Clinical Characteristics of Allergic Rhinitis According to Allergic Rhinitis and Its Impact on Asthma Guidelines

OBJECTIVES: The Allergic rhinitis and its impact on asthma (ARIA) guidelines were suggested for use to classify allergic rhinitis (AR). However, few studies have been performed in Asians. The objective of this study is to identify the clinical characteristics of AR in Korean patients according to the ARIA guidelines. METHODS: For the study, 610 patients who had been diagnosed with allergic rhinitis at Seoul National University Bundang Hospital and 545 patients who had been diagnosed with allergic rhinitis at 3 local clinics were included. All the patients were categorized into 4 groups, such as the mild intermittent, mild persistent, moderate-severe intermittent and moderate-severe persistent groups. The patients were given a questionnaire on allergic rhinitis-related symptoms and they underwent blood tests, including the blood eosinophil count and the serum total IgE level. RESULTS: The most prevalent type was the moderate-severe persistent group (34.7%), and the moderate-severe intermittent group (17.1%) was the rarest. There were significant differences among the 4 groups for olfaction (P<0.001), self-awareness of rhinitis (P=0.013), a previous history of AR (P<0.001), self-awareness of asthma (P=0.001) and allergic conjunctivitis (P<0.001). On the allergy laboratory tests, there was a significant difference between the groups for the eosinophi count (P=0.004). The number of blood eosinophil was more in the persistent groups than in the intermittent groups. CONCLUSION: According to the ARIA guidelines, the moderate-severe persistent group was the most prevalent for Korean patients. Blood eosinophilia and olfactory dysfunction were the most severe in the moderate-severe persistent group.

The Role of Allergy in the Severity of Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although allergic rhinitis is one of the most common factors associated with the development of chronic rhinosinusitis, the role of allergy in the severity of chronic rhinosinusitis was not well defined. This study is aimed to determine whether the allergy or factors such as nasal polyp, asthma, aspirin sensitivity can induce more extensive chronic rhinosinusitis, and to determine whether the severity of chronic rhinosinusitis depends on the severity of allergy. MATERIALS AND METHODS: A total of 98 chronic rhinosinusitis patients who underwent endoscopic sinus surgery were evaluated. The severity of chronic rhinosinusitis was assessed by CT scores and symptom scores. An allergic prick test, MAST (Multiple-antigen simultaneous test), the total IgE, and a serum eosinophil count were evaluated for diagnosis and assessment of the severity of allergy. Influences of another factors such as nasal polyp, asthma, and aspirin sensitivity to the severity of chronic rhinosinusitis were evaluated. RESULTS: Although the symptom scores of allergic chronic rhinosinusitis patients were greater than those of non-allergic chronic rhinosinusitis patients, there were no CT score differences between the two groups. Differences in the CT scores and symptom scores in allergic chronic rhinosinusitis patients according to the severity of allergy were statistically insignificant. Nasal polyp, asthma, and aspirin sensitivity did not induce more severe chronic rhinosinusitis. CONCLUSION: Allergy may be associated with the development of chronic rhinosinusitis, but the severity of allergy is not correlated to the severity of chronic rhinosinusitis.

Correlation between Nasal Obstruction Symptoms and Objective Parameters of Peak Nasal Inspiratory Flow Metry and Acoustic Rhinometry

BACKGROUND AND OBJECTIVES: Measurement of the peak nasal inspiratory flow rate (PNIFR) is a useful technique for obtaining a quick measure of nasal obstruction and changes in PNIFR, reflecting changes in symptoms. The aim of the present study was to correlate changes in nasal obstruction symptoms with changes in several parameters of acoustic rhinometry (AR) and peak nasal inspiratory flow metry (PNIFM) before and after decongestion and to examine whether changes in PNIFR correlate with changes in nasal cross-sectional areas and volume. MATERIALS AND METHODS: The subjects of the current study were 30 patients with nasal obstruction symptoms and 20 normal subjects. Subjective nasal patency was assessed by visual analogue scale (VAS). We measured PNIFR and minimal cross-sectional area (MCA), cross-sectional area at distances of 3.3 (CA3.3), 4.0 (CA4.0), and 6.4 (CA6.4) cm from the nostril and volume from the nostril 6.4 cm (V6.4) towards the choanae, in each nasal cavity before and after decongestion. RESULTS: The VAS had no significant correlation with PNIFR, each cross-sectional area and volume in bilateral nasal cavities before decongestion. There was a significant correlation between the changes in VAS and PNIFR and MCA before and after decongestion. There was a significant correlation between changes in PNIFR and MCA and CA3.3 in one side and both sides of nasal cavity before and after decongestion. CONCLUSIONS: These results suggest that PNIFM and AR may have no sensitive diagnostic values in estimating the severity of nasal obstruction symptoms in the nondecongested state of the bilateral nasal cavities, but PNIFM and AR can be recommended especially in provocation studies because PNIFR and MCA reflect changes in subjective symptoms by mucosal changes.

