal sinusitis. Invasive fungal sinusitis is characterized by fungi not confined to the paranasal sinuses or the nasal cavity but invading the adjacent tissue and bone. Chronic invasive fungal sinusitis is one type of invasive fungal sinusitis and is a relatively rare disease. It can invade the adjacent sinus bone and tissue for months to years, resulting in bony sclerotic change, formation of mass and bony destruction, which can be mistaken for pseudotumor or malignant tumor. In this report, we report a case of a patient with chronic invasive fungal sinusitis, which was mimicking sino-nasal malignancy.

A Case of 40-Year-Old Male with Onodi Cell Mucocele / 대한이비인후과학회지

Sphenoethmoidal (Onodi) cells originate from the ethmoid sinus and are located at the posterior and lateral direction. The obstruction of the sinus ostium leads to the accumulation of mucous fluid and eventually leads to the formation of a mucocele. Onodi cell mucoceles can cause visual loss or disturbance due to the adjacency to the orbital apex. Here we report a case of Onodi cell mucocele with a visual field disturbance, where the patient underwent an endoscopic sinus surgery 12 days after the initial symptom. After 21 days of onset, the subjective symptom started to subside. For Onodi cell mucocele patients with visual disturbance, we recommend rapid diagnosis with computed tomography and early marsupialization of the mucocele.

Therapeutic Outcome of Primary Snoring and Mild Obstructive Sleep Apnea and Clinical Suggestion for Treatment Approaches / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#The clinical significance and need for the treatment of primary snoring and mild obstructive sleep apnea have been recently questioned. In this study, we analyzed therapeutic outcome and the methods of treatment of such diseases.SUBJECTS AND METHOD: A retrospective review was conducted using the medical records of patients diagnosed with primary snoring or mild obstructive sleep apnea at a single institution from 2013 to 2015 through polysomnography or WATCHPAT.@*RESULTS@#Of the 18 patients (37%) with primary snoring, 13 patients (72.2%) underwent surgery, four patients (22.2%) were treated with surgery and mandibular advancement device, and one patient (5.6%) underwent automatic positive airway pressure therapy. Of the 78 patients (61%) with mild obstructive sleep apnea, 35 patients (44.8%) had surgery, 24 patients (30.8%) were treated with mandibular advancement device, 13 patients (16.7%) were treated with surgery and mandibular advancement device and 6 patients (7.7%) received automatic positive airway pressure therapy. For primary snoring, while Epworth Sleepiness Scale and Pittsburg Sleep Quality Index did not improve, the snoring visual analog scale decreased significantly. In patients with mild obstructive sleep apnea, Apnea-Hypopnea Index, snoring decibel, Epworth Sleepiness Scale, and Pittsburg Sleep Quality Index were significantly decreased after treatment and the lowest oxygen saturation was significantly increased after treatment.@*CONCLUSION@#For primary snoring, the direction of treatment should be determined in accordance with the presence of associated diseases related to sleep disturbance breathing. For mild obstructive sleep apnea, active treatment may be helpful.

Therapeutic Outcome of Primary Snoring and Mild Obstructive Sleep Apnea and Clinical Suggestion for Treatment Approaches / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The clinical significance and need for the treatment of primary snoring and mild obstructive sleep apnea have been recently questioned. In this study, we analyzed therapeutic outcome and the methods of treatment of such diseases. SUBJECTS AND METHOD: A retrospective review was conducted using the medical records of patients diagnosed with primary snoring or mild obstructive sleep apnea at a single institution from 2013 to 2015 through polysomnography or WATCHPAT. RESULTS: Of the 18 patients (37%) with primary snoring, 13 patients (72.2%) underwent surgery, four patients (22.2%) were treated with surgery and mandibular advancement device, and one patient (5.6%) underwent automatic positive airway pressure therapy. Of the 78 patients (61%) with mild obstructive sleep apnea, 35 patients (44.8%) had surgery, 24 patients (30.8%) were treated with mandibular advancement device, 13 patients (16.7%) were treated with surgery and mandibular advancement device and 6 patients (7.7%) received automatic positive airway pressure therapy. For primary snoring, while Epworth Sleepiness Scale and Pittsburg Sleep Quality Index did not improve, the snoring visual analog scale decreased significantly. In patients with mild obstructive sleep apnea, Apnea-Hypopnea Index, snoring decibel, Epworth Sleepiness Scale, and Pittsburg Sleep Quality Index were significantly decreased after treatment and the lowest oxygen saturation was significantly increased after treatment. CONCLUSION: For primary snoring, the direction of treatment should be determined in accordance with the presence of associated diseases related to sleep disturbance breathing. For mild obstructive sleep apnea, active treatment may be helpful.

