Bilateral paranasal sinus fungal balls: A retrospective cohort study in 28 patients over a 21-year period.

Paranasal fungal balls are rare entities for which a recent increase in reported cases has been observed. Fungal balls are most commonly unilateral, and there are few bilateral cases in the literature. Here we report the clinical features of bilateral fungal balls in 24 patients treated in our institution over the past 20 years. In this retrospective study, we reviewed the medical records of 5279 patients who underwent endoscopic sinus surgery performed by a single surgeon from January 1996 to December 2016 at a tertiary care center in order to identify patients diagnosed with fungal balls confirmed histopathologically. Demographic data and radiologic findings of patients with bilateral fungal balls were compared with those who had unilateral fungal balls. Multiple logistic regression test was used to compare demographic information between patients with unilateral and bilateral fungal balls. The most commonly involved sinus in bilateral cases was maxillary (87.5%), followed by ethmoid (37.5%) and sphenoid (33.3%). Of the 24 patients, 19 were female, and patient age ranged from 45 to 83 years, with an average of 65.1 years. Common existing comorbidities were hypertension (45.8%), diabetes (29.2%), cardiac problem (16.7%), cerebral infarction (8.3%), pulmonary tuberculosis (8.3%), and lung cancer (4.2%). The clinically relevant features of patients diagnosed with bilateral fungal balls from our review include advanced age and immunocompromised status compared to those with unilateral fungal balls. These features contribute to the clinical distinction of bilateral fungal ball disease from unilateral fungal balls and invasive fungal sinusitis.

Roles of PI3K pan-inhibitors and PI3K-δ inhibitors in allergic lung inflammation: a systematic review and meta-analysis.

Meta-analysis can be applied to study the effectiveness of the summary estimates for experimental papers, producing objective and unbiased results. We investigated the effects of phosphoinositide-3-kinase (PI3K) on the inflammatory profile in allergic mouse models, which are currently under development in signal transduction materials. PubMed, EMBASE and Web of Science databases were searched for relevant literature using the search terms " PI3K inhibitor" and "allergy" or "asthma". Cochrane Review Manager and R were used for handling continuous variables. The primary outcomes of the inflammatory profile were divided into cell counts and inflammatory cytokines. We used a random effects model to draw a forest plot. Through the database search and subsequent selection, 17 articles were identified. Regarding the cell counts, both the PI3K pan-inhibitors and PI3K-δ inhibitors effectively reduced the total cell counts, eosinophils, neutrophils and lymphocytes. In contrast to PI3K-δ inhibitors, PI3K pan-inhibitors effectively reduced macrophages. Regarding the inflammatory cytokines, PI3K pan-inhibitors and PI3K-δ inhibitors effectively reduced total IgE, IL-4, IL-5, IL-13, TNF-α, IL-1ß, VEGF and had no effect on IL-6. Compared to the PI3K pan-inhibitors, which block all pathways, selective PI3K-δ inhibitors are expected to be relatively less toxic. Regarding the efficacy, PI3K-δ inhibitors have at least the same or better efficacy than PI3K pan-inhibitors in effector cells and inflammatory mediators.

Is septal deviation associated with headache?: A nationwide 10-year follow-up cohort study.

To investigate the potential relationship between septal deviation (SD) and headache using nationwide representative cohort sample data.This study used a nationwide cohort sample from the Korean National Health Insurance Service database. The cohort sample was composed of 1 million patients, which is obtained by propensity score matching from 2002 to 2013. There were 9171 individuals in the SD group and 28243 in the control or no SD group. The Kaplan-Meier survival analysis, the log-rank test, and Cox proportional hazard regression analysis were used to calculate the incidence, survival curve, and hazard ratio of headache for each group.There were no statistically significant differences in sex (P = .7708), age (P = .991), residential area (P = .9626), or socioeconomic status (P = .9982) between the 2 groups. The survival curve between SD and control or no SD showed a statistically significant difference. The adjusted hazard ratio for headache incidence during the 10-year follow-up period of the SD group was 1.37 (95% CI: 1.31-1.43).This cohort study suggests that SD is associated with headache. Therefore, these findings suggest that septoplasty can be considered as 1 of the treatment option in SD patients with headache.

Lipid keratopathy and septal abscess: Case report.

