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Background The conventional escalation regimen for sublingual immunotherapy (SLIT) in patients with allergic rhinitis has been proven to be safe and successful in reducing allergic symptoms. However, few studies compared the efficacy and safety between a conventional escalation regimen for SLIT and once-daily SLIT. The aim of the present study was to compare the efficacy and safety of once-daily SLIT without escalation (SLITsE) to conventional escalation therapy (SLITwE). Methods This study was a nonrandomized open label observational study. In total, 153 patients suffering from allergic rhinitis symptoms and sensitized to the perennial house dust mite allergens Dermatophagoides pteronyssinus and Dermatophagoides farinae, were enrolled in this study from July 2008 to December 2009. The patients were divided into 2 groups, SLITwE and SLITsE. Each patient was followed with a diary card on which a symptom score, a rescue medication score, and adverse events were recorded. Results All of the nasal symptoms, including rhinorrhea, sneezing, nasal obstruction, itching, and olfactory symptoms, defined as a total nasal symptom score, were reduced after 6 months in both groups (p < 0.05). The rescue medication score, defined as the sum of all of the allergy medications used, also decreased in both groups. Adverse events were similar in both groups, and no major adverse events, such as anaphylaxis, were reported. Conclusion Once-daily SLITsE was well tolerated and showed safe and comparable efficacy compared with a conventional SLITwE regimen.

Guyuron type 2 and Mladina type 1 were the most common types of nasal septal deformity (NSD) in Koreans. The Guyuron classification showed a higher concordance rate with computed tomography (CT) findings than the Mladina classification.The purpose of this study was to classify the NSD according to the Guyuron and Mladina classifications, and to evaluate the correlation between anterior rhinoscopy and CT findings.Each septum of the patients who visited Seoul National University Hospital Health Care Center was classified according to the Guyuron and Mladina classifications. For the patients who underwent septoplasty, the correlation of NSD between anterior rhinoscopy and CT findings was evaluated.Of 970 patients, 50.3% had NSD. According to the Guyuron and Mladina classifications, type 2 (41.4%) and type 1 (35.4%) were most common, respectively. Among 64 patients who underwent septoplasty, the concordance rates with CT findings were 71.9% for the Guyuron classification and 50% for the Mladina classification. This difference was statistically significant (chi-squared test, p = 0.026).

Nasal polyposis implies a refractory clinical course in case of chronic rhinosinusitis (CRS). Although hypoxia is believed to be associated with nasal polyposis, little is known about the mechanism underlying polypogenesis.To determine if hypoxia drives nasal polyposis by epithelial-to-mesenchymal transition (EMT).Immunoblotting, immunofluorescence, flow cytometry, and real-time polymerase chain reaction were performed to evaluate EMT and hypoxic markers in human nasal epithelial cells (hNECs) and in sinonasal tissues from patients with CRS with or without polyps. In addition, the effects of hypoxia-inducible factor (HIF)-1α inhibitors on nasal polypogenesis were investigated in a murine model.E-cadherin and α-smooth muscle actin (α-SMA) were down-regulated and up-regulated, respectively, in patients with polyps as compared with patients without polyps. Under hypoxia, hNECs transformed to a mesenchymal shape, and demonstrated representative changes in EMT markers; that is, mesenchymal markers (α-SMA, vimentin, and twist) increased but epithelial markers (E-cadherin and β-catenin) decreased. Mechanistically, E-cadherin level was recovered in hypoxia by silencing HIF-1α and decreased in normoxia by expressing HIF-1α. Furthermore, hypoxia was found to down-regulate PP2Ac phosphatase and up-regulate pSmad3, which led to α-SMA induction. In CRS sinonasal specimens, HIF-1α expression was found to correlate with E-cadherin loss and α-SMA expression. Finally, HIF-1α inhibitors suppressed nasal polypogenesis in a murine model.hNECs undergo EMT during hypoxia and this process is critically mediated by HIF-1α and pSmad3. This study shows that hypoxia-induced EMT is likely to contribute to nasal polyposis in CRS, and suggests that HIF-1α be viewed as a therapeutic target for nasal polyposis.

Background Nonasthmatic subjects with allergic rhinitis often have bronchial hyperresponsiveness (BHR), characteristic of asthma. The presence and degree of atopy is suggested to be important for BHR in patients with asthma. We aimed to assess BHR to methacholine (direct stimulus) and to adenosine 5′-monophosphate (AMP; indirect stimulus) in preschool children with allergic rhinitis and to investigate their relationship with the degree of atopy. Methods Methacholine and AMP bronchial challenges were performed in preschool children with allergic rhinitis (n = 96), using a modified auscultation method. The end point concentration, resulting in audible wheezing and/or oxygen desaturation, was determined for each challenge. The degree of atopy was assessed using serum total IgE levels, the number of positive skin-prick tests, and atopic scores (sum of graded wheal size). Results BHR to methacholine (end point concentration, ≤ 8 mg/mL) and to AMP (end point concentration, ≤ 200 mg/mL) was observed in 32 (33.3%) and 26 (27.1%) subjects, respectively. No significant relationship was observed between BHR to methacholine and any atopy parameter. In contrast, the atopic scores were higher in the AMP–BHR+ group compared with the AMP–BHR− group, and a significant association was found between the degree of atopic scores and the frequency of BHR to AMP (score for trend, p = 0.006). Such a relationship was not observed for serum total IgE levels and the number of positive SPTs. Conclusion BHR to methacholine and BHR to AMP were detected in a significant proportion of preschool children with allergic rhinitis. The degree of atopy in terms of atopic scores seems to be an important factor for BHR to AMP but not for BHR to methacholine.

