Comparison of the Effects of Middle Ear Implants and Conventional Hearing Aids on Cognitive Function / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The association between hearing impairment and cognitive function has been established in previous studies. The aim of this study was to compare the effects of conventional hearing aids and middle ear implants on cognitive function. SUBJECTS AND METHOD: This study included 22 participants who underwent middle ear implantation between October 2013 and September 2016. Their mean age at surgery was 70 years. Using Pure tone audiometry (PTA), the Speech discrimination test (SDT), and the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, we compared audiologic benefits of three conditions [without hearing aids, with conventional hearing aids, or with Vibrant Sound bridge (VSB)]. Cognitive ability was evaluated using neuropsychological testings (Seoul Neuropsychological Screening Battery) at intervals of approximately eight weeks. RESULTS: The results of PTA showed a 7.96 dB HL gain with conventional hearing aids and a 10.00 dB HL gain with the use of VSB. SDT results showed a 4.10% gain with conventional hearing aids and a 10% gain with the use of VSB. Results of the APHAB questionnaire showed a significant increase with the use of VSB compared to conventional hearing aids. In the Korean Mini-Mental State Examination, a slight improvement was observed after middle ear implantation. In the Digit Span Test and Korean-Boston Naming Test, a significant improvement was seen with the use of VSB compared to conventional hearing aids. CONCLUSION: The use of middle ear implants in rehabilitation of hearing communication in patients showed improvements in cognitive abilities, compared to the use of conventional hearing aids.

A Case of Co-Existence Squamous Cell Carcinoma with Granuloma in Posterior Glottis / 대한이비인후과학회지

The laryngeal granuloma (LG) is non-neoplastic lesion that mainly develops in the posterior vocal folds. It is welknown that mis- or overuse of voice, habitual coughing, and endotracheal intubation can become the cause of LG. The laryngopharyngeal reflux also comes into the spotlight as an etiologic factor. Although LG has a tendency to recur easily, it is not a premalignant lesion. The co-existence with granuloma and laryngeal cancer has not been reported earlier. Recently, we encountered a 72-year-old man with a posterior glottic mass, which was diagnosed as squamous cell carcinoma coexisting with granuloma. To our knowledge, this is a first report on two coexisting carcinomas in the glottis.

Two Cases of Immunoglobulin G4-Related Sclerosing Disease in Submandibular Triangle / 대한이비인후과학회지

Immunoglobulin G4-related sclerosing disease (IgG4-RD) is histologically a chronic inflammatory disorder characterized by infiltration of lymphoplasmacytes, sclerosis, and an elevated serum level of IgG4 and IgG4 positive plasmocytes. IgG4-RD is associated with autoimmune pancreatitis, sclerosing cholangitis, sialalithiasis, retroperitoneal diseases, inflammatory arotitis and Mikulicz's disease, typically including the lacrimal glands, salivary glands, pancreas, thyroid gland, lungs and kidneys. It is important to distinguish IgG4-RD from neoplastic disease as it responses well to steroid. Because consensus for nomenclature of IgG4-RD is recently made, reports of IgG4-RD in the Head and Neck area are still rare. In the first case, a 68-year-old man presented with a recurring submandibular gland mass from 7 years ago; he underwent submandibular gland resection and was diagnosed as IgG4-RD. In the second case, a 69-year-old mass presented with a relapsing right neck mass on level Ib. He underwent an exsional biopsy and was diagnosed with the same disease entity. We experienced two cases of IgG4-RD, and so report them with a brief literature review.

Papillary Thyroid Cancer from Lateral Aberrant Thyroid Masquerading as Cervical Metastasis from Larynx Cancer: A Case Report

The aberrant or ectopic thyroid in lateral neck is a rare developmental anomaly. Furthermore, the primary thyroid carcinoma arising in ectopic thyroid is extremely rare, only a few cases have been reported so far in English literature. We report a 64-year-old male with left transglottic cancer and primary papillary carcinoma from lateral aberrant thyroid in left lateral neck. Preoperatively, we diagnosed as transglottic cancer with ipsilateral neck metastasis. The patient underwent total laryngectomy, left selective neck dissection and left thyroidectomy. Finally, the patient was diagnosed as left transglottic cancer and papillary carcinoma from lateral aberrant thyroid. Surgeons should take into account a primary ectopic thyroid carcinoma arising in lateral neck may co-exist with another type of head and neck tumor.

