The Impact of the COVID-19 Pandemic on Bell's Palsy and Ramsay-Hunt Syndrome: A Multicenter Retrospective Study.

BACKGROUND: This article presents a comprehensive review of data on the impact of facial palsy during the coronavirus disease 2019 (COVID-19) pandemic. The possible causes and pathophysiological mechanisms of changes in the epidemiology of facial palsy during the COVID-19 pandemic are also discussed. METHODS: This multicenter retrospective cohort study included 943 patients diagnosed with Bell's palsy or Ramsay Hunt syndrome. This study compared patient demographics, comorbidities, symptoms, and treatments before the COVID-19 pandemic (from 2017 to 2019) and during the COVID-19 pandemic, from 2020 to 2022). RESULTS: Following the COVID-19 outbreak, there has been a significant increase in the number of cases of Bell's palsy, particularly among elderly individuals with diabetes. Bell's palsy increased after the COVID-19 outbreak, rising from 75.3% in the pre-COVID-19 era to 83.6% after the COVID-19 outbreak. The complete recovery rate decreased from 88.2% to 73.9%, and the rate of recurrence increased from 2.9% to 7.5% in patients with Bell's palsy. Ramsay Hunt syndrome showed fewer changes in clinical outcomes. CONCLUSION: This study highlights the impact of the COVID-19 pandemic on the presentation and management of facial palsy, and suggests potential associations with COVID-19. Notably, the observed increase in Bell's palsy cases among elderly individuals with diabetes emphasizes the impact of the pandemic. Identifying the epidemiological changes in facial palsy during the COVID-19 pandemic has important implications for assessing its etiology and pathological mechanisms of facial palsy disease.

The clinical availability of facial nerve enhancement in temporal bone MRI for the patients of idiopathic acute peripheral facial palsy.

PURPOSE: This study is to evaluate the duration of facial nerve enhancement in gadolinium-enhanced temporal bone MRI after the onset of acute facial palsy. METHODS: Gd-enhanced MRI imagines were examined in 13 patients with idiopathic acute facial palsy within 14 days after the onset. The degree of facial nerve function was measured according to the House-Brackmann (H-B) grading system at their first visit at outpatient clinic. The follow-up MRI was taken about 16.5 months (7-24 months) after onset of disease. The degree of facial nerve enhancement was measured with signal intensity (SI) which was quantitatively analyzed using the region-of-interest (ROI) measurements for each segment of the facial nerve. SI was statistically analyzed by comparing SI values of contralateral site and ipsilateral site using the paired t test with SPSS program. RESULTS: The gadolinium enhancement was statistically increased at labyrinthine segment and geniculate ganglion area of facial nerve at initial temporal bone MRI. The gadolinium enhancement was statistically decreased at all the segments of facial nerve except tympanic segment (p < 0.05) at follow-up MRI. CONCLUSIONS: The facial nerve enhancement in Gd-enhanced MRI images prolonged more than 21 months of the onset. The newly developed pathologic lesions of acute facial palsy especially occur at the site of labyrinthine and geniculate ganglion.

Factors Affecting the Extrusion Rate and Complications After Ventilation Tube Insertion: A Multicenter Registry Study on the Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis Media With Effusion-Part II.

