Effects of Middle Meatal Antrostomy on Ciliary Beat Frequency and Histopathology of the Nasal Mucosa in Experimentally Induced Maxillary Sinusitis in Rabbits / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to observe the effects of middle meatal antrostomy (MMA) on ciliary beat frequency (CBF) and histopathology of the nasal mucosa in experimentally induced maxillary sinusitis in rabbits. MATERIALS AND METHOD: Maxillary sinusitis was induced in both maxillary sinuses (MSs) of 30 Pasturella-free New Zealand white rabbits by partially occluding the natural ostium and inoculating with P. aeruginosa. After 4 weeks, the MS and inferior turbinate mucosae were obtained in 5 rabbits. In the remaining 25 rabbits, the ostia were reopened. Five rabbits were sacrificed 2, 4, 6, 8, and 12 weeks after MMA, respectively and the MS and inferior turbinate mucosae were obtained. Another 5 normal rabbits were used as a control group. CBF was measured by video-computerized analysis. Degree of inflammation in histopathology was graded using a 100-point scale of inflammation score. CBF and inflammation score were compared among the 6 experimental and control groups. RESULTS: CBF of the MS mucosa significantly improved after MMA in a time-dependent pattern, but did not reach a normal level even after 12 weeks. CBF of the inferior turbinate mucosa significantly improved after MMA in a time-dependent pattern, and reached a normal level after 12 weeks. Inflammation scores of the MS and inferior turbinate mucosae were significantly decreased after MMA in a time-dependent pattern. However, they did not reach a normal level of the control group even after 12 weeks. CONCLUSION: MMA can improve not only the primary inflammation of the MS mucosa but also functionally and morphologically improve the secondarily developed inflammation of the nasal mucosa in experimentally induced maxillary sinusitis in rabbits.

Effects of Experimentally Induced Maxillary Sinusitis on Ciliary Beat Frequency and Histopathology of the Nasal Mucosa in Rabbits / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although sinusitis is commonly caused by nasal diseases that interfere with ostiomeatal unit, non-rhinogenic sinusitis, for example, post-traumatic or odontogenic, is often encountered. However, it remains unclear whether non-rhinogenic sinusitis affects the function and morphology of the nasal mucosa. The aim of the current study is to observe effects of experimentally induced maxillary sinusitis on ciliary beat frequency and histopathology of the nasal mucosa in rabbits. MATERIALS AND METHOD: Maxillary sinusitis was induced in the right sides of 10 rabbits by partially occluding the natural ostia and inoculating the maxillary sinus with P. aeruginosa. After 4 weeks, the nasal mucosa was obtained from the inferior turbinate and the septum in the right (experimental group) and the left side (control group A). Both sides of the nasal mucosa in another 5 normal rabbits were used as the control group B. Ciliary beat frequency (CBF) was measured by video-computerized analysis and degree of inflammation in histopathology was graded using a 100-point scale of inflammation score. CBF and inflammation score were compared between the three groups. RESULTS: CBFs of the experimental group were significantly lower than those of the control groups A and B. Inflammation scores of the experimental group were significantly higher than those of the control groups. In the experimental group, there were no correlations between CBFs of the maxillary and nasal mucosa, but weak correlations existed between inflammation scores of the maxillary and nasal mucosa. CONCLUSION: Primary maxillary sinusitis can locally induce dysfunction and inflammation of the nasal mucosa.

