Outcomes of Modified Canal Wall Down Mastoidectomy and Mastoid Obliteration Using Autologous Materials

OBJECTIVES: The traditional canal wall down mastoidectomy (CWDM) procedure commonly has potential problems of altering the anatomy and physiology of the middle ear and mastoid. This study evaluated outcomes in patients who underwent modified canal wall down mastoidectomy (mCWDM) and mastoid obliteration using autologous materials. METHODS: Our study included 76 patients with chronic otitis media, cholesteatoma, and adhesive otitis who underwent mCWDM and mastoid obliteration using autologous materials between 2010 and 2015. Postoperative hearing air-bone gap and complications were evaluated. RESULTS: During the average follow-up of 64 months (range, 20 to 89 months), there was no recurrent or residual cholesteatoma or chronic otitis media. No patient had a cavity problem and anatomic integrity of the posterior canal wall was obtained. There was a significant improvement in hearing with respect to the postoperative air-bone gap (P<0.05). A retroauricular skin depression was a common complication of this technique. CONCLUSION: The present study suggests that our technique can prevent various complications of the classical CWDM technique using autologous tissues for mastoid cavity obliteration. It is also an appropriate method to obtain adequate volume for safe obliteration.

Epithelial-Myoepithelial Carcinoma of the Inferior Turbinate: A Case Report

Treatment of Carcinoma in Situ of Glottis by KTP Fiberoptic Laryngeal Laser Surgery Under Local Anesthesia

The optimal treatments of carcinoma in situ of glottis include radiotherapy, laser surgery and vertical partial laryngectomy. Conventional surgical treatments need general anesthesia and radiotherapy has several complications. Recently, the effectiveness of 532 nm potassium titanyl phosphate (KTP) laser has been proven and widely used in vocal fold diseases even some cases of vocal fold dysplasia. A patient with difficult laryngeal exposure underwent fiberoptic laryngeal laser surgery using KTP laser under local anesthesia, showed improved voice outcome and the glottic lesion was removed successfully without local recurrence and regional metastasis 18 months after surgery.

A Case of Synchronous Double Primary Cancer in the Nasopharynx and Nasal Cavity Related with Epstein-Barr Virus / 대한이비인후과학회지

Multiple primary malignant neoplasms indicate an occurrence of two or more malignancies in a patient, and double primary cancers are the most common type. When the second primary cancer occurs simultaneously or within 6 months after the first primary cancer is diagnosed, it is called synchronous carcinoma. If the second primary cancer occurs after 6 months, it is defined as metachronous carcinoma. Recently, we experienced a patient who was diagnosed as double primary cancer in the nasopharynx and nasal cavity. The tumors occurred simultaneously and histopathological examinations revealed nasopharyngeal nonkeratinizing carcinoma in the right nasopharynx and extranodal NK/T-cell lymphoma in the left nasal cavity (inferior turbinate). In situ hybridization showed positivity for Epstein-Barr virus, which encoded early RNA in the neoplastic cells of both specimens. We present this rare disease entity with a review of the relevant literature and a survey of the clinical characteristics.

Changes of Sleep Disordered Breathing and Quality of Life after Adenotonsillectomy in Pediatric Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pediatric obstructive sleep apnea (OSA) can have an effect on the quality of life (QOL) such as behavior, school performance, emotional distress and daytime function. We aim to verify changes in sleep disordered breathing based on polysomnographic findings and disease specific health related QOL before and after adenotonsillectomy in Korean children with OSA. SUBJECTS AND METHOD: A total 20 children aged 3 through 13 years old (mean age=6.7 years old and male/female=14/6) with OSA were included. We evaluated respiratory disturbances in patients using the standard polysomnography and the OSA-specific health related QOL based on Korean Obstructive Sleep Apnea-18 Survey (KOSA-18). RESULTS: There were significant improvements in apnea-hypopnea index (from 9.4±7.4 to 1.1±0.8 events/hour, p<0.001) and total score of KOSA-18 (71.3±26.0 to 33.6±10.7, p<0.001) after adenotonsillectomy. CONCLUSION: Sleep disordered breathing and QOL improve significantly after adenotonsillectomy in Korean OSA children.

