Sialendoscopy as a Useful Diagnostic and Interventional Tool for the Various Salivary Gland Disease: Our Experiences / 대한이비인후과학회지

Background and Objectives@#Sialendoscopy is useful for the diagnosis and treatment of obstructive salivary gland diseases, but not yet universally employed because it requires dedicate, expensive, and fragile endoscopic equipment; moreover, the surgical technique is also delicate. Here, we describe our initial experience of sialendoscopy, as well as the learning curve, precautions, and drawbacks that beginners must overcome in employing sialendoscopy.Subjects and Method The medical records of 98 patients who underwent sialendoscopic procedures at Eunpyeong St. Mary’s Hospital from May 2019 to March 2022 were retrospectively reviewed. The type of procedure, success rate, operation time, and complications were analyzed. @*Results@#We have performed a total of 85 sialendoscopic procedures, including 79 to treat submandibular sialolithiasis, two to treat submandibular ductal stenosis, two to treat parotid sialolithiasis, and two to treat parotid ductal stenosis. Of the total of 81 patients with sialolithiasis, 82.4% were treated by sialendoscopy only, 15.3% by hybrid procedure, and 2.3% opted to preserve the salivary gland and convert to external submandibular gland excision. Four patients with ductal stenosis were treated via endoscopic bougination; stents were placed for 4 weeks without any restenosis. The operation time was significantly shorter for the second half than for the first half of the patients (58.6 min vs. 39.8 min). Longer operation time was associated with the parotid gland diseases, larger stones (>5 mm in diameter), more proximal stones (from the salivary gland), and multiple stones. We encountered no major surgical complications. @*Conclusion@#Sialendoscopy is useful and safe; even beginners can evaluate and manage obstructive salivary gland diseases.

Effect of Occupational Noise Exposure on the Prevalence of Benign Vocal Fold Lesions: A Nationwide Population-Based Study

Objectives@#. Voice abuse in noisy environments can result in voice disorders. However, insufficient studies have sought to differentiate vocal cord lesions through laryngoscopic examinations among workers in noisy environments. This study investigated the relationship between a history of noise exposure in the workplace and benign vocal fold lesions (BVFLs). @*Methods@#. We used Korea National Health and Nutrition Examination Survey data from 2010 to 2012. The chi-square test was used to compare characteristics between two groups according to the presence or absence of BVFLs. To investigate the association between BVFLs and noise exposure in the workplace, we calculated adjusted odds ratios and 95% confidence intervals (CIs) using multiple logistic regression analysis. @*Results@#. In total, 10,170 participants with available laryngoscopy results were enrolled. Smoking history, hypertension, diabetes, and exposure to noise for more than 3 months at the workplace were significantly more common in participants with BVFLs. After adjusting for age, sex, smoking, drinking, obesity, hypertension, diabetes, income, education, and occupation as confounders, we confirmed that BVFLs were 1.52 times more likely (95% CI, 1.157–1.990) to occur in individuals with occupational noise exposure. @*Conclusion@#. Working in a noisy environment could induce BVFLs in workers through voice abuse. Social recognition that a noisy environment is a risk factor for BVFLs needs to be improved, and preventive measures should be implemented.

Effects of Periosteal Elevation Before Lateral Osteotomy in Rhinoplasty: A Meta-Analysis of Randomized Controlled Trials

Objectives@#. Although osteotomy is an important part of rhinoplasty, it is known to be closely related to postoperative eyelid edema and ecchymosis. We aimed to evaluate the effects of periosteal elevation prior to osteotomy on eyelid edema and ecchymosis. @*Methods@#. Two authors reviewed studies in the Medline, Scopus, and Cochrane databases published through May 2019. Randomized controlled trials comparing periosteal elevation (subperiosteal tunneling) with periosteal preservation that reported eyelid edema or ecchymosis or subconjunctival hemorrhage as outcomes of interest were included. From each study, the baseline characteristics of the study subjects, the quality of the study, the number of patients in the treatment and control groups, and outcomes were extracted. @*Results@#. Data for meta-analysis were identified in six studies with a total of 208 patients. Eyelid ecchymosis and edema within 3 days postoperatively were significantly more common in the periosteal elevation group than in the preservation group, although such an association was not found for edema on postoperative day 7 (standardized mean difference [SMD], 0.21; 95% confidence interval [CI], –0.09 to 0.50; I2 =0%). There was no significant difference in subconjunctival hemorrhage on day 1 (SMD, 0.31; 95% CI, –0.09 to 0.72; I2 =0%). @*Conclusion@#. Periosteal preservation during lateral osteotomy may reduce eyelid edema and ecchymosis compared to periosteal elevation. Further studies with rigorous research methods should be carried out to determine the effectiveness of different techniques in lateral osteotomy.

