The Benefit of Supplemental Cough Suppression Therapy for Chronic Refractory Cough

Background and Objectives@#Cough suppression therapy (CST) is a physiotherapy that can be used for patients with chronic refractory cough (CRC). We aimed to investigate the efficacy of CST for CRC.Materials and Method A prospective randomized controlled trial was conducted in 27 patients with CRC. Participants were randomized to receive either standard mucolytic medications for CRC combined with supplemental CST (CST group) or standard medications alone (control group). CST consists of laryngeal hygiene management, humidification, cough suppression technique, breathing method, and counseling. We assessed the symptoms change at baseline and week 4 with the Leicester Cough Questionnaire (LCQ). Secondary efficacy outcomes included the degree of cough Visual Analog Scale (VAS) score (0 to 100 scale). @*Results@#From 2019 to 2021, 14 CST group patients and 13 control group patients were included. The improvement was significantly greater in the CST group than in the control group for cough VAS score (36.67 to 13.33 vs. 74.29 to 16.43, p<0.001). Patients in the CST group had a significant improvement in total (70.14 to 107.71, p=0.005), physical (31.42 to 43.86, p= 0.015), psychological (23.57 to 40.14, p=0.003), and social (15.14 to 23.71, p=0.005) LCQ scores. However, there was not a significant pre- to post-treatment LCQ score improvement in control group. @*Conclusion@#CST might be an effective supplemental intervention for CRC.

Retropharyngeal Lymph Node Metastasis from Thyroid Papillary Carcinoma with Airway Obstruction / 대한이비인후과학회지

Lymph node metastases of thyroid papillary carcinomas typically occur in the central and lateral neck lymph nodes. Metastasis to the retropharyngeal node is rare for this tumor type, especially when accompanied with airway obstruction. We treated one patient with retropharyngeal lymph node (RPLN) metastasis of thyroid papillary carcinoma with airway obstruction. The RPLN was successfully resected without complications via transcervical approach. Although the present case is rare, metastasis to the retropharyngeal nodes should be considered at the time of diagnosis and follow-up for thyroid papillary carcinoma. The dissection of thyroid papillary carcinoma metastases to the RPLN should be based on estimated prognosis, complaints, performance status, surgical skill, and complications.

Functional Organ Preservation Surgery for Head and Neck Cancer / 대한이비인후과학회지

Organ preservation strategy in treatment of the head and neck cancer (HNC) has led to an increase in the use of primary chemoradiation in both laryngeal and extralaryngeal sites for recent two decades. Primary non-surgical chemoradiotherpay has replaced the traditional gold standard of surgery followed by postoperative radiation with saving the organ and no compromising oncological outcomes. In accompany with wide clinical extension of primary chemoradiation, organ preservation surgery through open transcervical or transoral route has been increasingly used in the patients with HNC at both primary and salvage settings. Minimally invasive transoral approach using lasers or robots has been more spotlighted as a sensible strategy for organ preservation of the HNC patients. There is, however, a paucity of randomized controlled clinical trial data comparing primary organ-preserving chemoradiation to organ preservation surgery. Future direction leads to conduct well-designed clinical trials to establish the functional and oncological benefits of the organ preservation surgery. This article reviews the role of organ preservation surgery in head and neck cancer.

Outcomes of Salvage Surgery after Concurrent Chemoradiation for Advanced Hypopharyngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We evaluated treatment outcomes of patients with advanced hypopharyngeal cancer for whom surgical salvage was attempted after primary concomitant chemoradiation therapy (CRT) had failed as a treatment. The pre-salvage factors were assess-ed to predict the prognosis of salvage surgery. SUBJECTS AND METHOD: A retrospective analysis was conducted from 1997 to 2006 for 22 patients with stage III-IV hypopharyngeal cancer who had undergone salvage surgery after local and/or regional CRT failures with no distant metastasis. RESULTS: Larynx-sacrificing pharyngectomy was performed in 12 (54.5%) of all patients. Postoperative complications occurred in 9 (40.9%), and carotid artery blowout occurred in two of these patients. After salvage surgery, the 2-year and 5-year overall survival rates were 52.8% and 28.9%, respectively. The 2-year disease specific survival rate and locoregional control rate were 45.5% and 60.0%, respectively. The initial N2-3 stage (p=0.038) and the concurrent local and regional failures (p=0.035) were independent predictors for decreased survival after salvage surgery. Two-year overall survival rates for patients with 2, 1, or none of these predictive factors were 23.3%, 66.7%, and 80.0%, respectively (p=0.027). CONCLUSION: Although salvage surgery after CRT has postoperative complications and unfavorable larynx preservation, it can be considered as a viable option with acceptable oncologic outcomes for advanced hypopharyngeal cancer. The initial N2-3 stage and concurrent local and regional failures were independent predictors that can stratify patients into distinct prognostic groups for postsalvage survival.

