A Case of Laryngeal Mucosa Associated Lymphoid Tissue Lymphoma Mimicking Laryngeal Amyloidosis / 대한이비인후과학회지

Laryngeal amyloidosis is a rare disorder characterized by localized amyloid deposition and carries an excellent prognosis. On the other hand, mucosa associated lymphoid tissue (MALT) lymphoma is the most common type of marginal zone lymphoma. MALT lymphoma has a poorer prognosis compared to laryngeal amyloidosis due to more frequent local recurrence, distant metastasis and malignant changes. Despite the differences, as both are found in the form of benign mass and have slow progression, accurate diagnosis is necessary. This report deals with the case of a patient with voice change accompanied by a mass, in which the initial biopsy did not include enough specimen for an accurate diagnosis. However, in the second attempt, an adequate sample was obtained, hence the final diagnosis of laryngeal MALT lymphoma. Based on our recent experience and a review of related literature, we report a case of laryngeal MALT lymphoma mimicking laryngeal amyloidosis.

Endoscope-Assisted Parapharyngeal Space Abscess Drainage / 대한이비인후과학회지

Background and Objectives@#Parapharyngeal space abscess (PPSA) may cause severe complications such as, airway obstruction, jugular thrombophlebitis, and mediastinitis unless early diagnosed and properly treated. Transoral drainage is known to reduce morbidity and hospital stays compared to the external drainage. The aim of this study is to assess the effect of endoscope when draining of PPSA via transoral approach.Subjects and Method We retrospectively reviewed charts of patients who were diagnosed with PPSA and treated surgically between February 2013 and September 2018. We included in the study 39 patients who underwent incisional drainage via transoral approach. Pateints were excluded had they undergo drainage via external approach or who treated with medication alone or operated for parapharyngeal space tumor. Thirty-nine patients were classified into two groups according to whether an endoscope was used or not when draining PPSA. We compared the hospital stays, estimated blood loss (EBL), operating time, revision rate, depth of abscess, and postoperative complications between two groups. @*Results@#Of the 39 patients [22 males (M), 17 females (F)], 13 patients (M:F=7:6) were classified as an endoscope group (EG) and 26 (M:F=15:9) as without endoscope group (WEG). The mean hospital stays of the EG and WEG were 7.6±4.6 and 9.8±4.8 days, respectively (p=0.188); the mean EBL of the EG and WEG were 222.2 and 254.0 mL, respectively (p=0.595); the mean operating time of the EG and WEG were 40.0±22.5 and 35.4±14.5 minutes, respectively (p= 0.457); the mean depth of PPSA of the EG and WEG were 4.5±0.9 and 4.0±0.7 c-spine level, respectively (p=0.043), and the revision cases of the EG and WEG were 1 and 2, respectively (p=1.000). @*Conclusion@#Endoscopes enabled the draining of PPSA to sit more deeply in the neck compared without it.

Schwannoma of the Tongue Base with Imaging Features and Differential Diagnosis: a Rare Case Report and Literature Review

Schwannoma or neurilemmoma is a benign peripheral nerve sheath tumor that arises from Schwann cells. Approximately 25–45% of all schwannomas occur in the head and neck regions, and the intraoral presentation of these is only 1%. We report a rare case of a patient presenting tongue base schwannoma with characteristic imaging features on computed tomography and magnetic resonance imaging.

Combined Bifrontal Transcranial Direct Current Stimulation and Tailor-Made Notched Music Training in Chronic Tinnitus

BACKGROUND AND OBJECTIVES: We evaluated the short-term treatment outcomes of combined bifrontal transcranial direct current stimulation (tDCS) and tailor-made notched music training (TMNMT) in tinnitus patients. The associations of patient characteristics with treatment responsiveness were investigated. SUBJECTS AND METHODS: Four sessions of bifrontal tDCS (F4: anode, F3: cathode) and TMNMT were conducted over a 2-week period in tinnitus patients. For tDCS, the stimulation intensity was 1.5 mA and the duration was approximately 20 min. During tDCS, patients listened to music lacking the frequency band within 1 octave of the tinnitus frequency. Patients were also instructed to listen to this music at home for at least 2 hours per day. One month after the final tDCS session, loudness (LD), awareness (AW), annoyance (AN), and effect on life (EL) of tinnitus were assessed subjectively using a visual analog scale. RESULTS: A total of 14 patients were enrolled in this study. After treatment, a 50% or greater improvement in AN, AW, EL, and LD was observed in 57.1, 42.9, 35.7, and 28.6% of patients, respectively. Furthermore, 78.6% of patients showed a 50% or greater improvement in their tinnitus handicap inventory scores. For AN, the absence of sleep disturbance was significantly associated with treatment responsiveness (p=0.041, OR=24.0). CONCLUSIONS: Combined bifrontal tDCS and TMNMT is a promising treatment for chronic tinnitus. To maximize the treatment outcomes of this therapy, sleep disturbances should also be addressed in candidate patients.

