Surgical Outcomes of Jugular Foramen Tumors; Postoperative Facial Nerve Palsy and Lower Cranial Nerve Palsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgical treatment of jugular foramen tumors can have significant complications such as facial nerve palsy due to complicated regional anatomy. In this study, we investigated the outcomes and complications of surgical approach to the jugular foramen tumors. SUBJECTS AND METHOD: Thirteen patients had operations for their tumors around jugular foramen with a mean follow-up period of 52 months. We reviewed their medical records with emphasis on postoperative facial nerve palsy and other low cranial nerve palsies. RESULTS: There were jugular foramen schwannoma (n=9), glomus jugulare (n=2), meningioma (n=1) and chondrosarcoma (n=1). Gross total removal was achieved in 12 patients. Facial nerves were rerouted at genigulate ganglion (long rerouting) or at the second genu (short rerouting). Mastoidectomies were performed with canal wall-up (CWU) fashion or with canal wall-down (CWD) fashion. The mean size of tumor with long rerouting was significantly larger than that with short rerouting (p=0.037). Facial nerve palsy (FNP) greater than House-Brackmann grade (HB grade) III remained for more than 6 months in a patient. Low cranial nerve palsies were developed in 3 patients. CONCLUSION: Surgical treatment of jugular foramen tumors had a good local control rate with a low rate of complications. Depending on the size and location of tumors, detailed surgical methods can be determined to avoid unnecessary manipulation of facial nerve and loss of hearing.

Diagnosis and Clinical Courses of 108 Foreign Body Aspiration Cases / 소아알레르기및호흡기학회지

PURPOSE: Foreign body aspiration in the tracheobronchial tree is a common medical emergency in children and represents an important cause of morbidity and mortality. This study was aimed to analyze the clinical spectrum of tracheobronchial foreign bodies in children and to evaluate the causes of late diagnoses. METHODS: A total of 108 patients with foreign body aspiration were recruited in the last 10 years, who had a flexible or rigid bronchoscopic examination. The age, sex, symptoms, causes of aspiration, radiologic findings, and clinical courses were investigated retrospectively. Patients were divided into 2 groups according to the elapsed time from aspiration to a definite diagnosis as early (24 hours after aspiration). The two groups were compared for clinical courses, radiologic findings, and the duration of admission of early- and late-diagnosed foreign body aspiration. RESULTS: Approximately 80% of the patients were less than 24 months of age and the most common symptoms were the sudden onset of a cough. Hyperinflation or obstructive emphysema (52.8%) and normal chest radiographs (19.4%) were the most frequent radiologic findings. Plain chest radiographies revealed visible foreign bodies in 7.4% of all patients with foreign body aspiration. Nuts were the most common foreign bodies aspirated. Sudden onset of a persistent cough and fever were predominant in the late-diagnosed group.(P<0.05) CONCLUSION: Our results suggest that clinical suspicion upon interviewing is enough to indicate bronchoscopy. The best way to reduce the number of accidents and deaths associated with foreign body aspiration is to promote public prevention polices.

Effect of Vocal Hygiene Education in the Patients with Vocal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgical removal is generally known as the gold standard treatment of vocal polyp. However, the authors have not infrequently observed marked reduction or complete disappearance of the vocal polyps when vocal hygiene education was provided as a part of preoperative routine preparation. The aim of this study was to assess the effect of vocal hygiene education and to define the factors that can predict which patients with vocal polyp will get benefits from it. SUBJECTS AND METHOD: We reviewed the medical records of 190 patients with vocal polyp, and selected 88 patients who had received vocal hygiene education and completed a series of follow-up evaluation at 3 months later. According to the change of polyp size, patients were grouped into two: improvement and no improvement group. Eight factors (age, gender, duration of hoarseness, initial polyp size, hemorrhagic change of vocal polyp, degree of occupational voice abuse, smoking, and presence of reflux symptoms )were compared between the two groups. RESULTS: When given the vocal hygiene education, 19% of overall 190 patients and 41% of 88 patients who were followed up belonged to the improvement group. Univariate analyses showed that female patients, shorter duration of hoarseness, smaller polyp size, less occupational voice abuse, and no smoking are the meaningful favorable predictive factors. Multivariate analyses demonstrated that female patients with a small polyp and no symptoms of reflux have the largest possibility of getting improved. CONCLUSION: Vocal hygiene education should be provided as a first line of treatment for patients with vocal polyp, especially when a female patient without reflux symptom has a small polyp.