Neurogenesis and Regulation of Olfactory Epithelium

The olfactory epithelium is capable of structural and functional recovery after injury through neurogenesis. Neurogenesis occurs via stem cells in the olfactory epithelium. Horizontal basal cells and globose basal cells in the basal layer of the epithelium have the characteristics of stem cells and progenitor cells of olfactory neurons. In order for the horizontal basal cells and globose basal cells to differentiate into olfactory neurons, distinct transcriptional factors are required at each stage. These transcription factors inhibit or synergize with each other or cells at each differentiation stage, regulating olfactory neurogenesis. Recently, the regulation of neurogenesis and development through epigenetic controls that change gene expression without changing the gene sequence have been studied. Studies of olfactory epithelium have helped to elucidate complex neurological systems including spinal cord and brain. In particular, features of neurogenesis will lead to medical advances in the treatment of central nervous diseases, which until this time have been considered impossible.

Nasal Trigeminal Chemoreception / 대한이비인후과학회지

The sensory function of the trigeminal nerve is to provide tactile, proprioceptive, and nociceptive afference by chemical stimulation. Various physical responses of the trigeminal nerve to stimuli help to defend against harmful substances. Recently, many studies have been conducted on solitary chemoreceptor cells innervated by trigeminal nerve. Most volatile organic compounds stimulate both the olfactory and trigeminal nervous systems. In general, the trigeminal nervous system is less sensitive than the olfactory nervous system. Studies have shown that sensation of the trigeminal nerve by chemical stimulation results in inhibition of olfaction. This indicates that the olfactory and trigeminal nerves interact with each other in the central nervous system. It is important to study various noxious stimuli acting on the trigeminal nerve in modern society where environmental concerns are intensifying.

The Effect of Olfactory Training Using Korean Version Odorants: A Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Several studies have reported the benefits of olfactory training (OT) for patients with olfactory dysfunction. However, training odorants should be customized according to the characteristics of individual patients. The aim of this study was to evaluate the effects of OT using odorants familiar to Korean patients with post-upper respiratory infection (URI) olfactory dysfunction. SUBJECTS AND METHOD: We prospectively evaluated patients with post-URI olfactory loss. We carried out OT over a period of 6 months using four odorants: pine, cinnamon, lemon, and peppermint. Olfaction was tested before and at 1, 3, and 6 months after training initiation using the following olfactory tests; Butanol threshold test (BTT), Cross-Cultural Smell Identification Test (CCSIT) and Visual Analog Scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE) scale, Sino-Nasal Outcome Test (SNOT-20), and Beck Depression Inventory (BDI). RESULTS: Of the 88 patients who initially enrolled, 82 completed the BTT, CCSIT, VAS, NOSE, SNOT-20, and BDI. In total, 10 Korean patients were included in our analysis, nine of whom showed an improvement in olfaction after OT. All patients reported changes in olfaction and the perception of smells over the duration of OT. Some patients reported an increased sense of smell after OT, although he could not distinguish different smells. CONCLUSION: OT using odorants specifically selected for Korean patients resulted in improved olfactory function, as indicated by the BTT and CCSIT scores. The findings of the present study suggest that customization of odorants to fit the characteristics of patients, including ethnicity, environment, and race, among others, increases the effectiveness of OT.

Factors Affecting the Expansion of Chondrocytes Harvested from Rabbit Auricle and Nasal Septum / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In tissue engineering of the cartilage, cellular expansion is an essential step for creating useful amounts of tissue required. Many variables such as media composition, growth factors and cell seeding density have been utilized to stimulate the ability of cellular proliferation and to reduce the number of expansion in monolayer. The object of this study was to evaluate the effects of human serum (HS) and rabbit serum (RS) on cellular proliferation of auricular and nasal septal chondrocytes of the rabbit. SUBJECTS AND METHOD: Auricular and nasal septal chondrocytes of the New Zealand White Rabbit were expanded in monolayer in medium supplemented with 2% RS, 5% RS, 10% RS, or 10% HS with or without adding of growth factors. The effect of the supplements on the cellular proliferation was compared. RESULTS: The proliferation yield of chondrocytes grown in RS was comparable to that with HS. Both serums results in increased proliferation; however, the amount of cellular proliferation was not correlated with the concentration of the serum. The proliferation rate of nasal septal chondrocytes was higher than that of auricular chondrocytes. CONCLUSION: Both HS and RS resulted in the increased proliferation of rabbit auricular and nasal septal chondrocytes. The results show that the determination of appropriate types and concentrations of serum is required for cell expansion in constructing tissue-engineered cartilage.

