Rhino-orbito-cerebral mucormycosis is a rare opportunistic invasive fungal infection, with rapid progression and high mortality. It is characterized by an aggressive necrotizing infection spreading from the nose to the paranasal sinuses, orbit, and the brain. This disease is often associated with diabetic ketoacidosis, leukemia, malnutrition, AIDS and immunocompromis ed patients. Typical initial symptoms of a patient with rhino-orbito-cerebral mucormycosis are facial pain and swelling, headache, fever, and blood-tinged rhinorrhea. Symptoms rapidly progressed to facial or orbital cellulitis, proptosis, and visual loss, facial nerve palsy. We report a case report of a 66-year-old woman with poorly controlled diabetes mellitus who developed mucormycosis which involved unilateral paranasal sinus, orbit, and selective cranial nerves.
Aged ; Brain ; Cranial Nerves ; Diabetes Mellitus ; Diabetic Ketoacidosis ; Exophthalmos ; Facial Nerve ; Facial Pain ; Female ; Fever ; Headache ; Humans ; Leukemia ; Malnutrition ; Mortality ; Mucormycosis* ; Nose ; Orbit ; Orbital Cellulitis ; Paralysis ; Paranasal Sinuses

In the past, the treatments for acute dacryocystitis with abscess formation were warm compression, systemic and topical antibiotics, and drainage of the abscess, if fluctuation occurs. Acute dacryocystitis with abscess formation is rarely primary, but often secondary to distal obstruction or extension of contiguous inflammation. After resolution of acute infection, evaluation and treatment of the underlying cause should be initiated. Recent reports have demonstrated that endoscopic dacryocystorhinostomy is an effective treatment for acute dacryocystitis associated with nasolacrimal duct obstruction. We experienced a case of acute dacryocystitis with lacrimal sac abscess formation. Drainage of lacrimal sac abscess was safely accomplished with endoscopic dacryocystorhinostomy. The patient had an excellent postoperative course without recurrence.
Abscess* ; Anti-Bacterial Agents ; Dacryocystitis ; Dacryocystorhinostomy* ; Drainage ; Humans ; Inflammation ; Lacrimal Apparatus ; Nasolacrimal Duct ; Recurrence

BACKGROUND AND OBJECTIVES: Pain and anxiety control is the most important factor for patients that have undergone endoscopic sinus surgery under local anesthesia. Monitored anesthesia care (MAC) technique has been applied to local anesthetic patients for anxiolysis and analgesia. This technique encompasses the use of sedatives, tranquilizers and analgesics in combination to local supplements. This study was performed to evaluate the effectiveness of MAC for intraoperative pain control in patients who have undergone endoscopic sinus surgery. MATERIALS AND METHODS: We studied 83 patients undergoing ambulatory endoscopic sinus surgery. Patients were randomly allocated into 2 groups of MAC (n=49) and placebo (n=34). We administrated alfentani1 and propofol intravenously at 2-3 minutes before local anesthesia for endoscopic sinus surgery. We evaluated the intraoperative pain with visual analogue pain score (VAS) and satisfactory score to pain control. RESULTS: Overall, MAC cases showed statistically significant better VAS than placebo cases. Satisfactory score to pain control was also higher in MAC cases than placebo cases. CONCLUSION: We conclude that MAC is an effective method using intravenous sedatives and analgesics for intraoperative sedation and pain control in patients undergoing endoscopic sinus surgery under local anesthesia.
Analgesia ; Analgesics ; Anesthesia* ; Anesthesia, Local ; Anxiety ; Humans ; Hypnotics and Sedatives ; Propofol

Nasal polyp is an intractable condition usually associated with chronic hyperplastic sinusitis with allergic rhinitis. IL-4 is known to contribute to the inflammatory reaction by enhancing binding of inflammatory cells in the nasal polyp. The objectives of this study were to evaluate the effect of roxithromycin (300 mg daily) and intranasal fluticasone spray (200 microgram daily ) in reducing symptoms of chronic sinusitis and polyp size and to compare pre - and post-treatment secretion of IL-4. Twenty-four patients with chronic sinusitis with nasal polyp and allergic rhinitis were selected and allocated into 3 groups ; roxythromycin, fluticasone propionate and combined use group. Statistically significant decrease in symptoms was observed in both the roxythromycin and fluticasone propionate groups. Significant improvement of rhinorrhea and postnasal drip was observed in the combined use group. The polyp size decreased significantly in all three groups. IL-4 secretion decreased significantly in the combined use group after treatment. Long term medication of roxithromycin and intranasal fluticasone spray were effective in reducing symptoms and polyp size in chronic sinusitis with allergic rhinitis. They were also effective in reducing IL-4.
Diethylpropion ; Humans ; Interleukin-4* ; Nasal Polyps ; Polyps* ; Rhinitis ; Roxithromycin* ; Sinusitis* ; Fluticasone

