Increased Anti-Allergic Effects of Secretome of Low-Level Light Treated Tonsil-Derived Mesenchymal Stem Cells in Allergic Rhinitis Mouse Model.

BACKGROUND: Low-level light therapy (LLLT) is widely used for the photobiomodulation of cell behavior. Recent studies have shown that LLLT affects the proliferation and migration of various types of mesenchymal stem cells (MSCs). However, there is a lack of studies investigating the effect of LLT on enhancing the immunomodulatory properties of tonsil-derived MSCs (T-MSCs). OBJECTIVE: The aim of this study was to investigate the immunomodulatory effects of conditioned media from T-MSCs (T-MSCs-CM) treated with LLLT in allergic inflammation. METHODS: We isolated T-MSCs from human palatine tonsils and evaluated the ingredients of T-MSCs-CM. The effect of T-MSCs-CM treated with LLLT was evaluated in a mouse model of allergic rhinitis (AR). We randomly divided the mice into four groups (negative control, positive control, T-MSCs-CM alone, and T-MSCs-CM treated with LLLT). To elucidate the therapeutic effect, we assessed rhinitis symptoms, serum immunoglobulin (Ig), the number of inflammatory cells, and cytokine expression. RESULTS: We identified increased expression of immunomodulatory factors, such as HGF, TGF-ß, and PGE, in T-MSCs-CM treated with LLLT, compared to T-MSCs-CM without LLLT. Our animal study demonstrated reduced allergic symptoms and lower expression of total IgE and OVA-specific IgE in the LLLT-treated T-MSCs-CM group compared to the AR group and T-MSCs-CM alone. Moreover, we found that T-MSCs-CM treated with LLLT showed significantly decreased infiltration of eosinophils, neutrophils, and IL-17 cells in the nasal mucosa and reduced IL-4, IL-17, and IFN-γ expression in OVA-incubated splenocytes compared to the AR group. CONCLUSIONS: The present study suggests that T-MSCs-CM treated with LLLT may provide an improved therapeutic effect against nasal allergic inflammation than T-MSCs-CM alone.

Effects of Wnt signaling on epithelial to mesenchymal transition in chronic rhinosinusitis with nasal polyp.

BACKGROUND: Epithelial to mesenchymal transition (EMT) is associated with the pathophysiology of chronic rhinosinusitis with nasal polyp (CRSwNP). Wnt signaling is causative for EMT, whereas the mechanism in CRSwNP is not fully understood. OBJECTIVE: We sought to evaluate the role of Wnt signaling in EMT of CRSwNP using a murine nasal polyp (NP) model and human tissues. METHODS: Inflammatory markers and EMT-related molecules were evaluated in NP models using adenomatosis polyposis coli (Apc)Min/+ mice with activated Wnt signaling and NP models treated with Wnt signaling inhibitor, indocyanine green-001 (ICG-001). EMT markers and Wnt signaling-associated mediators were analysed using human sinonasal tissues from control subjects and CRSwNP patients. RESULTS: ApcMin/+ mice-induced NPs exhibited more frequent polypoid lesions and upregulation of Wnt-related molecules, including nuclear ß-catenin, WNT3A and cyclin D1. Markers of EMT were significantly overexpressed in the ApcMin/+ NP mice (p<0.001 for E-cadherin and α-smooth muscle actin), and interleukin (IL)-17A+ cells and neutrophilic infiltration were increased in ApcMin/+ NP mice (p<0.001). Inhibition of Wnt signaling via ICG-001 resulted in significantly decreased nasal polypoid lesions (p<0.001), EMT-related markers (p=0.019 for E-cadherin and p=0.002 for vimentin) and the mRNA levels of IL-4 (p<0.001) and IL-17A (p=0.004) compared with the positive control group. Finally, nuclear ß-catenin (p=0.042) was significantly increased compared with the control, and the expression levels of Wnt ligands and receptors were upregulated in human NP tissues (p=0.045 for WNT3A and p=0.042 for FZD2), suggesting increased Wnt signaling and EMT in CRSwNP. CONCLUSION: Wnt signaling may contribute to the pathogenesis of NPs through EMT. Therefore, inhibition of Wnt signaling may be a potential therapeutic strategy for patients with CRSwNP.

