Undetected Metallic Chopstick Stabbed on Neck Resulting Tinnitus and Foreign Body Sensation

Penetrating neck injuries constitute 5-10% of all trauma cases. These injuries may cause life-threatening suppurative or vascular complications, but the severity and extent of damage depends upon the inflicting object and the involved structures. If significant complications are not expected, then it is best to leave the foreign body embedded and avoid surgical risks. We present a rare case of a foreign body embedded in the neck causing tinnitus and foreign body sensation.

Progress and Prospect: A Bibliometric Analysis of Research Papers by Korean Allergists Over Recent Five Years (2009-2013)

Since the establishment of the academic society in 1972, Korean allergists have made continuous efforts to elucidate pathogenic mechanisms and therapeutic advances for allergic diseases. The present study aimed to summarize recent progress and explore future prospects of research performance by Korean allergists. We performed a comprehensive bibliometric analysis for research papers published in the Science Citation Index (SCI) or SCI-expanded journals by Korean allergists between 2009 and 2013. Research performance was quantitatively analyzed for the numbers of papers by publication year, research type, and main topic. In addition, the performance was also examined for qualitative indices, such as impact factor and citation number. A total of 1,091 papers were identified. The number of publication increased continuously, with an annual increase rate of 12.3%. Clinical and basic studies were the most frequent types of research, and recently the number of epidemiological studies has increased. By research topic, asthma was the most commonly studied, accounting for 20.9% of the total number of publications. Notably, the amount of rhinitis/rhinosinusitis research has risen steeply in 2013. Qualitative analyses also indicated continuous progress; the median impact factor of published journals increased from 1.918 in 2009 to 2.746 in 2013, yielding an annual increase rate of 7.4%. In conclusion, the present analyses identified a continuous increase in the research performance of Korean allergists over a recent 5 year period (2009-2013), both quantitatively and qualitatively. A more significant contribution is expected in the forthcoming era.

Long-term Effects of Specific Allergen Immunotherapy Against House Dust Mites in Polysensitized Patients With Allergic Rhinitis

PURPOSE: Allergen-specific immunotherapy is the only currently available treatment to modify the natural history of allergic rhinitis (AR). If patients are polysensitized, it is difficult to identify the allergen causing the allergic symptoms. We evaluated the effectiveness of immunotherapy against house dust mites (HDMs) in AR patients polysensitized to both HDMs and seasonal allergens. METHODS: Thirty AR patients polysensitized to both HDMs and seasonal allergens (group A) and 30 patients sensitized to HDMs only (group B) were enrolled in this study. All subjects who received immunotherapy against HDMs for more than 2 years were evaluated by the multiple allergen simultaneous test (MAST) to determine the specific IgE level in luminescence units, total eosinophil counts in peripheral blood, serum total IgE, total nasal symptom scores, and the rhinoconjunctivitis quality of life questionnaire (RQLQ) before and after immunotherapy. RESULTS: There were no statistical differences in levels of total and specific IgE, or total eosinophil count between the two groups. The total nasal symptom scores, RQLQ and medication scores significantly decreased after immunotherapy in both groups, however no significant differences were noted between the two groups. CONCLUSIONS: We determined that the primary causative allergen of AR in Seoul, Korea is perennial allergens, such as HDMs, rather than seasonal allergens. This study provides a reference for the selection of allergens to use in immunotherapy for polysensitized AR patients living in an urban environment.

A Case of Fungal Infection in the Onodi Cell with Diplopia / 대한이비인후과학회지

The orbital apex syndrome is a very rare complication of fungal sinusitis, as well as of other conditions, and is characterized by blindness, diplopia, proptosis of the eye and ophthalmoplegia. We present a case of diplopia caused by a fungal ball in the Onodi cell. A 62-year-old woman, diagnosed with orbital apex syndrome and suffering from ophthalmalgia and diplopia in the right eye, was presented to our outpatient clinic. Computed tomography showed a soft tissue lesion occupying the right Onodi cell with chronic inflammation. Patients who have an Onodi cell carry a high risk for optic nerve injury, so endoscopic sinus surgery using navigation was performed. Histopathology examination confirmed the diagnosis of a fungal ball. We experienced a rare case of a fungal ball in the Onodi cell, which caused damage to the adjacent cavernous sinus structure and led to diplopia and orbital pain. We present this case with a brief review of these disease entities.

