A Case of Syringocystadenoma Papilliferum of External Auditory Canal / 대한이비인후과학회지

Ceruminous glands are specialized sudoriferous glands located in the external auditory canal (EAC). Tumors originating from these ceruminous glands are rare lesions of EAC; in particular, syringocystadenoma papilliferum (SCAP) is an extremely rare ceruminous glands neoplasm to occur in the EAC. Although it is rare, the association of SCAP with tubular apocrine adenoma in the background of nevus sebaceous on the body, extremities, and scalp is well documented. In this article, we report on a 60-year-old male who presented a mass in EAC, which was surgically removed. The final diagnosis of SCAP was determined by histological analysis and the patient has been well without recurrence.

Validation of Simultaneous Endoscopic Sinus Surgery and Transsphenoidal Surgery in Patients with Chronic Rhinosinusitis and Pituitary Tumors / 대한이비인후과학회지

Background and Objectives@#Transsphenoidal (TS) surgery for removal of pituitary lesions has become popular with improvements in diagnostic and treatment modalities, as well as endonasal and endoscopic methods, resulting in reduced complications. Rhinosinusitis (RS) is considered a risk factor for postoperative intracranial infections. Previously, we showed that concurrent TS surgery and endoscopic sinus surgery (ESS) yielded a favorable outcome in cases with pituitary lesions and RS. However, there seems to be a lack of consensus in performing simultaneous TS and ESS for patients with a pituitary lesion and RS. We would like to validate the feasibility of performing two operations concurrently.Subjects and Method We reviewed the medical records of 13 patients who underwent simultaneous TS surgery and ESS between 2007 and 2016. One patient underwent concurrent TS surgery and ESS twice due to the regrowth of pituitary macroadenoma and recurrence of RS. @*Results@#There were only four minor nasal complications during the postoperative period, which were controlled with conservative treatment. Only one patient exhibited postoperative cerebrospinal fluid leakage and no patients experienced intracranial complications. @*Conclusion@#This study shows that it might be better to treat patients with pituitary lesion and RS simultaneously. Also, further studies with large cases would be necessary to manage these patients without intracranial complications.

A Case of Venous Malformation in Temporomandibular Joint Causing Stenosis of External Auditory Canal / 대한이비인후과학회지

Both neoplasm and infections arising from the external auditory canal (EAC) can involve the temporomandibular joint (TMJ) but rarely the reverse. A benign TMJ mass that presents as an EAC mass is a rare otologic entity as only seven cases have been reported worldwide. The authors experienced a 72-year-old male patient presenting with EAC mass with fluctuation when opening the mouth, which turned out to be caused by venous malformation of the TMJ. Surgical excision of the mass via endaural approach was successful. We present this case with a review of the literature.

A Case of Venous Malformation in Temporomandibular Joint Causing Stenosis of External Auditory Canal / 대한이비인후과학회지

Both neoplasm and infections arising from the external auditory canal (EAC) can involve the temporomandibular joint (TMJ) but rarely the reverse. A benign TMJ mass that presents as an EAC mass is a rare otologic entity as only seven cases have been reported worldwide. The authors experienced a 72-year-old male patient presenting with EAC mass with fluctuation when opening the mouth, which turned out to be caused by venous malformation of the TMJ. Surgical excision of the mass via endaural approach was successful. We present this case with a review of the literature.

Two Cases Report of Myxoid Degeneration of the Auricular Cartilage / 대한이비인후과학회지

Myxoid degeneration (MD) in the cartilage results from the accumulation of hyaluronic acid in the stroma. However, it is rarely found in the auricular cartilage, with only one published report to date. This article describes two histologically confirmed cases of MD of the auricle that was excised with favorable aesthetic results. Two men presented with auricular masses, with no history of trauma or tumors in the auricle. Laterally protruding masses were located around the helix and antihelix, which were similar in appearance to the normal auricular cartilage. We made an aesthetic skin incision under local anesthesia, and carved the mass from the normal cartilage for pathological and cosmetic reasons. Both excised masses showed MD of the auricular cartilage. We report these two cases with a review of the literature.

