Prevalence of otolaryngologic diseases in South Korea: data from the Korea national health and nutrition examination survey 2008

Epidemiology of Chronic Suppurative Otitis Media: Systematic Review To Estimate Global Prevalence

BACKGROUND

Chronic Suppurative Otitis Media (CSOM) is a disorder characterised by a perforation of the tympanic membrane leading to ear discharge and hearing loss, a disability causing marginalisation in employment, education, social stigma, and reduced wellbeing and quality of life. Previous studies on the global epidemiology of this condition, despite methodological limitations, have estimated global prevalence at 200 million.

METHODS

Adhering to PRISMA guidelines, published literature was systematically reviewed across Ovid and Embase databases, with original community-based studies on CSOM published from 2004 to March 19th, 2025 extracted for final consideration on quality and relevance. Studies focusing on hospital populations were excluded as they seem more likely to represent a biased group of severe cases. Published articles were analysed for data on CSOM prevalence and associated risk factors.

RESULTS

From 5,394 articles, 29 cross-sectional studies met the inclusion criteria. Included studies predominantly originated from low- and middle-income countries (LMICs) and focused on paediatric populations. A pooled average estimate revealed a CSOM global prevalence of 3.8% of the global population, or 297 million people, 85% (252 million) of which in LMICs. 64 million (21.5%) of those affected had bilateral disease, and 184 million (62%) had disabling hearing loss defined as > 25-30 dB. Hearing impairment was reported in only four studies, which affected 50-78% of participants. Frequency of ear discharge was reported in only one study.

CONCLUSION

The study identifies a significant global burden of CSOM, disproportionately affecting LMICs, and signals to healthcare providers and policymakers a pressing need for initiatives to prevent and manage this disease.

Global Incidence and Prevalence of Chronic Rhinosinusitis: A Systematic Review

OBJECTIVE

Data on the global prevalence of chronic rhinosinusitis (CRS) is significantly varied and limited across countries and over time. Therefore, we aimed to conduct a comprehensive investigation into the global, regional, and national burden of CRS from the years 1980 to 2021, as well as identify those factors that influence levels of such burden.

DESIGN

We conducted a systematic review and meta-analysis of general population-based observational studies focusing on CRS. We calculated pooled estimates of CRS prevalence and incidence with 95% confidence intervals (CIs). Subgroup analyses were conducted stratifying by sex, age cohorts, geographic regions, smoking status, obesity, and comorbid conditions.

DATA SOURCES

PubMed/MEDLINE, EMBASE, CINAHL, Google Scholar, and Cochrane databases.

ELIGIBILITY CRITERIA FOR SELECTION

We included general population-based observational studies on CRS published from database inception through October 20, 2023.

RESULTS

A total of 28 eligible studies, encompassing more than 237 million participants and 11,342,923 patients with CRS from 20 countries across four continents, were included in the analysis. Global pooled prevalence of CRS and CRS with nasal polyps (CRSwNP) was found to be 8.71% (95% CI, 6.69-11.33; number of studies, 20) and 0.65% (95% CI, 0.56-0.75; number of studies, 4), respectively. The prevalence of CRS was greater in Europe compared with North America, South America, and Asia; adults compared with children; smokers compared with never-smoker; those with obesity compared with normal weight; and those with comorbidities such as asthma, diabetes mellitus, eczema, and nasal septal deviation. Pooled prevalence of CRS increased from 1980 to 2020 (1980-2000: 4.72%; 95% CI, 2.12-10.49; 2014-2020: 19.40%; 95% CI, 12.12-31.07). Similar patterns were observed in CRS incidence.

CONCLUSIONS

Our study provides valuable insights into CRS prevalence and incidence across diverse demographic and clinical factors, highlighting its increasing global burden. The reported prevalence of CRS varies internationally, and may be increasing over time. To enhance data quality and comparability, standardization of reporting methodologies is imperative.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (registration no. CRD42024527805).

Association between tinnitus and hearing impairment among older adults with age-related hearing loss: a multi-center cross-sectional study

Objective

The relationship between tinnitus in the elderly with hearing loss remains elusive. This study aimed to reveal the association between tinnitus and hearing impairment among older adults with age-related hearing loss (ARHL).

Methods

This cross-sectional study was conducted among a population of outpatients diagnosed with ARHL at four medical centers in different regions of China, from June 2020 to June 2023. ARHL patients were divided into two groups based on their self-reported tinnitus: tinnitus and non-tinnitus. Multivariable linear regression models were used to assess the association between tinnitus and hearing impairment in ARHL patients. Subgroup analyses, stratified by gender and age, were performed to further evaluate the association.

Results

A total of 418 older adults with ARHL were included in the study. Compared to the non-tinnitus group, ARHL patients with tinnitus had lower hearing thresholds (β = -5.07; 95% confidence interval (CI) -9.32 to -0.81; p = 0.020). On subgroup analyses stratified by gender and age, the male ARHL patients with tinnitus still had lower hearing thresholds compared to those without tinnitus (β = -6.96; 95% CI -12.70 to 1.22; p = 0.018). In females, tinnitus was not associated with hearing thresholds (β = -3.69; 95% CI -10.11 to 2.74, p = 0.262). There was no association between tinnitus and hearing thresholds in both the age group of ≥70 years (β = -4.31; 95% CI -9.65 to 1.03; p = 0.116) and the age group of <70 years (β = -3.54; 95% CI -9.96 to 2.89; p = 0.282).

Conclusion

Based on this multi-center cross-sectional study, we reveal that there is no evidence for the assumption that tinnitus may exacerbate hearing loss in the elderly for the first time. On the contrary, tinnitus is associated with better hearing in the male elderly with ARHL. More extensive longitudinal studies are needed to give a comprehensive insight of the present findings and the underlying mechanisms.

"Can physical activity reduce the risk of having tinnitus?"

OBJECTIVE

Tinnitus, the perception of sound without an external source, affects many adults, impacting quality of life. While factors like hearing loss and psychological distress are linked to tinnitus, the relationship with physical activity remains unclear. This study aimed to explore the association between physical activity, sedentary behaviour, and the presence of tinnitus.

DESIGN

This study is a cross-sectional study. The participants completed the long form of the International Physical Activity Questionnaire. Adjusted logistic regression models were used to investigate associations between (components of) physical activity and the presence of tinnitus, and odds ratios (ORs) were calculated.

STUDY SAMPLE

This study involved 3004 participants (2751 tinnitus patients, 253 healthy controls).

RESULTS

Engaging in moderate or vigorous-intensity physical activity during leisure time for more than 2.5 hours per week was associated with a reduced risk of having tinnitus (OR = 0.515, p < 0.001). Conversely, individuals who reported sitting for more than 7 hours per day had a significantly higher risk of having tinnitus (OR = 2.366, p < 0.001).

CONCLUSIONS

The study suggests a potential protective effect of leisure-time physical activity against tinnitus and highlights the importance of reducing sedentary behaviour. Further research is needed to confirm these findings and to understand underlying mechanisms.

Association between nasal septal deviation and tinnitus: Insights from a 9-year nationwide cohort study

Tinnitus is a condition where sound is perceived in the ear or head when no external sound stimulation is present. To date, no study has explored the correlation between nasal septal deviation (SD) and tinnitus using large-scale real-world data. This study hypothesized a potential relationship between tinnitus and SD, which we investigated using a 9-year large-scale cohort study. Nationwide cohort observational study. The SD group was selected from 1 million individuals randomly extracted from the National Health Insurance Service database. The non-SD group was obtained through propensity score matching considering several variables. The primary endpoint was tinnitus diagnosis. The study (SD) group included 10,790 individuals, and the non-SD group (control group) included 21,580 individuals. The overall hazard ratio (HR) for tinnitus in the SD group was 1.74 (95% CI: 1.62-1.89). In the subgroup analysis, the HR was 0.73 (95% CI: 0.68-0.79) for tinnitus in the male group, 1.12 (95% CI: 1.04-1.21) in the group with high economic status, 0.81 (95% CI: 0.75-0.89) in the group living in metropolitan areas, and 0.45 (95% CI: 0.42-0.49) in the younger age group (<50 years). In the SD group, the HR for tinnitus after septoplasty significantly decreased to 0.75 (95% CI: 0.63-0.90). From long-term follow-up, the prevalence of tinnitus was 1.74 times higher in the SD group compared with the control group. This phenomenon significantly decreased after septoplasty.

