• Imaging Science in Dentistry
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• v.50 no.4
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• pp.299-307
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• 2020

Purpose: The diagnosis of chronic rhinosinusitis requires a comprehensive knowledge of the signs and symptoms of the disease and an accurate radiographic assessment. Computed tomography (CT) is the superior imaging modality for diagnosis of chronic rhinosinusitis. However, considering the lower dose and higher resolution of cone-beam computed tomography (CBCT) compared to CT, this study aimed to assess the agreement between the findings of CBCT and functional endoscopic sinus surgery (FESS). Materials and Methods: This descriptive prospective study evaluated 49 patients with treatment-resistant chronic rhinosinusitis who were candidates for FESS. Preoperative CBCT scans were obtained before patients underwent FESS. The agreement between the CBCT findings and those of FESS was determined using the kappa correlation coefficient. The frequency of anatomical variations of the paranasal sinuses was also evaluated on CBCT scans. Results: Significant agreement existed between pathological findings on CBCT scans and those of FESS, such that the kappa correlation coefficient was 1 for mucosal thickening, 0.644 for nasal deviation, 0.750 for concha bullosa, 0.918 for nasal polyp, 0.935 for ostiomeatal complex (OMC) obstruction, and 0.552 for infundibulum thickening. Furthermore, 95.9% of patients had 1 or more and 79.6% had 2 or more anatomical variations, of which nasal deviation was the most common (67.3%). Conclusion: Considering the significant agreement between the findings of CBCT and FESS for the detection of pathological changes in the paranasal sinuses, CBCT can be used prior to FESS to detect chronic rhinosinusitis and to assess anatomical variations of the OMC.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.16 no.1
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• pp.191-197
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• 2003

Maxillary sinus retention cysts are probably common findings on PNS series. Many patients remain asymptomatic in the presence of these lesions, but a variety of local and systemic symptoms have been associated with them. A patient presented with symptoms of chronic rhinosinusitis had a finding of both maxillary sinus retention cysts on PNS series. He has taken the Gal-gen-tang and treated by acupunture & infra-red. After about 4 months' treatment, his symptoms resolved and PNS series were normal. In conclusion, Maxillary sinus retention cysts may become clinically important when they occur in the setting of symptoms compatible with chronic rhinosinusitis, or when the diagnosis is in doubt.

• The Journal of Pediatrics of Korean Medicine
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• v.32 no.3
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• pp.44-54
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• 2018

Objectives The purpose of this study is to analyze clinical studies on effectiveness of herbal medicine in rhinosinusitis. Methods We searched the randomized controlled trials (RCTs) with herbal medicine treatment on rhinosinusitis from the Pubmed in recent 10 years (from 2008 to 2018). Results 11 RCTs were reviewed. In 10 out of 11 studies showed that the herbal medicine may be effective in the treatment of chronic rhinosinusitis without nasal polyp and uncomplicated acute rhinosinusitis. However, inclusion and exclusion criteria, and outcome measures were varied among different studies. No serious adverse reactions were reported from the herbal medicine treatment. Conclusions The results of these trials showed that herbal medicine may be effective in the treatment of rhinosinusitis. Well-designed RCTs for domestic herbal medicine treatment on rhinosinusitis are needed to prove its efficacy clearly.

• Clinical and Experimental Pediatrics
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• v.56 no.7
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• pp.286-290
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• 2013

