The Study of Combined Voice Therapy with Intralaryngeal Injection

BACKGROUND AND OBJECTIVES: Though voice therapy is proven to be effective in academia, treatment results and satisfaction level are inconsistent in clinics. The inconsistency may rise from diverse vocal cords misuse patterns in patient population as they suffer from different diseases or have bad phonation habits. In order to overcome the limitation, we uniformized patients' vocal cords with injection laryngoplasty prior to voice therapy. The efficacy of voice therapy and consistency in treatment results after injection laryngoplasty were assessed. MATERIALS AND METHODS: Patients diagnosed with vocal nodules were either treated with injection laryngoplasty followed by voice therapy (combined treatment group) or voice therapy only (voice therapy group). Each group consisted of 15 patients. Acoustic measures (jitter, shimmer, NHR), aerodynamic measures (MPT, Psub, MAFR), and subjective auditory conscious measures (K-VHI, K-VRQOL) between two groups were analyzed. RESULTS: After treatments, both groups improved in terms of acoustic, aerodynamic, and subjective auditory conscious measures compared to pre-treatment. Combined treatment group had statistically significantly greater improvement in shimmer, P in K-VHI, and PF in K-VRQOL compared to voice therapy group. CONCLUSION: Injection laryngoplasty treatment prior to voice therapy synergizes in treating patients compared to voice therapy only.

The Study of Satisfaction of Voice Therapy in Patients with Voice Disorders

BACKGROUND AND OBJECTIVES: Voice therapy is proven to be effective, but patients are reluctant to receive the therapy when physicians recommend it. This phenomenon may due to patients'lack of trust in or low satisfaction level of the therapy. This study aimed to evaluate patients'satisfaction level after voice therapy and identify factors that could increase the satisfaction. MATERIALS AND METHODS: First, the fraction of patients who were recommended voice therapy ahead and completed it was studied, and survey was conducted on those who finished ten voice therapy sessions. The patients'1) satisfaction level during the therapy, 2) satisfaction level about physician's explanation about the therapy, 3) willingness to recommend, 4) satisfaction level about the results were assessed, and was correlated with overall satisfaction level. In each category, patients' gender-, age-, and disease type-related differences were analyzed. RESULTS: Patients under 19 years old were most satisfied during the voice therapy; patients above 40 years old showed statistically significantly higher satisfaction level regarding satisfaction with physician explanation about treatments and with treatment results compared to other ages groups. Patients above 40 also showed the highest willingness to recommend. 26.5% of patients either refused to or discontinued voice therapy. 84.3% were satisfied with treatment results. Considering variabilities among factors, patients'satisfaction with physician explanation about treatment and willingness to recommend had positive correlation. CONCLUSION: Though 26.3% of patients received voice therapy when physicians recommended, patients who completed the therapy were overall satisfied.

The Effects of Intralaryngeal Needle Technique in Intracordal Cyst

BACKGROUND AND OBJECTIVES: Surgery is considered the primary treatment for intracordal cyst. However, patients who had undergone surgery are still subject to recurrence and continued voice changes. Intracordal cysts naturally disappear in some patient population. Cyst does not always recur in patients who had received partial surgical removal, too. Contradicting results raises a question whether complete surgical removal of intracordal cyst is necessary and demonstrate need for better treatment. Herein, the author proposes novel surgical method technique intralaryngeal needle technique (INT), a technique using surgical needle for not only injection but also for aspiration and excision of cyst. This study aims to examine the potential of intralaryngeal needle technique in treating intracordal cysts. MATERIALS AND METHODS: Surgical procedures were done on in-patients diagnosed with intracordal cyst. 23 patients received follow-up screening after the surgery for one year. Patients' subjective satisfaction levels, acoustic measures, aerodynamic measures, laryngeal stroboscopic results were compared before and after the treatment. RESULTS: Overall patients were satisfied with novel surgical excision method. In terms of aerodynamic measures, maximum phonation time, mean air flow rate improved after the surgery. In terms of acoustic measures, Jitter, Shimmer, NHR, and voice pitch changes after the treatment showed statistically significant differences. Laryngeal stroboscopy results showed significant decreases in cyst sizes. Post-surgery patients had improved mucosal waves and amplitudes values. CONCLUSION: The results show the validity of intralaryngeal needle technique in reducing intracordal cyst size by excision, aspiration, and injection. The author believes this novel technique can be used as an alternative surgical method for intracordal cysts.

