A Case of Chondroma Originated from the Nasal Septum / 대한이비인후과학회지

Chondroma is a benign tumor characterized by the formation of mature cartilage. Chondromas occur infrequently in nasal area, but are found more commonly in metaphyseal area of the phalanges and metacarpals of the hands, pelvis, sternum, and scapula. Since it was first described by Morgan in 1842, about 150 cases of nasal chondroma have been recorded in the world literature. The authors present an unusual case of histologically proven benign nasal chondroma arising from the nasal septum. Diagnostic studies included intranasal endoscopy and CT scanning and MRI of the nose. An intranasal endoscopic tumor removal with an adequate margin of normal tissue was performed. After six months of treatment, there was no evidence of recurrence.

Acoustic Rhinnometric Accessment of Nasal Cavity in Normal Neonates / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acoustic rhinometry, introduced by Hilberg in 1989, is an important investigative tool in rhinology. It should be well suited for studies of the nasal cavities of infants and children in whom nasal airway is more important than in adults. The main objective of this study was to find normal data of nasal cavity dimension in Korean full-term normal neonates. SUBJECTS AND METHOD: Between March 2003 and November 2003, the nasal airways of 100 normal full-term neonates (56 males; 44 females) were examined by acoustic rhinometry (Rhinometrics) and miniprobe. MCA (minimal cross-sectional area), TMCA (total MCA), DMCA (distance from the nostril to the position of MCA) and TVOL40 (sum of volume of the anterior 40 mm of the nasal airway) were calculated. RESULTS: The mean values of TMCA, DMCA and TVOL40 were 0.220 cm2 0.944 cm, 1.716 cm3 respectively. CONCLUSION: Acoustic rhinometry is quick to perform, non-invasive, and it requires minimal co-operation and has no adverse effects. Nasal airway evaluation in neonates is significant in this age group, but limitations in equipment make this difficult. Further studies are required for more accurate evaluation of the nasal airway of neonates and infants.

Clinical Analysis of Endoscopic Transnasal Transsphenoidal Hypophysectomy of Pituitary Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various surgical approach has been used for the removal of pituitary tumor. Recently, endoscopic transnasal transsphenoidal approach has been technically upgraded and the morbidity associated with surgical treatment of the pituitary tumor has been decreased. The objectives of our study was to describe surgical techniques and materials used in sellar repair after endoscopic transnasal transsphenoidal approach. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 18 patients who had received endoscopic transnasal transsphenoidal pituitary surgery between November 2002 and January 2004. We evaluated effectiveness of this technique by analyzing surgical techniques, symptom improvement and complications after surgery. RESULTS: In most of the case, tumor was found to be macroadenoma and 8 of the cases had suprasellar extension. Tumor was totally removed in 13 cases and partially removed in 5 cases. In all cases we used endoscopic unilateral transnasal transsphenoidal approach with anterior sphenoidotomy. CONCLUSION: We may consider that this approach is more safe and effective and a better treatment method for pituitary tumor surgery than the transcranial approach.

Predictive Value of Kushida Index and Acoustic Pharyngometry for the Evaluation of Upper Airway in Subjects With or Without Obstructive Sleep Apnea

Acoustic pharyngometry is a relatively new noninvasive method that quantifies geometrically complexed pharyngeal dimensions. Our study aimed to investigate the predictability and usefulness of acoustic pharyngometry in diagnosis of obstructive sleep apnea (OSA), and we developed a prospective clinical trial in 16 subjects without apnea and 54 subjects with apnea. All seventy subjects received polysomnography (PSG) to assess the sleep architecture, including breathing and the degree of apnea hypopnea index. Acoustic pharyngometry was performed in four body positions (sitting, supine, right and left lateral) while awake with tidal breathing in addition to morphometric measurements (Kushida index) of oral cavity. This study shows that the cross-sectional area and volume of the upper airway is smaller in the supine position than any other positions. As well, the oropharyngeal junction area of the supine position is the most predictive parameter to discriminate between subjects with or without OSA. Acoustic pharyngometry can be a clinically useful tool for localizing the narrowed portion of the upper airway and predicting obstructive sleep apnea.

