Predictors of Early and Late Response to Esomezol and Lifestyle Modification in Adults With Laryngopharyngeal Reflux Disease: A Prospective, Multicenter, Open-Label Cohort Study

Objectives@#. This study aimed to assess predictors of the response to varying durations of proton pump inhibitor (PPI) use and lifestyle modification treatment for laryngopharyngeal reflux disease (LPRD). @*Methods@#. Between October 2014 and June 2016, a prospective, multicenter, open-label, single-cohort, intention-to-treat, observational study was conducted at eight referral hospitals across the Republic of Korea to examine predictors of early and late response to treatment in adult patients (age ≥19 years) with LPRD. Participants underwent standard treatment (PPI [Esomezol] and lifestyle modification) for 3 months. Response to treatment was defined as greater than 50% improvement in reflux symptom index score. The primary outcome was potential predictors of treatment response at 1 and 3 months. The secondary outcome was potential predictors distinguishing early from late responders. @*Results@#. In total, 394 patients were enrolled. Improved sleep habits was a positive predictor (odds ratio [OR], 1.785; 95% confidence interval [CI], 1.06–3.007; P=0.029), while initial alcohol consumption (OR, 0.587; 95% CI, 0.355–0.969; P=0.037) and past medication history (OR, 0.438; 95% CI, 0.215–0.891; P=0.005) were negative predictors of response after 1 month of treatment. High pre-reflux finding score was a positive predictor (OR, 1.187; 95% CI, 1.049– 1.344; P=0.007), while male sex (OR, 0.516; 95% CI, 0.269–0.987; P=0.046), higher depression score (OR, 0.867; 95% CI, 0.784–0.958; P=0.005), and past thyroid hormone medication history (OR, 0.161; 95% CI, 0.033–0.788; P=0.024) were negative predictors of response after 3 months of treatment. Past medication history (OR, 0.438; 95% CI, 0.215–0.891; P=0.023) was the only negative predictor for early responders compared to late responders. @*Conclusion@#. Adult patients with LPRD and a history of prior medication use may require longer treatment durations to achieve a therapeutic response. Future research should explore the incorporation of diverse treatment approaches to improve treatment outcomes for patients exhibiting negative prognostic indicators.

Comparison of the Voice Outcome After Injection Laryngoplasty: Unilateral Vocal Fold Paralysis Due to Cancer Nerve Invasion and Iatrogenic Injury

Background and Objectives@#Injection laryngoplasty is a common method for treatment of unilateral vocal fold paralysis. Unilateral vocal fold paralysis has various causes, including idiopathic, infection, stroke, neurologic condition, surgery and nerve invasion by cancer. To the knowledge of the authors, there was no study on the relationship between the causes of vocal cord paralysis and the outcome of injection laryngoplasty. Therefore, we tried to investigate the difference in the outcomes of injection laryngoplasty between vocal cord paralysis after surgery group and nerve invasion by cancer group.Materials and Method A retrospective analysis was performed for 24 patients who underwent vocal cord injection due to unilateral vocal cord paralysis caused by surgery or nerve invasion by cancer. The objective quality of the voice was assessed by acoustic voice analysis with the Multi-Dimensional Voice Program. @*Results@#Both group showed an improvement of fundamental frequemcy (F0), jitter percent, shimmer (percent), and noise to hearmonic ratio (NHR) after injection laryngoplasty. The vocal cord paralysis due to nerve invasion group showed more improvement in both the mean and median value of F0, shimmer percent and NHR than the vocal cord paralysis due to surgery group, but there was not statistically significant. @*Conclusion@#Our study did not show a statistically significant difference in outcome between vocal cord paralysis due to cancer invasion group and surgery group, but statistically tendency was suggested. The vocal cord paralysis due to nerve invasion group showed more improvement in both the mean and median value of acoustic voice analysis than surgery group.

A Case of Intrathyroidal Spread of Papillary Thyroid Carcinoma / 대한두경부종양학회지

Papillary thyroid carcinoma (PTC) typically has a good prognosis, but it frequently metastasizes to the regional lymph nodes. Although survival impact of lymph node metastasis is not clear, complementary treatment is generally added after surgery when lymphatic metastasis exists. Several previous studies have reported that the multifocal PTC is associated with poor prognosis and requires selective neck dissection to prevent regional lymph node metastasis, but they are under controversy. In this study, we present a 24-year-old female patient, diagnosed as PTC with intrathyroidal spread and regional lymph node metastases. Intrathyroidal spread of PTC can only be observed microscopically and is believed to have the similar origin of unicentric multifocal PTC. As multifocal PTC is highly associated with regional lymph node metastasis and requires an additional treatment, PTC with intrathyroidal spread may follow a similar clinical course and treatment plan. Here we report the case with a brief literature review and expect its attribution to further academic interest of treatment choice.

