Epidermal cysts are generally benign tumors that usually originate from the skin caused by inflammation of hair cortex and proliferation of epidermal cells within the dermis; however, for these cysts to occur in the bony external auditory canal (EAC) is rare. They are often present as a solitary, painless lesion and usually asymptomatic and the diagnosis depends on the results of the histological examination. In treatment, the cyst wall must be completely removed surgically. We recently encountered a 82-year-old male with a mass in the right EAC. An otoscopic examination showed a polypoid mass on the bony EAC, which was finally diagnosed as epidermal cyst after an initial misdiagnosis as EAC carcinoma. We report the rare, unique case with literature review.
Aged, 80 and over ; Dermis ; Diagnosis ; Diagnostic Errors ; Ear Canal* ; Epidermal Cyst* ; Hair ; Humans ; Inflammation ; Male ; Skin

A congenital cholesteatoma is a benign mass formed from the keratinizing stratified squamous epithelium. It usually occurs in young children's anterosuperior part of the middle ear. A congenital cholesteatoma which originates from mastoid temporal bone or expands to posterior cranial fossa is rare. Standard treatment of an intracranial cholesteatoma is surgical removal with craniotomy. A 69-year-old woman was diagnosed with a congenital cholesteatoma of mastoid temporal bone that expanded to the posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy. This is a first documented case of a congenital cholesteatoma of mastoid temporal bone that expanded to posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy.
Aged ; Cholesteatoma* ; Cranial Fossa, Posterior* ; Craniotomy ; Ear, Middle ; Epithelium ; Female ; Humans ; Mastoid* ; Occipital Bone ; Temporal Bone*

It is challenging to achieve sufficient hearing gain in patients with mixed hearing loss. In chronic middle ear diseases, conventional passive reconstructive surgeries often result in suboptimal hearing gain and additional hearing aids may have limitations due to insufficient sound amplification, occlusion effect, acoustic feedback, and skin irritation. Middle ear implantation (MEI) using Vibrant Soundbridge (VSB) is another option for auditory rehabilitation in mixed hearing loss as well as sensorineural hearing loss. The floating mass transducer of VSB can be placed on various middle ear structures either directly or using different types of couplers in order to deliver vibratory mechanical energy to the cochlea. We report a patient who presented with bilateral mixed hearing loss due to chronic otitis media and had limitations using conventional hearing aids in the worse hearing ear. The patient was successfully treated with MEI using the Bell coupler together with middle ear surgery in a single step.
Acoustics ; Cochlea ; Ear ; Ear, Middle* ; Hearing ; Hearing Aids ; Hearing Loss, Mixed Conductive-Sensorineural* ; Hearing Loss, Sensorineural ; Humans ; Ossicular Prosthesis* ; Otitis Media ; Rehabilitation ; Skin ; Transducers

The most common cause of treatment failure in oral cavity cancer is when it is found to have local recurrence, usually occurring in the ipsilateral cervical lymph node. On the contrary, it is extremely rare to find local recurrence in soft tissue metastasis (STM) in the contralateral neck. Furthermore, lung cancer and malignant lymphoma are most commonly confined to their primary sites. The poor general condition increases the likelihood of STM, which indicates bad prognosis. A 72-year-old man with a hard and fixed mass on the right submandibular space visited our clinic. He had received a wide excision with local flapreconstruction for squamous cell carcinoma in the left corner of lower lip 18 months ago. We performed the wide excision with bilateral selective neck dissection (I–III), and he was finally diagnosed as STM from contralateral lip cancer. We report this unique and rare disease entity with a literature review.
Aged ; Carcinoma, Squamous Cell ; Humans ; Lip Neoplasms* ; Lip* ; Lung Neoplasms ; Lymph Nodes ; Lymphoma ; Mouth ; Neck ; Neck Dissection ; Neoplasm Metastasis* ; Neoplasm Recurrence, Local ; Prognosis ; Rare Diseases ; Recurrence* ; Soft Tissue Neoplasms ; Treatment Failure

