Lobular Capillary Hemangioma of the Hypopharynx / 대한이비인후과학회지

Lobular capillary hemangioma (LCH) is a rapidly growing benign vascular neoplasm of unknown etiology. LCH usually occurs on the cutaneous and mucosal surfaces, such as gingiva, lips, fingers, and face. LCH was previously called ‘pyogenic granuloma (PG),’ because it was thought to be granulation of tissue occurring in reaction to an infectious etiology despite the fact that it demonstrates no infectious signs in histology or microbiology. Instead, its features seem more like angiomatous lesions rather than granulomatous lesions, so the term ‘LCH’ has been used thereafter. Reports of LCH of hypopharynx have been rare. Here we report a 63-yearold male patient with LCH of hypopharynx with a review of related literature.

Unilateral Vocal Cord Palsy Caused by Cervical Osteophyte / 대한이비인후과학회지

Cervical osteophytes are bone spurs that grow on any part of the cervical spine. Osteophytes in the spine are a normal sign of aging and can be associated with conditions such as degenerative disc diseases, osteoarthritis, spinal stenosis, and others. When cervical osteophytes become large enough, main symptoms can include neck pain, radicular pain, neurological problems, and sometimes dysphagia, as well as hoarseness in rare cases. The authors report a case of left vocal cord palsy in a 75-year-old male patient with a large cervical osteophyte with a left anterior protrusion in the C5/C6 level.

A Case of Quadriplegia after Parotidectomy in a Patient with Asymptomatic Cervical Spondylosis / 대한이비인후과학회지

Cervical spondylosis is a common degenerative disease of the cervical spine affecting the cervical vertebral bodies and intervertebral discs. During parotidectomy, the patient is placed in a supine position with the neck extended and head rotated to the contralateral side. This position could exacerbate pre-existing cervical spondylosis and cause cervical myelopathy. We present a case of postoperative quadriplegia secondary to cervical myelopathy after parotidectomy. A 68-year-old man without symptoms of cervical spondylosis underwent partial parotidectomy for a right parotid mass and subsequently developed quadriplegia 8 hours postoperatively. Magnetic resonance imaging revealed severe cervical myelopathy. Emergency laminoplasty was performed, and steroid therapy was initiated. He showed near-complete recovery six months later.

A Case of Quadriplegia after Parotidectomy in a Patient with Asymptomatic Cervical Spondylosis / 대한이비인후과학회지

Cervical spondylosis is a common degenerative disease of the cervical spine affecting the cervical vertebral bodies and intervertebral discs. During parotidectomy, the patient is placed in a supine position with the neck extended and head rotated to the contralateral side. This position could exacerbate pre-existing cervical spondylosis and cause cervical myelopathy. We present a case of postoperative quadriplegia secondary to cervical myelopathy after parotidectomy. A 68-year-old man without symptoms of cervical spondylosis underwent partial parotidectomy for a right parotid mass and subsequently developed quadriplegia 8 hours postoperatively. Magnetic resonance imaging revealed severe cervical myelopathy. Emergency laminoplasty was performed, and steroid therapy was initiated. He showed near-complete recovery six months later.

Headache Characteristics in Rhinologic Patients and the Role of Surgical Treatment

OBJECTIVES: Even though headache is a common symptom in patients with chronic rhinosinusitis (CRS) or nasal septal deviation (NSD), there are very few recent reports investigating headache characteristics in rhinologic patients. Therefore, we investigated the headache characteristics and differences in CRS and NSD patients who were diagnosed by computerized tomography and endoscopic exams. METHODS: We enrolled 257 patients who had undergone nasal and sinus surgery between January 2012 and December 2013. The subjects were divided into a CRS group (n=147) and NSD group (n=110). They were asked to fill out a Sinonasal Outcome Test (SNOT-20) and questionnaire about pre-operation headaches (1 day prior) and post-operation headaches (1 month after) they experienced, to evaluate their sinonasal symptoms and headache characteristics. RESULTS: There was no significant pre-operative difference in rhinologic symptoms and headache characteristics between the CRS and NSD groups. Females experienced more headaches. Both groups reported significant improvements to their headaches after surgery; however, we found no significant differences in the degree of improvement between the two groups. CONCLUSIONS: There was no significant difference in the headache characteristics and the degree of post-operative improvement between the CRS and NSD groups. Surgical treatments appear to reduce headaches in patients with rhinologic diseases.

