• Title/Summary/Keyword: 후두수술

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Postoperative Change in Hypertrophic Rhinitis(Study Using Nasometer, CSL and Acoustic Rhinometer) (비후성 비염환자에서 음성검사 및 음향비강통기도검사를 이용한 수술전후 비교)

  • 유영삼;우훈영;윤자복;최정환;조경래
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.12 no.1
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    • pp.34-38
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    • 2001
  • Background and Objectives : With the development of computerized systems, an objective evaluation methods of nasal speech and nasal geometry have become readily available by means of a simple, noninvasive technique. In this study, we assessed the nasality, nasal formant, nasal volume and nasal area in patients with hypertrophic rhinitis before and after turbinate surgery. Material and Method : With the nasometer, we measured nasalance, which reflects the ratio of acoustic energy output of nasal sounds from the nasal and oral cavities. With CSL 4300B, we measured nasal formants. We used acoustic rhinometer to measure nasal area and nasal volume. Postoperative changes of above factors were compared with preoperative values. Paired t-test and Pearson's correlation were used for statistical analysis. Results : The first nasal formant frequency, nasalance scores of three passages(baby, mamma and rabbit passages), minimal cross sectional area(MCA) of narrow side, nasal volume of narrow side and nasal volume of wide side had increased significantly after turbinate surgery (p <0.05). The MCA and nasal volume of narrow side and MCA of wide side showed significant correlation with nasalance score of rabbit passage and baby passage showed significant correlation with nasal volume of narrow side(p<0.05). Conclusion : There were significant increases in nasalance scores, first nasal formant frequency, MCA and nasal volume after turbinate surgery. Thus, we must consider the possibility of voice changes postoperatively in professional voice users.

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Surgical Treatment of Vocal Cord Granuloma (성대돌기 육아종의 수술적 치료)

  • Yu, Myeong-Sang;Song, Hyung-Min;Roh, Jong-Lyel;Choi, Seung-Ho;Kim, Sang-Yoon;Nam, Soon-Yuhl
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.17 no.1
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    • pp.49-52
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    • 2006
  • Background and Objectives: Vocal cord granuloma is a exophytic inflammatory mass and caused by gastroesophageal reflux, voice abuse, endotracheal intubation. There has been a controversy in the treatment of vocal cord granuloma. Our aim of study is to know the clinical characteristics and the results of surgical management for vocal cord granuloma. Materials and Methods: We have reviewed and analyzed medical records of 55 patients who were diagnosed and surgically treated as vocal cord granuloma in Asan medical center from 1997 to 2005 retrospectively. Results: 25 cases were intubation granuloma and 30 cases were contact granuloma. In intubation granuloma, the clinical manifestation was hoarseness(70%), foreign body sensation(44%), chronic cough(21%). In contact granuloma, the clinical manifestation was hoarseness(67%), foreign body sensation(60%), throat clearing(21%). The recurrence rate after surgery was 8% in intubation granuloma and 33% in contact granuloma. Mean recurrence time was 4.1months in intubation granuloma and 3.2months in contact granuloma. Conclusion: Although there is no significant difference, recurrence rate after surgery was high in contact granuloma compared to intubation granuloma(p=0.125). Although this study is retrospective, surgical management must be considered in resolving diagnostic doubt, treating airway obstruction, and failure in conservative treatments.

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Endoscopic Laser Cordectomy for Early Glottic Cancer (초기 성문암종에서 레이저를 이용한 성대절제술의 효과)

  • Choi Jong-Ouck;Park Jung-Soo;Min Hun-Ki;Jung Kwang-Yoon;Choi Geon;Yoo Hong-Kyun
    • Korean Journal of Head & Neck Oncology
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    • v.12 no.2
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    • pp.201-205
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    • 1996
  • Early detection of glottic cancer, facilitated by rigid telescopes or flexible fiberoptic laryngoscope in addition to sparse true vocal cord lymphatics, makes this a highly curable tumor in its early stage. Early glottic cancer has a high cure rate with only radiotherapy or conservative surgery. However complications such as mucositis with radiotherapy and voice complications with conservative surgery has raised recent interest in endolaryngeal laser cordectomy. Laser cordectomy can preserve phonatory function and avoid the complications such as mucositis of radiotherapy. To determine the effectiveness of laser cordectomy, the authors made a two year retrospective study of 23 early glottic cancer cases. Fourteen cases(60.9%) who underwent 1 to 3 endoscopic laser cordectomy with KTP-532 laser were cured with this procedure alone. Seven cases needed an additional radiotherapy and three cases needed therapy with salvage operation. We conclude that the endoscopic laser surgery is a good strategy for the properly selected glottic cancer.

