Clinical Aspects of Chronic Idiopathic Postnasal Drip: An Entity Not to Be Overlooked.

BACKGROUND/AIM: Postnasal drip may be related to several diseases, but not all patients are clearly diagnosed. Patients with chronic, idiopathic postnasal drip symptoms are easily overlooked, and their clinical features are yet to be identified. This study aimed to analyze the clinical features and response to first generation antihistamine-decongestant therapy in patients with chronic idiopathic postnasal drip, suggesting it as a distinct entity. PATIENTS AND METHODS: A retrospective cohort study involving 157 chronic idiopathic postnasal drip patients was conducted, analyzing demographics, symptoms, and treatment response to first-generation antihistamines and nasal decongestants. RESULTS: Mean age of patients was 55.4±17.0 years old. Median duration of symptom was 36 months (range=12-66 months) and severity in the visual analogue scale was 7 (range=5-8). Throat discomfort was the most frequently associated symptom (73.7%). Cough was recorded in 30.3% of patients. Viscosity of postnasal drip was associated with rhinorrhea and throat discomfort. Of the patients, 71.6% responded positively to 1st generation antihistamine-decongestant medication. However, 25.9% of patients presented symptom re-occurrence. Patients with nasal stiffness or persistent symptoms presented a higher re-occurrence rate compared to others. CONCLUSION: This study outlines the clinical features of patients with chronic idiopathic postnasal drip and suggests it as a distinctive entity., This proposal aims to enhance diagnostic precision and promote further research in the field.

Detection of Cancer Recurrence Using Systemic Inflammatory Markers and Machine Learning after Concurrent Chemoradiotherapy for Head and Neck Cancers.

Pretreatment values of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are well-established prognosticators in various cancers, including head and neck cancers. However, there are no studies on whether temporal changes in the NLR and PLR values after treatment are related to the development of recurrence. Therefore, in this study, we aimed to develop a deep neural network (DNN) model to discern cancer recurrence from temporal NLR and PLR values during follow-up after concurrent chemoradiotherapy (CCRT) and to evaluate the model's performance compared with conventional machine learning (ML) models. Along with conventional ML models such as logistic regression (LR), random forest (RF), and gradient boosting (GB), the DNN model to discern recurrences was trained using a dataset of 778 consecutive patients with primary head and neck cancers who received CCRT. There were 16 input features used, including 12 laboratory values related to the NLR and the PLR. Along with the original training dataset (N = 778), data were augmented to split the training dataset (N = 900). The model performance was measured using ROC-AUC and PR-AUC values. External validation was performed using a dataset of 173 patients from an unrelated external institution. The ROC-AUC and PR-AUC values of the DNN model were 0.828 ± 0.032 and 0.663 ± 0.069, respectively, in the original training dataset, which were higher than the ROC-AUC and PR-AUC values of the LR, RF, and GB models in the original training dataset. With the recursive feature elimination (RFE) algorithm, five input features were selected. The ROC-AUC and PR-AUC values of the DNN-RFE model were higher than those of the original DNN model (0.883 ± 0.027 and 0.778 ± 0.042, respectively). The ROC-AUC and PR-AUC values of the DNN-RFE model trained with a split dataset were 0.889 ± 0.032 and 0.771 ± 0.044, respectively. In the external validation, the ROC-AUC values of the DNN-RFE model trained with the original dataset and the same model trained with the split dataset were 0.710 and 0.784, respectively. The DNN model with feature selection using the RFE algorithm showed the best performance among the ML models to discern a recurrence after CCRT in patients with head and neck cancers. Data augmentation by splitting training data was helpful for model performance. The performance of the DNN-RFE model was also validated with an external dataset.

Delayed Recovery in Idiopathic Sudden Sensorineural Hearing Loss.

Sudden hearing loss is an easily encountered disease in clinics, but its prognosis has not been completely elucidated. In the present study, we investigated the long-term prognosis of sudden hearing loss with 130 patients who were diagnosed based on strict criteria and provided uniform treatment. The patients with incomplete recovery were reevaluated after 2 months without receiving additional treatment. Hearing levels at different time points were compared. Moreover, the associated factors affecting the degree of hearing improvement over time were evaluated using stepwise multiple linear regression. After treatment, 73 out of the 130 (56.1%) patients attained incomplete recovery and were reevaluated after 2 months. Seventeen out of the seventy-three (23.3%) patients showed a grade promotion, fifty-four (74%) were constant, and two (2.7%) were aggravated. The mean interaural hearing differences (IHDs) showed significant improvement. Old age, poor initial IHD, and poor recovery grade were significantly associated with a profitable delayed hearing gain. Poorer hearing level at the time of onset might be a sign for slower recovery rather than a poorer prognostic factor. The treatment outcome of idiopathic sudden sensorineural hearing loss (ISSNHL) should be evaluated at least 2 months after treatment completion, and counseling is required due to the need for long-term follow-up in patients with ISSNHL.

