The Relative Risk of Cancer in Sonographically Detected Thyroid Nodules with Calcifications / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this retrospective study was to evaluate the significance of sonographically detected thyroid calcifications in the diagnosis of thyroid cancer. SUBJECTS AND METHOD: Two hundred ninety-one patients with thyroid disease, including 75 with thyroid cancer and 54 with calcified thyroid nodule, were reviewed during the period of January 2001 to May 2003. Each patient underwent preoperative high resolution sonography to evaluate the thyroid gland for the presence of calcifications. RESULTS: The highest incidence of calcification was found in thyroid cancer (36%), followed by multinodular goiter (20%), follicular adenoma (13%), and single nodular goiter (3%). The incidence of cancer was significantly higher in calcified nodules (50%) than in noncalcified nodules in the entire group (20%) (p<0.001), with a relative risk of 3.9. In the group of solitary thyroid nodules, the incidence of cancer in the calcified nodules (56%) was higher than that in the nodules without calcification (21%) (p=0.002). In the group of multiple thyroid nodules, the incidence of cancer in the calcified nodules (47%) was higher than that in the nodules without calcification (19%) (p=0.001). The relative risk in presence of calcification was 4.6 in the solitary nodules and 3.7 in the multiple nodules. Compared with multiple noncalcified thyroid nodules, the solitary calcified nodules demonstrated a relative risk of 5.2. In patients younger and older than 40 years, the relative risk in the presence of calcification was about the same, around 4. CONCLUSION: The detection of thyroid calcifications by sonography is diagnostically valuable. The presence of calcifications should raise the suspicion of malignancy.

Telelaryngoscopic Findings in the Unilateral Vocal Fold Paralysis with Diplophonia / 대한이비인후과학회지

OBJECTIVES: Diplophonia is the voice of two separate tones through quasi-periodic variations in the vocal cord vibration when an imbalance in the tension and the level applied to the vocal cords. The purpose of this study is to investigate the relationship between the occurrence of the diplophonia and the endoscopic findings in the unilateral vocal cord paralysis. MATERIALS AND METHOD: A retrospective review was employed using video recorded images of larynx with unilateral vocal cord paralysis. A total 104 patients selected for this study complained of voice change due to unilaterally paralyzed vocal cord. Video-recordings were obtained using a laryngeal telescope. The paralyzed positions, bowing, shapes of the paralyzed arytenoids and level differences between two vocal folds were evaluated according to whether diplophonia. existed or not. RESULTS: A large number of patients of paramedian paralysis showed diplophonia when the bowing of paralyzed vocal fold was shown. However, diplophonia was shown in a small number of patients with median and intermediate paralysis. Diplophonia also seems to occur when the vertical mismatch was shown. CONCLUSION: Occurene of diplophonia depends largely on the paralyzed position, adequate glottal gap such as paramedian position, with the presence of bowing of paralyzed vocal cord.

Primary Hodgkin's Lymphoma of the Parotid Gland / 대한이비인후과학회지

Hodgkin's lymphoma with its primary manifestation in the parotid gland is an exceedingly rare entity and seldom described in the literature. The vast majority of lymphoma occurs within lymph nodes. Lymphoma of parotid glands are typically a manifestation of systemic disease processes. This case report describes a parotid gland mass as a first symptom of Hodgkin's lymphoma. The patient underwent surgical excision and chemotherapy. The final diagnosis was established after an excisional biopsy and immunohistochemical staining.