Treatment of Thoracolumbar Fracture

The most common fractures of the spine are associated with the thoracolumbar junction. The goals of treatment of thoracolumbar fracture are leading to early mobilization and rehabilitation by restoring mechanical stability of fracture and inducing neurologic recovery, thereby enabling patients to return to the workplace. However, it is still debatable about the treatment methods. Neurologic injury should be identified by thorough physical examination for motor and sensory nerve system in order to determine the appropriate treatment. The mechanical stability of fracture also should be evaluated by plain radiographs and computed tomography. In some cases, magnetic resonance imaging is required to evaluate soft tissue injury involving neurologic structure or posterior ligament complex. Based on these physical examinations and imaging studies, fracture stability is evaluated and it is determined whether to use the conservative or operative treatment. The development of instruments have led to more interests on the operative treatment which saves mobile segments without fusion and on instrumentation through minimal invasive approach in recent years. It is still controversial for the use of these treatments because there have not been verified evidences yet. However, the morbidity of patients can be decreased and good clinical and radiologic outcomes can be achieved if the recent operative treatments are used carefully considering the fracture pattern and the injury severity.

Mycoplasma hominis Septic Arthritis of the Hip Developed in the Postpartum Period / 대한정형외과학회잡지

Septic arthritis of the hip is rarely caused by Mycoplasma hominis. It rarely develops in a patient during the postpartum period. However, delayed treatment of septic arthritis of the hip may lead to serious sequelae; therefore, it is important for clinicians not to overlook patients with the disease. This case illustrates the clinical steps in diagnosis and treatment of M. hominis septic arthritis of the hip.

A Case of Diffuse Large B-Cell Lymphoma of Sinonasal Tract with Acute Visual Disturbance / 대한이비인후과학회지

Malignant lymphoma of the sinonasal tract is relatively uncommon. In particular, B-cell lymphoma is hardly found in the Asian population although the NK/T-cell type of lymphoma is relatively commonly found. The authors experienced a case of diffuse large B-cell lymphoma originating from the ethmoid sinus, which caused the unexpected visual disturbance without nasal symptoms and/or systemic B symptoms, such as fever, night sweat, and weight loss. Diagnosis of B cell lymphoma is often delayed because it does not always show the specific symptoms of lymphoma. Therefore, starting with careful physical and imaging studies are always important while higly suspecting malignancy. Furthermore, early precise biopsy is of great important for precise diagnosis and proper management for the treatment of malignant lymphoma.

Anatomical Analysis of Intraorbital Structures Regarding Sinus Surgery Using Multiplanar Reconstruction of Computed Tomography Scans

OBJECTIVES: This study aimed to investigate the anatomy of the intraorbital structures regarding to endoscopic sinus surgery and external frontal sinus surgery analyzing computer tomography (CT) scans. METHODS: The CT scans of 100 patients were retrospectively evaluated. The anatomic relationships between the intraorbital structures and paranasal structures were measured using multiplanar reconstruction of the CT scan. RESULTS: The mean distances from the medial orbital floor (MOF) to the intraorbital structures were measured at the depth of the anterior ethmoid (AE), basal lamella (BL), and midportion of posterior ethmoid (PE) in the coronal planes respectively. The mean distances from the MOF to the medial rectus muscle and inferior rectus muscle at the depth of AE were approximately 8 mm and those distances in the BL and PE decreased rapidly. The mean distances from the MOF to the infraorbital nerve at the depth of the AE and BL were approximately more than 10 mm. The mean distances from the vertical axis, which passed through the MOF, to the superior oblique muscle and optic nerve at the depth of the PE were approximately 5 mm medially and 1 mm laterally. In addition, the mean distance from the midline to the trochlea of the superior oblique muscle was approximately 15 mm. CONCLUSIONS: Those measurements provide spatial information on the placements of the extraocular muscles within the orbit. The measurements will contribute to the avoidance of orbital complications during sinus surgery.

