Journal of Rhinology最新文献

Background and objectives: Natural killer T-cell lymphoma (NKTCL) and diffuse large B-cell lymphoma (DLBCL) are the two most prevalent subtypes of lymphoma in the sinonasal region. Accurately differentiating between sinonasal DLBCL and NKTCL is crucial for determining the appropriate treatment and prognosis. The present study compared the clinical characteristics of these two conditions.

Methods: We conducted a retrospective review of 173 patients diagnosed with sinonasal lymphoma at a single institute between 2004 and 2017. This review included only patients with DLBCL and NKTCL who had more than 6 months of follow-up records. We analyzed patient data encompassing clinical characteristics, pathologic findings, radiologic findings, treatment modalities, recurrence, and survival.

Results: Among the patients analyzed, 117 patients were diagnosed with NKTCL and 45 with DLBCL. Endoscopic evaluation revealed a significantly higher incidence of crusting (p<0.001) and necrotic lesions (p=0.001) in patients with NKTCL, whereas polypoid masses were more commonly observed in patients with DLBCL (p<0.001). Computed tomography (CT) scans indicated no significant differences in bilaterality or bone destruction between the two groups. The DLBCL group exhibited a higher rate of concurrent lymph node or organ involvement than the NKTCL group (p<0.001). The 5-year overall survival rate was 67.4% for DLBCL and 69.1% for NKTCL, with no significant difference between the two.

Conclusion: Clinical differences exist between sinonasal DLBCL and NKTCL in terms of endoscopic and CT findings. These distinct characteristics can aid in distinguishing between the two types of sinonasal lymphoma during clinical diagnosis.

Background and objectives: The serum galactomannan test (GM test) and the (1,3)-β-D-glucan test (G test) are utilized in diagnosing invasive fungal sinusitis. However, their effectiveness in detecting paranasal sinus fungus balls (FBs) has not been established. This study aimed to explore their diagnostic value in patients with FBs.

Methods: We retrospectively reviewed the medical records of 105 patients (42 with FBs and 63 with chronic rhinosinusitis [CRS]) who underwent serum GM and G tests between June 2020 and May 2021. Olfactory test results and demographics were also analyzed.

Results: There were 42 FB patients (10 men, 32 women) and 63 CRS patients (27 men, 36 women). The positivity rates for serum GM (7.1% in the FB group vs. 3.2% in the CRS group, p=0.640) and G test (9.5% in the FB group vs. 11.1% in the CRS group, p=0.482) did not differ significantly between groups. The sensitivities of the GM and G tests were 7.1% and 9.5%, respectively, and their specificities were 96.8% and 88.9%, respectively. The positive predictive values were 60.0% for the GM test and 36.3% for the G test, and the negative predictive values were 61.0% for the GM test and 59.6% for the G test.

Conclusion: Serum GM and G tests demonstrated low sensitivity and high specificity, indicating limited effectiveness in differentiating between patients with FBs and those with CRS. Histological examination remains the gold standard for the definitive diagnosis of FBs.

Background and objectives: The present study evaluated the efficacy of cryoablation of the posterior nasal nerve in alleviating symptoms associated with chronic rhinitis.

Methods: A systematic review of pertinent literature sourced from PubMed, Scopus, Embase, Web of Science, and Cochrane databases was conducted through May 2024. The analysis focused on studies that appraised changes in quality of life and rhinitis-associated symptomatology before and after cryoablation treatment.

Results: A total of seven studies (495 patients) were included in the analysis. Significant improvements in rhinitis-related symptoms were observed in patients undergoing cryoablation, irrespective of etiology (allergic or nonallergic rhinitis). Furthermore, cryoablation yielded improvements in disease-specific quality of life, as measured by the Rhinoconjunctivitis Quality of Life Questionnaire. Notably, a clinically significant reduction (≥30% decrease from baseline) in total nasal symptomatology was noted in 71% of cases following cryoablation. Regarding the incidence of adverse effects, nasal dryness, epistaxis, ocular symptoms, and palatal numbness occurred in <5% of patients, while postoperative pain occurred in 10% and headache in 20% of patients who underwent treatment. In subtype analysis, the total nasal symptom score in nonallergic rhinitis showed a significantly increasing pattern over time (p=0.0017).

Conclusion: Cryoablation of the posterior nasal nerve appears to yield a decrease in subjective nasal symptom scores and an improvement in disease-specific quality of life. Notably, these effects persisted for up to 12 months post-treatment, with marked improvements observed in both allergic and nonallergic rhinitis subtypes.

