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Background and Objectives There have been several studies on the factors affecting posttonsillectomy bleeding; however, investigations on the relationship between postoperative bleeding and diet are insufficient. Different countries have different types of food, and while there have been studies on the effects of diet in other countries, no such studies have been reported in Korea. Therefore, we aimed to investigate the relationship between Korean diet and postoperative bleeding after tonsillectomy.Subjects and Method To compare the postoperative bleeding outcomes, patients who underwent tonsillectomy by a single surgeon between January 2017 and 2020 were divided into those who had a diet restriction after surgery and those who had a free diet. Postoperative bleeding outcomes were divided according to the degree of intervention for hemostasis and compared.Results The study included 115 and 124 patients in the diet-restricted group and free-diet group, respectively. There were no statistical differences between the two groups in terms of gender, age, presence of snoring and frequent tonsillitis, and surgical method. Bleeding occurred in four patients in the diet-restricted group and three patients in the free-diet group. There was no statistical difference between the two groups in the frequency and severity of postoperative bleeding.Conclusion Since dietary restriction after tonsillectomy was not helpful to prevent postoperative bleeding, a free and sufficient diet after surgery may prove to be better.

Many rhinoplasty techniques, including dorsum augmentation and tip surgery, could be performed under conscious sedation rather than general anesthesia. However, as osteotomy is an invasive procedure, it is burdensome for surgeons to perform osteotomy under conscious sedation. As patient ratings of pain and satisfaction when osteotomy is performed under conscious sedation are unknown, this study aimed to determine discomfort of osteotomy performed under conscious sedation.Patients who underwent rhinoplasty with conscious sedation were prospectively included in the study. The patients were classified into an osteotomy and a nonosteotomy group. Questionnaires with a visual analog scale ranging from 0 to 10 were utilized to assess patient pain and satisfaction. Patients were also asked whether they would choose conscious sedation for future rhinoplasty operations. To evaluate adverse events, cardiopulmonary vital signs and nausea or vomiting were assessed.Forty-five patients with a mean age of 32.7 years were included in the study. The mean patients' visual analog scale scores for pain and satisfaction were 3.3±2.0 and 7.2±1.9, respectively. Most of the patients [42, (93%)] stated that they would choose conscious sedation again if they had further operations in the future. No significant adverse effects occurred, and there were no significant differences in patients' ratings of pain and satisfaction between osteotomy and nonosteotomy groups when conscious sedation was used.Patients' ratings of pain and satisfaction, and a lack of significant adverse effects, indicated that rhinoplasty can be performed under conscious sedation, even with osteotomy.

Objective This study evaluated the prevalence and characteristics of tonsillar human papillomavirus (HPV) infection in tumor-free patients undergoing tonsillectomy. Methods We prospectively enrolled healthy patients who underwent tonsillectomy for tumor-free tonsillar disease. Their tonsillar HPV infections were evaluated using CLART HPV2, and subsequent p16 immunohistochemistry was performed in patients with positive HPV infection. Moreover, the results of tonsillar HPV infection were analyzed according to sex, age, and indication of tonsillectomy. Results A total of 362 patients were included. HPV test was positive in 8 patients, with an overall prevalence of 2.2%. All detected HPV types were high-risk, including HPV 16 in six patients, HPV 52 in one patient, and HPV 58 in one patient. P16 was negative in all 8 patients with HPV infection. The prevalence of tonsillar HPV infection in males and females was 2.4% (6/246) and 1.7% (2/116), respectively (P > 0.999), and in pediatric and adult patients, 2.2% (5/228) and 2.2% (3/134), respectively (P > 0.999). The prevalence showed a bimodal peak at 1st and 6th decades, with the prevalence of 2.6% (5/194) and 7.9% (3/38), respectively. The prevalence of tonsillar HPV infection in tonsillitis and non-tonsillitis groups were 0.0% (0/104) and 3.1% (8/258), respectively (P = 0.111). Conclusion The prevalence of tonsillar HPV infection in tumor-free patients was low, but all detected HPV infections were high-risk types. Our results support using a 9-valent vaccine which covers all high-risk HPV types found in this study

