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1.  Radiographic Changes of the Nasal Septal Body Among Patients With Sinonasal Diseases 
Objectives
This study aims to determine the anatomical changes occurring in the nasal septal body (NSB) among patients with sinonasal disease and compares the measurements obtained from patients without sinonasal disease.
Methods
This was a retrospective study involving review of 405 (93 without and 212 with sinonasal disease) plain paranasal sinus computed tomography (PNS CT) on coronal view at a tertiary training hospital, which was done consecutively from January 2014 to December 2015. NSB measurements from 3 areas were done: anterior part (A), located anterior and superior to inferior turbinate; middle or widest (M) part, located anterior to middle turbinate and superior to inferior turbinate and posterior (P) part, located within the anterior 1/3 of middle turbinate not going beyond the crista galli. Posterior part of septum (sP) was measured at the area of horizontal attachment of middle turbinate to the lateral nasal wall and superior turbinate to represent the less vasoactive part of the septum. Demographic data and NSB diameters were also analyzed.
Results
The mean NSB diameter measurements were significantly larger among the diseased group (disease vs. control; A: 6.88 mm vs. 5.92 mm, P=0.001; M: 12.74 mm vs. 10.47 mm, P=0.001; P: 8.35 mm vs. 6.79 mm, P=0.001). A similar observation in sP part (3.35 mm vs. 2.54 mm, P=0.014) was noted. When grouped by age, among the control group, older subjects had considerable decrease in NSB size in all points of measurements except for sP (P>0.05). Such reduction in size is noticeable for those in their 4th, 5th, 6th, and 7th decades of life. For the diseased group, a trend of increasing NSB and sP size was noted as the subjects are getting older. However, only the anterior part (A) of NSB reached statistical significance (P=0.016).
Conclusion
With aging we expect nasal mucosal atrophy among normal subjects. However, patients with chronic sinonasal disease showed thickened nasal mucosa. Further study for the reversibility of thickened mucosa is needed.
doi:10.21053/ceo.2017.00080
PMCID: PMC5678036  PMID: 28602068
Nasal Septal Body; Nasal Septal Swell Body
2.  The Effect of Insulin Like Growth Factor-1 on Recovery of Facial Nerve Crush Injury 
Objectives
The aim of this study is to investigate the efficacy of locally applied insulin-like growth factor 1 (IGF-1) on the recovery of facial nerve functions after crush injury in a rabbit model.
Methods
The rabbits were randomly assigned into three groups. Group 1 consisted of the rabbits with crush injury alone; group 2, the animals applied saline solution onto the crushed facial nerve and group 3, IGF-1 implemented to the nerve in the same manner. Facial nerve injury was first electrophysiologically studied on 10th and 42nd days of the procedure. The damage to the facial nerves was then investigated histopathologically, after sacrification of the animals.
Results
In the electrophysiological study, compound muscle action potential amplitudes of the crushed nerves in the second group were decreased. In pathological specimens of the first and second groups, the orders of axons were distorted; demyelination and proliferation of Schwann cells were observed. However, in IGF-1 treated group axonal order and myelin were preserved, and Schwann cell proliferation was close to normal (P<0.05).
Conclusion
Local application of IGF-1 in a slow releasing gel was found efficacious in the recovery of the facial nerve crush injury in rabbits. IGF-1 was considered worthy of being tried in clinical studies in facial nerve injury cases.
doi:10.21053/ceo.2016.00997
PMCID: PMC5678033  PMID: 28264555
Insulin-Like Growth Factor I; Facial Nerve Injuries; Therapy; Animal Model
3.  A Survey of Korean Physicians’ Prescription Patterns for Allergic Rhinitis 
Objectives
The aim of this study was to compare the prescription patterns according to characteristics of physicians using a survey distributed amongst physicians in Korea.
Methods
We surveyed the prescription patterns for allergic rhinitis (AR) of the members of the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI) and the Korean Association of Otorhinolaryngologists (KAO). Questionnaire contained 4 categories with 28 queries. 448 physicians including 98 internal medicine (IM), 113 pediatrics (PED), and 237 otorhinolaryngology (ENT) were responded.
Results
Although the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines are most frequently used in all specialties, seasonal or perennial AR is the most frequent classification system. For the definitive diagnosis of AR, ENT physicians reported using multiple allergen simultaneous test (MAST)/radio allergy sorbent test (RAST) more than others (IM, 10.9%; PED, 20.6%; ENT, 44.2%; P<0.001). In treatment, most physicians reported that antihistamine medication is the initial treatment for AR. PED physicians prescribed fewer intranasal steroid to combinations with an antihistamine than other specialists (IM, 65.3%; PED, 42.5%; ENT, 63.3%), but preferred leukotriene antagonists (IM, 4.1%; PED, 23.0%; ENT, 3.9%; P=0.041). Overall, 53% (235/448) of the physicians performed allergen immunotherapy (AIT), and IM administers the most AIT (IM, 71.6%; PED, 42.0%; ENT, 39.5%; P=0.019). Furthermore, university and general hospital physicians prescribed more AIT than doctors at other hospital types (university hospital, 76.4%; general hospital, 64.3%; local hospital, 21.4%; private clinic, 20.2%; P<0.001).
