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노환중,김태원,이정훈,이현순,고의경,왕수건 대한이비인후과학회 2004 대한이비인후과학회지 두경부외과학 Vol.47 No.8
Background and Objectives:This study was designed to compare sinonasal distribution of topical nasal drops and spray according to head positions and to suggest optimal head position for efective topical delivery. Subjects and Methods:The study group included five healthy subjects (normal group) (ESS group). A visual asesment of the intranasal distribution of nasal drops and spray was made using Fluorescein Blue Filter System after instillation of TobraDexdrops and Nasonexdyed with 0.2% fluorescein. Each group took five kinds of head position for nasal drops and two for nasal spray. Results:Drops instilled with head back position were found along the nasal flor, and drops tilled in Mygind position and Ragan position were found in the midle meatus and head of the middle turbinate in the normal group, and in the middle meatus, ethmoidectomized cavity, and maxilary sinus in the ESS group. The head neutral position showed efective dis-tribution to the septum, lateral nasal wal, and midle turbinate in the normal group, and in the ethmoidectomized cavity in the ES group, compared to the head forward position which distributed the drops lower depending portion. Conclusion:These o the olfactory cleft, and Mygind position and Ragan position are proposed to the midle meatal region in non-surgery patients and ethmoidectomized cavity and maxillary sinus in post-ES patients. Head neutral position is recommendable for efective delivery of nasal spray compared to head forward position regardles of ESS.
만성 부비동염 환자에서 중비도, 사골동, 상악동의 배양균주의 연관성
노환중,조규섭,김태원,이현순 대한비과학회 2006 Journal of rhinology Vol.13 No.1
Background and Objectives:The bacteriology of chronic sinusitis helps us to understand sinusitis and plays an important role in selecting appropriate antibiotics. In recent studies, a good correlation was found between middle meatus and maxillary sinus cultures. We correlate middle meatus, ethmoid sinus and maxillary sinus microbiology in patients with chronic sinusitis and try to determine whether middle meatus cultures can replace maxillary sinus and ethmoid sinus cultures as noninvasive alternative methods. Study Design:Prospective study. Patients and Methods:32 patients with chronic sinusitis who didn’t respond to medical therapy and received endoscopic sinus surgery were selected. Intraoperative middle meatus, anterior ethmoid and maxillary sinus samples from 32 patients under endoscopic visualization using sterile cotton swabs (BBL Culture Swab®, BBL, USA) were collected. Results:The overall correlation rate of middle meatus and ethmoid sinus cultures was estimated to be 84.4%. The overall correlation rate of middle meatus and maxillary sinus cultures was estimated to be 84.4%. The most frequently isolated bacteria were coagulase negative Staphylococci in middle meatus and Staphylococcus aureus in ant. Ethmoid and maxillary sinus. Conclusion:This study demonstrates that middle meatus cultures correlate well with anterior ethmoid and maxillary sinus cultures and can be used to guide antibiotics selection in chronic sinusitis.
노환중,김기태,이현순,이상준,전경명 대한이비인후과학회 2004 대한이비인후과학회지 두경부외과학 Vol.47 No.7
Background and Objectives:This study was designed to compare the clinical outcomes according to surgical approach of extranasal, endonasal endoscopic, and a combined approach of the two, suggesting the indication of each surgical approach for excision of sinonasal inverted papiloma (IP). Subjects and Method:Fifty-six IP patients who had been operated at the de-assessed. The patients were arbitrarily divided into three groups such as excision through extranasal approach (EEA), endonasal endoscopic excision (EEE), and EE combined with Caldwell-Lucs aproach (EEE+ C-L) group. Results:The most com-monly afected sites by CT/MRI preoperatively was the nasal cavity folowed in the decreasing order of frequency by maxilary, ethmoid, sphenoid, and frontal sinus. In the EEA group, the originated sites were the nasal cavity (2/6), maxillary (1/6), and frontal sinus (2/6). In the EE group, the origin sites by operative findings were the nasal cavity (30/41), maxillary (5/41), sp-henoid (3/41), and ethmoid (2/41) sinus. In the E + C-L group, eight cases (8/9) originated from the maxillary sinus. There were six cases associated with malignant tumors, five synchronous and one metachronous, treated combined with radiotherapy (1/6) in EEA, 14.6% (6/41) in EE and 10.1% (1/9) in EEE+C-L group, and there was no significant diference acording to surgical approaches. Conclusion:E yielded a sucesful outcome only when the IP was limited to the originating sites of nasal cavity, medial and uper wall of maxillary sinus, ethmoid sinus, and sphenoid sinus. The complete removal of the tumor by EE alone could not be achieved when the tumor was originated from the anterior, inferior, and posterolateral wall of maxillary sinus, requiring aplication of C-Ls aproach at the same time. EA can be used with more benefits than EE when the tumor is originated from the frontal sinus or when the mas tends to invade extensively.
만성기침을 동반한 만성 비부비동염 환자에서 비강분비물과 기관폐포세척액의 세포병리학적 비교
노환중,이일우,왕수건,김철민,이민기,박순규 대한이비인후과학회 2003 대한이비인후과학회지 두경부외과학 Vol.46 No.1
Background and Objectives:Postnasal drip is one of the most comon symptoms of chronic rhinosinusitis (CRS), and is the main cause of chronic cough. To evaluate the effect of upper airway inflammation defined as CRS on lower bronchial airway, we compared the cytology of nasal secretion (NS) and bronchoalveolar lavage fluid (BALF) of normal controls and patients with chronic rhinosinusitis acompanying with and without chronic cough normal controls. Materials and Method:Ten patients . NS collected using Juhns tymanic tap and BALF collected through fiberoptic bronchoscopy were diluted with dithiothreitol and PBS. These samples were centrifused and then cytospin slide was prepared. The cytology of the slides were evaluated under light microscope after Wright stain. To examine neutrophil activity, nitroblue tetrazolium dye (NBT) test was performd. Statis-tical analysis was performed using Mann-Whitney Rank Sum W test. Results:In NS, there were no significant diferences in the cel populations among coughing, noncoughing, and the normal control group. NBT positivity of coughing (34.2%) and noncoughing ( ) groups showed significantly higher than those of controls (8.6%). In BALF of coughing group, the popu-lation of macrophages (78.0%) was significantly lower than noncoughing (86.6%) and control (92.8%) groups, and population of lymphocytes (20.8%) was significantly higher than noncoughing (12.6%) and the control (6.4%) groups. In BALF of Conclusion:These results suggest that CRS enhances increased local imune responses and decreased phagocytic activity of the lower airway. And chronic cough in patients with CRS is thought to be dependent on individual tolerance to cough provocation, not on aspiration of postnasal drip of discharge. (Korean J Otolaryngol 2003 ;46 :42-7)