Clinical Practice Guidelines for Oropharyngeal Dysphagia / 대한연하장애학회지

Objective@#Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. @*Methods@#Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. @*Results@#Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. @*Conclusion@#This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Development of Differential Diagnosis Scale Items for Adductor Spasmodic Dysphonia and Evaluation of Clinical Availability

BACKGROUND AND OBJECTIVES@#The purpose of this study was to develop the differential diagnosis scale containing items from adductor spasmodic dysphonia (ADSD) to muscle tension dysphonia (MTD) and the determine clinical utility of newly developed items.MATERIALS AND METHOD: The four parts of pitch, redirected phonation, automatic speech and voiced sound were selected for analyzing the characteristics of ADSD in the literature. One part of tense voiceless sound was developed according to the Korean manner of articulation. The content validity was evaluated based on 5 scales (1–5 point) analysis from 30 experts. One hundred patients (50 ADSD and 50 MTD) were recorded in reading a sentence and sustained phonation. The two speech language pathologist evaluated recorded voices through a blind test using 4 scales (0–3 point) for newly developed items.@*RESULTS@#As a result of verifying the content validity of items with experts, it was identified that the differentiated items were valid with 4.2 out of 5. Through the differential diagnosis between two groups according to the items, the correlation between sub-domains and total scores was shown as higher than 0.710. The result of analyzing the reliability on each diagnosis domain was 0.840–0.893, which showed the internal consistency of items was great. Newly developed five parts of ADSD were significantly higher than those of MTD with strong correlation (p<0.01). The reliability among the evaluators was analyzed as high with 0.892.@*CONCLUSION@#In this study, the differential diagnosis scale of ADSD was revealed as having validity and reliability. It is considered that it will be useful for differentiating ADSD and MTD in the clinical field.

Expert's Consensus on Terminology of Auditory Perceptual Assessment in Voice Disorder / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to conduct a preliminary study to develop a standardized guideline for terminology necessary to describe auditory perception qualitatively and quantitatively in voice disorders in the Korean language. SUBJECTS AND METHOD: At first, a subjective questionnaire for Korean translation and definition of 25 auditory perceptual assessment terms proposed by Titze was answered by six speech-language pathologists. Secondly, a new questionnaire that was reconstructed with objective items based on the responses to the first questionnaire was completed by 14 experts who had experience on voice disorder for more than 10 years in Korea. In both questionnaires, the necessity of 32 auditory perceptual assessment terms selected from the 25 terms defined by Titze, GRBAS and CAPE-V was surveyed. RESULTS: The consensus on the Korean translation of auditory perceptual assessment terms was moderate (52.6%) between experts. The terms ‘ rough’ and ‘ shimmer’ demonstrated highest consensus of 85.7%. The consensus on Korean definition of auditory perceptual assessment terms was also moderate (61.6%). The term ‘ yawny’ showed complete consensus (100%). The necessity of auditory perceptual assessment terms varied with terms, but showed high consensus. CONCLUSION: It is necessary to develop and apply various standardized vocabulary terms for clinical evaluation so that they can express pathology and physiological characteristics during vocalization. In addition, despite the fact that there are a lot of auditory-perceptual terms, there is a lack of knowledge about voice quality terms, suggesting the need to promote and educate the developed voice quality terms.

Noise-Induced Neural Degeneration and Therapeutic Effect of Antioxidant Drugs

The primary site of lesion induced by noise exposure is the hair cells in the organ of Corti and the primary neural degeneration occurs in synaptic terminals of cochlear nerve fibers and spiral ganglion cells. The cellular basis of noise-induced hearing loss is oxidative stress, which refers to a severe disruption in the balance between the production of free radicals and antioxidant defense system in the cochlea by excessive production of free radicals induced by noise exposure. Oxidative stress has been identified by a variety of biomarkers to label free radical activity which include four-hydroxy-2-nonenal, nitrotyrosine, and malondialdehyde, and inducible nitric oxide synthase, cytochrome-C, and cascade-3, 8, 9. Furthermore, oxidative stress is contributing to the necrotic and apoptotic cell deaths in the cochlea. To counteract the known mechanisms of pathogenesis and oxidative stress induced by noise exposure, a variety of antioxidant drugs including oxygen-based antioxidants such as N-acetyl-L-cystein and acetyl-L-carnitine and nitrone-based antioxidants such as phenyl-N-tert-butylnitrone (PBN), disufenton sodium, 4-hydroxy PBN, and 2, 4-disulfonyl PBN have been used in our laboratory. These antioxidant drugs were effective in preventing or treating noise-induced hearing loss. In combination with other antioxidants, antioxidant drugs showed a strong synergistic effect. Furthermore, successful use of antioxidant drugs depends on the optimal timing of treatment and the duration of treatment, which are highly related to the time window of free radical formation induced by noise exposure.

