Nitric oxide (NO) signaling has been one of the most rapidly growing areas of study in biology. We know today that NO acts as a signal molecule in the nervous system, a weapon against infection, a regulator of blood pressure, and a gatekeeper of blood flow to different organs. However, much remains to be determined about the physiological and pathophysiological role of NO in the airways. NO appears to be co-localized to cholinergic innervation and involved in vasomotor and secretomotor control of the nasal mucosa. NO is present in exhaled air and appears to originate mainly from paranasal sinus epithelium. Moreover, immunohistochemical and in situ hybridization studies identify all three known isoforms of NO synthase in nasal mucosa. Inhaled endogenous NO in the airways is suggested as playing a role in host defense, and involved in the regulation of pulmonary function as an 'aerocrine.' However, the role of NO in airway inflammation is complicated and clearly has to be determined. The physiological role of NO in the nasal mucosa and its possible pathophysiological role in rhinitis are to be discussed.
Biology ; Blood Pressure ; Epithelium ; In Situ Hybridization ; Inflammation ; Nasal Mucosa* ; Nervous System ; Nitric Oxide Synthase ; Nitric Oxide* ; Protein Isoforms ; Rhinitis*

No abstract available.
Sinusitis*

Systemic corticosteroids currently represent the most effective treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), but their long-term use is constrained due to their detrimental side effects. Until recently, development of novel drugs for CRSwNP has been difficult partly due to the absence of a standard animal model of CRSwNP. Exotoxins of Staphylococcus aureus such as staphylococcal enterotoxin B (SEB), are well-known superantigens which can induce a strong immune response; there have been many studies on the association of staphylococcal enterotoxins and development of CRSwNP over the past two decades. Based on previous studies, we invented a mouse model of CRSwNP using SEB. Herein, we explain the protocol development for the mouse model, as well as identify histological and immunological similarities between this mouse model and humans. Furthermore, we describe a study that analyzed the risk factors for CRSwNP such as smoking, and also elaborate on a series of studies that searched for new potential drugs for CRSwNP, including resveratrol, anti-periostin antibody, topical hypoxia-inducible factors, and topical cyclosporine. Based on preceding studies, we have concluded that this mouse model might be a useful tool to investigate the pathophysiology and development of novel drugs for CRSwNP.
Adrenal Cortex Hormones ; Animals ; Cyclosporine ; Enterotoxins ; Exotoxins ; Humans ; Mice* ; Models, Animal ; Nasal Polyps* ; Risk Factors ; Smoke ; Smoking ; Staphylococcus aureus ; Superantigens

Allergic fungal sinusitis (AFS) is a benign, noninvasive form of fungal sinusitis. Histologically, AFS is characterized by allergic mucin, which consists of eosinophilic mucinous material with occasional laminar deposits of eosinophils. A diagnosis of AFS can be made when there is a demonstration of characteristic allergic mucin and an appearance of fungal hypae scattered within the mucin with no evidence of tissue invasion, or when fungi cultures yield positive results. Until now, no cases of AFS have been reported in Korea, though there have been many cases of mycetomas and a few cases of invasive fungal sinusitis. We present the first two cases of AFS in Korea. The patients demonstrated characteristic allergic mucin, fungal hypae scattered within the mucin, and no evidence of tissue invasion on histopathology. Nasal polyps, involvement of the unilateral sinuses, peripheral eosinophilia, an elevated total IgE, and hyperattenuated masses observed in the CT supported the diagnosis of AFS. The patients recovered and did not display recurrence after surgery and treatment with topical steroids and saline irrigation.
Diagnosis ; Eosinophilia ; Eosinophils ; Fungi ; Humans ; Immunoglobulin E ; Korea ; Mucins ; Mycetoma ; Nasal Polyps ; Recurrence ; Sinusitis* ; Steroids

Organized hematoma of the maxillary sinus is a rare clinical disease. We report a case of organized hematoma of the maxillary sinus presenting with acute sinusitis. This is the first article describing such a case. Included is a review of the literatures, highlighting the diagnostic signs of organized hematoma of the maxillary sinus.
Hematoma ; Maxillary Sinus ; Sinusitis

The korean society of otolaryngology has had and experience on intraining examination since 1992. We also had the fortieth annual board examination for specialist in 1997. But we have no evidence on the validity of these tests yet. The aim of this study is to examine the validity of the intraining examinations as a tool of formative evaluation, to present a personal progress index demonstrating constructive validity, and to examine the validity of the board examination as a tool of summative evaluation. We did statistic analysis on the consecutive personal scores of 1995 and 1996 intraining examinations, and 1997 written and oral board examinations. Analysis of the averages, standard deviations, distribution curves, and Wilcoxon singed rank test on the scores of 1995 and 1996 intraining examinations demonstrated the constructive validity. Chi-square test revealed that those who had low scores in intraining examinations of two consecutive years had low scores in 1997 board examinations and personal progress index demonstrated the predictive validity. Correlation and linear regression analysis demonstrated a strong correlation between 1997 written and oral board examination. Analysis of the averages, standard deviations, distribution curves, and Spearman rank correlation coefficient revealed that 1997 written board examination had higher concurrent validity than the that of oral examination.
Diagnosis, Oral ; Humans ; Linear Models ; Otolaryngology* ; Specialization

