Guideline for the Surgical Management of Locally Invasive Differentiated Thyroid Cancer From the Korean Society of Head and Neck Surgery

The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.

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.

Standardization of FEES Evaluation for the Accurate Diagnosis of Dysphagia / 대한연하장애학회지

Objective@#Fiberoptic endoscopic evaluation of swallowing (FEES) is a standard diagnostic tool for swallowing disorders. However, it has not been used frequently in Korea because of the long test time, low cost, and the absence of a standard evaluation system. The purpose of this study was to suggest a standard fill-out form for the FEES result. @*Methods@#From February 2019 to June 2020, a total of 98 FEES tests were performed by an otolaryngologist (JYJ) at the Wonkwang University Hospital. After the exclusion of 68 cases, 30 cases were analyzed twice by 4 raters with over 5 years of experience as otolaryngologists working in various hospitals. The results were measured for the rater’s test-retest reliability and inter-rater consistency. @*Results@#Cohen’s kappa values for measuring the intra-rater consistency of the four raters were 0.984, 0.887, 0.848, and 0.930, respectively, meaning very good alignment of 0.8 or more, respectively. The Fleiss Kappa value for measuring inter-rater consistency was 0.276, meaning ‘fair’ for values of 0.2 or more. To examine consistency, an intraclass correlation coefficient (ICC) analysis conducted by assuming the grading score to be a constant continuous variable gave an ICC value of 0.729 (P＜0.001), showing a very reliable tendency. @*Conclusion@#In this study, all the items of the fill-out form were rated using a three-step grading scale, so the degree of agreement was high when performed twice by the same rater, but the degree of agreement among raters was relatively low. Therefore, our fill-out form for FEES will be useful in evaluating the improvement of a patient over the course of clinical treatment.

Recurrent Submandibular Gland Swelling Relieved by Antihistamine Medication: Is It Eosinophilic Sialodochitis? / 대한이비인후과학회지

Sialodochitis fibrinosa is a disease characterized by salivary duct obstruction. A 21-year-old male presented with a painful submandibular gland (SMG) swelling. Serum eosinophilia and Whartons’ duct dilatation with strong enhancement were observed on contrast CT. Core needle biopsy (CNB) for SMG parenchyma revealed lymphocytic infiltration between dilated intralobular ducts. In another case, a 39-year-old male complained of recurrent major salivary glands swelling for ten years with an itching sensation on the overlying skin of the salivary gland. Enhancement of both SMG parenchyma, dilatation of both Wharton’s ducts and elevated serum eosinophilia were observed on contrast CT study. CNB for SMG parenchyma revealed lymphocytic infiltration with many eosinophils around a markedly dilated interlobular duct. The recurrent SMG swelling in both cases were relieved by antihistamine medication, warranting suspicion that these cases might organ-specific eosinophilic disease. We dicuss these two cases with a literature review.

Clinical Manifestations and Prognosis of Benign Paroxysmal Positional Vertigo according to Etiology / 대한이비인후과학회지

Background and Objectives@#This work investigates the clinical characteristics of benign paroxysmal positional vertigo (BPPV) according to etiology by comparing idiopathic BPPV (iBPPV), BPPV occurring after head trauma (tBPPV) and BPPV associated with idiopathic sudden sensory neural hearing loss (sBPPV).Subjects and Method A total of 869 patients who were diagnosed and treated for BPPV were reviewed retrospectively. Patients were divided into three groups according to the probable etiology of BPPV: iBPPV vs. tBPPV vs. sBPPV. We investigated and compared demographics, the affected sides and canals, the number of canalith repositioning procedure (CRP) performed to achieve successful reposition, canal conversion and recurrence among the three groups. Among the three groups, BPPV patients who performed caloric test and/or video head impulse test (vHIT) were additionally evaluated and compared. @*Results@#The iBPPV group (n=787) had greater female preponderance (72%, 567/787) than the tBPPV (n=51) and sBPPV groups (n=31, p<0.001). The mean number of CRPs needed for successful repositioning in the iBPPV group (1.40±0.03) was significantly (p<0.001) lower than that in the tBPPV and sBPPV groups (2.04±0.24 and 2.45±0.36). There was no difference between the tBPPV and sBPPV groups. Recurrence rate was not significantly different among three groups (14.6% vs. 17.7% vs. 16.2%) statistically. The presence of canal paresis and abnormal results of vHIT test were not related with a greater number of CRPs required and recurrence. @*Conclusion@#More CRPs were required for successful repositioning in the tBPPV and sBPPV patients than in the iBPPV patients and there was no difference between tBPPV and sBPPV patients. Recurrence rate was not different among the three groups. This information may be helpful for clinicians in counselling and managing BPPV patients.

