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Gossypiboma of the Neck Mimicking an Isolated Neck Recurrence.

Kyu Jin KIM ; Jae Yol LIM ; Jeong Seok CHOI ; Young Mo KIM

Clinical and Experimental Otorhinolaryngology.2013;6(4):269-271.

A gossypiboma (also called textiloma or retained surgical sponge) of the neck is rarely reported compared to intraabdominal or intrathoracic gossypibomas and also can be misdiagnosed as metastatic lymph nodes. A patient was referred to our clinic for a supraclavicular neck mass 6 months after thyroidectomy and neck dissection for papillary thyroid carcinoma in another hospital. It was initially considered an isolated neck recurrence, but it was finally diagnosed as gossypiboma by a pathological examination of the surgically-excised specimen. Characteristic findings of computed tomography or positron emission tomography/computed tomography might be helpful to differentiate the gossypiboma from malignant neck mass or other inflammatory conditions. It is essential for clinicians to be aware of this disease entity in differential diagnosis of neck recurrence because a gossypiboma in the neck can be misinterpreted as a malignancy to induce unwarranted radical surgery.
Carcinoma ; Diagnosis, Differential ; Electrons ; Humans ; Lymph Nodes ; Neck Dissection ; Neck* ; Recurrence* ; Surgical Sponges ; Thyroid Neoplasms ; Thyroidectomy

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Juvenile Paget's Disease with Paranasal Sinus Aplasia.

Ki Beom BAE ; Jae Hwan KWON ; Young Ho KIM ; Tae Young JUNG ; Joong Hwan CHO

Clinical and Experimental Otorhinolaryngology.2008;1(4):224-226.

Juvenile Paget's disease (JPD) is a rare skeletal disorder that's characterized by bone demineralization and elevated levels of serum alkaline phosphatase. JPD involves the paranasal sinuses in extremely rare cases. We report here on a 25-month-old Asian male who was diagnosed of JPD associated with aplasia of the paranasal sinuses, but not the ethmoid sinuses. The patient was successfully treated by surgery and we undertook no medical intervention. This appears to be the first reported case of JPD associated with bilateral paranasal sinus aplasia.
Alkaline Phosphatase ; Asian Continental Ancestry Group ; Ethmoid Sinus ; Humans ; Male ; Osteitis Deformans ; Paranasal Sinus Neoplasms ; Paranasal Sinuses ; Preschool Child

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Massive Concha Bullosa with Secondary Maxillary Sinusitis.

Joong Seob LEE ; Il Ju KO ; Han Dong KANG ; Hun Suk LEE

Clinical and Experimental Otorhinolaryngology.2008;1(4):221-223.

Concha bullosa is a common anatomic variation of the middle turbinate; however, sinusitis secondary to the concha bullosa is rare. A 52-yr-old woman presented with nasal obstruction and posterior nasal drip. Computed tomography and examination of the nasal cavity revealed septal deviation on the left side, and a massive concha bullosa and maxillary sinusitis on the right side. The lateral lamella of the affected turbinate was removed and the inspissated material was drained. Histopathologic examination of the excised lesion in the concha bullosa revealed bacterial colonies in the mucus plug. We report here on a massive concha bullosa with secondary maxillary sinusitis.
Anatomic Variation ; Female ; Humans ; Maxillary Sinus ; Maxillary Sinusitis ; Mucus ; Nasal Cavity ; Nasal Obstruction ; Sinusitis ; Turbinates

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Moderately Differentiated Neuroendocrine Carcinoma of the Larynx.

Eun Jae CHUNG ; Seung Kuk BAEK ; Soon Young KWON ; Jung Soo WOO ; Kwang Yoon JUNG

Clinical and Experimental Otorhinolaryngology.2008;1(4):217-220.

Neuroendocrine neoplasm of the larynx is a morphologically heterogeneous group of tumors. This unusual neoplasm includes the four different type of tumors. Paraganglioma is the best-known neural origin tumor. The epithelial origin tumor is further divided based on the degree of differentiation into well, moderately, and poorly differentiated carcinoma. The diverse biological behavior of neuroendocrine neoplasm of larynx makes an accurate diagnosis of paramount importance, since treatment depends on diagnostic accuracy. The diagnosis is based primarily on light microscopy, and immunohistochemical and/or ultrastructural investigations are needed to diagnose correctly. The mainstay of treatment of moderately differentiated neuroendocrine carcinoma of the larynx is surgery. Elective neck treatment should be performed considering the high likelihood of cervical lymph node metastases. The 5-yr survival rate approximates 50%, and 10-yr survival rate is only 30%.
Carcinoma, Neuroendocrine ; Larynx ; Light ; Lymph Nodes ; Microscopy ; Neck ; Neoplasm Metastasis ; Paraganglioma ; Survival Rate

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Early Sensorineural Hearing Loss in Ob/Ob Mouse, an Animal Model of Type 2 Diabetes.

