Assessment of the Test-Retest Reliability of Level III Polysomnography: Comparison of Results Using Difference of Apnea-Hypopnea Index Score and Severity of Obstructive Sleep Apnea / 대한이비인후과학회지

Background and Objectives@#Although studies of test-retest reliability of the standard polysomnography has been reported numerous times, studies of portable sleep devices have been reported in very few cases to date. The purpose of this study is to investigate the test-retest reliability of level III devices, to examine the characteristics of patients with tendency of underestimation and to determine whether there are factors that can predict when retest is needed. Subjects and Method We enrolled 74 patients for this study from April 2014 to March 2019. Two indicators were used to assess night to night variability. If the difference of apneahypopnea index (AHI) score was less than 10 or there is no difference of severity of obstructive sleep apnea (OSA) between two nights, we decided that the results have a reliability. @*Results@#Seventeen out of 57 patients with an AHI difference of less than 10 showed unreliable results based on severity, and 3 out of 17 patients with the AHI difference more than 10 showed reliable results based on severity. Eight out of 74 patients were diagnosed at Night 2 but not at Night 1. In other words, about 11% of the subjects needed retest. Based on the change in severity of OSA, subjective sleep scores showed a statistically significant difference, indicating that the subjective sleep score should be considered when deciding a retest. AHI differed by more than 10 in about 23% of the subjects in this study, falling within “15%- 32%,” which has been reported in the literature on the level I test. @*Conclusion@#This suggests that there is no significant difference in reliability between level I and III.

Melanotic Oncocytic Metaplasia of the Nasopharynx in the Patient with Suspicious Hemoptysis: Case Report

Melanotic oncocytic metaplasia (MOM) in the nasopharyngeal space is a very rare entity. Only 35 cases have been reported in the English literature, and most patients were East Asian males between 60 and 70 years of age. MOM presents as a brown or black lesion with slight elevation of the mucosa. These lesions are benign and defined as cellular enlargement with eosinophilic granular melanin-pigmented cytoplasm caused by mitochondrial accumulation. However, such presentation can lead physicians to misjudge MOM as a malignant lesion. Recently, we experienced a case of MOM of the nasopharynx. A 58-year-old woman was admitted to the internal medicine department with small-volume hemoptysis and referred to the ENT department for evaluation. She was a regular smoker without any medical history. Sinus endoscopy showed black pigmented lesions on both the torus tubaris and left posterior tonsillar pillar, with low bleeding risk. Excisional biopsy of the lesion was performed, and oncocytic metaplasia was confirmed pathologically. Hemoptysis showed spontaneous remission and no recurrence or other symptoms over 12 months of follow up. Melanotic oncocytic metaplasia in the nasopharynx should be clinically recognized to avoid misdiagnosis as a malignancy like melanoma.

A Case of Huge Nasolabial Cyst in 56 Year-Old Patient

A nasolabial cyst is a rare, non-odontogenic cyst that develops within the area adjacent to the ala of the nose around the uppermost portion of the nasolabial crease. The origin of such a cyst is unclear but may be due to developmental problems. Clinical characteristic of asymptomatic nasolabial swelling and radiological findings are important for diagnosis. Treatment is usually surgical resection via a sublabial approach but can also involve incision and drainage or marsupialization. Unlike the typical clinical features reported in other cases, we experienced a case of a giant nasolabial cyst of 4.4 cm in a 56-year-old male with elevation of the nasal cavity base, gingival swelling, and perilesional bony destruction. In this case, we discussed the growth potential of a nasolabial cyst and proper timing of treatment.

A Case of Hemophilia B Diagnosed after Rhinosinus Surgery in 37 Year-Old Patient / 대한이비인후과학회지

Hemophilia is an X-linked recessive disorder, which is classified into hemophilia A, defined by factor VIII deficiency and hemophilia B, defined by factor IX deficiency. The usual clinical presentation is spontaneous bleeding and prolonged activated partial thromboplastin time in a person without history of a coagulation disorder. The severity of hemophilia describes how serious a problem is and has been defined by a traditional classification into three forms: severe, moderate, mild. Hemophilia has never been reported after a rhinosinus surgery in otorhinolaryngology in Korea, but we encountered a 37-year-old man with hemophilia B who had undergone a rhinosinus surgery. He had no bleeding tendency in the past nor a family history for bleeding. But the patient presented with continuous nasal bleeding for a few days after surgery. We report this case of hemophilia B diagnosed after rhinosinus surgery that was cured with Factor IX replacement therapy with a review of the relevant literature.