A Case of Retrobulbar Hematoma after Septal Surgery Under General Anesthesia / 대한이비인후과학회지

Retrobulbar hematoma is a rare complication following septal surgery under general anesthesia. Symptoms and physical findings include temporary blindness, ophthalmoplegia, mydriasis, ptosis, proptosis and eyelid ecchymosis. Recently, we experienced a rare case of the right retrobulbar hematoma after septal surgery. At present, there is no literature about the occurrence of retrobulbar hematoma following septal surgery. We hereby present this case with an emphasis on the importance of prevention, identification and management of retrobulbar hematoma.

Prevalence of Snoring and High Risk of Obstructive Sleep Apnea Syndrome in Young Male Soldiers in Korea

There are little information on prevalence of obstructive sleep apnea syndrome (OSAS) and clinical features in the young military population. The purpose of this study was to estimate the prevalence of snoring and high risk of OSAS in young male soldiers in Korea and to identify the risk factors of OSAS. A total of 665 participants (aged 20-23 yr) who visited the Armed Forces Ildong Hospital for regular physical examination were enrolled. All participants completed the Berlin Questionnaire and underwent a physical examination. The participants with high risk for OSAS completed portable sleep monitoring. The prevalence of snoring and high risk of OSAS in young male soldiers in Korea was 13.5% and 8.1%, respectively. The prevalence of high arched palate, tongue indentation, long uvula, large tonsil and retrognathia was significantly higher in the high risk OSAS group. High arched palate, long uvula or low lying soft palate, tonsil size III or IV, Epworth Sleepiness Scale score > 10 and obesity (BMI > 27 kg/m2) were found to independently predict OSAS. For early identification and treatment of young soldiers with OSAS in a military environment, a precise screening by questionnaire and physical examination is needed.

The Usefulness of Latex-covered Merocel(R) Packing in Septal Surgery

BACKGROUND AND OBJECTIVES: Nasal packing after nasal surgery is commonly practiced. Merocel(R) is one of the most popular packing material, however it can be associated with significant pain and bleeding on its removal. A prospective study was performed to compare the efficacy and patient tolerance of Merocel(R) and newly designed Latex-covered Merocel(R) (LCM). MATERIALS AND METHOD: Sixty patients underwent septoplasty for septal deviation. Following septoplasty, the patients were randomly allocated into two groups of 30 patients each who underwent insertion of either Merocel(R) or LCM. Patients were asked to record pain levels using a visual analogue scale(VAS) before and after packing removal, and number of analgesic injection were recorded. Resistance and amount of bleeding on packing removal were also recorded. RESULTS: Both nasal packs effectively prevented post-operative bleeding. However the VAS score for nasal pain and numbers of analgesic use before and after packing removal were significantly lower in the LCM group. LCM was removed more smoothly causing significantly less amount of bleeding on removal. CONCLUSION: LCM provides good post-operative hemostasis and its removal is less traumatic and painful for the patients, therefore improving patient's comfort.