Irritable Larynx Syndrome with Dyspnea

An irritable larynx syndrome is characterized by a sudden episodic dyspnea and dysphonia that is difficult to diagnose, and patients are often treated unnecessarily and/or too much. A correct diagnosis can be made by monitoring the larynx closing in the reversed direction during inhalation and posterior chink with videolaryngoscopy and by measuring a decrease in air flow volume during inhalation with a lung function test. Patients can be effectively treated with thorough differential diagnosis. Medications targeting precipitating factors, physical therapy sessions to improve abnormal larynx movement, counseling to reduce patients'anxiety rising from dyspnea, and etc. can effectively alleviate symptoms.

The Effects of Botulinium Toxin in Vocal Nodules / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Vocal nodules are the most common voice disorder due to vocal misuses. Vocal nodules are primarily treated with voice therapy and are rarely removed through laryngomicrosurgery. Although the rate of recovery for individual patients may vary, 60-70% of them are fully treated. Because vocal nodules have many possible causes, 30-40% of patients remain untreated. Also, vocal nodules recurrence after the surgical treatment is sometimes observed. The author claims that incomplete contact between vocal cords during phonation is a major cause of the vocal nodules. Most vocal nodules do occur from incomplete contact between vocal cords during phonation, and various voice therapies are designed to improve habitual misuses of the vocal cords. However, vocal nodules tend to remain unhealed unless patients change their habitual misuses of the vocal cords. The cricothyroid muscle tension is known to hinder the contact between vocal cords. The author injected a restricted amount of botulinium toxin to the cricothyroid muscle to reduce the muscle tension and observed changes in vocal cords' movement. SUBJECTS AND METHOD: In this study, the author injected botulinium toxin to the cricothyroid muscle of 21 patients. For 2-4 weeks, we observed patients' responses to the treatment, by measuring changes in subglottal pressure, mean air flow rate, maximum phonation time, jitter, shimmer, noise-to-harmonic ration of patients and subjective evaluation of voice changes. In addition, the author conducted stroboscopy to evaluate the usefulness of the treatment. RESULTS: The improvement was in the subjective evaluation of voice changes and stroboscopic findings. CONCLUSION: The observation demonstrated a great improvement in vocal nodules after the injection of botulinium toxin into the cricothyroid muscle.

Results of Acellular Dermal Graft (Surederm(R)) Implantation Laryngoplasty in Adhesive True Vocal Cord / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study investigated the quality of life improvement after Surederm(R) implantation laryngoplasty in patients with adhesive true vocal cord. SUBJECTS AND METHOD: A prospective study was conducted in 18 patients with adhesive vocal cord who underwent laryngoplasty using Surederm(R). The exploration of adhesive lesions or lamina propria through the fenestration allowed for the creation of a pocket for Surederm(R) implantation within the intermediate layer of the lamina propria. Analyzed were the preoperative and postoperative parameters including the Korean-Voice Handicap Index, jitter, shimmer, noise to harmonic ratio, maximum phonation time and mucosal waves in stroboscopic findings. RESULTS: During the follow-up time of 12 months, the patients demonstrated excellent long-term vocal fold augmentation and significant improvement in all parameters measured. There is improved pliability of the vocal fold with good oscillation in all patients. CONCLUSION: According to these results, it is suggested that Acellular Dermal Graft (Sure-derm(R)) implantation laryngoplasty can be a stable and effective surgical treatment for adhesive true vocal cord.

The Usefulness of Ambulatory Phonation Monitoring(APM) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The use of voice can be a cause of common voice disorders but may also affect the course of treatment. The information of voice use has been limited by relying on the subjective patient self-report in the past. In this study, however, we tried to determine the effectiveness of ambulatory phonation monitoring, which can provide objective vocal use parameters such as phonation time, fundamental frequency and sound pressure level. SUBJECTS AND METHOD: Four subjects (2; normal, 2; vocal disease) were recorded with Ambulatory Phonation Monitor Model 3,200 (KayPENTAX) during a working day. Ambulatory Phonation Monitor (APM) is an unobtrusive, portable device consisting of a small accelerometer, a microprocessor and the APM software. All subjects were instructed to wear APM during the entire day of normal activities and write an activity diary according to time. RESULTS: APM data displays 5 graphs which reveal important characteristics of each subject's phonatory behavior throughout the day. The patient's diary can provide the person's schedule and the correlation between subject's self recognition and the objective data analyzed by APM. CONCLUSION: APM is an overall useful device for measuring phonation parameters and evaluating voice behaviors in natural conditions. It can be used not only for the diagnosis of vocal diseases but also as a voice therapy for feedback on voice use.

