Clinical Trial to Reconfirm the Efficacy and Safety of Cefetamet Pivoxil Treatment in Sinusitis Patients: A Double-Blind, Randomized, Parallel Designed, Multicenter, Active Comparator Study (CASIS Study).

OBJECTIVE: To evaluate the clinical efficacy and safety of cefetamet pivoxil for the treatment of acute bacterial rhinosinusitis in Korean patients compared to treatment with cefdinir. METHODS: A prospective, multicenter, randomized double-blind, comparative study was conducted by the Departments of Otorhinolaryngology-Head and Neck Surgery at 17 hospitals or universities in the Republic of Korea from March 2017 to April 2019. A total of 309 patients were screened and 249 patients participated in the study. RESULTS: Treatment with cefetamet pivoxil for 2 weeks showed 82.4% clinical cure and improvement rates in patients with acute bacterial rhinosinusitis compared to 84.68% in those taking cefdinir for 2 weeks, showing that cefetamet pivoxil administered twice a day for 2 weeks was as effective as cefdinir 3 times a day for 2 weeks for the treatment of acute bacterial rhinosinusitis. The overall adverse reaction rates of both drugs were 10.56% in the cefetamet pivoxil group and 15.49% in the cefdinir group, without serious adverse events or drug reactions. CONCLUSIONS: Cefetamet pivoxil twice a day was as efficacious and safe as cefdinir 3 times a day for the treatment of acute bacterial rhinosinusitis, which suggested that cefetamet pivoxil may be a suitable alternative to cefdinir.

Can the sensitisation to staphylococcal enterotoxin predict the severity of chronic rhinosinusitis?

BACKGROUND: Evidence is accumulating that Staphylococcus aureus plays an important role as a disease modifier in upper and lower airway disease. We aimed to assess the association of staphylococcal enterotoxins (SEs) with allergic multimorbidity as well as the severity of chronic rhinosinusitis. METHODS: We retrospectively reviewed the medical records of 97 subjects aged 6 years or older between March 2018 and June 2019 and analysed symptom scores, computed tomography scores, serum IgE levels to SEs, serum total and specific IgE levels to inhalant allergens. To evaluate eosinophilic chronic rhinosinusitis (ECRS), we used refractory ECRS score from the Japanese epidemiological survey. RESULTS: Of the 97 patients enrolled, 29 (29.9%) were non-sensitised, 33 (34.0%) were mono-sensitised, and 35 (36.1%) were poly-sensitised. Sensitisation to SEs was closely associated with poly-sensitisation to inhalant allergens. SE-sensitised participants had higher median values for total and specific IgE levels to inhalant allergens than did non-SE-sensitised participants. SE sensitisation was associated with allergic multimorbidity and severe allergic diseases, such as ECRS. CONCLUSIONS: This preliminary study suggested that sensitisation to SEs may play a role in the initiation of type-2 inflammatory responses, such as allergic rhinitis, ECRS, and allergic multimorbidity. Furthermore, sensitisation to SEs correlated with the severity of ECRS.

Role of specific IgE on staphylococcal enterotoxin B in chronic rhinosinusitis severity.

