Superior Orbital Subperiosteal Abscess due to Infected Mucocele: A Case Report and Review of the Literature / 대한이비인후과학회지

Subperiosteal abscess is one of the most common orbital complications of acute sinusitis. It can result in significant morbidity if not appropriately managed. Mucoceles of the paranasal sinuses are chronic lesions containing inspissated mucus, which occurs when sinus ostium is obstructed. A 64-year-old woman was presented with infected mucocele and subperiosteal abscess located in the superior wall of orbit simultaneously. The infected ethmoid mucocele was treated by endoscopic surgery but subperiosteal abscess was managed by traditional external approach because it was difficult to treat with endoscopic surgical approach.

Congenital Defect of Vomer: A Case Report and Review of the Literature / 대한이비인후과학회지

Among the variety of local and systemic causative factors of nasal septal defects, the most frequent cause is the iatrogenic perforation found during septal surgery. We report a 10-year-old boy who showed a defect at the posteroinferior portion of the septum that appeared to coincide with the location of the vomer. He didn't have nasal surgery, any trauma, infectious disease or drug Abuse. These findings suggests that a developmental abnormality of the vomer taken place during the prenatal period may have resulted in a congenital defect of the vomer. To the best of our knowledge, this report is the first case of a congenital defect of the vomer reported in Korea.

A Study of Susceptibility between Allergic Rhinitis and Tumor Necrosis Factor Gene Polymorphism Study in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tumor necrosis factor-alpha (TNF-alpha) is recognized as a proinflammatory host alert cytokine that is synthesized early during inflammation, and elevations of this cytokine have been reported in patients with allergic rhinitis. The TNF-alpha gene is located on chromosome 6p within the class III region of the major histocompatibility complex. The most widely studied polymorphism within the TNF-alpha gene involves a guanine (G)/adenine (A) substitution at position -308. We therefore tested whether TNF-alpha -308G/A polymorphism are associated with allergic rhinitis in a Korean population. SUBJECTS AND METHOD: Blood samples for genetic analysis were obtained from 191 individuals with allergic rhinitis and from 192 healthy subjects without atopic diseases. Polymerase chain reaction-based assay for TNF-alpha -308G/A was used for genotyping. Serum total IgE levels were determined by using the immunoassay. Eosinophil values were determined by eosinophil numbers per total cell numbers per microliter. RESULTS: There were no differences in the frequencies of the genotypes and alleles of TNF-alpha -308G/A in the controls and patients(p>0.05). Blood eosinophil count and total serum IgE levels were not statistically different in the genotypes of TNF-alpha -308G/A in allergic rhinitis(p>0.05). CONCLUSION: We thought that the TNF-alpha -308G/A polymorphism is unlikely to be an important marker for predisposition to allergic rhinitis. A further study involving a larger Korean population might be in need.

A Study of Susceptibility between Allergic Rhinitis and Glutathione S-Transferase Gene Polymorphism Study in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Glutathione S-transferase (GST) enzymes have an important role in preventing the build-up of reactive oxygen species. Polymorphisms in genes involved in response to oxidative stress may play a role in the susceptibility to allergic diseases in human. A common homozygous deletion(null type) polymorphism of the GST gene abolishes the antioxidative enzyme activity. We investigated whether the profile of GSTM1 and GSTT1 genotypes might be associated with the risk of allergic rhinitis. SUBJECTS AND METHOD: Blood samples for genetic analysis were obtained from 287 individuals with allergic rhinitis and from 262 healthy subjects without atopic diseases. Multiplex polymerase chain reaction-based assay for GSTM1and GSTT1 was used for genotyping. RESULTS: The null genotype was more frequent in controls and the frequencies of the genotypes of GSTM1 were statistically different between controls and patients (p0.05). CONCLUSION: Our result suggests that the GSTM1 and GSTT1 polymorphism is not associated with the susceptibility to allergic rhinitis in Koreans.

