The aim of this study was to identify the pathogens of chronic recalcitrant sinusitis and to obtain information for determining appropriate antibiotics through sensitivity testing. A prospective study was conducted on 100 patients with chronic sinusitis who had undergone endoscopic sinus surgery after failed medical treatment. Specimens were obtained from the maxillary sinuses and sent for bacterial cultures and sensitivity tests. Bacteria were isolated in 75 (75%) of the 100 cases. Aerobic bacteria were isolated in 73 cases (73%). Gram-positive aerobes were recovered in 54 cases (54%) and Gram-negative aerobes in 20 cases (20%). Anaerobes were isolated in three cases (3%). Mixed infections were found in two cases (2%). More than 90% of the aerobic bacteria were resistant to penicillin, and 48.8% of the Staphylococci were resistant to oxacillin. Seventy percent of Gram-positive aerobes were sensitive to trimethoprim-sulfamethoxazole, 75% to clindamycin, and 93% to ciprofloxacin. Ninety percent of Gramnegative aerobes were sensitive to ciprofloxacin, and 95% to trimethoprim-sulfamethoxazole. In conclusion, most of the isolated bacteria were aerobic, and in contrast to previous reports, mixed or anaerobic bacterial infection was not frequent. Among the oral antibiotics tested for sensitivity in this study, ciprofloxacin, trimethoprim-sulfamethoxazole, and clindamycin are most strongly recommended for treating chronic sinusitis refractory to first-line antibiotic treatment.
Anti-Bacterial Agents* ; Bacteria* ; Bacteria, Aerobic ; Bacteria, Anaerobic ; Bacterial Infections ; Ciprofloxacin ; Clindamycin ; Coinfection ; Humans ; Maxillary Sinus* ; Oxacillin ; Penicillins ; Prospective Studies ; Sinusitis* ; Trimethoprim, Sulfamethoxazole Drug Combination

As a surgical treatment of congenital choanal atresia, transnasal approach has been more widely used with the development of endoscopic surgical techinque. We have experienced 4 cases of congenital choanal atresia, which were treated via transnasal endoscopic approach. Three cases were unilateral, and one case was bilateral. We have fenestrated the atretic plate under endoscopic guide using forceps, curette, and/or Nd-YAG laser. Silastic stents were inserted in two cases and left in place for 3 weeks. No restenosis developed in the two cases to which stents were applied, while restenosis developed in two cases without stents. Revision transpalatal approach was performed in one case with bilateral atresia. No complication such as palatal deformity was developed. Newly formed choanal opening had a tendency to decrease in size with the passage of time. So, the opening should be wider initially, and postoperive endoscopic follow-up is needed.
Choanal Atresia* ; Congenital Abnormalities ; Endoscopy ; Follow-Up Studies ; Lasers, Solid-State ; Stents ; Surgical Instruments

PURPOSE: To evaluate the possibility of lowering tourniquet pressure to 200 mmHg during total knee arthroplasty (TKA) by pressing the femoral artery. Lowering the toniquette pressure can attribute to minimize the soft tissue damage and pain after the operation. MATERIALS AND METHODS: We analyzed patients who had TKA from Sep 16th, 2010 to Mar 3rd, 2011. Among them, 35 patients (test I) had operations on both knees, and 50 patients (test II) underwent operation on one knee. We excluded the patients who had a previous operation, infection, or bleeding tendency. We put a cotton roll at the antero-medial side of the thigh just under the tourniquet in order to apply more pressure on the femoral artery that is scanned by ultrasonography. We scored 0 on non-bleeding, 1 on bleeding that did not affect the operation, and 2 on bleeding which disturbed the operation. RESULTS: In test I, the group which applied 200 mmHg with local pressure, 24 patients (68.6%) scored 0, 9 patients (25.7%) scored 1, and two patients (5.7%) scored 2. In the other group used pressure 250 mmHg, however, 31 patients (88.6%) scored 0, 4 patients (11.4%) scored 1, and no one scored 2 (p=0.039). Totally, in the 200 mmHg group with local pressure, 33 patients had no problem in surgery, and only for 2 patients (5.7%), we had to increase pressure. For the patients with 250 mmHg, however, we had to increase pressure on nobody (0%). In test II, in the group which had operation on one knee with 200 mmHg with local pressure, 14 patients scored 0, 8 patients scored 1, and one patient scored 2. Also in the 250 mmHg group, 24 patients scored 0, 2 patients scored 1, and one patient scored 2. (p=1.000). Overall results demonstrate no differences in bleeding that disturb operations statistically. CONCLUSION: Even with a little more bleeding compared to the 250 mmHg group, 94.8% of patients can have operation with no bleeding problems by using a cotton roll and the pressure 200 mmHg. For successful operations, there is no difference between groups using 250 mmHg and 200 mmHg with local pressure on femoral artery.
Arthroplasty ; Femoral Artery ; Hemorrhage ; Humans ; Knee ; Thigh ; Tourniquets

BACKGROUND AND OBJECTIVES:There are several methods to improve voice quality in the patients with paralyzed vocal cord, such as thyroplasty type I, injection, arytenoid adduction. The goal of surgical medialization of the paralyzed vocal fold is to attain complete glottic closure. The purpose of this study is to evaluate the effectiveness of thyroplasty type I through qualifying the vocal function and glottal gap. MATERIALS & METHODS: We experienced 20 cases of unilateral vocal fold paralysis who underwent thyroplasty type I. We performed preoperative and postoperative videoimage analysis (normalized glottal gap area) and computer-assisted voice analysis in all patients. RESULTS: The glottal gap was significantly reduced after thyroplasty type I. Postoperative voice quality was characterized by an improved pitch and amplitude perturbation (jitter and shimmer), maximum phonation time and subglottic pressure . But noise to harmonic ratio was not improved. CONCLUSION: Thyroplasty type I is an effective method in the point of regaining glottal closure and vocal function.
Humans ; Laryngoplasty* ; Noise ; Paralysis* ; Phonation ; Vocal Cord Paralysis ; Vocal Cords ; Voice Quality ; Voice*

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.
Surveys and Questionnaires ; Delivery of Health Care ; Dizziness ; Electronic Mail ; Korea ; Otolaryngology ; Otolithic Membrane ; Public Opinion ; Vertigo