OBJECTIVE: To investigate the clinical significance of specific IgE-staphylococcal enterotoxin B (IgE-SEB) in CRS (chronic rhinosinusitis). DESIGN: Retrospective analysis of patients who were positive for specific IgE-staphylococcal enterotoxin B. SETTING: Tertiary rhinology clinic. PARTICIPANTS: A total of 965 patients who were tested for specific IgE-staphylococcal enterotoxin B from December 2016 to December 2017. MAIN OUTCOME MEASURES: We retrospectively reviewed the records of 965 patients who were tested for specific IgE-staphylococcal enterotoxin B from December 2016 to December 2017. Patient demographics, titre-specific IgE to staphylococcal enterotoxin B levels, MAST, serologic test and medical records were reviewed. RESULTS: IgE-SEB (KU/L) was higher in CRS patients than non-CRS patients (0.13 ± 0.37 vs 0.08 ± 0.22, respectively; P-value: .044), and the IgE-SEB (+, ≥0.35) rate was also higher (10.06% vs 4.46%, respectively; P-value: .030). IgE-SEB (KU/L) was higher in the CRS group than in the fungal sinusitis group (0.13 ± 0.37 vs 0.03 ± 0.05, respectively; P-value: <.001), and the IgE-SEB (+, ≥0.35) rate was also higher (10.06% vs 0%, respectively; P-value: .015). Between the CRSsNP (chronic rhinosinusitis without nasal polyps) and CRSwNP (chronic rhinosinusitis with nasal polyps) groups, there were no differences in IgE-SEB (KU/L) or IgE-SEB (+) rates. IgE-SEB positivity was not associated with the presence of polyps, concomitant asthma or postoperative recurrence. As the values of IgE-SEB (KU/L) and the IgE-SEB (+, >0.1) rate increased, the CRS severity also increased. CONCLUSIONS: IgE-SEB showed a positive correlation with Lund-Mackay CT severity score, but not with postoperative recurrence or nasal polyps. Further studies are needed to obtain clear evidence that IgE-SEB can be considered as an independent CRS endotype.

Prevalence and clinical characteristics of allergic rhinitis in the elderly Korean population.

PURPOSE: The proportion of elderly people aged ≥ 65 years is increasing worldwide. Although the reported prevalence of sinonasal disease can vary according to the diagnostic methods used, differences in allergic rhinitis prevalence in the elderly according to diagnostic method have not been reported. We thus aimed to evaluate allergic rhinitis prevalence in the elderly according to diagnostic criteria obtained from questionnaires, physician diagnoses, and allergy tests. METHODS: We compared the allergic rhinitis prevalence in the elderly aged ≥ 65 years with adults aged 19-64 years, using data from the Korean National Health and Nutrition Examination Survey 2008-2012. Total serum IgE and IgE levels specific to allergens of Dermatophagoides farina, cockroach, and dog dander were examined, and factors affecting specific IgE levels were investigated. RESULTS: Allergic rhinitis prevalence according to the questionnaire responses, physician diagnoses, and allergy test results was 35.02%, 14.89%, and 17.56%, respectively. The prevalence based on all diagnostic methods assessed was significantly lower in the elderly than in the general adult group (p < 0.001). Rhinorrhea incidence was significantly increased in the elderly (p = 0.018). Sensitization to Dermatophagoides farina was significantly decreased in the elderly (p = 0.006) and did not correlate with socioeconomic status and/or general health factors. CONCLUSIONS: The elderly population has a distinct clinical presentation, including a low prevalence of allergic rhinitis, and an increased incidence of rhinorrhea symptoms, compared with the general adult population. The management of allergic rhinitis in elderly patients may therefore require a different therapeutic approach to improve rhinorrhea rather than nasal obstruction.

Prospective assessment of gustatory function after radiotherapy for head and neck cancers.

BACKGROUND: Taste disorders are major causes of morbidity in patients undergoing head and neck irradiation. We quantitatively assessed the gustatory function of patients with head and neck cancers who underwent radiotherapy using recently developed standardised tools for measuring taste. METHODS: Twenty patients undergoing head and neck irradiation responded to a specific questionnaire and were assessed by olfactory and gustatory function tests. To assess changes over time, testing was performed before, immediately after, and at 2- and 4-week intervals following the start of radiotherapy. Concurrently, patients were evaluated for xerostomia from radiotherapy. RESULTS: A decrease in the taste recognition threshold was observed in the second week after the beginning of radiotherapy. The taste detection threshold improved within the 14th-18th week. Most affected patients demonstrated that their gustatory function primarily decreased independent of the olfactory function. Disturbances in taste were exponentially worsened beyond an accumulated dose of 30 Gy and involved all tastants. According to a multivariate analysis, radiation-induced taste impairment was not influenced by the degree of xerostomia. However, there was an association between the dose of irradiation and the severity of taste disturbance. CONCLUSIONS: In this preliminary study, we found that the taste function was worse 2 weeks after the start of radiotherapy and returned to pretreatment levels within 4.5 months. Taste disturbances were exponentially worse beyond an accumulated dose of 20 Gy. Taste dysfunction after radiotherapy was not influenced by the degree of xerostomia, whereas only the dose of irradiation was associated with the severity of taste dysfunction.