Role of IL-17A in Chronic Rhinosinusitis With Nasal Polyp.

PURPOSE: Th17-associated inflammation is increased in chronic rhinosinusitis with nasal polyp (CRSwNP), and is associated with disease severity and steroid resistance. Overexpressed interleukin (IL)-17A affects CRSwNP by tissue remodeling, eosinophilic accumulation, and neutrophilic infiltration. We aimed to identify the role of IL-17A in CRSwNP and to evaluate the effects of anti-IL-17A blocking antibody on nasal polyp (NP) formation using a murine NP model. Moreover, we sought to investigate whether the inhibition of mechanistic target of the rapamycin (mTOR) signal pathway could suppress IL-17A expression and NP formation. METHODS: Human sinonasal tissues from control subjects and patients with chronic rhinosinusitis (CRS) were analyzed using immunohistochemistry (IHC) and immunofluorescence staining. The effects of IL-17A neutralizing antibody and rapamycin were evaluated in a murine NP model. Mouse samples were analyzed using IHC, quantitative real-time polymerase chain reaction, and enzyme-linked immunosorbent assay. RESULTS: IL-17A⁺ inflammatory cells were significantly increased in number in NP from patients with CRSwNP compared to that in uncinate process tissues from control subjects and patients with CRS without NP or CRSwNP. CD68⁺ M1 macrophages dominantly expressed IL-17A, followed by neutrophils and T helper cells, in NP tissues. Neutralization of IL-17A effectively reduced the number of NPs, inflammatory cytokines, and IL-17A-producing cells, including M1 macrophages. Inhibition of IL-17A via the mTOR pathway using rapamycin also attenuated NP formation and inflammation in the murine NP model. CONCLUSIONS: IL-17A possibly plays a role in the pathogenesis of CRSwNP, the major cellular source being M1 macrophage in NP tissues. Targeting IL-17A directly or indirectly may be an effective therapeutic strategy for CRSwNP.

Inhibition of IRF4 in dendritic cells by PRR-independent and -dependent signals inhibit Th2 and promote Th17 responses.

Cyclic AMP (cAMP) is involved in many biological processes but little is known regarding its role in shaping immunity. Here we show that cAMP-PKA-CREB signaling (a pattern recognition receptor [PRR]-independent mechanism) regulates conventional type-2 Dendritic Cells (cDC2s) in mice and reprograms their Th17-inducing properties via repression of IRF4 and KLF4, transcription factors essential for cDC2-mediated Th2 induction. In mice, genetic loss of IRF4 phenocopies the effects of cAMP on Th17 induction and restoration of IRF4 prevents the cAMP effect. Moreover, curdlan, a PRR-dependent microbial product, activates CREB and represses IRF4 and KLF4, resulting in a pro-Th17 phenotype of cDC2s. These in vitro and in vivo results define a novel signaling pathway by which cDC2s display plasticity and provide a new molecular basis for the classification of novel cDC2 and cDC17 subsets. The findings also reveal that repressing IRF4 and KLF4 pathway can be harnessed for immuno-regulation.

Effect of Topical Propolis on Wound Healing Process After Tonsillectomy: Randomized Controlled Study.

