• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.33 no.1
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• pp.26-30
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• 2022

Background and Objectives Cough suppression therapy (CST) is a physiotherapy that can be used for patients with chronic refractory cough (CRC). We aimed to investigate the efficacy of CST for CRC. Materials and Method A prospective randomized controlled trial was conducted in 27 patients with CRC. Participants were randomized to receive either standard mucolytic medications for CRC combined with supplemental CST (CST group) or standard medications alone (control group). CST consists of laryngeal hygiene management, humidification, cough suppression technique, breathing method, and counseling. We assessed the symptoms change at baseline and week 4 with the Leicester Cough Questionnaire (LCQ). Secondary efficacy outcomes included the degree of cough Visual Analog Scale (VAS) score (0 to 100 scale). Results From 2019 to 2021, 14 CST group patients and 13 control group patients were included. The improvement was significantly greater in the CST group than in the control group for cough VAS score (36.67 to 13.33 vs. 74.29 to 16.43, p<0.001). Patients in the CST group had a significant improvement in total (70.14 to 107.71, p=0.005), physical (31.42 to 43.86, p=0.015), psychological (23.57 to 40.14, p=0.003), and social (15.14 to 23.71, p=0.005) LCQ scores. However, there was not a significant pre- to post-treatment LCQ score improvement in control group. Conclusion CST might be an effective supplemental intervention for CRC.

• Journal of Veterinary Clinics
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• v.39 no.1
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• pp.1-8
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• 2022

The current, retrospective study aimed to assess the short-term prognosis and postoperative complications associated with the surgical correction of elongated soft palate using harmonic scalpel and to compare the postoperative complications associated with the application of harmonic scalpel and traditional surgery using Metzenbaum scissors. Harmonic scalpel was used to perform staphylectomy in 21 dogs. A total of ten dogs underwent sacculectomy; six dogs with harmonic scalpel and four dogs using Metzenbaum scissors. Stenotic nares were corrected by wedge resection. Postoperative complications were recorded through monitoring and radiographic examinations. Telephone interviews were conducted on the first, third, and seventh day after discharge and continued until the resolution of postoperative complications. Postoperative edema at the surgical site was identified and mitigated within a day or two. Snoring and dyspnea improved dramatically in the group that underwent staphylectomy alone. Moreover, three dogs presented with postoperative gastrointestinal complications, especially retching. The symptoms persisted for seven days and ten days in two dogs that underwent sacculectomy with harmonic scalpel and for two days in one dog that underwent sacculectomy with Metzenbaum scissors. The clinical signs and symptoms of brachycephalic syndrome disappeared without recurrence. Harmonic scalpel provides a hemostatic effect during staphylectomy, is convenient, and does not cause postoperative complications. Conversely, the use of harmonic scalpel during sacculectomy necessitated a longer period for the resolution of complications without any significant hemostatic efficacy, compared to traditional surgery.

• Radiation Oncology Journal
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• v.37 no.4
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• pp.271-278
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• 2019

Purpose: To investigate the differences in treatment outcomes between two radiation techniques, intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT). Materials and Methods: We retrospectively analyzed 160 (IMRT = 23, 3DCRT = 137) patients with stage I glottic cancer treated from January 2005 through December 2016. The IMRT was performed with TomoTherapy (16 patients), volumetric-modulated arc therapy (6 patients), and step-and-shoot technique (1 patient), respectively. The 3DCRT was performed with bilateral parallel opposing fields. The median follow-up duration was 30 months (range, 31 to 42 months) in the IMRT group and 65 months (range, 20 to 143 months) in the 3DCRT group. Results: The 5-year overall survival and 3-year local control rates of the 160 patients were 95.7% and 91.4%, respectively. There was no significant difference in 3-year local control rates between the IMRT and 3DCRT groups (94.4% vs. 91.0%; p = 0.587). Thirteen of 137 patients in the 3DCRT group had recurrences. In the IMRT group, one patient had a recurrence at the true vocal cord. Patients treated with IMRT had less grade 2 skin reaction than the 3DCRT group, but this had no statistical significance (4.3% vs. 21.2%; p = 0.080). Conclusion: IMRT had comparable outcomes with 3DCRT, and a trend of less acute skin reaction in stage I glottic cancer patients.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.9
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• pp.3645-3651
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• 2015