Cerebral Venous Thrombosis and Persistent Pulsatile Tinnitus After Sigmoid Sinus Resurfacing Surgery.

We report a case with rare complication of cerebral venous thrombosis, as well as an incomplete response, after sigmoid sinus resurfacing surgery for pulsatile tinnitus (PT). A 24-year-old female patient with PT originating from the sigmoid sinus underwent sigmoid sinus resurfacing surgery. The tinnitus was immediately resolved, but it recurred with headache 5 days after surgery. A cerebral venous thrombosis was identified and treated, but PT persisted, although its frequency and loudness decreased. Sigmoid sinus resurfacing surgery is a safe and effective method to treat PT, but in some patients, it can cause serious complications and/or persistent tinnitus. In our patient, factors such as changes in blood viscosity due to warfarin intake or increased blood flow due to weight loss may have influenced the persistence of the tinnitus. It is important to identify the various associated factors and the weight of each of these factors to provide more tailored treatment of PT for individual patients in the future and to reduce complications and increase the effectiveness of sigmoid sinus resurfacing surgery.

The diagnostic predictive value of neutrophil-to-lymphocyte ratio in thyroid cancer adjusted for tumor size.

The role of systemic inflammation has not been clearly defined in thyroid cancers. There have been conflicting reports on whether systemic inflammatory markers have predictive value for thyroid cancers. We aimed to evaluate the association between systemic inflammatory markers and clinicopathological factors in thyroid cancers and to assess their predictive value for thyroid cancers in detail. Five hundred thirty-one patients who underwent surgery for thyroid nodules were included. The patient population consisted of 99 individuals (18.6%) with benign thyroid nodules and 432 individuals (81.4%) with thyroid cancers. In 432 patients with thyroid cancers, neutrophil-to-lymphocyte ratio (NLR) was significantly higher in the cases with tumors greater than 2 cm than in those with tumors less than 2 cm. (p = 0.027). NLR and platelet-to-lymphocyte ratio (PLR) were significantly higher in cases with lateral lymph node metastasis (LNM) than in those without LNM (p = 0.007 and 0.090, respectively). The nodule size was significantly higher in benign thyroid nodules than in thyroid cancers (p < 0.001). When the cases were stratified by tumor size, NLR was a significant predictor of thyroid cancers in cases with nodules greater than 2 cm (Exp(B) = 1.85, 95% CI = 1.15-2.97, p = 0.011), but not in those with nodules less than 2 cm. In thyroid cancers, preoperative NLR was associated with pathological prognosticators such as tumor size and lateral lymph node metastasis. When the size difference between thyroid cancers and benign thyroid nodules was adjusted, NLR could be a significant predictor of thyroid cancers.

Temporomandibular Joint Herniation: Review of the Literature.

OBJECTIVE: To define clear clinical characteristics and management strategies of herniation of temporomandibular joint (TMJ) into the external auditory canal (EAC). DATA SOURCE: MEDLINE, PubMed, and EMBASE databases. STUDY SELECTION: A search was conducted using the keywords "temporomandibular joint" and "herniation" with all of their synonyms. Literature selection criteria included articles published in English, and articles dating back no further than 1970. RESULTS: Forty articles regarding 51 cases were eligible for critical appraisal. According to the previously published papers, TMJ herniation has following characteristics; symptoms are nonspecific, but a distinguishable feature is a protruding mass into the EAC that can be seen to appear and disappear as the mouth opens and closes. High-resolution computed tomography scans are sensitive to the bony defect and are helpful in diagnosing TMJ herniation. In the surgical treatment of TMJ herniation, wall reconstruction rather than simple mass excision could be a safe and long-lasting strategy. CONCLUSIONS: Herniation of TMJ into the EAC is a rare condition, but can be encountered in the clinic at any time. This literature review could be helpful in the diagnosis and treatment of TMJ herniation into the EAC.

