PURPOSE: Allergen-specific immunotherapy is the only currently available treatment to modify the natural history of allergic rhinitis (AR). If patients are polysensitized, it is difficult to identify the allergen causing the allergic symptoms. We evaluated the effectiveness of immunotherapy against house dust mites (HDMs) in AR patients polysensitized to both HDMs and seasonal allergens. METHODS: Thirty AR patients polysensitized to both HDMs and seasonal allergens (group A) and 30 patients sensitized to HDMs only (group B) were enrolled in this study. All subjects who received immunotherapy against HDMs for more than 2 years were evaluated by the multiple allergen simultaneous test (MAST) to determine the specific IgE level in luminescence units, total eosinophil counts in peripheral blood, serum total IgE, total nasal symptom scores, and the rhinoconjunctivitis quality of life questionnaire (RQLQ) before and after immunotherapy. RESULTS: There were no statistical differences in levels of total and specific IgE, or total eosinophil count between the two groups. The total nasal symptom scores, RQLQ and medication scores significantly decreased after immunotherapy in both groups, however no significant differences were noted between the two groups. CONCLUSIONS: We determined that the primary causative allergen of AR in Seoul, Korea is perennial allergens, such as HDMs, rather than seasonal allergens. This study provides a reference for the selection of allergens to use in immunotherapy for polysensitized AR patients living in an urban environment.
Allergens ; Desensitization, Immunologic* ; Eosinophils ; Humans ; Immunoglobulin E ; Immunotherapy ; Korea ; Luminescence ; Natural History ; Pyroglyphidae* ; Quality of Life ; Rhinitis* ; Seasons ; Seoul ; Surveys and Questionnaires

The orbital apex syndrome is a very rare complication of fungal sinusitis, as well as of other conditions, and is characterized by blindness, diplopia, proptosis of the eye and ophthalmoplegia. We present a case of diplopia caused by a fungal ball in the Onodi cell. A 62-year-old woman, diagnosed with orbital apex syndrome and suffering from ophthalmalgia and diplopia in the right eye, was presented to our outpatient clinic. Computed tomography showed a soft tissue lesion occupying the right Onodi cell with chronic inflammation. Patients who have an Onodi cell carry a high risk for optic nerve injury, so endoscopic sinus surgery using navigation was performed. Histopathology examination confirmed the diagnosis of a fungal ball. We experienced a rare case of a fungal ball in the Onodi cell, which caused damage to the adjacent cavernous sinus structure and led to diplopia and orbital pain. We present this case with a brief review of these disease entities.
Ambulatory Care Facilities ; Blindness ; Cavernous Sinus ; Diagnosis ; Diplopia* ; Exophthalmos ; Female ; Humans ; Inflammation ; Middle Aged ; Ophthalmoplegia ; Optic Nerve Injuries ; Orbit ; Sinusitis

Retrobulbar hematoma is a rare complication following septal surgery under general anesthesia. Symptoms and physical findings include temporary blindness, ophthalmoplegia, mydriasis, ptosis, proptosis and eyelid ecchymosis. Recently, we experienced a rare case of the right retrobulbar hematoma after septal surgery. At present, there is no literature about the occurrence of retrobulbar hematoma following septal surgery. We hereby present this case with an emphasis on the importance of prevention, identification and management of retrobulbar hematoma.
Anesthesia, General* ; Blindness ; Ecchymosis ; Exophthalmos ; Eyelids ; Hematoma* ; Mydriasis ; Ophthalmoplegia

BACKGROUND AND OBJECTIVES: Nasal packing after nasal surgery is commonly practiced. Merocel(R) is one of the most popular packing material, however it can be associated with significant pain and bleeding on its removal. A prospective study was performed to compare the efficacy and patient tolerance of Merocel(R) and newly designed Latex-covered Merocel(R) (LCM). MATERIALS AND METHOD: Sixty patients underwent septoplasty for septal deviation. Following septoplasty, the patients were randomly allocated into two groups of 30 patients each who underwent insertion of either Merocel(R) or LCM. Patients were asked to record pain levels using a visual analogue scale(VAS) before and after packing removal, and number of analgesic injection were recorded. Resistance and amount of bleeding on packing removal were also recorded. RESULTS: Both nasal packs effectively prevented post-operative bleeding. However the VAS score for nasal pain and numbers of analgesic use before and after packing removal were significantly lower in the LCM group. LCM was removed more smoothly causing significantly less amount of bleeding on removal. CONCLUSION: LCM provides good post-operative hemostasis and its removal is less traumatic and painful for the patients, therefore improving patient's comfort.
Hemorrhage ; Hemostasis ; Humans ; Nasal Surgical Procedures ; Prospective Studies

