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Solitary fibrous tumors (SFTs) are spindle-cell tumors that rarely arise within extrathoracic area. Massive SFTs involving the pterygopalatine fossa are extremely rare and surgical excision represents a multidisciplinary surgical challenge. We present a case of 64-year-old female with a huge mass originating from the pterygopalatine fossa invading the skull base. Distinct microscopic findings and a positive nuclear staining of signal transducer and activator of transcription 6 (STAT-6) pathologically confirmed SFT. The right internal maxillary artery branch was embolized preoperatively and a surgical excision was performed through a combined technique of transpalatal, mid-facial degloving and endoscopic approach. Postoperative radiotherapy successfully removed the remnant tumor adjacent to the carvenous sinus. Follow- up MR images showed no evidence of recurrence for two years. To our knowledge, there has been no previous report of the successful treatment of this vast extent of SFT in the pterygopalatine region via endoscopic-external-combined approach and radiotherapy.

Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by elevated parathyroid hormone levels. In most cases, the disease involves a single parathyroid adenoma, followed by parathyroid hyperplasia, but the incidence of ectopic parathyroid adenoma is rare. However, in cases where the parathyroid hormone level remains high even after parathyroid surgery, an ectopic parathyroid gland should be considered. Here in a case of a 60-year-old female who presented PHPT is reported. She had undergone a surgical removal of the parathyroid gland of suspected hyperplasia, but still represented persistent PHPT, postoperatively. Ectopic mediastinal parathyroid adenoma was identified by 99mTc-sestamibi parathyroid scan and surgical excision via a median sternotomy approach was performed. Thirty-eight months postoperatively, there was no evidence of recurrence. Preoperative localization assessment is critical for minimizing surgical failure in cases of PHPT.

The revolutionary development of artificial intelligence (AI) such as machine learning and deep learning have been one of the most important technology in many parts of industry, and also enhance huge changes in health care. The big data obtained from electrical medical records and digitalized images accelerated the application of AI technologies in medical fields. Machine learning techniques can deal with the complexity of big data which is difficult to apply traditional statistics. Recently, the deep learning techniques including convolutional neural network have been considered as a promising machine learning technique in medical imaging applications. In the era of precision medicine, otolaryngologists need to understand the potentialities, pitfalls and limitations of AI technology, and try to find opportunities to collaborate with data scientists. This article briefly introduce the basic concepts of machine learning and its techniques, and reviewed the current works on machine learning applications in the field of otolaryngology and rhinology.

Sleep surgery is part of a continuum of care for obstructive sleep apnea (OSA) that involves medical, pharmacologic, and behavioral therapy. Upper airway surgery for OSA can significantly improve stability by way of modulating the critical negative closing pressure. This is the same mechanism of action as positive airway pressure or oral appliance therapy. The updated surgical algorithm in this review adds precision in three areas: patient selection, identification of previously unaddressed anatomic phenotypes with associated treatment modality, and improved techniques of previously established procedures. While the original Riley and Powell phase 1 and 2 approach to sleep surgery has focused on individual surgical success rate, this algorithm strives for an overall treatment success with multi-modal and patient-centric treatments.

There are many ways to categorize surgery for obstructive sleep apnea (OSA), one of which is to distinguish between intrapharyngeal and extrapharyngeal procedures. While the general otolaryngologist treating OSA is familiar with intrapharyngeal procedures, such as uvulopalatopharyngoplasty and tongue base reduction, extrapharyngeal sleep operations such as maxillomandibular advancement (MMA) and upper airway stimulation (UAS) have evolved rapidly in the recent decade and deserve a dedicated review. MMA and UAS have both shown predictable high success rates with low morbidity. Each approach has unique strengths and limitations, and for the most complex of OSA patients, the two in combination complement each other. Extrapharyngeal airway operations are critical for achieving favorable outcomes for sleep surgeons.

Adenoid cystic carcinoma is one of the most common minor salivary gland malignancies of the head and neck region. However, adenoid cystic carcinoma of the nasal septum is extremely rare. The authors herein report a case of a septal adenoid cystic carcinoma in a 68-year-old man who complained of nasal bleeding and nasal obstruction for several months. Diagnostic nasal endoscopy revealed a protruding mass arising from the anterosuperior part of the nasal septum. The tumor was removed with a safety margin using the open rhinoplasty approach and primary reconstruction of the surgical defect was performed using septal cartilage. Histopathology indicated an adenoid cystic carcinoma with cribriform pattern. Two years postoperatively, there was no evidence of recurrence, the functional and cosmetic results were good, and the patient was satisfied with the treatment outcome.

