Effect of Adenotonsillectomy on Pediatric Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adenotonsillar hypertrophy is the leading cause for obstructive sleep apnea (OSA) in children. However, clinical improvement after adenotonsillectomy has not been confirmed objectively in Korean children. We evaluated the effects of adenotonsillectomy on polysomnography (PSG) in children with OSA. SUBJECTS AND METHOD: Fifteen children (age range 3 to 13) who had macroscopic adenotonsillar hypertrophy and a respiratory disturbance index (RDI) greater than 1 on preoperative PSG were enrolled in this study and underwent adenotonsillectomy. All children underwent preoperative and postoperative PSG at 10 weeks after adenotonsillectomy. In addition, the care-givers of each child were asked to check the deficit hyperactivity disorder rating scale-IV (ADHD RS-IV) before and 8 weeks after surgery. Scores from the preoperative and postoperative PSG and ADHD RS-IV were compared using the paired samples t-test. RESULTS: The improvements in RDI, apneahypoapnea index, apnea index, arousal index, lowest O2 saturation and snoring time on postoperative PSG were significant (p<0.05). About 67% (10 of 15) patients were successfully treated with surgery, but 33% (5 of 15) children had RDI greater than 1 after surgery. ADHD RS-IV score showed significant improvement (p<0.05). CONCLUSION: This study suggests that adenotonsillectomy is effective in the treatment of childhood OSA, but dose not have perfect results. The presence of residual OSA after surgery in a large number of patients is a significant probability that deserves more studies and intervention.

Long Term Follow-Up Results of Adenotonsillectomy on Pediatric Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adenotonsillecotmy is the most commonly recommended for pediatiric obstructive sleep apnea (OSA). The clinical improvement after surgery had been suggested on previous studies, which looked at only very short time follow-up. We aimed to study long-term changes in polysomnography (PSG) after adenotonsillectomy for OSA in children. SUBJECTS AND METHOD: Nine children (age range 3 to 13) who had macroscopic adenotonsillar hypertrophy and a respiratory disturbance index (RDI) greater than 1 on preoperative PSG were enrolled in this study and underwent adenotonsillectomy. All children underwent preoperative and postoperative PSG at 3 months and 12 months after surgery. In addition, the caregivers for each child were asked to check attention deficit hyperactivity disorder rating scale-IV (ADHD RS-IV) before, 3 months and 12 months after surgery. Scores from preoperative and postoperative PSG and ADHD RS-IV were compared using the paired sample t-test. RESULTS: Mean of RDI and apnea index improved significantly in postoperative 3 months and 12 months (p<0.05). About 67% (6 of 9) patients had RDI lesser than 1 in postoperative 3 months. However, 12 months later, 44% (4 of 9) children had RDI lesser than 1. ADHD RS-IV score showed significant improvement in postoperative 3 months and 12 months (p<0.05). CONCLUSION: This study suggests that adenotonsillectomy is effective in the treatment of childhood OSA. And the effects of adenotonsillecotmy on pediatric OSA are maintained at least 12 months.

A Case of Angiomyolipoma Originated in Larynx / 대한이비인후과학회지

Angiomyolipoma is a benign tumor that is composed of adipose tissue, blood vessels and smooth muscle. The kidney is the most commonly affected organ. In the general population, the incidence of angiomyolipoma is about 0.3%. It is sometimes associated with tuberous sclerosis. However, extrarenal angiomyolipoma is uncommon, although it has been observed in other organs such as liver, heart, mediastinum, spermatic cord, vaginal wall, oral cavity, etc. In the larynx, angiomyolipoma has been rarely reported in the literature. We present a case of angiomyolipoma in the larynx, which was completely removed by laryngomicrosurgery. Thus, we report this case with a review of the literature.

Myoepitheliomas of the Soft Palate: Helical CT Findings in Two Patients

We describe the enhancement patterns of myoepithelioma in two patients with a soft palate mass. In the first case, helical CT revealed a faintly enhancing mass. Histologically, the tumor was composed of plasmacytoid cells in a background of rich myxoid stroma. Immunostaining for CD34 showed scanty blood vessels. In the second case, helical CT revealed an intensely enhancing mass. Histologically, the mass was a cellular tumor with fibrous stroma. Immunostaining for CD34 also showed frequent blood vessels.

Effect of Adenotonsillectomy on Inattention and Hyperactivity in Children with Sleep Disordered Breathing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep disordered breathing (SDB) is a common problem in the otolaryngology clinic and adenotonsillar hypertrophy is thought to be one of the most common etiologic factors. SDB possibly exhibits problems of behavioral regulation, such as inattention, hyperactivity and impulsive behavior. The goal of this study was to assess the effect of adenotonsillectomy on inattention and hyperactivity in children. SUBJECTS AND METHOD: We selected 54 pediatric patients with sleep disordered breathing. Adenotonsillectomy was performed for all patients. Adenotonsillar hypertrophy and the degree of SDB were evaluated preoperatively. The degree of inattention and hyperactivity was evaluated by attention deficit hyperactivity disorder rating scale-IV (ADHD RS-IV) before and after surgery. RESULTS: ADHD RS-IV score showed significant improvement after the operation in most children with SDB. But the improvement of ADHD RS-IV was not associated with the degree of adenotonsillar hypertrophy. However, much improvement in postoperative ADHD RS-IV was observed with children having higher preoperative ADHD RS-IV and/or SDB scale. CONCLUSION: Adenotonsillectomy seems to improve inattention and hyperactivity in most children with SDB. Improvement is more apparent in children with severe sleep disturbance and severe attention deficit and hyperactivity.