Background Sinonasal inverted papilloma (IP) is a neoplasm in the nasal cavity, characterized by its local aggressiveness and tendency to cause malignancy. Despite the frequent recurrence of IP, few studies have reported the effects of situational parameters including smoking on the recurrence rate of IP. This study was performed to evaluate clinical and environmental factors including smoking that can predict neoplasm recurrence after surgery in patients with IP. Methods This study was conducted retrospectively on 132 patients who were diagnosed with IP between November 1985 and September 2007. The study focused on the risk factors of recurrence, such as smoking behaviors, diabetes mellitus (DM), hypertension (HTN), allergic rhinitis (AR), the sites of tumor origin and involvement, neoplasm staging, and the surgical method. The age of the patients ranged from 22 to 85 years, and among the 132 patients, 39 patients were smokers (29.5%), 17 (13.3%) with DM, 31 (24.4%) with HTN, and 11 (9.3%) with AR. Results The recurrence rate showed great disparity between the groups of smokers and nonsmokers: 28.2% of smokers suffered recurrence compared with 10.7% recurrence from the nonsmoker group. The Krouse stage IV group experienced more frequent recurrence than the stage I, II, and III groups. Some patients in Krouse stage III (5/72, 6.9%) and IV (3/3, 100%) groups underwent malignant transformation of IP. Histories of DM, HTN, and AR did not exert a statistically meaningful influence on the recurrence and malignant transformation. Conclusion The smoking behavior and tumor with extranasal/sinus extension appear to be associated with recurrence of IP after surgical resection.

Background There have been no data on sublingual immunotherapy (SLIT) in Asian patients with allergic rhinitis (AR) sensitized to house-dust mites (HDMs). This study aimed to investigate the efficacy and immunologic change after 12 months of SLIT in Korean patients. Methods Fifty-eight patients, who had AR caused by Dermatophagoides pteronyssinus and Dermatophagoides farinae and who completed 12 months of SLIT were included. Symptom scores were evaluated before and after 12 months of SLIT, and medication scores were assessed throughout the study. Peripheral blood eosinophil counts, eosinophil cationic protein (ECP), total IgE, and specific IgE were also evaluated. Results All of the symptoms of AR were significantly improved with reduced medication scores. In addition, there were significant decrements in peripheral blood eosinophil counts and ECP (p = 0.025 and p = 0.048, respectively). Specific IgE for D. farinae slightly increased (p = 0.019), whereas specific IgE for D. pteronyssinus and total IgE did not change significantly. Thirty-six (62%) of 58 patients were in the effective response group. Although not statistically significant, findings in the study showed that the effective response group had a tendency to have higher ECP levels before SLIT than the ineffective response group (p = 0.056). Conclusion SLIT improved the symptoms and medication scores in Korean patients with AR from HDM. Laboratory parameters including eosinophil counts, ECP, and specific IgE for D. farinae seemed to be modified after 1-year SLIT. A high ECP level may be a useful parameter to predict the effectiveness of SLIT and select the patient for the treatment.

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.

Objective To determine the influence of allergic rhinitis (AR) on the expression of matrix metalloproteinase (MMP)-9, MMP-2, and tissue inhibitor-1 of metalloproteinase (TIMP-1) in nasal polyposis. Study Design A case-control study. Setting A tertiary referral center. Subjects and Methods The expression of MMP-9, MMP-2, and TIMP-1 was investigated in the nasal polyp tissue (NP) and maxillary sinus mucosa (MM) samples from 20 AR patients and 20 nonallergic patients undergoing endoscopic sinus surgery. Trichrome, periodic acid–Schiff, and hematoxylin-eosin staining were also performed and those expression levels were compared. Results Infiltration of eosinophils was shown more intensely in NP rather than in MM, especially in the presence of AR. In the NP of AR patients, increased expression of MMP-9, MMP-2, and TIMP-1 was observed more prominently than in that of the control group. In case of MM, however, there was no significant difference between AR patients and the control group. Conclusion The presence of AR may enhance the expression of MMP-9, MMP-2, and TIMP-1 associated with airway remodeling in nasal polyposis.

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.

Summary Objective Tonsillectomy is one of the most commonly performed procedures in children. However, parents often hesitate to agree to the procedure because of concerns of the possible harmful impact on their child's psychological health. The present study was performed to examine the short-term psychological impact on children who had undergone tonsillectomy. Methods Forty-three pediatric patients aged 3–11 years who underwent tonsillectomy were enrolled in the study. Postoperative pain was assessed using a 10-point visual analog scale (VAS) on postoperative days 1, 2, 7, and 21. The Korean version of the Child Behavior Checklist (K-CBCL) was given to the parents of the children to evaluate the psychosocial effect of tonsillectomy on the preoperative day and on postoperative day 21. Results There were no significant differences in postoperative pain according to age, tonsil size, degree of adhesion, or operation time. There was no significant relationship between postoperative pain score and K-CBCL score. Sociality, total behavioral problems, externalizing problems, internalizing problems, anxiety/depression, social immaturity, and emotional lability domain scores on the K-CBCL were improved significantly. Conclusions Improvements in general emotional and social status were observed at 3 weeks after tonsillectomy. Tonsillectomy itself does not have a harmful effect on children's psychological status.

Objective/hypothesis Ciliary wave disorder (CWD) is essential for effective mucociliary transport. The purpose of this study was to investigate morphologic and functional restoration in recovered sinus mucosa after 12 weeks of experimentally induced rhinosinusitis and regenerated sinus mucosa after mechanical injury. Study design Prospective study with animal models. Methods Ten New Zealand white rabbits weighing between 2.5 and 3 kg were used for this experiment. In the recovered mucosa group (n = 5), the natural ostium of the maxillary sinus was closed with a synthetic sponge and removed 2 weeks later. In the regenerated sinus mucosa group (n = 5), maxillary sinus mucosa was stripped off through the anterior wall. Left sinus mucosae were used as controls. Twelve weeks postoperatively, ciliary beat frequency (CBF) and CWD were measured using an image analysis system. Morphologic changes in cilia were also observed using a scanning electron microscope (SEM). Results The average CBFs in control, recovered, and regenerated mucosa were 13.21 +/- 3.66 Hz, 13.20 +/- 3.53 Hz, and 14.16 +/- 3.87 Hz, respectively. The average CWDs in these groups were 8.46 +/- 4.4, 21.04 +/- 14.73, and 24.43 +/- 19.2, respectively. SEM showed that loss of cilia and irregularities of ciliary arrangements were prominent in regenerated sinus mucosa. Conclusion Although 12 weeks is enough for morphologic regeneration of the ciliated epithelium after experimental sinusitis in rabbit maxillary sinuses, it does not appear long enough for full functional recovery. Restoration of CBFs does not equate to concurrent CWD restoration.

