Impact of the Preoperative Neutrophil to Lymphocyte Ratio on Patients with Head and Neck Cancer / 대한이비인후과학회지

Background and Objectives@#To investigate the prognostic value of the neutrophil to lymphocyte ratio (NLR) in patients with head and neck squamous cell cancer (HNSCC).Subjects and Method Clinical data from 259 patients with HNSCC were collected retrospectively. NLR was adopted as potential prognostic biomarkers. @*Results@#NLR was associated with cancer recurrence (p=0.002 and p＜0.001, respectively). Patients with a NLR ＞2.15 had significantly decreased 5-year disease specific survival (DSS) based on the Kaplan-Meier survival curves (p＜0.001 and p=0.029, respectively). The Multivariate Cox regression analysis confirmed a significant association between 5-year DSS and the NLR (using 2.15 as the cut-off; hazard ratio, 1.852; 95% confidence interval, 1.237-2.771; p= 0.003). @*Conclusion@#A NLR cut-off value ≥2.15 was associated with adverse outcomes in patients with HNSCC.

The Association between Sleep Duration and Dizziness in Korean Women: The Korea National Health and Nutrition Examination Survey

BACKGROUND: The aim of this study was to investigate the association between sleep duration and dizziness in a representative Korean population. METHODS: We analyzed data from the Korea National Health and Nutrition Examination Surveys (2010–2012). A total of 12,499 adults who completed otolaryngologic examinations were evaluated. RESULTS: Both men and women with severely short sleep duration (≤ 5 hours) and severely long sleep duration (≥ 9 hours) tended to have higher dizziness prevalence. However, the adjusted odds ratio (OR) for sleep duration was only significant in women with dizziness after adjusting for confounders. Compared to that in an optimal sleep group (6–8 hr/day), the OR (95% confidence interval) for dizziness prevalence after adjusting for age and health behaviors (body mass index, smoking habit, alcohol consumption, level of exercise, metabolic syndrome, and tinnitus) was 1.473 (1.194–1.818) for the severely short sleep group (≤ 5 hr/day) and 1.472 (1.078–2.009) for the severely long sleep group (≥ 9 hr/day) only in women. CONCLUSION: In the Korean population, dizziness was associated with shorter or longer sleep durations only among women. Further epidemiologic and experimental studies are necessary to clarify the impact of dizziness on sleep disorders.

Analysis of Relationship between Reflux Symptom Index and Psychiatric Problems / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study investigated the relationship between reflux symptom index (RSI) and psychiatric problems such as depression, somatization, and anxiety. SUBJECTS AND METHOD: We prospectively analyzed 231 patients with symptoms with laryngopharyngeal reflux (LPR) using the RSI and the reflux finding score. RESULTS: Seventy nine patients (34.2%) were diagnosed with LPR. A significant correlation was detected between the RSI and depression (18.4±8.3 vs. 12.3±7.0, p < 0.001), anxiety (19.5±8.5 vs. 13.0±7.3, p < 0.001), and somatization (19.2±9.1 vs. 13.6±7.5, p < 0.001). A multivariate analysis confirmed a significant association between heartburn and depression [odds ratio (OR): 1.241, 95% confidence interval (CI): 1.003–1.537, p=0.047], choking and anxiety (OR: 1.747, 95% CI: 1.297–2.352, p < 0.001), and choking and somatization (OR: 1.707, 95% CI: 1.248–2.336, p=0.001). CONCLUSION: Our preliminary results suggest that patients with high RSI may need to be carefully evaluated for psychiatric problems.

Assessment of Age-Related Dimensions of the Salivary and Thyroid Glands Using Three-Dimensional Computed Tomography in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to determine the dimensions of normal salivary and thyroid glands and assess their relationship with respect to age and sex using three-dimensional imaging in children. SUBJECTS AND METHOD: One hundred twenty patients were divided into four age groups: group 1 (0-5 years), group 2 (6-10 years), group 3 (11-15 years), and group 4 (16-20 years). The volume, thickness, width, and length of the each gland were measured. RESULTS: The parotid glands exhibited a growth spurt in group 2. There were no differences between genders for parameters of the parotid gland in groups 1, 2, and 3 except in group 4. The length of submandibular gland exhibited a monomodal growth pattern, which increased until 20-years-of-age. There was a significant difference of volume and thickness between the right and left thyroid gland in all groups. CONCLUSION: Volume and other parameters of the salivary and thyroid gland increase with age.