A Case of Angiomyoma of Auricle / 대한이비인후과학회지

The angiomyoma or vascular leiomyoma is an uncommon type of leiomyoma composed of smooth muscle cells and vascular endothelium. The tumor occurs mostly in the lower extremities as a slowly growing, firm and mobile mass, occasionally accompanied by pain. There are few cases of auricular angiomyoma reported in the literature; however, recently, we experienced a case of a 18-year-old man with protruding auricular mass. We performed a surgical excision and the final pathological result confirmed to angiomyoma. We report this case with a review of the related literatures.

A Case of Totally Lateralized Tympanic Membrane / 대한이비인후과학회지

Lateralized tympanic membrane is a complication of tympanoplasty resulting in conductive hearing loss. We describe a case of a 23-year-old patient who developed totally lateralized left tympanic membrane with hearing disturbance. The blind-pouch appearance of the left ear canal and conductive hearing loss were checked. The revision of underling tympanoplasty was performed using temporalis fascia and conchal cartilage. The ossicular chain was reconstructed with partial ossicular replacement prosthesis. Canaloplasty and split thickness skin graft were applied for the skin defect of the left external auditory meatus. Totally lateralized tympanic membrane was successfully reconstructed with cartilage tympanoplasty and canaloplasty, achieving improved hearing.

Current Trends in the Treatment of Subjective Tinnitus at University Hospitals in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effective management of subjective tinnitus should start with an accurate diagnosis based on an appropriate classification. Since there is no gold standard for managing subjective tinnitus, clinicians can select from various treatment options after considering the multifactorial etiology of tinnitus. This study surveyed otologists at university hospitals in Korea to identify the treatments used for subjective tinnitus and to obtain basic information on evidence-based medicine for treating tinnitus. SUBJECTS AND METHOD: A five-major-item questionnaire on current tinnitus treatments was sent by email to otologists at 37 university hospitals in Korea; 30 (81.1%) replied. RESULTS: The mean incidence of tinnitus in otology outpatient clinics was 22.7% (range 10-40%). Common treatments were oral pharmacological therapy, regular counseling with tinnitus retraining or cognitive behavioral therapy and hearing aids. Tinnitus retraining therapy and hearing aids were considered the most effective when the visual analog scale scores were 7.0 and 6.6, respectively, and considered safe when the scores were 9.9 and 9.3. Ginkgo biloba and benzodiazepines were the most frequently prescribed drugs, although their reported effectiveness was questionable. Intra-tympanic steroid injection was not considered effective (3.8) or safe (6.3). Somatosensory-based treatments such as treating neck muscle or temporomandibular joint disorders were also used to relieve a subgroup of somatic tinnitus. CONCLUSION: Our results showed trends similar to those in other countries, yet we have not reached the level of evidence-based clinical practice due to the lack of reliable and effective treatment options. Further research on tinnitus-treatments is needed, particularly about randomized controlled studies with blinding.

Ossiculoplasty for Monocrural Stapes Anomaly / 대한이비인후과학회지

Congenital anomalies of ossicle in the middle ear are rare and could appear in various forms. The most common congenital isolated ossicular anomalies are stapes fixation and incudostapedial discontinuity, with isolated congenital stapes fixation representing about one third of ossicular malformations. We present a rare case of monocrural anomaly of unilateral stapes in a 36-year-old woman with nonprogressive conductive hearing loss. During explotympanotomy, the lateral half of the suprastructure of anomalous stapes was removed and sculptured total ossicular replacement prosthesis was fitted between the long process of incus and remained stapes. Postoperative pure tone audiogram showed a significant decrease in air-bone gap. We report this case with a review of literature.

A Case of Branchio-Otic Syndrome / 대한이비인후과학회지

Branchio-oto-renal (BOR) syndrome is a clinically heterogeneous autosomal dominant form of syndromic hearing loss characterized by variable hearing impairment, malformations of the pinnae, the presence of branchial arch remnants, and various renal abnormalities. BOR syndrome is caused by mutations in EYA1 and SIX1, which are critical to organogenesis and are expressed together in developing otic, branchial, and renal tissue. Branchio-otic (BO) syndrome comprises branchial fistulas and preauricular pits, but lacks renal anomalies. We present a case of BO syndrome in 30year-old man with a review of the literature.

