Jong Hwan Wang

Rhinovirus enhances various bacterial adhesions to nasal epithelial cells simultaneously

Viral upper respiratory tract infections are often followed by secondary bacterial infections in the form of acute rhinosinusitis. We investigate the effect of rhinovirus infection on the expression of cell adhesion molecules and bacterial adherence to primary human nasal epithelial cells.

Natural Course of Retention Cysts of the Maxillary Sinus: Long‐Term Follow‐Up Results

Objectives: Retention cysts of the maxillary sinus are an incidental finding on radiographs. These cysts usually appear as rounded, dome‐shaped, soft tissue masses, most often on the floor of the maxillary sinus. The aim of this study was to investigate the long‐term natural course of retention cysts of the maxillary sinus.

Tutoplast-Processed Fascia Lata for Dorsal Augmentation in Rhinoplasty:

OBJECTIVE: Tutoplast-processed fascia lata (TPFL) is a commercially available homograft, which has been successfully used as human graft tissue for physical support procedures. The present report evaluates the use of TPFL in rhinoplasty. STUDY DESIGN AND SETTING: The study involved a retrospective analysis of rhinoplasty cases using TPFL. The study population consisted of 69 patients (52 male and 17 female) and a minimum follow-up of 12 months. RESULTS: TPFL was used as a smoothening graft after correction of deviated and hump noses, as a major dorsal contouring graft for saddle or flat noses, and in secondary rhinoplasty following silicone implant complications. TPFL alone was used in 41 cases and in combination with other material in 28 cases. The only complication was major resorption in three cases, with two being secondary rhinoplasty patients. CONCLUSION: TPFL alone or in combination with other materials can be used as a dorsal augmentation material in rhinoplasty. TPFL was particularly useful for correction of dorsal irregularities and in cases requiring a minimal amount of augmentation.

Cutting and Suture Technique of the Caudal Septal Cartilage for the Management of Caudal Septal Deviation

OBJECTIVES To introduce the cutting and suture technique of the caudal L-strut for the management of caudal septal deviation and to evaluate its efficacy and surgical outcomes. DESIGN Retrospective study. SETTING Tertiary care rhinology clinic. PATIENTS Forty-five patients who underwent endonasal septoplasty using the cutting and suture technique of the caudal L-strut. INTERVENTIONS After elevation of the mucoperichondrial flap, deviated portions of cartilage and bone were excised, leaving at least a 1.5-cm strip of L-strut. If caudal septal deviation persisted, the caudal strut was cut at the convex-most part, and the cut ends were slightly overlapped and sutured together. MAIN OUTCOME MEASURES Improvement in the treatment of nasal obstruction using a visual analog scale and a questionnaire for subjective satisfaction were evaluated 2 to 6 months after septoplasty. To evaluate outcomes objectively, endoscopic photographs of the nasal cavity before and after surgery were evaluated by 2 independent surgeons. RESULTS Significant improvement in the treatment of nasal obstruction was achieved, with mean visual analog scale scores of 7.93 preoperatively and 3.63 postoperatively (P < .001). Subjective satisfaction was rated as much improved in 68% of patients, improved in 15%, and no change in 17%. Endoscopic examinations showed that 51% of patients had near-complete correction of the septum and that 47% had improved but a little persisting caudal deviation. One patient had no change in caudal septal deviation on endoscopic examination. CONCLUSION The cutting and suture technique of the caudal L-strut seems to be a useful technique that can be performed with relative ease and simplicity.

Levocetirizine inhibits rhinovirus-induced ICAM-1 and cytokine expression and viral replication in airway epithelial cells

