Clinical Effect and Safety of Endoscopic Sinus Surgery in Patients over Seventy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Chronic rhinosinusitis (CRS) is common in the elderly. There are increasing evidence that endoscopic sinus surgery (ESS) can be used to manage geriatric patients safely, although there are still concerns about complications after ESS. Therefore, the clinical effect and the safety of ESS in old patients was evaluated in the present study.SUBJECTS AND METHOD: Retrospective observational studies were performed based on medical records of patients over the age of 70 and who underwent ESS for CRS from January 2009 to December 2017. The clinical effect of ESS was assessed by comparing the sino-nasal outcome test (SNOT-22) scores before and 3 months after surgery. The safety of the operation was evaluated by the occurrence of postoperative major surgical (skull base, orbital and hemorrhage) and medical (ventricular fibrillation, ischemic attack, primary cardiac arrest, cerebrovascular accident, pneumonia, other organ failure and death) complications.@*RESULTS@#Seventy three subjects were enrolled in this study. Bilateral disease was observed in 37 cases (50.7%), and CRS with nasal polyp was found in 31 cases (42.5%). Eight patients (11.0%) had revision cases. The majority (93.2%) had at least one comorbid condition and got prescribed related medicine (87.7%). There was a significant decrease in SNOT-22 score after surgery. Furthermore, there were no major surgical or medical complications except two cases with epistaxis.@*CONCLUSION@#CRS in geriatric patients can also be treated effectively and safely by ESS as it is done for younger adults. However, as the incidence of comorbidities is high in elderly subjects, it is important to evaluate the risk factors preoperatively.

Clinical Effect and Safety of Endoscopic Sinus Surgery in Patients over Seventy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis (CRS) is common in the elderly. There are increasing evidence that endoscopic sinus surgery (ESS) can be used to manage geriatric patients safely, although there are still concerns about complications after ESS. Therefore, the clinical effect and the safety of ESS in old patients was evaluated in the present study. SUBJECTS AND METHOD: Retrospective observational studies were performed based on medical records of patients over the age of 70 and who underwent ESS for CRS from January 2009 to December 2017. The clinical effect of ESS was assessed by comparing the sino-nasal outcome test (SNOT-22) scores before and 3 months after surgery. The safety of the operation was evaluated by the occurrence of postoperative major surgical (skull base, orbital and hemorrhage) and medical (ventricular fibrillation, ischemic attack, primary cardiac arrest, cerebrovascular accident, pneumonia, other organ failure and death) complications. RESULTS: Seventy three subjects were enrolled in this study. Bilateral disease was observed in 37 cases (50.7%), and CRS with nasal polyp was found in 31 cases (42.5%). Eight patients (11.0%) had revision cases. The majority (93.2%) had at least one comorbid condition and got prescribed related medicine (87.7%). There was a significant decrease in SNOT-22 score after surgery. Furthermore, there were no major surgical or medical complications except two cases with epistaxis. CONCLUSION: CRS in geriatric patients can also be treated effectively and safely by ESS as it is done for younger adults. However, as the incidence of comorbidities is high in elderly subjects, it is important to evaluate the risk factors preoperatively.

A Case of Second Branchial Cyst in Retropharyngeal Space, Appearing as Dyspnea and Dysphagia / 대한이비인후과학회지

The authors report the clinical features of a huge retropharyngeal second branchial cyst in a 53-year-old woman. The patient showed acute exacerbation of dyspnea and dysphagia. On endoscopic examination and computed tomography (CT), a cyst-like lesion narrowing the oropharynx was observed in the right retropharyngeal space. However, a retropharyngeal abscess was also suspected on some CT images. A cystic mass was found and removed completely via exploration by trans-oral approach. According to the literature review, a branchial cleft anomaly mimicking retropharyngeal abscess is very rare.

A Case of Retropharyngeal Tuberculosis Presenting as a Huge Cystic Lesion / 대한이비인후과학회지

The authors report the clinical features of huge retropharyngeal cyst, which was confirmed as tubercular abscess, in a 24-year-old woman. Retropharyngeal tuberculosis is a rare type of disease and only four cases have been reported in Korea. In this case, the patient experienced foreign body sensation and hoarseness in the throat. On endoscopic examination and computed tomography, a cyst-like lesion which narrowed the oropharynx was shown in the left retropharyngeal space. The patient was successfully treated with surgical drainage and anti-tubercular therapy.