A Case of Cholesterol Granuloma of Maxillary Sinus Misdiagnosed as Odontogenic Cyst

Cholesterol granuloma is a disease in which cholesterol crystals act as a foreign substance in the surrounding tissues and cause granulomatous reaction and fibrosis within the chamber. It is found in various locations of the body, but the most common location is the temporal bone associated with middle ear disease. Because the disease is associated with breathing disturbance, it may also occur in the paranasal sinus. However, it has been rarely reported since its first report by Graham and Michaels in 1978. Recently, we experienced a case of cholesterol granuloma of the right maxillary sinus of a 63-year-old female patient without any nasal symptoms. We successfully managed this case with Caldwell-Luc operation. Also, we summarized the cases of cholesterol granuloma of the sinonasal region reported in Korea.

Effects and Related Factors of Endotracheal Intubation on Voice Change Following General Anesthesia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reliable studies about the impact of short-term intubation, particularly as part of general anesthesia, are scarce. That scarcity led to the following research objectives. First of all, we tried to find out how often and why voice change last more than 72 hours after intubation conducted for general anesthesia. SUBJECTS AND METHOD: The study enrolled 80 patients who were due to undergo general anesthesia at the Seoul Paik Hospital from Aug. 2009 to May 2010. The patients were examined through stroboscopic examination and voice analysis before surgery. Three days after the surgery, the same tests were performed again to single out patients whose results were abnormal; thus a proportion could be calculated. The other objective was to determine the factors involved with voice change. This was done according to the Mallampati classification, using the images from laryngoscopy and compiling records of cuff pressure, cuff volume, tube size, duration of intubations, and the number of intubation trials. RESULTS: 7.5% of the patients suffered from voice change longer than 3 days. Three factors, namely, cuff pressure, duration of anesthesia and patient age demonstrated statistically significant relationships among them. CONCLUSION: The results indicate that there is a need for patients scheduled to face general anesthesia to receive sufficient explanation about the possible postoperative voice change that could last longer than 3 days. Furthermore, surgeons and anesthesiologists need to cooperate closely by taking the patient age, duration of anesthesia and cuff pressure into account in order to limit postoperative voice change to the minimum extent.

Two Cases of Acute Palatine Tonsillitis and Adenoiditis Caused by the Phylloporia Ribis Intoxication / 대한이비인후과학회지

It is said, arguably, that a Phylloporia ribis is effective on epilepsy and a range of malignancies. That's why the Korean traditional or alternative medicine sector often takes advantage of that. Nevertheless, to the best of authors' knowledge, there's no report about toxicities. Recently, the researchers encountered two patients, a 52-year-old female and her 28-year-old son, who boiled a Phylloporia ribis and drank its extract seven days before the visit. Both started to experience sore throat 6 days later, accompanied by chills. The complete blood cell tests revealed that they were suffering from acute tonsillitis, with leukopenia and thrombocytopenia.

Laser Cartilage Reshaping / 대한이비인후과학회지

No abstract available.

Primary Angiosarcoma of the Parotid Gland / 대한이비인후과학회지

Angiosarcoma is an exceedingly rare and highly malignant neoplasm which develops from the endothelium of blood vessels. Only a few cases of primary angiosarcoma of the non-irradiated parotid gland have been reported. In this case, we report a primary angiosarcoma of the parotid gland in a 64-year-old man without prior irradiation of the head and neck region. MRI finding revealed a 3.9x2.7 cm sized mass located in the right parotid gland with unhomogenous enhancement in T2 weighted image. The patient underwent a total parotidectomy and radical neck dissection. The histologic diagnosis was high-grade angiosarcoma showing pleomorphic spindle or epithelioid tumor cells growing as solid infiltrative pattern or slit-like irregular vascular lumina formation. Despite postoperative radiation therapy, the patient died of lung metastasis with hemorrhage 3 months later.

