Kun Hee Lee

Prevalence of Otolaryngologic Diseases in South Korea: Data from the Korea National Health and Nutrition Examination Survey 2008

Objectives The aims of this study were to evaluate the prevalence of otolaryngologic diseases in Korea. Methods We obtained data from the 2008 Korea National Health and Nutrition Examination Surveys (KNHANES), which were cross-sectional surveys of the civilian, non-institutionalized population of South Korea (n=4,930). A field survey team that included an otolaryngologist, nurses, and interviewers moved with a mobile examination unit and performed otolaryngologic interviews and physical examinations. Results The prevalence of subjective hearing loss, tinnitus, preauricular fistua, tympanic membrane perforation, and cholesteatoma were 11.97%, 20.27%, 2.08%, 1.60%, and 1.18%, respectively. Dizziness and vestibular dysfunction were common among Korean adults, since 23.33% of the participants reported symptoms of dizziness or imbalance, and the prevalence of vestibular dysfunction was 3.86%. The prevalence of nasal diseases was relatively high, as the prevalence of allergic rhinitis, chronic rhinosinusitis, and a deviated nasal septum were 28.01%, 7.12%, and 42.94%, respectively. Subjective dysphonia was found in 6.60% of the participants, and the prevalence of subjective dysphonia increased with age. Conclusion This is the first nation-wide epidemiologic study to assess the prevalence of otolaryngologic diseases by both the Korean Otolaryngologic Society and the Ministry of Health and Welfare. Considering the high prevalence of otolaryngologic diseases in Korea, the results call for additional studies to better prevent and manage otolaryngologic diseases.

Prevalence of Subjective Olfactory Dysfunction and Its Risk Factors: Korean National Health and Nutrition Examination Survey

Background Population-based studies for olfactory dysfunction are lacking. The aim of this study is to evaluate the prevalence of subjective olfactory dysfunction and its risk factors in the Korean general population. Methods The data were obtained from the 2009 Korea National Health and Nutrition Examination Survey (KNHANES), which was a cross-sectional survey of non-institutionalized population all around the country (n = 10,533). All interviewees underwent medical interviews, physical examinations, endoscopic examination and blood/urine tests. Whether sense of smell has been normal or abnormal during the last 3 months was asked. Complete olfaction data were obtained from 7,306 participants and the participants were divided into normosmic and hyposmic group. Multivariate logistic regression analyses were performed to identify its risk factors. Results The weighted prevalence of subjective olfactory dysfunction was 4.5%. Its increased prevalence was significantly associated with the increasing age for both men and women. In the multivariate analyses, low income (adjusted odds ratio [OR] = 1.43, 95% Confidence Interval [CI] = 1.01–2.03), habitual exposure to air pollutants (adjusted OR = 2.18, CI = 1.33–3.55), a history of hepatitis B (adjusted OR = 3.10, CI = 1.25–7.68), rhinitis (adjusted OR = 1.78, CI = 1.26–2.51) and chronic sinusitis (adjusted OR = 14.55, CI = 10.06–21.05) were risk factors of olfactory dysfunction. Conclusion Our population-based study showed that olfactory dysfunction was quite prevalent and several risk factors were associated with impaired sense of smell. Given its prevalence, further researches for its prevention and management are required.

Changes in histological features of nasal polyps in a Korean population over a 17-year period.

Objective Nasal polyps can be categorized as eosinophilic or non-eosinophilic, depending on inflammatory cell infiltration. There are geographical differences in the prevalence of types of pathologic polyps. The aim of this study was to evaluate the change in the prevalence of histological subtypes of polyps over time in a Korean population. Study Design A retrospective cross-sectional study with histologic analysis. Setting A single academic medical center. Subjects and Methods A total of 230 patients with nasal polyps were enrolled between 1993-1994 (group A) and 2010-2011 (group B). Specimens were fixed in formalin and embedded into paraffin blocks. Slides were stained with hematoxylin-eosin (H&E) and were subsequently reviewed by 2 of the authors. The numbers of eosinophils per high power field (HPF), as well as other cellular, epithelial, and stromal markers, were recorded. Results We compared nasal polyp eosinophil counts according to time period. The average eosinophil count/HPF increased from 6.8 in group A to 19.3 in group B (P = .006). The prevalence of eosinophilic polyps also increased from 24.0% in group A to 50.9% in group B (P < .001). Among other histologic markers, lymphocytes, basement membrane thickening, and gland hyperplasia showed significant differences between groups. Conclusion After comparison of histopathologic findings of nasal polyps from 1993 and 2011 at 1 academic medical center in Korea, the prevalence of eosinophilic nasal polyps, which are known to be rare among Asians, has significantly increased.

