Computed Tomography and Magnetic Resonance Imaging Evaluation in Pediatric Unilateral Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Children with unilateral sensorineural hearing loss (USNHL) are not actively evaluated by physicians. The diagnostic tool for evaluation of USNHL is also controversial, and no strategy for diagnosing USNHL through imaging studies has been established. We examined the results of temporal bone computed tomography (TBCT) imaging and magnetic resonance imaging (MRI) studies on children with USNHL. SUBJECTS AND METHOD: Eighty-nine patients with USNHL were reviewed. Of these patients, 21 underwent both TBCT and MRI, 51 underwent temporal MRI only, and 17 underwent TBCT only. RESULTS: The etiology of USNHL were determined through imaging studies in 20 patients. The most common abnormal finding (65%) was a narrow internal auditory canal identified on TBCT and cochlear nerve aplasia on temporal MRI. Incomplete partition (20%), common cavity (10%), and labyrinthitis ossificans (5%) were also observed in imaging studies. The hearing threshold was lower in USNHL patients with normal findings (76.1±28.7 dB) than in USNHL patients with abnormal findings on TBCT or temporal MRI (100.1±22.3 dB). CONCLUSION: Cochlear and cochlear nerve abnormalities can be detected through imaging studies in approximately 25% of patients with USNHL. Therefore, we suggest that children should undergo TBCT when USNHL is confirmed through audiologic evaluation.

Computed Tomography and Magnetic Resonance Imaging Evaluation in Pediatric Unilateral Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Children with unilateral sensorineural hearing loss (USNHL) are not actively evaluated by physicians. The diagnostic tool for evaluation of USNHL is also controversial, and no strategy for diagnosing USNHL through imaging studies has been established. We examined the results of temporal bone computed tomography (TBCT) imaging and magnetic resonance imaging (MRI) studies on children with USNHL.SUBJECTS AND METHOD: Eighty-nine patients with USNHL were reviewed. Of these patients, 21 underwent both TBCT and MRI, 51 underwent temporal MRI only, and 17 underwent TBCT only.@*RESULTS@#The etiology of USNHL were determined through imaging studies in 20 patients. The most common abnormal finding (65%) was a narrow internal auditory canal identified on TBCT and cochlear nerve aplasia on temporal MRI. Incomplete partition (20%), common cavity (10%), and labyrinthitis ossificans (5%) were also observed in imaging studies. The hearing threshold was lower in USNHL patients with normal findings (76.1±28.7 dB) than in USNHL patients with abnormal findings on TBCT or temporal MRI (100.1±22.3 dB).@*CONCLUSION@#Cochlear and cochlear nerve abnormalities can be detected through imaging studies in approximately 25% of patients with USNHL. Therefore, we suggest that children should undergo TBCT when USNHL is confirmed through audiologic evaluation.

Predictive Factors for Occult Contralateral Papillary Thyroid Carcinoma in Patients with Ipsilateral Multifocality on Frozen Biopsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Papillary thyroid carcinoma (PTC) frequently occurs as multifocal and bilateral tumors. However, multifocality and bilaterality are not easy to detect preoperatively and contralateral remnant tumor might lead to reoperation after hemithyroidectomy. We aimed to demonstrate the frequency of bilaterality and predictive factors for occult contralateral PTC when a frozen biopsy of hemithyroidectomy shows multifocal PTCs in one of the lobes. SUBJECTS AND METHOD: One hundred and thirty patients with PTC were enrolled in this study. All patients underwent hemithyroidectomy and frozen biopsy, followed by total thyroidectomy because of ipsilateral multifocality. Medical records, pathologic results, and preoperative ultrasound results were reviewed retrospectively. Patients were divided into two groups depending on bilaterality (unilateral or bilateral). RESULTS: Bilaterality was detected in 74 of 130 patients (56.9%). Bilateral group showed more number of carcinomas (3.9±1.4 vs. 2.3±0.9) and more tendency of existence of contralateral nodule (87.8% vs. 55.3%). Tumor size of 1 cm or more and contralateral nodules were significant predictive factors for the existence of occult contralateral PTC. The suspicious sonographic feature of contralateral nodule had 75.7% sensitivity and 75% specificity for detecting bilaterality. CONCLUSION: The incidence of bilateral PTC is high in patients with ipsilateral multiple tumors. When the frozen biopsy result shows multifocality in one of the lobes, the remnant tumor may lead to reoperation under recent guidelines on thyroid surgical extent. Characteristics of contralateral nodule can help physicians and patients to make the decision regarding surgical extent.

