BACKGROUND AND OBJECTIVES:Although adenotonsillectomy (ATE) is widely accepted for obstructive sleep apnea and recurrent tonsillitis, its effectiveness in reducing respiratory tract infections (RTIs) remains a topic of debate. This nationwide population-based cohort study evaluated the association between ATE and the incidence of upper and lower RTIs in pediatric patients. METHODS:Data were obtained from the Korean National Health Insurance Service sample cohort for 2010-2017. Children who underwent ATE were identified and matched with nonsurgical controls at a 1:5 ratio by age and sex. Hospital visits due to RTIs-including acute upper RTIs, influenza or pneumonia, and acute lower RTIs-were assessed from 1 year before surgery through 3 years after surgery. The odds of hospital visits were estimated using multivariable logistic regression, with odds ratios and 95% confidence intervals. RESULTS:A total of 6,848 children who underwent ATE and 34,240 matched controls were included. Compared with the matched nonsurgical control group, the ATE group had higher odds of hospital visits due to upper and lower RTIs, whereas no significant difference was observed for pneumonia. Age-stratified analyses showed that lower RTIs increased first in younger children and later in older age groups during follow-up. Sex-stratified analyses showed increased lower RTIs in boys during postoperative years 1-2 and increased influenza or pneumonia in girls during postoperative years 2-3. Postoperative increases in RTIs were more pronounced among children without preoperative infection histories. CONCLUSION:ATE was not associated with fewer RTIs in pediatric patients. Instead, certain subgroups had a higher incidence of upper and lower RTIs after surgery. These findings suggest that ATE may have limited effectiveness in preventing RTIs and should not be performed solely for this purpose.
Microplastics (MPs) are pervasive environmental contaminants with potential implications for human health. Although inhalation is considered a major route of exposure, most investigations have focused on the lower respiratory tract, leaving the upper airway relatively understudied. Recent studies have detected MPs in nasal lavage fluid, specimens from patients with allergic rhinitis, tissue from patients with chronic rhinosinusitis, and the olfactory bulb of the human brain. Concerns have also been raised that synthetic polymer-based medical devices, including nasal irrigation bottles and continuous positive airway pressure systems, may contribute to upper airway exposure. This review summarizes current evidence on the detection and characterization of MPs in the human nasal cavity and upper airway, discusses environmental and medical device-related exposure pathways, and examines emerging implications for rhinologic diseases. Methodological limitations and priorities for future research are also reviewed.
Randomized controlled trials (RCTs) remain the gold standard for evaluating treatment efficacy because randomization minimizes measured and unmeasured confounding. In rhinology, however, RCTs are often impractical because of ethical constraints, patient preferences, financial limitations, and logistical challenges related to surgical interventions or long-term follow-up. Consequently, observational studies based on real-world data have become increasingly important for comparative effectiveness research. Despite their practical advantages, observational studies are inherently vulnerable to confounding by indication, selection bias, prevalent-user bias, and immortal time bias. Propensity score (PS) methods were developed to mitigate measured confounding and improve the internal validity of non-randomized comparisons. Since their introduction, PS approaches have expanded beyond traditional matching to include advanced weighting strategies, such as inverse probability of treatment weighting, overlap weighting, and doubly robust estimation. This review provides a clinician-oriented overview of PS methods, including their conceptual foundations, practical implementation, study design considerations, target population implications, diagnostic tools, strengths, limitations, and modern methodological extensions. The review emphasizes the application of these methods to rhinologic research, in which treatment allocation is frequently influenced by disease severity and patient characteristics.