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Tendency and Parameters of Subjective Voice Change after Adenotonsillectomy or Tonsillectomy (편도 및 아데노이드 수술 후 주관적 음성 변화의 양상과 인자)

  • Kim, Jong-Yang;Choi, Sun-Myung;Choi, Se-Jun;Nam, Soon-Yuhl;Kim, Sang-Yoon;Choi, Seung-Ho
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.15 no.1
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    • pp.5-9
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    • 2004
  • Some patients who have undergone adenotonsillectomy (AT) or tonsillectomy(T) complain of voice change. Research was designed to determine the relationship between subjective voice change and change of parameters in boice analysis and to find the degree of voice change according to age and excised tissue volume. In 34 patients who underwent AT and 17 patients who underwent T, we measured the masalance, the fundamental frequency of /a/phonation and the formants and bandwidths of /a/, /i/, /u/ phonations. These parameters were measured preoperatively and also 7 days after the operation. Excised tissue volume was measured on operation. Postoperative changes were statistically analyzed. Any subjective voice change was asked to be reported at the visit 7 days after the operation. There was analysis for the difference of above parameters between some who answered "voice change" (A group) and the others who answered "no voice change" (B group). 24 patients(71%) who underwent AT and 4 voice change. Nasals nasalance change is an important factor in subjective voice change after AT.

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Analysis of Pre and Post-Operative Speech In Combined Operation of Type I Thyroplasty and Arytenoid Adduction for Unilateral Vocal Cord Palsy (편측성대마비에 대한 제 1형 갑상성형술과 피열연골내전술의 동시수술시 술전 및 술후 음성언어분석비교)

  • 최홍식;정유삼;김성국;김영호;김광문
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.9 no.1
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    • pp.66-70
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    • 1998
  • Background and Objectives : The managements of unilateral vocal cord palsy include type Ⅰ thyroplasty and arytenoid adduction. One type operation has been shown no satisfactory effect. We evaluated preoperative and postoperative speech of unilateral vocal cord palsy patients who received combined operation of type Ⅰ thyroplasty and arytenoid adduction to help for the management plan of unilateral vocal cord palsy patients. Materials and Methods : We reviewed the postoperative results and complication of 17 surgically treated patients of unilateral vocal cord palsy at Severance hospital from Nov. 1996 to Dec. 1997 retrospectively. They were received combined operation of type Ⅰ thyroplasty and arytenoid adduction. Their pre and post-operative speech were analyzed with MDVP(Multi-Dimension-Voice analysis Program) of CSL(Computerized Speech Lab). Results : After the operation, MPT(Maximal Phonation Time) was increased and MFR(Mean Flow Rate) was decreased in all patients. NHR(Noise to Harmonic Ratio) and VTI(Voice Turbulence Index) were decreased : liner, RAP(Relative Average Perturbation Quotient), PPQ(Pitch Period Perturbation Quotient), sPPQ(smoothed Pitch Period Perturbation Quotient), vFo(fundamental frequency Variation) were decreased : Shimmer, APQ(Amplitude Perturbation Quotient), sAPQ(Smoothed Amplitude Perturbation Qoutient), vAm(Peak Amplitude Variation) were decreased in all the patients. Conclusions : In unilateral vocal cord pals), combined operation of type Ⅰ thyroplasty and arytenoid adduction could obtain satisfactory postoperative voice. MDVP has many parameters and good method for evaluation of voice surgery.

