Risk Factors for Recurrence Free Survival in Patients With Parotid Gland Cancer: 10-Year Single Center Experience / 대한이비인후과학회지

Background and Objectives@#Parotid cancer is a rare malignancy tumor, constituting about 3% of head and neck cancers. Treatment of parotid carcinoma is challenging because of its rarity and unpredictable clinical course. Therefore, it is important to evaluate risk factors associated with prognosis and to predict adverse outcomes. In this article, we aimed to analyze risk factors associated with recurrence free survival in our 10-year single center retrospective study.Subjects and Method Retrospective medical chart review was performed for patients with parotid gland cancer who underwent parotidectomy with or without adjuvant treatment in our institute 2011 to 2020. Patient demographics, histopathologic results, operative method, treatment outcome were assessed. @*Results@#A total of 8 patients (15%) experienced recurrence. Old age and low body mass index was associated with recurrence. Univariate analysis also revealed that high clinical stage, tumor involvement in deep lobe and facial nerve, postoperative radiotherapy or concurrent chemo radiotherapy, positive resection margin, and high histologic grade were statistically significant with recurrence. Multivariate analysis concluded that facial nerve involvement with tumor was associated with higher incidence of recurrence. Deep lobe and facial nerve involvement, postoperative radiotherapy or concurrent chemo radiotherapy, positive resection margin, clinical stage, and histologic grade were statistically significant factors associated with recurrence free survival. @*Conclusion@#Our 10-year single institute study will be helpful for predicting adverse outcomes in parotid cancer patients.

Microlaryngobronchoscopy Without Tracheostomy in Large Subglottic Cyst Obliterating Airway / 대한이비인후과학회지

Extended endotracheal intubation in infancy causes various complications. Upper airway disruption is very rare but reversible cause of respiratory insufficiency. Tracheostomy may not be avoidable in severe upper respiratory tract lesions especially in large subglottic cysts and severe subglottic stenosis; however, avoiding it is a priority when possible. A 7-month-old child who had a history of newborn respiratory distress syndrome and extended endotracheal intubation developed respiratory symptoms including stridor. A subglottic cyst was found by bronchoscopy and surginally removed with the tubeless anesthesia technique without tracheostomy. This method was successful even on infants. We report this case with a review of literature.

Balloon Laryngoplasty: Contemporary Management of Pediatric Subglottic Stenosis / 대한이비인후과학회지

Balloon laryngoplasty is a noninvasive procedure for managing pediatric subglottic stenosis with promising outcomes of a lower rate of tracheostomy and a higher decannulation rate. It can be applied even in a severely narrowed airway stenosis such as Myer-Cotton grade III. It is gaining popularity because, unlike the traditional rigid dilation method, it is considered an option to avoid shearing mucosal damages. Endoscopic balloon laryngoplasty may be recommended as a primary treatment option in a symptomatic pediatric subglottic stenosis before performing an invasive laryngotracheal reconstruction surgery. Herein, we introduce our institute’s balloon laryngoplasty procedure step-by-step.

A Case of Migrated Esophageal Foreign Body Removal Through Cervical Approach Under C-Arm Fluoroscopic Guidance / 대한이비인후과학회지

Foreign bodies in the upper airway and the esophagus are common and often removed in the outpatient setting using the rigid or flexible laryngoscope. Although most esophageal foreign bodies are removed from the digestive tract, in some cases, surgical intervention is required due to its difficult location. Esophageal foreign bodies often removed by esophagogastroduodenoscopy, but when they penetrate the esophagus and move to deep neck spaces, other approaches should be taken into consideration. We report a rare case of a 13-year-old patient whose esophageal foreign body moved to a deep neck compartment, which was embedded in the anterior vertebral muscle. We decided to perform neck exploration under C-arm guidance, successfully targeted and removed the foreign body.

Application of an Intraoperative Neuromonitoring System Using a Surface Pressure Sensor in Parotid Surgery: A Rabbit Model Study

