Prediction of Location of the Parotid Tumors that Cross Over Anatomical Criteria for Facial Nerve on Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To find more accurate way to determine the location of parotid tumors that cross anatomical criteria for the facial nerve (FN). SUBJECTS AND METHOD: Two hundred patients were included in the study and retrospectively studied. Five anatomical criteria were used to predict the location of parotid tumors on computed tomography (CT). Deep portion of tumors was measured and then, cut-off value was obtained after receiver operator curve analysis. The location of tumor was predicted by using the cut-off value and by the conventional way, in which the side where most of the tumor is located is determined as the tumor site. RESULTS: The parotid tumors were located in superficial lobes in 148 cases, and in deep lobes in 52 cases by operative record. The tumors that cross the anatomical criteria were defined as ‘crossing tumor.’ The cut-off values for prediction of ‘crossing tumor’ location on CT were 6.7 mm for anatomical line, 6.4 mm for FN line, 11.2 mm for retromandibular vein, 4.9 mm for Utrecht line and 3.8 mm for Conn's arc. The accuracy of 5 anatomical criteria for ‘crossing tumor’ was between 55.9% and 81.6% when the cut-off value was used, whereas the accuracy was between 25.7% and 68.9% when conventional way was used. CONCLUSION: In cases of ‘crossing tumor,’ the cut-off value obtained by measurement of deep portion of tumor can be applied to improve the diagnostic performance for the prediction of tumor location.

Clinical Characteristics of Patients Receiving Sinonasal Surgery after Neurologic Evaluation

The Effects of Olfactory Training with Intranasal Corticosteroid Spray in Korean Patients with Olfactory Dysfunction

Prediction of Location of the Parotid Tumors that Cross Over Anatomical Criteria for Facial Nerve on Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#To find more accurate way to determine the location of parotid tumors that cross anatomical criteria for the facial nerve (FN).SUBJECTS AND METHOD: Two hundred patients were included in the study and retrospectively studied. Five anatomical criteria were used to predict the location of parotid tumors on computed tomography (CT). Deep portion of tumors was measured and then, cut-off value was obtained after receiver operator curve analysis. The location of tumor was predicted by using the cut-off value and by the conventional way, in which the side where most of the tumor is located is determined as the tumor site.@*RESULTS@#The parotid tumors were located in superficial lobes in 148 cases, and in deep lobes in 52 cases by operative record. The tumors that cross the anatomical criteria were defined as ‘crossing tumor.’ The cut-off values for prediction of ‘crossing tumor’ location on CT were 6.7 mm for anatomical line, 6.4 mm for FN line, 11.2 mm for retromandibular vein, 4.9 mm for Utrecht line and 3.8 mm for Conn's arc. The accuracy of 5 anatomical criteria for ‘crossing tumor’ was between 55.9% and 81.6% when the cut-off value was used, whereas the accuracy was between 25.7% and 68.9% when conventional way was used.@*CONCLUSION@#In cases of ‘crossing tumor,’ the cut-off value obtained by measurement of deep portion of tumor can be applied to improve the diagnostic performance for the prediction of tumor location.

Expert's Consensus on Terminology of Auditory Perceptual Assessment in Voice Disorder / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to conduct a preliminary study to develop a standardized guideline for terminology necessary to describe auditory perception qualitatively and quantitatively in voice disorders in the Korean language. SUBJECTS AND METHOD: At first, a subjective questionnaire for Korean translation and definition of 25 auditory perceptual assessment terms proposed by Titze was answered by six speech-language pathologists. Secondly, a new questionnaire that was reconstructed with objective items based on the responses to the first questionnaire was completed by 14 experts who had experience on voice disorder for more than 10 years in Korea. In both questionnaires, the necessity of 32 auditory perceptual assessment terms selected from the 25 terms defined by Titze, GRBAS and CAPE-V was surveyed. RESULTS: The consensus on the Korean translation of auditory perceptual assessment terms was moderate (52.6%) between experts. The terms ‘ rough’ and ‘ shimmer’ demonstrated highest consensus of 85.7%. The consensus on Korean definition of auditory perceptual assessment terms was also moderate (61.6%). The term ‘ yawny’ showed complete consensus (100%). The necessity of auditory perceptual assessment terms varied with terms, but showed high consensus. CONCLUSION: It is necessary to develop and apply various standardized vocabulary terms for clinical evaluation so that they can express pathology and physiological characteristics during vocalization. In addition, despite the fact that there are a lot of auditory-perceptual terms, there is a lack of knowledge about voice quality terms, suggesting the need to promote and educate the developed voice quality terms.