OBJECTIVES: The post-tonsillectomy pain and post-tonsillectomy hemorrhage are the two main problems after tonsillectomy. The aim of this study was to investigate the beneficial effects of water soluble ethanol extract propolis on post-tonsillectomy patient. METHODS: One hundred and thirty patients who underwent tonsillectomy or adenotonsillectomy were randomly divided into the control and propolis groups, each including 65 patients. The propolis group was applied with propolis orally immediately after surgery and by gargle. The pain scores were assessed on post-tonsillectomy 0, 1st, 2nd, 3rd, and 7th-10th day using a visual analogue scale score. Postoperative wound healing was evaluated by scoring pinkish membrane of tonsillar fossae on postoperative days 3 and 7-10. The incidence of post-tonsillectomy bleeding was examined in each group. RESULTS: Post-tonsillectomy pain was significantly less in propolis group compared to control group on postoperative days 3 and 7-10. Post-tonsillectomy hemorrhage was significantly less in the propolis group compared to the control group (P<0.05). The wound healing was significantly better in the propolis group compared to the control group on postoperative day 7-10 (P=0.002). CONCLUSION: Applying the propolis to post-tonsillectomy wound showed beneficial effect of reducing postoperative pain, preventing hemorrhage, and accelerating of wound healing of tonsillar fossae.

The Impact of Allergic Rhinitis on Symptom Improvement in Pediatric Patients After Adenotonsillectomy.

OBJECTIVES: It is well known that allergic rhinitis (AR) has positive association with adenotonsillectomy. However, the impact of AR on symptom improvement after adenotonsillectomy is not well documented. Hence, we aimed to evaluate the effect of AR on the symptom improvement after adenotonsillectomy between AR and nonallergic patients. METHODS: A retrospective analysis was performed on 250 pediatric patients younger than 10 years old who received adenotonsillectomy from June 2009 to June 2014 in a tertiary referral hospital. All patients underwent skin prick test or multiple allergen simultaneous test (MAST) before surgery and classified into AR group and control group. Obstructive and rhinitis symptoms including snoring, mouth breathing, nasal obstruction, rhinorrhea, itching, and sneezing were evaluated before and 1 year after surgery using questionnaire and telephone survey. RESULTS: AR group was 131 and control group was 119, showing higher prevalence (52.4%) of AR among adenotonsillectomized patients. Both groups showed dramatic improvement of symptoms such as snoring and mouth breathing after surgery (all P<0.05). However, AR group showed significantly less improvement than control group in snoring, mouth breathing, nasal obstruction, and rhinorrhea (all P<0.05). Multivariate analysis showed that preoperative mouth breathing and snoring were dependent on tonsil grade and postoperative symptoms were mainly dependent on presence of AR. Nasal obstruction was dependent on tonsil grade and presence of AR preoperatively and presence of AR postoperatively. These suggest the importance of AR as a risk factor for mouth breathing, snoring, and nasal obstruction. CONCLUSION: AR has positive association with adenotonsillectomy and not only allergic symptoms but also obstructive symptoms such as snoring and mouth breathing improved less in AR group than control group. Hence, patients with AR should be monitored for long-term basis and more carefully after adenotonsillectomy.

Effect of a Chitosan Gel on Hemostasis and Prevention of Adhesion After Endoscopic Sinus Surgery.

OBJECTIVES: Postoperative bleeding and adhesion formation are the two most common complications after endoscopic sinus surgery (ESS). The former sometimes can be life threatening and the latter is the most common reason requiring revision surgery. This study was designed to evaluate the effect of newly developed chitosan gel (8% carboxymethyl chitosan, Surgi shield) on hemostasis and wound healing after ESS. METHODS: A prospective, randomized, double-blind controlled trial was conducted in 33 patients undergoing symmetric ESS. At the conclusion of the operation, Surgi shield was randomly applied on one side of the nasal cavity, with the opposite side acting as control and the bleeding quantity of the surgical field was evaluated every 2 minutes. And then, Merocel was placed in the ethmoidectomized areas of the both sides. Five milliliters of Surgi shield was applied to the Merocel of intervention side and saline was applied to the other side. Merocel in both nasal cavities was removed and 5 mL of Surgi shield was applied again to the intervention side on the second day after surgery. The nasal cavity was examined using a nasal endoscope and the degree of adhesion, crusting, mucosal edema, infection, and granulations were graded at 1, 2, and 4 weeks after surgery. RESULTS: Complete hemostasis was rapidly achieved in the Surgi shield applied side compared with the control side at 2, 4, 6, 8, and 10 minutes after application of Surgi shield (P=0.007, P=0.004, P<0.001, P=0.001, and P<0.001, respectively). There were significantly less adhesions on the Surgi shield applied side at postoperative 1, 2, and 4 weeks (P=0.001, P<0.001, and P<0.001, respectively). The degree of mucosal edema, infection, crusting, or granulation formation assessed by the endoscopic features in the Surgi shield applied side was not significantly different from that of the control side (P>0.05). No adverse effects were noted in the patient series. CONCLUSION: Surgi shield containing chitosan can be used safely to achieve rapid hemostasis immediately after ESS and to prevent adhesion formation.