Changes of Alpha1-Antitrypsin Levels in Allergen-induced Nasal Inflammation

OBJECTIVES: Alpha1-antitrypsin (AAT) is the main inhibitor of human neutrophil elastase, and plays a role in counteracting the tissue damage caused by elastase in local inflammatory conditions. The study evaluated the involvement of AAT in nasal allergic inflammation. METHODS: Forty subjects with mono-sensitization to Dermatophagoides pteronyssinus (Dpt) were enrolled. Twenty allergic rhinitis patients frequently complained of nasal symptoms such as rhinorrhea, stuffiness, sneezing, and showed positive responses to the nasal provocation test (NPT) with Dpt (Group I). The other 20 asymptomatic patients showed sensitization to Dpt but negative NPT (Group II). The levels of AAT, eosinophil cationic protein (ECP), and Dpt-specific IgA antibodies were measured in the nasal lavage fluids (NLFs), collected at baseline, 10 minutes, 30 minutes, 3 hours, and 6 hours after the NPT. Nasal mucosa AAT expression was evaluated with immunohistochemical staining from Group I and Group II. RESULTS: At baseline, only the Dpt-specific IgA level was significantly increased in the NLFs of Group I compared with Group II, while ECP and AAT levels were not significantly different between two groups. After Dpt provocation, AAT, ECP, and Dpt-specific IgA levels were significantly increased in the NLFs of Group I during the early and late responses. The protein expression level of AAT was mostly found in the infiltrating inflammatory cells of the nasal mucosa, which was significantly increased in Group I compared to Group II. CONCLUSION: The increment of AAT showed a close relationship with the activation of eosinophils induced by allergen-specific IgA in the NLFs of patients with allergic rhinitis after allergen stimulation. These findings implicate AAT in allergen-induced nasal inflammation.

Changes of Alpha1-Antitrypsin Levels in Allergen-induced Nasal Inflammation

OBJECTIVES: Alpha1-antitrypsin (AAT) is the main inhibitor of human neutrophil elastase, and plays a role in counteracting the tissue damage caused by elastase in local inflammatory conditions. The study evaluated the involvement of AAT in nasal allergic inflammation. METHODS: Forty subjects with mono-sensitization to Dermatophagoides pteronyssinus (Dpt) were enrolled. Twenty allergic rhinitis patients frequently complained of nasal symptoms such as rhinorrhea, stuffiness, sneezing, and showed positive responses to the nasal provocation test (NPT) with Dpt (Group I). The other 20 asymptomatic patients showed sensitization to Dpt but negative NPT (Group II). The levels of AAT, eosinophil cationic protein (ECP), and Dpt-specific IgA antibodies were measured in the nasal lavage fluids (NLFs), collected at baseline, 10 minutes, 30 minutes, 3 hours, and 6 hours after the NPT. Nasal mucosa AAT expression was evaluated with immunohistochemical staining from Group I and Group II. RESULTS: At baseline, only the Dpt-specific IgA level was significantly increased in the NLFs of Group I compared with Group II, while ECP and AAT levels were not significantly different between two groups. After Dpt provocation, AAT, ECP, and Dpt-specific IgA levels were significantly increased in the NLFs of Group I during the early and late responses. The protein expression level of AAT was mostly found in the infiltrating inflammatory cells of the nasal mucosa, which was significantly increased in Group I compared to Group II. CONCLUSION: The increment of AAT showed a close relationship with the activation of eosinophils induced by allergen-specific IgA in the NLFs of patients with allergic rhinitis after allergen stimulation. These findings implicate AAT in allergen-induced nasal inflammation.

Validation of Embletta for Diagnosis of Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Overnight polysomnography (PSG) in a sleep laboratory is the standard method of confirming the diagnosis of obstructive sleep apnea (OSA). However, PSG is expensive, time-consuming, uneasily accessible and labor-intensive, so many patients need a more convenient tool that is ambulatory. The aim of this study was to investigate the usefulness of Embletta by comparing the respiratory parameters derived from Embletta with those of PSG. SUBJECTS AND METHOD: PSG and Embletta sleep study were performed for 42 patients prospectively. Respiratory parameters, such as apnea index (AI), hypopnea index (HI), apnea-hypopnea index (AHI), and oxygen parameters, such as lowest oxygen saturation (LSAT), mean oxygen saturation (MSAT), and oxygen desaturation index (ODI) were measured automatically from Embletta and by hand from PSG. All parameters of Embletta were compared with those of PSG. In addition, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for Embletta were calculated for the diagnosis of OSA. RESULTS: Most of the respiratory parameters and the oxygen parameters were well correlated between PSG and Embletta and the correlation coefficients were well correlated and statistically significant as well. The sensitivity, specificity, PPV, and NPV were 90%, 75%, 0.9, and 0.75, respectively, for Embletta for the diagnosis of OSA. CONCLUSION: Embletta might be clinically useful as a screening device of OSA patients based on its high correlation to PSG and positive predictive value.

