After the trauma of frontoethmoidal sinus, post-traumatic mucocele may occur. Surgical removal of the lesions rarely produces cerebrospinal fluid (CSF) leakage and even delayed tension pneumocephalus. We experienced a case of fronto-ethmoid mucocele complicated with peri-operative CSF leakage and post-operative tension pneumocephalus which was improved by conservative treatment. It is imperative to take into account the potential for tension pneumocephalus when a patient suffers from severe headache after sinus surgery.
Cerebrospinal Fluid Leak* ; Cerebrospinal Fluid* ; Ethmoid Sinus ; Frontal Sinus ; Headache ; Humans ; Mucocele ; Pneumocephalus*

Objectives: The objective of this study was to develop models for predicting obstructive sleep apnea (OSA) based on easily obtainable clinical information of patients using various machine learning techniques. Methods: We used a data set that included the records of 1,368 patients, in which 1,074 patients were male (78.5 %), and 294 patients were female (21.5 %). We randomly divided the data into a training set (1,000) and test set (368). Five machine learning methods, i.e., support vector machine model, lasso logit model, naïve bayes, discriminant analysis, and K-nearest neighbor (KNN), with a 10-cross fold technique were used with the proposed model to predict OSA. We evaluated the accuracy, sensitivity, specificity, and precision of each model for three thresholds [Apnea-Hypopnea Index (AHI)≥5, AHI≥15, and AHI≥30]. Results: Among the machine learning techniques, KNN showed the best results compared to the other techniques. The accuracy, sensitivity, specificity, and precision of OSA prediction were 87.0%, 91.0%, 74.4%, and 91.9%, respectively, based on AHI≥5. When the threshold of OSA was AHI≥15 or AHI≥30, KNN provided lower accuracy (79.6% each) and precision (79.0% and 68.7%), which were still higher than those of the other techniques. Conclusions The model derived from the KNN technique exhibited the best performance based on its highest level of accuracy. We demonstrate that this model is a useful tool for predicting OSA.

Adenoid cystic carcinoma arises rarely in the nasal cavity and paranasal sinus. Treatment strategy showing the best survival rate includes surgical excision and adjuvant radiotherapy. There were a few case reports of radiation-induced osteosarcoma from adenoid cystic carcinoma overseas but not in Korea. We experienced a case of radiation-induced low-grade osteosarcoma in the middle skull base including sphenoid bone, which had arisen after 10 years of radiotherapy of adenoid cystic carcinoma. Authors present this case with serial imaging findings and literature review.
Carcinoma, Adenoid Cystic* ; Korea ; Nasal Cavity* ; Neoplasms, Radiation-Induced ; Osteosarcoma* ; Radiotherapy* ; Radiotherapy, Adjuvant ; Skull Base* ; Sphenoid Bone ; Survival Rate

Objectives: . In extracorporeal septoplasty (ECS), the entire septal cartilage is harvested, and a neo-L strut is built extracorporeally. Thus, ECS can simultaneously achieve septum straightening and tip projection. This study evaluated the functional and esthetic outcomes of the ECS technique for rhinoplasty in Asian patients. Methods: . We conducted a retrospective review of 64 patients who underwent rhinoplasty using ECS between January 2016 and March 2018. Subjective patient satisfaction was assessed and objective surgical outcomes were evaluated. Improvement in nasal obstruction was rated using a visual analog scale (VAS). Anthropometric changes were compared between preoperative and postoperative facial photographs. Complications and revisions were also analyzed. Results: . The participants comprised 64 patients (48 males and 16 females, with a mean age of 29.3 years). The mean operative time was 89.3 minutes. In total, 61 patients were satisfied with the esthetic outcome, and the overall objective rhinoplasty outcome score was 3.45. Preoperative nasal obstruction symptoms (7.9±1.2 on VAS) improved postoperatively (3.1±1.3, P<0.001), and significant improvements were also observed in the nasofrontal angle (152.3° to 148.1°, P<0.001), nasolabial angle (88.8° to 92.0°, P<0.001), and nasal tip projection (0.62 to 0.66, P<0.033). Recurrent deviation of the nasal septum and external nose or tip deprojection did not occur in any patients, and there were no cases of revision during the mean follow-up period of 13.3 months. Conclusion . ECS might be an esthetically and functionally satisfactory alternative rhinoplasty technique for Asian patients with a shortage of septal cartilage.