A Case of Mixed Hemangioma of Maxillary Sinus / 대한이비인후과학회지

A hemangioma is a benign tumor, which occurs mostly on the skin of the head and neck, but it is relatively rare in the nasal cavity. We experienced a case of a mixed hemangioma originating from right maxillary sinus. A 14-year-old female was presented with frequent epistaxis and progressive right-sided nasal obstruction for 5 month. A physical examination revealed a large polypoid reddish mass in the right nasal cavity. After preoperative embolization, surgical resection was performed via endoscopic and canine fossa approach and the result of surgery was successful. We report this case with a review of literatures.

A Case of Osseous Hemangioma of Maxillary Sinus

Osseous hemangiomas typicallyoccur in the vertebral column and skull bones. Osseous hemangioma in the nasal cavity is extremely rare; only eight cases originating in theturbinates and maxillar bone have been reported in the English and Korean literature. Recently, we observed a case of osseous hemangioma occupying the right maxillary sinus. After preoperative embolization, the mass was completely removed by endoscopic inferomedial maxillectomy. There wasno evidence of recurrence at24 months postoperatively. To our knowledge, this is the first reported case of osseous hemangioma occupying the maxillary sinus.

Anatomical Analysis of Intraorbital Structures Regarding Sinus Surgery Using Multiplanar Reconstruction of Computed Tomography Scans

OBJECTIVES: This study aimed to investigate the anatomy of the intraorbital structures regarding to endoscopic sinus surgery and external frontal sinus surgery analyzing computer tomography (CT) scans. METHODS: The CT scans of 100 patients were retrospectively evaluated. The anatomic relationships between the intraorbital structures and paranasal structures were measured using multiplanar reconstruction of the CT scan. RESULTS: The mean distances from the medial orbital floor (MOF) to the intraorbital structures were measured at the depth of the anterior ethmoid (AE), basal lamella (BL), and midportion of posterior ethmoid (PE) in the coronal planes respectively. The mean distances from the MOF to the medial rectus muscle and inferior rectus muscle at the depth of AE were approximately 8 mm and those distances in the BL and PE decreased rapidly. The mean distances from the MOF to the infraorbital nerve at the depth of the AE and BL were approximately more than 10 mm. The mean distances from the vertical axis, which passed through the MOF, to the superior oblique muscle and optic nerve at the depth of the PE were approximately 5 mm medially and 1 mm laterally. In addition, the mean distance from the midline to the trochlea of the superior oblique muscle was approximately 15 mm. CONCLUSIONS: Those measurements provide spatial information on the placements of the extraocular muscles within the orbit. The measurements will contribute to the avoidance of orbital complications during sinus surgery.

A Case of Verruca Vulgaris of the Maxillary Sinus Coexisting with an Inverted Papilloma in the Nasal Cavity / 대한이비인후과학회지

Verruca vulgaris in the nasal cavity is derived from the stratified squamous epithelium. It is commonly seen in the nasal vestibule and characterized by exophytic proliferation and extensive surface keratinization. Recently, we observed a case of verruca vulgaris occupying the right maxillary sinus coexisting with an inverted papilloma in the nasal cavity. Two separate masses in the nasal cavity and maxillary sinus were removed by endoscopic surgery. To our knowledge, this is the first reported case of verruca vulgaris involving the maxillary sinus coexisting with an inverted papilloma in the nasal cavity.

The Correlation between Butanol Threshold Test (BTT) and Cross Cultural Smell Identification Test (CC-SIT) According to Causes of Olfactory Disorders / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Olfaction is a critical function of our body that allows one to avoid potential dangers in daily living. Although there are numerous subjective and objective tests evaluating the olfactory function, there exist no studies assessing correlations among such tests for various causes of olfactory dysfunction, especially in Korea. SUBJECTS AND METHOD: We collected the olfactory functional test results of 473 subjects who visited our outpatient clinic. We categorized these patients into 5 groups: head trauma, post-upper respiratory infection, chronic sinonasal disease, toxic exposure, and idiopathic. All patients were examined using the Butanol Threshold Test (BTT) and Cross Cultural Smell Identification Test (CC-SIT). The patients' subjective symptoms were recorded using the Visual Analog Scale (VAS). RESULTS: The three tests showed significant correlations in different pairs (CC-SIT and BTT; r=0.512, p<0.001, BTT and VAS; r=0.558, p<0.001 and VAS & CC-SIT; r=0.567, p<0.001). Correlation results were lower in patients with olfactory disorders caused by an upper respiratory infection and head trauma than in those with olfactory disorders caused by sinonasal diseases. CONCLUSION: The results from all three tests showed significant correlations with one another. CC-SIT and VAS score seem to represent the olfactory loss caused by sensorineural dysfunction better than BTT.

