Clinical Analysis of Olfactory Disorders / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The sense of smell is indispensable for men to appreciate food flavors and avoid potential dangers, such as spoiled foods, smoke, and gases. Despite these important roles, there have been only a few studies investigating the cause and nature of olfactory disorders. In this study, we investigated clinical aspects of olfactory disorders. MATERIALS AND METHODS: The demographic, medical, and chemosensory data of 497 patients who visited clinics complaining of smell loss were retrospectively analyzed with medical charts and a questionnaire. The statistical analyses were performed using ANOVA and chi-square test to compare several variables of data. RESULTS: Nasal and paranasal sinus disease, upper respiratory tract infection, idiopathic, and head trauma were the major causes of smell loss. The onset of smell loss, the distribution of gender and age, the incidence and severity of olfactory loss with gustatory dysfunction differed among causal groups. The association of olfactory score with allergies in nasal diseases was not noted in this study. In addition, the presence of intranasal polyp affected the severity of olfactory dysfunction, but we could not see this effect in patients who had the history of sinonasal surgery. CONCLUSION: We recommend that physicians have to consider many clinical aspects including the cause and nature of olfactory loss to treat patients with chemosensory dysfunction effectively.

The Usefulness of CC-SIT(Cross-Cultural Smell Identification Test) in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many clinical and experimental methods have been developed to evaluate human olfactory function, but there is not a standard test which can be used clinically in Korea. CC-SIT (Cross-Cultural Smell Identification Test) is a smell identification test that consists of 12 items well known in most non-English-speaking cultures. So, authors evaluated the usefulness of CC-SIT in assessing olfactory function in Korea. MATERIALS AND METHODS: One hundred ninety patients who visited clinics complaining of smell loss were categorized to 3 groups (mild hyposmia, moderate hyposmia, severe hyposmia) by questionnaire and 41 healthy subjects were chosen for the normal control group. CC-SIT and a smell threshold test was performed to both patients and controls. The statistical analysis was performed using ANOVA and the Pearson correlation method. RESULTS: There were significant differences in the CC-SIT scores among 3 groups and the severity of hyposmia was correlated with the CC-SIT score. Also, the CC-SIT scores were correlated significantly with the smell threshold. In addition, the difference of familiarity among 12 items was observed. CONCLUSION: CC-SIT is a convenient, practical smell function test which can tell olfactory tunction loss and can he used clinically in Korea.

Autogenous Mucosa-Lined Tracheal Prosthesis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reliable prosthetic or tissue graft of trachea for reconstruction of large, circumferential tracheal defect has not yet been developed. The major limitations in this area have been anastomotic dehiscence and stenosis, which are attributed to poor epithelialization and vascularization of prosthetic grafts. MATERIALS AND METHOD: We developed a new tracheal prosthesis which has a viable lined mucosa and is well-vascularized. The prosthesis consists of Prolene mesh reinforced with polypropylene rings, and is coated with gelatin. We lined the luminal surface of the prosthesis with transplanted autogenous oral mucosa and wrapped the prosthesis with greater omentum. Animal experiments were performed using 8 adult Mongrel dogs. RESULTS: The transplanted mucosa and the greater omentum that was wrapped were tightly adhered to the prosthesis to make a single unit within two weeks. The mucosa survived well, having been vascularized by new vessels from the greater omentum, and showed normal histology. CONCLUSION: We concluded that this highly biocompatible tracheal prosthesis could be very useful for stage4 reconstruction of tracheal defects.

