Effect of Endoscopic Sinus Surgery on Paranasal Sinus Fungus Balls / 昆明医科大学学报

Objective To study and observe the effect of transnasal endoscopic surgery in the treatment of patients with fungal paranasal sinusitis.Methods A total of 82 cases of patients with fungal paranasal sinusitis were collected and divided into the control group (40 cases) and the observation group (40 cases) according to the principles of random,single blind and parallel control design,the patients in the control group received conventional surgical treatment,and the patients in the observation group received transnasal endoscopic surgical treatment,the two groups were observed and compared in terms of treatment efficiency,sinus cavity scores in the lesion range,average operation time,postoperative complication rate and patients' satisfaction degree.Results The effective rate in treatment group was 94.6％,significantly higher than that of control group (80.0％);the lesions sinus cavity score was 0 points in observation group,significantly lower than the control group (13.1 ± 1.9),the average operation time was (45.4 ± 10.9) min in the observation group,significantly shorter in the control group (76.3 ± 10.5) min;the postoperative complication rate was 3.2％ in the observation group,which was significantly lower than that of 25.6％ in the control group (P＜0.05).Conclusion The transnasal endoscopic surgery in the treatment of patients with fungal paranasal sinusitis can effectively improve the treatment efficiency,remove the mold lesions in the sinuses of patients,shorten the operation time and reduce the postoperative complication rate,and is conducive to promoting the rehabilitation of patients and improving the quality of life of patients,thus it is worth popularization and application.

Alternaria alternata infection associated osteomyelitis of maxilla: A rare disease entity.

Alternaria alternata is one of the rarest fungi associated with paranasal sinusitis. Alternaria species are pigmented (also known as dematiaceous or phaeoid) filamentous fungi, which are well-known soil saprophytes and plant pathogens that infrequently cause infection in humans mainly, cutaneous lesions. We present a case of osteomyelitis of maxilla caused by a rare fungus- A. alternata in a diabetic patient with poor glycemic control who was successfully treated with antifungal and surgical debridement over the period of 6 months.

Paranasal Sinusitis Occurred by Anthracosis / 대한이비인후과학회지

Anthracosis is a black pigmentation of bronchial mucosa or lung parenchyma induced by inhaled soot. It is most commonly found in those persons who have worked as coal miners. Anthracosis is known to be induced when coal dust remains on the surface of the mucous membranes after it is inhaled through the bronchi, which can cause changes or atrophy of the upper airway and abnormality of the self-purification function and it can disrupt the defensive reaction of the respiratory organs. To our knowledge, there has been no report of recurrent paranasal sinusitis caused by anthracosis. Herein, with a review of the literature, we report a rare case of paranasal sinusitis caused by anthracosis in a 51-year-old man.

Evaluating the Quality and Contents of Paranasal Sinusitis-Related Information on the Web-Sites in Western Physician and Eastern Physician

BACKGROUND AND OBJECTIVES: A large amount of information related to paranasal sinusitis is available on the internet; however, little is known about the quality and content of such information. We assessed paranasal sinusitis-related information on web sites of western and eastern physicians. MATERIALS AND METHODS: Using the search engine of Naver and Daum, a total of 159 web sites (108 by western physicians, 51 by eastern physicians) were identified by the keyword search "paranasal sinusitis" and were classified using the categories of location and field of contents. These web sites were evaluated for several aspects, and an informational value score was assigned to each. RESULTS: Regarding the location, Seoul (38), Gyeonggi (28), Busan (10) accounted for 70% of sites by western physicians, compared with 76% for the eastern physicians [Seoul (27), Gyeonggi (9), Busan (3)]. With respect to content, main content and Q/A were excellent in sites by eastern physicians whereas clinical schedule was excellent in those by western physicians. The mean informational value of the web sites was 5.17 for western physicians and 2.19 for eastern physicians (p<0.05). CONCLUSION: Web sites on paranasal sinusitis concentrated very firmly on metropolitan areas. Web sites by western physicians provided better paranasal sinusitis-related information than those by eastern physicians.