OBJECTIVES: Alpha1-antitrypsin (AAT) is the main inhibitor of human neutrophil elastase, and plays a role in counteracting the tissue damage caused by elastase in local inflammatory conditions. The study evaluated the involvement of AAT in nasal allergic inflammation. METHODS: Forty subjects with mono-sensitization to Dermatophagoides pteronyssinus (Dpt) were enrolled. Twenty allergic rhinitis patients frequently complained of nasal symptoms such as rhinorrhea, stuffiness, sneezing, and showed positive responses to the nasal provocation test (NPT) with Dpt (Group I). The other 20 asymptomatic patients showed sensitization to Dpt but negative NPT (Group II). The levels of AAT, eosinophil cationic protein (ECP), and Dpt-specific IgA antibodies were measured in the nasal lavage fluids (NLFs), collected at baseline, 10 minutes, 30 minutes, 3 hours, and 6 hours after the NPT. Nasal mucosa AAT expression was evaluated with immunohistochemical staining from Group I and Group II. RESULTS: At baseline, only the Dpt-specific IgA level was significantly increased in the NLFs of Group I compared with Group II, while ECP and AAT levels were not significantly different between two groups. After Dpt provocation, AAT, ECP, and Dpt-specific IgA levels were significantly increased in the NLFs of Group I during the early and late responses. The protein expression level of AAT was mostly found in the infiltrating inflammatory cells of the nasal mucosa, which was significantly increased in Group I compared to Group II. CONCLUSION: The increment of AAT showed a close relationship with the activation of eosinophils induced by allergen-specific IgA in the NLFs of patients with allergic rhinitis after allergen stimulation. These findings implicate AAT in allergen-induced nasal inflammation.
Antibodies ; Dermatophagoides pteronyssinus ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Immunoglobulin A ; Inflammation ; Leukocyte Elastase ; Nasal Lavage Fluid ; Nasal Mucosa ; Nasal Provocation Tests ; Pancreatic Elastase ; Rhinitis ; Rhinitis, Allergic, Perennial ; Sneezing

OBJECTIVES: Alpha1-antitrypsin (AAT) is the main inhibitor of human neutrophil elastase, and plays a role in counteracting the tissue damage caused by elastase in local inflammatory conditions. The study evaluated the involvement of AAT in nasal allergic inflammation. METHODS: Forty subjects with mono-sensitization to Dermatophagoides pteronyssinus (Dpt) were enrolled. Twenty allergic rhinitis patients frequently complained of nasal symptoms such as rhinorrhea, stuffiness, sneezing, and showed positive responses to the nasal provocation test (NPT) with Dpt (Group I). The other 20 asymptomatic patients showed sensitization to Dpt but negative NPT (Group II). The levels of AAT, eosinophil cationic protein (ECP), and Dpt-specific IgA antibodies were measured in the nasal lavage fluids (NLFs), collected at baseline, 10 minutes, 30 minutes, 3 hours, and 6 hours after the NPT. Nasal mucosa AAT expression was evaluated with immunohistochemical staining from Group I and Group II. RESULTS: At baseline, only the Dpt-specific IgA level was significantly increased in the NLFs of Group I compared with Group II, while ECP and AAT levels were not significantly different between two groups. After Dpt provocation, AAT, ECP, and Dpt-specific IgA levels were significantly increased in the NLFs of Group I during the early and late responses. The protein expression level of AAT was mostly found in the infiltrating inflammatory cells of the nasal mucosa, which was significantly increased in Group I compared to Group II. CONCLUSION: The increment of AAT showed a close relationship with the activation of eosinophils induced by allergen-specific IgA in the NLFs of patients with allergic rhinitis after allergen stimulation. These findings implicate AAT in allergen-induced nasal inflammation.
Antibodies ; Dermatophagoides pteronyssinus ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Immunoglobulin A ; Inflammation ; Leukocyte Elastase ; Nasal Lavage Fluid ; Nasal Mucosa ; Nasal Provocation Tests ; Pancreatic Elastase ; Rhinitis ; Rhinitis, Allergic, Perennial ; Sneezing

BACKGROUND AND OBJECTIVES: Overnight polysomnography (PSG) in a sleep laboratory is the standard method of confirming the diagnosis of obstructive sleep apnea (OSA). However, PSG is expensive, time-consuming, uneasily accessible and labor-intensive, so many patients need a more convenient tool that is ambulatory. The aim of this study was to investigate the usefulness of Embletta by comparing the respiratory parameters derived from Embletta with those of PSG. SUBJECTS AND METHOD: PSG and Embletta sleep study were performed for 42 patients prospectively. Respiratory parameters, such as apnea index (AI), hypopnea index (HI), apnea-hypopnea index (AHI), and oxygen parameters, such as lowest oxygen saturation (LSAT), mean oxygen saturation (MSAT), and oxygen desaturation index (ODI) were measured automatically from Embletta and by hand from PSG. All parameters of Embletta were compared with those of PSG. In addition, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for Embletta were calculated for the diagnosis of OSA. RESULTS: Most of the respiratory parameters and the oxygen parameters were well correlated between PSG and Embletta and the correlation coefficients were well correlated and statistically significant as well. The sensitivity, specificity, PPV, and NPV were 90%, 75%, 0.9, and 0.75, respectively, for Embletta for the diagnosis of OSA. CONCLUSION: Embletta might be clinically useful as a screening device of OSA patients based on its high correlation to PSG and positive predictive value.
Apnea ; Hand ; Humans ; Mass Screening ; Oxygen ; Polysomnography ; Prospective Studies ; Sensitivity and Specificity ; Sleep Apnea, Obstructive