The Anti-tumor Effect of Adoptive Immunotherapy with Dendritic Cells Cultured from the Bone Marrow in a Murine Squamous Cell Carcinoma Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is known that patients with malignant tumor often have depressed antitumor immunity. Much information has been generated about a biologically-based therapy, which can induce or activate antitumor cytotoxic T lymphocytes (CTL) capable of recognizing the antigens associated with the major histocompatibility complex molecules (MHC). Optimal induction of CTL seems to require contact with antigenic peptides presented by antigen presenting cell (APC). Dendritic cells (DC) are currently considered to be the most effective and professional APC. MATERIALS AND METHODS: With an injection of SCC cells (1x105) to the back of C3H mouse, a consistent and immunocompetent experimental animal tumor model was achieved. DCs were successfully cultured from the bone marrow of C3H mouse, and phenotypically they expressed high levels of co-stimulatory molecules and abundant MHC. Cultured DCs were intraperitoneally injected into the tumor-established mouse. RESULTS: In the treated group, tumor sizes were smaller, infiltration to the adjacent structures were limited. T cells extracted from the spleen of the treated group showed better proliferative and cytolytic activity toward tumor cells. The results of this study suggest that DCs have an effect to suppress the growth of tumors and to induce higher T cell reactivity toward tumor cells. CONCLUSION: These results may help in proceeding further immunologic approaches to reduce the morbidity and mortality in patients with the head and neck SCC.

Free Flap Reconstruction in the Head and Neck Regions: A Review of 40 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With the advent of free flap reconstruction techniques, several free flaps were used for a variety of head and neck defects. The objective of this study was to review our experience during 3-year period in performing 40 microvascular free flaps for head and neck defects. Materials and Method: A review of 40 microvascular free flaps performed in 38 patients between April 1995 through August 1998 was undertaken. Patient's age, sex, stage of disease, types of free flaps, short-term postoperative outcome including the flap success rate, postoperative complications, effect of preoperative irradiation on the development of the wound complications such as fistula were evaluated. RESULTS: 36 (90%) of 40 free flaps were successful with 4 failures resulting from 3 venous thromboses and 1 infection. Emergent reexploration was done in 2 patients, none of whom were successfully salvaged. The postoperative surgical complications including donor site complications and medical complications were seen in 17 flaps (47%) and in 8 flaps (22%), with multiple complications seen in several patients. The preoperative radiotherapy did not affect the incidence of the postoperative surgical complications (p=0.273). CONCLUSION: In review of our experience, we believe that free flap reconstruction in head and neck regions has become a useful procedure with acceptable outcome and complication rates and has surpassed conventional techniques cosmetically and functionally.

A Case of Oculoauriculovertebral Spectrum with Ossicular Deformity Managed by Oval Window Fenestration / 대한이비인후과학회지

Oculoauriculovertebral spectrum (OAVS) is a disease which has wide range of phenotypic expression from hemifacial microsomia. Hemifacial microsomia denotes unilateral microtia, mandibular hypoplasia to Goldenhar syndrome, which consists of epibulbar dermoids and vertebral anomalies in addition. Various auricular, external ear and middle ear deformities are combined in this disease spectrum. We experienced a case which was characterized as OAVS. The patient complained about congenital hearing loss and showed unilateral conductive hearing loss. Microtia type I with mild stenosis of ear canal, hemifacial microsomia and abnormality of cervical vertebrae were found. Exploration revealed middle ear anomalies with ossicular deformity and aberrant facial nerve. To correct the conductive hearing loss, oval window fenestration was performed with KTP laser and piston wire prosthesis was inserted. Hearing was improved successfully after the surgery. It should be stressed that hearing should be carefully assessed in the patients with OAVS, regardless of the type of clinical findings. The correction of anomalies of the middle ear would be one of the important points for otolaryngologists in treatment of OAVS.

Effects of Endoscopic Sinus Surgery on Nasality / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: When the impairment of nasal airway patency in patients with chronic sinusitis such as mucosal edema or nasal polyps is resolved after functional endoscopic sinus surgery (FESS), it is expected that patients no longer complain of hyponasal voice. However, patients who have undergone FESS sometimes complain of more hyponasal voice, or thick voice. The purpose of this study was to examine the effect of FESS on voice in terms of nasality. MATERIALS AND METHODS: Thirty-three patients who underwent FESS and thirty normal adults who had no sinus or nasal pathology were selected for this study. We performed nasalance test for patients group before and 3 months after the operation and for the control group without any medication. RESULTS: Patients' preoperative mean nasalance were not low compared with that of control group in all sentences. It was different from perceptual hyponasality they had complained. Postoperative mean nasalance in patients showed statistically significant increase. Higher change ratio of nasalance was noted in Mamma passage than the other passages. CONCLUSION: There was significant increase in nasalance scores after FESS. Thus, we must consider the possibility of voice changes postoperatively in professional voice users.

