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Effect of Dexamethasone Combination With Gentamicin in Chemical Labyrinthectomy on Hearing Preservation in Patients With Meniere’s Disease

Yujin LEE ; Jeon Mi LEE ; Hyun Jin LEE ; Gina NA ; Sung Huhn KIM ; Seong Hoon BAE

Korean Journal of Otolaryngology - Head and Neck Surgery.2022;65(8):472-475. doi:10.3342/kjorl-hns.2022.00563

Chemical labyrinthectomy may be performed in patients with Meniere’s disease who have intractable vertigo that does not respond to drug. By using aminoglycosides, the surgical procedure ablates vestibular type 1 hair cells. However, the risk of hearing loss remains a main concern for clinicians because gentamicin ablates cochlear hair cells as well as vestibular hair cells. To deal with the concern for hearing loss, dexamethasone can be combined with gentamicin during chemical labyrinthectomy. Herein, we show that chemical labyrinthectomy using gentamicin combined with dexamethasone preserve hearing at high-frequency compared to the conventional method.

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Recurrent Submandibular Gland Swelling Relieved by Antihistamine Medication: Is It Eosinophilic Sialodochitis?

Do Hyung KIM ; Sang Eun LEE ; Kang Min HAN ; Bo Hae KIM

Korean Journal of Otolaryngology - Head and Neck Surgery.2022;65(8):467-471. doi:10.3342/kjorl-hns.2021.01074

Sialodochitis fibrinosa is a disease characterized by salivary duct obstruction. A 21-year-old male presented with a painful submandibular gland (SMG) swelling. Serum eosinophilia and Whartons’ duct dilatation with strong enhancement were observed on contrast CT. Core needle biopsy (CNB) for SMG parenchyma revealed lymphocytic infiltration between dilated intralobular ducts. In another case, a 39-year-old male complained of recurrent major salivary glands swelling for ten years with an itching sensation on the overlying skin of the salivary gland. Enhancement of both SMG parenchyma, dilatation of both Wharton’s ducts and elevated serum eosinophilia were observed on contrast CT study. CNB for SMG parenchyma revealed lymphocytic infiltration with many eosinophils around a markedly dilated interlobular duct. The recurrent SMG swelling in both cases were relieved by antihistamine medication, warranting suspicion that these cases might organ-specific eosinophilic disease. We dicuss these two cases with a literature review.

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A Case of Sensorineural Hearing Loss Caused by Neurosyphilis in Patient Who Is Treated by Anti-Interleukin 17A Monoclonal Antibody

Dong Gyu KIM ; Da Jung JUNG ; Min Ji OH ; Kyu-Yup LEE

Korean Journal of Otolaryngology - Head and Neck Surgery.2022;65(8):461-466. doi:10.3342/kjorl-hns.2021.01081

Syphilis is a sexually transmitted disease caused by Treponema pallidum, which can invade various organs. Syphilis can also cause otologic symptoms such as hearing impairment, tinnitus or dizziness and these otologic symptoms can occur at any stage of syphilis and can be associated with neurosyphilis. We report here a case of rapid progressive neurosyphilis showing hearing impairment in a patient with ankylosing spondylitis. He was treated with anti-interleukin 17A monoclonal antibody. Since syphilis is one of the causes of reversible sensorineural hearing loss and syphilis infection with immunosuppression can cause progressive hearing loss if patients in immunomodulatory therapy have sensorineural hearing loss, the possibility of syphilis should be considered.

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Vocal Fold Augmentation: Current Review

Choung-Soo KIM

Korean Journal of Otolaryngology - Head and Neck Surgery.2022;65(8):431-436. doi:10.3342/kjorl-hns.2022.00570

Glottic closure is essential for vocalization and airway protection. Several pathological conditions cause glottic insufficiency, such as vocal fold paralysis and presbylarynx, which is the age-related atrophy of laryngeal muscle. Injection laryngoplasty is common technique to treat glottic insufficiency, because it can be easily and inexpensively performed in an outpatient setting. Different injection material should be selected according to the purpose and patient condition before the procedure. Ideal material for injection laryngoplasty must be biocompatible, and the injected volume should be maintained for the desired duration without migration. Further, it will be better if it could be easily injected and removed. In this article, we reviewed the published research related to material for the injection laryngoplasty and tried to think about the limitations of current studies and the future direction of treatment.

