Reliability of Interference Pattern on Laryngeal Electromyography for Prediction of Prognosis of Vocal Fold Paralysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngeal electromyography (LEMG) is valuable for the prognosis of vocal fold paralysis (VFP). However, there is a lack of reliable data to apply it to clinical practice. The aim of this study is to evaluate the reliability of interference pattern of LEMG in order to predict the prognosis of VFP by comparing interference pattern and vocal cord mobility. SUBJECTS AND METHOD: A retrospective chart review was performed for patients who underwent LEMG from January 2012 to October 2015. Gender and age of patients, cause and treatment of VFP, vocal cord mobility, and result of LEMG were analyzed. The interference pattern of LEMG was used as a predictive marker of prognosis, which is compared with vocal cord mobility during the last follow-up. RESULTS: Fifteen patients were enrolled in this study. Among them, five patients were predicted by LEMG evaluation to have good prognosis, and 10 patients were predicted to have poor prognosis. All of the five patients with good prognosis showed improvement in vocal cord mobility, while seven out of 10 patients predicted with bad prognosis showed vocal fold fixation at the last follow-up. The reliability of prognostic prediction through interference pattern was 80%. CONCLUSION: Interference pattern of LEMG is reliable data to predict the prognosis of VFP, especially it showed perfect consistency for good prognosis.

Hearing Outcomes and Prognostic Factors in Idiopathic Sudden Sensorineural Hearing Loss Patients with Combined Intratympanic and Systemic Steroid Therapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hearing outcomes and prognostic factors of idiopathic sudden sensorineural hearing loss (SSNHL) were investigated in patients who underwent combined intratympanic and systemic steroid therapy. SUBJECTS AND METHOD: This study was performed by retrospective chart review. Clinical outcomes and prognostic factors were evaluated in 147 patients who received intratympanic steroid plus systemic steroid therapy. RESULTS: Complete hearing recovery was achieved in 36.7% (n=54) of the patients, partial recovery in 12.9% (n=19), slight recovery in 12.3% (n=18), and total recovery in 61.9% (n=91). Age was identified as an independent, negative prognostic factor for hearing recovery. The recovery rates of the down sloping and profound types were poorer than those of the up sloping type as determined by audiography. CONCLUSION: The results of this study suggest that the combined treatment of intratympanic and systemic steroids for idiopathic SSNHL results in high hearing recovery rates, and that the down-sloping and profound types of audiogram patterns and age are negative prognostic factors.

Surgical Strategies for Prevention and Treatment of Airway Aspiration in Head and Neck Cancer Patients

Postoperative airway aspiration is not uncommon in patients with head and neck cancer. Airway aspiration has serious consequences, such as swallowing disorders, nutrition-related health problem, or reducing the quality of life due to maintenance of tracheal or nasogastric tubes. The postoperative oropharyngeal defect due to the surgery may interfere with normal swallowing reflex, or the laryngeal dysfunction caused by radiation therapy may cause severe airway aspiration, which may lead to complications such as dyspnea and pneumonia. Complete removal of the disease is also important in the treatment of head and neck cancer, but it is necessary to select a method to avoid and predict the occurrence of airway aspiration according to the treatment method. The most important factor to prevent airway aspiration after surgery is to preserve the proper volume of the oropharynx and to preserve at least one of the cricoarytenoid joint function. It is also the most effective way to reduce additional complications by seeking appropriate surgical treatment according to airway aspiration status. The purpose of this study is to review the operative methods that can induce airway aspiration and consider the prevention and treatment strategy through review of the literature.

Age-Related Changes in Nuclear Factor Erythroid 2-Related Factor 2 and Reactive Oxygen Species and Mitochondrial Structure in the Tongues of Fischer 344 Rats

OBJECTIVES: Previously the authors reported age-related changes in the activities of anti-oxidative enzyme activities and protein expressions in the tongues of rats. Because more information is required about relations between aging and oxidative stress and anti-oxidative enzyme efficiency, the authors investigated differences between the expression of master regulator of anti-oxidative enzymes (nuclear factor erythroid 2-related factor 2 [Nrf2]), levels of reactive oxygen species (ROS), and mitochondrial structures in the tongues of young and aged Fischer 344 rats. METHODS: Age-dependent changes in Nrf2 protein and ROS were determined by Western blotting and using chemical kits, respectively. Tongue specimens were examined by electron microscopy. The study was conducted using rats aged 7 months (young, n=8) or 22 months (old, n=8). RESULTS: Nrf2 protein levels in the tongues of aged rats were lower than in young rats. ROS levels were higher in older rats and mitochondrial structural deficits were observed their tongues. Three young rats showed moderate mitochondrial degeneration, whereas profound degeneration with mitochondrial cristae disruption, swelling, rupture, or intramitochondrial vacuole formation was observed in all 8 old rats. Notably, mitochondrial rupture was observed in 5 old rats. CONCLUSION: Antioxidant defense systems of old rats were compromised by Nrf2 deficiency, which could lead to the deleterious accumulation and release of ROS and probably mitochondrial structural deficits in aged tongue tissues.