Conclusion
The prescription patterns for AR were different according to the physicians’ characteristics and general rate of prescribing AIT is just about 53% in Korea. Thus, the development of complementary Korean-specific guidelines is needed and proper clinical instruction of AIT would be necessary.
doi:10.21053/ceo.2017.00143
PMCID: PMC5678034  PMID: 28449551
Allergic Rhinitis; Drug Prescriptions; Surveys and Questionnaires
4.  Analysis of Eustachian Tube Dysfunction by Dynamic Slow Motion Video Endoscopy and Eustachian Tube Dysfunction Questionnaire in Chronic Otitis Media 
Objectives
Eustachian tube dysfunction has been associated with most cases of middle-ear disease. We aimed to assess the effectiveness of dynamic slow motion video endoscopy (DSVE) as a test of eustachian tube dysfunction. Furthermore, we assessed the correlation of the test with the Valsalva maneuver, the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and intraoperative findings of the eustachian tube.
Methods
We retrospectively reviewed medical records from April to September 2014 to identify patients who were diagnosed with chronic otitis media (COM) at Korea University Ansan Hospital. They all underwent surgery because of COM without cholesteatoma and were assessed via the DSVE and ETDQ-7 to determine eustachian tube function.
Results
We reviewed 46 COM patients and examined 46 ears with COM and 46 ears on the contralateral side to COM that were thought to be normal. The mean DSVE grade in COM ears was 1.57±0.96, while the mean DSVE grade in contralateral ears was 1.15±0.94. The difference in DSVE between COM ears and normal ears was statistically significant (P=0.006). In the ETDQ-7, a higher score was related to intraoperative obstruction of the eustachian tube (P=0.012).
Conclusion
DSVE and ETDQ-7 can provide information regarding preoperative status of eustachian tube dysfunction by measuring dynamic structural changes of the eustachian tube in combination with other diagnostic tests.
doi:10.21053/ceo.2016.01683
PMCID: PMC5678035  PMID: 28602066
Eustachian Tube; Endoscopy; Otitis Media; Seven-Item Eustachian Tube Dysfunction Questionnaire; Dynamic Slow Motion Video Endoscopy
5.  Swallowing and Aspiration: How Much Is Affected by the Number of Arytenoid Cartilages Remaining After Supracricoid Partial Laryngectomy? 
Objectives
The aim of this study was to compare the effect of the presence of one or two arytenoids on early/late period swallowing-aspiration functions.
Methods
Supracricoid partial laryngectomy (SCPL) with the diagnosis of laryngeal cancer between 2012 and 2014 were retrospectively evaluated. The patients were categorized into two groups as follows: group I, patients who underwent SCPL with one arytenoid cartilage and group II, patients who underwent SCPL with two arytenoid cartilages. The time of decannulation and oral feeding onset, and swallowing-aspiration functions were evaluated and compared in the early nutritional period, first, and third months.
Results
There was no significant correlation between decannulation time and swallowing-aspiration. The aspiration rates in group I and group II were similar and there was no significant difference in oral feeding onset and aspiration grades in the first and third months between both groups.
Conclusion
We found similar oncological and functional outcomes in SCPL which protected one or two arytenoid cartilages. Therefore we suggest to be performed one arytenoid cartilage SCPL in selected patients who was advance stage and tumor volume over with larynx cancer.
doi:10.21053/ceo.2015.01837
PMCID: PMC5678037  PMID: 27440130
Arytenoid; Aspiration; Partial Laryngectomy; Swallowing
6.  Substance P and Calcitonin Gene-Related Peptide in the Glands of External Auditory Canal Skin 
Objectives
The earwax (cerumen) that covers external auditory canal (EAC) skin contains a mixture of ceruminous and sebaceous gland substances, such as lipids, peptides, and proteins. The components secreted from the ceruminous gland that is a modified sweat gland form cerumen and contain several antimicrobial factors. Since substance P (SP) and calcitonin gene-related peptide (CGRP), known as a secretagogue, have been found in sweat glands, our purpose was to determine the expression of SP and CGRP in the glands of EAC skin.
Methods
Sections of normal human EAC skins were immunostained for the presence of SP and CGRP using polyclonal antibodies. Immunoreactivity was detected using an avidin-biotin peroxidase complex method.
Results
SP staining was found in ceruminous gland acini and myoepithelial cells. But the SP staining was not found in the sebaceous glands and epidermal region. CGRP was strongly stained in the ceruminous gland and weakly in the sebaceous gland cells. Interestingly, most prominent staining of SP and CGRP was noted in the myoepithelial cells of the ceruminous gland.
