A Case of Glossopharyngeal Schwannoma Protruding to the Larynx: A Case Report

Schwannoma is benign tumor that can occur in any part of the nerve that contains a Schwann cell. It is rare in the head and neck region and is characterized by common postoperative neurologic symptoms. We experienced a cervical schwannoma in a 22-year-old young man. Except for a foreign body sensation in the neck and a mass in the anterior region, there were no other complaints. A retropharyngeal schwannoma was most suspected considering neck computed tomography, magnetic resonance imaging, laryngoscopy and fine needle aspiration. Surgical treatment was performed, and the origin of the schwannoma was diagnosed as the tonsillar branch of the glossopharyngeal nerve. Histopathological examination confirmed the presence of a schwannoma with typical characteristics. After surgery, the patient recovered without any side effects. We report this case with a review of the literature.

Gene signature for prediction of radiosensitivity in human papillomavirus-negative head and neck squamous cell carcinoma

Purpose@#The probability of recurrence of cancer after adjuvant or definitive radiotherapy in patients with human papillomavirus-negative (HPV(–)) head and neck squamous cell carcinoma (HNSCC) varies for each patient. This study aimed to identify and validate radiation sensitivity signature (RSS) of patients with HPV(–) HNSCC to predict the recurrence of cancer after radiotherapy. @*Materials and Methods@#Clonogenic survival assays were performed to assess radiosensitivity in 14 HNSCC cell lines. We identified genes closely correlated with radiosensitivity and validated them in The Cancer Genome Atlas (TCGA) cohort. The validated RSS were analyzed by ingenuity pathway analysis (IPA) to identify canonical pathways, upstream regulators, diseases and functions, and gene networks related to radiosensitive genes in HPV(–) HNSCC. @*Results@#The survival fraction of 14 HNSCC cell lines after exposure to 2 Gy of radiation ranged from 48% to 72%. Six genes were positively correlated and 35 genes were negatively correlated with radioresistance, respectively. RSS was validated in the HPV(–) TCGA HNSCC cohort (n = 203), and recurrence-free survival (RFS) rate was found to be significantly lower in the radioresistant group than in the radiosensitive group (p = 0.035). Cell death and survival, cell-to-cell signaling, and cellular movement were significantly enriched in RSS, and RSSs were highly correlated with each other. @*Conclusion@#We derived a HPV(–) HNSCC-specific RSS and validated it in an independent cohort. The outcome of adjuvant or definitive radiotherapy in HPV(–) patients with HNSCC can be predicted by analyzing their RSS, which might help in establishing a personalized therapeutic plan.

Management of Laryngopharyngeal Reflux in Asia

Objectives@#. This study was conducted to investigate the current practices of Asian otolaryngologists for laryngopharyngeal reflux (LPR). @*Methods@#. An online survey about LPR was sent to 2,000 members of Asian otolaryngological societies, and a subgroup analysis was performed between Western and Eastern Asian otolaryngologists. The survey was conducted by the Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies. @*Results@#. Among approximately 1,600 Asian otolaryngologists, 146 completed the survey (62 from Western Asian countries, 84 from Eastern Asian countries). A substantial majority (73.3%) of the otolaryngologists considered LPR and gastroesophageal reflux disease to be different diseases. The symptoms thought to be closely related to LPR were coughing after lying down, throat clearing, and globus sensation. The findings thought to be closely related to LPR were posterior commissure granulations and hypertrophy, arytenoids, and laryngeal erythema. The respondents indicated that they mostly diagnosed LPR (70%) after an empirical therapeutic trial of proton pump inhibitors (PPIs). Although multichannel intraluminal impedance-pH (MII-pH) monitoring is a useful tool for diagnosing nonacid or mixed LPR, 78% of Asian otolaryngologists never or very rarely used MII-pH. Eastern Asian otolaryngologists more frequently used once-daily PPIs (64.3% vs. 45.2%, P=0.021), whereas Western Asian otolaryngologists preferred to use twice-daily PPIs (58.1% vs. 39.3%, P=0.025). The poor dietary habits of patients were considered to be the main reason for therapeutic failure by Asian otolaryngologists (53.8%). Only 48.6% of Asian otolaryngologists considered themselves to be adequately knowledgeable and skilled regarding LPR. @*Conclusion@#. Significant differences exist between Western and Eastern Asian otolaryngologists in the diagnosis and treatment of LPR. Future consensus statements are needed to establish diagnostic criteria and therapeutic regimens.

Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction

BACKGROUND: Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures. METHODS: A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctivalincision and an elevator through the intraoral incision. RESULTS: The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted. CONCLUSIONS: The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.

Refractory Granulomatosis with Polyangiitis Presenting as Facial Paralysis and Bilateral Sudden Deafness

Granulomatosis with polyangiitisis [(GPA) or Wegener granulomatosis] is a multi-system disease characterized by granuloma formation and necrotizing vasculitis. GPA classically shows involvement of the respiratory tracts and the renal system. However, locoregional disease is common and may include otologic manifestations. Although otologic involvement can occur during the course of GPA, no report has described facial palsy with sudden sensorineural total deafness with vertigo as the presenting feature of GPA. This case describes a patient with multiorgan involving resistant form of GPA initially presenting with bilateral profound sudden sensorineural hearing loss and left facial paralysis with vertigo. The condition responded well to treatment with rituximab.

Association between Insomnia and Depression in Tinnitus Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: About one third of all people experience tinnitus in their life. And insomnia is the second most common symptom in tinnitus patients, following hearing disturbance. The aim of this study was to define the influence of insomnia on the clinical features of tinnitus patients and to assess the relation of tinnitus to insomnia and depression. SUBJECTS AND METHOD: The consecutive 197 patients with tinnitus were enrolled from May 2012 to May 2013 for this study. All patients with tinnitus filled out the following questionnaire, Visual Analogue Scale, Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI) for evaluating clinical features of tinnitus patients. Also we examined pure tone audiometry and tinnitogram for evaluating audiologic characteristics. RESULTS: When the insomnia was defined as more than five scores in PSQI, 46 of 197 patients had insomnia. Loudness of tinnitus was significantly higher in the tinnitus patients with insomnia group when compared to those of the tinnitus without insomnia group (p=0.018). The score of THI and BDI were significantly higher in the tinnitus with insomnia group, too (p=0.003, <0.001, respectively). A strong correlation (r=0.616, p<0.001) was shown between THI score and BDI score in both groups. CONCLUSION: It appears, due to the high possibility that depression and insomnia are related in tinnitus patients with insomnia, that proper evaluations about sleep disturbance and depression of tinnitus patients are necessary to produce better therapeutic results.

Intravascular Papillary Endothelial Hyperplasia of the Nasopharynx: A Case Report and Review of the Literature / 대한이비인후과학회지

Intravascular papillary endothelial hyperplasia (IPEH) is a rare benign proliferation of intravascular endothelial cells. However, IPEH can be easily mistaken for an angiosarcoma, thus differential diagnosis is very important to avoid over-treatment. We report the case of a 22-year-old man who presented with small lobulating mass in nasopharynx. Computed tomography showed about 4 cm homogenous mass in the nasopharynx without extension into soft tissues. Complete surgical excision was done and biopsy during operation showed distended vessels and numerous papillae consist of endothelial cells lining a hyaline core. At follow up, no other complications were observed. Thus we present the case and a review of the literature.

Ocular Vestibular Evoked Myogenic Potential in Vestibular Neuritis Patients: Comparative Study with Cervical Vestibular Evoked Myogenic Potential and Subjective Visual Vertical / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Subjective visual vertical (SVV) reflects utricle and superior vestibular neural functions, and cervical vestibular evoked myogenic potentials (cVEMP) reflect saccule and inferior vestibular neural functions. But, origin and characteristics of ocular VEMP (oVEMP) remain controversial, especially in case of evoked by air conducted sound (ACS). Thus, the aim of this study was to identify the origin and characteristics of oVEMP by comparing with various otolith function tests. MATERIALS AND METHODS: Forty vestibular neuritis patients were enrolled from September 2012 to January 2013 in this study. We examined cVEMP, oVEMP using 500 Hz air-counducted sounds. And, we measured static and dynamic SVV. RESULTS: Abnormal cVEMP responses were observed in 6 (15%) patients, and abnormal oVEMP responses were observed in 28 (70%) patients. Abnormal static and dynamic SVV were observed in 18 (45%), 35 (87.5%) patients, respectively. There was strong correlation between oVEMP and dynamic SVV (p=0.009). CONCLUSION: ACS oVEMP responses showed different tendency from cVEMP responses in vestibular neuritis patients, but similar tendency with results of dynamic SVV. The results suggest that origin of oVEMP is different from that of cVEMP and maybe utricle and superior vestibular neuron.