Changes of Sleep Disordered Breathing and Quality of Life after Adenotonsillectomy in Pediatric Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pediatric obstructive sleep apnea (OSA) can have an effect on the quality of life (QOL) such as behavior, school performance, emotional distress and daytime function. We aim to verify changes in sleep disordered breathing based on polysomnographic findings and disease specific health related QOL before and after adenotonsillectomy in Korean children with OSA. SUBJECTS AND METHOD: A total 20 children aged 3 through 13 years old (mean age=6.7 years old and male/female=14/6) with OSA were included. We evaluated respiratory disturbances in patients using the standard polysomnography and the OSA-specific health related QOL based on Korean Obstructive Sleep Apnea-18 Survey (KOSA-18). RESULTS: There were significant improvements in apnea-hypopnea index (from 9.4±7.4 to 1.1±0.8 events/hour, p<0.001) and total score of KOSA-18 (71.3±26.0 to 33.6±10.7, p<0.001) after adenotonsillectomy. CONCLUSION: Sleep disordered breathing and QOL improve significantly after adenotonsillectomy in Korean OSA children.

Analysis of Prognostic Factors in Malignant External Otitis

OBJECTIVES: Malignant external otitis (MEO) is a potentially fatal infection of the external auditory canal, temporal bone, and skull base. Despite treatment with modern antibiotics, MEO can lead to skull base osteomyelitis. Until now, there have been few studies on the prognostic factors of MEO. METHODS: We performed a retrospective study to identify prognostic factors of MEO, and a meta-analysis of other articles investigating MEO. On the basis of disease progression the 28 patients in our study were divided into ‘controlled’ and ‘uncontrolled’ groups, consisting of 12 and 16 patients, respectively. We identified three categories of prognostic factors: those related to patient, disease, and treatment. We compared these prognostic factors between the controlled and uncontrolled groups. RESULTS: In our study, the duration of diabetes mellitus (DM), presence of inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), and computed tomography or magnetic resonance imaging findings influenced the prognosis of MEO. In contrast, prognosis was unrelated to age, gender, mean glucose level, hemoglobin A1c level, pathogen, comorbidity, or cranial nerve involvement. No factor related to treatment modality was correlated with prognosis, such as surgery, steroid therapy, or interval to the first appropriate treatment. Cranial nerve involvement has been proven to be associated with disease progression, but the relationship between cranial nerve involvement and the prognosis of MEO remains controversial. As a part of this study, we conducted a meta-analysis of cranial nerve involvement as a prognostic factor of MEO. We found that cranial nerve involvement has a statistically significant influence on the prognosis of MEO. CONCLUSION: We found that glycemic control in diabetes mellitus, cranial nerve involvement, and the extent of disease determined from various imaging modalities influence the prognosis of MEO. We suggest that significant prognostic factors should be monitored to determine the prognosis of patients with MEO.

Endoscopic Repair of Spontaneous Cerebrospinal Fluid Rhinorrhea with a Nasoseptal Flap

Cerebrospinal fluid (CSF) rhinorrhea is classified into traumatic and non-traumatic types. Traumatic CSF rhinorrhea comprises the majority of cases, and major causes include head trauma, rhinologic procedures, and neurosurgery. Non-traumatic (spontaneous) CSF rhinorrhea with normal cerebrospinal pressure is a rare condition, occurring in only 4% of cases. We recently experienced a case of spontaneous CSF rhinorrhea complicated with bacterial meningitis. The defect site was identified in the left sphenoid sinus and was successfully repaired with a nasoseptal flap under an endoscopic approach. We present the etiology, classification, and treatment of this rare disease entity with a review of the literature.

