Effect of Endonasal Dilator on Nasal Airflow and Sleep Test Index on Sleep Apnea Patients

BACKGROUND AND OBJECTIVES: We aimed to evaluate effects of endonasal dilators (END) on sleep quality in patients with obstructive sleep apnea (OSA) by improving nasal airflow. MATERIALS AND METHODS: In 13 patients with OSA, changes of total nasal volume (TNV) and minimal cross-sectional area (MCA) before and after END use were evaluated. The change in peak nasal inspiratory flow (PNIF) was also measured. Subjects completed Epworth Sleepiness Scale questionnaire before and 2 weeks after END use. Finally, changes in apnea-hypopnea index (AHI), respiratory distress index (RDI), oxygen desaturation index (ODI), sleep time, sleep position and loudness of snoring (in decibels) were obtained by repetitive portable polysomnography. RESULTS: After END use, TNV (11.4±3.1 cm3 to 19.4±5.7 cm3) and MCA (0.7±0.2 cm2 to 0.9±0.1 cm2) increased significantly (p=0.001). PNIF also increased significantly after END (147.3±39.5 to 194.6±57.6 liter/min, p=0.001). Among 11 patients undergoing 2-week follow-up, 7 reported improvement in daytime sleepiness. Although AHI, RDI and ODI showed no statistically significant change before and after END (p>0.05), the proportion of subjects sleeping in the supine position increased from 38.0 to 44.5%. CONCLUSION: END may be an effective adjunctive tool for patients with OSA with the potential to improve nasal airflow and daytime sleepiness.

Paradoxical Response to Cold Dry Air Provocation according to the Season in Allergic Rhinitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We investigated the seasonal variation of nonspecific hyperreactivity by performing the cold dry air (CDA) provocation test in both summer and winter in patients with rhinitis. SUBJECTS AND METHOD: We performed the CDA provocation test in 57 patients with allergic rhinitis (AR) or non-allergic rhinitis (NAR). Depending on the season and the type of rhinitis, we divided patients into four groups (Summer AR group, n=17; Winter AR group, n=15; Summer NAR group, n=18 and Winter NAR group, n=7) and compared the changes in nasal symptoms, total nasal volume (TNV), and minimal cross-sectional area (MCA) measured by acoustic rhinometry after CDA provocation in each group. RESULTS: When the CDA provocation was performed for AR patients in summer, nasal symptoms improved slightly, which was significantly different from those shown in winter (Summer AR vs. Winter AR, p=0.012). In addition, there was a significant difference in symptom change between AR and NAR patients in the summer (Summer AR vs. Summer NAR, p=0.033). There was no significant difference in TNV or MCA changes after CDA provocation depending on the type of rhinitis and season (p>0.05). CONCLUSION: When performing CDA provocation in AR patients in summer, the examiner should pay attention to the possible paradoxical response.

Paradoxical Response to Cold Dry Air Provocation according to the Season in Allergic Rhinitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#We investigated the seasonal variation of nonspecific hyperreactivity by performing the cold dry air (CDA) provocation test in both summer and winter in patients with rhinitis.SUBJECTS AND METHOD: We performed the CDA provocation test in 57 patients with allergic rhinitis (AR) or non-allergic rhinitis (NAR). Depending on the season and the type of rhinitis, we divided patients into four groups (Summer AR group, n=17; Winter AR group, n=15; Summer NAR group, n=18 and Winter NAR group, n=7) and compared the changes in nasal symptoms, total nasal volume (TNV), and minimal cross-sectional area (MCA) measured by acoustic rhinometry after CDA provocation in each group.@*RESULTS@#When the CDA provocation was performed for AR patients in summer, nasal symptoms improved slightly, which was significantly different from those shown in winter (Summer AR vs. Winter AR, p=0.012). In addition, there was a significant difference in symptom change between AR and NAR patients in the summer (Summer AR vs. Summer NAR, p=0.033). There was no significant difference in TNV or MCA changes after CDA provocation depending on the type of rhinitis and season (p>0.05).@*CONCLUSION@#When performing CDA provocation in AR patients in summer, the examiner should pay attention to the possible paradoxical response.