A Case of Intrathyroidal Spread of Papillary Thyroid Carcinoma / 대한두경부종양학회지

Papillary thyroid carcinoma (PTC) typically has a good prognosis, but it frequently metastasizes to the regional lymph nodes. Although survival impact of lymph node metastasis is not clear, complementary treatment is generally added after surgery when lymphatic metastasis exists. Several previous studies have reported that the multifocal PTC is associated with poor prognosis and requires selective neck dissection to prevent regional lymph node metastasis, but they are under controversy. In this study, we present a 24-year-old female patient, diagnosed as PTC with intrathyroidal spread and regional lymph node metastases. Intrathyroidal spread of PTC can only be observed microscopically and is believed to have the similar origin of unicentric multifocal PTC. As multifocal PTC is highly associated with regional lymph node metastasis and requires an additional treatment, PTC with intrathyroidal spread may follow a similar clinical course and treatment plan. Here we report the case with a brief literature review and expect its attribution to further academic interest of treatment choice.

A Case of Newly Found Lymphoepithelial Carcinoma in Retropharynx of the Patient Who Had Been in the NED State of Nasopharyngeal Carcinoma: Controversy about the Recurrence of Undiffentiated Nasopharyngeal Carcinoma / 대한이비인후과학회지

Lymphoepithelial carcinoma is a rare subtype of head and neck malignancy. Histologically, it is an undifferentiated carcinoma accompanied by a prominent reactive lymphoplasmacytic infiltrate. We report a case of anewly found lymphoepithelial carcinoma in the retropharynx of a patient who had been diagnosed and treated as nasopharyngeal carcinoma with multiple metastasis; the case could not be ruled out as a recurrence of nasopharyngeal carcinoma according to recent World Health Organization pathology guideline.

Two Cases of Transoral Resection of Retropharyngeal Lymph Node Metastasis from Papillary Thyroid Carcinoma Diagnosed by PET-CT Follow-Up after Lateral Neck Dissection / 대한이비인후과학회지

The presence of lymph node metastasis of thyroid papillary carcinoma usually occurs in the internal jugular and paratracheal space on the side of the lesion. For this reason, metastasis to the retropharyngeal lymph nodes from papillary thyroid carcinoma is rare. We currently experienced two cases of retropharyngeal lymph node metastasis of thyroid papillary carcinoma. Both patients had a history of total thyroidectomy and ipsilateral neck dissection and had undergone retropharyngeal lymph node dissection via transoral approach after the diagnosis of retropharyngeal node metastasis. We suggest that the metastatic retropharyngeal lymph nodes can be successfully removed through transoral apparoach. The diagnosis of this rare lymph node metastasis requires sufficient imaging studies such as MRI, CT or PET-CT as well as appropriate history taking and physical examination.

Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.

Study on Assessment and Treatment Patterns of Speech-Language Pathologists in Pediatric Vocal Problem Through Multicenter Survey

BACKGROUND AND OBJECTIVES: Pediatric vocal health problems are relatively common. However, it is not yet well studied whether uniform diagnosis and treatment is done properly in South Korea. The purpose of this study was to investigate the methods that the Korean speech therapists use to diagnose and treat pediatric voice problem. MATERIALS AND METHOD: An anonymous online questionnaire was administered to 32 speech language therapists registered at the Korean laryngeal speech linguistics society detailing demographics, employment institution, general management of pediatric patients with vocal problem including assessment and treatment procedures. RESULTS: Current practice patterns were analyzed on 32 speech language therapists providing services in South Korea mostly working at tertiary university hospital. One third of pediatric patients were assessed without proceeding to treatment. One fifth of patients were treated without assessment. Perceptual assessment was the main pre-treatment assessment methods used. Treatment was done in the following order : Voice rest, SOVT, yawn-sigh and resonant voice. Post-treatment evaluation was used in the following order : Instrumental assessment, clinical judgment, and recording comparison. CONCLUSION: Speech language therapists practice in South Korea mostly follows the ASHA practice guidelines. However, there are still great amount of cases in which only the evaluation was done without appropriate treatment. Further research is needed to make SPLs more systematic and efficient for evaluating and treating pediatric vocal patients.

