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The Innate Immune Responses in Pathogenesis of Chronic Rhinosinusitis.

Journal of Rhinology.2014;21(1):22-27.

Chronic rhinosinusitis (CRS) is a multifactorial and heterogeneous disease, and variousfactors, such as inflammation, infection, fungus, and superantigens, have been proposed to play crucial roles in its pathogenesis. Recently, the dominant mechanismof CRS pathogenesis has shiftedfrom microbial infection and environmental factors to host susceptibility. Host susceptibility relies not only on adaptive immunity, but also on innate immunity, and there has recently been much research into innate immunity. Innate immunity is an evolutionally conserved immune system that recognizes microbial signature molecules via pattern recognition receptors and is a primary defense system that elicits inflammatory and bactericidal responses. Dysfunction of the host response to pathogens is suggested to be involved in pathogenesis of CRS and an irrelevant response of the host's innate immunity could cause a failure toeradicate the pathogens, thereby contributing to CRS pathogeneses. Among these innate immune systems, toll-like receptors and epithelial barrier functions have been studied extensively, and new players, such as innate lymphoid cells,have beensurfacing. Betterunderstanding of innate immunity couldhelp to investigateand treat this complex disease. In this review, toll-like receptors, epithelial barrier functions, and innate lymphoid cells,among many subjects related to innate immunity,will be discussed in terms of pathogenesis.
Adaptive Immunity ; Fungi ; Immune System ; Immunity, Innate* ; Inflammation ; Receptors, Pattern Recognition ; Superantigens ; Toll-Like Receptors

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Endoscopic Management of Cerebrospinal Fluid Rhinorrhea.

Sung Jae HEO ; Jung Soo KIM

Journal of Rhinology.2014;21(1):15-21.

Cerebrospinal fluid (CSF) rhinorrhea has become a relatively common disease due to increasingincidents oftraffic accidents and endoscopic sinus surgeries, including skull base surgery. Improvements in surgical skills and endoscopicequipment have contributed to broadening the indicationsforendoscopic management ofCSF rhinorrhea. Precise identification of the etiology and leakage site is important for the treatment of CSF rhinorrhea. A variety of sealing techniques, such as overlay, underlay, and bath-plug, showed similar surgical outcomes. In addition, the type of graft material did not make a difference inthe surgical results. Therefore, thechoice of technique and graft material depends on the judgment of the surgeon. Endoscopic management of CSF rhinorrhea demonstrated anexcellent success rate and low morbidity. There were only few complications duringendoscopic management of CSF rhinorrhea and these were not serious. In conclusion, endoscopic management is effective for CSF rhinorrhea and should be initially considered for the treatment of CSF leakage.
Cerebrospinal Fluid ; Cerebrospinal Fluid Rhinorrhea* ; Endoscopes ; Judgment ; Skull Base ; Transplants

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Otorhinolaryngologic Application of Stem Cells.

Byung Ki YOON ; Dong Kyu KIM ; Dae Woo KIM ; Hong Ryul JIN

Journal of Rhinology.2014;21(1):8-14.

Stem cells can be isolated from almost any tissue in the body and are capable of proliferating in an undifferentiated manner and, under appropriate inductive conditions, differentiating into multiple cell lineages. Numerous studies are being conducted around the world using stem cells in various medical fields, including otorhinolaryngology. This review provides a brief overview of the method used for human stem cell isolation, the current status of clinical applications in the field of otorhinolaryngology as well as in general medicine, and lastly, suggests the future potential of stem cells in otorhinolaryngologic surgery. Within the field of otorhinolaryngology, stem cells have been clinically used or studied in four main areas: bony framework reconstruction, soft tissue augmentation, cartilage repair and wound healing. Outcomes of stem cell application appear promising; however, further basic research and clinical studies with longer follow-up periods are needed to develop safe and successful clinical applications.
Cartilage ; Cell Lineage ; Humans ; Otolaryngology ; Stem Cells* ; Tissue Engineering ; Wound Healing

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A Case of Rhino-Orbito-Cerebral Mucormycosis.

Kyung Chul LEE ; Seok Jin HONG ; Tae Hyung KIM ; Il Gyu KANG

Journal of Rhinology.2003;10(1, 2):49-52.

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

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Endoscopic Dacryocystorhinostomy for the Treatment of Lacrimal Sac Abscess.

Kyung Chul LEE ; Ji Hwan YUN ; Bong Ju KANG ; Chang Gyu KIM

Journal of Rhinology.2003;10(1, 2):46-48.

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

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The Effect of MAC (Monitored Anesthesia Care) on Perioperative Pain in Endoscopic Sinus Surgery.

Hyun Seung CHOI ; Hyun Jik KIM ; Seung Jae BAEK ; Kyu Bo KIM ; Jin Young KIM ; Hye Geum GIL ; Jeung Gweon LEE

Journal of Rhinology.2003;10(1, 2):42-45.

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

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Effect of Roxithromycin and Intranasal Fluticasone Spray in Reducing Symptoms of Chronic Sinusitis, Polyp Size and IL-4 in Allergic Patients.

Byung Guk KIM ; Dong Mok LEE ; Jin Hee JO ; Dae Gun JUNG ; Jun Myung KANG ; Sung Won KIM

Journal of Rhinology.2003;10(1, 2):37-41.

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

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Development of Paranasal Sinus Mucocele Following Endoscopic Sinus Surgery.

Jae Jin SONG ; Woo Sub SHIM ; Dae Woo KIM ; Seung Sin LEE ; Chae Seo RHEE ; Chul Hee LEE ; Yang Gi MIN

Journal of Rhinology.2003;10(1, 2):33-36.

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

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Effect of Patient-Controlled Analgesia after Tonsillectomy with Laser Resection of Palatopharynx (LRPP).

Hyun Jik KIM ; Hyun Seung CHOI ; Yong Seok SEO ; Woo Chul SHIN ; Seung Jae BAEK ; Hye Keum KIL ; Jeung Gweon LEE

Journal of Rhinology.2003;10(1, 2):27-32.

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*

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Lack of Association between an Insertion/Deletion Polymorphism of the Angiotensin-Converting Enzyme Gene and Allergic Rhinitis in a Korean Population.

Jae Hoon LEE ; Tae Wook CHOI ; Sung Weon YOON ; Jeong Joong KIM

Journal of Rhinology.2003;10(1, 2):23-26.

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

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