Journal of Rhinology最新文献

IgG4-related disease (IgG4-RD) is a systemic inflammatory condition characterized by tissue infiltration with IgG4-positive plasma cells and a tendency to form mass-like lesions in various organs. IgG4-related sinusitis, although a relatively rare manifestation of IgG4-RD, significantly impacts the paranasal sinuses. A 52-year-old man presented with persistent rhinorrhea, nasal obstruction, and headaches. He was diagnosed with IgG4-RD involving the bilateral nasal cavity, paranasal sinuses, submandibular glands, lacrimal glands, and parotid glands. We recently managed a case of IgG4-related sinusitis, which was successfully diagnosed and treated. This condition represents a distinct subset of chronic rhinosinusitis, with unique pathophysiological and clinical features. Accurate diagnosis and effective management of IgG4-related sinusitis require a high index of suspicion and a multidisciplinary approach.

To evaluate the long-term effects of submucosal Medpor implants in patients with empty nose syndrome (ENS), using the Sinonasal Outcome Test (SNOT) score as a measure of clinical improvement. A comprehensive search of six databases was conducted up to October 2024. The analysis included studies that examined the impact of submucosal Medpor implants on refractory ENS symptoms, as assessed by various symptom-specific questionnaires. Post-intervention SNOT scores were evaluated during follow-up periods of over 12 months, showing a statistically significant improvement in ENS symptoms (standardized mean difference [95% confidence interval]= 1.4676 [1.2067; 1.7285]; I²=37.2%). This meta-analysis indicates that submucosal Medpor implantation in patients with ENS is associated with significant long-term improvements in nasal symptoms.

Background and objectives: Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by recurrent upper airway obstruction, leading to disrupted sleep and various health complications. Positional OSA (POSA) refers to patients whose OSA severity is significantly influenced by body position, especially when lying supine. This study aimed to evaluate the polysomnographic characteristics of POSA and non-positional OSA (non-POSA) and to assess their clinical implications.

Methods: This retrospective study included patients diagnosed with OSA who underwent type 1 polysomnography. Patients were categorized into POSA and non-POSA groups based on whether their apnea-hypopnea index (AHI) in the supine position was at least twice as high as that in the lateral position. We collected and analyzed clinical and polysomnographic parameters, including AHI, oxygen desaturation index, arousal index, nadir peripheral oxygen saturation (SpO₂), and sleep position proportions. These were compared across different OSA severity levels-mild, moderate, and severe-to assess differences between the POSA and non-POSA groups.

Results: In total, 500 patients with OSA were analyzed, of whom 63.4% were classified as having POSA. Patients with POSA exhibited milder disease severity than those without, with an average AHI of 23.3±15.3/h versus 43.9±27.9/h, respectively, and a higher nadir SpO₂ of 82.8%±6.6% versus 77.1%±9.8%. POSA was more common in patients with mild OSA (76.5%) and moderate OSA (72.8%), while severe OSA cases were predominantly non-POSA (POSA was 47.4%). Moreover, patients with POSA spent significantly more sleep time in the lateral position (43.8%±22.7%) than non-POSA patients (27.2%±28.2%).

Conclusion: Patients with POSA generally exhibited milder disease and more favorable polysomnographic profiles than non-POSA patients. POSA is prevalent in mild-to-moderate OSA, and identifying it via polysomnography may inform tailored treatment strategies.

Background and objectives: Microplastics, which originate from the breakdown of larger plastic fragments or are intentionally produced for industrial applications, pose significant human and ecological risks through inhalation, ingestion, and dermal contact. Our study examined the release of microplastics during the preparation of homemade saline solutions, specifically when tearing open powder packets and mixing the powder with water.

Methods: We used commercially available polypropylene nasal irrigation bottles from the Korean market and collected six samples of nasal irrigation fluids. The samples were categorized into two groups: the control group comprised three samples, without sodium chloride powder, while the powder-added group consisted of three experimental samples, where a sachet of sodium chloride powder was mixed into the water to achieve a 0.9% sodium chloride concentration. The preparation involved cooling boiled water before mixing in the powder sachet. A Raman XploRA Plus confocal microscope was used for the detection and analysis of microplastics.

Results: We observed 17, 56, and 26 microplastic particles in the control group samples, with a mean of 33.00±20.42, and 7, 6, and 34 microplastic particles in the powder-added group, with a mean of 15.66±15.88. There was no significant difference in microplastic content between the groups. Analysis revealed that the control samples contained 66 fragments (67%) and 33 fibers (33%), while the powder-added samples contained 45 fragments (96%) and two fibers (4%). We identified three types of polymers: polypropylene (control: 96, powder-added: 41), polyethylene (control: 2, powder-added: 3), and polyethylene terephthalate (control: 1, powder-added: 3).