Purpose: Although chronic and recurrent rhinosinusitis is prevalent in children, little is known about its causes. Here, we investigated the humoral immunity in children with chronic or recurrent rhinosinusitis. Methods: We examined 16 children attending the outpatient clinic at the CHA Bundang Medical Center including 11 boys and 5 girls, aged 3-11 years (mean age, 5.6 years), who had rhinosinusitis for >3 months or >3 times per year. The complete blood count with differential and total serum concentrations of Immunoglobulin (Ig) E, IgA, IgD, IgM, IgG, and IgG subclasses ($IgG_1$, $IgG_2$, $IgG_3$, and $IgG_4$) of all children were measured. All subjects received 23-polysaccharide pneumococcal vaccination (PPV), and the levels of antibodies to 5 serologic types (4, 6B, 14, 18C, and 23F) of pneumococcal capsular polysaccharide antigens were measured before and after vaccination. Post-PPV antibody titers ${\geq}0.35{\mu}g/mL$ or with a ${\geq}4$-fold increase were considered as positive responses. Results: The titers of IgG, IgA, IgD, and IgM were within normal range in all 16 children, whereas the total IgE concentration was higher than normal in 2 children. $IgG_1$ deficiency was observed in 1 patient and $IgG_3$ deficiency in 3. After PPV, 1 patient failed to respond to all 5 serologic types, 2 failed to respond to 4 serologic types, and 2 failed to respond to 3 serologic types. Conclusion: Clinicians should consider the evaluation of humoral immune functions in children with chronic or recurrent rhinosinusitis who do not respond to prolonged antibiotic treatment.

• Molecules and Cells
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• v.45 no.6
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• pp.353-361
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• 2022

Chronic rhinosinusitis (CRS) is a multifactorial, heterogeneous disease characterized by persistent inflammation of the sinonasal mucosa and tissue remodeling, which can include basal/progenitor cell hyperplasia, goblet cell hyperplasia, squamous cell metaplasia, loss or dysfunction of ciliated cells, and increased matrix deposition. Repeated injuries can stimulate airway epithelial cells to produce inflammatory mediators that activate epithelial cells, immune cells, or the epithelial-mesenchymal trophic unit. This persistent inflammation can consequently induce aberrant tissue remodeling. However, the molecular mechanisms driving disease within the different molecular CRS subtypes remain inadequately characterized. Numerous secreted and cell surface proteins relevant to airway inflammation and remodeling are initially synthesized as inactive precursor proteins, including growth/differentiation factors and their associated receptors, enzymes, adhesion molecules, neuropeptides, and peptide hormones. Therefore, these precursor proteins require post-translational cleavage by proprotein convertases (PCs) to become fully functional. In this review, we summarize the roles of PCs in CRS-associated tissue remodeling and discuss the therapeutic potential of targeting PCs for CRS treatment.

• Molecules and Cells
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• v.42 no.4
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• pp.345-355
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• 2019

Eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP) is one of the most challenging problems in clinical rhinology. FZD5 is a receptor for Wnt5A, and its complex with Wnt5A contributes to activating inflammation and tissue modification. Nasal polyps and eosinophil/non-eosinophil counts are reported to be directly correlated. This study investigated the expression and distribution of FZD5, and the role of eosinophil infiltration and FZD5 in eosinophilic CRSwNP pathogenesis. The prognostic role of eosinophil levels was evaluated in seven patients with CRSwNP. Fifteen patients with CRS were classified based on the percentage of eosinophils in nasal polyp tissue. Methylated genes were detected using methylCpG-binding domain sequencing, and qRT-PCR and immunohistochemistry were used to detect FZD5 expression in nasal polyp tissue samples. The results showed that mRNA expression of FZD5 was upregulated in nasal polyps. FZD5 expression was significantly higher in nasal polyp samples from patients with eosinophilic CRSwNP than in those from patients with non-eosinophilic CRSwNP, as indicated by immunohistochemistry. Furthermore, inflammatory cytokine levels were higher in eosinophilic CRSwNP-derived epithelial cells than in normal tissues. In conclusion, FZD5 expression in nasal mucosal epithelial cells is correlated with inflammatory cells and might play a role in the pathogenesis of eosinophilic CRSwNP.