Fungal Sinusitis: a Retrospective Analysis of Operated 298 Cases at a Single Medical Center, 2005–2015 / 대한의진균학회지

BACKGROUND: Many articles have reported an increased prevalence of fungal sinusitis in otherwise healthy individuals, although invasive fungal sinusitis is a well-documented disease in immunocompromised patients. OBJECTIVE: This study aimed to analyze the linear trend of changes in clinical characteristics of fungal sinusitis from 2005 to 2015. METHODS: Of the 3198 patients who underwent endoscopic sinus surgery between 2005 and 2015, 298 cases that were pathologically confirmed to be fungal sinusitis were retrospectively analyzed by reviewing their medical records. RESULTS: From 2005 to 2015, the mean age of fungal sinusitis patients showed increasing trend. The number and the proportion of fungal sinusitis cases in FESS (functional endoscopic sinus surgery) patients showed increasing trend. The percentages of fungal sinusitis patients with hypertension, allergic rhinitis, and septal deviation also showed increasing trend for eleven years. There were no statistical relationship between the direction of septal deviation and affected sinuses. CONCLUSION: Fungal sinusitis had increased from 2005 to 2015. The age and comorbidities such as hypertension, allergic rhinitis, and septal deviation in fungal sinusitis patient had also increased.

Propranolol as a First-line Treatment for Pediatric Hemangioma: Outcome of a Single Institution Over One Year / 임상소아혈액종양

BACKGROUND: Propranolol, a beta-blocker and well known anti-hypertensive medication, has been used as the first-line therapy for pediatric hemangioma since 2010. The objective of this study is to analyze the efficacy and safety of propranolol when used to treat pediatric hemangioma patients for one year or longer in a single institution.METHODS: A retrospective chart review analysis was done of 65 pediatric hemangioma patients treated with oral propranolol as the first-line therapy from 2010 to 2016. The patients were examined regularly at an interval of 1 to 2 months for changes in hemangioma size, growth and development, and occurrence of acute side effects of propranolol such as hypotension, hypoglycemia and bronchial constriction.RESULTS: Twenty patients were treated with propranolol for a year or longer and their median age was 202 days (range, 36 to 4,284 days) and mean duration of treatment was 22.5 months (range, 12 to 49 months). At 12 months of treatment, the average percentage of size decrement was 40.5%. When the weight and height percentile were compared between at diagnosis and 12 months post-treatment, all 20 patients showed normal growth curve and development. Patients did not show any acute side effects of propranolol during 12 months of treatment. One patient experienced hypoglycemia induced seizure, but this event was subsequently diagnosed as ketotic hypoglycemia induced from prolonged fasting.CONCLUSION: Propranolol was effective and well tolerated in children with hemangioma when used for one year or longer.