Inflammatory diseases, such as non-specific sinusitis, fungal sinusitis and mucocele, commonly involve the sphenoid sinus. Endoscopic surgery provides an easy and successful access to isolated sphenoid sinus diseases (ISSDs) with rare complications.The incidence of ISSDs has decreased since a wide use of antibiotics. ISSDs can cause severe complications due to the deep location in the skull base. Endoscopic surgery for the sphenoid sinus has recently become popular, with several advantages. The aim of this study was to analyse ISSDs in terms of the clinical symptoms, histological diagnosis and treatment outcomes with our 22 years' experience.Seventy-six patients with ISSDs, who were treated at Seoul National University Hospital between 1985 and 2007, were analysed. Patients with lesions confined to the sphenoid sinus were included. A retrospective chart review was performed with respect to the symptoms, pathology and treatment outcomes.Fifty-seven of 76 cases were inflammatory lesions, 9 neoplastic lesions and 10 fibrous dysplasia. Headache was the most common symptom (65.8%), followed by nasal obstruction (22.4%) and postnasal drip (21.0%). Ophthalmologic symptoms were observed in 15 cases (19.7%). Endoscopic sphenoidotomy was performed in 51 of the 57 ISSDs. Symptoms completely improved in 92.2% of the patients.

Background: Subjects with allergic rhinitis but no clinical evidence of asthma have greater bronchial hyperresponsiveness (BHR), and several factors have been implicated as its determinants. However, studies in young children are lacking. The aims of this study were to evaluate the prevalence of BHR in young children with allergic rhinitis and to investigate its risk factors. Methods: Methacholine bronchial challenges were performed in 4- to 6-year-old nonasthmatic children with allergic rhinitis (n = 83) and in healthy nonatopic controls (n = 32), using a modified auscultation method. The end-point was defined as the appearance of wheezing and/or oxygen desaturation. Subjects were considered to have BHR when they had end-point concentrations of methacholine ≤8 mg/mL. Clinical and laboratory data in allergic rhinitis patients and a history of allergic diseases in their parents were collected. Results: BHR was observed in 27 subjects with allergic rhinitis (32.5%) and three controls (9.4%). Among subjects with allergic rhinitis, serum total IgE, the number and pattern of skin-prick test responses, blood eosinophil markers, and parental history of allergic rhinitis and atopic dermatitis were not different between the BHR(+) and BHR(−) groups, whereas the persistent type of rhinitis and parental history of asthma were more frequent in the BHR(+) group than in the BHR(−) group. These associations remained significant in a multivariable logistic regression. Conclusions: Young children with allergic rhinitis alone showed an increased prevalence of BHR. Both persistent type of rhinitis and parental history of asthma were significant and independent risk factors for BHR in these children.

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.

The changes of nasal resistance and cross-sectional area (CSA) with aging could suggest that it might be attributed to the change (atrophy) of the non-erectile structural tissues including bone and soft tissues rather than the erectile tissues. Subjects older than 60 years of age had significantly slower ciliary beat frequency (CBF), which could suggest nasal function might begin to decrease at around 60 years of age.Nasal physiology can be changed with aging, however, there has been little data that prove senile change of the nasal cavity. This study was conducted to evaluate the effect of aging on nasal resistance and ciliary movement of the nasal cavity.One hundred and fifty three healthy subjects were included in this study. Acoustic rhinometry and rhinomanometry before and after nasal decongestion, and CBF were measured.The CSA at the attachment of the inferior turbinate was increased with age in both before and after decongestion. However, the difference of CSA between pre- and post-decongestion did not change significantly with age. At the nasal valve area, the CSA showed almost same values between age groups and the difference between pre-and post-decongestion was very small. The nasal resistance was markedly decreased from 2nd to 3rd decade and did not change significantly after 3rd decade. Subjects older than 60 years of age had significantly slower CBFs compared to those younger than 60 years (10.18+/-0.98 vs. 12.43+/-1.46) (P.001).

The results of our study suggest that Staphylococcus aureus enterotoxin A (SEA) may play an important role in the pathogenesis of rhinosinusitis by ciliostatic effects at high concentrations, and by a different mechanism at low concentrations.To investigate the in vitro effects of SEA on ciliary activity and its in vivo effects on histology of the sinus mucosa.The in vitro effects of SEA on ciliary activity at different concentrations and exposure time were investigated using maxillary sinus mucosa harvested from experimental rabbits. After in vivo instillation of different concentrations (high and low dose) of SEA into the maxillary sinus, ciliary beat frequency (CBF) and histologic findings of the maxillary sinus mucosa were examined.After exposure to low doses of SEA (0.03 and 0.3 ng/ml), CBF did not decrease, but after exposure to high doses of SEA (1.5, 3, and 30 ng/ml), CBF decreased significantly as a function of time. At 24 h after instillation of high-dose SEA (30 ng/ml) into the sinus, CBF decreased significantly and rhinosinusitis was induced after 7 days. Although no alteration was observed in the CBF of the sinus mucosa after instillation of low-dose SEA (0.3 ng/ml), histological findings of rhinosinusitis including subepithelial edema and inflammatory cell infiltration were observed.

Objectives This study aimed to investigate the cellular pathogenetic mechanism involved in olfactory tissue injury and regeneration. Study Design Adult male mice were exposed to 40 ppm SO2 for 2 hours. Methods The mice were sacrificed immediately, 4 hours, and 1, 3, 5, 7, 10, 14, and 21 days after exposure to SO2. Olfactory neuroepithelium and bulbs were harvested at the time of sacrifice. Western blot and immunohistochemical staining were performed. Results Injuries of the olfactory neuroepithelium were found 24 hours after exposure to SO2. The number of total olfactory neuroepithelial cells decreased after SO2 exposure and recovered after 3 weeks. In contrast, the number of proliferating cell nuclear antigen (PCNA)–positive cells increased after SO2 injury and then decreased. In the neuroepithelium, where PCNA expression increased, olfactory marker protein (OMP)–positive cells were sparse. The expression of inducible nitric oxide synthase (iNOS) was localized in the lateral half of the turbinates. However, there was no expression of iNOS in the medial half of the turbinates, in which PCNA was strongly expressed. There was increased immunoreactivity of neuronal NOS (nNOS) in the surviving cells after SO2 exposure. Immediately after exposure to SO2, the immunoreactivity to phosphorylated fraction of extracellular signal-regulated kinases (phospho-ERK)-1/2 increased in the cytoplasm and nucleus of supporting cells. In Western blot analysis, nNOS expression increased 4 hours after SO2 exposure. Conclusions These findings suggest that the regenerative activity of the neuroepithelium might be well demonstrated by PCNA immunoreactivity and that regeneration of the neuroepithelium can be activated several days after SO2 injury. The two NOS isoforms, iNOS and nNOS, might contribute to neuroprotection in the olfactory neuroepithelium.

