Clinical Analysis of External Auditory Canal Osteoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#External auditory canal osteoma is an uncommon benign lesion and represents as unilateral solitary pedunculated mass. The aim of this study is to evaluate the clinical symptoms of osteoma and its treatment outcomes over a 10-year period in a tertiary hospital.SUBJECTS AND METHOD: Eight patients underwent operation to remove an external auditory canal osteoma at Chungbuk National University Hospital from 2008 to 2017. The medical records were retrospectively reviewed with regard to clinical characteristics, size and location of osteoma, method of surgery and treatment outcomes.@*RESULTS@#The average age of patients was 41.8 years with the male predominance of 6:2. All of the lesions in the osteoma were unilateral and solitary (average size 5.0 mm). All of the eight cases were pedunculated: in four cases, the stalks of the osteoma were found on the tympanomastoid suture line and in three cases, it was found on the tympanosquamous suture line. Four patients were asymptomatic, where the lesions were found incidentally during unrelated evaluations. No patients were found with conductive hearing loss in the pure tone audiometry. Transcanal and endaural approach were used in five and three cases, respectively. Most of the cases were removed by curettage only, except for the two who needed additional drilling. The average surgery time was 15.6 minutes. There was no postoperative complication or recurrence.@*CONCLUSION@#The external auditory canal osteoma was mostly unilateral and solitary. The removal of osteoma in the early stage was relatively easy with no recurrence or complication.

Clinical Analysis of External Auditory Canal Osteoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: External auditory canal osteoma is an uncommon benign lesion and represents as unilateral solitary pedunculated mass. The aim of this study is to evaluate the clinical symptoms of osteoma and its treatment outcomes over a 10-year period in a tertiary hospital. SUBJECTS AND METHOD: Eight patients underwent operation to remove an external auditory canal osteoma at Chungbuk National University Hospital from 2008 to 2017. The medical records were retrospectively reviewed with regard to clinical characteristics, size and location of osteoma, method of surgery and treatment outcomes. RESULTS: The average age of patients was 41.8 years with the male predominance of 6:2. All of the lesions in the osteoma were unilateral and solitary (average size 5.0 mm). All of the eight cases were pedunculated: in four cases, the stalks of the osteoma were found on the tympanomastoid suture line and in three cases, it was found on the tympanosquamous suture line. Four patients were asymptomatic, where the lesions were found incidentally during unrelated evaluations. No patients were found with conductive hearing loss in the pure tone audiometry. Transcanal and endaural approach were used in five and three cases, respectively. Most of the cases were removed by curettage only, except for the two who needed additional drilling. The average surgery time was 15.6 minutes. There was no postoperative complication or recurrence. CONCLUSION: The external auditory canal osteoma was mostly unilateral and solitary. The removal of osteoma in the early stage was relatively easy with no recurrence or complication.

Congenital Cholesteatoma: Analysis of Risk Factors for the Postoperative Recurrence / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of recurrence after surgery of congenital cholesteatoma is increasing due to the widespread use of otoendoscopy as well as an increased awareness of these lesions among primary care physicians. There is no general consensus on the risk factors affecting recurrence. In this study, analyzing clinical characteristics of recurred cases from a tertiary hospital, we investigated risk factors for the recurrence of congenital cholesteatoma after surgery. SUBJECTS AND METHOD: From 1999 to 2016, data were collected from retrospective chart reviews of patients who have undergone surgeries for congenital cholesteatoma at Hospital. We analyzed data about clinical characteristics and recurrence according to the age at diagnosis, location, stage and type of disease, pneumatization of mastoid, ossicular erosion, and surgical techniques. RESULTS: Sixty-eight patients underwent surgery for congenital cholesteatoma. The average age at operation was 4.8 years. Recurrence was detected in 7 cases of the 68 patients, with the recurrence rate of 10.3%. Sex, age, cholesteatoma type, location, stage, mastoid pneumatization, and operation method did not show significant differences between the recurred group and the non-recurred group in the univariated analysis. CONCLUSION: The recurrence rate of congenital cholesteatoma after primary operation was 10.3%. In this study, there was no statistically significant risk factor for postoperative recurrence of congenital cholesteatoma.

Updates in Noise Induced Hearing Loss / 대한이비인후과학회지

Noise-induced hearing loss could be caused by mechanical destruction of the delicate membranes of the inner ear, hair cells and supporting structures of the organ of Corti, and by intense metabolic activity, which increases free radical formation in the cochlea. When exposure is continuous, injury is a consequence of the total amount of energy to which cochlear tissues are exposed and a hearing conservation program is essential including hearing protection devices. Several therapeutic trials including antioxidant agents have been shown at least partially effective in prevention of hearing loss and hair cell death.

