A Case of External Approach Treatment of Pott's Puffy Tumor / 대한이비인후과학회지

Pott's puffy tumor is a rare clinical entity, which has been described as a subperiosteal abscess in the frontal bone secondary to frontal osteomyelitis. Pott's puffy tumor can be associated with venous thrombosis, epidural abscess, subdural empyema, and brain abscess. In the present paper, we describe our experience of treating a 59-year old man who complained of a headache and a swelling of forehead. Because of bilateral lesion and obstruction of frontal recess, an external approach of the frontal sinus was carried out. To our knowledge, this is the first report of Pott's puffy tumor involving the bilateral frontal sinus.

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.

Sudden Hearing Loss Subsequent to the Percutaneous Coronary Intervention / 대한이비인후과학회지

Sudden sensorineural hearing loss is otologic emergency, accompanying tinnitus and vertigo occasionally within several hours or a few days. Many etiologic theories such as viral infection, vascular occlusion, cochlear membrane break, bacterial infection, autoimmune disorder and neurologic diseases and so forth have been suggested. The risk of cerebrovascular accident in cardiac catheterization and percutaneous coronary intervention is less than 0.5%. The main mechanism of injury results from microembolism and hypoperfusion. A 66-years-old male with long-standing history of ischemic heart disease was presented complaining profound hearing loss, ear fullness, and tinnitus in his right ear and mild vertigo subsequent to the percutaneous coronary intervention in the right side. There was sensory deficit on the right facial side and impairment of eyeball movement on the same side. The T1, T2-weighted and diffusion-weighted magnetic resonance imaging showed acute infarction of the right pons. Heparin was infused intravenously for 5 days. On the 8th day of treatment, the hearing threshold level was completely recovered to the level of the opposite ear. We report a case of hearing loss subsequent to coronary intervention with a review of literature.

A Case of Extramedullary Plasmacytoma of the Tonsil / 대한이비인후과학회지

Plasmacytoma is a rare malignant tumor characterized by a monoclonal proliferation of plasma cell. The most frequently involved sites of extramedullary plasmacytoma are head and neck regions, although it accounts for less than 1% of all head and neck malignancy. The diagnosis and management of extramedullary plasmacytoma require imaging and laboratory test. The treatment prognosis is different according to the site where plasmacytoma is originated. We report a case of extramedullary plasmacytoma of tonsil in a 28 year-old female patient with a review of literature.

Sialolipoma of the Partoid Gland / 대한이비인후과학회지

Sialolipoma is a new variant of salivary gland lipoma containing secondary entrapment of acini and ducts of normal salivary gland, first described by Nagao et al. in 2001. We present the clinicopathologic features of two cases, with a review of 18 cases of sialolipoma reported in the literature so far. In our cases, both 59-year-old and 74-year-old men had painless, movable, and soft mass. The finding of neck enhanced computed tomography was a well-demarcated hypodense mass within the superficial lobe of left parotid gland in both cases. So we performed a superficial parotidectomy with preservation of the facial nerve. Grossly, this tumor was a well-demarcating, soft, greasy, yellowish mass, and microscopically, it consisted of mature adipose tissues and normal entrapped glandular epithelium of acini and ducts. This had been recently recognized as a separate entity under the term, "sialolipoma". We report two cases with a review of the literature.

Lipoprotein Analysis in the Elderly Men with Tinnitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus is the conscious experience of sound that originates in the head or neck, and without voluntary origin obvious to that person. The aim of this study was to evaluate the prevalence of dyslipoproteinemias and its correlation with subjective tinnitus in the healthy elderly men (especially in men older than 60 years). SUBJECTS AND METHOD: From January 2007 to January 2008, we randomly selected 150 men at our office visit. Of these men, only 102 complained of subjective tinnitus. All men underwent pure tone audiogram, pitch-match and loudness-balance test for tinnitus, simple X-ray (mastoid series), blood sampling such as total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride and lipoprotein(a) etc, and if necessary, temporal bone imaging study, and vestibular function test. Statistical analyses were performed using the SPSS version 15.0, and the p-value was considered significant when less than 5%. RESULTS: The prevalence of hyperlipoproteinemia had no significant difference between the tinnitus group and the control group. Although there was no correlation between loudness (r=0.008, p>0.05) and pitch (r=0.026, p>0.05) for tinnitus with the serum lipoprotein(a) level, the mean value of serum lipoprotein(a) was significantly different between the two groups (p<0.05). CONCLUSION: The high level of serum lipoprotein(a) may have influence on the subjective tinnitus as a risk or aggravation factor in the healthy elderly men.

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.

Allergic Immune Reaction in Recurrent Aphthous Ulceration by Multiple Allergosorbent Test(MAST) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recurrent aphthous ulceration (RAU) is most common among benign oral mucosal diseases, but its pathogenesis is not clearly defined yet. We aimed to evaluate the allergic reaction and identify the allergen by using the multiple allergosorbent test (MAST). SUBJECTS AND METHOD: We selected a total of 20 patients with RAU. RAU was not diagnosed by biopsy but by clinical findings, and MAST was performed in all patients. Parameters used were total IgE concentration, type of positive allergens, and the specific IgE concentration. RESULTS: The results were as follows: 1) The total IgE concentration was increased more in the RAU group than in the control group (p<0.05). 2) The type of positive allergens was multiple and had more even distribution in the RAU group than in the control group (p<0.05). 3) The specific IgE concentration according to the positive allergen was higher in the RAU group than in the control group (p<0.05). CONCLUSION: Allergic reactions could be invol-ved in the pathogenesis of RAU. The pathomechanism of allergic reaction to the RAU and the feasibility of treatment options such as avoidance therapy, the immune therapy, and the antihistamine usage need further study.