Hyun Seok LEE ; Ki Ryung KIM ; Won Ho CHUNG ; Yang Sun CHO ; Sung Hwa HONG

Clinical and Experimental Otorhinolaryngology.2008;1(4):211-216.

OBJECTIVES: There have been many studies on the relationship between diabetes mellitus and presbycusis. Microangiopathy and neuropathy that's caused by chronic hyperglycemia may lead to damage to the inner ear. Several clinical studies on humans and animal studies have been performed to investigate the association between diabetes and hearing loss, however, this relationship is still a matter of debate. We investigated the association of diabetes and sensorineural hearing loss in an animal model of type-2 diabetes and obesity (the ob/ob mouse [OM]). METHODS: The auditory brainstem response (ABR) thresholds were obtained in the OM and the wild type mice (C57BL/6J mice) up to 25 weeks after birth. After the animals were sacrificed, their cochleae were retrieved and then subjected to histopathologic observations. RESULTS: The OM exhibited significantly elevated ABR thresholds at 21 weeks of age, yet the C57BL/6J mice exhibited no significant change until 25 weeks of age. On the histological findings, outer hair cell degeneration and loss of spiral ganglion cells were observed in the middle and basal turns of the OM. On the contrary, no degenerative change was observed until 25 weeks of age in the C57BL/6J mice. CONCLUSION: This study suggests that chronic hyperglycemia and obesity may lead to early sensorineural hearing loss.
Animals ; Cochlea ; Diabetes Mellitus ; Ear, Inner ; Evoked Potentials, Auditory, Brain Stem ; Hair ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Hyperglycemia ; Mice ; Mice, Obese ; Models, Animal ; Obesity ; Parturition ; Presbycusis ; Spiral Ganglion

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Ki67 Antigen as a Predictive Factor for Prognosis of Sinonasal Mucosal Melanoma.

Dong Kyu KIM ; Dae Woo KIM ; Si Whan KIM ; Dong Young KIM ; Chul Hee LEE ; Chae Seo RHEE

Clinical and Experimental Otorhinolaryngology.2008;1(4):206-210.

OBJECTIVES: Sinonasal mucosal melanoma is a rare and aggressive disease. The aim of this study was to analyze the clinical features of patients with sinonasal mucosal melanoma and to determine the role of Ki67 antigen as a predictor of prognosis in sinonasal mucosal melanoma. METHODS: This was a retrospective case- series study at a single institution, an academic tertiary referral center. From 1995 to 2007, 27 patients with sinonasal mucosal melanoma were reviewed retrospectively, and the expression of Ki67 antigen was assessed by immunohistochemistry. RESULTS: The overall 5-yr survival rate was 33.9%. No significant differences were observed in 5-yr survival according to age, sex, stage, or the presence of melanin. The rates of local failure, regional failure, and distant failure were 37.0%, 14.8%, and 11.1%, respectively. Patients with spindle or mixed cell types had better prognoses than those with other cell types. At a cut-off value of 35%, patients with lower Ki67 scores showed better survival than those with higher Ki67 scores. CONCLUSION: The presence of spindle or mixed cell types may indicate a better prognosis than other cell types. Ki67 immunostaining may be a useful predictor of prognosis in patients with mucosal malignant melanoma of the sinonasal tract.
Humans ; Immunohistochemistry ; Melanins ; Melanoma ; Nasal Cavity ; Paranasal Sinuses ; Prognosis ; Retrospective Studies ; Survival Rate ; Tertiary Care Centers

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Management for the Children with Otitis Media with Effusion in the Tertiary Hospital.

Yun Hoon CHOUNG ; You Ree SHIN ; Seong Jun CHOI ; Keehyun PARK ; Hun Yi PARK ; Jong Bin LEE ; Dong Hee HAN ; Hison KAHNG

Clinical and Experimental Otorhinolaryngology.2008;1(4):201-205.

