Voice and Imaging Analysis After Thyroplasty Type l in the Treatment of Unilateral Vocal Paralysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES:There are several methods to improve voice quality in the patients with paralyzed vocal cord, such as thyroplasty type I, injection, arytenoid adduction. The goal of surgical medialization of the paralyzed vocal fold is to attain complete glottic closure. The purpose of this study is to evaluate the effectiveness of thyroplasty type I through qualifying the vocal function and glottal gap. MATERIALS & METHODS: We experienced 20 cases of unilateral vocal fold paralysis who underwent thyroplasty type I. We performed preoperative and postoperative videoimage analysis (normalized glottal gap area) and computer-assisted voice analysis in all patients. RESULTS: The glottal gap was significantly reduced after thyroplasty type I. Postoperative voice quality was characterized by an improved pitch and amplitude perturbation (jitter and shimmer), maximum phonation time and subglottic pressure . But noise to harmonic ratio was not improved. CONCLUSION: Thyroplasty type I is an effective method in the point of regaining glottal closure and vocal function.

Isolated Bacteria and Their Susceptibility to Antibiotics in Chronic Sinusitis : Results of Endoscopically Guided Cultures of Maxillary Sinus Secretions

The aim of this study was to identify the pathogens of chronic recalcitrant sinusitis and to obtain information for determining appropriate antibiotics through sensitivity testing. A prospective study was conducted on 100 patients with chronic sinusitis who had undergone endoscopic sinus surgery after failed medical treatment. Specimens were obtained from the maxillary sinuses and sent for bacterial cultures and sensitivity tests. Bacteria were isolated in 75 (75%) of the 100 cases. Aerobic bacteria were isolated in 73 cases (73%). Gram-positive aerobes were recovered in 54 cases (54%) and Gram-negative aerobes in 20 cases (20%). Anaerobes were isolated in three cases (3%). Mixed infections were found in two cases (2%). More than 90% of the aerobic bacteria were resistant to penicillin, and 48.8% of the Staphylococci were resistant to oxacillin. Seventy percent of Gram-positive aerobes were sensitive to trimethoprim-sulfamethoxazole, 75% to clindamycin, and 93% to ciprofloxacin. Ninety percent of Gramnegative aerobes were sensitive to ciprofloxacin, and 95% to trimethoprim-sulfamethoxazole. In conclusion, most of the isolated bacteria were aerobic, and in contrast to previous reports, mixed or anaerobic bacterial infection was not frequent. Among the oral antibiotics tested for sensitivity in this study, ciprofloxacin, trimethoprim-sulfamethoxazole, and clindamycin are most strongly recommended for treating chronic sinusitis refractory to first-line antibiotic treatment.

Four Cases of Choanal Atresia Managed by Endoscopic Endonasal Repair / 대한이비인후과학회지

As a surgical treatment of congenital choanal atresia, transnasal approach has been more widely used with the development of endoscopic surgical techinque. We have experienced 4 cases of congenital choanal atresia, which were treated via transnasal endoscopic approach. Three cases were unilateral, and one case was bilateral. We have fenestrated the atretic plate under endoscopic guide using forceps, curette, and/or Nd-YAG laser. Silastic stents were inserted in two cases and left in place for 3 weeks. No restenosis developed in the two cases to which stents were applied, while restenosis developed in two cases without stents. Revision transpalatal approach was performed in one case with bilateral atresia. No complication such as palatal deformity was developed. Newly formed choanal opening had a tendency to decrease in size with the passage of time. So, the opening should be wider initially, and postoperive endoscopic follow-up is needed.