Correlation between Nasal Obstruction Symptoms and Objective Parameters of Peak Nasal Inspiratory Flow Metry and Acoustic Rhinometry

BACKGROUND AND OBJECTIVES: Measurement of the peak nasal inspiratory flow rate (PNIFR) is a useful technique for obtaining a quick measure of nasal obstruction and changes in PNIFR, reflecting changes in symptoms. The aim of the present study was to correlate changes in nasal obstruction symptoms with changes in several parameters of acoustic rhinometry (AR) and peak nasal inspiratory flow metry (PNIFM) before and after decongestion and to examine whether changes in PNIFR correlate with changes in nasal cross-sectional areas and volume. MATERIALS AND METHODS: The subjects of the current study were 30 patients with nasal obstruction symptoms and 20 normal subjects. Subjective nasal patency was assessed by visual analogue scale (VAS). We measured PNIFR and minimal cross-sectional area (MCA), cross-sectional area at distances of 3.3 (CA3.3), 4.0 (CA4.0), and 6.4 (CA6.4) cm from the nostril and volume from the nostril 6.4 cm (V6.4) towards the choanae, in each nasal cavity before and after decongestion. RESULTS: The VAS had no significant correlation with PNIFR, each cross-sectional area and volume in bilateral nasal cavities before decongestion. There was a significant correlation between the changes in VAS and PNIFR and MCA before and after decongestion. There was a significant correlation between changes in PNIFR and MCA and CA3.3 in one side and both sides of nasal cavity before and after decongestion. CONCLUSIONS: These results suggest that PNIFM and AR may have no sensitive diagnostic values in estimating the severity of nasal obstruction symptoms in the nondecongested state of the bilateral nasal cavities, but PNIFM and AR can be recommended especially in provocation studies because PNIFR and MCA reflect changes in subjective symptoms by mucosal changes.

Expression of Glucocorticoid Receptor in Nasal Polyps and Nasal Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Glucocorticoids are currently the most potent medication available for the treatment of nasal polyposis and allergic rhinitis, but exact mechanisms and cellular targets in the nasal mucosa are uncertain. Multifactorial effects of glucocorticoid are initiated by their binding to a specific cytoplasmic glucocorticoid receptor (GR). We performed this study to investigate the localization and distribution ot' human 4R and GR j3 isoform in nasal mucosa and to examine the influence of allergy and eosinophilic infiltration on GR and GR betaisoform expression in nasal polyps. MATERIALS AND METHODS: Nasal polyps (NP), middle turbinate mucosa (MT) and inferior turbinate (IT) mucosa were taken from 40 patients with chronic sinusitis and nasal polyps. We examined to have concomitant allergic rhinitis. Specimens were stained to quantify eosinophils and immunohistochemically stained to quantify GR and GR beta isaform in the unit area of tissues. RESULTS: Immunostaining of GR and GR betaisoform was predominantly localized in epithelial cell and infiltrating inflammatory cell in subepithelial layer, with lesser amounts in the endothelial cells and in the cells surrounding glands. Immunostaining of GR was mostly co-expressed with GR beta isoform. No correlation was found between Gk and GR beta isoform expression in subepithelial layer and the intensity of eosinophilic inflammation and allergy in NP. There was no significant differences in GR and GR beta isoform expression between NP, MT, and IT. CONCLUSION: Epithelial cells may be an important site of action for intranasal steroids, and the increased number of eosinophils infiltrating the mucosa and allergy did not amplify the number of immunostaining of GK and GR beta isoform.

Expression of Inducible Nitric Oxide Synthase and Its Steroid Effect in TDI-Induced Nasal Hyperreactive Guinea Pigs / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) in exhaled air is elevated in allergy. Topical corticosteroid therapy which has been shown to reduce airway inflammation is associated with reduction in exhaled levels of NO in allergy. The aim of this study is to investigate the induction of inducible nitric oxide synthase (iNOS) and the effect of steroid on the expression of iNOS in the nasal mucosa of TDI (toluene diisecyanate)-induced nasal hyperreactive guinea pig. MATERIALS AND METHODS: We developed an allergy model in guinea pigs using the intranasal application of TDI, We evaluated the iNOS expression and in vivo effects of triamcinolone on the expression of iNOS and infiltration of eosinophil in TDI-sensitized guinea pigs by immunohistochemical stain. RESULTS: Nasal symptoms were significantly suppressed and the number of eosinophils in the nasal mucosa were significantly inhibited by the treatment of triamcinolone. Immunoreactivity to iNOS was localized to ciliated cells of epithelium, vascular endothelial cells, secretory cells of nasal glands and some inflammatory cells in the mucosa of the control group. High expression of iNOS in the nasal mucosa of the TDI-sensitized group was demonstrated, and it was suppressed by triamcinolone therapy. CONCLUSION: These results show that increased expression of iNOS may contribute to allergic inflammation and the antiinflammatory effect of steroid in allergy is partly mediated by the reduction of iNOS expression.

