Palatine Tonsil Size Predicts Upper Airway Obstruction in Adults with Obstructive Sleep Apnea

지창록,구수권,고태경,우주영 대한이비인후과학회 부산,울산,경남 지부회 2022 임상이비인후과 Vol.33 No.2

Background and Objectives: Drug-induced sleep endoscopy (DISE) is widely used to diagnose obstructive sleep apnea syndrome (OSAS). Palatine tonsil hypertrophy is a frequently encountered potential source of upper airway obstruction. Here, we determined whether the pre-surgery size of the palatine tonsil could be used to predict the extent and pattern of upper airway obstruction during DISE of adults with OSA. Materials and Methods: We retrospectively evaluated 268 patients (mean age 42.80±12.34 years, range 17–73 years) who underwent polysomnography and were diagnosed with OSAS in a single medical center from 2013 to 2020. The Brodsky tonsil scores of all subjects were obtained via physical examination. DISE proceeded with each patient supine. The extent of obstruction was evaluated by dividing the upper airway into retropalatal and retrolingual levels (the Koo's DISE classification system). Data were analyzed via simple linear regression. A p<0.05 was considered statistically significant. Results: We found relationships between the Brodsky tonsil score and the extents of obstruction at the retropalatal level. A significantly negative relationship between the score and retropalatal anteroposterior collapse was apparent (slope coefficient –0.115, p<0.05), as well as a significantly positive relationship between the score and retropalatal lateral collapse (slope coefficient 0.274, p<0.05). However, at the retrolingual level, no significant relationship was apparent between the Brodsky score and the extent of obstruction (p>0.05). Conclusion: In adult patients with OSA, as the palatine tonsil size increased, lateral pharyngeal wall obstruction at the retropalatal level became more severe, and the pattern of upper airway collapse at that level tended to be lateral rather than anteroposterior or concentric.

A Case of Low Grade Thyroid Like Nasopharyngeal Papillary Adenocarcinoma in Posterior Nasal Septum

지창록,박근형,구수권,이화선 대한이비인후과학회 부산,울산,경남 지부회 2020 임상이비인후과 Vol.31 No.1

Nasopharyngeal papillary adenocarcinoma of low-grade malignancy (LGNPPA) is an extremely rare neoplasm. A thyroid-like LGNPPA morphologically resembles a papillary thyroid carcinoma; the lesion is usually a polypoid or pedunculated mass <1-3 cm in diameter, often in the posterosuperior wall of the nasopharynx. Here, we report a case of a thyroid-like LGNPPA in the left posterior septal wall. Surgical removal of the tumor was performed by transnasal endoscopic resection using laryngeal cutting forceps. The tumor was completely resected, bleeding was minimal, and the patient had no complaints of nasal pain, nasal congestion, or epistaxis. Further evaluation including immunohistochemistry confirmed a diagnosis of thyroid-like LGNPPA. No postoperative adjuvant treatment was administered.

비중격 성형술에서 Morniflumate, Paracetamol, Pregabalin의 통증 조절 효과 비교

지창록,정성훈,박근형,이호병,구수권 대한이비인후과학회 부산,울산,경남 지부회 2019 임상이비인후과 Vol.30 No.1

Background and Objectives:Septoplasty is a common otolaryngological procedure. Patients who undergo septoplasty frequently complain of pain in the early postoperative period due to surgical trauma and nasal packing. The oral analgesics morniflumate (a nonsteroidal anti-inflammatory drug [NSAID]), paracetamol, and pregabalin are commonly used to control pain after septoplasty. We compared the efficacy of these analgesics in controlling postoperative pain. Materials and Methods:The study included 44 male patients who underwent septoplasty due to nasal septal deviation. The patients received morniflumate (350 mg twice daily, n=15), paracetamol (650 mg three times daily, n=14), or pregabalin (75 mg twice daily, n=15), and postoperative pain was assessed for 3 days after surgery. Results:The postoperative pain decreased significantly over the observation period despite the type of analgesic administered. Although morniflumate was the most effective, followed by paracetamol and pregabalin, the differences were not statistically significant. Conclusions:We found no significant differences in efficacy among the three analgesics most commonly prescribed for postoperative pain after septoplasty.

비인두에 발생한 Melanotic Oncocytic Metaplasia(MOM) 1예

박근형,지창록,고태경,이화선 대한이비인후과학회 부산,울산,경남 지부회 2020 임상이비인후과 Vol.31 No.1

Melanotic oncocytic metaplasia (MOM) of the nasopharynx is a rare lesion that occurs mostly in Asian men in their 60s to 70s who are heavy smokers. Although it is a benign lesion, it’s sometimes mistaken for malignant melanoma, nevus or early nasopharyngeal carcinoma. A 75 year-old male visited our outpatient clinic with hearing loss that occurred a week earlier. Otoscopic findings revealed left serous otitis media. A nasopharyngoscopic examination to rule out a malignant tumor in the nasopharynx revealed multiple black nodules in the left torus tubarius and left nasal floor. Under local anesthesia, some of nodules were excised for histopathology. The histological examination revealed oncocytic metaplasia of mucous glands and the presence of numerous browncolored melanin pigments. Immunohistochemically, S 100-positive and HMB 45-negative dendritic melanocytes were identified. During 3 months of regular follow up, there was no recurrence at the excision site and no expansion of the remaining lesion.

