Invasive Aspergillosis Associated Bacterial Infection in the Nasal Septum After Sphenoid Sinus Surgery / 대한이비인후과학회지

Nasal septal infection can result from progression of a fungal infection from the adjacent sinuses. Nasal septal fungal abscesses complicating nasal trauma, surgical procedures, sinus, and dental infections have previously been reported in a small number of cases. Adequate management involves early diagnosis, prompt empiric antifungal therapy, and surgical debridement in order to prevent the development of life-threatening complications. We report a rare case of nasal septum necrosis from Aspergillus infection in a 79-year-old man with diabetes mellitus and chronic renal failure following endoscopic sphenoid sinus surgery due to an isolated sphenoid fungal ball.

A Case of Epithelioid Hemangioendothelioma of the Nasal Cavity / 대한이비인후과학회지

Epithelioid hemangioendothelioma (EHE), a rare vascular tumor that is both clinically and histologically an intermediate between angiosarcoma and hemangioma, was first described by Sharon Weiss and Franz Enzinger. It is characterized by proliferation of a distinct type of endothelial cells, which exhibit epithelioid morphology. It typically occurs in the 20-40 age range with no sex predilection, although the overall age range involved is much broader. This indolent tumor is potentially recurrent, but it rarely metastasizes. There are very few cases of EHE of nasal cavity described in the English literature. We describe here a case of EHE on the left middle turbinate of a 17-year-old male who presented with history of intermittent epistaxis.

Headache Characteristics in Rhinologic Patients and the Role of Surgical Treatment

OBJECTIVES: Even though headache is a common symptom in patients with chronic rhinosinusitis (CRS) or nasal septal deviation (NSD), there are very few recent reports investigating headache characteristics in rhinologic patients. Therefore, we investigated the headache characteristics and differences in CRS and NSD patients who were diagnosed by computerized tomography and endoscopic exams. METHODS: We enrolled 257 patients who had undergone nasal and sinus surgery between January 2012 and December 2013. The subjects were divided into a CRS group (n=147) and NSD group (n=110). They were asked to fill out a Sinonasal Outcome Test (SNOT-20) and questionnaire about pre-operation headaches (1 day prior) and post-operation headaches (1 month after) they experienced, to evaluate their sinonasal symptoms and headache characteristics. RESULTS: There was no significant pre-operative difference in rhinologic symptoms and headache characteristics between the CRS and NSD groups. Females experienced more headaches. Both groups reported significant improvements to their headaches after surgery; however, we found no significant differences in the degree of improvement between the two groups. CONCLUSIONS: There was no significant difference in the headache characteristics and the degree of post-operative improvement between the CRS and NSD groups. Surgical treatments appear to reduce headaches in patients with rhinologic diseases.

Vegetable or Pulse Granuloma in the Nasal Cavity

Vegetable granuloma or pulse granuloma results from the implantation of food particles of vegetable origin. Pulse granulomas have mainly been reported in association with lung aspirations, the oral cavity with a history of oral procedures and less frequently in gastrointestinal tracks. We report a 31-year-old woman who presented with right nasal obstruction and was found to have a firm mass in the right nasal cavity. Paranasal sinus computerized tomography scans identified a calcified ring lesion in her right nasal cavity. Endoscopic sinus surgery was performed, and pathology examination revealed a lesion consistent with a pulse granuloma that contains starch granules with cellulose envelopes appearing as hyaline rings surrounded by inflammation cells and concentrically arranged delicate connective tissue. Pulse granuloma is a well described entity with distinct histopathology. However, pulse granulomas are rare, and especially extraoral pulse granulomas are extremely rare. We found that pulse granuloma can be occurred in the nasal cavity through regurgitation.

