Journal of Rhinology最新文献

Background and objectives: Empty nose syndrome (ENS) is a chronic and debilitating condition characterized by atrophic nasal mucosa and impaired mucosal function, resulting in persistent nasal discomfort and breathing difficulties. Despite various surgical and medical interventions, an effective treatment remains elusive. This study investigated the therapeutic potential of a human nasal turbinate stem cell (hNTSC)-based therapeutic agent for ENS.

Methods: ENS was induced in a rabbit model via electrocautery, and varying concentrations of hNTSC-based spheroids combined with collagen hydrogel were administered (n=3 per group). Histological and mRNA expression analyses were performed one month posttreatment to assess epithelial thickness and FOXJ1 expression levels.

Results: Histological analysis revealed that hNTSC treatment significantly increased epithelial thickness, with the most pronounced effect observed in the medium-dose group (1×107 cells/mL, 50 μL). mRNA analysis showed a dose-dependent increase in FOXJ1 expression, with the highest levels observed in the high-dose group. However, this did not correlate with superior histological recovery, suggesting that epithelial remodeling is optimal at specific cell concentrations.

Conclusion: These findings demonstrate that hNTSC-based therapy effectively promotes epithelial regeneration in ENS, with an optimal therapeutic dose identified at 1×107 cells/mL. This study highlights the potential clinical application of stem cell therapy for ENS and underscores the need for precise dose optimization to maximize therapeutic outcomes.

Background and objectives: In June 2018, South Korea expanded insurance coverage for polysomnography (PSG) to improve diagnostic access for obstructive sleep apnea (OSA). This study investigated the impact of this policy by analyzing changes in PSG utilization and diagnostic outcomes.

Methods: A multicenter retrospective study was conducted using data from 17 tertiary hospitals across South Korea. Patients aged ≥20 years who visited the hospitals for suspected OSA between 2015 and 2023 were included. The pre-coverage period was defined as 2015-2017, and the post-coverage period as 2019-2023. Demographics, PSG implementation rates, and apnea-hypopnea index (AHI) distributions were compared.

Results: A total of 29,055 patients were included (7,800 pre-coverage; 21,255 post-coverage). PSG utilization significantly increased from 51.3% to 74.4% (p<0.001). The proportion of female patients rose from 20.0% to 23.0%, and the mean age increased from 45.8 to 49.8 years (p<0.001). The average AHI increased from 31.2 to 35.3. The proportion of patients with severe OSA (AHI ≥30) rose from 42.8% to 48.8%, while cases with normal AHI (<5) declined from 11.6% to 8.3% (p<0.001).

Conclusion: The expansion of insurance coverage significantly improved PSG accessibility, particularly for older adults, women, and high-risk patients. The observed shift toward more severe diagnoses suggests enhanced detection of untreated OSA rather than overdiagnosis of mild or normal cases. These findings support the ongoing implementation of inclusive health policies while emphasizing the importance of appropriate patient selection.

Background and objectives: The aim of this study was to perform a systematic review and meta-analysis evaluating the efficacy of topical manuka honey in the postoperative management of chronic rhinosinusitis following endoscopic sinus surgery.

Methods: A systematic search was conducted using PubMed, Embase, OVID, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials. Data were extracted from the randomized trials identified for meta-analysis. Outcome measures-including visual analogue scales, quality of life assessed by the Sinonasal Outcome Test-22, the Philpott-Javer endoscopic score or Lund-Kennedy endoscopic score, post-treatment culture negativity, and adverse effects-were compared between the manuka honey treatment and control groups. Heterogeneity was assessed within subgroups.

Results: Four studies including 134 patients were incorporated into the meta-analysis. All subgroup analyses exhibited low heterogeneity. Visual analogue scale scores showed no significant differences, indicating that manuka honey did not cause definite discomfort (standardized mean difference [SMD], -0.46; 95% confidence interval [CI], -1.02 to 0.10). Similarly, improvement in the Sinonasal Outcome Test-22 score was not statistically significant (SMD, -0.03; 95% CI, -0.58 to 0.52). Although the Philpott-Javer score was slightly better in the manuka honey group, the difference was not statistically significant (SMD, 0.13; 95% CI, -0.26 to 0.52), and changes in the Lund-Kennedy endoscopic score from baseline were comparable (SMD, 0.59; 95% CI, -0.03 to 1.21). Culture negativity following manuka honey treatment was marginally improved compared to saline, yet without statistical significance (risk ratio, 0.43; 95% CI, 0.16 to 1.15). No serious adverse effects were reported in any study.

