Pathophysiology, Diagnosis, and Treatment of Allergic Rhinitis / 대한이비인후과학회지

Allergic rhinitis (AR) requires treatment with a stepwise approach depending on the severity and duration of symptoms. Treatment options for AR include allergen avoidance, pharmacotherapy, immunotherapy, and surgery. Recently, anti-IgE antibody and specific antibody to cytokines, such as interleukin (IL)-4 or IL-5, have emerged in connection with understandings of the mechanisms of AR. Sublingual immunotherapy has been widely used based on its efficacy, safety, and convenience, which replaces subcutaneous immunotherapy. Although allergen avoidance and immunotherapy are theoretically ideal, it is thought that antihistamines and intranasal corticosteroids will play the main role in the management of AR until an innovative treatment develops. However, patients' main symptoms, the duration and severity of AR, patients' compliance, the safety of medication, and cost-effectiveness should be considered when treatment options are selected. In this aspect, physicians should be aware of the etiology, pathophysiology, symptoms, signs, and diseases related to AR in order to make correct diagnoses and choose proper treatment options for each patient.

Roles of Periostin in Symptom Manifestation and Airway Remodeling in a Murine Model of Allergic Rhinitis

PURPOSE: Periostin was originally identified as a secreted factor during screening of a mouse osteoblastic library. In a recent study, periostin was found to directly regulate eosinophil accumulation in allergic mucosal inflammation. Chronic eosinophilic inflammation is related to the development of remodeling. The present study examined the expression of periostin and evaluated its role in the inflammatory process and remodeling associated with allergic rhinitis. METHODS: A murine model of allergic rhinitis was established in periostin knockout mice. We analyzed the expression of periostin, manifestation of nasal symptoms, eosinophilic inflammation, and subepithelial fibrosis as well as the expression of MMP-2, TIMP-1, and type 1 collagen in nasal tissue. RESULTS: Periostin was mainly distributed in the subepithelial tissue of the nasal mucosa. The subepithelial tissue was thinner in the knockout group than in the control group. No differences in the expression of MMP-2 or TIMP-1 were found in the knockout group. However, after a month of allergen challenge, type I collagen in the nasal tissue was lower in the knockout group than in the control group. The number of eosinophils and the symptom score were also lower in the knockout group. CONCLUSIONS: Periostin is expressed in nasal tissues of murine models of allergic rhinitis. Periostin deficiency may affect the remodeling of nasal tissue with reduced subepithelial fibrosis, and lead to less eosinophilic inflammation.

Role of Angiogenic Factors in Airway Remodeling in an Allergic Rhinitis Murine Model

PURPOSE: There is growing evidence that nasal airway remodeling occurs in allergic rhinitis (AR). Although angiogenesis is an important component of airway remodeling in asthma, its involvement in AR has been little studied. Furthermore, information regarding the role of potent angiogenic factors, such as vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF), in the nasal airway remodeling process is limited. This study was conducted to investigate the role of VEGF and PDGF in nasal airway remodeling, and to assess the preventive effects of anti-angiogenic drugs on this process in a murine AR model. METHODS: Mice were systemically sensitized and subjected to inhalation of ovalbumin (OVA) twice a week for 3 months. Control mice were challenged with phosphate buffered saline, while the treatment group received SU1498, a VEGF receptor inhibitor, and/or AG1296, a PDGF receptor inhibitor, via intraperitoneal injection 4 hours prior to each OVA inhalation. Staining using hematoxylin and eosin, Masson's trichrome, and periodic acid-Schiff were separately performed to assess eosinophil infiltration, subepithelial fibrosis, and goblet cell hyperplasia, respectively, in the nasal airway. Immunohistochemical staining for matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) was also conducted. RESULTS: Repetitive intranasal inhalation of OVA resulted in significant increases in eosinophil infiltration, subepithelial fibrosis, goblet cell count, and MMP-9/TIMP-1 expression. Administration of SU1498 or AG1296 prevented these abnormal responses. CONCLUSIONS: The results of this study suggest that a causal relationship may exist between angiogenic factors and nasal airway remodeling in AR. Inhibition of VEGF or PDGF receptors may, in turn, suppress the remodeling process through the regulation of MMP-9/TIMP-1 expression.

