Long-term Breastfeeding in the Prevention of Allergic Rhinitis: Allergic Rhinitis Cohort Study for Kids (ARCO-Kids Study)

OBJECTIVES: There is a great deal of interest in the possibility that environmental factors may influence the risk of developing allergic rhinitis (AR) in early life. We investigated the simultaneous effects of mode of delivery and duration of breastfeeding on the development of AR in children. METHODS: Data from 1,374 children participating in the Allergic Rhinitis Cohort Study for kids (ARCO-kids study) was analyzed. All subjects were divided into AR or non-allergic rhinitis (NAR) groups. Data on environmental factors, mode of delivery and duration of breastfeeding were collected using a questionnaire. RESULTS: Compared with short-term breastfeeding (<6 months), long-term breastfeeding (≥12 months) was significantly associated with a lower prevalence of AR (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.34 to 0.88). Children in the AR group also had a higher cesarean delivery rate than those in the NAR group (39.1% vs. 32.8%, P=0.05). Regarding the combined effects of mode of delivery and duration of breastfeeding, long-term breastfeeding with a vaginal delivery strongly suppressed the development of AR, compared to short-term breastfeeding with a cesarean delivery (aOR, 0.47; 95% CI, 0.30 to 0.73). CONCLUSION: Long-term breastfeeding (≥12 months) and a vaginal delivery are associated with a lower risk of developing childhood AR.

Normal Mastoid Air Cell System Geometry: Has Surface Area Been Overestimated?

OBJECTIVES: The aim of this study was to emphasize the necessity of a standard in segmentation threshold and algorithm for measuring volume and surface area of mastoid air cell system (MACS). METHODS: First, we obtained axial computed tomography scans of 54 normal temporal bones from 27 subjects. Then, we manipulated Hounsfield units (HU) image data in DICOM (digital imaging and communications in medicine) files directly using our program. The volume and surface area of MACS were computed and compared at segmentation thresholds (HU) from -700 to 0 at intervals of 50 using 2 algorithms; square pixel based (SP) algorithm and marching square (MS) algorithm. RESULTS: No significant difference was found between the volumes computed by SP and MS algorithms at each segmentation threshold. The surface area computed by SP algorithm, however, was significantly larger than that by MS algorithm. We could minimize this significant difference through a modification of the SP algorithm. As the lower HU threshold value was set, the smaller volume was measured. The surface area showed a plateau at a threshold of approximately -200 HU. The segmentation threshold had greater influence on the measured volume of MACS than the algorithm did. CONCLUSION: A standard method for measuring volume and surface area of MACS is thought to be necessary. We suggest that the MS algorithm and -200 HU of the threshold could be a standard in the measurement of volume and surface area of MACS.

Efficacy and safety of eltrombopag in adult refractory immune thrombocytopenia

BACKGROUND: Eltrombopag is a thrombopoietin receptor agonist with excellent treatment outcomes in immune thrombocytopenia (ITP). Here, we analyzed the dose of eltrombopag required to achieve and maintain safe platelet counts in Korean ITP patients. METHODS: Adult refractory ITP patients ( or =50,000 cells/microL). After achieving the target platelet count, the dose of concomitant ITP medications and eltrombopag was reduced to identify the lowest effective dose required to maintain the platelet count. RESULTS: Among 18 patients, 66.7% achieved complete response, 5.6% achieved platelet counts between 50,000 and 100,000 cells/microL, and 27.8% failed to achieve the target platelet count. The median ITP duration was significantly shorter in patients who achieved the target platelet count. The initial dose required to achieve the target platelet count was 25 mg/d. The adjusted maintenance doses were 25 mg twice per week or 25 mg/d. After discontinuation, 83.3% relapsed, and the median relapse-free survival was 15 days. Two relapsed and 1 failed patient switched to romiplostim. The response to romiplostim was similar to eltrombopag. During eltrombopag treatment, 38.9% showed hepatobiliary laboratory anomalies. Among 9 follow-up bone marrow examinations, 1 revealed fibrosis after 1 year of treatment. CONCLUSION: Eltrombopag was well tolerated with excellent treatment outcomes in refractory adult ITP patients. Low-dose eltrombopag effectively maintained the target platelet count. However, some patients required longer or higher-dose treatment to maintain the target platelet count, especially in heavily pretreated or longer ITP cases.

