Ingestion of multiple magnets is a growing concern as it often leads to severe complications like intestinal perforation or, rarely, tracheoesophageal fistula (TEF) due to magnetic attraction across tissue walls. We report a rare case of simultaneous tracheal and esophageal magnet foreign bodies found in a 9-year-old boy. Two adhered magnets were found across the trachea and esophagus, and six others in the intestine at day one of ingestion. To prevent acute desaturation, the tracheal magnet was prioritized and removed using a Storz ventilating bronchoscope. The esophageal magnet was subsequently identified and successfully extracted using a metallic suction tube, utilizing the property of magnets. This case emphasizes that early intervention is critical to prevent severe sequelae like TEF, as delayed management often results in fistula formation. A thorough understanding of magnet characteristics and surgical priority is essential for successful diagnosis and management of such complex foreign bodies.
Background and Objectives Nasal obstruction is a prevalent symptom that is usually reported subjectively. The Nasal Obstruction Symptom Evaluation (NOSE) scale is a reliable method for evaluating subjective nasal obstruction. This study aimed to evaluate the reliability and validity of the Korean version of the questionnaire (K-NOSE).Subjects and Method The cross-cultural adaptation of the K-NOSE followed generally accepted methodologies. The patient group included individuals undergoing surgery for nasal obstruction, and the control group consisted of individuals without nasal obstruction complaints. Patients completed the K-NOSE three times (twice at a 2-week interval preoperatively and once postoperatively) while controls completed it once. To assess criterion-related validity, all participants also completed a visual analog scale (VAS) for nasal obstruction. Reliability, validity, and responsiveness of the K-NOSE were evaluated in 57 patients and 52 controls.Results The K-NOSE showed good internal consistency (Cronbach’s α >0.7). Test-retest reliability of the questionnaire in the patient group was found to be statistically significant (p<0.001). The scores were significantly lower for controls than for patients (p<0.001), indicating good discriminant validity of the questionnaire. Postoperative scores significantly decreased compared to preoperative scores (1.15±1.482 vs. 13.85±3.701; p<0.001), indicating good sensitivity to change. Correlation analysis between VAS and K-NOSE showed a statistically significant association in the patient group (p<0.05), supporting criterion-related validity.Conclusion The K-NOSE was found to be reliable and valid. It can be used as a practical tool to evaluate patients’ subjective nasal obstruction and surgical outcomes.
Tuberculous otitis media (TOM) is a rare form of chronic otitis media that often exhibits atypical characteristics and is challenging to diagnose. We report the case of a 35-year-old man with 6 months of persistent otorrhea, aural fullness, and hearing loss that did not respond to antibiotic treatment. Otoscopy showed a thickened and retracted tympanic membrane without perforation, and temporal bone computed tomography revealed soft tissue density in the middle ear and mastoid. Although the middle ear biopsy was inconclusive, pulmonary lesions were detected on chest imaging, and Mycobacterium tuberculosis was confirmed by polymerase chain reaction from bronchoalveolar lavage. The patient was diagnosed with TOM associated with pulmonary tuberculosis and treated with standard anti-tuberculosis medication, resulting in resolution of otorrhea, improvement of hearing, and no recurrence at 18 months. This case highlights the importance of considering TOM in refractory otitis media and shows that early suspicion can enable successful medical treatment without surgery.
Tinnitus, defined as the perception of sound without an external source, can be particularly distressing when persistent. Among various treatment approaches, repetitive transcranial magnetic stimulation (rTMS) has gained attention as a non-invasive method for modulating maladaptive neuroplastic changes, specifically the hyperactivity and aberrant neural synchrony observed in the auditory cortex (AC) of patients with chronic tinnitus. This report outlines a practical rTMS protocol currently used in clinical settings for tinnitus management. The standard protocol consisted of 1 Hz stimulation at 100%-110% of the resting motor threshold (rMT), applied to the left or contralateral AC, delivering 1800-2000 pulses per session across 10 consecutive treatment days. In selected patients, adjunct excitatory stimulation was delivered to the left dorsolateral prefrontal cortex, especially in cases with comorbid affective symptoms. rTMS offers a safe, adaptable therapeutic option, particularly for patients with concurrent mood disturbances.
