A Case of Branchio-Otic Syndrome / 대한이비인후과학회지

Branchio-oto-renal (BOR) syndrome is a clinically heterogeneous autosomal dominant form of syndromic hearing loss characterized by variable hearing impairment, malformations of the pinnae, the presence of branchial arch remnants, and various renal abnormalities. BOR syndrome is caused by mutations in EYA1 and SIX1, which are critical to organogenesis and are expressed together in developing otic, branchial, and renal tissue. Branchio-otic (BO) syndrome comprises branchial fistulas and preauricular pits, but lacks renal anomalies. We present a case of BO syndrome in 30year-old man with a review of the literature.

Differentiation between Benign and Malignant Solid Thyroid Nodules Using an US Classification System

OBJECTIVE: To evaluate the diagnostic accuracy of a new ultrasound (US) classification system for differentiating between benign and malignant solid thyroid nodules. MATERIALS AND METHODS: In this study, we enrolled 191 consecutive patients who received real-time US and subsequent US diagnoses for solid thyroid nodules, and underwent US-guided fine-needle aspiration. Each thyroid nodule was prospectively classified into 1 of 5 diagnostic categories by real-time US: "malignant," "suspicious for malignancy," "borderline," "probably benign," and "benign". We evaluated the diagnostic accuracy of thyroid US and the cut-off US criteria by comparing the US diagnoses of thyroid nodules with cytopathologic results. RESULTS: Of the 191 solid nodules, 103 were subjected to thyroid surgery. US categories for these 191 nodules were malignant (n = 52), suspicious for malignancy (n = 16), borderline (n = 23), probably benign (n = 18), and benign (n = 82). A receiver-operating characteristic curve analysis revealed that the US diagnosis for solid thyroid nodules using the 5-category US classification system was very good. The sensitivity, specificity, positive and negative predictive values, and accuracy of US diagnosis were 86%, 95%, 91%, 92%, and 92%, respectively, when benign, probably benign, and borderline categories were collectively classified as benign (negative). CONCLUSION: The diagnostic accuracy of thyroid US for solid thyroid nodules is high when the above-mentioned US classification system is applied.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules Smaller Than 5 mm in the Maximum Diameter: Assessment of Efficacy and Pathological Findings

OBJECTIVE: The aim of this study was to determine the efficacy of the use of an ultrasound-guided fine-needle aspiration biopsy (US-FNAB) to diagnose thyroid nodules smaller than 5 mm in the maximum diameter and to evaluate pathological findings of small thyroid malignancies. MATERIALS AND METHODS: From May 2007 to April 2008, we evaluated the findings of US-FNABs of small thyroid nodules less than 5 mm in the maximum diameter. The cytopathological findings were retrospectively reviewed and the diagnostic performance of the use of an US-FNAB was examined in all patients. RESULTS: Of 201 small thyroid nodules in 180 patients, there were 162 adequate specimens (81%). Among 180 patients, 75 patients underwent thyroid surgery and 50 malignant and 33 benign nodules were identified based on a pathological examination. All small malignant thyroid nodules were identified as papillary thyroid microcarcinomas (PTMCs). There were 34 (55%) true positive, 0 (0%) false positive, 23 (37%) true negative and five (8%) false negative results for malignancy after performing a first US-FNAB in 62 surgically confirmed nodules. The sensitivity (87%), specificity (100%), positive predictive value (100%), negative predictive value (82%), accuracy (92%), false positive rate (0%) and false negative rate (8%) for an US-FNAB were determined. In 23 patients with a primary PTMC, capsular invasion (9%, 2 of 23), a perithyroidal lymph node metastasis (30%, 7 of 23), the rate of multifocality (9%, 2 of 23) and bilaterality (4%, 1 of 23) were also determined. CONCLUSION: An US-FNAB of thyroid nodules smaller than 5 mm in the maximum diameter is an effective diagnostic procedure.

