A Huge Dacryolith Presenting as a Mass of the Inferior Meatus / 대한이비인후과학회지

A dacryolith is a concretion within the lacrimal drainage system. Although it may cause intermittent epiphora without inflammation, dacryoliths are often underlying contributors to recurrent or chronic dacryocystitis. It may occur anywhere along the lacrimal drainage system, albeit most commonly in the lacrimal sac. We report an interesting case of a dacryolith presenting as a mass of inferior meatus, which was managed via endonasal endoscopic approach.

Life-Threatening Upper Airway Obstruction Caused by Delayed Hematoma Occurring 8 Days Post-Thyroidectomy

Due to modern methods, thyroid surgery is generally considered quite safe. However, post-thyroidectomy hematomas, although rare, can be life-threatening and unpredictable complications of thyroid surgery. Most postthyroidectomy hematomas occur within 24 hours of surgery, with delayed hematomas occurring after one post-operative week being exceedingly rare. Herein, we report a case of delayed post-thyroidectomy hematoma with respiratory distress occurring on the eighth post-operative day in a patient who was not taking anticoagulants and had no hematologic diseases. Although most bleeding occurs within 24 hours, caution should be used even in such patients who are considered low-risk.

A Case of Hemangioendothelioma of the External Auditory Canal / 대한이비인후과학회지

Hemangioendothelioma (HE) is a group of vascular neoplasms that may be considered benign or malignant in their activity. HE is differentiated by both its characteristic behavior and histologic appearance into benign (hemangioma) and malignant tumor (angiosarcoma). The tumor is characterized by neoplastic proliferation of epitheloid or histiocytic endothelial cells, and it commonly occurs in the soft tissues of extremities and liver, lung, but rarely in the external auditory canal. Surgical excision is the treatment of choice and the prognosis is generally good. The authors report, along with a review of related literatures, a 66 year-old male patient with HE of the right external auditory canal.

The Demonstration of Bacterial Biofilm and It's Impact on Postoperative Course in Patients with Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Bacterial biofilm is thought to contribute to the progression and persistence of chronic rhinosinusitis. There are many studies which demonstrate these structures on chronic rhinosinusitis (CRS), but the majority of the studies just focus on the documentation of their presence and the method for identification. There are also a few researches that show the impact of biofilm on postoperative surgical outcomes. In this study, we demonstrated bacterial biofilm in CRS patients and determined whether they affect clinical courses and outcomes after surgery. SUBJECTS AND METHOD: The mucosa of ethmoid bulla was obtained during endoscopic sinus surgery from 21 CRS patients. Fluorescent microscope and scanning electron microscopy (SEM) were used for the determination of biofilm. The outcomes of the surgery were evaluated by endoscope every two weeks for 6 months. Preoperative symptom scores, CT scores, and the post operative results were compared between patients with biofilm and patients without biofilm. RESULTS: Bacterial biofilm were seen in 13 (62%) of the 21 CRS patients. A statistical association existed between the presence of biofilm and the worsened preoperative symptom scores, but the preoperative CT scores were not related to the presence of biofilm. Patients with biofilm had long-lasting postoperative mucosal inflammation and a prolonged healing time, and these differences have statistical significance. CONCLUSION: This study showed that the presence of bacterial biofilm were significantly correlated with worsening preoperative symptom scores and the prolonged postoperative recovery time. Therefore, bacterial biofilm may play an important role in the recalcitrant and resistant nature of CRS.

Extracranial Trigeminal Schwannoma Involving the Inferior Alveolar Canal / 대한이비인후과학회지

Although trigeminal schwannomas (TS) are rare tumors that may involve any parts of the trigeminal nerve, most of these tumors are located in the intracranium. Extracranial TS are extremely rare. Management of extracranial TS is challenging because of the anatomic complexity around the tumor. Therefore, thorough surgical planning should be required preoperatively for complete tumor removal with the least morbidities. We presented a 64-year-old man with a trigeminal mandibular schwannoma in the left infratemporal, parapharyngeal, pterygomandibular space and inferior alveolar canal of mandible.