Relationship between Meteorological Factors and Emergency Department Visits for Epistaxis in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epistaxis may be related to changes in weather, but this relationship has not been well-defined. We investigated the effects of climate fluctuations (temperature, humidity, and barometric pressure) on the number of emergency department (ED) visits for epistaxis. SUBJECTS AND METHOD: In total, our study population included 1910 patients who visited the ED of a large, urban hospital during a 5-year period for epistaxis. Patients with clear etiology for epistaxis (trauma, iatrogenic, coagulopathy, and/or hypertension) were excluded, leaving 912 patients for subsequent analysis. Daily climate data was collected through the Korea Meteorological Administration. Correlation between epistaxis ED visits and weather variables were investigated using Poisson distribution and multiple regression analysis. The effect of climate factor was evaluated on the day and up to 3 days prior to ED presentation. Additionally, analyses were conducted separately for children ( or =65 years-old). RESULTS: Changes in the lowest temperature 2 days prior to ED presentation significantly increased the number of ED visits for epistaxis (beta=-0.043, p=0.033). No associations were found between the number of ED visits and changes in humidity or atmospheric pressure. However, in children, interday changes in the highest atmospheric pressure between 2 and 3 days prior to ED presentation were both significantly associated with increased number of epistaxis ED visits. CONCLUSION: Cold temperatures 2 days prior to ED presentation were related to the increased incidence of epistaxis. Fluctuations in barometric pressure appear to influence the number of pediatric ED visits for epistaxis.

Vegetable or Pulse Granuloma in the Nasal Cavity

Vegetable granuloma or pulse granuloma results from the implantation of food particles of vegetable origin. Pulse granulomas have mainly been reported in association with lung aspirations, the oral cavity with a history of oral procedures and less frequently in gastrointestinal tracks. We report a 31-year-old woman who presented with right nasal obstruction and was found to have a firm mass in the right nasal cavity. Paranasal sinus computerized tomography scans identified a calcified ring lesion in her right nasal cavity. Endoscopic sinus surgery was performed, and pathology examination revealed a lesion consistent with a pulse granuloma that contains starch granules with cellulose envelopes appearing as hyaline rings surrounded by inflammation cells and concentrically arranged delicate connective tissue. Pulse granuloma is a well described entity with distinct histopathology. However, pulse granulomas are rare, and especially extraoral pulse granulomas are extremely rare. We found that pulse granuloma can be occurred in the nasal cavity through regurgitation.

The Characteristics of Sinonasal and Psychological Symptoms and Quality of Life in Rhinologic Patients and the Role of Surgical Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic diseases of the nose and sinuses have been shown to influence patients, not only physically but also psychologically affecting the overall well-being. We evaluated the quality of life of rhinologic patients, and the effect of surgery on them. In addition, we assessed the correlation between the symptom scores and objective findings. SUBJECTS AND METHOD: From November 2009 to January 2011, a total of 194 patients haveing nasal and sinus surgery were enrolled. They were divided into nasal cavity disease (NCD) group (n=103) and chronic rhinosinusitis (CRS) group (n=91). These patients had to fill out a questionnaire at different points, at 1 day, 1 month, 3 and 6 months prior to surgery. The normal control group (n=30) also had to fill out four questionnaires: our questionnaires were Sinonasal Outcome Test-20 (SNOT-20), Rhinosinusitis Disability Index (RSDI), Version 2 of Short-Form 36 item Health Survey (SF-36v2(TM)), Symptom Checklist-90-Revised (SCL-90-R). For the CRS group, Lund-Mackay score was calculated using CT scans. RESULTS: Both experimental groups showed more severe scores than the control group. The CRS group exhibited more severe symptoms than the NCD group. Both experimental groups achieved significant improvements after surgery. CRS group showed more significant improvement than the NCD group in SNOT-20. The Lund-Mackay score showed no significant correlation with the subjective symptom scores. CONCLUSION: Chronic rhinologic diseases affect the quality of life. CRS patients show more severe scores than the NCD patients. CRS patients have more improved effectiveness than NCD patients after surgical treatment. Objective conditions and subjective symptoms may be correlated inconsistently, and the evaluation for the overall quality of life is important to reflect on the therapeutic effect.