What is the Relationship between the Localization of Maxillary Fungal Balls and Intranasal Anatomic Variations?

OBJECTIVES: Although the mechanisms underlying the initiation and maintenance of inflammation in unilateral maxillary fungal balls (FBs) are poorly understood, the relationship between intranasal anatomy and maxillary FB is thought to play an important role. The aim of this study was to investigate the relationship between anatomic variations and FB. METHODS: We enrolled 140 patients who were composed of 56 patients with FB, 56 patients with unilateral chronic rhinosinusitis (CRS), and 28 patients with no sinus disease. Computed tomography scans were retrospectively analyzed to identify and compare the associated nasal anatomic abnormalities. To measure the volume of the nasal cavity and middle meatus, computed tomography scans were reconstructed into three-dimensional images. RESULTS: The relatively larger volume of the middle meatus was associated with the localization of the FB in contrast with the CRS. However, the nasal-cavity volume, nasal valve area, and nasal septal deviation were not significantly associated with localization of FB. The mean volumetric and areal measurements such as nasal cavity, middle meatus, and nasal valve in FB-ipsilateral sides were not significantly different from those in contralateral sides as well as other groups. CONCLUSION: The middle meatus bears the major part of the inspiratory nasal airflow, and its volume may influence the occurrence of FB.

Response of Peripheral Blood Mononuclear Cells to Staphylococcus Aureus Exotoxin in Nasal Polyposis

BACKGROUND AND OBJECTIVES: Superantigens such as Staphylococcus aureus exotoxin (SE) have been implicated in the pathogenesis of chronic rhinosinusitis with nasal polyposis (NP). The aim of this study was to determine the immunologic response of peripheral blood mononuclear cells (PBMCs) to staphylococcal exotoxin B (SEB) in patients with NP. METHODS: The interleukin (IL)-4, IL-5, and interferon-gamma(IFN-gamma) responses of PBMCs to nonspecific mitogens such as phylohemagglutin (PHA) and SEB were examined in 24 NP patients and 16 control subjects. The presence or absence of atopy and asthma was determined to evaluate the correlation of these conditions with the levels of cytokines. RESULTS: PBMCs from the NP patients were more likely to produce IL-4 and IL-5 in response to SEB than those from controls. There was no difference in the mitogen-induced cytokine responses between NP patients and controls. SEB-induced IL-5 and IL-4 levels were higher in patients with NP with asthma than in patients with NP without asthma. CONCLUSION: Patients with NP show an exaggerated Th2 cytokine response of PBMCs to SEB.

Effect of Adenotonsillectomy on Symptoms and Growth in Children with Sleep Disordered Breathing : Long-Term Results / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic upper airway obstruction attributable to adenotonsillar hypertrophy is the most common cause of sleep disordered breathing (SDB) in children. The objective of this study was to evaluate the long-term effects of adenotonsillectomy on the degree of SDB and growth in children with SDB. SUBJECTS AND METHOD: Forty-three children (mean age, 6.1+/-2.4 years) clinically diagnosed as SDB were enrolled, and they were scheduled for adenotonsillectomy (T&A ) based on their response to the validated, 22-item sleep related breathing disorder (SRBD) scale and a physical examination that showed adenotonsillar hypertrophy. Weight, height, and BMI (body mass index) were evaluated before and three years after T&A. RESULTS: SRBD scales decreased significantly after T&A(p<0.001). Their Z scores (standard deviation scores) for weight, height, and BMI of 43 children were significantly higher three years after T&A compared with before T&A (p<0.01). CONCLUSION: Children with SDB who underwent adenotonsillectomy showed significant long-term increases in weight, height, and BMI as well as a significant long-term improvement in quality of the sleep.