Regulation of Cytokine Gene Expression in Nasal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The etiology and pathogenesis of nasal polyp are still ill-defined and have been debated for many years. Recently, the identification and localization of mRNA of cytokines, chemokines, and growth factors that may be involved in the formation of nasal polyp have been studied. But, transcription factors that control the expressions of cytokines have not been studied. The purpose of this study is to investigate IL-12 and IL-4 mRNA in the polyps of the patients with allergy-associated and nonallergy-associated chronic sinusitis and compared it with controls. IL-12 receptor and IRF-1, c-maf and GATA-3 which are transcription factors of IFN-gamma, IL-4 and IL-5, respectively were also studied. MATERIALS AND METHOD: Nasal polyp tissues were surgically obtained from two groups of patients with chronic sinusitis: those who had allergic rhinitis (n=) and those without allergy (n=3). The normal nasal mucosa from inferior turbinate were obtained from normal subjects. IL-12p35, IL-12p40, IL-12Rbeta2, IRF-1, IL-4, GATA-3 and c-maf mRNA expression were analysed by means of the reverse transcription and polymerase chain reaction and southern blot in three groups. RESULTS: The expression of IL-12p40, IL-12Rbeta2, IRF-1 mRNA were significantly higher in the nonallergic polyp group than in the control group (p<0.05). GATA-3 mRNA was significantly expressed in allergic polyp group than in the control group (p<0.05). CONCLUSION: These results suggest IL-12, IL-12Rbeta2 and IRF-1 may be involved in nonallergic polyp formation. GATA-3 may contribute to allergic polyp formation.

Long Term Results after CO2 Laser Turbinate Surgery for Perennial Allergic Rhinitis

BACKGROUND AND OBJECTIVES: Although CO2 laser turbinate surgery is known to be an effective method in reducing the nasal symptoms of perennial allergic rhinitis, the long term effects have not yet been evaluated. Therefore, the purpose of this study was to assess the subjective and objective long term results of CO2 laser surgery. MATERIALS AND METHODS: The charts and questionnaires of 49 patients who received laser surgery at our department from January 1994 to December 1999 were reviewed. Preoperative and postoperative nasal volume of 20 randomly selected patients were measured by acoustic rhinometry. Nasal mucosa of 10 patients before and after laser surgery yearly for 6 years were examined under light and electron microscopy. RESULTS: Watery nasal discharge, nasal obstruction and sneezing had improved significantly after laser surgery. Postoperative nasal volumes also increased significantly. Histological findings 6 years after laser surgery revealed focal squamous epithelium and regenerating ciliated columnar epithelium. Decreased goblet cells, fibrous proliferation and scarce vessels and glands were also observed. CONCLUSIONS: CO2 laser surgery proves to be an effective method in reducing the symptoms of perennial allergic rhinitis for short and long periods.

Long Term Results after CO2 Laser Turbinate Surgery for Perennial Allergic Rhinitis

BACKGROUND AND OBJECTIVES: Although CO2 laser turbinate surgery is known to be an effective method in reducing the nasal symptoms of perennial allergic rhinitis, the long term effects have not yet been evaluated. Therefore, the purpose of this study was to assess the subjective and objective long term results of CO2 laser surgery. MATERIALS AND METHODS: The charts and questionnaires of 49 patients who received laser surgery at our department from January 1994 to December 1999 were reviewed. Preoperative and postoperative nasal volume of 20 randomly selected patients were measured by acoustic rhinometry. Nasal mucosa of 10 patients before and after laser surgery yearly for 6 years were examined under light and electron microscopy. RESULTS: Watery nasal discharge, nasal obstruction and sneezing had improved significantly after laser surgery. Postoperative nasal volumes also increased significantly. Histological findings 6 years after laser surgery revealed focal squamous epithelium and regenerating ciliated columnar epithelium. Decreased goblet cells, fibrous proliferation and scarce vessels and glands were also observed. CONCLUSIONS: CO2 laser surgery proves to be an effective method in reducing the symptoms of perennial allergic rhinitis for short and long periods.

Effects of External Nasal Dilators on Nasal Respiration and Patency in Patients with Deformity of the Nasal Septum by Mladina ClaSSIFICATION: An Acoustic Rhinometric Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The external nasal dilator (END) was designed to improve nasal respiration by expanding the nasal valve area and authors have proven in previous reports that the END improves nasal respiration and patency in patient with DSN. The present study attempts to assess the different effects of the END on nasal respiration and patency in DSN patients with dysfunction of the nasal valve area and in those with dysfunction of some other areas. MATERIALS AND METHODS: Fourty-six male patients (ages 18-49, average age 31.5) without any other nasal or sinus disease and who are not classified as Mladina types 1, 4 or 7 were used as subjects. The type of DSN was determined by Mladina classification. Those with dysfunction of the nasal valve area (Type 2) were classited as Group A and those with dysfunction of some other anatomical area as Group B (Type 3, 5, 6). The subjective sensation of nasal respiration, average minimum cross-sectional area (MCA) and nasal volume (V5: nasal volume from 0-5 cm) of all subjects were assessed and compared before and after the application of an END. RESULTS: Subjective sensation of nasal respiration, MCA and V, improved sign ificantly in both groups after the application of an END, but there were no significant differences between the two groups. CONCLUSION: Although an F,ND significantly improves nasal respiration and patency, this effect does not show any significant differences between patients with dysfunction of the nasal valve area and those with dysfunction of some other anatomical areas. This is because ENDs equally affect all Types of septal deformity.

