Monthly Variation in Bell's Palsy Based on Population Data of Korea.

INTRODUCTION: Several studies have reported that the number of patients with Bell's palsy varied significantly by month and season. However, few studies have reported the monthly variation in Bell's palsy based on the whole population. We investigated the monthly variation in Bell's palsy in Korea during a long-term period based on whole population data. METHODS: This retrospective study used the data of the National Health Insurance Service of Korea, which included the entire Korean population from 2008 to 2020. The monthly incidence of Bell's palsy per 100,000 was evaluated in total and according to sex, age, and residence. RESULTS: The total average monthly incidence differed significantly by month, with the highest observed in January (9.1 per 100,000) and the lowest in June (7.7 per 100,000) (p < 0.001). The average monthly incidence according to sex, age, and residence also varied significantly by month, with most of the highest values noted in January and the lowest in June. CONCLUSION: There was significant monthly variation in the incidence of Bell's palsy, with the highest in January during the winter and the lowest in June during the summer, based on whole population data over a long-term period in Korea.

The Impact of the COVID-19 Pandemic on Bell's Palsy and Ramsay-Hunt Syndrome: A Multicenter Retrospective Study.

BACKGROUND: This article presents a comprehensive review of data on the impact of facial palsy during the coronavirus disease 2019 (COVID-19) pandemic. The possible causes and pathophysiological mechanisms of changes in the epidemiology of facial palsy during the COVID-19 pandemic are also discussed. METHODS: This multicenter retrospective cohort study included 943 patients diagnosed with Bell's palsy or Ramsay Hunt syndrome. This study compared patient demographics, comorbidities, symptoms, and treatments before the COVID-19 pandemic (from 2017 to 2019) and during the COVID-19 pandemic, from 2020 to 2022). RESULTS: Following the COVID-19 outbreak, there has been a significant increase in the number of cases of Bell's palsy, particularly among elderly individuals with diabetes. Bell's palsy increased after the COVID-19 outbreak, rising from 75.3% in the pre-COVID-19 era to 83.6% after the COVID-19 outbreak. The complete recovery rate decreased from 88.2% to 73.9%, and the rate of recurrence increased from 2.9% to 7.5% in patients with Bell's palsy. Ramsay Hunt syndrome showed fewer changes in clinical outcomes. CONCLUSION: This study highlights the impact of the COVID-19 pandemic on the presentation and management of facial palsy, and suggests potential associations with COVID-19. Notably, the observed increase in Bell's palsy cases among elderly individuals with diabetes emphasizes the impact of the pandemic. Identifying the epidemiological changes in facial palsy during the COVID-19 pandemic has important implications for assessing its etiology and pathological mechanisms of facial palsy disease.

Distribution of Medical Service Use for Facial Palsy Between Medicine and Traditional Korean Medicine Based on Population-Based Data of Korea.

We investigated the distribution of medical service uses for Bell's palsy and Ramsay Hunt syndrome between medicine and traditional Korean medicine using the National Health Insurance Service National Sample Cohort data of Korea from 2006 to 2015. Patients were identified with diagnostic codes and medication or treatment claim codes. For Bell's palsy, there were 5,970 (68.8%) patients who used traditional Korean medical service only, whereas for Ramsay Hunt syndrome, there were 749 (93.6%) patients who used medical service only. The proportion of traditional Korean medical service use was higher than that of medical service use in patients with Bell's palsy, while the opposite was found in patients with Ramsay Hunt syndrome.

Schwannoma in the External Auditory Canal.

ABSTRACT: Schwannoma is a slow-growing, benign tumor originating from the Schwann cells of peripheral nerve sheaths. Schwannoma in the external auditory canal is rare but should be included in the possible diagnosis of a cystic mass. If schwannoma is suspected, computed tomography or magnetic resonance imaging should be performed to explore tumor size, location, possible extension, and origin before excision. The authors here present a large schwannoma that almost completely occluded the external auditory canal and was completely excised using a transcanal approach.

The effect of tonsillectomy with adenoidectomy on medical services used in association with otitis media based on Korean national sample cohort data.

