1.Efficacy and Safety of Fat Graft Myringoplasty Combined With Platelet-Rich Plasma for Managing Chronic Tympanic Membrane Perforations: A Systematic Review and Meta-Analysis
Yun Jin KANG ; Gulnaz STYBAYEVA ; Se Hwan HWANG
Clinical and Experimental Otorhinolaryngology 2026;19(1):70-78
Objectives:
Platelet-rich plasma (PRP) is an autologous product derived from whole blood through the process of gradient density centrifugation. Autologous PRP has been shown to be safe and effective in promoting natural wound healing processes. This study assessed the efficacy of fat graft myringoplasty combined with PRP in tympanic membrane (TM) healing in dry TM perforation due to chronic otitis media and compared it to that of fat graft myringoplasty.
Methods:
A systematic review and meta-analysis of prospective or retrospective studies was conducted, with database searches (PubMed, Cochrane Library, Embase, Web of Science, Scopus, and Google Scholar) performed through April 2025. The outcomes included the success rate (complete closure of the TM postoperatively) and changes in air-bone conduction gap (ABG) (preoperatively and postoperatively) in the audiogram.
Results:
Five studies (n=522) were included. Fat myringoplasty with PRP resulted in greater improvement in ABGs (standardized mean difference [SMD], 0.329; 95% CI, 0.132 to 0.527) and higher success rates (odds ratio [OR], 3.129; 95% CI, 1.882 to 5.203) compared to fat myringoplasty alone. In medium-sized perforations, combination therapy demonstrated superior outcomes in both success rate (OR, 3.179; 95% CI, 1.891 to 5.343) and ABG (SMD, 0.357; 95% CI, 0.128 to 0.586). However, no significant differences were observed in cases involving small and medium-sized perforations (success rate: OR, 2.154; 95% CI, 0.174 to 26.672 and changes in ABG: SMD, 0.249; 95% CI, –0.141 to 0.638). Both liquid and gel PRP significantly improved ABGs and TM closure rates, with no significant difference between types.
Conclusion
This study demonstrated a higher success rate and greater hearing improvement with PRP-assisted fat myringoplasty, especially in medium-sized perforations. Both liquid and gel PRP forms were effective, with no significant difference between them.
2.The Efficacy of Intranasal Insulin in the Treatment of Post-Viral Persistent Olfactory Dysfunction: A Systematic Review
Do Hyun KIM ; David W. JANG ; Se Hwan HWANG
Clinical and Experimental Otorhinolaryngology 2026;19(2):120-128
Objectives:
. This study aimed to evaluate the therapeutic efficacy of intranasal insulin in treating persistent and refractory olfactory dysfunction following viral infections.
Methods:
. A comprehensive literature search was performed across PubMed, Scopus, Embase, Web of Science, Google Scholar, and the Cochrane Library, covering all articles indexed up to July 2025. Studies were included if they evaluated changes in olfactory scores in patients receiving intranasal insulin, either compared with a control group (placebo or no treatment) or between pre- and post-treatment measurements. Secondary outcomes included serum glucose and insulin levels and the proportion of patients achieving significant olfactory recovery.
Results:
. Eight studies including 457 participants were reviewed. Intranasal insulin was generally associated with improvement in olfactory scores. Delivery via absorbable materials may enhance both threshold and discrimination outcomes, whereas self-administration demonstrated minimal benefit. Several studies also reported higher rates of substantial olfactory recovery with absorbable material-based delivery. Combination therapy with intranasal insulin and budesonide was suggested to further improve threshold scores. Overall, treatment was well tolerated, with no major changes in serum glucose levels, although one study documented a mild hypoglycemic event.
Conclusion
. Current evidence suggests that intranasal insulin, particularly when delivered using absorbable materials, may offer therapeutic benefit for persistent post-viral olfactory dysfunction. Corticosteroid coadministration may also provide additional improvements. These findings remain preliminary and require confirmation in larger, well-controlled studies.