Clinical Characteristics and Comorbidities of Hereditary Hemorrhagic Telangiectasia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hereditary hemorrhagic telangiectasia (HHT), often manifested as epistaxis, is also manifested in combination with serious comorbid diseases. The authors reviewed 12 cases of HHT and investigated the manifestations and comorbid diseases of HHT in the Korean population. SUBJECTS AND METHOD: Medical records of the HHT patients in our department from July 2004 to December 2011 were reviewed retrospectively. Twelve patients who had been classified as definite or possible HHT according to the Curacao criteria were enrolled in this study. Clinical manifestations, treatment methods, results, and comorbid diseases were investigated. RESULTS: Recurrent epistaxis occurred in 100% of the patients. Epistaxis was managed by bipolar or laser cauterization (n=9), embolization of the feeding vessel (n=1), intranasal application of bevacizumab (Avastin(R))(n=2) or septodermoplasty (n=1). The symptoms of seven patients showed much improvement while the other two did not. Comorbid diseases included pulmonary arteriovenous malformation (AVM) in 5 patients (41.7%) and cerebral AVM in 2 patients (16.7%). Three patients with pulmonary AVM received embolization and one patient with cerebral AVM received gamma knife surgery with good prognosis. CONCLUSION: Epistaxis by HHT can be improved by active treatment using various methods. Pulmonary and cerebral AVMs are common comorbid diseases and should be considered in the management of HHT.

Glucocorticoid Receptor-beta Overexpression According to Nasal Polyp Severity: Immunohistochemical Study

BACKGROUND AND OBJECTIVES: The aims of the study were to reintroduce a surgical technique for a "mini" Caldwell-Luc operation and to determine its efficacy. MATERIALS AND METHODS: A prospective study was performed in 23 patients undergoing the "mini" Caldwell-Luc operation. Improvements in clinical symptoms and endoscopic and computed tomographic (CT) findings were evaluated postoperatively over a follow-up period ranging from 6 to 21 months. All patients were surveyed for nasal symptoms (nasal obstruction, rhinorrhea, posterior nasal drip, headache, and anosmia), complications (tooth or gum pain, numbness, persistent facial pain, and facial hypo-paresthesia), and recurrence. Preoperative nasal polyps were classified by the Gaskins method, and preoperative paranasal sinusitis was graded according to the Kennedy CT staging system. RESULTS: Symptom scores were all significantly reduced postoperatively (paired t-test, p<0.05). There were no major complications specific to this technique. Among 29 maxillary sinuses that received the "mini" Caldwell-Luc operation, seven showed recurrence (24%). CONCLUSION: The "mini" Caldwell-Luc operation provides an alternative method of obtaining access to the maxillary antrum and is associated with minimal morbidity.

The Pathophysiology, Diagnosis and Treatment of Allergic Rhinitis

Treatment of AR requires a stepwise approach depending on the severity and duration of symptoms. Treatment options for AR consist of allergen avoidance, pharmacotherapy, immunotherapy and surgery. For the mechanisms of AR, anti-IgE antibody and specific antibody to cytokines such as IL-4 or IL-5 that correlate with allergic inflammation have recently emerged. SLIT is currently widely used due to its efficacy, safety and convenience, which replaces subcutaneous immunotherapy. Although allergen avoidance and immunotherapy are theoretically ideal, antihistamines and intranasal corticosteroids will play the main role in the management of AR until an innovative treatment develops. However, patients' main symptom, the duration and severity of AR, patients' compliance, safety of medication and cost-effectiveness should be considered when treatment options are chosen. In conclusion, physicians should be aware of etiology, pathophysiology, symptoms, signs and diseases related to AR in order to make a correct diagnosis and choose a proper treatment option for each patient.

