Long-Term Follow-Up of Patients with Benign Paroxysmal Positional Vertigo / 대한평형의학회지

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is one of most common peripheral vestibular disorders. The aim of this study was to identify recurrence in the long-term follow-up of patients with BPPV after successful canalith repositioning maneuvers, and to determine which factors contribute to recurrence. METHODS: The authors reviewed the medical records of 202 consecutive patients with BPPV during the period January 2002 to December 2004 and investigated 112 patients with BPPV treated over the same period. Finally, 71 patients were enrolled in this study. The estimated risk of recurrence used a Kaplan-Meier analysis. For long-term follow-up, patients were contacted by telephone for further information by one experienced doctor. RESULTS: A total of 71 patients with idiopathic BPPV fulfilled the inclusion criteria. Forty-two patients had posterior semicircular canal-BPPV and 29 patients lateral semicircular canal-BPPV. Recurrence rates in the posterior semicircular canal-and lateral semicircular canal-BPPV were 24% (18/42) and 41% (12/29), respectively (p>0.05). Recurrence following successful treatment during a long-term follow-up period was 23 out of 30 patients within 1 year, 5 patients between 1 and 3 years, 1 patient at between 3 and 5 years, 1 patient after 5 years, respectively. CONCLUSION: The authors found no significant difference between the posterior semicircular canal and lateral semicircular canal-BPPV regarding recurrence. Recurrence mostly occurred within the first 3 years (93%) following successful canalith repositioning procedure.

Bilateral Benign Paroxysmal Positional Vertigo Occurred during Dancing Rehearsal / 대한평형의학회지

Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vestibular vertigo. The etiology of BPPV is unidentified in 50%-70% of patients. However in secondary BPPV, the etiologies are well known a head injury as an example. And it has been reported that even minor head trauma can evoke BPPV. The authors experienced a case of bilateral BPPV occurred during a dancing rehearsal in a school thereby we report the case with a review of the related literatures.

A Case of Surgically Treated Pulsatile Tinnitus by Sigmoid Sinus Diverticulum and/or Dehiscence (SSDD) / 대한이비인후과학회지

Tinnitus is a bothersome symptom, and definite treatment of tinnitus is unclear. However, somatostatic tinnitus caused by vascular bruit is sometimes treatable. Sigmoid sinus diverticulum and/or dehiscence (SSDD) is common vascular abnormality, which is also known to cause pulsatile tinnitus. An endovascular embolization that can treat SSDD has been reported already, however, an external approach has not been reported yet in Korea. We experienced a 34-year-old woman who had complained of pulsatile tinnitus by SSDD and she was successfully treated with an external apporoach. So we report this case with a review of literatures.

Clinical Characteristics and Course of Recurrent Vestibulopathy Following Diuretics Medication / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Recurrent vestibulopathy (RV) is a clinical syndrome of unknown etiology characterized by multiple episodic vertigo without auditory or neurological signs or symptoms. The purpose of this study is to investigate the clinical characteristics and the natural course of RV with diuretics medication. MATERIALS AND METHODS: During the period January 2008 to December 2010, we reviewed the clinical records of 30 patients diagnosed with RV. All patients were given hydrochlorothiazide medication at least 3 months, approached by telephone and using a questionnaire to make a long term follow-up. The analysis included age, sex distribution, natural history, pure tone audiometry, caloric response, age at onset, and the characteristics of vertigo. RESULTS: Median follow-up was 29 months (range, 27-37 months). Patients had a mean age at onset of 48.2 years and a mean duration of 2.75 years. An obvious female predilection was found, and unilateral caloric paresis (> or =25%) was seen in 23.3%. Of the 30 patients, symptoms resolved in 80% but were unchanged in 20%. No patient with RV developed a central nervous system disease or benign paroxysmal positional vertigo during follow-up. CONCLUSION: The present study shows that in the majority of cases, vertigo resolved following diuretics medication. In cases of the patients with severe or disabling recurrent vestibulopathy, the diuretics medication may be effective in reducing the frequency of vertigo attacks.

