A Case of Sphenoidal Meningoencephalocele Masquerading as an Isolated Sphenoid Mucocele / 대한이비인후과학회지

Isolated sphenoid sinus disease is often misdiagnosed because of its rarity and varing clinical presentation. A 51-year-old male visited the hospital with abnormal brain CT findings which showed homogenous opacification associated with sinus wall expansion on the right sphenoid sinus. Under the impression of isolated sphenoid mucocele, the fenestration of sphenoid sinus was conducted without surgical complication. But, cerebrospinal fluid rhinorrhea spontaneously developed 3 days after fenestration operation and then stopped by sealing the suspicious leakage site with free graft of inferior turbinate mucosa. Based on the pathological findings, paranasal sinus CT and MRI findings, this case is reported to be meningoencephalocele developed in sphenoid sinus.

Upregulation of the Vitamin D Receptor in the Nasal Mucosa of Patients With Allergic Rhinitis

Background and Objectives@#Vitamin D modulates immunity, including that of allergic diseases, and plays its roles through contact with vitamin D receptors (VDR). Recent studies have shown that patients with allergic rhinitis have low systemic serum vitamin D level. However, the expression of VDR in local tissue such as human nasal mucosa has not been investigated. Our study demonstrated that, in nasal mucosa of normal controls and patients with allergic rhinitis. @*Materials and Methods@#Nasal mucosa were harvested from twenty-five patients who had normal nasal mucosa and twenty-five patients with allergic rhinitis. After the total RNA isolation, we performed reverse transcriptase-polymerase chain reaction, immunohistochemical staining and western blot analysis. @*Results@#VDR were expressed in submucosal glands and the superficial layer of epithelial cell, and that inflammatory cells are expressed more highly in the nasal mucosa of patients with allergic rhinitis compared to those without. In the mucosa of patients with allergic rhinitis, VDR expression level was upregulated compared to that in normal nasal mucosa. @*Conclusion@#This findings suggest that VDR plays a role in the pathogenesis of allergic rhinitis. Additional research is needed to determine the mechanism and consequences of VDR upregulation.

A Case of Huge Solitary Fibrous Tumor with Maxillary Sinus Wall Destruction Masquerading as Maxillary Sinus Cancer / 대한이비인후과학회지

Solitary fibrous tumors (SFT) are rare fibroblastic mesenchymal neoplasms which are originally described as neoplasms of the pleura originating from the spindle cells. Although it can originate from extrapleural sites including the head and neck, it is exceedingly rare in the sinonasal tract. There has been no reported cases of SFT involving the paranasal sinuses in Korea; however, there was case of a 34-year-old man who presented with persistent left nasal obstruction and watering of the left eye. Imaging by CT and MRI revealed a large, highly vascular tumor occupying the maxilloethmoidal sinus cavities associated with bony wall destruction, masquerading as maxillary sinus cancer. The tumor mass occupying sinus cavities was removed through endoscopic and Caldwell-Luc approach. Histopathological examination of the tumor was consistent with SFT. We report this case to further insights regarding the diagnosis and management of this rare tumor.

Antiallergic Effects of Trichostatin A in a Murine Model of Allergic Rhinitis

OBJECTIVES: Trichostatin A (TSA), an inhibitor of histone deacetylase, has been shown to play an important role in attenuating asthmatic inflammation. However, the effect of TSA in allergic rhinitis is not known. The aims of this study were to investigate the effect of TSA on allergic nasal inflammation and on the induction of regulatory T cells in a murine model of allergic rhinitis. METHODS: BALB/c mice were sensitized intraperitoneally with ovalbumin (OVA) and then challenged intranasally with OVA. TSA (1 mg/kg) was given to the treatment group, and multiple parameters of allergic responses were evaluated to determine the effects of TSA on allergic rhinitis. Allergic nasal symptom scores, including frequency of rubbing and sneezing, were checked. Eosinophil infiltrations were stained with Chromotrope 2R, and the expression levels of OVA-specific IgE, T-helper 1 (Th1) cytokine (interferon-gamma [IFN-gamma]), Th2 cytokines (interleukin [IL] 4 and IL-5) and Treg (Foxp3, IL-10, and transforming growth factor-beta [TGF-beta]) were measured by quantitative reverse transcription-polymerase chain reaction or enzyme-linked immunosorbent assay. RESULTS: TSA reduced the scores of allergic nasal symptoms and the amount of eosinophil infiltration into the nasal mucosa. TSA suppressed OVA-specific IgE levels and reduced expression of the IL-4 and IL-5. However, the expression of IFN-gamma was unchanged in the treatment group. The levels of Foxp3, IL-10, and TGF-beta were increased in pretreatment with TSA as compared to control group. CONCLUSION: This study shows that TSA induced antiallergic effects by decreasing eosinophilic infiltration and Th2 cytokines in a murine model of allergic rhinitis via regulation of Tregs. Thus, TSA may be considered a potentially therapeutic agent in treating allergic rhinitis.