The Pathophysiology, Diagnosis and Treatment of Allergic Rhinitis

Treatment of AR requires a stepwise approach depending on the severity and duration of symptoms. Treatment options for AR consist of allergen avoidance, pharmacotherapy, immunotherapy and surgery. For the mechanisms of AR, anti-IgE antibody and specific antibody to cytokines such as IL-4 or IL-5 that correlate with allergic inflammation have recently emerged. SLIT is currently widely used due to its efficacy, safety and convenience, which replaces subcutaneous immunotherapy. Although allergen avoidance and immunotherapy are theoretically ideal, antihistamines and intranasal corticosteroids will play the main role in the management of AR until an innovative treatment develops. However, patients' main symptom, the duration and severity of AR, patients' compliance, safety of medication and cost-effectiveness should be considered when treatment options are chosen. In conclusion, physicians should be aware of etiology, pathophysiology, symptoms, signs and diseases related to AR in order to make a correct diagnosis and choose a proper treatment option for each patient.

Assessment of Allergic Rhinitis Websites in Korea

OBJECTIVES: The internet has become an important source of medical information and a great amount of information related to allergic rhinitis (AR) is available on the internet. However, the quality of this information is still a matter of debate. Therefore, this study was conducted to assess the AR-related information on Korean websites. METHODS: The key word "allergic rhinitis" was entered into 4 popular search engines, and this led to identifying 40 websites. After being categorized according to authorship, the informational value of these websites was evaluated using 4 different assessment tools such as the Journal of the American Medical Association (JAMA) benchmarks, the DISCERN questionnaire, the Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update and the Health On the Net (HON) code. RESULTS: The 40 websites containing AR-related information were categorized according to their authorship as Western physician: 20, Oriental physician: 14, commercial: 1, and others: 5. The mean citation frequencies of the JAMA benchmarks and the ARIA 2008 Update concepts was 1.23 out of 4 and 4.33 out of 8, respectively, while the mean DISCERN score was 1.92 out of 5. When the websites were evaluated based on the type of authorship, the mean citation frequencies of the ARIA 2008 Update concepts were Western physician: 5.35, Oriental physician: 2.64. Additionally, three websites authored by Western physicians and 13 authored by Oriental physicians contained unreliable information. Among these 16 websites, only 3 websites met the requirements for the HON code "Justification". CONCLUSION: AR-related information available on Korean websites is of variable quality and not all of the information provided is justifiable. Thus, performing surveillance of the medical information on these websites is necessary. Furthermore, common criteria that can be used to evaluate the websites created by both Western and Oriental physicians are also needed.

Effect of Staphylococcal Enterotoxin on the Development of Allergic Rhinitis in Mice

BACKGROUND AND OBJECTIVES: The aim of this study is to investigate the role of staphylococcal enterotoxin B (SEB) in the development of allergic rhinitis. MATERIALS AND METHODS: Nasal mucosa and serum were obtained from sensitized mice and control groups, and the frequencies of allergic symptoms, such as sneezing and nasal rubbing, were counted. Eosinophil counts in the nasal mucosa were compared between the study groups. The serum levels of ovalbumin-specific IgE were measured by ELISA. Differences between the sensitized and control groups were statistically analyzed using the Kruskal-Wallis test and the Mann-Whitney U test. RESULTS: The frequencies of sneezing and serum levels of ovalbumin-specific IgE were significantly higher in the groups locally sensitized with SEB than in the control group. On the other hand, they sneezed less frequently and showed lower serum levels of ovalbumin-specific IgE than those in the group locally sensitized with ovalbumin. CONCLUSION: SEB may participate in the pathogenesis of allergic rhinitis although it is a less potent inducer than ovalbumin.