OBJECTIVES: The impacts of ventilation tube (VT) type and effusion composition on the VT extrusion rate and complications in children with otitis media remain unclear. This part II study evaluated the factors affecting the extrusion rate, recurrence rate, and complications of VT insertion. METHODS: A prospective study was conducted between June 2014 and December 2016 (the EVENT study [analysis of the effectiveness of ventilation tube insertion in pediatric patients with chronic otitis media]), with follow-up data collected until the end of 2017. Patients aged <15 years diagnosed with otitis media with effusion who received VT insertion were recruited at 15 tertiary hospitals. The primary outcomes were time to extrusion of VT, time to effusion recurrence, and complications. RESULTS: Data from 401 patients were analyzed. After excluding the. RESULTS: of long-lasting tubes (Paparella type II and T-tubes), silicone tubes (Paparella type I) exhibited a significantly longer extended time to extrusion (mean, 400 days) than titanium tubes (collar-button-type 1.0 mm: mean, 312 days; P<0.001). VT material (hazard ratio [HR], 2.117, 95% confidence interval [CI], 1.254-3.572; P=0.005), age (HR, 3.949; 95% CI, 1.239-12.590; P=0.02), and effusion composition (P=0.005) were significantly associated with the time to recurrence of middle ear effusion. Ears with purulent (mean, 567 days) and glue-like (mean, 588 days) effusions exhibited a shorter time to recurrence than ears with serous (mean, 846 days) or mucoid (mean, 925 days) effusions. The revision VT rates during follow-up were 3.5%, 15.5%, 10.4%, and 38.9% in ears with serous, mucoid, glue-like, and purulent effusions, respectively (P<0.001). The revision surgery rates were higher among patients aged <7 years than among those aged ≥7 years. CONCLUSION: Silicone tubes (Paparella type I) were less prone to early extrusion than titanium 1.0 mm tubes. VT type, patient age, and effusion composition affected the time to recurrence of effusion.

Influence of Cochlear Dead Regions on Hearing Outcome in Sudden Sensorineural Hearing Loss.

OBJECTIVE: The aims of this multicenter study were to prospectively evaluate the prevalence of dead regions (DRs) in sudden sensorineural hearing loss (SSNHL) and compare the clinical characteristics and hearing outcomes of SSNHL according to the presence of DRs. STUDY DESIGN: Prospective study. SETTING: Multicenter study. PATIENTS AND METHODS: The threshold-equalizing noise (TEN) test was prospectively performed on a total of 130 patients diagnosed with SSNHL. All patients received systemic steroid therapy and/or intratympanic steroid injection within 1 month after onset. Pure-tone audiograms and the TEN test were conducted before and after steroid treatment. Age, sex, side of affected ear, recurrence, onset of symptoms, presence of dizziness, and comorbid diseases were also collected. The prevalence of DRs in SSNHL and clinical factors related to the DRs were assessed. Hearing outcomes for SSNHL according to DRs were evaluated in 68 patients who followed a pure-tone audiogram. RESULTS: The overall prevalence of one or more DRs in SSNHL evaluated using the TEN test was 20.8% (27/130 subjects) and the overall frequency-specific prevalence of DR was 6.7% (61/910 DRs). Although the DRs (+)and DR (-) groups had similar initial pure-tone thresholds, the DRs (+) group had significantly worse initial WRS compared to the DRs (-) group (p = 0.015). The presence of DRs was not associated with hearing recovery in a multivariate logistic regression model, but it was significantly associated with the degree of hearing gain in a multivariate linear regression model (p = 0.018). CONCLUSIONS: The presence of DRs can be considered one of the poor prognostic factors for SSNHL and the TEN test may contribute to assess the prognosis of SSNHL in clinical settings.

The Clinical Characteristics and Surgical Outcomes of Carcinoma of the External Auditory Canal: A Multicenter Study.

OBJECTIVE: To analyze the clinical characteristics and evaluate the surgical outcomes of carcinoma of the external auditory canal (CEAC). MATERIALS AND METHODS: Overall, 31 patients from four multicenter hospitals, who were diagnosed and surgically treated for CEAC in 2009-2014, were enrolled for this retrospective study. Medical records were reviewed to determine cancer stage according to the Pittsburgh classification. Clinical data of age, sex, site, initial symptoms, surgery extent, postoperative complications including recurrence, follow-up period, and current patient status were collected for analysis. Five-year cumulative survival rate was obtained using Kaplan-Meier method. RESULTS: At initial diagnosis, 22 patients were in the early stages (stage I: 15; stage II: 7) and 9 patients were in the advanced stages (stage III: 1; stage IV: 8). Lymph node metastasis was present in 5 patients and distant metastasis in 2. Of the 31 patients, 4 patients died (stage II: 1, stage IV: 3) during the follow-up period. Early-stage patients showed 100% 5-year estimated cumulative survival rate, whereas the advanced-stage patients showed 5-year estimated survival rate of 53.6% (p=.006). The overall survival rate of all enrolled patients was 90.3%. Although 5-year estimated disease-free survival rate of stage I was 100.0%, that for stage II was low at 30.0% because of considerable recurrences. CONCLUSION: The results of this multicenter study suggest that more aggressive treatment modality, including adjuvant therapy, is necessary for patients with CEAC with Pittsburgh stage II or more.