Histopathologic Diagnosis Associated with Delayed Diagnosis of Inferior Turbinate Pathology / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Conditions of inferior turbinate other than hypertrophy are rare and its morphology of inferior turbinate is variable. Therefore, the diagnosis of this fatal disease is often delayed. In the present study, histopathologic characteristics of inferior turbinate lesions associated with delayed diagnosis are determined by reviewing the clinical and diagnostic outcomes in patients with inferior turbinate lesions. MATERIALS AND METHOD: The medical records of patients who underwent endoscopic inferior turbinate biopsy following histopathologic evaluation from 2002 to 2013 were retrospectively reviewed, including the previous medical history, physical examination, radiologic findings, histopathologic results, therapy, and follow-up examination. RESULTS: A total 21 patients were included. The most common primary symptoms were nasal obstruction and frequent epistaxis. Diagnosed were 9 benign tumors, 7 malignant tumors, 2 infectious lesions, and 3 autoimmune lesions. Six of 21 patients visited more than three different hospitals before visiting our hospital. One-third of the cases with delayed diagnosis were malignant tumors, which included mucosal melanoma and natural killer/T cell lymphoma. CONCLUSION: In patients with nasal obstruction unresponsive to multiple therapeutic attempts, inferior turbinate neoplasia should be suspected to avoid delaying diagnosis and proper treatment.

Comparison of Intranasal Ciclesonide, Oral Levocetirizine, and Combination Treatment for Allergic Rhinitis

PURPOSE: To evaluate the efficacy and safety of once-daily ciclesonide in comparison to both levocetirizine alone, and a ciclesonide/levocetirizine combination in patients with seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR). METHODS: Subjects exhibiting moderate to severe allergic rhinitis for longer than 1 year were randomized in an open-label, 3-arm, parallel group, multicenter study. Subjects received 200 microg ciclesonide, 5 mg levocetirizine, or a combination of both. Changes from baseline until the end-of-study visit (2 weeks following) were evaluated by reflective total nasal symptom scores (rTNSSs), reflective total ocular symptom scores (rTOSSs), physician-assessed overall nasal signs and symptoms severity (PANS), and rhinoconjunctivitis quality-of-life questionnaires (RQLQ). RESULTS: Significant improvements in rTNSS, PANS, and RQLQ in the ciclesonide monotherapy group were observed in comparison to the levocetirizine alone group. Three individual symptoms of rTNSS, including runny nose, nasal itching, and congestion, were improved in the ciclesonide-treated group. rTOSS scores for ciclesonide monotherapy improved from baseline, but no superiority over levocetirizine was shown. The absolute score and changes in rTNSS and PANS were positively correlated. Ciclesonide spray was more effective than levocetirizine in reducing nasal symptoms in both SAR and PAR patients. Ciclesonide and levocetrizine were well tolerated alone and in combination. CONCLUSIONS: Our results provide support for an AR and its Impact on Asthma (ARIA) recommendation stipulating that ciclesonide is superior to levocetirizine for the treatment of AR, with tolerable safety. Addition of levocetirizine to ciclesonide did not give further clinical benefit over monotherapy.

Mechanisms of Glucocorticoid Action in Chronic Rhinosinusitis

The innate immune system and its complex interplay with the adaptive immune system are increasingly being recognized as important factors in the pathogenesis of chronic rhinosinusitis (CRS). Adaptive immune components, including resident and inflammatory cells, and their associated mediators, have been the subject of most research in CRS. For this reason, theories of CRS pathogenesis have involved the concept that inflammation, rather than infection, is the dominant etiologic factor in CRS. Therefore, glucocorticoids are increasingly used to treat CRS. This review will outline our current knowledge of action mode of glucocorticoids in CRS.

