The Efficacy of Posterior Turbinoplasty in Combination with Tonsillectomy and Adenoidectomy in Pediatric Sleep Disordered Breathing Patients / 대한이비인후과학회지

Background and Objectives@#Tonsillectomy and adenoidectomy (T&A) are effective for the treatment of pediatric sleep disorder breathing. However, in some pediatric patients, there remain unresolved snoring and mouth breathing problems after the operation. This study is aimed at evaluating the efficacy of coblation of hypertrophic posterior turbinate in combination with tonsillectomy and adenoidectomy.Subjects and Method We analyzed data from 50 children aged between 5 to 13 years old who were scheduled to undergo T&A operation from June 2018 to December in 2018. We randomly divided them into two groups. The first group consisted of 25 patients who were scheduled to perform only tonsillectomy and adenoidectomy. The second group was 21 patients who were scheduled to perform posterior turbinoplasty in combination with tonsillectomy and adenoidectomy. We evaluated preoperative and postoperative polysomnogram [Apnea-Hypopnea Index (AHI), O2 saturation], acoustic rhinometry (minimal cross section area, nasal volume), and Korean Obstructive Sleep Apnea-18 Survey (KOSA-18) score. @*Results@#After additional turbinoplasty (coblation of hypertrophic posterior turbinate), the rate of snoring and mouth breathing remaining was decreased. There were significant improvements in AHI, oxygen saturation, Visual Analog Scale and Epworth Sleepiness Scale in two groups. Symptoms (snoring and mouth breath) remaining postoperatively was much more decreased in the posterior turbinoplasty combined with T&A group than in the single T&A group in terms of KOSA-18. @*Conclusion@#When it comes to pediatric sleep disorder breathing surgery, nasal cavity evaluation is an important factor for patient’s postoperative satisfaction for sleeping and snoring. For pediatric sleep disorder breathing patients with hypertrophic posterior turbinate, who are scheduled to do tonsillectomy and adenoidectomy, an additional coblation of posterior turbinate should be considered.

Effect of Filmogen Topical Gel on Pain and Hemorrhage after Tonsillectomy / 대한이비인후과학회지

Background and Objectives@#Tonsillectomy is one of the most common operative procedures in otorhinolaryngology. Most patients following tonsillectomy suffer from postoperative pain and hemorrhage. This study was performed to investigate whether filmogen topical gel (PHARGELⓇ, Vitrobio SAS), applied to the tonsillectomy site after tonsillectomy reduced pain and hemorrhage.Subjects and Method A total of 40 patients over 15 years old scheduled for elective tonsillectomy were randomly divided into two groups. After tonsillectomy and postoperative day 0, 1, 2, and 7, one group was applied with the filmogen topical spray 3-5 times a day but the other group remained without applying it. Pain and postoperative hemorrhage were measured at the postoperative day 0, 1, 2, and 7 of the operation. Pain was measured by using a visual analogue scale. @*Results@#Patients who applied the filmogen topical spray presented lower pain scores than patients who didn’t applied the spary. There was no difference for postoperative hemorrhage between two groups. @*Conclusion@#Filmogen topical spray is an effective postoperative control for pain but not for hemorrhage on the tonsillectomy site.

Effect of Nasal Surgery in Patients with Remained Snoring and Sleep Apnea after Obstructive Sleep Apnea Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea syndrome is one type of sleep disorder breathing. During sleep, in respiration, nasal obstruction causes negative pressure, which in turn causes the pharyngeal airway to collapse during inspiration. We investigated how nasal surgery affects patients who have undergone OSA surgery but still suffer from the remaining symptoms of snoring and sleep disorder breathing. SUBJECTS AND METHOD: We reviewed 24 patients, who had undergone obstructive sleep apnea (OSA) surgery only to show no enhancement in snoring and qualities of sleep; they showed nasal septal deviation or inferior turbinate hypertrophy. Septal surgery or inferior turbinoplasty was performed by the same otolaryngologist. Over the period between preoperation and 1, 3, 6, 12 months after operation, we evaluated Apnea-Hypopnea Index (AHI) and oxygen saturation by polysomnography, degree of snoring by Visual Analogue Sacle (VAS) score, satisfaction for quality of sleep by Epworth Sleepiness Scale (ESS), minimal cross section area and volume of nasal cavity by acoustic rhinometry, respectively. RESULTS: After nasal surgery, the volume of nasal cavity and MCA increased. There were significant improvements of AHI, oxygen saturation, VAS and ESS score. CONCLUSION: As for OSA surgery, the evaluation of nasal cavity is an indispensible factor for improving the quality of sleep and snoring. When treating OSA patients who have nasal obstruction, nasal surgery including septoplasty and inferior turbinoplasty should be considered.

The Long Term Efficacy of Microdebrider Assisted versus Coblation Assisted Inferior Turbinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The study aimed to evaluate the long term efficacy of micro-debrider assisted inferior turbinoplasty (MAIT) compared to coblation assisted inferior turbinoplasty (CAIT) for hypertrophic inferior turbinates. SUBJECTS AND METHOD: From January 2008 to December 2008 inclusively, 96 patients with persistent hypertrophic inferior turbinates mucosa refractory to medical therapy were enrolled into this study. All patients were suffering from nasal obstruction and related symptoms. Overall, 56 patients were treated with microdebrider assisted inferior turbinoplasty (MAIT group) and 40 patients were treated with coblation assisted inferior turbinoplasty (CAIT group). Postoperative changes in degree of nasal obstruction, sneezing, rhinorrhea, minimal cross sectional area (MCA), and nasal volume from the nostril to 7 cm posteriorly (V7), operation time, duration of crust formation, intraoperative bleeding and delayed bleeding were compared between the two surgical methods prospectively in the 1st and 6 months, and in the 1st and 2nd years after the procedure. Also patient's satisfaction with procedure was evaluated. RESULTS: The nasal obstruction and related nasal symptoms improved significantly in MAIT group and persisted within the periods of 2 years after surgery, while in CAIT group the significant improvements took place in the 1st and 6th months after surgery but no significant improvements from 1 to 2 years after were noted. Nasal patency (MCA and V7) also showed more improvement and persistence in MAIT group than CAIT group. There were no significant differences in operation time and intraoperative bleeding and delayed bleeding but the duration of crust formation was significantly shorter in MAIT group. And patient satisfaction in the MAIT group was higher than that in the CAIT group. CONCLUSION: From the analysis of this study, it can be said that MAIT is more effective and satisfactory for the long term relief of nasal obstruction, related nasal symptoms and reduction of hypertrophic inferior turbinate mucosa than CAIT.

A Case of Primary Laryngeal Aspergillosis Confused with Vocal Cyst / 대한이비인후과학회지

With a surge in the population of immunocompromised patients, the incidence of laryngeal fungal infection has also been increased. Infection by aspergillus, which is a kind of mold, or a filamentous fungus, occurs rarely in larynx. Furthermore, most aspergillosis of the upper airway is an extension of the pulmonary or systemic aspergillosis in the immunocompromised host. So, the primary laryngeal aspergillosis that occurrs as an isolated laryngeal infection of aspergillus without other aerodigestive tract extension is very rarely encountered. We present a case of primary laryngeal aspergillosis misconceived as a vocal cord cyst in a 24-year-old female who had no past history of immune deficiency, voice abuse or steroid use.