Background: Previous studies evaluating the association between the xeroderma pigmentosum group G (XPG) Asp1104His polymorphism and head and neck cancer susceptibility have proven controversial. This meta-analysis of the literature was performed to obtain a more precise estimation of the relationship. Materials and Methods: We systematically searched PubMed, Embase and Web of Science with a time limit of Dec 18, 2014. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of any association. Results: We performed a meta-analysis of eight published case-control studies, including 3,621 cases and 5,475 controls. Overall, no significant association was found between the XPG Asp1104His polymorphism and head and neck cancer susceptibility under all genetic models. In the subgroup analysis by ethnicity, the XPG Asp1104His polymorphism had statistically significant association with elevated head and neck cancer risk under CC vs GG (OR=1.24, 95% CI=1.00~1.54) and the recessive model (OR=1.22, 95%CI=1.01~1.46) in Asian populations. A similar result was found under CC vs GG (OR =1.22, 95%CI=1.01~1.47) in the population based subgroup by source of control. When performed by tumor site, the XPG Asp1104His polymorphism had statistically significant association with elevated laryngeal cancer under all genetic models (CC vs GG: OR=1.59, 95% CI=1.16~2.19; GC vs GG: OR=1.38, 95%CI=1.10~1.72; dominant model: OR=1.42, 95% CI=1.15~1.74; recessive model: OR=1.36, 95% CI=1.02~1.81). Conclusions: This meta-analysis suggested that the XPG Asp1104His polymorphism is a risk factor for head and neck cancer susceptibility, especially for laryngeal cancer and in Asian populations.

• Korean Journal of Head & Neck Oncology
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• v.18 no.1
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• pp.60-64
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• 2002

Objectives: Three classic treatment modalities have been used to treat Graves' disease: antithyroid medication, radioiodine ablation, and subtotal thyroidectomy. Postoperative thyroid functions were studied in patients with Graves' disease treated by subtotal thyroidectomy to evaluate the superiority of surgical treatment. Materials and Methods: One hundred fourty patients of Graves' disease were analysed retrospectively in follow-up for more than three years following subtotal thyroidectomy. Postoperative serum levels of $T_3,\;T_4, TSH, TSH-R Ab, free $T_4$, were evaluated to watch hypo- or hyperthyroidsm. Results: In the evaluation of preop- and postoperative thyroid function after three years of subtotal thyroidectomy, $T_3$ was changed from $464.10{\pm}196.16ng/dl$ to $140.41{\pm}76.56ng/dl$ in mean value, $T_4$ was changed from $20.76{\pm}7.98{\mu}g/dl$ to $9.54{\pm}4.02{\mu}g/dl$, $TSHT_3$ was changed from $0.55{\pm}4.42{\mu}u/ml$ to $4.96{\pm}7.20{\mu}u/ml$, TSH-R Ab was changed from $41.6{\pm}28.27%$ to $28.7{\pm}28.79%$ and free $T_4$ was changed from $4.45{\pm}2.33ng/dl$ to $1.44{\pm}0.69ng/dl$ in mean value. Euthyroidism was noted in 118 patients(84.3%), overt hyperthyroidism in 6 patiens(4.3%), latent hyperthyroidism in 8 patients(5.7%), overt hypothyroidism in 2 patint(1.4%), and latent hypothyroidism in 6 patients(4.3%). Of surgical complications, permanant hypoparathyroidism was found in one patient, recurrent laryngeal nerve injury in two patients, postoprative bleeding with reoperation in two patients, and death in one patient. Conclusion: The thyroid function after subtotal thyroidectomy in diffuse toxic goiter is normal level (euthyroidism) in 84.3% and low recurrence rate of hyperthyroidism is showed with rare surgical complication. Therefore, subtotal thyroidectomy in diffuse toxic goiter is more effective and safe than RI or longterm ATD treatment, if the operation is performed by skillful surgeon.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.154-162
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• 1999

The laryngopharyngectomy for tumor ablation is the most common indication for pharyngoesophageal reconstruction in our country. Most of these cases are advanced laryngeal cancer that has spread beyond the larynx, pharynx and cervical esophagus. Such patients are obviously unable to breathe, swallow, or speak in the normal manner. The ideal reconstruction would restore normal anatomy, permitting patients to breathe and swallow without aspiration, and would not require a permanent tracheostomy. Reconstruction of the pharyngoesophageal defect traditionally been carried out with tubed local random flap, deltopectoral or musculocutaneous flap. Another approach is the pedicled enteric flap. But microsurgical reconstruction of the pharyngoesophagus, using either the free jejunal or the tubed radial forearm flap, have now become the preferred technique. Among them, we used jejunal free flap in 39 cases, tubed radial forearm free flap in 5 cases, patched radial forearm free flap in 2 cases and pectoralis major myocutaneous island flap in 2 cases from December 1990 to Febrary 1999. In this paper we illustrated that both forearm and jejunal free flap is a usful alternative in reconstruction of hypopharynx and cervical esophagus.