Clinical Characteristics of Bilateral Chronic Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to determine the prevalence of bilateral chronic otitis media (BCOM) and the ratio of unilateral or bilateral cholesteatoma in BCOM. Pre- and post-operative hearing were analyzed to see if bilateral balanced hearing were achieved. SUBJECTS AND METHOD: A retrospective review was done with a computerized otologic database to identify all patients who underwent surgical treatments for COM between 1998 and 2011, and has a follow up duration for at least 6 months. Comparative analysis between pre- and post-operation hearing was measured by pure tone audiometry and achievement of bilateral balanced hearing was analyzed with 'The Belfast rule of thumb'. RESULTS: Two hundred and eighty-one (14.5%) of 1938 patients suffered from BCOM, and of these, 73 (25.9%) of the patients with BCOM had cholesteatomas in one (12.4%) or both ears (13.5%). When a patient with BCOM is found with cholesteatoma in one ear, the odds of there being cholesteatoma in the other ear was 52.1%. According to 'The Belfast rule of thumb', it is considered difficult to achieve successful bilateral hearing gains sufficient for the patients to perceive subjective hearing improvements in BCOM. CONCLUSION: Approximately 15% of the COM patients were found with the disease in both ears, and the odds of a patient with BCOM having cholesteatoma in one ear also having cholesteatoma in the other ear was 53.4%. It was difficult to achieve subjective, successful and balanced bilateral hearing gain with three-dimensional hearing improvements.

Clinical Characteristics of Labyrinthine Concussion

BACKGROUND AND OBJECTIVES: Inner ear symptoms like hearing loss, dizziness or tinnitus are often developed after head trauma, even in cases without inner ear destruction. This is also known as labyrinthine concussion. The purpose of this study is to determine the clinical manifestations, characteristics of audiometry and prognostic factors of these patients. MATERIALS AND METHODS: We reviewed the medical records of the 40 patients that had been diagnosed as labyrinthine concussion from 1996 to 2007. We studied the hearing levels in each frequency and classified them according to type and degree of hearing loss. Rates of hearing improvement were evaluated according to age, sex, hearing loss type, degree and presence of dizziness or tinnitus. To find out any correlation between hearing improvement and these factors, we used chi2 test or Fisher's exact test. RESULTS: Bilateral hearing loss was observed in 22 patients, and unilateral hearing loss in 18 patients. There were 4 (6.5%) ascending, 34 (54.8%) descending, 24 (38.7%) flat type hearing loss, which indicated hearing loss was greater in high frequencies than low frequencies. Among 62 affected ears, 20 (32.3%) gained improvement, and it was achieved mainly in low frequencies. There were only 2 ears with dizziness in 20 improved ears and among 20 dizziness accompanied ears, also only 2 ears were improved. CONCLUSIONS: High frequencies are more vulnerable to trauma than low frequencies. The hearing gain is obtained mainly in low frequencies, and association with dizziness serves poor prognosis.

Clinical Characteristics and Management of Sudden Sensorineural Hearing Loss

Sudden sensorineural hearing loss (SSNHL) is characterized by abrupt unilateral loss of hearing, sometimes accompanied by tinnitus or vertigo. From the majority of patients with SSNHL, no specific cause can be identified, but numerous conditions including viral infection, vascular compromise and intracochlear membrane break are considered as possible causes of disease. According to these etiologic hypotheses, a combination therapy has been frequently used combining several options among steroids, antiviral agents, vasodilators, volume expanders, stellate ganglion block and carbogen or hyperbaric oxygen. The contents of the combination could vary according to the experience of each clinic, but steroids have been accepted as the mainstay of the treatment for SSNHL since Wilson's landmark study although two recent meta-analysis of steroid treatment suggested there was no benefit. The amount and the length of oral steroid therapy have not been well established. Commonly used regimen of oral steroid therapy is prednisone. A reported success rate with systemic steroid therapy is between 49% and 89%, whereas only 30% to 65% of patients without treatment achieved hearing improvement. Recently there is an obvious trend for an increasing number of positive results of intratympanic steroids injection. It is difficult to evaluate the efficacy of a certain drug or regimen prescribed for SSNHL because of various drugs used as combination therapy, many prognostic factors and different inclusion criteria.