Objectives@#. Facial nerve monitoring (FNM) can be used to identify the facial nerve, to obtain information regarding its course, and to evaluate its status during parotidectomy. However, there has been disagreement regarding the efficacy of FNM in reducing the incidence of facial nerve palsy during parotid surgery. Therefore, instead of using electromyography (EMG) to identify the location and state of the facial nerve, we applied an intraoperative neuromonitoring (IONM) system using a surface pressure sensor to detect facial muscle twitching. The objective of this study was to investigate the feasibility of using the IONM system with a surface pressure sensor to detect facial muscle twitching during parotidectomy. @*Methods@#. We evaluated the stimulus thresholds for the detection of muscle twitching in the orbicularis oris and orbicularis oculi, as well as the amplitude and latency of EMG and the surface pressure sensor in 13 facial nerves of seven rabbits, using the same stimulus intensity. @*Results@#. The surface pressure sensor detected muscle twitching in the orbicularis oris and orbicularis oculi in response to a stimulation of 0.1 mA in all 13 facial nerves. The stimulus threshold did not differ between the surface pressure sensor and EMG. @*Conclusion@#. The application of IONM using a surface pressure sensor during parotidectomy is noninvasive, reliable, and feasible. Therefore, the IONM system with a surface pressure sensor to measure facial muscle twitching may be an alternative to EMG for verifying the status of the facial nerve.

Application of Novel Intraoperative Neuromonitoring System Using an Endotracheal Tube With Pressure Sensor during Thyroid Surgery: A Porcine Model Study

Objectives@#. The loss of signal during intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroidectomy is one of the biggest problems. We have developed a novel IONM system with an endotracheal tube (ETT) with an attached pressure sensor instead of EMG to detect laryngeal twitching. The aim of the present study was to investigate the feasibility and reliability of this novel IONM system using an ETT with pressure sensor during thyroidectomy in a porcine model. @*Methods@#. We developed an ETT-attached pressure sensor that uses the piezoelectric effect to measure laryngeal muscle twitching. Stimulus thresholds, amplitude, and latency of laryngeal twitching evaluated using the pressure sensor were compared to those measured using transcartilage needle EMG. The measured amplitude changes by EMG and the pressure sensor during recurrent laryngeal nerve (RLN) traction injury were compared. @*Results@#. No significant differences in stimulus threshold intensity between EMG and the pressure sensor were observed. The EMG amplitude detected at 0.3 mA, increased with increasing stimulus intensity. When the stimulus was more than 1.0 mA, the amplitude showed a plateau. In a RLN traction injury experiment, the EMG amplitude did not recover even 20 minutes after stopping RLN traction. However, the pressure sensor showed a mostly recovery. @*Conclusion@#. The change in amplitude due to stimulation of the pressure sensor showed a pattern similar to EMG. Pressure sensors can be feasibly and reliably used for RLN traction injury prediction, RLN identification, and preservation through the detection of laryngeal muscle twitching. Our novel IONM system that uses an ETT with an attached pressure sensor to measure the change of surface pressure can be an alternative to EMG in the future.

Development of a Novel Intraoperative Neuromonitoring System Using an Accelerometer Sensor in Thyroid Surgery: A Porcine Model Study

OBJECTIVES: The sensitivity and positive predictive value of widely used intraoperative neuromonitoring (IONM) using electromyography (EMG) of the vocalis muscle in thyroid surgery are controversial. Thus, we developed a novel IONM system with an accelerometer sensor that uses the piezoelectric effect instead of EMG to detect laryngeal twitching. The objective of this study was to evaluate the feasibility and safety of this novel IONM system during thyroid surgery in a porcine model. METHODS: We developed an accelerometer sensor that uses the piezoelectric effect to measure laryngeal twitching in three dimensions. This novel accelerometer sensor was placed in the anterior neck skin (transcutaneous) or postcricoid area. Stimulus thresholds, amplitude, and latency of laryngeal twitching measured using the accelerometer sensor were compared to those measured through EMG of the vocalis muscle. RESULTS: The amplitudes of the accelerometer sensor at the anterior neck and postcricoid area were significantly lower than those of EMG because of differences in the measurement method used to evaluate laryngeal movement. However, no significant differences in stimulus thresholds between the EMG endotracheal tube and transcutaneous or postcricoid accelerometer sensors were observed. CONCLUSION: Accelerometer sensors located at the anterior neck or postcricoid area were able to identify laryngeal twitching. The stimulus intensity measured with these sensors was equivalent to that from conventional vocalis EMG. Our novel IONM system with an accelerometer sensor that checks changes in surface acceleration can be an alternative to EMG of the vocalis muscle for IONM in the future.

