Body Weight is Inversely Associated with Anti-SARS-CoV-2 Antibody Levels after BNT162b2 mRNA Vaccination in Young and Middle Aged Adults / 감염과화학요법

Background@#This study aimed to determine factors affecting serum levels of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies 2 months after coronavirus disease 2019 (COVID-19) vaccination in young and middle aged healthy adults. @*Materials and Methods@#Healthcare workers who have no history of SARS-CoV-2 infection, were enrolled at 2 months after second shot of BNT162b2 mRNA COVID-19 vaccine. Antibody immunoglobulin G against the spike protein subunit of SARS-CoV-2 was semi-quantitatively measured using 4 commercial enzyme-linked immunosorbent assay kits. Factors affecting anti-SARS-CoV-2 antibodies levels were investigated. @*Results@#Fifty-one persons (22 - 54 years, male sex; 19.6%) were enrolled and all participants acquired anti-SARS-CoV-2 antibodies in four diagnostic kits. Anti-SARS-CoV-2 antibodies were strongly correlated between diagnostic kits; SG Medical and Genscript (r = 0.942), SG Medical and HB Healthcare (r = 0.903), and HB Healthcare and Genscript (r = 0.868). We investigated factors affecting antibody level using SG medical kit. The median inhibition was 93.1%, and 84.0% of participants showed >90.0% inhibition. Systemic adverse event severity had no association with the anti-SARS-CoV-2 antibodies level. Antibody level was inversely correlated with weight (-0.312, P = 0.027), body mass index (BMI) (r = -0.303, i>P = 0.032), and body surface area (r = -0.285, i>P = 0.044). In multivariate analysis, the upper 50% of antiSARS-CoV-2 antibodies (≥93.1%) was inversely associated with weight (odds ratio [OR]: 0.19; 95% confidence interval [CI]: 0.04 - 0.83 in weight ≥55kg) and BMI (OR: 0.12; 95% CI: 0.03 - 0.61 in BMI ≥22 kg/m2 ). @*Conclusion@#Anti-SARS-CoV-2 antibody was inversely correlated with weight and BMI, which may be used as a marker to predict immune response of BNT162b2 mRNA vaccination in young and middle aged adults.

Comparison of the Effect of Dietary Restriction and Free Diet on Postoperative Bleeding After Tonsillectomy / 대한이비인후과학회지

Background and Objectives@#There have been several studies on the factors affecting posttonsillectomy bleeding; however, investigations on the relationship between postoperative bleeding and diet are insufficient. Different countries have different types of food, and while there have been studies on the effects of diet in other countries, no such studies have been reported in Korea. Therefore, we aimed to investigate the relationship between Korean diet and postoperative bleeding after tonsillectomy.Subjects and Method To compare the postoperative bleeding outcomes, patients who underwent tonsillectomy by a single surgeon between January 2017 and 2020 were divided into those who had a diet restriction after surgery and those who had a free diet. Postoperative bleeding outcomes were divided according to the degree of intervention for hemostasis and compared. @*Results@#The study included 115 and 124 patients in the diet-restricted group and free-diet group, respectively. There were no statistical differences between the two groups in terms of gender, age, presence of snoring and frequent tonsillitis, and surgical method. Bleeding occurred in four patients in the diet-restricted group and three patients in the free-diet group. There was no statistical difference between the two groups in the frequency and severity of postoperative bleeding. @*Conclusion@#Since dietary restriction after tonsillectomy was not helpful to prevent postoperative bleeding, a free and sufficient diet after surgery may prove to be better.

Questionable Effect of Crosshatching Incision in Septoplasty

Objectives@#. Crosshatching incision has been considered a useful method for correcting cartilaginous septal deviation. The aim of this study was to determine the utility and limitations of this approach. @*Methods@#. This retrospective case-control study included 353 patients who underwent septoplasty performed by a senior surgeon between January 2004 and December 2010. Patients were classified into two groups according to whether crosshatching incision was performed (n=151) during septoplasty or not (n=202). All other techniques performed during septoplasty were identical. The parameters of surgical success (improvement of nasal obstruction, correction of deviation, and acoustic rhinometry results) and adverse effects were compared between the groups. @*Results@#. There were no significant differences in the parameters of surgical success between the groups (improvement of nasal obstruction, P=0.333; correction of deviation, P=0.608; acoustic rhinometry results, P=0.322 for the difference in the minimal cross-sectional area; P=0.919 for difference in volume). Relative to patients who did not undergo the cross-hatching incision, patients with whom the technique was performed showed a significantly higher incidence of saddle nose (0/202 vs. 4/151 cases, P=0.033) and overcorrection (0/202 vs. 5/151 cases, P=0.014). @*Conclusion@#. Crosshatching incision during septoplasty did not produce better surgical outcomes; however, it caused adverse effects such as saddle nose and overcorrection. Therefore, the use of crosshatching incision should be re-evaluated.