Impact of Dietary Intake and Habits on Subjective Voice and Laryngeal Mucosal Diseases: Analysis From Korean National Health and Nutritional Examination Survey Between 2008 and 2021

OBJECTIVES

Dysphonia negatively affects social communication, leading to reduced quality of life. Comprehensive research on dysphonia and laryngeal mucosal diseases using large-scale epidemiological data is lacking. Therefore, we investigated how dietary and habitual factors influence dysphonia and laryngeal mucosal diseases using data from the Korean National Health and Nutritional Examination Survey.

STUDY DESIGN

A population-based cross-sectional study.

METHODS

The study included individuals aged 19 years and older who both underwent laryngoscopic examinations and completed a dysphonia survey. Dietary and habitual factors and results of the laryngoscopic examinations were collected. Risk factors for dysphonia and laryngeal mucosal diseases were identified.

RESULTS

The weighted frequency of dysphonia and laryngeal mucosal diseases was 6.4% and 6.0%, respectively. In univariable analyses for dysphonia, sex, body weight change, alcohol ingestion, and various minerals and vitamins showed statistically significant associations. However, in the multivariable analysis, only age, body weight, female sex, and vitamin A intake were significantly associated with dysphonia. Age, body weight, body mass index, sex, smoking, amount of sodium intake, and alcohol intake were associated with laryngeal mucosal diseases in the univariable analyses, but in the multivariable analysis, only age, smoking, and amount of niacin intake were significant factors.

CONCLUSIONS

In this large-scale epidemiological analysis, subjective dysphonia and laryngeal mucosal diseases had different frequencies and risk factors. Age was a risk factor for both dysphonia and mucosal diseases, but smoking was only a risk factor for laryngeal mucosal diseases. Diet types, calories, and water and alcohol intake were not significant risk factors for either laryngeal mucosal diseases or dysphonia.

Deterioration of Hearing Due to Hearing Aids

OBJECTIVES

A primary reason for the low adoption of hearing aids (HAs) among the large population with sensorineural hearing loss is the perception that these devices may negatively impact remaining hearing ability. Research addressing this issue has yielded conflicting results. This study examined the long-term effects of HAs on standard audiometric changes in individuals with sensorineural hearing loss.

METHODS

We retrospectively analyzed patients who acquired unilateral HAs between 2015 and 2017 and demonstrated consistent use over a 5-year period. We examined demographics, medical comorbidities, audiometric data, and questionnaire results from the Hearing Handicap Inventory for the Elderly and the International Outcome Inventory for Hearing Aids. Additionally, we reviewed each patient's history of noise exposure and prior HA use.

RESULTS

The study included 55 patients who used unilateral HAs, with a mean follow-up period of 5.32 years. Among them, 31 patients (56.4%) used the HA on the right side. Audiometric data from the aided side showed no significant difference from the unaided side in either the pre-fit pure-tone average of air conduction (AC) or word recognition score (WRS) (P =0.73 and P =0.11, respectively). Similarly, no significant differences were noted in the 5-year follow-up audiometry of AC and WRS (P=0.98 and P=0.07, respectively) or in the change from pre-fit to final audiometry for either parameter (AC, P=0.58; WRS, P=0.70). Eleven patients (20%) exhibited a deterioration in hearing (as measured by AC) of 5 dB or greater on the aided side compared with the unaided side, while 23 (53.5%) showed greater WRS deterioration on the aided side. No significant factors were found to contribute to the difference in hearing deterioration between groups for either AC or WRS.

CONCLUSION

No significant factors were identified as contributing to hearing deterioration after prolonged HA use. Overall, the use of HAs did not adversely impact residual hearing.

Evaluation of Serum Levels of Vitamin D3 and IgE in Patients with Chronic and Allergic Sinusitis: A Cross-sectional Study

BACKGROUND

Chronic rhinosinusitis is known as a common problem with inflammatory and allergic causes. Several factors are associated with developing chronic rhinosinusitis, including immunoglobulin E (IgE) production and vitamin D deficiency.

OBJECTIVE

In this study, we investigated the role of IgE and Vitamin D deficiency and differences between patients with chronic, allergic sinusitis and controls.

METHODS

A total of 90 subjects were included in 3 groups (n=30) in this cross-sectional, correlational descriptive study. The subjects were divided into three groups, including control (healthy subjects), chronic sinusitis patients, and allergy patients. A checklist was used to collect the necessary data, including age, gender, and body mass index (BMI). To evaluate serum levels of vitamin D3 and IgE, ELISA kits were used.

RESULTS

The mean vitamin D was 22 g/ml. Fifty-four participants (60%) out of all included people had insufficient vitamin D, 13% had a deficiency, and the high deficiency and insufficiency were in the group of allergic sinusitis. Our results indicated that gender (female) was significantly associated with vitamin D deficiency (p =0.01). Thirty-nine participants (43.3%) out of all studied subjects had high IgE, and the highest level of abnormality of IgE was in the allergic sinusitis group. Furthermore, it was found that gender and IgE were not significantly related. However, IgE was significantly associated with vitamin D deficiency in the allergic sinusitis group.

CONCLUSION

Our findings highlighted that most of the patients with chronic and allergic sinusitis had insufficient vitamin D. A possible association was also found between low vitamin D and IgE levels and the prevalence of allergic sinusitis. This study showed that patients with allergic sinusitis may be more vulnerable to lower serum levels of vitamin D. Therefore, vitamin D supplementation as an adjunctive therapy may be considered in these patients.

Acoustic differences in tinnitus between noise-induced and non-noise-induced hearing loss

BACKGROUND

Tinnitus, the perception of sound without external stimuli, varies across hearing loss types. The present study compared the acoustic characteristics of tinnitus in patients with noise-induced hearing loss (NIHL) and in those with hearing loss unrelated to noise exposure.

OBJECTIVE

This study compared the acoustic characteristics of tinnitus in patients with noise-induced and non-noise-induced hearing loss.

METHODS

A total of 403 patients with tinnitus were divided into those with noise-induced and non-noise-induced hearing loss. Patients were evaluated by pure tone audiometry (PTA), tinnitogram, transient evoked otoacoustic emission (TEOAE), distortion product otoacoustic emission (DPOAE), and auditory brainstem evoked response (ABR) tests.

RESULTS

Patients with NIHL exhibited significantly higher hearing thresholds across all frequencies (125-8000 Hz) (p < .05) and reported significantly higher tinnitus intensity (p < .05). Otoacoustic emission tests showed that response rates were significantly lower (p < .05), and ABR tests found that latency periods were significantly more prolonged (p < .05), in patients with NIHL.

CONCLUSIONS

Tinnitus differs acoustically between patients with NIHL and those with non-noise-induced hearing loss, with specific patterns of intensity and auditory responses. These findings emphasize the need for tailoring the management of tinnitus according to the underlying type of hearing loss.

Tinnitus Prevalence in the Adult Population-Results from the Gutenberg Health Study

Background and Objectives: Tinnitus is a common symptom in medical practice, although data on its prevalence vary. As the underlying pathophysiological mechanism is still not fully understood, hearing loss is thought to be an important risk factor for the occurrence of tinnitus. The aim of this study was to assess tinnitus prevalence in a large German cohort and to determine its dependence on hearing impairment. Materials and Methods: The Gutenberg Health Study (GHS) is a population-based cohort study and representative for the population of Mainz and its district. Participants were asked whether they suffer from tinnitus and how much they are burdened by it. Extensive audiological examinations using bone- and air-conduction were also performed. Results: 4942 participants (mean age: 61.0, 2550 men and 2392 women) were included in the study. The overall prevalence of tinnitus was 26.1%. Men were affected significantly more often than women. The prevalence of tinnitus increased with age, peaking at ages 75 to 79 years. Considering only annoying tinnitus, the prevalence was 9.8%. Logistic regression showed that participants with severe to complete hearing loss (>65 dB) were more likely to have tinnitus. Conclusions: Tinnitus is a common symptom, and given demographic changes, its prevalence is expected to increase.

Changes in Subjective Outcomes during the Early Period after Septoturbinoplasty

PURPOSE

Septoturbinoplasty is frequently performed to correct nasal obstruction; however, there is still a lack of research on changes in nasal and nose-related symptoms early after septoturbinoplasty. Therefore, we aimed to investigate changes in subjective outcomes within 6 months after septoturbinoplasty.

