Usefulness of Unilateral Nasal Packing for Recurred Septal Deviation within a Month after Septoplasty: Preliminary Study

BACKGROUND AND OBJECTIVES: To investigate the effect of unilateral nasal packing on the correction of recurred septal deviation after septoplasty. MATERIALS AND METHOD: We analyzed 12 patients who had undergone septoplasty and developed septal deviation recurrence. Polyvinylacetate and Vaseline gauze were inserted into the nasal passage on the convex side of the septum for 4 days in order to shift the septum to the midline. We analyzed nasal symptoms, acoustic rhinometric results, and endoscopic findings before and after unilateral packing in order to evaluate the treatment outcomes. RESULTS: Ten (83%) out of 12 patients showed improvements in nasal obstruction, acoustic rhinometric results, and endoscopic findings. The mean visual analogue scale (VAS) score for nasal obstruction was 5.25±1.60 before and 2.08±1.50 after packing (p=0.004). The minimal cross-sectional area (MCA) improved from 0.17±0.14 to 0.27±0.13 (p=0.002), and the mean endoscopic score improved from 2.0±0.43 to 1.08±0.29 (p=0.002). CONCLUSION: Unilateral nasal packing was a safe, easy, and effective method for correcting recurred septal deviation after septoplasty.

Intralymphatic Immunotherapy Alleviates Allergic Symptoms During Allergen Exposure in Daily Life

No abstract available.

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.

Failed septal extension graft in a patient with a history of radiotherapy / 대한악안면성형재건외과학회지

BACKGROUND: This report describes the authors’ experience of “melting” septal cartilage after placement of a septal extension graft in a nasopharyngeal cancer patient that had been previously undergone radiation therapy, and provides a review of the literature. METHODS: Electronic medical records were used to obtain details of the patient's clinical history. RESULTS: A 32-year-old woman, who had previously undergone radiotherapy for nasopharyngeal cancer, visited our department to for rhinoplasty. Rhinoplasty was performed using a septal extension graft to raise the nasal tip (first operation). Five days after surgery, it was found that the septal extension graft was melting without any signs of infection, that is, the graft had softened, lost elasticity, thinned, and partially disappeared without any sign of infection at 5 days, and thus, the nasal tip was reconstructed with conchal cartilage (second operation). Five months after surgery, it was found that almost all septal cartilage had disappeared without any sign of infection, and thus, the entire nasal septum was reconstructed using 2-mm costal cartilage and an onlay graft was used for tip augmentation (third operation). CONCLUSIONS: After cartilage has been exposed to radiotherapy, its patency should be viewed with suspicion. Further studies are needed for determine the mechanism responsible for cartilage damage after radiotherapy.

A Case of Angioleiomyoma Arising from the Right Inferior Turbinate / 대한이비인후과학회지

Leiomyoma is a benign smooth muscle neoplasm that rarely becomes malignant. It can occur in any organ of the human body that contains smooth muscles, but the most common forms occur in female genitourinary organs, including the uterus, gastrointestinal organs, including the small bowel and the esophagus and the skin. It rarely occurs in the head and neck area, including the sinonasal cavity. When it occurs in the nasal cavity, its clinical symptoms include nasal obstruction, nasal discharge, nasal bleeding, and pain. We describe herein a case of a 55-year-old man with a leiomyoma in his right inferior nasal turbinate. Transnasal endoscopic excision and paranasal sinus CT were performed. A soft tissue mass on the right inferior turbinate was confirmed from the paranasal sinus CT, and the pathological results revealed a vascular leiomyoma.

