Effect of Adenotonsillectomy on Inattention and Hyperactivity in Children with Sleep Disordered Breathing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep disordered breathing (SDB) is a common problem in the otolaryngology clinic and adenotonsillar hypertrophy is thought to be one of the most common etiologic factors. SDB possibly exhibits problems of behavioral regulation, such as inattention, hyperactivity and impulsive behavior. The goal of this study was to assess the effect of adenotonsillectomy on inattention and hyperactivity in children. SUBJECTS AND METHOD: We selected 54 pediatric patients with sleep disordered breathing. Adenotonsillectomy was performed for all patients. Adenotonsillar hypertrophy and the degree of SDB were evaluated preoperatively. The degree of inattention and hyperactivity was evaluated by attention deficit hyperactivity disorder rating scale-IV (ADHD RS-IV) before and after surgery. RESULTS: ADHD RS-IV score showed significant improvement after the operation in most children with SDB. But the improvement of ADHD RS-IV was not associated with the degree of adenotonsillar hypertrophy. However, much improvement in postoperative ADHD RS-IV was observed with children having higher preoperative ADHD RS-IV and/or SDB scale. CONCLUSION: Adenotonsillectomy seems to improve inattention and hyperactivity in most children with SDB. Improvement is more apparent in children with severe sleep disturbance and severe attention deficit and hyperactivity.

Management of Rhinolithiasis through Endoscopic Approach / 대한이비인후과학회지

A Lithiasis within the nasal cavity (rhinolith) can be formed by either endogenous or exogenous material. It occurs as a result of the solidification of mucus and nasal debris by mineral salts, calcium, magnesium phosphate and carbonate. Rhinolithiasis leads to unilateral obstruction of the nasal airway followed by inflammation of the nasal mucus membrane and the paranasal cavities. It can be seen by the endoscopic examination as a hard intranasal mass, but diagnosis of rhinolithiasis can be difficult due to the varying clinical presentations. Surgery is obligatory for the removal of rhinoliths and in most cases it can be done by nasal endoscopic removal. Giant rhinolith, which is penetrated into the surrounding anatomical structures, needs more extended surgical approaches such as Caldwell-Luc operation or lateral rhinotomy. Here, we report one case of rhinolithiasis, which was removed surgically for the purpose of diagnosis and treatment, and present a literature review of this condition.

Efficacy of Benzodiazepines to Laryngopharyngeal Reflux: A Double-Blind, Randomized Controlled Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Anti-anxiety drugs such as benzodiazepines are often given to globus patients in practice, based on the notion that globus is a kind of somatization disorder. However, many of globus are caused by laryngopharyngeal reflux (LPR) and the effects of anti-anxiety drugs to LPR are unknown. The study goal was to assess the efficacy of benzodiazepines to LPR. SUBJECTS AND METHOD: We selected 51 LPR patients, who were confirmed by 24-hour double-probe ambulatory pH monitoring. Patients were allocated into case and control groups at random and entered into a double-blind trial. Patients in the control group received proton pump inhibitors and prokinetics. Diazepam was added to patients in the case group. Assessments were made after 4 weeks of treatment using reflux symptom index (RSI) and reflux finding score (RFS). RESULTS: In both groups, RSI and RFS were improved significantly at the end of the study. However, there was no significant difference between the two groups. CONCLUSION: Diazepam seems to have little efficacy in the treatment of LPR.

Study on Correlations among Polysomnogram Indices for Obstructive Sleep Apnea-Hypopnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The polysomnography is essential for diagnosis of obstructive sleep apnea-hypopnea (OSAH) and provides important objective information. But, in fact, there are some difficulties for comprehensive interpretation of multiple indices from the polysomnogram. This study was designed to find out which polysomnogram indices were significant to respiratory distress indices (RDI) and apnea index (AI) on statistical correlation and which other indices should be considered together for proper management plan apart from RDI and AI (respiratory index). SUBJECTS AND METHOD: We evaluated 40 patients whose RDI were over 5 as the result of overnight polysomnography before any management from February 2003 to September 2003 at Eulji medical center. By multiple linear regression analysis, we studied the relationship of RDI and AI as dependent variables to ST, O2 desaturation events (O2DE), lowest O2 saturation (LoO2), slow wave sleep portion (S3&S4), arousal index (ArI), body-mass index (BMI) and age. We also studied the relationship of ST as an dependent variable to O2DE, LoO2, S3&S4, ArI, BMI, and age. RESULTS: 1) There were significant correlations between RDI and O2DE, ArI as was true between AI and O2DE, ArI (p<0.05). And there was no significant difference in the degree of the correlation between RDI and AI. 2) Other variables such as ST, LoO2, S3&S4, BMI and age were not significant. 3) ST had no significant correlation with respiratory index and any other variables (p<0.05). CONCLUSION: Because the respiratory index may not the entire physical status during sleep for OSAH patients, multiple indices (such as LoO2, BMI, ST, S3&S4, age) should be considered together apart from the respiratory index for proper management plan.