Altered Gravity and Immune Response / 항공우주의학회지

It is essential to study the effects of hypergravity on the human body in the research field of aerospace medicine. Previous studies have shown that hypergravity could act in a harmful way to the human body. However, recent studies have shown that moderate degree of hypergravity can act in a beneficial way to the human body. The authors have in particular been studying the effects of hypergravity on immune diseases, especially allergic asthma and rhinitis. Therefore, this review paper will introduce the results of recent studies on hormetic (health promotion) effect of hypergravity. In addition, this review paper also examines the mechanism by which hormetic effect of hypergravity could be possible. Furthermore, we will also discuss how to apply these hormetic effects in clinical practice.

Cold Dry Air Provocation and Immunoglobulin E in Nasal Fluid for Diagnosing Nonspecific Hyper-Reactivity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to evaluate the usefulness of cold dry air (CDA) provocation test in patients with non-allergic or allergic rhinitis. SUBJECTS AND METHOD: Twenty-one patients (13 males and 8 females, mean age 36.9±17.6 years) with symptoms of rhinitis were enrolled. We classified patients into groups A (control group, n=9) and B (allergic group, n=12) according to their skin prick test results. Before and after CDA provocation (0℃, relative humidity<10%, total 400 liters during 6 minutes), we evaluated changes in nasal symptoms. We collected serum, and nasal fluid before and after CDA provocation using the filter paper method. We measured serum and nasal fluid IgE levels, compared them between the groups, and evaluated the correlation between serum and nasal fluid IgE. RESULTS: After the CDA provocation, group B had more aggravation of symptoms than group A, with a statistical significance (for nasal obstruction, group A: 3.0±2.4, group B: 5.8±3.4, p=0.049; for itching, group A: 1.0±1.6, group B: 3.8±3.4, p=0.045). The level of serum total IgE was significantly higher in group B (group A: 152.7±67.3 ng/mL, group B: 612.1±291.4 ng/mL, p=0.001). The titer of nasal fluid IgE was higher in group B, before and after the CDA challenge (before CDA, group A: 91.7±52.6 ng/mL, group B: 810.0±1042.3 ng/mL, p=0.029, after CDA, group A: 55.8±43.8 ng/mL, group B: 354.9±236.7 ng/mL, p=0.003). There was a significant correlation between the serum IgE and nasal fluid IgE levels after the CDA provocation test (R2=0.749, p<0.001). CONCLUSION: The CDA provocation test and measurement of nasal fluid IgE level could be useful for the evaluation of nonspecific hyper-reactivity.

Usefulness of Allerkin House Dust Mite Extract for Nasal Provocation Testing

OBJECTIVES: We evaluated the clinical usefulness of Allerkin (Lofarma) for nasal provocation testing (NPT) in patients with rhinitis symptoms, by examining changes in nasal symptoms and acoustic parameters after exposure to house dust mite (HDM) extract. METHODS: Twenty patients (16 males and 4 females, mean age: 29.6±14.6 years) were enrolled. We performed skin prick test (SPT) before and 15 and 30 minutes after intranasal challenge with Allerkin HDM extract, and we evaluated symptom changes (nasal obstruction, rhinorrhea, sneezing, and itching) using a visual analogue scale. We also evaluated changes in acoustic parameters such as total nasal volume (TNV) and minimal cross-sectional area (MCA) before and after challenge. RESULTS: Group A (the nonallergic group, n=8) showed negative results for all tested aeroallergens in SPT and nonprovocative results ( 29% decrease in TNV/MCA from the baseline value). Patients in group C showed significant aggravation of nasal obstruction compared to those in group A (P < 0.05). Thirty minutes after HDM challenge, patients in groups B and C showed significantly greater decreases in MCA compared to those in group A (P < 0.01). CONCLUSION: Allerkin HDM extract can be a useful provocative agent in NPT for diagnosing allergic rhinitis and local allergic rhinitis.

