Tracheostomy in COVID-19 Pandemic Era / 대한이비인후과학회지

The outbreak of new coronavirus (COVID-19) has emerged as the cause of a severe acute respiratory. The COVID-19 pandemic led to an unexpected increase in the number of patients who are critically ill and required mechanical ventilation for active respiratory support. Tracheostomy is a common surgical procedure performed on patient to provide long-term ventilator support or to manage upper airway obstruction. It could be a critical role in the management of COVID-19 patients. Insertion of a tracheal cannula has become a viable alternative to prolonged endotracheal intubation, with the benefits of decreased airway resistance, improved patient comfort, reduced need for sedation, easier sputum removal. While these interventions could be necessary to provide adequate care, they require special precautions to minimize occupational risk. Because the spread of COVID-19 happened by aerosol and fine droplets, medical staffs are in direct danger of occupational exposure while caring for these patients. The purpose of this article is to review the preoperative preparation and tracheostomy guidelines related to COVID-19 pandemic spread.

Underlay Versus Modified Circumferential Subannular Graft Technique in Endoscopic Tympanoplasty / 대한이비인후과학회지

Background and Objectives@#To describe and evaluate modified circumferential subannular tympanoplasty (MCST) via endoscopic approach, we compared the results of MCST to those of the underlay technique and the results of previous studies.Subjects and Method A retrospective comparative study was conducted of 31 patients who underwent endoscopic transcanal tympanoplasty. Patients were classified into the MCST group (n=11) and the underlay group (n=20) according to the graft technique. Demographic data, size and location of the perforation, pre- and postoperative hearing, operating time, complication rate, and graft success rate were analyzed in each group. @*Results@#No significant differences between the two groups were observed in the demographic data or the locations of the perforations. The sizes of the perforations were 31.4±14.3% and 25.0±18.1%, respectively. The average operating times were 68.6±16.5 min and 64.9±9.3 min, respectively, and canaloplasty was not required in any patient. The postoperative hearing improvement and air-bone gap were not significantly different. No postoperative complications were observed in either group. @*Conclusion@#MCST is a feasible and effective technique for endoscopic transcanal tympanoplasty. The postoperative results and operating times of MCST were comparable to those of other graft techniques. MCST showed more stable results in anterior perforation than in underlay graft.

A Case of Epithelial-Myoepithelial Carcinoma of Parotid Gland and Analysis of 33 Cases Reported in Korea / 대한두경부종양학회지

Epithelial-myoepithelial carcinoma is rare, low-grade malignant neoplasm that compromises approximately 1% of all salivary gland neoplasms. We reported a 68-year-old woman with epithelial-myoepithelial carcinoma in the parotid gland. We analyzed demographic and clinicopathological characteristics of salivary gland epithelial-myoepithelial carcinoma which has been reported in 33 cases in Korea from 1992 to 2017, and compared this result to overseas retrospective cohort studies. There was no significance in terms of mean age at diagnosis, the predominance of females, low frequency in regional lymph nodes, and distant metastasis between the two groups. However, T classification and AJCC stage at diagnosis in domestic cases are more advanced than those of overseas cases. Although the recurrence rate in domestic cases has been reported lower than that of overseas, further study may be needed considering that the follow-up period after treatment is short in domestic cases.

Is There Any Age Cutoff to Treat Elderly Patients with Head and Neck Cancer? Comparing with Septuagenarians and Octogenarians