A Case of Intracranial and Extradural Cholesterol Granuloma / 대한이비인후과학회지

Cholesterol granuloma is a histological term used for the description of a tissue response to a foreign body such as cholesterol crystals. The pathogenesis of cholesterol granuloma is controversial. But three factors are thought to have an important role in its development: obstruction of ventilation, impaired drainage, and hemorrhage. It may arise from any portion of the pneumatized temporal bone. But huge cholesterol granuloma with intracranial and extradural extension has been rarely reported. Recently, we experienced a case of huge cholesterol granuloma with intracranial and extradural extension. The patient has never experienced chronic otitis media before. The cholesterol granuloma was successfully removed by transmastoid approach. So we report this case along with a literature review.

Clinical Characteristics and Treatment Results of Sudden Deafness in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden deafness, an important disease characterized by abrupt sensorineural hearing loss, is rare in children and the prognosis in children is accepted to be worse than that in adults. However, clinical studies are not sufficient to define the clinical characteristics and prognosis of sudden deafness in children. The author analyzed clinical manifestation of sudden deafness in children and compared the treatment results of children with those of adults. SUBJECTS AND METHOD: A retrospective analysis was performed in 25 patients (29 ears) who were treated for sudden deafness from January 1993 to May 2008. RESULTS: 1) The overall hearing recovery rate (79%) was significantly higher in adults (53.7%). The prognosis in children less than 10 years old (73%) was also higher than that in adults. 2) The rate of complete recovery (61%) was higher in children than in adults (38.5%). CONCLUSION: The sudden deafness in children has unique clinical characteristics and the recovery rate is more favorable than in adults.

A Case of Pulsatile Tinnitus from Dehiscent High Jugular Bulb Treated by Reconstruction of the Hypotympanum / 대한이비인후과학회지

Vascular tinnitus, a sort of pulsatile tinnitus, should be differentiated with other sensorineural tinnitus because it is possible to be cured by correction of underlying systemic disease or surgery. The dehiscent high jugular bulb, a common cause of venous pulsatile tinnitus, can be cured by reconstruction of hypotympanum. We present a case of pulsatile tinnitus with dehiscent high jugular bulb which has been treated by surgery. Preoperative microscopic finding showed dark bluish pulsating mass in posteroinferior portion of tympanic membrane. Temporal bone CT showed high jugular bulb with bone defect of hypotympanum. The hypotympanum was reconstructed and high jugular bulb lowered using the harvested bony fragment from mastoid cortical bone. The pulsatile tinnitus disappeared immediately after surgery.

Usefulness of Strut in Ossiculoplasty during Canal Wall Down Tympanomastoidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hearing improvement after CWD tympanomastoidectomy is another major goal of surgery after eradication of disease, especially in cases with intact stapes. The objective of this study is to compare the postoperative results of hearing gain and middle ear condition according to the types of ossiculoplasty described above. SUBJECTS AND METHOD: Of patients who received CWD tympanomatoidectomy, 90 who had been followed up for more than 1 year after surgery were selected. We found 30 cases of classical tympanoplasty type III, 38 SC tympanoplasty cases, and 22 PORP tympanoplasty cases. Age and sex distribution, success rate of hearing improvement, mean of postoperative air-bone gap (ABG), rate of middle ear adhesion were analysed according to the type of surgery. RESULTS: At 3 months after surgery, success rates of hearing improvement were 37.0%, 51.4%, 57.1% for classical tympanoplasty type III, SC tympanoplasty, PORP tympanoplasty, respectively. Means of postoperative ABG in the above listed order were 25.1 dB, 19.4dB, 17.2 dB, respectively. Hearing results were statistically better in PORP tympanoplasty when compared with other groups (ANOVA with Duncan's multiple range test). At 1 year after surgery, success rates of hearing improvement were 21.1%, 35.5%, 64.7% in classical tympanoplasty type III, SC tympanoplasty, PORP tympanoplasty, respectively. Means of postoperative ABG in the above listed order were 29.1 dB, 20.3 dB, 16.7 dB, respectively. Hearing results were statistically better in PORP tympanoplasty compared with other groups (ANOVA with Duncan's multiple range test.). Rates of middle ear adhesion were 23.1%, 54.5% in classical tympanoplasty type III, tympanoplasty using strut, respectively. CONCLUSION: In cases with intact stapes in CWD tympanoplasty, we conclude that tympanoplasty using strut is more useful for hearing improvement and prevention of middle ear adhesion than classical tympanoplasty type III; for the strut material, we found PORP more effective than autologous materials.