Low Concentration PM10 Had No Effect on Nasal Symptoms and Flow in Allergic Rhinitis Patients

OBJECTIVES: Since Korea is geographically close to China (the origin site for Asian sand dust [ASD]) the health influence of ASD event will be still greater in Korea. We aimed to evaluate the effect of PM₁₀ (particulate matter with aerodynamic diameter 100 μg/m³) RESULTS: There was no significant difference between group A and B in nasal symptoms and PNIF during the 120-day period. Changes in nasal symptoms and PNIF were not statistically significant before or after a PM₁₀ concentration rise above 100 μg/m³. CONCLUSION: Low concentration PM10 does not have significant effect on nasal symptoms and PNIF in AR patients.

Evidences for Local Allergic Rhinitis

Local allergic rhinitis is defined as a localized allergic reaction of the nasal mucosa in the absence of systemic atopy. Its main pathophysiological mechanism can be summarized as: 1) increased specific immunoglobulin E in the nasal fluid, and 2) Th2 allergic mechanism localized in the nasal mucosa. In patients whose result of a skin prick test is totally negative for all antigens, practitioners could diagnose local allergic rhinitis using a nasal provocation test. Oral antihistamines and intranasal steroids can be an effective treatment. Subcutaneous immunotherapy can also be helpful. Further study is essential to further elucidate the detailed pathophysiologic mechanism and set up global standard diagnostic criteria.

Effect of Long-Term Antiorthostatic Suspension in a Murine Model of Acute Lung Injury

OBJECTIVES: Antiorthostatic suspension (AOS) is ground-based model of simulated microgravity. There is still no study about the effect of long-term microgravity on the clinical course of acute lung injury. We evaluated the effect of simulated microgravity using AOS in a murine model of acute lung injury by lipopolysaccharide (LPS). METHODS: Thirty BALB/c mice were used. During 4 weeks, mice were equally allocated to control (free movement), restraint (tail suspended, but hindlimbs not unloaded), and AOS group (hindlimb unloaded). After then, mice got intranasal challenge with LPS (20 mg/kg, 50 μL). We measured: weight gain before and after AOS, the number of inflammatory cells and titers of cytokines (interleukin [IL]-1β, IL-6, IL-10, tumor necrosis factor-α, and interferon-γ) in bronchoalveolar lavage (BAL) fluid, titer of myeloperoxidase (MPO) in serum and lung homogenate, and histopathologic examination of lung tissue. RESULTS: AOS group had significant weight loss compared to control and restraint group (P<0.001). AOS group also showed significantly decreased lymphocytes (P=0.023) compared to control group. In AOS group, titer for IL-1β in BAL fluid was significantly lower than restraint group (P=0.049). Titer for serum MPO was significantly decreased in AOS group compared to restraint group (P=0.004). However, there was no significant difference of MPO titers in lung tissue between groups. Histopathologic examination of lung tissue revealed no significant difference in the degree of pulmonary infiltration between restraint and AOS group. CONCLUSION: In spite of modest anti-inflammatory effect, prolonged AOS caused no significant change in LPS-induced pulmonary inflammation.

Serum Prealbumin Affected More by Serum CRP Than by Residual Burned Surface Area

PURPOSE: Prealbumin is known as a biochemical marker for assessing nutritional status, and it is influenced by a systemic inflammatory condition. This study aims to find any correlation between patients' low serum prealbumin in electrical burn and unhealed burn surface area and insufficient nutritional support. METHODS: Data were collected by a review of the medical charts of patients admitted to Hanil General Hospital for electrical burn. Laboratory results such as prealbumin, albumin, total lymphocyte count (TLC), and C-reactive protein (CRP) were collected and tested every week. Residual burn surface area (residual BSA) during a specific period was calculated from the surgery record. Statistical analysis was conducted using Pearson's correlation and multiple regression analysis. RESULTS: A total of 30 subjects were selected, all male. Average total burn surface area was 20.9±14.9%, and patients were operated on about three times after admission. There was statistical significance among all variables in Pearson's correlation test, but in multiple regression analysis, albumin and CRP were significant compared with prealbumin. CONCLUSION: The results could indicate that burn causes a systemic inflammatory reaction, which could affect the serum prealbumin level. Further study concerning the biological plausibility of each variable is needed.

