Efficacy of Percutaneous Ethanol Injection for Benign Neck Cyst / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Advantages of percutaneous ethanol injection (PEI) were represented by insignificant mortality, minimal damage to normal parenchyma, relatively low cost and easy availability. The objective of the present study was to evaluate the efficacy of ethanol ablation as a minimally invasive management of cystic lesions in the neck or arising from the neck. SUBJECTS AND METHOD: Between August 2010 and December 2015, 28 patients with cystic lesions in the neck were diagnosed and treated with percutaneous ethanol injection. We evaluated the outcome of treatment using the alteration of volume reduction and the improvement of symptomatic and cosmetic complaints and complications. RESULTS: The initial mean tumor volume was 21 mL (range, 1.6-36.9 mL), as shown by ultrasonography. The mean number of the treatment sessions was 3.5 (range, 1-9 sessions). At the last follow-up, the mean volume of the treated neck cyst decreased significantly from 21 mL to 2.7 mL (p<0.001). The average volume reduction rate was 82.4% with the success rate of procedure of 82%. The mean symptoms and cosmetics visual analog scale improved from 5.4 to 2.4 and from 4.8 to 1.5 (p<0.001). No significant complications were observed during follow-ups. CONCLUSION: PEI is simple, easy, safe, and effective without surgical scars and hospitalization for neck cyst patients and favorable outcomes can be achieved without significant complications. It can be used as a substitute for surgery in the treatment of benign neck cyst lesions.

A Case of Nasopharyngeal Carcinoma Presenting as Middle Ear Tumor / 대한이비인후과학회지

Nasopharyngeal carcinoma (NPC) evolves most commonly from the pharyngeal recess posteromedial to the medial crura of the Eustachian tube opening in the nasopharynx. Therefore unilateral middle ear effusion with hearing loss is a common presenting symptom of NPC, and its presence in adult patients make physicians suspect NPC. Recently, we experienced a 72- year-old female patient with advanced NPC which invaded Eustachian tube and middle ear cavity. She had long standing chronic otitis media with large perforation of tympanic membrane. Because of tympanic membrane perforation, she did not have any Eustachian tube-related symptoms such as newly developing ear fullness or hearing loss and even the physician had overlooked the diagnosis of NPC. Her NPC was diagnosed at a very advanced stage after performing biopsy of middle ear tumor. This case report shows that NPC can present with very unusual findings like middle ear tumor.

A Case of Image-Guided Posterior Tympanotomy in Chronic Otitis Media / 대한이비인후과학회지

Posterior tympanotomy is a procedure performed to access the posterior mesotympanum through a mastoid exposure while preserving the posterior external auditory canal wall. It is dangereous to drill the the site of procedure, as it is surrounded by incuidal fossa superiorly, facial nerve posteriomedially, and chorda tympani nerve anterolaterally, and forms a very narrow pathway. There is always a risk of surgical trauma involving important surgical structures, especially facial nerve and chorda tympani nerve. The development of image-guided surgery (IGS) has significantly improved the performance of many surgical procedures by aiding the identification of surgical landmarks, improving surgical outcomes, rendering the procedure safer and more efficient, especially for beginner otologic surgery, in revision operations, in cases of massive bleeding and tumor of complex anatomy. To see how IGS could help otologic surgeons to identify fine, important structures during posterior tympanotomy, we report a case of posterior tympanotomy in chronic otitis media, which was done using the image-guided surgical technique.