Bilateral Pneumothorax and Pneumomediastinum Following Total Thyroidectomy with Central Neck Dissection

We describe a 60-year-old woman who developed extensive emphysema, bilateral pneumothorax, and pneumomediastinum after total thyroidectomy and central neck dissection with sacrifice of a recurrent laryngeal nerve. In this report, we discuss the possisle etiology of those rare complications.

Cochlear Implantation in a Deaf Patient with Bilateral Temporal Bone Fractures / 대한이비인후과학회지

Transverse temporal bone fracture can make a profound sensorineural hearing loss. This temporal bone fracture usually happens in the single side; however, the bilateral temporal bone fracture can make the postlingual deafness. Therefore, the deafness from bilateral temporal bone fractures can be one of the indications for the cochlear implantation. We report on the experience of the cochlear implantation in a deaf patient after bilateral temporal bone fractures.

Relationship of the Area Measurement of the Large Endolymphatic Duct and Sac Syndrome as well as the Clinical Symptoms with CT and MR Imaging Results

PURPOSE: To evaluate the CT and MRI findings of the large endolymphatic duct or sac syndrome (LEDS) and its associated anomalies, with clinical features. MATERIALS AND METHODS: We retrospectively reviewed the MR and CT images of 52 ears obtained from 26 patients with LEDS. We reviewed the clinical findings, audiology testing, and treatment results. The degree of hearing loss was classified from normal to profound, based on pure tone audiometry. The largest areas were measured at each endolymphatic duct and analyzed to determine whether a correlation exists with the degree of hearing loss. We also analyzed the differences in measurements between CT and MRI findings. RESULTS: All 26 patients had some degree of sensorineural hearing loss, which resulted in 18 ears to undergo a cochlear implantation. One patient was diagnosed with Cornelia de Lange syndrome. Five patients had a sudden hearing loss onset. Ten ears had incomplete cochlear partitions, whereas 28 ears had enlarged vestibules. All patients had severe to profound hearing loss. We found no statistical correlation between the size of the largest area of the endolymphatic duct and the degree of hearing loss. The mean area of the endolymphatic ducts, as per an MRI examination, revealed slightly greater areas than the CT findings, although the differences were not significant. CONCLUSION: Enlarged vestibules and incomplete partitions of the cochlea were common anomalies associated with LEDS. We found no statistical correlation between the largest area of the endolymphatic duct or sac with the degree of hearing loss.

A Case of Benign Paroxysmal Positional Vertigo and Sudden Hearing Loss during Recovery Phase of Vestibular Neuritis

Although vestibular neuritis is defined as acute peripheral vestibulopathy without associated hearing loss, a handful of cases reported sudden hearing loss without concurrent vertigo during follow-up of vestibular neuritis. In addition, some patients show benign paroxysmal postional vertigo(BPPV) ipsilateral to the lesion side with various interval after vestibular neuritis, and they are considered to be "secondary" BPPV. Viral and vascular etiologies have been assumed for the vestibular neuritis but, both of those failed to explain exact pathomechanism so far. Authors experienced a case of sudden hearing loss with simultaneous ipsilateral BPPV after vestibular neuritis. There has been no report of concurrent of BPPV and sudden hearing loss after vestibular neuritis. Sequential viral activations are considered to be responsible for this case.

Analysis of Complications after Endoscopic Maxillary Sinus Surgery with Canine Fossa Puncture and Microdebrider / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In patients with extensive polyposis of maxillary sinus or antrochoanal polyp, it is very difficult to remove entire diseased mucosa through middle meateal antrostomy and often require the procedure of canine fossa puncture. The aim of this study was to analyze the complications associated with this procedure. MATERIALS AND METHOD: We performed a prospective study and questionnaire about complications on 56 patients who had undergone a canine fossa puncture and removal of diseased mucosa with microdebrider. RESULTS: A total of 91 canine fossa punctures were performed in 56 patients. Twenty five patients (44.6%) experienced more than one adverse effect. The most common complaint was facial or cheek swelling (29.7%) followed by facial or cheek pain (24.8%), facial bruise (17.9%), facial numbness (11.9%), dental numbness (7.9%), tingling sensation (5.9%) and infection of puncture site (1.9%). Most complications (94.1%) resolved within 4 weeks after surgery. Only one patient (0.9%) had persistent facial numbness even at 14 months after the procedure. CONCLUSION: Removal of extensive polyposis and diseased mucosa of the maxillary sinus with microdebrider through canine fossa puncture is a very useful technique. However, a significant number of patients experience temporary or permanent complications after surgery. Surgeons should be aware of these side effects and inform the patients before performing the surgical procedure.

