The Effect of Intensive Therapy Using Nebulized Antibiotics after Endoscpic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are some difficulties and dilemmas in treating patients who show acute recurrent infection or persistent inflammation after sinus surgery. Recently, nebulized antibiotic therapy was recommended as another treatment option for these patients. Our study was to evaluate the effect of nebulized antibiotic therapy in these patients. SUBJECTS AND METHOD: We selected 38 adult patients who had received endoscopic surgery previously. They were patients of the refractory group who have showed persistent purulent rhinorrhea despite treatment for 2 months after sinus surgery and the acute exacerbation group who have showed repeated worsening of their symptoms more than 3 times for 6 months. Cultures were taken from all cases and proper oral antibiotics were used based on their culture results. Oral antibiotics were stopped during the nebulized antimicrobial therapy. Nebulized antibiotics therapy was performed 5 times a week for 4 weeks with cefmenoxime hydrochloride using ultrasonic nebulizer. The symptom score and endoscopic appearance were checked also before and 1, 2 and 3 months after the treatment. RESULTS: In 38 patients, 6 patients were excluded due to follow up loss or voluntary stop of treatment and 32 patients were available. S. aureus, P. aeruginosa and coagulase-negative Staphylococcus were most common organisms in all patients. The symptom score and endoscopic appearance after the treatment showed significant improvement. No complication was found in all cases. CONCLUSION: Nebulized antibiotic therapy might be considered as another therapeutic option for patients with refractory or acute exacerbation of chronic rhinosinusitis after endoscopic sinus surgery.

A Case Report of Correction of Bilateral Cryptotia Using Modified Ohmori's Method / 대한이비인후과학회지

Cryptotia is a congenital anomaly of the auricle that the upper pole of the auricular cartilage is buried beneath the skin of the scalp and auriculocephalic sulcus is obliterated. In addition, there is often a deformity of the antihelix, especially its superior crus. The principle of the surgery is to deepen the auriculocephalic sulcus, to correct deformed cartilage and to correct the malposition. For the correction of the bilateral cryptotia, we have applied the modified Ohmori's method and have obtained good result without complication. We report this case with a review of related literature.

Correlation between the Pure Tone Audiometry Results and the Subjective Hearing Benefit of Tympanoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Measuring the therapeutic effect of tympanoplasty is usually dependent on the surgeon's view-point and the results of pre- and post-operative pure tone audiometry (PTA). But there is considerable discrepancy between the subjective hearing benefit and the PTA, so the aim of this study is to evaluate the correlation between them among the patients who had tympanoplasty for chronic suppurative otitis media. SUBJECTS AND METHOD: One hundred patients who had tympanoplasty between 2000 and 2001 were studied. Patients were divided into two groups, improved and not-improved group, according to their answers to the questionnaire asking his or her subjective hearing benefit. The pre and postoperative air conduction threshold (AC), bone conduction threshold (BC), air-bone gap (ABG) and the amount of increment or decrement of these parameters were compared between the two groups. RESULTS: Analysis of the data showed significant differences between the two groups with respect to preoperative ABG, postoperative AC, postoperative ABG, AC decrement and ABG decrement. Especially, when the amount of AC decrement was more than 10 dB or the ABG decrement was more than 20 dB, the rate of improved subjective hearing group was increased very strongly. CONCLUSION: Among the pre- and post-tympanoplasty PTA results, the most useful indicators of patient's subjective hearing benefit are the amount of AC decrement (more than 10 dB) and ABG decrement (more than 20 dB).

Evaluation of the Obstructive Site in Patients with Obstructive Sleep Apnea Using Sleep Endoscopy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep endoscopy is a valuable modality for an anatomical assessment in patients with snoring and obstructive apnea. The aims of this study is to observe the anatomical obstructive site using sleep endoscopy and to compare the sleep endoscopic findings and the results of the Mueller maneuver in clinical setting. SUBJECTS AND METHOD: Thirty patients with obstructive sleep apnea syndrome underwent sleep endoscopy. After intravenous administration of midazolam, obstructive events were observed. The levels of obstruction were classified as palatal, palatal with tonsil and palatal with tongue base. Obstruction was defined when the site was collapsed more than 50% compared with normal respiration during the apneic episode. RESULTS: On sleep endoscopy, retropalatal obstruction was observed in 14 patients (47%). Obstruction in the retropalatal area combined with the tonsillar area was found in 9 patients (30%). Obstruction in the retropalatal area combined with the tongue base area was found in 7 patients (23%). However, the results of Mueller maneuver showed retropalatal obstruction in 19 patients (63%), obstruction in the retropalatal with tonsillar area in 9 patients (30%) and obstruction in the retropalatal with tongue base area in 2 patients (7%). CONCLUSION: Sleep endoscopy is a useful modality to assess the accurate anatomical site of obstruction during sleep state and provide information useful in planning of further treatment.