Treatment outcomes of sinonasal malignant melanoma: a Korean multicenter study.

BACKGROUND: The aim of this work was to evaluate factors that influence local recurrence and survival after surgical resection of sinonasal malignant melanoma, using a large population-based multicenter study in Korea. METHODS: Retrospective analysis was performed for 155 newly diagnosed sinonasal malignant melanoma patients gathered from 15 university hospitals throughout Korea. Demographic data, tumor characteristics, surgical approach, adjuvant treatment, recurrence, and outcomes were analyzed. RESULTS: Three-year and 5-year overall survival rates were 48.8% and 40.1%, respectively. Local recurrence rate was 46.6%, with a mean recurrence time of 15.5 months. On multivariate analysis, patients who underwent surgery that included an endoscopic approach showed decreased local recurrence rate (p = 0.042) and increased survival rate (hazard ratio [HR], 1.702; 95% confidence interval [CI], 1.007 to 2.875; p = 0.047) compared to those who underwent an external approach. Patients with postoperative radiotherapy showed a decreased local recurrence rate (p = 0.001), but without impact on survival rate. Male gender, tumor beyond the nasal cavity, and presence of distant metastasis were associated with poor survival. CONCLUSION: An endoscopic-including surgical approach was associated with improved local control and survival in sinonasal malignant melanoma patients. Postoperative radiotherapy helped increase the local control rate.

Immunomodulatory effect of tonsil-derived mesenchymal stem cells in a mouse model of allergic rhinitis.

BACKGROUND: Although several studies have claimed that mesenchymal stem cells (MSC) derived from human tissues can ameliorate allergic airway inflammation, the immunomodulatory mechanism of MSCs remains unclear. OBJECTIVE: We aimed to determine the effects and the underlying mechanism of tonsil-derived MSCs (T-MSC) on allergic inflammation compared with adipose tissue-derived stem cells (ASC) in a mouse model of allergic rhinitis (AR). METHODS: MSCs were isolated from human palatine tonsil (T-MSC) and the surface markers were analyzed. The effect of T-MSCs was evaluated in 24 BALB/c mice that were randomly divided into four groups (negative control group, positive control group, T-MSC group, and ASC group). MSCs were administered intravenously to ovalbumin (OVA) sensitized mice (T-MSC and ASC groups) on days 18 to 23, and subsequent OVA challenge was conducted daily from days 24 to 28. Several parameters of allergic inflammation were assessed. RESULTS: T-MSC and ASC had similar characteristics in surface markers. Intravenous injection of T-MSC significantly reduced allergic symptoms, eosinophil infiltration, serum total, and OVA-specific immunoglobulin E (IgE), and the nasal and systemic T-helper (Th) 2 cytokine profile. Further analysis revealed that nasal innate cytokines, such as interleukin (IL) 25 and IL-33, and chemokines, such as CCL11, CCL24, induction was suppressed in T-MSCs injected groups, which explained their underlying mechanism. In addition, the T-MSC group had more inhibition of allergic inflammation than did the ASC group, which might be attributed to the more proliferative activity of T-MSC. CONCLUSION: Administration of T-MSC effectively reduced allergic symptoms and inflammatory parameters in the mouse model of AR. T-MSC treatment reduced Th2 cytokines and OVA-specific IgE secretion from B cells. In addition, innate cytokine (IL-25 and IL-33) expression and eotaxin messenger RNA expression was inhibited in the nasal mucosa, which is suggestive of the mechanism of reduced allergic inflammation. Therefore, T-MSC treatment is potentially an alternative therapeutic modality in AR.