The Relationship between Snoring Noise and Hearing Impairment in Snorers and Their Spouses / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Snoring is a condition that affects a large percentage of population and is associated with various medical and social complications. However, there are only few published reports investigating the effects of chronic snoring exposure on hearing. In the present study, we examined whether there is an association between chronic snoring noise exposure and noise induced hearing impairment not only in snorers but also in their spouses. Subjects and MethodZZSixty snorers and 27 spouses under the age of 55 were recruited. All participants had more than 5 years of exposure to snoring. Questionnaire for snoring and pure tone audiometry were conducted. Subjects were classified into normal hearing group and hearing impairment group. SUBJECTS AND METHOD: Sixty snorers and 27 spouses under the age of 55 were recruited. All participants had more than 5 years of exposure to snoring. Questionnaire for snoring and pure tone audiometry were conducted. Subjects were classified into normal hearing group and hearing impairment group. RESULTS: Forty percent of snorers and 25.9% of spouses had hearing impairment. The snorers with hearing impairment had longer duration of snoring than the snorers with normal hearing. However, there were no statistical differences in loudness of snoring between the two groups. In the spouse group, there were statistical differences in loudness of exposed snoring and in duration of snoring exposure between the hearing impairment group and the normal hearing group. CONCLUSION: The result of this study indicated that chronic exposure to snoring noise may be associated with hearing impairment in snorers and their spouses. But in the snorers, further studies are required to identify the factors other than snoring noise associated with hearing impairment.

Propranolol as a First-line Treatment for Pediatric Hemangioma: Outcome of a Single Institution Over One Year / 임상소아혈액종양

BACKGROUND: Propranolol, a beta-blocker and well known anti-hypertensive medication, has been used as the first-line therapy for pediatric hemangioma since 2010. The objective of this study is to analyze the efficacy and safety of propranolol when used to treat pediatric hemangioma patients for one year or longer in a single institution. METHODS: A retrospective chart review analysis was done of 65 pediatric hemangioma patients treated with oral propranolol as the first-line therapy from 2010 to 2016. The patients were examined regularly at an interval of 1 to 2 months for changes in hemangioma size, growth and development, and occurrence of acute side effects of propranolol such as hypotension, hypoglycemia and bronchial constriction. RESULTS: Twenty patients were treated with propranolol for a year or longer and their median age was 202 days (range, 36 to 4,284 days) and mean duration of treatment was 22.5 months (range, 12 to 49 months). At 12 months of treatment, the average percentage of size decrement was 40.5%. When the weight and height percentile were compared between at diagnosis and 12 months post-treatment, all 20 patients showed normal growth curve and development. Patients did not show any acute side effects of propranolol during 12 months of treatment. One patient experienced hypoglycemia induced seizure, but this event was subsequently diagnosed as ketotic hypoglycemia induced from prolonged fasting. CONCLUSION: Propranolol was effective and well tolerated in children with hemangioma when used for one year or longer.

The Benefits of One Day, One Eye Surgery in Bilateral ICL Implantation

PURPOSE: To evaluate the benefits of one day, one eye ICL implantation which allows the ICL size of the later-operated eye to be adjusted after evaluating the postoperative vault of the first-operated eye in order to reduce the postoperative ICL size exchange rates of both eyes. METHODS: A total of 426 eyes of 213 patients who received one day, one eye bilateral ICL implantation were included in the present study. The cases where a different ICL size was implanted in the later-operated eye because of high or low postoperative vault of the first-operated eye were analyzed as well as the ICL exchange rates. RESULTS: Among 213 patients, same size ICLs were implanted in both eyes in 188 patients (88%) as planned. However, a different ICL size was implanted in the later-operated eye in 25 patients (12%). Eight eyes of 8 patients out of 25 patients needed their ICL size exchanged during the follow-up period and all 8 eyes were first-operated eyes. This occurred in 8 patients (3.8%) out of 213 patients. CONCLUSIONS: One day, one eye ICL implantation, which can help the size adjustment of the later-operated eye according to the postoperative 1 day vault of the first-operated eye, can reduce the risk of bilateral ICL size exchange operation.

