Jee Hye Wee

Prevalence, risk factors and comorbidities of allergic rhinitis in South Korea: The Fifth Korea National Health and Nutrition Examination Survey.

Background There has been no nationwide epidemiological investigation of allergic rhinitis (AR) that was diagnosed by both questionnaires and laboratory tests in Korea. This study investigated the prevalence, risk factors, and comorbidities of AR in South Korea. Methods The Korean National Health and Nutritional Examination Survey examined a representative sample of the Korean population. A total of 2305 participants underwent immunoradiometric assay for specific IgE antibodies against common indoor allergens. Healthy, atopy only, and AR groups were defined according to the results of allergen test. The weighted prevalence for each group was calculated. Risk factors including food and comorbidities were identified using univariate or multivariate analyses. The patients were also categorized into four subgroups according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) classification and associated comorbidities were analyzed. Results The prevalence of atopy only and AR was 30.0 ± 1.2% and 16.2 ± 1.0%, respectively. The multivariate analysis showed that the prevalence was influenced by sex (p < 0.01) for atopy only and sex (p = 0.09), age (p = 0.02), marital status (p = 0.24), and stress level (p = 0 for AR. Compared with the healthy group, asthma (odds ratio [OR] = 4.77), nasal polyp (NP; OR = 3.44), chronic rhinosinusitis (OR = 13.93), and olfactory dysfunction (OR = 4.88) were more prevalent in the AR group. Based on the ARIA guideline, intermittent mild rhinitis was most common (58.1%). Asthma was correlated to severity and atopic dermatitis and NPs was associated with persistency. Daily intake of less mackerel and more carrots, bread, and bean curd were associated with the increased risk of AR. Conclusion Prevalence, risk factors, and comorbidities of AR were evaluated in the general Korean population, which will contribute to prevention and treatment of AR and its comorbidities in Koreans.

Prevalence of Subjective Olfactory Dysfunction and Its Risk Factors: Korean National Health and Nutrition Examination Survey

Background Population-based studies for olfactory dysfunction are lacking. The aim of this study is to evaluate the prevalence of subjective olfactory dysfunction and its risk factors in the Korean general population. Methods The data were obtained from the 2009 Korea National Health and Nutrition Examination Survey (KNHANES), which was a cross-sectional survey of non-institutionalized population all around the country (n = 10,533). All interviewees underwent medical interviews, physical examinations, endoscopic examination and blood/urine tests. Whether sense of smell has been normal or abnormal during the last 3 months was asked. Complete olfaction data were obtained from 7,306 participants and the participants were divided into normosmic and hyposmic group. Multivariate logistic regression analyses were performed to identify its risk factors. Results The weighted prevalence of subjective olfactory dysfunction was 4.5%. Its increased prevalence was significantly associated with the increasing age for both men and women. In the multivariate analyses, low income (adjusted odds ratio [OR] = 1.43, 95% Confidence Interval [CI] = 1.01–2.03), habitual exposure to air pollutants (adjusted OR = 2.18, CI = 1.33–3.55), a history of hepatitis B (adjusted OR = 3.10, CI = 1.25–7.68), rhinitis (adjusted OR = 1.78, CI = 1.26–2.51) and chronic sinusitis (adjusted OR = 14.55, CI = 10.06–21.05) were risk factors of olfactory dysfunction. Conclusion Our population-based study showed that olfactory dysfunction was quite prevalent and several risk factors were associated with impaired sense of smell. Given its prevalence, further researches for its prevention and management are required.

Complications Associated With Autologous Rib Cartilage Use in Rhinoplasty: A Meta-analysis