Background and Objectives Olfactory and gustatory dysfunctions have been known as characteristic symptoms of coronavirus disease 2019 (COVID-19). However, the study of the clinical features of olfactory and gustatory dysfunctions in COVID-19 is still insufficient.Subjects and Method Mild COVID-19 patients who complained of olfactory or gustatory dysfunctions in the telephone monitoring from March 8 to April 8, 2020 were included in this study. Patient information was collected using a Google questionnaire. COVID-19 symptoms, severity and improvement of olfactory and gustatory dysfunctions of patients were investigated.Results A total of 228 patients participated in this study. The number of male and female were 76 and 152, and the average age was 32.1±11.5 years. There were 210 patients (92.1%) of olfactory dysfunction, 179 patients (78.5%) of gustatory dysfunction, and 165 patients (71.4%) who complained of both symptoms. The 18.4% of patients complained only olfactory or gustatory dysfunction without other symptoms of COVID-19, and 51.1% of patients presented olfactory and gustatory dysfunctions as the first symptoms. Most of the patients (95.6%) improved olfactory and gustatory dysfunctions within several months, but only 79.8% of patients were normalized.Conclusion Since olfactory and gustatory dysfunctions are the first symptoms in the numerous COVID-19 patients, and continued research on these patients play an important role in the screening and prevention of COVID-19. Long-term observation and further studies of treatment are needed for 20.2% of patients who have not fully recovered.

Floating ring seals are widely used as a leakage control solution for turbomachines because they effectively operate with small clearances between the shaft and seal. The oxidizer pump of the 7 tonf liquid engine in the Korea Space Launch Vehicle II (KSLV-II) operates at high rotational speeds and under cryogenic conditions and has floating ring seals in the bearing cooling path to reduce leakages. In this study, we evaluated the frictional force acting on the nose of the floating ring in the oxidizer pump of the 7 tonf turbopump using numerical analysis, and we investigated the radial force on the floating ring induced by the vibration of the rotor and the flow characteristics around the floating ring seal. Through a comparison of the frictional and floating forces according to the change in the diameter of the floating ring noses, we also estimated the dynamic positioning of the floating ring. In addition, we examined the leakage of the floating ring seals with the rotational speed and gap size of the floating ring, and we used the results as data for designing a floating ring seal. Finally, we performed turbopump real-propellant tests with the floating ring seal of the high and the middle noses, finding that the test result was in good agreement with the results of numerical analysis.

Anisakiasis is a parasitic infection caused by ingesting raw or undercooked fish and seafood infected with Anisakis larvae. Anisakis genus is mostly found in the mucosal or submucosal layer of the stomach and intestine. However, the reports of anisakiasis in tonsils are highly uncommon. A 54-year-old woman with clinical features of sore throat and foreign-body sensation for 10 days after eating raw and undercooked fish. A wriggling worm was noted beneath the mucosa of the right palatine tonsil upon endoscopic examination. The worm was immediately removed completely and histological examination revealed anisakiasis. Reports of anisakia-sis in the tonsils are scarce, but it should be considered at the initial physical examination of patients who visit the hospital for sore throat after eating raw fish. We report a case of anisakiasis in the palatine tonsils, which to date has been rarely reported in the literature.

Paranasal fungal balls are rare entities for which a recent increase in reported cases has been observed. Fungal balls are most commonly unilateral, and there are few bilateral cases in the literature. Here we report the clinical features of bilateral fungal balls in 24 patients treated in our institution over the past 20 years. In this retrospective study, we reviewed the medical records of 5279 patients who underwent endoscopic sinus surgery performed by a single surgeon from January 1996 to December 2016 at a tertiary care center in order to identify patients diagnosed with fungal balls confirmed histopathologically. Demographic data and radiologic findings of patients with bilateral fungal balls were compared with those who had unilateral fungal balls. Multiple logistic regression test was used to compare demographic information between patients with unilateral and bilateral fungal balls. The most commonly involved sinus in bilateral cases was maxillary (87.5%), followed by ethmoid (37.5%) and sphenoid (33.3%). Of the 24 patients, 19 were female, and patient age ranged from 45 to 83 years, with an average of 65.1 years. Common existing comorbidities were hypertension (45.8%), diabetes (29.2%), cardiac problem (16.7%), cerebral infarction (8.3%), pulmonary tuberculosis (8.3%), and lung cancer (4.2%). The clinically relevant features of patients diagnosed with bilateral fungal balls from our review include advanced age and immunocompromised status compared to those with unilateral fungal balls. These features contribute to the clinical distinction of bilateral fungal ball disease from unilateral fungal balls and invasive fungal sinusitis.