OBJECTIVES: Recently, new evidence-based recommendations have been introduced for diagnosing and managing otitis media with effusion (OME) in children. However, there are some difficulties to follow the general guidelines in the tertiary hospitals. The purpose is to evaluate the efficiency of antibiotics or antihistamines for treatment of children with OME in the tertiary hospital with a randomized prospective clinical study. METHODS: Eighty-four children with OME who had been diagnosed in the tertiary hospital were randomized to receive 5 different medications for 2 weeks. We prescribed antibiotics (amoxicillin-clavulanate syrup) in Group I (n=16), antibiotics/steroids (prednisolone) in Group II (n=18), antibiotics/antihistamines (ebastine) in Group III (n=15), antibiotics/steroids/antihistamines in Group IV (n=17), and mucolytics (ivy leaf extract) in Group V (n=17) for control. We followed-up children every 2 weeks and evaluated the state of OME at 3 months. RESULTS: Thirty six (42.9%) of 84 children were resolved within average 6.9 weeks after the treatments. Thirty-six (42.9%) were treated with ventilation tube insertion and 12 patients (14.3%) were observed. There was no difference in the resolution rates of OME among the five different protocols (P>0.05). There was no difference in the resolution rates among groups who used steroids, antihistamines, steroids and antihistamines, or other medications to manage 42 children with allergies (P>0.05). CONCLUSION: In the tertiary hospital, the cure rate of children with OME was not as high as well-known, and antibiotics or anti-allergic medications were not more effective than control. We may, therefore, need any other guidelines which are different from the previous evidence-based recommendations, including early operation in the tertiary hospitals.
Anti-Bacterial Agents ; Child ; Expectorants ; Histamine Antagonists ; Humans ; Hypersensitivity ; Otitis ; Otitis Media ; Otitis Media with Effusion ; Prospective Studies ; Steroids ; Tertiary Care Centers ; Ventilation

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Clinical Characteristics of Allergic Rhinitis According to Allergic Rhinitis and Its Impact on Asthma Guidelines.

Chul Hee LEE ; Jeong Hun JANG ; Hyun Jong LEE ; Ic Tae KIM ; Mu Jin CHU ; Chun Dong KIM ; Yu Sung WON ; Jeong Whun KIM

Clinical and Experimental Otorhinolaryngology.2008;1(4):196-200.

OBJECTIVES: The Allergic rhinitis and its impact on asthma (ARIA) guidelines were suggested for use to classify allergic rhinitis (AR). However, few studies have been performed in Asians. The objective of this study is to identify the clinical characteristics of AR in Korean patients according to the ARIA guidelines. METHODS: For the study, 610 patients who had been diagnosed with allergic rhinitis at Seoul National University Bundang Hospital and 545 patients who had been diagnosed with allergic rhinitis at 3 local clinics were included. All the patients were categorized into 4 groups, such as the mild intermittent, mild persistent, moderate-severe intermittent and moderate-severe persistent groups. The patients were given a questionnaire on allergic rhinitis-related symptoms and they underwent blood tests, including the blood eosinophil count and the serum total IgE level. RESULTS: The most prevalent type was the moderate-severe persistent group (34.7%), and the moderate-severe intermittent group (17.1%) was the rarest. There were significant differences among the 4 groups for olfaction (P<0.001), self-awareness of rhinitis (P=0.013), a previous history of AR (P<0.001), self-awareness of asthma (P=0.001) and allergic conjunctivitis (P<0.001). On the allergy laboratory tests, there was a significant difference between the groups for the eosinophi count (P=0.004). The number of blood eosinophil was more in the persistent groups than in the intermittent groups. CONCLUSION: According to the ARIA guidelines, the moderate-severe persistent group was the most prevalent for Korean patients. Blood eosinophilia and olfactory dysfunction were the most severe in the moderate-severe persistent group.
Asian Continental Ancestry Group ; Asthma ; Conjunctivitis, Allergic ; Eosinophilia ; Eosinophils ; Hematologic Tests ; Humans ; Hypersensitivity ; Immunoglobulin E ; Rhinitis ; Rhinitis, Allergic, Perennial ; Smell ; Surveys and Questionnaires

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Toll-like Receptors 2 and 4 and Their Mutations in Patients with Otitis Media and Middle Ear Effusion.