Comparison of Component-Resolved Diagnosis by Using Allergen Microarray With the Conventional Tests in Allergic Rhinitis Patients: The First Using in Korea

OBJECTIVES: The aim of this study was to evaluate the component-resolved diagnosis using a microarray allergen chip (Immuno Solid-phase Allergen Chip, ImmunoCAP ISAC) and to compare this new diagnostic tool with the established ImmunoCAP methods for allergen-specific IgE detection in allergic rhinitis patients. METHODS: One hundred sixty-eight allergic rhinitis patients were included in this study. All the patients were diagnosed with allergic rhinitis according to their clinical symptoms, physical examination and a positive skin prick test. We analyzed their specific IgEs for house dust mites (Dermatophagoides farine [DF] and Dermatophagoides pteronyssinus [DP]), Alternaria alternata, birch, and mugwort using ImmunoCAP and ImmunoCAP ISAC in the same patient sample. We compared the sensitivity and correlation between the two tests. RESULTS: In cases of allergies to DP and DF, the sensitivity of the specific IgE was 80% and that of the allergen microarray was 78.9%. The correlation between the two tests was significant for both DP and DF (P<0.001). For the A. alternata, birch and mugwort allergens, the sensitivity of ImmunoCAP ISAC was slightly lower than that of ImmunoCAP. CONCLUSION: These results suggest that the allergen microarray chip method is a reliable new method to diagnose the components of an allergen in patients with allergic rhinitis sensitive to house dust mites. Further study about the utility of the allergen microarray is needed.

Recent Knowledge of Facial Plastic and Reconstructive Surgery / 대한이비인후과학회지

Performance of facial aesthetic surgeries except rhinoplasty in otorlarygoloic department is not usual in South Korea. However, otolaryngologic doctors have been performing facial surgeries, thus, their knowledge of facial surgical anatomy is better than that of other doctors. For this reason, otolaryngologic doctors should study hard in order to learn about performance of facial aesthetic surgeries. Recently, in South Korea, because many facial aesthetic surgeries have been performed, many complications have been reported and facial aesthetic surgery techniques have been developed rapidly. Herein, I would like to introduce some facial aesthetic and reconstructive techniques that are not usually performed in the otolaryngologic department in South Korea.

A Case of Multiple Schwannoma That Originated in the Nasal Septum / 대한이비인후과학회지

Schwannomas are benign peripheral nerve sheath tumors that occur throughout the body. They may appear as either a solitary mass or multiple masses. A 76-year-old woman visited our clinic with swelling of her nasal tip. Initially, based on her medical history, physical examination and CT scan, we diagnosed the disease as a neurogenic tumor or metastatic carcinoma; however, the incisional biopsy result revealed schwannomas that had originated from the nasal septum. The two masses were completely resected using the external rhinoplasty approach. Multiple schwannomas that originate in the nasal septum are extremely rare, and we report herein with a review of literature.

Personality Characteristics of Patients with Obstructive Sleep Apnea and Simple Snoring : A Preliminary Study / 수면정신생리

OBJECTIVE: Few studies have evaluated the personality characteristics of patients with obstructive sleep apnea (OSA) and simple snoring. We investigated the personality characteristics of OSA and simple snoring patients and compared differences in personality between the two groups using the Eysenck Personality Questionnaire (EPQ). MATERIALS AND METHODS: Two hundred and thirty-seven patients who were suspected to have OSA or simple snoring participated in this study. A self-questionnaire which included the EPQ was administered to all participants. All subjects underwent polysomnography in a sleep laboratory and those with an apnea-hypopnea index (AHI) > or =5 were included in the OSA group, while those with an AHI <5 were included in the simple snoring group. RESULTS: OSA patients had significantly lower scores for Psychoticism (F=4.563, p=0.034) than simple snorers. There were no significant differences in Extraversion (F=3.029, p=0.083), Lie (F=0.398, p=0.529), or Neuroticism (F=3.367, p=0.068) scores between the two groups. In the correlation analysis of the OSA group, AHI was positively correlated with Extraversion score (r=0.16, p=0.029) and negatively correlated with Lie score (B=-0.31, p<0.001). Using multiple stepwise linear regression analysis with the four EPQ parameter scores as dependent variables, Lie score was associated with older age (B=0.14, p<0.001) and lower AHI (B=-0.05, p<0.001), Psychoticism score was associated with higher Pittsburgh Sleep Quality Index (PSQI ; B=0.14, p<0.001), Neuroticism score was associated with higher PSQI (B=0.34, p=0.001) and female sex (B=3.15, p=0.003), and Extraversion score was associated with younger age (B=-0.08, p=0.020) and higher body mass index (B=0.26, p=0.023). CONCLUSION: This study suggests that patients with OSA are significantly less prone to psychotic personality characteristics than those with simple snoring. Among OSA patients, higher AHI was correlated with low falsehood and high extraversion tendencies.