MATERIALS AND METHODS

The medical records of patients who underwent septoturbinoplasty at Gangnam Severance Hospital were retrospectively analyzed. Symptom scores were evaluated using the Sino-nasal Outcome Test (SNOT-22) and obstruction scores. The SNOT-22 and obstruction scores were investigated before surgery and at 1, 3, and 6 months after surgery.

RESULTS

We noted significant decreases in both SNOT-22 and obstruction scores at 1 month after surgery, compared to those before surgery (p<0.001). However, there were no significant changes at 3 and 6 months after surgery, compared to scores at 1 month after surgery. Using multivariate logistic regression analysis, a larger difference between SNOT-22 scores preoperatively and 1 month after surgery was significantly associated with a significant improvement in symptoms at 3 or 6 months after septoturbinoplasty (p=0.029).

CONCLUSION

These results imply that subjective outcomes and degree of improvement in the first month after septoturbinoplasty can be used as a predictor of the results thereof and for counseling patients about its progress.

Bilateral Congenital Preauricular Fistula of the Cavum Conchae

A 16-year-old female who had left auricular sinus infections was admitted to our hospital. On physical examination, bilateral sinus tract openings were noted at the cavum conchae. We used a surgical microscope to complete the total resection of the bilateral sinus at the cavum conchae. Also dissected was the cartilage from the cavum conchae. To our knowledge, surgical excision of cavum conchae sinuses has not been previously described.

Prevalence and associated risk factors of tinnitus among adult Palestinians: a cross-sectional study

Tinnitus is a common complaint with potentially negative impact on quality of life. Prevalence of tinnitus ranges from 5 to 43% worldwide. This variation could be due to the heterogeneity of tinnitus assessment. This has limited the progress in understanding tinnitus. Therefore, we employed a standardized and a validated assessment method to determine the prevalence and related risk factors of tinnitus among Palestinians for the first time. This is a cross-sectional study in which we questioned a representative sample of 618 subjects in one-to-one interviews. The prevalence of any tinnitus was 30.6% among adult Palestinians. Participants from the oldest age group were almost five times more likely to have tinnitus. Moreover, participants with head and neck pain syndrome, severe hearing impairment, sleeping disorders or frequent complaints of vertigo were approximately two times more likely to have tinnitus. Our study provides novel information regarding tinnitus in Palestine and improves our understanding of tinnitus. This will improve the diagnosis and consequently will contribute in reducing the prevalence and perhaps in preventing tinnitus. As tinnitus still has no known cure, further investigations of modifiable risk factors and causes of tinnitus are crucial to prevent it in the future.

Chronic Rhinosinusitis and the Increased Incidence of Atopic Dermatitis

BACKGROUND

Chronic rhinosinusitis (CRS) is often associated with other comorbidities due to chronic inflammation. However, no population-based, longitudinal study has investigated the relationship between CRS and chronic skin inflammation.

OBJECTIVE

To investigate the potential relationship between CRS and chronic skin inflammatory diseases, such as atopic dermatitis (AD), vitiligo, and psoriasis.

METHODS

A total of 5638 patients with CRS and 11 276 without CRS as a comparison group, were included from the Korean National Health Insurance Service database from 2002-2013. A propensity score matching (1:2) was performed using the nearest neighbor matching method, sociodemographic factors, and enrollment year. The Cox proportional hazards model was used to analyze the hazard ratio of CRS for AD, vitiligo, and psoriasis.

RESULTS

Results from this study showed that patients with CRS had no significant risk of the subsequent development of vitiligo or psoriasis compared to patients without CRS. However, we found a significantly higher incidence of AD in CRS patients than in those without CRS. The incidence of AD was 63.59 per 1000 person-years in the CRS group and 45.38 per 1000 person-years in the comparison group. Additionally, young and middle-aged CRS patients were independently associated with a higher incidence of subsequent AD events, but we could not find a significantly higher incidence of AD events in the elderly group.

CONCLUSIONS

Our findings suggest there are no significant differences in the overall risk of vitiligo and psoriasis events in patients with CRS; however, we detected a higher risk of AD in young and middle-aged CRS patients. Therefore, clinicians should consider the risk of developing AD in specific patients who are newly diagnosed with CRS.

Prevalence of Tympanic Membrane Perforations Among Adolescents, Adults, and Older Adults in the United States

Tympanic membrane (TM) perforations can occur at any age, but limited population-level data are available. Using data from the National Health and Nutrition Examination Survey, we performed a cross-sectional analysis of the prevalence and population estimates for TM perforations among individuals ≥12 years old in the United States. Overall, TM perforations have a prevalence of 2.1% (95% CI, 1.7%-2.6%), corresponding to 5.8 million Americans. Across the life course, older adults have the highest prevalence of TM perforations at 6.1% (95% CI, 4.7%-7.6%), corresponding to nearly 3 million Americans, as opposed to a prevalence of 0.6% (95% CI, 0.3%-0.9%) in adolescents, which equates to 0.2 million Americans. Males and females have a similar prevalence at 2.3% (95% CI, 1.6%-3.0%) among males and 2.0% (95% CI, 1.4%-2.6%) among females. These prevalence and population estimates provide the first US-based population estimates of the burden of TM perforations over the life course.

Association of temporomandibular disorders and tinnitus with health-related quality of life: A cross-sectional study using the Fifth Korea National Health and Nutrition Examination Survey

BACKGROUND

Few studies have examined the associations of temporomandibular disorders (TMDs) and tinnitus with health-related quality of life on a national level.

OBJECTIVE

We aimed to investigate the associations of TMDs, tinnitus and quality of life among the Korean population, aged 19 years or older.

METHODS

Data were obtained from the fifth Korea National Health and Nutrition Examination Survey (2012; N = 5786). TMDs, tinnitus and health-related quality of life were assessed using self-report data from EuroQol-5 Dimension. Participants were divided into four groups: no TMD and no tinnitus, TMD present but no tinnitus, no TMD but tinnitus present and both TMD and tinnitus present.

RESULTS

Among the participants, 21.88% had TMD, 24.93% had tinnitus, and 7.74% had both. The prevalence of most TMD and all types of tinnitus was higher among females than among males. The group with both TMD and tinnitus reported the highest percentage of problems in the usual activity, pain/discomfort and anxiety/depression dimensions. Moreover, the odds ratio (OR) for lower quality of life was significantly higher in the group with both TMD and tinnitus compared to the group without TMD and tinnitus: mobility (OR = 1.527, 95% confidence interval [CI]: 1.014-2.300), pain/discomfort (OR = 2.072, 95% CI: 1.570-2.735), anxiety/depression (OR = 1.692, 95% CI: 1.034-2.767), EQ-5D score (OR = 1.651, 95% CI: 1.121-2.431) and EQ-VAS (OR = 1.682, 95% CI: 1.246-2.269).

CONCLUSION

The presence of both TMD and tinnitus has a considerable impact on HRQoL in the Korean population. In our study, the group with both TMD and tinnitus showed lower HRQoL than without TMD and tinnitus group. These results emphasise the need for a multilateral and comprehensive approach to address these disorders and provide baseline data for developing appropriate interventions.

A non-invasive, automated diagnosis of Menière's disease using radiomics and machine learning on conventional magnetic resonance imaging: A multicentric, case-controlled feasibility study

Purpose

This study investigated the feasibility of a new image analysis technique (radiomics) on conventional MRI for the computer-aided diagnosis of Menière’s disease.

Materials and methods

A retrospective, multicentric diagnostic case–control study was performed. This study included 120 patients with unilateral or bilateral Menière’s disease and 140 controls from four centers in the Netherlands and Belgium. Multiple radiomic features were extracted from conventional MRI scans and used to train a machine learning-based, multi-layer perceptron classification model to distinguish patients with Menière’s disease from controls. The primary outcomes were accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the classification model.

Results

The classification accuracy of the machine learning model on the test set was 82%, with a sensitivity of 83%, and a specificity of 82%. The positive and negative predictive values were 71%, and 90%, respectively.

Conclusion

The multi-layer perceptron classification model yielded a precise, high-diagnostic performance in identifying patients with Menière’s disease based on radiomic features extracted from conventional T2-weighted MRI scans. In the future, radiomics might serve as a fast and noninvasive decision support system, next to clinical evaluation in the diagnosis of Menière’s disease.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11547-021-01425-w.

Analysis of medical services provided to patients with peripheral facial palsy in Korea: a descriptive, cross-sectional study of the health insurance review and assessment service national patient sample database

Background

This cross-sectional, retrospective, observational study analyzed the demographics of patients with peripheral facial palsy in South Korea and their use of healthcare services.