Endoscopic Maxillary Sinus Surgery Using the Microdebrider

In the treatment of chronic maxillary sinusitis, endoscopic sinus surgery, unlike the more radical Caldwell-Luc (C-L) operation, enables the preservation of mucosa. However, although a middle meatal antrostomy is superior in function and patency to an inferior meatal antrostomy, at times it is very difficult to remove diseased mucosa located at the antero-inferior or antero-medial side of the maxillary sinus : to prevent recurrence, the C-L procedure is often chosen. In an effort to decrease the failure rate of endoscopic maxillary sinus surgery, we applied the microdebrider technique, a new approach of puncture and shaving. To evaluate the effectiveness of the microdebrider technique, we retrospectively reviewed the medical records of 33 patients (43 sinuses) who have been treated by this method. We analyzed the clinical courses of these patients during recovery and evaluated endoscopic findings made during follow-up examinations. Nasal symptoms were alleviated in every case except for two. Three cases required revision ESS or a C-L procedure at the puncture and shaving site. The maxillary sinuses of most patients (80%) were normalized, but five sinuses demonstrated polypoid or thickened mucosa. The ostiums of 36 maxillary sinuses remained patent but nine sinuses became stenotic. Complications, which included facial pain and facial paresthesia, were rare and disappeared shortly. We consider this new technique to be an effective method of eradicating maxillary sinus disease that is not otherwise accessible through the MMA window.

Acoustic Reflex Facilitation with Various Frequencies and Amplitudes of Pure Tone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are several methods for lowering the acoustic reflex hreshold, a process known as "facilitaion". The most popular facilitation method is the simultaneous stimulation of a high-frequency tone (facilitator) with a reflex-elicing tone (activator). This study was performed in order to analyze and generalize the facilitation phenomenon, and infer clinical applications from this phenomenon. MATERIALS AND METHODS: Authors measured the acoustic reflex thresholds when the facilitators of various amplitudes and frequencies was simultaneously stimulated in normal population. Also, the effects of facilitation was observed on the growth function curve (a curve showing the acoustic reflex pattern in subthreshold and suprathreshold stimulation). RESULTS: Facilitation was observed more effectively by using facilitators of high frequencies and high amplitudes. In the analysis of growth function curve, we found similar result as above. But there was no correlation between the frequency of activator and the mode of facilitation. CONCLUSION: We analyzed the factors affecting the phneomenon of facilitation and discussed a several proposals explaining the different tendencies of facilitation. Further studies should be made on the clinical implication of this phenomenon to sensorineurally hearing-impaired patients or children.

Endoscopic Orbital Decompression for Dysthyroid Optic Neuropathy / 대한이비인후과학회지

Many techniques have been employed for the treatment of dysthyroid optic neuropathy. With the development of intranasal endoscopic skills, endoscopic orbital decompression is now performed as one of surgical treatments of the disease. Orbital decompression was performed by endoscopic approach on 3 orbits in 2 patients. Proptosis was reduced 3 mm each in 2 orbits of a patient by Hertel measurement and visual acuity was improved in both patients. The endonasal endoscopic approach provided visual improvement without the morbidity of the traditional Walsh-Ogura method.