A Case of Nasal Angiomyolipoma in Young Man / 대한이비인후과학회지

Angiomyolipoma is a benign tumor that is composed of adipose tissue, blood vessels and smooth muscle. The kidney is the most common site for this tumor. Although extrarenal angiomyolipoma is rarely found in areas other than the kidney, it has been observed in other organs such as liver, heart, mediastinum, spermatic cord, vaginal wall, oral cavity, and so on. Angiomyolipoma in the nasal cavity especially, has been very rarely reported in literature. Furthermore, nasal angiomyolipoma is mostly found in middle aged or old men. In this case, angiomyolipoma was found in a 29-year-old male patient who was the youngest of the reported cases. He complained of nasal obstruction and physical examination revealed a 1.5 cm sized mass in the left posterior part of the nasal septum. The mass was composed of an intimate mixture of mature fat, smooth muscle cells, and thick walled varying sized blood vessels histopathologically coinciding with angiomyolipoma. It was removed via endoscopic surgery without complications.

Incidental Finding of Squamous Cell CarcinomaAccompanying a Fungal Ball in the Maxillary Sinus / 대한이비인후과학회지

Malignant tumors rarely occur in the paranasal sinuses. Paranasal tumors, when they occur, exhibit atypical symptoms, such as nasal obstruction, rhinorrhea, facial pain, and nasal bleeding. Because of nonspecific symptoms commonly observed in the sinusitis and their infrequent occurrence, malignant tumors of the paranasal sinuses are generally diagnosed late. If there is bone destruction or invasion of the surrounding tissues in the imaging studies, malignant tumors could be suspected; however, without such findings, it is difficult to predict the existence of cancer. It is more difficult to suspect malignant tumors when they coexist with sinus diseases. In addition, since the concomitant presence of fungal balls and cancer is extremely rare, it is difficult to suspect the presence of cancer when treating fungal balls. We report a case of a fungal ball accompanied by squamous cell carcinoma without any sign of malignancy, such as bone destruction, which has not been reported in the English literature to date.

Efficacy of Treatment with Coblation Turbinate Reduction in Patients with Allergic Rhinitis Responding to Medication / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effectiveness of turbinate surgery has been well demonstrated in allergic rhinitis refractory to medication. On the contrary, the efficacy of surgery in allergic rhinitis that responds to medication has not been assessed. The aim of this study was to determine the surgical outcomes in patients with allergic rhinitis responsive to medication. SUBJECTS AND METHOD: Patients with allergic rhinitis responsive to medication and those who had undergone coblation turbinate reduction were enrolled in this study. The visual analog scale was used to assess the allergic symptoms before treatment, during medication treatment as well as postoperatively at 6 and 12 months. In addition, the degree of patient satisfaction regarding the surgery was investigated postoperatively at 12 months. RESULTS: Twenty-four patients (mean age=33.6±14.9 years; men-to-women ratio=1:1) were included in this study. During the pretreatment period, all allergic symptoms significantly improved after treatment with both medication and surgery. At 6 months postoperatively, the degree of patients' allergic symptoms was lower than in those treated with medication. However, when compared at 12 months postoperatively, all the symptoms, excluding nasal obstruction, were not significantly different from those who received medication. Surveyed postoperatively at 12 months 54.2% of patients advocated for surgical treatment. CONCLUSION: Although surgery yielded better outcome than did medication during the early postoperative period, there was little difference in the outcome at 12 months postoperatively. Therefore, we need to be careful when choosing surgical intervention for patients with allergic rhinitis responsive to medication.

