Delayed Facial Nerve Paralysis after Tympanomastoid Surgery: The Potentiality of Fungal Infection and Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to assess the clinical courses and clinical outcomes of delayed facial nerve paralysis (DFNP) after middle ear and mastoid surgery. SUBJECTS AND METHOD: In our hospital, postoperative DFNP occurred in 13 cases among the patients who underwent ear surgery from December 2000 to February 2010. During the same period, another 4 cases with postoperative DFNP were diagnosed at a local clinic. We assessed the degree of DFNP by using House-Brackmann grade (HBG) and separated 8 patients in grade II, 6 patients in grade III and 3 patients in Grade IV. Among 17 patients, DFNP occurred after open cavity mastoidectomy in 11 cases and after closed cavity mastoidectomy in the rest of 6 cases. RESULTS: Among 17 postoperative DFNP, fungal infections were found in three patients. Patients for whom antifungal agent was relatively delayed in application, their condition did not improved. CONCLUSION: After treatment, most of patients recovered within 1 month and there were no other associated infection during hospitalization. We suggest that antifungal agents should be used as soon as possible when patients complain about DFNP following open cavity mastoidectomy.

Efficacy of Single-Field Non-Mydriatic Digital Fundus Photography for Screening Diabetic Retinopathy

PURPOSE: To evaluate the efficacy of a single field, non-mydriatic, 45degrees digital photography as a diagnostic tool for diabetic retinopathy. METHODS: A total of 303 consecutive diabetic patients (606 eyes) who underwent digital fundus photography and indirect ophthalmoscopy were included in the present study. The optical discs and macular area of all patients were subjected to single fundus photography using a non-mydriatic 45-degree digital fundus camera. All patients also underwent fundus examinations after pupil dilation via indirect ophthalmoscopy. RESULTS: The sensitivity and specificity for determining diabetic retinopathy were 47.6% and 97.6%, respectively. The false positive rate, false negative rate, positive predictive value, and negative predictive values were 2.3%, 2.1%, 45.5%, and 97.8%, respectively. Among the digital fundus images, 12.9% (78 eyes) were non-gradable. The patients with non-gradable digital fundus images were older (p < 0.001), had a longer duration of diabetes, (p < 0.001) and more often suffered from systemic hypertension (p = 0.003) compared to patients with gradable photographs. CONCLUSIONS: The present study showed that single-field, non-mydriatic, 45 degree digital photography for detecting diabetic retinopathy had relatively low sensitivity and high technical failure rates. The failure rates could be improved with higher resolution non-mydriatic wide-field photography cameras and with additional peripheral images for diabetic retinopathy screening.

Study on Survey of Knowledge and Awareness Level of Diabetic Retinopathy in Type 2 Diabetes Patients: Results from Seoul Metro-City Diabetes Prevention Program Survey

PURPOSE: To investigate the knowledge and awareness level of diabetic retinopathy (DR) in type 2 diabetes patients. METHODS: A total of 437 participants with diabetes were recruited in the Seoul Metro-City Diabetes Prevention Program (SMC-DPP). Participants underwent clinical and laboratory examinations and questionnaire survey to evaluate diabetes complications. The DR was diagnosed by grading fundus photographs 5 standard fields taken per eye. RESULTS: The overall prevalence of any DR was 20.4% and only 6.6% of patients were aware of their DR. The DR patients who underwent an eye examination within the previous year were 42.3%, and 50.3% out of 437 patients enrolled were educated on diabetes. Of the survey participants, 83.8% answered positive to 'Evaluation of diabetes mellitus complication must be performed every year', 61.1% answered positive to 'Must control blood pressure and lipid level for diabetes management' and 28.4% believed 'It takes a long time for complications of diabetes to develop'. The DR self awareness was 14.6% and an eye examination within the previous year was 50.6% among the 89 DR participants. CONCLUSIONS: Results of the survey with SMC-DPP type 2 diabetes participants showed a low knowledge and awareness level of chronic complications such as DR.

Clinical Characteristics of Thyroid Micropapillary Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Thyroid micropapillary carcinoma (equal or less than 10 mm at great dimension) is now reported with increasing incidence due to fine needle aspiration under high-resolution ultrasonography. The extent of thyroidectomy and lymph node dissection has been an issue of controversy. The purpose of this study was to analyze clinical characteristics of thyroid micropapillary carcinoma with total thyroidectomy and preventive central neck dissection. SUBJECTS AND METHOD: For suspicious thyroid micropapillary carcinoma, total thyroidectomy and preventive central neck dissection was performed in 63 patients (18 male, 45 female, mean ages of 59 years) between November 2004 and September 2008. They were suspected to have micropapillary carcinoma by fine needle aspiration and diagnosed with micropapillary carcinoma postoperatively. RESULTS: The mean tumor size was 6 mm. Twenty-one patients (33.3%) had multifocal diseases and 19 patients (30.2%) had extrathyroid extension. Lymph node metastases were found in 20 patients (31.7%) on central neck and 7 patients (11.1%) on lateral neck. There were no relations between multifocal disease or extrathyroid lesion and lymph node metastases (p> 0.05). There was no significance of variables according to tumor size of 5 mm (p> 0.05). There was a significant relation between central and lateral lymph node metastasis (p< 0.05). CONCLUSION: These data can be used for future studies for necessity or unnecessity of total thyroidectomy and/or preventive central neck dissection for thyroid micropapillary carcinoma. The possibility of coexistence of central and lateral neck metastasis should be considered.

Two Cases of Pediatric Nasopharyngeal Carcinoma / 대한이비인후과학회지

Nasopharyngeal carcinoma (NPC) is one of the infrequently occurring malignant tumors in childhood. It is different from the adult form of the disease by its close association with Epstein-Barr virus infection, lymphoepithelial histology, and the high incidence of locoregional advancement of the disease. However, these tumors are associated with higher cure rates as they are very sensitive to radiation. We report two cases of pediatric nasopharyngeal carcinoma with locoregional advancement.

Submandibular Cutaneous Draining Sinus Tract from Mandibular Osteomyelitis / 대한이비인후과학회지

Chronically draining cutaneous sinus tracts are frequently misdiagnosed and incorrectly treated. Diagnostic errors can result in multiple surgical excisions and biopsies, long-term antibiotic therapy, and even radiation therapy or electrodessication. The most common cause of skin drainage is a chronically infected tooth. A sinus tract from a mandibular osteomyelitis is very rare and hard to detect. A 36-year-old woman was presented to the hospital with a 1.5 year history of purulent discharge from a cutaneous sinus present at submandibular region. The patient had received three excisions and drainage procedures but the drainage recurred. The neck computed tomography revealed a focal disruption with radiolucence on the posterior surface of the left inferior mandibular body. The disease was completely cured after the excision of sinus tract and thorough curettage of the affected lesion of the mandible. We report a cutaneous submandibular draining sinus tract that developed from a mandibular osteomyelitis unrelated to a tooth inflammation