Background Use of absorbable packing materials after functional endoscopic sinus surgery (FESS) is associated with increased patient comfort and a lack of need for packing removal. Different materials may induce different patterns of mucosal healing and hemostasis. This study investigated the effect of fibrin sealant (FS; Tisseel) or biodegradable synthetic polyurethane foam (Nasopore®) packing on hemostasis and wound healing after FESS. Methods This prospective randomized controlled trial included 35 consecutive patients who underwent bilateral FESS for chronic rhinosinusitis. The patients were randomized to receive FS through aerosol spraying on 1 side and Nasopore packing on the opposite side. They were followed at 1, 2, 4, 8, and 12 weeks after surgery. Endoscopically visible packing material, crusting, adhesion, bleeding, granulation tissue formation, frontal sinus patency, and adverse effects were assessed. Subjective symptoms related to nasal packing were evaluated by using questionnaires quantified with a visual analogue scale. Results No significant differences were found between the FS-treated side and the Nasopore-packed side with respect to postoperative bleeding, adhesion, or frontal sinus patency. However, crusting and granulation were significantly lower in FS-treated nostrils (p < 0.01). The patients’ satisfaction and willingness to reuse the material were not significantly different between FS and Nasopore. There were no allergic reactions to either material. Conclusion FS and Nasopore were equally successful in achieving hemostasis and patient satisfaction after FESS. However, our results suggest that differential mucosal healing patterns may be induced by alternative absorbable hemostatic materials. FS-treated sides showed more optimal healing patterns than Nasopore-packed sides.

Background/objective The aim of this study was to evaluate the usefulness of simultaneous middle and inferior meatal antrostomies (SMIAs) as a treatment modality in patients with maxillary fungal sinusitis and to compare the efficacy of SMIA with that of conventional middle meatal antrostomy (MMA). Methods A retrospective study was performed on consecutive patients with noninvasive fungal maxillary sinusitis. Twenty-one patients underwent endoscopic sinus surgery with SMIA group and the remaining 24 patients were treated with the conventional MMA group. Medical records were reviewed for history, clinical presentation, radiographic findings, surgical intervention, complications, and outcomes. Outcomes consisted of the visual analog scale (VAS) for the main symptoms and maxillary sinus endoscopic scores. The stenosis or obstruction of the antrostomy site and postoperative mucociliary function was also evaluated. Results VAS scores for facial pain and nasal discharge/postnasal drip were significantly improved in the SMIA group. The maxillary endoscopic score was also significantly reduced in the SMIA group. There were no significant differences between 2 groups with respect to the preoperative Lund–Mackay score, VAS score of nasal obstruction, nasal bleeding, postoperative mucociliary function, and MMA patency. Conclusions The SMIA technique is useful for identifying and removing fungal debris that cannot be reached through the MMA and could bring better surgical outcomes.

Background and Objective Radiofrequency (RF) turbinoplasty may be effective in treating nonallergic rhinitis in elderly patients. The present study evaluated the efficacy of nasal turbinate surgery with RF for the treatment of nonallergic rhinitis in elderly patients refractory to medical therapy. Methods A total of 35 consecutive patients older than 65 years of age (mean subject age, 75.5 ± 9.6 [standard deviation] years) with nonallergic rhinitis refractory to medical therapy who underwent RF turbinate surgery were enrolled in this study. The efficacy of RF turbinoplasty in treating nonallergic rhinitis in elderly patients was evaluated by using rhinoscopy and a visual analog scale score of nasal symptoms. Results The response rate of primary RF turbinate surgery for nonallergic rhinitis refractory to medical therapy was 68.6%. Postoperative symptom scores for rhinorrhea and nasal obstruction were significantly improved. Persistent crust formation developed in seven patients (20.0%). No patient experienced major complications (e.g., septal hematoma, abscess, septal perforation), but partial bone necrosis was observed in one patient. Conclusion RF turbinoplasty appeared to be effective for treating some nonallergic rhinitis symptoms in elderly patients, including rhinorrhea and nasal obstruction. These preliminary results are encouraging and warrant further investigation.