IMPORTANCE Although autologous rib cartilage is a preferred source of graft material in rhinoplasty, rib cartilage for dorsal augmentation has been continuously criticized for its tendency to warp and for high donor-site morbidities. However, no meta-analysis or systemic review on complications associated with autologous rib cartilage use in rhinoplasty has been conducted. OBJECTIVE To carry out a systematic review and a meta-analysis of available literature to evaluate complications regarding autologous rib cartilage in rhinoplasty. DATA SOURCES The studies reporting complications associated with the autologous rib cartilage use in rhinoplasty were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for sources published from 1946 through June 2013. STUDY SELECTION The selected articles included clinical studies conducted with at least 10 patients and at least 1 postoperative long-term complication or donor-site morbidity in rhinoplasty. Excluded were nonhuman studies; review articles; case reports; abstracts; and reports of nasal reconstruction as indication for surgery, use of homologous rib cartilage, and diced or laminated methods. DATA EXTRACTION AND SYNTHESIS Two investigators independently reviewed all studies and extracted the data using a standardized form. A meta-analysis was performed using a random-effects model. MAIN OUTCOMES AND MEASURES Number of patients; follow-up duration; and rates of complication, donor-site morbidity, and revision surgery. Also noted were study authors and year of publication. RESULTS Ten studies involving a total 491 patients were identified. Mean follow-up across all studies was 33.3 months. In meta-analysis, the combined rates were 3.08% (95% confidence interval [CI], 0%-10.15%) for warping, 0.22% (95% CI, 0%-1.25%) for resorption, 0.56% (95% CI, 0%-2.61%) for infection, 0.39% (95% CI, 0%-1.97%) for displacement, 5.45% (95% CI, 0.68%-13.24%) for hypertrophic chest scarring, 0% (95% CI, 0%-0.32%) for pneumothorax, and 14.07% (95% CI, 6.19%-24.20%) for revision surgery. CONCLUSIONS AND RELEVANCE The overall long-term complications and donor-site morbidity rates associated with autologous rib cartilage use in rhinoplasty were low. Warping and hypertrophic chest scarring showed relatively higher rates, warranting a surgeons attention. Because a limited number of studies and patients were eligible, and consistent definitions of complications were lacking in this meta-analysis, future studies with a larger series of patients and objective outcome measurements are needed to obtain more reliable results. LEVEL OF EVIDENCE 4.

Factors associated with hypertrophy of the lingual tonsils in adults with sleep-disordered breathing.

IMPORTANCE This study shows factors affecting lingual tonsil hypertrophy (LTH) in sleep-disordered breathing. OBJECTIVE To identify the factors associated with LTH in adults with sleep-disordered breathing. DESIGN Retrospective analysis. SETTING Academic tertiary referral center. PARTICIPANTS Ninety-seven adult patients with obstructive sleep apnea, who visited the Department of Otorhinolaryngology sleep clinic, were included from February 2009 through August 2011. INTERVENTIONS All patients underwent WatchPAT (peripheral arterial tone) examination, endoscopic examination of the upper airway, simple skull lateral radiography, and cine magnetic resonance imaging (MRI) sleep study of the upper airway tract. MAIN OUTCOMES AND MEASURES Prognostic factors indicating LTH in adults with sleep-disordered breathing. RESULTS A total of 97 subjects were included in this study. The median (interquartile range) apnea hypopnea index was 16.5/h (7.6/h-27.5/h). The median (interquartile range) thickness of the lingual tonsils as measured by MRI was 3.6 mm (1.9-5.2 mm) and 4.9 mm (2.9-6.7 mm) in the midline and paramidline of the tongue base, respectively (P < .001). Laryngopharyngeal reflux (reflux finding score >7) was present in 32 patients. The endoscopic grade of LTH agreed with the radiographic grade (κ = 0.731; P < .001). Lingual tonsil thickness as measured by MRI was correlated with the endoscopic grade of LTH (P < .001). Multivariate analysis revealed that laryngopharyngeal reflux (P < .001) and body mass index (P = .046) were independently significant factors associated with LTH as measured by MRI. CONCLUSIONS AND RELEVANCE Reflux finding score and body mass index were significantly associated with LTH in adults with sleep-disordered breathing, whereas the respiratory parameters were not associated with LTH.

Sublingual immunotherapy (SLIT) for house dust mites does not prevent new allergen sensitization and bronchial hyper-responsiveness in allergic rhinitis children.

Introduction The aim of this study is to identify the effects of sublingual immunotherapy (SLIT) on immunologic parameters and bronchial-hyper-responsiveness in children with allergic rhinitis to house-dust mite (HDM), through long-term follow-up cohort. Methods Among the Allergic Rhinitis Cohort Study for Kids, pediatric patients who visited the hospital for rhinitis symptoms and proven allergy to HDM through skin prick test were studied. In this cohort, 37 patients received SLIT more than 3-years (SLIT group), and 184 patients received only pharmacologic therapy (non-SLIT group) were included in this study. The results of skin prick test, eosinophil percent and count, total immunoglobulin E (IgE), and bronchial provocation test at initial and 3-year followed-up were compared in the two groups. Results After 3 year follow-up, only the serum eosinophil percent decreased more significantly in SLIT group than that in the non-SLIT group. New-sensitization rate other than HDM between SLIT and non-SLIT group did not show any significant differences. The distribution of sensitized allergen other than HDM showed increasing tendency after 3 years in both groups. Older age and a small number of sensitized allergen affected the improvement of bronchial hyper-responsiveness regardless of SLIT. Conclusion HDM SLIT in allergic rhinitis children for 3 years in Korea does not affect prevention of new sensitization and poly-sensitization rate increment, and improvement of bronchial hyper-responsiveness.