Summary Background Allergic rhinitis is a known predictor and correlate of asthma incidence. However, it is not clear which patients with allergic rhinitis are at greater risk of the development of asthma. Objective The aim of this study was to investigate whether airway hypersensitivity and/or increased maximal response on the dose–response curve to methacholine would predict the development of asthma in subjects with allergic rhinitis. Methods One hundred and forty-one children with allergic rhinitis were prospectively studied for 7 years. At the initiation of the study, bronchial provocation test with methacholine using a stepwise increasing concentration technique was performed to measure PC20 (provocative concentration causing a 20% fall in FEV1) and maximal response. Each subject was evaluated at least every 6 months and details of asthmatic symptoms or signs experienced during the intervening period were taken. Results Twenty of 122 subjects available for the follow-up developed asthma. Nine (19.6%) of 46 hypersensitive (PC20

Objectives To introduce a new surgical technique for endoscopic removal of the antral portion of antrochoanal polyp (ACP) by powered instrumentation and to determine its efficacy by measures of relevant patient outcome. Study Design Prospective study in 28 patients undergoing endoscopic sinus surgery for ACP by our surgical technique. Methods Improvements of clinical symptoms and endoscopic and computed tomographic findings were evaluated postoperatively with a follow-up period ranging from 12 to 52 months. All symptom scores on a 100-mm visual analogue scale before operation were compared with those at the last visit after operation. Postoperative endoscopic and computed tomographic findings were graded using a three-point scale ranging from 0 to 2. In surgical technique, the antral portion of ACP was identified through the enlarged ostium under intranasal endoscopy and removed by a blade of powered instrumentation that was inserted through the canine fossa. Results Symptom scores were all significantly reduced postoperatively. All but one patient showed improvement in clinical symptoms and endoscopic and computed tomographic findings during the follow-up period. There were no major complications specific to this technique. Conclusion Our technique provides an attractive alternative to other methods for removing the antral portion of an ACP and is associated with excellent outcomes and minimal morbidities.

Various saline solution formulae are frequently used in patients with rhinosinusitis. Osmolarity affects ciliary beat frequency (CBF); however, little is known about the effects of saline solutions on ciliary activity of nasal epithelial cells. The aim of this study was to assess whether CBF of normal turbinate mucosa is affected by hypertonic, isotonic, or hypotonic saline solution in vitro and whether histologic changes are associated with the alteration of ciliary movement. We assessed variations of CBF after exposure to 0.06%, 0.12%, 0.9%, 3.0%, or 7.0% saline solutions and histologic changes were examined by transmission electron microscopy. Isotonic and hypotonic solutions produced no ciliary slowing; however, ciliostasis was observed within a few minutes in 3.0% or 7.0% solution. The histologic changes demonstrated that the ciliary slowing might be attributed to epithelial damage by fluid transport toward the surrounding medium. In conclusion, hypertonic saline solutions decrease CBF and disrupt nasal epithelial cells in vitro. (Otolaryngol Head Neck Surg 2001;124:313-6.)

Multicenter Study on the Prevalence of Perennial Allergic Rhinitis and Allergy-Associated Disorders This study was aimed to determine the prevalence of perennial allergic rhinitis (PAR) using the skin test, radioallergosorbent test (RAST), or multiple allergosorbent test (MAST) and to clarify the clinical aspects of the patients diagnosed as having PAR by the questionnaire survey and rhinologic examination. The 71,120 subjects who had visited the 23 otolaryngology clinics at the randomly selected tertiary referral hospitals in Korea between November 1, 1999 and April 30, 2000 were studied. PAR was diagnosed when subjects complained of two or more associated symptoms and the skin test, RAST, or MAST using perennial inhalant allergens was positive. The questionnaire survey and rhinologic examination were performed in subjects with PAR. The prevalence of PAR was 3.93%. We could find no significant difference in the prevalence of PAR between the two sexes. However, there was a significant difference in the prevalence of PAR between the child and adult groups. The chief complaints were, in order of decreasing frequency, nasal obstruction, watery rhinorrhea, and sneezing. There was a family history of PAR in 40.2% of the subjects. The 39.6% of the subjects had associated allergic diseases, being atopic dermatitis most common. In conclusion, the prevalence of PAR in tertiary referral hospitals in Korea is 3.93%. Many subjects with PAR have family history and appear to be associated with other allergic diseases.

Objectives Temperature-controlled and temper-ature-monitored radiofrequency tissue volume reduction (RFTVR) for the turbinate is a new treatment modality for nasal obstruction secondary to turbinate hypertrophy. We compared the nasal functions after the treatment of RFTVR and laser vaporizing turbinoplasty (LVT) using subjective symptom scores and objective tests. Study Design Prospective, randomized clinical trial. Methods Twenty-four patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively evaluated from March 1999 to October 1999 at Seoul National University Hospital (Seoul, Korea). Si-teen patients were treated with RFTVR, and eight patients with LVT. The preoperative and postoperative nasal functions were investigated by visual analogue scale of symptoms, butanol threshold test, saccharine test, acoustic rhinometry, rhinomanometry, and ciliary beat frequency. Results At 8 weeks postoperatively, the severity and the frequency of nasal obstruction improved subjectively in 81.3% and 93.8% of RFTVR group and in 87.5% and 87.5% of LVT group, respectively. Significant improvement of nasal symptoms began from 2 to 3 days after the operation in the RFTVR group, whereas there was significant improvement of nasal symptoms at 8 weeks after operation in the LVT group. However, objective nasal functions including nasal volume and total nasal resistance were significantly improved at 8 weeks after surgery in both groups. Among patients reporting symptoms of hyposmia, 55.6% of RFTVR group and 63.6% of LVT group showed improved olfaction. Saccharin transit time and ciliary beat frequency were preserved after RFTVR. Conclusion RFTVR for the turbinate may be useful as an alternative approach for the treatment of chronic turbinate hypertrophy.