Morphologic Analysis of Crista Galli Using Computed Tomography

OBJECTIVE: We often observe the variation of Crista galli (CG) which lies in the midline above the cribriform plate on computed tomography (CT) scans. We investigated the variations in CG and the factors which affect its pneumatization. MATERIALS AND METHODS: We analyzed the CT images of 818 chronic rhinosinusitis patients between July 2003 and July 2011. We investigated height, position relative to the cribriform plate, degree of pneumatization, and cell origin for the pneumatization in CG. We analyzed the relationship between several factors (age, sex, and position of CG) and pneumatization of CG. RESULTS: The average height of CG was 17.98 mm. In 13.9% of subjects, the base of CG did not extend below the level of the cribriform plate. In 84.2%, CG extended less than 50% of its height below the cribriform plate. In 1.8%, CG extended more than 50% of its height below the cribriform plate. Pneumatization of CG was found in 12.2%. Except one, every pneumatization was connected with the frontal sinus. The rate of pneumatization was significantly different depending on age. CONCLUSION: Our study demonstrated that CG showed various morphology and pneumatizaiton. The pneumatization of CG was mainly originated from frontal sinus and related to aging.

A Case of Ectopic Salivary Gland with Fistula in the Anterior Neck / 대한이비인후과학회지

Ectopic salivary gland tissue represents an uncommon lesion, usually presenting as a discharging fistula in the anterior lower neck. Though the origin of this entity still remains unclear, it is thought to be a heteroplasia of the epithelium of the precervical sinus of His. We have experienced a case of ectopic salivary gland with cervical fistula in a 10-year-old. This was thought clinically to be the second branchial cleft cyst, but the pathology showed an ectopic salivary gland. This should be considered as one of the causes of a cystic neck mass or fistula in children.

A Case of Suspension Laryngoscope Assisted Removal of Migrating Cervical Screw after Anterior Cervical Fusion / 대한이비인후과학회지

Anterior cervical approaches to the cervical spine have been widely and safely used in spine surgery in recent years; however, they also have posed some otorhinolaryngological complications. We present a case of suspension laryngoscope assisting in the removal of a cervical screw. The patient was a 63-years-old man who was operated on traumatic cervical herniated disc. Surgical interference included C5 corpectomy, iliac bone autograft, anterior cervical fusion at C4-C6 level using an anterior cervical plate and screws. Five years later, he presented a foreign body sensation in the neck and odynophagia. The laryngoscopic exam showed the medial wall of the right pyriform sinus protrusion and the migration of an upper screw was observed in plain films and computed tomography of the cervical spine. The suspenson laryngoscope and C-arm fluoroscope were used for the transpharyngeal screw removal. The removal of the screw in question was successful with no complications. We report this case with a review of the literature.

A Case of Organizing Hematoma of the Nasal Septum / 대한이비인후과학회지

Organizing hematomas are rare benign tumors and appear as forms of mass which is composed of neovascularization with organizing fibrous tissue in hematoma. There have been sporadic reports of the organizing hematoma not only in soft tissue but also in brain, spinal cord, lung, and maxillary sinus. We report a case of organizing hematoma that was restricted in the nasal cavity without inclusion of the paranasal sinus. This is the first article describing the organizing hematoma of the nasal septum. We present this case with a review of literature.

Clinical Features of Bilateral Paranasal Sinus Fungus Ball

BACKGROUND AND OBJECTIVES: Paranasal sinus fungus balls occur usually in a single sinus, most frequently the maxillary sinus. The goal of this study was to delineate the clinical features of a bilateral paranasal sinus fungus ball. MATERIALS AND METHODS: We retrospectively reviewed seven patients who presented with a bilateral sinus fungus ball and who received endoscopic sinus surgery between July 2004 and January 2009. We analyzed age, gender, chief complaint, associated symptoms, nasal endoscopic findings, ostiomeatal unit (OMU) computed tomography (CT) results, and surgical findings. RESULT: The male to female ratio was 1:6, and the age range was from 40 to 76 years. The chief complaints were nasal obstruction in three patients, foul odour in two, postnasal dripping in one, and cheek pain in one patient. Calcification of the paranasal sinus upon CT was observed in three cases (43%). A fungus ball was found in the maxillary sinus or middle meatus in all cases. CONCLUSION: Bilateral paranasal sinus fungus balls usually involve the bilateral maxillary sinus or middle meatus and often invade the anterior ethmoid sinus or frontal sinus.