Computed Tomography and Magnetic Resonance Imaging Findings of Nasal Cavity Hemangiomas According to Histological Type

OBJECTIVE: To compare computed tomography (CT) and magnetic resonance imaging (MRI) findings between two histological types of nasal hemangiomas (cavernous hemangioma and capillary or lobular capillary hemangioma). MATERIALS AND METHODS: CT (n = 20; six pre-contrast; 20 post-enhancement) and MRI (n = 7) images from 23 patients (16 men and seven women; mean age, 43 years; range, 13-73 years) with a pathologically diagnosed nasal cavity hemangioma (17 capillary and lobular capillary hemangiomas and six cavernous hemangiomas) were reviewed, focusing on lesion location, size, origin, contour, enhancement pattern, attenuation or signal intensity (SI), and bony changes. RESULTS: The 17 capillary and lobular hemangiomas averaged 13 mm (range, 4-37 mm) in size, and most (n = 13) were round. Fourteen capillary hemangiomas had marked or moderate early phase enhancement on CT, which dissipated during the delayed phase. Four capillary hemangiomas on MRI showed marked enhancement. Bony changes were usually not seen on CT or MRI (seen on five cases, 29.4%). Half of the lesions (2/4) had low SI on T1-weighted MRI images and heterogeneously high SI with signal voids on T2-weighted images. The six cavernous hemangiomas were larger than the capillary type (mean, 20.5 mm; range, 10-39 mm) and most had lobulating contours (n = 4), with characteristic enhancement patterns (three centripetal and three multifocal nodular), bony remodeling (n = 4, 66.7%), and mild to moderate heterogeneous enhancement during the early and delayed phases. CONCLUSION: CT and MRI findings are different between the two histological types of nasal hemangiomas, particularly in the enhancement pattern and size, which can assist in preoperative diagnosis and planning of surgical tumor excision.

Interleukin-33 and Mast Cells Bridge Innate and Adaptive Immunity: From the Allergologist's Perspective / 대한배뇨장애요실금학회지

Interleukin (IL) 33, a member of the IL-1 superfamily, is an "alarmin" protein and is secreted in its active form from damaged cells undergoing necrotic cell death. Mast cells are one of the main effector cell types in allergic disorders. They secrete a variety of mediators, including T helper 2 cytokines. As mast cells have high-affinity IgE receptors (FcepsilonRI) on their surface, they can capture circulating IgE. IgE-bound mast cells degranulate large amounts of histamine, heparin, and proteases when they encounter antigens. As IL-33 is an important mediator of innate immunity and mast cells play an important role in adaptive immune responses, interactions between the two could link innate and adaptive immunity. IL-33 promotes the adhesion of mast cells to laminin, fibronectin, and vitronectin. IL-33 increases the expression of adhesion molecules, such as intracellular adhesion molecule-1 and vascular cell adhesion molecule-1, in endothelial cells, thus enhancing mast cell adhesion to blood vessel walls. IL-33 stimulates mast cell proliferation by activating the ST2/Myd88 pathway; increases mast cell survival by the activation of survival proteins such as Bcl-XL; and promotes the growth, development, and maturation of mast cell progenitors. IL-33 is also involved in the activation of mature mast cells and production of different proinflammatory cytokines. The interaction of IL-33 and mast cells could have important clinical implications in the field of clinical urology. Epithelial dysfunction and mast cells could play an important role in the pathogenesis of interstitial cystitis. Urinary levels of IL-33 significantly increase in patients with interstitial cystitis. In addition, the number of mast cells significantly increase in the urinary bladders of patients with interstitial cystitis. Therefore, inhibition of mast cell activation and degranulation in response to increase in IL-33 is a potential therapeutic target in the treatment of interstitial cystitis.

The Current Knowledge of Allergen Nasal Provocation Test

Nasal provocation test (NPT) is a procedure used to evaluate the hyper-responsiveness of nasal mucosa after exposure to a provocative allergen. We aimed to identify the clinical indication and contra-indication for the use of NPT, and to introduce the actual NPT laboratory protocol in our clinical practice. We also provide clinical information which could be useful in conducting NPT. Finally, we discuss the current limitations of NPT and present a plan to overcome these difficulties.

