고실내 약물 주입술을 이용한 내이질환의 치료

양형채,조형호 대한이비인후과학회 2014 대한이비인후과학회지 두경부외과학 Vol.57 No.6

During treatment of inner ear diseases, the blood-cochlear barrier limits the drug delivery into the cochlea. Intratympanic drug injection for inner ear diseases is a safe procedure where drugs reach high concentrations in the cochlea and systemic side effects are minimized. This paper reviews the updated status of intratympanic drug injections for the treatment of inner ear disease. Intratympanic drug injection is an effective procedure for the control of inner ear disorders such as Ménière’s disease and sudden sensorineural hearing loss. Although the effect of intratympanic injection on tinnitus and noise-induced hearing loss is open to discussion, its indications could be extended, like as drug, gene, and cell-based therapy. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(6):364-72

대이개 신경 뒷가지 희생군과 보존군에서 감각 차이의 비교

양형채,이성수,조시영,이창준,김록영,이준규 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.3

Background and Objectives Whether to sacrifice the posterior branch of great auricular nerve (GAN) during parotidectomy is disputatious. This study was to provide a guideline for de-cision-making. Subjects and Method Thirty-two patients who underwent parotidectomy due to parotid mass were randomized into two groups. Three patients who underwent further treatment were ex-cluded. Fourteen patients underwent classic parotidectomy by sacrificing GAN whereas 15 patients underwent surgery that preserved the nerve. A two-point discrimination test, sensation of light touch, sharp instrument, blunt instrument and temperature were evaluated preoperatively, and at 7 days, 1, 3, 6, 12 months and 45 months, postoperatively. Patients’ preference for the ope-ration time to preserve the nerve was also evaluated. Results The mean preservation time was 156 seconds. There was no difference in touch sensa-tion, preoperatively, between the two groups. The two-point discrimination test of the infra-auricular area showed significant differences at 1 week postoperatively (p<0.05). The two-point discrimination test of lobule showed significant differences at 1 month (p<0.05), but these dif-ferences disappeared at 1 and 3 months. All measured data had no statistically sig-nificant differences at 3 and 6 months. At one year, light touch sensation of lobule and temperature sensa-tion of infra-auricular area showed significant differences (p<0.05). Differences in tempera-ture were found at 45 months of follow-up. Of the patients, 95% wanted to preserve the nerve. Conclusion The authors suggest that the posterior branch of GAN was preserved according to patients’ preference for the sensation of temperature in the infra-auricular area.

Donor-Site Morbidity Following Minimally Invasive Costal Cartilage Harvest Technique

양형채,조형호,조시영,장철호,조용범 대한이비인후과학회 2015 Clinical and Experimental Otorhinolaryngology Vol.8 No.1

Objectives. Autologous costal cartilage is a promising alternative for mastoid obliteration. However, donor-site morbidities of the chest wall limit the use of this graft. To address this issue, we have developed a minimally-invasive technique of harvesting costal cartilage and report donor site morbidity associated with the procedure. Methods. Donor site morbidities were evaluated for 151 patients who underwent costal cartilage harvest, canal wall down mastoidectomy, and mastoid obliteration. Pain and cosmetic concern were evaluated via visual analogue scale (VAS). Scars were evaluated via the modified Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Postoperative complications were assessed during the follow-up period. Results. The mean duration of noticeable pain was 5.3 days post operation. The mean VAS score for pain was 3.0 of 10 on the first day after the operation and gradually declined. At the 6 months post operation, the mean VAS cosmetic score at the costal cartilage harvest site was 0.6 of 10. The mean VSS score was 9.5 out of 10 total, and the mean POSAS score was 23.27 out of 110 total. Conclusion. The minimally-invasive chopped costal cartilage harvest technique resulted in acceptable pain, cosmetic concern, and postoperative complications for most patients. There were no major postoperative complications. Costal cartilage is an acceptable donor for mastoid obliteration in canal wall down mastoidectomy, especially in the context of the extremely low donor site morbidity of the minimally-invasive technique presented in the study.

