Nam-Kyung Yeo

Rhinovirus infection-induced alteration of tight junction and adherens junction components in human nasal epithelial cells

Manifestations of rhinovirus (RV) infections include mucus overproduction, increased vascular permeability, and secondary bacterial infection. These effects may reflect disrupted epithelial barrier functions, which are mainly regulated by intercellular junctions, referred to as tight junctions (TJs) and adherens junctions (AJs). The objective of this study was to investigate changes in the components of TJs (ZO‐1, occluding, and claudin‐1) and AJs (E‐cadherin) after RV infection in cultured nasal epithelial cells.

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.

Use of Nasal Septal Bone to Straighten Deviated Septal Cartilage in Correction of Deviated Nose

Objectives: Septoplasty for correction of deviated nose often requires removal of the deviated part of the quadrangular cartilage and the perpendicular plate of the ethmoid bone or vomer. In most cases, the removed bone is discarded. We describe our experience using septal bone for deviated nose correction, and analyze the postoperative results. Methods: A retrospective study was performed on 23 patients who underwent correction of deviated nose using nasal septal bone to straighten deviated septal cartilage from January 2004 to August 2008. The subjective satisfaction of patients was evaluated 6 to 12 months after rhinoplasty with a questionnaire. Aesthetic outcomes were evaluated by 2 independent rhinoplastic surgeons who compared preoperative and postoperative photographs. To evaluate outcomes objectively, we made anthropometric measurements of the deviated nose before and after surgery using facial photographs. Results: All patients indicated cosmetic satisfaction and improvement in nasal obstruction. The outcome analysis by 2 independent rhinoplastic surgeons indicated that 13 patients had excellent, 5 patients had good, and 5 had fair outcomes. Anthropometric measurements of the deviated nose showed that both the curved deviated angles and the linear deviated angle had improved (p < 0.05). Conclusions: Use of nasal septal bone to straighten deviated septal cartilage appears to be feasible in corrective rhinoplasty, and may be particularly beneficial in cartilage-depleted patients.

Asian sand dust enhances rhinovirus-induced cytokine secretion and viral replication in human nasal epithelial cells.

Context: Asian sand dust (ASD) originating in the arid deserts of Mongolia and China causes annual severe air pollution events in the Asia-Pacific area, including Korea, Japan, and China. ASD is thought to impact public health by aggravating or inducing respiratory illness. Among the most common respiratory illnesses is the common cold caused by rhinovirus (RV) infection. To date, however, the impact of ASD on RV infection has not been studied. Objective: In this study, we investigated the effect of ASD on RV infection in human nasal epithelial cells. Methods: Primary human nasal epithelial cells grown at an air-liquid interface were treated with ASD and/or RV. After RV infections were confirmed using semi-nested reverse transcription-polymerase chain reaction (RT-PCR), mRNA expression and protein secretion of the inflammatory cytokines interferon-γ (IFN-γ), interleukin-1β (IL-1β), IL-6, and IL-8, indicators of the severity of RV-induced inflammation, were measured by real-time PCR and enzyme-linked immunosorbent assays. Viral titer was also assayed by culturing viruses to compare viral replication between RV-only and ASD-plus-RV groups. Results: ASD significantly increased RV-induced IFN-γ, IL-1β, IL-6, and IL-8 mRNA levels and protein secretion in primary nasal epithelial cells. In addition, ASD caused a significant increase in RV replication. Conclusions: Our results suggest that ASD may potentiate common cold symptoms associated with RV infection not only by enhancing IFN-γ, IL-1β, IL-6, and IL-8 secretion, but also by increasing viral replication.

Nasal skin thickness measured using computed tomography and its effect on tip surgery outcomes.

Objective. Skin thickness can be a major factor affecting rhinoplasty outcomes. However, few studies have examined the impact of nasal skin thickness on rhinoplasty aesthetic results. The aim of this study is to determine the effect of nasal skin thickness on the tip surgery outcome objectively. Study Design. Case series with chart review. Setting. Academic tertiary care medical center. Subjects and Methods. The study involved 77 patients who were evaluated using preoperative computed tomography scans and underwent rhinoplasty including tip surgery. Surgical outcomes were classified as excellent, good, or poor. Nasal skin thickness was measured at nasion, rhinion, nasal tip, and columella using computed tomography scans and was analyzed according to surgical outcomes. Results. The mean nasal skin thickness was 3.3 mm for nasion, 2.4 mm for rhinion, 2.9 mm for nasal tip, and 2.3 mm for columella. Postoperative outcomes were classified as excellent in 45, good in 17, and poor in 15 patients. The excellent outcome group had the thinnest nasal tip and columella nasal skin (2.8 mm and 2.2 mm), whereas the poor outcome group had the thickest skin in these regions (3.4 mm and 2.6 mm) (P < .0001 and P = 0.01, respectively). Conclusion. Nasal skin is thickest over the nasofrontal angle, thins over the rhinion, is thick again in the nasal tip, and thins out over the columella. Thick skin at the nasal tip and columella was associated with poor surgical outcomes. Regional skin thickness appears to be an important prognostic factor for tip surgery success.

