A case of generalized tonic seizures related to acute myocarditis

It is challenging to clinically distinguish between convulsive syncope and true seizure. We describe a 7-year-old girl presenting with generalized tonic seizure caused by acquired complete atrioventricular block related to acute myocarditis. After hospitalization following 6 episodes of new-onset fever with seizure, she had a short episode of abrupt complete atrioventricular block followed by another generalized tonic seizure. The concentrations of cardiac enzymes were elevated, and her echocardiogram showed a decreased left ventricular function. This case underlines the necessity of cardiac investigations in children with convulsive syncope.

A case of generalized tonic seizures related to acute myocarditis

It is challenging to clinically distinguish between convulsive syncope and true seizure. We describe a 7-year-old girl presenting with generalized tonic seizure caused by acquired complete atrioventricular block related to acute myocarditis. After hospitalization following 6 episodes of new-onset fever with seizure, she had a short episode of abrupt complete atrioventricular block followed by another generalized tonic seizure. The concentrations of cardiac enzymes were elevated, and her echocardiogram showed a decreased left ventricular function. This case underlines the necessity of cardiac investigations in children with convulsive syncope.

A Case of Transient Visual Disturbance and Ocular Paresis after Endoscopic Sinus Surgery

Endoscopic sinus surgery (ESS) is widely used as standard surgical treatment for chronic rhinosinusitis. Orbital complications of varying degrees occurred during ESS have been widely reported. If the orbital symptoms occurred immediately after surgery, ocular damage associated with surgery is suspected if the patient’s preoperative ocular function was patent. If immediate action is not taken, permanent visual loss might develop, so it is very important to diagnose orbital complications and take appropriate action. In our case, there was no definite intraorbital hemorrhage when sudden visual loss was noted. The symptoms were fully recovered without further treatment and it is clinically suspected to be caused by transient ocular muscle toxicity of local anesthetics.

Usefulness of a Novel Staging System for Congenital Cholesteatoma of the Middle Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Although there are number of studies on the risk factors of recidivism in the congenital middle ear cholesteatoma, few have focused on the staging system. In this study, we aimed to investigate the postoperative recurrence rate in surgical cases of congenital middle ear cholesteatoma, and compare the results of using the Potsic staging system with those of a novel Kim staging system. Additionally, we also studied to see if the Kim staging system could suggest an appropriate surgical approach for each stage.SUBJECTS AND METHOD: Surgical cases of the disease from January, 1989 to August, 2017 performed at Kangdong Sacred Heart or Hallym University Sacred Heart Hospital were included and those data were retrospectively reviewed. All the cases were pre-operatively assigned to the stages using both Potsic and Kim staging system, retrospectively. The post-operative recurrence rate was analyzed for each subject according to the findings of one year after surgery using both staging systems. Additionally, surgical approach performed in these cases, such as mastoidectomy and/or ossiculoplasty were analyzed and compared among the stage groups of Kim staging system.@*RESULTS@#The Potsic staging system showed that recurrence was significantly lower in the stage I than in the other stages, and the Kim staging system showed that recurrence was significantly higher in the revision R stage than in the primary A, P, and M stages. The Kim staging system showed that mastoidectomy was performed more frequently in the M stage, and ossiculoplasty was performed less frequently in the A stage than in the other stages.@*CONCLUSION@#Although Potsic and Kim staging systems were both useful for predicting prognosis, the Kim staging system can additionally provide a clue for an appropriate surgical approach for each stage.

New Discoveries Regarding Endotypes of Chronic Rhinosinusitis with Nasal Polyp / 대한이비인후과학회지

Chronic rhinosinusitis (CRS) is a common chronic inflammatory disease of the nasal and paranasal mucosa and it usually affects substantial impaired quality of life. CRS is a highly heterogeneous disease and currently defined as subgroups of patients based on nasal endoscopic findings, accompanied either by CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP). However, clinical phenotypes does not adequately reflect the pathophysiologic diversity within patients with CRS. Thus, CRS was also classified according to the inflammatory endotypes, which defined as subtypes of disease with an immunologically different from others by the involvement of a specific molecule or cell. To date, it has been well known that CRSsNP patients characterized by a predominant T helper cell type 1 inflammatory response, whereas CRSwNP patients from Western driven by a T helper cell type 2 inflammation and increased eosinophil infiltration. Meanwhile, CRSwNP patients from Asian displayed a mixed T cell profile with a non-eosinophilic inflammation pattern. However, recent some studies have reported the new discoveries regarding immunologic different endotypes of CRSwNP, such as innate lymphoid cells and activated B-cell mediated immune response. Therefore, herein we describe concepts and new discoveries of immunologic endotype in patients with CRSwNP.

Chronic Obstructive Pulmonary Disease Is Negatively Related with Nasal Polyp in Middle Aged and Elderly Chronic Rhinosinusitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is known to induce chronic rhinosinusitis (CRS). Nasal polyp, which is frequently found in patients with CRS, seems to have close relationship with COPD, but little is known about its relationship with COPD. In this study, we investigated the relationship between COPD and nasal polyp in middle aged and elderly CRS patients. SUBJECTS AND METHOD: We analyzed the clinical data of 174 patients (age of over 50 years) with CRS. Patients were divided as COPD [forced expiratory volume (FEV1)/forced vital capacity (FVC)<70%, n=30] and non-COPD group (FEV1/FVC≥70%, n=144) according to the pulmonary function test results. Binary logistic regression analysis was used to describe the relationships between clinically relevant factors related to nasal polyp. RESULTS: On logistic regression analysis, no significant relationship was found between age [adjusted odds ratio (AOR): 1.058, 95% confidence interval for the difference (CI)=0.995-1.126, p=0.073], sex AOR: 0.897, 95% CI=0.366-2.415, p=0.897), smoking (AOR: 0.434, 95% CI=0.154-1.219, p=0.113) and obesity (underweight AOR: 3.833, 95% CI=0.781-18.808, p=0.098, overweight AOR: 5.169, 95% CI=0.996-26.814, p=0.051, obese AOR: 2.911, 95% CI=0.335-25.329, p=0.333) with polyp. However, there was a negative correlation between COPD history and nasal polyp with statistical significance (AOR: 0.288, 95% CI=0.102-0.809, p=0.018). CONCLUSION: Our findings suggest that patients with COPD are less likely to have nasal polyp than patients without COPD.

Characteristics of Microbiology of Peritonsillar Abscess / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to review the characteristics of microbiology of peritonsillar abscess and to recommend adequate empirical antibiotics. SUBJECTS AND METHOD: Patients (437) who underwent surgical drainage for peritonsillar abscess were reviewed retrospectively. We analyzed correlations between age, gender, obesity and diabetes mellitus and cultured organisms with respect to susceptibility of antibiotics. RESULTS: The leading pathogens were α-hemolytic streptococcus (44.3%), Streptococcus viridians (12.3%), β-hemolytic streptococcus (8.2%) and Streptococcus pyogenes (6.8%). The rates of α-hemolytic streptococcus and Streptococcus pyogenes growth were p=0.002 and p=0.032, respectively; these values were significantly higher in patients under the age of 40 than those over the age of 40. Klebsiella pneumoniae infection was observed more frequently in the diabetic group than in the non-diabetic group. Antibiotics susceptibility test showed that four leading pathogens were susceptible to ampicillin/sulbactam. CONCLUSION: Only ampicillin/sulbactam was sufficient to treat peritonsillar abscess empirically. In conclusion, the use of third generation Cephalosporin or other antibiotics for anaerobes is not considered necessary for the empirical treatments of peritonsillar abscess.