Obesity is positively related and tobacco smoking and alcohol consumption are negatively related to an increased risk of thyroid cancer.

The purpose of this study was to evaluate the relationships of smoking, alcohol consumption, and obesity with thyroid cancer in Korean residents. The Korean National Health Insurance Service-Health Screening Cohort includes individuals ≥ 40 years who were assessed from 2002 to 2013. In total, 4977 thyroid cancer participants were matched with respect to age, sex, income, and region of residence with 19,908 controls at a ratio of 1:4. Crude and adjusted (for the Charlson comorbidity index, smoking status, frequency of alcohol consumption, and obesity) odds ratios (ORs) were analyzed using conditional logistic regression analyses. Additionally, 95% confidence intervals (CIs) were calculated. The adjusted OR of smoking for thyroid cancer was 0.62 (95% CI 0.54-0.72, P < 0.001), and that of alcohol consumption was 0.83 (95% CI 0.75-0.92, P < 0.001). The adjusted ORs of the BMI categories were 1.13 (95% CI 1.05-1.22, P = 0.002) for obese I, and 1.24 (95% CI 1.04-1.47, P = 0.014) for obese II. The ORs of smoking and alcohol consumption were lower, and those of overweight and obesity were higher in thyroid cancer patients than in individuals in the control group.

A population-based study on the association between rheumatoid arthritis and voice problems.

The objective of this study was to investigate whether rheumatoid arthritis increases the frequency of organic laryngeal lesions and the subjective voice complaint rate in those with no organic laryngeal lesion. We performed a cross-sectional study using the data from 19,368 participants (418 rheumatoid arthritis patients and 18,950 controls) of the 2008-2011 Korea National Health and Nutrition Examination Survey. The associations between rheumatoid arthritis and organic laryngeal lesions/subjective voice complaints were analyzed using simple/multiple logistic regression analysis with complex sample adjusting for confounding factors, including age, sex, smoking status, stress level, and body mass index, which could provoke voice problems. Vocal nodules, vocal polyp, and vocal palsy were not associated with rheumatoid arthritis in a multiple regression analysis, and only laryngitis showed a positive association (adjusted odds ratio, 1.59; 95 % confidence interval, 1.01-2.52; P = 0.047). Rheumatoid arthritis was associated with subjective voice discomfort in a simple regression analysis, but not in a multiple regression analysis. Participants with rheumatoid arthritis were older, more often female, and had higher stress levels than those without rheumatoid arthritis. These factors were associated with subjective voice complaints in both simple and multiple regression analyses. Rheumatoid arthritis was not associated with organic laryngeal diseases except laryngitis. Rheumatoid arthritis did not increase the odds ratio for subjective voice complaints. Voice problems in participants with rheumatoid arthritis originated from the characteristics of the rheumatoid arthritis group (higher mean age, female sex, and stress level) rather than rheumatoid arthritis itself.

Evaluation of the prevalence of and factors associated with laryngeal diseases among the general population.

OBJECTIVES/HYPOTHESIS: Despite the high prevalence of voice disorders, the prevalence of laryngeal disease in the general population has not been determined using laryngoscopy. Factors considered associated with laryngeal disease have mostly been assessed using patient data or highly specific populations. We evaluated the prevalence of and associated factors with laryngeal diseases in the general Korean population. STUDY DESIGN: Cross-sectional study. METHODS: We analyzed data from the Korea National Health and Nutrition Examination Survey for 19,039 participants assessed between 2008 and 2011. The prevalence, subjective discomforts rates of, and odd ratios (demographics, life-style factors, and diseases factors) for laryngeal disease were analyzed using simple and multiple logistic regression analyses, taking into account the complex sampling structure of the data. RESULTS: The top five laryngeal diseases in prevalence were laryngitis (3,513/100,000), vocal nodules (1,487/100,000), vocal polyp (404/100,000), Reinke's edema (347/100,000), and epiglottic cyst (296/100,000). Prevalence of laryngeal disease was higher in males, whereas the rate of subjective voice complaints was higher in females. In the logistic regression analysis, gender was not associated with laryngeal diseases after adjusting for other factors. We observed a positive association between low body mass index (BMI) and vocal nodules, and between high BMI and laryngitis, smoking and epiglottic cyst/hyperkeratosis/laryngeal cancer, higher education level and vocal nodules, and allergic rhinitis and vocal nodules/laryngitis/epiglottic cyst. CONCLUSIONS: The rate of subjective voice complaints and laryngeal disease co-occurrence was low. This study provides more reliable information of laryngeal disease because it includes participants without subjective complaints. LEVEL OF EVIDENCE: 2b.