Schwannoma of the Epiglottis / 대한이비인후과학회지

Schwannoma of the larynx are rare benign tumor. Most laryngeal schwannomas were seen at the aryepiglottic fold or the false vocal cords. But there were extremely rare reports about schwannoma of the epiglottis. We report an unusual case of epiglottic schwannoma with the literature.

Two Cases of Laryngeal Myxoma / 대한이비인후과학회지

Myxomas are benign mesenchymal tumors that occur rarely in the head and neck. When they occur in the head and neck region, they mainly involve facial bones such as mandible and maxilla. Myxomas arising from subcutaneous soft tissues, including the larynx, are very rare. There are only sporadic cases of laryngeal myxomas reported in English literature. Within the larynx, the vocal folds, aryepiglottic fold, and epiglottis are the reported sites of involvement. The most common clinical presentation is hoarsness and difficulty in breathing. We described two cases of laryngeal myxomas in a 62-year-old male and a 52-year-old male.

Bilateral Vocal Cord Palsy Associated with Multiple Symmetrical Lipomatosis(Madelung's Disease) / 대한이비인후과학회지

Multiple symmetrical lipomatosis (MSL) is a rare disorder characterized by the presence of multiple, symmetric, unencapsulated fat masses in the face, neck, and other areas. Typically, this entity has been related to the presence of three anterior bulges in the neck. MSL is usually described in adults from 30 to 60 years old, with an incidence of about 1 in 25,000 and a male-to-female ratio of 15 : 1 to 30 : 1. More than 90% of the patients have associated alcoholism. The etiology of MSL remains unknown, but an abnormal lipogenesis induced by catecholamines has been observed. The accumulation of fat prevents accurate clinical assessment of the neck and obscures other underlying abnormalities. In the current report, the authors described one case of MSL associated with bilateral vocal cord palsy and reviewed the associated literature.

A Case of Metastatic Hemangiosarcoma in the Parotid Gland / 대한이비인후과학회지

Angiosarcoma is a rare, highly aggressive tumor of vascular endothelium, representing less than 1% of all soft tissue sarcomas. Angiosarcoma can occur anywhere in the body, but in the skin, it is most commonly observed in the head and neck of elderly men. It has a poor prognosis because it can recur locally and metastasize to regional lymph nodes and distantly, especially to the lung or vertebrae. We present an extremely rare case of a metastatic angiosarcoma in the parotid gland after complete remission of the primary angiosarcoma in scalp. Previously, radiotherpy and chemotherapy was given to primary scalp tumor. We performed radical parotidectomy followed by radiotherapy of the region. He has no evidence of disease over 6 months.

A Case of Osteoma between the Malleus and Incus / 대한이비인후과학회지

We present a case of osteoma that was diagnosed incidentally in the middle ear. Osteomas are benign tumors and may occur as a solitary lesion in the squama, mastoid, middle ear and petrous pyramid. Even though osteomas in the middle ear are extremely rare, those lesions may be one of the causes of the conductive hearing loss by impinging upon the ossicular chain. There are only 22 cases of osteoma reported in the medical literature to date. In most patients, the diagnosis is confirmed by CT scan or at the time of surgery. CT scanning of these disorders is very useful, especially in examining the extent of the lesion and detailed bone destruction.