Comparison of Patient Satisfaction and Complications of Rhinoplasty between Local and General Anesthesia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Since rhinoplasty techniques require meticulous and delicate manipulation, proper anesthesia is essential. The aim of the current study is to compare patient satisfaction and complication of rhinoplasty performed under local anesthesia against general anesthesia. SUBJECTS AND METHOD: Patients who underwent rhinoplasty by a single surgeon between March 2014 and January 2017 were enrolled in this study. Midazolam was utilized to sedate the patient during local anesthesia. Pain and memory of surgery under local anesthesia, satisfaction of anesthesia, and willingness to undergo the surgery with the same anesthesia method again were evaluated. Cardiopulmonary events, nausea, and vomiting were assessed as complications. Aesthetic satisfaction of patients and the doctor was evaluated 6 month after the surgery. The parameters were compared between local and general anesthesia. RESULTS: A total 120 patients were included in this study. The degree of pain was low during surgery under local anesthesia. Although most of patients remembered the process of surgery during local anesthesia, satisfaction of local anesthesia was high. The satisfaction of anesthesia and willingness to undergo surgery with same anesthesia were not signifcantly different between local and general anesthesia. No serious complications developed during local anesthesia and there were no signifcant differences of aesthetic satisfaction between local and general anesthesia. CONCLUSION: Patient satisfaction and aesthetic results of rhinoplasty performed under local anesthesia were comparable to general anesthesia, indicating that surgeons do not need to be afraid of applying local anesthesia in rhinoplasty.

A Case of Solitary Fibrous Tumor in the Cheek

Solitary fibrous tumor is a rare spindle cell neoplasm of mesenchymal origin that occurs most commonly in the pleura. This tumor can be found in various extrathoracic sites that contain soft tissue. There are few reports of solitary fibrous tumors in the head & neck and only 5 cases of solitary fibrous tumors of the cheek have been reported. A 53-year-old man visited our department complaining of a firm mass in the left cheek. We suspected a schwannoma originating from the infraorbital nerve. The mass was removed via a gingivobuccal approach and was diagnosed as a solitary fibrous tumor.

Bone Anchoring for the Correction of Posterior Nasal Septum / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various techniques have been reported for the correction of deviated nasal septum, most of them for caudal septal cartilage. For deviated posterior septal cartilage, the typical method of the day is the resection of deviated portion. However, we developed a bone anchoring technique that conservatively corrects deviated posterior septal cartilage. The aim of the current study is to determine the efficacy of this bone anchoring technique. SUBJECTS AND METHOD: The patients who had undergone septoplasty using bone anchoring technique by a single surgeon (J.S.K) between October 2015 and June 2016 were enrolled in this study. The result of the surgery was evaluated using a visual analogue scale (VAS, ranged 0– 10) for nasal obstruction, acoustic rhinometry, and assessment of surgeon. RESULTS: A total of 44 patients were included in this study. The VAS of nasal obstruction was significantly decreased after surgery from 7.5±1.7 to 2.4±1.4. In acoustic rhinometry, minimal cross-sectional area and volume were increased after surgery from 0.35±0.18 to 0.52±1.40 cm2 and from 3.6±1.1 to 5.8±1.5 cm3, respectively. Most of the deviated septum was well corrected, and complication or recurrence did not developed. CONCLUSION: Bone anchoring technique is easy to perform. It enables the preservation of septal cartilage, which is useful in revision septoplasty or rhinoplasty. We conclude that this technique is a good method for the correction of deviated posterior septal cartilage.

Caloric Test as a Possible Prognostic Indicator in Sudden Deafness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Dizziness has been known as a prognostic factor in sudden sensorineural hearing loss (SSHL), but it is difficult to describe and quantify its subjective symptoms. Also, dizziness itself cannot imply vestibular dysfunction in SSHL. Comprehensive evaluation of vestibular function may help us understand the extent of lesions in sudden deafness. The purpose of this study is to determine whether an impaired caloric response is associated with disease severity and hearing outcome. SUBJECTS AND METHOD: A retrospective chart review was conducted of 488 patients diagnosed as unilateral SSHL. The patients were divided into two, an abnormal caloric group (canal paresis >20%) and normal caloric group (canal paresis ≤20%). Initial demographic and audiologic findings and final hearing outcomes were compared between the two groups. RESULTS: The initial pure tone averages of SSHL patients of abnormal caloric group and normal caloric group were 75.4±28.4 dB HL and 68.2±25.4 dB HL (p=0.004), respectively. Patients of abnormal caloric test group showed worse hearing outcome across all frequencies compared to those of the normal caloric group. Also, a significant correlation was noted between the magnitude of hearing recovery and canal paresis (r=-0.223, p < 0.001). CONCLUSION: SSHL patients of abnormal caloric test showed worse initial hearing level and poorer hearing outcome. Evaluation of vestibular function in SSHL patients is important because subjective symptoms alone cannot account for vestibular hypofunction patients, and the caloric test can help in the counseling of patients and prediction of hearing outcome in SSHL patients.