Long-term Subjective and Objective Outcomes of Adenotonsillectomy in Korean Children With Obstructive Sleep Apnea Syndrome

OBJECTIVES: Adenotonsillar hypertrophy is the most common etiology in pediatric obstructive sleep apnea syndrome (OSAS), and adenotonsillectomy is the mainstay of treatment modalities. This study evaluates the long-term effectiveness of adenotonsillectomy in children with OSAS. METHODS: Subjective symptoms evaluated with a 7-point Likert scale and objective respiratory disturbances evaluated by polysomnography were compared before and after adenotonsillectomy. RESULTS: A total of 17 children with OSAS aged 4-15 years (mean age, 6.65+/-3.02 years; male:female, 13:4) completed the study. The mean follow-up period was 57 months (range, 30 to 98 months). Significant changes were found in apnea-hypopnea index (from 12.49+/-12.96 to 1.96+/-2.01, P<0.001), apnea index (from 5.64+/-7.57 to 0.53+/-0.78, P=0.006), minimum SaO2 (from 81.88+/-14.36 to 92.76+/-4.31, P=0.003), snoring (from 43.28+/-70.63 to 10.70+/-13.72, P=0.042), and arousal index (from 19.58+/-7.57 to 11.36+/-3.99, P=0.006) after adenotonsillectomy. Significant changes were also found after surgery in most of symptoms including snoring, witnessed apnea, morning headache, mouth breathing, gasping during sleep, restless sleep, nasal obstruction, and difficulty with morning arousal. Long-term surgical cure rate and response rate were 47.1% (8/17) and 70.6% (12/17), respectively. CONCLUSION: Most of subjective OSAS symptoms and objective respiratory disturbances improved continuously about 5 years after adenotonsillectomy in children with OSAS. However, close follow-up and a sufficient observation period are necessary because of the risk for long-term incomplete resolution.

Histamine Promotes the Release of Interleukin-6 via the H1R/p38 and NF-kappaB Pathways in Nasal Fibroblasts

PURPOSE: Based on the close relationship between histamine and interleukin 6 (IL-6), we hypothesized that histamine may regulate the production of cytokines, such as IL-6, during allergic inflammation. Here, we examined the role of histamine in IL-6 production and histamine receptor activity in nasal fibroblasts, along with the mechanisms underlying these effects. METHODS: Experiments were performed using nasal fibroblasts from 8 normal patients. RT-PCR was used to identify the major histamine receptors expressed in nasal fibroblasts. Fibroblasts were then treated with histamine with or without histamine-receptor antagonists, and monitored for IL-6 production using an ELISA. Four potential downstream signaling molecules, p38, extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and NF-kappaB, were evaluated by Western blot, and a luciferase reporter assay. RESULTS: Elevated expression was seen for all histamine receptors, with IL-6 protein levels increasing significantly following histamine stimulation. Among the histamine-receptor specific antagonists, only the H1R antagonist significantly decreased IL-6 production in histamine-stimulated nasal fibroblasts. Histamine increased the expression level of phosphorylated p38 (pp38), pERK, and pJNK, as well as NF-kappaB induction. The H1R antagonist actively suppressed pp38 and NF-kappaB expression in histamine-induced nasal fibroblasts, but not pERK and pJNK. The p38 inhibitor strongly attenuated IL-6 production in histamine-stimulated nasal fibroblasts. CONCLUSIONS: The data presented here suggest that antihistamines may be involved in the regulation of cytokines, such as IL-6, due to the role of histamine as an inflammatory mediator in nasal fibroblasts.

Effect of Isolated Uvulopalatopharyngoplasty on Subjective Obstructive Sleep Apnea Symptoms

OBJECTIVES: The aims of this study were 1) to evaluate the effect of isolated uvulopalatopharyngoplasty (UPPP) on subjective obstructive sleep apnea (OSA) symptoms in adult patients regardless of the response to surgery, and ultimately 2) to investigate the differences in changes in subjective OSA symptoms between successful and unsuccessful surgery groups. METHODS: Twenty consecutive adult patients who underwent isolated UPPP were enrolled. Pre- and postoperative subjective OSA symptoms (snoring, witnessed apnea, daytime sleepiness, morning headache, daytime fatigue, restless sleep, difficulty with morning arousal) and polysomnographic data were evaluated in all subjects. Changes in subjective OSA symptoms before and after surgery were investigated in the successful (n=11) and unsuccessful (n=9) groups. Surgical success was defined as a reduction of at least 50% in the preoperative apnea-hypopnea index (AHI) and a postoperative AHI less than 20 per hour. RESULTS: After isolated UPPP, all subjective OSA symptoms changed significantly in the patients, especially in the successful group. In the unsuccessful group, snoring, witnessed apnea and daytime fatigue changed significantly, while other symptoms did not change significantly after surgery. CONCLUSION: Isolated UPPP may improve subjective OSA symptoms in adult patients whom surgery was successful or unsuccessful. However, after isolated UPPP, the improvements in subjective OSA symptoms in the unsuccessful group may be different from those in the successful group.