An Uncommon Presentation of Human Otoacariasis by Haemaphysalis longicornis.

Ticks are obligate parasites on animals and sometimes humans. They usually suck the blood of the hosts and can carry various infectious diseases as a vector. Otoacariasis is the presence of ticks and mites within the ear canal and relatively common in domestic and wild animals. However, tick infestations of human ear canals are rarely reported in the scientific literature and hardly occur in developed countries. Herein, we report a rare case of otoaracariasis involving Haemaphysalis longicornis . A 9-year-old girl living in a suburb presented with otalgia of left ear for 1 day. Otoscopic examination revealed a huge insect occluding the tympanic membrane. Tick removal and washing of external auditory canal was done successfully. The causative tick was identified as the H. longicornis. To our knowledge, this is the first reported case of human otoacariasis by a H. longicornis in Korea.

Microbiological Results From Middle Ear Effusion in Pediatric Patients Receiving Ventilation Tube Insertion: Multicenter Registry Study on the Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis Media With Effusion: Part I.

OBJECTIVES: The aim of this multicenter registry study was to investigate the effectiveness of ventilation tube insertion and the microbiology of otitis media with effusion (OME) in children. This part I study was conducted to evaluate the microbiological profile of children with OME who needed ventilation tube insertion. METHODS: Patients <15 years old who were diagnosed as having OME and received ventilation tube insertion were prospectively enrolled in 16 tertiary hospitals from June 2014 to December 2016. After excluding patients with missing data, the data of 397 patients were analyzed among a total of 433 enrolled patients. The clinical symptoms, findings of the tympanic membrane, hearing level, and microbiological findings were collected. RESULTS: In 103 patients (25.9%), antibiotics were used within 3 weeks before surgery. Ventilation tube insertion was performed in a total of 710 ears (626 in both ears in 313 patients, 55 in the left ear only, and 29 in the right ear only). Culture of middle ear effusion was done in at least one ear in 221 patients (55.7%), and in a total of 346 ears. Only 46 ears (13.3%) showed positive results in middle ear effusion culture. Haemophilus influenzae (17.3%, followed by coagulase-negative Staphylococcus and Staphylococcus auricularis) was the most common bacteria detected. CONCLUSION: H. influenzae was the most commonly found bacteria in middle ear effusion. Relatively low rates of culture positivity were noted in middle ear effusion of patients with OME in Korea.

Evaluation of temporal bone pneumatization with growth using 3D reconstructed image of computed tomography.

OBJECTIVE: To evaluate temporal bone pneumatization with growth using 3D reconstructed computed tomography (CT) images. PATIENTS AND METHODS: Eighty-four temporal bones of 42 patients under the age of 16 years who had undergone head and facial bone CT were included in this retrospective study. The bony growth of the temporal bone and the head size were evaluated with horizontal- and vertical-plane CT images. Pneumatization of the temporal bone was investigated with 3D reconstruction software using axial CT images, dividing them as follows: medially, anterosuperiorly, posterolaterally, and inferiorly. Pneumatization of each individual part was compared with that of other parts and was also evaluated according to the aging process. RESULTS: The mean pneumatization was measured as 1696.7mm3 in patients aged under 2 years, 3609.1mm3 in those aged 2-4 years, 5351.1mm3 in those aged 5-7 years, 7295.9mm3 in those aged 8-10 years, 7797.5mm3 in those aged 11-13 years, and 8526.6mm3 in those aged 14-16 years. The degree of temporal bone pneumatization of each part was correlated with that of other parts (p<0.05). The volume of pneumatization increased with growth of the temporal bone and with aging. The degree of pneumatization of specific parts might be related to developmental periods. CONCLUSION: The pneumatization of one part might affect the pneumatization of other nearby parts, or all parts might be affected by the same driving force of pneumatization.

