A Case of Relapsing Polychondritis with Sequentially Bilateral Sudden Sensory Neural Hearing Loss / 대한이비인후과학회지

Relapsing polychondritis is a relatively rare systemic disease of unknown etiology. The disease is considered as an autoimmune disorder and characterized by episodic recurrent inflammation of cartilage and connective tissue, most often of the ears, nose, eyes, joints, respiratory tract, cardiovascular system and audiovestibular system. Treatment plans involve suppression of the immune system with corticosteroid. However, steroid therapy is associated with a number of adverse effects, and non-steroidal anti-inflammatory agents and immunosuppressive agents are helpful in treating the disease. Authors have recently experienced a case of relapsing polychondritis in a 24-year-old man who had both auricular chondritis and bilateral sudden hearing loss with vertigo. The patient showed a significant hearing improvement with the treatment using steroid and immunosuppressive agents. We report this case with a review of the literature.

Prevention Technique Using Inferior Turbinate Mucosal Flap for Septal Perforation after Septoplasty

BACKGROUND AND OBJECTIVES: Septal surgery is the most common cause of nasal septal perforation. The aims of this study are to introduce a new technique for the prevention of septal perforation during septal surgery by installingan inferior turbinate mucosal flap on the injured mucosal surface, and to determine its usefulness by evaluating the treatment outcomes. MATERIALS AND METHODS: Between March 2012 and March 2013, 90 cases of conventional septoplasty were performed. Bilateral mucoperichondrial tears on corresponding areas occurred in 4 cases. Autologous cartilage was inserted and then both sides were repaired using inferior turbinate mucosal flaps. Follow-up periods ranged from 5 to 6 months. RESULTS: Three of the four patients had successful outcomes with complete repair of injuries. The remaining patient had a septal perforation. CONCLUSIONS: The technique of using an inferior turbinate mucosal flap may be an easy, effective method for the prevention of septal perforation during septal surgery.

A Large Dentigerous Cyst Found in the Mandible

Dentigerous cysts are benign odontogenic cysts that are associated with the crowns of permanent teeth. They are developmental epithelial-lined lesions which are formed from fluid accumulation in the space between the reduced enamel epithelium and the surface of crown. This may occure due to the obstructin of venous return caused by tooth impaction. The most prevalent location of dentigerous cysts are the third molar of mandible. While the single dentigerous cysts are the second most common odontogenic cysts following the radicular cysts of jaw, multiple cysts are observed in patients with some conditions such as mucopolysaccharidosis type IV, basal cell nevus syndrome, and cleidocranial dysplasia. They occur in young patients in the second or third decades of life, but it is a rare occurrence for children. A sixteen-year-old girl with painful swelling in the right mandible visited to our department. All routine laboratory test results were within normal limits. However, we were able to diagnose that she had facial asymmetry. Computed tomography showed a well-defined soft tissue mass obliterating right mandible ramus with an impacted tooth. We performed total enucleation of cyst and molar tooth. The pathology revealed a non-keratinized squamous epithelial lined cyst associated with an undamaged tooth.

Use of Triamcinolone-Impregnated Nasal Packing Following Endoscopic Sinus Surgery

OBJECTIVES: To investigate the effectiveness of steroid-impregnated absorbable nasal dressing on wound healing and surgical outcomes after endoscopic sinus surgery (ESS). MATERIALS AND METHODS: Chronic rhinosinusitis patients with nasal polyps who were to undergo bilateral ESS were recruited and randomized to receive triamcinolone-impregnated bioresorbable dressing (Nasopore(R); Polyganics, Groningen, Netherlands) in one nasal cavity and saline-impregnated dressing contralaterally. Postoperative healing assessments of edema, crusting, secretions, and scarring were done at postoperative days 7, 14, and 21 and at 1 and 3 months using validated Lund-Kennedy scores. RESULTS: Analysis of the 20 enrolled patients who completed observation showed no significant difference in Lund-Kennedy scores between the preoperative cavity scores. There was, however, a statistically significant difference in Lund-Kennedy scores of the treatment and control groups at days 7 and 14 (P =0.005 and P=0.0039, respectively), and a significant difference in Lund-Kennedy scores was also detected between the groups at the 3-month time point (P =0.042). CONCLUSION: The results of the data analysis suggest a significant improvement in early postoperative healing and improved healing for up to 3 months postoperatively in nasal cavities receiving triamcinolone-impregnated absorbable nasal packing following ESS.