Development of a Novel Intraoperative Neuromonitoring System Using a Surface Pressure Sensor to Detect Muscle Movement: A Rabbit Model Study

OBJECTIVES: False-negative or false-positive responses in intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroid surgery pose a challenge. Therefore, we developed a novel IONM system that uses a surface pressure sensor instead of EMG to detect muscle twitching. This study aimed to investigate the feasibility and safety of a new IONM system using a piezo-electric surface pressure sensor in an experimental animal model. METHODS: We developed the surface pressure sensor by modifying a commercial piezo-electric sensor. We evaluated the stimulus thresholds to detect muscle movement, as well as the amplitude and latency of the EMG and surface pressure sensor in six sciatic nerves of three rabbits, according to the stimulus intensity. RESULTS: The surface pressure sensor detected the muscle movements in response to a 0.1 mA stimulation of all six sciatic nerves. There were no differences in the thresholds of stimulus intensity between the surface pressure sensor and EMG recordings to detect muscle movements. CONCLUSION: It is possible to measure the change in surface pressure by using a piezo-electric surface pressure sensor instead of EMG to detect muscle movement induced by nerve stimulation. The application of IONM using a piezo-electric surface pressure sensor during surgery is noninvasive, safe, and feasible. Measuring muscle twitching to identify the state of the nerves using the novel IONM system can be an alternative to recording of EMG responses.

Validity and Reliability of Korean Version of the Aging Voice Index (KAVI)

BACKGROUND AND OBJECTIVES: Voice disorder is recognized as a major problem because it negatively affects the elderly's social participation and quality of life. The purpose of this study was to examine the validity and reliability of Korean aging voice index (KAVI), which assesses the quality of life related to the voice of the elderly. MATERIALS AND METHOD: This study was conducted on 211 elderly people aged 65 years or older : 111 patients with voice disorder (mean age 69.8, range 65–80 years) and 100 nomorphonic participants (mean age 70.6, range 65–82 years). Aging voice index was translated into Korean and used and Korean voice-related quality of life (KVQOL) was conducted to verify KAVI. The validity (item validity, concurrent validity, and construct validity) and reliability (test-retest reliability and internal consistency reliability) of KAVI. RESULTS: The item validity (ICC=0.895) and construct validity (r=0.765) showed a high correlation, respectively. And concurrent validity (r=0.748), test-retest reliability (0.851), and internal consistency reliability (α=0.832) were statistically significant in voice disorder group. In addition, there was a significant difference between the voice disorder and the nomorphonic group in AVI total score. CONCLUSION: KAVI is a validated and reliable quality of life tool that will be useful for assessing the presence and effectiveness of interventions in clinical settings.

Postoperative Hypoparathyroidism and the Viability of the Parathyroid Glands During Thyroidectomy

OBJECTIVES: To prevent hypoparathyroidism after thyroidectomy, preservation of the parathyroid glands and their vascularity are essential. The aim of this study was to determine the association between postoperative parathyroid function and the viability of the parathyroid glands during thyroidectomy. METHODS: We prospectively analyzed 111 patients who underwent total thyroidectomy and in whom all 4 parathyroid glands were preserved in situ during the operation. The surgeons scored the viability of each parathyroid gland from 0 (normal) to 3 (severely compromised viability) based on its gross appearance and vascularity intraoperatively. The index of parathyroid viability score (IPVS) was defined as the sum of the viability scores of the 4 parathyroid glands. We evaluated the relationship between postoperative parathyroid function and IPVS. RESULTS: Transient hypoparathyroidism occurred in 25 patients (22.5%), and permanent hypoparathyroidism in 4 patients (3.6%). The IPVS were significantly different in the three groups: 2.87±1.46 in the normal group, 3.68±1.41 in the transient hypoparathyroidism group and 7.50±1.00 in the permanent hypoparathyroidism group. The rates of transient hypoparathyroidism were 13.6% in patients with IPVS 0–2, 23.8% in patients with IPVS 3–4, and 42.9% in patients with IPVS 5–6. All the patients with IPVS of 7 or more had permanent hypoparathyroidism. CONCLUSION: IPVS is correlated with the incidence of hypoparathyroidism. It could be a good quantitative indicator of the probability of hypoparathyroidism after thyroidectomy.

Clinical Implications of Snoring Time (%) in Patients with Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Snoring is the vibration sound of respiratory structures when air stream flows through the narrowed airway during sleep. In this study, we aimed to determine the clinical meaning of snoring time (%) of patients who have simple snoring or obstructive sleep apnea (OSA). MATERIALS AND METHODS: We performed a retrospective review of 240 cases of clinical data and polysomnography, which were diagnosed with either simple snoring (n=53) or OSA (n=187). Clinical data included anthropometric measurements such as body mass index, neck and waist circumference (WC), and wasit-hip ratio (WHR). Snoring time (%) was calculated as the total time of snoring per hour of sleep. RESULTS: In the female group, snoring time (%) increased in OSA compared to simple snoring, which showed a negative correlation with N3 (r=-0.395, p=0.002) and a positive correlation with the arousal index (r=0.39, p=0.003). Moreover, in females, snoring time (%) showed significant correlations with respiratory indexes: hypopnea index (p=0.008), apnea-hypopnea index (p=0.049), and lowest SpO₂ (p=0.003). WC and WHR showed significant correlations with snoring time (%) in both male and female. CONCLUSION: Snoring time (%) of females showed important clinical associations with sleep quality and respiratory index. Therefore, snoring may have an important role in the pathogenesis of OSA in females.

