Joong Keun Kwon

Comparison of different grafting techniques in type I tympanoplasty in cases of significant middle ear granulation.

Objective To assess anatomical and hearing results after different reconstruction methods of tympanic membrane in cases of severe middle ear granulation. Study Design Retrospective review. Setting Secondary care medical center. Patients Forty patients with severe middle ear granulation were included. Interventions Canal wall-up mastoidectomy with Type I tympanoplasty. Temporalis fascia was used in 22 patients, cartilage island flap was used in 10 patients, and cartilage palisade was used in 8 patients. Main Outcome Measures Graft take, air-bone gap, and air-bone gap closure ratio of 50% or more. Results In the fascia group, the graft take rate was 91%, whereas the graft take rate for the cartilage island group and the cartilage palisades group was 100% (p = 0.617). Mean ± SD preoperative air-bone gaps for the fascia, island flap, and cartilage palisades were 30 ± 9.4, 26 ± 11.7, and 25 ± 10.8 dB, respectively. Postoperative air-bone gaps were 17 ± 10.2, 14 ± 8.4, and 19 ± 7.5 dB, respectively, in the same order. The cartilage palisades group failed to show statistically significant difference between preoperative and postoperative air-bone gaps (p = 0.195). Air-bone gap closure ratio of 50% or more was found in 11 cases (50%) of the fascia group, in 5 cases (50%) of the island flap group, and in 1 case (13%) of the cartilage palisades group. Conclusion Cartilage palisades showed reliable graft take but slightly poor hearing results. Thus, fascia or cartilage island grafting might be better for tympanoplasty in cases of severe middle ear granulation tissue.

Impact of adenotonsillectomy on nocturnal enuresis in children with sleep-disordered breathing: A prospective study.

To investigate the relationship between sleep‐disordered breathing (SDB) and nocturnal enuresis (NE) in children and to prospectively evaluate the effectiveness of adenotonsillectomy on resolving enuresis in indicated SDB patients with NE.

Acute supraglottitis in adults: What's the optimal airway intervention?

OBJECTIVES To validate the Friedman stage and define the proper timing for airway intervention in adult cases of acute supraglottitis, we evaluated the clinical courses and management of adult patients. METHODS 202 adult patients with acute supraglottitis were included in this study. The diagnosis of supraglottitis was established by flexible nasolaryngoscopic examination. Friedman stages were classified in each patient. In this study, the first three days of serial nasolaryngoscopic findings for each patient were evaluated. RESULTS All patients were treated successfully with only conservative methods. There were no significant differences between patients with Friedman stages I or II/III. Among the patients that had serial nasolaryngoscopic findings, only one patient presented with progressive swelling of the epiglottis, and there were no cases of persistent swelling. CONCLUSION The airway intervention threshold should be raised from Friedman stages II-III. And, airway intervention should not be needed if patients are tolerant of their respiratory discomfort.

Effect of fibrin-coated collagen fleece (TachoComb) on pain and bleeding after adenotonsillectomy in children

Abstract Conclusion: Even though the use of TachoComb does not decrease pain after tonsillectomy, it is safe and useful to reduce bleeding after tonsillectomy. Objectives: Sealing the post-tonsillectomy wound would be expected to reduce pain and bleeding by decreasing the exposure of the traumatized tissue and sensory nerves. TachoComb is a powerful topical hemostatic agent. The objectives of this study were to evaluate the effect of TachoComb on reduction of pain and bleeding after tonsillectomy. Methods: A prospective randomized double-blind study was performed on 120 pediatric patients undergoing adenotonsillectomy. The patients were randomized into two groups: use/non-use of TachoComb. In the study group, each tonsillar bed was covered with a TachoComb strip at the end of operation. No hemostatic agents were used in the control group. After surgery, patients were monitored for pain, bleeding, oral intake, medication administration, activity, and complications using a 10-day diary. Results: In all, 110 patients returned and filled in the diary. The use of TachoComb did not decrease pain, reduce the use of analgesic drugs or speed recovery to normal everyday life. Post-surgery bleeding was not experienced by any of the TachoComb patients, but occurred in five of the control patients. The result had borderline statistical significance (p < 0.1).

Simultaneous versus Sequential Intratympanic Steroid Treatment for Severe-to-Profound Sudden Sensorineural Hearing Loss

Objectives: Severe-to-profound sudden sensorineural hearing loss (SSNHL) has a poor prognosis. We aimed to compare the efficacy of simultaneous and sequential oral and intratympanic steroids for this condition. Methods: Fifty patients with severe-to-profound SSNHL (>70 dB HL) were included from 7 centers. The simultaneous group (27 patients) received oral and intratympanic steroid injections for 2 weeks. The sequential group (23 patients) was treated with oral steroids for 2 weeks and intratympanic steroids for the subsequent 2 weeks. Pure-tone averages (PTA) and word discrimination scores (WDS) were compared before treatment and 2 weeks and 1 and 2 months after treatment. Treatment outcomes according to the modified American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria were also analyzed. Results: The improvement in PTA and WDS at the 2-week follow-up was 23 ± 21 dB HL and 20 ± 39% in the simultaneous group and 31 ± 29 dB HL and 37 ± 42% in the sequential group; this was not statistically significant. Complete or partial recovery at the 2-week follow-up was observed in 26% of the simultaneous group and 30% of the sequential group; this was also not significant. The improvement in PTA and WDS at the 2-month follow-up was 40 ± 20 dB HL and 37 ± 35% in the simultaneous group and 41 ± 25 dB HL and 48 ± 41% in the sequential group; this was not statistically significant. Complete or partial recovery at the 2-month follow-up was observed in 33% of the simultaneous group and 35% of the sequential group; this was also not significant. Seven patients in the sequential group did not need intratympanic steroid injections for sufficient improvement after oral steroids alone. Conclusions: Simultaneous oral/intratympanic steroid treatment yielded a recovery similar to that produced by sequential treatment. Because the addition of intratympanic steroids can be decided upon based on the improvement after an oral steroid, the sequential regimen can be recommended to avoid unnecessary intratympanic injections.

Intradiploic Epidermoid of Temporal Bone Presenting as Pulsatile Tinnitus.

FIG. 1. CT and MRI scans of temporal bone. A, Axial view of Pulsatile tinnitus i that is synchronous with the patient’s heartbeat. Causes of pulsatile tinnitus are various and well documented in the literature. Venous causes of pulsatile tinnitus include a dehiscent jugular bulb, high flow through condylar or mastoid vein, local venous stenosis, idiopathic intracranial hypertension, sigmoid sinus diverticulum or dehiscence, and superior canal dehiscence associated with the superior petrosal sinus. In this case, intradiploic epidermoid caused pulsatile tinnitus by eroding the bony walls of the sigmoid sinus and posterior fossa.

Vallecular Rupture With Cervical Spine Fracture After a Failed Hanging Suicide Attempt

AbstractHanging is a common method of suicide. We present a case of vallecular rupture and cervical spine fracture without an external wound after a failed hanging suicide attempt. Surgical treatment involved posterior fusion of C2 to 3, followed by repair of the vallecular rupture via an external approach. The patient recovered with no residual physical or mental sequelae.