One Case of Persistent Stapedial Artery Combined with Aberrant Internal Carotid Artery / 대한이비인후과학회지

A 2-year-old girl had 2-month history of both secretory otitis media . Nine weeks after the first visit, physical examination revealed a whitish mass behind the intact right tympanic membrane. A CT study showed absence of the right foramen spinosum. The right ICA had an aberrant course running laterally in the middle ear cavity with ossesous canal. The soft tissue density in the normal location of the tympanic segment of facial nerve was markedly enlarged. A diagnosis of aberrant ICA and persistent stapedial artery was made. Vascular mass in the middle ear space are very uncommon. They continue to present a diagnostic problem, as the clinical symptoms and signs are often nonspecific and require radiological investigation to distinguish between glomus tumors, other vascular tumors, a dehiscent jugular bulb and an aberrant internal carotid artery. In approximately one per cent of the population, a dehiscent ICA canal is present and can result in the passing of an aberrant ICA through the middle ear space. The persistent stapedial artery is a rare congenital vascular anomaly that may present as a pulsatile middle ear mass or that may appear as an incidental finding. It is important for the otologist to be aware of this anomaly, as a misdiagnosis can have catastrophic consequences.

Objective olfactory function test through analysis of human Q-EEG changes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Increased industrialization and the changing environment have caused complex olfactory problems in the modern population, and the need for an objective evaluation of such problems has thus come to our attention. In this study, we used the human Q-EEG (Bio-Logic, Brain Atlas III) equipment to evaluate olfactory fuction, and tried to lay out a basis for an objective test of olfactory function in humans. MATERIALS AND METHODS: Twenty normosmic adults and ten anosmic patients were studied by the human Q-EEG equipment. EEG changes were analyzed by a nonparametric test (Mann-Whitney test, p<0.05). A mixture of S-D alcohol, benzophenol, BHT (benzyl hydroxy toluene), water, and fragrance were used as an odorant. The odorant was applied to the one third anterior of the inferior turbinate using a small piece of filter paper soaked in the odorant. RESULTS: During odorant stimulation, the Q-EEG analyzer showed that the delta band (0-3.5 Hz) decreased in the whole brain region, while the alpha band (8-11.5 Hz) increased in the bilateral temporal region in the normosmic patients. There was no Q-EEG changes in the anosmic patients. CONCLUSION: It is suggested that human Q-EEG analysis may provide the basis for the development of an objective test of olfactory function in humans.

A Case of Allergic Fungal Sinusitis / 대한이비인후과학회지

Allergic fungal sinusitis (AFS) has been clinicopathologically defined as a noninvasive form of fungal infection. AFS was first reported in 1983. The first case of AFS was associated with Aspergillus, but recently other fungal organisms have been implicated. AFS should be suspected in any atopic patients with refractory nasal polyps. Sinus computed tomograms and magnetic resonance imaging findings can be quite distinctive, but definite diagnosis requires histopathologic examination which shows characteristic allergic mucin. Current recommendations for therapy include conservative but complete exenteration of all allergic mucin. Adjunctive systemic steroids are often helpful. The authors present a case of allergic fungal sinusitis for the first time in Korea. The patient had nasal polyp and showed hypersitivity to fungus in RAST, elevation of total IgE, peripheral eosinophilia. On histopathologic examination, typical allergic mucin including Charcot-Leyden crystals, eosinophils and fungal hyphae were found.

Changes of the Olfactory Epithelium in Artificially Induced Hypothyroid Rats

BACKGROUND AND OBJECTIVES: This study was performed to investigate, through immunohistochemical analysis, the thyroid hormone's effect on the olfactory receptor neurons of adult rats. MATERIALS AND METHODS: Hypothyroidism was induced by adding reversible goitrogen propylthiouracil (PTU) to the rats' drinking water (30 mg/kg weight). Sprague-Dawly rats aged nine to ten weeks were divided into three groups : control, six weeks or PTU therapy, and 12 weeks of PTU therapy. Light microscopic investigation of the olfactory mucosa was conducted with an immunohistochemical stain to observe for proliferating cell nuclear antigen (PCNA) and protein genepeptide (PGP) 9.5. RESULTS: The rats in the experimental groups gained less weight compared with normal rats of the same age. Light microscopic examination revealed no statistically significant differences in the thicknesses of the olfactory epithelium and the numbers of cells among the three groups in H-E stains, but the ratio of PCNA(+) supporting cells decreased significantly with longer durations of PTU treatment. As PTU therapy continued, immunoreactivities to PGP 9.5 in olfactory receptor cells decreased remarkably. After 12 weeks of PTU treatment, no immunoreactivity was observed in the olfactory receptor cells. CONCLUSION: These results indicate that the thyroid hormone is essential for maturation of the olfactory receptor neuron.

