Background: The Xpert MTB/RIF Ultra (Xpert Ultra) was introduced to enhance the sensitivity of tuberculosis detection, particularly in smear-negative cases, compared with its predecessor, Xpert MTB/RIF (Xpert). However, its performance in high-resource, intermediateburden settings remains unassessed. We prospectively compared the diagnostic accuracy of Xpert Ultra and Xpert for detecting Mycobacterium tuberculosis (MTB) and rifampin resistance in Korea. Methods: In total, 309 respiratory specimens were analyzed using both assays. We used two reference standards: mycobacterial culture and a composite reference standard based on clinical diagnosis and treatment decisions. Diagnostic performance, including sensitivity, specificity, and agreement between the two assays, was assessed. Spiking experiments using 13 MTB isolates with known rpoB mutations were performed to evaluate rifampin resistance detection. Results: Xpert Ultra showed increased, albeit not significantly, sensitivity (73.7% vs. 65.8% with culture; 63.8% vs. 53.2% with the composite reference standard) over Xpert. Its specificity was comparable to that of Xpert; however, a few false-positive results were observed among trace- and very low-positives. Among six culture-negative but Xpert Ultra-positive cases, two were clinically diagnosed as tuberculosis. Of the 13 rpoB mutant strains, Xpert correctly detected all mutations in the rifampin resistance-determining region, whereas Xpert Ultra yielded indeterminate results for Q432P and Q429H/L430P/H445Q. Conclusions Xpert Ultra tends to have increased sensitivity; however, it shows potential diagnostic ambiguity associated with trace- or very low-positive results. These findings highlight the importance of clinical correlation, particularly in culture-negative cases. Indeterminate results in certain rpoB mutations require cautious interpretation.

OBJECTIVES: The traditional canal wall down mastoidectomy (CWDM) procedure commonly has potential problems of altering the anatomy and physiology of the middle ear and mastoid. This study evaluated outcomes in patients who underwent modified canal wall down mastoidectomy (mCWDM) and mastoid obliteration using autologous materials. METHODS: Our study included 76 patients with chronic otitis media, cholesteatoma, and adhesive otitis who underwent mCWDM and mastoid obliteration using autologous materials between 2010 and 2015. Postoperative hearing air-bone gap and complications were evaluated. RESULTS: During the average follow-up of 64 months (range, 20 to 89 months), there was no recurrent or residual cholesteatoma or chronic otitis media. No patient had a cavity problem and anatomic integrity of the posterior canal wall was obtained. There was a significant improvement in hearing with respect to the postoperative air-bone gap (P<0.05). A retroauricular skin depression was a common complication of this technique. CONCLUSION: The present study suggests that our technique can prevent various complications of the classical CWDM technique using autologous tissues for mastoid cavity obliteration. It is also an appropriate method to obtain adequate volume for safe obliteration.
Adhesives ; Cartilage ; Cholesteatoma ; Depression ; Ear, Middle ; Follow-Up Studies ; Hearing ; Humans ; Mastoid ; Methods ; Otitis ; Otitis Media ; Physiology ; Skin

The optimal treatments of carcinoma in situ of glottis include radiotherapy, laser surgery and vertical partial laryngectomy. Conventional surgical treatments need general anesthesia and radiotherapy has several complications. Recently, the effectiveness of 532 nm potassium titanyl phosphate (KTP) laser has been proven and widely used in vocal fold diseases even some cases of vocal fold dysplasia. A patient with difficult laryngeal exposure underwent fiberoptic laryngeal laser surgery using KTP laser under local anesthesia, showed improved voice outcome and the glottic lesion was removed successfully without local recurrence and regional metastasis 18 months after surgery.
Anesthesia, General ; Anesthesia, Local ; Carcinoma in Situ ; Glottis ; Humans ; Laryngectomy ; Laser Therapy ; Lasers, Solid-State ; Neoplasm Metastasis ; Potassium ; Radiotherapy ; Recurrence ; Vocal Cords ; Voice

Female ; Humans ; Middle Aged ; Nasal Cavity ; Nasal Obstruction ; Parotid Gland ; Pathology ; Salivary Glands ; Turbinates

Multiple primary malignant neoplasms indicate an occurrence of two or more malignancies in a patient, and double primary cancers are the most common type. When the second primary cancer occurs simultaneously or within 6 months after the first primary cancer is diagnosed, it is called synchronous carcinoma. If the second primary cancer occurs after 6 months, it is defined as metachronous carcinoma. Recently, we experienced a patient who was diagnosed as double primary cancer in the nasopharynx and nasal cavity. The tumors occurred simultaneously and histopathological examinations revealed nasopharyngeal nonkeratinizing carcinoma in the right nasopharynx and extranodal NK/T-cell lymphoma in the left nasal cavity (inferior turbinate). In situ hybridization showed positivity for Epstein-Barr virus, which encoded early RNA in the neoplastic cells of both specimens. We present this rare disease entity with a review of the relevant literature and a survey of the clinical characteristics.
Herpesvirus 4, Human* ; Humans ; In Situ Hybridization ; Lymphoma ; Nasal Cavity* ; Nasopharynx* ; Neoplasms, Multiple Primary ; Neoplasms, Second Primary ; Rare Diseases ; RNA

