Malignant Melanoma of the Sphenoid Sinus

Sinonasal malignant melanoma comprises 0.5% ~ 1.5% of all malignant melanomas. Malignant melanoma in the nasal cavity is relatively more predominant than in the paranasal sinus. The maxillary sinus is the most common sinus cavity affected by malignant melanoma, and the sphenoid sinus is a very rare site regardless of a primary or secondary origin. We encountered a patient with frequent epistaxis who was found to have malignant melanoma at the nasal septum and sphenoid sinus. She was treated successfully with endoscopic sinus surgery, and we report this case, along with the associated literature.

Two Cases of Respiratory Epithelial Adenomatoid Hamartoma in Nasal Cavity

Respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon non-neoplastic proliferation of the sinonasal tract that presents as a mass-like lesion. It can be confused with a variety of benign and malignant entities including inflammatory polyp, inverted papilloma and low-grade sinonasal adenocarcinoma. Misinterpretation may result in unnecessary radical surgery. Recently we have experienced two patients of REAH in the nasal cavity. One was originated from the lateral nasal wall and the other was from the both olfactory clefts. Therefore, we report these cases with a brief literature review.

Two Cases of Respiratory Epithelial Adenomatoid Hamartoma in Nasal Cavity

Respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon non-neoplastic proliferation of the sinonasal tract that presents as a mass-like lesion. It can be confused with a variety of benign and malignant entities including inflammatory polyp, inverted papilloma and low-grade sinonasal adenocarcinoma. Misinterpretation may result in unnecessary radical surgery. Recently we have experienced two patients of REAH in the nasal cavity. One was originated from the lateral nasal wall and the other was from the both olfactory clefts. Therefore, we report these cases with a brief literature review.

Possibility of Discriminating the Presence of Tinnitus through Repeated Tinnitograms

BACKGROUND AND OBJECTIVES: The evaluation of tinnitus is becoming increasingly important in assessing the degree of disability. However, until now, there are no tools to verify the presence of tinnitus. The aim of this study was to identify the possibilities in discriminating the presence of tinnitus through tinnitus test, pitch match test and loudness balance test. MATERIALS AND METHODS: Typically, 50 patients who have suffered from continuous tinnitus and 20 subjects with normal hearing ability who did not suffer from tinnitus were selected for the present investigation. All the patients underwent the tests for pitch match and loudness balance, which were replicated thrice with 1-minute intervals with a TDH 49 headphone and an oribiter model 922, GN otometrics in a soundproof room. Non-tinnitus group that didn't have tinnitus chose virtual tinnitus based on their own discretion. RESULTS: The most similar sounds mimicking tinnitus were of pure tone in both the groups. However, subjects of the tinnitus group were exposed to a greater variety of sounds than those of the non-tinnitus group. Moreover, the most common frequency of tinnitus was 4 and 8 kHz in the tinnitus group, but 1 kHz in the non-tinnitus group. The mean loudness of tinnitus was 7.28 dBSL in the tinnitus group and 13.6 dBSL in the non-tinnitus group. The loudness of tinnitus in the tinnitus group was less than that in the non-tinnitus group in a statistically significant manner (p<0.05). Loudness in each repeated tinnitus tests was identical in tinnitus group, but significantly different in non-tinnitus group (p<0.05). CONCLUSIONS: We concluded that repeated tinnitus tests for loudness matching were helpful in identifying the presence of tinnitus.

Retrosigmoid Approach in the Removal of Vestibular Schwannoma

BACKGROUND AND OBJECTIVES: The use of several approaches, involving different cerebellopontine angles, has enabled vestibular schwannoma removal to be tailored to each patient's pathology and physiological status. The retrosigmoid approach provides simple and direct access to cerebello-pontine angle lesions. SUBJECTS AND METHODS: We retrospectively assessed outcomes in 35 consecutive patients who underwent vestibular schwannoma removal via the retrosigmoid approach. RESULTS: Of the 35 patients, 12 were men and 23 women; their age was 52.5+/-10.4 years (range, 35-75 years). One tumor was small (3 cm). Symptoms included hearing disturbance (31 patients, 89%), tinnitus (14 patients, 40%), headache (12 patients, 34%), vertigo (11 patients, 31%), and facial palsy (9 patients, 25%). Postoperative complications included facial palsy, intracranial hemorrhage, dysphagia, and disseminated intravascular coagulopathy, with facial palsy remaining permanently. Four patients (11.4%) had tumor regrowth, at a mean of 36.3 months after primary surgery. The mean diameter of regrowing tumors was 20.5+/-4.4 mm (range 14.5-25.0 mm). CONCLUSIONS: The retrosigmoid approach for vestibular schwannoma removal was associated with higher rates of facial palsy and hearing loss. This approach, however, can minimize injury to the lower cranial nerve.