Related factors of sinusitis after radiotherapy for nasopharyngeal carcinoma / 中华放射医学与防护杂志

Objective To explore the incidence and factors of paranasal sinusitis among nasopharyngeal carcinoma (NPC) patients after radiotherapy. Methods Retrospectively evaluated the clinical data of 144 NPC patients without paranasal sinusitis before radiotherapy, including 82 cases in T1/T2 stage and 62 cases in T3/T4 stage treated in the First Affiliated Hospital of Bengbu Medical College from 2000 to 2005. MRI images before and after radiotherapy were compared. The incidence and factors of paranasal sinusitis were analyzed. There were 58 cases of nasal invasion. Nasopharyngeal carcinoma was given at face-neck joint portal with 6 MV X-ray fractionated irradiation 68-78 Gy during 6-8 weeks. The number of patients who received radiotherapy with less than or equal to 70 Gy, more than 70 Gy radiation doses were 89 and 55, respectively. Cervical part were treated with high-energy electron beam, patients with positive neck lymph nodes and with negative neck lymph nodes received 64-74 Gy doses during 6-8 weeks and 50-54 Gy during 4-5 weeks, respectively. Results Among the 144 NPC patients 86.8%(125/144) developed paranasal sinusitis after radiotherapy, the incidence rates of paranasal sinusitis (IRPS) was higher among stage T3 + T4 patients than that among stage T1 + T2 patients (94% vs 82% ,x2=4.32, P ＜0.05). Among patients who were given radiotherapy with more than 70 Gy,less than or equal to 70 Gy radiation doses on the nasopharynx, the IRPS were 95% and 82.0% (x2 = 4.65, P ＜ 0.05 ). The IRPS in patients with nasal cavity infringement was higher than that in others (95% vs. 81% , x2 = 5.46,P ＜0.05). The IRPS at 3, 6, 12 months, and more than 1 year after radiotherapy were 13.6% ,31.2% ,48.8% and 6.4%, respectively (x2 = 70.48, P ＜ 0.001 ). Conclusions The incidence of paranasal sinusitis in NPC patients after radiotherapy was very high, and reached a peak in one year. It was influeneed by invasion of nasal cavity or not, the dose of radiotherapy and T stage.

Clinical Features of Bilateral Paranasal Sinus Fungus Ball

BACKGROUND AND OBJECTIVES: Paranasal sinus fungus balls occur usually in a single sinus, most frequently the maxillary sinus. The goal of this study was to delineate the clinical features of a bilateral paranasal sinus fungus ball. MATERIALS AND METHODS: We retrospectively reviewed seven patients who presented with a bilateral sinus fungus ball and who received endoscopic sinus surgery between July 2004 and January 2009. We analyzed age, gender, chief complaint, associated symptoms, nasal endoscopic findings, ostiomeatal unit (OMU) computed tomography (CT) results, and surgical findings. RESULT: The male to female ratio was 1:6, and the age range was from 40 to 76 years. The chief complaints were nasal obstruction in three patients, foul odour in two, postnasal dripping in one, and cheek pain in one patient. Calcification of the paranasal sinus upon CT was observed in three cases (43%). A fungus ball was found in the maxillary sinus or middle meatus in all cases. CONCLUSION: Bilateral paranasal sinus fungus balls usually involve the bilateral maxillary sinus or middle meatus and often invade the anterior ethmoid sinus or frontal sinus.