Clinical Manifestation of Odontogenic Sinusitis : As to Pathophysiology and Management / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE : Sinusitis of odontogenic source is common disease accounts for about one tenth of cases of all maxillary sinusitis. Odontogenic sinusitis differs in its pathophysiology, clinical manifestation and the management from sinusitis of other causes. As the advance of dental procedure, the characteristics of odontogenic sinusitis are changing. The purpose of this study was to define the characteristics of odontogenic sinusitis with respect to the pathophysiology and management. SUBJECTS AND METHOD: Sixty two patients who were diagnosed to odontogenic sinusitis between May 2000 and May 2008 were included. All the diagnosis was supported by both dentist and otolaryngologist with objective data such as endoscopic exam and radiologic finding. All the medical records were reviewed retrospectively. RESULTS: Dental caries was most common cause of odontogenic sinusitis. Iatrogenic injuries during invasive procedure such as tooth extraction and implants were considerable. Most commonly presented symptom is facial discomfort. The surgical managements including local treatment were needed over 80% of cases. Average follow up period was 15.7 months, no complication was observed. CONCLUSION: The half of cases of odontogenic sinusitis was resulted from iatrogenic problem. The combination of a medical and surgical approach is generally required for the treatment.

Clinical Analysis of Sinonasal Inverted Papilloma according to the Staging System / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this work is to evaluate our results in the treatment of the nasal inverted papillomas according to staging system using a retrospective case series. SUBJECTS AND METHOD: Between March, 1997 and July, 2007,we treated 157 patients with nasal inverted papillomas. A retrospective assessment was performed to evaluate the demographic data, clinical presentations, and involved site of tumor. Inclusion criteria for the study required a histologically proven case of inverted papillomas and a minimum of 12 months follow-up period. All patients were staged according to the Krouse's staging system and a new staging system by Citardi et al. We compared the recurrence rate according to the tumor stage. RESULTS: The median age was 53.7 years (range 21 to 81 years) with males comprising 71%. The most frequent presenting complaint was nasal obstruction. The most common site of involvement was the lateral nasal wall. According to the Krouse's staging system, T1, T2, T3 and T4 were 29 (19.3%), 69 (46%), 51 (34%) and 1 (0.7%). According to the staging system by Citardi et. al., groups A, B and C were 98 (65.3%), 51 (34%) and 1 (0.7%). The recurrence rates of T1, T2, T3 and T4 were 3 (10.3%), 8 (11.6%), 8 (15.7%) and 1 (100%). The recurrence rates of group A, B and C were 11 (11.2%), 8 (15.7%) and 1 (100%). CONCLUSION: The Krouse's staging system, based on the involvement of IP, is a simple tool for grading IP. The new staging system by Citardi et. al. provides information about recurrence rates after surgery. Both staging system could provide important objective data for preoperative planning and prognosis.

The Usefulness of Endoscopic Management in Benign Sinonasal Tumors

BACKGROUND AND OBJECTIVES: There are increasing evidence suggesting that the endoscopic approach can be used successfully for the treatment of benign sinonasal tumors. In the present study, we reviewed a 12-year experience of our institution for endoscopic management of benign sinonasal tumors. MATERIALS AND METHODS: We retrospectively reviewed the medical records and radiologic findings of 185 patients who underwent endonasal endoscopic resection of benign sinonasal tumors at the Catholic Medical Center between 1996 and 2007. RESULT: Inverted papilloma (119 cases, 64.3%) was most common, followed by hemangioma (14 cases), pyogenic granuloma (11 cases), angiofibroma (9 cases), and osteoma (7 cases). The most common symptom was nasal obstruction (70.8%). Sixteen cases (8.6%) recurred after endoscopic resection (12 cases of inverted papilloma, 2 cases of ossifying fibroma, and 2 cases of fibrous dysplasia). No major complications were reported. CONCLUSION: Endoscopic approach allows for successful surgical outcomes and good cosmetic effects among patients with benign sinonasal tumors. We suggest that, in selected cases, benign tumors involving the sinonasal tract can be safely and radically removed using the endoscopic technique.

