Primary Extracranial Meningioma Presenting as a Cheek Mass

Meningioma is well known as common disease of the central nervous system, whereas primary extracranial meningioma is rare, representing 1% to 2% of all meningiomas. We have experienced a case of primary extracranial meningioma presenting as a right cheek mass. The tumor was completely excised via a right lateral rhinotomy incision. Histopathologic examination confirmed the diagnosis of primary extracranial meningioma.

Effects of Middle Ear Lesions on Pre and Postoperative Hearing Outcomes in Patients with Chronic Otitis Media

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the effects of middle ear lesions on pre and postoperative hearing in patients with chronic otitis media (COM) and to assess the relationship between various prognostic factors and pre and postoperative hearing using more than 2000 COM surgery records retrieved from a computerized database released by the Korean Otologic Society in 2005. SUBJECTS AND METHODS: Data of 2312 COM surgeries, which had been conducted by a single surgeon from 1989 to 2009, were reviewed retrospectively. Mean preoperative and postoperative air-bone gap (ABG) was analyzed using a four-frequency (500, 1000, 2000, and 3000 Hz) pure tone average (PTA). Pre and postoperative ABGs were compared with regard to several prognostic factors, including disease duration, age, Eustachian tube function, existence of otorrhea, size of tympanic membrane perforation, degree of ossicular destruction, presence of cholesteatoma, and its type. RESULTS: Mean pre and postoperative ABGs of PTA in the 2079 cases studied were 27.88+/-13.33 dB and 17.38+/-15.64 dB, respectively, with a hearing success rate of 69%. The results suggested that preoperative ABGs were affected by Eustachian tube function, Griffin grade, presence of cholesteatoma and its type, and the degree of ossicular destruction. Hearing gains differed significantly among the groups when compared with factors of Griffin grade, presence or type of cholesteatoma, and the degree of ossicular destruction. CONCLUSIONS: Many factors affected pre and postoperative ABGs and postoperative hearing outcomes. These results will be useful for designing future clinical studies on COM surgery, as well as for surgical planning and patient counseling in clinical practice.

Eustachian Tube Function and Mastoid Pneumatization as Prognostic Factors of Type 1 Tympanoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pre-operative eustachian tube function (ETF) and mastoid aeration are important in maintaining a post-operative aerated middle ear. In this study, we evaluated the prognostic value of pre-operative ETF and of mastoid aeration predicting post-operative outcomes after chronic otitis media surgery. SUBJECTS AND METHOD: One hundred eighty patients of non-cholesteatomatous chronic otitis media who underwent type 1 tympanoplasty were categorized into two groups (well-patent ETF versus obstructed ETF) according to the results of Valsalva maneuver test, and also categorized into four groups according to the results of a modified pressure inflation-deflation equilibration test. The extent of mastoid aeration was measured using high resolution computerized tomography scan of the temporal bone and image analysis software (Rapidia(R)). The post-operative outcomes at 3 months of surgery were compared with those of the tympanoplasty only group and the mastoidectomy with tympanoplasty (MT) group as well as with the different pre-operative ETF groups. RESULTS: Successful post-operative outcome was 87.9% in the well-patent ETF group and 82.8% in the obstructed ETF group according to the Valsalva maneuver test (p=0.418). Successful outcome was 90.6% in the good ETF group and 74.5% in the poor ETF group according to the modified pressure equilibration inflation-deflation test, which was significantly different (p=0.047). Patients with successful outcome had greater extent of mastoid aeration than those with poor surgical outcome (p=0.026). Distributions of surgical outcome were not statistically different between the tympanoplasty only group and the MT group (p>0.05). CONCLUSION: The ETF measured by modified pressure inflation-deflation equilibration test and the extent of mastoid aeration measured using the Rapidia(R) program were valuable information that can be used to predict post-operative outcomes after chronic otitis media surgery.

Intramural Esophageal Abscess and Dissection due to Retropharygeal Abscess / 대한이비인후과학회지

Intramural esophageal dissection is a rare esophageal disorder characterized by sudden severe retro-sternal pain, hematemesis, odynophagia and dysphagia due to longitudinal separation of submucosa from muscle layer of the esophagus. Even though the etiology of this disorder still remains uncertain, it is usually associated with a rapid increase of intra-esophageal pressure in addition to coagulation disorder. We treated a patient who initially presented with retropharyngeal abscess, but finally progressed to an intramural esophageal dissection, which was successfully treated by endoscopic procedure. This is the first case that recorded disease progression and treatment from a retropharyngeal abscess to esophageal dissection.

Recording of Ictal Nystagmus in a Case of Syncope Presenting Vertigo / 대한평형의학회지

Prevalence of dizziness has been reported to be as high as nearly twenty percent and one half of these population had social handicap to some degree. The diagnostic approach of dizziness heavily relies on the premise that dizziness type predicts the underlying etiology-e.g, vertigo with vestibular causes and presyncope with cardiovascular causes. However, such symptomatological approach sometimes delays correct diagnosis as the presenting symptom of individual patient is typically vague to designate the type. In this paper, a case of a 57-year-old woman who has experienced recurrent rotatory vertigo of cardiovascular origin was discussed. When her head were turned to the left, a fast downbeat nystagmus following a slow upward eye deviation was recorded using video nystagmogram. Hence, we report this single case of syncope presented as peripheral vertigo type with literature review.

The Effect of Smoking on Outcome in Endoscopic Sinus Surgery

BACKGROUND AND OBJECTIVES: This study is designed to assess the effect of smoking on the outcome of endoscopic sinus surgery. MATERIALS AND METHODS: A total of 66 patients who underwent endoscopic sinus surgery with the diagnosis of chronic sinusitis were evaluated. They were divided into 3 groups; non-smoking, quit-smoking and still-smoking groups. Preoperative and postoperative visual analogue scale (VAS), Sinonasal Outcome Test (SNOT), and endoscopic score for each group were obtained and compared. RESULTS: There were statistically significant correlations between VAS, SNOT score and smoking. However, all patients showed a similar degree of improvement on the subjective symptoms regardless of smoking or nonsmoking. And, postoperative relief of subjective symptoms was not apparent after smoking cessation. In objective findings, postoperative endoscopic scores were 1.6 in non-smoking group, 1.8 in quit-smoking group and 2.7 in still-smoking group. Stillsmoking group had the worst endoscopic result, However, these differences did not reach a statistical significance. CONCLUSION: This study suggests that smoking had a negative effect on subjective symptoms but not in objective endoscopic findings. In addition, the cessation of smoking after sinus surgery may have no meaningful benefit on the outcome of surgery.