A Case of Frontal Mococele Treated with Transblepharoplasty Approach Combined with Endoscopic Approach

In recent years, endoscopic sinus marsupialization has become the treatment of choice for the treatment of paranasal sinus mucoceles due to its noninvasiveness and successful outcome. However, mucoceles located at the lateral portion of the frontal sinus and protruding into the orbit with erosion of the frontal sinus floor arestill difficult to address with standard endoscopic sinus surgery techniques. Here, we report a case of a mucocele located atthe lateral side of the frontal sinus and successfully marsupialized with a transblepharoplasty approach combined with an endoscopic approach.

Role of Caffeic Acid on Collagen Production in Nasal Polyp-Derived Fibroblasts

OBJECTIVES: Caffeic acids are known to have anti-oxidant, anti-inflammatory, immunomodulatory, and tissue reparative effects. The purposes of this study were to determine the effect of caffeic acid on transforming growth factor (TGF) beta1-induced myofibroblast differentiation and collagen production, and to determine whether caffeic acid is involved in the antioxidant effect in nasal polyp-derived fibroblasts (NPDFs). METHODS: NPDFs were pretreated with caffeic acid (1-10 microM) for 2 hours and stimulated with TGF-beta1 (5 ng/mL) for 24 hours. The expression of alpha-smooth muscle actin (SMA), collagen types I and III, and Nox4 mRNA was determined by a reverse transcription-polymerase chain reaction, and the expression of alpha-SMA protein was determined by actin ned by immunofluorescence microscopy. The amount of total soluble collagen production was analyzed by the Sircol collagen dye-binding assay. The reactive oxygen species (ROS) generated by NPDFs were determined using 2',7'-dichlorfluorescein-diacetate. siNox4 was used to determine the effect of Nox4. RESULTS: The expression of alpha-SMA and production of collagen were significantly increased following TGF-beta1 treatment. In contrast, the level of expression of alpha-SMA and the level of production of collagen were decreased by pretreatment with caffeic acid. The activation of Nox4 and the subsequent production of ROS were also reduced by pretreatment with caffeic acid. The expression of alpha-SMA was prevented by inhibition of ROS generation with siNox4. CONCLUSION: Caffeic acid may inhibit TGF-beta1-induced differentiation of fibroblasts into myofibroblasts and collagen production by regulating ROS.

A Randomized, Multi-Center, Single Blind, Active-Controlled, Matched Pairs Clinical Study to Evaluate Prevention of Adhesion Formation and Safety of HyFence in Patients After Endoscopic Sinus Surgery

OBJECTIVES: Recurrent mucosal disease and anatomic obstruction are commonly cited causes of failed endoscopic sinus surgery (ESS). Hyaluronic acid (HA) has been reported to reduce scarring and to promote wound healing in sinonasal surgery. HyFence is HA stabilized by 1, 4-butandiol diglycidyl ether, which makes it less-water-soluble and highly viscoelastic. The purpose of this study is to examine the anti-adhesion effect of HyFence after ESS compared to that of HA-CMC (Guardix-Sol). METHODS: Seventy-four patients with chronic rhinosinusitis who underwent ESS were included in the study. After the ESS procedure, Merocel was placed in the ethmoidectomized areas of the both sides. Five milliliters of Guardix-Sol was then applied to the Merocel of one side and HyFence LV was applied to the other side. The effect of the agents was evaluated at one, two, and four weeks after surgery by endoscopic examination. The severity of adhesion, edema, infection and complications were evaluated. RESULTS: There was no significant difference in the incidence of postoperative adhesion between the HyFence group and the Guardix-Sol group (P>0.05). Mean postoperative grades of edema and infection showed no significant difference between groups (P>0.05). There was no significant postoperative complications associated with either anti-adhesion agent (P>0.05). CONCLUSION: HyFence has equivalent anti-adhesion effect compared to Guardix-Sol following ESS.

A Case of Primitive Neuroectodermal Tumor in the Nasal Cavity

A primitive neuroectodermal tumor is a highly malignant, small, round-cell tumor characterized by a neuroectodermal origin and poor prognosis. These tumors are found in nervous tissue in children and adolescents. The thoracopulmonary region is known to be the most common site of this disease, and it is rare that a primitive neuroectodermal tumor would occur in the nasal cavity. We report a case of a primitive neuroectodermal tumor in the left nasal cavity with a review of relevant literature.

