Changes in Subjective Outcomes during the Early Period after Septoturbinoplasty

Purpose@#Septoturbinoplasty is frequently performed to correct nasal obstruction; however, there is still a lack of research on changes in nasal and nose-related symptoms early after septoturbinoplasty. Therefore, we aimed to investigate changes in subjective outcomes within 6 months after septoturbinoplasty. @*Materials and Methods@#The medical records of patients who underwent septoturbinoplasty at Gangnam Severance Hospital were retrospectively analyzed. Symptom scores were evaluated using the Sino-nasal Outcome Test (SNOT-22) and obstruction scores.The SNOT-22 and obstruction scores were investigated before surgery and at 1, 3, and 6 months after surgery. @*Results@#We noted significant decreases in both SNOT-22 and obstruction scores at 1 month after surgery, compared to those before surgery (p<0.001). However, there were no significant changes at 3 and 6 months after surgery, compared to scores at 1 month after surgery. Using multivariate logistic regression analysis, a larger difference between SNOT-22 scores preoperatively and 1 month after surgery was significantly associated with a significant improvement in symptoms at 3 or 6 months after septoturbinoplasty (p=0.029). @*Conclusion@#These results imply that subjective outcomes and degree of improvement in the first month after septoturbinoplasty can be used as a predictor of the results thereof and for counseling patients about its progress.

The role of adjuvant external beam radiation therapy for papillary thyroid carcinoma invading the trachea

PURPOSE: To evaluate the effect of adjuvant external beam radiation therapy (EBRT) on local failure-free survival rate (LFFS) for papillary thyroid cancer (PTC) invading the trachea. MATERIALS AND METHODS: Fifty-six patients with locally advanced PTC invading the trachea were treated with surgical resection. After surgery, 21 patients received adjuvant EBRT and radioactive iodine therapy (EBRT group) and 35 patients were treated with radioactive iodine therapy (control group). RESULTS: The age range was 26–87 years (median, 56 years). The median follow-up period was 43 months (range, 4 to 145 months). EBRT doses ranged from 50.4 to 66 Gy (median, 60 Gy). Esophagus invasion and gross residual disease was more frequent in the EBRT group. In the control group, local recurrence developed in 9 (9/35, 26%) and new distant metastasis in 2 (2/35, 6%) patients, occurring 4 to 68 months (median, 37 months) and 53 to 68 months (median, 60 months) after surgery, respectively. Two patients had simultaneous local recurrence and new distant metastasis. There was one local failure in the EBRT group at 18 months after surgery (1/21, 5%). The 5-year LFFS was 95% in the EBRT group and 63% in the control group (p = 0.103). In the EBRT group, one late grade 2 xerostomia was developed. CONCLUSION: Although, EBRT group had a higher incidence of esophagus invasion and gross residual disease, EBRT group showed a better 5-year LFFS. Adjuvant EBRT may have contributed to the better LFFS in these patients.

Bepotastine-induced urticaria, cross-reactive with other antihistamines

Second-generation antihistamines are widely prescribed for the control of symptoms of allergic inflammation such as itchy hives, coryza, and itchy eyes. In rare circumstances, these drugs might provoke allergic inflammation. Hypersensitivity to bepotastine besilate, a second-generation antihistamine has never been reported. A 17-year-old schoolgirl, whose paroxysmal itchy hives had been controlled with bepotastine, experienced aggravation of the hives. An oral provocation test confirmed her hypersensitivity to bepotastine and cross-reactivity to levocetirizine. She showed no reaction to chlorpheniramine, ketotifen, or olopatadine among the 13 antihistamines tested. While searching for an antihistamine to control her itchy hives, we found that she also exhibited cross-reactivity to various antihistamines with different chemical structures from that of bepotastine, which is not predicted according to the chemical classification of antihistamines. We report a case of hypersensitivity to bepotastine besilate in a patient with chronic spontaneous urticaria.

A Case of Subdural Empyema Caused by Sinusitis in a Child / 소아감염

The current paper reports on a case of subdural empyema secondary to frontal sinusitis in an otherwise healthy child. Sinusitis is a common and benign condition in most pediatric cases. Because of the widespread use of antibiotics, intracranial extension of pediatric sinusitis is rarely seen today; however, complications (e.g., cavernous sinus thrombosis, orbital infection, meningitis, and subdural empyema) are potentially life threatening. A 15-year-old right-handed male presented with a 3-day history of fever, headache, and left-sided palsy. Computed tomography revealed right-sided subdural empyema with right frontal sinusitis and maxillary sinusitis. A postoperative inpatient neurological consultation was requested 2 months post-surgery due to motor function deficits. The results suggested that early and accurate diagnosis of subdural empyema leads to prompt treatment and a favorable outcome for the patient.

Two Cases of Diffuse Large B-cell Lymphoma of Sinonasal Tract

Nasal lymphoma is an uncommon neoplasm in the sinonasal tract. The NK/T-cell type of lymphoma is more commonly found in Asian populations. However, B-cell lymphoma is more common in the western countries whereas it is rare in Asia. Recently, we experienced two cases of sinonasal B-cell lymphoma, which are rare cases in Korea, one in an advanced stage and one in an early stage. Both patients had no specific nasal symptoms or systemic B symptoms (fever, night sweat, weight loss). As our cases demonstrate, diagnosis of B cell lymphoma is often delayed in many cases because B-cell lymphoma does not show any specific symptoms. Thus, careful physical examination and biopsy under suspicion of malignancy are important for early diagnosis of nasal lymphoma.