Conclusion: Our findings indicate that adding sodium chloride powder to nasal irrigation fluids does not significantly alter microplastic release, highlighting the importance of considering potential microplastic pollution from common medical devices.

Background and objectives: The medications preferred by patients for allergic rhinitis and their usage remain unclear. This study investigated treatment-seeking behaviors in patients with allergic rhinitis, including medical treatments, environmental controls, and surgical treatments.

Methods: In this study, a cross-sectional survey was conducted by internal medicine, pediatric, or otorhinolaryngology physicians at university hospitals from January 2022 to April 2022. A questionnaire was administered to patients with confirmed allergic rhinitis to collect information regarding medical treatments (prescription and over-the-counter medication use patterns, comorbid asthma, and allergen-specific immunotherapy), environmental controls (usage of air purifiers and pet avoidance), and experiences with surgical treatments.

Results: We included 51 patients with allergic rhinitis with a mean age of 31.6±16.0 years. Among them, 47 (92.2%) and 6 (11.8%) patients had pollen allergies and asthma, respectively. Furthermore, 41 (80.4%) patients took prescribed medicines, while 39 (76.5%) patients only used the medication when experiencing symptoms. Thirty patients (58.8%) reported concurrent use of intranasal sprays and oral medications. Thirty-three patients (64.7%) reported awareness of immunotherapy, and there were no preferential differences between subcutaneous (52%) and sublingual immunotherapy (48%). Of the 36 patients (70.6%) who reported using an air purifier, 38.9% considered it helpful in preventing allergic rhinitis symptoms. Fourteen patients (27.5%) currently or previously had a companion animal, with half experiencing worsening of symptoms. Twelve patients had received surgical treatment and reported high satisfaction levels (41.6%, very satisfied; 41.6%, satisfied).

Conclusion: Patients with allergic rhinitis showed similar preferences for oral and spray medications. They also showed satisfaction with surgical treatments and an interest in the environmental management of allergic rhinitis.

Mesenchymal stem cells (MSCs) are multipotent progenitor cells present in adult tissues that are recognized as promising candidates for cell therapy due to their ease of access, straightforward isolation, and capacity for bio-preservation with minimal loss of potency. However, the clinical application of MSCs faces significant challenges, such as donor site morbidity, underscoring the need for alternative sources. Recent studies have suggested that inferior turbinate tissues, which are commonly removed during turbinate surgery, may be a viable donor site for MSCs. Turbinate surgery is a safe and effective procedure frequently performed to alleviate nasal obstruction, a prevalent chronic condition treated by otolaryngologists. This implies that harvesting MSCs from turbinate tissue for tissue engineering and regenerative medicine could serve as a simple, minimally invasive method with faster healing and minimal risk of morbidity or scarring at the donor site. This review highlights previous research indicating that MSCs derived from human turbinate tissues maintain their stability and demonstrate multi-differentiation potential. Therefore, the turbinate could be an alternative to traditional MSC sources for producing functionally competent cells for future clinical applications.

Background and objectives: Flexible nasopharyngolaryngoscopy (F-NPLS) is a routine procedure performed in office settings. We compared two different intranasal scope navigation techniques used during F-NPLS, evaluating patient comfort and practitioner satisfaction.

Methods: This is a prospective, randomized, parallel-group controlled study. Patients undergoing F-NPLS to evaluate the upper airway were enrolled and randomized into two study groups. Patients in group A underwent intranasal scope negotiation following a trajectory below the middle turbinate; for group B, a trajectory along the inferior turbinate was used. The primary outcome evaluated was the successful, unhindered negotiation of the scope on the first attempt. Secondary outcomes included patient-perceived pain, incidents of mucosal trauma and bleeding, and the frequency and necessity of repeat scopy.

Results: In total, 111 patients were randomized into group A (n=53) and group B (n=58). Baseline characteristics, such as age and sex, were similar in both groups. There was no statistically significant difference between the groups with respect to the primary outcome (group A: 52.8% vs. group B: 55.2%, p=0.8). The frequency of F-NPLS without episodes of mucosal trauma was significantly higher in group B (group A: 56.9% vs. group B: 35.9%, p=0.004). Mucosal ecchymosis was a common finding in group A (group A: 41.5% vs. group B: 13.8%, p=0.03), while nasal bleeding was more frequently observed in group B, although the difference was not statistically significant (group A: 29.3% vs. group B: 22.6%, p=0.42).