Usefulness of Berlin and STOP Questionnaires as a Screening Test for Sleep Apnea in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although obstructive sleep apnea is common, it has often gone undiagnosed in primary care encounters until now, with no validated screening tool of obstructive sleep apnea (OSA) for Korean patients. The aim of this study was to investigate the usefulness of Berlin questionnaire (Berlin Q) and STOP questionnaire (STOP Q) as a screening test for sleep apnea for the Korean patients. SUBJECTS AND METHOD: We administered Berlin Q and STOP Q to 106 patients who received a full night polysomnography. We investigated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each questionnaire according to patients' severity by apnea hypopnea index (AHI). RESULTS: Results were categorized according to AHI severity using cut-off points of AHI greater than 5, 15, and 30. The sensitivity and specificity of the Berlin Q were 69, 72, 78% and 41, 43, 39%, respectively. NPV and PPV of Berlin Q were 0.20, 0.43, 0.74 and 0.86, 0.72, 0.43, respectively. The sensitivity and specificity of the STOP Q was 97, 97, 98% and 35, 20, 12%, respectively. NPV and PPV for STOP Q were 0.67, 0.78, 0.89 and were 0.89, 0.71, 0.40, respectively. CONCLUSION: Our results indicate that STOP Q shows higher sensitivity than Berlin Q with similar specificity. Therefore, STOP Q is a more convenient and better means than Berlin Q to screen patients for obstructive sleep apnea.

The Clinical Characteristics of Anisakis Allergy in Korea

Anisakidae larvae can cause anisakiasis when ingested by humans. Although several groups have reported a gastrointestinal Anisakis allergy among people in Spain and Japan, our report is the first to summarize the clinical features of 10 Anisakis allergy cases in Korea. We enrolled 10 Korean patients (6 men and 4 women) who complained of aggravated allergic symptoms after ingesting raw fish or seafood. Sensitization to Anisakis was confirmed by detecting serum specific IgE to Anisakis simplex. The most common manifestation of anisakiasis was urticaria (100%), followed by abdominal pain (30%) and anaphylaxis (30%). All patients presenting with these symptoms also exhibited high serum specific IgE (0.45 to 100 kU/L) to A. simplex. Nine patients (90%) exhibited atopy and increased total serum IgE levels. The fish species suspected of carrying the Anisakis parasite were flatfish (40%), congers (40%), squid (30%), whelk (10%), and tuna (10%). Anisakis simplex should be considered as a possible causative food allergen in adult patients presenting with urticaria, angioedema, and anaphylaxis following the consumption of raw fish or seafood.

Changes of Taste Function after Palatopharyngeal Surgery in Obstructive Sleep Apnea Syndrome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Postoperative taste changes after uvulopalatopharyngoplasty (UPPP) is regarded as an unusual and minor complication. This study aims to evaluate the objective changes of taste threshold according to time course and subjective symptoms change. MATERIALS AND METHOD: With 45 patients who underwent UPPP and 35 patients who underwent nasal surgery as control group, we have prospectively studied postoperative taste changes using a questionnaire, and an electrogustometer (EGM) with regard to symptoms at 7th, 28th days after the surgery. EGM was measured at 5 areas. Also, we have checked pre-operatively about the serum level of zinc. RESULTS: With EGM, the threshold of taste was increased at 7th days after the surgery (p<0.05), but recovered 28th days after the surgery at the posterior part of the tongue in the UPPP group. There were no significant changes in subjective taste dysfunction, smell dysfunction, tongue sensory abnormality, and dysgeusia. CONCLUSION: Taste changes after UPPP was transient and they disappeared within the 1st postoperative month. There were no patients who complained of subjective taste dysfunction, dysgeusia, tongue sensory abnormality after UPPP.

