Efficacy of Treatment with Coblation Turbinate Reduction in Patients with Allergic Rhinitis Responding to Medication / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effectiveness of turbinate surgery has been well demonstrated in allergic rhinitis refractory to medication. On the contrary, the efficacy of surgery in allergic rhinitis that responds to medication has not been assessed. The aim of this study was to determine the surgical outcomes in patients with allergic rhinitis responsive to medication. SUBJECTS AND METHOD: Patients with allergic rhinitis responsive to medication and those who had undergone coblation turbinate reduction were enrolled in this study. The visual analog scale was used to assess the allergic symptoms before treatment, during medication treatment as well as postoperatively at 6 and 12 months. In addition, the degree of patient satisfaction regarding the surgery was investigated postoperatively at 12 months. RESULTS: Twenty-four patients (mean age=33.6±14.9 years; men-to-women ratio=1:1) were included in this study. During the pretreatment period, all allergic symptoms significantly improved after treatment with both medication and surgery. At 6 months postoperatively, the degree of patients' allergic symptoms was lower than in those treated with medication. However, when compared at 12 months postoperatively, all the symptoms, excluding nasal obstruction, were not significantly different from those who received medication. Surveyed postoperatively at 12 months 54.2% of patients advocated for surgical treatment. CONCLUSION: Although surgery yielded better outcome than did medication during the early postoperative period, there was little difference in the outcome at 12 months postoperatively. Therefore, we need to be careful when choosing surgical intervention for patients with allergic rhinitis responsive to medication.

A Case of Skull Base Plasmacytoma Presenting with Unilateral Cheek Paresthesia in Patient with Multiple Myeloma

Plasmacytoma is a monoclonal neoplastic proliferation of plasma cells derived from bone marrow. Plasmacytoma of the skull base is very rare. Recently, the authors experienced a case of a 50-year-old woman with a tumor like lesion originating from the right sphenoid bone. The patient presented with a 3-month history of right facial pain and paresthesia. She had been diagnosed and treated with multiple myeloma for more than 5 years, although she was in complete remission until recently. Imaging studies including contrast CT scan and MRI, showed a huge, enhanced and irregular shaped lesion in the sphenoid bone along with skull base destruction and intracranial invasion. The patient underwent transnasal endoscopic biopsy under local anesthesia. The pathology was consistent with a plasma cell tumor and it was confirmed as a solitary plasmacytoma of the bone of the skull base. We report this rare case along with a literature review.

Coblation Turbinate Reduction in Patient with Nasal Obstruction / 대한이비인후과학회지

Chronic nasal obstruction is a common symptom and usually comes from mucosal disease associated with turbinate hypertrophy. Diverse surgical treatments have been used to improve chronic nasal obstruction in patients with inferior turbinate hypertrophy. However, there is no common consensus about the values of the various methods. The ideal turbinate surgery should effectively decrease the volume of turbinate, keep physiologic function of nose, and avoid complications. Recently, office-based inferior turbinate reduction using radiofrequency energy has been gaining popularity. In this article, the efficacy and morbidity of coblation turbinate reduction for nasal obstruction will be reviewed.

A Case of Nosocomial Nasal Myiasis in Comatose Patient / 대한이비인후과학회지

A 82-year-old female was injured in a car accident and admitted to the emergency department in a comatose state. The patient was intubated and then transferred to the intensive care unit. After 2 days, live maggots were discovered from both nostrils. The maggots were treated by mechanical removal and irrigation with an antiseptic solution. After treatment of maggots, endoscopic examination revealed no remnant maggot and abnormal lesion in the nasal cavity. On the following day, maggots were retrieved from mouth in spite of a continuous appliance of an antiseptic solution into the nostrils. More careful concerns to nasal and oral hygiene were performed and no other maggots were found. We present the case of myiasis with a literature review of treatment methods of maggot.

Unilateral Optic Neuropathy by Huge Sphenoid Sinus Mucocele: a Case Report to Emphasize the Importance of Early Detection and Treatment

A mucocele of the sphenoid sinus is relatively rare, and it has nonspecific clinical features. Hence, it is hard to diagnose it with the history of the illness alone. However, if the sphenoid mucocele is not detected and treated in early stage, its sequalae could be very serious or permanent, such as intracranial complication or blindness. Recently, the authors experienced a case of a sphenoid mucocele with unilateral visual disturbance for a period of one year. The patient underwent endoscopic sinus surgery-marsupialization successfully, but remnant visual disturbance as a sequalae did not fully recover. Thus high index of suspicion, prompt diagnosis using imaging studies, and urgent surgical intervention are crucial for promising of complete recovery from the disease.