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate surgical completeness in endoscopic total thyroidectomy with central neck dissection via unilateral axillo-breast approach (UABA) compared with bilateral axillo-breast (BABA) and open approach (OA) by means of the radioactive iodine uptake (RAIU) ratio and thyroglobulin (Tg) of remnant thyroid. SUBJECTS AND METHOD: From July 2010 to March 2013, 82 patients who had underwent total thyroidectomy with central neck dissection and postoperative radioactive iodine (RAI) ablation for papillary thyroid carcinoma were enrolled. Of these patients, 27 patients underwent UABA, 24 patients BABA, and 31 patients OA. Clinicopathologic data, surgical outcome, stimulated Tg and RAIU ratio on the first postoperative RAI ablation scan were compared among 3 groups. RESULTS: Patients in the endoscopic surgery groups (UABA, BABA) were younger than those in the OA groups. Invasiveness such as operation time, postoperative pain, and drain amount in UABA was less than that in BABA and severer than that in OA. Other variables regarding clinicopathologic and surgical data were not significantly different. Stimulated Tg and RAIU ratio did not show significant differences among 3 groups (p=0.659 and p=0.664). CONCLUSION: The completeness of UABA was comparable with that of BABA and OA. The UABA may be a safe option for patients who need endoscopic thyroidectomy for papillary thyroid carcinoma.
Endoscopy ; Humans ; Iodine ; Methods ; Neck Dissection* ; Neck* ; Pain, Postoperative ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy*

BACKGROUND AND OBJECTIVES: This study investigated the relationship between reflux symptom index (RSI) and psychiatric problems such as depression, somatization, and anxiety. SUBJECTS AND METHOD: We prospectively analyzed 231 patients with symptoms with laryngopharyngeal reflux (LPR) using the RSI and the reflux finding score. RESULTS: Seventy nine patients (34.2%) were diagnosed with LPR. A significant correlation was detected between the RSI and depression (18.4±8.3 vs. 12.3±7.0, p < 0.001), anxiety (19.5±8.5 vs. 13.0±7.3, p < 0.001), and somatization (19.2±9.1 vs. 13.6±7.5, p < 0.001). A multivariate analysis confirmed a significant association between heartburn and depression [odds ratio (OR): 1.241, 95% confidence interval (CI): 1.003–1.537, p=0.047], choking and anxiety (OR: 1.747, 95% CI: 1.297–2.352, p < 0.001), and choking and somatization (OR: 1.707, 95% CI: 1.248–2.336, p=0.001). CONCLUSION: Our preliminary results suggest that patients with high RSI may need to be carefully evaluated for psychiatric problems.
Airway Obstruction ; Anxiety ; Depression ; Heartburn ; Humans ; Laryngopharyngeal Reflux ; Methods ; Multivariate Analysis ; Prospective Studies ; Somatoform Disorders

BACKGROUND AND OBJECTIVES: Previous studies have suggested the usefulness and importance of postoperative voice therapy, for which there are indirect and direct methods. The aim of this study was to evaluate the efficacy of treatment according to different voice therapy methods. SUBJECTS AND METHOD: Patients with vocal polyp were divided into three groups. Group 1 received direct voice therapy after phonomicrosurgery and Group 2 indirect voice therapy after phonomicrosurgery. Group 3 did not receive any voice therapy. RESULTS: Perceptual, acoustic, aerodynamic voice outcome parameters differed significantly between pre and post-operative treatments. In almost all of the voice analysis, Group 1, who underwent direct voice therapy, improved more significantly compared with Group 2 and 3. CONCLUSION: Postoperative voice therapy following phonomicrosurgery may be an effective adjuvant treatment in patients with vocal polyps. In particular, direct voice therapy can be effective for improving postoperative voice outcome.
Acoustics ; Humans ; Methods ; Polyps* ; Voice*