Crushed cartilage grafts are used to conceal irregularities and achieve a smoother nasal surface. They can potentially be stabilized by a fibrin sealant acting as a carrier. The primary purpose of this study was to assess the clinical outcome of crushed cartilage-fibrin sealant combination grafts for radix augmentation performed in Asian patients.This study included 51 patients (38 men and 13 women) who underwent rhinoplasty with radix augmentation using crushed cartilage grafts. The malleable construct used for radix augmentation contained autologous crushed cartilage grafts stabilized with a fibrin sealant. Preoperative and postoperative photographs were reviewed for objective and subjective assessment of aesthetic outcomes. The mean follow-up period was 18.5 months (range, 12 to 25 months).Preoperative and postoperative objective measurements indicated that the mean increment of the radix projection was 28.5 ± 7.9 percent and that of the nasofrontal angle was 11.5 ± 3.8 degrees. Most patients showed prominent radix augmentation and good cosmetic results. Postoperative aesthetic outcomes were graded as excellent in 41.2 percent of cases, good in 37.3 percent, fair in 15.7 percent, and unchanged/poor in 5.9 percent. Complications included one case (2.0 percent) of partial graft resorption and two cases (3.9 percent) of graft visibility.The results show that the use of a crushed cartilage-fibrin sealant graft is a reliable and effective technique of stabilizing grafts for radix augmentation in Asian patients.Therapeutic, IV.

Objective Septal body hypertrophy, like inferior turbinate hypertrophy, can result in changes to the nasal cross-sectional area and resistance to airflow. The aim of this study is to evaluate the efficacy of septal body volume reduction (SBVR) for the treatment of septal body hypertrophy in patients with nasal obstruction. Study Design Prospective randomized study. Methods The study was conducted on two groups (51 patients) with symptoms and signs of nasal obstruction associated with septal body and inferior turbinate hypertrophy that were refractory to medical therapy. In the turbinoplasty only (ITR) group (n = 25), conventional turbinoplasty was only performed on the inferior turbinate. In the septal body reduction (SBR) group (n = 26), concurrent bilateral microdebrider-assisted SBVR was performed during the turbinate surgery. Results The nasal symptoms, including nasal obstruction, rhinorrhea, itching, and sneezing, had significantly improved at 3 months after treatment in both groups (P

Background The purpose of this study was to investigate the effect of aerosolized fibrin sealant (FS) compared with that of polyvinyl acetal sponge packing on hemostasis and wound healing after functional endoscopic sinus surgery (FESS). Methods We conducted a prospective randomized controlled trial of the use of aerosolized FS in 41 consecutive patients who underwent bilateral FESS between February 2011 and March 2012. The patients were randomized to receive FS applied via an aerosol spray in one nasal cavity and polyvinyl acetal sponge packing in the opposite cavity. The patients were followed up at 1, 2, 4, 8, and 12 weeks postoperatively. Crusting, adhesion, bleeding, granulation tissue formation, infection, and frontal sinus ostium stenosis after endoscopic surgery were assessed using a grading scale. Subjective symptoms related to nasal packing were evaluated using questionnaires quantified by visual analog scales. Results The degree of granulation and crusting was significantly reduced in the side treated with FS compared with the polyvinyl acetal sponge side, as were bleeding and pain during nasal packing removal (p < 0.05). In addition, general satisfaction and willingness to reuse the material were significantly higher for the FS-treated side than for the polyvinyl acetal sponge-packed side (p < 0.001). Conclusions Compared with polyvinyl acetal sponge, aerosolized FS shows beneficial effects on hemostasis and wound healing after FESS. The application of FS resulted in a high degree of patient satisfaction without additional morbidity.