Prognostic Factors for Improved Daytime Sleepiness after Uvulopalatal Flap for Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to evaluate pre-operative factors for patients with obstructive sleep apnea (OSA) and determine the correlation these factors have with the improvement of daytime sleepiness based on the change of Epworth Sleepiness Scale (ESS) score before and after uvulopalatal flap (UPF). SUBJECTS AND METHOD: Twenty-two patients with OSA who had received UPF surgery were enrolled in the study. We checked age, body mass index (BMI), size of tonsils, and position of palate. Using the Muller maneuver, we quantified the degree of obstruction at the velopharynx and the tongue base level. The cephalometric variables were checked by X-ray. Apnea-hypopnea index, respiratory distress index, and lowest oxygen saturation were obtained by portable monitoring. Finally, we obtained ESS score before and after UPF. The correlation between the aforementioned pre-operative factors and changes in ESS score was evaluated. RESULTS: A significant correlation was observed between the change in ESS score and patients' age (R=0.168, p=0.031), BMI (R=0.642, p=0.004), and posterior airway space (PAS)(R=0.378, p=0.029). Patients who were older than 40 years old (p=0.030), obese patients with BMI> or =25.0 (p=0.001), and those who had reported severe daytime sleepiness before surgery (pre-operative ESS score >10, p<0.01) reported greater improvement of daytime sleepiness after UPF. CONCLUSION: We propose age, BMI, and wider PAS as predictors for greater improvement of daytime sleepiness after UPF in patients with OSA.

A Case of Metastatic Renal Cell Carcinoma to the Maxillary Sinus Treated with Tyrosine Kinase Inhibitor / 대한이비인후과학회지

Renal cell carcinoma is a rare metastatic malignant neoplasm of the paranasal sinus. The clinical picture and radiologic findings might sometimes be insufficient to suspect metastatic renal cell carcinoma. Therefore, the definite diagnosis should be made according to the result of intraoperative biopsy. Recently, tyrosine kinase inhibitor, sunitinib, is considered as an effective agent in the treatment of metastatic renal cell carcinoma. We report a case of 69-year-old patient with metastatic renal cell carcinoma of the right maxillary sinus with accompanying fungal sinusitis. After 6 times of chemotherapy with sunitinib malate, there was no sign of recurrence or local advancement of the tumor during the 1-year follow-up period.

A case of huge extramedullary plasmacytoma arising from both nasal cavity

A 52-year-old patients suffering from nasal stuffiness had necrotic, ulcerative polypoid mass in both nasal cavity. CT and MRI revealed bilateral polypoid mass with bony invasion in left maxillary anterior and posterior wall, left pterygopalatine fossa and right central skull base. The patient was diagnosed as plasmacytoma by histologic examination. To rule out multiple myeloma, several additive studies such as bone scan, bone marrow biopsy, urine Bence-Jons protein, serum protein electrophoresis, peripheral blood smear were performed and all results were negative. The patient was transferred to department of hemato-oncology and got 2 times of chemotherapy consisting of cyclophosphamide and dexamethasone and radiotherapy (5400 cGy / 30 fractionation). A month after the completion of chemoradiotherapy, the sized of mass decreased significantly without evidence of progression.

Rare complication of acute maxillary sinusitis: Abscess of inferior turbinate and nasal Dorsum

An 8-year-old boy visited our clinic suffering from painful swelling of the left cheek and eye pain. His left nasal dorsum and left cheek were severely swollen with reddish discoloration and tenderness by light touch. A CT scan revealed left maxillary sinusitis and abscess extending to the left inferior turbinate and subcutaneous soft tissue beneath the skin covering the left maxillary sinus. Because of unsuccessful 3 days of medical treatment, surgical drainage of the abscess of the turbinate, nasal dorsum, and eradication of inflammation in the maxillary sinus was performed. Clinical suspicion and prompt imaging workup could hasten the definite diagnosis and appropriate surgical management, as in our case.