Medicolegal Considerations in Hearing Injury with an Aggravation of Disability / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: When a disability is superimposed on a previous disability, the concept of aggravation of disability should be applied. In rating the disability for hearing loss, we focused on the aggravation of disability and the methods of assessment. SUBJECTS AND METHOD: For the past 12 years, we have provided legal advisory for 111 cases of hearing injury, for which disability had to be rated. In 11 of those 111 cases, disability was assessed in consideration of aggravation of disability. We assessed disability using three rating methods: they were based on 1) a change of hearing level from assumed normal, 2) apportionment of new hearing injury in final hearing, and 3) a change in disability rating. We evaluated for significant differences and correlations between the values obtained by each method. RESULTS: There was a significant difference between the results by the methods 1 and 2. The disability rating by the method 2 showed good correlations with those assessed by the methods 1 and 3. CONCLUSION: When considering aggravation of disability in hearing, the method 2 could be a good alternative when the standard method 3 is inappropriate.

Seasonal Variation in Skin Sensitivity to Aeroallergens

PURPOSE: We previously demonstrated seasonal variation in sensitization to aeroallergens in a small group of patients with exercise-induced asthma. This study was performed to confirm the relationship in a much larger population. METHODS: The charts of 1,891 patients who received allergy skin prick tests were reviewed retrospectively. The test results from subjects aged < or =60 years were compared between the groups classified according to the season when the patients received the tests (spring: March-May, summer: June-August, fall: September-November, winter: December-February). The data from 25 respiratory allergy patients who received the tests two or more times and showed a positive response at least once were analyzed longitudinally. RESULTS: The most prevalent among 29 tested aeroallergens were house dust mites (HDMs) Dermatophagoides pteronyssinus and D. farinae. The skin sensitization rates to D. pteronyssinus (23.2% vs. 32.1%, P=0.004) and D. farinae (22.2% vs. 30.2%, P=0.009) were significantly lower in the summer and higher in the fall (38.3% vs. 26.6% and 35.6% vs. 25.3%; P=0.001 respectively) than those in other seasons in patients with a respiratory allergy (n=1,102). The sensitization rates to weed pollens in the fall (13.9% vs. 8.3%, P=0.006) and to Aspergillus fumigatus in the winter (2.9% vs. 0.7%, P=0.005) were significantly higher. In patients with non-respiratory allergy such as urticaria/anaphylaxis (n=340), the D. farinae sensitization rate was significantly lower in the summer also but higher in the spring. The trend of the HDM sensitization rate being lower in the summer and higher in the fall was observed in the longitudinal study. CONCLUSIONS: Skin sensitivity to aeroallergens such as HDMs, pollens, and molds demonstrates seasonal variation in respiratory allergy patients. Non-respiratory allergy patients also showed seasonal variation in sensitivity to aeroallergens, which might be related to the "priming" effect of allergens.

Role of Sleep Center for Integrative Approach to Sleep Disorders / 이화의대지

The prevalence of sleep disorder is about 30% of the population. Common sleep disorders are insomnia, obstructive sleep apnea, narcolepsy, restless legs syndrome, rapid eye movement sleep behavior disorder and parasomnia. These sleep disorders lead various medical and mental complications. However, most sleep disorders are underdiagnosed and not treated appropriately. Sleep medicine is important for treating these sleep disorders and maintaining general healthy conditions. Specialized and comprehensive treatments for sleep disorder are important in sleep medicine.

Surgical Management for Obstructive Sleep Apnea Syndrome / 이화의대지

Obstructive sleep apnea syndrome (OSAS) is caused by repetitive upper-airway narrowing or collapse during sleep resulting in hypopneas and apneas. When a patient is diagnosed of OSAS with polysomnogram, he/she should receive upper airway evaluation to find the narrow site. The anatomic narrow site can be nasal cavity, nasopharynx, oropharynx, and/or hypopharynx. Surgical treatment for OSAS should be tailored to the anatomic narrow site. In this article, the authors describe surgical treatment options for OSAS.