Predictability of Acoustic Pharyngometry for the Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acoustic pharyngometry is a relatively new noninvasive method that quantifies the geometrically complex oropharyngeal dimensions. We aimed this study to investigate the predictability and usefulness of acoustic pharyngometry in the diagnosis of obstructive sleep apnea (OSA). SUBJECTS AND METHOD: We conducted a prospective clinical trial in consecutive 49 patients with snoring or sleep apnea. Polysomnography was used to determine whether the patient had OSA. All subjects were examined by acoustic pharyngometry in sitting, supine, and both lateral recumbent positions while awake with tidal breathing. Morphometric oral cavity measurements were obtained and the Kushida index was calculated for each patient. RESULTS: Upper-airway cross-sectional areas measured by acoustic pharyngometry were significantly smaller in patients with OSA than in subjects without OSA. Especially, the oropharyngeal junction area (OPJ) in supine position was the most prominent parameter to discriminate between them. CONCLUSION: Acoustic pharyngometry can be a clinically useful tool for localizing the upper-airway obstruction and for predicting obstructive sleep apnea.

The Effect of Topical Steroid Nasal Instillation in Induced Anosmic Mice / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the effect of intranasal Mometasone furoate instillation into the nasal cavity of mice which had peripherally induced anosmia. SUBJECTS AND METHOD: Three groups of mice were studied: normal control group (nasal instillation of normal saline, n=6), Mometasone furoate non-instillation group (no treatment after nasal instillation of zinc sulfate, n=12), and Mometasone furoate instillation group (daily mometasone furoate instillation after nasal instillation of zinc sulfate, n=12). Tissues of olfactory mucosa were obtained on 1, 2, 3, 4 weeks after the instillation of zinc sulfate, and processed for immunohistochemistry using antisera to olfactory marker protein (OMP) for evaluation of olfactory regeneration. RESULTS: No OMP-positive cells were observed in the first week after the instillation of zinc sulfate in both groups. However, OMP-positive cells began appearing in the second week in both groups and gradually increased as time goes by. In the Mometasone furoate instillation group, the increase of OMP-positive cells was significantly greater than that of Mometasone furoate non-instillation group. CONCLUSION: Mometasone furoate instillation enhances regeneration of olfactory receptor cells after injury. Mometasone furoate instillation can be suggested as an effective treatment modality for olfactory dysfunction.

Effect of Roxithromycin and Intranasal Fluticasone Spray in Reducing Symptoms of Chronic Sinusitis, Polyp Size and IL-4 in Allergic Patients

Nasal polyp is an intractable condition usually associated with chronic hyperplastic sinusitis with allergic rhinitis. IL-4 is known to contribute to the inflammatory reaction by enhancing binding of inflammatory cells in the nasal polyp. The objectives of this study were to evaluate the effect of roxithromycin (300 mg daily) and intranasal fluticasone spray (200 microgram daily ) in reducing symptoms of chronic sinusitis and polyp size and to compare pre - and post-treatment secretion of IL-4. Twenty-four patients with chronic sinusitis with nasal polyp and allergic rhinitis were selected and allocated into 3 groups ; roxythromycin, fluticasone propionate and combined use group. Statistically significant decrease in symptoms was observed in both the roxythromycin and fluticasone propionate groups. Significant improvement of rhinorrhea and postnasal drip was observed in the combined use group. The polyp size decreased significantly in all three groups. IL-4 secretion decreased significantly in the combined use group after treatment. Long term medication of roxithromycin and intranasal fluticasone spray were effective in reducing symptoms and polyp size in chronic sinusitis with allergic rhinitis. They were also effective in reducing IL-4.