With the increase in life expectancy, age is no longer considered as a limitation for treatment. Nevertheless, the treatment of elderly patients with head and neck cancer (HNC) remains controversial. Here, we aimed to review our experience with the treatment for elderly patients, while particularly focusing on the differences among older old patients (septuagenarians vs. octogenarians). We retrospectively reviewed the records of 260 elderly patients who were assigned to 3 groups according to age: 70 years old ≤ group 1 < 75 years old, 75 years old ≤ group 2 < 80 years old, and group 3 ≥ 80 years old. The patients were assessed for comorbidities using the Adult Comorbidity Evaluation (ACE)-27, and the American Society of Anesthesia (ASA) physical status was also compared. Group 1, 2, and 3, consisted of 97, 102, and 61 patients, respectively. No significant difference in demographic data was noted among the groups. However, group 3 showed more comorbidities than groups 1 and 2. With regard to the initial treatment for HNC, radiation therapy (RT) was more frequently performed in group 3 than in groups 1 and 2. Among 7 patients of non-compliant to treatment in group 3, 6 patients had have performed RT. In group 3, a total of 18 patients underwent surgery, including microvascular free flap reconstruction and no significant difference in complications was observed postoperatively compared with group 1 and 2. Moreover, no significant difference was noted in overall survival between the groups, regardless of the treatment modality chosen. In conclusion, octogenarians with HNC should be more carefully managed than septuagenarians with HNC. Surgical treatment can be considered in octogenarians with HNC, if it can be tolerated.

Is There Any Age Cutoff to Treat Elderly Patients with Head and Neck Cancer? Comparing with Septuagenarians and Octogenarians

With the increase in life expectancy, age is no longer considered as a limitation for treatment. Nevertheless, the treatment of elderly patients with head and neck cancer (HNC) remains controversial. Here, we aimed to review our experience with the treatment for elderly patients, while particularly focusing on the differences among older old patients (septuagenarians vs. octogenarians). We retrospectively reviewed the records of 260 elderly patients who were assigned to 3 groups according to age: 70 years old ≤ group 1 < 75 years old, 75 years old ≤ group 2 < 80 years old, and group 3 ≥ 80 years old. The patients were assessed for comorbidities using the Adult Comorbidity Evaluation (ACE)-27, and the American Society of Anesthesia (ASA) physical status was also compared. Group 1, 2, and 3, consisted of 97, 102, and 61 patients, respectively. No significant difference in demographic data was noted among the groups. However, group 3 showed more comorbidities than groups 1 and 2. With regard to the initial treatment for HNC, radiation therapy (RT) was more frequently performed in group 3 than in groups 1 and 2. Among 7 patients of non-compliant to treatment in group 3, 6 patients had have performed RT. In group 3, a total of 18 patients underwent surgery, including microvascular free flap reconstruction and no significant difference in complications was observed postoperatively compared with group 1 and 2. Moreover, no significant difference was noted in overall survival between the groups, regardless of the treatment modality chosen. In conclusion, octogenarians with HNC should be more carefully managed than septuagenarians with HNC. Surgical treatment can be considered in octogenarians with HNC, if it can be tolerated.

Autonomic Nervous System Dysfunction in Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To investigate the prevalence of autonomic dysfunction and to evaluate the relationship between autonomic dysfunction and clinical parameters in patients with systemic lupus erythematosus (SLE). METHODS: Fifty-eight patients with SLE who met the American College of Rheumatology criteria for SLE and forty-five healthy controls were selected at our hospital. Cardiovascular autonomic nervous function (CAN) test, including heart rate variation in deep breathing, Valsalva maneuver and orthostatic change and blood pressure response to standing, handgrip, was done in patient group and controls. Erythrocyte sedimentation rate (ESR), antinuclear antibody, anti-dsDNA antibody, complete blood count, complement and disease duration of patients were retrospectively reviewed and disease activity was assessed by Mexican SLE disease activity index (MEX-SLEDAI). RESULTS: The frequency of parasympathetic damage was 51.7% in patients with SLE and 15.6% in controls. There was significant difference between 2 groups in heart rate variation in deep breathing. No significant correlations were observed between autonomic dysfunction and ESR, antinuclear antibody, anti-dsDNA antibody, thrombocytopenia, complement, disease duration of patients, but there was slightly positive correlation between number of abnormal parasympathetic function test and MEX-SLEDAI (r=0.32, p<0.05). CONCLUSION: The prevalence of autonomic dysfunction was high in SLE patients and there was high frequency in patients with high disease activity. Prospective studies are needed to determine the clinical significance of autonomic dysfunction in the morbidity and mortality of SLE.