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Comparison of the Effect of Dietary Restriction and Free Diet on Postoperative Bleeding After Tonsillectomy

Min Chul KO ; Hyung Joon CHO ; Jung Soo KIM ; Sung Jae HEO

Korean Journal of Otolaryngology - Head and Neck Surgery.2022;65(8):444-447. doi:10.3342/kjorl-hns.2022.00073

Background and Objectives: There have been several studies on the factors affecting posttonsillectomy bleeding; however, investigations on the relationship between postoperative bleeding and diet are insufficient. Different countries have different types of food, and while there have been studies on the effects of diet in other countries, no such studies have been reported in Korea. Therefore, we aimed to investigate the relationship between Korean diet and postoperative bleeding after tonsillectomy.Subjects and Method To compare the postoperative bleeding outcomes, patients who underwent tonsillectomy by a single surgeon between January 2017 and 2020 were divided into those who had a diet restriction after surgery and those who had a free diet. Postoperative bleeding outcomes were divided according to the degree of intervention for hemostasis and compared. Results: The study included 115 and 124 patients in the diet-restricted group and free-diet group, respectively. There were no statistical differences between the two groups in terms of gender, age, presence of snoring and frequent tonsillitis, and surgical method. Bleeding occurred in four patients in the diet-restricted group and three patients in the free-diet group. There was no statistical difference between the two groups in the frequency and severity of postoperative bleeding. Conclusion Since dietary restriction after tonsillectomy was not helpful to prevent postoperative bleeding, a free and sufficient diet after surgery may prove to be better.

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Risk Factors for Local Recurrence in Patients With N1b Papillary Thyroid Carcinoma

Jung Woo LEE ; Gab-Kyun LEE ; Ji Won JANG ; Yongil CHEON ; Sung-Chan SHIN ; Jin-Choon LEE ; Bo Hyun KIM ; In Ju KIM ; Choong Rak KIM ; Byung-Joo LEE

Korean Journal of Otolaryngology - Head and Neck Surgery.2022;65(8):448-456. doi:10.3342/kjorl-hns.2021.01004

Background and Objectives: Papillary thyroid carcinoma (PTC) with lateral neck lymph node metastasis is known as a major risk factor for tumor recurrence after surgical treatment. The aim of this study is to identify risk factors for loco-regional recurrence in patients with PTC with lateral neck lymph node metastasis, which has a high risk of recurrence.Subjects and Method This study involved 319 patients who underwent total thyroidectomy, central lymph node (LN) and lateral LN dissection due to PTC. The patients’ demographics and pathological factors, including lymph node metastasis were retrospectively reviewed. Univariate, multivariate and C-index with variable selection analyses were performed to identify factors associated with recurrence-free survival (RFS). Results: A mean follow-up of 101 months, 35 (10.9%) patients had a loco-regional recurrence. In multivariate analysis according to loco-regional recurrence, patients with a primary tumor of more than 4 cm, multifocality, vascular invasion, and bilateral lateral cervical metastasis were associated with worse RFS. In the variable selection analysis, lateral lymph node metastasis ratio was also statistically significant. Conclusion PTC with lateral neck lymph node metastasis included tumors larger than 4 cm. Multifocality, vascular invasion, high lateral lymph node metastasis ratio and bilateral neck lymph node metastasis are predictive factors of loco-regional recurrence, and these risk factors should be carefully followed-up after surgery.

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A Case of Tonsillectomy and Adenoidectomy in Child With Down Syndrome With Obstructive Sleep Apnea

Chang Bin YUN ; Ki Jong HYUN ; Hyunzu KIM ; Young Hyo KIM

Korean Journal of Otolaryngology - Head and Neck Surgery.2022;65(8):457-460. doi:10.3342/kjorl-hns.2021.01018

Children with obstructive sleep apnea (OSA) show symptoms such as snoring, sleep apnea, and oral breathing. The diagnosis of the disease can be made through polysomnography and as the most common causes are tonsillar and adenoid hypertrophy, tonsillectomy and adenoidectomy (T et A) are considered as initial treatment. OSA is an increasingly recognized problem in children with Down syndrome, who are more prone to facial hypoplasia, hypoplasia of the mandible, and have a large tongue. In OSA Down syndrome patients, T et A can be performed if tonsillar hypertrophy is present. However, because these patients have underlying diseases (atlatoaxial unstability, airway problem, heart problem, endocrine problem), general anesthesia may be difficult and cervical extension may be limited during the operation. We describe a case of 10-year-old child with Down syndrome and OSA, who underwent T et A under general anesthesia through multidisciplinary care.