Role of Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Preoperative Staging of Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) has been widely used to detect regional and distant metastasis or second primary cancers at initial evaluation. The aim of this study was to evaluate the role of combined FDG-PET/CT in detecting early glottic cancers, which has low incidence of regional or distant metastasis. SUBJECTS AND METHOD: We enrolled in our study 551 patients who had previously untreated glottic cancer between 2001 and 2008. Of these, 124 patients with early glottic cancer underwent FDG-PET/CT. Retrospectively, we compared the detection rates of regional, distant metastasis or second primary cancer by FDG-PET/CT with those after neck computed tomography (CT), chest X-ray, and liver sonography. RESULTS: In detecting regional metastasis, the sensitivity and specificity of FDG-PET/CT were 66.67% and 97.25%, respectively, with the positive predictive value (PPV) of 40%, the negative predictive value (NPV) of 99.16%, and the accuracy of 96.77%. The sensitivity, specificity, PPV, NPV and accuracy of neck CT were 66.67%, 96.69%, 33.33%, 99.15%, and 95.96%, respectively. The suspicious distant metastasis (n=1) and second primary cancers (n=7) were observed in FDG-PET/CT. The true second primary cancers occurred at the colon (n=1) and the prostate (n=2). The other cases were proved to be false positive. Distant metastasis and second primary cancers were not detected by the conventional work-up tests. CONCLUSION: The regional metastasis detection rate of FDG-PET/CT was similar to those of the conventional work-up tests. However, compared to the conventional tests, FDG-PET/CT is useful for detecting distant metastasis or second primary cancers in patients with early glottic cancer.

Primary Non-Hodgkin's Lymphoma of the Larynx / 대한이비인후과학회지

Non-Hodgkin's lymphoma rarely involves the larynx. We retrospectively reviewed six patients with the diagnosis of lymphoma involving the larynx from January 1997 to December 2007. Fiberoptic examination showed diverse features involving the supraglottis. On histologic examination of the biopsy specimen, there were mucosa-associated lymphoid tissue lymphoma (MALT) in 2 cases, Mantle cell lymphoma in 2 cases, and NK/T cell lymphoma in 2 cases. In 4 cases, there was no systemic involvement by the lymphoma. These patients were treated with multiagent chemotherapy and radiotherapy and developed a complete response to therapy. But in one NK/T cell lymphoma patient, tumor recurrence was detected in nasopharynx after 3 years. In the other NK/T cell lymphoma patient, there was appendix involvement and he expired after 3 weeks in diagnosis. The early symptoms of laryngeal NHL are usually subtle and easily neglected. Early detection and aggressive therapy should be considered in laryngeal NHL

Predictive Factors of Level II Lymph Node Metastasis in N1b Papillary Thyroid Carcinoma Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cervical lymph node (LN) metastases are common in papillary thyroid carcinoma (PTC) and cervical neck dissection (ND) is frequently performed to improve regional control of the disease. However, there is a controversy as to the extent of lateral cervical ND. In the present study, we examined the diagnostic accuracy of ultrasonography (US) or CT and the predictive factors of level II LN metastases in PTC patients with clinically positive lateral neck nodes. SUBJECTS AND METHOD: We retrospectively analyzed 78 patients who underwent thyroidectomy and lateral ND including level II LN between August 1998 to June 2008. To identify predictive factors of cervical node metastases to level II, diverse factors were analyzed. RESULTS: The most common site of metastasis was level IV (83.3% of cases). The accuracy of diagnostic imaging in the detection of level II metastasis revealed sensitivity of 89.4%, and specificity of 93.5%. The results of the univariate analysis showed that the presence of level II metastases was significantly associated with the location of primary tumor (p<0.001), number of metastatic LN (p=0.001), and great size of metastatic LN (p=0.010). In addition, the multivariate analysis showed that the location of primary tumor and number of metastatic LN were an independent risk factor for the presence of level II metastasis. CONCLUSION: Preoperative imaging was accurate for detecting the presence of level II LN metastasis. Patients with upper lobe tumor and multiple metastatic LN have a higher risk of harboring metastatic disease at the level II. We suggest that routine dissection of the level II LN may not be necessary for patients with no evidence of diagnostic imaging and predictive factors of level II LN metastasis.