The Effect of Stellate Ganglion Block on the Treatment of Sensorineural Olfactory Disorder Following Upper Respiratory Tract Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although systemic steroid is widely used, there is no established standard treatment for patients with sensorineural olfactory disorder. The aim of this study was to prospectively investigate the effect of stellate ganglion block (SGB) in patients with sensorineural olfactory disorders unresponsive to systemic steroids. SUBJECTS AND METHOD: Twenty patients with anosmia or hyposmia following upper respiratory tract infection (URI) that was unresponsive to systemic steroid treatments were included in this study from February 2009 through December 2009. Nine patients were treated with SGB (the treatment group) and compared with the 11 untreated patients (the control group). Except for SGB, both groups were treated the same otherwise (with topical steroids, vitamins, peripheral vasodilators) during the treatment period. We evaluated the olfactory function using Korean Version of Sniffin' Sticks test II (KVSS II) and the subjective symptom questionnaire (SSQ). RESULTS: The KVSS II scores improved significantly only in the treatment group, showing a significant difference between the two groups, whreas the SSQ scores were improved in both groups and did not show significant differences. KVSS II and SSQ scores showed a significant correlation. CONCLUSION: These results suggest that SGB may be effective in the treatment for patients with sensorineural olfactory disorder following URI unresponsiveness to systemic steroid treatments.

Role of Reactive Oxygen Species in Allergic Rhinitis / 대한이비인후과학회지

Among many factors explaining recent increase in the prevalence of asthma and allergic rhinitis, role of reactive oxygen species (ROS) during development of these diseases is increasingly considered. Due to their highly reactive nature, ROS produced mainly by the phagocyte nicotinamide adenine dinucleotide phosphate oxidase complex have been considered harmful mediators of inflammation for a long time. However, there are an increasing number of findings suggesting that ROS are anti-inflammatory and prevent autoimmune responses and allergic diseases, thus challenging existing dogma. ROS might not only be produced as a mechanism to eradicate invading pathogens, but rather as a means by which to fine-tune the inflammatory response, depending on when, where and at what amounts they are produced. In this review, the author aim to describe the current findings highlighting ROS as regulators of inflammation, focusing on asthma and allergic rhinitis.

Clinical Features of Ectopic Tooth Occurring in Sinonasal Cavity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The presence of ectopic tooth in the sinonasal cavity is an unusual phenomenon and the underlying etiology remains unclear. Because of its rarity, clinical observation studies about sinonasal ectopic tooth are very rare. The aim of this study was to analyze the clinical characteristics of ectopic tooth occurring in the sinonasal cavity. SUBJECTS AND METHOD: Medical records and radiologic studies of 11 patients, who were treated between January 2006 and June 2012 for ectopic nasal teeth were reviewed retrospectively, with regard to sex, age, location, symptoms and treatment methods. RESULTS: Among 11 patients, 8 patients were male and 3 patients were female. The average age was 24.2 years. Among 7 patients who had symptoms, nasal obstruction was the most common followed by rhinorrhea, postnasal drip, facial swelling or pain, headache. The nasal cavity was the most frequently affected site. Among 14 ectopic teeth from eleven patients, 7 were removed by intrasnasal endoscopy and 2 by external premaxillary approach. Five teeth which were unerupted within the hard palate or maxillary sinus were offered conservative treatment with periodic follow-up. CONCLUSION: Removal of ectopic nasal tooth is generally advocated to alleviate the symptoms and prevent complications; if conservative treatment is decided, periodic monitoring of the patient is recommended. We suggest that treatment be carefully planned based on the symptoms of patients, location of the ectopic tooth, and whether the tooth is erupted or not.

A Study on the General and Nutritional Information of Children's Preference Foods Sold in the Middle, High School Stores / 대한지역사회영양학회지

The purpose of this study was to provide preliminary data for better safety control over children's preference foods sold in school stores. The survey was conducted from June to July 2009, to collect 749 types of children's preference foods sold in 150 middle and high school stores nation-wide excluding Jeju Island and general and nutrition information were analyzed. Out of 749 types of snack food items, 689 and 602 snacks were sold at high school and middle school stores respectively. Among children's preference foods, cookies, bread, and ice-cream were the main items. Among them, 98% of snacks were domestic products and the price range of each individual snacks were mostly between 600 and 900 won. 27.8% of children's preference foods sold were found to be in the high calorie/low nutrition food group. Even though the proportion of candy and fruit/vegetable beverages sold were not high, their proportion in high calorie/low nutrition snack group were higher than 68.1%. Among the children's preference foods sold in middleand high school stores, carbonated drinks and ramen were continuously sold in certain middle and high schools, even though sales were prohibited. This study concludes that government, corporations and retailers should work together in developing healthier children's snack distribution environment. In addition, dairy products, which take up 15% of children's preference food, should be diversified to meet their nutrient requirements.