Conclusion
The findings in this study suggest that SP and CGRP are expressed in the glands of the EAC skin and secreted in the process of ceruminous gland secretion.
doi:10.21053/ceo.2017.00129
PMCID: PMC5678038  PMID: 28866875
Substance P; Calcitonin Gene-Related Peptide; External Auditory Canal; Gland
7.  Review of Heterotopic Thyroid Autotransplantation 
Total thyroidectomy is increasingly accepted for the management of bilateral benign thyroid disorders. Postoperatively, patients require lifelong levothyroxine replacement therapy to avoid postoperative hypothyroidism, which besides the burden of compliance, has been proven to be associated with several long-term side effects. Heterotopic thyroid autotransplantation was proposed several decades ago to avoid the need for life-long postoperative replacement therapy with maintaining the autoregulatory mechanism of thyroxin production inside the body according to its needs. Available data regarding this topic in literature is relatively poor. Before applying thyroid autotransplantation on humans, several studies have been done on animals, where the autologous transplantations were found to be successful in almost all the cases, proved by follow up postoperative 8-week measurements of thyroid hormones and histopathological examination of the removed autografts. Regarding the clinical application, few trials have been done using cryopreserved in vivo, in vitro or immediately autotransplanted thyroid autografts. Satisfactory results were obtained, however, the number of these studies and the number of patients per each study was very low. Besides the study methodologies were not so consistent.
doi:10.21053/ceo.2016.01578
PMCID: PMC5678039  PMID: 28535579
Thyroid; Transplantation, Autologous; Transplantation, Heterotopic; Thyroidectomy; Review
8.  Effect of Proparacaine in a Mouse Model of Allergic Rhinitis 
Objectives
Lidocaine, a local anaesthetic is a treatment option in uncontrolled asthma due to its immunomodulatory effects. In the present study, proparacaine (PPC), a derivative of lidocaine was examined for its therapeutic application in a mouse model of allergic rhinitis.
Methods
The mice were grouped into 4 groups: control group, allergic rhinitis (AR) group, ciclesonide (CIC) group, and PPC group. Nasal symptom scores, eosinophil counts, goblet cell counts, and mast cells counts in the nasal mucosa were measured. Serum ovalbumin (OVA)-specific immunoglobulin (Ig) E, OVA-specific IgG1, OVA-specific IgG2a, interleukin (IL)-4, IL-5, and cortisol levels were measured.
Results
Intranasal administration of PPC significantly decreased nasal symptoms, number of eosinophils, goblet cells, and mast cells in the lamina propria of the nasal mucosa. Serum OVA-specific IgE, OVA-specific IgG1, OVA-specific IgG2a was significantly higher in the AR compared with the control group. Serum level of IL-4 was significantly lower in the CIC group and PPC group in comparison with AR group. Serum IL-5 showed no significant difference among all groups. No significant difference in serum cortisol levels was observed among the 4 groups.
Conclusion
PPC appears to have a therapeutic potential in treatment of allergic rhinitis in a mouse model by reducing eosinophil, goblet cell, and mast cell infiltration in the nasal mucosa.
doi:10.21053/ceo.2017.00101
PMCID: PMC5678040  PMID: 28449552
Ciclesonide; Mice; Ovalbumin; Proparacaine; Allergic Rhinitis
9.  The Efficacy of Fibroblast Growth Factor for the Treatment of Chronic Vocal Fold Scarring: From Animal Model to Clinical Application 
Objectives
This study assessed the regenerative efficacy of basic fibroblast growth factor (FGF) in a rabbit model of chronic vocal fold scarring and then confirmed its utility and safety in a prospective trial of patients with this condition.
Methods
FGF was injected three times, at 1-week intervals, into a chronic vocal fold scar created in a rabbit model. After 1 month, mRNA level of procollagen I, hyaluronic acid synthetase 2 (HAS 2), and matrix metalloproteinase 2 (MMP 2) were analyzed by real-time polymerase chain reaction. The relative densities of hyaluronic acid (HA) and collagen were examined 3 months post-injection. From April 2012 to September 2014, a prospective clinical trial was conducted at a tertiary hospital in Korea. FGF was injected into the mild vocal fold scar of 17 consecutive patients with a small glottic gap. The patients underwent perceptual, stroboscopic, acoustic aerodynamic test, and Voice Handicap Index (VHI) survey prior to and 3, 6, and 12 months after FGF injection.
Results
FGF injection of the vocal fold scar decreased the density of collagen and increased mRNA level of HAS 2 and MMP 2 expression significantly compared to the control group injected with phosphate buffered solution in a rabbit model (P<0.05). In the clinical trial, significant improvements in the majority of the subjective and objective voice parameters were registered 3 months after FGF injection and were maintained at 12 months. Complications associated with the FGF injections, such as granuloma, were not observed during the follow-up period.
Conclusion
Based on the animal model and the prospective clinical trial, vocal fold injections of FGF in patients with mild chronic vocal fold scarring can significantly improve voice quality for as long as 1 year and without side effects. Our results recommend the use of FGF vocal fold injection as an alternative treatment modality for mild chronic vocal fold scarring.
doi:10.21053/ceo.2016.00941
PMCID: PMC5678041  PMID: 27671715
Fibroblast Growth Factors; Vocal Cord; Dysphonia
10.  Age-Related Changes in Nuclear Factor Erythroid 2-Related Factor 2 and Reactive Oxygen Species and Mitochondrial Structure in the Tongues of Fischer 344 Rats 
Objectives
Previously the authors reported age-related changes in the activities of anti-oxidative enzyme activities and protein expressions in the tongues of rats. Because more information is required about relations between aging and oxidative stress and anti-oxidative enzyme efficiency, the authors investigated differences between the expression of master regulator of anti-oxidative enzymes (nuclear factor erythroid 2-related factor 2 [Nrf2]), levels of reactive oxygen species (ROS), and mitochondrial structures in the tongues of young and aged Fischer 344 rats.