p53 Mutation of Head and Neck Squamous Cell Carcinoma Cell Lines / 대한암학회지

PURPOSE: Structural alterations of p53 and overexpression of the p53 protein are the most common genetic abnormalities in various kinds of human cancers. In this study, we examined the mutational status and the frequency of p53 mutations in head and neck squamous cell carcimona (HNSCC) cell lines. MATERIALS AND METHODS: 7 human head and neck squamous cell carcinoma cell lines were included in this analysis. Using polymerase chain reaction(PCR), single strand confonmation polymorphism(SSCP) and PCR-DNA sequencing analysis, we tested the mutational status of 7 cell lines. Exon 4~9 of the p53 gene was amplified for the direct DNA sequencing analysis. RESULTS: Our results showed 100% nuclear p53 immunostaining and 3 electrophoretic abnomalities by PCR-SSCP in three cancer cell lines and mutations of the p53 gene including 2 base substitutions and 1 base deletion were detected in 3 cancer cell lines using PCR directed DNA sequencing analysis. CONCLUSION: 7 HNSCC cell lines examined in this study provide excellent systems for study of gene therapy using p53 gene.

A Case of Diffuse Idiopathic Skeletal Hyperostosis with Dysphagia / 대한이비인후과학회지

Diffuse idiopathic skeletal hyperostosis (DISH) is an idiopathic, ossifying diathesis characterized by ossification and thickening at the site of attachment of a ligament or tendon to bone. Although DISH generally affects the lumbar spine, any segment of the spine may be involved. When cervical spine is affected, the extensive cervical spine osteophytes may produce dysphagia and laryngeal symptoms such as hoarseness, dysphonia, and dyspnea etc. We report a DISH patient with dysphagia as a presenting complaint. Plain radiographs and modified barium swallow (MBS) study demonstrated narrowing of esophagus due to severe cervical vertebral osteophytes. Anterior cervical decompression relieved dysphagia and restored esophageal function without major complications.

Hypercholesterolemia and Abnormal Liver Function in Obstructive Sleep Apnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Abnormalities in serum cholesterol and liver enzymes are frequently encountered during preoperative evaluation for patients with obstructive sleep apnea (OSA). Obesity is known to be one of the possible causes and aggravating factors of OSA, and it is also known to be associated with hyperlipidemia, glucose intolerance and fatty liver. We tried to elucidate whether OSA itself, without the effects of obesity, can induce abnormalities in liver function and lipid metabolism. MATERIALS AND METHODS: The levels of fasting serum cholesterol, glucose and alanine aminotransferase (ALT) were checked in 215 adults who had received polysomnographic sleep study. The relationship between the apnea-hypopnea index (AHI) and these variables was evaluated using the general linear model analysis. RESULTS: A statistically significant correlation was found between AHI and cholesterol level. However, ALT was found to be more dependent on sex and obesity, than AHI. CONCLUSION: The study showed that, without the influence of obesity, age and sex, OSA itself had a meaningful correlation with hypercholesterolemia. This relationship could offer as one of the possible explanations for the increased cardiovascular risk in patients with OSA.

Postoperative Complication and Prognosis of Salivary Gland Tumor / 대한이비인후과학회지

We retrospectively analyzed 125 patients of salivary gland tumor operated at Asan medical center from 1989 to 1996. The most commonly involved gland was parotid(69.6%) and the most frequent tumor was pleomorphic adenoma(56%). The proportion of the malignancy was 25.8% in parotid, 17.6% in submandibular gland, respectively. Facial palsy was developed postoperatively in 29 patients, however, seven patients were lost of follow up because five were died of disease and two were transferred to other hospitals. Persistent facial palsy were seven:four in the benign tumor, three in the malignant tumor. Transient facial palsy were 15:12 in the benign tumor, three in the malignant tumor. In the transient facial palsy, 10 patients were recovered within three months. Among 32 malignant tumor, the number of recurrence or distant metastasis were 12:four were distant metastasis alone, two were metastasis to the cervical lymph node, four were local recurrence alone and two were local recurrence with distant metastasis. The highest recurrence of the tumor was found in high grade-mucoepidermoid carcinoma(83.3%). Overall tumor recurrences were significantly related to positive cervical lymph node metastasis or positive resection margin:recurrence rate of the positive lymph node metastasis was 44.4%(four of nine) and the recurrence rate of positive resection margin was 50%(seven of 14).

