RESUMO
Chronic rhinosinusitis (CRS) is further classified as CRS with nasal polyp and CRS without nasal polyp. It is also divided into type 2 and none-type 2 by immunological endotype. Nowadays, novel biological products targeting type 2 inflammation are developed and used for the treatment of CRS with nasal polyp.Current Concepts: Dupilumab, which inhibits interleukin-4 and interleukin-13, and omalizumab, which targets immunoglobulin E, were recently approved and are currently being used as the treatment regimen for patients with recurrent CRS with nasal polyp in Korea. Many studies demonstrated enough effects of both biological products on nasal symptoms, including smell, quality of life, and polyp size. The indication of biological products is refractory CRS with nasal polyp with severe symptoms even after endoscopic sinus surgery. However, the main drawback of these biological products is a high cost since they are non-reimbursement regimens as defined by Korean national health insurance.Discussion and Conclusion: Further research on the use of dupilumab and omalizumab in Korean patients will be needed because the Korean CRS endotype, which is characterized by less-type-2 CRS, is different from Western CRS endotypes. Additionally, investigations on the comparison of efficacy among various biological products are essential to prescribe the most appropriate biological products depending on the patients’ endotypes.
RESUMO
Background and Objectives@#In 2021, biologics were approved for treating chronic rhinosinusitis with nasal polyps (CRSwNP) in Korea. However, CRS is a heterogeneous disease, and its characteristics are thought to differ between Western and Korean populations. This study aimed to evaluate the experiences of members of the Korean Rhinologic Society during the first year of biologic usage for the treatment of nasal polyps. @*Methods@#An anonymous survey consisting of 15 items was conducted from November to December 2021. The survey included questions about participant demographics, use of biologics for treating CRSwNP, and expectations regarding the effectiveness of biologics for treating CRSwNP. @*Results@#In total, 44 members participated in the survey. Approximately half of the respondents were in their 40s (50.0%) and had 5–9 years of clinical experience as otorhinolaryngologists (47.7%). The majority of participants held academic positions (95.4%). About half of them worked in Gyeonggi Province. The utilization of biologics did not differ significantly based on clinical experience (p=0.192). When asked about the factors considered for prescribing biologics, the most common reason was recurrence of polyps after surgery (87.2%). The most frequent reason for discontinuing biologics was cost (48.6%). When asked about the extent to which they expected that the availability of biologics for CRSwNP treatment would reduce endoscopic sinus surgery (ESS), 45.5% of members expected a reduction of approximately 10%–29%. In addition, 20.5% expected a reduction of 50% or more. However, 61.4% expected a reduction of less than 10% in primary ESS. In addition, most respondents (93.2%) agreed with the need for Korea-specific guidelines for biologic treatment. @*Conclusion@#There are discrepancies between the current guidelines for biologic treatment of CRSwNP and the reality of the situation, highlighting the need for the development of Korea-specific guidelines.
RESUMO
Objectives@#. In this study, we review our institutional experience with pediatric laryngomalacia (LM) and report our experiences of patients undergoing supraglottoplasty using the spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen (STRIVE Hi) technique. @*Methods@#. The medical records of 29 children with LM who visited Seoul National University Hospital between January 2017 and March 2019 were retrospectively reviewed. Surgical management was performed using the STRIVE Hi technique. Intraoperative findings and postoperative surgical outcomes, including complications and changes in symptoms and weight, were analyzed. @*Results@#. Of the total study population of 29 subjects, 20 (68.9%) were female. The patients were divided according to the Onley classification as follows: type I (n=13, 44.8%), II (n=10, 34.5%), and III (n=6, 20.7%). Twenty-five patients (86.2%) had comorbidities. Seventeen patients (58.6%) underwent microlaryngobronchoscopy under STRIVE Hi anesthesia. Four patients with several desaturation events required rescue oxygenation by intermittent intubation and mask bagging during the STRIVE Hi technique. However, the procedure was completed in all patients without any severe adverse effects. Overall, 15 children (51.7%) underwent supraglottoplasty, of whom 14 (93.3%) showed symptom improvement, and their postoperative weight percentile significantly increased (P=0.026). One patient required tracheostomy immediately after supraglottoplasty due to associated neurological disease. @*Conclusion@#. The STRIVE Hi technique is feasible for supraglottoplasty in LM patients, while type III LM patients with micrognathia or glossoptosis may have a higher risk of requiring rescue oxygenation during the STRIVE Hi technique.
RESUMO
Fungal sinusitis is a sinus infection caused by fungal species, most of which are aspergillus species. They can be classified mainly into two groups, invasive fungal sinusitis and non-invasive fungal sinusitis. Invasive fungal sinusitis is characterized by fungi not confined to the paranasal sinuses or the nasal cavity but invading the adjacent tissue and bone. Chronic invasive fungal sinusitis is one type of invasive fungal sinusitis and is a relatively rare disease. It can invade the adjacent sinus bone and tissue for months to years, resulting in bony sclerotic change, formation of mass and bony destruction, which can be mistaken for pseudotumor or malignant tumor. In this report, we report a case of a patient with chronic invasive fungal sinusitis, which was mimicking sino-nasal malignancy.
RESUMO
Fibrous dysplasia (FD) is a non-malignant progressive condition, which replaces normal bone and marrow with fibrous tissue and woven bone. Sinus mucocele is a cystic, expansile, and destructive lesion that occurs as a result of obstruction of the sinus ostium secondary to inflammation, trauma, anatomical variation, previous sinus surgery, tumor or FD. Among them, FD combined with mucocele has been rarely reported. Here we report the first case of FD combined with ethmoid mucocele. The patient underwent endoscopic debulking of FD and marsupialization of mucocele. The mucocele was successfully marsupialized, and the patient’s symptoms were completely resolved. We propose a new hypothesis that nasal mucosa invaginates into FD and forms a mucocele. For the treatment of ethmoid FD combined with mucocele, we recommend an endoscopic transnasal approach for debulking and marsupialization.
RESUMO
Objectives@#. This study aimed to evaluate the clinical characteristics of maxillary sinus fungus ball (MFB) to increase the preoperative diagnostic accuracy. @*Methods@#. A retrospective review of 247 patients who underwent endoscopic sinus surgery for unilateral maxillary sinusitis from January 2015 to December 2017 at a single institution was performed. Patients with pathologically proven MFB were compared to those with unilateral chronic maxillary sinusitis (CMS). Patient demographics and computed tomography (CT) findings were evaluated. The CT features were categorized as intralesional hyperdensity (calcification), the irregular lobulated protruding lesion (fuzzy appearance), maxillary sinus full haziness without mass effect, maxillary sinus full haziness with mass effect, and others. A regression tree analysis was performed. @*Results@#. In total, 247 patients were analyzed; among them, 179 (72.5%) had MFB and 68 (27.5%) had CMS. MFB showed predominance in older individuals. Among the radiological features, intralesional hyperdensity was most commonly associated with MFB. The presence of a fuzzy appearance or full opacity with mass effect was also associated with MFB. The highest area under the curve was noted with the regression tree analysis based on the model, which included the presence of intralesional hyperdensity, demographic data (age), and presence of fuzzy appearance or maxillary sinus full haziness with mass effect in case of absence of intralesional hyperdensity (0.904). @*Conclusion@#. A simple algorithm to optimize the preoperative diagnosis of MFB was developed. Physicians should be aware of such findings in the management of patients presenting with unilateral CMS.
