Rhino-orbito-cerebral mucormycosis (ROCM) is an invasive fungal infection that usually occurs in immunocompromised patients. It is aggressive and has a high risk of mortality. With unclear guidelines, ROCM is treated in various ways. We present a patient who underwent kidney transplant and who treated for ROCM without major complications.

The laryngeal framework surgery (LFS) is an operation to correct the position and tension of the vocal cords by changing the laryngeal cartilage and muscles. LFS such as type 1 thyroplasty, arytenoid adduction, and arytenopexy is performed to improve the voice of patients with unilateral vocal cord paralysis. It is known that the voice improvement effect of LFS in patients with unilateral vocal cord paralysis is excellent and lasts for a long time. LFS can also be operated under local anesthesia. Complications are not common, however, severe complications like airway obstruction could occur after the operation. Recently, several other attempts to modify the traditional surgical method have been reported. This review is intended to be helpful in understanding the characteristics and changes in laryngeal framework surgery.

Abstract BackgroundIntralymphatic immunotherapy (ILIT) is a promising alternative for the treatment of patients with allergic rhinitis, providing similar therapeutic efficacy to conventional allergen-specific immunotherapy (AIT). However, the allergic mechanism of ILIT is not completely known. The aim of this study was to determine the efficacy of ILIT in a house dust mite (HDM) mouse model of allergic rhinitis.Methods Six-week-old female BALB/c mice were divided into four groups. Four groups were established: Group 1 (G1, n=10), control group without allergy; Group 2 (G2, n=10), allergy group sensitized with HDM without ILIT; Group 3 (G3, n=10), allergy group with ILIT (L1: starting with HDM 1.25 mg/mL); and Group 4 (G4, n=10), allergy group with ILIT (L2: starting with HDM 2.5 mg/mL) After the murine model of allergic rhinitis with HDM was established, mice were administered an intralymphatic injection through the inguinal lymph nodes with HDM once per week for 5 weeks. Thereafter, the levels of total serum IgE, interleukin IL-6, IL-13, IL-17A, IL-25, IL-33, and interferon (IFN)-γ in serum and spleen were measured using ELISA kits. Eosinophils in nasal mucosa were also evaluated via hematoxylin and eosin staining. Cytokine expression in nasal mucosa were determined using RT-PCR and the effects of ILIT on FoxP3(+) Treg cell in splenocytes were assessed using flow cytometry. ResultsILIT significantly decreased serum total IgE and eosinophil counts in nasal mucosa; IL-6 IL-17A, IL-25, and IFN-γ in serum (P< 0.05); and IL-17A and IL-33 in splenocyte supernatant (P< 0.05). ILIT also reduced the mRNA expression of IL-4, IL-6, IL-17A, and IL-33 cytokines in nasal mucosa. FoxP3(+) Treg cell expression was significantly decreased in the allergic group and significantly increased in the ILIT group (P< 0.05). ConclusionOur results suggest that ILIT regulates the specific immunotherapy immunologic mechanism by downregulating Th1, Th2, and Th17 cytokines and upregulating FoxP3(+) T reg cells in the HDM allergic mouse model.

Objectives. Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterized by recurrent epistaxis, telangiectasia, and visceral arteriovenous malformations (AVMs). Activin A receptor-like type 1 (ACVRL1/ALK1) and endoglin (ENG) are the principal genes whose mutations cause HHT. No multicenter study has yet investigated correlations between genetic variations and clinical outcomes in Korean HHT patients.Methods. Seventy-two members from 40 families suspected to have HHT based on symptoms were genetically screened for pathogenic variants of ACVRL1 and ENG. Patients with genetically diagnosed HHT were also evaluated.Results. In the HHT genetic screening, 42 patients from 24 of the 40 families had genetic variants that met the pathogenic criteria (pathogenic very strong, pathogenic strong, pathogenic moderate, or pathogenic supporting) based on the American College of Medical Genetics and Genomics Standards and Guidelines for either ENG or ACVRL1: 26 from 12 families (50%) for ENG, and 16 from 12 families (50%) for ACVRL1. Diagnostic screening of 42 genetically positive HHT patients based on the Curaçao criteria revealed that 24 patients (57%) were classified as having definite HHT, 17 (41%) as having probable HHT, and 1 (2%) as unlikely to have HHT. Epistaxis was the most common clinical presentation (38/42, 90%), followed by visceral AVMs (24/42, 57%) and telangiectasia (21/42, 50%). Five patients (12%) did not have a family history of HHT clinical symptoms.Conclusion. Only approximately half of patients with ACVRL1 or ENG genetic variants could be clinically diagnosed as having definite HHT, suggesting that genetic screening is important to confirm the diagnosis.

