Soo Kyoung Park

Objectives: Factors influencing outcomes of endoscopic dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction remain unclear. We evaluated clinical factors associated with surgical success. Methods: We retrospectively reviewed patients who underwent endoscopic DCR for this indication (2012–2022). Allergic rhinitis, obstruction level and type, canalicular intubation stent (CIS) insertion, and adjunctive procedures were analyzed against surgical success, epiphora scores, and SNOT-22 change using multivariate logistic regression. Results: Among 300 eyes (259 patients), the success rate was 82.0%. Epiphora scores improved from 7.6 ± 1.3 to 4.0 ± 2.3 and SNOT-22 from 17.3 ± 19.1 to 11.1 ± 14.2 (both p < 0.001). Sac-level and duct–sac junction obstructions had higher success than canalicular obstruction, and allergic rhinitis was associated with less epiphora improvement. CIS insertion was associated with lower success; however, this was confined to functional (42.0% vs. 92.0%) and canalicular-level (53.3% vs. 77.6%) obstruction—where CIS was selectively used—and absent in drainage-level obstruction (85.3% vs. 85.7%), indicating confounding by indication. Conclusions: Endoscopic DCR yields favorable outcomes with significant epiphora and quality-of-life improvement. Obstruction level, allergic rhinitis, and CIS insertion were associated with surgical outcomes; the CIS association, however, likely reflects confounding by indication rather than a direct adverse effect, as CIS was selectively used in functional and canalicular-level obstruction.

Obstructive sleep apnea (OSA) is a common disorder associated with hypertension, coronary disease, stroke, and increased long-term mortality. Despite this, a growing body of observational studies, particularly analyses of administrative databases and intensive care cohorts, has reported lower short-term or in-hospital mortality among patients diagnosed with OSA. This unexpected finding has been termed the “OSA mortality paradox.” This narrative review synthesizes the evidence supporting this paradox, contrasts it with the well-established long-term risks of untreated OSA, and evaluates competing explanations for its occurrence. Potential biological mechanisms include intermittent hypoxia-induced preconditioning, obesity-related metabolic reserve, and adaptation of the right ventricle or autonomic system to recurrent physiological stress.However, the most compelling explanations are methodological. These include detection bias, under-recognition of OSA in comparison groups, residual confounding by obesity and healthcare access, and the inability of many datasets to capture disease severity, hypoxic burden, frailty, and adherence to positive airway pressure therapy. A key distinction in interpreting this paradox lies between physiological OSA and diagnosed OSA. While physiological OSA is plausibly harmful, diagnosed OSA may identify patients who are already engaged with healthcare, screened for comorbidities, and more likely to receive cardiopulmonary monitoring or treatment. We contend that current evidence does not support a genuinely protective effect of OSA itself. Instead, the paradox is best understood as a context-specific epidemiological artifact superimposed on a biologically heterogeneous disease. Future research should integrate polysomnographic severity, hypoxic burden, treatment exposure, and modern causal inference methods to ensure that short-term outcome studies do not confuse diagnostic labeling with true pathophysiological benefit.

Objectives. Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that is strongly influenced by obesity, the most important modifiable risk factor. Effective weight management is therefore essential for optimal OSA care. This guideline provides updated, evidence-based recommendations for the evaluation and management of obesity in adults with OSA, incorporating recent advances in lifestyle, pharmacologic, and surgical interventions.Methods. The Korean Society of Sleep and Breathing convened a multidisciplinary panel. A systematic literature search was performed across major databases through 2025. Evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and recommendations were formulated by consensus using the Evidence-to-Decision framework.Results. Eight statements were developed. Key recommendations include recognizing obesity as a major risk factor; routinely assessing overweight and obesity; and implementing structured weight reduction through diet, exercise, and behavioral therapy. Glucagon-like peptide-1 receptor agonists are recommended when lifestyle interventions are insufficient, and bariatric/metabolic surgery is advised for severe obesity unresponsive to nonsurgical treatment. Weight loss improves the apnea-hypopnea index, symptoms, and cardiometabolic markers and may reduce positive airway pressure needs. Continued follow-up is recommended even after clinical improvement.Conclusion. Weight management is a core component of OSA treatment. This guideline offers practical, evidence-based strategies to support clinicians in delivering effective, obesity-focused care for adults with OSA.

