A Case of Multiple Myeloma in Bilateral Paranasal Sinuses with Loss of Vision / 대한이비인후과학회지

Plasmacytoma refers to malignant plasma cell tumor, which consists of abnormal proliferation of plasma cells. It can be classified into several types, multiple myeloma, solitary medullary plasmacytoma and extramedullary plasmacytoma according to clinical and histological aspects of the tumor. Multiple myeloma is the most common plasmacytoma and its main feature is the infiltration of plasma cells into the bone marrow. Over 10% of plasma cell count among the nuclear cells in the bone marrow biopsy allows diagnosis of multiple myeloma. This involves multiple organs and extramedullary sites including the spleen, liver, lymph nodes and kidney; however, the involvement of nasal cavity and paranasal sinus is rare. Recently, we experienced a case of multiple myeloma, which was present in both nasal cavities and paranasal sinuses. The case was treated with chemotherapy and radiotherapy followed by autologous bone marrow transplantation. We report on it with literature review.

Endoscopic Repair with Above and Below Technique of Recurrent Cerebrospinal Fluid Leak from the Posterior wall of Frontal Sinus: Case Report

Cerebrospinal fluid (CSF) rhinorrhea can be caused by head trauma, brain or sinus surgery, or neoplastic sinonasal disease. There are many diverse techniques for repairing skull base defects, and recently there has been a shift from using external approaches to endoscopic approaches. The reported success rate after endoscopic repair is 97%, but CSF rhinorrhea may recur in some cases. Recently, we witnessed one case of recurrent CSF rhinorrhea from the posterior wall of the frontal sinus after a traffic accident. The patient was a 48-year-old male and had recurrent CSF rhinorrhea, severe pneumocephalus and mental change even after a CSF leakage repair operation was performed by the neurosurgeon using the periosteal flap. We successfully treated recurrent frontal CSF rhinorrhea with fat graft and mucosal graft, using the above and below approach with the guidance of a navigation system.

A Case of Thyroid Granular Cell Tumor / 대한이비인후과학회지

Granular cell tumor is an uncommon neoplasm that can occur everywhere in the human body. Granular cell tumor of the thyroid gland is very rare and only eight cases of thyroid granular cell tumor have been reported. Histopathologically, granular cell tumor consists of large polygonal cells with small dark nuclei and abundant, fine, granular eosinophilic cytoplasm that show positive immunohistochemical staining using S-100 protein. Surgical excision is the treatment of choice for granular cell tumor. Recurrence is rare, but inadequate resection of granular cell tumor may cause local recurrence. We have experienced one case of thyroid granular cell tumor that we report here with a review of literatures.

Auditory Brainstem Response in Newborns with Hyperbilirubinemia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Neonatal hyperbilirubinemia is one of the important causative factors of sensorineural hearing loss including auditory neuropathy. The auditory brain stem response (ABR) is widely used as a screening or diagnostic tool for newborn hearing loss. This study aimed to analyze serial ABR results of newborns with severe hyperbilirubinemia. SUBJECTS AND METHOD: This study examined 120 full term infants treated for hyperbilirubinemia in the neonatal intensive care unit. The first ABR was performed within one month after birth. Follow-up tests were conducted in patients with abnormal results (25 cases). The control group was composed of 21 healthy newborns who passed the newborn hearing screening. RESULTS: The mean ABR threshold was higher in the newborns with hyperbilirubinemia than in the control group (43.8 dB nHL versus 30.0 dB nHL, p<0.001). Of the 25 newborns who underwent follow-up ABR, 15 newborns demonstrated recovery of the hearing threshold up to 30 dB nHL. The hearing threshold did not improve below 50 dB nHL for five newborns, of whom one was diagnosed with auditory neuropathy spectrum disorder. There was no difference in the mean ABR interwave latency between newborns with hyperbilirubinemia and the control group. CONCLUSION: Neonates with hyperbilirubimenia might suffer transient or permanent hearing loss. Serial ABR tests might be essential for the diagnosis of sensorineural hearing loss in patients with neonatal hyperbilirubinemia.

The Combination Effects of Early Intratympanic Dexamethasone Injection for the Patients with Sudden Sensorineural Hearing Loss

BACKGROUND AND OBJECTIVES: Intratympanic dexamethasone injection (ITDI) offers the potential for directed delivery of high concentrations of steroids to the inner ear while mitigating the risks involved with high doses of systemic steroids. We investigated the effectiveness of combination therapy, sequential early ITDI accompanied with systemic therapy on sudden sensorineural hearing loss (SSNHL). MATERIALS AND METHODS: We gathered 151 SSNHL patient's data, who were refractory to systemic treatment for 5 days. Injection group (n=47) were administered systemic therapy and 4 times of ITDI within 2 weeks after break of SSNHL. Control group (n= 104) only received traditional treatment. We compared last concreted hearing level and recovery rate according to initial hearing level and frequency. RESULTS: Overall hearing improvement was observed in 47 of 104 (45.2%) control patients and in 30 of 47 (63.8%) ITDI patients (p= 0.034). Depending on the degree of initial hearing loss, the patients with severe hearing loss who treated with ITDI showed significant higher recovery rate than control group (83.8% vs. 50.0%)(p=0.049). When we analyzed hearing improvements according to the frequency, clinically significant hearing improvements were observed at lower and mid-frequencies (250, 500 and 1,000 Hz) in the ITDI group than in the control group. CONCLUSIONS: Early combination the-rapy of intratympanic dexamethasone injection within 2 weeks accompanied with initial systemic treatment is effective for patients with refractory SSNHL, especially for patients with severe hearing loss.