A Case of Extramedullary Relapsed Acute Promyelocytic Leukemia Presenting as a Mass in the External Auditory Canal / 대한이비인후과학회지

Acute promyelocytic leukemia (APL) is a unique subtype of acute myelogenous leukemia for which complete remission is induced by using anticancer drugs with all-trans retinoic acid (ATRA). Extramedullary involvement at relapse is occasionally observed in patients with APL, and is said to be more common after treatment with ATRA. We describe a 35-year-old man who had a relapse due to a mass that developed in the external auditory canal after treatment with ATRA. He was successfully treated with arsenic trioxide and radiotherapy.

The Difference of Clinical Symptoms and Audiovestibular Function between Intrameatal and Extrameatal Acoustic Neuroma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various hearing tests and vestibular function tests are used to diagnose acoustic neuroma. We analyzed the clinical characteristics and the results of audiovestibular function tests between patients of intrameatal and extrameatal acoustic neuroma. SUBJECTS AND METHOD: Reviewing the medical records for 64 patients with acoustic neuroma between March 2007 and February 2014, we divided the patients into two groups, intrameatal (31 patients) and extrameatal acoustic neuroma (33 patients) according to the involvement of cerebropontine angle. We compared the clinical characteristics, pure tone audiograms, speech audiometry, caloric test, and vestibular evoked myogenic potential (VEMP) between the two groups. RESULTS: While hearing loss was the most frequent presenting symptom in patients with intrameatal acoustic neuroma, dizziness was the most common symptom in patients with extrameatal acoustic neuroma. Hearing thresholds measured by pure tone audiometry and speech discrimination scores were significantly worse for patients with extrameatal acoustic neuroma. Abnormal unilateral canal paresis of caloric test was significantly higher for extrameatal acoustic neuroma than for intrameatal acoustic neuroma. Most patients with acoustic neuroma showed abnormal findings in the VEMP test, but the number of patients between intrameatal and extrameatal acoustic neuroma did not differ significantly. CONCLUSION: Clinical symptoms and the results of audiovestibular function tests differed according to the tumor size of acoustic neuroma. Physicians should counsel patients presenting with audiovestibular symptoms of the possibility of acoustic neuroma.

A Case of Bariatric Surgery for an OSAS Patient with Severe Obesity / 수면정신생리

Obstructive sleep apnea syndrome (OSAS) has negative effects on health, including increased mortality, risk of cardiovascular disease, and neurocognitive difficulties. OSAS is common in obese patients and obesity is an important risk factor of OSAS. A 41-year-old female OSAS patient with severe obesity (body mass index [BMI] ≥ 35) who failed dietary weight loss underwent bariatric surgery. After surgery, there were improvements in BMI (from 36.9 to 31.7 kg/m2) and polysomnographic data, including the apnea-hypopnea index (from 25.1 to 11.2 events/hr) and minimum SaO2 (from 69 to 82%). This case demonstrates that bariatric surgery may be an effective therapeutic option to reduce sleep-disordered breathing in severely obese patients with moderate OSAS. Bariatric surgery as a treatment option for OSAS should be considered in OSAS patients with severe obesity who failed dietary weight loss.

Endoscopic Resection of a Vocal Cord Polyp in a Patient with Difficult Laryngeal Exposure

Vocal cord polyps are generally removed using a direct laryngoscope and surgical microscope. In some case of laryngeal microsurgery, laryngeal exposure with surgical microscope is difficult because of severalfactors. We experienced a case of vocal polyp with difficult laryngeal exposure in a 56 year old male patient. The vocal cord polyp was removed successfully through endoscopic approach.

Thrower's Fracture on the Shaft of the Humerus: 4 Cases Report / 대한정형외과학회잡지

A fracture of the shaft of the humerus in young adults is known to occur as a result of high energy injuries such as traffic accidents and falls from a height. In baseball, which is one of the popular sports in the world, the incidence of a fracture of the shaft of the humerus during pitch motion is increasing even in non-professional players. Over the course of a year, we analyzed four cases of humeral shaft fractures that occurred during pitch motion through the pitch count, type of pitch, duration of playing, and prodromal pain. It was found that these fractures can easily occur through the torsion developed by the uncoordinated contraction of the muscle. The mechanism of the fracture should be recognized in order to prevent this type of fracture while playing baseball.