Objectives To investigate the in vitro effects of staphylococcal β-to-in on ciliary activity and the in vivo effects on sinusitis induction. Study Design The in vitro effects of staphylococcal β-to-in on ciliary activity were investigated at different concentrations and e-posure times. E-perimental sinusitis was induced in rabbits with application of β-to-in and confirmed 7 days later. Methods Ciliated epithelial cells were taken from the ma-illary sinus mucosa of 10 rabbits. Five culture dishes from each rabbit were used for the e-perimental group, and one culture dish from each rabbit was used for the control group. In the experimental group, ciliary beat frequency (CBF) was measured at concentrations of 0.1, 1, 2, 5 and 10 U/mL of β-toxin using a video-computerized analysis technique, while in the control group, culture medium containing no toxin was used. CBF was measured 1, 2, 4, 6, 8, 12, 24, and 48 hours after administration of β-toxin. To induce experimental sinusitis, 2 U/mL of β-toxin was percutaneously applied to the maxillary sinus of 10 rabbits without occlusion of the natural ostium, while normal saline was percutaneously applied to the right-side maxillary sinus of 4 rabbits in the control group. At 7 days, mucosal membranes were taken from the inferomedial wall of the maxillary sinus for light microscopic study. Results CBF dropped significantly after an 8-hour incubation at 2, 5, and 10 U/mL of β-to-in. No ciliary activity was observed after a 24-hour incubation at 2 and 5 U/mL and a 12-hour incubation at 10 U/mL of β-to-in. Mucoid, purulent discharge was observed in the ma-illary sinuses of the β-to-in–applied group. Prominent epithelial disruption and infiltration of inflammatory cells into the epithelium and lamina propria were observed in the β-to-in–applied group. Conclusions Staphylococcal β-to-in may reduce ciliary activity and induce sinusitis without occlusion of the natural ostium of the ma-illary sinus in rabbits. This study provides another animal model of sinusitis for understanding the pathogenesis of sinusitis induced by bacterial e-oto-ins.

Platelet activating factor (RAF), a potent chemical mediator in inflammation and allergic reaction, has been thought to induce mucociliary inhibition and epithelial damage in the airway mucosa. However, several recent papers have reported that PAF may not readily damage the airway epithelium. The aim of this study was to elucidate the pathogenesis of PAF-induced epithelial damage in terms of ultrastructural changes. Sixteen micrograms of PAF (1 mL of 16 μg/mL) was administered into the maxillary sinuses of rabbits. The rabbits were divided into 2 groups according to time intervals, and the antral mucosa was taken 1 and 3 days after administration of PAF. The tissue was processed for routine transmission electron microscopy. No epithelial degeneration was observed other than platelet aggregation, red blood cell stasis, and swelling of the endothelial cells 1 day after administration of PAF. Migration of inflammatory cells into the perivascular connective tissue, infiltration of eosinophils into the subepithelial and intraepithelial spaces, and vacuolar degeneration of the epithelial cells with focal loss of cilia were seen 3 days after administration of PAF. In conclusion, PAF induced infiltration of eosinophils into the epithelium, and resulted in epithelial degeneration that varied according to the time interval. Our findings suggest that PAF may cause epithelial damage through a series of secondary events, probably due to cytotoxicity of eosinophils infiltrating the epithelium.

Macrolide antibiotics have a variety of actions along with antimicrobial action. To determine the effects of oral administration of clarithromycin (CAM) on rheological properties, we measured the spinability, dynamic viscoelasticity, and solid composition of human nasal mucus from 18 patients with chronic sinusitis before and after administration of CAM for 4 weeks. After administration of CAM, the spinability and percent solid composition of nasal mucus increased from 26.5 ± 12.2 mm to 40.2 ± 18.7 mm and 7.86% ± 3.47% to 13.90% ± 3.67% (p < .05), respectively, whereas the ratio of the viscosity to the elasticity (η′/G′) of nasal mucus after the administration of CAM decreased in all of the mucus samples. These results suggest that treatment with CAM may modulate the rheological properties of nasal mucus in patients with chronic sinusitis.

Study objective: There is growing evidence that regular b2-agonist use in patients with asthma is associated with decreased airway caliber and increased bronchial responsiveness. The aim of this study was to determine whether regular treatment with b2-agonists induces changes in lung function and bronchial responsiveness in patients with primary ciliary dyskinesia. Design: A randomized, double-blind, placebo-controlled, crossover study. Patients: Nineteen children with primary ciliary dyskinesia. Interventions: Subjects received inhaled salbutamol or identical placebo (2 3 100 mg qid) for periods of 6 weeks with a wash-out period of 4 weeks. Measurements and results: FEV1 was measured before and 3 weeks and 6 weeks after salbutamol or placebo treatment. High-dose methacholine inhalation tests were performed before and 6 weeks after each treatment. The provocative concentration of methacholine producing a 20% fall in FEV1 (PC20) and maximal airway narrowing (MDFFEV1) was measured. No significant change in FEV1 was observed during the salbutamol or placebo periods. No significant differences in the parameters of bronchial responsiveness (PC20 and MDFFEV1) were noted as the result of either salbutamol or placebo treatment. Conclusion: Our data have shown that salbutamol, inhaled regularly for 6 weeks, did not cause either a decline in lung function or an increase in bronchial responsiveness in subjects with primary ciliary dyskinesia. (CHEST 2000; 117:427‐ 433)

Objective: The in vitro effects of staphylococcal α-toxin on ciliary activity were investigated at different concentrations and exposure times. Study Design: Ciliated epithelial cells of the sphenoid sinus were taken from patients operated on for pituitary tumors. Video-computerized analysis technique and transmission electron microscopy were used to analyze the effects of the toxin on ciliary activity. Methods: Ciliary beat frequency (CBF) was measured in four different concentrations of α-toxin including 0.1, 1, 10, and 50 μg/mL. CBF was measured at 2, 4, 6, 12, 24, and 48 hours after administration of the toxin. To observe reversibility of the reduced ciliary activity, after 24-hour incubation in the media containing 10 μg/mL of α-toxin, the media were replaced with α-toxin-free media. The tissues were also processed for transmission electron microscopy to observe ultrastructural changes of the epithelial cells. Results: CBF increased significantly at 2-hour incubation and then decreased significantly after 12-hour incubation in 10 μg/mL of α-toxin (P< .05, repeated-measures ANOVA). The transmission electron microscopic findings showed mitochondrial swelling and a slight protrusion of the plasma membrane of the cilia. In toxin-free media, loss of ciliary activity was not recovered. Conclusions: CBF increased at first, but with increasing incubation time ciliary movements decreased gradually and stopped eventually. This loss of CBF may be an irreversible change associated with ultrastructural changes in the mitochondria and the plasma membrane of the cilia.