Effects of Preincisional Infiltration with Bupivacaine and Oral Dextromethorphan on Postoperative Pain in Uvulopalatopharyngoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Uvulopalatopharyngoplasty is one of the most painful surgical procedures in otolaryngology. Repetitive nociceptive impulses from injured peripheral tissues and activation of N-methyl-D-aspartic acid (NMDA) receptors induce central sensitization and post-injury pain hypersensitivity states. We aimed this study to evaluate whether bupivacaine for preincisional block of nociceptive afferent inputs and dextromethorphan, a clinically available NMDA receptor antagonist could reduce postoperative pain after uvulopalatopharyngoplasty. MATERIALS AND METHOD: Thirty patients scheduled for uvulopalatopharyngoplasty were randomly assigned to one of the three groups : control, bupivacaine, and bupivacaine- dextromethorphan groups. The second and third group had 10 ml of 0.25% bupivacaine hydrochloride infiltrated around tonsils and soft palate before incision. The third group was given oral doses of dextromethorphan before and after surgery. Pain was assessed using numeric rating scale at rest and on swallowing on postoperative day 0, 1, 2, 3, and 5. Daily consumption of supplementary diclofenac sodium was also recorded. RESULTS: Resting pain scores were significantly lower in the groups treated with bupivacaine infiltration with or without dextromethorphan on postoperative days 0, 1, 2, 3, and 5. Swallowing pain scores were significantly lower in the bupivacaine-dextromethorphan group on days 0, 1, and 2. CONCLUSION: Preincisional infiltration with bupivacaine and oral dextromethorphan could decrease the intensity of postoperative pain following uvulupalatopharyngoplasty.

A Case of Nasopharyngeal Tuberculosis with Retropharyngeal Abscess / 대한이비인후과학회지

The nasopharyngeal tuberculosis with retropharyngeal abscess is a rare disease. Recently, the authors experienced a 26 year-old female patient who had been admitted with odynophagia for 1 month. The physical examination revealed isolated granulomatous lesion on the nasopharynx and protrusion of the posterior pharyngeal wall between the nasopharynx and the oropharynx. Biopsies from the nasopharynx showed caseating epitheloid granuloma with multinucleated giant cell. Needle aspiration of the retropharyngeal space yielded 50ml of pus. She was diagnosed with nasopharyngeal tuberculosis with retropharyngeal abscess. We effectively treated her with trial anti-tuberculosis chemotherapy and intraoral drainage. We report it with a review of the literature.

Experimental Otitis Media with Effusion Induced by Interleukin 2 / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The etiology and pathogenesis of otitis media with effusion (OME) have not been fully elucidated, although multiple theories exist. These pathogenic factors are eustachian tube dysfunction, allergy, local immune dysfunction and bacterial infection. Recently, many studies have focused on the immune regulation and cytokines associated with the pathogenesis of OME. Interleukin 2 (IL-2) is produced by activated T cells which act on T cells, promoting their proliferation and inducing the production of other cytokines involved in the cell-mediated immunity. This study tested the hypothesis that IL-2 in the middle ear cleft can induce OME and that an IL-2 antagonist can prevent IL-2 induced OME. In addition, we examined histopathological changes in the middle ear. MATERIALS AND METHODS: IL-2 (group 1: 0.01ng, group 2: 0.1ng) or with its antagonist (group 3: 0.1ng) were injected transtympanically into the middle ear of normal rats. RESULTS: After 24 hours, IL-2 had produced a cellular effusion (group 1: 75%, group 2: 88%) and histopathological changes including thickening of the subepithelial space and increased infiltration of inflammatory cells. Neutrophils were the predominant cell type. Finally, transtympanic injection of the IL-2 antagonist prevented IL-2 induced OME. CONCLUSION: This study demonstrated that the IL-2 injection into middle ear can induce OME and that IL-2 antagonist can effectively prevent IL-2 induced OME. These findings suggest that IL-2 plays an important role in the pathogenesis of OME and that the IL-2 antagonist may be applied for the treatment of human OME.