Comparative Study of Preoperative Imaging Detection and Localization Test for Hyperparathyroidism / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Accurate preoperative localization of abnormal parathyroid gland is essential for successful parathyroidectomy. The aim of this study was to evaluate the accuracy of a localization test for hyperparathyroidism including ultrasonography (US), computed tomography (CT) and 99mTc-sestamibi scan. SUBJECTS AND METHOD: We studied 47 patients with hyperparathyroidism who underwent parathyroidectomy from January 2003 through December 2010, retrospectively. 99mTc-sestamibi scan, US and CT were carried out as a preoperative localization test and their accuracy were analyzed according to the size, location and pathology of parathyroid lesions. RESULTS: The accuracy of 99mTc-sestamibi scan, US and CT were 93%, 77% and 65%, respectively. The accuracy of 99mTc-sestamibi scan and CT combined was 94% and US and CT 73%. The accuracy of combination of US and 99mTc-sestamibi scan was 96%, which was not different depending on size, location and pathology of parathyroid lesions. CONCLUSION: The combination of 99mTc-sestamibi scan and US is the most effective method for preoperative detection and the localization of hyperparathyroidism.

Epistaxis in Patients Taking Oral Anticoagulant and Antiplatelet Medication / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epistaxis can be caused or exacerbated by anticoagulant and antiplatelet medication. The use of these medications has been increasing markedly in Korea over the recent years due to it becoming an aging society. This retrospective study assessed the proportion of patients taking anticoagulant and antiplatelet in epistaxis patients and monitored differences in patients' clinical courses. SUBJECTS AND METHOD: A retrospective chart review was performed for consecutive patients referred to the ENT department with epistaxis from the emergency room over a one-year period. RESULTS: One hundred eighty eight patients presented to the emergency room with epistaxis, representing 0.6% of all emergency attendances. Of these patients, 143 (76%) were referred to the ENT department: of these referred to us, 24% had been taking anticoagulant or antiplatelet medication. There were 5 taking Warfarin, 32 Aspirin, 3 Clopidogrel, and six more than one medication simultaneously. Patients that were taking these medications were older and had higher prevalent rate of hypertension. There was no difference in the bleeding site, the recurrence rate, hospitalization and duration of in-patient stay, and method of treatment between groups. CONCLUSION: Patients with epistaxis in ENT emergency taking anticoagulant and antiplatelet medication have been increasing recently, so an understanding of the action of such medication may enable health care personnels to provide more effective management of these patients.

The Combination Effects of Early Intratympanic Dexamethasone Injection for the Patients with Sudden Sensorineural Hearing Loss

BACKGROUND AND OBJECTIVES: Intratympanic dexamethasone injection (ITDI) offers the potential for directed delivery of high concentrations of steroids to the inner ear while mitigating the risks involved with high doses of systemic steroids. We investigated the effectiveness of combination therapy, sequential early ITDI accompanied with systemic therapy on sudden sensorineural hearing loss (SSNHL). MATERIALS AND METHODS: We gathered 151 SSNHL patient's data, who were refractory to systemic treatment for 5 days. Injection group (n=47) were administered systemic therapy and 4 times of ITDI within 2 weeks after break of SSNHL. Control group (n= 104) only received traditional treatment. We compared last concreted hearing level and recovery rate according to initial hearing level and frequency. RESULTS: Overall hearing improvement was observed in 47 of 104 (45.2%) control patients and in 30 of 47 (63.8%) ITDI patients (p= 0.034). Depending on the degree of initial hearing loss, the patients with severe hearing loss who treated with ITDI showed significant higher recovery rate than control group (83.8% vs. 50.0%)(p=0.049). When we analyzed hearing improvements according to the frequency, clinically significant hearing improvements were observed at lower and mid-frequencies (250, 500 and 1,000 Hz) in the ITDI group than in the control group. CONCLUSIONS: Early combination the-rapy of intratympanic dexamethasone injection within 2 weeks accompanied with initial systemic treatment is effective for patients with refractory SSNHL, especially for patients with severe hearing loss.