Two-Track Medical Treatment Strategy According to the Clinical Scoring System for Chronic Rhinosinusitis

PURPOSE: The previously reported Japanese clinical scoring study (JESREC) suggests that chronic rhinosinusitis (CRS) can be divided into 4 subtypes according to the degree of eosinophilic CRS (ECRS) and offers the information regarding the prognosis of CRS to clinicians. However, this scoring system has not yet been validated by an immunological study and needs to provide treatment guidelines based on underlying immunologic profiles. We investigated the immunologic profile of each CRS subgroup according to the JESREC classification and suggest its clinical application. METHODS: A total of 140 CRS patients and 20 control subjects were enrolled. All patients were classified into 4 groups according to the JESREC (non-, mild, moderate and severe ECRS). Nasal tissues were analyzed for mRNA expression of major cytokines (IL-5, IL-10, IL-13, IL-17A, IL-22, IL-23p19, IFN-γ, periostin, thymic stromal lymphopoietin [TSLP] and ST2), major chemokines (CCL11, CCL24, CXCL1 and CXCL2), transcription factors (T-bet, GATA3, RORC and FOXP3) and COL1A1 for type I collagen. Protein levels of 3 major cytokines (IL-5, IL-17A and IFN-γ) were also measured by multiplex immunoassay. Principal component analysis (PCA) was conducted to investigate the overall profile of multiple mediators. RESULTS: The moderate/severe ECRS showed up-regulation of type 2-related mediators (IL-5, IL-13, periostin, TSLP and ST-2), whereas INF-γ (type 1 cytokine) and CXCL1 (neutrophil chemokine) expressions were increased in non-/mild ECRS compared with moderate/severe ECRS. The JESREC classification reflected an immunological endotype. In PCA data, PCA1 indicates a relative type 2 profile, whereas PCA2 represents a type 1/type 17-related profile. In this analysis, mild ECRS was indistinguishable from non-ECRS, whereas moderate to severe ECRS showed a distinct distribution compared with non-ECRS. The JESREC classification could be divided into 2 categories, non-/mild vs. moderate/severe ECRS based on underlying immunological analyses. CONCLUSIONS: The CRS clinical scoring system from the JESREC study reflects an inflammatory endotype. However, the immunologic profile of mild ECRS was similar to that of non-ECRS. Therefore, we propose type 2-targeted medical treatment for moderate to severe ECRS and type 1/type 17-targeted for non-ECRS and mild ECRS as the first treatment option.

Analysis of Proteoglycan Gene Messages in Human Nasal Mucosa and Nasal Polyp using Dot Blot Hybridization / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It has been suggested that the formation and growth of nasal polyp require the remodeling of extracellular matrix. Proteoglycans (PGs) are the major components of the extracellular matrix that maintain the integrity of the structural tissues The leucine-rich repeat PGs include lumican, decorin and biglycan, all of which have many important biologic activities in various pathologic conditions, including the remodeling of the extracellular matrix. Therefore, these small-PG families may be involved in the formation and growth of nasal polyp. MATERIALS AND METHODS: Surgical specimens of nasal polyps and the normal nasal mucosa were assessed for mRNA expressions coding for lumican, decorin and biglycan using the reverse transcription-polymerase chain reaction,which was followed by dot blot hybridization. RESULTS: Lumican, decorin and biglycan mRNAs were expressed in all tissue samples examined. Semi-quantitative dot blot hybridization revealed that the levels of the lumican and biglycan messages are lower in the nasal polyp tissues than in the nasal mucosa. The decorin messages in the nasal polyp were expressed at levels similar to those in the nasal mucosa. CONCLUSION: These results suggest that lumican, decorin and biglycan may be important components of the extracellular matrix in the nasal mucosa. Considering the function of these PGs, the normal levels of decorin associated with low levels of biglycan and lumican may play a role in the pathogenesis of nasal polyposis.