A hamartoma is a benign tumor that arises from the disorganized proliferation of tissue and can occur anywhere in the body. Hamartomas are notably found in the lung, skin, heart, brain, and breast, while their occurrence in the head and neck is rare. We describe a case involving a 17-year-old male patient who presented with a mass in a unilateral palatine tonsil, discovered incidentally. The patient was treated with tonsillectomy and, after pathological review, was diagnosed with a hamartomatous polyp of the palatine tonsil. Our case report highlights this rare benign neoplasm and presents a review of the literature.

Chronic rhinosinusitis (CRS) is characterized by prolonged inflammation of the nasal and paranasal sinus mucosa lasting over 12 weeks. CRS is divided into two main types based on the presence of nasal polyps: CRS without nasal polyps and CRS with nasal polyps. The condition is further classified into endotypes based on type 1, type 2, and type 3 inflammatory signatures, with differences in terms of disease severity, prognosis, and treatment response. Recent studies have emphasized the importance of the epithelial-mesenchymal transition (EMT) in CRS progression. In CRS, the EMT can be triggered by infections, allergens, hypoxia, and environmental pollutants. Specifically, EMT induction proceeds through the following mechanisms: viral and bacterial infections disrupt the epithelial barrier, house dust mites and other allergens activate the TGF-β and EGFR signaling pathways, hypoxia increases HIF-1α and other mesenchymal markers, and diesel exhaust particles and particulate matter cause oxidative stress. Maintaining the integrity of the epithelial barrier is essential for nasal mucosa homeostasis. In CRS, barrier damage activates repair processes that trigger the EMT, resulting in barrier dysfunction and tissue remodeling. Epithelial barrier dysfunction allows antigens and pathogens to penetrate, perpetuating inflammation and promoting the EMT. This disruption is a hallmark of CRS, emphasizing the importance of barrier integrity in the development of the disease. Key signaling pathways regulating the EMT in CRS include TGF-β, Wnt, HMGB1, AGE/ERK, TNF-α, and various miRNAs. These signaling pathways connect to various downstream pathways, such as the Smad2/3, GSK-3β/β-catenin, RAGE, and NF-κB pathways. This review focuses on the complex mechanisms of the EMT in CRS, emphasizing the role of epithelial barrier dysfunction and subsequent EMT processes in driving the disease's development and progression. A deeper understanding of these EMT-driven mechanisms will help identify the potential therapeutic targets aimed at restoring epithelial integrity and reversing the EMT.

Background and objectives: Air pollution, particularly particulate matter (PM), has a variety of adverse effects on human health. PM is known to induce cell death through various pathways, including pyroptosis. Despite its significance, research on PM-induced pyroptosis in nasal epithelial cells remains limited. This study aimed to explore PM-induced pyroptosis in cultured human nasal epithelial cells.

Methods: For the in vitro experiments, human nasal epithelial cells were cultured. Cell viability was assessed using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, while cell death was evaluated through propidium iodide (PI) staining and lactate dehydrogenase (LDH) release measurement. Protein expression levels related to pyroptosis were examined via western blot using antibodies against NOD-like receptor family, pyrin domain containing 3 (NLRP3), cleaved caspase-1 (CASP1 P20), gasdermin D (GSDMD)-N, and glyceraldehyde phosphate dehydrogenase. Immunofluorescent staining with a CASP1 P20 antibody was conducted to visualize cellular localization. Enzyme-linked immunosorbent assay was utilized to quantify interleukin (IL)-1β and IL-18 protein levels.

Results: Treatment with PM resulted in decreased cell viability, elevated LDH release, and intensified PI staining, indicating cell death. Pyroptosis was confirmed by the elevated expression of NLRP3, CASP1 P20, and GSDMD-N, along with increased levels of IL-1β and IL-18. Inhibiting the NLRP3 inflammasome with MCC950 reduced the PM-induced effects on protein expression and cytokine release, highlighting the role of the NLRP3 inflammasome in PM-triggered pyroptosis in human nasal epithelial cells.

Conclusion: We showed that PM triggers pyroptosis in human nasal epithelial cells, driven by NLRP3 inflammasome-dependent signaling pathways.

Background and objectives: This study aimed to evaluate the factors that influence deep sleep restoration in patients with obstructive sleep apnea (OSA) following positive airway pressure (PAP) therapy.

Methods: In total, 363 patients diagnosed with OSA who received PAP therapy over at least 3 months were enrolled in the study. Polysomnographic parameters, anatomical characteristics, and subjective sleep-related parameters were evaluated according to the presence of daytime sleepiness and morning headache before and after 3 months of PAP treatment.