Methods
Age-dependent changes in Nrf2 protein and ROS were determined by Western blotting and using chemical kits, respectively. Tongue specimens were examined by electron microscopy. The study was conducted using rats aged 7 months (young, n=8) or 22 months (old, n=8).
Results
Nrf2 protein levels in the tongues of aged rats were lower than in young rats. ROS levels were higher in older rats and mitochondrial structural deficits were observed their tongues. Three young rats showed moderate mitochondrial degeneration, whereas profound degeneration with mitochondrial cristae disruption, swelling, rupture, or intramitochondrial vacuole formation was observed in all 8 old rats. Notably, mitochondrial rupture was observed in 5 old rats.
Conclusion
Antioxidant defense systems of old rats were compromised by Nrf2 deficiency, which could lead to the deleterious accumulation and release of ROS and probably mitochondrial structural deficits in aged tongue tissues.
doi:10.21053/ceo.2016.01095
PMCID: PMC5678042  PMID: 28002926
Tongue; Aging; NF-E2-Related Factor 2; Reactive Oxygen Species; Mitochondria
11.  Hearing Improvement in A/J Mice via the Mouse Nerve Growth Factor 
Objectives
To investigate the otoprotective effects of mouse nerve growth factor (mNGF) in A/J mice.
Methods
The mice at postnatal day 7 (P7) were randomly separated into a mNGF treated group (mNGF group) and a distilled water (for injection) treated group (control group). The mNGF dissolved in distilled water or distilled water alone was given to the mice once every other day from P7 by intramuscular injection in the hips. The otoprotective effects of mNGF in A/J mice were observed in a time course manner. The thresholds of auditory-evoked brainstem response (ABR) were tested from the age of the 3rd to the 8th week. Sections of the inner ears were stained by hematoxylin and eosin, and spiral ganglion neurons (SGNs) were observed at the age of the 3rd, the 6th,and the 8th week. Counts of whole mount outer hair cells (OHCs) in the cochleae were made at the age of 8 weeks. Expression of apoptosis related genes was determined by quantitative real-time polymerase chain reaction and Western blotting.
Results
ABR thresholds of the mNGF group were significantly lower than those of the control group at the age of the 6th and the 8th week. Moreover, the mNGF preserved OHC and SGN in the mouse cochleae in this period. Further experiments showed that the expression of caspase genes (including caspase-3) was inhibited in the mouse inner ears in the mNGF group.
Conclusion
The mNGF improves hearing in A/J mice by preserving SGN and OHC in the cochleae.
doi:10.21053/ceo.2016.01354
PMCID: PMC5678043  PMID: 28264554
Nerve Growth Factor; Hair Cells; Neurons; Protection
12.  Relationships Among Factors Relevant to Abdominal Fat and Age-Related Hearing Loss 
Objectives
Metabolic syndrome is related with abdominal fat and with age-related hearing loss (ARHL). In this study, we evaluated the association between a variety of factors relevant to abdominal fat (FRAs) and hearing thresholds.
Methods
We reviewed retrospectively the medical records of 2,602 subjects aged over 40 years with symmetrical sensorineural hearing loss who underwent abdominal fat computed tomography (CT) scans. Univariate and multivariate linear regression analyses were used to demonstrate the association between each FRA and hearing thresholds at low and high frequencies.
Results
Four of 5 FRAs were associated with hearing thresholds at high frequencies in males. All FRAs examined showed a relationship with hearing thresholds at low frequencies in females. Diabetes mellitus (DM) among clinical factors and visceral adipose tissue (VAT) among the 5 FRAs were the most reflective of hearing thresholds in both males and females.
Conclusion
We found that FRAs were associated with hearing loss with frequency specific characteristics according to sex and reinforced that DM and VAT is particularly an important role for hearing.
doi:10.21053/ceo.2017.00017
PMCID: PMC5678044  PMID: 28494527
Hearing Loss; Abdominal Fat; Visceral Fat; Body Mass Index
13.  Cytokeratin 13, Cytokeratin 17, and Ki-67 Expression in Human Acquired Cholesteatoma and Their Correlation With Its Destructive Capacity 
Objectives
Cholesteatoma is a nonneoplastic destructive lesion of the temporal bone with debated pathogenesis and bone resorptive mechanism. Both molecular and cellular events chiefly master its activity. Continued research is necessary to clarify factors related to its aggressiveness. We aimed to investigate the expression of Ki-67, cytokeratin 13 (CK13) and cytokeratin 17 (CK17) in acquired nonrecurrent human cholesteatoma and correlate them with its bone destructive capacity.
Methods
A prospective quantitative immunohistochemical study was carried out using fresh acquired cholesteatoma tissues (n=19), collected during cholesteatoma surgery. Deep meatal skin tissues from the same patients were used as control (n=8). Cholesteatoma patients were divided into 2 groups and compared (invasive and noninvasive) according to a grading score for bone resorption based upon clinical, radiologic and intraoperative findings. To our knowledge, the role of CK17 in cholesteatoma aggressiveness was first investigated in this paper.