Reconstruction of a Columellar Defect With a Nasolabial Island Flap

Columellar skin defects may be caused by excision of cutaneous malignancy, trauma, or tissue necrosis associated with surgery. Although columellar skin necrosis rarely occurs following rhinoplasty, this condition might be more common when using an external approach than a closed approach. Columellar skin incision performed with exaggerated tip augmentation may cause columellar necrosis. The nasolabial island flap, used unilaterally to cover columellar skin defects, is used for a single-stage reconstruction procedure and is generally not associated with the need for secondary surgeries. This technique is well suited for repairing columellar skin defects. We experienced a patient with columellar skin necrosis occurring after rhinoplasty which was reconstructed using a unilateral single-stage nasolabial island flap.

A Case of Intraosseous Hemangioma of the Maxilla Bone / 대한이비인후과학회지

Intraosseous hemangioma is a rare tumor, occurring especially in the maxilla. Because hemangioma is a benign tumor with increased vascularity, some authors call it hamartoma. This tumor originates and expands into bony structures. We experienced a female patient with intraosseous hemangioma of the right maxilla. The tumor was completely removed through a gingivobuccal incision and the feeding vessel was embolized. We report this case regarding the radiologic work-up, differential diagnosis, pathology and treatment with a brief review of the literature.

The Effect of Obstructive Sleep Apnea on DNA Damage and Oxidative Stress

OBJECTIVES: Obstructive sleep apnea syndrome (OSAS) is associated with repeated hypoxia and re-oxygenation. This characteristic of OSAS may cause oxidative stress and DNA damage. However, the link of OSAS with oxidative stress and DNA damage is still controversial. In the current study, we investigated whether OSAS causes DNA damage using alkaline single-cell gel electrophoresis (comet assay) and measuring oxidative stress by monitoring serum malondialdehyde (MDA) levels. METHODS: From March 2009 to August 2010, 51 patients who underwent polysomnography (PSG) during the night were enrolled in this study. We obtained serum from the patients at 6 AM. DNA damage and oxidative stress were evaluated using a comet assay and measuring serum MDA, respectively. We divided the patients into two groups according to the existence of comets appearing in the comet assay. Group 1 included 44 patients with negative assay results and group 2 consisted of seven patients with positive comet assay findings. We compared the age, gender proportion, PSG data (respiratory disturbance index [RDI], lowest O2 saturation level, and arousal index [AI]), time of disease onset, smoking habits, and serum MDA levels between the two groups. RESULTS: The average age and gender proportion of the two groups were not statistically different (P>0.05). The average of RDI for group 1 was 30.4+/-18.4 and 8.0+/-7.7 (P0.05). No relationship between positive comet assay results and OSAS severity was identified. CONCLUSION: Results of the current study showed that OSAS was not associated with DNA damage as measured by comet assays or oxidative stress according to serum MDA levels.

Clinical and Physical Characteristics That Affect Apnea-Hypopnea Index in Suspected Obstructive Sleep Apnea Patients : The Preliminary Study

OBJECTIVES: The purpose of this study is to find the influential clinical and physical characteristics which affect apnea-hypopnea index (AHI) in suspected obstructive sleep apnea (OSA) patients. METHODS: We evaluated the comprehensive factors including sleep related symptoms, clinical scales, medical history, substance use, and anthropometric data of the 119 participants who complained of the symptoms of OSA. All the participants underwent attended-full night laboratory polysomnography. The correlation and multiple regression analysis were conducted to find the influential and predictive factors of AHI. RESULTS: A multiple linear regression model 1 showed that higher AHI was associated with higher body mass index (BMI)(p < 0.001) and higher frequency of observed apnea (p = 0.002). In multiple linear regression model 2, AHI was associated with higher BMI (p < 0.001) and loudness of snoring (p = 0.018). CONCLUSIONS: The present preliminary results suggest that BMI and observed apnea are most influential factors that affect AHI in suspected OSA patients. In the future study we will design the prediction formula for the OSA and AHI, which is useful in the clinical medical field.

