Rhino-Orbito-Cerebral Mucormycosis in an Immunocompromised Patient

Rhino-orbito-cerebral mucormycosis (ROCM) is an invasive fungal infection that usually occurs in immunocompromised patients. It is aggressive and has a high risk of mortality. With unclear guidelines, ROCM is treated in various ways. We present a patient who underwent kidney transplant and who treated for ROCM without major complications.

Genetic Variants and Clinical Phenotypes in Korean Patients With Hereditary Hemorrhagic Telangiectasia

Objectives@#. Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterized by recurrent epistaxis, telangiectasia, and visceral arteriovenous malformations (AVMs). Activin A receptor-like type 1 (ACVRL1/ALK1) and endoglin (ENG) are the principal genes whose mutations cause HHT. No multicenter study has yet investigated correlations between genetic variations and clinical outcomes in Korean HHT patients. @*Methods@#. Seventy-two members from 40 families suspected to have HHT based on symptoms were genetically screened for pathogenic variants of ACVRL1 and ENG. Patients with genetically diagnosed HHT were also evaluated. @*Results@#. In the HHT genetic screening, 42 patients from 24 of the 40 families had genetic variants that met the pathogenic criteria (pathogenic very strong, pathogenic strong, pathogenic moderate, or pathogenic supporting) based on the American College of Medical Genetics and Genomics Standards and Guidelines for either ENG or ACVRL1: 26 from 12 families (50%) for ENG, and 16 from 12 families (50%) for ACVRL1. Diagnostic screening of 42 genetically positive HHT patients based on the Curaçao criteria revealed that 24 patients (57%) were classified as having definite HHT, 17 (41%) as having probable HHT, and 1 (2%) as unlikely to have HHT. Epistaxis was the most common clinical presentation (38/42, 90%), followed by visceral AVMs (24/42, 57%) and telangiectasia (21/42, 50%). Five patients (12%) did not have a family history of HHT clinical symptoms. @*Conclusion@#. Only approximately half of patients with ACVRL1 or ENG genetic variants could be clinically diagnosed as having definite HHT, suggesting that genetic screening is important to confirm the diagnosis.

The Study of Standardization for a Korean Dizziness Handicap Inventory for Patient Caregivers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Several questionnaires had been developed to assess the handicap due to dizziness. The questionnaires for adults were used and these had been translated into Korean with validity and reliability. However, there is no Korean translation of dizziness inquiry form owing to the little concern of the pediatric dizziness. The objective of this study was to determine the reliability and validity of a Korean Dizziness Handicap Index for Patient Caregivers (KDHI-PC), and revealed the factor analysis of this index. SUBJECTS AND METHOD: We sampled the 24 pediatric patients who had dizziness-related symptoms and visited the hospitals. The patients completed a questionnaire (DHI-PC) that had been translated and reverse translated into Korean. The results of this investigation were analyzed using exploratory factor analysis, Cronbach's α coefficient and internal consistency reliability. RESULTS: By exploratory factor analysis, KDHI-PC was divided into two scales. This questionnaire showed a good internal consistency (Cronbach's α=0.945). All items had good item-total correlations. CONCLUSION: The KDHI-PC is a reliable tool for evaluating the dizziness of pediatric patients.

The Study of Standardization for a Korean Dizziness Handicap Inventory for Patient Caregivers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Several questionnaires had been developed to assess the handicap due to dizziness. The questionnaires for adults were used and these had been translated into Korean with validity and reliability. However, there is no Korean translation of dizziness inquiry form owing to the little concern of the pediatric dizziness. The objective of this study was to determine the reliability and validity of a Korean Dizziness Handicap Index for Patient Caregivers (KDHI-PC), and revealed the factor analysis of this index.SUBJECTS AND METHOD: We sampled the 24 pediatric patients who had dizziness-related symptoms and visited the hospitals. The patients completed a questionnaire (DHI-PC) that had been translated and reverse translated into Korean. The results of this investigation were analyzed using exploratory factor analysis, Cronbach's α coefficient and internal consistency reliability.@*RESULTS@#By exploratory factor analysis, KDHI-PC was divided into two scales. This questionnaire showed a good internal consistency (Cronbach's α=0.945). All items had good item-total correlations.@*CONCLUSION@#The KDHI-PC is a reliable tool for evaluating the dizziness of pediatric patients.