Treatment Result of Proton Pump Inhibitor, Steroid Inhaler and Botulinum Tonxin Injection for Contact Granuloma

BACKGROUND AND OBJECTIVES: This study evaluated the efficacy of combination therapy of proton pump inhibitor (PPI) and steroid inhaler (SI), with or without botulinum toxin injection (BTX) for contact granuloma. SUBJECTS AND METHODS: Fourteen contact granuloma patients were enrolled in this study. Combination therapy of PPI and SI were used for the first line treatment. When combination therapy was not effective, BTX was performed as the second method. Treatment results were recorded as responsible or non-responsible. Farwell grade, size, history of voice abuse, gender, and reflux finding score (RFS) were compared between responsible group and non-responsible group. RESULTS: Initial response rate was 28.6% after treatment of PPI and SI. BTX was performed on three un-responsible patients. After BTX injection, three patients had complete remission of granuloma. Final response rate was 50.0%. Un-responsible group had significantly higher RFS than responsible group. CONCLUSION: The efficacy of PPI and SI was limited for contact granuloma in this study. Botulium toxin injection was recommended in early phase when PPI and SI did not effective for contact granuloma. Prospective studies evaluating the effects of PPI and SI are warranted.

Age-Related Changes in Antioxidative Enzyme Capacity in Tongue of Fischer 344 Rats

OBJECTIVES: Antioxidative enzyme efficiency changes in some organs with age. However, no study has been conducted on age-related antioxidant enzyme changes in tongue. In the present study, the authors investigated the activities of four antioxidative enzymes and their protein expressions in the tongues of young and old Fischer 344 rats. METHODS: Age-dependent changes in the enzyme activities of total superoxide dismutase (SOD), Mn-SOD, Cu/Zn-SOD, catalase (CAT), and glutathione peroxidase (GPx) were determined using chemical kits, and the protein expressions levels of these enzymes by Western blotting. The study was conducted using rats aged 7 months (the young group, n=8) and 22 months (the old group, n=8). RESULTS: Total SOD, Cu/Zn-SOD, and GPx activities in the tongues of old rats were lower than in young rats, and similarly, corresponding protein expressions were downregulated in old rats. On the other hand, although the protein expressions of Mn-SOD and CAT were lower in old rats, their enzyme activities were not. CONCLUSION: The results of this study provide a possible mechanism for the tongue aging process, as in old Fischer 344 rats the antioxidant defense system was diminished with respect to enzyme activity levels and protein abundances.

Failed septal extension graft in a patient with a history of radiotherapy / 대한악안면성형재건외과학회지

BACKGROUND: This report describes the authors’ experience of “melting” septal cartilage after placement of a septal extension graft in a nasopharyngeal cancer patient that had been previously undergone radiation therapy, and provides a review of the literature. METHODS: Electronic medical records were used to obtain details of the patient's clinical history. RESULTS: A 32-year-old woman, who had previously undergone radiotherapy for nasopharyngeal cancer, visited our department to for rhinoplasty. Rhinoplasty was performed using a septal extension graft to raise the nasal tip (first operation). Five days after surgery, it was found that the septal extension graft was melting without any signs of infection, that is, the graft had softened, lost elasticity, thinned, and partially disappeared without any sign of infection at 5 days, and thus, the nasal tip was reconstructed with conchal cartilage (second operation). Five months after surgery, it was found that almost all septal cartilage had disappeared without any sign of infection, and thus, the entire nasal septum was reconstructed using 2-mm costal cartilage and an onlay graft was used for tip augmentation (third operation). CONCLUSIONS: After cartilage has been exposed to radiotherapy, its patency should be viewed with suspicion. Further studies are needed for determine the mechanism responsible for cartilage damage after radiotherapy.