The expanded endonasal approach (EEA) to the ventral skull base provides endoscopic access from the frontal sinus to the second cervical vertebra. Potential advantages of the EEA include not only improved cosmesis but more importantly, the potential for reduced neurovascular manipulation. EEA is based on the principle of extracapsular dissection with full visualization of important neurovascular structures. There are significant risks of neural and vascular injury associated with EEA, and the reconstruction of dural defects is challenging. Experienced teams including rhinologists and neurosurgeons are needed for successful implementation of EEA. The surgical team must have adequate endoscopic skills to achieve hemostasis and address vascular emergencies. Advantages of having a skilled second surgeon to provide endoscopic visualization include dynamic adjustments of the endoscope to ensure the best view and avoid contact interference of instruments, second surgical opinions in complex anatomical areas, and maintenance of endoscopic views in cases of crisis such as vascular injury. Complications of the EEA such as neurovascular injury, cerebrospinal fluid leaks and infection are the same as those of open approaches. With the advent of the nasoseptal flap, problematic cases involving huge bony defects subsequent to the resection of skull base tumors have been greatly resolved.
Dietary Sucrose ; Emergencies ; Endoscopes ; Frontal Sinus ; Hemostasis ; Reconstructive Surgical Procedures ; Sella Turcica ; Skull Base ; Spine ; Surgical Flaps ; Vascular System Injuries

Foreign bodies in the paranasal sinuses are rare, but they may become more common with an increasing number of road traffic accidents. Foreign bodies in the paranasal sinuses cause vague symptoms. They are occasionally encountered either after occurrence of complications or after radiological workup for some other reasons. They may be missed if their presence is not suspected initially. Therefore, the presence of foreign bodies should be suspected even in seemingly trivial lacerations over the paranasal sinuses in cases of maxillofacial trauma. The suspicion of foreign bodies may prevent the development of intracranial and intrasinus complications. Although a wide variety of foreign bodies have been reported in the paranasal sinuses, glass were rare in the frontal sinus. We present a case of frontal mucocele with glass in the frontal sinus which occurred as a result of road traffic accident with a brief review of the literature.
Accidents, Traffic ; Craniocerebral Trauma* ; Foreign Bodies* ; Frontal Sinus ; Glass* ; Head* ; Humans ; Lacerations ; Mucocele* ; Paranasal Sinuses

BACKGROUND AND OBJECTIVES: An understanding of the cross-sectional structures and histological features of experimental animals is necessary for conducting the research of rhinosinusitis in experimental animals. The aim of this study is to determine the most suitable cross-sectional level of rhinosinusitis in a rat model. MATERIALS AND METHODS: The study examined the histological features of the mucosal epithelium, gland, lymphoid tissue, and vomeronasal organs using 4 week-old male rats weighing 60-70 g as test subjects. Whole mounted sinus-nose complexes were divided into four levels of areas which were sectioned according to the coronal plane and each section was stained with hematoxylin-eosin and observed under light microscopy. RESULTS: Level I revealed the nasal turbinate, maxilloturbinale, and nasolacrimal duct. Level II revealed the nasal turbinate, maxilloturbinale, vomeronasal organ, and nasolacrimal duct. Level III revealed the ectoturbinale I, II, endoturbinale II, III, maxillary sinus, Steno's gland, maxillary sinus gland, and nasal associated lymphoid tissue (NALT). Level IV revealed the ectoturbinale II, endoturbinale III, IV, pharyx respiratorius, and NALT. The lining epithelia were squamous, respiratory and olfactory. However, the squamous epithelium was not observed in level III and IV. CONCLUSION: The Level III appears to be the most suitable for the rhinosinusitis animal rat model since we can observe the respiratory epithelium lined sinonasal airspace including the maxillary sinus and NALT.
Animals ; Epithelium ; Humans ; Lymphoid Tissue ; Male ; Maxillary Sinus ; Microscopy ; Models, Animal ; Nasal Cavity* ; Nasolacrimal Duct ; Nose ; Paranasal Sinuses* ; Rats* ; Respiratory Mucosa ; Turbinates ; Vomeronasal Organ

BACKGROUND AND OBJECTIVES: Traumatic optic neuropathy (TON) is a relatively rare complication associated with closed head injury. However, it represents an extremely poor prognosis, and its management remains controversial. We present the treatment results of 15 patients with immediate and complete TON who were treated with megadose steroids (MDS), and, in cases where MDS produced no response, intranasal optic nerve decompression (OND). PATIENTS AND METHODS: The diagnosis of TON was based on evidence of the following : complete loss of vision, absence of direct pupillary light reflex and intact consensual response. All of the patients underwent high resolution CT scans of the orbit and received a complete neuro-opthalmologic examination. MDS was started immediately after the diagnosis. If no response occurred by 48 hours, an intranasal OND was conducted. RESULTS: Two of the 15 patients exhibited improved vision after treatment with MDS, and six of the remaining 13 patients who were unresponsive to MDS demonstrated improved vision after OND. Overall, eight out of the 15 patients experienced improved vision. CONCLUSION: This study is uncontrolled, but suggests that our protocol of MDS and, in cases where this produced no response, OND may be an effective and valid treatment modality for patients with immediate complete TON, which is generally believed to represent an extremely poor prognosis regardless of treatment.
Decompression* ; Diagnosis ; Head Injuries, Closed ; Humans ; Optic Nerve Injuries* ; Optic Nerve* ; Orbit ; Prognosis ; Reflex ; Steroids* ; Tomography, X-Ray Computed