Long-term Effects of Specific Allergen Immunotherapy Against House Dust Mites in Polysensitized Patients With Allergic Rhinitis

Purpose Allergen-specific immunotherapy is the only currently available treatment to modify the natural history of allergic rhinitis (AR). If patients are polysensitized, it is difficult to identify the allergen causing the allergic symptoms. We evaluated the effectiveness of immunotherapy against house dust mites (HDMs) in AR patients polysensitized to both HDMs and seasonal allergens. Methods Thirty AR patients polysensitized to both HDMs and seasonal allergens (group A) and 30 patients sensitized to HDMs only (group B) were enrolled in this study. All subjects who received immunotherapy against HDMs for more than 2 years were evaluated by the multiple allergen simultaneous test (MAST) to determine the specific IgE level in luminescence units, total eosinophil counts in peripheral blood, serum total IgE, total nasal symptom scores, and the rhinoconjunctivitis quality of life questionnaire (RQLQ) before and after immunotherapy. Results There were no statistical differences in levels of total and specific IgE, or total eosinophil count between the two groups. The total nasal symptom scores, RQLQ and medication scores significantly decreased after immunotherapy in both groups, however no significant differences were noted between the two groups. Conclusions We determined that the primary causative allergen of AR in Seoul, Korea is perennial allergens, such as HDMs, rather than seasonal allergens. This study provides a reference for the selection of allergens to use in immunotherapy for polysensitized AR patients living in an urban environment.

Comparison of level and degree of upper airway obstruction by Müller's maneuver and drug-induced sleep endoscopy in obstructive sleep apnea patients

OBJECTIVE This study aimed to compare and analyze the level and degree of observed upper airway obstruction in patients with obstructive sleep apnea (OSA) using Müllers maneuver (MM) and drug-induced sleep endoscopy (DISE). We sought to find a method for evaluating the upper airway that could be used to determine surgical sites. METHODS This study included 80 OSA patients who visited Kyung Hee Medical Center and underwent polysomnography (PSG) from March 2013 to March 2014. Obstructive levels observed by MM were classified into retropalatal level, or the lateral wall and retroglossal level. These levels were compared with those determined by DISE through the VOTE classification. RESULTS Based on the results of MM and DISE, lateral wall and retropalatal level obstructions showed relatively high conformity, while retroglossal level obstruction exhibited considerable differences. When evaluated at each level, patients with obstruction on MM also showed partial or complete obstruction on DISE at same level, and patients with no obstruction on DISE also showed no obstruction on MM at same level. CONCLUSION Both examination methods revealed the same obstruction levels in all cases except epiglottic level, but there were some differences in obstructive degree. MM is capable of detecting obstruction levels in the upper airway and can be used to determine surgical sites in cases when DISE cannot be used due to a patients condition or a clinics circumstances.

Multilevel surgery in patients with rapid eye movement-related obstructive sleep apnea.

Objective: To compare the anatomic features and the results of a multilevel surgery in patients with rapid eye movement–related obstructive sleep apnea (REM OSA) and non-REM OSA. Study Design: Cohort study of 90 consecutive mild or moderate OSA patients. Subjects and Methods: The apnea-hypopnea index (AHI) was also calculated during REM sleep (AHIREM) and during non-REM sleep (AHINREM), and patients were classified as having REM OSA if their AHIREM/AHINREM ratio was >2, otherwise they were classified as non-REM OSA patients. All patients underwent concurrent uvulopalatopharyngoplasty and a radiofrequency tongue base reduction procedure. Results: A total of 31.1 percent patients were classified as REM OSA and 68.9 percent patients as non-REM OSA. There were no differences in the anatomical features between two groups. However, the AHI, HI, and arousal index were significantly higher in the non-REM OSA group than in the REM OSA group. When a successful outcome was defined as a postoperative AHI <20 with at least a 50 percent reduction from the preoperative level, 50 percent of the patients with REM OSA and 35.5 percent of the patients with non-REM OSA met the criteria for a successful outcome. Conclusions: REM OSA patients had milder obstructive sleep apnea, and multilevel surgery might be more effective in REM OSA patients.