Analysis of Characteristics and Steroid Effects in Olfactory Dysfunction Patients

BACKGROUND AND OBJECTIVES: Olfactory dysfunction is a common sensory disorder, but there are currently no standard diagnostics or therapeutic methods. We analyzed the effects of systemic steroid therapy in patients with olfactory dysfunction. MATERIALS AND METHOD: We analyzed patients who visited our ENT department with olfactory dysfunction for 3 years. We reviewed their charts and classified the patients according to age, sex, etiology of olfactory dysfunction, degrees of olfactory dysfunction and the effect of systemic steroid therapy. RESULTS: The mean age was 44.3 years old and there were 50 males and 55 females; 55 patients had inflammatory disease and 50 patients had non-inflammatory disease. The distribution of degrees of olfactory disorder according to cause was not significantly different (p=0.120). In 105 patients, 20% experienced improvements after systemic steroid therapy, and the response of systemic steroid therapy was better among patients with inflammatory causes. In cases of inflammatory disease, there was a larger amount of severe hyposmia patients, and their response to systemic steroid therapy was significant (p=0.015). Patients with mild and moderate hyposmia were more responsive to systemic steroid therapy than patients with severe hyposmia (p=0.382). CONCLUSION: In cases of hyposmia due to inflammatory disease, systemic steroid therapy with proper operative management may increase therapeutic effects.

Injection Laryngoplasty for The Treatment of Vocal Fold Scar, and Sulcus

BACKGROUND AND OBJECTIVES: The clinical reports for the treatment of vocal fold scar and sulcus vocalis are limited, also there is no best one for the treatment of them. This study is to evaluate the effect of Injection laryngoplasty (IL) for the treatment of vocal fold scar and sulcus vocalis. MATERIALS AND METHODS: from January 2013 to May 2015, the Nineteen patients who were diagnosed as vocal fold scar, sulcus and atrophy, and underwent IL, were engaged in this study. Clinical information and voice parameters were analyzed by retrospective chart review. Pre and post voice parameters were compared. RESULTS: Subgroups of diagnosis were classified into sulcus vocalis for 12 patients, vocal fold scar for 5, and atrophy for 2. IL was performed under local anesthesia through cricothyroid membrane except one patient. Atesense®, Radiessess®, and Rofilan® were used as injected materials in 9, 9, and 1 patients respectively. Maximal phonation time (p=0.0124), dynamic range (p=0.0028), pitch range (p=0.0141), voice handicap index (p=0.028), glottal closure (p=0.0229), and mucosal wave (p=0.0132) had significant improvement for post-IL voice assessment than Pre-IL. While GRBAS, Mean flow rate, Jitter, Shimmer, Harmony to Noise ratio didn't have improvement. CONCLUSION: IL is a feasible option for the treatment of glottis incompetence with normally mobile vocal folds such as sulcus vocalis and vocal fold scar.

The Symptom Improvement of Adjunctive Hypochlorous Acid Nasal Cavity Irrigation in Post-Surgically Intractable Chronic Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Low concentration hypochlorous acid is known for being an endogenous anti-bacterial and anti-viral agent. Saline irrigation has been used as an adjunctive treatment for patients with chronic sinusitis. In this study, we tried to compare the effectiveness of hypochlorous acid and saline nasal irrigation to patients with intractable sinusitis after surgery. SUBJECTS AND METHOD: A total of 35 patients who had a frequent relapse of chronic sinusitis or had persisting symptoms post-surgically were recruited. The experimental group was given hypochlorous acid and saline nasal irrigation, while the control group was given saline nasal irrigation for eight weeks. The curative effects were assessed on the basis of the symptom score, nasal endoscopic score, bacterial culture, and inflammatory cytokines on the first day, fourth week, and eighth week after treatment. RESULTS: A total of 26 participants were assessed. The study finally consisted of 15 patients in experimental group and 11 in the control group. The symptom scores in the experimental group were substantially lower before, and after four and eight weeks of treatment. However, there was no specific difference in symptom score improvement between the two groups. The endoscopic score improved in experimental group (p<0.01). Similar tendencies were shown in the bacterial culture test of both groups. In the experimental group, the values of TNF-alpha, IL-8, and IL-1beta decreased in the fourth week, whereas they increased in the eighth week. CONCLUSION: Hypochlorous acid nasal irrigation may be to used as an alternative adjunctive treatment in addition to saline irrigation.

