KAAACI Evidence-Based Clinical Practice Guidelines for Chronic Cough in Adults and Children in Korea

Chronic cough is common in the community and causes significant morbidity. Several factors may underlie this problem, but comorbid conditions located at sensory nerve endings that regulate the cough reflex, including rhinitis, rhinosinusitis, asthma, eosinophilic bronchitis, and gastroesophageal reflux disease, are considered important. However, chronic cough is frequently non-specific and accompanied by not easily identifiable causes during the initial evaluation. Therefore, there are unmet needs for developing empirical treatment and practical diagnostic approaches that can be applied in primary clinics. Meanwhile, in referral clinics, a considerable proportion of adult patients with chronic cough are unexplained or refractory to conventional treatment. The present clinical practice guidelines aim to address major clinical questions regarding empirical treatment, practical diagnostic tools for non-specific chronic cough, and available therapeutic options for chronic wet cough in children and unexplained chronic cough in adults in Korea.

Analysis of Biofilms in Recurrent Tonsillitis Using Confocal Laser Scanning Microscope and Fluorescent In Situ Hybridization: A Case-Control Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Biofilm is an encased colony of bacteria and the bacteria with-in the biofilm have resistance to antibiotics and the humoral immune system. Biofilm is currently thought to play an important role and to be very refractory to conventional therapeutics. The aim of this study is to analyze the relationship between the biofilm of the tonsil and recurrent tonsillitis with a case-control study. SUBJECTS AND METHOD: This is a case-control study. The case group included 31 patients who had histories of tonsillitis and the control group included 29 volunteers who had no history of tonsillitis. Confocal laser scanning microscopy was performed to identify biofilms. We compared the prevalence rates of biofilm between the 2 groups. Fluorescent in situ hybridization (FISH) was performed to identify bacteria, using probes for S. aureus, S. pyogenes, H. influenzae, S. pneumoniae, and K. pneumonia. RESULTS: In case group, biofilms were found in 22 (71.0%) of 31 and in control group, biofilms were found in 12 (41.4%) of 29. The prevalence rates of biofilm were significantly higher in case group (p=0.036). Twenty nine cases were enrolled in FISH and 12 cases of them were positive for FISH. S. aureus was most commonly identified. CONCLUSION: This study suggests that the biofilms could play a causative role in recurrent tonsillitis, further studies are needed to confirm pathogenic relation between biofilm and recurrent tonsillitis.

Comparison of Fungus Detection between PCR and Fungus Culture in Chronic Sinusitis and Normal Controls / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fungi are found in normal flora in various amounts. However, fungi in chronic sinusitis are poorly understood, and it is not clearly defined whether it is a pathogen or simply a part of normal flora. The polymerase chain reaction (PCR) is proposed as a more reliable test to detect fungal DNA than the conventional culture technique. The aim of this study was to compare the sensitivity of conventional culture technique and PCR analysis in detecting fungus of the nasal cavity and to compare fungal species found in normal controls and patients with chronic sinusitis. MATERIALS AND METHOD: Sterile saline irrigation was performed and then mucin filled saline was collected from the nasal cavity of patients with chronic sinusitis and normal controls. Fungus culture and PCR analysis were carried out with irrigated saline. RESULTS: PCR for panfungal gene was positive in 92.5% and 97.5% while fungus cultures were positive in 23.3% and 30.5% of patients with chronic sinusitis and normal controls, respectively. There was no significant difference in the prevalence of fungus and species of fungus between patients with chronic sinusitis and normal controls. CONCLUSION: PCR for panfungal gene was more sensitive for fungus detection than fungus culture in patients with chronic sinusitis and normal controls. Presence of fungus alone was insufficient to implicate it as the pathogen of chronic sinusitis. It will be necessary to study further about fungal species in patients with chronic sinusitis and normal controls.

The Effects of Septal Surgery for Snoring and Obstructive Sleep Apnea (OSA) on Polysomnography (PSG) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal obstruction is common in patients with snoring and obstructive sleep apnea (OSA). A hypothesis has been reported that nasal obstruction causes more negative pressure in the upper airway and induces an inspiratory collapse at the pharyngeal level. We tried to assess the efficacy of the septal surgery on snoring and OSA by using portable polysomnography (PSG). MATERIALS AND METHOD: We reviewed 21 patients who had nasal obstruction and snoring. Septal surgery was performed. Each patient was assessed by pre and postoperative PSG. We measured respiratory distress index (RDI), apnea index (AI), oxygen saturation index (OSI) and the duration of the snoring. Selection criteriae were a RDI over 15 on the PSG, clinical nasal obstruction and deviated nasal septum by examination. RESULTS: After septal surgery, RDI decreased from 39 to 29 (p=0.0001). AI decreased from 19 to 16 (p=0.0209). OSI decreased from 48 to 32 (p=0.0001). The duration of the snoring decreased from 44% to 39% (p=0.1595). Snoring and OSA were completely relieved in 4 patients (19%) who didn't need any additional surgical therapy. CONCLUSION: Snoring and OSA can be corrected merely by the septal correction in some patient. And secondary surgery (uvulopalatoplasty) should be considered after thorough evaluation of postoperative PSG.

