A Case of Suspension Laryngoscope Assisted Removal of Migrating Cervical Screw after Anterior Cervical Fusion / 대한이비인후과학회지

Anterior cervical approaches to the cervical spine have been widely and safely used in spine surgery in recent years; however, they also have posed some otorhinolaryngological complications. We present a case of suspension laryngoscope assisting in the removal of a cervical screw. The patient was a 63-years-old man who was operated on traumatic cervical herniated disc. Surgical interference included C5 corpectomy, iliac bone autograft, anterior cervical fusion at C4-C6 level using an anterior cervical plate and screws. Five years later, he presented a foreign body sensation in the neck and odynophagia. The laryngoscopic exam showed the medial wall of the right pyriform sinus protrusion and the migration of an upper screw was observed in plain films and computed tomography of the cervical spine. The suspenson laryngoscope and C-arm fluoroscope were used for the transpharyngeal screw removal. The removal of the screw in question was successful with no complications. We report this case with a review of the literature.

Clinical Features of Bilateral Paranasal Sinus Fungus Ball

BACKGROUND AND OBJECTIVES: Paranasal sinus fungus balls occur usually in a single sinus, most frequently the maxillary sinus. The goal of this study was to delineate the clinical features of a bilateral paranasal sinus fungus ball. MATERIALS AND METHODS: We retrospectively reviewed seven patients who presented with a bilateral sinus fungus ball and who received endoscopic sinus surgery between July 2004 and January 2009. We analyzed age, gender, chief complaint, associated symptoms, nasal endoscopic findings, ostiomeatal unit (OMU) computed tomography (CT) results, and surgical findings. RESULT: The male to female ratio was 1:6, and the age range was from 40 to 76 years. The chief complaints were nasal obstruction in three patients, foul odour in two, postnasal dripping in one, and cheek pain in one patient. Calcification of the paranasal sinus upon CT was observed in three cases (43%). A fungus ball was found in the maxillary sinus or middle meatus in all cases. CONCLUSION: Bilateral paranasal sinus fungus balls usually involve the bilateral maxillary sinus or middle meatus and often invade the anterior ethmoid sinus or frontal sinus.

A Case of Organizing Hematoma of the Nasal Septum / 대한이비인후과학회지

Organizing hematomas are rare benign tumors and appear as forms of mass which is composed of neovascularization with organizing fibrous tissue in hematoma. There have been sporadic reports of the organizing hematoma not only in soft tissue but also in brain, spinal cord, lung, and maxillary sinus. We report a case of organizing hematoma that was restricted in the nasal cavity without inclusion of the paranasal sinus. This is the first article describing the organizing hematoma of the nasal septum. We present this case with a review of literature.

Ultrasonography Guided Percutaneous Aspiration and Drainage of Deep Neck Abscesses / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For abscesses in the head and neck, traditional open surgical incision-and-drainage procedure may incur added morbidity and result in disfiguring scars. Therefore, a noninvasive alternative to open surgical drainage may be quite beneficial. The purpose of this study was to evaluate the efficacy of percutaneous ultrasonography-guided aspiration and drainage in the management of the selected head and neck abscesses. SUBJECTS AND METHOD: Retrospective review was done for 12 patients with unilocular or multilocular abscess sized 2 cm or more in the greatest in different locations and origins. All patients did not present imminent airway compromise and subsequently underwent ultrasonography guided aspiration and drainage. RESULTS: All of the abscesses were resolved in 11 patients within 10 days. Even multilocular abscesses were resolved without open surgical drainage. One abscess in which Mycobacterium tuberculosis was isolated persisted more than 3 weeks in spite of ultrasonography guided aspiration and drainage, and resolved by antituberculosis medication of more than 10 months. CONCLUSION: Percutaneous ultrasonography-guided aspiration and drainage is a safe and effective procedure, for the abscesses in the head and neck without life threatening conditions.

