Pub Date : 2022-03-01Epub Date: 2022-03-28DOI: 10.18787/jr.2021.00386
Jungghi Kim, Jong-Gyun Ha, Hyung-Ju Cho
Central sleep apnea (CSA) is defined as an absence of breathing without respiratory drive during sleep. It can occur after treatment of obstructive sleep apnea (OSA), a phenomenon known as treatment-emergent central sleep apnea (TECSA). We present a case of a 23-year-old male who developed CSA after pharyngeal and nasal surgery for severe OSA. High loop gain and increased ventilations from frequent arousal are likely explanations for our patient's central apnea, which resolved with positive airway pressure therapy that possibly alleviated residual airway obstruction and ventilatory instability. This case suggests that effectiveness of treatment for OSA should be based on careful long-term observation with multiple follow-up polysomnography tests, especially in patients at high risk of TECSA.
{"title":"Development of Central Sleep Apnea After Sleep Surgery.","authors":"Jungghi Kim, Jong-Gyun Ha, Hyung-Ju Cho","doi":"10.18787/jr.2021.00386","DOIUrl":"10.18787/jr.2021.00386","url":null,"abstract":"<p><p>Central sleep apnea (CSA) is defined as an absence of breathing without respiratory drive during sleep. It can occur after treatment of obstructive sleep apnea (OSA), a phenomenon known as treatment-emergent central sleep apnea (TECSA). We present a case of a 23-year-old male who developed CSA after pharyngeal and nasal surgery for severe OSA. High loop gain and increased ventilations from frequent arousal are likely explanations for our patient's central apnea, which resolved with positive airway pressure therapy that possibly alleviated residual airway obstruction and ventilatory instability. This case suggests that effectiveness of treatment for OSA should be based on careful long-term observation with multiple follow-up polysomnography tests, especially in patients at high risk of TECSA.</p>","PeriodicalId":33935,"journal":{"name":"Journal of Rhinology","volume":" ","pages":"56-58"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44420458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01Epub Date: 2022-02-11DOI: 10.18787/jr.2021.00390
Ki-Il Lee, Tae-Bin Won, Sangmin Hyun, Hyungmin Song, Yong Ju Jang, Ji Yun Choi, Seung-No Hong, Hyo Yeol Kim, Ji Sun Kim, Soo Whan Kim
Open rhinoseptoplasty has been widely performed in the field of otorhinolaryngology. However, from the perspective of beginners, rhinoseptoplasty is a hard-to-learn surgery that involves a relatively steep learning curve. Therefore, practical guidance is essential to enhance the skills needed for excellent surgical outcomes. Here, we provide a step-wise dissection manual using a commercialized silicone nose model designed for rhinoseptoplasty. The contents include general approaches with regard to transcolumellar inverted V incision, flap elevation, osteotomy, septoplasty, modification of the lower lateral cartilage for tip surgery, and dorsal augmentation using silicone implants. In addition, we introduce novel techniques such as dorsal augmentation using a ready-made mold with tissue glue applied to diced cartilage and polycaprolactone mesh for rhinoseptoplasty. The present study also provides photos of individual surgical procedures using a silicone nose model for actual guidance. The authors expect that this manual will help beginning rhinoseptoplasty surgeons improve their confidence.