Conclusion: Although topical manuka honey appears to have no serious adverse effects, its efficacy should be reconsidered given the lack of statistically significant improvement in sinus mucosal status and post-treatment culture negativity. Further well-designed trials are warranted to clarify its potential benefits.

Sinonasal malignant melanoma is an extremely rare and aggressive malignancy. Diagnosis is often delayed because of nonspecific symptoms and complex histopathology. The primary treatment is surgical resection, with adjuvant radiotherapy frequently employed, although its survival benefit remains controversial. Systemic therapies, including immunotherapy and targeted therapy, show limited efficacy compared with cutaneous melanoma, partly due to distinct genetic profiles. The authors present the experience of a single-referral center with 10 patients diagnosed with sinonasal malignant melanoma. Despite treatment, which primarily involved surgery with adjuvant radiotherapy (n=7), outcomes were poor, with frequent recurrence and metastasis. Only one patient who achieved clear surgical margins and received adjuvant radiotherapy remained disease-free for more than five years. Based on these data, achieving clear surgical margins and establishing an early diagnosis are critical prognostic factors in the treatment of sinonasal mucosal melanoma. Management of this condition remains challenging, and no standardized treatment protocol has been established. Continued investigation and research are imperative to develop definitive therapeutic approaches.

Seborrheic keratosis (SK) is a common benign epithelial neoplasm most often found on sun-exposed skin, particularly in elderly individuals. Despite its prevalence, involvement of the nasal vestibule is extraordinarily rare, with only a few documented cases. We present the case of a 59-year-old man with a verrucous lesion in the left nasal vestibule that was completely excised and histopathologically confirmed as SK. This case emphasizes the importance of distinguishing SK from benign and malignant tumors such as basal cell carcinoma and squamous cell carcinoma, which occur more frequently in this anatomical site. A comprehensive review of the literature regarding the presentation, diagnosis, histopathology, and treatment of SK at atypical locations is also provided.

Rhinolithiasis is a rare condition characterized by the deposition of mineralized masses within the nasal cavity. These calcified deposits cause chronic unilateral nasal obstruction and malodorous discharge, often leading to misdiagnosis as chronic rhinosinusitis. This report presents the case of a 45-year-old woman who experienced persistent unilateral nasal obstruction and foul-smelling discharge for 5 years. Previous treatment for presumed chronic rhinosinusitis produced limited improvement. Subsequent nasal endoscopy and computed tomography revealed bilateral rhinoliths extending into the nasopharynx and oropharynx, with greater involvement on the left side. The patient underwent successful endoscopic removal, resulting in complete symptom resolution. This case highlights the importance of considering rhinolithiasis in the differential diagnosis of patients presenting with chronic unilateral or bilateral nasal complaints. Early identification followed by minimally invasive, endoscopy-guided surgical intervention enables effective management and prevention of potential complications.

Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic and associated nonpharmaceutical interventions, including mask-wearing and hand hygiene, have led to a global decline in otorhinolaryngologic conditions, with the monthly incidence of chronic rhinosinusitis decreasing from 39.49 to 14.56 per 100,000 people. This study compared the prevalence and severity of paranasal sinus abnormalities observed on magnetic resonance imaging (MRI) before and during the COVID-19 pandemic.

Methods: This retrospective study analyzed brain MRI scans from 3,762 individuals (1,881 men and 1,881 women; mean age, 56.2±9.8 years) performed at a single health-screening center in Seoul, South Korea, between January 2018 and December 2022. The study period was divided into pre-COVID-19 and COVID-19 phases, with March 2020 as the cutoff. A total of 428 scans demonstrating incidental paranasal sinus abnormalities, including mucosal thickening, retention cysts or polyps, fluid collection, and fungal balls, were evaluated using the Lund-Mackay (LM) scoring system.

Results: The overall prevalence of incidental paranasal sinus abnormalities was 11.4% (428/3,762), with a significant decline from the pre-COVID-19 to the COVID-19 period (16.1% vs. 8.6%, p<0.001). However, the mean LM score among participants with abnormalities was significantly higher during the COVID-19 period than in the pre-COVID-19 period (3.64±3.22 vs. 3.01±2.58, p=0.026). The proportion of nasal polyps was also greater during the COVID-19 period than in the pre-COVID-19 period (10.8% vs. 5.8%, p=0.028).

