OBJECTIVES: The purpose of this study was to assess the effectiveness of human papillomavirus (HPV) vaccination administered to adolescent girls through Korea’s National Immunization Program. METHODS: This retrospective cohort study included patients who were 12-13 years old, whether vaccinated or unvaccinated, between July 2016 and December 2017. The incidence of genital warts (GWs) was monitored through 2021. Time-stratified hazard ratios (HRs) were estimated, adjusting for birth year, socioeconomic status, and the level of urbanization of the region, and were presented with 95% confidence intervals (CIs). Data were sourced from the Immunization Registry Integration System, linked with the National Health Information Database. RESULTS: The study included 332,062 adolescent girls, with an average follow-up period of approximately 4.6 years. Except for the first year, the HRs for the vaccinated group were lower than those for the unvaccinated group. The HRs for specific cut-off years were as follows: year 2, 0.62 (95% CI, 0.31 to 1.13); year 3, 0.58 (95% CI, 0.35 to 0.96); and year 4 and beyond, 0.39 (95% CI, 0.28 to 0.52). CONCLUSIONS Our findings indicate that HPV vaccination was associated with a reduction in the risk of GWs among adolescent girls. Notably, this reduction became significant as the incidence of GWs increased with age.

The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.

Background and Objectives: Snoring is the most common symptom of obstructive sleep apnea (OSA) and is caused by turbulent airflow due to narrowing of the upper airways. In patients with positional OSA, a change in sleep posture from supine to lateral is known to reduce snoring and sleep apnea. This study was performed to compare changes in snoring sound intensity and formant frequencies according to sleep position.Subjects and Method A total of 19 patients (male: 18; female: 1) diagnosed with positional OSA by polysomnography (PSG) were enrolled in this study. The snoring sounds recorded during PSG were analyzed acoustically and compared according to sleep position (i.e., supine vs. lateral). Results: Snoring disappeared on changing sleep position in five patients, all of whom had Apnea-Hypopnea Index (AHI) <15. In other patients, the snoring sounds tended to decrease with posture change, and the degree of decrease was inversely proportional to AHI (p=0.015) and respiratory disturbance index (RDI) (p=0.013). Formant frequencies 1, 3, and 4 (F1, F3, and F4, respectively) decreased when sleeping in the lateral position (p=0.02, 0.03, and 0.01, respectively). Conclusion In patients with positional OSA, a change in sleep posture from supine to lateral during sleep reduced the intensity and frequency of snoring sound.

Background and Objectives: The purpose of this study was to investigate the effect of unvoiced segments on the cepstral analysis in patients with vocal cord paralysis (VCP).Subjects and Method A total 302 subjects (173 subjects with VCP and 129 normal voice subjects) participated in this study. The sustained vowel /a/ 2 seconds and one sentence of ‘Sanchaek’ were edited, and analyzed by Praat script. The cepstral analyses were performed using sustained vowel (SV), continuous speech (CS), and extracted continuous speech (EXT) samples. The auditory-perceptual (AP) rating was also completed by three raters. Results: First, there were significant differences in all variables except low-to high spectral ratio(L/H ratio)_EXT between two groups. Second, cepstral peak prominence (CPP), smoothed cepstral peak prominence (CPPS), and L/H ratio showed significant differences in SV, CS, and EXT samples. Third, cepstral measurements were highly correlated with the AP ratings. Finally, the level of discrimination of dysphonia estimated from CPP and CPPS gotten from SV and CS values was more than area under the curve (AUC) of 0.941. AUC of 0.880 or more was also found in EXT. Conclusion In this study, we confirmed that both CS and EXT are highly predictive of pathologic speeches. Further study will also need to be validated for a more diverse group of voice disorders.

BACKGROUND AND OBJECTIVES: Adenotonsillectomy is a commonly performed surgical procedure carried out by otolaryngologists for children. Anatomical changes to the vocal tract occur after the surgery and may alter the patient's voice. This study evaluated the effects of adenotonsillectomy on the voice in Korean children.SUBJECTS AND METHOD: total of 20 children who underwent adenotonsillectomy were enrolled. The speech of patients was recorded before and at one month of the surgery and acoustic features, especially the formant frequency, were analyzed. Perceptual analysis was also carried out and the Pediatric Voice Handicap Index (PVHI) questionnaire was used to assess subjective changes in the children's voice and the effects of these changes on social functions. RESULTS: Acoustic analysis revealed significant decreases in the vowel /i/ in the second formant, compact-diffuse, and grave-acute features of the voice (p=0.026, 0.022, and 0.031, respectively). A significant decrease was also observed in the intensity of the voice for the vowel /u/ (p=0.025). Perceptual analysis revealed that 86.6% of patients' voice recordings had post-operative changes. The mean preoperative PVHI score was 2.70±3.37, which decreased to 1.65±2.21 (p=0.011) after the surgery. CONCLUSION The results suggest that adenotonsillectomy affects Korean children's voices both acoustically and perceptually.

