The Usefulness of Cone Beam Computed Tomography in Endoscopic Sinus Surgery

BACKGROUND AND OBJECTIVES: Cone beam CT is a relatively new radiologic technique for head and neck imaging, and is widely used in dentistry to plan implant procedures. Compared to conventional CT, it has greater spatial resolution, a lower radiation dose (about 10% that of conventional CT), and lower cost. The objective of this study was to evaluate the utility of cone beam CT for endoscopic sinus surgery. SUBJECTS AND METHODS: A total of 50 patients were involved. Endoscopic sinus surgery was performed unilaterally under local anesthesia, so we used the half Lund-Mackay score to quantify preoperative CT findings. The intraoperative severity score was also determined, and the relationship between the preoperative Lund-Mackay score and intraoperative severity was assessed. The subjective level of operator satisfaction was scored on a ten-point visual analogue scale in terms of four items: overall satisfaction, disease extent of each sinus, identification of anatomic landmarks, and distinction of soft tissue characteristics. RESULTS: The preoperative half Lund-Mackay score was 5.26 and the intraoperative severity score was 5.02; these two scores were significantly correlated (p < 0.01). The level of overall operator satisfaction was relatively high (9.04/10). CONCLUSION: Cone beam CT is a useful imaging method for preoperative evaluation of endoscopic sinus surgery.

Analysis of Nasalance according to Pattern of Phonation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various phonation patterns yield various voice characteristics. Voice therapy using nasal stimulatory sounds seems to facilitate phonation in voice disodered patients. Under the hypothesis that nasalance may be influenced by the pattern of phonation, we studied the relationship between nasalance and voice disorders by observing abnormal supraglottic movements and vocol cord gaps in phonation. SUBJECTS AND METHOD: There were 143 patients who complained of voice problems and showed abnormal false vocal cord movements under stroboscopy. In addition to the four previously described types of MTD (muscle tension dysphonia), we described two more types of MTD (V: false vocal cord contracted posteriorly, VI: false vocal cord dilated laterally). We measured the vocal cord gaps in phonation and analyzed nasalance. RESULTS: Among those groups showing the pattern of false vocal cord (MTD 1, 2, 4), the vocal cord gaps in phonation were increased and nasalance was significantly decreased in MTD types, III and IV, and showed a tendency to decrease in MTD types, II and V, compared to the normal group. CONCLUSION: The supraglottis has a tendency to contract as the vocal cord gap in phonation increases, and this movement reduces nasalance.

Analysis of Snoring Sound for Predicting Laser-Assisted Uvulopalatoplasty Results / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laser-assisted uvulopalatoplasty is well established and relatively successful operation in the treatment of snoring and obstructive sleep apnea (OSA). But, there have been no reports about snoring sound of patients who had been performed LAUP. This study was performed to evaluate the results of LAUP analysing preoperative snoring sounds. MATERIALS AND METHODS: There were 38 patients who were diagnosed as OSA by polysomnography and had been performed LAUP between Mar, 1998 and July, 2002. Preoperative and postoperative snoring sounds were recorded during sleep and we performed an acoustic analysis using spectrogram (SPG), which was classified. And postoperative subjective satisfaction of bed time partner was compared in each type and the degree of satisfaction was measured by VAS (visual analogue scale) score. According to previous study, types of spectrogram of snoring sounds were classified as palatal, tongue base and mixed. RESULTS: In postoperative analysis, snoring loudness was most decreased in palatal type, and snoring pitch was only increased in tongue base type. The average satisfaction of bed time partner was highest at palatal type and lowest at tongue base type. CONCLUSION: Preoperative analysis of snoring sounds can aid the prediction of the loudness and pitch of snoring sounds and the subjective satisfaction of patients after LAUP.