BACKGROUND AND OBJECTIVES: Although obstructive sleep apnea is common, it has often gone undiagnosed in primary care encounters until now, with no validated screening tool of obstructive sleep apnea (OSA) for Korean patients. The aim of this study was to investigate the usefulness of Berlin questionnaire (Berlin Q) and STOP questionnaire (STOP Q) as a screening test for sleep apnea for the Korean patients. SUBJECTS AND METHOD: We administered Berlin Q and STOP Q to 106 patients who received a full night polysomnography. We investigated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each questionnaire according to patients' severity by apnea hypopnea index (AHI). RESULTS: Results were categorized according to AHI severity using cut-off points of AHI greater than 5, 15, and 30. The sensitivity and specificity of the Berlin Q were 69, 72, 78% and 41, 43, 39%, respectively. NPV and PPV of Berlin Q were 0.20, 0.43, 0.74 and 0.86, 0.72, 0.43, respectively. The sensitivity and specificity of the STOP Q was 97, 97, 98% and 35, 20, 12%, respectively. NPV and PPV for STOP Q were 0.67, 0.78, 0.89 and were 0.89, 0.71, 0.40, respectively. CONCLUSION: Our results indicate that STOP Q shows higher sensitivity than Berlin Q with similar specificity. Therefore, STOP Q is a more convenient and better means than Berlin Q to screen patients for obstructive sleep apnea.
Apnea ; Berlin ; Humans ; Korea ; Mass Screening ; Polysomnography ; Primary Health Care ; Surveys and Questionnaires ; Sensitivity and Specificity ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive

OBJECTIVE: The purpose of this study was to evaluate the efficacy of a transforaminal suprapedicular approach, semi-rigid flexible curved probe, and 3-dimensional reconstruction computed tomography (3D-CT) with discogram in the endoscopic treatment of non-contained lumbar disc herniations. METHODS: The subjects were 153 patients with difficult, non-contained lumbar disc herniations undergoing endoscopic treatment. The types of herniation were as follows : extraforaminal, 17 patients; foraminal, 21 patients; high grade migration, 59 patients; and high canal compromise, 56 patients. To overcome the difficulties in endoscopic treatment, the anatomic structures were analyzed by 3D reconstruction CT and the high grade disc was extracted using a semi-rigid flexible curved probe and a transforaminal suprapedicular approach. RESULTS: The mean follow-up was 18.3 months. The mean visual analogue scale (VAS) of the patients prior to surgery was 9.48, and the mean postoperative VAS was 1.63. According to Macnab's criteria, 145 patients had excellent and good results, and thus satisfactory results were obtained in 94.77% cases. CONCLUSION: In a posterolateral endoscopic lumbar discectomy, the difficult, non-contained disc is considered to be the most important factor impeding the success of surgery. By applying a semi-rigid flexible curved probe and using a transforaminal suprapedicular approach, good surgical results can be obtained, even in high grade, non-contained disc herniations.
Diskectomy ; Diskectomy, Percutaneous ; Follow-Up Studies ; Humans

BACKGROUND AND OBJECTIVES: Postoperative taste changes after uvulopalatopharyngoplasty (UPPP) is regarded as an unusual and minor complication. This study aims to evaluate the objective changes of taste threshold according to time course and subjective symptoms change. MATERIALS AND METHOD: With 45 patients who underwent UPPP and 35 patients who underwent nasal surgery as control group, we have prospectively studied postoperative taste changes using a questionnaire, and an electrogustometer (EGM) with regard to symptoms at 7th, 28th days after the surgery. EGM was measured at 5 areas. Also, we have checked pre-operatively about the serum level of zinc. RESULTS: With EGM, the threshold of taste was increased at 7th days after the surgery (p<0.05), but recovered 28th days after the surgery at the posterior part of the tongue in the UPPP group. There were no significant changes in subjective taste dysfunction, smell dysfunction, tongue sensory abnormality, and dysgeusia. CONCLUSION: Taste changes after UPPP was transient and they disappeared within the 1st postoperative month. There were no patients who complained of subjective taste dysfunction, dysgeusia, tongue sensory abnormality after UPPP.
Dysgeusia ; Humans ; Nasal Surgical Procedures ; Prospective Studies ; Surveys and Questionnaires ; Sleep Apnea, Obstructive ; Smell ; Taste Threshold ; Tongue