Two Cases of Angioleiomyoma in the Nasal Cavity

Leiomyoma is a benign tumor arising from smooth muscle cells. They are commonly found in the uterus, skin, and gastrointestinal tract. However, it is rare in the head and neck area. Especially, only 3% of leiomyomas in the head and neck area occur in the nasal cavity. Rhinologists need to know leiomyoma as a differential diagnosis of the tumors in the nasal cavity. Herein we present two cases of angioleiomyoma in the nasal cavity and review the literature.

Two Cases of Angioleiomyoma in the Nasal Cavity

Leiomyoma is a benign tumor arising from smooth muscle cells. They are commonly found in the uterus, skin, and gastrointestinal tract. However, it is rare in the head and neck area. Especially, only 3% of leiomyomas in the head and neck area occur in the nasal cavity. Rhinologists need to know leiomyoma as a differential diagnosis of the tumors in the nasal cavity. Herein we present two cases of angioleiomyoma in the nasal cavity and review the literature.

A Case of Metastatic Renal Cell Carcinoma in the Sphenoid Sinus

Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney which takes up 85% of primary malignant renal tumors. RCC commonly metastasize to the lung, regional lymph nodes, bone, liver, and head and neck sites in decreasing order. Although RCC is the third most common infraclavicular neoplasm (after lung cancer and breast cancer) which metastasizes to the head and neck, it is a rare situation that RCC metastasize to the paranasal sinuses. In this paper, we report a case of metastatic RCC involving the sphenoid sinus after radical nephrectomy with a review of literature.

A Case of Metastatic Renal Cell Carcinoma in the Sphenoid Sinus

Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney which takes up 85% of primary malignant renal tumors. RCC commonly metastasize to the lung, regional lymph nodes, bone, liver, and head and neck sites in decreasing order. Although RCC is the third most common infraclavicular neoplasm (after lung cancer and breast cancer) which metastasizes to the head and neck, it is a rare situation that RCC metastasize to the paranasal sinuses. In this paper, we report a case of metastatic RCC involving the sphenoid sinus after radical nephrectomy with a review of literature.

Orbital Apex Syndrome Related to Isolated Sphenoid Fungal Sinusitis

Orbital apex syndrome (OAS) has been described as malfunction of cranial nerve II in the optic canal and cranial nerves III, IV, V1, and VI in the superior orbital fissure due to vascular compromise, compression, or infiltration. Symptoms include ophthalmoplegia, ptosis, decreased corneal sensation, and vision loss. There are many potential causes of OAS including inflammation, infection, iatrogenic, neoplasm, vascular disease, or trauma. Among these, however, fungal sinusitis is one of the more rarely reported etiologies. Infections of the sphenoid sinuses typically occur in conjunction with other paranasal sinuses, while isolated sphenoid sinusitis is uncommon. In this case report, we describe OAS due to isolated sphenoid fungal sinusitis in a 67-year old man who presented with periorbital pain, acute vision loss, and ophthalmoplegia. He was treated surgically and was given postoperative antifungal agents as well as steroids for three months. We present this rare case along with a literature review of OAS.

Orbital Apex Syndrome Related to Isolated Sphenoid Fungal Sinusitis

Orbital apex syndrome (OAS) has been described as malfunction of cranial nerve II in the optic canal and cranial nerves III, IV, V1, and VI in the superior orbital fissure due to vascular compromise, compression, or infiltration. Symptoms include ophthalmoplegia, ptosis, decreased corneal sensation, and vision loss. There are many potential causes of OAS including inflammation, infection, iatrogenic, neoplasm, vascular disease, or trauma. Among these, however, fungal sinusitis is one of the more rarely reported etiologies. Infections of the sphenoid sinuses typically occur in conjunction with other paranasal sinuses, while isolated sphenoid sinusitis is uncommon. In this case report, we describe OAS due to isolated sphenoid fungal sinusitis in a 67-year old man who presented with periorbital pain, acute vision loss, and ophthalmoplegia. He was treated surgically and was given postoperative antifungal agents as well as steroids for three months. We present this rare case along with a literature review of OAS.