{"title":"Dissection Manual for Open Rhinoseptoplasty in a Silicone Nose Model.","authors":"Ki-Il Lee, Tae-Bin Won, Sangmin Hyun, Hyungmin Song, Yong Ju Jang, Ji Yun Choi, Seung-No Hong, Hyo Yeol Kim, Ji Sun Kim, Soo Whan Kim","doi":"10.18787/jr.2021.00390","DOIUrl":"10.18787/jr.2021.00390","url":null,"abstract":"<p><p>Open rhinoseptoplasty has been widely performed in the field of otorhinolaryngology. However, from the perspective of beginners, rhinoseptoplasty is a hard-to-learn surgery that involves a relatively steep learning curve. Therefore, practical guidance is essential to enhance the skills needed for excellent surgical outcomes. Here, we provide a step-wise dissection manual using a commercialized silicone nose model designed for rhinoseptoplasty. The contents include general approaches with regard to transcolumellar inverted V incision, flap elevation, osteotomy, septoplasty, modification of the lower lateral cartilage for tip surgery, and dorsal augmentation using silicone implants. In addition, we introduce novel techniques such as dorsal augmentation using a ready-made mold with tissue glue applied to diced cartilage and polycaprolactone mesh for rhinoseptoplasty. The present study also provides photos of individual surgical procedures using a silicone nose model for actual guidance. The authors expect that this manual will help beginning rhinoseptoplasty surgeons improve their confidence.</p>","PeriodicalId":33935,"journal":{"name":"Journal of Rhinology","volume":" ","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46814347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Kim, Ho Yun Lee, Tae Hyun Kim, Tae Hoon Kim, Kun‐Hee Lee
Background and Objectives: The alar-columellar relationship plays an important role in the esthetic balance of the nose. We analyzed alar rim deformities and aesthetic concerns and expectations among patients by deformity type in Korean primary rhinoplasty patients.Materials and Methods: Retrospective photographic analysis was done on 336 patients planning to undergo primary rhinoplasty at Kyung Hee University Hospital at Gangdong. We categorized their alar rim deformities as normal, hanging columella, retracted columella, hanging ala, retracted ala, convex ala, concave ala, thick ala, and a combination of the above. Patients’ aesthetic concerns and expectations about their nose were analyzed by preoperative questionnaire.Results: Of the enrolled patients, 38 (11.3%) had no alar rim deformities, and the other 298 patients (88.7%) had one or more deformities. The most prevalent alar rim deformity was hanging ala (59.2%), followed by convex ala (53.3%) and thick ala (32.1%). Male patients were more likely to have convex ala and retracted columella than female patients. More than one-half of the patients (64.1%) had two or more deformities and tended to be young (p=0.028). Patients with thick ala had several reasons for being dissatisfied with their nose and various demands for correction.Conclusion: Distinctive characteristics of alar rim deformities should be considered in surgical planning in order to obtain satisfactory results in Korean primary rhinoplasty patients.
{"title":"Alar Rim Deformities in Korean Primary Rhinoplasty Patients","authors":"S. Kim, Ho Yun Lee, Tae Hyun Kim, Tae Hoon Kim, Kun‐Hee Lee","doi":"10.18787/jr.2021.00365","DOIUrl":"https://doi.org/10.18787/jr.2021.00365","url":null,"abstract":"Background and Objectives: The alar-columellar relationship plays an important role in the esthetic balance of the nose. We analyzed alar rim deformities and aesthetic concerns and expectations among patients by deformity type in Korean primary rhinoplasty patients.Materials and Methods: Retrospective photographic analysis was done on 336 patients planning to undergo primary rhinoplasty at Kyung Hee University Hospital at Gangdong. We categorized their alar rim deformities as normal, hanging columella, retracted columella, hanging ala, retracted ala, convex ala, concave ala, thick ala, and a combination of the above. Patients’ aesthetic concerns and expectations about their nose were analyzed by preoperative questionnaire.Results: Of the enrolled patients, 38 (11.3%) had no alar rim deformities, and the other 298 patients (88.7%) had one or more deformities. The most prevalent alar rim deformity was hanging ala (59.2%), followed by convex ala (53.3%) and thick ala (32.1%). Male patients were more likely to have convex ala and retracted columella than female patients. More than one-half of the patients (64.1%) had two or more deformities and tended to be young (p=0.028). Patients with thick ala had several reasons for being dissatisfied with their nose and various demands for correction.Conclusion: Distinctive characteristics of alar rim deformities should be considered in surgical planning in order to obtain satisfactory results in Korean primary rhinoplasty patients.","PeriodicalId":33935,"journal":{"name":"Journal of Rhinology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43687002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ki-Il Lee, Gwanghui Ryu, S. Yoo, Yong Min Kim, J. Mo, Seung-Heon Shin
Well-characterized in chronic rhinosinusitis, type 2 inflammation is frequently associated with nasal polyps, comorbid asthma, and nonsteroidal anti-inflammatory drug hypersensitivity. Despite medical and surgical treatment, it recurs in a significant proportion of patients. Thus, severe uncontrolled type 2 chronic rhinosinusitis with nasal polyps is the most difficult-to-treat phenotype of chronic rhinosinusitis. Recently, dupilumab, a monoclonal antibody against IL-4 receptor α, and omalizumab, a monoclonal antibody against immunoglobulin E, were approved for patients with chronic rhinosinusitis with nasal polyps in the United States, Europe, and Korea. Therefore, rhinologists should understand novel biologics and their use. Here, we provide a literature review of several biologics with their indications, effectiveness, and safety.
