Horizontal Dorsal Septal Incision for High Deviation Correction During Septoplasty / 대한이비인후과학회지

When performing septoplasty in patients with a high deviation of the nasal septum, effective correction is difficult and postoperative complications such as a saddle nose may result if the bone or cartilage is removed inordinately. Although several surgical techniques have been introduced, some are difficult to apply easily. Furthermore, the deviation may persist despite the application of surgical techniques due to the rebound memory of the remaining cartilage. This study aimed to describe a simple and safe surgical technique for crooked nasal septa with a high deviation. This method using horizontal dorsal septal incision allows easy separation of the highly deviated portion from the upper lateral cartilage. Furthermore, it is less traumatic than other methods, and predictably preserves the keystone area.

Does Nasal Septal Deviation and Concha Bullosa Have Effect on Maxillary Sinus Volume and Maxillary Sinusitis?: A Retrospective Study

Purpose@#This study aimed to determine whether nasal septal deviation and concha bullosa affect the maxillary sinus volume, and whether this effect is associated with the prevalence of chronic sinusitis. @*Materials and Methods@#This study retrospectively reviewed 209 paranasal sinus CT (PNS CT) images of patients with sinonasal symptoms from January 2017 to December 2018. The maxillary sinus volume was measured twice by a radiologist, and statistical analysis was performed using SAS 9.4. @*Results@#Intersex comparison of the maxillary sinus volume (on left and right sides) revealed that the volume was significantly larger on both the sides (p < 0.0001) in men compared with that in women. Concha bullosa was found to occur mainly in the concave cavity of the septal deviation (p < 0.0001). No significant association was found between nasal septal deviation and maxillary sinusitis (p = 0.8756) as well as between concha bullosa and maxillary sinusitis prevalence (p = 0.3401) or maxillary sinus volume (both:p = 0.6289, Rt.: p = 0.9522, Lt.: p = 0.9201). @*Conclusion@#Although nasal septal deviation and the location of concha bullosa may affect each other, maxillary sinus volume and maxillary sinusitis were neither associated with nasal septal deviation nor concha bullosa.

Validation of Korean-Language Version of Chronic Otitis Media Questionnaire-12 to Reflect the Disease Activity of Chronic Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Chronic Otitis Media Questionnaire-12 (COMQ-12) was developed in the United Kingdom to assess disease specific Health-Related Quality of Life (HRQoL) of chronic otitis media (COM) patients. We assessed the validity of Korean version of COMQ-12 (K-COMQ-12) and its correlation with the disease activity of COM classified according to the type of surgery. MATERIALS AND METHOD: We translated the original COMQ-12 into Korean and also performed a back-translation of the translated text into English. Enrolled were 106 COM patients and 106 healthy subjects. Cronbach alpha was used to evaluate internal consistency, and factor analysis was performed to prove reliability. We compared K-COMQ-12 scores between normal subjects and COM patients to assess validity. The scores were also compared by dividing groups according to disease activity of COM. RESULTS: Cronbach's alpha showed good internal consistency (0.939). There was a significant difference in K-COMQ-12 scores between healthy subjects (1.99±4.34) and COM patients (22.69±12.41). Also, scores go higher as the disease activity of COM increased. A cut-off score of 6 of K-COMQ-12 sets 0.915 of sensitivity and 0.934 of specificity. CONCLUSION: The K-COMQ-12 is a reliable and valid tool to assess HRQoL in patients with COM. The K-COMQ-12 could be also used as an objective tool that reflects the disease activity of COM.

Validation of Korean-Language Version of Chronic Otitis Media Questionnaire-12 to Reflect the Disease Activity of Chronic Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#The Chronic Otitis Media Questionnaire-12 (COMQ-12) was developed in the United Kingdom to assess disease specific Health-Related Quality of Life (HRQoL) of chronic otitis media (COM) patients. We assessed the validity of Korean version of COMQ-12 (K-COMQ-12) and its correlation with the disease activity of COM classified according to the type of surgery.MATERIALS AND METHOD: We translated the original COMQ-12 into Korean and also performed a back-translation of the translated text into English. Enrolled were 106 COM patients and 106 healthy subjects. Cronbach alpha was used to evaluate internal consistency, and factor analysis was performed to prove reliability. We compared K-COMQ-12 scores between normal subjects and COM patients to assess validity. The scores were also compared by dividing groups according to disease activity of COM.@*RESULTS@#Cronbach's alpha showed good internal consistency (0.939). There was a significant difference in K-COMQ-12 scores between healthy subjects (1.99±4.34) and COM patients (22.69±12.41). Also, scores go higher as the disease activity of COM increased. A cut-off score of 6 of K-COMQ-12 sets 0.915 of sensitivity and 0.934 of specificity.@*CONCLUSION@#The K-COMQ-12 is a reliable and valid tool to assess HRQoL in patients with COM. The K-COMQ-12 could be also used as an objective tool that reflects the disease activity of COM.

