Seasonal Specificity of Seasonal Allergens and Validation of the ARIA Classification in Korea

PURPOSE: In Korea, tree pollens are known to be prevalent in spring, grass pollens in summer and weed pollens in autumn. However, few studies have revealed their seasonal specificity for allergic rhinitis symptoms. An ARIA (Allergic Rhinitis and its Impact on Asthma) classification of allergic rhinitis was recently introduced and its clinical validation has not been well proved. The aim of this study was to evaluate the seasonal specificity of seasonal allergens and to validate the ARIA classification with the conventional seasonal and perennial allergic rhinitis (SAR/PAR) classification. METHODS: Two hundred twenty six patients with allergic rhinitis were included in this study. The patients were classified according to the sensitized allergens and the ARIA classifications. A questionnaire survey was performed and the data on the seasonal symptom score, the severity of symptoms and the SNOT (sinonasal outcome test)-20 score was obtained and the data was analyzed and compared between the conventional SAR/PAR classification and the ARIA classification. RESULTS: Seasonal pollens (tree, grass, weed) were not specific to the pollen peak season and the patients' symptoms were severe during spring and autumn regardless of the offending pollens. More than 60% of the patients with SAR showed persistent symptoms and 33% of the patients with perennial allergic rhinitis (PAR) had intermittent symptoms, showing the lack of association between the SAR/PAR/PAR+SAR classification and the ARIA classification. The ARIA classification showed better association not only with the symptomatic score, but also with the SNOT-20 score, which showed better validity than the conventional SAR/PAR classifications. CONCLUSIONS: Seasonal pollens were not specific to their season of prevalence in terms of the severity of symptoms, and the ARIA classification showed better representation of allergic symptoms and quality of life (SNOT-20 score) than did the SAR/PAR classification.

A Case of Nasal Septal Abscess Caused by Combined Bacterial and Fungal Infection in the Immunocompromised Patient / 대한이비인후과학회지

Nasal septal abscess (NSA) occurs more commonly after minor trauma and subsequent bacterial infection. However, it rarely occurs without trauma and can be associated with poor immunity. In the immunocompromised patient, NSA can occur due to fungal as well as bacterial infection; cases caused by fungal infection have been rarely reported. We experienced a case of NSA caused by combined fungal and bacterial infection without trauma in a patient with poorly-controlled diabetes mellitus. He underwent incision and drainage. Organism cultured from NSA was Staphylococcus epidermidis. Pathologic examination identified granulomatous inflammation in the septal cartilage and septate, branching fungal hyphae that had invaded the cartilage. He was treated by adequate blood glucose control and antibiotics coverage without antifungal medications. His symptom was improved despite the antifungal agent was not used. Therefore, we present this case with a brief review of the disease entity and discuss the necessity of antifungal treatment in this case.

Clinical Comparison Between Ocular and Cervical Vestibular Evoked Myogenic Potentials / 대한평형의학회지

BACKGROUND AND OBJECTIVES: The goal of this study was to compare the outcome between cervical vestibular-evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) in the patients with definite vestibular dysfunction. Also, the subjective discomfort level was compared between cVEMP, classic oVEMP and head positioned oVEMP (a new method designed by the authors). MATERIALS AND METHODS: Eighteen patients with dizziness associated with unilateral vestibular hypofunction were included in this study. Vestibular neuritis, Ramsay-hunt syndrome and sudden sensorineural hearing loss with vertigo were included in unilateral vestibular hypofunction disease. cVEMP, classic oVEMP, and head positioned oVEMP were assessed and compared. To compare the subjective discomfort during the tests, visual analogue scale on discomfort was checked. RESULTS: There was a discrepancy between the cVEMP and classic oVEMP in 31.3% of the cases. The classic oVEMP were associated with more discomfort than the cVEMP. But, there was no difference between the classic and head positioned oVEMP. CONCLUSION: Since a substantial discrepancy was identified between the cVEMP and oVEMP, the pathways involved in cVEMP and oVEMP are likely different even with the same air conduction tone stimuli. The head positioned oVEMP may be an alternative to the classic oVEMP which has similar results and subjective discomfort levels.

