후두음성 질환에 대한 인공지능 연구

석준걸,권택균 대한후두음성언어의학회 2022 대한후두음성언어의학회지 Vol.33 No.3

Diagnosis using voice is non-invasive and can be implemented through various voice recording devices; therefore, it can be used as a screening or diagnostic assistant tool for laryngeal voice disease to help clinicians. The development of artificial intelligence algorithms, such as machine learning, led by the latest deep learning technology, began with a binary classification that distinguishes normal and pathological voices; consequently, it has contributed in improving the accuracy of multi-classification to classify various types of pathological voices. However, no conclusions that can be applied in the clinical field have yet been achieved. Most studies on pathological speech classification using speech have used the continuous short vowel /ah/, which is relatively easier than using continuous or running speech. However, continuous speech has the potential to derive more accurate results as additional information can be obtained from the change in the voice signal over time. In this review, explanations of terms related to artificial intelligence research, and the latest trends in machine learning and deep learning algorithms are reviewed; furthermore, the latest research results and limitations are introduced to provide future directions for researchers.

침샘 악성종양의 발생에 대한 최신 경향

석준걸(Jungirl Seok),박은혜(Eun Hye Park),정규원(Kyu-Won Jung),장재원(Jae Won Chang) 대한두경부종양학회 2022 대한두경부 종양학회지 Vol.38 No.2

Due to the low incidence and histologic diversity of salivary gland cancer, analyzing the incidence of salivary gland cancer is necessary to understand the macroscopic aspects. We intend to investigate the international trend of the reported incidence rate of salivary gland cancer. Using the Korea Central Cancer Registry data, the domestic change in the incidence rate was examined. As a result, a significant increasing trend was confirmed, consistent with the United States and Japan trends. The etiology of the change is unclear, and various factors that may influence the direction are reported. Additional research is needed to understand the pathophysiology of salivary gland cancer, and further efforts are required to understand salivary gland cancer.

갑상선 유두암의 외측 경부림프절 전이에 대한 수술 전 평가로서 CT의 역할

석준걸(Jungirl Seok),김형규(Hyung gu Kim),김윤중(Yoonjoong Kim),한규희(Kyu-Hee Han),안순현(Soon-Hyun Ahn) 대한두경부종양학회 2013 대한두경부 종양학회지 Vol.29 No.2

Background and Objectives:To assess the usefulness of computed tomography image before papillary thy-roid cancer surgery, focus on confirmation of lateral cervical lymph node metastasis not detected by ultrasonogra-phy. Material and Methods:From January 2008 to May 2009, total 150 patients who had undergone thyroid sur-gery and been confirmed papillary thyroid cancer pathologically were enrolled. They had taken neck computed tomography following the ultrasonography. Results:Computed tomography had found suspicious metastatic lat-eral neck lesion in 13 patients. After the image study, lateral neck lymph node dissection had been included in their surgical plan. Of these, only 7 cases were confirmed pathologically lateral neck lymph node metastasis(positive predictive value=0.54). Taken as whole 150 patients, additionally 4.7% of patients confirmed lateral neck lymph node metastasis by preoperative computed tomography. Conclusion:If preoperative ultrasonography was per-formed precisely, additional benefits that could be achieved by computed tomography were not much.

연속 문장 발화에서 사전 정의된 청크 검출에 대한 인공지능 기반의 후향적 분석 연구

김재영,석준걸,이제현,이정훈,권택균 대한후두음성언어의학회 2024 대한후두음성언어의학회지 Vol.35 No.1

Background and Objectives In institutional settings, manually segmenting connected speech is a time-consuming and labor-intensive process. This study aims to develop a deep-learning model for automating this process, evaluating its accuracy, and determining the minimum dataset size for effective performance. Materials and Method Voice data from 524 individuals with pathological conditions and 502 individuals with normal conditions, totaling 1026 samples, were used. Each voice sample had 17 chunks, including a “summer” sentence (15 chunks) and vowels /α/ and /i/. The deep-learning model employed in this study is based on the multi-layer perceptron-mixer architecture. This study evaluated performance using the Intersection over Union (IoU) metric, commonly employed in artificial intelligence-based image detection for chunk segmentation. Results The accuracy of chunk identification at the frame level was 96.47%. Using IoU metrics, chunk segmentation accuracy was 98.15% at IoU ≥0.6, 96.03% at IoU ≥0.7, and 89.78% at IoU ≥0.8. Optimal dataset size exploration indicated that more than 700 connected speech datasets were needed for successful training, maintaining F1-scores up to 95% at IoU ≥0.7. Conclusion The artificial intelligence model is suitable for the development of an automated system that efficiently divides segments in the institutional collection of voice data. This suggests its potential utility in advancing voice research using connected speech