Three-dimensional Anatomical Analysis of Surgical Landmarks for the Middle Cranial Fossa Approach.

This study describes the microsurgical anatomy of the middle cranial fossa approach using temporal bone three-dimensional (3D) computed tomography (CT) reconstruction, which should contribute to determining the drilling point for the internal auditory meatus (IAM) when bony landmarks are absent. Thirty temporal bone CT scans were reviewed retrospectively. We measured the shortest and longest distances to IAM from the petrous ridge, and measured the angle between the facial nerve and various labyrinth structures. Three-dimensional reconstructed images were obtained using high-resolution axial temporal bone CT (0.7-mm-thick slices, FOV 90 × 90, KVp 120, 305 mA, width 2,800, and level 800). The mean shortest and longest distances to IAM from the petrous ridge were 5.22 and 10.1 mm, respectively. The mean distance to the IAM from the cochlea was 9.91 mm. The mean angle between the IAM and superior semicircular canal was 47.21°, which was more acute than previously reported. The mean angle between the IAM and geniculate ganglion (GG) and external auditory canal was 113.8°, and the mean distance from the GG to the IAM was 15.44 mm. Understanding the 3D relationships among the microsurgical structures will help to decide the drilling point for the IAM when bony landmarks are absent. A preoperative evaluation might be useful for preserving important neurovascular structures while approaching the middle fossa.

Predictive factors influencing facial nerve outcomes in surgery for small-sized vestibular schwannoma.

CONCLUSION: The most important predictive factor of facial nerve outcome in surgery for small-sized vestibular schwannoma (VS) is the adhesion between the tumor and the facial nerve. OBJECTIVES: To compare the facial nerve outcomes between middle cranial fossa (MCF) and translabyrinthine (TL) approaches, and to analyze the preoperative and intraoperative factors influencing facial nerve outcome after small VS surgery in our neurotologic department. METHODS: A total of 29 patients were retrospectively analyzed, with 16 in the MCF group and 13 in the TL group. Facial function was serially evaluated according to the House-Brackmann classification at 7 days, 1 month, 3 months, 6 months, and 1 year postoperatively. The effects of variables such as the surgical approach, tumor size, nerve origin, extrameatal extension, intraoperative tumor adhesion to the facial nerve, and facial nerve displacement were determined. RESULTS: Early and late facial nerve outcomes showed no significant correlation with surgical approach, tumor origin, tumor size, extrameatal extension, or facial nerve displacement pattern. However, a significant correlation was observed with tumor adhesion to the facial nerve and facial nerve outcomes.

Efficacy of intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss: comparison with systemic steroid therapy and combined therapy.

CONCLUSION: Intratympanic steroid therapy (IT-S) was as effective as systemic steroid therapy (SST) or combined therapy (CT) and could be considered a first-line therapeutic modality for idiopathic sudden sensorineural hearing loss (SSNHL). Due to its known safety and efficacy, IT-S will be particularly suitable for patients with SSNHL who have chronic diseases such as diabetes mellitus, hypertension, or chronic renal failure. OBJECTIVES: Systemic high dose steroid therapy is the main therapeutic modality for SSNHL. Comparable therapeutic efficacies for IT-S and CT with SST and IT-S for SSNHL have been reported recently. We compared the efficacy of IT-S, SST, and CT for treating SSNHL. METHODS: A retrospective, multicenter study investigating the therapeutic efficacy of SST, IT-S, and CT for SSNHL was designed and involved 735 patients with idiopathic SSNHL who were diagnosed and treated at seven tertiary referral medical centers of the Catholic University of Korea between 2007 and 2011. Patients were divided into three groups according to the treatment methods they received: IT-S group, SST group, and CT group (SS plus IT-S). Hearing was evaluated by pure tone audiogram performed before initial treatment and at 4 weeks following the final treatment. More than a 10 dB HL decrease in average air conduction threshold of hearing at 500, 1000, 2000, and 3000 Hz was defined as improved hearing. RESULTS: Among 735 patients with SSNHL, 94 were included in the IT-S group, 444 in the SST, and 197 in the CT group. Age, gender, interval from disease onset to start of treatment, and initial hearing level were not different among the three groups. Patients who had concomitant medical disorders such as diabetes mellitus, hypertension, or chronic renal failure were more frequently treated with IT-S. No difference in the level of hearing gain or ratio of hearing improvement was observed among the three groups (p = 0.147 and p = 0.067, respectively).