Treatment of Facial Bone Fracture Using Octyl-2-Cyanoacrylate: Case Report

Precise fixation of fracture fragments is important for the successful management of facial bone fractures. However, the conventional metal plates and screws used in such procedures are sometimes difficult to place when the facial bone fracture occurs in a narrow area or has significant comminution. We report herein our experience with 6 patients with facial fractures, which were difficult to fix using titanium plates and screws. All injuries were satisfactorily repaired using octyl-2-cyanoacrylate (OCA). In addition, there were no significant complications related to OCA during the follow-up period.

Bilateral Maxillary Dentigerous Cysts in a Non-Syndromic Patient / 대한이비인후과학회지

Dentigerous cysts are the most common type of developmental odontogenic cysts and the second most common odontogenic cyst of the jaw after radicular cysts. Dentigerous cysts are usually solitary, but can be multiple in patients with certain syndromes, such as mucopolysaccharidosis type IV. There are cases of multiple cysts occurring in non-syndromic patients as well. A fourteen-year-old girl presented to our department with painful swelling in the left cheek. Except for the bulging of the left nasal lateral wall, the physical examination was unremarkable and all routine laboratory test results were within normal limits. Computed tomography (CT) showed a well-defined soft tissue density obliterating both maxillary sinuses with a tooth in the medial wall. We removed the cyst and teeth with forceps via a large middle meatal antrostomy. The pathology revealed a non-keratinized squamous epithelial lined cyst associated with the teeth.

The Present State of Korean Traditional Medicine and Alternative Medicine in Nasal Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Alternative medicine is becoming increasingly popular and is frequently used for treating patients with nasal diseases. While western medicine and operative treatment are proven treatments, herbal medicine and alternative medicine are widely used without any supporting evidence for treating cases of allergic rhinitis, sinusitis and hypertrophic rhinitis. So, we have tried to assess the present state of Korean traditional medicine (KTM) and alternative medicine for treating nasal cavity diseases. MATERIALS AND METHOD: We surveyed 204 patients who visited our department and were diagnosed with allergic rhinitis, sinusitis, deviated septum and/or hypertrophic rhinitis. The questionnaire included questions about whether or not the patients had tried KTM or alternative medicine, the reason for using KTM or alternative medicine, the frequency, kind, duration, effectiveness, cost and satisfaction and side effects. RESULTS: Among 204 patients, 14% of the patients had used KTM and 18% of the patients had used alternative medicine. The percent of those who had used KTM or alternative medicine in each of the allergic rhinitis patient, the sinusitis patient and the deviated septum with hypertrophic rhinitis patient groups were 46, 41, and 24%, respectively. The satisfaction rate for KTM was 47% and that for alternative medicine was 40%. The satisfaction rate for western medicine was higher than that for KTM and alternative medicine. CONCLUSION: Many patients used non-western medicine with obscure expectations. However, KTM and alternative medicine are not evidence-based treatments, so further research and education for patients are needed.

The Treatment of Maxillary Sinus Benign Tumor with Osteoplastic Technique and Nasal Endoscopic Approach

OBJECTIVE: This article describes use of the osteoplastic technique in the treatment of maxillary benign tumors. This procedure yielded favorable outcomes in situations where the tumor was difficult to remove using the standard endoscopic approach. METHODS: This study included six sinuses of six patients with maxillary sinus benign tumors (five inverted papillomas and one hemangioma). The tumors were located in the anterior wall of the maxillary sinus and were difficult to remove by the endoscopic approach. The traditional gingivobuccal incision was performed to expose the anterior maxillary sinus wall. A rectangular bone flap was designed on the anterior maxillary wall and a bony window was made using a reciprocating saw. After eradicating all lesions, the bone flap was repositioned to its original site and fixed with a miniplate. Postoperative paranasal sinus computed tomography was performed after 12 and 24 months. RESULTS: All bone flaps healed without any complications. Patients had succes-sful postoperative outcomes without any complications. In one inverted papilloma case, the lesion recurred and was removed easily with the same procedure. CONCLUSION: The osteoplastic technique is a simple and useful method to eradicate benign lesions in the maxillary sinus due to its good access to the maxillary sinus antrum, optical surgical view, and minimal complications.

A Case of Infection of Tutoplast-Processed Fascia Lata in Augmentation Rhinoplasty

Numerous materials have been used in augmentation rhinoplasty. The representative materials include silastics, Gore-Tex, autologous cartilage, and homologous materials. The use of alloplastic materials in rhinoplasty is often discouraged due to possible risk of infection and extrusion. Currently, the use of Tutoplast-processed fascia lata (TPFL) in augmentation rhinoplasty is increasing in Korea because it can avoid donor site morbidity and decrease the surgical time. However, there have been no reports of infections related to rhinoplasty using TPFL in Korea. We experienced a case of infection that occurred after rhinoplasty using TPFL. We report this case along with a brief review of the literature.