{"title":"Practical Review of Biologics in Chronic Rhinosinusitis With Nasal Polyps","authors":"Ki-Il Lee, Gwanghui Ryu, S. Yoo, Yong Min Kim, J. Mo, Seung-Heon Shin","doi":"10.18787/jr.2021.00382","DOIUrl":"https://doi.org/10.18787/jr.2021.00382","url":null,"abstract":"Well-characterized in chronic rhinosinusitis, type 2 inflammation is frequently associated with nasal polyps, comorbid asthma, and nonsteroidal anti-inflammatory drug hypersensitivity. Despite medical and surgical treatment, it recurs in a significant proportion of patients. Thus, severe uncontrolled type 2 chronic rhinosinusitis with nasal polyps is the most difficult-to-treat phenotype of chronic rhinosinusitis. Recently, dupilumab, a monoclonal antibody against IL-4 receptor α, and omalizumab, a monoclonal antibody against immunoglobulin E, were approved for patients with chronic rhinosinusitis with nasal polyps in the United States, Europe, and Korea. Therefore, rhinologists should understand novel biologics and their use. Here, we provide a literature review of several biologics with their indications, effectiveness, and safety.","PeriodicalId":33935,"journal":{"name":"Journal of Rhinology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42869588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Objectives: The aim of the present study was to investigate the effects of a combination of crushed cartilage and thin silastic sheet for patients with a risk of septal perforation during septoplasty.Materials and Methods: A total of 195 people who underwent septoplasty surgery at Dong-A University Hospital from January 2019 to December 2020 were enrolled retrospectively. Among 195 people, our surgical method was provided for those with damage to both septal mucosa. The cartilage was collected, crushed with the cartilage crusher, and inserted between perforated mucosa. After the cartilage insertion, a 0.254-mm-thin silastic sheet was designed to cover both sides of the perforated septal mucosa. Next, a penetrating suture was placed. After thin silastic was applied on both mucosa, a 1-mm-thick silastic sheet was inserted on both sides of the nasal cavity and penetrating sutures were placed on the anterior and inferior septum. The operation concluded after packing both sides of the nasal cavity using non-absorbable packing material. The packing was removed on the second day after the operation, and the nasal cavity condition was checked every week. Thick silastic sheets were removed 5 days after surgery, and thin silastic sheets were maintained until both septal mucosa healed.Results: Of nine total cases, only one 78-year-old male experienced septal perforation at the cartilage portion two months after surgery. In this case, no other action was taken to cover the perforation site because he reported no symptoms or discomfort during the 9 months after surgery. In the other eight cases, both septal mucosa healed completely, and there were no complications.Conclusion: This method with crushed cartilage and silastic sheets to fill the defect after septal surgery is thought to help prevent postoperative perforation at no additional cost, and further research is needed.