Comparative Values of External Nose Measurement with Photograph According to Sex and Age in Korean Adults

BACKGROUND AND OBJECTIVES: Rhinoplasty has been frequently performed for correction of injured nose or cosmetic reasons. Korean standard values are insufficient, and most reference values are based on Caucasian ones. We measured Korean values of external nose with photographs according to sex and age. MATERIALS AND METHODS: Three hundred forty seven subjects without past history of operation or trauma were included in this study. With scaled instrument for head fixation, frontal and profile views were taken. On frontal view, physiognomic face height and nasal width were measured. On profile view, midface height, nasal height, alar height, glabellar depth, nasion depth, nasal dorsum depth, nasal tip depth, nasal depth, nasofrontal angle and nasolabial angle were measured. And location of nasion and shape of nasal dorsum were also classified. RESULT: Physiognomic face height decreased with age in both men and women groups. Nasofrontal angle increased with age in men. Nasion was located between upper end of upper eyelid and lateral canthus in most cases. On classifying the shape of nasal dorsum, straight type was the most in both men and women groups. CONCLUSION: We could know average measurements of external nose and differences of those according to sex and age in Korean adults. And it is thought that these data will be useful to facial plastic surgery including rhinoplasty.

A Case of Carcinoma ex Pleomorphic Adenoma of Hard Palate / 대한이비인후과학회지

Carcinoma ex pleomorphic adenoma is a rare neoplasm of the salivary gland. It has been reported that the most frequently affected site is the parotid gland, while the incidence rates in palatal minor salivary gland are much lower. Misdiagnosis is common, because the residual mixed tumor component may be small, and various carcinoma subtypes are possible. Clinical manifestations are mostly asymptomatic and have space occupying lesion sometimes. The recommended treatment is surgical excision with wide margins and subsequent radiation therapy. The author recently experienced a carcinoma ex pleomorphic adenoma of hard palate in a 62-year-old female with palatal mass. We treated with total excision with wide margins and there was no recurrence during the follow-up period of 2 years until now. We report this case with review of the literature.

Verruca Vulgaris of the Larynx: A Case Report / 대한이비인후과학회지

Verruca vulgaris is commonly seen on skin, but extremely rare in other areas, especially in larynx, where it could be not uncommonly misdiagnosed as verrucous carcinoma. In the recent studies, we noted that verruca vulgaris of the larynx is related to human papilloma virus type 6, 11, which is different from human papilloma virus type 2, 4, which is found on skin. Verruca vulgaris of the larynx occurs in old age with the average of 56 years, and it looks white in color on laryngoscopic examination, which is limited to the true vocal cords. It recurs infrequently. Pathologically, it is heavily keratinized and it contains prominent keratohyaline granules and exhibits koilocytosis. We experienced a case of verruca vulgaris of the larynx in a patient with hoarseness lasted for 3 months. So we report this case with a review of literature.

Two Cases of Postoperative Cheek Cyst with Exophthalmos / 대한이비인후과학회지

Postoperative cheek cysts develop as a delayed complication of Caldwell-Luc operation, usually 10 to 20 years following the surgery. The general clinical presentations are swelling of the cheek, accompanied by dull maxillary facial pain and numbness. Enlarged postoperative cheek cysts infrequently protrude into the orbit and elevate the eyeball, causing double vision. Recently, we experienced two cases of exophthalmos caused by the protrusion of a postoperative cheek cyst into the orbit. One patient, a 39-year-old man, underwent Caldwell-Luc operation 21 years ago, and the other patient, a 53-year-old man, 36 years ago. We were able to secure an accurate measurement of the defective orbital floor using the preoperative 3-dimensional reconstruction CT scan. The postoperative cheek cyst was completely removed using the endonasal and transantral endoscopic approach, and the widely defective orbital floor was reconstructed with Medpor(R).