Expression of Angiogenic Growth Factor in Middle Ear Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Angiogenesis is important both in normal and pathologic processes, including wound healing and inflammation. Because proliferating tissues require an enhanced blood supply, angiogenesis appears to be a prerequisite for expansion of cholesteatoma. This study was aimed to investigate mRNA and protein expression of angiogenic growth factors such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), transforming growth factor-alpha (TGF-alpha) and platelet derived-endothelial cell growth factor (PD-ECGF) in middle ear cholesteatoma. SUBJECTS AND METHOD: Cholesteatoma tissues and retroauricular skins were obtained from 12 patients during operation. The mRNA expression was detected by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR), and the degree of expression was measured by comparing density ratio of beta-actin by NIH imaging analysis system. The protein expression was evaluated by immunohistochemistry, and the degrees of expression in epithelial, endothelial, inflammatory cells of cholesteatoma and retroauricular skin were judged by two pathologists and then converted on a 5-grade rating scale according to intensity of expression. RESULTS: The expression rate of mRNA in cholesteatoma and retroauricular skin was 67.7 and 33.3% in VEGF, 75.0 and 50.0% in bFGF, 53.8 and 8.3% in TGF-alpha, 67.7 and 75% in PD-ECGF. There was statistically significant difference only in TGF-alpha (p0.05). The degrees of VEGF, bFGF and PD-ECGF protein expression in cholesteatoma tissue were more intense at the inflammatory (p0.05) than in retroauricular skin. And the degree of TGF-alpha protein expression in cholesteatoma tissue was more intense at all three cells (p<0.05) than in the retroauricular skin. CONCLUSION: These results suggest that angiogenesis processes in cholesteatoma perimatrix and the expression of angiogenic growth factors are upregulated by mRNA. Further studies for evaluating the factors that can affect the expression of mRNA and also for disclosing the roles and control mechanisms of these factors in cholesteatoma angiogenesis must be followed.

A Case of Glomangioma of the Neck / 대한이비인후과학회지

Glomus tumor (glomangioma) is an uncommon, painful benign hyperplsia of the normal constituents of the glomus. The most common location is in the subungal region of the fingers. Occasionally, they are found in unusual locations, such as nasal cavity, stomach, mediastinum, trachea, heart, vagina and lung etc. Microscopically, they include small and large vascular spaces lined by a narrow endothelium surrounded by layers of cuboidal or spindle cells with rounded uniform nuclei in a loose stroma. Unusual locations and the difficulty of preoperative pathological confirmation can lead to misdiagnosis of malignancy. We present a case of glomangioma of neck in a 64-year-old female with a review of literature.

A Case of Concurrent Mature Teratoma and Heterotopic Gastrointestinal Cyst in Head and Neck / 대한이비인후과학회지

Teratoma is a congenital tumor which occurs rarely in the head and neck. Head and neck teratomas have been described infrequently in the literature as a result of their low incidence, occuring in only 1 in 20, 000 to 40, 000 live births. And the heterotopic gastrointestinal cyst, a type of choristoma, is uncommon in head and neck also. Patients with these tumors have symptoms related to difficulties with swallowing and respiration that could result in high degree of morbidity and mortality by virtue of size and location of tumor. The purpose of this paper is to report a case of neonate who had mature teratoma of nasopharynx and a heterotopic gastrointestinal cyst of left submandibular gland. We review the literature pertaining to teratoma and heterotopic gastrointestinal cyst in head and neck.

Change of Age on Adenoidectomy in 1990s / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adenoid enlargement occurs most commonly between the age of three and ten. Atrophy usually begins at the age of ten and is completed before the age of twenty. In recent years, an increasing number of adolescents undergoing adenoidectomy has been noticed. We investigated the age change in 1990s. MATERIALS AND METHOD: A retrospective study was performed on 1,198 patients who underwent adenoidectomy due to adenoid vegetation confirmed by physical, radiologic, and endoscopic studies. The mean age was analyzed annually and the period of 1990s was divided into the first (from January 1990 to December 1994) and second half (from January 1995 to December 1999). In addition, the same analysis was performed for each age group below ten and above eleven. RESULTS: The study showed that the mean age of study population was 7.35, with the mean age of the first half being 7.10 and the second 7.52. Specifically, the mean age of the group below ten was 6.37 in the first half and 6.16 in the second half, and the group above eleven was 12.56 in the first half and 13.32 in the second half. CONCLUSION: The mean age of the patients who underwent adenoidectomy have increased during the econd half, especially in the age groups greater more than eleven.