Progression of Left Ventricular Pseudoaneurysm after an Acute Myocardial Infarction

Left ventricular (LV) pseudoaneurysms rarely occur, but are detected more often with the development of new diagnostic tools. Since LV pseudoaneurysms are life-threatening, early surgical intervention is recommended. This report describes an 87-year-old woman with heart failure and a large LV pseudoaneurysm which progressed from a small LV pseudoaneurysm after an acute myocardial infarction over a 1-year period.

Analysis of Nasalance according to Pattern of Phonation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various phonation patterns yield various voice characteristics. Voice therapy using nasal stimulatory sounds seems to facilitate phonation in voice disodered patients. Under the hypothesis that nasalance may be influenced by the pattern of phonation, we studied the relationship between nasalance and voice disorders by observing abnormal supraglottic movements and vocol cord gaps in phonation. SUBJECTS AND METHOD: There were 143 patients who complained of voice problems and showed abnormal false vocal cord movements under stroboscopy. In addition to the four previously described types of MTD (muscle tension dysphonia), we described two more types of MTD (V: false vocal cord contracted posteriorly, VI: false vocal cord dilated laterally). We measured the vocal cord gaps in phonation and analyzed nasalance. RESULTS: Among those groups showing the pattern of false vocal cord (MTD 1, 2, 4), the vocal cord gaps in phonation were increased and nasalance was significantly decreased in MTD types, III and IV, and showed a tendency to decrease in MTD types, II and V, compared to the normal group. CONCLUSION: The supraglottis has a tendency to contract as the vocal cord gap in phonation increases, and this movement reduces nasalance.

Classification of Antrochoanal Polyp according to the Extension / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently, there have been many reports of antrochoanal polyp (ACP), but the classification of ACP according to the extension of ACP is not yet available. Little is known about what effects the extention of ACP has on the nasal structure. So, in this article, we classified ACP according to the extension of ACP (Type I-extend to nasal cavity, Type II-to nasopharynx, Type III-to oropharynx). SUBJECTS AND METHOD: There were 29 patients who were diagnosed as ACP at the Daejin Medical Center (DMC) recently. There were 4 cases of type I, 20 cases of type II, and 5 cases of type III ACPs. We assessed the clinical, radiological, image-related, and surgical aspects according to the type. The clinical symptom, average symptom duration and surgical aspect were examined using the medical and surgical record. Radiological and image-related feature were analyzed by using CT, navigation software. RESULTS: Nasal obstruction was the most common symptom and the average symptom duration of each type was 18.5 months for type I, 31.1 months for type II, and 32.3 months for type III, repectively. The average fontanelle size of affected maxillary sinus (MS) was larger than that of non-affected side. The volume of affected MS was smaller than that of non-affected side. There was no difference between non-affected and affected MS in the 3-D image at each ACP type. CONCLUSION: We classified ACPs based on the extension of ACP. According to the ACP extension, CT findings were changed but 3-D image and volume of MS were not affected.

Analysis of Snoring Sound for Predicting Laser-Assisted Uvulopalatoplasty Results / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laser-assisted uvulopalatoplasty is well established and relatively successful operation in the treatment of snoring and obstructive sleep apnea (OSA). But, there have been no reports about snoring sound of patients who had been performed LAUP. This study was performed to evaluate the results of LAUP analysing preoperative snoring sounds. MATERIALS AND METHODS: There were 38 patients who were diagnosed as OSA by polysomnography and had been performed LAUP between Mar, 1998 and July, 2002. Preoperative and postoperative snoring sounds were recorded during sleep and we performed an acoustic analysis using spectrogram (SPG), which was classified. And postoperative subjective satisfaction of bed time partner was compared in each type and the degree of satisfaction was measured by VAS (visual analogue scale) score. According to previous study, types of spectrogram of snoring sounds were classified as palatal, tongue base and mixed. RESULTS: In postoperative analysis, snoring loudness was most decreased in palatal type, and snoring pitch was only increased in tongue base type. The average satisfaction of bed time partner was highest at palatal type and lowest at tongue base type. CONCLUSION: Preoperative analysis of snoring sounds can aid the prediction of the loudness and pitch of snoring sounds and the subjective satisfaction of patients after LAUP.