Merocel, a polyvinyl acetal sponge, is a nonabsorbable nasal packing material widely used after sinonasal surgery because of its hemostatic efficacy and ease of placement. However, nonabsorbable packing is generally removed within 48 hours to reduce the risks of mucosal injury, infection, and adhesion. A 48-year-old man underwent endoscopic sinus surgery (ESS) for chronic rhinosinusitis at a secondary hospital. The Merocel pack was inadvertently retained for 50 days, resulting in acute pansinusitis with foul odor, postnasal drip, and facial pain. Attempts to remove the packing by traction and irrigation at the secondary hospital were unsuccessful and caused fragmentation of the Merocel. The patient was subsequently referred to our tertiary center, where revision ESS revealed firmly adherent Merocel fragments. Histopathological examination demonstrated inflammatory tissue ingrowth into the porous Merocel structure without bone fragment entrapment or osseous ingrowth. The patient recovered uneventfully, with no recurrence at the 3-month follow-up. Prolonged retention of a Merocel nasal pack may cause acute sinusitis and firm adhesion through inflammatory tissue ingrowth, even without histopathological evidence of bone involvement. Prevention requires timely pack removal, structured follow-up, and comprehensive patient education.
Intraosseous hemangiomas are rare benign vascular tumors that account for less than 1% of all bone tumors and are exceptionally uncommon in the sinonasal region. Their aggressive-appearing radiological features may mimic those of malignant bone tumors, creating diagnostic challenges. An 18-year-old man presented with right-sided nasal obstruction and epistaxis. Imaging revealed a large destructive mass in the right maxillary sinus that was suspicious for malignancy, including osteosarcoma. Endoscopic biopsy showed nonspecific benign osseous features that were discordant with the radiological findings. For this reason, endoscopic medial maxillectomy was performed. Histopathological examination with CD31 and CD34 immunostaining confirmed intraosseous venous hemangioma. Intraosseous hemangioma should be considered in the differential diagnosis of aggressive-appearing sinonasal masses, especially when imaging and biopsy findings are discordant, as its recognition may help prevent unnecessarily aggressive treatment.
Allergic fungal sinusitis (AFS)-like syndrome refers to clinical presentations resembling AFS that do not fully satisfy established diagnostic criteria. We report a case of AFS-like syndrome in a 33-year-old woman, characterized by the presence of fungal hyphae within eosinophilic mucin despite negative systemic allergy testing, and we evaluate the limitations of current diagnostic frameworks. This report further examines the shared immunopathological spectrum between AFS and allergic bronchopulmonary aspergillosis, highlighting the importance of an integrated clinical approach to fungal hypersensitivity disorders affecting both the upper and lower airways.
Obstructive sleep apnea (OSA) is a common sleep disorder associated with substantial cardiovascular morbidity and mortality. Although positive airway pressure (PAP) remains the gold-standard treatment, poor long-term adherence often limits its clinical effectiveness, underscoring the need for safe and effective pharmacological alternatives. Advances in the understanding of OSA endotypes, including anatomical collapsibility, upper airway muscle responsiveness, arousal threshold, and loop gain, have shifted research toward precision pharmacotherapy. Early studies of single-agent therapies, such as protriptyline and acetazolamide, were limited by modest efficacy or clinically significant adverse effects. More recent dual-drug combinations and anti-obesity medications have shown greater promise. In particular, atomoxetine plus oxybutynin has demonstrated significant reductions in the apnea–hypopnea index (AHI) by enhancing upper airway muscle tone across sleep stages. In parallel, glucagon-like peptide-1 receptor agonists have substantially changed the management of obesity-related OSA. Tirzepatide, in particular, has produced marked weight loss of nearly 20% and an AHI reduction of more than 50%, leading to its recent U.S. Food and Drug Administration approval for OSA. Despite earlier skepticism, the shift from broad-spectrum agents toward endotype-specific and metabolic-targeted therapies may improve the management of selected patients with OSA. However, long-term safety and cost-effectiveness require further evaluation before these emerging pharmacological options can be broadly integrated into care for patients who cannot tolerate conventional PAP therapy.
