A Case of Trigeminal Schwannoma Mimicking Meniere's Disease / 대한이비인후과학회지

Meniere's disease is diagnosed by excluding other possible causes of symptoms characterized by relapsed vertigo, aural fullness, hearing loss and tinnitus. Several disease entities may mimic Meniere's disease when the disease does not manifest its own characteristic findings. We present the case of a 40-year-old male patient who was suffering from the spontaneous and repeated onset of vertigo, and complaining of aural fullness, hearing loss and tinnitus in his left ear. A diagnosis of definite Meniere's disease was made and medical treatment was applied with diuretics. One year later, he complained of a tingling sensation in his face, and MRI revealed an intracranial mass. Mass excision was performed with subtemporal approach and operative findings revealed trigeminal schwannoma. We supposed that the tumor might have compromised his vascularity and altered his CSF dynamics, leading to symptoms mimicking Meniere's disease. Trigeminal schwannoma should be considered as an exclusion category of Meniere's disease, and MRI is necessary to exclude the central lesion

Clinical Evaluation and Proper Antibiotics Therapy in Office Base for the Patients Who were Infected with MRSA after ESS / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Methicillin resistant staphylococcus aureus (MRSA) prevalence has increased over the world during past several decades and now it has become a world wide problem. It is especially more serious in domestic situations but unfortunately, until this time, there is no report about MRSA infection treatment after endoscopic sinus surgery (ESS). The objective of our study is to evaluate clinical feature of MRSA infection and to find out what kinds of treatment is the best way to control of the MRSA infection after ESS. SUBJECTS AND METHOD: The medical records of 58 patients who had the evidence that they were infected with MRSA after ESS were retrospectively reviewed. Samples were obtained by sinus endoscopy in the office base. RESULTS: Those of MRSA infected only cases were 26 cases. Co-infected cases with another microorganism were 32 cases. Forty-three cases were treated with oral rifampin alone and 11 cases were treated by a combination with oral quinolone or trimethoprim-sulfimethoxazole. Four cases failed to be treated with oral antibiotic therapy. CONCLUSION: Rifampin is the useful medication for the treatment of MRSA infected patients who had underwent ESS. Also, Rifampin is a cost effective medication compared with the glycopeptide antibiotics especially if it is used in the office base.

Clinical Analysis of Pharyngocutaneous Fistula after Total Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pharyngocutaneous fistula after total laryngectomy is one of the most common complication in the immediate postoperative period. The objective of this study is to evaluate the variable predisposing factors after total laryngectomy and to investigate the management of pharyngocutaneous fistula. SUBJECTS AND METHOD: One hundred fifty cases who had been performed total laryngectomy were investigated retrospectively. Fifteen of 150 cases (10.0%) developed pharyngocutaneous fistula after total laryngectomy. We analyzed clinical parameters such as age, sex, smoking, alcohol intake, DM (diabetes mellitus), hypertension, liver disease, postoperative hemoglobin, albumin etc. RESULTS: Smoking, DM, hypertension, postoperative hemoglobin, postoperative albumin were significant factors associated with pharyngocutaneous fistula. Nine patients were managed with conservative treatment and six patients underwent surgical reconstruction by using pectoralis major myocutaneous flap. The average duration of oral feeding was 30 postoperative days in conservative treatment group and 83 postoperative days in surgical intervention group. CONCLUSION: Pharyngocutaneous fistula may be preventable by correcting the predisposing factors. We must consider the initial size of fistula and the response of conservative treatment to determine methodology and timing of surgical management.