Short Term Follow-up of Hearing Changes according to Insertion Site of Temporalis Muscle Fascia in Type I Tympanoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are two types of methods in the underlay technique that are employed according to the graft insertion site. The purpose of this study is to evaluate the short term follow-up results of air-bone conduction threshold changes according to the insertion of temporalis muscle fascia to medial and lateral side of malleus in type I tympanoplsty with simple mastoidectomy. MATERIALS AND METHOD: 72 patients with perforated tympanic membrane over the half size in pars tensa were operated in type I tympanoplasty with simple mastoidectomy. Patients were divided into two groups according to the insertion of fascia of temporalis muscle to either i) lateral side of the malleus (group A, 32 cases) or ii) medial side of the malleus (group B, 40 cases). Each group was divided into three subgroups according to size of perforation in the tympanic membranes, ranging from moderate, large, to total. Difference in the air-borne conduction threshold changes between the first preoperative and postoperative year was analyzed for each group. RESULTS: The differences in the pre and postoperative air-bone conduction gap (ABG) between the group A and B were 14.4+/-7.1 dB, 10.4+/-6.2 dB, respectively. There was no statistical difference between the two groups (p>0.05). The pre and postoperative ABG differences for different sizes of perforation in the tympanic membrane in group A were 17.5+/-12.2 dB (moderate), 14.1+/-7.4 dB (large), 14.5+/-8.5 dB (total), and in group B were 9.5+/-4.8, dB (moderate), and 9.3+/-7.2 dB (large), and 12.0+/-7.1 dB (total). There was no statistical difference between the subgroups of the same group (p>0.05). The pre and postoperative bone conduction threshold of group A decreased at 250, 500, 1000, and 2000 Hz but increased at 3000, 4000 Hz. The threshold of group B decreased at all frequency. Postoperative reperforations were observed in just 2 cases of the group B. One case was observed at 5 postoperative months in the large perforation group, and the other case was observed at 15 months in the total perforation group, with the former case healing spontaneously at 6 months. CONCLUSION: The results suggest that the two methods of underlay technique could be selected properly by location of perforation, middle ear anatomy and its pathological state, and continuity of ossicles, as well as per operator's preference. When the perforation is located at the anterior, anterosuperior and anteroposterior portion of tympanic membrane, the tympanic membrane is thickened severely so the boundary becomes uncertain between the middlear mucosa and the tympanic membrane. The insertion of fascia to lateral side of malleus is therefore recommended.

A Case of Angiolymphoid Hyperplasia with Eosinophilia of the Tongue / 대한이비인후과학회지

Angiolymphoid hyperplasia with eosinophilia(ALHE) is an uncommon disorder manifested as solitary or multiple nodules mainly in the dermis and subcutaneous tissue of head and neck region. Histological characteristics of ALHE is proliferation of endothelial cells in the small to medium sized vessels and infiltration of lymphocytes, plasma cells and eosinophils. ALHE affecting the tongue is very rare. We report a case of ALHE of the tongue in an 56 year old man with the review of literatures.

Differences between pre- and post-operative bone conduction threshold changes according to the types of mastoidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been many studies about elevated bone conduction (BC) thresholds in patients with chronic otitis media (COM) with or without cholesteatoma and the relationships between operative techniques and postoperative changes of BC thresholds. The purposes of this study are evaluation of the effect of chronic otitis media on BC thresholds, the relationships between various operative techniques and postoperative BC threshold changes. MATERIALS AND METHODS: Preoperative BC thresholds in 237 patients with ipsilateral COM were evaluated and pre- and postoperative differences of BC thresholds were compared by each frequency in all patients. The patients were divided into three groups according to the severity of diseases: (1) Simple: relatively healthy middle ear mucosa and thus only simple mastoidectomy (SM) was done (N=92), (2) Severe: mastoidectomy with posterior tympanotomy (ICWM) or open cavity mastoidectomy (OCM) were done because of severe edematous middle ear mucosa, granulation tissues, or poor ventilation (N=89), (3) cholesteatomas (Chole, N=56). RESULTS: Preoperative audiograms revealed a significant relationship between the elevation of BC threshold and the severity of diseases. Postoperative BC thresholds were improved in 49% of SM (13.8 +/- 8.5), 51% of ICWM (13.8 +/- 6.1), and 35% of OCM (14.4 +/- 8.4), maintained in 45% of SM, 37% of ICWM, and 43% of OCM, but worsened in 6% of SM (-8.7 +/- 1.4), 12% of ICWM (-10.9 +/- 5.2), and 22% of OCM (-13.8 +/- 6.0). CONCLUSION: The preoperative BC threshold were maintained or improved in the majority of patients postoperatively. In OCM, more patients were worsened in BC hearing postoperatively than the others.