The Application of Diagnostic Tools of Central Auditory Processing Disorder and Their Normative Value in Each Age Group in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To develop and apply a diagnostic test tool for central auditory processing disorder (CAPD) and to obtain normative data of Korean subjects with normal hearing. SUBJECTS AND METHOD: After obtaining the approvement of the Institution Review Board of Asan Medical Center for this clinical study, we conducted this study for 135 subjects with normal hearing. Frequency & duration pattern tests and dichotic test were administered to subjects with normal hearing were evaluated by pure tone audiometry. Patients were separated into the following age categories:up to and including 7-year-olds, 8- and 9-year-olds, 10- and 11-year-olds, 12- to 18-year-olds and adults over 18. RESULTS: The frequency pattern test showed that the mean score was 14.4+/-7.1, 19.7+/-9.2, 23.8+/-8.6, 24.1+/-7.0 and 28.5+/-2.7, for each age category, respectively. The duration pattern test showed that the mean score was 13.8+/-6.2, 17.0+/-6.1, 21.6+/-5.4, 25.6+/-4.3 and 28.4+/-2.1, respectively. The dichotic test showed that the right mean scores were 26.5+/-3.2, 27.0+/-3.2, 27.8+/-3.2, 29.4+/-0.9, 27.9+/-1.5 and left the mean scores 26.4+/-3.7, 27.0+/-2.6, 28.6+/-1.4, 28.6+/-1.3, 27.9+/-1.6 for each age category, respectively. CONCLUSION: We obtained the normative data of Korean subjects for the diagnosis of CAPD. Additional diagnostic tools and treatment methods must be developed continuously.

A Case of Schwannoma of the Larynx / 대한이비인후과학회지

Neurogenic neoplasms involving the head and neck are uncommon. We report a case of supraglottic schwannoma. The tumor was located in the right false vocal cord level. It was removed by transoral CO2 laser surgery.

The Validity Using Two-stage Automated Auditory Brainstem Response as a Universal Newborn Hearing Screening Protocol : Experiences in Asan Medical Center / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Universal newborn hearing screening is widely accepted due to socioeconomic harm of congenital hearing loss. The aim of this study was to assess whether two-stage automated auditory brainstem response (AABR) is acceptable method for newborn hearing screening and to check the presence of potential false negative cases by using another criterion considering sweep number. SUBJECTS AND METHOD: Among 3761 neonates who were born from March 2004 to December 2005, 3053 healthy neonates (81.18%) whose parents agreed to hearing screening protocol were screened with AABR. Failed neonates ('refer') at first stage test and neonates showing high sweep number (>4000) on repeated test were received second stage retest within 24 hours from the first test. Neonates whose retest AABR results were failed or high sweep number continuously were tested with conventional ABR as a confirmative study within 3 months. RESULTS: 94 neonates (3.08%) were failed and 180 neonates (5.89%) showed high sweep number on first stage AABR test. On second stage AABR test, neonates with 'final refer' result were 46 (1.51%) and neonates with 'final high sweep number' result were 44 (1.44%). Neonates with threshold of over 30 dB at ABR were 14 among final refer group and 5 among final high sweep number group. Three bilateral profound hearing loss cases were detected and proper management was done. Nine false negative cases were detected and of these, 3 neonates showed moderate hearing loss. There is no clear relationship between predicting false negative case and sweep number. CONCLUSION: Our current two stage AABR test is useful tool for newborn hearing screening with acceptable referral rate and positive predictive value. False negative cases detected through our protocol have no clear relationship with high sweep number.

Analysis of Therapeutic Effects of Lipo-Prostaglandin E1 for Treatment of Sudden Sensorineural Hearing Loss in Patients with Type 2 Diabetes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : Diabetes mellitus (DM) is a risk factor for sudden sensorineural hearing loss (SSNHL), possibly due to microvascular damage as well as increased blood viscosity and embolic and thrombotic episodes. To perform a prospective, randomized clinical trial to evaluate the therapeutic effect of lipo-prostaglandin E(1) (lipo-PGE(1)) on SSNHL in Korean patients with type 2 diabetes. MATERIALS AND METHOD : The study group consisted of 270 patients (130 males, 140 females) consecutively diagnosed with SSNHL. Patients were classified as diabetic or nondiabetic by the new American Diabetes Association criteria. With the approval of the institute ethics committee, patients were randomly assigned to treatment with a continuous infusion of 10 L lipo-PGE(1) (lipo-PGE(1) group) or saline (placebo group). In addition, all patients studied were treated with 48 mg methylprednisolone for 5 days. RESULTS : The overall recovery rates after treatment were 51.5% in diabetic and 64.2% in nondiabetic patients. In diabetic patients, there was a significantly higher rate of hearing improvement in the lipo-PGE(1) group (64.7%) than in the placebo group (37.5%), whereas, in nondiabetic patients, there was no significant difference in the rate of hearing improvement between the lipo-PGE(1) group (70.3%) and the placebo group (58.3%). CONCLUSION : Lipo-PGE(1) may have beneficial effects in the treatment of SSNHL in Korean patients with type 2 diabetes.