{"title":"Prevention of Septal Perforation Using a Combination of Crushed Cartilage and Thin Silastic Sheet During Septoplasty","authors":"Young Gun Kim, Sang Jun Kim, W. Bae","doi":"10.18787/jr.2021.00378","DOIUrl":"https://doi.org/10.18787/jr.2021.00378","url":null,"abstract":"Background and Objectives: The aim of the present study was to investigate the effects of a combination of crushed cartilage and thin silastic sheet for patients with a risk of septal perforation during septoplasty.Materials and Methods: A total of 195 people who underwent septoplasty surgery at Dong-A University Hospital from January 2019 to December 2020 were enrolled retrospectively. Among 195 people, our surgical method was provided for those with damage to both septal mucosa. The cartilage was collected, crushed with the cartilage crusher, and inserted between perforated mucosa. After the cartilage insertion, a 0.254-mm-thin silastic sheet was designed to cover both sides of the perforated septal mucosa. Next, a penetrating suture was placed. After thin silastic was applied on both mucosa, a 1-mm-thick silastic sheet was inserted on both sides of the nasal cavity and penetrating sutures were placed on the anterior and inferior septum. The operation concluded after packing both sides of the nasal cavity using non-absorbable packing material. The packing was removed on the second day after the operation, and the nasal cavity condition was checked every week. Thick silastic sheets were removed 5 days after surgery, and thin silastic sheets were maintained until both septal mucosa healed.Results: Of nine total cases, only one 78-year-old male experienced septal perforation at the cartilage portion two months after surgery. In this case, no other action was taken to cover the perforation site because he reported no symptoms or discomfort during the 9 months after surgery. In the other eight cases, both septal mucosa healed completely, and there were no complications.Conclusion: This method with crushed cartilage and silastic sheets to fill the defect after septal surgery is thought to help prevent postoperative perforation at no additional cost, and further research is needed.","PeriodicalId":33935,"journal":{"name":"Journal of Rhinology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47969898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Kim, Dabin Lee, Tae Hoon Lee, B. Choi, M. Han, Sang Hag Lee, Tae Hoon Kim
Vitamin D is an important hormone that has many physiologic roles. It’s major role is the regulation of serum level of calcium. In addition, it modulates bone metabolism, blood pressure, and electrolytes. Recently, new physiological functions of vitamin D have been identified. New evidence is that the most active form of vitamin D which was 25 (OH)2D3 regulates both innate and adaptive immune systems. Vitamin D deficiency is related with susceptibility to infection, especially respiratory infection, also to the occurrence of a various cancers, cardiovascular disease, and autoimmune diseases. The occurrence of atopic disease, for example, asthma and anaphylaxis, is also affected by vitamin D. Furthermore, epidemiological studies showed that serum 25 (OH)2D3 levels are linked to allergic rhinitis, and supplementing vitamin D in infancy increased the incidence of allergic rhinitis later. Vitamin D binds to the vitamin D receptors (VDR) and then exerts biological activities, regulating differentiation process of T helper cell and Th cytokine. Vitamin D receptors (VDR) are steroid thyroid of nuclear receptors which can be found in various cells like airway epithelial and immune cells. Dysregulation of the VDR contributes to increase prevalence of some autoimmune diseases such as Hashimoto’s thyroiditis. In animal study, mice deficient in VDR failed to make experimental allergic asthma. These results suggest that VDR are related to Th2 cell me-
{"title":"Upregulation of the Vitamin D Receptor in the Nasal Mucosa of Patients With Allergic Rhinitis","authors":"H. Kim, Dabin Lee, Tae Hoon Lee, B. Choi, M. Han, Sang Hag Lee, Tae Hoon Kim","doi":"10.18787/jr.2021.00364","DOIUrl":"https://doi.org/10.18787/jr.2021.00364","url":null,"abstract":"Vitamin D is an important hormone that has many physiologic roles. It’s major role is the regulation of serum level of calcium. In addition, it modulates bone metabolism, blood pressure, and electrolytes. Recently, new physiological functions of vitamin D have been identified. New evidence is that the most active form of vitamin D which was 25 (OH)2D3 regulates both innate and adaptive immune systems. Vitamin D deficiency is related with susceptibility to infection, especially respiratory infection, also to the occurrence of a various cancers, cardiovascular disease, and autoimmune