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Zygomatic Mastoiditis with Extracranial Complications: An Extremely Rare Cause of Cheek Swelling

Woongsang SUNWOO ; Dong Woo NAM ; Young Ho KIM

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(2):110-113. doi:10.3342/kjorl-hns.2016.16796

Zygomatic mastoiditis is an extremely rare cause of an inflamed, swollen cheek. We encountered a 10-year-old girl with left preauricular swelling, pain, and mild trismus. Temporal bone computed tomography revealed a zygomatic root abscess with bone defects and a scanty amount of soft tissue lesion in Prussak's space. After antibiotic therapy for 2 weeks, her pain subsided, but the swelling persisted. All inflamed air cells, including the lesion in the zygomatic root, were eradicated. The swelling subsided after the surgery. The patient has not experienced any postoperative complications or shown any evidence of relapse for more than 1 year.

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Intramuscular Hemangioma of the Sternocleidomastoid Muscle: An Unusual Neck Mass

Jeong Rok KIM ; Su Jong KIM ; Byungjin KANG ; Jeong Soo WOO

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(2):106-109. doi:10.3342/kjorl-hns.2016.17097

Hemangiomas are the most common benign tumors in infancy, occurring most often on cutaneous and mucosal surfaces. Although less than 1% of hemangiomas occur in skeletal muscle, 15% of intramuscular hemangiomas arise in the head and neck musculature. Less than 10 cases of the sternocleidomastoid muscle have been reported in the English literatures. The masseter muscle is most commonly involved in the head and neck. Clinically, these tumors are present as distinct, localized, rubbery swelling. Neck computed tomography scan with enhancement may suggest a vascular mass within the muscle while angiography may detect feeding arteries in large intramuscular hemangiomas. The treatment of the hemangiomas is based on location, accessibility, depth of invasion, age, and cosmetic considerations. The optimal treatment is complete wide resection including the cuff of surrounding muscle. We report a case of hemangioma that occurred in the sternocleidomastoid muscle along with a with literature review.

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A Case of Mammary-Type Myofibroblastoma of the Tongue

Jin Su PARK ; Yong Woo LEE ; Sang Hyuk LEE ; Sung Min JIN

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(2):103-105. doi:10.3342/kjorl-hns.2016.16866

A mammary-type myofibroblastoma is a rare benign mesenchymal neoplasm composed of spindle cells initially described to occur in the breast. However, they also arise at extra-mammary sites including the inguinal area, breast, chest wall/axilla, trunk, upper and lower extremities, and head and neck regions. In particular, mammary-type myofibroblastoma of the head and neck are extremely rare and may occur at any age. Immunohistochemically, it is typically CD34 and desmin positive. Currently, complete excision is considered as the first line treatment and recurrence of the tumor is rare. We experienced a 41-year-old man who visited with 1 cm sized firm mass of the tongue. The mass was resected and tissue biopsy revealed a diagnosis of mammary-type myofibroblastoma. Herein we report a rare case of mammary-type myofibroblastoma of the tongue with a review of the literature.

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Diagnosis and Treatment of Peritonsillar Abscess with Single Enhanced Computed Tomography

Kudamo SONG ; Jun LEE ; So Young CHOI ; Myoung Su CHOI

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(2):99-102. doi:10.3342/kjorl-hns.2017.01025

BACKGROUND AND OBJECTIVES: Diagnostic features of peritonsillar abscess are an asymmetrically enlarged palatine tonsil with peripheral rim enhancement and central low density in the post-contrast computed tomography (CT). Although it is necessary to differentiate tumorous conditions of tonsils to compare pre- and post-contrast CT, pre-contrast CT may be less useful in the diagnosis of peritonsillar abscess. This study aims to evaluate of the efficacy of single post-contrast CT for diagnosis and treatment of peritonsillar abscess.SUBJECTS AND METHOD: We retrospectively compared 29 patients with peritonsillar abscess, who were diagnosed by single post-contrast CT, with 36 patients diagnosed by pre- and post-contrast CT to determine the success rates of pus drainage and hospital days. Additionally, two otorhinolaryngologists made a judgment of abscess presence for sixty randomly mixed CT images of peritonsillar abscess or tonsillitis with pre- and post-contrast CT or single post-contrast CT. RESULTS: There were no significant differences in the success rate of drainage (p=0.622) and hospital days (p=0.504) between groups with/without pre-contrast CT. Abscess presence was judged by raters with/without pre-contrast CT. Inter-rater agreement value (Cohen's kappa) was 0.825 (p<0.01). CONCLUSION Single post-contrast CT of peritonsillar abscess may be a good alternative for diagnosis and treatment and may reduce unnecessary exposure to radiation.