Relationship between Meteorological Factors and Emergency Department Visits for Epistaxis in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epistaxis may be related to changes in weather, but this relationship has not been well-defined. We investigated the effects of climate fluctuations (temperature, humidity, and barometric pressure) on the number of emergency department (ED) visits for epistaxis. SUBJECTS AND METHOD: In total, our study population included 1910 patients who visited the ED of a large, urban hospital during a 5-year period for epistaxis. Patients with clear etiology for epistaxis (trauma, iatrogenic, coagulopathy, and/or hypertension) were excluded, leaving 912 patients for subsequent analysis. Daily climate data was collected through the Korea Meteorological Administration. Correlation between epistaxis ED visits and weather variables were investigated using Poisson distribution and multiple regression analysis. The effect of climate factor was evaluated on the day and up to 3 days prior to ED presentation. Additionally, analyses were conducted separately for children ( or =65 years-old). RESULTS: Changes in the lowest temperature 2 days prior to ED presentation significantly increased the number of ED visits for epistaxis (beta=-0.043, p=0.033). No associations were found between the number of ED visits and changes in humidity or atmospheric pressure. However, in children, interday changes in the highest atmospheric pressure between 2 and 3 days prior to ED presentation were both significantly associated with increased number of epistaxis ED visits. CONCLUSION: Cold temperatures 2 days prior to ED presentation were related to the increased incidence of epistaxis. Fluctuations in barometric pressure appear to influence the number of pediatric ED visits for epistaxis.

Morphologic Analysis of Crista Galli Using Computed Tomography

OBJECTIVE: We often observe the variation of Crista galli (CG) which lies in the midline above the cribriform plate on computed tomography (CT) scans. We investigated the variations in CG and the factors which affect its pneumatization. MATERIALS AND METHODS: We analyzed the CT images of 818 chronic rhinosinusitis patients between July 2003 and July 2011. We investigated height, position relative to the cribriform plate, degree of pneumatization, and cell origin for the pneumatization in CG. We analyzed the relationship between several factors (age, sex, and position of CG) and pneumatization of CG. RESULTS: The average height of CG was 17.98 mm. In 13.9% of subjects, the base of CG did not extend below the level of the cribriform plate. In 84.2%, CG extended less than 50% of its height below the cribriform plate. In 1.8%, CG extended more than 50% of its height below the cribriform plate. Pneumatization of CG was found in 12.2%. Except one, every pneumatization was connected with the frontal sinus. The rate of pneumatization was significantly different depending on age. CONCLUSION: Our study demonstrated that CG showed various morphology and pneumatizaiton. The pneumatization of CG was mainly originated from frontal sinus and related to aging.

The Characteristics of Sinonasal and Psychological Symptoms and Quality of Life in Rhinologic Patients and the Role of Surgical Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic diseases of the nose and sinuses have been shown to influence patients, not only physically but also psychologically affecting the overall well-being. We evaluated the quality of life of rhinologic patients, and the effect of surgery on them. In addition, we assessed the correlation between the symptom scores and objective findings. SUBJECTS AND METHOD: From November 2009 to January 2011, a total of 194 patients haveing nasal and sinus surgery were enrolled. They were divided into nasal cavity disease (NCD) group (n=103) and chronic rhinosinusitis (CRS) group (n=91). These patients had to fill out a questionnaire at different points, at 1 day, 1 month, 3 and 6 months prior to surgery. The normal control group (n=30) also had to fill out four questionnaires: our questionnaires were Sinonasal Outcome Test-20 (SNOT-20), Rhinosinusitis Disability Index (RSDI), Version 2 of Short-Form 36 item Health Survey (SF-36v2(TM)), Symptom Checklist-90-Revised (SCL-90-R). For the CRS group, Lund-Mackay score was calculated using CT scans. RESULTS: Both experimental groups showed more severe scores than the control group. The CRS group exhibited more severe symptoms than the NCD group. Both experimental groups achieved significant improvements after surgery. CRS group showed more significant improvement than the NCD group in SNOT-20. The Lund-Mackay score showed no significant correlation with the subjective symptom scores. CONCLUSION: Chronic rhinologic diseases affect the quality of life. CRS patients show more severe scores than the NCD patients. CRS patients have more improved effectiveness than NCD patients after surgical treatment. Objective conditions and subjective symptoms may be correlated inconsistently, and the evaluation for the overall quality of life is important to reflect on the therapeutic effect.

Proteomic Analysis of the Protein Expression in the Cochlea of Noise-Exposed Mice