Radiofrequency-Assisted Uvulopalatoplasty with Tonsillectomy for the Treatment of Mild to Moderate Obstructive Sleep Apnea

BACKGROUND AND OBJECTIVES: In radiofrequency surgery, energy is usually delivered to the submucosal tissue of the palate through a special probe in order to reduce the volume and rigidity (palatal channeling). However, the same probe can be used to make cuts in the free edge of the soft palate, as in laser-assisted uvulopalatoplasty [radiofrequency-assisted uvulopalatoplasty (RAUP)]. The objective of the current study was to evaluate the role of RAUP with tonsillectomy for the treatment of mild or moderate obstructive sleep apnea (OSA). MATERIALS AND METHODS: Eighty-two patients with mild to moderate obstructive sleep apnea (5< or =AHI<30, BMI<30) were included in this clinical trial. All patients received RAUP with tonsillectomy. Patients were followed for six months and were asked to respond to a questionnaire regarding standard visual analogue score pattern. Assessment was performed prior to the surgery and was repeated six month postoperatively. Visual analogue scores were measured for the parameters of pain, speech deficits, dysphagia and snoring (according to the partner). The Epworth sleepiness scale (ESS) was also utilized. Polysomnography was conducted preoperatively and was repeated six months postoperatively. RESULTS: There were significant differences in improvement of snoring, ESS and AHI before and after the procedure, and the success rate of the surgical treatment was 62%. Postoperative pain, speech disturbance, dysphagia were decreased two weeks after the operation. CONCLUSION: The results of the study suggest that RAUP with tonsillectomy is an effective treatment for patients with mild to moderate obstructive sleep apnea.

Clinical Comparison of Post-Tonsillectomy Pain : Tonsillectomy Using Cold Instrument Versus Tonsillectomy Using Electrocautery

BACKGROUND AND OBJECTIVES: Tonsillectomy is one of the most common operations in otolaryngology and is performed with various surgical techniques. It seems that there is no superior technique regarding post-tonsillectomy pain. We attempted to identify preferable methods of tonsillectomy in clinical practice by comparing the levels of postoperative pain. MATERIALS AND METHODS: Between June 2009 and Jan 2010, 80 cases of tonsillectomy were performed. In Group A (age : 10-15 years, 40 cases), 20 cases involved tonsillectomy via snare. The other 20 underwent tonsillectomy using electrocautery. The same surgical division was applied in Group B (25-40 ages, 40 cases). All tonsillectomies were performed under general anesthesia by the same surgeon. RESULT: The mean duration of postoperative pain after tonsillectomy by snare and tonsillectomy by electrocautery in Group A was 5.2+/-2.1 and 6.7+/-3.7, respectively. The mean duration of postoperative pain after tonsillectomy by snare and tonsillectomy by electrocautery in Group B was 7.4+/-1.4 and 10.8+/-3.2, respectively. The results indicate that electrocautery is the more painful method of the two tested methods. The difference in post-tonsillectomy pain was statistically significant between the surgical methods. CONCLUSION: It seems that snare tonsillectomy is a useful method for reducing post-tonsillectomy pain compared with that after electrocautery tonsillectomy.

