Background and Objectives: There are several diagnostic and therapeutic modalities for chronic rhinosinusitis (CRS), but specific guidelines have not been developed for Koreans. This study sought to evaluate and report CRS practice patterns of members of the Korean Rhinologic Society.Materials and Method: An anonymous survey including 32 items was conducted from August to September 2015. The survey items were categorized into three parts: general information, diagnosis and treatment of CRS, and endoscopic sinus surgery. Results: A total of 267 members participated in this survey. Almost half of the respondents (41.9%) were in their 40s and 42.7% had 10-20 years of experience. A total of 61.8% were private practitioners, while the rest worked in hospitals (38.2%). The prevalence rate of acute rhinosinusitis was higher in private clinics compared to hospitals (p<0.001). Intranasal steroids and saline irrigation were more commonly prescribed among hospital doctors compared to private practitioners (p<0.001). Amoxicillin/clavulanic acid was the drug of choice for adult and pediatric CRS patients among private practitioners. However, hospital doctors preferred macrolides for adult CRS patients and third-generation cephalosporins for pediatric CRS patients. Most private clinics performed surgery under local anesthesia (90.8%), while those in a hospital setting preferred general anesthesia (78.4%). Revision surgery rates were higher in hospitals compared to private clinics (p<0.001). Conclusion There were significant variations in CRS practice patterns between private clinics and hospitals. For effective and standardized diagnosis and management of CRS, appropriate local guidelines are needed.

Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has been spreading worldwide since its outbreak in December 2019, and World Health Organization declared it as a pandemic on March 11, 2020. SARS-CoV-2 is highly contagious and is transmitted through airway epithelial cells as the first gateway. SARS-CoV-2 is detected by nasopharyngeal or oropharyngeal swab samples, and the viral load is significantly high in the upper respiratory tract. The host cellular receptors in airway epithelial cells, including angiotensin-converting enzyme 2 and transmembrane serine protease 2, have been identified by single-cell RNA sequencing or immunostaining. The expression levels of these molecules vary by type, function, and location of airway epithelial cells, such as ciliated cells, secretory cells, olfactory epithelial cells, and alveolar epithelial cells, as well as differ from host to host depending on age, sex, or comorbid diseases. Infected airway epithelial cells by SARSCoV-2 in ex vivo experiments produce chemokines and cytokines to recruit inflammatory cells to target organs. Same as other viral infections, IFN signaling is a critical pathway for host defense. Various studies are underway to confirm the pathophysiological mechanisms of SARS-CoV-2 infection. Herein, we review cellular entry, host-viral interactions, immune responses to SARS-CoV-2 in airway epithelial cells. We also discuss therapeutic options related to epithelial immune reactions to SARS-CoV-2.

Amyloidosis is a systemic disease characterized by the accumulation of amyloid protein in multiple organs. Amyloidoma, in contrast, is an uncommon localized form of amyloidosis that presents as a single mass or tumor-like lesion. Primary amyloidoma in the central nervous system is rare, and only a few cases have been reported. Notably, the Gasserian ganglion is the most frequently affected site of amyloidoma in the central nervous system, and progressive trigeminal neuropathy is a characteristic finding. Among these cases, the bilateral occurrence of amyloidoma is exceedingly rare. In this report, we present the case of a 51-year-old woman diagnosed with bilateral trigeminal amyloidoma, confirmed by an endoscopic biopsy via the transsphenoidal approach.