Comparison of olfactory and taste functions between eosinophilic and non-eosinophilic chronic rhinosinusitis.

OBJECTIVE: Most patients with chronic rhinosinusitis (CRS) complain of olfactory and/or taste dysfunctions. However, olfactory and taste dysfunctions depending on the subtype of CRS, classified as eosinophilic CRS (ECRS) and non-eosinophilic CRS (NCRS), have not been clearly reported. Therefore, the purpose of this study was to investigate the clinical features in olfactory and taste functions according to the subtype classified as ECRS and NCRS. METHODS: We retrospectively analyzed the electronic medical records of patients who underwent endoscopic sinus surgery and were diagnosed with CRS. The patients were divided into ECRS and NCRS groups, according to their Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) scores. We analyzed demographic characteristics, Sino-Nasal Outcome Test findings, Lund-Mackay score, and the results of previously-validated tests, including the Korean Version of Sniffin' Stick test and chemical gustatory function test. RESULTS: Patients with ECRS and NCRS had decreased olfactory and taste functions compared to the control group. In particular, the olfactory score of ECRS patients was lower than that of NCRS patients (18.1 ± 9.5 vs 23.7 ± 8.5, respectively, p <0.001). On the other hand, taste scores of ECRS patients were not statistically different compared to NCRS patients (19.1 ± 4.7 vs. 18.3 ± 4.7, respectively, p = 0.166). Olfactory score decreased with increase in JESREC score (r=-0.203, p = 0.002), but it had no correlation with taste score (r = 0.072, p = 0.276). CONCLUSION: We found a difference in olfactory function but no difference in taste function between patients in ECRS and NCRS groups. These results may provide valuable clinical features in terms of olfactory and taste functions according to the subtypes of CRS.

Epithelial-myoepithelial carcinoma originating from a minor salivary gland in the nasal septum: A case report and literature review.

RATIONALE: Epithelial-myoepithelial carcinoma is an extremely rare, malignant neoplasm that occurs most frequently in the major salivary glands and accounts for approximately 1% of all salivary gland neoplasms. Few reports have described the presence of epithelial-myoepithelial carcinoma in the sinonasal region; hence, the treatment guideline and prognosis remain unclear. PATIENT CONCERNS: We reported a case of a 75-year-old woman with complaint of nasal obstruction and frequent epistaxis for 3 years. During the nasal endoscopic examination, a mass in the left nasal cavity originating from the left nasal septum that caused bleeding on touch was observed. DIAGNOSES: A diagnosis of epithelial-myoepithelial carcinoma was made based on the features of histopathology and immunohistochemistry of the surgical specimens. The patient was treated by surgical removal of the septal mass using the endonasal endoscopic approach. OUTCOMES: In the serial follow-up paranasal sinus imaging and endoscopic inspection, evidence of recurrence was absent for 18 months after surgery. LESSONS: This report highlights a case of epithelial-myoepithelial carcinoma originating from a minor salivary gland in the nasal septum, one of the most unusual locations. Diagnosis of epithelial-myoepithelial carcinoma should be made based on the findings of immunohistochemistry of the operative specimen. Clinicians should consider complete surgical resection as the effective treatment of choice.

Three Cases of Primary Ciliary Dyskinesia Combined With Reduced Exhaled Nitric Oxide.