Importance Chronic rhinosinusitis (CRS) is associated with a decreased quality of life, affecting physical and emotional aspects of daily function, the latter of which could manifest as depression and anxiety. Objective To evaluate the risk of depression and anxiety in CRS, depending on the CRS phenotype (CRS without nasal polyps [CRSsNP] and CRS with nasal polyps [CRSwNP]). Design, Setting, and Participants This retrospective nationwide cohort study used population-based insurance data (consisting of data from approximately 1 million patients). The study population included 16 224 patients with CRS and 32 448 individuals without CRS, with propensity score matching between groups according to sociodemographic factors and enrollment year. Data were collected from January 1, 2002, through December 31, 2013, and analyzed from July 1 through November 15, 2018. Main Outcomes and Measures Survival analysis, the log-rank test, and Cox proportional hazards regression models were used to calculate the incidence, survival rate, and hazard ratio (HR) of depression and anxiety for each group. Results Among the 48 672 individuals included in the study population (58.8% female), the overall incidence of depression during the 11-year follow-up was 1.51-fold higher in the CRS group than in the non-CRS group (24.2 vs 16.0 per 1000 person-years; adjusted HR, 1.54; 95% CI, 1.48-1.61). The incidence of anxiety was also higher in the CRS group than in the comparison group (42.2 vs 27.8 per 1000 person-years; adjusted HR, 1.57; 95% CI, 1.52-1.62). Moreover, the adjusted HRs of developing depression (CRSsNP, 1.61 [95% CI, 1.54-1.69]; CRSwNP, 1.41 [95% CI, 1.32-1.50]) and anxiety (CRSsNP, 1.63 [95% CI, 1.57-1.69]; CRSwNP, 1.45 [95% CI, 1.38-1.52]) were greater in patients with CRSsNP than in those with CRSwNP. Conclusions and Relevance This observational study suggests that CRS is associated with an increased incidence of depression and anxiety. Specifically, findings from this study found that patients without nasal polyps showed a higher risk of developing depression and anxiety than those with nasal polyps.

Low-concentration hypochlorous acid (HOCl) is an endogenous antibacterial and antiviral agent. The purpose of this study was to evaluate the effectiveness of HOCl irrigation in patients with chronic rhinosinusitis (CRS) refractory to medical therapy. Forty-three adult patients (mean age 45.5 years) were enrolled in this study. They were randomly chosen to receive nasal irrigation with either low-concentration HOCl generated by a Salicid device (n = 21), or a placebo (saline; n = 22) for 8 weeks. The outcome measures were scores on the 20-Item SinoNasal Outcome Test (SNOT-20), rhinosinusitis disability index (RSDI), nasal endoscopic score, and bacterial cultures. The SNOT-20 scores were significantly lower in the HOCl group than in the placebo group after 2 weeks of treatment (p 0.05) and remained lower after 4 weeks of treatment. With respect to the RSDI scores, there was a significant improvement in the HOCl group at 1 week after treatment and in both groups at 2 weeks after treatment (p 0.05). There were no significant differences in the endoscopic scores between the two groups after the treatment. The bacterial culture rates were lower in the HOCl group than in the placebo group after 4 weeks of treatment, but this was not significant (p 0.05). Our results showed that low-concentration HOCl irrigation resulted in a greater improvement in CRS symptoms as compared to saline irrigation.

Radiofrequency surgery was introduced to minimize thermal damage to the tissue. A radiofrequency electrode can be used to make cuts in the free edge of the soft palate like those done in laser-assisted uvulopalatoplasty [radiofrequency-assisted uvulopalatoplasty (RAUP)]. Tonsillectomy can enlarge the lateral diameter of the pharynx. The aim of our study was to evaluate the efficacy of RAUP with tonsillectomy in treatment of obstructive sleep apnea syndrome (OSAS). Ninety-two patients with obstructive sleep apnea were included in this study. Patients were categorized according to disease severity and Friedman's staging system. Patients were assessed with the preoperative visual analog scale (VAS) for snoring, Epworth Sleepiness Scale (ESS) and apnea-hypopnea index (AHI) at baseline and repeated at 6 months postoperatively. The intensity of postoperative pain, speech deficits and dysphagia were also recorded. There was a significant improvement in the VAS score for snoring, ESS and AHI before and after surgery. Overall, the results of the present study indicated a surgery success rate (a 50 % decrease in AHI and AHI