Histopathologic Changes in Nasal Mucosa of Rat with Benzalkonium Chloride / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benzalkonium Chloride (BZC) is one of the most often used preservatives that has strong germicidal effect. Not only is it used for nasal drops, but also for eye drops and cosmetics. However, there have been many reports that lesions such as dermatitis and conjunctivitis are considered the results of irritation induced by BZC. We evaluated the histological changes after long-term administration of BZC on rat nasal respiratory mucosa. MATERIAL AND METHODS: We divided 40 BZC treated animals into 4 groups. First group received low-concentrated BZC solution which is commonly used for nasal sprays. Second group received high-concentrated BZC solution which is reported to induce dermatitis in human. Third and Fourth group received steroid mixed in the BZC solutions of low and high concentrations, respectively. Control group was administrated with normal saline. After 1, 2, and 4 weeks of topical administration in each group, the symptomatic and histological changes with H&E stain were observed. RESULTS: Sneezing and nose rubbing with forelegs were observed in all subgroups on the 5th day of treatment. The BZC induced lesions, including glandular formation, inflammatory cell infiltration, and edematous changes. The symptomatic and histological changes were pronounced when the duration of BZC administration was increased. Similar results were observed in groups that received steroid mixed in the BZC solution. CONCLUSION: We found that even low concentration of BZC preservative can cause nasal lesions. Thus, there is a strong need to develope a preservative that can be used safely.

A Case of Giant Cell Tumor of Bilateral Maxilla with Paget's Disease / 대한이비인후과학회지

Giant cell tumors acount for 4% of all bone tumors and usually occur in the epiphyses of long bones and rarely involve the head and neck region, representing about 9% of them. The incidence of giant cell tumor arising in Paget's disease, which is characterized by a bizarre and greatly exaggerated skeletal turnover, is probably less than 0.2%. We experienced a case of giant cell tumor in the bilateral maxilla with Paget's disease of bone, which was treated by excision and curettage of the tumor mass via endoscopic approach.

A Sphenoid Mucocele with Bilateral Ophthalmic Symptoms / 대한이비인후과학회지

Mucoceles of the sphenoid sinus are relatively rare and it is difficult to dignose them with the history of the illness or with the physical examination alone. However, if it is not treated rapidly, it may give rise to visual loss, extraocular motor disturbance or other ophthalmic sequalae. Recently, we experienced a case of mucocele originating from the sphenoid sinus, which was managed by functional endonasal sinus surgery-marsupialization. We obtained satisfactory results after steroid treatments were applied on the post-operative visual disturbance of the left eye and the pre-operative occular motion disturbance of the right eye.

Sinonasal Infections in Immunocompromised Patients Undergoing Bone Marrow Transplantation / 대한이비인후과학회지

BACKGROUND: Sinonasal infection is potentially a fatal disease in the immunocompromised patients who are undergoing bone marrow transplantation(BMT). OBJECTIVES: The aim of this study is to determine the incidence, symptoms and signs, risk factors, treatment modalities and the prognostic factors of the sinonasal infections in the immunocompromised BMT patients. MATERIALS AND METHODS: We reviewed the records of 235 patients who had received bone marrow transplantation in St. Mary's hospital from December 1983 to August 1995 to determine the clinical features of sinonasal infections in these patients. RESULTS: Forty six patients(19.6%) were affected by sinonasal infections. In 40 patients(17.0%) the infection occurred before BMT. In 11 patients(4.7%), the infection occurred after BMT. Five out of 11 patients(2.1%) had previous sinonasal infections. The most common symptoms and signs were fever and rhinorrhea. Fourteen patients had no discernible symptoms or signs that suggested the presence of sinonasal infection. In our study, patients with previous history of sinonasal infection were more likely to be infected again after BMT. Medical treatment with broad-spectrum antibiotics is the initial treatment modality and surgical treatment is indicated in intractable cases. CONCLUSIONS: The immunocompromised BMT patients have high incidence of serious sinonasal infections than normal immunocompetent persons. Early detection and aggressive combined treatment with medical and surgical modalities are essential for the treatment of sinonasal infections in the BMT patients.

Effect of Topical Corticosteroid on Nasal Polyps / 대한이비인후과학회지

BACKGROUND: Topical nasal corticosteroid therapy produces clinical improvement in patients with nasal polyposis, but there are lots of controversy about the pathogenesis of nasal polyps and the mode of action of steroid therapy. OBJECTIVES: To examine the mechanism of steroid effect, we investigated the histological change in apex, body and stalk of nasal polyps individually after topical steroid therapy. MATERIALS AND METHODS: Ten patients with nasal polyposis were treated with budesonide nasal spray, 100ng(50ng/puff) twice daily in each nostril for 4 weeks. we quantified the number of inflammatory cell types and compared the histologic types and structures in each portion of nasal polyps from the patients. RESULTS: Administration of topical corticosteroid over 2 weeks caused changes in each portion of nasal polyps histologically. The histologic changes showed decreased edema and increased fibrosis under light microscope and it was evident with longer administration of the topical corticosteroid. The number of plasma cells in body portion was decreased after treatment. Electron microscopy showed that the number of degranulated granules of mast cell was increased in 2 weeks after treatment and then decreased in 4 weeks at pedicle portion of nasal polyps. CONCLUSION: The results of this study suggest that the administration of topical corticosteroid may cause activation of healing process histologically.