Autologous vs Irradiated Homologous Costal Cartilage as Graft Material in Rhinoplasty

Importance Studies comparing surgical results of rhinoplasty using autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are rare. Objectives To compare the clinical results of major augmentation rhinoplasty using ACC vs IHCC and analyze the histologic properties of both types of cartilage. Design, Setting, and Participants A retrospective clinical study was conducted among patients who had undergone rhinoseptoplasty using ACC or IHCC from January 1, 2009, to December 31, 2014. Patients were followed up for more than 1 year after surgery and the histologic characteristics of ACC and IHCC were compared. The details of the surgical procedures and complications, including warping, infection, resorption, and/or donor-site morbidity, were evaluated by reviewing medical records and facial photographs. Patients’ subjective satisfaction with aesthetic and functional results was evaluated using a questionnaire. Main Outcomes and Measures The details of the surgical procedures and complications, including warping, infection, resorption, and/or donor-site morbidity; patients’ subjective satisfaction with aesthetic and functional results’ objective evaluation of surgical outcomes, including symmetry, dorsal height, dorsal length, dorsal width, tip projection, tip rotation, tip width, and overall result; and histologic structures. Objective evaluation of surgical outcomes was graded using the Objective Rhinoplasty Outcome Score, which assessed symmetry, dorsal height, dorsal length, dorsal width, tip projection, tip rotation, tip width, and overall result. Histologic structures were evaluated using hematoxylin and eosin, Masson trichrome, Alcian blue, and Verhoeff elastic stains. Results A total of 63 patients (27 males and 36 females; mean [SD] age, 30.6 [9.5] years) had rhinoseptoplasty using ACC and 20 (9 males and 11 females; mean [SD] age, 35.4 [15.4] years) had rhinoseptoplasty using IHCC. Among observed complications, only notable resorption occurred more frequently in patients using IHCC (6 [30%]) than with ACC (2 [3%]) (P = .002). In subjective evaluations of aesthetic satisfaction, patients who received ACC showed significantly greater satisfaction (37 of 51 patients [73%] were very satisfied) than did those who received IHCC (6 of 20 [30%]) (P = .001). However, there was no between-group difference in subjective functional outcomes: 4 of 51 patients receiving ACC (8%) and 5 of 20 receiving IHCC (25%) were satisfied (P = .50) and 45 of 51 receiving ACC (88%) and 15 of 20 receiving IHCC (75%) were very satisfied (P = .15). Regarding objective aesthetic outcomes, all scores for both ACC and IHCC were more than 3.1 (between good and excellent). Histologic analyses showed larger, more evenly distributed, uniform chondrocytes and more collagens and proteoglycan contents in ACC than in IHCC. Conclusions and Relevance Compared with patients receiving IHCC, those receiving ACC for rhinoseptoplasty showed superior aesthetic satisfaction; ACC also had less frequent notable resorption. Autologous costal cartilage also had better histologic properties than IHCC did, suggesting it as an ideal graft material with less chance of long-term resorption. Level of Evidence 3.

Prevalence of nasal polyps and its risk factors: Korean National Health and Nutrition Examination Survey 2009-2011.

Background Although nasal polyps (NPs) are thought to be a common otorhinolaryngologic disease, there have been few population-based epidemiologic studies on the prevalence of NPs. The aim of this study is to evaluate the prevalence of NPs and the risk factors in the general Korean population. Methods The data were obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) (2009-2011), which was a cross-sectional survey of noninstitutionalized populations all around the country (n = 28,009). Among them, 19,152 participants (age more than or equal to 20 years) completed medical interviews, physical examinations and endoscopic examination. Analyses were performed using a complex sample design to identify the prevalence and its risk factors. Results The weighted prevalence of NPs was 2.5%. The increased prevalence was associated with increasing age. In the multivariate analyses, male sex [adjusted odds ratio (OR) = 1.68, 95% confidence interval (CI) = 1.25-2.26], low education level (adjusted OR = 1.57, CI = 1.16-2.13), obesity (adjusted OR = 1.49, CI = 1.19-1.87), asthma (adjusted OR = 1.80, CI = 1.24-2.62), and thyroid cancer (adjusted OR = 2.98, CI = 1.26-7.09) were associated with NPs. Among those with NPs, the proportion of symptomatic NPs was 34.4% and asthma was the only significant associated risk factor. Conclusion The prevalence of NPs in the Korean general population was not low despite advances in medical and surgical treatment and two thirds of the subjects with NPs were asymptomatic. Further investigation is needed to exhibit the causal relationship between the associated risk factors identified and NPs.