Papillary thyroid carcinoma (PTC) is a lymphotropic cancer in which cervical nodal metastasis may precede the detection of the primary tumor. Incidental cervical masses are increasingly identified with the wider use of ultrasonography in local clinics. Although PTC is often first recognized from a cervical mass, it is generally assumed to originate in the thyroid. Very rarely, metastatic PTC presents without an identifiable thyroid primary, and only a few such cases have been reported worldwide. We recently managed an incidentally detected metastatic PTC without a demonstrable primary tumor. A 50-year-old male presented with a cervical mass detected on ultrasonography. This case report outlines diagnostic considerations and management without postoperative radioactive iodine treatment for metastatic PTC of unknown primary with cervical lymphatic involvement.
A 54-year-old male with hyperlipidemia presented with a 2-week history of throat discomfort and blood-tinged saliva. Biopsy of the ulcerative mass in the right palatine tonsil suggested pleomorphic sarcoma or poorly differentiated carcinoma. Imaging revealed a 1.8-cm tonsillar mass and systemic lesions in the left lung, left hilum, and small intestine. Endobronchial ultrasound- guided biopsy confirmed non-small cell lung carcinoma (NSCLC), and repeat tonsillar biopsy demonstrated poorly differentiated metastatic carcinoma consistent with the lung primary. The patient subsequently developed intussusception due to small bowel metastasis, which was resected and confirmed as showing identical histology. Given the disseminated disease, pembrolizumab immunotherapy and tonsillar radiotherapy were initiated. This case illustrates tonsillar metastasis as the initial manifestation of NSCLC and highlights the importance of considering distant metastasis in atypical tonsillar masses.
An exhalation delivery system for fluticasone (EDS-FLU) is designed to deposit drug into sinonasal regions above the inferior turbinate, particularly sinus drainage pathways not reached by standard nasal steroid sprays. We evaluated the efficacy and safety of EDS-FLU for chronic rhinosinusitis (CRS). We reviewed four independent randomized controlled trials derived from three published articles identified through searches of PubMed, Embase, SCOPUS, Google Scholar, Web of Science, and the Cochrane Library up to April 2024. Outcomes included 22-item Sinonasal Outcome Test (SNOT-22) scores, nasal symptom scores, nasal polyp scores, patient global impression of change (PGIC), responder and surgical indication rates, and adverse events. Compared with EDS-placebo, EDS-FLU produced greater reductions in nasal polyp scores and SNOT-22 scores over 6 months. At 3 months, nasal congestion, facial pain, rhinorrhea, and olfactory dysfunction improved more with EDS-FLU, and PGIC responder and complete response rates were higher at 3 and 6 months. EDS-FLU reduced surgical indication and increased overall responder rates at 3 months but not at 6 months. Epistaxis and nasal septal erosion or ulceration occurred more frequently with EDS-FLU, whereas rates of headache, nasal congestion, nasopharyngitis, and upper respiratory infection were similar between groups. EDS-FLU provides clinically meaningful improvements in subjective and objective outcomes in CRS but is associated with an increased risk of local nasal adverse events, warranting individualized risk-benefit assessment.