Ultrasonography Guided Percutaneous Aspiration and Drainage of Deep Neck Abscesses / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For abscesses in the head and neck, traditional open surgical incision-and-drainage procedure may incur added morbidity and result in disfiguring scars. Therefore, a noninvasive alternative to open surgical drainage may be quite beneficial. The purpose of this study was to evaluate the efficacy of percutaneous ultrasonography-guided aspiration and drainage in the management of the selected head and neck abscesses. SUBJECTS AND METHOD: Retrospective review was done for 12 patients with unilocular or multilocular abscess sized 2 cm or more in the greatest in different locations and origins. All patients did not present imminent airway compromise and subsequently underwent ultrasonography guided aspiration and drainage. RESULTS: All of the abscesses were resolved in 11 patients within 10 days. Even multilocular abscesses were resolved without open surgical drainage. One abscess in which Mycobacterium tuberculosis was isolated persisted more than 3 weeks in spite of ultrasonography guided aspiration and drainage, and resolved by antituberculosis medication of more than 10 months. CONCLUSION: Percutaneous ultrasonography-guided aspiration and drainage is a safe and effective procedure, for the abscesses in the head and neck without life threatening conditions.

Solitary Cutaneous Reticulohistiocytoma on the Nasal Vestibule / 대한이비인후과학회지

Reticulohistiocytosis represents a rare spectrum of non-Langerhans cell histiocytosis: the solitary cutaneous form (reticulohistiocytoma), the diffuse cutaneous form without systemic involvement, and multicentric reticulohistiocytosis with systemic involvement. We report a case of solitary cutaneous reticulohistiocytosis in a 46-years-old male, who presented with an asymptomatic firm, dome-shaped nodule on the right vestibule of nose. The lesion was completely excised and no evidence of recurrence was observed.

Acetic Acid Induced Laryngitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acetic acid is not uncommon suicidal material and it can cause serious laryngitis. The purpose of this study was to investigate the clinical characteristics, proper management, and clinical course of laryngitis induced by acetic acid. SUBJECTS AND METHOD: We analyzed the medical records of 39 patients with acetic acid ingestion from 1996 to 2006, retrospectively. RESULTS: Flexible fiberoptic laryngoscopy showed supraglottic laryngeal edema or mucosal ulcer with narrowed airway in 15 cases (38.5%). More common reason of ingestion was suicidal attempt than accidental exposure. There was no significant correlation between severity and the amount of ingestion, or the reason of ingestion. Eight patients needed orotracheal intubation for airway management, but no emergency tracheotomy was imperative. Most laryngeal lesions were relieved by supportive care within 2 weeks. CONCLUSION: Acetic acid laryngitis could narrow airway, and could be resolved by supportive management. Flexible fiberoptic laryngoscopy was useful in evaluating laryngeal involvement and severity.

Anisakiasis in Oral Cavity: A Case Report / 대한이비인후과학회지

Anisakiasis is a disease caused by human infection by the Anisakis larvae, a marine nematode found in raw or undercooked fish. Most of anisakiasis are found in gastric or intestinal mucosa, but Anisakiasis in the oral cavity is rare. So, we elaborate on it in the present report with a review of literatures. This is the first report about anisakiasis of oral cavity in the recent literatures in Korea.

Mechanism of Acetylcholine-induced Endothelium-dependent Relaxation in the Rabbit Carotid Artery by M3-receptor Activation

The present study were designed to characterize the action mechanisms of acetylcholine (ACh) -induced endothelium-dependent relaxation in arteries precontracted with high K (70 mM). For this, we simultaneously measured both muscle tension and cytosolic free Ca2 concentration ([Ca2 ]i), using fura-2, in endothelium-intact, rabbit carotid arterial strips. In the artery with endothelium, high K increased both [Ca2 ]i and muscle tension whereas ACh (10microM) significantly relaxed the muscle and increased [Ca2 ]i. In the presence of NG-nitro-L-arginine (L-NAME, 0.1 mM), ACh increased [Ca2 ]i without relaxing the muscle. In the artery without endothelium, high K increased both [Ca2 ]i and muscle tension although ACh was ineffective. 4-DAMP (10 nM) or atropine (0.1microM) abolished ACh-induced increase in [Ca2 ]i and relaxation. The increase of [Ca2 ]i and vasorelaxation by ACh was siginificantly reduced by either 3microM gadolinium, 10microM lanthanum, or by 10microM SKF 96365. These results suggest that in rabbit carotid artery, ACh-evoked relaxation of 70 mM K -induced contractions appears to be mediated by the release of NO. ACh-evoked vasorelaxation is mediated via the M3 subtype, and activation of the M3 subtype is suggested to stimulate nonselective cation channels, leading to increase of [Ca2 ]i in endothelial cells.