A Clinical Analysis of Revision Endoscopic Sinus Surgery: Single-Center 10-Year Experience

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery (ESS) has become a popular procedure for treating chronic sinusitis. Despite recent developments in medical and surgical techniques, primary ESS can still fail. Although revision ESS is one solution to the problem of recurrent sinusitis, revision surgery is stressful for patients and otolaryngologists. Therefore, we examined the causes of ESS failure and sought to find ways to prevent the failure of primary ESS. MATERIALS AND METHODS: All patients who underwent revision ESS in our department between April 2003 and March 2012 were studied retrospectively. RESULTS: During this period, revision ESS was performed 40 times to treat chronic sinusitis. We analyzed the preoperative computed tomographic (CT) findings of primary and revision ESS cases using the Lund-Mackay and Kennedy CT staging scores to compare disease severity. In our cases, the failure of ESS was not affected by the extent of disease, asthma, or allergy. Polyposis was the only useful predictor of revision ESS. CONCLUSION: Polyposis is an important predictor of revision ESS. We recommend that patients be followed frequently and carefully, especially those with polyps.

The Correlation between Butanol Threshold Test (BTT) and Cross Cultural Smell Identification Test (CC-SIT) According to Causes of Olfactory Disorders / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Olfaction is a critical function of our body that allows one to avoid potential dangers in daily living. Although there are numerous subjective and objective tests evaluating the olfactory function, there exist no studies assessing correlations among such tests for various causes of olfactory dysfunction, especially in Korea. SUBJECTS AND METHOD: We collected the olfactory functional test results of 473 subjects who visited our outpatient clinic. We categorized these patients into 5 groups: head trauma, post-upper respiratory infection, chronic sinonasal disease, toxic exposure, and idiopathic. All patients were examined using the Butanol Threshold Test (BTT) and Cross Cultural Smell Identification Test (CC-SIT). The patients' subjective symptoms were recorded using the Visual Analog Scale (VAS). RESULTS: The three tests showed significant correlations in different pairs (CC-SIT and BTT; r=0.512, p<0.001, BTT and VAS; r=0.558, p<0.001 and VAS & CC-SIT; r=0.567, p<0.001). Correlation results were lower in patients with olfactory disorders caused by an upper respiratory infection and head trauma than in those with olfactory disorders caused by sinonasal diseases. CONCLUSION: The results from all three tests showed significant correlations with one another. CC-SIT and VAS score seem to represent the olfactory loss caused by sensorineural dysfunction better than BTT.

A Case of Nasal Polypoid Mass Originated from Nasal Foreign Body

Intranasal dacryocystorhinostomy(DCR) has been used as a primary treatment of nasolacrimal duct obstruction. Silicon tube or stent(Song's stent in this case) is used in intranasal dacryocystorhinostomy (DCR) for improvement of the lacrimal drainage system. But this material reacting with nasal mucosa induced inflammatory reaction. Consequently, we report a rare case of nasal polypoid mass caused by probably originated from nasal foreign body.

Skin Prick Testing of Patients with Allergic Rhinitis and/or Asthma: a Study in Catholic Medical Center, Korea

BACKGROUND AND OBJECTIVES: Allergic rhinitis is closely related to asthma. The skin prick test is an essential diagnostic tool for allergic disease. We evaluated differences in skin sensitization patterns between groups of patients with allergic rhinitis or asthma, or allergic rhinitis with asthma, in Korea. MATERIALS AND METHODS: From 2000 to 2009, patients with positive results from skin prick testing were divided into three groups: allergic rhinitis (AR), allergic asthma (AS), and allergic rhinitis with allergic asthma (AR+AS). We analyzed demographic data, rhinitis and asthma symptoms, and sensitization patterns. RESULTS: The most common aeroallergen was the house dust mite. The age distributions of the three disease groups differed significantly. Sensitization number, sensitization index, and atopy index were all significantly higher among the AR+AS group than among the AR or AS groups. CONCLUSION: Patients with allergic rhinitis with high numbers of skin sensitizations or intensive positivities should be considered to have concomitant asthma or to be at high risk for asthma development.

What is the Relationship between the Localization of Maxillary Fungal Balls and Intranasal Anatomic Variations?