Methods

The 2016 Korean Health Insurance Review and Assessment National Patient Sample dataset was used; a total of 4790 patients, diagnosed with facial palsy, who had used healthcare services at least once between January 2016 and December 2016 were included, and data on the use of medical services, hospitalizations, sociodemographic factors, treatments, and medications were analyzed.

Results

Overall, 326 patients per 100,000 individuals used healthcare services at least once because of peripheral facial palsy in 2016, with higher numbers for women and those aged 50–59 years. The percentage of patients who used Korean traditional medicine (KM), Western medicine (WM), and both KM and WM was 54.4, 23.3, and 22.3%, respectively. Users of both WM and KM had higher per capita medical costs, more visits, and longer treatment durations. Physiotherapy was the most frequent WM treatment (44.4%), and “examinations” was the costliest (24.7%) category. “Procedures” was both the most frequent and costliest KM category (99.9 and 57.3%, respectively). “Continuous intravenous injections” (8.6%) and “superficial heat therapy” (8.3%) were the most frequent WM treatments, while acupuncture accounted for 98% of all KM treatments.

Conclusions

This study analyzed the demographic characteristics and medical service use of patients with peripheral facial palsy in detail. These results can be used as basic information to improve clinical and policy strategies for the management and treatment of peripheral facial palsy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07078-9.

Acoustic drug delivery to the maxillary sinus

Acoustic drug delivery (ADD) is an innovative method for drug delivery to the nose and paranasal sinuses and can be used to treat chronic rhinosinusitis (CRS). The underlying mechanism of ADD is based on the oscillatory exchange of air between the nasal cavity (NC) and the maxillary sinus (MS) through the ostium, which assists with the transfer of the drug particles from the NC to the sinuses. This study aims to examine the efficacy of ADD for drug delivery to the MS using an acoustic wave applied to nebulised aerosols entering the nostril. Here, the effect of acoustic frequency, amplitude, and nebulisation flowrate on the efficiency of ADD to the MS is investigated experimentally. A computational fluid dynamics model was also developed to understand the deposition and transport patterns of the aerosols. The results showed that superimposing an acoustic frequency of 328 Hz, which is the resonance frequency of the selected 3D printed model of the NC-MS combination, on the nebulised aerosols could improve the efficiency of the drug delivery to the MS by 75-fold compared with non-acoustic drug delivery case (p < 0.0001). The experimental data also shows that an increase in the amplitude of excitation, increases the concentration of aerosol deposition in the MS significantly; however, it reaches to a plateau at a sound pressure level of 120 dB re 20 µPa.

Prevalence and Symptom Burden of Nasal Polyps in a Large Austrian Population

BACKGROUND

Although chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory condition with significant morbidity and financial cost, information regarding prevalence and disease burden of this condition is scarce.

OBJECTIVE

In this study we determined nasal polyp prevalence, polyp grade, concomitant disease, and symptom burden in > 10,000 central European subjects.

METHODS

In this retrospective, cross-sectional study, 10,259 patients who had undergone routine examination of their nose by nasal endoscopy during a visit at a publicly accessible ENT outpatient facility in Vienna were included. Patient details including presenting complaint, nasal symptoms, polyp score, age, gender, treatment, asthma and allergic status were extracted retrospectively. A detailed questionnaire including history of nasal symptoms, SNOT-20 GAV, and VAS was available for 101 patients with nasal polyps.

RESULTS

Nasal polyps were detected in 189 (1.84%) of the 10,259 patients. The calculated prevalence of polyps in Austria, adjusted for age and gender, was 1.95%. The average TPS was 3.4, 72.5% had a TPS of ≤4, with males and asthmatics having significantly larger polyps. Questionnaire analysis revealed that 67% suffered from a low symptom burden of ≤36. According to current EPOS guidelines, 6% of polyp patients fulfilled and another 8% potentially fulfil the eligibility criteria for biological therapy.

CONCLUSION

Nasal polyp prevalence was calculated to be 1.95% of the Austrian population. Large polyps (TPS>4) were found in 25%, 33% suffered from a high nasal symptom burden, and between 6 to 14% of polyp patients would be eligible for biological therapy according to EPOS guidelines.

[Neutrophil extracellular traps in the pathogenesis of chronic rhinosinusitis]

The review presents the current understanding of the pathogenesis of chronic rhinosinusitis. The causes of damage to the mucous membrane of the paranasal sinuses are most often the result of a combination of immunological, infectious and anatomical factors. This indicates the need for a multidisciplinary approach to the study of the pathogenesis of this pathology. There is no single universally recognized classification of chronic rhinosinusitis, which takes into account histological and immunological changes in the mucous membrane of the paranasal sinuses. The discovery of the mechanism of completion of the life cycle of neutrophils - the formation of a neutrophil extracellular trap or NETosis, different from necrosis and apoptosis, opened up new prospects in the study of the pathogenesis of inflammatory processes, including rhinosinusitis. Neutrophil extracellular traps reduce the permeability of the epithelial barrier in the mucous membrane of the paranasal sinuses. This determines their possible role in the etiopathogenesis of rhinosinusitis. In recent years, more and more attention has been paid to the feasibility, effectiveness and safety of therapy that affects the immune component of the inflammatory process, including NETosis. The data obtained in the study of extracellular traps can be used in clinical practice. It is neutrophil extracellular traps that can become a potential target in the treatment of patients with chronic rhinosinusitis.

The "hype" of hydrops in classifying vestibular disorders: a narrative review

Background

Classifying and diagnosing peripheral vestibular disorders based on their symptoms is challenging due to possible symptom overlap or atypical clinical presentation. To improve the diagnostic trajectory, gadolinium-based contrast-enhanced magnetic resonance imaging of the inner ear is nowadays frequently used for the in vivo confirmation of endolymphatic hydrops in humans. However, hydrops is visualized in both healthy subjects and patients with vestibular disorders, which might make the clinical value of hydrops detection on MRI questionable.

Objective

To investigate the diagnostic value of clinical and radiological features, including the in vivo visualization of endolymphatic hydrops, for the classification and diagnosis of vestibular disorders.

Methods

A literature search was performed in February and March 2019 to estimate the prevalence of various features in healthy subjects and in common vestibular disorders to make a graphical comparison between healthy and abnormal.

Results

Of the features studied, hydrops was found to be a highly prevalent feature in Menière’s disease (99.4%). Though, hydrops has also a relatively high prevalence in patients with vestibular schwannoma (48.2%) and in healthy temporal bones (12.5%) as well. In patients diagnosed with (definite or probable) Menière’s disease, hydrops is less frequently diagnosed by magnetic resonance imaging compared to the histological confirmation (82.3% versus 99.4%). The mean prevalence of radiologically diagnosed hydrops was 31% in healthy subjects, 28.1% in patients with vestibular migraine, and 25.9% in patients with vestibular schwannoma. An interesting finding was an absolute difference in hydrops prevalence between the two diagnostic techniques (histology and radiology) of 25.2% in patients with Menière’s disease and 29% in patients with vestibular schwannoma.

Conclusions

Although the visualization of hydrops has a high diagnostic value in patients with definite Menière’s disease, it is important to appreciate the relatively high prevalence of hydrops in healthy populations and other vestibular disorders. Endolymphatic hydrops is not a pathognomic phenomenon, and detecting hydrops should not directly indicate a diagnosis of Menière’s disease. Both symptom-driven and hydrops-based classification systems have disadvantages. Therefore, it might be worth to explore features “beyond” hydrops. New analysis techniques, such as Radiomics, might play an essential role in (re)classifying vestibular disorders in the future.

Electronic supplementary material

The online version of this article (10.1007/s00415-020-10278-8) contains supplementary material, which is available to authorized users.

Systematic literature review of the epidemiology and clinical burden of chronic rhinosinusitis with nasal polyposis

OBJECTIVES

We conducted a systematic literature review (SLR) to determine the epidemiology and clinical burden of chronic rhinosinusitis with nasal polyps (CRSwNP) and to describe how the addition of biologics has affected outcomes for patients with CRSwNP.

METHODS

The SLR adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Embase, MEDLINE, and Evidence-Based Medicine Reviews databases were searched using OVID. Relevant studies published between 1 January 2008 and 8 February 2019, for epidemiology, and 1 January 2008 and 16 February 2019, for clinical burden, and relevant conference abstracts from 1 January 2017 to 7 March 2019, for epidemiology and 1 January 2017-16 February 2019 for clinical burden were included.