Background and Objectives: Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) is characterized by type 2 inflammation, prominent eosinophil accumulation, and enhanced epithelial–mesenchymal transition (EMT). Although interleukin (IL)-5 plays a central role in eosinophil differentiation and activation, its involvement in driving EMT in human nasal epithelial cells (HNECs) remains unclear. This study investigated IL-5 receptor α (IL-5Rα)–mediated signaling and EMT profiles in ECRSwNP, aiming to determine whether IL-5–activated eosinophil-like cells promote EMT in HNECs.Methods: Nasal tissues from healthy controls, non-ECRSwNP patients, and ECRSwNP patients (n=12 per group) were analyzed using hematoxylin and eosin staining, quantitative real-time polymerase chain reaction, immunohistochemistry, and Western blotting. HL-60 promyelocytic leukemia cells were differentiated into eosinophil-like cells and subsequently stimulated with IL-5. HNECs were cocultured with undifferentiated HL-60 cells, differentiated HL-60 cells, or IL-5–stimulated differentiated HL-60 cells using a Transwell system. Expression of EMT-related markers was assessed by Western blotting and immunofluorescence.Results: ECRSwNP tissues demonstrated markedly increased eosinophil infiltration, elevated IL-4 and IL-5 transcript levels, and significantly higher expression of IL-5Rα, phosphorylated Janus kinase 2 (JAK2), and phosphorylated signal transducer and activator of transcription 5 (STAT5) compared with controls and non-ECRSwNP tissues. EMT-associated changes, characterized by reduced E-cadherin and increased vimentin expression, were most pronounced in ECRSwNP. In vitro, IL-5 stimulation enhanced IL-5Rα expression, activated JAK2/STAT5 signaling, and increased secretion of eosinophil-associated mediators in differentiated HL-60 cells. Co-culture with IL-5-stimulated eosinophil-like cells induced EMT in HNECs, whereas unstimulated HL-60 cells exerted minimal effects.Conclusion: IL-5Rα-mediated signaling is upregulated in ECRSwNP and may contribute to EMT through eosinophil-dependent mechanisms. IL-5–activated eosinophils promote EMT-related changes in HNECs, providing a mechanistic link between type 2 inflammation and epithelial remodeling. These findings suggest that IL-5Rα signaling may represent a potential therapeutic target for modulating tissue remodeling in ECRSwNP.
Nasopharyngeal lipoma is a rare benign tumor, with only a small number of cases reported in the English-language literature. We present the case of a 43-year-old woman in whom nasal endoscopy incidentally identified a 1.5-cm pedunculated mass immediately anterior to the left Eustachian tube orifice. Computed tomography showed a well-circumscribed, homogeneous lesion with fat attenuation. Although these imaging findings strongly supported the diagnosis of conventional lipoma, complete endoscopic excision was performed to obtain definitive histologic confirmation because the lesion was small, pedunculated, and readily accessible for complete removal. Histopathologic examination confirmed conventional lipoma, with no nuclear atypia or lipoblasts, and the patient had no evidence of recurrence at 12 months. This case describes a nasopharyngeal lipoma arising at an uncommon anatomic site immediately anterior to the Eustachian tube orifice and suggests that limited posterior inferior turbinectomy can facilitate safe endoscopic access in selected cases.
Eosinophilic granulomatosis with polyangiitis (EGPA) frequently presents with asthma and sinusitis, making otorhinolaryngologic manifestations potential early indicators of systemic vasculitis. However, these manifestations are often misdiagnosed as common inflammatory diseases. We report two cases of EGPA diagnosed based on distinct rhinologic presentations. The first case involved a 52-year-old woman who developed mononeuritis multiplex and cutaneous vasculitis following surgery for nasal polyps, which ultimately led to a definitive diagnosis of EGPA. The second case involved a 39-year-old woman who presented with nasal septal perforation and was subsequently diagnosed with an acute exacerbation of EGPA accompanied by pulmonary infiltrates. These cases highlight that not only nasal polyps but also atypical findings, such as nasal septal perforation, may serve as critical diagnostic clues for EGPA. Otorhinolaryngologists play a pivotal role in identifying this potentially fatal systemic vasculitis through careful evaluation of localized sinonasal manifestations.