Early Compliance and Efficacy of Sublingual Immunotherapy in Patients with Allergic Rhinitis for House Dust Mites

OBJECTIVES: Sublingual immunotherapy (SLIT) has recently received much attention around the world as a treatment for allergic rhinitis. This study aimed to investigate the efficacy and adverse effects of SLIT in Korean patients with allergic rhinitis caused by house dust mites. The treatment compliance and the patient satisfaction with SLIT were also assessed. METHODS: The patients who were sensitized to Dermatophagoides pteronyssinus and Dermatophagoides farinae and who started SLIT between November 2007 and July 2008 were included in this study. The symptom questionnaires, which included items on rhinorrhea, sneezing, nasal obstruction, itchy nose, olfactory disturbance, eye discomfort and sleep disturbance, were obtained before and 6 months after SLIT. The patient satisfaction and the adverse effects were also investigated. RESULTS: One hundred forty-two patients started SLIT and 98 of them continued SLIT for 6 months or more. Ninety-two of the 98 patients completed the questionnaires. The duration of receiving SLIT was 9.8 months on average (range, 6 to 13 months). All the symptoms of allergic rhinitis were improved with SLIT. Forty-five percent of the patients were satisfied for SLIT, while 12% were unsatisfied. The incidence of adverse effects was 12% during maintenance therapy, although it was 48% during the up-dosing phase. The drop-out rate of SLIT was 31.0%. CONCLUSION: The subjective symptoms were improved with SLIT in Korean patients with allergic rhinitis for house dust mites. Yet the drop out rate was high despite of the symptomatic improvement.

Clinical Experiences of Diagnosis and Treatment for Wegener's Granulomatosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Because most patients with Wegener's granulomatosis (WG) visit otolaryngologists complaining of head and neck symptoms, otolaryngologists may play an important role in early diagnosis. In this study, we investigated clinical features, laboratory findings and treatment outcomes of 33 patients with WG, and propose a new algorithm for the diagnosis of WG. SUBJECTS AND METHOD: Thirty-three patients with WG who visited the clinic between January 1980 and December 2007 were included. The medical records of 13 male and 20 female patients were retrospectively reviewed. The mean follow-up duration was 68 months. RESULTS: Most WG patients had ENT symptoms such as nasal obstruction, rhinorrhea, otorrhea, hearing loss, dyspnea and hoarseness. The mean duration from ENT examination to diagnosis was 6.7 months (3 days- 102 months) and tissue biopsy was performed on an average of 2.1 times to confirm the diagnosis. While 16 patients could be diagnosed by the first biopsy, the others were required to repeat the biopsy. ANCA was positive in 17 patients (50%). Twentysix patients (78.7%) had multiple organ involvements such as lung, kidney, joint and skin. Twenty-eight patients received a combination of prednisolone and cyclophosphamide with the remission rate of 87%. CONCLUSION: Based on this study, we propose a better algorithm for the diagnosis of WG to avoid unnecessary delay in the diagnosis and treatment of WG.

Comparison of Polysomnographic Findings according to Obstruction Sites in Obstructive Sleep Apnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to identify differences in polysomnographic findings according to the upper airway obstruction level in patients with obstructive sleep apnea (OSA). SUBJECTS AND METHOD: Eighty-four patients with OSA were included in this study. Every patient underwent polysomnography (PSG) and upper airway pressure measurement using a four-sensor catheter simultaneously. The catheter was positioned at the posterior nasal cavity, uvula tip, tip of the epiglottis, and mid-esophagus level, which was inserted through the nasal cavity down to the esophagus. The patients were categorized into two groups of single site obstruction and multi-site obstruction. RESULTS: Twenty-one patients showed single site obstruction and sixtythree patients showed multi-site obstruction. Apnea-hypopnea index, apnea index, and minimal oxygen saturation showed statistically significant differences between two groups. There was no difference in bony mass index (BMI). CONCLUSION: Upper airway pressure measurement can be a method to evaluate the upper airway obstruction site. This study shows that OSA patients with multisite obstruction have severer sleep apnea than those with single site obstruction.