RESULTS

For the epidemiology and clinical burden SLR, 147 and 119 records, respectively, met the inclusion criteria. We found the prevalence of CRSwNP was 1-2.6% and was greater in men. Asthma, allergy, and allergic rhinitis were the most common comorbidities identified. Reported risk factors included asthma, gene polymorphisms, age, and eosinophilia. Studies indicated that dupilumab, mepolizumab, and omalizumab each improved different clinical outcomes. Non-biologics (drugs such as corticosteroids or antibiotics, surgery, or aspirin desensitization) improved clinical outcomes as well.

CONCLUSIONS

CRSwNP is fairly prevalent in the general population. Despite the significant efficacy of existing treatments, several unmet needs remain. The high burden of uncontrolled symptoms, frequent recurrence of nasal polyps after surgery, and long-term adverse effects of oral corticosteroids indicate that new therapies addressing these unmet needs should be developed. Although data on biologics from randomized controlled trials look promising, the efficacy of biologics in the real world has yet to be established. The SLR of the epidemiology and clinical burden of CRSwNP revealed key gaps in the literature. There was a paucity of prevalence data across many geographic areas, and no prevalence projections could be determined. Studies showed varying efficacy of non-biologics and no studies directly compared biologics for efficacy. Data regarding clinical efficacy of agents for eosinophilic CRSwNP or severe CRSwNP were lacking, and these patient populations would be served by more trials.

A prediction modeling based on SNOT-22 score for endoscopic nasal septoplasty: a retrospective study

Background

To create a nomogram prediction model for the efficacy of endoscopic nasal septoplasty, and the likelihood of patient benefiting from the operation.

Methods

A retrospective analysis of 155 patients with nasal septum deviation (NSD) was performed to develop a predictive model for the efficacy of endoscopic nasal septoplasty. Quality of life (QoL) data was collected before and after surgery using Sinonasal Outcome Test-22 (SNOT-22) scores to evaluate the surgical outcome. An effective surgical outcome was defined as a SNOT-22 score change ≥ 9 points after surgery. Multivariate logistic regression analysis was then used to establish a predictive model for the NSD treatment. The predictive quality and clinical utility of the predictive model were assessed by C-index, calibration plots, and decision curve analysis.

Results

The identified risk factors for inclusion in the predictive model were included. The model had a good predictive power, with a AUC of 0.920 in the training group and a C index of 0.911 in the overall sample. Decision curve analysis revealed that the prediction model had a good clinical applicability.

Conclusions

Our prediction model is efficient in predicting the efficacy of endoscopic surgery for NSD through evaluation of factors including: history of nasal surgery, preoperative SNOT-22 score, sinusitis, middle turbinate plasty, BMI, smoking, follow-up time, seasonal allergies, and advanced age. Therefore, it can be cost-effective for individualized preoperative assessment.

Association between Bone Metabolism and Vestibular Problems in the Modified Romberg Test: Data from the 2009-2010 Korean National Health and Nutrition Examination Survey

Osteoporosis contributes to the occurrence of falling and vestibular problems, particularly in elderly patients. This study aimed to investigate the association between bone metabolism with vestibular problems and falling. A total of 4054 participants of the Korean National Health and Nutrition Examination Survey (KNHANES) from 2009 to 2010 aged ≥50 years old were surveyed on their history of falling, vestibular problems evaluated by the modified Romberg test, variables involving bone metabolism, and serum levels of vitamin D and alkaline phosphatase. They also underwent dual energy X-ray absorptiometry. The crude (simple) and adjusted odd ratios (ORs) of variables involving bone metabolism for vestibular problems in the modified Romberg test and falling were analyzed using a logistic regression model. A subgroup analysis was performed according to sex and the presence of menopause in females. Vestibular problems in the modified Romberg test group but not the falling group were associated with decreased serum vitamin D levels (p < 0.001; odds ratio (OR) = 0.951; 95% confidence interval (CI), 0.926-0.976). In subgroup analysis according to sex, the post-menopause group showed a higher rate of vestibular problems in the modified Romberg test compared to the pre-menopause group (4.5% vs. 0.7%, p = 0.019). In the post-menopause group, osteoporosis was positively associated with vestibular problems in the modified Romberg test (p = 0.001, OR = 10.971, 95% CI = 2.650-45.414). On the other hand, a history of hormone replacement therapy was negatively related with vestibular problems in this subgroup (p = 0.035; OR = 0.473; 95% CI = 0.239-0.948). A decrease in serum vitamin D levels may impact the vestibular system through neural signaling or by osteoporotic changes of the otic capsule, as well as otolith particles. Decreased estrogen levels in postmenopausal women may make them more prone to osteoporotic changes, which were associated with vestibular problems in the modified Romberg test. Because this is a cross-sectional study, the causal relationship of bone metabolism with vestibular function needs to be investigated.

Clinical Performance Evaluation of a Personal Sound Amplification Product vs a Basic Hearing Aid and a Premium Hearing Aid

Importance

Hearing loss is a highly prevalent condition with multiple negative associated outcomes, yet few persons with hearing loss have hearing aids (HAs). Personal sound amplification products (PSAPs) could be an alternative low-cost solution to HAs, but data are lacking on the performance of PSAPs.

Objective

To evaluate the clinical efficacy of a PSAP by comparing its performance with that of a basic HA and a premium HA in participants with mild, moderate, and moderately severe hearing impairment.

Design, Setting, and Participants

A prospective, single-institution cohort study was performed with a total of 56 participants, including 19 with mild hearing loss, 20 with moderate hearing loss, and 17 with moderately severe hearing loss. All participants underwent 4 clinical hearing tests with each of the PSAP, basic HA, and premium HA, and all completed an evaluative questionnaire.

Interventions

All hearing devices (PSAP, basic HA, and premium HA) were applied by a clinician to prevent bias and order effects; participants were blinded to the device in use, and sequence of devices was randomized.

Main Outcomes and Measures

The study used the Korean version of the hearing in noise test, the speech intelligibility in noise test, listening effort measurement using a dual-task paradigm, pupillometry, and a self-rating questionnaire regarding sound quality and preference. These tests were administered under the following 4 hearing conditions: unaided hearing, use of PSAP, use of basic HA, and use of premium HA.

Results

The study included 56 participants with a mean age of 56 years (interquartile range, 48-59 years); 29 (52%) were women. In the mild and moderate hearing loss groups, there was no meaningful difference between PSAP, basic HA, and premium HA for speech perception (Cohen d = 0.06-1.05), sound quality (Cohen d = 0.06-0.71), listening effort (Cohen d = 0.10-0.92), and user preference (PSAP, 41%; basic HA, 28%; premium HA, 31%). However, for the patients with moderately severe hearing loss, the premium HA had better performance across most tests (Cohen d = 0.60-1.59), and 70% of participants preferred to use the premium HA.

Conclusions and Relevance

The results indicate that basic and premium HAs were not superior to the PSAP in patients with mild to moderate hearing impairment, which suggests that PSAPs might be used as an alternative to HAs in these patient populations. However, if hearing loss is more severe, then HAs, especially premium HAs, should be considered as an option to manage hearing loss.

Acromioplasty rates in patients with shoulder disorders with and without acupuncture treatment: a retrospective propensity score-matched cohort study

OBJECTIVE

This retrospective propensity score-matched cohort study aimed to examine the frequency of acromioplasty among patients with shoulder disorders receiving and not receiving acupuncture, based on Korea National Health Insurance Service-National Sample Cohort (NHIS-NSC) data.

METHODS

We included cases of high-frequency shoulder disorders-adhesive capsulitis, rotator cuff syndrome, shoulder impingement syndrome, and sprain and strain of the shoulder joint-stratified from the Korea NHIS-NSC database between 2002 and 2013; cases were classified into two groups based on a history of acupuncture treatment performed at least twice within 6 weeks (acupuncture group: n = 111,561; control group: n = 71,340). We examined propensity scores and hazard ratios (HRs) for the frequency of acromioplasty, within 2 years of the first treatment or first examination in the acupuncture and control groups, respectively; cumulative survival rates were estimated using Kaplan-Meier survival analysis.

RESULTS

Following propensity score matching, no differences were observed between the acupuncture and control groups for variables including sex, age, income and the Charlson comorbidity index. In addition, the incidence rates of acromioplasty within 2 years were lower in the acupuncture group than in the control group (HR 0.264; 95% confidence interval 0.224-0.311). Based on differences in sensitivity analyses for the numbers of acupuncture sessions and treatment duration, the frequency of acromioplasty within 2 years was lower in the acupuncture group than in the control group.