Myofibromas are rare mesenchymal neoplasms that primarily affect infants and young children, most commonly arising in the skin, subcutaneous tissue, muscle, or bone. These tumors present with a broad clinical spectrum, ranging from self-limiting lesions to disseminated and fatal cases. In adults, the solitary form is encountered more frequently than the multicentric type. Although myofibromas may occur in the oral region of the head and neck, isolated cases involving the nasal septum are exceedingly rare. Here, we describe a case of solitary adult-onset myofibroma of the nasal septum that was successfully excised through transnasal endoscopic surgery.
Background and Objectives Glomangiopericytoma (GPC) is a rare, low-grade mesenchymal neoplasm that most commonly arises in the nasal cavity and paranasal sinuses. Its rarity, together with overlapping histopathological features shared with other spindle-cell tumors, makes diagnosis challenging, and available data regarding its clinical behavior and optimal management remain limited. This study aimed to present a retrospective case series of GPC from a tertiary referral center, with particular emphasis on clinical presentation, diagnostic evaluation, histopathological characteristics, surgical management, and outcomes. Methods Following institutional ethics approval, we conducted a retrospective review of patients treated for GPC between January 2010 and August 2025 at a tertiary care center. Collected data included demographic characteristics, clinical presentation, imaging findings, histopathological features with immunohistochemistry, surgical management, and follow-up outcomes. Results Eleven patients (six women and five men; mean age, 70.9 years) were included. The most common presenting symptoms were unilateral nasal obstruction, rhinorrhea, headache, and recurrent epistaxis. Tumors predominantly involved the nasal cavity—particularly the posterior septum, sphenoethmoidal recess, and middle turbinate—as well as the ethmoid sinus. Four cases demonstrated locoregional extension, and two required skull base reconstruction. Tumor diameter ranged from 0.8 to 4.0 cm. All patients underwent endoscopic endonasal resection. No recurrences were observed during follow-up, which ranged from 1 month to 15 years (mean, 3.54 years); however, these findings should be interpreted cautiously given the variability in follow-up duration. Immunohistochemistry consistently demonstrated nuclear β-catenin positivity and negative STAT6 expression. Conclusion GPC is a rare and distinct vascular neoplasm characterized by perivascular spindle-cell proliferation and nuclear β-catenin expression. Endoscopic resection was the primary treatment modality in our cohort, and long-term surveillance remains essential because of the potential for delayed recurrence. This case series provides a descriptive overview of the clinical features, diagnostic approaches, and management of GPC.
Background and Objectives: Differentiating inverted papilloma (IP) from squamous cell carcinoma arising in IP (IP+SCC) is challenging when computed tomography (CT) demonstrates no bone destruction. This study aimed to identify CT and magnetic resonance imaging (MRI) features that distinguish IP from IP+SCC in cases without bone destruction on CT.Methods: We retrospectively reviewed 30 patients with histologically confirmed sinonasal IP (n=15) or IP+SCC (n=15) who underwent preoperative CT and MRI between 2010 and 2023. Imaging variables assessed included tumor origin, tumor volume, CT enhancement pattern, signal intensity on T2-weighted and contrast-enhanced T1-weighted images, apparent diffusion coefficient (ADC), and the presence or loss of the convoluted cerebriform pattern (CCP). Group differences were analyzed using appropriate statistical tests, with p<0.05 considered statistically significant.Results: There was no statistically significant difference in tumor origin between the IP and IP+SCC groups. Tumor volume and CT enhancement patterns also did not differ significantly between the groups. On MRI, IP+SCC more frequently demonstrated intermediate signal intensity on both T2-weighted and contrast-enhanced T1-weighted images compared with IP (p=0.025 and p=0.029, respectively). Median ADC values were significantly lower in the IP+SCC group than in the IP group (0.99×10-3 vs. 1.20×10-3 mm2/s; p=0.026). Loss of the CCP was more common in the IP+SCC group, although the difference did not reach statistical significance.Conclusion: In sinonasal IP without bone destruction on CT, MRI appears to be more informative than CT for distinguishing IP+SCC from IP. Intermediate signal intensity on T2-weighted and contrast-enhanced T1-weighted images, along with lower ADC values, supports malignant transformation, whereas tumor size, CT enhancement, and CCP alone are less reliable discriminators.
