A Case of Syringocystadenoma Papilliferum of External Auditory Canal / 대한이비인후과학회지

Ceruminous glands are specialized sudoriferous glands located in the external auditory canal (EAC). Tumors originating from these ceruminous glands are rare lesions of EAC; in particular, syringocystadenoma papilliferum (SCAP) is an extremely rare ceruminous glands neoplasm to occur in the EAC. Although it is rare, the association of SCAP with tubular apocrine adenoma in the background of nevus sebaceous on the body, extremities, and scalp is well documented. In this article, we report on a 60-year-old male who presented a mass in EAC, which was surgically removed. The final diagnosis of SCAP was determined by histological analysis and the patient has been well without recurrence.

Validation of Simultaneous Endoscopic Sinus Surgery and Transsphenoidal Surgery in Patients with Chronic Rhinosinusitis and Pituitary Tumors / 대한이비인후과학회지

Background and Objectives@#Transsphenoidal (TS) surgery for removal of pituitary lesions has become popular with improvements in diagnostic and treatment modalities, as well as endonasal and endoscopic methods, resulting in reduced complications. Rhinosinusitis (RS) is considered a risk factor for postoperative intracranial infections. Previously, we showed that concurrent TS surgery and endoscopic sinus surgery (ESS) yielded a favorable outcome in cases with pituitary lesions and RS. However, there seems to be a lack of consensus in performing simultaneous TS and ESS for patients with a pituitary lesion and RS. We would like to validate the feasibility of performing two operations concurrently.Subjects and Method We reviewed the medical records of 13 patients who underwent simultaneous TS surgery and ESS between 2007 and 2016. One patient underwent concurrent TS surgery and ESS twice due to the regrowth of pituitary macroadenoma and recurrence of RS. @*Results@#There were only four minor nasal complications during the postoperative period, which were controlled with conservative treatment. Only one patient exhibited postoperative cerebrospinal fluid leakage and no patients experienced intracranial complications. @*Conclusion@#This study shows that it might be better to treat patients with pituitary lesion and RS simultaneously. Also, further studies with large cases would be necessary to manage these patients without intracranial complications.

A Case of Venous Malformation in Temporomandibular Joint Causing Stenosis of External Auditory Canal / 대한이비인후과학회지

Both neoplasm and infections arising from the external auditory canal (EAC) can involve the temporomandibular joint (TMJ) but rarely the reverse. A benign TMJ mass that presents as an EAC mass is a rare otologic entity as only seven cases have been reported worldwide. The authors experienced a 72-year-old male patient presenting with EAC mass with fluctuation when opening the mouth, which turned out to be caused by venous malformation of the TMJ. Surgical excision of the mass via endaural approach was successful. We present this case with a review of the literature.

A Case of Venous Malformation in Temporomandibular Joint Causing Stenosis of External Auditory Canal / 대한이비인후과학회지

Both neoplasm and infections arising from the external auditory canal (EAC) can involve the temporomandibular joint (TMJ) but rarely the reverse. A benign TMJ mass that presents as an EAC mass is a rare otologic entity as only seven cases have been reported worldwide. The authors experienced a 72-year-old male patient presenting with EAC mass with fluctuation when opening the mouth, which turned out to be caused by venous malformation of the TMJ. Surgical excision of the mass via endaural approach was successful. We present this case with a review of the literature.

Two Cases Report of Myxoid Degeneration of the Auricular Cartilage / 대한이비인후과학회지

Myxoid degeneration (MD) in the cartilage results from the accumulation of hyaluronic acid in the stroma. However, it is rarely found in the auricular cartilage, with only one published report to date. This article describes two histologically confirmed cases of MD of the auricle that was excised with favorable aesthetic results. Two men presented with auricular masses, with no history of trauma or tumors in the auricle. Laterally protruding masses were located around the helix and antihelix, which were similar in appearance to the normal auricular cartilage. We made an aesthetic skin incision under local anesthesia, and carved the mass from the normal cartilage for pathological and cosmetic reasons. Both excised masses showed MD of the auricular cartilage. We report these two cases with a review of the literature.

Chordoid Glioma with Intraventricular Dissemination: A Case Report with Perfusion MR Imaging Features

Chordoid glioma is a rare low grade tumor typically located in the third ventricle. Although a chordoid glioma can arise from ventricle with tumor cells having features of ependymal differentiation, intraventricular dissemination has not been reported. Here we report a case of a patient with third ventricular chordoid glioma and intraventricular dissemination in the lateral and fourth ventricles. We described the perfusion MR imaging features of our case different from a previous report.

