Sensorineural Hearing Loss of Suspected Autoimmune Etiology: Two Cases of Cogan’s Syndrome / 대한이비인후과학회지

Cogan’s syndrome is a rare inflammatory disease characterized by non-syphilitic keratitis and vestibulo-auditory symptoms including hearing loss, tinnitus, and vertigo. Although its precise pathogenesis is not known, Cogan’s syndrome is generally considered an autoimmune disease. This hypothesis is supported by the frequently successful remission of hearing loss after steroid administration and the association with other autoimmune disorders such as rheumatoid arthritis. Medical treatment of Cogan’s syndrome depends on disease severity and on how extensive the disease is. The involvement of inner ear pathology requires systemic corticosteroid therapy. In cases of treatment failure or the need for a corticosteroid-sparing effect, other immunosuppressive drugs can be used. We experienced two patients with typical Cogan’s syndrome, presenting bilateral progressive sensorineural hearing loss and dizziness with ocular involvement, which we have successfully treated with systemic steroid administration and immunosuppressive therapy.

Clinical Effect and Safety of Endoscopic Sinus Surgery in Patients over Seventy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Chronic rhinosinusitis (CRS) is common in the elderly. There are increasing evidence that endoscopic sinus surgery (ESS) can be used to manage geriatric patients safely, although there are still concerns about complications after ESS. Therefore, the clinical effect and the safety of ESS in old patients was evaluated in the present study.SUBJECTS AND METHOD: Retrospective observational studies were performed based on medical records of patients over the age of 70 and who underwent ESS for CRS from January 2009 to December 2017. The clinical effect of ESS was assessed by comparing the sino-nasal outcome test (SNOT-22) scores before and 3 months after surgery. The safety of the operation was evaluated by the occurrence of postoperative major surgical (skull base, orbital and hemorrhage) and medical (ventricular fibrillation, ischemic attack, primary cardiac arrest, cerebrovascular accident, pneumonia, other organ failure and death) complications.@*RESULTS@#Seventy three subjects were enrolled in this study. Bilateral disease was observed in 37 cases (50.7%), and CRS with nasal polyp was found in 31 cases (42.5%). Eight patients (11.0%) had revision cases. The majority (93.2%) had at least one comorbid condition and got prescribed related medicine (87.7%). There was a significant decrease in SNOT-22 score after surgery. Furthermore, there were no major surgical or medical complications except two cases with epistaxis.@*CONCLUSION@#CRS in geriatric patients can also be treated effectively and safely by ESS as it is done for younger adults. However, as the incidence of comorbidities is high in elderly subjects, it is important to evaluate the risk factors preoperatively.

Comparison of the Postoperative Outcome for Pediatric Obstructive Sleep Apnea According to the Type of the Tonsillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Partial intracapsular tonsillectomy and adenoidectomy (PITA) has become a well-recognized technique for tonsillectomy in children. Several studies have reported that PITA shows better postoperative morbidity compared to the conventional technique. However, there is still concern about the regrowth of remnant tonsil tissues. The authors evaluated the postoperative results of PITA, combined extracapsular and intracapsular tonsillectomy, and conventional tonsillectomy.SUBJECTS AND METHOD: The authors studied 97 children (male: 62, female: 35) aged 2 to 13 years old, who underwent tonsillectomy and adenoidectomy (PITA, combined extracapsular and intracapsular tonsillectomy, and conventional tonsillectomy). The degree of adenotonsillar hypertrophy, apnea-hypopnea index and lowest oxygen saturation was confirmed for all subjects. Operation time, quality of life, scale for postoperative pain, frequency of postoperative bleeding, and recurrence with tonsillar regrowth were compared after surgery performed by different surgical procedures.@*RESULTS@#Regardless of the surgical technique, all the cases presented significant improvement in the quality of life before and after surgery. On the day of surgery and four days after surgery, PITA showed superior results in terms of postoperative pain level compared to the conventional technique. There were no statistically significant results with respect to the operation time and postoperative bleeding. Six months after the surgery, the recurrence of sleep apnea due to the regrowth of remaining tonsil was not obvious.@*CONCLUSION@#Tonsillectomy technique preserving tonsillar capsule may show better results on early postoperative pain. It can be a good alternative to the conventional technique in surgical treatment for pediatric obstructive sleep apnea in terms of early postoperative pain control.