Two Cases of Transoral Resection of Retropharyngeal Lymph Node Metastasis from Papillary Thyroid Carcinoma Diagnosed by PET-CT Follow-Up after Lateral Neck Dissection / 대한이비인후과학회지

The presence of lymph node metastasis of thyroid papillary carcinoma usually occurs in the internal jugular and paratracheal space on the side of the lesion. For this reason, metastasis to the retropharyngeal lymph nodes from papillary thyroid carcinoma is rare. We currently experienced two cases of retropharyngeal lymph node metastasis of thyroid papillary carcinoma. Both patients had a history of total thyroidectomy and ipsilateral neck dissection and had undergone retropharyngeal lymph node dissection via transoral approach after the diagnosis of retropharyngeal node metastasis. We suggest that the metastatic retropharyngeal lymph nodes can be successfully removed through transoral apparoach. The diagnosis of this rare lymph node metastasis requires sufficient imaging studies such as MRI, CT or PET-CT as well as appropriate history taking and physical examination.

A Case of Newly Found Lymphoepithelial Carcinoma in Retropharynx of the Patient Who Had Been in the NED State of Nasopharyngeal Carcinoma: Controversy about the Recurrence of Undiffentiated Nasopharyngeal Carcinoma / 대한이비인후과학회지

Lymphoepithelial carcinoma is a rare subtype of head and neck malignancy. Histologically, it is an undifferentiated carcinoma accompanied by a prominent reactive lymphoplasmacytic infiltrate. We report a case of anewly found lymphoepithelial carcinoma in the retropharynx of a patient who had been diagnosed and treated as nasopharyngeal carcinoma with multiple metastasis; the case could not be ruled out as a recurrence of nasopharyngeal carcinoma according to recent World Health Organization pathology guideline.

Merkel Cell Carcinoma of Cheek: 2 Case Reports / 대한이비인후과학회지

Merkel cell carcinoma (MCC) is a rare aggressive skin cancer with the mortality rate of 33%. MCC was first described by Toker in 1972 as a trabecular cell carcinoma and is classified as a neuroendocrine tumor similar to small cell lung carcinoma and melanoma. The pathogenesis of MCC remains largely unknown. However, ultraviolet radiation and immunosuppression are likely to play a significant pathogenic role. The primary skin lesion is usually asymptomatic and it typically presents as a red or purple dome-shaped nodule. The management of MCC is controversial, however, local wide excision followed by radiotherapy is accepted as the primary treatment modality. The regional draining nodal basin is the most common site for recurrence. Therefore, sentinel lymph node biopsy is recommended in all cases, except for the clinically node-negative cases. We herein report two cases of MCC on the left cheek with different clinical manifestations.

Clinical Characteristics of Benign Oral Cavity Tumors: A Single-Institution Retrospective Study of 257 Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The study aimed to analyze the histopathologic types and clinical characteristics of benign oral cavity tumors and to identify their possible etiologic factors. SUBJECTS AND METHOD: This was a 10-year retrospective analysis of histologically diagnosed benign tumors in the oral cavity. Data was compiled for each case, documenting information about gender, age, habits (smoking and alcohol), characteristics of the lesion (site, size, color, surface and consistency), comorbidities and denture. RESULTS: Of 257 pathologically confirmed cases of excisional biopsies, the most prevalent were in the order of mucocele (47.08%), fibroma (14.79%), and hemangioma (9.34%). Labium (50.19%) and oral tongue (22.18%) were among the most frequently affected sites. In this study, there was a significant female predominance in fibroma and granuloma. On comparing the mean age of the patients for the different types of tumors, we found that mucocele had the lowest age and that there is a similar mean age among the tumors. The vast majority (99.2%) was represented by non-ulcerated masses and only 2 (0.8%) were ulcerative masses. With respect to habits, we found no significance between comorbidities and denture. CONCLUSION: Based on this study, we can state that while mucocele is the most frequent benign tumor of the oral cavity, labium is the most frequently affected site. The mean age of the patients is lowest for mucocele, and there is a high prevalence of fibroma and granuloma occurring among females. However, with respect to habits, we found no significance between comorbidities and denture.