OBJECTIVES: The diagnosis of primary ciliary dyskinesia (PCD) is often delayed in part related to the limitations of the available diagnostic tests. We present 3 cases of PCD diagnosed using an exhaled nitric oxide (eNO) measurement. METHODS: Three cases with a clinical phenotype consistent with PCD were evaluated using an eNO assay with additional transmission electron microscopy (TEM) and/or genetic panel testing. RESULTS: One male and 2 female patients presented with common symptoms included recurrent respiratory infection from early childhood and a history of neonatal respiratory distress as term newborn. Two of them had situs inversus totalis. Fractional eNO measurement revealed extremely low NO levels, and subsequently, TEM analysis confirmed ciliary ultrastructural defects in all patients. One patient had compound heterozygous mutation of the PCD-causative gene (DNAH5) identified using next generation sequencing. CONCLUSION: Our report stresses the reliability of eNO measurement in the diagnosis of PCD, accompanied by clinical phenotypes and additional diagnostic tools, such as TEM analysis and genetic testing.

Eosinophil extracellular trap formation is closely associated with disease severity in chronic rhinosinusitis regardless of nasal polyp status.

Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory airway disease involving non-eosinophilic and eosinophilic phenotypes, which translate to various endotypes. Activated eosinophils and neutrophils are known to generate extracellular traps consisting of DNA and cytotoxic granule proteins. We sought to investigate the presence of eosinophil and neutrophil extracellular traps (EETs and NETs, respectively) in human CRS tissues and to clarify the associations with their clinical features. Nasal polyp (NP) or ethmoid tissue slides of 43 subjects from endoscopic sinus surgery for CRS were analysed. Quantitative analysis of EETs and NETs was performed by confocal microscopy using immunofluorescent staining. For correlation study, the presence of NPs, number of infiltrating tissue eosinophils, preoperative Lund-Mackay scores, and other comorbidities were analysed. EET formation was observed to varying degrees in all CRS groups and was correlated with the number of tissue eosinophils (r = 0.83, p < 0.001) regardless of the presence of NPs. Patients with more EETs demonstrated higher Lund-Mackay scores (r  =  0.51, p  = 0.009), blood eosinophilia (r  =  0.80, p  < 0.001), and decreased olfactory function (r  = -0.65, p  < 0.001). No correlation between the extent of EET formation and the presence of atopy or asthma was apparent. However, none of the CRS groups containing neutrophils formed NETs in this study. Eosinophilic CRS indicates the presence of EETs. Formation of EETs could have a role in clinical decision-making and prediction of treatment outcome of CRS, regardless of NP status.

Multiple airborne allergen-induced eosinophilic chronic rhinosinusitis murine model.

PURPOSE: Several murine models have been established to mimic human eosinophilic chronic rhinosinusitis (ECRS). However, in most of these models, ECRS was induced using ovalbumin, which does not cause sinusitis in humans. Thus, we aimed to develop a more clinically relevant murine model of ECRS using multiple airborne allergens. We also investigated the effects of exposure duration of the allergens on ECRS development. METHODS: C57BL/6 mice were intranasally administered multiple airborne allergens (house dust mite, Aspergillus fumigatus, Alternaria alternata, and protease from Staphylococcus aureus) three times weekly for 4, 8, 12, and 16 consecutive weeks. Histopathological changes, the levels of cytokines and chemokines in the nasal lavage fluid, and immune cells of the blood and spleen were analyzed. RESULTS: The mice administered multiple allergens showed significantly increased eosinophil infiltration, epithelial thickening and disruption, and subepithelial collagen deposition from 8 weeks compared to the control group. Goblet cell hyperplasia, polyp-like lesions, and blood eosinophils, as well as the levels of interleukin-5 and eotaxin in the nasal lavage fluid were considerably increased in the ECRS group from 12 weeks compared to those of controls. Instillation of allergens for 16 weeks exacerbated the eosinophil infiltration and eotaxin increase in the nasal lavage fluid. CONCLUSIONS: We successfully established a new murine model of ECRS using more clinically relevant multiple airborne allergens. Prolonged exposure to airborne allergens for 12 weeks or more, corresponding to the definition of human ECRS, strongly induced eosinophil infiltration as well as epithelial remodeling.

Geographic and demographic variations of inhalant allergen sensitization in Koreans and non-Koreans.