Neonatal hearing screening in a neonatal intensive care unit using distortion product otoacoustic emissions / 소아과

PURPOSE: Early detection and intervention of hearing impairment is believed to improve speech and language development and behavior of children. The aim of this preliminary study was to determine the prevalence of hearing impairments, and to identify the association of risk factors relating to refer response in high risk neonates who were screened using distortion product otoacoustic emissions (DPOAE). METHODS: The subjects included 871 neonates who were admitted to the neonatal intensive care unit of the Pediatric Department in Soonchunhyang University Bucheon Hospital from May, 2001 to December, 2004. They were screened using DPOAE. Based on DPOAE, we divided the neonates in two groups:'Pass' and 'Refer'. The differences in risk factors between the pass group and the refer group were analyzed. RESULTS: The incidence of the refer group was 12.1 percent(106 out of 871). The bilateral refer rate was 5.4 percent(47 out of 871). And the unilateral refer rate was 6.7 percent(59 out of 871). Gender, birth place, family history of hearing loss, small/large for gestational age, obstetrical factor, hyperbilirubinemia and use of gentamicin were not statistically related to the refer rate. Statistically related to refer rate were birth weight, resuscitated neonates, Apgar score, craniofacial anomaly, mechanical ventilator application, sepsis, using of vancomycin(P or = 60 dB) in this study was 2 percent(18 out of 871). CONCLUSION: This study showed a higher prevalence of hearing impairment in high-risk neonates. Thus neonatal hearing screening should be carried out in high-risk neonates.

Inner Ear Anomalies Causing Congenital Sensorineural Hearing Loss: CT and MR Imaging Findings

Many congenital dysplasias of the osseous labyrinth have been identified, and the differential diagnosis of these dysplasias is essential for delivering proper patient management. We retrospectively reviewed the computed tomography (CT) and magnetic resonance (MR) imaging findings of 20 children who had congenital sensorineural hearing loss. The children included cases of enlarged vestibular aqueduct and endolymphatic sac (n=8), aplasia of the semicircular canal (n=4), lateral semicircular canal-vestibule dysplasia (n=3), common cavity malformations with a large vestibule (n=1), cochlear hypoplasia (n=1), Mondini's dysplasia with large vestibular aqueduct (n=1), Mondini's dysplasia with a large vestibule (n=1), and small internal auditory canal (n=1). Six cases were unilateral. Nine cases had combined deformities, and nine cases had cochlear implants. CT was performed with a 1.0-mm thickness in the direct coronal and axial sections with using bone algorithms. MR was performed with a temporal 3D T2 FSE 10-mm scan and with routine brain images. We describe here the imaging features for the anomalies of the inner ear in patients suffering from congenital sensorineural hearing loss.

Vertebrobasilar Occlusion Initially Presenting with Sudden Bilateral Hearing Loss with Vertigo

A 57-year-old man complained of sudden hearing loss and vertigo as sole initial symptoms. Pure tone audiometry revealed severe bilateral sensorineural hearing loss. Brain MRI demonstrated multiple scattered small acute infarctions in the bilateral thalami, occipital lobe, cerebellum and ventral upper pons, however, none in the level of vestibulocochlear nuclei. Cerebral angiography revealed vertebrobasilar occlusion with collateral circulation. On the seventh day of the patient's hospital stay, he developed dysarthria, dysphagia and ataxia. Five months later, his hearing loss persisted, but other neurologic deficits improved substantially.