Impact of COVID-19-related concerns and depression on hand-washing practice among community-dwelling older adults: a secondary analysis of the 2020 Korea Community Health Survey

Purpose@#This study investigated hand-washing practice among community-dwelling older adults during the coronavirus disease 2019 (COVID-19) pandemic and aimed to identify the impact of COVID-19-related concerns and depression on hand-washing practice. @*Methods@#This was a secondary analysis of data extracted from the 2020 Community Health Survey. The primary data were collected through self-reporting from August 10 to September 8, 2020 in a cross-sectional study. The subjects consisted of 1,350 adults aged 65 or older living in J Province who participated in the 2020 Community Health Survey. Results: The factors affecting hand-washing practice among older adults were male gender (β = –.18, p < .001), age (β = –.07, p = .001), no education (β = –.20, p < .001) and elementary, middle, and high school graduation (β = –.15, p < .001) compared to a college or higher education, poor health perception (β = –.13, p < .001), COVID-19-related concerns (β = .08, p = .005), and depression (β = –.07, p = .001). To summarize, the factors negatively affecting hand-washing practice included male gender, lower education level, poor health perception, and depression, while the factors positively associated with hand-washing practice included COVID-19-related concerns. @*Conclusion@#These findings show the importance of considering these multifaceted determinants when designing targeted interventions and educational programs aimed at promoting hand-washing among older adults. Additionally, based on the relationship between hand-washing practice and COVID-19-related concerns and depression, interventions that can alleviate mental problems along with providing proper education are required.

Chronic Lymphocytic Leukemia: A Rare Cause of Pathological Fracture of the Femur.

The incidence rate of chronic lymphocytic leukemia (CLL) in the United States is approximately 0.005%; men are at slightly higher risk than women. Bony involvement or pathological fracture rarely occurs in CLL, and it may be the initial presentation. An 85-year-old woman presented with acute respiratory failure secondary to pneumonia. Symptomatology included dyspnea. She was found to have pathological fracture of the femur caused by CLL. The diagnosis of CLL had been made 6 years previously, but the patient had refused therapy. On admission, the patient required endotracheal intubation, mechanical ventilation, and admission to the medical intensive care unit. Endotracheal intubation extubation was successful after 48 hours. The patient then complained of severe left knee pain. Bone radiograph and femoral computed tomography scan revealed acute pathological fracture of the left distal femur. There was no history of trauma. The fracture was stabilized with extension lock splint. Pathological fracture in patients with CLL is associated with hypercalcemia, Richter's transformation, or multiple myeloma. This patient exemplifies the fact that pathological fracture can be caused by CLL in the absence of hypercalcemia, Richter's transformation, or multiple myeloma and can be the initial presentation of CLL.

Depression is Associated with Chewing and Swallowing Function among Elderly Vendors in a Conventional Market: A Preliminary Research / 대한연하장애학회지

Objective@#This study aimed to investigate the level of chewing and swallowing function (CSF) and the factors related to CSF among elderly vendors in a conventional market. @*Methods@#The cross-sectional study was conducted between August 10 through September 8, 2020, using a self-reporting questionnaire to collect data. The study sample comprised 61 elderly vendors aged 65 years and over, from a conventional market at Jeju-si. CSF was measured using the Questionnaire for Chewing and Swallowing Function of the elderly, and depression was assessed by applying the Center for Epidemiologic Studies Depression Scale. @*Results@#Chewing and swallowing dysfunctions were reported by 34.4% of elderly vendors. CSF was significantly associated with the current smoking status (β=0.39, P=0.001) and depression (β=0.33, P=0.006). @*Conclusion@#These results indicate that current smoker and depression are significant factors affecting CSF. The factors determined in this study may be used in community health programs for preventing and managing chewing and swallowing dysfunction among the elderly vendors in a conventional market.

Depression is Associated with Chewing and Swallowing Function among Elderly Vendors in a Conventional Market: A Preliminary Research / 대한연하장애학회지

Objective@#This study aimed to investigate the level of chewing and swallowing function (CSF) and the factors related to CSF among elderly vendors in a conventional market. @*Methods@#The cross-sectional study was conducted between August 10 through September 8, 2020, using a self-reporting questionnaire to collect data. The study sample comprised 61 elderly vendors aged 65 years and over, from a conventional market at Jeju-si. CSF was measured using the Questionnaire for Chewing and Swallowing Function of the elderly, and depression was assessed by applying the Center for Epidemiologic Studies Depression Scale. @*Results@#Chewing and swallowing dysfunctions were reported by 34.4% of elderly vendors. CSF was significantly associated with the current smoking status (β=0.39, P=0.001) and depression (β=0.33, P=0.006). @*Conclusion@#These results indicate that current smoker and depression are significant factors affecting CSF. The factors determined in this study may be used in community health programs for preventing and managing chewing and swallowing dysfunction among the elderly vendors in a conventional market.