BACKGROUND AND OBJECTIVES: The open surgical biopsy (OSB) of neck lymph nodes is considered a definite diagnostic procedure; however, the diagnostic accuracy of this procedure has not been fully studied. Thus, we aimed to identify the false negative rates of OSB for malignancy and the possible causes of misdiagnosis that might severely affect patient prognosis. SUBJECTS AND METHOD: We extracted the data from 495 OSB of neck lymph nodes between 2005 and 2012. The diagnostic accuracy of OSB of neck lymph nodes was estimated based on re-biopsy. In addition, we reviewed possible clinical factors related to false negativity, cause of misdiagnosis and its clinical impacts. RESULTS: The false negative rate of OSB of neck nodes was 2.2% with a risk of 3.8% false diagnosis among subjects with initial 'benign' results. The cases of the initial misdiagnosis (n=7) had the dismal outcomes (4 deaths, 1 disease progression). The main cause of misdiagnosis was the failure to target the disease-affected lymph nodes (85.7%). Malignancy-related symptoms persisted in all cases of misdiagnosis, which required re-biopsy. CONCLUSION: Accurate targeting of lymph nodes, close monitoring of clinical symptoms and comparison of biopsy results with symptoms are very important to reduce false negativity for malignancy in OSB of neck lymph nodes.
Biopsy* ; Diagnosis ; Diagnostic Errors ; False Negative Reactions ; Humans ; Lymph Nodes* ; Neck* ; Prognosis

BACKGROUND AND OBJECTIVES: To evaluate the usefulness of wideband tympanometry in predicting middle ear disorders by comparing the absorbance measurements of the disorder and the norm. SUBJECTS AND METHOD: Wideband tympanometry, pure tone audiometry, and endoscopic examination were performed on 284 ears of 190 subjects. Wideband absorbance (WBA) was measured from normal ears (adults: 128 ears, children: 32 ears), disorders of middle ear included effusion (adults: 24 ears, children: 21 ears), tympanic membrane (TM) retraction (adults: 26 ears, children: 6 ears) and perforation (47 adult ears). RESULTS: The normative data of WBA were similar to previous reports from other countries. WBA of the 17-29 age group showed higher values than other age groups at 1600-3150 Hz. Men had higher absorbance at low frequencies whereas women had higher absorbance at high frequencies. There was a significant gender difference at 4000 Hz. Adults showed higher absorbance at 1000, 1250, and 1600 Hz and lower absorbance at 2500, 3150, and 4000 Hz than children did at those respective frequencies. Compared to the normal group, WBA was decreased at all frequencies by more than 500 Hz in ears with middle ear effusion and at most frequencies by less than 2000 Hz in ear with TM retraction. TM perforation showed higher absorbance in low frequencies; the absorbance decreased as the size of perforation increased. CONCLUSION: The present study established normative WBA data and the results showed comparable statistics to former studies in age and gender difference. WBA provided a high reliability in discrimination of middle ear effusion and TM retraction. WBA is a simple, non-invasive and useful diagnostic tool for middle ear disease.
Acoustic Impedance Tests ; Adult ; Audiometry ; Child ; Discrimination (Psychology) ; Ear ; Ear, Middle* ; Female ; Humans ; Male ; Methods ; Otitis Media with Effusion ; Tympanic Membrane ; Tympanic Membrane Perforation

BACKGROUND AND OBJECTIVES: The patients with bilateral vestibulopathy (BV) suffer from unsteadiness and oscillopsia, and despite of appropriate rehabilitation, permanent disability is inevitable. However, the level of functional outcomes could be influenced by whether there is residual vestibulo-ocular reflex (VOR) or not. Under the hypothesis that residual VOR function could result in better performances, we tried to compare in functional outcomes between complete and incomplete BV. MATERIALS AND METHODS: Fifty patients who have been diagnosed with BV in our institution were retrospectively reviewed retrospectively between 2008 and 2012. We classified them into complete BV group (n=19) and incomplete BV (n=31) group according to the presence of residual VOR. Among them, 31 patients responded to telephone survey (6 in complete group and 25 in incomplete group). The survey includes 5 categories such as the subjective dizziness restriction on daily life, oscillopsia, unsteadiness and depression. Each score ranged from 0 to 4 and patients were asked twice in different time period. RESULTS: There was no difference in etiology between complete and incomplete group. Incomplete group showed significant improvement in dizziness, restriction on daily life, oscillopsia and unsteadiness compared to complete group. Among 5 catergories, dizziness score was significantly improved in incomplete group (each mean improved sore+/-standard deviation; dizziness 1.84+/-0.83, oscillopsia 0.44+/-0.64, unsteadiness 1+/-1.09, depression 0.24+/-0.86 restriction on daily life 1.16+/-0.97). CONCLUSION: The presence of residual VOR function had better functional outcomes in bilateral vestibulopathy.
Depression ; Dizziness ; Humans ; Prognosis ; Reflex, Vestibulo-Ocular ; Rehabilitation ; Retrospective Studies ; Telephone