Cigarette smoke promotes eosinophilic inflammation, airway remodeling, and nasal polyps in a murine polyp model.

BACKGROUND: Exposure to cigarette smoking (CS) is a major risk factor for airway inflammation. However, little is known about the effects of CS exposure on eosinophilic rhinosinusitis with nasal polyps (ERSwNPs). Histopathological and molecular studies were performed to investigate its effects using a murine model of ERSwNPs. METHODS: Mice were assigned to one of the following four groups (n = 8 for each group): control group, CS exposure (CS group), ERSwNP (ERS group), and ERSwNPs exposed to CS (ERS + CS group). Histopathological changes were investigated using various stains, including hematoxylin and eosin for inflammation and polyp-like lesions, Sirius red for eosinophils, toluidine blue for mast cells, Alcian blue for goblet cells, and Masson's trichrome stain for collagen fibers. mRNA expression of cytokines from nasal mucosae was measured. Serum IgE and systemic cytokine levels were measured by enzyme-linked immunosorbent assays. The expression of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor (HIF) 1-alpha was evaluated by immunohistochemical staining. RESULTS: The ERS + CS group showed more severe symptoms, increased the number of polyp-like lesions, infiltration of eosinophils, goblet cell hyperplasia, and subepithelial fibrosis, compared with the ERS group. Additionally, mRNA expressions of IL-4 and IL-17A were up-regulated in ERS + CS group and higher levels of IL-4, IL-6, IL-17A, and interferon gamma from splenocytes were observed significantly in the ERS + CS group compared with the ERS group. In the ERSwNP murine model, exposure to CS enhanced the expression of VEGF and HIF-1-alpha in nasal epithelial cells. CONCLUSION: Chronic exposure to CS aggravated eosinophilic inflammation and promoted airway remodeling and nasal polyp formation in a murine model of ERSwNPs. The underlying mechanism might involve up-regulated expression of VEGF and HIF-1-alpha.

Regenerative and proliferative activities of chondrocyte based on the degree of perichondrial injury in rabbit auricular cartilage.

Although the regeneration process for injured cartilage requires an intact perichondrium, few studies have addressed the importance of the intact perichondrial layer in the regeneration of damaged cartilage. In this study, we evaluated the role of the perichondrium on regenerative activities in injured cartilage according to different degrees of perichondrial injury. Auricular cartilage harvested from six New Zealand white rabbits was irradiated with a 1,460-nm diode laser at two different power settings (0.3 or 0.5 W). Irradiated cartilage was reimplanted into a subperichondrial pocket under three different conditions: non-injured perichondrium (NPI), unilaterally injured perichondrium (UPI), or bilaterally injured perichondrium (BPI). Rabbits were sacrificed at 1, 2, and 4 weeks after reimplantation and the auricular cartilage was reharvested. A histopathological study using hematoxylin and eosin staining, a live/dead viability assay, and immunohistochemical staining for proliferating cell nuclear antigen were performed to evaluate structural changes and regenerative and proliferative activities of the injured chondrocytes. A modified array and restored boundary of chondrocytes were observed in the NPI and UPI groups. Regeneration of chondrocytes was prominent in the NPI and UPI groups, but was not observed in the BPI group. Proliferative activity of chondrocytes was observed only when the perichondrium was preserved in the NPI and UPI groups. In contrast, proliferative activity was not observed until 4 weeks in the BPI group. The degree of perichondrial injury affected proliferation and regeneration in injured elastic cartilage. In the case of unilateral perichondrial injury, the surgeon should be careful to avoid damaging the other side of the perichondrium, because at least a unilateral perichondrial layer is needed for the regeneration of elastic cartilage.