Navigation Assisted Transsphenoidal Approach for Pituitary Tumor

The transsphenoidal approach is the choice of surgical approach for the treatment of pituitary tumors located on the upper portion of the sphenoid sinus. The proximity of vital anatomic structures (e.g. optic nerve, carotid artery, carvernous sinus, and anterior cranial fossa) surrounding the sphenoid sinus makes it difficult for surgeons to recognize the precise location during the transsphenoidal approach. We report 16 cases of transsphenoidal approach performed via the navigation system to identify vital anatomic structures and important surgical landmarks. We analyzed 16 patients to perform the transcrural transcolumellar approach under the guidance the navigation system for pituitary tumor resection. For the verification of important anatomic structures during operation, the navigation system demonstrates the position and direction of the probe on CT scans in real time. The intrasphenoidal septum was in the midline in only four cases but not so in the other 12 cases. However, the posterior portion of the bony nasal septum attached to the anterior wall of the sphenoid sinus was located in the mid-portion of the sphenoid sinus in all cases. Without any serious damage to the important structures around the sella turcica, we successfully performed the pituitary tumor operation in all cases. Using the navigation system, we identified the relationship between the sella turcica and surrounding important structures on CT scan in real time, and successfully removed the pituitary tumors without complications. In addition, we suggest that the posterior portion of the bony nasal septum attached to the anterior wall of the sphenoid sinus may be one of the available landmarks for the localization of the midline during a transsphenoidal approach.

The Comparative Study on the Efficacy of Ranitidine and Rabeprazole in Reflux Laryngitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reflux laryngitis gives rise to inflammatory change in the pharyngolaryngeal tissue with various otolaryngologic and respiratory symptoms. Histamine H2 receptor antagonists and H(+)-K(+)-Exchanging ATPase are currently used as therapeutic medications. However, the efficacy of those two drugs on reflux laryngitis has never been proven yet. Therefore, we intended to analyze and compare the efficacy of the two drugs on reflux laryngitis. MATERIALS AND METHOD: Among the patients who had visited the Department of Otolaryngology, those with the total score of greater than 6 and having more than 2 symptoms that score greater than 2, had undergone laryngoscopy. Of these, the patients who had shown greater than 7 on the Belafsky's Reflux Finding Score (RFS) were studied. The RAN (Ranitidine) group (59 subjects) with Ranitidine administered and RAB (Rabeprazole)group (66 subjects) with Rabeprazole were followed up for 12 weeks, and then the efficacy of each drug was evaluated at 2nd, 4th, and 12th week. Then, the Symptom Score Improvement (SSI) and RFS were compared and analyzed. RESULTS: In comparison the RAN group that had Histamine H2 receptor antagonists and prokinetic agents administered to the RAB group that had H(+)-K(+)-Exchanging ATPase and prokinetic agents administered for the improvement of symptoms caused by reflux laryngitis, no difference was observed till after the first 2 weeks. On the evaluation at 4th and 12th week, statistically higher therapeutic efficacy was shown to a great extent in the RAB group. The findings of laryngoscopy at the 12th week also showed higher therapeutic efficacy in the RAB group. In comparison of symptoms between the groups, there were significant differences in pharyngolaryngeal foreign body sense and chronic throat clearing, and laryngeal edema and injection as well. CONCLUSION: For therapy of reflux laryngitis patients with moderately severe symtpoms, the use of H(+)-K(+)-Exchanging ATPase and prokinetic agents were superior in improving symptoms and clinicopathologic findings of larynx than Histamine H2 receptor antagonists and prokinetic agents.