Activation of Lysozyme and Lactoferrin in Endolymphatic Duct of Rats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Secretory activity, particularly of antibacterial agents such as lysozyme and lactoferrin, is an important aspect of the mucosal defense mechanism. The development of these agents may have a direct bearing on the susceptibility of the mucosa to infection. The antibacterial secretory enzymes such as lysozymes and lactoferrins are found in various mucosal tissues, and it has been suggested that these enzymes contribut to the defense against local mucosal infection. Specifically, lysozyme and lactoferrin are important components of innate immunity against pathogens at mucosal surfaces. The purpose of this study is to identify the distribution and expression of lysozyme, lactoferrin in endolymphatic duct of rat. MATERIALS AND METHOD: Normal rats (129P3/J, 10 cases) were used for this study. The expression level and distribution of lysozyme mRNA were analyzed by RT-PCR and quantitative image analysis. RESULTS: The expression of lysozyme and lactoferrin mRNA in endolymphatic ducts of rats was compared by quantitative image analysis. The results indicate that the relative expression of lysozyme mRNA resulted as 2.5 times greater than that of lactoferrin mRNA. CONCLUSION: The distribution and expression of lysozyme and lactoferrin in the endolymphatic duct of rat were identified. The study suggests that innate immunity such as lysozyme and lactoferrin are important components of defense mechanisms along with mucociliary clearance. Additionally, the authors think that the activity of lysozymes is more effective than that of lactoferrin in the endolymphatic duct of rat.

Prevention of Septal Perforation During Septal Surgery Using Inferior Turbinate Mucosa and Fibrin Glue

BACKGROUND AND OBJECTIVES: As septal surgery is being performed more and more often, the incidence of septal perforation as a complication arising from the surgery has also increased. In septal surgery, if corresponding mucoperichondrial tears occurred on both sides, autologous cartilage is usually placed between the injured mucopercondrium. However, septal perforation is sometimes found after septal surgery even after this effort. The aims of this study were to introduce a new technique for the prevention of septal perforation during septal surgery using inferior turbinate mucosa and fibrin glue and to determine its usefullness by evaluating the treatment outcome. MATERIALS AND METHODS: Between June 2005 and May 2007, 358 cases of septal surgery were performed. Bilateral mucoperichondrial tears on corresponding areas occurred in 26 cases. In Group 1 (15 cases), autologous cartilage was inserted between injured mucoperichondrium. In Group 2 (11 cases), autologous cartilage was inserted and then was repaired using fibrin glue and inferior turbinate mucosa. The authors compared the perforation rate between the two groups. RESULTS: In Group 1, septal perforation occurred in 7 of 15 patients (46.7%) and in Group 2, 1 of 11 patients (9.0%) had perforation. Perforation rates were significantly lower in Group 2. CONCLUSION: The technique of using fibrin glue and inferior turbinate mucosa may be an easy, effective method for the prevention of septal perforation during septal surgery.

Clinical Analysis of the Etiology of Korean Olfactory Disorders / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study examined the causes and epidemiologic factors of smell loss in Koreans using the Korean Version of the Sniffin' Sticks Test and compared the results with cases of foreign countries. SUBJECTS AND METHOD: The data of 386 patients who visited clinics complaining of smell loss were retrospectively analyzed with medical charts. RESULTS: Idiopathic, upper respiratory tract infection, trauma, nasal and paranasal sinus disease were the major causes of smell loss in this study. The distribution of gender and age, severity of smell loss, association of smell loss with allergies and nasal polyps were discussed in detail. CONCLUSION: The proportion of each cause observed in this study was different compared with the results of other domestic reports of nasal and paranasal sinus disease, but came out similar to the results of foreign studies.

Inferior Turbinate Surgery for Chronic Hypertrophic Rhinitis: Comparison of Three Techniques / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgical reduction of the turbinate size is the treatment of choice for symptomatic hypertrophy of the inferior turbinate, which is unresponsive to medication. In the present series, three of techniques for the reduction of the size of the inferior turbinate were evaluated and compared. SUBJECTS AND METHOD: Sixty patients with chronic hypertrophic rhinitis which is refractory to medical therapy were divided into three groups, the submucosal resection with microdebrider (SMRM) group (20 patients), the radiofrequency-assisted partial turbinoplasty (RFAPT) group (20 patients) and the partial turbinectomy (PT) group (20 patients). Postoperative changes in degrees of nasal obstruction, minimal cross-sectional area and the volume of nasal cavity were evaluated prospectively at 3 months after operation. Operation time, postoperative pain, duration of crust formation and delayed bleeding were also compared. RESULTS: Nasal obstruction was improved significantly in all groups. In the SMRM and PT group, the degree of improvement was higher than that of the RFAPT group. In the RFAPT group, the operation time and duration of crust formation were shorter, and postoperative pain was less than those of the SMRM and PT group. In the SMRM group, the duration of crust formation was shorter than that of the PT group. CONCLUSION: This study suggest that SMRM is a more effective treatment of chronic hypertrophic rhinitis for patients with bony hyprtrophy, whereas RFAPT is better for patients with prominent mucosal hypertrophy.