The Safety of Low Concentration Hypochlorous Acid as an Oral Gargle Solution and Its Anti-Microbial Effects / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The authors aimed to evaluate the safety of low concentration hypochlorous acid as an oral gargle solution. To do this, we carried out in vitro and in vivo experiments and evaluated its efficacy by compared with normal saline and chlorhexidine gargle using throat culture before and after gargling. MATERIALS AND METHOD: The authors treated oral mucosal epithelial cell with 3.5 ppm hypochlorous acid and evaluated cytotoxicity. For evaluation of morphological change, oral mucosa specimens were obtained during surgery before 30 minutes and 2 hours after treatment with hypochlorous acid. The specimens were evaluated with light microscopy. For evaluation of efficacy, we performed oral gargle with normal saline, chlorhexidine and hypochlorous acid in 10 healthy volunteers. The throat cultures were performed before and after each gargling. Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, Klebsiella pneumoniae, Aspergillus fumigatus, Rhizopus oryzae were evaluated semi-quantitatively (Grade 0 to 4). RESULTS: There was no cellular toxicity in MTT assay and the morphological changes were not observed. Both chlorhexidine and hypochlorous acid showed significant decrease of microbes (chlorhexidine: p=0.036, hypochlorous acid: p=0.031). There was no significant differences between them (p=0.217). CONCLUSION: Low concentration hypochlorous acid is safe for the oral mucosal epithelium and has antimicrobial efficacy similar to that of chlorhexidine.

Surgical Outcomes after Total Colectomy with Ileorectal Anastomosis in Patients with Medically Intractable Slow Transit Constipation

PURPOSE: The aim of this study was to evaluate outcomes of a total colectomy with ileorectal anastomosis in patients with slow transit constipation. METHODS: A retrospective review of 37 consecutive patients with slow transit constipation who underwent a total colectomy between 1994 and 2008 was undertaken. Preoperative and postoperative Wexner's constipation scores were collected and used to evaluate the outcomes after surgical treatment. Also patients' postoperative satisfaction scores were collected using a 4-point scale. RESULTS: The 37 patients consisted of 31 women and 6 men, with a median age of 41 years (range, 17 to 71 years). Pre- and post-operative Wexner's scores were collected from 33 patients (89.1%), and the mean preoperative Wexner's score was 19.3 (range, 11 to 24), which decreased to an average post-operative score of 2.3 (range, 0 to 8). Neither intraoperative complications nor postoperative mortalities were noted. Five patients (13.5%) had early postoperative complications, and the most common complication was postoperative ileus (10.8%). Seven patients (18.9%) had late postoperative complications, and postoperative ileus (10.8%) was also the most common. Twenty seven of 33 patients were satisfied with their surgical outcome (81.8%). CONCLUSION: A total colectomy with ileorectal anastomosis might be an effective surgical procedure with acceptable morbidity to treat medically intractable slow transit constipation.

Effects of Septal Deviation on Symptom Change and Results of the Nasal Provocation Test according to Bilateral Acoustic Rhinometry in Patients with Allergic Rhinitis

BACKGROUND AND OBJECTIVES: We aimed to evaluate the effects of septal deviation on patient symptoms and acoustic rhinometry measurements in patients with allergic rhinitis and to determine which side of the septum is the better choice. MATERIALS AND METHODS: The bilateral nasal provocation test with acoustic rhinometry was performed on patients with septal deviation and allergic rhinitis (Group A, n=25) and in patients with allergic rhinitis alone (Group B, n=26). Fifteen to 60 minutes after provocation, the change in symptoms as measured by the visual analogue scale, the change in total nasal volume (TNV) and minimal cross-sectional area (MCA) were compared between the concave and convex septal sides. The degrees of change in TNV and MCA were also compared between the groups. RESULTS: Group A had higher basal values and more changes in nasal obstruction than did Group B. Changes in TNV and MCA were most prominent after 30 minutes on both sides, without significant differences. By summing the sides together, we were able to obtain more stable results without paradoxical increase. CONCLUSION: Septal deviation itself has little effect on the result of nasal provocation in patients with allergic rhinitis. By summing the parameters of acoustic rhinometry from both nasal cavities, clinicians can achieve more stable results.