Effects of External Nasal Dilators on Snoring and Obstructive Sleep Apnea in Korean Adults: A Polysomnographic Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It was reported that external nasal dilators (ENDs) can reduce snoring and obstructive sleep apnea (OSA) in white people by dilating the nasal valve area and then, improving nasal breathing. However, there are no available data on Asians, whose geometry of nasal cavities is different from that of white people. The aim of this study is to evaluate the effects of ENDs on snoring and OSA in Korean adults. MATERIALS AND METHODS: Twelve simple snorers (3 female and 9 males, aged 19 to 44 years) and 35 OSA patients (35 males, aged 22 to 65 years) without nasal diseases were included in this study. Polysomnography including measurement of snoring intensity was performed at two separate nights, one with and the other without an END. Averaged maximum snoring intensity, apnea index (AI), respiratory disturbance index (RDI), ratio of deep sleep (stage 3 and 4) to total sleep time, and minimum arterial oxygen saturation (SaO2) with and without an END were measured and compared. RESULTS: Snoring intensity was reduced in 6 (50.0%) of 12 simple snorers and 16 (45.7%) of 35 OSA patients. In overall, snoring improved significantly in both groups. In OSA patients, AI and RDI improved significantly, but ratio of deep sleep time and minimum SaO2 did not. There were no significant correlations between change of snoring intensity and change of AI or RDI in OSA patients. CONCLUSION: These results suggest that ENDs are helpful to improvement of snoring and respiration during sleep, but the sleep stages remain almost unchanged by ENDs in Korean adults with snoring and/or OSA.

A Study of the Expression of Cytokines and p53 in Nasal Polyps

BACKGROUND AND OBJECTIVES: Nasal polyps are a condition of uncertain etiology. Cytokines are thought to play a role in nasal polyps in vitro, but in vivo studies on the patterns of cytokine expression in nasal polyps have been limited. The aim of the present study is to gain a better understanding of the pathophysiology of nasal polyps by defining the patterns of expression of cytokine mRNA and p53 in the nasal mucosa of patients with nasal polyps. MATERIALS AND METHODS: This objective was supported by performing RT-PCR (reverse transcription-polymerase chain reaction) for IL-2, INF-gamma (T1 cytokine), IL-5, IL-8, IL-10, IL-13 (T2 cytokine), TNF-alpha, TGF-beta1, and p53. RESULTS: Observation of the nasal polyps indicated significant increases in mRNA for T2 cytokines and p53 over controls. The expressions of IL-10 and IL-13 mRNA in the nasal mucosa of non-allergic patients were stronger than in that of allergic patients. CONCLUSION: This result suggests that the pathogenesis of nasal polyps is associated with T2 cytokines and p53.