Fibrous Dysplasia Involving Paranasal Sinuses / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fibrous dysplasia of the paranasal sinus is rare. It is usually secondary to the extension of disease from adjacent bones and rarely limited to the sinuses. The purpose of this study is to get an improved appreciation of the clinical features and courses of fibrous dysplasia involving paranasal sinuses. SUBJECTS AND METHOD: Medical records of 15 patients diagnosed as fibrous dysplasia involving paranasal sinuses from 1990 to 2004 were reviewed retrospectively. Clinical informations including age of diagnosis, presenting symptoms, radiographic findings, treatment and clinical outcome for each patient were analyzed. The male to female ratio was 7 : 8. Their ages ranged from 7 to 68 with the median of 32. Seven patients were younger than 30 years old at presentation. RESULTS: The most common complaint was headache followed by facial swelling. The mean duration of illness was 11 months. In the findings of CT, eight patients belonged to the sclerotic type, six to the pagetoid type, and one the tocystic type. Eight patients were polyostotic while the others were monostotic. The most commonly involved sinus was the sphenoid sinus followed by ethmoid sinus. Seven patients who had facial swelling, exophthalmos or nasal obstruction underwent surgery, and in four of them, the lesion was in progression or recurred. Lesions in eight patients who were older than 30 years old and had no symptoms except headache did not progress thereafter. CONCLUSION: The progression of fibrous dysplasia stops when the bony growth is completed. Thus, if the patients are diagnosed with fibrous dysplasia over the age of 30 and do not have specific symptoms, there may be no need for surgical treatment.

Clinical Manifestation and Treatment Outcomes of Nasal Cavity & Ethmoid Sinus Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to evaluate the clinical manifestation and treatment outcome of the nasal cavity squamous cell carcinoma (SCC) and compared its survival rate with that of the maxillary sinus (MS) SCC. SUBJECTS AND METHOD: Thirty two patients who were diagnosed as nasal cavity SCC or ethmoid sinus SCC between 1984 and 2005 were selected. These patients were referred to as the intranasal (IN) SCC group. Ten prognostic factors were evaluated in terms of survival rate and recurrence. The survival rate of 61 patients who were diagnosed as MS SCC was compared with that of the IN SCC. RESULTS: Chief complaints of the patients with IN SCC were nasal obstruction (40.4%), epistaxis (25.0%), and rhinorrhea (13.5%). The 5 year survival rate of IN SCC was 44.6% and the 5 year disease free survival rate was 27.7%. The most important prognostic factor was T stage (p<.001). The 5 year survival rate of MS SCC was 55.4%, and it was statistically not different from that of the IN SCC (p=.472). In the T1, T2, T3 stages, the 5-year-survival rate of the IN SCC was similar to that of MS SCC (p=.637). But in the T4 stage, IN SCC tended to have a worse prognosis (p=.074). CONCLUSION: The prognosis of IN SCC was similar to that of the MS SCC. However, MS SCCs were detected in a more advanced stage and T4 stage of the IN SCC had a worse prognosis compared to the same stage of MS SCC.

