A Case of Spontaneous Neck Bleeding in Neurofibromatosis Type I / 대한이비인후과학회지

It is rare to find spontaneous cervical bleedings for which a wide variety of etiologies have been reported. We experienced a case of spontaneous cervical bleeding that caused emergency operation. We present this case with a review of the literature. This case demonstrates a potentially lethal complication in patients with neurofibroma. Neurofibroma is an inherited disease, classified as 'classical (type I, von Recklinghausen, multiple or peripheral neurofibromatosis)', 'central (type II, bilateral acoustic neurofibromatosis)' and other types. The pathognomic features of classical neurofibromatosis are cafe-au-lait spots and neurofibromas. Other clinical features are variably expressed and occurnece of severe hemorrhage is an unusual complication. Conservative management do not stop the hemorrhage. Surgical exploration must be undertaken for cure.

A Case of Hemangiopericytoma in Nasal Cavity / 대한이비인후과학회지

Hemangiopericytomas are very rare tumor in the paranasal sinuses. It is vascular tumor derived from Zimmerman's pericytes. Sinonasal hemangiopericytoma is generally benign with a low potential for local recurrence of metastasis via the blood stream and lymphatic system. They account for about 1% of all vascular tumors. About 5% of the cases occur in the nasal cavity and usually show well-differentiated tumors. The treatment of choice is surgical resection. We present a case of nasal hemangiopericytoma treated by endoscopic resection.

Bacteriological Findings and Antimicrobial Susceptibility in Chronic Sinusitis with Nasal Polyp

BACKGROUND AND OBJECTIVES: Microbiologic data in chronic sinusitis with nasal polyps, which is the foundation of proper antibiotic treatment, is insufficient due to problems with sampling and culture technique. Therefore, the objective of this study is to identify the causative agents in chronic sinusitis with nasal polyps based on culture results in adults and children and the relationship between the results of the middle meatus and maxillary sinus. Materials and Method: Samples were obtained with middle meatus swabs and endoscopically guided maxillary sinus aspirations and then transferred to a microbiology laboratory using different media for aerobic and anaerobic cultures. RESULTS: Eighty one samples were studied. Sixty six from the middle meatus and sixty four from the maxillary sinus bacterial isolates were recovered. The most frequently isolated aerobic organisms were the Staphylococcus, Haemophilus influenza and Streptococcus while those of the anaerobic organisms in adults were the Prevotella and Peptostreptococcus. No anaerobic microorganisms were isolated in the children. Concordance rates of aerobic bacteria were 75.4% among adults and 90.0% among children. That of anaerobic bacteria was 83.6% among adults and 100% among children between the middle meatal swab and the maxillary sinus aspiration. CONCLUSION: Authors recommend amoxacillin/clavulanate, cephalosporins and macrolide as the first-line medical treatment. In cases where there are no improvement of symptoms, cultures should be taken from the middle meatus, followed by appropriate selection of second-line antibiotics according to the sensitivity test results.

Membrane-Specific Expression of Functional Purinergic Receptors in Normal Human Nasal Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Extracellular purines and pyrimidines regulate various physiological responses via cell surface receptors known as purinoreceptors, and may exert autocrine or paracrine effects on ion transport, fluid transport, ciliary beat frequency and mucin secretion. This study aims to investigate the expression patterns of such purinoreceptors found in normal human nasal epithelial (NHNE) cells. MATERIALS AND METHOD: In RT-PCR, the mRNAs for several P2X (P2X3, P2X4, P2X7) and P2Y (P2Y1, P2Y2, P2Y4, P2Y6, P2Y11, P2Y12) receptors were identified in NHNE cells. Functional localizations of P2 receptors were investigated by measuring [Ca2+]i increases in a membrane-specific manner using a double-perfusion chamber. Absence of the responses of -Me ATP and 2MeS-ATP excluded functionally active P2X3, P2X4, and P2Y1 receptors as far as [Ca2+]i increase was concerned. RESULTS: Applications with ATP and UTP revealed that luminal membranes of NHNE cells express P2Y2 and P2Y6 receptors and basolateral membranes P2Y2 receptors. Expressions of P2Y2 and P2Y6 receptors in NHNE cells were further verified by the immunoblotting using specific antibodies. In addition, the results with BzATP indicated that the P2Y11 receptor may be present on the luminal side. CONCLUSION: The NHNE cells express functionally active P2Y2, P2Y6 and P2Y11 receptors in a membrane-specific pattern, which may play an important role in the control of mucin and fluid secretion in NHNE cells.