Association of Dietary Factors with Presence and Severity of Septal Deviation: Results of the Korean National Health and Nutrition Survey 2010–2012 / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#The data of Korean National Health Survey from 2010 to 2012 were used to analyze the correlation between the westernized dietary style with the incidence of septal deviation in the Korean population.SUBJECTS AND METHOD: A total of 25532 candidates between the ages of 13–97 was analyzed with their nutrition uptake, body characteristic differences, and the incidence of septal deviation. Inclusion criteria for the candidate were normal values for the smell test, no rhinological abnormalities, and patients who underwent all of the otolaryngologic examinations. Nutrition uptake of the following was examined: total energy uptake per day (kcal), total daily uptake of food, carbohydrate, protein, fat, water (g), total daily uptake of fiber, potassium, calcium, phosphate, iron, and sodium (mg). Each category was examined, compared, and analyzed to investigate a possible relationship with the incidence of septal deviation.@*RESULTS@#When height, waist, and body mass index (BMI) were categorized according to sex and analyzed for relationship with the incidence of disease, the male group showed a positive correlation with the incidence of septal deviation in all three factors. BMI, an important clinical predictive factor for physical growth, showed a positive relationship for obesity rate and septal deviation with the males aged between 10 and 20.@*CONCLUSION@#Males in their 10's and 20's are the most affected by the westernized diet change; therefore, we believe that this is the reason for this age group's association with a higher septal deviation incidence rate compared to other age group.

Association of Dietary Factors with Presence and Severity of Septal Deviation: Results of the Korean National Health and Nutrition Survey 2010–2012 / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The data of Korean National Health Survey from 2010 to 2012 were used to analyze the correlation between the westernized dietary style with the incidence of septal deviation in the Korean population. SUBJECTS AND METHOD: A total of 25532 candidates between the ages of 13–97 was analyzed with their nutrition uptake, body characteristic differences, and the incidence of septal deviation. Inclusion criteria for the candidate were normal values for the smell test, no rhinological abnormalities, and patients who underwent all of the otolaryngologic examinations. Nutrition uptake of the following was examined: total energy uptake per day (kcal), total daily uptake of food, carbohydrate, protein, fat, water (g), total daily uptake of fiber, potassium, calcium, phosphate, iron, and sodium (mg). Each category was examined, compared, and analyzed to investigate a possible relationship with the incidence of septal deviation. RESULTS: When height, waist, and body mass index (BMI) were categorized according to sex and analyzed for relationship with the incidence of disease, the male group showed a positive correlation with the incidence of septal deviation in all three factors. BMI, an important clinical predictive factor for physical growth, showed a positive relationship for obesity rate and septal deviation with the males aged between 10 and 20. CONCLUSION: Males in their 10's and 20's are the most affected by the westernized diet change; therefore, we believe that this is the reason for this age group's association with a higher septal deviation incidence rate compared to other age group.

Does Herpes Virus Reactivation Affect Prognosis in Idiopathic Sudden Sensorineural Hearing Loss?