Effects of Preservation of the Lamina Propria of the Maxillary Sinus Mucosa on Mucosal Regeneration in Experimentally Induced Maxillary Sinusitis with Polyposis in Rabbits / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It remains unclear whether the lamina propria (LP) of the sinus mucosa should be preserved in the management of the paranasal sinuses with severely diseased mucosa. The aim of this study is to evaluate the effects of preservation of the LP of the maxillary sinus (MS) mucosa on mucosal regeneration in maxillary sinusitis with polyposis in rabbits. MATERIALS AND METHODS: Maxillary sinusitis with polyposis was induced in 180 of the 190 MSs in 95 rabbits and, from these, 10 MSs were used as control. After 4 weeks, the ostia were reopened and 180 MSs were divided into 3 groups according to the following different procedures on the MSs; preservation of the whole mucoperiosteum without removal of polyps and polypoid mucosa (group A), complete removal of the whole mucoperiosteum (group B), and preservation of part of the LP and the periosteum with removal of polyps and polypoid mucosal surface (group C). Each of the experimental groups was explored after 0, 2, 4, 6, 8 and 12 weeks, respectively. Changes of mucociliary transport (MCT) speed, ciliary beat frequency (CBF), and inflammation score in histopathology were evaluated. RESULTS: Eight and/or 12 weeks after the procedures, there were significant improvements in MCT speed, CBF and inflammation score of the group C, compared with those of the group A and/or the group B. CONCLUSION: Preservation of the LP and the periosteum with removal of only polyps and polypoid mucosal surface may be more beneficial to mucosal regeneration than preservation or complete removal of the whole mucoperiosteum including polyps and polypoid mucosa in the surgical management of maxillary sinusitis even though the MS mucosa was severely diseased.

Effects of External Nasal Dilators on Nasal Respiration and Patency in Patients with Deformity of the Nasal Septum: An Acoustic Rhinometric Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Some types of deformities of the nasal septum (DNSs) interfere with the nasal valve function. External nasal dilators (ENDs) were developed to improve the nasal airway by mechanically dilating the nasal valve. The aim of this study is to evaluate the effects of ENDs on nasal respiration and patency in patients with DNS. MATERIALS AND METHODS: Fifty-four patients with DNS (37 males and 17 females, aged 18 to 46 years) without other sinonasal diseases were included in this study. All subjects were required to assess their own sensation of nasal respiration on a 100 mm visual analog scale. Minimal cross-sectional areas (MCAs) and volumes of 0 to 5 cm from the nostril (V 5s) of both nasal cavities were measured by acoustic rhinometry, respectively. All measurements before application of an END were compared with those 5 minutes after application. RESULTS: The subjective sensation of nasal respiration improved significantly after application of an END in both male and female. The END increased MCA and V5 significantly in both sexes. However, there were no significant correlations between changes in the subjective and objective parameters. CONCLUSION: ENDs offer an effective, nonsurgical therapeutic approach in the management of DNS by improving nasal respiration and by increasing MCA and nasal cavity volume. However, it should be kept in mind that this improvement in nasal patency does not always coincide with the improvement in subjective sensation of nasal respiration.

A Follow-up Study of Endoscopic Sinus Surgery in Chronic Sinusitis-Assessment of Preoperative OMU-CT Gradings and Postoperative Follow-up Period- / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery has become an effective tool for the treatment of chronic sinusitis. The success of this procedure can be best determined by a long-term evaluation of the surgery results from patients who are grouped according to the prepoerative severity of the disease. In this study we attempted to evaluate the results of endoscopic sinus surgery according to the severity of the disease and the length of the follow-up period. MATERIALS AND METHODS: Questionnaires were sent out to 313 patients with chronic sinusitis who underwent endoscopic sinus surgery at our department from April 1992 to October 1995. Replies from 118 patients (37.69%) were analyzed. All patients had taken preoperative ostiomeatal unit computed tomography (OMU-CT) and their results were graded according to the Levine and May's grading system. The follow-up periods ranged from 7 to 51 months, with the mean of 27 months. RESULTS: All nasal symptoms including nasal obstruction, rhinorrhea, postnasal drip, anosmia and headache significantly improved. The nasal obstruction symptom improved by 76.8%, rhinorrhea 62.1%, postnasal drip 64.4%, anosmia 50.0% and headache 80.0%. However, no statistical significance could be drawn between the improvement rate and the different lengths of the follow-up periods. CONCLUSION: The results suggest that endoscopic sinus surgery might improve nasal symptoms in patients with chronic sinusitis regardless of the severity of disease and the length of follow-up period.

