Jae Ho Ban

Surgical Treatment Using an Allograft Dermal Matrix for Nasal Septal Perforation

Purpose Numerous methods have been utilized to repair nasal septal perforation with varying degrees of success; however, no consensus has been reached on nasoseptal perforation repair. Here, the authors describe a surgical method based on human dermal allograft (Surederm™, Hans Biomed Corp. Korea) for the repair of nasal septal perforations. Materials and Methods Eleven patients with a nasal septal perforation were included in this study. The causes of these septal perforations included previous nasal surgery, trauma, foreign body (button battery), and idiopathy. There were several sites of perforation: 9 in the central area, 1 in the posterior-central area, and 1 in the anterior area. An interpositional graft incorporating Surederm™ was positioned between bilateral mucoperichondrial flaps using an intranasal approach. A silastic sheet was then left in the nasal septum bilaterally until complete healing had occurred through new nasal mucosa, which took a mean duration of 6 weeks. Results Outcomes in ten of the eleven patients were successful, with complete septal perforation closure. The remaining perforation, which was caused by a button battery, closed incompletely; however, its initial size of 2 cm was reduced to 5 mm. Conclusion The described technique has a high success rate and can be performed under local anesthesia without external scarring. In the absence of donor site morbidity, this technique can also be utilized to repair posterior or multiple septal perforations without difficulty.

Nystagmus-Based Approach to Vertebrobasilar Stroke Presenting as Vertigo without Initial Neurologic Signs

Background: We aimed to investigate the clinical courses and common nystagmus of isolated vertigo patients with vertebrobasilar stroke. Methods: The patients who presented with isolated acute spontaneous vertigo with spontaneous nystagmus (acute vestibular syndrome) at the Emergency Department were retrospectively analyzed. They were referred to the Otolaryngology Department due to the absence of neurologic signs or even of imaging abnormalities after the initial examination at the Emergency Department. Various clinical features, including presenting symptoms, delayed neurologic signs, the site of infarction, and videonystagmographic (VNG) findings were analyzed. Results: Of the 468 cases of acute vestibular syndrome, 23 (4.9%) cases of radiologically proven vertebrobasilar stroke were identified. Of the 23 patients, 17 (74%) showed aggravation of vertigo or delayed neurologic signs during the admission. In the analysis of VNG, 11 (48%) cases of direction-changing gaze-evoked nystagmus, 7 (30%) cases of fixation failure in the caloric test, 6 (27%) cases of periodic alternating nystagmus, and 4 (17%) cases of atypical head-shaking nystagmus were presented. Stroke occurred in the cerebellum (n = 18, 78%), medulla (n = 4, 17%), and pons (n = 1, 4%). Conclusion: In the early stage of vertebrobasilar stroke, an accurate diagnosis was difficult in the Emergency Department even though a radiologic study was performed, but various VNG abnormalities and delayed neurologic signs could help to diagnose whether the origin is central or not.

Basaloid squamous cell carcinoma of the external auditory canal: case report

Basaloid squamous cell carcinoma (BSCC) is a rare malignancy, with features of both basal cell carcinoma and squamous cell carcinoma. The tumor has a predilection for the upper aerodigestive tract, and has been suggested to behave more aggressively than squamous cell carcinoma (SCC). To the author’s knowledge, BSCC confined to the external auditory canal (EAC) has not been previously described. BSCC of EAC manifests similar characteristics as the conventional EAC cancer, presenting a mass with chronic otorrhea and itching sense. Excision of the tumor was accomplished by modified lateral temporal bone resection. This report describes the first case of BSCC in this location, and includes reviews of the pathologic and clinical aspects of this disease.

Immediate and Short-Term Therapeutic Results Between Direction-Changing Positional Nystagmus with Short- and Long-Duration Groups.

