A Case of Dual Ectopic Thyroid / 대한이비인후과학회지

Ectopic thyroid is an uncommon status characterized by the presence of thyroid tissue in a site other than in its usual region. It is rare for dual ectopic thyroid to have two ectopic foci simultaneously. Three cases of dual ectopic thyroid have been reported in the Korean literature. Clinically, most cases in ectopic thyroid were noted at adolescence or postpartum due to increased physiologic hormonal demands. Clinical manifestation, thyroid function test, and radiologic imaging should be employed to make a diagnosis and therapeutic plan of this disease. We present a patient with dual ectopic thyroid tissue in the suprahyoid and infrahyoid area without thyroid tissue in its normal thyroid bed.

Cranial Polyneuropathy in Ramsay Hunt Syndrome Manifesting Severe Pharyngeal Dysphagia: a Case Report and Literature Review

Ramsay Hunt syndrome (RHS) is characterized by herpes zoster oticus, facial nerve palsy, and vestibulocochlear symptoms. Dysphagia caused by the involvement of multiple cranial nerves (CNs) in RHS is very rare. We encountered a rare case presented with severe dysphagia due to cranial polyneuropathy involving trigeminal nerve (CN V), facial nerve (CN VII), vestibulocochlear nerve (CN VIII), glossopharyngeal nerve (CN IX), vagus nerve (CN X), and hypoglossal nerve (CN XII) in RHS. This case report suggested that the prognosis for dysphagia in RHS seems favorable, and swallowing rehabilitation therapy could be beneficial in expediting tube removal.

Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.

A Measurement of the Frontal Sinus Ostium Using the Sagittal Images of Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic management of frontal sinus disease remains a difficult task. In order to minimize the risk of intracranial complication, easily identifiable landmarks and measurements should be required. This study aims to identify standard distances from the columella to the anterior and posterior borders of the frontal sinus ostium in Korean men and women. SUBJECTS AND METHOD: We obtained the sagittal images taken from 30 men and 30 women. Measurements from the columella to the nasofrontal beak (NFB) and anterior skull base (ASB) were made. Also, the angle between the lines of the columella to the ASB and hard palate was measured. RESULTS: The mean distance from the columella to the NFB was 55.3+/-3.9 mm in men and 52.1+/-4.7 mm in women (p0.05). CONCLUSION: This study suggests sinus surgeons to stay a distance from the columella of less than 57.6 mm in men and 54.3 mm in women to minimize skull base injury.

A Case of Periorbital Necrotizing Fasciitis Occurred in a Diabetes Mellitus Patient Accompanied with Chronic Sinusitis with Nasal Polyp / 대한이비인후과학회지

Necrotizing fasciitis is a soft tissue infection characterized by necrosis of fascia and subcutaneous tissue. It rarely occurs in the craniocervical area but when it does, it can be fatal. Early recognition and prompt intervention are important in minimizing morbidity and mortality rates. We report on a diabetes mellitus patient with periorbital necrotizing fasciitis, which was treated with a combination of intravenous antibiotics and debridement of necrotic tissue and meticulous local wound management.

A Case of Fungal Ball Accompanied with a Microplate as Metallic Foreign Body in Maxillary Sinus / 대한이비인후과학회지

Fungal balls are the most frequent non-invasive form of fungal sinusitis occurring in the immunocompetent individuals. The pathophysiology of fungus balls remains questionable despite known theories such as the obstruction of osteomeatal complex and overfilling of dental cavities. Foreign bodies in maxillary sinus can cause sinusitis by persistent mucosal irritation. Most cases of foreign bodies in the maxillary sinus are related to iatrogenic dental procedure. Foreign bodies in the maxillary sinus, even if they do not result in any symptoms, should be removed because they cause fungal ball growth. Reported herein is a 76-year-old woman who has a history of dental surgery, and who was found to have a fungal ball accompanied with a metallic foreign body as a microplate between the left maxillary sinus and inferior meatus.