The Usefulness of Heavy Smoking Index as a Test for Nicotine Dependence

BACKGROUND: The Fagerstrom Test for Nicotine Dependence (FTND) is a widely used six-item questionnaire. Its completion require a few minutes, but such time may be too much for busy clinicians and large epidemiologic surveys. The goals of this study was to compare the sensitivity and the specificity of Heavy Smoking Index (HSI) of high nicotine dependence. METHODS: The FTND was administered to 943 current smokers from a smoking-cessation clinic in Gwangjin-gu, Seoul. The HSI which combines two items of the FTND (the number of cigarettes per day and the time of the first cigarette of the day) was compared to the FTND. We measured cigarette per day, duration of smoking, and age of smoking initiation. RESULTS: A cutoff score equal or greater than 4 on the HSI detected a similar rate of nicotine dependence as a cutoff score equal or greater than 6 on the FTND. The HSI showed a sensitivity of 88.0% and a specificity of 86.5%. The concordance between the two instruments was high (kappa= 0.74). CONCLUSION: The HSI was proven to be very useful. If HSI had a proper validity, the HSI can be a good standard of high nicotine dependence for busy clinician and epidemiologists.

A Case of Removal of Esophageal Foreign Body Causing Esophageal Submucosal Hematoma / 대한이비인후과학회지

Foreign bodies in upper digestive tract are one of frequently encountered accidental cases in otolaryngologic fields. Esophageal hematoma have been reported in association with impaired hemostasis, emetogenic, food-related injury, and spontaneous disorder. Submucosal hematoma of the esophagus caused by food-related traumatic injury is a rare entity. A study has reported that various foods, such as fish bones, hot noodles, steak, spice, and hard confections cause esophageal injury, resulting in esophageal submucosal hematoma. Hematoma occurs within the submucosal plane of the esophagus, causing dissection of mucosa from its underlying muscle, resulting in extramucosal narrowing of the esophageal lumen. Its prognosis is good, and improvement is achieved by conservative treatment. We experienced an uncommon esophageal submucosal hematoma caused by an esophageal fish bone. Therefore, we report this case with a review of literature.

A Case of Paraganglioma of the Nasal Cavity / 대한이비인후과학회지

Paragangliomas arising from the nasal cavity and paranasal sinuses are extremely rare. Sinonasal paraganglioma causes repeated nasal bleeding, nasal stuffiness, headache and edema on the face. It occurs in the middle turbinate, lateral nasal wall, paranasal sinus and the roof of nasal cavity. Histopathologically, chief cells composing tumors are arranged in the "zellballen" pattern. Sinonasal paraganglioma is usually treated through radical surgical excision. We experienced a rare case of paraganglioma of the nasal cavity and treated it without recurrence through nasal endoscopic excision.