A Pilot Randomized Comparative Study of Two Diathermy Power Settings for Monopolar Microdissection and Bipolar Hemostasis during Tonsillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Optimal electrical power required for diathermy during tonsillectomy has not been determined. The aim of this pilot study was to evaluate and compare surgical outcomes of using diathermy power settings at 15 watts (W) and 25W for monopolar microdissection and bipolar hemostasis during tonsillectomy. SUBJECTS AND METHOD: This prospective, single-center, single-blind, randomized study was conducted on 92 patients who underwent 15W or 25W monopolar microdissection and bipolar hemostasis for tonsillectomy. Operation times, post-operative pain severities, and rates of hemorrhage were compared between the 15W and 25W groups. RESULTS: The 92 patients were randomized equally into two study groups. The mean operation duration for the 15W group was significantly longer than in the 25W group (18.5±6.11 versus 13.4±6.04 minutes, p<0.01). The rate of minimal hemorrhage (defined as an episode of bleeding not significant enough for hospital visitation) for the 15W group was significantly higher than for the 25W group (41.3% versus 20.5%, p<0.05). No significant intergroup difference was observed between the rates of primary or secondary hemorrhage or postoperative pain scores. CONCLUSION: Twenty-five watt monopolar microdissection and bipolar hemostasis for tonsillectomy had a shorter mean operation time and a lower post-operative minimal hemorrhage rate than 15W monopolar microdissection and bipolar hemostasis.

Injection Laryngoplasty for The Treatment of Vocal Fold Scar, and Sulcus

BACKGROUND AND OBJECTIVES: The clinical reports for the treatment of vocal fold scar and sulcus vocalis are limited, also there is no best one for the treatment of them. This study is to evaluate the effect of Injection laryngoplasty (IL) for the treatment of vocal fold scar and sulcus vocalis. MATERIALS AND METHODS: from January 2013 to May 2015, the Nineteen patients who were diagnosed as vocal fold scar, sulcus and atrophy, and underwent IL, were engaged in this study. Clinical information and voice parameters were analyzed by retrospective chart review. Pre and post voice parameters were compared. RESULTS: Subgroups of diagnosis were classified into sulcus vocalis for 12 patients, vocal fold scar for 5, and atrophy for 2. IL was performed under local anesthesia through cricothyroid membrane except one patient. Atesense®, Radiessess®, and Rofilan® were used as injected materials in 9, 9, and 1 patients respectively. Maximal phonation time (p=0.0124), dynamic range (p=0.0028), pitch range (p=0.0141), voice handicap index (p=0.028), glottal closure (p=0.0229), and mucosal wave (p=0.0132) had significant improvement for post-IL voice assessment than Pre-IL. While GRBAS, Mean flow rate, Jitter, Shimmer, Harmony to Noise ratio didn't have improvement. CONCLUSION: IL is a feasible option for the treatment of glottis incompetence with normally mobile vocal folds such as sulcus vocalis and vocal fold scar.

A Rare Case of Bleeding Ectopic Lingual Thyroid Presenting as Hematemesis

No abstract available.

Colon Interposition via the Retrosternal Approach without Enlargement of the Thoracic Inlet for the Management of Esophageal Stricture / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To report our experience of colon interposition without thoracic inlet widening for the management of esophageal stricture. SUBJECTS AND METHOD: Between 2005 and 2012, five patients underwent esophageal replacement using colon graft. Clinical data, such as surgical techniques including thoracic inlet widening, surgical outcomes, and patient's age and gender were retrospectively analyzed. The follow-up period ranged from 10 months to 5 years. RESULTS: All five patients had corrosive esophageal stricture and underwent colon interposition without thoracic inlet widening; four underwent pharyngocologastrostomy and one total laryngopharyngectomy and pharyngocologastrostomy. No major complications, such as aspiration, dysphagia, reflux, or swallowing disorder developed during the postoperative long term follow-up. CONCLUSION: A colon graft without enlargement of the thoracic inlet is an excellent esophageal substitute for patients with an esophageal corrosive stricture. Further surgical experience and more long-term follow-up data are required to produce more precise and statistically meaningful results.

A Case of Epithelial-Myoepithelial Carcinoma Originating from Minor Salivary Gland of Tongue Base / 대한이비인후과학회지

Epithelial-myoepithelial carcinoma (EMC) is a rare, often low grade malignant neoplasm that occurs most commonly in the parotid gland. However, EMC originating from a minor salivary gland is extremely rare. A 38-year-old female patient was referred to our department for dysarthria and a huge mass at the base of tongue. Transoral resection of the mass was performed using a midline glossotomy approach. The pathological examination revealed epithelial-myoepithelial carcinoma of a minor salivary gland. Sequential adjuvant chemoradiotherapy was performed. After clinical follow-up of 26 months, she has remained free of disease. We report on this rare condition in order to share our experience.