diseases. The occurrence of atopic disease, for example, asthma and anaphylaxis, is also affected by vitamin D. Furthermore, epidemiological studies showed that serum 25 (OH)2D3 levels are linked to allergic rhinitis, and supplementing vitamin D in infancy increased the incidence of allergic rhinitis later. Vitamin D binds to the vitamin D receptors (VDR) and then exerts biological activities, regulating differentiation process of T helper cell and Th cytokine. Vitamin D receptors (VDR) are steroid thyroid of nuclear receptors which can be found in various cells like airway epithelial and immune cells. Dysregulation of the VDR contributes to increase prevalence of some autoimmune diseases such as Hashimoto’s thyroiditis. In animal study, mice deficient in VDR failed to make experimental allergic asthma. These results suggest that VDR are related to Th2 cell me-","PeriodicalId":33935,"journal":{"name":"Journal of Rhinology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44671434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Yi, J. Sim, Jae Hyuk Choi, N. Choi, Jeong Hong Kim
There are many causes of nasal septal perforation (NSP) including nasal surgery, trauma, cauterization, nasal packing, vasculitis, and nasal drug abuse. Infectious and inflammatory processes, such as Wegener’s granulomatosis, collagen vascular disease, tuberculosis and syphilis could also cause NSP. Among them, nasal surgery including septoplasty and rhinoplasty is the most common cause of NSP. It is associated with nasal obstruction, crusting, rhinorrhea, recurrent epistaxis, whistling sound, parosmia, and neuralgia which result in poor quality of life. NSP is formed when both side mucoperichondriums of nasal septum are loss and blood supply is disrupted. Therefore, condition of mucosa, cartilage, and blood supply of nasal cavity should be considered when repair of NSP. Various surgical techniques have been introduced to repair the NSP depending on the size of perforation and condition of mucosa and cartilage. Small (less than 0.5 cm) and medium size (0.5 to 2 cm) defects could be closed endonasally by free mucosal graft or advancement flap with or without interposition graft including autologous and allograft. Inferior turbinate free mucosal graft demonstrated satisfiable results with a success rate between 83% and 88% in case of small perforation, but it is difficult to fix to the correct perforation site and its bulk could cause nasal obstruction. Mucosal advance flap usually requires the wide dissection extent of septal mucosa which could result in delayed healing and time spending. Rotational mucosal flap with inferior turbinate is the most popular and effective technique for small to medium size perforation, but symptomatic perforations usually too anterior to reach the inferior turbinate rotational flap. In addition, inferior turbinate rotational flap could cause intranasal adhesions between the septum and turbinate and nasal obstruction due to flap bulk. To overcome those disadvantages, we tried to perform the turbinate free mucosal graft with bioscaffold (Lyoplant, pISSN 1229-1498 / eISSN 2384-4361
{"title":"Endonasal Septal Perforation Repair: Free Mucosal Graft With Lyoplant® Bioscaffold","authors":"H. Yi, J. Sim, Jae Hyuk Choi, N. Choi, Jeong Hong Kim","doi":"10.18787/jr.2021.00356","DOIUrl":"https://doi.org/10.18787/jr.2021.00356","url":null,"abstract":"There are many causes of nasal septal perforation (NSP) including nasal surgery, trauma, cauterization, nasal packing, vasculitis, and nasal drug abuse. Infectious and inflammatory processes, such as Wegener’s granulomatosis, collagen vascular disease, tuberculosis and syphilis could also cause NSP. Among them, nasal surgery including septoplasty and rhinoplasty is the most common cause of NSP. It is associated with nasal obstruction, crusting, rhinorrhea, recurrent epistaxis, whistling sound, parosmia, and neuralgia which result in poor quality of life. NSP is formed when both side mucoperichondriums of nasal septum are loss and blood supply is disrupted. Therefore, condition of mucosa, cartilage, and blood supply of nasal cavity should be considered when repair of NSP. Various surgical techniques have been introduced to repair the NSP depending on the size of perforation and condition of mucosa and cartilage. Small (less than 0.5 cm) and medium size (0.5 to 2 cm) defects could be closed endonasally by free mucosal graft or advancement flap with or without interposition graft including autologous and allograft. Inferior turbinate free mucosal graft demonstrated satisfiable results with a success rate between 83% and 88% in case of small perforation, but it is difficult to fix to the correct perforation site and its bulk could cause nasal obstruction. Mucosal advance