Relationship between the Expression of Platelet-Derived Endothelial Cell Growth Factor(PD-ECGF), Basic Fibroblast Growth Factor(bFGF), Vascular Endothelial Growth Factor(VEGF) and Clinical Stage in Squamous Cell Carcinoma of Larynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Normal angiogenesis occurs as a part of the body's repair processes like the healing of wounds and fractures. By contrast, uncontrolled angiogenesis can often be pathological. Vascular remodelling could therefore play an important role in the growth process of solid tumors. The aim of this study was to detect the expression of platelet-derived endothelial cell growth factor (PD-ECGF), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF), and investigate the correlation between these factors. Also, we studied the relationships between the expressions of these factors and the clinical stage, nodal involvement, and histologic grade in the squamous cell carcinoma of larynx. MATERIALS AND METHOD: The authors examined the expression of three angiogenic factors in specimens of laryngeal squamous cell carcinoma (n=17). The mRNA expressions of angiogenic factors were detected by the semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). Statistics were analysed using the Fisher's exact test, the Wilcoxon signed rank test, and the Spearman correlation coefficiency. RESULTS: PD-ECGF and bFGF were significantly higher in the stages III and IV cancers than in the stages I and II cancers, and thus shows that bFGF was related to severity of the nodal involvement. The expression of more than one factor was significantly related with stages III and IV cancer. PD-ECGF and VEGF were related with each other. CONCLUSION: The authors suggest that angiogenic factors, especially, PD-ECGF and bFGF, may be used as prognostic factors for the squamous cell carcinoma of larynx.

A Case of Primitive Neuroectodermal Tumor in the Maxillary Sinus / 대한이비인후과학회지

Primitive neuroectodermal tumor is a malignant small round cell tumor of presumed neural crest origin, which usually affect adolescents and children. Primitive neuroectodermal tumor occasionally occurs in the periphery. Peripheral primitive neuroectodermal tumor is usually located in the thoracopulmonary region and rarely found in the nasal cavity without intracranial metastasis. Due to frequent recurrence and early metastasis, prognosis of this tumor is bad and the treatment requires concomittant surgical removal, chemotheraphy, and radiation theraphy to ablate any residual disease. The authors experienced a case of primitive neuroectodermal tumor located in the maxillary sinus, so we report this case with a review of literature.

Analysis of the T Lymphocyte Subsets Using Flow Cytometry in Sudden Deafness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although there are a number of reports concerned with the role of immunity in the sudden onset of progressive sensorineural hearing loss, there are only a few references dealing with the involvement of immuneme- mediated mechanism in sudden deafness. This study was performed to define the alteration of peripheral blood T lymphocyte subsets in a group of patients with sudden deafness. MATERIALS AND METHODS: The study was carried out prior to the start of and after the steroid therapy. Thirty two patients (18 men and 14 women : mean age, 43.19 years) were compared with 15 healthy control subjects (7 men and 8 women : mean age, 44 years). Patients were divided into 2 groups according to their responses to the steroid therapy. RESULTS: A decreased number of both CD4' helper cells (38.44% vs 42.36%; p < 0.05) was observed in the patient group compared with those in the control group. In the group of patients who showed good response to the steroid therapy, there was a tendency toward normalization of the CD4 (pretreatment, 34.41%; posttreatment, 43.91%) cell counts, with a slight decrease in the CD8' population (pretreatment, 20.66%: posttreatment, 19.16%). However, there was no significant increment in patients with the poorer response when there was a increase in the CD4' (pretreatment, 32.12% ; posttreatment, 38.6%) cell counts after the steroid therapy. CONCLUSION: These results demonstrate that there is significant abnormality in the subpopulations of lymphocytes in patients with sudden hearing loss, suggesting the immune system as a possible etiopathogenic factor in this entity.

A Case of Primary Myxoid Liposarcoma of the Neck / 대한이비인후과학회지

Liposarcoma is a relatively common malignant tumor that can be originated from adipose tissue in the body, especially in the lower extremity and in the retroperitoneal space. But it is extremely rare in the head and neck region. Liposarcoma can be classified histopathologically into four subtypes; well differentiated, myxoid, round cell, and pleomorphic type. The prognosis of liposarcoma is known to be generally poor due to the high local recurrence rate in spite of complete resection. We report a case of myxoid liposarcoma of the neck in a 41-year old male, who was treated with primary excision of tumor and postoperative radiation therapy. The histopathology, clinical appearance, management and prognosis of this rare condition are discussed.

