Two Cases of the Inverted Papilloma in the Maxillary Sinus Treated by Modified Transnasal Endoscopic Medial Maxillectomy / 대한이비인후과학회지

Although inverted papilloma (IP) of the nose and paranasal sinus is a benign neoplasm, it is associated with frequent recurrence and malignant transformation. Various surgical techniques have been employed for resection of this tumor. Transnasal endoscopic medial maxillectomy (TEMM) is an effective surgical management of IP originating from the maxillary sinus. It usually removes the inferior turbinate, lateral wall of the nasal cavity, and nasolacrimal duct, and may cause adverse effects such as atrophic rhinitis, empty nose syndrome, impairment of nasal physiological function, and epiphora. Recently, however, a modified TEMM, which preserves the inferior turbinate, lateral wall of the nasal cavity, and nasolacrimal duct has been introduced. We present two cases of IP successfully treated by the modified TEMM.

The Usefulness of Rectified VEMP

OBJECTIVES: For a reliable interpretation of left-right difference in Vestibular evoked myogenic potential (VEMP), the amount of sternocleidomastoid muscle (SCM) contraction has to be considered. Therefore, we can ensure that a difference in amplitude between the right and left VEMPs on a patient is due to vestibular abnormality, not due to individual differences of tonic muscle activity, fatigue or improper position. We used rectification to normalize electromyograph (EMG) based on pre-stimulus EMG activity. This study was designed to evaluate and compare the effect of rectification in two conventional ways of SCM contraction. METHODS: Twenty-two normal subjects were included. Two methods were employed for SCM contraction in a subject. First, subjects were made to lie flat on their back, lifting the head off the table and turning to the opposite side. Secondly, subjects push with their jaw against the hand-held inflated cuff to generate cuff pressure of 40 mmHg. From the VEMP graphs, amplitude parameters and inter-aural difference ratio (IADR) were analyzed before and after EMG rectification. RESULTS: Before the rectification, the average IADR of the first method was not statistically different from that of the second method. The average IADRs from each method decreased in a rectified response, showing significant reduction in asymmetry ratio. The lowest average IADR could be obtained with the combination of both the first method and rectification. CONCLUSION: Rectified data show more reliable IADR and may help diagnose some vestibular disorders according to amplitude-associated parameters. The usage of rectification can be maximized with the proper SCM contraction method.

Correction of Caudal Septal Deformity via Open Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Caudal septal deformities are surgically challenging disorders. A number of corrective programs have been described with variable success. Causes of frequent failure in correction of the caudal deformities have been conservatism and unrealistic dependence on incisional method such as cross hatching, and limited comprehension of the extrinsic and intrinsic forces causing caudal deformities. We reviewed and evaluated the surgical techniques for correction of the caudal septal deformities performed at our institution. SUBJECTS AND METHOD: A retrospective study was performed on 24 patients who underwent septal surgeries for severe caudal septal deformities between Feb 2001 to May 2004. With open approach, all deforming forces around the caudal septum were released and definite intraoperative correction was possible. RESULTS: All 24 patients showed definite improvement in terms of functional and anesthetic outcomes. Potential complications related with structural instability as well as other inherent complications of nasal surgery have not been encountered. CONCLUSION: For successful correction of the caudal septal deformities, completed exposure and releasing all the extrinsic forces around the caudal deformities via open rhinoplasty approach is desirable to avoid frequent recurrences.