A Immunohistochemical Study of Expression of Inducible Isoform of Heme Oxygenase on Human Nasal Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal polyp is non-neoplastic, chronic inflammatory disease of the nasal mucosa. Oxidative stress may be related to the pathogenesis of nasal polyp. Oxidative stress may be potential inducers of heme oxygenase (HO-1) expression. To illustrate the role of the HO-1 in the nasal polyp, we investigated the expressive pattern of the HO-1 in the nasal polyp and the influence of corticosteroids on its expression. SUBJECTS AND METHOD: The study materials were 28 specimens of nasal polyp (steroid user: 13 cases, steroid non-user: 15 cases) taken from 28 patients during endoscopic sinus surgery and 11 cases of normal nasal mucosa of the inferior turbinate as control. The HO-1 expression was assessed by immunohistochemical staining. RESULTS: The HO-1 was mainly expressed on non-epithelial cells in the lamina propria of nasal polyps in 20/28 (71.4%). The expression of HO-1 was positive in 11 out of 13 (84.6%) and 9 out of 15 (60%) subjects for steroid user and steroid non-user group, respectively. The inflammatory cells were almost identified as macrophage by using a macrophage specific marker (CD68+). The HO-1 was not expressed in normal control at all. There was no significant difference in the expression of HO-1 between the steroid user group and the non-user group. CONCLUSION: HO-1, as an important endogenous antioxidant enzyme, may play a protective role in the pathogenesis of nasal polyp. Steroid may not regulate the HO-1 expression in the nasal polyp.

A Study of Susceptibility between Allergic Rhinitis and FcepsilonRIbeta Gene Polymorphism Study in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Human basophils and mast cells play a central role in allergic disease. The beta subunit of the high affinity IgE receptor (FcepsilonRIbeta) gene is one of the candidate genes for atopy because of its important role in initiating type I allergic reaction in mast cells and basophils. We therefore tested whether Gly237Glu variants of FcepsilonRIbeta are associated with atopy in the Korean population. SUBJECTS AND METHOD: Blood samples for genetic analysis were obtained from 175 individuals with allergic rhinitis and from 191 healthy subjects without atopic diseases. Polymerase chain reaction-based assay for FcepsilonRIbeta Glu237Gly was used for genotyping. Serum total IgE levels were determined by using the immunoassay. Eosinophil values were determined by eosinophil numbers per total cell numbers per microliteriter. RESULTS: There were no differences in the frequencies of the genotypes and alleles of FcepsilonRIbeta between the controls and patients (p>0.05). Blood eosinophil count and total serum IgE levels were not statistically different in the genotypes of FcepsilonRIbeta in allergic rhinitis (p>0.05). Although statistical significance of genotypes of FcepsilonRIbeta was not observed with respect to gender in allergic rhinitis (p=0.057), mutant genotype was two times more prevalent in male patients than in female patients. CONCLUSION: Our results suggest the FcepsilonRIbeta Glu237Gly polymorphism does not affect the susceptibility of Koreans to allergic rhinitis. But our finding indicates that, males as opposed to females, might be predisposed to have the mutant genotype.

A Study of Susceptibility between Allergic Rhinitis and IL-4 Receptor alpha Gene Polymorphism Study in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The IL-4 receptor (IL-4R) gene has been suggested as a candidate gene for atopic diseases. The IL-4R consists of two subunits: the alpha chain (IL-4Ralpha), which is a high-affinity IL-4 binding site shared with the IL-13R, and the common gamma chain shared with several other cytokine receptors that amplifies signalling of the alpha chain. A Gln551Arg polymorphism of the IL-4Ralpha gene was shown to be a gain-of-function mutation and was associated with atopy. We tested whether a Gln551Arg polymorphism of IL-4Ralpha gene is associated with allergic rhinitis, blood eosinophil counts and total serum IgE levels in the Korean population. SUBJECTS AND METHOD: Blood samples for genetic analysis were obtained from 192 individuals with allergic rhinitis and from 191 healthy subjects without atopic diseases. Polymerase chain reaction-based assay for IL-4Ralpha Gln551Arg was used for genotyping. Serum total IgE levels were determined by using the immunoassay. Eosinophil values were determined by eosinophil numbers per total cell numbers per microL . RESULTS: There were no differences in the frequencies of the genotypes of IL-4Ralpha in the controls and patients (p>0.05). The frequencies of the IL-4Ralpha Arg551 allele were statistically different between controls and patients (p>0.05). Blood eosinophil count and total serum IgE levels were not statistically different in the genotypes of IL-4Ralpha Gln551Arg in allergic rhinitis (p>0.05). CONCLUSION: Our result suggests that the IL-4Ralpha Gln551Arg polymorphism might not give susceptibility to the development of allergic rhinitis in Koreans.