Comparison of the Postoperative Outcome for Pediatric Obstructive Sleep Apnea According to the Type of the Tonsillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Partial intracapsular tonsillectomy and adenoidectomy (PITA) has become a well-recognized technique for tonsillectomy in children. Several studies have reported that PITA shows better postoperative morbidity compared to the conventional technique. However, there is still concern about the regrowth of remnant tonsil tissues. The authors evaluated the postoperative results of PITA, combined extracapsular and intracapsular tonsillectomy, and conventional tonsillectomy. SUBJECTS AND METHOD: The authors studied 97 children (male: 62, female: 35) aged 2 to 13 years old, who underwent tonsillectomy and adenoidectomy (PITA, combined extracapsular and intracapsular tonsillectomy, and conventional tonsillectomy). The degree of adenotonsillar hypertrophy, apnea-hypopnea index and lowest oxygen saturation was confirmed for all subjects. Operation time, quality of life, scale for postoperative pain, frequency of postoperative bleeding, and recurrence with tonsillar regrowth were compared after surgery performed by different surgical procedures. RESULTS: Regardless of the surgical technique, all the cases presented significant improvement in the quality of life before and after surgery. On the day of surgery and four days after surgery, PITA showed superior results in terms of postoperative pain level compared to the conventional technique. There were no statistically significant results with respect to the operation time and postoperative bleeding. Six months after the surgery, the recurrence of sleep apnea due to the regrowth of remaining tonsil was not obvious. CONCLUSION: Tonsillectomy technique preserving tonsillar capsule may show better results on early postoperative pain. It can be a good alternative to the conventional technique in surgical treatment for pediatric obstructive sleep apnea in terms of early postoperative pain control.

Clinical Effect and Safety of Endoscopic Sinus Surgery in Patients over Seventy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis (CRS) is common in the elderly. There are increasing evidence that endoscopic sinus surgery (ESS) can be used to manage geriatric patients safely, although there are still concerns about complications after ESS. Therefore, the clinical effect and the safety of ESS in old patients was evaluated in the present study. SUBJECTS AND METHOD: Retrospective observational studies were performed based on medical records of patients over the age of 70 and who underwent ESS for CRS from January 2009 to December 2017. The clinical effect of ESS was assessed by comparing the sino-nasal outcome test (SNOT-22) scores before and 3 months after surgery. The safety of the operation was evaluated by the occurrence of postoperative major surgical (skull base, orbital and hemorrhage) and medical (ventricular fibrillation, ischemic attack, primary cardiac arrest, cerebrovascular accident, pneumonia, other organ failure and death) complications. RESULTS: Seventy three subjects were enrolled in this study. Bilateral disease was observed in 37 cases (50.7%), and CRS with nasal polyp was found in 31 cases (42.5%). Eight patients (11.0%) had revision cases. The majority (93.2%) had at least one comorbid condition and got prescribed related medicine (87.7%). There was a significant decrease in SNOT-22 score after surgery. Furthermore, there were no major surgical or medical complications except two cases with epistaxis. CONCLUSION: CRS in geriatric patients can also be treated effectively and safely by ESS as it is done for younger adults. However, as the incidence of comorbidities is high in elderly subjects, it is important to evaluate the risk factors preoperatively.

Extranasopharyngeal Angiofibroma of the Nasal Septum: A Case Report

Angiofibroma is benign hypervascular tumor that usually occurs in the nasopharynx of adolescent male patient and rarely originates from outside of the nasopharynx, called extranasopharyngeal angiofibroma. The clinical and radiologic findings of extranasopharyngeal angiofibroma are similar to other hypervascular tumors, which may delay diagnosis and treatment. We present a case of extranasopharyngeal angiofibroma arising from nasal septum of a 43-year-old male who complained of right nasal obstruction. Contrast enhancement CT revealed a hypervascular tumor of the nasal septum and the tumor was removed by endoscopic resection. Histopathologic examination confirmed the diagnosis of angiofibroma.

