• 임상이비인후과
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• 제29권2호
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• pp.229-234
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• 2018

Background and Objectives : Vocal nodules occur with a 12-22% prevalence in pediatric populations. Most otolaryngologists recommend voice therapy as the primary treatment. The aim of this study is to evaluate patient compliance with voice therapy and its effect on vocal nodules in children. Materials and Methods : We retrospectively reviewed 44 pediatric patients between 3 and 11 years old diagnosed with vocal nodules between March 2015 and December 2017. We evaluated the treatment adoption rate, dropout rate during voice therapy, and reasons for dropout. For patients who completed voice therapy, we measured the changes in nodule size, perceptual parameters, and acoustic parameters. We evaluated patient satisfaction using the pediatric voice handicap index (P-VHI). Results : Of the 44 pediatric patients diagnosed with vocal nodules, 22 (50%) agreed to voice therapy. Of the 22 patients who started voice therapy, 5 (22.7%) dropped out during therapy because they were unsatisfied with their treatment. Another 4 patients discontinued therapy for reasons unrelated to treatment effectiveness. Vocal nodule disappeared or decreased in all 13 patients who completed voice therapy. All voice parameters were improved and statistically significant changes were observed in perceptual, acoustic, and P-VHI parameters. Conclusions : Although compliance to voice therapy among the pediatric patients with vocal nodules was low, there were significant improvements in voice parameters for those who completed voice therapy. A change toward a positive perception of voice therapy is necessary and a multidisciplinary approach is needed to improve the effect of voice therapy on pediatric patients with vocal nodules.

• 임상이비인후과
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• 제29권2호
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• pp.182-189
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• 2018

Background and Objectives : There were few literatures about the relationship between upper airway disorders and cardiovascular risk factors such as hypertension, although an association between impaired lower respiratory function and cardiovascular alterations was often reported. Our purpose was to assess the relationships between chronic sinusitis and hypertension. Materials and Methods : Three hundred subjects with bilateral chronic sinusitis who underwent functional endoscopic sinus surgery between 2015and 2017 were evaluated. Six hundred forty subjects without any nasal diseases were enrolled as a control group. Blood pressure and body mass index (BMI) were measured using a standardized method, and subjects were asked about current use of any antihypertensive medication, history of diabetes, smoking and alcohol drinking habits.Sinusitis group was assessed by nasal endoscopic examination, paranasal sinus CT scan and allergy test. Results : Average systolic and diastolic blood pressures were statistically significantly higher in subjects with sinusitis than control group. Chronic rhinosinusitis was associated with a 1.415-fold (95% confidence interval 1.053-1.930) increased hazard of hypertension after multivariate adjustment. Conclusions : These results suggest that sinusitis is associated with high blood pressure. Therefore patients with sinusitis may need special attention for blood pressure control. Further studies need to be performed to elucidate the pathogenesis behind such associations.

• 임상이비인후과
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• 제29권2호
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• pp.190-197
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• 2018

Background and Objectives : Positional OSAS is characterized by an apnea-hypopnea index (AHI) score >5, which, while sleeping in the supine position, is double that in non-supine position. This study was performed to compare the clinical characteristics of positional OSAS and non-positional OSAS patients, and the effects of the modified jaw thrust maneuver during drug-induced sleep endoscopy (DISE) between positional OSAS and non-positional OSAS patients. Materials and Methods : 68 positional OSAS patients and 19 non-positional OSAS patients were included. They all underwent full-night polysomnography and DISE. The modified jaw thrust maneuver was introduced during DISE. Airway structural changes induced by the modified jaw thrust maneuver were evaluated and documented. Results : There were no statistically significant differences in Friedman stage or tonsil grade, body mass index, Epworth sleepiness scale (ESS) score, blood pressure, AHI, or obstructive pattern between the positional and non-positional OSAS patients. However, mean arterial oxygen saturation (SaO2), lowest SaO2, and total arousal index values were more severe in the non-positional OSAS patients. After introduction of the modified jaw thrust maneuver, retrolingual level obstruction showed a tendency toward a higher rate of airway opening in positional OSAS patients than in non-positional OSAS patients. Conclusions : The effects of a mandibular advancement device (MAD) can be estimated by carrying out a modified jaw thrust maneuver during DISE. The tendency toward a higher rate of airway opening in positional OSAS patients than non-positional OSAS patients in retrolingual level obstruction after jaw thrust maneuver introduced during DISE may be clinically important for MAD.

• 임상이비인후과
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• 제29권2호
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• pp.235-239
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• 2018

Due to the structure with one end closed, the external ear resonance effect in which the high frequency is amplified can be generated, and the sound can be perceived well. The external ear resonance normally has a first peak and a second peak. On average, the first peak has a gain of 18.6 dB at 2620 Hz and the second peak has a gain of 18.2 dB at 4210 Hz. The resonance of the external auditory canal changes with the state of the tympanic membrane, the presence of the ventilation tube, and the structure (length, diameter, shape) of the external auditory canal. A patient with a postauricular meatomastoid cutaneous fistula was admitted to the hospital with a foreign body which is the molding of the hearing aid. After removal of the foreign body, the resonance of the external auditory canal was lost and the subjective sound cognitive ability decreased. In the case of postauricular meatomastoid cutaneous fistula, we confirmed the improvement of sound cognitive ability, the change of pure tone hearing threshold, and the change of the external ear resonance after reconstruction of the ear canal without middle ear reconstruction.