RATIONALE: Epistaxis is a common otorhinolaryngological emergency, but septal abscess has not been reported before as a complication of epistaxis. PATIENT CONCERNS: We report a case of a 51-year-old man complaining of nasal obstruction and facial numbness for 3 weeks. He had a history of epistaxis, and had been treated with electrocauterization of the left nasal septum at a local clinic 1 month earlier. DIAGNOSES: On nasal endoscopy, swelling of the septum was noticed; computed tomography (CT) was performed, and revealed a septal abscess. INTERVENTIONS: The patient was treated with incision and drainage under local anesthesia. A left vertical hemitransfixion incision was made and 4 mL of purulent material was drained. There was no quadrangular septal cartilage. OUTCOMES: On the 5th postoperative day, the patient complained of blurred vision in his right eye. Visual acuity of the left eye was 0.5, but acuity of the right eye was finger count at 50 cm. Examination of the right eye revealed a whitish fan-shaped corneal opacity on the medial side with neovascularization, diagnostic of lipid keratopathy. CONCLUSION: Electrocautery of epistaxis should be performed carefully during hemostasis, and there should be careful follow-up after the procedure to detect the occurrence of septal hematoma or septal abscess. These conditions should be treated as early as possible to avoid further serious complications. Since lipid keratopathy is difficult to treat once it occurs, care should be taken to avoid a septal abscess.

Extranasopharyngeal Angiofibroma of the Frontal Sinus.

Angiofibroma is a rare tumor that accounts for about 0.05% of all head and neck tumors; it mainly occurs in the region of the nasopharynx. To date, no study originating in the frontal sinus has been reported. The authors report a report of an 18-year-old male complaining of severe pain in the right periocular area, forehead, and temporal area for 1 week. Endoscopic sinus surgery in combination with trephination was used to remove the tumor and the tumor was diagnosed as angiofibroma from histopathologic examination. It is hard to consider a tumor as being angiofibroma when it is not located in the nasopharynx. In particular, although extranasopharyngeal angiofibroma can occur in all head and neck regions, a tumor which has developed in the frontal sinus is more difficult to diagnose as angiofibroma because no patients have been reported until now. With this study, surgeons now need to be aware of the possibility of occurrence of angiofibroma in the frontal sinus.

What Affects Postoperative Sinusitis and Implant Failure after Dental Implant: A Meta-analysis.

OBJECTIVE: The dental implant is an innovative instrument that enables the edentulous patient to chew. Many factors have a bearing on the success of dental implantation. There are also many complications after dental implantation. In this meta-analysis, we investigated which factors increase the risk of postoperative sinusitis and implant failure after dental implant for the first time. DATA SOURCES: Included data were searched through the PubMed, EMBASE, and Cochrane library databases. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 2 authors (J.S.K., S.H.K.) independently extracted data by multiple observers. REVIEW METHODS: We used a random-effects model considering the variation between and within the included studies. RESULTS: Twenty-seven studies were included in our final meta-analysis. The proportion of postoperative sinusitis, perforation of the sinus membrane, and implant failure was 0.05 (95% confidence interval [CI], 0.04-0.07), 0.17 (95% CI, 0.13-0.22), and 0.05 (95% CI, 0.04-0.07), respectively, using the single proportion test. The only factors that affected postoperative sinusitis were preoperative sinusitis and intraoperative perforation of the Schneiderian membrane ( P < .01 and P < .01, respectively). The only factors that affected dental implant failure were smoking and residual bone height of the maxilla ( P < .05 and P < .01, respectively). CONCLUSIONS: Two factors affect postoperative sinusitis after implant surgery: preoperative sinusitis and Schneiderian membrane rupture. It should also be noted that the factors affecting implant failure are residual bone height and smoking. These findings will have a significant impact on the counseling and treatment policy of patients who receive dental implants.

Rhinocerebral mucormycosis after functional endoscopic sinus surgery: A case report.

RATIONALE: Mucormycosis is a rare fungal infection which mainly develops in compromised hosts and the associated mortality rate is high. PATIENT CONCERNS: We report a case of mucormycosis in a 59-year-old woman following routine endoscopic sinus surgery. The patient had a history of diabetes mellitus (DM) and bronchial asthma. DIAGNOSES: On follow-up 4 weeks after the first functional endoscopic sinus surgery (FESS), she complained of a severe headache and was readmitted for a second period. Endoscopic examination revealed bony erosion and a whitish discharge on the left middle turbinate, which was confirmed as mucormycosis by endoscopic biopsy. INTERVENTIONS: Endoscopic debridement of the necrotic tissue and middle turbinectomy were performed and the patient was treated with intravenous amphotericin B for 3 months (3.5 mg/kg/day). OUTCOMES: About 1 month into the second period of hospitalization, left Bell's palsy had occurred. The facial palsy improved naturally after 2 months of hospitalization. One year after endoscopic debridement, follow-up endoscopy showed that there was no residual lesion. CONCLUSION: This is the first report of mucormycosis after routine endoscopic sinus surgery. We did not miss headache symptom after FESS surgery, and diagnosed mucormycosis through early endoscopic biopsy, which played an important role in curing the patient. In addition to the importance of medical therapy such as DM control for patients, emotional support and psychiatric treatment are also important factors as these patients require hospitalization for a long period, 3 months in the case of this patient.