CT Features and Appearances of Fungal Paranasal Sinusitis / 医学研究杂志

Objective To study evaluate the CT findings of Fungal Paranasal Sinusitis.Methods CT findings in 13 patients with pathologically-proved fungal poranasal sinusitis were retrospectively analyzed.Results out of 23 patients.the lesion of chronic invasive fungal poranasal sinusitis occurred from maxillary sinus in 15,from sphenoid sinus in 5,and from ethmoidal sinus in 3.On CT scans,lncreased attenuation of diseased paraotsil sinuses,lump or linear calcification in maxillary sinus,Air bubbles within high-dense muddy shadow in maxillary cavity.Bony destruction or absorption,expanding or thinning of maxillary sinus wall.Conclusions Fungal Paranasal Sinusitis carries some characteristics on CT scan,such as lump high-dense shadow,linear caleificatiom and air bubbles within the diseased sinus.Combined with nasal endoscopy,CT seanning can provide important diagnostic information.

Treatment Outcomes and Acoustic Rhinometric Results in Endoscopic Sinus Surgery of Adult Chronic Paranasal Sinusitis / 영남의대학술지

BACKGROUND: Chronic paranasal sinusitis is one of the most common disease in the otorhinolaryngologic field. Endoscopic sinus surgery is treatment of choice in chronic paranasal sinusitis. The aim of this study was to evaluate objective and subjective treatment outcomes of endoscopic sinus surgery in adult chronic paranasal sinusitis with or without polyp. MATERIALS AND METHODS: We reviewed 84 adult patients underwent endoscopic sinus surgery by one surgeon from June 1999 to June 2000, prospectively. We analyzed preoperative and postoperative subjective symptom scores and acoustic rhinometric results. RESULTS: Fifty cases were male and thirty four cases female. The average age was of 33 year-old (range: 17 to 66 years). There was significantly improvement of symptom scores in postoperative 3 months and 6 months compared with preoperative symptom scores. There was significantly increased postoperative total volume of nasal cavity. When we compared high score group with low score group, there was statistically significant improvement of symptom scores between preoperative stage and postoperative 3 months in radiologic grading group. CONCLUSIONS: Endoscopic sinus surgery is considered to be effective for the treatment of chronic paranasal sinusitis. It seems to be helpful to employ subjective symptom score system and objective total volume change of nasal cavity through acoustic rhinometric test to analyze effectiveness of endoscopic sinus surgery. In this study, the most important preoperative factor of sinus surgery outcomes is radiologic grading system.

Treatment Outcomes and Acoustic Rhinometric Results in Endoscopic Sinus Surgery of Adult Chronic Paranasal Sinusitis / 영남의대학술지

BACKGROUND: Chronic paranasal sinusitis is one of the most common disease in the otorhinolaryngologic field. Endoscopic sinus surgery is treatment of choice in chronic paranasal sinusitis. The aim of this study was to evaluate objective and subjective treatment outcomes of endoscopic sinus surgery in adult chronic paranasal sinusitis with or without polyp. MATERIALS AND METHODS: We reviewed 84 adult patients underwent endoscopic sinus surgery by one surgeon from June 1999 to June 2000, prospectively. We analyzed preoperative and postoperative subjective symptom scores and acoustic rhinometric results. RESULTS: Fifty cases were male and thirty four cases female. The average age was of 33 year-old (range: 17 to 66 years). There was significantly improvement of symptom scores in postoperative 3 months and 6 months compared with preoperative symptom scores. There was significantly increased postoperative total volume of nasal cavity. When we compared high score group with low score group, there was statistically significant improvement of symptom scores between preoperative stage and postoperative 3 months in radiologic grading group. CONCLUSIONS: Endoscopic sinus surgery is considered to be effective for the treatment of chronic paranasal sinusitis. It seems to be helpful to employ subjective symptom score system and objective total volume change of nasal cavity through acoustic rhinometric test to analyze effectiveness of endoscopic sinus surgery. In this study, the most important preoperative factor of sinus surgery outcomes is radiologic grading system.