Blood Level of Soluble CD30 and Soluble E-Selectin in Allergic Rhinitis Patients

BACKGROUND AND OBJECTIVES: Blood levels of soluble CD30 and soluble E-selectin are related to allergic diseases such as atopic dermatitis or asthma. However, these levels have not been well investigated in allergic rhinitis. We evaluated the association of blood concentrations of these cytokines in allergic rhinitis. MATERIALS AND METHODS: The concentrations of soluble CD30 and soluble E-selectin in blood were analyzed by enzyme linked immunosorbant assay. The levels of these cytokines were compared between allergic rhinitis patients (n=48) and age-matched healthy controls (n=27), and a relationship was found with symptom severity. RESULT: The concentration of soluble CD30 was significantly increased in allergic rhinitis patients compared to that in normal healthy people (p=0.042). However, soluble E-selectin was not significantly increased in allergic rhinitis patients (p>0.05). CONCLUSION: These results suggest a possible role of soluble CD30 in the blood of allergic rhinitis.

Larynx-Preserving Partial Pharyngectomy via Lateral Pharyngotomy for the Treatment of Small (T1~2) Hypopharyngeal Squamous Cell Carcinoma

OBJECTIVES: To evaluate the oncologic and functional results of larynx-preserving partial pharyngectomy (LPP) via lateral pharyngotomy approach as a primary treatment for small (T1 or T2) hypopharyngeal squamous cell carcinoma (HPSCC). METHODS: We performed a retrospective review of 23 patients who underwent LPP through lateral pharyngotomy approach for small HPSCC at the our department between January 1991 and June 2007. Fourteen (61%) patients had adjuvant postoperative radiotherapy. RESULTS: The 2-years and 5-years disease specific survival rate was 77% and 61%, respectively. Nine patients (39%) had tumor recurrence. The most common pattern of recurrence was isolated distant failure (n=4, 44%) followed by local (n=2, 22%) and loco-regional (n=3, 34%) recurrence. The ultimate cure rate of the primary tumor was 87% (20 of 23). Twenty-two of the 23 patients (95%) could be decannulated, tolerate an oral diet, and had acceptable postoperative phonatory function. CONCLUSION: LPP via lateral pharyngotomy approach appears to be a feasible procedure for selected small HPSCC patients in terms of both oncologic and functional outcomes.

Larynx-Preserving Partial Pharyngectomy via Lateral Pharyngotomy for the Treatment of Small (T1~2) Hypopharyngeal Squamous Cell Carcinoma

OBJECTIVES: To evaluate the oncologic and functional results of larynx-preserving partial pharyngectomy (LPP) via lateral pharyngotomy approach as a primary treatment for small (T1 or T2) hypopharyngeal squamous cell carcinoma (HPSCC). METHODS: We performed a retrospective review of 23 patients who underwent LPP through lateral pharyngotomy approach for small HPSCC at the our department between January 1991 and June 2007. Fourteen (61%) patients had adjuvant postoperative radiotherapy. RESULTS: The 2-years and 5-years disease specific survival rate was 77% and 61%, respectively. Nine patients (39%) had tumor recurrence. The most common pattern of recurrence was isolated distant failure (n=4, 44%) followed by local (n=2, 22%) and loco-regional (n=3, 34%) recurrence. The ultimate cure rate of the primary tumor was 87% (20 of 23). Twenty-two of the 23 patients (95%) could be decannulated, tolerate an oral diet, and had acceptable postoperative phonatory function. CONCLUSION: LPP via lateral pharyngotomy approach appears to be a feasible procedure for selected small HPSCC patients in terms of both oncologic and functional outcomes.

Expression and Distribution of Tumor Necrosis Factor-Alpha in Mice Cochlea Exposed to Noise / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recent studies have shown that inflammatory responses occur in the inner ear under various damaging conditions including noise-overstimulation.Identification of time-dependent expression patterns of pro-inflammatory cytokines during the response initiation should lead to rational therapeutic strategies that block the response and reduce the damaging sequelae. MATERIALS AND METHOD: We evaluated the time-dependent expression pattern of pro-inflammatory cytokines in noise-exposed mouse cochlea (white noise, 120 dB SPL, 3 hours) using immunohistochemistry and reverse transcriptase-polymerase chain reaction(RT-PCR). RESULTS: The most potent pro-inflammatory cytokine, the tumor necrosis factor-alpha (TNF-alpha), was up-regulated after noise exposure. Immunohistochemical analyses showed that the TNF-alpha expression was distinctively induced within the spiral ganglion and stria vascularis. RT-PCR showed that TNF-alpha was induced shortly after noise exposure and persisted upto seven days following noise exposure. CONCLUSION: Taken together, acoustic trauma induces cochlear inflammation and the data suggest that TNF-alpha may have some role in cochlea damage that occur following noise exposure.

