Case Report: Cervicofacial Actinomycosis-Misdiagnosed to Parotid Abscess / 대한이비인후과학회지

Actinomycosis is a disease caused by an anaerobic bacteria called Actinomyces species (predominantly Actinomyces israelii), which is a common and normally nonpathogenic organism found in the nose and throat. The four major clinical presentations of actinomycosis include the cervicofacial, thoracic, abdominal, and pelvic region. Actinomycosis is difficult to diagnose because of variable presentation and fastidious nature of the organism in culture. A high index of suspicion and biopsy are often necessary to make the diagnosis, because the disease can mimic neoplasm or a chronic granulomatous infection. We present, with the appropriate review, a case of actinomycosis in the mandibular angle area which was mistaken for a parotid abscess.

Correlation between Olfactory Dysfunction Measured by T&T Olfactometer and Disease Severity Staged by CT in Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis is a common etiology in olfactory dysfunction. There have been several studies regarding olfactory dysfunction in chronic rhinosinusitis using olfactory diagnostic tools, other than T & T olfactometer. To establish a relationship between the disease severity and severity of olfactory dysfunction, we evaluated the correlation between disease severity by using sinus CT scan as graded by the Harvard system and olfactory function by using the Butanol threshold test and T & T olfactometer. SUBJECTS AND METHOD: Fifty patients with chronic rhinosinusitis were evaluated. We scored each CT scan on the Harvard system, and the Butanol threshold test and T & T olfactemeter were performed for each patient. Correlation between the CT scores, Butanol test scores and T & T olfactometer scores was assessed. We also assessed for correlation between the 5 odorants used in the T & T olfactometer with the CT scores. RESULTS: The CT scores graded by the Harvard system and the score of Butanol threshold test was correlated significantly (p<0.01). The CT scores and the scores of T & T olfactometer, and those of each odorant used in the T & T olfactometer were correlated significantly (p<0.01). CONCLUSION: Using a T & T olfactometer, we found that disease severity is correlated with the severity of olfactory dysfuction. All odorants of T & T olfactometer were similarly correlated with the disease severity.

Comparison of Usefulness of CT and Endoscope in the Diagnosis of Adult Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Rhinosinusitis is a leading health care problem that is increasing in both prevalence and incidence. The current definition of chronic rhinosinusitis is symptom-based, as it is described as a disease lasting more than 12 weeks of presenting two or more major sinus symptoms or at least one major and two minor sinus symptoms with or without findings on physical exams. This study evaluated the usefulness of object testing such as endoscopy or computed tomography (CT) in the diagnosis of chronic rhinosinusitis. SUBJECTS AND METHOD: The study was designed to evaluate 44 patients who were diagnosed with chronic rhinosinusitis using the same-day endoscopy and CT scanning based on the foregoing definition. RESULTS: Of the 44 patients, 30 (68%) had positive endoscopic and CT results. There were 4 (9%) patients who gave negative endoscopic and positive CT results. Four (9%) patients had positive endoscopic and negative CT results, and 6 (14%) had negative endoscopic and negative CT results. Overall, 34 (77%) patients had positive CT results, and 10 (23%) patients had negative CT results. On the basis of CT as the standard, we determined that the positive predictive value of endoscopy was 88% and the negative predictive value of endoscopy 60%. The results of this study show that the definition of chronic rhinosinusitis needs to be called into question on the basis of endoscopic and CT results. CONCLUSION: We find that the use of endoscopy and/or CT scanning is important in making a more accurate diagnosis and planning appropriate treatment measures.

The Role of Inducible Nitric Oxide Synthase in the Development of Nasal Hyper-responsiveness of the Rhinosinusitis Rat Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hyper-responsiveness to nonspecific stimuli is a characteristic finding of all allergic diseases. It is probably due to eosinophil infiltration, release of cytotoxic proteins, and epithelial damage in the airway mucosa. However, the whole mechanism has not been clearly established. We aimed to understand the role of inducible nitric oxide synthase (iNOS) expression in nasal hyper-responsiveness of rhinosinusitis. MATERIALS AND METHOD: 1) To develop a platelet activating factor (PAF)-induced rhinosinusitis rat model, 50 micro liter of 16 micro gram/ml PAF was applied into the nose of rats. At days 1, 3 and 5, the rats were killed. 2) To demonstrate the hyper-responsiveness to topically applied capsaicin, 30 micro liter of 10 micro M capsaicin was applied intranasally and the amount of microvascular leakage in the nasal mucosa was measured with Evans blue assay at days 1, 3 and 5 in the rhinosinusitis model and the control rats. 3) To examine the effect of iNOS, 75 mg/kg of aminoguanidine was pretreated systemically 1 hour before the application of capsaicin. 4) To localize the expression of iNOS, immunohistochemical staining was performed using the avidin-biotin-peroxidase method with an anti-iNOS antibody. RESULTS: Induction of rhinosinusitis by application of PAF was confirmed with histology. A significant infiltration of eosinophils and loss of the epithelium, varied according to the time interval, were observed. A significant enhancement of microvascular leakage was clearly demonstrated by topically applied capsaicin, which was completely blocked by aminoguanidine, the iNOS inhibitor in the PAF-induced rhinosinusitis. The expression of iNOS was localized in the inflammatory cells infiltrated in the mucosa. CONCLUSION: The expression of iNOS in the inflammatory cells as well as epithelial damage related to eosinophil infiltration may cause nasal hyper-responsiveness.

A Case of Osteomyelitis of the Maxilla with Associated Aspergillosis / 대한이비인후과학회지

Osteomyelitis of the maxilla is a relatively rare disease. Although the advent of antibiotics has decreased its incidence and morbidity significantly, osteomyelitis still remains a potentially dangerous condition because of the possible risk of intracerebral complications. Clinically, patients present facial swelling, localized pain and tenderness, low-grade fever, draining sinus tracts, suppuration, dental loss, and sequestrum formation. We experienced a case of osteomyelitis of the maxilla with associated aspergillosis. In this paper, we report this case with a review of literature.