Retrosigmoid Approach in the Removal of Vestibular Schwannoma

BACKGROUND AND OBJECTIVES: The use of several approaches, involving different cerebellopontine angles, has enabled vestibular schwannoma removal to be tailored to each patient's pathology and physiological status. The retrosigmoid approach provides simple and direct access to cerebello-pontine angle lesions. SUBJECTS AND METHODS: We retrospectively assessed outcomes in 35 consecutive patients who underwent vestibular schwannoma removal via the retrosigmoid approach. RESULTS: Of the 35 patients, 12 were men and 23 women; their age was 52.5+/-10.4 years (range, 35-75 years). One tumor was small (3 cm). Symptoms included hearing disturbance (31 patients, 89%), tinnitus (14 patients, 40%), headache (12 patients, 34%), vertigo (11 patients, 31%), and facial palsy (9 patients, 25%). Postoperative complications included facial palsy, intracranial hemorrhage, dysphagia, and disseminated intravascular coagulopathy, with facial palsy remaining permanently. Four patients (11.4%) had tumor regrowth, at a mean of 36.3 months after primary surgery. The mean diameter of regrowing tumors was 20.5+/-4.4 mm (range 14.5-25.0 mm). CONCLUSIONS: The retrosigmoid approach for vestibular schwannoma removal was associated with higher rates of facial palsy and hearing loss. This approach, however, can minimize injury to the lower cranial nerve.

Changes of Mastoid Gas Physiology in Virtual Mastoidectomy Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is essential to understand gas physiology of mastoid cavity to study the pathophysiology of middle ear diseases, and the surface area and volume of mastoid mucosa are important parameters for evaluating gas physiology. However, the surface area and mastoid volume of the mastoid cavity have not been practically measured yet. Therefore, we measured and compared surface area and volume of the mastoid cavity before and after mastoidectomy using a virtual mastoidectomy model. SUBJECTS AND METHOD: We performed a virtual mastoidectomy using 10 cases of temporal bone CT indicating pneumatic mastoid. First, we removed all air cells after outlining with irregular AOI function after loading axial CT images to Image-Pro Plus 4.0. Then we filled the removed area with equal planes using local equalization filter. Finally, we calculated and compared the total surface area, volume and area to volume (A/V) ratio by estimating their circumference and area. RESULTS: The mean surface area of pneumatized mastoid cavity was 127.8 cm2 (range: 94.2-165.3 cm2), and the mean volume was 7.1 cm3 (range: 5.2-11.0 cm3). The mean surface area and volume were altered to 42.8 cm2 (range: 35.9-55.0 cm2) and 12.6 cm3 (range: 10.3-18.7 cm3), respectively, after virtual mastoidectomy. As a result, the A/V ratio decreased from 18 to 3.4 after a virtual mastoidectomy in the pneumatic mastoid cavity. CONCLUSION: When a complete mastoidectomy is performed in the pneumatic mastoid, the surface area is decreased by one third compared to a relatively minor increase in volume. Therefore, the surface area per unit volume is expected to greatly decrease after mastoidectomy. Some physiologic problems occurring after mastoidectomy could be more accurately explained using a virtual mastoidectomy model.

A Case of Facial Palsy Following Tooth Extraction / 대한이비인후과학회지

Facial palsy following tooth extraction is rare and its mechanism is unclear. Possible mechanisms are direct anesthesia of facial nerve, compression and ischemia of facial nerve during edema, neurotoxicity of local anesthetic solution, viral reactivation and ascending infection. Viral reactivation and ascending infection are most likely mechanisms among them. Therefore, it is important to use an antiviral agent combined with steroid for treatment of dental origin facial palsy. We report our recent experience with one case of facial palsy that followed tooth extraction.

Ultrastructure of nasal cilia in children with recurrent or persistent respiratory diseases / 소아과

PURPOSE: Ciliary abnormalities of the respiratory system usually accompany recurrent or persistent respiratory diseases such as paranasal sinusitis, bronchiectasis, rhinitis, and/or otitis media, since they cause certain derangements in ciliary cleaning activities. This disease is usually inherited by autosomal recessive trait, but may also be found to be acquired or transient in rare cases after heavy exposure to pollutants, cigarette smoking or severe infection. We performed this study in children with frequently recurrent or persistent respiratory diseases to clarify if the ciliary abnormalities are preceding factors. METHODS: We enrolled 17 children with suspected respiratory ciliary abnormalities. The indications for evaluation of ciliary ultrastructure were recurrent or persistent respiratory infections. Children with immunologic abnormalities were excluded. From August 2000 to July 2003, we performed a biopsy on nasal mucosa and examined the structure of ciliary status by using an electron microscope. RESULTS: Of the subjects, there were seven males and 10 females, aged 2 to 10 years. Out of the 17 subjects, 12 cases of chronic paranasal sinusitis, nine chronic coughs, nine frequent upper respiratory infections, seven cases of recurrent otitis media, four cases of recurrent pneumonia, and four cases of bronchial asthma were found. Out of the 17 cases on which histologic examinations were conducted, four cases showed pathologic findings, including one case of inner dynein arm defect, one of microtubular transposition, one of supernumerous tubules, and one singlet, respectively. CONCLUSION: It is essential for differential diagnosis and effective treatment to identify the abnormalities of ultrastructure of nasal cilia in children with symptoms of frequently recurrent or persistent respiratory diseases, if immunodeficiency or respiratory allergy could be excluded.