The Study of Distribution and Expression of Water Channel Proteins(Aquaporins) in the Rat Eustachian Tube / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The mucosal epithelium of middle ear and eustachian tube needs hydration to maintain proper amount of moisture. Recent discoveries of various types of water channel proteins (aquaporins ; AQPs) in mucous epithelium suggest that they play critical roles in the regional regulation of water balance. The purpose of this study is to assess the distribution and expression of different subtypes of AQPs in the rat eustachian tube. SUBJECTS AND METHOD: We analyzed the distribution and expression of AQP1, 2, 4, 5, and 7 using RT-PCR, Western blot, and immunohistochemistry study in the rat middle ear and eustachian tube samples. RESULTS: The expression of the mRNA of AQP1, 4, and 5 were observed in the rat eustachian tube and middle ear. The bands of AQP1, 4, and 5 were detected at 28 kDa, 31 kDa, and 26 kDa proteins in the Western blot analysis, respectively. The immunohistochemical analysis demonstrated that AQP1 was expressed in fibroblasts at subepithelial portions of the rat eustachian tube and that AQP4 was observed at the basolateral membrane of the ciliated epithelial cells. The distribution of AQP5 in rat eustachian tube was limited to the apical surface of serous gland cells, but all of the epithelial goblet cells were labeled negative. CONCLUSION: We demonstrated that there are various subtypes of AQP in rat eustachian tube and that they existed at specific cells and sites. This study may be a preliminary study to determine the possibility of relationship between AQP expression and AQP-related disease in the middle ear and eustachian tube.

Treatment of Allergic Rhinitis Using Bipolar Radiofrequency-Assisted Partial Turbinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The ideal treatment for allergic rhinitis that is refractory to medical therapy is still lacking. Recently, radiofrequency-assisted partial turbinoplasty (RFAPT) has been introduced as a new treatment modality for reduction of inferior turbinate volume. The aim of the study is to evaluate the efficacy of RFAPT for the treatment of allergic rhinitis that is unresponsive to medical therapy and compare the postoperative outcome of RFAPT with that of Laser-assisted partial turbinoplasty (LAPT). SUBJECTS AND METHOD: Forty-eight patients with nasal obstruction due to allergic rhinitis which is refractory to medical therapy were prospectively evaluated with a follow-up period of 3 months. Twenty patients (40 sides) were treated with RFAPT, and 28 patients (56 sides) with LAPT. The the degree of postoperative changes in nasal obstruction, rhinorrhea, itchy nose, sneezing, operation time, operation-associated pain, intraoperative bleeding, duration of crust formation was compared between the two surgical methods. RESULT: There were no significant differences in the improvement of allergic symptoms and intraoperative bleeding between the two groups. Operative time was less in the RFAPT group and crust was formed for a shorter postoperative period. Operation-associated pain was less in the LAPT group. CONCLUSION: The study demonstrates that RFAPT appears to be effective for treating allergic rhinitis whihc demonstrates poor response to medical therapy.

A Case of Angiofibroma Arising from the Middle Turbinate of an Adult Woman / 대한이비인후과학회지

Juvenile nasopharyngeal angiofibroma accounts for less than 0.5% of head and neck tumors. It primarily affects male adolescents, and originates in the posterolateral wall of the nasopharynx. Although angiofibromas extend beyond the nasopharynx commonly, they rarely originate outside the nasopharynx. Primary extranasopharyngeal angiofibromas have been sporadically reported in the literature. We report an unusual case of an angiofibroma arising from the middle turbinate. The tumor was completely removed through endonasal, endoscopic technique after pre-operative embolization.

Distribution and Expression of Lysozyme in Trachea of Normal Rat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Airway mucosa is protected by several complex of defense mechanisms, namely mucociliary clearance, immunoglobulins, cellular components, and antibacterial secretary enzymes. In particular, lysozymes, also known as muramidase, are important components of innate immunity against pathogens at mucosal surfaces. Trachea mucosa is mainly protected by mucociliary clearance, and recently, lysozymes are also known to be in the trachea tissues. The purpose of this study is to identify the distribution and expression of lysozymes in the trachea of normal rats. MATERIALS AND METHOD: Tra-cheas were collected from male Wistar-kyoto rats. The expression level and distribution of mRNA of lysozyme were analyzed by RT-PCR and immunohistochemistry. Western blot assessed and confirmed the expression of lysozyme. RESULTS: The expression of mRNA of lysozyme in trachea was observed. Immunohistochemical analysis demonstrated that lysozyme was expressed in the epithelium and the submucosal serous gland. Western blot was detected at the molecular weight of 14 kDa. CONCLUSION: We identified the distribution and expression of lysozymes in the trachea of normal rats. The result suggests that innate immunity such as that played by lysozymes is an important component of defense mechanisms along with mucociliary clearance.