A Case of Multiple Lobular Capillary Hemangiomas of the Nasal Septum / 대한이비인후과학회지

Lobular capillary hemangioma (LCH) is a benign lesion of unknown etiology. LCH is a rapidly growing lesion usually affecting skin and oral mucosa. It is known to be relatively rare in the nasal cavity or sinuses. LCH bleeds easily even with a little irritation because of its excessive vascularity. Hormonal imbalance and microtrauma are known as the major etiologic factors in the development of LCH. The authors experienced a case of multiple LCH in the nasal cavity, which was completely removed with endoscopic approach. According to the literature review, there has been no case report on multiple lobular capillary hemangioma occurring in the nasal cavity. Therefore, the authors report a case with a review of literatures.

A Case of Vascular Leiomyoma in Nasal Cavity: Case Report and Literature Review / 대한이비인후과학회지

Vascular leiomyoma may arise from the muscular layer of blood vessel wall, which is extremely rare in the nasal cavity or paranasal sinuses. According to the online search on pubmed and koreamed, only 62 cases with vascular leiomyoma arising from nasal cavity or paranasal sinuses, including 13 cases of the nasal septum, have been reported since the first case was reported in 1966. The authors experienced a case of vascular leiomyoma arising in the left side of nasal septum in a patient. It was successfully removed by trans-nasal approach. In addition, we conducted a literature review of clinical features of the 62 cases of vascular leiomyoma in the nasal cavity.

Predictors of Excessive Daytime Sleepiness in Korean Snoring Patients

BACKGROUND: Excessive daytime sleepiness is one of the most common symptoms in snoring patients. However, the reason why some individuals complain of daytime sleepiness and others do not is unclear. In this study, we evaluated snoring individuals and examined several demographic and polysomnographic profiles in an attempt to identify predictors of excessive daytime sleepiness. METHODS: The inclusion criteria for patients were the following: 1) patients who underwent an overnight polysomnograph, 2) patients with the chief complaint of snoring, and 3) patients who completed the Korean version of the Epworth sleepiness scale. We used the Epworth sleepiness scale to estimate excessive daytime sleepiness. We quantified correlations between the Epworth sleepiness scale and the demographic/polysomnographic parameters. We also analyzed the parameters affecting excessive daytime sleepiness using multiple linear regression analysis. RESULTS: One hundred nineteen patients met the inclusion criteria for this study. Multiple regression analysis showed that young age was the only independent variable showing statistical significance for predicting excessive daytime sleepiness, and was well-correlated with the Epworth sleepiness scale. However, there were no polysomnographic parameters that were predictive. CONCLUSIONS: Clinicians need to be cautious when using the Epworth sleepiness scale for the diagnosis of obstructive sleep apnea and determining the response to treatment.

Early Endoscopic Electrocoagulation of the Sphenopalatine Artery for Refractory Posterior Epistaxis: Preliminary Study

BACKGROUND AND OBJECTIVES: Intractable epistaxis is a challenging problem associated with clinical morbidity and high costs due to prolonged hospitalization. Early endoscopic electrocoagulation of the sphenopalatine artery can be a good alternative management. SUBJECTS AND METHODS: This study is a retrospective review of 6 patients with uncontrolled epistaxis between January 2013 and January 2014. A decision to surgically intervene was made within 24 hours of hospitalization in all cases. Endoscopic electrocoagulation of the sphenopalatine artery was conducted under general anesthesia. Clinical and hematologic information, preoperative and surgical care, postoperative complications and surgical outcome, and duration of preoperative and postoperative hospital stay were evaluated. RESULTS: Epistaxis was effectively controlled in all cases. Four patients (66.7%) complained of nasal dryness and one of them endured nasal crusting for 9 months after surgery. Recurrent posterior epistaxis occurred after 5 postoperative months in one case, which was successfully controlled without surgery. The average length of postoperative hospital stay was 2.5+/-0.5 days. The average total length of hospital stay was 4.8+/-0.8 days. CONCLUSIONS: Early endoscopic electrocoagulation of the sphenopalatine artery seems effective for controlling intractable epistaxis.