컴퓨터단층촬영을 이용한 비중격 만곡증 환자의 안와벽 결손 유병률에 대한 연구

우주영,구수권,고태경,지창록,박근형 대한이비인후과학회 부산,울산,경남 지부회 2021 임상이비인후과 Vol.32 No.2

Background and Objectives: The orbit contains important structures such as the eyeball, optic nerve, and extra- ocular muscles. A defect the orbital wall is a clinically important anatomical variation because it can cause serious complications during nasal surgery. The authors investigated the incidence of orbital defects in patients of chronic sinusitis with nasal septal deviation and found out whether there is a relationship between chronic sinusitis and orbital defects to help the surgical treatment of these patients. Materials and Methods: The computed tomography (CT) and medical records of 247 patients with chronic sinusitis with septal deviation (study group) and 470 patients with septal deviation only (control group) were analyzed retrospectively. The average age of patients was 34.05 years for males and 33.67 years for females. Results: The incidence of orbital defects was statistically higher with 22 out of 247 subjects in the study group (8.9%) than 22 out of 470 subjects in the control group (4.7%)(Chi-square verification result, significance level 0.05). In both groups, the direction and degree of nasal septal deviation did not significantly affect the incidence of orbital defects, and medial orbital defects were the most common in both groups (study group, 90.9%, 20/22, control group, 86.4%, 19/22). Conclusions: About 9% of patients with chronic sinusitis with septal deviation showed defects of the orbital wall, which is easy to be damaged in sinus surgery and can lead to permanent complications. We should prevent such complications through evaluating CT and detailed medical history of the patient before surgery.

수면호흡장애 환자에서 체질량지수가 약물유도수면내시경상 상기도폐쇄에 미치는 영향

우주영,구수권,고태경,지창록 대한이비인후과학회 2022 대한이비인후과학회지 두경부외과학 Vol.65 No.12

Background and Objectives Drug-induced sleep endoscopy (DISE) usefully determinesthe sites of airway obstruction in patients with sleep-disordered breathing. It is widely acceptedthat obesity increases obstructive sleep apnea. However, no study has explored how andwhere obesity causes obstructions. In this study, we described the patterns of upper airway obstructionrevealed by DISE in patients of various body mass indices (BMIs) with sleep-disorderedbreathing. Subjects and Method All subjects had sleep-disordered breathing and underwent DISE. Endoscopic findings at the retropalatal (upper lateral, upper anteroposterior [AP]) and retrolingual(lower lateral, lower AP) levels were graded; obstruction was complete (2), partial (1),or none (0). Subjects with BMI <25 (<25 group), 25≤BMI<30 (25<30 group), and ≥30 kg/m2(>30 group) were compared using a dummy variable; to this end, we employed R ver. 4.0.5. Results For the total of 153 patients reviewed, the mean age was 43.1±12.2 years and themean BMI was 26.0±3.4 kg/m2. At the retropalatal AP level, the DISE grade was significantlyhigher in the 25<30 group than in the <25 group (p=0.029) but not in the >30 group (p=0.248). At the retropalatal lateral level, significant increases were evident in both of the higher BMIgroups (p=0.06 and p=0.024, respectively). No significant relationship was found at the retrolinguallevel. Conclusion In terms of the retropalatal AP and lateral diameters, a higher BMI is associatedwith a greater incidence of more severe obstruction.

Relationships of Direction and Degree of Nasal Septum Deviation with Nasal Floor Morphology

구수권,박근형,고태경,이호병,지창록 대한이비인후과학회 부산,울산,경남 지부회 2020 임상이비인후과 Vol.31 No.2

Background and Objectives: Nasal septum deviation can affect nasal bone growth and facial morphology. We used computed tomography image to clarify the relationships between nasal septal deviation and nasal floor morphology in Koreans. Materials and Methods: From 2006 to 2016, CT images of 687 patients of nasal septal deviation and 100 of non-nasal septal deviation were retrospectively analyzed. Relationship between nasal septum and nasal floor was analyzed on 271 subjects whose nasal septum and nasal floor are both deviated. Only cephalocaudal C-shape was analysed, based on the Guyuron classification . The angle of the nasal floor measured at three vertical reference planes were used to assess the relationships with angle of nasal septal deviation. Results: The number of patients with nasal floor deviation was 39.4% in nasal septal deviation group and 17.0% in control group, respectively; nasal floor was more uneven when nasal septum deviated (p<0.001). In 271 patients with both nasal septum and floor deviation, the mean angles of nasal septum and nasal floor were 11.24° and 5.60° respectively. The direction of nasal floor was significantly deviated in the opposite to nasal septum (28% : 72%, p<0.01) in both sex. But the degree of asymmetry of the nasal floor was not significantly correlated with the degree of nasal septal deviation. Conclusions: Nasal floor asymmetry occurred in the opposite direction to nasal septal deviation in 72% of patients. In patients with nasal septal deviation during growth, facial growth may occur asymmetrically, which is an important consideration during treatment of nasal septal deviation.