The Effect of Asian Sand Dust in Allergic Inflammation of Allergic Mouse / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Asian sand dust (ASD) is known to aggravate the respiratory symptoms in patients with bronchial asthma. However, the effect of ASD in allergic rhinitis is not known. The objective of this study was to investigate whether ASD can activate the allergic inflammation in allergic mouse model. MATERIALS AND METHOD: Forty female BALB/c mice were divided into 4 groups. Group 1 was nebulized with saline and group 2 with ASD. Group 3 was nebulized with ovalbumin (OVA) only and Group 4 with OVA plus ASD after intraperitoneal injection with OVA. The allergic symptom scores were checked. The mouse OVA specific IgE/IgG1, IL-4, IL-5 and IFN-gamma were measured by ELISA. The nasal mucosa was examined for the expression of IL-4 and IL-5 by immunohistochemical stain. RESULTS: The average symptom score was increased in Group 4 compared to Group 3 (p< 0.05). The IgE was significantly increased in Group 4 compared to Group 3 (p< 0.01). The IL-4 level of nasal lavagefluid (NALF) was significantly increased in Group 4 compared to Group 3 (p< 0.05). The IL-5 level showed no significant difference between the Group 3 and Group 4 both in the serum and NALF. The level of IFN-gamma was not changed in NALF. Immunohistochemical staining showed that the positive cells for IL-4 were expressed in epithelial layer and submucous gland and the positive cells were more increased in Group 4 than in Group 3. CONCLUSION: In allergic mouse model, ASD has shown to activate the allergic inflammatory reaction by the stimuli of Th2 cytokineproduction.

Cerebellar Venous Angioma Confused with Peripheral Vestibulopathy / 대한이비인후과학회지

Venous angioma is a congenital disease of vascular malformation, which is a mass like lesion consisted of dilated medullary veins. It is generally a silent lesion since it is found in normal brain tissues and tends to have low blood flow and pressure. The venous angioma could be diagnosed with magnetic resonance imaging and angiography, but most of them are incidentally diagnosed, because it is usually asymptomatic. The patients with venous angioma have nonspecific symptoms, such as headache, nausea and vomiting, seizures, progressive neurological deficit and hemorrhage. In particular, the venous angioma in cerebellum could cause hearing disturbance, tinnitus and dizziness. We report a case of venous angioma in cerebellum that had been mistaken for peripheral vestibulopathy in a patient complaining of dizziness

A Case of Post-Traumatic Cerebrospinal Fluid Rhinorrhea with Encephalocele / 대한이비인후과학회지

Posttraumatic cerebrospinal fluid (CSF) leakage may frequently develop after a skull base fracture. A patient with a 1-month history of intermittent watery rhinorrhea was referred to our department from the Department of Neurosurgery. He had been treated for 8 months due to a skull base fracture after a motor vehicle accident. He had undergone cranial trephination due to brain abscess prior to this presentation. On radiologic examination, a large skull base defect with encephalocele was observed. Using the nasal endoscopic approach, we identified a large protruding mass of soft brain tissue with pulsating CSF in the ethmoid roof. CSF lumbar drainage was performed in order to reduce the protruding mass by decreasing intracranial pressure. After CSF lumbar drainage, the protruding brain tissue was returned to the cranial cavity, and the leak site was successfully repaired with septal cartilage and graft material.

A Case of Tolosa-Hunt Syndrome

Tolosa-Hunt syndrome (cavernoussinusitis) is a term used to describe diseases involving the content of the superior orbital fissure and/or anterior cavernous sinus, presenting as painful ophthalmoplegia, along with granulomatous inflammation. The third, fourth, fifth and sixth cranial nerves pass through the carvenous sinus. Thus, when infection spreads into the cavernous sinus, these cranial nerves may be paralyzed and corneal reflexes may disappear. Pain and hypoesthesia of the area, which is innervated by the maxillary branch of the fifth nerve, can be accompanied with this syndrome. Tolosa-Hunt syndrome can be improved dramatically with high-dose steroid therapy. A 15-year-old boy who had retro-orbital pain, diplopia and exophthalmos was diagnosed with sphenoid sinusitis by PNS CT. He underwent brain MRI and neurologic examination because the symptoms persisted after the endoscopic sinus surgery. He was finally diagnosed with Tolosa-Hunt syndrome and his symptoms were improved with steroid therapy.