A Case of Invasive Fungal Otitis Media Progressed to Brain Abscess / 대한이비인후과학회지

Although invasive fungal infections of the paranasal sinuses have been well described in immunocompromised patients, those affecting the ear and temporal bone are uncommon. For these diseases, early suspicion and proving the invasiveness of the fungus with biopsy are very important. Systemic antifungal treatment and wide surgical debridement are the treatment of choice. However, a latent infection is always at risk during the long-term medical therapy. We report, with a literature review, a case of brain abscess from invasive fungal otitis media in an immunocompromised patient who has shown improvement with earlier antifungal medication and surgical debridement.

Meta-Analysis of Squamous Cell Carcinoma of Thyroid / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Primary squamous cell carcinoma (SCC) of thyroid is an unusual tumor, accounted for approximately 1.1% of all neoplasms of the thyroid gland. It is highly lethal, like anaplastic thyroid carcinoma, in terms of aggressive clinical behavior. In the literature, the best treatment of this tumor is by surgery and the use of combination therapy that includes postoperative radiation, chemotherapy and radioiodine therapy; however, the effect of treatment is very poor. This study aims to identify the clinical features of SCC of thyroid, and to devise a better treatment method. SUBJECTS AND METHOD: Journals citing SCC of thyroid were identified from Pubmed, Korea Med, and Google and the clinical records reported therewithin from 1990 to 2013 were reviewed. A total of 40 patients were analyzed from 21 well-organized papers by searching the following keywords: squamous cell carcinoma, primary, thyroid, excerpt of the patient's age, sex, clinical features, pathologic findings, therapy, course and prognosis. RESULTS: We analyzed the treatment results of 40 patients from a total of 21 papers. Patients, consisting of 17 men and 23 women, were found in the age range of 24-88, with the mean age of 63.2. The follow-up period ranged from one to 96 months, with the mean being 15 months, and the size of the mass varied from 1 cm to 15 cm. Histopathologically, we found 13 patients with only SCC mixture of SCC and 22 patients with papillary thyroid carcinoma (PTC). Each of the following diseases were identified with one patient: a mixture of SCC and Hashimoto thyroiditis, a mixture of follicular thyroid carcinoma (FTC), SCC and FTC and mixed Hurtle cell cancer, SCC and PTC and mixed Hashimoto thyroiditis, and SCC, PTC with mixed insula cancer. Thirty-two patients underwent total thyroidectomy, and 30 patients underwent total thyroidectomy accompanied by neck dissection. Twelve patients received postoperative radiation therapy, and five patients received postoperative chemotherapy. Nineteen patients were observed without recurrence of the disease, and ten patients were found to be in stage III or less. CONCLUSION: SCC of the thyroid showed aggressive clinical characteristics, however, good results can be expected with early diagnosis and treatment. If tumor is found only within the thyroid, we expect good therapeutic results after the same treatment as PTC.

Clinical Characteristics and Natural Course of Benign Paroxysmal Vertigo of Childhood: A Long-Term Follow-Up Study / 대한평형의학회지

BACKGROUND AND OBJECTIVES: It is suggested that some patients with benign paroxysmal vertigo of childhood (BPVC) go on to develop migraine. However, neither the natural course nor the clinical features of BPVC have been determined, and therefore, the aim of this study was to investigate the clinical characteristics and the natural course of BPVC. MATERIALS AND METHODS: During the period January 2002 to December 2009, we reviewed the clinical records of 58 patients diagnosed with BPVC. All patients were approached by telephone and using a questionnaire. The clinical characteristics of vertigo, such as sex and age distribution, duration and frequency of vertigo, associated symptoms, development of migraine, and neurologic abnormalities, were analyzed. RESULTS: Mean follow-up duration was 73.2 months (range, 31-119 months). Patients had a mean age at onset of 11.8 years and a mean duration of 6.1 years. An obvious female predilection was found, and 40% of BPVC developed to migraine had a family history of migraine. Of the 32 patients, symptoms resolved in 68.7% but were unchanged in five patients (15.6%). BPVC developed to migraine in five patients (15.6%). CONCLUSION: This study suggests that vertigo spontaneously resolves in the majority of cases. However, the incidence of development to migraine in the BPVC patients is higher than that in general population.

