Recurrent Middle Ear Barotrauma in Student Pilots.

INTRODUCTION: The present study evaluated the efficacy of the nine-step inflation-deflation tympanometric test for predicting recurrence of middle ear barotrauma.METHODS: Student pilots who were diagnosed with middle ear barotrauma from October 2010 to April 2011 were enrolled. The grade of barotrauma was assigned using Teed's classification. All subjects underwent tympanometry and nine-step inflation-deflation testing at first visit and after improvement. Recurrence was monitored for 2 wk after they resumed flight. The relationships among the recurrence of middle ear barotrauma, the grade and duration of disease, and tympanometric and nine-step test results were evaluated.RESULTS: There were 35 cases enrolled. According to Teed's classification, 16 cases were Grade 0 (45.7%) and 11 cases were Grade I (31.4%). Grade III was shown in seven cases (20.0%) and one subject was Grade IV (2.9%). The mean duration of illness was 5.9 d. In the initial 9-step tests, 29 subjects (85.3%) failed to pass the entire test. On follow-up tests, eight cases (22.9%) failed. Seven pilots (20.0%) showed recurrent middle ear barotrauma after resumed flight. All of the cases with recurrence failed the follow-up nine-step tests. The nine-step test showed high sensitivity and specificity values for predicting recurrence. A clear correlation was observed between recurrence and nine-step test results.DISCUSSION: The nine-step inflation-deflation test provides useful information about Eustachian tube function. The nine-step test can be useful to reduce the risk of recurrence of middle ear barotrauma in pilots.Sohn JH. Recurrent middle ear barotrauma in student pilots. Aerosp Med Hum Perform. 2019; 90(8):681-687.

Sarcomatoid carcinoma after radiotherapy for early-stage oral squamous cell carcinoma: Case report.

RATIONALE: Sarcomatoid carcinoma is a rare variant of squamous cell carcinoma (SCC) with poor prognosis. Previous radiation has been reported as one of the etiologic factors. PATIENT CONCERNS: We describe a case of a 57-year-old man presented with a painless mass in the left supraclavicular area. Five years before, he was diagnosed with SCC in floor of mouth (FOM) and underwent radiotherapy (RT). DIAGNOSES: Sonography-guided biopsy on the supraclavicular lymph node revealed diffuse spindle cell proliferation with a focus of squamous differentiation. Local recurrence on primary site or distant metastasis was not obvious on both computed tomography (CT) of the neck and F-fluorodeoxyglucose positron emission tomography CT. The final diagnosis was confirmed as sarcomatoid carcinoma via surgery. INTERVENTIONS: The patient underwent surgery including explorative resection of the mouth floor, excision of the submandibular gland, and modified radical neck dissection. Following surgery, the patient received adjuvant radiation therapy. OUTCOMES: There were no complications according to the surgery. Six months after adjuvant therapy, distant metastasis to liver was identified. The patient is currently undergoing palliative chemotherapy. LESSONS: This may be the first reported case of sarcomatoid carcinoma arising from early-stage SCC in FOM that was previously treated with RT alone. When RT is performed as a single modality for oral SCC, even in an early stage, rigorous follow-up should be performed.

Middle Ear Barotrauma in Student Pilots.

INTRODUCTION: The present study reports the clinical features of middle ear barotrauma in student pilots in the Republic of Korea Air Force. METHODS: The authors reviewed medical records of student pilots with barotrauma. The grade of barotrauma was assigned using Teed's classification. This study included nasal symptoms, endoscopic findings of the nasal cavity, and clinical course (duration, recurrence). The relationship between middle ear barotrauma and the nasal airway was also evaluated. RESULTS: There were 57 cases in 51 pilots included. There were 49 cases (86.0%) that showed unilateral disease and 4 subjects experienced relapse. Two subjects (3.9%) had chronic rhinosinusitis and four subjects (7.8%) had allergic rhinitis. Ear fullness was reported in all cases, while hearing loss and persistent ear pain were reported in 3 cases (5.3%) and 19 cases (33.3%), respectively. Stuffy nose (26 cases, 45.6%) and rhinorrhea (24 cases, 42.1%) were relatively common. Most cases were Grade 0 (23 cases, 40.3%) or Grade III (27 cases, 47.4%) according to Teed's classification. Septal deviation was observed in 12 cases (21.0%), while turbinate hypertrophy was seen in 53 cases (93.0%) and increased nasal discharge in 33 cases (57.9%). The grade of barotrauma varied significantly according to the severity of turbinate hypertrophy and nasal discharge. The mean duration of disease was 6.8 d. DISCUSSION: Nasal symptoms and endoscopic findings showed some association with the grade and duration of barotrauma. Most cases resolved within a week; however, barotrauma showed persistence or relapse in some cases.Sohn JH, Cho KR. Middle ear barotrauma in student pilots. Aerosp Med Hum Perform. 2017; 88(4):406-412.

Nasal obstruction and palate-tongue position on sleep-disordered breathing.

OBJECTIVES: We wanted to evaluate whether the presence of nasal obstruction makes a change on the association between the modified Mallampati score and the severity of sleep-disordered breathing (SDB) and the sleep quality. METHODS: Polysomnography (PSG), the modified Mallampati score (MMS), the body-mass index, and a questionnaire about nasal obstruction were acquired from 275 suspected SDB patients. The subjects were divided into two groups according to the presence of nasal obstruction. The clinical differences between the two groups were evaluated and the associations between the MMS and PSG variables in each group were also assessed. RESULTS: Significant correlations were found between the MMS and many PSG variables, including the apnea-hypopnea index, the arousal index and the proportion of deep sleep, for the patients with nasal obstruction, although this was not valid for the total patients or the patients without nasal obstruction. CONCLUSION: The severity of SDB and the quality of sleep are well correlated with the MMS, and especially for the patients with nasal obstruction. The MMS can give more valuable information about the severity of SDB when combined with simple questions about nasal obstruction.

Systemic effects and safety of triamcinolone-impregnated nasal packing after endoscopic sinus surgery: a randomized, double-blinded, placebo-controlled study.

BACKGROUND: Steroid-infused absorbable nasal dressings after endoscopic sinus surgery (ESS) have been used to improve wound healing and to reduce the recurrence of polyps. However, their systemic effects are not well known. The purpose of this study was to evaluate the systemic effects and safety of steroid-impregnated absorbable nasal packing after ESS. METHODS: Patients who underwent bilateral ESS for chronic rhinosinusitis were recruited and randomized into two groups. Ten patients in the triamcinolone (TA) group received a TA (20 mg)-soaked bioabsorbable dressing in both nasal cavities while 10 patients in the control group took saline-impregnated dressing in both nasal cavities. Nasal dressings were not removed until postoperative day 10. Serum cortisol, 12-hour urine cortisol, serum adrenal-corticotropic hormone (ACTH), and serum osteocalcin were measured preoperatively and on postoperative days 2 and 10. Serum cortisol levels were checked 1 day after surgery additionally, while urine cortisol levels were not checked at postoperative day 10. RESULTS: All 20 patients completed this study. The serum cortisol levels were significantly suppressed at postoperative days 1 and 2 in the TA group. Serum ACTH and 12-hour urine cortisol levels were lower 2 days after surgery in the TA group, although these changes were not statistically significant. There were no differences in all other parameters between the TA and control groups on postoperative day 10. CONCLUSIONS: TA-impregnated nasal dressings suppress serum cortisol levels during the early postoperative period. This systemic effect was recovered gradually and normalized 10 days after the operation.