Surgical Morbidity of Intraoral Removal of the Submandibular Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For surgery of chronically inflamed submandibular gland, most head and neck surgeons carry out skin incision on the neck, but several clinical problems after surgery has been mentioned. An intraoral approach as an alternative to the standard transcervical approach has been reported. To evaluate a postoperative morbidity in the intraoral approach for excision of submandibular gland. SUBJECTS AND METHODS: A total of 62 surgery cases for chronic submandibular sialoadenitis with or without stone, including those resulting from benign tumor of submandibular gland, were carried out via intraoral approach during a 3-year period. RESULTS: Most patients (85.5%) had sialoadenitis with or without stone. Early postoperative complications developed in 87.1% of the temporary lingual sensory paresis, followed by temporary limitation of tongue movement in 67.7% and 2 cases of postoperative bleeding and 1 case of abscess formation. The tongue paresis resolved spontaneously in all patients in a mean period of 3-4 weeks, whereas late complications developed in 3 cases of residual salivary gland and abnormal sense of mouth floor and one case of gustatory sweating syndrome. No residual inflammation in Wharton's duct was noted. Neurological complications of hypoglossal and marginal mandibular nerves were not observed at all. CONCLUSION: The major advantages of this approach are no external scar, no injury to the marginal mandibular nerve or to the hypoglossal nerve, and no residual Whartons duct inflammation. The disadvantage is a more difficult dissection to transcervical approach before proper expert due to narrow surgical field, especially in the severe adhesion of salivary gland to surrounding tissue. However, with experience, the intraoral dissection of submandibular gland should be easier.

A Case of Recurrent Facial Palsy with Severe Hypertension due to Dysplastic Kidney and Renal Artery Aneurysm / 대한이비인후과학회지

Facial paralysis was first described in a hypertensive patient by Moxon in 1869. Subsequently, there have been reports and facial palsy is mentioned as a rare feature of hypertension. Recently, we experienced a case of recurrent facial paralysis in a severe hypertensive child. A 13-month-old boy was admitted because of right peripheral facial paralysis. Two months ago, transarterial embolization of his left renal aneurysm with coils was performed due to left renal dysplasia and renal artery aneurysm. On admission, his blood pressure was 200/110 mmHg. He was treated conservatively with antihypertensive agents and his facial paralysis completely resolved during the next two months. One year later, he experienced facial paralysis again. He was admitted and treated with antihypertensive agents. And his paralysis resolved in the next two months. After his left nephrectomy, performed three years later, there was no additional episode of facial paralysis during the next seven years. We report this case with a brief review of literatures.

Pathophysiologic Consideration of Benign Paroxysmal Positional Vertigo due to the Horizontal Semicircular Canal Cupulolithiasis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular disorders. There have been some reports suggesting that directional changing positional nystagmus occurs due to canalolithiasis and cupulolithiasis of the horizontal semicircular canal (HC). The canalolithiasis theory of HC-BPPV is presented with a transient geotropic direction changing horizontal nystagmus as the pathophysiologic mechanism of BPPV. The HC-BPPV cupulolithiasis is characterized by a positional nystagmus that does not fatigue, but persists as long as the position is held, and changes direction in different head positions. There is still a controversy relating to differentiating the lesion side and the otolith adherent sites on the cupula differentiation. The purpose of this study was to differentiate the lesion side and the otolith adherent site on the cupula, and propose a treatment through analyses of clinical features, electronystagmographic (ENG) results, treatment maneuvers and its effectiveness. SUBJECTS AND METHOD: Fifteen patients who showed ageotropic direction changing horizontal nystagmus were included in this study. Supine head turning test was performed to induce positional nystagmus. Various findings of the nystagmus were recorded with ENG. Other ENG tests (visual tracking tests and bithermal caloric test) and magnetic resonance imaging were checked to exclude the possibility of any central lesion. Cupulolith repositioning maneuver (CuRM) was applied on the all patients and these patients were instructed to keep the healthy side at the lateral decubitus position while sleeping. RESULTS: All patients showed significant differences between the intensity of each side nystagmus, and all of them showed stronger ageotropic direction changing horizontal nystagmus when the head was rotated to the unaffected side in a supine head turning test. The nystagmus had a short latency, no fatigability, and persistency in character. Typical nystagmus and spinning sensation in the supine head turning test had completely subsided after physical therapy. CONCLUSION: In the cupulolithiasis of horizontal semicircular canal, ageotropic nystagmus was stronger when the pathological ear was at the uppermost position, and this excitatory nystagmus beats to the lesion side. The proposed CuRM and post-treatment lateral decubitus position kept during the night (while sleeping on the day of treatment) were effective in differentiating the otolith adherent site on the cupula and treating the cupulolithiasis of the horizontal semicircular canal.