A Case of Giant Tonsillolith / 대한이비인후과학회지

The tonsillolith is a white or yellow colored calcified lesion that forms in the crypts of the palatine tonsil. Small tonsilloliths are frequently found on tonsils, while giant tonsilloliths are a rare clinical entity. We had a 35-years old female patient, who presented throat discomfort due to a giant tonsillolith. The stone was removed and tonsillectomy was performed. We reviewed the literature on this rare clinical entity.

Shielded Swab: A New Swab Technique Avoiding Contamination in Endoscopically Guided Middle Meatal Culture / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopically guided middle meatal culture is recommended to determine organ-specific antibiotic therapy in sinusitis. This study was designed to decrease the chance of contamination in endoscopically guided middle meatal swab through a shielded pathway using a sterile straw to bypass the contaminated area in the nose from the vestibule to the middle meatus. SUBJECTS AND METHOD: Seventeen healthy volunteers underwent endoscopically guided middle meatal culture. With or without the sterilization of the nasal vestibule, endoscopically guided middle meatal culture was performed by using a sterile cotton swab (routine swab) and using a sterile cotton swab through a sterile straw (shielded swab). We compared the contamination rates between the routine swab versus shielded swab. RESULTS: With and without the sterilization of the nasal vestibule, the contamination rates of the routine swab was 11.7% and 64.7%, respectively and the contamination rates of the shielded swab was 5.8% in both. CONCLUSION: In endoscopically guided middle meatal culture, the contamination rates was significantly decreased by using the shielded swab without sterilization of the nasal vestibule. This study suggests that the shielded swab is a new and reliable swab method that can be used easily and simply at the office.

Analysis of 32 Cases of Acute Laryngeal Trauma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngeal trauma occurs uncommonly, but when it does, it can cause acute airway obstruction and longterm voice and airway problems. The purpose of this study was to analyze the clinical presentation of larynx trauma and to assess the outcome of the treatment. MATERIALS AND METHOD: We analyzed the medical records of 32 patients with acute laryngeal trauma from 1992 to 2006, retrospectively. RESULTS: The most common cause of injury was traffic accident. Voice change was the most common symptom. Vocal cord palsy in patients with redistributed in minor injury was improved in all of the group that received conservative management. If there are significant endolaryngeal laceration or arytenoid disruption, which can occur with major trauma, consideration should be given to placing an endolaryngeal stent. But there was no difference in improvement rates between those receiving treatment with stent and those without stent. Thus, consider severity, treatment with stent is likely to yield to significant benefit. CONCLUSION: Vocal cord palsy in patients with redistributed in minor trauma may be managed conservatively. We conclude that patients with major trauma of endolaryngeal mucosa should use a stent in their treatment.

A Rat Model of Acute Rhinosinusitis Induced by Alpha-Toxin of Staphylococcus Aureus

BACKGROUND AND OBJECTIVES: Staphylococcus Aureus (S. Aureus) is one of the most common and predominant form of bacteria in the nasal airway that roduces toxin. Alpha toxin from S. Aureus, also known as alpha-hemolysin, causes damage to the membrane in many types of cells. The purpose of this study is to develop a rat model of rhinosinusitis induced by the intra-nasally applied alpha-toxin of S. Aureus. MATERIAL AND METHODS: Forty micro-liters of 100 microgram/ml of alpha-toxin was applied intra-nasally to 4-6 weeks-old Sprague-Dawley rats and the same amount of vehicle was applied to control rats. At days 1, 5 and 14 the rats were sacrificed and their nasal cavity prepared for histological investigation. RESULTS: Inflammatory cell clusters were observed in the alpha-toxin applied rats. The number of sinus air spaces occupied by inflammatory cell clusters increased significantly at days 1 and 5 compared with the control rats. Comparisons across the time interval demonstrated statistically significant changes, showing a peak at day 1 among alpha-toxin applied rats. CONCLUSION: Intra-nasally applied alpha-toxin induces acute rhinosinusitis in the rats. The histological evidence of rhinosinusitis revealed the appearance of inflammatory cell clusters in the sinonasal air spaces. These findings indicate that this rat model of alpha-toxin induced rhinosinusitis may be applied for better understanding of the role of bacterial toxin in the pathogenesis of rhinosinusitis.

Lower Lip Reconstruction Using a Reversed Depressor Anguli Oris Musculocutaneous Flap / 대한이비인후과학회지

The lips are essential in maintaining oral competence and assist in mastication, deglutition, and articulation. The lips are also important aesthetically, contributing to appearance and facial expression. Defects of up to one third of the lower lip can be closed primarily, but larger defects require more complex techniques. Successful lip reconstruction require careful meticulous planning to achieve the optimum functional and cosmetic result. When planning a reconstruction of a large defect of the lower lip, the following points should be taken into consideration: 1) maintain the sphincter function, 2) retain the sensation, 3) acquire a large enough opening for the mouth, 4) strive for an acceptable cosmetic appearance. It is not possible to satisfy all these criteria in every instance, and careful preoperative evaluation is essential. We describe here a successful technique to reconstruct a large lower lip defect using a depressor anguli oris musculocutaneous flap and a mucosal flap for elderly patients.

Conductive Hearing Loss with Intact Tympanic Membrane: Two Cases of Fibrous Change of the Ossicles / 대한이비인후과학회지

In general, causes of conductive hearing loss with the intact tympanic membrane and external auditory canal are known as congenital anomaly of the ossicular chain, otosclerosis, and head trauma-induced ossicular discontinuity. But it may also occur due to fibrotic change by potential inflammation of the ossicular chain as a result of otitis media in the infancy or childhood. We report two cases of fibrous change of the ossicles by probable middle ear inflammation with a review of the related literature.

Two Cases of Peripheral Facial Nerve Neurilemmoma / 대한이비인후과학회지

Neurilemmomas are benign tumors that arise from the nerve sheath. Facial nerve neurilemmomas are uncommon, slow-growing neoplasms that occur anywhere along the course of the facial nerve. The majority of facial nerve neurilemmomas are intratemporal, with a few cases arising from the intraparotid portion. The clinical presentations are generally insidious and the nature of the disease depends on the location and extent of the tumor. They are difficult to diagnose preoperatively and are frequently misdiagnosed because of the variety of their clinical manifestations. Therefore, early and correct diagnosis and evaluation are necessary. Recently, we experienced two cases of facial nerve neurilemmoma with relatively good surgical result, involving the mastoid segment of the facial nerve and the main trunk of the facial nerve in the parotid gland. We reviewed the diagnosis, pathology, and treatement of this case, and report the cases with reviews of literature.