The two main categories of benign fibro-osseous lesions are ossifying fibroma and fibrous dysplasia. Both entities occur infrequently in the sinonasal tract. Fibro-osseous lesions involving the nasal turbinates, in particular, are extremely rare. A 19-year-old woman presented with chronic nasal obstruction and purulent rhinorrhea and was diagnosed with fibrous dysplasia involving the inferior turbinate. A 16-year-old boy presented with similar symptoms and was diagnosed with ossifying fibroma involving the middle turbinate. Both patients underwent endoscopic endonasal resection. Postoperatively, symptoms improved, and no recurrence was observed during follow-up. These cases highlight the rarity of turbinate involvement and suggest that endoscopic endonasal surgery is an effective treatment option.
Background and Objectives This study conducted a comprehensive bibliometric analysis of articles published in the Journal of Rhinology (JR), the official journal of the Korean Rhinologic Society, to examine research trends, thematic evolution, and emerging hotspots in rhinology. Methods A total of 836 JR articles (1994–2025) were retrieved from PubMed and Research Information Sharing Service (RISS) after duplicate removal. The R bibliometrix package was used to perform keyword trend and thematic evolution analyses. VOSviewer was used to visualize keyword co-occurrence networks and temporal relationships between keywords. Gephi was used to calculate centrality measures, providing insight into the structural characteristics of the research network. Results From 1994 to 2025, JR published an average of 26.6 articles per year, with publication activity increasing in recent years. Keyword and thematic analyses demonstrated that the research focus gradually shifted from basic disease- and anatomy-related topics and traditional clinical themes in the 2010s to functional conditions, infectious diseases, and increasingly surgical, procedural, and methodological research after 2020, while “rhinitis” and “sleep apnea syndromes” were consistently addressed. Co-occurrence analysis further identified “endoscopy” as a central keyword, highlighting its continued importance in JR research. Conclusion The articles published in JR encompass a broad spectrum of rhinology research, integrating disease pathophysiology, clinical applications, surgical techniques, and evidence-based approaches. These findings highlight evolving research trends and provide guidance for future domestic and international studies in rhinology.
Chronic invasive fungal rhinosinusitis (CIFR) is a rare subtype of invasive fungal rhinosinusitis characterized by a slow clinical course and histopathologic evidence of tissue invasion. It is distinct from noninvasive fungal ball rhinosinusitis and acute invasive fungal rhinosinusitis. The standard treatment for CIFR consists of surgical debridement combined with systemic antifungal therapy. However, systemic antifungal agents may not be feasible in certain patients because of drug-related toxicity, impaired renal function, or socioeconomic constraints. In addition, the optimal role of topical antifungal therapy in CIFR has not been clearly established. Herein, we describe two patients with diabetes mellitus who had CIFR confined to the sinonasal cavity and were managed with surgical debridement combined with topical amphotericin B application, without systemic antifungal therapy. Both patients demonstrated favorable clinical outcomes. These cases suggest that, in carefully selected patients with localized CIFR, a surgery-centered management strategy incorporating adjunctive topical amphotericin B may represent a feasible alternative when systemic antifungal therapy cannot be administered, provided that careful and prolonged follow-up is ensured.
Postoperative epistaxis is the most common complication after endoscopic sinus surgery (ESS) and septoplasty; however, it is usually immediate and self-limited. Delayed, severe hemorrhage is rare and should prompt evaluation for systemic causes. We report a rare case of acute immune thrombocytopenia (ITP) presenting as delayed, severe epistaxis after routine nasal surgery. A 46-year-old man with no history of bleeding disorders and normal coagulation profiles and platelet counts underwent ESS and revision septoplasty. On postoperative day 5, he presented with massive epistaxis and hypovolemic shock. Laboratory evaluation demonstrated severe isolated thrombocytopenia, with a platelet count of 5×103/μL. He was treated successfully with intravenous immunoglobulin and high-dose corticosteroids, which resulted in platelet recovery and cessation of bleeding. Although uncommon, surgical stress may act as a precipitating trigger for ITP, and this diagnosis should be included in the differential diagnosis of delayed, massive postoperative hemorrhage after routine nasal surgery.