Objectives: The objective of this study was to develop models for predicting obstructive sleep apnea (OSA) based on easily obtainable clinical information of patients using various machine learning techniques. Methods: We used a data set that included the records of 1,368 patients, in which 1,074 patients were male (78.5 %), and 294 patients were female (21.5 %). We randomly divided the data into a training set (1,000) and test set (368). Five machine learning methods, i.e., support vector machine model, lasso logit model, naïve bayes, discriminant analysis, and K-nearest neighbor (KNN), with a 10-cross fold technique were used with the proposed model to predict OSA. We evaluated the accuracy, sensitivity, specificity, and precision of each model for three thresholds [Apnea-Hypopnea Index (AHI)≥5, AHI≥15, and AHI≥30]. Results: Among the machine learning techniques, KNN showed the best results compared to the other techniques. The accuracy, sensitivity, specificity, and precision of OSA prediction were 87.0%, 91.0%, 74.4%, and 91.9%, respectively, based on AHI≥5. When the threshold of OSA was AHI≥15 or AHI≥30, KNN provided lower accuracy (79.6% each) and precision (79.0% and 68.7%), which were still higher than those of the other techniques. Conclusions The model derived from the KNN technique exhibited the best performance based on its highest level of accuracy. We demonstrate that this model is a useful tool for predicting OSA.

PURPOSE: Allergic rhinitis (AR) is a multifactorial disease whose genetic and environmental risk factors have been studied for decades. Many pediatric studies have pointed out the familial history of allergy, hygiene hypothesis, breast-feeding, pet ownership, and diets as risk factors of AR. However, most of factors are still up for debate. This preliminary report aimed to confirm the known risk factors and find the novel risk factors for AR in the Korean pediatric population. METHODS: A bi-seasonal, winter and summer, study in 2 elementary schools included all students whose parents completed the questionnaire of medical and social histories, quality of life, infant and early-childhood history, and the living styles. Skin prick tests and endoscopic examinations were conducted on all participants. RESULTS: Among total 1,020 children, 338 participants had AR. The multivariate logistic regression analysis highlighted 6 factors: male gender (OR, 2.10; 95% CI, 1.32-3.33), older age (1.65; 1.03-2.65), previous history of allergic conjunctivitis (14.25; 4.99-40.74), asthma (2.73; 0.96-7.76) and pneumonia (0.39; 0.19-0.82), and an hour increase in daily playing time (0.90; 0.80-1.00). CONCLUSIONS: Lack of pneumonia in early childhood and short playing time are newly found risk factors for Korean pediatric AR in this study confirming male gender, older age and previous history of allergic conjunctivitis and asthma as the risk factors.
Asthma ; Child* ; Conjunctivitis, Allergic ; Diet ; Humans ; Hygiene Hypothesis ; Hypersensitivity ; Infant ; Logistic Models ; Male ; Ownership ; Parents ; Pneumonia ; Quality of Life ; Rhinitis* ; Risk Factors* ; Skin ; Surveys and Questionnaires