BACKGROUND AND OBJECTIVES: Positional therapy is a therapeutic method for obstructive sleep apnea (OSA). However, little is known about the effectiveness of positional OSA treatment based on meta-analysis. Therefore, we undertook a review and meta-analysis of studies to assess the effect of positional therapy on OSA. SUBJECTS AND METHOD: We searched PubMed (Medline), OVID Medline, EMBASE, Cochrane Library, SCOPUS, KoreaMed, MedRIC, and KSI KISS using the key words “obstructive sleep apnea” and “positional therapy”. To estimate the effect of positional OSA therapy, we analyzed the ratio of means (ROM) for pre- and post-treatment polysomnographic data including apnea-hypopnea index (AHI), lowest oxygen saturation, arousal index, and sleep efficiency. RESULTS: Finally, twenty two studies from 21 papers were included in the meta-analysis. Positional therapy significantly decreased AHI by 54.1% [ROM, 0.459; 95% confidence interval (CI), 0.394 to 0.534] and increased lowest oxygen saturation by 3.3% (ROM, 1.033; 95% CI, 1.020 to 1.046). However, positional therapy did not significantly change arousal index (ROM, 0.846; 95% CI, 0.662 to 1.081) or sleep efficiency (ROM, 1.008; 95% CI, 0.990 to 1.027). CONCLUSION: Positional therapy significantly improves respiratory parameters including AHI and lowest oxygen saturation in patients with OSA.
Arousal ; Humans ; Methods ; Oxygen ; Polysomnography ; Sleep Apnea, Obstructive*

BACKGROUND AND OBJECTIVES: Altough tonsillectomy is one of the most common otolaryngological procedures, a highly reliable and effective method for reducing postoperative pain has yet to be identified. This study evaluated the efficacy of a non-steroidal anti-inflammatory drug (NSAID) mouthwash on postoperative pain in tonsillectomy patients. SUBJECTS AND METHOD: A total of 64 patients who underwent tonsillectomy were randomly assigned to one of two groups (32 patients each). One group received the NSAID mouthwash and the other a distilled water mouthwash. Postoperative pain in the two groups was compared by assessing pain severity 1-9 days postoperatively using a visual analog scale. RESULTS: Compared to the distilled water mouthwash group, patients using the NSAID mouthwash showed a statistically significant decrease in postoperative pain over the first 9 postoperative days. CONCLUSION: A NSAID mouthwash may be a simple and effective method for controlling post-tonsillectomy pain when administered in conjunction with routine medications.
Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Methods ; Mouthwashes ; Pain, Postoperative ; Tonsillectomy ; Visual Analog Scale ; Water

BACKGROUND AND OBJECTIVES: Pediatric obstructive sleep apnea (OSA) can have an effect on the quality of life (QOL) such as behavior, school performance, emotional distress and daytime function. We aim to verify changes in sleep disordered breathing based on polysomnographic findings and disease specific health related QOL before and after adenotonsillectomy in Korean children with OSA. SUBJECTS AND METHOD: A total 20 children aged 3 through 13 years old (mean age=6.7 years old and male/female=14/6) with OSA were included. We evaluated respiratory disturbances in patients using the standard polysomnography and the OSA-specific health related QOL based on Korean Obstructive Sleep Apnea-18 Survey (KOSA-18). RESULTS: There were significant improvements in apnea-hypopnea index (from 9.4±7.4 to 1.1±0.8 events/hour, p<0.001) and total score of KOSA-18 (71.3±26.0 to 33.6±10.7, p<0.001) after adenotonsillectomy. CONCLUSION: Sleep disordered breathing and QOL improve significantly after adenotonsillectomy in Korean OSA children.
Adenoidectomy ; Child ; Humans ; Methods ; Polysomnography ; Quality of Life* ; Sleep Apnea Syndromes* ; Sleep Apnea, Obstructive* ; Tonsillectomy

A Killian-Jamieson diverticulum (KJD) is an unfamillar and unusual cervical esophageal diverticulum. This diverticulum originates on the anterolateral aspect of the esophagus through the Killian-Jamieson's area that is formed between cricopharyngeal muscle and the lateral to longitudinal esophageal muscle. Recently, we experienced a patient who was found outpouching lesion on lateral side of left esophagus on the duodenoscopy. Then, a barium esophagography performed and in left lateral position demonstrated a left-sided diverticulum with a frontal projection, highly suggestive of a KJD. There are two ways of surgical approach to manage the KJD. First is external approach, another one is endoscopic approach. In common, external approach has been recommended for the treatment of KJD because of concern of nerve injury. We present a case of KJD that underwent external approach and sternocleidomastoid muscle flap in the management of KJD.
Barium ; Diverticulum* ; Diverticulum, Esophageal ; Duodenoscopy ; Esophagus* ; Humans

Lyme disease is a tick-borne zoonotic infectious disease caused by Borrelia burgdorferi. The present study assessed the infection status of B. burgdorferi among horses reared in Korea using ELISA and PCR. Between 2009 and 2013, blood samples were collected from 727 horses throughout Korea. Data for each animal including age, gender, breed, and region of sample collection were used for epidemiological analysis. Overall, 38 (5.2%; true prevalence: 5.5%) of 727 horses were seropositive by ELISA. There were statistically significant differences according to breed and region (P<0.001) whose differences might be attributed to the ecology of vector ticks and climate conditions. Using 2 nested PCR, none of the samples tested positive for B. burgdorferi. Thus, a positive ELISA result can indicate only that the tested horse was previously exposed to B. burgdorferi, with no certainty over the time of exposure. Since global warming is likely to increase the abundance of ticks in Korea, continuous monitoring of tick-borne diseases in Korean horses is needed.
Animals ; Antibodies, Bacterial/blood ; Borrelia burgdorferi/*physiology ; Enzyme-Linked Immunosorbent Assay/veterinary ; Female ; Horse Diseases/*epidemiology ; Horses ; Lyme Disease/epidemiology/*veterinary ; Male ; Republic of Korea/epidemiology