Acetic Acid Induced Laryngitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acetic acid is not uncommon suicidal material and it can cause serious laryngitis. The purpose of this study was to investigate the clinical characteristics, proper management, and clinical course of laryngitis induced by acetic acid. SUBJECTS AND METHOD: We analyzed the medical records of 39 patients with acetic acid ingestion from 1996 to 2006, retrospectively. RESULTS: Flexible fiberoptic laryngoscopy showed supraglottic laryngeal edema or mucosal ulcer with narrowed airway in 15 cases (38.5%). More common reason of ingestion was suicidal attempt than accidental exposure. There was no significant correlation between severity and the amount of ingestion, or the reason of ingestion. Eight patients needed orotracheal intubation for airway management, but no emergency tracheotomy was imperative. Most laryngeal lesions were relieved by supportive care within 2 weeks. CONCLUSION: Acetic acid laryngitis could narrow airway, and could be resolved by supportive management. Flexible fiberoptic laryngoscopy was useful in evaluating laryngeal involvement and severity.

Allele Distribution of Human Surfactant Protein A in Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surfactant protein A (SP-A) which plays a role in the innate host defense of lung is also expressed in Eustachian tube. However the genes underlying the susceptibility to otitis media with effusion (OME) are known insufficiently. The current study attempts to evaluate the difference in the allele distribution of SP-A1 and SP-A2 between normal subjects and subjects with otitis media with effusion. SUBJECTS AND METHOD: PCR-cRFLP-based methodology was used to detect SP-A genotypes in the 38 children with OME, and in the 55 normal newborns for control. RESULTS: The frequencies of specific genotypes such as 6A(2), 1A(2) were increased in OME group, but the frequency of 6A3 was increased in control group. CONCLUSION: It is presumed that SP-A alleles may be inductive (6A(2), 1A(2)) or protective (6A(3)) factors for OME. Specific genoytypes of SP-A may be an important determinant for the predisposition to OME.

Salvage Surgery for Locally Recurred Nasopharyngeal Carcinoma / 대한이비인후과학회지

There are several options for the management of patients with locally recurred nasopharyngeal carcinoma after irradiation. Many patients can benefit from reirradiation but the complications of high dose irradiation for the second time are often severe and unbearable. In some patients, the recurred lesion may persist even after the reirradiation. Obtaining an adequate exposure of the nasopharynx for an oncologic surgical procedure has been challenging because of its surgical inaccessibility. However, improvements in the surgical approaches to the nasopharynx and paranasopharynx have been made in recent years. Two illustrative cases, in which we performed salvage surgery, are presented in this article. Using the maxillary swing approach, we removed the recurrent nasopharyngeal tumor in a 43 year old female patient. The reassembly of the osseous and soft tissues was not difficult and the associated morbidity was acceptable. In a 19 year old male patient, subtemporal-preauricular infratemporal fossa approach was performed with low morbidity for the removal of tumor recurred at the pterygopalatine fossa.

Voice and Videostroboscopic Analysis after Neurorrhaphy of Recurrent Laryngeal Nerve Injured during Thyroidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Injury of recurrent laryngeal nerve is one of the major complications of thyroidectomy. One of the treatment options, which has met with some criticism, may be the repair of the injured nerve. This study was designed to investigate the efficiency of the neurorrhaphy of the injured recurrent laryngeal nerve with voice and videostroboscopic analysis. MATERIALS AND METHODS: For the injured recurrent laryngeal nerve, ansa hypoglossi-recurrent laryngeal nerve anastomosis has been performed in 6 patients, and direct end to end anastomosis has been performed in 4 patients. Postoperative parameters of perceptual analysis, acoustic analysis, aerodynamic study, and videostroboscopy after 6 months were compared with those of 11 patients whose recurrent laryngeal nerves were resected and left without neurorrhaphy. RESULTS: Perceptual breathy vocal quality and the aerodynamic parameters were better in anastomosed group, but there were no differences in the acoustic parameters. Medialization of vocal cord and the glottic closure was better in anastomosed group. No patient of the anastomosed group experienced dyspnea due to synkinesis. CONCLUSION: The results of this study indicates that the neurorrhaphy of injured recurrent laryngeal nerve is effective in improving the glottic closure, but unsatisfactory in achieving symmetric glottic tension and mucosa wave during phonation.