Objectives: Slight/mild hearing loss is detrimental to communication and academic achievements. This study aimed to describe the prevalence of hearing loss, and to investigate the factors related to noise-induced hearing loss among South Korean adolescent. Methods: As a population-based retrospective study, 1845 South Korean adolescents aged from 12 to 19 years were analyzed using the data from Korea National Health and Nutrition Examination Survey V (KNHANES V, 2010-2012). The prevalence of hearing loss according to the side, severity, and frequency was calculated. For assessing the noise-induced hearing loss in adolescent, the prevalence of hearing loss only in high-frequency (onlyHFHL, defined as 1) thresholds at 0.5 and 1 kHz of <= 15 dB HL, and 2) maximal thresholds at 3, 4, or 6 kHz >= 15 dB HL higher than the highest threshold for 0.5 and 1 kHz) was analyzed. Moreover, the relevance of onlyHFHL in context of sociodemographic factors and noise exposure history was evaluated. Results: The prevalence of unilateral and bilateral hearing loss based on the average of six frequencies (0.5, 1, 2, 3, 4, and 6 kHz) in South Korean adolescents were 8.56% and 1.03%, respectively, and most cases were hearing loss with slight/mild degree. The prevalence of unilateral and bilateral onlyHFHL were 32.74% and 5.53%, respectively. Factors found to be associated with onlyHFHL were sex (female) and household income (high). Conclusions: According to this population-based study, the prevalence of slight/mild hearing loss and onlyHFHL in the South Korean adolescents were considerably high. With knowledge of the factors related with onlyHFHL, paying more attention to slight/mild hearing loss will be helpful in preventing hearing loss in adolescents.

Tae-Hun Kim, Heung Eog Cha, Jong-Geun Lee, Gi Jung Im, Jae-Jun Song, Shin Hye Kim, Il Joon Moon, Young Ho Kim, Jae Yong Byun, and Sung-Won Chae Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul; and Department of Otorhinolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon University of Medicine and Science, Incheon; and Department of Otorhinolaryngology-Head and Neck Surgery, Inje University College of Medicine, Haeundae Paik Hospital, Busan; and Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul; and Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea

The case of a 59-year-old woman who underwent endoscopic sinus surgery for right maxillary sinusitis 5 years before visiting our otorhinolaryngologic department complaining of right-sided facial depression was described in this study. Computed tomography (CT) scans revealed right facial depression and retraction of the orbital floor due to a hypoplastic right maxillary sinus. Symptoms and CT findings corresponded with silent sinus syndrome. Facial depression is a rare symptom in silent sinus syndrome and is well corrected by autologous fat transfer.

Objective: To report the case of a 38-year-old woman who underwent osteoplastic flap surgery for recurrent frontal sinus mucocele. During surgery, the exact shape of the frontal sinus was duplicated using a surgical navigation system. Methods: In this case report, the authors suggest intraoperative surgical navigation systems are useful for accurately determining the dimensions of the frontal sinus for osteoplastic flap surgery. Results: The patient underwent successful and safe osteoplastic flap surgery using a surgical navigation system. Conclusion: Surgical navigation is useful and safe for frontal sinus osteoplastic flap surgery.

A 58-year-old female patient was presented, who complained about breathing and aesthetic difficulties due to external nasal valve obstruction and nasal deformity that developed after nasal trauma surgery. Nasal stenosis recurs easily after surgery, especially if internal nasal stenosis is not adequately managed. Nasal stenosis in this case was well treated using a composite skin graft.

This study describes a 68-year-old man who was presented to the emergency department with left orbital cavity penetration by his eyeglasses. The eyeglasses had entered the orbit and at presentation his eyesight could not be measured. The foreign body was extracted carefully and panfacial bone fractures were then reduced through lateral rhinotomy combined with a lip-splitting incision. When planning removal of an unusual foreign body from the orbital cavity, care should be taken not to injure the optic nerve, periorbital musculatures, or the eyeball.