Analysis of various risk factors predisposing subjects to allergic rhinitis.

BACKGROUND: In Korea, the prevalence of allergic rhinitis (AR) is increasing, as in other industrialized countries. However, no large population-based study defining risk factors for AR has yet been conducted. OBJECTIVE: The purpose of this study was to evaluate the prevalence and risk factors of AR in large population-based study. METHODS: A cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey. We evaluated data from 31,217 subjects who were interviewed between 2008 and 2011. RESULTS: The prevalence of AR decreased with age (adjusted odds ratio [AOR] = 0.985; 95% CI = 0.984-0.987). Higher-level stress (AOR for severe stress = 1.470; 95% CI = 1.209-1.788); asthma (AOR = 1.868; 95% CI = 1.582-2.205); atopic dermatitis (AOR = 1.552; 95% CI = 1.309-1.841); pulmonary tuberculosis (AOR = 1.320; 95% CI = 1.119-1.555); depression (AOR = 1.250; 95% CI = 1.117-1.400); and thyroid disease (AOR = 1.328; 95% CI = 1.104-1.597) increased the risk of AR. Participants whose parents had a history of AR also had higher AORs (father, AOR = 1.566; 95% CI = 1.130-2.172; mother, AOR = 1.546; 95% CI = 1.190-2.008). Marriage (AOR = 0.846; 95% CI = 0.741-0.966) decreased the risk of AR. Farmers, fishers, laborers, and soldiers were at lower risk of AR. Although high BMI, a high educational level, living in a large household, specific types of daily living, and a history of diabetes mellitus have been reported as risk factors for AR; none of these factors attained statistical significance in the present study. CONCLUSION: Our study revealed that age, stress level, marriage, occupation, asthma, atopic dermatitis, pulmonary tuberculosis, depression, thyroid disease, and parental AR history, all affected the prevalence of AR. We believe that defining the influence of various factors on AR will help to prevent development of the condition in the future.

Analysis of the prevalence and associated risk factors of tinnitus in adults.

BACKGROUND: Tinnitus is a common condition in adults; however, the pathophysiology of tinnitus remains unclear, and no large population-based study has assessed the associated risk factors. The aim of this study was to analyze the prevalence and associated risk factors of tinnitus. METHODS: We conducted a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey, with 19,290 participants ranging in age from 20 to 98 years old, between 2009 and 2012. We investigated the prevalence of tinnitus using a questionnaire and analyzed various possible factors associated with tinnitus using simple and multiple logistic regression analysis with complex sampling. RESULTS: The prevalence of tinnitus was 20.7%, and the rates of tinnitus associated with no discomfort, moderate annoyance, and severe annoyance were 69.2%, 27.9%, and 3.0%, respectively. The prevalence of tinnitus and the rates of annoying tinnitus increased with age. The adjusted odds ratio (AOR) of tinnitus was higher for females, those with a smoking history, those reporting less sleep (≤ 6 h), those with more stress, those in smaller households, those with a history of hyperlipidemia osteoarthritis, rheumatoid arthritis, asthma, depression, thyroid disease, an abnormal tympanic membrane, unilateral hearing loss, bilateral hearing loss, noise exposure from earphones, noise exposure at the workplace, noise exposure outside the workplace, and brief noise exposure. Additionally, unemployed individuals and soldiers had higher AORs for tinnitus. The AOR of annoying tinnitus increased with age, stress, history of hyperlipidemia, unilateral hearing loss, and bilateral hearing loss. CONCLUSIONS: Tinnitus is very common in the general population and is associated with gender, smoking, stress, sleep, hearing loss, hyperlipidemia, osteoarthritis, rheumatoid arthritis, asthma, depression, and thyroid disease history.