A Case of Recurrent and Multiple Schwannomas in the Caudal Septum

Schwannomas are benign neoplasms arising from the sheath of myelinated nerve fibers and may occur in any part of the body. They mostly occur in the head and neck region, accounting for about 25% to 45% of all cases. The eighth cranial nerve is the most common site of origin. About 4% of all head and neck schwannomas originate in the nasal cavity and paranasal sinuses. The best treatment of schwannomas is surgical excision. Since it is an encapsulated tumor, difficultly is rarely encountered in its complete removal, and recurrence is unlikely. We present a unique and rare case of a 71-year-old man with a recurrent septal mass, finally diagnosed as a schwannoma, with a review of the literature.

A Case of Metastatic Renal Cell Carcinoma of Parotid Gland / 대한이비인후과학회지

Renal cell carcinoma (RCC) is known for its high propensity for early metastasis and one third of patients diagnosed with RCC present with metastatic disease at the time of diagnosis. RCC commonly metastasizes to the lung, bone, liver, brain, and skin by hematogenous spread, whereas metastasis to the head and neck region is rarer. In cases of head and neck metastasis, the thyroid accounts for a large percent. Parotid metastasis from renal cell carcinoma is an extremely rare finding. We recently encountered a 67-year-old man with left parotid mass and finally diagnosed as metastatic renal cell carcinoma. We report the rare case with a review of literature.

Primary Thyroid Lymphoma Associated with Dyspnea in an Old Age Patient: A Case Report / 대한갑상선학회지

Primary thyroid lymphoma is a rare tumor which patients usually present an enlarging neck mass, often causing local obstructive symptoms. Hypothyroidism is seen in 30-40% of the patients with primary thyroid lymphoma. We report a 77-year-old man with history of hypothyroidism, presenting enlarging anterior neck mass which pathologically confirmed as thyroid lymphoma with literature review.

A Case of Neurofibroma Presenting as a Nasolabial Mass

Neurofibroma is a benign neurogenic tumor thatmost often occurs in the head and neck region. However, a solitary neurofibroma on the nasolabial fold is extremely rare, with only a few reported cases reported in the English literature. A 45-year-old woman with a nasolabial mass visited our department, and we performed an excisional biopsy using asublabial approach. The histopathology of the mass revealed it to be neurofibroma. We report a unique case of neurofibromain thenasolabial region with an associated literature review. To the best of our knowledge, no such case has previouslybeen reported in Korea.

Association Study of FOS-Like Antigen-2 Promoter Polymorphisms With Papillary Thyroid Cancer in Korean Population

OBJECTIVES: FOS-like antigen-2 (FOSL-2), a member of the FOS gene family, encode leucine zipper proteins that can heterodimerize with proteins of Jun family. Thus, activating protein (AP)-1 transcription factor is formed, has a crucial role in proliferation, differentiation and apoptosis of normal tissue as well as oncogenic transformation and progression. We performed an association study of single nucleotide polymorphisms (SNPs) in the FOSL-2 with papillary thyroid cancer (PTC). We also estimated the relationships between the SNPs and the clinicopathologic characteristics of PTC. METHODS: One promoter SNPs (rs925255) of FOSL-2 gene were genotyped with direct sequencing method in 94 PTC and 213 controls. PTC patients were dichotomized and compared with respect to clinical parameters of PTC. Genetic data were analyzed using Helixtree, SNPAnalyzer, SNPStats. Multivariate logistic regression analysis was fulfilled to evaluate the genetic effect with adjustment for age and sex. RESULTS: SNP (rs925255) in FOSL-2 showed a significant association (codominant 1 model [G/G vs. A/G]: odds ratio [OR], 0.531, 95% confidence interval [CI], 0.293 to 0.96, P=0.036; dominant model: OR, 0.50, 95% CI, 0.28 to 0.89, P=0.015) with PTC. The frequency of allele G in rs925255 was also significantly associated with PTC (OR, 0.59; 95% CI, 0.34 to 0.91; P=0.02). But we fail to prove significant association between this polymorphism (rs925255) and clinico-pathological parameters. CONCLUSION: Our findings suggest that the rs925255 SNP and its allele G show significant association with the PTC in Korean population.

A Case of Multiple Extraparotid Pleomorphic Adenomas in Subcutaneous Peri-Auricular Area / 대한이비인후과학회지

Pleomorphic adenoma (PA) usually arises as a benign tumor of major salivary glands. However, multiple PAs on subcutaneous preauricular region are extremely rare. A-62-year-old man presented with a pre- and infra-auricular mass of 2 years duration. An excisional biopsy revealed a pleomorphic adenoma, which originated in the subcutaneous layer. He had no sign of recurrence so far. We report a unique case of multiple extraparotid pleomorphic adenoma with a literature review.