The Effect of Electrical Stimulation at Tympanic Membrane on Tinnitus Suppression / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Electrical stimulation is one of various methods of treatment for patients suffering from tinnitus. However, the effect or mechanism of electrical stimulation is still unclear. Also, although the success rate of electrical stimulation ranged from 13% to 80% in other studies, the best condition of electrical stimulation is unknown yet. The purpose of this study is to elucidate the effect of alternate current electrical stimulation at tympanic membrane on tinnitus suppression and to seek the best condition that yield maximum tinnitus reduction. SUBJECTS AND METHOD: Forty-five patients who suffered from tinnitus with moderately severe hearing loss above 56 dB and 20 patients with limited frequency hearing loss above 56 dB were selected for this study. The study was performed in 4 phases. Fourty-five patients who passed the screening phase received 10 min duration of electrical stimulation twice a week for 6 weeks. RESULTS: The results were as follows. 1) Among the 65 patients, alternate current stimulation suppressed tinnitus in 45 patients (69%) in the screening phase. So 45 patients were selected for the electrical stimulation group. 2) Tinnitus suppression was most effective in patients with sudden deafness in the screening phase. 3) Effective tinnitogram for electrical stimulation was white noise and 8 kHz (pure tone) in the screening phase. 4) The most common optimal stimulation was the low frequency square wave. 5) The mean intensity of the current was 47.5 microliterA. 6) Suppression of tinnitus was achieved in 30 patients (67%) among 45 patients who received electrical stimulation therapy. 7) Long term treatment was more effective than short term, but adaptation phenomenon was noted during the treatment phase in 15 patients (33%). CONCLUSION: These results showed that alternate current stimulation for patients with tinnitus is effective and that the optimal condition to use is the low frequency square wave. We found good response to electrical stimulation in patients with sudden deafness and moderate to severe hearing loss. Therefore, we think electrical stimulation is a good treatment for patients with tinnitus for whom it is difficult to apply TRT (tinnitus retraining therapy).

Psychological Analysis with Symptom Check List-90-Revision in Patients with Tinnitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Psychological distress may develop from tinnitus, or that recognition of tinnitus may even be greater during exposure to environmental stress. So, patients with tinnitus need to consider the psychologic aspect in their diagnosis and treatment. The aim of this study is to evaluate the degree and characteristics of the psychologic factors associated in patients undergoing tinnitus retraining therapy. MATERIALS AND METHOD: 119 patients with tinnitus who received the Symptom Check List-90-Revision (SCL-90-R) and a control group without tinnitus were compared first; and then 92 out of 119 patients performed the follow up study after three months of tinnitus retraining therapy. RESULTS: The results were as follows. 1. The tinnitus group scored higher than the control group in somatization, anxiety, phobic anxiety (p0.05). 3. The psychologic aspect of patients with tinnitus were related to loudness, pitch, annoyance (p<0.05). 4. The follow-up study of 3 months on patients who underwent tinnitus retraining therapy showed diminished score in all components of SCL-90-R, except phobic anxiety, and paranoid (p<0.05). CONCLUSION: This study indicated that the compliant behaviour of tinnitus is related closely with intrinsic psychodynamic mechanism.

A Case of Pregnancy Induced Venous Hum Treated by Ligation of the Internal Jugular Vein / 대한이비인후과학회지

The patient with pulsatile tinnitus can bo annoying and the tinnitus can be the only clue to a potentially devastating and life-threatening disease, too. This tinnitus may originate from the arterial, arteriovenous, venous vessels and the myoclonus. Occasionally it is the cause of underlying condition in increased flow volume such as anemia, hyperthyroidism, pregnancy, medication or increased intracranial pressure. And then control of these underlying condition is important treatment in those occasions. If anyone suffered from venous pulsatile tinnitus, then simple ligation of the internal jugular vein could be the simplest treatment. Recently the authors experienced a case of 28-year-old woman with left pulsatile tinnitus originating from venous hum. The tinnitus had developed at fourth month of pregnancy and persisted after 20 months of delivery. The patient was treated by ligation of the internal jugular vein in local anesthesia. The proper ligation site was decided by angiography. She remains free of symptoms and complications 7 months after treatment.