Conclusion: The present study demonstrated that the success rate of unhindered F-NPLS was comparable between the two trajectories. However, patients experienced moderate to severe pain during repeat scopy compared to the initial F-NPLS attempt.

Background and objectives: Congenital choanal atresia is a rare condition that occurs in approximately 1 in 7,000 to 8,000 live births and involves the obstruction of the posterior nasal airway. It may present as either unilateral or bilateral, with bilateral cases being more severe due to the risk of immediate neonatal respiratory distress. Bilateral congenital choanal atresia (BCCA) necessitates prompt medical intervention to prevent cyanosis and significant breathing difficulties. This study focuses on the timing of surgery, the duration of stent use, and postoperative care in patients with bilateral congenital choanal atresia who underwent endoscopic transnasal surgery. Unlike previous studies, this research emphasizes the efficacy of an extended stenting period and introduces novel stenting techniques aimed at reducing restenosis.

Methods: From 2018 to 2021, three patients with BCCA underwent transnasal surgery that included the placement of stents. We retrospectively analyzed their medical records, focusing on the surgical outcomes in relation to the duration of stent placement and postoperative care. A novel approach was adopted, involving the use of customized stent sizes tailored to the specific anatomical factors of each patient, which facilitated improved neochoana maintenance.

Results: The average interval from diagnosis to surgery was 3.6 weeks. Surgery was successful in all cases, and the stent was removed after 6 months. In all patients, stable neochoanae were maintained without significant restenosis. Additionally, we observed that maintaining a stent for a period longer than previously recommended significantly reduced the risk of restenosis compared to the shorter durations used in earlier studies.

Conclusion: Our study suggests that an extended stenting period of 6 months or more is crucial for maintaining long-term patency in patients with BCCA. This approach could lead to a more reliable stenting protocol and improved postoperative care, potentially establishing a new standard for managing BCCA.

Background and objectives: This study aimed to evaluate whether preoperative oral prednisolone improves the intraoperative parameters and postoperative outcomes over a 3-month period in patients of sinonasal polyposis who undergo functional endoscopic sinus surgery.

Methods: In a triple-blind, randomized controlled study, 43 patients diagnosed with sinonasal polyposis in the Department of ENT, AIIMS, Jodhpur, were enrolled. After obtaining institutional ethics clearance and registering the clinical trial, randomization was conducted to assign participants into experimental and control groups. Preoperatively, patients were assessed using the clinical severity score (Sino-nasal Outcome Test; SNOT-22), radiological severity score (Lund-Mackay score), and endoscopic severity scores (discharge-inflammation-polyp [DIP] score and Lund-Kennedy score). Intraoperative assessment was done using the Perioperative Sinus Endoscopy (POSE) score, the duration of surgery, intraoperative blood loss, and visual analog scale for visual field during surgery and for the ease of disease removal. Postoperatively, at 3 months all the preoperative parameters were reassessed, and, using independent t-test, comparison was made between the two groups.

Results: Twenty-one patients were included in the experimental group (48%), and 22 in the control group (51%). Although the mean duration of surgery in the experimental group was shorter than in the control group, the difference was not statistically significant. Similarly, although the postoperative SNOT-22 score was lower in the experimental group compared to the control group, there was no statistically significant difference in outcomes between the two groups across any of the parameters assessed.

Conclusion: Although the role of oral steroids has been established in the treatment of sinonasal polyposis, our study did not find any significant difference between the group that received oral steroids prior to surgery and the group that received placebo.

Schwannomas are benign tumors that can develop in any part of a nerve containing Schwann cells. Skull base schwannomas are rare, representing approximately 4% of extracranial schwannomas. Among these, vidian nerve schwannomas are particularly uncommon, with only a few documented cases. In this report, we describe the case of a 58-year-old female patient who presented with an incidental finding of a skull base mass. The patient's only symptoms were intermittent headaches and dry eyes. No mass was detected during the physical examination. Radiographic evaluation revealed a neoplasm within the vidian canal, and the lesion's characteristics suggested a schwannoma. The patient underwent endoscopic resection, and subsequent histopathological analysis confirmed the diagnosis of schwannoma. Follow-up imaging and physical examination showed no evidence of recurrence. This case report highlights a schwannoma located in the vidian canal and extending into the foramen rotundum, which was successfully managed with endoscopic surgery.