Background and Objectives Despite increased global attention to hearing loss and the proven benefits of hearing aids, the access to adopting the device remains suboptimal for people hard of hearing, particularly in Korea. Over-the-Counter (OTC) hearing aids, recently introduced in the United States, are expected to lower barriers to access. This study aimed to compare, prior to national implementation, perceptions, concerns, and expectations regarding OTC hearing aids among the general public, individuals at risk for hearing loss, and audiology professionals.Subjects and Method A cross-sectional survey was conducted with 200 participants divided into five groups: adults aged 20-50, adults over 60, people at risk for hearing loss, licensed audiologists, and audiology students. Each group completed a validated questionnaire addressing the knowledge, interest, safety, self-adjustment, service concerns, counseling, and efficacy of OTC hearing aids.Results Audiologists and older adults expressed significant concerns about the absence of professional involvement, potential misdiagnosis, difficulties in device handling, and diminished service quality. Meanwhile, younger adults and those at risk of hearing loss were more neutral or optimistic, but they nonetheless demonstrated limited awareness and interest. All groups recognized the potential for improved accessibility through OTC hearing aids; however, concerns about consumer protection, self-management, and lack of counseling were substantial, especially among professionals and older adults.Conclusion While OTC hearing aids may enhance accessibility in Korea, our findings indicate a strong need for targeted education, enhanced consumer protection, and multidisciplinary support systems to ensure safe and effective adoption. Policymakers should consider these group-specific attitudes in strategies for successful integration.
Background and Objectives YouTube has become a major source of health information, raising concerns regarding the accuracy of medical content. Facial nerve paralysis is a clinically significant condition with substantial functional, social, emotional, and economic impact. However, only limited studies have evaluated the quality of YouTube videos addressing facial palsy. This study aimed to review video content and assess the quality of information related to facial palsy on YouTube.Subjects and Method A YouTube search was performed using five Korean keywords: “안면신경마비,” “벨마비,” “람세이헌트,” “얼굴마비,” and “구안와사.” The top 100 Korean-language videos were screened using a newly created account. Videos unrelated to facial palsy were excluded. Content creators were categorized by professional background. Video quality was assessed using the Patient Education Materials Assessment Tool for Audiovisual Materials and a modified DISCERN score.Results Among the 100 included videos, 9 were produced by otolaryngologists, 44 by traditional Korean medicine doctors, 27 by other medical professionals, and 20 by lay persons. Bell’s palsy was the most commonly discussed condition, whereas Ramsay Hunt syndrome, central facial palsy, and traumatic facial paralysis were less frequently addressed. Otolaryngologists’ videos covered verified treatments such as corticosteroids, antiviral drugs, and protective agents for the eyes. Otolaryngologists’ videos showed significantly higher understandability and quality of information compared to others.Conclusion YouTube videos on facial palsy frequently contain low-quality or unverified information, which may negatively influence patients. The findings in this study highlight the importance of specialist involvement in providing accurate and reliable medical information.
Tumoral calcinosis is an uncommon ectopic calcification disorder that typically affects the periarticular soft tissue but rarely involves the cervical muscles. We report a 40-year-old male with an end-stage renal disease secondary to IgA nephropathy, who presented with a slowly enlarging right neck mass with tenderness and partial limitation of neck movement. Ultrasonography and contrast-enhanced CT demonstrated a multilobulated, densely calcified mass like lesion arising from the cervical muscles, displacing major neck vessels anteriorly. Serum studies revealed hyperphosphatemia with secondary hyperparathyroidism, which was diagnosed as secondary tumoral calcinosis. The mass was completely excised without complication. Histopathology showed amorphous calcified deposits surrounded by foreign-body giant cells. During 22 months of clinical and imaging follow-up, no recurrence has been observed. This case underscores the need to include tumoral calcinosis in the differential diagnosis of calcified cervical masses in dialysis patients in order that phosphate control and definitive surgery may achieve favorable outcomes.
Since the Fourth Industrial Revolution was declared at the World Economic Forum in 2016, we have witnessed significant technological innovations across various fields. Artificial intelligence (AI) technology has developed alongside computing technology, algorithms, and platforms, but its most crucial foundation lies in data collection and management capabilities. This paper aims to share expertise gained through our experience in constructing medical databases, including the Hearing Big Data Center, Common Data Model implementation, and balance function test databases. We first explain the fundamental concepts of databases, distinguishing between structured and unstructured data, and introduce relational database models and data schemas particularly relevant to otolaryngology. We then describe practical strategies for designing and operating medical databases that can flexibly handle both structured and unstructured data, using hearing and vestibular function test data as representative examples. Additionally, we address important considerations for healthcare database construction, including privacy regulations, de-identification processes, and data combination techniques according to South Korean guidelines. Finally, we discuss how well-designed medical databases can be linked with AI and machine learning models, enabling multimodal analysis that integrates clinical data, imaging, and physiological signals. We argue that by understanding database design principles and proper data management approaches, medical researchers can more efficiently utilize vast medical data resources while maintaining patient privacy, ultimately advancing medical research and clinical practice in the era of AI.
