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1.  Hematoxylin and Eosin Staining for Detecting Biofilms: Practical and Cost-Effective Methods for Predicting Worse Outcomes After Endoscopic Sinus Surgery 
Objectives
Although biofilms have been implicated in poor prognosis after endoscopic sinus surgery (ESS), traditional methods detecting biofilm such as scanning electron microscope and confocal scanning laser microscope were rarely used in the practice. The aims of this study was to determine whether the presence or absence of a biofilm detected by hematoxylin and eosin (H&E) staining followed by light microscopy (LM) that is widely used in daily practice, predicts surgical outcomes after ESS.
Methods
Retrospective analysis of prospectively collected data. Fifty-five consecutive adult patients (>18 years) who underwent ESS for chronic rhinosinusitis with a minimum of 12-months of follow-up were enrolled in this study. Random sinonasal mucosal samples were assessed for biofilm presence using H&E staining with LM. Three independent observers scored whether a biofilm was present or absent based on H&E staining/LM, and the interrater variability was calculated. Pre- and postoperative sinus symptoms and sinonasal mucosal grading were assessed.
Results
Biofilms were present in 28 patients (51%), and the intraclass correlation coefficient according to H&E staining/LM was 0.731. The presence of a biofilm was associated with a higher preoperative Lund-MacKay computed tomography score (22.3 for biofilm-positive patients vs. 18.6 for biofilm-negative patients; P=0.021) and persistent inflammation (mucosal edema and discharge) after ESS (P<0.05).
Conclusions
The presence or absence of a biofilm based on H&E staining/LM is correlated with disease severity and surgical outcomes after ESS. H&E staining/LM for detecting biofilm could be practical and cost-effective methods for predicting prognosis of ESS.
doi:10.3342/ceo.2014.7.3.193
PMCID: PMC4135155  PMID: 25177435
Biofilms; Chronic rhinosinusitis; Endoscopic sinus surgery; Hematoxylin-eosin staining; Light microscope; Nasendoscopy; Postsurgical outcomes
2.  The Efficacy of Preemptive Analgesia With Pregabalin in Septoplasty 
Objectives
Pregabalin is used to treat neuropathic pain and has shown analgesic properties in postoperative pain. The aim of this study was to investigate the effectiveness and safety of pregabalin in reducing postoperative pain in patients after septoplasty.
Methods
Forty-seven patients scheduled for elective septoplasty were randomly assigned to groups that received either pregabalin (150 mg) or placebo, both one hour before surgery and 12 hours after the initial dose. Pain (verbal numerical rating scale, VNRS) and side effect assessments were performed at 6, 12, 12 to 24, and 24 to 48 hours postoperatively.
Results
From 1 to 12 hours postoperatively, VNRS scores for pain were lower in the pregabalin group (n=24) than in the placebo group (n=23; P<0.05). The number of patients who needed rescue analgesics was lower in the pregabalin group (P=0.042). The incidence of nausea and vomiting did not differ between groups (P=0.666), and the incidence of sedation was higher in the placebo groups (P=0.022).
Conclusion
The perioperative administration of oral pregabalin (150 mg twice) is an effective and safe way to reduce early postoperative pain in patients undergoing septoplasty.
doi:10.3342/ceo.2014.7.2.102
PMCID: PMC4050080  PMID: 24917905
Postoperative pain; Pregabalin; Septoplasty; Preemptive analgesia
3.  Nasal Obstruction and Palate-Tongue Position on Sleep-Disordered Breathing 
Objectives
We wanted to evaluate whether the presence of nasal obstruction makes a change on the association between the modified Mallampati score and the severity of sleep-disordered breathing (SDB) and the sleep quality.
Methods
Polysomnography (PSG), the modified Mallampati score (MMS), the body-mass index, and a questionnaire about nasal obstruction were acquired from 275 suspected SDB patients. The subjects were divided into two groups according to the presence of nasal obstruction. The clinical differences between the two groups were evaluated and the associations between the MMS and PSG variables in each group were also assessed.
Results
Significant correlations were found between the MMS and many PSG variables, including the apnea-hypopnea index, the arousal index and the proportion of deep sleep, for the patients with nasal obstruction, although this was not valid for the total patients or the patients without nasal obstruction.