Increasing thyroid cancer rate and the extent of thyroid surgery in Korea.

BACKGROUND: It is evident that the rate of thyroid cancer is increasing throughout the world. One reason is increased detection of preclinical small cancers. However, it is not clear whether the increase in thyroid cancer rate is reducing the extent of thyroid surgeries. The purpose of this study was to evaluate the thyroid cancer rate and analyze recent changes in the extent of thyroid cancer surgeries in Korea. METHODS: An observational study was conducted using data from Korea's Health Insurance Review and Assessment Service (HIRAS) for thyroidectomy with/without neck dissection, with 228,051 registered patients between 2007 and 2011. Data were categorized by the extent of surgery: unilateral thyroidectomy without neck dissection (UT), bilateral thyroidectomy or radical thyroidectomy without neck dissection (TT), any thyroidectomy with unilateral selective neck dissection (SND), any thyroidectomy with unilateral modified radical neck dissection (MRND), any thyroidectomy with unilateral radical neck dissection (RND), and any thyroidectomy with bilateral neck dissection (BND). Annual rate difference for each surgery was analyzed with a linear by linear association. RESULTS: The absolute numbers of total thyroid surgeries (UT+TT+SND+MRND+RND+BND) were increased from 28539 to 61481. The proportion of patients who underwent only thyroidectomy without neck dissection (UT+TT) decreased from 67.30% to 60.50%, whereas the proportion of patients who underwent neck dissection (SND+MRND+RND+BND) increased from 32.70% to 39.50% during the 5-year study period. CONCLUSION: Despite the increase in rate of thyroid cancer due to earlier detection, increased rate of neck dissection was noted.

Analysis of incidence and genetic predisposition of preauricular sinus.

OBJECTIVES: To evaluate the incidence of preauricular sinus, the association between preauricular sinus of a parent and their children, and the odds of hearing impairments in patients with preauricular sinus. METHODS: A cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey. We evaluated data from 23,533 subjects who were interviewed between 2010 and 2012. RESULTS: The incidence of unilateral preauricular sinus was 1.3% and that of bilateral preauricular sinus was 0.3%. Female gender was statistically associated with preauricular sinus (adjusted odd ratio, AOR=1.401). There was no statistical difference between right- and left-sided preauricular sinus. There was an association between parents and their children for bilateral preauricular sinus (AOR of father's bilateral preauricular sinus=35.711; AOR of mother's bilateral preauricular sinus=7.683), but there was no association found for unilateral preauricular sinus. There was no link found between hearing impairment and preauricular sinus. CONCLUSION: This large population-based study provides reliable information about the incidence of preauricular sinus, the association between preauricular sinus in parents and their children, and the lack of an association with hearing impairment; these results can help clinicians in the management of their patients.

Selective embolization for hypervascular metastasis from differentiated thyroid cancer: a case series.

INTRODUCTION: The technique of selective embolization has been applied for years in the treatment of vascular anomalies, severe hemorrhage, and for benign and malignant tumors. Some hypervascular skeletal metastases are prone to massive hemorrhage. CASE PRESENTATION: We describe the cases of two patients with thyroid carcinoma presenting with neuromuscular symptoms due to large skeletal metastases in the shoulder and sternum respectively. Pre-operative percutaneous selective catheterizations of the arteries feeding the metastatic tumors were performed, followed by infusion of gelfoam. The procedures were technically successful in both patients without adverse effects or bleeding. Complete resections of the skeletal metastases were then performed without substantial bleeding. CONCLUSION: Selective embolization is an effective treatment for bony metastases from thyroid cancer.

CXCR4 antagonist inhibits perineural invasion of adenoid cystic carcinoma.