OBJECTIVES: Several etiologies have been proposed to underlie idiopathic sudden sensorineural hearing loss (ISSNHL), including viral infection, vascular disturbance, and immune-mediated mechanisms. However, none of these mechanisms are conclusive. Should ISSNHL be caused by reactivation of a viral infection, antiviral treatment would be an important option. Thus, in this study, we reported the prognosis according to serologic test results of herpes viruses in patients with ISSNHL. We also evaluated treatment response with acyclovir and corticosteroids versus corticosteroids alone in herpes simplex virus (HSV) seropositive ISSNHL patients. METHODS: We compared hematologic examinations and the results of audiometry testing in 232 patients with ISSNHL. Statistical analyses for initial hearing impairment, progression of hearing impairment, recovery of hearing loss, and laboratory results were performed in all patients. All statistical analyses were performed using SPSS software. RESULTS: The 232 ISSNHL patients were divided into two subgroups according to HSV immunoglobulin M (IgM) serologic results (seropositive or seronegative). When the seropositive group was compared to the seronegative group, age, gender, body mass index (BMI), white blood cell, absolute neutrophil count, absolute monocyte count, and platelet count were not significantly different. Initial hearing level, final recovery hearing level, and recovery time were also not significantly different between the two groups (P>0.05). Though there were no significant differences in age, gender, BMI, or viral HSV IgM titer, the two groups had similar initial hearing level, final recovery hearing level, and recovery time. The difference in hearing threshold before and after treatment was larger (18.7±37.1) in the group receiving antiviral medication than in the corticosteroids group (11.0±44.5), but this difference was not significant (P=0.619). CONCLUSION: There was no significant difference of prognosis between the patients with and without reactivation of HSV. In addition, there seems to be no benefit for the treatment of acyclovir combined with the corticosteroids in the patients with ISSNHL.

Clinical Features and Prognosis of Sudden Sensorineural Hearing Loss Secondary to Intralabyrinthine Hemorrhage

BACKGROUND AND OBJECTIVES: A number of etiologies of idiopathic sudden sensorineural hearing loss (ISSNHL) have been proposed, including viral infection, vascular disturbance, and immune-mediated mechanisms. Intralabyrinthine hemorrhage (ILH) as a cause of SSNHL is extremely rare, and there have been no studies defining the characteristics of hearing impairment and prognosis in patients with ISSNHL due to ILH. This study aimed to investigate the difference in impaired hearing patterns and prognosis for hearing recovery between patients with ISSNHL due to ILH confirmed by magnetic resonance imaging (MRI) and sex- and age-matched patients with ISSNHL due to causes other than ILH. SUBJECTS AND METHODS: We compared the results of audiometry and MRI in 12 patients who had ILH on MRI (hemorrhage group) and in 23 sex- and age-matched controls without abnormal findings related to their hearing loss on MRI (non-hemorrhage group). Initial hearing impairment, progression, and recovery of hearing loss were compared between the two groups. RESULTS: A majority of patients (92%) in the hemorrhage group complained of dizziness. Initial hearing impairment was more frequent in the hemorrhage group than in the non-hemorrhage group (94.09±35.9 vs. 66.66±30.1, p-value=0.036). The final recovery threshold in the hemorrhage group was worse (78.19±46.26 vs. 37.17±31.96, p-value=0.014) than that in the non-hemorrhage group. In the hemorrhage group, hearing recovery seemed to occur less often at high frequencies (2,000, 4,000, and 8,000 Hz) than at low frequencies (250, 500, and 1,000 Hz). CONCLUSIONS: The presence of ILH was associated with poor hearing prognosis and the occurrence of vertigo. The abrupt onset of hearing loss associated with vertigo and the presence of hyperresonance on fat-suppressed T1-weighted MRI images of labyrinthic fluid strongly suggests acute intralabyrinthine hemorrhage, and is predictive of considerable hearing impairment and poor prognosis.

A Case of Pancreatic Intraepithelial Neoplasia Presenting as Aucte Pancreatitis / 대한소화기내시경학회지

Pancreatic intraepithelial neoplasia (PanIN) is a precancerous lesion. A 72-year old man was admitted to our hospital because of abdominal pain, and he had an elevated serum level of pancreatic amylase. ERCP showed a focal stricture of the main pancreatic duct without upstream dilatation in the body of the pancreas. Cytologic evaluation with an endoscopic brush at the stricture suggested the presence of adenocarcinoma. After subtotal pancreatectomy, the features of PanIN were observed in the branch pancreatic duct. ERCP with brush cytology seems to be a useful method for detecting PanIN at the precancerous stage. We report here on a case of PanIN associated with a stricture of the main pancreatic duct.

