Solitary fibrofolliculoma on the nasal septum: a case report

Fibrofolliculoma is a benign, perifollicular, connective tissue tumor that usually arises in the form of multiple lesions; it is rarely seen as a solitary lesion. The lesions are clinically asymptomatic, 2 to 4 mm skin-colored, soft dome-shaped papules. Here, we report a patient who visited our hospital with a palpable lesion on the nasal septum. The lesion did not cause pain upon palpation, and nasal endoscopy confirmed an irregular wart-like lesion measuring 6 × 6 mm in the left anterior nasal septum near the columella. Other otolaryngology findings were normal, and there were no similar lesions in other parts of the body. None of the patient’s family members were known to have had such lesions. An excisional biopsy was performed on the mass for removal of the lesion, and histological examination confirmed the lesion as fibrofolliculoma. We report the first case of solitary fibrofolliculoma in the nasal septum in a healthy 62-year-old woman along with a review of the relevant literature.

Relationship Between Adenotonsillar Size and Snoring Sound: Acoustic Analysis / 대한이비인후과학회지

Background and Objectives@#The most common cause of snoring in children is enlarged tonsils and adenoids. However, there is insufficient evidence to determine whether the subjective measurement of tonsil hypertrophy, the most common prevailing method, reflects the actual tonsil size and volume. Therefore, we tried to determine whether the subjective grading of tonsil size and actual tonsil volume is related, and whether tonsil volume, weight, and adenoid index are correlated with the acoustic analysis of snoring.Subjects and Method The study was conducted on 21 children between the ages of 4 and 15 who came for tonsillectomy and adenoidectomy due to snoring symptoms. The degree of adenotonsillar hypertrophy was measured using the Brodsky grading scale and adenoid index. After tonsillectomy, the volume and weight of resected tonsil were measured. For acoustic analysis, the Praat software was used to determine formant frequency and sound intensity. A linear regression model and a dummy variable were used to determine the correlation between the quantitative values of tonsil, adenoid and the result of acoustic analysis. @*Results@#The Brodsky tonsil grade tended to match the actual tonsil volume, but it was not statistically significant (p=0.073). There was no correlation between snoring intensity and actual tonsil volume, weight, and adenoid index. Formant frequency 1 and 2 were statistically negatively correlated with the actual tonsil volume (p=0.011, 0.002). @*Conclusion@#The study confirmed that the acoustic analysis of pediatric snoring could be a screening test to predict tonsil volume and changes in the vocal tract due to tonsil hypertrophy.

Effect of Body Mass Index on Upper Airway Obstruction as Revealed by Drug-Induced Sleep Endoscopy in Patients With Sleep-Disordered Breathing / 대한이비인후과학회지

Background and Objectives@#Drug-induced sleep endoscopy (DISE) usefully determines the sites of airway obstruction in patients with sleep-disordered breathing. It is widely accepted that obesity increases obstructive sleep apnea. However, no study has explored how and where obesity causes obstructions. In this study, we described the patterns of upper airway obstruction revealed by DISE in patients of various body mass indices (BMIs) with sleep-disordered breathing.Subjects and Method All subjects had sleep-disordered breathing and underwent DISE. Endoscopic findings at the retropalatal (upper lateral, upper anteroposterior [AP]) and retrolingual (lower lateral, lower AP) levels were graded; obstruction was complete (2), partial (1), or none (0). Subjects with BMI 30 group) were compared using a dummy variable; to this end, we employed R ver. 4.0.5. @*Results@#For the total of 153 patients reviewed, the mean age was 43.1±12.2 years and the mean BMI was 26.0±3.4 kg/m2. At the retropalatal AP level, the DISE grade was significantly higher in the 2530 group (p=0.248). At the retropalatal lateral level, significant increases were evident in both of the higher BMI groups (p=0.06 and p=0.024, respectively). No significant relationship was found at the retrolingual level. @*Conclusion@#In terms of the retropalatal AP and lateral diameters, a higher BMI is associated with a greater incidence of more severe obstruction.