AIM: Perineural invasion and expression of CXCR4 is characteristic of adenoid cystic carcinoma (ACC). Herein, we aimed to demonstrate CXCR4 expression in ACC, identify its association with perineural invasion and investigate the impact of CXCR4 inhibitor in vitro and in a murine perineural invasion model. METHODS: Expression of CXCR4 was assessed in ACC cell lines and in human tissue. The effects of gene knockdown using siRNA and specific blocker of CXCR4 (AMD3100) were evaluated in vitro. A preclinical perineural invasion model was developed using BALB/c nude mouse. The effect of AMD3100 was evaluated in vivo. RESULTS: CXCR4 was highly expressed in aggressive strains of ACC in vitro, in the tumour in the animal model and in the tumour of human tissue. SDF-1 expression was also demonstrated in the nerve of murine and human tissue. Gene knockdown by siRNA and inhibition by a CXCR4-specific inhibitor AMD3100 effectively abrogated invasion but not proliferation of ACC in vitro. The rate of perineural invasion was significantly decreased with AMD3100 treatment in the animal model. CONCLUSIONS: CXCR4 is associated with perineural invasion in ACC. AMD3100, which can effectively diminish perineural invasion of ACC, may have an adjuvant role in the management of ACC.

Analysis of the prevalence of and risk factors for tinnitus in a young population.

BACKGROUND: Tinnitus in children and adolescents is known to be as common as in adults. However, tinnitus in this young population is often overlooked, and a large population-based study designed to adjust for various risk factors for tinnitus is lacking. METHODS: A cross-sectional study was conducted using data from the Korea National Health and Nutrition Examination Survey, with 3047 participants aged 12 to 19 years, from 2008 through 2011. We investigated the tinnitus prevalence by questionnaire and analyzed risk factors for tinnitus of three types: personal, otologic, and parental factors. RESULTS: The prevalence of tinnitus in the young population was 17.7%, although only 0.3% of subjects reported severe discomfort caused by tinnitus. The tinnitus prevalence increased with age (adjusted odds ratio [AOR], 1.087). Female gender (AOR, 1.401), sleeping less than 9 hours (sleep 7 or 8 h: AOR, 1.437; sleep 6 h or less: AOR, 1.737), noise exposure in other places (AOR, 6.395), and momentary noise exposure (AOR, 5.504) increased the risk of tinnitus. Participants whose mother had a history of tinnitus showed higher AORs. However, high body mass index, alcohol consumption, stress, monthly household income, having an abnormal tympanic membrane, unilateral or bilateral hearing loss, noise exposure caused by earphone, and noise exposure in the workplace, all reported risk factors for tinnitus, showed no statistically significant difference. A tinnitus history in the father was also not associated with tinnitus in children. CONCLUSION: We believe that understanding the influences of these factors will help in preventing tinnitus.

Follicular thyroid carcinoma presenting as bilateral cheek masses.

Mandibular metastasis of thyroid carcinoma is extremely rare. We present the case of a 46-year-old woman who had bilateral huge cheek masses that had grown rapidly over several years. Intra-oral mucosal tissue biopsy and imaging work-up including computed tomography scan and magnetic resonance imaging were performed and the initial diagnosis was presumed to be central giant cell granuloma. Incidentally detected thyroid lesions were studied with ultra-sonography guided fine needle aspiration and diagnosed as simple benign nodules. Due to continuous oral bleeding and the locally destructive feature of the lesions, we decided to excise the mass surgically. To avoid functional deficit, a stepwise approach was performed: Firstly, the larger left mass was excised and the mandible was reconstructed with a fibular free flap. The final pathologic diagnosis was follicular thyroid cancer. Postoperative I-131 thyroid scan and whole body positron-emissions-tomography were performed. Right side mass was revealed as a thyroid malignancy. Multiple bony metastases were detected. Since further radioactive iodine therapy was required, additional total thyroidectomy and right side mandibulectomy with fibular free flap reconstruction was performed. The patient also underwent high dose radioactive iodine therapy and palliative extra-beam radiotherapy for the metastatic lumbar lesion. Follicular thyroid carcinoma should be considered as a differential diagnosis for mandibular mass lesions.

Sunitinib inhibits papillary thyroid carcinoma with RET/PTC rearrangement but not BRAF mutation.

