Background: The majority of patients with obstructive sleep apnea do not receive timely diagnosis and treatment because of the complexity of a diagnostic test. We aimed to predict obstructive sleep apnea based on heart rate variability, body mass index, and demographic characteristics in a large Korean population. Methods: Models of binary classification for predicting obstructive sleep apnea severity were constructed using 14 features including 11 heart rate variability variables, age, sex, and body mass index. Binary classification was conducted separately using apnea-hypopnea index thresholds of 5, 15, and 30. Sixty percent of the participants were randomly allocated to training and validation sets while the other forty percent were designated as the test set. Classifying models were developed and validated with 10-fold cross-validation using logistic regression, random forest, support vector machine, and multilayer perceptron algorithms. Results: A total of 792 (651 men and 141 women) subjects were included. The mean age, body mass index, and apnea-hypopnea index score were 55.1 years, 25.9 kg/m 2 , and 22.9, respectively. The sensitivity of the best performing algorithm was 73.6%, 70.7%, and 78.4% when the apnea-hypopnea index threshold criterion was 5, 10, and 15, respectively. The prediction performances of the best classifiers at apnea-hypopnea indices of 5, 15, and 30 were as follows: accuracy, 72.2%, 70.0%, and 70.3%; specificity, 64.6%, 69.2%, and 67.9%; area under the receiver operating characteristic curve, 77.2%, 73.5%, and 80.1%,respectively. Overall, the logistic regression model using the apnea-hypopnea index criterion of 30 showed the best classifying performance among all models. Conclusion Obstructive sleep apnea was fairly predicted by using heart rate variability, body mass index, and demographic characteristics in a large Korean population. Prescreening and continuous treatment monitoring of obstructive sleep apnea may be possible simply by measuring heart rate variability.

Endolymphatic sac decompression (ESD) is indicated in intractable Meniere's disease patients with serviceable hearing. A 43-year-old man presented with recurrent vertigo and fluctuating right hearing loss that had been intractable to medical treatment. ESD was performed for the purpose of vertigo control with hearing preservation. Positional vertigo with profound hearing loss developed immediate after surgery and positional vertigo was resolved within days. Following paralytic vestibulopathy with positive sign on head thrust test also resolved after 2 weeks, while sensorineural hearing loss was not recovered to preoperative level during 1 year of follow up. Recurrent vertigo attacks were developed again 1 year after the operation. Hearing preservation was not always guaranteed in ESD. Furthermore, chance of hearing loss should be included in informed consent though the procedure is purposed for hearing preservation.
Adult ; Decompression ; Endolymphatic Sac ; Follow-Up Studies ; Head Impulse Test ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Informed Consent ; Meniere Disease ; Vertigo

The human microbiome is a collection of microbial species and their associated genomes that live on and in the body. Recent advances in molecular biology methods have revolutionized microbiome analysis techniques. Studies of the airway microbiome have illustrated that the paranasal sinuses are not sterile in the healthy state. Because human airways are in constant contact with the external environment and their mucosal surfaces are colonized with microorganisms, it is assumed that the local microbiota might influence immune homeostasis as well. Chronic rhinosinusitis and allergic rhinitis are the most common chronic airway diseases that yield a significant amount of socioeconomic burden. Despite the problematic nature of the diseases, a thorough understanding of their cause and pathogenesis is still lacking. At present, bacteria are believed to play a pathogenetic role in the propagation of inflammation and it is necessary to establish the relationship between the microbiome and inflammatory patterns to find their clinical reflections and also their possible causal relationship. Such investigations may elucidate the path to therapeutic approaches in correcting an imbalanced microbiome. In this review, we summarized recent typical studies dealing with the upper airway microbiome and discuss their clinical significance focusing on chronic rhinosinusitis and allergic rhinitis.
Bacteria ; Colon ; Genome ; Homeostasis ; Humans ; Inflammation ; Metagenomics ; Microbiota* ; Molecular Biology ; Paranasal Sinuses ; Rhinitis, Allergic*

Schwannomas are slow-growing, benign neurogenic tumors arising from the sheath of myelinated nerve fibers. They usually occur in the head and neck region. Only 4% of schwannomas found in the head and neck region originate in the sinonasal tract. Schwannoma of the nasal septum is rarer, and only few cases have been previously reported in the literature. We experienced a rare case of the schwannoma of the posterior nasal septum in a 71-year-old woman. She was treated successfully by transnasal endoscopic surgery. No recurrence was detected within 18 months follow-up period.
Aged ; Female ; Follow-Up Studies ; Head ; Humans ; Nasal Septum ; Neck ; Nerve Fibers, Myelinated ; Neurilemmoma ; Nose Neoplasms ; Recurrence

Extrapulmonary small cell carcinoma originated from the paranasal sinus is extremely rare, and its local and distant metastasis is common and the prognosis is poor. We recently experienced a rare case of small cell carcinoma that originated from the maxillary sinus. However, the diagnosis was delayed for several reasons, one of which included accompanied bilateral fungal sinusitis. The patient received chemotherapy for four times, but the therapy was discontinued due to poor general conditions. We report our case with a review of the literature.