Comparison Study of Epithelial Cell Proliferation in Nasal Polyp and Nasal Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: Nasal polyposis is a chronic inflammatory disease with structural modification of the mucosal epithelium and the lamina propria. In one of recent studies related to the lamina propria, the myofibroblast, which is a potent inducer of extracellular matrix (ECM) synthesis, was found to increase the pedicle area of the nasal polyp. In this study, we intended to quantify epithelial cell proliferation of the polyp. We also tried to identify the active area of epithelial proliferation within nasal polyp and to compare it with the active area of ECM synthesis. MATERIALS AND METHODS: During the endoscopic surgery of nasal polyposis patients, anatomically intact polyp, uncinate process, inferior turbinate and middle turbinate were sampled. The normal nasal mucosa of the inferior turbinate and the septum were obtained from patients who underwent septoplasty. The proliferation cell nuclear antigen (PCNA) expression in the samples were quantified by immunohistochemistry. The PCNA index of the two groups were compared. RESULTS: Epithelial proliferation of the nasal polyp was found to be more active than the normal nasal mucosa. The active area of epithelial proliferation within the nasal polyp was the body area. CONCLUSION: The active area of epithelial proliferation was different from the pedicle area, which is the active area of ECM production.

Expression of Nitiric Oxide Synthase lsoenzymes in Normal Nasal and Polyp Mucosa of Human / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) seems to have some potential to play a regulatory role in the airway function and it maybe related to the pathophysiology of several airway diseases. Although the pathophysiology of nasal polyp is poorly understood, a recent study has suggested that airway NO produced from paranasal sinus epithelium where mNOS is expressed constituitively without immunologic stimulation may play a critical role in the genesis of inflammatory nasal disease. MATERIALS AND METHODS: We examined the presence of mNOS and eNOS in the nasal cavity and paranasal sinus mucosa in 10 healthy persons of nasal septal deviation and 20 patients with nasal polyp by immunohistochemical staining using rabbit polyclonal anti- eNOS and anti-mNOS IgG. Relative quantification of eNOS and mNOS was done by RT-PCR. RESULTS: Immunoreactivity to eNOS and mNOS was positive in all nasal polyps and this reactivity was mainly restricted to the epithelial layer. Immunoreactivity to mNOS in the controls was negative for the inferior turbinate. RT-PCR showed more mNOS reactivity in the nasal polyp than in the control (p<0.03). CONCLUSION: These findings reinforce the concept that the epithelial layer is the main locus and mNOS may be one of the potential factors in the pathogenesis of nasal polyp.

A Case of Giant Intradiploic Epidermoid Cyst of the Temporal Bone / 대한이비인후과학회지

Intradiploic epidermoid cysts are extradural and very uncommon lesions that may occur in all flat bones of the calvarium. The very slow growth rate and the benign histological nature of these tumors explain their long preoperative evolution and the mild neurological signs. We report a giant intradiploic epidermoid cyst of the temporal bone with an intracranial extension into the posterior fossa which was probably responsible for the destruction of the endolymphatic sac and presenting intermittent vertigo and profound hearing loss. It was discovered incidentally during the evaluation of chronic otitis media. Plain film, CT and MRI all demonstrated the characteristic appearances of intradiploic epidermoid cyst. The tumor was totally removed and cranioplasty was performed.

Effects of Peritonsillar Infiltration with Bupivacaine and Oral Dextromethorphan on Post-Tonsillectomy Pain / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Peripheral tissue or nerve injury often leads to post-injury pain hypersensitivity caused by peripheral and central sensitization. Central sensitization which plays a significant role is triggered by nociceptive afferent inputs and mainly results from N-methyl-D-aspartic acid (NMDA) receptor activation. If the afferent impulses are prevented from gaining access to the CNS or if NMDA receptor is blocked by antagonist, central sensitization will not develop and then less pain will result. Previous studies demonstrated that preoperative infiltration of local anesthetics or oral NMDA receptor antagonist could alleviate postoperative pain. We investigated the effects of peritonsillar infiltration with bupivacaine and oral dextromethorphan on post-tonsillectomy pain. MATERIALS AND METHODS: Forty consecutive patients were randomly allocated to one of four groups. Group I was bupivacaine-treated group, and group II was dextromethorphan-treated group. Group III was both bupivacaine and dextromethorphan-treated group, and group IV was control group. Pain scores were assessed using self-rating numeric rating scale ( NRS) at rest and on swallowing during the postoperative day 0, 1, 2, and 7. Doses of supplementary diclofenac administered postoperatively were also recorded. RESULTS: Group I, II, and III showed significantly lower NRS pain scores compared with control group at rest and on swallowing throughout the postoperative 7 days. Diclofenac doses were not statistically different among the four groups. CONCLUSION: Preoperative peritonsillar infiltration with bupivacaine and/or medication with dextromethorphan contributed to decrease the intensity of postoperative pain after tonsillectomy.