Results
Both Ki-67 and CK17 were significantly overexpressed in cholesteatoma than control tissues (P<0.001 for both Ki-67 and CK17). In addition, Ki-67 and CK17 were significantly higher in the invasive group than noninvasive group of cholesteatoma (P=0.029, P=0.033, respectively). Furthermore, Ki-67 and CK17 showed a moderate positive correlation with bone erosion scores (r=0.547, P=0.015 and r=0.588, P=0.008, respectively). In terms of CK13, no significant difference was found between cholesteatoma and skin (P=0.766).
Conclusion
Both Ki-67 and CK17 were overexpressed in cholesteatoma tissue and positively correlated with bone resorption activity. The concept that Ki-67 can be a predictor for aggressiveness of cholesteatoma was supported. In addition, this is the first study demonstrating CK17 as a favoring marker in the aggressiveness of acquired cholesteatoma.
doi:10.21053/ceo.2016.01263
PMCID: PMC5545701  PMID: 28073243
Cholesteatoma; Middle Ear; Bone Resorption; Ki-67 Antigen; Cytokeratin 17
14.  Analysis of Prognostic Factors in Malignant External Otitis 
Objectives
Malignant external otitis (MEO) is a potentially fatal infection of the external auditory canal, temporal bone, and skull base. Despite treatment with modern antibiotics, MEO can lead to skull base osteomyelitis. Until now, there have been few studies on the prognostic factors of MEO.
Methods
We performed a retrospective study to identify prognostic factors of MEO, and a meta-analysis of other articles investigating MEO. On the basis of disease progression the 28 patients in our study were divided into ‘controlled’ and ‘uncontrolled’ groups, consisting of 12 and 16 patients, respectively. We identified three categories of prognostic factors: those related to patient, disease, and treatment. We compared these prognostic factors between the controlled and uncontrolled groups.
Results
In our study, the duration of diabetes mellitus (DM), presence of inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), and computed tomography or magnetic resonance imaging findings influenced the prognosis of MEO. In contrast, prognosis was unrelated to age, gender, mean glucose level, hemoglobin A1c level, pathogen, comorbidity, or cranial nerve involvement. No factor related to treatment modality was correlated with prognosis, such as surgery, steroid therapy, or interval to the first appropriate treatment. Cranial nerve involvement has been proven to be associated with disease progression, but the relationship between cranial nerve involvement and the prognosis of MEO remains controversial. As a part of this study, we conducted a meta-analysis of cranial nerve involvement as a prognostic factor of MEO. We found that cranial nerve involvement has a statistically significant influence on the prognosis of MEO.
Conclusion
We found that glycemic control in diabetes mellitus, cranial nerve involvement, and the extent of disease determined from various imaging modalities influence the prognosis of MEO. We suggest that significant prognostic factors should be monitored to determine the prognosis of patients with MEO.
doi:10.21053/ceo.2016.00612
PMCID: PMC5545692  PMID: 27671716
Otitis Externa; Malignant; Prognosis; Meta-Analysis
15.  Usefulness of Allerkin House Dust Mite Extract for Nasal Provocation Testing 
Objectives
We evaluated the clinical usefulness of Allerkin (Lofarma) for nasal provocation testing (NPT) in patients with rhinitis symptoms, by examining changes in nasal symptoms and acoustic parameters after exposure to house dust mite (HDM) extract.
Methods
Twenty patients (16 males and 4 females, mean age: 29.6±14.6 years) were enrolled. We performed skin prick test (SPT) before and 15 and 30 minutes after intranasal challenge with Allerkin HDM extract, and we evaluated symptom changes (nasal obstruction, rhinorrhea, sneezing, and itching) using a visual analogue scale. We also evaluated changes in acoustic parameters such as total nasal volume (TNV) and minimal cross-sectional area (MCA) before and after challenge.
Results
Group A (the nonallergic group, n=8) showed negative results for all tested aeroallergens in SPT and nonprovocative results (<25% decrease of TNV and MCA from the baseline value) in NPT. Group B (the allergic group, n=7) exhibited strongly positive results (wheal size larger than that of histamine) for HDM allergens on SPT. Group C (the local allergic group, n=5) showed negative results on SPT, but a provocative response on NPT (>29% decrease in TNV/MCA from the baseline value). Patients in group C showed significant aggravation of nasal obstruction compared to those in group A (P<0.05). Thirty minutes after HDM challenge, patients in groups B and C showed significantly greater decreases in MCA compared to those in group A (P<0.01).
Conclusion
Allerkin HDM extract can be a useful provocative agent in NPT for diagnosing allergic rhinitis and local allergic rhinitis.
doi:10.21053/ceo.2016.01137
PMCID: PMC5545693  PMID: 27992712
Allergic Rhinitis; Nasal Provocation Tests; Dermatophagoides pteronyssinus; Acoustic Rhinometry
16.  Postoperative Hypoparathyroidism and the Viability of the Parathyroid Glands During Thyroidectomy 
Objectives
To prevent hypoparathyroidism after thyroidectomy, preservation of the parathyroid glands and their vascularity are essential. The aim of this study was to determine the association between postoperative parathyroid function and the viability of the parathyroid glands during thyroidectomy.
