Tobacco Smoking Could Accentuate Epithelial-Mesenchymal Transition and Th2-Type Response in Patients With Chronic Rhinosinusitis With Nasal Polyps.

Tobacco smoking (TS) has been known as one of the most potent risk factors for airway inflammatory diseases. However, there has been a paucity of information regarding the immunologic alteration mediated by TS in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). To identify the effect of TS, we harvested human tissue samples (never smoker: n=41, current smoker: n=22, quitter: n=23) and analyzed the expression of epithelial-derived cytokines (EDCs) such as IL-25, IL-33, and thymic stromal lymphopoietin. The expressions of Th2 cytokines and total serum IgE showed a type-2 inflammatory alteration by TS. In addition, the epithelial marker E-cadherin and epithelial-mesenchymal transition (EMT)-associated markers (N-cadherin, α-SMA, and vimentin) were evaluated. Histological analysis showed that EDC expressions were upregulated in the current smoker group and downregulated in the quitter group. These expression patterns were consistent with mRNA and protein expression levels. We also found that the local Th2 cytokine expression and IgE class switching, as well as serum IgE levels, were elevated in the current smoker group and showed normal levels in the quitter group. Furthermore, the expressions of E-cadherin decreased while those of N-cadherin, α-SMA, and vimentin increased in the current smoker group compared those in the never smoker group. Taken together, these results indicate that TS contributes to the deterioration of pathogenesis by releasing local EDCs and Th2 cytokines, resulting in EMT in patients with CRSwNP. We verified that alterations of immunological response by TS in sinonasal epithelium can play a vital role in leading to CRSwNP.

Does Metabolic Syndrome Affect the Incidence and Prognosis of Sudden Sensorineural Hearing Loss?

Earlier studies reported that the occurrence of sudden sensorineural hearing loss (SSNHL) is associated with chronic metabolic disorders such as hypertension, diabetes, and hyperlipidemia. Instead of focusing on the relationship between SSNHL and each metabolic disorder, this study aimed to identify the association with metabolic syndrome as a whole, including either prehypertension or prediabetes. As a case-control study, we reviewed 239 patients who experienced SSNHL, and compared them with the same number of healthy subjects (N = 478). Metabolic syndrome-related variables of SSNHL patients were compared to those of healthy control subjects. In addition, patients with SSNHL were classified into two subgroups: the first subgroup showed improvement in hearing ('response group'), and the second did not present significant improvement ('non-response group'). Metabolic syndrome was diagnosed according to the US National Heart, Lung, and Blood Institute's National Cholesterol Education Program Adult Treatment Panel III criteria. The risk for SSNHL was 4.3 times higher in patients with metabolic syndrome compared with patients without the syndrome (95% confidence interval, 1.98 to 9.33), even after adjusting for variables that showed significant between-group differences. The likelihood of being unresponsive to treatment was higher in those with metabolic syndrome (1.21 to 3.93; adjusted odds ratio = 2.18), and when the initial hearing loss pattern on a pure-tone audiometry was high tone or flat. Metabolic syndrome appears to be an independent risk factor for SSNHL and, simultaneously, a predictor of poor prognosis.

Delta neutrophil index levels can be a good indicator to predict patients with chronic rhinosinusitis who need surgery.

OBJECTIVES: Predicting the need for surgical treatment among patients with chronic rhinosinusitis (CRS) is challenging. The delta neutrophil index (DNI) has been proposed as a useful laboratory marker of immature granulocytes, which indicates infection or severe inflammation in several diseases. This study evaluated DNI as an early predictor of the need for surgery in patients with CRS. METHODS: A total of 117 patients diagnosed with CRS were enrolled in this retrospective and observational study. Medical records, including symptoms data, WBC count, ESR level, LUC count, Lund-Mackay scores, and DNI, were reviewed. The receiver operating characteristic (ROC) curves were analyzed to determine the optimal cut-off values for predicting surgery. RESULTS: Among 117 patients, 49 patients (41.9%) needed surgical intervention. The areas under the WBC, ESR, LUC, and DNI ROC curves were .571, .600, .592, and .782, respectively. The optimal cut-off value of DNI to predict surgery was .9%. The prognostic precision of DNI showed that the sensitivity was 59.2% and the specificity was 98.5%. In the analysis of risk factors, DNI levels were significantly associated with surgical intervention (odds ratio, 2.22; 95% confidence interval, 1.48-3.34; P < .01). CONCLUSIONS: The level of DNI, which reflects the severity of the disease, may be a useful predictor for determining the need for surgical intervention in patients with CRS. This is the first literature to verify the role of DNI in upper airway disease.

Tolosa-Hunt Syndrome Misdiagnosed as Surgical Complication After Frontal Balloon Sinuplasty.

ABSTRACT: Tolosa-Hunt syndrome (THS) is a rare benign disease caused by granulomatous inflammation in the craniofacial region. It is mostly idiopathic and generally presents with painful ophthalmoplegia, ipsilateral oculomotor paresis, and steroid responsiveness. There are few reports of THS after sinus surgery. Here, we present a case of THS in an adult immunocompetent patient with severe ophthalmic pain and diplopia after frontal balloon sinuplasty. The patient was initially misdiagnosed as having a surgical complication. The patient was treated with massive corticosteroid pulse therapy, and the symptoms resolved dramatically. There were no complications or recurrence in the 7-month follow-up period.