BACKGROUND AND OBJECTIVES: When noise-induced hearing loss occurs, destruction of the hair cells is accompanied by mechanical injury, chemical injury, and hypoxia. Proteomics is a powerful tool for protein analysis, as it provides valuable information regarding the biochemical processes involved in diseases, monitors cellular processes, and characterizes protein expression levels. We attempted to identify the proteins associated with the pathophysiology of noise-induced hearing loss, as well as the mechanisms of this disease, using a proteomics approach. MATERIALS AND METHODS: We used BALB/C male mice. The control mice were placed in a booth without noise, while the experimental mice were exposed to noise for three hours daily for three consecutive days. Cochleae from each group were obtained for total protein extraction. The proteins were separated into numerous spots using two-dimensional electrophoresis. Seven protein spots that were strongly detected only in the noise-exposed cochleae were selected and subsequently analyzed using matrix-assisted laser desorption/ionization time of flight mass spectrometry. RESULTS: Approximately 286 protein spots were detected in the noise group. Seven selected spots were analyzed and various proteins identified, including tyrosine protein kinase MEG2, angiopoietin-like 1, heat shock 70 kDa protein, sodium dicarboxylate cotransporter 1, myeloid Elf-1-like factor, disintegrin, metalloproteinase domain 7, and activated leukocyte-cell adhesion molecule. CONCLUSIONS: We identified several proteins expressed in noise-induced hearing loss using a proteomics approach. These proteins may help us to understand the pathogenic mechanisms of noise-induced hearing loss.

A Case of Organizing Hematoma of the Nasal Septum / 대한이비인후과학회지

Organizing hematomas are rare benign tumors and appear as forms of mass which is composed of neovascularization with organizing fibrous tissue in hematoma. There have been sporadic reports of the organizing hematoma not only in soft tissue but also in brain, spinal cord, lung, and maxillary sinus. We report a case of organizing hematoma that was restricted in the nasal cavity without inclusion of the paranasal sinus. This is the first article describing the organizing hematoma of the nasal septum. We present this case with a review of literature.

Clinical Characteristics of the Adenoid Cystic Carcinoma of the Sinonasal Tracts

BACKGROUND AND OBJECTIVES: Adenoid cystic carcinoma is occasionally found, second to the squamous cell carcinoma, in the sinonasal tracts. The purpose of this study is to find out the clinical features, treatment outcome, and prognostic factors of adenoid cystic carcinoma in the sinonasal tracts. MATERIALS AND METHODS: Between September 1993 and December 2005, 16 cases of adenoid cystic carcinoma of the sinonasal tracts (6 males, 10 females, ages ranging between 35-70 years; a mean age of 49 years) were selected. We reviewed medical records of the patients to examine their clinical presentations, treatment options, and their outcomes. RESULT: The most common site of affliction was the nasal cavity (37.5%) followed by the maxillary sinus (31.3%). Patients displayed various symptoms such as nasal obstruction, facial pain, and epistaxis. Nine out of 16 patients (56%) were diagnosed to be in stage IV (AJCC staging system). Histopathological examination revealed cribriform type (13 patients: 81%) and solid type (3 patients:19%). In 3 patients, perineural invasion was observed. Surgery with or without postoperative radiation therapy (RT) was applied for 8 patients (stage I, II, III, IV), RT only for 7 patients (stage III, IV), and RT and chemotherapy for 1 patient (stage IV). Total recurrence rate was 43.8% (7 out of 16 patients) and the recurrence rate of the patients followed up over 5 years was 62.5% (5 out of 8 patients). CONCLUSION: Adenoid cystic carcinoma of the sinonasal tract develops more frequently among women and is usually discovered in the advanced stage. Surgery and postoperative RT are the main stay of the treatment.

Correlation between the Size of Adenoid and the Preoperative and Postoperative Symptoms after Tonsillectomy and Adenoidectomy

BACKGROUND AND OBJECTIVES: For the documentation of nasopharyngeal adenoid tissue, various methods, including radiological, aerodynamic diagnostic modalities, have been utilized but were not practically efficient. The previous evaluation method of radiology was used to measure the shortest A-P diameter of nasopharyngeal air space (NPD min) in the preoperative skull lateral view or adenoidal-nasopharyngeal ratio (A/N ratio) related to the subjective symptoms. The authors attempted to compare the correlation between the narrowest, upper third, middle third, low third A-P diameter of nasopharyngeal air space, A/N ratio in the pre & postoperative skull lateral view and pre & postoperative subjective symptoms. MATERIALS AND METHODS: We evaluated the data from 100 children (61 males, 39 females: age range 2-14 years, mean 8.2 years), who received adenoidectomy and tonsillectomy from a single surgeon (senior author) from January 2004 to August 2004. RESULTS: There was no significance in the correlation between A/N ratio in the pre & postoperative skull lateral view and the most pre & postoperative subjective symptoms. However, the degree of postoperative nasal obstruction and cough were significantly related to the postoperative narrowest A-P diameter of nasopharyngeal air space, regardless of the location. The upper third, middle third and low third AP diameter of nasopharyngeal air space were also significantly related to the degree of postoperative cough. CONCLUSION: It is necessary to resolve the narrowest A-P diameter of nasopharyngeal air space on the skull lateral view for the improvement of the subjective symptom such as nasal obstruction and cough due to adenoid hypertrophy.