The Relationship between Anatomic Variation of Nasal Cavity and Paranasal Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although several studies have failed to confirm an increased incidence of sinusitis in association with anatomic factors, the anatomic variations of the nasal cavity and paranasal sinus are considered as important factors in causing paranasal sinusitis. The aim of this study was to evaluate the effects of anatomic abnormality and septal deviations on the development of paranasal sinusitis. MATERIALS AND METHOD: To evaluate the effect of anatomic variations in sinusitis, computed tomography (CT) of 165 patients with chronic sinusitis and 70 patients with orbital pathology were reviewed to analyze the mucosal abnormalities and the bony anatomic variations. RESULTS: There were no significant difference in the prevalence of anatomic variations between two groups. In patients with deviated septum, paranasal sinusitis was more common and severe in the wide side of the nasal cavity. CONCLUSION: There was no clinical significance of anatomic variations in formation of sinusitis. In septal deviation, the change of air current may affect the development of sinusitis. The increased airflow in the widened nasal cavity may impair the mucociliary clearing function of the nasal cavity and sinuses, which eventually induce the stasis of mucus in sinuses and finally results in paranasal sinusitis.

Multiple Pulmonary Nodules in A Patient with Sinusitis, Proteinuria and Hematuria / 결핵

A 49-year old man who had been treated for five months at a private clinic due to chronic paranasal sinusitis was admitted to our hospital because of recently aggravated nasal stuffiness, headache, and cough. The X-ray film of paranasal sinuses and facial CT scan showed marked mucosal thickening of the nasal cavity and paranasal sinuses. The plain chest film and chest CT scan showed multiple, variable sized, pulmonary nodules in both lungs. The level of c-ANCA was elevated and urinalysis revealed proteinuria and hematuria. Percutaneous lung and kidney biopsies were performed for confirmative diagnosis. Histologic examination of the lung nodule demonstrated extensive necrosis and poorly-formed granulomatous inflammation. The histologic finding of the kidney showed focal necrotizing glomerulonephritis. A diagnosis of Wegener's granulomatosis involving the paranasal sinuses, lung and kidney was made, and treatment was successfully performed with cyclophosphamide and prednisone.

Clinical Characteristics of Chronic Paranasal Sinusitis in the Patients with End Stage Renal Disease

BACKGROUND AND OBJECTIVES: Infections account for much of the morbidity and nearly half of the mortality in renal transplant recipient. Recently there has been a marked increase in the number of renal transplantation and preoperative screening test for chronic paranasal sinusitis. Authors analyzed the clinical manifestations and postoperative courses after the endoscopic sinus surgery in the patients with end stage renal disease. MATERIALS AND METHODS: 1,175 patients had been consulted to the otolaryngology department for routine evaluations about the presence of acute and chronic paranasal sinusitis prior to kidney transplantation between Jun. 1989 to Aug. 1998. Among them, 30 patients were diagnosed as significant chronic paranasal sinusitis and 5 patients were treated with endoscopic sinus surgery. Medical records and radiographs of the 30 patients were reviewed retrospectively. RESULTS: The prevalence of chronic paranasal sinusitis in patients with end stage renal disease was 2.5%. Twelve patients were asymptomatic and chief complaints of symptomatic patients were nasal obstruction (55.6%), rhinorrhea (27.8%), and postnasal drip (16.7%). Eleven patients had nasal polyps and twelve patients showed purulent discharge. All the patients who were surgically treated experienced postopertive bleeding and 2 of them required transfusion. CONCLUSION: The presence of asymptomatic sinusitis among the patients with end stage renal disease necessitates diagnositc screening tests for chronic paranasal sinusitis. The incidence of postoperative bleeding after endoscopic sinus surgery in patients with end stage renal disease is much higher than that of otherwise healthy sinusitis patients.