BACKGROUND AND OBJECTIVES: This study was performed to evaluate the long-term effect of adenotonsillectomy on childhood growth by examining preoperative growth status and presenting symptoms. SUBJECTS AND METHOD: One hundred and four patients who underwent adenotonsillectomy from January to December 2009 were enrolled in this study. Clinical data were collected from medical record reviews and through the administered questionnaire. We investigated symptoms and growth changes during 5 years following the surgery. RESULTS: The mean age of patients was 6.0±1.94 years (range, 3–10), with the male to female ratio of 62:42. Pre-operative symptoms were significantly improved after the surgery. The mean pre-operative height and weight percentiles were 53.6±27.4 and 59.6±29.2 at initial evaluation, and 67.1±26.4 and 59.6±28.6 at 5 years post adenotonsillectomy (p < 0.001, p=0.989), respectively. An increase in height percentile was more prominent in patients whose pre-operative height percentile was less than 50 compared to those with a percentile of 50 or more (p < 0.001). Weight percentile was significantly increased in those with the pre-operative weight percentile of less than 50 and decreased in patients with a percentile of 50 or more. CONCLUSION: Adenotonsillectomy has a positive effect on height growth in children with adenotonsillar hypertrophy, especially in patients whose height percentile is less than 50. Weight gain also can be expected in preoperative low-weight children.
Adenoidectomy ; Child ; Female ; Humans ; Hypertrophy ; Male ; Medical Records ; Methods ; Tonsillectomy ; Weight Gain

BACKGROUND AND OBJECTIVES: The representative mucin genes in the human airway are MUC5AC and MUC5B, which are regulated by several inflammatory and anti-inflammatory substances. Triptolide (TPL), udenafil, betulinic acid, changkil saponin, and glucosteroid are some of the many anti-inflammatory substances that exist. TPL is a diterpenoid compound from the thunder god vine, which is used in traditional Chinese medicine for treatment of immune inflammatory diseases, such as rheumatoid arthritis, systemic lupus erythematosus, nephritis and asthma. However, the effects of TPL on mucin expression of human airway epithelial cells have yet to be reported. Hence, this study investigated the effect of TPL on lipopolysaccharide (LPS)-induced MUC5AC and MUC5B expression in human airway epithelial cells. SUBJECTS AND METHOD: The NCI-H292 cells and the primary cultures of human nasal epithelial cells were used to investigate the effects of TPL on LPS-induced MUC5AC and MUC5B expression using real-time polymerase chain reaction, enzyme immunoassay, and Western blot. RESULTS: TPL significantly decreased the LPS-induced MUC5AC and MUC5B mRNA expression and protein production. TPL also significantly decreased the nuclear factor-kappa B (NF-kB) phosphorylation. CONCLUSION: These results suggest that TPL down regulates MUC5AC and MUC5B expression via inhibition of NF-kB activation in human airway epithelial cells. This study may provide important information about the biological role of triptolide on mucus-secretion in airway inflammatory diseases and the development of novel therapeutic agents for controlling such diseases.
Arthritis, Rheumatoid ; Asthma ; Blotting, Western ; Epithelial Cells* ; Humans* ; Immunoenzyme Techniques ; Lupus Erythematosus, Systemic ; Medicine, Chinese Traditional ; Methods ; Mucins ; Nephritis ; NF-kappa B ; Phosphorylation ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Saponins

BACKGROUND AND OBJECTIVES: Tinnitus, a common complaint of workers who are exposed to noise, can cause substantial negative effects on the quality of life of these workers. The aim of this study was to analyze the characteristics of tinnitus in patients with noise-induced hearing loss and the relationship between tinnitus and the duration of noise exposure. SUBJECTS AND METHOD: Thirty-three patients with subjective tinnitus and noise-induced hearing loss were included in this study. Tinnitus questionnaire, Tinnitus Handicap Inventory (THI) and audiological examinations were investigated according to the duration of noise exposure. RESULTS: There was a significant correlation between the tinnitus loudness and the duration of noise exposure. Patients who had longer periods of noise exposure had a louder tinnitus and higher THI score. However, there is no significant correlation between the characteristics of tinnitus and aging process. CONCLUSION: The duration of noise exposure influences the loudness and distress of tinnitus. An awareness of tinnitus should be considered as part of hearing conservation program.
Aging ; Hearing ; Hearing Loss ; Hearing Loss, Noise-Induced* ; Humans ; Methods ; Noise* ; Quality of Life ; Tinnitus*