Histopathology of the Inferior Turbinate Showing Compensatory Hypertrophy in Patients with Deviated Nasal Septum / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Deviation of the nasal septum toward one side is often associated with an outgrowth of the inferior turbinate, which occupies the expansive space of the contralateral nasal cavity. It is assumed that this contrabalanced mechanism characterized by compensatory hypertrophy has originated to protect the more patent nasal side from excessive airflow with its drying and crusting effect. We tried to investigate histologic differences of inferior turbinate mucosa of both sides in patients with nasal septal deviation. MATERIALS AND METHOD: Specimens were taken from the anterior portion of inferior turbinates of 15 patients with deviated nasal septum and compensatory hypertrophy of the inferior turbinate. After staining by hematoxylin-eosin, the histologic differences of bilateral turbinate mucosa were examined under light microscope. RESULTS: Epithelia of both sides showed normal or epithelial exfoliation. The number of submucosal glands was significantly higher in the opposite side than in the hypertrophied side. Inflammatory cell infiltration was more severe in the hypertrophied side than in the opposite side. CONCLUSION: Above results suggest that heavy infiltration of inflammatory cells and decreased number of glands in the hypertrophied side might result from aerodynamic change originated from difference of area of airway.

Comparison with Hearing Gains by the Different Methods of Operation in the Defect of Malleus and Incus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Multiple techniques of ossicular replacement have been advocated for hearing gain in the setting of chronic otitis media. The purpose of this study is to investigate hearing gain in the middle ear surgery according to the surgical technique and the materials. MATERIALS AND METHOD: Ninety-nine cases with ossicular replacement with mastoidectomy in the Konkuk University Hospital from 1995 to 2001 were reviewed retrospectively. Postoperative hearing gains were compared with the two methods of mastoidectomy and the two materials of ossicular replacement separately. RESULTS: A successful hearing gain was defined as a postoperative air-bone gap less than 30dB. According to this criterion, 47% of intact canal wall mastoidectomy cases and 43% of open cavity mastoidectomy cases were successful. Thirty-one percent of ossicular replacement case using cartilage-perichondrium and 62% using hydroxyapatite-PORP were successful. The extrusion rate was zero % in ossicular replacement using cartilage-perichondrium, and 57% in ossicular replacement using PORP. CONCLUSION: There was a significant differences in hearing gain and extrusion rate by using two different materials for ossicular replacement such as cartilage and hydroxyapatite-PORP (p0.05).

Morphological Changes of Cochlear Structures after Cisplatin Administration / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cisplatin is frequently used in the treatment of various forms of malignancies. It's therapeutic efficacy, however, is limited due to the occurrence of sensorineural hearing loss. Little is known about the course of hearing loss after cessation of cisplatin administration. We observed the cochlear duct morphology with normal and cisplatin treated animals. MATERIALS AND METHODS: Healthy rats (strain Sprague-Dawly, weighting 80-100 mg) were used for all experiments. Total 15 rats were selected. They were divided into two groups, a treated group and a control. Four survival groups (n=3, respectively) were assigned as the treated group. After treatment with cisplatin, each survival group was sacrificed 1, 4, 10, 20 days. Except for the normal control (n=3), twelve animals were treated with cisplatin by daily I.P. injection of 1.5 mg/kg for 8 consecutive days. RESULTS: One day after cessation of cisplatin administration, outer hair cells (OHCs) loss and stria vascularis were degenerated especially in the basal turn. At 4, 10, 20 days, the OHCs and stria vascularis morphology of the survival group were similar to those of the survival group at one day. CONCLUSION: Our findings suggest cisplatin ototoxicity is predominantly involved in the basal turn of cochlear duct. This finding was significantly correlated with high frequency hearing loss of cisplatin ototoxicity.