Speech Recognition in Real-Life Background Noise by Young and Middle-Aged Adults with Normal Hearing

BACKGROUND AND OBJECTIVES: People usually converse in real-life background noise. They experience more difficulty understanding speech in noise than in a quiet environment. The present study investigated how speech recognition in real-life background noise is affected by the type of noise, signal-to-noise ratio (SNR), and age. SUBJECTS AND METHODS: Eighteen young adults and fifteen middle-aged adults with normal hearing participated in the present study. Three types of noise [subway noise, vacuum noise, and multi-talker babble (MTB)] were presented via a loudspeaker at three SNRs of 5 dB, 0 dB, and -5 dB. Speech recognition was analyzed using the word recognition score. RESULTS: 1) Speech recognition in subway noise was the greatest in comparison to vacuum noise and MTB, 2) at the SNR of -5 dB, speech recognition was greater in subway noise than vacuum noise and in vacuum noise than MTB while at the SNRs of 0 and 5 dB, it was greater in subway noise than both vacuum noise and MTB and there was no difference between vacuum noise and MTB, 3) speech recognition decreased as the SNR decreased, and 4) young adults showed better speech recognition performance in all types of noises at all SNRs than middle-aged adults. CONCLUSIONS: Speech recognition in real-life background noise was affected by the type of noise, SNR, and age. The results suggest that the frequency distribution, amplitude fluctuation, informational masking, and cognition may be important underlying factors determining speech recognition performance in noise.

FAST Reappraisal: Cross-sectional Study

PURPOSE: Focused Assessment with Sonography for Trauma (FAST) provides an important initial screening examination in adult trauma patients. However, due to its low sensitivity, FAST is not a replacement for computed tomography (CT) in hemodynamically stable trauma patients. The aim of this study was to determine the test characteristics of FAST in adult, hemodynamically stable, blunt abdominal trauma patients by using a critical action as a reference standard. METHODS: The medical records for FAST examination at a single hospital from January 2009 to February 2011 were retrospectively reviewed. The inclusion criterion was isolated, hemodynamically stable, blunt abdominal trauma. Hemodynamically unstable patients or patients with penetrating injuries were excluded. The reference standard was the presence of a critical action, which was defined as one of the following: 1) operative intervention for a finding discovered on CT, 2) interventional radiology for bleeding, 3) transfusion of 2 or more packed RBCs, or 4) death at the emergency department. RESULTS: There were 230 patients who met the inclusion criterion. There were 20 true positive, 206 true negative, 0 false positive, and 4 false negative results. The sensitivity and the specificity were 83% and 100%, respectively. CONCLUSION: Despite its low sensitivity for detecting any abnormal finding discovered on CT, negative FAST could aid to exclude critical action in hemodynamically stable, blunt abdominal trauma patients.

The Clinicopathologic Features and Recurrence of Resection-Line Involvement of Gastric Cancer after Gastrectomy

PURPOSE: The purpose of this study was to analyze the clinical courses of patients with gastric cancer and positive resection margins after a gastrectomy for gastric cancer who did not undergo subsequent surgery. MATERIALS AND METHODS: Among 4,452 patients who underwent surgery for gastric cancer from January 2001 to December 2007, 20 patients with positive resection margins after gastrectomy for gastric cancer who did not undergo subsequent surgery were included. The recurrence patterns were confirmed by postoperative computed tomography and gastroscopy, which were performed on a planned schedule. All recurrence patterns after gastrectomy were classified as loco-regional, peritoneal, or distant metastases. RESULTS: The patients with confirmed recurrence all had advanced stage cancer (III-IV), and the recurrence sites were variable. However, peritoneal and distant recurrences were more common than loco-regional recurrences. The patients with loco-regional recurrence also had peritoneal and/or distant recurrence. CONCLUSIONS: Patients with gastric cancer and a positive resection margin showed more frequent peritoneal and distant metastases than loco-regional recurrence. In addition, patients with loco-regional recurrence also had peritoneal and distant recurrence. A positive resection margin of gastric cancer was related with poor histological differentiation, diffuse type, and advanced stage (III-IV).

Proximal Splenic Artery Pseudoaneurysm after Radical Subtotal Gastrectomy

Splenic artery pseudoaneurysm (SAP) is a very rare case, postoperatively. SAP originates from many causes such as complication of chronic pancreatitis in adults and blunt abdominal trauma in children. SAP related to surgery may result from direct tissue injury during operation. Urgent angiography is helpful in diagnoses and life-saving procedures as the endovascular embolization simultaneously. However, endovascular management is not a definite treatment modality in patients previously operated on because the blood supply of remaining organs will be insufficient after embolization. In this paper, we report a rare case that is proximal splenic artery pseudoaneurysm after radical subtotal gastrectomy in a 63-year-old male patient with early gastric cancer, as well as a brief review.