Management of Rhinolithiasis through Endoscopic Approach / 대한이비인후과학회지

A Lithiasis within the nasal cavity (rhinolith) can be formed by either endogenous or exogenous material. It occurs as a result of the solidification of mucus and nasal debris by mineral salts, calcium, magnesium phosphate and carbonate. Rhinolithiasis leads to unilateral obstruction of the nasal airway followed by inflammation of the nasal mucus membrane and the paranasal cavities. It can be seen by the endoscopic examination as a hard intranasal mass, but diagnosis of rhinolithiasis can be difficult due to the varying clinical presentations. Surgery is obligatory for the removal of rhinoliths and in most cases it can be done by nasal endoscopic removal. Giant rhinolith, which is penetrated into the surrounding anatomical structures, needs more extended surgical approaches such as Caldwell-Luc operation or lateral rhinotomy. Here, we report one case of rhinolithiasis, which was removed surgically for the purpose of diagnosis and treatment, and present a literature review of this condition.

A Case of Congenital Sensorineural Hearing Loss with Multinodular Goiter / 대한이비인후과학회지

Pendred syndrome is an autosomal recessive condition classically characterized by congenital deafness and goiter, and is the most common cause of hereditary deafness in Korea. It is caused by mutations in the PDS gene (SLC26A4) located in 7q31. The PDS gene encodes a chloride-iodide transport protein called pendrin, which plays a role in the reabsorption of endolymph and the maintenance of the endolymph homeostasis in the inner ear and in the uptake and organification of iodide in the thyroid gland. A mutation in PDS also causes non-syndromic recessive deafness (DFNB4) and therefore securing the diagnosis is important for genetic counseling purposes. The perchlorate discharge test and radiological conformation of the inner ear anomaly are useful diagnostic aids but have limited diagnostic value. However, because PDS mutations are widely distributed along the gene, it consumes too much time and money to perform molecular studies in clinics. We present a case of congenital sensorineural hearing loss with multinodular goiter, which shows definite findings of Pendred syndrome.

Efficacy of Benzodiazepines to Laryngopharyngeal Reflux: A Double-Blind, Randomized Controlled Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Anti-anxiety drugs such as benzodiazepines are often given to globus patients in practice, based on the notion that globus is a kind of somatization disorder. However, many of globus are caused by laryngopharyngeal reflux (LPR) and the effects of anti-anxiety drugs to LPR are unknown. The study goal was to assess the efficacy of benzodiazepines to LPR. SUBJECTS AND METHOD: We selected 51 LPR patients, who were confirmed by 24-hour double-probe ambulatory pH monitoring. Patients were allocated into case and control groups at random and entered into a double-blind trial. Patients in the control group received proton pump inhibitors and prokinetics. Diazepam was added to patients in the case group. Assessments were made after 4 weeks of treatment using reflux symptom index (RSI) and reflux finding score (RFS). RESULTS: In both groups, RSI and RFS were improved significantly at the end of the study. However, there was no significant difference between the two groups. CONCLUSION: Diazepam seems to have little efficacy in the treatment of LPR.

Clinicopathological Characteristics of Eosinophilic Fungal Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Since allergic fungal sinusitis (AFS) has been described in 1983, only a few cases have been reported in the domestic scientific journals. This leads to alleviate the strict criteria because many patients with allergic mucin and fungal hyphae reveal negative results of allergic skin test or serologic tests for fungal antigens. To classify these patients, the term `eosinophilic fungal rhinosinusitis (EFS)' was first coined in 1999. The objective of this study was to evaluate the clinicopathological features of EFS. SUBJECTS AND METHOD: The authors retrospectively reviewed medical records of 21 patients who had been diagnosed as EFS between June 2002 and November 2003 at the department of otolaryngology, Asan medical center. RESULTS: Chief complaints at first visits were in the order of nasal obstruction, postnasal drip, headache, foul odor, and rhinorrhea. Nasal endoscopic findings showed nasal polyp, purulent discharge, and fungal debris. 14.2% of patients revealed no abnormal findings. All patients had increased intrasinus attenuation at non-contrast media-enhanced CT. 47.6% of patients had complete opacification of maxillary sinus predominantly. No patients had the evidence of type I hypersensitivity for fungal antigens. Twenty patients had undergone endoscopic sinus surgery and surgical specimens proved to have allergic mucin with fungal hyphae. Postoperatively, four patients (20%) had recurrent symptoms and polypoid mucosal changes, which showed responses to short term oral steroid therapy. CONCLUSION: EFS is a frequent type of fungal sinusitis if surgical specimens are carefully examined histologically. Out of patients who received endoscopic sinus surgery, bi-meatal approach for the maxillary sinus lesions, and local steroid therapy, 80% were cured with no sign of relapse. The existence of eosinophilic infiltration and allergic mucin leads us to believe that focal allergic reaction occurs inside the sinus.