Detection of Haemophilus Influenzae and Streptococcus Pneumoniae by Polymerase Chain Reaction (PCR) in Chronic Otitis Media with Effusion (OME) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Otitis media with effusion (OME) is one of the major causes of hearing loss in childhood. The pathogenesis still remains unclear, although it is closely related to bacterial infections. Thus, it is necessary to develop a sensitive and specific method to detect of bacteria in OME in order to examine the relationship between bacterial infection and the pathogenesis of OME. To determine if the polymerase chain reaction (PCR) can detect bacterial DNA in pediatric middle ear effusions that are sterile by standard cultural methods. MATERIALS AND METHODS: total of 52 middle ear effusions were collected from pediatric patients during myringotomy and the ventilation tube insertion. All patients had failed multiple courses of antimicrobial therapy. PCR and the conventional culture method were applied to detect Haemophilus influenzae and Streptococcus pneumoniae in the middle ear effusions. RESULTS: Of the 52 specimens of OME, 3 (6%) tested positive by culture for Staphylococcus aureus, 1 (2%) for Gram positive bacilli. H. influenzae and S. pneumoniae were not detected by culture in all samples. But 32 (61.5%) were positive for H. influenzae and 7 (13%) for S. pneumoniae by PCR. The positive rate was significantly greater with PCR than with the culture method. CONCLUSION: The PCR assay is useful to detect middle ear pathogens of OME, even in the "sterile" fluids by the conventional bacterial culture. PCR positive specimens from the middle ear pediatric patients are suggestive of bacterial infections.

A Case of Nasopharyngeal and Oropharyngeal Tuberculosis / 대한이비인후과학회지

Nasopharyngeal and oropharyngeal tuberculosis is a rare disease. The authors have recently experienced a case of a 40-year-old woman who had been presented with throat discomfort for 3 months. Her medical history showed no pulmonary tuberculosis, but the physical examination revealed isolated granulomatous lesion on the nasopharynx and an isolated ulcerated granulomatous lesion on the posterior wall between nasopharynx and oropharynx (naso-oropharynx). Biopsies from the both sides showed tuberculoid granuloma with multinucleated giant cells, caseous necrosis, and chronic granulomatous infla-mmation. A trial of anti-tuberculous chemotherapy reduced the size and produced gradual healing of the lesion in seven months. We report this case with a review of literature.

Morphological Changes of Cochlear Hair Cells in the Streptozotocin-Induced Diabetic Rat / 대한이비인후과학회지

BACKGROUND: Diabetes Mellitus has been known as a multisystemic disorder for a long time. An association between diabetes and hearing loss was first postulated in the one case report published by Jordao in 1857. The typical hearing loss from diabetes is a progressive and bilateral sensorineural deficit that predominantly occurs in the high frequency and in the elderly patients. OBJECTIVES: The purpose of this study was to investigate the morphological changes of cochlear hair cells in the insulin-dependent diabetes mellitus induced by Streptozotocin. MATERIALS AND METHODS: Thirty two rats were used for this study and divided into control and diabetic group. Furthermore each group was subdivided into 4 weeks, 8 weeks, 12 weeks and 16 weeks group. All experimental animal were put in the same environmental condition. Insulin-dependent diabetes mellitus was induced by intravenous injection of Streptozotocin (65 mg/kg of body weight). Hair cell loss and their ultrastructural changes were observed with phase contrast light microscope and transmission electron microscope. CONCLUSION: The results of this study suggest that metabolic change of diabetes mellitus may affect the cochlear hair cells.