Efficacy of Adenoidectomy in Preventing Recurrence of Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Previous studies of the efficacy of adenoidectomy in otitis media with effusion have yielded conflicting results. The aim of this study was to investigate the efficacy of adenoidectomy and influences of other associated risk factors on the recurrence of otitis media with effusion (OME). SUBJECTS AND METHOD: A retrospective analysis was carried out on 441 ears of 266 patients who underwent tympanostomy tube (T-tube) insertions from January 1990 to December 2000. Patients were grouped according to the surgical procedures they underwent; T-tube insertion only, T-tube insertion and adenoidectomy and T-tube insertion and adenotonsillectomy. In addition to the type of surgical procedure, the time elapsed to the extrusion of T-tube, age, paranasal sinusitis, the nature of effusion, and adenoid size were chosen as factors affecting the recurrence of otitis media with effusion. The recurrence of OME, the reinsertion of T-tube, and the number of T-tube insertions during each patients' follow-up period were defined as the dependent variables. Statistical analyses were performed by multiple logistic regression and cumulative multiple logistic regression methods. RESULTS: A significant benefit was observed with adenoidectomy in preventing recurrence of OME (p<0.001), which was not enhanced by tonsillectomy. The effect of adenoidectomy was independent of adenoid size. Earlier extrusion of tympanostomy tubes was strongly correlated with the recurrence of otitis media with effusion (p<0.0001). OME tended to recur if the patients had younger age. CONCLUSION: Performing adenoidectomy at the time of the insertion of tympanostomy tube substantially reduces the recurrence of otitis media with effusion and the likelihood of reinsertion of T-tube.

A Case of Inflammatory Pseudotumor of the Temporal Bone with Extraocular Muscle Palsy / 대한이비인후과학회지

Inflammatory pseudotumors are benign tumors rarely that occurs in the head and neck. We present the case of a 39-year-old man presenting extraocular muscle palsy with inflammatory pseudotumor affecting the temporal bone including mastoid, middle ear and petrosal apex. At computed tomography and magnetic resonance imaging (MRI) scan, the lesion appeared as an enhancing mass of soft tissue occupying the majority of the mastoid bone and petrosal apex causing diplopia. The patient was treated with conservative surgical excision (a open cavity mastoidectomy and tympanoplasty) and postoperative steroid therapy. Microscopic examination showed predominantly mature plasma cells. The patient remains free of disease 8 months after treatment. We believe this is the first case report of inflammatory pseudotumor affecting the middle ear and mastoid involving the petrous apex.

Efficacy of Adenoidectomy on Pediatric Chronic Rhinosinusitis

BACKGROUND AND OBJECTIVES: Adenoid vegetation can induce chronic rhinosinusitis in children by obstruction of the nasopharynx or as a reservoir for bacteria. The aim of this study is to determine the efficacy of adenoidectomy in chronic pediatric rhinosinusitis. Materials and Methods: Symptoms of chronic rhinosinusitis were evaluated in 17 patients who underwent an adenoidectomy between November 2001 and July 2002. Patients' age ranged from 4 to 11 years old. Caregivers of the patients were asked about symptoms of chronic rhinosinusitis, which were nasal obstruction, rhinorrhea, postnasal drainage, headache, cough and sputum, by a 10-graded visual analogue scale of 6 items at preoperative and postoperative 2, 3, 4, 5, 6, 8, 10 and 12 weeks, respectively. We assessed the grades of plain radiographic (Waters' view) findings at postoperative 1, 2 and 3 months consecutively. RESULTS: Symptoms of chronic rhinosinusitis were significantly improved following adenoidectomy. Significant improvement of symptom scores began at postoperative 2 weeks on the average. Plain radiographic findings were significantly improved at postoperative 1 month. After postoperative 7 months, 'Cure' was reported in 9 (53%) of 17 patients. Conclusions: In majority of cases, symptoms and radiographic findings of chronic rhinosinusitis in children are improved by adenoidectomy. Adenoidectomy should be considered as a first-line surgical option for pediatric chronic rhino-sinusitis.

The Role of Allergy in the Severity of Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although allergic rhinitis is one of the most common factors associated with the development of chronic rhinosinusitis, the role of allergy in the severity of chronic rhinosinusitis was not well defined. This study is aimed to determine whether the allergy or factors such as nasal polyp, asthma, aspirin sensitivity can induce more extensive chronic rhinosinusitis, and to determine whether the severity of chronic rhinosinusitis depends on the severity of allergy. MATERIALS AND METHODS: A total of 98 chronic rhinosinusitis patients who underwent endoscopic sinus surgery were evaluated. The severity of chronic rhinosinusitis was assessed by CT scores and symptom scores. An allergic prick test, MAST (Multiple-antigen simultaneous test), the total IgE, and a serum eosinophil count were evaluated for diagnosis and assessment of the severity of allergy. Influences of another factors such as nasal polyp, asthma, and aspirin sensitivity to the severity of chronic rhinosinusitis were evaluated. RESULTS: Although the symptom scores of allergic chronic rhinosinusitis patients were greater than those of non-allergic chronic rhinosinusitis patients, there were no CT score differences between the two groups. Differences in the CT scores and symptom scores in allergic chronic rhinosinusitis patients according to the severity of allergy were statistically insignificant. Nasal polyp, asthma, and aspirin sensitivity did not induce more severe chronic rhinosinusitis. CONCLUSION: Allergy may be associated with the development of chronic rhinosinusitis, but the severity of allergy is not correlated to the severity of chronic rhinosinusitis.