Postoperative Septal Abscesses According to the Techniques of the Septoplasty

BACKGROUND AND OBJECTIVES: Recently, the swinging door and grafting techniques have been heavily used for straightening and holding the caudal septum. However, reconstructive septoplasties require more extensive dissection of septal structures. Extensive anatomical dissection and complicated procedures may affect the probability of postoperative bleeding and infection. MATERIALS AND METHOD: We retrospectively reviewed the records of 141 consecutive patients who underwent septal surgeries from February 2013 to December 2015. The patients were classified into two groups according to surgical technique: those who underwent submucous resection with or without endoscopy were classified as the “resection” group, while those who underwent the swinging door or batten graft technique were classified as the “reconstruction” group. The resection and reconstruction groups were matched using the propensity score. The incidence of postoperative septal abscesses (PSAs) was analyzed between the two groups. RESULTS: For the two groups, 36 patients were matched with 36 patients (1:1) using the propensity score. Of the 72 patients, PSAs developed in 5 patients (6.9%). One patient was in the resection group (2.8%), while the other four patients were in the reconstruction group (11.1%). However, the incidence of PSAs was not significantly higher in the reconstruction group according to Fisher's exact test (p=0.164). CONCLUSION: Reconstructive septoplasty resulted in more septal abscesses than resection, but the difference was not significant.

Parotid Abscess Treated with Percutaneous Drainage / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The parotid abscess is a rare disease. It occurs mainly in patients with poor oral hygiene, dehydration, and immune compromised. This study aims to analyze clinical presentations of the parotid abscess treated with ultrasonography and fluoroscopy guided percutaneous drainage. SUBJECTS AND METHOD: A retrospective review of medical records were carried out for nine patients with parotid abscess treated with percutaneous drainage during the period from March 2007 to May 2013. RESULTS: Of the nine patients identified with parotid abscess, there were seven males and two females who were in the age range of 41 to 85 years (mean age of 61.8). The mean level of the serum amylase was 167.4 IU/L (ranging from 52 to 343). Of the nine patients, two were found with intra-parotid cystic tumor, one was infected with the Tuberculosis, and six were found with an unidentifed parenchymal infection. All except one patient were improved after percutaneous drainage. One patient, who suffered underlying diabetes, chronic renal failure and liver cirrhosis, died due to sepsis that rapidly progressed from parotid abscess despite percutaneous drainage. The mean period of hospitalization was 16.1 days. Bacteria isolations resulted in identification for 4 patients (44.4%). CONCLUSION: Parotid abscess could be successfully treated with ultrasonography and fluoroscopy guided percutaneous drainage unless it involved multiple regions or progressing rapidly.

Therapeutic Effect of Zinc and Lipoprostaglandin E1 for Idiopathic Sudden Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to analyze the therapeutic effect of zinc, lipoprostaglandin E1 in addition to systemic steroid therapy on hearing improvement for the treatment of idiopathic sudden hearing loss. SUBJECTS AND METHOD: Retrospective medical chart reviews of 500 patients who had been diagnosed with unilateral idiopathic sudden hearing loss between May 2006 and April 2014 were performed. Then, we conducted a multiple linear regression analysis using the data of individual patients. RESULTS: Better hearing gain was associated with low tone hearing loss (p<0.001), better initial contralateral hearing (p<0.001), and the absence of dizziness (p=0.015). Patients who underwent intratympanic steroid treatment as salvage treatment showed a lower hearing gain (p<0.001). Zinc supplementation was effective for the treatment of patients with mild hearing loss (p<0.001). On the contrary, significant improvements in hearing gain were found in patients with profound hearing loss who were treated with an additional lipoprostaglandin E1 (p<0.001). CONCLUSION: An additional use of zinc and lipoprostaglandin E1 may enhance hearing improvement for the treatment of idiopathic sudden hearing loss.

