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Background Radionecrosis is a complication of nasopharyngeal carcinoma (NPC) that is difficult to treat. Endoscopic debridement is the first-line treatment for radionecrosis. After debridement, however, either bone or the internal carotid artery is exposed and requires mucosal coverage. Objectives This study sought to demonstrate the effectiveness of a nasoseptal flap (NSF) after endoscopic debridement of radionecrosis in the reconstruction ofnasopharyngeal or skull base defects. Methods Nine patients with NPC who underwent navigation-guided endoscopic debridement, followed by NSF reconstruction between April 2013 and July 2016, were included. The patients' clinical features and outcomes were evaluated. Results All nine patients had headaches, and eight had a foul odor associated with their radionecrosis. One patient underwent three radiotherapy treatments, four had two treatments, and the remaining four had just one treatment. The foul odor disappeared after treatment in all the patients who had been affected. The headache was significantly reduced after treatment in all patients. The NSF detached in two patients. In one patient, NSF failed, and the patient experienced postoperative rupture of the internal carotid artery. In the seven other patients, the NSF successfully covered the resultant defects, despite one intraoperative internal carotid artery rupture. Only two patients required further debridement, whereas the others experienced complete healing after just one surgical procedure. The nasopharyngeal surface was healthy-appearing in eight patients (median follow-up, median 11 months). Conclusion Reconstruction by using NSF after endoscopic debridement for radionecrosis of NPC allowed for faster healing and reduced the need for further debridement.

Background There have been few comparative studies on olfactory function and sinonasal-specific quality of life (QOL) after endoscopic or microscopic surgery using a transsphenoidal approach (TSA). Methods A retrospective review of a prospectively collected database was performed. Thirty-five patients who underwent a transnasal endoscopic approach and 20 patients who underwent a transnasal transseptal microscopic approach for treatment of pituitary adenoma were evaluated. An anterior skull base (ASK) nasal inventory and a subjective visual analog scale (VAS) (0-100) for olfaction were evaluated before and at one and three months after surgery. A cross-cultural smell identification test (CC-SIT) and a butanol threshold test (BTT) were also measured before and three months after surgery. Results There was no significant difference in subjective olfaction or CC-SIT or BTT score between the endoscopic and microscopic groups. The microscopic group (11.35 ± 3.67 and 9.72 ± 2.54, respectively) showed better ASK nasal inventory outcomes at one and three months after surgery compared with the endoscopic group (14.00 ± 4.85 and 11.70 ± 3.28, respectively; p = 0.029 and 0.036, respectively) especially in the subdomains of “nasal crusting” and “urge to blow nose.” Conclusion Transnasal transseptal microscopic pituitary surgery confers a better early postoperative sinonasal QOL with a comparable olfactory outcome compared with the endoscopic approach. Although many believe that an endoscopic approach is less invasive, preservation of the sinonasal mucosa proves to be more important in terms of sinonasal QOL than use of an endoscope or microscope.

BackgroundSinonasal inverted papilloma (IP) is one of the most common benign tumors of the sinonasal area and malignant transformation has frequently been reported. However, the exact mechanism of the transition from benign lesion to malignancy is not known. The Wnt signaling pathway involves a network of multiple signaling glycoproteins that are known to play an important role in embryogenesis and carcinogenesis.ObjectiveThe purpose of this study was to evaluate the role of the Wnt pathway and signaling proteins in malignant transformation of IP to dysplasia and squamous cell carcinoma.MethodsExpression of the Wnt signaling pathway proteins, including Wnt-1, beta-catenin, cyclin D1, and Dishevelled-1 (Dvl-1), were detected by immunohistochemistry by using 3-mm tissue core microarrays that consisted of 115 cores of IP tissue. Each of the IP cores was graded as I (prominent squamous metaplasia), II (inverted pattern), III (dysplasia), or IV (squamous cell carcinoma). The expression pattern of each protein and the correlation between the expression of each target protein and IP grade were evaluated.ResultsMembranous staining of beta-catenin showed a significant positive correlation with IP grade (ρ = 0.247, p < 0.001), as did staining of cyclin D1 (ρ = 0.365, p < 0.001), which showed a nuclear pattern and staining of Dvl-1 (ρ = 0.380, p < 0.001), which showed a membranous, cytoplasmic, and nuclear pattern. For Dvl-1, a nuclear expression pattern was more frequently observed in grade III and IV IP (p = 0.036). In the case of Wnt-1, cytoplasmic expression was observed; however, it did not show a significant correlation with IP grade (ρ = 0.141, p = 0.130).ConclusionsWnt signaling proteins, including beta-catenin, cyclin D1, and Dvl-1, may play crucial roles in the malignant transformation of IP.