Four Cases of Primary Tuberculosis Otitis Media / 대한이비인후과학회지

The early diagnosis and treatment of tuberculous otitis media can prevent it from becoming irreversible and spread to other organs. Only 0.04% of chronic suppurative otitis medias are tuberculous origin, so that the index of suspicion is often low. The clinical signs of the disease have changed in recent years, making it more difficult to recognize and thus investigate for. False negatives for culture often occur, due both to the fastidious nature of the tuberculous bacilli, and other bacteria in the specimen interfering with the growth of bacilli. Recently, We experienced four cases of pathologically confirmed primary tuberculous otitis media without pulmonary involvement, so report these cases with review of literature.

A Case of Primary Nasopharyngeal Tuberculosis / 대한이비인후과학회지

Tuberculosis of the upper respiratory tract is an uncommon disease, and the nasopharynx is particulary a rare site. Tuberculosis of the nasopharynx is mainly secondary infection from pulmonary tuberculosis via contagious, hematogenous or lymphogenous routes. The nasopharynx may be a portal entry for tubercle bacilli in patients who develope cervical lymphadenitis. Involvement of the nasopharynx by tuberculosis may be underdiagnosed because it does not produce obvious symptoms or phyiscal signs. Recently authors experinced a case of nasopharyngeal tuberculosis, here we present this case with a review of literature.

Glottic Reconstruction by Muscle Fascia and Perichondrium following Vertical Hemilaryngectomy in Mongrel Dogs / 대한이비인후과학회지

BACKGROUND: The various methods of the laryngeal reconstruction have been tried attesting to the challenge of minimizing complications such as aspiration, airway obstruction, and hoarseness after surgery. But, no ideal reconstruction material was found. OBJECTIVES: The purpose of this study was to determine outcomes and clinical applications after reconstruction by sternohyoid muscle with external thyroid perichondrium or its fascia following vertical hemilaryngectomy in the dogs. MATERIALS AND METHODS: Nine of 12 dogs, underwent reconstruction of laryngeal defect by bipedicled sternohyoid muscle flap with perichondrium(Group I) and muscle fascia itself(Group II), were investigated. RESULTS: Larynges were investigated for a 8-week period in perichondrium group and 32-week in fascia and were analyzed by clinical, endoscopic and histologic assessment. Author's results were summarized as follows: 1) Patent airway without aspiration was seen in all cases. 2) Under the endoscope, it was found that granulation tissue was developed in early period, but pseudocord development and position in both group were similar. 3) In the histological examination, mucosal reepithelization was done by pseudostratified squamous epithelium in the vocal cord. Although slow pseudocord development and many inflammation were seen in fascia group, similar results was found in both group in long term follow-up. CONCLUSION: The perichondial group were superior in infection, reepithelization of glottis, but similar results were seen in fascia group in long term follow-up. So fascia graft for glottic reconstruction is useful method in large laryngeal defect.

A Case of Giant Keratoacanthoma of the Lower Lip Treated with Intralesional Methotrexate / 대한이비인후과학회지

Keratoacanthoma(KA) is a rapidly growing benign cutaneous neoplasm, usually occurring on sunexposed sites in elderly people, and it has a close clinical and pathologic resemblance to squamous cell carcinoma. Giant KA of the lower lip is extremely rare. Various treatment modalities have been reported including radiation therapy, systemic oral retinoids, and the intralesional application of 5-fluorouracil(5-FU), methotrexate(MTX) or interferon alpha-2a. Excisional surgery, however, remains the treatment of choice for the majority of KA. The disadvantages of excision are the possible requirement for extensive reconstructive surgery and the resultant cosmetic or functional deficit. Recently, we experienced a case of giant KA of the lower lip in a 60-year-old male, and he was treated successfully with intralesional methotrexate. Now we report the case with a brief review of literature.