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate acoustic (acoustic voice quality index, AVQI) and auditory-perceptual evaluation (grade, rough, breathy, asthenic, strained; GRBAS and consensus auditory-perceptual evaluation of voice; CAPE-V) as a predictor of voice recovery after laryngeal microsurgery (LMS) in patients with vocal polyp. SUBJECTS AND METHODS: A total of 68 patients with vocal polyp participated in this study. Voice samples were analyzed for AVQI by Praat and auditory-perceptual ratings were performed by three speech language pathologists. Voice handicap index-10 (VHI-10) was evaluated by patients themselves. RESULTS: Decreased AVQI, VHI-10, overall severity (OS), and increased smoothed cepstral peak prominence (CPPS) values were measured and statistically significant changes were noted after LMS. The ratio of Grade 0 and Grade 1 was increased. AVQI was correlated with CPPS, Grade, and OS, but not with VHI-10. The voice recovery of pedunculated polyp appeared in all vocal polyp sizes after LMS, but statistically significant differences were found only in small and medium sizes. After LMS of sessile polyps, AVQI, VHI-10, and OS decreased whereas CPPS increased; however, statistically significant difference was confirmed only in VHI-10 and OS. The receiver operating characteristic curve analysis showed the following results: AVQI [cutoff=5.5, sensitivity=61.8%, specificity=76.5%, area under the curve (AUC)=0.712], CPPS (cutoff=5.0, sensitivity=89.7%, specificity=48.5%, AUC=0.743), VHI-10 (cutoff=13.0, sensitivity=77.9%, specificity=89.7%, AUC=0.893), Grade (cutoff=2.0, sensitivity=70.6%, specificity=69.1%, AUC=0.728), and OS (cutoff=51.0, sensitivity=86.8%, specificity=66.2%, AUC=0.833). CONCLUSION: Acoustic and auditory-perceptual variables showed significant positive changes and predicted recovery of voice. In this study, we believe that the acoustic and auditory-perceptual evaluations.
Acoustics* ; Consensus ; Humans ; Microsurgery* ; Polyps* ; ROC Curve ; Voice Quality ; Voice*

BACKGROUND AND OBJECTIVES: Adenotonsillectomy is a highly effective treatment for obstructive sleep apnea symptoms in children. In this study, to investigate the effects of adenotonsillectomy on snoring in children, we analyzed and compared snoring sounds recorded using a smartphone before and after adenotonsillectomy. We also determined whether it is possible to use acoustic analysis to monitor snoring in children. SUBJECTS AND METHOD: A total of 20 children diagnosed with snoring and had undergone adenotonsillectomy performed by the same surgeon were enrolled for the study. Snoring was recorded by patients' caregivers using smartphones before and after the surgery (mean of 8.5 days) and analyzed. Questionnaires were conducted by telephone survey at 3 months and 12 months after the surgery to determine snoring status. RESULTS: Snoring completely ceased in 25% of patients and decreased in the remaining 75% during the immediate follow-up period (mean of 8.5 days; from 58.07±9.35 dB to 42.59±7.89 dB, p<0.001), and disappeared in all of the patients by 3 months after adenotonsillectomy. Snoring recurred only in one patient after 1 year. A frequency analysis offered no evident statistically significant changes during the immediate follow-up period, indicating that although snoring volume had decreased, no anatomical change had developed in the patient. Spectrography was useful in investigating the snoring patterns before and after adenotonsillectomy. CONCLUSION: The results showed that acoustic analysis of snoring sounds obtained using a smartphone may be useful for monitoring snoring during follow-up after adenotonsillectomy in pediatric snoring patients.
Acoustics* ; Caregivers ; Child* ; Follow-Up Studies ; Humans ; Methods ; Sleep Apnea, Obstructive ; Smartphone* ; Snoring* ; Telephone ; Tonsillectomy

OBJECTIVES: The purpose of this study was to explore the effects of injection laryngoplasty (IL) with hyaluronic acid in patients with vocal fold paralysis (VFP). METHODS: A total of 50 patients with VFP participated in this study. Pre- and post-IL assessments were performed, which included analyzing the sustained vowel /a/ phonation, and the patient reading 1 Korean sentence from the “Walk” passage that comprised 25 syllables in 10 words. To investigate the effect of IL on vocal fold function, acoustic analysis (acoustic voice quality index, cepstral peak prominence, maximum phonation time, speaking fundamental frequency) was conducted and auditory-perceptual (grade and overall severity), visual judgment (gap), and self-questionnaire (voice handicap index-10) assessments were performed. RESULTS: The patients with VFP showed statistically significant differences between pre-and post-IL assessments for acoustic and auditory-perception, visual judgment, and self-questionnaire assessments. CONCLUSION: The patients with VFP showed positive change in vocal fold function between pre- and post-IL measurements. The findings showed that IL with hyaluronic acid is an effective method to improve vocal fold function in patients with VFP.
Acoustics ; Humans ; Hyaluronic Acid* ; Judgment ; Laryngoplasty* ; Methods ; Paralysis* ; Phonation ; Vocal Cords* ; Voice Quality

This study aimed to survey the status of quality control (QC) assurance for stool examinations at clinical laboratories in Korea. We sent a questionnaire related to QC practices in stool examination by electronic mail to Korean clinical laboratories that performed stool examination. Overall, 20 of the 39 laboratories (51.3%) reported performing stool concentration methods, and 28 (71.8%) examined the slides using only saline. A large proportion (74.4%) of respondents did not check the internal QC because of the restriction of appropriate control materials. Only four laboratories (10.3%) checked the reactivity of the dye solution routinely. For appropriate external QC systems, QC slides (43.6%) were preferred, followed by QC materials (30.8%), virtual slides (17.9%), and a combination of the above options (7.7%). The most commonly observed parasites in stool samples at the clinical laboratories were Clonorchis sinensis (75%), followed by Endolimax nana, Enterobius vermicularis, and Entamoeba coli. The present study describes the difficulties in internal QC assessment due to the absence of standardized QC materials and systems. We hope the findings of this report will provide a foundation for a QC assessment program for stool examinations in the near future.
Clonorchis sinensis ; Electronic Mail ; Endolimax ; Entamoeba ; Enterobius ; Hope ; Korea ; Parasites ; Quality Control ; Surveys and Questionnaires

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
Advisory Committees ; Consensus ; Counseling ; Drug Therapy ; Glottis ; Humans ; Laryngeal Neoplasms* ; Neck*