A Case of Ethmoidal Sarcoidosis / 대한이비인후과학회지

Sarcoidosis is a multisystemic, chronic granulomatous disease of unknown etiology. Most commonly, it involves the lung parenchyme and hilar lymph nodes. Head and neck involvement is found in 9% of the patients, with sinonasal involvement demonstrated only in 1% of these patients. Diagnosis is usually performed according to the clinical, laboratory, radiographic and histological features and by excluding other granulomatous diseases. Of these features, the histologic finding is a major diagnostic tool. In sinonasal sarcoidosis, the most common symptoms are nasal obstruction and crusting, and the most consistent finding was an edematous, friable, erythematous and hypertrophied mucosa. The clinical course is variable and there is no consensus about the treatment options. But, the systemic corticosteroid is the mainstay of treatment. We report a case of ethmoidal sarcoidosis which was successfully managed by endoscopic sinus surgery along with systemic corticosteroid. To our knowledge, this is the first report of sinonasal sarcoidosis in Korea.

Bilateral Second Branchial Cleft Fistulas: A Case Report / 대한이비인후과학회지

The branchiogenic anomalies are common congenital cervical anomalies. They usually arise from an incomplete obliteration of the branchial apparatus during fetal development. These anomalies may be confused with and mistaken for other potentially more serious lesions, such as cystic hygromas, teratomas, and lymphomas. The anomalies are typically discovered in the pediatric and adolescent population and develop unilaterally. Bilateral manifestations are very rare and have a familial tendency. In addition, anomalies such as intrauterine and postnasal growth retardation, premature aging and unusual faces may be related with bilateral occurrence. This is the first report in the Korean language literature of bilateral branchial fistulas.

Functional Results of Voice and Swallowing in Patients Treated with Surgery or Radiation Therapy for Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngeal neoplasms such as early glottic cancer can be effectively treated with several methods, namely laser surgery, conservation laryngeal surgery and radiotherapy. Therefore, the preservation of the ability to speak and swallow normally is another important consideration in the selection of therapy for early glottic cancer. The purpose of this study is to compare the functional results of voice and deglutition for early glottic cancer patients treated with surgery or radiation. SUBJECTS AND METHOD: Between January 2002 and September 2004, 17 patients with the early glottic cancer who had undergone radiotherapy (n=6) or surgery (n=11) were retrospectively investigated. All the patients were phonetically analysed using CSL and Fo, Jitter, Shimmer and NHR were evaluated. For aerodynamic test, maximum phonation time (MPT) and mean air flow rate (MFR) were also evaluated. Modified barium swallow (MBS) was performed to evaluate swallowing function. RESULTS: There were no significant difference in all the vocal parameters between radiotherapy group and surgery group. But Shimmer differed significantly between radiotherapy group and laser cordectomy group. In aerodynamic study, MPT was significantly longer in the radiotherapy group than in the surgery group, but no significant difference was observed between the radiotherapy group and laser cordectomy group. MBS showed better results in the surgery group than in the radiotherapy group. CONCLUSION: Therapeutic modality for patients with early glottic cancer should be chosen in consideration of voice quality and swallowing, and according to multiple parameters of the patients' conditions.

Treatment of Acute Mastoiditis with Subperiosteal Abscess;Is the Mastoidectomy Necessary? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Subperiosteal abscess, the most common complication of acute mastoiditis, has traditionally been treated with mastoidectomy. We aimed in this study to investigate the effectiveness of mastoidectomy in the management of acute mastoiditis with subperiosteal abscess. SUBJECTS AND METHOD: We reviewed restrospectively the charts of 19 patients who had been admitted to our hospitals with acute mastoiditis complicated with subperiosteal abscess during the years 1994-2004. RESULTS: All patients received intravenous antibiotics. While the mastoidectomy with ventilation tube insertion was done in 13 cases, 5 cases received incision and drainage of the abscess with ventilation tube insertion. In one patient who developed a subperiosteal abscess after the resolution of acute mastoiditis, only incision and drainage of the abscess was done. All cases showed complete recovery. CONCLUSION: Incision and drainage of the abscess accompanied by application of intravenous anti-biotics and ventilation tube would be an appropriate treatment for acute mastoiditis with subperiosteal abscess instead of routine mastoidectomy. or in cases with no evidence of facial nerve palsy, cholesteatoma and intracranial complications such as meningitis, cerebral abscess and sigmoid sinus thrombophlebitis etc.

Secondary Tongue Cancer in Patients with Chronic Graft-Versus-Host Disease(GVHD) after Bone Marrow Transplantation: Report of Two Cases / 대한이비인후과학회지

We report two patients with chronic graft-versus-host disease (GVHD) after bone marrow transplantation (BMT) who developed cancers in the mobile tongue. The first patient, a 15-year old female who had undergone bone marrow transplantation for Fanconi's anemia five years ago, developed chronic GVHD on the oral cavity 1.5 years after the transplantation and have suffered from it ever since. Recently, she developed squamous cell carcinoma in the tongue. The second patient, a 50-year old male who had received the bone marrow transplantation due to severe aplastic anemia, developed chronic GVHD on the oral cavity 5 months later and have suffered from it thereafter. He developed squamous cell carcinoma of the tongue 15 years later after BMT. These cases imply that cancers including tongue neoplasms may develop in patients with GVHD after bone marrow transplantation. A thorough examination of head & neck and close follow-up are recommended to patients treated with bone marrow transplantation, particularly to those with GVHD.

