A Case of Benign Vascular Tumor of Tympanic Membrane / 대한이비인후과학회지

Benign vascular lesions are rarely found on the tympanic membrane. To date, only 21 cases restricted to tympanic membrane and/or external auditory canal have been reported, and all cases are hemangioma. We recently experienced a case of a vascular lesion arising from the atrophic tympanic membrane, which did not respond to initial CO2 laser therapy. Subsequent surgical excision of the vascular lesion was successfully performed. The clinical manifestations and management of benign vascular lesion of tympanic membrane are discussed with a review of literature.

Analysis of Risk Factors for the Occurrence of Residual Cholesteatoma after Congenital Cholesteatoma Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A higher residual rates after surgery have been reported in patients with congenital cholesteatoma than those with acquired cholesteatoma. The aim of this study was to document the risk factors of residual cholesteatoma after surgery for congenital cholesteatoma. SUBJECTS AND METHOD: From 1989 to 2006, 90 patients with congenital cholesteatoma treated at the Department of Otorhinolaryngology, Seoul National University Hospital were investigated retrospectively. Data were analyzed according to the location, type, stage, ossicular involvement, and initial surgery types for residual cholesteatoma. RESULTS: Residual cholesteatoma was detected in 18.9% (17/90) of total patients. With respect to residual cholesteatoma, significant risk factors were found with the open type, mastoid involvement and stapes supra-structure erosion. On the other hand, location, initial surgery types did not show statistical significance. CONCLUSION: The Staged 2nd look operation should be performed for patients with congenital cholesteatoma, especially in either case of the open type, advanced stage or in the presence of supra-structure erosion.

Clinical Features and Solutions of Facial Nerve Stimulation after Cochlear Implantation in Deaf Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Facial nerve stimulation (FNS) as a complication of cochlear implantation can produce significant discomfort, limit effective use of cochlear implant, and require extensive reprogramming in some patients. The purpose of this study is to review the clinical features of children with FNS after cochlear implantation and to discuss its possible solutions. SUBJECTS AND METHOD: Thirteen children who had FNS after cochlear implantation were included. Their medical records were reviewed retrospectively regarding the presence of inner ear anomaly (IEA), the programming techniques for cochlear implant, timing and progression of FNS, and the management of it. RESULTS: Ten out of 13 children (76.9%) with FNS had IEA. In those 10 patients with IEA, FNS appeared within 6 months from the operation and showed a tendency of being relevant to all electrodes. Authors used four methods to eliminate FNS. They included (a) turning off the specific electrodes when FNS seems related to some specific electrodes, (b) changing the coding strategy or the programming mode, which proved not to be effective, (c) reducing the C-level, which resulted in severe narrowing of dynamic range as well as a relative control of FNS, and (d) surgical exploration in specific cases. CONCLUSION: FNS after CI is at greater risk for IEA. FNS in those cases can interfere with the progression of speech development. This should be sufficiently informed of the parents of CI candidates with IEA preoperatively. Surgical exploration can be reserved for elimination of FNS in specific cases.

Clinical Features and Management of Parapharyngeal Space Tumors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Parapharyngeal space tumors are extremely rare head and neck tumors. Therefore, there are just a few reports about them. The purpose of this study was to report our experiences of parapharyngeal space (PPS )tumors regarding clinicopathological features and management. SUBJECTS AND METHOD: This study included 51 patients with PPS tumors which were diagnosed from January 1990 through June 2004. Medical records were reviewed retrospectively. RESULTS: The male-to-female ratio was close to 1:1. The mean age was 47 years (6 mo -83 Y ). The most frequent presenting manifestation was asymptomatic neck mass. All patients were subjected to CT scan, while 31 patients underwent MRI in addition. Diagnostic accuracy of fine needle aspiration cytology of 28 cases matched with pathologic reports by 50%. Salivary gland neoplasms occupied the biggest parts (43.1%, 53.8%)of both benign and malignant PPS tumors. Thirteen patients (25.5%)had malignant lesions. Surgical excision was performed in 39 cases (76.5%). The transcervical (30.8%)and the transcervical-transparotid approaches (38.5%)were commonly performed surgical procedures. Overall postoperative morbidity rate was 23.1%. There were 3 recur-rences (42.8%)in malignant tumors and no recurrence in benign ones after surgical excision during the mean follow-up period of 35 months (13 -89 mo ). Close observation, sclerotherapy and radiotherapy were only applicable for a few selected benign lesions. CONCLUSION: Most benign PPS tumors could be removed surgically with low complication and recurrence rates. Optimal surgical approach based on transcervical approach allows safe removal of various types of PPS tumors.

Cerebellopontine Angle Kaposiform Hemangioendothelioma: A Case Report / 대한이비인후과학회지

Hemangioendothelioma (HE) is an uncommon vascular neoplasm, and its intracranial occurrence is extremely rare, especially in the pediatric age group. The authors report a 7-month-old male patient with kaposiform HE who presented with left-sided facial paralysis and hearing loss. Initial magnetic resonance imaging (MRI) revealed a small lesion that filled the internal auditory meatus and exhibited the neuroimaging features of a vestibular schwannoma (VS). Six months later, follow-up MRI showed markedly enlarged mass. Biopsy disclosed kaposiform HE. After vascular embolization, partial resection was performed via transmastoid approach due to massive bleeding, followed by medical treatment with steroid and interferon-alpha. The tumor nearly disappeared 6 months after medical treatment. To our knowledge, it is a first reported case of kaposiform HE mimicking a VS in the cerebellopontine angle (CPA) area. A proper diagnosis is important because its treatment differs dramatically from that of VS. So, we report this case with a literature review.