Delayed Treatment of Zygomatic Tetrapod Fracture

Since maxillofacial injury is frequently accompanied by other diseases, its evaluation and treatment are open delayed. When the evaluation is delayed, the surgical treatment can be difficult or impossible. A 21-yr-old man presented with right facial swelling and deformity after injury. We planned immediate surgical repair for his right tetrapod fracture, but the operation was delayed for two months due to severe hyperthyroidism. During the operation, we reducted and fixed the deviated bone after refracture of the zygomatic arch with an osteotome to achieve mobility. The facial deformity and difficulty in mouth opening were improved after the operation. Even in the presence of accompanying fractures, early evaluation and proper management can prevent complications and achieve acceptable cosmetic outcomes in maxillofacial trauma patients. In patients with malunion of fracture sites, fixation after refracture using an osteotome can be a good treatment option for obtaining good mobility.

Cerebellar Venous Angioma Confused with Peripheral Vestibulopathy / 대한이비인후과학회지

Venous angioma is a congenital disease of vascular malformation, which is a mass like lesion consisted of dilated medullary veins. It is generally a silent lesion since it is found in normal brain tissues and tends to have low blood flow and pressure. The venous angioma could be diagnosed with magnetic resonance imaging and angiography, but most of them are incidentally diagnosed, because it is usually asymptomatic. The patients with venous angioma have nonspecific symptoms, such as headache, nausea and vomiting, seizures, progressive neurological deficit and hemorrhage. In particular, the venous angioma in cerebellum could cause hearing disturbance, tinnitus and dizziness. We report a case of venous angioma in cerebellum that had been mistaken for peripheral vestibulopathy in a patient complaining of dizziness

Efficacy of Rotating Chair Test And Caloric Test For The Diagnosis of Acute Unilateral Vestibular Neuritis

BACKGROUND AND OBJECTIVES: The acute unilateral vestibular neuritis is fairly a common disease and the precise diagnostic tool is needed for the selection of effective treatments. Therefore, we studied the clinical usefulness of the rotatory chair test and caloric test which have been commonly used in patient of acute unilateral vestibular neuritis. MATERIALS AND METHODS: One hundred and sixty four patients who were diagnosed with acute unilateral vestibular neuritis from August of 2004 to June of 2007 were included. Their medical records of the rotating chair test and caloric test were reviewed retrospectively to study the correlation of the two tests. RESULTS: Of 164 patients, 101 patients (61.6%) and 88 patients (53.7%) showed significant canal paresis (CP) and directional preponderance (DP) on the caloric tests that corresponded with the physical exam. 130 patients (79.3%) and 84 patients (51.2%) showed significant asymmetry and time constant (Tc) on the rotating chair test that corresponded with the predictive direction with spontaneous nystagmus. CONCLUSIONS: For acute unilateral vestibular neuritis patients, the asymmetry of the rotatory chair test showed the highest correlation with clinical findings. But physical exam should be preceded because neither rotator chair test nor caloric test yields a specific correlation with the physical exam. Especially, single test only may too many false negative results. For these tests can reduce false positive cases of the physical exam and raise the specificity of the diagnosis, the planning of proper treatments should be followed thereafter.

Clinical Analysis of Factors Affecting on Treatment of Deep Neck Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The treatment of deep neck infection is antibiotic therapy followed by surgery when it is indicated. There is no detailed guideline for the treatment according to clinical feature or extension of infection. So the purpose of this study is to find out factors affecting the treatment of deep neck infection in the point of clinical feature, laboratorial study and CT finding. SUBJECTS AND METHOD: We have conducted a retrospective study of 67 patients that had been seen between January 2005 and July 2007. We divided patients into a non-surgical group and a surgical group, analyzed clinical informations and laboratorial tests between the two groups, and studied the relations between lesion size, degree of infection and treatment method. RESULTS: There were significant differences between the non-surgically treated and surgically treated groups. The latter group presented with older age, larger lesion, more numbers of involved spaces, highly elevated WBC counts, more decreased in protein counts and had longer treatment period prior to hospitalization than the former group. Also, the size of the affected lesion was bigger, the incidence of abscess formation higher and required surgical treatment more often. CONCLUSION: Surgical management has an advantage when the lesion size is more than 7 cm, even if it presents an incomplete abscess. If the laboratory study reveals highly sustained WBC counts after proper antibiotic therapy and low protein counts, more aggressive treatment should be considered, especially for old patients.