This study aimed to investigate expression of various cytokine mRNAs, including IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma in maxillary sinus mucosa of patients with chronic sinusitis. Maxillary sinus mucosae of six patients with chronic sinusitis and turbinate mucosae of six healthy subjects were obtained. We performed RT-PCR and Southern blot to examine gene expression of the cytokines IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma in maxillary sinus mucosa and compared the results with cytokine gene expressions in normal turbinate mucosa. IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma mRNAs were expressed more frequently in maxillary sinus mucosa from patients with chronic sinusitis than in normal turbinate mucosa. All the maxillary sinus mucosa specimens revealed relatively higher mean density ratio for each cytokine investigated than did normal turbinate mucosa. IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma mRNAs were expressed simultaneously in maxillary sinus mucosa of chronic sinusitis. These cytokines may be responsible for recruitment of inflammatory cells and for mucosal thickening in chronic sinusitis, and thus chronicity of the disease.

Nasal polyps are the most common mass lesion of the nasal cavity. Various pathogenetic mechanisms have been proposed. However, the cause is still largely unknown, and treatment methods have not been changed for several hundred years. In order to investigate the role of cytokines in the pathogenesis of nasal polyps, expression of cytokine messenger RNAs (mRNAs) in nasal polyps was investigated. We performed reverse transcriptase-polymerase chain reaction and Southern blot to examine gene expression of the cytokines interleukin (IL)-1 beta, IL-6, IL-8, transforming growth factor (TGF)-beta, IL-4, IL-5, and interferon (IFN)-gamma and compared the results with the gene expressions of these cytokines in normal nasal mucosa. Nasal polyp tissues were obtained from 14 patients undergoing polypectomy for nasal obstruction. Among them, 4 patients suffered from associated perennial allergic rhinitis. The mRNAs of IL-4 and IL-5 (Th2 cytokines) as well as IFN-gamma (Th1 cytokine) were expressed in all of the nasal polyps obtained from the 14 patients, irrespective of the presence or absence of allergy, while 2, 0, and 4 of 6 normal turbinate mucosae expressed IL-4, IL-5, and IFN-gamma mRNAs, respectively. The mRNAs of IL-1 beta, IL-6, IL-8, and TGF-beta were expressed in 6, 1, 2, and 3 of 6 normal turbinate mucosae, respectively, while the mRNAs of these cytokines were expressed in all of the 14 polyp tissues except IL-6 mRNA, which was expressed in 13 nasal polyp tissues. There were no differences in the mean density ratios of each cytokine band on Southern blot between polyp tissues with allergy and those without allergy. These results suggest that many cytokines are produced in nasal polyps, that they may play important roles in the pathogenesis of nasal polyps, and that allergy per se may not play a fundamental role in the pathogenesis of nasal polyps.

Previous reports suggest that cytokines may be involved in proliferation of the epithelium. The aim of this study was to determine the effects of cytokines, IL-1 beta, TNF-alpha, and TGF-beta on proliferation of human nasal epithelial cells (HNECs) in vitro. Primary cells were cultured from HNECs on collagen gel matrix. Subcultured HNECs were incubated in a medium with recombinant human (rh) cytokines, rhIL-1 beta, rhTNF-alpha, and rhTGF-beta at different concentrations of 0.01 ng/mL, 0.1 ng/mL, 1 ng/mL, 10 ng/mL, and 100 ng/mL. After 2-day incubation with these cytokines, daily cell proliferation was measured by MTT assay for 6 days. While rhIL-1 beta inhibited proliferation of HNECs in concentration-dependent and time-dependent manners, rhTNF-a stimulated HNEC growth at concentrations ranging from 0.01 ng/mL to 10 ng/mL in concentration-dependent and time-dependent manner. In contrast, rhTGF-b inhibited HNEC growth irrespective of concentration and incubation time. This study suggests that IL-1 beta, TNF-alpha, and TGF-beta may have an important role in the repair of the nasal mucosa by regulating proliferation of the nasal epithelium.

The in vitro effects of phenylephrine solution on ciliary beat frequency (CBF) in terms of different concentrations and exposure times were investigated using a video-computerized analysis technique. Nasal epithelial cells were taken from inferior turbinate of 10 volunteers by scraping the nasal mucosa with a cytology brush. CBF was measured in five different concentrations including 0.125%, 0.25%, 0.5%, 1%, and 2.5%. Each specimen was incubated in different solution for 6 days and CBF was measured at 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, 12 hours, 1 day, 2 days, 3 days, 4 days, 5 days, and 6 days. CBF decreased significantly after 12-hour incubation in 0.125% phenylephrine solution and after 8-hour incubation in 0.25% phenylephrine solution, both clinically used concentrations. There were significant decreases in CBF after incubation in 0.5% phenylephrine for 2 hours, in 1% for 1 hour, and in 2.5% for 30 minutes (P < 0.05, repeated measure analysis of variance [ANOVA]). CBF of the nasal respiratory ciliated cells significantly decreased with increasing concentrations of phenylephrine solution and with increasing incubation times at the same concentration (P < 0.05, repeated measure ANOVA). The results of this study suggest that phenylephrine may inhibit ciliary beat in vitro by its pharmacological effect at lower concentrations than clinically used ones.

Introduction Obstructive sleep apnea syndrome (OSAS) is associated with erectile dysfunction (ED). The improvement of ED after medical therapy including continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is still controversial. Furthermore, the efficacy of surgical treatment has been little investigated. Aim The aim of this nonrandomized prospective study was to evaluate the effects of surgical (uvulopalatopharyngoplasty [UPPP]) and nonsurgical approaches (CPAP and MAD) on ED and quality of life (QOL) in OSAS. Methods OSAS patients underwent UPPP (N = 30), CPAP (N = 16), or MAD (N = 10) and completed the Korean versions of the International Index of Erectile Function questionnaire (KIIEF-5) and the Calgary Sleep Apnea Quality of Life Index (SAQLI) before and after a median of 7 months of treatment (interquartile range, 4–15 months). All patients underwent a full-night in-laboratory polysomnography at baseline and follow-up. Main Outcome Measure The main outcome measures are the KIIEF-5 and SAQLI scores. Results CPAP group showed older age, higher body mass index, and more severe OSAS than other groups. Apnea–hypopnea index and lowest oxygen saturation level improved significantly in all groups, but Epworth Sleepiness Scale score decreased significantly in UPPP and MAD groups. Significant increase of KIIEF-5 was observed in patients who underwent UPPP ( P = 0.039, paired t -test), but not in nonsurgical treatment group. All groups had the tendency of better QOL after treatment, but statistical significance was found only in MAD group. Neck circumference ( r = 0.360, P = 0.006) and KIIEF-5 score ( r = −0.484, P Conclusions This study demonstrated that ED in OSAS may improve following UPPP. Better disease-specific QOL was observed after both surgical and nonsurgical therapies in OSAS. These findings suggest that interventions for OSAS can provide the alleviation of ED and increase QOL in OSAS patients with ED, especially if they had pronounced complaints of ED and wide neck circumferences. Shin H-W, Park J-H, Park J-W, Rhee C-S, Lee CH, Min Y-G, and Kim D-Y. Effects of surgical vs. nonsurgical therapy on erectile dysfunction and quality of life in obstructive sleep apnea syndrome: A pilot study. J Sex Med 2013;10:2053-2059.