코로나 19와 도시계획

양형채,김성은 (사)한국도시계획가협회 2020 Urban planners Vol.7 No.3

비강수술이 인두기도에 미치는 영향 분석

윤성호,양형채,Nutsalai Galiulina,강태구,김희영,임혜린,임상철 대한이비인후과학회 2020 대한이비인후과학회지 두경부외과학 Vol.63 No.1

Background and Objectives Nasal surgery is known to improve the quality of life in patientswith obstructive sleep apnea; however, its effect on the airway structure is little known. This study attempted to identify the impact of nasal surgery on the pharyngeal airway structure. Subjects and Method We enrolled in the study patients who underwent nasal surgery fromJuly 2015 to March 2018 due to nasal obstruction with severe snoring or sleep apnea. Patientswith palate surgery or previous history of airway surgery were excluded. Demographic factors,symptoms regarding nasal obstruction, sleep study, preoperative cephalometry, and postoperative3-month cephalometry were taken into account and analyzed. We also performed asubgroup analysis according to the severity of sleep apnea. Results Sixty-three patients were enrolled in this study. Soft palate thickness showed no significantchange. Pre and postoperative soft palate thickness were 10.82±3.00 and 11.11±3.35(p=0.261), respectively. However, the pharyngeal airway space was enlarged via nasal surgeryfrom 12.05±3.35 to 13.04±3.35 (p=0.006), respectively. The subgroup analysis showed that thepharyngeal airway was mainly enlarged in the patients with lower Apnea-Hypopnea Index (AHI). Conclusion Although nasal surgery does not reduce soft palate thickness, it can enlarge thepharyngeal airway space. The effect of surgery would be more prominent in patients withAHI of lower than 15 event/hour (p=0.005) as nasal surgery alone does not affect the pharyngealairway of patients with AHI greater than 15.

Patients’ Characteristics according to Allergic Sensitization in Chronic Rhinitis

성충만,양형채,조형호 대한이비인후과학회 2018 대한이비인후과학회지 두경부외과학 Vol.61 No.2

Background and Objectives Chronic rhinitis is divided into allergic rhinitis (AR) and non-allergic rhinitis (NAR), both of which have similar symptoms but differ in treatment approaches. For the diagnosis of AR, allergen-specific immunoglobulin E (IgE) tests along with characteristic symptoms are required. However, these tests are costly and not always practicable. The purpose of this study was to investigate how symptoms respond differently to different allergen sensitization or sensitized allergen. Subjects and Method We retrospectively reviewed 1661 patients who underwent multiple allergen simultaneous test (MAST) for chronic rhinitis symptoms. The total nasal symptom (TNS) scores of these patients from 2006 to 2014 were assessed for rhinorrhea, nasal obstruction, itching, and sneezing. Patients were classified as AR and NAR according to the results of MAST and their association with symptoms. Results There were 1021 patients designated to the AR group and 640 patients to the NAR. The AR group had lower age, higher TNS, and higher serum IgE levels than the NAR group. In addition, sneezing and itching were more common in the AR group. Furthermore, sneezing was a positive predictor for seasonal allergen sensitization. On the other hand, itching was a positive predictor for perennial allergen sensitization. Conclusion AR and NAR patients showed different demographic characteristics and symptoms. These results may be helpful in classifying and treating patients with chronic rhinitis, especially when the allergen specific IgE test cannot be performed.

Vascular Leiomyoma in the Head and Neck Region: 11 Years Experience in One Institution

윤태미,양형채,최유덕,이동훈,이준규,임상철 대한이비인후과학회 2013 Clinical and Experimental Otorhinolaryngology Vol.6 No.3

Objectives. Vascular leiomyoma is an uncommon benign tumor of smooth muscle origin that arises from the muscularis layer of blood vessel walls. We report our experiences with the clinical manifestations, pathologic characteristics, and management of vascular leiomyoma in the head and neck. Methods. The clinical records of 12 patients with vascular leiomyoma of the head and neck in the 11-year period were reviewed retrospectively. Results. The 12 patients included nine men and three women. The locations of the tumors were variable, including nasal cavity, auricle, hard palate, upper lip, upper eyelid, and supraclavicular space. All but three patients reported an asymptomatic spherical mass; the other three patients complained of intermittent epistaxis or unilateral nasal obstruction resulting from the tumor originating in the nasal cavity. All tumors were painless. Computed tomography consistently revealed a well-defined, intensely enhanced small mass on the mucosa. No case was dignosed corretly as vascular leiomyoma before surgical excision. All patients underwent localized surgical excision of the tumor without recurrence. Five of 12 tumors (42%) were of solid type, four (33%) were of venous type, and three (25%) were of cavernous in histological classification. The histologic type was not related to gender, site of occurrence, and presence of pain. Conclusion. Vascular leiomyoma presents as a small, painless mass in various locations of the head and neck region. Localized surgical excision is the only way to make the diagnosis and yields excellent results.

