Clinical Characteristics Other Than Intralesional Hyperdensity May Increase the Preoperative Diagnostic Accuracy of Maxillary Sinus Fungal Ball

Objectives@#. This study aimed to evaluate the clinical characteristics of maxillary sinus fungus ball (MFB) to increase the preoperative diagnostic accuracy. @*Methods@#. A retrospective review of 247 patients who underwent endoscopic sinus surgery for unilateral maxillary sinusitis from January 2015 to December 2017 at a single institution was performed. Patients with pathologically proven MFB were compared to those with unilateral chronic maxillary sinusitis (CMS). Patient demographics and computed tomography (CT) findings were evaluated. The CT features were categorized as intralesional hyperdensity (calcification), the irregular lobulated protruding lesion (fuzzy appearance), maxillary sinus full haziness without mass effect, maxillary sinus full haziness with mass effect, and others. A regression tree analysis was performed. @*Results@#. In total, 247 patients were analyzed; among them, 179 (72.5%) had MFB and 68 (27.5%) had CMS. MFB showed predominance in older individuals. Among the radiological features, intralesional hyperdensity was most commonly associated with MFB. The presence of a fuzzy appearance or full opacity with mass effect was also associated with MFB. The highest area under the curve was noted with the regression tree analysis based on the model, which included the presence of intralesional hyperdensity, demographic data (age), and presence of fuzzy appearance or maxillary sinus full haziness with mass effect in case of absence of intralesional hyperdensity (0.904). @*Conclusion@#. A simple algorithm to optimize the preoperative diagnosis of MFB was developed. Physicians should be aware of such findings in the management of patients presenting with unilateral CMS.

Principal Clinical Factors Predicting Therapeutic Outcomes After Surgical Drainage of Postoperative Cheek Cysts: Experience From a Single Center

OBJECTIVES: Postoperative cheek cyst (POCC) is a late postoperative complication of radical maxillary sinus surgery including the Caldwell-Luc (C-L) operation. The present study aimed to evaluate the therapeutic outcomes of surgical treatment for POCC and to assess the clinical factors correlated to these outcomes. METHODS: This study included 57 patients (67 nostrils) diagnosed with POCC who underwent surgical drainage. The medical records of the patients were retrospectively reviewed for radiological findings, treatment modalities, residual symptoms, and recurrences. RESULTS: In total, 30 patients were male and 27 patients were female with a mean age of 55 years, and the patients were usually diagnosed with POCC 28.2 years after radical surgery. Endonasal endoscopic marsupialization was performed via inferior meatal antrostomy, and if possible, middle meatal antrostomy was performed at the same time. In patients with cysts that were difficult to reach using an endonasal endoscopic approach, additional open C-L approaches were performed. The median follow-up period was 19.4 months. Overall, adequate drainage and symptomatic relief were achieved in 91% (61/67) of the patients. The recurrence rate was significantly higher in patients who had anterolateral POCC. Failure to achieve symptomatic relief was correlated to a smaller cyst and the use of the open C-L approach for drainage. CONCLUSION: The location and size of the cyst as well as the use of the open surgical approach were important factors in predicting the therapeutic outcome of POCC. The time point of treatment and surgical approaches should be based on the above-mentioned findings.

Biomarkers in Chronic Rhinosinusitis with Nasal Polyp: Personalized Medicine Based on Endotype / 대한이비인후과학회지

Chronic rhinosinusitis (CRS) is divided into CRS with nasal polyp (CRSwNP) and CRS without nasal polyp (CRSsNP) according to the presence of a nasal polyp. Some of the CRSwNP patients are relatively well managed without recurrences while others are difficult due to recurrence and refractoriness after surgical or medical treatment. Thus CRSwNP is not a single disease but is rather considered as a disease that has a variety of disease spectrum. Various biomarkers have been proposed to distinguish endotypes of CRSwNP. CRSwNP with high tissue eosinophil infiltration with robust type 2 inflammation (e.g., IL-5) is usually associated with comorbid asthma and is likely to recur. This type of CRSwNP is relatively common in Western countries. However, in Asian countries, CRSwNP is often presented as a heterogeneous disease comprising a mixture of type 1 (e.g., IFN-γ), type 2 and type 3 (e.g., IL-17) inflammation. In Asians, up-regulation of IL-8, IFN-γ and associated neutrophilic inflammation is prone to have disease refractoriness. Different underlying inflammatory profile indicates different underlying pathogenesis. Therefore, in the era of precision medicine, treatment should be based upon according to endotype.

