Fine Needle Aspiration for Thyroid Nodule: Clinical Application of Bethesda Classification / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To evaluate the usefulness of fine needle aspiration (FNA) for thyroid nodule using the new Bethesda classification. SUBJECTS AND METHOD: Patient cytology data were reviewed by retrospective search of thyroid FNA. Cytologic diagnoses were classified as unsatisfactory, benign/negative for malignancy, indeterminate (ID), follicular neoplasm (FN), suspicious for malignancy (SM), and positive for malignancy (PM) according to the proposing of The National Cancer Institute. We analyzed the follow-up FNA diagnoses and the cytologic-histologic correlations. RESULTS: Of 1983 patients, 16.8% was classified as unsatisfactory, 73.6% as benign, 1.1% as ID, 0.4% as FN, 1.4% as SM, and 6.8% as PM. After the cytologic follow-up, the groups designated as unsatisafactory (80.2%) and ID (50%) mainly showed significant change in diagnosis. Two hundred fifty patients had surgical follow-up. Sensitivity, specificity, and accuracy, positive predictive values and negative predictive values for malignancy of thyroid were 87.6%, 97.2%, 91%, 98.3% and 81.2%, respectively. The cytologic-histologic diagnostic discrepancy rate was 13.6%. CONCLUSION: FNA for thyroid nodule using the new Bethesda classification was an accurate and sensitive method for the diagnosis of thyroid nodule, and can provide useful information for the management of thyroid nodule.

IgA and Differentiation-associated Transcription Factors in Chronic Otitis Media with Effusion

OBJECTIVES: Inadequate antibody responses to pathogens may lead to the recurrence of otitis media with effusion (OME). Although B-cell production by antibodies is controlled by transcription factors, the status of these factors has not been assessed in patients with OME. METHODS: Expression of immunoglobulin was measured by enzyme-linked immunosorbent assay. Expression of transcription factors Bcl-6, Blimp-1, Pax-5, and XBP-1 was assessed by RT-PCR in the middle-ear fluid of 29 children with >4 OME episodes in 12 months or >3 episodes in 6 months (the OME-prone group) and in 32 children with 0.05). CONCLUSION: Lower concentrations of IgA, Blimp-1 and XBP-1 in middle ear fluid of patients with OME may be related to OME recurrence and chronicity.

Changes of Taste Function after Palatopharyngeal Surgery in Obstructive Sleep Apnea Syndrome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Postoperative taste changes after uvulopalatopharyngoplasty (UPPP) is regarded as an unusual and minor complication. This study aims to evaluate the objective changes of taste threshold according to time course and subjective symptoms change. MATERIALS AND METHOD: With 45 patients who underwent UPPP and 35 patients who underwent nasal surgery as control group, we have prospectively studied postoperative taste changes using a questionnaire, and an electrogustometer (EGM) with regard to symptoms at 7th, 28th days after the surgery. EGM was measured at 5 areas. Also, we have checked pre-operatively about the serum level of zinc. RESULTS: With EGM, the threshold of taste was increased at 7th days after the surgery (p<0.05), but recovered 28th days after the surgery at the posterior part of the tongue in the UPPP group. There were no significant changes in subjective taste dysfunction, smell dysfunction, tongue sensory abnormality, and dysgeusia. CONCLUSION: Taste changes after UPPP was transient and they disappeared within the 1st postoperative month. There were no patients who complained of subjective taste dysfunction, dysgeusia, tongue sensory abnormality after UPPP.

The Effectiveness of the Hearing Aid in Hearing Loss with Tinnitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hearing aids are commonly used to alleviate the effects of tinnitus. But the investigations for effectiveness of hearing aids on tinnitus gave variable results according to survey methods. We will determine the effects of the hearing aid on the perception of tinnitus using the THI (Tinnitus Handicap Inventory) and investigate the relationships between THI & SADL (Satisfaction with Amplification in Daily Life) scale. SUBJECTS AND METHOD: THI score was assessed at pre-aid time and 4 weeks after fitting with the same inventory prospectively by 36 hearing impaired patients who reported tinnitus. Also, the SADL scale was completed at 4 weeks after fitting. The relationship between SADL score and THI benefit was evaluated. RESULTS: Twenty-two of thirty six patients (61.1%) showed subjective beneficial effect of hearing aid on tinnitus. The use of hearing aid significantly reduced the tinnitus handicap score in all subclasses and total THI. The only positive effect in the subscale of SADL was related to the THI benefit statistically. CONCLUSION: The hearing aid can provide relief from tinnitus associated with hearing loss and improve the subjective satisfaction of fitting.

