A Case of Multiple Vasculitis and Stroke due to Sphenoid Sinusitis / 대한이비인후과학회지

Sinogenic intracranial complications are rare but serious conditions. Sometimes, the diagnosis is delayed because the initial symptoms of sphenoid sinuses intracranial complications are not remarkable especially when they are of sphenoid sinus origin. Deep location of the sphenoid sinuses places them adjacent to the dura mater, major intracranial vessels, and some cranial nerves. Therefore, delayed diagnosis of the sphenoid sinusitis and its complications can make disastrous results. We experienced a 55 year old female patient who developed fulminant meningitis, vasculitis, and a stroke due to vasculitis as a complication of sphenoid sinusitis. We review the case and related articles.

Bacteriologic Evaluation of Peritonsillar Abscess / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Peritonsillar abscess (PTA) is a collection of pus lateral to tonsil and is located between the fibrous capsule of the palatine tonsil, usually at its upper pole, and the superior to the pharyngeal constrictor muscle. It frequently occurs as a complication of acute tonsillitis. Bacteriology including clinical characteristics in PTA were evaluated. SUBJECTS AND METHOD: Sixty-one patients with peritonsillar abscess, who visited National Medical Center from January 1997 through August 2001 were entered into the study. Each patient was asked to answer a questionnaire for clinical aspects of PTA. Needle aspirations were performed and pus was drained in all cases. Bacterial susceptibility to ampicillin, cephazoline, ciprofloxacin, erythromycin, tetracyclin, and vancomycin was tested on the ioslated bacteria. RESULTS: Among 61 cases, aerobes were isolated in 15 cases (24.6%) and anaerobes in 16 cases (26.2%). There was no significant difference in the culture positive rate of aerobes (p=0.767) and anaerobes (p=1.0) between antibiotics-medicated patients and nonmedicated patients. Among the cultured organisms, peptostreptococcus was the most common and the second most common was beta-hemolytic streptococcus. However, alpha-hemolytic streptococcus, an important pathogen considered in the previous study, was detected at 1.6%. CONCLUSION: Antibiotics medication was not a significant factor in culture positive rate in our study. Peptostreptococcus as an anaerobe and beta-hemolytic streptococcus as an aerobe were the major causes that contributed to the decreased state of peritonsillar abscess and culture positive rate of alpha-hemolytic streptococcus.

A Case of Acute Airway Obstruction due to Intracystic Hemorrhage of Thyroid Papillary Cancer / 대한이비인후과학회지

Thyroid papillary cancer is the most common type of thyroid cancer and the incidence rate is 70-80% of entire thyroid cancer. 10-year survival rate is more than 90%. It is mostly irregular marginated- hard mass but, may have cystic property. The most common clinical symptom is silent neck mass, but rapid growth or local invasion may develope the symptoms such as pain, hoarseness, dysphagia, hemoptysis and dyspena. With the 10% of invasion rate, it spreads to adjacent muscle, recurrent laryngeal nerve, pharynx, larynx, trachea, esophagus and spinal cord. We report a case of acute airway obstruction due to intracystic hemorrhage of thyroid papillary cancer which invades the retropharynx.

Frontal Sinusitis Related to Anatomic Variations / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The frontal recess is the drainage pathway for the frontal sinus and its boundaries are formed by adjacent structures: they include agger nasi (anterior wall), medial orbital wall (lateral wall), ethmoid bulla/agger nasi (lateral wall), ground lamella (posterior wall), and anterior ethmoid air cells (posterosuperior). It is known that the drainage of the frontal recess is influenced by anatomic variants (agger nasi cell, frontal cells, supraorbital cell, intersinus septal cell, and attachment type of uncinate process). Because of its complex anatomy, the frontal sinus has been a difficult area in which to obtain consistently good long-term surgical results. SUBJECTIVES AND METHOD: To show the prevalence of anatomic variants and the relationship between the variants and frontal sinusitis, we analyzed the coronal and axial computed tomography of 225 patients, and 450 side sinuses (from 2001-6-1 to 2002-12-31). RESULTS: Frontal cells are observed in 176 cases (40.1%), agger nasi cell in 380 cases (84.8%), supraorbital cell in 17 cases (3.8%), and intersinus septal cell in 19 cases (11%). In the attachment type of the uncinate process, the lamellar type was seen in 272 cases (60.2%), the skull base type in 171 cases (26%), and the middle turbinate type in 62 cases (13.8%). The frontal sinusitis were seen in 8 cases (88.9%) among the type IV frontal cell group (9 cases) and in 149 cases (39.1%) among the agger nasi group. CONCLUSION: Relatively higher prevalence of anatomic variants was seen. The type IV frontal cells and agger nasi cells were significantly related to the frontal sinusitis.

A Case of Pleomorphic Adenoma Arising from Nasopharynx / 대한이비인후과학회지

Pleomorphic adenoma is most frequently seen in the major salivary glands. Pleomorphic adenoma in minor salivary gland is relatively rare and can be found in palate, lip, buccal mucosa, tongue, oropharynx, nasal cavity, paranasal sinus, parapharynx as well as in the nasopharynx. Pleomorphic adenoma of nasopharynx is very rare, and only a few cases were reported both in neonates (congenital type) and adults (acquired type). We report the adult case of nasopharyngeal pleomorphic adenoma (Eustachian tube origin) with a review of literature.

A Case of Laryngeal Amyloidosis / 대한이비인후과학회지

Laryngeal amyloidosis is a rare disease that was first documented in 1875. The incidence of the larynx limited amyloidosis is less than 1% of all benign lesions of larynx. It may occur as primary or secondary to other diseases. Generalized secondary amyloidosis is very rare among them. It is a condition characterized by the extracellular deposition of homogenous, eosinophilic, proteinous material in the form of fibrils. The aim of treatment is to maintatin or improve voice quality and to maintain laryngeal airway. We report a case of laryngeal amyloidosis of AL (amyloid light chain) type that was treated with KTP laser (potassium titany phosphate laser).

A Case of Sinusitis-Induced Intracranial Complication / 대한이비인후과학회지

Sinusitis is a common problem that is routinely diagnosed and treated by most primary care physicians. Although most cases usually respond to appropriate therapy, some occasionally progress to the development of intracranial complications, including meningitis, osteomyelitis, epidural and subdural empyema, intracranial mucocele or polyps, and frank brain abscess. It is important to develop a rational approach to the diagnosis and treatment of these conditions. Intracranial complications are pathologically caused by direct extension of the disease through the bony defect or hematogenous spread. Radiologic evaluation must include computerized tomography for accurate diagnosis and surgical planning. Therapy includes surgical drainage and high doses of intravenous antibiotics. Recently we have experienced one subdural abscess secondary to acute sinusitis.