Bacteriologic Evaluation of Peritonsillar Abscess / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Peritonsillar abscess (PTA) is a collection of pus lateral to tonsil and is located between the fibrous capsule of the palatine tonsil, usually at its upper pole, and the superior to the pharyngeal constrictor muscle. It frequently occurs as a complication of acute tonsillitis. Bacteriology including clinical characteristics in PTA were evaluated. SUBJECTS AND METHOD: Sixty-one patients with peritonsillar abscess, who visited National Medical Center from January 1997 through August 2001 were entered into the study. Each patient was asked to answer a questionnaire for clinical aspects of PTA. Needle aspirations were performed and pus was drained in all cases. Bacterial susceptibility to ampicillin, cephazoline, ciprofloxacin, erythromycin, tetracyclin, and vancomycin was tested on the ioslated bacteria. RESULTS: Among 61 cases, aerobes were isolated in 15 cases (24.6%) and anaerobes in 16 cases (26.2%). There was no significant difference in the culture positive rate of aerobes (p=0.767) and anaerobes (p=1.0) between antibiotics-medicated patients and nonmedicated patients. Among the cultured organisms, peptostreptococcus was the most common and the second most common was beta-hemolytic streptococcus. However, alpha-hemolytic streptococcus, an important pathogen considered in the previous study, was detected at 1.6%. CONCLUSION: Antibiotics medication was not a significant factor in culture positive rate in our study. Peptostreptococcus as an anaerobe and beta-hemolytic streptococcus as an aerobe were the major causes that contributed to the decreased state of peritonsillar abscess and culture positive rate of alpha-hemolytic streptococcus.

Induction of Mucosal Tolerance Using House Dust Mite-Cholera Toxin B Conjugate in Mouse Model of Allergic Rhinitis: Prophylactic and Long-Term Therapeutic Effects / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cholera toxin B (CTB) is an effective immunomodulating agent. Mucosal tolerance is a well recognized method for inducing tolerance, but large amounts of antigen is needed. The dosage required can be dramatically reduced through coupling the antigen to the CTB. This study aimed to examine whether mucosal administration of house dust mite coupled to CTB (HDM-CTB conjugate) would modulate specific type 1 hypersensitivity in the murine model of allergic rhinitis and to evaluate the prophylactic and long-term therapeutic effects. MATERIALS AND METHOD: C57BL/6 mice were sensitized with Dermatophagoides farinae extract. After administration of HDM-CTB conjugate, several parameters of allergic response were evaluated. RESULTS: After mucosal adminstration of HDM-CTB conjugate, allergic symptoms, eosinophilic infiltration into nasal mucosa, specific IgE, and the splenic T cell proliferation after Dermatophagoides farinae allergen challenge were suppressed. CONCLUSION: These findings show that HDM-CTB conjugate has an anti-allergic effect in the murine model of allergic rhinitis and suggest that house dust mite allergy can be modulated with mucosal administration of allergen coupled to CTB.

Diagnostic Efficacy of High Resolution Computerized Tomography (HRCT) on Labyrinthine Fistula / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of the study was to evaluate the diagnostic efficacy of high resolution computed tomography (HRCT) of the labyrinthine fistulae on the temporal bone. MATERIALS AND METHODS: 47 labyrinthine fistula cases that had undergone preoperative HRCT of the temporal bone were reviewed retrospectively. All the patients were proved to have labyrinthine fistulae during the operation for chronic otitis media with cholesteatoma from January 1983 through July 1999. RESULTS: Fistulae on the lateral semicircular canal were more effectively detected (78.6%) with conventional axial and coronal view than other site (21.4%). Detection rates of fistula were increased with decreased thickness of HRCT slices. CONCLUSION: With decreasing thickness of HRCT slices, the temporal bone CT's detection rate of labyrinthine fistulae were increased. For the fistulae on the superior and posterior semicircular canal, the efficacy of the temporal bone CT was limited.

Surgical Experiences of Sylvian AVMs

An AVM located in or adjacent to the sylvian fissure is one of the most difficult to remove because it is surrounded by critical structures such as the basal ganglia and internal capsule and it involves the middle cerebral artery. We have operated on 6 cases of arteriovenous malformation(AVM) in and around the sylvian fissure. We describe the characteristic features of these AVMs from the anatomical and surgical points of view. The surgical results were satisfactory in 5 cases, and 1 patients died.