Coblation vs. Electrocautery Tonsillectomy: A Prospective Randomized Study Comparing Clinical Outcomes in Adolescents and Adults

OBJECTIVES: Coblation is operated in low temperature, so it is proposed that tonsillectomy with coblation involves less postoperative pain and allows accelerated healing of the tonsillar fossae compared with other methods involving heat driven processes. However, the results of the previous studies showed that the effect of coblation tonsillectomy has been equivocal in terms of postoperative pain and hemorrhage. Though, most of the previous studies which evaluated coblation tonsillectomy were performed in children. Recently, electrocautery tonsillectomy has been used most widely because of the reduced intraoperative blood loss and shorter operative time compared to other techniques. This prospective study compared intraoperative records and postoperative clinical outcomes in adolescents and adults following coblation and electrocautery tonsillectomies. METHODS: Eighty patients over 16 years of age with histories of recurrent tonsillitis were enrolled. The patients were randomly allocated into coblation (n=40) and electrocautery tonsillectomy groups (n=40). All operations were performed by one surgeon who was skilled in both surgical techniques. Intraoperative parameters and postoperative outcomes were checked. RESULTS: Postoperative pain and otalgia were not significantly different between the two groups; however, there was a tendency towards reduced pain and otalgia in the coblation group. More cotton balls for swabbing the operative field were used introoperatively in the electrocautery group (P=0.00). There was no significant difference in postoperative hemorrhage, wound healing, commencement of a regular diet, and foreign body sensation between the groups. CONCLUSION: Only cotton use, which represented the amount of blood loss, was less in the coblation tonsillectomy group. Coblation tonsillectomy warrants further study with respect to the decreased postoperative pain and otalgia.

Sclerosing Polycystic Adenosis of the Nasal Septum: The Risk of Misdiagnosis

Sclerosing polycyctic adenosis (SPA) is a rare lesion of unknown etiology morphologically resembling fibrocystic changes of the breast. To date, approximately 41 cases of SPA have been reported. Most cases of SPA have originated in the parotid and submandibular glands, with a few cases of intra-oral minor salivary gland origin. This is the first reported case of sclerosing polycystic adenosis of nasal minor salivary gland origin. The differential diagnosis of SPA includes polycystic disease, sclerosing sialadenitis, and benign and malignant glandular neoplasias. Although atypia ranging from mild dysplasia to carcinoma in situ can occur in some cases, SPA has a favorable outcome. It is important to be familiar with SPA to avoid aggresive treatment that results from a misdiagnosis. We present a case of a 49-year-old man who had 1-year history of right nasal obstruction.

Clinical Experience of Sinonasal Schwannomas

BACKGROUND: Schwannomas are benign tumors of ectodermal origin derived from Schwann cells of the nerve sheath. Approximately less than 4% of these tumors are found in the paranasal sinuses and there has been little information reported concerning the presentation and surgical management of sinonasal schwannomas. The purpose of this study was to analyze the clinical data, management, and long-term outcomes of sinonasal schwannomas. METHODS: Retrospective chart review of patients with sinonasal schwannomas treated from January 2001 to March 2012 was performed. Clinical data and follow-up information were obtained from a review of the patients' charts and the operative, anesthesia, and pathology reports. RESULTS: There were 4 females and 4 males included in this study. The mean age was 37.5 years (range, 22-51 years). The mean tumor size was 3.1 cm (range 1.0-6.0 cm). The origin of the tumors included: nasal septum (n = 2), nasal vestibule (n = 2), pterygopalatine fossa (n = 2), ethmoid sinus (n = 1), and inferior turbinate (n = 1). Seven patients had endoscopic resections and one patient with a schwannoma in the nasal vestibule underwent a sublabial approach. The mean follow-up was 59 months. There were no tumor recurrences during the study period. CONCLUSIONS: Schwannomas in sinonasal cavity can be treated effectively with the endoscopic approach with minimal morbidity and long-term disease control.