Chlorfenapyr-Induced Toxic Leukoencephalopathy with Radiologic Reversibility: A Case Report and Literature Review

Chlorfenapyr is a widely used, moderately hazardous pesticide. Previous reports have indicated that chlorfenapyr intoxication can be fatal in humans. We reported the first non-fatal case of chlorfenapyr-induced toxic leukoencephalopathy in a 44-year-old female with resolution of extensive and abnormal signal intensities in white matter tracts throughout the brain, brain stem, and spinal cord on serial magnetic resonance imaging.

Successful Cross-circulation Stent-Retriever Embolectomy Through Posterior Communicating Artery for Acute MCA Occlusion by Using Trevo XP ProVue / 신경중재치료의학

Acute ischemic stroke due to embolic occlusion of the middle cerebral artery (MCA) in patients with chronic ipsilateral internal carotid artery (ICA) occlusion is quite rare. Several previous reports demonstrated that intra-arterial (IA) thrombolytic therapy or aspiration thrombectomy using the cross-circulation technique via an alternative collateral pathway is feasible in acute stroke patients with an unfavorable direct route to the occluded sites. However, stent-retriever embolectomy via the cross-circulation approach has not been reported in the literature. The present paper reports the first case of successful stent-retriever embolectomy for acute MCA occlusion via the patent posterior communicating artery (PComA) by using Trevo XP ProVue stent-retriever in a patient with acute MCA stroke and chronic occlusion at the origin site of the ipsilateral ICA.

Laparoscopic Totally Extraperitoneal Hernia Repair after Radical Prostatectomy or Lower Abdominal Surgery Except for Appendectomy: Experience of 35 Cases

PURPOSE: Laparoscopic totally extraperitoneal (TEP) hernia repair is known to be relatively difficult in cases with a history of lower abdominal surgery. We assess the feasibility of laparoscopic TEP hernia repair in those patients. METHODS: Thirty five patients with a previous history of radical prostatectomy or lower abdominal surgery who underwent laparoscopic TEP hernia repair for inguinal hernia were reviewed retrospectively. All operations were performed by a single experienced surgeon. RESULTS: Thirty three out of the 35 patients (94%) were men. Laparoscopic TEP hernia repair was performed successfully in 30 out of 35 cases. Twenty five cases (71%) were right inguinal hernia, 6 cases (17%) were left hernias, and 4 cases (11%) had an inguinal hernia on both sides. Five cases were converted to transabdominal preperitoneal (TAPP) (n=3) or open methods (n=2). Mean operation time was 111 minutes. The patient group with previous radical prostatectomy was the largest (n=22, 63%) and required a longer operation time (124 minutes). Blood loss was less than 50 cc in all cases. Average hospital stay was 1.2 days after surgery. Voiding difficulties requiring catheterization were observed in 13 cases (37%). CONCLUSION: Laparoscopic TEP hernia repair for a patient with previous history of radical prostatectomy or lower abdominal surgery except for appendectomy can be safely performed by an experienced surgeon, but is not recommended as a standard choice because of a longer operation time and higher conversion rate.

A Case of Angiomyoma of Auricle / 대한이비인후과학회지

The angiomyoma or vascular leiomyoma is an uncommon type of leiomyoma composed of smooth muscle cells and vascular endothelium. The tumor occurs mostly in the lower extremities as a slowly growing, firm and mobile mass, occasionally accompanied by pain. There are few cases of auricular angiomyoma reported in the literature; however, recently, we experienced a case of a 18-year-old man with protruding auricular mass. We performed a surgical excision and the final pathological result confirmed to angiomyoma. We report this case with a review of the related literatures.

A Case of Totally Lateralized Tympanic Membrane / 대한이비인후과학회지

Lateralized tympanic membrane is a complication of tympanoplasty resulting in conductive hearing loss. We describe a case of a 23-year-old patient who developed totally lateralized left tympanic membrane with hearing disturbance. The blind-pouch appearance of the left ear canal and conductive hearing loss were checked. The revision of underling tympanoplasty was performed using temporalis fascia and conchal cartilage. The ossicular chain was reconstructed with partial ossicular replacement prosthesis. Canaloplasty and split thickness skin graft were applied for the skin defect of the left external auditory meatus. Totally lateralized tympanic membrane was successfully reconstructed with cartilage tympanoplasty and canaloplasty, achieving improved hearing.