Objective Conventional bilateral same-day tympanoplasty or myringoplasty has been rarely performed because of the risk of postoperative complications. Inlay butterfly cartilage myringoplasty (IBCM) has been shown effective for same-day closure of bilateral tympanic membrane perforations and is a quicker and more comfortable procedure for the patient. Immediate postoperative hearing is not compromised by packing materials because no external canal packing or middle ear support is required. We assessed the efficacy and safety of bilateral same day IBCM. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Of the 81 patients (age range, 9-64 years) who underwent conventional tympanoplasty/mastoidectomy for bilateral perforated chronic otitis media between June 2005 and September 2009, 17 with small-to-medium perforations and no history of otorrhea underwent same-day cartilage IBCM on the contralateral ear. Median follow-up duration was 13.0 months. Results The graft take rate was 100 percent, with no retraction pockets or displaced grafts observed during follow-up. Mean air−bone gap was improved from 15.8 to 8.4 dB. Twelve patients had an average air−bone gap between 0 and 10 dB, three between 11 and 20 dB, and two between 21 and 30 dB. Two patients had myringitis postoperatively, but it improved with antibiotic treatment. Conclusion Bilateral same-day IBCM offers favorable outcomes in selected patients.

Purpose Fibrin sealant (FS) was approved as a hemostatic agent, sealant, and adhesive by the Food and Drug Administration in 1998. Our study sought to determine whether FS also reduced edema and pain in rhinoplasty without osteotomy. Materials and Methods We conducted a prospective randomized trial involving patients who underwent open rhinoplasty without osteotomy. The patients were randomly assigned to 1 of 2 groups: those treated with aerosolized FS (FS group) and those not treated (control group). The effect of FS on edema of the eyelid, edema of the dorsum and tip of the nose, and periorbital ecchymosis was separately rated postoperatively using a scale of 0 to 4 or 0 to 3. Postoperative pain was evaluated using questionnaires quantified with a visual analog scale. The Mann-Whitney U and Wilcoxon tests were used to compare parameters between the groups. Results A total of 41 patients were included in this study. The FS group (n = 20) consisted of 13 male and 7 female patients with a mean age of 34.8 ± 5.8 years. The control group (n = 21) consisted of 15 male and 6 female patients with a mean age of 32.4 ± 4.8 years. There were no statistically significant differences between the 2 groups with respect to age, gender, or combined surgical techniques (P > .05). Aerosolized FS significantly reduced not only ecchymosis and swelling in the periorbital area but also edema of the nasal dorsum (P Conclusions Aerosolized FS can be effective for reducing eyelid edema, dorsal edema, and periorbital ecchymosis after open rhinoplasty. FS may serve as an adhesive for minimizing dead space by promoting adherence of the skin flap and as a hemostatic agent in reducing the amount of postoperative bleeding by sealing capillary vessels.

When compared with Caucasian noses, the typical Asian nose appears to be relatively small and flat and has poor tip definition. Therefore, the main concept of rhinoplasty for Asians is augmentation rather than reduction. In selecting the dorsal implant material, skin thickness should be considered. Although autologous cartilage has the lowest risk of infection among graft materials, autologous cartilage including costal cartilage is associated with a significant risk of revision surgery due to aesthetic failure. Alloplastic implants, including silicone and Gore-Tex, are easy to use and can reduce operation time. But they carry significant risks of complications including infection, deviation, extrusion, and delayed inflammation, which must be seriously considered by rhinoplasty surgeons. Cartilage grafting procedures, including shield graft, onlay graft, modified vertical dome division, and septal extension graft, are mainstays in proper projection and better refinement of the Asian tip, which is intrinsically round and underdeveloped in its appearance. In placing a shield graft, it is important to place an additional supporting graft at the cephalic border and additional tip grafts at the caudal aspect, so that the final tip graft complex has an antero-caudal projection on the profile view.