Characteristics of Glottic Closure Reflex in a Canine Model

PURPOSE: The most important function of the larynx is airway protection which is provided through a polysynaptic reflex closure triggered by the receptors in the glottic and supraglottic mucosa, evoking the reflex contraction of the laryngeal muscles especially by strong adduction of vocal cords. Based on the hypotheses that central facilitation is essential for this bilateral adductor reflex and that its disturbance can result in weakened laryngeal closure, we designed this study to elucidate the effect of central facilitation on this protective reflex. MATERIALS AND METHODS: Seven adult, 20 kg mongrel dogs underwent evoked response laryngeal electromyography under 0.5 to 1.0 MAC (minimum alveolar concentration) isoflurane anesthesia. The internal branch of the superior laryngeal nerve was stimulated through bipolar platinum-iridium electrodes, and recording electrodes were positioned in the ipsilateral and contralateral thyroarytenoid muscles. RESULTS: Ipsilateral reflex closure was consistantly recorded regardless of anesthetic levels. However, contralateral reflex responses disappeared as anesthetic levels were deepened. Additionally, late responses (R2) were detected in one animal at lower level of anesthesia. CONCLUSIONS: Deepened level of anesthesia affects central facilitation and results in the loss of the crossed adductor reflex, predisposing to a weakened glottic closure response. Precise understanding of this effect may possibly provide a way to prevent aspiration in unconscious patients.

Decompression of Internal Auditory Canal via Middle Fossa Approach in Neurofibromatosis Type II with Only Hearing Ear / 대한이비인후과학회지

Neurofibromatosis type II (NF2) is a genetic disease and is transmitted as an autosomal dominant trait. NF2 is characterized by bilateral acoustic neuroma with multiple tumors of central nervous system. Progressive hearing loss is a significant problem in patients with NF2, and hearing preservation is an important factor for choice of treatment plan, especially in a NF2 patient with only one hearing ear. We report an experience of preservation of hearing in a NF2 patient with only one hearing ear through decompression of the internal auditory canal via middle cranial fossa approach.

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.

A Clinical Review on 173 Cases of Unilateral Vocal Cord Paralysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Unilateral vocal cord paralysis is a common finding in the practice of otolaryngology. Having an idiopathic cause, requiring surgeries on neck and chest, presenting tumors, trauma and neurological diseases are considered to be its major etiology. We reviewed and compared both domestic and international papers and analyzed the trend of clinical characteristics and causes of unilateral vocal cord palsy in Korean patients. MATERIALS AND METHOD: We reviewed 173 patients who visited the Severance Hospital and the Yong dong Severance Hospital from April, 1995 to December, 2001. They were diagnosed with unilateral vocal cord palsy by reviewing systems, physical examination, radiographic studies, and endoscopy. They were analyzed according to sex, age, cause of vocal cord palsy, condition of the paralyzed vocal cord and treatment methods by a preestablished protocol. RESULTS: The male to female ratio was 1.6: 1. Patients in their fifties consisted of 24.3% of the total number of cases, and patients over 60 formed 30.6%, showing that the frequency of unilateral vocal cord palsy increased with age. The paralyzed vocal cord was fixed at paramedian position in 79.8% of the cases. The left vocal cord was paralyzed about twice as much as the right vocal cord. Among the causes of vocal cord palsy, 32.4% of the cases were due to postoperative paralysis, and most of those were developed after thyroid surgery. About 67% of the cases were not related to surgery, of which the causes were most commonly idiopathic, with tumor being the next frequent. In 38.4% of the patients, atrophy of the membranous portion of the paralyzed vocal cord was noted. Rotation of the arytenoid cartilage was seen in 25.3%. CONCLUSION: Vocal cord paralysis is not only a disease entity in itself, but can be seen as a sign of an underlying disease. Thus, determining the cause of vocal cord paralysis is extremely important. Although the number of cases of vocal cord paralysis due to surgery is now decreasing, those due to trauma or idiopathic causes are rising and paralysis due to tumor is increasing. Consequently, it is necessary to perform a complete and thorough search for the underlying cause of vocal cord paralysis.

Retinoic Acid Depletion Induces Keratinizing Squamous Differentiation in Human Middle Ear Epithelial Cell Culture / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The pathogenesis of cholesteatoma behind an intact tympanic membrane remains controversial. Squamous metaplasia of the middle ear mucosa is thought to be a possible mechanism in such cases. However, to date, no definitive experimental results have proved the association. This study was undertaken to investigate whether normal human middle ear epithelial (NHMEE) cells undergo keratinizing squamous differentiation in retinoic acid (RA)-deficient culture. MATERIALS AND METHOD: We examined the morphological differences between RA-deficient and RA-sufficient cultures, and determined the expressions of the mucin gene and cornifin-alpha mRNAs as indicators of mucous and squamous differentiation, respectively. RESULTS: Histomorphologically, the NHMEE cells differentiated into a keratinizing squamous epithelium in RA-deficient culture. In addition, the expressions of mucin gene 5AC (MUC5AC) and MUC8 mRNA were suppressed, and the expression of cornifin-alpha mRNA increased progressively as a function of differentiation in RA-deficient culture. CONCLUSION: Our study shows that RA depletion induces keratinizing squamous differentiation in NHMEE cell culture.