Current Trends in the Treatment of Subjective Tinnitus at University Hospitals in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effective management of subjective tinnitus should start with an accurate diagnosis based on an appropriate classification. Since there is no gold standard for managing subjective tinnitus, clinicians can select from various treatment options after considering the multifactorial etiology of tinnitus. This study surveyed otologists at university hospitals in Korea to identify the treatments used for subjective tinnitus and to obtain basic information on evidence-based medicine for treating tinnitus. SUBJECTS AND METHOD: A five-major-item questionnaire on current tinnitus treatments was sent by email to otologists at 37 university hospitals in Korea; 30 (81.1%) replied. RESULTS: The mean incidence of tinnitus in otology outpatient clinics was 22.7% (range 10-40%). Common treatments were oral pharmacological therapy, regular counseling with tinnitus retraining or cognitive behavioral therapy and hearing aids. Tinnitus retraining therapy and hearing aids were considered the most effective when the visual analog scale scores were 7.0 and 6.6, respectively, and considered safe when the scores were 9.9 and 9.3. Ginkgo biloba and benzodiazepines were the most frequently prescribed drugs, although their reported effectiveness was questionable. Intra-tympanic steroid injection was not considered effective (3.8) or safe (6.3). Somatosensory-based treatments such as treating neck muscle or temporomandibular joint disorders were also used to relieve a subgroup of somatic tinnitus. CONCLUSION: Our results showed trends similar to those in other countries, yet we have not reached the level of evidence-based clinical practice due to the lack of reliable and effective treatment options. Further research on tinnitus-treatments is needed, particularly about randomized controlled studies with blinding.

Ossiculoplasty for Monocrural Stapes Anomaly / 대한이비인후과학회지

Congenital anomalies of ossicle in the middle ear are rare and could appear in various forms. The most common congenital isolated ossicular anomalies are stapes fixation and incudostapedial discontinuity, with isolated congenital stapes fixation representing about one third of ossicular malformations. We present a rare case of monocrural anomaly of unilateral stapes in a 36-year-old woman with nonprogressive conductive hearing loss. During explotympanotomy, the lateral half of the suprastructure of anomalous stapes was removed and sculptured total ossicular replacement prosthesis was fitted between the long process of incus and remained stapes. Postoperative pure tone audiogram showed a significant decrease in air-bone gap. We report this case with a review of literature.

A Case of Steroid-induced Hyperinfective Strongyloidiasis with Bacterial Meningitis / 대한소화기학회지

Strongyloides stercoralis is a soil transmitted intestinal nematode that is endemic in the tropical and subtropical regions. In most individuals who are infected, chronic, usually asymptomatic, gastrointestinal infection persists. But, in immunocompromized hosts or in patients receiving immunosuppressive therapy, autoinfection of S. stercoralis may result in the dissemination of larvae, leading to fatal hyperinfection and increased rate of complications. We report a case of hyperinfective strongyloidiasis with bacterial meningitis in a patient receiving steroid therapy. Strongyloidiasis was diagnosed by the presence of filariform larvae of S. stercoralis in the bronchoalveolar lavage cytology and upper gastrointestinal endoscopic biopsy specimen. Her clinical symptoms had progressively aggravated and developed bacterial meningitis during treatment. She died despite aggressive antibiotic and antihelminthic therapy.

A Case of Squamous Cell Carcinoma of the Breast in a Patient with Crohn's Disease Taking Azathioprine / 대한소화기학회지

Azathioprine (AZA) treatment in transplant or autoimmune patients and subsequent appearance squamous cell carcinomas at various sites, particularly skin and cervix, has shown a close relationship. However, it remains uncertain whether this is true for the patients with Crohn's disease. We report a case of squamous cell carcinoma of the breast occurred in a 35-year-old female with Crohn's disease taking AZA. She was first diagnosed with Crohn's disease 10 years ago and has taken AZA with 5-aminosalicylic acid (5-ASA) on regular follow up in gastrointestinal department for 9 years. She had no family history of breast cancer. She visited breast cancer clinic due to incidentally found right breast mass. A mastectomy on the right breast was performed and 6.3x5.5 cm mass was removed. The mass was microscopically proven to be poorly differentiated squamous cell carcinoma with focal keratin pearl formation. At age of 25, she was first diagnosed with active Crohn's disease. 5-ASA and corticosteroid induced remission. Then, steroid was tapered off and AZA was maintained at 1 mg/kg due to leukopenia at higher dose. She stopped taking AZA at her discretion during her two pregnancies and reported total of 67 months of AZA medication on her breast cancer diagnosis.

Esophageal Perforation after Change of a Percutaneous Endoscopic Gastrostomy Tube / 대한소화기내시경학회지

Percutaneous endoscopic gastrostomy (PEG) has become a widely used and safe method for long-term enteral feeding in patients who are unable to tolerate oral feeding. Although a number of complications can occur following PEG placement, most of these complications are not life threatening. Serious complications occur rarely after this procedure and they include peritonitis, visceral perforation, major gastrointestinal bleeding, and necrotizing fasciitis. An esophageal perforation following PEG placement is very rare and predisposing factors include Zenker's or epiphrenic esophageal diverticuli, esophageal strictures, and mass lesions. We recently experienced a case of distal esophageal perforation following a PEG tube change. The predisposing esophageal perforation factor in this case was uncertain, and we successfully treated the patient with surgical intervention.