Laryngoscopy During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has taken a toll on human lives and health systems worldwide and is still affecting all medical practices years later. In particular, much medical staff had to sacrifice in areas where the medical system was overloaded in the early stages of the outbreak and the resulting shortage of medical resources. In the future, another pandemic disease seems to emerge, which should threaten otolaryngologists inevitably. It is necessary to understand viral aerosolization and practice recommendations for COVID-19. These can guarantee the most effective treatment for the patients during the pandemic and protect the safety of our medical staff and patients.

Aspiration Patterns Observed in Patients With Free Flap Reconstruction Following T3 and T4 Tongue and Oropharyngeal Cancer Surgery: A Fiberoptic Endoscopic Evaluation of Swallowing / 대한이비인후과학회지

Background and Objectives@#The objectives of this study were to investigate the aspiration patterns in patients with T3 and T4 oral and oropharyngeal cancers after free flap reconstruction following primary tumor resection and determine the effect of tongue base resection on aspiration patterns in these patients.Subjects and Method The aspiration pattern was evaluated via fiberoptic endoscopic evaluation of swallowing and classified into three groups based on the timing of aspiration in relation to the swallowing process. More than two types of aspiration patterns observed simultaneously in a patient suggested combined aspiration pattern. @*Results@#The major pattern of aspiration in 31 patients with oral cavity cancer was aspiration after swallowing in the group with base of tongue (BOT) preserved (83.3%, 10/12) and combined aspiration in the group with BOT resection (63.2%, 12/19), showing a significant difference in aspiration pattern between the two groups (p<0.001). In oropharyngeal malignancies, the major pattern of aspiration was aspiration after swallowing in both BOT-preserving (87.5%, 21/24) and BOT-resecting groups (75.0%, 9/12), showing a significant difference in aspiration pattern between the two groups (p=0.031). @*Conclusion@#The most common pattern observed in the advanced T stage tongue cancer patients after glossectomy was aspiration after swallowing. Resection of BOT greater than 25% in the tongue and oropharyngeal cancer was a significant factor causing the combined type of aspiration.

A Case Report of Acute Laryngitis with Auricular Lesion: Herpes Zoster Infection with Isolated Vagus Nerve Involvement and Vocal Fold Paresis / 대한이비인후과학회지

Acute laryngitis and acute inflammatory diseases of either infectious or non-infectious causes have similarities with herpes zoster of the vagus nerve (VHZ). We present a case which was initially diagnosis wtih acute laryngitis but finally diagnosed as VHZ. A 41-year-old male presented with an ongoing fever, throat pain and right otalgia lasting for two days with worsening symptoms despite nonsteroidal anti-inflammatory drug medication. Initially, he was treated conservatively as acute laryngitis was suspected. However, VHZ was subsequently diagnosed in this patient after considering unilateral auricular and laryngeal vesicles which were followed by ipsilateral vocal fold paresis. An antiherpetic agent and prednisolone were administered upon the presentation of vocal fold paresis. Axonotmesis was discovered by laryngeal electromyography one week after the appearance of vocal fold paresis. All symptoms subsided after one month. These results highlight the importance of understanding vagus nerve function in developing a differential diagnosis for laryngitis and VHZ.

