Relationship of Vertigo and Postural Instability in Patients With Vestibular Schwannoma

OBJECTIVES: Growth of vestibular schwannomas (VS) causes progressive vestibular symptoms and postural instability. Since the tumor grows slowly, compensation of decaying vestibular input may decrease subjective symptoms of dizziness. This study aims to estimate the relationship of subjective vestibular symptoms and objective postural instability in patients with VS. METHODS: A retrospective review of 18 patients newly diagnosed with VS and with subjective vertigo symptoms was performed. The results of vestibular function tests including the sensory organization test (SOT) using computerized dynamic posturography, caloric test, and self-report measures of subjective dizziness handicap (Dizziness Handicap Inventory) and visual analogue scale were compared according to the onset of vertigo symptoms. RESULTS: In VS patients, SOT showed decreased equilibrium score for all vestibular function related conditions, condition (C) 5 and 6, and composite (COMP) score. COMP scores were not correlated with visual analogue scale or Dizziness Handicap Inventory scores. Acute onset group included six patients and insidious onset group, 12 patients. Equilibrium scores for C5 and C6, and COMP scores were lower for insidious onset group, but the difference was not statistically significant. CONCLUSION: Our findings confirmed postural instability is prevalent in VS patients. SOT parameters did not differ significantly between acute onset and insidious onset groups, but increased tumor size and canal weakness were noted in the insidious onset group. Clinicians should consider that postural instability is likely present even in patients who do not complain of acute vertigo, and appropriate counseling should be discussed with the patients.

Two Cases of Mucosal Bridge Crossing the Membrane of Vocal Folds / 대한이비인후과학회지

Mucosal bridges of vocal fold have been described as a parallel band to vocal folds with the presence of sulcus vocalis. However, the type of mucosal bridge crossing each vocal fold has not been well documented in the literature. Herein, we present two cases of mucosal bridge found in the vocal fold connecting the mid-portions of true vocal folds. Two patients who had no history of laryngeal trauma, surgery or oro-tracheal intubation visited our clinic due to voice change. Laryngoscopic examination revealed that they had a mid-portion mucosal band without any other mucosal lesions. Two patients underwent laryngomicrosurgery with pulsed dye laser. After the surgery, they showed significant improvement of voice quality.

Surgical Treatment of Sulcus Vocalis Using KTP Laser

Sulcus vocalis remains a surgical challenge despite many recent advances in laryngomicrosurgeries. We previously reported that 585-nm Pulsed dye laser (PDL) exerts favorable outcome in treatment of sulcus vocalis due to its therapeutic effects of collagen rearrangement and improved wound remodeling. In spite of the usefulness of PDL glottoplasty for treating sulcus vocalis, the device is no more available in the country. It prompted us to focus another angiolytic laser ; 532-nm KTP laser which has similar mechanisms of action and has been used for treatment of other laryngeal lesions elsewhere. Herein, we present a case of sulcus vocalis successfully treated with KTP laser. A patient underwent laryngomicrosurgery with angiolytic KTP laser (KTP glottoplasty) by the same surgical procedure with PDL glottoplasty. After the surgery, the patient presented improved voice outcome in time without complications.

A Case Report of Incidental Endotracheal Tube Firing in Operating Room during CO2 Laser-Assisted Laryngomicrosurgery / 대한이비인후과학회지

Operating room fires are a rare but preventable danger in modern operating rooms. But sometimes accidental fires in operating room can be life threatening. Surgical fires require an ignition source, oxidizer, and fuel. Recently, laser as an ignition source in the presence of anesthetic gases has been associated with operating room fires in otorhinolaryngologic field. We describe a 30-year-old patient diagnosed with recurrent laryngeal papillomatosis treated by CO2 laser-assisted laryngomicrosurgery. In this case, we experienced endotracheal tube flaring during CO2 vaporization and then incidental endotracheal tube firing due to CO2 laser under high O2 circumference. Shortly after removal of firing endotracheal tube, the anesthesiologist considered careful re-intubation. To minimize the risk of operating room fires, surgeons must familiarize with the common possibilities where fire is known to occur. Furthermore, the prevention of operating room firing should be strongly considered during all operations using lasers.

Analysis of Prevalence and Risk Factors of Chronic Rhinosinusitis in Hyperlipidemia Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: According to previous studies, acute and chronic cholesterol depletion in the cell membranes of human airway epithelial cells suppresses MUC5AC gene expression. Also statins and lipid-lowering drugs are known to have anti-inflammatory effects. From these results, we hypothesize that the use of statin decreases the prevalence of chronic rhinosinusitis (CRS). Therefore, this study aimed to analyze the correlation between hyperlipidemia and the use of statin and prevalence of CRS in Korea. SUBJECTS AND METHOD: The data were based on the Korean National Health and Nutrition Examination Survey in 2010 and 2011. Symptom-based criteria of European Position Paper on Rhinosinusitis and Nasal Polyps 2012 were used to define CRS. 12000 people were enrolled in this study. RESULTS: The CRS prevalence of hyperlipidemia group (14.13%) was significantly higher than that of non-hyperlipidemia group (10.87%) (p=0.0005). However, the CRS prevalence between statin users (14.27%) and nonusers (13.94%) in hyperlipidemia group showed no significant differences. Thus, hyperlipidemia itself was a risk factor of CRS regardless of using statin. Allergic rhinitis was the only significant risk factor of CRS in hyperlipidemia group in multivariate regression analysis. CONCLUSION: Hyperlipidemia patients who have allergic rhinitis are at risk of CRS regardless of whether they use statins; however, further study using objective data will be required to verify this result.