A Study of Susceptibility between Allergic Rhinitis and IL-13 Exon 4 G2044A Gene Polymorphism Study in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: High total serum IgE level is one of the characteristics seen in allergic rhinitis. IL-13 provides impetus to immunoglobulin class switching to IgE. The IL-13 promoter single nucleotide polymorphism has been shown to be associated with allergic diseases and abnormal IL-13 production. We tested whether a polymorphism in the coding region of IL-13 gene is associated with allergic rhinitis, blood eosinophil counts and total serum IgE levels in Korean. SUBJECTS AND METHOD: Blood samples for genetic analysis were obtained from 307 individuals with allergic rhinitis and from 268 healthy subjects without atopic diseases. Polymerase chain reaction-based assay for IL-13 exon 4 G2044A was used for genotyping. Serum total IgE levels were determined by using the immunoassay. Eosinophil values were determined by eosinophil numbers per total cell numbers per microl. RESULTS: There were no differences in the frequencies of the genotypes of IL-13 in the controls and patients (p>0.05). The frequencies of the IL-13 exon 4 2044A allele were statistically different between controls and patients (p0.05). CONCLUSION: Our result suggests that the IL-13 exon 4 G2044A polymorphism might give susceptibility to the development of allergic rhinitis in Koreans.

Undifferentiated Small Round Cell Tumor of the Nasal Vestibule / 대한이비인후과학회지

Small round cell tumors of the nasal vestibule are very uncommon tumors and encountered rarely in the late-adolescent and adult age group. The authors experienced a case of undifferentiated small round cell tumor of left nasal vestibule in a 19-year old male patient. Histopathologic findings showed a small cell with irregular oval shape nuclei. Immunohistochemical study showed undifferentiated small round cell carcinoma because of all negative stain except vimentin. The computed tomography (CT) scan of paranasal sinus and chest X-ray showed no evidence of invasion and regional metastasis. The patient received local resection and vestibuloplasty using a free composite graft of auricular cartilage and skin, and had no recurrence or complication. We report our case with a brief review of the literatures.

A Study of Susceptibility between Allergic Rhinitis and STAT6 Gene G2964A Polymorphism Study of a Korean Population / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: T helper-type 2 cytokines, such as IL-4 and IL-13, may play a central role in allergic diseases. The proteins known as signal transducers and activators of transcription 6 (STAT-6) are key transcription factors involved in both IL-4 and IL-13 mediated biological responses. Since a polymorphism of STAT6 G2964A has been found, we investigated the association between the polymorphism of STAT6 G2964A and allergic rhinitis in Korean. SUBJECTS AND METHOD: Blood samples for genetic analysis were obtained from 229 individuals with allergic rhinitis and from 278 healthy subjects without atopic diseases. Polymerase chain reaction-based assay for the STAT6 G2964A variant was used for genotyping. RESULTS: There were no differences in the frequencies of the genotypes between the controls and patients (p>0.05). The frequencies of the STAT6 2964A allele were not statistically different between controls and allergic rhinitis patients (p>0.05). CONCLUSION: Our result suggests that the STAT6 G2964A polymorphism might not give susceptibility to the development of allergic rhinitis in Koreans.