The Impact of Peripheral Arterial Disease on the Treatment and Amputation of Diabetic Foot Ulcer

PURPOSE: Diabetic foot ulcers are one of the most important complications of patients with diabetes for their quality of life. Yet the data on factors that affect the treatment outcome and the guidelines for a multidisciplinary approach are limited. The purpose of this study was to assess the clinical characteristics that affect healing of diabetic foot ulcers, and especially when this is associated with peripheral arterial disease (PAD). METHOD: We retrospectively reviewed the clinicopathologic data of 112 patients who were admitted for the treatment of diabetic foot ulcers from May 2004 to December 2007 at Bundang Seoul National University Hospital. The patient's demography and co-morbidities, the laboratory and radiological details, the surgical data and the treatment outcomes were evaluated and analyzed according to the presence of PAD. RESULT: The mean age of the patients was 66 years old and the male to female ratio was 2.3:1. Except for simple dressing of the ulcers, skin graft, amputation or revascularization were performed for 77 patients. Ulcers healed in 74 patients (66.1%) and recurrence was observed in 42 patients (37.5%). Major amputation was performed on 11 patients (9.8%). The non-healing group had a higher incidence of male gender (P=0.049), end stage renal disease (P=0.038), coronary arterial disease (P=0.018), the presence of PAD (P=0.034) and a higher level of cholesterol (P=0.011) and triglyceride (P=0.039). Patients with PAD had a lower ankle-brachial index (P<0.001) and a higher rate of undergoing revascularization (P<0.001), overall amputation (P=0.003), non-healing (P=0.034) and recurrence (P<0.001). After revascularization, the rate of major amputation was not reduced (P=0.915). CONCLUSION: The risk of non-healing, overall amputation and recurrence is increased in the presence of PAD. Evaluating the PAD status and multidisciplinary treatment strategies are needed to treat these patients with diabetic foot ulcer.

Peripheral Bronchopleural Fistula: CT Evaluation in 22 patients

PURPOSE: To determine the usefulness of CT for the evaluation of peripheral bronchopleural fistulas. MATERIALS AND METHODS: CT scans of 22 patients with persistent air leak, as seen on serial chest PA, and aclinical history, were retrospectively evaluated. We determined the visibility of direct communication between thelung and pleural space, and the frequeucy and location of this, and if direct communications were not visualizedthe probable cause. RESULTS: A bronchopleural fistula(n=13) or its probable cause(n=6) was visualized in 19patients(86%). Direct communications between the lung and pleural space were seen in 13 patients(59%); there weresix cases of tuberculous empyema, three of tuberculosis, two of necrotizing empyema, one of trauma, and one ofpostobstructive pneumonitis. In six patients, bronchiectatic change in peripheral lung adjacent to the pleuralcavity was noted, and although this was seen as a probable cause of bronchopleural fistual, direct communicationwas invisible. Bronchopleural fistula or its probable cause was multiple in 18 of 19 patients, involving the upperand lower lobe in eight, the upper in nine, and the lower in two. CONCLUSIONS: CT is useful for evaluating thepresence of bronchopleural fistula, and its frequency and location, and in patients in whom the fistula is notdirectly visualized, the cause of this.

Is CT Effective in Diagnosing the Acute Appendicitis?: Focus on Comparison of Unenhanced CT with Barium Enema

PURPOSE:To evaluate the role of unenhanced CT in diagnosing the acute appendicitis. METHOD AND MATERIALS: We retrospectively analyzed conventional contrast-enhanced abdominal CT scans of 197 normal patients and barium enemas of 26 out of the 197 patients. Additional unenhanced CT scans of right lower abdomen were performed on 30 patients who were suspected of having acute appendicitis;barium enema was performed in 26 patients. RESULTS: in the analysis of the conventional CT scans, we could detect 132(67%) normal appendicies. On barium enema of 26 out of 197 patients, abruptly narrowed appendix was visualized in 5 cases and luminal irregularity in 4 cases but all 26 cases showed normal appendix on CT. In the 30 cases of unenhanced CT, all appendicies were visualized. Among 12 Cases which were proved as acute appendicitis, barium enenma was done in 10 case;abruptly narrowed appendix was shown in 3 and luminal irregularity in 1. Among 18 cases which were diagnosed as normal appendix, nonvisualization of appendix' was in 1 case, abruptly narrowed lumen in 3, and luminal irregularity in 9. CONCLUSION:Unenhanced CT in the area of the cecum may be an effective and safe diagnostic tool for acute appendicitis.