PURPOSE: This study investigated the long-term efficacy, safety, and compliance associated with sublingual immunotherapy (SLIT) in Korean patients with allergic rhinitis sensitized to house dust mites. METHODS: This is a retrospective cohort study. A total of 164 patients who were sensitized to Dermatophagoides pteronyssinus and Dermatophagoides farinae and who received SLIT were enrolled between November 2007 and January 2010. Each patient was followed up using a diary card, on which a symptom score, rescue medication score, and adverse events (AEs) were recorded. RESULTS: All allergic rhinitis symptoms improved after 3 years of SLIT (P<0.05), and the rescue medication score decreased with time (P<0.05). The incidence of AEs associated with SLIT was 31% (51 of 164 patients) during the first month of therapy, and there were no severe AEs. The dropout rate was 19.5% (32 of 164 patients) during the first month, 34% (56 of 164 patients) after 6 months, and 41% (68 of 164 patients) after 1 year of SLIT. The 3-year compliance rate was approximately 40% (65 of 164 patients). The most common causes of dropout during the first month of SLIT were high cost and inconvenience. The improvement in allergic symptoms was the most common cause of dropout after 6 months. CONCLUSIONS: Allergic symptoms significantly decreased after 1 year of SLIT treatment, and this effect was sustained after 2 or 3 years of treatment. By increasing compliance through patient education, the 3-year use of SLIT for house dust mite allergies may be effective in the management of allergic rhinitis.
Cohort Studies ; Compliance ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Follow-Up Studies* ; Humans ; Hypersensitivity ; Incidence ; Patient Dropouts ; Patient Education as Topic ; Pyroglyphidae* ; Retrospective Studies ; Rhinitis* ; Sublingual Immunotherapy*

BACKGROUND AND OBJECTIVES: Absence of incus is one of the most common ossicular anomalies and also frequently found in chronic otitis media or chornic otitis media with cholesteatoma. Ossiculoplasty with malleus footplate assembly (MFA) can be an excellent option in the above situations. We reviewed our procedures and evaluated the hearing results of ossiculoplasty using the MFA. SUBJECTS AND METHODS: This study retrospectively reviews a series of 32 patients who underwent MFA ossiculoplasty between September 2001 and March 2010 in an academic tertiary referral center. The autologous incus or hydroxyapatite (HA) was used as materials for reconstruction. RESULTS: Thirteen of 32 patients (40.6%) had ossicular chain anomaly, 9 patients (28.1%) had congenital cholesteatoma and 8 patients (25.0%) had chronic otitis media with cholesteatoma and 2 patients (6.3%) had chronic otitis media. The patients with ossicular chain ano-maly showed the greatest air-bone gap (ABG) closure. Overall, postoperative ABG was 17.7+/-11.7 dB at postoperative 6 months and 19.7+/-14.3 dB at postoperative 1 year, compared with preoperative ABG of 37.9+/-9.3 dB. There was no statistical difference of ABG at postoperative 12 months, 24 months between MFA using incus (n=17) and HA (n=15)(p=0.300, and p=0.563). There was no meaningful difference of postoperative ABG between the patients with combined mastoidectomy (n=10) and those without mastoidecmoy (n=22)(p=0.555). No extrusions occurred. CONCLUSIONS: MFA can be an effective option in the case of absent incus expecting good postoperative hearing results.
Cholesteatoma ; Durapatite ; Hearing ; Humans ; Incus ; Malleus ; Ossicular Prosthesis ; Otitis Media ; Retrospective Studies ; Tertiary Care Centers

Cushing disease in children and adolescents, especially with multiple pituitary adenomas (MPAs), is very rare. We report 17-year-old boy with MPAs. He presented with a vertebral compression fracture, weight gain, short stature, headache, and hypertension. On magnetic resonance imaging (MRI), only a left pituitary microadenoma was found. After surgery, transient clinical improvement was observed but headache and hypertension were observed again after 3 months later. Follow-up MRI showed a newly developed right pituitary microadenoma 6 months after the surgery. The need for careful clinical and radiographic follow-up should be emphasized in the search for potential MPAs in patients with persistent Cushing disease.
Adolescent* ; Child ; Follow-Up Studies ; Fractures, Compression* ; Headache ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Male ; Pituitary ACTH Hypersecretion* ; Pituitary Neoplasms* ; Weight Gain