3.Efficacy of Montelukast–Antihistamine Combination Therapy Versus Antihistamine Monotherapy in Allergic Rhinitis: A Systematic Review and Meta-Analysis
Ji-Sun KIM ; Gulnaz STYBAYEVA ; Se Hwan HWANG
Clinical and Experimental Otorhinolaryngology 2026;19(2):164-176
Objectives:
. Allergic rhinitis (AR) can substantially compromise daily functioning and well-being, and many patients require more than a single agent to obtain satisfactory symptom control. This study examined whether adding montelukast to antihistamine could manage AR symptoms and quality-of-life outcomes effectively.
Methods:
. A review was performed in PubMed, Embase, Medline, Scopus, the Cochrane Library, and Google Scholar to identify eligible studies reported through April 2025. Eligible studies compared combination therapy with montelukast plus antihistamine against antihistamine monotherapy and reported nasal symptoms or rhinoconjunctivitis quality of life questionnaire (RQLQ) scores. Treatment effects were further examined by antihistamine class.
Results:
. Fifteen studies including 2,882 subjects were analyzed. Combination therapy significantly improved daytime nasal symptoms (standardized mean difference [SMD] [95% CI], 0.44 [0.21–0.67]), nighttime nasal symptoms (0.12 [0.01–0.23]), and RQLQ scores (0.14 [0.00–0.27]) versus monotherapy. Individual nasal or ocular symptoms, sneezing, nasal obstruction, and rhinorrhea improved significantly, while nasal itching and ocular symptoms did not. Combinations with desloratadine and levocetirizine showed greater benefits than those with loratadine or fexofenadine.
Conclusion
. Montelukast–antihistamine combination therapy reduced overall symptoms and improved quality of life versus antihistamine monotherapy. The magnitude of benefit appears to vary depending on the specific antihistamine used, highlighting the possible value of individualized treatment strategies in the treatments of AR.
4.Usefulness of the ID-Migraine Screening Tool for Diagnosing Migraines in Patients With Headache and Facial Pain: A Systematic Review and Meta-Analysis
Do Hyun KIM ; David W. JANG ; Se Hwan HWANG
Journal of Rhinology 2026;33(1):1-10
Background and Objectives:
A substantial proportion of patients presenting with sinus headaches are ultimately diagnosed with migraines. The ID-Migraine tool has been developed to aid in identifying migraine patients in primary care settings. Therefore, we conducted a meta-analysis of validation studies evaluating the diagnostic accuracy of the ID-Migraine tool.
Methods:
Data were extracted regarding true positives, false positives, true negatives, and false negatives, along with study characteristics. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.
Results:
In total, 30 studies involving 9,942 participants were included in the final analysis. The pooled diagnostic odds ratio for the ID-Migraine tool was 13.84. The area under the summary receiver operating characteristic curve was 0.846. The pooled sensitivity and specificity were 0.865 and 0.702, respectively, while the negative predictive value was 0.791 and the positive predictive value was 0.799.
Conclusion
The ID-Migraine screening tool is highly accurate and user-friendly for identifying migraines among patients presenting with sinus headaches. By employing this tool, unnecessary diagnostic tests or treatments can be minimized, and patients can be promptly referred to appropriate specialists.
5.Determinant of Aggressive Phenotype in Metastatic Hormone-Sensitive Prostate Cancer Depends on an Intrinsic, Highly Aggressive Cell Cluster: Integrated Single-Cell RNA and Whole Transcriptomic Sequencing Analyses
Minyong KANG ; ByulA JEE ; Jiwoong YU ; Soohyun HWANG ; Kyunghee PARK ; Kyung Yeon HAN ; Wan SONG ; Hyun Hwan SUNG ; Hwang Gyun JEON ; Byong Chang JEONG ; Seong Il SEO ; Se Hoon PARK ; Woong-Yang PARK ; Seong Soo JEON
Journal of Urologic Oncology 2025;23(2):98-111
Purpose:
Although the combination of androgen deprivation therapy with docetaxel or abiraterone acetate and prednisone has become a standard treatment for metastatic hormone-sensitive prostate cancer (mHSPC) and has shown improved overall survival, a subset of patients still progress to castration-resistant disease. However, the underlying molecular features in these patients remain poorly understood.