A Study of Prevalence between Allergic Rhinitis and CCR5 Gene Polymorphism Study of a Korean Population / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: CC chemokine receptor (CCR5) is characteristic of the Th 1 phenotype, the receptor of RANTES, MIP-1alphaand MIP-1beta. The receptor of CCR5 delta32 (a 32 bp deletion in the CCR5 gene, mutant type) results in the production of a non-functional receptor. Given the potential importance of CCR5 in allergic inflammation, we hypothesized that individuals carrying the CCR5 delta32 allele would show a reduced prevalence of allergic rhinitis. SUBJECTS AND METHOD: Blood samples for genetic analysis were obtained from 187 individuals with allergic rhinitis and from 278 healthy subjects without atopic diseases. Polymerase chain reaction-based assay for the CCR5 gene polymorphism was used for genotyping. RESULTS: We could not find the CCR5 delta32 homozygotes and heterozygotes at all in neither of the controls nor allergic rhinitis Korean patients. CONCLUSION: Since the CCR5 delta32 allele frequency did not deviate from that in the healthy control population, it is unlikely that this allele influences predisposition to allergic rhinitis in Koreans.

Genetic Susceptibilities of MCP-1 and CCR2 to the Risk for Korean Allergic Rhinitis Patients Using Polymorphism Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A biallelic A/G polymorphism in the Monocyte chemotactic protein (MCP) -1 at position -2518 has been found to affect the level of MCP-1 expression. To investigate if these polymorphisms in chemokine ligand and receptor genes are relevant for the development of allergic rhinitis, we investigated polymorphisms of MCP-1 and CC chemokine receptor 2 (CCR2) known as the receptor of MCP-1. MATERIALS AND METHOD: Blood samples for genetic analysis were obtained from 198 individuals with allergic rhinitis and from 278 healthy subjects without atopic diseases. Polymerase chain reaction-based assay for MCP-1 -2518 A/G (A/G polymorphism in the MCP-1 at position -2518) and CCR2 V64I polymorphisms (replacement of valine by isoleucine in CCR2 64) was used for genotyping. RESULTS: There were no differences in the frequencies of the genotypes in the controls and patients (p>0.05). The frequencies of the MCP-1 G and CCR2 A alleles were not statistically different between controls and allergic rhinitis patients (p>0.05). The odds ratios (95% confidence interval) of MCP-1 G/G and CCR2 A/A genotypes for allergic rhinitis were not statistically significant, whereas, alleles frequencies of MCP-1 -2518G and CCR2 A of controls were various according to the ethnic background. CONCLUSION: Our result suggests MCP-1 -2518 A/G and CCR2 V64I polymorphisms are not part of the factors contributing to genetical susceptibility in the development of allergic rhinitis in Koreans.

STAT6 Gene Polymorphisms in Allergic Rhinitis

T helper-type 2 cytokines, such as IL-4 and IL-13, may play a central role in allergic diseases. The protein known as signal transducers and activators of transcription 6 (STAT6) is a key transcription factor involved in both IL-4- and -13-mediated biological responses. Two polymorphisms of the STAT 6 gene (exon 1 and G2964A variant) have been found. We investigated whether these STAT6 gene polymorphisms were associated with allergic rhinitis. Blood samples for genetic analysis were obtained from 285 individuals with allergic rhinitis and from 271 healthy subjects without atopic disease. The G2964A variant of the STAT6 gene was genotyped using PCR-RFLP analysis. The GT repeat polymorphism in exon 1 of the STAT6 gene was genotyped by fragment analysis. There was no association between the 2964A variant and GT repeat polymorphism in exon 1 of the STAT6 and allergic rhinitis in a Korean population (both p > 0.05). Our results suggest that a combination of STAT6 gene polymorphisms is not a useful marker for predicting allergic rhinitis.