A Case of Pleomorphic Adenoma Arising from Inferior Turbinate Treated with Endoscopic Removal / 대한이비인후과학회지

Pleomorphic adenomas are the most common benign salivary gland neoplasms. However, they are rarely present in the minor salivary glands, neck, ear, mediastinum, external nose and nasal cavity. This case report describes a rare and unusual lesion found in a 48-year-old man, who, diagnosed as pleomorphic adenoma of the minor salivary glands in the inferior nasal turbinate, was treated with endoscopic removal.

Upregulation of Prostasin in Nasal Polyps

OBJECTIVES/HYPOTHESIS: Prostasin is a protease that activates epithelial sodium channels (ENaC), which mediate Na+ absorption across epithelial surfaces. Human nasal polyps absorb more ENaC-mediated Na+ than normal mucosa. We investigated the expression and distribution of prostasin in normal mucosa and nasal polyp. STUDY DESIGN: This was a controlled, prospective study. METHODS: The distribution patterns and levels of expression of prostasin in normal sinus mucosa and nasal polyps were evaluated using real-time polymerase chain reaction (PCR), immunohistochemical staining and western blotting. RESULTS: Real-time PCR revealed that the mRNA expression of prostasin was higher in nasal polyps than in normal sinus mucosa. The expression of prostasin was faint in immunohistochemical staining of superficial epithelial cells and submucosal glandular epithelial cells of normal sinus mucosa, but was intense in superficial epithelial cells and submucosal glandular epithelial cells in nasal polyps. Inflammatory cells infiltrating into the nasal mucosa also showed prostasin immunoreactivity in nasal polyps. Western blot analysis with prostasin antiserum detected prostasin protein in normal sinus mucosa and nasal polyps. The expression levels of prostasin were increased in nasal polyps compared with normal sinus mucosa. CONCLUSIONS: The levels of expression of prostasin were upregulated in nasal polyps compared to normal sinus mucosa, suggesting a role in the pathogenesis of nasal polyps. However, the exact pathophysiologic function of prostasin in nasal epithelium warrants further investigation.

Optimal Continuous Positive Airway Pressure Level in Korean Patients with Obstructive Sleep Apnea Syndrome

OBJECTIVES: The aim of this study was to investigate optimal continuous positive airway pressure (CPAP) level, to examine the factors affecting optimal CPAP level, and to develop a predictive equation for optimal CPAP level in Korean patients with obstructive sleep apnea syndrome (OSAS). METHODS: A total of 202 patients with OSAS who underwent successful manual titration for CPAP treatment were included in this study. Correlations between the optimal CPAP level and baseline data including anthropometric and polysomnographic variables were analyzed. A predictive equation for optimal CPAP level was developed based on anthropometric and polysomonographic data. RESULTS: The mean optimal CPAP level in 202 patients with OSAS was 7.8+/-2.3 cm H2O. The mean optimal CPAP level in the mild, moderate, and severe OSAS groups was 6.0+/-1.3, 7.4+/-1.9, and 9.1+/-2.1 cm H2O, respectively. The apneahypopnea index (AHI) (r=0.595, P<0.001), arousal index (r=0.542, P<0.001), minimal SaO2 (r=-0.502, P<0.001), body mass index (BMI) (r=0.494, P<0.001), neck circumference (r=0.265, P<0.001), and age (r=-0.164, P=0.019) were significantly correlated with optimal CPAP level. The best predictive equation according to stepwise multiple linear regression analysis was: Optimal CPAP level (cm H2O)=0.681+(0.205xBMI)+(0.040xAHI). Forty-two percent of the variance in the optimal CPAP level was explained by this equation (R2=0.42, P<0.001). CONCLUSION: A predictive equation for optimal CPAP level in Korean patients with OSAS was developed using AHI and BMI, which can be easily measured during the diagnostic process.