Methods
We prospectively analyzed 111 patients who underwent total thyroidectomy and in whom all 4 parathyroid glands were preserved in situ during the operation. The surgeons scored the viability of each parathyroid gland from 0 (normal) to 3 (severely compromised viability) based on its gross appearance and vascularity intraoperatively. The index of parathyroid viability score (IPVS) was defined as the sum of the viability scores of the 4 parathyroid glands. We evaluated the relationship between postoperative parathyroid function and IPVS.
Results
Transient hypoparathyroidism occurred in 25 patients (22.5%), and permanent hypoparathyroidism in 4 patients (3.6%). The IPVS were significantly different in the three groups: 2.87±1.46 in the normal group, 3.68±1.41 in the transient hypoparathyroidism group and 7.50±1.00 in the permanent hypoparathyroidism group. The rates of transient hypoparathyroidism were 13.6% in patients with IPVS 0–2, 23.8% in patients with IPVS 3–4, and 42.9% in patients with IPVS 5–6. All the patients with IPVS of 7 or more had permanent hypoparathyroidism.
Conclusion
IPVS is correlated with the incidence of hypoparathyroidism. It could be a good quantitative indicator of the probability of hypoparathyroidism after thyroidectomy.
doi:10.21053/ceo.2016.00724
PMCID: PMC5545694  PMID: 27515510
Parathyroid Glands; Hypoparathyroidism; Hypocalcemia; Thyroidectomy
17.  Differences of the Voice Parameters Between the Population of Different Hearing Tresholds: Findings by Using the Multi-Dimensional Voice Program 
Objectives
To compare voice parameters in subjects with different hearing level.
Methods
The evaluation consisted of Multi-Dimensional Voice Program (MDVP) and electroglottography. Group 1 consisted of normal hearing subjects which is bilateral average hearing better than 25 decibels (dB) whereas group 2 consisted of patients who have bilateral average hearing between the 25 and 60 dB and group 3 consisted of patients who have bilateral average hearing between the 60 and 90 dB. The evaluations were performed on males and females separately.
Results
In female subjects, fundamental frequency (F0), absolute jitter, %jitter and soft phonation index (SPI) were significantly different between the group 1 and group 2. Also, we detected significant difference on maximum phonation time (MPT), fundamental frequency, absolute jitter and %jitter, and variable F0 (vF0) values between group 1 and group 3. Male subjects demonstrated significant difference between the group 1 and group 2 in MPT, absolute jitter, %jitter, vF0, and SPI parameters. Between the group 3 and group 1; differences in absolute jitter, %jitter, shimmer, %shimmer, vF0, and SPI were also significant.
Conclusion
This study concluded that even mild to moderate hearing losses may affect voice patterns in adults and also females and males react differently to hearing loss in some parameters.
doi:10.21053/ceo.2015.01900
PMCID: PMC5545695  PMID: 27459200
Voice; Hearing Loss; Adult; Sex
18.  Pathologic Evaluation of Routine Nasopharynx Punch Biopsy in the Adult Population: Is It Really Necessary? 
Objectives
To retrospectively evaluate the patients who underwent nasopharyngeal biopsy with imaging and biopsy results, who have or don’t have symptoms for nasopharyngeal pathology and to determine the ratio of the nasopharyngeal cancer cases and other pathologic conditions.
Methods
In this retrospective study, 983 patients who underwent endoscopic nasopharyngeal biopsy for symptomatic nasopharyngeal lesions were included. All pathological results, benign or malign was recorded and classified due to the patients’ presenting symptoms such as symptomatic for nasopharyngeal pathology or asymptomatic. Computed tomography (CT) or magnetic resonance imaging (MRI) reports were also recorded separately as group A for malignancy or group B for not malignancy.
Results
Forty-five (4.6%) of 983 biopsies were malignant. In this group, there is no statistically significant difference between symptomatic and asymptomatic group. For malignant pathologies, the sensitivity of MRI was found 88.2% and CT was 61.5%.
Conclusion
For early diagnosis of nasopharyngeal cancer, all patients admitted to Ear, Nose and Throat (ENT) referral clinics should be examined endoscopically irrespective of their complaints and suspicious cases should be investigated by imaging especially by MRI. If MRI report clearly indicates Thornwaldt cyst or reactive lymphoid hyperplasia and this result is compatible with endoscopic findings, biopsy may not be necessary. Apart from these cases, all suspected lesions should be biopsied.
doi:10.21053/ceo.2015.01256
PMCID: PMC5545696  PMID: 27459201
Nasopharyngeal Neoplasms; Biopsy; Multidetector Computed Tomography; Magnetic Resonance Imaging
19.  A Study of Single Nucleotide Polymorphisms of Tumour Necrosis Factor α-1031 And Tumour Necrosis Factor β+ 252 in Chronic Rhinosinusitis 
Objectives
This case-controlled study aimed to identify the association of tumor necrosis factor (TNF)α-1031 and TNFβ+ 252 gene polymorphisms between chronic rhinosinusitis (CRS) and healthy controls. Another purpose of this study was to investigate the associations of these gene polymorphisms with factors related to CRS.
Methods
All deoxyribonucleic acid (DNA) samples were genotyped for TNFα-1031 and TNFβ+252 genes by mean of polymerase chain reaction (PCR) and restriction fragment length polymorphisms (RFLP). The statistical analysis were carried out using chi-square test or Fisher exact test to determine the associations of these gene polymorphisms in CRS. Multiple logistic regression was performed to evaluate the associations of these gene polymorphisms in CRS and its related risk factors.