Clinical Characteristics of Chronic Paranasal Sinusitis in the Patients with End Stage Renal Disease

BACKGROUND AND OBJECTIVES: Infections account for much of the morbidity and nearly half of the mortality in renal transplant recipient. Recently there has been a marked increase in the number of renal transplantation and preoperative screening test for chronic paranasal sinusitis. Authors analyzed the clinical manifestations and postoperative courses after the endoscopic sinus surgery in the patients with end stage renal disease. MATERIALS AND METHODS: 1,175 patients had been consulted to the otolaryngology department for routine evaluations about the presence of acute and chronic paranasal sinusitis prior to kidney transplantation between Jun. 1989 to Aug. 1998. Among them, 30 patients were diagnosed as significant chronic paranasal sinusitis and 5 patients were treated with endoscopic sinus surgery. Medical records and radiographs of the 30 patients were reviewed retrospectively. RESULTS: The prevalence of chronic paranasal sinusitis in patients with end stage renal disease was 2.5%. Twelve patients were asymptomatic and chief complaints of symptomatic patients were nasal obstruction (55.6%), rhinorrhea (27.8%), and postnasal drip (16.7%). Eleven patients had nasal polyps and twelve patients showed purulent discharge. All the patients who were surgically treated experienced postopertive bleeding and 2 of them required transfusion. CONCLUSION: The presence of asymptomatic sinusitis among the patients with end stage renal disease necessitates diagnositc screening tests for chronic paranasal sinusitis. The incidence of postoperative bleeding after endoscopic sinus surgery in patients with end stage renal disease is much higher than that of otherwise healthy sinusitis patients.

Clinical Manifestations of Intracranial Complication Associated With Paranasal Sinus Infection

BACKGROUND: Intracranial complications of paranasal sinus infection are rare and may be misdiagnosed during an initial evaluation because they often show subtle symptoms, which include elusive physical and neurological findings and imaging. The late recognition of these conditions and the delayed treatment can increase morbidity and mortality rates. We aimed to characterize the typical clinical features of intracranial complications associated with sinusitis. METHODS: Twelve patients who visited the Eulji Medical Center from 1994 to 2000, with sinogenic suppurative intracranial lesions were reviewed. Medical records and radiological studies were reviewed retrospectively. RESULTS: There were 12 cases with 15 sinogenic intracranial complications. The ratio of males to female was 2 : 1. The ages of patients ranged from 16 to 81 (average: 46.7). Four cases had meningitis, four had focal cerebritis, three had cavernous sinus throm-bophlebitis, two had subdural empyema, and two had epidural abscess or empyema. The primary lesions of paranasal sinusitis were located at the sphenoid in three, ethmoid sinus in two, frontal sinus in one and the multiple sinus in six. The outcome revealed complete recovery in six cases, mild neurologic sequelae in three cases, death in two cases and recurrence in one case. CONCLUSIONS: The type of intracranial complication and origin of paranasal sinusitis may be changing. Cases in which such complications are suspected, in order for an early diagnosis, a MRI should be considered. The successful management of intracranial complications consists of timely antibiotics therapy combined with surgical drainage of the loculated infection. (J Korean Neurol Assoc 19(5):457~463, 2001)

Osteitis in Patients with Chronic Paranasal Sinusitis Evaluated by 99mTc-MDP bone SPECT / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The objective of this study is to investigate the incidence and clinical implication of osteitis in patients with chronic paranasal sinusitis. MATERIALS AND METHODS: Forty three patients diagnosed as chronic paranasal sinusitis were examined with 99mTc-MDP bone SPECT preoperatively and underwent endoscopic operation, and 6 volunteers were recruited and examined as a control group. Each SPECT image was semiquantitatively assigned one of three grades of 0, 1, 2 according to intensities of isotope uptake. Quantitative analysis of the uptake of the isotope was performed by computer. The incidence of osteitis was analyzed. The correlation between semiquantitative grades and quantitative uptake indices was evaluated, and degree of isotope uptake and the severity of mucosal pathology on CT was correlated. The degree of isotope uptake between the patients who had recurrence and had not was compared. RESULTS: Quantitative evaluation of uptake indices were significantly higher in the patient group than in the control group. Marked uptakes of isotope on the sinus areas, suggesting the presence of osteitis, were shown in the patient group by 53.5%. The semiquantitative grades and quantitative indices showed positive correlation, and SPECT and CT scan findings also showed significant correlation. The uptake indices of patients who had recurrence were significantly higher than those of patients who showed no recurrence in both ethmoid sinus areas. CONCLUSIONS: The results of this study showed that significant proportion of patients with chronic paranasal sinusitis have osteitis, and patients with more severe osteitis represent poorer postoperative courses.