CONCLUSION

This study found that the frequency of acromioplasty was reduced in patients with shoulder disorders who had been treated with acupuncture. Although the findings need to be verified by prospective randomized clinical trials, these results imply that acupuncture may be effective at reducing the incidence rate of shoulder surgery.

Increased risk of psoriasis in patients with chronic rhinosinusitis without nasal polyps: a longitudinal follow-up study using Korean national sample cohort

PURPOSE

Focal chronic inflammation or infection is thought to be one of the causes of psoriasis. Few reports on the association between chronic rhinosinusitis (CRS) and psoriasis exist, thus it is poorly defined. This study seeks to investigate the incidence of psoriasis in patients with CRS with reference to a matched control group.

METHODS

This national cohort study relies on data from Korean Health Insurance Review and Assessment Service-National Sample Cohort (HIRA-NSC), which were entered from 2002 to 2013. A total of 34,219 patients with CRS without nasal polyps was matched with 136,976 controls. The Cox proportional hazard model was used to analyze the crude (simple) and adjusted hazard ratios (HRs) of psoriasis. For subgroup analysis, participants were grouped by age and sex.

RESULTS

The risk of psoriasis was higher in the CRS group than in the control group (adjusted HR 1.28, 95% CI 1.12-1.47, P < 0.001). Children, adolescents below 19 years regardless of sex, and old adult men above 60 years are at significantly higher risk for subsequent psoriasis after CRS diagnosis.

CONCLUSION

CRS may increase the risk of psoriasis.

Standard Audiograms for Koreans Derived through Hierarchical Clustering Using Data from the Korean National Health and Nutrition Examination Survey 2009-2012

Assessments of standardized region/population-specific audiological characteristics are needed for provision of effective rehabilitative services through reducing costs associated with hearing aids. This study aims to propose a set of standard audiograms representing the Korean population that were derived by analyzing data from the 2009–2012 Korea National Health and Nutrition Examination Survey (KNHANES), a nationwide epidemiologic study conducted by Korean government organizations. Standard audiograms were derived by applying a hierarchical clustering method from recorded audiologic data that were obtained independently at 6 frequencies for each ear: 0.5, 1.0, 2.0, 3.0, 4.0, and 6.0 kHz (in dB HL). To derive the optimal number of clusters of the desired standard audiograms, cubic clustering criterion, pseudo-F-, and pseudo-t2-statistics were calculated. These analyses resulted in 29 clusters representing a standard audiogram of the South Korean population. Eighteen of the clusters represented normal hearing audiograms (73.11%), while 11 represented hearing-impaired (HI) standard audiograms (27.89%). Of the 11 HI audiograms, 7 were defined as flat-type (17.81%), while the remaining 4 were defined as sloping-type (9.08%). In conclusion, 29 audiograms representing standard audiograms for the Korean population have been derived using KNHANES data. Improved understanding of the characteristics of each cluster may be helpful for development of more personalized, fixed-setting hearing aids.

Therapeutic effect of topical administration of red onion extract in a murine model of allergic rhinitis

The aim of this study was to evaluate the effect of topical administration of onion (Allium cepa) extract on nasal cavity for treatment of allergic rhinitis (AR). BALB/c mice were sensitized by intraperitoneal injection of ovalbumin (OVA) and challenged with intranasal instillation of OVA with or without onion extracts for five times a week on 3 consecutive weeks. Allergic symptom score according to frequencies of sneezing, serum total and OVA specific immunoglobulin E (IgE) level, cytokine levels of nasal mucosa and eosinophilic infiltration were analyzed. Allergic symptom score, serum total and OVA specific IgE, cytokine levels of nasal mucosa (interleukin (IL)-4, IL-5, IL-10, IL-13, IFN-γ, TNF-α and COX-2) and eosinophilic infiltration were higher in allergic mouse group than negative control group. Topical application of onion extracts significantly reduced allergic symptoms and OVA specific IgE levels. Cytokine levels of IL-4, IL-5, IL-10, IL-13 and IFN-γ were significantly decreased in groups treated with onion extract. In addition, eosinophil infiltration of nasal turbinate mucosa was also significantly decreased after treatment with onion extract. Topical administration of onion extract significantly reduces allergic rhinitis symptom and allergic inflammatory reaction in a murine allergic model. It can be assumed that the topical application of onion extract regulates allergic symptoms by suppressing the type-1 helper (Th1) and type-2 helper (Th2) responses and reducing the allergic inflammatory reaction.

Effect of comorbid depression on health-related quality of life of patients with chronic diseases: A South Korean nationwide study (2007-2015)

OBJECTIVE

Patients with chronic physical diseases often have concomitant depression. Depression influences an individual's health and his or her overall health-related quality of life (HRQoL). The extent to which depression incrementally worsens HRQoL in patients with ≥1 comorbid physical chronic diseases remains unclear.

METHODS

This cross-sectional study is based on data of 50,844 respondents (age, ≥19 years) who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) (2007-2015). HRQoL was measured using the modified EuroQol five-dimensional (EQ-5D) score. Mean HRQoL scores were compared between subgroups of respondents with or without depression. The association between HRQoL and disease status was evaluated using multiple regression models after controlling for sociodemographic variables.

RESULTS

HRQoL score decreased when depression was concomitant. HRQoL score of respondents who had ≥3 chronic diseases with concomitant depression (mean = 0.83, SE = 0.010) were significantly lower (p = 0.002) than those of respondents who had ≥3 chronic diseases but no concomitant depression (mean = 0.87, SE = 0.007). Moreover, respondents with ≥3 chronic diseases comorbid with depression showed the largest negative association (coefficient = -0.133, p < 0.001) with HRQoL among all disease status groups.

CONCLUSION

Presence of depression incrementally worsened individual's HRQoL when comorbid with other physical diseases. Especially, depression showed substantial negative effect on HRQoL level in patients with ≥2 physical diseases.

Changing Disease Trends in the Northern Gyeonggi-do Province of South Korea from 2002 to 2013: A Big Data Study Using National Health Information Database Cohort

Objectives

To investigate the chronological patterns of diseases in Northern Gyeonggi-do province, South Korea, and compare these with national data.

Methods

A National Health Insurance cohort based on the National Health Information Database (NHID Cohort 2002–2013) was used to perform a retrospective, population-based study (46,605,433 of the target population, of which 1,025,340 were randomly sampled) to identify disease patterns from 2002 to 2013. Common diseases including malaria, cancer (uterine cervix, urinary bladder, colon), diabetes mellitus, psychiatric disorders, hypertension, intracranial hemorrhage, bronchitis/bronchiolitis, peptic ulcer, and end stage renal disease were evaluated.

Results

Uterine cervix cancer, urinary bladder cancer and colon cancer had the greatest rate of increase in Northern Gyeonggi-do province compared with the rest of the country, but by 2013 the incidence of these cancers had dropped dramatically. Acute myocardial infarction and end stage renal disease also increased over the study period. Psychiatric disorders, diabetes mellitus, hypertension and peptic ulcers showed a gradual increase over time. No obvious differences were found for intracranial hemorrhage or bronchitis/bronchiolitis between the Northern Gyeonggi-do province and the remaining South Korean provinces. Malaria showed a unique time trend, only observed in the Northern Gyeonggi province, peaking in 2004, 2007 and 2009 to 2010.

Conclusion

This study showed that the Northern Gyeonggi-do province population had a different disease profile over time, compared with collated data for the remaining provinces in South Korea. “Big data” studies using the National Health Insurance cohort database can provide insight into the healthcare environment for healthcare providers, stakeholders and policymakers.

Safety and efficacy of Galgeun-tang-ga-cheongung-sinyi, a herbal formula, for the treatment of chronic rhinosinusitis: A study protocol for a randomized controlled trial

INTRODUCTION

A herbal formula, Galgeun-tang-ga-cheongung-sinyi (GGTCS), is traditionally used for the treatment of rhinosinusitis in East Asian countries. However, there is a dearth of clinical evidence supporting the effects of this medication. Here, we describe the protocol for a randomized controlled study designed to investigate the efficacy and safety of GGTCS for the treatment of chronic rhinosinusitis (CRS).