Primary Facial Skin Cancer: Clinical Characteristics and Surgical Outcome in Chungbuk Province, Korea

Clinical features of facial skin cancer in Asian population including Korean are not readily available. In the present study, we analyzed the clinical characteristics and the surgical results of primary facial skin cancer in Chungbuk Province, Korea. Eighty-six cases of primary facial skin cancer collected during a 10-yr period (1994-2003) were retrospectively reviewed about the clinical characteristics including age, sex, annual diagnostic rate, types of tumor, specific sites of occurrence, and the surgical results. The average age at the diagnosis was 67 and male to female ratio was 1 to 1.05. The average annual diagnostic rate was 0.73% and the rate surged during the period 2001-2003 compared with the period 1994 to 2000. Basal cell carcinoma was the most common tumor and the nose was the most frequent site. Traditional surgical excision with immediate reconstruction was performed in 81 cases. During the 23 months of average follow-up, three patients had recurrences (3.7%) and three patients had secondary skin cancers. Facial skin cancer is increasing in the province and basal cell carcinoma is most frequent. Traditional surgical excision and immediate reconstruction with local flap are a good therapeutic modality with an acceptable recurrence rate.

5 Cases of Major Complications after Rhinologic Surgery: Avoidable and Unavoidable Cases

Otolaryngologists are sometimes confronted with various complications. They may be minor or sometimes they can be major, and rarely fatal. Some complications can be prevented, but some are unavoidable. Five cases of major complications, which occurred during or after routine rhinologic surgery, are presented. Two patients died of toxic shock syndrome: one patient after endoscopic sinus surgery (ESS) and the other patient after closed nasal bone reduction. One patient died of acute myocardial infarction during the recovery of anesthesia after uneventful ESS. One patient had a lidocaine shock, which required treatment in the intensive care unit. One patient had a transient unilateral blindness after intranasal steroid injection. Though the 3rd and 4th cases of complications were unavoidable, the others could have been prevented if precautions had taken place. The presumed pathophysiology, possible prevention measures, and their implications in routine otolaryngologic surgery are discussed.

Endoscopic Endonasal Dacryocystorhinostomy: Prevention of Neo-Ostium Obstruction Using Nasal Mucosal Flap / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The success rate of endoscopic endonasal dacryocystorhinostomy (DCR) is not satisfactory enough compared to that of external approach because the newly made ostium is easily obstructed due to granulation tissue formed around the small ostium. The objective of this study is to describe a new technique of an endoscopic DCR which minimizes the stenosis of neo-ostium and to report its success rate. MATERIALS AND METHOD: Twenty patients who had undergone endoscopic DCR with the diagnosis of proximal nasolacrimal duct obstruction were investigated retrospectively. All procedures were done by the same surgeon. The surgical technique includes elevation of mucosal flap, full sac exposure using diamond drill, and design of mucosal flap to cover the denuded bone and approximate with opened sac mucosa. Postoperative symptom improvement and endoscopic finding of the neo-ostium were evaluated. The mean duration of follow-up was 8 months. RESULTS: Ninety percent success rate was noted without any serious complications. Obstruction of the neo-ostium with granulation tissue was observed in two patients. CONCLUSION: Endoscopic DCR using mucosal flap after full sac exposure gives satisfactory success rate without any serious complications.

Management of Facial Skin Cancer: Surgical Excision and Immediate Reconstruction / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Successful management of facial skin cancer needs complete removal of tumor with appropriate reconstruction of facial defect. A variety of methods have been used for the removal of tumor and reconstruction of the defect. The purpose of this study is to report our experience on management of facial skin cancer by surgical excision and immediate reconstruction. METHOD: Twenty-three cases of facial skin cancer which were treated by surgical excision and immediate reconstruction, were analyzed retrospectively. Basal cell carcinoma was the most common skin cancer and the nose was the most common site. Surgical excision was done with appropriate safety margin and the resection margin was confirmed with permanent sections. Immediate reconstruction was done using primary closure, skin graft, and local flaps according to the type, size, and location of the tumor. RESULTS: There were no recurrent cases during 13 months of follow up. There were no significant complications after the reconstruction except minor esthetic dissatisfaction. Local flap was the most efficient method for reconstruction with good esthetic outcome. CONCLUSION: Facial skin cancer can be successfully managed by surgical excision and immediate reconstruction.

Use of Auricular Composite Graft to Repair Nostril Stenosis: A Case Report

Nostril stenosis is a rare disease causing cosmetic problem and nasal airway obstruction. Various etiologies including iatrogenic cause the stenosis. Usually the shortage of internal lining of vestibule initiates secondary intention healing where granulation and contracture results in the stenosis. Many surgical techniques have been used to correct the stenosis. The objective of this article is to present a case of iatrogenic unilateral nostril stenosis which was successfully repaired with the use of auricular composite graft.