Materials and Methods:
We performed single-cell RNA sequencing (scRNA-seq) on 12 tissue samples, including 2 mHSPC samples, 7 primary prostate cancer (PCa) samples, and 3 matched normal samples from 7 patients. Raw sequencing data was processed by Cell Ranger software (10X Genomics) and aligned to the human reference genome (GRCh38). A comprehensive analysis of samples from patients with mHSPC was also conducted and validated using a cohort of 52 patients with mHSPC.
Results:
Our results identified distinct subpopulations within luminal and mononuclear phagocyte (MNP) clusters characterized by proliferative activation associated with unfavorable clinical outcomes. Furthermore, we observed that the MNP cluster exhibited significant proliferation activity. To understand the underlying mechanisms associated with aggressiveness, we conducted cell-cell interaction, copy number variation and pseudotime analysis. Utilizing 87 network genes from scRNA-seq, we classified 52 mHSPC patients into 2 molecular subtypes and demonstrated their correlation with distinct transcriptomic profiles and survival outcomes. Importantly, a 14-gene signature derived from 3 distinct gene sets exhibited a strong association with patient survival and drug response. The prognostic value of our findings was further validated in large-scale cohorts comprising localized PCa, metastatic PCa, mHSPC, and metastatic castration-resistant PCa patients.
Conclusion
This study provides valuable insights into the identification of high-risk patients, novel biomarkers, and potential therapeutic targets for individuals with mHSPC. Furthermore, the results in this study can serve as a basis for future investigations aimed at refining prognostic strategies and developing targeted therapies for patients with mHSPC.
6.A Review of the Long-Term Efficacy of Submucosal Medpor Implantation for Empty Nose Syndrome: A Short Communication
Journal of Rhinology 2024;31(3):176-178
To evaluate the long-term effects of submucosal Medpor implants in patients with empty nose syndrome (ENS), using the Sinonasal Outcome Test (SNOT) score as a measure of clinical improvement. A comprehensive search of six databases was conducted up to October 2024. The analysis included studies that examined the impact of submucosal Medpor implants on refractory ENS symptoms, as assessed by various symptom-specific questionnaires. Post-intervention SNOT scores were evaluated during follow-up periods of over 12 months, showing a statistically significant improvement in ENS symptoms (standardized mean difference [95% confidence interval]= 1.4676 [1.2067; 1.7285]; I2=37.2%). This meta-analysis indicates that submucosal Medpor implantation in patients with ENS is associated with significant long-term improvements in nasal symptoms.
7.Human Nasal Turbinate-Derived Stem Cells for Tissue Engineering and Regenerative Medicine
Journal of Rhinology 2024;31(3):133-137
Mesenchymal stem cells (MSCs) are multipotent progenitor cells present in adult tissues that are recognized as promising candidates for cell therapy due to their ease of access, straightforward isolation, and capacity for bio-preservation with minimal loss of potency. However, the clinical application of MSCs faces significant challenges, such as donor site morbidity, underscoring the need for alternative sources. Recent studies have suggested that inferior turbinate tissues, which are commonly removed during turbinate surgery, may be a viable donor site for MSCs. Turbinate surgery is a safe and effective procedure frequently performed to alleviate nasal obstruction, a prevalent chronic condition treated by otolaryngologists. This implies that harvesting MSCs from turbinate tissue for tissue engineering and regenerative medicine could serve as a simple, minimally invasive method with faster healing and minimal risk of morbidity or scarring at the donor site. This review highlights previous research indicating that MSCs derived from human turbinate tissues maintain their stability and demonstrate multi-differentiation potential. Therefore, the turbinate could be an alternative to traditional MSC sources for producing functionally competent cells for future clinical applications.