Snoring Sound Intensity and Formant Frequencies by Sleep Position in Patients with Positional Obstructive Sleep Apnea

고태경,권순복,구수권,이호병,지창록,박근형,이상준 대한이비인후과학회 2020 대한이비인후과학회지 두경부외과학 Vol.63 No.7

Background and Objectives Snoring is the most common symptom of obstructive sleepapnea (OSA) and is caused by turbulent airflow due to narrowing of the upper airways. In patientswith positional OSA, a change in sleep posture from supine to lateral is known to reducesnoring and sleep apnea. This study was performed to compare changes in snoring sound intensityand formant frequencies according to sleep position. Subjects and Method A total of 19 patients (male: 18; female: 1) diagnosed with positionalOSA by polysomnography (PSG) were enrolled in this study. The snoring sounds recordedduring PSG were analyzed acoustically and compared according to sleep position (i.e., supinevs. lateral). Results Snoring disappeared on changing sleep position in five patients, all of whom hadApnea-Hypopnea Index (AHI) <15. In other patients, the snoring sounds tended to decreasewith posture change, and the degree of decrease was inversely proportional to AHI (p=0.015)and respiratory disturbance index (RDI) (p=0.013). Formant frequencies 1, 3, and 4 (F1, F3,and F4, respectively) decreased when sleeping in the lateral position (p=0.02, 0.03, and 0.01,respectively). Conclusion In patients with positional OSA, a change in sleep posture from supine to lateralduring sleep reduced the intensity and frequency of snoring sound.

구개편도 및 아데노이드 크기와 코골이 소리의 연관성: 음성학적 연구

우주영,구수권,권순복,지창록,고태경 대한이비인후과학회 2022 대한이비인후과학회지 두경부외과학 Vol.65 No.12

Background and Objectives The most common cause of snoring in children is enlargedtonsils and adenoids. However, there is insufficient evidence to determine whether the subjectivemeasurement of tonsil hypertrophy, the most common prevailing method, reflects the actualtonsil size and volume. Therefore, we tried to determine whether the subjective gradingof tonsil size and actual tonsil volume is related, and whether tonsil volume, weight, and adenoidindex are correlated with the acoustic analysis of snoring. Subjects and Method The study was conducted on 21 children between the ages of 4 and15 who came for tonsillectomy and adenoidectomy due to snoring symptoms. The degree ofadenotonsillar hypertrophy was measured using the Brodsky grading scale and adenoid index. After tonsillectomy, the volume and weight of resected tonsil were measured. For acousticanalysis, the Praat software was used to determine formant frequency and sound intensity. Alinear regression model and a dummy variable were used to determine the correlation betweenthe quantitative values of tonsil, adenoid and the result of acoustic analysis. Results The Brodsky tonsil grade tended to match the actual tonsil volume, but it was notstatistically significant (p=0.073). There was no correlation between snoring intensity and actualtonsil volume, weight, and adenoid index. Formant frequency 1 and 2 were statisticallynegatively correlated with the actual tonsil volume (p=0.011, 0.002). Conclusion The study confirmed that the acoustic analysis of pediatric snoring could be ascreening test to predict tonsil volume and changes in the vocal tract due to tonsil hypertrophy.

The Effect of Adenotonsillectomy on Korean Children’s Voice

박근형,권순복,고태경,구수권,이상훈,이호병,지창록 대한이비인후과학회 2019 대한이비인후과학회지 두경부외과학 Vol.62 No.11

Background and Objectives Adenotonsillectomy is a commonly performed surgical procedurecarried out by otolaryngologists for children. Anatomical changes to the vocal tractoccur after the surgery and may alter the patient’s voice. This study evaluated the effects ofadenotonsillectomy on the voice in Korean children. Subjects and Method A total of 20 children who underwent adenotonsillectomy were enrolled. The speech of patients was recorded before and at one month of the surgery and acousticfeatures, especially the formant frequency, were analyzed. Perceptual analysis was alsocarried out and the Pediatric Voice Handicap Index (PVHI) questionnaire was used to assesssubjective changes in the children’s voice and the effects of these changes on social functions. Results Acoustic analysis revealed significant decreases in the vowel /i/ in the second formant,compact-diffuse, and grave-acute features of the voice (p=0.026, 0.022, and 0.031, respectively). A significant decrease was also observed in the intensity of the voice for the vowel/u/ (p=0.025). Perceptual analysis revealed that 86.6% of patients’ voice recordings had postoperativechanges. The mean preoperative PVHI score was 2.70±3.37, which decreased to1.65±2.21 (p=0.011) after the surgery. Conclusion The results suggest that adenotonsillectomy affects Korean children’s voicesboth acoustically and perceptually