The MUSC Department of Otolaryngology–Head & Neck Surgery has a history of research excellence that spans more than two decades. The first R01 grant from the NIH was received by Jack Mills, Ph.D. in 1975. Under his leadership, the Auditory Neuroscience Laboratory developed a hearing research program consist-ing of a strong basic science core supplemented by ongoing translational research in human patients. Auditory Neuroscience Laboratory1975 • First R01 (PI, Jack Mills, PhD)1981 • 3 RO1s, 1NSF, 1 NIH Contract Hearing and deafness funding1987 • Program Project Grant in Age-Related Hearing Loss (renewed 1992, 1997, 2002)2002 • $2.2 million institution and NIH matching grant for laboratory renovation and expansionPresent Investigators:John H. Mills, Ph.D. Ning-Ji He, Ph.D.Judy R. Dubno, Ph.D. Amy R. Horwitz, Ph.D.Jayne B. Ahlstrom, M.S. Fu-Shing Lee, Ph.D.Mark A. Eckert, Ph.D. Lois J. Matthews, M.S.Kelly C. Harris, Ph.D. Richard A. Schmiedt, Ph.D. Over the last six years, extramural funding has more than doubled, and for FY06 the department ranked #10 in the United States (#1 in the Southeast) in NIH awards to Departments of Otolaryngology – Head and Neck Surgery. NIH and other extramural grants totaled more than $4 million in FY07. Sco pe4HEVol. 8 No.2MUSC DEPARTMENT OF OTOLARYNGOLOGYHEAD & NECK SURGERYPaul R. Lambert, M.D.INSIDEResearch RealmClinical UpdateCME EventsM. Boyd Gillespie, M.D.EDITORChairman’s Cornerwww.MUSCENT.orgHistory of Research Excellence This edition of the Scope celebrates our faculty’s research success. Our mission of discovering new knowledge and translating it into novel strategies for disease prevention and improved health and quality of life is made possible by their work. This research environment also facilitates our mission of training the next generation of clinician–scientists. The Department’s research growth parallels our institution’s success in expanding basic and translational research. In the last 5 years, the Medical University of South Carolina has increased research funding almost 50% (9th fastest growth in NIH dollars among academic medical centers). Balance characterizes the Department’s research activities – balance in the areas of investigation (audi-tory, cancer, swallowing, sinus/immunology); balance in the compliment of investigators (junior, senior, emeritus); and balance in the funding sources (NIDCD, NCI, VA, CDC, and various foundations, societies and industry/pharmaceutical companies). In addition to the Auditory Neuroscience Laboratory, there are robust research programs in Tumor Biology, Oral Cancer and Functional Outcomes, Rhinosinusitis and Allergy, Swallowing Physiology and Cochlear Implantation.Extramural Funding$1,900,000$4,250,00020012007&ALL www.MUSCENT.org MUSC • DISCOVERY, UNDERSTANDING, HEALING SINCE 1824Realm2ESEARCHAlergic fungal rhinosi-nusitis (AFRS) appears to be a unique subset of chronic rhinosinus-itis (CRS) with nasal polyposis that has an increased inci-dence in the southeastern US. Our division has been active in studying both the clinical and immunologic characteristics of this disease. Clinical characteristics: A retrospective review of 54 AFRS patients, 58 CRS patients with nasal polyps (CRSwNP) who did not meet classic AFRS diagnostic crite-ria, and 57 non-polyp CRS patients (CRSsNP) was performed. AFRS patients present at an earlier age (p < 0.001), are more commonly African-Americans (p < 0.001) and more often uninsured or have Medicaid (p < 0.001) than other CRS groups. AFRS patients resided in counties with higher percentages of residents below poverty level (p < 0.01), lower mean income (p < 0.05), and higher percentage of AA resi-dents (p < 0.05) than CRSsNP. No significant differences were found between diagnostic groups for gender, physicians per 1,000 county residents, or geographic region of patient residence within the state of SC.1 AFRS patients are also more likely to present with bony erosion of the orbit or skull base when compared to other types of CRS,2 (figure) and within the AFRS group, bony erosion appears to be more common in males while race and socioeconomic factors do not appear to play a role.3 In patients with significant proptosis due to orbital erosion/expansion, compre-hensive surgical and medical management has been shown to be adequate treatment and proptosis typically resolves within months without any significant diplopia.4 Immunologic characteristics: Our previous research into the pathophysiology of AFRS has demonstrated that systemic IgE to inhaled fungal antigens leads to a Th2 eosinophilic inflammatory response, in contrast to the mixed Th1/Th2 response with elevated innate mediators, such as surfactant proteins, seen in cystic fibrosis.5,6 Prior to this immune response, antigen must be taken up and processed in order to trigger subsequent innate and adaptive responses. Dendritic cells (DC) are potent antigen presenting cells, and their role in influencing the immune response in AFRS has not been described. We stained immunohistochemically for CD207, a marker of Langerhans cells, and CD208, a mature DC marker and found a greater subepithelial infiltrate of CD208 positive cells in AFRS (p<0.01).7 This study suggests that mature dendritic cells, which have already presented antigen and are located in the subepithelium, may play an active role in the pathogenesis of AFRS and polyp formation. Additionally, our group is in the process of examining the role of localized IgE in AFRS. We have found that AFRS polyps and turbinates have increased IgE compared to control sinus and turbinate tissue and that AFRS pol-yps have increased IgE compared to turbinate tissue in the same patient. This variability in localized IgE may contribute to anatomic differences in polyp formation within the sino-nasal cavity despite and increased exposure to inhaled antigen at the inferior turbinate. Further work is being conducted to determine the exact site of this localized IgE expression and if it is specific for fungal antigen or a broader spec-trum of antigens. Conclusion: AFRS appears to be a subset of CRS with unique clinical and immunological charac-teristics. Further investigations are needed to determine if these char-acteristics impact clinical treatment and prognosis.MUSC Nose and Sinus Center:The Clinical and Immunologic Characteristics of Allergic