Background Acute invasive fungal rhinosinusitis (AIFR) is an aggressive opportunistic infection with a high mortality rate. There are few reports that demonstrate an improvement in the overall prognosis. Furthermore, definite prognostic factors related to patient survival remain unclear. Objective The objective of this study was to evaluate the various clinical factors related to survival of patients with AIFR. Methods This is a retrospective case series with patients treated for AIFR between 1997 and 2013. A total of 45 patients with AIFR were enrolled for analysis. We evaluated demographics, clinical characteristics, and disease course. Results Mean age of patients was 59.6 years. AIFR developed most commonly in patients with immunocompromised host, such as diabetes (n = 23) or hematologic malignancy (n = 17). There were two main genera of fungus, Aspergillus (n = 30) and Mucor (n = 14). Headache, cranial neuropathy, visual loss, and orbital pain were the most common presenting symptoms. Overall survival was 53%. Underlying hematologic malignancy and diabetes were significantly associated with overall survival, and accompanying severe neutropenia and elevated C-reactive protein (CRP) were also related to poor prognosis. Initial presentation with facial swelling, involvement of nasal septum, or shorter symptom duration was also associated with survival reduction. Multivariate analysis revealed that CRP more than 5.50 mg/dL (Hazard ratio [HR], 9.04; p = 003) was an independent prognostic factor in patients with AIFR. Conclusions Overall survival rate remained approximately 50% in patients with AIFR. The prognosis of AIFR is significantly influenced by underlying diseases, accompanying neutropenia, CRP levels, symptom duration, involvement of septum, and the presence of facial swelling. Elevation of CRP, in particular, was an independent predictor of poor outcomes and should be monitored appropriately.

Background Allergic rhinitis (AR) is often accompanied by multiple ocular symptoms. This study aimed to evaluate the prevalence of ocular symptoms and the impact of ocular symptoms on the quality of life in patients with AR. Methods One thousand one hundred seventy-four patients with AR were enrolled from 24 centers in Korea. They were classified into four groups according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) guideline and also classified into perennial AR (PAR) and seasonal AR groups. All patients were asked to complete the questionnaire regarding the presence of ocular symptoms, such as eye itching, watery eyes, and red eyes. The correlation between ocular symptoms and the rest of the quality-of-life areas in the Mini-Rhinoconjunctivitis Quality of Life Questionnaire (Mini-RQLQ) was also asked. Results Seven hundred nineteen (61.2%) of 1174 patients had ocular symptoms. In detail, the numbers of patients with eye itching, watery eyes, red eyes, and other ocular symptoms were 605 (51.5%), 313 (26.7%), 207 (17.6%), and 66 (5.6%), respectively. Female patients (72.5%) complained of ocular symptoms more commonly than male patients (55.1%). The patients with moderate–severe persistent AR showed the highest prevalence of ocular symptoms. The correlation coefficients between ocular symptoms and the rest of the quality-of-life areas in the Mini-RQLQ were statistically significant (p < 0.05). Conclusion Sixty-one percent of Korean AR patients experienced ocular symptoms. The patients who were women and had PAR and more severe AR showed higher prevalence of ocular symptoms. The ocular symptoms might have a significant impact on the quality of life in patients with AR.