BACKGROUND: To diagnose and treat respiratory allergic diseases, it is important to identify the specific allergens involved. Many differences exist between common inhalant allergens depending on the residential environment and demographic factors. This study aimed to compare common inhalant allergens between Koreans and non-Koreans according to their residential region, age, and sex. METHODS: This study evaluated 15,334 individuals who underwent serum tests for multiple allergen-specific immunoglobulin E at a tertiary academic medical center between January 2010 and December 2016. The individuals included 14,786 Koreans and 548 non-Koreans. The AdvanSure™ Allostation assay (LG Life Science, Korea) was used to test for 33 inhalant allergens. RESULTS: The house dust mite (HDM) was the most common allergen in both Koreans and non-Koreans, although the proportion of individuals with HDM sensitization was greater among Koreans. High sensitization rates for various pollen types were detected among Koreans in Gangwon region, whereas Japanese cedar pollen was unique among Koreans in Jeju region. Grass pollen and animal dander were relatively common among individuals from the Americas, whereas weed and grass pollen accounted for the 10 most common allergens for individuals from Central Asia. The total sensitization rate, sensitization to HDM, and sensitization to animal dander peaked among adolescents and young adults, then subsequently decreased with age. CONCLUSIONS: This large-scale study demonstrates that various regional and age-related differences exist in the allergen sensitization rates of Koreans and non-Koreans. These data could be useful for development of avoidance measures, immunotherapy for causative allergens, and policymaking regarding allergic diseases.

Prevalence and Risk Factors of Chronic Rhinosinusitis in the Elderly Population of Korea.

BACKGROUND: Although a significant number of the clinical features and pathophysiologic mechanisms of chronic rhinosinusitis (CRS) have been described, only a few studies have been published on characterization of CRS in the field of aging. OBJECTIVE: We investigated the prevalence and risk factors of CRS in elderly (≥65 years old) Koreans using large-scale nationwide epidemiological data and compared the risk factors of elderly with those of younger adult participants (19-64 years old). METHODS: Data from 25 529 participants who completed the 2008-2012 Korean National Health and Nutrition Examination Survey were analyzed. Diagnosis of CRS was done according to the EP3OS 2012 guideline for epidemiologic study. Risk factors of CRS were compared in the aspects of sociodemographics, general health behaviors, clinical characteristics, and comorbidities of participants. RESULTS: The prevalence of CRS was significantly higher in 5590 elderly than in 19 939 younger adults (6.55% vs 5.69%; P = .016. Some variables of socioeconomic status and mental health in the adult group were associated with increased risk of CRS but did not show association in the elderly group. We observed a significant association between CRS prevalence and comorbid allergic rhinitis, asthma, and atopic dermatitis in both groups ( P < .05). However, in the elderly group, the associations were significantly weaker with regard to allergic rhinitis ( P-interaction = .03) and asthma ( P-interaction = .002). CONCLUSION: These results suggest that elderly populations have distinct pathophysiology and clinical presentations from adult CRS, and management for elderly patients with CRS may require different or additional therapeutic approaches.

Lack of correlation between serum 25(OH)D level and endoscopy-based chronic rhinosinusitis in Korean adults.

BACKGROUND: Several previous studies have shown that serum 25(OH)D deficiency is associated with increased risk of chronic rhinosinusitis (CRS) in adults and also correlated with disease severity. We aimed to investigate the correlation between serum 25(OH)D level and endoscopy-based CRS in adults using the Korean National Health and Nutrition Examination Survey. METHODS: The data were based on the Korean National Health and Nutrition Examination Survey from 2008 to 2011. Diagnosis of endoscopy-based CRS was based on endoscopic findings of mucopurulent rhinorrhea in the middle meatus or nasal polyps, with nasal symptoms satisfying symptom-based CRS based on European Position Paper on Rhinosinusitis and Nasal Polyps 2012 criteria. Nasal symptoms included nasal obstruction, anterior/posterior nasal drip, facial pain, and the loss of smell. Serum 25(OH) D level was defined as deficient (less than 20 ng/mL), insufficient (20â€"29.9 ng/mL), or sufficient (less than or equal to 30 ng/mL). RESULTS: The serum 25(OH)D level in the CRS group was 19.293 'plus or minus' 7.035 ng/mL, which was higher than that of the control group (18.057 'plus or minus' 6.56 ng/mL, p = 0.0072). Among symptom combinations of endoscopy-based CRS, some combinations with mucopurulent rhinorrhea at the middle meatus were significantly related to normal serum 25(OH)D level. CONCLUSION: Low serum 25(OH)D level might not be associated with increased prevalence of CRS in Korean adults; rather, patients with CRS showed higher serum 25(OH)D levels than the control group. Thus, these results, contradicting those of previous studies, should be further verified in other countries to investigate the role of the serum 25(OH)D in CRS.