Role of Staphylococcus Aureus Exotoxins in Chronic Rhinosinusitis with Nasal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Staphylococcal exotoxins (SEs) have been implicated in the pathogenesis of chronic rhinosinusitis with nasal polyp (CRSwNP). In the current study, we determined the prevalence of specific immunoglobulin E (IgE) antibodies to SEs in serum and polyp tissues of patients with CRSwNP and tried to find out whether there is an association between the presence of SEs-IgE antibody and eosinophilic inflammation. SUBJECTS AND METHOD: Blood, nasal polyp and mucosa samples were obtained from 43 patients undergoing endoscopic sinus surgery for CRSwNP and 11 controls undergoing septoplasty without CRS. Specimens were analyzed for the presence of specific IgE antibody to four SEs [staphylococcal enterotoxin A (SEA), staphylococcal enterotoxin B (SEB), staphylococcal enterotoxin C (SEC), toxic shock syndrome toxin 1 (TSST-1)] using ImmunoCAP assay. Eosinophil cationic protein (ECP) in serum and nasal polyp tissue were also analyzed using ImmunoCAP. Eosinophil counts were estimated in polyp tissue. RESULTS: SEs-specific IgE antibodies were detected in 13 (30.2%) patients of the CRSwNP group. In contrast, only one (9.1%) control patient had IgE to SEs. Serum ECP level was increased significantly in the CRSwNP group compared with controls. However, there were no significant differences in Lund-MacKay score, the ECP level in the serum and polyp tissue, and eosinophil count in the polyp tissue between the SEs-IgE antibody positive [SEs-IgE Ab (+)] group and the SEs-IgE antibody negative [SEs-IgE Ab (-)] group. CONCLUSION: SEs may play a certain role in the pathogenesis of CRSwNP. However, there is no close correlation between the presence of SEs-IgE antibody and eosinophilic inflammation.

Formation of Biofilm in Patients with Chronic Otitis Media and Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In many chronic infections, bacteria are present as a form of biofilms. Recently, bacterial biofilm has been implicated in persistent or recurrent chronic otolaryngologic infections, because they are highly resistant to treatment with antimicrobial agents and capable of shedding individual bacteria to the surrounding tissues. In this study, we aimed to evaluate biofilm in chronic middle ear infections. SUBJECTS AND METHOD: A total of 85 cases with chronic middle ear infections were included in this study. Histomorphologic studies for middle ear granulations and cholesteatomas were performed using light and electron microscopy. RESULTS: In middle ear granulations, about 33% of the cases showed the evidence of bacterial biofilm. In comparison, about 64% of the cases in cholesteatoma tissues have the evidences of bacterial biofilm. CONCLUSION: Biofilms are associated with chronic middle ear infection and they may play a role in the pathogenesis of refractory or persistent chronic middle ear infections.

An Unusual Case of Extramedullary Plasmacytoma Occurring in Arytenoid Apex / 대한이비인후과학회지

Extramedullary plasmacytoma (EMP) is a rare plasma cell neoplasm occurring anywhere in the body. Paranasal sinus is the most commonly involved site of head and neck region, and then nasal cavity, oropharynx on the decreasing frequency. EMP of larynx is quite rare and only two cases of EMP were reported to have occurred in the epiglottis and the false cord of larynx, respectively, in the Korean literature. We report an unusual case of EMP occurring in the arytenoid that was treated by surgical excision.

A Case of Myospherulosis in the Nasal Septum / 대한이비인후과학회지

Myospherulosis is an unusual foreign-body reaction usually occurring in tissue exposed to petrolatum-based products. Since the initial description of myospherulosis of the paranasal sinus by Kyriakos in 1974, reported cases have been increasing. All of the lesions described by Kyriakos were located in the paranasal sinuses, nose, middle ear, or upper eyelid. However, there had not been any cases of myospherulosis reported in Korea. We report a case of myospherulosis in the nasal septum with a review of the related literature.