Tinnitus in patients with profound hearing loss and the effect of cochlear implantation.

The objectives of this study were to characterize the features of tinnitus in patients with profound sensorineural hearing loss and to evaluate the effect of cochlear implantation (CI) on their tinnitus. Medical records were reviewed for 35 patients who underwent CI, and completed tinnitus questionnaire between March 2003 and August 2011. Of them, 22 had tinnitus prior to CI (62.9 %) and the tinnitus group was older than the non-tinnitus group (47.5 ± 15.1 vs. 28.9 ± 15.2). The mean tinnitus handicap inventory (THI) score of the tinnitus group was 50.5 ± 28.7 before surgery, and the mean THI score and visual analogue scale (VAS) scores for loudness, annoyance, effect on life, and awareness decreased significantly after CI, with a mean follow-up period of 10.7 months. Tinnitus was completely eliminated in ten patients (45.5 %) and THI scores decreased in all patients. In a correlation analysis of the decrease in THI scores, preoperative VAS scores for loudness, awareness, effect on life, and annoyance, as well as preoperative THI scores, were highly correlated with the degree of decrease in THI scores postoperatively. The auditory performance of patients older than 40 years did not differ from that of younger patients, but their tinnitus was more improved after CI. In conclusion, tinnitus is a common complaint in patients with cochlear implants, and is more prevalent in elderly implantees. In the present study, CI improved tinnitus in all patients, although the most severe cases had the greatest benefit.

Functional evaluation of paratubal muscles using electromyography in patients with chronic unilateral tubal dysfunction.

Eustachian tube dysfunction is closely related to the development of otitis media and result from several factors including inflammation within the nasal cavity and nasopharynx, adenoid hypertrophy, cleft palate and nasopharyngeal carcinoma. To some extent, eustachian tube dysfunction may be related to weakness of the paratubal muscles, such as the tensor veli palatini and levator veli palatini muscles. The aim of the study is to find out myogenic factors in eustachian tube dysfunction using electromyography (EMG), and to evaluate the clinical feasibility of EMG. Ten patients with unilateral eustachian tube dysfunction were included in this study. The healthy side of each patient was used as a control. EMG tests on paratubal muscles were conducted under the view of a 30° endoscope or fiberoptic laryngoscope. EMG on the tensor veli palatini showed decreased amplitudes on the affected side in one patient during phonation. EMG on the levator veli palatini showed decreased amplitudes on the affected side in two patients during both deglutition and phonation, one patient during phonation only, and two patients during deglutition only. The only patient who had decreased amplitude on EMG of the tensor veli palatini also had decreased amplitude on EMG of the levator veli palatini. In conclusion, although it is generally accepted that the tensor veli palatini plays a major role in opening the eustachian tube, reduced activity of the levator veli palatini may be related to eustachian tube dysfunction. When assessing eustachian tube function, EMG is useful for evaluating myogenic factors.

Intracochlear schwannoma extending to vestibule.

Intralabyrinthine schwannomas are benign tumors arising de novo from the perineural Schwann cell sheath of the intralabyrinthine branches of the vestibulocochlear nerve. The development of magnetic resonance imaging (MRI) has significantly increased the diagnosis of these tumors. Intralabyrinthine schwannomas can be sub-classified into seven groups according to the structures of the inner ear that are affected. The management strategy for intralabyrinthine schwannoma is regular monitoring with MRI, as the tumor grows slowly. In cases where the tumor growth is documented on serial MRI or disturbing vestibular symptoms are present, surgical removal can be considered. The surgical approach varies based on tumor location and size. We report a case of intravestibulocochlear schwannoma causing vertigo that developed from an intracochlear tumor during MRI. We successfully removed the tumor via the transotic approach.