The Diagnostic Rate and Phonetic Characters of Benign Vocal Fold Lesions with Sulcus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is not uncommon in patients with benign vocal fold lesions with voice change to accompany sulcus. The authors postulated that the coexistence of such benign lesions with sulcus would result in numerous problems related with phonation. The aim of this study was to recognize through voice analysis any particular phonation characteristics in patients with benign vocal fold lesions with coexisting sulcus, and to aid in diagnosis and treatment. MATERIALS AND METHOD: The study involved 574 patients who had been diagnosed with benign vocal fold lesions that accompanied voice change from Jan. 2001 through Sept. 2002. The diagnosis was made by videostroboscopy. The benign vocal fold lesions were observed in patients with sulcus and those without sulcus. Also specific benign vocal fold lesions were grouped into pairs determined by the existence of sulcus. Thus, patients with vocal nodules accompanied with sulcus were grouped as group NS and those without sulcus as group N: similarly, patients with vocal polyp and sulcus were grouped as PS and those without sulcus as group P: patients with Reinke's edema and sulcus as group RS and those without sulcus as group R, and patients with laryngeal edema and sulcus were grouped as group LS and without sulcus as group L. Each individual group went through psychoacoustic, acoustic and aerodynamic analyses and were compared against each other. RESULTS: Among patients with benign vocal fold lesions, about 50.2% had sulcus. It was observed that the rate of finding patients with sulcus increased when we began to have keen interest in sulcus. Among patients with benign vocal fold lesions without the accompaniment of sulcus, the most common form of benign vocal fold lesions was the vocal nodule. With coexisting sulcus, the most common form was laryngeal edema. In the psychoacoustic analysis group, the group NS exhibited more hoarseness than the group N: the group R exhibited greater hoarseness than the group RS. However, these results did not have statistical significance. In the acoustic analysis, the group NS had significantly higher shimmer score than the group N. In the aerodynamic analysis, the group NS and PS had exhibited significanlyt higher MFR scores than the groups N and P. CONCLUSIONS: The existence of sulcus in patients with benign vocal fold lesions has a clinical significance regarding treatment and prognosis. Although some acoustic analytic references may be useful in discovering the accompanying sulcus, careful observation of all vocal cords remains the most important component of such discoveries.

A Case of Fish Bone Foreign Body Presenting as Anterior Neck Mass / 대한이비인후과학회지

Foreign bodies in the oral cavity and pharyngolarynx are commonly encountered accidental cases in the emergency room and out patient departments in the otolaryngological fields. Of such foreign bodies, fish bones are the most commonly observed. Most foreign bodies in oral cavity, laryngopharyngeal, and esophagus can be recognized and their precise locations can be plotted by careful history taking, precise physical examination, and through simple radiological procedures. Similarly, their removal is relatively simple with the manipulation of endoscopes and various instruments. Reports of such foreign bodies are relatively frequent in their finding, however, foreign bodies that penetrate the esophagus and laryngopharynx to appear as a cervical mass are rare. When such foreign bodies migrate, locating their precise positions must involve a more thorough search utilizing such aids as computed tomography. Similarly, their removal may involve surgical intervention depending upon their location. The authors of this study experienced such a rare case of an elderly female patient aged 62, presenting an anterior neck mass of 7 days as a chief complaint. She had swallowed a fish bone 10 days ago. Her standard battery of blood tests, simple cervical X-ray and endoscopic findings all proved within normal limits. However, an excisional biopsy of the involved site revealed a piece of fish bone that had penetrated the pharyngolarynx and had migrated to position itself as an anterior neck mass. We hereby report this case along with the relevant literature.

The Relationship between Nasalance Score and Benign Vocal Fold Lesions / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Voice therapy using nasal stimulus sounds seems to facilitate a more easily produced, often better-sounding voice in benign vocal fold lesions. This study was designed (1) to determine whether nasalance score was different in patients with or without vocal fold masses, (2) to test if nasalance score was different from each disease group, and (3) to determine the difference between the normal and the disease group according to the reading materials. SUBJECTS AND METHOD: One hundred and sixty-eight subjects were evaluated. Each subject received a complete otolaryngological evaluation including physical examination, videostrobolaryngoscopy, objective voice measures, and evaluation by a speech-language pathologist. The control group consisted of 48 subjects with no nasal and vocal fold pathology. Subjects were evaluated on a nasometric assessment with three passages of oral-nasal sound. RESULTS: All disease groups demonstrated lower nasalance scores than the control group. CONCLUSION: There are significant differences in the nasalance scores between each disease group and the control group. Differences were also found according to the reading materials.

Rheumatoid Arthritis of the Larynx: A Case Report / 대한이비인후과학회지

Rheumatoid arthritis is a destructive systemic disorder of unknown etiology. The disease follows a prolonged and fluctuating course. It is characterized by periods of remission and exacerbation. Typically articular manifestations are encountered in the smaller peripheral joints. It has been estimated that 25% of patients with rheumatoid arthritis will show clinical evidence of laryngeal involvement in the course of disease course. Postmortem studies suggest that the actual incidence of laryngeal arthritis may be as high as 50-80%. Yet the studies of laryngeal arthritis have not been reported in Korea. It is thought that because of the lack of interest in laryngeal arthritis, a lot of diseases caused by laryngits or vocal cord paralysis have been overlooked. Authors report with a review of the literature that a patient who suffered from voice change and cord palsy was confirmed to have laryngeal arthritis.