Sunitinib, a multi-targeted tyrosine kinase inhibitor, is frequently incorporated into the management of papillary thyroid carcinoma refractory to standard therapies. Although clinical trials are in progress, the mechanism of action in papillary thyroid carcinomas is not clear, especially regarding the effect on BRAF mutation. We investigated the effect of sunitinib on papillary thyroid carcinoma cells harboring RET/PTC rearrangement and BRAF mutation using TPC-1M, SNU-790, and B-cPAP cell lines. Cell growth of papillary thyroid cancer cells with RET/PTC rearrangement was effectively inhibited at low doses of sunitinib (IC50=0.658 µM), whereas that of BRAF mutated cells required higher doses. Immunoblotting revealed effective blocking of MEK/ERK pathway in RET/PTC rearrangement cells, but not in BRAF mutated cells. Cell cycle analysis showed G1 arrest in RET/PTC rearrangement cells. In vivo orthotopic thyroid cancer mouse model demonstrated statistically significant tumor growth inhibition by sunitinib in RET/PTC rearrangement cancer cells. We conclude that sunitinib effectively inhibits RET/PTC rearrangement cells but not BRAF mutated cells. These data suggest that sunitinib exerts its effect by inhibiting the upstream MAPK signaling cascade. These findings support the unsatisfactory treatment outcomes of sunitinib in many already ongoing clinical trials compared to other tyrosine kinase inhibitors. Clinical application of sunitinib should be directed accordingly.

Surgical management of locally advanced thyroid cancer.

PURPOSE OF REVIEW: To summarize recent literature with respect to locally invasive thyroid cancer and discuss the variety of surgical management techniques according to the sites involved. RECENT FINDINGS: Different philosophies for surgical strategy in patients with locally invasive thyroid cancer still exist. Intraoperative neuromonitoring assessment of the functional status of the recurrent laryngeal nerve is helpful to decide surgical extent. A staging system based on the degree of invasion has been suggested for the proper management of laryngotracheal invasion. SUMMARY: The goal of treatment of locally invasive thyroid cancer is to maximize local control and overall survival while minimizing the morbidity of a radical resection or preserving function of adjacent vital structures with conservative procedures. It is imperative that the operating surgeon be familiar with an algorithm for the appropriate workup and surgical planning. In addition, various factors such as the patient's age, tumor biology and histopathology, previous response to treatment, presence of distant metastasis, or adjuvant therapy can affect the extent of surgical resection.

Calcium hydroxylapatite injection laryngoplasty for the treatment of presbylaryngis: long-term results.

OBJECTIVES/HYPOTHESIS: Presbylaryngis is a normal part of the aging process, but many people visit hospitals with communication difficulties. The authors evaluated the efficacy of calcium hydroxylapatite (CaHA) injection laryngoplasty in patients with presbylaryngis. STUDY DESIGN: Retrospective review. METHODS: Thirty-three patients with diagnosed presbylaryngis were administered a CaHA injection, and 17 of these patients without other vocal pathologies were included in the analysis. All 17 were male (mean age 65.9 years), mean follow-up duration was 335 days, and all injections were performed through the cricothyroid membrane under local anesthesia in a clinic. RESULTS: Subjective ratings, perceptual ratings, maximum phonation time, and closed quotients significantly improved after injection, and these improvements persisted without significant change for over 12 months. No major complications were encountered except for transient hematoma, pain, and a foreign body sensation. CONCLUSIONS: The authors conclude that CaHA injection laryngoplasty offers an effective and safe means of treating presbylaryngis.

Nasal polyps: An independent risk factor for bronchial hyperresponsiveness in patients with allergic rhinitis.

BACKGROUND: Many studies were conducted to figure out the relationship between allergic rhinitis (AR) and lower airway diseases. This study was designed to elucidate the clinical parameters that could predict the coexistence of bronchial hyperresponsiveness (BHR) in AR and suggest a guideline for lower airway evaluation in these patients. METHODS: One hundred seventy-three patients newly diagnosed with AR were evaluated for the lower airway with the methacholine bronchoprovocation test. RESULTS: BHR was more prevalent in patients with nasal polyps (p = 0.01), in patients complaining of moderate to severe symptoms (p = 0.023), with higher serum total IgE levels (p = 0.001), and with blood eosinophil count (p = 0.008). No statistically significant difference was observed between intermittent and persistent AR patients (p = 0.364). Blood eosinophil count that could predict BHR was calculated as 320 cells/µL (p = 0.004). CONCLUSION: Instead of a routine lower airway evaluation for all AR patients, we recommend lower airway evaluation for the selected patients with nasal polyps, moderate to severe symptoms, and high blood eosinophil count.