Background and Objectives The clinical reports for the treatment of vocal fold scar and sulcus vocalis are limited, also there is no best one for the treatment of them. This study is to evaluate the effect of Injection laryngoplasty (IL) for the treatment of vocal fold scar and sulcus vocalis. Materials and Methods from January 2013 to May 2015, the Nineteen patients who were diagnosed as vocal fold scar, sulcus and atrophy, and underwent IL, were engaged in this study. Clinical information and voice parameters were analyzed by retrospective chart review. Pre and post voice parameters were compared. Results Subgroups of diagnosis were classified into sulcus vocalis for 12 patients, vocal fold scar for 5, and atrophy for 2. IL was performed under local anesthesia through cricothyroid membrane except one patient. Atesense®, Radiessess®, and Rofilan® were used as injected materials in 9, 9, and 1 patients respectively. Maximal phonation time (p=0.0124), dynamic range (p=0.0028), pitch range (p=0.0141), voice handicap index (p=0.028), glottal closure (p=0.0229), and mucosal wave (p=0.0132) had significant improvement for post-IL voice assessment than Pre-IL. While GRBAS, Mean flow rate, Jitter, Shimmer, Harmony to Noise ratio didn’t have improvement. Conclusion IL is a feasible option for the treatment of glottis incompetence with normally mobile vocal folds such as sulcus vocalis and vocal fold scar. Key words: Sulcus vocalis ㆍ Vocal atrophy ㆍ Scar ㆍ Injection laryngoplasty 핵심용어: 성대구증 ㆍ 성대위축 ㆍ 반흔 ㆍ 주사후두성형ìˆ

Background and Objectives: Olfactory dysfunction is a common sensory disorder, but there are currently no standard diagnostics or therapeutic methods. We analyzed the effects of systemic steroid therapy in patients with olfactory dysfunction. Materials and Method: We analyzed patients who visited our ENT department with olfactory dysfunction for 3 years. We reviewed their charts and classified the patients according to age, sex, etiology of olfactory dysfunction, degrees of olfactory dysfunction and the effect of systemic steroid therapy. Results: The mean age was 44.3 years old and there were 50 males and 55 females; 55 patients had inflammatory disease and 50 patients had non-inflammatory disease. The distribution of degrees of olfactory disorder according to cause was not signifi cantly different (p=0.120). In 105 patients, 20% experienced improvements after systemic steroid therapy, and the response of systemic steroid therapy was better among patients with inflammatory causes. In cases of inflammatory disease, there was a larger amount of severe hyposmia patients, and their response to systemic steroid therapy was significant (p =0.015). Patients with mild and moderate hyposmia were more responsive to systemic steroid therapy than patients with severe hyposmia (p=0.382). Conclusion: In cases of hyposmia due to inflammatory disease, systemic steroid therapy with proper operative management may increase therapeutic effects.

During the placement of a mould for a hearing aid by a hearing aid dispenser, moulding MATERIALS entered the middle ear through preexisting perforations in the tympanic membrane. Middle ear foreign bodies are common otorhinolaryngological emergencies and must be removed to avoid complications. Surgical removal of the moulding MATERIALS by tympanotomy was necessary. Here, we report a case of a middle ear foreign body caused by an ear moulding procedure in a 74-year-old woman, and review the related literature.

Paranasal sinus mucoceles (PSMs) can involve the orbit because the topographic anatomies of the paranasal sinuses and orbit are interrelated. We encountered 27 patients with PSMs involving the orbit that caused orbital symptoms. In this study, we evaluated the frequent symptoms and signs of PSMs involving the orbit, and report postoperative changes of orbital symptoms including the effects on visual acuity. A retrospective chart review, radiologic evaluation, and interviews were conducted after Institutional Review Board approval was obtained. Over the past 11 years, we encountered 27 patients with PSMs involving the orbit. We classified the patients according to orbital symptoms and PSM origin, and evaluated the surgical outcomes. A total of 27 patients (17 males and 10 females) with PSMs involving the orbit were included in the present study. The mean patient age was 51.0 ± 9.7 years (range 32–90) and the mean follow-up period was 20.5 months (range 2–84). Proptosis (15/27, 56 %) was the most common symptom. Other common symptoms included orbital pain (9/27, 33 %), decreased visual acuity or vision loss (9/27, 33 %), and diplopia (7/27, 26 %). All symptoms except for vision loss were improved by endoscopic marsupialization regardless of the disease period. Four out of five patients with decreased visual acuity experienced complete recovery. The remaining patient showed partial improvement after surgery. Four patients who were blind when they initially visited the hospital did not show any improvement after surgery. For PSM patients with decreased visual acuity, we can predict that vision will improve after surgery regardless of the disease duration. However, blindness will probably not resolve after endoscopic marsupialization. Even if the orbital symptoms (except for blindness) have persisted for a long time, surgery could still produce positive outcomes.