Melanotic Oncocytic Metaplasia of the Nasopharynx in the Patient with Suspicious Hemoptysis: Case Report

Melanotic oncocytic metaplasia (MOM) in the nasopharyngeal space is a very rare entity. Only 35 cases have been reported in the English literature, and most patients were East Asian males between 60 and 70 years of age. MOM presents as a brown or black lesion with slight elevation of the mucosa. These lesions are benign and defined as cellular enlargement with eosinophilic granular melanin-pigmented cytoplasm caused by mitochondrial accumulation. However, such presentation can lead physicians to misjudge MOM as a malignant lesion. Recently, we experienced a case of MOM of the nasopharynx. A 58-year-old woman was admitted to the internal medicine department with small-volume hemoptysis and referred to the ENT department for evaluation. She was a regular smoker without any medical history. Sinus endoscopy showed black pigmented lesions on both the torus tubaris and left posterior tonsillar pillar, with low bleeding risk. Excisional biopsy of the lesion was performed, and oncocytic metaplasia was confirmed pathologically. Hemoptysis showed spontaneous remission and no recurrence or other symptoms over 12 months of follow up. Melanotic oncocytic metaplasia in the nasopharynx should be clinically recognized to avoid misdiagnosis as a malignancy like melanoma.

Flap Complications of LASIK

Laser in situ keratomileusis[LASIK]for myopia reduces the risk of corneal haze but adds to the risk of flap complications. We assessed the incidence of flap complications overall, the management, the impact of the complications on best corrected visual acuity[BCVA], and the trend in these complications during the surgeon's learning curve in the series of 621 eyes undergoing LASIK.Twenty[3.2%]of 621 eyes had flap-related complications.The incidence of intraop-erative complications was fourteen eyes[2.2%], and it included irregular keratectomy in ten eyes[1.6%], incomplete keratectomy in four eyes[0.6%].The incidence of postoperative complications was six eyes[1.0%], and it included epithelial ingrowth in five eyes[0.8%], and diffuse lamellar keratitis in one eye[0.2%].There weren't grave complications such as infectious keratitis or corneal perforation.There was no change between preoperative and postoperative BCVA in seventeen eyes[85%].No eye lost 2 or more lines of BCVA because of flap complications. In conclusion, flap complications after LASIK were relatively uncommon, and rarely lead to a permanent decrease in visual acuity.Physician experience with the microkeratome and the careful handling of the corneal flap may be important to decrease the incidence of flap mplications.But even though it occurs, proper management and treatment will result in good surgical outcomes without grave visual impairment.

Systemic Risk Factors for Postoperative Vitreous Hemorrhage Following Diabetic Vitrectomy

PURPOSE: To determine the incidence of and the systemic risk factors for postoperative vitreous hemor-rhage(PVH). METHOD: The records of 503 consecutive diabetic vitrectomy cases were reviewed. RESULT: Eighty-seven eyes(17.3%) had at least one episode of PVH. Sixty-five eyes(12.9%) had PVH within 3 months after vitrectomy, and the mean onset time of the first episode of PVH was about 13 weeks after vitrectomy. The mean follow-up period was 17.2 months in non-hemorrhage group, and 21.9 months in hemorrhage group. While 34 eyes(29.6%) had spontaneous absorption of blood, 42 eyes(36.5%) required air(or gas)-fluid exchange and 39 eyes(33.9%) vitreous cavity lavage. Using univariate analysis, the factors associated with increased incidence of PVH include type 1 diabetes mellitus(p=0.01), method of glycemia control(p=0.02), anemia(p=0.04), and hypercholesterolemia(p=0.005). Multivariate analysis revealed diabetic nephropathy(p=0.02) and hypercholesterolemia(p=0.01) were the risk factors. Five eyes(1.0%) lost light perception, 7 eyes(1.4%) had rhegmatogenous retinal detachment, and 11 eyes(2.2%) had neovascular glaucoma. CONCLUSION: Vitreous hemorrhage after diabetic vitrectomy occurred in the 17.3%, three quarters of them within 3 months. About one third had spontaneous clearing, and two-thirds required reoperation. Diabetic nephropathy and hypercholesterolemia were the systemic risk factors of vitreous hemorrhage after diabetic vitrectomy.