METHODS AND ANALYSIS

To investigate the clinical efficacy and safety of GGTCS for the treatment of CRS, a randomized, double-blind, placebo-controlled, parallel group, clinical trial has been designed. A total of 58 participants with CRS will be recruited and randomly allocated to a GGTCS or placebo group in a 1:1 ratio. The participants will be administered GGTCS or placebo granules 3 times a day for 8 weeks. Data will be collected from the participants at baseline and at 1, 2, 4, and 8 weeks after random allocation. The primary outcome measure will be the mean change in the Sino-Nasal Outcome Test-22 score from baseline to 8 weeks. The secondary outcomes will include the Total Nasal Symptom Score, EuroQoL 5 Dimensions 5 Levels score, Nasal Endoscopy Index, Lund-Mackay score, and total serum immunoglobulin E level.

DISCUSSION

The key elements for conducting a high-quality randomized clinical trial have been addressed in this protocol. In summary, the findings of this study are expected to provide a base for large-scale randomized controlled trials to confirm the safety and efficacy of GGTCS for the treatment of CRS and may consequently serve to improve future treatment strategies for this condition.

TRIAL REGISTRATION

This study has been registered at the Korean National Clinical Trial Registry, Clinical Research Information Service (KCT0002835).

Tinnitus, depression, and suicidal ideation in adults: A nationally representative general population sample

Tinnitus is strongly associated with psychiatric symptoms, including depression and suicidality. We aimed to further investigate the association of tinnitus with depressive mood and/or suicidal ideation, and explore the shared risk factors for these within a representative sample of the adult general population. We also investigated potential mediation pathways among tinnitus, suicidal ideation, depression, shared risk factors, and perceived stress levels. We analysed data from 28,930 adults (aged ≥19 years) from the fourth and fifth Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2008 to 2012 in South Korea. We investigated the presence and severity of tinnitus, depressive mood, suicidal ideation, perceived usual stress level, and socioeconomic and health-related variables. We conducted logistic regression and mediation analyses. Tinnitus and its severity were significantly associated with depressive mood and suicidal ideation. Tinnitus, depressive mood, and suicidal ideation shared common socioeconomic and health-related risk factors. Tinnitus significantly mediated the association of shared risk factors for depressive mood and suicidal ideation. Perceived usual stress level mediates the association of tinnitus with depressive mood and suicidal ideation. The correlation of perceived usual stress levels with depression and suicidal ideation was also mediated by tinnitus. Our findings implicate that tinnitus may contribute substantially to the development of depressive symptom and suicidal ideation in adults via apparent interactions with shared risk factors and stress levels.

Impact of nasal conditions on chronic otitis media: a cross-sectional study in Koreans

OBJECTIVES

We evaluated the relationship between pathological nasal conditions and pathological middle ear conditions on a large-scale epidemiological basis, conducted as a cross-sectional study at the population level using Korean National Health and Nutrition Examination Survey (KNHANES) data.

STUDY DESIGN

A cross-sectional study.

METHODS

In a retrospective cohort study, we analyzed data from the KNHANES (2008-2012), which used a stratified, multi-stage, probability-cluster sampling method in a rolling sampling survey of South Korean citizens.

RESULTS

The prevalences of nasal and middle ear pathologies were evaluated. Chronic postnasal drip, chronic hypertrophic rhinitis, and nasal polyps were correlated with the presence of middle ear pathologies; allergic rhinitis was negatively correlated. The prevalences of chronic otitis media and septal deviation showed no relationship. Only nasal polyps showed a tendency to be associated with cholesteatomatous otitis media in patients with COM.

CONCLUSIONS

Our results indicate the need for a nasal assessment when evaluating COM. Additionally, correction of nasal pathologies may be useful with the surgical treatment of COM to improve patient success rates and satisfaction.

The role of interleukin-33 in chronic rhinosinusitis

RATIONALE

Interleukin (IL)-33, a new member of the IL-1 family, is constitutively expressed in epithelial tissues and lymphoid organs and plays an important role in the pathogenesis of allergic disease. However, the role of IL-33 in chronic rhinosinusitis with nasal polyps (CRSwNP) remains unclear.

OBJECTIVE

To investigate the role of IL-33 in the pathophysiology of CRSwNP.

METHODS

We investigated IL-33 expression and its cellular origins in the nasal polyps (NPs) of human subjects by immunohistochemistry (IHC), quantitative reverse transcription PCR (qRT-PCR), and multiplex cytokine assays. Correlations between IL-33 expression and other inflammatory markers were also explored. To investigate the role of IL-33 in CRSwNP, anti-IL-33 antibody was used in a murine model of CRS.

RESULTS

Uncinate process tissues from control (19), CRSsNP (61), CRSwNP (69) and NP tissues (71) were used in this study. Increased expression of IL-33 mRNA and protein in patients with CRSwNP compared with controls was observed. The concentration of IL-33 protein in CRSwNP was positively correlated with the number of neutrophils and the expression of several Th1 and Th17 inflammatory markers, including interferon (IFN)-γ, IL-1β, tumour necrosis factor (TNF)-α, IL-17A, IL-22, and various markers for neutrophil recruitment. However, protein levels of IL-5 and quantity of eosinophils were inversely correlated with levels of IL-33. The expression of tissue inhibitor of metalloproteinase (TIMP)-1 was negatively correlated with IL-33 protein levels, while the expression of matrix metalloproteinase (MMP)-2 and MMP-9 was positively correlated with IL-33 protein levels. In animal studies, IL-33 expression was upregulated in the CRSwNP group compared with controls. Anti-IL-33 treatment reduced the thickness of oedematous mucosa, subepithelial collagen deposition, and infiltration of neutrophils, but infiltration of eosinophils was not reduced. This treatment also inhibited the expression of neutrophilic inflammatory cytokines, but not IL-4. In addition, the expression of intracellular adhesion molecule 1, vascular adhesion molecule 1 and CXCL-2 in the nasal mucosa was suppressed in mice treated with anti-IL-33 antibody.

CONCLUSIONS

Our data suggest a role for IL-33 in the pathogenesis of CRSwNP via neutrophil recruitment. Therefore, anti-IL-33 may provide a new treatment strategy to target infiltrating neutrophils in CRSwNP.

A Survey of Korean Physicians' Prescription Patterns for Allergic Rhinitis

Objectives

The aim of this study was to compare the prescription patterns according to characteristics of physicians using a survey distributed amongst physicians in Korea.

Methods

We surveyed the prescription patterns for allergic rhinitis (AR) of the members of the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI) and the Korean Association of Otorhinolaryngologists (KAO). Questionnaire contained 4 categories with 28 queries. 448 physicians including 98 internal medicine (IM), 113 pediatrics (PED), and 237 otorhinolaryngology (ENT) were responded.

Results

Although the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines are most frequently used in all specialties, seasonal or perennial AR is the most frequent classification system. For the definitive diagnosis of AR, ENT physicians reported using multiple allergen simultaneous test (MAST)/radio allergy sorbent test (RAST) more than others (IM, 10.9%; PED, 20.6%; ENT, 44.2%; P<0.001). In treatment, most physicians reported that antihistamine medication is the initial treatment for AR. PED physicians prescribed fewer intranasal steroid to combinations with an antihistamine than other specialists (IM, 65.3%; PED, 42.5%; ENT, 63.3%), but preferred leukotriene antagonists (IM, 4.1%; PED, 23.0%; ENT, 3.9%; P=0.041). Overall, 53% (235/448) of the physicians performed allergen immunotherapy (AIT), and IM administers the most AIT (IM, 71.6%; PED, 42.0%; ENT, 39.5%; P=0.019). Furthermore, university and general hospital physicians prescribed more AIT than doctors at other hospital types (university hospital, 76.4%; general hospital, 64.3%; local hospital, 21.4%; private clinic, 20.2%; P<0.001).

Conclusion

The prescription patterns for AR were different according to the physicians’ characteristics and general rate of prescribing AIT is just about 53% in Korea. Thus, the development of complementary Korean-specific guidelines is needed and proper clinical instruction of AIT would be necessary.