Conclusion
The severity of SDB and the quality of sleep are well correlated with the MMS, and especially for the patients with nasal obstruction. The MMS can give more valuable information about the severity of SDB when combined with simple questions about nasal obstruction.
doi:10.3342/ceo.2013.6.4.226
PMCID: PMC3863671  PMID: 24353862
Sleep apnea syndrome; Nasal obstruction; Mouth breathing; Modified Mallampati score; Sleep disordered breathing
4.  Role of Intranasal Topical Steroid in Pediatric Sleep Disordered Breathing and Influence of Allergy, Sinusitis, and Obesity on Treatment Outcome 
Objectives
To evaluate efficacy of short term intranasal corticosteroid (mometasone furoate) treatment in pediatric sleep-disordered breathing (SDB) patients.
Methods
A prospective, observational study was done. A total of 41 children (2-11 years old) were enrolled into this study. All patients received 4-weeks course of mometasone furoate 100 µg/day treatment. They were evaluated at pretreatment and immediately after treatment with obstructive sleep apnea (OSA)-18 quality of life survey and lateral neck X-ray. Also, the assessment of each patients included history, skin prick test or CAP test, and sinus radiography. We compared the OSA-18 survey score and adenoidal-nasopharyngeal (AN) ratio between before and after treatment.
Results
Total OSA-18 score and AN ratio decreased significantly after treatment regardless of allergy, sinusitis, and obesity (P=0.003, P=0.006). There was no complication after treatment of mometasone furoate.
Conclusion
Pediatric SDB patients with adenoid hypertrophy could be effectively treated with 4-weeks course of mometasone furoate. Allergy, obesity, and sinusitis did not affect on the result of treatment.
doi:10.3342/ceo.2011.4.1.27
PMCID: PMC3062224  PMID: 21461060
Steroid; Topical administration; Sleep disorder; Adenoid; Pediatrics; Allergy
5.  Endodontic Treatment: A Significant Risk Factor for the Development of Maxillary Fungal Ball 
Objectives
The risk factors for maxillary fungal ball are largely unknown. The aim of this study was to determine whether endodontic treatment of maxillary teeth is a risk factor for fungal ball development in the maxillary sinus, and to identify other possible risk factors.
Methods
One hundred and twelve case patients diagnosed with maxillary fungal ball (FB group) and age and gender matched control patients diagnosed with chronic paranasal rhinosinusitis (PNS group) were included to determine associations between previous endodontic treatment and maxillary fungal ball. In addition, we reviewed the dental extraction status of maxillary teeth and the underlying disease in both groups to analyze the other risk factors for maxillary fungal ball.
Results
There were 36.3% of patients in the FB group and 16.1% in the PNS group showed evidence of endodontic treatment on the maxillary teeth (P<0.001). Even after correction for possible confounding factor - the frequency of dental extractions - the rate of endodontic treatment remained higher in the FB group. The mean number of endodontically treated maxillary teeth in the FB group and PNS group were 0.63 and 0.27, respectively (P=0.001). In addition, 20.5% of the patients in the FB group and 13.4% in the PNS group has diabetes mellitus (P=0.154).
Conclusion
Endodontic treatment on maxillary teeth was a significant risk factor for the development of fungal balls in the maxillary sinus.
doi:10.3342/ceo.2010.3.3.136
PMCID: PMC2950265  PMID: 20941331
Fungal sinusitis; Fungal ball; Endodontics; Endodontic treatment; Maxillary sinus
6.  An Extremely Rare Variety of Anomalous Coronary Artery: Right Coronary Artery Originating From the Distal Left Circumflex Artery 
Korean Circulation Journal  2010;40(9):465-467.
A single coronary artery (SCA) is a rare congenital anomaly of the coronary circulation, which is often associated with myocardial ischemia and other congenital cardiac anomalies. A 77-year-old woman visited our hospital complaining of typical chest pain. Coronary angiography revealed an isolated SCA. The right coronary artery did not originate from the aorta, but instead emerged from the distal left circumflex artery, with significant stenosis at the proximal portion of the left anterior descending artery. A stent was successfully implanted at the culprit lesion. There was no perfusion defect detected by a cardiac SPECT study.
doi:10.4070/kcj.2010.40.9.465
PMCID: PMC2957636  PMID: 20967149
Coronary vessel anomalies; Angina pectoris
7.  Initial Adherence to Autotitrating Positive Airway Pressure Therapy: Influence of Upper Airway Narrowing 
Objectives
There is still debate concerning the reason for the high initial failure rate of positive airway pressure (PAP) treatment. The objective of this study is to investigate the factors of the initial adherence to PAP, with an emphasis on the role of upper airway narrowing.