Early Development of the Nose in Human Embryo: A Stereomicroscopic and Histologic Analysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to analyze the morphologic features of the nose in the human embryo from 4th to 8th developmental weeks according to the Carnegie stage. MATERIALS AND METHOD: A total of 27 cases of embryos, ranging from Carnegie stage of 13 to 23, were analyzed. The external morphology was observed with a stereomicroscope, photographed and analyzed. The histologic features were observed with a light microscope in the horizontally-transected specimens stained with hematoxylin-eosin staining. RESULTS: The nasal placode was observed at the stage 13, and it became flat or even concave at the stage 14. At the stage 15, the nasal pit was formed. At the stage 16, the nasal sac and nasal fin were observed. At the stage 17, the oronasal membrane was formed by thinning of the nasal fin. At the stage 18, the primitive choana was established by rupture of the oronasal membrane. At the stage 19, the lateral palatine process projected vertically below the level of the tongue. The cartilaginous nasal capsule was formed at the stage 20. At the stage 21, the olfactory area was localized to the upper portion of the lateral nasal wall and the nasal septum. At the stage 22, the lateral palatine process developed in a somewhat horizontal orientation. At the stage 23, the premaxilla and primitive choana were formed. CONCLUSION: The development of the nose is most active from the Carnegie stage of 13 to 19, which corresponds to the end of the 4th embryonic week to the end of the 7th week. Thus, this period is considered to be the most important period in human nasal embryonic development.

MUC8 as a Ciliated Cell Marker in Human Nasal Epithelium / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To examine the MUC8 mRNA expression patterns according to the mucociliary differentiation of the normal human nasal epithelial (NHNE) cells, and to investigate the localization of the MUC8 proteins in the nasal polyps. MATERIALS AND METHODS: The passage-2 NHNE cells were cultured using an air-liquid interface technique and nasal polyp specimens. On the 2, 7, 14, and 28 days after confluence, the ciliated cells were counted using cytospin slide immunostaining using H6C5 and beta-tubulin, and the MUC8 mRNA levels were determined using real-time quantitative PCR. After synthesizing the polyclonal anti-MUC8 peptide antibodies, MUC8 immunostaining was preformed using the nasal polyps. The MUC8 mRNA and protein levels were determined with the NHNE cells treated with IL-1beta (10 ng/ml for 24 hours) using RT-PCR and Western blot analysis. RESULTS: The increasing pattern of the number of ciliated cells as well as the MUC8 gene expression level with increasing culture time in the NHNE cells was quite similar. MUC8 was expressed in the ciliated cells of the human nasal polyps. The MUC8 protein level as well as the mRNA level was up-regulated as a result of the IL-1beta treatment. CONCLUSIONS: This study indicates that the MUC8 protein is expressed in ciliated cells from the human nasal epithelial cells and is up-regulated by the IL-1beta treatment. These results suggest that the MUC8 gene and protein expression levels might be used as a ciliated cell marker in the human nasal epithelium.

Structural Changes of Inferior Turbinate in Patients with Septal Deviation: Surgical Implication

Septal deviation causes various nasal symptoms and other sinonasal disease. We evaluated the relationship between septal deviation and morphologic changes of the inferior turbinate. PNS CT of 31 patients (septal deviation group) and 20 normal subjects (normal control group) were reviewed. We measured the thickness of the inferior turbinate and the angle between the lateral nasal wall and the inferior turbinate in each group. Each measurements were analyzed using t-test and compared. The thic-kness of the inferior turbinate and the angle between the lateral nasal wall and the inferior turbinate showed no difference between the right and left side in the control group. The same measurement of the convex side in the septal deviation group were not different from those of the control group. However, the thickness of the inferior turbinate and the angle between the lateral nasal wall and the inferior turbinate differed significantly from the control group data. Changes of the inferior turbinate in septal deviation were caused not only by hypertrophy of the inferior turbinate, but also by the increased angle between the lateral nasal wall and the inferior turbinate.