A Case of Peritoneal Mesothelioma with Direct Invasion to Gastric Mucosa / 대한소화기학회지

Mesothelioma is a rare aggressive tumor arising from the mesothelial cell and regarded as universally fatal disease with average survival around 1 year. The incidence rate is varied from one to forty per million in different countries and increasing by the year. The most common site of tumor origin is the pleura and only 20% to 33% of mesothelioma arise from the peritoneum. There are increasing reports of malignant mesothelioma with forty to fifty fatal cases per year in Korea. Histological studies with immunohistochemical stain is helpful for the diagnosis of peritoneal mesothelioma and imaging modality alone is not sufficient for diagnosis, so it is difficult to confirm diagnosis. A 64-year-old male patient was admitted to the hospital with a palpable mass on abdomen. The 6x6 cm sized huge mass was seen on the body of stomach adjacent to the peritoneum. We report a case of malignant peritoneal mesothelioma without evident exposure to asbestos, of which direct invasion to the gastric mucosa was confirmed by endoscopic biopsy and immunohistochemical stain.

Calcifying Fibrous Pseudotumor of the Stomach That Was Diagnosed by Endoscopic Submucosal Dissection / 대한소화기내시경학회지

Calcifying fibrous pseudotumor (CFPT) is very rare and especially at an intrinsic visceral location such as the stomach. The CFPT is generally located in the subcutaneous or deep soft tissue and the subserosal area of organs and it is mainly diagnosed during childhood or young adulthood. The etiology and pathophysiology of CFPT are unclear. Herein we describe a case of gastric CFPT and we review the related literature. A thirty-year-old asymptomatic female patient visited our hospital for the evaluation of a submucosal tumor that was seen on previous endoscopy. On the endoscopic ultrasonography (EUS), a subepithelial lesion was found at the gastric angle and it was a slightly hypoechoic, homogenous mass located at the submucosal layer of the gastric wall. Endoscopic submucosal dissection was performed under the suspicion of carcinoid. On the microscopic findings, most of the tissue was composed of hyalinized collagenous tissue. Mild lymphocytic infiltration and several dystrophic calcifications were also seen. Immunohistochemically, bcl-2 and CD34 staining was negative, so we diagnosed the mass as CFPT.

A Case of Lymphoepithelial Cyst in the Lower Esophagus / 대한소화기내시경학회지

Lymphoepithelial cyst is a rare benign cystic tumor that is composed of a squamous epithelial cyst surrounded by lymphoid tissue, and this type of cyst is histologically similar to the branchial cleft cysts of the lateral neck. It is most often found in the head and neck and it is only rarely found in the pancreas, mediastinum and hypopharynx. Lymphoepithelial cysts of the esophagus have been described in Japan by Kataoka and Asami. We report here on a case of esophageal lymphoepithelial cyst that was removed endoscopically without serious complications.

A Case of Sclerosed Hemangioma Mimicking Intrahepatic Cholangiocarcinoma / 대한소화기학회지

Hemangioma is one of the most frequently encountered benign hepatic neoplasm which can develop secondary degeneration. Sclerosed hemangioma is a rare disease histologically characterized by large amount of collagen and elastic fibril between sclerosed small vessels. Its differential diagnosis is very difficult. It should be included in the differential diagnosis of other hepatic lesions such as hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and metastatic hepatic tumor. A 77-year old male was admitted with upper abdominal discomfort. Abdominal ultrasonography revealed GB stone, dilated common bile duct with bile duct stone, and a 4.6 cm sized hyperechoic mass at segment 5 and 6 of the liver. Abdominal dynamic computed tomography demonstrated dilated intrahepatic bile ducts and a 5x5 cm sized mass which showed minimally delayed enhancement. Abdominal magnetic resonance imaging revealed the mass with low signal intensity in T1 weighted image, high signal intensity and focal low signal in T2 weighted image which showed minimal enhancement. We removed common bile duct stone with endoscopic retrograde cholangiopancreatography then decided to undergo right lower segmentectomy of liver due to possibility of cholangiocarcinoma. Histopathological examination of hepatic mass showed large amount of fibrous tissue with occasional residual vascular channels. We describe one case of sclerosed hemangioma mimicking cholangiocarcinoma.