BACKGROUND: The effect of tonsillectomy with adenoidectomy (T&A) on otitis media has been investigated, but there have been no reports of the relationship between T&A and medical services used in association with otitis media. We investigated the effect of T&A on otitis media with regard to the number and cost of medical services used. METHODS: From the National Health Insurance Service National Sample Cohort data in Korea, we selected patients 7 years old or younger in 2002 who had T&A in 2005 while between the ages of three and ten. A control group was established matching the patient group with similar propensities of demographic characteristics. The number and cost of medical services used in association with otitis media were analyzed for 3 years before T&A through 8 years after T&A. RESULTS: The total number of patients was 1,338, with 227 in the T&A group and 1,111 in the non-T&A group. The number of medical services used was not significantly different between the T&A and non-T&A groups before and after surgery. The cost of medical services used was significantly higher in the T&A group than in the non-T&A group one year before surgery. The cost of medical services used was not significantly different between the two groups after surgery. CONCLUSIONS: There were no significant differences between the T&A and non-T&A groups in the number and cost of medical services used in association with otitis media after surgery.

Dermoid Cyst in the Postauricular Area.

Dermoid cyst is a rare benign tumor and about 7% of occurrences are found in the head and neck region. Its location is almost always in the midline of the body such as the orbit, oral cavity, and nose, but it is rarer in and around the auricle. The authors present a 31-year-old woman with dermoid cyst in the postauricular area which is a rare site for this lesion. In surgery under local anesthesia, the mass was limited to the subcutaneous area and excised completely. Surgical excision should be considered for cosmetic reasons and the mass should be excised completely to prevent recurrence and infection. Histopathologic confirmation is important and mandatory after excision to confirm the pathologic diagnosis and rule out the possibility of malignancy.

High Risk of Sudden Sensorineural Hearing Loss in Several Autoimmune Diseases according to a Population-Based National Sample Cohort Study.

OBJECTIVE: We investigated the risk of sudden sensorineural hearing loss (SSNHL) in patients with autoimmune diseases compared with a control group in a population-based study using a National Health Insurance Service National Sample Cohort data from Korea. METHODS: We enrolled autoimmune-disease patients who were ≥20 years of age in 2006 into the autoimmune-disease group, and selected a control group with similar demographic characteristics. We tracked the 2 groups from 2006 to 2015 and compared the proportions of patients who developed SSNHL. RESULTS: Of 13,250 patients in the autoimmune-disease group, 145 experienced an SSNHL event (1.09%). Of the 66,250 in the control group, 484 experienced an SSNHL event (0.73%). The SSNHL risk was significantly higher in the autoimmune-disease group than in the control group. SSNHL incidence was significantly higher among patients with antiphospholipid syndrome (APS), multiple sclerosis (MS), rheumatoid arthritis (RA), and connective-tissue diseases including Sjögren syndrome and Behçet disease. In detailed stratified analyses using reinforced additional diagnostic codes, only RA patients had a significantly higher SSNHL incidence than the control group. CONCLUSION: The association of several autoimmune diseases with SSNHL was evaluated in this large-scale, population-based, big-data study. The risk of SSNHL was significantly higher in patients with APS, MS, RA, and connective-tissue diseases including Sjögren syndrome and Behçet disease than in patients without autoimmune diseases. SSNHL, in particular, was significantly associated with RA according to detailed analyses using reinforced additional diagnostic codes.

Congenital Vomer Defect Incidentally Detected on Preoperative Evaluation for Nasal Septoplasty and Turbinoplasty.

A perforation in posterioinferior portion of nasal septum is rare and caused by vomeral defect. We report a case of 56-year-old man who had a vomer defect, which was detected incidentally during preoperative evaluation of nasal septoplasty and turbinoplasty. The patient had a surgery of septoplasty and bilateral turbinoplasty under general anesthesia. There was no septal mucosal tear or defect during septoplasty and turbinoplasty. When the patient who has vomeral defect with nasal obstruction is planned for septoplasty and turbinoplasty, the surgery should be performed carefully to protect the mucosa.

A drug-repositioning screening identifies pentetic acid as a potential therapeutic agent for suppressing the elastase-mediated virulence of Pseudomonas aeruginosa.