Levocetirizine inhibits the production of intercellular adhesion molecule (ICAM)-1 and secretion of interleukin (IL)-6 and IL-8, which may have beneficial effects on the pathophysiologic changes related to human rhinovirus (HRV) infection. We investigated the effects of levocetirizine on rhinovirus infection in primary human nasal epithelial cells (HNEC) and A549 cells. Cells were treated with different concentrations of levocetirizine, ranging from 0.5, 5 or 50nM, either starting at the time of infection and continuing thereafter, or beginning 24h before infection and continuing thereafter. Levocetirizine treatment inhibited the HRV-induced increase in ICAM-1 mRNA and protein levels, as well as the HRV-induced expression of IL-6 and IL-8 mRNA and protein levels. Viral titer, as measured by culture in MRC-5 cells, was reduced by levocetirizine. Levocetirizine treatment also reduced the increased nuclear factor-kappa B (NF-kappaB) expression seen with HRV infection. Levocetirizine inhibited the expression of Toll-like receptor (TLR)3 mRNA and protein levels. These findings indicate that, in HNEC and A549 cells, levocetirizine inhibits HRV replication and HRV-induced upregulation of ICAM-1, IL-6, and IL-8, TLR3 expression and NF-kappaB activation. The results of this study suggest that levocetirizine may have a possible clinical application in the treatment of airway inflammation caused by HRV infection.

Staphylococcus aureus increases cytokine and matrix metalloproteinase expression in nasal mucosae of patients with chronic rhinosinusitis and nasal polyps.

Background Staphylococcus aureus is a common bacterial pathogen associated with chronic rhinosinusitis with/without nasal polyps (CRSw/sNP). We investigated the effect of S. aureus on the secretion of eotaxin, interleukin (IL)-5, IL-8, IL-13, matrix metalloproteinase (MMP) 2, MMP-9, and tissue inhibitor of MMP (TIMP) 1 in nasal mucosae from CRSwNP patients to assess the roles of these materials in NP pathogenesis. Methods We infected organ cultures of NP and inferior turbinate (IT) mucosae taken from patients with CRSwNP with S. aureus ATCC 25923 for 24 hours and incubated the cultures for an additional 48 hours at 37°C. S. aureus infection and staphylococcal enterotoxins were confirmed by real-time polymerase chain reaction. Eotaxin, IL-5, IL-8, IL-13, MMP-2, MMP-9, and TIMP-1 protein levels were measured by ELISA. Results S. aureus infection significantly increased the concentrations of eotaxin, IL-5, IL-8, and IL-13 in the IT and NP groups (p < 0.01 for all comparisons). S. aureus infection also significantly increased the concentrations of MMP-2, MMP-9, and TIMP-1 in both groups (p < 0.001 for all comparisons). After S. aureus infection, the relative increases in eotaxin (6.42 versus 3.56), IL-5 (15.29 versus 8.89), MMP-2 (1.95 versus 1.58), MMP-9 (2.34 versus 1.95), and TIMP-1 (1.45 versus 1.31) were greater in the NP group than in the IT group. Conclusion S. aureus infection enhances the secretion of cytokines, MMP-2, MMP-9, and TIMP-1 by both NPs and IT mucosae from patients with CRSwNP. S. aureus may play an important role in the pathogenesis of NP via tissue remodeling as well as eosinophilic inflammation.

Detection of parainfluenza virus 3 in turbinate epithelial cells of postviral olfactory dysfunction patients.

Objectives/Hypothesis: Postviral olfactory dysfunction (PVOD) develops after a common cold, but little is known about the viral pathogen inducing olfactory dysfunction. We hypothesized that human parainfluenza virus 3 (PIV3) may cause PVOD. We therefore assayed the nasal cavity mucosae of PVOD patients for the presence or persistence of PIV3.

Measurement of aesthetic proportions in the profile view of Koreans.

We have evaluated the usefulness of direct soft tissue measurements in profile photographs for determining the nasal proportions and angles of young Korean individuals and those of rhinoplasty patients, and we compared these findings with existing norms of Caucasian populations. We retrospectively compared preoperative profile measurements of nasal length, nasal tip projection, dorsal height, radix height, nasolabial angle, and nasofrontal angle in 123 patients who underwent rhinoplasty, with measurements in 21 young Korean adults. Rhinoplasty patients were grouped by preoperative diagnosis as deviated nose without saddle or hump, saddle nose, hump nose, and low radix. The young Koreans had a nasal length to nasal tip projection to dorsal height to radix height ratio of 2:0.97:0.61:0.28. Dorsal height differed significantly among groups of rhinoplasty patients. Those with low radix had the lowest dorsal and radix height, whereas those with saddle nose had the smallest nasal tip projection. The average nasolabial and nasofrontal angles were 78.5 degrees and 82.7 degrees, respectively, in young male Koreans and 126.0 degrees and 133.6 degrees, respectively, in young female Koreans. In the deviated nose group, all parameters except for nasofrontal angle were significantly changed after rhinoplasty. In the saddle nose group, nasal tip projection and dorsal height were significantly increased, whereas, in the hump nose group, nasal tip projection and nasolabial angle were significantly altered. Direct soft tissue measurement on profile photographs is useful for assessing nasal characteristics and postrhinoplasty outcomes. Compared with Caucasians, young Koreans had relatively lower dorsum and radix and more acute nasolabial angle, but similar nasofrontal angle.