Effect of lidocaine-soaked nasal packing on pain relief after endoscopic sinus surgery.

BACKGROUND: Nasal packing is usually performed to control bleeding after endoscopic sinus surgery (ESS). Although new packing materials have been developed, they still cause pain. This study was designed to evaluate the effect of lidocaine-soaked packs on pain after ESS. METHODS: A prospective, randomized, double-blind controlled trial was conducted in 63 patients with CRS undergoing ESS. At the conclusion of the operation, 2% lidocaine-soaked biodegradable synthetic polyurethane foam and saline-soaked polyurethane foam were inserted in both nasal cavities of 31 patients and 32 control patients, respectively. The same lidocaine or saline was reapplied into the nasal packs at postoperative 8 hours. Pain was evaluated using a visual analog scale at postoperative 1, 4, 8, 16, 20, and 24 hour(s). The number of gauze that cleaned the blood around the nose was counted. Heart rate, rhythm, and blood pressures were checked preoperatively and postoperatively to evaluate the influence of lidocaine on vital signs. RESULTS: Postoperative pain decreased in lidocaine group at all of the postoperative time periods (p < 0.05). Lidocaine reduced postoperative bleeding at postoperative 8 and 24 hours. Changes of blood pressure from preoperative values in the lidocaine group were not different from those in the control group (p > 0.05). Heart rate in the lidocaine group was more stable than that in the control group (p < 0.05). CONCLUSION: Lidocaine-soaked packs significantly reduced postoperative pain without serious changes on vital sign. These findings suggest that topical lidocaine application to nasal packs could be a useful method to reduce pain during the early postoperative period after ESS.

A thyroglossal duct cyst causing obstructive sleep apnea in adult.

Obstructive sleep apnea (OSA) is a common disorder. It usually results from the structural compromise of the upper airway. In patients with OSA, the obstruction predominantly occurs along the pharyngeal airway, and also a variety of tumors have been reported to cause such a condition. We present here the case of a thyroglossal duct cyst causing OSA in adult. This case demonstrates that thyroglossal duct cyst or some kind of mass lesions in the airway lesions should be considered in the differential diagnosis of OSA patients.

Inverted papilloma of the nasal cavity and paranasal sinuses: a Korean multicenter study.

OBJECTIVES/HYPOTHESIS: The study group for sinonasal tumors at the Korean Rhinologic Society analyzed the results of the Korean multicenter experience for sinonasal inverted papilloma (IP) surgeries. STUDY DESIGN: Multicenter cohort study and retrospective analysis. METHODS: In total, 939 patients diagnosed with sinonasal IP treated between 1998 and 2007 at 17 university hospitals were enrolled. Demographic data and information about previous surgeries, the origin and involved site of the tumor, the surgical approach, follow-up duration, recurrence, and the presence of malignancy were collected. There were 361 patients whose follow-up was <12 months who were excluded, and 578 patients were included for recurrence analysis. RESULTS: The mean follow-up duration for recurrence analysis was 41.0 months, and 15.7% (91/578) had recurrences, with a mean time to recurrence of 32.6 months. However, the group whose follow-up was longer than 3 years had a higher chance of tumor recurrence. Patients whose IPs involved the frontal sinus or the medial wall of the maxillary sinus had higher recurrence rates. There was no significant difference in recurrence rates according to stage or surgical approach. In the T3 stage of Krouse, the T3-A stage of Furuta, and group B of the Citardi staging system, the endoscopic approach alone resulted in higher recurrence rates. CONCLUSIONS: Generally, there were no significant differences in recurrence rates according to clinical stage or surgical approach. Given the rate of delayed recurrence, follow-up of >3 years is required. Moreover, surgeons should always consider combined approaches to reduce the chances of recurrence.