Factors related to regional recurrence in early stage squamous cell carcinoma of the oral tongue.

OBJECTIVES: This study analyzed various clinical and histopathologic factors for patients with early stage squamous cell carcinoma (SCC) of the oral tongue to define a high risk group for regional recurrence and finally to find out the indication of elective neck dissection (END). METHODS: Retrospective chart review was performed for 63 patients with T1-T2N0 SCC of the oral tongue who underwent partial glossectomy with/without END. Clinical and histopathologic factors assessed were age, gender, clinical T stage, tumor cell differentiation, depth of invasion, pathologic nodal status, and intrinsic muscle involvement, perineural invasion, lymphovascular emboli and resection margin involvement. RESULTS: Five year overall survival rate was 97.1% in stage I and 76.2% in stage II, and 5-yr disease free survival rate was 76.7% in stage I and 43.5% in stage II. Rates of occult nodal metastasis in stage I and II were 15.4% and 42.9%, respectively. Overall regional recurrence rate was 15.9%, which consisted of 10.2% in stage I and 35.7% in stage II. The success rate of salvage treatment was 100% in stage I and 40% in stage II. Higher T stage, higher histologic grade, depth of invasion >/=3 mm, presence of intrinsic muscle involvement were significantly related to regional recurrence (P=0.035, P=0.011, P=0.016, P=0.009, respectively). In stage I, the non-END group (n=36) showed 13.9% of regional recurrence rate, while END group (n=13) did not have any regional recurrence (P=0.198). Five year disease free survival rate of END group was significantly higher than non-END group (100% and 68.7%, respectively, P=0.045). CONCLUSION: We recommend to perform END in early stage SCC of the oral tongue if the primary tumor has T2 stage, and T1 stage with higher histologic grade, depth of invasion more than 3 mm, or presence of intrinsic muscle involvement.

Primary and secondary fungal infections of the paranasal sinuses: clinical features and treatment outcomes.

CONCLUSION: In a retrospective study of 239 cases of fungal sinusitis, noninvasive paranasal sinus aspergillosis was most common and successfully treated by endoscopic sinus surgery (ESS) with postoperative sinus irrigation. For the treatment of fungal sinusitis, ESS with or without antifungal agents and control of predisposing factors for secondary cases are recommended. OBJECTIVE: The aim of this study was to investigate the clinical characteristics of fungal sinusitis and evaluate the treatment outcomes of primary and secondary fungal infections of the paranasal sinuses. MATERIALS AND METHODS: Two hundred thirty-nine cases of fungal infection of the paranasal sinuses seen between January 1997 and December 2006 were retrospectively analyzed by reviewing their medical records. There were 200 cases of primary fungal infection and 39 cases of secondary fungal infection. RESULTS: The symptoms of chronic rhinosinusitis such as nasal obstruction, purulent rhinorrhea, and postnasal drip were commonly present in both primary and secondary infections, and the sphenoid sinus was commonly involved in secondary infection. The radiological findings in fungal sinusitis included haziness, calcification, and bone destruction of the involved sinuses. CT scans in 80% of the primary and 69% of the secondary cases revealed calcific densities in a paranasal soft tissue mass. Twenty-eight of 38 cases which had MR showed decreased signal intensities on T1-weighted images and markedly reduced signal intensities surrounded by bright signal on T2-weighted images. In secondary cases, the most common concomitant disease was diabetes mellitus. All patients received surgery including biopsy, ESS, and Caldwell-Luc's operation. Mucosal hypertrophy with fungus ball, which was the most common finding in both types, was found in 124 cases (62%) with primary and in 26 cases (67%) with secondary cases, and aspergillosis was most common, followed by unidentifiable colony, and mucormycosis. Eleven cases received amphotericin-B postoperatively. Two hundred thirty-eight cases showed no recurrence during the mean follow-up period of 11 months.