Effect of Non-Steroidal Anti-Inflammatory Drug Mouthwash on Post-Tonsillectomy Pain: Randomized, Controlled Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Altough tonsillectomy is one of the most common otolaryngological procedures, a highly reliable and effective method for reducing postoperative pain has yet to be identified. This study evaluated the efficacy of a non-steroidal anti-inflammatory drug (NSAID) mouthwash on postoperative pain in tonsillectomy patients. SUBJECTS AND METHOD: A total of 64 patients who underwent tonsillectomy were randomly assigned to one of two groups (32 patients each). One group received the NSAID mouthwash and the other a distilled water mouthwash. Postoperative pain in the two groups was compared by assessing pain severity 1-9 days postoperatively using a visual analog scale. RESULTS: Compared to the distilled water mouthwash group, patients using the NSAID mouthwash showed a statistically significant decrease in postoperative pain over the first 9 postoperative days. CONCLUSION: A NSAID mouthwash may be a simple and effective method for controlling post-tonsillectomy pain when administered in conjunction with routine medications.

Effect of Positional therapy on Patients with Obstructive Sleep Apnea: Meta-Analysis

BACKGROUND AND OBJECTIVES: Positional therapy is a therapeutic method for obstructive sleep apnea (OSA). However, little is known about the effectiveness of positional OSA treatment based on meta-analysis. Therefore, we undertook a review and meta-analysis of studies to assess the effect of positional therapy on OSA. SUBJECTS AND METHOD: We searched PubMed (Medline), OVID Medline, EMBASE, Cochrane Library, SCOPUS, KoreaMed, MedRIC, and KSI KISS using the key words “obstructive sleep apnea” and “positional therapy”. To estimate the effect of positional OSA therapy, we analyzed the ratio of means (ROM) for pre- and post-treatment polysomnographic data including apnea-hypopnea index (AHI), lowest oxygen saturation, arousal index, and sleep efficiency. RESULTS: Finally, twenty two studies from 21 papers were included in the meta-analysis. Positional therapy significantly decreased AHI by 54.1% [ROM, 0.459; 95% confidence interval (CI), 0.394 to 0.534] and increased lowest oxygen saturation by 3.3% (ROM, 1.033; 95% CI, 1.020 to 1.046). However, positional therapy did not significantly change arousal index (ROM, 0.846; 95% CI, 0.662 to 1.081) or sleep efficiency (ROM, 1.008; 95% CI, 0.990 to 1.027). CONCLUSION: Positional therapy significantly improves respiratory parameters including AHI and lowest oxygen saturation in patients with OSA.

A Case of Killian-Jamieson Diverticulum in the Esophagus

A Killian-Jamieson diverticulum (KJD) is an unfamillar and unusual cervical esophageal diverticulum. This diverticulum originates on the anterolateral aspect of the esophagus through the Killian-Jamieson's area that is formed between cricopharyngeal muscle and the lateral to longitudinal esophageal muscle. Recently, we experienced a patient who was found outpouching lesion on lateral side of left esophagus on the duodenoscopy. Then, a barium esophagography performed and in left lateral position demonstrated a left-sided diverticulum with a frontal projection, highly suggestive of a KJD. There are two ways of surgical approach to manage the KJD. First is external approach, another one is endoscopic approach. In common, external approach has been recommended for the treatment of KJD because of concern of nerve injury. We present a case of KJD that underwent external approach and sternocleidomastoid muscle flap in the management of KJD.

The Association of Social Support with Health Status and Health Behavior among Rural Aged Population / 農村醫學 地域保健

OBJECTIVE: The objective of this study was to evaluate the association of social support with health status and health behavior. METHODS: This study was conducted with 79 elderly people in Gunja-ri, Dongsan-myun, Chuncheon. We performed face to face interview which was composed of socio-demographic characteristics, social support, health status and health behavior. The association between social support and result variables was analysed by Chi-square test and logistic regression. We used SAS ver9.1 for statistic analysis. RESULTS: Mean age of the study population was 72.0+/-7.0, social support score was 14.3+/-4.7 with full marks of 20 and 36.25% of the total population were shown to have depression. When the social support score was changed, depression (p=0.0007) and physical exercise (p=0.0312) showed significant difference. The self-rated health status was significantly related to the relationship with family members (OR=0.25, 95% CI=0.07-0.95) and the quality of sleep was also significantly associated to the relationship with family members (OR=0.21, 95% CI=0.06-0.73). The physical exercise was done significantly less in the group 'without' close friends than in the group with 'many' close friends (OR=0.21, 95% CI=0.05-0.94) and the depression was significantly more in the group without community participation than in the group with community participation (OR=4.79, 95% CI=1.62-14.15). CONCLUSIONS: Through this study, we could conclude that the social support factors are associated with health status and health behavior. Therefore, to improve the health status of rural elderly, we need to approach to develop social support.