CT Diagnosis of Fungus Infection of Paranasal Sinuses(An Analysis of 16 Cases) / 实用放射学杂志

Objective To evaluate CT features and diagnostic value of fungus infection of paranasal sinuses. Methods CT findings in 16 patients with fungus infection of paranasal sinuses proved surgically and pathologically were analyzed.Results CT findings of fungus infection of paranasal sinuses included: unilateral involved, maxillary sinus was mainly affected or other paranasal sinuses involved simaltaneously, the soft tissue within paranasal sinuses presented as hyperplasia of nodule and polyp-like, and there were some punctuated and tubercular calcification inside .Sinus cavity enlarged and the bone wall was destroyed in some cases. Conclusion CT manifestations of fungus infection of paranasal sinuses are of characteristics, CT scan is of important value in diagnosing this disease.

Microbiologic Study of Chronic Sinusitis in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The microbiology of chronic sinusitis in children can be anticipated according to the patient's age, clinical presentation, and immunologic state. In acute stage, viral upper respiratory infections frequently precede bacterial superinfection by Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis. In contrast to acute sinusitis, alpha-hemolytic Streptococcus, coagulase negative Staphylococcus and Staphylococcus aureus are common in chronic sinusitis, which may be caused by exacerbations of infection with the bacterial species that cause acute disease. The use of empiric antibiotics directed at the most offending organism is usually appropriate and effective in clinical situation. But the emergency and increasing occurrence of antibiotic resistance has increased the failure rate. MATERIAL AND METHODS: In this prospective study, 50 patients with the diagnosis of chronic sinusitis were evaluated microbiologically by Sinoject (Atos, Sweden) guided aspiration. RESULTS: We cultured alpha-hemoltic Streptococcus in 14 patients, coagulase negative Staphylococcus in 4 patients, Staphylococcus aureus in three patients, gram-positive bacilli in two patients, Streptococcus pneumoniae in one patient. The results of PCR for Hemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis were 32%, 20%, 10%, respectively, and it showed higher detection rates than conventional culture test. CONCLUSION: We advise that all bacterial isolates of cultures of chronic sinusitis in children should undergo appropriate typing and antibiotic sensitivity tests so that the appropriate antibiotic treatment may be employed.

A Case of Orbital Subperiosteal Abscess Associated with Acute Paranasal Sinusitis after Trauma

Although orbital abscess is seen in all age, it is found predominantly in children 16 years of age or less. It may result from orbital trauma, foreign body, inflammation and direct spillage or hematogenous extension of bacteria from sinuses to orbit. The authors experienced a 8-year-old male patient who presented with proptosis, decreased visual acuity, and limitation of eyeball movement on left eye after injury by soccer ball. Orbital subperiosteal abscess or orbital rhabdomyosarcoma were suspected, and the patient was operated for biopsy and removal of mass. Subperiosteal abscess was found below frontal bone during exploration, and incisional drainage and massive irrigation was done. At postoperative seventh day, visual acuity of the patient was 20/20, proptosis was markedly decreased and eyeball movement was normal. The authors experienced a case of orbital subperiosteal abscess associated with acute paranasal sinusitis after trauma, and a good result was obtained following surgical draining.