Gustatory Function after Radiofrequency Tongue Base Reduction in Patients with Obstructive Sleep Apnea

Objectives. To investigate the changes in gustatory function as a complication after radiofrequency tongue base reduction (RTBR) in patients with obstructive sleep apnea (OSA). Study Design. Before-and-after study. Setting. Academic tertiary medical center. Subjects and Methods. Thirty-four patients with suspected velopharyngeal collapse only underwent uvulopalatopharyngoplasty (UPPP group). Twenty-five patients with velopharyngeal and retrolingual collapse underwent concurrent UPPP with RTBR (RTBR group). All patients were evaluated before surgery and at 1 and 4 weeks after surgical treatment. A questionnaire was given to assess symptoms of hypogeusia, dysgeusia, hyposmia, and sensation of the tongue. Electrogustometry (EGM) in 4 areas was used to determine gustatory function. Results. Postoperative values for subjective symptoms did not significantly change following surgical treatment in either group. EGM thresholds of all tested in both groups did not significantly change 1 week and 4 weeks after surgery. Conclusions. Gustatory function remained unchanged after RTBR in patients with OSA. The authors suggest that RTBR is a safe procedure in terms of taste sensation in OSA patients.

Analysis of mandibular structure using 3D facial computed tomography.

Objective This study measured and analyzed the position and dimension of genial tubercle (GT) and mental foramen (MF) Study Design Retrospective chart review study. Setting Tertiary care teaching hospital. Subjects and Methods Two hundred ten subjects were included who received 3-dimensional (3D) facial computed tomography (CT), and the GT and MF were evaluated. Subjects were divided into 4 groups by gender and skeletal type. Seven variables were measured: (1) height of GT (GTH), (2) width of GT (GTW), (3) distance from apices of lower incisors to superior border of GT (LI-SGT), (4) distance from inferior border of GT to inferior border of mandible (IGT-IBM), (5) thickness of anterior mandible (MT), (6) distance from symphysis of mandible to MF (S-MF), and (7) distance from superior border of GT to inferior border of mandible (SGT-IBM). Results All the parameters showed marked differences in individuals. Class I males showed longer GTH, MT, and SGT-IBM than class I females (P < .05). IGT-IBM and S-MF were longer in class II males than in class I females (P < .05). LI-SGT and IGT-IBM also showed personal variation. Conclusion Anatomical features of mandibular structures showed individual variations. GTH, IGT-IBM, MT, S-MF, and SGT-IBM also showed differences between the groups.

Evaluation of functional rhinoplasty using the Modified Cottle test in Asian patients.

CONCLUSION MCT is a useful tool to pre-operatively determine whether internal nasal valve (INV) narrowing affects a nasal obstruction. Functional rhinoplasty seemed to produce better results than septoplasty in Asian patients with a nasal obstruction, due to INV narrowing. OBJECTIVE This study compared pre-operative modified Cottle test (MCT) findings and post-operative clinical improvement according to surgical approach in an Asian population. METHODS One-hundred and sixty-four patients who underwent septal surgery were enrolled. The clinical symptoms, radiological findings, and paranasal computed tomography (PNS CT) scan results were compared and analyzed between the MCT-positive and -negative groups, focusing on internal nasal valve narrowing. Post-operative clinical improvement were also compared based on whether septoplasty or functional rhinoplasty was performed. RESULTS The MCT-positive group had significantly higher pre-operative visual analog scale scores for nasal obstruction and rhinorrhea than those in the negative group. The MCT-positive group had a significantly higher percentage of highly deviated septa on PNS CT and endoscopic findings than those in the MCT-negative group. The functional rhinoplasty group had a significantly higher MCT conversion rate (positive to negative) and improvement in nasal obstruction than those in the septoplasty group.

Anatomical anomalies of alar cartilage.

bicularis muscle coincided with the direction of the epicanthal folds. The epicanthus tarsalis, epicanthus supraciliaris, and epicanthus palpebralis, which are thought to be on the same anatomical line,2,3 may be differentiated on the basis of which part of the oblique direction preseptal orbicularis muscle affects most. From this standpoint, a case without the epicanthal fold may be under the influence of the pretarsal orbicularis muscle. An epicanthal fold revision is described, therefore, to change the influence under the preseptal orbicularis muscle to that of the pretarsal orbicularis muscle. DOI: 10.1097/PRS.0b013e31825dc611