Surgical Management of Allergic Rhinitis

The prevalence of allergic rhinitis is nowadays increasing with industrial development. Patients with allergic rhinitis have symptoms such as nasal obstruction, watery rhinorrhea, sneezing and are frequently associated with sleep apnea, asthma and sinusitis. In patients with allergic rhinitis, conservative management including medical treatment, avoidance and immunotherapy are generally enough for controlling symptoms, but some patients refractory to conservative management need surgical management to improve nasal patency and decrease allergic response, which is inhibited by scarring of lamina propria after turbinate surgery. Surgical management include chemical cautery, laser cautery, cryotherapy, radiofrequency needle ablation, surgical resection of turbinate, vidian neurectomy and sinus surgery. Cautery of turbinate by laser and radiofrequency electrode is widely used because of its low morbidity and efficacy against vasomotor symptoms. Submucosal resection of turbinate and turbinopalsty improves nasal patency preserving mucociliary function. In addition, when it is combined with submucosal cautery, allergic response is inhibited more effectively. In conclusion, surgical management may be required for the treatment of allergic rhinitis which is refractory to conservative management or has anatomical abnormality.

Results of Otolith Reposition Therapy in Various Types of BPPV / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) has been well controlled with otolith reposition maneuver. The purpose of this study was to investigate the incidence of various forms of BPPVs such as type change during the reposition maneuver, combined type and recurred cases, to study the therapeutic result of physical therapy in various forms of BPPVs, and to figure out the therapeutic strategy. MATERIALS AND METHOD: One hundred and twenty-seven patients who were diagnosed with BPPV were included in this study. Reposition maneuver was performed once a day until nystagmus disappeared. In the case of posterior canal BPPV, Epley maneuver was performed. In the case of lateral canal BPPV, barbecue rotation maneuver was performed in canalolithiasis type, and cupulolith reposition maneuver in cupulolithiasis type. In each type of BPPV, we analyzed the number of treatment, recurrence, changing type, and the relationship between recurrence and age or sex of patients. RESULTS: Posterior canal origin was more common than lateral canal origin. All cases except 2 were recovered by reposition maneuver. In 8 cases, the type of disease was changed, and the treatment of these cases were changed according to new type and origin. Overall recurrence rate was 14%, and they were completely treated with reposition maneuver. There was no correlation between recurrence and origin, type, age or sex of patients. CONCLUSION: Patients showed various origin, type and recurrence. Type of the disease was possibly changeable. Almost all the cases were cured with suitable reposition maneuver. Recurrence rate was relatively high, and the close follow up is required.

Preliminary Results of Mitomycin-C Application in the Treatment of Laryngeal Stenosis and Granuloma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mitomycin-C is an antibiotic, antineoplastic agent that inhibits DNA and protein synthesis, and fibroblast proliferation. It has been successfully used in adjunction to glaucoma surgery, dacryocystorhinostomy, pterygium surgery, and middle meatal antrostomy. The purpose of this study is to evaluate the efficacy and safety of intraoperative Mitomycin-C application as an adjunct therapy in the endoscopic treatment of laryngeal stenosis and granulation. MATERIALS AND METHOD: A total 13 subjects, of whom 2 had anterior glottic web, 4 posterior laryngeal stenosis, and 7 laryngeal granuloma were included. All underwent stroboscopy and were treated with endoscopic laryngomicrosurgery with CO2 laser. Then, 1 cc of 0.4 mg/mL Mitomycin-C was directly applied for 4 minutes on the surgical site. The patients' symptoms were assessed, and the size of the airway was graded on a scale of I (< or =50%) to IV (total occlusion) after a mean follow-up period of 5 months. The recurrence of the laryngeal granuloma was checked. RESULTS: There was a significant improvement in postoperative symptoms in the group of posterior laryngeal stenosis. Two with tracheotomy underwent decannulation. The postoperative size of airway was markedly increased and restenosis was not noted. There was only one case of recurrence in the granuloma group. CONCLUSION: According to these preliminary results, it is suggested that application of Mitomycin-C can be used as a beneficial adjunct therapy in the endoscopic COc laser excision for laryngeal stenosis and granuloma.