Clinical Study of the Intranasal Hemangioma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hemangioma of the nasal cavity is an uncommon benign vascular tumor. This study aimed to analyze the clinical manifestations, radiologic findings, treatment modalities, and outcomes of intranasal hemangiomas. SUBJECTS AND METHOD: Retrospective reviews of the medical record were performed on 13 patients, who were treated for intranasal hemangioma from 2005 to 2014. RESULTS: Of the 13 patients identified, there were seven males and six females ranging from 11 to 80 years of age (mean age of 48.1+/-21.5). Epistaxis was the most common presenting symptom. Most common site of origin was the inferior turbinate. CT scans showed variable enhancement of the nasal mass without bony erosion. Preoperative diagnosis accuracy rate was 76.9%. The tumor was histopathologically classified as follows: capillary hemangioma (n=6, 46.1%), cavernous hemangioma (n=3, 23.1%), venous hemangioma (n=2, 15.4%), and mixed hemangioma (n=2, 15.4%). Endoscopic excisional surgery (n=11, 94.6%) and local excision (n=2, 15.4%) were performed for complete removal of the hemangioma. Preoperative selective embolization was performed on one patient. No evidence of recurrence after the surgery was observed. CONCLUSION: Intranasal hemangioma was usually found to occur in the inferior turbinate and the most common symptom was epistaxis. Capillary hemangioma was the most common type. Complete excision was recommended to prevent recurrence.

Selective Arterial Embolization in Intractable Recurrent Epistaxis: A Clinical Analysis with Literature Review / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epistaxis usually responds to conservative therapy such as nasal packing or electrocauterization. But sometimes more invasive techniques such as selective embolization is justified. We report our experience of 10 patients with selective endovascular embolization for refractory epistaxis. SUBJECTS AND METHOD: Ten patients were referred for selective arterial embolization for refractory epistaxis. Medical records were reviewed for clinical data, recurrence, and complication. RESULTS: Early rebleeding requiring treatment occurred in 1 patient (10%) and initial success rate of embolization was 90%. There was no major complication. Minor complications such as mild fever, groin pain, and voiding difficulty occurred in 2 patients (20%). CONCLUSION: Selective arterial embolization for refractory epistaxis is safe and effective for treatment of refractory intractable epistaxis.

Unidentified Bright Objects on Brain Magnetic Resonance Imaging Affect Vestibular Neuritis

OBJECTIVES: The aim of this study was to investigate the differences in clinical manifestations of in two groups of vestibular neuritis (VN) patients with or without unidentified bright objects (UBOs). METHODS: A prospective, observational study with 46 patients diagnosed with VN between May 2013 and November 2013 was executed. A caloric test, a cervical vestibular-evoked myogenic potentials (cVEMPs) test, brain magnetic resonance imaging (MRI), spontaneous nystagmus test, head impulse test, and head-shaking nystagmus test were performed. RESULTS: Of the patients, 56.5% (n=26) were classified as UBO-positive by MRI. These showed lower caloric weakness and more prominent cVEMP asymmetry compared with the UBO-negative group (P0.05). CONCLUSION: UBOs on T2-weighted or fluid attenuated inversion recovery MRI may affect the patterns of the vestibular nerve in patients with VN.

Clinical and Histological Analysis of Oral Mucocele / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucoceles usually occur as asymptomatic, dome-shaped, translucent cysts in the lower lip and oral cavity containing mucin. Mucoceles are usually associated with the minor salivary glands and are classified histologically into the extravasation type and the retention type. The objective of the present study was to establish the prevalence of these lesions according to age, gender, histologic type, and site of occurrence. SUBJECTS AND METHOD: We retrospectively reviewed the medical records from January 2008 to February 2013 pertaining to age, sex, clinical history, and other findings of 52 patients who underwent operation and confirmed as mucocele histologically. We re-evaluated all mucocele cases by an experienced pathologist. RESULTS: Of the 52 cases analyzed, 32 (61.5%) were females and 20 (38.5%) were males. Age ranged from 2 to 77 years (mean age 20.6 years), with 78.8% occurring between the ages of 0 and 30 years with peak incidences in the twenties for female patients and in the thirties for male (34%). There was a more predominance among women (61.5%). The lower lip was the site most frequently affected by the lesions (59.6%), whereas the lowest prevalence was observed for the soft palate (2%), and buccal mucosa (2%). Tongue (15.4%) and floor of mouth (21.2%) were not uncommonly affected sites. Histologically mucous extravasation type (96.2%) was more predominant than the retention type (3.8%). CONCLUSION: In this study, mucocele was found predominant in younger age groups, with the lower lip being the most frequently affected site. Histologically, the mucus extravasation type was the most common.