• Korean Journal of Head & Neck Oncology
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• v.14 no.2
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• pp.164-168
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• 1998

Background: Supraglottis and glottis have a different embryologic origin. Supraglottic cancer is characterized by high incidence of cervical lymph node metastasis at initial diagnosis, and favored surgical management of the early supraglottic cancer was partial supraglottic laryngectomy, however the procedure resulted in frequent incidences of postsurgical aspiration and voice disabilities. Objectives: We retrospectively analyzed the problems and the advantages of the endoscopic laser assisted supraglottic partial laryngectomy as a part of surgical management for early supraglottic cancer. Materials and Methods: During the past nine years 25 cases of supraglottic cancer(Tl 10 cases, T2 15 cases) were treated by tracheotomy and laser assisted supraglottic partial laryngectomy(KTP532, 15 Watt, continuous type) and in 10 cases with cervical lymph node metastasis, they were additionally managed by neck dissection one week later, and all cases received postoperative irradiation therapy. Results: At present, 19 cases are alive with no evidence of disease. During the follow up period total of six cases(primary failure: three cases, nodal failure: three cases) were recurred. In relation to tumor staging, One of the 10 Tl cases and two of the 15 T2 cases recurred showing 88% locoregional recurrence rate for early supraglottic cancer. Postoperative com-plication included bleeding in three cases who were controlled by electrocautery under general anesthsia, one case of longstanding aspiration and two cases of laryngeal stenosis as a delayed complication. Conclusion: High control rate suggests that the endoscopic laser assisted supraglottic partial laryngectomy may be a good initial management method for early supraglottic cancer, however it is difficult to determine the resection margin, therefore, accurate tumor staging must be done prior to surgery. In order to prepare for postoperative bleeding, edema and aspiration, the tracheotomy must be performed prior to surgery.

• Phonetics and Speech Sciences
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• v.15 no.3
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• pp.53-58
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• 2023

After thyroidectomy, some patients who show normal vocal cord movement still complain of subjective voice problems, which could lead to a decrease in quality of life related to communication. This study aims to investigate the effectiveness of a newly designed voice therapy applying neck exercise and semi-occluded vocal tract exercise (SOVTE) to improve voice problems after thyroidectomy without neurological injury. For this purpose, voice therapy was randomly assigned to 10 women who received thyroidectomy. Acoustic analysis [fundamental frequency, jitter, shimmer, noise-to-harmonics ratio, min Voice Range Profile (VRP), max VRP, VRP] was performed before and after surgery and immediately after voice therapy to compare voice changes. The study showed a statistically significant increase in max VRP and VRP after voice therapy compared to before surgery. These results suggest that the voice therapy methods in this study effectively improve a major symptom of voice problems after thyroidectomy, specifically the reduction in the high-frequency range. However, this study was limited in the number of s participants and did not control for the type of surgery. Therefore, further research utilizing larger sample sizes and controlled variables is needed to investigate the long-term effects of voice therapy.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1982.05a
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• pp.10.1-10
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• 1982