Efficacy of Adjuvant Short Term Oral Steroid Therapy for Acute Pharyngitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sore throat due to acute pharyngitis is one of the most common ailments and complaints for hospital visits. This report aims to study the effects of oral steroids on pain relief, duration of illness, to get bacterial culture result and its relation to therapeutic effect. MATERIALS AND METHOD: Data was collected from 109 patients who have been clinically diagnosed with acute pharyngitis from March 2002 to August 2002. The 109 patients were arbitrarily divided into 3 groups and each group was prescribed different combinations of oral steroid and NSAIDS. All groups were commonly prescribed with antibiotics and analgesics after having performed a pharyngeal culture. Follow up was performed via telephone survey 24 and 48 hours after the clinical visit to measure subjective complaints of pain. The degree of pain was measured by the VAS (visual analogue system). RESULTS: The 3 groups scored an average of 3.23, 4.14 and 5.90, respectively, on the VAS scale after 24 hours of visit. After 48 hours the 3 groups scored 2.00, 1.65 and 3.03, respectively. From these results, VAS score was significantly lower in the group of oral steroid prescription, regardless of NSAIDS use, and this pattern increased in cases where bacterial cultures showed positive. However, there were no significant differences in the duration of illness, oral intake and limitation of activity among the 3 groups. CONCLUSION: The use of short term oral steroids for the treatment of acute pharyngitis can help to decrease the intensity and duration of pain, and this tendency seems to increase in cases where bacterial cultures show positive results.

Short Term Follow-up of Hearing Changes according to Insertion Site of Temporalis Muscle Fascia in Type I Tympanoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are two types of methods in the underlay technique that are employed according to the graft insertion site. The purpose of this study is to evaluate the short term follow-up results of air-bone conduction threshold changes according to the insertion of temporalis muscle fascia to medial and lateral side of malleus in type I tympanoplsty with simple mastoidectomy. MATERIALS AND METHOD: 72 patients with perforated tympanic membrane over the half size in pars tensa were operated in type I tympanoplasty with simple mastoidectomy. Patients were divided into two groups according to the insertion of fascia of temporalis muscle to either i) lateral side of the malleus (group A, 32 cases) or ii) medial side of the malleus (group B, 40 cases). Each group was divided into three subgroups according to size of perforation in the tympanic membranes, ranging from moderate, large, to total. Difference in the air-borne conduction threshold changes between the first preoperative and postoperative year was analyzed for each group. RESULTS: The differences in the pre and postoperative air-bone conduction gap (ABG) between the group A and B were 14.4+/-7.1 dB, 10.4+/-6.2 dB, respectively. There was no statistical difference between the two groups (p>0.05). The pre and postoperative ABG differences for different sizes of perforation in the tympanic membrane in group A were 17.5+/-12.2 dB (moderate), 14.1+/-7.4 dB (large), 14.5+/-8.5 dB (total), and in group B were 9.5+/-4.8, dB (moderate), and 9.3+/-7.2 dB (large), and 12.0+/-7.1 dB (total). There was no statistical difference between the subgroups of the same group (p>0.05). The pre and postoperative bone conduction threshold of group A decreased at 250, 500, 1000, and 2000 Hz but increased at 3000, 4000 Hz. The threshold of group B decreased at all frequency. Postoperative reperforations were observed in just 2 cases of the group B. One case was observed at 5 postoperative months in the large perforation group, and the other case was observed at 15 months in the total perforation group, with the former case healing spontaneously at 6 months. CONCLUSION: The results suggest that the two methods of underlay technique could be selected properly by location of perforation, middle ear anatomy and its pathological state, and continuity of ossicles, as well as per operator's preference. When the perforation is located at the anterior, anterosuperior and anteroposterior portion of tympanic membrane, the tympanic membrane is thickened severely so the boundary becomes uncertain between the middlear mucosa and the tympanic membrane. The insertion of fascia to lateral side of malleus is therefore recommended.