Pulmonary Consolidation Pattern on the Chest CT: Malignant vs Benign

PURPOSE: It is not easy to determine the cause of pulmonary consolidative lesion. Even without any definite mass, malignancy cannot be ruled out. And sometimes, it is difficult to differentiate tuberculosis from pneumonia. To differentiate malignant consolidative lesion from benign one, we studied patterns of air bronchogram, mucoid impaction, and computed tomographic anglogram etc. MATERIALS AND METHODS: Fifty seven cases of pulmonary consolidative lesions(23 cases of malignancy,34 cases of benign lesion) were retrospectively reviewed by three radiologists. RESULTS: Among the 28 cases which showed a little air bronchogram(less than 1/3 of the whole lesion in volumetric measure with the eye) 19 cases were malignancy and nine cases were benign lesions. All of the 12 cases which showed profound air bronchogram over 2/3 of the whole lesion were benign lesions. Bronchiectasis was detected in 31 cases(four of malignancy and 27 of benign lesions). Among the 20 cases which didn't show the mucoid impaction five cases were malignancy and 15 cases were benign lesions. Out of eight cases with mucoid impaction filling the long segments(branching tree shape), seven cases were malignancy and one case was benign lesion. So called CT anglogram was detected in nine cases of malignancy and two cases of benign lesions. All of nine cases of malignancy showed CT anglogram which was like arborizing tree. CONCLUSION: Scanty air bronchogram, profound arborizing mucoid impaction and/or CT angoigram within consolidative lesion could suggest malignancy.

Anatomical variants of paranasal sinus affecting the ostiomeatal unit

It is well known that anatomic variations affecting the ostiomeatal unit (OMU) become one of the causes of mucosal abnormalities of paranasal sinuses (PNS). Findings of coronal plane CT scans of PNS were analyzed in 95 patients with sinusitis or sinusitis-like complaints. Anatomical variations were seen in 88 cases of 60 patients. Mucosal abnormalities were seen in 27 of 47 cases with concha bullosa, 23 of 37 cases with enlarged ethmoid bulla, 8 of 33 cases with Agger nasi, 20 of 26 cases with nasoseptal deviation, 7 of 8 cases with Haller cell, 3 of 6 cases with duoble middle turbinate, 4 of 6 cases with medially bent uncinate process, 1 cases with laterally bent uncinate process, and 33 of 40 cases with mixed variations. Mucosal abnormalities in cases with antomical variations were detected in 61 cases, including maxillary sinus(51 cases), anterior ethmoid sinus (26 cases), frontal sinus (4 cases), and mixed (32 cases). Mucosal abnormalities without anatomical variations were detected in 13 cases involving maxillary sinuses (7 cases), anterior ethmoid sinuses (5 cases), and frontal sinus(1 cases). In conclusion, as coronal plane CT scan has the capability of dolineating anatomical variations and mucosal abnormalities of PNS, it is considered useful in evaluating the treatment and prognosis of chronic or recurrent sinusitis.

Anatomical variants of paranasal sinus affecting the ostiomeatal unit

It is well known that anatomic variations affecting the ostiomeatal unit (OMU) become one of the causes of mucosal abnormalities of paranasal sinuses (PNS). Findings of coronal plane CT scans of PNS were analyzed in 95 patients with sinusitis or sinusitis-like complaints. Anatomical variations were seen in 88 cases of 60 patients. Mucosal abnormalities were seen in 27 of 47 cases with concha bullosa, 23 of 37 cases with enlarged ethmoid bulla, 8 of 33 cases with Agger nasi, 20 of 26 cases with nasoseptal deviation, 7 of 8 cases with Haller cell, 3 of 6 cases with duoble middle turbinate, 4 of 6 cases with medially bent uncinate process, 1 cases with laterally bent uncinate process, and 33 of 40 cases with mixed variations. Mucosal abnormalities in cases with antomical variations were detected in 61 cases, including maxillary sinus(51 cases), anterior ethmoid sinus (26 cases), frontal sinus (4 cases), and mixed (32 cases). Mucosal abnormalities without anatomical variations were detected in 13 cases involving maxillary sinuses (7 cases), anterior ethmoid sinuses (5 cases), and frontal sinus(1 cases). In conclusion, as coronal plane CT scan has the capability of dolineating anatomical variations and mucosal abnormalities of PNS, it is considered useful in evaluating the treatment and prognosis of chronic or recurrent sinusitis.

Serum IgE Levels in Bronchiolitis Patients

No abstract available.

Primary Vesicourteral Reflux in Children

No abstract available.