Yong Gi Jung

Objective usefulness of thin silastic septal splints after septal surgery.

Background Silastic splints have been used as effective tools for septal support, avoiding adhesion, and mucosal healing after septal surgery. Furthermore, although many surgeons insert septal splints, no well-designed trials exist to support their use. A randomized double-blinded controlled trial was performed. Methods We recruited 40 subjects who had undergone septoplasty only without sinus surgery or turbinoplasty. A silastic septal splint was inserted in one side of the nasal cavity at the end of each septoplasty, with the other side serving as a control. The splint side and control side were randomly selected. Nasal discomfort score (10-point scale) and mucosal status (grades 1–4) were surveyed in a blinded setting on postoperative days 7 and 14. Results Forty of 83 subjects fulfilled the enrollment criteria. On the 7th postoperative day there was no significant difference in nasal discomfort between the splint and control sides (6.2 ± 1.28 and 5.7 ± 1.27, respectively; p = 0.116), but the mucosal status was better on the splint side than on the control side (1.5 ± 0.51 and 2.5 ± 0.85; p < 0.001). At 14 days postoperatively, the symptom score (2.7 ± 1.06 versus 3.8 ± 1.25; p < 0.001) and mucosal status (1.5 ± 0.55 versus 1.9 ± 0.68; p = 0.013) were significantly better on the splint side compared with the control side. Conclusion Insertion of a silastic septal splint after septal surgery should be accepted as a routine procedure.

Effect of steroid, carbogen inhalation, and lipoprostaglandin E1 combination therapy for sudden sensorineural hearing loss

PURPOSEnThe purpose of this study was to evaluate the efficacy of combined therapy with steroid, carbogen inhalation, and lipoprostaglandin E(1) (lipo-PGE(1)) treatment and compare the results with other treatment modalities in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).nnnSUBJECTS AND METHODSnThe study group consisted of 670 patients diagnosed with unilateral ISSNHL. Two hundred patients (DCP group) were treated with steroid, lipo-PGE(1) and carbogen inhalation combination therapy, 194 patients (DC group) with steroid and carbogen inhalation, and 276 patients (D group) with steroid medication only. The therapeutic effects of the treatment groups were evaluated 2 months after treatment, using pure tone averages. Siegels criteria for hearing improvement were used for the assessments.nnnRESULTSnThe overall recovery rate after treatment was 57.5%. For each group, the recovery rate was as follows: 67.0% in the DCP group, 52.6% in the DC group, and 53.9% in the D group. The DCP group had a significantly better improvement rate than the other 2 groups. In addition, the DCP treatment was better than the other 2 groups for patients: less than 50 years of age, with an initial hearing loss less than 90 dB HL, had treatment started within 1 week from the onset of hearing loss, had tinnitus or an ascending type audiogram, and/or had no vertigo.nnnCONCLUSIONnSteroid, lipo-PGE(1), and carbogen inhalation therapy was more effective than the other treatment modalities studied for patients with ISSNHL.

Predictive Capabilities of Serum Eosinophil Cationic Protein, Percentage of Eosinophils and Total Immunoglobulin E in Allergic Rhinitis without Bronchial Asthma

This study identified cut-off values for allergy markers for use in the diagnosis of allergic rhinitis in the absence of other allergic diseases. Total immunoglobulin E (IgE), eosinophil cationic protein (ECP) and the numbers of eosinophils were measured in serum samples from 442 patients with typical symptoms of allergic rhinitis. A definite diagnosis was made on the basis of the presence of specific IgE levels. Cut-off values with a maximal discrimination to diagnose allergic rhinitis were found to be 98.7 IU/ml, 24.7 μg/ml and 4.0% for total IgE, ECP and eosinophils, respectively. Sensitivity, specificity and odds ratio for these values were 75.2%, 69.7% and 6.93, respectively, for total IgE, 55.7%, 74.4% and 3.70 for ECP, and 57.5%, 72.0% and 3.47 for eosinophils. A composite score representing positive results for all three markers had a positive predictive value of 85.3%, with an odds ratio of 8.55. It was concluded that total serum IgE, ECP and eosinophil percentage are strong predictors of allergic rhinitis and the determination of cut-off values for these markers can aid in the diagnosis of allergic rhinitis in the clinical setting.

Role of Wnt signaling pathway in progression of sinonasal inverted papilloma to squamous cell carcinoma.