The Therapeutic Efficacy of Combined Antiviral Treatment in Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The idiopathic sudden sensorineural hearing loss (ISSHL) is a disease occurring instantly or developing over several days. An etiological role for virus families is assumed. Corticosteroids improve the prognosis for hearing recovery in ISSHL, but the effects of acyclovir are still uncertain. The purpose of this study is to evaluate the therapeutic efficacy of antiviral drug acyclovir (Zoylex) in ISSHL. MATERIALS AND METHODS: One hundred thirty four ears were divided into a study (41 ears, using acyclovir and steroid) and a control (93 ears, using steroid only) groups. Prognostic factors such as initial hearing loss, pattern of initial audiogram, coexistence of dizziness or tinnitus were used for parameters of comparison between two groups. RESULTS: The overall recovery rate of the study group (53.7%) was better than that of the control group (46.2%), but it was not statistically significant (p>0.05). The recovery rate of the study group was better than that of the control group on some prognostic factors, especially the period between the symptom attack and the beginning of treatment: however, there were no statistically significant differences either (p>0.05). CONCLUSION: Therefore, no beneficial effects from combining acyclovir with prednisolone could be established in ISSHL.

Diagnostic Criteria of Internal Jugular Phlebectasia in Korean Children

Internal jugular phlebectasia (IJP) is a fusiform dilatation of the internal jugular vein (IJV), usually presented as a neck mass in children. Accurate diagnosis from carefully directed history, physical examination, and radiological study could result in lifesaving therapy. We performed our study to suggest possible clinical diagnostic criteria for IJP in Korean children. We reviewed three cases of IJP (patients group) and compared the diameter of the internal jugular phlebectasias with diameters of IJVs in ten normal children (control group) using ultrasonography (USG). There were no significant differences in the range of diameters in the resting state between the two groups. The diameters on the right side, compared with those on the left side, showed no statistical significance (p < 0.05). Te range of expanding diameter and average expanding ratios (resting state to Valsalva maneuver X 100%) showed a statistical difference between the two groups (p < 0.05).

Diagnosis of Cervical Tuberculous Lymphadenitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although the incidence of tuberculosis has decreased recently, cervical tuberculous lymphadenitis is one of the most common causes of neck mass in Korea. Its confirmative diagnosis is not common, especially when the presence of acid-bacilli is not proven. So, the treatment of cervical tuberculous lymphadenitis is generally carried out by clinical diagnosis, not by confirmative diagnosis. In this study, we designed to verify theusefulness of fine needle aspiration cytology (FNAC), AFB stain, Mycobacterium tuberculosis polymerase chain reaction (PCR) and excisional biopsy prospectively. MATERIALS AND METHODS: We underwent FNAC, AFB stain and PCR as a first stage work-up through fine needle aspiration in forty-eight patients who were suspected of cervical tuberculous lymphadenits. In patients with positive results on the first stage work-up, we treated the patients with antituberculosis chemotherapy under clinical diagnosis of tuberculosis. In patients with negative test results, we performed excisional biopsy. Also in patients who revealed positive results with no response to the antituberculosis chemotherapy, we performed an excisional biopsy too. RESULTS: The sensitivity and specificity of first stage work-up were 64.9% and 81.8%, respectively. The sensitivity of FNAC, AFB stain and PCR were 8.1%, 13.5% and 56.8 %, respectively. The specificity of PCR was 81.8%. Thirteen (59.1%) of 22 patients who revealed negative results in their first stage work-up were proven to have cervical tuberculous lymphadentis through excisional biopsy, and two of the positive results in PCR were false positive. CONCLUSION: In clinical diagnosis of cervical tuberculous lymphadentis, the first stage work-up used in this study is found to be useful methods which resulted 64.9% sensitivity and 81.8% specificity. Especially, PCR is the most useful tool among them and suggest that, if its result is negative, excisional biopsy should be considered positively.

Non-traumatic Subcutaneous Emphysema in the Head and Neck / 대한이비인후과학회지

Subcutaneous emphysema often occurs as a result of surgery, trauma of the aerodigestive tract, and increased alveolar pressure. Generally, spontaneous emphysema is rare, because "spontaneous" is only used to describe emphysema that has no obvious etiology. We reviewed six cases of non-traumatic subcutaneous emphysema occurring in the head and neck. Among them, four cases were associated with pneumomediastinum. Two occurred without obvious etiology, another two were due to heavy lifting events, one due to severe vomiting, and the last one due to severe blowing. Most cases occurred in young males. Clinical symptoms, commonly involved sites, treatments and results of these cases of spontaneous emphysema were analysed.