Anatomical Structures of the Aortic Root in Koreans / 대한흉부외과학회지

BACKGROUND: It is very important to determine the surgical anatomy of the aortic root when performing spreading aortic root preserving heart surgery. This study focuses on the surgical aspect of the aortic root anatomy by performing dissection of Korean cadavers. MATERIAL AND METHOD: The subjects were 62 cadavers. We measured the intercommissural distances, heights of the sinuses and the circumference of the sinotubular junction and the aortic annulus. RESULT: The mean age of death was 61.3 years. The intercommissural distance for the right coronary sinus was 0.73+/-2.23 mm, that for the non coronary sinus was 19.34+/-2.03 mm, and that for the left coronary sinus was 18.58+/-2.15 mm. The height of sinus was 20.59+/-2.48 mm for the right coronary sinus, 18.61+/-2.26 mm for the non coronary sinus and 17.95+/-19 mm for the left coronary sinus. The circumference of the sinotubular junction was 70.73+/-5.94 mm and that of the aortic annulus was 77.94+/-5.63 mm. There is no correlation between age and STJ, aortic annulus and the ratio of STJ of aortic annulus respectively (p=0.920, p=0.111, p=0.073). The tilting angle of the sinotubular junction and aortic annulus is from 2.03 degrees to 7.77 degrees (mean=4.90 degrees). CONCLUSION: The intercommissural distance and the height of the sinus were largest in the right coronary sinus, and the position of the sinotubular junction to the aortic annulus is obliquely tilted levo-posteriorly.

Morphological Study on the Radiation-induced Follicular Atresia and the Follicular Macrophage / 대한산부인과학회잡지

OBJECTIVE: It is well known that X-ray induces follicular atresia, but the exact mechanism of atresia is not still unveiled completely. In addition, the role of macrophage related with clean-up the dead granulosa cells and other functions within the ovarian follicle is emphasized recently. The aim of this study is to assess the radiation-induced morphological changes of ovarian follicles and follicular macrophages. METHODS: 8 Gy X-ray irradiated on the 3-week old rats (Sprague-Dawley strain), sacrificed at 6, 12, and 24 hours after irradiation, and performed morphological studies with light and transmission electron microscopy, TUNEL, and macrophage immunohistochemistry. RESULTS: Follicular atresia increased significantly (p<0.01) at 6 hours after X-irradiation, and it was decreased significantly (p<0.01) at 12 and 24 hours after irradiation. X-ray induced chromatin condensation in the nucleus and nuclear fragmentation of granulosa cells, which were the typical features of apoptosis. Apoptotic granulosa cells were phagocytosed by the neighboring normal granulosa cells and the macrophages. During atresia of follicles, radioresistant granulosa cells were found in some follicles, which showed similar features morphologically with the granulosa cells of normal follicles. Macrophages were found both within the antrum and at the follicular granulosa layer. CONCLUSION: X-radiation induced follicular atresia by means of granulosa cell apoptosis, and radioresistant granulosa cells which have similar features morphologically with the granulosa cells of normal follicles were observed in some follicles. And the macrophages which phagocytose the apoptotic granulosa cells were located within the follicular antrum and at the follicular granulosa layer.

Contributing Factors Analysis for the Driving Status in Spinal Cord Injury

OBJECTIVE: To provide informations on contributing factors analysis for the driving status in spinal cord injured people through basic statistics from an analysis of the survey results. METHOD: The survey was administered to 121 spinal cord injured persons with no evidence of head injury. Subjects were divided to driver group and non-driver group and compared to their general charateristics, neurologic characteristics, status of activity of daily living (ADL). Logistic regression was used to analyze contributing factors for the driving status. RESULTS: Forty-four (36.4%) of 121 respondents were driving and among them male drivers were 35 (79.6%). The average age and the age at the time of injury were lower in the driver group than non-driver group. Among complete lesions, C7 was the highest level who could drive independently. The mean score of ADL was significantly higher in the driver group than non-driver group. The significant factors that affect the driving of spinal cord injured persons were sex, age, age at the time of injury, Frankel type, motor score, jobs after their injury, compensations for their accidents, means of ambulation, sports activities, and ADL status. Especilly significant factors were age at the time of injury, means of ambulation, ADL status. CONCLUSION: We suggested that the driver training should be an essential part of the rehabilitaion program for the spinal cord injured people to maximize their quality of life in the community.