Clinical utility of three-dimensional facial computed tomography in the treatment of nasal bone fractures: a new modality involving an air-bone view with a volume rendering technique.

To evaluate the utility of three-dimensional (3D) reconstruction when planning the surgical treatment of nasal bone fractures. The axial scan of high-resolution facial bone CT was reconstructed in 3D using the program V-works 4.0 (CyberMed, Seoul, Korea) with a volume and surface rendering technique. For detailed stereoscopic examination of the nasal valve area, an air-bone view with the volume rendering technique was obtained using thresholds for air, cartilage, and bone. In most nasal bone fractures, 2D and 3D CT had similar detection rates. However, to determine the fracture angle and dimpled area, and identify multiple fractures, surgeons can get better information to help with the reduction of the fractured bone from 3D reconstruction images. Additionally, with a septal deformity, this view helps in deciding on the need for septal surgery during nasal reduction. The air view of the nasal passage provides clues to obstruction of the nasal cavity. We could identify the contour and location of the fracture site accurately from 3D CT images. The detection rate of fractures was similar to that of 2D CT. However, 3D CT enabled the accurate determination of the distance and direction of the fractured bony fragment from normal bone structure. Additionally, a stereoscopic image of the fracture site facilitated an understanding of the location and range of reduction. The air-bone view gave more information about the pathological obstruction of the nasal air passage.

Risk factors for decreased distance between internal carotid artery and pharyngeal wall.

OBJECTIVES: The risk of disastrous bleeding during pharyngeal surgery is increased in cases of an internal carotid artery (ICA) that is medially displaced due to its anomalous course. We attempted to assess the distance between the ICA and the pharyngeal wall (DIP) and to evaluate the predisposing factors associated with ICA variation. METHODS: The course of ICA was studied in 509 CT scans, and a retrospective chart review was performed. The course of ICA and DIP were evaluated at each level of the pharynx: nasopharynx (NP), oropharynx (OP), and hypopharynx (HP). RESULTS: The mean DIP value was greatest (15.8±4.6mm) at NP, decreased at OP (15.8±4.6mm), and was shortest at HP (13.5±6.0mm). DIP was significantly shorter in females compared with males at all three pharyngeal levels. Age was inversely correlated with DIP at NP and OP. Tortuous ICA was most common (51.4%), followed by straight (41.2%), kinking (6.9%), and coiling (0.5%) types. DIP was longest in the straight type and decreased as the curvature of ICA increased. The most common ICA type differed between younger (<60 years; 56.2% having the straight type) and older groups (≥60 years; 66.2% having the tortuous type). Females older than 60 years displayed a higher incidence of kinking ICA compared with males. CONCLUSIONS: Hypopharynx, old age, female gender, and tortuous or kinking ICA types were risk factors for a decreased distance between the ICA and the pharyngeal wall. Meticulous examination of the pharyngeal wall should therefore be performed prior to pharyngeal surgery in patients with these associated risk factors.

A case of malignant small round cell tumor of temporal bone with facial paralysis.

Malignant small round cell tumor is very rare, especially in the head and neck area. It is also difficult to make a differential diagnosis due to their undifferentiated or primitive character. Immunohistochemical staining and chromosomal study is useful to categorize these tumors. Since these are rare tumors, treatment protocols are is not well established. While combined treatments (surgery, chemotherapy, radiotherapy) is currently being applied, the tumor still has a poor prognosis. We present a rare case of a rapidly growing temporal bone malignant small round cell tumor which initially showed facial paralysis.

Frequency-specific hearing results after surgery for chronic ear diseases.