The Possibility of Morning Sickness from Olfactory Hypersensitivity during Pregnancy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nausea and vomiting in early pregnancy are well-known phenomena. It has been suggested that the mechanism that triggers nausea and vomiting in pregnancy may be related to olfactory changes. We planned to investigate olfactory function changes and the relationship between olfaction changes and nausea and vomiting in early pregnancy. SUBJECTS AND METHODS: Two groups of participants with the total of 75 women (35 pregnant women; 40 non-pregnant women) were analyzed prospectively. Objective olfactory function was tested using Korean Version of Sniffin' Sticks-II test (KVSS-II test). In addition, pregnant subjects were investigated using the questionnaire to evaluate the severity of nausea and vomiting, and whether the changes were due to olfactory sensitivity. RESULTS: Subjective olfactory sensitivity was increased in pregnant subjects. However, there was no significant difference in the objective olfactory function between the two groups. CONCLUSION: Based on this study, we concluded that pregnancy is accompanied by changes in subjective olfactory sensitivity and higher subjective olfactory discomfort. But these findings do not support the hypothesis that nausea and vomiting is dependent of the changes in the objective olfactory function during early pregnancy.

A Case of Supernumerary Tooth within Fungus Ball in the Maxillary Sinus / 대한이비인후과학회지

The ectopic eruption of a supernumerary tooth can occur in the sinonasal area, but due to its rarity, few cases of ectopic tooth eruption in the maxillary sinus have been reported. A fungus ball in the paranasal sinuses usually involves just one sinus, most frequently the maxillary sinus. Here, the authors present a case of an ectopic supernumerary tooth embedded in a fungus ball of the maxillary sinus.

A Case of Multiple Extramedullary Plasmacytoma Arising from Both Nasal Cavity and Nasopharynx / 대한이비인후과학회지

Extramedullary plasmacytoma is a neoplastic proliferation of plasmacytes in reticuloendothelial tissue and is found predominantly in the head and neck region, especially in the upper respiratory tract and the oral cavity. The most common subsites are the paranasal sinuses, nasal cavity and nasopharynx. The tumor can be staged according to the spread of the disease and has been rarely met in the form of multiple lesions below the 10%. We have recently experienced a case of multiple extramedullary plasmacytoma arising from both nasal cavity and nasopharynx treated with surgical excision and postoperative radiotherapy.

A Case of Septal Perforation Reconstructed with Alloderm Interposition Graft Resulted from Magnetic Nasal Foreign Bodies / 대한이비인후과학회지

Nasal cavity foreign bodies are common accidents in children, especially between the newly born and four years of age, and sometimes lead to complications such as epistaxis, vestibulitis, sinusitis bronchoaspiration and nasal septal damage etc. Diagnosis is often made with anterior rhinoscopy, but sometimes nasal fibroendoscopy and imaging may be useful. If the diagnosis is confirmed, prompt foreign body removal should be done to avoid complications. We have recently experienced a case of nasal septal perforation secondary to magnetic nasal foreign bodies attracting each other across the nasal septum. After the removal of foreign bodies, the nasal septal perforation was repaired with acellular human dermal allograft.

Alteration of Olfactory Function in Chronic Viral Hepatitis Patients

BACKGROUND AND OBJECTIVES: Alterations of olfactory function among patients with cirrhosis of the liver, acute viral hepatitis or alcoholic liver disease have been reported. The goal of this study is to evaluate the alteration of olfactory function among chronic viral hepatitis patients. MATERIALS AND METHODS: The study group consisted of 21 patients with chronic active viral hepatitis and 32 normal subjects. Between December 2006 and January 2008, olfactory function among the study groups was evaluated using the Connecticut Chemosensory Clinical Research Center and the Cross Cultural Smell Identification Test. Then, correlations between the olfactory function test scores and serological data were analyzed. RESULTS: Hepatitis patients had significantly lower smell identification test scores. Only serum total bilirubin level had negative correlation with smell identification test scores. CONCLUSION: Chronic viral hepatitis appears to influence olfactory function.