Computerized Tomographic Study on the Paranasal Sinusitis / 대한구강악안면방사선학회지

OBJECTIVES: The purpose of this study was to evaluate the computed tomographic (CT) images of the paranasal sinusitis(PNS). MATERIALS AND METHODS: The author examined the extent and the recurring patterns of the paranasal sinusitis and some important anatomic landmarks. The author analyzed PNS images retrospectively in 500 patients who visited Chonbuk National University Hospital between January 1996 and December 1997. RESULTS: The most frequently affected sinus was maxillary sinus(82.9%), followed by anterior ethmoid sinus(67.9%), posterior ethmoid sinus(48.9%), frontal sinus(42.0%) and sphenoid sinus(41.4%). The characteristic features of CT images of the sinusitis were sinus opacification(22.4%), mucoperiosteal thickening(34.3%), and polyposis(2.0%). Sinonasal inflammatory diseases were categorized into 5 patterns according to Babbel's classification. They were 1) infundibular(13.0%), 2) ostiomeatal unit(67.4%), 3)sphenoethmoidal recess(13.0%), 4) sinonasal polyposis(9.6%) and 5) unclassifiable patterns(18.0%). The incidences of contact between sinus and optic nerve were as follows ; the incidences of contact with posterior ethmoid sinus, sphenoid sinus, both posterior sinuses were 11.4%, 66.8%, 6.3%, respectively. The incidences of contact between sphenoid sinus and maxillary nerve, vidian nerve, internal carotid artery were 74.5%, 79.2%, 45.1% respectively. The incidences of pneumatization of the posterior ethmoid sinus were as follows ; normal 70.6% and overriding type 29.4%. The incidences of sphenoid sinus pneumatization were as follows ; normal 56.9% , rudimentary 12.5%, pterygoid recess 22.7%, anterior clinoid recess 2.7%, and both pterygoid and anterior clinoid recess 5.2%. CONCLUSIONS: The inflammatory sinonasal diseases were classified into five patterns using the CT of PNS, which was proven to be an excellent imaging modality providing detailed information about mucosal abnormality, pathologic patterns and the proximity of the important structures to the posterior paranasal sinuses. This result will aid in the interpretation of CT of PNS functionally and systemically.

Changes of specific IgE, Bronchial hyperreactivity and sinusitis after immunotherapy in asthmatic children / 천식및알레르기

BACKGROUND: Though immunotherapy(IT) has become an effective rnethod in extrinsic allergic patients who didn't respond to pharmacologic therapy or couldn't avoid allergen, the mechanism, termination index and prognostic index of IT have not been clarified yet. METHOD: We selected 81 asthmatic children on immunotherapy with house dust mite (Dermatophagoides pteronyssinus and Dermatophagoides farinae). We measured the hematologic findings, the levels of serum IgG and IgE, allergen(house dust, Dermatophagoides pteronyssinus and Dermatophagoides farinae)-specific IgE concentrations, lymphocyte subsets and methacholine challenge test yearly during IT, and checked the radiographs of chest and paranasal sinus. RESULTS: Peripheral white blood cell count, the percentage of eosinophil and total eosinophil count decreased significantly after 2 years of IT. Serum IgG level increased significantly after 3 years of IT. Serum total and specific IgE levels decreased significantly after 3 years of IT, but they were still higher than the normal values. CD4+, CD8+, and B lymphocytes did not change with the IT, but CD3+ lymphocytes increased significantly after 2 years of IT. PC20-methacholine increased significantly after 1 year of IT, but no correlation was found between the duration of IT and bronchial hyperreactivity. Twenty-eight patients(34.6%) had abnormal findings on chest radiographs: 15 patients(53.6%) as bronchitis, 10 patients(35.7%) as bronchopneumonia, 2 patients(7.1%) as hyperinflation and 1 patient(3.6%) as atelectasis. Sixty-three patients(77.8%) had abnormal findings on paranasal sinus radiographs. In the follow-up radiographs of 49 patients, 28 patients(57.1%) showed improvement of paranasal sinusitis after 1 year of IT. CONCLUSION: This study showed some changes of the immunologic findings such as eosinophil count, IgG, IgE, allergen-specific IgE and CD3+ lymphocytes, and improvement of bronchial hyperreactivity and paranasal sinusitis' in asthmatic children during IT. These findings were closely related to clinical improvement.