Pseudomonas aeruginosa, a Gram-negative bacterium of clinical significance, produces elastase as a predominant exoprotease. Here, we screened a library of chemical compounds currently used for human medication and identified diethylene triamine penta-acetic acid (DTPA, pentetic acid) as an agent that suppresses the production of elastase. Elastase activity found in the prototype P. aeruginosa strain PAO1 was significantly decreased when grown with a concentration as low as 20 µM DTPA. Supplementation with Zn(2+) or Mn(2+) ions restored the suppressive effect of DTPA, suggesting that the DTPA-mediated decrease in elastase activity is associated with ion-chelating activity. In DTPA-treated PAO1 cells, transcription of the elastase-encoding lasB gene and levels of the Pseudomonas quinolone signal (PQS), a molecule that mediates P. aeruginosa quorum sensing (QS), were significantly downregulated, reflecting the potential involvement of the PQS QS system in DTPA-mediated elastase suppression. Biofilm formation was also decreased by DTPA treatment. When A549 alveolar type II-like adenocarcinoma cells were infected with PAO1 cells in the presence of DTPA, A549 cell viability was substantially increased. Furthermore, the intranasal delivery of DTPA to PAO1-infected mice alleviated the pathogenic effects of PAO1 cells in the animals. Together, our results revealed a novel function for a known molecule that may help treat P. aeruginosa airway infection.

Risk factors for middle ear cholesteatoma surgery based on Korean population data.

BACKGROUND: Studies of risk factors for middle ear cholesteatoma surgery using population-based data are lacking. OBJECTIVES: To investigate the risk factors for cholesteatoma surgery in adults based on population data from Korea. MATERIALS AND METHODS: For this retrospective study, we used Korean National Health Insurance Service National Sample Cohort data. Patients who were 20 years or older and underwent mastoidectomy from 2006 through 2015 under the diagnostic codes of cholesteatoma were defined as patients with middle ear cholesteatoma surgery. The control group was comprised of the remaining database sample in 2006. Sociodemographic factors in 2006 and histories of medical diseases, allergic diseases, and chronic sinusitis from 2003 through 2005 were compared between cholesteatoma surgery and control groups. RESULTS: A total of 459 patients underwent cholesteatoma surgery. In multivariate Cox regression analysis, age 40-59 years and residence in metropolitan cities and small- and medium-sized cities and counties were significant risk factors for cholesteatoma surgery whereas allergic rhinitis, asthma, atopic dermatitis, and chronic sinusitis were not significant risk factors for middle ear cholesteatoma surgery. CONCLUSIONS AND SIGNIFICANCE: The present study found no evidence of associations between allergic diseases or chronic sinusitis and cholesteatoma surgery in adults.

Seasonal variation in peripheral vestibular disorders based on Korean population data.

Objectives: Comprehensive studies in which the seasonal variation in peripheral vestibular disorders was evaluated using data from an entire population are insufficient. The seasonal variation in peripheral vestibular disorders based on data from the entire Korean population was investigated in the present study. Methods: Retrospective data from the National Health Insurance Service of Korea from 2008 to 2020 was analyzed. Benign paroxysmal positional vertigo (BPPV), vestibular neuritis (VN), and Meniere's disease (MD) were defined based on diagnostic, treatment, or audiovestibular test codes. The seasonal incidence for each peripheral vestibular disorder was calculated among all study subjects. Results: For the entire study cohort, the incidence of BPPV was significantly higher in spring (odds ratio [OR] = 1.031, 95% confidence interval [CI] = 1.026-1.037), autumn (OR = 1.024, 95% CI = 1.019-1.029), and winter (OR = 1.051, 95% CI = 1.046-1.056) than in summer. The incidence of VN was significantly lower in winter (OR = 0.917, 95% CI = 0.907-0.927) than in summer. The incidence of MD was significantly higher in spring (OR = 1.027, 95% CI = 1.015-1.039) and autumn (OR = 1.029, 95% CI = 1.017-1.041) and significantly lower in winter (OR = 0.919, 95% CI = 0.908-0.931) than in summer. Differences were also observed in seasonal variation based on sex and age. Conclusions: Significant seasonal variation occurred in peripheral vestibular disorders including BPPV, VN, and MD based on the entire Korean population data. Furthermore, seasonal variation showed differences based on sex and age. Level of Evidence: 4.

Nodular Fasciitis in the Preauricular Area in Pediatric Patients.

