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.

Outcomes of Salvage Surgery after Concurrent Chemoradiation for Advanced Hypopharyngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We evaluated treatment outcomes of patients with advanced hypopharyngeal cancer for whom surgical salvage was attempted after primary concomitant chemoradiation therapy (CRT) had failed as a treatment. The pre-salvage factors were assess-ed to predict the prognosis of salvage surgery. SUBJECTS AND METHOD: A retrospective analysis was conducted from 1997 to 2006 for 22 patients with stage III-IV hypopharyngeal cancer who had undergone salvage surgery after local and/or regional CRT failures with no distant metastasis. RESULTS: Larynx-sacrificing pharyngectomy was performed in 12 (54.5%) of all patients. Postoperative complications occurred in 9 (40.9%), and carotid artery blowout occurred in two of these patients. After salvage surgery, the 2-year and 5-year overall survival rates were 52.8% and 28.9%, respectively. The 2-year disease specific survival rate and locoregional control rate were 45.5% and 60.0%, respectively. The initial N2-3 stage (p=0.038) and the concurrent local and regional failures (p=0.035) were independent predictors for decreased survival after salvage surgery. Two-year overall survival rates for patients with 2, 1, or none of these predictive factors were 23.3%, 66.7%, and 80.0%, respectively (p=0.027). CONCLUSION: Although salvage surgery after CRT has postoperative complications and unfavorable larynx preservation, it can be considered as a viable option with acceptable oncologic outcomes for advanced hypopharyngeal cancer. The initial N2-3 stage and concurrent local and regional failures were independent predictors that can stratify patients into distinct prognostic groups for postsalvage survival.

A Case of Transoral Excision Using CO2 Laser in Management of Lingual Thyroid with Oral Bleeding / 대한이비인후과학회지

Lingual thyroid is an uncommon developmental anomaly and is the result of failure of the thyroid to descend from the foramen cecum to its prelaryngeal site during embryogenesis. Massive bleeding from a lingual thyroid is an unusual symptom and occasionally fatal. Current surgical treatment options range from tumor extirpation or transposition to excision and reimplantation. The use of CO2 laser for removal of lingual thyroid offers advantages over traditional surgical managements. We experienced a case of lingual thyroid which was successfully excised via transoral approach using CO2 laser. We discussed rationale for the use of the CO2 laser for this lesion.