Journal of Rhinology最新文献

Background and objectives: Although positive airway pressure (PAP) is known to be more effective than uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea (OSA), PAP is a more expensive treatment in Korea. Therefore, it is necessary to compare the cost-effectiveness of these two treatments.

Methods: We assumed patients with moderate to severe OSA and divided them into three groups: those who used PAP (the PAP Treatment group), those who received UPPP (surgery group), and those who did not receive a diagnosis or treatment (No Treatment group). We compared their medical costs over 10 years. The incidence rate of common complications and accidents (coronary heart disease, heart failure, stroke, depression, diabetes, vehicle accident, and work-related accident) with or without treatment was adopted through a literature review. The average medical expenses for treating each complication and accident were also found by searching several databases.

Results: The incidence of all complications was higher in the control group than in the PAP Treatment group or the surgery group. However, since the absolute incidence rate was not high in all groups and medical expenses in Korea are low, the expected treatment cost was not high (KRW 108,209 per year for the PAP Treatment group, KRW 141,228 for the surgery group, and KRW 178,369 for the No Treatment group). In contrast, the costs of a polysomnography examination, PAP rental, and mask purchase were relatively high. Based on these results, the 10-year medical expenses for the PAP Treatment group were KRW 10,246,948, and those for the surgery were only KRW 925,095.

Conclusion: Although PAP treatment reduces the incidence of complications in OSA patients, it is not as cost-effective as UPPP in Korea, where medical costs are low.

Background and objectives: Epistaxis is one of the most common emergencies in otolaryngology, and the recently developed Rapid Rhino nasal pack, a balloon-type nasal packing device, is widely used in emergency departments. Rebleeding after initial treatment increases patients' discomfort and medical costs. The aim of this study was to investigate risk factors for rebleeding in patients treated with Rapid Rhino packing.

Methods: In this retrospective study, 93 patients with epistaxis treated with Rapid Rhino from January 2020 to November 2022 were divided into the well-controlled group (39 patients) and the rebleeding group (54 patients), and the baseline characteristics, management methods, and complications were compared between these groups. The rebleeding group was divided according to whether patients experienced a single episode of rebleeding (38 patients) or multiple rebleeding episodes (16 patients), and the differences between these two groups were compared.

Results: Oral anticoagulation therapy was associated with a higher risk of rebleeding after Rapid Rhino packing (odds ratio [OR]=8.41, p=0.047). A history of nasal surgery was associated with multiple rebleeding (OR=22.55, p=0.009). Age, sex, the management method, complications, and the site of bleeding were not found to be related to rebleeding.

Conclusion: Patients with rebleeding after Rapid Rhino nasal packing had a higher rate of concurrent oral anticoagulation therapy. A history of nasal surgery was strongly associated with multiple episodes of rebleeding. A detailed medical history can be important for assessing the risk of rebleeding in epistaxis patients treated with Rapid Rhino packing.

Background and objectives: The purpose of this study was to conduct a meta-analysis of the effects of intraoperative pharyngeal packing on postoperative nausea, vomiting, and sore throat in nasal surgery patients.

Methods: Databases were searched from inception to December 2022. Randomized controlled trials comparing saline-soaked pharyngeal packing (packing group) with no packing (control group) during intubation in patients undergoing nasal surgery were included. The primary outcomes of interest were the incidence of postoperative nausea, vomiting, and sore throat at 24 hours.

Results: Eleven studies, including a total of 931 patients, were included. There was no significant difference between the two groups in the incidence of postoperative nausea and vomiting and severity scores at 2, 6, and 24 hours postoperatively. The incidence of throat pain was higher in the packing group than in the control group immediately after surgery and at 24 hours postoperatively. However, no significant difference was observed between the two groups in the incidence of sore throat at 6 and 12 hours postoperatively.

Conclusion: Intraoperative saline-soaked pharyngeal packing did not significantly decrease postoperative nausea and vomiting. However, the use of pharyngeal packing was associated with a higher incidence of sore throat in the initial recovery period.

IgG4-related disease (IgG4-RD) is a systemic inflammatory disease characterized by IgG4-positive plasma cell and T lymphocyte infiltration of multiple organs. It commonly involves the pancreas, lacrimal glands, and salivary glands, and it has been rarely reported in the sinonasal cavity. We herein report the case of a 47-year-old male patient whose chief complaint was decreased visual acuity. A tumefactive mass was found on imaging studies, originating from the sinonasal cavity and invading the orbit, kidney, and meninges. The mass was resected through endoscopic sinus surgery and was pathologically confirmed to be IgG4-RD. The patient was treated with steroid therapy and showed clinical improvement.

A dog bite is the most common trauma among animal bites, and it has varying severity, from simple skin lacerations to defects in whole tissue layers. Considering the aesthetic and functional importance of the nose, an appropriate reconstruction should be conducted for large and full-thickness tissue defects. Although this is quite common, literature detailing surgical reconstruction is lacking, especially in domestic journals. A 45-year-old male patient visited an outpatient clinic due to nasal trauma caused by a dog bite. The patient's nose showed whole-layer tissue defects, with necrotic tissues at the periphery. Nasal reconstruction surgery was conducted using a forehead flap and ear cartilage composite graft. Pedicle division was conducted three weeks after primary surgery. The functional and aesthetic outcomes of the surgery were satisfactory. Our experience demonstrates that the forehead flap is a useful option for reconstructing a nose badly injured by a dog bite.