Nodular fasciitis is a benign myofibroblastic and fibroblastic proliferative lesion that can be found in the subcutaneous tissue, muscle, and fascia. It is frequently observed in young adults aged 20 to 40 years and less commonly in pediatric patients. Rapid growth, high cellularity, and remarkable mitotic activity of this lesion could lead to misdiagnosis as a soft tissue sarcoma. Here, two cases of nodular fasciitis in the preauricular area in pediatric patients were reported. Nodular fasciitis in the preauricular area in a pediatric patient is rare. It could be confused with soft tissue sarcoma. However, nodular fasciitis should be suspected in a pediatric patient with a rapidly growing mass in the head and neck region. Surgical excision should be performed to confirm the histopathologic diagnosis when clinical diagnosis is uncertain and there is possibility of malignancy.

Intratympanic membrane cholesteatoma after traumatic tympanic membrane perforation: a case report.

BACKGROUND: Intratympanic membrane cholesteatoma presents as an asymptomatic, white, round mass on the tympanic membrane, and is usually detected incidentally in children. CASE PRESENTATION: A 12-year-old Korean boy visited our otorhinolaryngology clinic for a whitish mass on the right tympanic membrane. He had a history of traumatic tympanic membrane perforation in the right ear that had occurred 1 year prior, which had healed well with a paper patch placement. The mass was completely removed under local anesthesia during surgery with a microscope. The mass was on the outer epithelial layer of the right tympanic membrane and did not invade the middle fibrous and inner mucosal layers. Cholesteatoma was diagnosed on the basis of histopathology. CONCLUSION: Intratympanic membrane cholesteatoma may not induce symptoms or invade the middle ear because it can grow outwards into the external auditory canal. However, intratympanic membrane cholesteatoma can grow over time, and then after growth, it can compress the tympanic membrane and advance into the middle ear, which can cause symptoms such as hearing loss. Intratympanic membrane cholesteatoma in children should be carefully evaluated and followed, and surgical removal should be considered, even for asymptomatic cases, to minimize potential damage and hearing loss.

Incidence of peripheral vestibular disorders based on population data of South Korea.

BACKGROUND: There have been no comprehensive studies on the incidence of peripheral vestibular disorders based on population-based data for a long-term period. OBJECTIVE: We investigated the incidence of peripheral vestibular disorders using population-based data representing the whole population of South Korea. METHODS: This study used the National Health Insurance Service data in Korea from 2008 to 2020. Peripheral vestibular disorders such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis (VN), and Meniere's disease (MD) were defined with diagnostic, treatment, or audiovestibular test codes. The annual incidence in total and according to sex, age, and residence was analyzed. RESULTS: The annual incidence of BPPV, VN, and MD per 100,000 was 51.4, 22.7, and 12.4 in 2008 and 181.1, 62.9, and 50.5 in 2020, respectively. The incidence of each was significantly different by sex (p < 0.001), age (p < 0.001), and residence (p < 0.001), with the highest value in female, people aged 60 years or older, and people who resided in metropolitan cities. CONCLUSIONS: The annual incidence of BPPV, VN, and MD had increasing trends from 2008 through 2020 in South Korea, and all were significantly higher in female, people aged 60 years or older, and people who resided in metropolitan cities.

Neuromuscular retraining therapy combined with preceding botulinum toxin A injection for chronic facial paralysis.

BACKGROUND: Neuromuscular retraining therapy (NMRT) is the central treatment for synkinesis. The efficacy of botulinum toxin type A (BTX-A) may be enhanced with the addition of physical therapy. OBJECTIVES: To investigate the effects of NMRT combined with preceding BTX-A injection (NMRT-B) on facial synkinesis and asymmetry in chronic facial paralysis. MATERIALS AND METHODS: We recruited 99 patients with unilateral facial paralysis and no recovery for > 6 months who underwent NMRT-B for > 1 year. The patients were scheduled to receive NMRT after 1-2 weeks of BTX-A injection. We used a computer-based numerical scoring system to evaluate the facial functions. Primary, secondary, and final facial movement scores were evaluated before and after 1 year of treatment. RESULTS: Patients with chronic facial paralysis who underwent NMRT-B exhibited improved facial movement after 1 year of treatment. NMRT-B provided satisfactory control of synkinesis and improved the primary movements. The mean primary and final facial movement scores were significantly increased after treatment, while the mean secondary facial movement scores were significantly decreased. CONCLUSIONS AND SIGNIFICANCE: NMRT-B improved the final facial movement in patients with chronic facial paralysis and synkinesis, regardless of the degrees of facial synkinesis and asymmetry before treatment.