BACKGROUND The failure rate for frontal sinusotomy is higher than that of overall endoscopic sinus surgery (ESS). To prevent frontal sinus obstruction, systemic or topical steroids are commonly used, but systemic steroid therapy can cause significant morbidity and topical sprays can not be distributed to the frontal ostium. This study was designed to determine the efficacy of anatomically directed topical steroid drops in reducing frontal ostium stenosis compared with topical steroid sprays after ESS. METHODS A prospective, randomized, single-blind study was conducted in 43 patients (77 nasal cavities) who had undergone ESS, including frontal sinusotomy. Twenty-one patients (39 nasal cavities) used steroid drops applied with the Mygind technique, and 22 patients (38 nasal cavities) used steroid sprays for 8 weeks postoperatively. The patency of the frontal ostium was evaluated endoscopically 3 months postoperatively. RESULTS The study included 29 men and 14 women (mean age, 48.2 years; range, 19-62 years). Endoscopic scores in terms of polypoid change, edema, and scar in the middle meatus and frontal recess were not significantly different between the groups, although the drop group showed a tendency to superior scores when compared with the spray group (p > 0.05). The frontal sinus patency of the drop group was significantly higher than of the spray group (p < 0.05). CONCLUSION Topical steroid drops using the Mygind technique led to a 16% improvement in frontal sinus patency rates in 3 month after ESS in this study compared with postoperative topical steroid use.

Background Despite the importance of olfactory function, no effective medications have been identified to treat olfactory disorders. This study was performed to evaluate the functional recovery of olfaction damaged by 3-methylindole (3MI) in a mouse model with hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins). Methods In a randomized placebo-controlled trial, 24 healthy female BALB/c mice (aged 9–10 weeks and weighing 18–20 g each) were randomly allocated to statin-treated or control groups. Olfactory loss was induced by i.p. injections of 3MI. Atorvastatin (10 mg/kg) or normal saline was then administered per os with a gastric tube for 3 weeks. The effects of treatment were evaluated by food-finding tests and Western blot analysis. Results Both groups showed complete losses of olfactory function 1 week after 3MI injection. Three weeks after 3MI injection, 9 of the 12 mice in the statin-treated group (75%) passed a food-finding test, in which they were able to find the food within 3 minutes, at least two times out of three trials. However, only two mice in the control group (16.6%) passed the food-finding test, and this difference was statistically significant (p = 0.004; chi-square test). The expression level of the olfactory marker protein was also elevated in the statin-treated group (p = 0.030; Wilcoxon rank sum test). Conclusion Statins are associated with recovery of olfaction after 3MI injection in a mouse model.

This study identified cut-off values for allergy markers for use in the diagnosis of allergic rhinitis in the absence of other allergic diseases. Total immunoglobulin E (IgE), eosinophil cationic protein (ECP) and the numbers of eosinophils were measured in serum samples from 442 patients with typical symptoms of allergic rhinitis. A definite diagnosis was made on the basis of the presence of specific IgE levels. Cut-off values with a maximal discrimination to diagnose allergic rhinitis were found to be 98.7 IU/ml, 24.7 μg/ml and 4.0% for total IgE, ECP and eosinophils, respectively. Sensitivity, specificity and odds ratio for these values were 75.2%, 69.7% and 6.93, respectively, for total IgE, 55.7%, 74.4% and 3.70 for ECP, and 57.5%, 72.0% and 3.47 for eosinophils. A composite score representing positive results for all three markers had a positive predictive value of 85.3%, with an odds ratio of 8.55. It was concluded that total serum IgE, ECP and eosinophil percentage are strong predictors of allergic rhinitis and the determination of cut-off values for these markers can aid in the diagnosis of allergic rhinitis in the clinical setting.