The Clinical Usefulness of Axial OMU CT in ESS for Chronic Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: OMU CT scans are taken on a direct coronal plane for chronic sinusitis and thus allows evaluation only from the coronal plane. However, axial OMU CT provides view of the surrounding vital structures, variation of air cells, and the anterior to posterior relations of structures associated with chronic sinusitis. We investigated the clinical usefulness of axial OMU CT in chronic sinusitis. MATERIALS AND METHODS: A prospective study was performed in 100 sinuses of 50 patients with chronic sinusitis who underwent endoscopic sinus surgery from May through July of 1998. RESULTS: We observed that axial OMU CT has the advantage of evaluating the outline of the lateral lamella of lamina cribrosa, anterior and posterior ethmoid canal, optic nerve in sphenoid sinus, internal carotid artery in sphenoid sinus, Onodi cell, and anterior to posterior relations of these structures. CONCLUSION: We found that, in chronic sinusitis, axial OMU CT is effective in evaluating the important vital structures, normal variation, and the relations between the structures and that it can help prevent complication during ESS. We therefore recommend axial OMU CT to be included in the routine radiological evaluation for ESS in chronic sinusitis.

The Evaluation and Measurement of Anterior Ethmoidal Canal in Axial OMU CT / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The anterior ethmoid canal is the important surgical landmark in endoscopic sinus surgery, intranasal ethmoidectomy, and frontal sinus surgery. However it is not enough to evaluate the anterior ethmoid canal by coronal OMU CT, especially relating anterior to posterior relationship of the anterior ethmoid canal. The pulpose of this study is to evaluate the anterior ethmoid canal in 1 mm axial OMU CT and measure the five parameters relating the anterior ethmoid canal. MATERIALS AND METHODS: A prospective study was performed in 100 sinuses of 50 patients with chronic sinusitis who underwent endoscopic sinus surgery from May through July of 1998. RESULTS: The anterior ethmoid canal is well demonstrated by 1 mm axial OMU CT. The average of five parameters are 6.2+/-1.5 mm, 6.4+/-4.3 mm, 18.5+/-3.9 mm, 26.5+/-5.6 mm, 24.6+/-14.6degrees. However, there is no difference between the right and left side statistically. We observed that the anterior ethmoid canal is located just posterior to the frontal recess without anterior ethmoid air cell in front of the antirior ethmoid canal in 23%. CONCLUSION: The anterior ethmoid canal is well remarked by the 1 mm axial OMU CT. The length and directional angle of the anterior ethmoid canal is individually variable and there is no anterior ethmoid air cell in front of the anterior ethmoid canal in 23%. In these cases, the anterior ethmoid canal is more likely to be injured. So axial OMU CT may be useful in the radiologic evaluation for endoscopic sinus surgery in chronic sinusitis.

A Case of Transnasal Endoscopic Orbital Decompression in Grave's Ophthalmopathy / 대한이비인후과학회지

Grave's disease is an autoimmune disorder and affects thyroid gland and orbit. Ocular manifestations of this disease, referred to as Grave's ophthalmopathy are caused by deposition of antithyroglobulin immune complexes into extraocular muscles and orbital fats. Consequent increase in volume of orbital contents results in exopthalmos. Severe exopthalmos results in several significant visual consequences as follows: exposure keratitis, diplopia and optic neuropathy. Orbital decompression for Grave's ophthalmopathy has traditionally been performed through either an external or a transantral approach. The advent of intranasal endoscopes allowed for the development of a transnasal approach for medial and inferior orbital wall decompression. Recently, the authors experienced a case of Grave's ophthalmopathy complicated with exposure keratitis and performed endoscopic transnasal orbital decompression, so report this case with a review of literature.

Ten cases of congenital anomalies diagnosed by prenatal ultrasonography / 대한산부인과학회잡지

No abstract available.

Epidemiological Studies on Geriatric Hypertension in Korea

A total of 4757 apparently healthy aged persons over 65 years of age was surveyed for geriatric hypertension. A single blood pressure measurement was taken in the sitting position. Mean systolic blood pressure rose significantly with age in female but didn't in male and mean diastolic blood pressure didn't change with age in both sex. The prevalence of pure systolic hypertension, i.e., a systolic blood pressure greater than or equal to 160 mmhg and a diastolic blood pressure less than 95mmhg, increased with age. The prevalence was slighty lower for female than it was for male, being 7.0% for female and 8.0% for male. The prevalence of classical hypertension-defined as diastolic blood pressure greater than or equal to 95mmhg - was 42.7% for female and 48.2% for male and it rose with age in female. The prevalence of both pure systolic and classical hypertension was 49.7% for female and 56.1% for male.