Objectives/Hypothesis: Vertical dome division (VDD) is a useful nasal tip surgery technique. However, it is associated with postoperative complications and has never been studied in Asian patients. This study examined results following application of our modified VDD approach in Asian patients requiring nasal tip surgery. Study Design: A retrospective clinical chart review. Methods: We retrospectively studied 37 patients who underwent rhinoplasty using our modified VDD procedure. The indications were thick tip skin and relatively strong and well-developed lower lateral cartilages. Outcome measurements were made using preoperative and postoperative photographs. Doctors and patients separately indicated satisfaction using a visual analogue scale (from 1 = satisfied, to 4 = dissatisfied). Results: Following surgery, the mean tip projection increment across the population was 15.8%, and the nasofrontal and nasolabial angle increments were 1.4° and 5.5°, respectively. Doctor and patient satisfaction scores were 1.54 ± 0.76 and 1.61 ± 0.81, respectively. Most patients showed prominent tip projection and good cosmetic results. Two patients (5.4%) were dissatisfied, one due to a narrow tip and the other due to nostril asymmetry. Conclusions: The modified VDD was an effective method for nasal tip projection and rotation in selected Asian patients. Laryngoscope, 2010

Burkitt's lymphoma is a highly aggressive small B-cell lymphoma. The treatment of choice is complex chemotherapy. As a rare tumor in the head and neck area, Burkitt's lymphoma usually involves cervical lymph nodes, and only fewer than 25% of cases involves extranodal regions. Involvement of the paranasal sinuses has been reported in only 14 cases in the past century. We describe here two patients with rare, sporadic, American type Burkitt's lymphoma involving the nasal cavity and paranasal sinuses manifesting nasal obstruction. We also review clinical and histological features of Burkitt's lymphoma.

Background: Preoperative computer simulation (PCS) is a tool for demonstrating potential rhinoplasty results to patients and determining the patient’s preferred external nasal appearance. Objectives: The authors evaluated the effectiveness of PCS in Asian rhinoplasty patients. Methods: The records of 224 patients who underwent rhinoplasty were reviewed. Sixty-eight (30.4%) of these patients had received PCS. To evaluate the accuracy of PCS in predicting postoperative results, postoperative photographs and PCS images were graded on a 4-point scale by a panel of 3 otolaryngologists. Postoperative patient satisfaction was compared between the PCS and non-PCS groups. Aesthetic parameters were assessed in the PCS images to determine the patient’s preferred external nasal appearance. Results: The mean overall accuracy of PCS was 86.0% according to the otolaryngologist panel’s ratings: 41.2% of the surgical results were rated as identical, 44.1% as similar, 13.2% as approximate, and 1.5% as poor. There were no significant differences between the PCS and non-PCS groups in terms of patient satisfaction or revision rates ( P > .05). The most favored nasal appearances were straight dorsum (63.2%), straight columella (50.0%), and convergent alar axis (64.7%). The mean (± standard deviation) preferred nasofrontal and nasolabial angles were 137.5° ± 6.9° and 97.3° ± 8.6°, respectively. Conclusions: Preoperative computer simulation is an accurate tool for assessing preferred external nasal appearance and can be a reliable predictor of postoperative rhinoplasty results in Asian patients. Level of Evidence: 3 ![Graphic][1] [1]: /embed/inline-graphic-1.gif

Tutoplast-processed fascia lata (TPFL) is a commercially available homograft that has been successfully used as graft tissue for rhinoplasty. The present study evaluates the histomorphological changes of TPFL in a rabbit rhinoplasty model.Prospective study using a rabbit model.Animal laboratory of the Asan Medical Center.The study used 15 New Zealand White rabbits. Each rabbit was implanted with a TPFL (experimental group) and autologous fascia lata (control group) graft of equal size into the nasal dorsum. Rabbits were killed at 1, 3, and 6 months, and the grafts were removed and microscopically assessed for fibroblast proliferation, neovascularization, inflammation, and thickness.For TPFL grafts, the degree of inflammation significantly decreased between 1 and 3 months (P = .041). The degree of fibroblast proliferation continually increased over time. There was a mild degree of neovascularization for the TPFL graft at 1 month. The degree of neovascularization increased between 3 and 6 months (P = .041). For the degree of inflammation, fibroblast proliferation, and neovascularization, there was no significant difference between TPFL and autologous fascia lata at 6 months. Mean thickness analysis showed that there was no significant thickness reduction in both TPFL and autologous fascia lata grafts at 6 months.The TPFL grafts showed negligible resorption rates and favorable tissue reactions in the rabbit rhinoplasty model.