Brain abscess caused by chronic invasive actinomycosis in the nasopharynx: A case report and literature review.

RATIONALE: Actinomycosis is a rare anaerobic, gram-positive bacterial infection caused by Actinomyces, which is part of the normal flora in the oral cavity and respiratory and female genitourinary tracts. The cervicofacial area is the most common site of involvement, and involvement of the central nervous system is rare. PATIENT CONCERNS: We report a case involving a 51-year-old woman who developed an actinomycotic brain abscess 15 months after the treatment of noninvasive nasopharyngeal actinomycosis, which recurred as an invasive form. DIAGNOSES: Histopathological examination of the surgical specimens revealed actinomycosis. INTERVENTIONS: The patient was treated by surgical drainage of the brain abscess and long-term antibiotic treatment. OUTCOMES: Follow-up brain imaging performed 12 months after surgery showed complete resolution of the brain abscess, and there were no further signs or symptoms of infection. LESSONS: Physicians should be aware of the typical clinical presentations of cervicofacial actinomycosis. Moreover, they should know that actinomycosis may mimic the process of malignancy at various anatomical locations.

Radiological comparison of inferior turbinate hypertrophy between allergic and non-allergic rhinitis: does allergy really augment turbinate hypertrophy?

BACKGROUND: Inferior turbinate hypertrophy could be a result of allergic rhinitis (AR) that leads to nasal congestion and nasal airway obstruction, which is the most bothersome complaint in patients with AR. However, evidence regarding whether patients with AR have a more hypertrophied inferior turbinate than do patients with non-AR is lacking. OBJECTIVE: We aimed to evaluate the degree of inferior turbinate hypertrophy according to the presence of AR using radiological measurements of the inferior turbinate. METHODS: For evaluating the inferior turbinate, which contributes to nasal obstruction in patients with AR, we enrolled 90 adult patients with septal deviation and divided them into two groups (AR group: n = 49; non-AR group: n = 41). Allergic rhinitis was diagnosed according to the presence of an allergic history, positive multiple allergen simultaneous test, and serological total immunoglobulin E level (≥ 100 kU/L). We analyzed the minimal cross-sectional area on acoustic rhinometry for both groups. The bilateral total width as well as medial mucosa and nasal cavity space in the anterior and posterior portions of the inferior turbinate were measured using computed tomography. RESULTS: We could not find any significant differences in the anterior and posterior dimensions of the inferior turbinate, intranasal space, and choanal spaces between the AR and non-AR groups. Instead, the anterior part of the inferior turbinate in both the groups showed significant differences between the deviated and contralateral sides. The contralateral side had a larger width than did the deviated side, but no significant difference was noted in the posterior portion of the inferior turbinate. CONCLUSION: The degree of inferior turbinate hypertrophy showed no difference between patients with and without AR. Therefore, we suggest that surgical treatment for reducing the size of the inferior turbinate hypertrophy should be considered when performing septoplasty in patients with symptoms of nasal obstruction, regardless of the presence of AR.

Development of a Gustatory Function Test for Clinical Application in Korean Subjects.