A Comparison between Coronal and Axial Scans in PNS CT

BACKGROUND AND OBJECTIVES: A coronal section computerized tomography (CT) is essential for the diagnosis of paranasal sinusitis, especially in the evaluation of the ostiomeatal unit. Although the coronal scan is preferred to the axial scan, the role of the axial scan during endoscopic sinus surgery has not been thoroughly examined. The aim of this study is to compare the advantages and disadvantages of coronal and axial scans in the paranasal sinuses. MATERIALS AND METHODS: Selected for study were the coronal and axial scans of 30 preoperative sinus CTs showing minimal sinus pathology. The rates of detecting 15 anatomic structures in the coronal and axial sections were analyzed across 60 sides. RESULTS: The coronal scan was superior to the axial scan in detecting eight normal structures, including the anterior ethmoid artery, the opening of the maxillary sinus and the superior meatus (p<0.05). The axial scan was useful in showing the vertical portion of the 3rd basal lamella and the opening and the anterior wall of the sphenoid sinus (p<0.05). CONCLUSION: The coronal scan is more informative than the axial scan but has limitations in showing the structures lying on the coronal plane. The axial scan plays a complementary role in covering this limitation. Together, the coronal and axial sections of a sinus CT can help the surgeon to understand the three dimensional structure of the paranasal sinus before endoscopic sinus surgery.

Endoscopic Maxillary Sinus Surgery Using the Microdebrider

In the treatment of chronic maxillary sinusitis, endoscopic sinus surgery, unlike the more radical Caldwell-Luc (C-L) operation, enables the preservation of mucosa. However, although a middle meatal antrostomy is superior in function and patency to an inferior meatal antrostomy, at times it is very difficult to remove diseased mucosa located at the antero-inferior or antero-medial side of the maxillary sinus : to prevent recurrence, the C-L procedure is often chosen. In an effort to decrease the failure rate of endoscopic maxillary sinus surgery, we applied the microdebrider technique, a new approach of puncture and shaving. To evaluate the effectiveness of the microdebrider technique, we retrospectively reviewed the medical records of 33 patients (43 sinuses) who have been treated by this method. We analyzed the clinical courses of these patients during recovery and evaluated endoscopic findings made during follow-up examinations. Nasal symptoms were alleviated in every case except for two. Three cases required revision ESS or a C-L procedure at the puncture and shaving site. The maxillary sinuses of most patients (80%) were normalized, but five sinuses demonstrated polypoid or thickened mucosa. The ostiums of 36 maxillary sinuses remained patent but nine sinuses became stenotic. Complications, which included facial pain and facial paresthesia, were rare and disappeared shortly. We consider this new technique to be an effective method of eradicating maxillary sinus disease that is not otherwise accessible through the MMA window.

A Study on the Diagnosis of Fungus Ball

BACKGROUND: Fungus ball should always be considered in the differential diagnosis of chronic or recurrent sinusitis resistant to adequate medicinal treatment. MATERIALS AND METHODS: From January 1, 1995, to September 31, 1997, 32 patients were diagnosed with fungus ball based on the pathologic confirmation. We reviewed the 32 patients from the diagnostic point of view, evaluating clinical symptoms, signs, computerized tomography (CT) findings, and operative findings. We also reviewed five cases of clinical misdiagnosis, in which pathologic confirmation failed to identify fungus despite operative and radiologic findings suggesting its presence. RESULTS: Among 32 patients, 19 cases (59%) were suspected prior to surgery as having fungus ball. Eleven cases (34%) were suspected only upon historical and physical examination. CONCLUSION: A high index of suspicion is necessary for the diagnosis of fungus ball. A pathologic confirmation is necessary for a definite diagnosis.

Incidence and Types of Sphenoethmoid Cell in Patients with Chronic Paranasal Sinusitis

The sphenoethmoid cell is the most posterior ethmoid cell, pneumatizing far laterally and to some degree superiorly to the sphenoid sinus. A accurate understanding of the sphenoethmoid cell is important for avoiding fatal injury to the orbit and safely approaching the sphenoid sinus. To investigate the incidence of sphenoethmoid cells, the authors analyzed the coronal CT scans of 50 patients who underwent endoscopic sinus surgery for sinusitis. Sphenoethmoid cells were identified in 39 out of 100 nasal cavities and divided into two types according to their relationship with the optic canal and the sphenoid sinus : type 1 cells, where the optic nerve bordered the sphenoethmoid cell and the sphenoid sinus, were observed in 14 cavities, and type 2 cells, where the optic nerve bordered only the sphenoethmoid cell, were observed in 25 cavities. We anticipate the existence of an optic canal in the posterior ethmoid sinus in one third of the cases, and the direction of the approach to the anterior wall of the sphenoid sinus should be modified according to the type of sphenoethmoid cell if one is present.

Three cases of cholesterol granuloma presenting as intratympanic mass / 대한이비인후과학회지

No abstract available.