A Case of Branchio-Otic Syndrome / 대한이비인후과학회지

Branchio-oto-renal (BOR) syndrome is a clinically heterogeneous autosomal dominant form of syndromic hearing loss characterized by variable hearing impairment, malformations of the pinnae, the presence of branchial arch remnants, and various renal abnormalities. BOR syndrome is caused by mutations in EYA1 and SIX1, which are critical to organogenesis and are expressed together in developing otic, branchial, and renal tissue. Branchio-otic (BO) syndrome comprises branchial fistulas and preauricular pits, but lacks renal anomalies. We present a case of BO syndrome in 30year-old man with a review of the literature.

Delayed Diagnosis of Metastatic Prostatic Adenocarcinoma in Temporal Bone / 대한이비인후과학회지

Metastasis to the temporal bone is uncommon. In some cases, metastasis may be the first evidence of malignant dissemination, but more frequently, the diagnosis is unsuspected, possibly because ear symptoms are overshadowed by those deriving from the primary tumor. It is not until they have symptoms like hearing loss, otalgia, facial nerve paralysis, periauricular swelling, otorrhea, or even an aural mass that patients usually undergo treatment at the late stage of the disease course. Tumors of the breast, lung, and kidney are the most common sources of temporal bone metastasis. Although axial bone and cranial metastases are common in patients with prostatic carcinoma, temporal bone involvement is extremely rare. We report a case of metastatic prostatic adenocarcinoma in the temporal bone which was diagnosed with delay.

Distribution of Histologic Type of Nasal Polyp and Expression of Vascular Endothelial Growth Factor According to Nasal Polyp Type / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To determine the frequency of the histologic types of nasal polyp in Korea and their relationships with respect to age, laterality, asthma, allergic rhinitis (AR) and expression of vascular endothelial growth factor (VEGF). SUBJECTS AND METHOD: Tissue slides obtained from 282 patients with nasal polyps were examined; polyps were classified either as eosinophilic polyp or chronic inflammatory polyp. VEGF expression was determined using immunohistochemical staining. RESULTS: Of the 282 subjects, 169 (59.9%) had chronic inflammatory polyps, 113 (40.1%) had eosinophilic polyps, and 232 (82.3%) had bilateral polyps. Twenty-two subjects (7.8%) had asthma and 23 (8.2%) had AR. There was no statistical relationship between nasal polyp type and laterality or the presence of asthma or AR. Of 10 children, 9 (90%) had chronic inflammatory polyps. VEGF expression was significantly higher in eosinophilic polyps than in chronic inflammatory polyps, and significantly higher in the samples of each polyp type from the subjects with AR than those without AR. In subjects with asthma, however, the VEGF expression did not differ between eosinophilic polyps and chronic inflammatory polyp samples. CONCLUSION: In the Korean population, chronic inflammatory nasal polyps are more common than eosinophilic nasal polyps. VEGF expression was the highest in eosinophilic polyps of the subjects with AR, suggesting that VEGF might contribute to the polyp formation via local allergic action.

Endoscopic Marsupialization of Postoperative Cheek Cyst with Orbital Floor Defect

BACKGROUND AND OBJECTIVES: The postoperative cheek cyst with orbital involvement is a rare condition and the treatment of eroded orbital floor is controversial. This study evaluated the efficacy of endoscopic marsupialization for treating postoperative cheek cyst with orbital floor defect and assessed the requirements of a direct orbital approach for orbital reconstruction. MATERIALS AND METHODS: The study involved a retrospective review of twelve patients with postoperative cheek cyst and orbital floor defect. Medical records were reviewed for details of previous surgery, presenting symptoms, surgical approach and the results of the operation. The maximum diameter of the involved orbital floor was calculated using the coronal imaging of paranasal sinus computed tomography (PNS CT). RESULTS: All patients had previously undergone Caldwell-Luc procedures. The most common symptom was pressure on the cheek. According to PNS CT, the maximum diameter of the involved orbital floor ranged from 0.7 to 3.1 cm (mean 1.46 cm) and the involved orbital area ranged from 0.35 to 4.23 cm2 (mean 1.87 cm2). All patients underwent only endoscopic marsupialization without orbital reconstruction. Postoperatively, all patients showed no recurrence of symptoms or required revision surgery. CONCLUSION: Endoscopic marsupialization without reconstruction of the orbital floor could be considered as a first treatment option for postoperative cheek cyst combined with orbital floor defect.