Asian Sand Dust Enhances Allergen-Induced Th2 Allergic Inflammatory Changes and Mucin Production in BALB/c Mouse Lungs

PURPOSE: Recent studies have reported that Asian sand dust (ASD) has a potential risk of aggravating airway inflammation. The purpose of this study was to investigate the effect of ASD on inflammation and mucin production in the airways of allergic mice. METHODS: Forty BALB/c female mice were divided into four groups: saline (group 1); ASD (group 2); ovalbumin (OVA) alone (group 3); and OVA+ASD (group 4). OVA-specific immunoglobulin E (IgE) in serum and interleukin (IL)-4, IL-5, IL-13, and interferon-gamma (IFN-gamma) in bronchoalveolar lavage fluid (BALF) were measured by enzyme-linked immunosorbent assay (ELISA). Hematoxylin & eosin (H&E) and Periodic acid-Schiff (PAS) staining was performed on lung tissues. In addition, immunohistochemical staining for IL-4, IL-5, MUC5AC, and transforming growth factor alpha (TGF-alpha) was conducted. RESULTS: Serum IgE levels were significantly higher in group 4 than in group 3 (P<0.05). IL-4 and IL-5 in BALF were significantly higher in group 4 than in group 3 (P<0.05, respectively). Based on H&E staining, inflammatory cell numbers were significantly greater in group 4 than in the other groups (P<0.05). The number of PAS-positive cells was also significantly greater in groups 3 and 4 than in groups 1 and 2 (P<0.05). The numbers of IL-4 and IL-5-positive cells were higher in group 4 than in group 3 (P<0.05). The number of MUC5AC and TGF-alpha-positive cells were also higher in group 4 than in group 3 (P<0.05). CONCLUSIONS: Our data suggest that ASD increases cytokine expression and mucin production in an allergic murine model. The increased inflammatory reactions were related to cytokine production.

Treatment of Facial Bone Fracture Using Octyl-2-Cyanoacrylate: Case Report

Precise fixation of fracture fragments is important for the successful management of facial bone fractures. However, the conventional metal plates and screws used in such procedures are sometimes difficult to place when the facial bone fracture occurs in a narrow area or has significant comminution. We report herein our experience with 6 patients with facial fractures, which were difficult to fix using titanium plates and screws. All injuries were satisfactorily repaired using octyl-2-cyanoacrylate (OCA). In addition, there were no significant complications related to OCA during the follow-up period.

A Case of Olfactory Groove Meningioma Presenting Anosmia / 대한이비인후과학회지

The common causes of anosmia include sinonasal disorder, post-upper respiratory infection, trauma and chemicals. Intracranial tumor also frequently cause anosmia, so it is not easy to diagnose an intracranial tumor in patients who present with no definite related symptoms other than anosmia. Therefore, otolaryngologists should focus their attention on these disorders when they see patients with anosmia. We have experienced a case of olfactory groove menigioma presenting with only anosmia. We herein report this case with a brief review of the literature.

A Case of Post-Traumatic Olfactory Disorder Presenting Negative Results of Schneider Test due to Trigeminal Nerve Injury / 대한이비인후과학회지

There has been a considerable increase in the number of patients with olfactory disorder due to head and facial injuries. Conventional olfactory function evaluation methods, such as T&T olfactometer, the Schneider test and the Alinamin test have been widely used in clinical practice. Among these, the Schneider test can determine whether the patient is a malingerer. A woman who sustained head and facial injuries visited our department with the chief complaint of anosmia. The patient underwent conventional olfactory function tests, including T&T olfactometer and the Schneider test. T&T olfactometer revealed olfactory loss, but the Schneider test did not. Thus, she was diagnosed with malingering. However, her diagnosis of olfactory disorder and concurrent trigeminal nerve injury was made definite during the follow-up period. We herein report a 30-year-old female patient with olfactory disorder who was misdiagnosed with olfactory malingering based on the negative result of the Schneider test. A brief review of the literature has been included.