Comparison of Radiologic Characteristics between Inverted Papilloma and That Associated with Squamous Cell Carcinoma

BACKGROUND AND OBJECTIVES: Inverted papilloma (IP) is not infrequently associated with squamous cell carcinoma (SCCa). Preoperative punch biopsy for the nasal mass of patients with associated carcinoma often results only in an inverted papilloma, which is followed by an inadequate surgery. In this study, the authors aim to differentiate the inverted papilloma associated with carcinoma from the simple inverted papilloma in the preoperative CT scan. MATERIALS AND METHODS: Between January, 1997 and February, 2005, twelve cases of IP with carcinoma (IP+SCCa) were diagnosed and treated at the Department of Otolaryngology, Asan Medical Center. The control group, made up of twenty-six cases of IP, was selected randomly during the same period. We analyzed the paranasal sinus CT (PNS CT) findings and reviewed medical records of the patients. The CT characteristics such as calcification, bridging the antronasal border, heterogenous enhancement, tumor necrosis, bony thickening, choanal extension, bony remodeling, bony destruction and surrounding structures were compared between the two groups. RESULTS: Both the IP and the IP+SCCa had developed unilaterally. The most common site was the middle meatus in the IP and the ethmoid sinus in the IP+SCCa. On the PNS CT, the IP+SCCa had intraorbital and pterygopalatine fossa invasion were more frequent than in the IP. Bony thickening and bone destruction were the statistically significant findings that favor the IP+SCCa (p=0.049 & p=0.000). CONCLUSION: Bone destruction of the maxillary sinus wall in the preoperative PNS CT suggests the association of SCCa among the IP patients. Preoperative instruction for the patients and surgical planning for the possible SCCa should be strongly considered.

Treatment of Tuberculous Cervical Abscess / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tuberculous cervical lymphadenitis is not an uncommon inflammatory disorder in Korea. It often does not respond to the antituberculous medication, but grows up gradually making the cervical abscess. Authors aimed to find out the clinical features and the treatment modalities of tuberculous cervical abscess. SUBJECTS AND METHOD: From Jan. 2001 through Dec. 2005, 52 cases of the tuberculous cervical abscess (16 males, 36 females : age range 18-63 years, mean 30.4 years) were diagnosed and managed at the Department of Otolaryngology, Asan Medical Center. We reviewed medical records of patients to find out their presentations, diagnostic considerations, therapeutic options, and outcomes. Patients were followed up for sixteen months on the average after treatment. RESULTS: There was no difference in the duration of antituberculous chemotherapy according to the surgical methods. However, in the cases of mass excision (91.7%), cure rate (remnant mass size <5 mm) was higher, compared to incision and drainage (80.0%). Compared to excision (3/15, 25%, 39 days), incision and drainage needed more days for dressing for healing (4/5, 80%, 90 days). CONCLUSION: Therefore, we recommend, if possible, complete excision as a therapeutic modality in cases of tuberculous cervical abscess.

The Diagnostic Value of Magnetic Resonance Imaging in Patients with Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

OBJECTIVES: To evaluate the diagnostic value of magnetic resonance imaging (MRI) of patients with sudden sensorineural hearing loss (SSNHL) and to analyze the various clinical aspects and treatments of the patients with abnormal MRI findings. SUBJECTS AND METHOD: We retrospectively reviewed medical and radiological records of patients with SSNHL over 5-year period. All consecutive patients took gadolinium-enhanced MRI including whole brain and all MRIs were evaluated by experienced independent investigators. RESULTS: Twelve patients (8.0%) had obvious etiologies of SSNHL, which consisted of 5 cases of vestibular schwannoma, 3 cases of tumors of cerebellopontine angle, 3 cases of pontine infarction, and 1 case of inflammatory granuloma of internal auditory canal. One patient (0.7%) had possible etiologies of SSNHL, which was labyrinthitis ossificans. CONCLUSION: Gadolinium-enhanced magnetic resonance imaging (MRI) including whole brain seems to be an essential examination in patients with SSNHL and we recommend its application.