Learning Curve of Septoplasty with Radiofrequency Volume Reduction of the Inferior Turbinate

OBJECTIVES: Since few studies on surgical training and learning curves have been performed, majority of inexperienced surgeons are anxious about performing operations. We aimed to access the results and learning curve of septoplasty with radiofrequency volume reduction (RFVR) of the inferior turbinate. METHODS: We included 270 patients who underwent septoplasty with RFVR of the inferior turbinate by 6 inexperienced surgeons between January 2009 and July 2011. We analyzed success score, cases of revision, cases of complication, operation time, and acoustic rhinometry. RESULTS: Success score was relatively high and every surgeon had few cases of revision and complication. No significant difference was found in success score, revision, complication case, or acoustic rhinometry values between early cases and later cases. Operation time decreased according to increase in experience. However, there was no significant difference in the operation time after more than 30 cases. CONCLUSION: We can conclude that 30 cases are needed to develop mature surgical skills for septoplasty with RFVR of the inferior turbinate and that training surgeons do not need to be anxious about performing this operation in the unskilled state.

Endoscopic Sinus Surgery and Septoplasty Performed Under Local Anesthesia: Comparative Analysis of Patient Discomfort

OBJECTIVES: The goal of this study is to compare the degree of patient discomfort between endoscopic sinus surgery (ESS) and septoplasty under local anesthesia. MATERIAL AND METHODS: A total 95 patients that underwent ESS and septoplasty under local anesthesia between July 2009 and January 2010 were enrolled in this study. The patients estimated the parameters of their own discomfort (pain, position, noise, anxiety, and memory). The score of each of the parameters ranged from 0 to 4. We compared the scores of the parameters between the ESS and septoplasty groups. RESULTS: Of the 95 patients, 61 (64%) received ESS, 32 (34%) received septoplasty, and 2 (2%) received both. The scores of all the parameters were not greater than moderate in both groups. There were no significantly statistical differences between the two groups. However, the ESS group had lower scores than the septoplasty group in the parameters of pain, position, noise, and memory. No remarkable complications occurred. CONCLUSION: The patients in this study had modest discomfort and no noticeable complications during the surgeries under local anesthesia. Although no statistical difference existed between the two groups, the ESS group experienced relatively lower discomfort levels during the surgery under local anesthesia compared to the septoplasty group.

Result of Laser Cordectomy in Early Glottic Cancer and Observation of Malignant Transformation from Precancerous Lesion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laser cordectomy has been widely acknowledged to have advantages for the treatment of early glottic carcinoma. This study was performed to assess the results of laser cordectomy for its oncologic safeness, time-effectiveness, and to report a few interesting precancerous cases that have progressed to glottic cancer. SUBJECTS AND METHOD: Subjects (47) who had undergone laser cordectomy for the treatment of early glottic cancer from April 2006 to July 2009 were enrolled in this study. We analyzed the oncologic outcomes, the duration of hospital treatment after the surgery, and postoperative complications by reviewing of medical records. RESULTS: For 47 cases, the mean age was 66 years and the mean follow up period was 22.6 months. The mean duration of treatment was 1.9 days. Among them, 24 cases were classified into T1a, 12 T1b, and 2 T2. Local recurrence was observed in 2 cases, so salvage treatments, such as radiation therapy or near total laryngectomy, were performed, and both of them were alive in the disease-free state. The most common complication was anterior commissure web, which was observed in 6 cases (15.8%), followed by granuloma observed in 5 cases (13.1%). Serious complications such as aspiration, respiratory distress, and dysphagia were not found in any of 47 cases. Also, we could observe 3 cases in which the precancerous glottic lesion had progressed to glottic carcinoma over a long period of time. CONCLUSION: Laser cordectomy might be the treatment of choice for patient's convenience because of its excellent oncologic outcomes, low morbidity, and time-effectiveness.