Clinical Characteristics and Prognostic Factors in Pediatric Chronic Rhinosinusitis with Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis with nasal polyps is an uncommon pathology in the pediatric population and a challenging problem to otolaryngologists. In this study, we aimed to assess the clinical characteristics and postoperative results of children who underwent sinus surgery due to nasal polyps. SUBJECTS AND METHOD: We retrospectively reviewed medical records of 45 pediatric patients who had sinus surgery from 2009 to 2012. We studied the relationship between clinical parameters and postoperative results. RESULTS: Forty-five patients (18 women and 27 men with an age range of 8 to 17 years) were treated surgically in our hospital. We found statistically significant correlation between the preoperative CT scores (p=0.043), the nasal obstruction symptom scores (p=0.032) and postoperative recurrence, but not between other parameters. CONCLUSION: In this study, prognostic factors affecting the postoperative outcome were preoperative CT score and nasal obstruction symptom score.

Carcinosarcoma of the Maxillary Sinus

Carcinosarcoma is a highly malignant tumor characterized by dual malignant histologic differentiation of epithelial and mesenchymal components. The tumor is extremely rare in the sinonasal tract. We report a case of a 62-year-old man with carcinosarcoma involving the maxillary sinus.

A Case of Primary Ewing's Sarcoma of Arising from the Nasal Cavity / 대한이비인후과학회지

Ewing's sarcoma is an uncommon malignancy that usually occurs in children. It most commonly involves the lower extremity, with the pelvis being the next most common site. Primary Ewing's sarcoma that arises in the head and neck region is extremely rare, representing only 1-4% of all Ewing's sarcoma cases. We report a case of primary Ewing's sarcoma in the nasal cavity in a 10-year old patient with a non-specific past medical history, in which the patient received 3 trials of neoadjuvant chemotherapy, endoscopic wide excision, followed by 2 more trials of adjuvant chemotherapy. Currently, it has been 5 years since treatment and the patient did not exhibit any signs or symptoms of recurrence of the disease.

A Case of Cryptococcal Abscess Involving Deep Neck Space in an Immunocompetent Patient / 대한이비인후과학회지

The encapsulated yeast, Cryptococcus, has rapidly risen to a worldwide major opportunistic fungal pathogen. Infection with Cryptococcus neoformans usually occurs in immunocompromised host and but may occur also occur in immunocompetent patients. Cryptococccal infection commonly involves the lung or central nervous system; it can disseminate to any organ. However, Cryptococcal abscess in deep neck space is rare. We report an immunocompe-tent patient, who was 60-years-old with cryptococcal abscess in deep neck space. Incisional biopsy of the involved soft tissue revealed the presence of Cryptococcus neoformans. Abscess culture also yielded Cryptococcus. Surgical debriment and antifungal therapy resulted in cure.

Estimate Hearing Recovery Rate Using Statistical Analysis of Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden deafness is not rare but its pathophysiology has not been fully determined and treatment is controversial at present. There is much debate regarding the prognostic factors in sudden deafness patients. Various studies have been done to find out factors concerned with the recovery of sudden deafness, but there are still many unknown components as the probability of recovery from sudden deafness depends on many factors. The aim of this study is to identify an expectation of recovery by regression formula. SUBJECTS AND METHOD: We reviewed the records of 241 patients who were admitted for treatment between 2002 and 2005 under the initial diagnosis of idiopathic sudden hearing loss. The patients were treated with steroid, vasodilator and plasma expander. Improvement of hearing was measured by Siegel's criteria and correcting rate. Prognostic factors that might be associated with the degree of hearing recovery were classified and analyzed by the optimal scale regression analysis method using SPSS ver. 12.0. RESULTS: Siegel's criteria and correcting rate have statistical correlation with respect to age, initial hearing level, patterns of pure tone audiogram and duration of initial treatment from onset to hearing improvement after treatment. Vertigo is not associated with hearing improvement. CONCLUSION: The initial hearing level, patterns of pure tone audiogram and duration of initial treatment from onset are associated with the degree of hearing recovery. We produced a calculating model of hearing improvement based on factors affecting hearing improvement.