Snoring Sound Intensity and Formant Frequencies by Sleep Position in Patients with Positional Obstructive Sleep Apnea / 대한이비인후과학회지

Background and Objectives@#Snoring is the most common symptom of obstructive sleep apnea (OSA) and is caused by turbulent airflow due to narrowing of the upper airways. In patients with positional OSA, a change in sleep posture from supine to lateral is known to reduce snoring and sleep apnea. This study was performed to compare changes in snoring sound intensity and formant frequencies according to sleep position.Subjects and Method A total of 19 patients (male: 18; female: 1) diagnosed with positional OSA by polysomnography (PSG) were enrolled in this study. The snoring sounds recorded during PSG were analyzed acoustically and compared according to sleep position (i.e., supine vs. lateral). @*Results@#Snoring disappeared on changing sleep position in five patients, all of whom had Apnea-Hypopnea Index (AHI) <15. In other patients, the snoring sounds tended to decrease with posture change, and the degree of decrease was inversely proportional to AHI (p=0.015) and respiratory disturbance index (RDI) (p=0.013). Formant frequencies 1, 3, and 4 (F1, F3, and F4, respectively) decreased when sleeping in the lateral position (p=0.02, 0.03, and 0.01, respectively). @*Conclusion@#In patients with positional OSA, a change in sleep posture from supine to lateral during sleep reduced the intensity and frequency of snoring sound.

The Effect of Adenotonsillectomy on Korean Children's Voice / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Adenotonsillectomy is a commonly performed surgical procedure carried out by otolaryngologists for children. Anatomical changes to the vocal tract occur after the surgery and may alter the patient's voice. This study evaluated the effects of adenotonsillectomy on the voice in Korean children.SUBJECTS AND METHOD: total of 20 children who underwent adenotonsillectomy were enrolled. The speech of patients was recorded before and at one month of the surgery and acoustic features, especially the formant frequency, were analyzed. Perceptual analysis was also carried out and the Pediatric Voice Handicap Index (PVHI) questionnaire was used to assess subjective changes in the children's voice and the effects of these changes on social functions.@*RESULTS@#Acoustic analysis revealed significant decreases in the vowel /i/ in the second formant, compact-diffuse, and grave-acute features of the voice (p=0.026, 0.022, and 0.031, respectively). A significant decrease was also observed in the intensity of the voice for the vowel /u/ (p=0.025). Perceptual analysis revealed that 86.6% of patients' voice recordings had post-operative changes. The mean preoperative PVHI score was 2.70±3.37, which decreased to 1.65±2.21 (p=0.011) after the surgery.@*CONCLUSION@#The results suggest that adenotonsillectomy affects Korean children's voices both acoustically and perceptually.

Carotid Arterial Calcium Scoring Using Upper Airway Computed Tomography in Patients with Obstructive Sleep Apnea: Efficacy as a Clinical Predictor of Cerebrocardiovascular Disease

OBJECTIVE: To evaluate the value of airway computed tomography (CT) in patients with obstructive sleep apnea (OSA) as a predictor of cerebrocardiovascular disease (CCVD) clinically, by quantitatively analyzing carotid arterial calcification (CarAC). MATERIALS AND METHODS: This study included 287 patients aged 40–80 years, who had undergone both polysomnography (PSG) and airway CT between March 2011 and October 2015. The carotid arterial calcium score (CarACS) was quantified using the modified Agatston method on each upper airway CT. The OSA severity was categorized as normal, mild, moderate, and severe using the PSG results. Clinical characteristics, comorbid diseases, and lipid profiles of all patients were analyzed, and the prevalence of CCVDs was investigated during the follow up period (52.2 ± 16.0 months). RESULTS: CCVD occurred in 27 patients (9.3%) at the end of follow-up, and the CCVD-present groups showed a significantly older mean age (57.5 years vs. 54.2 years), higher prevalence of hypertension (59% vs. 34%) and CarAC (51.9% vs. 20.8%), whereas sex, other comorbid diseases, and severity of OSA were not significantly different from the CCVD-absent group. A univariate analysis showed that age, hypertension, incidence of CarAC, and CarACS were risk factors for the occurrence of CCVD events. In a multivariate analysis, the incidence of CarAC was the only independent risk factor for CCVD. CONCLUSION: CarAC is an independent risk factor for CCVD, whereas the severity of OSA is not a contributory risk factor in patients with OSA. Therefore, additional analysis of CarACS based on airway CT scans may be useful for predicting CCVD.