Blood Level of IL-31, Stem Cell Factor, and B Cell-Activating Factor in Persistent Allergic Rhinitis Patients

BACKGROUND AND OBJECTIVES: Stem cell factor (SCF), B cell-activating factor (BAFF) and Interleukin (IL)-31 are related to allergic diseases such as atopic dermatitis or asthma. But they have not been sufficiently investigated in connection with IgEmediated allergic rhinitis. In this study, we evaluated the association between plasma concentrations of these cytokines and allergic rhinitis. SUBJECTS AND METHODS: A comparative study of the concentrations of plasma SCF, BAFF and IL-31 were conducted between persistent allergic rhinitis patients and a healthy control group using ELISA. RESULTS: Plasma BAFF and IL-31 concentrations were significantly increased in allergic rhinitis group (BAFF, 1,255 pg/mL, Plasma BAFF and IL-31 concentrations were significantly increased in the allergic rhinitis group (BAFF, 1,255 pg/mL, p<0.001;IL-31, 221 pg/mL, p<0.001) than in the control group (BAFF, 1,089 pg/mL;IL-31, 153 pg/mL). But the level of SCF did not exhibit any difference between the allergic rhinitis patients and the control group. CONCLUSION: Our results suggest that plasma BAFF and IL-31 might be associated with the inflammatory mechanism of persistent allergic rhinitis patients.

A Case of Petrosquamosal Sinus: A Rare Emissary Vein of the Temporal Bone / 대한이비인후과학회지

The petrosquamosal sinus (PSS) is a rare emissary vein of the temporal bone. This vein connects dural sinuses with external jugular venous system. This pathway has been known to regress during fetal and early postnatal life however, several cadavaricstudies have revealed that the PSS is a relatively common feature in human. The imaging diagnosis of the PSS, such as digital subtraction angiography or high resolution CT scan, has been rarely reported in humans. We report a case of PSS in a patient with cholesteatoma with a review of literature.

Expression of p53, p21, Cycin D1, and Ki-67 in Sinonasal Tumors

BACKGROUND AND OBJECTIVES: The goal of this study is to investigate alterations of cell-cycle-related molecules, including p53, p21, cyclin D1 and Ki-67, in tumors arising in the sinonasal region. MATERIALS AND METHODS: The study materials were 16 specimens of normal nasal mucosa, 16 inverted papillomas (IPs) and 12 sinonasal squamous cell carcinomas. The p53, p21, cyclin D1 and Ki-67 expression was assessed by immunohistochemical staining. RESULT: IP and squamous cell carcinoma showed significant increase in the expression of p53, cyclin D1 and Ki-67 than normal mucosa. The expression of p53, cyclin D1 and Ki-67 of the carcinoma was stronger than the IP. But, the p21 expression was not associated with the IP and carcinoma. CONCLUSION: Increased levels of p53, cyclin D1 and Ki-67 expression correlate with increased cell proliferation in the tumors of sinonasal regions. These findings indicate that p53, cyclin D1 and Ki-67 expression may be useful markers for the dysregulations of cell kinetics in the tumors of sinonasal region.

One Case of Persistent Stapedial Artery Combined with Aberrant Internal Carotid Artery / 대한이비인후과학회지

A 2-year-old girl had 2-month history of both secretory otitis media . Nine weeks after the first visit, physical examination revealed a whitish mass behind the intact right tympanic membrane. A CT study showed absence of the right foramen spinosum. The right ICA had an aberrant course running laterally in the middle ear cavity with ossesous canal. The soft tissue density in the normal location of the tympanic segment of facial nerve was markedly enlarged. A diagnosis of aberrant ICA and persistent stapedial artery was made. Vascular mass in the middle ear space are very uncommon. They continue to present a diagnostic problem, as the clinical symptoms and signs are often nonspecific and require radiological investigation to distinguish between glomus tumors, other vascular tumors, a dehiscent jugular bulb and an aberrant internal carotid artery. In approximately one per cent of the population, a dehiscent ICA canal is present and can result in the passing of an aberrant ICA through the middle ear space. The persistent stapedial artery is a rare congenital vascular anomaly that may present as a pulsatile middle ear mass or that may appear as an incidental finding. It is important for the otologist to be aware of this anomaly, as a misdiagnosis can have catastrophic consequences.