A Case of Epithelioid Hemangioendothelioma on the Choana

Epithelioid hemangioendothelioma is a rare vascular tumor with intermediate malignity and metastasis risk. It presents epithelioid cells with intracytoplasmic vacuoles and low mitotic activity. Its vascular nature can be confirmed by immunohistochemical studies (vimentin, CD31, CD34, and factor VIII). It is extremely rare in the nasal cavity, with only one case reported on the middle turbinate in Korea. The authors present a case of epithelioid hemangioendothelioma on the choana with a size of 2mm, which easily coult have been misdiagnosed as a blood clot.

Low-Grade Fibromyxoid Sarcoma Arising in Posterior Nasal Cavity: Case Report and Review of the Literature / 대한이비인후과학회지

Low-grade fibromyxoid sarcoma (LGFMS), a soft tissue tumor that has high recurrence and metastasizing potential, rarely occurs in the head and neck region. Therefore, the treatment for LGFMS in the facial area is challenging in terms of cosmetic and functional maintenance. The authors report a case of LGFMS in the posterior nasal cavity. It was completely removed in parallel with the nasal endoscopic and oral approach, but the lower margin was closed by preserving the soft palate. The patient is well without any recurrence or metastasis after 5 years of follow-up.

C-Reactive Protein and High Blood Pressure are the Predictive Factors of Deciding the Surgical Treatment in Deep Neck Infection: A Retrospective Cohort Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In clinical settings, some deep neck infections may be managed by conservative treatment but some still require surgical treatment. In this study, we use univariate and multivariate analysis to discuss whether or not there are significant differences between conservative treatment and surgical treatment on patients with deep neck infections. SUBJECTS AND METHOD: We conducted a retrospective analysis using medical records of 88 patients with deep neck infections from January 2010 to December 2015. Among 88 patients, 56 patients were managed by conservative treatment with antibiotics and 32 patients were managed by surgical treatment via transcervical approach with antibiotics. As for data analysis, Mann-Whitney U test and multiple logistic regression analysis was used. RESULTS: Age, duration from symptom onset to hospitalization, hospital days, incidence of underlying disease, white blood cell count, erythrocyte sedimentation rate, and C-reactive protein (CRP) were found higher in the surgical treatment group than in the conservative treatment group. But there was no statistical significance except for the incidence of high blood pressure and CRP. CONCLUSION: CRP and incidence of high blood pressure were significant predictive factors for choosing the surgical treatment in deep neck infection. Contrary to our expectations, the incidence of diabetes mellitus was not a significant factor that determined the treatment options for the patients with deep neck infection.

The Results of Unilateral Osteotomy to Correct the Deviated Nose / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Osteotomy, usually carried out bilaterally, is a commonly performed procedure to correct the bony dorsum of deviated nose. However, it is an invasive maneuvers which can affect the stability of nasal bone and develop complications, such as, edema and ecchymosis. This study aims to evaluate the usefulness of unilateral osteotomy in correcting a deviated nose with various scoliosis. SUBJECTS AND METHOD: We studied 9 of the 69 patients who underwent corrective rhinoplasty with unilateral osteotomy to correct the bony nasal dorsum between 2010 and 2014. For patients whose bony nasal dorsum was corrected well after performing osteotomy on the convex side of the bony dorsum, the opposite side was not operated on; however, if correction was incomplete, osteotomy was additionally performed on the opposite side. For this study, patients who underwent bilateral osteotomy were excluded from the study. The improvement of correction was assessed by comparing the preoperative and postoperative photos. RESULTS: Of the nine patients treated with unilateral osteotomy, 5 cases were C or reverse C type deviations, 1 case was S type deviation and 3 were straight deviations. Five of the nine patients improved greatly and the rest improved significantly. None of the patients experienced worsening change postoperatively. CONCLUSION: Osteotomy is essential but invasive maneuver, so it is desirable to reduce the number of times to execute. By performing osteotomy on the convex side of the nose first, we can correct the deviated nose effectively while reducing the number of implementation.