Changes in Clinical Characteristics of the Patients Who Received Endoscopic Sinus Surgery according to 10 Year Temporal Difference: A Retrospective Observational Study

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery (ESS) was introduced to Korea in the 1980s and has since developed rapidly. There have been many changes in ESS over this period. Thus, in this paper, we explore trends in the clinical characteristics of ESS. SUBJECTS AND METHOD: We retrospectively reviewed patients who underwent the ESS at 000 Hospital performed by a single surgeon at a 10-year interval. By comparing 106 patients who underwent ESS in 2003 and 108 patients who underwent ESS in 2013, we investigated changes in ESS in terms of the target group of surgical indications, CT scores, range of operation and complications. RESULTS: With regard to surgical indications, the proportion of patients who underwent surgery due to nasal polyps in 2013 (32.4%) was lower than in 2003 (59.4%), while the proportion of patients undergoing fungal sinusitis surgery in 2013 (13.9%) was higher than in 2003 (0.0%). In terms of preoperative CT evaluation, Lund-Mackay scores for the maxillary sinus, ethmoid sinus, and ostiomeatal unit were lower in 2013 than in 2003. The proportion of ESS performed only in the maxillary sinus in 2013 (20.0%) was higher than in 2003 (10.0%). CONCLUSION: According to this study, the range and extent of sinusitis was favorable in 2013 compared to in 2003. The group of patients requiring treatment for only maxillary sinus disease accounted for a larger proportion of patients in 2013 than in 2003.

A Case of Endoscopic Reconstruction of Skull Base Defect Combined with Meningoencephalocele in the Sphenoid Sinus / 대한이비인후과학회지

A skull base defect mainly occurs as a result of congenital defect, trauma, iatrogenic injury, inflammatory erosion, increased intracranial pressure or neoplasm. Meningoencephalocele is one of them resulting in skull base defects. Among the several types of meningoencephalocele, protrusion to lateral wall of sphenoid sinus in the basal type is less frequently encountered than other types and has not been reported in Korea. We report a patient with meningoencephalocele protruded to sphenoid sinus wall. It was successfully repaired with nasoseptal flap through the intranasal endoscopic approach.

Assessing Olfactory Function in Healthy Korean Children Using the Cross-Cultural Smell Identification Test and Butanol Threshold Test / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are no reported studies of olfactory function of Korean children, and the existing tests of olfactory function for Korean adults may not be suitable for very young children. This study assessed the applicability of the Butanol Threshold Test (BTT) and Cross-Cultural Smell Identification Test (CC-SIT) to children. SUBJECTS AND METHOD: A total of 79 children were included in the study: they were between 6-12 years of age, and had visited University Hospital Health Care Center between January 2012 and December 2013. All children were administered the BTT and CC-SIT. RESULTS: Using BTT, 69.62% of the sample was classified as moderate hyposmia. On the other hand, when CC-SIT was used, 45.57% of the sample was classified as moderate and 43.04% as mild hyposmia. CC-SIT and BTT scores were not correlated. Although gender and age were not taken into account in the test results, the CC-SIT could measure age-specific olfactory development. CONCLUSION: Our study provides fundamental data on the clinical use of the CC-SIT and BTT in healthy Korean children.

A Case of Image-Guided Surgery in Congenital Aural Atresia / 대한이비인후과학회지

The repair of congenital aural atresia remains one of the most challenging otologic procedures because of the scarcity of surgical landmarks, the complexity and the variety of the temporal bone anatomy, and the limited space for reconstruction. The risks of facial nerve injury and profound sensorineural hearing loss following atresia surgery are common concerns. Furthermore, the rarity of the disease makes it difficult to improve surgical learning. Image-guided surgery may aid otologic surgeons in repairing atresia as it allows identifying the exact position of surgical instruments in relation to the specific anatomy. To our knowledge, there have been no published reports on image-guided atresia surgery in Korea. Herein, we report a case of congenital aural atresia, which was repaired using image-guided surgical technique.

A Case of Nasal Schwannoma Coexisting with Epidermal Cyst / 대한이비인후과학회지

Schwannomas of the sinonasal tract are very rare benign neoplasm, which can arise from nerve sheath containing Schwann cells. Epidermal cysts are also rarely present in nasal cavity. They are thought to be congenital lesion associated with various craniofacial disorders or arise as a result of implantation of epidermal cells into the deeper dermal element. Several cases of the nasal schwannoma or epidermal cyst have been reported repectively, however nasal schwannoma with epidermal cyst never has been reported yet. We report the first case of nasal schwannoma which is coexists with epidermal cyst at the superior turbinate of the nasal cavity.