An anatomic study on the overlap patterns of structural components in the keystone area in noses of koreans.

OBJECTIVES: The keystone area has critical importance in maintaining the stability of the nasal dorsum. However, overlap patterns between structural components in the keystone area have rarely been studied, especially in the noses of Koreans. METHODS: Dissections were performed on 18 cadaveric noses. The length and width of the structural components in the keystone area were measured. The shape of the caudal margin of the nasal bone and the overlap patterns between the upper lateral cartilage and the nasal bone were classified. RESULTS: THE SHAPE OF THE CAUDAL MARGIN OF THE NASAL BONE WERE CLASSIFIED AS FOLLOWS: type A, curvilinear margin; type B, paramedian retractions or "M" shape; type C, elongated midline; and type D, retracted midline. The overlap area between the upper lateral cartilage and the nasal bone was classified as follows: type Ao, crescent shape; type Bo, short midline extension; and type Co, long midline extension. The cephalocaudal length of the overlap area between the upper lateral cartilage and the nasal bone was 4-10 mm (mean, 7 mm) in the midline, and 0-7 mm (mean, 3.1 mm) in the paramedian area. The overlap width of the upper lateral cartilage with the nasal bone was 8-14 mm (mean, 9.7 mm). CONCLUSION: The overlap pattern of the structural components in the keystone area is variable. Therefore, a thorough understanding and a cautious evaluation of the relationships of these components before and during surgery is important in performing safe and effective nasal procedures.

Analysis of the Development of the Nasal Septum according to Age and Gender Using MRI.

OBJECTIVES: This study was designed to evaluate the normal development of the nasal septum in Koreans using sagittal MRI for the valuable clinical information on septal procedures. METHODS: Two hundred eighty patients who had their whole nasal septum visualized in the midline sagittal view were selected among the 3,904 patients with brain MRI from January, 2004 to December, 2006 at Dankook University Hospital. The patients who had a history of nasal septal surgery or nasal trauma were excluded. Following parameters are calculated and analyzed: lengths of bony and cartilage dorsum and septal cartilage-nasal bone overlap, total septal area, septal cartilage area and, the proportion of the cartilage area to septal area and the maximal harvestable cartilage for grafting were calculated using the PAC program. RESULTS: All the parameters were increased until adolescence. Thereafter, bony dorsal length, cartilage dorsal length, total dorsal length, total septal area and maximal harvestable cartilage for grafting have not changed significantly with age, while SC-NB overlap length, septal cartilage area, and proportion of the cartilage area to the total septal area were significantly decreased with age. The SC-NB overlap length was positively correlated with the septal cartilage area and the proportion of the cartilage area to the total septal area. CONCLUSION: The small septal cartilage area and its proportion to the total septal area were significantly correlated with a short overlap length of the septal cartilage under the nasal bone. Septal procedures should be carefully performed in the elderly due to the risk of incurring saddle nose.

Intranasal Helicobacter pylori colonization does not correlate with the severity of chronic rhinosinusitis.

OBJECTIVE: To investigate the prevalence of Helicobacter pylori (HP) in the nasal cavity of patients with chronic rhinosinusitis (CRS) and to correlate it with the severity of CRS. STUDY DESIGN AND SETTING: Intranasal HP was investigated using rapid urease (CLO) testing and immunohistochemical (IHC) analysis and confirmed with transmission electron microscopy. To evaluate the severity of sinusitis, CT scans were graded according to the Lund-MacKay scoring system, and CRS symptom scores were recorded. RESULTS: Twelve of 48 patients (25.0%) were positive, but only 1 of 29 (3.4%) controls was positive for both CLO testing and IHC analysis (P = 0.025). The mean preoperative CT grade (P = 0.439) and symptom scores (P = 0.515) were not related to the severity of CRS. CONCLUSIONS: Intranasal HP was more prevalent in patients with CRS than healthy controls. However, there was no significant correlation observed between the severity of sinusitis and intranasal HP colonization. SIGNIFICANCE: HP has a limited role in pathogenesis of CRS.