Availability of Spectral Gradient Acoustic Reflectometry / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Spectral gradient acoustic reflectometry (SGAR) determines the probability of middle ear fluid by measuring the response of the tympanic membrane to a sound. To assess the sensitivity and specificity of SGAR for the diagnosis of otitis media with effusion (OME) in the Korean population, we compared accurate diagnostic rates of OME obtained from SGAR and tympanometry. Pneumatic otoscope was used for diagnostic standard of OME. SUBJECTS AND METHOD: SGAR and tympanometry were performed on 488 ears from May 27th, 2008 to July 30th, 2008. Exclusion criteria were the presence of tympanic membrane perforation, and/or pressure equalization tubes, noncompliance, otorrhea, external auditory canal stenosis and signs of acute inflammation such as fever or otalgia. In all cases, pneumatic otoscopic examination was conducted and diagnostic accurate rates of OME were calculated in SGAR and tympanogram. RESULTS: Using spectral gradients of 3 or higher as breakpoints for indicating OME, in the case of pediatrics under 2 years old, with the sensitivity of 58.3%, specificity of 94.7%, positive predictive value (PPV) of 77.8% and negative predictive value (NPV) of 87.8%. In the case of the pediatrics between 2 and 12 years old, it showed the sensitivity of 67.2%, specificity of 90.3%, PPV of 74.5% and NPV of 86.8%. In the case of the pediatrics over 12 years old, they showed sensitivity of 87.3%, specificity of 88.8%, PPV of 67.6% and NPV of 96.3%. CONCLUSION: SGAR has the higher tendency of specificity and NPV, and will be a useful screeningtest with good portability and economical efficiency.

Change of Middle Ear Mechanics after Tympanoplasty Type I with Thin Sliced Cartilage Island / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cartilage offers the advantage of higher mechanical stability compared with membranous transplants but it may alter the acoustic transfer characteristics, which could depend on its thickness. So, author attempted to design the thin sliced cartilage island for grafting material by tragal cartilage. The purpose of this study is to understand the usefulness of the thin sliced cartilage technique by comparing with conventional temporalis fascia technique with the method of tympanometry. SUBJECTS AND METHOD: From March 2002 to August 2005, 101 cases of tympanoplasty type I using the thin sliced cartilage island technique and 50 cases of tympanoplasty type I using the temporalis fascia performed by one surgeon had been followed up for 6 months and reviewed. Static compliance, tympanometric width and tympanometric pattern were followed up after 6 month. RESULTS: The static compliance in the thin sliced cartilage island technique group was 72% and temporalis fascia group was 66% at normal compliance (0.2-1.6 ml). The tympanometric width in the thin sliced cartilage island technique group was 59% and temporalis fascia group was 54% at normal tympanometric width (60-150 mmH2O). The tympanometric pattern in the thin sliced cartilage island technique group was 67% and temporalis fascia group was 62% at normal tympanometric pattern (A type). CONCLUSION: There is no significant statistical difference between the thin sliced cartilage island and temporalis fascia observed in the impedence audiometry. The thin sliced cartilage island technique is suggested to be good for tympanoplasty.

The Effect of Lesser Palatine Nerve Block on Pain after Pediatric Tonsillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This prospective, randomized double-blind study was performed to evaluate the analgesic effect of lesser palatine nerve block after pediatric tonsillectomy, and we measured analgesic efficacy and degree of blocks induced by ropivacaine. SUBJECTS AND METHOD: Children who weighed 20-40 kg and scheduled for an elective tonsillectomy were randomized into three groups. Patients received lesser palatine nerve block, using divided doses of 0.05 ml/kg of 0.2% ropivacaine (Naropin registered), 5 min prior to the beginning of tonsillectomy (Pre-block group) or immediately after surgery (Post-block group). Patients allocated into the control group did not receive any nerve blocks. Postoperative pain was measured immediately after surgery and at 3, 6, 12 and 24 hours following the operation by using a 0 to 4 points pain scale, based on a facial expression of pain scale ruler. Side effects and the number of analgesic inductions were observed for 24 hours postoperatively. RESULTS: No significant differences in the pain scores were observed immediately after surgery and at 3, 6, 12 and 24 hours after operation in the three group (p>0.05). The number of analgesic injections were similar in the groups. CONCLUSION: The results of this study reveal that the lesser palatine nerve block was not effective for postoperative pain control following pediatric tonsillectomy, and that the pre-emptive block offered no pain control benefit over the postoperative block. Therefore, we do not recommend lesser palatine nerve blocks for the management of postoperative pain after pediatric tonsillectomy.

Nevoid Basal Cell Carcinoma Syndrome: A Case Report and Literature Review / 대한이비인후과학회지

Nevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin-Goltz syndrome, shows autosomal dominant pattern of inheritance with variable expressivity. The most important features are the occurrence of basal cell carcinoma and odontogenic keratosis. Recently, we experienced a case of nevoid basal cell carcinoma syndrome with multiple odontogenic keratocysts, basal cell carcinoma on cheek, cerebral calcification and palmar pits. We report this case with literature review.