A Case of Extramedullary Plasmacytoma Presenting with the Mass in Nasal Cavity

Extramedullary plasmacytoma (EMP) arises outside the bone marrow, particularly in the head and neck region (nasopharynx, nasal cavity, sinuses, and tonsils etc), and can be associated with multiple myeloma (MM). The most frequently involved sites of EMP are head and neck regions, although it accounts for less than 1% of all head and neck malignancy. It is essential for otolaryngologists and head and neck surgeons to be familiar with this entity because total excision and radiation therapy for plasmacytomas can be curative in patients who have no underlying overt plasma cell dyscrasias. We have recently experienced a case of solitary EMP arising from left nasal cavity and report it with a review of literature.

A Case of Extramedullary Plasmacytoma Presenting with the Mass in Nasal Cavity

Extramedullary plasmacytoma (EMP) arises outside the bone marrow, particularly in the head and neck region (nasopharynx, nasal cavity, sinuses, and tonsils etc), and can be associated with multiple myeloma (MM). The most frequently involved sites of EMP are head and neck regions, although it accounts for less than 1% of all head and neck malignancy. It is essential for otolaryngologists and head and neck surgeons to be familiar with this entity because total excision and radiation therapy for plasmacytomas can be curative in patients who have no underlying overt plasma cell dyscrasias. We have recently experienced a case of solitary EMP arising from left nasal cavity and report it with a review of literature.

A Case of Bilateral Peripheral Tapia's Syndrome Subsequent to Coronary Artery Bypass Graft / 대한이비인후과학회지

The Tapia's syndrome means symptom complex that result from unilateral vago-hypoglossal nerve paralysis. This syndrome is rare disease entity, bilateral attack is extremely rare. Only three cases have been reported in English literature. A-66-year-old man received the coronary artery bypass graft in our hospital. After the operation, he complained of severe dyspnea, voice change and drooling. The laryngoscopic findings showed the bilateral vocal cord palsy. He could not move the tongue toward any directions. We diagnosed as bilateral Tapia's syndrome. Usually, unilateral Tapia's syndrome is related to the complications of anesthesia and position of the patient's head during surgery. Otherwise, our case may be associated with the complications of operation and anesthesia. The patient's recovered three months later, but the right vocal cord palsy is persistent. We report the very unique disease entity with literature review.

A Case of Pulsatile Tinnitus from the Atherosclerosis and Atheroma in Superior Labial Artery and Facial Artery

Tinnitus is one of the most common symptoms in an audiologic field. It can be classified as either as subjective or objective; former referring to the sensation heard by both patient and examiner. Pulsatile tinnitus is perceived as sounds that vary in frequency, intensity and duration. The cause of pulsatile tinnitus include high jugular bulb, benign intracranial hypertension, glomus tumors, carotid artery stenosis, vascular lesions of the temporal bone, arteriovenous malformation, aneurysms, and Arnold-Chiari malformation. Vascular tinnitus is most common (7.6%). Recently, the authors experienced one case of the pulsatile tinnitus caused by atherosclerosis and atheroma in superior labial artery & facial artery. After surgery, the symptom had disappeared. We report a unique case regarding the objective tinnitus with the literature review.

A Case of Pulsatile Tinnitus from the Atherosclerosis and Atheroma in Superior Labial Artery and Facial Artery

Tinnitus is one of the most common symptoms in an audiologic field. It can be classified as either as subjective or objective; former referring to the sensation heard by both patient and examiner. Pulsatile tinnitus is perceived as sounds that vary in frequency, intensity and duration. The cause of pulsatile tinnitus include high jugular bulb, benign intracranial hypertension, glomus tumors, carotid artery stenosis, vascular lesions of the temporal bone, arteriovenous malformation, aneurysms, and Arnold-Chiari malformation. Vascular tinnitus is most common (7.6%). Recently, the authors experienced one case of the pulsatile tinnitus caused by atherosclerosis and atheroma in superior labial artery & facial artery. After surgery, the symptom had disappeared. We report a unique case regarding the objective tinnitus with the literature review.