Infection Rate and Virus-Induced Cytokine Secretion in Experimental Rhinovirus Infection in Mucosal Organ Culture: Comparison Between Specimens From Patients With Chronic Rhinosinusitis With Nasal Polyps and Those From Normal Subjects

OBJECTIVE To investigate the difference in susceptibility to rhinovirus (RV) infection and RV-induced inflammatory response between the nasal mucosae from patients with chronic rhinosinusitis with nasal polyps (CRS/NP) and subjects without CRS/NP (hereinafter, normal subjects). DESIGN In vitro study. SETTING Tertiary care rhinology clinic. PATIENTS We conducted RV infection experiments on the organ cultures of NPs and inferior turbinate mucosae from 16 patients with CRS/NP and sphenoid sinus and inferior turbinate mucosae from 19 patients who underwent transsphenoidal pituitary surgery. MAIN OUTCOME MEASURES Successful RV-16 infection was determined by positive identification of RV on the surface fluid of organ culture using seminested reverse transcriptase-polymerase chain reaction. Effects of RV on interleukin 6 (IL-6) and IL-8 secretion were measured by enzyme-linked immunosorbent assay. RESULTS The successful RV infection was achievable in 9 of 16 NP samples (56.3%) and 9 of 16 turbinate samples (56.3%) from patients with CRS/NP compared with 11 of 19 sphenoid sinus samples (57.9%) and 15 of 19 turbinate samples (78.9%) from normal subjects. The RV infection increased IL-6 and IL-8 secretion 236% and 173%, respectively, in NP samples, and 218% and 178%, respectively, in turbinate samples from patients with CRS/NP; compared with 231% and 145%, respectively, in sphenoid mucosa samples, and 181% and 148%, respectively, in turbinate samples from normal subjects. However, there were no statistical differences among the 4 groups. CONCLUSION These in vitro findings suggest that subjects with CRS/NP mucosa might not be more susceptible to RV infection, and did not secrete more cytokines in response to rhinovirus infection, than those with normal mucosa.

Classification of the deviated nose and its treatment.

OBJECTIVE To present a simplified classification of the deviated nose and the associated treatment outcome. DESIGN Retrospective analysis. SETTING Tertiary care rhinology clinic. PATIENTS Seventy-five individuals (49 males and 26 females) who underwent rhinoplasty for a deviated nose with minimum follow-up of 36 months. MAIN OUTCOME MEASURES Depending on the orientation of 2 horizontal subunits (the bony pyramid and the cartilaginous vault) with respect to the facial midline, the nasal deviations are classified into 5 types: I, a straight tilted bony pyramid with a straight tilted cartilaginous vault in the opposite direction; II, a straight tilted bony pyramid with a concavely or convexly bent cartilaginous vault; III, a straight bony pyramid with a tilted cartilaginous vault; IV, a straight bony pyramid with a bent cartilaginous vault, and V, a straight tilted bony pyramid and a tilted cartilaginous dorsum in the same direction. RESULTS Deformities of types I through V occurred in 24 (32%), 19 (25%), 19 (25%), 7 (9%), and 6 (8%) patients, respectively, in whom 1, 3, 2, 1, and 1 unsuccessful outcomes were found. Four of the 8 failed cases had been approached endonasally. CONCLUSION The proposed classification for the deviated nose could serve as a valuable adjunct in the treatment of these patients.