Clinical Features and Treatment Outcomes of Mucosal Malignant Melanomas of Nasal Cavity and Paranasal Sinuses / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucosal malignant melanoma of the nasal cavity and paranasal sinuses is an uncommon tumor with poorer prognosis compared with its cutaneous counterpart. The purpose of this study is to investigate the clinical features and treatment outcomes of mucosal malignant melanoma of the nasal cavity and paranasal sinuses. SUBJECTS AND METHOD: Eighteen patients who were diagnosed and treated as mucosal malignant melanoma of nasal cavity and paranasal sinuses from 1995 to 2004 were included. Male to female ratio was 10 to 8. Their ages ranged from 43 to 87 years with median of 62 years. The medical records were reviewed retrospectively with respect to presenting symptoms, stage, treatment modalities and outcome. RESULT: The most common symptoms were epistaxis and nasal obstruction. The mean duration of symptom was 4.2 months. Commonly involved sites were middle turbinate, inferior turbinate, maxillary sinus and ethmoid sinus. Eight cases belonged to stage I, nine cases to stage II and only one case to stage III. Among them, seventeen patients underwent surgery with or without radiotherapy and immunotherapy. Of the seventeen patients who underwent surgery, twelve had recurrence and the mean period for recurrence was 8.2 months. During the follow-up periods, five had distant metastases. Five-year survival rate was 27.2% and the survival rates according to age, sex, tumor size and stage were not statistically significant. CONCLUSION: Mucosal malignant melanomas of the nasal cavity and paranasal sinuses developed commonly in the 6th to 8th decades. Epistaxis and nasal obstruction were the most common presenting symptoms. Almost all cases belonged to the stage I or II and the mainstay of the treatment was surgery. However, it was associated with frequent recurrences and a poor prognosis.

Prevalence of Allergic Rhinitis on the Basis of ARIA Classification / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Allergic rhinitis (AR) is commonly sub-classified into seasonal and perennial rhinitis. The recent "Allergic Rhinitis and its impact on Asthma (ARIA) Workshop" proposed to replace these terms by intermittent vs persistent AR. But the validity of this new classification is still largely unknown. SUBJECTS AND METHOD: Three hundred-eleven allergic rhinitis patients were included in this study. Patients were categorized into seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR) groups, according to sensitized allergens. Twenty-eight items questionnaire filled out by patients were designed for this study. Based on the questionnaire, patients were classified into either intermittent or persistent AR. Patients' information and associated factors were analysed between the groups. RESULTS: Within the population with AR, 58% of the subjects had persistent AR. About 41% of the patients were classified as moderate-severe persistent AR. There was no association between the intermittent/persistent and the SAR/PAR classifications. Subjects with persistent AR had more severe symptoms, higher rate of self-awareness and had been previously diagnosed with AR. There were no significant difference in sensitization to allergens. However, grass, tree, house dust mite allergy is more common in persistent AR than in intermittent AR. More patients in "Blockers" and "Mixed" groups had persistent AR. CONCLUSION: A statistical comparison of the two classifications showed that they cannot be used interchangeably, as they do not represent the same stratum of disease. There is also an evidence that the persistent type describes a distinct group with characteristics that differentiates them from intermittent AR. These results support the validity of the new ARIA classification as shown in other studies.

The Mechanism of Methacholine Induced Ciliostimulation: The Relationship with Cyclooxygenase Pathway and Nitric Oxide / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucociliary movement of respiratory ciliated epithelium is one of important protective mechanisms in the upper respiratory airway. It is well known that methacholine induces a ciliostimulation. This study designed to investigate the regulatory mechanism of methacholine induced ciliostimulation. MATERIALS AND METHOD: We investigated in vitro effect of methacholine, a beta-methyl ester of acetylcholine, and nitric oxide on ciliary beat frequency (CBF) of nasal septal mucosa of SD rat. CBF was measured using a video computerized analysis system. RESULTS: Methacholine (10(-6) mol/L) increased CBF upto 6 hours with a maximum increase of 44%. Diclofenac inhibited the ciliostimulatory effect of methacholine completely. LNAME inhibited the increase in CBF by methacholine significantly (p<.05). CONCLUSION: The results suggest that ciliostimulatory effects by methacholine in airway epithelium involves prostaglandin pathway and may be regulated by nitric oxide.