Lack of Association between an Insertion/Deletion Polymorphism of the Angiotensin-Converting Enzyme Gene and Allergic Rhinitis in a Korean Population

BACKGROUND AND OBJECTIVES: Angiotensin -converting enzyme (ACE) inactivates bradykinin, substance P, and neurokinin A, which are thought to play important roles in the pathogenesis of inflammatory diseases. An insertion/deletion (I/D) poly - morphism in the ACE gene was reported to be associated with atopy in a Czech population. MATERIALS AND METHODS: Using the polymerase chain reaction, we investigated the frequencies of the genotypes and alleles of the ACE gene in 137 patients with allergic rhinitis and 498 healthy control subjects. RESULTS: There was no difference in the frequencies of the genotypes in the controls and patients with allergic rhinitis (p>0.05). The D allele was more frequent in patients with allergic rhinitis, but the difference was not statistically significant (p>0.05). CONCLUSION: Our results indicate that I/D polymorphism in the ACE gene is not related to susceptibility to allergic rhinitis in the Korean population.

Histopathology of Meconium Contamination in the Middle Ear of Neonate / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Perinatal meconium aspiration and prolonged membrane rupture are correlated with a higher incidence of otitis media. Contamination of the ammniotic fluid with meconium presumably increases the concentration of desquamated epithelial cells. Therefore, more of these cells might be expected to be found in the middle ear and mastoid cavities of neonates born through meconium stained amniotic fluid (MSAF). The purpose of this study is to evaluate whether postmorterm findings of meconium aspiration syndrome might correlate with the amount of amniotic fluid cellular content in the middle ear. MATERIALS AND METHOD: We compared temporal bones of 14 patients born through MSAF with those of 15 patients born through clear amniotic fluid. The volume of contaminant was measured for each patient. RESULTS: Patients with larger volumes of contaminant in the middle ear were born through thick MSAF. Conversely, patients with lesser volumes of contaminant in the middle ear were born through unstained amniotic fluid. CONCLUSION: These results suggest that patients born through thick, MSAF may be at greater risk of sequelae such as otitis media from foreign body inflammatory reaction.

Free Fat Autograft with Topical Anticholinergic for Patulous Eustachian Tube / 대한이비인후과학회지

Patulous eustachian tube is a distressing condition for the patient with such symptoms as autophonia and a sensation of fullness in the ear. No specific therapy has been established. We treated two cases by free fat graft using intranasal endoscopy with postoperative topical anticholinergic (ipratropium bromide). The result suggests that this method should be an effective treatment. So we report with review of the literatures.

Effect of Antioxidants on the Toxicity of Oxygen Radicals to the Cultured Mouse Schwann Cells in vitro / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Oxygen radical scavengers and inhibitors are known to have protective functions (or roles) against hypoxia and noise exposure in the cochlea and brain. The purpose of this study was to examine the toxic effect of oxygen radicals (xanthine oxidase and hypoxanthine) on cultured mouse facial nerve Schwann cells, and determine if antioxidants (TPEN and DFO) might ptotect Schwann cells from oxidant-induced neurotoxicity. MATERIALS AND METHODS: Dissociated cell cultures were prepared from the facial nerve of a mouse. After dissociation of Schwann cells, isolated cells were washed, resuspended in feeding medium, and plated onto poly-L-lysine-coated Aclar plastic cover slips (12 mm diameter) in petri dishes or in 96 well multichambers at cell density of 2X105 ceIls/coverslip or lX10(5) ceIls/we11. The feeding medium consisted of Eagle's minimum essential medium (MEM) containing 5% horse serum, 5 mg/ml D-glucose, and 25 ng/ml gentamicin. Cultures were grown in 5% CO2/95% atmosphere at 37degreesC, and the medium was renewed twice a week. Cultures grown for 4-5 days were utilized for experiments. Oxygen radical exposure was done using XO and HX, and antioxidant pretreatment was carried out using tetrakis (2-pyridylmethyl) ethylenediamine (TPEN) and desferrioxamine (DFO). Cytotoxicity assay was performed by MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide cytotoxic assay and inverted microscopy. RESULTS: Cell viability of cultured mouse Schwann cells treated with markedly decreased in a dose-dependent manner. Cultured mouse Schwann cells exposed to XO/HX for 4 hours showed degenerative changes such as the decrease of cell number and process. Pretreatment of 80 uM TPEN for 2 hours increased remarkably the cell viability of cultured Schwann cells exposed to 20 mU/ml XO/0.1 mM HX, while DFO did not show any protective effects on oxidant-induced neurotoxicity in these cultures. CONCLUSION: It is suggested that oxygen radicals induce neurotoxic effect on cultured mouse Schwann cells, and that selective antioxidants such as TPEN is very effective in blocking oxidant-induced neurotoxicity.