STUDY OBJECTIVES: Drug-induced sleep endoscopy (DISE) has been suggested to be a valuable method for determining the obstruction patterns causing sleep-disordered breathing. However, since DISE is not performed throughout the duration of sleep but for less than 1 hour, the reproducibility and reliability of DISE are questionable. Therefore, we aimed to determine the test-retest reliability of DISE using midazolam. METHODS: Thirty-four patients diagnosed with obstructive sleep apnea were prospectively included in this study. The patients underwent 2 separate DISE examinations that were performed at different days using the same drug and technique. For a more accurate comparison, the depth of sleep and examination time were identically controlled. VOTE classification was used to classify the obstruction findings, and the findings of upper airway obstruction were compared between the 2 tests. RESULTS: There were 30 men and four women; the mean age was 45.4 ± 13.1 years. The mean apnea-hypopnea index was 38.3 ± 22.6, and the lowest oxygen saturation was 77.5% ± 12.4%. The lateral wall of the oropharynx, tongue base, and epiglottis showed very good agreement, and the velum showed good agreement between the first and second DISE examinations. CONCLUSIONS: The reliability of DISE is debatable because it observes only a small portion of the total sleep, but this study suggests that DISE is a reliable test because the findings of 2 separate DISE examinations on different days showed a high concordance rate. CITATION: Kim J-S, Heo, SJ. Test-retest reliability of drug-induced sleep endoscopy using midazolam. J Clin Sleep Med. 2020;16(5):675–678.

Malignant tumors rarely occur in the paranasal sinuses. Paranasal tumors, when they occur, exhibit atypical symptoms, such as nasal obstruction, rhinorrhea, facial pain, and nasal bleeding. Because of nonspecific symptoms commonly observed in the sinusitis and their infrequent occurrence, malignant tumors of the paranasal sinuses are generally diagnosed late. If there is bone destruction or invasion of the surrounding tissues in the imaging studies, malignant tumors could be suspected; however, without such findings, it is difficult to predict the existence of cancer. It is more difficult to suspect malignant tumors when they coexist with sinus diseases. In addition, since the concomitant presence of fungal balls and cancer is extremely rare, it is difficult to suspect the presence of cancer when treating fungal balls. We report a case of a fungal ball accompanied by squamous cell carcinoma without any sign of malignancy, such as bone destruction, which has not been reported in the English literature to date.

This study aimed to determine factors affecting serum levels of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies 2 months after coronavirus disease 2019 (COVID-19) vaccination in young and middle aged healthy adults.Healthcare workers who have no history of SARS-CoV-2 infection, were enrolled at 2 months after second shot of BNT162b2 mRNA COVID-19 vaccine. Antibody immunoglobulin G against the spike protein subunit of SARS-CoV-2 was semi-quantitatively measured using 4 commercial enzyme-linked immunosorbent assay kits. Factors affecting anti-SARS-CoV-2 antibodies levels were investigated.Fifty-one persons (22 - 54 years, male sex; 19.6%) were enrolled and all participants acquired anti-SARS-CoV-2 antibodies in four diagnostic kits. Anti-SARS-CoV-2 antibodies were strongly correlated between diagnostic kits; SG Medical and Genscript (r = 0.942), SG Medical and HB Healthcare (r = 0.903), and HB Healthcare and Genscript (r = 0.868). We investigated factors affecting antibody level using SG medical kit. The median inhibition was 93.1%, and 84.0% of participants showed90.0% inhibition. Systemic adverse event severity had no association with the anti-SARS-CoV-2 antibodies level. Antibody level was inversely correlated with weight (-0.312,Anti-SARS-CoV-2 antibody was inversely correlated with weight and BMI, which may be used as a marker to predict immune response of BNT162b2 mRNA vaccination in young and middle aged adults.ClinicalTrials.gov Identifier: NCT05083026.