Endoscopically Applied Biodegradable Stent in a Rabbit Model of Pediatric Tracheomalacia

최지숙,석준걸,Min Rye Eom,정은지,박수아,주상민,전여진,손길원,권성근 대한이비인후과학회 2021 Clinical and Experimental Otorhinolaryngology Vol.14 No.3

Objectives. A polydioxanone (PDO) stent was developed to treat tracheomalacia in pediatric patients. However, its safety and efficacy need to be verified in animal studies before clinical trials in patients can be conducted. This study evaluated the safety and efficacy of a PDO stent in normal and tracheomalacia-model rabbits. Methods. In total, 29 New Zealand white rabbits were used: 13 for evaluating the biocompatibility of the PDO stent in normal rabbits and 16 for the creation of a tracheomalacia model. The tracheomalacia model was successfully established in 12 rabbits, and PDO stents were placed in eight of those rabbits. Results. The PDO stent was successfully positioned in the trachea of the normal rabbits using an endoscopic approach, and its degradation was observed 10 weeks later. The stent fragments did not induce distal airway obstruction or damage, and the mucosal changes that occurred after stent placement were reversed after degradation. The same procedure was performed on the tracheomalacia-model rabbits. The survival duration of the tracheomalacia rabbits with and without stents was 49.0±6.8 and 1.0±0.8 days, respectively. Thus, the PDO stent yielded a significant survival gain (P=0.001). In the tracheomalacia rabbits, stent degradation and granulation tissue were observed 7 weeks after placement, leading to airway collapse and death. Conclusion. We successfully developed a PDO stent and an endoscopic guide placement system. The degradation time of the stent was around 10 weeks in normal rabbits, and its degradation was accelerated in the tracheomalacia model. The mucosal changes associated with PDO stent placement were reversible. Placement of the PDO stent prolonged survival in tracheomalacia-model rabbits.

COVID-19 시대에 중환자실 전담의사 감독 하에 두경부 전문의에 의해 시행된 기관절개술에 대한 후향적 분석 연구

한원호,이윤임,백선화,석준걸 대한후두음성언어의학회 2022 대한후두음성언어의학회지 Vol.33 No.2

Background and Objectives Tracheostomy is a relatively safe procedure, and the recent emergence of COVID-19 has raised the need to perform tracheostomy immediately in the bed of an intensive care unit (ICU) rather than an operating room. The purpose of this study was to determine the occurrence of complications related to surgical tracheotomy performed in the ICU by an ENT specialist.Materials and Method From March 2019 to January 2022, a total of 101 patients underwent tracheostomy in the ICU. Demographics and complications were classified according to postoperative period.Results Within 24 hours after the procedure, bleeding events were confirmed in 2 patients (2.0%) with mild bleeding. One case (1.0%) of ventricular fibrillation occurred shortly after the procedure. There were no complications from 24 hours to 1 week after procedure. After one week, 4 patients (4.5%) had a local infection, and 3 patients (3.4%) had a tube obstruction. During all follow-up periods, there were no serious side effects such as death, major vascular injury, pneumothroax. No complications were observed throughout the entire period in 6 COVID-19 patients.Conclusion The number of complications of surgical tracheotomy in the ICU performed by a specialist was lower than in previous studies, and there were no complications that delayed treatment or endangered life. The ENT training hospitals should provide sufficient training opportunities for residents to perform surgical tracheostomy and strive to minimize complications associated with the procedure and pre- and post-operative management under the detailed guidance and supervision of specialists.

Clinical Implications of Septal Deviation in Lateralized Olfaction

최윤석,유윤종,이지혜,석준걸,한성준,진홍률,김대우 대한이비인후과학회 2016 Clinical and Experimental Otorhinolaryngology Vol.9 No.1