The effectiveness of lumbar drainage in the conservative and surgical treatment of traumatic cerebrospinal fluid rhinorrhea

Abstract Conclusions: We found no differences in clinicopathologic factors and post-treatment effects between patients who did and did not receive lumbar drains (LDs) in the management of cerebrospinal fluid (CSF) rhinorrhea. Care should be taken in using LDs, after considering their effectiveness and complications, although routine use of an LD is not indicated in the management of traumatic CSF rhinorrhea. Objectives: We assessed the role and effectiveness of LDs in patients managed conservatively and surgically. Methods: Of 117 patients treated for CSF rhinorrhea, 61 were managed conservatively and 56 were initially managed surgically. We compared the clinicopathologic features and factors related to treatment outcome between patients who did and did not receive LDs. Results: Of 61 conservatively managed patients, 32 were managed without and 29 with LDs. There were no between-group differences in any clinicopathologic factors, recurrence rate, or incidence of meningitis during/after treatment, but duration of hospitalization differed significantly (15.3 vs 23.2 days, p = 0.03). Of 56 surgically managed patients, 24 were managed without and 32 with postoperative LDs. Except for age, there were no between-group differences in clinicopathologic factors. In terms of treatment outcome-related factors, there was no significant difference in recurrence rate, incidence of meningitis, or duration of hospitalization.

Expression of matrix metalloproteinase 2 and 9 and tissue inhibitor of metalloproteinase 1 in nonrecurrent vs recurrent nasal polyps

BACKGROUND Matrix metalloproteinases (MMPs) 2 and 9 are a group of Zn2+-dependent endopeptidases to remodel the extracellular matrix. The association of these 2 endopeptidases with the development of morphologic changes in nasal polyps was previously described. OBJECTIVE To determine whether MMP-2, MMP-9, and tissue inhibitor of MMP-1 (TIMP-1) play a role in the recurrence of nasal polyps. METHODS To compare MMP-2, MMP-9, and TIMP-1 expression in recurrent vs nonrecurrent polyps, nasal polyps (NPs) and recurrent nasal polyps (RNPs) were obtained from 15 NP patients with chronic rhinosinusitis (CRS) undergoing endoscopic sinus surgery (ESS) and 15 RNP patients with CRS undergoing revision ESS. Fifteen specimens of inferior turbinate mucosa from patients undergoing nasal septal surgery were used as control. Through real-time polymerase chain reaction and immunohistochemistry, MMP-2, MMP-9, and TIMP-1 expressions were measured among controls, NP patients, and RNP patients. RESULTS Expression of MMP-9 messenger RNA in the NP patients was significantly higher than in the controls. In addition, expression of MMP-9 messenger RNA in the RNP patents was significantly increased compared with NP patients. With immunohistochemistry, a more increased expression of MMP-9 was observed in NP patients than controls. Expression of MMP-9 in RNP patients was also significantly high compared with NP patients, particularly in stroma. CONCLUSION Expression of MMP-9 is increased in NP patients, and it is so more in the mucosa of RNP patients. Increased expression of MMP-9 is particularly found in the stoma of RNP patients, and it may contribute to the recurrence of NP.

Vegetable or Pulse Granuloma in the Nasal Cavity

Vegetable granuloma or pulse granuloma results from the implantation of food particles of vegetable origin. Pulse granulomas have mainly been reported in association with lung aspirations, the oral cavity with a history of oral procedures and less frequently in gastrointestinal tracks. We report a 31-year-old woman who presented with right nasal obstruction and was found to have a firm mass in the right nasal cavity. Paranasal sinus computerized tomography scans identified a calcified ring lesion in her right nasal cavity. Endoscopic sinus surgery was performed, and pathology examination revealed a lesion consistent with a pulse granuloma that contains starch granules with cellulose envelopes appearing as hyaline rings surrounded by inflammation cells and concentrically arranged delicate connective tissue. Pulse granuloma is a well described entity with distinct histopathology. However, pulse granulomas are rare, and especially extraoral pulse granulomas are extremely rare. We found that pulse granuloma can be occurred in the nasal cavity through regurgitation.

Contributing Factors to Prevent Prolonged Epiphora After Maxillectomy

OBJECTIVE To analyze the incidence of prolonged epiphora after maxillectomy according to transected nasolacrimal duct management technique, type of tumor, radiotherapy, and timing of tube removal and performance of dacryocystorhinotomy. DESIGN Retrospective medical record review. Settings University hospitals. PATIENTS We studied 89 patients (90 cases) who underwent nasolacrimal duct transection during maxillectomy with preservation of orbital contents for the management of sinonasal tumors between July 1, 1996, and January 31, 2008. MAIN OUTCOME MEASURES The incidence of prolonged epiphora was analyzed according to 4 different transected nasolacrimal duct management techniques: simple transection without any additional procedure, silicone tube stenting, transcanalicular Silastic stenting, and marsupialization without stenting. We also analyzed the relationship between other factors (type of tumor, radiotherapy, and timing of tube removal) and the incidence of prolonged epiphora. Prolonged epiphora was defined as persistent if it lasted longer than 6 months. RESULTS The overall incidence of prolonged epiphora was 15.6% (14 of 90 cases). The prolonged epiphora rates differed according to the management technique (no procedure, 27.3% [3 of 11 cases]; silicone tube, 7.0% [4 of 57 cases]; transcanalicular Silastic stenting, 66.7% [4 of 6 cases]; marsupialization, 18.8% [3 of 16 cases]; P = .002). The silicone tube technique showed the lowest rate (odds ratio = 0.20, P = .06). In contrast, the incidence of prolonged epiphora was not affected by the type of tumor, postoperative radiotherapy, or timing of tube removal. CONCLUSION Silicone tube stenting can be used as the effective and convenient transected nasolacrimal duct reconstructive technique to prevent prolonged epiphora.