The Symptom Improvement of Adjunctive Hypochlorous Acid Nasal Cavity Irrigation in Post-Surgically Intractable Chronic Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Low concentration hypochlorous acid is known for being an endogenous anti-bacterial and anti-viral agent. Saline irrigation has been used as an adjunctive treatment for patients with chronic sinusitis. In this study, we tried to compare the effectiveness of hypochlorous acid and saline nasal irrigation to patients with intractable sinusitis after surgery. SUBJECTS AND METHOD: A total of 35 patients who had a frequent relapse of chronic sinusitis or had persisting symptoms post-surgically were recruited. The experimental group was given hypochlorous acid and saline nasal irrigation, while the control group was given saline nasal irrigation for eight weeks. The curative effects were assessed on the basis of the symptom score, nasal endoscopic score, bacterial culture, and inflammatory cytokines on the first day, fourth week, and eighth week after treatment. RESULTS: A total of 26 participants were assessed. The study finally consisted of 15 patients in experimental group and 11 in the control group. The symptom scores in the experimental group were substantially lower before, and after four and eight weeks of treatment. However, there was no specific difference in symptom score improvement between the two groups. The endoscopic score improved in experimental group (p<0.01). Similar tendencies were shown in the bacterial culture test of both groups. In the experimental group, the values of TNF-alpha, IL-8, and IL-1beta decreased in the fourth week, whereas they increased in the eighth week. CONCLUSION: Hypochlorous acid nasal irrigation may be to used as an alternative adjunctive treatment in addition to saline irrigation.

Bilateral Maxillary Dentigerous Cysts in a Non-Syndromic Patient / 대한이비인후과학회지

Dentigerous cysts are the most common type of developmental odontogenic cysts and the second most common odontogenic cyst of the jaw after radicular cysts. Dentigerous cysts are usually solitary, but can be multiple in patients with certain syndromes, such as mucopolysaccharidosis type IV. There are cases of multiple cysts occurring in non-syndromic patients as well. A fourteen-year-old girl presented to our department with painful swelling in the left cheek. Except for the bulging of the left nasal lateral wall, the physical examination was unremarkable and all routine laboratory test results were within normal limits. Computed tomography (CT) showed a well-defined soft tissue density obliterating both maxillary sinuses with a tooth in the medial wall. We removed the cyst and teeth with forceps via a large middle meatal antrostomy. The pathology revealed a non-keratinized squamous epithelial lined cyst associated with the teeth.

The Present State of Korean Traditional Medicine and Alternative Medicine in Nasal Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Alternative medicine is becoming increasingly popular and is frequently used for treating patients with nasal diseases. While western medicine and operative treatment are proven treatments, herbal medicine and alternative medicine are widely used without any supporting evidence for treating cases of allergic rhinitis, sinusitis and hypertrophic rhinitis. So, we have tried to assess the present state of Korean traditional medicine (KTM) and alternative medicine for treating nasal cavity diseases. MATERIALS AND METHOD: We surveyed 204 patients who visited our department and were diagnosed with allergic rhinitis, sinusitis, deviated septum and/or hypertrophic rhinitis. The questionnaire included questions about whether or not the patients had tried KTM or alternative medicine, the reason for using KTM or alternative medicine, the frequency, kind, duration, effectiveness, cost and satisfaction and side effects. RESULTS: Among 204 patients, 14% of the patients had used KTM and 18% of the patients had used alternative medicine. The percent of those who had used KTM or alternative medicine in each of the allergic rhinitis patient, the sinusitis patient and the deviated septum with hypertrophic rhinitis patient groups were 46, 41, and 24%, respectively. The satisfaction rate for KTM was 47% and that for alternative medicine was 40%. The satisfaction rate for western medicine was higher than that for KTM and alternative medicine. CONCLUSION: Many patients used non-western medicine with obscure expectations. However, KTM and alternative medicine are not evidence-based treatments, so further research and education for patients are needed.