Recent studies have indicated that biofilms are involved in the pathogenesis of recurrent and recalcitrant chronic rhinosinusitis (CRS). The present study was performed to evaluate the presence of biofilms and to evaluate the relationships between the presence of biofilms and clinical features of CRS. A total of 33 patients were included in this study. Maxillary sinus mucosa from 26 CRS patients and the ethmoid mucosa from 7 patients undergoing septoplasty were collected. Biofilms were evaluated by scanning electron microscopy. Preoperative symptom scores, preoperative and intraoperative nasoendoscopic findings, and postoperative healing period were compared between the groups. Biofilms were detected in 14 (42.4 %) of the 33 patients. Biofilms were present in 13 (50 %) of the 26 patients in the CRS group, but in only one (14.3 %) of the seven patients in the control group. There were no significant differences in preoperative symptom scores or preoperative nasal Lund-Kennedy endoscopic scores between the groups. However, the average Lund-Mackay and intraoperative sinus Lund-Kennedy endoscopic scores were significantly higher in biofilm-positive than biofilm-negative patients (P < 0.05). In the follow-up period, the healing time was significantly longer in biofilmpositive than biofilm-negative patients (P < 0.05). This study suggested that the presence of bacterial biofilms may contribute to the pathogenesis of CRS and the clinical characteristics of CRS patients after endoscopic sinus surgery.

The position and size of the jugular bulb is incredibly variable. High mega jugular bulb is a vascular abnormality of the internal jugular vein at the jugular foramen. Mostly, high jugular bulb remains asymptomatic although ear diseases are present in some cases. The position of jugular bulb diverticulum determines the kind and degree of related symptoms. High jugular bulb could even mimic Meniere's disease with severe acute vertigo episodes, sensorineural hearing loss, and tinnitus. We present a rare case of a 17-year-old male patient with symptomatic high mega jugular bulb with diverticulum requiring surgery along with literature review.

Conclusion: This study attempted to develop a new rat model of subglottic stenosis (SGS), resulting from subglottic mucosal injury administered by electrocauterization. Despite failure of the posterior SGS model, the anterior SGS model was considered feasible. Objective: To investigate the feasibility of using rats as an animal model for SGS. Methods: Thirty-seven female Sprague-Dawley rats were assigned to the control group or to the anterior or posterior subglottic injury group. Electrical cauterization was performed on the anterior or posterior 180 degrees of the subglottic mucosa. Animals were euthanized at 4 weeks after injury. Histologic features of the subglottis were evaluated as regards changes in the subglottic lumen, lamina propria, cartilage, and epithelium after hematoxylin and eosin and Masson trichrome staining. Results: Survival in the anterior injury group was 80% (13/15) until 4 weeks, and results of histologic evaluation showed an increase in thickness of lamina propria with fibrosis and cartilage damage, resulting in luminal narrowing. A high rate of mortality was observed in the posterior injury group.

Background Sinus irrigation has been used to treat chronic rhinosinusitis refractory to medical and surgical treatments. The aim of this study was to evaluate the effect of maxillary sinus saline irrigation on the prevention of purulent rhinorrhea, extensive granulation formation, and polyp recurrence after endoscopic sinus surgery (ESS). Methods This prospective, controlled study was approved by the Institutional Review Board of Gachon University Gil Medical Center. Between August 1, 2011, and May 31, 2012, we recruited a total of 30 patients who underwent bilateral ESS. Group A was composed of 15 patients that were treated with bilateral maxillary sinus saline irrigation for 2 months after ESS. Group B was composed of 15 patients who were followed up during the same period after ESS. We checked for persistent purulent discharge, extensive granulation, and recurrent polyps in both groups to evaluate the effects of maxillary sinus irrigation on their prevention. Results Age, gender, and preoperative Lund-Mackay scores were not significantly different between the two groups (p > 0.05). In group A, one patient showed polyp recurrence. In group B, one patient showed extensive granulation tissue, two patients showed uncontrolled purulent discharge, three patients showed extensive granulation tissues and uncontrolled purulent discharge, and one patient showed recurrent polyps (p = 0.03). In addition, total endoscopic scores in the 3rd month were significantly different between groups A and B (p = 0.01). Conclusion Maxillary sinus saline irrigation may be effective in the prevention of poor prognostic factors, such as persistent purulent discharge, at the early stages after ESS.