Effects of Pseudomonas Aeruginosa Infection and Mechanical Trauma to the Sinus Mucosa on Polyp Formation in the Rabbit Maxillary Sinuses

The aim of this study is to develop an animal model of polyps that is more suitable for further polyp studies by semiquantitatively analyzing the effects of Pseudomonas aeruginosa infection and/or mechanical trauma to the sinus mucosa, based on the epithelial rupture theory, on polyp formation in the rabbit maxillary sinuses. The natural ostia were occluded in 30 Pasturellafree New Zealand white rabbits. All rabbits were divided into three groups according to the following modes of manipulation on the right maxillary sinus: inoculation with P. aeruginosa (group A), brushing of the sinus mucosa (group B), and inoculation with P. aeruginosa accompanied by brushing of the mucosa (group C). The left maxillary sinuses were used as the control. After four weeks, macroscopic polyps and light microscopic polyps and/or polypoid mucosa were semiquantitatively analyzed. The number of macroscopic polyps per sinus was significantly larger in groups A (1.0 polyps) and C (1.3 polyps) than in group B (0.0 polyps). Microscopic examination revealed significantly higher levels of polyps and/or polypoid mucosa in groups A and C than in group B. The results of this study suggest that a rabbit model of polyps using P. aeruginosa is suitable for further polyp studies and that induction of this type of model needs no mechanical trauma to the sinus mucosa.

Effects of Mechanical Trauma to the Sinus Mucosa on Polyp Formation in Induction of Maxillary Sinusitis in Rabbits by Streptococcus Pneumoniae / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pathogenesis, definition, and treatment of sinonasal polyps remain uncertain. To elucidate them, many studies on polyps have been made. However, recently reported studies on polyps using animal models seldom provided comparative data on polyp formation in various conditions. The aim of this study is to develop an animal model of polyps which is more suitable for further polyp studies. We attempted a semiquantitative analysis on the effects of mechnical trauma to the sinus mucosa on formation of polyps and polypoid mucosa in duction of rabbit maxillary sinusitis by Streptococcus pneumoniae and compared the prevalences of polyps under the different conditions. MATERIALS AND METHODS: The natural ostia of both sinuses were occluded in 10 Pasturella-free New Zealand white rabbits. Both sinuses were inoculated with S. pneumoniae, without brushing the mucosa in the left maxillary sinuses (control group) and with brushing in the right sinuses (experimental group). After four weeks, all sinuses were re-opened. Macroscopic polyp and light microscopic polyps and/or polypoid mucosa were semiquantitatively analyzed and each prevalence was compared between the two groups. RESULTS: The number of macroscopic polyps per sinus was significantly larger in the experimental group (1.1 polyps) than that in the control group (0.1 polyps). Microscopic examination revealed significantly more polyps and/or polypoid mucosa in the experimental group than in the control group. CONCLUSIONS: Our results suggest that mechanically traumatizing the sinus mucosa, such as brushing, is more helpful to polyp formation when a rabbit model of polyps is to be induced by S. pneumoniae.

Anatomical Relationship of the Anterior Ethmoid Canal to the Anterior Skull Base: A Computed Tomographic Analysis on the Types of the Fovea Ethmoidalis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As the anterior ethmoid canal (AEC) provides a good surgical landmark and its injury may result in serious complications, the anatomical relationship of the AEC to the anterior skull base (ASB) should be evaluated preoperatively. Despite some studies on the ASB, studies analyzing this anatomical relationship and the types of the fovea ethmoidalis (FE) on computed tomography (CT) are rare. The aim of this study is to better understand this anatomical relationship by determining the frequency of each type of the FE and distances between anatomical structures on the CT scans with our new classification. MATERIALS AND METHOD: Four hundred sides of the FE were analyzed from the preoperative coronal CT scans of 200 chronic sinusitis patients (100 males and 100 females, aged 20 to 59 years). The FE was classified into 4 types (I: non-separated type, II: partially separated type, III: completely separated type, IV: unidentifiable type) and 2 subtypes (A: developed medial cranial wall, B: undeveloped medial cranial wall). Heights of the medial cranial wall (a), the AEC (b), and the ethmoid roof (c) were measured on the CT image. RESULTS: Frequencies of the types I-IV were 48.0% (IA: 25.2%, IB: 22.8%), 19.3% (IIA: 4.3%, IIB: 15.0%), 29.5% (IIIA: 29.5%, IIIB: 0%), and 3.2%, respectively. The medial cranial wall of type IIIA was significantly longer than those of the other types, and the AEC of type IIIA was in a significantly lower position than those of the other types. CONCLUSION: On the CT scans, we found the AEC in 96.8% and type IIIA in nearly 30% of all types of the FE. Sinus surgery should be performed only after preoperative evaluation of these anatomical relationship on the CT scans under close scrutiny. For the type IIIA, surgery should be performed with utmost care due to high risk of injury to the AEC and the medial cranial wall.