Craniopharyngioma is rare epithelial tumor that develops along the craniopharyngeal duct, and most of these tumors occur in the sellar and suprasellar regions. Although it rarely occurs in the extracranial region, sphenoid solitary lesions were not reported in previous literature. In this study, we report a case of infrasellar craniopharyngioma within the sphenoid sinus without intracranial lesion. A patient with intermittent headache visited a private clinic and presented with sphenoid lesions based on the Magnetic resonance imaging scan results. The mass was completely removed using endoscopic endonasal transsphenoidal approach without any complications and showed characteristic pathologic findings, which lead to the diagnosis of craniopharyngioma.

Objective: In this study, we wanted to check working conditions of public health care doctors(PHDs) working in unbridged island of korea.Methods: We made structured Self-administered questionnaire and sent to all of PHDs working in unbridged island and PHDs working in land as a controlled group.Result: 52 PHDs working in unbridged island and 130 PHDs working in land responded to our survey.PHDs working in unbridged island had difficulty using holiday, sick leave, and offical holiday to participate seminar. especially, difficult to use sick leave was statically significant(p

Background: The imaging features of sinonasal extramedullary plasmacytoma (EMP) are non-specific and similar to those of other lesions, such as sinonasal non-Hodgkin’s lymphoma (NHL) and squamous cell carcinoma (SCC). Objectives: To analyze the computed tomography (CT) and magnetic resonance (MR) images of patients with EMP, NHL, and SCC to identify the radiological characteristics differentiating sinonasal EMP from NHL and SCC. Patients and Methods: In this cross-sectional study, the CT and MR imaging features of 37 patients with sinonasal EMP, 46 patients with NHL, and 44 patients with SCC were analyzed. Sinonasal NHL was categorized into two distinct types, namely, natural killer/T-cell lymphoma (n = 32) and diffuse large B-cell lymphoma (n = 14). The tumor volume was determined by measuring the region of interest (ROI) in the picture archiving and communication system (PACS) program. Besides, homogeneity, apparent diffusion coefficient (ADC) in the ADC maps, degree of enhancement, adjacent bone destruction, and invasion to Waldeyer’s ring and cervical or retropharyngeal lymph nodes were evaluated. Results: Although the tumor volume was larger in the EMP group as compared to the NHL and SCC groups, the difference was not statistically significant. The NHL group showed the highest tumor homogeneity on both CT and MR images. EMP was more heterogenous than NHL, with moderate signal intensity on T1-weighted MR images. On the other hand, EMP and NHL showed significantly lower ADCs as compared to SCC. The majority of patients with sinonasal EMP, NHL, and SCC showed an avid enhancement. Also, destructive tumor growth involving the adjacent bone was more frequent in SCC than in EMP or NHL. However, there were no significant differences among sinonasal EMP, NHL, and SCC in terms of invasion to Waldeyer’s ring and cervical or retropharyngeal lymph node metastasis. Conclusion: Marked heterogeneity on T1-weighted images, low ADCs, and lack of adjacent bone destruction were the CT and MR imaging features that favored the diagnosis of EMP over NHL or SCC.

Recent studies have shown a high prevalence of obstructive sleep apnea in myasthenia gravis compared to the normal population. The aim of this study was to elucidate clinical and polysomnographic differences between clinically stable Korean MG patients with and without OSA. A total of 18 consecutively stable MG patients were included in this prospective study. We compared MG patients with OSA (n = 7) and without OSA (n = 11) with respect to the baseline characteristics and overnight polysomnography (PSG) parameters. Demographic parameters, prescribed medication status, thymectomy status, myasthenia gravis foundation of America score, and antibody status were obtained from their medical records. We performed the Korean version of Pittsburg sleep quality index to assess the subjective quality of sleep. Statistical analyses were performed using SPSS version 18.0 with Wilcoxon rank sum test, chi-square test, Fisher’s exact test, and Spearman correlation test. Among the clinical parameters, MG patients with OSA showed a higher proportion of male sex (p = 0.016) and increased body mass index (p = 0.033). The PSG showed an 11-fold higher supine apnea-hyponea index (AHI) in MG patients with OSA. AHI was further analyzed with supine and non-supine position. MG patients with OSA had a higher supine AHI (19.5 ± 15.8) compared to those without OSA (1.9 ± 1.2, P = 0.008). Most of MG patients with OSA (85.7%) showed more than two times higher supine AHI than non-supine AHI. This study showed that the occurrence of OSA in patients with MG is associated with male sex and obesity, which is in accordance with the normal population. Moreover, PSG data showed a high prevalence of supine dominant OSA in MG patients with OSA.