The Long Term Follow-up of Maxillary Sinus Retention Cyst / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Retention cyst of the maxillary sinus is a common incidental finding on Waters' view. The purpose of this study is to evaluate the fate of maxillary sinus retention cyst after at least 3-year follow-up. MATERIALS AND METHOD: Twenty-five patients diagnosed to have maxillary sinus retention cyst on Waters' view between 1997 to 1999 were asked to revisit for the follow-up Waters' view at least 3 years later. Nine patients complied with the request. Medical records, endoscopic nasal findings, and radiological data of nine patients were reviewed. Cyst size was measured by the 2-dimensional milimeter scale and the relative percentage of the total antral area. RESULTS: The cyst was located in the right maxillary sinus in 4 patients, left in 4, and bilateral in 1. Nine out of ten cysts appeared to arise from the floor of the sinus. The area of the cysts ranged in size from 232 mm2 (ratio 36.4%) to 370 mm2 (55.3%), as measured on Waters' view. Six of the cysts resolved spontaneously, three showed no change in size and only one has enlarged twice the size of initial cyst. The patient with enlarged cyst didn't complain of any specific symptoms. CONCLUSION: The majority of cysts (90%) decreased in size or spontaneously resolved after 3 years. Thus, `wait and see' policy may be appropriate unless associated with specific symptoms.

Usefulness of Voice Handicap Index in Patients with Hoarseness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Voice Handicap Index (VHI) was developed to assess patients' perception on the severity of their voice disorders. The purpose of this study was to determine the severity of handicap expressed by patients with various voice disorders, and to help clinicians in making future treatment plan. VHI may also be used as a guideline in making diagnosis according to different factors of voice quality. SUBJECTS AND METHOD: The people who had visited the Asan Medical Center with hoarseness from August 2000 to August 2001 were studied. They filled out the questionnaire composed of 30 questions about their voice disorders. The subjects were consisted of 6 groups; 50 patients with vocal cord nodule, 43 patients with laryngitis, 42 patients with vocal cord polyp, 25 patients with glottic cancer and 14 patients with unilateral vocal cord paralysis. Descriptive statistics were used to analyze the data and mean value of VHI scores. RESULTS: The mean score of VHI was found to be statistically higher in the subjects with the history of voice abuse (p<0.002). Overall, the group with unilateral vocal cord paralysis showed the highest VHI score that was statistically significant (p<0.001). When the functional factor is considered, groups with unilateral vocal cord paralysis and glottic cancer had shown higher scores compared to the other groups. When the physical factor is considered, groups with unilateral vocal cord paralysis and vocal cord polyp had shown higher scores. When the emotional factor is considered, groups with unilateral vocal cord paralysis had shown higher scores. CONCLUSION: Measurement of VHI in patients with voice disorders provides a measure of self-perception on the severity of the problems that cannot be assessed through visual perception or objective acoustic and aerodynamic measures. In addition, the measurement of VHI score was easy to perform, non-invasive, and inexpensive. In using this method, we expect to reveal the efficacy of the treatment for voice disorders.

Clinical Study of Sarcomas in Head and Neck / 대한이비인후과학회지

BACKGROUNDS: Head and neck sarcomas constitute a heterogenous group of rare malignant tumors occurring at rare sites. The purpose of this retrospective study is to evaluate the pathologic features, treatment modalities, outcome, patterns of failure, survival, and other prognostic factors. MATERIALS AND METHOD: The medical records of 33 patients whose tumors were diagnosed as head and neck sarcomas and treated at the department of otolaryngology in Asan Medical Center between 1990 to 2001 were reviewed. Potential prognostic factors including age, tumor size, histology, and adjuvant treatment were evlauated. RESULTS: All 33 of histologic classification consist of : rhabdomyosarcoma (10), angiosarcoma (4), spindle cell sarcoma (4), osteosarcoma (3), follicular dendritic cell sarcoma (2), synovial sarcoma (2), chondrosarcoma (2), malignant fibrous histiocytoma (2), hemangiopericytoma (1), leiomyosarcoma (1), unclassified (2). The ratio of male to female was 1.2 : 1 (19 : 14). The median age was 42 years (range 4-78 years). The mean follow-up period was 24.7 months. At 3 years, the disease-specific survival rates for patients with rhabdomyosarcoma were 100% and patients with other types of sarcoma had 78.0% mean survival. Twenty-three patients (70%) had undergone surgical approach with adjuvant chemotherapy or radiotherapy. Five patients had undergone surgical treatment only. The univariate analysis showed that tumor size is one of the most important prognostic factors for the survival. CONCLUSION: The rhabdomyosarcoma showed a better survival rate than other sarcomas of head and neck. Tumor size more or less than 5 cm was important prognostic factor for survival. We could not find the proven treatment guidelines, but surgery may be essential to the treatment for head and neck sarcomas.