Background This study was performed to investigate whether statins can enhance the recovery of the olfactory epithelium (OE) damaged by 3-methylindole (3MI), an olfactotoxicant, and to compare the effects with those of steroids. Methods Randomized placebo-controlled trial was performed. Fifty-four healthy female Sprague–Dawley rats (aged 9–10 weeks and weighing 160–180 g each) were randomly allocated to the statin-treated, steroid-treated, or control groups. Olfactory loss was induced using i.p. injection of 3MI in adult rats. Atorvastatin (10 mg/kg for 4 weeks), prednisolone (1 mg/kg for 2 weeks), or normal saline (1 cc for 4 weeks) was then administered per os with a gastric tube. Hematoxylin and eosin (H&E) staining and immunohistochemical staining were performed to evaluate the change of thickness and the arrangement of the OE, and immunoreactivity to protein gene product (PGP) 9.5 and proliferating cell nuclear antigen (PCNA). Results The statin-treated group showed the earliest increase of the thickness of the OE (p = 0.002 at 7 days after 3MI injection) and the immunoreactivity to PCNA (p = 0.032 at 7 days after 3MI injection) among the three groups. The immunoreactivity to PGP 9.5 showed significantly better improvement at the 7th and 28th days after 3MI injection compared with the steroid-treated or control groups (p = 0.002 and p < 0.001, respectively). Conclusion Statins might enhance the proliferation and neuroregenesis of the OE after 3MI injection.

Background The aim of this study was to determine the characteristics of acoustic rhinometric parameters in patients with paradoxical nasal obstruction. Methods The medical records of 1844 patients who had nasal septal deviation between 1998 and 2004 at our institute were assessed retrospectively. The authors selected 31 subjects for the experimental group and 256 subjects for the control group. Minimal cross-sectional area (MCA), volume, and degree of mucosal change at baseline and decongested phase were analyzed. Results MCA of the convex side in the baseline state for the experimental (paradoxical) group is wider than that for the control group (p = 0.005). Degree of mucosal change of the experimental group is smaller than that of the control group in the convex side (p = 0.001). Other parameters are similar for the two groups. Conclusion Patients with paradoxical nasal obstruction might be explained by less degree of mucosal change in the concave side of the nasal cavity during nasal cycle than the control group.

Objectives: In this study, we aimed to investigate the release and response of interleukin (IL)-18 to steroid treatment in a mouse model of allergic rhinitis. Methods: BALB/c mice were sensitized systemically by intraperitoneal injection of ovalbumin and locally by ovalbumin inhalation. Dexamethasone sodium phosphate was given by intraperitoneal injection in the steroid treatment group. Symptom scores, eosinophil counts, and IL-18 concentrations in the nasal and lung lavage fluids 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). The mean IL-18 concentrations in the nasal lavage fluid were not significantly different among the three groups (56.68 ± 9.57, 63.39 ± 8.93, and 64.47 ± 6.83 pg/mL, respectively). The IL-18 concentrations in the lung lavage fluid were significantly different between the positive control group and the steroid treatment group (430.75 ± 154.54 and 69.94 ± 14.26 pg/mL, respectively, p = .028). Conclusions: The IL-18 concentration was found to be increased in the lung lavage fluid, but not in the nasal lavage fluid, in a mouse model of allergic rhinitis. Increased IL-18 concentrations returned toward the previous concentrations after steroid treatment. These results suggest that the roles of IL-18 may be different in the pathogenesis of allergic rhinitis and the pathogenesis of asthma.