An Immunohistochemical Study on the Expression of Matrix Metalloproteinase-2, Tissue Inhibitor of Metalloproteinase-2 and Angiogenesis in Human Laryngeal Squamous Cell Carcinoma / 대한이비인후과학회지

The clinical staging systems for laryngeal cancer is limited as a prognostic indicator because of different biological characteristics of cancer in this region. To determine biological characteristics of laryngeal cancer and whether the matrix metalloproteinase-2(MMP-2), tissue inhibitor of metalloproteinase-2(TIMP-2) and angiogenesis can be used as prognostic indicators, the authors performed immunohistochemical staining of MMP-2, TIMP-2 and factor VIII related antigen in 20 cases of surgically treated squamous cell carcinoma of the larynx. The results are as follows: (1) The positive rates of MMP-2 and TIMP-2 expression in laryngeal squamous cell carcinoma were 55% and 95% respectively.(2) As the clinical stage was advanced, the expression of MMP-2 and TIMP-2 increased significantly(p=0.043, p=0.014).(3) The microvessel count(MVC) did not correlate with the clinical stage and histopathologic grading.(4) As the MVC increased, the expression of MMP-2 and TIMP-2 increased significantly(p=0.0004, p=0.0025). In conclusion, MMP-2 and TIMP-2 can be used as a prognostic indicator of laryngeal squamous cell carcinoma. As MMP-2 increases, so does neovascularization. And as neovascularization increases TIMP-2 does also in order to inhibit it. Since TIMP is an expression of the host response to a tumor and this response is different in each tumor, studies on MMP, TIMP and angiogenesis in other tumors should also be encouraged.

Endoscopic Repair of Iatrogenic Cerebrospinal Fluid Rhinorrhea with Osteomucoperiosteal Free Flap Obtained from the Middle Turbinate / 대한이비인후과학회지

Iatrogenic cerebrospinal fluid(CSF) rhinorrhea, rarely occuring, is one of the major complications, and should be managed immediately if it occurs during operation. CSF leakage can be repaired intracranially or extracranially. Extracranial approaches are subdivided into extranasal and intranasal. Recent advance in nasal endoscopy and its advantage of low morbidity allow more surgeons to perform the intranasal approach using endoscope. As graft materials, free or rotational flaps of temporalis muscle fascia, muscle, fat, and mucosa or mucoperiosteum in the nasal septum or turbinates have widely been used. Sometimes composite graft such as osteomucoperiosteal(OMP) free flap was also used. By intranal endoscopic approach using OMP free flap obtained from the middle Turbinate(MT), we successfully repaired CSF leakage from a defect, 5~7mm in size, which had occured in the right ethmoid roof near the lamina cribrosa during endoscopic sinus surgery on a patient with chronic paranasal sinusitis. Repair of CSF rhinorrhea using MT OMP free flap may be an useful technique for immediate intraoperative management of the defect, if it is not so large, because of availability and easy handling of this flap in the same surgical field.

A Case of Spontaneous Regression of Basaloid Squamous Cell Carcinoma / 대한이비인후과학회지

Basaloid squamous cell carcinoma(BSCC) is a rare distant variant of squamous cell carcinoma of head and neck region, of which about 90 cases was reported in the world. BSCC has aggressive biologic behavior with a high incidence of cervical lymph node metastasis, distant spread, and death from disease. S pontaneous regression has not been previously reported in BSCC. However, we experienced a case of spontaneous regression of BSCC in nasal cavity with characteristic histopathologic and immunologic feature in 53 old male patient. T herefore, we report the first case of spontaneous regression of BSCC.