Rationale: Multiple system atrophy (MSA) is a rare neurodegenerative disease characterized by Parkinsonism and autonomic dysfunction or cerebellar ataxia. MSA can be accompanied by stridor caused by laryngeal stenosis secondary to vocal cord dysfunction. Patient concern: A 60-year-old woman with MSA, complaining of difficulty in breathing during sleep. Her bed partner reported witnessing grunting-like sounds during sleep. Diagnosis: Isolated stridor without any other sleeping breathing disorder diagnosed using drug-induced sleep endoscopy (DISE) in a patient with MSA. Interventions: On polysomnography, there was no obstructive sleep apnea. Using DISE, abnormally adducted vocal cords during inspiratory respiration were identified, leading to a diagnosis of stridor. We prescribed positive airway pressure to resolve the stridor. Outcome: Our patient was also prescribed continuous positive airway pressure for the treatment of nocturnal stridor, and it is improved. Lessons: In summary, when MSA patients present with nocturnal stridor, it is important to evaluate the exact diagnosis and cause of stridor in patients by confirming the movement of vocal cords using DISE, as well as polysomnography.

STUDY OBJECTIVES: The modified jaw-thrust maneuver (MJTM) during drug-induced sleep endoscopy (DISE) is known to predict the treatment effect of mandibular advancement devices. However, its effect on the depth of sedation and potential to provoke arousal by awakening patients during the maneuver has not been studied so far. This study investigated the effect of the MJTM on the depth of sedation during DISE. METHODS: Forty patients on whom the MJTM was performed during DISE were included. The effect of the maneuver was evaluated at the levels of the velum, lateral wall of the oropharynx, base of the tongue, and epiglottis. Obstruction was defined as the collapse of the upper airway exceeding 75%, and improvement with the MJTM was defined as the widening of the upper airway by more than 50% during the maneuver. A bolus injection of midazolam was used to induce sedation and control the depth of sedation (bispectral index value of 60 to 80). RESULTS: Obstructions were present in the velum of all patients, lateral wall of the oropharynx of 13 patients, base of the tongue of 28 patients, and epiglottis of 6 patients. After the MJTM, improvement of the obstruction was observed in 57.5%, 61.5%, 82%, and 66.7% of patients with velum, lateral wall of the oropharynx, base of the tongue, and epiglottis obstructions, respectively. An increase in the bispectral index value of more than 20 was observed in 8 patients. Four patients awakened during the procedure. CONCLUSIONS: The MJTM significantly relieved obstruction during DISE, especially at the base of the tongue. However, this might have been caused by an increase in the degree of awakening during the maneuver. Therefore, MJTM’s effect on the depth of sedation may help in improving the degree of airway obstruction. CITATION: Park D, Kim J-S, Heo SJ. The effect of themodified jaw-thrust maneuver on the depth of sedation during drug-induced sleep endoscopy. J Clin SleepMed. 2019;15(10):1503–1508.

Nasal septal abscesses are commonly caused by nasal trauma, infection, and nasal surgery. As delayed treatment of nasal septal abscesses can cause various complications, including saddle nose, a prompt diagnosis with the relevant intervention is important. However, the diagnosis of nasal septal abscesses is difficult when nasal pain occurs after cauterization because there have been no formal reports of nasal septal abscesses owing to cauterization for epistaxis. Here, the authors report the first case of a nasal septal abscess that developed after cauterization. A 48-year-old woman underwent radiofrequency cauterization as a treatment for epistaxis. She developed nasal pain 10 days following cauterization, and a computed tomography scan revealed a nasal septal abscess. Careful observation should be undertaken in patients who undergo cauterization of the nasal septum, especially in patients complaining of nasal pain.