Two Cases of Primary Papillary Thyroid Cancer with a Squamous Cell Carcinoma Component / 대한이비인후과학회지

Primary squamous cell carcinoma (SCC) of the thyroid is an unusual neoplasm. Recently, a new theory has been expounded suggesting that papillary thyroid carcinoma has an SCC component, as squamous differentiation is detected in only a portion of papillary thyroid carcinomas. We experienced two cases of primary squamous cell carcinoma of the thyroid. One case was an 82-year-old woman who underwent a total thyroidectomy. Histopathologic findings revealed that the squamous cell carcinoma was extended to the soft tissue. The woman was treated with postoperative radiotherapy, but her prognosis was poor. On the other hand, the case of a 31-year-old woman who was diagnosed with squamous cell carcinoma and papillary carcinoma within the thyroid displayed good prognosis. We review the literature and discuss these two cases that bring into focus the different prognoses.

A Case of Adenosquamous Carcinoma of the Posterior Occipital Scalp / 대한이비인후과학회지

Primary cutaneous adenosquamous carcinomas are very rare with only few published reports. The histopathologic finding consists of two different components - mucin secreting cells (adenocarcinoma) and squamous cells (squamous cell carcinoma). We experienced a case of occipital scalp adenosquamous carcinoma, which is an extremely rare neoplasm in scalp. The lesion is histologically distinctive because of the presence of mixed areas of unequivocal adenocarcinoma and squamous cell carcinoma. It is found that combined surgery and additional radiation therapy is necessary because the biological behavior and prognosis of this neoplasm are considered as more aggressive and worse than that of conventional squamous cell carcinoma.

Clinical Results of Endoscopic Endonasal Transsphenoidal Hypophysectomy during an Acceleration Phase of Learning Curve / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to compare endoscopic endonasal transsphenoidal hypophysectomy (EETSA) with microscopic transseptal transsphenoidal hypophysectomy (MTTSA) in terms of clinical results during an acceleration of learning curve. SUBJECTS AND METHOD: A retrospective chart review was performed of the first 14 cases of EETSA and previous 14 cases of MTTSA. Resection results, endocrinologic outcomes, complication rates, operating time, and duration of hospital stay were investigated. A non-parametric analysis was performed to determine the significance of differences between groups. RESULTS: EETSA was performed, achieving gross total removal, based on postoperative MRI, for 12 of the 14 patients (86%) and hormonal remission for 4 of the 5 patients (80%); on the other hand, MTTSA was performed, achieving gross total removal for 9 of the 14 patients (64%) and hormonal remission for 1 of the 5 patients (20%). We found better resection results in patients who underwent EETSA than in those who did MTTSA with respect to tumors extending into suprasellar area (p<0.05). Visual improvement was achieved in all the cases with visual defect (n=5) after EETSA, whereas 4 of 6 cases (66%) were improved after MTTSA. Significant differences in complication rates, operating time and hospital stay could not be determined. All cases with CSF leakage in EETSA were successfully managed by using the nasoseptal flap. CONCLUSION: EETSA provided better resection results than MTTSA did, especially in cases extending into the suprasellar area, showing good hormonal cure and visual improvement rates. Two approaches were comparable with respect to complications during the learning curve.

A Case of Desmoid-Type Fibromatosis That was Taken for Recurred Papillary Thyroid Cancer / 대한이비인후과학회지

Desmoid-type fibromatosis occurs rarely, especially in the head and neck region. It is a non-malignant neoplasm, has a good prognosis but sometimes occurs as local invasion. Complete excision surgery should carry out to reduce morbidity. In recurrent cases, supplemental radiotherapy and chemotherapy can be tried. We encountered a patient presenting desmoid-type fibromatosis which was misdiagnosis as a recurrent case of papillary thyroid cancer. Probably, the mass had occurred in that lesion because of the trauma of a previous thyroidectomy. We discuss this case with a review of literatures.

A Case of Papillary Carcinoma in Thyroglossal Duct Cyst / 대한갑상선학회지

The malignant neoplasm of thyroglossal duct cyst (TGDC) is a rare tumor and is mostly revealed accidently in the course of histologic examinations after surgery. The most common histopathologic type is a papillary carcinoma. We experience a 25-year-old young woman of papillary carcinoma in thyroglossal duct cyst and the position of pyramidal lobe was unusual. She was treated by Sistrunk's operation with total thyroidectomy. We report this case with a review of literature.