Effects of Amniotic Membrane Extract on the Hyperplastic Response of the Middle Ear Mucosa in a Bacterially-Induced Otitis Media Rat Model: A Preliminary Study

Objectives@#. Human amniotic membrane extract (AME) is known to contain numerous bioactive factors and anti-inflammatory substances. However, the anti-inflammatory effects of AME on the middle ear (ME) mucosa are unclear. This study assessed the effects of AME on the growth of the ME mucosa in response to bacterially-induced otitis media (OM). @*Methods@#. OM was induced by inoculating nontypeable Haemophilus influenzae (NTHi) into the ME cavity of rats. ME mucosal explants were cultured in AME concentrations of 0, 5, 10, or 50 μg/mL. The area of explant outgrowth was measured in culture and analyzed at 1, 3, 5, and 7 days after explantation. The expression of Ki-67, mucin 5AC (MUC5AC), tumor necrosis factor-α (TNF-α), and interleukin-10 (IL-10) in the explants was also evaluated using quantitative polymerase chain reaction (PCR) and immunocytochemistry (ICC). @*Results@#. The NTHi-induced ME mucosa growth increased gradually over the 7-day culture period in all explants at different AME concentrations. There was a trend for mucosal growth inhibition at higher concentrations of AME, although the growth was not significantly different among the groups until day 5. The ME mucosal explants treated with the 50 μg/mL concentration of AME showed significantly suppressed growth on postexplantation day 7 compared with other explants on the same day. PCR and ICC staining revealed that the expression of Ki-67, MUC5AC, TNF-α, and IL-10 further decreased in the explants with higher concentrations of AME than in those with lower concentrations of AME. @*Conclusion@#. Our results showed that higher concentrations of AME reduced the mucosal proliferative response in bacterial OM in rats. These findings provide evidence that AME has an influence on the inflammatory and proliferative responses to NTHi infection in ME mucosa.

A Case of Proliferative Myositis Arising from the Sternocleidomastoid Muscles: Diagnosis and Treatment / 대한이비인후과학회지

We describe here diagnosis treatment of a case that rose from the sternocleidomastoid muscle and was treated without surgical excision. A 56-year-old man presented with a rapidly growing, painless and not well-circumscribed mass at the right side of the neck. We diagnosed this tumor as proliferative myositis (PM) based on the typical findings from ultrasonography, computed tomography, and core-needle biopsy, and treated it without surgical excision. Herein we report a successful diagnosis and treatment process of a case of PM, which was followed-up with ultrasonography.

Comparison of Treatment Outcomes for T3 Glottic Squamous Cell Carcinoma: A Meta-Analysis

OBJECTIVES: This study compared the survival outcomes, local control rate, and laryngeal preservation rate of various treatment strategies in the treatment of T3 squamous cell carcinoma of the glottis using proportional meta-analyses. METHODS: Twenty-five retrospective case-series studies were included in these analyses. Treatment strategies were classified as total laryngectomy (TL), open partial laryngectomy (PL), transoral laser microsurgery (TLM), chemo-radiation therapy (CRT), and radiation therapy (RT) alone. RESULTS: The overall survival rate and disease-specific survival rate among laryngeal preservation treatments did not differ from the overall survival rate of TL. However, the local control rate was lower with RT than TL and PL, and laryngeal preservation rates of TLM and CRT were higher than RT alone. CONCLUSION: Consideration of preservation of laryngeal function is necessary when treating T3 glottic squamous cell carcinoma. PL, TLM, and, CRT are considered more appropriate initial laryngeal preservation strategies if available.