Objectives. Results of butanol threshold tests (BTTs) have shown that birhinal olfaction tends to converge toward monorhinal olfaction of the dominant nostril. However, birhinal olfaction may also be worse than dominant-side monorhinal olfaction. The goal of our study was to investigate the effect of deviated nasal septum on birhinal olfaction in patients with lateralized olfaction and to examine the effect of septoplasty in these patients. Methods. A retrospective study with planned data collection was conducted in 518 patients who underwent BTTs. Lateralized olfaction was defined as monorhinal BTT scores that differed by >2 between sides. Underestimated birhinal olfaction was defined as a birhinal BTT score >2 lower than the dominant nostril monorhinal BTT score. Patients with lateralized olfaction were divided into 2 groups: group 1, underestimated birhinal olfaction; and group 2, without underestimated birhinal olfaction. Results. Among 518 patients, 112 with lateralized olfaction were enrolled in this study. Group 1 included 23 patients (20.5%) and group 2 included 89 patients (79.5%). The severity of septal deviation (ratio of the distance of narrower side to wider side) did not differ between the 2 groups. Septal deviation to the dominant nostril was more common in group 1 than group 2 (73.9% vs. 37.6%; P=0.002). Five patients with septal deviation to the dominant nostril with underestimated birhinal olfaction underwent septoplasty. Improved lateralized olfaction occurred in all 5 patients postoperatively (P=0.041). Conclusion. Septal deviation of the dominant nostril in patients with lateralized olfaction is associated with underestimated birhinal olfaction. Septoplasty may improve olfaction by increasing airflow in the dominant olfactory side.

Feasibility of Brachial Plexus Schwannoma Enucleation With Intraoperative Neuromonitoring

이도영,Jeong-Yeon Chi,석준걸,한성준,이민형,정우진,정영호 대한이비인후과학회 2020 Clinical and Experimental Otorhinolaryngology Vol.13 No.2

Objectives. To evaluate the feasibility of brachial plexus schwannoma enucleation under intraoperative neuromonitoring. Methods. Five patients who were treated for brachial plexus schwannoma under intraoperative neuromonitoring from 2008 to 2018 were included in this retrospective review. Neuromonitoring was performed with a 100-μV event threshold of the neuromonitoring system (NIM-2 or 3) at the deltoid, biceps brachii, triceps brachii, and brachioradialis muscles. Patient characteristics, tumor size and location, intraoperative neuromonitoring findings, and postoperative function were evaluated. Results. The intraoperative neuromonitoring findings were in accordance with the preoperative assessment of the included nerve root. Three patients had no postoperative morbidity, one patient had temporary paresthesia of the forearm for 2 months, and one patient mild loss of grip strength for 1 month. Conclusion. Intraoperative neuromonitoring of the arm and forearm muscles during enucleation of brachial plexus schwannoma promoted confident and successful surgery with minimal postoperative morbidity.

횡격막 아래 장기에서 발생한 악성 종양의 경부림프절 전이 사례 분석

김진일(Jinil KIM),송슬기(Seulki SONG),석준걸(Jungirl SEOK),이민형(Minhyung LEE),한성준(Sung Jun HAN),정영호(Young Ho JUNG),안순현(Soon Hyun AHN),정우진(Woo-Jin JEONG) 대한두경부종양학회 2018 대한두경부 종양학회지 Vol.34 No.2

Background/Objectives: Cancers of the abdominal or pelvic organ rarely metastasize to the cervical lymph nodes. Although it indicates distant metastasis, perceivable prolongation of survival or cure may be possible in selected cases. We sought to identify patients with cervical metastasis from cancers below the diaphragm and identify patients who may benefit from aggressive treatment. Materials & Methods: From 2009 to 2017, patients with pathologically confirmed metastatic cervical lymph nodes originating from below the diaphragm were included for analysis. Patient demographics, cancer characteristics, treatment course, and clinical outcomes were analyzed. Results: 208 patients were identified. Left supraclavicular node (Virchow’s node) was the most frequently involved. Irrespective of treatment, survival for uterine cervical and ovarian cancers was significantly longer than that of other primaries. Patients with isolated cervical metastasis (oligometastasis) had significantly longer median survival compared to patients with concomitant bone, lung, brain, and mediastinal metastases. Conclusion: Although cervical metastasis from cancers of the abdominal and pelvic organ represent distant metastasis, patients with uterine cervix and ovary primary and oligometastatic lesions may benefit from aggressive treatment. Prudent patient selection and further investigation is warranted.

Guideline for the Surgical Management of Locally Invasive Differentiated Thyroid Cancer From the Korean Society of Head and Neck Surgery

박준욱,권순영,백승국,김주현,주영훈,김상연,김근전,김현범,이동현,홍현준,박영민,정은재,지용배,오경호,이형신,이동근,박기남,반명진,김보해,김도훈,조재근,안동빈,김민수,석준걸,장전엽,최효근,김희진,박성준,정은경,김연수,홍용태,이영찬,원호륜,신성찬 대한이비인후과학회 2023 Clinical and Experimental Otorhinolaryngology Vol.16 No.1

The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients withlocally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invadingsurrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, theoptimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. OnOctober 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers werereviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Developmentand Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommenda-tions. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an inter-vention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completingthe draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgicalextent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework,trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-basedguidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatmentof patients with locally invasive DTC.