Efficiency of Tympanostomy Tube Insertion in Children with Chronic Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic otitis media with effusion is common in the pediatric population. One of the treatment options, which has been met with some criticism, may be the placement of tympanosotmoy tubes. This study was designed to analyze the outcome of children who have undergone tympanosotmoy tubes for the treatment of chronic otitis media with effusion. In addition, we investigated the efficiency of secondary tympanosotmoy tube insertion. MATERIALS AND METHODS: A retrospective study was carried out on 513 ears of children aged under 16 years and treated with tympanosotomy tubes. We documented the resolution rate of effusion, duration in situ of the tubes, prognostic factors, and the rate of complications. We also compared the treatment outcomes of the use of the secondary tympanosotomoy tube with that of the primary tube. RESULTS:The resolution rate of effusion was 87.1% and 70.0% for the primary tubes and the secondary tubes, respectively. The duration in situ of the secondary tube was shorter than that of the primary tube. The rates for complications of using tympaonosotomy tubes such as otorrhea, perfroation, cholesteatoma were relatively low. There were no significant differences between the complication rates of the primary and the secondary tympaonsotmoy tubes. CONCLUSION: This study indicates that the use of tympanosotomy tube is effective in treating chronic otitis media with effusion in children. The complication rates of' the secondary tube for recurred or persisted effusion after extrusion of the primary tube are low enough to support further use of this method of therapy.

Voice and Videostroboscopic Analysis of Sulcus Vocalis after Slicing Mucosa Surgical Technique / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sulcus vocalis is not an uncommon cause of breathy dysphonia. One of the treatment options may be the slicing mucosa surgical technique which has been met with some criticism. This study was designed to investigate the efficiency of slicing mucosa surgical technique for the treatment of sulcus vocalis with voice and stroboscopic analysis. MATERIALS AND METHODS: In 18 sulcus vocalis patients (10 males, 8 females), the slicing mucosa surgical technique was performed followed by voice therapy for 4 weeks. Postoperative parameters of perceptual analysis, acoustic analysis, aerodynamic study, and videostroboscopy after 6 months were compared with those of preoperative results. RESULTS: In the perceptual analysis, the rough component of dysphonia was improved in 71.4% of patients, whereas the breathy component was improved in 25.0% of patients. Fundamental frequency, jitter, shimmer of acoustic analysis were significantly improved, but MPT, MFR of aerodynamic study showed no changes. There was anatomical evidences of sulcus in 4 of 18 patients postoperatively. Videostroboscopy mucosa waves during phonation showed improvement in 72.2% of patients, but glottic insufficiencies showed improvement only in 38.9%. CONCLUSION: The results of this study indicate that the slicing mucosa surgical technique is effective in improving the anatomical abnormality and stiffness of vocal cord mucosa, but unsatisfactory in improving glottic insufficiency of sulcus vocalis. It may be helpful to develop a new or an additional technique that can simultaneously promote improved rnucosa vibration and glottic closure.

Voice and Stroboscopic Analysis of Sulcus Vocalis / 대한이비인후과학회지

OBJECTIVES: We aimed to describe objectively the voice features of sulcus vocalis, thereby setting up some useful guidelines for its treatment. MATERIALS AND METHODS: The voices of thirty-seven sulcus vocalis pateints were analyzed. RESULTS: In the acoustic analysis, the fundamental frequency, jitter, and shimmer were significantly increased. Noise to harmonic ratio was also increased although it was not statistically significant. In the aerodynamic study, we found that maximal phonation time was decreased, whereas the mean air flow rate and subglottic pressure were increased. The glottic insuffiency on phonation, small vibratory mucosal wave and amplitude were frequently observed by videostroboscopy. CONCLUSION: The bowing of vocal fold edge results in an incomplete glottic closure during vibratory cycles. The increase in stiffness of the vocal fold edge during phonation results in small mucosal wave and small vibratory amplitude. Glottic insufficiency and stiffness of vibratory movement contribute to dysphonia of sulcus vocalis.