• BMB Reports
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• v.51 no.2
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• pp.59-64
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• 2018

The airway epithelium is the first place, where a defense mechanism is initiated against environmental stimuli. Mucociliary transport (MCT), which is the defense mechanism of the airway and the role of airway epithelium as mechanical barriers are essential in innate immunity. To maintain normal physiologic function, normal oxygenation is critical for the production of energy for optimal cellular functions. Several pathologic conditions are associated with a decrease in oxygen tension in airway epithelium and chronic sinusitis is one of the airway diseases, which is associated with the hypoxic condition, a potent inflammatory stimulant. We have observed the overexpression of the hypoxia-inducible factor 1 (HIF-1), an essential factor for oxygen homeostasis, in the epithelium of sinus mucosa in sinusitis patients. In a series of previous reports, we have found hypoxia-induced mucus hyperproduction, especially by MUC5AC hyperproduction, disruption of epithelial barrier function by the production of VEGF, and down-regulation of junctional proteins such as ZO-1 and E-cadherin. Furthermore, hypoxia-induced inflammation by HMGB1 translocation into the cytoplasm results in the release of IL-8 through a ROS-dependent mechanism in upper airway epithelium. In this mini-review, we briefly introduce and summarize current progress in the pathogenesis of sinusitis related to hypoxia. The investigation of hypoxia-related pathophysiology in airway epithelium will suggest new insights on airway inflammatory diseases, such as rhinosinusitis for clinical application and drug development.

• Journal of Rhinology
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• v.25 no.2
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• pp.63-68
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• 2018

Olfactory dysfunction is one of the most common complaints of patients with chronic rhinosinusitis. Patients who suffer from olfactory dysfunction report a negative effect on their overall quality of life. Chronic rhinosinusitis-related olfactory impairment is the most treatable form of olfactory disorder; however, outcomes after endoscopic sinus surgery (ESS) are challenging to predict. Previous studies have documented a wide range in overall improvement after ESS. The purpose of this study is to review the factors that predict changes in olfaction after ESS.

• Journal of Clinical Otolaryngology Head and Neck Surgery
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• v.29 no.2
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• pp.182-189
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• 2018

Background and Objectives : There were few literatures about the relationship between upper airway disorders and cardiovascular risk factors such as hypertension, although an association between impaired lower respiratory function and cardiovascular alterations was often reported. Our purpose was to assess the relationships between chronic sinusitis and hypertension. Materials and Methods : Three hundred subjects with bilateral chronic sinusitis who underwent functional endoscopic sinus surgery between 2015and 2017 were evaluated. Six hundred forty subjects without any nasal diseases were enrolled as a control group. Blood pressure and body mass index (BMI) were measured using a standardized method, and subjects were asked about current use of any antihypertensive medication, history of diabetes, smoking and alcohol drinking habits.Sinusitis group was assessed by nasal endoscopic examination, paranasal sinus CT scan and allergy test. Results : Average systolic and diastolic blood pressures were statistically significantly higher in subjects with sinusitis than control group. Chronic rhinosinusitis was associated with a 1.415-fold (95% confidence interval 1.053-1.930) increased hazard of hypertension after multivariate adjustment. Conclusions : These results suggest that sinusitis is associated with high blood pressure. Therefore patients with sinusitis may need special attention for blood pressure control. Further studies need to be performed to elucidate the pathogenesis behind such associations.

• Journal of the Korean Data and Information Science Society
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• v.28 no.4
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• pp.899-910
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• 2017

Nomogram is useful for predicting the prevalence of each patient through the scoring system without a complex formula. Because there are few studies on chronic otitis media (COM) in adults, this study aims to identify the relevant risk factors for COM in Korean adults and to build a nomogram for the risk factors. The Health Interview Survey data subset, derived from the Sixth Korean National Health and Nutrition Examination Survey (KNHANES VI), was used to evaluate the participants. Of the participants, the weighted prevalence of COM was 5.3%. Residence, earphone use, atopic dermatitis, allergic rhinitis, chronic rhinosinusitis, and subjective hearing status were identified as risk factors for COM. Using 6 risk factors, we propose a nomogram for COM, and use AUC to verify the discrimination of the nomogram.