Clinical Significance of Immature Reticulocyte Fraction and Reticulocyte Cellular Indices in Pediatric Anemia Patients / 소아과

PURPOSE: Flow cytometric automated reticulocyte analysis is a superior method to manual reticulocyte counting, with respect to precision and sensitivity. Furthermore, flow cytometric analysis is able to measure immature reticulocyte fraction(IRF) and reticulocyte cellular indices(RCI:cell hemoglobin content: CHr, mean cell volume:MCVr, cell hemoglobin concentration mean:CHCMr, distribytion width:RDWr, HDWr, CHDWr). In this study, we investigated the mean values and clinical significances of IRF and RCI in healthy children and pediatric anemia patients. METHODS: IRF and RCI were measured with an automated blood cell analyzer, ADVIA 120(Bayer, USA) using oxazine 750 dye, in 57 healthy children and 61 children with anemia. The anemia group consisted of 27 iron deficiency anemia(IDA) patients and 34 patients with anemia associated with acute infection(AAI). We compared the mean values of IRF and RCI in the control group classified according to age, between anemia groups and the control group, and between the IDA group and the AAI group. RESULTS: For the normal control group, the mean values of IRF, CHr, MCVr and HDWr were higher in neonates when compared to older children. The mean values of IRF and RDWr were significantly higher, and the mean values of CHr and CHCMr were significantly lower in the IDA group when compared to the control group. The mean value of IRF was significantly higher, and the mean value of CHDWr was significantly lower in the AAI group when compared to the control group. The mean values of IRF, CHr and CHCMr were significantly lower in the IDA group when compared to the AAI group. CONCLUSION: We could determine the normal mean values of IRF and RCI in healthy children classified according to age for understanding of hematopoietic response differences according to age. The evaluation of IRF and RCI by automated reticulocyte analyzer seemed to be accurate and clinically useful for the early diagnosis of anemia and the differentiation of IDA from AAI.

Serum and Cerebrospinal Fluid(CSF) Nitric Oxide, Macrophage Inflammatory Protein-1 alpha and Lactoferrin Levels in Aseptic Meningitis / 소아과

PURPOSE: The pathologic mechanisms of central nervous system(CNS) injuries in human meningitis are not yet completely understood. Recent studies indicate that the host inflammatory responses are as important in brain damage as the infecting organisms and toxins. There have been some reports on the relationship of nitric oxide(NO), macrophage inflammatory protein-1 alpha (MIP-1 alpha ), and lactoferrin in bacterial meningitis, but few reports in aseptic meningitis. Thus, we investigated the concentrations of NO, MIP-1 alpha and lactoferrin in cerebrospinal fluid(CSF) and serum of patients with aseptic meningitis and control subjects and evaluated their relationship with other parameters of meningitis. METHODS: CSF and blood were obtained from 25 subjects with aseptic meningitis and 15 control subjects. After centrifugation, supernatants were stored at -70degrees C and we assayed the concentrations of NO, MIP-1 alpha and lactoferrin with the ELISA method. There were no patients with neurologic sequelae after being recovered from aseptic meningitis. RESULTS: Concentrations of CSF and serum NO, MIP-1 alpha were not increased in aseptic meningitis subjects compared to control subjects. Concentration of CSF lactoferrin was significantly elevated in patients with aseptic meningitis and concentration of serum lactoferrin was significantly decreased in patients with aseptic meningitis compared with those in control subjects(P<0.05). CSF lactoferrin level was positively correlated with CSF WBC counts(rs=0.449, P=0.007), especially with neutrophil counts(rs=0.574, P<0.001) and CSF protein level(rs=0.508, P=0.002). CONCLUSION: Lactoferrin plays an important role in aseptic meningitis and may be released from neutrophils recruited from blood to the CSF through breakdown of blood-brain barrier. NO and MIP-1 alpha may not be important factors in the pathogenesis of aseptic meningitis without neurologic sequelae.

Two Cases Suggesting the Relationship of IgA Nephropathy and Henoch-Sch nlein Purpura

There are a considerable number of reports suggesting a common pathogenesis of IgA nephritis(IgAN) and Henoch-Sch nlein purpura(HSP). In previous reports, a patient develops IgAN after kidney transplantation for HSP nephritis, one of Identical twin boys, developed IgAN and the other HSP, and a boy with IgAN later developed HSP. We report two cases, one with IgAN who later developed HSP and the other with HSP who later developed IgAN, suggesting that IgAN and HSP have a common pathogenesis.