The Study for Various Movements of the Arytenoid Cartilage in Functional Diseases of Vocal Folds / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Functional diseases of vocal folds have shown various movements of the arytenoid cartilage, however, they have not been documented yet. We studied to find out the relationships between functional diseases of vocal folds and arytenoid movements. MATERIALS AND METHOD: 224 subjects were evaluated by using videostroboscopic examinations. The subjects were classified into three types; notch, ball, and flat types according to the patterns of arytenoid movement during phonation. Vocal fold lesions were investigated and arytenoid movements were compared between normal and disease groups. RESULTS: The arytenoid movements of notch type were more than ball type or flat type in both normal and disease groups. The disease group showed many asymmetric movements of arytenoid cartilage when compared with the normal group. Vocal nodule and vocal polyp showed asymmetric movements of arytenoid cartilage. Conclusions: We found that the functional diseases of vocal folds were related to the asymmetric movements of arytenoid cartilage. We suggest that the various movements of arytenoid cartilage should be considered when functional diseases of vocal folds are examined.

The Study of Asymmetric Laryngeal Movements / 대한이비인후과학회지

BACKMROUND AND ackground and Objectives: Voice is produced by the vibration of the vocal fold mucosa and laryngeal movements affect its vibration. It is speculative that asymmetric laryngeal movements might be the cause of inadequate vibration of the vocal fold mucosa. Using the pharyngogram, authors studied the relation between the asymmetric laryngeal movements and laryngeal nodule in functional voice disorders. MATERIALS AND METHOD: Thirty patients with laryngeal nodule and thirty normal subjects were evaluated. All subjects were evaluated by an acoustic analysis and maximum phonation time. Laryngeal movements were investigated with a laryngostroboscopy. And we investigated the asymmetric movement of larynx and perilarynx using /i/ phonation pharyngogram. RESULTS: Acoustic analysis and maximum phonation time of the patients with laryngeal nodule were different with that of normal subjects. Asymmetry of arytenoid movements and asymmetry of thyroid cartilage protrudings were more common in patients with laryngeal nodule during the examination of the laryngostroboscopy. Asymmetry of pyriform sinus was more common in the patients with laryngeal nodule in the examination of the /i/ phonation pharyngogram. CONCLUSION: Laryngeal asymmetry might affect more commonly the vibration of the vocal fold mucosa in the patients with laryngeal nodule.

The Role of Lymphocyte Compartment and Cytokine in Coal Workers Pneumoconiosis / 결핵

BACKGROUND: Coal-worker's pneumoconiosis(CWP) is characterized by a chronic inflammatory lung reaction associated with macrophage accumulation in the alveolar spaces. CWP is usually divided into two stages : simpl e pneumoconiosis(SP) where there are a limited number of fibrotic lesions remain limited, with radiological opacities smaller than 1cm and progressine massive fibrosis(PMF), which is characterized by the development of a perifocal extensive fibrotix response of the lung and severws alterations in pulmonary function. In this study, the lymphocyte compartment and cytokine were evaluated by measuring the serum levels in the control, SP and PMF groups. METHODS: The coal workers selected for this study were employees(patients?) of the Tae-Baek and Dong-Hae hospital. All were men, 45-76 years old and the mean duration of their exposure to coal dust was 23.2 years in the lymphocyte compartment and 24.3 years in the cytokine checked group. According to the X-ray examination results, the patients were classified into either one of the SP, PMF categories. The normal controls examnied were 26-70 years old men. The serum cytokine levels were estimated by using an end point enzyme immunoassay technique. RESULTS: T lymphocyte, helper and suppressor T cells were highly related to pneumoconiosis in this study. A statistically significant decrease in the number of suppressor T lymphocytes was observed in this simple pneumoconiosis patients and at the same time, there was an increase in the lymphocyte index. However, there was no statistically defference in the serum cytokines levels among the SP, PMF and control groups. CONCLUSION: T lymphocyte, helper T, and suppressor T cells may be highly related to the development of CWP compared to the control group particularly in the early stage of pneumoconiosis. The changes obseved in the immunological system in patients with pneumoconiosis may lie at the bottom of the pathogenesis of fibrosis. Further study is needed to evaluated the lymphocyte compartment as a marker of pneumoconiosis developement in the early stage.