OBJECTIVES: Although the mechanisms underlying the initiation and maintenance of inflammation in unilateral maxillary fungal balls (FBs) are poorly understood, the relationship between intranasal anatomy and maxillary FB is thought to play an important role. The aim of this study was to investigate the relationship between anatomic variations and FB. METHODS: We enrolled 140 patients who were composed of 56 patients with FB, 56 patients with unilateral chronic rhinosinusitis (CRS), and 28 patients with no sinus disease. Computed tomography scans were retrospectively analyzed to identify and compare the associated nasal anatomic abnormalities. To measure the volume of the nasal cavity and middle meatus, computed tomography scans were reconstructed into three-dimensional images. RESULTS: The relatively larger volume of the middle meatus was associated with the localization of the FB in contrast with the CRS. However, the nasal-cavity volume, nasal valve area, and nasal septal deviation were not significantly associated with localization of FB. The mean volumetric and areal measurements such as nasal cavity, middle meatus, and nasal valve in FB-ipsilateral sides were not significantly different from those in contralateral sides as well as other groups. CONCLUSION: The middle meatus bears the major part of the inspiratory nasal airflow, and its volume may influence the occurrence of FB.

Oroantral Fistula Originating from Osteomyelitis Accompanied by Maxillary Sinusitis

Osteomyelitis caused by maxillary sinusitis is clinically rare. We report a case of a 43-year-old woman who presented with an oroantral fistula on the hard palate, originating from osteomyelitis complicated by maxillary sinusitis. To our knowledge, oroantral fistula on the hard palate caused by chronic rhinosinusitis is rare. Physical, radiological, and cytological findings revealed the clues suggesting osteomyelitis. We performed endoscopic sinus surgery for the sinus lesion and the fistula healed spontaneously after the procedure.

Response of Peripheral Blood Mononuclear Cells to Staphylococcus Aureus Exotoxin in Nasal Polyposis

BACKGROUND AND OBJECTIVES: Superantigens such as Staphylococcus aureus exotoxin (SE) have been implicated in the pathogenesis of chronic rhinosinusitis with nasal polyposis (NP). The aim of this study was to determine the immunologic response of peripheral blood mononuclear cells (PBMCs) to staphylococcal exotoxin B (SEB) in patients with NP. METHODS: The interleukin (IL)-4, IL-5, and interferon-gamma(IFN-gamma) responses of PBMCs to nonspecific mitogens such as phylohemagglutin (PHA) and SEB were examined in 24 NP patients and 16 control subjects. The presence or absence of atopy and asthma was determined to evaluate the correlation of these conditions with the levels of cytokines. RESULTS: PBMCs from the NP patients were more likely to produce IL-4 and IL-5 in response to SEB than those from controls. There was no difference in the mitogen-induced cytokine responses between NP patients and controls. SEB-induced IL-5 and IL-4 levels were higher in patients with NP with asthma than in patients with NP without asthma. CONCLUSION: Patients with NP show an exaggerated Th2 cytokine response of PBMCs to SEB.

Effect of Adenotonsillectomy on Symptoms and Growth in Children with Sleep Disordered Breathing : Long-Term Results / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic upper airway obstruction attributable to adenotonsillar hypertrophy is the most common cause of sleep disordered breathing (SDB) in children. The objective of this study was to evaluate the long-term effects of adenotonsillectomy on the degree of SDB and growth in children with SDB. SUBJECTS AND METHOD: Forty-three children (mean age, 6.1+/-2.4 years) clinically diagnosed as SDB were enrolled, and they were scheduled for adenotonsillectomy (T&A ) based on their response to the validated, 22-item sleep related breathing disorder (SRBD) scale and a physical examination that showed adenotonsillar hypertrophy. Weight, height, and BMI (body mass index) were evaluated before and three years after T&A. RESULTS: SRBD scales decreased significantly after T&A(p<0.001). Their Z scores (standard deviation scores) for weight, height, and BMI of 43 children were significantly higher three years after T&A compared with before T&A (p<0.01). CONCLUSION: Children with SDB who underwent adenotonsillectomy showed significant long-term increases in weight, height, and BMI as well as a significant long-term improvement in quality of the sleep.

A Case of Warthin's Tumor Associated with Primary Tuberculosis of the Parotid Gland in a Patient with Acquired Immunodeficiency Syndrome / 대한이비인후과학회지

Parotid gland is an uncommon location for tuberculosis, but the incidence in this lesion has increased in human immunodeficiency virus (HIV) infection. Warthin's tumor is a relatively common benign tumor of the salivary glands. However, a coincidence of tuberculosis and Warthin's tumor in the parotid gland is extremely rare. We report a case of a patient with acquired immunodeficiency syndrome (AIDS) who presented parotid swelling. After superficial parotidectomy, the lesion was diagnosed to be tuberculosis associated with Warthin's tumor.