The use of phonosurgery in the recent development of laryngomicrosurgery has enabled the restoration of a normal voice in respect to functional laryngeal surgery which in Korea in the past limited to simple removal of benign laryngeal tumor such as laryngeal polyp or nodules and cordal injection of $Teflon^{{\circledR}}$ for the treatment of recurrent nerve paralysis under the vision of suspension laryngoscopy. Performance of phonosurgery for the treatment of cord paralysis, mutational dysphonia, vocal cord atrophy, hyperkinetic dysphonia and sulcus vocalis is a happy event in the view point of development of phonosurgery in Korea. In this aspect thyroplasty to change the position and physical characteristics of the cord outside the glottis instead of the direct handling of the vocal cord through direct endoscopy is popular. Among the 4 types of thyroplasty, classified by Insshiki(1974), type I thyroplasty(1ateral compression of vocal cord) and type IV thyroplasty(lengthening of vocal cord) were effective in the treatment of unilateral vocal cord paralysis. Advantages of this operation are the fine adjustment of the degree of lateral compression under local anesthesia according to the phonation of the patient during operation and avoidance of dyspnea and intralaryngeal hemorrhage due to the manipulation outside the internal perichondrium of the thyroid cartilage. We did 7 cases of thyroplasty for the treatment of unilateral vocal cord paralysis in the 7 months from September 1981 to March 1982. Before the operation aerodynamic study, psychoacoustical evaluation, stroboscopy and sound spectrographic analysis were done. Two months after the operation the above procedures were performed again. Results of preoperative and postoperative examination were compared and the following results were obtained. 1) In the aerodynamic study, maximum phonation time increased to 158% of the preoperative value and the phonation quotient and the mean flow rate decreased to 58% and 54% of preoperative values. 2) The degree of hoarseness improved in the psychoacoustical evaluation and the glottic chink during phonation was decreased in the stroboscopic examiantion. 3) In the sound spectrographic analysis, periodicity was much restored and noise distribution decreased especially in the high frequency area.

• Radiation Oncology Journal
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• v.18 no.4
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• pp.233-243
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• 2000

Purpose : First of all, this study was performed to assess the result of curative radiotherapy and to evaluate different possible prognostic factors for squamous cell carcinoma of the supraglottic larynx treated at the Pusan National University Hospital. The second goal of this study was by comparing our data with those of other study groups, to determine the better treatment policy of supraglottic cancer in future. Methods and Material : Thirty-two patients with squamous cell carcinoma of the supraglottic larynx were treated with radiotherapy at Pusan National University Hospital, from August 1985 to December 1996. Minimum follow-up period was 29 months, Twenty-seven patients (84.4$\%$) were followed up over 5 years. Radiotherapy was delivered with 6 MV photons to the primary laryngeal tumor and regional iymphatics with shrinking field technique. Ail patients received radiotherapy under conventional fractionated schedule (once a day). Median total tumor dose was 70.2 Gy (range, 55.8 to 75.6 Gy) on primary or gross tumor lesion. Thirteen patients had Induction chemotherapy with cisplatln and 5-fluorouracil (1-3 cycles). Patient distribution, according to the different stages, were as follows: stage I, 5/32 (15.6$\%$): stage II, 10/32 (31.3$\%$); stage III, 8/32 (25$\%$): stage IV, 9/32 (28.1$\%$). Results :The 5-year overall survival rate of the whole series (32 patients) was 51.7$\%$. The overall survival rate at 5-years was 80$\%$ in stage I, 66.7$\%$ in stage II, 42.9$\%$ in stage III, 25$\%$ in stage IV (p=0.0958). The S-year local control rates after radiotherapy were as fellows: stage I, 100$\%$; stage II, 60$\%$ stage III, 62.5$\%$; stage IV, 44.4$\%$ (p=0.233). Overall vocal preservation rates was 65.6$\%$, 100% In stage I, 70% in stage II, 62.5$\%$ In stage III, 44.4$\%$ in stage IV (p=0.210). There was no statistical significance in survival and local control rate between neoadjuvant chemotherapy followed by radiotherapy group and radiotherapy alone group. Severe laryngeal edema was found in 2 cases after radiotllerapy, emergent tracheostomy was done. Four patients were died from distant metastsis, . three in lung, one in brain. Double primary tumor was found in 2 cases, one in lung (metachronous), another in thyroid (synchronous). Ulcerative lesions were revealed as unfavorable prognostic factor ( p=0.0215), and radiation dose (more or less than 70.2 Gy) was an important factor on survival (p=0.002). Conclusion : The role of radiotherapy treatment of supraglottic carcinoma is to important factor on survival and to preserve the laryngeal function. Based on our data and other studies, early and moderately advanced supragiottic carcinomas could be successfully treated with either consewative surgery or radiotherapy alone. Both modalities showed similar results in survival and vocal preservation. For the advanced cases, radiotherapy alone is Inadequate for curative aim and surgery combined with radiotherapy should be done in operable patients. When patients refuse operation or want to preserve vocal function, or for the patients with inoperable medical conditions, combined chemoradiotherapy (concurrent) or altered fractionated radiotherapy with or without radiosensitizer should be taken into consideration in future.