A Case of Occupational Rhinitis Caused by Porcine Pancreatic Extract Developing into Occupational Asthma

Porcine pancreatic extracts (PPE), which are widely used as a digestive drug in Korea, are composed of alpha-amylase and lipase. Such enzymes are commonly described as occupational allergens. This is the first report of occupational rhinitis caused by PPE developing into occupational asthma in a hospital nurse. She showed strong positive response in the skin prick test (SPT) (5+, wheal ratio of allergen to histamine) and had a high serum-specific IgE level to PPE, but showed a negative response in the methacholine bronchial challenge test (MBT). She had been exposed to PPE intermittently with intermittent medications for rhinitis. Two years later, she presented with rhinitis and additional asthmatic symptoms. In contrast to her first visit, she showed a positive response in the MBT, and developed bronchoconstriction in the PPE-bronchial provocation test (BPT). These findings suggest that inhalation of PPE powder can induce IgE-mediated occupational rhinitis in a hospital setting, which will develop into occupational asthma if avoidance is not complete.

Impact of Symptomatic Allergic Rhinitis on Attention and Development of Personality and Behavior in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Allergic rhinitis reduces the quality of life as a result of suffering from symptoms and possibly of impaired cognition and performance. The difference in attention and development of personality and behavior between the symptomatic children group and normal children was evaluated to delineate more clearly the impact of allergic rhinitis on children. SUBJECTS AND METHOD: The comparison of allergic symptoms, attentiveness, cognitive function, development of personality and behaviors as well as the parenting style of 38 patients with symptomatic allergic rhinitis and 31 healthy controls were matched for intelligence, age and sex. The clinical analysis was carried out by a pediatric psychologist who interpreted the results. RESULTS: A defective frontal lobe function and decreased constant concentration were observed in allergic rhinitis group. There was a significant decrease in verbal development and performance development in the allergic rhinitis group. Parents of allergic rhinitis group were found to have said some swear words or hurt child's feeling by using bad language. CONCLUSION: Allergic rhinitis group was more deteriorated compared to the control group in regards to attentiveness, frontal lobe function, verbal and performance development, thus we can say that allergic rhinitis can affect attention, cognitive function and personality development of the child.

Clinical Efficiency of Adenoidectomy Using Microdebrider / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Remnant adenoid tissue after adenoidectomy or immoderate procedure result in various complications such as bleeding, damage to the mucosa of posterior nasopharyngeal wall or orifice of Eustachian tube. The purpose of this paper is to compare conventional adenoidectomy with microdebrider-assisted adenoidectomy based on postoperative outcome and intraoperative effectiveness. MATERIALS AND METHOD: We performed a prospective study comparing thirty cases of adenoidectomy using conventional approach with fifteen cases of transoral microdebrider adenoidectomy using an indirect laryngeal mirror. Skull lateral radiographs and a symptom scale were used to evaluate preoperative and postoperative states. RESULTS: There was no significant difference in the improvement of symptoms and postoperative outcome between the conventional group and the microdebrider adenoidectomy group. However, it was found that more adenoid tissue could be removed in the microdebrider group. Postoperative nasopharyngeal endoscopic views revealed that microdebrider removed adenoid tissue precisely and preserved the posterior nasopharyngeal wall better when compared to the conventional group. CONCLUSION: Compared with the conventional procedure, adenoidectomy using the transoral microdebrider with an indirect laryngeal mirror was similar in achieving symptom improvement and postoperative outcomes, but removed more adenoid tissue with higher precision. From this study, we suggest that using microdebrider with indirect laryngeal mirror is another valuable method of adenoidectomy in the aspect of precision.

Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) as an Evaluator of Perennial Allergic Rhinitis Patients-The First Report- / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The symptom score index (SSI) has not been able to express fully the states of the perennial allergic rhinitis patients. So, other tools were deemed necessary to not only evaluate the degree of severity but also to evaluate the efficacy of the newly developed drugs on perennial allergic rhinitis. The aim of this study was to evaluate the impact of perennial allergic rhinitis on the quality of life of patients and to verify the correlation between the nasal symptoms and other factors influencing the patients' complaints on allergic rhinitis. MATERIALS AND METHOD: One hundred and three allergic rhinitis patients who do not have nasal septal deviation, chronic rhinosinusitis and nasal polyps were subjected to study. The patients answered the quality of life questionnaire on the scale of one to five. We calculated the frequency, importance and correlation coefficient of each nasal symptom item and the other question items. We also carried out a x(2)-test for the test group and the control group. RESULTS: In addition to nasal symptoms, patients experienced impairment of the quality of life due to generalized symptoms of allergic rhinitis and practical problems. On the questionnare, generalized symptoms, practical problems, emotional problems, activity limitations and ocular symptoms were frequently checked complaint items, but sleep disorder was not. The relationship between the quality of life of patients with nasal symptoms was statistically significant, but sleep disorder was not. CONCLUSIONS: This questionnaire was effective as an evaluator of impairment of quality of life in patients with perennial allergic rhinitis.

Arterial Embolization in Rhinological Field: an Analysis of 19 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The progress of arterial embolization made it possible to control intractable nasal bleeding and to reduce the blood supply of nasopharyngeal angiofibroma. MATERIALS AND METHODS: We reviewed 19 cases of patients who received arterial embolization from Jan. 1993 to Dec. 1999. We analyzed the cases according to the age, sex, hypertension, purpose, result and complications of arterial embolization. RESULTS: Thirteen patients received arterial embolization due to uncontrolled epistaxis by conservative management. Except one patient who had bleeding from the anterior ethmoidal artery, 12 patients stopped bleeding after successful embolization. Three patients received the arterial embolization for continuous bleeding after endoscopic sinus surgery, and other three patients received it for reducing the blood supply of the nasopharyngeal angiofibroma preoperatively. The complications were seizure like movements, fever and facial pain: but these complications were limited to few cases, and were minimal and temporary. CONCLUSION: Arterial embolization is a safe and effective method that should be considered in the treatment of refractory nasal bleeding and for reducing the intraoperative bleeding in angiofibroma.

Result of Allergic Skin Test, MAST and Nasal Provocation Test in Children with Atopic Dermatitis / 대한이비인후과학회지

BACKGROUND & OBJECTIVES: Allergic diseases are considered to be systemic diseases. Atopic diseases are the first manifestation among allergic diseases, with the suggested relation to allergic rhinitis and asthma, as reported in several studies. The objective of this study was to evaluate the responses to allergic tests in children who have atopic dermatitis or have allergic rhinitis and atopic dermatitis. Materials & Methods : Eighty subjects without atopic dermatitis (control group) and 80 patients with atopic dermatitis (atopy group) were subjected to study from Nov. 1997 to Nov. 1999. The atopic group included pediatric patients who were diagnosed as having atopic dermatitis, but excluded patients who received medical treatment of steroid or antihistamine before the test for 1 month. In all the control and atopic groups, the nasal cavity volume was first estimated by acoustic rhinometry, followed by the allergic skin test (AST) and MAST. A nasal provocation test was taken with a positive allergen for patients who showed positive response to AST and MAST; for patients who showed negative response to AST and MAST, the test was taken with the House dust mites. RESULTS: In the atopic dermatitis group, the rate of positive responses to AST and MAST were 65% and 72.5%, respectively; in the control group, the rates were 25% and 35%, respectively. The most common positive allergen was the House dust mite in AST and MAST. In the nasal provocation test, the more positive rate was observed in the atopic group. CONCLUSION: The atopic group showed more positive response than the control group to AST, MAST and the nasal provocation test. Also, the nasal mucosa of 37.5% of the atopic dermatitis patients were sensitized to a certain allergen.