Schwannomas are slow-growing, benign neurogenic tumors arising from the sheath of myelinated nerve fibers. They usually occur in the head and neck region. Only 4% of schwannomas found in the head and neck region originate in the sinonasal tract. Schwannoma of the nasal septum is rarer, and only few cases have been previously reported in the literature. We experienced a rare case of the schwannoma of the posterior nasal septum in a 71-year-old woman. She was treated successfully by transnasal endoscopic surgery. No recurrence was detected within 18 months follow-up period.

Background and Objectives: There is no clear standard for the difference in the thresholds of auditory brainstem response (ABR) and pure tone audiometry (PTA) when using ABR to evaluate the reliability of PTA. Therefore, we assessed the difference in the thresholds of ABR and PTA for each frequency. Consequently, we present here the actual difference values between the two tests that can be used as a reference in the clinic.Subjects and Method We retrospectively assessed the audiometry results of 129 ears. Ears in which the hearing thresholds of each frequency continuously declined were classified as the downward group. We compared the average of differences between the two tests by frequency. The differences were compared for each hearing level from 50 dB or higher. Results: For all ears, the appropriate range of difference value was ±5 dB at 2 kHz. At 1 kHz, the ABR threshold was 10 dB higher than PTA, and it was 10 dB less than PTA at 4 kHz. In the downward group, the difference value increased by 10 dB at 1 kHz and 4 kHz. In the subgroups at each hearing level, the difference value showed similar results (p<0.05). Conclusion The difference in the threshold, regardless of the severity or tendency of hearing loss, was the smallest at 2 kHz and the range was ±5 dB. ABR was 10 dB higher at 1 kHz and and 10 dB lower at 4 kHz than PTA. In the downward group, the difference at 1 kHz and 4 kHz increased by 10 dB each.

Background and Objectives: Patients with hearing loss and tinnitus experience difficulty in engaging in daily conversations. However, only few studies have examined how tinnitus affects individual speech discrimination to comprehend speech. This study aimed to analyze the correlation between tinnitus frequency and speech discrimination in patients with hearing loss and tinnitus.Subjects and Method A total of 275 ears with hearing impairment were retrospectively analyzed via audiometry and tinnitogram. The ears were divided into three groups depending on the frequency of their tinnitus. Average pure tone audiometry (PTA), hearing threshold of tinnitus frequency, speech discrimination test (SDT), degree of discrepancy between tinnitus frequency and worst PTA frequency were collected and compared among the three groups. Results: No significant difference was observed in PTA in the three patient groups. Hearing threshold of tinnitus frequency was the highest at 78.27 dB in the high-frequency group and the lowest at 45.14 dB in the low-frequency group. SDT was significantly lower (53.69%) in the low-frequency group. The correlation between tinnitus loudness and SDT was the strongest in the low-frequency group. The degree of discrepancy between tinnitus frequency and worst PTA frequency was also significantly observed in the low-frequency group. Conclusion Patients who are severely affected by tinnitus are found to have significant discrepancy between tinnitus frequency and worst PTA frequency, indicating decreased SDT.

We report a recently encountered case of angioleiomyoma in the tracheal wall. The patient was a 40-year-old man. The main symptoms were coarse breathing sound and dyspnea on exertion. Computed tomography revealed a 2.0 cm-sized, well-defined enhancing round mass originating in the tracheal wall. The tumor was successfully removed with wedge shaped tracheal cartilage resection performed under general anesthesia, and the tracheal wall was closed primarily. Histopathologically, the tumor was composed of proliferating smooth muscle fibers and dilated blood vessels which were well-circumscribed. Angioleiomyoma is a type of benign tumor found rarely in the head and neck area. Complete surgical removal is the treatment of choice as it yields very low recurrence rates.
Adult ; Anesthesia, General ; Angiomyoma* ; Blood Vessels ; Cartilage ; Dyspnea ; Head ; Humans ; Muscle, Smooth ; Neck ; Recurrence ; Respiratory Sounds ; Trachea

Hereditary hemorrhagic telangiectasia (HHT) is a hereditary, autosomal dominant, vascular dysplasia characterized by mucocutaneous telangiectasia, epistaxis, gastrointestinal bleeding, and iron deficiency anemia. Epistaxis in HHT is a recurrent and debilitating symptom, which is difficult to manage. Many methods have been tried with little success. Bevacizumab (Avastin®), a VEGF inhibitor, has been recently tried intranasally or systemically to control the recurrent epistaxis. We report three patients with HHT who were treated with intranasal bevacizumab application together with cauterization. In all three patients, recurrent epistaxis decreased considerably with improvement in quality of life. Here we describe the application methods, treatment results, and complications with literature review. We believe that this is the first report of treating epistaxis in HHT with intranasal application of bevacizumab in South Korea.
Anemia, Iron-Deficiency ; Bevacizumab* ; Cautery ; Epistaxis ; Hemorrhage ; Humans ; Korea ; Quality of Life ; Telangiectasia, Hereditary Hemorrhagic* ; Telangiectasis ; Vascular Endothelial Growth Factor A