Intranasal Phototherapy in the Patients with Perennial Allergic Rhinitis

BACKGROUND AND OBJECTIVES: Phototherapy has a profound immuno- suppressive effect and is widely used for the treatment of immune- mediated skin diseases. The purpose of this study was to investigate the effectiveness of intranasal phototherapy in treating patients with perennial allergic rhinitis. MATERIALS AND METHODS: We conducted a study on 19 patients with perennial allergic rhinitis from January 2008 to July 2008. Each intranasal cavity was illuminated three times in the first week and then once a week the following five weeks. Symptom scores and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) were assessed. RESULTS: Phototherapy was well tolerated by the patients and resulted in a significant improvement of clinical symptoms for rhinorrhea, nasal obstruction, nasal itching, sneezing and total nasal score. In addition, significant improvements were achieved for itching of eyes, itching of the palate and total non-nasal symptom score except tearing and redness of eyes. After six weeks, the overall RQLQ scores significantly improved by 51% from the baseline in the treatment. CONCLUSION: These Results suggest that phototherapy is an effective modality for treating clinical symptoms of perennial allergic rhinitis and represents an alternative treatment for perennial allergic rhinitis.

A Case of Spindle Cell Carcinoma Originating from the Maxillary Sinus / 대한이비인후과학회지

Spindle cell (sarcomatoid) carcinoma of the upper respiratory tract is a rare malignancy, and its diagnosis, treatment, and prognosis still remain controversial. Histopathologic examination of this uncommon tumor shows surface epithelialcarcinoma and an underlying spindle-shaped proliferation. In the head and neck region, it is found predominantly in the larynx and oral cavity. To our knowledge, spindle cell carcinoma of the paranasal sinus has been rarely reported. We report a 57-year-old woman with a spindle cell carcinoma originating from the maxillary sinus. She was treated with surgery and post operative radiotherapy. After 8 months of close follow-up, she shows no sign of recurrence or distant metastasis. We offer this case and a review of the related literature in an effort to increase awareness of this rare malignancy.

The Changes of Polysomnographic Indices after Adenotonsillectomy in Pediatric Obstructive Sleep Apnea Syndrome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adenotonsillar hypertrophy is one of the leading causes in pediatric obstructive sleep apnea syndrome. Because untreated obstructive sleep apnea syndrome in children is associated with various complications such as neurobehavioral and cardiovascular dysfunction, it is very important to exactly diagnose and properly treat those patients. This study evaluates the effectiveness of adenotonsillectomy by assessing polysomnographic indices in pediatric obstructive sleep apnea syndrome. SUBJECTS AND METHOD: We evaluated children aged 4 through 15 years old (mean age=8.14 years old), a total 19 (Male=11, Female=8) with obstructive sleep apnea syndrome using the laboratory based polysomnography before and after adenotonsillectomy. RESULTS: After surgical managements, such as adenoidectomy or adenotonsillectomy, 89% of pediatric obstructive sleep apnea syndrome were successfully treated. The apnea-hypopnea index (from 10.76/hour to 0.78/hour, p=0.001), apnea index (from 5.64/hour to 0.54/hour, p=0.027), snoring (from 27.74% to 5.71%, p=0.002), arousal index (from 21.31/hour to 9.43/hour, p=0.001), minimal SaO2 (from 83.53% to 92.47%, p=0.017) were improved significantly following surgery. CONCLUSION: In children with obstructive sleep apnea syndrome, we identified that various polysomnographic indices were significantly improved after surgical treatments.

Changes in Quality of Life after Adenotonsillectomy in Children with Sleep Disordered Breathing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep disordered breathing (SDB) comprises a spectrum of airway disorders that range from simple snoring to obstructive sleep apnea (OSA). In children, SDB can have an effect on the quality of life such as behavior, school performance, emotional distress and daytime function. We aim to verify changes in disease specific health related quality of life before and after adenotonsillectomy in children with SDB. SUBJECTS AND METHOD: Children aged 4 through 15 years old, a total of 50 (M:36, F:14) with symptoms of snoring, mouth breathing, sleep apnea and physical examination results demonstrating tonsil size of 3+ or greater, were included. To evaluate the quality of life in children, two standard questionnaires KOSA-18 (Korean Obstructive Sleep Apnea-18 Survey) and KOSA-6 (Korean Obstructive Sleep Apnea-6 Survey) were given to the parents of children to complete, preoperatively and postoperatively. RESULTS: There was significant improvement after adenotonsillectomy in the total score of KOSA-18 and KOSA-6. In KOSA-18 and KOSA-6, all domain scores showed improvement after surgery. CONCLUSION: Children with SDB who undergo adenotonsillectomy show significant improvement in the quality of life. Therefore, we suggest that surgical intervention could be recommended to improve the quality of life in children with adenotonsillar hypertrophy.