A Case of Chronic Noninvasive Actinomycosis in the Nasal Cavity / 대한이비인후과학회지

Actinomycosis is a rare anaerobic, gram-positive bacterial infection caused by Actinomyces, which is a normal flora in the gastrointestinal and female genitourinary tracts. The cervicofacial area is a common infection site for actinomycosis, while nasal cavity is rare. Generally, standard treatment of the disease is a long term antibiotics therapy. However, a treatment strategy for nasal actinomycosis has not been established due to its rarity. We present a case of nasal actinomycosis that was managed by surgical removal. A 49-year-old woman visited our clinic with epistaxis and foul odor and nasoendoscopy showed a mass in patient's right nasal cavity. The mass comprised of Actinomyces was easily removed by endoscopic surgery. Further histopathologic examination revealed that the surrounding tissues did not contain Actinomyces, so we stopped applying antibiotics to the patients. No recurrence has been observed for 26 months. We report this rare case of nasal actinomycosis with a literature review regarding treatment.

A Case of Fungal Ball Caused by Retained Glass Foreign Body in Maxillary Sinus for 30 Years

The fungal ball is the most frequent non-invasive form of fungal sinusitis. Some authors have reported opportunistic fungus infections caused by retained foreign bodies in the maxillary sinus. Whereas previously reported foreign bodies were almost always metal materials, we report the case of a fungus ball caused by retained pieces of glass for 30 years. The patient complained of unilateral nasal obstruction. Computed tomography revealed fungal sinusitis and foreign bodies in the left maxillary sinus. The fungus ball and foreign bodies were removed via an endoscopic sinus surgery. After surgical removal, the patient became free from nasal symptoms.

Clinical Characteristics and Treatment of Oroantral Fistula / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Oroantral fistula is an epithelialized communication between the oral cavity and the maxillary sinus. The aim of this study is to investigate the clinical characteristics and treatment of oroantral fistula. SUBJECTS AND METHOD: Patients who have undergone treatment for oroantral fistula between May 1995 and December 2015 were enrolled in this study. The demographic data of these patients and characteristics of oroantral fistula were analyzed. Patients with oroantral fistula were initially administered oral antibiotics for 3 weeks. If fistula persists in spite of the medication, surgery (soft tissue flap with or without bone graft) was performed. The surgical results according to the presence of bone graft were compared. RESULTS: Twenty-two patients were in accordance with the inclusion criteria. The male to female ratio of patients was 12:10, with the mean age of 47.9±13.4 years. The main complaint of patients was pus discharge from the fistula. Two patients were successfully treated with antibiotics whereas 20 patients underwent surgery. Recurrence occurred in 3 patients, who were treated with soft tissue flap, but no recurrence developed in the patients treated with soft tissue flap and bone graft. Although dehiscence of soft tissue flap occurred in one patient treated with bone graft, it was successfully treated by secondary intention without an additional surgery. CONCLUSION: Bone graft bears the negative pressure of the oral cavity and the weight of secretions including the blood. In addition, it induces secondary intention for the dehiscence of the flap. In this regard, bone graft seems to contribute to the surgical success of oroantral fistula.

Burn Injury Caused by Electrosurgical Unit during Adenotonsillectomy / 대한이비인후과학회지

Electrosurgical units are frequently employed during adenotonsillectomies to reduce both operation time and the amount of bleeding. Complications related to electrosurgical units have rarely been reported or taken into consideration by the majority of surgeons during operations. We report a case of an electrosurgical unit induced burn injury during an adenotonsillectomy. More specifically, the injury was a second-degree burn that occurred on the right oral commissure and the lip. The exact cause of the burn was not determined despite a close examination of the electrosurgical unit. An ointment was applied frequently to the lesion to prevent the wound from drying; the wound subsequently healed without any permanent scarring. Preventive methods, such as a thorough inspection of devices prior to surgery, the technique of using the third finger, and the use of a cheek retractor, may be necessary to avoid burn injuries caused by electrosurgical units.