Effects of Corticosteroid on Expression of IL-18 in the Airway Mucosa of Allergic Rhinitis Mouse Model

Background: This study aimed to investigate the release and response of IL-18 to steroid treatment in the allergic rhinitis (AR) mouse model. MATERIALS AND METHODS: BALB/c mice were sensitized systematically using an intraperitoneal ovalbumin (OVA) injection and locally by OVA inhalation. The steroid treatment group had an intraperitoneal dexamethasone injection. Symptom scores, eosinophil counts in nasal septal mucosa, and IL-18 concentrations in nasal and lung lavage fluid were analyzed. RESULTS: The symptom scores and eosinophil counts of the negative control and steroid treatment groups were significantly lower than those of the positive control group (p<.01). Meanwhile IL-18 concentrations of nasal lavage fluid of the three groups were not significantly different (56.68+/-9.57, 63.39+/-8.93, and 64.47+/-6.83 pg/mL, repectively). IL-18 concentration of lung lavage fluid was significantly different between the positive control and steroid treatment groups (430.75+/-154.54 and 69.94+/-14.26pg/mL respectively, p=.028). CONCLUSION: In this study, IL-18 concentration increased not in the nasal lavage fluid but in the lung lavage fluid in AR mouse model. The increased IL-18 concentration decreased after the steroid therapy. This result suggests that the role of IL-18 in the pathogenesis of AR may be different from that of asthma.

Analysis of the Treatment Outcomes of Obstructive Sleep Apnea Syndrome according to the Friedman Staging System / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In 2002, Friedman et al. suggested a clinical staging system of obstructive sleep disorder patients based on palate position, tonsil size, and body mass index. The purpose of this study was to compare the treatment outcomes of uvulopalatopharyngoplasty (UPPP) and coblation assisted uvulopalatopharyngoplasty (CAUP) according to the Friedman staging system. SUBJECTS AND METHOD: Fifty patients with obstructive sleep apnea who underwent UPPP or CAUP were included. Apnea index (AI), Respiratory distress index (RDI), and Body-mass index (BMI) of preoperative polysomnography were measured. The questionnaires about snoring, apnea, and Epworth sleepiness scale (ESS) were taken by the patients and their bed partners before and after operation. All patients were stratified according to the Friedman staging system. RESULTS: Stage II patients were most common (41 cases, 82%). There was no difference in preoperative polysomnography parameters among stages. Preoperative polysomnography was decisive parameters on the determination of operative modality. UPPP was more effective than CAUP for symptom of sleep apnea with high success rate of 92.7%. CONCLUSION: In stage II, the success rates of sleep apnea and snoring were 80.4% and 63.4%. Though UPPP showed better success rate in treating sleep apnea, the success rate of CAUP in treating snoring was comparable to that of UPPP. CAUP is a good alternative to UPPP in treating snoring.

Effects of Enterotoxins of Staphylococcus Aureus on Ciliary Activity of the Nasal Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The pathogenesis of paranasal sinusitis has not been fully understood. The role of staphylococcal enterotoxins in the development of the paranasal sinusitis has recently been identified. The aim of the study is to investigate the in vitro effects of enterotoxin of Staphylococcus aureus on ciliary activity of the nasal mucosa and its in vivo activity on histology of sinus mucosa. MATERIALS AND METHOD: Maxillary sinus mucosa of the rabbit is harvested and prepared. Ciliary beat frequency (CBF) of the mucosa is observed in the culture media containing staphylococcal enterotoxin A (SEA). After direct instillation of SEA into the maxillary sinus, CBF and the histological finding of the maxillary sinus mucosa are examined. RESULTS: After exposure to low dose enterotoxin (0.03 or 0.3 ng/ml of SEA), CBF did not decrease. But, after exposure to high dose enterotoxin (1.5, 3, 30 ng/ml of SEA), CBF decreased significantly as a function of time. Twenty four hours after instillation of high dose (30 ng/ml) SEA, CBF decreased. Seven days after instillation of high dose SEA, sinusitis is observed. After instillation of low dose (0.3 ng/ml) SEA, CBF and epithelial integrity is not affected. But, subepithelial edema and the infiltration of inflammatory cells are observed. CONCLUSION: The induction of sinusitis with high dose SEA may be related to the ciliostatic effect of staphylococcal enterotoxin. But, low dose staphylococcal enterotoxin can induce sinus inflammation without ciliostatic effect.