Microbiology of Chronic Maxillary Sinusitis in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Problems with antibiotic susceptibility have recently been raised in the treatment of paranasal sinusitis. Therefore, well-established antimicrobial policy is needed. Samples collected in children who have sinusitis can be useful to monitor the evolution of resistance. However, relatively a little is known about the maxillary sinus flora in children with chronic sinusitis. This study aims to get a better insight into the maxillary sinus flora and its resistance. SUBJECTS AND METHOD: Maxillary sinus samples were obtained through inferior meatal puncture from 120 children with history of chronic sinusitis, who have undergone adenoidectomy or adenotonsillectomy. Samples were sent to the laboratory for bacterial cultures and antibiotics sensitivity tests. RESULTS: Organisms were isolated from 142 sinuses (59.0%) of 240 sinus culture, and 98 sinuses (41.0%) were sterile. Among the 142 sinuses, 97 sinuses have single strain, and 45 sinuses have mixed strains. Most recovered organisms were gram (+) aerobes. Among the gram (+) aerobes, Staphylococcus aureus strains in 41 strains (17.1%), -hemolytic Streptococcus in 42 strains (17.5%), coagulase negative Staphylococcusin 15 strains (6.3%) were the commonly encountered organism. In an antibiotic sensitivity test for gram (+) bacteria, Vancomycin and Teicoplanin showed sensitivity over 95%. CONCLUSION: Most isolated organisms were Staphylococcus aureus and -hemolytic Streptococcus. These organisms showed increased resistance to previously used antibiotics, as compared with the result of similar study carried 18 years ago.

Proteomic Analysis of the Specific Protein Expression in Inverted Papilloma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Inverted papilloma is a benign tumor of nasal cavity and paranasal sinuses with a propensity for local invasiveness, recurrence, and malignant transformation. Proteomics is a powerful tool for protein analysis, providing valuable information on biochemical processes involved in diseases, monitoring of cellular processes, and characterizing the protein expression levels. We tried to find the proteins that are associated with pathophysiology of the inverted papilloma and mechanisms of the disease by proteomic approach. MATERIALS AND METHOD: Normal nasal mucosa and inverted papilloma tissue was obtained during augmentation rhinoplasty and endoscopic surgery, respectively. Total protein was isolated and separated into numerous spots by two-dimensional electrophoresis. Twenty four protein spots that were only detected in inverted papilloma were selected and subsequently analyzed with matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). RESULTS: About 700 protein spots were detected. Selected spots were analyzed, and various proteins were identified. These include T-cell receptor beta chains, Ca2+ binding proteins, caltractin, calneuron, ras-related proteins, a rab-2b oncogene family, chloride intracellular channel proteins, tumor protein D53, and tumor necrosis factor precursors. CONCLUSION: We identified the proteins expressed in the inverted papilloma with proteomic approach. These proteins may help us in understanding the mechanisms of pathogenesis of inverted papilloma, and may be used as possible tumor markers.

Correlation between Quality of Life and Indices of Polysomnography in Children with Obstructive Sleep Apnea Syndrome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep disordered breathing (SDB) can have an effect on the quality of life in children by causing sleep disturbance, physical symptoms, emotional distress and daytime function. We aim to verify the correlation between the sleep related quality of life and indices of full nocturnal polysomnography in children with obstructive sleep apnea syndrome. SUBJECTS AND METHOD: Twenty-three children aged from 3 through 15 years old (male:16, female:7) diagnosed to have obstructive sleep apnea syndrome using the full nocturnal polysomnography were studied. The caregivers for each child were asked to complete a KOSA-18 (Korean Obstructive Sleep Apnea-18) survey to define the sleep related quality of life. The relationship between indices of polysomnography and the total score of KOSA-18 (KOSA-18 T score) were analyzed by Spearman correlation. RESULTS: There was significant correlation between KOSA-18 T score and respiratory disturbance index (RDI) (R=0.556, p=006), KOSA-18 T score and arousal index (R=0.466, p=.025), and KOSA-18 T score and snoring (R=0.472, p=.027). However, the others did not show significant correlation. CONCLUSION: The 70% in children with obstructive sleep apnea syndrome has higher degree of impairment in the sleep related quality of life. The larger the impairment in the children'squality of life by obstructive sleep apnea is, the higher the score of RDI, arousal index and snoring are. Therefore, earlier and more aggressive management may be needed in children with high KOSA-18.