Conclusion: The prevalence of incidental paranasal sinus abnormalities on MRI decreased during the COVID-19 period compared to the pre-COVID-19 period, whereas the severity, as reflected by the LM score, increased.

Background and objectives: Empty nose syndrome (ENS) can occur as a consequence of aggressive turbinate surgery. However, some patients with similar surgical histories do not develop ENS, suggesting that host-related factors may contribute to its onset. Dysregulation of the autonomic nervous system (ANS), which innervates the nasal mucosa, may play a role in triggering ENS. This study used the Composite Autonomic Symptom Scale-31 (COMPASS 31) questionnaire to compare ANS dysfunction between patients with ENS and asymptomatic controls.

Methods: Twenty-six patients with ENS and 43 control participants without nasal symptoms, rhinitis, or rhinosinusitis were enrolled. ENS diagnostic criteria included a history of turbinate surgery, reduced turbinate volume on endoscopy or computed tomography scan, and an Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) score of ≥11. ENS was also diagnosed in patients with an ENS6Q score ≤11 if clinical findings strongly suggested ENS and the cotton test was positive.

Results: The ENS group showed significantly higher total COMPASS 31 scores than the controls. Although total ENS6Q and COMPASS 31 scores were not correlated, the crusting subscore was positively correlated with the total COMPASS 31 score (p=0.012).

Conclusion: Patients with ENS demonstrated markedly elevated total COMPASS 31 scores, and the crusting score in the ENS6Q was positively associated with total COMPASS 31 scores. These findings suggest that ANS dysfunction may contribute to ENS pathogenesis.

Background and objectives: This study investigates whether residual vascularity following preoperative embolization influences surgical outcomes in patients with juvenile nasopharyngeal angiofibroma (JNA) undergoing endoscopic endonasal surgery.

Methods: We retrospectively reviewed the medical records of 29 patients who underwent treatment at a tertiary referral hospital between January 2007 and December 2021. Patients were categorized according to the presence of residual vascularity after embolization and by tumor extent. Surgical outcomes were compared between groups, including estimated blood loss (EBL), transfusion requirements, total operation time, and the presence of residual tumor.

Results: Residual vascularity was observed in 19 patients (RV+) and was absent in 10 patients (RV-). Patients with extensive tumors exhibited a significant increase in EBL and transfusion requirements compared to those with limited tumors, regardless of residual vascularity status. While residual vascularity was associated with increased operation time, greater EBL, and a higher likelihood of transfusion, these differences were not statistically significant.

Conclusion: Residual vascularity appears to have a less pronounced influence on surgical outcomes than tumor extent. However, patients with extensive tumors and residual vascularity tended to experience higher blood loss and transfusion rates. Tumor extent may therefore represent a more critical prognostic factor than residual vascularity in JNA surgery.

Background and objectives: Rhino-orbito-cerebral mucormycosis (ROCM) shows elevated levels of the pro-inflammatory biochemical marker interleukin-6 (IL-6) compared with healthy subjects, and this increase is significantly correlated with morbidity and disease outcome. Surgical debridement has been shown to provide significant protection against mortality in patients with ROCM. This study aimed to identify serum IL-6 levels in patients with sino-nasal mucormycosis with or without orbital/cerebral involvement, both before and after operative interventions, and to explore their possible role in disease severity.

Methods: A single-centre prospective cohort study was conducted from June 2021 to December 2022. A total of 40 patients met the inclusion and exclusion criteria. Surgical debridement combined with antifungal therapy was performed as part of the management protocol. Pre-operative and post-operative IL-6 levels were assessed, with post-operative measurement performed on day 7. Patients were further subcategorised into three groups according to radiological extent, and separate analyses were conducted for these subgroups.

Results: Among the 40 patients, 21 (52.5%) had sinus involvement, 12 (30%) had sinus with orbital involvement, and 7 (17.5%) had sinus with orbital and cerebral involvement. Pre-operative IL-6 levels were significantly correlated with disease extent (p<0.001). In addition, there was a significant reduction between pre-operative and post-operative IL-6 levels (p<0.001).

Conclusion: The study indicates that IL-6 levels are correlated with disease severity. This marker may therefore serve as a valuable tool for pre-operative counselling, prognosis prediction, and guiding future treatment outcomes.