A Study of Susceptibility between Allergic Rhinitis and IL-4 Receptor alpha Gene Polymorphism Study in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The IL-4 receptor (IL-4R) gene has been suggested as a candidate gene for atopic diseases. The IL-4R consists of two subunits: the alpha chain (IL-4Ralpha), which is a high-affinity IL-4 binding site shared with the IL-13R, and the common gamma chain shared with several other cytokine receptors that amplifies signalling of the alpha chain. A Gln551Arg polymorphism of the IL-4Ralpha gene was shown to be a gain-of-function mutation and was associated with atopy. We tested whether a Gln551Arg polymorphism of IL-4Ralpha gene is associated with allergic rhinitis, blood eosinophil counts and total serum IgE levels in the Korean population. SUBJECTS AND METHOD: Blood samples for genetic analysis were obtained from 192 individuals with allergic rhinitis and from 191 healthy subjects without atopic diseases. Polymerase chain reaction-based assay for IL-4Ralpha Gln551Arg was used for genotyping. Serum total IgE levels were determined by using the immunoassay. Eosinophil values were determined by eosinophil numbers per total cell numbers per microL . RESULTS: There were no differences in the frequencies of the genotypes of IL-4Ralpha in the controls and patients (p>0.05). The frequencies of the IL-4Ralpha Arg551 allele were statistically different between controls and patients (p>0.05). Blood eosinophil count and total serum IgE levels were not statistically different in the genotypes of IL-4Ralpha Gln551Arg in allergic rhinitis (p>0.05). CONCLUSION: Our result suggests that the IL-4Ralpha Gln551Arg polymorphism might not give susceptibility to the development of allergic rhinitis in Koreans.

A Case of Intravascular Papillary Endotheliel Hyperplasia of Inferior Turbinate / 대한이비인후과학회지

Intravascular papillary endothelial hyperplasia (IPEH), so called Masson's hemangioma, is a benign vascular lesion thought to represent a primary process with a subsequent thrombus formation or an unusual manifestation of a thrombus. The important histologic features for IPEH are endothelial proliferation and papillary projections. IPEH should be distinguished from malignant angiosarcoma due to microscopic similarity. We report on a case of IPEH from inferior turbinate appearing in a 56-year-old woman who presented with unilateral nasal obstruction and epistaxis. To the best of our knowledge, the present study is the first case reported of IPEH in a vascular lesion that originated from the inferior turbinate.

A Study of Susceptibility between Allergic Rhinitis and Tumor Necrosis Factor Gene Polymorphism Study in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tumor necrosis factor-alpha (TNF-alpha) is recognized as a proinflammatory host alert cytokine that is synthesized early during inflammation, and elevations of this cytokine have been reported in patients with allergic rhinitis. The TNF-alpha gene is located on chromosome 6p within the class III region of the major histocompatibility complex. The most widely studied polymorphism within the TNF-alpha gene involves a guanine (G)/adenine (A) substitution at position -308. We therefore tested whether TNF-alpha -308G/A polymorphism are associated with allergic rhinitis in a Korean population. SUBJECTS AND METHOD: Blood samples for genetic analysis were obtained from 191 individuals with allergic rhinitis and from 192 healthy subjects without atopic diseases. Polymerase chain reaction-based assay for TNF-alpha -308G/A was used for genotyping. Serum total IgE levels were determined by using the immunoassay. Eosinophil values were determined by eosinophil numbers per total cell numbers per microliter. RESULTS: There were no differences in the frequencies of the genotypes and alleles of TNF-alpha -308G/A in the controls and patients(p>0.05). Blood eosinophil count and total serum IgE levels were not statistically different in the genotypes of TNF-alpha -308G/A in allergic rhinitis(p>0.05). CONCLUSION: We thought that the TNF-alpha -308G/A polymorphism is unlikely to be an important marker for predisposition to allergic rhinitis. A further study involving a larger Korean population might be in need.