Chronic rhinosinusitis (CRS) is increasingly recognized as a heterogeneous disease with distinct inflammatory endotypes, among which eosinophilic CRS (ECRS)—a category that substantially overlaps with, but is not equivalent to, Type 2 CRS—is associated with severe symptoms, frequent recurrence, and comorbid asthma. Accurate identification of Type 2 CRS has become clinically essential with the emergence of biologic therapies that target Type 2 inflammatory pathways. However, most diagnostic criteria, including those proposed by European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020), were developed from Western populations, in which ECRS with nasal polyps predominates. This review critically examines the applicability of these criteria in Asian populations, in which non-eosinophilic and mixed inflammatory endotypes remain prevalent. Evidence from Korean and Japanese cohorts indicates that the EPOS 2020 Type 2 criteria have poor specificity in Asian patients with CRS with nasal polyps, classifying nearly all such patients as Type 2 because of differences in baseline biomarker distributions. We discuss histological thresholds for defining ECRS and highlight that Asian studies support higher tissue eosinophil cut-offs, approximately 70 eosinophils per high-power field (HPF) or around 10% of total inflammatory cells, compared with the 10 eosinophils per HPF recommended by Western guidelines. This review also evaluates outpatient-friendly scoring systems, such as Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) and newly proposed Korean diagnostic criteria, as well as emerging machine-learning approaches for noninvasive prediction of ECRS. We conclude that clinicians in Asia should adopt regionally validated criteria that integrate histological, serological, and clinical parameters to accurately identify Type 2 CRS, optimize selection of biologic candidates, and improve prognostic counseling in this population.
A sinus mucocele is a dilated, epithelial-lined cystic lesion containing encapsulated mucus. Although its etiology remains uncertain, secondary infection may transform it into a pyocele. A 68-year-old female presented with sudden-onset ophthalmoplegia, ptosis, and blurred vision during the acute phase of COVID-19 infection. Physical examination and imaging identified an ethmoid sinus mucocele causing significant orbital compression. The patient underwent urgent endoscopic marsupialization. Intraoperative findings revealed increased internal pressure within the mucocele. Postoperatively, her ocular motility and ptosis improved immediately, with a full recovery of visual acuity within two weeks. This case suggests that COVID-19-associated mucosal inflammation or immune dysregulation may lead to the rapid expansion of pre-existing asymptomatic mucoceles. Clinicians should consider mechanical sinus lesions in the differential diagnosis of acute cranial nerve palsies during COVID-19 infection to ensure timely surgical decompression.
Background and Objectives A substantial proportion of patients presenting with sinus headaches are ultimately diagnosed with migraines. The ID-Migraine tool has been developed to aid in identifying migraine patients in primary care settings. Therefore, we conducted a meta-analysis of validation studies evaluating the diagnostic accuracy of the ID-Migraine tool. Methods Data were extracted regarding true positives, false positives, true negatives, and false negatives, along with study characteristics. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Results In total, 30 studies involving 9,942 participants were included in the final analysis. The pooled diagnostic odds ratio for the ID-Migraine tool was 13.84. The area under the summary receiver operating characteristic curve was 0.846. The pooled sensitivity and specificity were 0.865 and 0.702, respectively, while the negative predictive value was 0.791 and the positive predictive value was 0.799. Conclusion The ID-Migraine screening tool is highly accurate and user-friendly for identifying migraines among patients presenting with sinus headaches. By employing this tool, unnecessary diagnostic tests or treatments can be minimized, and patients can be promptly referred to appropriate specialists.
