The Treatment of Acute External Laryngotracheal Injuries / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute laryngotracheal injury is uncommon but can be a life-threatening event and often poses as a difficult airway management problem. Therefore, the immediate recognition and appropriate initial assessment and treatment are vital for a successful outcome. We performed this study to evaluate an appropriate management of acute laryngotracheal injury patients. MATERIALS AND METHOD: Twenty-two patients with acute external laryngotracheal injury who underwent conservative treatment or surgery from 1998 to 2003 were evaluated. The record of patients were reviewed retrospectively. These patients have been studied with attention to clinical symptoms, sign, injury mechanism, injury site, degree of injury, treatment and outcome after the treatment. RESULTS: Sixteen cases were categorized as blunt trauma and the other six cases as penetrating trauma. The main symptoms and signs were dyspnea and hoarseness. Common sites of injury were laryngeal mucosa, thyroid cartilage and trachea. The patients in group I, II were treated conservatively mainly and those in group III, IV, V were mainly treated surgically. All patients were decannulated. Sixteen patients made a full return to normal voice, and six were assessed fair. CONCLUSION: The immediate recognition of acute external laryngotracheal injury and early proper treatment are vital for life and successful outcome.

Factors That Affect the Development of Tympanosclerosis after Ventilation Tube Insertion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The tympanosclerosis is an abnormal deposits of collagen materials on the lamina propria of the tympanic membrane or the middle ear mucosa. It usually appears as a whitish plaque on the tympanic membrane through otoscopic examination. The etiology of tympanosclerosis is not known, but there are some theories that attempt to explain the pathogenesis. The aim of this study is to understand the pathogenesis of tympanosclerosis and to find out the methods to minimize the occurrence of tympanosclerosis after ventilation tube insertion. MATERIALS AND METHODS: Otoscopic examination, impedance and pure tone audiometry were performed on 190 patients (306 ears) with serous otitis media, and on those who have undertaken ventilaton tube insertion from 1990 to 1998 at the otolaryngology department in Hanyang University Hospital. Then, the patients' medical and operative records were reviewed and analyzed in view of location and pathogenesis of tympanosclerosis. RESULTS: Incidence rate of tympanosclerosis was 42.5% in non-cleft patients and 61.9% in congenital cleft and palate patients. The rate increased when larger and heavier tube was used and the middle ear fluid was highly viscous. Most common sites for the development of tympanosclerosis were in the posteroinferior and anteroinferior portions of the tympanic membrane. Tympanosclerosis had little effect on hearing but in severe cases, it caused mild degree of hearing loss. CONCLUSION: We consider that tympanosclerosis is an inevitable result of ventilation tube insertion and its pathogenesis is multifactorial. We found that we can minimize the occurrence of tympanosclerosis by using small and light ventilation tubes, and avoid intraoperative bleeding and minimal mechanical trauma on the tympanic membrane by aspiring the middle ear fluid.

Clinical Evaluation of Cholesteatoma Using Computerized Tomogram / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Computerized tomography (CT) is the method of choice in radiologic diagnostic evaluation of cholesteatoma, since it reveals the presence of soft tissue mass and erosion of bony structure. Also CT enable us to predict the route of cholesteatoma extension, so we hope to hypothesize the unknown pathogenesis of cholesteatoma indirectly. MATERIALS AND METHODS: Preoperative CT and surgical treatment were performed on 80 patients with acquired cholesteatoma from 1996 to 1998 at otolaryngology department in Hanyang University Hospital. The charts and CT findings of the patients were retrospectively reviewed and analyzed according to types of cholesteatoma and its location and extension route. RESULTS: Pars flaccida cholesteatoma is the highest incidence of cholesteatoma and it is possible to predict the direction of progression of cholesteatoma using CT in most cases. Sensitivity of destruction of ossicles and semicircular canal in CT is over 96%. Incidence of obstruction of tympanic isthmus and eustachian tube is higher in pars flaccida cholesteatoma than in pars tensa cholesteatoma. CONCLUSION: Temporal bone CT is a very useful tool to evaluate the clinical characteristics and predict the pathogenesis of cholesteatoma by evaluating of extension route of it.

Comparative Analysis of Therapeutic Effect between Topical Vancomycin and Systemic Vancomycin in Otorrhea by Methicillin-resistent Staphylococcus Aureus (MRSA) Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently, methicillin resistent Staphylococcus aureus (MRSA) infecton in persistent otorrhea is on the increase. Beside the systemic side effects of vancomycin, systemic vancomycin injection needs admission and higher medical cost. We used vancomycin topically in the treatment of otorrhea by MRSA infection to minimize the disadvantages of systemic vancomycin injection. The objective of this study was to compare the therapeutic effects between topical and systemic use of vancomycin. MATERIALS AND METHODS: Twenty-five patients with persistent otorrhea were performed ordinary culture and sensitivity test. Among them, 18 patients were proved to have MRSA and they were divided into two groups. One group was treated with topical vancomycin packing, the other with systemic injection. RESULTS: MRSA was cultured in 18 cases (72%) among the 25 patients with persistent otorrhea. Therapeutic effects of topical vancomycin on MRSA infection was 77% and the average therapeutic period was 13.5 days. On the other hand, therapeutic effect was 100% and the average period was 5.6 days in systemic vancomycin injection group. CONCLUSION: Topical vancomycin packing in the treament of chronic otitis media with MRSA infection has advantages in view of time and economy, though the average therapeutic period is longer than that of systemic vancomycin injection.

Surgical Anatomy around the Maxillary Sinus Ostium in Cadavers

OBJECTIVES: The goal of this study is to observe the anatomy around the maxillary sinus ostium and gain an understanding that will help prevent serious complications during middle meatal antrostomies. MATERIALS AND METHODS: Dissection of the maxillary sinuses was carried out in 64 embalmed frozen cadavers, 105 maxillary sinuses. Using a digital ruler, forceps and a malleable probe, we measured the important anatomical relationships around the maxillary sinus ostium and uncinate process, the accessory ostium, and the nasolacrimal duct. RESULTS: 1) The mean width of the uncinate process was 4.9 mm in the mid portion ; 2) A natural ostium of the canal type was observed in 76% of cases ; 3) An accessory ostium was found in 18% of cases and the mean size was 3.17x2.41 mm ; and 4) The mean shortest distance between the nasolacrimal duct and the natural ostium was 4.8 mm. CONCLUSION: Surgeons must keep surgical anatomy in mind to prevent complications when performing endoscopic sinus surgery.