Application of Negative Pressure Wound Therapy for Deep Neck Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Negative Pressure Wound Therapy (NPWT) has been used in many surgery to treat complicated wound and impaired wound healing by delivering negative pressure at the wound site through a patented dressing, which helps draw wound edges together, remove infectious materials, and actively promote granulation at the cellular level. Recently application of NPWT has been increased to treat deep neck infection. We aimed to retrieve indications and guidelines to treat deep neck infection from our cases and after reviewing articles. SUBJECTS AND METHOD: From our experience with 9 cases presented as deep neck abscess in which the application of a Vacuum-assisted closure device was used instead of common drainage tubes after surgical evacuation and journal review, indications and guidelines to apply NPWT as one of the tools to treat deep neck infection were retrieved. RESULTS: Indication and Guideline of NPWT. 1) For simple abscess involving single space excepting the mediastinum, intravenous administration of broad-spectrum antibiotics, needle aspiration or simple surgical drainage is recommended. 2) In the case of failure of previous treatments, NPWT will be necessary for immunocompromised hosts such as diabetic patients for whom more than two spaces are involved, the mediastinal involvement, compromised airway or disseminated intravascular coagulation. In severe cases involving the chest, video-assisted thoracoscopic surgery or mediastinoscopy could be used. 3) For patients with improving signs such as decreasing pus, increasing granulation formation, negative culture results from sponge, and normalized C-reactive protein, we can stop NPWT and convert to the regular wound care. CONCLUSION: Indication and Guideline of NPWT could be applied to treat deep neck infection.

Chondrocutaneous Advancement Flap for Helical Rim Defect / 대한이비인후과학회지

Helical rim defects of the auricle are usually the result of injury or tumor excision. Acquired helical rim defects are eye-catching and cosmetically unacceptable. We experienced a case of squamous cell carcinoma at the helical rim. The lesion was resected with clear margin and the defect was successfully reconstructed with a helical rim chondrocutaneous advancement flap.

A Case of Non-Communicating Dumbbell Shaped Fourth Branchial Cleft Cyst / 대한이비인후과학회지

The fourth branchial cleft cyst is rare and frequently unknown to clinicians. Misdiagnosis is common and definitive surgery is often made difficult by previous episodes of infection and incision. We have experienced a case of non-communicating dumbbell shaped fourth branchial cleft cyst. We performed complete excision of the entire epithelial tract after disarticulating the cricothyroid joint. There was no recurrence.

Clinical Features of Cholesteatoma in the Normal Hearing Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cholesteatoma in the normal hearing ear represents a surgical challenge. We aimed to identify the clinical features and surgical results of these patients. SUBJECTS AND METHOD: Sixty-three ears with cholesteatoma had preoperative pure-tone averages of less than 25 dB. Parameters for study were age, location of cholesteatoma, type of tympanoplasty, status of ossicles, and type of mastoidectomy. Postoperative audiogram was evaluated. RESULTS: Hearing was preserved within 30 dB on air conduction audiometry in 60.3% on postoperative 2 months and in 60.5% on postoperative 6 months. The rate of hearing preservation was related to the location of cholesteatoma. Similar hearing outcomes resulted from the comparisions of adult versus children, intact versus reconstructed ossicular chains and open versus closed mastoidectomy. CONCLUSION: Preserving an intact ossicular chain and maintaining an intact canal wall did not have a significant effect on hearing preservation, but the location of cholesteatoma does.

Auditory Effects of Microperfused Lidocaine on Guinea Pig Cochlea / 대한이비인후과학회지

OBJECTIVES: Lidocaine is one of the therapeutic trials to treat tinnitus. However, the exact mechanism of the effect of lidocaine remains unclear. The aim of this study was to elucidate the action site of lidocaine in the cochlea by measuring compound action potential (CAP) and transient evoked otoacoustic emission (TEOAE) amplitude in guinea pigs. METHOD: Artificial perilymph was perfused into the scala tympani of the guinea pig cochlea in the control group, and lidocaine diluted with artificial perilymph was perfused into the scala tympani of the experimental groups. Electrocochleogram (ECoG) and TEOAE were measured in each groups both before and after lidocaine perfusion. RESULTS: Artificial perilymph perfused to the scala tympani of the guinea pig cochleae did not affect either the CAP threshold or the TEOAE response. But, lidocaine perfused into the scala tympani of the guinea pig cochleae produced a dose-dependent increase in CAP threshold, but did not affect TEOAE response. CONCLUSION: This study revealed that lidocaine perfused into the scala tympani of the guinea pig cochlea affects the CAPthreshold but not the TEOAE amplitude and reproducibility. It means that the locally perfused lidocaine affects the cochlear nerve greater than the outer hair cells.