Results
The genotype and allele frequencies of TNFα-1031 and TNFβ+252 gene did not show any significant associations between CRS and healthy controls. However, a significantly statistical difference of TNFα-1031 was observed in CRS participants with atopy (P-value, 0.045; odds ratio, 3.66) but not in CRS with asthma or aspirin intolerance.
Conclusion
Although the presence of TNFα-1031 and TNFβ+252 gene polymorphisms did not render any significant associations between CRS and healthy control, this study suggests that TNFα-1031 gene polymorphisms in CRS patients with atopy may be associated with increase susceptibility towards CRS.
doi:10.21053/ceo.2016.01732
PMCID: PMC5545697  PMID: 28449554
Rhinosinusitis; Tumour Necrosis Factors; Single Nucleotide Polymorphism
20.  Changes in the Reflux Symptom Index After Multilevel Surgery for Obstructive Sleep Apnea 
Objectives
This study evaluated whether the symptoms of laryngopharyngeal reflux (LPR) change after multilevel surgery for obstructive sleep apnea (OSA).
Methods
Patients who underwent multilevel surgery for OSA between April 2009 and September 2014 were enrolled in this study. All patients underwent preoperative polysomnography prior to surgery and were asked to complete the reflux symptom index (RSI) questionnaire before and after surgery.
Results
Of 73 enrolled patients, 24 (33%) reported an RSI score >13 and were thus classified as having reflux. The mean RSI score before surgery was 11.48±7.95; this number decreased to 4.95±6.19 after surgery (P<0.001). The rate of positive RSI responses was 33% before surgery and 9% after surgery. Each variable that comprised the RSI improved significantly after surgery, except for difficulty with swallowing. Regarding the degree of RSI improvement after surgery, there were no significant differences between subgroups according to sex, age, body mass index, OSA severity, or surgical outcome.
Conclusion
LPR symptoms are prevalent in OSA patients. Treatment for OSA using multilevel surgery potentially reduces the symptoms of LPR.
doi:10.21053/ceo.2017.00052
PMCID: PMC5545698  PMID: 28449553
Obstructive Sleep Apnea; Laryngopharyngeal Reflux
21.  Association Between Hearing Impairment and Albuminuria With or Without Diabetes Mellitus 
Objectives
Few studies have evaluated the accurate association between hearing loss (HL) and albuminuria in patients with or without diabetes mellitus (DM). The aim of our study was to identify the clinical effects of albuminuria on HL with or without DM.
Methods
This study included 9,762 patients from the Korean National Health and Nutrition Examination Survey between 2011 and 2013. Participants were divided into 4 groups based on DM and urine albumin/creatinine ratio levels: group 1 included participants with neither DM nor albuminuria, group 2 included participants without DM and with albuminuria, group 3 included patients with DM and without albuminuria, and group 4 included patients with both DM and albuminuria. The low- or mid-frequency and high-frequency, and average hearing threshold values were obtained.
Results
There were 7,508, 545, 1,325, and 384 participants in groups 1, 2, 3, and 4, respectively. Univariate and multivariate analyses showed that the 3 hearing thresholds in group 1 were the lowest and those in group 4 were the highest among the 4 groups. No significant differences were observed in those thresholds between groups 2 and 3. Group 4 was associated with HL compared with the other groups, but moderate to severe HL was not associated with DM or albuminuria.
Conclusion
The presence of albuminuria was associated with a modest effect on hearing thresholds regardless of presence of DM.
doi:10.21053/ceo.2016.00787
PMCID: PMC5545699  PMID: 28002925
Diabetes Mellitus; Albuminuria; Hearing Threshold; Hearing Loss
22.  Temporomandibular Joint Disorders as a Cause of Aural Fullness 
Objectives
Temporomandibular joint disorders (TMD) are often associated with aural manifestations. However, it is not clear whether aural fullness could be induced by TMD. The purpose was to investigate the TMD and effectiveness of TMD treatments in patients with mainly or exclusively aural fullness complaint.
Methods
One hundred and twelve patients, who had aural fullness as the main or sole complaint, presented to the Otolaryngology Department, PLA Army General Hospital, Beijing, China, between January 2010 and January 2015. Patients’ medical history indicated that they had previously been diagnosed and treated for otitis media or sensorineural hearing loss but without positive results. Patients were subjected to pure tone audiometry and acoustic immittance screening using GSI-61 clinical audiometer and GSI TympStar middle ear analyzer respectively. Patients were examined by questionnaire, X-ray and/or computed tomography scan of temporomandibular joint. TMD was categorized according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Patients were then treated for TMD.
Results
All the patients showed normal eardrum and type A tympanogram. The patients of 60.7% (68/112) were classified as group I TMD disorders (muscle disorders), 34.8% (39/112) were group II (disc displacements), and 4.5% (5/112) were group III (arthralgia, osteoarthritis, and osteoarthrosis). Aural fullness was completely resolved or significantly improved in 67 and 34 patients respectively following treatments aimed at improving TMD, with a combined effectiveness of 90.2% (101/112). TMD treatments are especially effective (94.1%) in group I TMD.