Background Sinonasal inverted papilloma (IP) is one of the most common benign tumors of the sinonasal area and malignant transformation has frequently been reported. However, the exact mechanism of the transition from benign lesion to malignancy is not known. The Wnt signaling pathway involves a network of multiple signaling glycoproteins that are known to play an important role in embryogenesis and carcinogenesis. Objective The purpose of this study was to evaluate the role of the Wnt pathway and signaling proteins in malignant transformation of IP to dysplasia and squamous cell carcinoma. Methods Expression of the Wnt signaling pathway proteins, including Wnt-1, beta-catenin, cyclin D1, and Dishevelled-1 (Dvl-1), were detected by immunohistochemistry by using 3-mm tissue core microarrays that consisted of 115 cores of IP tissue. Each of the IP cores was graded as I (prominent squamous metaplasia), II (inverted pattern), III (dysplasia), or IV (squamous cell carcinoma). The expression pattern of each protein and the correlation between the expression of each target protein and IP grade were evaluated. Results Membranous staining of beta-catenin showed a significant positive correlation with IP grade (ρ = 0.247, p < 0.001), as did staining of cyclin D1 (ρ = 0.365, p < 0.001), which showed a nuclear pattern and staining of Dvl-1 (ρ = 0.380, p < 0.001), which showed a membranous, cytoplasmic, and nuclear pattern. For Dvl-1, a nuclear expression pattern was more frequently observed in grade III and IV IP (p = 0.036). In the case of Wnt-1, cytoplasmic expression was observed; however, it did not show a significant correlation with IP grade (ρ = 0.141, p = 0.130). Conclusions Wnt signaling proteins, including beta-catenin, cyclin D1, and Dvl-1, may play crucial roles in the malignant transformation of IP.

Effects of statins on the recovery of olfactory function in a 3-methylindole-induced anosmia mouse model.

Background Despite the importance of olfactory function, no effective medications have been identified to treat olfactory disorders. This study was performed to evaluate the functional recovery of olfaction damaged by 3-methylindole (3MI) in a mouse model with hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins). Methods In a randomized placebo-controlled trial, 24 healthy female BALB/c mice (aged 9–10 weeks and weighing 18–20 g each) were randomly allocated to statin-treated or control groups. Olfactory loss was induced by i.p. injections of 3MI. Atorvastatin (10 mg/kg) or normal saline was then administered per os with a gastric tube for 3 weeks. The effects of treatment were evaluated by food-finding tests and Western blot analysis. Results Both groups showed complete losses of olfactory function 1 week after 3MI injection. Three weeks after 3MI injection, 9 of the 12 mice in the statin-treated group (75%) passed a food-finding test, in which they were able to find the food within 3 minutes, at least two times out of three trials. However, only two mice in the control group (16.6%) passed the food-finding test, and this difference was statistically significant (p = 0.004; chi-square test). The expression level of the olfactory marker protein was also elevated in the statin-treated group (p = 0.030; Wilcoxon rank sum test). Conclusion Statins are associated with recovery of olfaction after 3MI injection in a mouse model.

Influence of Intranasal Epinephrine and Lidocaine Spray on Olfactory Function Tests in Healthy Human Subjects

Objective. Although topical decongestants and anesthetics are widely used in preparation for nasal endoscopy, no controlled trials have evaluated the effects of these agents on olfaction. Study Design. Randomized double-blinded controlled trial. Setting. Tertiary referral hospital. Materials and Methods. The authors recruited 72 healthy subjects and randomly assigned them to 1 of 4 groups (control, phenylephrine group, lidocaine group, and both agents). After baseline tests with the Korean version of Sniffin’ Stick Test II (KVSS II), topical agents were applied to each nostril. Fifteen minutes later, repeat tests were carried out. Pre- and postspray results of the olfactory tests were compared, and the differences among groups were analyzed. Results. The mean ± SD prespray KVSS II score of the study group was 30.2 ± 3.8, and there were no statistically significant differences among the study groups (P = .353). Mean ± SD pre- and postspray KVSS II scores were 29.0 ± 3.5 and 30.7 ± 3.7 (P = .128) in the control group, 30.6 ± 3.6 and 31.7 ± 3.3 (P = .262) in the phenylephrine group, and 31.4 ± 3.6 and 32.1 ± 3.1 (P = .557) in the lidocaine group, respectively. In the phenylephrine and epinephrine spray group, the mean ± SD pre- and postspray scores were 29.9 ± 4.4 and 31.3 ± 3.7 (P = .071), respectively. Conclusions. Neither topical intranasal phenylephrine nor lidocaine use affected the results of the olfactory test, even when the agents were used in combination.