Injection Laryngoplasty for The Treatment of Vocal Fold Scar, and Sulcus

BACKGROUND AND OBJECTIVES: The clinical reports for the treatment of vocal fold scar and sulcus vocalis are limited, also there is no best one for the treatment of them. This study is to evaluate the effect of Injection laryngoplasty (IL) for the treatment of vocal fold scar and sulcus vocalis. MATERIALS AND METHODS: from January 2013 to May 2015, the Nineteen patients who were diagnosed as vocal fold scar, sulcus and atrophy, and underwent IL, were engaged in this study. Clinical information and voice parameters were analyzed by retrospective chart review. Pre and post voice parameters were compared. RESULTS: Subgroups of diagnosis were classified into sulcus vocalis for 12 patients, vocal fold scar for 5, and atrophy for 2. IL was performed under local anesthesia through cricothyroid membrane except one patient. Atesense®, Radiessess®, and Rofilan® were used as injected materials in 9, 9, and 1 patients respectively. Maximal phonation time (p=0.0124), dynamic range (p=0.0028), pitch range (p=0.0141), voice handicap index (p=0.028), glottal closure (p=0.0229), and mucosal wave (p=0.0132) had significant improvement for post-IL voice assessment than Pre-IL. While GRBAS, Mean flow rate, Jitter, Shimmer, Harmony to Noise ratio didn't have improvement. CONCLUSION: IL is a feasible option for the treatment of glottis incompetence with normally mobile vocal folds such as sulcus vocalis and vocal fold scar.

Variability of Offending Allergens of Allergic Rhinitis According to Age: Optimization of Skin Prick Test Allergens

PURPOSE: This study evaluates offending allergens in patients with allergic rhinitis (AR) according to age that establish a minimal panel for skin prick test (SPT) allergens required to identify if a patient is sensitized. METHODS: We retrospectively analyzed SPT results according to age to determine the minimum test battery panel necessary to screen at least 93%-95% of AR patients. Allergic skin tests (common airborne indoor and outdoor allergens) were performed on 7,182 patients from January 2007 to June 2011. All patients were classified into 9 groups according to age; subsequently, we investigated offending allergens by age group. RESULTS: A total of 5,032 (70.1%) patients were found sensitized to at least one of the 55 aeroallergen extracts tested. The annual ranking of offending allergens was not significantly different from each other over the past 5 years. House dust mites (HDM) were the most prevalent allergens ranked from first to third for all 5 years. The allergens in the minimum test panel differed slightly among all age groups; in addition, the types of sensitized allergen sources were more diverse in the older versus younger age group. HDM covered a larger proportion of the sensitized allergens in the younger age group versus the older age group. Testing with 5 allergens (Dermatophagoides farinae, Tetranychus urticae, oak, mugwort and cockroach) adequately identified over 90% of the sensitized patients. CONCLUSIONS: A SPT with around 5-7 allergens adequately detected most of the sensitization in the majority of the age groups in Korea. However, this study suggests that physicians perform the SPT with appropriately selected allergens in each age category for the screening of AR.

Update of Sublingual Immunotherapy for Allergic Rhinitis

Current treatment strategies for allergic rhinitis include avoidance of the offending allergens, pharmacotherapy, immunotherapy and surgery. Among them, immunotherapy is the only therapeutic option that modifies the basic allergic mechanism by inducing desensitization and producing a state of anergy in the presence of offending allergens. Immunotherapy by subcutaneous allergen injection (subcutaneous immunotherapy, SCIT) has been used since 1911 and has been demonstrated to be a clinically effective treatment for allergic disorders such as rhinoconjunctivitis and asthma. However, the inconvenience, invasiveness and potentially lethal adverse systemic events associated with SCIT have motivated physicians to develop other routes for the administration of allergens such as orally, sublingually or intranasally. Sublingual immunotherapy (SLIT) has recently received considerable attention around the world as a treatment for allergic rhinitis and is now widely used as an alternative to the subcutaneous route. The Allergic Rhinitis and Its Impact on Asthma (ARIA) group of the WHO has acknowledged the potential effectiveness of SLIT for pollen or mite-sensitized allergic rhinitis. Clinical trials evaluating the efficacy and safety of SLIT have been ongoing worldwide since 1980, and newer studies are evaluating practical applications for improving patient care. SLIT has recently been introduced and become widely available for allergic rhinitis treatment in Korea. We previously published our experiences with SLIT and its use in allergic rhinitis patients sensitized to house dust mites. As evidence continues to accumulate, the validity of SLIT as one of the initial treatment options for allergic rhinitis is now becoming more widely accepted.

A clinical study of results after operation using Tension-free vaginal tape / 대한산부인과학회잡지

OBJECTIVE: The purpose of the study was to evaluate the safety and efficacy of tension-free vaginal tape (TVT) placement for surgical treatment of stress urinary incontinence (SUI) in women. METHODS: A retrospective study of 38 cases with SUI underwent the TVT procedure underlying local anesthesia at Daedong and Sewoong Hospital from March 2000 to December 2000, followed up more than six months who included in the study. RESULT: Operation times ranged from 20 to 53 minutes with a mean of 37.5 minutes. The mean blood loss was 90 mL. One major complication was encountered -bladder perforation (2.5%) and urinary retention was developed in 4 cases (10.5%). Length of hospital stay ranged from 0.8 to 11.3 days with a mean of 1.8 days. On postoperative follow-up from 6.1 to 17.5 months, thirty-three patients (87%) were cured, four (10.5%) were significantly improved and one was failed (2.5%). CONCLUSION: Althouth the follow-up period was short, the TVT procedure seemed to be a safe and effective method for the treatment of stress urinary incontience.

Early Experience of Intravesical Capsaicin for Treatment of Detrusor Hyperreflexia in Patients with Spinal Cord Injury

PURPOSE: The clinical and urodynamic effects of intravesical capsaicin, a neurotoxic substance causing a reversible suppression of unmyelinated C fiber afferent neuronal activity, were investigated for treatment of detrusor hyperreflexia in patients with spinal cord injury. MATERIALS AND METHODS: Capsaicin solution (2mM) dissolved in 30% alcohol was instilled intravesically in 7 men with detrusor hyperreflexia due to spinal cord injury. Effects on bladder function and subjective symptoms were evaluated before and after intravesical instillation of capsaicin. RESULTS: Bladder function was improved in all but 1 patient. The improvement was expressed as an increase from 108ml to 270ml in maximal bladder capacity and a decrease from 75cmH2O to 44cmH2O in maximal detrusor pressure. Four patients had subjective improvement following treatment and the effects lasted for 4 to 6 weeks. Immediately after capsaicin instillation the ice water test was negative in 2 patients. Autonomic dysreflexia was observed in 4 patients, suprapubic discomfort in 3 patients and gross hematuria in 1 patient. CONCLUSION: Intravesical capsaicin seems to be a promising method for treatment of detrusor hyperreflexia, but the general use of intravesical capsaicin was limited due to side effects.