Inverted papilloma (IP) and angiofibroma are both rare benign sinonasal tumors that require differentiation, and their coexistence is even rarer. Here, we report an unusual case involving the coexistence of IP and angiofibroma in the nasal cavity. A 77-year-old female who presented with a right-sided nasal mass underwent facial CT, MRI, and punch biopsy of the right nasal mass. Discrepancies were noted between these examinations: a 4 cm enhancing mass displaying features suggestive of angiofibroma on facial CT and MRI, and a benign hyperplastic squamous epithelium indicating IP on biopsy. Preoperative angiography and embolization of the feeding artery of the nasal cavity mass were performed, and endoscopic sinus surgery was performed to remove the tumor. The final pathological results revealed the coexistence of IP and angiofibroma. We emphasize the need for accurate diagnosis and surgical treatment, considering that IP and angiofibroma in the nasal cavity can exist simultaneously.
Background and Objectives High-speed videolaryngoscopy (HSV) is the most effective tool for visualizing vocal fold vibrations, offering superior image quality compared to laryngeal videostroboscopy (LVS). Digital kymography (DKG), derived from HSV, allows objective analysis of vibratory patterns, but lacks audio feedback, limiting its diagnostic utility. In contrast, LVS enables simultaneous audio-visual feedback, aiding in the diagnosis of functional voice disorders. To address this limitation, we developed an automated DKG system with synchronized voice playback and evaluated its diagnostic value.Subjects and Method We enrolled 102 patients with various voice disorders, including muscle tension dysphonia (n=16), spasmodic dysphonia (n=15), vocal tremor (n=14), vocal fold palsy (n=12), presbyphonia (n=12), and others. We compared diagnostic accuracy among three conditions: conventional DKG, DKG with non-synchronized voice playback, and DKG with synchronized voice playback. Two otolaryngologists and one speech-language pathologist assessed intra- and inter-rater reliability.Results Diagnostic accuracy was highest for DKG with synchronized voice playback (76.1%), compared to non-synchronized voice playback (58.1%) and conventional DKG (41.5%). The synchronized system showed significantly improved accuracy and reliability.Conclusion This is the first study to validate automated DKG with synchronized voice feedback. It presents a promising tool for diagnosing voice disorders, complementing HSV by incorporating auditory cues. Further clinical validation is needed.
Background and Objectives This study aimed to develop a Korean version of the Cochlear Implant Quality of Life (K-CIQOL) and to evaluate its validity and reliability for use in adult cochlear implant (CI) users.Subjects and Method The K-CIQOL was developed and validated in two stages. In the development stage, the original English version of the CIQOL was translated into Korean, culturally adapted, and content-validated, resulting in two forms: the K-CIQOL-35 Profile and the K-CIQOL-10 Global. In the evaluation stage, 54 adult CI users completed the K-CIQOL twice with a two-week interval. Construct and convergent validity were assessed, and reliability was examined through internal consistency and test-retest reliability.Results The K-CIQOL-35 Profile consisted of six domains measured on a 5-point Likert scale, explaining 77.63% of the total variance. The K-CIQOL-10 Global demonstrated a single- factor structure, accounting for 66.51% of the variance. Both forms showed good convergent validity with the Korean Spatial Hearing Questionnaire. Internal consistency was high (Cronbach’s α ≥0.91), and test-retest reliability was excellent (ICC ≥0.96) for both instruments.Conclusion The K-CIQOL-35 Profile and K-CIQOL-10 Global are reliable and valid tools for assessing the quality of life in Korean adult CI users, supporting their application in both clinical and research settings.