Background/Objectives: This study evaluates the efficacy of hypoglossal nerve stimulation as an alternative intervention for pediatric patients with obstructive sleep apnea (OSA) unresponsive to standard therapies and examines the uniformity of therapeutic outcomes across different patient cohorts. Methods: An extensive systematic search was performed across four principal databases (PubMed, EMBASE, Cochrane Library, and Web of Science) utilizing keywords associated with pediatric OSA and hypoglossal nerve stimulation, encompassing studies up to July 2025 that provided objective polysomnographic metrics (e.g., apnea-hypopnea index [AHI] values) to enable the quantitative assessment of pre- and post-intervention effects in children. The primary outcome measured was the ratio of means (ROM), determined from pre–post data in single-group studies, with summary estimates obtained using the fixed-effects model. Results: The systematic review included nine eligible studies with a total of 140 pediatric subjects, the majority of whom were adolescents with Down syndrome. AHI meta-analysis outcomes indicated a marked improvement in OSA severity, yielding an overall ROM of 0.57 [95% confidence interval: 0.49–0.65]. The therapeutic benefit demonstrated a high degree of uniformity across cohorts, as indicated by minimal statistical heterogeneity (I² = 16%, p = 0.30). Funnel plot assessment showed no statistically significant evidence of systematic publication bias. Conclusions: Current evidence suggests that hypoglossal nerve stimulation therapy is a safe, effective, and valuable alternative for pediatric OSA patients who do not respond to conventional therapies.

Background and Objectives: In June 2018, South Korea expanded insurance coverage for polysomnography (PSG) to improve diagnostic access for obstructive sleep apnea (OSA). This study investigated the impact of this policy by analyzing changes in PSG utilization and diagnostic outcomes.Methods: A multicenter retrospective study was conducted using data from 17 tertiary hospitals across South Korea. Patients aged ≥20 years who visited the hospitals for suspected OSA between 2015 and 2023 were included. The pre-coverage period was defined as 2015–2017, and the post-coverage period as 2019–2023. Demographics, PSG implementation rates, and apnea-hypopnea index (AHI) distributions were compared.Results: A total of 29,055 patients were included (7,800 pre-coverage; 21,255 post-coverage). PSG utilization significantly increased from 51.3% to 74.4% (p<0.001). The proportion of female patients rose from 20.0% to 23.0%, and the mean age increased from 45.8 to 49.8 years (p<0.001). The average AHI increased from 31.2 to 35.3. The proportion of patients with severe OSA (AHI ≥30) rose from 42.8% to 48.8%, while cases with normal AHI (<5) declined from 11.6% to 8.3% (p<0.001).Conclusion: The expansion of insurance coverage significantly improved PSG accessibility, particularly for older adults, women, and high-risk patients. The observed shift toward more severe diagnoses suggests enhanced detection of untreated OSA rather than overdiagnosis of mild or normal cases. These findings support the ongoing implementation of inclusive health policies while emphasizing the importance of appropriate patient selection.

Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent upper airway collapse during sleep, leading to intermittent hypoxemia and sleep fragmentation. Untreated OSA is associated with increased risks of cardiovascular, metabolic, and neurocognitive comorbidities, as well as considerable socioeconomic burden. Positive airway pressure (PAP) remains the gold standard therapy; however, limited long-term adherence underscores the need for alternative, patient-centered approaches. Conventional modalities such as oral appliances, surgery, weight reduction, and positional therapy provide clinical benefits but have variable efficacy and tolerability. Recent advances highlight innovative strategies, including hypoglossal nerve stimulation (HGNS), anti-obesity pharmacotherapy with glucagon-like peptide-1 receptor agonists, and upper airway muscle–targeted agents, which exemplify precision medicine approaches tailored to individual OSA phenotypes. This review synthesizes current evidence on both conventional and emerging therapies, emphasizing the transition from a “one-size-fits-all” model toward integrated, phenotype-driven management aimed at improving outcomes and quality of life for patients with OSA.

Background and Objectives Abatacept is a chimeric protein that combines the Fc region of human immunoglobulin G1 with human cytotoxic T-lymphocyte-associated protein-4. Abatacept is increasingly used for inflammatory disease including rheumatoid arthritis. However, the impact of abatacept on chronic rhinosinusitis remains largely unexplored. This study aimed to evaluate the therapeutic potential of abatacept in a mouse model of eosinophilic chronic rhinosinusitis (ECRS).Materials and Method The mice were assigned to four different treatment groups: control, ECRS, abatacept-treated (Aba), and dexamethasone-treated (Dexa) groups. To assess the effects of abatacept in the mouse model of ECRS, several techniques were employed, including hematoxylin and eosin staining, Periodic acid-Schiff staining, real-time quantitative polymerase chain reaction, Western blot analysis, and enzyme-linked immunosorbent assay.Results Epithelial thickness, the number of goblet cells and eosinophil infiltration in the nasal mucosa, was significantly decreased in the Aba and Dexa groups compared with the ECRS group. The concentrations of interleukin (IL)-10, IL-4, and IL-5 in the nasal lavage fluid were significantly reduced in both the Aba and Dexa groups compared to the ECRS group. Similarly, the expression levels of IL-4, IL-5, IL-10, IL-13, IL-17A, and interferon gamma in the nasal mucosa were markedly lower in the Aba and Dexa groups than in the ECRS group.Conclusion Abatacept treatment reduced the number of Th immune response-associated molecules and cytokines, resulting in the suppression of nasal polyp formation and mucosal inflammation in ECRS mice. Based on these results, Abatacept could be considered a potential therapeutic option for patients with ECRS.

