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Background: Olfactory dysfunction is a frequently encountered sensory disorder that increases with aging, assessed magnetic resonance imaging (MRI); however, reference quantitative values for associated anatomical structures have rarely been suggested. The aim of this study was to assess the parameters of the olfactory bulbs (OBs) and olfactory sulcus (OS) in Korean adults according to age, along with their olfactory function., Methods: We retrospectively evaluated 217 consecutive patients (104 men, 113 women; mean age, 52.4 ± 15.6 years) who underwent sellar MRI and olfactory function testing before transsphenoidal approach at a single tertiary center from March 2022 to December 2023. Based on the T2-weighted MRI, we evaluated the quantitative size parameters and morphological features of patients' OB and OS, along with their olfactory function test scores. We assessed the relationship between OB volume and age in pairwise correlations., Results: The mean OB volume was 45.6 ± 15.3 mm³ in all patients. The patients' mean Korean version of the Sniffin' Sticks (KVSS) test II score was 26.8 ± 4.1. OB volume ( P < 0.001), height ( P < 0.001), and anteroposterior diameter (APD) ( P < 0.001) differed significantly among the different age groups. Reduced OB volume was significantly associated with aging ( r = -0.58, P < 0.001) and a decline in olfactory function scores ( r = 0.34, P < 0.001)., Conclusion: Based on MRI, we proposed reference OB and OS values in adults of different age groups, highlighting the reduction in OB parameters, especially height and APD along with volume associated with aging and olfactory decline. These values can be useful for evaluating adult patients undergoing MRI for olfactory dysfunction., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2024 The Korean Academy of Medical Sciences.)

This study aimed to investigate the effect of age in patients with chronic rhinosinusitis with nasal polyp (CRSwNP). 269 patients were divided into eosinophilic and non-eosinophilic groups based on tissue eosinophilia, defined by eosinophils accounting for more than 20% of the total inflammatory cells. Patients were then further divided into younger and older groups based on the age of 35 years. Clinical characteristics including blood eosinophil, Lund Mackay score, and modified Lund-Kennedy (mLK) scores were compared. Levels of 14 cytokines from nasal tissues of an additional 78 patients were analyzed. Tissue eosinophilia was significantly associated with age and the proportion of non-eosinophilic CRSwNP was significantly higher in younger patients as compared to older patients (79.2% vs 56.6%). There was no difference in clinical characteristics and cytokine levels between the younger and older patients with eosinophilic CRSwNP. In contrast, in patients with non-eosinophilic CRSwNP, younger patients had significantly lower preoperative blood eosinophils and higher mLK scores at three and six months, postoperatively, compared to older patients. Alpha-1 antitrypsin and IL-5 levels were significantly lower in younger patients than in older patients in non-eosinophilic CRSwNP. This study suggests a potential association between age, non-type 2 inflammation and treatment outcome in CRSwNP., (© 2022. The Author(s).)

Conventionally, apnea-hypopnea index (AHI) is used to define and categorize the severity of obstructive sleep apnea. However, routine polysomnography (PSG) includes multiple parameters for assessing the severity of obstructive sleep apnea. The goal of this study is to identify and categorize obstructive sleep apnea phenotypes using unsupervised learning methods from routine PSG data. We identified four clusters from 4,603 patients by using 29 PSG variable and arranged according to their mean AHI. Cluster 1, spontaneous arousal (mean AHI = 8.52/h); cluster 2, poor sleep and periodic limb movements (mean AHI = 12.16/h); cluster 3, hypopnea (mean AHI = 38.60/h); and cluster 4, hypoxia (mean AHI = 69.66/h). Conventional obstructive sleep apnea classification based on apnea-hypopnea index severity showed no significant difference in cardiovascular or cerebrovascular mortality (Log rank P = 0.331), while 4 clusters showed an overall significant difference (Log rank P = 0.009). The risk of cardiovascular or cerebrovascular mortality was significantly increased in cluster 2 (hazard ratio = 6.460, 95% confidence interval 1.734-24.073) and cluster 4 (hazard ratio = 4.844, 95% confidence interval 1.300-18.047) compared to cluster 1, which demonstrated the lowest mortality. After adjustment for age, sex, body mass index, and underlying medical condition, only cluster 4 showed significantly increased risk of mortality compared to cluster 1 (hazard ratio = 7.580, 95% confidence interval 2.104-34.620). Phenotyping based on numerous PSG parameters gives additional information on patients' risk evaluation. Physicians should be aware of PSG features for further understanding the pathophysiology and personalized treatment.

Conclusion: Reconstruction of a large anterior skull base defect (SBD) with the nasoseptal flap (SF) is feasible in Asians. We consider the width of the SF to be the determining factor. Increasing flap width by incorporating the mucoperiosteum of the nasal floor can compensate for the relatively small septum in Asians., Objectives: To assess the feasibility of the SF for reconstruction of large anterior SBD in Koreans, and attempt to provide tips for improving its design., Methods: Radioanatomic measurements and intraoperative findings were analyzed. Specific skull base landmarks were measured to estimate the anticipated SBD and actual SBD. The length and width of the potential SF dimension was also measured and compared with the defect size to assess its feasibility., Results: The lengths of the actual SBDs were longer than those of anticipated SBDs in all patients, while the width of actual SBDs showed less discrepancy. Length and anterior width of the potential SF exceeded the needed SF dimensions in two patients, while the posterior width of potential SF fell short of the needed dimension. In both patients, the length of harvested SF was long enough to repair the entire length of SBD, while shortage of SF width was encountered in one patient.

Objectives/hypothesis: The study group for sinonasal tumors at the Korean Rhinologic Society analyzed the results of the Korean multicenter experience for sinonasal inverted papilloma (IP) surgeries., Study Design: Multicenter cohort study and retrospective analysis., Methods: In total, 939 patients diagnosed with sinonasal IP treated between 1998 and 2007 at 17 university hospitals were enrolled. Demographic data and information about previous surgeries, the origin and involved site of the tumor, the surgical approach, follow-up duration, recurrence, and the presence of malignancy were collected. There were 361 patients whose follow-up was <12 months who were excluded, and 578 patients were included for recurrence analysis., Results: The mean follow-up duration for recurrence analysis was 41.0 months, and 15.7% (91/578) had recurrences, with a mean time to recurrence of 32.6 months. However, the group whose follow-up was longer than 3 years had a higher chance of tumor recurrence. Patients whose IPs involved the frontal sinus or the medial wall of the maxillary sinus had higher recurrence rates. There was no significant difference in recurrence rates according to stage or surgical approach. In the T3 stage of Krouse, the T3-A stage of Furuta, and group B of the Citardi staging system, the endoscopic approach alone resulted in higher recurrence rates., Conclusions: Generally, there were no significant differences in recurrence rates according to clinical stage or surgical approach. Given the rate of delayed recurrence, follow-up of >3 years is required. Moreover, surgeons should always consider combined approaches to reduce the chances of recurrence., (Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.)