The Factors Influencing Postoperative Aspiration after Supraglottic Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Supraglottic laryngectomy is a well established technique for the treatment of appropriate carcinoma of supraglottic larynx. The purpose of this study was to determine factors that may contribute to postoperative aspiration related to deglutition problem following supraglottic laryngectomy. MATERIALS AND METHOD: A retrospective analysis of medical records of 19 patients who consecutively underwent supraglottic laryngectomy was undertaken. Contribution of the following factors was investigated: age, T stage, pack-years of smoking, and parameters of pulmonary function test. The authors used a computerized acoustic analysis program (CSL-MDVP) to measure fundamental frequency, jitter, shimmer, and noise to harmonics ratio. RESULTS: Eleven patients had no problem, 5 patients had clinically insignificant problem, and 3 patients had moderate problem in postoperative 6 months. A greater number of pack-years of smoking and decreasing FEV1/FVC were significantly correlated with poor outcome with regards to postoperative aspiration and deglutition problem. No statistically significant difference was seen between patients with supraglottic laryngectomy and the control group. CONCLUSION: This study showed that less than 60% FEV1/FVC signifies a greater risk for postoperative aspiration.

Organizing Hematoma of the Maxillary Sinus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Organizing hematoma of the maxillary sinus can be developed by organizing procedure of hematoma in the unaerated maxillary sinus. To our knowledge, this is the second article describing organizing hematoma in the maxillary sinus. We experienced 7 cases recently, and aimed to describe clinical features, radiologic characteristics, and pathological findings. MATERIALS AND METHODS: Seven patients were diagnosed as organizing hematoma pathologically. We reviewed computed tomography (CT) and medical records to find out clinical features of organizing hematoma of the maxillary sinus. Of seven patients, five were male and two were female. Their mean age was 49 years. RESULTS: All patients had a history of frequent epistaxis without bleeding tendency. They also complained of nasal obstruction, hyposmia, headache, and cheek swelling. Rhinoscopy revealed obliterated nasal cavity due to bulging lateral wall. CT scans showed soft-tissue densities expanding the maxillary sinus with the minimal contrast enhancement. Destruction of the bony wall was observed in two patients. Endoscopic sinus surgery, Caldwell-Luc's operation, and Denker's operation were applied for the treatment singly or in combination, and resulted in successful outcome. CONCLUSION: Organizing hematoma should be included in the differential diagnosis when patients have frequent epistaxis and expansile lesion in the maxillary sinus.

Overcorrected Septums as a Complication of Septoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Overcorrection is defined as obvious deviation of the septum to the opposite direction after septoplasty and it is not infrequently developed in young patients. We investigated the rate of its incidence, especially in relation to age. MATERIALS AND METHODS: We retrospectively studied 1,124 patients undergoing septoplasty operation for septal deviation between 1994 and 1999. The operations and postoperative observation were performed by a single surgeon. We reviewed the medical records for age, sex, symptoms, combined operations, direction of deviation before and after septoplasty. RESULTS: Out of 1,124 patients, 22 (2.0%) had their septum overcorrected after septoplasty and 21 (95%) complained of nasal obstruction of the newly deviated side. The incidence of overcorrection was 7.3% (16/218) in teens, 1.7% (5/294) in twenties, 0.4% (1/250) in thirties, and 0% in older ages. The incidence in teens and early twenties was 5%. Patients of teenagers revealed significantly higher incidence as compared to other age groups (p<0.05). CONCLUSION: Overcorrected septum as a complication of septoplasty develops at the incidence rate of 5% in patients of teens and early twenties. Authors suggest that the depth of cross-hatching incision on the cartilage should be superficial or half-thickness to avoid overcorrection in young patients. And the possibility of overcorrection or revision septoplasty should be informed preoperatively.

Acoustic characteristics of patients undergoing short-term endotracheal intubation with or without thyroidectomy who had no nerve injury / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We carried out an acoustic analysis to investigate the phonatory characteristics of patients undergoing short-term endotracheal intubation with or without thyroidectomy, and who had no nerve injury. MATERIALS AND METHODS: The patients were divided into two groups, one undergoing thyroidectomy (39 cases) and the other not undergoing thyroidectomy (25 cases). All patients of the thyroidectomy group had undergone thyroidectomy using general anesthesia with endotracheal intubation. All patients of the other group had undergone chronic ear surgery with the same anesthetic method and duration. For the evaluation of voice, preoperative and postoperative acoustic analyses were done. RESULTS: On the acoustic analysis of thyroidectomy group, jitter, shimmer and the vocal range were significantly increased at one day after thyroidectomy. But one month after thyroidectomy, these changes return to statistically insignificant increments, except for shimmer and the vocal range. These acoustical changes were not related to the extent of surgery between total thyroidectomy and hemithyroidectomy. In comparison with acoustical changes after short-term endotracheal intubation, the change of jitter and shimmer of thyroidectomy group did differ significantly. CONCLUSION: Voice alteration after thyroidectomy without nerve injury may be associated with the disturbance of the prelaryngeal musculature. This voice changes emphasize the importance of the extralaryngeal skeleton for pitch control and early intensive speech therapy, especially in patients who need their voice professionally.

The Clinical Application of Voice Analysis in Identifying the Presence of Laryngopharyngeal Reflux in Patients with Pharyngeal Neurosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pharyngeal neurosis is a common problem in the otolaryngology clinic. Laryngopharyngeal reflux is suggested as one of the etiologic factors in pharyngeal neurosis. The purpose of this study was to find usefulness of voice analysis in diagnosis of pharyngeal neurosis and correlation between voice analysis and 24-hour ambulatory double-probe pH monitoring. MATERIALS AND METHODS: 42 patients with pharyngeal neurosis underwent fiberoptic laryngoscopy, voice analysis, and 24-hour ambulatory double-probe monitoring. The authors used a computerized acoustic analysis pr-ogram (CSL-MDVP) to measure fundamental frequency, jitter, shimmer, and noise to harmonics ratio. RESULTS: There was a significant difference between the positive group and negative group during 24-hour ambulatory pH monitoring regarding jitter and shimmer. Correlation results were good between voice analysis and 24-hour ambulatory double-probe pH monitoring, poor between fiberoptic laryngoscopy and 24-hour ambulatory double-probe pH monitoring. CONCLUSION: This study showed that when abnormal results in voice analysis were found in patients of pharyngeal neurosis, the probability that 24-hour ambulatory double-probe pH monitoring would be abnormal was high.

The Study for Prognostic Factors in Anaplastic Carcinoma of the Thyroid / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Anaplastic carcinoma of thyroid gland is a lethal entity: few patients live more than 12 months following the diagnosis. We retrospectively reviewed the experience with this entity at our institute with respect to prognostic factors influencing survival. MATERIALS AND METHODS: Thirteen cases of anaplastic carcinoma of thyroid gland diagonsed from 1995 to 2000 were analyzed retrospectively. The median age at presentation was 66.2 years; the male/female ratio was 1.17:1: and the most common symptom was a rapidly enlarging neck mass. RESULTS: All but one patient died within one year of diagnosis. Tumor size of less than 7 cm and complete resection of tumor were significant prognostic factors. Patients who had operation with or without radiotherapy and/or chemotherapy survived significantly longer than other patients. Median survival duration was 74 days. CONCLUSION: This study showed that complete resection and multimodal treatment for tumor of size less than 7 cm resulted in prolonged survival for a subgroup of patients with anaplastic thyroid carcinoma.