Staloral(R) in Adult Patients with Allergic Rhinitis

BACKGROUND: Sublingual immunotherapy (SLIT) is currently accepted as a treatment of allergic rhinitis. SLIT has been demonstrated to be an effective and safe treatment in many studies; however, there have been few studies on Asian patients with allergic rhinitis. The goal of this study was to investigate the efficacy and safety of SLIT for Asian patients with allergic rhinitis to house-dust mites. METHODS: A total of 116 adult patients who had allergic rhinitis to Dermatophagoides pteronyssinus and Dermatophagoides farinae were included. All patients were treated with SLIT (Staloral(R)). Symptom scores and quality of life were evaluated by questionnaires for one year after SLIT. The medication score was also assessed monthly by a medication diary card. Adverse effects and compliance were also investigated. RESULTS: All nasal and non-nasal symptoms and quality of life were significantly improved after treatment except for itchy palate (p < 0.05). The total medication score was decreased significantly after SLIT (p < 0.05). Some minor adverse effects were reported, but no patient developed a systemic reaction. The drop-out rate was 19%. CONCLUSION: Staloral(R) for Asian patients with allergic rhinitis to house-dust mites is an efficient and safe therapeutic tool.

Relationship between the Korean Version of the Sniffin' Stick Test and the T&T Olfactometer in the Korean Population

OBJECTIVES: The Korean version of the Sniffin' stick (KVSS) test is widely used in Korea to evaluate olfactory function. However, its validity and reliability have not been studied well. In this study, the authors administered the KVSS and the T%T olfactometer test to evaluate olfactory function and to establish relationships between these two test measures. METHODS: Two hundred and eleven patients participated in this prospective randomized study. One hundred and nine patients with no olfactory symptoms and 102 patients with decreased olfaction participated. All participants were underwent KVSS II and T&T olfactometer testing. RESULTS: The mean recognition threshold of the T&T olfactometer was -1.8+/-0.9 for patients with normal olfaction and 4.0+/-2.6 for patients with decreased olfaction. The mean Threshold-Discrimination-Identification score of the KVSS II was 30.0+/-3.8 for patients with normal olfaction and 15.9+/-7.1 for patients with decreased olfaction. Correlation coefficient between the two tests was significantly high (r(s)=-0.725, P<0.01). CONCLUSION: The KVSS and T&T olfactometry test are both reliable tests of olfactory function and their results are well correlated with each other.

Availability of Korean Hearing in Noise Test (KHINT) in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Individuals with similar degrees of hearing impairment frequently show significantly different speech understanding in noise stimulation. A Korean version of the Hearing in Noise Test (KHINT) has been developed to assess the ability to recognize speech in noise. However, sentences in KHINT have been designed for subjects older than 16 years old and there have been no reports on KHINT related to the effect of age in the children younger than that age. The objective of this study was to evaluate the result of KHINT in children. SUBJECTS AND METHOD: One hundred one children between 7 and 16 years with no otologic history and normal hearing were included in this study. KHINT was conducted under the following four different conditions: speech in the quiet environment, with noise in the front, with noise in the right or in the left. The mean reception threshold for speech (RTS) in the quiet condition and signal to noise ratio (SNR) in the noisy condition were measured under four different conditions. RESULTS: There was no correlation between age and RTS. However, SNR with noise in the front, left and right conditions, as well as composite SNR, showed significant decrease with the decreasing age of children. CONCLUSION: According to KHINT, children showed decreased speech with decreasing age. Therefore, a separate KHINT with correlation factors to assess children's functional hearing ability in noise should be developed.

Fronto-Ethmoidal Osteoid Osteoma with Orbital Extension

An osteoid osteoma is a benign tumor that is usually located in the cortex of long bones and vertebrae and rarely involves paranasal sinuses. We report a case of a 58-year-old woman with right epiphora, orbital pain, and exophthalmos. The mass was removed via an external frontoethmoidectomy approach. After surgery, the patient reported prompt relief of the orbital pain and epiphora, and opthalmologic examination showed improvement of exophthalmos. The post-operative CT scan of the paranasal sinus obtained 1 year later showed no evidence of tumor recurrence or complication. Although osteoid osteoma is rare in paranasal sinuses, it should be considered if there is a bone density mass and complete excision should be performed with care.

Histochemical studies on Clonorchis sinensis The distribution of carbonic anhydrase

The authors carried out histochemical studies on Clonorchis sinensis, especially, histochemical demonstration of carbonic anhydrase activity. Kurada's method was applied for the histochemicl staining in this study. The result obtained were summerized as follows : Carbonic anhydrase activity was intensely positive in oral sucker cells, reticular tissue cells, epithelium of the intestine and testes, more or less intensely positive in vitelline gland cells and yolk of eggs as well.