Long-term Subjective and Objective Outcomes of Adenotonsillectomy in Korean Children With Obstructive Sleep Apnea Syndrome

OBJECTIVES: Adenotonsillar hypertrophy is the most common etiology in pediatric obstructive sleep apnea syndrome (OSAS), and adenotonsillectomy is the mainstay of treatment modalities. This study evaluates the long-term effectiveness of adenotonsillectomy in children with OSAS. METHODS: Subjective symptoms evaluated with a 7-point Likert scale and objective respiratory disturbances evaluated by polysomnography were compared before and after adenotonsillectomy. RESULTS: A total of 17 children with OSAS aged 4-15 years (mean age, 6.65+/-3.02 years; male:female, 13:4) completed the study. The mean follow-up period was 57 months (range, 30 to 98 months). Significant changes were found in apnea-hypopnea index (from 12.49+/-12.96 to 1.96+/-2.01, P<0.001), apnea index (from 5.64+/-7.57 to 0.53+/-0.78, P=0.006), minimum SaO2 (from 81.88+/-14.36 to 92.76+/-4.31, P=0.003), snoring (from 43.28+/-70.63 to 10.70+/-13.72, P=0.042), and arousal index (from 19.58+/-7.57 to 11.36+/-3.99, P=0.006) after adenotonsillectomy. Significant changes were also found after surgery in most of symptoms including snoring, witnessed apnea, morning headache, mouth breathing, gasping during sleep, restless sleep, nasal obstruction, and difficulty with morning arousal. Long-term surgical cure rate and response rate were 47.1% (8/17) and 70.6% (12/17), respectively. CONCLUSION: Most of subjective OSAS symptoms and objective respiratory disturbances improved continuously about 5 years after adenotonsillectomy in children with OSAS. However, close follow-up and a sufficient observation period are necessary because of the risk for long-term incomplete resolution.

Comprehensive Comparison between Snoring and Non-Snoring Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Snoring is very common among children; however, there is a controversy regarding its effects on children. The purpose of this study is to identify risk factors and comorbidities associated with the condition collectively. SUBJECTS AND METHOD: 208 children were invited to participate in this study. Parents were surveyed for each child's snoring status, chronic rhinitis, behavior, and the parents' snoring and smoking status. Measurements were taken of each child's height, weight, waist and neck circumference, and blood pressure. X-rays and physical exams were used to record tonsil and adenoid size. All children also received an intelligence test and comprehensive blood test. Results were then compared between snoring and non-snoring children. RESULTS: Among 208 children, 175 participated in the study voluntarily. Out of the participants, 55 were snorers and 120 were non-snorers. Body mass index, neck and waist circumferences, and prevalence of chronic rhinitis were higher among the snorer. Mothers of snoring children snored more frequently. Inattention and impulsivity scores were also higher among snorers than non-snorers. There were no differences of cognition, tonsil or adenoid size, or blood test results between the two. CONCLUSION: There were some differences in physical, family-related, and behavior trait between snoring and non-snoring children.

Decreased Serum Epinephrine in Children With Positive Skin Prick Test

OBJECTIVES: To evaluate the association between catecholamine levels and skin prick test results among children. METHODS: Two hundred eight first grade children from one elementary school were invited to participate in this study. Skin prick test (SPT) for six allergens (2 house dust mites, cat, dog, mugwort, and pollen mixture) was performed, and patient demographic information was recorded. The parents were surveyed using questionnaires about rhinitis-related symptoms. Finally, venous blood sampling was done to measure catecholamine levels (epinephrine, norepinephrine, and dopamine) by high-performance liquid chromatography. RESULTS: Out of 208 children, 174 (106 boys and 68 girls) enrolled in this study. Ninety-six of the children (55%) had negative SPT (nonsensitization group), while 78 (45%) had a positive SPT to at least one of six allergens (sensitization group). The diagnosis of chronic rhinitis was more prevalent in the sensitization group (35.9%) than nonsensitization group (26.0%), however the finding was not significant (P=0.186). Epinephrine levels were decreased between the sensitization group compared to the nonsensitization group (P=0.004). There was no difference in norepinephrine and dopamine levels (P>0.05). CONCLUSION: Epinephrine levels are lower in children with positive SPT compared to controls, however, the level of the catecholamine was not associated with the presence or absence of rhinitis symptoms.

Obstructive Sleep Apnea Syndrome in Children / 한양의대학술지

Obstructive sleep apnea is characterized by partial or complete upper airway obstruction which leads to reduction of blood oxygenation often accompanied by frequent arousal during sleep. Obstructive sleep apnea in children has many different clinical features, compared with adults. In children, obstructive sleep apnea is mainly caused by enlarged tonsils and adenoids. Other conditions such as obesity, craniofacial abnormality, and neuromuscular disease are also relevant predisposing factors. Pediatric obstructive sleep apnea is associated with various secondary sequelae such as cognitive dysfunction, behavioral problem, attention deficit, reduced sleep-related quality of life and so on. The objective diagnostic test, standard polysomnograhy is often needed to diagnose and stratify the severity of obstructive sleep apnea, because subjective symptoms and signs related to obstructive sleep apnea are not always consistent with the severity of respiratory disturbance. Childhood obstructive sleep apnea should be diagnosed and treated, if clinically suspected, because various symptoms, signs and consequences can be improved with proper management. Adenotonsillectomy is the first-line treatment modality in pediatric obstructive sleep apnea with adenotonsillar hypertrophy. In addition, continuous positive airway pressure, rapid maxillary expansion, weight control, topical steroids, and antileukotrienes may be considered as adjuvant treatment options.