Control of perioperative infection can increase the success rate of organ transplant. The incidence, clinical features, and optimal management of chronic otitis media (COM) in solid organ transplant recipients have not been adequately evaluated. We therefore assessed the incidence and clinical course of COM in solid-organ transplant recipients.Case series with chart review.Tertiary referral center.We reviewed the medical records of 3278 patients who underwent solid organ transplantations between February 1995 and December 2007 to identify those diagnosed with COM before and after transplant. We analyzed the long-term clinical course and management of COM in these patients.Of 3278 solid organ transplant recipients, 65 (2.0%) were diagnosed with pretransplant COM with a perforated ear drum, including 31 liver, 28 renal, and 6 heart transplant recipients. The primary symptom was otorrhea, followed by hearing disturbance, otalgia, and tinnitus. Middle ear swab culture showed bacterial growth in 17 of the 40 patients (42.5%) with suppurative COM. Of these 40 patients, 14 underwent tympanomastoid surgery (operation group) and 26 were prescribed antibiotics (medication group). The remaining 25 patients, with dry perforated ear drums and well-pneumatized mastoids, were observed without treatment (observation group). After transplantation, the incidence of otorrhea was significantly lower in the operation group (11.1%) than in either the medication (26.9%) or observation (26.7%) group (P = .040, .048, respectively).Precise diagnosis and proper surgical intervention for COM may reduce the rate of otorrhea and exacerbation of COM in solid organ transplant recipients.

Objective To evaluate changes in vertigo and hearing from patients with Meniere's disease managed by endolymphatic mastoid shunt (EMS). Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Data from 16 patients were analyzed using 1995 AAO–HNS criteria. Results Among 16 patients, six had class A vertigo control two years after treatment, five had class B, one class C, three class D, and one class F. At four years after surgery, seven patients had class A, four class B, three class C, and two class F. The mean functional level before surgery was 4.8 and improved to 2.9 and 2.6 at two years and four years after surgery, respectively. The bone conduction pure-tone averages (four frequencies) were 43.3 before surgery and improved to 33.5 dB HL and 35.5 dB HL at three and six months after surgery, respectively. At two years of follow-up, the hearing level was 38.6 dB HL and was not different from the preoperative hearing level. Two years after surgery, the hearing level gradually decreased and was 42.0 dB HL at five years of follow-up. Conclusion EMS appears to be beneficial in the short term for the symptomatic patients.

Primary intraosseous venous malformations are rare benign tumors that account for approximately 1% of all primary osseous tumors. They are rarely found in the midface. The authors report a case of an intraosseous venous malformation in a 28-year-old woman who presented with a bony lesion in the nasal bone. Treatment involved surgical excision via open rhinoplasty. Histopathology indicated an intraosseous venous malformation. 16 months postoperatively, there was no evidence of recurrence, the functional and cosmetic results were good, and the patient was satisfied with the treatment outcome.

비성 두통은 비강이나 부비동의 직접적인 원인에 의해 발 생하는 이차성 두통으로서 그 원인으로 비부비동염이나 비 내 접촉점이 있는 경우, 혈관 운동성 비염 등을 들 수 있다. 급 성 또는 만성 비부비동염에 의한 통증은 두통과 안구 주위 둔통의 원인 중 하나로, 비내시경이나 영상 검사 등에서 비 부비동염의 소견이 관찰되고 비부비동염이 심해질 경우 두 통이 더 심해지는 양상으로 비부비동염의 성공적인 치료시 약 7일 이내 호전을 보이는 것을 말한다. 접촉점 두통은 비내 시경이나 전산화단층촬영에서 접촉점이 관찰되는 경우로, 접촉면에 국소 마취시 5분 이내 통증이 사라지고 접촉면 교 정시 7일 이내 의미 있는 임상 증상의 호전이 있는 경우 생각 해 볼 수 있다. 물론 급성이나 만성 부비동염 등 염증의 증 거가 있는 경우엔 접촉점 두통의 진단에서 제외된다. 저자들 은 수년간의 약물 치료와 수술적 치료에도 반응하지 않는, 접촉점은 관찰되지 않으나 비강내 국소적 마취에 의해 통증 이 경감되는 양상의 비성 두통에 대하여 고주파 투열 치료 후 증상 호전된 1예를 치험하여 문헌 고찰과 함께 보고하고 자 한다.