Importance Drug-induced sleep endoscopy (DISE) has been suggested to be a valuable technique for identifying the obstruction site associated with sleep-disordered breathing. However, the reliability of DISE findings is controversial because the procedure uses sedative drugs, which may have implications for the obstruction patterns observed on DISE. Objective To compare the obstruction patterns during DISE with the obstruction patterns during natural sleep endoscopy (NSE). Design, Setting, and Participants This prospective cohort study was conducted between June 2013 and May 2018 in Kyungpook National University Chilgok Hospital in Daegu, South Korea. All analysis took place from June 1 to July 31, 2018. Participants had an obstructive sleep apnea diagnosis, were older than 18 years, and had an apnea hypopnea index higher than 5 on type I polysomnography. The patients initially enrolled were excluded from the study for not reaching adequate sleep depth and waking up during insertion of the nasopharyngoscope. Intervention Patients underwent DISE using midazolam and NSE without sedatives on 2 different days. Main Outcomes and Measures Obstruction findings were observed only in the same range (65-75) of the bispectral index on both days. Obstruction findings were classified according to the VOTE (velum, oropharynx lateral wall, tongue base, and epiglottis) classification. The extent of agreement between DISE and NSE findings was evaluated using Cohen weighted κ value. Results The study included 26 patients with snoring or obstructive sleep apnea (mean [SD] age, 44.7 [10.3] years; predominantly male [22 (85%)]). The mean (SD) apnea hypopnea index was 41.9 (17.2) and the lowest mean (SD) oxygen saturation was 79.8% (12.2%). The degree of agreement in upper-airway obstruction between DISE and NSE was 76.9% (Cohen weighted κ = 0.42; 95% CI, 0.02-0.83) in the velum, 88.5% (Cohen weighted κ = 0.84; 95% CI, 0.67-1.01) in the oropharynx lateral wall, 69.2% (Cohen weighted κ = 0.66; 95% CI, 0.46-0.86) in the tongue base, and 92.3% (Cohen weighted κ = 0.67; 95% CI, 0.24-1.11) in the epiglottis. Agreement of configuration of the velum was 88.5% (Cohen weighted κ = 0.50; 95% CI, −0.03 to 1.03) and the epiglottis was 92.3% (Cohen weighted κ = 0.67; 95% CI, 0.24-1.11). Conclusions and Relevance Obstruction patterns of the upper airway appeared to be in agreement between DISE and NSE, suggesting that DISE may be a reliable test; future studies of multiple positions and sleep stages with larger sample sizes may confirm these results.

Rationale: A postoperative maxillary mucocele (POMM) is a delayed complication of maxillary sinus surgery. Although transoral enucleation is a conventional approach for its treatment, the intraoperative risk of injury to the inferior rectus muscle increases when there is an orbital floor defect. The transnasal endoscopic marsupialization has also been used widely for treatment. However, it has a potential risk of postoperative stenosis of the meatal antrostomy site, especially when the medial wall of the maxillary sinus is thick. Patient concerns: A 60-year-old man who underwent a right Caldwell–Luc operation about 30 years ago came to the emergency room with pain and swelling in the right periorbital region. Diagnosis: He was diagnosed with a POMM accompanied by an orbital floor defect and a thick medial wall of the maxillary sinus. Interventions: Transnasal endoscopic marsupialization was performed, and a cylindrical penrose drain was placed at the antrostomy site for one month. Outcomes: The patient's periorbital pain disappeared after surgery. After 3 months, the postoperative computed tomography scan showed good opening at the meatal antrostomy site. Lessons: In a patient with POMM with an orbital floor defect and a thick medial wall of the maxillary sinus, transnasal endoscopic marsupialization with penrose drain insertion could prevent both injury of the inferior rectus muscle and postoperative stenosis.