Impact of Open-Mouth Breathing on Upper Airway Anatomy in Patients with Sleep-Disordered Breathing

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the impact of open-mouth breathing on the upper airway anatomy of patients with sleep-disordered breathing (SDB) based on polysomnography. MATERIALS AND METHODS: A total of 114 subjects (101 males and 13 females) with a mean age of 42.7 years and a mean body mass index (kg/m2) of 26.2 were enrolled in this study. All subjects were divided into four groups (simple snoring, mild obstructive sleep apnea syndrome[OSAS], moderate OSAS and severeOSAS) according to the apnea-hypopnea index. Lateral cephalometric radiograms (retropalatal, retroglossal, and hypopharyngeal distance, and pharyngeal length) were taken with the mouth closed and open. RESULTS: The lateral cephalometric variables were compared between the mouth closed and open positions, and it was found that the retropalatal and retroglossal distances and pharyngeal length were significantly changed in all groups. However, the hypopharyngeal distance did not change significantly in any of the groups. CONCLUSION: Open-mouth breathing significantly reduces the retropalatal and retroglossal distance and lengthens the pharynx in patients with SDB. Since these anatomical changes may worsen SDB or decrease positive airway pressure treatment compliance, ENT doctors should attempt to convert SDB patients from open-mouth breathing to nasal breathing.

Efficacy and feasibility of laparoscopic subtotal cholecystectomy for acute cholecystitis.

BACKGROUNDS/AIMS: For patients with acute cholecystitis, conversion from laparoscopic cholecystectomy to open surgery is not uncommon due to possibilities of serious hemorrhage at the liver bed and bile duct injury. Recent studies reported successful laparoscopic subtotal cholecystectomy for acute cholecystitis. The purpose of this study was to determine the efficacy and feasibility of such an operation based on the experience of surgeons at our facility. METHODS: In this study, we enrolled 144 patients who had received either laparoscopic subtotal cholecystectomy (LSC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC) for acute cholecystitis from January 2004 to December 2009 at the Department of Surgery of our hospital. Their symptoms, signs, operative findings, pathologic results and postoperative results were compared and analyzed. RESULTS: There were 26 patients in the LSC group 80 in the LC group and 38 in the OC group. There were no differences in mean age, sex, and symptoms of acute cholecystitis. The LSC group showed higher CRP levels (p<0.001) and a higher grade according to the Tokyo criteria (p=0.001). The mean operative time was 115.6 minutes and mean blood loss was 158.9 ml without intra-operative or postoperative transfusion. There weren't any bile duct injuries during the operation. No group suffered bile leakage. Drains were removed 3.3 days after the operation in the LC group, the shortest time compared to the other groups (p<0.001). LC and LSC groups demonstrated shorter postoperative hospital days and time to diet resumption than the OC group (p<0.001). CONCLUSIONS: LSC appears to be a safe and effective treatment in cases of severe acute cholecystitis that require consideration of conversion to open surgery.

A Case of Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal / 대한이비인후과학회지

Bony defects of the external auditory canal (EAC) may arise from a tumor, infection, inflammation, trauma, complications from ear surgery, or congenital disease. Congenital bony defects of the EAC are known as a patent Huschke's foramen. Here, we describe a 76-year-old male patient who presented an otalgia in his right ear. Physical examination revealed a dome shaped swelling of the anterior EAC wall, which repeated swelling and retraction as the patient's mouth closed and opened. Computed tomography revealed a bony defect of the anterior EAC wall. We believe that the patent Huschke's foramen allowed spontaneous herniation of the temporomandibular joint into the EAC.

Characteristics of Melanocytic Nevus Arising from the External Auditory Canal / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A nevus is a benign tumor composed of nevus cells that are derived from melanocytes. It may occur anywhere on the skin, but its appearance in the external auditory canal (EAC) is very rare. The aim of this study is to analyze the characteristics of melanocytic nevi of the EAC. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 10 consecutive patients who underwent surgical excision of EAC nevi between March 2004 and February 2009. RESULTS: The size of these nevi ranged from 4 mm to 12 mm in diameter, with an average of 6.1 mm. Otoscopic examination revealed 7 cases of dome-shaped mass and 3 cases of papillomatous mass. Histological examinations revealed intradermal nevi in all cases, but there was one case of dysplastic nevus and two cases of papillomatous nevi that coexisted with cholesteatoma. These nevi were composed of epidermal hyperplasia and necrobiotic keratin debris within the papillomatous cleft. There has been no recurrence in these patients after 6 to 26 months (average 12.6 months) of follow-up. CONCLUSION: A melanocytic nevus of the EAC may be composed of dysplastic cells or coexist with cholesteatoma; in particular, its gross appearance is papillomatous. Therefore, every nevus should be excised to make a histopathological diagnosis.

A Case of Anterior Inferior Cerebellar Artery Infarction Initially Presented a Sudden Sensorineural Hearing Loss with a Normal Diffusion-weighted Brain MRI / 대한평형의학회지

A sudden hearing loss with vertigo may originate from vascular insufficiency and sometimes presents as a prodrome of anterior inferior cerebellar artery infarction. Here we describe the case of a 48-year-old male patient who presented with a sudden onset of hearing loss in his right ear and severe, whirling type dizziness without associated neurological signs or symptoms. The diffusion-weighted magnetic resonance imaging (MRI) was normal on initial presentation, but 4 weeks after the onset of symptoms, the patient developed ipsilateral facial paralysis and dysarthria. A follow-up MRI revealed acute infarction in the territory of the anterior inferior cerebellar artery, involving the right lateral pons, right middle cerebellar peduncle, and inferolateral cerebellum.