Maxillary Sinus Mucocele Secondary to Organized Hematoma / 대한이비인후과학회지

Excluding cases of maxillary sinus mucoceles developing 1-2 decades after Caldwell-Luc's operation, the primary mucoceles of the maxillary sinus are very rare and believed to result from chronic obstruction of sinus ostium. Organized hematoma represents a rare benign lesion with locally destructive behavior. After the first case reported in 1996, there have been only a few reports for organized hematoma of the maxillary sinus. To our knowledge, this is the first article describing a maxillary sinus mucocele resulting from obstruction of natural ostium by organized hematoma presenting with unilateral cheek hypesthesia and retro-orbital pain. We present this first case with a review of literature.

Two Cases of Mesiodens in Nasal Cavity / 대한이비인후과학회지

Supernumerary teeth, which is described as teeth or tooth substance that develops in excess of deciduous and permanent teeth, most commonly involve the anterior maxilla. Mesiodens are one type of supernumerary teeth that develops in paramedian space of premaxilla. Sometimes mesiodens can be inverted with its crown facing the nasal cavity. Because of its own pathology and possible disruption of neighboring normal teeth, supernumerary teeth should be removed regardless of its eruption. We experienced two cases of mesiodens detected in the nasal floor and so report these cases with a review of literature.

Effect of Palatine Tonsil and Adenoid Tissue on Gastric Infection of Helicobacter Pylori / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although Helicobacter pylori (H. pylori) infection is one of the major pathogenetic factors in the development of various gastric diseases, its mode of transmission is not yet fully understood. Because palatine tonsils and adenoids are composed of mucosa-associated lymphoid tissue, which is also observed in H. pylori-related gastritis, these tissues may be considered to be an extragastric reservoir for H. pylori infection. In the present study, we investigated whether H. pylori colonization in adenoid and tonsillar tissue was associated with gastric infection. SUBJECTS AND METHOD: This study included 38 patients aged 6 to 35 who had undergone adenotonsillectomy or tonsillectomy. Urea breath test (UBT) was performed on each patient prior to surgery. Tonsil and adenoid tissue samples were placed in Campylobacter-like organism (CLO) test kit immediately after their removal. And Giemsa stain was used for histologic localization of H. pylori. RESULTS: Eleven (28.9%) of the 38 patients were H. pylori-positive on UBT, eight (21.1%) were positive on CLO test, and seven (18.4%) were positive on histologic study. In either CLO test or histologic study, 12 patients were H. pylori-positive. H. pylori-positive rate on UBT was higher significantly in group with H. pylori-positive tonsil tissues than in group with H. pylori-negative ones. CONCLUSION: These results suggest that palatine tonsils may either be an extragastric reservoir for H. pylori, or a transmission route for H. pylori infection. Thus, H. pylori colonization in adenoid and tonsil tissue may be associated with H. pylori-related gastric diseases.

Effect of Systemic Steroid on the Expression of TGF-beta and IL-10 in Nasal Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Etiology and pathogenesis of nasal polyps are still not fully understood. Transforming growth factor-beta (TGF-beta) and interleukin-10 (IL-10) are important cytokines for nasal polyp formation and immunomodulation. This study was aimed to evaluate the effect of systemic steroid, which is the most potent medications used for the treatment of nasal polyposis, on the expression of TGF-beta and IL-10 in nasal polyps. SUBJECTS AND METHOD: According to the status of steroid treatment, the polyps (n=22) removed during an endoscopic sinus surgery were divided into treatment or control groups. For treatment group, 30 mg of prednisolone per day was administered preoperatively for seven days. Eosinophil infiltration, expression and concentration of TGF-beta1 and IL-10 in nasal polyps were analyzed. RESULTS: Although there was no statistical significance, the infiltration of eosinophils decreased in the treatment group. In the immunohistochemical study, the expression of TGF-beta1 decreased in the epithelial layer of the treatment group compared with that of the control group (p=0.043). Expression of IL-10 increased in the stromal layer of the treatment group compared with that of the control group (p=0.008). TGF-beta1 concentration measured by ELISA showed no differences between each group. IL-10 concentration increased in the treatment group (p=0.021). CONCLUSION: These findings suggest that systemic steroid may exert a beneficial effect on nasal polyp treatment by at least following two mechanisms : the suppression of epithelial differentiation and proliferation, and squamous metaplasia through the down regulation of TGF-beta, and the down regulation of inflammatory responses by increasing IL-10.