• 임상이비인후과
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• 제29권2호
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• pp.198-203
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• 2018

Background and Objectives : Pediatric orbital blowout fractures occur in discreet patterns, in reference to the characteristic developmental anatomy of the facial skeleton at the time of injury. The purpose of this study was to investigate the clinical characteristics, ocular symptom, fracture type and postoperative results of orbital blowout fractures in the pediatric population. Material and Methods : A retrospective study was conducted from January 2009 to June 2015 in 116 patients with orbital floor fractures ; all less than 18 years old. Patients were divided into 3 groups by age : 0 to 6, 7 to 12, and 13 to 18 years of age. The cause of fracture, fracture site and type, preoperative and postoperative ocular symptoms, timing of surgery were reviewed from their records. Results : Medial wall fractures were the most common site in the 0 to 6 years old group, and floor fractures were the most common site in other age groups. However, floor fracture was the most common site of the need for surgery in all age groups. Trapdoor type of fractures occurred more frequently than open door type of fractures in all age groups. Preoperative symptoms did not differ among the 3 age groups. In case of need surgery, frequency of preoperative ocular symptoms increased with age. However, as age group was young, rate of residual postoperative ocular symptoms were increased. Conclusions : The younger patients are more to have trapdoor type fracture and residual postoperative ocular symptom. Earlier surgical intervention more needed for children with entrapment results.

• 지질공학
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• 제17권3호
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• pp.393-404
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• 2007

본 연구는 절리암반사면의 현장상태 및 위험도에 대한 현장조사를 기초로 사면의 상대적 위험도를 판단 할 수 있는 토대를 마련하기 위하여 개별요인이 사면안정성에 미치는 영향을 고찰하였으며 사면붕괴에 영향을 미치는 요인들에 대한 통계적 분석을 수행하였다. 사면의 붕괴요인으로는 기존에 제시된 인장균열, 지반변형, 구조물 변형, 붕괴발생규모, 절리주향, 절리경사, 절리상태, 사면경사, 강우 및 지하수위, 절취상태, 배수조건, 보호보강상태 등 12가지 항목을 고려하였다. 본 연구를 위한 조사지역은 경상남도 지방도로에 위치한 절취사면 중 붕괴 이력이 있거나 다소 불안감을 보이는 위험 절개지 233개소이다. 조사지역의 사면안정성평가는 각각의 평가요인(붕괴요인)에 따른 사면의 결함지수와 사면위험등급에 의해 수행되었다. 조사된 총 233개소의 사면 중 토사사면을 제외한 암반사면 126개소를 선별하여, 각각의 붕괴요인들과 사면위험등급과의 통계적 연관성분석을 실시하였다. 또한, 다중회귀분석을 수행하고 적용성을 고찰하여 사면결함지수와 위험등급을 예측할 수 있는 통계모형을 제시하였다.

• 임상이비인후과
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• 제29권2호
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• pp.212-222
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• 2018

Background and Objectives : The purpose of this study was to compare the measured values of acoustic and auditory perceptual assessments between normal and functional dysphonia (FD) groups. Materials and Methods : 102 subjects with FD and 59 normal voice groups were participated in this study. Mid-vowel portion of the sustained vowel /a/ and two sentences of 'Sanchaek' were edited, concatenated, and analyzed by Praat script. And then auditory-perceptual (AP) rating was completed by three listeners. Results : The FD group showed higher acoustic voice quality index version 2.02 and version 3.01 (AVQIv2 and AVQIv3), slope, Hammarberg index (HAM), grade (G) and overall severity (OS), values than normal group. Additionally, smoothed cepstral peak prominence in Praat (PraatCPPS), tilt, low-to high spectral band energies (L/H ratio), long-term average spectrum (LTAS) in FD group were lower than normal voice group. And the correlation among measured values ranged from -0.250 to 0.960. In ROC curve analysis, cutoff values of AVQIv2, AVQIv3, PraatCPPS, slope, tilt, L/H ratio, HAM, and LTAS were 3.270, 2.013, 13.838, -22.286, -9.754, 369.043, 27.912, and 34.523, respectively, and the AUC of each analysis was over .890 in AVQIv2, AVQIv3, and PraatCPPS, over 0.731 in HAM, tilt, and slope, over 0.605 in LTAS and L/H ratio. Conclusions : In conclusion, AVQI and CPPS showed the highest predictive power for distinguishing between normal and FD groups. Acoustic analyses and AP rating as noninvasive examination can reinforce the screening capability of FD and help to establish efficient diagnosis and treatment process plan for FD.