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Pharyngocutaneous Fistula Formation Rate after Total Laryngectomy, Related with Previous Radiotherapy and Extent of Surgery (방사선 치료 유무 및 수술 범위에 따른 후두전절제술 후 인두피부누공 발생률 분석)

  • Kim, Seong Dong;Yi, Yeo-Jeen;Kim, Min-Soo;Jeong, Woo-Jin;Ahn, Soon-Hyun
    • Korean Journal of Head & Neck Oncology
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    • v.30 no.2
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    • pp.39-42
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    • 2014
  • Background and Objectives : Pharyngocutaneous fistula is the most common complication after total laryngectomy. The objective of this study was to determine the incidence of pharyngocutaneous fistula after total laryngectomy in patients operated on in our department and to establish whether specific factors predispose to fistula formation. Materials and Methods : For 10 years(2003-2014), 49 cases of patients who were diagnosed with laryngeal cancer and underwent total laryngectomy in our department. Patients who underwent radiotherapy before the surgery was 24 cases(48.9%) of all total laryngectomy patients. And those who were needed flap reconstruction because of extensive tumor involvement to hypopharynx were also 24 cases(48.9%), whereas primary closure were performed in 25 cases(51%). Results : The postoperative pharyngocutaneous fistula was found in 12 of the 49 patients(24.5%). The radiotherapy before surgery was a statistically significant factor that increase the incidence of postoperative fistulas(p=0.037). Large extent of surgery including flap reconstruction was almost statistically significant factor of raising postoperative fistula rates(p=0.051). Conclusion : According to this study, the presence of postoperative fistula seems to be influenced by previous radiotherapy and the extent of surgery. These could be the risk factors of pharyngocutaneous fistula after total laryngectomy.

Comparison of Pre and Post-operational Phonatory Aerodynamic Parameters in Vocal Polyp and Vocal Cord Palsy Patients (성대마비 및 성대용종 환자의 수술 전과 후의 공기역학적 변수 비교)

  • Lee, Dahye;Kim, Jaeock;Oh, JaeKoon;Choi, Hong-Shik
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.26 no.2
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    • pp.112-116
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    • 2015
  • Background and Objectives : Aerodynamic analysis is an examination which provides information regarding various vocalization measures indicating laryngeal efficiency. Voice evaluation using such examination must be capable of distinguishing between normal to abnormal voice. It also observes variables on aerodynamic characteristics by gender in regards to patients of vocal disorders, especially of vocal cord paralysis and vocal polyp, and compares the conditions before and after surgery. This paper therefore, seeks to build a framework for establishing standard levels of aerodynamical characteristic on vocal disorders. Subjects and Methods : The study was intended for a total number of 20 patients with vocal polyp or unilateral vocal cord paralysis. Those with the vocal polyp underwent laryngomycroscopy surgery and the vocal cord paralysis, vocal fold injection using Restylane. Aerodynamic analysis fulfilled the Maximum sustained Phonation (MXPH) and Voicing Efficiency (VOEF) by using PAS Model 6600 (KayPENTAX, USA). Results : In MXPH, increase in PHOT were evident with vocal polyp after surgery. As for patients with vocal cord paralysis, MAXDB, MEADB, DHODB, PHOT all have increased and MEAP, PEF, MEAF decreased after surgery. In VOEF, patients with vocal cord paralysis who underwent surgery showed increase in MAXDB, MEADB, DHODB, FET100, ARES, but decreases in PEF, TARF. Conclusion : Overall, it can be concluded that patients with the vocal polyp and vocal cord paralysis seemed to get closer to the normal values after than before surgery in majority of measures. This confirms that the function of their vocal cord has improved nearly to normality through operations.

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The clinical effects of Rabeprazole sodium (Pariet$\circledR$) in the treatment of Laryngopharyngeal Reflux (인후두역류질환 ( Laryngopharyngeal Reflux Disease. LPRD )에서 Rabeprazole Sodium (Pariet$\circledR$)의 임상효과)