Young Chan LEE ; Chul KIM ; Ju Sup SHIM ; Jae Yong BYUN ; Mun Suh PARK ; Chang Il CHA ; Young Il KIM ; Jin Woo LEE ; Seung Geun YEO

Clinical and Experimental Otorhinolaryngology.2008;1(4):189-195.

OBJECTIVES: Toll-like receptors (TLRs) detect microbial infections and they can directly induce innate host defense responses. TLR 2 has been shown to be primarily involved in the recognition of peptidoglycans and lipoteichoic acid of gram positive bacteria. TLR 4 recognizes lipopolysaccharides and lipoteichoic acids from both gram-negative and gram-positive bacteria. Both mutations lead a reduced capacity to elicit inflammation and they increase the risk for gram-positive and negative infections. This study was performed to investigate the expressions of TLR 2 and 4 and their mutations in patients suffering with otitis media and middle ear effusion. METHODS: Middle ear fluid samples were collected from 40 otitis media effusion (OME) patients who had ventilating tubesinserted. Bacteria in the effusion fluid were detected by standard bacterial culture. The secreted IgG, IgA and IgM were measured by Enzyme-linked immunosorbent assay. TLR 2 and 4 were assessed by performing RT-PCR. The genomic DNA from each patient was isolated from the middle ear fluid samples that were collected from 60 OME patients, and the presence of mutations was determined by performing restriction digestion and DNA sequencing analysis. RESULTS: Among the 40 middle ear fluid samples, bacteria were detected in 13 middle ear fluid samples. The amounts of IgM, IgA, and IgG were 151.20+/-60.94 ng/mL, 21.59+/-7.96 ng/mL and 11.55+/-16.98 ng/mL, respectively. TLR 2 and 4 were expressed in the middle ear fluid and the expression of TLR 2 was higher than that of TLR 4. However, there was no correlation between the expressions of TLR 2 and 4, and the concentration of immunoglobulin or the presence of bacteria (P>0.05). There ware no mutations of TLR 2 (Arg753Gln, Arg677Trp) and TLR 4 (Asp299Gly, Thr399Ile). CONCLUSION: TLR 2 and 4 were expressed in all the middle ear fluid samples of OME, but the mutations of TLR 2 and 4 were not detected. TLR 2 and 4 may play a vital role in the immunological responses of patients with OME.
Bacteria ; Digestion ; DNA ; Ear, Middle ; Enzyme-Linked Immunosorbent Assay ; Gram-Positive Bacteria ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Inflammation ; Lipopolysaccharides ; Otitis ; Otitis Media ; Otitis Media with Effusion ; Peptidoglycan ; Sequence Analysis, DNA ; Stress, Psychological ; Teichoic Acids ; Toll-Like Receptors

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Clinical Comparison of the Auditory Steady-State Response with the Click Auditory Brainstem Response in Infants.

Hyo Sook LEE ; Joong Ho AHN ; Jong Woo CHUNG ; Tae Hyun YOON ; Kwang Sun LEE

Clinical and Experimental Otorhinolaryngology.2008;1(4):184-188.

OBJECTIVES: Our goal was to determine the effectiveness of using the auditory steady state response (ASSR) as a measure of hearing thresholds in infants who are suspected of having significant hearing loss, as compared with using the click-auditory brainstem response (C-ABR). METHODS: We retrospectively analyzed the audiologic profiles of 76 infants (46 boys and 30 girls, a total of 151 ears) who ranged in age from 1 to 12 months (average age: 5.7 months). The auditory evaluations in 76 infants who were suspected of having hearing loss were done via the C-ABR and ASSR. In addition, for reference, the mean ASSR thresholds were compared to those of 39 ears of infants and 39 ears of adults with normal hearing at 0.5, 1, 2, and 4 kHz. RESULTS: The highest correlation between the C-ABR and ASSR thresholds was observed at an average of 2-4 kHz (r=0.94). On comparison between the hearing of infants and adults at 0.5, 1, 2, and 4 kHz, the mean ASSR threshold in infants was 12, 7, 8, and 7 dB higher, respectively, than that in adults. CONCLUSION: ASSR testing may provide additional audiometric information for accurately predicting the hearing sensitivity, and this is essential for the management of infants with severe to profound hearing loss.
Adult ; Auditory Threshold ; Brain Stem ; Ear ; Evoked Potentials, Auditory, Brain Stem ; Hearing ; Hearing Loss ; Humans ; Infant ; Retrospective Studies

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