This study attempts to evaluate the use of auricular cartilage for the treatment of nasal septal defects. A defect was made in the nasal septal cartilage in five rabbits and auricular cartilage grafted into the defect. The cartilage was microscopically examined 4 weeks later. The implanted cartilage was completely covered by ciliated columnar epithelium with minimal scar formation. Proliferation of the implanted cartilage and scattered ossification were observed. Seventeen patients with a nasal septal defect were treated by auricular cartilage implantation from April 1987 to through June 1992. Fifteen patients (88%) had relief of symptoms and showed complete closure of the defect with a follow-up period of 2 years. The results of this study suggest that auricular cartilage may be of value in the repair of a nasal septal defect.

The aim of this study was to evaluate the incidence of paranasal sinusitis and the histologic changes in the sinus mucosa after long-term administration of topical nasal decongestants, phenylephrine and oxymetazoline. Experimental animals were divided into 3 groups for topical administration for 1 week, 2 weeks, and 4 weeks. Purulent maxillary sinusitis developed in 4 of 10 two-week phenylephrine group, 6 of 10 four-week phenylephrine group, 1 of 10 two-week oxymetazoline group and 3 of 10 four-week oxymetazoline group. Administration of phenylephrine and oxymetazoline for more than 2 weeks caused histologic changes in the maxillary mucosa of the rabbits. Light microscopy showed ciliary loss, epithelial ulceration, inflammatory cell infiltration and edema. The histologic changes were more pronounced with increasing duration of administration of the decongestants. Ciliary loss was more prominent in the 4-week phenylephrine group than in the oxymetazoline group. Dilatation of mitochondria and vacuolization in cytoplasm were prominent in the 4-week groups with both phenylephrine and oxymetazoline. The results of this study suggest that the administration of decongestants may cause ciliary loss with subsequent sinusitis.

To investigate the physiological role of substance P innervation (SPI) in the nasal mucosa from inhaled irritant macromolecules, SPI in the rat nasal mucosa was selectively stimulated with capsaicin and the degree of horseradish peroxidase (HRP) permeability across the nasal epithelium was evaluated by enzyme immunoassay or by histochemical electron microscopy. The serum level of HRP was reduced significantly in capsaicin-administered rats compared to control rats along the time course with quantitative analysis of the enzyme immunoassay. Control rats showed heavy permeation of HRP across the epithelium, but capsaicin-administered rats showed weak permeation of HRP across the epithelium with histochemical electron microscopy. The epithelial lining and its tight junctions were left intact as judged by electron microscopy. In conclusion, selective stimulation of SPI of the rat nasal mucosa with capsaicin decreased the epithelial absorption permeability to HRP without compromising the epithelial integrity. These findings imply that the physiological role of capsaicin-sensitive SPI in the rat mucosa is to protect the airway from inhaled irritant macromolecules.

To evaluate the efficacy of antibiotic delivered by polyactic acid (PLA) polymer in sinusitis, we induced maxillary sinusitis in 32 New Zealand white rabbits by occluding the sinus ostium and inoculating the sinus cavity with Streptococcus pneumoniae. The rabbits were divided into three groups consisting of group 1 (control group, 8 rabbits), which was treated only by reopening the ostium; group 2, which was treated by both reopening the ostium and injecting ampicillin intramuscularly (40 mg/kg/day in three divided doses, 12 rabbits); and group 3 (12 rabbits) in which a piece of PLA-polymer ampicillin (0.326 mg) sheet (1.5 x 1.5 cm) was placed within the sinus after re-establishing ostial patency. The light microscopic findings such as epithelial ulceration, loss of cilia, infiltration of inflammatory cells, and edema were less pronounced in group 2 and minimal in group 3. The electron microscopic findings such as swelling of mitochondria and endoplasmic reticulum and protruded cytoplasm were severest in the control group, followed by groups 2 and 3. The mucociliary transport speed measured at the medial wall of the maxillary sinus was highest in group 3. The results of this study suggest that treatment with PLA-polymer ampicillin may have a better efficacy in maxillary sinusitis than that with systemic administration of ampicillin.

Ostiomeatal unit (OMU) plays an important role in the development of paranasal sinusitis. The ethmoidal infundibulum is bordered medially by the uncinate process, and the anatomic relationship between the ethmoidal infundibulum and the frontal recess may depend upon the types of attachment of the uncinate process. The aim of this study was to evaluate the types of attachment of the uncinate process and its implications in the development of sinus inflammation. The most frequently observed type of the uncinate process attachment on OMU computerized tomographic (CT) scans was the lamina papyracea (LP) attachment, followed by the skull base (SB) and the middle turbinate (MT) attachments. The order of frequency of both partial and total opacification in the anterior ethmoidal and frontal sinuses was LP, MT, and SB types. However, the maxillary sinus was most frequently involved in SB type. When only total opacification of the paranasal sinuses on CT scans was considered, it was less frequent in SB type than the other types. The results of this study suggest that ventilation and drainage of the paranasal sinus may be more favorable in SB type than in LP or MT type.