Unmet Primary Physicians' Needs for Allergic Rhinitis Care in Korea

Allergic rhinitis (AR) is one of the most common chronic allergic respiratory diseases worldwide. Various practical guidelines for AR have been developed and updated to improve the care of AR patients; however, up to 40% patients remain symptomatic. The unmet need for AR care is one of the greatest public health problems in the world. The gaps between guideline and real-world practice, and differences according to the region, culture, and medical environments may be the causes of unmet needs for AR care. Because there is no evidence-based AR practical guideline reflecting the Korean particularity, various needs are increasing. The purpose of the study was to evaluate whether existing guidelines are sufficient for AR patient management in real practice and whether development of regional guidelines to reflect regional differences is needed in Korea. A total of 99 primary physicians comprising internists, pediatricians, and otolaryngologists (n=33 for each) were surveyed by a questionnaire relating to unmet needs for AR care between June 2 and June 16 of 2014. Among 39 question items, participants strongly agreed on 15 items that existing guidelines were highly insufficient and needed new guidelines. However, there was some disagreement according to specialties for another 24 items. In conclusion, the survey results demonstrated that many physicians did not agree with the current AR guideline, and a new guideline reflecting Korean particularity was needed.

Hearing aid silicone impression material as a foreign body in the middle ear

We report an extremely rare case of hearing aid silicone impression material as a foreign body in the middle ear. Symptoms of the patient were otorrhea and vertigo after taking of a mold impression on his only hearing ear, and the symptoms mimicked chronic otitis media. A temporal bone CT scan revealed foreign body material in the middle ear and Eustachian tube. An intact canal wall mastoidectomy with a facial recess approach and type IV tympanoplasty was performed to remove the silicone impression material. In addition to the case report, we review the literature regarding impression material foreign bodies.

Nasal septal deviation with obstructive symptoms: Association found with asthma but not with other general health problems

BACKGROUND

Nasal septal deviation (NSD) is a very common deformity. Because it may induce chronic upper airway obstruction in the nose, clinicians encounter some patients who have concerns about whether this can be a risk factor for general health. However, the influence of NSD on general health has rarely been studied.

OBJECTIVE

To determine associations between NSD, especially NSD with nasal obstructive symptom, and general health problems in an adult Korean population.

METHODS

This nationwide study analyzed data from the Korea National Health and Nutritional Examination Survey, 2008-2009. NSD was evaluated by using a nasal endoscope, and a nasal obstructive symptom was assessed via individual interviews. The survey also investigated general health problems, such as medical comorbidity, mental health status, and quality of life. Medical conditions included neurocardiovascular, respiratory, metabolic, musculoskeletal, gastrointestinal, and malignant diseases. To eliminate the effect of combined nasal problems in otorhinolaryngology, subjects with rhinosinusitis and allergic rhinitis were excluded. This study focused on obstructive NSD, which is defined as an anatomic NSD with a chronic nasal obstructive symptom.

RESULTS

We enrolled 8865 participants, and the prevalence of NSD was 44.8%. No general health problems showed a significant association with NSD. However, the prevalence of NSD with an obstructive symptom was 2.1%. Obstructive NSD had no association with all the general health problems, except asthma. A significant association was found between obstructive NSD and asthma (odds ratio 2.648 [95% confidence interval, 1.211-5.791]).

CONCLUSION

Among various general health problems, our study found that NSD was associated with asthma only when NSD was accompanied by a chronic nasal obstructive symptom.

Prevalence and associated factors of facial palsy and lifestyle characteristics: data from the Korean National Health and Nutrition Examination Survey 2010-2012

OBJECTIVES

To report the nationwide prevalence of facial palsy (FP) of grade III or worse in the House-Brackmann (H-B) grading system in South Korea and assess the associated factors.

DESIGN

Cross-sectional analysis of a nationwide health survey.

SETTINGS

South Korea.

METHODS

We obtained data from the 2010 to 2012 Korea National Health and Nutrition Examination Surveys, which were cross-sectional surveys of the South Korean civilian population living in households and aged ≥1 year (N=23 533). A field survey team performed interviews, physical examinations and laboratory tests. Facial expression was evaluated based on the H-B grading system.

RESULTS

Among the population aged ≥1 year, the prevalence of FP of grade III or worse in the H-B grading system was 0.12% (95% CI 0.07% to 0.17%). FP was more prevalent in women (p=0.01) and the prevalence rate increased with age (p<0.001). In participants aged ≥19 years, age, female gender, history of cardiovascular disease and the serum total cholesterol level were associated with FP in a multivariable analysis. In the evaluation of lifestyle, the individuals with FP had a higher rate of depressive mood and were more restricted in their daily activities.

CONCLUSIONS

Considering the significance of facial expression in psychosocial activities, public acknowledgement and further intervention are required to support patients with this distressing condition.

The prevalence and factors associate with vocal nodules in general population: Cross-sectional epidemiological study

The purpose of this study was to analyze the prevalence of vocal nodules and to identify factors related with an increased risk for vocal nodules.This study was conducted using data from the Korean National Health and Nutrition Examination Survey 2008 to 2011. The subjects consisted of 19,636 men and women aged ≥19 years. Related factors such as age, marital status, incomes, and education level were assessed in individual interviews, and health-related behaviors including smoking, alcohol, and activity were assessed with self-administered questionnaires. Also, examination survey such as laryngoscopy examination, basic physical examination, and blood sampling was conducted.The prevalence of vocal nodules was 1.31% (n = 258). Among variable factors, age, education level, and voice disorder were related with the presence of vocal nodules (P < 0.05). Other factors including sex, alcohol, smoking, physical activities, hypertension, obesity, waist circumference and metabolic syndrome, hypercholesterolemia, serum calcium, and vitamin D did not show any meaningful relationship with the presence of vocal nodules.This result may help reduce the incidence of vocal nodules and offer proper management for patients with vocal nodules, and may also facilitate efficient allocation of public health resources.

Normative Hearing Threshold Levels in Koreans with Normal Tympanic Membranes and Estimated Prevalence of Hearing Loss

Objectives

We investigated the normative data on the hearing threshold levels of Koreans with normal tympanic membranes and the prevalence of hearing loss (HL) and nonserviceable hearing using the data from the Korea National Health and Nutrition Examination Surveys (KNHANES) during 2010–2012.

Methods

Data obtained from 16,673 participants ≥12-year-of-age with normal tympanic membranes who completed audiometric testing. We defined HL as the pure tone average (PTA) >25 dB hearing level at 500, 1,000, 2,000, and 3,000 Hz and non-serviceable hearing as PTA >40 dB hearing level.

Results

The hearing levels at some frequencies (0.5, 3, and 6 kHz) did not differ in between the 10’s and 20’s, but the hearing thresholds at all frequencies increased gradually from the 30’s. The hearing thresholds were higher in men than in women at high frequencies (3, 4, and 6 kHz) in the 30’s and older. The prevalence of HL in either ear was 16.5% (estimates of 5.9 million), from 2.4% in the 10’s up to 75.4% in the 70’s and older. The prevalence of nonserviceable hearing in either ear was 6.8% (estimates of 2.5 million) and that of bilateral nonserviceable hearing was 2.5% (estimates of 0.9 million).

Conclusion

Hearing loss aggravated from the 30’s at all frequencies and men showed poorer hearing levels than women at high frequencies. Hearing loss was a common condition and the prevalence of non-serviceable hearing in either ear, which needs hearing rehabilitation to help social communication, was 6.8%. Normative pure tone thresholds at each frequency can be used as referent values when counseling patients complaining of hearing loss.

A Population-Based Cross-Sectional Study of Alcohol Consumption and Risk of Benign Laryngeal Disease in Korean Adults

OBJECTIVE

Studies on alcohol consumption and benign laryngeal disease (BLD) in the general population are rare. The aim of this study was to investigate the relationship between alcohol consumption and BLD in the Korean general population.

STUDY DESIGN

This was a cross-sectional study of a national health survey.

MATERIALS AND METHODS

Subjects were 3141 noninstitutionalized civilian adults older than 19 years (1313 men and 1828 women) who completed the laryngeal examination of the Korea National Health and Nutrition Examination Survey of 2008. Frequency of drinking was classified into less than once per week, two to three times per week, and more than four times per week. Binge drinking was defined as five or more drinks (≥61 g of alcohol) per episode for men and as four or more drinks (≥41 g of alcohol) per episode for women. Poisson regression analyses were conducted to examine the relationship between alcohol drinking and BLD.

RESULTS

Adjusting for covariates (age, sex, income, level of education, occupation, and cigarette smoking), it was found that those who drank more than four times a week, compared with those who drank less than once per week, were more likely to have BLD (risk ratio = 2.15, 95% confidence interval: 1.01-4.59, P < 0.05). However, the amount of alcohol consumed was not associated with BLD.

CONCLUSIONS

Frequent drinking (ie, more than four times a week) was found to be a risk factor for BLD.