Although fungus-related sinusitis has been described for at least 2 centuries, a more detailed pathologic description of the problem as it relates to eosinophilic disease was not detailed until 1983, when “allergic fungal sinusitis” was described histopathologically. Until then, most fungal sinus disease was perceived to occur in immunosuppressed diabetic patients with invasive fungus. It is now acknowledged that depending upon the immune status of the host, fungus-related sinus disease can take several forms. Interest in this subject matter was intensified in 1999, when it was suggested that fungi might be an important cause of most cases of chronic rhinosinusitis. This hypothesis remains controversial, and there is mounting evidence to support the multifactorial nature of chronic rhinosinusitis, which may include fungus. In fact, etiologic factors for all forms of fungus-related sinus disease are still poorly understood. The prevalence of the disease and the dominant fungal pathogen appear to vary in different geographic regions and probably are related to individual host conditions. Immunoglobulin E-mediated allergic reactions to mold appear to be associated with disease in some patients, but not in all. Although antifungal therapy is known to be lifesaving for invasive disease, its role in extramucosal disease is less well defined. Preliminary trials suggest that some systemic and topical antifungal agents are of clinical benefit in extramucosal disease. Since sinus fungi are rarely invasive in immunocompetent individuals, it is not clear whether the effects of the antifungal treatments are a result of the antifungal action itself, or due to additional properties these drugs possess. This review summarizes the available data and presents some of our clinical and experimental findings as to the role of fungus in chronic rhinosinusitis.

Background The phenomenon of recirculation involves the circulation of mucous secretion between the natural ostium and other openings and is observed mainly after surgery when the surgical opening is not connected. Methods Seven patients with a mucous stream transporting into an accessory ostium, as found during endoscopic examination, were entered into study. The coronal computed tomogram findings of the mucous recirculation were analyzed at three levels: anterior, middle, and posterior portion of it. Results The anterior portion was visualized at the level of the natural ostium in five patients. The middle portion inside the maxillary sinus was visible in six cases. The posterior portion was visualized at the level of the accessory ostium in five patients. Among the axial scans, mucous rings were visible in two patients. Conclusions The primary mucous recirculation between the natural and accessory openings is shown as a ring structure in coronal computed tomogram scans.

Background Of 15 patients with primary unilateral antrochoanal polyps (ACPs), we noticed that all ACPs except one extended through the accessory ostium of the maxillary sinus projected posterior along the nasal cavity. We observed no structural changes in ostiomeatal area on a coronal computed tomography scan. Methods We classified 15 patients with ACP into three stages according to the coronal computed tomography findings of (i) status of the accessory ostium of the maxillary sinus and (ii) level of extension to the nasopharynx. The extent of inflammation in the computed tomography and histologic aspects were also evaluated according to such stages. Results In three patients, ACPs did not extend to the nasopharynx (stage I). Among the other ACPs reaching the nasopharynx, complete occlusion of the opening (stage II) was noted in seven patients, and partial occlusion of the opening (stage III) was noted in five patients. The extent of ipsilateral, as well as bilateral, inflammation in the imaxillary sinus in stages I and II was greater than that in stage III. More severe inflammatory cell infiltration was observed in stage II in histologic examination. Conclusions We hypothesize that stage I may correspond to an early stage, stage II to full-blown disorder, and stage III to a regression stage. When the exit site of an ACP is the accessory ostium, this opening should be connected to the natural ostium of the maxillary sinus to prevent a possible recirculation phenomenon.

Backgound The purpose of this study was to investigate differences in the extent of disease in patients with chronic rhinosinusitis (CRS) both with and without asthma. Methods Medical records and computed tomographic (CT) scans of 48 consecutive asthmatic patients and 523 nonasthmatic patients with CRS between April 1995 and December 2001 were reviewed, retrospectively. Each sinus in the ostiomeatal complex CT scans was assigned a score of 0–2 according to the extent of disease using the Lund-Mackay scoring system, and the ratios of the score of each sinus to the total score were analyzed for the difference between the asthmatic and nonasthmatic groups. A Mann-Whitney test was used for statistical evaluation, with p < 0.05 accepted as statistically significant. Results The ratios of ethmoid sinus score to total score were higher in asthmatic patients than in nonasthmatic patients (p < 0.001), and the ratios of the score of maxillary sinus to total score were lower in asthmatic patients than in nonasthmatic patients (p < 0.001). Conclusion Our study shows that the ethmoid sinus is the preferred site of CRS in patients with coexisting asthma.