Functional Results of Tongue Reconstruction Using Free Flaps after Total Glossectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Total glossectomy and postoperative radiotherapy is the treatment of choice for advanced carcinoma of the floor of mouth and tongue. But, it has the potential for causing severe speech impairment and disrupting the deglutition and may cause life-threatening aspiration. Proper reconstruction is essential for the postoperative functional rehabilitation. The aim of the present study is to evaluate the oncologic results and the results of speech and swallowing function tests in patients who were reconstructed using surgical flaps after total glossectomy. MATERIALS AND METHODS: We reviewed the medical records of 7 patients who underwent total glossectomy (Jul. 1995 to Feb. 2000). Modified barium swallow (MRS) according to Longmann's method was done in 5 patients and speech function tests which comprised of Kim's method, Bzoch's method and Allison's method were done in 4 patients. RESULTS: Six patients were found to be stage T4 primary tumors and one was stage a T3 primary tumor. The lateral thigh free flap was most commonly was used in five cases. In two cases, either a rectus abdominis free flap or a radial forearm free flap was used. Six patients received postoperative radiotherapy. Currently, four patients are completely cured but three developed recurrence, of whom two have expired and one is living. Six patients regained swallowing and independent oral alimentation. MBS showed poor intraoral transport but, good propulsive pharyngeal emptying. Also, they regained intelligible speech. Speech intelligibility was grade 4 in all patients. CONCLUSION: The reconstruction with the free flap after total glossectomy provides considerably satisfactory functional results in swallowing and speech as well as providing better oncologic results in advanced tongue cancers.

Effect of Inhibitor of TNF-alpha on Lipopolysaccharide-induced Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tumor necrosis factor (TNF)-alpha, a potent inflammatory mediator, seems to be important in the pathogenesis of otitis media with effusion (OME). The purpose of this study is to determine the effect of TNF-alpha antagonist on the outcome of experimental OME induced by lipopolysaccharide (LPS) in rats. MATERIALS AND METHODS: Otitis media was induced by injecting 40 microliter (1 mg/ml) of Pseudomonas aeruginosa LPS transtympanically in one group of rats. Other groups were treated with LPS after transtympanic injection of TNF-alphaantagonist, soluble TNF receptor type I (sTNF RI), 10 microliter (0.1 microgram/ microliter), and with saline as controls. Twelve hours after inoculation of LPS, otoscopic examination and aspiration of middle ear effusion (MEE) were done. The temporal bones in each group were harvested and examined histopathologically and vascular permeability (VP) of middle ear (ME) mucosa was measured by Evans blue vital dye technique. RESULTS: The percentage of MEE developing in the LPS and LPS with sTNF RI (combination) groups were 90% and 0%, respectively. Histopathologic examination of ME revealed less inflammation and mucosal thickening, and a significant decrease in the middle ear VP in the combination group when compared with the LPS group. CONCLUSION: Transtympanic administration of TNF-alphaantagonist appears to suppress the development of LPS-induced OME. This study suggests that TNF-alpha antagonist along with antibiotics may have an adjunctive role in the future treatment of MEE.

Expression of Cytokeratin Subtypes in Advanced Laryngeal Carcinoma and Its Relationship to p53 and Human Papilloma Virus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study investigated the expression of cytokeratin 8, 18, 19 with low molecular weight, which have been classified as a group of simple epithelium-related marker for advanced squamous cell carcinoma of the larynx. MATERIALS AND METHODS: Detection of cytokeratin expression was performed by immunohistochemical study using antikeratin monoclonal antibodies (CAM5.2, RCK108). Immunohistochemical study was used further to detect the presence of p53 mutation in larynx carcinoma, and PCR was performed to detect the infection of HPV. We then tried to draw relationship among these factors with regard to advanced larynx carcinoma. RESULTS: Cytokeratin 8, 18 (CAM5.2) was detected in 17 cases among the 19 advanced larynx carcinoma, and in 3 cases among the 15 normal larynx. Cytokeratin 19(RCK108) was detected in 18 cases among the advanced larynx carcinoma, and in 11 cases among the 15 normal larynx. HPV DNA was detected in 4 of the 19 cases of larynx carcinoma. With regard to subtypes of HPV, HPV 16 was detected in 2 cases. And p53 was detected in 6 out of the 19 cases of larynx carcinoma. There was no correlation among the cytokeratin expression, the p53 expression, and the HPV infection. CONCLUSION: This results show that cytokeratin 8, 18 (CAM5.2) expression might be a meaningful parameter in malignant change of the larynx, but the prognostic role of the cytokeratin and the role of p53 and HPV in cytokeratin expression in larynx carcinoma was not confirmed.

A Case of Lateral Semicircular Canal Dysplasia with Normal Cochlea / 대한이비인후과학회지

Congenital anomalies of the inner ear in comparison with anomalies of the external and middle ear present a clinical problem for diagnosis, because the inner ear structures can not be observed directly. Ontolaryngologists can diagnose these anomalies by radiological study alone. In recent years, high-resolution computed tomographs permits more reliable and definitive diagnosis of these anomalies. Although the incidence of anomalies of the vestibular canals have been less well studied than those of cochlear anomalies, congenital malformation of the semicircular canals are rare. We present one case with computed tomographic findings of lateral semicircular canal dysplasia with normal cochlea development. Initial air and bone conductions were within normal limits, although he mainly complained dizziness. Bithermal caloric responses were absent on the involved side. Computed tomogram showed isolated lateral semicircular canal dysplasia. To our knowledge, this case is the first report of labyrinthine dysplasia with normal cochlear development in Korea.