Surgical Approach for Oral Cavity Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In the treatment of oral cancer, appropriate surgical approaches should be chosen in order to eradicate cancer while preserving the function of oral cavity and facial contour. This study was performed to evaluate the usefulness and effectiveness of various surgical approaches in the surgical treatment of oral cancer. SUBJECTS AND METHOD: A total of 112 oral cancer patients, excepting those with lip cancer, and who underwent surgery from 1994 to Aug 2008, were enrolled. We reviewed medical records retrospectively and analyzed the primary sites, stage, surgical approaches, management of mandible and neck, reconstruction methods, recurrence and survival rates. RESULTS: Of the 112 patients, 64 were transoral, 23 pull-through, 6 mandibular lingual releasing, 6 upper cheek flap , 5 lower cheek flap , 6 mandibulotomy and 2 visor flap approach. Most of T1, T2 lesions could be resected by transoral (71.6%) or pull-through approach (21.0%). In the advanced T3, T4 lesions, transoral (21.9%), pull-through (37.5%), cheek flap (21.9%), mandibulotomy (15.6%) were used. There was no statistically significant difference with respect to locoregional recurrence and survival rate according to surgical approach. CONCLUSION: The transoral approach was the effective method for the surgery of T1, T2 and part of T3 oral cancer. The pull-through or mandibular lingual releasing approach was the effective method of surgery for T2, T3 tongue or floor of mouth (FOM) cancer while avoiding mandibulotomy.

A Case of Osseous Choristoma of Thyroid Gland / 대한이비인후과학회지

Osseous choristoma rarely occurs, but when it does, the oral cavity of the head and neck lesion is the most common site. It appears as a mass of normal bony structure, consisting of mature osteocytes in an ectopic position. Appearing as a calcification of thyroid mass on radiologic examinations, it could be a benign lesion, chronic inflammation, or carcinoma; the final diagnosis can only be obtained by a pathologic confirmation. Histologically, the lesions show a well-circumscribed mass of vital bone. The treatment of choice is surgical excision. We report a case of osseous choristoma that occurred on the thyroid gland. To our knowledge, such has not been reported previously as a site of osseous choristoma.

A Spatial Index Analysis for Decision on the First Opening of Facial Recess in Posterior Tympanotomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Temporal bone is a complicated structure anatomically. Highresolution computed tomography (HRCT) provides a good method for examination of the middle ear, inner ear anatomy and pathologic changes in the temporal bones. The purpose of this study is to evaluate the relations of facial nerve and other structures in temporal bone and factors influencing access to posterior tympanotomy according to the age, sex and degree of temporal bone pneumatizaton. SUBJECTS AND METHOD: A total of 133 ears of temporal bone computer tomograph (TBCT) were analyzed. We measured the distances and angle between important surgical landmarks, and compared the data according to the age, sex and mastoid pneumatization. RESULTS: We presented the angle between the posterior wall of external auditory canal and the facial nerve with the index for facial nerve preservation in posterior tympanotomy. This angle is 10.05 degrees other indices are not related statistically. CONCLUSION: This results may enable preoperative assessment and provide background knowledge to prevent facial nerve injury when performing a posterior tympanotomy.

Multiple Traumatic Pyomucocele

The mucocele of paranasal sinuses is a mucus-filled, epithelial-lined cystic structure resulting from the destruction of the sinus ostia secondary by recurrent inflammation, trauma or intrinsic disease. A 42-year-old man was presented with a left periorbital swelling that developed 7 days ago. CT scan revealed mass lesions with soft tissue density in the left anterior ethmoid and frontal sinus. MRI showed a well- demarcated cystic mass in the left anterior ethmoid sinus with a high signal on both the T1-weighted and T2-weighted images as well as in the left frontal sinus with a low signal on the T1-weighted images and a high signal on the T2- weighted images. The patient subsequently underwent the removal of the left anterior ethmoid and frontal mucocele via a Lynch's approach and a left endoscopic anterior ethmoidectomy. He has no recurrence 6 months after surgery.

Multiple Cholesterol Granuloma Involving the Paranasal Sinus: A Case Report

Cholesterol granuloma is a chronic inflammatory process associated with foreign body reaction to hemorrhage-related cholesterol crystal. It occurs most commonly in the middle ear cavity and the mastoid air cell complex. Sinonasal cholesterol granuloma is very rare, and there have been only 37 reported cases in the English literature so far. In this study, we examined a 61-year-old man suffering from bilateral orbital pain, headache and diplopia for 2 years. He had underwent a bilateral Caldwell-Luc operation 15 years ago. The brain MRI findings revealed 3 different cystic mass involving the bilateral sphenoid sinuses, and left ethmoid and maxillary sinuses. The patient was referred from the department of neurology, and the PNS CT findings were similar to the brain MRI. In the nasal endoscopic finding, there was a hard bilateral submucosal mass in the middle meatus. We planned an endoscopic sinus surgery for the mass, diagnosed as mucocele. The mass was accompanied by a greenish fluid and yellowish crystal in the left side of the lesion and dark reddish matter on the opposite site. Bone defects were observed in the left lamina papyracea and the intersinus septum of sphenoid sinus. The pathology was confirmed as a typical cholesterol granuloma. There is no recurrence during the last 18 months. We report this case of multiple cholesterol granuloma of the paranasal sinuses for the first time with literatures review.