Phosphoinositide 3-kinase-delta could be a biomarker for eosinophilic nasal polyps.

Nasal polyps (NP) cause diverse clinical symptoms of chronic rhinosinusitis (CRS). Chronic inflammation of sinonasal mucosa is known to be crucial in NP formation. We aimed to define the implications of phosphoinositide 3-kinase (PI3K)-δ in nasal inflammation associated with NP by analyzing NP tissue obtained from CRS patients. Results showed that expression of p110δ, a regulatory subunit of PI3K-δ, in NP tissue was increased compared to control tissue. Increased p110δ expression was closely correlated with more severe CRS features. Interestingly, p110δ expression was increased in eosinophilic NP, which are closely related to more complicated clinical courses of the disease. Furthermore, CRS patients possessing NP with higher p110δ expression displayed more eosinophils in NP tissue and blood, higher levels of IL-5 in NP tissue, and more severe features of the disease. Therefore, PI3K-δ may contribute to the formation of NP, especially eosinophilic NP associated with more severe clinical presentations and radiological features.

Effect of single-dose intravenous dexamethasone on subjective voice quality after thyroidectomy: A meta-analysis.

BACKGROUND: Corticosteroids are widely used to treat voice change after thyroidectomy. In this study, we evaluated the effect of a single dose of intravenous dexamethasone after thyroidectomy using a metaanalysis. METHODS: Relevant studies were identified by searching the following databases: Medline, Embase, and Cochrane through February 2017. We followed PRISMA guidelines. The following search terms were used: "thyroidectomy," "voice," "steroid." Random-effects models were used to estimate standardized mean differences (SMDs) and 95% confidence intervals. RESULTS: Our search yielded one retrospective cohort study involving 122 thyroidectomy patients and 3 randomized controlled studies involving 242 thyroidectomy patients. The pooled SMD for voice quality after thyroidectomy was -0.80 (P < .05). Subgroup analysis showed significant voice quality change 1 day after administration of dexamethasone. CONCLUSIONS: Single-dose intravenous dexamethasone after thyroidectomy significantly improves subjective voice quality on day 1. The effect was not different significantly after day 1. LEVEL OF EVIDENCE: Level 2a.

Sinonasal osteoblastomas in the middle turbinate: Two case reports.

RATIONALE: Sinonasal osteoblastoma is an extremely rare benign bone-forming tumor. PATIENT CONCERNS: We report 2 extremely rare cases of sinonasal osteoblastoma in the middle turbinate. DIAGNOSES: The preoperative diagnosis was osteoma in the middle turbinate. INTERVENTIONS: We performed endoscopic removal of the mass in the middle turbinate and frontal recess. OUTCOMES: Histological examination of biopsy specimens revealed osteoblastoma. LESSONS: Clinicians should consider osteoblastoma in the differential diagnosis of tumors arising in the nasal cavities.

Localized nasopharyngeal amyloidosis mimicking malignancy: A case report.

RATIONALE: Nasopharyngeal amyloidosis is a benign, slowly progressive disease that is characterized by extracellular eosinophilic deposition. PATIENT CONCERNS: We report a rare case of localized nasopharyngeal amyloidosis. DIAGNOSES: The initial chief complaint of this patient was frequent epistaxis and right aural fullness. The initial diagnosis was nasopharyngeal tumor. INTERVENTIONS: There is no universally effective medical treatment for nasopharyngeal amyloidosis but surgery can be an option. We performed careful observation with regular follow-up by nasopharyngoscopy and radiologic study. OUTCOMES: The patient reported no further complaints at 1-year follow-up and the lesion from nasopharyngeal amyloidosis was still present. LESSONS: Although it is rare, nasopharyngeal amyloidosis should be considered in the differential diagnosis of epistaxis, nasal obstruction, and otitis media with effusion, which are the main symptoms of nasopharyngeal carcinoma. In the absence of systemic disease, localized nasopharyngeal amyloidosis may be treated conservatively.

Can Intracapsular Tonsillectomy Be an Alternative to Classical Tonsillectomy? A Meta-analysis.

Objective Tonsillectomy is the most common operation performed in the otolaryngologic fields. Efforts have been made to reduce postoperative complications, and one of these is intracapsular tonsillectomy and adenoidectomy (ICTA), which leaves the tonsillar tissue with tonsillar capsule. This study aimed to evaluate intracapsular tonsillectomy compared with classical extracapsular tonsillectomy in terms of efficacy of the technique for managing obstructive sleep apnea (OSA) and reducing postoperative complications. Data Sources We performed a literature search using PubMed, EMBASE, and the Cochrane Library through December 2016. Review Methods Summarized risk ratio (RR), risk differences (RDs), and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated by summarizing the risk estimates of each study using random-effects models that considered both within- and between-study variations. Results Our search included 15 randomized controlled studies. The RRs for postoperative bleeding and residual tonsils were, respectively, 0.44 ( P = .01) and 6.02 ( P = .0002). There were significant differences in postoperative pain ( P = .0022), need for analgesics ( P < .0001), days to normal diet ( P = .006), and days to normal activity ( P < .00001) between intracapsular tonsillectomy and extracapsular tonsillectomy. Conclusions Intracapsular tonsillectomy can effectively reduce postoperative pain and bleeding, which shortens the time required to return to normal life. There was no difference between microdebrider and coblator in intracapsular tonsillectomy regarding postoperative pain and bleeding. It can increase the risk of remnant tonsils; however, it does not increase the risk of recurrent infection.