Excellent Local Tumor Response after Fractionated Stereotactic Radiation Therapy for Locally Recurrent Nasopharynx Cancer / 대한치료방사선과학회지

PURPOSE: This study is to report experience with Fractionated Stereotactic Radiation Therapy (FSRT) for locally recurrent nasopharynx cancer after curative conventional radiation therapy. MATERIALS AND METHODS: Three patients with locally recurrent and symptomatic nasopharynx cancer were given FSRT as reirradiation method between the period of September of 1995 and August of 1996. For two patients, application of FSRT is their third radiation therapy directed to the nasopharynx. Two patients were given low dose chemotherapy as radiation sensitizer concurrently with FSRT. Authors used 3-dimensional coordinate system by individually made, relocatable Gill-Thomas-Cosman (GTC) stereotactic frame and multiple non-coplanar arc therapy dose planning was done using XKnife-3. Total of 45 Gy/18 fractions or 50 Gy/20 fractions were given. RESULTS: Authors observed satisfactory symptomatic improvement and remarkable objective tumor size decrease by follow-up MR images taken 1 month post-FSRT in all three patients, while no neurologic side effect attributable to reirradiation was noticed. Two died at 7 and 9 months with loco-regional and distant seeding outside FSRT field, while one patient is living for 4 month. CONCLUSION: Authors experienced satisfactory therapeutic effectiveness and safety of FSRT as reirradiation method for locally recurrent nasopharynx cancer. Development of more effective systemic chemotherapeutic regimen is desired for distant metastasis.

A Clinical Analysis of Intubation Granuloma / 대한이비인후과학회지

BACKGROUND: Intubation granuloma of the larynx occurs from direct mechanical irritation of mucosa from a traumatic or prolonged endotracheal intubation. Surgical excision can be accomplished with microlaryngeal instruments or with CO2 laser under general anesthesia. OBJECTIVE: To investigate clinical characteristics of intubation granuloma and to suggest a jet ventilation technique appropriate in general anesthesia. MATERIAL AND METHOD: The clinical presentation, management of 14 consecutive cases of intubation granuloma were reviewed retrospectively from August, 1989 to December, 1995. RESULTS: 1) Age distribution was mostly in the 20-49 years old group(86%). The ratio of male to female was 2:12, with female predominance. 2) The site of lesions were bilateral in 3 cases and unilateral in 11 cases(left in 2 cases, right in 9 cases). The locations were vocal process of arytenoid cartilage in 12 cases(86%), and posterior 1/3 of true vocal cord other than vocal process in 2 cases(14%). 3) Thirteen cases were developed after general anesthesia using endotracheal intubation and 1 case after endotracheal intubation in drug intoxication. Among the 13 cases of general anesthesia, there were 8 cases of Cesarian section delivery. 4) We used the suspension laryngoscope in all cases, high-frequency jet ventilation technique was used for anesthesia in 8 cases and neuroleptic anesthesia in 6 cases. The CO2 laser was used in 5 cases among the jet ventilation technique. There was no complication associated with jet ventilation. CONCLUSION: Jet-ventilation is a useful anesthetic technique in removal of intubation granuloma.

A Case of Oncocytic Schneiderian Papilloma in the Maxillary Sinus

Oncocytic Schneiderian papilloma (OSP) is a rare neoplasm of the nose and paranasal sinuses, and is often mistaken histologically for papillary adenocarcinoma or even rhinosporidiosis. Recently, we experienced a case of oncocytic Schneiderian papilloma of the left maxillary sinus developed in 53-year-old female patient. She complained of unilateral nasal obstruction, bloody rhinorrhea and frontal headache. The tumor mass was resected surgically through intranasal endoscopic and Caldwell-Luc's approach. We report its clinical manifestations and histologic characteristics.

Clinical analysis on transseptal transsphenoidal hypophysectomy using columellar flap / 대한이비인후과학회지

No abstract available.

Three cases of cholesterol granuloma presenting as intratympanic mass / 대한이비인후과학회지

No abstract available.

A mandibulotomy approach to malignant neoplasms of oral cavity and oropharynx / 대한이비인후과학회지

No abstract available.