Brown Tumor of the Humerus Associated with Secondary Hyperparathyroidism: A Case Report of Successful Treatment after Subtotal Parathyroidectomy / 대한내분비외과학회지

Brown tumor is a bone disease that arises in the setting of increased osteoclastic activity and fibroblastic proliferation in the involved bone. It is well recognized as serious complication of hyperparathyroidism. Brown tumor is uncommon, and brown tumor with secondary hyperparathyroidism resulting from chronic renal failure has rarely been reported. We recently experienced a case of a 28-year-old Korean woman with chronic renal failure caused by chronic glomerulonephritis, on hemodialysis for nine years. She has been hospitalized with left shoulder pain for two years. Image studies showed multiple cystic masses, and both suspicious marked thinning and partial destruction of the cortex on the head of the left humerus. Histopathologic analysis of the mass lesion showed a fibrotic capsule, hemosiderin pigmentation, and giant cell, all characteristic of brown tumor. A subtotal parathyroidectomy was done without surgery of the bony lesion (brown tumor), with successful results. We report this case with a brief review of the literature.

Rhinosinusitis and Olfactory Dysfunction in HIV-Infected Patients

The prevalence of HIV infection is gradually increasing every year. Rhinosinusitis and complaints in relation to olfactory dysfunction are common in HIV-infected patients. These are rarely life-threatening but otolaryngologist should treat these patients aggressively, because rhinosinusitis and olfactory dysfunction can have a negative impact on the patients'quality of life. This paper covers these issues so that otolaryngologists may reasonably prevent, diagnosie, and treat persons suffering from rhinosinusitis and olfactory dysfunction related to HIV infection.

Rhinosinusitis and Olfactory Dysfunction in HIV-Infected Patients

The prevalence of HIV infection is gradually increasing every year. Rhinosinusitis and complaints in relation to olfactory dysfunction are common in HIV-infected patients. These are rarely life-threatening but otolaryngologist should treat these patients aggressively, because rhinosinusitis and olfactory dysfunction can have a negative impact on the patients'quality of life. This paper covers these issues so that otolaryngologists may reasonably prevent, diagnosie, and treat persons suffering from rhinosinusitis and olfactory dysfunction related to HIV infection.

Headache and Facial Pain in Rhinologic Field : A 1 Year Experience

BACKGROUND AND OBJECTIVES: Sinus headaches are frequently mistaken as primary headaches, and thus, emphasizes the necessity of a specific diagnosis of symptoms to treat patients properly. Therefore, the authors investigated the specific clinical symptoms of patients who visited a rhinologist complaining of headaches or facial pain. SUBJECTS AND METHODS: The present study was performed with retrospective clinical analysis of 990 patients who visited rhinologists from August 2010 to August 2011. The presence and characteristics of headaches or facial pain, physical findings, and the results of treatment were investigated. RESULTS: One hundred sixteen out of 990 rhinologic patients complained of headaches or facial pain. Nineteen out of 69 patients with acute rhinosinusitis (27.5%), 28 out of 317 patients with chronic rhinosinusitis (8.8%), 7 out of 11 patients with fungal sinusitis (63.6%), and 10 out of 222 patients with allergic rhinitis (4.5%) had headaches or facial pain. The symptoms of the majority of cases were ameliorated after an appropriate rhinologic treatment. CONCLUSION: The differential diagnosis of diseases causing headache or facial pain in the rhinologic field should be strongly considered in order to cure patients with headaches more accurately, minimizing erroneous prescriptions.

A Case of Mature Teratoma Originating from Eustachian Tube

Teratoma is a tumor derived from totipotential cells and composed of tissues originating from all 3 germinal layers. The tumor can be malignant based on histologic differentiation, size and location and is commonly found in the sacrococcygeal region, but uncommonly occurs in the head and neck region. A mature teratoma rarely occurs in the Eustachian tube. The authors of the current study present a case of a mature teratoma originating from the Eustachian tube of a 23-year-old woman who complained of left otorrhea. In addition, a review of the literature is presented.

A Case of Hemangiopericytoma Occurring in the Infratemporal Fossa / 대한이비인후과학회지

Hemangiopericytoma is an uncommon vascular tumor in the head and neck region that originates from Zimmerman's pericytes, the small, spindle-shaped pericapillary cells. Clinical diagnosis of such a lesion is an extremely challenging task because there are very few detailed reports of such lesions and one would hardly think of a diagnosis such as hemangiopericytoma while examining a lesion. Only 15% of hemangiopericytomas are localized in the cervicofacial region, with occurrence in the infratemporal fossa is particularly exceptional. In this article, we report an unusual case of hemangiopericytoma originating from the right infratemporal area and extending into the pterygomaxillary fissure, the buccal fat pad, and the hard palate. We present a case of infratemporal fossa hemangiopericytoma that was treated by resection of the transantral approach.