The Impact of Thyroid Nodule Size and Fine-Needle Aspiration Biopsy Result on the Risk of Malignancy in the Patients Who Underwent Thyroidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The frequency of ultrasonography and cytological examinations for thyroid nodules has increased. But the efficacy of fine needle aspiration biopsy varies according to the size of the nodules. The study aimed to identify the effect of thyroid nodule size on malignancy. SUBJECTS AND METHOD: The medical records of patients who underwent total or hemithryoidectomy in a single tertiary hospital were retrospectively analyzed. A total of 204 nodules were obtained from 193 patients who underwent fine needle aspiration biopsy before thyroid surgery. After each nodule was classified by size, the results of the fine needle aspiration test and risk of the final diagnosis were evaluated using logistic regression analysis. RESULTS: The average size of 204 Bethesda class 2 (benign) nodules was 2.99 cm, which was larger than those of other classes (p<0.05). In the final histopathologic diagnosis, there was a difference in size between benign (2.41 cm) and malignant nodules (1.23 cm) (p<0.05). In addition, a logistic regression analysis showed that the nodules below 2.0 cm in size showed an odd ratio of 7.81, compared to the nodules larger than 2.0 cm (p<0.05). CONCLUSION: According to the results of this study, malignancy was higher when the thyroid nodule was less than 2 cm. Therefore, a careful observation is needed for nodules less than 2 cm for which fine needle aspiration biopsy would be recommended. Conversely, it is necessary to reconsider the diagnostic surgery for nodules larger than 2 cm.

A Case of Mucinous Cystadenoma Mimicking Mucoepidermoid Carcinoma in Parotid Gland / 대한이비인후과학회지

Cystadenoma rarely arises in the parotid gland. It grows slowly without pain. Histopathologically, it is subdivided into papillary cystadenoma and mucinous cystadenoma. Mucinous cystadenoma arising from the salivary gland is a very rare benign tumor. A 25-year-old female patient visited our hospital with a left infra-auricular mass. Computed tomography scan showed a 3.1x2.3 cm size heterogeneous lesion with an irregular margin in the left parotid gland. Sono guided gun biopsy was performed to reveal fibrous tissue with atypical epithelial cell with mucin. Suspecting mucoepidermoid carcinoma, partial parotidectomy was performed for treatment and diagnosis. Histopathologic exam revealed mucinous cystadenoma. Cystadenoma of salivary gland has no distinct clinical feature, and is difficult to differentiate clinically from other salivary gland tumors as well as its malignancy. Thus, the possibility of malignancy must be considered for differential diagnosis.

A Case of Neurilemmoma of the Larynx Excised via Trans-Cricothyroid Membrane Approach without Tracheostomy / 대한이비인후과학회지

Neurilemmoma of the head and neck is not rare in parapharynx, but rare in the larynx. The treatment of choice in neurilemmoma of the larynx is a complete surgical resection. A small size lesion can be removed via an endoscopic approach. For a large size lesion, an external approach, such as the median or lateral thyrotomy, or pharyngotomy, can be more useful. These surgical methods often require preliminary tracheostomy to secure the airway. Through a case of neurilemmoma of the larynx, we present this disease and the treatment course of a patient, who has been successfully treated by surgical excision via trans-cricothyroid membrane approach without tracheostomy. Furthermore, we discuss its symptoms, physical examinations, microscopic features and other options of treatment for laryngeal schwannoma through literature reviews.

Two Cases of Bilateral Tonsillar Carcinoma with Extensive Metastasis / 대한이비인후과학회지

Tonsillar carcinoma is the most common cancer of oropharynx. Panendoscope guided biopsy has been estabilished as a diagnostic and therapeutic procedure for patients with cervical nodes from metastasis of unknown origin. There is a controversy about regarding bilateral tonsillectomy as the standard procedure. In studies where bilateral tonsillectomy are routinely performed for diagnosis of unknown primaries, the rates of occult tonsillar carcinoma could be as high as 40%. On the other hand, the incidence of synchronous tonsil carcinoma is exceedingly rare with less than 15 reports in the English literature although synchronous, metachronous carcinomas are more common in head and neck carcinomas than in other sites because the risk factors for the development of carcinomas are shared between the two. We report two cases of bilateral tonsillar carcinoma with literature reviews. In these particular cases, they present an aggressive clinical feature despite small size of the primary lesion. A careful, systemic work up should be performed in bilateral tonsillar carcinoma.