A Case of Adenoid Cystic Carcinoma of the Ectopic Lacrimal Gland

Adenoid cystic carcinoma (ACC) of the lacrimal gland is a rare malignant tumor accounting for 1.6% of all orbital tumors. We report a case of ectopic adenoid cystic carcinoma that developed on the nasal orbital side of the face adjacent to the nasal cavity. A 60-year-old man developed progressive right ocular proptosis and pain for over three years. The orbit MRI and CT revealed a 24x36x17 mm-sized lower signal mass on the medial side of the right medial rectus muscle. It also showed an erosion of the orbital bone in the superior and medial orbital walls. An endoscopic biopsy was performed and a frozen section of the tissue in the operating room showed no evidence of a malignancy. The mass was excised by endoscopic surgery. The final pathology was an adenoid cystic carcinoma. An orbital exenteration was recommended but the patient refused the procedure and, after receiving chemotherapy and radiation therapy, his condition is being followed. Some of the orbital mass remains in the posterior orbital area immediately after the endoscopic excision. The patient underwent his first session of Cyberknife radiosurgery therapy after concurrent chemotherapy and radiotherapy.

Clinical Characteristics of Inflammtory Pseudotumor of the Orbit / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Inflammatory pseudotumor is not malignant, but similar to malignancy lesions with respect to its clinical and radiological manifestations. It is well-known to opthalmologists and neurosurgeons, but unfamiliar to otolaryngologists. The objective of this study is to determine the diagnosis and treatment of inflammatory pseudotumor of the orbit. SUBJECTS AND METHOD: We reviewed 17 patients who visited Kangnam St. Mary's hospital and were diagnosed with inflammatory pseudotumor with clinical manifestations and radiological studies between September, 1994 and December, 2006. RESULTS: Seventeen patients were treated with high dose steroid, and of these, 12 showed clinical improvement, although 7 of these patients later showed recurrence. Of the five patients who initially showed no clinical improvement, one received radiation therapy but did not show improvement whereas two patients showed no improvement. One patient's symptoms improved after surgical decompression. CONCLUSION: Our study suggests that the initial treatment of inflammatory pseudotumor should be high dose steroid treatment without improvement and the second treatment should be radiation therapy or surgical treatment.

A Case of the Intrasellar Arachnoid Cyst with Extension to the Sphenoid Sinus / 대한이비인후과학회지

We report a case of intrasellar arachonoid cyst with extension to the sphenoid sinus, which is a very uncommon lesion. Preoperatively, we studied the PNS CT & Brain MRI and these images showed a large cyst in the widened sellar turcica with extension to the sphenoid anterior wall. We planned endoscopic surgery via transnasal-transphenidal approach. The endoscopic surgery was performed with no complication. We reviewed the literature and discussed the treatment of the intrasellar arachnoid cyst.

A Case of Intraductal Papilloma in the Parotid Gland / 대한이비인후과학회지

Intraductal papilloma is a rare benign salivary gland tumor that occurs most commonly in the minor salivary gland. We recently experienced a case of intraductal papilloma arising from the parotid gland in a 24-year-old woman. Radiologic imaging shows a well-circumscribed unicystic mass in the right parotid gland. Superficial parotidectomy was performed. Micoscopically, the mass has papillary epithelial proliferation within the dilated lumen of the salivary duct. We report this case with a brief review of literature.

Results of Endoscopic Transnasal Transsphenoidal Treatment of Prolactin Secreting Pituitary Adenoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The endoscopic transnasal transsphenoidal approach is a common approach for pituitary tumor. The objectives of our study is to report indication, efficacy, safety and endocrine result of endoscopic transnasal transsphenoidal surgery in patients with prolactin secreting pituitary adenoma. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 10 patients who had received endoscopic transnasal transsphenoidal pituitary surgery of prolactin secreting pituitary adenoma. RESULTS: Three patients were resistant and intolerant in medical therapy. Visual symptoms were developed in 8 patients. Postoperatively, 4 patients (40%) achieved normalization of prolactin and relief of symptoms from endoscopic surgery alone. Four of the remaining 6 patients achieved postoperative normalization of prolactin with medication. Visual symptom was improved in all patients. One patient had postoperative diabetes insipidus. CONCLUSION: We believe that the endoscopic method is a safe, hardly invasive and efficient surgical technique in prolactinoma. Medical treatment with dopamine agonist drugs is the mainstay of treatment and endoscopic surgery will be used in cases of drug resistance, intolerance and development of acute visual symptom, we may offer endoscopic surgery as a viable treatment option.