Objectives. Crosshatching incision has been considered a useful method for correcting cartilaginous septal deviation. The aim of this study was to determine the utility and limitations of this approach.Methods. This retrospective case-control study included 353 patients who underwent septoplasty performed by a senior surgeon between January 2004 and December 2010. Patients were classified into two groups according to whether crosshatching incision was performed (n=151) during septoplasty or not (n=202). All other techniques performed during septoplasty were identical. The parameters of surgical success (improvement of nasal obstruction, correction of deviation, and acoustic rhinometry results) and adverse effects were compared between the groups.Results. There were no significant differences in the parameters of surgical success between the groups (improvement of nasal obstruction, P=0.333; correction of deviation, P=0.608; acoustic rhinometry results, P=0.322 for the difference in the minimal cross-sectional area; P=0.919 for difference in volume). Relative to patients who did not undergo the cross-hatching incision, patients with whom the technique was performed showed a significantly higher incidence of saddle nose (0/202 vs. 4/151 cases, P=0.033) and overcorrection (0/202 vs. 5/151 cases, P=0.014).Conclusion. Crosshatching incision during septoplasty did not produce better surgical outcomes; however, it caused adverse effects such as saddle nose and overcorrection. Therefore, the use of crosshatching incision should be re-evaluated.

Coblation-assisted turbinoplasty is an effective and safe method to manage nasal obstruction. The common complications of the procedure are pain, bleeding, and crust formation. Since coblation does not generate high heat, direct burn injuries by coblation have been rarely reported. Nevertheless, the authors experienced a skin burn injury in a patient, which is the first patient related to coblation-assisted turbinoplasty. Therefore, surgeons need to be careful and prepared for an inadvertent heat injury at the site that touches the coblation device. Here the authors present a patient along with suggestions to prevent the aforesaid accident.

The aim of the study is to identify the following associations: (1) severity of obstructive sleep apnea syndrome (OSAS) and laryngopharyngeal reflux (LPR)-related clinical parameters, such as reflux finding score (RFS), reflux symptom index (RSI), and LPR–health-related quality of life (LPR–HRQOL) and (2) complete obstruction on drug-induced sleep endoscopy (DISE) and LPR-related clinical parameters. Subjects included the OSAS patients without surgery history and all patients perform the polysomnography (PSG) and DISE for their OSAS. Demographics, polysomnographic data, DISE results, and LPR-related parameters were collected prospectively. The patients were divided into age-, sex-, and BMI-matched two groups, according to numbers of complete obstruction on DISE (complete obstruction at 0–1 subsites (unilevel) vs. 2–4 subsites (multilevel). Finally, 19 patients with unilevel complete obstruction and 38 patients with multilevel complete obstruction were compared. The multiple linear regression analysis was employed to determine the predictors of LPR-related quality of life. Among 88 patients, 19 patients demonstrated unilevel complete obstruction, and 69 patients demonstrated multilevel complete obstruction on DISE. There were no significant correlation between OSAS severity and RFS, RSI, and scores of LPR–HRQOL. Multilevel complete obstruction on DISE did not affect the LPR-related clinical parameters (p > 0.05). The result of multiple linear regression demonstrated complete obstruction at the epiglottis had a strong influence on the high scores of LPR–HRQOL. LPR is commonly developing disease with OSAS, but the OSAS severity did not affect the LPR-related parameters. The multilevel complete obstruction on DISE was not associated with the LPR-related clinical parameters.

Angiofibroma is a rare tumor that accounts for about 0.05% of all head and neck tumors; it mainly occurs in the region of the nasopharynx. To date, no study originating in the frontal sinus has been reported. The authors report a report of an 18-year-old male complaining of severe pain in the right periocular area, forehead, and temporal area for 1 week. Endoscopic sinus surgery in combination with trephination was used to remove the tumor and the tumor was diagnosed as angiofibroma from histopathologic examination. It is hard to consider a tumor as being angiofibroma when it is not located in the nasopharynx. In particular, although extranasopharyngeal angiofibroma can occur in all head and neck regions, a tumor which has developed in the frontal sinus is more difficult to diagnose as angiofibroma because no patients have been reported until now. With this study, surgeons now need to be aware of the possibility of occurrence of angiofibroma in the frontal sinus.