The Effect of Antibiotic Nebulizer Therapy for Treatment of Pediatric Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : The management of chronic recurrent rhinosinusitis in children has become controversial, because there are now various treatment modalities. We assessed nebulized antibiotic therapy, which had been studied as a treatment option in the postoperative infection in adult patients, for its effectiveness in children with chronic rhinosinusitis. Subjects and METHOD : We have selected 34 pediatric chronic rhinosinusitis patients who have received treatment for 3 months or 3 times for recent 6 months with oral antibiotics. They were treated with a nebulized antibiotic therapy for 4 weeks. We have compared pre-and post-treatment symptom scores, physical scores, and radiologic scores. After 6 months of follow up, infection free period was assessed. RESULTS : In 34 patients, 25 patients were selected for study. The symptoms and physical findings were improved in 76%, and the radiologic findings were also improved in 56%. Improvement in rhinorrhea, nasal obstruction, coughing and nasal swelling were significant. Mean infection free period was 13.7 weeks. CONCLUSION : Nebulized antibiotic therapy might be considered as another therapeutic option for pediatric patients with chronic sinusitis who have failed to respond to oral antibiotics or who cannot tolerate them.

Two Cases of Nasopharyngeal Angiofibroma in Pterygopalatine Fossa Treated by Transantral Microsurgery and Endoscopic Removal / 대한이비인후과학회지

Nasopharyngeal angiofibroma occurs predominantly in adolescent males, and shows frequent epistaxis, nasal obstruction, mouth breathing and facial deformities. Because its recurrence rate ranges from 7.1% to 50%, complete removal of this tumor is important to prevent recurrence. Traditionally, many surgical approaches including lateral rhinotomy and transpalatal approaches have been used for this tumor depending on the site and size of the tumor. If the tumor is small and present within the nasal cavity, endoscopic approach can be used. But when tumor has extended to pterygopalatine fossa, endoscopic approach has some limitations for complete removal. In such a case, we have used a transantral microsurgery and transnasal endoscopic combined approach. We present two cases of nasopharyngeal angiofibromas treated by deep transantral microsurgery and intranasal endoscopic approach. By this approach, we have ligated the internal maxillary artery after emboliztion of intenal maxillary artery and could remove the tumor completely. Two patients have been followed over 12 months without recurrence.

A Case of Recurrent Frontal Sinus Mucocele Complicated by Visual Disturbance and Treated by Endoscopic Marsupialization and Intrafrontal Stent Insertion

Paranasal sinus mucocele is a slowly expanding benign lesion which can occur as a result of obstruction in the sinus ostium or ostial tract. Frontal sinus mucocele differ from mucoceles of other sinuses in that the frontal outflow tract is usually narrower and less accessible. Since the introduction of endoscopic sinus surgical instrument and techniques, there has been an increasing trend towards the use of endoscopic transnasal technique for managing the paranasal sinus mucoceles. Some studies also recommend the use of intrafrontal stent to reduce the rate of restenosis of frontal sinus outflow tract. We experienced a case of recurrent frontal sinus mucocele complicated by visual disturbance and periorbital swelling. To treat this condition, an intranasal marsupialization was performed and an intrafrontal stent was applied. This paper reports the particulars of this case with a review of related literature.

Chicken Embryo as a Model of Inner Ear Study

BACKGROUND AND OBJECTIVES:Nowdays, numbers of patient who suffers from inner ear disease are increased and we need to completely understand about inner ear anatomy and embryology. But we have many problems to use human itself as a model, so it is difficult for us to study. Instead of using human as a model, recent days, many doctors use mammalians and birds. In this study, we used chicken embryo as a model whose inner ear was thought to be similar with human's inner ear and we made effort to get inner ear images by light microscope. MATERIALS AND METHOD:We incubated Gallus domesticus in auto-incubator for 12days. In each embryonic day (4th to 12th days), we got the chicken embryo and made paraffin block. Next, with micro-tomb, we made slice section and fixed to slide. Using micro-digital camera system, we took the picture of the inner ear of chicken embryo. RESULTS:We observed the structures of inner ear of chicken embryo from 4th embryonic day to 12th embryonic day. In 4th day and 5th day, we could not get the definite clear image. But from 6th to 12th day, we got the clear images of utricle, saccule, semicircular canals, etc. In several micro-section methods, making oblique coronal section was showed the best images of inner ear. CONCLUSION:This study was the start point of chicken inner ear embryology and anatomy. Hereafter, we should make the deeper study about chicken inner ear with these results and investigate the genetic and extrinsic factors which influence to inner ear disease. So we should solve the fundamental problem of inner ear disease based on this study