The Efficacy of the Alternating Technique in TEOAE Suppression by Contralateral Acoustic Stimulation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Contralateral acoustic stimulation (CAS) is known to reduce the amplitude of the transient evoked otoacoustic emission (TEOAE) in human. However, the magnitude of the suppression effect evoked by CAS is too small to overcome the problems associated with fluctuating patient conditions as well as the environmental changes. We used an alternating technique to overcome this problem and compared the efficacy of this technique with the classic technique. The aims of this study are to show reduction of the amplitude of the TEOAE with CAS and to evaluate the efficacy of the alternating technique in measuring TEOAE suppression. MATERIALS AND METHOD: TEOAE suppression was measured in 24 ears of 12 normal hearing subjects. Both the alternating technique and classic technique were used in the same subject and condition. TEOAEs were recorded with an ILO 92 dual cannel OAE analyzer. In the alternating technique, one channel was used to stimulate and record TEOAEs from the test ear while the other channel was used to deliver 40, 50 and 60 dBSPL broadband noise to the contralateral ear. But in the classic technique, one channel was used to stimulate and record TEOAEs from the test ear while the broadband noise was applied to the contralateral ear via audiometer headphone. RESULTS: The overall contralateral noise of 40, 50 and 60 dBSPL reduced the amplitude of the TEOAE but only with 60dBSPL significantly reduced in both techniques. As larger CAS was given, the suppressive effect on the TEOAEs was greater in both techniques. But the significant difference was not found between the alternating technique and the classic technique. A total test time was 6 minutes for the alternating technique and 10 minutes for the classic technique. CONCLUSION: We confirmed the reduction of the amplitude of the TEOAE with CAS using both the techniques. No significant difference was found between the results of the alternating technique and the classal technique. We found that the alternating technique thereby decreasing the chance of fluctuating patient and environmental condition.

The Protective Effect of Free Oxygen Radical Inhibitors on Na-salicylate Induced Cochlear Damage in Guinea Pig / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To elucidate the mechanism of salicylate ototoxicity of free oxygen radicals (FORs), we made an animal model with Na-salicylate cochlear toxicity and evaluated the protective effect of free oxygen radical inhibitors. MATERIALS AND METHODS: Na-salicylate soaked in gelfoam was placed on the round window niche of guinea pigs for 2 hours. After removal of gelfoam, electrocochleography and evoked otoacoustic emission test were performed at regular time intervals. These tests were repeated to see the protective effect of FORs inhibitors after the injection of allopurinol or superoxide dismutase (SOD). RESULTS: Hearing loss was noted after removal of gelfoam which was soaked with Na-salicylate. After 6 hours, these ototoxicity effects disappeared. The OAE test showed similar response. FORs inhibitors showed protective effects and SOD was more effective than allopurinol. CONCLUSION: These results support the idea that FORs activity contributes to ototoxicity of Na-salicylate. This damage can be diminished by treatment with drugs that scavenge and inhibit the formation of FORs.

Evaluation of Clinical Validity of Cross-Cultural Smell Identification Test (CC-SIT) in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The development of a l2-item Cross-Cultural Smell Identification Test (CC-SIT) was based upon items from the University of Pennsylvania Smell Identification Test (UPSIT), The selected CC-SIT items were familiar to most persons from American, European, and Asian cultures. Since there were no reports about its clinical validity for Koreans, we evaluated its identifiability in this study. MATERIALS AND METHODS: The CC-SIT were administered to 30 normal subjects and 32 patients with decreased sense of smell, and compared with those of the Korean K-SIT and buthanol threshold test (BTT), items of which many Koreans are familiar with. RESULTS: In the normal group, the mean percent-correct scores of CC- SIT and K-SIT were 87.5+/-7.8% and 90.5+/-9.7%, respectively. In the patient group, the scores were 48.2+/-14.1 and 49.6+/-10.2%, respectively. The results of CC-SIT showed a high correlation with the K-SIT (gamma=0.822, p < 0.001). CONCLUSION: The CC- SIT can be used as an olfactory identification test for Koreans.