Methods
The patients were divided into two groups according to the continuation of therapy within the first three months of treatment. The demographic and polysomnographic findings, the minimal nasal cross sectional area (MCA), the degree of palatine tonsilar hypertrophy (PTH) and the modified Mallampati grade of the oropharynx inlet (Orophx) were compared between the study groups.
Results
Among 36 patients, 23 continued the auto-adjusting positive airway pressure (APAP) therapy (the adherent group) and 13 discontinued APAP within three months (the non-adherent group). The apnea-hypopnea index (AHI) was significantly higher in the adherent group than in the non-adherent group (P<0.001). The AHI distributions of the two groups are extremely different. Thirteen of the 23 patients in the adherent group had an AHI of more than 60/hr, while none of the patients in the non-adherent group had an AHI of more than 60/hr. In the patients with an AHI from 15 to 60/hr, the MCA at the wide side of the nasal cavity and the sum of the MCAs of both sides were significantly larger in the adherent group than those values in the non-adherent group (P=0.004). The PTH and the Orophx were not significantly different between the two groups.
Conclusion
AHI is a definite significant factor of adherence to APAP therapy. The dimension of the nasal cavity has an influence on initial APAP adherence in the patients who have a not too high level of AHI.
doi:10.3342/ceo.2009.2.4.181
PMCID: PMC2804093  PMID: 20072692
Continuous positive airway pressure; Compliance; Adherence; Upper airway; Nasal cavity
8.  A Relationship between the Obstructive Sleep Apnea Syndrome and the Erythrocyte Sedimentation Rate 
Objectives
The erythrocyte sedimentation rate (ESR) is a marker for inflammation, and it has been identified as a risk factor for atherothrombotic cardiovascular disease. The aim of this study was to determine the relationship between the plasma ESR level and nocturnal oxygen desaturation or other polysomnographic variables and to examine the role of obesity in patients with obstructive sleep apnea syndrome (OSAS).
Methods
This retrospective study included 72 patients with a diagnosis of OSAS who underwent overnight polysomnography and routine blood tests between July and December of 2005. We compared the plasma ESR level with the sum of all the polysomnographic variables and divided the patient group into obese and non-obese patients.
Results
The mean ESR level was 8.45 mm/hr. There was a significant difference in the ESR level between genders (P<0.001). A significant correlation was found between the percentage of time spent at a SpO2 below 90% and the ESR level in the obese group (BMI ≥25, N=43, P=0.012). In addition, the ESR levels had a positive correlation with age in the obese group (P=0.002). However, there was no significant correlation with the percentage of time spent at a SpO2 below 90% in the whole group of patients and in the non-obese group (BMI <25, N=29). The ESR level showed no correlation with the other polysomnographic variables.
Conclusion
The duration of deoxygenation in obese patients with OSAS may be associated with the ESR level which is an independent predictor of cardiovascular disease.
doi:10.3342/ceo.2009.2.3.126
PMCID: PMC2751876  PMID: 19784404
Blood sedimentation; Obstructive sleep apnea; Oximetry; Polysomnography
9.  Nasal Chondromesenchymal Hamartoma: CT and MR Imaging Findings 
Korean Journal of Radiology  2009;10(4):416-419.
We report CT and MR imaging findings for a case of nasal chondromesenchymal hamartoma occurring in a 19-month-old boy. A nasal chondromesenchymal hamartoma is a rare benign pediatric hamartoma that can simulate malignancy. Although rare, knowledge of this entity is essential to avoid potentially harmful therapies.
doi:10.3348/kjr.2009.10.4.416
PMCID: PMC2702054  PMID: 19568473
Nose, neoplasms; Paranasal sinus, neoplasms; Paranasal sinus, CT; Paranasal sinus, MR

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