OBJECTIVES: To analyze frequency-specific hearing results after surgery for chronic ear diseases while considering pathological findings and various surgical factors. METHODS: Patients who underwent surgical management of chronic otitis media were reviewed retrospectively (n=559). Using pure tone audiometry, air conduction (AC), bone conduction (BC), and air bone gap (ABG) change between pre- and post-operative tests were calculated for the frequencies of 250, 500, 1,000, 2,000, 3,000, 4,000 (AC and BC), and 6,000 Hz (AC). Frequency-specific results were investigated, considering various surgical factors, such as type of surgery, type of ossiculoplasty and pathological findings. RESULTS: AC results in the intact canal wall mastoidectomy showed improvement at each frequency except 4,000, 6,000 Hz. AC results in the tympanoplasty showed improvement at each frequency except 6,000 Hz. AC and ABG results in the open cavity mastoidectomy showed improvement only at the frequencies of 250, 500, 2,000 Hz. AC and ABG improved at low and mid frequencies but not in high frequencies above 3,000 Hz when ossicular reconstruction was conducted. AC and ABG results also improved at low and mid frequencies in the cholesteatoma, and ABG results improved at all frequencies except 3,000 Hz in the non-cholesteatoma. CONCLUSION: After chronic ear surgery, AC and ABG changes improved, primarily in the low and mid frequencies. Further evaluation and studies for post-operative hearing loss at high frequencies are recommended for rehabilitation of hearing ability after surgery.

CT evaluation of vocal cord paralysis due to thoracic diseases: a 10-year retrospective study.

PURPOSE: To discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases. MATERIALS AND METHODS: From records from the past 10 years at our hospital, we retrospectively reviewed 115 cases of VCP that were evaluated with CT. Of these 115 cases, 36 patients (23 M, 13 F) had VCP due to a condition within the thoracic cavity. From these cases, we collected the following information: sex, age distribution, side of paralysis, symptom onset date, date of diagnosis, imaging, and primary disease. The etiology of VCP was determined using both historical information and diagnostic imaging. Imaging procedures included chest radiograph, CT of neck or chest, and esophagography or esophagoscopy. RESULTS: Thirty-three of the 36 patients with thoracic disease had unilateral VCP (21 left, 12 right). Of the primary thoracic diseases, malignancy was the most common (19, 52.8%), with 18 of the 19 malignancies presenting with unilateral VCP. The detected malignant tumors in the chest consisted of thirteen lung cancers, three esophageal cancers, two metastatic tumors, and one mediastinal tumor. We also found other underlying etiologies of VCP, including one aortic arch aneurysm, five iatrogenic, six tuberculosis, one neurofibromatosis, three benign nodes, and one lung collapse. A chest radiograph failed to detect eight of the 19 primary malignancies detected on the CT. Nine patients with lung cancer developed VCP between follow-ups and four of them were diagnosed with a progression of malignancy upon CT evaluation of VCP. CONCLUSION: CT is helpful for the early detection of primary malignancy or progression of malignancy between follow-ups. Moreover, it can reveal various non-malignant causes of VCP.

A comparative analysis of intranasal volume and olfactory function using a three-dimensional reconstruction of paranasal sinus computed tomography, with a focus on the airway around the turbinates.

The aim of this study was to investigate the relationship between the intranasal airway around the turbinates and olfactory function. In total, 32 nostrils of 16 patients who were awaiting septal surgery were involved in this study. For measurements of the volume of the nasal cavity, paranasal sinus computed tomography scans were performed and reconstructed into three-dimensional images. The Butanol Threshold Test and Cross-Cultural Smell Identification Test were used to evaluate olfactory function. The results were analyzed with Pearson's test. The volume around the turbinates was significantly correlated with the olfactory threshold. However, olfactory identification had no significant correlation with each volume. The airway around the turbinates is very important for nasal airflow and its volume influences olfactory function. Understanding such relationships may help in preserving or improving olfactory function in septal, turbinate or sinus surgery. Further studies are needed regarding the relationships between not only the volume of the nasal cavity and nasal airflow, but also between nasal volume changes and olfactory function.