Rationale: Epistaxis is a common otorhinolaryngological emergency, but septal abscess has not been reported before as a complication of epistaxis. Patient concerns: We report a case of a 51-year-old man complaining of nasal obstruction and facial numbness for 3 weeks. He had a history of epistaxis, and had been treated with electrocauterization of the left nasal septum at a local clinic 1 month earlier. Diagnoses: On nasal endoscopy, swelling of the septum was noticed; computed tomography (CT) was performed, and revealed a septal abscess. Interventions: The patient was treated with incision and drainage under local anesthesia. A left vertical hemitransfixion incision was made and 4 mL of purulent material was drained. There was no quadrangular septal cartilage. Outcomes: On the 5th postoperative day, the patient complained of blurred vision in his right eye. Visual acuity of the left eye was 0.5, but acuity of the right eye was finger count at 50 cm. Examination of the right eye revealed a whitish fan-shaped corneal opacity on the medial side with neovascularization, diagnostic of lipid keratopathy. Conclusion: Electrocautery of epistaxis should be performed carefully during hemostasis, and there should be careful follow-up after the procedure to detect the occurrence of septal hematoma or septal abscess. These conditions should be treated as early as possible to avoid further serious complications. Since lipid keratopathy is difficult to treat once it occurs, care should be taken to avoid a septal abscess.

Rationale: Tetanus is caused by a neurotoxin (tetanospasmin) secreted by a spore forming gram-positive, anaerobic rod-shaped motile bacillus, Clostridium tetani. The most common symptoms of tetanus are trismus (100%), dysphagia (70.5%), dysarthria (35.2%), and neck stiffness (29.4%). Respiratory failure, laryngeal spasm, seizure, chest pain, nausea/vomiting, opisthotonus, back pain, and rigid abdominal wall can also be observed during progression of the disease. However, there has been no report of periocular discomfort as an initial manifestation after endoscopic sleep surgery in a patient with tetanus. Here, we report a patient who underwent endoscopic sleep surgery with a concurrent diagnosis of tetanus infection presenting with atypical periocular discomfort as the initial symptom. Patient concerns: A 63-year-old man complaining of sleep apnea, snoring, and daytime sleepiness visited our department. He subsequently underwent sleep surgery (anterior pharyngoplasty with tonsillectomy, septoplasty, microdebrider-assisted inferior turbinoplasty, and an endoscopic sinus surgery) for the treatment of his newly diagnosed obstructive sleep apnea. After 3 weeks of surgery, he visited the outpatient clinic of our department with right side periocular discomfort. Diagnoses: Four days after presenting with periocular discomfort, he was diagnosed with tetanus by presenting trismus, jaw pain, dysphagia, and ptosis at an emergency department of a different hospital. Interventions: Tetanus immunoglobulin and antibiotics were administered. Outcomes: His symptoms then resolved after a month without sequelae. Lessons: Although periocular discomfort is atypical and is not uncommon after nasal and oral surgeries, care should be taken when patients present with periocular pain because it could be a rare initial symptom of tetanus.

OBJECTIVES Since few studies on surgical training and learning curves have been performed, majority of inexperienced surgeons are anxious about performing operations. We aimed to access the results and learning curve of septoplasty with radiofrequency volume reduction (RFVR) of the inferior turbinate. METHODS We included 270 patients who underwent septoplasty with RFVR of the inferior turbinate by 6 inexperienced surgeons between January 2009 and July 2011. We analyzed success score, cases of revision, cases of complication, operation time, and acoustic rhinometry. RESULTS Success score was relatively high and every surgeon had few cases of revision and complication. No significant difference was found in success score, revision, complication case, or acoustic rhinometry values between early cases and later cases. Operation time decreased according to increase in experience. However, there was no significant difference in the operation time after more than 30 cases. CONCLUSION We can conclude that 30 cases are needed to develop mature surgical skills for septoplasty with RFVR of the inferior turbinate and that training surgeons do not need to be anxious about performing this operation in the unskilled state.

Although a foreign body ingestion is common in infants and young children, serious complication such as penetration of the esophagus is a relatively rare event. Delayed diagnosis may result from lack of classical symptoms and history, leading to serious result, even to death. A 2-year-old boy was admitted to the emergency room with dyspnea. He had wheezing and stridor for a 1.5-year and unfortunately treated as a bronchial asthma for a long time. Chest X-ray and cervical CT scan revealed esophageal foreign body. Intraoperative findings showed a plastic material in the esophagus and tracheoesophageal fistula with tracheal stenosis as a complication of the retained foreign body. Therefore, we should keep in mind that foreign body can present atypical symptoms like respiratory symptoms, especially in infant and young children.