flap usually requires the wide dissection extent of septal mucosa which could result in delayed healing and time spending. Rotational mucosal flap with inferior turbinate is the most popular and effective technique for small to medium size perforation, but symptomatic perforations usually too anterior to reach the inferior turbinate rotational flap. In addition, inferior turbinate rotational flap could cause intranasal adhesions between the septum and turbinate and nasal obstruction due to flap bulk. To overcome those disadvantages, we tried to perform the turbinate free mucosal graft with bioscaffold (Lyoplant, pISSN 1229-1498 / eISSN 2384-4361","PeriodicalId":33935,"journal":{"name":"Journal of Rhinology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45681233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Exhaled nitric oxide (eNO) from the lower respiratory tract is used commonly in diagnosis and treatment monitoring of asthma patients. However, nasal nitric oxide (nNO) has not been widely used in patients with upper airway inflammatory diseases due to its lack of standardized measurement methods. Nasal nitric oxide is produced mainly by the paranasal sinus mucosa and partially by the nasal mucosa and increases with inflammation. Nasal nitric oxide not only locally supports the defensive mechanism of the upper respiratory tract, but also remotely controls pulmonary function by acting as an aerocrine. Nasal NO can be affected by various physiologic and pathologic factors of the upper respiratory tract. This article will review the origin of nNO, its function, various measurement methods, and difference in presentation among upper respiratory tract inflammatory diseases such as allergic rhinitis, upper respiratory tract infection, nasal polyp, rhinosinusitis, primary ciliary dyskinesia, cystic fibrosis, Young’s syndrome, diffuse panbronchiolitis, empty nose syndrome, and obstructive sleep apnea. Future studies should identify the mechanism of action of nNO in various upper respiratory tract inflammatory diseases and obtain highly reproducible normal values of nNO based on a standardized measurement method with a deeper understanding of factors affecting nNO. Then, nNO will be useful for more rapid and simpler diagnosis of various upper respiratory tract diseases and for monitoring their treatment.
{"title":"Nasal Nitric Oxide in the Upper Airway Inflammatory Diseases","authors":"Jin Hyeok Jeong","doi":"10.18787/jr.2021.00361","DOIUrl":"https://doi.org/10.18787/jr.2021.00361","url":null,"abstract":"Exhaled nitric oxide (eNO) from the lower respiratory tract is used commonly in diagnosis and treatment monitoring of asthma patients. However, nasal nitric oxide (nNO) has not been widely used in patients with upper airway inflammatory diseases due to its lack of standardized measurement methods. Nasal nitric oxide is produced mainly by the paranasal sinus mucosa and partially by the nasal mucosa and increases with inflammation. Nasal nitric oxide not only locally supports the defensive mechanism of the upper respiratory tract, but also remotely controls pulmonary function by acting as an aerocrine. Nasal NO can be affected by various physiologic and pathologic factors of the upper respiratory tract. This article will review the origin of nNO, its function, various measurement methods, and difference in presentation among upper respiratory tract inflammatory diseases such as allergic rhinitis, upper respiratory tract infection, nasal polyp, rhinosinusitis, primary ciliary dyskinesia, cystic fibrosis, Young’s syndrome, diffuse panbronchiolitis, empty nose syndrome, and obstructive sleep apnea. Future studies should identify the mechanism of action of nNO in various upper respiratory tract inflammatory diseases and obtain highly reproducible normal values of nNO based on a standardized measurement method with a deeper understanding of factors affecting nNO. Then, nNO will be useful for more rapid and simpler diagnosis of various upper respiratory tract diseases and for monitoring their treatment.","PeriodicalId":33935,"journal":{"name":"Journal of Rhinology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48211126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Schwannoma is a benign solitary neoplasm emerging from the Schwann cells of the peripheral, cranial and autonomic nerves. Approximately 25 to 45% of schwannomas occur in the head and neck region. However, schwannoma in the subfrontal area, nasal cavity or paranasal sinus is very rare and accounts for only 4% of these neoplasms. We experienced a case of schwannoma in the subfrontal area and left nasal cavity in a 74-year-old man who complained of recurrent rhinorrhea. We report this unusual case of schwannoma with a review of the literature.