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Expression of Toll-Like Receptor Messenger Ribonucleic Acid in the Distal Facial Nerve After Facial Nerve Injury

Hye Kyu MIN ; Jae Min LEE ; Jun Yang JUNG ; Young Il KIM ; Sang Hoon KIM ; Seung Geun YEO

Korean Journal of Otolaryngology - Head and Neck Surgery.2022;65(8):437-443. doi:10.3342/kjorl-hns.2021.00129

Background and Objectives: This study aimed to evaluate whether Toll-like receptors (TLRs) messenger ribonucleic acid (mRNA) were expressed in the facial nerve after incurring a crush or an injury of the facial nerve.Materials and Method An adult Sprague-Dawley underwent a crush or injury of the unilateral facial nerve. The crush or injury was incurred by a cutting at the midpoint between the facial nerve trunk and its branch. The whisker movement of vibrissae muscle was examined 4 and 14 days after injury. Real-time polymerase chain reaction was performed for the normal facial nerve taken from the left side and the damaged nerve taken from the right side. Results: On the 4th day of injury, the expression of TLR 9, 13 mRNA was significantly lower in the crush and injured groups than in the control group (p<0.05). On the 14th day of injury, the expression of TLR 2 mRNA was significantly higher in the injured group than in the control group (p<0.05). Conclusion The expressions of TLR 9, 13 mRNA in the distal facial nerve after injury in the crush and injured groups were significantly lower than that in the control group, but the expression of TLR 2 mRNA in the injured group was significantly higher. Therefore, TLRs may be involved in facial nerve damage and regeneration.

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Horizontal Dorsal Septal Incision for High Deviation Correction During Septoplasty

Cheol Hyo KU ; Eun Jung LEE ; Sang Man PARK ; Ha Neul LEE ; Hyun Su LEE ; Dong-Joon PARK

Korean Journal of Otolaryngology - Head and Neck Surgery.2022;65(7):419-422. doi:10.3342/kjorl-hns.2022.00367

When performing septoplasty in patients with a high deviation of the nasal septum, effective correction is difficult and postoperative complications such as a saddle nose may result if the bone or cartilage is removed inordinately. Although several surgical techniques have been introduced, some are difficult to apply easily. Furthermore, the deviation may persist despite the application of surgical techniques due to the rebound memory of the remaining cartilage. This study aimed to describe a simple and safe surgical technique for crooked nasal septa with a high deviation. This method using horizontal dorsal septal incision allows easy separation of the highly deviated portion from the upper lateral cartilage. Furthermore, it is less traumatic than other methods, and predictably preserves the keystone area.

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A Case of Laryngeal Amyloidosis: Role of US and US-CNB for Preoperative Diagnosis

Dongbin AHN ; Eun Jung OH ; Ji Hye KWAK ; Jin Ho SOHN

Korean Journal of Otolaryngology - Head and Neck Surgery.2022;65(7):414-418. doi:10.3342/kjorl-hns.2021.01137

Amyloidosis is a rare benign disease characterized by the extracellular deposition of nonsoluble fibrillar proteins (amyloids) within organs. Laryngeal amyloidosis (LA) accounts for only 9%-15% of all cases of amyloidosis. Since clinical manifestations and laryngoscopic findings often overlap with those of laryngeal cancer, it is challenging to differentiate LA from laryngeal cancer prior to surgical biopsy. We report a case of LA mimicking laryngeal cancer, in which the diagnosis was facilitated by preoperative ultrasonography (US) and US-guided core-needle biopsy (US-CNB) prior to surgical biopsy. The US findings of this case were distinguishable from those of laryngeal cancer, which enabled us to consider a diagnosis other than laryngeal cancer. Amyloidosis was diagnosed preoperatively using office-based percutaneous US-CNB, avoiding general anesthesia needed for suspension laryngoscopic examination. This case suggests that US and US-CNB could be used as supplementary diagnostic modalities to evaluate suspicious laryngeal masses mimicking laryngeal cancer.

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