Effect of Weight Lifting on Electroglottography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As a technique to assess vocal function, electroglottography (EGG) has become popular among clinicians and researchers. Because it is fairly simple and non-invasive, EGG is easily adopted for routine clinical use. The purpose of this study is to evaluate the effect of weight lifting on the tension of laryngeal adductory muscles and electroglottography. MATERIALS AND METHODS: The normal control group was composed of 10 healthy males and 10 healthy females who do have voice disorder. The disease group was composed of 10 male and 10 female patients who have vocal polyp or nodule. Electroglottography taken during comfortable phonation was compared with that taken during phonation produced when the subjects were lifting a weight of 15 kg. RESULTS: The closed quotient of electroglottography in the normal male and female groups were 0.46+/-0.04 and 0.46+/-0.05, respectively. The closed quotient in the male and female patients were 0.47+/-0.05 and 0.50+/-0.05, respectively. The closed quotient of electroglottography was not different between the comfortable voice and the voice during weight lifting. The exception was the normal male control group, but the actual effect of weight lifting in this group was not so significant, compared to the effect of increasing vocal intensity. CONCLUSION: Weight lifting does not produce significant short-term effects on laryngeal muscle tension and on the closed quotient of electroglottography.

The Effect of All-trans-retinoic Acid on the Cell Cycle of Head and Neck Squamous Cell Carcinomas / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: Retinoids, including vitamin A and its synthetic analogs, are known to suppress carcinogenesis in various epithelial tissues and also to inhibit the cell growth of head and neck squamous cell carcinomas (HNSCC). However, the exact mechanism of retinoids is not yet known. The aim of this study is to investigate the effect of all-trans-retinoic acid (RA) on the cell cycle in HNSCCs and to see if the inhibition of cell growth by RA is due to the arrest of cell cycle. MATERIALS AND METHODS: For in vitro study, AMC-HN-4 and AMC-HN-6 (HNSCC cell lines) were treated with 1 nM of RA and cultured for 6 days. CellTiter 96(TM) AQ(ueous) Non-Reactive Cell Proliferation Assay kit was used to analyze the inhibition of cell growth. Flow cytometric analysis was performed for cell cycle analysis. For in vivo study, AMC-HN-4 and AMC-HN-6 were injected subcutaneously into athymic nude mice and RA (20 mg/kg) was orally administered once a day for 30 days. Tumor volumes were measured with digimatic caliper and the cell cycle was analyzed using frozen specimens. RESULTS: The growth of AMC-HN-4 and AMC-HN-6 were inhibited by RA in vitro and in vivo. The inhibitory effect of RA was more significant in AMC-HN-4 than in AMC-HN-6. RA had no significant effect on the cell cycle in the medium containing 10% fetal bovine serum (FBS), but there was a mild increase in the G1 phase in the medium containing 0.5% FBS in vitro. In vivo, the increase in G1 phase was observed in both AMC-HN-4 and AMC-HN-6. Also, G1 arrest was more significant in AMC-HN-4 than in AMC-HN-6. CONCLUSION: This study suggests that RA may induce G1 arrest, which might be associated with the inhibition of cell growth in HNSCCs.

Treatment Results of Osteoplastic Frontal Sinus Operation / 대한이비인후과학회지

Objectives: We aimed to look for indications and find out treatment outcomes of osteoplastic frontal sinus operation (OFSO) for frontal sinus diseases. MATERIALS AND METHODS: We retrospectively evaluated nine patients undergoing OFSO between 1993 and 1997 and examined indications for surgery, complications, and outcomes. All patients were male and their ages ranged from 27 to 63 years with a mean age of 42 years. RESULTS: Indications for surgery were found in 3 cases of fracture involving frontal sinus, mucopyocele (3 cases), osteoma (2 cases), and inverted papilloma (1 case). In five patients, bilateral frontal sinuses were opened through bone flaps and in four patients unilateral frontal sinus was opened. Follow up information was available on 8 patients all of whom were cured without evidence of recurrence to date. No serious complications, either intracranial or orbital, occurred, however, all 8 followed up patients have persistent abnormal forehead sensation and abnormal bony contour of forehead, either depression or bossing, developed in 4 patients. CONCLUSION: Osteoplastic frontal sinus operation seems to be a rational approach to eradicate frontal sinus diseases such as tumors, fractures, and mucopyoceles, which cannot be treated by endoscopic sinus surgery. Minor sequelae such as supraorbital hypesthesia and forehead deformity may develop postopera-tively and the patients should be informed of them preoperatively.

Four Cases of Rhabdomyosarcoma in the Head and Neck / 대한이비인후과학회지

Rhabdomyosarcoma is a highly aggressive malignant tumor with an incidence of 1/500,000 children per year. Head and neck is the most common site of the embryonal rhabdomyosarcoma. We experienced four cases of embryonal rhabdomyosarcoma, each case originating from temporalis muscle, nasal cavity, parapharynx and nasopharynx. The median age of four patients was 12.5 years old (range, 3-25 years), and the male and female ratio was 2:2 . Two patients were treated with operation and postoperative chemotherapy and irradiation. One patient was treated with induction chemotherapy before operation, and then received postoperative chemotherapy and irradiation. The remaining one patient was incidentally confirmed by excisional biopsy and treated with chemotherapy and irradiation. The median follow-up period was 24 months (range, 6-56 months). Three patients recovered completely with no further evidence of disease. One patient showed breast metastasis after 3 months later.