Clinical characteristics of chronic rhinosinusitis with asthma.

OBJECTIVE: This study was directed at identifying clinical features of chronic rhinosinusitis with asthma, and examining the differences of the postoperative outcomes in asthmatics and nonasthmatics. STUDY DESIGN AND SETTING: Twenty-one asthmatic and 77 nonasthmatic patients who underwent functional endoscopic sinus surgery (FESS) were entered into the study. The following six parameters were determined in asthmatic and nonasthmatic groups; the presence of allergy, previous sinus surgery, severity of preoperative rhinosinusitis symptoms, improvements in postoperative rhinosinusitis symptoms, preoperative disease extent, and postoperative endoscopic outcomes. RESULTS: Symptom scores improved significantly in both asthmatics and nonasthmatics postoperatively, and asthmatics exhibited significantly worse postoperative endoscopic outcomes compared with nonasthmatics. No difference was found in other parameters between two groups. Multivariate analysis revealed asthma continues to be an independent predictor of success. CONCLUSIONS: The present study found that chronic rhinosinusitis in asthmatics showed worse postoperative outcomes than in nonasthmatics, and every attempt should be made for the improvement of surgical results in these patients.

Hyperostosis may affect prognosis after primary endoscopic sinus surgery for chronic rhinosinusitis.

OBJECTIVE: To investigate the independent effect of hyperostosis on outcome after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). STUDY DESIGN AND SETTING: The medical records of 81 consecutive patients who had undergone primary ESS for CRS were reviewed retrospectively. Sinus CT scans were evaluated for the presence of hyperostosis to investigate the association with postoperative outcomes. The independent effect of hyperostosis on surgical outcome was analyzed, controlling for possible confounding factors with a multiple logistic regression model. RESULTS: Sixty percent of the patients showed hyperostosis, and there was a statistically significant association between the hyperostosis and postoperative outcome (P = 0.035, chi(2) test), which was confirmed after adjustment for the possible confounding factors (P = 0.048, odds ratio [OR] = 3.19, logistic regression analysis). CONCLUSIONS: Our study suggests that patients with CRS who have hyperostosis may have a poorer surgical outcome than those without hyperostosis. EBM RATING: B-2b.

Prognostic factors of pediatric endoscopic sinus surgery.

OBJECTIVE: Pediatric endoscopic sinus surgery (ESS) is performed for refractory cases of rhinosinusitis that do not respond to medical management. However, few studies have been reported for the prognostic factors affecting the outcomes of pediatric ESS. The aim of this study was to investigate the prognostic factors affecting the outcomes of pediatric ESS. MATERIALS AND METHOD: Medical records of 97 pediatric patients who had undergone ESS from February 1995 to October 2003 were reviewed retrospectively. We classified the patients into two groups based on outcome, i.e., either good or poor, according to the postoperative endoscopic findings. Then univariate and multivariate analyses were performed to compare the following nine characteristics between the good and poor outcome groups: the presence of allergy, bronchial asthma, adenotonsillar hypertrophy, history of previous sinus surgery, presence of a smoker in the family, degree of polyposis, preoperative disease extent scored by CT scan findings, blood eosinophil count, and eosinophil infiltration in the nasal mucosa. RESULT: The overall success rate was 70% based on the objective postoperative endoscopic finding. Statistical differences were found between the good and poor groups in terms of the degree of preoperative polyposis and CT staging in univariate analysis, whilst in multivariate logistic regression analysis severe polyposis and indirect smoking predicted poor outcome after pediatric ESS. CONCLUSION: Pediatric ESS with severe polyposis, high CT rhinosinusitis staging, or indirect smoking predisposes to a poorer outcome. This needs to be taken into consideration when performing ESS for children.