Oropharyngeal Dysphagia in the Elderly / 대한연하장애학회지

Dysphagia is difficulty of effect movement of the bolus from the mouth to the stomach. From and anatomical standpoints, dysphagia is typically classified as oropharyngeal dysphagia (OPD) and esophageal dysphagia (ED). In general, OPD is more highly prevalent condition compared with ED, and associated with severe complications such as malnutrition, dehydration and aspiration pneumonia. These complications are fatal especially in the elderly. Therefore, for preventing severe complications, appropriate and prompt management should be provided to dysphagia patients. However, the decrease of swallowing function is considered as a part of natural aging process. This condition is called as presbyphagia. Although Presbyphagia refers to characteristic changes in the process of swallowing of healthy elderly, it can be a risk factor of dysphagia. With this in mind, for avoiding overdiagnosis or underdiagnosis of dysphagia, we should distinguish among presbyphagia, dysphagia and other related diagnoses. For this reason, understanding about physiology of normal swallowing and natural changes of swallows by aging are essential for physicians. Hence, this review discusses the normal swallow, senile changes of swallow, and dysphagia especially in OPD.

Pathophysiology and Management of the Ranula / 대한이비인후과학회지

Ranulas are pseudocysts on the floor of the mouth resulting from the retention or extravasation of saliva from the sublingual gland (SLG). The etiology of ranulas is unknown, but they have been associated with local trauma or previous surgery. The anatomic variation of the ductal system of the SLG such as Bartholin's duct might be a possible cause of ranulas. Treatment modalities range from conservative to various surgical techniques, including sclerotherapy, marsupialization, excision of the ranulas with or without excision of the SLG and botox injection. Recently, less invasive treatment modality such as micro-marsupialization has been introduced. It was able to easily and safely treat the ranulas. But it also has the possibility of recurrence, especially in cases having anatomic variation of the ductal system of the SLG. A definitive and reliable treatment choice is surgical resection of the SLG with or without marsupialization than other, more conservative treatments.

A Case of Intravascular Papillary Endothelial Hyperplasia in Unilateral Maxillary Sinus / 대한이비인후과학회지

Intravascular papillary endothelial hyperplasia (IPEH) is a rare benign reactive vascular lesion, characterized by thrombus formation and subsequent intravascular endothelial proliferation. IPEH should be differentially diagnosed from angiosarcoma because of their microscopic similarity. The clinical manifestation of IPEH varies according to involved site. We report a rare case of IPEH in the maxillary sinus of 35-year-old male presenting with epistaxis, which is completely removed without complications.

Evaluation of Anxiety and Depressive Levels in Tinnitus Patients

BACKGROUND AND OBJECTIVES: The aims of this study were to evaluate the relationship between tinnitus and the level of anxiety and depression experienced by subjective tinnitus patients, and to determine the effect of the level of anxiety and depression to the results of tinnitus treatment. SUBJECTS AND METHODS: A total of 104 patients were included in this study. All the patients conducted Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), State Trait Anxiety Inventory 1, 2 (STAI 1, 2) to evaluate their psychometric properties. The subjective patterns of tinnitus before and after treatment were assessed through questionnaires. RESULTS: Significant correlation between THI scores and BDI, STAI 1, 2 scores were observed in the moderate and severe tinnitus group. The patients were classified into two groups depending on their THI scores, and also classified into two groups according to BDI, STAI 1, 2 results. Analysis of differences after treatment indicated significantly improved VAS scores after treatment in all groups. CONCLUSIONS: The subjective level of tinnitus is significantly related with depression and anxiety symptoms when inconvenience caused by tinnitus was moderate or over. Assessments on tinnitus after treatment appeared to have improved significantly regardless of the severity of tinnitus, level of depression or anxiety disorder.

A Case of Bilateral Bell's Palsy with Uncontrolled Diabetes Mellitus / 대한이비인후과학회지

Bilateral facial palsy is uncommon and it accounts for 0.3-2.0% of the facial palsy cases. In contrast to unilateral facial palsy, bilateral facial palsy may occur in association with a variety of neurological, infectious, neoplastic, traumatic, metabolic or degenerative disorders. Diabetes has been associated with bilateral facial palsy. Diabetes is more common among patients with bilateral facial palsy. But the correlation between diabetics and bilateral facial palsy is unclear. Herein, we report a case of a 66 year-old woman with bilateral Bell's palsy associated with uncontrolled diabetes mellitus.