Clinical Study of Surgical Treatment for Frontal Sinus Disease: Osteoplastic Frontal Sinus Surgery versus Endoscopic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Depending on the pathologic process the treatment of frontal sinus disease has consisted of obliteration of the sinus, or restoration of drainage into the nose. Endoscopic sinus surgery (ESS) gives advantages for dramatically reducing operative morbidity of surgery for frontal sinus disease by offering a minimally invasive alternative to previous osteoplastic or other radical frontal sinus surgery. We present our experience with 18 frontal sinus diseases in which osteoplastic approach or endoscopic sinus were attempted. MATERIALS AND METHODS: Retrospective review of 18 cases were done. Ten patients were treated by ESS, and 8 cases by osteoplastic frontal sinus surgery (OFSS) with obliteration. RESULTS: During the follow-up period, 10 patients treated by ESS had complete resolution of all symptoms but 3 cases treated by OFSS had at least one episode of headache. No recurrence of ESS patients has been noted to date according to the endoscopic follow-up of up to 16 months, and gradual absorbtion of obliterated fat without recurrence was observed. But there was no absorption of obliterated hydroxyapatite granule after long-term period. The frontal sinus can be visualized with follow-up endoscopy, and the difficult evaluation of the obliterated cavity can be avoided. CONCLUSION: ESS is much better than OFSS, but osteoma, fracture and some limited situations are bound to be treated by OFSS. In case of OFSS, hydroxyapatite obliteration shows long-term stability than fat.

Salivary and Blood Flow Responses to Different Frequency Stimulation of the Cervical Sympathetic Nerve of the Submandibular Gland in the Cat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It has been assumed that salivary glands receive secretory fibers both from parasympathetic and sympathetic nerves. In fact, however, the existence of sympathetic secretory fibers in the cervical sympathetic nerve has not been established yet, because the salivary response to the cervical sympathetic stimulation is variable and short-lasting, and it tends to cease in spite of continued stimulation. This study investigated whether or not the cervical sympathetic nerve contains specific secretory fibers. MATERIALS AND METHODS: Salivary and blood flow responses to different frequency stimulation of the cervical sympathetic nerve, and often some autonomic drugs administration were observed from the submandibular gland in chloralose-anesthetized cats. RESULTS: 1) Low frequency stimulation (1-2 Hz) of the sympathetic nerve did not evoke salivary outflow and any change of blood flow, whereas high frequency stimulation of the nerve evoked salivary outflow and decrease of blood flow, in which salivary response tended to cease in spite of continued stimulation. 2) The salivary and blood flow responses to high frequency stimulation (20 Hz) of the nerve were not affected by the intravenous administration of propranolol, but were abolished by regitine. 3) Noradrenalin evoked salivary outflow and decreased blood flow which were not affected by the administration of propranolol but were abolished by regitine. 4) Isoproterenol increased blood flow but did not evoke salivary outflow, and the blood flow response was abolished by propranolol. CONCLUSION: These results suggest that the cervical sympathetic nerve does not contain specific secretory fibers and salivary outflow response to high frequency stimulation of the nerve may be due to either excitation of motor fibers innervating contractile elements of the excretory duct or chemical transmitters released from the vasomotor fibers.