A Case of Orbital Medial Wall Fracture in a Pilot

Incidences of blowout fractures have increased due to rapid industrialization and rise in violent crimes. However, there have been few studies on the proper follow-up guidelines or protocol after reduction of the orbital wall for patients working in a high atmospheric pressure environment. We have experienced a pilot with an orbital medial wall fracture who underwent reduction through an endoscopic approach. The patient underwent the Valsalva maneuver and scan of paranasal sinuses 8 weeks after reduction. Emphysema did not occur in the orbit even after the Valsalva maneuver and he was able to return to his workplace without any complications. We report this case with a brief review of the literature.

Predictive Satisfactory Factors of the Nasal Bone Fracture Treatment

BACKGROUND AND OBJECTIVES: There are many factors affecting the satisfactory results of nasal bone fracture, such as age, sex, severity of nasal bone fracture and the time from the onset of injury to the beginning of treatment etc. The aim of this study is to evaluate the predictable factors of satisfaction for nasal bone fracture treatment. MATERIALS AND METHODS: The authors retrospectively reviewed the medical records of 85 patients with nasal bone fracture to examine and analyze according to sex and age distribution, cause of injury and the time from the onset of injury to the beginning of treatment. RESULT: In this study, age, sex and severity of nasal bone fracture were found to be unrelated to the satisfactory result. The time from the onset of injury to the beginning of treatment is statistically related to the satisfactory result of nasal bone fracture (p<0.05). CONCLUSION: Early intervention of nasal bone fracture is necessary to obtain satisfactory results.

Efficacy of Rotating Chair Test And Caloric Test For The Diagnosis of Acute Unilateral Vestibular Neuritis

BACKGROUND AND OBJECTIVES: The acute unilateral vestibular neuritis is fairly a common disease and the precise diagnostic tool is needed for the selection of effective treatments. Therefore, we studied the clinical usefulness of the rotatory chair test and caloric test which have been commonly used in patient of acute unilateral vestibular neuritis. MATERIALS AND METHODS: One hundred and sixty four patients who were diagnosed with acute unilateral vestibular neuritis from August of 2004 to June of 2007 were included. Their medical records of the rotating chair test and caloric test were reviewed retrospectively to study the correlation of the two tests. RESULTS: Of 164 patients, 101 patients (61.6%) and 88 patients (53.7%) showed significant canal paresis (CP) and directional preponderance (DP) on the caloric tests that corresponded with the physical exam. 130 patients (79.3%) and 84 patients (51.2%) showed significant asymmetry and time constant (Tc) on the rotating chair test that corresponded with the predictive direction with spontaneous nystagmus. CONCLUSIONS: For acute unilateral vestibular neuritis patients, the asymmetry of the rotatory chair test showed the highest correlation with clinical findings. But physical exam should be preceded because neither rotator chair test nor caloric test yields a specific correlation with the physical exam. Especially, single test only may too many false negative results. For these tests can reduce false positive cases of the physical exam and raise the specificity of the diagnosis, the planning of proper treatments should be followed thereafter.

Evaluation of the Obstructive Site in Patients with Obstructive Sleep Apnea Using Sleep Endoscopy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep endoscopy is a valuable modality for an anatomical assessment in patients with snoring and obstructive apnea. The aims of this study is to observe the anatomical obstructive site using sleep endoscopy and to compare the sleep endoscopic findings and the results of the Mueller maneuver in clinical setting. SUBJECTS AND METHOD: Thirty patients with obstructive sleep apnea syndrome underwent sleep endoscopy. After intravenous administration of midazolam, obstructive events were observed. The levels of obstruction were classified as palatal, palatal with tonsil and palatal with tongue base. Obstruction was defined when the site was collapsed more than 50% compared with normal respiration during the apneic episode. RESULTS: On sleep endoscopy, retropalatal obstruction was observed in 14 patients (47%). Obstruction in the retropalatal area combined with the tonsillar area was found in 9 patients (30%). Obstruction in the retropalatal area combined with the tongue base area was found in 7 patients (23%). However, the results of Mueller maneuver showed retropalatal obstruction in 19 patients (63%), obstruction in the retropalatal with tonsillar area in 9 patients (30%) and obstruction in the retropalatal with tongue base area in 2 patients (7%). CONCLUSION: Sleep endoscopy is a useful modality to assess the accurate anatomical site of obstruction during sleep state and provide information useful in planning of further treatment.