Background and ObjectivesZZKawasaki diseases (KD) sometimes present themselves as cervical lymphadenitis or deep neck infection.These unusual Kawasaki diseases then lead to unnecessary antibiotic therapy or surgical intervention or delaying therapy.The purpose of this study is to determine clinical characteristics of early expressions of atypical Kawasaki diseases presenting as deep neck infection.Subjects and MethodZZWe reviewed the medical records of the 6 patients who had been treated for Kawasaki disease that initially presented as fever and cervical lymphadenitis between March, 2007 and December, 2008.ResultsZZThe contrast neck CT scan of four of the cases revealed no ring enhancement but retropharyngeal space fluid collection suggestive of retropharyngeal abscess.The contrast neck CT scan of the other two cases showed homogenous nonsuppurative cervical lymph node enlargement.We administered intravenous antibiotics but patients did not response to them.We then immediately administered intravenous immunoglobulin and aspirin after making the diagnosis of Kawasaki disease.The clinical condition of all the cases improved dramatically with defervescence.ConclusionZZThe possibility of Kawasaki disease should be considered in the following three situations: first, if the fever is refractory to intravenous antibiotic treatment in the febrile child with cervical lymphadenopathy, secondly, if the neck CT scan reveals a soft tissue swelling with no ring enhancement, and lastly, if the fever subsides dramatically after starting intravenous immunoglobulin and aspirin.Echocardiography should be performed as early as possible.

Objectives Many factors influence the outcome of endoscopic dacryocystorhinostomy (DCR). One of the most important prognostic factors is the level of obstruction in the lacrimal drainage system. The main objective of this report is to evaluate both the frequency of obstruction by anatomical region of the lacrimal drainage system on dacryocystography (DCG) and the surgical outcome of endoscopic DCR according to the obstruction level. Methods A retrospective series of 48 patients (60 eyes) who had undergone endoscopic DCR from January 2005 to November 2007 were enrolled. Preoperative evaluation consisted of a standard examination which included lacrimal irrigation, probing, DCG and osteomeatal unit (OMU) computed tomography. Patients were classified into four groups according to the obstruction level on DCG. Surgical outcome was evaluated postoperatively by subjective improvement of epiphora and patent rhinostomy opening on nasal endoscopic exam. Results Of 60 eyes, the levels of obstruction were the common canaliculus in 14 eyes (23.3%), the lacrimal sac in 13 eyes (21.7%), the duct-sac junction in 13 eyes (21.7%) and the nasolacrimal duct (NLD) in 20 eyes (33.3%). The ductsac junction obstruction was treated most successfully (100%), followed by NLD obstruction (90%), common canaliculus obstruction (78.6%) and saccal obstruction (69.2%). Conclusion In patients with lacrimal drainage system obstruction, preoperative evaluation of obstruction level using DCG may be helpful for predicting the surgical outcome of endoscopic DCR. The saccal obstruction may have a worse prognosis than the other obstruction levels.

Background and ObjectivesZZThe knowledge about chromosomal aberrations manifestated in cancer has been spotlighted recently. The genetic analyses based on the knowledge about chromosomal aberrations are important for the development of diagnotic methods and evaluation of prognostic factors in cancers. Comparative genomic hybridization (CGH) is a powerful tool for evaluating chromosomal aberrations and array CGH significantly enhances these diagnostic effectiveness. The incidence of head and neck squamous cell carcinoma (HNSCC) has been increasing worldwide but the treatment outcomes still have been limited. The aim of this study is to evaluate the location of chromosomal aberrations in HNSCC cell lines with the combination of CGH and array CGH.

Background and ObjectivesZZSudden deafness, an important disease characterized by abrupt sensorineural hearing loss, is rare in children and the prognosis in children is accepted to be worse than that in adults. However, clinical studies are not sufficient to define the clinical characteristics and prognosis of sudden deafness in children. The author analyzed clinical manifestation of sudden deafness in children and compared the treatment results of children with those of adults. Subjects and MethodZZA retrospective analysis was performed in 25 patients (29 ears) who were treated for sudden deafness from January 1993 to May 2008. ResultsZZ1) The overall hearing recovery rate (79%) was significantly higher in adults (53.7%). The prognosis in children less than 10 years old (73%) was also higher than that in adults. 2) The rate of complete recovery (61%) was higher in children than in adults (38.5%). ConclusionZZThe sudden deafness in children has unique clinical characteristics and the recovery rate is more favorable than in adults. Korean J Otorhinolaryngol-Head Neck Surg 2009;52:805-9 Key WordsZZSudden deafness·Sensorineural hearing loss·Children·Prognosis.

Background and Objectives：The timing of surgery is an important consideration point in the management of blowout fracture (BOF) of the orbit. This study aimed to compare the surgical outcome of early and delayed reduction and to suggest the best timing of surgery in the pure medial BOF of the orbit. Subjects and Method：Fifty-two patients who had endoscopic endonasal reduction of medial BOF were studied retrospectively. Patients were divided into an early group (N=42) who had surgery within one month after the trauma and a delayed group (N=10) who had surgery after one month from the trauma. Surgical indications, results of the surgery, and complications were compared between the two groups. Results：The surgical indications in the early group were persistent diplopia, large defect expecting later enophthalmos and limitation of EOM, whereas the delayed group complained mainly of enophthalmos and diplopia. There were no significant differences in surgical outcomes and the rate of complications between the two groups. Conclusion：When patients with pure medial BOF have large defects without any persistent diplopia and limitation of EOM, surgery would be safely deferred until significant enophthalmos occurs. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:796-9)

Vascular tinnitus, a sort of pulsatile tinnitus, should be differentiated with other sensorineural tinnitus because it is possible to be cured by correction of underlying systemic disease or surgery. The dehiscent high jugular bulb, a common cause of venous pulsatile tinnitus, can be cured by reconstruction of hypotympanum. We present a case of pulsatile tinnitus with dehiscent high jugular bulb which has been treated by surgery. Preoperative microscopic finding showed dark bluish pulsating mass in posteroinferior portion of tympanic membrane. Temporal bone CT showed high jugular bulb with bone defect of hypotympanum. The hypotympanum was reconstructed and high jugular bulb lowered using the harvested bony fragment from mastoid cortical bone. The pulsatile tinnitus disappeared immediately after surgery. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:751-4)