Results: Age was significantly different according to whether excessive daytime sleepiness (EDS) was alleviated (average: 49.35 years) or persisted (average: 52.82 years) (p=0.001). Age was also significantly associated with morning headache (p=0.037). Body mass index (BMI) was higher in the alleviated EDS group (28.70 kg/m²) than in the persistent EDS group (27.13 kg/m²; p=0.002). The apnea-hypopnea index (AHI) was correlated with the EDS outcome (p=0.011). The group with alleviated EDS had a longer mandibular plane to hyoid distance (MPH) than the group with persistent EDS (17.95 mm vs. 15.38 mm; p<0.001). However, BMI, AHI, and MPH showed no significant associations with morning headache. Epworth Sleepiness Scale scores were higher in the alleviated EDS and alleviated morning headache groups (EDS: p<0.001, morning headache: p=0.001). Self-Efficacy Measure for Sleep Apnea (SEMSA) values differed significantly between the EDS groups (p<0.001), but not between the morning headache groups (p=0.122). After 3 months of PAP therapy, the MPH was negatively correlated with EDS in univariate (odds ratio [OR]=0.921, p<0.001) and multivariate analyses (OR=0.937, p=0.028). The SEMSA score was also negatively correlated with EDS in univariate (OR=0.961, p<0.001) and multivariate (OR=0.973, p=0.019) analyses.

Conclusion: Age, polysomnographic metrics, and anatomical considerations were important for sleep quality-associated daytime symptoms. In addition, anatomical characteristics and the patient's self-efficacy were significantly associated with the effect of PAP treatment on sleep quality.

Background and objectives: Various ear, nose, and throat (ENT) conditions can result in vision loss. The purpose of this study is to identify the etiologies, presentations, and radiological findings associated with impaired vision in the context of ENT. Additionally, this article discusses management protocols, including optic nerve decompression and orbital decompression.

Methods: In a retrospective study, we examined the period from 2016 to 2022 at a tertiary care hospital in Mumbai, India. The analysis included 11 patients who presented with progressive diminution of vision. All patients received a regimen of broad-spectrum intravenous antibiotics and high-dose intravenous steroids. This was followed by either endoscopic optic nerve decompression or orbital decompression. Subsequent improvements in vision were documented, and any complications were evaluated.

Results: A total of 11 patients were treated with medical management followed by successful surgery, with 10 patients demonstrating significant vision improvement.

Conclusion: Identifying the etiology of vision loss and managing the condition can present challenges for otorhinolaryngologists. A thorough grasp of the underlying pathophysiology, combined with active surveillance of clinical and radiological indicators, can enable these clinicians to achieve effective and rewarding outcomes.

While primarily observed in adults, this case contributes valuable insights into the manifestation and management of this benign salivary gland tumor within the pediatric population. This paper reports the first documented case of sinonasal pleomorphic adenoma in pediatric otolaryngology, presenting a unique perspective on this rare nasal tumor in a 9-year-old boy. The patient presented with progressive nasal obstruction and epistaxis and underwent a smooth endoscopic resection of a 2-cm pleomorphic adenoma on the right anterior nasal septum. The subsequent discussion covered background, histology, imaging, and management strategies. Surgical removal with clear margins, particularly through the endoscopic approach, emerged as the primary and successful treatment method, minimizing morbidity and reducing recurrence risk. Long-term clinical surveillance is recommended due to an estimated 8.8% recurrence rate. In conclusion, this paper explains the challenges and solutions in diagnosing and treating sinonasal pleomorphic adenomas in children. It emphasizes the critical importance of early diagnosis, precise surgical intervention, and continuous monitoring, which are essential for achieving optimal patient outcomes.

Sinus mucoceles are nonmalignant cystic tumors lined by non-neoplastic epithelium, typically involving the frontal and ethmoid sinuses. Although it is common for these mucoceles to cause destruction of surrounding bone tissue due to their growth, cerebrospinal fluid leaks resulting from skull base penetration by an ethmoid sinus mucocele have rarely been reported. A 24-year-old male patient presented with right proptosis and right periorbital pain, who underwent bilateral endoscopic sinus surgery 12 years ago. Endoscopic sinus surgery was performed to treat the right ethmoid sinus mucocele, and confirmed the presence of a basal skull defect during surgery. We reconstructed the skull base defect using septal cartialge and free mucosal graft. The symptoms were completely resolved after surgery and no cerebrospinal fluid leakage was noted during follow up period. This case report highlights a rare instance of direct mucocele extension to the skull base.