{"title":"A Case of Schwannoma in Subfrontal Area and Nasal Cavity","authors":"Nam Yoon Jung, J. Heo, Song-Hee Han, W. Bae","doi":"10.18787/jr.2021.00354","DOIUrl":"https://doi.org/10.18787/jr.2021.00354","url":null,"abstract":"Schwannoma is a benign solitary neoplasm emerging from the Schwann cells of the peripheral, cranial and autonomic nerves. Approximately 25 to 45% of schwannomas occur in the head and neck region. However, schwannoma in the subfrontal area, nasal cavity or paranasal sinus is very rare and accounts for only 4% of these neoplasms. We experienced a case of schwannoma in the subfrontal area and left nasal cavity in a 74-year-old man who complained of recurrent rhinorrhea. We report this unusual case of schwannoma with a review of the literature.","PeriodicalId":33935,"journal":{"name":"Journal of Rhinology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44043951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Objectives: Positive airway pressure (PAP) is effective at reducing the number of complications in patients with obstructive sleep apnea (OSA). To the best of our knowledge, no cost-effectiveness analysis of PAP has been conducted in Korea. Subjects and Method: We classified subjects into two groups, those with moderate-to-severe OSA who used PAP after polysomnography (PAP treatment group) and those who did not receive a diagnosis and treatment (control group), and compared their medical expenses over a period of 10 years. The incidence rate of common complications and accidents (coronary heart disease, heart failure, stroke, depression, diabetes, vehicular accidents, and work-related accidents) with or without PAP was adopted through a literature review. The average medical expenses for treating each complication and accident were found by searching several databases. The analysis consisted of a payer’s perspective and a societal perspective. Results: The incidence of all complications was higher in the control group than in the PAP treatment group. However, since the absolute incidence rate was not high in either group and medical expenses in Korea are low, the expected treatment cost was not high. In contrast, the PAP rental fee was relatively high. To obtain 1 unit of disability-adjusted life year, it costs 40,873,288 won from the payer’s perspective and 31,791,810 won from the societal perspective. Conclusion: PAP treatment reduces patient complications and extends their lifespan, but costs must be considered.
{"title":"Cost-Effectiveness Analysis of Positive Airway Pressure in Patient with Obstructive Sleep Apnea","authors":"Hansol Kim, J. K. Kim, J. Cho","doi":"10.18787/jr.2021.00357","DOIUrl":"https://doi.org/10.18787/jr.2021.00357","url":null,"abstract":"Background and Objectives: Positive airway pressure (PAP) is effective at reducing the number of complications in patients with obstructive sleep apnea (OSA). To the best of our knowledge, no cost-effectiveness analysis of PAP has been conducted in Korea. Subjects and Method: We classified subjects into two groups, those with moderate-to-severe OSA who used PAP after polysomnography (PAP treatment group) and those who did not receive a diagnosis and treatment (control group), and compared their medical expenses over a period of 10 years. The incidence rate of common complications and accidents (coronary heart disease, heart failure, stroke, depression, diabetes, vehicular accidents, and work-related accidents) with or without PAP was adopted through a literature review. The average medical expenses for treating each complication and accident were found by searching several databases. The analysis consisted of a payer’s perspective and a societal perspective. Results: The incidence of all complications was higher in the control group than in the PAP treatment group. However, since the absolute incidence rate was not high in either group and medical expenses in Korea are low, the expected treatment cost was not high. In contrast, the PAP rental fee was relatively high. To obtain 1 unit of disability-adjusted life year, it costs 40,873,288 won from the payer’s perspective and 31,791,810 won from the societal perspective. Conclusion: PAP treatment reduces patient complications and extends their lifespan, but costs must be considered.","PeriodicalId":33935,"journal":{"name":"Journal of Rhinology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43954571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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