Distribution of Histologic Type of Nasal Polyp and Expression of Vascular Endothelial Growth Factor According to Nasal Polyp Type / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To determine the frequency of the histologic types of nasal polyp in Korea and their relationships with respect to age, laterality, asthma, allergic rhinitis (AR) and expression of vascular endothelial growth factor (VEGF). SUBJECTS AND METHOD: Tissue slides obtained from 282 patients with nasal polyps were examined; polyps were classified either as eosinophilic polyp or chronic inflammatory polyp. VEGF expression was determined using immunohistochemical staining. RESULTS: Of the 282 subjects, 169 (59.9%) had chronic inflammatory polyps, 113 (40.1%) had eosinophilic polyps, and 232 (82.3%) had bilateral polyps. Twenty-two subjects (7.8%) had asthma and 23 (8.2%) had AR. There was no statistical relationship between nasal polyp type and laterality or the presence of asthma or AR. Of 10 children, 9 (90%) had chronic inflammatory polyps. VEGF expression was significantly higher in eosinophilic polyps than in chronic inflammatory polyps, and significantly higher in the samples of each polyp type from the subjects with AR than those without AR. In subjects with asthma, however, the VEGF expression did not differ between eosinophilic polyps and chronic inflammatory polyp samples. CONCLUSION: In the Korean population, chronic inflammatory nasal polyps are more common than eosinophilic nasal polyps. VEGF expression was the highest in eosinophilic polyps of the subjects with AR, suggesting that VEGF might contribute to the polyp formation via local allergic action.

Delayed Diagnosis of Metastatic Prostatic Adenocarcinoma in Temporal Bone / 대한이비인후과학회지

Metastasis to the temporal bone is uncommon. In some cases, metastasis may be the first evidence of malignant dissemination, but more frequently, the diagnosis is unsuspected, possibly because ear symptoms are overshadowed by those deriving from the primary tumor. It is not until they have symptoms like hearing loss, otalgia, facial nerve paralysis, periauricular swelling, otorrhea, or even an aural mass that patients usually undergo treatment at the late stage of the disease course. Tumors of the breast, lung, and kidney are the most common sources of temporal bone metastasis. Although axial bone and cranial metastases are common in patients with prostatic carcinoma, temporal bone involvement is extremely rare. We report a case of metastatic prostatic adenocarcinoma in the temporal bone which was diagnosed with delay.

Endoscopic Marsupialization of Postoperative Cheek Cyst with Orbital Floor Defect

BACKGROUND AND OBJECTIVES: The postoperative cheek cyst with orbital involvement is a rare condition and the treatment of eroded orbital floor is controversial. This study evaluated the efficacy of endoscopic marsupialization for treating postoperative cheek cyst with orbital floor defect and assessed the requirements of a direct orbital approach for orbital reconstruction. MATERIALS AND METHODS: The study involved a retrospective review of twelve patients with postoperative cheek cyst and orbital floor defect. Medical records were reviewed for details of previous surgery, presenting symptoms, surgical approach and the results of the operation. The maximum diameter of the involved orbital floor was calculated using the coronal imaging of paranasal sinus computed tomography (PNS CT). RESULTS: All patients had previously undergone Caldwell-Luc procedures. The most common symptom was pressure on the cheek. According to PNS CT, the maximum diameter of the involved orbital floor ranged from 0.7 to 3.1 cm (mean 1.46 cm) and the involved orbital area ranged from 0.35 to 4.23 cm2 (mean 1.87 cm2). All patients underwent only endoscopic marsupialization without orbital reconstruction. Postoperatively, all patients showed no recurrence of symptoms or required revision surgery. CONCLUSION: Endoscopic marsupialization without reconstruction of the orbital floor could be considered as a first treatment option for postoperative cheek cyst combined with orbital floor defect.