A Case of Papillary Carcinoma in Thyroglossal Duct Cyst / 대한갑상선학회지

The malignant neoplasm of thyroglossal duct cyst (TGDC) is a rare tumor and is mostly revealed accidently in the course of histologic examinations after surgery. The most common histopathologic type is a papillary carcinoma. We experience a 25-year-old young woman of papillary carcinoma in thyroglossal duct cyst and the position of pyramidal lobe was unusual. She was treated by Sistrunk's operation with total thyroidectomy. We report this case with a review of literature.

Migration of Fish Bone Following Penetration of the Submandibular Gland Presenting as a Neck Mass / 대한이비인후과학회지

An ingested fish bone presenting as an unresolving inflamed neck mass is rare. The purpose of this article was to describe the clinical and microscopic features of a foreign-body granuloma in submandibular region that resulted from a fish bone embedded in the floor of mouth. A 45-year-old male patient complained of a hard mass in submandibular region. Computer tomography allowed that localize of the lesion and the fish bone penetrating a submandibular gland. We successfully operated on the patient to excise the mass. A microscopic examination showed a anewly-formed granuloma, composed of lympocytes and epithelioid cells, and some microabscess with neurophiles. The final diagnosis was a foreign-body granuloma with a fish bone. Even though foreign-body granulomas in submandibular region are rare lesions, surgeons should be familiar with their features and include them in the differential diagnosis of tissue masses.

Primary Squamous Cell Carcinoma in Parotid Gland / 대한이비인후과학회지

Squamous cell carcinoma (SCC) is a common head and neck cancer that is usually restricted to the mucosal surfaces and skin, so sometimes it is very difficult to diagnose a primary lesion. We report a case of a 73-year-old man who presented as a small skin ulcer and parotid mass. The pathologic diagnosis was a squamous cell carcinoma, although it was very difficult to distinguish between skin cancer invading the parotid gland and a primary SCC of the arotid gland extending to the skin. The patient was treated with surgical resection and radiation therapy.

A Case of Unilateral Thyroid Agenesis with Contralateral Huge Goiter / 대한이비인후과학회지

A unilateral thyroid agenesis that is found coexisting with a huge nodular goiter is very rare. We present a 43-year old woman with a recent history of a respiratory difficulty and a painless mass in the right side of her lower neck. A CT scan of her neck showed a 9x5 cm sized solid mass in the right infra-thyroid and thoracic area and left thyroid agenesis. The patient underwent surgery. The mass was identified as a structure separated from the right lobe of the thyroid, compressing the trachea. The histology revealed it to be a nodular goiter. The patient had an uneventful postoperative recovery and subsequently indicated euthyroid with normal normal calcium levels.

Percutaneous Vertebroplasty in Osteoporotic Vertebral Body Compression Fracture

PURPOSE: To determine the clinical efficacy of percutaneous vertebroplasty in cases of painful and medically intractable osteoporotic vertebral compression fracture. MATERIALS AND METHODS: Ninety-eight patients (20 men and 78 women; mean age, 69 years) underwent 122 per-cutaneous vertebroplasty procedures for the treatment of osteoporotic vertical compression fracture. For the evaluation of bone mass, bone densitometry was performed in 45 patients, and to assess the recent evolution of the fracture, all 98 underwent MRI. Percutaneous vertebroplasty involves percutaneous transpedicular puncture of the involved vertebrae followed by the injection of a Polymethylmethacrylate(PMMA)-Barium mixture into the vertebral body. To assess leakage of the mixture into the epidural tissue, neural foramina, venous plexus and paravertebral tissue, we then immediately obtained a computerized tomographic (CT) scan, assessing the clinical efficacy of the procedure on the basis of time required for pain relief (defined as more than 60% reduction of initial pain), and time required for ambulation without significant pain. RESULTS: Percutaneous vertebroplasty was successful in all patients. Pain relief was accomplished within 1-5(mean, 1.8) days and early ambulation without significant pain was possible within 2 -15 (mean, 3.3) days. Post-procedural CT scanning revealed leakage of the PMMA-barium mixture into Paravertebral tissue(n=41), the paravertebral venous plexus (n=34) and epidural tissue (n=4). No neural foraminal leakage was identified, and no procedure-related complication requiring surgical treatment occurred. CONCLUSION: Percutaneous vertebroplasty is an effective new interventional procedure for the treatment of osteoporotic vertebral compression fracture. It relieves pain, provides early mobilization, and strengthens involved vertebral bodies.