8.A Review of the Long-Term Efficacy of Submucosal Medpor Implantation for Empty Nose Syndrome: A Short Communication
Journal of Rhinology 2024;31(3):176-178
To evaluate the long-term effects of submucosal Medpor implants in patients with empty nose syndrome (ENS), using the Sinonasal Outcome Test (SNOT) score as a measure of clinical improvement. A comprehensive search of six databases was conducted up to October 2024. The analysis included studies that examined the impact of submucosal Medpor implants on refractory ENS symptoms, as assessed by various symptom-specific questionnaires. Post-intervention SNOT scores were evaluated during follow-up periods of over 12 months, showing a statistically significant improvement in ENS symptoms (standardized mean difference [95% confidence interval]= 1.4676 [1.2067; 1.7285]; I2=37.2%). This meta-analysis indicates that submucosal Medpor implantation in patients with ENS is associated with significant long-term improvements in nasal symptoms.
9.Human Nasal Turbinate-Derived Stem Cells for Tissue Engineering and Regenerative Medicine
Journal of Rhinology 2024;31(3):133-137
Mesenchymal stem cells (MSCs) are multipotent progenitor cells present in adult tissues that are recognized as promising candidates for cell therapy due to their ease of access, straightforward isolation, and capacity for bio-preservation with minimal loss of potency. However, the clinical application of MSCs faces significant challenges, such as donor site morbidity, underscoring the need for alternative sources. Recent studies have suggested that inferior turbinate tissues, which are commonly removed during turbinate surgery, may be a viable donor site for MSCs. Turbinate surgery is a safe and effective procedure frequently performed to alleviate nasal obstruction, a prevalent chronic condition treated by otolaryngologists. This implies that harvesting MSCs from turbinate tissue for tissue engineering and regenerative medicine could serve as a simple, minimally invasive method with faster healing and minimal risk of morbidity or scarring at the donor site. This review highlights previous research indicating that MSCs derived from human turbinate tissues maintain their stability and demonstrate multi-differentiation potential. Therefore, the turbinate could be an alternative to traditional MSC sources for producing functionally competent cells for future clinical applications.
10.Perinatal Risk Factors for Asthma and Allergic Rhinitis in Children and Adolescents
Se Hwan HWANG ; Hyesoo SHIN ; Gulnaz STYBAYEVA ; Do Hyun KIM
Clinical and Experimental Otorhinolaryngology 2024;17(2):168-176
Objectives:
. In this study, we evaluated the associations between birth-related exposures, postnatal factors, and the risk of allergic rhinitis and asthma in children and adolescents.
Methods:
. We performed a comprehensive search of five literature databases up to May 2023. To quantify the associations of birth-related exposures (birth weight, delivery mode, prematurity, sex, maternal age, and parental allergy history) and postnatal factors (birth order, number of siblings, breastfeeding exclusivity, and breastfeeding duration) with allergic disease, we calculated pooled odds ratios and 95% confidence intervals. We conducted subgroup analyses for allergic disease type, birth order, number of siblings, and parental allergy history. The methodological quality of the identified studies was evaluated using the Newcastle-Ottawa Scale.
Results:
. This meta-analysis included 31 studies, encompassing 218,899 patients in total. The birth-related exposures of low birth weight, maternal age, and prematurity (less than 37 weeks gestation) were not significantly associated with the risk of asthma or allergic rhinitis during childhood or adolescence. Male sex, family history of allergy, and cesarean delivery were linked to an elevated risk of asthma or allergic rhinitis. Among postnatal factors, exclusive breastfeeding, breastfeeding for longer than 6 months, second or later birth order, and having siblings exhibited protective effects against allergic diseases in offspring.
Conclusion
. The risks of allergic rhinitis and asthma were elevated in male patients, those delivered by cesarean section, and those with a family history of allergy. Conversely, exclusive breastfeeding, breastfeeding for longer than 6 months, and having siblings corresponded to a reduced risk of respiratory allergic diseases.

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