The Antibiotic-Vaseline Soaked Cotton Pledget as an Adjuvant Material for Endoscopic Endonasal Fungal Ball Removal

김영윤,양형채,김재구,김희영,박종민,남광일,송민근,임상철 대한비과학회 2020 Journal of rhinology Vol.27 No.1

Background and Objectives: Treatment choice for fungal ball is endoscopic endonasal removal. However, it is not easy to remove fungal elements from the maxilla using only an endonasal approach. To overcome this difficulty, we introduced a cotton pledget technique and evaluated its efficacy through a cadaveric study and clinical research.Materials and Method: A cadaveric study was performed using 10 half heads of seven cadavers. The ease and safety of the cotton pledget technique were compared to those of a previously reported technique. In clinical research, we enrolled 52 patients who underwent surgery with the cotton pledget technique and 36 patients who underwent surgery using the conventional endoscopic approach. Demographic factors, preoperative Lund-Mackay (LM) score, sinonasal outcome test (SNOT) score, surgical morbidity, and incomplete removal rate were analyzed.Results: The cadaveric study showed that the cotton pledget technique was easier (p=0.011) than the conventional technique. In addition, clinical evaluation showed that the cotton pledget group had significantly lower incomplete removal rate than that of the control group (p=0.010).Conclusion: The cotton pledget technique is an easy and safe method that enables fungal ball removal more effectively than the conventional technique without need for inferior meatal antrostomy (IMA) or the Caldwell-Luc (CL) approach.

고실 유양동 수술 후 발생한 지연성 안면신경 마비: 진균 감염의 가능성 및 치료

이대웅,양형채,이동훈,조형호,조용범 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.5

Background and Objectives The purpose of this study was to assess the clinical courses and clinical outcomes of delayed facial nerve paralysis (DFNP) after middle ear and mastoid surgery. Subjects and Method In our hospital, postoperative DFNP occurred in 13 cases among the patients who underwent ear surgery from December 2000 to February 2010. During the same period, another 4 cases with postoperative DFNP were diagnosed at a local clinic. We assessed the degree of DFNP by using House-Brackmann grade (HBG) and separated 8 patients in grade II, 6 patients in grade III and 3 patients in Grade IV. Among 17 patients, DFNP occurred after open cavity mastoidectomy in 11 cases and after closed cavity mastoidectomy in the rest of 6 cases. Results Among 17 postoperative DFNP, fungal infections were found in three patients. Patients for whom antifungal agent was relatively delayed in application, their condition did not improved. Conclusion After treatment, most of patients recovered within 1 month and there were no other associated infection during hospitalization. We suggest that antifungal agents should be used as soon as possible when patients complain about DFNP following open cavity mastoidectomy.

Congenital Cholesteatoma of Mastoid Temporal Bone and Posterior Cranial Fossa Treated with Transmastoid Marsupialization

성충만,양형채,조용범,장철호 대한이비인후과학회 2018 대한이비인후과학회지 두경부외과학 Vol.61 No.12

A congenital cholesteatoma is a benign mass formed from the keratinizing stratified squamousepithelium. It usually occurs in young children’s anterosuperior part of the middle ear. A congenitalcholesteatoma which originates from mastoid temporal bone or expands to posteriorcranial fossa is rare. Standard treatment of an intracranial cholesteatoma is surgical removalwith craniotomy. A 69-year-old woman was diagnosed with a congenital cholesteatoma of mastoidtemporal bone that expanded to the posterior cranial fossa, which was successfully treatedwith transmastoid marsupialization without craniotomy. This is a first documented case ofa congenital cholesteatoma of mastoid temporal bone that expanded to posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy.