Clinical Implications of Snoring Time (%) in Patients with Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Snoring is the vibration sound of respiratory structures when air stream flows through the narrowed airway during sleep. In this study, we aimed to determine the clinical meaning of snoring time (%) of patients who have simple snoring or obstructive sleep apnea (OSA). MATERIALS AND METHODS: We performed a retrospective review of 240 cases of clinical data and polysomnography, which were diagnosed with either simple snoring (n=53) or OSA (n=187). Clinical data included anthropometric measurements such as body mass index, neck and waist circumference (WC), and wasit-hip ratio (WHR). Snoring time (%) was calculated as the total time of snoring per hour of sleep. RESULTS: In the female group, snoring time (%) increased in OSA compared to simple snoring, which showed a negative correlation with N3 (r=-0.395, p=0.002) and a positive correlation with the arousal index (r=0.39, p=0.003). Moreover, in females, snoring time (%) showed significant correlations with respiratory indexes: hypopnea index (p=0.008), apnea-hypopnea index (p=0.049), and lowest SpO₂ (p=0.003). WC and WHR showed significant correlations with snoring time (%) in both male and female. CONCLUSION: Snoring time (%) of females showed important clinical associations with sleep quality and respiratory index. Therefore, snoring may have an important role in the pathogenesis of OSA in females.

A Case of Multiple Myeloma in Bilateral Paranasal Sinuses with Loss of Vision / 대한이비인후과학회지

Plasmacytoma refers to malignant plasma cell tumor, which consists of abnormal proliferation of plasma cells. It can be classified into several types, multiple myeloma, solitary medullary plasmacytoma and extramedullary plasmacytoma according to clinical and histological aspects of the tumor. Multiple myeloma is the most common plasmacytoma and its main feature is the infiltration of plasma cells into the bone marrow. Over 10% of plasma cell count among the nuclear cells in the bone marrow biopsy allows diagnosis of multiple myeloma. This involves multiple organs and extramedullary sites including the spleen, liver, lymph nodes and kidney; however, the involvement of nasal cavity and paranasal sinus is rare. Recently, we experienced a case of multiple myeloma, which was present in both nasal cavities and paranasal sinuses. The case was treated with chemotherapy and radiotherapy followed by autologous bone marrow transplantation. We report on it with literature review.

Combined Endoscopic Sinus Surgery and Rhinoplasty: Efficacy and Limitation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Combined endoscopic sinus surgery (ESS) and rhinoplasty may benefit patients but can pose a considerable task to the surgeon at the same time. The aim of this study is to analyze the surgical outcomes of the concurrent ESS and rhinoplasty with emphasis on the efficacy and limitation. SUBJECTS AND METHOD: Consecutive 21 patients who underwent concurrent ESS and rhinoplasty (combined group) were identified. For comparison, rhinoplasty group who had only rhinoplasty and ESS group who had only ESS over the same period were selected. Medical records, endoscopic findings, and CT scans were reviewed. A telephone survey was done to evaluate subjective outcomes of the surgery. Objective aesthetic outcomes of rhinoplasty were evaluated by comparing the preoperative and postoperative photos by two rhinoplasty surgeons. RESULTS: In the combined group, ten patients (24%) had ESS-related complications and one patient (5%) had rhinoplasty-associated complications. On the other hand, only one patient (5%) had recurred rhinosinusitis in the ESS group but three patients (14%) had complications including revision surgery in rhinoplasty group. Subjective functional satisfaction score after ESS and subjective aesthetic satisfaction score after rhinoplasty did not show any significant difference between the combined group and each matching group. Objective aesthetic evaluation did not show any difference either. CONCLUSION: Concurrent ESS and rhinoplasty have similar subjective functional improvement and objective surgical outcome compared with ESS alone or rhinoplasty alone. However, concurrent surgery had a tendency to show poorer surgical outcome in ESS than in rhinoplasty warranting a cautious approach with patient selection.

Otorhinolaryngologic Application of Stem Cells

Stem cells can be isolated from almost any tissue in the body and are capable of proliferating in an undifferentiated manner and, under appropriate inductive conditions, differentiating into multiple cell lineages. Numerous studies are being conducted around the world using stem cells in various medical fields, including otorhinolaryngology. This review provides a brief overview of the method used for human stem cell isolation, the current status of clinical applications in the field of otorhinolaryngology as well as in general medicine, and lastly, suggests the future potential of stem cells in otorhinolaryngologic surgery. Within the field of otorhinolaryngology, stem cells have been clinically used or studied in four main areas: bony framework reconstruction, soft tissue augmentation, cartilage repair and wound healing. Outcomes of stem cell application appear promising; however, further basic research and clinical studies with longer follow-up periods are needed to develop safe and successful clinical applications.

The Role of Superantigen in Nasal Polypogenesis

Superantigens are potent immunostimulatory exotoxins well known to be produced by Staphylococcus aureus (S. aureus). These exotoxins have capacity to act as superantigens by binding with the variable beta(Vbeta) region of lymphocytes in chronic rhinosinusitis with nasal polyposis, bypassing normal antigen processing and directly stimulating a massive inflammatory response. Accumulated evidence is now convincing that S. aureus superantigens may play an important role in development of chronic rhinosinusitis with nasal polyposis which are thought to skew the cytokine response towards a Th2 phenotype inducing eosinophilia and the production of polycolonal IgE. This review summarizes the current evidence of characteristics and its role superantigens in pathophysiology of nasal polyposis.

The Role of Superantigen in Nasal Polypogenesis

Superantigens are potent immunostimulatory exotoxins well known to be produced by Staphylococcus aureus (S. aureus). These exotoxins have capacity to act as superantigens by binding with the variable beta(Vbeta) region of lymphocytes in chronic rhinosinusitis with nasal polyposis, bypassing normal antigen processing and directly stimulating a massive inflammatory response. Accumulated evidence is now convincing that S. aureus superantigens may play an important role in development of chronic rhinosinusitis with nasal polyposis which are thought to skew the cytokine response towards a Th2 phenotype inducing eosinophilia and the production of polycolonal IgE. This review summarizes the current evidence of characteristics and its role superantigens in pathophysiology of nasal polyposis.

Two Cases of Malignant Melanoma with Nodal Metastasis from Unknown Primary Site / 대한이비인후과학회지

About 1% of malignant melanoma is found in the head and neck region and among them, about 2-16% is presented with palpable regional metastatic melanoma with unknown primary lesion (MUP). We have experienced two cases of MUP which were diagnosed after excisional biopsy. MUP has better prognosis than that with known primary lesion. To get good prognosis, the initial treatment of MUP should be regional lymphadenectomy, indicating the importance of an accurate diagnosis. Although the radiologic finding for malignant melanoma may offer no specific findings, physicians should be aware of the possibility of melanoma in neck mass patients. We present two cases of MUP with a literature review.

The Consequence of Cardiovascular Sympathetic Nervous System in Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The previous studies have shown that patients with obstructive sleep apnea (OSA) have shown high levels of cardiovascular diseases. These cardiovascular diseases are related to imbalance of cardiac autonomic systems. Alteration of QT interval in EKG reflects the increased cardiac sympathetic activity. The purpose of this study is to compare the cardiac sympathetic nerve activity between the control and OSA patients. SUBJECTS AND METHOD: All the patients were divided into the control group (n=20), whose RDI was less than 5 and the OSA group (n=40), whose RDI was more than 5. The OSA group was also divided into 3 groups, mild, moderate and severe, according to their RDI. The corrected QT interval (QTc) in EKG was checked at day time and during polysomnography. RESULTS: The number of hypertensive patients was significantly greater in the OSA group than the control group (p<0.001). The QTc interval was increased proportional to the RDI (p<0.001). There was a significant difference in the QTc intervals between the daytime period and apnea peak (p=0.031). CONCLUSION: Our results showed that the QT prolongation might be a prognostic factor in predicting the cardiac sympathetic hyperactivity in obstructive sleep apnea patients.

Efficacy of Rotating Chair Test And Caloric Test For The Diagnosis of Acute Unilateral Vestibular Neuritis

BACKGROUND AND OBJECTIVES: The acute unilateral vestibular neuritis is fairly a common disease and the precise diagnostic tool is needed for the selection of effective treatments. Therefore, we studied the clinical usefulness of the rotatory chair test and caloric test which have been commonly used in patient of acute unilateral vestibular neuritis. MATERIALS AND METHODS: One hundred and sixty four patients who were diagnosed with acute unilateral vestibular neuritis from August of 2004 to June of 2007 were included. Their medical records of the rotating chair test and caloric test were reviewed retrospectively to study the correlation of the two tests. RESULTS: Of 164 patients, 101 patients (61.6%) and 88 patients (53.7%) showed significant canal paresis (CP) and directional preponderance (DP) on the caloric tests that corresponded with the physical exam. 130 patients (79.3%) and 84 patients (51.2%) showed significant asymmetry and time constant (Tc) on the rotating chair test that corresponded with the predictive direction with spontaneous nystagmus. CONCLUSIONS: For acute unilateral vestibular neuritis patients, the asymmetry of the rotatory chair test showed the highest correlation with clinical findings. But physical exam should be preceded because neither rotator chair test nor caloric test yields a specific correlation with the physical exam. Especially, single test only may too many false negative results. For these tests can reduce false positive cases of the physical exam and raise the specificity of the diagnosis, the planning of proper treatments should be followed thereafter.

A Case Report of Correction of Bilateral Cryptotia Using Modified Ohmori's Method / 대한이비인후과학회지

Cryptotia is a congenital anomaly of the auricle that the upper pole of the auricular cartilage is buried beneath the skin of the scalp and auriculocephalic sulcus is obliterated. In addition, there is often a deformity of the antihelix, especially its superior crus. The principle of the surgery is to deepen the auriculocephalic sulcus, to correct deformed cartilage and to correct the malposition. For the correction of the bilateral cryptotia, we have applied the modified Ohmori's method and have obtained good result without complication. We report this case with a review of related literature.