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Characteristics and Outcomes of Septoplasty in Patients with Paradoxical Nasal Obstruction

Yeon Jun YANG ; Young Hwan KIM ; Hong Geun KIM ; Dong Jun LEE ; Ji Hun MO ; Young Jun CHUNG

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(2):91-98. doi:10.3342/kjorl-hns.2017.00626

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate clinical characteristics and outcome of septoplasty in patients complaining of paradoxical nasal obstruction.SUBJECTS AND METHOD: Medical records of 637 patients who underwent septoplasty from 2011 to 2016 were reviewed retrospectively. One hundred sixty-nine patients whose follow up periods were longer than 3 months were included. These patients were categorized into two groups, the experimental group (paradoxical nasal obstruction) and the control group. We analyzed the degree of nasal obstruction, the sino-nasal outcome test (SNOT)-22 score, which is the sino-nasal outcome, and the minimal cross-sectional area in acoustic rhinometry. The effect of concurrent turbinoplasty was also evaluated. RESULTS: Paradoxical nasal obstruction was found in 19 patients (11.2%). Compared to the control group, the degree of mucosal change (both concave and convex side) had no statistical significance. Although the degree of nasal obstruction and SNOT-22 scores were significantly improved after surgery in both groups (p<0.05), the values for the experimental group were slightly increased at 3 months of surgery after having been improved at one month of surgery. In contrast, those values improved steadily over time in the control group. The tendency of psychologic domain scores was significantly different between the two groups (p=0.021). The results of volume reductive turbinoplasty showed that it maintained the improved symptoms better when performed along with septoplasty. CONCLUSION Although septoplasty showed beneficial effects in patients with paradoxical nasal obstruction, the effect of septoplasty decreased over time. Concurrent volume reductive turbinate surgery maintained the effect of septoplasty in paradoxical nasal obstruction.

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Patients' Characteristics according to Allergic Sensitization in Chronic Rhinitis

Chung Man SUNG ; Hyung Chae YANG ; Hyong Ho CHO

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(2):85-90. doi:10.3342/kjorl-hns.2017.00388

BACKGROUND AND OBJECTIVES: Chronic rhinitis is divided into allergic rhinitis (AR) and nonallergic rhinitis (NAR), both of which have similar symptoms but differ in treatment approaches. For the diagnosis of AR, allergen-specific immunoglobulin E (IgE) tests along with characteristic symptoms are required. However, these tests are costly and not always practicable. The purpose of this study was to investigate how symptoms respond differently to different allergen sensitization or sensitized allergen.SUBJECTS AND METHOD: We retrospectively reviewed 1661 patients who underwent multiple allergen simultaneous test (MAST) for chronic rhinitis symptoms. The total nasal symptom (TNS) scores of these patients from 2006 to 2014 were assessed for rhinorrhea, nasal obstruction, itching, and sneezing. Patients were classified as AR and NAR according to the results of MAST and their association with symptoms. RESULTS: There were 1021 patients designated to the AR group and 640 patients to the NAR. The AR group had lower age, higher TNS, and higher serum IgE levels than the NAR group. In addition, sneezing and itching were more common in the AR group. Furthermore, sneezing was a positive predictor for seasonal allergen sensitization. On the other hand, itching was a positive predictor for perennial allergen sensitization. CONCLUSION AR and NAR patients showed different demographic characteristics and symptoms. These results may be helpful in classifying and treating patients with chronic rhinitis, especially when the allergen specific IgE test cannot be performed.