A Case of Granular Cell Tumor of the Vocal Fold / 대한이비인후과학회지

Granular cell tumor is a rare, usually benign neoplasm that can occur in various parts of the body. Half of all granular cell tumors occur in the head and neck, with 33% of these occurring in the tongue. The larynx is relatively an uncommon location, accounting for approximately 7% to 10% of all reported cases. Typically, the most common presenting symptom is hoarseness, with some patients also presenting stridor, hemoptysis, dysphagia, and otalgia. But the tumor may be asymptomatic and discovered only incidentally during a routine examination. The diagnosis is usually made on the histopathological findings, characterized by abundant eosinophilic cytoplasm filled with granules of varying sizes. Complete excision with an attempt to maintain normal structures generally results in cure. We experienced a 16-year-old man with laryngeal granular cell tumor, which involves the right true vocal fold. He was successfully treated with local excision under laryngomicroscopic fine dissection. So we present this case with a review of literature.

A Case of Schwannoma of the Trachea / 대한이비인후과학회지

Schwannoma is a distinct subset of peripheral nerve sheath tumor distinguished by unique histologic and immunohistochemical features. Tracheal schwannomas are among the rarest of tracheal tumors. The surgical approach to such tumors has been debated. We report a case of a primary tracheal schwannoma causing airway obstruction in a 52-year-old woman. Computerized tomography demonstrated an intraluminal growing mass in the trachea. Tracheofissure was performed to remove the mass. Histologic analysis revealed a benign neurogenic tumor of Schwann cell. We plan to follow up and examine the patient very carefully for the possibility of recurrence.

The Application of Laser Doppler Flowmetry for Allergic Rhinitis and Rhinitis Medicamentosa

BACKGROUND AND OBJECTIVES: Allergic rhinitis (AR) and rhinitis medicamentosa (RM) have different mucosal color and pathophysiology. To investigate whether the mucosal color and nasal blood flow are different between the diseases in spite of same symptoms, we designed this study. Materials and Methods: 20 patients with allergic rhinitis and 21 patients with rhinitis medicamentosa were compared with 20 normal volunteers using mucosal color grading and Laser Doppler flowmetry. The Laser Doppler flowmetry was performed with a Periflux 4001 (Perimed, Jrtlla, Sweden) and perfusion unit (PU), velocity unit (VU), and concentration Unit (CU) were measured. The Laser Doppler flowmetry data in AR and RM were compared with those of the normal subjects, and between AR and RM. RESULTS: The perfusion score of AR and RM were lower than the control (p<0.05) and it was statistically significant that the mucosal color of AR were pale and of RM were reddish, comparing to the control group (p<0.05). CONCLUSION: The nasal blood flow was decreased with AR and RM compared to control but the mucosal color of AR and RM were different because of the difference of pathophysiology of diseases. When diagnosing RM, observation of mucosal color and measurement of nasal blood flow will be helpful besides the history of long-term use of nasal decongestant.

En-bloc Dissection of Deep and Superficial lobe of Parotid gland with Preserving the Facial Nerve / 대한이비인후과학회지

Total parotidectomy is indicated when the tumor is originated from a deep lobe of the parotid gland. Because of the facial nerve, the usual sequence of total parotidectomy of a deep lobe tumor is to first perform superficial parotidectomy separately and then to remove the deep lobe. However, it is desirable to remove the parotid gland en-bloc while preserving the facial nerve. We designed a simple procedure that could remove a deep lobe tumor without separating the superficial portion of the parotid gland. This surgical technique is discussed with the present cases.