Conclusion
TMD as a potential cause of aural fullness should be considered in otolaryngology practice.
doi:10.21053/ceo.2016.01039
PMCID: PMC5545700  PMID: 28103655
Temporomandibular Joint Disorders; Aural Fullness; Otolaryngology
23.  The Phonetic Characteristics in Patients of Bilateral Vocal Fold Paralysis Without Tracheotomy 
Objectives
Patients with bilateral vocal fold paralysis (BVFP) theoretically have difficulty producing voiceless consonants. However, perceptual studies have revealed clear production of voiceless consonants with good articulation scores in nontracheostomized patients. The purpose of this study was to clarify the production of voiceless stops during articulation in patients with BVFP compared to normal speakers.
Methods
The perceptual, acoustic, and aerodynamic characteristics of patients with BVFP and those with normal speech were investigated with special reference to voiceless stop consonants. Test words were prepared to place the stop consonants in different phonological environments, and were all nonsense words.
Results
The patients with BVFP perceptually produced the three types of stops successfully. However, they acoustically varied voice onset time to produce phonetically representative stops but decreased voice onset time of /ph/ and /p/ compared to those of normal speakers. These patients may properly control air pressure to produce the three types of stop consonants similar to normal speakers.
Conclusion
The patients with BVFP realized the distinctions between the three types of stops similar to the normal speakers. Although vocal mobility was absent in the patients with BVFP, voice onset time, vowel duration, closure duration, and air pressure were similar to those of normal speakers.
doi:10.21053/ceo.2016.00626
PMCID: PMC5545702  PMID: 27927010
Bilateral Vocal Fold Paralysis; Voice
24.  Current Treatment Options for Bilateral Vocal Fold Paralysis: A State-of-the-Art Review 
Vocal fold paralysis (VFP) refers to neurological causes of reduced or absent movement of one or both vocal folds. Bilateral VFP (BVFP) is characterized by inspiratory dyspnea due to narrowing of the airway at the glottic level with both vocal folds assuming a paramedian position. The primary objective of intervention for BVFP is to relieve patients’ dyspnea. Common clinical options for management include tracheostomy, arytenoidectomy and cordotomy. Other options that have been used with varying success include reinnervation techniques and botulinum toxin (Botox) injections into the vocal fold adductors. More recently, research has focused on neuromodulation, laryngeal pacing, gene therapy, and stem cell therapy. These newer approaches have the potential advantage of avoiding damage to the voicing mechanism of the larynx with an added goal of restoring some physiologic movement of the affected vocal folds. However, clinical data are scarce for these new treatment options (i.e., reinnervation and pacing), so more investigative work is needed. These areas of research are expected to provide dramatic improvements in the treatment of BVFP.
doi:10.21053/ceo.2017.00199
PMCID: PMC5545703  PMID: 28669149
Vocal Cord Paralysis; Synkinesis; Recurrent Laryngeal Nerve Injuries; Electric Stimulation Therapy; Botulinum Toxins
25.  Efficacy and Safety of Guardcel Nasal Packing After Endoscopic Sinus Surgery: A Prospective, Single-Blind, Randomized Controlled Study 
Objectives
Nasal packing after endoscopic sinus surgery is frequently used to control postoperative bleeding, enhance the wound healing process, and prevent lateralization of the middle turbinate, which causes insufficient ventilation. Many biodegradable materials have been developed to reduce pain and mucosal damage during packing removal. The purpose of this study was to compare the efficacy of Guardcel (Genewel Co.) middle meatal packing with a traditional nonabsorbable middle meatal packing, Merocel (Medtronic Xomed), on wound healing and patient satisfaction.
Methods
In this prospective, single-blind, randomized controlled study, we enrolled 32 consecutive patients (64 nostrils) undergoing bilateral endoscopic sinus surgery at Korea University Guro Hospital from February 2015 to August 2015. Guardcel and Merocel were inserted postoperatively into a randomly assigned side. Objective findings about bleeding, hemostasis, adhesion, and infection were evaluated with nasal endoscopy. Patients’ symptoms including pain and nasal obstruction were evaluated with a visual analog scale. Each evaluation was done at 2–3 days, 1 week, 2 weeks, and 4 weeks after surgery.
Results
At 2–3 days after endoscopic sinus surgery, the Guardcel side had a significantly less hemostasis time than the Merocel side (P=0.001). During this period, the pain during packing removal was significantly lower on the Guardcel-inserted side than the Merocel-inserted side (P=0.002). At two weeks after surgery, the adhesion score on the Guardcel side was significantly lower than that of the Merocel side (P=0.011). Other parameters during the study follow-up periods were not statistically significant. There were no severe adverse reactions.
Conclusion
Guardcel, a newly developed packing material, appeared to shorten the hemostasis time and reduce pain sensation at 2–3 days after surgery; it also prevented adhesion formation 2 weeks after surgery when compared with the control. Guardcel can be an effective and safe candidate to replace conventional packing materials after endoscopic sinus surgery.
doi:10.21053/ceo.2016.01081
PMCID: PMC5545704  PMID: 27927009
Nasal Packing; Absorbable Packing; Hemostasis; Adhesion; Endoscopic Sinus Surgery

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