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Clinical Feasibility of Suppression Head Impulse Test in Vestibulopathy Patients

Yun Jin KANG ; Beom Cho JUN ; Ye Sun CHO ; Ji Hyung LIM ; Do Yeon KIM

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(2):76-84. doi:10.3342/kjorl-hns.2017.00353

BACKGROUND AND OBJECTIVES: The suppression head impulse (SHIMP) test has emerged as one of the new vestibular function tests. The SHIMP test is an analysis of anti-compensatory saccadic movements in gazing moving targets as the head moves. In this study, we investigated the accuracy and sensitivity of the test.SUBJECTS AND METHOD: We analyzed the results of SHIMP test (gain, amplitude, and latency) in 24 cases, which included normal, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), Meniere's disease, bilateral vestibular function loss, temporal bone fracture, tuberculosis meningitis and acoustic schwannoma patients. We also carried out a physical exam, audiologic study, video electronystagmography (vENG) and a conventional video head impulse test to evaluate the feasibility of SHIMP test in cases of vesitibulopathy. RESULTS: In patients with vestibulopathy, the analysis of SHIMP test indicated high sensitivity and accuracy, which were supported by accompanying audio-vestibular studies. Patients suspected with BPPV, vestibular neuronitis and Meniere's disease showed low vestibulo ocular reflex (VOR) gain and delayed anticompensatory saccade with smaller and more scattered amplitudes than the control. Patients with bilateral vestibular function loss, temporal bone fracture, tuberculosis meningitis, and acoustic schwannoma showed delayed latency, and small amplitude or few anticompensatory saccades. Finally, changes in the SHIMP test values might be a hint that patients had recovered from vestibular neuronitis and tuberculosis meningitis. CONCLUSION We found the feasibility of SHIMP test in detecting the pathologic condition of VOR in vestibulopathy patients. We argue that the usefulness of SHIMP test might be extended to evaluating the effectiveness of rehabilitation.

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Current Developments and Challenge of Implantable Bone Conduction Hearing Aids

Saea KIM ; Woojae HAN

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(2):67-75. doi:10.3342/kjorl-hns.2017.00864

It is acknowledged that implantable bone conduction hearing aids such as a bone anchored hearing aid provide benefit and satisfaction to patients with unilateral hearing loss in terms of sound localization and speech perception under noise circumstances. This review paper introduces current models of the implantable bone conduction hearing aids, their candidacy, brief surgical procedures, and general audiological examinations. A table summary was used for nine published research papers which have very similar results by three points, i.e., no change in ability of sound localization, better performance of Hearing-In-Noise Test, and improved satisfaction of sound quality using questionnaires after the implantation. Unfortunately, systematic fitting strategy for users of the implantable bone conduction hearing aids has not been either studied or developed yet. Futhermore, there is no scientific based approach of reason why the implantation has no benefit in sound localization but still provides better performance for speech perception in noise. In conclusion, specific and effective fitting strategy of the current implantable bone conduction hearing aids should be developed and also support effect of the implantation with sensitivity and specificity for both clinicians and patients while accompanying their advanced technology.

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A Case of Periorbital Necrotizing Fasciitis Occurred in Patient with Fungal Sinusitis

Dong Hwan KIM ; Min Song KIM ; Han Seok YOO ; Jin Hyeok JEONG

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(1):56-60. doi:10.3342/kjorl-hns.2016.17181

Orbital complications due to sinusitis usually occur in children and spread from the ethmoid or frontal sinusitis. Periorbital necrotizing fasciitis, which is an aggressive infection characterized by extensive necrosis and gas formation in the fascia and subcutaneous tissue, is uncommon as an orbital complication due to sinusitis. Because most of orbital complications of the fungal sinusitis occur from invasive fungal infection in immunocompromised patients, orbital complications due to non-invasive maxillary fungal ball in healthy patients are extremely rare, especially if the complication is periorbital necrotizing fasciitis. We report a case of periorbital necrotizing fasciitis that occurred in a healthy 44-year-old male patient with non-invasive fungal sinusitis, which was treated with a combination of intravenous antibiotics and endoscopic sinus surgery and ophthalmologic surgical treatment.

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Angioleiomyoma Originating from the Auricle

Ji Hwan PARK ; Soo Keun KONG ; Eui Kyung GOH ; Se Joon OH

Korean Journal of Otolaryngology - Head and Neck Surgery.2018;61(1):52-55. doi:10.3342/kjorl-hns.2016.16859

Angioleiomyoma is a benign tumor which arises from vascular smooth muscle. It originates primarily in the upper and lower extremities, but several isolated cases have been described. Although angioleiomyoma has a benign nature, there is a potential risk of malignant change and recurrence in case of incomplete resection. We acknowledge that venous type angioleiomyoma on the posterior surface of auricle has not been reported in the Korean literature. We report a rare case of 49-year-old male who had angioleiomyoma originating from the auricle along with a literature review.

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