A Case of Mucoepidermoid Carcinoma on Inferior Turbinate in Nasal Cavity / 대한이비인후과학회지

Malignant carcinoma involving the sinonasal cavity is a rare tumor that is usually diagnosed as squamous cell carcinoma. Mucoepidermoid carcinoma is relative common, originating from the salivary glands of the oral cavity, pharynx and lacrimal glands. But mucoepidermoid carcinoma of nasal cavity, paranasal sinuses and respiratory tract is very rare. In particular, 38 cases of mucoepidermoid carcinoma occurring in the primary sinonasal tract were reported in the English literature, but only one case of mucoepidermoid carcinoma arising from the nasal cavity has been previous reported to date in the Korean literature. Recently, we experienced a 51-year-old man presenting with progressive nasal obstruction and recurrent epistaxis. He was diagnosed as mucoepidermoid carcinoma extending into the inferior turbinate in the nasal cavity and it was excised with nasal endoscope. We present the clinical characteristics and therapeutic methods of this case with a review of the literature.

A Case of Multiple Discrete Fungus Balls of the Bilateral Paranasal Sinuses / 대한이비인후과학회지

Fungus balls of the paranasal sinuses are usually found in only one sinus, most frequently in the maxillary sinus. Multisinus involvement was found only in 6.4% of the largest review of this disease entity. Though fungus ball could be involved in multiple sinuses, these sinuses were mostly contiguous. In addition, bilateral involvement is rare in the literature : only one case of triple discrete fungus balls in a patient has been reported. We recently experienced a rare case of multifocal discrete fungus ball involving the bilateral maxillary sinus and left sphenoid sinus in a 58 year-old female. Therefore, we present this rare case with a brief review of this disease entity.

Possibility of Misdiagnosing the Lesion Side in Unilateral Vestibular Weakness / 대한평형의학회지

Sudden sensorineural Hearing Loss with Vertigo (SHLV) is characteristic of sudden onset vertigo and unilateral hearing loss, due to acute and profound deterioration in a vestibular and cochlear system. It is relatively easy to determine the lesion side in SHLV, because the patient will complain of unilateral hearing loss. But, it might not beapplicable to vestibular neuritis case, and several vestibular function tests may be helpful in deciding the lesion side. We have recently encountered a patient with SHLV whose caloric and SHA did not match with the lesion side. We speculated that the uncompensated dynamic defect and imbalance of the cerebellar clamping has been implicated in this lab finding. Although the exact mechanism of this curious finding cannot be explained by this single case report, we should consider that one could make a mistake to determine the involved site just only by lab finding in vestibular neuritis.

Clinical Implication of Dissociation between Subjective Visual Horizontal and Subjective Visual Vertical / 대한평형의학회지

BACKGROUND AND OBJECTIVES Subject visual vertical (SVV) and subject visual horizontal (SVH) is well known otolith function test. Patients with acute unilateral vestibular weakness fail to set the test bar within normal range in SVH/SVV showing abnormal deviation toward lesion side. In some cases, SVH and SVV are deviated towards different directions, and analysis of these findings is rarely reported. The authors analyzed correlation of SVH/SVV and other vestibular function tests in patients with various vestibular diseases. MATERIALS AND METHODS From April 2005 to July 2007, total 234 patients who had admitted for dizziness were enrolled. All patients were divided in two groups, non-dissociation group (n=215) and dissociation group (n=19). Correlation of SVH, SVV, Videonystagmography (VNG), the rotating chair test was compared. RESULTS 8.1% of patients showed dissociation between SVH and SVV. Clinical features did not showed significant difference between groups. In non-dissociation group, SVH/SVV showed correlation with VNG, rotating chair test. However in dissociation group, VNG and rotating chair test revealed high rate of consistency with deviation of SVH than that of SVV. Also direction of SVH and dizziness had higher consistency (88.9%) than that of SVV (11.1%). CONCLUSION The SVH showed consistency with other vestibular function test and may be more reliable than SVV when the result is dissociated.