Metastatic Renal Cell Carcinoma in the Paranasal Sinus: A Case Report and Literature Review / 대한이비인후과학회지

Metastatic renal cell carcinoma is very rare, especially in the paranasal sinus. Metastasis to multiple sites and late recurrence frequently occur in renal cell carcinoma. Moreover, typical treatment methods applied to this form of tumor have not produced a good response. Therefore, prognosis of patients with metastatic renal cell carcinoma is typically poor, and a consensus on appropriate treatment methods for these tumors has not been established. Recently, systemic immunotherapy and target therapy were employed to treat the tumor, but they have not been considered as definite treatment methods for metastatic renal cell carcinoma. Since paranasal sinus is surrounded by vital organs, choosing a treatment modality for a tumor in the paranasal sinus is more difficult than in other sites. We present the case of metastatic renal cell carcinoma in the paranasal sinus that was successfully treated by endoscopic surgery with a literature review about treatment methods.

Generalized Myasthenia Gravis with Spasmodic Dysphonia

Myasthenia gravis (MG) is an autoimmune disease that affects neuromuscular junctions and usually manifests with muscle weakness that exhibits diurnal variability. However, MG can present with atypical symptoms, including very rarely cases presenting with a flaccid type of dysphonia. We report the first case of spasmodic dysphonia with a final diagnosis of generalized MG, which occurred in a 32-year-old female.

Oncocytic Sialolipoma of the Submandibular Gland

Sialolipoma, a rare tumor of the salivary gland, is a recently described variant of salivary gland lipoma. Oncocytic sialolipoma was first described by Pusiol et al. in 2009. We report the case of an oncocytic sialolipoma of the submandibular gland in a 43-year-old female. Excision of the tumor was performed with preservation of the submandibular gland. The tumor had a thin, fibrous capsule and consisted of abundant adipose tissue, an oncocytic nodule, and scattered normal glandular structures surrounded by adipose tissue. Four cases of sialolipoma of the submandibular gland, including the present case, were reviewed. All 4 tumors were developed on the right submandibular glands, with a composition of adipose tissue as high as that of sialolipoma of the parotid gland; in contrast to previous reports, three cases were in females. As newly described tumor type, care should be taken to distinguish oncocytic sialolipoma from other salivary gland neoplasms such as simple lipoma, pleomorphic adenoma, or oncocytoma.

Endoscopic Management of Cerebrospinal Fluid Rhinorrhea

Cerebrospinal fluid (CSF) rhinorrhea has become a relatively common disease due to increasingincidents oftraffic accidents and endoscopic sinus surgeries, including skull base surgery. Improvements in surgical skills and endoscopicequipment have contributed to broadening the indicationsforendoscopic management ofCSF rhinorrhea. Precise identification of the etiology and leakage site is important for the treatment of CSF rhinorrhea. A variety of sealing techniques, such as overlay, underlay, and bath-plug, showed similar surgical outcomes. In addition, the type of graft material did not make a difference inthe surgical results. Therefore, thechoice of technique and graft material depends on the judgment of the surgeon. Endoscopic management of CSF rhinorrhea demonstrated anexcellent success rate and low morbidity. There were only few complications duringendoscopic management of CSF rhinorrhea and these were not serious. In conclusion, endoscopic management is effective for CSF rhinorrhea and should be initially considered for the treatment of CSF leakage.

Expiratory Stridor Improved With Positive Airway Pressure Therapy in Multiple System Atrophy-Cerebellar Type

No abstract available.

A Case of Nosocomial Nasal Myiasis in Comatose Patient / 대한이비인후과학회지

A 82-year-old female was injured in a car accident and admitted to the emergency department in a comatose state. The patient was intubated and then transferred to the intensive care unit. After 2 days, live maggots were discovered from both nostrils. The maggots were treated by mechanical removal and irrigation with an antiseptic solution. After treatment of maggots, endoscopic examination revealed no remnant maggot and abnormal lesion in the nasal cavity. On the following day, maggots were retrieved from mouth in spite of a continuous appliance of an antiseptic solution into the nostrils. More careful concerns to nasal and oral hygiene were performed and no other maggots were found. We present the case of myiasis with a literature review of treatment methods of maggot.