Backround and Objectives: Mucocele of the paranasal sinuses could be developed as secondary to trauma, tumor or surgical manipulation. This study was conducted to investigate clinical eatures of paranasal sinus mucocele following endoscopic sinus surgery and to determine the effect of endoscopic wide marsupialization for the treatment of mucocele. MATERIALS AND METHODS: Thirty-five patients with paranasal sinus mucocele who were diagnosed and surgically treated at Seoul National University Hospital from Nov. 1996 through Dec. 2002 were retrospectively analyzed by their medical records and radiological imaging. RESULTS: The most common chief complaint of patients with mucocele were ocular symptoms including periorbital swelling, proptosis and headache. Previous sinus operation, especially endoscopic sinus surgery was the most common cause of mucocele, which developed at mean period of 50 months after surgery. Most commonly involved sinuses were ethmoid and frontal sinuses. Thirty-three out of 35 patients underwent endoscopic wide marsupialization of the mucocele cavity, and the other two patients were treated via external approaches. No recurrence was observed until mean followup of 33 months. CONCLUSION: One should suspect the possibility of mucocele recurrence if a patient complains of ocular symptoms several years after endoscopic sinus surgery. Meticulous operation and postperative treatment, and regular followup are needed for patients who underwent endoscopic sinus surgery because of a possible development of mucocele as a late complication. Although transnasal endoscopic wide marsupialization for the treatment of mucocele showed safe and good results, long term follow-up data is needed to establish it as the gold standard for treatment of paranasal sinus mucocele.
Exophthalmos ; Follow-Up Studies ; Frontal Sinus ; Headache ; Humans ; Medical Records ; Mucocele* ; Paranasal Sinuses ; Recurrence ; Retrospective Studies ; Seoul

BACKGROUND AND OBJECTIVES: Pain control is one of the most important factors for the patients that underwent the snoring surgery. This study was performed to investigate the effectiveness of intravenous patient-controlled analgesia (PCA) for postoperative pain control after tonsillectomy with laser resection of palatopharynx. MATERIALS AND METHODS: In this double-blind randomized study, 44 patient were randomly allocated to 2 groups. In the PCA group comprising 32 patients, fentanyl citrate, ketorolac tromethamine and zofran in normal saline solution were administered by PCA equipment. In the control group comprising 12 patients, normal saline solution was given without analgesic drug by PCA equipment. Visual analogue pain score (VAS) was recorded right after surgery and 2, 4, 6, 12, 18, and 24 hours after surgery and satisfaction score was recorded just before discharge from the hospital. RESULTS: VAS was significantly higher in the control group of all time points. Overall satisfaction score was also higher in PCA group than control group. CONCLUSION: The results of this study suggest that intravenous PCA is an effective method for postoperative pain control after tonsillectomy with laser resection of palatopharynx.
Analgesia, Patient-Controlled* ; Fentanyl ; Humans ; Ketorolac Tromethamine ; Ondansetron ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Snoring ; Sodium Chloride ; Tonsillectomy*

BACKGROUND AND OBJECTIVES: Angiotensin -converting enzyme (ACE) inactivates bradykinin, substance P, and neurokinin A, which are thought to play important roles in the pathogenesis of inflammatory diseases. An insertion/deletion (I/D) poly - morphism in the ACE gene was reported to be associated with atopy in a Czech population. MATERIALS AND METHODS: Using the polymerase chain reaction, we investigated the frequencies of the genotypes and alleles of the ACE gene in 137 patients with allergic rhinitis and 498 healthy control subjects. RESULTS: There was no difference in the frequencies of the genotypes in the controls and patients with allergic rhinitis (p>0.05). The D allele was more frequent in patients with allergic rhinitis, but the difference was not statistically significant (p>0.05). CONCLUSION: Our results indicate that I/D polymorphism in the ACE gene is not related to susceptibility to allergic rhinitis in the Korean population.
Alleles ; Angiotensins ; Bradykinin ; Genotype ; Humans ; Neurokinin A ; Polymerase Chain Reaction ; Rhinitis* ; Substance P