Relationship between Effusion Bacteria and Concentrations of Immunoglobulin in Effusion Fluid in Recurrent Otitis Media with Effusion Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Upper respiratory infections and host immunity against infection may be important in the pathophysiology of otitis media effusion (OME) in children with as yet undeveloped Eustachian tubes. So, we measured Ig concentrations in effusion fluid and serum, and examined their relationship with the presence of bacteria in effusion fluid, as determined by the conventional culture methods and PCR. SUBJECTS AND METHOD: Middle ear effusion was collected from 61 OME patients who had undergone ventilation tube insertion. Bacteria in effusion fluid were detected by standard bacterial culture and polymerase chain reaction. Middle ear fluid immunoglobulins in the OME prone group and OME non-prone group were evaluated. RESULTS: The level of IgA in the otits media prone group was significantly lower than in the otitis media non-prone group, but there was no significant difference in the level of IgG, IgM between two groups (p<0.05). Bacteria detection rate were 59% in the prone group and 50% in the non-prone group. The level of IgA in the bacterial detection group was signifi-cantly lower than that of the non-detection group (p<0.05). CONCLUSION: These results suggest that IgA seems to be important in the protection of bacterial growth and local immunity in the middle ear and may be related to the chronicity or relapse of OME.

Decreased Serum Immunoglobulin in Recurrent Otitis Media with Effusion

BACKGROUND: Defective or immature antibody responses to pathogens in children may explain the increased susceptibility to acute otitis media. However, there is no study in Korea patients whether a correlation exists between otitis media with effusion and the levels of serum immunoglobulins, IgG subclasses, IgA, IgM and IgE. METHODS: 45 children with otitis media with effusion more than 4 episodes in 12 months or 3 episodes in 6 months, 62 children with otitis media with effusion less than 3 episodes in 12 months and 102 children for control group took part in the study at the Department of Otorhinolaryngology of the KyungHee University from May 2004 to Feburary 2007. Serum immunoglobulin levels were determined by nephelometry. And then the relationship between otitis media with effusion and serum immunoglobulin level was evaluated. RESULTS: In otitis media prone group, serum IgG1, IgG2, IgG4, and IgA level was lower than those level of control group, it was significantly decreased (p0.05). CONCLUSION: Lower immunoglobulins in children with otitis media with effusion suggest a generalized decreased antibody responses. Lower levels of serum IgG1, IgG2, IgG4, and IgA may be related with chronicity or intractability of otitis media with effusion.

Outcome of Fornix-Based Versus Limbus-Based Conjunctival Flaps in Trabeculectomy with Mitomycin C

PURPOSE: To compare the surgical outcome of limbus-based group with that of fornix-based group undergone trabeculectomy with mitomycin C (MMC). METHODS: 46 eyes of 42 patients with trabeculectomy with MMC who were observed for 6 months or more were included. A limbus-based conjunctival flap was used for 23 eyes of 21 patients, and a fornix-based conjunctival flap for the other 23 eyes of 21 patients. And the intraocular pressure (IOP), visual acuity and postoperative complications were checked. RESULTS: In the IOP control, there were no differences between two groups after surgery except 18 months. The IOP of the limbus-based group at 18 months was lower than that of fornix-based group (10.7 +/- 9.5: 14.8 +/- 11.2 mmHg, p=0.030). In the postoperative complications, the number of persistent hypotony in limbus-based group was more than that of fornix-based group (6: 1 eyes, p=0.048). There were no differences between two groups in the success rates without additional medication, but the success rates of fornix-based group with additional medication at 12 months were higher than those of limbus-based group (44.4: 77.3%, p=0.033). Also the cumulative success rates of fornix-based group with medication were higher than those of limbus-based group (p=0.040). CONCLUSIONS: Fornix-based conjunctival flap which has shown lower persistent hypotony and higher success rates than that of limbus-based conjunctival flap is recommendable for trabeculectomy with MMC.

Clinical Assessment of Anomalous Head Postures in Children

PURPOSE: The purpose of this study is to establish techniques in evaluating and planning therapy in children who presented anomalous head postures (AHP). METHODS: We studied the types of AHP, the different causes and their frequency, and therapeutic results in children who presented with a complaint of an AHP at the department of ophthalmology. RESULTS: Of 55 children, there was ocular AHP in 49, muscular AHP in 3, hearing loss in 1, and idiopathic AHP in 2 cases. Frequency of the ocular AHP was as follows: strabismus in 22, refractive error in 18, amblyopia in 6, and nystagmus in 3 cases. Superior oblique palsy and astigmatism were most common in each group. The main form of AHP was head tilt in the group of strabismus and face turn in the group of refractive error. Of 19 children with strabismus who underwent surgery, AHP was corrected completely in 12, partially in 6, and not corrected in 1 case. The age at surgery was younger in the group with completely corrected than in the group with partially corrected or failed (4.2: 6.1 years, p=0.04). CONCLUSIONS: The evaluation for strabismus and refractive error as the first step may help treat children with ocular AHP. In the case of AHP due to strabismus, it is important to operate as soon as possible for complete success.