Coblation vs. Electrocautery Tonsillectomy: A Prospective Randomized Study Comparing Clinical Outcomes in Adolescents and Adults

OBJECTIVES: Coblation is operated in low temperature, so it is proposed that tonsillectomy with coblation involves less postoperative pain and allows accelerated healing of the tonsillar fossae compared with other methods involving heat driven processes. However, the results of the previous studies showed that the effect of coblation tonsillectomy has been equivocal in terms of postoperative pain and hemorrhage. Though, most of the previous studies which evaluated coblation tonsillectomy were performed in children. Recently, electrocautery tonsillectomy has been used most widely because of the reduced intraoperative blood loss and shorter operative time compared to other techniques. This prospective study compared intraoperative records and postoperative clinical outcomes in adolescents and adults following coblation and electrocautery tonsillectomies. METHODS: Eighty patients over 16 years of age with histories of recurrent tonsillitis were enrolled. The patients were randomly allocated into coblation (n=40) and electrocautery tonsillectomy groups (n=40). All operations were performed by one surgeon who was skilled in both surgical techniques. Intraoperative parameters and postoperative outcomes were checked. RESULTS: Postoperative pain and otalgia were not significantly different between the two groups; however, there was a tendency towards reduced pain and otalgia in the coblation group. More cotton balls for swabbing the operative field were used introoperatively in the electrocautery group (P=0.00). There was no significant difference in postoperative hemorrhage, wound healing, commencement of a regular diet, and foreign body sensation between the groups. CONCLUSION: Only cotton use, which represented the amount of blood loss, was less in the coblation tonsillectomy group. Coblation tonsillectomy warrants further study with respect to the decreased postoperative pain and otalgia.

A Case of Actinomycosis of the Hypopharynx / 대한이비인후과학회지

Actinomycosis is a rare form of disease caused by Actinomyces such as A. israelii and A. bovis, which may take the form of an acute or a subacute disease progression. Clinically, it is categorized into cervicofacial, thoraxic, abdomen, pelvis, and systemic infections, of which cervicofacial infection accounts for 50%. It presents as a challenging clinical diagnostic dilemma because of variable presentations in the head and neck. Actinomycosis of the hypopharynx is rare. We report a case of actinomycosis in the posterior hypopharyngeal wall presenting as a dysphagia in a 72-year-old woman with a review of the literature.

Does the Kyphotic Change Decrease the Risk of Fall?

OBJECTIVES: Falls are a major problem in the elderly. Age-related degeneration of the human balance system increases the risk of falls. Kyphosis is a common condition of curvature of the upper spine in the elderly and its development occurs through degenerative change. However, relatively little is known about the effect of kyphotic changes on balance in the elderly. The aim of this study is to investigate the influence of kyphosis on the balance strategy through use of the motor control test (MCT) in computerized dynamic posturography. METHODS: Fifty healthy subjects who were not affected by other medical disorders that could affect gait or balance were enrolled in the study. By simulation of kyphotic condition through change of the angles of the line connecting the shoulder to the hip and the ankle axis by approximately 30degrees, the latency and amplitude of the MCT were measured in upright and kyphotic condition. RESULTS: In the kyphotic condition, latency was shortened in backward movement. In forward movement, latency was shortened only in large stimulation. The amplitude in forward movement was decreased in kyphotic condition. However, the change of amplitude was not significant in large intensity backward movement in the same condition. CONCLUSION: Kyphotic condition decreases the latency of MCT, especially in backward movement. These findings imply that kyphotic condition may serve as a protective factor against falls.

Inflammatory Myofibroblastic Tumor of the Nasal Cavity / 대한이비인후과학회지

Inflammatory myofibroblastic tumor is an uncommon tumor composed of myofibroblasts and various types of inflammatory infiltrates that rarely undergoes malignant transformation. It commonly involves the lung, liver, mesentery but rarely affects the head and neck region. Although inflammatory myofibroblastic tumor is generally considered a benign reactive inflammatory process, it may present clinically and radiologically as an invasive mass destructing the surrounding structures. Therefore, it should be considered as one of several differential diagnoses from malignant tumors. We present a case of inflammatory myofibroblastic tumor involving the nasal cavity, maxillary, ethmoid, and sphenoid sinus with a fatal outcome.