BACKGROUND AND OBJECTIVES: The effect of the hypertonic nasal douching solutions on mucociliary clearance was studied to ascertain the effect of hypertonic seawater. MATERIALS AND METHODS: Twenty-eight normal subjects were included in a randomized double -blind crossover trial. Hypertonic seawater (3%, Sinomarin(R)) was used as a hypertonic nasal douching solution. In order to determine the effect of hypertonic seawater on nasal mucosa, the mucociliary clearance was measured by the saccharin clearance time (SCT). RESULTS: The resultant SCT after administration of hypertonic seawater was significantly reduced compared with normal saline (0.9%)(p<0.05). CONCLUSION: This results showed that the hypertonic seawater improved mucociliary clearance time in the nasal cavity. The mechanism of this effect is probably brought about by changes in mucus viscoelastic properties.
Mucociliary Clearance* ; Mucus ; Nasal Cavity ; Nasal Mucosa ; Saccharin ; Seawater* ; Therapeutic Irrigation

Backgrounds and Objectives: We studied the effect of long-term low-dose macrolide therapy on the level of IL-8, IL-1 beta, and TNF-alpha in the nasal secretions get from children with chronic rhinosinusitis before and after medication, and investigated the association between the changes in the chemical mediator levels and the clinical outcome before and after macrolide treatment. MATERIALS AND METHODS: The nasal lavage was obtained from 10 patients with nonallergic chronic rhinosinusitis and also from 10 healthy children. Nasal lavage was obtained before and 1 month after full dose (8 mg/kg ) macrolide administration, and then second lavage was obtained after half dose (4 mg/kg ) administration for 2 month. The level of IL-8, IL-1 beta and TNF-alpha in nasal lavage were measured by using ELISA kit. The symptoms were also scored by visual analogue scale before and after treatment. RESULTS: The IL-8 concentration was decreased from 317.4 pg/ml to 227.1 pg/ml at 12 weeks after this treatment (p<0.05). The level of IL-1beta was decreased from 412.5 pg/ml to 41.5 pg/ml (p<0.05), and TNF-alpha was also decreased from 49.8 pg/ml to 3.9 pg/ml (p<0.05). The symptoms of most patients with macrolide treatment were improved at 3 months after treatment. CONCLUSION: Macrolide decreased the concentration of inflammatory mediators in nasal discharge, such as IL-8, IL-1beta and TNF-alpha and this anti-inflammatory effect of macrolide could explain the way of improvement with subclinical dosage of drug.
Child* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-1beta ; Interleukin-8 ; Nasal Lavage ; Therapeutic Irrigation ; Tumor Necrosis Factor-alpha

BACKGROUND AND OBJECTIVES: Previous studies have reported that irradiation influences mucociliary clearance by damaging ciliary motility in respiratory mucosa. The purpose of this study is to investigate the effect of radiotherapy (RT) on opacification of paranasal sinuses in patients with nasopharyngeal carcinoma, and to find out what kind of influence anatomic variations such as nasal septal deviation or concha bullosa may have on the pathogenesis of sinus opacification. MATERIALS AND METHODS: Subjects were 26 patients (19 males and 7 females, aged 23 to 69) of early nasopharyngeal carcinoma (T1, T2) who were treated with RT between 1989 and 1999. Pre-RT and post-RT Computerized Tomography (CT) and medical records were reviewed retrospectively. The mean radiation dosage was 6965 cGy and mean follow-up period was 30 months (6 months to 7 yeas 1 month). Eighteen patients had nasal septal deviation and 9 patients had nasal septal deviation with concha bullosa. A total of 52 maxillary sinuses and 52 ethmoid sinus sides were analyzed. RESULTS: In 15 (57.7%) of 26 patients, opacifications of sinuses were newly developed or were aggravated after RT. The prevalence of aggravated sinus opacification according to anatomic variations was as follows : 30.8% in no anatomic variations, 32.1% in the concave side of nasal septal deviation, 36.8% in the convex side of nasal septal deviation, 42.9% in the concave side of nasal septal deviation with concha bullosa, and 68.8% in the convex side of septal deviation with concha bullosa. There was a significant difference in sinus opacification between sinuses without variations and sinuses with septal deviations combined with concha bullosa (p<0.05). CONCLUSION: These data suggest that irradiation of the nasopharynx may induce or aggravate paranasal sinusitis, and anatomic variations such as nasal septal deviation or concha bullosa may contribute to the pathogenesis of sinusitis.
Ethmoid Sinus ; Female ; Follow-Up Studies ; Humans ; Male ; Maxillary Sinus ; Medical Records ; Mucociliary Clearance ; Nasopharyngeal Neoplasms* ; Nasopharynx ; Paranasal Sinus Diseases ; Paranasal Sinuses ; Prevalence ; Radiation Dosage ; Radiotherapy ; Respiratory Mucosa ; Retrospective Studies ; Sinusitis