Sinonasal Hemangioma: Diagnosis, Treatment, and Follow-Up of 37 Patients at a Single Center.

PURPOSE: Hemangioma is a common benign vascular lesion of the head and neck region. It rarely involves the mucous membranes of the nasal cavity and paranasal sinuses. It should be added to the differential diagnosis of nasal cavity masses when the presenting symptoms are epistaxis or nasal obstruction. MATERIALS AND METHODS: A retrospective chart review was conducted of a histologic diagnosis of lobular capillary hemangioma or cavernous hemangioma of the sinonasal mucous membranes treated at the Chonbuk National University Hospital from January 1995 through December 2015. There were 1,479 patients diagnosed with hemangiomas in the total body area. Medical records were reviewed to gather data on clinical symptoms, demographic characteristics, site of tumor, imaging and histologic features, and treatment. A review of the literature on previously diagnosed cases of sinonasal hemangioma was performed. RESULTS: Three hundred patients had hemangiomas in the head and neck region and only 37 patients (12.5%) had hemangiomas of the sinonasal mucous membranes. The most common complaint was nasal obstruction (59.5%), followed by epistaxis (51.4%). There were 18 male (48.6%) and 19 female (51.4%) patients. The predominant subsites were the nasal septum (40.5%), followed by the inferior turbinate (29.7%), the maxillary sinus (8.1%), and the uncinate process (8.1%). Lobular capillary hemangioma (24 of 37) was more common than cavernous hemangioma (13 of 37). There was a meaningful correlation between the histologic type and tumor site of the hemangioma. CONCLUSION: Sinonasal hemangiomas are relatively uncommon. Clinicians should be aware of the clinical, radiologic, and histologic features of sinonasal hemangiomas to avoid a misdiagnosis of a malignant tumor, angiofibroma, or other benign mass.

Different characteristics of a single sinonasal inverted papilloma from sequential PET-CT: A case report.

RATIONALE: Inverted papilloma (IP) is a benign tumor that should be monitored carefully because it frequently recurs and has the potential to become malignant. PATIENT CONCERNS: We report a case of a 59-year-old woman who presented with a mass which had been found incidentally on positron emission tomography computed tomography (PET CT). DIAGNOSES: Using endoscopy and CT, the preoperative diagnosis was inverted papilloma. PET CT showed a mass with hot uptake in the left ethmoid and frontal sinus (maximum standardized uptake value (SUVmax) = 7.80). INTERVENTIONS: We performed endoscopic sinus surgery (ESS) using 4 mm 0° and 70° endoscopes under general anesthesia. After 15 months of follow-up, remnant masses existed in the left frontal and supraorbital ethmoid cells. In the second PET CT taken at this time, a mass with lower SUV compared to the preoperative PET was observed in the lateral side of the left frontal sinus (SUVmax= 1.71). Revision ESS was performed using the "above and below" technique. OUTCOMES: Two years after initial surgery, follow-up CT showed there was no tumor recurrence in the frontal sinus or supraorbital ethmoid cell. There were no complications such as numbness in the forehead area after the operations. CONCLUSION: If the tumor is located at a site that is difficult to reach with an endoscope alone, it is faster and less painful to choose a more convenient approach for the patientand it can avoid unnecessary cost burden. It should also be noted that the SUV of PET is not a tool to distinguish IP from other inflammatory polyps or cancer.

An ethmoid mucocele causing diplopia: A case report.

RATIONALE: Mucocele is a disease lined primarily by epithelium, and occurs mainly when the sinus ostium is obstructed. PATIENT CONCERNS: We report a case of a 37-year-old man who presented with painless proptosis of the right eye and diplopia. DIAGNOSES: The preoperative finding was mucocele of the ethmoid sinus. INTERVENTIONS: We performed endoscopic sinus surgery, which included uncapping of the anterior and superior wall of the mucocele. OUTCOMES: The mucocele was treated safely and effectively without touching the medial orbital wall. LESSONS: Clinicians should note that minimally invasive surgery to remove ethmoid mucoceles is relatively straightforward and can prevent the various complications associated with these lesions.