Acute Lymphadenitis with Cellulitis Caused by Staphylococcus lugdunensis / 대한진단검사의학회지

Although coagulase-negative staphylococci (CNS) have been considered part of the resident flora on the human skin, Staphylococcus lugdunensis is an unusually virulent CNS and can cause many types of infection. We report a rare case of acute lymphadenitis with cellulitis in the right infraauricular region caused by S. lugdunensis. A 62-yr-old woman visited the Department of Otolaryngology of Busan Paik university hospital. She had a palpable mass and swelling in the right infraauricular region and complained of aggressive pain and a febrile sensation in the region for 5 days. On the suspicion of abscess with infection, percutaneous aspiration was performed and smooth, flat, white, opaque colonies grew on a blood agar plate as a pure culture. The biochemical test results showed the organism to be catalase positive, tube coagulase negative, ornithine decarboxylase positive, slide coagulase positive, and latex agglutination tests for coagulase positive. The API Staph Kit was used to identify the isolate to the species level as S. lugdunensis with a 64.6% probability (profile 6716152). We confirmed the species identification of this strain by 16S rDNA sequence analysis. The patient's clinical condition improved with appropriate antimicrobial therapy and pus drainage.

Iatrogenic Temporal Encephalocele Managed by Combined Transmastoid and Middle Cranial Fossa Approach / 대한이비인후과학회지

Herniation of the brain into the middle ear or mastoid is a rare but potentially life-threatening complication of chronic otitis media with or without cholesteatoma. The advent of antibiotic therapy and microsurgical techniques has greatly lowered the incidence of brain herniation but this complication still occurs, with potential devastating sequelae. Because of the non specificity of the clinical signs and symptoms, brain herniation is often discovered incidentally at the time of surgery for chronic otitis media. The patient was a 56-year-old female who had a history of tympanomastoid surgery for right ear about 7 years ago and had complained of intermittent ipsilateral pain in the postauricular area and progressive hearing disturbance. Preoperative imaging studies suggested a temporal encephalocele with infected middle ear and mastoid cavity. The patient underwent a repair of the temporal encephalocele and a revision tympanomastoidectomy using the combined transmastoid and middle cranial fossa approach.

A Case of Concurrent Osteoma and Lobular Capillary Hemangioma of the Middle Turbinate / 대한이비인후과학회지

Osteoma is a slowly growing benign tumor composed of compact or cancellous bone and usually found in paranasal sinuses. Lobular capillary hemangioma is a rapidly growing lesion usually affecting skin and oral mucosa. Both lesions may occur at any age group but most frequently in the third decade. The authors experienced a case of concurrent osteoma and lobular capillary hemangioma in the middle turbinate, which were removed via endonasal endoscopic approach. Concerning our case, we speculate that the slow growth of the osteoma may have caused inflammatory change on nasal mucosa, resulting in lobular capillary hemangioma. We report a case with a review of literatures.

A Case of Mucous Membrane Plasmacytosis Arising from Oropharynx / 대한이비인후과학회지

Mucous membrane plasmacytosis is a rare benign condition characterized by plasma cell infiltration of the mucosa of upper aerodigestive tract. The lesions typically produce a cobblestone or warty appearance of the larynx, pharynx, palate, lips, mouth, tongue and trachea. Histologically, the lesions are characterized by a diffuse expanse of inflammatory cells situated in submucosal tissues, composed mainly of mature plasma cells with scattered polymorphonuclear cells and lymphocytes. Immunohistochemistry for kappa, lambda light chain showed polyclonal immunoglobulin content in all cases examined. A variety of medical and surgical treatments have been tried but none has led to improvement in the condition. In this study, we report, with a review of literature, a mucous membrane plasmacytosis arising from oropharynx in a 30 year-old female patient.