Prognosis of postviral olfactory loss: follow-up study for longer than one year.

Background There have been very few studies on the prognosis of postviral olfactory dysfunction. The aim of the study was to evaluate its long-term prognosis and factors influencing the prognosis. Methods This study included patients who were diagnosed with postviral olfactory dysfunction at least one year ago in a Smell and Taste Clinic and whose telephone interviews were available. Their medical records were reviewed, and they were asked to score their subjective olfactory function on a 100-point scale by telephone interview. Results A total of 63 patients and 20 normal controls without nasal pathology were included. The mean of the patients was 49.5 years, and 19 males and 44 females were included. The mean length of follow-up was 33.4 months. Olfactory dysfunction was subjectively improved in 85.7% of the patients. The recovery rate to subjective normosmia was 31.7%. The mean symptom scores for smell significantly increased in comparison with baseline from 25.6 to 69.0. Among the 25 patients (37.7%) who underwent follow-up butanol threshold test (BTT), the score improved from 4.6 to 7.3. Olfactory improvement was more frequently reported by females (p = .003) and in patients with follow-up duration for longer than 2 years (p = .043). Conclusions Follow-up of postviral olfactory loss revealed that over 80% of the patients reported subjective recovery after one year. The more favorable prognosis was associated with longer follow-up duration and female gender.

Post–Rib Harvesting Pain Should be Considered as a Potential Significant Morbidity in Reconstructive Rhinoplasty—Reply

patients as being a clinically significant risk associated with the procedure, its rate is very low (0% [95% CI, 0%-0.35%]), as highlighted by Wee et al 2 in their recent article. The reported low frequency may be due to awareness of this complication mitigating its risk of occurrence through considered surgical technique rather than a bias in reporting. Moreover, their review 2 does not consider pain following rib harvesting. 3,4 Such postoperative pain is especially pertinent because subsequent restricted respiratory excursion may lead to poorly ventilated distal lung zones, consolidation, and pneumonia. 5 Preventative measures to control postoperative pain together with adjunctive treatment, such as early mobilization and respiratory physiotherapy, may help to reduce its incidence. Consequently, we feel that a review that assesses the complications of autologous rib harvesting should consider the issue of this clinically significant potential morbidity.

Comparison of success criteria based on long-term symptoms and new-onset hypertension in mandibular advancement device treatment for obstructive sleep apnoea: observational cohort study

Objective To identify adequate criteria to determine the success or failure of mandibular advancement device (MAD) treatment for obstructive sleep apnoea (OSA) based on long-term symptoms and new-onset hypertension. Design Observational cohort study. Setting A tertiary care hospital setting in South Korea. Participants Patients (age >18 years) who were diagnosed with OSA by a polysomnography (PSG) or Watch peripheral arterial tonometry (PAT), and who had been treated with MAD between January 2007 and December 2014 were enrolled. Primary and secondary outcome measures Patients underwent PSG or Watch PAT twice; before and 3 months after the application of MAD. The patients were categorised into success and failure groups using seven different criteria. MAD compliance, witnessed apnoea and snoring, Epworth Sleepiness Scale score and occurrence of new-onset hypertension were surveyed via telephonic interview to determine the criteria that could identify success and failure of MAD. Results A total of 97 patients were included. The mean follow-up duration was 60.5 months, and the mean apnoea–hypopnoea index (AHI) was 35.5/hour. Two of the seven criteria could significantly differentiate the success and failure groups based on long-term symptoms, including (1) AHI<10/hour with MAD and (2) AHI<10/hour and AHI reduction of >50% with MAD. Kaplan-Meier survival analysis showed that one criterion of AHI<15/hour with MAD could differentiate the success and failure groups based on new-onset hypertension (p=0.035). The receiver operating characteristic curve analysis indicated that the cut-off AHI for new-onset hypertension was 16.8/hour (71.4% sensitivity and 75.0% specificity). Conclusion Our long-term follow-up survey for symptoms and new-onset hypertension suggested that some of the polysomnographic success criteria, that is, AHI<10/hour with MAD, AHI<10/hour and AHI reduction of >50% with MAD and AHI<15/hour with MAD may be useful in distinguishing the success group from failure one. Further prospective longitudinal studies are warranted to validate these criteria.