Combined 18F-FDG PET/CT Imaging for the Initial Evaluation of Glottic Cancer

OBJECTIVES: The primary aim of this study was to determine whether 18F-FDG-PET/CT (PET/CT) scans provide additional diagnostic information in addition to the direct laryngoscopic examination (L/E) and contrast-enhanced CT (CT) in patients with glottic cancer during the initial evaluation. METHODS: Fifty-five consecutive patients with glottic cancer of the larynx that had L/E, CT and PET/CT were enrolled. The diagnostic value of each modality was compared for their accuracy in predicting the extent of the primary tumors on sub-site based analysis and the final tumor staging. The reference standards were either the surgical pathology findings or clinical/radiological follow-up outcome. Changes in patient care based on PET/CT results were compared with the treatment decisions based on L/E with CT. RESULTS: For primary tumor sub-site based analysis, the sensitivity was significantly higher for L/E (92.8%) than for PET/CT (79.4%, P=0.028). The comparisons between L/E vs. CT and CT vs. PET/CT did not reach statistical significance. As an initial tumor-staging method the L/E had a diagnostic accuracy of 76.4%, compared to 61.8% for CT and 41.8% for PET/CT. The L/E and CT were better than the PET/CT (P=0.0009 and 0.049) for the initial TNM staging. PET/CT scanning changed the clinical decision-making based on the L/E with CT results in 12.7% of cases, of whom 5.5% had no additional PET/CT related benefit. CONCLUSION: Conclusion. The results of this study showed that PET/CT imaging added no clinical information benefit compared to the L/E and CT for the initial evaluation of patients with glottic cancer.

Revision Surgery for Chronic Otitis Media: Characteristics and Outcomes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of our study is to analyze the characteristics and outcomes of revision surgery for chronic otitis media. SUBJECTS AND METHOD: Retrospective review of the revision tympanomastoidectomy from January 1, 1997 to December 31, 2004 (N=208) were performed. The control group who underwent primary canal wall down mastoidectomy (CWDM, N=51) was compared with the case group who underwent revision CWDM. RESULTS: As a cause of revision ear surgery, recurrent cholesteatoma comprised 38% of the cases, and granulation tissue in the unexenterated air cells were found to be 62%. Mastoid tip and perisinal air cells were most frequent sites of unexenterated air cells. CWDM was performed in 96.6% of the patients. Disease control was achieved in 88.5% of the patients. The 70.1% of revision CWDM with ossiculoplasty achieved a residual air-bone gap (ABG) of < or = 30 dB. Complications after revision surgery were wound infection (3.8%) and temporary facial nerve palsy (1.9%). In the control group, disease control rate, postoperative ABG < or = 30 dB, wound infection and facial nerve palsy were 90.2%, 90.5%, 5.9% and 0% of patients, respectively. CONCLUSION: Disease control rates and complications after revision surgery are similar to primary cases. However, hearing results were worse and wound healing time was longer than primary ones.

Influence of Upper Airway Obstruction on Continuous Positive Airway Pressure / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : Nasal continuous positive airway pressure (CPAP) is a useful and efficient treatment modality, but the patient's compliance depends on several factors such as nasal CPAP level. The aim of this study was to evaluate the relationship between upper airway obstruction and nasal CPAP level in obstructive sleep apnea syndrome (OSAS). SUBJECTS AND METHOD : This retrospective study (from August 1995 through May 2005) included 50 patients suffering from OSAS with a mean apneahypopnea index of 43.78/hr, and those who underwent overnight polysomnography, laboratory nasal CPAP, and acoustic rhinometry(AR) for the measurement of minimal cross-sectional area (MCA) of the nasal cavity. We compared the nasal CPAP level with the degree of anatomic upper airway obstruction including tonsil and palate grade, MCA, subjective symptoms, or body mass index(BMI). A single linear regression analysis and one-way analysis of variance (ANOVA) were performed to compare variables. RESULTS : The mean nasal CPAP level was 6.32+/-2.17 cmH2O. We found a significant correlation between the nasal CPAP level and BMI (p25) revealed no correlation with the nasal CPAP level. CONCLUSION : Upper airway obstruction including nasal obstruction and tonsillar hypertrophy may increase the nasal CPAP level. Correction of nasal obstruction and tonsillectomy may reduce the nasal CPAP level in nonobese patients.

A Case of Herpes Zoster Oticus Involving Vestibular Nerve without Facial Nerve Palsy

Herpes zoster oticus (Ramsay Hunt syndrome) is characterized by facial nerve paralysis associated with vesticular eruptions and cochleovestibular symptoms. Many evidences have supported that it is caused by the reactivation of latent varicella-zoster virus in the geniculate ganglion. Recently we experienced a case 49-year-old man presented severe vertigo and a vesicular eruptions of auricle and external ear canal. It is an unusual variant of herpes zoster oticus that involves only vestibular nerve without facial nerve palsy and hearing loss. We believe this case results from reactivation of latent varicella zoster virus in the vestibular ganglion and report with a review of literatures.

Clinical Characteristics of Dizziness in Children

BACKGROUND AND OBJECTIVES: The children who are complaining of dizziness are difficult to manage. Because the incidence is quite low and the diagnostic spectrum is different from the adult. The purpose of this study is to analyze the clinical characteristics and vestibular function test in dizzy children, leading to provide a proper diagnostic approach. MATERIALS AND METHOD: A total of 57 children with dizziness who underwent vestibular function test were included in this study. Theses patients were retrospectively reviewed based on clinical charts. The average age of the patients was 11.1 years (range: 4-15). Caloric and rotation chair tests were performed in 57 and 31 patients respectively. Imaging study such as computed tomography and magnetic resonance imaging was performed in selective cases. RESULTS: Recurrent vertigo (49.1%) is the most common symptoms in dizzy children. Most common diagnostic entity in dizzy children is benign positional vertigo (BPV) (31.6%). Compared to adults, BPPV is relatively uncommon. Uncertain diagnosis is also common in dizzy children. Caloric test suggested that 19.3% of dizzy patients showed unilateral weakness. However, among normal caloric responders who underwent rotation chair test simultaneously, 11 out of 23 (47.8%) showed abnormal VOR gain and oculomotor abnormality. CONCLUSION: Most common diagnosis of dizzy children is BPV, although many patients were remained uncertain. Abnormality of oculomotor test and VOR is relatively common, that suggests abnormal visual vestibular interaction is related with dizzy symptoms in children. The evaluation of vertigo in children should include a complete history and vestibular function test related with visual vestibular interaction.