PURPOSE: To obtain validated clinical values suitable for developing a gustatory function test, including umami taste, in a Korean population. MATERIALS AND METHODS: The investigation involved 297 participants with self-reported normal sense of taste and smell. Liquid solutions were used for the assessment of gustatory function. The test consisted of 30 taste solutions [six concentrations of five tastants (sweet, bitter, salty, sour, and umami)]. For evaluation of overall gustatory function, the number of detected or correctly recognized taste thresholds was combined to form a "taste score." RESULTS: Mean values of each detection and recognition threshold for the five tastes in men were consistently lower than those of women. The 10th percentile of taste score for recognition was used as the cut-off value for distinguishing normogeusia from hypogeusia. In subgroup analysis, total taste score from recognition thresholds revealed a significant negative correlation with age, indicating lower scores for increasing age. Taste score for non-smokers was significantly higher than that of smokers, in terms of detection and recognition of taste sensitivities. CONCLUSION: This gustatory function test was easy to perform, affordable, and time-saving, with the capacity to self-produce and obtain reliable data. Gustatory function was more sensitive in young people, women, and non-smokers.

Randomized controlled trial of steroid-soaked absorbable calcium alginate nasal packing following endoscopic sinus surgery.

OBJECTIVES/HYPOTHESIS: To evaluate the potential efficacy of steroid-soaked, absorbable calcium alginate nasal packing following endoscopic sinus surgery. STUDY DESIGN: Prospective, randomized, single-blinded, placebo-controlled trial. METHODS: Twenty-two patients (44 nostrils) who had chronic rhinosinusitis with polyps underwent bilateral endoscopic sinus surgery. Only those with an intersinus difference in Lund-Mackay severity score of 1 or less were included. In each patient, one randomly selected nostril was packed with calcium alginate soaked with 2 mL of triamcinolone (40 mg/mL) (triamcinolone group), whereas the contralateral nostril received an identical packing soaked in 2 mL of normal saline (saline group). Two independent investigators blinded to the packing allocation scored the surgical field using the validated Perioperative Sinus Endoscopy (POSE) scores 1, 4, and 8 weeks after surgery. RESULTS: All 44 nostrils were analyzed; the Lund-Mackay scores did not differ significantly between the groups before surgery. Eight weeks after surgery, the total POSE scores were significantly lower in the triamcinolone group (P = .014). The POSE scoring parameters were then compared between groups, and the following variables were significantly different: middle turbinate synechiae with the lateral wall (P = .037), polypoid degeneration of the ethmoid cavity (P = .006), and sphenoid sinus severity (P = .036). CONCLUSIONS: This study demonstrated that steroid-soaked, absorbable nasal packing can be used to enhance wound healing after endoscopic sinus surgery and to prevent polypoid changes in the nasal mucosa. LEVEL OF EVIDENCE: 1b. Laryngoscope, 128:311-316, 2018.

Predictors of success in combination of tongue base resection and lateral pharyngoplasty for obstructive sleep apnea.

The base of the tongue has been recognized as a significant site of obstruction in patients with obstructive sleep apnea (OSA). Our aim was to determine the independent predictors of surgical success in tongue base resection combined with lateral pharyngoplasty for OSA. Thirty-one OSA patients who underwent endoscopie-guided coblator or transoral robotic tongue base resection in combination with lateral pharyngoplasty for the treatment of retroglossal obstruction between March 2012 and December 2015 were enrolled in this study. Retroglossal obstruction was identified by preoperative nasopharyngoscopy with drug-induced sleep endoscopy and/or Müller's maneuver in supine position. Patients were divided into success and failure groups according to surgical outcome (postoperative apnea-hypopnea index (AHI) less than 20 and reduction more than 50% in baseline AHI). Physical profile, polysomnography, cephalometry parameters, and drug-induced sleep endoscopy and/or Müller's maneuver findings were compared between the two groups. Tonsil grade (p = 0.002), lateral oropharyngeal wall collapse on Müller's maneuver (p = 0.002), and AHI during rapid eye movement (REM AHI) (p = 0.038) were significantly higher in the success group than in the failure group. Tongue base collapse was more evident in the failure group than in the success group when patients open their mouth. (p = 0.037) Bigger tonsil size and higher REM AHI are favorable predictive factors, even in multilevel surgery such as tongue base resection, whereas tongue base collapse during mouth opening may be an unfavorable predictive factor.