Background and objectives: We compared pain levels, cardiovascular parameters, and complications according to whether patients underwent nasal packing with non-absorbable or biodegradable materials.

Methods: Patients who underwent septoplasty from May 2015 to April 2020 were retrospectively reviewed. Numeric rating scale (NRS) scores for pain, blood pressure, and heart rate were measured three times (immediately after surgery, 6 hours later, and on postoperative day [POD] 1). We collected data on complications, including postoperative bleeding, septal hematoma, adhesions, septal perforation, and the recurrence of septal deviation.

Results: In total, 200 patients underwent septoplasty, of whom 100 underwent nasal packing with Merocel and 100 underwent packing with Nasopore. The summed NRS scores over the three time points did not differ significantly between the groups. The NRS scores at 6 hours after surgery were highest in both groups. The systolic and diastolic blood pressure and the heart rate immediately after surgery were significantly higher than before surgery in both groups. The blood pressure and heart rate at 6 hours after surgery and on POD 1 did not differ significantly from those before surgery in either group. The incidence of sleep disturbance, postoperative bleeding, septal hematoma, adhesions, septal perforation, and recurrence of septal deviation did not differ significantly between the two groups.

Conclusion: Although the level of postoperative pain and the cardiovascular parameters changed over time, we found no significant differences in pain, blood pressure, heart rate, or the complication rate according to whether patients underwent nasal packing with Nasopore or Merocel.

Guillain-Barré syndrome (GBS) is an autoimmune disease that is generally preceded by an infection. Its typical symptoms are progressive symmetric paresis and an absence of deep tendon reflexes. GBS could be a life-threatening condition due to the paralysis of respiratory muscles, and admission to the intensive care unit should be considered for close monitoring. Intravenous immunoglobulin can improve the course of the disease. Postoperative GBS is most likely to occur after gastrointestinal, cardiac, thoracic, neurological, or orthopedic surgery, as well as surgery in the female reproductive tract. The duration of surgery, age, infectious diseases, preexisting autoimmune diseases, and malignant diseases are associated with postoperative GBS. Patients with these factors have a higher risk of postoperative GBS and therefore require precautions to be taken after surgery. We report a case of 53-year-old woman who had experienced GBS after Nasal surgery preceded by gastrointestinal infection and treated by intravenous immunoglobulin.

Obstructive sleep apnea (OSA) is a relatively common sleep disorder characterized by repetitive narrowing or obstruction of the upper airway, including the nasal cavity, pharynx, and larynx, during sleep. OSA can cause a variety of symptoms and/or complications, such as excessive daytime sleepiness, reduced concentration, hypertension, type II diabetes, and stroke. Accordingly, an accurate diagnosis and appropriate treatments are required for OSA. Obesity is an important risk factor for OSA and is characterized by the abnormal accumulation of fat in the body, including the upper airway. When the body weight increases, adipose tissue accumulates in the pharynx, which can narrow the diameter of the upper airway and lead to dysfunction of the pharynx dilator muscles. These changes caused by weight gain can cause or exacerbate OSA. Various therapeutic options exist for patients with overweight or obesity, including diet, behavioral modifications, exercise, pharmacological treatments, and surgical procedures. Of these, diet, behavioral modifications, and exercise constitute the first-line management for obesity. However, their results are relatively unsatisfactory, and pharmacotherapy and bariatric surgery are generally implemented in obese patients with OSA. Therefore, the purpose of this paper is to review pharmacological and surgical management strategies for obesity that are currently commonly used in overweight or obese adult patients with OSA.

Foreign bodies pose a diagnostic challenge to clinicians, and nasal foreign bodies have the potential to lead to significant morbidity. Although foreign bodies in the nasal cavity are a commonly encountered problem in pediatric patients, a foreign body in the nasal cavity not associated with a trauma history is rare in adults. We recently experienced a 35-year-old man who presented with a foreign body in his right nasal cavity and anterior tooth pain. He was not sure what the material was, and we were not able to confirm the material type preoperatively. However, we found that a very large and thick material was impacted and totally obstructed the right anterior nasal cavity. We surgically removed it as a bone block and confirmed postoperatively that the material was glass. This case provided several lessons, and we would like to share our experience.

Positive airway pressure (PAP) therapy is known to be an effective treatment for obstructive sleep apnea (OSA) that does not generally have serious complications. However, pneumothorax following lung barotrauma with the use of PAP has rarely been reported. We recently experienced the case of a 72-year old male patient with chronic obstructive pulmonary disease who developed pneumothorax after the use of automatic PAP (APAP). After 4 months of APAP use with a pressure of 4-8 cm H₂O, he complained of sudden severe dyspnea at midnight. He eventually underwent surgical repair for pneumothorax. After 4 months, continuous PAP with low pressure of 5 cm H₂O was applied without any complications. In summary, we emphasize the risk of barotrauma when PAP is used by OSA patients with lung disease.