Objectives: Clinicians sometimes treat patients with relatively long-duration geotropic direction-changing positional nystagmus (DCPN), without latency. Recently, the concept of a “light cupula” in the lateral canal that reveals persistent geotropic DCPN has been introduced. In the present study, we investigated the immediate and short-term therapeutic findings in long-duration DCPN. Design: The authors prospectively compared the therapeutic efficacy of a canalith-repositioning procedure (CRP) in short- and long-duration geotropic DCPN. Results: In patients with long-duration DCPN, the authors found no immediate therapeutic effect, and the number of patients showing short-term effects (on the next day) was very low compared with the comparable figure among those with short-duration DCPN. In addition, no cases exhibited canal conversion after the CRP. Conclusion: Our results suggest that CRP is not useful in patients with long-duration geotropic DCPN, and the pathogenesis of long-duration geotropic DCPN may not originate from free-floating debris but from deflection of the cupula.

Outcomes of endoscopic sinus surgery in an elderly population: comparison with those in an adult population.

Clin. Otolaryngol. 2010, 35, 300–306

Investigation into psychological correlates of patients with vocal nodules using the Symptom Checklist-90-Revision.

OBJECTIVE The purpose of this study was to analyze the psychological characteristics of patients with vocal nodules and to establish the relationship between these characteristics and the development of vocal nodules. SETTING A tertiary medical centre. DESIGN AND METHOD The patient group consisted of 41 housewives with vocal nodules, and the control group consisted of 35 housewives who did not have any vocal pathology. The subjects completed questionnaires related to the voice disorder and the Symptom Checklist-90-Revision. OUTCOME MEASURES The scores of the patient group with less than 1 year of symptom duration (acute) and more than 1 year of symptom duration (chronic) were also compared with those of the controls. RESULTS AND CONCLUSION The total patient group differed statistically from the control group on seven neurotic dimensions (p < .001) and one psychotic dimension (p < .05). The acute group differed on two neurotic dimensions (p < .05). We suggest that the neurotic traits found in the acute group may play a role in the development of vocal nodules. The dimensions in which the total patient group differed significantly from the control group may indicate the changes that occur in the psychological characteristics following voice change. The collective results indicate that psychological characteristics play an important role in the pathogenesis of vocal nodules. Hence, greater attention should be given to the psychological and emotional aspects of patients for the treatment and prevention of vocal nodules.

ORIGINAL ARTICLE: Outcomes of endoscopic sinus surgery in an elderly population: comparison with those in an adult population

Clin. Otolaryngol. 2010, 35, 300–306

Effect of Medication for Residual Symptoms in BPPV: Randomized Controlled Trials:

Objectives: Even after successful canalith repositioning procedures (CRPs) in benign paroxysmal positional vertigo (BPPV), residual symptoms could be continued without positional nystagmus. The aim of this study was to evaluate the effect of adjuvant medication on residual symptoms after successful CRPs Methods: Between January 2011 and August 2012, 150patients with idiopathic BPPV participated. Patients who had previous history of psychiatric disorder or migraine were excluded. All participants were diagnosed by video-nystagmography (VNG), and Dizziness Handicap Inventory (DHI) questionnaires were completed before CRPs. All subjects were divided into three groups after successful CRPs. Medication (M) group was treated with vestibular suppressant (dimenhydrinate 25mg), placebo (P) group and no medication (N) group. One week after, all patients completed follow up VNG for recurrence and repeated DHI questionnaires for comparing residual symptoms. Results: All participants regardless of groups showed significant symptom improvement after successful CRPs, but 76 patients complained of residual symptoms. Presence of residual symptoms was more prevalent in P or N group compared with M group (P = 0.048, P = 0.03, respectively). Most frequent characteristics of residual symptoms were lightheadedness or mild headache (n = 36). However, in the analysis of DHI, total and subscale scores of DHI were not different between three groups before and after successful CRPs. Conclusions: Vestibular suppressant significantly reduced residual symptoms after CRPs. However, there is no significant reduction on DHI scores compared to a control group. It seems that residual symptoms may not be true vertigo but lightheadedness or headache.

ORIGINAL ARTICLE: Outcomes of endoscopic sinus surgery in an elderly population: comparison with those in an adult population: Endoscopic sinus surgical outcomes in an elderly and an adult population

Clin. Otolaryngol. 2010, 35, 300–306