Pneumosinus dilatans is a rare disease in which 1 or more paranasal sinuses are dilated without functional alteration. The frontal sinus is the most commonly affected site, with involvement of the maxillary sinus being rare. A 25-year-old man had complained of facial pain and headache of frontal area. These symptoms were aggravated after nose blowing. A computed tomographic scan showed a hyperaeration of both maxillary sinus and frontal sinus. We treated the condition by endoscopic sinus surgery (middle meatal antrostomy, both). Just after operation, facial pain and headache of frontal sinus have subsided. No recurrence was detected. In this article, the authors present surgical options for the treatment of pneumosinus dilatans of the maxillary sinus, including a review of the literature. � Korean J Otorhinolaryngol-Head Neck Surg 2013;56:233-6

Penetrating traumatic laryngeal injuries are relatively rare and traumatic injuries to the epiglottis are extremely rare. The present case is 58-year old man with suicidal history, chronic alcoholism, and schizophrenia who complained of neck laceration and unconsciousness after stab injury. Examination revealed a large transverse laceration of 7 cm in size, penetrating deep to the level of thyroid cartilage from the lateral border of the sternocleidomastoid muscle, exposing the thyroid cartilage. There was about a 3 cm-sized deep wound under the thyroid gland level but no major vessel injury. The stump of transected epiglottis accompanied by rupture of thyroid membrane was shown but the esophagus was intact. We sewed the amputated epiglottis with the rest of the epiglottis by using two Lambert sutures with vicryl 4-zero on each side under general anesthesia. There was no necrosis of the severed epiglottis, swallowing difficulty, and aspiration on eating food. We report here on the penetrating lacera tion with subtotal transection of epiglottis that was successfully repaired. � Korean J Otorhinolaryngol-Head Neck Surg 2012;55:369-72 Key WordsZZPenetrating neck injury ㆍAmputated epiglottis ㆍSurgery ㆍ Sternocleidomastoid(SCM).

It is important to both recognize parotid duct injuries and immediately repair them to prevent complications that accompany these injuries. Although there have been some reports of successful conservative treatments of the parotid duct injury, many authors recommend early surgical repair of the parotid duct and, when possible, primary anastomosis as the best treatment. Sialography is very useful for the diagnosis of parotid duct injury and can also support the information of parotid duct system. We present three cases of successful treatment of parotid duct injury with surgical repair. Also, we discuss about the effectiveness of surgical repair of parotid duct injury and how to assess it preoperatively. � Korean J Otorhinolaryngol-Head Neck Surg 2011;54:77-80

Paget's disease is a well-known disorder of unclear etiology that results in deformity and enlargement of single or multiple bones due to abnormal osteoclastic-osteoblastic remodeling of bone. Osteoclastoma, also known as giant cell tumor, is a rare complication of Paget's disease that usually occurs in the skull or facial bones. This is a report of a 35-year-old woman with recurrent osteoclastoma of the sino-nasal tract, a complication of Paget's disease, for which she underwent 4 operations. Clinicopathological features of this rare disease are described here.

Background Burr-hole trephination is a widely used surgical technique for chronic subdural hematoma (CSDH). Although various postoperative complications following burr-hole craniostomy have been discussed, no contralateral acute SDH (ASDH) immediately after the initial surgery without concurrent hemorrhages has been reported so far; we experienced this very rare complication in a previously healthy 84 year old male. Details of this very rare case are presented in this report. Materials and methods 87 patients with chronic SDH underwent a burr hole trephination, that is, craniostomy between July 2012 and June 2014; there were 47 male and 40 female patients. 24 of 87 patients harbored bilateral SDHs. 67 of 111 lesions were drained with two catheters and the remaining 44 employed a single catheter. Results Unsatisfactory results following the craniastomy included recurrence, insufficient drain, aggravated acute SDH and contralateral development of incracranial hemorrhage. Contralateral intracranial hemorrhage occurred to three patients. One died and the other two were discharged without any sequelae. One of the three contralateral hemorrhages was a mere ASDH which was complicated to a previously healthy 84 year old male within less than an hour after the initial surgery. The patient was discharged without sequelae. Conclusion This report represents a contralateral ASDH that occurred less than an hour after a burr-hole trephination for CSDH. Several hypotheses concerning the etiology of this rare complication, albeit inconclusive, are worth contemplation. Excessive drain of CSDH must be refrained from in order not to encounter any unexpected complications.