Nasal Patency Assessed by Acoustic Rhinometry after Endoscopic Sinus Surgery for Chronic Sinusitis

Nasal obstruction is one of the most frequent symptoms of chronic sinusitis. Since 1989, acoustic rhinometry has proven to be relatively accurate in evaluating the severity of nasal obstruction in a clinical setting. This study was conducted to evaluate the efficacy of acoustic rhinometry before and after endoscopic surgery in relieving nasal obstruction in patients with chronic sinusitis. Nasal airway patency was measured by acoustic rhinometry, preoperatively and postoperatively, in 48 patients with chronic sinusitis. Total volume (TV), distances and areas of the first and second notches, and areas at 3.3 cm (A(3.3)), 4.0 cm (A(4.0)) and 6.4 cm (A(6.4)) from nose pieces were measured. The patients were divided into 4 groups according to the duration of their postoperative follow-up period. Group 1 had a postoperative follow-up period less than 1 year ; group 2, between 1 and 2 years ; group 3, between 2 and 3 years ; group 4, between 3 and 4 years. There was a significant increase in TV, A(4.0), and A(6.4) postoperatively (p<0.05, paired t-test). Postoperative values including TV, A(4.0), and A(6.4) increased significantly in group 1, group 2, and group 3, but decreased in group 4 (p<0.05, ANOVA). However, there was no significant difference between groups in distances and areas of the first and second notches. These results suggest that endoscopic sinus surgery is effective in relieving nasal obstruction of patients with chronic sinusitis and that acoustic rhinometry may be a useful tool in objectifying symptomatic improvement in patients with nasal obstruction following endoscopic sinus surgery.

Improvement of Olfactory Function according to Postoperative Period after Endoscopic Sinus Surgery / 대한이비인후과학회지

BACKGROUND: Rhinosinusitis is the most common cause of olfactory impairment and endoscopic sinus surgery(ESS) is considered as an effective method in the treatment of rhinosinusitis. OBJECTIVES: The aim of this study is to determine the therapeutic effects of endoscopic sinus surgery in olfactory dysfunction. MATERIALS AND METHODS: The subjects of this study were one hundred and eighteen chronic sinusitis patients who had undergone ESS at the department of otolaryngology of Ewha Womans University Hospital, from April 1992 to December 1995. The patients were evaluated subjectively by questionaire and among them, fifty three patients were randomized to receive quantitative butanol test. RESULTS: Twenty-eight(68.3%) of 41 patients with olfactory dysfunction had marked improvement postoperatively but the degree of improvement(postoperative threshold score-preoperative threshold score) decreased during the postoperative period. After postoperative 2 and 2-3 years, the degree of improvement significantly decreased to 2.5 and 1.0, respectively(p<0.005). CONCLUSION: Olfactory dysfunction in patients with chronic sinusitis can be improved significantly initially after ESS but the smell acuity decreases postoperative period, especially after posto-perative 2 years.

Clinical Analysis for Complications after Endoscopic Sinus Surgery in Korea during Past 7 Years / 대한이비인후과학회지

BACKGROUND: Based on the work of Messerklinger, endoscopic sinus surgery(ESS) has become popular during recent years. Many reports on the technique of, indications for, and results of ESS have been published. Few reports are devoted exclusively to the complications of ESS in Korea. OBJECTIVES: In this paper, the complications of ESS in Korea and the findings and prevention of complications are discussed through early recognition and appropriate management. MATERIALS AND METHODS: A retrospective study about the complications of ESS was done on 42 hospitals from 1988 to 1995 in Korea. The incidence of complications of ESS in Korea(total 31,012 cases) is compared to complications in three other series of patients(total 2,165 cases) who underwent ESS in foreign contries and three series of patients(total 2,454 cases) who underwent conventional endonasal sinus surgery. RESULTS: Major complications occurred in 0.04% and major bleeding was the commonest. Minor complications occurred in 22.54% and were related to recurrent inflammatory symptom and midddle turbinate adhesions. CONCLUSIONS: There are some differences in incidence of each complications according to surgical approach. In major complications, the incidence of intracranial and orbital complication with the conventional endonasal sinus surgery approach was higher than that of endoscopic approach. Another difference is that adhesions do not occur with the conventional approach because middle turbinate is routinely removed. The incidence of recurrent symptoms was highest with ESS in Korea. We discuss complications of the procedures and the related factors to complications.