Pediatric obstructive sleep apnea (OSA) presents unique challenges in diagnosis and management, particularly when considering the diverse phenotypes that can be observed by polysomnography (PSG). Phenotypes of pediatric OSA can be broadly categorized into common, adult and congenital phenotypes, each associated with distinct anatomical and physiological characteristics that influence both the presentation and treatment outcomes of OSA. The common phenotype typically involves tonsillar and adenoidal hypertrophy, which is prevalent in early childhood and can lead to significant airway obstruction. The congenital phenotype is often associated with syndromes such as Pierre Robin sequence or Down syndrome, which involves structural abnormalities that severely compromise airway patency. The adult phenotype in children, often associated with obesity, exhibits symptoms similar to those seen in adult patients with OSA. This review explores current research to highlight the importance of phenotype-specific diagnostic and treatment strategies to improve treatment efficacy and patient outcomes. Through a detailed analysis of various studies, this paper highlights the need for accurate phenotype identification using PSG to effectively tailor interventions and improve the overall management of pediatric OSA.

Background: Allergic rhinitis (AR) is a common disease that requires more convenient, safe, and effective therapy. This study aimed to investigate the therapeutic effect of Forkhead box protein3 (Foxp3) introduced with poly(d,l-lactic-co-glycolic acid) (PLGA) nanoparticles (Foxp3 NPs) in an AR mouse model. Methods: A murine model of allergic rhinitis was established using BALB/c mice through initial sensitization by intraperitoneal administration of ovalbumin (OVA), followed by repeated intranasal OVA challenges. Foxp3 plasmid-loaded PLGA nanoparticles were subsequently administered via either the intranasal or intraperitoneal route to evaluate therapeutic efficacy. Episodes of sneezing and nose rubbing were counted. The serum total IgE, OVA-specific IgE, and cytokine levels in nasal lavage fluid (NALF) were determined by ELISA (Enzyme-Linked ImmunoSorbent Assay). Nasal mucosa from each group were analyzed using protein, reverse transcriptase–polymerase chain reaction (RT-PCR), and histological analyses. Result: Rubbing and sneezing symptoms improved in the Foxp3 NPs intranasal administration group. Foxp3 NPs intranasal administration markedly ameliorated OVA-induced nasal allergic inflammation. The total IgE and OVA-specific IgE serum level and IL-4, IL-13 expression levels of NALF were significantly decreased in the treated Foxp3 NPs group. The histopathological results of nasal mucosa were also normal, with no cellular infiltration and no inflammation in the Foxp3 NPs group. Conclusions: These results suggest that Foxp3 NPs alleviate nasal allergic inflammation and may have therapeutic value in the treatment of AR.

Background/Objectives: Odontogenic sinusitis (ODS) is a distinct subtype of chronic rhinosinusitis that arises from dental pathology, with unique etiologies and treatment strategies. This study aimed to evaluate the clinical features, radiological findings, and surgical outcomes of ODS patients treated with endoscopic sinus surgery (ESS). Methods: This retrospective study included 139 patients diagnosed with ODS who underwent ESS. Demographic characteristics, clinical symptoms, radiological findings, and treatment outcomes were analyzed. Outcomes were assessed using pre- and postoperative LundKennedy (L-K) scores, with additional evaluation of the impact of concurrent dental treatment. Results: The most common etiology was periodontal disease (60.4%), followed by dental implants (20.1%) and dental extractions (19.4%). Radiological findings revealed sinus involvement beyond the maxillary sinus in 78.4% of patients, with common abnormalities including periapical abscesses (60.4%), oroantral fistulas (19.4%), and implant-related complications (20.1%). Patients who received concurrent dental treatment with ESS demonstrated significantly better outcomes, with success rates of 96.4% compared to 73.9% for those without dental treatment (p = 0.003). Conclusions: ODS is frequently underdiagnosed due to overlapping symptoms with chronic rhinosinusitis of other origins. Radiological imaging is crucial for identifying dental pathologies contributing to ODS. Combining ESS with dental treatment significantly improves outcomes and is recommended as the optimal management strategy for ODS.