  • 최홍식;김한수;최현승
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 2002.12a
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    • pp.9-9
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    • 2002
  • 이비인후과 영역에 있어서 위산 역류에 의한 질환의 진단은 쉽지 않고 분명하지 않은 점이 많지만, 병변의 영향은 광범위하며, 실제로 역류에 의한 증상을 가지고 내원하는 환자도 증가하는 추세이다. 인후두역류질환의 치료는 크게 생활습관의 변경, 약물복용, 항역류수술로 나눌 수 있으며, 사용약제는 크게 두 부류로 나누는데, 제산제, H2 수용체 차단제, PPI(Proton Pump Inhibitor) 제제와 같은 산억제 약물군과 Prokinetic 약물군이다. Rabeprazole sodium(Pariet(R))은 PPI 제제에 해당하는 약제로 기존의 omeprazole, lansoprazole, pantoprazole과는 달리 대사 과정 중 CYP2C19에 대한 의존도가 낮아, 개체 간 차이가 적고 빠르고 일정하게 산분비 억제 효과를 나타내는 것으로 알려져 있은 약물이다. 2001년 5월부터 2002년 4월까지 32개 병원에서 Pariet(R) 를 복용한 2166명의 환자를 대상으로 분석하였다. 복용기간에 따라 4군(1군;1-14일, 2군;15-28일, 3군;29-56일, 4군:57일 이상)으로 나누었으며, 8가지 증상(Heart burn, Regurgitation, Chronic cough, Hoarseness, Globus sensation, Chronic throat clearing, Sore throat, Dysphagia)에 대한 호전 여부 및 후두내시경상 개선 정도, 의사에 의한 유용도 평가, 부작용 발생 여부에 대해 연구하였다. 증상개선율 50%이상을 치료 반응군으로 했을때 전체 2166명중 1627명(75.1%)에서 증상의 호전을 보았으며, 이는 복용기간이 길수록 증가하였다. 후두 내시경상 개선 정도는 현저한 개선이 32.9%, 중등도 개선이 38.7%로 대부분 환자에서 객관적인 병변의 호전을 보였으며, 유용도 평가에서는 매우 유용이 37.6%, 유용이 50.3%로 치료효과에 대한 만족도도 높은 것을 알수 있었다. PPI 제제의 부작용으로 보고되고 있는 두통, 오심, 설사, 복통. 변비, 어지럼증. 피곤 중. 소수의 환자가 두통을 호소하였으나, 그다지 심각한 정도는 아니었다. 인후두역류증 치료제로서 Pariet(R) 는 비교적 안전하고 효과가 높은 약물임이 임상 연구 결과 밝혀졌기에 보고하는 바이다.

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Tracheostomy Performed by a Head and Neck Surgeon Under the Supervision of an Intensive Care Unit Specialists in the COVID-19 Era: A Retrospective Analysis (COVID-19 시대에 중환자실 전담의사 감독 하에 두경부 전문의에 의해 시행된 기관절개술에 대한 후향적 분석 연구)

  • Han, Won Ho;Lee, Yun Im;Baek, Sunhwa;Seok, Jungirl
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.33 no.2
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    • pp.97-102
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    • 2022
  • 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 Studies on Locally Invasive Thyroid Cancer (국소침범한 갑상선암의 임상적 고찰)

  • Kim Young-Min;Lee Chang-Yun;Yang Kyung-Hun;Rho Young-Soo;Park Young-Min;Lim Hyun-Jun
    • Korean Journal of Head & Neck Oncology
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    • v.14 no.2
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    • pp.236-243
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    • 1998
  • Objectives: Local invasion of the thyroid cancer that is invasion of the upper aerodigestive tract, neurovascular structures of the neck and superior mediastinum, is infrequent and comprises of 1-16% of well-differentiated thyroid cancer. However the proximity of the thyroid gland to these structures provides the means for an invasive cancer to gain ready access into theses structures and when invasion occurs, it is the source of significant morbidity and mortality. So locally invasive thyroid cancer should be removed as much as possible, but still much debates have been exist whether the surgical method should be radical or conservative. This study was desinged to evaluate the clinical characteristics and the surgical treatment of the locally invasive thyroid cancer. Material and Methods: At the department of otorhinolaryngology of Hallym university, 10 patients diagnosed as locally invasive thyroid cancer among the 81 patients treated for thyroid cancer between 1991 to 1997 were retrospectively evaluated. Results: Of the 10 patients, 3 patients had histories of previous surgical treatment with or without radiation or radioactive iodine therapy. The site of invasion of thyroid cancer were trachea(7 cases), recurrent laryngeal nerve(5 cases), mediastinal node(5 cases), esophagus(3cases), larynx(3cases), carotid artery(3 cases), pharynx(l case), and other sites(4 cases). The operation techniques included 1 partial laryngectomy and 1 partial cricoid resection, 2 shavings and 3 window resections of the trachea, 1 sleeve resection of the trachea with end-to-end anastomosis and 1 cricotracheoplasty for tracheal invasion, 2 shavings and 1 partial esophagectomies for esophageal invasion, and 1 wall shaving and 2 partial resections with $Gortex^{\circledR}$ tube reconstruction for carotid artery invasion, and so on. Conclusions: These data and review of literature suggest that the surgical method should be perfomed on the basis of individual condition and complete removal of all gross tumor with preservation of vital structures whenever possible will offer a good result.

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