Chondroblastoma of Temporal Bone / 대한이비인후과학회지

Chondroblastoma is an uncommon primary benign bone tumor that usually arises in the epiphyses of the long bones. Chondroblastoma of temporal bone is extremely rare. Its biological nature is often benign but is sometimes aggressive because of the local invasion. Recently, the authors have experienced two cases of chondroblastoma of temporal bone which were completely excised. We report these cases of chondroblastoma of the temporal bone with a review of literature.

Hearing preservation and surgical complications after extended middle cranial fossa approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The advent of magnetic resonance imaging has enabled surgeons to detect small intracanalicular tumors. Therefore, many patients with acoustic tumors can be candidates for hearing preservation. This study was designed to analyze hearing results following acoustic tumor removal through the extended middle cranial fossa approach (EMCFA) and to determine the prognostic factors associated with successful hearing preservation. MATERIALS & METHODS: We retrospectively reviewed 11 patients whose tumor was removed via EMCFA (10:acoustic tumor, 1:lymphangioma). RESULTS: In 9 patients, the tumors were completely removed with EMCFA and in one patient, the suboccipital approach was combined with EMCFA. However, the approach was transformed to the translabyrinthine approach in one patient, because the tumor adhered to the cochlear nerve. The overall success rate of hearing preservation was 60% (6 of 10). In 20% of patients, the hearing was worse and other 20% of patients lost their hearing. Preoperative hearing level, location of tumor and origin of tumor affect the postoperative hearing. But tumor size did not relate to hearing preservation. CONCLUSION: In most cases, we could preserve the patient's hearing with EMCFA. However, the patients with poor preoperative hearing and tumor originated from the superior vestibular nerve were at risk for hearing loss.

Two Cases of Ceruminous Adenoma Arising from the External Auditory Canal / 대한이비인후과학회지

The external auditory canal is composed of skin, subcutaneous tissue and gland. The mass originated from external auditory canal can produce otorrhea and some obstructive symptoms. Ceruminoma is a broad term expressing the tumor arising from the ceruminous gland. The ceruminous gland tumors is assigned to one of four categories(adenoma, pleomorphic adenoma, adenocystic carcinoma & adenocarcinoma) by Wetli's protype. The wide local excision is a treatment of choice for all benign ceruminous gland tumors except the malignant tumors needed combined treatment modalities as surgery and radiotherapy. We report our recent experience of two ceruminous adenomas causing ear canal obstruction & otorrhea.

Myxoma: life-threatening benign nonepithelial tumor of the larynx

Myxoma is a rare nonepithelial neoplasm of the larynx frequently misdiagnosed as a large vocal polyp due to its slow-growing nature. Myxoma is a benign but often infiltrating neoplasm of uncertain mesenchymal cell origin, characterized by irregular round, spindle or stellate cells within a matrix containing abundant mucoid material, scant vascularity and a variable meshwork of reticulum and collagen. We report one case of myxoma with life-threatening dyspnea requiring tracheotomy.

Effect of Botulinum Toxin Injection in Patients with Adductor Spasmodic Dysphonia / 대한이비인후과학회지

In the treatment of spasmodic dysphonia, local injection of botulinum toxin A has been reported to be successful. The treatment of adductor type spasmodic dysphonia using botulinum toxin type A was conducted in 31 patients. These patients were given toxins in the vocal fold(s), unilaterally or bilaterally, under telelaryngoscopic guidance with 23 gauge scalp needle attached by laryngeal forceps. Before the above procedure, laryngeal anesthesia was done with 2% pontocain instillation. Among the 31 patients, 30 patients were given the toxin successfully. Telephone interview were made at 2 weeks and then at 4 weeks post injection. Among the above 30 patients, 90% reported that the injection was of significant benefit. The functional status of the patient's disorder was classified into four grades. The mean pre-injection grade for the patients in this study was 2.10 and it was significantly lowered to 1.13 after the injection(p<0.01). As a self assessment method, the patients were asked to rate their voice on a scale of 100. In this study, the mean pre-injection score was 40 and it was significantly improved to 69.8 after the injection(p<0.01). In conclusion, botulinum toxin injection using telelaryngoscope is a safe and effective method for the treatment of adductor type spasmodic dysphonia.