Expression of Hypoxia-Inducible Factor-1alpha and Correlation between Hypoxia-Inducible Factor-1alpha and Vascular Endothelial Growth Factor in Nasal Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The function of hypoxia-inducible factors (HIFs) in the hypoxic environment is to orchestrate adaptational adjustments of vascular homeostasis through the activation of several dozens of target genes including vascular en-dothelial growth factors (VEGF). It has been suggested that VEGF is involved in the pathogenesis of nasal polyp. The purpose of this study is to determine and correlate concentrations of HIF-1alpha and VEGF in nasal polyps. MATERIALS AND METHOD: Twenty-five nasal polyps were collected at the time of endoscopic sinus surgery. The production of HIF-1alpha and VEGF messenger RNA (mRNA) was measured by reverse transcriptase polymerase chain reaction (RT-PCR) and HIF-1alpha and VEGF proteins were determined by immunohistochemical staining. RESULTS: The expressions of HIF-1, VEGF mRNA and proteins were detected in nasal polyps. RT-PCR demonstrated that the level of mRNA expression of HIF-1alpha and VEGF were 1.12+/-0.33 and 1.11+/-0.42, respectively. A positive correlation was observed between HIF-1alpha and VEGF mRNA (correlation coefficient [r]=0.49, p<0.05). The immunohistochemical studies revealed that HIF-1alpha was predominantly expressed in surface epithelial cells, submucosal glandular cells, endothelial cells and inflammatory cells in the stroma and VEGF was more strongly and diffusely expressed in subglandular epithelial cells, vascular endothelial cells, and inflammatory cells than in surface epithelial cells. The expressions of HIF-1alpha and VEGF proteins were 3.24+/-1.80 and 3.52+/-1.89, respectively. A positive correlation was observed between HIF-1alpha and VEGF proteins (r=0.76, p<0.05). CONCLUSION: We suggest that HIF-1alpha has a role in inducing VEGF in nasal polyps, and hypoxia is an important factor in the growth of nasal polyps.

A Case of Pleomorphic Adenoma of the Nasal Vestibule / 대한이비인후과학회지

Pleomorphic adenoma is most frequently seen in the major salivary glands, but can also be found in oral mucosa, hard and soft palate, temporal bone, hypophyseal duct, limbs, skin, inguinal region as well as in the nasal cavity. The majority of intranasal pleomorphic adenomas originate from the mucosa of nasal septum and lateral nasal wall. The treatment of choice is local but adequate excision. The authors experienced a rare case of pleomorphic adenoma that arose from the nasal vestibule: it was treated with local excision. We report the case with a review of literatures.

The Effect of Short-Term Systemic and Long-Term Topical Steroid Treatment on Nitric Oxide Synthases in Nasal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) is an endogenous free radical gas mediator, synthesized by a family of nitric oxide synthases (NOS). Established properties of NO of potential relevance to the formation of nasal polyps include vasodilatation, direct regulation of eosinophil and neutrophil function, and potentiation of histamine-induced plasma exudation. Steroids are currently the most potent medication available for the treatment of nasal polyposis, but the exact mechanisms are uncertain. The purpose of this study was to evaluate the response of three NOS isoenzymes to short-term systemic and long-term topical steroid in nasal polyps. MATERIALS AND METHOD: Steroid-untreated nasal polyp patients (n=10), oral steroid-treated nasal polyp patients (n=10, prednisolone 30 mg per day for 7days) and topical steroid-treated nasal polyp patients (n=10, Fluticasone 100 microgram per day for more than 1 month) underwent nasal endoscopy and biopsy of the polyps. The protein expressions of NOS in nasal polyp tissues were evaluated by immunohistochemistry. RESULTS: Immunohistochemical studies revealed that expression levels of proteins produced by three NOS isoenzymes were significantly decreased in steroid-treated nasal polyps when compared with steroid-untreated nasal polyps, and there was no difference in the effects between short-term systemic and long-term topical steroid treatment on nasal polyps. CONCLUSION: These results show that the expressions of constitutive NOS as well as inducible NOS in nasal polyp tissue were suppressed by steroid therapy. There was no difference in the NOS isoenzymes expression between short-term systemic and long-term topical steroid-treated polyps.