We used the IL088 Otodynamic Analyzer system to study click-evoked otoacoustic emissions (CEOAEs) in 30 healthy guinea pigs. The animals were anesthetized and patterns of the CEOAEs were evaluated before manipution, after the tympanic bulla was opened, and after formation of a microfistula on the basal turn of the cochlea. The animals then were divided into three pressure loading groups (10, 20, and 30 cm H2O). CEOAEs were recorded with a capillary manometer at pretest, 5, 10, 20, 30, 45, and 60 min after perilymphatic pressure loading to the basal turn of cochlea, and 10 and 20 min after pressure unloading. As perilymphatic pressure increased, all three pressure groups showed maximum decreases in both echo response and reproducibility 5 min after pressure loading. In the 10 cm H2O pressure group, emissions recovered 10 min after pressure loading, and this tendency continued. However, in the 20 and 30 cm H2O pressure groups, no recovery of emissions was seen throughout the 60 min observation period, except for emissions after pressure unloading. The results suggest that the echo response and reproducibility may be sensitive indicators of cochlear function and perilymphatic pressure regulation capacity.

Objective: To investigate the clinical relevance of serum IL-17 levels in AR patients treated with sublingual immunotherapy (SLIT) to identify the function of TH17 cells and IL-17 in AR.Method: The patients with AR to HDM starting to receive SLIT in Seoul National University Hospital between June 2008 and August 2010 were enrolled. We detected serum IL-17 levels via ELISA before and 1 and 2 years after starting SLIT. Symptom diaries, rescue medication use, and other immunological parameters were analyzed.Results: Longer onset of symptoms and moderate to severe symptoms were significantly related to higher serum IL-17 levels before starting SLIT. HDM-specific IgE significantly increased between the baseline and the first year of SLIT, while HDM-specific IgG4 had no significant change. There was a significant positive correlation between serum ECP and IL-17 levels during SLIT. The changes of serum IL-17 and total IgE levels for 1 year had an inverse relationship with the effectiveness of SLIT. Changed serum...

The objective of this study was to analyze the expression of cysteinyl leukotriene 1 (CysLT1) receptor and glucocorticoid receptors (GRs) in nasal polyps, and to evaluate the relationship between the expression of CysLT1 receptors and that of GRs. Nasal polyps were taken from 32 patients of chronic rhinosinusitis with nasal polyposis. Samples of middle turbinate from seven healthy subjects were used as controls. Specimens were immunohistochemically stained for CysLT1 receptor, GR-α and GR-β receptor, and were quantified in the unit area of the tissues. Numbers of CysLT1 receptor-positive cells were much increased in nasal polyps than in middle turbinate (281 ± 67 vs. 157 ± 85 cells/mm(2), P = .01). There was no significant difference in the numbers of GR-α positive cells between nasal polyps and normal turbinate mucosa. GR-β positive cells were increased in nasal polyps as compared to normal turbinate mucosa (36 ± 8 vs. 19 ± 7 cells/mm(2), P = .03). A significant relationship was found between the expression of CysLT1 receptor and GR-β in nasal polyps (R = .525, P = .04), whereas there was no significant relationship between the expression of CysLT1 receptor and GR-α in nasal polyps. Our study shows that CysLT1 receptor expression predominates on GR-β over-expressed polyps. This may suggest the additional effect of CysLT1 receptor antagonist for the treatment of nasal polyposis resistant to steroid alone.

Genetic dysregulation may be associated with development of obstructive sleep apnea (OSA).Genetic expression was investigated in the soft palate of patients with OSA to evaluate the biomolecular characteristics of the tissue where airway obstruction actually occurs.Soft palate mucosa was obtained during uvulopalatal flap surgery. Three patients with apnea/hypopnea index (AHI)30/h and three simple snoring patients with AHI5/h were enrolled. After total RNA was extracted and amplified, gene expression levels were determined by microarray analysis, and relative signal intensities for each gene were evaluated.Of the 45,034 genes analyzed, 137 were up-regulated in OSA patients compared with simple snorers and 95 were down-regulated. Gene network analysis showed that genes related to RNA interference and transcription were most commonly involved in the functional pathophysiology of OSA. In particular, genes encoding proliferating cell nuclear antigen and proteasome 26S subunit ATPase 6 were functionally connected with other genes.

The results of this study suggest that staphylococcal enterotoxin B (SEB) enhances inflammation in allergic rhinitis (AR) and interleukin (IL)-17 may play a significant role in regulation of the inflammatory process induced by SEB.Exposure to SEB is associated with severe symptoms in AR patients. However, how SEB influences the inflammatory process in AR has not been elucidated so far. The aim of this study was to identify the role of SEB and IL-17 in AR.BALB/c and IL-17-deficient mice were divided into three groups: control, OVA, and SEB groups. The control group was challenged with phosphate-buffered saline, the AR group was challenged with ovalbumin (OVA), and the SEB group was treated with SEB before OVA challenge. Nasal symptoms, eosinophil infiltration, serum total and OVA-specific immunoglobulin E levels, and cytokine levels including IL-1β, IL-4, IL-6, and interferon (IFN)-γ in splenocyte culture were compared between the groups.The SEB group produced significantly greater amounts of cytokines such as IL-1β, IL-4, IL-6, and IFN-γ than the OVA group in wild-type mice. However, these enhanced inflammatory responses in the SEB group compared with the OVA group were not observed in IL-17-deficient mice.

The conventional escalation regimen for sublingual immunotherapy (SLIT) in patients with allergic rhinitis has been proven to be safe and successful in reducing allergic symptoms. However, few studies compared the efficacy and safety between a conventional escalation regimen for SLIT and once-daily SLIT. The aim of the present study was to compare the efficacy and safety of once-daily SLIT without escalation (SLITsE) to conventional escalation therapy (SLITwE).This study was a nonrandomized open label observational study. In total, 153 patients suffering from allergic rhinitis symptoms and sensitized to the perennial house dust mite allergens Dermatophagoides pteronyssinus and Dermatophagoides farinae, were enrolled in this study from July 2008 to December 2009. The patients were divided into 2 groups, SLITwE and SLITsE. Each patient was followed with a diary card on which a symptom score, a rescue medication score, and adverse events were recorded.All of the nasal symptoms, including rhinorrhea, sneezing, nasal obstruction, itching, and olfactory symptoms, defined as a total nasal symptom score, were reduced after 6 months in both groups (p0.05). The rescue medication score, defined as the sum of all of the allergy medications used, also decreased in both groups. Adverse events were similar in both groups, and no major adverse events, such as anaphylaxis, were reported.Once-daily SLITsE was well tolerated and showed safe and comparable efficacy compared with a conventional SLITwE regimen.