Association between hearing loss and trauma based on population data of Korea.

BACKGROUND: Although several studies have been conducted to assess the association between hearing loss (HL) and trauma, no studies have analyzed trauma comprehensively based on population-based data. OBJECTIVES: To investigate the association between HL and trauma in daily life using National Health Insurance Service National Sample Cohort data of Korea. MATERIALS AND METHODS: People who were registered with severe or mild hearing disability by the Korean government from 2002 to 2015, were included in this study. Trauma was defined as an outpatient visit or admission under diagnostic codes associated with trauma. The risk for trauma was analyzed using multiple logistic regression model. RESULTS: There were 5,114 subjects in the mild hearing disability group and 1,452 in the severe hearing disability group. The risk for trauma was significantly higher in the mild and severe hearing disability groups than in the control group. The risk was higher in the mild hearing disability group than in the severe hearing disability group. CONCLUSIONS AND SIGNIFICANCE: Individuals with hearing disability are at a higher risk for trauma based on population-based data in Korea, which indicates that HL increases the risk for trauma.

Myopericytoma in the Antitragus of the Auricle: A Rare Tumor.

A myopericytoma in the auricle is rare. If an auricle contains a large, firm, red-brown mass, excision should be considered because the mass may be a myopericytoma. After excision, histopathological and immunohistochemical diagnoses are essential to rule out malignancy. Long-term follow-up is required because the tumor is slow-growing.

Incidence and Risk Factors of Vestibular Schwannoma in Korea : A Population-Based Study.

OBJECTIVE: This study aims to investigate the incidence of vestibular schwannoma (VS) and demographic characteristics in Korea using population-based National Health Insurance Service data. METHODS: This study analyzed Korean National Health Insurance Service data from 2005 to 2020, based on the International Classification of Diseases, 10th version, Clinical Modification codes D333 and D431. Only those patients who had undergone magnetic resonance imaging and audiologic tests were considered definitive cases. Demographic variables included age, sex, treatment modality, hypertension, diabetics, dyslipidemia, smoking history, alcohol history, and income status. RESULTS: The total number of VS patients was 5751. The average incidence rate was 0.71 per 100000 from 2005 to 2020, and the annual incidence rate increased from 0.33 in 2005 to 1.32 in 2019 but decreased to 0.80 in 2020. Incidence was highest in those aged 60-69 years (1.791) and lowest in those younger than 20 years (0.041). Incidence was higher in females, and the number of patients who received radiosurgery (46.64%) was largest compared to the wait and scan group (37.96%), microsurgery group (12.85%), or the group who received both (2.56%). Diabetes, dyslipidemia, and alcohol consumption increased the risk of VS, while cigarette smoking reduced the risk of VS. CONCLUSION: The incidence of VS exhibited an increasing trend from 2005 to 2019. Radiosurgery (46.64%) was the most common treatment modality. Diabetes, dyslipidemia, and alcohol consumption increased the risk of VS, while cigarette smoking reduced the risk of VS.

Risk for depression and anxiety in patients with facial palsy based on population-based data from Korea.

BACKGROUND: Several studies point out the association of facial palsy with psychiatric distress such as depression and anxiety. However, there have been few studies on this association based on population-based data. OBJECTIVES: To investigate the risk for depression and anxiety disorders in patients with Bell's palsy and in those with Ramsay Hunt syndrome. MATERIALS AND METHODS: This retrospective study included data from the Korean National Health Insurance Service National Sample Cohort. From 2006 to 2015, patients with Bell's palsy and those with Ramsay Hunt syndrome were defined using diagnostic and medication claim codes. Patients with depression or anxiety were defined using diagnostic and medication claim codes. Occurrences of depression and anxiety were included in analyses. RESULTS: There were significantly higher risks for depressive and anxiety disorders in the group of patients with Bell's palsy than in the control group, as well as in the group of patients with Ramsay Hunt syndrome than in the control group. CONCLUSIONS AND SIGNIFICANCE: There were significantly higher risks for depression and anxiety in patients with facial palsy including Bell's palsy and Ramsay Hunt syndrome based on population-based data from Korea.