The Diagnostic Rate and Phonetic Characters of Benign Vocal Fold Lesions with Sulcus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is not uncommon in patients with benign vocal fold lesions with voice change to accompany sulcus. The authors postulated that the coexistence of such benign lesions with sulcus would result in numerous problems related with phonation. The aim of this study was to recognize through voice analysis any particular phonation characteristics in patients with benign vocal fold lesions with coexisting sulcus, and to aid in diagnosis and treatment. MATERIALS AND METHOD: The study involved 574 patients who had been diagnosed with benign vocal fold lesions that accompanied voice change from Jan. 2001 through Sept. 2002. The diagnosis was made by videostroboscopy. The benign vocal fold lesions were observed in patients with sulcus and those without sulcus. Also specific benign vocal fold lesions were grouped into pairs determined by the existence of sulcus. Thus, patients with vocal nodules accompanied with sulcus were grouped as group NS and those without sulcus as group N: similarly, patients with vocal polyp and sulcus were grouped as PS and those without sulcus as group P: patients with Reinke's edema and sulcus as group RS and those without sulcus as group R, and patients with laryngeal edema and sulcus were grouped as group LS and without sulcus as group L. Each individual group went through psychoacoustic, acoustic and aerodynamic analyses and were compared against each other. RESULTS: Among patients with benign vocal fold lesions, about 50.2% had sulcus. It was observed that the rate of finding patients with sulcus increased when we began to have keen interest in sulcus. Among patients with benign vocal fold lesions without the accompaniment of sulcus, the most common form of benign vocal fold lesions was the vocal nodule. With coexisting sulcus, the most common form was laryngeal edema. In the psychoacoustic analysis group, the group NS exhibited more hoarseness than the group N: the group R exhibited greater hoarseness than the group RS. However, these results did not have statistical significance. In the acoustic analysis, the group NS had significantly higher shimmer score than the group N. In the aerodynamic analysis, the group NS and PS had exhibited significanlyt higher MFR scores than the groups N and P. CONCLUSIONS: The existence of sulcus in patients with benign vocal fold lesions has a clinical significance regarding treatment and prognosis. Although some acoustic analytic references may be useful in discovering the accompanying sulcus, careful observation of all vocal cords remains the most important component of such discoveries.

A Case of Fish Bone Foreign Body Presenting as Anterior Neck Mass / 대한이비인후과학회지

Foreign bodies in the oral cavity and pharyngolarynx are commonly encountered accidental cases in the emergency room and out patient departments in the otolaryngological fields. Of such foreign bodies, fish bones are the most commonly observed. Most foreign bodies in oral cavity, laryngopharyngeal, and esophagus can be recognized and their precise locations can be plotted by careful history taking, precise physical examination, and through simple radiological procedures. Similarly, their removal is relatively simple with the manipulation of endoscopes and various instruments. Reports of such foreign bodies are relatively frequent in their finding, however, foreign bodies that penetrate the esophagus and laryngopharynx to appear as a cervical mass are rare. When such foreign bodies migrate, locating their precise positions must involve a more thorough search utilizing such aids as computed tomography. Similarly, their removal may involve surgical intervention depending upon their location. The authors of this study experienced such a rare case of an elderly female patient aged 62, presenting an anterior neck mass of 7 days as a chief complaint. She had swallowed a fish bone 10 days ago. Her standard battery of blood tests, simple cervical X-ray and endoscopic findings all proved within normal limits. However, an excisional biopsy of the involved site revealed a piece of fish bone that had penetrated the pharyngolarynx and had migrated to position itself as an anterior neck mass. We hereby report this case along with the relevant literature.

Efficacy of Adjuvant Short Term Oral Steroid Therapy for Acute Pharyngitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sore throat due to acute pharyngitis is one of the most common ailments and complaints for hospital visits. This report aims to study the effects of oral steroids on pain relief, duration of illness, to get bacterial culture result and its relation to therapeutic effect. MATERIALS AND METHOD: Data was collected from 109 patients who have been clinically diagnosed with acute pharyngitis from March 2002 to August 2002. The 109 patients were arbitrarily divided into 3 groups and each group was prescribed different combinations of oral steroid and NSAIDS. All groups were commonly prescribed with antibiotics and analgesics after having performed a pharyngeal culture. Follow up was performed via telephone survey 24 and 48 hours after the clinical visit to measure subjective complaints of pain. The degree of pain was measured by the VAS (visual analogue system). RESULTS: The 3 groups scored an average of 3.23, 4.14 and 5.90, respectively, on the VAS scale after 24 hours of visit. After 48 hours the 3 groups scored 2.00, 1.65 and 3.03, respectively. From these results, VAS score was significantly lower in the group of oral steroid prescription, regardless of NSAIDS use, and this pattern increased in cases where bacterial cultures showed positive. However, there were no significant differences in the duration of illness, oral intake and limitation of activity among the 3 groups. CONCLUSION: The use of short term oral steroids for the treatment of acute pharyngitis can help to decrease the intensity and duration of pain, and this tendency seems to increase in cases where bacterial cultures show positive results.