Rosacea: Clinical Study of 67 Cases

BACKGROUND: Rosacea is a chronic skin disease which primarily affects the face. There have been many basic and clinical studies on rosacea in the West, but little in Korea. OBJECTIVE: This study was to investigate clinical features of rosacea in Korea and to compare them with those in the West. METHODS: During a 20-month period, 67 patients diagnosed as having rosacea were examined for their clinical presentations by means of personal interview. RESULTS: Erythema and telangiectasia were found in almost all of the 67 patients. Comparing with the results in the West, flushing and telangiectasia were more common whereas papules, pustules, and rhinophyma were less common with no case of ocular complaints or migraine. CONCLUSION: Because early detection and treatment is necessary to prevent the progression of rosacea, it is important to realize that rosacea is not uncommon in Korea and to recognize its somewhat different clinical manifestations from those in the West.

Localized Trichorrhexis Nodosa Arising From Habitual Rubbing

Trichorrhexis nodosa(TN) denotes small node-like swelling with a loss of cuticle of the hair shaft through which the hair readily fractures. The basic cause of TN is mechanical or chemical trauma, and a contributing factor is an inherent weakness of the hair shaft. We report a case of localized TN in a 37-year-old male. He had an ovoid hair patch with multiple small white-gray dotted and stubby hairs localized to the right occipital scalp. TN is known to be the commonest of all hair shaft anomalies (Price, 1975). However TN is rarely reported, and there have been only four reports in Korean dermatological literature, to our knowledge, which might be due to underdiagnosis of this disorder. We postulated that diagnostic difficulty lies in the discrepancy between terminology and gross morphological findings.

The Effect of Sympathetic Blocks in the Prevention of Postherpetic Neuralgia / 대한피부과학회지

BACKGROUND: Many investigators have advocated neural and especially regional sympathetic blockade for acute herpe. zoster pain. Some believe that nerve blocks not only relieve acute pain but also, if given early in the course of clinical disease, prevent progression to postherpetic neuralgia. OBJECTIVE: The purpose of this study was to evaluate the preventive effect of sympathetic blockade on herpes zoster METHODS: Fifteen patients with herpes zoster were treated with sympathetic blocks according to the severity of pain. RESULTS: The total score of pain degree decreased from 3.4 to 1.1 with sympathetic blocks in 15 patients in 2 months. Sympathetic blocks prevented or relieved postherpetic neuralgia in more than 90% of patients treated within 2 weeks of the onset of the acute phase of the disease and in more than 85% of patients over 60. CONCLUSION: Sympathetic blocks are effective in preventing postherpetic neuralgia if applied soon after the onset of the acute phase of herpes zoster.

Three Cases of Sarcoidosis / 대한피부과학회지

We report three cases of sarcoidosis with pulmonary involvement. The skin lesions showed three types of cutaneous manifestations which were erythema nodosum, pruritic maculopapular eruptions, and subcutaneous nodules respectively. Erythema nodosum in our cases accompanied by arthralgia and bilateral hilar adenopathy, so we call it Lofgrens syndrome. Histopathologic findings of the case with eythema nodosum revealed septal panniculitis and the others showed characteristic histopathologic findings of sarcoidosis so-called naked tubercle. Regressions of the skin lesions were obtained with systemic and/or topical corticosteroid therapy except for subcutaneous nodules. Subcutaneous nodules initially improved but new lesions have been found.

Ileal Atresia Secondary to Intrauterine Segmental Volvulus

A 2-day-old male {Premie, Large for gestational age(LGA), Intrauterine period (IUP) 33 weeks, birth weight 2,955 gram} was transferred with marked abdominal distention, bilious return via the orogastric tube, respiratory difficulty, and generalized edema (hydrops fetalis). He was born by cesarean section to a 36 year-old mother. Antenatal ultrasonogram at IUP 31 weeks demonstrated multiple dilated bowel loops suggestive of intestinal obstruction. There was no family history of cystic fibrosis. Simple abdominal films disclosed diffuse haziness and suspicious fine calcifications in the right lower quadrant. Barium enema demonstrated a microcolon. Sweat chloride test was not available in our institution. At laparotomy, there noted 1) a segmental volvulus of the small bowel with gangrenous change, associated with meconium peritonitis, 2) an atresia of the ileum at the base of the volvulus, and 3) the terminal ileum distal to the volvulus was narrow and impacted with rabbit pellets-like thick meconium. These findings appeared to be very similar to those of a complicated meconium ileus. In . summary, the ileal atresia and meconium peritonitis seemed to be caused by antenatal segmental volvulus of the small intestine in a patient with probable meconeum ileus.