Contralateral Suppression of Transient Evoked Otoacoustic Emission in Vestibular Neuritis / 대한평형의학회지

BACKGROUND AND OBJECTIVES: The etiology of vestibular neuritis is unknown. Many investigators have suggested that this condition spares the inferior vestibular nerve system. However, others have reported that the lesion sometimes affects the inferior vestibular nerve system based on vestibular evoked myogenic potential. The function of the inferior vestibular nerve was studied in acute vestibular neuritis by monitoring medial olivocochlear bundle (MOCB) function. Under normal conditions, contralateral acoustic stimulation has inhibitory effects on ipsilateral otoacoustic emissions through the MOCB. MATERIALS AND METHODS: Twenty patients that presented with dizziness and spontaneous nystagmus, and were confirmed to have acute vestibular neuritis by rotatory chair and caloric testing were enrolled in this study. We evaluated the evoked otoacoustic emissions with and without contralateral acoustic stimulation in both ears in all patients. The percent loss of normal inhibitory action on otoacoustic emissions was determined in the normal and affected ears. RESULTS: All patients showed inhibitory effects in response to contralateral acoustic stimulation on evoked otoacoustic emissions in normal ears. Fifteen patients (75%) had an absence of contralateral suppression of otoacoustic emissions on the affected side. CONCLUSION: The findings of this study suggest the presence of dysfunction of the MOCB in patients with acute vestibular neuritis.

Clinical Features of Cholesteatoma in the Normal Hearing Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cholesteatoma in the normal hearing ear represents a surgical challenge. We aimed to identify the clinical features and surgical results of these patients. SUBJECTS AND METHOD: Sixty-three ears with cholesteatoma had preoperative pure-tone averages of less than 25 dB. Parameters for study were age, location of cholesteatoma, type of tympanoplasty, status of ossicles, and type of mastoidectomy. Postoperative audiogram was evaluated. RESULTS: Hearing was preserved within 30 dB on air conduction audiometry in 60.3% on postoperative 2 months and in 60.5% on postoperative 6 months. The rate of hearing preservation was related to the location of cholesteatoma. Similar hearing outcomes resulted from the comparisions of adult versus children, intact versus reconstructed ossicular chains and open versus closed mastoidectomy. CONCLUSION: Preserving an intact ossicular chain and maintaining an intact canal wall did not have a significant effect on hearing preservation, but the location of cholesteatoma does.

A Case of Metachronous Carcinosarcoma and Squamous Cell Carcinoma of the Both Parotid Glands / 대한이비인후과학회지

Carcinosarcoma of the parotid gland is rare. Furthermore, metachronous bilateral double primary carcinoma of the parotid gland is very rare. We report a case of metachronous bilateral double primary Carcinosarcoma and Squamous cell carcinoma of both parotid glands in the same patient. He received operation and postoperative radiotherapy for a left parotid gland cancer. Four years later, the right parotid gland cancer developed, which was treated by excision followed by radiotherapy. At follow-up, he remained free of disease.

Grommet Cholesteatoma / 대한이비인후과학회지

There are occasional complications after tympanostomy tube insertion due either to the operative procedure itself or to the anato-mical or physiological effects of the tubes. Hearing loss, persisting perforation, tympanosclerosis, atrophy, atelectasis, and the development of cholesteatoma have all been attributed to the tympanostomy tubes. The development of a secondary cholesteatoma at the site of the tube placement Grommet cholesteatoma- is a very uncommon complication. We report one case of cholesteatoma associated with tympanostomy tube insertion.

Three Cases of Lymphoepithelial Carcinoma / 대한이비인후과학회지

Lymphoepithelial carcinoma was first reported in 1962. Since then, about 130 cases have been reported in the English-language literature. Lymphoepithelial carcinoma is a rare tumor of the major salivary gland. Most reported cases have occurred in Asians and Eskimos. We report two cases of lymphoepithelial carcinoma of the major salivary glands and one case of lymphoepithelial carcinoma of unknown origin. They received operation and postoperative radiotherapy. At follow-up, they remained free of disease.