A Case of Odontogenic Infratemporal Fossa Abscess / 대한이비인후과학회지

Infratemporal fossa abscess is difficult to diagnose by conventional physical examination because of the anatomic location of this structure. Infratemporal fossa abscess has been seen secondary to maxillary sinus fracture and infections involving the maxillary molars. It is difficult to observe on plain films but is readily apparent on CT evaluation. The loss of the retromaxillary fat plane is the most notable feature. Streptococcus spp and Bacteroides spp have been isolated from the abscess. Therapy consists of incision and drainage, and appropriate antibiotic therapy. The following case report and review of the literature are offered in hope of alerting physicians to the occurrence of this disease and to the circumstances in which the diagnosis should be actively excluded.

C-fos Expression in Brain Stem of Rats after Salicylic Acid Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Subjective tinnitus, a distracting internal noise, is experienced by humans. Tinnitus is evoked by salicylic acid treatment in rats as confirmed by Jastreboff in 1994 in an animal behavior model of tinnitus with salicylic acid. The objective of this study is to evaluate c-fos expression in the brain stem of rats after salicylic acid treatment. MATERIALS AND METHOD: After salicylic acid (450 mg/kg) and saline treatment (450 mg/kg), c-fos immunohistochemical staining expression in the auditory and nonauditory brain stem nuclei were observed. RESULTS: Many immunoreactive cells were observed in the Locus Ceruleus of the salicylic acid treated animals, but not in the saline treated animals. No immunoreactive cells were found in the auditory brain stem nuclei. CONCLUSION: The Locus Ceruleus is the nucleus of the brain stem and produce norepinephrine which results in arousal of the neuronal activity for stress. These results suggest that salicylic acid may evoke tinnitus through a combined effect on the auditory and nonauditory brain nuclei. It seems possible that the interaction of these effects at particular locations of the brain causes tinnitus.

Effects of Salicylate on ABR and ECoG in Guinea Pig / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It has been recognized that salicylate induces ototoxicity in animals and humans. Many studies have been done to identify the mechanisms of ototoxicity of salicylate with histopathological, biochemical and electrophysiological methods. Among these methods, the electrophysiological method is useful for clinical diagnosis and evaluation of therapeutic effect. The studies reported here were aimed at performing electrophysiological effects of salicylate by using Auditory Brainstem Response (ABR) and Electrocochleography (EcoG) through non-invasive approach. MATERIAL AND METHODS: Auditory brainstem response and electrocochleogram were observed by non-invasive approaching method after the intraperitoneal injection of 450 mg/kg of lysine salicylate on 10 ears of 5 guinea pigs. RESULTS: The threshold shifting of ABR and ECoG were less than 10 dB. The latency of ABR waves and Summating Potential were increased after salicylate was administered especially at low intensity sound stimulation. CONCLUSION: The latency of ABR wave and SP would be useful in diagnosing ototoxicity and evaluating the therapeutic effect in ototoxic patients.

A Case of Jugular Bulb Diverticulum Accompanied with Pulsatile Tinnitus / 대한이비인후과학회지

Pulsatile tinnitus is perceived as sounds that vary in frequency, intensity and duration. It is also characterised by its unique feature of rhythmicity that is synchronous with the human pulse. Clinically, it is a serious disorder because it is associated with other life threatening or curable diseases. Pulsatile tinnitus may originate from several sites including the arterial, arteriovenous, venous vessels and the myoclonus. Jugular bulb diverticulum, one of the causes of venous pulsatile tinnitus, is observed as a protrusion of the jugular vein lumen with a waist like margin. It may extend either laterally in the tympanic cavity or medially towards the petrous pyramid close to the inner ear. This leads to pulsatile tinnitus, sensorineural or conductive hearing loss and vertigo. In this paper we report a recent case in which we confirmed jugular bulb diverticulum in a 59 years-old woman whose complaint of pulsatile tinnitus was spontaneously disappeared during the follow up.