Analysis of Sleep Questionnaires of Commercial Vehicle Operators in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is highly prevalent in commercial vehicle operators (CMVOs). This study aimed to evaluate the poor sleep quality, daytime sleepiness, and the prevalence of self-reported OSA in CMVOs. SUBJECTS AND METHOD: We performed a retrospective review of the medical records of patients who visited a single institution with sleep problems from 2011 January to 2016 December. Among the patients, a total of 38 CMVOs was analyzed. Clinical information, questionnaires about sleep quality (Pittsburg sleep questionnaire, PSQI), excessive daytime sleepiness (Epworth sleepiness scale, ESS) and risk factors for OSA (STOP-Bang) were analyzed. The frequency of motor vehicle accidents and near accidents was assessed, and polysomnography (PSG) was used for OSA diagnosis purposes. RESULTS: The mean age of the study population was 45.3±11.8 years. The average score of PSQI, ESS, and STOP-Bang were 6.75±4.22, 10.79±7.12, and 4.62±3.34, respectively. A significant association between near accidents and high-risk group of OSA was observed [odds ratio (OR)=2.73, 95% confidence interval (CI)=1.08–4.48]. Subjects with poor sleep quality showed significantly increased risk of near accidents (OR=2.34, 95% CI=1.01–3.56). Receiver operating characteristic curves of STOP-Bang questionnaire using apnea-hypopnea index (cut-off value=5) indicates that suspected OSA group predicted by STOP-Bang score was significantly correlated with OSA severity (area under curve=0.72, sensitivity 77.1%, specificity 59.4%). CONCLUSION: Administration of STOP-Bang questionnaire before a PSG can identify high-risk subjects, supporting its further use in OSA screening of CMVOs.

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.

Biomarkers in Chronic Rhinosinusitis with Nasal Polyp: Personalized Medicine Based on Endotype / 대한이비인후과학회지

Chronic rhinosinusitis (CRS) is divided into CRS with nasal polyp (CRSwNP) and CRS without nasal polyp (CRSsNP) according to the presence of a nasal polyp. Some of the CRSwNP patients are relatively well managed without recurrences while others are difficult due to recurrence and refractoriness after surgical or medical treatment. Thus CRSwNP is not a single disease but is rather considered as a disease that has a variety of disease spectrum. Various biomarkers have been proposed to distinguish endotypes of CRSwNP. CRSwNP with high tissue eosinophil infiltration with robust type 2 inflammation (e.g., IL-5) is usually associated with comorbid asthma and is likely to recur. This type of CRSwNP is relatively common in Western countries. However, in Asian countries, CRSwNP is often presented as a heterogeneous disease comprising a mixture of type 1 (e.g., IFN-γ), type 2 and type 3 (e.g., IL-17) inflammation. In Asians, up-regulation of IL-8, IFN-γ and associated neutrophilic inflammation is prone to have disease refractoriness. Different underlying inflammatory profile indicates different underlying pathogenesis. Therefore, in the era of precision medicine, treatment should be based upon according to endotype.

Analysis of Sleep Questionnaires of Commercial Vehicle Operators in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Obstructive sleep apnea (OSA) is highly prevalent in commercial vehicle operators (CMVOs). This study aimed to evaluate the poor sleep quality, daytime sleepiness, and the prevalence of self-reported OSA in CMVOs.SUBJECTS AND METHOD: We performed a retrospective review of the medical records of patients who visited a single institution with sleep problems from 2011 January to 2016 December. Among the patients, a total of 38 CMVOs was analyzed. Clinical information, questionnaires about sleep quality (Pittsburg sleep questionnaire, PSQI), excessive daytime sleepiness (Epworth sleepiness scale, ESS) and risk factors for OSA (STOP-Bang) were analyzed. The frequency of motor vehicle accidents and near accidents was assessed, and polysomnography (PSG) was used for OSA diagnosis purposes.@*RESULTS@#The mean age of the study population was 45.3±11.8 years. The average score of PSQI, ESS, and STOP-Bang were 6.75±4.22, 10.79±7.12, and 4.62±3.34, respectively. A significant association between near accidents and high-risk group of OSA was observed [odds ratio (OR)=2.73, 95% confidence interval (CI)=1.08–4.48]. Subjects with poor sleep quality showed significantly increased risk of near accidents (OR=2.34, 95% CI=1.01–3.56). Receiver operating characteristic curves of STOP-Bang questionnaire using apnea-hypopnea index (cut-off value=5) indicates that suspected OSA group predicted by STOP-Bang score was significantly correlated with OSA severity (area under curve=0.72, sensitivity 77.1%, specificity 59.4%).@*CONCLUSION@#Administration of STOP-Bang questionnaire before a PSG can identify high-risk subjects, supporting its further use in OSA screening of CMVOs.

A Case of 18-Year-Old Female with Nasopharyngeal Diffuse Large B Cell Lymphoma / 대한이비인후과학회지

Malignant lymphoma is tumor of the immune system. It is mainly found in the lymph node but it can also originate from extranodal organs such as gastrointestinal tract, sinonasal tract, and etc. We experienced a case of 18-year-old female patient with a huge nasopharyngeal mass. The patient visited our clinic with complaints of nasal obstruction and mouth breathing without general symptoms. After extirpation and biopsy of the nasopharyngeal mass, lesion was diagnosed as malignant lymphoma. In immunohistochemistry, CD 20, Bcl-2, Bcl-6 were positive. Final diagnosis was diffused large B cell lymphoma, for which she received chemotherapy (Rituximab, Cyclophosp, Ahamide, Adriamycin, Vincristine, Prednisone). We report a case of huge malignant lymphoma that occurred in the nasopharynx with a brief review of literature.