Barotraumatic perilymph fistula is difficult to diagnose and needs diagnosis of suspicion. Symptoms like hearing loss, tinnitus, ear fullness and positional dizziness can develop following barotrauma such as valsalva, nose blowing, straining and diving, etc. We reported 2 cases of perilymph fistula following barotrauma. The patients developed hearing loss, tinnitus and ear fullness followed by sudden onset of positional dizziness mimicking benign paroxysmal positional vertigo (BPPV). On positional tests, the direction of nystagmus has changed over time. In addition, the characteristics of nystagmus on positional test were not similar to typical BPPV, which showed longer duration of nystagmus, no reversibility and no fatigability. We concluded that barotraumatic perilymph fistula could present as hearing loss with positional dizziness mimicking sudden hearing loss with BPPV. The differential diagnostic points were history of barotrauma, time sequence of development of hearing loss and positional dizziness, and atypical positional nystagmus unlike BPPV.
Barotrauma ; Diagnosis ; Diving ; Dizziness ; Ear ; Fistula ; Hearing Loss ; Hearing Loss, Sudden ; Humans ; Nose ; Nystagmus, Physiologic ; Perilymph ; Tinnitus ; Vertigo

Arteriovenous malformation is a vascular malformation with fast-flow shunt from the artery to the vein. Extracranial arteriovenous malformation in the head and neck area is rare disease compared to other vascular malformations such as venous malformation or lymphatic malformation. Extracranial arteriovenous malformations especially on face can cause aesthetic problems, therefore surgeons should consider an importance of cosmetic outcome and choose appropriate treatment plan. We report a case of 51-year-old male who presented with enlarged nasal tip diagnosed arteriovenous malformation. This case showed successful outcome after combination therapy consisted of superselective embolization and surgical resection.

Background and Objectives: In 2021, biologics were approved for treating chronic rhinosinusitis with nasal polyps (CRSwNP) in Korea. However, CRS is a heterogeneous disease, and its characteristics are thought to differ between Western and Korean populations. This study aimed to evaluate the experiences of members of the Korean Rhinologic Society during the first year of biologic usage for the treatment of nasal polyps. Methods: An anonymous survey consisting of 15 items was conducted from November to December 2021. The survey included questions about participant demographics, use of biologics for treating CRSwNP, and expectations regarding the effectiveness of biologics for treating CRSwNP. Results: In total, 44 members participated in the survey. Approximately half of the respondents were in their 40s (50.0%) and had 5–9 years of clinical experience as otorhinolaryngologists (47.7%). The majority of participants held academic positions (95.4%). About half of them worked in Gyeonggi Province. The utilization of biologics did not differ significantly based on clinical experience (p=0.192). When asked about the factors considered for prescribing biologics, the most common reason was recurrence of polyps after surgery (87.2%). The most frequent reason for discontinuing biologics was cost (48.6%). When asked about the extent to which they expected that the availability of biologics for CRSwNP treatment would reduce endoscopic sinus surgery (ESS), 45.5% of members expected a reduction of approximately 10%–29%. In addition, 20.5% expected a reduction of 50% or more. However, 61.4% expected a reduction of less than 10% in primary ESS. In addition, most respondents (93.2%) agreed with the need for Korea-specific guidelines for biologic treatment. Conclusion There are discrepancies between the current guidelines for biologic treatment of CRSwNP and the reality of the situation, highlighting the need for the development of Korea-specific guidelines.